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 (65)
- Adverse Drug Events (ADE) (33)
- Adverse Events (86)
- Alcohol Use (5)
- Ambulatory Care and Surgery (29)
- Antibiotics (40)
- Antimicrobial Stewardship (18)
- Anxiety (23)
- Arthritis (6)
- Asthma (75)
- Autism (23)
- Back Health and Pain (1)
- Behavioral Health (172)
- Blood Clots (2)
- Blood Pressure (12)
- Brain Injury (15)
- Breast Feeding (1)
- Burnout (2)
- Cancer (34)
- Cancer: Breast Cancer (3)
- Cardiovascular Conditions (27)
- Care Coordination (20)
- Caregiving (93)
- Care Management (27)
- Case Study (19)
- Catheter-Associated Urinary Tract Infection (CAUTI) (3)
- Central Line-Associated Bloodstream Infections (CLABSI) (10)
- Children's Health Insurance Program (CHIP) (34)
- (-) Children/Adolescents (1542)
- Chronic Conditions (107)
- Clinical Decision Support (CDS) (24)
- Clinician-Patient Communication (44)
- Colonoscopy (1)
- Communication (44)
- Community-Acquired Infections (10)
- Community-Based Practice (14)
- Community Partnerships (1)
- Comparative Effectiveness (26)
- Complementary and Alternative Medicine (3)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (11)
- COVID-19 (44)
- Critical Care (60)
- Cultural Competence (9)
- Data (9)
- Decision Making (51)
- Dental and Oral Health (24)
- Depression (43)
- Diabetes (17)
- Diagnostic Safety and Quality (74)
- Digestive Disease and Health (8)
- Disabilities (23)
- Disparities (47)
- Domestic Violence (13)
- Ear Infections (5)
- Education (19)
- Education: Continuing Medical Education (17)
- Education: Curriculum (1)
- Education: Patient and Caregiver (27)
- Electronic Health Records (EHRs) (61)
- Emergency Department (108)
- Emergency Medical Services (EMS) (22)
- Emergency Preparedness (1)
- Evidence-Based Practice (103)
- Eye Disease and Health (4)
- Falls (1)
- Family Health and History (45)
- Genetics (8)
- Guidelines (46)
- Healthcare-Associated Infections (HAIs) (44)
- Healthcare Cost and Utilization Project (HCUP) (70)
- Healthcare Costs (56)
- Healthcare Delivery (48)
- Healthcare Utilization (47)
- Health Information Exchange (HIE) (3)
- Health Information Technology (HIT) (108)
- Health Insurance (42)
- Health Literacy (13)
- Health Promotion (12)
- Health Services Research (HSR) (35)
- Health Status (13)
- Health Systems (1)
- Heart Disease and Health (13)
- Hepatitis (4)
- Home Healthcare (12)
- Hospital Discharge (31)
- Hospitalization (107)
- Hospital Readmissions (34)
- Hospitals (93)
- Human Immunodeficiency Virus (HIV) (12)
- Imaging (13)
- Implementation (17)
- Infectious Diseases (36)
- Influenza (13)
- Injuries and Wounds (20)
- Inpatient Care (48)
- Intensive Care Unit (ICU) (74)
- Kidney Disease and Health (4)
- Labor and Delivery (2)
- Lifestyle Changes (15)
- Long-Term Care (21)
- Low-Income (39)
- Maternal Care (9)
- Medicaid (66)
- Medical Devices (3)
- Medical Errors (26)
- Medical Expenditure Panel Survey (MEPS) (30)
- Medication (168)
- Medication: Safety (26)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (15)
- Mortality (18)
- Neonatal Intensive Care Unit (NICU) (2)
- Neurological Disorders (36)
- Newborns/Infants (41)
- Nursing (13)
- Nutrition (35)
- Obesity (81)
- Obesity: Weight Management (31)
- Opioids (16)
- Organizational Change (1)
- Orthopedics (2)
- Osteoporosis (1)
- Outcomes (71)
- Pain (7)
- Palliative Care (10)
- Patient-Centered Healthcare (52)
- Patient-Centered Outcomes Research (107)
- Patient Adherence/Compliance (16)
- Patient and Family Engagement (38)
- Patient Experience (26)
- Patient Safety (120)
- Patient Self-Management (9)
- Payment (5)
- Pneumonia (16)
- Policy (40)
- Practice Patterns (34)
- Pregnancy (14)
- Pressure Ulcers (1)
- Prevention (88)
- Primary Care (80)
- Primary Care: Models of Care (8)
- Provider (17)
- Provider: Clinician (4)
- Provider: Health Personnel (7)
- Provider: Nurse (3)
- Provider: Pharmacist (5)
- Provider: Physician (16)
- Provider Performance (3)
- Public Health (20)
- Quality Improvement (70)
- Quality Indicators (QIs) (21)
- Quality Measures (46)
- Quality of Care (108)
- Quality of Life (19)
- Racial and Ethnic Minorities (78)
- Registries (16)
- Research Methodologies (13)
- Respiratory Conditions (107)
- Risk (75)
- Rural/Inner-City Residents (3)
- Rural Health (13)
- Screening (63)
- Sepsis (27)
- Sex Factors (5)
- Sexual Health (17)
- Sickle Cell Disease (24)
- Simulation (5)
- Skin Conditions (31)
- Sleep Problems (17)
- Social Determinants of Health (50)
- Social Media (7)
- Social Stigma (3)
- Stress (9)
- Stroke (2)
- Substance Abuse (26)
- Surgery (67)
- Surveys on Patient Safety Culture (1)
- Teams (10)
- Telehealth (26)
- Tobacco Use (8)
- Tobacco Use: Smoking Cessation (4)
- Tools & Toolkits (3)
- Training (16)
- Transitions of Care (24)
- Transplantation (27)
- Trauma (26)
- Treatments (17)
- U.S. Preventive Services Task Force (USPSTF) (41)
- Uninsured (6)
- Urban Health (13)
- Urinary Tract Infection (UTI) (4)
- Vaccination (57)
- Vitamins and Supplements (2)
- Vulnerable Populations (51)
- Web-Based (5)
- Women (17)
- Workflow (4)
- Workforce (1)
- Young Adults (37)
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
201 to 225 of 1542 Research Studies DisplayedKoball H, Kirby J, Hartig S
AHRQ Author: Kirby J
The relationship between states' immigrant-related policies and access to health care among children of immigrants.
