National Healthcare Quality and Disparities Report
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Topics
- Adverse Events (1)
- Asthma (2)
- Care Management (1)
- Central Line-Associated Bloodstream Infections (CLABSI) (1)
- Children/Adolescents (4)
- Chronic Conditions (1)
- Clinician-Patient Communication (1)
- Communication (2)
- Decision Making (5)
- Depression (1)
- Disparities (1)
- Education: Continuing Medical Education (1)
- Elderly (1)
- Emergency Department (3)
- Evidence-Based Practice (13)
- (-) Guidelines (24)
- Healthcare-Associated Infections (HAIs) (2)
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- Healthcare Utilization (1)
- Health Services Research (HSR) (2)
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- Implementation (2)
- Inpatient Care (1)
- Intensive Care Unit (ICU) (1)
- Labor and Delivery (1)
- Medication (2)
- Neurological Disorders (1)
- Newborns/Infants (1)
- Outcomes (1)
- Patient-Centered Healthcare (4)
- Patient-Centered Outcomes Research (1)
- Patient and Family Engagement (2)
- Patient Safety (3)
- Pregnancy (1)
- Prevention (2)
- Primary Care (2)
- Provider Performance (1)
- Quality Improvement (9)
- Quality Indicators (QIs) (2)
- Quality Measures (3)
- (-) Quality of Care (24)
- Respiratory Conditions (3)
- Sepsis (1)
- Surgery (4)
- Teams (1)
- Training (1)
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 24 of 24 Research Studies DisplayedBierman AS, Wang J, O'Malley PG
AHRQ Author: Bierman AS, Wang J, O'Malley PG, Moss DK
Transforming care for people with multiple chronic conditions: Agency for Healthcare Research and Quality's research agenda.
This article describes issues addressing the needs of those with multiple chronic conditions and discusses the AHRQ research agenda.
AHRQ-authored.
Citation: Bierman AS, Wang J, O'Malley PG .
Transforming care for people with multiple chronic conditions: Agency for Healthcare Research and Quality's research agenda.
Health Serv Res 2021 Oct;56(Suppl 1):973-79. doi: 10.1111/1475-6773.13863..
Keywords: Chronic Conditions, Health Services Research (HSR), Healthcare Delivery, Quality of Care, Primary Care, Guidelines, Evidence-Based Practice
Trent SA, George N, Havranek EP
Established evidence-based treatment guidelines help mitigate disparities in quality of emergency care.
Evidence-based guidelines are often cited as a means of ensuring high-quality care for all patients. The objective of this study was to assess whether emergency department (ED) adherence to core evidence-based guidelines differed by patient sex and race/ethnicity and to assess the effect of ED guideline adherence on patient outcomes by sex and race/ethnicity. The investigators concluded that longstanding, nationally reported evidence-based guidelines can help eliminate sex and race/ethnicity disparities in quality of care.
AHRQ-funded; HS022400.
Citation: Trent SA, George N, Havranek EP .
Established evidence-based treatment guidelines help mitigate disparities in quality of emergency care.
Acad Emerg Med 2021 Sep;28(9):1051-60. doi: 10.1111/acem.14235..
Keywords: Evidence-Based Practice, Guidelines, Emergency Department, Disparities, Quality of Care
Dworsky JQ, Shenoy R, Childers CP
Older veterans undergoing inpatient surgery: what is the compliance with best practice guidelines?
This study’s objective was to determine the documented compliance with best practice guidelines for optimal perioperative care for the older adult surgical patient that were created by the American College of Surgeons Quality Improvement Program and the American Geriatrics Society. The guidelines include 38 measures. A retrospective chart review was conducted on 86 older adults undergoing elective inpatient coronary artery bypass graft, prostatectomy, or colectomy over a 2-year period at a single Veterans Affairs hospital. Mean reported compliance across measures was 41% ± 4%. Of the 38 analyzed measures, 10 measures were achieved for 0 patients, and only 1 patient for 7 measures. Future work is needed to understand barriers for implementation.
AHRQ-funded; HS000046.
Citation: Dworsky JQ, Shenoy R, Childers CP .
