Objective Children with invasive home mechanical ventilation (HMV) are a growing population with complex health service needs. Single institution studies provide insight into successful program structures and outcomes. Our study objectives were to assess health service structures, providers, and programs caring for this population throughout the U.S., and to understand barriers to high‐quality care. Design Using purposeful sampling with capture‐recapture and snowball sampling methods, we identified key informants for care of the U.S. pediatric HMV population. Informants received web‐based surveys with two reminders. Survey domains included respondent characteristics, HMV team composition, and barriers to care. Results Survey response was 71% with 101 completed. Respondents caring for patients in 45 states included physicians (61%), nurses (20%), therapists (12%), case managers (4%), and social workers (2%). Half (53%) of physicians were fellowship trained, most commonly pulmonology (22%) and critical care medicine (13%). The majority (65%) of providers described a dedicated HMV service. The majority (61%) of respondents from a HMV service provided both inpatient and outpatient care. Nearly all respondents (96%) described an inadequate supply of home nurses and 88% reported inadequate respite facilities. Conclusions Children with HMV assistance receive care from a diverse group of providers with varied team structure. Heterogeneity may reflect patient diversity and provider interest, increasing efficacy but challenging standardization nationwide. Despite team structure variability, similar home care difficulties were universally experienced. Data suggest that the home nursing shortage is a national impediment to quality and efficient discharge with limited community‐based support for this vulnerable population.

BACKGROUND AND OBJECTIVES: Little is known about the use of chronic medications (CMs) in children. We assessed the prevalence of CM use in children and the association of clinical characteristics and health care resource use with the number of CMs used. METHODS: This is a retrospective study of children ages 1 to 18 years using Medicaid from 10 states in 2014 grouped by the annual number of CMs (0, 1, 2-4, 5-9, and $10 medications), which are defined as a dispensed $30-day prescription with $2 dispensed refills. Trends in clinical characteristics and health care use by number of CMs were evaluated with the Cochran-Armitage trend test. RESULTS: Of 4 594 061 subjects, 18.8% used CMs. CM use was 44.4% in children with a complex chronic condition. Across all children, the most common CM therapeutic class was neurologic (28.9%). Among CM users, 48.8% used multiple CMs (40.3% used 2-4, 7.0% used 5-9, and 0.5% used $10). The diversity of medications increased with increasing number of CMs: for 1 CM, amphetamine stimulants were most common (29.0%), and for $10 CMs, antiepileptics were most common (7.1%). Of $2.3 billion total pharmacy spending, 59.3% was attributable to children dispensed multiple CMs. Increased CM use (0 to $10 medications) was associated with increased emergency department use (32.1% to 56.2%) and hospitalization (2.3% to 36.7%). CONCLUSIONS: Nearly 1 in 5 children with Medicaid used CMs. Use of multiple CMs was common and correlated with increased health care use. Understanding CM use in children should be fundamentally important to health care systems when strategizing how to provide safe, evidence-based, and cost-effective pharmaceutical care to children. WHAT'S KNOWN ON THIS SUBJECT: Children insured by Medicaid frequently use medications, but little is known specifically about chronic medication (CM) use. Without understanding which children use CMs, it is challenging to plan investigations to determine the appropriateness of current prescription practices. WHAT THIS STUDY ADDS: One in 5 children insured by Medicaid use a CM annually; nearly 1 in 10 used multiple CMs. Central nervous system agents accounted for nearly 30% of all CMs. CMs were positively correlated with health care resource use and spending.

Objective To compare health care use and spending in children using vs not using respiratory medical equipment and supplies (RMES). Study design Cohort study of 20 352 children age 1-18 years continuously enrolled in Medicaid in 2013 from 12 states in the Truven Medicaid MarketScan Database; 7060 children using RMES were propensity score matched with 13 292 without RMES. Home RMES use was identified with Healthcare Common Procedure Coding System and International Classification of Diseases codes. RMES use was regressed on annual per-member-per-year Medicaid payments, adjusting for demographic and clinical characteristics, including underlying respiratory and other complex chronic conditions. Results Of children requiring RMES, 47% used oxygen, 28% suction, 22% noninvasive positive-pressure ventilation, 17% tracheostomy, 8% ventilator, 5% mechanical in-exsufflator, and 4% high-frequency chest wall oscillator. Most children (93%) using RMES had a chronic condition; 26% had ≥6.

Discussion | In this study, which is to our knowledge the first to longitudinally examine sexual identity and sexual contact in a nationally representative sample of high school students, an increase was noted for nonheterosexual identity but not same-sex sexual contact. However, it is unclear to what extent this increase reflects a change in the true prevalence of nonheterosexual sexual identities or whether the observed increase was in part because of increased comfort with selfdisclosure.In terms of additional limitations, the YRBS questionnaire never explicitly defined the term sexual contact 4 and failed to adequately distinguish between same-sex and samegender sexual contact. 5 Moreover, some participants may have responded to the question assessing sex with their gender identity, leading to the incorrect classification of same-sex sexual contact. Furthermore, some youths in sexual minority groups may have felt their identity was not represented by the available responses to the question regarding sexual identity. Additionally, adolescents may have underreported nonheterosexual sexual identities and same-sex sexual contact because of persistent stigma associated with sensitive topics such as sexual identity. 6 Although the YRBS measures are imperfect, the apparent increase in nonheterosexual identity among youth in the US calls for greater vigilance among health care professionals regarding the heightened risks faced by these youths, such as bullying and mental health challenges.

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