Jay Berry

• Harvard University

This cross-sectional study assesses the association between Child Opportunity Index and revisits for violent reinjury among children within 1 year of an index firearm-related injury.

BACKGROUND AND OBJECTIVES Boarding for pediatric mental health (MH) conditions is common at US children’s hospitals while patients await care at a psychiatric facility. We sought to describe recent trends in boarding encounters and to identify factors associated with prolonged length of stay. METHODS We performed a retrospective cross-sectional st...

Pediatric home health care represents a vital system of care for children with disability and medical complexity, encompassing services provided by family caregivers and nonfamily home health care providers and the use of durable medical equipment and supplies. Home health care is medically necessary for the physiologic health of children with disa...

BACKGROUND Traditional classification of children’s and nonchildren’s hospitals is based on physical structure and branding. We grouped hospitals with the most similar types of pediatric patients. METHODS Retrospective analysis of 2.8 million hospitalizations in 3993 hospitals for patients 0 to 20 years in the 2019 Kids’ Inpatient Database. After...

BACKGROUND AND OBJECTIVES Children with neurologic and neuromuscular complex chronic conditions (NNCCCs) undergo various procedures to optimize their health. We assessed the prevalence, characteristics, and risk of postoperative pneumonia (PoP) across surgery types, hospitals, and comorbidities in children with NNCCC. METHODS This study is a retro...

Airway clearance therapies (ACT) are often used to optimize respiratory function for children with neurologic impairment (CNI) hospitalized with acute respiratory infections (ARI). In a five‐center retrospective cohort study of CNI aged 1–18 years hospitalized between 2013 and 2015 with ARI, we assessed the association of admission ACT with hospita...

Background Children with non-ambulatory cerebral palsy (CP) frequently develop progressive neuromuscular scoliosis and require surgical intervention. Due to their comorbidities, they are at high risk for developing peri- and post-operative complications. The objectives of this study were to compare stepwise and LASSO variable selection techniques f...

BACKGROUND Understanding the postoperative length of stay (LOS) by surgical procedure is important for hospital medicine clinicians involved in surgical co-management. We assessed variation in postoperative LOS for children after elective surgical procedures and risk factors for prolonged LOS. METHODS This study is a retrospective analysis of pedi...

BACKGROUND AND OBJECTIVES Although skin and soft tissue infections (SSTIs) are among the most common indications for pediatric hospitalization, little is known about outpatient care received for SSTI before and after hospitalization. We assessed peri-hospitalization care for SSTI, including antibiotic exposures and their impact on hospital length o...

OBJECTIVES Examine family safety-reporting after implementing a parent–nurse–physician–leader coproduced, health literacy-informed, family safety-reporting intervention for hospitalized families of children with medical complexity. METHODS We implemented an English and Spanish mobile family-safety-reporting tool, staff and family education, and pr...

BACKGROUND AND OBJECTIVES Children with chronic neuromuscular conditions (CCNMC) have many coexisting conditions and often require musculoskeletal surgery for progressive neuromuscular scoliosis or hip dysplasia. Adequate perioperative optimization may decrease adverse perioperative outcomes. The purpose of this scoping review was to allow us to as...

Aim To identify and describe assessment tools used to measure the impact of comorbidities on postoperative outcomes in children with complex chronic conditions (CCC). Method This was a scoping review using five electronic databases. The search was conducted in March 2022 by a medical librarian. There were no date or language restrictions. Included...

Background The coronavirus disease 2019 (COVID-19) pandemic caused disruptions to pediatric surgical care. Although surgical capacity has returned to the prepandemic state, barriers to surgical access may still exist for children who are medically underserved. We assessed pediatric plastic and oral and maxillofacial surgical volumes by sociodemogra...

Objectives Racial and ethnic disparities in healthcare delivery for acutely ill children are pervasive in the United States; it is unknown whether differential critical care utilization exists. Design Retrospective study of the Pediatric Health Information System (PHIS) database. Setting Multicenter database of academic children’s hospitals in th...

