Health Insurance
Caregiver Opinion of In-Hospital Screening for Unmet Social Needs by Pediatric Residents
Child health is strongly influenced by social determinants. Little is known about the opinions of primary caregivers regarding the physicians' role in addressing social needs. Our objective was to examine caregivers' opinions about that role and any associations between those opinions, previous exposure to screening for needs by pediatric residents, and socioeconomic status (SES).Hospitalization: Are We Missing an Opportunity to Identify Food Insecurity in Children?
Food security is the ability to access sufficient food to maintain a healthy, active life. Previous studies link food insecurity with adverse health outcomes. Our objectives were to determine the prevalence of food insecurity, identify sociodemographic risk factors, and quantify receipt of public nutrition assistance among recently hospitalized children in the United States.Maintenance of Increased Childhood Influenza Vaccination Rates 1 Year After an Intervention in Primary Care Practices
Influenza vaccination rates among some groups of children remain below the Healthy People 2020 goal of 70%. Multistrategy interventions to increase childhood influenza vaccination have not been evaluated recently.Developmental Screening Disparities for Languages Other than English and Spanish
Limited English proficiency (LEP) is a known barrier to preventive care. Children from families with LEP face socioeconomic circumstances associated with increased odds of developmental delays and decreased participation in early care and education programs. Little is known about developmental surveillance and screening for children from families who speak languages other than English and Spanish. We sought to compare developmental surveillance and screening at well-child visits (WCVs) by preferred parental language.Physician Perspectives on Medical Home Recognition for Practice Transformation for Children
To examine child-serving physicians' perspectives on motivations for and support for practices in seeking patient-centered medical home (PCMH) recognition, changes in practice infrastructure, and care processes before and after recognition, and perceived benefits and challenges of functioning as a PCMH for the children they serve, especially children with special health care needs.Incidence of Urinary Tract Infection Among Siblings of Children With Vesicoureteral Reflux
Siblings of children with vesicoureteral reflux (VUR) are at elevated risk of VUR. Screening siblings may identify VUR before a clinical illness such as a urinary tract infection (UTI), but the benefit of screening has not been demonstrated. We sought to determine the incidence of UTI among siblings, and we hypothesized that the sibling UTI rate is similar between screened and unscreened siblings.Underserved Areas and Pediatric Resident Characteristics: Is There Reason for Optimism?
To examine whether resident characteristics and experiences are related to practice in underserved areas.Juvenile Incarceration and Health
Addressing the health status and needs of incarcerated youth represents an issue at the nexus of juvenile justice reform and health care reform. Incarcerated youth face disproportionately higher morbidity and higher mortality compared to the general adolescent population. Dental health, reproductive health, and mental health needs are particularly high, likely as a result of lower access to care, engagement in high-risk behaviors, and underlying health disparities. Violence exposure and injury also contribute to the health disparities seen in this population.Variation in Educational Services Receipt Among US Children With Developmental Conditions
To examine the relationship between ease of access to needed community-based services (ease of access) and educational services receipt, and variation in educational services receipt by sociodemographic and need factors among a nationally representative sample of children with autism spectrum disorder (ASD), developmental delay (DD), and/or intellectual disability (ID).Parental Use of Electronic Cigarettes
To describe parental use of electronic cigarettes (e-cigs) to better understand the safety risks posed to children.Trends in Type of Health Insurance Coverage for US Children and Their Parents, 1998–2011
To examine trends in health insurance type among US children and their parents.A Comparison of Ambulatory Care Sensitive Hospitalizations Among Children With and Without Autism Spectrum Disorder
To compare the prevalence of hospitalizations for ambulatory care sensitive conditions (ACSC) in children with and without autism spectrum disorder (ASD) and to compare inpatient health care utilization (total charges and length of stay) for the same conditions in children with and without ASD.Trends in Disparities in Low-Income Children's Health Insurance Coverage and Access to Care by Family Immigration Status
To examine time trends in disparities in low-income children's health insurance coverage and access to care by family immigration status.Multiple Behavior Change Intervention to Improve Detection of Unmet Social Needs and Resulting Resource Referrals
It is critical that pediatric residents learn to effectively screen families for active and addressable social needs (ie, negative social determinants of health). We sought to determine 1) whether a brief intervention teaching residents about IHELP, a social needs screening tool, could improve resident screening, and 2) how accurately IHELP could detect needs in the inpatient setting.Enrollment, Expenditures, and Utilization After CHIP Expansion: Evidence From Alabama
In October 2009, Alabama expanded eligibility in its Children's Health Insurance Program (CHIP), known as ALL Kids, from 200% to 300% of the federal poverty level (FPL). We examined the expenditures, utilization, and enrollment behavior of expansion enrollees relative to traditional enrollees (100–200% FPL) and assessed the impact of expansion on total program expenditures.Children with Special Health Care Needs in CHIP: Access, Use, and Child and Family Outcomes
To assess how the Children's Health Insurance Program (CHIP) affects outcomes for children with special health care needs (CSHCN).CHIP and Medicaid: Evolving to Meet the Needs of Children
To examine the evolution of Children's Health Insurance Program (CHIP) and Medicaid programs after passage of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), focusing on policies affecting eligibility, enrollment, renewal, benefits, access to care, cost sharing, and preparation for health care reform.How Well Is CHIP Addressing Primary and Preventive Care Needs and Access for Children?
