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Nazif J, Silver E, Okada C, Gross E. Comparison of Children Hospitalized for Asthma Before and During the COVID-19 Pandemic. Pediatr Allergy Immunol Pulmonol 2022; 35:174-178. [PMID: 36537703 DOI: 10.1089/ped.2022.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: Studies suggest that children with asthma experienced improved symptom control and less frequent inpatient admission during the COVID-19 (coronavirus disease 2019) pandemic. The characteristics of hospitalized children remain less well defined. Methods: This retrospective cohort study compared patients admitted for asthma during the pandemic with patients hospitalized the year prior at a children's hospital in the Bronx, New York. Results: In the year before the pandemic, 667 children were hospitalized for asthma, compared with 177 children the following year. Children admitted during the pandemic were older (7.8 versus 7.0 years, P = 0.04), more likely underweight (P < 0.01), and more likely to have public insurance (P = 0.02). Additionally, children hospitalized during the pandemic required intensive care (P = 0.03) and magnesium sulfate (P = 0.05) more frequently. Despite this, length of stay remained similar. Conclusion: While inpatient utilization for asthma decreased during the pandemic, children hospitalized were sicker on presentation. The cause of this is likely multifactorial and requires further study.
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Affiliation(s)
- Joanne Nazif
- Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York, USA
| | - Ellen Silver
- Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York, USA
| | - Chihiro Okada
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Elissa Gross
- Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York, USA
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Philips K, Zhou R, Lee DS, Marrese C, Nazif J, Browne C, Sinnett M, Tuckman S, Modi A, Rinke ML. Implementation of a Standardized Approach to Improve the Pediatric Discharge Medication Process. Pediatrics 2021; 147:peds.2019-2711. [PMID: 33408070 PMCID: PMC7849199 DOI: 10.1542/peds.2019-2711] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The pediatric inpatient discharge medication process is complicated, and caregivers have difficulty managing instructions. Authors of few studies evaluate systematic processes for ensuring quality in these care transitions. We aimed to improve caregiver medication management and understanding of discharge medications by standardizing the discharge medication process. METHODS An interprofessional team at an urban, tertiary care children's hospital trialed interventions to improve caregiver medication management and understanding. These included mnemonics to aid in complete medication counseling, electronic medical record enhancements to standardize medication documentation and simplify dose rounding, and housestaff education. The primary outcome measure was the proportion of discharge medication-related failures in each 4-week period. Failure was defined as an incorrect response on ≥1 survey questions. Statistical process control was used to analyze improvement over time. Process measures related to medication documentation and dose rounding were compared by using the χ2 test and process control. RESULTS Special cause variation occurred in the mean discharge medication-related failure rate, which decreased from 70.1% to 36.1% and was sustained. There were significantly more complete after-visit summaries (21.0% vs 85.1%; P < .001) and more patients with simplified dosing (75.2% vs 95.6%; P < .001) in the intervention period. Special cause variation also occurred for these measures. CONCLUSIONS A systematic approach to standardizing the discharge medication process led to improved caregiver medication management and understanding after pediatric inpatient discharge. These changes could be adapted by other hospitals to enhance the quality of this care transition.
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Affiliation(s)
- Kaitlyn Philips
- Children's Hospital at Montefiore, Bronx, New York; .,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Roy Zhou
- NewYork-Presbyterian Queens Hospital, Flushing, New York
| | - Diana S. Lee
- Mount Sinai Kravis Children’s Hospital, New York, New York; and
| | - Christine Marrese
- Baystate Children’s Hospital, Baystate Medical Center, Springfield, Massachusetts
| | - Joanne Nazif
- Children’s Hospital at Montefiore, Bronx, New York;,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | | | - Mark Sinnett
- Children’s Hospital at Montefiore, Bronx, New York
| | | | - Anjali Modi
- Children’s Hospital at Montefiore, Bronx, New York
| | - Michael L. Rinke
- Children’s Hospital at Montefiore, Bronx, New York;,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
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Kaiser S, Gupta N, Mendoza J, Azzarone G, Parikh K, Nazif J, Cattamanchi A. Predictors of Quality Improvement in Pediatric Asthma Care. Hosp Pediatr 2020; 10:1114-1119. [PMID: 33257318 DOI: 10.1542/hpeds.2020-0163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Little is known about what hospital and emergency department (ED) factors predict performance in pediatric quality improvement efforts. OBJECTIVES Identify site characteristics and implementation strategies associated with improvements in pediatric asthma care. METHODS In this secondary analysis, we used data from a national quality collaborative. Data on site factors were collected via survey of implementation leaders. Data on quality measures were collected via chart review of children with a primary diagnosis of asthma. ED measures included severity assessment at triage, corticosteroid administration within 60 minutes, avoidance of chest radiographs, and discharge from the hospital. Inpatient measures included early administration of bronchodilator via metered-dose inhaler, screening for tobacco exposure, and caregiver referral to smoking cessation resources. We used multilevel regression models to determine associations between site factors and changes in mean compliance across all measures. RESULTS Sixty-four EDs and 70 inpatient units participated. Baseline compliance was similar by site characteristics. We found significantly greater increases in compliance in EDs within nonteaching versus teaching hospitals (12% vs 5%), smaller versus larger hospitals (10% vs 4%), and rural and urban versus suburban settings (6%-7% vs 3%). In inpatient units, we also found significantly greater increases in compliance in nonteaching versus teaching hospitals (36% vs 17%) and community versus children's hospitals (23% vs 14%). Changes in compliance were not associated with organizational readiness or number of audit and feedback sessions or improvement cycles. CONCLUSIONS Specific hospital and ED characteristics are associated with improvements in pediatric asthma care. Identifying setting-specific barriers may facilitate more targeted implementation support.
