Sunday, August 24, 2014

Adult Obesity Continues to Increase

The new County Health Statistics from the University of Wisconsin Population Health Institute are published.  They can be reviewed in detail online.  The web site is very user friendly and interesting to study.

One of the most disappointing stats is the persistent increase in adults with BMI over 30 or obese.  Hamilton County is now at 31% of the population with a BMI of 30 or above.

It is clear that more detail of this data is needed.  The work of the Pediatric Health Improvement Coalition has found that there is a dramatic variation in obesity rates by demographic factors in the Chattanooga Region.  We have also seen that some communities, especially the at-risk communities, have started to fatigue on addressing obesity.  I hope that this continued increase in obesity will propel a coordinated and effective effort to curb the impact of obesity in the Tennessee Valley.

PHIC Vice-President and Children's CEO Speak Out about Cover Kids Program

The changes to CoverKids are among a series of recent cost-saving measures made by TennCare and other insurers over the past two years that have hit children’s hospitals’ bottom lines to an unprecedented degree, said Dr. Alan Kohrt, CEO of T.C. Thompson Children’s Hospital at Erlanger. Kohrt is also chairman of the Children’s Hospital Alliance of Tennessee, which met with state leaders this week.
Children’s at Erlanger for example, has lost more than $3 million from a string of recent cuts.
“We’re seeing increasing cuts to the children’s hospitals that threaten the level of care that we provide,” Kohrt said. “We have not had to cut any services — yet. But we continue to face financial pressure.”

Friday, February 21, 2014

Local Families Have a Voice in Children’s Health

Local Families Have a Voice in Children’s Health
As the Pediatric Healthcare Improvement Coalition Announces
The Tennessee Valley Pediatric Health Week
March 3rd through March 6th

Chattanooga, TN - The Pediatric Healthcare Improvement Coalition for the Tennessee Valley (PHIC-TV) is releasing the announcement of four regional Pediatric Health Forums.  These open meetings will invite the public to comment on personal experience with local health services for children in the Tennessee Valley (Southeast Tennessee, North Alabama, North Georgia and South Western North Carolina).

The first week of March will be the Tennessee Valley Pediatric Health Week.  PHIC-TV will have four public listening forums in Alton Park, East Side, Dalton and Hixson.  These will be meetings driven by the attendees.  The focus will be perceived barriers to good health, areas of local health success and elements we must have to meet the needs for our future.

The Alton Park Forum will be at the Bethlehem Center on Monday, March 3rd at 7PM.  The Dalton, Georgia forum will be at the Mack Gaston Community Center on Tuesday, March 4th at 7PM.  The East Side and East Lake forum will be held at East Side Elementary School on Thursday, March 6th at 4PM.  And, the Hixson forum will be held at DuPont Elementary School on Thursday, March 6th at 7PM.  Everyone is welcome to attend any of the forums.  Forums will not be limited to the immediate neighborhood community.

The purpose of the forums is to reach out to all families, especially those who utilize a significant amount of pediatric health resources.  We want to listen to the individual triumph, success, challenges, barriers and dreams for the future as families look to our local pediatric delivery of care.  We also want to hear the community’s view of barriers to good public health in general.

The Pediatric Health Improvement Coalition of the Tennessee Valley (PHIC-TV) is an organization that is working to improve the health of all children in our region.  This organization is dedicated to breaking down barriers to our children to effective and innovative healthcare.  Please support the ongoing work of PHIC-TV by getting more information at or following on Twitter @PHIC_TV.

R. Allen Coffman, Jr., MD, FAAP
President, Pediatric Healthcare Improvement Coalition or the TN Valley
Pediatrician, Highland Pediatrics

Pediatric Healthcare Improvement Coalition – Tennessee Valley
P.O. Box 96
Signal Mountain, TN  37377



Sunday, December 15, 2013

Shocking Rates of Pediatric Asthma in the Tennessee Valley are the Number One Cause of School Absence

Asthma is a chronic medical condition that affects the lungs.  Patients can experience frequent cough, shortness of breath, and chest pain or tightness on a regular basis.  Occasionally a patient with asthma will suffer an “asthma attack.”   During an attack the airways in the lungs become inflamed, make excess mucous, and become constricted.  An asthma attack causes significant trouble breathing and can lead to an emergency room visit, a hospital stay, or even death.  Infections, allergies, and irritants, such as cigarette smoke and pollution, can lead to an asthma attack.  Attacks can easily be prevented with regular doctor visits and effective and inexpensive medications.

