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Priorities and Outcomes for Youth-Adult Transitions in Hospital Care: Perspectives of Inpatient Clinical Leaders at US Children's Hospitals

Priorities and Outcomes for Youth-Adult Transitions in Hospital Care: Perspectives of Inpatient Clinical Leaders at US Children's Hospitals

Adults with chronic conditions originating in childhood experience ongoing hospitalizations; however, efforts to guide youth-adult transitions rarely address transitioning to adult-oriented inpatient care. A group of authors including HIP Investigator, Dr. Ryan Coller identified the perceptions of clinical leaders on important and feasible inpatient transition activities and outcomes, including when, how, and for whom inpatient transition processes are needed.

Authors found that children's hospital clinical leaders rated inpatient youth-adult transition activities and outcome measures as important and feasible; however, feasibility may ultimately drive implementation.

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Child in hospital with IV

The Intersection of Complex Care and Hospital Medicine: Opportunities to Advance Health for Chronically Ill Populations

The Intersection of Complex Care and Hospital Medicine: Opportunities to Advance Health for Chronically Ill Populations

Children with medical complexity (CMC) are a high-need, high-cost population representing 1% of all children yet accounting for nearly one-third of all child health-related costs. Parents of CMC take responsibility for the vast majority of caregiving and face many challenges in doing so. Caregivers themselves experience physical and mental health problems that can compromise their ability to effectively perform caregiving tasks. Additionally, direct clinical encounters for CMC in health care settings are often inefficient and poorly coordinated.

Pediatric hospitalists have an essential role to play in the development of innovative solutions to improve care for CMC. In response, hospitalists have been integral in refining and studying structured complex care programs for CMC. In this article, HIP Investigator, Dr. Ryan Coller et al. evaluated complex care program efforts to improve care for CMC.

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Ambulatory Quality, Special Health Care Needs, and Emergency Department or Hospital Use for US Children

Ambulatory Quality, Special Health Care Needs, and Emergency Department or Hospital Use for US Children

Hospital and emergency department (ED) visits are measures of health and chronic disease control. Reducing hospital and ED use is a family‐centered goal and can lower health care spending. However, a key unknown is whether and how ambulatory care quality predicts ED and hospital utilization in children by underlying chronic illness. HIP Investigator, Dr. Ryan Coller et al. sought to identify associations between parent‐reported ambulatory care quality and pediatric ED or hospital visits and evaluated how these relationships vary among children with different levels of medical complexity.

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Bandaging amputee

Expect Delays: Poor Connections Between Rural and Urban Health Systems Challenge Multidisciplinary Care for Rural Americans With Diabetic Foot Ulcers

Expect Delays: Poor Connections Between Rural and Urban Health Systems Challenge Multidisciplinary Care for Rural Americans With Diabetic Foot Ulcers

Over 30 million people in the United States have diabetes, and up to 25% of them will develop a diabetic foot ulcer (DFU). Specific to DFUs, rural patients face 50% higher odds of major (above-ankle) amputation and 40% higher odds of death compared to their urban counterparts. A group of authors including HIP Investigators, Dr. Meghan Brennan and Dr. Christie Bartels sought to understand what health system factors contribute to the rural disparity in diabetic foot ulcer outcomes.

The authors concluded that future interventions focusing on mitigating the poor connections across rural and urban healthcare systems could reduce the rural disparity in major amputations.

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Predictors of Smoking Cessation in Patients With Rheumatoid Arthritis in Two Cohorts: Healthcare Factors Most Predictive

Predictors of Smoking Cessation in Patients With Rheumatoid Arthritis in Two Cohorts: Healthcare Factors Most Predictive

Smoking doubles the risk of developing rheumatoid arthritis (RA) and additionally contributes to cardiovascular, pulmonary, and oncologic diseases, the main causes of death in patients with RA. While patients are more likely to quit smoking after diagnosis of a smoking-related chronic disease, research shows most will continue to smoke.

HIP Investigator, Dr. Christie Bartels et al. identified predictors of smoking cessation in patients with RA in two health systems to guide future intervention implementation efforts. Authors found that emphasizing smoking cessation with new or seropositive RA patients and leveraging health system interventions could improve smoking cessation and outcomes in RA.

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The Balanced Opioid Initiative

The Balanced Opioid Initiative

Rates of opioid prescribing tripled in the USA between 1999 and 2015 and were associated with significant increases in opioid misuse and overdose death. Roughly half of all opioids are prescribed in primary care. The challenge remains in implementing guidelines in a way that balances safety and effectiveness when following clinical guidelines recommending opioid prescribing practices.

HIP Investigator, Dr. Andy Quanbeck et al. designed a study to discover the most cost-effective sequence and combination of strategies for improving opioid prescribing practices in diverse primary care clinics. The results of the study promise to help understand how to cost effectively improve the implementation of evidence-based practices.

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Growing Evidence for Successful Care Management in Children With Medical Complexity

Growing Evidence for Successful Care Management in Children With Medical Complexity

In this article, Dr. Mary Ehlenbach and HIP Investigator Dr. Ryan Coller reviewed the success of programs designed to better coordinate children with medical complexity care. With respect to changes in acute care use, children likely respond to complex care models in different ways. Additionally, what complex care achieves and how it achieves it for any given child is likely not uniform in cross section or over time.

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Telemedicine for Glaucoma: Guidelines and Recommendations

Telemedicine for Glaucoma: Guidelines and Recommendations

Glaucoma is the leading cause of irreversible blindness worldwide, estimated to affect >60 million people. Access to glaucoma specialists is challenging and likely to become more difficult as the population ages. Glaucoma care guidelines are not as standardized as those for diabetic retinopathy, which allow for significant regional and provider variability in glaucoma diagnosis and management.

In these guidelines, co-authored by HIP Investigator Dr. Yao Liu, authors reviewed considerations and practice recommendations for teleglaucoma programs.

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Practice Guidelines for Ocular Telehealth-Diabetic Retinopathy, Third Edition

Practice Guidelines for Ocular Telehealth-Diabetic Retinopathy, Third Edition

The third edition of the Practice Guidelines for Ocular Telehealth-Diabetic Retinopathy includes fundamental requirements to be followed when providing medical and other health care services using telecommunication technologies, and any other electronic communications between patients, practitioners, and other health care providers, as well as “best practice” recommendations. These guidelines were co-authored by HIP Investigator, Dr. Yao Liu and aim to assist providers in pursuing a sound course of action in providing safe and effective medical care using telehealth tools based on current scientific knowledge, technological requirements, and patient needs.

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Blood pressure young girl

Health System Research Priorities for Children and Youth With Special Health Care Needs

Health System Research Priorities for Children and Youth With Special Health Care Needs

Children and youth with special health care needs (CYSHCN) have, or are at an increased risk for, chronic physical, developmental, behavioral, or emotional conditions and also require health and related services of a type or amount beyond that required by children generally.

HIP Investigator, Dr. Ryan Coller et al. synthesized the opinions of a national multidisciplinary group of CYSHCN experts, including family caregivers, to prioritize research topics facing CYSHCN. Authors sought to take a foundational step toward developing a national research agenda for CYSHCN systems of care.

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