The Challenging Realities of Rural Pediatrics

Sharing data transparently, whether at a local or a national level, is a foundational contributor to healthcare quality. Atul Gawande wrote about this in his 2004 essay labeled ‘The Bell Curve’. Over the last several decades, we have seen many pediatric specialties organize and collaborate around data collection at a national scale to improve care. We’ve seen firsthand how our hospital’s participation in a national cardiac critical care registry has driven quality improvement, better measurable outcomes and improved cardiac arrest rates for patients. Getting the data collection right is the first challenge. In between that first step and actually seeing improvements is a tremendous amount of work. In this episode, we explore the value of data sharing and transparency to improve outcomes for kids. Our experts for this episode are Carly Scahill, DO, and Kelly O’Neil. Dr. Scahill specializes in pediatric cardiology as a pediatric cardiac intensivist. She is also the Fellowship Director for pediatric cardiology and the cardiac intensive care unit (CICU), as well as an associate professor of pediatrics at the University of Colorado School of Medicine. Kelly O’Neil is a registered nurse and the Manager of the Heart Institute Data Registries and Outcomes. Before her current role, she was a CICU nurse for over ten years. Some highlights from this episode include:  The purpose and use of clinical registries  How data collection improves measurable outcomes  The future of data collection in healthcare  How to get more entities involved  For more information on Children’s Colorado, visit: childrenscolorado.org.    

Over the last few decades, the roles of nurse practitioners (NPs) and physician assistants (PAs), also known as advanced practice providers (APPs), have greatly expanded to touch even more patient-family lives. They are an essential part of the care we provide, and their roles have evolved over time. In this episode, we explore the crucial part they play in our medical system and how that might continue to evolve in the future. For this episode, we are joined by two University of Colorado leaders who continue to help keep our APP programs among the top ranked in the country. Jonathan Bowser is the Child Health Associate and Physician Assistant Program Director at the University of Colorado School of Medicine. He is also the Associate Dean of Physician Assistant Studies, the Section Head of Pediatrics, and an associate professor. Jill Marks, NP, is the Specialty Director of the Acute Care Pediatric Nurse Practitioner Program at the University of Colorado College of Nursing. She is also an inpatient nurse practitioner for the section of pediatric neurology at the University of Colorado School of Medicine. Some highlights from this episode include:  Background on the creation of NPs and PAs  The ways these roles have changed over time  The impact APPs make on patient care  The role APPs will play in healthcare in the future  For more information on Children’s Colorado, visit: childrenscolorado.org.    

Our medical community is committed to providing excellent patient care, and it’s also our duty for that care to extend to our planet. Climate change is an increasingly important global health issue where children are the most vulnerable to adverse health outcomes. One major contributing factor to climate change in medicine is the use of nitrous oxide in spaces like the operating room and outpatient clinics. Efforts are underway in hospitals across the country to decrease our environmental impact, including at Children’s Hospital Colorado. To explore the exciting new project happening at Children’s Colorado and to discuss the environmental impacts on a global scale, we are joined by two experts. Tom Majcher, DO, is the Chief of Anesthesiology at Children’s Colorado, as well as a professor of pediatrics and clinical practice for anesthesiology at the University of Colorado School of Medicine. Diane Gordon, MD, specializes in anesthesiology at Children’s Colorado and is an associate professor of pediatric anesthesiology at the University of Colorado School of Medicine. Some highlights from this episode include:  How nitrous oxide is currently used in medical settings  The damage it does on the environment  What efforts are underway to reduce its impact  How to keep the same standard of care with new alternatives  The importance of this transition in the operating room  For more information on Children’s Colorado, visit: childrenscolorado.org.    

  Over the last few decades, there have been many incredible medical advances in newborn care. At Children’s Hospital Colorado, we’re launching an exciting new initiative to take another step forward in care for our tiniest patients. For newborns who need to be hospitalized, getting home as soon as possible is critical for their successful development. A common barrier for discharge that can keep babies in the neonatal intensive care unit (NICU) for additional days or weeks is the need for a nasogastric (NG) tube. Ensuring an infant is receiving proper nutrition is essential to securing a safe discharge. What if we could deliver NG tube feeds at home and provide all the necessary support? That’s the game changing idea we explore in this episode with our neonatology experts. To dive into this topic, we are joined by three neonatologists practicing at Children’s Colorado. Stephanie Bourque, MD, Kathleen Hannan, MD, and Danielle Smith, MD, tell us about a new at-home NG tube feed program that the team at Children’s Colorado is currently developing. Dr. Smith is the Medical Director of the NICU, Dr. Bourque is the Associate Medical Director of the NICU, and all three of our guests are faculty at the University of Colorado School of Medicine. Some highlights from this episode include:  What the need has been historically for NG tubes  Model for this at-home program  What’s required to make this at-home model a reality  The role of the primary care provider in this partnership  The impact a change like this could have on patient outcomes and family satisfaction For more information on Children’s Colorado, visit: childrenscolorado.org.    

Join us for another insightful season of Charting Pediatrics! The same hosts you know and love will continue to bring the latest and greatest information about pediatric medicine to your ears. Joined by renowned experts, we will explore prominent topics while being moved by their personal stories. This is a season you won't want to miss! For more information on Children’s Colorado, visit: childrenscolorado.org.    

