National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (13)
- Adverse Drug Events (ADE) (7)
- Adverse Events (16)
- Alcohol Use (1)
- Ambulatory Care and Surgery (6)
- Antibiotics (9)
- Antimicrobial Stewardship (4)
- Anxiety (2)
- Arthritis (2)
- Asthma (21)
- Autism (12)
- Behavioral Health (51)
- Blood Clots (1)
- Blood Pressure (4)
- Brain Injury (7)
- Cancer (7)
- Cardiovascular Conditions (6)
- Care Coordination (3)
- Caregiving (17)
- Care Management (7)
- Case Study (7)
- Central Line-Associated Bloodstream Infections (CLABSI) (6)
- Children's Health Insurance Program (CHIP) (14)
- (-) Children/Adolescents (381)
- Chronic Conditions (41)
- Clinical Decision Support (CDS) (9)
- Clinician-Patient Communication (8)
- Colonoscopy (1)
- Communication (8)
- Community-Based Practice (2)
- Comparative Effectiveness (6)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (2)
- COVID-19 (25)
- Critical Care (17)
- Cultural Competence (2)
- Dental and Oral Health (9)
- Depression (6)
- Diabetes (7)
- Diagnostic Safety and Quality (25)
- Digestive Disease and Health (1)
- Disabilities (4)
- Disparities (15)
- Domestic Violence (4)
- Education (3)
- Education: Continuing Medical Education (5)
- Education: Curriculum (1)
- Education: Patient and Caregiver (3)
- Electronic Health Records (EHRs) (12)
- Emergency Department (35)
- Emergency Medical Services (EMS) (2)
- Evidence-Based Practice (32)
- Eye Disease and Health (1)
- Family Health and History (5)
- Genetics (3)
- Guidelines (18)
- Healthcare-Associated Infections (HAIs) (8)
- Healthcare Cost and Utilization Project (HCUP) (8)
- Healthcare Costs (12)
- Healthcare Delivery (7)
- Healthcare Utilization (12)
- Health Information Exchange (HIE) (1)
- Health Information Technology (HIT) (30)
- Health Insurance (8)
- Health Literacy (3)
- Health Promotion (2)
- Health Services Research (HSR) (6)
- Health Status (2)
- Heart Disease and Health (3)
- Hepatitis (2)
- Hospital Discharge (4)
- Hospitalization (12)
- Hospital Readmissions (5)
- Hospitals (16)
- Human Immunodeficiency Virus (HIV) (1)
- Imaging (5)
- Implementation (5)
- Infectious Diseases (11)
- Influenza (5)
- Injuries and Wounds (3)
- Inpatient Care (12)
- Intensive Care Unit (ICU) (18)
- Kidney Disease and Health (2)
- Labor and Delivery (2)
- Lifestyle Changes (4)
- Long-Term Care (1)
- Low-Income (6)
- Maternal Care (2)
- Medicaid (20)
- Medical Devices (1)
- Medical Errors (7)
- Medical Expenditure Panel Survey (MEPS) (7)
- Medication (45)
- Medication: Safety (5)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (4)
- Mortality (1)
- Neonatal Intensive Care Unit (NICU) (1)
- Neurological Disorders (11)
- Newborns/Infants (4)
- Nursing (2)
- Nutrition (4)
- Obesity (17)
- Obesity: Weight Management (8)
- Opioids (4)
- Orthopedics (1)
- Outcomes (19)
- Pain (3)
- Palliative Care (3)
- Patient-Centered Healthcare (10)
- Patient-Centered Outcomes Research (13)
- Patient Adherence/Compliance (3)
- Patient and Family Engagement (5)
- Patient Experience (5)
- Patient Safety (23)
- Patient Self-Management (1)
- Payment (1)
- Pneumonia (1)
- Policy (7)
- Practice Patterns (8)
- Pregnancy (4)
- Prevention (25)
- Primary Care (19)
- Primary Care: Models of Care (1)
- Provider (2)
- Provider: Clinician (1)
- Provider: Physician (6)
- Provider Performance (1)
- Public Health (9)
- Quality Improvement (23)
- Quality Indicators (QIs) (9)
- Quality Measures (25)
- Quality of Care (42)
- Quality of Life (2)
- Racial and Ethnic Minorities (20)
- Registries (5)
- Research Methodologies (2)
- Respiratory Conditions (25)
- Risk (19)
- Rural/Inner-City Residents (1)
- Rural Health (5)
- Screening (13)
- Sepsis (12)
- Sexual Health (4)
- Shared Decision Making (13)
- Sickle Cell Disease (7)
- Simulation (2)
- Skin Conditions (10)
- Sleep Problems (3)
- Social Determinants of Health (17)
- Stress (3)
- Substance Abuse (1)
- Surgery (11)
- Teams (5)
- Telehealth (7)
- Tobacco Use (1)
- Training (5)
- Transitions of Care (3)
- Transplantation (6)
- Trauma (6)
- Treatments (3)
- U.S. Preventive Services Task Force (USPSTF) (8)
- Uninsured (2)
- Urban Health (4)
- Urinary Tract Infection (UTI) (1)
- Vaccination (12)
- Vulnerable Populations (14)
- Women (3)
- Workflow (1)
- Workforce (1)
- Young Adults (8)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
101 to 125 of 381 Research Studies DisplayedSchur C, Johnson M, Doherty J
AHRQ Author: Mistry KB
Real-world considerations for implementing pediatric quality measures: insights from key stakeholders.
