- Email: [email protected]
Pediatric Providers’ Attitudes and Practices Regarding Concussion Diagnosis and Management
Poster Abstracts / 58 (2016) S63eS85
used to determine the effects of enrolling in PCMH on the receipt of preventive and mental health services. Results: Most patients were female, US-born Latino, with an average age of 20.8 years. Patients enrolled in APT between 2010 and 2014 were more likely to be female, Latino, foreign born, students, without health insurance (p<0.001). Propensity scores successfully achieved balance in the sample. Adjusted odds ratios (99% confidence intervals) comparing the receipt of preventive and mental health services of patients enrolled in APT to youth enrolled in PCMHs, but not in APT were: (1) preventive visits 3.00 (2.07, 4.33), (2) influenza 1.12 (0.76, 1.65), meningococcal 3.35 (2.07, 5.42), and Human papillomavirus vaccinations 2.56 (1.71, 3.84), (3) screening for sexually transmitted disease 2.30 (1.18, 4.46), (4) prescription of any type of contraception 3.46 (1.59, 7.55) and long acting reversible contraception 2.80 (1.26, 6.22), (5) cervical cancer screening 1.42 (0.70, 2.92), (6) and ER visits 0.34 (0.21, 0.57). Conclusions: Patients enrolled in APT home had higher odds of receiving multiple preventive services and lower odds of attending the ER compared to other patients receiving care at other PCMHs. These findings highlight the efficacy of the APT approach including confidentiality, family-centeredness, and culturally inclusiveness when providing clinical and preventive care for their client teens. Sources of Support: Eliminating Health Disparities Initiative, Minnesota Department of Health, and NRSA, US Department of Health and Human Services.
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Results: Most patients were female, US-born Hispanic/Latino, with an average age of 20.8 years. Patients enrolled in PCMH between 2010 and 2014 (n¼563) were more likely to be Latino, students, with health insurance (p<0.001). Propensity score successfully achieved balance in the sample. Adjusted odds ratios (99% confidence intervals) comparing the receipt of preventive services of patients enrolled in PCMH to youth who did not receive these services were: (1) preventive visits 1.10 (0.93, 1.29), (2) influenza 0.89 (0.74, 1.07), meningococcal 1.53 (1.30, 1.80), and Human papillomavirus vaccinations 1.53 (1.28, 1.84), (3) screening for sexually transmitted disease 1.69 (1.28, 2.24), (4) prescription of any type of contraception 2.18 (1.56, 3.03) and long acting reversible contraception 2.66 (1.89, 3.74), and (5) cervical cancer screening 1.14 (0.87, 1.48) and (6) emergency room visits 0.84 (0.72, 0.98). Conclusions: Patients enrolled in patient-centered medical homes had higher odds of receiving multiple preventive services and lower odds of emergency room visits. This model of care not only focuses on the specific needs of patients but also on their preventive care. More studies are needed to identify the core components of Patient-Centered Medical Homes as well as to develop strategies that increase youth access to this model. Sources of Support: Eliminating Health Disparities Initiative, Minnesota Department of Health, and National Research Service Award (NRSA) in Primary Medical Care, US Department of Health and Human Services.
134. DOES THE CONTEXT OF HEALTHCARE SERVICES AFFECT THE RECEIPT OF PREVENTIVE SERVICES? A RETROSPECTIVE STUDY OF PATIENT-CENTERED MEDICAL HOMES VS. USUAL PRIMARY CARE Diego Garcia-Huidobro, MD 1, Maria Veronica Svetaz, MD, MPH, FSAHM 2, Nathan Shippee, PhD 1, Jennifer O’Brien, MHP 2. 1
University of Minnesota; 2Hennepin County Medical Center.