To examine differences in primary care outcomes under the Children's Health Insurance Program (CHIP) compared to private coverage and being uninsured in 10 states.Enrollment and Disenrollment Experiences of Families Covered by CHIP
To understand why families enroll in and disenroll from Children's Health Insurance Program (CHIP), their experience with the CHIP application and renewal process, and the insurance coverage of their children after disenrolling.The Children's Health Insurance Program Lessons for Health Reform
The articles in this special Academic Pediatrics' supplement present a thoughtful analysis of the Children's Health Insurance Program (CHIP) contribution to the advancement of child health policy in the United States. CHIP has played a significant role in reducing the proportion of uninsured children in the United States, not only through the coverage subsidies it provides to millions of children, but also because of the heightened policy focus it has brought to the question of how to structure insurance for children and make coverage accessible.The Children's Health Insurance Program Strengthens Children's Health Care
The Children's Health Insurance Program (CHIP) has provided substantial coverage for critical groups of children and youth since its inception in the 1990s. Meant to cover children in households with incomes greater than financial eligibility for Medicaid but unable to obtain health insurance through a parent's workplace, CHIP has played a major role in achieving the lowest rate of uninsurance among America's children ever.1 With current funding through the Affordable Care Act (ACA) (and due to expire in September 2015), CHIP also serves, along with Medicaid's Early and Periodic Screening, Diagnosis, and Treatment program, as health insurance tailored specifically to the needs of children.The Children's Health Insurance Program and the Goldilocks Effect
Did you ever read the story of Goldilocks to your children? In one version of this story, Goldilocks is a tired, hungry, and lost little girl who encounters a house owned by 3 bears. She finds 3 bowls of porridge and judges whether each is too hot, too cold, or just right. She then finds 3 chairs, and determines whether each is too big, too small, or just right. Finally she is tired and finds 3 beds, and she assesses whether each bed is too hard, too soft, or just right. After she eats the porridge, sits in the chair, and lies on the bed that are all “just right,” she falls asleep.Alabama's Perspective of the Child Health Insurance Program
The articles in this supplement report on a Congressionally mandated evaluation of the Children's Health Insurance Program (CHIP) and highlight the effects of the program on insurance coverage and access to care in 10 study states. Here, we provide some insights on how CHIP has found success in Alabama by providing coverage to uninsured children and ensuring they have access to quality health care.The Children's Health Insurance Program Reauthorization Act Evaluation Findings on Children's Health Insurance Coverage in an Evolving Health Care Landscape
The Children's Health Insurance Program (CHIP) Reauthorization Act (CHIPRA) reauthorized CHIP through federal fiscal year 2019 and, together with provisions in the Affordable Care Act, federal funding for the program was extended through federal fiscal year 2015. Congressional action is required or federal funding for the program will end in September 2015. This supplement to Academic Pediatrics is intended to inform discussions about CHIP's future. Most of the new research presented comes from a large evaluation of CHIP mandated by Congress in the CHIPRA.Table of Contents
245 Integrating the Learner's Perspective in the Refinement of Competency-Based Assessments Jacob Robson, Duncan Henry, James Moses, Robert Vinci, and Daniel SchumacherParent Reports of Mental Health Concerns and Functional Impairment on Routine Screening With the Strengths and Difficulties Questionnaire
This study used the Strengths and Difficulties Questionnaire (SDQ) to describe the prevalence of parent-reported mental health (MH) concerns in youth presenting for primary care appointments and to examine relationships between children's MH issues and functional impairment. We hypothesized that increased MH symptomology would be associated with increased impairment and family burden.Assuring Adequate Health Insurance for Children With Special Health Care Needs: Progress From 2001 to 2009–2010
To report on coverage and adequacy of health insurance for children with special health care needs (CSHCN) in 2009–2010 and assess changes since 2001.Freelisting on Costs and Value in Health Care by Pediatric Attending Physicians
In preparation for the development of a curriculum on health care costs and value for pediatricians, the goal of this study was to assess pediatricians' baseline perceptions about the concepts of “cost” and “value” in health care, and topics that should be included in a curriculum that teaches about costs and value in pediatrics.Access to Private Coverage for Children Enrolled in CHIP
To provide updated information on the potential substitution of public for private coverage among low-income children by examining the type of coverage held by children before they enrolled in Children's Health Insurance Program (CHIP) and exploring the extent to which children covered by CHIP had access to private coverage while they were enrolled.How Well Is CHIP Addressing Health Care Access and Affordability for Children?
