C. Jason Wang, MD, PhD

All Publications

• The Risk of Aircraft-Acquired SARS-CoV-2 Transmission during Commercial Flights: A Systematic Review. International journal of environmental research and public health Zhao, D., Cheng, S., Tsui, F. R., Mathur, M. B., Wang, C. J. 2024; 21 (6)

  Abstract

  The aircraft-acquired transmission of SARS-CoV-2 poses a public health risk. Following PRISMA guidelines, we conducted a systematic review and analysis of articles, published prior to vaccines being available, from 24 January 2020 to 20 April 2021 to identify factors important for transmission. Articles were included if they mentioned index cases and identifiable flight duration, and excluded if they discussed non-commercial aircraft, airflow or transmission models, cases without flight data, or that were unable to determine in-flight transmission. From the 15 articles selected for in-depth review, 50 total flights were analyzed by flight duration both as a categorical variable-short (<3 h), medium (3-6 h), or long flights (>6 h)-and as a continuous variable with case counts modeled by negative binomial regression. Compared to short flights without masking, medium and long flights without masking were associated with 4.66-fold increase (95% CI: [1.01, 21.52]; p < 0.0001) and 25.93-fold increase in incidence rates (95% CI: [4.1, 164]; p < 0.0001), respectively; long flights with enforced masking had no transmission reported. A 1 h increase in flight duration was associated with 1.53-fold (95% CI: [1.19, 1.66]; p < 0.001) increase in the incidence rate ratio (IRR) of cases. Masking should be considered for long flights.

  View details for DOI 10.3390/ijerph21060654

  View details for PubMedID 38928901

• Recommendations and guidelines of integrative medicine for COVID-19 care: The APEC project outcome. Integrative medicine research Jia, L., Beidelschies, M., Evans, J. M., Niemtzow, R. C., Niemtzow, S. Z., Dusek, J. A., Lin, Y., Wu, C., Su, Y. C., Wang, C. J., Lin, C. Y., Astana, P. R., Ardiyanto, D., Hardjoutomo, R., Visithanon, K., Puagkong, J., Chokpaisarn, J., Lopez, M. V., Yotsuyanagi, H., Lee, M. S., Ramirez, H. J., Bobadilla, C. P., Quinteros, E. M., Galanti de la Paz, M., Maramba-Lazarte, C. C. 2024; 13 (1): 101022

  Abstract

  This article - Recommendations and Guidelines of Integrative Medicine (IM) for COVID-19 Care - was one of the outcomes from an Asia-Pacific Economic Cooperation (APEC) Project (Integrative Medicine (IM) and COVID -19 Care) during the time between May 2022 and March 2023. With the efforts from care providers, researchers, health policy makers and healthcare administrative leaders among APEC economies, the purpose of this file was to provide comprehensive IM systems for COVID-19 care as recommendations and suggestive guidelines including care methods, tools, procedures, symptom conditions and targets selections, and points need to be considered during care applications. All cited COVID-19 care practices have confirmed their efficacy and usefulness either used alone or combined with conventional medicine. This article provides current useful medical information on IM for COVID-19 care which could benefit APEC economies and world health communities on their healthcare system.

  View details for DOI 10.1016/j.imr.2024.101022

  View details for PubMedID 38434793

  View details for PubMedCentralID PMC10907161

• Addressing Health-Related Social Needs and Mental Health Needs in the Neonatal Intensive Care Unit: Exploring Challenges and the Potential of Technology. International journal of environmental research and public health van de Kamp, E., Ma, J., Monangi, N., Tsui, F. R., Jani, S. G., Kim, J. H., Kahn, R. S., Wang, C. J. 2023; 20 (24)

  Abstract

  Unaddressed health-related social needs (HRSNs) and parental mental health needs in an infant's environment can negatively affect their health outcomes. This study examines the challenges and potential technological solutions for addressing these needs in the neonatal intensive care unit (NICU) setting and beyond. In all, 22 semistructured interviews were conducted with members of the NICU care team and other relevant stakeholders, based on an interpretive description approach. The participants were selected from three safety net hospitals in the U.S. with level IV NICUs. The challenges identified include navigating the multitude of burdens families in the NICU experience, resource constraints within and beyond the health system, a lack of streamlined or consistent processes, no closed-loop referrals to track status and outcomes, and gaps in support postdischarge. Opportunities for leveraging technology to facilitate screening and referral include automating screening, initiating risk-based referrals, using remote check-ins, facilitating resource navigation, tracking referrals, and providing language support. However, technological implementations should avoid perpetuating disparities and consider potential privacy or data-sharing concerns. Although advances in technological health tools alone cannot address all the challenges, they have the potential to offer dynamic tools to support the healthcare setting in identifying and addressing the unique needs and circumstances of each family in the NICU.

  View details for DOI 10.3390/ijerph20247161

  View details for PubMedID 38131713

  View details for PubMedCentralID PMC10742453

• Multisite Quality Improvement Program Within the Project ECHO Diabetes Remote Network. Joint Commission journal on quality and patient safety Wang, C. J., Lewit, E. M., Clark, C. L., Lee, F. W., Maahs, D. M., Haller, M. J., Addala, A., Lal, R. A., Cuttriss, N., Baer, L. G., Figg, L. E., Anez-Zabala, C., Sheehan, E. P., Westen, S. C., Bernier, A. V., Donahoo, W. T., Walker, A. F. 2023

  Abstract

  BACKGROUND: The telementoring Project ECHO (Extension for Community Healthcare Outcomes) model has been shown to improve disease management in diabetes in many underserved communities. The authors aim to evaluate if ECHO could also be an effective tool for quality improvement (QI) of diabetes care in these communities.METHODS: Thirteen clinics in underserved communities in California and Florida participating in Project ECHO Diabetes were recruited for a 12-month QI program. The program provided weekly tele-education sessions, including a didactic presentation and case-based discussion. In addition, clinics chose their own set of quality measures to improve and met remotely to discuss their efforts, successes, and setbacks every quarter with mentorship from QI experts.RESULTS: Of the 31 QI initiatives attempted by different clinics, all had either made improvements (25 initiatives, 80.6%) or were in the process of making improvements (6 initiatives, 19.4%) in structural, process, and outcome measures. Examples of these measures include whether clinics have protocols to identify high-risk patients (structure), numbers of continuous glucose monitor prescriptions submitted by the clinics (process), and percentage of patients with diabetes whose most recent HbA1c are > 9% (outcome). For one measure, 40.0% of the clinics had achieved a higher percentage of cumulative HbA1c measurement in the third quarter of the year, compared to the fourth quarter in the previous year. The cost of QI implementation varied widely due to different number of personnel involved across sites.CONCLUSION: A QI program delivered via Project ECHO Diabetes can facilitate quality improvements in underserved communities.

  View details for DOI 10.1016/j.jcjq.2023.08.001

  View details for PubMedID 37718146

• Design and Rationale of RE-ENERGIZE FONTAN: RandomizEd Exercise iNtERvention desiGned to maximIZE fitness in FONTAN patients. American heart journal Tierney, E. S., Palaniappan, L., Leonard, M., Long, J., Myers, J., Dávila, T., Lui, M. C., Kogan, F., Olson, I., Punn, R., Desai, M., Schneider, L. M., Wang, C. H., Cooke, J. P., Bernstein, D. 2023

  Abstract

  In this manuscript, we describe the design and rationale of a randomized controlled trial in pediatric Fontan patients to test the hypothesis that a live-video-supervised exercise (aerobic+resistance) intervention will improve cardiac and physical capacity; muscle mass, strength, and function; and endothelial function. Survival of children with single ventricles beyond the neonatal period has increased dramatically with the staged Fontan palliation. Yet, long-term morbidity remains high. By age 40, 50% of Fontan patients will have died or undergone heart transplantation. Factors that contribute to onset and progression of heart failure in Fontan patients remain incompletely understood. However, it is established that Fontan patients have poor exercise capacity which is associated with a greater risk of morbidity and mortality. Furthermore, decreased muscle mass, abnormal muscle function, and endothelial dysfunction in this patient population is known to contribute to disease progression. In adult patients with two ventricles and heart failure, reduced exercise capacity, muscle mass, and muscle strength are powerful predictors of poor outcomes, and exercise interventions can not only improve exercise capacity and muscle mass, but also reverse endothelial dysfunction. Despite these known benefits of exercise, pediatric Fontan patients do not exercise routinely due to their chronic condition, perceived restrictions to exercise, and parental overprotection. Limited exercise interventions in children with congenital heart disease have demonstrated that exercise is safe and effective; however, these studies have been conducted in small, heterogeneous groups, and most had few Fontan patients. Critically, adherence is a major limitation in pediatric exercise interventions delivered on-site, with adherence rates as low as 10%, due to distance from site, transportation difficulties, and missed school or workdays. To overcome these challenges, we utilize live-video conferencing to deliver the supervised exercise sessions. Our multidisciplinary team of experts will assess the effectiveness of a live-video-supervised exercise intervention, rigorously designed to maximize adherence, and improve key and novel measures of health in pediatric Fontan patients associated with poor long-term outcomes. Our ultimate goal is the translation of this model to clinical application as an "exercise prescription" to intervene early in pediatric Fontan patients and decrease long-term morbidity and mortality.

  View details for DOI 10.1016/j.ahj.2023.02.006

  View details for PubMedID 36796574

• A Delphi Method for Development of a Barrett's Esophagus Question Prompt List as a Communication Tool for Optimal Patient-physician Communication. Journal of clinical gastroenterology Kamal, A. N., Wang, C. J., Triadafilopoulos, G., Diehl, D. L., DuCoin, C., Dunst, C. M., Falk, G., Iyer, P. G., Katzka, D. A., Konda, V. J., Muthusamy, R., Otaki, F., Pleskow, D., Rubenstein, J. H., Shaheen, N. J., Sharma, P., Smith, M. S., Sujka, J., Swanstrom, L. L., Tatum, R. P., Trindade, A. J., Ujiki, M., Wani, S., Clarke, J. O. 2023

  Abstract

  BACKGROUND METHODS: The question prompt list content was derived through a modified Delphi process consisting of 3 rounds. In round 1, experts provided 5 answers to the prompts "What general questions should patients ask when given a new diagnosis of Barrett's esophagus" and "What questions do I not hear patients asking, but given my expertise, I believe they should be asking?" Questions were reviewed and categorized into themes. In round 2, experts rated questions on a 5-point Likert scale. In round 3, experts rerated questions modified or reduced after the previous rounds. Only questions rated as "essential" or "important" were included in Barrett's esophagus question prompt list (BE-QPL). To improve usability, questions were reduced to minimize redundancy and simplified to use language at an eighth-grade level (Fig. 1).RESULTS: Twenty-one esophageal medical and surgical experts participated in both rounds (91% males; median age 52 years). The expert panel comprised of 33% esophagologists, 24% foregut surgeons, and 24% advanced endoscopists, with a median of 15 years in clinical practice. Most (81%), worked in an academic tertiary referral hospital. In this 3-round Delphi technique, 220 questions were proposed in round 1, 122 (55.5%) were accepted into the BE-QPL and reduced down to 76 questions (round 2), and 67 questions (round 3). These 67 questions reached a Flesch Reading Ease of 68.8, interpreted as easily understood by 13 to 15 years olds.CONCLUSIONS: With multidisciplinary input, we have developed a physician-derived BE-QPL to optimize patient-physician communication. Future directions will seek patient feedback to distill the questions further to a smaller number and then assess their usability.