Older veterans undergoing inpatient surgery: what is the compliance with best practice guidelines?
Surgery 2021 Feb;169(2):356-61. doi: 10.1016/j.surg.2020.08.033..
Keywords: Elderly, Surgery, Guidelines, Evidence-Based Practice, Quality Improvement, Quality of Care, Quality Measures
Harder VS, Shaw JS, McCulloch CE
Statewide asthma learning collaborative participation and asthma-related emergency department use.
This study looked at outcomes from participation of pediatric practices in a quality improvement (QI) collaborative to decrease asthma-related emergency department (ED) visits. A statewide network of practices participated in the collaborative from 2015 to 2016. Asthma-related ED visit rates per 100 child-years for children ages 3 to 21 was evaluated using the state’s all-payer claims databases. The authors found that in the postintervention year (2017) participating practices’ ED visit rate decreased by 5.8 per 100 child-years, compared to an increase of 1.8 per 100 child-years in non-participating practices. There were no statistically significant differences in asthma-related ED visit rates during 2016, which indicated that it took some time for QI elements to be successfully implemented in pediatric practices.
AHRQ-funded; HS025297.
Citation: Harder VS, Shaw JS, McCulloch CE .
Statewide asthma learning collaborative participation and asthma-related emergency department use.
Pediatrics 2020 Dec;146(6):e20200213. doi: 10.1542/peds.2020-0213..
Keywords: Children/Adolescents, Asthma, Emergency Department, Quality Improvement, Quality of Care, Primary Care, Guidelines
Kaiser SV, Lam Cabana, MD
Best practices in implementing inpatient pediatric asthma pathways: a qualitative study.
The objective of this study was to identify potential best practices in pathway implementation. Building upon a previous observational study in which the researchers identified higher and lower performing children's hospitals based on hospital-level changes in asthma patient length of stay after implementation of a pathway, they conducted semi-structured interviews with a sample of healthcare providers involved in pathway implementation at these hospitals. They identified several potential best practices to support pathway implementation. They recommended that hospitals implementing pathways consider applying these strategies to ensure success in improving quality of asthma care for children.
AHRQ-funded; HS024592.
Citation: Kaiser SV, Lam Cabana, MD .
Best practices in implementing inpatient pediatric asthma pathways: a qualitative study.
J Asthma 2020 Jul;57(7):744-54. doi: 10.1080/02770903.2019.1606237..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Hospitals, Inpatient Care, Guidelines, Evidence-Based Practice, Implementation, Quality Improvement, Quality of Care
Artis KA, Dweik RA, Patel B
Performance measure development, use, and measurement of effectiveness using the guideline on mechanical ventilation in acute respiratory distress syndrome. an official American Thoracic Society workshop report.
This report summarizes the proceedings of a workshop convened to advance the American Thoracic Society’s work in performance measure development and guideline implementation. The example of a low-tidal volume ventilation performance measure created from the 2017 ATS clinical practice guideline is used to illustrate the application of the ATS performance measure development framework, including detailed explanation of the rationale for the specifications chosen, identification of areas in need of further validity testing, and a preliminary strategy for testing the performance measure.
AHRQ-funded; HS024552.
Citation: Artis KA, Dweik RA, Patel B .
Performance measure development, use, and measurement of effectiveness using the guideline on mechanical ventilation in acute respiratory distress syndrome. an official American Thoracic Society workshop report.
Ann Am Thorac Soc 2019 Dec;16(12):1463-72. doi: 10.1513/AnnalsATS.201909-665ST..
Keywords: Respiratory Conditions, Guidelines, Evidence-Based Practice, Quality Measures, Quality of Care, Provider Performance
Ingraham AM, Ayturk MD, Kiefe CI
Adherence to 20 emergency general surgery best practices: results of a national survey.
The authors used a hybrid questionnaire to examine national adherence to emergency general surgery (EGS) best practices. They found that there was substantial room for performance improvement, and that adopting an acute care surgery model predicts better performance. They conclude that this novel overview of adherence to EGS best practices will enable surgeons and policymakers to address variations in EGS care nationally.
