Browsing by Author "Yazel-Smith, Lisa"

Now showing 1 - 6 of 6
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    Clinician Perceptions of a Computerized Decision Support System for Pediatric Type 2 Diabetes Screening
    (Thieme, 2020-03) El Mikati, Hala K.; Yazel-Smith, Lisa; Grout, Randall W.; Downs, Stephen M.; Carroll, Aaron E.; Hannon, Tamara S.; Pediatrics, School of Medicine
    Objective: With the increasing prevalence of type 2 diabetes (T2D) in youth, primary care providers must identify patients at high risk and implement evidence-based screening promptly. Clinical decision support systems (CDSSs) provide clinicians with personalized reminders according to best evidence. One example is the Child Health Improvement through Computer Automation (CHICA) system, which, as we have previously shown, significantly improves screening for T2D. Given that the long-term success of any CDSS depends on its acceptability and its users' perceptions, we examined what clinicians think of the CHICA diabetes module. Methods: CHICA users completed an annual quality improvement and satisfaction questionnaire. Between May and August of 2015 and 2016, the survey included two statements related to the T2D-module: (1) "CHICA improves my ability to identify patients who might benefit from screening for T2D" and (2) "CHICA makes it easier to get the lab tests necessary to identify patients who have diabetes or prediabetes." Answers were scored using a 5-point Likert scale and were later converted to a 2-point scale: agree and disagree. The Pearson chi-square test was used to assess the relationship between responses and the respondents. Answers per cohort were compared using the Mann-Whitney U-test. Results: The majority of respondents (N = 60) agreed that CHICA improved their ability to identify patients who might benefit from screening but disagreed as to whether it helped them get the necessary laboratories. Scores were comparable across both years. Conclusion: CHICA was endorsed as being effective for T2D screening. Research is needed to improve satisfaction for getting laboratories with CHICA.
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    Feasibility of Implementing Community Partnerships to Provide Diabetes Prevention Services to Youth
    (Springer, 2019-02) Pike, Julie M.; Yazel-Smith, Lisa; Haberlin, Kathryn M.; Hannon, Tamara S.; Pediatrics, School of Medicine
    Type 2 diabetes (T2D) in youth has increased as a result of the obesity epidemic. Diabetes prevention programming is needed for youth, at risk for T2D, and their families. However, there is a lack of diabetes prevention services for this population. There is evidence for the benefit of lifestyle modification for decreasing diabetes risk, however there are barriers for youth to access these services in a traditional clinical setting. Our Youth Diabetes Prevention Clinic (YDPC) created partnerships within the community to increase access to diabetes prevention services for at risk youth. YDPC personnel approached community organizations who had the expertise and capacity to partner in needed areas. These partnerships allowed for the development and facilitation of a community-based diabetes prevention group. Youth and their families participated in a 12 week diabetes prevention group. We measured attendance and participant satisfaction with the program. Families attended an average of 5.1 sessions from January to October 2016. Participant satisfaction was collected five times. Physical activity was rated as “awesome” or “good” by 88% of the respondents. The nutrition activities were rated as “awesome” or “good” by 97% of respondents. Physicians and families express a desire for diabetes prevention services, however barriers make it difficult for families to fully participate. Creating partnerships within the community allows for increased access to diabetes prevention services for high-risk, underserved families.
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    Forever-Fit Summer Camp: The Impact of a 6-Week Summer Healthy Lifestyle Day Camp on Anthropometric, Cardiovascular, and Physical Fitness Measures in Youth With Obesity
    (SAGE, 2020-01) El Mikati, Hala K.; Boateng, Anthony O.; McKinney, Brett M.; Haberlin-Pittz, Katie; Pike, Julie; Perry, Patrick; Hannon, Tamara S.; Yazel-Smith, Lisa; Medicine, School of Medicine
    Pediatric obesity is a public health concern with lifestyle intervention as the first-line treatment. Forever-Fit Summer Camp (FFSC) is a 6-week summer day program offering physical activity, nutrition education, and well-balanced meals to youth at low cost. The aim of the study was to assess the efficacy of this program that does not emphasize weight loss rather emphasizes healthy behaviors on body mass index, cardiovascular and physical fitness. Methods: The inclusion criteria were adolescents between 8 and 12 years and body mass index (BMI) ≥85th percentile. The data were collected at baseline and week 6 (wk-6) and was analyzed for 2013-2018 using paired-sample t tests. Results: The participants' (N = 179) average age was 10.6 ± 1.6 years with a majority of females (71%) and black race/ethnicity (70%). At wk-6, BMI and waist circumference decreased by 0.8 ± 0.7 kg/m2 and 1.0 ± 1.3 in, respectively. Resting heart rate, diastolic and systolic blood pressure decreased by 8.5 ± 11.0 bpm, 6.3 ± 8.8 mmHg, and 6.4 ± 10.1 mmHg, respectively. The number of pushups, curl-ups, and chair squats were higher by 5.8 ± 7.5, 6.7 ± 9.1, and 7.7 ± 8.5, respectively. Conclusion: The FFSC is efficacious for improving BMI, cardiovascular, and physical fitness in the short term. The effect of similar episodic efforts that implement healthy lifestyle modifications throughout the school year should be investigated.
