Dental Emergency Practice Characteristics Among North Carolina Pediatric and General Dentists.

Purpose: The purpose of this study was to assess after-hours practice characteristics of pediatric dentists (PDs) and general dentists (GDs) and determine how patients-of-record obtain after-hours emergency dental care.

Methods: A 29-item survey was electronically distributed to PDs and GDs in North Carolina in September 2014. Demographics and after-hours emergency practice characteristics were assessed.

Good to Great: Quality-Improvement Initiative Increases and Sustains Pediatric Health Care Worker Hand Hygiene Compliance.

Objective: The Joint Commission, the Centers for Disease Control and Prevention, and the World Health Organization challenge hospitals to achieve and sustain compliance with effective hand hygiene (HH) practice; however, many inpatient units fail to achieve a high level of reliability. The aim of the project was to increase and sustain health care worker (HCW) compliance with HH protocols from 87% (level of reliability [LOR] 1) to ≥95% (LOR 2) within 9 months on 2 pediatric inpatient units in an academic children's hospital.

Methods: This study was a time-series, quality-improvement project.

A policy review of after-hours emergency dental care responsibilities.

Objectives: To examine professional guidelines and/or requirements of state and national dental organizations regarding the responsibility of dentists for after-hours emergency care.

Methods: Guidelines of national dental professional organizations, specialties, and all 50 state dental boards were examined for language pertaining to after-hours emergency care. Guidelines were categorized as: a) no guidelines; b) deferral to American Dental Association (ADA) guidelines; c) specific guidelines outlined.

Pharmacologic treatment of bronchiolitis in infants and children: a systematic review.

Background: Bronchiolitis is the most common lower respiratory tract infection in infants. Up to 3% of all children in their first year of life are hospitalized with bronchiolitis. Bronchodilators and corticosteroids are commonly used treatments, but little consensus exists about optimal management strategies.

Diagnosis and testing in bronchiolitis: a systematic review.

Background: The diagnosis of bronchiolitis is based on typical history and results of a physical examination. The indications for and utility of diagnostic and supportive laboratory testing (eg, chest x-ray films, complete blood cell counts, and respiratory syncytial virus testing) are unclear.

Objectives: To review systematically the data on diagnostic and supportive testing in the management of bronchiolitis and to assess the utility of such testing.

Office preparedness for pediatric emergencies: a randomized, controlled trial of an office-based training program.

Objective: Many children enter the emergency medical system through primary care offices, yet these offices may not be adequately prepared to stabilize severely ill children. We conducted this study to evaluate the effectiveness of an office-based educational program designed to improve the preparation of primary care practices for pediatric emergencies.

Methods: A prospective, randomized, controlled trial was conducted of primary care practices (pediatric, family practice, and health departments) that were recruited from an existing database of North Carolina practices.

Bronchiolitis management preferences and the influence of pulse oximetry and respiratory rate on the decision to admit.

Objective: High incidence, rising admission rates, and relatively ineffective therapies make the management of bronchiolitis controversial. Since 1980, the rate of hospitalization for children with bronchiolitis has increased by nearly 250%, whereas mortality rates for the disease have remained constant. It has been speculated that the increasing use of pulse oximetry has lowered the threshold for admission and may have contributed to the rise in bronchiolitis-related admissions.

The association of handgun ownership and storage practices with safety consciousness.

Background: As with other injury prevention practices, education about safe firearm storage is recommended to prevent injuries to children.

Objective: To assess whether parents who are safety conscious in other respects also practice firearm safety.

Methods: Data come from responses to a baseline survey administered as part of an intervention study.

Outcomes research and emergency medical services for children: domains, challenges, and opportunities.

Outcomes research focuses on the end results of medical care. This paper describes the specific domains of outcomes research, namely, clinical effectiveness, quality of care, quality of life, patient satisfaction, cost-effectiveness, and organization of care, which are the primary domains of outcomes research. Specific examples of pediatric emergency medicine applications are provided for each domain.

From concept to application: the impact of a community-wide intervention to improve the delivery of preventive services to children.

Objective: To improve health outcomes of children, the US Maternal and Child Health Bureau has recommended more effective organization of preventive services within primary care practices and more coordination between practices and community-based agencies. However, applying these recommendations in communities is challenging because they require both more complex systems of care delivery within organizations and more complex interactions between them. To improve the way that preventive health care services are organized and delivered in 1 community, we designed, implemented, and assessed the impact of a health care system-level approach, which involved addressing multiple care delivery processes, at multiple levels in the community, the practice, and the family.

Improving preventive service delivery through office systems.