POSTER SESSION I: QUALITY IMPROVEMENT 135. PEDIATRIC PROVIDERS’ ATTITUDES AND PRACTICES REGARDING CONCUSSION DIAGNOSIS AND MANAGEMENT Khalida Itriyeva, MD, Ronald Alan Feinstein, MD, Linda Carmine, MD, FSAHM. Cohen Children’s Medical Center at North Shore-Long Island Jewish.
Purpose: Adolescent and young adults have low rates of receiving preventive services and high rates of emergency room visits. Patient-centered medical homes could increase the receipt of preventive care and decrease emergency room visits among patients of this age group. This study aims to determine the association between enrollment in patient-centered medical homes and the receipt of preventive services and the utilization of emergency rooms among patients aged 10-24. Methods: We used a retrospective cohort study. Clinics with patient-centered medical homes at Hennepin County Medical Center, Minnesota were included. Patients were residents of Hennepin County aged 10-24 who had face-to-face or telephone encounters with healthcare providers between 2010 and 2014 (n¼21,745). The exposure of interest was enrollment in patientcentered medical homes, which includes care coordination through phone and face-to-face encounters. Main outcomes were receipt of (1) preventive visits, (2) prescriptions for influenza, meningococcal, and Human papillomavirus vaccinations, (3) screening for sexually transmitted diseases, (4) prescription of any contraceptive method and long acting reversible contraceptives, and (5) cervical cancer screening and (6) emergency room visits. Data was extracted from patient’s electronic medical records. Generalized mixed effect models in a propensity score matched sample were used to determine the effects of enrolling in PCMH on the receipt of preventive services.
Purpose: The diagnosis and management of concussion, a form of mild traumatic brain injury, is an active area of research with evolving guidelines and recommendations resulting in varying practices among providers. The objective of our study was to assess how local pediatricians in New York Chapter 2 of the American Academy of Pediatrics (AAP) diagnose and treat pediatric patients who have suffered a concussion, and to evaluate the need for continuing education in this area. Methods: Survey Monkey, an online survey tool, was used to query participants regarding their approach to the diagnosis and treatment of concussion patients. A total of three emails containing the link to the multiple-choice survey were sent to all members of our local AAP chapter between January 2015 and June 2015. Potential participants included primary care pediatricians and subspecialists. The survey was adapted and modified with permission from one previously used by Zonfrillo et al. The study was approved under exempt status by our Institutional Review Board. Results: Of a total of 1616 New York Chapter 2 AAP members, 1436 had e-mail addresses registered with the chapter. We received a total of 115 responses from the 1436 potential participants to whom the survey link was sent, resulting in an 8% response rate. Respondents included primary care pediatricians (82.6%) and subspecialists (17.4%); 96.8% of respondents had seen at least one
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Poster Abstracts / 58 (2016) S63eS85
child or adolescent with a concussion in the previous 12 months and 76% reported referring some or all of their concussion patients for ongoing management. The most common reason for referral was “I am not always comfortable with management” (40.7%) and the most common subspecialist that patients were referred to was a neurologist (81.2%). Most participants reported that they did not use any guidelines in management of their concussion patients (55.7%) and only 59% were familiar with the New York State Education Department concussion guidelines. Most pediatric providers said they were comfortable educating families about the diagnosis of concussion (82%), as well as recommending the appropriate time to resume school (64%) and prescribing and monitoring a return to play protocol for sports (60%). Most (83%) also responded, however, that they would be interested in a webinar for Continuing Medical Education (CME) credit focused on concussion diagnosis and management. Conclusions: Most pediatric providers care for patients who have suffered a concussion, however many identify barriers to diagnosis and treatment resulting in a majority of patients being referred to subspecialists for further management. Many providers are also unfamiliar with, or do not use, published concussion guidelines and report varying practices in treatment of concussion patients due to evolving recommendations. This study demonstrates that there is a need for further education for pediatric providers who see patients with concussion. Sources of Support: None.
