National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 41 Research Studies DisplayedLuther M, Poppert Cordts KM, Williams CN
Sleep disturbances after pediatric traumatic brain injury: a systematic review of prevalence, risk factors, and association with recovery.
This is a systematic review to quantify sleep wake disturbances (SWD) after pediatric traumatic brain injury (TBI). These SWD can place children at risk for worse outcomes since sleep is needed for brain development and healing after injury. They also evaluated interventions for SWD and the association between SWD and other post-traumatic outcomes. Literature was searched from 1999-2019 evaluating sleep or fatigue in children hospitalized for TBI. Two independent reviewers assessed quality of the studies using the Newcastle-Ottowa Score for observational studies. Out of 966 identified articles, 126 full text articles were reviewed and 24 studies were included. Studies showed at least 20% of children with TBI had some degree of SWD including trouble falling or staying asleep, fatigue, daytime fatigue, and nightmares. SWD was negatively correlated with cognitive, behavioral, and quality of life outcomes. There was moderate-high risk of bias for all studies due to small sample size and lack of validated or objective SWD measures.
AHRQ-funded; HS022981.
Citation: Luther M, Poppert Cordts KM, Williams CN .
Sleep disturbances after pediatric traumatic brain injury: a systematic review of prevalence, risk factors, and association with recovery.
Sleep 2020 Oct;43(10):zsaa083. doi: 10.1093/sleep/zsaa083..
Keywords: Children/Adolescents, Sleep Problems, Brain Injury, Neurological Disorders, Trauma, Risk, Patient-Centered Outcomes Research, Outcomes, Quality of Life, Evidence-Based Practice
Lindly O, Crossman M, Eaves M
Health literacy and health outcomes among children with developmental disabilities: a systematic review.
This systematic literature review focused on the impact of health literacy on health outcomes of children with developmental disabilities (DDs). A review of the literature of most of the major scientific databases was conducted. Out of 2,768 unique records identified, 53 full text articles were reviewed and four articles were included. The associations of family health literacy with health outcomes among children with DDs were mixed. Future research was recommended.
AHRQ-funded; HS000063.
Citation: Lindly O, Crossman M, Eaves M .
Health literacy and health outcomes among children with developmental disabilities: a systematic review.
Am J Intellect Dev Disabil 2020 Sep 1;125(5):389-407. doi: 10.1352/1944-7558-125.5.389..
Keywords: Children/Adolescents, Health Literacy, Disabilities, Evidence-Based Practice, Patient-Centered Outcomes Research, Outcomes
Mogul DB, Perito ER, Wood N
Impact of acuity circles on outcomes for pediatric liver transplant candidates.
In December 2018, UNOS approved an allocation scheme based on recipients' geographic distance from a deceased donor ("acuity circles"). Previous analyses suggested acuity circles (AC) would reduce waitlist mortality overall, but their impact on pediatric subgroups was not considered. In this study, the investigators applied Scientific Registry of Transplant Recipients data from 2011-2016 towards the Liver Simulated Allocation Model (LSAM) to compare outcomes by age and illness severity for the UNOS-approved AC and the existing Donor Service Area (DSA)/Region-based allocation schemes.
AHRQ-funded; HS023876.
Citation: Mogul DB, Perito ER, Wood N .
Impact of acuity circles on outcomes for pediatric liver transplant candidates.
Transplantation 2020 Aug;104(8):1627-32. doi: 10.1097/tp.0000000000003079..
Keywords: Children/Adolescents, Transplantation, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice, Registries, Surgery, Access to Care
Kaiser SV, Johnson MD, Walls TA
Pathways to improve pediatric asthma care: a multisite, national study of emergency department asthma pathway implementation.
This quality improvement study’s aim was to determine the effects of pediatric asthma pathway implementation in a diverse, national sample of emergency departments (EDs). Desired outcomes included systemic corticosteroid administration within 60 minutes (primary), assessment of severity at ED triage, chest radiograph use, hospital admission or transfer for higher level of care, and ED length of stay. Charts were reviewed each month by EDs for children ages 2-17 years with a primary diagnosis of asthma. A total of 83 EDs were enrolled, with 37 of them children’s hospitals, and 46 community hospitals. Seventy-three percent completed the study (n = 22,963). There was a significant increase in systematic corticosteroid administration within 60 minutes of arrival as well as increased odds of severity assessment at triage and decreased rate of change in odds of hospital admission/transfer. Chest radiograph or ED length of stay was not associated with pathway implementation.
