Child Health Research: Identifying Quality Problems and Improving Care
Improving Health Care Quality for Children and Adolescents
Authors discuss Preventive Services Task Force perspective on recommendations for children.
In this article, several members of the AHRQ-supported U.S. Preventive Services Task Force Child Health Workgroup discuss evidence-based primary care preventive services as a strategy for addressing important pediatric conditions and illnesses, the process used by the Task Force in making evidence-based recommendations, the current library of Task Force recommendations for children and adolescents, and factors that influence the use of these recommendations and other guidelines by clinicians. Melnyk, Grossman, Chou, et al., Pediatrics 130(2):e399-e407, 2012 (AHRQ Publication No. 13-R003)*
Task Force updates vision screening recommendation for young children.
In an update to its 2004 recommendation, the U.S. Preventive Services Task Force now recommends vision screening for all children at least once between the ages of 3 and 5 years to detect amblyopia or its risk factors. The Task Force found insufficient evidence to assess the balance of benefits and harms of vision screening in children younger than age 3. Access the recommendation at http://www.uspreventiveservicestaskforce.org/uspstf/uspsvsch.htm.
Having a usual source of care promotes preventive health counseling for children.
The researchers analyzed 2002-2006 data from AHRQ's Medical Expenditure Panel Survey (MEPS) and found that more than 75 percent of children had both a usual source of care (USC) and continuous insurance coverage in a given year. Another 14 percent had a USC but were uninsured, while 5 percent of children had insurance but no USC; 4.2 percent of children had neither continuous insurance nor a USC. Children with both health insurance and a USC were most likely to receive preventive health counseling (PHC), and those without both insurance and a USC had the highest rates of missed PHC. Surprisingly, children with insurance but no USC were more likely than uninsured children with a USC to have never received PHC. DeVoe, Tillotson, Wallace, et al., Matern Child Health J 16:306-315, 2012. See also DeVoe, Tillotson, Wallace, et al., Ann Fam Med 9:504-513, 2011; and DeVoe, Tillotson, Wallace, et al., Med Care 39(9):818-827, 2011 (AHRQ HS 16181 and HS18569).
Routine screening is the best way to detect the majority of Chlamydia infections in adolescent girls.
Untreated Chlamydia trachomatis (CT) infections can lead to pelvic inflammatory disease, ectopic pregnancy, and infertility. Despite recommendations for annual screening, screening rates remain low among all sexually active adolescents and young adults under age 26. These researchers describe an intervention in a California HMO that improved CT screening during urgent care. As a result of the intervention, the change in the proportion of adolescent girls screened for CT increased by almost 16 percent in the five intervention clinics compared with a decrease of 2 percent in the comparison clinics. Tebb, Wibbelsman, Neuhaus, and Shafer, Arch Pediatr Adolesc Med 163(6):559-564, 2009 (AHRQ grant HS10537).
Quality measure compliance for children's asthma care reduces hospital readmissions.
Researchers analyzed data on more than 1,800 children hospitalized for asthma at a large academic children's hospital over a 6-year period. They found that 6-month asthma readmission rates dropped following implementation of a standardized care process model to increase provider compliance with the Joint Commission's three quality measures for children's inpatient asthma care. Fassl, Nkoy, Srivastava, et al., Pediatrics 130(3):482-491, 2012 (AHRQ grants HS18166, HS18678). See also Newman, Hedican, Herigon, et al., Pediatrics 129(3):e597-e604, 2012 (AHRQ HS10399).
Use of standardized feeding evaluation improves growth in newborns after surgery for congenital heart defects.
Treatment of a congenital heart defect in the left ventricle (hypoplastic left heart syndrome or HLHS) of newborns involves a series of surgeries to improve the heart's pumping capacity during an infant's first 4-6 months of life. Some pediatric cardiology centers use a "bundle" of practices to closely monitor weight gain or loss in newborns with HLHS following stage 1 surgery. Newborns treated in these centers have significantly better growth during the multistage repair process than newborns treated in centers that use fewer interventions, according to this study. Results showed that optimal growth of infants was associated with centers that used a combination of standard postoperative feeding evaluation before discharge, close weight monitoring after discharge with home scales, and specific gain/loss "red flags." Anderson, Iyer, Schidlow, et al., J Pediatr 161(1):16-21, 2012 (AHRQHS16957).
Consolidating blood draws may help reduce blood loss in critically ill children.