The purpose of this AHRQ-authored paper was to explore immigrants’ children’s access to preventive healthcare, and the impact of sanctuary policies (state policies that limit federal immigration enforcement involvement) and the provision of driver’s licenses for undocumented immigrants on that access. Primary outcomes included whether the child had a well child check-up, unmet medical needs, or a regular source for care. The 2008-2016 Medical Panel Expenditure Survey (MPES) merged with policy data at the state level were analyzed, with the researchers reporting that sanctuary policies and having a state driver’s license were both associated with having a regular source for care and less unmet medical needs among the children of immigrants. The researchers emphasized the importance of access to preventive care and concluded that sanctuary policies are related to increased access to preventive health care among the children of immigrants.
AHRQ-authored.
Citation: Koball H, Kirby J, Hartig S .
The relationship between states' immigrant-related policies and access to health care among children of immigrants.
J Immigr Minor Health 2022 Aug;24(4):834-41. doi: 10.1007/s10903-021-01282-9..
Keywords: Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Policy, Access to Care
Alkhouri N, Almomani A, Le P
The prevalence of alcoholic and nonalcoholic fatty liver disease in adolescents and young adults in the United States: analysis of the NHANES database.
The purpose of this study was to evaluate the prevalence of non-alcoholic fatty liver disease (NAFLD) and alcohol-associated fatty liver disease (ALD) in a cohort of adolescents and young adults (AYAs) using transient elastography to directly measure hepatic steatosis and suspected fibrosis. AYA’s aged 15-39 years without viral hepatitis, pregnancy, or ALT/ AST greater than 500 U/L were included in the study. The researchers compared subjects with excessive alcohol consumption to those without and found that those with excessive alcohol consumption suspected ALD was present in 56.59% and suspected significant fibrosis was present in 12.3% and suspected advanced fibrosis was present in 6.31%. In subjects without excessive alcohol consumption, suspected NAFLD was present in 40.04%. In those with suspected NAFLD, suspected significant fibrosis was present in 31.07% and suspected advanced fibrosis was present in 20.15%. The study concluded that a significant percentage of AYAs are at risk for ALD and NAFLD and a subset of these subjects is at risk for significant fibrosis.
AHRQ-funded; HS026937.
Citation: Alkhouri N, Almomani A, Le P .
The prevalence of alcoholic and nonalcoholic fatty liver disease in adolescents and young adults in the United States: analysis of the NHANES database.
BMC Gastroenterol 2022 Jul 30;22(1):366. doi: 10.1186/s12876-022-02430-7..
Keywords: Children/Adolescents, Young Adults, Alcohol Use, Chronic Conditions
Woods-Hill CZ, Colantuoni EA, Koontz DW
Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative.
The purpose of this AHRQ-funded prospective study was to assess the relationship between a 14-site PICU blood culture collaborative, the Bright STAR (Testing Stewardship for Antibiotic Reduction) collaborative, and culture rates, antibiotic use, and patient outcomes. The researchers collected data from each participating PICU across the United States and from the Children’s Hospital Association Pediatric Health Information System. The main outcome was blood culture rates, with secondary outcomes including: broad-spectrum antibiotic use and PICU rates of central line-associated bloodstream infection (CLABSI), Clostridioides difficile infection, readmission, length of stay, sepsis, severe sepsis/septic shock, and mortality. The study found that the blood culture rate preimplementation across the 14 PICUs was 149.4 per 1000 patient days per month, and the rate postimplementation was 100.5 for a 33% relative reduction postimplementation. For those same periods, the rate of antibiotic use decreased from 506 days per 1000 patient-days per month preimplementation to 440 days per 1000 patient-days per month postimplementation, which reflects a 13% relative reduction. Rates of CLABSI decreased from 1.8 to 1.1 per 1000 central venous line days per month, a 36% relative reduction. The variables of length of stay, readmission, sepsis, severe sepsis/septic shock, and mortality were similar before and after implementation. The researchers concluded that collaborative interventions can reduce blood culture and antibiotic use in the PICU.
