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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 246 Research Studies Displayed
Greenhawt M, Shaker M
Determining levers of cost-effectiveness for screening infants at high risk for peanut sensitization before early peanut introduction.
The authors sought to identify scenarios in which current early peanut introduction guidelines would be cost-effective. They found that the current screening approach to early peanut introduction could be cost-effective at a particular health utility for an in-clinic reaction, skin prick test sensitivity and specificity, and high baseline peanut allergy prevalence among high-risk infants. However, such conditions are unlikely to be plausible to achieve realistically. They recommend further research to define the health state utility associated with reaction location.
Citation: Greenhawt M, Shaker M . Determining levers of cost-effectiveness for screening infants at high risk for peanut sensitization before early peanut introduction. JAMA Netw Open 2019 Dec 2;2(12):e1918041. doi: 10.1001/jamanetworkopen.2019.18041..
Keywords: Patient-Centered Outcomes Research, Newborns/Infants, Children/Adolescents, Respiratory Conditions, Skin Conditions, Screening, Healthcare Costs, Evidence-Based Practice, Guidelines
Hsu HE, Abanyie F, Agus MSD
A national approach to pediatric sepsis surveillance.
The authors described the challenges specific to pediatric sepsis surveillance. They then proposed a preliminary pediatric sepsis event surveillance definition and outlined next steps for refining and validating these criteria so that they may be used to estimate the national burden of pediatric sepsis and support site-specific surveillance to complement ongoing initiatives to improve sepsis prevention, recognition, and treatment.
AHRQ-funded; HS023827; HS025008.
Citation: Hsu HE, Abanyie F, Agus MSD . A national approach to pediatric sepsis surveillance. Pediatrics 2019 Dec;144(6). doi: 10.1542/peds.2019-1790..
Keywords: Children/Adolescents, Sepsis
Napolitano N, Laverriere EK, Craig N
Apneic oxygenation as a quality improvement intervention in an academic PICU.
The objective of this prospective pre/post observational study was to evaluate if the use of apneic oxygenation during tracheal intubation in children is feasible and would decrease the occurrence of oxygen desaturation. The investigators concluded that implementation of apneic oxygenation in PICU was feasible, and was associated with significant reduction in moderate and severe oxygen desaturation. They suggest that use of apneic oxygenation should be considered when intubating critically ill children.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Napolitano N, Laverriere EK, Craig N . Apneic oxygenation as a quality improvement intervention in an academic PICU. Pediatr Crit Care Med 2019 Dec;20(12):e531-e37. doi: 10.1097/pcc.0000000000002123..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Quality Improvement, Quality of Care, Patient Safety, Adverse Events
Rudd BN, Last BS, Gregor C
Benchmarking treatment effectiveness of community-delivered trauma-focused cognitive behavioral therapy.
The objectives of the current study are to (a) evaluate the effectiveness of trauma-focused cognitive behavioral therapy (TF-CBT) delivered from 2013 to 2016 in 15 behavioral health agencies on youth PTSD as well as general mental health symptoms and functioning, and (b) benchmark these clinical outcomes against other published efficacy and effectiveness trials. This study is the first benchmarking study of TF-CBT and provides preliminary findings with regard to the effectiveness, and transportability, of TF-CBT to urban community settings that serve youth in poverty.
Citation: Rudd BN, Last BS, Gregor C . Benchmarking treatment effectiveness of community-delivered trauma-focused cognitive behavioral therapy. Am J Community Psychol 2019 Dec;64(3-4):438-50. doi: 10.1002/ajcp.12370..
Keywords: Children/Adolescents, Behavioral Health, Trauma, Stress, Outcomes, Treatments
Fleischer E, Neuman MI, Wang ME
Cerebrospinal fluid profiles of infants </=60 days of age with bacterial meningitis.
This study’s aim was to describe the cerebrospinal fluid (CSF) profiles in infants 60 days old or younger with bacterial meningitis and characteristics of infants with bacterial meningitis who do not have CSF abnormalities. Infants with culture-positive bacterial meningitis were evaluated in emergency departments of 11 children’s hospitals between 2011 and 2016. Clinical and laboratory data were abstracted from their medical records. Sensitivity of a CFS Gram-stain and corrected CSF pleocytosis was calculated for bacterial meningitis. Most infants 60 days or younger with bacterial meningitis have CSF pleocytosis or a positive Gram-stain result. Bacterial meningitis was unlikely in infants with no CSF pleocytosis and a negative Gram-stain result.