This study identified several ways that blood loss can be minimized in critically ill children being treated in a pediatric intensive care unit (PICU). The researchers analyzed chart data on 63 children who spent more than 2 days in the PICU at one institution. The number of blood draws for each child averaged 2.7 per day, and the blood volume drawn in excess of lab requirements was 1.4 mL per draw, resulting in an excess of 3.6 mL per day and 23.0 mL for the child's total stay in the PICU. Recommendations for minimizing blood loss in these children include using small-volume tubes and a closed system, consolidating tests, and taking advantage of adjunct monitoring to measure end-tidal CO2 and cerebral-mixed venous saturation. Valentine, and Bateman, Pediatr Crit Care Med 13(1):22-27, 2012 (AHRQ T32 HS00063).
Guidelines help clinicians assess and treat maladaptive aggression in youth.
A team of national experts reviewed the available scientific literature and developed a set of evidence-based consensus treatment recommendations for youth with maladaptive aggression. The first of two reports describes the literature review process and establishes nine recommendations to help health care providers engage families, assess youth, and effectively evaluate and manage maladaptive aggression. The second report offers 11 recommendations to help primary care and specialty providers select appropriate psychosocial interventions and medications to treat maladaptive aggression. See Knapp, Chait, Pappandopulos, et al., Pediatrics 129(6):e1562-e1576, 2012; and Rosato, Correll, Pappandopulos, et al., Pediatrics 129(6):e1577-e1586, 2012 (AHRQ grant HS16097).
Treatment guideline reduces hypoglycemic events in critically ill children.
A team of physicians in critical care medicine and endocrinology at a major children's hospital developed and implemented a guideline for the initiation and maintenance of insulin infusions for stress hyperglycemia in the pediatric intensive care unit. Hypoglycemic events declined significantly after implementation of the guideline, dropping from 36 percent before the guideline to 12 percent after its implementation. In addition, the average number of days between hypoglycemic events lengthened from 21 to 186 days. Chima, Schoettker, Varadarajan, et al., Qual Manag Health Care 21(1):20-28, 2012 (AHRQ HS16957).
Adherence to discharge guidelines for late-preterm newborns remains variable.
The American Academy of Pediatrics advises against early discharge (less than 48 hours after birth) of late-preterm (LP) newborns because they are at increased risk of neonatal complications. This study found that more than 50 percent of the 282,601 LP newborns in the study were discharged early. Researchers studied LP births from 611 hospitals in California, Pennsylvania, and Missouri and found that from 1995 to 2000, early discharge decreased from 71 percent of the sample to 40 percent. However, by 2005, 39 percent were still discharged early. Hispanic ethnicity, lack of insurance, and California residence were associated with early discharge. LP newborns whose mothers were younger than 20, had previous children, and/or lived in rural areas were more likely than other LP newborns to be discharged early. Goyal, Fager, and Lorch, Pediatrics 128(1):62-71, 2011 (AHRQ HS15696).
Recommendations on rounding pediatric doses may improve e-prescribing.
When adjusting medication doses for pediatric patients, clinical decision support systems for e-prescribing need to calculate a dose that is appropriate for a child's age and weight, is safe and effective, and can be prepared readily. The percentage change by which the prescribed dose can be "rounded" for ease of preparation and administration, while maintaining effectiveness and safety, varies from drug to drug, which has been problematic in designing e-prescribing systems for pediatric patients. In this study, the researchers drew on expert opinion and the scientific literature to classify 120 medications commonly prescribed to pediatric patients into three major categories related to dose rounding. After four rounds of discussion by an expert panel, consensus was reached on 99.3 percent of the medications. Johnson, Lee, Sponer, et al., Pediatrics 128(2):e422-e428, 2011 (AHRQ HS17216).
AHRQ evidence report focuses on inhaled nitric oxide therapy for preterm infants.
According to this review, there is insufficient scientific evidence to support giving inhaled nitric oxide therapy to preterm infants requiring mechanical ventilation to improve survival or decrease pulmonary morbidity or neurological impairment. Researchers were unable to determine whether inhaled nitric oxide therapy impacts long-term health outcomes, such as respiratory symptoms, rehospitalization after intensive care unit discharge, and growth. There also was insufficient evidence that use of inhaled nitric oxide therapy influences the incidence of cognitive, motor, or sensory impairment or neurodevelopmental disability in preterm infants who require mechanical ventilation. Go to Inhaled Nitric Oxide in Preterm Infants, at http://go.usa.gov/j5B5 (AHRQ contract 290-2007-10061-1).