AHRQ-funded; HS025642.
Citation: Woods-Hill CZ, Colantuoni EA, Koontz DW .
Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative.
JAMA Pediatr 2022 Jul;176(7):690-98. doi: 10.1001/jamapediatrics.2022.1024..
Keywords: Children/Adolescents, Sepsis, Critical Care, Antibiotics, Medication, Diagnostic Safety and Quality, Antimicrobial Stewardship
Hoffmann JA, Johnson JK, Pergjika A
Development of quality measures for pediatric agitation management in the emergency department.
This study’s objective was to develop quality measures for pediatric emergency department (ED) agitation management informed by multidisciplinary perspectives. A multidisciplinary panel was created to develop quality measures for pediatric ED agitation management through the modified Delphi method. The panelists included 36 physicians, nurses, social workers, security, child life specialists, hospital data analysts, and parents. Measures were ranked by panelists in importance and feasibility on a 9-point scale during 2 survey rounds, with a teleconference discussion between surveys. Consensus was defined at >75% of panelists ranking a quality measure greater or equal to 7 in importance and median feasibility of greater or equal to 4. Consensus was reached on 20 quality measures that incorporated multidisciplinary perspectives.
AHRQ-funded; HS026385.
Citation: Hoffmann JA, Johnson JK, Pergjika A .
Development of quality measures for pediatric agitation management in the emergency department.
J Healthc Qual 2022 Jul-Aug;44(4):218-29. doi: 10.1097/jhq.0000000000000339..
Keywords: Children/Adolescents, Quality Measures, Quality Indicators (QIs), Quality of Care, Emergency Department
VanderVeen DK, Oke I, Nihalani BR
Deviations from age-adjusted normative biometry measures in children undergoing cataract surgery: implications for postoperative target refraction and IOL power selection.
The purpose of this longitudinal cohort study was to assess whether children’s eyes that deviate from age-adjusted normative biometry measures are predictive of variations in target refraction and IOL power selection after cataract surgery. The researchers prospectively collected biometry data from the normal eyes of children under 10 years of age (100 eyes) with biometry data from eyes undergoing cataract surgery (162 eyes). The study analysis found greater myopic shift associated with younger age and male gender and concluded that adjustments can be made for cataract surgery for children’s eyes whose measures deviate from the norm for their age.
AHRQ-funded; HS000063.
Citation: VanderVeen DK, Oke I, Nihalani BR .
Deviations from age-adjusted normative biometry measures in children undergoing cataract surgery: implications for postoperative target refraction and IOL power selection.
Am J Ophthalmol 2022 Jul;239:190-201. doi: 10.1016/j.ajo.2022.02.022..
Keywords: Children/Adolescents, Eye Disease and Health, Surgery
Tyler A, Dempsey A, Spencer S
Do the guidelines apply?-A multisite, combined stakeholder qualitative case study to understand care decisions in bronchiolitis.
Researchers sought an improved understanding of factors that influence care decisions across multiple stakeholders and diverse settings in order to develop effective strategies to de-implement unnecessary testing and treatment for bronchiolitis. A qualitative case study was conducted across two geographically distinct university affiliated children's hospitals, including semistructured interviews and focus groups with patient participants. The researchers found that, incongruent with provider and care team perceptions, parents reported that they desire an evidence-based, less-is-more approach to bronchiolitis care.
AHRQ-funded; HS026512.
Citation: Tyler A, Dempsey A, Spencer S .
Do the guidelines apply?-A multisite, combined stakeholder qualitative case study to understand care decisions in bronchiolitis.
Acad Pediatr 2022 Jul;22(5):806-17. doi: 10.1016/j.acap.2021.08.003..
Keywords: Children/Adolescents, Respiratory Conditions, Decision Making, Guidelines, Evidence-Based Practice
Patil SJ, Tallon E, Wang Y
Effect of Stanford Youth Diabetes Coaches' Program on youth and adults in diverse communities.
This study’s objective was to assess the effects of the Stanford Youth Diabetes Coaches’ Program (SYDCP) on youth and adults from a rural and urban underserved high school community. The program trains high school students to become diabetes coaches for friends and adult family members. The authors used the Patient-Reported Outcomes Measurement Information System (PROMIS) measure Pediatric Sense of Meaning and Purpose. Coached adults were surveyed using measures from PROMIS Adult Global Health and Self-Efficacy. Twenty-five students participated in the study, with 15 having coached adults with diabetes or prediabetes. Postintervention results included significant improvement in students’ sense of meaning and purpose. Youth and adult-relatedness also led to improved health behaviors.