It is important for hospitals to understand how hospitalizations for children are changing to adapt and best accommodate the future needs of all patient populations. This study aims to understand how hospitalizations for children with medical complexity (CMC) and non‐CMC have changed over time at children's hospitals, and how hospitalizations for t...

Objectives Although children with medical complexity (CMC) with high health resource utilization use outpatient structured clinical programs (SCP) to optimize their health, little is known about variation in trends of their health service use shortly after enrollment. We measured these trends and assessed the utility of patient characteristics to p...

Background Craniosynostosis is treated with endoscopic, open, and/or distraction surgical techniques. We assessed institutional variation in the use these techniques for craniosynostosis and compared hospital resource use. Methods Retrospective analysis of 5249 infants age <18 months old undergoing surgical procedures for all types of craniosynost...

BACKGROUND The American Society of Anesthesiologists Physical Status Classification System (ASA-PS) is used to classify patients’ health before delivering an anesthetic. Assigning an ASA-PS Classification score to pediatric patients can be challenging due to the vast array of chronic conditions present in the pediatric population. The specific aims...

This cohort study uses state inpatient data to assess changes in distance traveled over time for hospitalization of common pediatric conditions in rural-residing children.

Importance Although durable medical equipment and supplies (DMES) are commonly used to optimize the health and function in pediatric patients, little is known about the prevalence of use and spending on DMES. Objective To categorize the Healthcare Common Procedure Coding System (HCPCS) for distinguishing DMES types, and to measure the prevalence a...

Objectives Prior research suggests that errors occur frequently for patients with medical complexity during the hospital-to-home transition. Less is known about effective postdischarge communication strategies for this population. We aimed to assess rates of 30-day (1) postdischarge incidents and (2) readmissions and emergency department (ED) visit...

Background: Children with medical complexity (CMC) experience adverse events due to multiorgan impairment, frequent hospitalizations, subspecialty care, and dependence on multiple medications/equipment. Their families are well-versed in care and can help identify safety/quality gaps to inform improvements. Although previous studies have shown fami...

Objective: Surgical encounters decreased during the coronavirus disease (COVID-19) pandemic and may have been deferred more in children with impeded healthcare access related to social/community risk factors. We compared surgery trends before and during the pandemic by childhood opportunity index (COI). Methods: Retrospective analysis of 321,998...

Objective: Pediatric researchers use AHRQ's Kids' Inpatient Database (KID) and National Inpatient Sample (NIS) to analyze the national resource use and outcomes of hospitalized children. Inherent KID-NIS sampling design differences may yield disparate findings. We compared discharge counts and length of stay (LOS) between KID and NIS for common an...

Objectives: Readmission to the PICU is associated with worse outcomes, but factors associated with PICU readmission within the same hospitalization remain unclear. We sought to describe the prevalence of, and identify factors associated with, early PICU readmission. Methods: We performed a retrospective analysis of PICU admissions for patients a...

Objective: The optimal management of acute mastoiditis remains controversial. Most existing studies are retrospective single-institutional experiences with small cohorts. Our objectives were to analyze the treatment of acute mastoiditis by pediatric centers across the United States and changes in management over time. Study design: Retrospective...

Background: Children with complex chronic conditions (CCCs) are at risk for adverse events (AEs) during hospitalizations. Objective: We compared the effect of Patient and Family Centered (PFC)I-PASS on AE rates in children with and without CCCs. Designs, settings, and participants: Patients were drawn from the PFCI-PASS study, which included 3...

Objective Thyroidectomy is the most commonly performed pediatric endocrine surgery. Our objective is to measure the short-term outcome of pediatric thyroidectomies, and report on factors associated with postoperative complications. Methods This is a retrospective cohort study, performed using the Pediatric Health Information System (PHIS) database...