7.1 million American children suffer from asthma, which is about 8% of all children, making it one of the most common chronic medical conditions of childhood.  Here in the Chattanooga area, however, 12.5% of our children have asthma, over 50% higher than the national average.  In fact, Chattanooga is the fifth worst city in the country for asthma according to the Asthma and Allergy Foundation of America.  WedMD places Chattanooga second.  These poor rankings are due to low air quality and high cigarette smoke exposure.  Such a staggeringly high rate of asthma in a city conducive to asthma attacks brings the scope of this local problem into focus when considering the following nationwide facts:
·        Asthma is the number one reason children miss school
·        Asthma is third most common reason for a child to spend the night in the hospital
·        Asthma costs our nation 56 billion dollars annually
·        157 children died from asthma in 2009
The most frustrating aspect of these alarming statistics lies in the relative ease in which asthma is treated and attacks are prevented.  Regular doctor visits and readily available medications virtually eliminate symptoms and prevent attacks.  In fact, a recent medical study showed that even 8% of elite athletes from the last five Olympics suffered from asthma.  These athletes have doctors, take their medicine regularly and are able to compete at the highest level of their sport.  Yet, in Chattanooga, one in five children does not have a primary care doctor.  7% of Hamilton County’s children have no insurance at all.  20% of babies in Chattanooga grow up breathing second hand cigarette smoke.  This area has childhood obesity rates 25% higher than national averages.  These factors all play a detrimental role in the lives of Chattanooga’s asthmatic children.

The Pediatric Healthcare Improvement Coalition—Tennessee Valley (PHIC—TV) is a community health partnership striving to decrease the negative impact of asthma on all Tennessee Valley children.  PHIC-TV is currently implementing a strategic initiative to define the asthma challenges for children and organize the means to address themPlease invest in the ongoing work of PHIC-TV and get more information at

Matthew Good, MD, FAAP
Chief of Staff, Children’s Hospital at Erlanger

Pediatric Healthcare Improvement Coalition – Tennessee Valley
P.O. Box 96
Signal Mountain, TN  37377



Monday, December 2, 2013

Untreated Mental Health in Children a Major Driver for School Dropout, Crime and Suicide in Chattanooga

The Pediatric Healthcare Improvement Coalition of the Tennessee Valley (PHIC-TV) has identified Mental Health issues as one of the five major challenges faced by children, adolescents, their families and pediatricians in the greater Chattanooga area. The U.S. Department of Health and Human Services has described mental health as a “state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to change and to cope with adversity.”[i]  The term “mental health” can be broad and often encompasses “behavioral,” “neurodevelopmental,” “psychiatric,” “psychological,” “social-emotional,” and “substance abuse,” as well as adjustment to stressors such as child abuse, neglect, domestic violence, grief and loss.[ii] The genesis of mental health problems stem from biological factors and psychosocial environment as well as interaction between the two.

According to studies cited by the Tennessee Chapter of the American Academy of Pediatrics, “between 9.5% and 14.2% of children birth to age five display social-emotional problems that affect family functioning.” Additionally, “1 in 10 children have a diagnosed behavioral health disorder and more than twice as many children have behavioral health symptoms that cause impairment. Unfortunately, 4 out of 5 of these children do not receive the services they need to improve their behavioral and emotional health.”

The consequences of this unmet need take many forms. In education, students with serious emotional disturbances fail more classes, miss more days of school, have lower grades, and have a higher dropout rate than other students with disabilities.[iii] Interpersonal and educational issues compound over time leading to higher rates of substance abuse, criminal activity and incarceration, poor preparedness for employment, suicide, and a greater impact on social safety nets. The National Alliance on Mental Health’s Children’s Mental Health Fact Sheet[iv] notes:

·         Approximately 50% of students with a mental disorder age 14 and older drop out of high school; this is the highest dropout rate of any disability group
·         65% of boys and 74% of girls in juvenile detention have at least one mental disorder.
·         Suicide is the third leading cause of death in youth aged 15 – 24.

·         When children with untreated mental disorders become adults, they use more health care services and incur higher health care costs than other adults. Left untreated, childhood disorders are likely to persist and lead to a downward spiral of school failure, limited or non-existent employment opportunities, and poverty in adulthood. No other illnesses harm so many children so seriously.(emphasis added)

Given the large number of children and families impacted in the Tennessee Valley and the profound social and economic ramifications when untreated or undertreated, the Pediatric Health Improvement Coalition (PHIC-TV) believes mental health interventions and systems of care should be at the forefront of pediatric healthcare discussions.  Please support PHIC-TV and get more information at

John Farrimond, MBA
President and CEO
Siskin Children’s Institute

Lois Kohrt, MBA
Administrative Director
Siskin Center for Developmental Pediatrics

[i] U.S. Department of Health and Human Services (2001). Mental Health: Culture, Race, and Ethnicity – A Supplement to Mental Health: A Report of the Surgeon General. Rockville, Maryland.
[ii] Enhancing Pediatric Mental Health Care: Strategies for Preparing a Community. Jane Meschan Foy, James Perrin and for the American Academy of Pediatrics Task Force on Mental Health. Pediatrics 2010;125;S75. DOI: 10.1542/peds.2010-788D
[iii] U.S. Department of Health and Human Services (2001). Mental Health: Culture, Race, and Ethnicity – A Supplement to Mental Health: A Report of the Surgeon General. Rockville, Maryland.