  View details for DOI 10.1097/MCG.0000000000001832

  View details for PubMedID 36753462

• Healthcare Disparities in Gastroesophageal Reflux Disease for Hispanic and Latino Americans: A Solution-Oriented Approach for Improvement. The American journal of gastroenterology Kamal, A. N., Wang, C. J., Triadafilopoulos, G., Clarke, J. O. 2022

  View details for DOI 10.14309/ajg.0000000000001976

  View details for PubMedID 36206196

• Childhood Handwashing Habit Formation and Later COVID-19 Preventive Practices: A Cohort Study. Academic pediatrics Chang, L. Y., Wang, C. J., Chiang, T. L. 2022

  Abstract

  This study identified developmental patterns of handwashing habit formation during childhood and examined their associations with later COVID-19 preventive practices.We used data from the Taiwan Birth Cohort Study, which included 11 254 adolescents with complete data on childhood handwashing behavior and age-15 COVID-19 survey items. Bias-adjusted 3-step latent class analysis was used to test study hypotheses.The rates of handwashing and mask-wearing during the pandemic were 63.8% and 93.8%, respectively. Five distinct patterns of handwashing habit formation were identified: early formation (14.89%), delayed formation (17.73%), gradual formation (42.98%), inconsistent formation (9.78%), and nonformation (14.62%). Compared with adolescents with an early formation pattern of handwashing habits, those with other patterns exhibited lower odds ratios (ORs) of handwashing during COVID-19; these ORs were 0.67 (95% confidence interval [CI], 0.49-0.85), 0.60 (95% CI, 0.44-0.77), 0.29 (95% CI, 0.08-0.49), and 0.21 (95% CI, 0.01-0.40) for those with delayed formation, gradual formation, inconsistent formation, and nonformation patterns, respectively. Moreover, relative to that of adolescents with the early formation pattern, mask-wearing was less common among adolescents with gradual formation, inconsistent formation, and nonformation patterns, with ORs of 0.54 (95% CI, 0.16-0.92), 0.50 (95% CI, 0.03-0.96), and 0.26 (95% CI, 0.00-0.65), respectively.The early formation of hygienic habits is associated with higher adherence to pandemic preventive practices among adolescents. Our findings suggest that interventions to promote hygienic behaviors can start as early as age 3 through the introduction of healthy habits such as handwashing.

  View details for DOI 10.1016/j.acap.2022.05.014

  View details for PubMedID 35863735

  View details for PubMedCentralID PMC9290330

• Development and Validation of Age-Specific Resilience Instruments for Early Childhood Assessment: A Taiwan Birth Cohort Study. Academic pediatrics Hsing, J. C., Lin, B. J., Pulendran, U., Jani, S. G., Chiang, W. L., Chiang, T. L., Wang, C. J. 2022

  Abstract

  We sought to develop and validate age-specific instruments for measuring early childhood resilience at ages 3, 5 and 8 in the Taiwan Birth Cohort Study, a national longitudinal study.Using data from 18,553 mother-infant pairs, we conducted exploratory factor analysis (EFA) on a simple random half of our sample. We then used the remaining half of these data for confirmatory factor analysis (CFA) to further assess the fit of three CFA models (i.e., first-order, second-order, and bifactor). Psychometric properties, distributions, and inter-item and inter-factor correlations of each instrument were also evaluated.EFA and CFA showed that the bifactor model of resilience (which included a general resilience factor and five specific factors) had the best fit for all three resilience scales, with 19 items at year 3, 18 items at year 5, and 19 items at year 8. All three resilience scales showed good psychometric properties, including construct validity, internal consistency, and normal distributions. For predictive validity, we found that in the face of adversity (measured by the High Risk Family Score), individuals with high resilience scores at age 3 had better general health scores at ages 3, 5, and 8 compared to those with low resilience scores.We describe the development and validation of age-appropriate survey instruments to assess resilience in young children at the population level. These instruments can be used to better understand how resilience can impact child health over time, and to identify key factors that can foster resilience.

  View details for DOI 10.1016/j.acap.2022.06.002

  View details for PubMedID 35691535

• Parents' Experiences and Needs Regarding Infant Sickle Cell Trait Results. Pediatrics Sims, A. M., Cromartie, S. J., Gessner, L., Campbell, A., Coker, T., Wang, C. J., Tarini, B. A. 2022

  Abstract

  Sickle cell trait (SCT) has reproductive implications and can rarely cause health problems. SCT counseling improves parent knowledge but is infrequently received by children with SCT compared with children with cystic fibrosis carrier status. There are no national guidelines on SCT disclosure timing, frequency, or counseling content. Parents' experiences with SCT disclosure and counseling are poorly understood but could inform the development of guidelines. We explored parents' experiences with and desires for SCT disclosure and counseling for their infants with SCT identified via newborn screening.Parents of infants 2 to 12 months old with SCT were recruited through a state newborn screening program for semistructured interviews to explore their experiences with and desires for SCT disclosure and counseling. Inductive thematic analysis was conducted.Sixteen interviews were completed from January to August 2020. Most parents reported that SCT disclosure occurred soon after birth, in person, and by the child's physician. Five themes were identified: parent knowledge before child's SCT disclosure, family planning, the dynamics of SCT disclosure and counseling, emotions and actions after SCT disclosure, and parent desires for the SCT disclosure and counseling process. Two primary parent desires were revealed. Parents want more information about SCT, particularly rare symptomatology, and they want SCT counseling repeated once the child approaches adolescence.Parents report receiving their child's SCT diagnosis in the early newborn period from their child's doctor but indicate they receive incomplete information. Opportunities exist in primary care pediatrics to better align SCT disclosure timing and counseling content with parent desires.

  View details for DOI 10.1542/peds.2021-053454

  View details for PubMedID 35441211

• Feasibility of Specimen Self-collection in Young Children Undergoing SARS-CoV-2 Surveillance for In-Person Learning. JAMA network open Altamirano, J., Lopez, M., Robinson, I. G., Chun, L. X., Tam, G. K., Shaikh, N. J., Hoyte, E. G., Carrington, Y. J., Jani, S. G., Toomarian, E. Y., Hsing, J. C., Ma, J., Pulendran, U., Govindarajan, P., Blomkalns, A. L., Pinsky, B. A., Wang, C. J., Maldonado, Y. 2022; 5 (2): e2148988

  Abstract

  There is an urgent need to assess the feasibility of COVID-19 surveillance measures in educational settings.To assess whether young children can feasibly self-collect SARS-CoV-2 samples for surveillance testing over the course of an academic year.This prospective pilot cohort study was conducted from September 10, 2020, to June 10, 2021, at a K-8 school in San Mateo County, California. The research consisted of quantitative data collection efforts: (1) demographic data collected, (2) student sample self-collection error rates, and (3) student sample self-collection time durations. Students were enrolled in a hybrid learning model, a teaching model in which students were taught in person and online, with students having the option to attend virtually as needed. Data were collected under waiver of consent from students participating in weekly SARS-CoV-2 testing.Errors over time for self-collection of nasal swabs such as contaminated swabs and inadequate or shallow swabbing; time taken for sample collection.Of 296 participants, 148 (50.0%) were boys and 148 (50.0%) were girls. A total of 87 participants (29.2%) identified as Asian; 2 (0.6%), Black or African American; 13 (4.4%), Hispanic/Latinx; 103 (34.6%), non-Hispanic White; 87 (29.2%), multiracial; and 6 (2.0%), other. The median school grade was fourth grade. From September 2020 to March 2021, a total of 4203 samples were obtained from 221 students on a weekly basis, while data on error rates were collected. Errors occurred in 2.7% (n = 107; 95% CI, 2.2%-3.2%) of student encounters, with the highest rate occurring on the first day of testing (20 [10.2%]). There was an overall decrease in error rates over time. From April to June 2021, a total of 2021 samples were obtained from 296 students on a weekly basis while data on encounter lengths were collected. Between April and June 2021, 193 encounters were timed. The mean duration of each encounter was 70 seconds (95% CI, 66.4-73.7 seconds).Mastery of self-collected lower nasal swabs is possible for children 5 years and older. Testing duration can be condensed once students gain proficiency in testing procedures. Scalability for larger schools is possible if consideration is given to the resource-intensive nature of the testing and the setting's weather patterns.

  View details for DOI 10.1001/jamanetworkopen.2021.48988

  View details for PubMedID 35175340

• Contact-tracing app curbs the spread of COVID NATURE Wang, C. 2021: 336-337

  View details for DOI 10.1038/d41586-021-01354-8

  View details for Web of Science ID 000654424300001

  View details for PubMedID 34035507

• PretermConnect: Leveraging mobile technology to mitigate social disadvantage in the NICU and beyond. Seminars in perinatology Jani, S. G., Nguyen, A. D., Abraham, Z., Scala, M., Blumenfeld, Y. J., Morton, J., Nguyen, M., Ma, J., Hsing, J. C., Moiwa-Grant, M., Profit, J., Wang, C. J. 2021: 151413

  Abstract

  Preterm birth (PTB) - delivery prior to 37-weeks gestation - disproportionately affects low-income and minority populations and leads to substantial infant morbidity and mortality. The time following a PTB represents an optimal window for targeted interventions that encourage mothers to prioritize their own health and that of their babies. Healthcare teams can leverage digital strategies to address maternal and infant needs in this postpartum period, both in the neonatal intensive care unit and beyond. We therefore developed PretermConnect, a mobile app designed to educate, engage, and empower women at risk for PTB. This article describes the participant-centered design approach of PretermConnect, with preliminary findings from focus groups and co-design sessions in different community settings and suggested future directions for mobile technologies in population health. Apps such as PretermConnect can mitigate social disadvantage by serving as remote monitoring tools, providing social support, preventing recurrent PTB and lowering infant mortality rates.

  View details for DOI 10.1016/j.semperi.2021.151413

  View details for PubMedID 33888330

• Considerations and a call to action for the use of noncontact forehead infrared handheld thermometers during the COVID-19 pandemic. Journal of global health Chan, W. P., Kosik, R. O., Wang, C. J. 2021; 11: 03023

  View details for DOI 10.7189/jogh.11.03023

  View details for PubMedID 33692878

  View details for PubMedCentralID PMC7914381

• Prospective Pilot Study Evaluating SARS-CoV-2 Transmission-Limiting Measures in an On-Site School. Academic pediatrics Jani, S. G., Ma, J., Pulendran, U., Hsing, J. C., Altamirano, J., Shah, S., Toomarian, E. Y., Maldonado, Y., Wang, C. J. 2021

  Abstract

  The purpose of our study is to evaluate the feasibility and reliability of a comprehensive set of preventive measures in limiting secondary transmission of COVID-19 in schools.A prospective cohort study was conducted to evaluate SARS-CoV-2 transmission in an independent K-8 school in San Mateo County, California. The research was conducted between September 14, 2020 through March 22, 2021 and consisted of: (1) demographic and epidemiological questionnaires; (2) daily symptom reporting; (3) weekly RT-PCR testing; and (4) periodic on-site qualitative observations.180 (79%) students and 63 (74%) on-site staff/contractors were enrolled. Participants reported symptoms in 144 (<1%) daily surveys of the 19,409 collected. Among those who reported symptoms and exposures, none tested positive during the 22-week study period. Of all participants, a total of 6 tested positive for SARS-CoV-2 at least once by RT-PCR; all were asymptomatic at time of testing. No in-school transmission occurred. Mask adherence was high among all grades, and incidents of improper mask use mostly occurred during non-instruction time. Physical distancing was well-enforced during class time and snack breaks, although adherence during non-instruction time waned as the school year progressed.Our comprehensive, prospective study following COVID-19 transmission over 22 weeks in a K-8 school demonstrates that: (1) surveillance testing is important for detecting asymptomatic infections in schools; (2) monitoring symptoms may not be necessary and/or sufficient for COVID-19; and (3) younger children can adhere to key mitigation measures (e.g., masking) which have the potential to limit transmission.

