angelo giardino - Academia.edu (original) (raw)
Papers by angelo giardino
Clinical Pediatrics, May 18, 2017
Use of complementary and alternative medicine (CAM) among US children is 12% according to the 201... more Use of complementary and alternative medicine (CAM) among US children is 12% according to the 2012 National Health Interview Study. Certain pediatric populations have higher CAM use. We studied an uninsured population because limited access to care likely results in higher CAM use. We surveyed 250 uninsured patients in a free pediatric mobile clinic program. In the largely Hispanic population, rate of CAM use in the preceding 12 months was 45% among children and 59% among parents. Ninety-one percent of children who used CAM had parents who used CAM while only 32% of parents used CAM for themselves but did not use CAM for their children ( P < .001). Seven parents (3%) and 4 children (2%) had ever discussed their CAM use with a physician. Since CAM use is significant in this uninsured population and families do not generally discuss CAM with physicians, health care providers must ask about CAM use and provide guidance.
SpringerBriefs in public health, 2020
SpringerBriefs in public health, 2017
This chapter addressed several related topic areas that have a connection to the risk for child p... more This chapter addressed several related topic areas that have a connection to the risk for child physical abuse, namely, corporal punishment, intimate partner violence, and disabilities or special health care needs. Each topic is briefly defined and then the connection to the risk for child physical abuse is explored noting the findings from several key articles and reports that provide the evidence to support or refute a connection to child physical abuse as well as a rationale for an approach to clinical practice around the specific topic.
Journal of family strengths, 2018
SpringerBriefs in public health, 2017
The use of general descriptive names, registered names, trademarks, service marks, etc. in this p... more The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.
Part I: Overview Chapter 1 Overview of the Problem Chapter 2 Overview of Presentations and Health... more Part I: Overview Chapter 1 Overview of the Problem Chapter 2 Overview of Presentations and Healthcare Evaluations Part II: Healthcare Evaluation Chapter 3 History and Interview Chapter 4 Physical Examination and Findings Chapter 5 Laboratory Findings, Diagnostic Testing, and Forensic Specimens Chapter 6 Sexually Transmitted Diseases Chapter 7 Differential Diagnosis: Conditions That Mimic Child Maltreatment Chapter 8 Neglect Chapter 9 Documentation Part III: Related Issues Chapter 10 Mental Health Aspects of Abuse Chapter 11 Adolescents and Abuse Chapter 12 Munchausen Syndrome by Proxy Chapter 13 Child Protective Services and Child Welfare Chapter 14 Legal Issues Chapter 15 Relationship of Domestic Violence to Child Abuse Chapter 16 Internet Risks to Children Chapter 17 Prevention: The Nurses Role
We define external quality improvement as the review of a physician or healthcare organization’s ... more We define external quality improvement as the review of a physician or healthcare organization’s performance by an external or outside body. Some external review systems have a legal statutory basis and are mandatory, while others are voluntary in nature. Their ultimate goals are to review, evaluate, and rank healthcare organizations based on explicit standards and measurements which can result in significant financial or nonfinancial incentives and sanctions. Legislative and regulatory mandates, market demands for accreditation by consumer groups and payers, and quality improvement efforts by healthcare providers are the backbone for external quality improvement and define the critical role played by these accrediting organizations in the certification of quality in healthcare. This chapter presents information on external quality improvement programs and organizations, including their most recent reports and updated changes and the effect they have on the accreditation and educati...
The finances for health-care transition (HCT) have long been recognized as a cornerstone of the c... more The finances for health-care transition (HCT) have long been recognized as a cornerstone of the care process. Each year about 500,000 AYASCHN reach adulthood, making efforts to determine how best to finance HCT imperative. Recognizing that effective HCT from pediatric to adult serving settings is a process not an event; the financing issues are complex. The current fee-for-service reimbursement model is more suited for counting events and paying for volume of care delivered rather than supporting a longitudinal care process that is more nuanced and embedded in a years-long set of conversations and activities among AYASHCN, their family, and health-care providers. Value-based initiatives that reimburse based on quality and outcomes rather than on discrete volumes of services may provide a financing vehicle where dollars saved via efficient care can be redirected to the HCT process, which would include the delivery of care in a patient- and family-centered medical home. Efforts are un...