Citation: Fleischer E, Neuman MI, Wang ME . Cerebrospinal fluid profiles of infants </=60 days of age with bacterial meningitis. Hosp Pediatr 2019 Dec;9(12):979-82. doi: 10.1542/hpeds.2019-0202..
Keywords: Newborns/Infants, Children/Adolescents, Infectious Diseases
Earnshaw VA, Bogart LM, Menino D
Disclosure, stigma, and social support among young people receiving treatment for substance use disorders and their caregivers: a qualitative analysis.
The purpose of this study was to investigate relational processes experienced by youth with substance use disorders (SUDs) and their caregivers that may act as barriers to, or facilitators of, recovery. Single-session qualitative semi-structured interviews were conducted by clinicians from a SUDs program. There was variability in disclosure experiences. Addressing relational processes within treatment by encouraging patients and caregivers to share the disclosure decision-making process may support the recovery of youth with SUDs.
Citation: Earnshaw VA, Bogart LM, Menino D . Disclosure, stigma, and social support among young people receiving treatment for substance use disorders and their caregivers: a qualitative analysis. Int J Ment Health Addict 2019 Dec;17(6):1535-49. doi: 10.1007/s11469-018-9930-8..
Keywords: Children/Adolescents, Caregiving, Substance Abuse, Social Stigma
Downs SM, Bauer NS, Saha C
Effect of a computer-based decision support intervention on autism spectrum disorder screening in pediatric primary care clinics: a cluster randomized clinical trial.
This study examined outcomes for implementation of a decision support system called CHICA (Child Health Improvement Through Computer Automation) to improve screening rates for autism in children aged 18 to 24 months. A random sample of 274 children in four urban clinics was used. Two clinics participated in the intervention, and two served as controls. Because participating clinics requested intervention be discontinued for children aged 18 months, only results for those aged 24 months was analyzed. Of the 263 children with reviewed results, 92% were enrolled in Medicaid, 52.5% were African American, and 36.5% were Hispanic. Screening rates increased from 0% at baseline to 100% in 24 months during the study period of November 2010 to November 2012. Screening results were positive for 265 of 980 children screened by CHICA in the time period, with 2 children from the intervention group positively diagnosed in the time frame of the study.
Citation: Downs SM, Bauer NS, Saha C . Effect of a computer-based decision support intervention on autism spectrum disorder screening in pediatric primary care clinics: a cluster randomized clinical trial. JAMA Netw Open 2019 Dec 2;2(12):e1917676. doi: 10.1001/jamanetworkopen.2019.17676..
Keywords: Autism, Clinical Decision Support (CDS), Decision Making, Health Information Technology (HIT), Primary Care, Children/Adolescents, Screening
Williams CN, Eriksson CO, Kirby A
Hospital mortality and functional outcomes in pediatric neurocritical care.
Pediatric neurocritical care (PNCC) outcomes research is scarce. In this study, the investigators aimed to expand knowledge about outcomes in PNCC by evaluating death and changes in Functional Status Scale (FSS) from baseline among PNCC diagnoses. The investigators concluded that PNCC patients had high rates of death and new disability at discharge, varying significantly between PNCC diagnoses. Multiple domains of disability were affected, underscoring the ongoing multidisciplinary health care needs of survivors.
Citation: Williams CN, Eriksson CO, Kirby A . Hospital mortality and functional outcomes in pediatric neurocritical care. Hosp Pediatr 2019 Dec;9(12):958-66. doi: 10.1542/hpeds.2019-0173..
Keywords: Children/Adolescents, Newborns/Infants, Intensive Care Unit (ICU), Critical Care, Neurological Disorders, Mortality, Hospitals, Inpatient Care, Outcomes, Patient-Centered Outcomes Research
Liu FF, Adrian MC
Is treatment working? Detecting real change in the treatment of child and adolescent depression.