AHRQ-funded; HS024592.
Citation: Kaiser SV, Johnson MD, Walls TA .
Pathways to improve pediatric asthma care: a multisite, national study of emergency department asthma pathway implementation.
J Pediatr 2020 Aug;223:100-07.e2. doi: 10.1016/j.jpeds.2020.02.080..
Keywords: Children/Adolescents, Emergency Department, Asthma, Quality Improvement, Quality of Care, Care Management, Healthcare Delivery, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes
Kaiser SV, Jennings B, Rodean J
Pathways for improving inpatient pediatric asthma care (PIPA): a multicenter, national study.
This study examined whether implementation of a pathway strategy for inpatient pediatric asthma patients improve outcomes for these patients. Outcomes measured included length of stay (LOS), early administration of metered-dose inhalers, screening for secondhand tobacco exposure and referral to cessation resources, and 7-day hospital readmissions or emergency revisits. Eighty-five hospitals were enrolled and 68 completed the study with (n=12,013) admissions. Pathways were associated with increases in early administration of metered-dose inhalers, and referral to smoking cessation resources, but no statistically significant changes in the other outcomes were observed. Most hospitals did improve in at least one outcome.
AHRQ-funded; HS024592; HS024554.
Citation: Kaiser SV, Jennings B, Rodean J .
Pathways for improving inpatient pediatric asthma care (PIPA): a multicenter, national study.
Pediatrics 2020 Jun;145(6):e20193026. doi: 10.1542/peds.2019-3026..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Inpatient Care, Patient-Centered Outcomes Research, Outcomes, Hospitalization, Care Management
Heneghan MB, Hussain T, Barrera L
Applying the COM-B model to patient-reported barriers to medication adherence in pediatric acute lymphoblastic leukemia.
This study examined parent- and patient-reported barriers to oral chemotherapy adherence with children with pediatric acute lymphoblastic leukemia (ALL). The medicine most often used was 6-mercaptopurine (6-MP). Forty-nine parents and 15 patients were surveyed and most reported at least one adherence barrier. Most of the barriers were about meeting other patients with ALL or meeting other parents. Patients also reported difficulty in finding out what their medications are, and what 6-MP does. These barriers can lead to relapse if they are not addressed.
AHRQ-funded; HS023011.
Citation: Heneghan MB, Hussain T, Barrera L .
Applying the COM-B model to patient-reported barriers to medication adherence in pediatric acute lymphoblastic leukemia.
Pediatr Blood Cancer 2020 May;67(5):e28216. doi: 10.1002/pbc.28216..
Keywords: Children/Adolescents, Treatments, Cancer, Medication, Patient Adherence/Compliance, Patient-Centered Outcomes Research
Whiteside SPH, Sim LA, Morrow AS
A meta-analysis to guide the enhancement of CBT for childhood anxiety: exposure over anxiety management.
Cognitive behavior therapy (CBT) is the most empirically supported therapy for childhood anxiety disorders (CADs) but has not reliably outperformed other credible interventions. The current study used meta-analysis to examine the frequency with which the most common treatment components are included in outcome studies and the relation of these components to symptom improvement.
AHRQ-funded; 290201500013I.
Citation: Whiteside SPH, Sim LA, Morrow AS .
A meta-analysis to guide the enhancement of CBT for childhood anxiety: exposure over anxiety management.
Clin Child Fam Psychol Rev 2020 Mar;23(1):102-21. doi: 10.1007/s10567-019-00303-2..
Keywords: Children/Adolescents, Anxiety, Behavioral Health, Treatments, Patient-Centered Outcomes Research, Evidence-Based Practice
Bowring MG, Massie AB, Chu NM
Projected 20- and 30-year outcomes for pediatric liver transplant recipients in the United States.
