IMPORTANCEUrgent care (UC) centers are a growing option to address children's acute care needs, which may cause unanticipated changes in health care use. OBJECTIVES To identify factors associated with high UC reliance among children enrolled in Medicaid and examine the association between UC reliance and outpatient health care use. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study used deidentified data on 4 133 238 children from the Marketscan Medicaid multistate claims database to calculate UC reliance and outpatient health care use. Children were younger than 19 years, with 11 months or more of continuous Medicaid enrollment and 1 or more UC, emergency department (ED), primary care provider (PCP; physician, advanced practice nurse, or physician assistant; well-child care [WCC] or non-WCC), or specialist outpatient visit during the 2017 calendar year. Statistical analysis was conducted from November 11 to 26, 2019. EXPOSURES Urgent care, ED, PCP (WCC and non-WCC), and specialist visits based on coded location of services.MAIN OUTCOMES AND MEASURES Urgent care reliance, calculated by the number of UC visits divided by the sum of total outpatient (UC, ED, PCP, and specialist) visits. High UC reliance was defined as UC visits totaling more than 33% of all outpatient visits. RESULTSOf 4 133 238 children in the study, 2 090 278 (50.6%) were male, with a median age of 9 years (interquartile range, 4-13 years). A total of 223 239 children (5.4%) had high UC reliance.Children 6 to 12 years of age were more likely to have high UC reliance compared with children 13 to 18 years of age (adjusted odds ratio, 1.07; 95% CI, 1.06-1.09). Compared with white children, black children (adjusted odds ratio, 0.81; 95% CI, 0.81-0.82) and Hispanic children (adjusted odds ratio, 0.61; 95% CI, 0.60-0.61) were less likely to have high UC reliance. Adjusted for age, sex, race/ ethnicity, and presence of chronic or complex conditions, children with high UC reliance had significantly fewer PCP encounters (WCC: adjusted rate ratio, 0.60; 95% CI, 0.60-0.61; and non-WCC: adjusted rate ratio, 0.41; 95% CI, 0.41-0.41), specialist encounters (adjusted rate ratio, 0.31; 95% CI, 0.31-0.31), and ED encounters (adjusted rate ratio, 0.68; 95% CI, 0.67-0.68) than children with low UC reliance. CONCLUSIONS AND RELEVANCEHigh UC reliance occurred more often in healthy, nonminority, school-aged children and was associated with lower health care use across other outpatient settings.There may be an opportunity in certain populations to ensure that UC reliance does not disrupt the medical home model.
Objectives: The Australian aged-care sector employees are diverse, with a wide range of training backgrounds and work experience. Compassion and personcentred care (PCC) are essential for quality care. Effective training is required to facilitate compassion and PCC in the diverse workforce. Methods: Eligible staff members (n = 732) participated in a 3-hour training activity using an aged simulation training suit. Training sessions were offered at eight ACH Group residential care sites. During the training, staff were required to complete functional daily tasks while wearing the suit. Pre-and post-training questionnaires were used to assess change in staff members' self-assessment of compassion and PCC. The Compassion Competence Scale and the Personcentred Care Assessment Tool were used to assess compassion and PCC. Results: In total, 160 (22%) staff members participated in the evaluation of the training. Overall, participants reported significant improvements in self-reported compassion (p < 0.01) and PCC after the training (p < 0.001), compassionate communication (p < 0.001) and insight (p < 0.001), and ability to personalise care (p < 0.001) and in recognising patients' environmental accessibility (p < 0.01). Conclusions:The simulation activity improved aspects of compassion and person-centred care for the aged-care workforce. Further research is required to understand whether these changes are reflected in daily practice.