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    Health Educator Perspectives on Seeking Medicaid Reimbursement in Indiana
    (Sage, 2019) Yazel-Smith, Lisa; Hancher-Rauch, Heidi L.; Britt-Spells, Angelitta; Pediatrics, School of Medicine
    Health education is a growing field. However, there is confusion about the role delineation of health education specialists (HES) and other health education (HE) providers. Additionally, recent reimbursement opportunities allow employers to bill for HE services but offer confusing language regarding eligible service-providing professionals. This study surveyed health educators in Indiana to assess knowledge, attitudes, and perceived abilities to bill Medicaid and other insurers for HE services. Using a cross-sectional research design, an original 22-item Web-based questionnaire was developed and distributed to all Certified Health Education Specialist/Master Certified Health Education Specialist (CHES/MCHES) practitioners residing in Indiana. Additional respondents were recruited using a snowball technique, as original respondents asked to share the survey with colleagues. A final data set of 61 respondents was analyzed. All respondents’ organizations provided HE services, with the majority indicating they do not charge and do not bill for HE services. Additionally, 60% of the respondents agreed that HES should be reimbursed for services, and the vast majority believed reimbursement to be important for the field. With recent reimbursement opportunities for HE and preventative health services, it is important that HES advocate for the profession and for potential reimbursement opportunities, such as Medicaid, to enhance the field and support HES jobs.
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    Integrating Diabetes Prevention Education Among Teenagers Involved in Summer Employment: Encouraging Environments for Health in Adolescence (ENHANCE)
    (Springer, 2020-08) Yazel-Smith, Lisa; El-Mikati, Hala K.; Adjei, Michael; Haberlin-Pittz, Kathryn M.; Agnew, Megan; Hannon, Tamara S.; Pediatrics, School of Medicine
    Type 2 diabetes (T2D) in youth is a growing healthcare and public health concern. It is costly, and youth suffer from disabling and deadly comorbid conditions at a faster pace than adult onset. However, T2D is preventable. The population of obese youth at greatest risk for T2D is of minority race/ethnicity and socioeconomically disadvantaged background, which creates barriers to health promoting lifestyles. Despite being the first line of prevention efforts for T2D, efficacious behavioral lifestyle interventions are still lacking at the community level. During the summers of 2016 and 2017, a study integrated obesity and diabetes prevention health education into TeenWorks summer employment program at Indy Urban Acres in Indianapolis, Indiana. Results were analyzed using paired sample t-tests. Participants (N = 168) had a mean age of 15.8 ± 0.7 years, 61% female, 13% Hispanic, 80% Black. By the end of the intervention, physical activity (p = 0.000) and prevention knowledge (p = 0.000) were significantly higher. Dietary intake (p = 0.204), self-efficacy (p = 0.58), food insecurity (p = 0.058) and depression screening scores (p = 0.809) were not significantly different. In light of the continuing childhood obesity epidemic and increasing prevalence of prediabetes and T2D in youth, there is a pressing need to understand and reduce barriers to obesity and diabetes prevention in high-risk populations. This study demonstrated the feasibility of integrating obesity and T2D prevention health education into a teen summer employment program.
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    Short-Term Change in Measures of Glycemia in Obese Youth Meeting Criteria for Prediabetes: A Retrospective Chart Review
    (Karger, 2020) El Mikati, Hala K.; McKinney, Brett M.; Yazel-Smith, Lisa; Alders, Sarah E.; Hannon, Tamara S.; Pediatrics, School of Medicine
    Background: The prevalence of youth diagnosed with prediabetes is increasing, yet there is a lack of guidelines on how to manage this condition clinically. Objectives: The aim was to determine the short-term outcomes of patients referred with prediabetes and to determine predictors of worsening dysglycemia in youth. Study Design: This is a retrospective chart review of patients referred to our Youth Diabetes Prevention Clinic (YDPC) with laboratory tests indicating an increased risk for type 2 diabetes (T2D). We defined glycemic categories by HbA1c with normoglycemia as HbA1c <5.7%, prediabetes I (P1) as HbA1c 5.7 to <6.0%, and prediabetes II (P2) as HbA1c 6.0 to <6.5%. We compared HbA1c at the time of referral (screening HbA1c) and at the YDPC visit (YDPC HbA1c) to assess for improvement or worsening. Multinomial logistic regression was used to assess predictors of prediabetes. Results: Among 562 patients seen, 336 had both screening and YDPC HbA1c values. Race (p < 0.001) and screening glycemic category (p < 0.001) were significantly associated with dysglycemia at the YDPC visit, while sex (p = 0.50), BMI z-score change (p = 0.27), and days from referral (p = 0.83) were not. As compared to those who reverted to normoglycemia, patients with prediabetes at YDPC were 7 times more likely to have a higher screening HbA1c (both P1 and P2). The majority of patients referred with prediabetes had lower HbA1c at the YDPC (75.4–82.6%). Conclusion: Patients with screening HbA1c <6% might benefit from a 4-month follow-up at primary care while recommending lifestyle changes. Patients of minority race and screening HbA1c ≥6% are more likely to have a persistent elevation of HbA1c.