المؤلفون: Rhodes, Erinn T., Phan, Thao-Ly T., Earley, Elizabeth R., Eneli, Ihuoma, Haemer, Matthew A., Highfield, Nikki C., Khan, Saba, Kim, Grace, Kirk, Shelley, Sullivan, Elizabeth Monti, Stoll, Janis M., Werk, Lloyd N., Zeribi, Karen Askov, Forrest, Christopher B., Lannon, Carole, Hassink, Sandra, Liu, Lenna, Siegel, Robert

المصدر: Childhood Obesity ; volume 20, issue 1, page 1-10 ; ISSN 2153-2168 2153-2176

مصطلحات موضوعية: Nutrition and Dietetics, Endocrinology, Diabetes and Metabolism, Pediatrics, Perinatology and Child Health

الإتاحة: https://doi.org/10.1089/chi.2022.0151Test

المؤلفون: Walsh, Kathleen E., Razzaghi, Hanieh, Hartley, David M., Utidjian, Levon, Alford, Shannon, Darwar, Rahul A., Shenkman, Elizabeth, Jonas, Susannah, Goodick, Mary, Finkelstein, Jonathan, Ozonoff, Al, Black, L. Vandy, Shapiro, Michael, Shaw, Kathryn, McCafferty-Fernandez, Jennifer, Marsolo, Keith, Kelly, Amy, Werk, Lloyd N., Smallwood, Jordan, Bailey, Charles

المصدر: Pediatric Quality & Safety ; volume 6, issue 4, page e432 ; ISSN 2472-0054

الوصف: Introduction: Health systems spend $1.5 billion annually reporting data on quality, but efficacy and utility for benchmarking are limited due, in part, to limitations of data sources. Our objective was to implement and evaluate measures of pediatric quality for three conditions using electronic health record (EHR)-derived data. Methods: PCORnet networks standardized EHR-derived data to a common data model. In 13 health systems from 2 networks for 2015, we implemented the National Quality Forum measures: % children with sickle cell anemia who received a transcranial Doppler; % children on antipsychotics who had metabolic screening; and % pediatric acute otitis media with amoxicillin prescribed. Manual chart review assessed measure accuracy. Results: Only 39% (N = 2,923) of 7,278 children on antipsychotics received metabolic screening (range: 20%–54%). If the measure indicated screening was performed, the chart agreed 88% of the time [95% confidence interval (CI): 81%–94%]; if it indicated screening was not done, the chart agreed 86% (95% CI: 78%–93%). Only 69% (N = 793) of 1,144 children received transcranial Doppler screening (range across sites: 49%–88%). If the measure indicated screening was performed, the chart agreed 98% of the time (95% CI: 94%–100%); if it indicated screening was not performed, the chart agreed 89% (95% CI: 82%–95%). For acute otitis media, chart review identified many qualifying cases missed by the National Quality Forum measure, which excluded a common diagnostic code. Conclusions: Measures of healthcare quality developed using EHR-derived data were valid and identified wide variation among network sites. This data can facilitate the identification and spread of best practices.

الإتاحة: https://doi.org/10.1097/pq9.0000000000000432Test

المؤلفون: Werk, Lloyd N., Diaz, Maria Carmen, Cadilla, Adriana, Franciosi, James P., Hossain, Jobayer

المصدر: Aria Health Papers

مصطلحات موضوعية: computerized clinical decision support, influenza vaccination, practice variation, quasi-experimental design, web-based training, Medicine and Health Sciences, Pediatrics, Primary Care

الوصف: OBJECTIVES: In the United States, nonadherence to seasonal influenza vaccination guidelines for children and adolescents is common and results in unnecessary morbidity and mortality. We conducted a quality improvement project to improve vaccination rates and test effects of 2 interventions on vaccination guidelines adherence. METHODS: We conducted a cluster randomized control trial with 11 primary care practices (PRACTICE) that provided care for 11 293 individual children and adolescents in a children's health care system from September 2015 through April 2016. Practice sites (with their clinicians) were randomly assigned to 4 arms (no intervention [Control], computerized clinical decision support system [CCDSS], web-based training [WBT], or CCDSS and WBT [BOTH]). RESULTS: During the study, 55.8% of children and adolescents received influenza vaccination, which improved modestly during the study period compared with the prior influenza season ( P = .009). Actual adherence to recommendations, including dosing, timeliness, and avoidance of missed opportunities, was 46.4% of patients cared for by the PRACTICE. The WBT was most effective in promoting adherence with vaccination recommendations with an estimated average odds ratio = 1.26, P < .05, to compare between preintervention and intervention periods. Over the influenza season, there was a significantly increasing trend in odds ratio in the WBT arm ( P < .05). Encouraging process improvements and providing longitudinal feedback on monthly rate of vaccination sparked some practice changes but limited impact on outcomes. CONCLUSIONS: Web-based training at the start of influenza season with monthly reports of adherence can improve correct dose and timing of influenza vaccination with modest impact on overall vaccination rate.