  View details for DOI 10.1016/j.acap.2021.11.019

  View details for PubMedID 34896273

• Influence of health beliefs on adherence to COVID-19 preventative practices: an online international study via social media. Journal of medical Internet research Hsing, J. C., Ma, J. n., Barrero-Castillero, A. n., Jani, S. G., Pulendran, U. P., Lin, B. J., Thomas-Uribe, M. n., Wang, C. J. 2021

  Abstract

  Health behavior is influenced by culture and social context. However, there are limited data evaluating the scope of these influences on COVID-19 response.This study aimed to compare handwashing and social distancing practices in different countries and evaluate practice predictors using the health belief model.From April 11th to May 1st, 2020, we conducted an online, cross-sectional survey disseminated internationally via social media. Participants were adults aged 18 years or older from four different countries: The United States, Mexico, Hong Kong (China), and Taiwan. Primary outcomes were self-reported handwashing and social distancing practices during COVID-19. Predictors included constructs of the health belief model, including perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and cues to action. Associations of these constructs with behavioral outcomes were assessed by multivariable logistic regression.We analyzed a total of 71,851 participants, with 3,070 from the United States, 3,946 from Mexico, 1,201 from Hong Kong (China), and 63,634 from Taiwan. Of these countries, respondents from the U.S. adhered to the most social distancing practices (chi-squared test = 2169.7, P<.001), while respondents from Taiwan performed the most handwashing (chi-squared test = 309.8, P<.001). Multivariable logistic regression analyses indicated that self-efficacy was a positive predictor for handwashing (OR [95% CI]; U.S. = 1.58 [1.21-2.07]; Mexico = 1.54 [1.21-1.96]; Hong Kong = 2.48 [1.80-3.44]; Taiwan = 2.30 [2.21-2.39]) and social distancing practices (U.S. = 1.77 [1.24-2.49]; Mexico = 1.77 [1.40-2.25]; Hong Kong = 3.25 [2.32-4.62]; Taiwan = 2.58 [2.47-2.68]) in all countries. Handwashing was positively associated with perceived susceptibility in Mexico, Hong Kong, and Taiwan, while social distancing was positively associated with perceived severity in the U.S., Mexico, and Taiwan.Social media recruitment strategies can be used to reach a large audience during a pandemic. Self-efficacy was the strongest predictor for handwashing and social distancing. Policies that address relevant health beliefs can facilitate adoption of necessary actions for preventing COVID-19. Our findings may be explained by the timing of government policies, the number of cases reported in each country, individual beliefs, and cultural context.

  View details for DOI 10.2196/23720

  View details for PubMedID 33571103

• The early detection of immunoglobulins via optical-based lateral flow immunoassay platform in COVID-19 pandemic. PloS one Chen, P. Y., Ko, C. H., Wang, C. J., Chen, C. W., Chiu, W. H., Hong, C., Cheng, H. M., Wang, I. J. 2021; 16 (7): e0254486

  Abstract

  The coronavirus disease (COVID-19) is the global public health challenge currently persisting at a grand scale. A method that meets the rapid quantitative detection of antibodies to assess the body's immune response from natural COVID-19 illness or vaccines' effects is urgently needed. In the present study, an attempt was made to integrate a newly designed spectrometer to the COVID-19 test strip procedure; this augmentation provides the quantitative capacity to a lateral flow immunoassay (LFIA). Optical interpretation of results by quantitative α index, rather than visual qualification, can be done quickly, in 5-10 minutes. The developed product was compared with several other serological IgM/IgG antibody reagents on the market by recruiting 111 participants suspected of having COVID-19 infection from March to May 2020 in a hospital. Taking RT-PCR as the diagnostic gold standard, the quantitative spectral LIFA platform could correctly detect all 12 COVID-19 patients. Concerning RT-PCR negative patients, all three antibody testing methods found positive cases. The optical-based platform exhibited the ability of early detection of immunoglobulins of RT-PCR negative patients. There was an apparent trend that elevation of IgM levels in the acute phase of infection; then IgG levels rose later. It exhibited the risk of a false-negative diagnosis of RT-PCR in COVID-19 testing. The significant detection ability of this new optical-based platform demonstrated clinical potential.

  View details for DOI 10.1371/journal.pone.0254486

  View details for PubMedID 34283860

• Primary Care Providers in California and Florida Report Low Confidence in Providing Type 1 Diabetes Care. Clinical diabetes : a publication of the American Diabetes Association Lal, R. A., Cuttriss, N. n., Haller, M. J., Yabut, K. n., Anez-Zabala, C. n., Hood, K. K., Sheehan, E. n., Basina, M. n., Bernier, A. n., Baer, L. G., Filipp, S. L., Wang, C. J., Town, M. A., Gurka, M. J., Maahs, D. M., Walker, A. F. 2020; 38 (2): 159–65

  Abstract

  People with type 1 diabetes may receive a significant portion of their care from primary care providers (PCPs). To understand the involvement of PCPs in delivering type 1 diabetes care, we performed surveys in California and Florida, two of the most populous and diverse states in the United States. PCPs fill insulin prescriptions but report low confidence in providing type 1 diabetes care and difficulty accessing specialty referrals to endocrinologists.

  View details for DOI 10.2337/cd19-0060

  View details for PubMedID 32327888

  View details for PubMedCentralID PMC7164993

• The Power of Telehealth Has Been Unleashed. Pediatric clinics of North America Wang, C. J., Car, J. n., Zuckerman, B. S. 2020; 67 (4): xvii-xviii

  View details for DOI 10.1016/j.pcl.2020.05.001

  View details for PubMedID 32650874

  View details for PubMedCentralID PMC7304401

• The Opportunities for Telehealth in Pediatric Practice and Public Health. Pediatric clinics of North America Wang, C. J., Ma, J. n., Zuckerman, B. n., Car, J. n. 2020; 67 (4): 603–11

  Abstract

  Telehealth can be delivered asynchronously, synchronously, or through remote patient monitoring. The cost of telehealth, patient use, and effectiveness vary by the technology deployed and by specialty. Telehealth use requires patient and provider adaptability. The improvement of telehealth is restricted by state and federal policies as well as privacy and security concerns. Current telehealth literature provides more consistent evidence of benefits for communication and counseling, and from remote patient monitoring of chronic conditions. However, the benefits and costs of telehealth programs are highly dependent on the technology used, the medical condition studied, and the health care context.

  View details for DOI 10.1016/j.pcl.2020.03.001

  View details for PubMedID 32650856

• Design, Adoption, Implementation, Scalability, and Sustainability of Telehealth Programs. Pediatric clinics of North America Wang, C. J., Liu, T. T., Car, J. n., Zuckerman, B. n. 2020; 67 (4): 675–82

  Abstract

  Telehealth and telemedicine services can be a solution for improving accessibility and reducing the cost of health care. Challenges remain in designing, implementing, and sustainably scaling telehealth solutions. Research is lacking on the health impacts and cost-effectiveness of telehealth; more data are needed in the evaluation of telehealth programs, adjusting for potential participant bias and extending the time frame of evaluating impact. In addition, rethinking and addressing the economic incentives and payment for telehealth services, as well as the medical-legal framework for provider competition across geographic regions (and jurisdictions), are needed for greater adoption of telehealth services.

  View details for DOI 10.1016/j.pcl.2020.04.011

  View details for PubMedID 32650866

• Workforce Shortage for Retinopathy of Prematurity Care and Emerging Role of Telehealth and Artificial Intelligence. Pediatric clinics of North America Barrero-Castillero, A. n., Corwin, B. K., VanderVeen, D. K., Wang, J. C. 2020; 67 (4): 725–33

  Abstract

  Retinopathy of prematurity (ROP) is the leading cause of childhood blindness in very-low-birthweight and very preterm infants in the United States. With improved survival of smaller babies, more infants are at risk for ROP, yet there is an increasing shortage of providers to screen and treat ROP. Through a literature review of new and emerging technologies, screening criteria, and analysis of a national survey of pediatric ophthalmologists and retinal specialists, the authors found the shortage of ophthalmology workforce for ROP a serious and growing concern. When used appropriately, emerging technologies have the potential to mitigate gaps in the ROP workforce.

  View details for DOI 10.1016/j.pcl.2020.04.012

  View details for PubMedID 32650869

• Connected Pediatric Primary Care for At-Risk Children. Pediatric clinics of North America Zuckerman, B. n., Ng, C. Y., Daglilar, J. O., Wang, C. J. 2020; 67 (4): 665–73

  Abstract

  Age-specific recommendations contain extensive information that cannot be presented adequately in pediatric preventative care visits. Parental guidance is important, especially for children with social and/or medical risks, but existing evidence-based interventions tend to be resource intensive and difficult to scale. Because the use of mobile technology is now prevalent even among low-income families, the benefits of utilizing the Internet and mobile apps to improve parental guidance are active areas of research. Analyses of patient-generated data from mobile apps may help identify effective ways to use social influences, social learning, and social networks for improving population health.

  View details for DOI 10.1016/j.pcl.2020.04.010

  View details for PubMedID 32650865

• How Community and Unity Can Help Americans Survive. Journal of general internal medicine Brook, R. H., Wang, C. J., Wenger, N. S. 2020

  View details for DOI 10.1007/s11606-020-05829-8

  View details for PubMedID 32291724

• Managing medication supply chain during the COVID-19 pandemic: key lessons from Taiwan JAPhA Kuo, S. C., Ou, H. T., Wang, C. J. 2020

  View details for DOI 10.1016/j.japh.2020.08.029

• How to Safely Reopen Colleges and Universities During COVID-19: Experiences from Taiwan Annals of Internal Medicine Cheng, S. Y., Wang, C. J., Shen, A., Chang, S. C. 2020

  View details for DOI 10.7326/M20-2927

• Response to COVID-19 in Taiwan: Big Data Analytics, New Technology, and Proactive Testing. JAMA Wang, C. J., Ng, C. Y., Brook, R. H. 2020

  View details for DOI 10.1001/jama.2020.3151

  View details for PubMedID 32125371

• An impact-oriented approach to epidemiological modeling J Gen Intern Med Shah, N. R., Lai, D., Wang, C. J. 2020

  View details for DOI 10.1007/s11606-020-06230-1

• Operational Considerations on the American Academy of Pediatrics Guidance for K-12 School Reentry. JAMA pediatrics Wang, C. J., Bair, H. n. 2020

  View details for DOI 10.1001/jamapediatrics.2020.3871

  View details for PubMedID 32780111

• An Impact-Oriented Approach to Epidemiological Modeling. Journal of general internal medicine Shah, N. R., Lai, D. n., Wang, C. J. 2020

  View details for DOI 10.1007/s11606-020-06230-1

  View details for PubMedID 32959348

• Child Health and Telehealth in Global, Underresourced Settings. Pediatric clinics of North America Hsing, J. C., Wang, C. J., Wise, P. H. 2020; 67 (4): 773–81

  Abstract

  Telehealth has improved delivery of health care worldwide by improving access to and the quality of health care and by improving the global shortage of health professionals through collaboration and training. Although many telehealth efforts have been reported in adult health care settings, it is important to examine telehealth efforts in the pediatric setting. Children who are most commonly ill and malnourished are often those of underserved populations of the developing world. This article examines current uses of pediatric telehealth in a global setting and discusses key approaches to how telehealth may become successfully integrated and scaled in those settings.