This AHRQ-authored paper describes key stakeholder insights focused on measure implementation and increasing the uptake of Pediatric Quality Measures (PQM). The PQMP Learning Collaborative conducted semistructured interviews with 9 key informants (KIs) presenting states, health plans, and other potential end users. The interviews focused on obtaining KIs’ perspectives on 6 research questions focused on assessing the feasibility and usability of PQM and strengthening the connection between measurement and improvement. The KIs uniformly acknowledged the complexity of the issues raised and pinpointed multiple unresolved issues.
AHRQ-authored; AHRQ-funded; 290201400003I.
Citation: Schur C, Johnson M, Doherty J .
Real-world considerations for implementing pediatric quality measures: insights from key stakeholders.
Acad Pediatr 2022 Apr;22(3S):S76-S80. doi: 10.1016/j.acap.2021.04.007..
Keywords: Children/Adolescents, Medicaid, Children's Health Insurance Program (CHIP), Quality Measures, Quality Improvement, Quality of Care, Implementation
Shenkman E, Mistry KB, Davis D
AHRQ Author: Mistry KB
Stakeholder engagement: bridging research and policy to improve measurement and dental care for children in Medicaid.
The University of Florida Child Health Quality (CHeQ) initiative, funded by the Agency for Health Care Research and Quality (AHRQ)/Centers for Medicare and Medicaid Services (CMS) Pediatric Quality Measurement Program, examined measures that states use to evaluate quality of oral health care for children in Medicaid and the Children’s Health Insurance Program (CHIP). This paper discusses stakeholder engagement in bridging research and policy to improve measurement and dental care for children in Medicaid.
AHRQ-authored; AHRQ-funded; HS025298.
Citation: Shenkman E, Mistry KB, Davis D .
Stakeholder engagement: bridging research and policy to improve measurement and dental care for children in Medicaid.
Acad Pediatr 2022 Apr;22(3S):S65-S67. doi: 10.1016/j.acap.2021.08.012..
Keywords: Children/Adolescents, Dental and Oral Health, Medicaid, Children's Health Insurance Program (CHIP), Quality Measures, Quality Improvement, Quality of Care
Kenney MK, Chanlongbutra A, Fanflick PL
AHRQ Author: Chanlongbutra A
Systems of care among children and youth with special health care needs with and without adverse childhood events: National Survey of Children's Health 2016-2017.
The purpose of the study was to compare Children and Youth with Special Health Care Needs (CYSHCN) with non-CYSHCN in the likelihood of experiencing Adverse Childhood Events (ACEs), and then document the differences in receiving recommended and needed health care services among CYSHCS with and without ACEs. The researchers studied a sample of 16,304 CYSHCN from the 2016 and 2017 National Survey of Children’s Health (N=71,181). The study found that CYHSCN had a greater likelihood of having each of the measured Adverse Childhood Events, and greater likelihood of experiencing aggregated levels of ACE’s than non-CYSHCN. In addition, an increase in ACEs was related to a decrease in the likelihood of a CYSHCN having a medical home with family-centered and coordinated care. Having one or greater ACEs increased the likelihood of having unmet mental health care needs. The study concluded that the researcher’s findings extend the current understanding of the relationship between CYSHCN and ACEs, and that the need for additional work to establish care systems for this vulnerable population continues.
AHRQ-authored.
Citation: Kenney MK, Chanlongbutra A, Fanflick PL .