Child Care Health and Development, Mar 1, 2010
Objective According to family stress models, parental responses to stress disrupt interactions be... more Objective According to family stress models, parental responses to stress disrupt interactions between parent and child and may lead to parental inability to seek timely medical care for their child. The objective of this study was to quantitatively assess the relationship between high parenting stress and child healthcare utilization. Methods We used the 2003-2004 National Survey of Children's Health to determine the prevalence of parenting stress in US families and associated socio-demographic variables. We used weighted logistic regression to investigate associations between parenting stress and healthcare utilization, controlling for other parental psychosocial and socio-demographic variables. The primary independent variables were parenting stress, parental mental health, parental coping and social support. The main dependent variables were emergency care, sick visits to primary care and preventive care in the past 12 months. Results Nationally, 13% of children lived in households with at least one parent experiencing high parenting stress. Socio-demographic variables associated with the highest odds of parenting stress included Black race, special needs status and non-English primary language. Parents with high parenting stress had a higher odds (adjusted odds ratio 1.24, 95% confidence interval 1.10-1.41) of seeking emergency care for their children compared with parents with low parenting stress, controlling for other parental psychosocial factors and socio-demographic variables. Conclusions Having a parent who is experiencing high parenting stress is associated with greater utilization of paediatric emergency care. Interventions targeted at parenting stress may provide families with needed support and reduce unnecessary emergency care utilization. the past several decades-increases in single-parent households, children living in poverty and mothers in the workforce-have the potential to create circumstances that, if not addressed, may lead to increased parenting stress (Schor 2003; Spencer 2003; Nichols 2006). Mental health conditions may create narrow parental focus, thereby compromising the ability to recognize a child's healthcare needs. A large body of research has focused on the Child: care, health and development
SpringerBriefs in Public Health, 2020
Medical Quality Management, 2020
A solid legal footing provides the framework and benchmarks for credible, persuasive, accountable... more A solid legal footing provides the framework and benchmarks for credible, persuasive, accountable quality management activities. Medical quality management (MQM) should reflect prevailing societal preferences, establishing a balance between the interests of patients, practitioners, institutional providers, health plans, regulatory agencies, and the general public. Legal standards help to ensure that these preferences are honored and bring clarity and accountability to the process. The quality of care delivered in a facility or health plan is directly influenced by the organization's quality improvement (QI) activities, including regulatory and accreditation compliance, provider credentialing, risk management, and clinical peer review. As medical care has become increasingly complex, government actions via laws and regulations have also become more complicated to address the many aspects of the evolving healthcare system. Particularly in the face of limits on resources, or where healthcare benefits are restricted or limited, MQM decision-making must be done in a transparent and ethical manner that is fully compliant with relevant laws and regulations. The purpose of this chapter is to provide a working knowledge of legal issues related to clinical quality, provide a context to better understand some of the current challenges, and provide benchmarks in MQM.
kin injuries are among the most common, and, certainly, the most visible, symptoms of physical ab... more kin injuries are among the most common, and, certainly, the most visible, symptoms of physical abuse in children. In some cases, these injuries may leave lasting marks on the bodies of the abused-enduring tokens of the pain inflicted upon them. Because professionals working with children will, at times, encounter such injuries, it is vital they be able to recognize abusive burns, bruises, and other skin injuries in order to differentiate them from accidental injuries and to respond appropriately when encountered. This new pocket atlas, the first of an ongoing series on child maltreatment, includes 600 full-color photographs of skin injuries in children, with diagnostic case studies written by attending medical professionals. It is expertly designed by and for first responders, medical practitioners, and social service professionals who routinely work with children. Any readers who encounter, or may encounter, cases of child abuse in the course of their work will enjoy the benefit of a pocket-sized photographic reference to better inform and support the identification of abusive skin injuries in children
It is a typically busy Saturday night. Your next patient is a one-year-old with a runny nose brou... more It is a typically busy Saturday night. Your next patient is a one-year-old with a runny nose brought to the ED by her pregnant 20-year-old mother. During your examination of the child, you notice that the mother has a bruise on her cheek. She reports that she slipped down the stairs and appears withdrawn when you ask about her injury. You wonder about the real cause of the accident, but aren’t sure how to ask if she was a victim of domestic violence. Besides, what could you do for her anyway?