POSTER SESSION I: TECHNOLOGY AND INTERNET 136. #MENTALHEALTHRESOURCES: A PILOT INTERVENTION TARGETING ADOLESCENTS POSTING DEPRESSION REFERENCES ON TUMBLR Erin Kelleher, BS 1, Megan A. Moreno, MD, MPH 2. 1
University of Wisconsin-Madison; 2Seattle Children’s Research Institute.
Purpose: Depression is among the most common illnesses affecting teens, but many teens do not seek clinical care or know about available resources. The vast majority of teens are online, and could access online mental health resources. The purpose of this pilot study was to determine whether a social media intervention offering online resources was appropriately targeted, accessed and useful for teens. Methods: Participants were identified by typing in “depress” in the Tumblr search bar. The inclusion criteria included: participants aged 15-23. Potential participants’ Tumblr profiles were evaluated for depression references, as defined by the Diagnostic and Statistical Manual of Mental Disorders - Major Depressive Episode (MDE) symptom criteria and were present on Tumblr within the preceding two weeks. Example posts that met the criteria included “WHY DO I ALWAYS FEEL LIKE IM NOT GOOD ENOUGH FOR ANYONE?” and “Each day, she dies a little more inside.” The first 40 participants who met these criteria were randomly assigned to intervention or control groups. The intervention included a resource sheet of online mental health resources developed in consultation with a mental health expert. The intervention was delivered via a private Tumblr message explaining the study and
providing the resources. Surveys for both groups included the Patient Health Questionnaire-9 (PHQ-9); surveys for the intervention participants also asked about resource access and usefulness, and control groups were asked whether they would have liked to receive resources. Participants were provided a $10 gift card as incentive. Results: Among the 40 participants, 24 (60% response rate) participants completed the survey. Participants were 66.7% female. The average age of participants was 17.4 average years. 10 intervention participants completed the survey. Average PHQ-9 score was 20 (SD¼ 4.5) for the intervention and 16.1 (SD¼5.9) for the control group. There was no statistically significant difference between the group means. 30% (3) of participants in the intervention group reported accessing the intervention resources. Half of the intervention participants felt the intervention was acceptable, but 71.4% (10) of control group participants reported they would not have wanted to receive resources. 64.3% (9) of the control and 60% (6) of the intervention group did not feel comfortable finding online resources for mental health independently. Conclusions: This pilot intervention study developed an online mental health resources sheet and used Tumblr to identify teens who posted about depression. The participants who received the resources thought this was an acceptable approach. Interestingly, participants that did not receive the resources did not think this would be an acceptable approach. Future studies should focus on testing this approach on a larger scale among adolescents and young adults who display depression references on social media. Sources of Support: The University of Wisconsin-Madison. 137. IMPORTANCE OF PICTORIAL ALCOHOL DISPLAYS AMONG COLLEGE FEMALES Molly E. Wilner, BS, Megan Moreno, MD, MPH. Seattle Children’s Research Institution.
Purpose: The ‘gender gap’ between male and female college drinkers has been closing steadily due to the dramatic increase in female drinking. However, it is unclear why this increase has taken place. Social norms are associated with alcohol behavior, and social networking sites are a way that these norms are propagated. Alcohol displays on social media sites are significantly associated with greater self-reported alcohol consumption, and pictorial displays are on the rise. The purpose of this study was to assess pictorial alcohol displays by college students on Facebook. Methods: In this two year study, incoming college students were randomly recruited from two large public universities. Participant’s Facebook profiles were evaluated every four weeks for alcohol displays, which were categorized as pictorial or textual displays. Pearson’s Chi-square test for proportions with Yates’s contingency correction and Student’s t tests were used to assess differences in male and female alcohol displays. Phone interviews were conducted after year two which included qualitative questions about attitudes about alcohol and Facebook, and the Alcohol Use Disorder Identification Test (AUDIT). AUDIT scores were calculated. A text based content analysis was conducted on a question about how Facebook influences alcohol consumption. Responses were coded as not influential if they contained the words “no”, “none”, and “hasn’t”. Responses that were coded as influential were further coded for inclusion of the words “picture”, “pics”, and “photos”.