We examine how access to care and care experiences under the Children's Health Insurance Program (CHIP) compared to private coverage and being uninsured in 10 states.Spotlight on Express Lane Eligibility (ELE): A Tool to Improve Enrollment and Renewal
We examine a new simplification policy, Express Lane Eligibility (ELE), introduced by the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), to understand ELE's effects on enrollment, renewal, and administrative costs.How Well Is CHIP Addressing Oral Health Care Needs and Access for Children?
We examine how access to and use of oral and dental care under the Children's Health Insurance Program (CHIP) compared to private coverage and being uninsured in 10 states.The Stepped Wedge Cluster Randomized Trial and Its Potential for Child Health Services Research: A Narrative Review
We foresee an increasing role for the stepped wedge cluster randomized trial design in child health services research. Although a recent systematic review only identified 25 such studies,1 those studies offer themselves as compelling examples to consider. As we will demonstrate, the stepped wedge cluster randomized trial is particularly apt as a research design for health services research. Furthermore, the stepped wedge cluster randomized trial is particularly attractive for health services research concerning children and adolescents because its design addresses problems that complicate child health services research and differentiate those efforts from adult health services research.Children's Emergency Department Use for Asthma, 2001–2010
Although the emergency department (ED) provides essential care for severely ill or injured children, past research has shown that children often visit the ED for potentially preventable illnesses, including asthma. We sought to determine how children's rate of ED visits for asthma has changed over the last decade and to analyze what factors are associated with a child's potentially preventable ED visit for asthma.A Successful Program for Training Parent Mentors to Provide Assistance With Obtaining Health Insurance for Uninsured Children
Seven million US children lack health insurance. Community health workers are effective in insuring uninsured children, and parent mentors (PMs) in improving asthmatic children's outcomes. It is unknown, however, whether a training program can result in PMs acquiring knowledge/skills to insure uninsured children. The study aim was to determine whether a PM training program results in improved knowledge/skills regarding insuring uninsured minority children.Health Status and Type of Out-of-Home Placement: Informal Kinship Care in an Investigated Sample
To assess the sociodemographic, health, and mental health of children in different types of out-of-home placements after investigation by child welfare agencies; to determine whether there are systematic differences in the children and their caregivers by type of out-of-home placements; and to provide the first description of these characteristics in a nationally representative sample for children in informal kinship care after child welfare involvement.Predictors of Unmet Dental Need in Children With Autism Spectrum Disorder: Results From a National Sample
Unmet dental need in children with autism spectrum disorder (ASD) is common. We tested hypotheses that lacking a medical home or having characteristics of more severe ASD is positively associated with having unmet dental need among children with ASD.Mental Health Beliefs and Barriers to Accessing Mental Health Services in Youth Aging out of Foster Care
To examine the perspectives of youth on factors that influence mental health service use after aging out of foster care.Kinship Care
About 4.2% (3.1 million) of children in the United States, according to census data,1 reside with relatives or close family connections and with neither parent, an arrangement termed kinship care (KC). Health professionals frequently encounter children in KC and may better serve these children if they are aware of both the benefits and complexities of kinship arrangements.Concept and Measurement of Pediatric Value
In the new health care marketplace, families will be making important decisions concerning choice of health plan, health provider, and even accountable care organizations. Ideally, they would make these decisions using information on health care value, which comprises the relationships between patient/family-centered outcomes (the outputs of health care services) and costs of providing care to achieve these outcomes. Providing information on pediatric value will require new investments in data collection systems that include outcomes that matter to children and families and costs measured at the level of the child.Quality Concerns in Antipsychotic Prescribing for Youth: A Review of Treatment Guidelines
Antipsychotic prescribing for youth has increased rapidly, is linked with serious health concerns, and lacks clear measures of quality for pediatric care. We reviewed treatment guidelines relevant to 7 quality concepts for appropriate use and management of youth on antipsychotics: 1) use in very young children, 2) multiple concurrent antipsychotics, 3) higher-than-recommended doses, 4) use without a primary indication, 5) access to psychosocial interventions, 6) metabolic screening, and 7) follow-up visits with a prescriber.Patient Reported Outcomes as Indicators of Pediatric Health Care Quality
