The APA and the rise of pediatric generalist network research

Attitudes of primary healthcare chief physicians towards research in Finland - a national study

OBJECTIVE

To illustrate the views of chief physicians in Finnish primary healthcare health centres (HCs) on the existing research capacity of their centres, their attitudes to practice-based research network activity, and research topics of interest to them.

DESIGN

A cross-sectional survey study.

SETTING

Finnish HCs.

SUBJECTS

Chief physicians in Finnish HCs.

MAIN OUTCOME MEASURES

We used a questionnaire that included five-point Likert scales and multiple choice and open-ended questions to identify the chief physician's profile, the HC content, the attitudes of chief physicians towards engagement in research, research topics of interest to them, and factors that may influence their motivation. Descriptive methods were used for the analysis of the quantitative data, while the qualitative data were processed using inductive thematic analysis.

RESULTS

There was a relatively good representation of all hospital districts. One-third of HCs had at least one person doing research, and 61% of chief physicians would support research in their setting. Their stimulus for research was primarily testing new therapies, protocols, and care processes, as well as effectiveness and healthcare improvement. The expected benefits that motivate engagement in Practice-based research networks (PBRNs) are evidence-based practice and raised professional capacity and profile of the HC.

CONCLUSIONS

Chief physicians regard research as an elementary part of the development of primary care practices and health policy. Their motivation to engage in PBRN activity is determined by the relevance of the research to their interests and the management of competing priorities and resource limitations.

Research and publication trends in hospital medicine

BACKGROUND

Research by hospitalists may aid the evolution of hospital medicine into an academic specialty.

OBJECTIVE

To describe the factors associated with research and publication activities among hospitalists and describe trends in hospitalist-led publications.

METHODS

We surveyed members of the Society of Hospital Medicine in June 2012 and conducted univariate analyses on their responses to determine predictors of successful authorship and to describe factors associated with research engagement. We searched PubMed from the database inception to October 2013 for publications with "hospitalist" or "hospital medicine" affiliated authors. Original research articles were reviewed for methodology and funding sources.

RESULTS

Of the 645 respondents (5.8% response rate), 277 (43%) had authored peer-reviewed publications, 126 (19%) had access to mentorship, and 68 (11%) reported funding support. There were 213 (33%) who were engaged in research, with the majority conducting quality improvement (QI) research (n = 152, 24%). Completion of a fellowship, pediatrics training, the presence of a mentor, funding, and >25% protected time for research were each individually associated with an increased likelihood of authoring publications. Hospitalist-led publications in PubMed have been increasing from 36 in 2006 to 179 in the first 10 months of 2013. Of the original research publications (n = 317), the majority were clinical (n = 129, 41%), and 58 (18%) were QI. Thirty-nine (22%) authors reported funding support.

CONCLUSIONS

Peer-reviewed publications by hospitalists are increasing, suggesting the academic maturation of hospital medicine. Provision of mentorship for hospitalists specifically in QI and guidance toward funding resources may assist in supporting this trend.

Creating a national home visiting research network

Home visiting can play a key role in the early childhood system of services. For home visiting to achieve its potential, decision-makers must make informed choices regarding adoption, adaptation, coordination, scale-up, and sustainment. We need a coordinated, focused, and theory-based home visiting research infrastructure to inform such decisions. The transdisciplinary Home Visiting Research Network (HVRN) was established in July 2012 with funding from the Health Resources and Services Administration. Its goal is to promote the translation of research findings into policy and practice. Its objectives are to (1) develop a national home visiting research agenda, (2) advance the use of innovative research methods; and (3) provide a research environment that is supportive of the professional development of emerging researchers interested in home visiting. A Management Team designs and directs activities to achieve these objectives through Work Teams. A Steering Committee of national leaders representing stakeholder groups oversees progress. HVRN's Coordinating Center supports the Work Teams and HVRN's Home visiting Applied Research Collaborative, a practice-based research network of home visiting programs. This article describes HVRN's rationale, approach, and anticipated products. We use home visiting-primary care coordination as an illustration, noting potential roles for pediatric practices and pediatric researchers and research educators in HVRN activities. HVRN creates the infrastructure for a rigorous program of research to inform policy and practice on home visiting as part of the system of services to improve family functioning, parenting, and child outcomes.

Increasing adolescent immunization rates in primary care: strategies physicians use and would consider implementing

Strategies to increase adolescent immunization rates have been suggested, but little is documented about which strategies clinicians actually use or would consider. In spring 2010, we surveyed primary care physicians from 2 practice-based research networks (PBRNs): Greater Rochester PBRN (GR-PBRN) and national pediatric COntinuity Research NETwork (CORNET). Network clinicians received mailed or online surveys (response rate 76%, n=148). The GR-PBRN patient population (51% suburban, 33% rural, and 16% urban) differed from that served by CORNET (85% urban). For nonseasonal vaccines recommended for adolescents, many GR-PBRN and CORNET practices reported using nurse prompts to providers at preventive visits (61% and 52%, respectively), physician education (53% and 53%), and scheduled vaccine-only visits (91% and 82%). Strategies not used that clinicians frequently indicated they would consider included patient reminder/recall and prompts to providers via nurses or electronic health records. As preventive visits and immunization recommendations grow more complex, using technology to support immunization delivery to adolescents might be effective.

Pediatric hospital medicine and children with medical complexity: past, present, and future

Children with medical complexity, regardless of underlying diagnoses, share similar functional and resource use consequences, including: intensive service needs, reliance on technology, polypharmacy, and/or home care or congregate care to maintain a basic quality of life, high health resource utilization, and, an elevated need for care coordination. The emerging field of complex care is focused on the holistic medical care of these children, which requires both broad general pediatrics skills and specific expertise in care coordination and communication with patients, families, and other medical and non-medical care providers. Many pediatric hospitalists have developed an interest in care coordination for CMC, and pediatric hospitalists are in an ideal location to embrace complex care. As a result of these factors, complex care has emerged as a field with many pediatric hospitalists at the helm, in arenas ranging from clinical care of these patients, research into their care, and education of future providers. The objective of this section of the review article is to outline the past, present, and possible future of children with medical complexity within several arenas in the field of pediatric hospital medicine, including practice management, clinical care, research, education, and quality improvement.