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Affiliation(s)
- Sunitha Kaiser
- Departments of Pediatrics, .,Clinical Epidemiology and Biostatistics, and
| | | | - Joanne Mendoza
- Department of Pediatrics, University of Virginia Children's Hospital, Charlottesville, Virginia
| | - Gabriella Azzarone
- Department of Pediatrics, Albert Einstein College of Medicine, New York City, New York; and
| | - Kavita Parikh
- Department of Pediatrics, School of Medicine, The George Washington University, Washington, DC
| | - Joanne Nazif
- Department of Pediatrics, Albert Einstein College of Medicine, New York City, New York; and
| | - Adithya Cattamanchi
- Internal Medicine, University of California, San Francisco, San Francisco, California
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Philips K, Zhou R, Lee DS, Marrese C, Nazif J, Browne C, Sinnett M, Tuckman S, Griffith K, Kiely V, Lutz M, Modi A, Rinke ML. Caregiver Medication Management and Understanding After Pediatric Hospital Discharge. Hosp Pediatr 2019; 9:844-850. [PMID: 31582401 PMCID: PMC6818354 DOI: 10.1542/hpeds.2019-0036] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Caregivers frequently make mistakes when following instructions on discharge medications, and these instructions often contain discrepancies. Minimal literature reflects inpatient discharges. Our objective was to describe failures in caregiver management and understanding of inpatient discharge medications and to test the association of documentation discrepancies and sociodemographic factors with medication-related failures after an inpatient hospitalization. METHODS This study took place in an urban tertiary care children's hospital that serves a low-income, minority population. English-speaking caregivers of children discharged on an oral prescription medication were surveyed about discharge medication knowledge 48 to 96 hours after discharge. The primary outcome was the proportion of caregivers who failed questions on a 10-item questionnaire (analyzed as individual question responses and as a composite outcome of any discharge medication-related failure). Bivariate tests were used to compare documentation errors, complex dosing, and sociodemographic factors to having any discharge medication-related failure. RESULTS Of 157 caregivers surveyed, 70% had a discharge medication-related failure, most commonly because of lack of knowledge about side effects (52%), wrong duration (17%), and wrong start time (16%). Additionally, 80% of discharge instructions provided to caregivers lacked integral medication information, such as duration or when the next dose after discharge was due. Twenty five percent of prescriptions contained numerically complex doses. In bivariate testing, only race and/or ethnicity was significantly associated with having any failure (P = .03). CONCLUSIONS The majority of caregivers had a medication-related failure after discharge, and most discharge instructions lacked key medication information. Future work to optimize the discharge process to support caregiver management and understanding of medications is needed.
