Mary Chesney | University of Minnesota - Twin Cities (original) (raw)

Papers by Mary Chesney

Pediatrics, Sep 1, 2007

OBJECTIVE. The objective of this study was to measure the factors that are associated with Mycoba... more OBJECTIVE. The objective of this study was to measure the factors that are associated with Mycobacterium tuberculosis infection in international adoptees. METHODS. A retrospective chart review was conducted on 880 international adoptees who presented to the International Adoption Clinic at the University of Minnesota between 1986 and 2001. Five tuberculin units of purified protein derivative were placed intradermally on the left forearm. The largest diameter of induration was measured in millimeters between 48 and 72 hours. Nutritional status was assessed using anthropometric measures at initial screening. Data on age, birth country, and year of adoption were assessed. RESULTS. Adoptees (mean age: 26 months; range: 1–200 months; 62% female) came from 33 birth countries. Twenty-eight percent and 5% had evidence of chronic and acute malnutrition, respectively. Twelve percent had evidence of M tuberculosis infection. The odds of M tuberculosis infection increased 7% for each subsequent year during the period studied, increased 142% with each additional year of age for children ≤24 months of age at baseline screening, and increased 15% with each additional year of age for children >24 months of age at the time of evaluation. Tuberculin skin test induration response was not associated with nutritional status or birth region. CONCLUSIONS. Our study demonstrated a high prevalence of M tuberculosis infection and malnutrition in internationally adopted children, placing them at considerable risk for progression to tuberculosis disease. These findings also support current guidelines recommending completion of tuberculin screening immediately after adoption.

Maternal and Child Health Journal, 2021

Urban, low-income, African American children and parents report lower quality primary care and fa... more Urban, low-income, African American children and parents report lower quality primary care and face negative social determinants of health. High-quality well-child care is critical for this population. The purpose of this qualitative study was to compare and contrast parent and health care provider experiences of well-child care for urban, low-income, African American families to better understand the complex factors involved in care quality and health outcomes. Two data sets were analyzed using conventional content analysis, parent focus group data, and provider interviews. After analysis, results were sorted into similar categories, and convergence coding was completed to identify areas of agreement, partial agreement, dissonance, and silence. Thirty-five parents took part in four focus groups, and nine providers were interviewed. Following convergence coding, five categories and 31 subcategories were identified. The five categories included: social determinants of health, sources of advice and support, challenges with the healthcare system, parent-provider relationships, and anticipatory guidance topics. Triangulation demonstrated convergence between parents and providers understanding of the concepts and functions of well-child care, however the prominence and meaning varied within each category and sub-category. The variance in agreement, areas of silence, and dissonance shed light on why the population reports lower overall quality primary care.

Journal of Pediatric Nursing, 2021

Purpose: Well-child care is the foundation of pediatric health promotion and disease prevention. ... more Purpose: Well-child care is the foundation of pediatric health promotion and disease prevention. Primary care quality is lower for low-income and African American children compared to white children, and social determinants have an increasingly acknowledged impact on child health. Ensuring that high-quality well-child care fulfills its potential to mitigate the negative effects of social determinants on African American children is imperative. This study provides an understanding of urban, low-income, African American well-child care experiences and expectations. Design and methods: A qualitative, focus group method was used. A purposive, volunteer sample of low-income, African American parents with children birth to age five was recruited from St. Louis and Milwaukee. Focus groups were held in convenient, community sites. Data was audio-digitally recorded. Transcribed data were coded and analyzed through inductive content analysis. Results: Thirty-five caregivers, 86% females, participated in four focus groups. Categories (and sub-categories) identified include: Community factors (We want better schools, It's getting more rough where I live); Sources of parenting advice (Google it, Call your parent, Older remedies); System challenges (Cost, Frequent new faces, Politics); Challenges with providers (Couldn't help me, Missed something important, Treated differently, Are you really listening?); Anticipatory guidance (Breastfeeding, Discipline, Vaccines, Development); and What parents desire (Know them, trust). Conclusions: This study reveals the contexts that give rise to health care disparities and provides insight into parent's healthcare behaviors. Practice implications: Results offer providers guidance in providing well-child care for this population to improve pediatric care quality and child health.