  View details for DOI 10.1016/j.pcl.2020.04.014

  View details for PubMedID 32650872

• Video consultations in primary and specialist care during the covid-19 pandemic and beyond British Medical Journal Car, J., Koh, G. C., Foong, P. S., Wang, C. J. 2020

  View details for DOI 10.1136/bmj.m3945

• How to Prevent and Manage Hospital-Based Infections During Coronavirus Outbreaks: Five Lessons from Taiwan Journal of Hospital Medicine Wang, C. J., Bair, H., Yeh, C. C. 2020

  View details for DOI 10.12788/jhm.3452

• Healthy Hearts via Live Video Conferencing: An Exercise and Diet Intervention in Pediatric Heart Transplant Patients JAHA Chen, A. C., Ramirez, F., Rosenthal, D. N., Couch, S. C., Berry, S., Stauffer, K. J., Brabender, J., McDonald, N., Lee, D., Barkoff, L., Nourse, S. E., Kazmucha, J., Wang, C. J., Olson, I., Tierney, E. S. 2020

  View details for DOI 10.1161/JAHA.119.013816

• Ethics and Governance for Digital Disease Surveillance Science Mello, M., Wang, C. J. 2020; 368 (6494): 951-954

  View details for DOI 10.1126/science.abb9045

• Associations Between Body Fat, Muscle Mass, and Nonalcoholic Fatty Liver Disease: A Population-Based Study. Hepatology communications Hsing, J. C., Nguyen, M. H., Yang, B., Min, Y., Han, S. S., Pung, E., Winter, S. J., Zhao, X., Gan, D., Hsing, A. W., Zhu, S., Wang, C. J. 2019; 3 (8): 1061–72

  Abstract

  Nonalcoholic fatty liver disease (NAFLD) is one of the most common forms of liver disease worldwide and has emerged as a significant public health concern in China. A better understanding of the etiology of NAFLD can inform effective management strategies for this disease. We examined factors associated with NAFLD in two districts of Hangzhou, China, focusing on the relationship of regional body fat distribution, muscle mass, and NAFLD. We used baseline data to carry out a cross-sectional analysis among 3,589 participants from the Wellness Living Laboratory (WELL) China study, a longitudinal population-based study that aims to investigate and promote well-being among the Chinese population. NAFLD was defined using the widely validated fatty liver index (FLI). Multivariate logistic regressions were performed to assess independent associations between NAFLD and metabolic risk factors (e.g., insulin resistance) and dual x-ray absorptiometry (DXA)-derived measures (e.g., android fat ratio [AFR] and skeletal muscle index [SMI]). Of the 3,589 participants, 476 (13.3%) were classified as having FLI-defined NAFLD (FLI ≥60). Among those, 58.0% were men. According to our analysis, AFR (odds ratio [OR], 10.0; 95% confidence interval [CI], 5.8-18.5), insulin resistance (OR, 4.0; 95% CI, 3.0-5.3), high alanine aminotransferase levels (OR, 7.6; 95% CI, 5.8-10.0), smoking (OR, 2.0; 95% CI, 1.4-3.0), and male sex (OR, 2.9; 95% CI, 2.0-4.2) were positively associated with NAFLD risk, while SMI (OR, 0.1; 95% CI, 0.07-0.13) was inversely associated with NAFLD risk. Conclusion: In addition to known metabolic risk factors, DXA-derived AFR and SMI may provide additional insights to the understanding of NAFLD. Interventions that aim to decrease AFR and increase SMI may be important to reduce the burden of NAFLD in this population.

  View details for DOI 10.1002/hep4.1392

  View details for PubMedID 31388627

• Keys to academic success for under-represented minority young investigators: recommendations from the Research in Academic Pediatrics Initiative on Diversity (RAPID) National Advisory Committee. International journal for equity in health Flores, G., Mendoza, F. S., DeBaun, M. R., Fuentes-Afflick, E., Jones, V. F., Mendoza, J. A., Raphael, J. L., Wang, C. J. 2019; 18 (1): 93

  Abstract

  BACKGROUND: Although Latinos, African-Americans, and American Indians/Alaska Natives comprise 34% of Americans, these under-represented minorities (URMs) account for only 7% of US medical-school faculty. Even when URMs become faculty, they face many substantial challenges to success. Little has been published, however, on keys to academic success for URM young faculty investigators.METHODS: The Research in Academic Pediatrics Initiative on Diversity (RAPID) goal is to enhance the professional advancement of URM junior faculty pursuing research careers in general academic pediatrics. One important RAPID component is the annual mentoring/career-development conference, which targets URM residents, fellows, and junior faculty, and has included 62 URM participants since its 2013 inception. A conference highlight is the panel discussion on keys to academic success for URM young investigators, conducted by the RAPID National Advisory Committee, a diverse group of leading senior researchers. The article aim was to provide a guide to academic success for URM young investigators using the 2018 RAPID Conference panel discussion. A modified Delphi technique was used to provide a systematic approach to obtaining answers to six key questions using an expert panel: the single most important key to success for URM young investigators; ensuring optimal mentorship; how to respond when patients/families say, "I don't want you to see my child because you are ____"; best strategies for maximizing funding success; how to balance serving on time-consuming committees with enough time to advance research/career objectives; and the single thing you wish someone had told you which would have substantially enhanced your success early on.RESULTS/CONCLUSIONS: This is the first published practical guide on keys to academic success for URM young investigators. Identified keys to success included having multiple mentors, writing prolifically, being tenaciously persistent, having mentors who are invested in you, dealing with families who do not want you to care for their child because of your race/ethnicity by seeking to understand the reasons and debriefing with colleagues, seeking non-traditional funding streams, balancing committee work with having enough time to advance one's research and career by using these opportunities to generate scholarly products, and asking for all needed resources when negotiating for new jobs.

  View details for DOI 10.1186/s12939-019-0995-1

  View details for PubMedID 31215424

• Telehealth requires expansion of physicians' communication competencies training MEDICAL TEACHER van Galen, L. S., Wang, C. J., Nanayakkara, P. B., Paranjape, K., Kramer, M. H., Car, J. 2019; 41 (6): 714–15

  Abstract

  We are in the midst of transformation of health systems where remote consulting (via video, telephone, email, and mobile messaging) is soon to become the dominant mode of consultation. Most of the literature on telehealth omits mentioning the need for telehealth communication competencies. Yet evidence base has been growing about how critical this training is - whether from clinical communication research or litigation claims analysis. In this article, we are calling for an urgent expansion of communication skills curricula to encompass these new telehealth domains from medical schools, specialty trainings to CMEs.

  View details for DOI 10.1080/0142159X.2018.1481284

  View details for Web of Science ID 000483250200019

  View details for PubMedID 29944031

• Healthy hearts in pediatric heart transplant patients with an exercise and diet intervention via live video conferencing-Design and rationale PEDIATRIC TRANSPLANTATION Chen, A. C., Rosenthal, D. N., Couch, S. C., Berry, S., Stauffer, K. J., Brabender, J., McDonald, N., Lee, D., Barkoff, L., Nourse, S. E., Kazmucha, J., Wang, C., Olson, I., Tierney, E. 2019; 23 (1)

  View details for DOI 10.1111/petr.13316

  View details for Web of Science ID 000457579500010

• Variation in Primary Care Management of Attention-Deficit/Hyperactivity Disorder by Primary Care Providers Academic Pediatrics Bannett, Y., Feldman, H. M., Bentley, J. P., Ansel, D. A., Wang, C. J., Huffman, L. C. 2019

  View details for DOI 10.1016/j.acap.2019.11.016

• Digital health at fifteen: more human (more needed). BMC medicine Huckvale, K. n., Wang, C. J., Majeed, A. n., Car, J. n. 2019; 17 (1): 62

  Abstract

  There is growing appreciation that the success of digital health - whether digital tools, digital interventions or technology-based change strategies - is linked to the extent to which human factors are considered throughout design, development and implementation. A shift in focus to individuals as users and consumers of digital health highlights the capacity of the field to respond to secular developments, such as the adoption of person-centred care and consumer health technologies. We argue that this project is not only incomplete, but is fundamentally 'uncompletable' in the face of a highly dynamic landscape of both technological and human challenges. These challenges include the effects of consumerist, technology-supported care on care delivery, the rapid growth of digital users in low-income and middle-income countries and the impacts of machine learning. Digital health research will create most value by retaining a clear focus on the role of human factors in maximising health benefit, by helping health systems to anticipate and understand the person-centred effects of technology changes and by advocating strongly for the autonomy, rights and safety of consumers.

  View details for PubMedID 30879466

  View details for PubMedCentralID PMC6421699

• Impact of a Mobile App-Based Health Coaching and Behavior Change Program on Participant Engagement and Weight Status of Overweight and Obese Children: Retrospective Cohort Study JMIR MHEALTH AND UHEALTH Cueto, C., Wang, C. J., Sanders, L. M. 2019; 7 (10): e14458

  View details for DOI 10.2196/14458

• “Following Through”: Addressing the Racial Inequality for Preterm Infants and Their Families Pediatric Research Stevenson, D. K., Wong, R. J., Profit, J. J., Shaw, G. M., Wang, C. J., Lee, H. C. 2019

  View details for DOI 10.1038/s41390-019-0602-6

• Hospitalization Patterns for Inpatient Surgery and Procedures in California:2000 – 2016 Anesthesia and Analgesia Muffly, M. K., Honkanen, A., Scheinker, D., Wang, T., Saynina, O., Singleton, M. A., , Wang, C. J., Sanders, L. M. 2019

  View details for DOI 10.1213/ANE.0000000000004552

• Theory-Based Health Behavior Interventions for Pediatric Chronic Disease Management A Systeindtic Review JAMA PEDIATRICS Ng, C. Y., Thomas-Uribe, M., Yang, Y. A., Chu, M. Y., Liu, S., Pulendran, U., Lin, B., Lerner, D. S., King, A. C., Wang, C. 2018; 172 (12): 1177–86

  View details for DOI 10.1001/jamapediatrics.2018.3039

  View details for Web of Science ID 000452130600015

• Parents' Knowledge and Education of Retinopathy of Prematurity in Four California Neonatal Intensive Care Units AMERICAN JOURNAL OF OPHTHALMOLOGY Eneriz-Wiemer, M., Liu, S., Chu, M. Y., Uribe-Leitz, T., Rajani, K., Sankar, M., Robbins, S. L., Lee, H. C., Woodard, C., Wang, C. 2018; 191: 7–13

  View details for DOI 10.1016/j.ajo.2018.03.039

  View details for Web of Science ID 000437387100007

• Outcomes of Follow-up Visits After Bronchiolitis Hospitalizations. JAMA pediatrics Schroeder, A. R., Destino, L. A., Brooks, R. n., Wang, C. J., Coon, E. R. 2018

  View details for PubMedID 29379947

• Managed Care, Hospital Characteristics, and Inpatient Utilization for Sickle Cell Disease Patients. Journal of general internal medicine Lewit, E. n., Thirumalai, K. n., Wang, C. J. 2018; 33 (12): 2053–55

  View details for PubMedID 30128790

  View details for PubMedCentralID PMC6258598

• Specialized Care without the Subspecialist: A Value Opportunity for Secondary Care. Children (Basel, Switzerland) Cohen, E. n., Wang, C. J., Zuckerman, B. n. 2018; 5 (6)

  Abstract

  An underutilized value strategy that may reduce unnecessary subspecialty involvement in pediatric healthcare targets the high-quality care of children with common chronic conditions such as obesity, asthma, or attention deficit hyperactivity disorder within primary care settings. In this commentary, we propose that "secondary care", defined as specialized visits delivered by primary care providers, a general pediatrician, or other primary care providers, can obtain the knowledge, skill and, over time, the experience to manage one or more of these common chronic conditions by creating clinical time and space to provide condition-focused care. This care model promotes familiarity, comfort, proximity to home, and leverages the provider's expertise and connections with community-based resources. Evidence is provided to prove that, with multi-disciplinary and subspecialist support, this model of care can improve the quality, decrease the costs, and improve the provider's satisfaction with care.