AHRQ-funded; HS022140.
Citation: Patil SJ, Tallon E, Wang Y .
Effect of Stanford Youth Diabetes Coaches' Program on youth and adults in diverse communities.
Fam Community Health 2022 Jul-Sep;45(3):178-86. doi: 10.1097/fch.0000000000000323..
Keywords: Children/Adolescents, Diabetes, Health Promotion, Lifestyle Changes
Randell KA, Ragavan MI, Query LA
Intimate partner violence and the pediatric electronic health record: a qualitative study.
The authors sought to explore expert perspectives on risks associated with the pediatric electronic health record (EHR) for intimate partner violence (IPV) survivors and their children and to identify strategies that may mitigate these risks. They conducted semistructured interviews with multidisciplinary pediatric IPV experts, and their findings suggested that the pediatric EHR may confer both risks and benefits for IPV survivors and their children. They recommended further work to develop best practices to address IPV risks related to the pediatric EHR, to ensure consistent use of these practices, and to include these practices as standard functionalities of the pediatric EHR.
AHRQ-funded; HS022242.
Citation: Randell KA, Ragavan MI, Query LA .
Intimate partner violence and the pediatric electronic health record: a qualitative study.
Acad Pediatr 2022 Jul;22(5):824-32. doi: 10.1016/j.acap.2021.08.013..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Domestic Violence
Ivlev I, Beil TL, Haynes JS
Rapid evidence review of digital cognitive-behavioral therapy for adolescents with depression.
This rapid evidence review was conducted to explore the benefits and harms of digital cognitive-behavioral therapy (dCBT) and the barriers to and facilitators of implementing dCBT for adolescents. An extensive literature review was done through December 6, 2021 for controlled trials conducted in settings highly applicable to the US. Additionally, the authors searched relevant systematic reviews for eligible studies. They identified 12 trials that examined the effects of nine dCBT programs. Overall, dCBT was slightly superior to other therapies in improving depression symptoms immediately, but not at a longer follow-up. There did not appear to be an increased risk for suicidal attempts or ideation with dCBT, however the number of events was very small. Potential barriers to implementing and maintaining dCBT included challenges engaging/retaining patients, developing infrastructure, and training therapists to facilitate dCBT. No data on harms or unintended negative consequences were reported in the included studies.
AHRQ-funded; HS026370.
Citation: Ivlev I, Beil TL, Haynes JS .
Rapid evidence review of digital cognitive-behavioral therapy for adolescents with depression.
J Adolesc Health 2022 Jul;71(1):14-19. doi: 10.1016/j.jadohealth.2022.01.220..
Keywords: Children/Adolescents, Depression, Behavioral Health, Evidence-Based Practice, Patient-Centered Outcomes Research
Lindell RB, Fitzgerald JC, Rowan CM
The use and duration of preintubation respiratory support is associated with increased mortality in immunocompromised children with acute respiratory failure.
The purpose of this retrospective cohort study was to examine the relationship between preintubation respiratory support and outcomes in pediatric patients with acute respiratory failure and to evaluate the impact of immunocompromised (IC) diagnoses on outcomes. The study utilized data from the Virtual Pediatric Systems database which included 82 centers, and focused on patients intubated in the Pediatric Intensive Care Unit (PICU) ranging in age from 1 month old to 17 years of age who received invasive mechanical ventilation (IMV) for more than or equal to 24 hours. Of the 5,348 PICU intubations across 82 centers, high-flow nasal cannula (HFNC) or noninvasive positive-pressure ventilation (NIPPV) or both were used before intubation in 34% (1,825) of patients. Fifty percent of the patients had no IC diagnosis. The researchers found that exposure to HFNC was associated with greater odds of PICU mortality when compared with patients intubated without prior support. When analyzing subgroups of IC status, preintubation support was related to higher odds of PICU mortality in IC patients and HCT patients when compared with IC/ HCT patients intubated without prior respiratory support. A duration of HFNC/NIPPV of more than 6 hours was associated with increased mortality in IC HCT patients. Rates of preintubation HFNC/NIPPV use and PICU mortality varied between the 82 centers. The researchers concluded that greater duration of exposure to HFNC/NIPPV prior to IMV is associated with increased mortality in HCT patients, and preintubation exposure to HFNC and/or NIPPV in IC pediatric patients is associated with increased odds of PICU mortality, independent of the severity of the illness.
AHRQ-funded; HS024511.
Citation: Lindell RB, Fitzgerald JC, Rowan CM .
The use and duration of preintubation respiratory support is associated with increased mortality in immunocompromised children with acute respiratory failure.
Crit Care Med 2022 Jul;50(7):1127-37. doi: 10.1097/ccm.0000000000005535..
Keywords: Children/Adolescents, Respiratory Conditions, Mortality, Critical Care
Nelson KE, Chakravarti V, Diskin C
Validation of neurologic impairment diagnosis codes as signifying documented functional impairment in hospitalized children.