Journal of Pediatric Health Care, 2005

Opinions about satisfaction with care are rarely solicited from children. This study&... more Opinions about satisfaction with care are rarely solicited from children. This study's purpose was to compare children's ratings of patient satisfaction with outpatient care to ratings given by parents. This descriptive and comparative survey study compared responses of a convenience sample of children and adolescents (n = 116) who received care at two metropolitan pediatric subspecialty clinics with their parents' responses (n = 115). Ratings were obtained using the "Satisfaction with Child Healthcare Survey," an instrument adapted with permission from the "Kids Count Survey" developed at McMaster Health Center in Ontario, Canada. Additionally, three open-ended questions were solicited and analyzed for major themes. There was moderate significant correlation between child-teen and parent scores. Parents rated care significantly higher than did the children. Children's responses to open-ended questions varied somewhat from their parents' opinions on various aspects of clinic visits. Findings suggested that having parents evaluate children's care may not accurately represent the views of children and teens. Findings supported children and teens' ability to provide valuable perceptions about care that can inform clinic improvement processes.

Journal of Pediatric Health Care, 2022

Environmentalists have forewarned that our planet is in peril because of serious degradation and ... more Environmentalists have forewarned that our planet is in peril because of serious degradation and pollution of the earth's land, air, water, and food sources. Climate change is present and worsening at an alarming rate. Gaping disparities exist between high-income and low-income countries and high-income and low-income zip codes in the United States, resulting in marginalized and vulnerable populations bearing the greatest burden from the ill effects of pollution and environmental toxins. Infants and children carry the greatest risk for pollution-related diseases and exposure to chemical toxins as their bodies are rapidly developing. This review article provides a historical overview of children's rights to protection from environmental health risks, effects of environmental injustice, and U.S. statutory and regulatory policies responsible for protecting food, air, and water quality. The authors advocate for policy and clinical strategies to support children's health and the right to environmental protection.

Journal of Pediatric Health Care, 2022

Journal of Pediatric Health Care

Journal of Nursing Regulation

Journal of Pediatric Health Care, 2015

Journal of Pediatric Health Care, 2015

Journal of Pediatric Health Care, 2015

Journal of Pediatric Health Care, 2014

Journal of Pediatric Health Care, 2014

Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners

Journal of Nursing Education and Practice, 2014

Introduction: The current state of our nation's healthcare delivery system, including inefficienc... more Introduction: The current state of our nation's healthcare delivery system, including inefficiencies in healthcare delivery, health disparities, and wasteful costs, accentuates the call for responsive action. Interprofessional education and collaborative practice (IPECP) has emerged as an innovative strategy for addressing many of these inadequacies through the restructuring of healthcare delivery systems and health professions education within the United States. This project was a five-week long course in a clinic setting on interprofessional education (IPE) that supplied basic knowledge of the field of IPECP and offered opportunities to apply knowledge gained in an interprofessional, collaborative manner. The project question was: Will learners exhibit a measurable change in attitudes underpinning a clinic-based culture after exposure to an IPE intervention aimed at guiding and shaping collaborative practice? Methods: This was a systems change project that implemented and assessed a pilot IPECP program. The IPE intervention consisted of a course comprised of two face-to-face sessions and five online modules for 15 pre-and post-licensure learners. Objectives were defined, and mixed methods were used for measurement and assessment, including a pre-and post-test design. Results: Pre-licensure learners showed high levels of engagement in the learning activities; post-licensure learners failed to meet online engagement objectives. All course learners demonstrated a shift in readiness to engage in IPECP. Quantitative findings were consistent with the qualitative data generated. Discussion: Findings suggested the beginnings of a shift in attitudes underpinning organizational culture. Findings also revealed barriers to IP learning and practice, including participant attitudes related to professional identity, assumptions about teamwork, and notions about hierarchy.

