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Trauma, Asthma, Autism Insurance Mandates, and Sexual Health

Published on July 15, 2016 in Cornerstone Blog · Last updated 4 months 1 week ago


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Some people slow down in summer, but here at The Children’s Hospital of Philadelphia, hot weather is no impediment to making research advances. This week, our roundup of CHOP research in the news covers a broad range of them. After first reflecting on how recent tragedies in the news affect us in our work and in our communities, we bring you the latest research on the varied costs of asthma care across different hospitals, the impact of state insurance mandates on autism diagnosis and treatment, and an intervention to improve sexual health and disease prevention among young African-American gay men.

Addressing the Trauma of High-Profile Shooting Deaths

The news cycle in the past two weeks has been dominated by discussion of the latest police-involved shooting deaths of African American citizens that were captured on video, as well as the sniper shooting of Dallas police officers that resulted in the deaths of five officers. Even though these tragic events may feel miles away from the day-to-day realities of pediatric research, their impact still reaches us and members of our communities.

“It is important to understand that these deaths, witnessed by millions of people on video, in addition to being heartrending losses, can also constitute trauma to those who have heard about them and watched them,” writes Krista Mehari, PhD, a psychology fellow who works with CHOP’s Violence Prevention Initiative. Dr. Mehari outlines ways that we in the realms of pediatric care and research, and as members of our communities, can move forward to support those around us who are experiencing trauma and stress in a blog post for CHOP’s Center for Injury Research and Prevention.

Variation in Costs and Practices for Acute Asthma Care

Hot on the heels of a study published last week showing no meaningful disparities in asthma care for children with Medicaid compared to those with private health insurance, Jeffrey Silber, MD, PhD, director of the Center for Outcomes Research at CHOP, has another new study this week about asthma care, this time focusing on costs of acute care in children’s hospitals.

Published in JAMA Pediatrics, Dr. Silber’s new study analyzed hospital records in a large national database and found that hospitals differed significantly in inpatient costs, length of stay, and time spent in the intensive care unit (ICU), even when patients were grouped by characteristics such as age or severity of illness. They found that for patients with a similar set of characteristics, median cost varied by 87 percent, total length of stay varied by 47 percent, and ICU usage was 254 percent higher, all when comparing the lower eighth to the upper eighth of hospitals.

“As the most prevalent chronic illness in children, asthma imposes a major financial burden on many healthcare systems,” Dr. Silber said. “If hospitals can better understand if their care practices are disproportionately expensive and inefficient compared to other hospitals, they may be better able to pinpoint opportunities for quality improvements.”

Read more in the CHOP press release.

Study Measures Impact on Autism Care from Laws Mandating Insurance Coverage

More children are being diagnosed and receiving treatments for autism spectrum disorder (ASD) after states have begun mandating that private health insurance cover the cost of these services, according to a new study published this week in JAMA Pediatrics. The researchers analyzed inpatient and outpatient health insurance claims for children 21 years or younger covered by three of the largest insurers in the U.S. from 2008 through 2012.

“We now know that more children are being served, but we are also acutely aware that these numbers are well below the prevalence of ASD in our society, indicating that the mandates have not had the full effect that advocates desired,” said study leader David Mandell, ScD, associate director of the Center for Autism Research at CHOP and a professor and director of the Center for Mental Health Policy and Services Research at the Perelman School of Medicine at the University of Pennsylvania. “This is merely a step in the right direction. These mandates represent a patch, not a panacea.”

Read more about the study in a Penn Medicine news release, article, and a Kaiser Health News article about this research when it was initially presented at a conference this spring.

Study Aims to Make Sexual Health Fun and Approachable in Philly Gay Scene

“There’s nothing out there like this, nothing that’s targeting these young people. We need more data,” said Richard LaBoy, a clinical research assistant at CHOP, in the Philly Gay News.

LaBoy is part of a team directed by Marné Castillo, MEd, PhD, in the Craig Dalsimer Division of Adolescent Medicine, which is one year into a five-year grant from the National Institute of Mental Health for a program called Project POSSE in both Chicago and Philadelphia. It aims to improve knowledge and behavior about sexual health among young black men who have sex with men. The program uses extensive community input to build health knowledge-sharing networks using existing social networks that participate in the House Ballroom competitive dancing subculture in the black gay community.

Earlier this year, the Centers for Disease Control and Prevention issued an estimate that if current diagnosis rates persist, one in two black men who have sex with men in the U.S. will become infected with HIV in his lifetime. Targeted efforts such as Project POSSE are seeking ways to prevent that projection from becoming reality by working in a collaborative partnership with the community.

Read more in the Philly Gay News.


In case you missed it, earlier this week on Cornerstone we brought you Chief Scientific Officer Bryan A. Wolf’s perspective on the promise of mHealth. (And check out the related special June/July issue of our newsmagazine, Bench to Bedside, with a special focus on mHealth.) And we shared the story of an ongoing immunology study that uses recurrent warts as a way to understand the normal functioning of the immune system in the skin.

Last week’s In the News post covered disparities (or lack thereof) between asthma care for kids with Medicaid vs. private health insurance, the use of technology to help high-risk youth with asthma maintain their basic care routines, and late effects on the endocrine system among survivors of childhood cancer.

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