The Future of Inpatient Community Hospital Care: Is There One?

Community hospital inpatient pediatric programs face a variety of challenges including financial instability, variable censuses, difficulty maintaining qualified staff, and a lack of focus for the hospital. With the addition of new payment models, such as bundled payments and global budgets, along with a global pandemic, the future of community hospital pediatric inpatient care is uncertain at best. In this article we summarize the challenges, opportunities, and potential solutions to maintaining high-quality care for hospitalized children in community hospitals.

A Hospital-Based Initiative to Reduce Postdischarge Sudden Unexpected Infant Deaths.

Background And Objectives: Sudden unexpected infant deaths (SUID) most often occur because infants are placed in unsafe sleep environments. Although authors of previous literature have demonstrated that parents who receive comprehensive safe sleep education increase knowledge and intention to place children in safe sleep environments, no studies have demonstrated improved outcomes. We describe the development of a hospital-based newborn SUID risk reduction quality improvement project and its effectiveness in reducing subsequent SUIDs in a community using linked outcome data from local Child Fatality Review Teams.

Changes in Asthma Maintenance Therapy Prescribing Patterns Following the 2006 Long-acting β-Agonist FDA Drug Warning.

Purpose: The US Food and Drug Administration issued a boxed warning on all products containing a long-acting β-agonist (LABA) in March 2006, after the findings from a trial suggested an increased risk for death in patients treated with salmeterol monotherapy. Almost nothing is known about the impact of this warning on LABA prescribing patterns or on clinicians' approaches to asthma maintenance therapy.

Methods: A cohort of asthmatic adults on LABA therapy was retrospectively identified from a Baltimore-area Medicaid data warehouse.

Improving infant sleep safety through a comprehensive hospital-based program.

We evaluated a comprehensive hospital-based infant safe sleep education program on parental education and safe sleep behaviors in the home using a cross-sectional survey of new parents at hospital discharge (HD) and 4-month follow-up (F/U). Knowledge and practices of infant safe sleep were compared to the National Infant Sleep Position Study benchmark. There were 1092 HD and 490 F/U surveys.

Advocacy and child neglect.

Pediatricians have a unique opportunity to intervene in the lives of children to identify and to prevent neglect. While it remains important to care for individual patients affected by neglect, the ecological model of child neglect requires intervention at the parent, family, community, and societal levels. Pediatricians can improve the outcomes for children by advocating for policies and interventions at each level.

Variability of the institutional review board process within a national research network.

Objective: To determine the variability of the institutional review board (IRB) process for a minimal risk multicenter study.

Methods: Participants included 24 Continuity Research Network (CORNET) sites of the Academic Pediatric Association that participated in a cross-sectional study. Each site obtained individual institutional IRB approval.

Effect of focused debriefing on team communication skills.

Background And Objective: Community hospitals often lack tertiary care support such as pediatric intensivists and anesthesiologists. Resuscitation of critically ill and injured children in community hospitals requires a well-coordinated team effort, because good team performance improves quality of care. The lack of subspecialty support makes team coordination and communication more imperative yet much more challenging.

Newborn adiposity by body mass index predicts childhood overweight.

Objective: To evaluate the association between adiposity at birth and in infancy with overweight at age 5 years. This study hypothesizes that adiposity at birth as approximated by body mass index (BMI) predicts childhood fatness.

Methods: Anthropomorphic data from birth to 5 years were used to calculate BMI percentiles.

Gender disparity in women's health training at a family medicine residency program.

Background And Objectives: Women's health services are an important part of the practice of family medicine. Anecdotally, family medicine residents' training experience in certain aspects of women's health differs based on the trainees' gender.

Methods: We conducted 5-year retrospective evaluation of acute and preventive women's health encounters at one site.

Does quality of primary care vary by level of training in pediatric resident continuity practices?

Objective: The aim of this study was to compare parental perception of quality of care provided by first- versus third-year pediatric residents who served as their children's primary care providers.

Methods: The Parents' Perception of Primary Care (P3C) survey was administered to all parents who identified a pediatric resident as a primary care provider at 19 Continuity Research Network (CORNET) sites. Parent survey scores were compared between those identifying first-year pediatric residents (PL-1) versus third-year pediatric residents (PL-3) as care providers by using t tests and linear regression modeling, as well as item-specific chi-square analysis and logistic regression.

Spanish-speaking patients perceive high quality care in resident continuity practices: a CORNET study.

Prior research has demonstrated that limited English proficiency in Hispanic patients is associated with adverse health outcomes. The authors sought to compare the perception of primary care in resident practices between Spanish-speaking and English-speaking parents using a previously validated tool, the Parents' Perception of Primary Care. Using survey results from 19 CORNET sites nationwide, they compared mean scores for each primary care domain and the full scale between the groups using Student's t test.

Update on child abuse prevention.

Purpose Of Review: Child abuse remains a significant problem in the United States with 2.9 million reports and 825 000 indicated cases in 2005. This report will highlight recent efforts toward child abuse prevention, focusing on home visiting programs, abusive head trauma primary prevention, parent training programs, sexual abuse prevention, and the effectiveness of laws banning corporal punishment.

Measuring primary care of children in pediatric resident continuity practices: a Continuity Research Network study.

Objectives: Pediatric resident continuity practices provide care to more than one fifth of the socioeconomically disadvantaged population of the United States. With the structural challenges of resident training, there may be concerns about a lower quality of care received by patients. The objectives of this study were to measure parental perception of resident primary care, to determine the characteristics associated with better care, and to compare perception with a previously published community standard.

Forced suffocation of infants with baby wipes: a previously undescribed form of child abuse.

Background: Foreign body aspiration in children is commonly seen in emergency departments and carries a significant mortality. Abusive foreign body suffocation is not well described.

Methods: We present a case-series of four infants who presented with aspiration of a baby wipe.

Redefining the community pediatric hospitalist: the combined pediatric ED/inpatient unit.

Background: The use of pediatric hospitalists in community hospitals has increased over the past decade in response to the desire to provide high-quality pediatric care. Many hospitals are challenged to create financially independent and productive programs.

Objective: To evaluate an alternative approach to traditional community hospital pediatric care of having pediatricians work in a combined pediatric Emergency Department (PED)/inpatient unit.