Journal of Pediatric Health Care, 2012

Accountable care organization, health care reform, integrated health system The rollout of health... more Accountable care organization, health care reform, integrated health system The rollout of health care reform legislation includes new approaches to care and payment models. These approaches are key to improving patient outcomes and decreasing health care costs nationally. One approach of the health care reform legislation to improve care coordination, ensure quality and safety, and reduce redundancy and waste is the accountable care organization (ACO). ACOs are provider-based organizations that assume responsibility and accountability for the quality, cost, and comprehensive care of a defined population of patients across the continuum of care (American Academy of Pediatrics [AAP], 2011; National Committee for Quality Assurance [NCQA], 2010; Rittenhouse, Shortell, & Fisher, 2009). ACOs are the topic of considerable legislation and rule making federally, some of which will affect pediatric care. In Section 3022 of the Affordable Care Act (P.L. 111-148), Congress established a Medicare Shared Savings Program to encourage the development of ACOs for Medicare beneficiaries. The Centers for Medicare and Medicaid (CMS) recently published their proposed rules to implement the Medicare Shared Savings Program (CMS-1345-P) for the care of Medicare patients. Also contained in the legislation is language calling for the Department of Health & Human Services to establish a Pediatric Demonstration Project to promote ACOs in Medicaid and Chil-drenÕs Health Insurance Programs (CHIPs) between 2012 and 2016. The CMS has not yet proposed ACO rules for Medicaid and CHIP; however, it is anticipated that the Medicaid and CHIP ACO programs will be largely modeled after the Medicare Shared Savings Program and ACO rules governing Medicare ACOs (AAP, 2011). Pediatric nurse practitioners (PNPs) need to understand basic structures and underlying principles of ACOs to be effective advocates for pediatric patients and NP roles within ACOs. This article presents an overview of ACO models and principles, describes anticipated risks and benefits for pediatric patients within models of care, proposes appropriate roles for PNPs within this new model of care, and outlines strategies for advocacy to improve access to high-quality pediatric care for children and families.

Journal of Pediatric Health Care, 2013

Medicaid is the largest provider of health insurance for children and adults in the United States... more Medicaid is the largest provider of health insurance for children and adults in the United States and provides critical financial support for the nationÕs safety net of clinics, hospitals, and long-term care facilities that serve the poor and uninsured. A major provision of the Patient Protection and Affordable Care Act (2010) expands the Medicaid program beginning in January 2014. This article will review current Medicaid enrollment and eligibility requirements and the change in funding mechanisms anticipated in the Affordable Care Act (ACA) Medicaid expansion. Implications of the June 2012 Supreme Court ruling on Medicaid expansion and the impact that expansion may hold for children and their families will be explored, along with providing strategies for ensuring that children and adolescents covered by Medicaid expansions continue to receive comprehensive health services for optimal growth and development. CURRENT MEDICAID ELIGIBILITY AND FUNDING MECHANISMS Medicaid is a federal entitlement program that is administered by the states and funded through state and federal partnerships (Kaiser Family Foundation, Kaiser Commission on Medicaid and the Uninsured, 2013c). Medicaid provides health insurance and long-term care coverage for more than 60 million low-income children, adults, elderly persons, and persons with disabilities. Thirty-one million children (one in three) and more than 60% of residents in nursing homes depend on Medicaid to receive health care services. Under current federal regulations, states must provide Medicaid coverage for children younger than 6 years of age with family income up to 133% of the federal poverty level (FPL) and children ages 6 to 18 years with family income at or less than 100% of the FPL (Kaiser Family Foundation, Kaiser Commission on Medicaid and the Uninsured, 2013b). Children whose family incomes are between 100% and 200% of the FPL are eligible

Nursing Outlook, 1999

Rising costs of health care require advanced practice nurses to be cost-effective and knowledgeab... more Rising costs of health care require advanced practice nurses to be cost-effective and knowledgeable regarding reimbursement of their services within rapidly expanding managed care organizations. However, the rapid pace of change in reimbursement legislation, policies, and procedures makes this a daunting task.