AHRQ-funded; HS022694.
Citation: Ingraham AM, Ayturk MD, Kiefe CI .
Adherence to 20 emergency general surgery best practices: results of a national survey.
Ann Surg 2019 Aug;270(2):270-80. doi: 10.1097/sla.0000000000002746..
Keywords: Surgery, Emergency Department, Guidelines, Quality of Care, Quality Improvement
Admon AJ, Gupta A, Williams M
Appraising the evidence supporting Choosing Wisely(R) recommendations.
This study’s objective was to appraise the evidence supporting the Choosing Wisely® campaign initiated by the American Board of Internal Medicine (ABIM) Foundation to advance dialogue on prevention of unnecessary medical tests, treatments, and procedures. The authors extracted all 320 recommendations that were published through August 2014. The recommendations were then categorized by evidence strength and then a sample of referenced clinical practice guidelines (CPGs) using the validated Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Overall, 70.3% of recommendations cited CPGs, whereas 22.2% cited primary research as their highest evidence level. Hospital medicine recommendations cited CPGs 90% of the time. However, the median overall score using AGREE II was 54.2% and even for hospital medicine-referenced CPGs was 58.3%.
AHRQ-funded; HS020672.
Citation: Admon AJ, Gupta A, Williams M .
Appraising the evidence supporting Choosing Wisely(R) recommendations.
J Hosp Med 2018 Oct;13(10):688-91. doi: 10.12788/jhm.2964..
Keywords: Decision Making, Evidence-Based Practice, Guidelines, Prevention, Quality of Care, Quality Improvement
Rhee C, Brown SR, Jones TM
Variability in determining sepsis time zero and bundle compliance rates for the Centers for Medicare and Medicaid services SEP-1 measure.
This study compared sepsis ‘time zero’ and CMS SEP-1 pass rates among 3 abstractors in 3 hospitals. Abstractors agreed on time zero in 29 out of 80 cases, and the perceived pass rates ranged from 9 to 19 out of 80 cases (23%). The authors conclude that this variability in time zero and perceived pass rates limits the utility of SEP-1 for measuring quality.
AHRQ-funded; HS025008.
Citation: Rhee C, Brown SR, Jones TM .
Variability in determining sepsis time zero and bundle compliance rates for the Centers for Medicare and Medicaid services SEP-1 measure.
Infect Control Hosp Epidemiol 2018 Aug;39(8):994-96. doi: 10.1017/ice.2018.134..
Keywords: Guidelines, Quality of Care, Quality Measures, Sepsis
Hoffman AS, Sepucha KR, Abhyankar P
Explanation and elaboration of the Standards for UNiversal reporting of patient Decision Aid Evaluations (SUNDAE) guidelines: examples of reporting SUNDAE items from patient decision aid evaluation literature.
This Explanation and Elaboration article expands on the 26 items in the SUNDAE guidelines, providing a rationale for each item, and including examples for how each item has been reported in published papers evaluating patient decision aids. Authors and reviewers may wish to use it broadly to inform structuring of patient decision aid evaluation reports, or use it as a reference to obtain details about how to report individual checklist items.
AHRQ-funded; HS024250.
Citation: Hoffman AS, Sepucha KR, Abhyankar P .
Explanation and elaboration of the Standards for UNiversal reporting of patient Decision Aid Evaluations (SUNDAE) guidelines: examples of reporting SUNDAE items from patient decision aid evaluation literature.
BMJ Qual Saf 2018 May;27(5):389-412. doi: 10.1136/bmjqs-2017-006985..
Keywords: Decision Making, Guidelines, Patient-Centered Healthcare, Patient and Family Engagement, Quality of Care
Hoffman AS, Sepucha KR, Abhyankar P
Explanation and elaboration of the Standards for UNiversal reporting of patient Decision Aid Evaluations (SUNDAE) guidelines: examples of reporting SUNDAE items from patient decision aid evaluation literature.
