Cincinnati Beacon Community Program highlights challenges and opportunities on the path to care transformation.

The Cincinnati, Ohio, metropolitan area was one of seventeen US communities to participate in the federal Beacon Community Cooperative Agreement Program to demonstrate how health information technology (IT) could be used to improve health care. Given $13.7 million to spend in thirty-one months, the Cincinnati project involved hundreds of physicians, eighty-seven primary care practices, eighteen major hospital partners, and seven federally qualified health centers and community health centers.

A case study of pediatric asthma alerts from the beacon community program in cincinnati: technology is just the first step.

Introduction: The Beacon Community in Cincinnati, Ohio was an innovative, community-wide initiative to use technology to transform care. One important feature was the development of regional alerts to notify practices when patients were hospitalized or seen in the emergency department. The purpose of this paper is to describe the way in which technology engages the improvement process, and to describe the early stages of learning how to use technology to enhance quality improvement.

Exemplar pediatric collaborative improvement networks: achieving results.

A number of pediatric collaborative improvement networks have demonstrated improved care and outcomes for children. Regionally, Cincinnati Children's Hospital Medical Center Physician Hospital Organization has sustained key asthma processes, substantially increased the percentage of their asthma population receiving "perfect care," and implemented an innovative pay-for-performance program with a large commercial payor based on asthma performance measures. The California Perinatal Quality Care Collaborative uses its outcomes database to improve care for infants in California NICUs.

Diagnostic reference ranges for pediatric abdominal CT.

Purpose: To develop diagnostic reference ranges (DRRs) and a method for an individual practice to calculate site-specific reference doses for computed tomographic (CT) scans of the abdomen or abdomen and pelvis in children on the basis of body width (BW).

Materials And Methods: This HIPAA-compliant multicenter retrospective study was approved by institutional review boards of participating institutions; informed consent was waived. In 939 pediatric patients, CT doses were reviewed in 499 (53%) male and 440 (47%) female patients (mean age, 10 years).

Image gently: a web-based practice quality improvement program in CT safety for children.

Objective: Radiologists want to improve quality and safety to benefit their pediatric patients and to comply with new requirements of the American Board of Radiology for maintenance of certification. The purpose for this article is to describe the development, construction, and content of a free, Web-based practice quality improvement (PQI) module in CT safety for children.

Conclusion: We describe an online tutorial accessible on the Image Gently Website that enables radiologists nationwide to perform PQI in CT safety for pediatric patients.

Transforming safety and effectiveness in pediatric hospital care locally and nationally.

Achieving dramatic, sustainable improvements in the safety and effectiveness of care for children requires a transformational approach to how hospitals individually focus on improvement and learn from each other to achieve national goals. The authors describe a theoretic framework for transformation that includes setting system-level priorities, aligning measures with each priority, identifying breakthrough targets, testing interventions to get results, and spreading successful interventions throughout the organization. Essential key drivers of transformation include leadership, building will, transparency, a business case for quality, patient and family engagement, improvement infrastructure, improvement capability, and reliability and standardization.

Improving influenza immunisation for high-risk children and adolescents.

Objective: To improve influenza vaccination rates for high-risk children and adolescents.

Methods: During the 2004-5 influenza season, 5 regional cystic fibrosis (CF) centres, 6 hospital clinics that participated in a similar initiative the previous year, 4 new hospital clinics, and 39 community-based paediatric practices implemented a multicomponent change package consisting of nine improvement strategies designed to increase immunisation of high-risk patients. Each site was encouraged to adopt and customize the improvement strategies to meet their specific culture and needs.

Financial impact of failing to prevent surgical site infections.

Background: Despite advances in infection-control practices, surgical site infections (SSIs) remain a substantial cause of morbidity, mortality, and increased costs among hospitalized patients.

Methods: We used a matched cohort design to compare costs and length of stay for 16 pediatric patients with an SSI with those of 16 matched control patients who had a similar operative procedure during the same time period but in whom an SSI did not develop.

Results: On average, length of stay was increased by 10.

Pay for performance alone cannot drive quality.

Objective: To determine whether aligning design characteristics of a pay-for-performance program with objectives of an asthma improvement collaborative builds improvement capability and accelerates improvement.

Design: Interrupted time series analysis of the impact of pay for performance on results of an asthma improvement collaborative.

Setting: Forty-four pediatric practices within greater Cincinnati.

Cincinnati Children's Hospital Medical Center: transforming care for children and families.

Background: Cincinnati Children's Hospital Medical Center pursues its vision to be the leader in improving child health through the creation of new knowledge, education of professionals and the community, and transformation of our health care delivery system.

Overall Approach To Quality And Safety: The strategic plan focuses on achieving the best medical and quality of life outcomes, patient and family experience of care, and value through horizontal integration of research and delivery system design, thereby accelerating the transfer of new knowledge to the bedside.

Creating Quality From The Family Perspective: Family members and patients participate at all levels of the organization, from the organizationwide family advisory council, to unit-based inpatient teams, to serving as family faculty who teach pediatric residents and orient new employees.