Pediatrics, Sep 1, 2007

OBJECTIVE. The objective of this study was to measure the factors that are associated with Mycoba... more OBJECTIVE. The objective of this study was to measure the factors that are associated with Mycobacterium tuberculosis infection in international adoptees. METHODS. A retrospective chart review was conducted on 880 international adoptees who presented to the International Adoption Clinic at the University of Minnesota between 1986 and 2001. Five tuberculin units of purified protein derivative were placed intradermally on the left forearm. The largest diameter of induration was measured in millimeters between 48 and 72 hours. Nutritional status was assessed using anthropometric measures at initial screening. Data on age, birth country, and year of adoption were assessed. RESULTS. Adoptees (mean age: 26 months; range: 1–200 months; 62% female) came from 33 birth countries. Twenty-eight percent and 5% had evidence of chronic and acute malnutrition, respectively. Twelve percent had evidence of M tuberculosis infection. The odds of M tuberculosis infection increased 7% for each subsequent year during the period studied, increased 142% with each additional year of age for children ≤24 months of age at baseline screening, and increased 15% with each additional year of age for children >24 months of age at the time of evaluation. Tuberculin skin test induration response was not associated with nutritional status or birth region. CONCLUSIONS. Our study demonstrated a high prevalence of M tuberculosis infection and malnutrition in internationally adopted children, placing them at considerable risk for progression to tuberculosis disease. These findings also support current guidelines recommending completion of tuberculin screening immediately after adoption.

Maternal and Child Health Journal, 2021

Urban, low-income, African American children and parents report lower quality primary care and fa... more Urban, low-income, African American children and parents report lower quality primary care and face negative social determinants of health. High-quality well-child care is critical for this population. The purpose of this qualitative study was to compare and contrast parent and health care provider experiences of well-child care for urban, low-income, African American families to better understand the complex factors involved in care quality and health outcomes. Two data sets were analyzed using conventional content analysis, parent focus group data, and provider interviews. After analysis, results were sorted into similar categories, and convergence coding was completed to identify areas of agreement, partial agreement, dissonance, and silence. Thirty-five parents took part in four focus groups, and nine providers were interviewed. Following convergence coding, five categories and 31 subcategories were identified. The five categories included: social determinants of health, sources of advice and support, challenges with the healthcare system, parent-provider relationships, and anticipatory guidance topics. Triangulation demonstrated convergence between parents and providers understanding of the concepts and functions of well-child care, however the prominence and meaning varied within each category and sub-category. The variance in agreement, areas of silence, and dissonance shed light on why the population reports lower overall quality primary care.

Journal of Pediatric Nursing, 2021

Purpose: Well-child care is the foundation of pediatric health promotion and disease prevention. ... more Purpose: Well-child care is the foundation of pediatric health promotion and disease prevention. Primary care quality is lower for low-income and African American children compared to white children, and social determinants have an increasingly acknowledged impact on child health. Ensuring that high-quality well-child care fulfills its potential to mitigate the negative effects of social determinants on African American children is imperative. This study provides an understanding of urban, low-income, African American well-child care experiences and expectations. Design and methods: A qualitative, focus group method was used. A purposive, volunteer sample of low-income, African American parents with children birth to age five was recruited from St. Louis and Milwaukee. Focus groups were held in convenient, community sites. Data was audio-digitally recorded. Transcribed data were coded and analyzed through inductive content analysis. Results: Thirty-five caregivers, 86% females, participated in four focus groups. Categories (and sub-categories) identified include: Community factors (We want better schools, It's getting more rough where I live); Sources of parenting advice (Google it, Call your parent, Older remedies); System challenges (Cost, Frequent new faces, Politics); Challenges with providers (Couldn't help me, Missed something important, Treated differently, Are you really listening?); Anticipatory guidance (Breastfeeding, Discipline, Vaccines, Development); and What parents desire (Know them, trust). Conclusions: This study reveals the contexts that give rise to health care disparities and provides insight into parent's healthcare behaviors. Practice implications: Results offer providers guidance in providing well-child care for this population to improve pediatric care quality and child health.

