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1.
Introduction
Children with special health care needs (CSHCN) have chronic conditions that generally are classified as developmental disabilities. Children with developmental disabilities are at high risk of malnutrition. Gastrostomy buttons are frequently used to provide enteral nutrition for children with developmental disabilities.Objective
This study aimed to understand caregivers’ perceptions regarding gastrostomy button placement for CSHCN.Methods
Caregivers (N?=?257) were recruited from CSHCN peer support groups to complete an online survey regarding perceptions of gastrostomy button placement. Kolmogorov–Smirnov testing found that results were not normally distributed. Nonparametric testing with Spearman rank correlation was used to determine the relationship between Overall Satisfaction With Choice and all other perception variables.Results
The findings suggested overall satisfaction and willingness to accept gastrostomy button placement earlier.Conclusion
Gastrostomy button placement has diverse effects for children with developmental disabilities and their families. Health care professionals must be knowledgeable about the positive and negative outcomes to effectively educate families as they consider gastrostomy placement. 相似文献2.
La Monica L. Hunter Stephanie Blake Catherine Simmons Julie Thompson Anne Derouin 《Journal of pediatric health care》2019,33(2):131-137
Background
Parents of preterm hospitalized infants, whose lengths of stay can range from a few days to several months, often experience emotional liability. Because the Neonatal Intensive Care Unit (NICU) or Special Care Nursery (SCN) is a stressful and intimidating environment, prompt attention should be given to reducing parental stress and increasing parental confidence in preparation to care for their child post-discharge.Methods
A quality improvement pilot project was designed to evaluate the parent education and support program, titled HUG Your Baby, in a Level II SCN for its ability to decrease stress and increase confidence for postpartum mothers of preterm infants born at less than 35 weeks gestation during the infant's hospitalization.Results
The outcomes demonstrated a statistically significant decrease in maternal stress and a statistically significant increase in maternal confidence.Discussion
The HUG Your Baby program is an effective parent education and support program that would benefit NICU and SCN families. 相似文献3.
Introduction
Asthma is underdiagnosed, particularly for children younger than 5 years old. Clinical practice guidelines have been shown to improve asthma diagnosis and management, but are underutilized. This evidence-based practice project aimed to develop, implement, and evaluate a three-page decision support tool (DST) to improve the asthma diagnosis process among children younger than 5 years old.Methods
This project used a pre-experimental design and was conducted in a pediatric primary care setting with a predominantly South Asian population. The authors analyzed the utilization of the DST as well as the end-users' perception of the tool.Results
Despite above-average results in the end-users' usability scale, the DST had poor utilization.Discussion
Implementation of the DST is recommended at similar pediatric primary care sites. The EBP Project team recommends translating the DST to the electronic health record and improving the roles of the champion. 相似文献4.
Introduction
Sudden cardiac arrest continues to be the leading cause of death in young athletes despite preparticipation sports screening (PPS). The devastating loss of children to sudden cardiac arrest has led communities to demand more comprehensive heart screenings. The purpose of this study was to evaluate a community youth heart screening program in Minnesota.Method
A retrospective chart review of 840 participants aged 14 to 18 years from August 2015 through March 2017 was conducted.Results
Referrals were made for two abnormal electrocardiography results, 12 abnormal echocardiography results, and 59 elevated blood pressure readings. Cross-tabulations showed one participant with an abnormal electrocardiogram and six participants with abnormal echocardiograms who had no other abnormal findings at the screening. Findings were not statistically significant.Discussion
It was clinically significant that six participants were found to have potentially lethal electrical or structural heart abnormalities who would have otherwise have remained unidentified with the standard preparticipation sports screening guidelines. 相似文献5.
