I am a Developmental-Behavioral Pediatrician (DBP) with clinical interests that include developmental delay, intellectual and learning disabilities, ADHD, autism, Asperger’s, anxiety, obsessive-compulsive, tic disorders, and psychopharmacology.
The first 28 years of my career were spent in clinical practice combining both DBP and primary care (the latter focused on serving CSHCN). During those years I was involved in numerous divide-bridging efforts - including programs to coordinate inpatient & outpatient medicine, connect tertiary & primary care, and promote teamwork between pediatricians, psychologists, nurse practitioners, and other community partners. I founded my own solo practice in 1989 and managed its growth to an 8-provider group over the next 25 years. Our practice was a founding member of the PPOC and I served on its board of directors for 6 years. The PPOC is one of the largest pediatric IPA’s in the country, with >200 member providers affiliated with Boston Children's Hospital. Over the years we've been involved in groundbreaking QI initiatives including those involving asthma, weight, and ADHD management; medical home; and behavioral health integration with primary care.
I’m pleased now to have an opportunity for a “second act” on the clinician-educator track here at Stanford. I hope to use my unique experience straddling primary care and sub-specialty worlds to develop programs supporting DB assessment and care inside the medical home generally, and across the Packard Children's Health Alliance primary care network in particular.
- Developmental Behavioral Pediatrics
Clinical Associate Professor, Pediatrics
Residency:Columbia Presbyterian Pediatric Residency Program (1986) NY
Internship:Columbia Presbyterian Pediatric Residency Program (1985) NY
Medical Education:UCLA GME Office (1984) CA
Board Certification: Developmental Behavioral Pediatrics, American Board of Pediatrics (2004)
Board Certification: Pediatrics, American Board of Pediatrics (1988)
Residency:Children's Hospital Boston (1987) MA
Variation in Rate of Attention-Deficit/Hyperactivity Disorder Management by Primary Care Providers.
To describe variation in rates of attention-deficit/hyperactivity disorder (ADHD) management by pediatrics primary care providers (PCPs) and to assess influence of clinician characteristics on variation.Retrospective cohort study of electronic health records (EHR) from all office visits of patients aged 4-17 years seen at least twice between 2015 and 2017 by 73 clinicians in 9 pediatrics practices of a community-based primary healthcare network in California. Outcomes per clinician: (1) % patients seen for ADHD management; (2) % ADHD patients with diagnosed comorbid conditions. Logistic random-effects regression models examined practice- and clinician-level variation.Of 40,323 patients in the cohort, 2,039 (5.1%) carried an ADHD diagnosis, of which 1,142 (56%) received ADHD medication. Percent of patients seen for ADHD management varied by clinician from 0.0 to 8.3% (median 3.0%). After accounting for practice-level variation and patient characteristics (i.e., sex, age, insurance), clinician characteristics explained 28% of clinician variation in ADHD management. ADHD management rate was associated with high percent Full Time Equivalent (OR 1.17; 95% CI 1.07-1.27). Percent of ADHD patients with diagnoses of comorbidities varied by clinician from 0.0 to 100% (median 35%). Association between ADHD management rate and comorbidity diagnosis was minimal (R=0.10).Objective EHR measures showed that PCPs in this network varied widely in their involvement in ADHD management. For most PCPs, % of patients with ADHD and diagnosis of comorbidities was lower than estimated prevalence rates. Exploration of modifiable factors associated with PCP variation is needed to inform strategies for implementation of evidence-based practices.
View details for DOI 10.1016/j.acap.2019.11.016
View details for PubMedID 31794864
- Children with Cleft Lip and Palate: A Parents' Guide to Early Speech-Language Development and Treatment (Book Review) JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS 2016; 37 (7): 601