Current Problems in Pediatric and Adolescent Health Care
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Value-based reimbursement arrangements tie financial incentives to achieving quality measures to ensure savings are not from withholding care. For patients and their families, the delivery of high-quality care is simply the expectation. Defining and measuring pediatric quality, however, is not standardized which has led to a large proliferation of metrics across multiple stakeholders. The majority of these measures are process rather than outcomes metrics often chosen for the ease at which the d...
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Value-based care has evolved differently for pediatric versus adult systems of care and clinically integrated networks (CINs) for children's hospitals look different in nearly every market. While differences abound, pediatric CINs have had to overcome similar challenges, including how to best engage providers, how to deliver evidence-based, high-quality care, how to position the CIN to be strategically relevant in the shadow of larger adult CINs and how to evolve and sustain their networks. Over...
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Pediatric-specific networks have emerged over the past decade as Medicaid payment models have shifted away from fee-for-service, which rewards volume of service delivery, towards more value-based payments that incentivize improved health outcomes. More recently, growing recognition that health care alone is insufficient to produce health has resulted in the Centers for Medicare and Medicaid Services advancing value-based payment models that allow greater flexibility for networks to address the “...
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COVID-19 has stressed primary care pediatric practices. In addition, other market pressures that began before the pandemic make this an optimal time to re-examine pediatric payment models. CMS is encouraging changes in the Medicare market toward alternative payment models. However, success is limited for older adults, and while components of these models can work for pediatricians, the needs of children, young adults and their families are different from older adults. The rapid evolution of tele...
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#1Rajkumar Agarwal (Wright State University)H-Index: 1
#2Latisha Gathers-Hutchins (Wright State University)
Last. Hara Stephanou (St. John's University)
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Psychogenic Non-Epileptic Seizures (PNES) are a relatively common condition in children. While their clinical presentation resembles epileptic seizures, the underlying cause for PNES involves a multitude of bio-psychosocial factors. Patients may be misdiagnosed with epilepsy and subjected to unnecessary treatments, often delaying the diagnosis for years. A strong understanding of its symptomatology is essential for diagnosis of PNES. Successful management depends on effective teamwork that invol...
1 CitationsSource
Pediatric headache impacts up to 80% of children, many recurrently, by the time they are 15 years old. Preventing the progression of episodic to chronic headache results in less truancy, staying current with schoolwork and improves children's quality of life. Lifestyle choices can play an important role in headache treatment. Early effective treatment of episodic headache can prevent transformation into a chronic form. While details of a child's headache are critical for making a proper diagnosi...
1 CitationsSource
Epilepsy is one of the most common neurological conditions in children. Most children with epilepsy respond to anti- epileptic drugs (AEDs) but approximately 30% of children develop drug resistant epilepsy (DRE) defined as ‘the failure of adequate trials of two tolerated, appropriately chosen and used anti-epileptic drugs (AEDs)’. DRE is associated with serious consequences including higher mortality and worse cognitive outcomes. DRE impacts several aspects of the child's and the caregiver's lif...
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Tourette syndrome (TS) causes academic, social, emotional, physical, and functional problems. Most TS patients also have comorbid neuropsychological conditions. The purpose of this review is to provide updated information to the clinician about phenomenology, epidemiology, comorbidities, pathophysiology and management strategies for tics (a hallmark of TS) and TS. Recent findings suggest that TS is likely due to a combination of several different genes and environmental factors, with possible in...
1 CitationsSource
Pediatric neuromuscular disorders are a diverse group of conditions that affect how muscle and nerve function. They involve the motor neurons, nerves, neuromuscular junction and muscles. Pathology of any of these regions leads to the inability to perform voluntary movements. Over time, the natural progression of most of these disorders is followed by significant disability, and at the most extreme, almost complete paralysis and death secondary to complications. Diagnostic measures for pediatric ...
1 CitationsSource
#1Ajay Goenka (Wright State University)
#2Mahesh Chikkannaiah (Wright State University)H-Index: 1
Last. Gogi Kumar (Wright State University)H-Index: 1
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Pediatric Auto-Immune Encephalitis (PAE) is a neuro-inflammatory disorder with a varied presentation. The discovery of the Anti NMDA receptor and other antibodies as the causative agents of PAE, has led to an increased need for guidelines for diagnosis and management of these disorders. PAE remains a challenging group of disorders due to their varying presentations and etiology with a prolonged clinical course. The wide spectrum of clinical symptoms involves altered mental status, movement disor...
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