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pediatric electronic health records

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https://www.readbyqxmd.com/read/28087684/the-effect-of-price-information-on-the-ordering-of-images-and-procedures
#1
Alyna T Chien, Smitha Ganeshan, Mark A Schuster, Lisa Soleymani Lehmann, Laura A Hatfield, Kate E Koplan, Carter R Petty, Anna D Sinaiko, Thomas D Sequist, Meredith B Rosenthal
BACKGROUND AND OBJECTIVES: Ordering rates for imaging studies and procedures may change if clinicians are shown the prices of those tests while they are ordering. We studied the effect of 2 forms of paid price information, single median price and paired internal/external median prices, on how often pediatric-focused and adult-oriented clinicians (most frequently general pediatricians and adult specialists caring for pediatric-aged patients, respectively) order imaging studies and procedures for 0- to 21-year-olds...
January 13, 2017: Pediatrics
https://www.readbyqxmd.com/read/28078809/three-year-analysis-of-repeated-laboratory-tests-for-the-markers-total-cholesterol-ferritin-vitamin-d-vitamin-b12-and-folate-in-a-large-research-and-teaching-hospital-in-italy
#2
Monica Lanzoni, Marco Fornili, Irene Felicetta, Rita Maiavacca, Elia Biganzoli, Silvana Castaldi
RATIONALE, AIMS AND OBJECTIVES: The increasing number of diagnostic tests requests all over the world is a problem that can partially be explained by inappropriate testing. Impact on the total costs of health systems becomes relevant when tests are performed in a large amount. In this paper, retesting of total cholesterol, ferritin, vitamin B12 , vitamin D, and folate is assessed. METHODS: The Quality Unit of Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano (Fondazione) decided to perform a first assessment of the appropriate use of the laboratory tests cholesterol, ferritin, vitamin B12 , vitamin D, and folate focusing on the retesting interval for the same patient in the time period January 1, 2012, to December 31, 2014, in every care setting...
January 12, 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/28025240/safety-of-quadrivalent-meningococcal-conjugate-vaccine-in-11-to-21-year-olds
#3
Hung-Fu Tseng, Lina S Sy, Bradley K Ackerson, Rulin C Hechter, Sara Y Tartof, Mendel Haag, Jeffrey M Slezak, Yi Luo, Christine A Fischetti, Harp S Takhar, Yan Miao, Marianne Cunnington, Zendi Solano, Steven J Jacobsen
BACKGROUND: Meningococcal conjugate vaccination is recommended in the United States. This study evaluates the safety of quadrivalent meningococcal conjugate vaccine in a cohort aged 11 to 21 years. METHODS: This cohort study with self-controlled case-series analysis was conducted at Kaiser Permanente Southern California. Individuals receiving MenACWY-CRM, a quadrivalent meningococcal conjugate vaccine, during September 30, 2011 to June 30, 2013, were included. Twenty-six prespecified events of interest (EOIs), including neurologic, rheumatologic, hematologic, endocrine, renal, pediatric, and pediatric infectious disease EOIs, were identified through electronic health records 1 year after vaccination...
January 2017: Pediatrics
https://www.readbyqxmd.com/read/27966006/medical-record-keeping-in-the-summer-camp-setting
#4
Laura Kaufman, Jaycelyn Holland, Stuart Weinberg, S Trent Rosenbloom
BACKGROUND: Approximately one fifth of school-aged children spend a significant portion of their year at residential summer camp, and a growing number have chronic medical conditions. Camp health records are essential for safe, efficient care and for transitions between camp and home providers, yet little research exists regarding these systems. OBJECTIVE: To survey residential summer camps for children to determine how camps create, store, and use camper health records...
December 14, 2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27965068/pda-based-self-work-sampling-study-of-pediatric-interns-quantifies-workday-and-educational-value
#5
Joyce K Campbell, Michael V Ortiz, Mary C Ottolini, Sarah Birch, Dewesh Agrawal
OBJECTIVE: Optimizing clinical proficiency and education of residents has become more important with restricted residency duty hours. Our objective was to investigate how interns spend their time on inpatient rotations and the perceived educational value of workday activities. METHODS: A descriptive, self-work sampling study using a personal digital assistant (PDA) to randomly query interns on inpatient rotations in real time as to their activity and the perceived educational value of that activity on a 4-point Likert scale...