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Affiliation(s)
- Kaitlyn Philips
- Children's Hospital at Montefiore, Bronx, New York;
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York; and
| | - Roy Zhou
- Children's Hospital at Montefiore, Bronx, New York
| | - Diana S Lee
- Children's Hospital at Montefiore, Bronx, New York
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York; and
| | | | - Joanne Nazif
- Children's Hospital at Montefiore, Bronx, New York
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York; and
| | | | - Mark Sinnett
- Children's Hospital at Montefiore, Bronx, New York
| | | | | | | | - Marcia Lutz
- Children's Hospital at Montefiore, Bronx, New York
| | - Anjali Modi
- Children's Hospital at Montefiore, Bronx, New York
| | - Michael L Rinke
- Children's Hospital at Montefiore, Bronx, New York
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York; and
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McDaniel CE, Singh AT, Beck JB, Birnie K, Fromme HB, Ginwalla CF, Griego E, King M, Maniscalco J, Nazif J, Patra KP, Seelbach E, Walker JM, Bhansali P. Current Practices and Perspectives on Peer Observation and Feedback: A National Survey. Acad Pediatr 2019; 19:691-697. [PMID: 30910598 DOI: 10.1016/j.acap.2019.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/25/2019] [Accepted: 03/05/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Peer observation and feedback (POF) is the direct observation of an activity performed by a colleague followed by feedback with the goal of improved performance and professional development. Although well described in the education literature, the use of POF as a tool for development beyond teaching skills has not been explored. We aimed to characterize the practice of POF among pediatric hospitalists to explore the perceived benefits and barriers and to identify preferences regarding POF. METHODS We developed a 14-item cross-sectional survey regarding divisional expectations, personal practice, perceived benefits and barriers, and preferences related to POF. We refined the survey based on expert feedback, cognitive interviews, and pilot testing, distributing the final survey to pediatric hospitalists at 12 institutions across the United States. RESULTS Of 357 eligible participants, 198 (56%) responded, with 115 (58%) practicing in a freestanding children's hospital. Although 61% had participated in POF, less than one half (42%) reported divisional POF expectation. The most common perceived benefits of POF were identifying areas for improvement (94%) and learning about colleagues' teaching and clinical styles (94%). The greatest perceived barriers were time (51%) and discomfort with receiving feedback from peers (38%), although participation within a POF program reduced perceived barriers. Most (76%) desired formal POF programs focused on improving teaching skills (85%), clinical management (83%), and family-centered rounds (82%). CONCLUSIONS Although the majority of faculty desired POF, developing a supportive environment and feasible program is challenging. This study provides considerations for improving and designing POF programs.
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Affiliation(s)
- Corrie E McDaniel
- Department of Pediatrics, University of Washington, Seattle (CE McDaniel, JB Beck, and E Griego).
| | - Amit T Singh
- Department of Pediatrics, Stanford University, Palo Alto, Calif (AT Singh)
| | - Jimmy B Beck
- Department of Pediatrics, University of Washington, Seattle (CE McDaniel, JB Beck, and E Griego)
| | - Krista Birnie
- Department of Pediatrics, Tufts University, Boston, Mass (K Birnie)
| | - H Barrett Fromme
- Department of Pediatrics, University of Chicago, Ill (HB Fromme)
| | - Cherie F Ginwalla
- Department of Pediatrics, University of California Davis, Sacramento (CF Ginwalla)
| | - Elena Griego
- Department of Pediatrics, University of Washington, Seattle (CE McDaniel, JB Beck, and E Griego)
| | - Marta King
- Department of Pediatrics, St. Louis University, Mo (M King)
| | - Jennifer Maniscalco
- Department of Pediatrics, Children's Hospital Los Angeles, Calif (J Maniscalco)
| | - Joanne Nazif
- Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY (J Nazif)
| | - Kamakshya P Patra
- Department of Pediatrics, West Virginia University, Morgantown (KP Patra)
| | - Elizabeth Seelbach
- Department of Pediatrics, University of Kentucky, Lexington (E Seelbach)
| | | | - Priti Bhansali
- Department of Pediatrics, Children's National Medical Center, Washington, DC (P Bhansali)
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Parikh K, Biondi E, Nazif J, Wasif F, Williams DJ, Nichols E, Ralston S. A Multicenter Collaborative to Improve Care of Community Acquired Pneumonia in Hospitalized Children. Pediatrics 2017; 139:peds.2016-1411. [PMID: 28148730 DOI: 10.1542/peds.2016-1411] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The Value in Inpatient Pediatrics Network sponsored the Improving Care in Community Acquired Pneumonia collaborative with the goal of increasing evidence-based management of children hospitalized with community acquired pneumonia (CAP). Project aims included: increasing use of narrow-spectrum antibiotics, decreasing use of macrolides, and decreasing concurrent treatment of pneumonia and asthma. METHODS Data were collected through chart review across emergency department (ED), inpatient, and discharge settings. Sites reviewed up to 20 charts in each of 6 3-month cycles. Analysis of means with 3-σ control limits was the primary method of assessment for change. The expert panel developed project measures, goals, and interventions. A change package of evidence-based tools to promote judicious use of antibiotics and raise awareness of asthma and pneumonia codiagnosis was disseminated through webinars. Peer coaching and periodic benchmarking were used to motivate change. RESULTS Fifty-three hospitals enrolled and 48 (91%) completed the 1-year project (July 2014-June 2015). A total of 3802 charts were reviewed for the project; 1842 during baseline cycles and 1960 during postintervention cycles. The median before and after use of narrow-spectrum antibiotics in the collaborative increased by 67% in the ED, 43% in the inpatient setting, and 25% at discharge. Median before and after use of macrolides decreased by 22% in the ED and 27% in the inpatient setting. A decrease in asthma and CAP codiagnosis was noted, but the change was not sustained. CONCLUSIONS Low-cost strategies, including collaborative sharing, peer benchmarking, and coaching, increased judicious use of antibiotics in a diverse range of hospitals for pediatric CAP.
