IU Indianapolis ScholarWorks :: Browsing by Author "Bauer, Nerissa S."

Browsing by Author "Bauer, Nerissa S."

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Acceptability of Group Visits for Attention-Deficit Hyperactivity Disorder in Pediatric Clinics
(Wolters Kluwer, 2017-10) Bauer, Nerissa S.; Azer, Nina; Sullivan, Paula D.; Szczepaniak, Dorota; Stelzner, Sarah M.; Downs, Stephen M.; Carroll, Aaron E.; Pediatrics, School of Medicine
OBJECTIVE: Children with attention-deficit hyperactivity disorder (ADHD) have ongoing needs that impair home and school functioning. Group visit models are a promising way to deliver timely parenting support but family and provider acceptance has not previously been examined. The objective was to describe the acceptability of ADHD group visits in busy pediatric clinics based on caregivers, child participants and facilitators. METHODS: Data were analyzed from school-age children and caregivers who participated in one of two 12-month long randomized controlled studies of the ADHD group visit model from 2012 to 2013 or 2014 to 2015. Feedback was obtained using semi-structured questions at each study end, by telephone or at the last group visit. Sessions were audio-recorded, transcribed and themes were extracted by participant type. RESULTS: A total of 34 caregivers, 41 children and 9 facilitators offered feedback. Caregivers enjoyed the "support group" aspect and learning new things from others. Caregivers reported improved understanding of ADHD and positive changes in the relationship with their child. Children were able to recall specific skills learned including how skills helped at home or school. Facilitators acknowledged systems-level challenges to offering group visits but felt the group format helped increase understanding of families' needs, improved overall care, and provided innovative ways to engage with families. CONCLUSION: The majority of comments from families and facilitators highlighted a variety of benefits of the use of a group visit model for ADHD chronic care. Despite systems-level barriers to implementation, families and facilitators felt the benefits outweighed the challenges.
Assessing Needs and Experiences of Preparing for Medical Emergencies Among Children with Cancer and Their Caregivers
(Wolters Kluwer, 2020-11) Mueller, Emily L.; Cochrane, Anneli R.; Moore, Courtney M.; Jenkins, Kelli B.; Bauer, Nerissa S.; Wiehe, Sarah E.; Pediatrics, School of Medicine
Background: Caregivers of children with cancer can experience stress when seeking care in the emergency department (ED). We sought to assess how caregivers prepare for and manage a medical emergency that arises in the community setting. Methods: A qualitative evaluation of ED visit preparations taken by children with cancer and their caregivers using self-reported interactive toolkits. Eligible participants included children with cancer (age: 11 to 21 y) currently receiving therapy for cancer diagnosis with an ED visit (besides initial diagnosis) within the previous 2 months and caregivers of same. Participants received a paper toolkit, which were structured as experience maps with several generative activities. Toolkits were transcribed, thematically coded, and iteratively analyzed using NVivo 12.0 software. Results: A total of 25 toolkits were received (7 children, 18 caregivers), with about three quarters of participants living >1 hour from the treating institution. Several important common themes and areas for improvement emerged. Themes included struggles with decision-making regarding when and where to seek ED care, preparing to go to the ED, waiting during the ED visit, repetition of information to multiple providers, accessing of ports, and provider-to-provider and provider-to-caregiver/patient communication. Conclusions: The information gained from this study has the potential to inform a tool to support this population in planning for and managing emergent medical issues. This tool has the potential to improve patient and caregiver satisfaction, patient-centered outcomes, and clinical outcomes.
