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Hofvander Y 《Acta paediatrica (Oslo, Norway : 1992)》2005,94(8):1012-1016
The Baby Friendly Hospitals Initiative (BFHI), organized as a global campaign by UNICEF and focusing mainly on the breastfeeding routines, attitudes and knowledge among staff and mothers at maternity centres, was introduced in Sweden in 1993. Four years later, all of the then 65 maternity centres had been designated “baby friendly” (BF). Concomitant with that, the 6-mo breastfeeding rate increased from about 50% to 73% on a national basis, presumably resulting from adherence to the “10 steps” and the development of a favourable breastfeeding climate. The BFHI has engaged practically all countries throughout the world with close to 20 000 maternity centres. On a global scale, about 30% of these maternity centres have been awarded BF status but with large variations between regions and countries; Europe and other industrialized areas being among the lowest.
Conclusion: Strong government support, an organized central lead group and support from the medical profession are necessary prerequisites for BFHI success, but continued work is necessary for sustaining attitudes and knowledge. 相似文献
Conclusion: Strong government support, an organized central lead group and support from the medical profession are necessary prerequisites for BFHI success, but continued work is necessary for sustaining attitudes and knowledge. 相似文献
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《Academic pediatrics》2014,14(5):517-525
BackgroundEducation in Quality Improvement for Pediatric Practice (EQIPP) is an online program designed to improve evidence-based care delivery by teaching front-line clinicians quality improvement (QI) skills. Our objective was to evaluate EQIPP data to characterize 1) participant enrollment, use patterns, and demographics; 2) changes in performance in clinical QI measures from baseline to follow-up measurement; and 3) participant experience.MethodsWe conducted an observational study of EQIPP participants utilizing 1 of 3 modules (asthma, immunizations, gastroesophageal reflux disease) from 2009 to 2013. Enrollment and use, demographic, and quality measure data were extracted directly from the EQIPP system; participant experience was assessed via an optional online survey.ResultsStudy participants (n = 3501) were diverse in their gender, age, and race; most were board certified. Significant quality gaps were observed across many of the quality measures at baseline; sizable improvements were observed across most quality measures at follow-up. Participants were generally satisfied with their experience. The most influential module elements were collecting and analyzing data, creating and implementing aim statements and improvement plans, and completing “QI Basics.”ConclusionsOnline educational programs, such as EQIPP, hold promise for front-line clinicians to learn QI. The sustainability of the observed improvements in care processes and their linkage to improvements in health outcomes are unknown and are an essential topic for future study. 相似文献
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Esther K. Chung Ruth S. Gubernick Marianna LaNoue Diane J. Abatemarco 《Academic pediatrics》2019,19(2):227-235
Objectives
Practicing Safety is an American Academy of Pediatrics toolkit to help practices address child abuse and neglect (CAN) risk by increasing screening and providing resources. The objectives in an urban practice serving low-income children were to 1) standardize CAN risk assessment and developmental screening, and 2) improve resource provision.Methods
A quality improvement initiative to standardize CAN risk assessment, using materials adapted from Practicing Safety, was conducted through the use of SmartTools in an electronic health record. The Edinburgh Postnatal Depression Scale and Parents Evaluation of Developmental Status were used to assess maternal depression and child development, respectively. Charts were reviewed in waves—pre-, immediate post-, and early post-implementation (waves 1 to 3); monthly for 6 months (waves 4 to 9); and quarterly for 12 months (waves 10 to 13)—to assess screening and resource provision for 6 domains: infant crying, maternal depression, development, discipline, temper tantrums, and toilet training.Results
A total of 581 charts were reviewed (92, 95, and 94 for waves 1 to 3, respectively; 30 each for waves 4 to 13). Screening for infant crying, maternal depression, development, and discipline rose from 0% pre-implementation to over 50% post-implementation. Screening for temper tantrums and toilet training rose from 6% to 72% and from 36% to 82%, respectively. For all measures, resource provision improved over time, and all improvements were maintained for 1.5 years post-implementation.Conclusions
Incorporating an adapted version of Practicing Safety into an electronic health record is a practical and effective approach to improving CAN risk assessment and resource provision. This quality improvement initiative is an example of a practice-wide improvement that resulted in clinical practice change. 相似文献7.
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Valerie S. Harder Sara E. Barry Bridget Ahrens Wendy S. Davis Judith S. Shaw 《Academic pediatrics》2018,18(4):437-444
Objectives
Despite the proven benefits of immunizations, coverage remains low in many states, including Vermont. This study measured the impact of a quality improvement (QI) project on immunization coverage in childhood, school-age, and adolescent groups.Methods
In 2013, a total of 20 primary care practices completed a 7-month QI project aimed to increase immunization coverage among early childhood (29–33 months), school-age (6 years), and adolescent (13 years) age groups. For this study, we examined random cross-sectional medical record reviews from 12 of the 20 practices within each age group in 2012, 2013, and 2014 to measure improvement in immunization coverage over time using chi-squared tests. We repeated these analyses on population-level data from Vermont's immunization registry for the 12 practices in each age group each year. We used difference-in-differences regressions in the immunization registry data to compare improvements over time between the 12 practices and those not participating in QI.Results
Immunization coverage increased over 3 years for all ages and all immunization series (P?≤?.009) except one, as measured by medical record review. Registry results aligned partially with medical record review with increases in early childhood and adolescent series over time (P?≤?.012). Notably, the adolescent immunization series completion, including human papillomavirus, increased more than in the comparison practices (P?=?.037).Conclusions
Medical record review indicated that QI efforts led to increases in immunization coverage in pediatric primary care. Results were partially validated in the immunization registry particularly among early childhood and adolescent groups, with a population-level impact of the intervention among adolescents. 相似文献10.
A Prospective Cohort Quality Improvement Study to Reduce the Time to Antibiotics for New Fever in Neutropenic Pediatric Oncology Inpatients
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Adam L. Green MD Joanna Yi MD Natalie Bezler MD Yana Pikman MD Venée N. Tubman MD MMSc Esther A. Obeng MD PhD Teresa O'Neil MSN RN Robert Mersereau MSE Lisa Morrissey MPH MSN RN Amy L. Billett MD 《Pediatric blood & cancer》2016,63(1):112-117
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David K. Hooper Jason Misurac Tom Blydt‐Hansen Annabelle N. Chua 《Pediatric transplantation》2021,25(1):e13891
Kidney transplantation increases life expectancy and improves quality of life for children with end‐stage kidney disease, yet sequelae of transplantation and treatment make it difficult for transplant recipients to enjoy health and quality of life similar to their healthy peers. The NAPRTCS network was among the first to use multicenter data to inform improvements in care and outcomes for children with a kidney transplant through observational research. Now, with new technologies and unprecedented access to data, it is possible to create learning health systems as envisioned by the US National Academy of Sciences to seamlessly integrate research and continuous improvement of clinical care. In this review, we present two pre‐eminent North American networks focused on using multicenter data to drive improved care and outcomes for children with a kidney transplant. Whereas, for the past 30 years NAPRTCS has focused on discovery of best practices through observational research and clinical trials, the Improving Renal Outcomes Collaborative, established in 2016, engages patients, families, clinicians, and researchers in redesigning the healthcare delivery system to enable practice change and continuous improvement of health outcomes. We discuss the history and past contributions of these networks, as well as current activities, barriers, and potential future solutions to more fully realize the vision of a true learning health system for pediatric kidney transplant recipients. 相似文献
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