December 10, 2016: Academic Pediatrics
https://www.readbyqxmd.com/read/27940770/a-quality-improvement-initiative-improving-the-frequency-of-inpatient-electronic-prescribing
#6
Jennifer Fuchs, Huay-Ying Lo, Andrew Peterman, Elizabeth Camp, Lindsay Chase
OBJECTIVE: To improve the frequency of electronic prescribing (e-prescribing) of discharge prescriptions at a children's hospital via a bundle of quality improvement interventions. METHODS: Surveys and focus groups were conducted with patient families and pediatric residents to identify barriers and propose solutions to e-prescribing. These data were used to generate a series of interventions, including the following: (1) provider education; (2) changes in patient registration workflow; and (3) electronic health record changes to improve the frequency of e-prescribing on the pediatric hospital medicine (PHM) service...
November 2016: Pediatrics
https://www.readbyqxmd.com/read/27940711/diagnosis-and-medication-treatment-of-pediatric-hypertension-a-retrospective-cohort-study
#7
David C Kaelber, Weiwei Liu, Michelle Ross, A Russell Localio, Janeen B Leon, Wilson D Pace, Richard C Wasserman, Alexander G Fiks
BACKGROUND AND OBJECTIVES: Pediatric hypertension predisposes children to adult hypertension and early markers of cardiovascular disease. No large-scale studies have examined diagnosis and initial medication management of pediatric hypertension and prehypertension. The objective of this study was to evaluate diagnosis and initial medication management of pediatric hypertension and prehypertension in primary care. METHODS: Retrospective cohort study aggregating electronic health record data on >1...
December 2016: Pediatrics
https://www.readbyqxmd.com/read/27940706/preschool-adhd-diagnosis-and-stimulant-use-before-and-after-the-2011-aap-practice-guideline
#8
Alexander G Fiks, Michelle E Ross, Stephanie L Mayne, Lihai Song, Weiwei Liu, Jennifer Steffes, Banita McCarn, Robert W Grundmeier, A Russell Localio, Richard Wasserman
OBJECTIVE: To evaluate the change in the diagnosis of attention-deficit/hyperactivity disorder (ADHD) and prescribing of stimulants to children 4 to 5 years old after release of the 2011 American Academy of Pediatrics guideline. METHODS: Electronic health record data were extracted from 63 primary care practices. We included preventive visits from children 48 to 72 months old receiving care from January 2008 to July 2014. We compared rates of ADHD diagnosis and stimulant prescribing before and after guideline release using logistic regression with a spline and clustering by practice...
December 2016: Pediatrics
https://www.readbyqxmd.com/read/27940506/improving-pediatric-asthma-outcomes-in-a-community-emergency-department
#9
Theresa A Walls, Naomi T Hughes, Paul C Mullan, James M Chamberlain, Kathleen Brown
BACKGROUND: Asthma triggers >775 000 emergency department (ED) visits for children each year. Approximately 80% of these visits occur in community EDs. We performed this study to measure effects of partnership with a community ED on pediatric asthma care. METHODS: For this quality improvement initiative, we implemented an evidence-based pediatric asthma guideline in a community ED. We included patients whose clinical impression in the medical decision section of the electronic health record contained the words asthma, bronchospasm, or wheezing...
January 2017: Pediatrics
https://www.readbyqxmd.com/read/27933151/improving-asthma-care-in-a-pediatric-resident-clinic
#10
Julia Lee, Albina Gogo, Daniel Tancredi, Erik Fernandez Y Garcia, Ulfat Shaikh
There is variation in pediatric asthma management in the outpatient setting. Adherence to national asthma guidelines provides a systematic standardized approach to asthma management. There is a gap between usual and guideline-consistent asthma care in resident clinics. Practice improvement modules aimed at improving resident physician adherence to asthma care guidelines have not been consistently utilized and have not yet been studied. Our aim was to increase guideline consistent care in our pediatric resident clinic in a twelve-month period via increasing performance on the following measures to 75%: spirometry testing; influenza immunization recommendation; level of control assessed through the use of a standardized questionnaire; appropriate medications per national guideline; and use of written asthma action plans...
