Effect of an Electronic Health Record Transition on the Provision of Recommended Well Child Services in Pediatric Primary Care Practices.

We sought to determine the effect of transitioning between electronic health record (EHR) systems on the quality of preventive care in a large pediatric primary care network. To study this, we performed a retrospective chart analysis of 42 primary care practices from the Pediatric Physicians' Organization at Children's who transitioned EHRs. We reviewed 24 random encounters per week distributed evenly across 6 age categories before, during, and after a transition period.

Five-Year Outcomes of Behavioral Health Integration in Pediatric Primary Care.

Background And Objectives: In the context of protracted shortages of pediatric behavioral health (BH) specialists, BH integration in pediatric primary care can increase access to BH services. The objectives of this study were to assess the structure and process of pediatric BH integration and outcomes in patient experience (access and quality), cost, and provider satisfaction.

Methods: In 2013, we launched a multicomponent, transdiagnostic integrated BH model (Behavioral Health Integration Program [BHIP]) in a large pediatric primary care network in Massachusetts.

Effect of Instrument-Based Vision Screening for 3- to 5-Year-Old Children on Referrals to Eye Care Specialists.

Recently, several professional groups have recommended a change from chart-based to instrument-based screening for preschool-age children, but the effect of this change on health care utilization is unknown. We performed a secondary analysis of a site-randomized quality improvement project on transitioning from chart-based to instrument-based vision screening for 3- to 5-year-old children in primary care. We analyzed visit rates to ophthalmologists and optometrists and costs of such care before and after implementation of instrument-based vision screening with comparison to nonparticipating practices.

Identifying children at risk of asthma exacerbations: beyond HEDIS.

Objectives: Asthma is a costly and variable disease necessitating routine population health monitoring. Insurance claims represent all paid pharmacy, diagnostic, outpatient, inpatient, and emergency care; however, current claims-based identification tools may be overly specific. We sought to determine how various definitions of asthma may improve detection of patients at risk of asthma exacerbations.

Primary Care Implementation of Instrument-Based Vision Screening for Young Children.

Vision screening for young children can detect conditions that may lead to amblyopia and vision loss if left untreated. Portable vision screening devices with high levels of precision are now available, but their effectiveness in busy primary care settings is unknown. We analyzed the effect of deploying instrument screening devices (SPOT Vision Screener, Welch-Allyn) in 19 pediatric practices.

Enhancing Pediatricians' Behavioral Health Competencies Through Child Psychiatry Consultation and Education.

The objective of this study was to assess feasibility, utilization, perceived value, and targeted behavioral health (BH) treatment self-efficacy associated with a collaborative child and adolescent psychiatry (CAP) consultation and BH education program for pediatric primary care practitioners (PCPs). Eighty-one PCPs from 41 member practices of a statewide pediatric practice association affiliated with an academic medical center participated in a program comprising on-demand telephonic CAP consultation supported by an extensive BH learning community. Findings after 2 years of implementation suggest that the program was feasible for large-scale implementation, was highly utilized and valued by PCPs, and was attributed by PCPs with enhancing their BH treatment self-efficacy and the quality of their BH care.

Educational Initiative to Standardize Concussion Management in Pediatric Primary Care.

Pediatric primary care providers report limited training and tools to manage concussion. We developed a learning community intervention for a large independent pediatric practice association affiliated with a university hospital to standardize concussion management and improve the use of consensus-based guidelines. The learning community included in-person and online didactics, followed by a web-based reinforcement platform to educate and train clinicians on our treatment algorithm and decision support tools.

Appropriateness of Tympanostomy Tubes in the Boston Metropolitan Area: Are the AAO-HNSF Guidelines Being Met?

Introduction Otitis media (OM) is the most common reason children receive general anesthesia, with bilateral tympanostomy tube (TT) insertion the second most common surgery in children. Prior research suggests overuse of TT. As part of a project designed to improve appropriateness of OM referrals, we evaluated appropriateness of TT insertion in a patient cohort.

