Implications of the 21st Century Cures Act in Pediatrics

Pageler, Natalie M.; Webber, Emily C.; Lund, Dennis P.

doi:10.1542/peds.2020-034199

Cited by 37 publications

(24 citation statements)

References 6 publications

(9 reference statements)

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“…23 In the US, the 21 st Century Cures Act provides a framework to facilitate patient, family, and provider access to medical records and electronic health information. 24…”

Section: Discussionmentioning

confidence: 99%

Population-level management of Type 1 diabetes via continuous glucose monitoring and algorithm-enabled patient prioritization: Precision health meets population health

Ferstad

Vallon

Jun

et al. 2021

Preprint

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Objective: To develop and scale algorithm-enabled patient prioritization to improve population-level management of type 1 diabetes (T1D) in a pediatric clinic with fixed resources, using telemedicine and remote monitoring of patients via continuous glucose monitor (CGM) data review. Research Design and Methods: We adapted consensus glucose targets for T1D patients using CGM to identify interpretable clinical criteria to prioritize patients for weekly provider review. The criteria were constructed to manage the number of patients reviewed weekly and identify patients who most needed provider contact. We developed an interactive dashboard to display CGM data relevant for the patients prioritized for review. Results: The introduction of the new criteria and interactive dashboard was associated with a 60% reduction in the mean time spent by diabetes team members who remotely and asynchronously reviewed patient data and contacted patients, from 3.2 +/- 0.20 to 1.3 +/- 0.24 minutes per patient per week. Given fixed resources for review, this corresponded to an estimated 147% increase in weekly clinic capacity. Patients who qualified for and received remote review (n=58) have associated 8.8 percentage points (pp) (95% CI = 0.6-16.9pp) greater time-in-range (70-180 mg/dL) glucoses compared to 25 control patients who did not qualify at twelve months after T1D onset. Conclusions: An algorithm-enabled prioritization of T1D patients with CGM for asynchronous remote review reduced provider time spent per patient and was associated with improved time-in-range.

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“…23 In the US, the 21 st Century Cures Act provides a framework to facilitate patient, family, and provider access to medical records and electronic health information. 24…”

Section: Discussionmentioning

confidence: 99%

Population-level management of Type 1 diabetes via continuous glucose monitoring and algorithm-enabled patient prioritization: Precision health meets population health

Ferstad

Vallon

Jun

et al. 2021

Preprint

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“…The demographic characteristics of respondents were overall representative of pediatric endocrinologists in the United States, 24,25 in that our respondents were mostly female and worked in academic centers with a wide range in duration of clinical practice. Although we did not assess this as a potential barrier due to the timing of our survey development and distribution, it is important to acknowledge the recently enacted 21st Century Cures Act as a potential barrier to documentation of screening, counseling, and treatment plans in EHR of pediatric patients 37,38 …”

Section: Discussionmentioning

confidence: 99%

Screening and counseling for nicotine use in youth with diabetes

et al. 2021

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Objective To assess current practice patterns and identify knowledge gaps among pediatric endocrinologists in the United States regarding screening and counseling for combustible tobacco and e‐cigarette use in youth with diabetes. Introduction Electronic cigarettes (e‐cigarettes) are the most used tobacco product among adolescents and may be associated with an increased risk of progression to combustible cigarette smoking, cardiovascular disease, and stroke. Diabetes mellitus is a known risk factor for cardiovascular disease, and nicotine products can increase this risk. We sought to assess current practice patterns and identify knowledge gaps among pediatric endocrinologists in the United States regarding screening and counseling for combustible tobacco and e‐cigarette use in youth with diabetes. Research Design and Methods We conducted an anonymous, online‐based survey of Pediatric Endocrine Society members who provide care to youth with Type 1 or Type 2 diabetes. The survey collected information about provider demographics and smoking habits, knowledge and attitudes regarding screening and counseling for combustible tobacco and e‐cigarette use, and current practice patterns. Results The survey was completed by 106 individuals of whom 64 reported providing care to youth with diabetes mellitus and ever asking about combustible tobacco or e‐cigarette use. The majority of respondents were female, attending providers, and working in academic medical centers. None reported a history of formal training in e‐cigarette counseling but recognized the harms of e‐cigarette use. Nearly all (98%) who ever screen for nicotine use reported routinely screening for combustible tobacco use, while 18% never screen for e‐cigarette use (p < 0.01). Over 80% of respondents reported feeling confident or very confident about discussing the harms of combustible tobacco, compared to 58% reporting the same confidence in discussing harms of e‐cigarette use (p < 0.0001). Over 90% of respondents agreed that pediatric endocrinology providers should ask about nicotine use with over half agreeing that counseling reduces the risk of initiating nicotine product use, and 30% reported lack of change with counseling as a barrier to discussing nicotine use. Lack of visit time was the most reported barrier to discussing nicotine use. More providers cited lack of knowledge regarding e‐cigarettes compared to combustible tobacco as a barrier to discussing its use. Conclusions Pediatric endocrinology providers recognize the harms of e‐cigarette use, but more frequently ask about combustible tobacco use compared to e‐cigarette use. This may be related to lower reported confidence and provider knowledge in counseling about e‐cigarette use. Increased utilization of existing resources and expanding opportunities for providers to learn more about e‐cigarettes may increase provider confidence and comfort in screening and counseling.

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“…A salient example is the recent regulation issued by the Office of National Coordinator for Health Information Technology to implement the 21st Century Cures Act (ONC Rule) [17,18]. The ONC Rule will have a major impact on adolescent confidentiality by requiring that clinical notes be shared with patients and sometimes with their parents directly or as proxies, usually via Web portals, which could inadvertently result in disclosure of ARA and other sensitive information [19,20]. Against this broad backdrop, the preferences and behaviors of adolescents with respect to privacy protection and disclosure of their confidential information are evolving as well.…”

Section: Evolving Confidentiality Challengesmentioning

confidence: 99%

Adolescent Relationship Abuse: Challenges in Confidentiality, Disclosure, and Protection

English¹

2021

Journal of Adolescent Health

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Implications of the 21st Century Cures Act in Pediatrics

Cited by 37 publications

References 6 publications

Population-level management of Type 1 diabetes via continuous glucose monitoring and algorithm-enabled patient prioritization: Precision health meets population health

Population-level management of Type 1 diabetes via continuous glucose monitoring and algorithm-enabled patient prioritization: Precision health meets population health

Screening and counseling for nicotine use in youth with diabetes

Adolescent Relationship Abuse: Challenges in Confidentiality, Disclosure, and Protection

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