2016: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/27932381/improving-the-efficiency-of-care-for-pediatric-patients-hospitalized-with-asthma
#11
Kathleen W Bartlett, Victoria M Parente, Vanessa Morales, Jillian Hauser, Heather S McLean
BACKGROUND: Asthma exacerbations are a leading cause of hospitalization among children. Despite the existence of national pediatric asthma guidelines, significant variation in care persists. At Duke Children's Hospital, we determined that our average length of stay (ALOS) and cost for pediatric asthma admissions exceeded that of our peers. Our aim was to reduce the ALOS of pediatric patients hospitalized with asthma from 2.9 days to 2.6 days within 12 months by implementing an asthma pathway within our new electronic health record...
January 2017: Hospital Pediatrics
https://www.readbyqxmd.com/read/27925849/development-and-prospective-federal-state-wide-evaluation-of-a-device-for-height-based-dose-recommendations-in-prehospital-pediatric-emergencies-a-simple-tool-to-prevent-most-severe-drug-errors
#12
Jost Kaufmann, Bernhard Roth, Thomas Engelhardt, Alex Lechleuthner, Michael Laschat, Christoph Hadamitzky, Frank Wappler, Martin Hellmich
OBJECTIVE: Drug dosing errors pose a particular threat to children in prehospital emergency care. With the Pediatric emergency ruler (PaedER), we developed a simple height-based dose recommendation system and evaluated its effectiveness in a pre-post interventional trial as the Ethics Committee disapproved randomization due to the expected positive effect of the PaedER on outcome. METHODS: Pre-interventional data were retrospectively retrieved from the electronic records and medical protocols of the Cologne Emergency Medical Service over a two-year period prior to the introduction of the PaedER...
December 7, 2016: Prehospital Emergency Care
https://www.readbyqxmd.com/read/27923649/food-allergy-trends-and-epinephrine-autoinjector-presence-in-summer-camps
#13
Natalie R Schellpfeffer, Harvey L Leo, Michael Ambrose, Andrew N Hashikawa
BACKGROUND: Pediatric campers with food allergies are at greater risk for exposure and anaphylaxis. A diagnosis of asthma increases risk for anaphylaxis. Epidemiological investigations of food-allergic children at high risk for allergic reactions requiring intervention in camp settings are lacking. OBJECTIVE: The objectives of this study were to estimate the prevalence of food allergies among otherwise healthy campers in summer camps throughout the United States and Canada, and to assess asthma comorbidity and determine rates of epinephrine autoinjector prescriptions present in this population...
December 3, 2016: Journal of Allergy and Clinical Immunology in Practice
https://www.readbyqxmd.com/read/27922762/nonchemotherapy-drug-induced-agranulocytosis-in-children-detected-by-a-prospective-pharmacovigilance-program
#14
Nicolás Medrano-Casique, Hoi Y Tong, Alberto M Borobia, Antonio J Carcas, Jesús Frías, Elena Ramírez
OBJECTIVES: A prospective evaluation of nonchemotherapy drug-induced agranulocytosis (DIA) cases, which are infrequent in the pediatric population. We characterize agranulocytosis cases and assess lab test differences between drug- and nondrug-induced agranulocytosis. METHODS: Through our Prospective Pharmacovigilance Program from Laboratory Signals at Hospital we detected pediatric agranulocytosis cases from July 2007 to December 2010. This program estimates the incidence, drug causality, clinical features, outcomes of DIA pediatric cases, and assesses laboratory differences with respect to non-DIA...
October 2016: Pediatric Hematology and Oncology
https://www.readbyqxmd.com/read/27902553/perspectives-and-uses-of-the-electronic-health-record-among-us-pediatricians-a-national-survey
#15
Julie W Doberne, Travis Redd, Daniel Lattin, Thomas R Yackel, Carl O Eriksson, Vishnu Mohan, Jeffrey A Gold, Joan S Ash, Michael F Chiang
Little is known about how existing electronic health records (EHRs) influence the practice of pediatric medicine. A total of 808 pediatricians participated in a survey about workflows using the EHR. The EHR was the most commonly used source of initial patient information. Seventy-two percent reported requiring between 2 and 10 minutes to complete an initial review of the EHR. Several moderately severe information barriers were reported regarding the display of information in the EHR. Pediatricians acquire information about new patients from EHRs more often than any other source...
