Performance of a Commonly Used Pressure Injury Risk Model Under Changing Incidence.

Background: Hospital-acquired pressure injuries (HAPIs) cause patient harm and increase health care costs. We sought to evaluate the performance of the Braden QD Scale-associated changes in HAPI incidence.

Methods: Using electronic health records data from a quaternary children's hospital, we evaluated the association between Braden QD scores and patient risk of HAPI.

Use of Prospective Audit and Feedback to Reduce Antibiotic Exposure in a Pediatric Cardiac ICU.

Objectives: We sought to determine whether a prospective audit and feedback intervention decreased antibiotic utilization in a pediatric cardiac ICU and to describe the characteristics of prospective audit and feedback audits and recommendations.

Design: Before-after study.

Setting: Pediatric cardiac ICU of a freestanding children's hospital.

Inpatient Observation After Transition From Intravenous to Oral Antibiotics.

Objectives: Children hospitalized with infections are commonly transitioned from intravenous (IV) to enteral (per os [PO]) antibiotics before discharge, after which they may be observed in the hospital to ensure tolerance of PO therapy and continued clinical improvement. We sought to describe the frequency and predictors of in-hospital observation after transition from IV to PO antibiotics in children admitted for skin and soft tissue infections (SSTIs).

Methods: We conducted a retrospective cohort study of children with SSTIs discharged between January 1, 2016, and June 30, 2018, using the Pediatric Health Information System database.

Key Drivers in Reducing Hospital-acquired Pressure Injury at a Quaternary Children's Hospital.

Introduction: Despite being a participating Solutions for Patient Safety (SPS) children's hospital and having attempted implementation of the SPS hospital-acquired pressure injuries (HAPIs) prevention bundle, our hospital remained at a HAPI rate that was 3 times the mean for SPS participating children's hospitals. This performance led to the launch of an enterprise-wide HAPI reduction initiative in our organization. The purpose of this article is to describe the improvement initiative, the key drivers, and the resulting decrease in the SPS-reportable HAPI rate.

Clinical Impact of Clostridium difficile PCR Cycle Threshold-Predicted Toxin Reporting in Pediatric Patients.

Background: Reliance on tests that detect only the presence of toxigenic Clostridium difficile can result in overdiagnosis and overtreatment of C difficile infection (CDI). The C difficile polymerase chain reaction (PCR) cycle threshold (CT) can sensitively predict the presence of free C difficile toxins; however, the clinical application for this testing strategy remains unexplored. We evaluated the impact of dual PCR and toxin result reporting, as predicted by the CT, on CDI management and outcomes in children.

Language barriers and LDL-C/SBP control among Latinos with diabetes.

Objectives: Language barriers in healthcare are associated with worse glycemic control among Latino patients with limited English proficiency and diabetes. We examined the association of patient-physician language concordance with lipid (low-density lipoprotein cholesterol [LDL-C]) and systolic blood pressure (SBP) control.

Study Design: Retrospective cohort study.

Predictors of Antimicrobial Stewardship Program Recommendation Disagreement.

OBJECTIVETo identify predictors of disagreement with antimicrobial stewardship prospective audit and feedback recommendations (PAFR) at a free-standing children's hospital.DESIGNRetrospective cohort study of audits performed during the antimicrobial stewardship program (ASP) from March 30, 2015, to April 17, 2017.METHODSThe ASP included audits of antimicrobial use and communicated PAFR to the care team, with follow-up on adherence to recommendations.

Identifying Spanish Language Competent Physicians: The Diabetes Study of Northern California (DISTANCE).

Objectives: Language barriers negatively impact health care access and quality for US immigrants. Latinos are the second largest immigrant group and the largest, fastest growing minority. Health care systems need simple, low cost and accurate tools that they can use to identify physicians with Spanish language competence.

A Guided Online and Mobile Self-Help Program for Individuals With Eating Disorders: An Iterative Engagement and Usability Study.

Background: Numerous digital health interventions have been developed for mental health promotion and intervention, including eating disorders. Efficacy of many interventions has been evaluated, yet knowledge about reasons for dropout and poor adherence is scarce. Most digital health intervention studies lack appropriate research design and methods to investigate individual engagement issues.