OBJECTIVES To compare the effectiveness of dexamethasone versus prednisone or prednisolone on hospital resource utilization for children hospitalized with acute croup. METHODS This is a retrospective cohort study of the Pediatric Health Information System database on children aged 6 months to <6 years who were hospitalized with acute croup between...

Background: Hip reconstruction surgery in patients with neurological complex chronic conditions (CCC) is associated with prolonged hospitalization and extensive resource utilization. This population is vulnerable to cognitive, developmental, and medical comorbidities which can increase length of stay (LOS). The aims of this study were to character...

Aim In children with neurological complex chronic conditions (CCC) undergoing hip surgery we aimed to: estimate the rate of postoperative pneumonia, determine the effect of pneumonia on postoperative hospital resource use, and identify predictors of postoperative pneumonia. Method A retrospective cohort study was conducted utilizing the Pediatric...

Background and objectives: Hospitalized children with medical complexity (CMC) are at high risk of medical errors. Their families are an underutilized source of hospital safety data. We evaluated safety concerns from families of hospitalized CMC and patient/parent characteristics associated with family safety concerns. Methods: We conducted a 12...

Objective To assess the number of days that children experienced a healthcare encounter and associations between chronic condition types and healthcare encounters. Methods Retrospective analysis of data from 5,082,231 children ages 0-18 years enrolled in Medicaid during 2017 in 12 U.S. states contained in the IBM Watson Marketscan Medicaid Databas...

Purpose: The need for pediatric post-acute facility care (PAC) is growing due to technological advances that extend the lives of many children, especially those with complex medical needs. The objectives were to describe [1] the types and settings of PAC; [2] the clinical characteristics of the pediatric patients requiring PAC; and [3] perceptions...

Objectives: To describe epidemiology, interventions, outcomes, and the health services experience for a cohort of children with pulmonary hypertension (PH) who underwent tracheostomy placement and to identify risk factors for inhospital mortality and 30-day readmissions. Design: Retrospective cohort study of the Pediatric Health Information Syst...

Background: Children with medical complexity are at increased risk of low bone mineral density (BMD) and complications after spinal fusion compared with idiopathic scoliosis patients. Our aim was to compare treatments and outcomes of children with medical complexity undergoing spinal fusion in those who had dual-energy x-ray absorptiometry (DXA) s...

To assess risk factors associated with 30-day hospital readmission after a prolonged neonatal intensive care stay. Retrospective analysis of 57,035 infants discharged >14 days from the NICU between 2013 and 2016. Primary outcome was 30-day, all-cause hospital readmission. Adjusted likelihood of readmission accounting for demographic and clinical ch...

Objective To test associations between parent-reported confidence to avoid hospitalization and caregiving strain, activation, and health-related quality of life (HRQOL). Study Design In this prospective cohort study, enrolled parents of (n=75) from three complex care programs received text messages (random times, every two weeks for three months)...

Children and youth with special health care needs (CYSHCN) “have or are at increased risk for chronic physical, developmental, behavioral or emotional conditions and also require health and related services of a type or amount beyond that required by children generally.” CYSHCN rely on health systems, which extend beyond traditional health care ent...

Background: It is well established that young infants have the highest risk of severe pertussis, which often results in hospitalization. Since the 2012 recommendation of administering tetanus toxoid, diphtheria toxoid, and acellular pertussis (Tdap) vaccine for every pregnancy, evaluation of pertussis hospitalizations among young infants in the Un...

Objectives To compare outcomes in children with congenital heart disease (CHD) undergoing noncardiac surgery by presence of chronic conditions (CCI) and identify associated risk factors. Study design Retrospective analysis of 14,031 children with CHD who underwent noncardiac surgery in the 2016 Healthcare Cost and Utilization Project Kid’s Inpatie...

BACKGROUND Although many children with medical complexity (CMC) use home health care (HHC), little is known about all pediatric HHC utilizers. Our objective was to assess characteristics of pediatric HHC recipients, providers, and payments. METHODS We conducted a retrospective analysis of 5 209 525 children age 0-to-17 years enrolled Medicaid in t...