Journal of Pediatric Health Care, 2005

Opinions about satisfaction with care are rarely solicited from children. This study&... more Opinions about satisfaction with care are rarely solicited from children. This study's purpose was to compare children's ratings of patient satisfaction with outpatient care to ratings given by parents. This descriptive and comparative survey study compared responses of a convenience sample of children and adolescents (n = 116) who received care at two metropolitan pediatric subspecialty clinics with their parents' responses (n = 115). Ratings were obtained using the "Satisfaction with Child Healthcare Survey," an instrument adapted with permission from the "Kids Count Survey" developed at McMaster Health Center in Ontario, Canada. Additionally, three open-ended questions were solicited and analyzed for major themes. There was moderate significant correlation between child-teen and parent scores. Parents rated care significantly higher than did the children. Children's responses to open-ended questions varied somewhat from their parents' opinions on various aspects of clinic visits. Findings suggested that having parents evaluate children's care may not accurately represent the views of children and teens. Findings supported children and teens' ability to provide valuable perceptions about care that can inform clinic improvement processes.

Journal of Pediatric Health Care, 2022

Environmentalists have forewarned that our planet is in peril because of serious degradation and ... more Environmentalists have forewarned that our planet is in peril because of serious degradation and pollution of the earth's land, air, water, and food sources. Climate change is present and worsening at an alarming rate. Gaping disparities exist between high-income and low-income countries and high-income and low-income zip codes in the United States, resulting in marginalized and vulnerable populations bearing the greatest burden from the ill effects of pollution and environmental toxins. Infants and children carry the greatest risk for pollution-related diseases and exposure to chemical toxins as their bodies are rapidly developing. This review article provides a historical overview of children's rights to protection from environmental health risks, effects of environmental injustice, and U.S. statutory and regulatory policies responsible for protecting food, air, and water quality. The authors advocate for policy and clinical strategies to support children's health and the right to environmental protection.

Journal of Pediatric Health Care, 2022

Journal of Pediatric Health Care

Journal of Nursing Regulation

Journal of Pediatric Health Care, 2015

Journal of Pediatric Health Care, 2015

Journal of Pediatric Health Care, 2015

Journal of Pediatric Health Care, 2014

Journal of Pediatric Health Care, 2014

Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners

Journal of Nursing Education and Practice, 2014

Introduction: The current state of our nation's healthcare delivery system, including inefficienc... more Introduction: The current state of our nation's healthcare delivery system, including inefficiencies in healthcare delivery, health disparities, and wasteful costs, accentuates the call for responsive action. Interprofessional education and collaborative practice (IPECP) has emerged as an innovative strategy for addressing many of these inadequacies through the restructuring of healthcare delivery systems and health professions education within the United States. This project was a five-week long course in a clinic setting on interprofessional education (IPE) that supplied basic knowledge of the field of IPECP and offered opportunities to apply knowledge gained in an interprofessional, collaborative manner. The project question was: Will learners exhibit a measurable change in attitudes underpinning a clinic-based culture after exposure to an IPE intervention aimed at guiding and shaping collaborative practice? Methods: This was a systems change project that implemented and assessed a pilot IPECP program. The IPE intervention consisted of a course comprised of two face-to-face sessions and five online modules for 15 pre-and post-licensure learners. Objectives were defined, and mixed methods were used for measurement and assessment, including a pre-and post-test design. Results: Pre-licensure learners showed high levels of engagement in the learning activities; post-licensure learners failed to meet online engagement objectives. All course learners demonstrated a shift in readiness to engage in IPECP. Quantitative findings were consistent with the qualitative data generated. Discussion: Findings suggested the beginnings of a shift in attitudes underpinning organizational culture. Findings also revealed barriers to IP learning and practice, including participant attitudes related to professional identity, assumptions about teamwork, and notions about hierarchy.

