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Desai AD, Tolpadi A, Parast L, Esporas M, Britto MT, Gidengil C, Wilson K, Bardach NS, Basco WT, Brittan MS, Johnson DP, Wood KE, Yung S, Dawley E, Fiore D, Gregoire L, Hodo LN, Leggett B, Piazza K, Sartori LF, Weber DE, Mangione-Smith R. Improving the Quality of Written Discharge Instructions: A Multisite Collaborative Project. Pediatrics 2023; 151:191090. [PMID: 37078242 DOI: 10.1542/peds.2022-059452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Written discharge instructions help to bridge hospital-to-home transitions for patients and families, though substantial variation in discharge instruction quality exists. We aimed to assess the association between participation in an Institute for Healthcare Improvement Virtual Breakthrough Series collaborative and the quality of pediatric written discharge instructions across 8 US hospitals. METHODS We conducted a multicenter, interrupted time-series analysis of a medical records-based quality measure focused on written discharge instruction content (0-100 scale, higher scores reflect better quality). Data were from random samples of pediatric patients (N = 5739) discharged from participating hospitals between September 2015 and August 2016, and between December 2017 and January 2020. These periods consisted of 3 phases: 1. a 14-month precollaborative phase; 2. a 12-month quality improvement collaborative phase when hospitals implemented multiple rapid cycle tests of change and shared improvement strategies; and 3. a 12-month postcollaborative phase. Interrupted time-series models assessed the association between study phase and measure performance over time, stratified by baseline hospital performance, adjusting for seasonality and hospital fixed effects. RESULTS Among hospitals with high baseline performance, measure scores increased during the quality improvement collaborative phase beyond the expected precollaborative trend (+0.7 points/month; 95% confidence interval, 0.4-1.0; P < .001). Among hospitals with low baseline performance, measure scores increased but at a lower rate than the expected precollaborative trend (-0.5 points/month; 95% confidence interval, -0.8 to -0.2; P < .01). CONCLUSIONS Participation in this 8-hospital Institute for Healthcare Improvement Virtual Breakthrough Series collaborative was associated with improvement in the quality of written discharge instructions beyond precollaborative trends only for hospitals with high baseline performance.
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Affiliation(s)
- Arti D Desai
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | | | | | - Megan Esporas
- Children's Hospital Association, Washington, District of Columbia
| | - Maria T Britto
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Karen Wilson
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Naomi S Bardach
- Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, California
| | - William T Basco
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Mark S Brittan
- Department of Pediatrics, University of Colorado, Aurora, Colorado
| | - David P Johnson
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Kelly E Wood
- Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Steven Yung
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Erin Dawley
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Darren Fiore
- Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, California
| | | | - Laura N Hodo
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brett Leggett
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Kirstin Piazza
- Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Laura F Sartori
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Danielle E Weber
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; and
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Clark SL, Begin B, De Souza HG, Mallett K, Hanna MG, Richardson T, Esporas M, Bowie A, Taylor K, Reyes LC, Hughey M, Neu A, Warady BA. Telehealth survey of providers and caregivers of children on peritoneal dialysis during the COVID-19 pandemic. Pediatr Nephrol 2023; 38:203-210. [PMID: 35425999 PMCID: PMC9010071 DOI: 10.1007/s00467-022-05543-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND There has been growing support for the adoption of telehealth (TH) services in pediatric populations. Children on chronic peritoneal dialysis (PD) represent a vulnerable population that could benefit from increased use of TH. The COVID-19 pandemic prompted rapid adoption of TH services in