Researchers aimed to use national registry data and parametric models to project 20- and 30-year post-transplant outcomes for recently transplanted pediatric liver transplant (LT) recipients. Using Scientific Registry of Transplant Recipients data, they found that projected long-term outcomes for recently transplanted pediatric LT recipients are excellent, reflective of substantial improvements in medical care, and informative for physician-patient education and decision making in the current era.
AHRQ-funded; HS023876.
Citation: Bowring MG, Massie AB, Chu NM .
Projected 20- and 30-year outcomes for pediatric liver transplant recipients in the United States.
J Pediatr Gastroenterol Nutr 2020 Mar;70(3):356-63. doi: 10.1097/mpg.0000000000002592..
Keywords: Children/Adolescents, Transplantation, Patient-Centered Outcomes Research, Outcomes, Surgery, Registries, Evidence-Based Practice
Barry-Menkhaus SA, Wagner DV, Riley AR
Small interventions for big change: brief strategies for distress and self-management amongst youth with type 1 diabetes.
In this article, the authors review existing evidence for brief interventions, describe several untested clinical strategies, and make recommendations for accelerating the translational study of brief interventions among youth with type 1 diabetes.
AHRQ-funded; HS022981.
Citation: Barry-Menkhaus SA, Wagner DV, Riley AR .
Small interventions for big change: brief strategies for distress and self-management amongst youth with type 1 diabetes.
Curr Diab Rep 2020 Jan 30;20(1):3. doi: 10.1007/s11892-020-1290-7..
Keywords: Diabetes, Patient-Centered Healthcare, Patient Self-Management, Patient Adherence/Compliance, Care Management, Patient-Centered Outcomes Research, Healthcare Delivery, Children/Adolescents
Robinson M, Greenhawt M, Stukus DR
Factors associated with epinephrine administration for anaphylaxis in children before arrival to the emergency department.
Researchers evaluated factors associated with anaphylaxis management before arrival at the emergency department (ED) or urgent care center (UCC). Reactions occurring at home were less likely to be treated with epinephrine compared with reactions occurring at school. The odds of receiving epinephrine before arrival at the ED or UCC were significantly lower with a 2-organ system or 3-organ system presentation compared with 1-organ system involvement.
AHRQ-funded; HS024599.
Citation: Robinson M, Greenhawt M, Stukus DR .
Factors associated with epinephrine administration for anaphylaxis in children before arrival to the emergency department.
Ann Allergy Asthma Immunol 2017 Aug;119(2):164-69. doi: 10.1016/j.anai.2017.06.001.
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Keywords: Children/Adolescents, Emergency Medical Services (EMS), Healthcare Utilization, Medication, Patient-Centered Outcomes Research
Weitlauf AS, Sathe N, McPheeters ML
Interventions targeting sensory challenges in autism spectrum disorder: a systematic review.
This review evaluated the effectiveness and safety of interventions targeting sensory challenges in ASD. It concluded that some interventions may yield modest short-term (<6 months) improvements in sensory- and ASD symptom severity-related outcomes; the evidence base is small, and the durability of the effects is unclear. Although some therapies may hold promise, substantial needs exist for continuing improvements in methodologic rigor.
AHRQ-funded; 290201500003I.
Citation: Weitlauf AS, Sathe N, McPheeters ML .
Interventions targeting sensory challenges in autism spectrum disorder: a systematic review.
Pediatrics 2017 Jun;139(6):e20170347. doi: 10.1542/peds.2017-0347.
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Keywords: Patient-Centered Outcomes Research, Evidence-Based Practice, Comparative Effectiveness, Children/Adolescents, Autism
Couch C, Franxman T, Greenhawt M
Characteristics of tree nut challenges in tree nut allergic and tree nut sensitized individuals.
The purpose of this study was to determine the relation between tree nut (TN) sensitization levels and oral food challenges (OFC) outcomes. The investigators concluded that TN challenges were frequently passed in patients with TN sensitization with or without a history of TN reactivity despite a TN SPT wheal of at least 3 mm or a TN sIgE level of at least 2 kUA/L. Nearly all patients with peanut allergy and TN co-sensitization passed the TN challenge, questioning the clinical relevance of "co-allergy."
AHRQ-funded; HS024599.
Citation: Couch C, Franxman T, Greenhawt M .
Characteristics of tree nut challenges in tree nut allergic and tree nut sensitized individuals.