Healthcare and outcomes for children with medical complexity (CMC) and their families can be improved by conducting well-conceived, designed, implemented, and analyzed research studies of clinical interventions. This article presents a framework for how to approach the study of clinical interventions for CMC, including 7 key questions and example a...

Background and objectives: Children with neurologic impairment (NI) are a growing subset of children who frequently use health care. We examined health care use and spending trends across services for children with NI during their first 5 years of life. Methods: This was a retrospective study of 13 947 children with NI in the multistate IBM Medi...

Background : Hospitalizations for children with complex chronic conditions (CCC) at pediatric hospitals have risen over time. Little is known about what hospital types, pediatric or adult, adolescents and young adults (AYA) with CCCs use. Objective : To assess the types of hospitals used by AYAs with CCCs Methods : We performed a cross-sectional...

Background: Perioperative outcomes of children depend on the skill and expertise in managing pediatric patients, as well as integration of surgical, anesthesiology, and medical teams. We compared the types of pediatric patients and inpatient surgical procedures performed in low- versus higher-volume hospitals throughout the United States. Methods...

Aim To identify the highest‐priority clinical research areas related to children with neurological impairment and medical complexity among clinicians and caregivers. Method A modified, three‐stage Delphi study using online surveys and guided by a steering committee was completed. In round 1, clinicians and family caregivers suggested clinical topi...

Background and objectives: Clinicians evaluating for herpes simplex virus (HSV) in febrile infants must balance detection with overtesting, and there is no universally accepted approach to risk stratification. We aimed to describe variation in diagnostic evaluation and empirical acyclovir treatment of infants aged 0 to 60 days presenting with feve...

Objective To assess the performance of previously published high-intensity neurologic impairment (NI) diagnosis codes in identification of hospitalized children with clinical NI. Methods Retrospective study of 500 randomly selected discharges in 2019 from a freestanding children's hospital. All charts were reviewed for 1) NI discharge diagnosis co...

Hospitals’ financial viability depends on adequate reimbursement of care. This dependency is particularly true for children’s hospitals, the medical safety net for children who are underserved and/or have medically complex conditions.¹ Reimbursement varies considerably across payers for adult patients; public programs (eg, Medicaid) tend to reimbur...

Measures to mitigate the COVID-19 pandemic affected children’s access to health services and their physical and mental health. Reductions in hospitalizations for children occurred in 2020 compared with prior years.¹ Little is known about the reasons for the decline and whether it varied by patient characteristics.

Objective: Reducing emergency department (ED) use in children with complex chronic conditions (CCC) is a national health system priority. Emergency department visits with minimal clinical intervention may be the most avoidable. We assessed characteristics associated with experiencing such a low-resource ED visit among children with a CCC. Methods...

Aim To assess the relationship of preoperative hematology laboratory results with intraoperative estimated blood loss and transfusion volumes during posterior spinal fusion for pediatric neuromuscular scoliosis. Methods Retrospective chart review of 179 children with neuromuscular scoliosis undergoing spinal fusion at a tertiary children’s hospita...

Children's hospitals responded to COVID-19 by limiting nonurgent healthcare encounters, conserving personal protective equipment, and restructuring care processes to mitigate viral spread. We assessed year-over-year trends in healthcare encounters and hospital charges across US children's hospitals before and during the COVID-19 pandemic. We perfor...

Objective: To describe the prevalence and characteristics of infection-related readmissions in children and to identify opportunities for readmission reduction and estimate associated cost savings. Study design: Retrospective analysis of 380,067 nationally representative index hospitalizations for children using the 2014 Nationwide Readmissions...

Background: Children with neurologic impairment (NI) are at risk for developing co-occurring chronic conditions, increasing their medical complexity and morbidity. We assessed the prevalence and timing of onset for those conditions in children with NI. Methods: This longitudinal analysis included 6229 children born in 2009 and continuously enrol...