Effectiveness of evidence-based treatments for youth remain modest at best; while practice parameters recommend measurement-based care to enhance youth depression treatment, the literature offers few guidelines on how to use assessment results to inform care decisions or to detect real and clinically meaningful change. The purpose of this study was to produce reliable change indices for two commonly used standardized assessments of youth depression: Patient Health Questionnaire-9 items, Modified for Adolescents (PHQ-9A) and the Short Moods and Feelings Questionnaire (SMFQ).
Citation: Liu FF, Adrian MC . Is treatment working? Detecting real change in the treatment of child and adolescent depression. J Am Acad Child Adolesc Psychiatry 2019 Dec;58(12):1157-64. doi: 10.1016/j.jaac.2019.02.011..
Keywords: Children/Adolescents, Depression, Behavioral Health, Evidence-Based Practice, Patient-Centered Outcomes Research
Parikh K, Perry K, Pantor C
Multidisciplinary engagement increases medications in-hand for patients hospitalized with asthma.
Asthma exacerbations in children are a leading cause of missed school days and health care use. Patients discharged from the hospital often do not fill discharge prescriptions and are at risk for future exacerbations. In this study, a multidisciplinary team aimed to increase the percentage of patients discharged from the hospital after an asthma exacerbation with their medications in-hand from 15% to 80%.
Citation: Parikh K, Perry K, Pantor C . Multidisciplinary engagement increases medications in-hand for patients hospitalized with asthma. Pediatrics 2019 Dec;144(6). doi: 10.1542/peds.2019-0674..
Keywords: Children/Adolescents, Asthma, Medication, Patient Adherence/Compliance, Teams, Hospital Discharge, Transitions of Care
Riley AR, Walker BL, Wilson AC
Parents' consumer preferences for early childhood behavioral intervention in primary care.
In this study, the investigators sought to better understand parents' preferences for the content and delivery method of behavioral health guidance in pediatric primary care and to determine the relationship of those preferences with demographic characteristics, child behavior problems, and parenting style. The investigators found that most parents were interested in behavioral guidance as part of primary care, but their preferences for the content and delivery of that guidance varied by known socioeconomic, child, and parenting risk factors.
Citation: Riley AR, Walker BL, Wilson AC . Parents' consumer preferences for early childhood behavioral intervention in primary care. J Dev Behav Pediatr 2019 Dec;40(9):669-78. doi: 10.1097/dbp.0000000000000736..
Keywords: Children/Adolescents, Primary Care, Behavioral Health, Caregiving, Healthcare Delivery
De Marchis EH, Hessler D, Fichtenberg C
Part I: A quantitative study of social risk screening acceptability in patients and caregivers.
This study evaluated patient and caregiver acceptability of social risk screening. Adult patients and the adult caregivers of pediatric patients were recruited from primary care clinics and emergency departments across nine states for a survey; survey items included the Center for Medicare and Medicaid Innovation Accountable Health Communities' social risk screening tool and questions about the appropriateness of screening and including social risk data in electronic health records. Results showed that a strong majority of surveyed patients and caregivers found social risk screening to be appropriate. Most also felt comfortable including social risk data in electronic health records. The researchers conclude that lack of patient acceptability is unlikely to be a major implementation barrier.
Citation: De Marchis EH, Hessler D, Fichtenberg C . Part I: A quantitative study of social risk screening acceptability in patients and caregivers. Am J Prev Med 2019 Dec;57(6 Suppl 1):S25-s37. doi: 10.1016/j.amepre.2019.07.010..
Keywords: Children/Adolescents, Caregiving, Screening, Social Determinants of Health, Electronic Health Records (EHRs), Health Information Technology (HIT)
Bushnell GA, Crystal S, Olfson M
Prescription benzodiazepine use in privately insured U.S. children and adolescents.
The goal of this cohort study was to describe youth initiating prescription benzodiazepine treatment, identify potential indications and prescribing concerns, estimate the duration of treatment by potential indication, and identify factors that predict long-term use. Investigators found that U.S. children and adolescents are prescribed benzodiazepines for various mental health and other medical conditions, many lacking evidence of pediatric efficacy. They concluded that long-term benzodiazepine treatment, concurrent opioid prescriptions, psychotropic use, and prior substance use disorder diagnoses suggest safety risks among some youth prescribed benzodiazepines.
