Supply and Utilization of Pediatric Subspecialists in the United States

Ray, Kristin N.; Bogen, Debra L.; Bertolet, Marnie; Forrest, Christopher B.; Mehrotra, Ateev

doi:10.1542/peds.2013-3466

Cited by 44 publications

(47 citation statements)

References 42 publications

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“…22 While these specialists may manage a portion of the care, they typically do not integrate care across the children's numerous providers. 23,24 Thus, no one specialist may take the responsibility to make the referral to hospice care. 25 Instead, families often become the primary caregivers, medical managers, and health system navigators for their children.…”

Section: Discussionmentioning

confidence: 99%

Multiple Complex Chronic Conditions and Pediatric Hospice Utilization among California Medicaid Beneficiaries, 2007–2010

Lindley

2017

Journal of Palliative Medicine

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Background: Over 42,000 children die each year in the United States, including many with multiple complex chronic conditions (MCCCs), but little is known about whether the presence of MCCCs influences families to utilize pediatric hospice care. Objective: The study objective was to examine the relationship between MCCCs and pediatric hospice utilization among Medicaid beneficiaries. Methods: A retrospective, longitudinal cohort design was conducted with 2007-2010 California Medicaid data to examine the relationship between MCCCs (i.e., two or more MCCCs) and pediatric hospice utilization (i.e., hospice enrollment, hospice length of stay). Multivariate logistic regression with year fixed effects examined the effect of MCCCs on hospice enrollment, and negative binomial model with year fixed effects explored the relationship between MCCCs and hospice length of stay. Results: More than 10% of children enrolled in hospice care with an average length of stay of approximately three days. In the study sample, 48.6% of the children had MCCCs. MCCCs were not significantly related to hospice enrollment. However, children with MCCCs (incidence rate ratios = 4.25, p < 0.01) were associated with an increase in the number of days in hospice care. Conclusions: This study demonstrated that children with MCCCs have limited hospice care utilization at end of life. Future research is needed to explore barriers to hospice care for children with MCCCs.

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Section: Discussionmentioning

confidence: 99%

Multiple Complex Chronic Conditions and Pediatric Hospice Utilization among California Medicaid Beneficiaries, 2007–2010

Lindley

2017

Journal of Palliative Medicine

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“…24 Similarly, some studies report a severe shortage of pediatric subspecialists with significant barriers to specialty access for children in Medicaid, 25 -27 whereas another study suggests that there might be overuse of pediatric specialists in some geographic areas. 28 There is a paucity of information on medication use in child high resource users. Although some medications are known to be extremely expensive (eg, factor replacement therapy for hemophilia 29 …”

Section: Discussionmentioning

confidence: 99%

Trends in Health Care Spending for Children in Medicaid With High Resource Use

et al. 2016

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CONCLUSIONS: Most children with high spending in Medicaid are without persistently high spending in subsequent years. Adolescent age, multiple chronic conditions, and certain complex chronic conditions increased the likelihood of persistently high spending; hospital and ED use decreased it. These data may help inform the development of new models of care and financing to optimize health and save resources in children with high resource use.

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“…These barriers and differential access to pediatric care are at least partly to blame for disparities in health outcomes, particularly for children with special healthcare needs living in underserved, rural communities (4). Children with suboptimal access to care have been shown to more frequently forgo visits to pediatric subspecialists and to rely more heavily on the emergency department for care (5,6).…”

Section: Introductionmentioning

confidence: 99%

Addressing health disparities in rural communities using telehealth

2015

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The regionalization of pediatric services has resulted in differential access to care, sometimes creating barriers to those living in underserved, rural communities. These disparities in access contribute to inferior healthcare outcomes among infants and children. We review the medical literature on telemedicine and its use to improve access and the quality of care provided to pediatric patients with otherwise limited access to pediatric subspecialty care. We review the use of telemedicine for the provision of pediatric subspecialty consultations in the settings of ambulatory care, acute and inpatient care, and perinatal and newborn care. Studies demonstrate the feasibility and efficiencies gained with models of care that use telemedicine. By providing pediatric subspecialty care in more convenient settings such as local primary care offices and community hospitals, pediatric patients are more likely to receive care that adheres to evidence-based guidelines. In many cases, telemedicine can significantly improve provider, patient, and family satisfaction, increase measures of quality of care and patient safety, and reduce overall costs of care. Models of care that use telemedicine have the potential to address pediatric specialists' geographic misdistribution and address disparities in the quality of care delivered to children in underserved communities.

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Supply and Utilization of Pediatric Subspecialists in the United States

Cited by 44 publications

References 42 publications

Multiple Complex Chronic Conditions and Pediatric Hospice Utilization among California Medicaid Beneficiaries, 2007–2010

Multiple Complex Chronic Conditions and Pediatric Hospice Utilization among California Medicaid Beneficiaries, 2007–2010

Trends in Health Care Spending for Children in Medicaid With High Resource Use

Addressing health disparities in rural communities using telehealth

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