Health care reform has increased demand for pediatric health care quality evaluations, particularly those that assess the impact of care on patient and population health outcomes. Many of today's most common childhood conditions are characterized by symptoms, behaviors, and functional limitations that are best assessed as patient reported outcomes (PROs). Although they remain greatly underutilized, PROs have the potential to improve pediatric health care quality assessment at the point of care and through system-level performance evaluations.Advancing the Science of Measurement in Pediatric Quality of Care
The Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 provides an opportunity to consider and enhance the measurement of children's health care quality as a means to improve child health.1 The legislation required the identification of an initial child core set of measures for voluntary use by Medicaid/Child Health Insurance (CHIP) programs. The initial child core set was published in 2009, and after its most current update in 2014, the list now includes 23 pediatric measures.The Transition Readiness Assessment Questionnaire (TRAQ): Its Factor Structure, Reliability, and Validity
National consensus statements recommend that providers regularly assess the transition readiness skills of adolescent and young adults (AYA). In 2010 we developed a 29-item version of Transition Readiness Assessment Questionnaire (TRAQ). We reevaluated item performance and factor structure, and reassessed the TRAQ's reliability and validity.Growing Up Poor: A Pediatric Response
The original mission of Boston City Hospital, established in 1864, now Boston Medical Center (BMC), was to provide medical care to all regardless of race, ethnicity, or ability to pay. Nationally, health insurance for children has increased, although disparities by race and income remain.1 However, despite the largest expansion of health insurance in the nation, covering 97% of Massachusetts children and biomedical treatment advances, the low-income and minority children seen at BMC continue to suffer disproportionally from low birth weight, asthma, learning disabilities, and most health problems compared to their nonpoor peers.Parental Psychological Distress and Children's Mental Health: Results of a National Survey
Questions persist as to which dimensions of child mental health are most associated with parental mental health status and if these associations differ by parental gender. We assessed associations between parental psychological distress and children's mental health.Identifying Sickle Cell Disease Cases Using Administrative Claims
To develop and test the accuracy of administrative claims method for identifying children with sickle cell disease (SCD) to enable quality of care assessments among children enrolled in Medicaid.School-Located Influenza Vaccination With Third-Party Billing: Outcomes, Cost, and Reimbursement
To assess rates of immunization; costs of conducting clinics; and reimbursements for a school-located influenza vaccination (SLIV) program that billed third-party payers.School-Located Influenza Vaccination With Third-Party Billing: What Do Parents Think?
School-located influenza vaccination (SLIV) may be instrumental in achieving high vaccination rates among children. Sustainability of SLIV programs may require third-party billing. This study assessed, among parents of elementary school students, the attitudes about SLIV and billing at school, as well as factors associated with being supportive of SLIV.Novel Immunization Reminder/Recall Approaches: Rural and Urban Differences in Parent Perceptions
To assess the following among parents of young children: 1) preferences about the source of immunization reminder/recall (R/R) messages, 2) the degree of acceptability of different R/R modalities, and 3) factors that influence preferences, including rural and urban characteristics.Children and the Patient Protection and Affordable Care Act: Opportunities and Challenges in an Evolving System
The Patient Protection and Affordable Care Act (ACA), passed in 2010, focused primarily on the problems of adults, but the changes in payment for and delivery of care it fosters will likely impact the health care of children. The evolving epidemiology of pediatric illness in the United States has resulted in a relatively small population of medically fragile children dispersed through the country and a large population of children with developmental and behavioral health issues who experience wide degrees of health disparities.Transition Care: Future Directions in Education, Health Policy, and Outcomes Research
All youth must transition from pediatric to adult-centered medical care. This process is especially difficult for youth with special health care needs. Many youth do not receive the age-appropriate medical care they need and are at risk during this vulnerable time. Previous research has identified barriers that may prevent effective transition, and protocols have been developed to improve the process. Health outcomes related to successful transition have yet to be fully defined. Health care transition can also be influenced by education of providers, but there are gaps in medical education at the undergraduate, graduate, and postgraduate levels.Child and Adolescent Health Care Quality and Disparities: Are We Making Progress?