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Affiliation(s)
- Kavita Parikh
- Division of Hospital Medicine, Children's National Health System, and George Washington University School of Medicine, Washington, District of Columbia;
| | - Eric Biondi
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Joanne Nazif
- Children's Hospital at Montefiore, Bronx, New York
| | - Faiza Wasif
- American Academy of Pediatrics, Elk Grove Village, Illinois
| | - Derek J Williams
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt and Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Elizabeth Nichols
- Dartmouth Institute for Health Policy and Clinical Effectiveness, Lebanon, New Hampshire; and
| | - Shawn Ralston
- Department of Pediatrics, Geisel School of Medicine at Children's Hospital at Dartmouth, Lebanon, New Hampshire
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Ralston S, Garber M, Narang S, Shen M, Pate B, Pope J, Lossius M, Croland T, Bennett J, Jewell J, Krugman S, Robbins E, Nazif J, Liewehr S, Miller A, Marks M, Pappas R, Pardue J, Quinonez R, Fine BR, Ryan M. Decreasing unnecessary utilization in acute bronchiolitis care: results from the value in inpatient pediatrics network. J Hosp Med 2013; 8:25-30. [PMID: 23047831 DOI: 10.1002/jhm.1982] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 07/30/2012] [Accepted: 08/20/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND Acute viral bronchiolitis is the most common diagnosis resulting in hospital admission in pediatrics. Utilization of non-evidence-based therapies and testing remains common despite a large volume of evidence to guide quality improvement efforts. OBJECTIVE Our objective was to reduce utilization of unnecessary therapies in the inpatient care of bronchiolitis across a diverse network of clinical sites. METHODS We formed a voluntary quality improvement collaborative of pediatric hospitalists for the purpose of benchmarking the use of bronchodilators, steroids, chest radiography, chest physiotherapy, and viral testing in bronchiolitis using hospital administrative data. We shared resources within the network, including protocols, scores, order sets, and key bibliographies, and established group norms for decreasing utilization. RESULTS Aggregate data on 11,568 hospitalizations for bronchiolitis from 17 centers was analyzed for this report. The network was organized in 2008. By 2010, we saw a 46% reduction in overall volume of bronchodilators used, a 3.4 dose per patient absolute decrease in utilization (95% confidence interval [CI] 1.4-5.8). Overall exposure to any dose of bronchodilator decreased by 12 percentage points as well (95% CI 5%-25%). There was also a statistically significant decline in chest physiotherapy usage, but not for steroids, chest radiography, or viral testing. CONCLUSIONS Benchmarking within a voluntary pediatric hospitalist collaborative facilitated decreased utilization of bronchodilators and chest physiotherapy in bronchiolitis.
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Affiliation(s)
- Shawn Ralston
- Department of Pediatrics, Division of Inpatient Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA.
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Delaney KM, Gewirtzman AJ, Cohen SR, Nazif J. Sepsis due to superinfected varicella? A case of a challenging rash. Hosp Pediatr 2012; 2:243-246. [PMID: 24313032 DOI: 10.1542/hpeds.2012-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Kristen M Delaney
- The Children's Hospital at Montefiore, Montefiore Medical Center, Department of Pediatrics, 3415 Bainbridge Ave, Bronx, NY 10467, USA.
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Tofteland ND, Stuart-Hilgenfeld M, Hunt R, Tamma P, Canares TL, Yao-Cohen M, Nazif J. Index of suspicion, case 1: hemoptysis, dyspnea, and hematuria, case 2: rash and headache in a wrestler, case 3: abdominal distention in a teenage girl. Pediatr Rev 2010; 31:477-82. [PMID: 21041426 DOI: 10.1542/pir.31-11-477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Nathan D Tofteland
- Department of Pediatrics, University of Kansas School of Medicine Wichita, Wichita, Ks., USA
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