وصف الملف: application/pdf

العلاقة: https://jdc.jefferson.edu/ariafp/3Test; https://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1002&context=ariafpTest

الإتاحة: https://jdc.jefferson.edu/ariafp/3Test
https://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1002&context=ariafpTest

المؤلفون: Phan, Thao-Ly Tam, Barnini, Nadia, Xie, Sherlly, Martinez, Angelica, Falini, Lauren, Abatemarco, Atiera, Waldron, Maura, Benton, Jane M, Frankenberry, Steve, Coleman, Cassandra, Nguyen, Linhda, Bo, Cindy, Datto, George A, Werk, Lloyd N

المصدر: JMIR mHealth and uHealth, Vol 6, Iss 11, p e10523 (2018)

مصطلحات موضوعية: Information technology, T58.5-58.64, Public aspects of medicine, RA1-1270

الوصف: BackgroundFitness trackers can engage users through automated self-monitoring of physical activity. Studies evaluating the utility of fitness trackers are limited among adolescents, who are often difficult to engage in weight management treatment and are heavy technology users. ObjectiveWe conducted a pilot randomized trial to describe the impact of providing adolescents and caregivers with fitness trackers as an adjunct to treatment in a tertiary care weight management clinic on adolescent fitness tracker satisfaction, fitness tracker utilization patterns, and physical activity levels. MethodsAdolescents were randomized to 1 of 2 groups (adolescent or dyad) at their initial weight management clinic visit. Adolescents received a fitness tracker and counseling around activity data in addition to standard treatment. A caregiver of adolescents in the dyad group also received a fitness tracker. Satisfaction with the fitness tracker, fitness tracker utilization patterns, and physical activity patterns were evaluated over 3 months. ResultsA total of 88 adolescents were enrolled, with 69% (61/88) being female, 36% (32/88) black, 23% (20/88) Hispanic, and 63% (55/88) with severe obesity. Most adolescents reported that the fitness tracker was helping them meet their healthy lifestyle goals (69%) and be more motivated to achieve a healthy weight (66%). Despite this, 68% discontinued use of the fitness tracker by the end of the study. There were no significant differences between the adolescent and the dyad group in outcomes, but adolescents in the dyad group were 12.2 times more likely to discontinue using their fitness tracker if their caregiver also discontinued use of their fitness tracker (95% CI 2.4-61.6). Compared with adolescents who discontinued use of the fitness tracker during the study, adolescents who continued to use the fitness tracker recorded a higher number of daily steps in months 2 and 3 of the study (mean 5760 vs 4148 in month 2, P=.005, and mean 5942 vs 3487 in month 3, P=.002). ConclusionsDespite high levels of satisfaction with the fitness trackers, fitness tracker discontinuation rates were high, especially among adolescents whose caregivers also discontinued use of their fitness tracker. More studies are needed to determine how to sustain the use of fitness trackers among adolescents with obesity and engage caregivers in adolescent weight management interventions.

وصف الملف: electronic resource

العلاقة: http://mhealth.jmir.org/2018/11/e10523Test/; https://doaj.org/toc/2291-5222Test

الوصول الحر: https://doaj.org/article/f2e2ef798bfb44dab2a174704731528eTest

المؤلفون: Hill, Samareh G, Phan, Thao-Ly T, Datto, George A, Hossain, Jobayer, Werk, Lloyd N, Abatemarco, Diane

المساهمون: Nemours Research Institute

المصدر: Journal of Child Health Care ; volume 23, issue 1, page 63-78 ; ISSN 1367-4935 1741-2889

مصطلحات موضوعية: Pediatrics, Pediatrics, Perinatology and Child Health

الوصف: Pediatric primary care providers play a critical role in managing obesity yet often lack the resources and support systems to provide effective care to children with obesity. The objective of this study was to identify system-level barriers to managing obesity and resources desired to better managing obesity from the perspective of pediatric primary care providers. A 64-item survey was electronically administered to 159 primary care providers from 26 practices within a large pediatric primary care network. Bivariate analyses were performed to compare survey responses based on provider and practice characteristics. Also factor analysis was conducted to determine key constructs that effect pediatric interventions for obesity. Survey response rate was 69% ( n = 109), with the majority of respondents being female (77%), physicians (67%), and without prior training in obesity management (74%). Time constraints during well visits (86%) and lack of ancillary staff (82%) were the most frequently reported barriers to obesity management. Information on community resources (99%), an on-site dietitian (96%), and patient educational materials (94%) were most frequently identified as potentially helpful for management of obesity in the primary care setting. Providers who desired more ancillary staff were significantly more likely to practice in clinics with a higher percentage of obese, Medicaid, and Hispanic patients. Integrating ancillary lifestyle expert support into primary care practices and connecting primary care practices to community organizations may be a successful strategy for assisting primary care providers with managing childhood obesity, especially among vulnerable populations.

الإتاحة: https://doi.org/10.1177/1367493518777308Test

المؤلفون: Diaz, Maria Carmen G., Wysocki, Tim, Crutchfield, James H., Franciosi, James P., Werk, Lloyd N.

