2023-09-28 14:46:10 +00:00
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abstract: 'The United States pediatric population with chronic health conditions is
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expanding. Currently, this demographic comprises 12-18\% of the American
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child and youth population. Affected children often receive fragmented,
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uncoordinated care. Overall, the American health care delivery system
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produces modest outcomes for this population. Poor, uninsured and
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minority children may be at increased risk for inferior coordination of
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services. Further, the United States health care delivery system is
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primarily organized for the diagnosis and treatment of acute conditions.
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For pediatric patients with chronic health conditions, the typical acute
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problem-oriented visit actually serves as a barrier to care. The
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biomedical model of patient education prevails, characterized by
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unilateral transfer of medical information. However, the evidence basis
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for improvement in disease outcomes supports the use of the chronic care
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model, initially proposed by Dr. Edward Wagner. Six inter-related
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elements distinguish the success of the chronic care model, which
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include self-management support and care coordination by a prepared,
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proactive team.
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United States health care lacks a coherent policy direction for the
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management of high cost chronic conditions, including rheumatic
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diseases. A fundamental restructure of United States health care
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delivery must urgently occur which places the patient at the center of
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care. For the pediatric rheumatology workforce, reimbursement policies
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and the actions of health plans and insurers are consistent barriers to
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chronic disease improvement. United States reimbursement policy and
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overall fragmentation of health care services pose specific challenges
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for widespread implementation of the chronic care model. Team-based
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multidisciplinary care, care coordination and self-management are
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integral to improve outcomes.
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Pediatric rheumatology demand in the United States far exceeds available
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workforce supply. This article reviews the career choice decision-making
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process at each medical trainee level to determine best recruitment
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strategies. Educational debt is an unexpectedly minor determinant for
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pediatric residents and subspecialty fellows. A two-year fellowship
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training option may retain the mandatory scholarship component and
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attract an increasing number of candidate trainees. Diversity, work-life
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balance, scheduling flexibility to accommodate part-time employment, and
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reform of conditions for academic promotion all need to be addressed to
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ensure future growth of the pediatric rheumatology workforce.'
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affiliation: 'Henrickson, M (Corresponding Author), Cincinnati Childrens Hosp, Med
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Ctr, Div Rheumatol, MLC 4010,3333 Burnet Ave, Cincinnati, OH 45229 USA.
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Cincinnati Childrens Hosp, Med Ctr, Div Rheumatol, Cincinnati, OH 45229 USA.'
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article-number: '24'
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author: Henrickson, Michael
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author-email: michael.henrickson@cchmc.org
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author_list:
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- family: Henrickson
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given: Michael
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da: '2023-09-28'
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doi: 10.1186/1546-0096-9-23
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eissn: 1546-0096
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files: []
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journal: PEDIATRIC RHEUMATOLOGY
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keywords: pediatric rheumatology; pediatric subspecialty; policy; workforce
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keywords-plus: 'CONTROLLABLE LIFE-STYLE; CHRONIC ILLNESS CARE; SPECIALTY CHOICE;
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SUBSPECIALTY WORKFORCE; FELLOWS PERSPECTIVES; MEDICAL-STUDENTS; FUTURE
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SCOPE; CHILDREN; MODEL; MANAGEMENT'
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language: English
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month: AUG 16
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number-of-cited-references: '80'
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papis_id: de5e899756fe6a6679cbb00d497656dc
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ref: Henrickson2011policychallenges
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researcherid-numbers: Henrickson, Michael/AAE-8221-2022
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tags:
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- review
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times-cited: '21'
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title: 'Policy challenges for the pediatric rheumatology workforce: Part II. Health
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care system delivery and workforce supply'
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000294857600001
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usage-count-last-180-days: '1'
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usage-count-since-2013: '8'
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volume: '9'
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web-of-science-categories: Pediatrics; Rheumatology
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year: '2011'
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