Systems of care among children and youth with special health care needs with and without adverse childhood events: National Survey of Children's Health 2016-2017.
Disabil Health J 2022 Apr;15(2):101226. doi: 10.1016/j.dhjo.2021.101226..
Keywords: Children/Adolescents, Disabilities, Healthcare Delivery, Vulnerable Populations
Scott K, Becker SJ, Helseth SA
Pharmacotherapy interventions for adolescent co-occurring substance use and mental health disorders: a systematic review.
This systematic literature review examined the impact of pharmacotherapy interventions on adolescents with substance use (SU) disorders and mental health issues. The authors included ten randomized controlled trials exploring seven pharmacotherapies in the final evaluation. All studies had low to moderate risk of bias. Four studies evaluated pharmacotherapy for co-occurring depression and SU, 3 evaluated ADHD and SU, and 3 evaluated bipolar disorder and SU. Five of the 10 studies included a behavioral intervention. They found no evidence that pharmacotherapy for co-occurring mental health diagnoses impacted SU.
AHRQ-funded; 290201500002I.
Citation: Scott K, Becker SJ, Helseth SA .
Pharmacotherapy interventions for adolescent co-occurring substance use and mental health disorders: a systematic review.
Fam Pract 2022 Mar 24;39(2):301-10. doi: 10.1093/fampra/cmab096..
Keywords: Children/Adolescents, Substance Abuse, Behavioral Health, Medication
Raman DL, Bixby EC, Wang K
A Comprehensive Unit-based Safety Program to improve perioperative efficiency in adolescent idiopathic scoliosis.
In this study, the Comprehensive Unit-based Safety Program (CUSP) methodology was utilized to improve perioperative efficiency in pediatric spine surgery, and pre-implementation and post-implementation efficiency were compared. Findings showed that CUSP was effective in enhancing perioperative efficiency, demonstrating strong improvement in on-time starts over 5 years. These results indicated that process improvement in operating rooms requires consistent attention to sustain gains over time. Recommendations included engaging frontline staff in quality improvement in order to foster collaboration and provide employee buy-in to promoting a culture of safety and improving value in patient care.
AHRQ-funded; HS022198.
Citation: Raman DL, Bixby EC, Wang K .
A Comprehensive Unit-based Safety Program to improve perioperative efficiency in adolescent idiopathic scoliosis.
J Pediatr Orthop 2022 Mar;42(3):123-30. doi: 10.1097/bpo.0000000000001992..
Keywords: Children/Adolescents, Patient Safety, Quality Improvement, Quality of Care
Starnes LS, Krehnbrink M, Carroll AR
A pain in the neck: an adolescent with neck pain.
This case study involves a 15-year-old boy who presents with several years of intermittent neck pain, which has acutely worsened during the past 4 days. Patient history, diagnosis (Salmonella osteomyelitis.), and treatment are explored.
AHRQ-funded; HS026122.
Citation: Starnes LS, Krehnbrink M, Carroll AR .
A pain in the neck: an adolescent with neck pain.
Pediatr Rev 2022 Mar;43(3):174-77. doi: 10.1542/pir.2020-004168..
Keywords: Children/Adolescents, Infectious Diseases, Diagnostic Safety and Quality, Case Study, Evidence-Based Practice
Kemme S, Yoeli D, Sundaram SS
Decreased access to pediatric liver transplantation during the COVID-19 pandemic.
The purpose of the study was to explore and understand the impact of the COVID-19 pandemic on nationwide pediatric liver transplants. The researchers compared data for transplant waiting list additions, removals, and liver transplants during pre-COVID-19 (March-November 2016-2019), early COVID-19 (March-May 2020), and late COVID-19 (June-November 2020). The study results showed a 38% decrease in liver transplantations during early COVID-19, recovering to pre-pandemic rates during late COVID-19. White children had a 30% decrease in overall liver transplantation, while non-White children had a 44% decrease in overall liver transplantation. Additions to the waiting list decreased 25% during COVID-19, with Black transplant candidates the most affected, and children spent longer on the waiting list during early COVID-19 compared to pre-COVID-19 (140 vs. 96 days). The study concluded that the COVID-19 pandemic decreased access to pediatric liver transplants, especially during early COVID-19. The researchers discussed that although the rate of pediatric liver transplants has resumed to pre-COVID-19 levels, racial disparities must be addressed.
AHRQ-funded; HS026510.
Citation: Kemme S, Yoeli D, Sundaram SS .
Decreased access to pediatric liver transplantation during the COVID-19 pandemic.