Child victims of sexual abuse face a number of short and long-term difficulties as a result of th... more Child victims of sexual abuse face a number of short and long-term difficulties as a result of their victimization. Prevention of child sexual abuse is ideal since the victimization would be stopped prior to a child being harmed and suffering the consequences of such betrayal of trust and abuse. The literature surrounding child sexual abuse prevention programs, typically called “safe environment training” is examined to determine the evidence for their effectiveness. This topical review explores the evidence to support core elements in the curricular structure that may indicate effectiveness. The ultimate goal of actually preventing child sexual abuse is difficult to reach from a methodology perspective. At this point, the literature contains measures related primarily to the structure and process of the safe environment program and the outcomes assess typically include an increase the child’s knowledge about the risk of child sexual abuse, a strengthening of their own self-awarenes...
The payer perspective is shaped by the transactional nature that defines the benefit management r... more The payer perspective is shaped by the transactional nature that defines the benefit management responsibilities at the core of what a health-care insurance organization exists to do. The most prominent transactions are around payment for services delivered by a health-care provider to adolescents and young adults with special health-care needs (AYASCHN). Payers are defined by their governance, either for-profit or nonprofit, and provide benefits ranging from private insurance through employer-sponsored plans to publicly funded entitlement programs through Medicaid. The payment models for payers to reimburse providers are undergoing monumental changes, and the traditional fee-for-service retrospective system based on volume of care delivered is shifting toward alternative payment models, generically referred to as value-based. Value-based models seek to pay for quality of services delivered as well as actual outcomes, many on a prospective population basis. The move toward value-bas...
Clinical Pediatrics, May 18, 2017
Use of complementary and alternative medicine (CAM) among US children is 12% according to the 201... more Use of complementary and alternative medicine (CAM) among US children is 12% according to the 2012 National Health Interview Study. Certain pediatric populations have higher CAM use. We studied an uninsured population because limited access to care likely results in higher CAM use. We surveyed 250 uninsured patients in a free pediatric mobile clinic program. In the largely Hispanic population, rate of CAM use in the preceding 12 months was 45% among children and 59% among parents. Ninety-one percent of children who used CAM had parents who used CAM while only 32% of parents used CAM for themselves but did not use CAM for their children ( P < .001). Seven parents (3%) and 4 children (2%) had ever discussed their CAM use with a physician. Since CAM use is significant in this uninsured population and families do not generally discuss CAM with physicians, health care providers must ask about CAM use and provide guidance.
SpringerBriefs in public health, 2020
SpringerBriefs in public health, 2017
This chapter addressed several related topic areas that have a connection to the risk for child p... more This chapter addressed several related topic areas that have a connection to the risk for child physical abuse, namely, corporal punishment, intimate partner violence, and disabilities or special health care needs. Each topic is briefly defined and then the connection to the risk for child physical abuse is explored noting the findings from several key articles and reports that provide the evidence to support or refute a connection to child physical abuse as well as a rationale for an approach to clinical practice around the specific topic.
Journal of family strengths, 2018
SpringerBriefs in public health, 2017
The use of general descriptive names, registered names, trademarks, service marks, etc. in this p... more The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.
