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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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A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers

A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers

Nearly 2 million Americans develop a diabetic foot ulcer each year; within 5 years of ulceration, 5% will undergo major amputation and 50% to 70% will die. Experts have recommended a multidisciplinary team approach to optimally address certain comorbidities in a coordinated manner and to reduce major amputations. Authors including HIP Investigators Dr. Meghan Brennan and Dr. Christie Bartels described multidisciplinary team composition and function using a systems engineering conceptual model and summarized the impact of multidisciplinary teams on major amputations. They hypothesized that multidisciplinary teams are associated with a reduced risk of major amputation.

The group found that multidisciplinary team composition was variable but reduced major amputations in 94% of studies.

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Earlier Hospital Discharge With Prospectively Designated Discharge Time in the Electronic Health Record

Earlier Hospital Discharge With Prospectively Designated Discharge Time in the Electronic Health Record

Hospital discharge requires multidisciplinary coordination. Insufficient coordination impacts patient flow, resource use, and postdischarge outcomes. A team of authors including HIP Investigator, Dr. Ryan Coller implemented a prospective, multidisciplinary discharge timing designation in the electronic health record (EHR) and evaluated its association with discharge timing.

The group found that the implementation of a prospective, multidisciplinary EHR discharge time designation was associated with more before-noon discharges. Next steps include replicating results in other settings and determining populations that are most responsive to discharge coordination efforts.

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Access to Care Among Individuals Who Experienced Medicaid Lockouts After Premium Nonpayment

Access to Care Among Individuals Who Experienced Medicaid Lockouts After Premium Nonpayment

As of September 2019, 5 states have received federal waivers to temporarily suspend Medicaid eligibility for individuals who fail to pay required premiums. These periods, ranging from 3 to 12 months, are called lockouts, noneligibility periods, or restrictive reenrollment periods. Wisconsin received a Section 1115 waiver allowing the application of premiums enforced by lockouts among adults receiving transitional medical assistance (TMA), a federally required Medicaid category that provides time-limited coverage to parents and/or caretakers when their incomes increase to exceed the Medicaid program maximum. Wisconsin did not expand Medicaid under the Patient Protection and Affordable Care Act; TMA covers some individuals who would otherwise be eligible for the expansion.

A team of authors including HIP Investigator, Dr. Marguerite Burns conducted a survey study comparing the demographic characteristics, access to care, and health status of recent Medicaid enrollees in Wisconsin with and without experience of Medicaid lockouts.

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FCR

System Factors Influencing the Use of a Family-Centered Rounds Checklist

System Factors Influencing the Use of a Family-Centered Rounds Checklist

Checklists are used to operationalize care processes and enhance patient safety; however, checklist implementation is difficult within complex health systems. A family-centered rounds (FCR) checklist increased physician performance of key rounding activities, which were associated with improved parent engagement, safety perceptions, and behaviors. To inform FCR checklist implementation and dissemination, a team of authors including HIP Investigator, Dr. Elizabeth Cox assessed physician compliance with this checklist and factors influencing its use.

Authors found that multiple factors within hospital systems may influence FCR checklist use. Strategies, such as providing rounding schedules and mobile computers, may promote optimal engagement of families during rounds and promote pediatric patient safety.

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Evaluating Integrated Care for Children: A Clarion Call or a Call for Clarity?

Evaluating Integrated Care for Children: A Clarion Call or a Call for Clarity?

“Integrated care” is often used to describe concepts such as coordinated and seamless care instead of the often fragmented and episodic care that patients receive. Integrated care reflects the aspirations of modern health care systems and receives significant academic attention. Authors Dr. Eyal Cohen and HIP Investigator, Dr. Ryan Coller conducted a broad search strategy to identify randomized controlled trials comparing integrated care with usual care.

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Hospital corridor

The Effects of Discrete Work Shifts on a Nonterminating Service System

The Effects of Discrete Work Shifts on a Nonterminating Service System

Hospital emergency departments (EDs) provide around‐the‐clock medical care, and as such are generally modeled as nonterminating queues. However, from the care provider's point of view, ED care is not a never‐ending process, but rather occurs in discrete work shifts and may require passing unfinished work to the next care provider at the end of the shift. HIP Investigator, Dr. Brian Patterson et al. used data from a large, academic medical center Emergency Department to show that the patients’ rate of service completion varies over the course of the physician shift. Furthermore, patients that have experienced a physician handoff have a higher rate of service completion than nonhanded off patients.

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Medics and patient

Transitioning from General Pediatric to Adult-Oriented Inpatient Care: National Survey of US Children's Hospitals.

Transitioning from General Pediatric to Adult-Oriented Inpatient Care: National Survey of US Children's Hospitals.

Hospital charges and lengths of stay may be greater when adults with chronic conditions are admitted to children's hospitals. Despite multiple efforts to improve pediatric-adult healthcare transitions, little guidance exists for transitioning inpatient care. In this study, HIP Investigator Dr. Ryan Coller et al. sought to characterize pediatricadult inpatient care transitions across general pediatric services at US children's hospitals.

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Complex Care Hospital Use and Postdischarge Coaching: A Randomized Controlled Trial.

Complex Care Hospital Use and Postdischarge Coaching: A Randomized Controlled Trial.

Complex care programs seek to influence key health outcomes for children with medical complexity (CMC), and investment in program infrastructure is often justified by anticipating savings from lower health care use. HIP Investigator, Dr. Ryan Coller et al. sought to examine the effect of a caregiver coaching intervention, Plans for Action and Care Transitions (PACT), on hospital use among children with medical complexity (CMC) within a complex care medical home. Among CMC within a complex care program, a health coaching intervention designed to identify, prevent, and manage patient-specific crises and postdischarge transitions appears to lower hospitalizations and charges.

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Elderly person falling

Using the Hendrich II inpatient fall risk screen to predict outpatient falls after ED visits

Using the Hendrich II inpatient fall risk screen to predict outpatient falls after ED visits

Dr. Brian Patterson et al. used electronic health record data to evaluate whether routinely collected Hendrich II fall scores can predict returns to the emergency department (ED) for falls within 6 months. The investigators found that using the score alone, the odds of returning to the ED for a fall in 6 months were 1.23 times as high for every 1-point increase in the Hendrich II score. When routinely collected data on other fall risk factors was combined with the fall risk score, the screening performed much better. 

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