AHRQ-funded; HS026001; HS021112; HS023258.
Citation: Bushnell GA, Crystal S, Olfson M . Prescription benzodiazepine use in privately insured U.S. children and adolescents. Am J Prev Med 2019 Dec;57(6):775-85. doi: 10.1016/j.amepre.2019.07.006..
Keywords: Children/Adolescents, Medication, Medication: Safety, Patient Safety
Ancker JS, Sharko M, Hong M
Should parents see their teen's medical record? Asking about the effect on adolescent-doctor communication changes attitudes.
Parents routinely access young children's medical records, but medical societies strongly recommend confidential care during adolescence, and most medical centers restrict parental records access during the teen years. In this study, the investigators sought to assess public opinion about adolescent medical privacy. The investigators concluded that although medical societies recommend confidential care for adolescents, public opinion was largely in favor of parental access.
Citation: Ancker JS, Sharko M, Hong M . Should parents see their teen's medical record? Asking about the effect on adolescent-doctor communication changes attitudes. J Am Med Inform Assoc 2018 Dec;25(12):1593-99. doi: 10.1093/jamia/ocy120..
Keywords: Caregiving, Children/Adolescents, Clinician-Patient Communication, Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Policy
Jones YO, Hubbell BB, Thomson J
Things we do for no reason: systemic corticosteroids for wheezing in preschool-aged children.
This installment of the “Things We Do For No Reason” series presents and discusses a case study concerning the administration of systemic corticosteroids in a 4-year-old child presenting with wheezing, tachypnea, and respiratory distress. The authors conclude that current evidence does not support the routine use of systemic corticosteroids for preschool-aged children admitted for mild to moderate wheezing episodes, and that the patient in the introductory case would likely receive no clinical benefit from dexamethasone treatment.
Citation: Jones YO, Hubbell BB, Thomson J . Things we do for no reason: systemic corticosteroids for wheezing in preschool-aged children. J Hosp Med 2019 Dec;14(12):774-76. doi: 10.12788/jhm.3255..
Keywords: Children/Adolescents, Respiratory Conditions, Asthma, Case Study, Decision Making, Medication
Zins ZP, Wheeler KK, Brink F
Trends in US physician diagnosis of child physical abuse and neglect injuries, 2006-2014.
The purpose of this study was to determine if US child physical abuse and neglect injury rates changed from 2006 to 2014, whether definitive diagnoses of physical abuse and neglect were used more often over time, and what patient factors influenced definitive physical maltreatment diagnoses. The investigators found that definitive diagnoses of physical abuse and neglect increased over the study period and were associated with hospital volume and patient characteristics which may reflect provider experience and possible bias.
Citation: Zins ZP, Wheeler KK, Brink F . Trends in US physician diagnosis of child physical abuse and neglect injuries, 2006-2014. Child Abuse Negl 2019 Dec;98:104179. doi: 10.1016/j.chiabu.2019.104179..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Diagnostic Safety and Quality, Domestic Violence, Injuries and Wounds, Emergency Department, Hospitalization
Meyer AND, Giardina TD, Khanna A
Pediatric clinician perspectives on communicating diagnostic uncertainty.
This study examined how pediatric clinicians discussed diagnostic uncertainty with their patients’ parents. A sample study was conducted at two large academic medical institutions in Texas. Twenty pediatric clinicians participated. Some clinicians felt more comfortable expressing diagnostic uncertainty to parents who were more educated. The strength of the parent-clinician relationship also changed how clinicians communicated with parents.
AHRQ-funded; HS022087; HS023602
Citation: Meyer AND, Giardina TD, Khanna A . Pediatric clinician perspectives on communicating diagnostic uncertainty. Int J Qual Health Care 2019 Nov 30;31(9):G107-G12. doi: 10.1093/intqhc/mzz061..
Keywords: Children/Adolescents, Caregiving, Clinician-Patient Communication, Communication
Wiese AD, Huang X, Yu C
Changes in otitis media episodes and pressure equalization tube insertions among young children following introduction of the 13-valent pneumococcal conjugate vaccine: a birth cohort-based study.