  View details for PubMedID 29866987

  View details for PubMedCentralID PMC6025251

• In-Person Interpreter Use and Hospital Length of Stay among Infants with Low Birth Weight International Journal of Environmental Research and Public Health Eneriz-Wiemer, M., Sanders, L., McIntrye, M., Mendoza, F., Do, D., Wang, C. 2018; 15 (8)

  Abstract

  To ensure timely appropriate care for low-birth-weight (LBW) infants, healthcare providers must communicate effectively with parents, even when language barriers exist. We sought to evaluate whether non-English primary language (NEPL) and professional in-person interpreter use were associated with differential hospital length of stay for LBW infants, who may incur high healthcare costs. We analyzed data for 2047 infants born between 1 January 2008 and 30 April 2013 with weight <2500 g at one hospital with high NEPL prevalence. We evaluated relationships of NEPL and in-person interpreter use on length of stay, adjusting for medical severity. Overall, 396 (19%) had NEPL parents. Fifty-three percent of NEPL parents had documented interpreter use. Length of stay ranged from 1 to 195 days (median 11). Infants of NEPL parents with no interpreter use had a 49% shorter length of stay (adjusted incidence rate ratio (IRR) 0.51, 95% confidence interval (CI) 0.43⁻0.61) compared to English-speakers. Infants of parents with NEPL and low interpreter use (<25% of hospital days) had a 26% longer length of stay (adjusted IRR 1.26, 95% CI 1.06⁻1.51). NEPL and high interpreter use (>25% of hospital days) showed a trend for an even longer length of stay. Unmeasured clinical and social/cultural factors may contribute to differences in length of stay.

  View details for DOI 10.3390/ijerph15081570

  View details for PubMedCentralID PMC6121500

• Association of a Bundled-Payment Program With Cost and Outcomes in Full-Cycle Breast Cancer Care JAMA ONCOLOGY Wang, C. J., Cheng, S. H., Wu, J., Lin, Y., Kao, W., Lin, C., Chen, Y., Tsai, S., Kao, F., Huang, A. T. 2017; 3 (3): 327-334

  View details for DOI 10.1001/jamaoncol.2016.4549

  View details for Web of Science ID 000397491400009

• Using a Medical Intranet of Things System to Prevent Bed Falls in an Acute Care Hospital: A Pilot Study. Journal of medical Internet research Balaguera, H. U., Wise, D. n., Ng, C. Y., Tso, H. W., Chiang, W. L., Hutchinson, A. M., Galvin, T. n., Hilborne, L. n., Hoffman, C. n., Huang, C. C., Wang, C. J. 2017; 19 (5): e150

  Abstract

  Hospitalized patients in the United States experience falls at a rate of 2.6 to 17.1 per 1000 patient-days, with the majority occurring when a patient is moving to, from, and around the bed. Each fall with injury costs an average of US $14,000.The aim was to conduct a technology evaluation, including feasibility, usability, and user experience, of a medical sensor-based Intranet of things (IoT) system in facilitating nursing response to bed exits in an acute care hospital.Patients 18 years and older with a Morse fall score of 45 or greater were recruited from a 35-bed medical-surgical ward in a 317-bed Massachusetts teaching hospital. Eligible patients were recruited between August 4, 2015 and July 31, 2016. Participants received a sensor pad placed between the top of their mattress and bed sheet. The sensor pad was positioned to monitor movement from patients' shoulders to their thighs. The SensableCare System was evaluated for monitoring patient movement and delivering timely alerts to nursing staff via mobile devices when there appeared to be a bed-exit attempt. Sensor pad data were collected automatically from the system. The primary outcomes included number of falls, time to turn off bed-exit alerts, and the number of attempted bed-exit events. Data on patient falls were collected by clinical research assistants and confirmed with the unit nurse manager. Explanatory variables included room locations (zones 1-3), day of the week, nursing shift, and Morse Fall Scale (ie, positive fall history, positive secondary diagnosis, positive ambulatory aid, weak impaired gait/transfer, positive IV/saline lock, mentally forgets limitations). We also assessed user experience via nurse focus groups. Qualitative data regarding staff interactions with the system were collected during two focus groups with 25 total nurses, each lasting approximately 1.5 hours.A total of 91 patients used the system for 234.0 patient-days and experienced no bed falls during the study period. On average, patients were assisted/returned to bed 46 seconds after the alert system was triggered. Response times were longer during the overnight nursing shift versus day shift (P=.005), but were independent of the patient's location on the unit. Focus groups revealed that nurses found the system integrated well into the clinical nursing workflow and the alerts were helpful in patient monitoring.A medical IoT system can be integrated into the existing nursing workflow and may reduce patient bed fall risk in acute care hospitals, a high priority but an elusive patient safety challenge. By using an alerting system that sends notifications directly to nurses' mobile devices, nurses can equally respond to unassisted bed-exit attempts wherever patients are located on the ward. Further study, including a fully powered randomized controlled trial, is needed to assess effectiveness across hospital settings.

  View details for PubMedID 28473306

  View details for PubMedCentralID PMC5438463

• Why do Patients Forget to Take Immunosuppression Medications and Miss Appointments: Can a Mobile Phone App Help? JMIR public health and surveillance Israni, A., Dean, C., Kasel, B., Berndt, L., Wildebush, W., Wang, C. J. 2016; 2 (1): e15

  Abstract

  Kidney transplant recipients must adhere to their immunosuppressive medication regimen. However, non-adherence remains a major problem.The aim of this paper is to determine how kidney transplant recipients remember to take their medications, and assess their perception and beliefs about adherence to immunosuppressive medications and barriers to medication adherence. In addition, we aim to assess perception and beliefs about willingness to use a hypothetical, mobile phone app to improve adherence.We conducted a qualitative study that included an average of three home or workplace visits of kidney transplant recipients (N=16) from a single urban transplant center.The qualitative study revealed that transplant recipients understood the importance of taking their immunosuppressive medications and this motivated them to take their medications. The visits showed that most participants have incorporated medication use into their daily lives and that any minor deviation from daily routines could result in non-adherence. Participants also reported other barriers to adherence. All participants were interested in using an app to remind them to take their medication; however, they reported potential barriers to using the app.Although kidney transplant recipients understood the importance of medication adherence, there were significant barriers to maintaining adherence. Participants also reported interest in using a mobile phone app.

  View details for DOI 10.2196/publichealth.5285

  View details for PubMedID 27227150

  View details for PubMedCentralID PMC4869221

• Quality Indicator Development for Positive Screen Follow-up for Sickle Cell Disease and Trait. American journal of preventive medicine Faro, E. Z., Wang, C. J., Oyeku, S. O. 2016; 51 (1 Suppl 1): S48–54

  Abstract

  Extensive variation exists in the follow-up of positive screens for sickle cell disease. Limited quality indicators exist to measure if the public health goals of screening-early initiation of treatment and enrollment to care-are being achieved. This manuscript focuses on the development of quality indicators related to the follow-up care for individuals identified with sickle cell disease and trait through screening processes. The authors used a modified Delphi method to develop the indicators. The process included a comprehensive literature review with rating of the evidence followed by ratings of draft indicators by an expert panel held in September 2012. The expert panel was nominated by leaders of various professional societies, the Health Resources and Services Administration, and the National Heart, Lung, and Blood Institute and met face to face to discuss and rate each indicator. The panel recommended nine quality indicators focused on key aspects of follow-up care for individuals with positive screens for sickle cell disease and trait. Public health programs and healthcare institutions can use these indicators to assess the quality of follow-up care and provide a basis for improvement efforts to ensure appropriate family education, early initiation of treatment, and appropriate referral to care for individuals identified with sickle cell disease and trait.

  View details for PubMedID 27320465

• Medical Device Market Silicon Valley – Economics for Success” (Chinese book published in Taiwan) Wang, C. J. http://www.drmaster.com.tw. 2016: 247
• Understanding Barriers to Early Intervention Services for Preterm Infants: Lessons From Two States ACADEMIC PEDIATRICS Little, A. A., Kamholz, K., Corwin, B. K., Barrero-Castillero, A., Wang, C. J. 2015; 15 (4): 430-438

  Abstract

  To explore existing barriers and challenges to Early Intervention (EI) referral, enrollment, and service provision for very low birth weight (VLBW; <1500 g) infants.We conducted 10 focus groups with parents of VLBW children (n = 44) and 32 interviews with key informants from EI (n = 7), neonatal intensive care units (n = 17), and outpatient clinics (n = 8) at 6 sites in 2 states. We used grounded theory to identify themes about gaps in services.Both parents and providers found EI helpful. However, they also identified gaps in the current EI system at the levels of eligibility, referral, family receptivity, and service provision and coordination with medical care. Inadequate funding and variable procedures for evaluation may affect children's eligibility. Referrals can be missed as a result of simple oversight or communication failure among hospitals, EI, and families; referral outcomes often are not formally tracked. Families may not be receptive to services as a result of wariness of home visits, social stressors, denial about potential developmental delays, or lack of understanding of the benefits of EI. Once a child is deemed eligible, services may be delayed or terminated early, and EI providers may have little specialized training. Communication and coordination with the child's medical care team is often limited.Systemic barriers, including funding and staffing issues, state and federal regulations, and communication with families and medical providers, have led to gaps in the EI system. The chronic care model may serve as a framework for integrating community-based interventions like EI with medical care for VLBW children and other vulnerable populations.

  View details for Web of Science ID 000357363400011

  View details for PubMedID 26142069

  View details for PubMedCentralID PMC4862651

• Sickle Cell Disease Treatment Demonstration Program Congressional Report Adams, W. W., Faro, E., Finnerty, P., Homer, C., Mai, E., Norton, A., Oyeku, S., Vanderkruik, R., Wang, C. J. Health Resources and Services Administration’s Contract HHSH250201000022C . 2014
• The HIPAA conundrum in the era of mobile health and communications. JAMA-the journal of the American Medical Association Wang, C. J., Huang, D. J. 2013; 310 (11): 1121-1122

  View details for DOI 10.1001/jama.2013.219869

  View details for PubMedID 23978879

• Pasteurized human donor milk use among US level 3 neonatal intensive care units. Journal of human lactation Parker, M. G., Barrero-Castillero, A., Corwin, B. K., Kavanagh, P. L., Belfort, M. B., Wang, C. J. 2013; 29 (3): 381-389

  Abstract

  Pasteurized human donor milk (DM) is recommended by the World Health Organization and American Academy of Pediatrics for preterm infants when mother's own milk is unavailable, yet the extent and predictors of use and criteria for use in US neonatal intensive care units (NICUs) are unknown.This study aimed to evaluate current DM use in US level 3 NICUs and predictors and criteria of use.We sent mail surveys to 302 US level 3 NICU directors. We used multivariable logistic regression to analyze predictors of DM use.Survey response rate was 60%, and 76 of 182 (42%) directors reported DM use. Among DM users, 30% have used DM < 2 years and 55% for 2 to 5 years. Among nonusers, 63% were uncertain of turnaround time when ordering DM, 36% were unclear what guidelines milk banks followed, and 31% were unsure of parent receptiveness. In multivariate analyses, > 800 annual admissions (odds ratio [OR], 4.11; 95% confidence interval [CI], 1.43-11.82; reference ≤ 400 admissions) and location in the Midwest (OR, 3.02; 95% CI, 1.17-7.76) and West (OR, 6.33; 95% CI, 2.28-15.57; reference Northeast) were positively associated with DM use; safety-net hospitals (> 75% Medicaid insurance) were negatively associated (OR, 0.35; 95% CI, 0.14-0.89).Pasteurized human donor milk use is rapidly emerging among US level 3 NICUs. Larger NICUs and those in the West and Midwest were more likely to use DM, while safety-net hospitals were less likely to use DM. Lack of knowledge by medical directors of accessibility, safety, and parental receptiveness may be barriers to DM use.

  View details for DOI 10.1177/0890334413492909

  View details for PubMedID 23764482

• Language in Medical Documentation Reply JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Wang, C. J. 2013; 309 (10): 984-984

  View details for Web of Science ID 000315938700019

• Quality-of-Care Indicators for Infantile Spasms JOURNAL OF CHILD NEUROLOGY Wang, C. J., Jonas, R., Fu, C. M., Ng, C. Y., Douglass, L. 2013; 28 (1): 13-20

  Abstract

  We developed a comprehensive set of quality-of-care indicators for the management of children with infantile spasms in the United States, encompassing evaluation, diagnosis, treatment, and prevention and management of side effects and comorbidities. The indicators were developed using the RAND/UCLA Modified Delphi Method. After a focused review of the literature and guidelines by the study team, an expert panel (nominated by leaders of Child Neurology Society, American Epilepsy Society, and National Institute for Neurologic Disorders) rated the draft indicators anonymously, met face-to-face to discuss each indicator, and rerated the revised indicators on validity, feasibility, and importance. The panel recommended 21 indicators, of which 8 were identified as most likely to have a large positive impact on improving quality of life and/or health outcomes for children with infantile spasms. The proposed indicators can be used to assess and document variations and gaps in quality-of-care and inform future research and quality improvement interventions.