Pediatr Transplant 2022 Mar;26(2):e14162. doi: 10.1111/petr.14162..
Keywords: Children/Adolescents, COVID-19, Transplantation, Access to Care, Disparities
Marshall TL, Rinke ML, Olson APJ
Diagnostic error in pediatrics: a narrative review.
This narrative review focuses on the relative paucity of large, high-quality studies of diagnostic errors and what is known at present about the incident and epidemiology as well as the established research for identifying, evaluating, and reducing diagnostic errors. The authors propose several key research questions aimed at addressing persistent gaps in the pediatric diagnostic error literature. The authors state that additional research is needed to better establish the epidemiology of diagnostic errors in pediatrics, including identifying high-risk clinical scenarios, patient populations, and groups of diagnoses.
AHRQ-funded; HS023827; HS026644.
Citation: Marshall TL, Rinke ML, Olson APJ .
Diagnostic error in pediatrics: a narrative review.
Pediatrics 2022 Mar;149(Suppl 3). doi: 10.1542/peds.2020-045948D..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Patient Safety, Medical Errors
Roberts JE, Campbell JI, Gauvreau K
Differentiating multisystem inflammatory syndrome in children: a single-centre retrospective cohort study.
This study’s objective was to identify clinical and laboratory findings that distinguished multisystem inflammatory syndrome in children (MIS-C) from febrile illnesses in which MIS-C was considered but ultimately excluded, and to examine the diseases that most often mimicked MIS-C in a tertiary medical center. All children who were hospitalized at the author’s center with fever were evaluated for MIS-C and were compared for clinical signs and symptoms, SARS-CoV-2 status, and laboratory studies between those with and without MIS-C. The authors identified 50 confirmed MIS-C cases (MIS-C(+)) and 68 children evaluated for, but ultimately not diagnosed with, MIS-C (MIS-C(-)). Symptoms of conjunctivitis, abdominal pain, fatigue, hypoxaemia, tachypnoea and hypotension at presentation were significantly more common among MIS-C(+) patients, with MIS-C(+) and MIS-C(-) patients having similar elevations in C-reactive protein (CRP), but were differentiated by thrombocytopenia, lymphopenia, and elevated ferritin, neutrophil/lymphocyte ratio, BNP and troponin. Children hospitalized with MIS-C were older, more likely to present with conjunctivitis, oral mucosa changes, abdominal pain and hypotension, and had higher neutrophil/lymphocyte ratios and lower platelet counts.
AHRQ-funded; HS000063.
Citation: Roberts JE, Campbell JI, Gauvreau K .
Differentiating multisystem inflammatory syndrome in children: a single-centre retrospective cohort study.
Arch Dis Child 2022 Mar; 107(3):e3. doi: 10.1136/archdischild-2021-322290..
Keywords: Children/Adolescents, COVID-19, Chronic Conditions, Diagnostic Safety and Quality
Kleinman LC, Howell EA
Equity and the hazard of veiled injustice: a methodological reflection on risk adjustment.
The researchers report that in the context of quality improvement research, risk adjustment (RA) methods can obscure disparities in health care. In this study the researchers address the impact of considering equity when conducting risk adjustments in pediatric health, and describe the danger of veiled justice, a type of overadjustment that takes place when risk adjustments obscure real disparities because more than one covariate, such as race and socioeconomic status, are on related causal paths. Underadjustment can occur when these same structural characteristics are not addressed when calculating models of payment. The purpose of this study was to describe the literature and present a conceptual framework that identifies these two problems for validity related to the interactions between risk adjustment and health equity in pediatric health care. The researchers conclude that the science of quality improvement must address issues of health equity as an essential construct, with the development of a specific conceptual model. Statistical analysis should be interpreted using the conceptual model, and the dynamics of child development and life course should also be addressed, as well as additional contextual and process factors such as the role of caregivers and public insurance, the epidemiology of the disease, family financial status, and others. The goal of RA is to make valid conclusions such that observed differences can be attributed to the relevant causes. When higher risk is attributed to social determinants and not disease differences, RA can obscure disparities (veiled injustice) and differences at the population level and experienced by individuals are falsely hidden. Not addressing these same structural characteristics when calculating models of payment can lead to patterns of underadjustment. The authors advise that these 2 sides of a similar coin reveal the critical importance of both the underlying model and the capacity to reliably evaluate disparities and quality.
AHRQ-funded; HS020518; 233201550088A.
