Exploring Health Literacy, Transition Readiness, and Healthcare Utilization in Medicaid Chronically Ill Youth.

PURPOSE: Youths with special healthcare needs face challenges transitioning from pediatric to adult health care. Understanding possible mechanisms contributing to poor healthcare transition could improve care. This study explores associations between health literacy (HL), transition readiness, and healthcare utilization. METHODS: Youths with special healthcare needs aged 12-18 years were recruited from a Medicaid accountable care organization (2012-2017). Outcome measures included transition readiness (Transition Readiness Assessment Questionnaire), and healthcare utilization (any well-check, hospitalization, emergency department [ED] visit, or ambulatory sensitive condition ED visit). Multivariate regression analyses examined whether HL (adequate vs. inadequate) predicted outcomes, after adjusting for covariates. Models were then created to examine whether the effect of HL on healthcare utilization was mediated by transition readiness. RESULTS: Among 417 youths with special healthcare needs, 67.1% reported adequate HL. Relative to inadequate HL, teens with adequate HL had significantly higher average Transition Readiness Assessment Questionnaire-20 scores (ß = .34, p < .001). Controlling for covariates, HL was a significant predictor of having an ambulatory sensitive condition ED visit and having any ED visits neared significance. There was a positive transition readiness mediation effect on having an ED visit, with higher transition readiness being associated with higher odds of having any ED visit in the mediation analysis. CONCLUSIONS: HL is independently associated with higher transition readiness and lower ambulatory sensitive condition ED use, but pathways of action require further study.

Racial disparities in clinic follow-up early in life among survivors of congenital heart disease.

OBJECTIVE: The current study aims to identify the rates of lapses in care and loss to follow-up before age one through age five for white and nonwhite congenital heart disease (CHD) survivors. Nonwhite CHD survivors were hypothesized to experience an earlier lapse in care and be lost to follow-up than whites. DESIGN: Patients were from a large pediatric hospital and had (1) at least one outpatient cardiology clinic visit or cardiac surgery visit before the age of one and (2) a diagnosis of moderate or complex structural CHD. Cardiology outpatient utilization rates were tracked from before age one through age five. Lapse in follow-up was defined as not having at least one outpatient cardiology visit per year, and loss to follow-up was not returning after a lapse in care by age five. Race was categorized as white and nonwhite. Covariates included sex, insurance type, noncardiology inpatient and outpatient hospital utilization, and CHD severity. RESULTS: The sample included 1034 patients. Overall, 75.7% experienced a lapse in care with only 41.6% of those returning by age five. Nonwhites experienced lapses in care at younger ages than whites. Nonwhites had a 53% increased risk of lapse in care. Medicaid patients and those with moderate CHD diagnoses also had an increased risk for lapse in care. CONCLUSIONS: Lapse in care appears prevalent among CHD survivors by age five, with nonwhites demonstrating elevated risk. Future multisite prospective studies should include the assessment of parental knowledge, barriers to accessing care, and satisfaction with care.

Quality Improvement Initiative to Improve Human Papillomavirus Vaccine Initiation at 9 Years of Age.

OBJECTIVE: Adolescent human papillomavirus (HPV) vaccine rates remain low. Early vaccination may improve the efficacy of the vaccine and immunization rates; however, clinicians have not routinely made a strong recommendation for younger adolescents. This study assessed the feasibility of routine vaccination at 9 years of age. METHODS: Three sequential quality improvement (QI) interventions were implemented to shift the initiation of the HPV vaccine to 9 years of age in a primary care network in low-income neighborhoods in Columbus, Ohio. The first intervention changed the electronic medical record alert for the HPV vaccine from 11 to 9 years of age and focused on cancer prevention when discussing the vaccine with families. The second intervention was formation of an HPV QI team. The third intervention was a clinic incentive for HPV captured opportunity rates. Immunization rates were monitored using statistical process control charts to compare the HPV immunization rate in a sample of 9- and 10-year-old children with a sample of 11- and 12-year-old children. RESULTS: The percentage of patients receiving an HPV vaccine before 11 years increased from 4.6% to 35.7% during the 6 months after the QI initiative began and to 60.8% 18 months after the project began. In comparison, the HPV vaccination rate in the sample of 11- and 12-year-olds increased from 78.7% to 82.8% 18 months later. CONCLUSIONS: This QI project used multiple interventions to increase HPV vaccination at 9 years of age in a large primary care network serving a diverse low-income population.