We all know what it feels like to have a headache, but each person can experience that intensity for dozens of different reasons. Globally, headache disorders affect approximately 40% of the population, which is about 3.1 billion people. Headaches are also among the three most common neurological conditions for most age groups starting at age 5. As such a ubiquitous issue, it’s important for providers to understand, diagnose and treat headaches. What are the most common reasons for headaches in children? How should pediatricians know when a headache is more than surface-level discomfort? To learn about the latest in pediatric headaches, we are joined by two headache experts, Marcy Yonker, MD, and Angelina Koehler, NP. Dr. Yonker is the Director of the Headache Program at Children’s Colorado and the Dale, Cindy and Kristin Francescon Endowed Chair for Headache Treatment with the University of Colorado Department of Pediatrics. Angelina Koehler is a certified pediatric nurse practitioner in the Neuroscience Institute at Children’s Colorado. Some highlights from this episode include:  What PCPs should take into account about migraines  How to approach headache treatment options  What to consider with hesitation around certain medications  When to look for signs of a more serious illness  For more information on Children’s Colorado, visit: childrenscolorado.org.    

  For almost 50 years, Dr. Fritz Karrer has been wearing a surgeon’s cap, growing as a surgeon alongside the evolution of his specialty. For 40 of those 50 years, he’s been at Children’s Hospital Colorado, making an everlasting impact on kids and their families. On the brink of retirement, we look at his exemplary career and discuss how he’s watched firsthand the progression of pediatric surgery. His half century of perspective makes him the perfect expert to dive into the growth of pediatric surgery. Dr. Karrer specializes in pediatric surgery and surgical critical care at Children’s Colorado and is a Professor of Pediatric Surgery at the University of Colorado School of Medicine. He’s also a colonel in the U.S. Army Reserve, he was recognized as a top doctor in 2023 by 5280 Magazine and he’s been awarded the James Strain Award and the Military Medical Merit from the U.S. Army. Some highlights from this episode include:    The incredible journey of Dr. Karrer’s career  The ways pediatric surgery has evolved over the last 50 years  The influence of technology on pediatric surgery  Advice for young doctors wanting to follow a similar path    For more information on Children’s Colorado, visit: childrenscolorado.org.    

  More than 50% of rural counties in the United States do not have a pediatrician, and more than 80% of counties lack access to healthcare services that are simply needed to maintain the health of their population. The medical experts in those areas are lifelines to their communities. They are providing essential care, approaching resource and access challenges with creativity and innovation, and connecting kids to specialists when needed. Area codes can determine as much about health and life expectancy as issues like genetic predisposition and lifestyle. Our two guests are doing this work in rural communities every day. Kelly Miller, MD, is a general pediatrician with Pediatric Partners of the Southwest in Durango, CO. Anna Mack, DNP, FNP, is a family nurse practitioner with Peak Vista Community Health Centers in Colorado Springs. She is also faculty at a post-graduate training advanced practice registered nurse fellowship program. Some highlights from this episode include:    What are the primary challenges for providers in rural pediatrics  How experts are overcoming rural mental health hurdles for kids  Ways providers are using innovative solutions for issues they face in rural areas  How more urban and rural organizations can work toward stronger partnerships   For more information on Children’s Colorado, visit: childrenscolorado.org.    

  Running is an increasingly popular sport, with high school track and field programs seeing booming participation rates. With rising interest comes more cases of injury, however, incredible sports medicine advancements and programs are helping young runners manage and prevent injuries. To break down the most common running-related injuries in youth and discuss comprehensive approaches to prevention and recovery, we are joined by three Children’s Hospital Colorado experts. Aubrey Armento, MD is a sports medicine physician, Medical Director of the Runners Clinic for Young Athletes, and an assistant professor of Orthopedics at the University of Colorado School of Medicine. Amanda McCarthy is a program coordinator of sports nutrition and a registered sports dietician. Cameron (Cody) Yeaman, DPT, is a sports physical therapist and a certified specialist in orthopedic sports and strength and conditioning. Some highlights from this episode include:    What to know about new diagnoses in young runners  What there is to be learned from dissecting a case study  How patients and families benefit from a variety of specialists at the Runners Clinic  How pediatricians can understand and tap into an athlete mentality to gain buy-in from their patients.    For more information on Children’s Colorado, visit: childrenscolorado.org.    

For some, COVID-19 may seem like a thing of the past, but for medical professionals, the data regarding post-acute sequalae of COVID infection is only just emerging. Four years ago, the start of the pandemic left doctors puzzled by certain symptoms. Today, we are learning more about the long-term impacts of SARS-CoV-2 in children, often called long COVID or PASC. As the population continues to struggle with persistent and debilitating after-effects and symptoms, we are looking for answers. To provide insight into this important diagnosis, we are joined by Suchitra Rao, MD. She is an infectious disease specialist at Children’s Hospital Colorado, as well as the Associate Medical Director of Infection Prevention and Control. She is also an associate professor of Pediatrics within the sections of Infectious Diseases, Epidemiology, and Hospital Medicine at the University of Colorado School of Medicine. Some highlights from this episode include:    The epidemiology of long COVID in kids  The difference between the data in adults and children A discussion of how to diagnose asymptomatic patients  A closer look at Dr. Rao’s groundbreaking research   For more information on Children’s Colorado, visit: childrenscolorado.org.