the population among pediatric centers participating in The Children's Hospital Association's Standardizing Care to Improve Outcomes in Pediatric ESKD (SCOPE) Collaborative. METHODS We developed a survey to explore the experience of both pediatric PD providers and caregivers of patients receiving PD care at home and using TH services during the COVID-19 pandemic. RESULTS We obtained responses from 27 out of 53 (50.9%) SCOPE centers that included 175 completed surveys from providers and caregivers. Major challenges identified by providers included inadequate/lack of physical exam, inability to visit with the patient/family in-person, and inadequate/lack of PD catheter exit site exam. Only 51% of caregivers desired future TH visits; however, major benefits of TH for caregivers included no travel, visit takes less time, easier to care for other children, more comfortable for patient, and no time off from work. Providers and caregivers agreed that PD TH visits are family centered (p = 0.296), with the lack of a physical exam (p < 0.001) and the inability to meet in-person (p = 0.002) deemed particularly important to caregivers and providers, respectively. CONCLUSIONS TH is a productive and viable visit option for children on PD; however, making this a successful, permanent part of routine care will require an individualized approach with standardization of core elements. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Stephanie L. Clark
- Department of Pediatrics, Division of Nephrology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
| | - Brandy Begin
- Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, OR USA
| | | | | | - Melisha G. Hanna
- Children’s Hospital Colorado, Department of Pediatrics, Division of Nephrology, University of Colorado, Aurora, CO USA
| | - Troy Richardson
- Children’s Hospital Association, Washington D.C. and Lenexa, KS USA
| | - Megan Esporas
- Children’s Hospital Association, Washington D.C. and Lenexa, KS USA
| | | | - Karri Taylor
- Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, OR USA
| | | | | | - Alicia Neu
- Department of Pediatrics, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD USA
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Leyenaar JK, Tolpadi A, Parast L, Esporas M, Britto MT, Gidengil C, Wilson KM, Bardach NS, Basco WT, Brittan MS, Williams DJ, Wood KE, Yung S, Dawley E, Elliott A, Manges KA, Plemmons G, Rice T, Wiener B, Mangione-Smith R. Collaborative to Increase Lethal Means Counseling for Caregivers of Youth With Suicidality. Pediatrics 2022; 150:e2021055271. [PMID: 36321386 PMCID: PMC10578326 DOI: 10.1542/peds.2021-055271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The number of youth presenting to hospitals with suicidality and/or self-harm has increased substantially in recent years. We implemented a multihospital quality improvement (QI) collaborative from February 1, 2018 to January 31, 2019, aiming for an absolute increase in hospitals' mean rate of caregiver lethal means counseling (LMC) of 10 percentage points (from a baseline mean performance of 68% to 78%) by the end of the collaborative, and to evaluate the effectiveness of the collaborative on LMC, adjusting for secular trends. METHODS This 8 hospital collaborative used a structured process of alternating learning sessions and action periods to improve LMC across hospitals. Electronic medical record documentation of caregiver LMC was evaluated during 3 phases: precollaborative, active QI collaborative, and postcollaborative. We used statistical process control to evaluate changes in LMC monthly. Following collaborative completion, interrupted time series analyses were used to evaluate changes in the level and trend and slope of LMC, adjusting for covariates. RESULTS In the study, 4208 children and adolescents were included-1314 (31.2%) precollaborative, 1335 (31.7%) during the active QI collaborative, and 1559 (37.0%) postcollaborative. Statistical process control analyses demonstrated that LMC increased from a hospital-level mean of 68% precollaborative to 75% (February 2018) and then 86% (October 2018) during the collaborative. In interrupted time series analyses, there were no significant differences in LMC during and following the collaborative beyond those expected based on pre-collaborative trends. CONCLUSIONS LMC increased during the collaborative, but the increase did not exceed expected trends. Interventions developed by participating hospitals may be beneficial to others aiming to improve LMC for caregivers of hospitalized youth with suicidality.
