- Pediatric Rheumatology
Clinical Assistant Professor, Pediatrics - Rheumatology
Board Certification: American Board of Pediatrics, Pediatric Rheumatology (2021)
MS, Stanford University, Health Research and Policy (2020)
Board Certification, American Board of Pediatrics, Pediatric Rheumatology (2021)
Fellowship: Stanford University Pediatric Rheumatology Fellowship (2020) CA
Board Certification: American Board of Pediatrics, Pediatrics (2017)
Residency: Kaiser Permanente Oakland Pediatric Residency (2016) CA
Medical Education: New York Medical College Registrar (2013) NY
Observational Study of Pediatric Rheumatic Diseases: The CARRA Registry
Continuation of the CARRA Registry as described in the protocol will support data collection on patients with pediatric-onset rheumatic diseases. The CARRA Registry will form the basis for future CARRA studies. In particular, this observational registry will be used to answer pressing questions about therapeutics used to treat pediatric rheumatic diseases, including safety questions.
Translating research into practice-implementation recommendations for pediatric rheumatology; Proceedings of the childhood arthritis and rheumatology research alliance 2020 implementation science retreat.
Pediatric rheumatology online journal
2022; 20 (1): 10
The translation of research findings into clinical practice is challenging, especially fields like in pediatric rheumatology, where the evidence base is limited, there are few clinical trials, and the conditions are rare and heterogeneous. Implementation science methodologies have been shown to reduce the research- to- practice gap in other clinical settings may have similar utility in pediatric rheumatology. This paper describes the key discussion points from the inaugural Childhood Arthritis and Rheumatology Research Alliance Implementation Science retreat held in February 2020. The aim of this report is to synthesize those findings into an Implementation Science Roadmap for pediatric rheumatology research. This roadmap is based on three foundational principles: fostering curiosity and ensuring discovery, integration of research and quality improvement, and patient-centeredness. We include six key steps anchored in the principles of implementation science. Applying this roadmap will enable researchers to evaluate the full range of research activities, from the initial clinical design and evidence acquisition to the application of those findings in pediatric rheumatology clinics and direct patient care.
View details for DOI 10.1186/s12969-022-00665-y
View details for PubMedID 35130904
Implementation Science in Pediatric Rheumatology: A Path to Health Equity.
Rheumatic diseases clinics of North America
2022; 48 (1): 331-342
Implementation science is the study of processes that promote reliable uptake of evidence-based practices into clinical care. The integration of implementation science and health disparities research approaches has been proposed as a method to reduce health inequity through detection, understanding, and implementation of health equity-focused interventions. In this review, we provide an argument for the study of implementation science in pediatric rheumatology in light of previously observed health disparities, present a framework for the study of health equity and implementation science in pediatric rheumatology, and propose next steps to accelerate action.
View details for DOI 10.1016/j.rdc.2021.08.006
View details for PubMedID 34798956
The Emerging Telehealth Landscape in Pediatric Rheumatology.
Rheumatic diseases clinics of North America
2022; 48 (1): 259-270
This article provides an in-depth review of telemedicine and its use in pediatric rheumatology. Historical barriers to the use of telemedicine in pediatric chronic care are described, and recent policy changes that have supported the use of telemedicine are discussed. Future directions and suggestions for the evaluation of telemedicine in pediatric rheumatology care are provided with a special focus on clinical outcomes, its use in research, patient acceptability, and health equity.
View details for DOI 10.1016/j.rdc.2021.08.005
View details for PubMedID 34798951
Supporting Patient-Centered Care in the Pediatric Rheumatology Setting: Patient, Family and Provider Experiences with OurNotes
WILEY. 2021: 2225-2228
View details for Web of Science ID 000744545204109
Semi-quantitative Chest Computed Tomography (CT) Analysis in Pediatric Rheumatologic (PR) Patients with Diffuse Lung Disease
WILEY. 2021: 352-355
View details for Web of Science ID 000744545200177
A challenging case of recurrent idiopathic hemophagocytic lymphohistiocytosis (HLH) initially presenting in an infant with Pneumocystis jirovecii pneumonia
SPRINGER/PLENUM PUBLISHERS. 2021: S55
View details for Web of Science ID 000639851600094
Pediatric subspecialty telemedicine use from the patient and provider perspective.
BACKGROUND: To characterize telemedicine use among pediatric subspecialties with respect to clinical uses of telemedicine, provider experience, and patient perceptions during the COVID-19 pandemic.METHODS: We performed a mixed-methods study of telemedicine visits across pediatric endocrinology, nephrology, orthopedic surgery, and rheumatology at a large children's hospital. We used deductive analysis to review observational data from 40 video visits. Providers and patients/caregivers were surveyed around areas of satisfaction and communication.RESULTS: We found adaptations of telemedicine including shared-screen use and provider-guided parent procedures among others. All providers felt that it was safest for their patients to conduct visits by video, and 72.7% reported completing some component of a clinical exam. Patients rated the areas of being respected by the clinical staff/provider and showing care and concern highly, and the mean overall satisfaction was 86.7±19.3%.CONCLUSIONS: Telemedicine has been used to deliver care to pediatric patients during the pandemic, and we found that patients were satisfied with the telemedicine visits during this stressful time and that providers were able to innovate during visits. Telemedicine is a tool that can be successfully adapted to patient and provider needs, but further studies are needed to fully explore its integration in pediatric subspecialty care.IMPACT: This study describes telemedicine use at the height of the COVID-19 pandemic from both a provider and patient perspective, in four different pediatric subspecialties. Prior to COVID-19, pediatric telehealth landscape analysis suggested that many pediatric specialty practices had pilot telehealth programs, but there are few published studies evaluating telemedicine performance through the simultaneous patient and provider experience as part of standard care. We describe novel uses and adaptations of telemedicine during a time of rapid deployment in pediatric specialty care.
