Faculty Bibliography

Purpose of study Enhanced emergent literacy, child language scores, and school readiness as a result of Reach Out and Read (ROR) are well described. Less is known about clinicians' subjective experience of implementing the intervention. The purpose of this study was to better understand what clinicians find meaningful about ROR. Methods used This study was a collaboration between ROR and Continuity Research Network (CORNET). Faculty and residents at participating CORNET sites completed an online survey. Participants were asked 'What has been the most meaningful experience you have encountered with using ROR?' and 'Is there anything else you would like to add?' Responses were randomly assigned to 1 of 3 groups, each group of responses was coded by 2 researchers, who came to consensus through discussion; then all coding was discussed by all 6 coders until consensus was reached. Summary of results Qualitative responses were provided by >500 faculty members and residents from 42 institutions. Four themes emerged 1) Child/Family Impact: 'Seeing a child read for the first time' and 'Better interaction and understanding about the importance of reading from the parents.' 2) Physician Impact: 'It is my favorite part of the WCC.' 'I have been able to use the books provided as a way to connect with patients and their families.' 3) Impact on clinic practice: 'I enjoy modeling for parents and use the books to assess my patients' development' and 'helping a child who is verbally delayed catch up through ROR.' 4) Social Determinants of Health: 'The books provided are an invaluable resource to our underserved population. At times there are no books in the home besides the ones we provide the family during clinic visits.' Conclusions Clinicians who implement ROR find that it has a positive impact on their pediatric patients and families, an impact on their own satisfaction, and on the way they practice. In addition, clinicians value the fact that the program addresses social determinants of health and facilitates developmental surveillance. Further study is needed to better understand how clinician's perspectives affect, and are affected by, their practice experiences

BACKGROUND AND OBJECTIVES/OBJECTIVE:Lack of medication pickup is associated with worse clinical outcomes for select patients. Identification of risk factors for not picking up discharge medications or approaches to this problem have received little study. We sought to identify factors associated with medication pickup rates after hospitalization at a tertiary care children's hospital. METHODS:We conducted a retrospective cohort study of 178 discharges from a children's hospital. We contacted pharmacies that received electronic prescriptions to ascertain whether patients and families picked up medications. The principal outcome was pickup of all medications within 48 hours of discharge. Covariates included demographic data, insurance type, discharge diagnosis, home zip code median income, medication number and/or class, and pharmacy type (on-site versus off-site). We performed a multivariable logistic regression analysis. RESULTS:= .003) had statistically significant associations with higher medication pickup rates. CONCLUSIONS:Certain factors are associated with rates of medication pickup after discharge. Use of an on-site hospital pharmacy may represent a strategy to improve medication pickup rates in children who are hospitalized.

BACKGROUND AND OBJECTIVES/OBJECTIVE:Despite recommendations supporting human papillomavirus (HPV) vaccination, pediatric vaccination rates remain suboptimal in the United States; lack of tools to support provider counseling is one barrier. We sought to evaluate HPV-related counseling materials for readability, suitability, and content, and assess parent perceptions of materials, using a health literacy perspective. METHODS:A systematic search was conducted for written materials developed for HPV vaccination counseling by examining state Department of Health Web sites and associated links to local and national organizations. Materials were assessed for the following: 1) readability (Flesch Reading Ease, Flesch-Kincaid, Gunning Fog, Simple Measure of Gobbledygook, Fry), 2) suitability (understandability and actionability) (Suitability Assessment of Materials; Patient Education Materials Assessment Tool for Printable Materials), and 3) coverage of 8 key content areas (recommended by Centers for Disease Control and Prevention). Semistructured interviews were conducted with English-speaking parents or caregivers of children 9 to 17 years of age from 3 pediatric clinics (New York, Ohio, Illinois) serving predominantly low-income families to assess perceptions and usefulness of 4 handouts selected for review. RESULTS:Thirty-eight documents were assessed. Mean ± standard deviation (SD) reading grade level was 9.4 ± 2; 10.5% (n = 4) had a reading level of 6th grade or below; 68.4% (n = 26) were considered not suitable. Mean understandability was 41.7% and mean actionability was 20.7%. Only 5.3% (n = 2) addressed all 8 content areas mean ± SD (number of areas = 6.7 ± 1.2). Brochure comprehensiveness and inclusion of a personal story were cited as factors that would be helpful in influencing parents to vaccinate against HPV. CONCLUSIONS:Few written materials for HPV vaccination counseling were optimal from a health literacy best practices perspective. Content comprehensiveness was important for informed decision making.

BACKGROUND AND OBJECTIVES:Limited-English-proficient (LEP) patients and families are at risk for worse hospital outcomes due to impaired communication. Family-centered rounds (FCR) have become the preferred format for information sharing among providers and families at pediatric institutions. However, there are limited data on FCR among LEP families, particularly regarding interpretation type. We sought to examine the relationships between interpretation type and FCR satisfaction and efficacy among Spanish-speaking families, the fastest growing LEP population in pediatric hospitals. METHODS:analyses. RESULTS:= .005). CONCLUSIONS:Spanish speakers report higher satisfaction with face-to-face interpreters during FCR, including in-person and video, compared with telephonic interpreters. Video interpretation via iPad during FCR may be a valuable and accessible approach to improve communication in the care of hospitalized children.