Ann Allergy Asthma Immunol 2017 May;118(5):591-96.e3. doi: 10.1016/j.anai.2017.02.010..
Keywords: Children/Adolescents, Nutrition, Outcomes, Patient-Centered Outcomes Research
Khan A, Baird J, Rogers JE
Parent and provider experience and shared understanding after a family-centered nighttime communication intervention.
This study assessed parent and provider experience and shared understanding after a family-centered, multidisciplinary nighttime communication intervention (nurse-physician brief, family huddle, family update sheet). It concluded that a family-centered, multidisciplinary nighttime communication intervention was associated with improvements in some, but not all, domains of parent/provider experience and shared understanding, particularly provider experience and nurse-family shared understanding.
AHRQ-funded; HS022986; HS000063.
Citation: Khan A, Baird J, Rogers JE .
Parent and provider experience and shared understanding after a family-centered nighttime communication intervention.
Acad Pediatr 2017 May - Jun;17(4):389-402. doi: 10.1016/j.acap.2017.01.012.
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Keywords: Children/Adolescents, Hospitalization, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Clinician-Patient Communication
Berger BA, Cossio A, Saravia NG
Cost-effectiveness of meglumine antimoniate versus miltefosine caregiver DOT for the treatment of pediatric cutaneous leishmaniasis.
The researchers performed a cost-effectiveness analysis comparing Miltefosine administered via in-home caregiver Directly Observed Therapy (cDOT) versus injectable meglumine antimoniate (MA) for pediatric cutaneous leishmaniasis (CL) in southwest Colombia. Treatment of pediatric CL miltefosine via cDOT was found to be cost saving from patient and societal perspectives, and moderately more costly from the government payer perspective compared to treatment with MA.
AHRQ-funded; HS022433.
Citation: Berger BA, Cossio A, Saravia NG .
Cost-effectiveness of meglumine antimoniate versus miltefosine caregiver DOT for the treatment of pediatric cutaneous leishmaniasis.
PLoS Negl Trop Dis 2017 Apr 6;11(4):e0005459. doi: 10.1371/journal.pntd.0005459.
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Keywords: Patient-Centered Outcomes Research, Healthcare Costs, Medication, Healthcare Costs, Children/Adolescents
Wilson JL, Eriksson CO, Williams CN
Endovascular therapy in pediatric stroke: utilization, patient characteristics, and outcomes.
This study aimed to describe endovascular therapy utilization and explore outcomes in a national sample of pediatric arterial ischemic stroke patients. In this sample of children with a diagnosis of arterial ischemic stroke, endovascular therapy was infrequently utilized. Patients with a procedure code for endovascular therapy had significant stroke-related deficits, but outcomes were similar to those in children who did not receive endovascular therapy.
AHRQ-funded; HS022981.
Citation: Wilson JL, Eriksson CO, Williams CN .
Endovascular therapy in pediatric stroke: utilization, patient characteristics, and outcomes.
Pediatr Neurol 2017 Apr;69:87-92.e2. doi: 10.1016/j.pediatrneurol.2017.01.013.
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Keywords: Children/Adolescents, Healthcare Cost and Utilization Project (HCUP), Patient-Centered Outcomes Research, Stroke
Dorris K, Liu C, Li D
A comparison of safety and efficacy of cytotoxic versus molecularly targeted drugs in pediatric phase I solid tumor oncology trials.
A systematic review of pediatric phase I solid tumor trials published in 1990-2013 was performed. The published reports were evaluated for patient characteristics, toxicity information, and response numbers. The review concluded that in phase I pediatric solid tumor trials, objective response rates were significantly higher for cytotoxic versus targeted agents. Stable disease rates were similar in targeted and cytotoxic drug trials.
AHRQ-funded; HS022437.
Citation: Dorris K, Liu C, Li D .
A comparison of safety and efficacy of cytotoxic versus molecularly targeted drugs in pediatric phase I solid tumor oncology trials.
Pediatr Blood Cancer 2017 Mar;64(3). doi: 10.1002/pbc.26258.
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Keywords: Patient Safety, Patient-Centered Outcomes Research, Children/Adolescents, Cancer, Medication
Sathe N, Chinnadurai S, McPheeters M
Comparative effectiveness of partial versus total tonsillectomy in children.