  View details for DOI 10.1177/0883073812443590

  View details for PubMedID 22566712

• Medical Documentation in the Electronic Era JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Wang, C. J. 2012; 308 (20): 2091-2092

  View details for Web of Science ID 000311537200021

  View details for PubMedID 23188023

• Improving Preterm Ophthalmologic Care in the Era of Accountable Care Organizations ARCHIVES OF OPHTHALMOLOGY Wang, C. J., Little, A. A., Kamholz, K., Holliman, J. B., Wise, M. D., Davis, J., Ringer, S., Cole, C., VanderVeen, D. K., Christiansen, S. P., Bauchner, H. 2012; 130 (11): 1433-1440

  Abstract

  OBJECTIVES To understand retinopathy of prematurity (ROP) follow-up care for preterm very low-birth-weight infants (VLBW; <1500 g) in the context of the chronic care model and identify opportunities for improvement under accountable care organizations. METHODS We conducted focus groups and interviews with parents (N = 47) of VLBW infants and interviews with neonatal intensive care unit and ophthalmologic providers (N = 28) at 6 sites in Massachusetts and South Carolina. Themes are reported according to consolidated criteria for reporting qualitative research guidelines. RESULTS Respondents perceived that legal liability and low reimbursement contributed to shortages of ROP providers. Some neonatal intensive care units offered subsidies to attract ophthalmologic providers or delayed transfers to institutions that could not provide ROP examinations and/or treatment. Sites used variable practices for coordinating ROP care. Even at sites with a tracking database and a dedicated ROP coordinator, significant time was required to ensure that examinations and treatment occurred as scheduled. Parents' ability to manage their children's health care was limited by parental understanding of ROP, feeling overwhelmed by the infant's care, and unmet needs for resources to address social stressors. CONCLUSIONS Under accountable care organizations, hospitals and ophthalmology practices should share responsibility for ensuring coordinated ROP care to mitigate liability concerns. To promote integrated care, reimbursement for ROP care should be bundled to include screening, diagnosis, treatment, and appropriate follow-up. Clinical information systems should be enhanced to increase efficiency and limit lapses in care. Self-management tools and connections to community resources could help promote families' attendance of follow-up appointments.

  View details for DOI 10.1001/archophthalmol.2012.1890

  View details for Web of Science ID 000310986700009

  View details for PubMedID 22777426

• Maternal note-taking and infant care: a pilot randomised controlled trial ARCHIVES OF DISEASE IN CHILDHOOD Kistin, C. J., Barrero-Castillero, A., Lewis, S., Hoch, R., Philipp, B. L., Bauchner, H., Wang, C. J. 2012; 97 (10): 916-918

  Abstract

  A pilot randomised controlled trial was conducted with postpartum mothers to assess the feasibility and impact of note-taking during newborn teaching. Controls received standard teaching; the intervention group received pen and paper to take notes. Subjects were called 2 days post-discharge to assess infant sleep position, breastfeeding, car seat use, satisfaction and information recall.126 mothers were randomised. There was a consistent trend that intervention subjects were more likely to report infant supine sleep position (88% vs 78%, relative risks (RR) 1.13; 95% CI 0.95 to 1.34), breastfeeding (96% vs 86%, RR 1.11; 95% CI 0.99 to 1.25) and correct car seat use (98% vs 87%, RR 1.12; 95% CI 1.00 to 1.25). Satisfaction and information recall did not differ. Among first-time mothers, intervention subjects were significantly more likely to report infant supine sleep position (95% vs 65%, RR 1.46; 95% CI 1.06 to 2.00).Maternal note-taking is feasible and potentially efficacious in promoting desirable infant care.

  View details for DOI 10.1136/archdischild-2012-302289

  View details for Web of Science ID 000309056100018

  View details for PubMedID 22806235

• Hemoglobinopathy Learning Collaborative: Using Quality Improvement (QI) to Achieve Equity in Health Care Quality, Coordination, and Outcomes for Sickle Cell Disease JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED Oyeku, S. O., Wang, C. J., Scoville, R., VanderKruik, R., Clermont, E., McPherson, M. E., Adams, W. G., Homer, C. J. 2012; 23 (3): 34-48

  Abstract

  Care and outcomes for individuals living with sickle cell disease (SCD) vary across institutions and communities. The Hemoglobinopathy Learning Collaborative (HLC) seeks to improve outcomes across the life course through improvement science. Faculty identified five key drivers of improved outcomes: a strong community network; knowledgeable, proactive individuals, families and providers; reliable identification and follow-up; seamless co-management between primary and specialty care; and appropriate treatment for acute episodes. Using a modified Delphi process, we selected improvement measures aligned with the drivers. Data are collected via a Web-based system linked to a reporting portal. Participating teams include consumers, community organizations and primary and specialty care providers. This commentary reviews the context of SCD in the U.S.; describes the framework, measures, and technology infrastructure already created for the HLC; reports on the early experience of teams; highlights the initiative's challenges and opportunities; and reflects on its implications in the setting of health reform.

  View details for Web of Science ID 000307413700007

  View details for PubMedID 22864486

• Setting the Agenda for Quality Improvement in Pediatric Sickle Cell Disease JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION Kenyon, C. C., Kavanagh, P. L., Fiechtner, L. G., Textor, T. E., Wang, C. J. 2012; 104 (7-8): 337-341

  Abstract

  Despite recent scientific advances, children with sickle cell disease (SCD) continue to experience high mortality and significant morbidity, in part due to variations in the care provided. We sought to identify and compare drivers for quality improvement among clinical staff and parents of children with SCD.We interviewed clinical staff across care settings in an urban teaching hospital to elicit their perspectives on improving care for children with SCD. Concurrently, we invited parents of children with SCD to participate in focus groups to identify their needs. Findings are reported according to Consolidated Criteria for Reporting Qualitative Research guidelines.We conducted 29 interviews with clinical staff and 4 focus groups with parents. Both groups identified the need for effective communication of relevant patient information across disciplines as a key area for improvement. Clinical staff cited standardization of care delivery as a top priority through increased accessibility of pertinent clinical information, enhanced pain assessment and management, and improved availability of clinical decision-making tools. Parents listed the need for increased community awareness about SCD, including school and day care staff, enhanced parental education and peer support, and self-management skills for their children as opportunities to improve pediatric SCD care.Identifying drivers for quality improvement is a critical first step in transforming the care provided to children with SCD. Using a systematic approach that includes eliciting the perspectives of both clinicians and parents may significantly enhance the development of a patient-centered quality improvement agenda.

  View details for Web of Science ID 000309845900003

  View details for PubMedID 23092048

• Electronic Health Record Technology Reply JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Wang, C. J., Huang, A. T. 2012; 307 (21): 2256-2256

  View details for Web of Science ID 000304801700013

• Integrating Technology Into Health Care What Will It Take? JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Wang, C. J., Huang, A. T. 2012; 307 (6): 569-570

  View details for Web of Science ID 000299992500019

  View details for PubMedID 22318276

• A Proposed Framework for Understanding the Forces behind Legislation of Universal Health InsuranceuLessons from Ten Countries HEALTH SERVICES RESEARCH Wang, C. J., Ellender, S. M., Textor, T., Bauchner, J. H., Wu, J., Bauchner, H., Huang, A. T. 2011; 46 (6): 2101-2118

  Abstract

  To understand the forces propelling countries to legislate universal health insurance. DATA SOURCE/STUDY DESIGN: Descriptive review and exploratory synthesis of historic data on economic, geographic, socio-demographic, and political factors.We searched under "insurance, health" on MEDLINE and Google Scholar, and we reviewed relevant books and articles via a snowball approach.Ten countries with universal health insurance were studied. For the five countries that passed final universal insurance laws prior to 1958, we found that two forces of "historical context" (i.e., social solidarity and historic patterns), one "ongoing dynamic force" (political pressures), and "one uniqueness of the moment" force (legislative permissiveness) played a major role. For the five countries that passed final legislation between 1967 and 2010, the predominant factors were two "ongoing dynamic forces" (economic pressures and political pressures) and one "uniqueness of the moment" force (leadership). In general, countries in the former group made steady progress, whereas those in the latter group progressed in abrupt leaps.The lessons of more recent successes-almost all of which were achieved via abrupt leaps-strongly indicate the importance of leadership in taking advantage of generalized economic and political pressures to achieve universal health insurance.

  View details for DOI 10.1111/j.1475-6773.2011.01320.x

  View details for Web of Science ID 000297244200005

  View details for PubMedID 22092227

• Management of Children With Sickle Cell Disease: A Comprehensive Review of the Literature PEDIATRICS Kavanagh, P. L., Sprinz, P. G., Vinci, S. R., Bauchner, H., Wang, C. J. 2011; 128 (6): E1552-E1574

  Abstract

  Sickle cell disease (SCD) affects 70 000 to 100 000 people in the United States, and 2000 infants are born with the disease each year. The purpose of this study was to review the quality of the literature for preventive interventions and treatment of complications for children with SCD to facilitate the use of evidence-based medicine in clinical practice and identify areas in need of additional research.We searched the Ovid Medline database and the Cochrane Library for articles published between January 1995 and April 2010 for English-language abstracts on 28 topics thought to be important for the care of children with SCD. We also added pertinent references cited by studies identified in our search. Each abstract was reviewed independently by 2 authors. Data from articles retrieved for full review were abstracted by using a common form.There were 3188 abstracts screened, and 321 articles underwent full review. Twenty-six articles (<1% of abstracts initially screened), which consisted of 25 randomized controlled trials and 1 meta-analysis, were rated as having level I evidence. Eighteen of the 28 topics selected for this review did not have level I evidence studies published. The management and prevention of pain episodes accounted for more than one-third of the level I studies.Although significant strides have been made in the care of children with SCD in the past 2 decades, more research needs to be performed, especially for acute events associated with SCD, to ensure that the health and well-being of children with SCD continues to improve.

  View details for DOI 10.1542/peds.2010-3686

  View details for Web of Science ID 000298131400023

  View details for PubMedID 22123880

• Communication of Urgent Public Health Messages to Urban Populations: Lessons From the Massachusetts Water Main Break DISASTER MEDICINE AND PUBLIC HEALTH PREPAREDNESS Wang, C. J., Little, A. A., Holliman, J. B., Ng, C. Y., Barrero-Castillero, A., Fu, C. M., Zuckerman, B., Bauchner, H. 2011; 5 (3): 235-241

  Abstract

  To study when and how an urgent public health message about a boil-water order reached an urban population after the Massachusetts water main break.In-person surveys were conducted in waiting areas of clinics and emergency departments at a large urban safety net hospital within 1 week of the event.Of 533 respondents, 97% were aware of the order; 34% of those who lived in affected cities or towns were potentially exposed to contaminated water. Among those who were aware, 98% took action. Respondents first received the message through word of mouth (33%), television (25%), cellular telephone calls (20%), landline calls (10%), and other modes of communication (12%). In multivariate analyses, foreign-born respondents and those who lived outside the city of Boston had a higher risk of exposure to contaminated water. New modes (eg, cellular telephones) were used more commonly by females and younger individuals (ages 18 to 34). Individuals who did not speak English at home were more likely to receive the message through their personal networks.Given the increasing prevalence of cellular telephone use, public officials should encourage residents to register landline and cellular telephone for emergency alerts and must develop creative ways to reach immigrants and non-English-speaking groups quickly via personal networks.