Journal of Pediatric Health Care, 2012

Accountable care organization, health care reform, integrated health system The rollout of health... more Accountable care organization, health care reform, integrated health system The rollout of health care reform legislation includes new approaches to care and payment models. These approaches are key to improving patient outcomes and decreasing health care costs nationally. One approach of the health care reform legislation to improve care coordination, ensure quality and safety, and reduce redundancy and waste is the accountable care organization (ACO). ACOs are provider-based organizations that assume responsibility and accountability for the quality, cost, and comprehensive care of a defined population of patients across the continuum of care (American Academy of Pediatrics [AAP], 2011; National Committee for Quality Assurance [NCQA], 2010; Rittenhouse, Shortell, & Fisher, 2009). ACOs are the topic of considerable legislation and rule making federally, some of which will affect pediatric care. In Section 3022 of the Affordable Care Act (P.L. 111-148), Congress established a Medicare Shared Savings Program to encourage the development of ACOs for Medicare beneficiaries. The Centers for Medicare and Medicaid (CMS) recently published their proposed rules to implement the Medicare Shared Savings Program (CMS-1345-P) for the care of Medicare patients. Also contained in the legislation is language calling for the Department of Health & Human Services to establish a Pediatric Demonstration Project to promote ACOs in Medicaid and Chil-drenÕs Health Insurance Programs (CHIPs) between 2012 and 2016. The CMS has not yet proposed ACO rules for Medicaid and CHIP; however, it is anticipated that the Medicaid and CHIP ACO programs will be largely modeled after the Medicare Shared Savings Program and ACO rules governing Medicare ACOs (AAP, 2011). Pediatric nurse practitioners (PNPs) need to understand basic structures and underlying principles of ACOs to be effective advocates for pediatric patients and NP roles within ACOs. This article presents an overview of ACO models and principles, describes anticipated risks and benefits for pediatric patients within models of care, proposes appropriate roles for PNPs within this new model of care, and outlines strategies for advocacy to improve access to high-quality pediatric care for children and families.

Journal of Pediatric Health Care, 2013

Medicaid is the largest provider of health insurance for children and adults in the United States... more Medicaid is the largest provider of health insurance for children and adults in the United States and provides critical financial support for the nationÕs safety net of clinics, hospitals, and long-term care facilities that serve the poor and uninsured. A major provision of the Patient Protection and Affordable Care Act (2010) expands the Medicaid program beginning in January 2014. This article will review current Medicaid enrollment and eligibility requirements and the change in funding mechanisms anticipated in the Affordable Care Act (ACA) Medicaid expansion. Implications of the June 2012 Supreme Court ruling on Medicaid expansion and the impact that expansion may hold for children and their families will be explored, along with providing strategies for ensuring that children and adolescents covered by Medicaid expansions continue to receive comprehensive health services for optimal growth and development. CURRENT MEDICAID ELIGIBILITY AND FUNDING MECHANISMS Medicaid is a federal entitlement program that is administered by the states and funded through state and federal partnerships (Kaiser Family Foundation, Kaiser Commission on Medicaid and the Uninsured, 2013c). Medicaid provides health insurance and long-term care coverage for more than 60 million low-income children, adults, elderly persons, and persons with disabilities. Thirty-one million children (one in three) and more than 60% of residents in nursing homes depend on Medicaid to receive health care services. Under current federal regulations, states must provide Medicaid coverage for children younger than 6 years of age with family income up to 133% of the federal poverty level (FPL) and children ages 6 to 18 years with family income at or less than 100% of the FPL (Kaiser Family Foundation, Kaiser Commission on Medicaid and the Uninsured, 2013b). Children whose family incomes are between 100% and 200% of the FPL are eligible

Nursing Outlook, 1999

Rising costs of health care require advanced practice nurses to be cost-effective and knowledgeab... more Rising costs of health care require advanced practice nurses to be cost-effective and knowledgeable regarding reimbursement of their services within rapidly expanding managed care organizations. However, the rapid pace of change in reimbursement legislation, policies, and procedures makes this a daunting task.