Adherence to evidence-based guidelines for catheter management is key to reducing blood stream infections in pediatric patients.
In a study that was conducted in 26 hospitals, these researchers found a 32 percent reduction in central venous catheter (CVC)-associated blood stream infections when care providers followed evidence-based guidelines for inserting and maintaining CVCs in pediatric ICUs. After implementing the guidelines for 9 months, the hospitals saw a median reduction in CVC-associated blood stream infections from 6.3 to 4.3 per 1,000 CVC days. Also, the intervention prevented an estimated 69 CVC-associated blood stream infections for a cost savings of nearly $3 million. Jeffries, Mason, Brewer, et al., Infect Control Hosp Epidemiol 30(7):645-651, 2009 (AHRQ grant HS13698)
Multifaceted QI intervention leads to significant reductions in serious safety events among hospitalized children.
Researchers at Cincinnati Children's Hospital implemented a quality improvement initiative focused on cultural and system changes that resulted in a significant and sustained reduction in serious safety events (SSEs) and an improvement in overall patient safety culture at the hospital. They created an SSE team to review current safety literature and recent SSEs at the hospital, instituted error prevention simulation training and the use of volunteer safety coaches, established a patient safety oversight group, and promoted sharing of lessons learned across the organization. Muething, Goudie, Schoettker, et al., Pediatrics 130(2):e423-e431, 2012 (AHRQ grant HS16957).
Bloodstream infections decline sharply in NICUs in nine States due to AHRQ's CUSP initiative.
This study found that central line-associated bloodstream infections (CLABSIs) in newborns were reduced by 58 percent in less than a year in hospital neonatal intensive care units (NICUs) participating in an AHRQ patient safety program. Frontline caregivers in 100 NICUs in nine States relied on the program's prevention practice checklists and better communication to prevent an estimated 131 infections and up to 41 deaths and to avoid more than $2 million in health care costs. Health care teams in the project States used AHRQ's Comprehensive Unit-Based Safety Program (CUSP) to improve safety culture and consistently implement catheter insertion and maintenance guidelines. More information and resources, including the CUSP Toolkit, are available at http://go.usa.gov/j5Bh.
Technical brief covers surgeries for seven fetal conditions.
This technical brief discusses fetal surgery for seven conditions, ranging from heart defects to spina bifida. It indicates that although fetal surgery research is advancing quickly, it has not progressed to the level of rigor required to optimally inform care. Key findings indicate that (1) work is needed to determine diagnostic approaches, determine which fetuses would benefit from surgery, and project long-term functioning for the targeted organ; (2) preliminary evidence is based in a few highly specialized centers; and (3) despite gaps in the literature, the field is moving toward more robust research and rigorous, more consistent documentation of outcomes over longer periods of time. See Maternal-Fetal Surgical Procedures, Technical Brief No. 5 (AHRQ Publication No. 10(11)-EHC059-EF); 2011. Available at http://go.usa.gov/j5K4.
Review finds two types of surgery equally effective for moving undescended testicles into normal position.
A review of existing research on evaluation and treatment of undescended testicles (cryptorchidism) found that both laparoscopic and open surgical techniques are effective for moving undescended testicles into normal position in the scrotum. However, the review also found that no specific imaging technique can consistently determine the presence or absence of testicles or the location of undescended testicles. Also, evidence is lacking on the utility of hormonal stimulation testing to determine the absence of testicles. Evaluation and Treatment of Cryptorchidism, Comparative Effectiveness Review No. 88 (AHRQ Publication No. 13-EHC001-1); 2012.* Available at http://to.usa.gov/j5Kk (AHRQ contract 290-2007-10065-I).
Adjusting hospital admissions by day can reduce overcrowding in children's hospitals.
Researchers examined the differences in weekday and weekend inpatient occupancy rates at children's hospitals to see if the practice of "smoothing" could assist with overcrowding. Smoothing is when a hospital proactively controls admissions to achieve more even occupancy levels over days of the week. The researchers collected daily inpatient census data for 1 year from 39 children's hospitals located in 23 States and found that occupancy rates varied from 70.9 percent to 108.1 percent during weekdays and 65.7 percent to 94.9 percent on weekends. Only 12.4 percent of scheduled admissions came in during weekends. They applied a hypothetical smoothing algorithm to each week's census and found that its use would have prevented occupancy rates reaching higher than 95 percent. Fieldston, Hall, Shah, et al., J Hosp Med 6(8):462-468, 2011 (AHRQ HS16418).