This Explanation and Elaboration article expands on the 26 items in the SUNDAE guidelines, providing a rationale for each item, and including examples for how each item has been reported in published papers evaluating patient decision aids. Authors and reviewers may wish to use it broadly to inform structuring of patient decision aid evaluation reports, or use it as a reference to obtain details about how to report individual checklist items.
AHRQ-funded; HS024250.
Citation: Hoffman AS, Sepucha KR, Abhyankar P .
Explanation and elaboration of the Standards for UNiversal reporting of patient Decision Aid Evaluations (SUNDAE) guidelines: examples of reporting SUNDAE items from patient decision aid evaluation literature.
BMJ Qual Saf 2018 May;27(5):389-412. doi: 10.1136/bmjqs-2017-006985..
Keywords: Decision Making, Guidelines, Patient-Centered Healthcare, Patient and Family Engagement, Quality of Care
Colla CH, Mainor AJ
Choosing Wisely Campaign: valuable for providers who knew about it, but awareness remained constant, 2014-17.
The Choosing Wisely campaign has codified recommendations of which health care services' use should be questioned and discussed with patients. The ABIM Foundation administered surveys in 2014 and 2017 to examine physicians' attitudes toward and awareness of the use of low-value care. There were no significant changes between 2014 and 2017 in awareness of the campaign among physicians or physician-reported difficulty in talking to patients about avoiding a low-value service.
AHRQ-funded; HS023812.
Citation: Colla CH, Mainor AJ .
Choosing Wisely Campaign: valuable for providers who knew about it, but awareness remained constant, 2014-17.
Health Aff 2017 Nov;36(11):2005-11. doi: 10.1377/hlthaff.2017.0945.
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Keywords: Decision Making, Guidelines, Quality of Care, Health Services Research (HSR), Clinician-Patient Communication
Ban KA, Gibbons MM, Ko CY
Surgical technical evidence review for colorectal surgery conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.
The objective of this article is to provide a comprehensive review of the evidence supporting the surgical components of the Improving Surgical Care and Recovery (ISCR) colorectal (CR) pathway. This review will evaluate the evidence supporting CR pathways and develop an evidence-based CR protocol to help hospitals participating in the ISCR program implement evidence-based practices.
AHRQ-funded; 233201500020I.
Citation: Ban KA, Gibbons MM, Ko CY .
Surgical technical evidence review for colorectal surgery conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.
J Am Coll Surg 2017 Oct;225(4):548-57.e3. doi: 10.1016/j.jamcollsurg.2017.06.017.
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Keywords: Evidence-Based Practice, Hospitals, Patient Safety, Quality Improvement, Surgery, Quality of Care, Guidelines
Shaughnessy AF, Vaswani A, Andrews BK
Developing a clinician friendly tool to identify useful clinical practice guidelines: G-TRUST.
The goal of this project was to develop a simple, easy-to-use checklist for clinicians to use to identify trustworthy, relevant, and useful practice guidelines, the Guideline Trustworthiness, Relevance, and Utility Scoring Tool (G-TRUST). They concluded that the 8-item G-TRUST developed by the project is potentially helpful as a tool for clinicians to identify useful guidelines.
AHRQ-funded; HS022940.
Citation: Shaughnessy AF, Vaswani A, Andrews BK .
Developing a clinician friendly tool to identify useful clinical practice guidelines: G-TRUST.
Ann Fam Med 2017 Sep;15(5):413-18. doi: 10.1370/afm.2119.
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Keywords: Evidence-Based Practice, Guidelines, Quality of Care, Patient-Centered Healthcare
Nuckols T, Conlon C, Robbins M
Quality of care for work-associated carpal tunnel syndrome.
This study evaluated the quality of care provided to individuals with workers' compensation claims related to carpal tunnel syndrome and identified patient characteristics associated with receiving better care. Overall, 81.6 percent of care adhered to recommended standards. Patients with classic/probable Katz diagrams, positive electrodiagnostic tests, and higher incomes received better care. However, age, sex, and race/ethnicity were not associated with quality.
AHRQ-funded; HS018982.
Citation: Nuckols T, Conlon C, Robbins M .
Quality of care for work-associated carpal tunnel syndrome.
