March 26, 2021
In This Issue

Research Spotlight:
Addressing Wealth to Bolster Health

CPCE In the News:
COVID-19 News

Upcoming Events & Announcements

Recent Publications
Addressing Wealth to Bolster Health through Medical Financial Partnerships
Innovation within the healthcare delivery setting can not only directly improve patient outcomes but alleviate poverty, fundamentally improving the quality of life for patients and their families. Medical financial partnerships (MFPs) are one of the latest innovations happening at CHOP, offering patient families access to and knowledge of financial resources that are often underutilized. Embracing this model, CHOP partnered with Campaign for Working Families (CWF) in 2019 to offer eligible individuals free tax preparation services. 
Since MFPs are still considered a novel approach, gaining acceptance across pediatrics, this partnership was an opportunity to assess the feasibility and impact of delivering tax preparation services to primary care patients. As part of the federal Volunteer Income Tax Assistance (VITA) program, services are focused on families who make $57,000 or less, persons with disabilities, and taxpayers with limited English proficiency. CWF provided the financial expertise, helping eligible individuals claim their earned income tax credits (EITC) and child tax credits (CTC) – which can be worth thousands of dollars – and maximizing their returns. 
The EITC is one of the most effective poverty-alleviation tools, but according to Pennsylvania data, 19% of those eligible to receive it do not claim it. This program sought to reach a cohort of individuals who otherwise may not have had access to filing the EITC. A case study of the pilot program, led by George Dalembert, MD, MSHP, and CPCE faculty contributors, Alexander G. Fiks, MD, MSCE, and Brian P. Jenssen, MD, MSHP, delves into the process of building and launching this successful MFP that has generated almost $700,000 in refunds to-date for individuals located in West Philadelphia.   
Implementation of the program, while ultimately successful, encountered challenges. Developing a workflow that did not interfere with clinical operations was critical. Maintaining team morale while building awareness of the program from the ground up was equally as important. The number of patients interested in taking advantage began to increase as positive word of mouth about the high quality and value of the offerings spread. Of course, the biggest hurdle came in March 2020 with the onset of COVID-19. The team was able to transition to an online model of free tax preparation with CWF, continuing to serve interested patients.  
The hospital is setting aside funds to continue mission-fulfilling work like this, hoping to expand and partner with organizations focused on other social services like food insecurity and housing instability. As one happy client stated, “I don’t know why anyone would not do it — it’s free and they are so helpful — I think everyone should go and do it.” Providing resources like tax preparation services in the pediatric setting proved to be of great value to participants.
Read the full case study that appeared in the New England Journal of Medicine (NEJM) Catalyst to learn more about this program and the steps required for launching a successful MFP.  
COVID-19 News

Earlier this week, Dustin Flannery, DO, MSCE, spoke with NBC10 Philadelphia about his research into babies born with COVID-19 antibodies, and the implications this has for pregnant women considering vaccination. Watch Dustin's conversation with reporter Jim Rosenfield here.

Last week, David Rubin, MD, MSCE spoke with The Washington Post as disease experts nationally keep a close eye on rising hot spots of infection. "There's a resurgence going on here," says Rubin, adding that it's too soon to call this a wave, but cases have been creeping up in parts of the Northeast and Mid-Atlantic. Read the full article here.
Stay up to date by visiting our COVID-19 News page.
Upcoming Events & Announcements

Seminar Series featuring Tyra Bryant-Stephens, MD Happening Today
This afternoon at 12 PM join Tyra Bryant-Stephens, MD for her seminar series presentation, "The Community Asthma Prevention Program (CAPP): Road to Achieving Health Equity." Tyra Bryant-Stephens is a faculty member at PolicyLab and the medical director of CAPP. CAPP was designed to improve the health and well-being of children with asthma by providing free asthma classes in the community for parents and their children with asthma. 

Meeting ID: 179 473 629

AAMI & Becton Dickinson’s Patient Safety Award
Each year, AAMI recognizes health technology’s best and brightest for their leadership, dedication, and contributions to AAMI and their fields. This year, CPCE Faculty Member Chris Bonafide, MD, MSCESara B. DeMauro, MD MSCE, Melissa C. McLoone RN, BSN, and James C. Won, PhD of the Patient Safety Learning Laboratory (PSLL) were awarded the 2021 Patient Safety Award! This award recognizes outstanding achievements by healthcare technology professionals who have made a significant advancement toward improving patient safety. Congratulations to the entire PSLL team!

2021 APA Young Investigator Award 
The Academic Pediatric Association recently selected Aditi Vasan’s proposal, “Impact of Government Nutrition Assistance Program Participation on Children's Healthcare Utilization and Expenditures”, for funding by the 2021 APA Young Investigator Awards Program through the APA YIA Funding Path. Through this award, Aditi will receive funding for this project and will be paired with a National Advisor who’ll provide advice and input on the project. Congratulations to Aditi and her project mentors, Chén Kenyon and Alex Fiks, on this accomplishment! 

The Historical Determinants of and Social Disparities in Healthcare
Date: April 7, 2021
Time: 12:00 - 1:30 pm
Join the Penn Center for Health Equity Advancement in partnership with Little Giant Creative, a social impact focused creative agency, for a frank and candid discussion of the deep seated racism within our society and the healthcare system, the historical events antecedent to the impacts we see today as well as highlight potential solutions. Learn more and register here.