MaryCatherine Arbour Mary Mackrain Elaine Fitzgerald Sidney Atwood 《Academic pediatrics》2019,19(2):236-244
Objective
To improve breastfeeding through home visiting.Methods
From 2013 to 2016, the Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN) enrolled 15 home visiting agencies serving 1000 families in 7 states. Using the Breakthrough Series Collaborative model, HV CoIIN faculty taught a theory of change and continuous quality improvement (CQI) skills, as well as facilitating opportunities for networked learning.Results
HV CoIIN improved home visitors’ breastfeeding competencies and use of data to inform practice. Breastfeeding initiation increased from 47% to 61%. Exclusive breastfeeding of 3-month-old babies increased from 10% to 13.5%, and for babies 6 months old it increased from 5% to 8%.Conclusions
Home visiting programs can improve breastfeeding among participants with very low baseline breastfeeding rates. Continuous quality improvement and the Breakthrough Series Collaborative model can be used to improve home visiting services in ways that advance national public health priorities. 相似文献6.
7.
Malinda S. Teague Marilyn Hockenberry Jayne Laurin Kinney Russell Coleman 《Journal of pediatric health care》2019,33(3):234-241
Introduction
Examining the impact of appropriate sleep evaluation on diagnosis of attention deficit disorders can improve the standard of care in pediatrics. This quality improvement project examined current practice and subsequent implementation of a validated standardized sleep evaluation tool in the assessment of children with symptoms of attention deficit.Methods
Retrospective chart review and implementation of the Children's Sleep Habits Questionnaire (CSHQ) for children 6 to 14years old with attention deficit symptoms.Measures
Rates of sleep screening, sleep referrals, diagnosis of sleep and attention deficit disorders, Vanderbilt scores, CSHQ scores.Results
In the retrospective group (n?=?41), 76% of patients had attention deficit disorder/attention deficit hyperactivity disorder, 19.5% had sleeping disorders. There were significant provider differences in diagnosing sleep problems (p?=?.007). In the intervention group (n?=?5), 60% had abnormal CSHQ scores.Discussion
There was considerable incidence of sleeping problems in children with symptoms of attention deficit and provider variation in sleep evaluation and diagnosis, with minimal referral to specialist care. Our findings support a more comprehensive and standardized evaluation of sleep when assessing for attention deficit disorders to improve appropriate referrals, diagnosis, and treatment in pediatrics. 相似文献8.
Arielle H. Sheftall Deena J. Chisolm Emily R. Alexy Laura J. Chavez Rita M. Mangione-Smith Renée M. Ferrari Paula H. Song 《Journal of pediatric health care》2019,33(3):255-262
Introduction
Children with disabilities have significant health care needs, and receipt of care coordinator services may reduce caregiver burdens. The present study assessed caregivers’ experience and satisfaction with care coordination.Method
Caregivers of Medicaid-enrolled children with disabilities (n?=?2,061) completed a survey (online or by telephone) collecting information on the caregivers’ experiences and satisfaction with care coordination using the Family Experiences with Coordination of Care questionnaire.Results
Eighty percent of caregivers with a care coordinator reported receiving help making specialist appointments, and 71% reported help obtaining community services. Caregivers who reported that the care coordinator helped with specialist appointments or was knowledgeable, supportive, and advocating for children had increased odds of satisfaction (odds ratio?=?3.46, 95% confidence interval?=?[1.01, 11.77] and odds ratio?=?1.07, 95% confidence interval?=?[1.03, 1.11], respectively).Discussion
Findings show opportunities for improving care coordination in Medicaid-enrolled children with disabilities and that some specific elements of care coordination may enhance caregiver satisfaction with care. 相似文献9.
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11.