Certain psychotherapeutic interventions may benefit children exposed to trauma.
A recent study found that approximately two-thirds of children and adolescents will experience at least one traumatic event by their 18th birthday. Although many children exposed to trauma do not experience long-term difficulties, others go on to develop traumatic stress syndromes, including post-traumatic stress disorder (PTSD). The goal of this research was to identify effective, evidence-based therapies for children exposed to traumatic events, such as accidents, natural disasters, school shootings, and war. They found that school-based treatments with elements of cognitive behavior therapy appear promising, based on their impact on children's PTSD, anxiety, depression, or anger symptoms. Child and Adolescent Exposure to Trauma: Comparative Effectiveness of Interventions Addressing Trauma Other than Maltreatment or Family Violence, Comparative Effectiveness Review No. 107 (AHRQ Publication No. 13-EHC054-1); 2013. Available at http://go.usa.gov/j5KP (AHRQ contract 290-2007-10056-I).
Some minority youths benefit more than others from evidence-based mental health interventions.
These researchers examined the impact of a quality improvement intervention designed to improve access to evidence-based depression care for minority youths and found a significant reduction in depression symptoms among blacks, significant improvement in care satisfaction among Hispanics, and no intervention effects among white youths. They examined outcomes for 344 youths who completed a 6-month followup assessment. Ngo, Asarnow, Lange, et al., Psychiatr Serv 60(10):1357-1364, 2009 (AHRQ grant HS09908).
Telephone coaching to improve asthma management may lead to better quality of life for children and parents.
Researchers compared usual asthma care practices with usual care plus a 12-month telephone coaching program for children with asthma being cared for by community pediatricians in St. Louis. Parents of children randomized to the coaching intervention received monthly (or more frequent) telephone calls from trained pediatric nurses to help them with day-to-day management of asthma care. A total of 190 children were randomized to the intervention group and 172 to the usual care control group. Quality-of-life scores improved significantly in the intervention group, and there was a significant reduction in the proportion of children with poorly controlled asthma. Garbutt, Banister, Highstein, et al., Arch Pediatr Adolesc Med 164(7):625-630, 2010 (AHRQ HS15378).
Authors describe interventions to improve symptom control for terminally ill children.
More than 50,000 children die each year, and many of these children do not receive optimum symptom-control near the end of life. This article provides a palliative care primer for the pediatric surgeon on interventions to improve quality of life for terminally ill children. The interventions covered include gastrostomy, pain control, thoracotomy, and tracheostomy. Shelton and Jackson, Surg Clin N Am 91:419-428, 2011 (AHRQ grant HS13833).
Use of a care process model to treat feverish infants with possible serious bacterial infections improves outcomes and lowers costs.
According to this study, implementing an evidence-based care process model (EB-CPM) for treating feverish infants up to 3 months of age at pediatric and community hospitals could result in better diagnosis, shorter hospitalizations, shorter antibiotic treatment, and lower health care costs. The researchers developed an EB-CPM that includes a history, physical exam, complete blood count, and urinalysis for all febrile infants. Their study included 8,044 infants with 8,431 episodes of fever that resulted in evaluation at a tertiary children's hospital and four regional medical centers in Utah from 2004 through 2009. Byington, Reynolds, Korgenski, et al., Pediatrics 130(10):e16-e24, 2012 (AHRQ HS18034).
Report compares the effectiveness of treatments for juvenile arthritis.
According to this report, medications known as disease-modifying anti-rheumatic drugs, or DMARDs, appear to be more effective than other treatments for children with arthritis, but there is not enough evidence to support one type of DMARD over another. The researchers compared DMARDs with conventional treatments, such as ibuprofen and steroids, and found that DMARDs work better than other treatments for alleviating the symptoms of juvenile idiopathic arthritis, but the evidence was unclear about the long-term effectiveness and safety of these medications. There is no cure for juvenile idiopathic arthritis, which affects as many as 400 of every 100,000 children in the United States. Disease-Modifying Antirheumatic Drugs (DMARDs) in Children with Juvenile Idiopathic Arthritis, Comparative Effectiveness Review No. 28 (AHRQ Publication No. 11-EHC039-1); 2011. Available at http://go.usa.gov/j5Kz (AHRQ contract 290-2007-10066).
Antibiotics are modestly more effective than no treatment for middle ear infections in children.