Assessing Parenting Behaviors to Improve Child Outcomes
(American Academy of Pediatrics, 2015-02) O’Connell, Lauren K.; Davis, Matthew M.; Bauer, Nerissa S.; Pediatrics, School of Medicine
Associations between early exposure to intimate partner violence, parental depression and subsequent mental health outcomes
(JAMA, 2013-04) Bauer, Nerissa S.; Gilbert, Amy L.; Carroll, Aaron E.; Department of Pediatrics, IU School of Medicine
Objective: To examine the association between parent reports of intimate partner violence (IPV) and depressive symptoms within the first 3 years of a child’s life with subsequent mental health conditions and psychotropic drug treatment. Design: Prospective cohort study linking parental IPV and depression with subsequent billing and pharmacy data. Setting: 4 pediatric clinics between November 2004 and June 2012 Patients/Participants: 2,422 children Main Exposure: Any report of IPV and/or parental depressive symptoms from birth to 3 years of age. Main Outcome Measures: ICD-9 mental health diagnoses and any psychotropic drug treatment between 3 and 6 years of age. Results: 2.4% of caregivers (n=58) reported both IPV and depressive symptoms before their children were 3 years of age, 3% (n=69) of caregivers reported IPV only, 29% (n=704) reported depressive symptoms only, and 65.7% (n=1,591) reported neither exposure. Children of parents reporting both IPV and depressive symptoms were more likely to have a diagnosis of attention deficit hyperactivity disorder (ADHD) (AOR 4.0; 95% CI: 1.5-10.9), even after adjusting for child gender, race/ethnicity, and insurance type. Children whose parents reported depressive symptoms were more likely to have been prescribed psychotropic medication (AOR 1.9; 95% CI: 1.0-3.4). Conclusions: Exposure to both IPV and depression before 3 years is associated with preschool onset ADHD; and early exposure to parental depression is associated with being prescribed psychotropic medication.
Child exposure to parental violence and psychological distress associated with delayed milestones
(American Academy of Pediatrics (AAP), 2013-12) Gilbert, Amy Lewis; Bauer, Nerissa S.; Carroll, Aaron E.; Downs, Stephen M.; Department of Pediatrics, IU School of Medicine
OBJECTIVE: To examine the association between parental report of intimate partner violence (IPV) and parental psychological distress (PPD) with child attainment of developmental milestones. METHODS: By using data collected from a large cohort of primary care patients, this cross-sectional study examined the relationship between parental report of IPV and/or PPD and the attainment of developmental milestones within the first 72 months of a child's life. Multivariate logistic regression analyses were used to adjust for parental report of child abuse concern and sociodemographic characteristics. RESULTS: Our study population included 16 595 subjects. Children of parents reporting both IPV and PPD (n = 88; 0.5%) were more likely to fail at least 1 milestone across the following developmental domains: language (adjusted odds ratio [aOR] 2.1; 95% confidence interval [CI] 1.3-3.3), personal-social (aOR 1.9; 95% CI 1.2-2.9), and gross motor (aOR 3.0; 95% CI 1.8-5.0). Significant associations for those reporting IPV-only (n = 331; 2.0%) were found for language (aOR 1.4; 95% CI 1.1-1.9), personal-social (aOR 1.7; 95% CI 1.4-2.2), and fine motor-adaptive (aOR 1.7; 95% CI 1.0-2.7). Significant associations for those reporting PPD-only (n = 1920; 11.6%) were found for: language (aOR 1.5; 95% CI 1.3-1.7), personal-social (aOR 1.6; 95% CI 1.5-1.8), gross motor (aOR 1.6; 95% CI 1.4-1.8), and fine-motor adaptive (aOR 1.6; 95% CI 1.3-2.0). CONCLUSIONS: Screening children for IPV and PPD helps identify those at risk for poor developmental outcomes who may benefit from early intervention.
Computer decision support changes physician practice but not knowledge regarding autism spectrum disorders
(Schattauer, 2015) Bauer, Nerissa S.; Carroll, Aaron E.; Saha, Chandan K.; Downs, Stephen M.; Department of Pediatrics, Indiana University School of Medicine
Objective: To examine whether adding an autism module promoting adherence to clinical guidelines to an existing computer decision support system (CDSS) changed physician knowledge and self-reported clinical practice. Methods: The CHICA (Child Health Improvement through Computer Automation) system, a CDSS, was enhanced with a module to improve management of autism in 2 of the 4 community pediatric clinics using the system. We examined the knowledge and beliefs of pediatric users using cross-sectional surveys administered at 3 time points (baseline, 12 months and 24 months post-implementation) between November 2010 and January 2013. Surveys measured knowledge, beliefs and self-reported practice patterns related to autism. Results: A total of 45, 39, and 42 pediatricians responded at each time point, respectively, a 95-100% response rate. Respondents’ knowledge of autism and perception of role for diagnosis did not vary between control and intervention groups either at baseline or any of the two post-intervention time points. At baseline, there was no difference between these groups in rates in the routine use of parent-rated screening instruments for autism. However, by 12 and 24 months post-implementation there was a significant difference between intervention and control clinics in terms of the intervention clinics consistently screening eligible patients with a validated autism tool. Physicians at all clinics reported ongoing challenges to community resources for further work-up and treatment related to autism. Conclusions: A CDSS module to improve primary care management of ASD in pediatric practice led to significant improvements in physician-reported use of validated screening tools to screen for ASDs. However it did not lead to corresponding changes in physician knowledge or attitudes.