Astrid B. Sarvis Robert C. Sarvis David Schnadower James M. Chamberlain David J. Mathison 《Academic pediatrics》2019,19(2):209-215
Background
Ninety percent of infants 29 to 60 days old presenting to the emergency department with fever and urinary tract infection are admitted due to fear of concomitant bacteremia. Many of these infants are at low risk for bacteremia and can be safely discharged with no heightened risk of adverse events. This study sought to estimate the potential savings from outpatient management of low-risk infants.Methods
A comparative cost analysis was performed using bacteremia probability estimates from a previously published prediction model. We estimated costs using a national pediatric database coupled with retrospective chart review of infants who presented to our emergency department between 2011 and 2015.Results
The relative cost savings for the discharge strategy were $80,333 ($19,127 vs $99,460; 80% savings) for each patient with bacteremia and $257,073 per 100 patients overall. Similar savings were found for charges—$304,949 ($71,421 vs $376,371; 80%) for each patient with bacteremia and $975,838 per 100 patients. Our institutional reimbursements provided an estimated savings of $148,924 ($73,280 vs. $222,204; 67%) and $476,533 per 100 patients overall.Conclusions
The relative cost savings from discharging rather than admitting low-risk infants with febrile urinary tract infection were significant, even accounting for expenditures associated with the return emergency room visit of initially discharged bacteremic patients. These savings are achievable without an increase in adverse events. Similar outcomes were demonstrated for hospital charges and reimbursements, further strengthening these results. This study emphasizes how risk stratification in clinical decision-making can lead to substantial cost savings without compromising patient outcomes. 相似文献12.
Elizabeth D. Allen Tricia Montgomery Gloria Ayres Jennifer Cooper Joshua Gillespie Sean P. Gleeson Judith Groner Stephen Hersey Gerd McGwire Courtney Rowe Dane Snyder David Stukus Kristin S. Stukus Christopher Timan Neal Wegener Richard J. Brilli 《Academic pediatrics》2019,19(2):216-226
Objective
This study evaluates the impact of a coordinated effort by an urban pediatric hospital and its associated accountable care organization to reduce asthma-related emergency department (ED) and inpatient utilization by a large, countywide Medicaid patient population.Methods
Multiple evidence-based interventions targeting general pediatric asthma care and high health care utilizers were implemented using standardized quality improvement methodologies. Annual asthma ED and inpatient utilization rates by 2- to 18-year-old members of an accountable care organization living in the surrounding county (>140,000 eligible members in 2016), adjusted per 1000 children from 2008 through 2016, were analyzed using Poisson regression. We compared these ED utilization rates to national rates from 2006 to 2014.Results
Asthma ED utilization fell from 18.1 to 12.9 visits/1000 children from 2008 to 2016, representing a 28.7% reduction, with an average annual decrease of 3.9% (P < .001), during a time when national utilization was increasing. Asthma inpatient utilization did not change significantly during the study period.Conclusions
Asthma-related ED utilization was significantly reduced in a large population of primarily urban, minority, Medicaid-insured children by implementing a multimodal asthma quality improvement program. With adequate support, a similar approach could be successful in other communities. 相似文献13.
Selin Tuysuzoglu Sagalowsky Angela M. Feraco Tamara E. Baer Heather J. Litman David N. Williams Robert J. Vinci 《Academic pediatrics》2019,19(3):263-268
Background
Burnout is prevalent among pediatric residents, and reducing burnout is a priority for pediatric residency programs. Understanding residents’ personal circumstances, including relationship satisfaction and perceived work-life conflict, may identify novel determinants of burnout.Objectives
To describe intimate partner relationships among pediatric residents and examine associations among relationship satisfaction, work-life factors, and burnout.Methods
We identified 203 partnered residents (married or in a self-identified committed, ongoing relationship) from a cross-sectional survey of 258 residents in 11 New England pediatric programs (response rate 54% of 486 surveys distributed), conducted from April through June of 2013. We analyzed associations among relationship satisfaction, work-life factors, and burnout using multivariable regression. Burnout was measured with the brief Maslach Burnout Inventory, and relationship satisfaction with the validated Relationship Assessment Scale.Results
Burnout was reported by 40.9% of partnered respondents. The vast majority of partnered residents (n?=?167; 85.2%) reported high relationship satisfaction. Lower relationship satisfaction was not associated with burnout. Approximately half of the respondents (n?=?102; 51.5%) reported being satisfied with life as a resident. When controlling for common stressors, such as sleep deprivation, work-life measures associated with burnout included frequent perceived conflicts between personal and professional life (adjusted odds ratio, 4.35; 95% confidence interval, 1.91–9.88) and dissatisfaction with life as a resident (adjusted odds ratio, 11.74; 95% confidence interval, 4.23–32.57).Conclusion
Low relationship satisfaction and common work-life stressors were not associated with burnout among partnered pediatric residents. However, perceived work-life conflict and dissatisfaction with resident life were strongly associated with burnout and are targets for residency programs seeking to ameliorate burnout. 相似文献14.