OBJECTIVE: We proposed and tested a theoretical framework for how use of Teach-back could influence communication during the pediatric clinical encounter. METHODS: Audio-taped pediatric primary care encounters with 44 children with asthma were coded using the Roter Interaction Analysis System to measure patient-centered communication and affective engagement of the parent. A newly created Teach-back Loop Score measured the extent to which Teach-back occurred during the clinical encounter; parental health literacy was measured by Newest Vital Sign. Logistic regression was used to test the relationship between Teach-back and features of communication. Focus groups held separately with clinicians and parents elicited perceptions of Teach-back usefulness. RESULTS: Teach-back was used in 39% of encounters. Visits with Teach-back had more patient centered communication (p=0.01). Adjusting for parent health literacy, parent age, and child age, Teach-back increased the odds of both patient centered communication [proportional AOR (95% CI)=4.97 (4.47-5.53)]and negative affect [AOR (95% CI)=5.39 (1.68-17.31)]. Focus group themes common to clinicians and parents included: Teach-back is effective, could cause discomfort, should be used with children, and nurses should use it. CONCLUSIONS: Teach-back was associated with more patient-centered communication and increased affective engagement of parents. PRACTICE IMPLICATIONS: Standardizing Teach-back use may strengthen patient-centered communication.

STUDY OBJECTIVE: Our aim was to assess: (1) medical trainee and practicing physician awareness about domestic sex trafficking of minors; and (2) whether respondents believe that awareness of trafficking is important to their practice. DESIGN AND SETTING: We designed an anonymous electronic survey, and a convenience sample was collected from June through October 2013. PARTICIPANTS: Voluntary participants were 1648 medical students, residents, and practicing physicians throughout the United States. INTERVENTIONS AND MAIN OUTCOME MEASURES: Data were analyzed for correlations between study cohort characteristics and: (1) agreement with the statement: "knowing about sex trafficking in my state is important to my profession"; (2) knowledge of national statistics regarding the sex trafficking of minors; and (3) knowledge of appropriate responses to encountering a trafficked victim. RESULTS: More practicing physicians than residents or medical students: (1) agreed or strongly agreed that knowledge about human trafficking was important to their practice (80.6%, 71.1%, and 69.2%, respectively; P = .0008); (2) correctly estimated the number of US trafficked youth according to the US Department of State data (16.1%, 11.7%, and 7.9%, respectively; P = .0011); and (3) were more likely to report an appropriate response to a trafficked victim (40.4%, 20.4%, and 8.9%, respectively; P = .0001). CONCLUSION: Although most medical trainees and physicians place importance on knowing about human trafficking, they lack knowledge about the scope of the problem, and most would not know where to turn if they encountered a trafficking victim. There exists a need for standardized trafficking education for physicians, residents, and medical students.

OBJECTIVES: Understanding the factors associated with child communication during subspecialty encounters may inform interventions promoting shared decision-making in chronic disease management. Objectives were to (1) describe the quantity and quality of child communication during outpatient subspecialty encounters and (2) determine if and how the quantity and quality of child communication vary by demographic and visit characteristics. METHODS: We videotaped subspecialty clinic encounters involving 20 health care providers and 155 children with one of the following conditions: acute lymphoblastic leukemia (consolidation/maintenance), persistent asthma, cystic fibrosis, type 1 diabetes, and obesity. The Roter interaction analysis system was used to code child utterances into one of 10 discrete categories. RESULTS: Children exhibited a mean of 15% of all utterances made during clinical encounters. Children spoke more during obesity encounters. CONCLUSIONS: Similar to the findings of studies in primary care settings, children spoke infrequently during the subspecialty visits, and the most common utterances tended to be replies to questions from adults. PRACTICE IMPLICATIONS: In this study, there was relatively higher engagement of children during obesity clinic encounters in the area of lifestyle choices. Strategies used to engage children in conversation in obesity clinics may be useful for engaging children in other subspecialty clinics.

BACKGROUND: Fundoplication is often performed in conjunction with gastrostomy tube (GT) placement in children, but there is a great deal of variation in rates of and indications for this procedure. Little is known about the impact of fundoplication on peri-operative outcomes. This study examines a national cohort of pediatric patients to compare risk-adjusted surgical outcomes in patients undergoing GT placement with or without concomitant fundoplication. METHODS: We identified all patients undergoing GT placement in the 2012 National Surgical Quality Improvement Program - Pediatric. We evaluated demographics, comorbidities, complications, and length of stay for GT with fundoplication versus GT alone. We defined composite morbidity as a dichotomous variable for the presence of any complication. Logistic regression was performed to identify predictors of morbidity after adjusting for covariates. RESULTS: 1289 GT patients were identified, and 148 (11.5%) underwent concurrent fundoplication. The fundoplication patients were more likely to be younger, have cardiac risk factors, and be on respiratory support. They also had higher rates of surgical site infection (7.4% vs 3.7%, p=0.03) and composite morbidity (16.9% vs 8.7%, p=0.001), and longer LOS (median 5 vs 3 days, p=<0.0001) compared to GT only. After adjusting for covariates, fundoplication was a predictor of composite morbidity and increased LOS. CONCLUSION: Concomitant fundoplication is an independent risk factor for 30-day post-operative morbidity in patients undergoing GT placement. These findings do not negate the value of fundoplication but underscore the importance of careful patient selection, and should be taken into consideration when discussing risks and benefits with families.