Health sensitivity: Age differences in the within-person coupling of individuals' physical health and well-being.

Well-being and physical health are central indicators of quality of life in old age. Research from a between-person difference perspective finds that people in better health than their peers also report higher well-being than their peers. However, we know very little about whether changes in one domain are accompanied by changes in the other domain, particularly at the within-person level. In the present study, we introduce the construct of health sensitivity, that is, how susceptible an individuals' well-being is to changes in physical health. In doing so, we used 9-wave longitudinal data covering 17 years from the Health and Retirement Study (N = 21,689; 50-109 year olds; 55% women) and applied multilevel modeling to examine the covariation of central indicators of well-being (depressive affect) and health (functional limitations) simultaneously at both the between-person and within-person level. At the within-person level, we found evidence of health sensitivity-on occasions when a typical person experienced more functional limitations than usual, he or she also reported more depressive affect-and that health sensitivity decreased with age. Survival analysis revealed that health sensitivity was related to mortality hazards, controlling for mean levels of health and well-being. We discuss the theoretical importance of examining within-person associations between health and well-being and consider practical implications. (PsycINFO Database Record

Examining the Interplay of Processes Across Multiple Time-Scales: Illustration With the Intraindividual Study of Affect, Health, and Interpersonal Behavior (iSAHIB).

Human development is characterized by the complex interplay of processes that manifest at multiple levels of analysis and time-scales. We introduce the Intraindividual Study of Affect, Health and Interpersonal Behavior (iSAHIB) as a model for how multiple time-scale study designs facilitate more precise articulation of developmental theory. Combining age heterogeneity, longitudinal panel, daily diary, and experience sampling protocols, the study made use of smartphone and web-based technologies to obtain intensive longitudinal data from 150 persons age 18-89 years as they completed three 21-day measurement bursts (t = 426 bursts, t = 8,557 days) wherein they provided reports on their social interactions (t = 64,112) as they went about their daily lives. We illustrate how multiple time-scales of data can be used to articulate bioecological models of development and the interplay among more 'distal' processes that manifest at 'slower' time-scales (e.g., age-related differences and burst-to-burst changes in mental health) and more 'proximal' processes that manifest at 'faster' time-scales (e.g., changes in context that progress in accordance with the weekly calendar and family influence processes).

Multidomain trajectories of psychological functioning in old age: a longitudinal perspective on (uneven) successful aging.

Life-span developmentalists have long been interested in the nature of and the contributing factors to successful aging. Using variable-oriented approaches, research has revealed critical insights into the intricacies of human development and successful aging. In the present study, we opted instead for a more subgroup-oriented approach and examined multiple-indicator information of late-life change at the person level. We applied latent profile analysis to 8-year longitudinal data pooled together across 4 Swedish studies of the oldest old (N = 1,008; Mage = 81 years at Time 1; 61% women). Results revealed 4 psychosocial aging profiles with uneven patterns of successful (and less successful) aging characterized by distinct trajectories of change across indicators of depressive symptoms, social, and memory functions: a preserved system integrity group of participants who maintained functioning across very old age; an aging in isolation group with a persistent lack of social support, and 2 groups of people with average well-being and social functions but distinctive memory profiles. A compromised memory group was characterized by poor memory throughout late life, whereas participants in a memory failing group exhibited dramatic memory declines late in life. The subgroups were also differentiated by sociodemographic characteristics, functional limitations, and mortality hazards, which may have served as antecedents, correlates, or consequents of profile trajectories. We discuss the promises and challenges of using subgroup-oriented approaches in the study of successful aging.