Mismatching Among Guidelines, Providers, and Parents on Controller Medication Use in Children with Asthma.

Background: Underuse of controller medicines among children with asthma remains widespread despite national guidelines.

Objectives: To (1) assess provider prescribing patterns for asthma controller medications; (2) assess how frequently parents' reports of their child's asthma controller medicine use were mismatched with their provider's recommendations; and (3) evaluate parent attitudes and demographic characteristics associated with these mismatches.

Methods: In this cross-sectional study, we conducted linked surveys of parents and providers of children with probable persistent asthma in a Medicaid program and 4 commercial health plans in 2011.

Ventilator-Associated Events in Neonates and Children--A New Paradigm.

Objectives: To identify a pediatric ventilator-associated condition definition for use in neonates and children by exploring whether potential ventilator-associated condition definitions identify patients with worse outcomes.

Design: Retrospective cohort study and a matched cohort analysis.

Setting: Pediatric, cardiac, and neonatal ICUs in five U.

Primary adherence to controller medications for asthma is poor.

Rationale: Few previous studies have evaluated primary adherence (whether a new prescription is filled within 30 d) to controller medications in individuals with persistent asthma.

Objective: To compare adherence to the major controller medication regimens for asthma.

Methods: This was a retrospective cohort study of enrollees from five large health plans.

Use of leukotriene receptor antagonists are associated with a similar risk of asthma exacerbations as inhaled corticosteroids.

Background: Based on results of clinical trials, inhaled corticosteroids (ICS) are the most-effective controller medications for preventing asthma-related exacerbations, yet few studies in real-life populations have evaluated the comparative effectiveness of ICS.

Objective: To determine the likelihood of asthma exacerbations among children with asthma after initiation of controller medications: ICS, leukotriene antagonists (LTRA), and ICS-long-acting β-agonist (LABA) combination therapy.

Methods: This was a retrospective cohort study of subjects who were part of the Population-Based Effectiveness in Asthma and Lung Diseases Network.

Statin exposure is associated with decreased asthma-related emergency department visits and oral corticosteroid use.

Rationale: Statins, or HMG-CoA reductase inhibitors, may aid in the treatment of asthma through their pleiotropic antiinflammatory effects.

Objectives: To examine the effect of statin therapy on asthma-related exacerbations using a large population-based cohort.

Methods: Statin users aged 31 years or greater with asthma were identified from the Population-Based Effectiveness in Asthma and Lung population, which includes data from five health plans.

Methicillin-resistant Staphylococcus aureus infection and hospitalization in high-risk patients in the year following detection.

Background: Many studies have evaluated methicillin-resistant Staphylococcus aureus (MRSA) infections during single hospitalizations and subsequent readmissions to the same institution. None have assessed the comprehensive burden of MRSA infection in the period after hospital discharge while accounting for healthcare utilization across institutions.

Methodology/principal Findings: We conducted a retrospective cohort study of adult patients insured by Harvard Pilgrim Health Care who were newly-detected to harbor MRSA between January 1991 and December 2003 at a tertiary care medical center.

Reliability of a patient survey assessing cost-related changes in health care use among high deductible health plan enrollees.

Background: Recent increases in patient cost-sharing for health care have lent increasing importance to monitoring cost-related changes in health care use. Despite the widespread use of survey questions to measure changes in health care use and related behaviors, scant data exists on the reliability of such questions.

Methods: We administered a cross-sectional survey to a stratified random sample of families in a New England health plan's high deductible health plan (HDHP) with ≥ $500 in annualized out-of-pocket expenditures.

Use of well-child visits in high-deductible health plans.

Objective: To examine how enrollment in high-deductible health plans (HDHPs) affects use of well-child visits relative to traditional plans, when preventive care is exempt from the deductible.

Study Design: Pre-post comparison between groups.

Methods: We selected children aged <18 years enrolled in a large Massachusetts health plan through employers offering only 1 type of plan.

Health care use and decision making among lower-income families in high-deductible health plans.