  View details for Web of Science ID 000296362300012

  View details for PubMedID 22003141

• Quality-of-Care Indicators for Children With Sickle Cell Disease PEDIATRICS Wang, C. J., Kavanagh, P. L., Little, A. A., Holliman, J. B., Sprinz, P. G. 2011; 128 (3): 484-493

  Abstract

  To develop a set of quality-of-care indicators for the management of children with sickle cell disease (SCD) who are cared for in a variety of settings by addressing the broad spectrum of complications relevant to their illness.We used the Rand/University of California Los Angeles appropriateness method, a modified Delphi method, to develop the indicators. The process included a comprehensive literature review with ratings of the evidence and 2 rounds of anonymous ratings by an expert panel (nominated by leaders of various US academic societies and the National Heart, Lung, and Blood Institute). The panelists met face-to-face to discuss each indicator in between the 2 rounds.The panel recommended 41 indicators that cover 18 topics; 17 indicators described routine health care maintenance, 15 described acute or subacute care, and 9 described chronic care. The panel identified 8 indicators most likely to have a large positive effect on improving quality of life and/or health outcomes for children with SCD, which covered 6 topics: timely assessment and treatment of pain and fever; comprehensive planning; penicillin prophylaxis; transfusion; and the transition to adult care.Children with SCD are at risk for serious morbidities and early mortality, yet efforts to assess and improve the quality of their care have been limited compared with other chronic childhood conditions. This set of 41 indicators can be used to assess quality of care and provide a starting point for quality-improvement efforts.

  View details for DOI 10.1542/peds.2010-1791

  View details for Web of Science ID 000295406100043

  View details for PubMedID 21844055

• Translating scientific advances to improved outcomes for children with sickle cell disease: a timely opportunity. Pediatric blood & cancer Raphael, J. L., Kavanagh, P. L., Wang, C. J., Mueller, B. U., Zuckerman, B. 2011; 56 (7): 1005-1008

  Abstract

  Despite the recent advances made in the care of children with sickle cell disease (SCD), premature mortality, especially among older children and young adults, remains a hallmark of this disease. The lack of survival gains highlights the translational gap of implementing innovations found efficacious in the controlled trial setting into routine clinical practice. Health services research (HSR) examines the most effective ways to finance, organize, and deliver high quality care in an equitable manner. To date, HSR has been underutilized as a means to improve the outcomes for children with SCD. Emerging national priorities in health care delivery, new sources of funding, and evolving electronic data collection systems for patients with SCD have provided a unique opportunity to overcome the translational gap in pediatric SCD. The purpose of this article is to provide a comprehensive HSR agenda to create patient-specific evidence of clinical effectiveness for interventions used in the routine care setting, understand the barriers faced by clinicians to providing high quality care, assess and improve the interactions of patients with the health care system, and measure the quality of care delivered to increase survival for all children and young adults with SCD.

  View details for DOI 10.1002/pbc.23059

  View details for PubMedID 21488152

• Can State Early Intervention Programs Meet the Increased Demand of Children Suspected of Having Autism Spectrum Disorders? JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Wise, M. D., Little, A. A., Holliman, J. B., Wise, P. H., Wang, C. J. 2010; 31 (6): 469-476

  Abstract

  To determine whether Early Intervention programs have the capacity to accommodate the expected increase in referrals following the American Academy of Pediatrics' 2007 recommendation for universal screening of 18- and 24-month-old children for Autism Spectrum Disorders (ASD).We conducted a telephone survey of all state and territory early. Intervention coordinators about the demand for ASD evaluations, services, and program capacity. We used multivariate models to examine state-level factors associated with the capacity to serve children with ASD.Fifty-two of the 57 coordinators (91%) responded to the survey. Most states reported an increase in demand for ASD-related evaluations (65%) and services (58%) since 2007. In addition, 46% reported that their current capacity poses a challenge to meeting the 45-day time limit for creating the Individualized Family Service Plan. Many states reported that they have shortages of ASD-related personnel, including behavioral therapists (89%), speech-language pathologists (82%), and occupational therapists (79%). Among states that reported the number of service hours (n = 34) 44% indicated that children with ASD receive 5 or fewer weekly service hours. Multivariate models showed that states with a higher percentage of African-American and Latino children were more likely to have provider shortages whereas states with higher population densities were more likely to offer a greater number of service hours.Many Early Intervention programs may not have the capability to address the expected increase in demand for ASD services. Early Intervention programs will likely need enhanced resources to provide all children with suspected ASD with appropriate evaluations and services.

  View details for DOI 10.1097/DBP.0b013e3181e56db2

  View details for Web of Science ID 000279648300002

  View details for PubMedID 20585267

• Payment Reform for Safety-Net Institutions -- Improving Quality and Outcomes. NEW ENGLAND JOURNAL OF MEDICINE Wang, C. J., Conroy, K. N., Zuckerman, B. 2009; 361 (19): 1821-1823

  View details for Web of Science ID 000271405800003

  View details for PubMedID 19890124

• Perceptions of Standards-based Electronic Prescribing Systems as Implemented in Outpatient Primary Care: A Physician Survey Annual Conference of the Agency-for-Healthcare-Research-and-Quality Wang, C. J., Patel, M. H., Schueth, A. J., Bradley, M., Wu, S., Crosson, J. C., Glassman, P. A., Bell, D. S. BMJ PUBLISHING GROUP. 2009: 493–502

  Abstract

  OBJECTIVE To compare the experiences of e-prescribing users and nonusers regarding prescription safety and workload and to assess the use of information from two e-prescribing standards (for medication history and formulary and benefit information), as they are implemented. DESIGN Cross-sectional survey of physicians who either had installed or were awaiting installation of one of two commercial e-prescribing systems. MEASUREMENTS Perceptions about medication history and formulary and benefit information among all respondents, and among e-prescribing users, experiences with system usability, job performance impact, and amount of e-prescribing. RESULTS Of 395 eligible physicians, 228 (58%) completed the survey. E-prescribers (n = 139) were more likely than non-e-prescribers (n = 89) to perceive that they could identify clinically important drug-drug interactions (83 versus 67%, p = 0.004) but not that they could identify prescriptions from other providers (65 versus 60%, p = 0.49). They also perceived no significant difference in calls about drug coverage problems (76 versus 71% reported getting 10 or fewer such calls per week; p = 0.43). Most e-prescribers reported high satisfaction with their systems, but 17% had stopped using the system and another 46% said they sometimes reverted to handwriting for prescriptions that they could write electronically. The volume of e-prescribing was correlated with perceptions that it enhanced job performance, whereas quitting was associated with perceptions of poor usability. CONCLUSIONS E-prescribing users reported patient safety benefits but they did not perceive the enhanced benefits expected from using standardized medication history or formulary and benefit information. Additional work is needed for these standards to have the desired effects.

  View details for DOI 10.1197/jamia.M2998

  View details for Web of Science ID 000267995500009

  View details for PubMedID 19390106

• Factors Influencing the Enrollment of Eligible Extremely-Low-Birth-Weight Children in the Part C Early Intervention Program ACADEMIC PEDIATRICS Wang, C. J., Elliott, M. N., Rogowski, J., Lim, N., Ratner, J. A., Schuster, M. A. 2009; 9 (4): 283-287

  Abstract

  To determine whether eligible extremely-low-birth-weight children (<1000 g) were enrolled in the federally enacted, state-coordinated Early Intervention (EI) program intended to help children with developmental delay or disability regardless of parental income, and the factors associated with enrollment.Retrospective analysis of 884 EI-eligible ELBW children born in South Carolina with birth weight 401 to 999 g, gestation > or =24 weeks, and survival for the first 120 days of life. We created a linked data set with data from Early Intervention (1996-2001), Vital Records (1996-1998), death certificates, and Medicaid. Each child was followed from birth to 3 years old, the program eligibility period.A total of 54% of ELBW children were enrolled in EI at any time from birth to 36 months. Even among children ever enrolled in Medicaid (83% of all ELBW children), only 63% were enrolled in EI. Being born in a multiple gestational birth, having heavier birth weight (750 to 999 g), and having ever enrolled in Medicaid were positively associated with EI enrollment. Among Medicaid patients for whom perinatal data were available, additional risk adjustment showed that EI enrollment was more likely with birth in level 3 hospitals, birth weight 750 to 999 g, Neonatal Medical Index severity level V (most severe), and longer initial length of hospital stay.Only about half of eligible ELBW children in South Carolina were enrolled-much lower than reported elsewhere. Efforts are needed to understand why eligible infants are not being enrolled and to develop strategies to remedy the situation.

  View details for Web of Science ID 000275913200014

  View details for PubMedID 19482532

• Quality indicators and quality assessment in child health ARCHIVES OF DISEASE IN CHILDHOOD Kavanagh, P. L., Adams, W. G., Wang, C. J. 2009; 94 (6): 458-463

  Abstract

  Quality indicators are systematically developed statements that can be used to assess the appropriateness of specific healthcare decisions, services and outcomes. In this review, the range and type of indicators that have been developed for children in the UK and USA by prominent governmental agencies and private organisations are highlighted. These indicators are classified in an effort to identify areas of child health that may lack quality measures. The current state of health information technology in both countries is reviewed, since these systems are vital to quality efforts. Finally, several recommendations are proposed to advance the quality indicator development agenda for children. The convergence of quality measurement and indicator development, a growing scientific evidence base and integrated information systems in healthcare may lead to substantial improvements for child health in the 21st century.

  View details for DOI 10.1136/adc.2008.137893

  View details for Web of Science ID 000266272100014

  View details for PubMedID 19307196

  View details for PubMedCentralID PMC2774840

• Adherence to Quality Indicators and Survival in Patients With Breast Cancer MEDICAL CARE Cheng, S. H., Wang, C. J., Lin, J., Horng, C., Lu, M., Asch, S. M., Hilborne, L. H., Liu, M., Chen, C., Huang, A. T. 2009; 47 (2): 217-225

  Abstract

  International initiatives increasingly advocate physician adherence to clinical protocols that have been shown to improve outcomes, yet the process-outcome relationship for adhering to breast cancer care protocol is unknown.This study explores whether 100% adherence to a set of quality indicators applied to individuals with breast cancer is associated with better survival.Ten quality indicators (4 diagnosis-related and 6 treatment-related indicators) were used to measure the quality of care in 1378 breast cancer patients treated from 1995 to 2001. Adherence to each indicator was based on the number of procedures performed divided by the number of patients eligible for that procedure. The main analysis of adherence was dichotomous (ie, 100% adherence vs. <100% adherence).The outcome measures studied were 5-year overall survival and progression-free survival, calculated using the Kaplan-Meier method. The Cox's proportional hazard regression model was used for univariate and multivariate analyses.Most patients received care that demonstrated good adherence to the quality indicators. Multivariate analysis revealed that 100% adherence to entire set of quality indicators was significantly associated with better overall survival [hazard ratio (HR): 0.46; 95% confidence interval (CI): 0.33-0.63] and progression-free survival (HR 0.51; 95% CI, 0.39-0.67). One hundred percent adherence to treatment indicators alone was also associated with statistically significant improvements in overall and progression-free survivals.Our study strongly supports that 100% adherence to evidence supported quality-of-care indicators is associated with better survival rates for breast cancer patients and should be a priority for practitioners.