used to determine the effects of enrolling in PCMH on the receipt of preventive and mental health services. Results: Most patients were female, US-born Latino, with an average age of 20.8 years. Patients enrolled in APT between 2010 and 2014 were more likely to be female, Latino, foreign born, students, without health insurance (p<0.001). Propensity scores successfully achieved balance in the sample. Adjusted odds ratios (99% confidence intervals) comparing the receipt of preventive and mental health services of patients enrolled in APT to youth enrolled in PCMHs, but not in APT were: (1) preventive visits 3.00 (2.07, 4.33), (2) influenza 1.12 (0.76, 1.65), meningococcal 3.35 (2.07, 5.42), and Human papillomavirus vaccinations 2.56 (1.71, 3.84), (3) screening for sexually transmitted disease 2.30 (1.18, 4.46), (4) prescription of any type of contraception 3.46 (1.59, 7.55) and long acting reversible contraception 2.80 (1.26, 6.22), (5) cervical cancer screening 1.42 (0.70, 2.92), (6) and ER visits 0.34 (0.21, 0.57). Conclusions: Patients enrolled in APT home had higher odds of receiving multiple preventive services and lower odds of attending the ER compared to other patients receiving care at other PCMHs. These findings highlight the efficacy of the APT approach including confidentiality, family-centeredness, and culturally inclusiveness when providing clinical and preventive care for their client teens. Sources of Support: Eliminating Health Disparities Initiative, Minnesota Department of Health, and NRSA, US Department of Health and Human Services.
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Results: Most patients were female, US-born Hispanic/Latino, with an average age of 20.8 years. Patients enrolled in PCMH between 2010 and 2014 (n¼563) were more likely to be Latino, students, with health insurance (p<0.001). Propensity score successfully achieved balance in the sample. Adjusted odds ratios (99% confidence intervals) comparing the receipt of preventive services of patients enrolled in PCMH to youth who did not receive these services were: (1) preventive visits 1.10 (0.93, 1.29), (2) influenza 0.89 (0.74, 1.07), meningococcal 1.53 (1.30, 1.80), and Human papillomavirus vaccinations 1.53 (1.28, 1.84), (3) screening for sexually transmitted disease 1.69 (1.28, 2.24), (4) prescription of any type of contraception 2.18 (1.56, 3.03) and long acting reversible contraception 2.66 (1.89, 3.74), and (5) cervical cancer screening 1.14 (0.87, 1.48) and (6) emergency room visits 0.84 (0.72, 0.98). Conclusions: Patients enrolled in patient-centered medical homes had higher odds of receiving multiple preventive services and lower odds of emergency room visits. This model of care not only focuses on the specific needs of patients but also on their preventive care. More studies are needed to identify the core components of Patient-Centered Medical Homes as well as to develop strategies that increase youth access to this model. Sources of Support: Eliminating Health Disparities Initiative, Minnesota Department of Health, and National Research Service Award (NRSA) in Primary Medical Care, US Department of Health and Human Services.
134. DOES THE CONTEXT OF HEALTHCARE SERVICES AFFECT THE RECEIPT OF PREVENTIVE SERVICES? A RETROSPECTIVE STUDY OF PATIENT-CENTERED MEDICAL HOMES VS. USUAL PRIMARY CARE Diego Garcia-Huidobro, MD 1, Maria Veronica Svetaz, MD, MPH, FSAHM 2, Nathan Shippee, PhD 1, Jennifer O’Brien, MHP 2. 1
University of Minnesota; 2Hennepin County Medical Center.
POSTER SESSION I: QUALITY IMPROVEMENT 135. PEDIATRIC PROVIDERS’ ATTITUDES AND PRACTICES REGARDING CONCUSSION DIAGNOSIS AND MANAGEMENT Khalida Itriyeva, MD, Ronald Alan Feinstein, MD, Linda Carmine, MD, FSAHM. Cohen Children’s Medical Center at North Shore-Long Island Jewish.
