Heidi Saliba

The Impact of Insurance on Satisfaction and Family-Centered Care for CSHCN

BACKGROUND: Children with special health care needs (CSHCN) have worse health outcomes and satisfaction compared with children with typical needs. Although individual characteristics influence satisfaction and family-centered care, additional effects of health insurance and state child health policies are unknown. OBJECTIVES: To determine if satisfaction and family-centered care varied among CSHCN, after adjusting for individual characteristics, according to insurance type and state child health policies. METHODS: We performed descriptive and multivariate analyses by using demographic, insurance, and satisfaction data from the 2006 National Survey of Children With Special Health Care Needs (N = 40723). Additional state data included Medicaid and State Childrens Health Insurance Program (SCHIP) characteristics and the supply of pediatricians. We supplemented the national findings with survey data from Floridas SCHIP comprehensive care program (CMS-Duval [“Ped-I-Care”]) for CSHCN (N = 300). RESULTS: Nationally, 59.8% of parents were satisfied with their childs health services, and two thirds (65.7%) received family-centered care. Adjusting for individual predictors, those uninsured and those with public insurance were less satisfied (odds ratios [ORs]: 0.45 and 0.83, respectively) and received less family-centered care (ORs: 0.43 and 0.80, respectively) than privately insured children. Of note, satisfaction increased with state Medicaid spending. Survey data from Ped-I-Care yielded significantly higher satisfaction (91.7%) compared with national levels of satisfaction in the SCHIP (54.2%) and similar rates of family-centered care (65.6%). These results suggest that satisfaction is based more on experiences with health systems, whereas family-centered care reflects more on provider encounters. CONCLUSIONS: Insurance type affects both satisfaction and family-centered care for CSHCN, and certain state-level health care characteristics affect satisfaction. Future studies should focus on interventions in the health care system to improve satisfaction and patient encounters for family-centered care.

Improving Developmental Screening in Pediatric Resident Education

Objective. Given that pediatricians cite low competency in developmental screening, this study aims to effectively teach screening to residents. Design. Using a quasiexperimental design, residents received an educational module and one-on-one teaching of 3 validated developmental screeners (Denver II, ASQ [Ages and Stages Questionnaire], and PEDS [Parents’ Evaluation of Developmental Status]), with subsequent independent use with all 3 screeners with their own continuity patients. Outcome measures included changes in knowledge, skills, and preferences. Results. All residents achieved significantly increased skills with all screeners. They strongly preferred the ASQ (70%), citing that this taught them normal (30.2%) and pathological (27.9%) development while negatively noting time (72.1%), scheduling issues (30.2%), and difficulties with child cooperation (20.9%). Knowledge specifics did not significantly increase. Conclusions. In-depth developmental screening education revealed marked improvement in skills and preferences. These evaluations led to full adoption of the ASQ in resident clinics. Future research must test if effective development teaching in residency leads to increased routine screenings in practice.

Are gymnasium equipment surfaces a source of staphylococcal infections in the community

To determine the staphylococcal colonization of gymnasium surfaces, we obtained cultures of 5 gym surfaces, before and after routine cleaning in 3 local gyms, 3 separate times. Of 240 cultures, none was positive for methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-sensitive S aureus (MSSA). Gym surfaces do not appear to be reservoirs for staphylococci; therefore, surface-to-skin contact in gymnasiums does not likely play a significant role in community transmission of MRSA or MSSA.

Pediatric Residents' Learning Styles and Temperaments and Their Relationships to Standardized Test Scores

BACKGROUND Board certification is an important professional qualification and a prerequisite for credentialing, and the Accreditation Council for Graduate Medical Education (ACGME) assesses board certification rates as a component of residency program effectiveness. To date, research has shown that preresidency measures, including National Board of Medical Examiners scores, Alpha Omega Alpha Honor Medical Society membership, or medical school grades poorly predict postresidency board examination scores. However, learning styles and temperament have been identified as factors that 5 affect test-taking performance. The purpose of this study is to characterize the learning styles and temperaments of pediatric residents and to evaluate their relationships to yearly in-service and postresidency board examination scores. METHODS This cross-sectional study analyzed the learning styles and temperaments of current and past pediatric residents by administration of 3 validated tools: the Kolb Learning Style Inventory, the Keirsey Temperament Sorter, and the Felder-Silverman Learning Style test. These results were compared with known, normative, general and medical population data and evaluated for correlation to in-service examination and postresidency board examination scores. RESULTS The predominant learning style for pediatric residents was converging 44% (33 of 75 residents) and the predominant temperament was guardian 61% (34 of 56 residents). The learning style and temperament distribution of the residents was significantly different from published population data (P  =  .002 and .04, respectively). Learning styles, with one exception, were found to be unrelated to standardized test scores. CONCLUSIONS The predominant learning style and temperament of pediatric residents is significantly different than that of the populations of general and medical trainees. However, learning styles and temperament do not predict outcomes on standardized in-service and board examinations in pediatric residents.