Children and adolescents are known to experience poor health care quality; some groups of children have poorer health care than others. We sought to examine trends over time in health care quality and disparities by race, Hispanic ethnicity, income, insurance, gender, rurality, and special health care needs.Financial and Nonfinancial Burden Among Families of CSHCN: Changes Between 2001 and 2009–2010
We use the latest data to explore multiple dimensions of financial burden among children with special health care needs (CSHCN) and their families in 2009–2010 and changes since 2001.Family Out-of-Pocket Health Care Burden and Children's Unmet Needs or Delayed Health Care
To assess the relationship between family members' out-of-pocket (OOP) health care spending and unmet needs or delayed health care due to cost for children with and without special health care needs (SHCN).Use of Complementary and Alternative Medical Therapies Among Youth With Mental Health Concerns
Use of complementary and alternative medical (CAM) therapies is common among adults with mental health concerns, but little is known about CAM use among adolescents with mental health concerns.Community Health Centers: Medical Homes for Children?
To explore medical home attributes of community health centers (CHCs) that provide care to low-income children nationwide compared to other providers for the poor.Stories That Work
I have never met Natoma Canfield, but I am unlikely to forget her story. Natoma is a woman with cancer who had dutifully paid her health insurance premiums over the years she was healthy but then could no longer afford them when she became sick, and they increased. Ultimately, she lost coverage. Natoma's story was the one President Barack Obama relayed on the historic day last summer that the Patient Protection and Affordable Care Act was upheld by the Supreme Court. Her experience encapsulated the health care debate at a time when all the facts—the pros, the cons—were questioned by the other side.Improving Immunization Delivery using an Electronic Health Record: The ImmProve Project
Though an essential pediatric preventive service, immunizations are challenging to deliver reliably. Our objective was to measure the impact on pediatric immunization rates of providing clinicians with electronic health record–derived immunization prompting.Annual Report on Health Care for Children and Youth in the United States: Trends in Racial/Ethnic, Income, and Insurance Disparities Over Time, 2002–2009
To examine trends in children's health access, utilization, and expenditures over time (2002–2009) by race/ethnicity, income, and insurance status/expected payer.Health Status, Emotional/Behavioral Problems, Health Care Use, and Expenditures in Overweight/Obese US Children/Adolescents
To examine the association of overweight/obesity with health, health care utilization, and expenditures in a national sample of 10- to 17-year-old children and adolescents.Primary Care Spatial Density and Nonurgent Emergency Department Utilization: A New Methodology for Evaluating Access to Care
To determine the spatial and demographic characteristics of pediatric patients who make nonurgent visits (NUVs) to an urban pediatric emergency department (ED). We hypothesized that the rate of NUVs would be inversely associated with the spatial density of primary care providers (PCPs).Health Care for Children and Youth in the United States: 13 Years of Evidence
Editor's Note: One of the challenges of leading such an agency as the Agency for Healthcare Research and Quality (AHRQ) is disseminating its products in a way that can be used by a variety of individuals for whom it is important. Dr. Clancy has met this challenge with a number of innovative reports and other strategies in providing readily used access to the analytic and policy products of AHRQ. The Annual Report in Academic Pediatrics is one of those strategies with a focus on access and use of health services by children and youth, a group often not well described in general population data.The Relationship of Reported Neighborhood Conditions With Child Mental Health
Although in many studies authors have documented the relationship between neighborhood socioeconomic status and child mental health, few have examined the association between neighborhood conditions and mental health disorders. The objective of this study was to determine whether parent-reported neighborhood conditions are associated with common child mental health disorders.Dietary and Physical Activity Behaviors of New York City Children From Different Ethnic Minority Subgroups
To examine racial/ethnic differences in diet and physical activity behaviors in ethnic minority New York City children.Notes to a Young Investigator on How We Might Change the World
I'd like to express my sincere gratitude to the APA for this tremendous honor and recognition. I am also extremely grateful to my mentors: my high-school biology teacher, Ben Kirkland; my college mentor, Ernest Williams; my Robert Wood Johnson Clinical Scholars Program mentors, Alvan Feinstein and Ralph Horwitz; my Robert Wood Johnson Harold Amos Medical Faculty Development Program mentor, Sandy Schwartz; and my cherished pediatric colleagues and mentors, Michael Weitzman, Paul Wise, and Fernando Mendoza.The United States 2012 General Election: Making Children's Health and Well-Being a Priority for the Candidates