This review of 135 studies published from 1999 through 2010 found that antibiotic treatment for uncomplicated acute otitis media (AOM) in low-risk children may have a slightly better success rate compared with no antibiotic treatment. There was no evidence that any other antibiotic works better at treating AOM than amoxicillin, the currently recommended first-choice antibiotic for AOM. Coker, Chan, Newberry, et al., JAMA 304(19):2161-2169, 2010 (AHRQ contract 290-2007-10056).
Gait assessment before surgery may offset the need for repeat surgery in children with cerebral palsy.
Children with cerebral palsy who have problems walking often undergo several rounds of surgery to correct their gait. According to this study of 313 children who received gait assessment prior to their initial surgery and 149 children who did not, only 11 percent of those who had gait assessment needed additional surgery, compared with 32 percent of the children who did not have gait assessment. Although the cost of the initial surgical session was higher in the children who had gait assessment, the additional total cost per personyear was nonsignificant ($20,448 vs. $19,535 for those with and without gait assessment, respectively). Wren, Kalisvaart, Ghatan, et al., J Pediatr Orthop 29(6):558-563, 2009 (AHRQ grant HS14169).
Medical home model improves delivery of preventive services to pediatric patients without raising costs.
Researchers examined data for 26,000 children on their access to a medical home and found that children's care delivered in a medical home is associated with 11 percent more preventive visits, 9 percent more dental visits, and 13 percent fewer emergency department visits, compared with care delivered in another care environment. There was no appreciable difference in mean expenditures between children with and without a medical home. Romaire, Bell, and Grossman, Med Care 50:262-269, 2012. See also, Romaire and Bell, Acad Pediatr 10(5):338-345, 2010 (AHRQ T32 HS13853).
QI collaborative improves outcomes in children with inflammatory bowel disease.
Due to the lack of consensus on the best way to treat children with inflammatory bowel disease (IBD)—which includes Chron's disease and ulcerative colitis—variations in care delivery exist in both diagnosis and treatment of IBD. According to this study, organizing care into a quality improvement collaborative led to changes in care delivery, based on the Chronic Illness Care Model. Recommendations were developed and implemented to standardize diagnosis, classify disease severity, and evaluate the patient's nutritional and growth status. Once care processes improved, other changes were made that centered on medications, managing nutrition and growth, and inducing and maintaining disease remission. Crandall, Margolis, Kappelman, et al., Pediatrics 129(4):e1030-e1041, 2012. See also Heaton, Tundia, Schmidt, et al., J Pediatr Gastroenterol Nutr 54(4):477-485, 2012 (AHRQ HS16957).
Care setting affects the likelihood that children with persistent asthma will receive inhaled steroids.
According to this study of 563 children with persistent asthma, those receiving care in community health centers or hospital clinics were significantly less likely than children seen in multispecialty practices to have received inhaled steroids for their asthma. Key components of quality care for children with asthma include prescribing inhaled steroids, vaccinating children against influenza, and discussing an asthma action plan with parents. Galbraith, Smith, Bokhour, et al., Arch Pediatr Adolesc Med 164(1):38-43, 2010 (AHRQ grant T32 HS00063).
Children's electronic health record format is now available.
Growing use of electronic health records (EHRs) continues to improve the quality and safety of health care in the United States, but many existing EHR systems are not tailored to capture or process health information about children. AHRQ and the Centers for Medicare & Medicaid Services recently announced the availability of a new pediatric EHR format that includes recommendations for child-specific data elements, such as vaccines, as well as functionality that will enable EHR developers to broaden their products to include modules tailored to children' health. More information is available at http://go.usa.gov/j5kC.
Researchers examine how changing from paper records to EHRs affects pediatric behavioral health screening.
These researchers investigated how changing over from paper health records to electronic health records (EHRs) affects behavioral health screening in children and adolescents. They found the transition period to be especially difficult, with declines in screening rates after the changeover. They note that the disruption lasted a long time before screening rates returned to pre-EHR implementation rates. Hacker, Penfold, Zhang, and Soumerai, Psychiatr Serv 65(3):256-261, 2012 (AHRQ grant HS10391).
Pediatric care providers identify desired attributes for computerized flu vaccination alerts.
Influenza vaccination rates among children continue to be suboptimal, partly due to missed vaccination opportunities. One possible solution, computerized vaccination alerts, has met with only modest success, perhaps due to design problems. These researchers conducted focus groups and interviews with 21 pediatric health care providers to identify desired characteristics and concerns about immunization alerts. The respondents suggested that an alert should appear early in the visit, facilitate ordering, be based on the electronic health record and immunization registry, and allow the provider to document reasons why the vaccine was not given by pasting back into the EHR note. Birmingham, Catallozzi, Findley, et al., Prev Med 52:274-277, 2011 (AHRQ HS18158).
