Pursuing perfection: an asthma quality improvement initiative in school-based health centers with community partners.

This article describes an innovative asthma quality improvement initiative conducted in school-based health centers (SBHCs) with collaboration among multiple community partners including the children's hospital, a federally qualified health center, the health department, the public school, and parents of children with asthma. The aim was to improve the health of children with asthma in these schools, as measured by minimal asthma-related activity restriction and reduction in asthma-related emergency department (ED) visits. Process measures tracked included the percent of children with (1) asthma severity classified, (2) persistent asthma with controller medication prescribed, and (3) written care plans.

Specialists understanding of the health care preferences of chronically ill adolescents.

Purpose: Doctors must understand patients' priorities to create an effective treatment partnership. Little is known about whether subspecialist pediatricians understand chronically ill adolescents' preferences.

Methods: A survey was conducted of 155 adolescents with chronic illnesses and 52 subspecialty physicians recruited from the same clinics of a children's hospital.

Health care preferences and priorities of adolescents with chronic illnesses.

Background: Efforts to make health care for adolescents with chronic illnesses more patient-centered must be grounded in an understanding and clear measures of adolescents' preferences and priorities.

Objective: To develop a measure of health care preferences of adolescents with chronic illnesses and to determine demographic, developmental, and health factors associated with adolescents' preferences.

Design: Mixed-method questionnaire development and survey.

Decreasing overuse of therapies in the treatment of bronchiolitis by incorporating evidence at the point of care.

Objective: To describe the effect of evidence-based point-of-care algorithms and rules, based on guideline recommendations, on the overuse of therapies for bronchiolitis. Study design Pre-postintervention for infants <1 year of age admitted with a first-time episode of bronchiolitis. Data collected for guideline-eligible patients discharged between January 15, 2002, and March 27, 2002, were compared with data collected for guideline-eligible patients discharged from the hospital with a diagnosis of bronchiolitis during the same time period in the first 5 years after the original guideline implementation (1997 to 2001).

A randomized controlled trial to change antibiotic prescribing patterns in a community.

Background: Excessive and inappropriate use of antibiotics has been identified as a leading cause of the emergence of multiply resistant strains of pneumococci.

Objective: To examine the effects of academic detailing and a parental education program on community pediatricians' prescription of antibiotics for young children.

Methods: Physician leaders in study practices prepared educational modules and presented the modules to their practices.

Impact of early newborn discharge legislation and early follow-up visits on infant outcomes in a state Medicaid population.

Objective: Scant information exists on the effects of legislation mandating coverage of minimum postnatal hospital stays on infant health outcomes. There are also gaps in knowledge regarding the effectiveness of early follow-up visits for newborns. The objective of this study was to determine the impact of 1) legislation mandating coverage of minimum postnatal hospital stays and 2) early follow-up visits by the age of 4 days on infant outcomes during the first month of life.

Is the frontal radiograph alone sufficient to evaluate for pneumonia in children?

Background: In our cost- and radiation-conscious environment, the feasibility of performing only a frontal radiograph for the diagnosis of pneumonia in children needs to be reassessed.

Objective: To determine the diagnostic efficacy of the frontal radiograph alone in comparison to the frontal and lateral combined radiographs for the radiographic diagnosis of pneumonia in children.

Materials And Methods: Three radiologists retrospectively and independently reviewed the frontal radiographs alone and separately reviewed the frontal and lateral radiographs of 1,268 children referred from the emergency room for chest radiographs.

Differences between adolescents' and parents' reports of health-related quality of life in cystic fibrosis.

Our objective was to determine the magnitude and direction of differences between adolescents with cystic fibrosis (CF) and their parents' reports of the adolescents' health-related quality of life (HRQOL) as measured by the adolescent and parent versions of the Child Health Questionnaire (CHQ). Sixty-two adolescents (mean age, 13.7 years; 46% female; mean forced expired volume in 1 sec, 73%) completed the 87-item adolescent form, and their parents (79% mothers; 77% working full or part time) completed the 50-item parent form of the CHQ during a routine clinic visit.

Characteristics of nonurgent emergency department use in the first 3 months of life.

Objectives: To determine the characteristics of nonurgent emergency department (ED) visits in the first 3 months of life.

Methods: The study cohort consisted of full-term newborns admitted to and discharged from one newborn nursery from September 1, 1992, to May 1, 1994. All visits in the first 90 days of life to one large urban ED were analyzed to determine whether they were nonurgent, based on history of present illness and final diagnosis or disposition.

The impact of legislation and secular trends on newborn length of stay for Medicaid infants in Ohio.

Objectives: To examine the impact of state legislation mandating minimum maternal and newborn length of stay (LOS).

Study Design: By using Medicaid claims data linked to vital statistics files, LOS, and "short stay" ( View Article and Find Full Text PDF

Relationship between early primary care and emergency department use in early infancy by the medicaid population.

Objective: To examine the relationship between the use and type of primary care and visits to the emergency department (ED) in early infancy by healthy infants who are Medicaid recipients.

Design: A population-based cohort study using a database linking birth certificate data to Medicaid claims.

Participants: A total of 151 464 full-term infants born in Ohio to mothers receiving Medicaid from July 1, 1991, through June 30, 1998.

Impact of a bronchiolitis guideline: a multisite demonstration project.

Study Objectives: The purpose of this study was to determine the impact of a multisite implementation of an evidence-based clinical practice guideline for bronchiolitis.

Design: Before and after study.

Setting: Eleven Child Health Accountability Initiative (CHAI) study hospitals.

Impact of recent pulmonary exacerbations on quality of life in patients with cystic fibrosis.

Objective: To compare the health-related quality of life (HRQOL) of people with cystic fibrosis (CF) to the general population, and to determine the relationship between HRQOL and clinical and demographic factors.

Design: Cross-sectional analysis of observational cohort.

Setting: Outpatient clinics of a Midwestern CF center.

Implementing an evidence-based acute gastroenteritis guideline at a children's hospital.

Background: Guidelines for preventing and treating acute gastroenteritis (AGE) have generally not been incorporated into medical practice. An evidence-based clinical practice guideline was adapted from national guidelines to meet the practice styles characterizing care in southwestern Ohio and implemented at the Children's Hospital Medical Center (Cincinnati). Its efficacy was assessed in terms of emergency department (ED) encounters and admissions, mean and total hospital costs, and mean length of hospitalization.