Part I: Overview Chapter 1 Overview of the Problem Chapter 2 Overview of Presentations and Health... more Part I: Overview Chapter 1 Overview of the Problem Chapter 2 Overview of Presentations and Healthcare Evaluations Part II: Healthcare Evaluation Chapter 3 History and Interview Chapter 4 Physical Examination and Findings Chapter 5 Laboratory Findings, Diagnostic Testing, and Forensic Specimens Chapter 6 Sexually Transmitted Diseases Chapter 7 Differential Diagnosis: Conditions That Mimic Child Maltreatment Chapter 8 Neglect Chapter 9 Documentation Part III: Related Issues Chapter 10 Mental Health Aspects of Abuse Chapter 11 Adolescents and Abuse Chapter 12 Munchausen Syndrome by Proxy Chapter 13 Child Protective Services and Child Welfare Chapter 14 Legal Issues Chapter 15 Relationship of Domestic Violence to Child Abuse Chapter 16 Internet Risks to Children Chapter 17 Prevention: The Nurses Role
We define external quality improvement as the review of a physician or healthcare organization’s ... more We define external quality improvement as the review of a physician or healthcare organization’s performance by an external or outside body. Some external review systems have a legal statutory basis and are mandatory, while others are voluntary in nature. Their ultimate goals are to review, evaluate, and rank healthcare organizations based on explicit standards and measurements which can result in significant financial or nonfinancial incentives and sanctions. Legislative and regulatory mandates, market demands for accreditation by consumer groups and payers, and quality improvement efforts by healthcare providers are the backbone for external quality improvement and define the critical role played by these accrediting organizations in the certification of quality in healthcare. This chapter presents information on external quality improvement programs and organizations, including their most recent reports and updated changes and the effect they have on the accreditation and educati...
The finances for health-care transition (HCT) have long been recognized as a cornerstone of the c... more The finances for health-care transition (HCT) have long been recognized as a cornerstone of the care process. Each year about 500,000 AYASCHN reach adulthood, making efforts to determine how best to finance HCT imperative. Recognizing that effective HCT from pediatric to adult serving settings is a process not an event; the financing issues are complex. The current fee-for-service reimbursement model is more suited for counting events and paying for volume of care delivered rather than supporting a longitudinal care process that is more nuanced and embedded in a years-long set of conversations and activities among AYASHCN, their family, and health-care providers. Value-based initiatives that reimburse based on quality and outcomes rather than on discrete volumes of services may provide a financing vehicle where dollars saved via efficient care can be redirected to the HCT process, which would include the delivery of care in a patient- and family-centered medical home. Efforts are un...
Child Care Health and Development, Mar 1, 2010
Objective According to family stress models, parental responses to stress disrupt interactions be... more Objective According to family stress models, parental responses to stress disrupt interactions between parent and child and may lead to parental inability to seek timely medical care for their child. The objective of this study was to quantitatively assess the relationship between high parenting stress and child healthcare utilization. Methods We used the 2003-2004 National Survey of Children's Health to determine the prevalence of parenting stress in US families and associated socio-demographic variables. We used weighted logistic regression to investigate associations between parenting stress and healthcare utilization, controlling for other parental psychosocial and socio-demographic variables. The primary independent variables were parenting stress, parental mental health, parental coping and social support. The main dependent variables were emergency care, sick visits to primary care and preventive care in the past 12 months. Results Nationally, 13% of children lived in households with at least one parent experiencing high parenting stress. Socio-demographic variables associated with the highest odds of parenting stress included Black race, special needs status and non-English primary language. Parents with high parenting stress had a higher odds (adjusted odds ratio 1.24, 95% confidence interval 1.10-1.41) of seeking emergency care for their children compared with parents with low parenting stress, controlling for other parental psychosocial factors and socio-demographic variables. Conclusions Having a parent who is experiencing high parenting stress is associated with greater utilization of paediatric emergency care. Interventions targeted at parenting stress may provide families with needed support and reduce unnecessary emergency care utilization. the past several decades-increases in single-parent households, children living in poverty and mothers in the workforce-have the potential to create circumstances that, if not addressed, may lead to increased parenting stress (Schor 2003; Spencer 2003; Nichols 2006). Mental health conditions may create narrow parental focus, thereby compromising the ability to recognize a child's healthcare needs. A large body of research has focused on the Child: care, health and development
SpringerBriefs in Public Health, 2020
Medical Quality Management, 2020
A solid legal footing provides the framework and benchmarks for credible, persuasive, accountable... more A solid legal footing provides the framework and benchmarks for credible, persuasive, accountable quality management activities. Medical quality management (MQM) should reflect prevailing societal preferences, establishing a balance between the interests of patients, practitioners, institutional providers, health plans, regulatory agencies, and the general public. Legal standards help to ensure that these preferences are honored and bring clarity and accountability to the process. The quality of care delivered in a facility or health plan is directly influenced by the organization's quality improvement (QI) activities, including regulatory and accreditation compliance, provider credentialing, risk management, and clinical peer review. As medical care has become increasingly complex, government actions via laws and regulations have also become more complicated to address the many aspects of the evolving healthcare system. Particularly in the face of limits on resources, or where healthcare benefits are restricted or limited, MQM decision-making must be done in a transparent and ethical manner that is fully compliant with relevant laws and regulations. The purpose of this chapter is to provide a working knowledge of legal issues related to clinical quality, provide a context to better understand some of the current challenges, and provide benchmarks in MQM.