المساهمون: Telemedicine and Advanced Technology Research Center

المصدر: American Journal of Medical Quality ; volume 34, issue 2, page 182-188 ; ISSN 1062-8606 1555-824X

الإتاحة: https://doi.org/10.1177/1062860618792667Test

المؤلفون: Wysocki, Tim, Diaz, Maria Carmen G., Crutchfield, James H., Franciosi, James P., Werk, Lloyd N.

المساهمون: Department of Defense - Telemedicine and Advanced Technology Research Center research

المصدر: Journal of Biomedical Informatics ; volume 70, page 14-26 ; ISSN 1532-0464

مصطلحات موضوعية: Health Informatics, Computer Science Applications

الإتاحة: https://doi.org/10.1016/j.jbi.2017.04.016Test
https://api.elsevier.com/content/article/PII:S1532046417300862?httpAccept=text/xmlTest
https://api.elsevier.com/content/article/PII:S1532046417300862?httpAccept=text/plainTest

المؤلفون: Druce Axley, Jennifer, Werk, Lloyd N.

المصدر: Pediatric Physical Therapy ; volume 28, issue 4, page 386-391 ; ISSN 0898-5669

الوصف: Purpose: To determine whether abdominal obesity is associated with lower exercise tolerance in children. Methods: Waist-to-height ratios (WHtRs) were determined for 50 children aged 8 to 12 years with body mass index greater than the 95th percentile and 6-minute walk distance (6MWD) conducted. Results: Mean 6MWD was found to be 510 (standard deviation = 60) m. Univariate analysis revealed that WHtR was the only significant predictor of 6MWD ( P = .01). In modeling using multiple regression analysis, 26% of the variance in 6MWD could be attributed to the participant's age, WHtR, and sex; WHtR was the only significant contributor to 6MWD ( P = .001). Conclusion: WHtR was the most strongly correlated factor with distance achieved on the 6-minute walk test, a measure of exercise tolerance, and is an important measure to screen for cardiovascular disease risk and to prompt further evaluation of functional exercise capacity.

الإتاحة: https://doi.org/10.1097/pep.0000000000000284Test
https://journals.lww.com/00001577-201628040-00008Test

المؤلفون: Diaz, Maria Carmen G., Handy, Lori K., Crutchfield, James H., Cadilla, Adriana, Hossain, Jobayer, Werk, Lloyd N.

المساهمون: Telemedicine and Advanced Technology Research Center

المصدر: Clinical Pediatrics ; volume 59, issue 11, page 988-994 ; ISSN 0009-9228 1938-2707

مصطلحات موضوعية: Pediatrics, Perinatology and Child Health

الوصف: Antibiotic choice for pediatric community-acquired pneumonia (CAP) varies widely. We aimed to determine the impact of a 6-month personalized audit and feedback program on primary care providers’ antibiotic prescribing practices for CAP. Participants in the intervention group received monthly personalized feedback. We then analyzed enrolled providers’ CAP antibiotic prescribing practices. Participants diagnosed 316 distinct cases of CAP (214 control, 102 intervention); among these 316 participants, 301 received antibiotics (207 control, 94 intervention). In patients ≥5 years, the intervention group had fewer non–guideline-concordant antibiotics prescribed (22/103 [21.4%] control; 3/51 [5.9%] intervention, P < .05) and received more of the guideline-concordant antibiotics (amoxicillin and azithromycin). Personalized, scheduled audit and feedback in the outpatient setting was feasible and had a positive impact on clinician’s selection of guideline-recommended antibiotics. Audit and feedback should be combined with other antimicrobial stewardship interventions to improve guideline adherence in the management of outpatient CAP.

الإتاحة: https://doi.org/10.1177/0009922820928054Test

المؤلفون: Myers, Joseph, Werk, Lloyd N., Hossain, M. Jobayer, Lawless, Stephen

المصدر: American Journal of Medical Quality ; volume 35, issue 5, page 411-418 ; ISSN 1062-8606 1555-824X

الوصف: Among children hospitalized for acute problems, comorbid obesity is commonly unaddressed. The objective was to improve identification and initial management of obesity among hospitalized children. In collaboration with nurses and dietitians, pediatric hospitalists of 2 children’s hospitals conducted a quality improvement project to improve body mass index (BMI) documentation, obesity diagnosis, diet, and nutrition consultation through clinician education, development of computerized clinical decision-support system tools, and workflow modifications. Participants received monthly performance feedback. Among those with elevated BMI, diagnosis rose to 70.2%; a documented obesity diagnosis was associated with being 35 times more likely ( P < .001) to receive at least 1 intervention while hospitalized. Participants reported an increase in skill in (27%), comfort with (27%), and knowledge of (33%) obesity management. Improvement in health care provider recognition and management of obesity in the inpatient setting is achievable. Additional work is needed to identify how best to sustain desired practice patterns.

الإتاحة: https://doi.org/10.1177/1062860619898534Test