Debra Lotstein

University of California, Los Angeles | UCLA · Department of Pediatrics

Background and objectives: The transition from pediatric to adult health care is a vulnerable period for youth with special health care needs. Although successful transitions are recognized as critical for improving adult outcomes and reducing health care utilization and cost, an educational gap in health care transitions for physicians persists....

This document contains a template that public health agencies can use to conduct a workshop to improve key aspects of Strategic National Stockpile (SNS) planning: pediatric dispensing, altered standards of care, and allocation of scarce resources. The template is designed to support health departments in both identifying gaps and developing concret...

Objective: To examine current US performance on transition from pediatric to adult health care and discuss strategies for improvement. Methods: The 2009-2010 National Survey of Children with Special Health Care Needs is a nationally representative sample with 17 114 parent respondents who have youth with special health care needs (YSHCN) ages 12...

Objective: Youth with type 1 diabetes mellitus are at risk for poor glycemic control as they age into adulthood. The aim of this study was to describe sociodemographic and clinical correlates of poor glycemic control associated with the transfer of care from pediatric to adult diabetes providers among a cohort of youth with type 1 diabetes diagnos...

Background: Despite over 500,000 adolescents with special health care needs transitioning to adulthood each year, limited information is available on their health status or their access to care after transition. Objective: To describe the change in health status and access to care of a nationally sampled, longitudinal cohort of young adults with...

Health working paper series. RAND working papers are intended to share researchers ’ latest findings and to solicit informal peer review. They have been approved for circulation by RAND Health but have not been formally edited or peer reviewed. Unless otherwise indicated, working papers can be quoted and cited without permission of the author, prov...

Although the transition to adulthood for youth with special health care needs (YSHCN) has been gathering attention, the impact of racial and ethnic disparities on this process has been relatively unexamined. In this review, we explore evidence of disparities in the transition to adulthood for YSHCN, which is important because the problems that YSHC...

To understand how early childhood developmental services are provided in other countries in comparison with the United States. Recent surveys document gaps in developmental services provided in the United States. Understanding pediatrician roles in other industrialized countries may shed light on how to meet emerging professional expectations aroun...

Many youth with special health care needs have difficulties transferring to adult medical care. To address this, the Maternal and Child Health Bureau has made receipt of transition services a core performance outcome for community-based systems of care for youth with special health care needs. In this article we describe the results for the transit...

The lack of frequent real-world opportunities to study preparedness for large-scale public health emergencies has hindered the development of an evidence base to support best practices, performance measures, standards, and other tools needed to assess and improve the nation's multibillion dollar investment in public health preparedness. In this art...

Transition of care from pediatric to adult-oriented health care providers is difficult for children with special health care needs. Children who have received solid organ transplants and their providers experience the same difficulties and frustrations as children with other major illnesses. A consensus conference was organized by several transplan...

Many public health departments seek to improve their capability to respond to large-scale events such as an influenza pandemic. Quality improvement (QI), a structured approach to improving performance, has not been widely applied in public health. We developed and tested a pilot QI collaborative to explore whether QI could help public health depart...

To describe access to care and identify factors associated with access for low-income young adults who aged out of a public program for children with special health care needs (CSHCN). This was a cross-sectional survey of graduates of the Title V CSHCN program in one California county. Subjects were 77 graduates (55% female) aged 21-24 years with o...

Quality improvement (QI) methods have been used in many industries to improve performance and outcomes. This chapter reviews key QI concepts and their application to public health emergency preparedness (PHEP). We conclude that for QI to flourish and become standard practice, changes to the status quo are necessary. In particular, public health sho...

The increasing scope of health supervision recommendations challenges well-child care delivery in the United States. Comparison of the United States with other countries' delivery systems may highlight different assumptions as well as structural approaches for consideration. Our goal was to describe the process of well-child care delivery in indust...

Increasing healthcare costs and the prevalence of managed care make population health management an imperative. Health-related quality of life (HRQOL) is a multidimensional construct that includes both physical and psychosocial (i.e., social, emotional and role) dimensions. Early studies suggest that HRQOL can predict costs of care for pediatric po...

To describe the proportion of youth with special health care needs (YSHCN) who are receiving services for medical transitions and to describe which sociodemographic and health care-related factors are associated with receiving transition services. We analyzed responses to questions about medical transitions from the 2001 National Survey of Children...

To examine associations between active patient-physician communication and measures of morbidity in patients with systemic lupus erythematosus (SLE). Audiotapes of routine visits between 79 women with SLE and their rheumatologists were coded for active patient participation and the degree of patient-centered communication of the physician, using a...

Modifiable psychosocial factors that are associated with health outcomes may provide new opportunities for treatment. We investigated the associations of various psychosocial factors with 3 measures of morbidity in women with systemic lupus erythematosus (SLE). We collected information on 16 social, psychological, behavioral, and medical care facto...

Health outcomes of patients with chronic illnesses are commonly worse in people of lower socioeconomic status (SES). We investigated psychosocial factors that may mediate the relationship between SES and measures of morbidity in women with systemic lupus erythematosus (SLE). We collected information on SES, psychosocial factors, and health status i...

Menstrual and hormonal disturbances have been reported in thin, dieting and exercising Western women, and also recently in rural African women. A study of salivary progesterone profiles was undertaken in a Nepali population to examine whether seasonal increases in workload and changes in energy balance influenced ovarian function. Women's energy ex...