kin injuries are among the most common, and, certainly, the most visible, symptoms of physical ab... more kin injuries are among the most common, and, certainly, the most visible, symptoms of physical abuse in children. In some cases, these injuries may leave lasting marks on the bodies of the abused-enduring tokens of the pain inflicted upon them. Because professionals working with children will, at times, encounter such injuries, it is vital they be able to recognize abusive burns, bruises, and other skin injuries in order to differentiate them from accidental injuries and to respond appropriately when encountered. This new pocket atlas, the first of an ongoing series on child maltreatment, includes 600 full-color photographs of skin injuries in children, with diagnostic case studies written by attending medical professionals. It is expertly designed by and for first responders, medical practitioners, and social service professionals who routinely work with children. Any readers who encounter, or may encounter, cases of child abuse in the course of their work will enjoy the benefit of a pocket-sized photographic reference to better inform and support the identification of abusive skin injuries in children
It is a typically busy Saturday night. Your next patient is a one-year-old with a runny nose brou... more It is a typically busy Saturday night. Your next patient is a one-year-old with a runny nose brought to the ED by her pregnant 20-year-old mother. During your examination of the child, you notice that the mother has a bruise on her cheek. She reports that she slipped down the stairs and appears withdrawn when you ask about her injury. You wonder about the real cause of the accident, but aren’t sure how to ask if she was a victim of domestic violence. Besides, what could you do for her anyway?
Child victims of sexual abuse face a number of short and long-term difficulties as a result of th... more Child victims of sexual abuse face a number of short and long-term difficulties as a result of their victimization. Prevention of child sexual abuse is ideal since the victimization would be stopped prior to a child being harmed and suffering the consequences of such betrayal of trust and abuse. The literature surrounding child sexual abuse prevention programs, typically called “safe environment training” is examined to determine the evidence for their effectiveness. This topical review explores the evidence to support core elements in the curricular structure that may indicate effectiveness. The ultimate goal of actually preventing child sexual abuse is difficult to reach from a methodology perspective. At this point, the literature contains measures related primarily to the structure and process of the safe environment program and the outcomes assess typically include an increase the child’s knowledge about the risk of child sexual abuse, a strengthening of their own self-awarenes...
The payer perspective is shaped by the transactional nature that defines the benefit management r... more The payer perspective is shaped by the transactional nature that defines the benefit management responsibilities at the core of what a health-care insurance organization exists to do. The most prominent transactions are around payment for services delivered by a health-care provider to adolescents and young adults with special health-care needs (AYASCHN). Payers are defined by their governance, either for-profit or nonprofit, and provide benefits ranging from private insurance through employer-sponsored plans to publicly funded entitlement programs through Medicaid. The payment models for payers to reimburse providers are undergoing monumental changes, and the traditional fee-for-service retrospective system based on volume of care delivered is shifting toward alternative payment models, generically referred to as value-based. Value-based models seek to pay for quality of services delivered as well as actual outcomes, many on a prospective population basis. The move toward value-bas...