The Chasm in Adolescent Medical Care: Psychiatric Disorders

"More than half of adolescents with psychiatric disorders receive no treatment of any sort, says a new study by E. Jane Costello, a Duke University professor of psychology and epidemiology and associate director of the Duke Center for Child and Family Policy. When treatment does occur, the providers are rarely mental health specialists, says the study, which was based on a survey of more than 10,000 American teenagers."

Read more from November 18, 2013 Duke University Press Release

Sunday, November 24, 2013

The Family Centered Medical Home is Key to Pediatric Health

On a clear fall day in October of 2004, Bridget Lane took her new daughter Mary Alice to see her pediatrician.  She was a fussy 7-week-old that did not want to grow.  The reason for her lack of growth was quickly identified as an inability to digest and absorb the fat in her formula.  This was just one complication of a disease called Cystic Fibrosis.  Mary Alice’s parents are now experts in Cystic Fibrosis and the care of a child with a complex, chronic disease.  This is because of their exceptional dedication to Mary Alice and a medical care delivery structure called “the Family Centered Medical Home.”  This structure has been at the backbone of the care of children for over 40 years. 

The American Academy of Pediatrics set the “Medical Home” as the standard of Pediatric care in 1992 with a formal policy statement:
The goal of pediatricians is that the medical care of infants, children and adolescents ideally should be accessible, continuous, comprehensive, family-centered, coordinated and compassionate.  It should be delivered or directed by well-trained physicians who are able to manage or facilitate essentially all aspects of pediatric care.  The physicians should be known to the child and family and should be able to develop a relationship of mutual responsibility and trust with them.

A Medical Home model of healthcare means that the pediatrician's office serves as the "hub" of a busy wheel of care.  Most children need some specialized services over the course of their childhood, adolescent and young adult years.  The “spokes” of this care wheel could be an Orthopedist for a broken arm, a Speech Therapist for a language problem or a Nutritionist for dietary causes of obesity.  For children with chronic, complex diseases; there can be many spokes.  The patient has the best chance of preventing or effectively managing their health challenges if the Medical Home serves as the hub, keeping all providers in good communication.  A study published in the Journal of Maternal and Child Health in 2011 clearly showed reduced health care costs, more stable health and reduced Emergency Room visits for children with special health care needs who have a Medical Home.

Advances in medical technology have made it possible for doctors to cure or provide life-sustaining treatments to patients whose illnesses would have been lethal only a few decades ago. However, for many of these patients and their families, maintaining their best quality of life involves the care of many medical subspecialists, taking many medications, and using various therapy services and medical devices. Navigating this degree of medical support is overwhelming for most parents of medically complex children. Ideally, parents should be able to count on a team to support the coordinated care among the roster of medical subspecialists and services. This pediatric care team, known as the "Medical Home", synthesizes information coming in from subspecialists and other providers and ensures the parents' understanding of all ongoing issues. The Medical Home team spots opportunities for prevention, keeps problems simple before they get more serious, streamlines care, minimizes complications and eliminates unnecessary therapies.

Unfortunately, one out of every five children in the Tennessee Valley region does not have a primary care physician, let alone a “Medical Home.”  These children, often, need this type of care coordination and family support the most.  The 2007 National Survey of Children’s Health showed that as children get older in Tennessee the likelihood of a child being in a Medical Home decreases.  The percent of children in a medical home from birth to preschool in our region is 67.1% and drops to 54.5% by 12-17 years.  Another factor is family income.  In families who make more than $94,000 per year, three out of four have a Medical Home.  In contrast, only half of the children in families who make less than $24,000 per year have a Medical Home.  Race also has an impact.  Seven out of ten White children have a medical home while only five out of ten Hispanic and four out of ten Black children have a medical home.

Mike Lane, Mary Alice’s father says, “Being a parent of a child with a chronic illness, I understand the importance of exemplary healthcare.  Fortunately we have access to this benefit and as a result, our daughter is flourishing.”  The Lanes have had a Family Centered Medical Home to help navigate Mary Alice’s Pulmonologist, her Gastroenterologist, her Nutritional needs and her special medical equipment.  The Lane’s have seen the goals of the Medical Home realized in their child.  Mr. Lane continues, “Sadly, many children in our area are not as lucky.  It is our responsibility, both financially and morally, to provide the availability of adequate healthcare to all children.”

The Pediatric Health Improvement Coalition of the Tennessee Valley (PHIC-TV) believes that the adequate healthcare for children is in a Family Centered Medical Home.  PHIC-TV is an organization that is working to define why children in our region do not have Family Centered Medical Homes.  This organization is dedicated to breaking down barriers to our children to this type of care.  Please support the ongoing work of PHIC-TV by getting more information at or following on Twitter @PHIC_TV.

Alan Kohrt, MD, FAAP
Professor and Chair, Department of Pediatrics, UTCOM, Chattanooga
CEO, Children's Hospital at Erlanger

Kourtney Santucci, MD, FAAP
Hospitalist Physician, Children's Hospital at Erlanger

R. Allen Coffman, Jr., MD, FAAP
Pediatrician, Highland Pediatrics
President, Tennessee Chapter of the American Academy of Pediatrics