Immunization, Antibiotic Use, and Pneumococcal Colonization Over a 15-Year Period.

Background: Rates of invasive pneumococcal disease have declined since widespread introduction of pneumococcal conjugate vaccines (PCVs) in the United States. We evaluated the impact of immunization status and recent antibiotic use on an individual child's risk of colonization.

Methods: This study extends previously reported data from children <7 years of age seen for well child or acute care visits in Massachusetts communities.

Prevalence of Parental Misconceptions About Antibiotic Use.

Background: Differences in antibiotic knowledge and attitudes between parents of Medicaid-insured and commercially insured children have been previously reported. It is unknown whether understanding has improved and whether previously identified differences persist.

Methods: A total of 1500 Massachusetts parents with a child <6 years old insured by a Medicaid managed care or commercial health plan were surveyed in spring 2013.

Impact of 13-Valent Pneumococcal Conjugate Vaccination on Streptococcus pneumoniae Carriage in Young Children in Massachusetts.

Background: In April 2010, a 13-valent pneumococcal conjugate vaccine (PCV13) replaced PCV7 for use in the United States. We evaluated rates of pneumococcal colonization, by serotype and antibiotic resistance, in Massachusetts communities where serial cross-sectional surveillance has been conducted for the past decade.

Methods: Nasopharyngeal swabs were obtained from children 0 to <7 years of age and seen by primary care providers for well child or acute illness visits in 2001, 2004, 2007, 2009, and 2011.

Recent trends in outpatient antibiotic use in children.

Objective: The goal of this study was to determine changes in antibiotic-dispensing rates among children in 3 health plans located in New England [A], the Mountain West [B], and the Midwest [C] regions of the United States.

Methods: Pharmacy and outpatient claims from September 2000 to August 2010 were used to calculate rates of antibiotic dispensing per person-year for children aged 3 months to 18 years. Differences in rates by year, diagnosis, and health plan were tested by using Poisson regression.

Childhood infections, antibiotics, and resistance: what are parents saying now?

Parental misconceptions and even "demand" for unnecessary antibiotics were previously viewed as contributors to overuse of these agents. We conducted focus groups to explore the knowledge and attitudes surrounding common infections and antibiotic use in the current era of more judicious prescribing. Among diverse groups of parents, we found widespread use of home remedies and considerable concern regarding antibiotic resistance.

Some families who purchased health coverage through the Massachusetts Connector wound up with high financial burdens.

Health insurance exchanges created under the Affordable Care Act will offer coverage to people who lack employer-sponsored insurance or have incomes too high to qualify for Medicaid. However, plans offered through an exchange may include high levels of cost sharing. We surveyed families participating in unsubsidized plans offered in the Massachusetts Commonwealth Health Insurance Connector Authority, an exchange created prior to the 2010 national health reform law, and found high levels of financial burden and higher-than-expected costs among some enrollees.

Including catheter-associated urinary tract infections in the 2008 CMS payment policy: a qualitative analysis.

The study presented in this article addresses the impact of the 2008 nonpayment policy of the Centers for Medicare and Medicaid Services (CMS) on catheter-associated urinary tract infections (CAUTIs) from the perspective of infection preventionists. With rich qualitative data, it sheds light on the day-to-day impact of this recent health policy on CAUTI prevention.

Perceived impact of the Medicare policy to adjust payment for health care-associated infections.

Background: In 2008, the Centers for Medicare and Medicaid Services (CMS) ceased additional payment for hospitalizations resulting in complications deemed preventable, including several health care-associated infections. We sought to understand the impact of the CMS payment policy on infection prevention efforts.

Methods: A national survey of infection preventionists from a random sample of US hospitals was conducted in December 2010.

Pneumococcal carriage and antibiotic resistance in young children before 13-valent conjugate vaccine.

Background: We sought to measure trends in Streptococcus pneumoniae carriage and antibiotic resistance in young children in Massachusetts communities after widespread adoption of heptavalent 7-valent pneumococcal conjugate vaccine (PCV7) and before the introduction of the 13-valent PCV (PCV13).

Methods: We conducted a cross-sectional study including collection of questionnaire data and nasopharyngeal specimens among children aged <7 years in primary care practices from 8 Massachusetts communities during the winter season of 2008-2009 and compared with similar studies performed in 2001, 2003-2004, and 2006-2007. Antimicrobial susceptibility testing and serotyping were performed on pneumococcal isolates, and risk factors for colonization in recent seasons (2006-2007 and 2008-2009) were evaluated.

Making the CMS payment policy for healthcare-associated infections work: organizational factors that matter.

Healthcare-associated infections (HAIs) are among the most common adverse events in hospitals, and the morbidity and mortality associated with them are significant. In 2008, the Centers for Medicare and Medicaid Services (CMS) implemented a new financial policy that no longer provides payment to hospitals for services related to certain infections not present on admission and deemed preventable. At present, little is known about how this policy is being implemented in hospital settings.

The Medicare policy of payment adjustment for health care-associated infections: perspectives on potential unintended consequences.

In 2008, the Centers for Medicare & Medicaid Services introduced a new policy to adjust payment to hospitals for health care-associated infections (HAIs) not present on admission. Interviews with 36 hospital infection preventionists across the United States explored the perspectives of these key stakeholders on the potential unintended consequences of the current policy. Responses were analyzed using an iterative coding process where themes were developed from the data.

Acceptance of Asthma Pharmacogenetic Study by Children and Adults.

Background: Pharmacogenetic testing may change clinical medicine by allowing clinicians to tailor medications based on a patient's genetic makeup, however, these tests must first be validated in large, real-life populations of subjects that include children. A dearth of knowledge exists for whether pediatric populations are as willing as adult populations to provide samples for such studies.

Objective: (1) To assess whether pediatric and adult patients with persistent asthma are willing to provide specimens for DNA extraction and genetic studies.

Financial barriers to the adoption of combination vaccines by pediatricians.

Objectives: To describe the prevalence of combination vaccine use and the associated financial barriers faced by pediatric practices, and to identify determinants of adoption of combination vaccines.

Design: Mailed national survey.

Setting: Pediatric practices during the period from August through October 2008.

Accuracy of data on influenza vaccination status at four Vaccine Safety Datalink sites.

Background: Studies of influenza vaccination using electronic medical records rely on accurate classification of vaccination status. Vaccinations not entered into electronic records would be unavailable for study.

Purpose: This study evaluated the sensitivity and negative predictive value (NPV) of electronic records for influenza vaccination and factors associated with failure to capture vaccinations.

Predictive value of seizure ICD-9 codes for vaccine safety research.

Post-licensure vaccine safety studies often monitor for seizures using automated screening of ICD-9 codes. This study assessed the positive predictive value (PPV) of ICD-9 codes used to identify seizure visits in children aged 6 weeks to 23 months who were enrolled in seven managed care organizations during January 2000 to December 2005. ICD-9 codes were used to identify visits for seizures in the 0-30-day period following receipt of a pneumococcal vaccine.