Computer system compares favorably with clinicians in assessing but not treating children with asthma.
The researchers developed a computerized decision-support system (CDSS) for pediatric asthma, based on the 2007 guidelines issued by the National Education and Prevention Program. They applied the CDSS to all asthma-related visits to a pediatric pulmonology clinic and found that clinicians' agreement with the CDSS was 70.8 percent for control assessments but only 37 percent of severity assessments and 29 percent of treatment step recommendations. Pediatric pulmonologists did not follow the guidelines in 8 percent of return visits and 18 percent of new visits. Hoeksema, Bazzy-Asad, Lomotan, et al., JAMIA 18(3):243-250, 2011 (AHRQ contract 290-08-10011). See also Fifield, McQuillan, Martin-Peele, et al., J Asthma 47:718-727, 2010 (AHRQ HS11068) and Bell, Grundmeier, Localio, et al., Pediatrics 125(4):e770-777, 2010 (AHRQ HS14873).
Parents using an electronic kiosk provide more accurate information than ED providers.
This study involved children being seen in urban and suburban Boston emergency departments for a variety of complaints, including head trauma, ear pain, respiratory problems, fever, and painful or difficult urination. Parents using the software program ParentLink in an electronic ED kiosk provided more accurate information relevant to the care of their children than the chart entries and paper records complied by providers, according to the researchers. The year-long study alternated 3-month intervention periods when ParentLink was used with 3-month control periods when only provider entry was used. Porter, Forbes, Manzi, et al., Qual Saf Health Care 19(5):e34, 2010 (AHRQ HS14947).
Parents find telemedicine to be a helpful and convenient option for delivering health care to their child at school or in day care.
During telemedicine "visits," a telehealth assistant at a school or child care site can use computer-linked instruments to capture a child's heart and lung sounds and a camera to visualize the child's eyes, ears, etc. These sounds and images are stored in a central server and uploaded to the off-site primary care provider for review. The doctor can talk with and assess the child via videoconference to make decisions about diagnosis and treatment. According to this study, parents found the telemedicine experience to be a great way to ease the family burdens associated with a sick child. They also liked not having to miss work and the ability to have medications delivered directly to the child care or school site. McConnochie, Wood, Herrendeen, et al., Telemed J E Health 16(5):533-542, 2020 (AHRQ HS15165).
Automated screening has the potential to reduce medication errors due to look-alike, sound-alike drugs.
Look-alike, sound-alike (LASA) medication errors occur when a drug is erroneously prescribed or delivered because the name of the drug sounds like or is similar in spelling to another drug. These researchers conducted a pilot study to discover the extent of LASA errors in outpatient prescriptions for children. They found that LASA errors are less likely than other types of medication errors and may be best addressed by automated processes to improve the readability of prescriptions and the ability of providers, including pharmacists, to cross-check any new prescriptions with those the child has received before. Basco, Ebeling, Hulsey, and Simpson, Acad Pediatr 10(4):233-237, 2010 (AHRQ HS156709).
Tools can be used to measure performance and adverse events related to tracheal intubation in pediatric ICUs.
Tracheal intubation is often performed on critically ill children in pediatric intensive care units (PICUs), but it can result in adverse events ranging from esophageal intubation to a drop in blood pressure to cardiac arrest. Two recent studies describe tools that can be used to characterize care and improve safety outcomes for children undergoing tracheal intubation in a PICU. In the first study, the National Emergency Airway Registry was adapted to identify intubation-associated adverse events. In the second study, an assessment tool was used to rate the technical and behavioral performance of airway management teams during real intubation events. Nishisaki, Ferry, Colborn, et al., Pediatr Crit Care Med 13(1):e5-e10, 2012; Nishisaki, Nguyen, Colborn, et al., Pediatr Crit Care Med 12(4):406-414, 2012 (AHRQ grant HS16678).
Expert panel identifies quality of care measures for complex pediatric patients.
The goal of this work was to assess through expert consensus recommended primary care processes for complex pediatric patients by using the patient-centered medical home approach as a first step toward establishing a candidate set of quality measures. Using a systematic literature review and an established methodology, a national expert panel was able to select 35 primary care quality measures for complex pediatric patients. Chen, Schrager, and Mangione-Smith, Pediatrics 129(3):433-445, 2012 (AHRQ HS18087).
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