Effect of a Computer-Based Decision Support Intervention on Autism Spectrum Disorder Screening in Pediatric Primary Care Clinics: A Cluster Randomized Clinical Trial
(JAMA Network, 2019-12-02) Downs, Stephen M.; Bauer, Nerissa S.; Saha, Chandan; Ofner, Susan; Carroll, Aaron E.; Pediatrics, School of Medicine
Importance: Universal early screening for autism spectrum disorder (ASD) is recommended but not routinely performed. Objective: To determine whether computer-automated screening and clinical decision support can improve ASD screening rates in pediatric primary care practices. Design, Setting, and Participants: This cluster randomized clinical trial, conducted between November 16, 2010, and November 21, 2012, compared ASD screening rates among a random sample of 274 children aged 18 to 24 months in urban pediatric clinics of an inner-city county hospital system with or without an ASD screening module built into an existing decision support software system. Statistical analyses were conducted from February 6, 2017, to June 1, 2018. Interventions: Four clinics were matched in pairs based on patient volume and race/ethnicity, then randomized within pairs. Decision support with the Child Health Improvement Through Computer Automation system (CHICA) was integrated with workflow and with the electronic health record in intervention clinics. Main Outcomes and Measures: The main outcome was screening rates among children aged 18 to 24 months. Because the intervention was discontinued among children aged 18 months at the request of the participating clinics, only results for those aged 24 months were collected and analyzed. Rates of positive screening results, clinicians' response rates to screening results in the computer system, and new cases of ASD identified were also measured. Main results were controlled for race/ethnicity and intracluster correlation. Results: Two clinics were randomized to receive the intervention, and 2 served as controls. Records from 274 children (101 girls, 162 boys, and 11 missing information on sex; age range, 23-30 months) were reviewed (138 in the intervention clinics and 136 in the control clinics). Of 263 children, 242 (92.0%) were enrolled in Medicaid, 138 (52.5%) were African American, and 96 (36.5%) were Hispanic. Screening rates in the intervention clinics increased from 0% (95% CI, 0%-5.5%) at baseline to 68.4% (13 of 19) (95% CI, 43.4%-87.4%) in 6 months and to 100% (18 of 18) (95% CI, 81.5%-100%) in 24 months. Control clinics had no significant increase in screening rates (baseline, 7 of 64 children [10.9%]; 6-24 months after the intervention, 11 of 72 children [15.3%]; P = .46). Screening results were positive for 265 of 980 children (27.0%) screened by CHICA during the study period. Among the 265 patients with positive screening results, physicians indicated any response in CHICA in 151 (57.0%). Two children in the intervention group received a new diagnosis of ASD within the time frame of the study. Conclusions and Relevance: The findings suggest that computer automation, when integrated with clinical workflow and the electronic health record, increases screening of children for ASD, but follow-up by physicians is still flawed. Automation of the subsequent workup is still needed.