Meckel’s diverticulum (MD) is a well-defined diagnosis in children presenting with either bleeding or obstruction. Although anecdotally adult patients may present with complications from MD, their presentation seems to be different, with a reported predominance of non-bleed-related presentations. Reports in this population, however, are limited, an...

Family perspectives on short-term recovery after spinal fusion for neuromuscular scoliosis are essential for improving patient outcomes. Semistructured interviews were conducted with 18 families of children within 3 months after spinal fusion performed August 2017 to January 2019 at a children’s hospital. Interviews were recorded, transcribed, and...

Design: Prospective cerebral palsy (CP) registry review. Objectives: (1) Evaluate the incidence/risk factors of gastrointestinal (GI) complications in CP patients after spinal fusion (SF); and (2) investigate the validity of the modified Clavien-Dindo-Sink classification. Background: Perioperative GI complications result in increased length of...

Aim To assess how co‐occurring conditions influence recovery after hip reconstruction surgery in children with neurological complex chronic conditions (CCCs). Method This was a retrospective analysis of 4058 children age 4 years or older with neurological CCCs who underwent hip reconstructive surgery between 1st January 2015 and 31st December 2018...

Objective To evaluate the associations between parent confidence in avoiding hospitalization and subsequent hospitalization in children with medical complexity (CMC); and feasibility/acceptability of a texting platform, ACTIV, to collect repeated measures of parent confidence. Study design This prospective cohort study purposively sampled parent-c...

Objectives & hypothesis: Children with home mechanical ventilation (HMV) require skilled care by trained caregivers, and their families feel the impacts of ubiquitous home nursing shortages. It is unknown which factors determine allocation; no standards for private duty nursing intensity exist. We sought to characterize provider experiences with a...

Background: Utilizing the intrinsic surgical risk (ISR) and the patient's chronic and acute conditions, this study aims to develop and validate a comprehensive predictive model of perioperative morbidity in children undergoing noncardiac surgery. Methods: Following institutional review board (IRB) approval at a tertiary care children's hospital,...

Rationale: In 2016 the ATS released Clinical Practice Guidelines for Pediatric Chronic Home Invasive Ventilation pertaining to discharge practices and subsequent management for patients with invasive ventilation using a tracheostomy. It is not known to what extent current US practices adhere to these recommendations. Objective: Hospital discharg...

Background: When applied to the pediatric population, the American Society of Anesthesiologists physical status (ASA-PS) classification has exhibited poor reliability due to its subjective and adult-focused definitions. This study was done to measure interrater agreement of a pediatric-adapted ASA-PS classification and to solicit multicenter persp...

Objectives: We sought to characterize the nature and prevalence of medication order errors (MOEs) occurring at hospital admission for children with medical complexity (CMC), as well as identify the demographic and clinical risk factors for CMC experiencing MOEs. Methods: Prospective cohort study of 1233 hospitalizations for CMC from November 1,...

Health is strongly influenced by both medical conditions and social determinants of health (SDH). The degree to which challenges in one affect the frequency or magnitude of challenges in the other is not fully understood. Children with medical complexity may be at especially high risk for related social complexity.¹,2 If so, then children with medi...

Objectives: In this study, we sought to establish priorities for a national research agenda for children and youth with special health care needs (CYSHCN) through a structured, multistakeholder, mixed-methods approach. Methods: Using surveys, we solicited responses from >800 members of expert-nominated stakeholder organizations, including CYSHCN...

Objective: To examine how characteristics vary between children with any mental health (MH) diagnosis who have typical spending and the highest spending; to identify independent predictors of highest spending; and to examine drivers of spending groups. Methods: This retrospective analysis utilized 2016 Medicaid claims from 11 states and included...

Background: The incidence of venous thromboembolism (VTE) after elective surgery in children with mobility impairments, including those with a neuromuscular complex chronic condition (NCCC), is unknown. Therefore, our objectives were to assess the incidence of VTE after elective spine and lower-extremity surgery in children with NCCC. Methods: A...