Citation: Kleinman LC, Howell EA .
Equity and the hazard of veiled injustice: a methodological reflection on risk adjustment.
Pediatrics 2022 Mar;149(Suppl 3). doi: 10.1542/peds.2020-045948G.
Keywords: Children/Adolescents, Disparities, Racial and Ethnic Minorities, Risk
Isserman RS, Cheung J , Varallo D
Increasing cefazolin use for perioperative antibiotic prophylaxis in penicillin-allergic children.
The purpose of this quality improvement initiative was to increase the percentage of pediatric patients with non-severe penicillin-class allergies who receive cefazolin for antibiotic prophylaxis. The researchers included approximately 400 children in their multidisciplinary education-focused interventions, and through the initiative were able to increase the percent of eligible patients receiving cefazolin for antibiotic prophylaxis to 80%. The increase lasted through the project, and in the final month the study exceeded the study goal of 85%m with 90% of eligible patients receiving cefazolin. The researchers concluded that the initiative resulted in a considerable increase in the use of cefazolin for perioperative antibiotic prophylaxis in pediatric patients with penicillin allergies.
AHRQ-funded; HS026393.
Citation: Isserman RS, Cheung J , Varallo D .
Increasing cefazolin use for perioperative antibiotic prophylaxis in penicillin-allergic children.
Pediatrics 2022 Mar;149(3). doi: 10.1542/peds.2021-050694..
Keywords: Children/Adolescents, Antibiotics, Medication, Prevention
Kalu IC, Kao CM, Fritz SA
Management and prevention of Staphylococcus aureus infections in children.
This review article discusses management and prevention of Staphylococcus aureus infections in children. Up to 30% of children are colonized with S aureus, though infection typically does not occur without skin barrier disruption. The article discusses ways to manage infection including promptly addressing the source of infection, including sites of metastatic infection, and initiation of effective antibiotics, which should be selected based on local antibiotic susceptibility patterns. Preventive measures including optimizing hygiene and decolonization regimens for outpatients and critically ill children with prolonged hospitalizations is also discussed.
AHRQ-funded; HS024269.
Citation: Kalu IC, Kao CM, Fritz SA .
Management and prevention of Staphylococcus aureus infections in children.
Infect Dis Clin North Am 2022 Mar;36(1):73-100. doi: 10.1016/j.idc.2021.11.006..
Keywords: Children/Adolescents, Infectious Diseases, Prevention
Choi K, Becerra-Culqui T, Bhakta B
Parent intentions to vaccinate children with autism spectrum disorder against COVID-19.
This study’s purpose was to investigate associations between parent vaccine confidence and intentions to have their child with autism vaccinated with the COVID-19 vaccine. A cross-sectional, web-based survey of 332 parents of children with autism spectrum disorder who were members of an integrated healthcare system in Southern California was conducted from May to July 2021. Approximately 35% of parents were going to vaccinate their child against COVID-19. Positive vaccine beliefs, healthcare provider trust, or parent vaccination status were associated with intention to vaccinate.
AHRQ-funded; HS026407.
Citation: Choi K, Becerra-Culqui T, Bhakta B .
Parent intentions to vaccinate children with autism spectrum disorder against COVID-19.
J Pediatr Nurs 2022 Mar-Apr;63:108-10. doi: 10.1016/j.pedn.2021.11.019..
Keywords: Children/Adolescents, COVID-19, Vaccination, Autism, Chronic Conditions
Cifra CL, Tigges CR, Miller SL
Reporting outcomes of pediatric intensive care unit patients to referring physicians via an electronic health record-based feedback system.
Before critically ill children are sent to a pediatric intensive care unit (PICU), many receive their initial evaluations from front-line emergency care clinicians with variable levels of pediatric training. The authors state that reporting pediatric patient outcomes back to the front-line clinicians who provided the emergency care may offer valuable lessons. The purpose of the study was to evaluate a semiautomated electronic health record (EHR)-supported feedback system, developed at a single institution, to determine its usability and clinical relevance in providing timely and relevant PICU feedback to the front-line referring emergency department (ED) clinicians. Applying the Health Information Technology Safety Framework as a guiding model, the researchers conducted qualitative research with stakeholders, and then translated stakeholder, organizational, and usability objectives to design, develop, implement, and assess a semi-automated HER-supported feedback system. The study applied three cycles of an iterative process of implementation and evaluation over 6 months and determined that an EHR-supported feedback process is feasible, and can provide timely, usable, and clinically relevant feedback. In usability testing, physicians reported the process added minimal workload, was well integrated into their existing clinical workflows, and both the act of delivering and receiving feedback was relevant to their clinical practice. The study concluded that a semiautomated EHR-supported clinical feedback system to provide referring ED clinicians with patient outcome feedback was feasible, usable, and relevant to providers. The authors recommend future research to explore applicability to other, similar clinical settings and situations.