Background: Lower-income families may face unique challenges in high-deductible health plans (HDHPs).

Methods: We administered a cross-sectional survey to a stratified random sample of families in a New England health plan's HDHP with at least $500 in annualized out-of-pocket expenditures. Lower-income families were defined as having incomes that were less than 300% of the federal poverty level.

Asthma care quality for children with minority-serving providers.

Objective: To compare asthma care quality for children with and without minority-serving providers.

Design: Cross-sectional telephone survey of parents, linked with a mailed survey of their children's providers.

Setting: A Medicaid-predominant health plan and multispecialty provider group in Massachusetts.

Outcomes after periodic use of inhaled corticosteroids in children.

Background: Many children with persistent asthma use inhaled corticosteroids on a periodic basis. Clinical trials in adults suggest that periodic use of inhaled corticosteroids may be effective for patients with mild persistent asthma. However, scant information exists on the clinical outcomes of children with asthma who are using inhaled corticosteroids on a periodic basis in real-world settings.

High-deductible health plans: are vulnerable families enrolled?

Objective: There is concern that high-deductible health plans may have negative effects on vulnerable groups. The objective of this study was to compare the characteristics of families who have children and switch to high-deductible health plans with those who stay in traditional plans.

Methods: This double-cohort study included families who had children aged <18 years and were enrolled in a Massachusetts health plan through employers who did not offer a choice of health plans.

Modifiable risk factors for suboptimal control and controller medication underuse among children with asthma.

Objectives: Our aims were (1) to describe rates of suboptimal control and controller medication underuse in a diverse population of children with asthma and (2) to identify potentially modifiable parental behaviors and beliefs associated with these outcomes.

Methods: We conducted telephone interviews with parents of 2- to 12-year-old children with persistent asthma, in a Medicaid plan and a large provider group. Suboptimal control was defined as >or=4 symptom days, >or=1 symptom night, or >or=4 albuterol use days in the previous 2 weeks.

Familial risk and colorectal cancer screening health beliefs and attitudes in an insured population.

Objective: To examine the relationship between health beliefs and attitudes toward colorectal cancer screening, strength of family history risk, and being appropriately screened for colorectal cancer.

Methods: In February 2004, 7000 randomly selected members of a multi-specialty group practice located in Boston, MA were mailed a brief survey that was used to ascertain colorectal cancer family history. A follow-up survey that contained questions representing selected constructs of the Health Belief Model, Theory of Planned Behavior, and healthcare experiences was then mailed to all 355 individuals who reported a family history in the initial survey and 710 randomly selected participants with no colorectal cancer family history.

Screening patients with a family history of colorectal cancer.

Objectives: To compare screening practices and beliefs in patients with and without a clinically important family history.

Design: We mailed a brief questionnaire asking about family history and a second, longer survey asking about knowledge of and beliefs about colorectal cancer to all respondents with a family history and a random sample of respondents without a family history of colorectal cancer. We reviewed electronic medical records for screening examinations and recording of family history.

Economic analysis of a randomized trial of academic detailing interventions to improve use of antihypertensive medications.

The authors estimated the costs and cost savings of implementing a program of mailed practice guidelines and single-visit individual and group academic detailing interventions in a randomized controlled trial to improve the use of antihypertensive medications. Analyses took the perspective of the payer. The total costs of the mailed guideline, group detailing, and individual detailing interventions were estimated at 1000 dollars, 5500 dollars, and 7200 dollars, respectively, corresponding to changes in the average daily per person drug costs of -0.

Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia.

Background: Serial interventions are often used to reduce the risk of health care-associated methicillin-resistant Staphylococcus aureus (MRSA) infections. To our knowledge, the relative impact of these interventions has not previously been ascertained.

Methods: We conducted a retrospective study of 4 major infection control interventions using an interrupted time series design to evaluate their impact on MRSA bacteremia in an 800-bed hospital with 8 intensive care units (ICUs).

Clinical and nonclinical correlates of adherence to prescribing guidelines for hypertension in a large managed care organization.