Objective: To compare hospital outcomes associated with commonly used antibiotic therapies for aspiration pneumonia in children with neurologic impairment (NI). Design/methods: A retrospective study of children with NI hospitalized with aspiration pneumonia at 39 children's hospitals in the Pediatric Health Information System database. Exposure...

Objectives: To evaluate factors associated with admission from emergency department (ED) encounters for children with medical complexity (CMC) and to quantify the hospital admission rate as well as variation in adjusted hospital admission rates across EDs. Study design: Retrospective study of 271 806 visits to 37 EDs in freestanding children's h...

Children with neurological impairment frequently experience unmet health care needs, high-severity acute illnesses, coexisting condition exacerbations, adverse medical events, and disproportionately high health care utilization and spending.¹,2 Our clinical experience within the clinical spectrum of neurological impairment has suggested that childr...

The aim of this study is to assess the impact of preoperative comanagement with complex care pediatricians (CCP) on children with neuromuscular scoliosis undergoing spinal fusion. We performed chart review of 79 children aged 5–21 years undergoing spinal fusion 1/2014–6/2016 at a children’s hospital, with abstraction of clinical documentation from...

Importance Adolescents and young adults (AYA) who have complex chronic disease (CCD) are a growing population that requires hospitalization to treat severe, acute health problems. These patients may have increased risk of readmission as demands on their self-management increase and as they transfer care from pediatric to adult health care practitio...

Background: The American Society of Anesthesiologists physical status (ASA-PS) classification system is used worldwide to classify patients based on comorbid conditions before general anesthesia. Despite its popularity, the ASA-PS classification system has been shown to have poor interrater reliability due to its subjective definitions, especially...

Objectives: To convey advice from families whose children recently underwent spinal fusion to families whose children are under consideration for initial spinal fusion for neuromuscular scoliosis and to providers who counsel families on this decision. Study design: We interviewed 18 families of children who underwent spinal fusion between August...

Background and objectives: Although potentially dangerous, little is known about outpatient opioid exposure (OE) in children and youth with special health care needs (CYSHCN). We assessed the prevalence and types of OE and the diagnoses and health care encounters proximal to OE in CYSHCN. Methods: This is a retrospective cohort study of 2 597 98...

Objective: To compare health care use and spending in children using vs not using respiratory medical equipment and supplies (RMES). Study design: Cohort study of 20 352 children age 1-18 years continuously enrolled in Medicaid in 2013 from 12 states in the Truven Medicaid MarketScan Database; 7060 children using RMES were propensity score match...

Background and objectives: Little is known about the use of chronic medications (CMs) in children. We assessed the prevalence of CM use in children and the association of clinical characteristics and health care resource use with the number of CMs used. Methods: This is a retrospective study of children ages 1 to 18 years using Medicaid from 10...

Background: Projecting postoperative recovery in pediatric surgical patients is challenging. We assessed how the patients' number of complex chronic conditions (CCCs) and chronic medications interacted with active health issues to influence the likelihood of postoperative physiologic decline (PoPD). Methods: A prospective study of 3295 patients...

Design: Retrospective comparative study. Objective: The purpose of this study is to measure SSI outcomes before and after implementation of our center's multidisciplinary clinical pathway protocol for high-risk spinal surgery. Background: Surgical site infections (SSIs) after spinal fusion harm patients and are associated with significant heal...

Hospital readmission rates are widely used as a quality measure for hospitalized patients. Hospital readmission gained attention largely from concerns about the quality of discharge care, including those patients discharged before they were adequately prepared to leave the hospital.¹ In adult patients, shorter index hospitalization length of stay (...

Objective Children with invasive home mechanical ventilation (HMV) are a growing population with complex health service needs. Single institution studies provide insight into successful program structures and outcomes. Our study objectives were to assess health service structures, providers, and programs caring for this population throughout the U....