AHRQ-funded; HS027363; HS026965.
Citation: Cifra CL, Tigges CR, Miller SL .
Reporting outcomes of pediatric intensive care unit patients to referring physicians via an electronic health record-based feedback system.
Appl Clin Inform 2022 Mar;13(2):495-503. doi: 10.1055/s-0042-1748147..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Electronic Health Records (EHRs), Health Information Technology (HIT)
Harris S, Farah W, Snitchler C. S, Farah W, Snitchler C
AHRQ Author: Harris S
Screening and interventions to prevent dental caries in children younger than five years.
This case study concerns Hispanic parents new to a practice who bring in their two children, two years of age and four months of age, for routine wellness visits. The parents have questions about dental care for their children. Three case study questions are provided along with answers. Bonus digital content provides an information sheet with a Clinical Summary of the USPSTF Recommendation.
AHRQ-authored.
Citation: Harris S, Farah W, Snitchler C. S, Farah W, Snitchler C .
Screening and interventions to prevent dental caries in children younger than five years.
Am Fam Physician 2022 Mar;105(3):299-300..
Keywords: Children/Adolescents, Dental and Oral Health, Screening, Guidelines, Evidence-Based Practice, Case Study
de Loizaga SR, Schneider K, Beck AF
Socioeconomic impact on outcomes during the first year of life of patients with single ventricle heart disease: an analysis of the National Pediatric Cardiology Quality Improvement Collaborative Registry.
In a retrospective cohort analysis of infants enrolled in the National Pediatric Cardiology Improvement Collaborative, researchers investigated the impact of community-level deprivation on morbidity and mortality for infants with single ventricle heart disease in the first year of life. They found that community deprivation was associated with mortality and length of stay for patients with single ventricle congenital heart disease. While patients near the mean deprivation index had a higher hazard of one year mortality compared to those at the extremes of the deprivation index, length of stay and deprivation index were linearly associated, demonstrating the complex nature of socioeconomic factors.
AHRQ-funded; HS021114.
Citation: de Loizaga SR, Schneider K, Beck AF .
Socioeconomic impact on outcomes during the first year of life of patients with single ventricle heart disease: an analysis of the National Pediatric Cardiology Quality Improvement Collaborative Registry.
Pediatr Cardiol 2022 Mar;43(3):605-15. doi: 10.1007/s00246-021-02763-2..
Keywords: Children/Adolescents, Social Determinants of Health, Quality Improvement, Quality of Care, Cardiovascular Conditions, Registries, Outcomes
Greenberg JK, Otun A, Kyaw PT
Usability and acceptability of clinical decision support based on the KIIDS-TBI tool for children with mild traumatic brain injuries and intracranial injuries.
The Kids Intracranial Injury Decision Support tool for Traumatic Brain Injury (KIIDS-TBI) is a validated risk prediction model designed to manage children with mild traumatic brain injuries (mTBI) and intracranial injuries. Implementing electronic clinical decision support (CDS) may help integrate this evidence-based guidance into clinical practice. The purpose of this study was to assess the acceptability and usability of an electronic CDS tool for managing children with mTBI and intracranial injuries. Emergency medicine and neurosurgery physicians (10 each) from 10 hospitals in the United States participated in usability testing of a novel CDS prototype within a simulated electronic health record environment. The testing involved a think-aloud protocol, an acceptability and usability survey, and a semi-structured interview. The prototype underwent two updates during testing based on user feedback. Usability issues identified in the videos were categorized using content analysis, while interview transcripts were analyzed using thematic analysis. The study found that of the 20 participants, the majority worked at teaching hospitals (80%), freestanding children's hospitals (95%), and level-1 trauma centers (75%). During the two prototype updates, issues with clarity of terminology and navigation within the CDS interface were identified and resolved. As a result, the number of usability problems decreased from 35 in phase 1 to 8 in phase 3, and the number of errors made dropped from 18 in phase 1 to 2 in phase 3. According to the survey, 90% of participants found the tool easy to use, 95% found the tool useful in determining a patient's level of care, 90% found it likely to improve resource utilization, and 79% found it likely to improve patient safety. Interview themes focused on the CDS's capability to support evidence-based decision-making and enhance clinical workflow, as well as suggested implementation strategies and potential challenges.