Objective With a growing emphasis on personalised care, there is a need for effective workforce training to enable person‐centred care (PCC) in aged care practice. The Australian aged care workforce is very diverse; thus, tools to evaluate compassion and PCC training need to reflect an understanding of these concepts relevant to the Australian context. There are currently no tools validated for use in aged care settings in Australia. Methods Two existing compassion and PCC questionnaires were modified for an Australian audience using cognitive interviews with aged care workers. The reliability of the modified questionnaires was assessed. Results The modified questionnaires were found to have acceptable inter‐reliability and test‐retest intra‐class correlation for the subscales and overall. However, the investigation also found low Cohen's kappa values between the test and retest responses for the individual items, subscales and overall, and had low inter‐class correlation for individual items, indicating poor inter‐rater agreement. High inter‐item correlation scores also suggest the questions encapsulate overly similar constructs. Conclusions While further investigation of the psychometric properties of the new items is needed, these modified questionnaires may offer a method of assessing and re‐assessing compassion and PCC using language that is understandable to the Australian aged care workforce. Tools to accurately measure Australian aged care staff perceptions of compassion and their ability to deliver PCC are important to improve the quality of care provided in aged care and facilitate the delivery of PCC in aged care settings.
Background: In the United States (US), Medicaid capitated managed care costs are controlled by optimizing patients' healthcare utilization. Adults in capitated plans utilize primary care providers (PCP) more than emergency departments (ED), compared to fee-for-service (FFS). Pediatric data are lacking. We aim to determine the association between US capitated and FFS Medicaid payment models and children's outpatient utilization. Methods: This retrospective cohort compared outpatient utilization between two payment models of US Medicaid enrollees aged 1-18 years using Truven's 2014 Marketscan Medicaid database. Children enrolled > 11 months were included, and were excluded for eligibility due to disability/complex chronic condition, lack of outpatient utilization, or provider capitation penetration rate < 5% or > 95%. Negative binomial and logistic regression assessed relationships between payment model and number of visits or odds of utilization, respectively. Results: Of 711,008 children, 66,980(9.4%) had FFS and 644,028(90.6%) had capitated plans. Children in capitated plans had greater odds of visits to urgent care, PCP-acute, and PCP-well-child care (aOR 1.21[95%CI 1.15-1.26]; aOR 2.07[95%CI 2.03-2.13]; aOR 1.86 [95%CI 1.82-1.91], respectively), and had lower odds of visits to EDs and specialty care (aOR 0.82 [95%CI 0.8-0.83]; aOR 0.61 [95%CI 0.59-0.62], respectively), compared to FFS. Conclusions: The majority of children in this US Medicaid population had capitated plans associated with higher utilization of acute care, but increased proportion of lower-cost sites, such as PCP-acute visits and UC. Health insurance programs that encourage capitated payment models and care through the PCP may improve access to timely acute care in lower-cost settings for children with non-complex chronic conditions.
We performed a prospective study to determine if the pre-test probability of a positive loop mediated isothermal amplification test is greater when there are more signs and symptoms of GAS pharyngitis. Patients were enrolled if a clinician obtained a GAS RADT. The McIsaac score was calculated. The prevalence of positive LAMP and RADT results increased as the McIsaac score increased. The calculated sensitivity of LAMP was superior to RADT.
Respiratory disorders are a leading cause of acute care visits by children. Data establishing the reliability of telemedicine in evaluating children with respiratory concerns are limited. The overall objective of this pilot study was to evaluate the use of telemedicine to evaluate children with respiratory concerns. We performed a pilot prospective cohort study of children 12 to 71 months old presenting to the emergency department (ED) with lower respiratory tract signs and symptoms. Three examinations were performed simultaneously—one by the ED clinician with the patient, one by a remote ED clinician using telemedicine, and one by the child's parent. We evaluated measures of agreement between (a) the local and remote clinicians, (b) the local clinician and the parent, and (c) the parent and the remote clinician. Twenty-eight patients were enrolled (84 paired examinations). Except for heart rate, all examination findings evaluated (general appearance, capillary refill time, grunting, nasal flaring, shortness of breath, retractions, impression of respiratory distress, respiratory rate, and temperature) had acceptable or excellent agreement between raters. In this pilot study, we found that telemedicine respiratory examinations of young children are feasible and reliable, using readily available platforms and equipment.
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