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Affiliation(s)
- JoAnna K. Leyenaar
- Department of Pediatrics and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | | | | | - Megan Esporas
- Children’s Hospital Association, Washington, District of Columbia
| | - Maria T. Britto
- Department of Pediatrics and Patient Services, Cincinnati Children’s Hospital Medical Center, and the University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Karen M. Wilson
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York
| | - Naomi S. Bardach
- Department of Pediatrics, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
| | - William T. Basco
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Mark S. Brittan
- Department of Pediatrics, University of Colorado and Children’s Hospital Colorado, Aurora, Colorado
| | - Derek J. Williams
- Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - Kelly E. Wood
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Steven Yung
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Erin Dawley
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Audrey Elliott
- Research Institute, Children’s Hospital Colorado, Aurora, Colorado
| | - Kirstin A. Manges
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Gregory Plemmons
- Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - Timothy Rice
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brandy Wiener
- Department of Pediatrics and Patient Services, Cincinnati Children’s Hospital Medical Center, and the University of Cincinnati College of Medicine, Cincinnati, Ohio
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Leyenaar JK, Esporas M, Mangione-Smith R. How Does Pediatric Quality Measure Development Reflect the Real World Needs of Hospitalized Children? Acad Pediatr 2022; 22:S70-S72. [PMID: 35339245 PMCID: PMC9614710 DOI: 10.1016/j.acap.2021.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/14/2021] [Accepted: 01/31/2021] [Indexed: 12/25/2022]
Affiliation(s)
- JoAnna K. Leyenaar
- The Department of Pediatrics and The Dartmouth Institute of Health Policy & Clinical Practice, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03755
| | - Megan Esporas
- Children’s Hospital Association, 600 13th Street, NW, Suite 500, Washington, DC 20005
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Dandoy CE, Kelley T, Gaur AH, Nagarajan R, Demmel K, Alonso PB, Guinipero T, Savelli S, Hakim H, Owings A, Myers K, Aquino V, Oldridge C, Rae ML, Schjodt K, Kilcrease T, Scurlock M, Marshburn AM, Hill M, Langevin M, Lee J, Cooksey R, Mian A, Eckles S, Ferrell J, El-Bietar J, Nelson A, Turpin B, Huang FS, Lawlor J, Esporas M, Lane A, Hord J, Billett AL. Outcomes after bloodstream infection in hospitalized pediatric hematology/oncology and stem cell transplant patients. Pediatr Blood Cancer 2019; 66:e27978. [PMID: 31486593 DOI: 10.1002/pbc.27978] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 02/01/2019] [Revised: 08/06/2019] [Accepted: 08/08/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Pediatric hematology/oncology (PHO) patients receiving therapy or undergoing hematopoietic stem cell transplantation (HSCT) often require a central line and are at risk for bloodstream infections (BSI). There are limited data describing outcomes of BSI in PHO and HSCT patients. METHODS This is a multicenter (n = 17) retrospective analysis of outcomes of patients who developed a BSI. Centers involved participated in a quality improvement collaborative referred to as the Childhood Cancer and Blood Disorder Network within the Children's Hospital Association. The main outcome measures were all-cause mortality at 3, 10, and 30 days after positive culture date; transfer to the intensive care unit (ICU) within 48 hours of positive culture; and central line removal within seven days of the positive blood culture. RESULTS Nine hundred fifty-seven BSI were included in the analysis. Three hundred fifty-four BSI (37%) were associated with at least one adverse outcome. All-cause mortality was 1% (n = 9), 3% (n = 26), and 6% (n = 57) at 3, 10, and 30 days after BSI, respectively. In the 165 BSI (17%) associated with admission to the ICU, the median ICU stay was four days (IQR 2-10). Twenty-one percent of all infections (n = 203) were associated with central line removal within seven days of positive blood culture. CONCLUSIONS BSI in PHO and HSCT patients are associated with adverse outcomes. These data will assist in defining the impact of BSI in this population and demonstrate the need for quality improvement and research efforts to decrease them.
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Affiliation(s)
- Christopher E Dandoy
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Tammy Kelley
- Children's Hospital of Atlanta, Atlanta, Georgia
| | - Aditya H Gaur
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Rajaram Nagarajan
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kathy Demmel
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Priscila Badia Alonso
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | - Hana Hakim
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Angie Owings
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kasiani Myers
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | - Mary Lynn Rae
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | | | | | | | | | | | | | | | - Amir Mian
- Arkansas Children's Hospital, Little Rock, Arkansas
| | | | - Justin Ferrell
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Javier El-Bietar
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Adam Nelson
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Brian Turpin
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - John Lawlor
- Children's Hospital Association, Washington, District of Columbia
| | - Megan Esporas
- Children's Hospital Association, Washington, District of Columbia
| | - Adam Lane
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Amy L Billett
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
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Abstract
Measurement and feedback are fundamental to quality improvement. There is a knowledge gap among health care professionals in knowing how to measure the impact of their quality improvement projects and how to use these data to improve care. This article presents a pragmatic approach to measurement and feedback for quality improvement efforts in local health care settings, such as hospitals or clinical practices. The authors include evidence-based strategies from health care and other industries, augmented with practical examples from the authors' collective years of experience designing measurement and feedback strategies.
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Affiliation(s)
- Greg Randolph
- Department of Pediatrics, North Carolina Children's Center for Clinical Excellence, North Carolina Children's Hospital, CB# 7230, Chapel Hill, NC 27599-7230, USA.
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