AHRQ-funded; HS027075.
Citation: Greenberg JK, Otun A, Kyaw PT .
Usability and acceptability of clinical decision support based on the KIIDS-TBI tool for children with mild traumatic brain injuries and intracranial injuries.
Appl Clin Inform 2022 Mar; 13(2):456-67. doi: 10.1055/s-0042-1745829..
Keywords: Children/Adolescents, Clinical Decision Support (CDS), Brain Injury, Health Information Technology (HIT)
Ray KN, Bohnhoff JC, Schweiberger K
Use of telemedicine for initial outpatient subspecialist consultative visit: a national survey of general pediatricians and pediatric subspecialists.
The authors performed a survey of general pediatricians and pediatric subspecialists about the use of telemedicine for patients newly referred for pediatric subspecialty care. They found that 76% of respondents thought telemedicine should be offered for some and 11% thought telemedicine should be offered for all initial subspecialist visits. Factors perceived to reduce the appropriateness of telemedicine for subspecialty consultation included the need for interpreter services and a prior history of frequent no-shows. They further found that responses from generalists and subspecialists rarely differed significantly.
AHRQ-funded; HS026393.
Citation: Ray KN, Bohnhoff JC, Schweiberger K .
Use of telemedicine for initial outpatient subspecialist consultative visit: a national survey of general pediatricians and pediatric subspecialists.
Healthc 2022 Mar;10(1):100600. doi: 10.1016/j.hjdsi.2021.100600..
Keywords: Children/Adolescents, Telehealth, Health Information Technology (HIT), Provider: Physician, Ambulatory Care and Surgery
Jaladanki S, Schechter SB, Genies MC
Strategies for sustaining high-quality pediatric asthma care in community hospitals.
This study’s objective was to identify strategies associated with sustained guideline adherence and high-quality pediatric asthma care in community hospitals. Hospitals who were part of the Pathways for Improving Pediatric Asthma Care (PIPA) national quality improvement (QI) intervention were included. Clinicians (n = 19) involved in clinical care of children hospitalized with asthma were interviewed from five higher- and three lower-performing hospitals. Higher-performing hospitals had dedicated local champions who consistently provided reminders of evidence-based practices and delivered ongoing education. These champions also modified/developed electronic health record (EHR) tools. Lower-performing hospital clinicians described unique barriers, including delays in modifying the EHR and lack of automation of EHR tools. For all hospitals, barriers to sustainability included challenges with quality monitoring, decreasing focus of local champions over time, and ongoing difficulties developing around evidence-based practices.
AHRQ-funded; HS027041.
Citation: Jaladanki S, Schechter SB, Genies MC .
Strategies for sustaining high-quality pediatric asthma care in community hospitals.
Health Serv Res 2022 Feb;57(1):125-36. doi: 10.1111/1475-6773.13870..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Chronic Conditions, Hospitals, Quality of Care
Durojaiye A, Fackler J, McGeorge N
Examining diurnal differences in multidisciplinary care teams at a pediatric trauma center using electronic health record data: social network analysis.
The purpose of this study was to apply social network analysis to electronic health record (EHR) data to explore diurnal differences in the multidisciplinary teams caring for pediatric trauma patients. The researchers created an event log comprised of clinical activity metadata obtained from the EHR. The resulting event log was separated into 6 unique event logs, with content based on clinical activity shift (day shift or night shift) and location of the activities (divided by emergency department (ED), pediatric intensive care unit (PICU), and floor). For each event log, social networks were constructed and community overlap identified. The researchers utilized a comparison with qualitative care team data to compare and validate daytime and nighttime network structures for each care location. Validation was assessed via member-checking interviews with clinicians and qualitatively derived care team data, obtained through semi-structured interviews. The study found that of the 413 clinical encounters taking place within the 1-year study period, 65.9% began during the day shift and 34.1% began during the night shift. Multiple communities were identified in the ED and on the floor during the night shift, while a single community was identified in the ED and on the floor during the day shift, and in the PICU during the night shift. Qualitative data results indicated that the networks were accurate representations of the composition and interactions of the care teams. The researchers concluded that social network analysis was an effective method for utilization on EHR data at a pediatric trauma center to explore, identify, and describe diurnal differences in multidisciplinary care teams.
AHRQ-funded; HS023837.