View details for DOI 10.1038/s41390-021-01443-4
View details for PubMedID 33753896
Exploring Pediatric Tele-Rheumatology Practices During COVID-19: A Survey of the PRCOIN Network.
Frontiers in pediatrics
2021; 9: 642460
Healthcare providers were rapidly forced to modify the way they practiced medicine during the coronavirus disease 2019 (COVID-19) pandemic. Many providers transitioned from seeing their patients in person to virtually using telemedicine platforms with limited training and experience using this medium. In pediatric rheumatology, this was further complicated as musculoskeletal exams typically require hands-on assessment of patients. The objective of this study was to examine the adoption of telemedicine into pediatric rheumatology practices, to assess its benefits and challenges, and to gather opinions on its continued use. A survey was sent to the lead representatives of each Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) site to collect data about their center's experience with telemedicine during the COVID-19 pandemic. Quantitative data were analyzed using descriptive statistics, and qualitative data were thematically analyzed. Responses were received from the majority [19/21 (90%)] of PR-COIN sites. All respondents reported transitioning from in-person to primarily virtual patient visits during the COVID-19 pandemic. All centers reported seeing both new consultations and follow-up patients over telemedicine. Most centers reported using both audio and video conferencing systems to conduct their telemedicine visits. The majority of respondents [13/19 (68%)] indicated that at least 50% of their site's providers consistently used pediatric Gait Arms Legs and Spine (pGALS) to perform active joint count assessments over telemedicine. Over half of the centers [11/19 (58%)] reported collecting patient-reported outcomes (PROs), but the rate of reliably documenting clinical components varied. A few sites [7/19 (37%)] reported performing research-related activity during telemedicine visits. All centers thought that telemedicine visits were able to meet providers' needs and support their continued use when the pandemic ends. Benefits reported with telemedicine visits included convenience and continuity of care for families. Conversely, challenges included limited ability to perform physical exams and varying access to technology. Pediatric rheumatology providers were able to transition to conducting virtual visits during the COVID-19 pandemic. Healthcare providers recognize how telemedicine can enhance their practice, but challenges need to be overcome in order to ensure equitable, sustainable delivery of quality and patient-centered care.
View details for DOI 10.3389/fped.2021.642460
View details for PubMedID 33748049
Telemedicine use by pediatric rheumatologists during the COVID-19 pandemic.
Pediatric rheumatology online journal
2021; 19 (1): 93
To characterize various aspects of telemedicine use by pediatric rheumatology providers during the recent pandemic including provider acceptability of telehealth practices, clinical reliability, and clinical appropriateness.An electronic survey was generated and disseminated amongst the Childhood Arthritis and Rheumatology Research Alliance (CARRA) listserv (n = 547). Survey items were analyzed via descriptive statistics by question.The survey response rate was 40.8% (n = 223) with the majority of respondents in an attending-level role. We observed that musculoskeletal components of the exam were rated as the most reliable components of a telemedicine exam and 86.5% of survey respondents reported engaging the patient or patient caregiver to help conduct the virtual exam. However, 65.7% of providers reported not being able to elicit the information needed from a telemedicine visit to make a complete clinical assessment. We also noted areas of disagreement regarding areas of patient engagement and confidentiality. We found that approximately one-third (35.8%) of those surveyed felt that their level of burnout was increased due to telemedicine.In general, providers found exam reliability (specifically around focused musculoskeletal elements) in telemedicine visits but overall felt that they were unable to generate the information needed to generate a complete clinical assessment. Additionally, there were suggestions that patient engagement and confidentiality varied during telemedicine visits when compared to in-person clinical visits. Further qualitative work is needed to fully explore telemedicine use in pediatric rheumatology.
View details for DOI 10.1186/s12969-021-00565-7
View details for PubMedID 34134709
Building a Viable Telemedicine Presence in Pediatric Rheumatology.
Pediatric clinics of North America
2020; 67 (4): 641–45
This article describes the present state of telemedicine in pediatric rheumatology. Specifically, it addresses the potential use of telemedicine to increase patient-provider access as well as its potential clinical limitations. The work also briefly describes the next steps with respect to telemedicine research as well as some new research findings specifically for pediatric rheumatology.
View details for DOI 10.1016/j.pcl.2020.04.006
View details for PubMedID 32650861
Utilization of Telemedicine in Pediatric Rheumatologic Care
WILEY. 2020: 317–18
View details for Web of Science ID 000542687800187
Open vs Laparoscopic vs Robotic Surgery for Rectal Cancer: A Cost-Effectiveness Analysis
ELSEVIER SCIENCE INC. 2019: S67
View details for Web of Science ID 000492740900109