This study’s objective was to assess the performance of previously published high-intensity neurologic impairment (NI) diagnosis codes in identification of hospitalized children with clinical NI. This retrospective study of 500 randomly selected discharges in 2019 was conducted at a freestanding children’s hospital. Charts were reviewed for: 1) NI discharge diagnosis codes and 2) documentation of clinical NI (a neurologic diagnosis and indication of functional impairment like medical technology). Diagnosis codes identified clinically documented NI with 88.1% specificity, and 79.4% sensitivity; negative predictive value (NPV) was 96.7%, and positive predictive value (PPV) was 49%. Including children with milder functional impaired results in NPV of 95.7% and PPV of 77.5%. Restriction to children with more severe functional impairment increased NPV and decreased PPV. Misclassification was mostly due to inclusion of children without functional impairments.
AHRQ-funded; HS025138.
Citation: Nelson KE, Chakravarti V, Diskin C .
Validation of neurologic impairment diagnosis codes as signifying documented functional impairment in hospitalized children.
Acad Pediatr 2022 Jul;22(5):782-88. doi: 10.1016/j.acap.2021.07.014..
Keywords: Children/Adolescents, Neurological Disorders, Diagnostic Safety and Quality
Balamuth F, Scott HF, Weiss SL
Validation of the pediatric Sequential Organ Failure Assessment score and evaluation of Third International Consensus Definitions for Sepsis and Septic Shock Definitions in the pediatric emergency department.
This study analyzed whether a measure used to quantity organ dysfunction, the Sequential Organ Failure Assessment (SOFA) in adults can also be used for critically ill children in an emergency department (ED) population. This retrospective cohort study took place in 9 US children’s hospitals included in the Pediatric Emergency Care Applied Research Network (PECARN registry from January 2012 to January 31, 2020. A score of 2 or more can indicate an infection. Almost 4 million ED visits were included, with 3.2% having a pSOFA score of 2 or more. The pSOFA score showed poor sensitivity as a screening tool for hospital mortality but children with a pSOfA score of 2 or less were at very low risk of death, with high specificity and negative predictive value.
AHRQ-funded; HS020270.
Citation: Balamuth F, Scott HF, Weiss SL .
Validation of the pediatric Sequential Organ Failure Assessment score and evaluation of Third International Consensus Definitions for Sepsis and Septic Shock Definitions in the pediatric emergency department.
JAMA Pediatr 2022 Jul;176(7):672-78. doi: 10.1001/jamapediatrics.2022.1301..
Keywords: Children/Adolescents, Sepsis, Emergency Department
Gay JC, Teufel RJ, Peltz A
Variation in condition-specific readmission rates across US children's hospitals.
This retrospective cohort study examined variation in condition-specific readmission rates across US children’s hospitals. The authors looked at 49 US children’s hospitals in the Pediatric Health Information System in 2017. They ranked the highest volume conditions by rate variation (RV, interquartile range divided by the median) for each condition across hospitals. The sample included 811,434 index hospitalizations with 6.2% 30-day readmissions. The RV across hospitals/conditions was between 0 and 2.8 with a median of 0.7. Common reasons for admission had low RVs across hospitals, including bronchiolitis, seizure, and asthma. They identified 33 conditions with high variation in readmission rates across hospitals, which accounted for 18% of all discharges and 11% of all pediatric readmissions.
AHRQ-funded; K08-HS024735.
Citation: Gay JC, Teufel RJ, Peltz A .
Variation in condition-specific readmission rates across US children's hospitals.
Acad Pediatr 2022 Jul;22(5):797-805. doi: 10.1016/j.acap.2022.01.007..
Keywords: Children/Adolescents, Hospital Readmissions, Hospitals
Eiraldi R, McCurdy BL, Khanna MS
Development and evaluation of a remote training strategy for the implementation of mental health evidence-based practices in rural schools: pilot study protocol.
This paper describes a pilot study protocol to develop and evaluate a remote training strategy for the implementation of mental health evidence-based practices (EBPs) in rural schools. Rural schools are increasingly implementing multi-tier positive behavioral interventions and supports (PBIS) to address school-climate problems. The study will use a mixed-methods approach for the development of the training platform, and a hybrid type 2, pilot randomized controlled trial to examine the implementation and student outcomes of two training strategies: Remote Video vs. Remote Video plus Coaching. The EPBs will be evaluated on appropriateness, feasibility, acceptability, usability, and preliminary student outcomes of the two online training strategies for the implementation of EPBs at PBIS Tier 2.
AHRQ-funded; HS027755.
Citation: Eiraldi R, McCurdy BL, Khanna MS .
Development and evaluation of a remote training strategy for the implementation of mental health evidence-based practices in rural schools: pilot study protocol.
Pilot Feasibility Stud 2022 Jun 17;8(1):128. doi: 10.1186/s40814-022-01082-4..
Keywords: Children/Adolescents, Behavioral Health, Evidence-Based Practice, Rural Health, Training
Campbell JI, Dubois MM, Savage TJ
Comorbidities associated with hospitalization and progression among adolescents with symptomatic coronavirus disease 2019.
