I graduated from UCLA (now Geffen) School of Medicine, did my pediatrics residency at Columbia-Presbyterian in NYC, followed by a clinical fellowship in developmental (what was then called an “ambulatory”) pediatrics at Boston Children’s Hospital. 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 were involved in groundbreaking QI initiatives including those involving asthma, weight, and ADHD management; medical home; and behavioral health integration with primary care.
I’m now well into my career's “second act” on the clinician-educator track here at Stanford. I'm proud to have piloted our division's primary care initiative (DBPCI) and am now in the process of planning for a second phase thereof, hoping to make improved collaboration between DBP and primary care more available to more patients. I also pioneered the use of telehealth in our division, and then helped guide its sudden widespread adoption by my peers during the COVID-19 crises. Looking forward, I expect what we have learned during the pandemic will inform what we do for DBPCI 2.0.
- Developmental Behavioral Pediatrics
- learning differences / disabilities
- complex ADHD
- high functioning autism & Asperger Syndrome
- anxiety / mood / behavior disorders in school age children
- care coordination for children with special needs
- special education
Clinical Associate Professor, Pediatrics
Lead Physician, DBP Primary Care Initiative (2015 - Present)
Lead Physician, DBP Middle Childhood Program (2018 - Present)
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: American Board of Pediatrics, Developmental Behavioral Pediatrics (2004)
Board Certification: American Board of Pediatrics, 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
Variation in Primary Care Management of Attention-Deficit/Hyperactivity Disorder by Primary Care Providers
View details for DOI 10.1016/j.acap.2019.11.016
- 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