Purpose: Adolescent and young adults have low rates of receiving preventive services and high rates of emergency room visits. Patient-centered medical homes could increase the receipt of preventive care and decrease emergency room visits among patients of this age group. This study aims to determine the association between enrollment in patient-centered medical homes and the receipt of preventive services and the utilization of emergency rooms among patients aged 10-24. Methods: We used a retrospective cohort study. Clinics with patient-centered medical homes at Hennepin County Medical Center, Minnesota were included. Patients were residents of Hennepin County aged 10-24 who had face-to-face or telephone encounters with healthcare providers between 2010 and 2014 (n¼21,745). The exposure of interest was enrollment in patientcentered medical homes, which includes care coordination through phone and face-to-face encounters. Main outcomes were receipt of (1) preventive visits, (2) prescriptions for influenza, meningococcal, and Human papillomavirus vaccinations, (3) screening for sexually transmitted diseases, (4) prescription of any contraceptive method and long acting reversible contraceptives, and (5) cervical cancer screening and (6) emergency room visits. Data was extracted from patient’s electronic medical records. Generalized mixed effect models in a propensity score matched sample were used to determine the effects of enrolling in PCMH on the receipt of preventive services.
Purpose: The diagnosis and management of concussion, a form of mild traumatic brain injury, is an active area of research with evolving guidelines and recommendations resulting in varying practices among providers. The objective of our study was to assess how local pediatricians in New York Chapter 2 of the American Academy of Pediatrics (AAP) diagnose and treat pediatric patients who have suffered a concussion, and to evaluate the need for continuing education in this area. Methods: Survey Monkey, an online survey tool, was used to query participants regarding their approach to the diagnosis and treatment of concussion patients. A total of three emails containing the link to the multiple-choice survey were sent to all members of our local AAP chapter between January 2015 and June 2015. Potential participants included primary care pediatricians and subspecialists. The survey was adapted and modified with permission from one previously used by Zonfrillo et al. The study was approved under exempt status by our Institutional Review Board. Results: Of a total of 1616 New York Chapter 2 AAP members, 1436 had e-mail addresses registered with the chapter. We received a total of 115 responses from the 1436 potential participants to whom the survey link was sent, resulting in an 8% response rate. Respondents included primary care pediatricians (82.6%) and subspecialists (17.4%); 96.8% of respondents had seen at least one
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Poster Abstracts / 58 (2016) S63eS85
child or adolescent with a concussion in the previous 12 months and 76% reported referring some or all of their concussion patients for ongoing management. The most common reason for referral was “I am not always comfortable with management” (40.7%) and the most common subspecialist that patients were referred to was a neurologist (81.2%). Most participants reported that they did not use any guidelines in management of their concussion patients (55.7%) and only 59% were familiar with the New York State Education Department concussion guidelines. Most pediatric providers said they were comfortable educating families about the diagnosis of concussion (82%), as well as recommending the appropriate time to resume school (64%) and prescribing and monitoring a return to play protocol for sports (60%). Most (83%) also responded, however, that they would be interested in a webinar for Continuing Medical Education (CME) credit focused on concussion diagnosis and management. Conclusions: Most pediatric providers care for patients who have suffered a concussion, however many identify barriers to diagnosis and treatment resulting in a majority of patients being referred to subspecialists for further management. Many providers are also unfamiliar with, or do not use, published concussion guidelines and report varying practices in treatment of concussion patients due to evolving recommendations. This study demonstrates that there is a need for further education for pediatric providers who see patients with concussion. Sources of Support: None.
POSTER SESSION I: TECHNOLOGY AND INTERNET 136. #MENTALHEALTHRESOURCES: A PILOT INTERVENTION TARGETING ADOLESCENTS POSTING DEPRESSION REFERENCES ON TUMBLR Erin Kelleher, BS 1, Megan A. Moreno, MD, MPH 2. 1
University of Wisconsin-Madison; 2Seattle Children’s Research Institute.