15.
Elisa Nasol Olivia J. Lindly Alison E. Chavez Katharine E. Zuckerman 《Academic pediatrics》2019,19(3):315-324
Objective
The 5.1million US children with attention-deficit/hyperactivity disorder (ADHD) have pronounced needs in education, occupational and speech therapy, and medical and behavioral treatments. Given known associations of ADHD diagnosis with race/ethnicity and parent education, this study aimed to assess how measures of socioeconomic status correlate with both adverse family financial impact of ADHD and disparities in unmet treatment need for ADHD.Methods
Secondary analysis of children ages 8 to 17years whose households participated in the 2014 National Survey of the Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder and Tourette Syndrome. Using bivariate testing, we examined associations among measures of socioeconomic status with unmet ADHD treatment need and family financial impact. Logistic regression models estimated the odds of having unmet treatment need, adjusting for demographic factors and family financial impact.Results
Among US school-aged children with a current ADHD diagnosis, 44.3% experienced an adverse family financial impact from ADHD, and 11.6% had unmet need for ADHD treatment. Children with younger age at first ADHD diagnosis were more likely to experience adverse family financial impact. Children from non-English-speaking households were less likely to report unmet need compared to those from primarily English-speaking households. The adjusted odds of unmet need were twice as great among those who reported adverse family financial impact.Conclusion
Deeper understanding of the influence of the household language is important in ADHD needs assessments. Considering overall family financial circumstances may also be pertinent, particularly as children age, because earlier diagnosiswas associated with adverse financial outcomes. These findings could shape future clinic policies for targeting community resources. 相似文献16.
Daniel J. Schumacher Abigail Martini Eric Holmboe Kartik Varadarajan Jamiu Busari Cees van der Vleuten Carol Carraccio 《Academic pediatrics》2019,19(2):177-185
Objective
Despite the need for quality measures relevant to the work residents complete, few attempts have been made to address this gap. Resident-sensitive quality measures (RSQMs) can help fill this void. This study engaged resident and supervisor stakeholders to develop and inform next steps in creating such measures.Methods
Two separate nominal group techniques (NGTs), one with residents and one with faculty and fellow supervisors, were used to generate RSQMs for 3 specific illnesses (asthma, bronchiolitis, and closed head injury) as well as general care for the pediatric emergency department. Two separate Delphi processes were then used to prioritize identified RSQMs. The measures produced by each group were compared side by side, illuminating similarities and differences that were explored through focus groups with residents and supervisors. These focus groups also probed future settings in which to develop RSQMs.Results
In the NGT and Delphi groups, residents and supervisors placed considerable focus on measures in 3 areas across the illnesses of interest: 1) appropriate medication dosing, 2) documentation, and 3) information provided at patient discharge. Focus groups highlighted hospital medicine and general pediatrics as priority areas for developing future RSQMs but also noted contextual variables that influence the application of similar measures in different settings. Residents and supervisors had both similar as well as unique insights into developing RSQMs.Conclusions
This study continues to pave the path forward in developing future RSQMs by exploring specific settings, measures, and stakeholders to consider when undertaking this work. 相似文献17.
