Showing posts with label quality improvement. Show all posts
Showing posts with label quality improvement. Show all posts

Monday, May 18, 2015

Meaningful Use and The Exchange of Electronic Health Records

By: Joann Schulte  DO, MPH; Editorial Board Member

     Doctors and hospitals know a lot about paper pushing. Your office staff can  spend hours arranging referrals for children who each need to see a sub-specialist.   After the appointment, the same staff must feel like they’re on a treasure hunt  as they search for  the consultant’s recommendations or that delayed  lab result in the  medical record.   
     Or maybe you’re the hospitalist who needs to report a case of meningitis to the state health department. You spend fifteen minutes finding the form you need to report the case and you may spend another thirty minutes filling out the paper form if it is not online and faxing it.  Those kinds of frustrations were some of the reasons that electronic health records (EHR) were developed.  The EHR systems are supposed to end some of the paper pushing.   Information is supposed to get where it needs to go, lab results appear, and diseases are reported. That’s the concept of meaningful use (MU) of EHRs.
     At the end of last year, about 3/4 of US hospitals had adopted a basic electronic medical record that included clinician notes.  MU is another matter. The federal Centers for Medicare and Medicaid offer incentive payments to encourage implementation of EHR and meaningful use(MU) of those records.  The first phase of MU includes medication reconciliation and the exchange of health information between facilities.
      A new report by Teufel et al. (doi: 10.1542/peds.2014-2720)  published in this months' Pediatrics explores the progress of EHR adoption in children's hospitals and what barriers are reported by those institutions.  Early reports suggest that implementing pediatric EHR use was difficult because programs didn't include basics, such as weight-based dosing for medications, and pediatric normal values  for vital signs and diagnostic testing.
     The researchers surveyed the 224 members of the Children’s' Hospital Association to assess EHR adoption challenges the hospitals faced and how many got MU payments. The study period covered September 2011 to May 2012. The survey results were linked to records from the American Hospital Association to characterize the hospitals and federal records to identify the payment of MU incentives.
     Survey responses came from 133 children's hospitals (59.4%) and 35% of those hospitals (47) received some MU incentive payment.  The hospitals reported their most frequently anticipated challenges included the exchange of information with other hospitals (49%) and the generation of numerator and denominator information from the EHR to report quality information (41%).   Among the 47 hospitals that received MU payments, 58% reported that  the greatest challenge to achieving MU was the lack of meaningful criteria to pediatric care. The hospitals getting MU incentive payments reported their most challenging issues remained exchanging information with other providers (17, 44%) and generating numerator and denominator data (18, 46%).
     This report assessed only the first phase of MU; others will be implemented through 2018.  It seems that pediatric hospitals have a long EHR road ahead.

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Tuesday, February 17, 2015

Racial-Ethnic Disparities in Managing Children with Type 1 Diabetes: Do They Exist?

     Everyone would agree that the care they provide to one child versus another shouldn't differ on the basis of race or ethnicity—but unfortunately, disparities in the management of diabetes do exist on that basis—as per some important findings contained in a study being released this week by Willi et al. (doi:10.1542/peds.2014-1774). 
The authors looked at disparities as documented in a national type 1 diabetes clinical registry for more than 10,000 children and teens between 1 year and 18 years of age with the disease.  Even after adjusting for socioeconomic status, differences existed in insulin treatment methods and treatment outcomes. 
So why does this happen—and just what are the disparities noted?  Are results due to different management strategies or perhaps it is because the genetics of the disease differs by race and ethnicity resulting in different achievable levels of hemoglobin A1C and other diabetic outcome measures. 
The authors offer some insight into the findings they have analyzed, but we have also asked diabetologist Dr. Stuart Chalew (doi: 10.1542/peds.2014-4136) to share his perspective on this study via a commentary released simultaneously.  Both the study and commentary are thought provoking, and we hope will generate some conversation from our readers as well via a response in the comments below, an e-letter or comment on our Facebook or Twitter pages.  Do you agree with the findings relative to your own practice?  We look forward to your comments as to whether the disparities noted are ones we can improve upon.

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Wednesday, October 1, 2014

Healthcare-Associated Infections in Critically Ill Children

Pediatrics Editorial Board Member Joann Schulte, DO, MPH, shares her expert perspective on a new article from our October issue. To learn more about Dr. Schulte, check out her bio on our Contributors page.

By: Joann Schulte, DO, MPH

Photo by daveynin via Flickr
Nosocomial infections have been bad news since the days of Ignaz Philipp Semmelweis who proved that washing hands drastically reduced the incidence of puerperal fever in mid-19th-century hospitals.

He has modern day counterparts in the infection control practitioners and hospital epidemiologists who combat healthcare-associated infections (HAIs) in US hospitals. There’s some good news about HAIs among children who got care in neonatal ICUs (NICUs) and pediatric ICUs (PICUs) documented in the October issue of Pediatrics (doi: 10.1542/peds.2014-0613).

A cohort study done with data reported to the US Centers for Disease Control and Prevention found the incidence rates of central-line associated blood infections and ventilator-associated pneumonia declined during a 5-year period between 2007 and 2012. The study examined data from 173 NICUs and 64 PICUs. Infections associated with central lines in NICUs declined from 4.9 to 1.5 per 1,000 central-line days and from 4.7 to 1.0 per 1,000 central line days in PICUs. Rates of pneumonia declined in NICUs from 1.6 to 0.6 per 1,000 ventilator days and in PICUs from 1.9 to 0.7 per 1,000 ventilator days. Rates of urinary tract infections associated with catheters did not change significantly in PICUs.

