Beck, AF; Riley, CL; Taylor, S; Brokamp, C; Kahn, RS. Pervasive Income-Based Disparities In Inpatient Bed-Day Rates Across Conditions And Subspecialties. Health Affairs. 2018; 37(4):551-559.
This study characterized patterns of population-level disparities in the total days children from one county spend hospitalized and the extent to which such disparities were present across pediatric conditions and hospital-based subspecialties. Over the six year study period, there were more than 40,000 hospitalizations involving nearly 25,000 unique patients who contributed 146,163 total bed-days (>400 child-years of hospital time). Researchers calculated inpatient bed-day rates for each of the 222 county census tracts. These rates varied markedly by underlying poverty rates for included census tracts: if all census tracts had the same inpatient bed-day rate as the 20% of the lowest poverty tracts, there would be a one-third prevention of all bed-days. That equates to 8,000 fewer bed-days per year, or 22 years children would spend at home instead of in the hospital. These gradients extend to multiple common pediatric conditions cared for across the range of pediatric sub-specialties. To achieve population health – that is, optimal and equitable outcomes – these data push us toward the identification of shared root causes driving disparities across conditions and specialties. Further, the results call for a more collaborative approach to precise assessments, referrals, interventions, and partnerships that facilitate identifying and then cooling “hot spots” of pediatric morbidity.
Greiner, MV; Beal, SJ; Nause, K; Staat, MA; Dexheimer, JW; Scribano, PV. Laboratory Screening for Children Entering Foster Care. Pediatrics. 2017; 140(6).
Because youth in protective custody (e.g. foster care) are at high risk for medical problems, and come from environments where they are in contact with adults known to be at high risk for infectious disease issues like HIV and Hepatitis C, there is a previous recommendation for routine laboratory screening for infectious disease for all youth entering foster care. This study identifies the risk for infectious disease is actually quite low for foster youth and that routine laboratory screening was costly with low yield. Higher impact screening includes lead levels for children under 6, hemoglobin screens, and sexually transmitted infection testing in children 12 and older. While more work needs to done to replicate these findings in other areas of the country, this work suggests that foster care status alone may not be an indicator of elevated risk for infectious diseases as previously thought and that targeted screening by clinicians based on community prevalence rates and other known risk factors may be more beneficial.
Hutton, JS; Gupta, R; Gruber, R; Berndsen, J; DeWitt, T; Ollberding, NJ; Van Ginkel, JB; Ammerman, RT. Randomized Trial of a Children's Book Versus Brochures for Safe Sleep Knowledge and Adherence in a High-Risk Population. Academic Pediatrics. 2017; 17(8):879-886.
Sleep-related infant deaths have been unacceptably high for the past 20 years, disproportionately affecting families of low socioeconomic status (SES). We conducted a randomized controlled trial involving 282 mothers at-risk for adverse outcomes enrolled in the Every Child Succeeds home visiting program, for the first time exploring the efficacy of printed educational materials for safe sleep guidance. Home visitors performed safe sleep teaching and assessments during three visits - third trimester, 1-week old, and 2-months old - exclusively utilizing either a specially designed children's book (Sleep Baby, Safe and Snug; Hutton & Busch) or an assortment of brochures. While knowledge of American Academy of Pediatrics (AAP) safe sleep recommendations increased similarly across all time points, adherence with these, notably exclusive crib use and avoiding bed-sharing, was more than two-fold higher for the book group, and mothers in the book group reported more book-sharing with their baby. We attribute these findings to enhanced parent-provider dialogue, simple reading level, and emotional engagement with empowering messaging, underscoring the potential of well-crafted children’s books for pediatric anticipatory guidance.
Henize, AW; Beck, AF; Klein, MD; Morehous, J; Kahn, RS. Transformation of a Pediatric Primary Care Waiting Room: Creating a Bridge to Community Resources. Maternal and Child Health Journal. 2018; 22(6):779-785.
Clinic-community partnerships have proven successful to help address social risks that frequently impact the health and well-being of children and families living in poverty. This paper is the first to describe the redesign of a pediatric primary care waiting room, typically a place of wasted time and space,  to enhance families’ engagement and connection to community resources. Design experts solicited families’ perspectives to identify needs for the space, which included linkage to community organizations, a welcoming environment, and positive distractions for children. Family caregivers surveyed before and after redesign were significantly more likely post-redesign to perceive the waiting room as a place to obtain help connecting to community resources and find information about clinical and educational resources. Families were also significantly more likely to report the waiting room as welcoming and relaxing, with sufficient privacy and space. These findings support the conclusion that a redesigned waiting room is a unique strategy to address social risks of low-income families and may serve as a bridge from clinical to community resources.
Millenson, ME; Braun, JM; Calafat, AM; Barr, DB; Huang, YT; Chen, A; Lanphear, BP; Yolton, K. Urinary organophosphate insecticide metabolite concentrations during pregnancy and children's interpersonal, communication, repetitive, and stereotypic behaviors at 8 years of age: The home study. Environmental Research. 2017; 157:9-16.
Prenatal exposure to organophosphate insecticides associates with poor neurobehavioral outcomes in children, but research findings are inconclusive. In a sample of 224 mother-child dyads enrolled in the Health Outcomes and Measures of the Environment (HOME) study, a longitudinal pregnancy and birth cohort study, we quantified concentrations of six nonspecific dialkyl phosphate (DAP) metabolites of organophosphate insecticides in urine samples collected from mothers at ~16 and ~26 weeks gestation. We also conducted genotyping of umbilical cord blood for PON1, an enzyme that aids metabolism of organophosphate insecticides. When children were age 8 years, mothers completed the social responsiveness scale (SRS), a continuous measure of various dimensions of interpersonal behavior, communication, and repetitive/stereotypic behaviors that is often used as a screener for autism spectrum disorders. After covariate adjustment, DAP concentrations were not associated with SRS scores. We also did not find evidence that child PON1 genotype modified the association between prenatal urinary ΣDAP concentrations and SRS scores.