Purpose: Depression is among the most common illnesses affecting teens, but many teens do not seek clinical care or know about available resources. The vast majority of teens are online, and could access online mental health resources. The purpose of this pilot study was to determine whether a social media intervention offering online resources was appropriately targeted, accessed and useful for teens. Methods: Participants were identified by typing in “depress” in the Tumblr search bar. The inclusion criteria included: participants aged 15-23. Potential participants’ Tumblr profiles were evaluated for depression references, as defined by the Diagnostic and Statistical Manual of Mental Disorders - Major Depressive Episode (MDE) symptom criteria and were present on Tumblr within the preceding two weeks. Example posts that met the criteria included “WHY DO I ALWAYS FEEL LIKE IM NOT GOOD ENOUGH FOR ANYONE?” and “Each day, she dies a little more inside.” The first 40 participants who met these criteria were randomly assigned to intervention or control groups. The intervention included a resource sheet of online mental health resources developed in consultation with a mental health expert. The intervention was delivered via a private Tumblr message explaining the study and
providing the resources. Surveys for both groups included the Patient Health Questionnaire-9 (PHQ-9); surveys for the intervention participants also asked about resource access and usefulness, and control groups were asked whether they would have liked to receive resources. Participants were provided a $10 gift card as incentive. Results: Among the 40 participants, 24 (60% response rate) participants completed the survey. Participants were 66.7% female. The average age of participants was 17.4 average years. 10 intervention participants completed the survey. Average PHQ-9 score was 20 (SD¼ 4.5) for the intervention and 16.1 (SD¼5.9) for the control group. There was no statistically significant difference between the group means. 30% (3) of participants in the intervention group reported accessing the intervention resources. Half of the intervention participants felt the intervention was acceptable, but 71.4% (10) of control group participants reported they would not have wanted to receive resources. 64.3% (9) of the control and 60% (6) of the intervention group did not feel comfortable finding online resources for mental health independently. Conclusions: This pilot intervention study developed an online mental health resources sheet and used Tumblr to identify teens who posted about depression. The participants who received the resources thought this was an acceptable approach. Interestingly, participants that did not receive the resources did not think this would be an acceptable approach. Future studies should focus on testing this approach on a larger scale among adolescents and young adults who display depression references on social media. Sources of Support: The University of Wisconsin-Madison. 137. IMPORTANCE OF PICTORIAL ALCOHOL DISPLAYS AMONG COLLEGE FEMALES Molly E. Wilner, BS, Megan Moreno, MD, MPH. Seattle Children’s Research Institution.
Purpose: The ‘gender gap’ between male and female college drinkers has been closing steadily due to the dramatic increase in female drinking. However, it is unclear why this increase has taken place. Social norms are associated with alcohol behavior, and social networking sites are a way that these norms are propagated. Alcohol displays on social media sites are significantly associated with greater self-reported alcohol consumption, and pictorial displays are on the rise. The purpose of this study was to assess pictorial alcohol displays by college students on Facebook. Methods: In this two year study, incoming college students were randomly recruited from two large public universities. Participant’s Facebook profiles were evaluated every four weeks for alcohol displays, which were categorized as pictorial or textual displays. Pearson’s Chi-square test for proportions with Yates’s contingency correction and Student’s t tests were used to assess differences in male and female alcohol displays. Phone interviews were conducted after year two which included qualitative questions about attitudes about alcohol and Facebook, and the Alcohol Use Disorder Identification Test (AUDIT). AUDIT scores were calculated. A text based content analysis was conducted on a question about how Facebook influences alcohol consumption. Responses were coded as not influential if they contained the words “no”, “none”, and “hasn’t”. Responses that were coded as influential were further coded for inclusion of the words “picture”, “pics”, and “photos”.