The team of investigators, led by Dr. Stephen Patrick at Vanderbilt University, used a time-series design to evaluate the changes in HAIs among hospitalized neonates and children. The investigators estimated the reduction in infections associated with central lines saved $131 million. The physicians and researchers who are the intellectual descendants of Semmelweis have done important work.  

Thursday, August 28, 2014

Benchmarks to Strive for in Caring for Children with Asthma, Bronchiolitis & Pneumonia

By: Lewis First, MD, MS; Editor-in-Chief 

Photo by Hey Paul Studios via Flickr
Pediatrics, along with other journals, has published studies on the variability of tests ordered, treatments used, and length of stay for a number of common pediatric illnesses. In fact, hospitalists use variability studies to help them identify care pathways to improve quality and reduce costs of care. But is there an ideal set of benchmarks we should strive for in creating our care pathways?

Parikh et al. (doi: 10.1542/peds.2014-1052) believe there are, as a result of their performing a cross-sectional study of data obtained from the Pediatric Health Information System (PHIS) to identify common benchmarks used at the top 10 percent of performing hospitals to note how often images, lab and viral studies, types of antibiotics and frequency of usage could be or should be utilized for inpatient care of asthma, bronchiolitis, and pneumonia.

And speaking of benchmarks, Ralston et al. (doi: 10.1542/peds.2014-1036) add to the discussion with release of their systematic review article of quality improvement studies on ways to reduce unnecessary tests and treatments for children hospitalized with bronchiolitis and provide some additional benchmarks for you to consider.

After reading these studies, you will want to reflect on your own patients or those cared for by your local hospitalists to see whether the benchmarks recommended in these two studies are being adhered to or not when children present with asthma, bronchiolitis, or pneumonia. Benchmark this article for further reference – you’ll likely need it as we move away from volume-based to value-based quality care.

Friday, June 20, 2014

Maintaining Certification and Attaining Quality Care

Deputy Editor Dr. Alex Kemper offers a preview of a Quality Report being early released this week from our July issue:

By: Alex Kemper, MD, MPH, MS

Photo by COD Newsroom via Flickr
The American Board of Pediatrics has made participating in quality-improvement activities a centerpiece of the maintenance-of-certification (MOC) process. This has been a good strategy to make otherwise busy clinicians aware of the “quality movement” and some of the steps necessary to improve care in their own practice. But, does it make a difference in the delivery of care?

Dr. Vernacchio and colleagues (doi: 10.1542/peds.2013-2643) share with us their experience in implementing an asthma project that could also provide credit for MOC. Three cohorts of pediatricians participated and nearly all received MOC credit, and more importantly, along the way, processes of care improved.

Let us know about your experience in getting Part 4 MOC credit! What did you learn? Would this learning collaborative approach work for your institution? Let us know. Leave a comment below, submit an eLetter through our journal site, or join in the conversation on Facebook or Twitter.

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Monday, June 16, 2014

Decreasing Asthma Readmissions

Deputy Editor Dr. Alex Kemper offers a preview of a Quality Report being early released this week from our July issue:

By: Alex Kemper, MD, MPH, MS

Photo by Hey Paul Studios via Flickr
There is a cacophony of asthma quality measures: Children’s Asthma Care (CAC) -1, CAC-2, CAC-3. CAC-1 and CAC-2 address medication use. CAC-3 is based on the completion of a home management care plan and requires post-discharge follow-up care coordination. Not surprisingly, CAC-3 is the most challenging of the measures. How can a hospital achieve high marks on these measures? Does it make a difference?

Dr. Bergert and colleagues (doi: 10.1542/ peds.2013-1406) share with us their experience. They assembled a multidisciplinary asthma task force to develop interventions and measured the outcomes. Their findings will make you breathe easier about the value of the CAC measures!

What does this inspire you to do for your patients? Let us know by leaving us a comment below or via eLetter on our journal site, or you can weigh in on Facebook or Twitter.

Wednesday, April 2, 2014

Quality Report: Reducing Hypothermia in Preterm Infants

Deputy Editor Dr. Alex Kemper offers a preview of a Quality Report being early released this week from our April issue:

Photo by bradleyolin via Flickr
Even very slight hypothermia can have a profound negative effect on preterm infants, including respiratory distress syndrome, metabolic derangements and intraventricular hemorrhage and other challenges that can lead to increased mortality and morbidity.

Today, we are releasing a Quality Report by Dr. Russo and colleagues on the implementation of strategies in the delivery room to minimize rates of hypothermia (doi: 10.1542/peds.2013-2544). Of course, aggressive strategies to avoid hypothermia could lead to hyperthermia, which is also dangerous.

Dr. Russo and colleagues implemented a multidisciplinary practice to safely warm up moderately hypothermic infants less than 35 weeks old by using an occlusive wrap (without drying the infant first), a warming mattress and cap for all infants, as well as keeping the operating room temperatures up between 21-23°C.

So, how did they do? Take a look and see how cool their work is and how you can be red hot in your NICU by adopting their strategies. Let us know how it goes. Comment below or on our Facebook page, find us on Twitter, or share your comments as an eLetter on our journal site.

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