Academic pediatrics
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Academic pediatrics · Nov 2013
ReviewPediatric collaborative networks for quality improvement and research.
Despite efforts of individual clinicians, pediatric practices, and institutions to remedy continuing deficiencies in pediatric safety and health care quality, multiple gaps and disparities exist. Most pediatric diseases are rare; thus, few practices or centers care for sufficient numbers of children, particularly in subspecialties, to achieve large and representative sample sizes, and substantial between-site variation in care and outcomes persists. Pediatric collaborative improvement networks are multi-site clinical networks that allow practice-based teams to learn from one another, test changes to improve quality, and use their collective experience and data to understand, implement, and spread what works in practice. ⋯ Statewide, regional, and national pediatric collaborative networks have demonstrated improvements in primary care practice as well as care for chronic pediatric diseases (eg, asthma, cystic fibrosis, inflammatory bowel disease, congenital heart disease), perinatal care, and patient safety (eg, central line-associated blood stream infections, adverse medication events, surgical site infections); many have documented improved outcomes. Challenges to spreading the improvement network model exist, including the need for the identification of stable funding sources. However, these barriers can be overcome, allowing the benefits of improved care and outcomes to spread to additional clinical and safety topics and care processes for the nation's children.
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Academic pediatrics · Nov 2013
Multicenter StudyNine states' use of collaboratives to improve children's health care quality in medicaid and CHIP.
We examine quality improvement (QI) collaboratives underway in 9 states participating in the Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program. A total of 147 diverse, child-serving practices were participating in the collaboratives. We conducted 256 semistructured interviews with key stakeholders from March to August 2012-2 years into the 5-year demonstration projects-and analyzed states' grant applications, operating plans, and progress reports. ⋯ However, practice staff also reported a variety of challenges, including difficulty learning from other practices that have very different preexisting QI and PCMH capacity and patient populations, or that are working on different topic areas and measures; a sometimes overwhelming amount of materials and ideas covered during in-person meetings; difficulty keeping up with Webinars, calls, and Web sites/blogs; and trouble motivating and sharing information with other practice staff not attending collaborative activities. As the demonstration projects continue, states and the national evaluation team will learn more about how best to use collaboratives and complementary strategies to support child-serving practices in QI and PCMH development. States will also search for ways to sustain and spread these activities after the demonstration ends, if they prove effective.
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Academic pediatrics · Sep 2013
Extending the medical home into the community: a newborn home visitation program for pediatric residents.
To describe the Health Begins at Home (HBH) intervention and examine pediatric resident change in knowledge, attitudes, and self-reported behaviors after the HBH intervention. ⋯ Conducting home visits was associated with residents' improved understanding of the community and home environment of their patients, which was sustained throughout the remainder of training. Residents reported that home visits provide an important educational experience and should be part of the permanent curriculum. Training programs should consider incorporating home visiting programs into curricula to improve resident knowledge of family home, community, and social determinants of health.
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Academic pediatrics · Sep 2013
A mixed methods study of parental vaccine decision making and parent-provider trust.
To describe parental vaccine decision making behaviors and characterize trust in physician advice among parents with varying childhood vaccination behaviors. ⋯ These results have implications for future interventions to address parental vaccination concerns. Such interventions may be more effective if they are applied early (during pregnancy) and often (pregnancy through infancy), and cover both the risks and benefits of vaccination.
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Academic pediatrics · Sep 2013
ReviewThe relationship between parent health literacy and pediatric emergency department utilization: a systematic review.
Low health literacy in parents can potentially impact understanding of a child's diagnosis and treatment course. No reviews have addressed parent health literacy in the emergency department (ED), the relationship between parent health literacy and child ED utilization, or the impact of low literacy interventions on child ED utilization. ⋯ Roughly 1 in 3 parents of children presenting to the ED have low health literacy. Importantly, interventions targeting parents likely to have low health literacy have an impact in reducing ED utilization.