J Occup Environ Med 2017 Jan;59(1):47-53. doi: 10.1097/jom.0000000000000916.
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Keywords: Guidelines, Quality of Care, Neurological Disorders, Patient-Centered Healthcare, Quality Indicators (QIs)
Burstein PD, Zalenski DM, Edwards JL
Changing labor and delivery practice: focus on achieving practice and documentation standardization with the goal of improving neonatal outcomes.
The researchers established a multifactorial shoulder dystocia response and management protocol to promote sustainable practice change. In the first year, there was a threefold increase in shoulder dystocia reporting, which continued in years 2 and 3. In the first year, 96 percent of clinicians completed all training elements. Overall teams reached a 99 percent adoption rate of the shoulder dystocia protocol.
AHRQ-funded; HS019608.
Citation: Burstein PD, Zalenski DM, Edwards JL .
Changing labor and delivery practice: focus on achieving practice and documentation standardization with the goal of improving neonatal outcomes.
Health Serv Res 2016 Dec;51 Suppl 3:2472-86. doi: 10.1111/1475-6773.12589.
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Keywords: Labor and Delivery, Newborns/Infants, Adverse Events, Quality Improvement, Quality of Care, Patient Safety, Patient-Centered Outcomes Research, Outcomes, Guidelines, Evidence-Based Practice, Pregnancy, Teams
Musuuza JS, Hundt AS, Zimbric M
Standardizing direct observation for assessing compliance to a daily chlorhexidine bathing protocol among hospitalized patients.
This paper describes the authors' experience training observers to conduct chlorhexidine gluconate bathing observations, and they present findings from pilot observations.
AHRQ-funded; HS024039.
Citation: Musuuza JS, Hundt AS, Zimbric M .
Standardizing direct observation for assessing compliance to a daily chlorhexidine bathing protocol among hospitalized patients.
Infect Control Hosp Epidemiol 2016 Dec;37(12):1516-18. doi: 10.1017/ice.2016.214.
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Keywords: Guidelines, Quality of Care, Healthcare-Associated Infections (HAIs), Patient Safety, Prevention
Morrato EH, Rabin B, Proctor J
Bringing it home: expanding the local reach of dissemination and implementation training via a university-based workshop.
The Colorado Research in Implementation Science Program (CRISP) developed and delivered an introductory D&I workshop adapted from national programs to extend training reach and foster a local learning community for D&I. This paper describes the context of the local training environment, findings from a pre-workshop needs assessment survey, training design and structure, and post-workshop evaluation. Lessons learned may inform others intending to develop local D&I training workshop.
AHRQ-funded; HS021138.
Citation: Morrato EH, Rabin B, Proctor J .
Bringing it home: expanding the local reach of dissemination and implementation training via a university-based workshop.
Implement Sci 2015 Jul 4;10:94. doi: 10.1186/s13012-015-0281-6..
Keywords: Communication, Education: Continuing Medical Education, Evidence-Based Practice, Guidelines, Quality of Care, Quality Improvement, Training, Implementation
Kerr EA, Chen J, Sussman JB
Stress testing before low-risk surgery: so many recommendations, so little overuse.
The researchers sought to determine the prevalence of cardiac stress testing before low-risk surgeries, prior to commencement of a campaign to reduce routine stress testing, in order to estimate the potential effect of the campaign on future use of resources. Their study of VA and Medicare patients found that the use of routine preoperative stress testing before low-risk surgeries was very low, suggesting that interventions to further decrease testing would minimally improve quality.
AHRQ-funded; HS018781
Citation: Kerr EA, Chen J, Sussman JB .
Stress testing before low-risk surgery: so many recommendations, so little overuse.
JAMA Intern Med. 2015 Apr;175(4):645-7. doi: 10.1001/jamainternmed.2014.7877..
Keywords: Decision Making, Guidelines, Quality of Care, Healthcare Utilization, Surgery
Abdelsattar ZM, Reames BN, Regenbogen SE
Critical evaluation of the scientific content in clinical practice guidelines.