  View details for Web of Science ID 000262913200012

  View details for PubMedID 19169123

• Koo Foundation Sun Yat-Sen Cancer Center: Breast Cancer Care in Taiwan Harvard Business Review Porter, M. E., Barron, J. F., Wang, C. J. 2009
• Variation in electronic prescribing implementation among twelve ambulatory practices JOURNAL OF GENERAL INTERNAL MEDICINE Crosson, J. C., Isaacson, N., Lancaster, D., McDonald, E. A., Schueth, A. J., DiCicco-Bloom, B., Newman, J. L., Wang, C. J., Bell, D. S. 2008; 23 (4): 364-371

  Abstract

  Electronic prescribing has been advocated as an important tool for improving the safety and quality of medication use in ambulatory settings. However, widespread adoption of e-prescribing in ambulatory settings has yet to be realized. The determinants of successful implementation and use in these settings are not well understood.To describe the practice characteristics associated with implementation and use of e-prescribing in ambulatory settings.Multi-method qualitative case study of ambulatory practices before and after e-prescribing implementation.Sixteen physicians and 31 staff members working in 12 practices scheduled for implementation of an e-prescribing program and purposively sampled to ensure a mix of practice size and physician specialty.Field researchers used observational and interview techniques to collect data on prescription-related clinical workflow, information technology experience, and expectations.Five practices fully implemented e-prescribing, 3 installed but with only some prescribers or staff members using the program, 2 installed and then discontinued use, 2 failed to install. Compared to practice members in other groups, members of successful practices exhibited greater familiarity with the capabilities of health information technologies and had more modest expectations about the benefits likely to accrue from e-prescribing. Members of unsuccessful practices reported limited understanding of e-prescribing capabilities, expected that the program would increase the speed of clinical care and reported difficulties with technical aspects of the implementation and insufficient technical support.Practice leaders should plan implementation carefully, ensuring that practice members prepare for the effective integration of this technology into clinical workflow.

  View details for DOI 10.1007/s11606-007-0494-8

  View details for Web of Science ID 000254456400004

  View details for PubMedID 18373131

• Communication of positive newborn screening results for sickle cell disease and sickle cell trait: Variation across states AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS Kavanagh, P. L., Wang, C. J., Therrell, B. L., Sprinz, P. G., Bauchner, H. 2008; 148C (1): 15-22

  Abstract

  In the US, all states and the District of Columbia have universal newborn screening (NBS) programs for sickle cell disease (SCD), which also identify sickle cell trait (trait). In this project, we surveyed follow-up coordinators, including one in the District of Columbia and two in Georgia, about protocols for stakeholder notification for SCD and trait. The primary outcomes were total number and type of stakeholder informed of a positive screen. We received 52 completed surveys (100% response). Primary care providers (PCPs) (100%), hematologists (81%), hospitals (73%), and families (40%) were the most commonly notified stakeholders of positive SCD screens, while PCPs (88%), hospitals (63%), and families (37%) were most commonly notified for trait. On average, 3.4 stakeholders were notified for a positive screening for SCD, compared to 2.4 stakeholders for sickle cell trait (P < 0.001). In multivariate analyses for SCD, we found a 2.9% increase in stakeholders notified for each additional year of universal screening mandated in a state (95% CI: 1.4-4.4%). For trait, we found an 8.5% increase in stakeholders notified for each additional follow-up staff (95% CI: 1.3-15.7%), and a 1.3% increase for each additional percent of black births in the state (95% CI: 0.1-2.5%). Wide variation exists in stakeholder notification by NBS programs of positive screenings for SCD and trait. This variation may alter the effectiveness of NBS programs by location of birth.

  View details for DOI 10.1002/ajmg.c.30160

  View details for Web of Science ID 000253482500003

  View details for PubMedID 18200513

• Population-based assessments of ophthalmologic and audiologic follow-up in children with very low birth weight enrolled in medicaid: A quality-of-care study PEDIATRICS Wang, C. J., Elliott, M. N., McGlynn, E. A., Brook, R. H., Schuster, M. A. 2008; 121 (2): E278-E285

  Abstract

  The purpose of our work was to determine whether children with very low birth weight (< 1500 g) who are at high risk for vision and hearing problems and enrolled in Medicaid receive recommended follow-up vision and hearing services and to examine predictors of services.We conducted a retrospective analysis of 2182 children born in South Carolina from 1996 to 1998 with birth weights of 401 to 1499 g, gestations of > or = 24 weeks, and survival of > or = 90 days of life. Receipt of services for Medicaid-enrolled children was assessed by using a linked data set that included files from vital records, death certificates, Medicaid, Chronic Rehabilitative Services, and the Early Intervention Program. We assessed the receipt of hearing rehabilitation by 6 months of age for children with nonconductive hearing loss and routine ophthalmologic examination between ages of 1 and 2 years for all children with very low birth weight. Multivariate logistic regression was restricted to ophthalmologic examinations because of sample size.Among children with very low birth weight with nonconductive hearing loss, 20% received hearing rehabilitation by 6 months of age. Twenty-three percent of children with very low birth weight received an ophthalmologic examination between the ages of 1 and 2 years. Limiting our analysis to children < 1000 g or extending the measurement period to 7 months (hearing) and age 3 years (vision) did not substantially increase the percentage of children receiving the services. The receipt of an ophthalmologic examination was associated positively with Medicaid enrollment by the time of hospital discharge and birth in a level-3 hospital and negatively associated with higher birth weight, an Apgar score of > or = 7, and black maternal race. Among children born at < 1000 g, all of whom were eligible for the Early Intervention Program, the receipt of an ophthalmologic examination was positively associated with program enrollment.There is a shortfall in the provision of critical services for children with very low birth weight. These findings reinforce the Institute of Medicine's concerns regarding inadequate outcome data and health care services for preterm infants and support the importance of enrollment in the Early Intervention Program for children with very low birth weight.

  View details for DOI 10.1542/peds.2007-0136

  View details for Web of Science ID 000252877600045

  View details for PubMedID 18245402

• Picking up where Reform Left off in Taiwan - Response for Davis and Huang Annals of Internal Medicine Wang, C. J. 2008
• Pilot Testing of Electronic Prescribing Standards Bell, D. S., Schueth, A. J., Crosson, J. C., Guinan, J. P., Wu, S., Pevnick, J. M., Wang, C. J., Neuman, S. L., Patel, M., Park, H., Tysinger, B., Malakar, C. L., Schoeff, D., Bradley, M., Newberry, S. J. Report to the Agency for Healthcare Research and Quality. 2007
• Primary Care Follow-up of Neurodevelopmental Status of Premature Infants Contemporary Pediatrics Vanderbilt, D., Wang, C. J., Parker, S. 2007; 24 (9)
• Quality-of-care indicators for the neurodevelopmental follow-up of very low birth weight children: Results of an expert panel process PEDIATRICS Wang, C. J., McGlynn, E. A., Brook, R. H., Leonard, C. H., Piecuch, R. E., Hsueh, S. I., Schuster, M. A. 2006; 117 (6): 2080-2092

  Abstract

  To develop a set of quality indicators for the neurodevelopmental follow-up care of very low birth weight (VLBW; <1500 g) children.We reviewed the scientific literature on predictors of neurodevelopmental outcomes for VLBW children and the clinical practice guidelines relevant to their care after hospital discharge. An expert panel with members nominated by the American Academy of Pediatrics, the National Institute of Child Health and Human Development, the Vermont Oxford Network, and the California Children's Service was convened. We used a modified Delphi method to evaluate and select the quality-of-care indicators.The panel recommended a total of 70 indicators in 5 postdischarge follow-up areas: general care; physical health; vision, hearing, speech, and language; developmental and behavioral assessment; and psychosocial issues. Of these, 58 (83%) indicators were in preventive care, 5 (7%) were in acute care, and 7 (10%) were in chronic care.The quality indicators cover follow-up care for VLBW infants with various medical conditions. Given the elevated rates of long-term neurodevelopmental disabilities and the potential impact of poor health care, this new set of indicators provides an opportunity to assess and monitor the quality of follow-up care with the ultimate aim of improving the quality of care for this high-risk population.

  View details for Web of Science ID 000237979000027

  View details for PubMedID 16740851

• Functional characteristics of commercial ambulatory electronic prescribing systems: A field study JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION Wang, C. J., Marken, R. S., Meili, R. C., Straus, J. B., Landman, A. B., Bell, D. S. 2005; 12 (3): 346-356

  Abstract

  To compare the functional capabilities being offered by commercial ambulatory electronic prescribing systems with a set of expert panel recommendations.A descriptive field study of ten commercially available ambulatory electronic prescribing systems, each of which had established a significant market presence. Data were collected from vendors by telephone interview and at sites where the systems were functioning through direct observation of the systems and through personal interviews with prescribers and technical staff.The capabilities of electronic prescribing systems were compared with 60 expert panel recommendations for capabilities that would improve patient safety, health outcomes, or patients' costs. Each recommended capability was judged as having been implemented fully, partially, or not at all by each system to which the recommendation applied. Vendors' claims about capabilities were compared with the capabilities found in the site visits.On average, the systems fully implemented 50% of the recommended capabilities, with individual systems ranging from 26% to 64% implementation. Only 15% of the recommended capabilities were not implemented by any system. Prescribing systems that were part of electronic health records (EHRs) tended to implement more recommendations. Vendors' claims about their systems' capabilities had a 96% sensitivity and a 72% specificity when site visit findings were considered the gold standard.The commercial electronic prescribing marketplace may not be selecting for capabilities that would most benefit patients. Electronic prescribing standards should include minimal functional capabilities, and certification of adherence to standards may need to take place where systems are installed and operating.

  View details for DOI 10.1197/jamia.M1759

  View details for Web of Science ID 000229384600014

  View details for PubMedID 15684122

• Doctors’ Orders: Better Electronic Prescribing Systems Could Improve Care Bell, D. S., Wang, C. J. RAND Review. (Summer Issue).. 2005
• Analysis of healthcare interventions that change patient trajectories Bigelow, J. H., Fonkych, K., Fung, C., Wang, J. MG408. 2005
• Recommendations for comparing electronic prescribing systems: results of an expert consensus process. Health affairs Bell, D. S., Marken, R. S., Meili, R. C., Wang, C. J., Rosen, M., Brook, R. H. 2004: W4-305 17

  Abstract

  Commercially available electronic prescribing systems may differ in their effects on patients' health outcomes and on patients' ability to manage costs. An expert panel convened to recommend specific features that would enable electronic prescribing systems to advance these goals. The panel authored sixty recommendations and rated each using a modified Delphi process. Ratings identified fifty-two recommendations as clearly positive for patient safety and health outcomes and forty-three recommendations as achievable in the average clinician's office within three years. Overall, these recommendations offer a synthesis of evidence and expert opinion that can help guide the development of electronic prescribing policy.

  View details for PubMedID 15451979

• Insuring Taiwan’s Health The McKinsey Quarterly Huang, A. T., Wang, C. J., Yaung, C. L. 2001; 4 (Emerging Markets)
• From Taiwan to Harvard II: So You Want to be a Doctor (Chinese book published in Taiwan) Wang, C. J. 1999
• Generation of a High Titre Retroviral Vector Capable of Expressing High Levels of the Human Beta-globin Gene Proceedings of the National Academy of Sciences Sadelain, M. W., Wang, C. J., Antoniou, M., Grosveld, F., Mulligan, R. C. 1995; 92: 6728-6732
• From Taiwan to Harvard: Experiences of an Immigrant Student in America (in Chinese) Wang, C. J. Chiu-Ko and Chien-Hsing Publishing Companies. 1995
• SALIVARY AMYLASE ACTIVITY OF THE AGED GERONTOLOGY Wang, C. H., WOOLFOLK, C. A. 1990; 36 (4): 193-198

  Abstract

  Previous studies from America and Japan have reported that salivary amylase activity was reduced in the elderly. In contrast to these studies, a recent Chinese study reported an increase in salivary amylase activity in the aged. Our study examined approximately equal numbers of Chinese and non-Chinese Americans. The concentration of salivary amylase was estimated from the activity obtained with a colormetric coupled assay utilizing 4NP-G7. Activity was found to be increased in the aged. Our data are discussed with respect to the claims of the previous studies.

  View details for Web of Science ID A1990EM62300002

  View details for PubMedID 1703102