To examine correlates of guideline adherence in a population with access to health care and prescription drug benefits, the authors conducted a cross-sectional analysis among 5789 patients undergoing hypertension treatment with a single medication in a large New England managed care organization. Logistic regression was used to determine correlates of adherence, defined as use of diuretics or beta blocker as antihypertensive monotherapy during the 1-year study period. Women were more likely than men to receive guideline-adherent therapy (odds ratio [OR], 1.

Building a virtual cancer research organization.

Background: The Cancer Research Network (CRN) comprises the National Cancer Institute and 11 nonprofit research centers affiliated with integrated health care delivery systems. The CRN, a public/private partnership, fosters multisite collaborative research on cancer prevention, screening, treatment, survival, and palliation in diverse populations.

Methods: The CRN's success hinges on producing innovative cancer research that likely would not have been developed by scientists working individually, and then translating those findings into clinical practice within multiple population laboratories.

Group versus individual academic detailing to improve the use of antihypertensive medications in primary care: a cluster-randomized controlled trial.

Purpose: To compare group versus individual academic detailing to increase diuretic or beta-blocker use in hypertension.

Methods: We conducted a cluster-randomized controlled trial in a large health maintenance organization. Subjects (N=9820) were patients with newly treated hypertension in the year preceding the intervention (N=3692), the 9 months following the intervention (N=3556), and the second year following intervention (N=2572).

Pediatricians' self-reported clinical practices and adherence to national immunization guidelines after the introduction of pneumococcal conjugate vaccine.

Background: Little is known about whether pneumococcal conjugate vaccine (PCV) has altered pediatricians' practices regarding well-child and acute care.

Objectives: To (1) describe whether PCV caused pediatricians to move other routine infant vaccines and/or add routine visits; (2) characterize adherence to national immunization recommendations; and (3) determine whether PCV altered pediatricians' planned clinical approach to well-appearing febrile infants.

Design And Methods: One year after PCV was added to the pediatric immunization schedule, we mailed a 23-item survey to 691 randomly selected pediatricians in Massachusetts.

Mothers' and clinicians' perspectives on breastfeeding counseling during routine preventive visits.

Background: Recent national statistics indicate that, despite increases in the proportion of mothers who initiate breastfeeding, the proportion that continue to breastfeed their infants through 6 months of age remains below the Healthy People 2010 goal of 50%. National professional organizations recommend that clinicians routinely counsel mothers about the benefits of breastfeeding. Little is known, however, about the counseling provided during these visits and how mothers and their clinicians perceive breastfeeding counseling.

Opinions and practices of clinicians associated with continuation of exclusive breastfeeding.

Background: The American Academy of Pediatrics recommends exclusive breastfeeding for the first 6 months of life. Recent statistics indicate that initiation and maintenance of exclusive breastfeeding are low in the United States. Unfortunately, little information is available on how clinicians and health care organizations can best promote continuation of exclusive breastfeeding.

Immunization status among children newly enrolled in a health plan: a new frontier for quality measurement?

Background: The National Scientific Panel on Immunization Measurement Standards recently recommended that the assessment population for the childhood immunization measure of the Health Plan Employer Data and Information Set include 24-month-olds with > or = 6 months of continuous enrollment in a health plan. The current inclusion criterion is > or = 12 months of continuous enrollment. The new recommendation would expand the assessment population to include children with more recent enrollment.

Pediatricians' views on financial barriers and values for pneumococcal vaccine for children.

Objectives: To 1) describe barriers to pneumococcal conjugate vaccine adoption and 2) estimate the value of the vaccine based on pediatricians' responses to willingness-to-pay questions.

Methods: In June 2000, we mailed a random sample of pediatricians in Massachusetts a questionnaire about barriers to adoption of the vaccine and willingness to pay for the vaccine and associated outcomes. Respondents were assigned at random to 1 of 2 survey versions: the Personal Perspective version, for which they imagined spending their own money for their own child, or the Public Perspective version, for which they imagined spending the government's money for the average child.