This study’s objective was to identify subgroups likely to benefit from monoclonal antibody and antiviral therapy to treat COVID-19 by evaluating the relationship between comorbidities and hospitalization among US adolescents aged 12-17 with symptomatic coronavirus disease 2019 (COVID-19). The authors used the Pediatric COVID-19 US registry to identify patients who met their inclusion criteria of comorbidities including obesity, chronic kidney disease (CKD), diabetes, immunosuppressive disease or treatment, sickle cell disease (SCD), heart disease, neurologic disease/neurodevelopmental disorders, and pulmonary disease (excluding patients with mild asthma). Out of 1877 total patients included 284 (15%) were hospitalized within 28 days of their COVID-19 diagnosis. The following comorbidities were associated with increased odds of hospitalization: SCD, immunocompromising condition, obesity, diabetes, neurologic disease, and pulmonary disease (excluding mild asthma).
AHRQ-funded; HS000063.
Citation: Campbell JI, Dubois MM, Savage TJ .
Comorbidities associated with hospitalization and progression among adolescents with symptomatic coronavirus disease 2019.
J Pediatr 2022 Jun;245:102-10.e2. doi: 10.1016/j.jpeds.2022.02.048..
Keywords: Children/Adolescents, Diabetes, Asthma, Kidney Disease and Health, Hospitalization
Khan A, Baird J, Kelly MM
Family safety reporting in medically complex children: parent, staff, and leader perspectives.
This qualitative study examined parent, staff, and hospital leader perspectives about family safety reporting in children with medical complexity (CMC) to inform future interventions. The study was conducted at 2 tertiary care children’s hospitals with dedicated inpatient complex care services. Hour-long semi-structured, individual interviews were conducted with English and Spanish-speaking parents of CMC, physicians, nurses, and hospital leaders. A total of 80 participants (34 parents, 19 nurses and allied health professionals, 11 physicians, and 16 hospital leaders) were interviewed. Four themes related to family safety reporting emerged: (1) unclear, nontransparent, and variable existing processes, (2) a continuum of staff and leadership buy-in, (3) a family decision-making calculus about whether to report, and (4) misaligned staff and parent priorities and expectations. The authors also identified potential strategies for engaging families and staff in family reporting.
AHRQ-funded; HS025781.
Citation: Khan A, Baird J, Kelly MM .
Family safety reporting in medically complex children: parent, staff, and leader perspectives.
Pediatrics 2022 Jun; 149(6). doi: 10.1542/peds.2021-053913..
Keywords: Children/Adolescents, Family Health and History, Chronic Conditions, Provider: Physician, Patient Safety, Medical Errors, Adverse Events, Inpatient Care
Creary SE, Beeman C, Stanek J
Impact of hydroxyurea dose and adherence on hematologic outcomes for children with sickle cell anemia.
The purpose of this study was to quantify the contributions of hydroxyurea dose and medication adherence to the association between hydroxyurea exposure and hematologic parameters in children with sickle cell anemia (SCA.) Using data from children with SCA who were enrolled in two prospective hydroxyurea adherence studies, the researchers assessed the association by video of directly observed therapy or electronic pill bottle and medication administration record. Forty-five participants were included in the analysis. The study reported that higher exposure was related with higher fetal hemoglobin and mean corpuscular volume. The researchers concluded that higher hydroxyurea dose was related with improved hematologic parameters and is affected by level of prescribed dose and adherence.
AHRQ-funded; HS023011.
Citation: Creary SE, Beeman C, Stanek J .
Impact of hydroxyurea dose and adherence on hematologic outcomes for children with sickle cell anemia.
Pediatr Blood Cancer 2022 Jun;69(6):e29607. doi: 10.1002/pbc.29607..
Keywords: Children/Adolescents, Medication, Sickle Cell Disease, Chronic Conditions, Outcomes, Patient Adherence/Compliance
Mobley EM, Moke DJ, Milam J
Interventions to address disparities and barriers to pediatric cancer survivorship care: a scoping review.
This scoping review’s aim was to demonstrate evidence-based approaches to alleviate barriers and decrease disparities among childhood cancer survivors. A literature review identified 16 proposed strategies to address disparities and barriers endorsed by professional organizations including 9 clinical practice guidelines, 4 policy statements, and 3 recommendations. Twenty-seven published studies evaluated an intervention; however these evaluated interventions were not well aligned with the proposed strategies endorsed by professional organizations. Interventions most commonly evaluated survivorship care plans (n = 11), or models of care (n = 11) followed by individual survivorship care services (n= 9). Interventions predominantly targeted patients rather than providers or systems.
AHRQ-funded; 75Q80120D00009
Citation: Mobley EM, Moke DJ, Milam J .
Interventions to address disparities and barriers to pediatric cancer survivorship care: a scoping review.
J Cancer Surviv 2022 Jun;16(3):667-76. doi: 10.1007/s11764-021-01060-4..