Experience with decision support system and comfort with topic predict clinicians’ responses to alerts and reminders
(Oxford, 2016-04) Bauer, Nerissa S.; Carroll, Aaron E.; Saha, Chandan; Downs, Stephen M.; Department of Pediatrics, IU School of Medicine
Objective Clinicians at our institution typically respond to about half of the prompts they are given by the clinic’s computer decision support system (CDSS). We sought to examine factors associated with clinician response to CDSS prompts as part of a larger, ongoing quality improvement effort to optimize CDSS use. Methods We examined patient, prompt, and clinician characteristics associated with clinician response to decision support prompts from the Child Health Improvement through Computer Automation (CHICA) system. We asked pediatricians who were nonusers of CHICA to rate decision support topics as “easy” or “not easy” to discuss with patients and their guardians. We analyzed these ratings and data, from July 1, 2009 to January 29, 2013, utilizing a hierarchical regression model, to determine whether factors such as comfort with the prompt topic and the length of the user’s experience with CHICA contribute to user response rates. Results We examined 414 653 prompts from 22 260 patients. The length of time a clinician had been using CHICA was associated with an increase in their prompt response rate. Clinicians were more likely to respond to topics rated as “easy” to discuss. The position of the prompt on the page, clinician gender, and the patient’s age, race/ethnicity, and preferred language were also predictive of prompt response rate. Conclusion This study highlights several factors associated with clinician prompt response rates that could be generalized to other health information technology applications, including the clinician’s length of exposure to the CDSS, the prompt’s position on the page, and the clinician’s comfort with the prompt topic. Incorporating continuous quality improvement efforts when designing and implementing health information technology may ensure that its use is optimized.
Follow-up of Mothers with Suspected Postpartum Depression from Pediatrics Clinics
(Frontiers, 2017-10-03) Bauer, Nerissa S.; Ofner, Susan; Pottenger, Amy; Carroll, Aaron E.; Downs, Stephen M.; Pediatrics, School of Medicine
Purpose Pediatric providers are increasingly screening for postpartum depression (PD), yet, it is unknown how often mothers comply with recommendations to seek treatment. The objectives were to describe the rate at which mothers with suspected PD seek treatment and explore factors that predict help-seeking behavior. Design and methods Mothers were recruited from four pediatric clinics after identification using the Child Health Improvement through Computer Automation (CHICA) system. Mothers with a positive screen were invited to participate in a telephone interview between January 2012 and December 2014. Mothers reported if they sought treatment or called a community resource. Results 73 of 133 eligible mothers participated (55% response rate). Fifty women recalled a recommendation to seek help. Only 43.8% (32/73) made a follow-up appointment with an adult provider and even fewer kept the appointment. Conclusion A majority of mothers suspected of having PD recalled a referral for further intervention; yet, less than half took action. Further investigation of barriers of help-seeking behavior is warranted.
Group Visits to Improve Pediatric ADHD Chronic Care Management
(Lippincott, Williams, and Wilkins, 2015-10) Bauer, Nerissa S.; Szczepaniak, Dorota; Sullivan, Paula D.; Mooneyham, GenaLynne; Pottenger, Amy; Johnson, Cynthia S.; Downs, Stephen M.; Department of Pediatrics, IU School of Medicine
Objective: Children with attention-deficit hyperactivity disorder (ADHD) may experience continued impairment at home and school even after medication initiation. Group visits offer a way for pediatricians to provide more time to address ongoing needs. A pilot study was undertaken to examine whether a group visit model improved ADHD management in the pediatric medical home. Methods: Parents and children aged 6 to 18 years with ADHD were recruited and randomized to group visits or a usual care control. Data included attendance at ADHD follow-up visits, parent-rated ADHD symptoms, adaptive functioning, and quality of life. Longitudinal linear mixed models (continuous variables) and generalized linear mixed models (binary outcomes) were used to compare groups. In our statistical models, child and family were random effects; study assignment was a fixed effect. Results: Twenty families representing 29 children participated (intervention: 9 parents/13 children and control: 11 parents/16 children). Aside from race, baseline characteristics of participants were similar. None of the intervention families missed the expected 5 ADHD follow-up visits over 1 year; control families missed 1 or more visits over the same period. Intervention families reported an improved level of adaptive functioning at 12 months compared with control (mean severity score: 3.7 vs 4.4, p = .003). All families reported greater limitations and poorer quality of life compared with national norms. Conclusion: Group visits in the pediatric medical home can improve adherence, and preliminary results show a variety of improvements for the family.

Browsing by Author "Bauer, Nerissa S."

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