In the first half of the 20th century, perhaps the most vulnerable group in the United States was elderly constituents. More than one-third were living in poverty, and fewer than one-half had health insurance.1,2 Democratic and Republican presidents, including Theodore Roosevelt, Franklin Roosevelt, and Lyndon Johnson, convinced Americans that there was a moral imperative for our country to care for its elderly.3–5 Through Social Security (enacted in 1935) and Medicare (enacted in 1965), a transformational shift in the well-being of seniors occurred.The Patient Protection and Affordable Care Act and the Future of Child Health Policy
With the United States Supreme Court’s landmark ruling in NFIB v Sebelius1 behind us, it is possible to attend to the full-scale implementation of the Affordable Care Act. The Act represents an unprecedented opportunity in child health policy, at least if those of us who in one way or another have immersed ourselves in child health make implementation a focus of our work. It would be naïve not to acknowledge the implementation challenges that lie ahead, conceptually, operationally, and politically, but working in a challenging environment hardly represents a new problem where improving child health is concerned.Health Literacy and Health Policy
Health literacy skills allow individuals to obtain, process, understand, and communicate information about health, as well as function in the health care system and make informed health decisions.1 Health literacy can also play an important role in successful implementation of health policies.2 Health literacy is therefore recognized as “…one of the top four national priorities for public health”,3 with health literacy research “becoming foundational in reforming health and health care in the United States”.Delayed Transition of Care: A National Study of Visits to Pediatricians by Young Adults
Despite numerous policy statements and an increased focus on transition of care, little is known about young adults who experience delayed transition to adult providers.Reading Level of Medicaid Renewal Applications
To examine compliance of Medicaid-renewal applications to established state guidelines for reading level of Medicaid-related materials.Well-Child Care Practice Redesign for Low-Income Children: The Perspectives of Health Plans, Medical Groups, and State Agencies
The aim of this study was to examine the views of key stakeholders in health care payer organizations on the use of practice redesign strategies to improve the delivery of well-child care (WCC) to low-income children aged 0 to 3 years.The Patient-Centered Medical Home, Practice Patterns, and Functional Outcomes for Children with Attention Deficit/Hyperactivity Disorder
To determine whether children with attention deficit/hyperactivity disorder (ADHD) receive care in a patient-centered medical home (PCMH) and how that relates to their ADHD treatment and functional outcomes.Profiling Health and Health-Related Services for Children With Special Health Care Needs With and Without Disabilities
The aims of this study were to profile and compare the health and health services characteristics for children with special health care needs (CSHCN), with and without disabilities, and to determine factors associated with unmet need.Reporting on Continuity of Coverage for Children in Medicaid and CHIP: What States Can Learn from Monitoring Continuity and Duration of Coverage
The Children’s Health Insurance Program Reauthorization Act (CHIPRA) requires states to measure and report on coverage stability in Medicaid and the Children’s Health Insurance Program (CHIP). States generally have not done this in the past. This study proposes strategies for both measuring stability and targeting policies to improve retention of Medicaid coverage, using Ohio as an example.Graduating Med-Peds Residents’ Interest in Part-Time Employment
As part-time work is becoming more popular among the primary care specialties, we examined the demographic descriptors of med-peds residents seeking and finding part-time employment upon completion of residency training.Monitoring Duration of Coverage in Medicaid and CHIP to Assess Program Performance and Quality
To assess measures of Medicaid and Children's Health Insurance Program (CHIP) coverage duration for potential inclusion in a core set of children's health care quality measures as called for by the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009.A National and State Profile of Leading Health Problems and Health Care Quality for US Children: Key Insurance Disparities and Across-State Variations
Parent/consumer–reported data is valuable and necessary for population-based assessment of many key child health and health care quality measures relevant to both the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009 and the Patient Protection and Affordable Care Act of 2010 (ACA).Measuring and Reporting Quality of Health Care for Children: CHIPRA and Beyond
The coming years could be a watershed period for children and health care as the nation implements the most significant federal health care legislation in 50 years: the Accountable Care Act (ACA). A year earlier, the American Recovery and Reinvestment Act (ARRA) set up a framework and road map for the eventual universal adoption of health information technology in its Health Information Technology for Economic and Clinical Health (HITECH) provisions, and the Children’s Health Insurance Program Reauthorization Act (CHIPRA) legislation articulated a new and compelling vision for quality measurement in child health services.Identifying Children’s Health Care Quality Measures for Medicaid and CHIP: An Evidence-Informed, Publicly Transparent Expert Process
