In This Issue
Research Spotlight: Interprofessional Communication and Family Centered Care
CPCE In the News:
The Affordable Care Act and Pediatric Emergency Department Utilization
CPCE In the News:
Conquer Cancer Foundation / Anna Braglia Endowed Young Investigator Award
CPCE In the News: New Class of SIDM Fellows in Diagnostic Excellence Announced
Upcoming Events
Recent Publications
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Interprofessional Communication and Family Centered Care
Providing a positive patient experience is something CHOP employees strive for every day. This month, we’re looking at some new research conducted by CPCE faculty members that touches on patient experience and the role the interprofessional team has on family centered care.
Prior studies have focused on care team-family dynamics and how this impacts patient outcomes, but little had been studied up to this point on how team members work with each other in preparation of meetings with families. CPCE faculty members
Jennifer Walter, MD, PhD, MS and
Chris Feudtner, MD, PhD, MPH, looked at the dynamics of care teams especially in the pediatric cardiac intensive care unit (CICU) in a
recently published article in the
Journal of Pain and Symptom Management.
Families of patients in the pediatric CICU can struggle to understand their child’s illness and make informed decisions during such a stressful time. Decision-making is made more difficult when the care team does not work together effectively and plan for discussions with families. Pre-Family meeting discussions were recorded and subsequently coded to evaluate communication behaviors between the team before the family was present. Physicians’ comments accounted for nearly 84% of the meeting, while nonphysicians spoke for an average of nearly 10%. Also, in two of ten meetings, non-physicians perceived the meeting to be significantly less collaborative than physicians did. Identification of missed opportunities for interprofessional involvement reveals areas where collaboration and communication in subsequent pre-family and family meetings could be improved.
In
another recently published piece, Walter and Feudtner argue for the best way that interprofessional teams can optimally prepare for and conduct family meetings with the dual goals of supporting patients and their own team members.
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The Affordable Care Act and Pediatric Emergency Department Utilization
CPCE Core Faculty member
Evan Fieldston, MD, MBA, MSHP was asked to comment on a recent
study published in
Pediatrics which found no immediate change in pediatric ED visit rates the year after the ACA took effect in 2014, but the rate of change from 2014 to 2016 was significantly higher than previous rate trends. The findings did not vary significantly when controlling for insurance coverage. Dr. Fieldston and co-authors
pointed out the many reasons why families may seek care from the ED, including convenience, ease of access, and comprehensive service, and particularly for those with Medicaid, relatively cost-effective.
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Conquer Cancer Foundation / Anna Braglia Endowed Young Investigator Award (YIA) in Cancer Supportive Care awarded to Allison Barz Leahy, MD
Allison Barz Leahy, MD, a
PHEOT alumna and CPCE Core Faculty member is the 2019 recipient of the Anna Braglia Endowed Young Investigator Award in Cancer Supportive Care from the Conquer Cancer Foundation of the American Society of Clinical Oncology (ASCO). The YIA funds physicians who are in the final years of training to aid their transition from a fellowship program to a faculty appointment. Dr. Leahy’s YIA project is entitled Symptom monitoring using patient-reported outcomes in newly diagnosed pediatric cancer patients. The award is endowed by Helsinn, a Swiss pharmaceutical group focused on building quality cancer care products, and is named in honor of the wife and mother of Helsinn group leadership.
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New Class of SIDM Fellows in Diagnostic Excellence Announced
Irit Rasooly, MD is among seven new Fellows in Diagnostic Excellence selected by the Society to Improve Diagnosis in Medicine (SIDM). The fellowship was established by SIDM in 2016 to provide support to early-career scholars researching the improvement of diagnostic quality and safety, and to amplify their work in a way that creates awareness about issues of diagnostic error. Dr. Rasooly is completing her MSCE degree, funded by the
PHEOT training grant. Her SIDM fellowship project will characterize a subset of diagnostic errors associated with the use of clinical algorithms embedded in the electronic health record in a pediatric hospital.
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Upcoming Events
The 7th annual Symposium on Advances in Genomics, Epidemiology and Statistics
Date: Friday, June 7, 2019
Location: Arthur H. Rubenstein Auditorium. Smilow Center for Translational Research
All participants of SAGES 2019 are invited to submit an abstract for poster presentation at the time of registration. Poster awards will be available for trainees in pre-doc as well as post-doc categories. A limited number of submissions will be selected for oral presentation at the Symposium. All trainees who submit an abstract for poster presentations are also eligible to receive travel support including transportation and lodging. For further information, please visit:
https://www.med.upenn.edu/sages/.
Global Health in Our Own Backyard: Controversies, Initiatives, and Innovations for Our Local Underserved Populations
Abstract submission deadline: June 14, 2019
Date: October 4-5, 2019.
Location: Colket Building
Abstract submission is open for the 11th Annual CHOP Global Health Conference "Global Health in Our Own Backyard," This Philadelphia-based Conference will explore the intersections between domestic, local and international global pediatric health to better reach the underserved here in the United States. We will take inspiration from innovative programs in the U.S. and from around the world, and think critically about how to apply both South-North and national lessons to provide better, more equitable care in the United States. Registration will open shortly, so please save the date. For more information, click
here.