January 2017: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27899166/pain-management-of-acute-appendicitis-in-canadian-pediatric-emergency-departments
#16
Andrea L Robb, Samina Ali, Naveen Poonai, Graham C Thompson
OBJECTIVES: Children with suspected appendicitis are at risk for suboptimal pain management. We sought to describe pain management patterns for suspected appendicitis across Canadian pediatric emergency departments (PEDs). METHODS: A retrospective medical record review was undertaken at 12 Canadian PEDs. Children ages 3 to 17 years who were admitted to the hospital in February or October 2010 with suspected appendicitis were included. Patients were excluded if partially assessed or treated at another hospital...
November 30, 2016: CJEM
https://www.readbyqxmd.com/read/27875603/emr-based-intervention-improves-lead-screening-at-an-urban-family-medicine-practice
#17
Kathryn McGrath, Krys Foster, Patrick Doggett, Marc Altshuler, Jewel Osborne-Wu, Christine Castellan, Kelly Lopez, Pheobe Askie, Daniel Chung, Laura Parente, Yury Parra
BACKGROUND AND OBJECTIVES: Elevated blood lead levels have well-described detrimental effects to growth and development in children, yet screening rates remain low. We sought to determine if a reminder within the electronic health record (EHR) could change provider behavior and improve blood lead level (BLL) screening test ordering rates in an urban academic family medicine practice. METHODS: Baseline BLL test ordering rates were calculated for children ages 9-72 months...
November 2016: Family Medicine
https://www.readbyqxmd.com/read/27856010/increased-capture-of-pediatric-surgical-complications-utilizing-a-novel-case-log-web-application-to-enhance-quality-improvement
#18
Jason C Fisher, Keith A Kuenzler, Sandra S Tomita, Prashant Sinha, Paresh Shah, Howard B Ginsburg
PURPOSE: Documenting surgical complications is limited by multiple barriers and is not fostered in the electronic health record. Tracking complications is essential for quality improvement (QI) and required for board certification. Current registry platforms do not facilitate meaningful complication reporting. We developed a novel web application that improves accuracy and reduces barriers to documenting complications. METHODS: We deployed a custom web application that allows pediatric surgeons to maintain case logs...
October 28, 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27846070/implementation-and-operational-research-an-integrated-and-comprehensive-service-delivery-model-to-improve-pediatric-and-maternal-hiv-care-in-rural-africa
#19
Anna Gamell, Tracy R Glass, Lameck B Luwanda, Herry Mapesi, Leila Samson, Tom Mtoi, Angelo Nyamtema, Lukas Muri, Alex Ntamatungiro, Marcel Tanner, Christoph Hatz, Manuel Battegay, Emilio Letang
BACKGROUND: Strategies to improve HIV diagnosis and linkage into care, antiretroviral treatment coverage, and treatment outcomes of mothers and children are urgently needed in sub-Saharan Africa. METHODS: From December 2012, we implemented an intervention package to improve prevention of mother-to-child transmission (PMTCT) and pediatric HIV care in our rural Tanzanian clinic, consisting of: (1) creation of a PMTCT and pediatric unit integrated within the reproductive and child health clinic; (2) implementation of electronic medical records; (3) provider-initiated HIV testing and counseling in the hospital wards; and (4) early infant diagnosis test performed locally...
December 15, 2016: Journal of Acquired Immune Deficiency Syndromes: JAIDS
https://www.readbyqxmd.com/read/27845473/preliminary-analysis-of-the-respiratory-disease-based-on-hospital-discharge-records-in-the-province-of-l-aquila-abruzzo-italy
#20
L Fabiani, L Mammarella, P Vittorini, F Zazzara, F Di Orio
BACKGROUND: The hospital discharge records (HDRs), integrated by other electronic health archives, besides some contra, can be a valuable and low-cost tool for monitoring public health. METHODS: Throughout a retrospective cohort study, we analyzed all hospitalizations in ordinary regime from the HDRs database of the residents in the province of L'Aquila, with the exception of day hospital, rehabilitation and long-hospital stay between 2008 and 2013, with a principal diagnosis of respiratory disease of 460 to 519, according to the ICD-9-CM...
November 2016: Annali di Igiene: Medicina Preventiva e di Comunità
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