The impact of 13-valent pneumococcal conjugate vaccine (PCV13) introduction on the occurrence of first and subsequent otitis media (OM) episodes in early childhood is unclear. In this study, the investigators compared the risk of OM episodes among children age <2 years before and after PCV13 introduction, accounting for the dependence between OM episodes. They concluded that the transition from PCV7 to PCV13 was associated with a decline of OM among children aged <2 years due to a reduction in the risk of both the first and subsequent OM episodes.
Citation: Wiese AD, Huang X, Yu C . Changes in otitis media episodes and pressure equalization tube insertions among young children following introduction of the 13-valent pneumococcal conjugate vaccine: a birth cohort-based study. Clin Infect Dis 2019 Nov 27;69(12):2162-69. doi: 10.1093/cid/ciz142..
Keywords: Children/Adolescents, Ear Infections, Vaccination
Feldman AG, Sundaram SS, Beaty BL
Immunization status at the time of liver transplant in children and adolescents.
In this research letter, the authors quantified the percentage of patients at Society of Pediatric Liver Transplantation centers who were up to date for their age on immunizations at the time of transplant, and determined whether demographic and clinical factors were associated with immunization status at the time of transplant. They concluded that further research is needed to understand barriers to immunization in the pediatric transplant population and called for novel tools that provide pretransplant vaccine education and enhance communication between primary care and subspecialty clinicians.
Citation: Feldman AG, Sundaram SS, Beaty BL . Immunization status at the time of liver transplant in children and adolescents. JAMA 2019 Nov 12;322(18):1822-24. doi: 10.1001/jama.2019.14386..
Keywords: Transplantation, Children/Adolescents, Vaccination, Surgery
Khan A, Yin HS, Brach C
AHRQ Author: Brach C
Association between parent comfort with English and adverse events among hospitalized children.
The purpose of this study was to examine the association between parents’ limited comfort with English (LCE) and adverse events in a cohort of hospitalized children. Participants included Arabic-, Chinese-, English-, and Spanish-speaking parents of patients 17 years and younger in the pediatric units of seven North American hospitals. Findings showed that hospitalized children of parents expressing LCE were twice as likely to experience harms due to medical care. Targeted strategies are needed to improve communication and safety for this vulnerable group of children.
AHRQ-authored; AHRQ-funded; HS022986.
Citation: Khan A, Yin HS, Brach C . Association between parent comfort with English and adverse events among hospitalized children. JAMA Pediatr 2020 Dec;174(12):e203215. doi: 10.1001/jamapediatrics.2020.3215..
Keywords: Children/Adolescents, Caregiving, Cultural Competence, Clinician-Patient Communication, Communication, Adverse Events, Patient Safety, Inpatient Care, Hospitalization
Hua CL, Brown JS
Childhood socioeconomic status and physical activity in later life: the role of perceived neighborhood cohesion and wealth in adulthood.
Researchers used data from the Health and Retirement Study and a structural equation modeling approach to examine whether perceived neighborhood social cohesion and adulthood wealth mediate the relationship between childhood socioeconomic status (SES) and physical activity. They found that perceived neighborhood social cohesion and adulthood wealth have small but statistically significant mediational effects in the relationship between childhood SES and physical activity.
Citation: Hua CL, Brown JS . Childhood socioeconomic status and physical activity in later life: the role of perceived neighborhood cohesion and wealth in adulthood. J Appl Gerontol 2022 Feb;41(2):506-14. doi: 10.1177/0733464820969312..
Keywords: Children/Adolescents, Social Determinants of Health
Calthorpe LM, Pantell MS
Differences in the prevalence of childhood adversity by geography in the 2017-18 National Survey of Children's Health.
This study examined differences in childhood exposures to adverse childhood experiences (ACEs) by geography and determined whether geography moderates the relationship between ACE exposure and health outcomes including overall health, asthma, ADHD, and special health care needs. Cross-sectional data from 2017-2017 National Survey of Children’s Health (NSCH) was analyzed. Rural residency was associated with 1.29 times increased odds of exposure to 4+ ACEs compared to suburban residency. Urban residency status was observed to increase the association between ACEs and asthma.