This review assessed the effectiveness of partial versus total tonsillectomy in children. Data did not allow firm conclusions regarding the comparative benefit of partial versus total removal; however, neither surgical technique nor extent of surgery appeared to affect outcomes markedly. Partial tonsillectomy conferred moderate advantages in return to normal diet/activity but was also associated with tonsillar regrowth and symptom recurrence.
AHRQ-funded; 290201500003I.
Citation: Sathe N, Chinnadurai S, McPheeters M .
Comparative effectiveness of partial versus total tonsillectomy in children.
Otolaryngol Head Neck Surg 2017 Mar;156(3):456-63. doi: 10.1177/0194599816683916.
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Keywords: Comparative Effectiveness, Children/Adolescents, Surgery, Patient-Centered Outcomes Research, Children/Adolescents
Goldman JL, Richardson T, Newland JG
Outpatient parenteral antimicrobial therapy in pediatric Medicaid enrollees.
The study’s objective was to characterize outpatient parenteral antimicrobial therapy (OPAT) use and clinical outcomes for a large population of pediatric Medicaid enrollees treated with OPAT. It found that ceftriaxone and vancomycin were the most commonly prescribed antimicrobials. An emergency department visit or hospital admission occurred during 38 percent of OPAT episodes, among which 61 percent were OPAT-related.
AHRQ-funded; HS023320.
Citation: Goldman JL, Richardson T, Newland JG .
Outpatient parenteral antimicrobial therapy in pediatric Medicaid enrollees.
J Pediatric Infect Dis Soc 2017 Mar 1;6(1):65-71. doi: 10.1093/jpids/piv106.
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Keywords: Antibiotics, Children/Adolescents, Medicaid, Ambulatory Care and Surgery, Patient-Centered Outcomes Research
Francis DO, Fonnesbeck C, Sathe N
Postoperative bleeding and associated utilization following tonsillectomy in children.
This review assessed posttonsillectomy hemorrhage (PTH), associated nonoperative readmissions/revisits, and reoperations in children. It concluded that PTH occurred in roughly 4 percent of tonsillectomies. Although studies typically did not report bleeding severity or amount, relatively few episodes of PTH necessitated reoperation for hemostasis. Frequency of PTH across techniques was similar; thus, it cannot be concluded that a given technique is superior.
AHRQ-funded; 290201500003I.
Citation: Francis DO, Fonnesbeck C, Sathe N .
Postoperative bleeding and associated utilization following tonsillectomy in children.
Otolaryngol Head Neck Surg 2017 Mar;156(3):442-55. doi: 10.1177/0194599816683915.
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Keywords: Children/Adolescents, Surgery, Adverse Events, Hospital Readmissions, Patient-Centered Outcomes Research
Lindly OJ, Zuckerman KE, Mistry KB
AHRQ Author: Mistry KB
Clarifying the predictive value of family-centered care and shared decision making for pediatric healthcare outcomes using the Medical Expenditure Panel Survey.
The researchers estimated (1) family-centered care (FCC) and shared decision-making (SDM) prevalence, and (2) associations of FCC and SDM (FCC/SDM) with health care outcomes among U.S. children. FCC/SDM prevalence in year 1 varied from 38.6 to 93.7 percent, and it was lower for composites with more stringent scoring approaches. FCC/SDM composites with stringent scoring approaches in year 1 were associated with reduced unmet needs in year 2.
AHRQ-authored.
Citation: Lindly OJ, Zuckerman KE, Mistry KB .
Clarifying the predictive value of family-centered care and shared decision making for pediatric healthcare outcomes using the Medical Expenditure Panel Survey.
Health Serv Res 2017 Feb;52(1):313-45. doi: 10.1111/1475-6773.12488.
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Keywords: Medical Expenditure Panel Survey (MEPS), Shared Decision Making, Patient-Centered Outcomes Research, Children/Adolescents, Healthcare Costs
Roxbury CR, Jatana KR, Shah RK
Safety and postoperative adverse events in pediatric airway reconstruction: analysis of ACS-NSQIP-P 30-day outcomes.
