Jerardi, KE; Fisher, E; Rassbach, C; Man, J; Blankenburg, R; Chase, L; Shah, N; Fellowship, C. Development of a Curricular Framework for Pediatric Hospital Medicine Fellowships. Pediatrics. 2017; 140(1):e20170698-e20170698.
Development of pediatric hospital medicine curricular framework. The American Board of Pediatrics recently gave the field of pediatric hospital medicine (PHM) status as the newest sub-specialty within pediatrics. With this designation, pediatricians who practice in PHM will complete additional training (known as a fellowship) to acquire the additional clinical and research skills. This paper, written by the national group of PHM fellowship directors, describes the process of creating a framework and presents the final framework for fellowship training. Specifically, the training proposes to include equal time for three sections: 1) clinical training relevant to pediatrics hospitalists, 2) scholarly training, and 3) time tailored for each individual in the training program. Dr. Karen Jerardi and Dr. Samir S. Shah will continue their leadership with an agency for healthcare research and quality-funded conference in Cincinnati this spring which will convene national fellowship and research leaders to determine the optimal way to provide research training for PHM fellows.
Thomson, J; Sucharew, H; Cruz, AT; Nigrovic, LE; Freedman, SB; Garro, AC; Balamuth, F; Mistry, RD; Arms, JL; Ishimine, PT; Kulik, DM; Neuman, MI; Shah, SS; Collaborative, P. Cerebrospinal Fluid Reference Values for Young Infants Undergoing Lumbar Puncture. Pediatrics. 2018; 141(3):e20173405.
Improving diagnosis of bacterial meningitis in infants. Bacterial meningitis is a serious infection of the membranes (meninges) surrounding the brain and spinal cord. Bacterial meningitis can result in death or serious disabilities if not diagnosed and treated in a timely fashion. Examination of cerebrospinal fluid (CSF) parameters, including white blood cell count, protein concentration, and glucose concentration, is crucial for timely diagnosis and treatment. However, interpretation of CSF parameters is challenging in infants as “normal” CSF parameters change over the first two months of life. In this study, authors defined age-specific CSF reference values and developed CSF parameter centile curves based on age for infants ≤ 60 days of age. This large multi-center study improves the precision and generalizability of previously published reference values as it includes more than 7,000 infants and represents the largest study to date. The age-dependent reference values presented in this study will provide guidance to clinicians in interpreting CSF parameters of young infants.
Unaka, N; Statile, A; Jerardi, K; Dahale, D; Morris, J; Liberio, B; Jenkins, A; Simpson, B; Mullaney, R; Kelley, J; Durling, M; Shafer, J; Brady, P. Improving the Readability of Pediatric Hospital Medicine Discharge Instructions. Journal of hospital medicine (Online). 2017; 12(7):551-557.
Improving the readability of discharge instructions. A child’s hospitalization is stressful for the entire family, and after the hospitalization there is an expectation of families to carry out post-discharge care plans. Clear and effective written instructions at discharge are hence critical. Hospital discharge instructions written at a high reading level may increase the risk of adverse outcomes for children as they transition from hospital to home, yet prior to this study only 13% of written discharge instructions were at ≤ 7th grade reading level. A multidisciplinary team of physicians, nurses, and parents worked together to increase the percentage of discharge instructions written ≤ 7th grade reading level from 13% to 98%. The most impactful intervention was the creation and dissemination of standardized disease-specific discharge instruction templates. Creating readable and standardized discharge instructions is now a hospital wide initiative. Through partnership with Cincinnati Children's Hospital Medical Center’s institutional Readmissions Collaborative, the creation over 100 disease specific discharge instructions are now used across the hospital.
Herrmann, LE; Hall, M; Kyler, K; Cochran, J; Andrews, AL; Williams, DJ; Wilson, KM; Shah, SS; PRIS, P. The Pipeline From Abstract Presentation to Publication in Pediatric Hospital Medicine. Journal of hospital medicine (Online). 2018; 13(2):E1-E6.
Need for research foundations in a growing field. Research plays a critical role in advancing care and improving outcomes for hospitalized children. Physicians often present earlier stages of their research at national scientific conferences as a prelude to publication in medical journals; subsequent publication in medical journals is necessary to meaningfully disseminate scientific advances. As pediatric hospital medicine is one of the most rapidly growing disciplines in pediatrics, this study examined the publication rate of abstracts submitted to the 2014 Pediatric Hospital Medicine conference. The authors found that only about 1/3 of submitted abstracts were ultimately published within 2.5 years of the conference. The overall low publication rate may indicate a need for increased mentorship and resources for research development in this growing specialty.
Hoefgen, ER; Andrews, AL; Richardson, T; Hall, M; Neff, JM; Macy, ML; Bettenhausen, JL; Shah, SS; Auger, KA. Health Care Expenditures and Utilization for Children With Noncomplex Chronic Disease. Pediatrics. 2017; 140(3):e20170492-e20170492.
Health care use and spending for children with noncomplex chronic disease. Children with chronic disease fall into two categories: those with complex chronic disease (e.g. cancer, cystic fibrosis, and neurologic impairment) or noncomplex chronic disease (e.g. asthma, attention-deficit hyperactivity disorder, diabetes, and depression). The authors described the total healthcare use and expenditures required to care for children with noncomplex chronic diseases in the United States, an area that was previously not well understood. We found that the percentage of children enrolled in Medicaid with noncomplex chronic diseases is substantial (36%). This group of children with noncomplex chronic diseases require expensive care, accounting for 33% of Medicaid pediatric expenditures. The majority of these expenditures take place in the outpatient setting, with the average child having 15 outpatient encounters over the two-year study period. Because of the high prevalence of children with noncomplex chronic disease, research and policy efforts should target this population in efforts to improve health and reduce health care costs on a national level.