Alyna T. Chien Sara L. Toomey Dennis Z. Kuo Jeanne Van Cleave Amy J. Houtrow Megumi J. Okumura Matthew Y. Westfall Carter R. Petty Jessica A. Quinn Karen A. Kuhlthau Mark A. Schuster 《Academic pediatrics》2019,19(3):291-299
Objective
To identify opportunities to improve care value for children with disabilities (CWD), we examined CWD prevalence within a commercially insured population and compared outpatient care quality and annual health plan spending levels for CWD relative to children with complex medical conditions without disabilities; children with chronic conditions that are not complex; and children without disabling, complex, or chronic conditions.Methods
This cross-sectional study comprised 1,118,081 person-years of Blue Cross Blue Shield Massachusetts data for beneficiaries aged 1 to 19years old during 2008 to 2012. We combined the newly developed and validated Children with Disabilities Algorithm with the Pediatric Medical Complexity Algorithm to identify CWD and non-CWD subgroups. We used 14 validated or National Quality Forum–endorsed measures to assess outpatient care quality and paid claims to examine annual plan spending levels and components.Results
CWD constituted 4.5% of all enrollees. Care quality for CWD was between 11% and 59% for 8 of 14 quality measures and >80% for the 6 remaining measures and was generally comparable to that for non-CWD subgroups. Annual plan spending among CWD was a median and mean 23% and 53% higher than that for children with complex medical conditions without disabilities, respectively; CWD mean and median values were higher than for all other groups as well.Conclusions
CWD were prevalent in our commercially insured population. CWD experienced suboptimal levels of care, but those levels were comparable to non-CWD groups. Improving the care value for CWD involves a deeper understanding of what higher spending delivers and additional aspects of care quality. 相似文献18.
Jessie Kemmick Pintor Héctor E. Alcalá Dylan H. Roby David T. Grande Cinthya K. Alberto Ryan M. McKenna Alexander N. Ortega 《Academic pediatrics》2019,19(3):325-332
Objective
To examine insurance-based disparities in provider-related barriers to care among children in California in the wake of changes to the insurance market resulting from the Affordable Care Act.Methods
Our sample included 6514 children (ages 0 to 11 years) from the 2014–2016 California Health Interview Survey. We examined parent reports in the past year of 1) having trouble finding a general provider for the child, 2) the child not being accepted by a provider as a new patient, 3) the child's health insurance not being accepted by a provider, or 4) any of the above. Multivariable models estimated the associations of insurance type—Medi-Cal (Medicaid), employer-sponsored insurance, or privately purchased coverage—and parent reports of these problems.Results
Approximately 8% of parents had encountered at least one of these problems. Compared with parents of children with employer-sponsored insurance, parents of children with Medi-Cal or privately purchased coverage had over twice the odds of experiencing at least one of the barriers. Parents of children with Medi-Cal had over twice the odds of being told a provider would not accept their children's coverage or having trouble finding a general provider and 3times the odds of being told a provider would not accept their children as new patients. Parents of children with privately purchased coverage had over 3times the odds of being told a provider would not accept their children's coverage.Conclusions
Our study found significant disparities in provider-related barriers by insurance type among children in California. 相似文献19.
William L. Cull Mary Pat Frintner Amy Jost Starmer Laurel K. Leslie 《Academic pediatrics》2019,19(3):256-262
Objective
Utilize the unique capabilities of a longitudinal design to 1) examine whether burnout is increasing over time among 2 cohorts of pediatricians, and 2) identify factors associated with decreased burnout.Methods
Data from a national longitudinal study, the American Academy of Pediatrics Pediatrician Life and Career Experience Study, were used to examine self-reported burnout over a 5-year period (2012 to 2016) among 2002 to 2004 and 2009 to 2011 residency graduates (N?=?1804). Study participation rates ranged from 94% in 2012 to 85% in 2016. Mixed-effects logistic regression for longitudinal analysis was used to examine burnout over time.Results
In any given year, between 20% and 35% of study pediatricians reported that they were currently experiencing burnout. Significant increases in burnout over time were found for all participants combined and for each subgroup examined. Several factors were associated with reduced burnout. The largest associations with reduced burnout were found for increased flexibility in work schedule (adjusted odds ratio [aOR], 0.28; 95% confidence interval [CI], 0.22–0.35), decreased work busyness (aOR, 0.28; 95% CI, 0.22–0.36), or a job change (aOR, 0.48; 95% CI, 0.36–0.65).Conclusions
Following 5 years of participation in a longitudinal study, more than 1 in 3 early- to mid-career pediatricians reported experiencing burnout. This represents a 75% relative increase in burnout from the start of the study. Specific characteristics of pediatricians’ jobs, such as flexible work schedules and busyness of work settings, were most strongly associated with reduced burnout. 相似文献20.