Mother and child with doctor

Influences of health and environmental deprivation on family relationships among children with chronic disease

Influences of health and environmental deprivation on family relationships among children with chronic disease

Families are often the primary source of close, comforting relationships for children and adolescents. Among chronically ill children, families play a critical role in managing aspects of the disease, often on a daily basis.

In this publication, authors including HIP Investigator, Dr. Elizabeth Cox used the Patient-Reported Outcomes Measurement Information System (PROMIS) Family Relationships measure over time to understand how family relationships are influenced by these three factors—the characteristics of the child and parent, environmental deprivation, and health over time, among children 8–17 years of age with one of three chronic illnesses (asthma, type 1 diabetes [diabetes], and sickle cell disease).

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Increasing Medicaid enrollment among formerly incarcerated adults

Increasing Medicaid enrollment among formerly incarcerated adults

Formerly incarcerated adults bear a disproportionate burden of disease, including substance use disorders, mental illness, and HIV, conditions that require timely and ongoing medical care. However, as they reenter the community from correctional facilities, the likelihood of receiving treatment for many chronic conditions declines relative to the incarceration period, and they experience high rates of emergency department use, substance use, and elevated rates of mortality particularly due to drug overdose.

Improved access to health care in the reentry period has the potential to mitigate these relatively high rates of morbidity and mortality. However, historically a key component of access, health insurance coverage, has been largely unavailable to this population. In this publication, HIP Investigator, Dr. Marguerite Burns et al. aimed to estimate the incremental associations between the implementation of expanded Medicaid eligibility and prerelease Medicaid enrollment assistance on Medicaid enrollment for recently incarcerated adults.

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Doctor working with mobile phone and stethoscope

Linking Parent Confidence and Hospitalization through Mobile Health: A Multisite Pilot Study

Linking Parent Confidence and Hospitalization through Mobile Health: A Multisite Pilot Study

In this publication, authors including HIP Investigator, Dr. Ryan Coller conducted a multisite pilot study of an mHealth platform with CMC caregivers (Assessing Confidence at Times of Increased Vulnerability [ACTIV]). ACTIV uses longitudinal text messaging to prospectively monitor parent confidence for their child to avoid hospitalization over the subsequent month. Their aim was to identify associations between ACTIV's repeated measures and CMC hospitalization, and to evaluate ACTIV's feasibility/acceptability when implemented within a complex care program.

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Quit smoking

Impact of a Rheumatology Clinic Protocol on Tobacco Cessation Quit Line Referrals

Impact of a Rheumatology Clinic Protocol on Tobacco Cessation Quit Line Referrals

Although smoking is a risk factor for patients with rheumatic conditions and contributes to greater symptom severity and cardiovascular disease risk, standard smoking cessation intervention is rare in rheumatology clinics. Primary care uses brief staff protocols to connect patients to free, state-run tobacco cessation quit line resources, but this approach had not been previously tested in rheumatology.

In this article, authors including HIP Investigators Dr. Christie Bartels and Dr. Edmond Ramly implemented a rheumatology staff-driven protocol, Quit Connect, to increase the rate of electronic referrals (e-referrals) to free, state-run tobacco quit lines (TQL). The group found that implementing Quit Connect in rheumatology clinics was feasible and improved referrals to a state-run TQL.

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WMJ: Impact of Race and Racism on Health

Identifying Substantial Racial and Ethnic Disparities in Health Outcomes and Care in Wisconsin Using Electronic Health Record Data

Identifying Substantial Racial and Ethnic Disparities in Health Outcomes and Care in Wisconsin Using Electronic Health Record Data

Although Wisconsin ranks highly in overall health care quality, the state performs poorly with respect to health disparities. To eliminate health disparities in Wisconsin, it is critical to understand where disparities exist.

Measuring disparities in health outcomes and care allows for benchmarking of current performance and monitoring changes over time. Measurement also allows stakeholders to prioritize efforts and develop and implement programs for the populations that are most impacted by disparities. Authors including HIP Investigator, Dr. Maureen Smith identified racial and ethnic disparities in health outcome and care measures in Wisconsin.

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Sustaining Gains in Diabetic Eye Screening: Outcomes from a Stakeholder-Based Implementation Program for Teleophthalmology in Primary Care

Sustaining Gains in Diabetic Eye Screening: Outcomes from a Stakeholder-Based Implementation Program for Teleophthalmology in Primary Care

Diabetic eye disease is the leading cause of blindness among working-age adults in the United States, primarily because of lack of access to eye screening. Teleophthalmology is a validated form of diabetic eye screening shown to prevent blindness but is significantly underutilized in U.S. primary care clinics.

In this article, authors including HIP Investigators Dr. Yao Liu and Dr. Maureen Smith hypothesized that stakeholder-based implementation program could increase teleophthalmology use and diabetic eye screening rates through improved integration of teleophthalmology into primary care workflows.

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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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