The researchers describe postoperative sequelae of pediatric airway reconstructive procedures and identify predictive factors for adverse events. They conclude that the 30-day adverse event rate in pediatric airway surgery is high, with no identifiable predictors noted in the analysis of these data. Findings imply that systematic collection of variables and outcomes will be essential to truly effect quality improvement in these high-risk procedures..
AHRQ-funded; HS022932.
Citation: Roxbury CR, Jatana KR, Shah RK .
Safety and postoperative adverse events in pediatric airway reconstruction: analysis of ACS-NSQIP-P 30-day outcomes.
Laryngoscope 2017 Feb;127(2):504-08. doi: 10.1002/lary.26165.
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Keywords: Children/Adolescents, Patient Safety, Adverse Events, Patient-Centered Outcomes Research, Surgery
Chinnadurai S, Jordan AK, Sathe NA
Tonsillectomy for obstructive sleep-disordered breathing: a meta-analysis.
This meta-analysis compared sleep, cognitive or behavioral, and health outcomes of tonsillectomy versus watchful waiting with supportive care in children with sleep-disordered breathing. It determined that, relative to watchful waiting, most studies reported better sleep-related outcomes in children who had a tonsillectomy.
AHRQ-funded; 290201500003I.
Citation: Chinnadurai S, Jordan AK, Sathe NA .
Tonsillectomy for obstructive sleep-disordered breathing: a meta-analysis.
Pediatrics 2017 Feb;139(2). doi: 10.1542/peds.2016-3491.
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Keywords: Children/Adolescents, Sleep Problems, Surgery, Evidence-Based Practice, Respiratory Conditions, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes
Stockmann C, Ampofo K, Pavia AT
Comparative effectiveness of oral versus outpatient parenteral antibiotic therapy for empyema.
This study compared outcomes between oral therapy and (outpatient parenteral antibiotic therapy (OPAT) for pediatric parapneumonic empyema (PPE) . The frequency of complications was similar with oral therapy and OPAT for children with PPE. Oral antibiotics may be considered safe and effective for children with PPE who will be discharged to complete therapy in the outpatient setting.
AHRQ-funded; HS023320.
Citation: Stockmann C, Ampofo K, Pavia AT .
Comparative effectiveness of oral versus outpatient parenteral antibiotic therapy for empyema.
Hosp Pediatr 2015 Dec;5(12):605-12. doi: 10.1542/hpeds.2015-0100.
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Keywords: Comparative Effectiveness, Patient-Centered Outcomes Research, Medication, Hospitalization, Children/Adolescents
Nkoy F, Fassl B, Stone B
Improving pediatric asthma care and outcomes across multiple hospitals.
This study aimed to assess the impact of an evidence-based care process model 5 years after implementation at Primary Children's Hospital, a tertiary care facility, and after its dissemination to 7 community hospitals. The intervention resulted in sustained, long-term improvement in asthma care and outcomes at the tertiary care hospital and successful dissemination to community hospitals.
AHRQ-funded; HS018166; HS018678.
Citation: Nkoy F, Fassl B, Stone B .
Improving pediatric asthma care and outcomes across multiple hospitals.
Pediatrics 2015 Dec;136(6):e1602-10. doi: 10.1542/peds.2015-0285..
Keywords: Children/Adolescents, Asthma, Hospitalization, Evidence-Based Practice, Patient-Centered Outcomes Research
Smith MJ, Gerber JS, Hersh AL
Inpatient antimicrobial stewardship in pediatrics: a systematic review.
The purpose of this paper was to describe the clinical and economic outcomes associated with pediatric antimicrobial stewardship programs and other supplemental antimicrobial stewardship interventions. The authors concluded that the studies researched demonstrated reductions in antimicrobial utilization, cost, and prescribing errors with no apparent negative impact on patient safety.
AHRQ-funded; HS023320.
Citation: Smith MJ, Gerber JS, Hersh AL .
Inpatient antimicrobial stewardship in pediatrics: a systematic review.
J Pediatric Infect Dis Soc 2015 Dec;4(4):e127-35. doi: 10.1093/jpids/piu141.
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Keywords: Antimicrobial Stewardship, Children/Adolescents, Healthcare Costs, Patient-Centered Outcomes Research, Children/Adolescents