Assessment of Metal Concentrations and Associations with Pulmonary Function among Children with Asthma in Chicago, Illinois.

Individuals living in areas with the potential for elevated metal exposure from industrial sources may have reduced pulmonary function. We evaluated cross-sectional associations of toenail concentrations of 17 metals within a community area of residence and asthma control in 75 children, and pulmonary function measures [forced expiratory volume in one second (FEV1; liters), forced vital capacity (FVC; liters), FEV1 to FVC ratio (FEV1:FVC), and mid-exhalation forced expiratory flow rate (FEF 25-75%; liters/second)], in a subsample of 39 children with diagnosed asthma in Chicago, Illinois. Linear regression models were used to estimate adjusted regression coefficients and standard errors (SE) for the associations between ≥ median versus

A Telehealth Initiative to Decrease No-Show Rates in a Pediatric Asthma Mobile Clinic.

BACKGROUND/PROBLEM: Failed patient care appointments (no-shows) can lead to negative patient health outcomes and increased healthcare costs. There is evidence that telehealth is a safe, effective, and a cost-efficient option for those unable to attend in-person visits. No-show rates in pediatrics are unique due to reliance on caregivers to attend appointments. A pediatric asthma mobile van, which provides specialty care to children at schools in low-income communities in Chicago, was experiencing a high no-show rate. METHODS/INTERVENTIONS: Building on evidence that the use of telehealth technology improves access to care, the purpose of this quality improvement initiative was to implement a new telehealth option for off-site parents to attend their child's on-site appointment. The designed initiative followed the Plan-Do-Study-Act model with three small phases of change. The first phase assessed telehealth interest using a Likert-scale questionnaire. The second phase designed and implemented a telehealth option and collected no-show rates pre- and post- implementation. The final phase assessed parental satisfaction using a Telehealth Usability Questionnaire. RESULTS: Over 50% of participants stated interest in the parent off-site telehealth option for their child's appointment. No-show rates decreased from 36% to 7.9%-18% per month over a 10-month implementation period. Post-telehealth surveys completed by parents revealed this version of telehealth improved access to care for their child, saved them time, and was simple to use. CONCLUSION: No-show rates decreased after successful implementation of an innovative approach to telehealth. This parent off-site telehealth model can be another approach toward increasing pediatric healthcare access.