Allan Joseph (@allanmjoseph.bsky.social)
@allanmjoseph
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I take care of critically ill kids, study the systems in which we take care of them, and try to make those systems better.
Cincinnati, OH
Joined June 2009
I want to highlight some new work just published in @JPediatr developing the concept of "pediatric hospital referral regions": https://t.co/TafdrpVFDs Most health services researchers know of the Dartmouth Atlas, but I've always wondered if they work for pediatrics.
jpeds.com
To develop a set of pediatric acute care hospital referral regions for use in studying pediatric acute care delivery and test their utility relative to other regional systems.
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This raises some questions for future work: namely, if we can identify these kids in the prehospital setting, can/should we send them straight to highly capable hospitals that have Pediatric ICU services? Can we improve outcomes this way?
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Unsurprisingly, the pediatric critical care system is mostly a hub-and-spoke design. More surprisingly, though, is that 24% of transferred children (and almost 40% of children in urban areas) ultimately end up in an ICU that wasn't much farther from their home than the first ED.
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Happy to share another project from fellowship, now out in @CritCareExplore, describing the geospatial relationships among where critically ill children live, where they first go for care, and where they ultimately end up in an ICU: https://t.co/upIhUIVJJ2
journals.lww.com
distances between the patient’s residence and the hospitals in which they receive care. DESIGN, SETTING, AND PARTICIPANTS: Retrospective geospatial analysis using five U.S. state-level administrative...
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For now, I suggest that researchers studying pediatric acute care in our included states use these regions to study variation in acute care. Online now, including links to the regions themselves: https://t.co/TafdrpVFDs
jpeds.com
To develop a set of pediatric acute care hospital referral regions for use in studying pediatric acute care delivery and test their utility relative to other regional systems.
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In short, the answer is that using pediatric-specific regions does seem to work better than using the Dartmouth Atlas. The next steps are to figure out how to make a national Atlas, which has always been precluded by the lack of a truly national dataset. We're working on it.
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Pediatric and adult acute-care systems are increasingly different, with more centralization in pediatric care. So it's not clear the Dartmouth Atlas will work to study pediatric acute care. We developed regions using pediatric all-payer data in 8 states to answer this question.
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🎉Congratulations to STAT Wunderkind, Michael Ann Kyle! Dedicated to transforming the healthcare system from bedside care to policy research, @michaelannica is focused on alleviating patients' administrative burdens. Read more: https://t.co/b1ETN71uaS
@statnews @harvardmed
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As a self-indulgent birthday gift from me to me, I'm threading some of my fav posts from back When This Website Was Great
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In case you didn't see it yet, my profile of @TedNesi and @KimKalunian is now LIVE on the @RIMonthly website! Really enjoyed getting to write about these true media pros and overall fantastic humans (and Samantha stole the show, of course).
rimonthly.com
It’s a Thursday afternoon in late May, the time of year when careers are made and deals brokered at the Rhode Island State House. In the House chamber,
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Family visits @CincyKidsPCCM to thank doctors that saved daughter from rare virus
local12.com
A short time later, her symptoms were so bad that she needed critical care.
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🎶 everything old is new again #tbt also to my 2017 NEJM editorial with @nicholas_bagley and @allanmjoseph
https://t.co/1Uue8UhgUV
nejm.org
The Trump administration may decide to permit states to partially expand their Medicaid programs to cover people with incomes up to 100% of the federal poverty level. Arkansas has requested a waive...
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"Researchers incensed over CMS data access change," with quotes from @asacarny and @A_Schwa (Accurate.) https://t.co/9oCHkNqONt
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Incredibly excited to join the faculty at Cincinnati Children's Hospital this summer - so thankful to all the amazing people who have supported me over the last 10+ years, and especially to @CHPPedSDP and @PCCMPittsburgh for truly incredible training. Pumped for what's next!
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International Consensus Criteria for Pediatric Sepsis and Septic Shock Out in @JAMA_current CCR Journal Watch https://t.co/Sp06oA6IDG Get the latest critical care literature every weekend via the CCR Newsletter - subscribe at https://t.co/nitMzacLrj
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That time somehow, some way, @allanmjoseph, @_Andrew_Owens and I ended up in an SI Cover Story.
Show us a Sports Illustrated cover that you will remember forever.
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A fantastic overview of this trend. Dr. Bruch's session on this at #ARM23 was literally standing-room-only - if you weren't there, read this, and think about what it means for American healthcare.
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This is a specific example of common problem: pediatric-specific drug studies are usually underpowered to detect important side effects. The median study for pediatric safety is really small, and half don't have control groups: https://t.co/Y30vw4xoXu
After 25 years, the concerns persist. Scientists are starting to study how a drug targeted at the airways might affects the brain. Meanwhile, many patients say their doctors did not warn them about the drug's possible side effects. W/ @benjmueller:
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When I was leafing through my parents @NatGeo’s as a kid, I could have never imagined I would be part of something so cool that I’d ever be amongst its pages. I am floored by this article on the children & families our #PedPC division @ChildrensPgh serves. @PittPediatrics #hapc
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