Drexel University Dornsife School of Public Health 2021 Population Health Symposium
Dates: April 7-8, 2021
This year’s inaugural symposium will bring together researchers, health practitioners, students, and the public at large to learn about the intersection of racism and health and discuss how we can collectively propose sustainable solutions towards health equity. Learn more and register here.
13th Annual University of Pennsylvania Conference on Statistical Issues in Clinical Trials
Date: April 12, 2021
Time: 8:30 am - 4:30 pm
Continuing its longstanding collaboration with the Department of Biostatistics, Epidemiology and Informatics at the University of Pennsylvania, the ASA, NISS and SCT is delighted to announce the 13th Annual Conference on Statistical Issues in Clinical Trials: Cluster Randomized Trials (CRTs) - Challenges and Opportunities. Learn more and register here.

*For CPCE/PolicyLab Virtual Seminar Series: If you would like to participate in any of the virtual events and did not receive an Outlook invitation, please contact [email protected]
Recent Publications

Abusive intra-abdominal injuries are less common than other types of injuries identified in victims of child physical abuse, but they can be deadly. Identification of intra-abdominal injuries can be important clinically or forensically. Abusive intra-abdominal injuries can be clinically occult, necessitating screening laboratory evaluations to inform decisions regarding imaging. Kate Henry, MD, MSCE, Joanne Wood, MD, MSHP and their colleagues describe the clinical, laboratory and imaging evaluation of the abdomen in the setting of suspected child abuse.

Acute gastroenteritis (AGE) is a common pediatric diagnosis in emergency medicine. Little is known about racial/ethnic differences in care in the setting of standardized care models. Christopher Bonafide, MD, MSCE and his team used quality improvement data for children 6 months to 18 years presenting to the emergency department (ED) for AGE/dehydration. Non-Hispanic-Black, Hispanic, and Non-Hispanic-other children were less likely to receive IVF or hospital admission and had shorter length of stay compared to Non-Hispanic-White counterparts. There was no difference in patient revisits which suggests discretionary overtreatment of Non-Hispanic-White patients, even with clinical guidelines in place. 

Researchers including Ariel Williamson, PhD, and Olivia Cicalese examined whether cumulative risk exposure moderated the link between sleep problems, including insomnia and poor sleep health, and child psychological outcomes. 205 caregiver-child dyads completed child sleep, family sociodemographic, and child psychological functioning questionnaires. Increased insomnia symptoms were significantly associated with increased child internalizing, externalizing, and global executive functioning impairments controlling for child age, race/ethnicity, and sex. Poor sleep health behaviors were associated with internalizing concerns. Children with the poorest sleep health behaviors and highest cumulative risks had the greatest internalizing concerns.

Jeffrey Gerber, MD, PhD, MSCE and his research team performed a retrospective cohort study to identify practice patterns in the duration of prescribed antibiotics for the treatment of ambulatory children with community-acquired pneumonia (CAP) and to compare the frequency of adverse clinical outcomes between children prescribed short- versus prolonged-duration antibiotics. Most children treated for CAP as outpatients are prescribed at least 10 days of antibiotic therapy. Among pediatric outpatients with CAP, no significant differences were found in rates of adverse clinical outcomes between patients prescribed short- versus prolonged-duration antibiotics.

CPCE faculty member Scott Lorch MD, MSCE and his colleagues ran a secondary analysis to determine the extent to which newborns with neonatal abstinence syndrome (NAS) are concentrated in some hospitals as compared with newborns without NAS and whether care quality and safety differed among these hospitals. Of the 659,403 newborns in this study, 3,130 were diagnosed with noniatrogenic NAS. They found that newborns with NAS were cared for in different hospitals compared with newborns without NAS (Gini coefficient 0.62, 95% confidence interval, 0.56-0.68) and that the hospitals in which they received care were rated as having poorer quality and safety (Gini coefficient 0.12, 95% confidence interval, 0.01-0.23).

The increasing prevalence of SARS-CoV-2 and the resulting COVID-19 pandemic pose concerns for the clinical management of solid organ transplant recipients (SOTR). Wearable devices that can measure physiologic changes in biometrics show utility for the early detection of infection before the clinical presentation of symptoms. Early detection of SARS-CoV-2 and other pathogens in SOTR could facilitate early interventions. Ongoing studies testing the utility of wearable devices for early detection of SARS-CoV-2 and other infections in the general population are reviewed here by Joseph W. Rossano, MD, MS, Sandra Amaral, MD, MHS, and their colleagues.

The impact of COVID-19 public health interventions on pediatric illnesses nationwide is unknown. Chén Kenyon, MD, MSHP and his team performed a multicenter, cross-sectional study to assess changes in pediatric healthcare utilization during the pandemic. The COVID-19 pandemic was associated with substantial reductions in encounters for respiratory diseases; these large reductions were consistent across illness subgroups. Although encounters for nonrespiratory diseases decreased as well, reductions were more modest and varied by age. Encounters for respiratory diseases among adolescents declined to a lesser degree and returned to previous levels faster compared with those of younger children. 

About CPCE

We are a pediatric research center dedicated to discovering and sharing knowledge about best practices in pediatric care by facilitating, organizing, and centralizing the performance of clinical effectiveness research research aimed at understanding the best ways to prevent, diagnose, and treat diseases in children. CPCE’s multidisciplinary team conducts research on a diverse range of clinical effectiveness topics.

CPCE News is edited by Deanna Crusco. Please feel free to contact us with questions or feedback.