Results of a primary care-based quality improvement project to optimize chart-based vision screening for preschool age children.

Purpose: To design chart-based vision screening for preschool-aged children.

Methods: Our program consisted of educational sessions for providers as well as hands-on training for practice staff. We evaluated the intervention through pre- and post-intervention review of medical records.

Practice-Based Quality Improvement Collaborative to Increase Chlamydia Screening in Young Women.

Background And Objective: Chlamydia trachomatis infections are common among sexually active young women. We developed a practice-based quality improvement (QI) collaborative to increase Chlamydia screening in at-risk young women.

Methods: Structured data fields were integrated into the electronic record for practices affiliated with Boston Children's Hospital.

Total Direct Medical Expenses and Characteristics of Privately Insured Adolescents Who Incur High Costs.

Importance: Accountable care payment models aim to reduce total direct medical expenses for high-cost patients through improved quality of care and preventive health services. Little is known about health care expenditures of privately insured adolescents, especially those who incur high costs.

Objectives: To assess health care expenditures for high-cost adolescents and to describe the patient characteristics associated with high medical costs.

Trends in Ambulatory Care for Children with Concussion and Minor Head Injury from Eastern Massachusetts between 2007 and 2013.

Objective: To characterize trends in health care utilization and costs for children diagnosed with concussion or minor head injury within a large pediatric primary-care association.

Study Design: We conducted a retrospective cohort analysis from 2007 through 2013 examining all outpatient medical claims related to concussion and minor head injury from 4 commercial insurance companies for children 6-21 years of age who were patients within a large pediatric independent practice association located throughout eastern Massachusetts.

Results: Health care visits for concussion and minor head injury increased more than 4-fold during the study period, with primary-care and specialty clinics experiencing the greatest increases in the rate of visits while emergency department visits increased comparatively less.

Shared care: a quality improvement initiative to optimize primary care management of constipation.

Background: Pediatric constipation is commonly managed in the primary care setting, where there is much variability in management and specialty referral use. Shared Care is a collaborative quality improvement initiative between Boston Children's Hospital and the Pediatric Physician's Organization at Children's (PPOC), through which subspecialists provide primary care providers with education, decision-support tools, pre-referral management recommendations, and access to advice. We investigated whether Shared Care reduces referrals and improves adherence to established clinical guidelines.

Effectiveness of an asthma quality improvement program designed for maintenance of certification.

Objective: Pediatricians are required to perform quality improvement for board recertification. We developed an asthma project within the Pediatric Physicians' Organization at Children's, an independent practice association affiliated with Boston Children's Hospital, designed to meet recertification requirements and improve asthma care.

Methods: The program was based on the learning collaborative model.

A quality improvement program to reduce unnecessary referrals for adolescent scoliosis.

Objective: Adolescent idiopathic scoliosis (AIS) is a relatively common reason for referral to orthopedic surgery, but most referred patients do not require bracing or surgery. We developed a quality improvement (QI) program within the Pediatric Physicians' Organization at Children's, an independent practice association affiliated with Boston Children's Hospital, to reduce unnecessary specialty referrals for AIS.

Methods: The QI program consisted of physician education, decision support tools available at the point of care, and longitudinal feedback of data on physician referrals for AIS.

Correlation of care process measures with childhood asthma exacerbations.

Objective: We sought to define processes of pediatric asthma care identifiable through administrative data that correlate with asthma exacerbations for use in quality improvement.

Methods: Commercially insured children aged 5 to 17 years from the Pediatric Physicians' Organization at Children's, an independent practice association affiliated with Boston Children's Hospital, with persistent asthma in 2008, 2009, or 2010 were identified. The correlations of various process measures with asthma exacerbations, defined as hospitalizations or emergency department visits for asthma or outpatient visits for asthma with an oral steroid prescription, were analyzed by using logistic regression.