Use of a Prenatal Risk Screen to Predict Maternal Traumatic Pregnancy-Associated Death: Program and Policy Implications

BACKGROUND Motor vehicle crashes, homicide, suicide, and drug abuse are among the leading causes of pregnancy-associated deaths. To prevent such deaths, identifying women for intervention is required. The universally offered Florida Healthy Start Prenatal Risk Screen was evaluated to identify women at increased risk for traumatic pregnancy-associated death. METHODS Floridas Enhanced Maternal Mortality Reporting Database for 1999 through 2005 was linked with Floridas Healthy Start Prenatal Risk Screen to identify traumatic pregnancy-associated death as the outcome. Distribution of Healthy Start risk scores among women who died were compared with the screened population. Traumatic death estimates per 100,000 births were drawn for each risk score, along with estimates of the relative risk (RR) of traumatic death for each score. The RR of women with scores greater than or equal to 4 were compared with the risk of women scoring 0 to 3. FINDINGS Almost 20% of the 620,959 women who did not die of traumatic death had a risk score of 0, compared with only 3% of the 144 women who did die of traumatic death. As risk scores increased, the chance of traumatic deaths sharply increased. A woman with a score of 4 had 11.78 times (confidence interval [CI], 4.63-29.69) the risk of traumatic death compared with a woman with a risk score of 0. CONCLUSIONS The implementation of prenatal risk screening to identify women at increased risk for traumatic pregnancy-associated death would help to ensure that policies to reduce infant risk factors also address maternal risk factors.

Is methicillin-resistant Staphylococcus aureus colonization changing? A study of academic health center daycare facilities.

of an outbreak of A. baumanni infection in the adult intensive care unit in 2010 that was spread to other ward units in the hospital. However, we observed a sustained increase in the number of patients with an ESBL-positive Enterobacteriaceae isolated (from 58 to 110 patients), and the rate of MRSA isolation remained constant or decreased (from 74 to 57 patients; Figure 1). Promoting appropriate use of antibiotics and preventing the spread of drug-resistant bacteria are key issues in tackling the public health problem of antimicrobial resistance. ASPs attempt to optimize prescribing of these drugs to benefit both current and future patients. The introduction of annual fluctuation in the rate of isolation as a measure of the incidence of bacterial isolation from nosocomial patients is an interesting method that provides valuable information easily and is potentially useful for medium-sized hospitals. It is possible to include more important and significant strains in each data cluster obtained and to measure frequency of isolation in the units that require a greater emphasis on infection control. It also provides a projection of the trend and avoids confounding factors, such as seasonal increases due to epidemic outbreaks, different levels of activity throughout the year, and the influence of staff changes that could modify the efficacy of this method in clinical units. In summary, because the local surveillance of antimicrobial resistance is very important, it is necessary that competent professionals regularly process, evaluate, compare, and interpret local data regarding clinically and epidemiologically important patterns of antimicrobial resistance. Intelligible and easy-to-implement outputs of this activity must be routinely distributed to all concerned personnel as appropriate, and the annual fluctuation in the rate of isolation can contribute to this objective.

The State of Florida, University-Based Pediatric Integrated Care System (Ped-I-Care) for Children with Special Health Care Needs

T he care of children with medically complex problems requires special attention and is costly. Children with special health care needs (CSHCN) represent less than 4% of the pediatric population, yet account for 60% of pediatric health care costs. According to Section 391.021 of the Florida statutes, “children with special health care needs” is defined as children younger than age 21 years who have chronic and serious physical, developmental, behavioral, or emotional conditions and who require healthcare and related services of a type or amount beyond that generally required by children. Several federal programs under the Centers for Medicare and Medicaid Services, which involve state-matching funds, provide funds to help ensure the medical care of CSHCN. In Florida, the care for CSHCN who receive services through Title XIX and Title XXI is administered by the Florida Department of Health (DOH), which established the Children’s Medical Services Network (CMSN). In August 2014, the CMSN transitioned into the Children’s Medical Services Managed Care Plan (CMSMCP), a specialty plan for CSHCN that is part of Florida’s Statewide Medicaid Managed Care (SMMC) program. A major component of the plan is the University of Florida–based Pediatric Integrated Care System (Ped-I-Care), which provides comprehensive care for CSHCN and represents an academic–state partnership with high patient satisfaction, quality metrics, and cost savings.