To describe the process used to identify the recommended core set of quality measures as mandated by the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) and provide an overview of the measures selected.Measures of Availability of Health Care Services for Children
The Children’s Health Insurance Program Reauthorization Act (CHIPRA) mandates that measures of availability of child health services be included in the recommended core measurement set. The objective of this work was to review and evaluate measures of availability of child health services for potential inclusion in the initial core set of health care quality measures as mandated by CHIPRA.A History of the Academic Pediatric Association’s Public Policy and Advocacy Initiatives
Throughout its 50-year history, the Academic Pediatric Association (APA) has recognized the importance of social, environmental, and public policy issues for children’s health. Since the organization’s inception, the APA and its members have taken an active interest in many major child health public policy initiatives (Table). APA members have worked to promote policies that benefit children’s health on a broad scale, conducting key research on health issues and health care interventions in order to inform policy debates, providing Congressional testimony, and leading initiatives for policy change.Future of Academic General Pediatrics—Areas of Opportunity
The dynamic change in the United States occurring in the diversity of pediatric populations and in health care will dramatically influence many dimensions of care, teaching, research, and advocacy in academic general pediatrics. By 2025, the nonwhite and Hispanic pediatric population will increase to 50% (Figure 1),1,2 leading the demographic change that is projected to occur in the whole United States population by 2050. This shift in population demographics is occurring concurrently with significant changes in both health care funding and the sophistication and complexity of systems caring for children, accentuated by an explosion of information technology.Children With Special Health Care Needs: A Celebration of Success!
This special issue of Academic Pediatrics represents a celebration. We honor the careers of several people, the leadership of the Maternal Child Health Bureau (MCHB), and the achievements of a large number of experts who have helped to improve health care for children with special health care needs (CSHCN). We acknowledge the lessons learned regarding the care of this population, and we recognize the challenges that remain. We celebrate these children and their families.Special Needs Children With Speech and Hearing Difficulties: Prevalence and Unmet Needs
The purpose of this study was to establish prevalences and sociodemographic characteristics associated with parent-reported speech and hearing difficulties among children with special health care needs (CSHCN); determine unmet needs for therapy, hearing aids, and communication devices; and examine the association between unmet needs and resources such as health insurance, early intervention/special education, and a medical home.Historical Perspective on Family-Centered Care
Partnerships between families and their children’s medical providers are essential to ensuring quality health care. Around the country, families partner with providers to make decisions about their individual children and to improve health care practices, programs, and policies that affect all children. Such partnerships have not always been the norm. Families of children and youth with special health care needs (CYSHCN) and visionary professional leaders have identified the effective elements of collaborative family provider relationships.A Measured Approach to Child Health
Children’s health and its measurement have gained increasing attention in the face of advances in treating disease, and the growing recognition of long-term implications of child health for adult health and the nation’s economy. Advances in measurement are aided by new conceptualizations, including a dynamic definition of child health and model of how it evolves. This paper discusses challenges in measurement of child health, the role of large-scale data sets, how to select a measure, 2 promising measurement frontiers, and the role of the Academic Pediatric Association in promoting a measured approach to child health.Assessing Family-Provider Partnerships and Satisfaction With Care Among US Children With Special Health Care Needs
Family-provider partnerships and satisfaction with services together are one of the Health Resources and Services Administration's (HRSA) Maternal and Child Health Bureau's (MCHB) 6 core outcomes for children with special health care needs (CSHCN) and are tracked using the 2005–2006 National Survey of Children with Special Health Care Needs. Our objectives were to examine demographic, health, and other correlates/associations, with the perception of family-provider partnership and satisfaction with care; determine the associations between these perceptions and other child/family outcomes; and evaluate differences in the perception of partnership and satisfaction between the families of CSHCN and other children.Health Care Services and the Transition to Young Adulthood: Challenges and Opportunities