Keywords: Children/Adolescents, Disparities, Cancer
Greenberg JK, Olsen MA, Johnson GW
Measures of intracranial injury size do not improve clinical decision making for children with mild traumatic brain injuries and intracranial injuries.
This study evaluated whether measuring traumatic brain injury size (eg, hematoma size) in children with mild traumatic brain injuries (mTBIs) and intracranial injuries (ICIs) improves risk prediction compared with the KIIDS intracranial injury decision support tool for traumatic brain injury (KIIDS-TBI) model. The cohort included children ≤18 years who presented to 1 of the 5 centers within 24 hours of TBI, had Glasgow Coma Scale scores of 13 to 15, and had ICI on neuroimaging. The data set was split into training and testing cohorts. The generalized linear model (GLM) and recursive partitioning (RP) models showed similar specificity across all risk cutoffs, but the GLM model had higher sensitivity. By comparison, the KIIDS-TBI model had slightly higher sensitivity but lower specificity.
AHRQ-funded; HS027075.
Citation: Greenberg JK, Olsen MA, Johnson GW .
Measures of intracranial injury size do not improve clinical decision making for children with mild traumatic brain injuries and intracranial injuries.
Neurosurgery 2022 Jun;90(6):691-99. doi: 10.1227/neu.0000000000001895..
Keywords: Children/Adolescents, Brain Injury, Decision Making
Petts RA, Walker BL, Hails KA
Parents' preferences for behavioral services in primary care during the COVID-19 pandemic.
The purpose of the study was to evaluate whether the COVID-19 pandemic impacted parent’s preferences and priorities for receiving behavioral health services for their young children in the pediatric primary care setting. In 5 pediatric primary care sites across the U.S., between July 2020 and January 2021, 301 parents of young children completed surveys on their preferences for behavioral subjects and methods of service delivery in primary care. The responses were compared to the responses from 396 parents who had been surveyed on the same measures in 2018. The study concluded that priorities for behavioral subjects during the pandemic were similar to parent’s priorities before the pandemic, with only one behavioral subject (child self-calming) rated significantly more important by the parents in the pandemic group than the pre-pandemic parents. The parents in the pandemic group were also significantly more interested in remote and media-based services such as mobile applications and videos than parents in the pre-pandemic group. The researchers conclude that pediatric primary care practices may wish to consider providing mobile apps, videos, and/ or other multimedia resources as part of their behavioral health services practices.
AHRQ-funded; HS022981.
Citation: Petts RA, Walker BL, Hails KA .
Parents' preferences for behavioral services in primary care during the COVID-19 pandemic.
J Dev Behav Pediatr 2022 Jun-Jul;43(5):291-96. doi: 10.1097/dbp.0000000000001033..
Keywords: Children/Adolescents, COVID-19, Behavioral Health, Primary Care
Milliren CE, Bailey G, Graham DA
Relationships between pediatric safety indicators across a national sample of pediatric hospitals: dispelling the myth of the "safest" hospital.
This observational study aimed to explore the covariance of pediatric hospital quality indicators and evaluate the use of a single composite score. Pediatric hospital performance across 13 safety indicators were extracted from the Pediatric Health Information System, a comparative database of children’s hospitals in the U.S. Patients discharged from 36 hospitals from 2016 to 2019 were included. The authors investigated relationships among patient safety measures from AHRQ pediatric quality indicators and Center for Medicare and Medicaid Services hospital-acquired conditions. They identified 5 orthogonal variance components accounting for 68% of variation in pediatric hospital quality indicators. The ranking comparison and summary found greater within-hospital variation compared with between-hospital variation. They observed discordant rankings among commonly used summary measures and concluded that these measures demonstrate at least 2 underlying variance components.
AHRQ-funded; HS026246.
Citation: Milliren CE, Bailey G, Graham DA .
Relationships between pediatric safety indicators across a national sample of pediatric hospitals: dispelling the myth of the "safest" hospital.
J Patient Saf 2022 Jun 1;18(4):e741-e46. doi: 10.1097/pts.0000000000000938..
Keywords: Children/Adolescents, Quality Indicators (QIs), Quality Measures, Patient Safety, Hospitals, Quality of Care
Bowring MG, Massie AB, Schwarz KB
Survival benefit of split-liver transplantation for pediatric and adult candidates.
The patient and graft survival rates for split -liver transplantations (SLTs) among pediatric and adult recipients are similar to those of whole-liver transplantations (WLTs), yet SLTs are rarely used. The purpose of the study was to compare the survival benefit of accepting an offer of a splittable graft vs waiting for a subsequent offer. The researchers utilized data from the 2010 to 2018 Scientific Registry of Transplant Recipients (SRTR) on 1814 adult and 928 pediatric liver transplantation candidates ever offered a splittable graft, and compared the eventual mortality between patients who accepted vs declined an offer for an SLT. The study discovered that among adult candidates, acceptance of an SLT offer was associated with a 43% reduction in mortality, and within 1 year of declining an offer 39.3% received a WLT, and 7.9% died. In pediatric cases with a weight of less than or equal to 7 kilograms, acceptance of a split liver offer versus declining the offer was associated with a 63% reduction in mortality, and within 1 year of declining 45.8% received a WLT and 6.4% died. In the group of pediatric cases with weight greater than 7 kilograms there was no significant difference between acceptance of an SLT offer and decline. The study concluded that accepting an offer for SLT could significantly improve survival for adults and small children on the liver transplant waiting list.