24th Annual Jonathan Lax Memorial Lecture: Discovery and Development of HIV Broadly Neutralizing Antibodies
Date: June 24, 2019
Time: 5:30 - 7:30 PM
Location: The Wistar Institute, Caplan Auditorium, 3601 Spruce Street
This free scientific lecture on innovations in HIV/AIDS research, treatment, and prevention is held each year in memory of leading AIDS activist Jonathan Lax. This year's honoree is Michel C. Nussenzweig, M.D., Ph.D., Zanvil A. Cohn and Ralph M. Steinman Professor, Investigator, Howard Hughes Medical Institute, and Senior Physician, The Rockefeller University.
Learn more.
Symposium on Gram Negative Bacteria Resistance
Date: July 31, 2019
Time: 8:30 AM - 6:00 PM
Location: The Wistar Institute, 3601 Spruce Street
The conference focuses on pathophysiology and prevention of Gram-negative bacteria. The goal is to bring together leading investigators in the field for in depth discussions on the current global state of infections that drive anti-microbial resistance (AMR). Perspectives to be covered include strategies to exploit novel bacterial vulnerabilities, updates on cutting-edge approaches towards Gram-negative infections and the next steps in combating AMR. Learn more and register
here.
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Recent Publications
Community-acquired pneumonia (CAP) is one of the most common infections in children, and is the largest contributor to total days of antibiotic use in children’s hospitals. Around 1.5 million pediatric healthcare visits each year in the USA are for CAP. CAP in most young children is caused by viral infections, which cannot be addressed successfully with antibiotics. There are drawbacks to unnecessary testing and antibiotic use. In 2011, the Pediatric Infectious Diseases Society (PIDS)/Infectious Diseases Society of America (IDSA) provided guidelines for pediatric CAP testing and treatment.
Jeffrey Gerber, MD, PhD, MSCE, contributed to a study that evaluated use of diagnostic testing and antibiotics in young outpatient children with CAP in the USA before and after the PIDS/IDSA guidelines were published, to determine adherence and the frequency of therapy and testing not recommended by this guideline. They found that testing and treatment rates remain high for many reasons, and effective interventions are needed to decrease unnecessary treatment and testing.
Pediatricians are in a good position to protect children from tobacco and secondhand smoke (SHS) exposure by educating, motivating, and initiating tobacco dependence treatment for parents who smoke. Parents who smoke often rarely see an adult healthcare clinician, but see their child’s doctor roughly three to four times every year. Pediatricians deliver effective tobacco dependence assistance to parents <3% of the time, with no parents reporting tobacco quitline enrollment at the visit. Using an electronic quitline referral system may help reduce the burden of providing smoking-cessation services and thus increase the likelihood that parents will enroll in some kind of treatment. In a recent study comparing enrollment rates of parents via eReferral versus parents given a quitline phone number. Smoking parent eReferral from pediatric primary care may increase quitline enrollment and could be adopted by practices interested in increasing rates of parent treatment.
Failure to thrive (FTT) is the clinical sign of inadequate weight gain in infants and young children, and it has been defined in numerous ways, with minimal evidence to support any specific definition. Children with FTT have long-term cognitive deficits compared to unaffected children, and differences can be decreased if FTT is diagnosed earlier, allowing children to receive treatment sooner. In 2010, the CDC recommended a switch to the World Health Organization’s growth standards, and this study sought to assess the public health impact of this growth curve change. Further, the researchers evaluated changes in the incidence of FTT diagnoses before and after the changed criteria, finding increases in FTT for infants under 6 months, and decreases in children 6-24 months old.
Sub-Saharan Africa has high under-5 mortality and low childhood immunization rates. Vaccine-preventable diseases cause one-third of under-5 deaths. Text messaging reminders improve immunization completion in urban but not rural settings in this area, possibly related to low adult literacy. This study looked at the feasibility and impact of combined automated voice and text reminders on immunization completion in rural sub-Saharan African, focusing on patients at hospitals in Nigeria who owned a mobile phone. The researchers found that paired automated call and text reminders significantly improved immunization completion and timeliness.
Health-related quality of life (HRQoL) is a multidimensional concept reflecting the impact of disease and treatment on a patient’s subjective assessment of their functional and emotional wellbeing. Patient and parent-proxy reported HRQoL measures serve as important measures of pain-related physical and psychosocial function in children and adolescents with juvenile fibromyalgia syndrome (JFMS). However, patients and their caregivers may experience questionnaire fatigue. By studying patient and proxy responses to questionnaires,
Sabrina Gmuca, MD, MSCE and colleagues found that there was good patient-proxy agreement on HRQoL in the target population of children and adolescents with JFMS. They recommend administering relevant questionnaires to patients only to minimize the burden in the clinical setting.
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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 E-News is edited by
Holly Burnside. Please feel free to contact us with questions or feedback.
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