The aim of this study was to examine the potential role of the health care system in the successful transition to young adulthood for all adolescents, with emphasis on adolescents with special health care needs (ASHCN), and to evaluate the system’s status in filling that role.From My Head and My Heart: Improving Quality of Care for Children and Youth With Special Health Care Needs
It is an enormous honor to speak on the subject of improving quality of care for children with chronic conditions at a symposium honoring Jim Perrin. Jim was my division chief and immediate supervisor in my first job after fellowship. The work that we started together—looking at variation in care and outcomes for children in Rochester, New Haven, and Boston—shaped my entire career, and Jim has continued to be a mentor, a colleague, and a friend since that time over 20 years ago.Underdiagnosis of Pediatric Obesity during Outpatient Preventive Care Visits
To examine obesity diagnosis, obesity-related counseling, and laboratory testing rates among obese pediatric patients seen in US preventive outpatient visits and to determine patient, provider, and practice-level factors that are associated with obesity diagnosis.Health Reform and Beyond: Delivering Results for Children
The affordable care Act (ACA) became law in March 2010.1 Although its full impact on Americans and the American health care system will unfold over many years, it represents fundamental change for patients and health care. Many may wonder how the law affects children and the health professionals who serve them. Some of the most publicized aspects of ACA (eg, guaranteed access to parents’ coverage for children aged less than 26 years, prohibitions against coverage denials for children aged less than 19 years with preexisting conditions) will directly help children, youth, and young adults.Health Care Reform for Children: Views From the Academic Pediatric Association
National public opinion polls indicate that a majority of Americans favor expanding the federal government's role in regulating health care to ensure coverage for all Americans.1 Polls conducted prior to the recently enacted Patient Protection and Affordable Care Act indicate that an increasing number of Americans were not satisfied with the proposed health care reforms.2,3 National physician surveys indicate that most physicians also believe that a larger portion of the population should have health insurance coverage and favor expanding the government's involvement to achieve this.Assessment of Disparities in the Use of Anxiolysis and Sedation Among Children Undergoing Laceration Repair
The aim of this study was to determine if race/ethnicity and socioeconomic status (SES) were associated with the provision of anxiolysis and/or sedation among children undergoing laceration repair.Annual Report on Health Care for Children and Youth in the United States: Racial/Ethnic and Socioeconomic Disparities in Children's Health Care Quality
The aim of this study was to explore the joint effect of race/ethnicity and insurance status/expected payer or income on children's health care quality.Impact of Managed Care on Publicly Insured Children with Special Health Care Needs
The aim of this review was to evaluate the impact of managed care on publicly insured children with special health care needs (CSHCN).Factors Associated with Detection and Receipt of Treatment for Youth with Depression and Anxiety Disorders
Anxiety and depression are common among youth and are associated with significant morbidity. Few youth with depression are diagnosed and receive treatment for these disorders. The purpose of this study was to examine the rate of recognition and management among an insured population and the factors associated with evidence of detection among youth.Dental Care and Children with Special Health Care Needs: A Population-Based Perspective
This paper grew out of a project reviewing progress in children's oral health after Oral Health in America: A Report of the Surgeon General was published in 2000. It includes a summary of advances in national surveillance of children with special health care needs (CSHCN), and presents more recent data on unmet dental care need among CSHCN. To that end, we used the 2006 National Survey of Children with Special Health Care Needs to determine the prevalence of unmet dental care need among CSHCN and to compare this within subgroups of CSHCN, as well as to children without special health care needs, and to results from the previous iteration of this survey.Putting Teeth in CHIP: 1997–2009 Retrospective of Congressional Action on Children's Oral Health
When Congress reenacted the Child Health Insurance Program (CHIP) in 2009, it incorporated a range of dental provisions that had not been considered when the program was initiated in 1997. This paper posits that this change evidences the establishment of pediatric oral health as a distinct policy issue within Congressional deliberations. During this period, the US Congress received impetus for action on behalf of children's oral health from multiple streams of activity: the Surgeon General's Report, Oral Health in America, policies enacted by states, advocacy by the professions, promotion by policy groups, attention by the press, and actions of federal agencies.