AHRQ-funded; HS023876.
Citation: Bowring MG, Massie AB, Schwarz KB .
Survival benefit of split-liver transplantation for pediatric and adult candidates.
Liver Transpl 2022 Jun;28(6):969-82. doi: 10.1002/lt.26393..
Keywords: Children/Adolescents, Transplantation
McCarthy SR, Golembiewski EH, Gravholt DL
Documentation of psychosocial distress and its antecedents in children with rare or life-limiting chronic conditions.
This study’s purpose was to characterize current medical record documentation practices around psychosocial distress among children with rare or life-limiting chronic conditions and their families. Medical records were reviewed for 60 patients with rare or life-limiting chronic conditions followed by a pediatric complex care program. Study team members extracted both structured data elements and note narratives from the most recent clinician visit. Psychosocial topics were analyzed using a mixed quantitative and qualitative approach. Psychosocial distress topics noted included child and parent emotional problems, parent social support, sibling emotional or physical problems, family structure (e.g., whether parents were together), and financial concern. However, 35% of notes lacked any mention of psychosocial concerns. The authors emphasized that this documentation is important to improve the ability of healthcare providers to identity and intervene on psychosocial concerns and their risk factors.
AHRQ-funded; HS026379.
Citation: McCarthy SR, Golembiewski EH, Gravholt DL .
Documentation of psychosocial distress and its antecedents in children with rare or life-limiting chronic conditions.
Children 2022 May 5;9(5). doi: 10.3390/children9050664..
Keywords: Children/Adolescents, Chronic Conditions
Michelson KA, Samuels-Kalow ME
Association of elementary school reopening status and county COVID-19 incidence.
This study examined the association between elementary school opening status (ESOS) and pediatric COVID-19 incidence. The authors conducted a cross-sectional study of US counties with school districts with ≥500 elementary school students. The main exposure was ESOS in September 2020 and outcome was county incidence of COVID-19. Among 3220 US counties, 19.2% were remote, 12.1% were hybrid, and 62.8% were in person. In unadjusted models, COVID-19 incidence after school started was higher among children in hybrid or in-person counties compared with remote only counties. After adjusting for local COVID-19 incidence, the incidence rate ratio compared with remote counties was 1.01 in hybrid counties and 0.79 in in-person counties.
AHRQ-funded; HS026503.
Citation: Michelson KA, Samuels-Kalow ME .
Association of elementary school reopening status and county COVID-19 incidence.
Acad Pediatr 2022 May-Jun;22(4):667-70. doi: 10.1016/j.acap.2021.09.006..
Keywords: Children/Adolescents, COVID-19, Public Health, Education
Adolphe S, Fernandez-Pastrana I, Scott H
EASE-ing the way for pediatric providers and parents: the Engagement and Access to Special Education (EASE) Clinic.
Primary Care Providers (PCPs) are tasked by the American Academy of Pediatrics to identify children who need special education and ensure that those children receive appropriate related services provided by the Individuals with Disabilities Education Act (IDEA). The IDEA entitles children between the ages of 3 and 21 to free education through individualized education programs (IEPs), and other related supports. The extent of PCP knowledge about the IDEA, special education, and available related support services and how to assess them, is largely unknown. Existing research indicates there is a lack of knowledge, training, and confidence in providers about special education. Boston Medical Center’s (BMC) Engagement and Access to Special Education (EASE) clinic was developed to provide support to the parents and PCPs of children with special education needs. The purpose of this article was to introduce and describe the EASE clinical model as a useful method for PCPs to strengthen their ability to provide appropriate and available comprehensive care to their patients requiring special education. The authors reported that of the 14,000 pediatric patients at the Boston Medical Center, 308 children were referred to the EASE clinic between its inception in 2017 and May 2021. The majority of children were Black non-Hispanic, English-speaking, and male, with an average age of 8.3 at first clinic. During that same time 452 total visits were completed, with a waiting list of less than 90 days. The authors conclude that for primary care practices with patients with special education needs, the BMC EASE clinic can serve as a useful model for improving their ability to provide care.
AHRQ-funded; HS022242.
Citation: Adolphe S, Fernandez-Pastrana I, Scott H .
EASE-ing the way for pediatric providers and parents: the Engagement and Access to Special Education (EASE) Clinic.
Acad Pediatr 2022 May-Jun;24(4):705-07. doi: 10.1016/j.acap.2022.02.011..
Keywords: Children/Adolescents, Caregiving, Patient and Family Engagement, Vulnerable Populations, Disabilities