The researchers sought to critically evaluate clinical practice guidelines (CPGs) on the basis of their overall development quality, the evidence base used to synthesize recommendations, and the scientific agreement between CPGs on key processes of care. They concluded that there is significant variation in CPG development processes, with associated differences in scientific content and interpretation of evidence, resulting in conflicting recommendations.
AHRQ-funded: HS000053.
Citation: Abdelsattar ZM, Reames BN, Regenbogen SE .
Critical evaluation of the scientific content in clinical practice guidelines.
Cancer 2015 Mar 1;121(5):783-9. doi: 10.1002/cncr.29124..
Keywords: Care Management, Evidence-Based Practice, Guidelines, Quality of Care
Gidengil CA, Linder JA, Hunter G
The volume-quality relationship in antibiotic prescribing: when more isn't better.
The researchers examined the impact of volume on more common medical conditions such as acute respiratory infections (ARIs). They found that higher ARI volume physicians had lower quality across a number of domains, including higher antibiotic prescribing rates, higher broad-spectrum antibiotic prescribing, and lower guideline concordance. When they prescribed an antibiotic for a diagnosis for which an antibiotic may be indicated, they were less likely to prescribe guideline-concordant antibiotics.
AHRQ-funded; HS018419.
Citation: Gidengil CA, Linder JA, Hunter G .
The volume-quality relationship in antibiotic prescribing: when more isn't better.
Inquiry 2015 Feb 10;52. doi: 10.1177/0046958015571130..
Keywords: Quality of Care, Medication, Respiratory Conditions, Guidelines
Kealey E, Scholle SH, Byron SC
Quality concerns in antipsychotic prescribing for youth: a review of treatment guidelines.
The authors reviewed treatment guidelines relevant to 7 quality concepts for appropriate use and management of youth on antipsychotics.They found that all 7 quality concepts were strongly endorsed by 1 or more guidelines, and 2 or more guidelines assigned their highest strength of recommendation ratings to 6 of the 7 concepts. Two guidelines rated evidence, providing high strength of evidence for 2 quality concepts.
AHRQ-funded; HS020503.
Citation: Kealey E, Scholle SH, Byron SC .
Quality concerns in antipsychotic prescribing for youth: a review of treatment guidelines.
Acad Pediatr 2014 Sep-Oct;14(5 Suppl):S68-75. doi: 10.1016/j.acap.2014.05.009.
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Keywords: Evidence-Based Practice, Children/Adolescents, Guidelines, Quality of Care, Medication
Rangachari P, Madaio M, Rethemeyer RK
Role of communication content and frequency in enabling evidence-based practices.
The study sought to promote central line bundle (CLB) implementation in a medical ICU and a pediatric ICU through periodic quality improvement (QI) interventions over a 52-week period. It found that proactive communications increased by 68 percent in the MICU and 61 percent in the PICU. During the same timeframe, both units increased CLB adherence to 100 percent. Both units also demonstrated statistically significant declines in catheter days.
AHRQ-funded; HS019785.
Citation: Rangachari P, Madaio M, Rethemeyer RK .
Role of communication content and frequency in enabling evidence-based practices.
Qual Manag Health Care 2014 Jan-Mar;23(1):43-58. doi: 10.1097/qmh.0000000000000017..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Communication, Evidence-Based Practice, Guidelines, Healthcare-Associated Infections (HAIs), Intensive Care Unit (ICU), Quality of Care, Quality Improvement
Lewandowski RE, Acri MC, Hoagwood KE
Evidence for the management of adolescent depression.
This article reports on the development of a care pathway and quality indicators (QIs) for the primary and specialty care management of adolescent depression. It also reviews clinical practice guidelines and identifies barriers to the development of QIs, such as gaps in the empirical evidence. Finally, a research agenda is suggested.
AHRQ-funded; HS020503
Citation: Lewandowski RE, Acri MC, Hoagwood KE .
Evidence for the management of adolescent depression.
Pediatrics. 2013 Oct;132(4):e996-e1009. doi: 10.1542/peds.2013-0600..
Keywords: Children/Adolescents, Depression, Quality Indicators (QIs), Guidelines, Quality of Care