Citation: Calthorpe LM, Pantell MS . Differences in the prevalence of childhood adversity by geography in the 2017-18 National Survey of Children's Health. Child Abuse Negl 2021 Jan;111:104804. doi: 10.1016/j.chiabu.2020.104804..
Keywords: Children/Adolescents, Social Determinants of Health, Health Status
Bahr N, Meckler G, Hansen M
Evaluating pediatric advanced life support in emergency medical services with a performance and safety scoring tool.
This study used simulation to evaluate Pediatric Advanced Life Support (PALS) guideline performance in pediatric emergency medical service (EMS) care and to introduce this easy-to-use tool to score guideline compliance and patient safety. Standard pediatric resuscitation simulations with a child manikin were created. The manikin was presented as a choking 6-year-old with a complex medical history who is unconscious and apneic, with bradycardic pulse. Teams were expected to monitor vitals, initiate airway management and CPR, and establish vascular access and administer epinephrine based on PALS guidelines. The authors observed 34 EMS teams providing care in P-OHCA simulations. Teams were found to be proficient in assessing vitals, using correct-sized equipment, intubation, and confirmation of tube placement. The teams were delayed in initiating positive pressure ventilation (PPV) and chest compressions, with many teams (53%) deviating from guidelines in chest compression. Half the teams performed continuous compressions before establishing an advanced airway and one team did not perform compressions. Twenty teams also deviated from medication guidelines with 12 teams failing to administer epinephrine, six teams underdosing, and two teams overdosing by more than 20%.
Citation: Bahr N, Meckler G, Hansen M . Evaluating pediatric advanced life support in emergency medical services with a performance and safety scoring tool. Am J Emerg Med 2021 Oct;48:301-06. doi: 10.1016/j.ajem.2021.06.061.
Keywords: Children/Adolescents, Emergency Medical Services (EMS), Critical Care, Cardiovascular Conditions
Anderson AC, Akre E, Chen J
Exploring national trends of patient- and family-centered care among US children.
This study examined national trends in the receipt of high-quality patient-physician communication and patient empowerment through behavioral health counseling among children in the United States. They used Medical Expenditure Panel Survey (MEPS) data from 2010 to 2014. Two measures of patient- and family-centered care (PFCC) were analyzed: 1) a composite measure of high-quality patient-physician communication, and 2) patient empowerment through behavioral health counseling about healthy eating and exercise. There were high rates of receiving high-quality physician-patient communication (92-93%) as opposed to behavioral counseling about healthy eating (53-60%) and exercise (37-42%). There was a higher rate of high-quality physician-patient communication in 2014 than in 2010, but there was not a similar increase in receiving behavioral health counseling. Lower odds of receiving behavioral health counseling were found for parents with low income and low educational attainment as well as lack of insurance.
Citation: Anderson AC, Akre E, Chen J . Exploring national trends of patient- and family-centered care among US children. J Child Health Care 2019 Jun;23(2):200-12. doi: 10.1177/1367493518786015..
Keywords: Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Clinician-Patient Communication, Communication, Patient and Family Engagement, Patient-Centered Outcomes Research, Family Health and History, Lifestyle Changes
Breitenstein SM, Laurent S, Pabalan L
Implementation findings from an effectiveness-implementation trial of tablet-based parent training in pediatric primary care.
The authors studied implementation of mobile delivery to deliver parent training in order to identify and address barriers and facilitators and inform sustainability efforts. They suggest that implementation fidelity may improve with additional education and training of the interdisciplinary team, clear messaging regarding the purpose and content of the program, defining roles within the care team, identifying practice champions, and use of the electronic health record. Findings from this evaluation, including data from the randomized controlled trial and literature to support intervention effectiveness and implementation, will be used to develop an implementation toolkit to include specific strategies for implementation and ideas for local adaptations.
Citation: Breitenstein SM, Laurent S, Pabalan L . Implementation findings from an effectiveness-implementation trial of tablet-based parent training in pediatric primary care. Fam Syst Health 2019 Dec;37(4):282-90. doi: 10.1037/fsh0000447..
Keywords: Telehealth, Health Information Technology (HIT), Primary Care, Children/Adolescents, Education: Patient and Caregiver