Objective: Rates of childhood immunizations and other preventive services are lower in many practices than national goals and providers' own estimates. Office systems have been used in adult settings to improve the delivery of preventive care, but their effectiveness in pediatric practices is unknown. This study was designed to determine whether a group of primary care practices in 1 community could implement office-based quality improvement systems that would significantly improve their delivery of childhood preventive services.

Measuring the process of preventive service delivery in primary care practices for children.

Background: Children may fall behind on preventive services because they do not receive needed services at the time of an office visit (a missed opportunity). However, methods are needed to measure problems in the care delivery process that lead to missed opportunities. We developed a method to examine the key steps in the preventive service delivery process and identify problems; we assessed the feasibility and validity of the method in primary care practices for children.

The effect of audit and feedback on immunization delivery: a systematic review.

Objective: To assess the effective of audit and feedback (A&F) on immunization delivery by health care professionals.

Design: Systematic review of published literature.

Main Outcome Measures: Changes in immunization rates.

A systematic review of vision screening tests for the detection of amblyopia.

Objective: To review the test characteristics and the quality of evidence regarding available screening tests for the detection of amblyopia in preschool-aged children to help primary care practitioners select a screening strategy.

Design: Systematic review of published studies.

Data Sources: The MEDLINE database was searched from 1966 through January 1999 using a broad and inclusive strategy.

Cost-effectiveness analysis of lead poisoning screening strategies following the 1997 guidelines of the Centers for Disease Control and Prevention.

Objective: To compare blood lead (BPb) poisoning screening strategies in light of the 1997 recommendations by the Centers for Disease Control and Prevention, Atlanta, Ga.

Design: Cost-effectiveness analysis from the perspective of the health care system to compare the following 4 screening strategies: (1) universal screening of venous BPb levels; (2) universal screening of capillary BPb levels; (3) targeted screening of venous BPb levels for those at risk; and (4) targeted screening of capillary BPb levels for those at risk. Costs of follow-up testing and treatment were included in the model.

Linking clinical and public health approaches to improve access to health care for socially disadvantaged mothers and children. A feasibility study.

Objective: To test the feasibility of combining home- and office-based interventions to improve access to health care and health outcomes of Medicaid-eligible mothers and infants.

Design: Randomized trial in 2 counties in North Carolina (1 rural, 1 urban). Information on health and developmental outcomes was obtained by face-to-face interviews, medical chart abstractions, hospital medical records, and state data tapes.

The delivery of immunizations and other preventive services in private practices.

Objectives: To measure the proportion of children cared for in private practices who are fully immunized and have been screened for anemia, tuberculosis (TB), and lead poisoning by 2 years of age.

Design: Cross-sectional chart review.

Setting: Fifteen private pediatric practices in central North Carolina (11 chosen randomly).

What mothers say about why poor children fall behind on immunizations. A summary of focus groups in North Carolina.

Objectives: To develop a more thorough understanding of the factors that impede poor parents' utilization of health care services for their children and to refine interventions to improve immunization rates.

Methods: We conducted focus group sessions with mothers whose children received care at the health departments in five North Carolina counties. Mothers were uninsured or were receiving Medicaid.

Factors responsible for immunizations referrals to health departments in North Carolina.

Background: Despite the existence of Medicaid and other programs designed to eliminate cost as a barrier to immunization in physicians' offices, referrals to local health departments for immunizations are common. Many children leave their physicians' offices without receiving needed immunizations.

Purpose: To determine: 1) the frequency and determinants of immunization referrals to health departments in North Carolina, and 2) the factors associated with private physicians' decisions to immunize Medicaid children in their offices and participate in the state-funded vaccine replacement program.

Rural-urban blood lead differences in North Carolina children.

Objective: To examine the prevalence of and risk factors for having a blood lead elevation among young children in a predominantly rural state.

Methods: 20,720 North Carolina children at least 6 months and < 6 years of age were screened between November 1, 1992 and April 30, 1993 using either capillary or venous measurements of blood lead. Children were tested through routine screening programs that target low-income families and, hence, were not randomly selected.

Universal hepatitis B immunization of infants: reactions of pediatricians and family physicians over time.

Objective: In November 1991 the Advisory Committee on Immunization Practice (ACIP) recommended universal hepatitis B immunization of infants. In February 1992 the American Academy of Pediatrics (AAP) and in August 1992 the American Academy of Family Physicians (AAFP) issued similar recommendations. The purpose of this study was to assess over time the effectiveness and impact of the dissemination efforts of the ACIP, AAP, and AAFP regarding this new recommendation and to determine the factors affecting its adoption.