Citation: Durojaiye A, Fackler J, McGeorge N .
Examining diurnal differences in multidisciplinary care teams at a pediatric trauma center using electronic health record data: social network analysis.
J Med Internet Res 2022 Feb 4;24(2):e30351. doi: 10.2196/30351..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Teams, Healthcare Delivery
Qin CX, Auerbach SR, Charnaya O
Antibody response to 2-dose SARS-CoV-2 mRNA vaccination in pediatric solid organ transplant recipients.
While many adult solid organ transplant recipients (SOTRs) have impaired antibody response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, pediatric SOTRs’ response has not been assessed. In this article, the researchers reported the immunogenicity and safety of BNT162b2 mRNA vaccination in pediatric SOTRs.
AHRQ-funded; HS026510.
Citation: Qin CX, Auerbach SR, Charnaya O .
Antibody response to 2-dose SARS-CoV-2 mRNA vaccination in pediatric solid organ transplant recipients.
Am J Transplant 2022 Feb;22(2):669-72. doi: 10.1111/ajt.16841..
Keywords: Children/Adolescents, Vaccination, COVID-19, Transplantation
Wu AJ, Aris IM, Hivert MF
Association of changes in obesity prevalence with the COVID-19 pandemic in youth in Massachusetts.
Using the Massachusetts Department of Public Health’s disease surveillance system (MDPHnet), the authors examined obesity prevalence in 3 periods from 2018 to 2020 in a fixed cohort of children and adolescents. They found that, although childhood obesity prevalence was rising prior to COVID-19, the prevalence increased by a greater difference in Massachusetts youth during the COVID-19 pandemic. They observed greater increases in obesity prevalence in Black and Hispanic youth, particularly in boys aged 6 to 11 years.
AHRQ-funded; HS000063.
Citation: Wu AJ, Aris IM, Hivert MF .
Association of changes in obesity prevalence with the COVID-19 pandemic in youth in Massachusetts.
JAMA Pediatr 2022 Feb;176(2):198-201. doi: 10.1001/jamapediatrics.2021.5095..
Keywords: Children/Adolescents, COVID-19, Obesity
Bogetz JF, Revette A, DeCourcey D
Bereaved parent perspectives on the benefits and burdens of technology assistance among children with complex chronic conditions.
The objective of this study was to understand bereaved parent perspectives on technology assistance among children with complex chronic conditions (CCCs). Researchers analyzed data from the cross-sectional Survey of Caring for Children with CCCs. Parents described both benefits and burdens of technology, with two emergent subthemes related to goals of care: technology was necessary to give time for life extension and/or to say goodbye, and technology greatly impacted the child's quality of life and symptoms. The second theme to emergence was complications and regret. The researchers concluded that it is important to understand parents' most goals when supporting decisions about technology assistance for children with CCCs.
AHRQ-funded; HS022986.
Citation: Bogetz JF, Revette A, DeCourcey D .
Bereaved parent perspectives on the benefits and burdens of technology assistance among children with complex chronic conditions.
J Palliat Med 2022 Feb; 25(2):250-58. doi: 10.1089/jpm.2021.0221..
Keywords: Children/Adolescents, Caregiving, Quality of Life, Chronic Conditions
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.
AHRQ-funded; HS000011.
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
Carroll AR, McCoy AB, Modes K
Decreasing pre-procedural fasting times in hospitalized children.
The purpose of this study was to decrease pre-procedural clear liquid fasting time from 10 hours, 13 minutes to 5 hours for pediatric hospital medicine (PHM) patients. The study included all children admitted to the PHM service at a quaternary care children's hospital with an NPO (nil per os) order associated with a procedure requiring general anesthesia or sedation from November 2, 2017 to September 19, 2021. The study found that after implementation of a SmartPhrase in the NPO order, there was special cause variation resulting in a centerline shift from a mean of 10 h 13 min to 6 h 37 min. After implementation of a hospital-wide change to the NPO order format, another centerline shift to 6 h 7 min occurred and has been sustained for 6 months. The study concluded that in hospitalized children, higher reliability interventions and quality improvement methods safely reduced the mean pre-procedural fasting time.
AHRQ-funded; HS026122.
Citation: Carroll AR, McCoy AB, Modes K .
Decreasing pre-procedural fasting times in hospitalized children.
J Hosp Med 2022 Feb;17(2):96-103. doi: 10.1002/jhm.12782..
Keywords: Children/Adolescents, Inpatient Care, Hospitals