Displaying radiation exposure and cost information at order entry for outpatient diagnostic imaging: a strategy to inform clinician ordering.

Background: Displaying radiation exposure and cost information at electronic order entry may encourage clinicians to consider the value of diagnostic imaging.

Methods: An urban safety-net health system displayed radiation exposure information for CT and cost information for CT, MRI and ultrasound on an electronic referral system for outpatient ordering. We assessed whether there were differences in numbers of outpatient CT scans and MRIs per month relative to ultrasounds before and after the intervention, and evaluated primary care clinicians' responses to the intervention.

Clinicians' views on displaying cost information to increase clinician cost-consciousness.

Objectives: To evaluate 1) clinician attitudes towards incorporating cost information into decision making when ordering imaging studies; and 2) clinician reactions to the display of Medicare reimbursement information for imaging studies at clinician electronic order entry.

Study Design: Focus group study with inductive thematic analysis.

Methods: We conducted focus groups of primary care clinicians and subspecialty physicians (nephrology, pulmonary, and neurology) (N = 50) who deliver outpatient care in 12 hospital-based clinics and community health centers in an urban safety net health system.

From admission to discharge: patterns of interpreter use among resident physicians caring for hospitalized patients with limited english proficiency.

Resident physicians' use of professional interpreters drives communication with hospitalized patients with limited English proficiency (LEP). We surveyed residents from three specialties across two hospitals affiliated with one academic medical institution about their communication with their last hospitalized LEP patient. Among 149 respondents (73% response rate), 71% reported using professional interpreters for fewer than 60% of hospital encounters.

Effect of Present-on-Admission (POA) Reporting Accuracy on Hospital Performance Assessments Using Risk-Adjusted Mortality.

Objective: To evaluate how the accuracy of present-on-admission (POA) reporting affects hospital 30-day acute myocardial infarction (AMI) mortality assessments.

Data Sources: A total of 2005 California patient discharge data (PDD) and vital statistics death files.

Study Design: We compared hospital performance rankings using an established model assessing hospital performance for AMI with (1) a model incorporating POA indicators of whether a secondary condition was a comorbidity or a complication of care, and (2) a simulation analysis that factored POA indicator accuracy into the hospital performance assessment.

Understanding how to improve collaboration between hospitals and primary care in postdischarge care transitions: a qualitative study of primary care leaders' perspectives.

Background: There is limited collaboration between hospitals and primary care despite parallel efforts to improve postdischarge care transitions.

Objective: To understand what primary care leaders perceived as barriers and facilitators to collaboration with hospitals.

Methods: Qualitative study with in-depth, semistructured interviews of 22 primary care leaders in 2012 from California safety-net clinics.

Coronary microvascular dysfunction is related to abnormalities in myocardial structure and function in cardiac amyloidosis.

Objectives: The purpose of this study was to test the hypothesis that coronary microvascular function is impaired in subjects with cardiac amyloidosis.

Background: Effort angina is common in subjects with cardiac amyloidosis, even in the absence of epicardial coronary artery disease (CAD).

Methods: Thirty-one subjects were prospectively enrolled in this study, including 21 subjects with definite cardiac amyloidosis without epicardial CAD and 10 subjects with hypertensive left ventricular hypertrophy (LVH).

Clinician perspectives on considering radiation exposure to patients when ordering imaging tests: a qualitative study.

Background And Objectives: Increased computer tomography (CT) scan use has contributed to a rise in medically-associated radiation exposure. The extent to which clinicians consider radiation exposure when ordering imaging tests is unknown. We examined (1) outpatient clinician attitudes towards considering radiation exposure when ordering CT scans; and (2) clinician reactions to displaying radiation exposure information for CT scans at clinician electronic order entry.

Left ventricular structure and function in transthyretin-related versus light-chain cardiac amyloidosis.

Background: Immunoglobulin amyloid light-chain (AL)-related cardiac amyloidosis (CA) has a worse prognosis than either wild-type (ATTRwt) or mutant (ATTRm) transthyretin (TTR) CA. Detailed echocardiographic studies have been performed in AL amyloidosis but not in TTR amyloidosis and might give insight into this difference. We assessed cardiac structure and function and outcome in a large population of patients with CA and compared findings in TTR and AL-related disease.