Asthma Education in Pediatric Primary Care Practices Improves Asthma Care

CHEST Journal ◽  
2011 ◽  
Vol 140 (4) ◽  
pp. 910A
Author(s):  
Shahid Sheikh ◽  
Muffy Chrysler ◽  
Karen McCoy
Keyword(s):  
Primary Care ◽  
Pediatric Primary Care ◽  
Asthma Care ◽  
Asthma Education ◽  
Care Practices ◽  
Primary Care Practices

scholarly journals Prevalence of Diagnosed Sleep Disorders in Pediatric Primary Care Practices

PEDIATRICS ◽  
2010 ◽  
Vol 125 (6) ◽  
pp. e1410-e1418 ◽  
Author(s):  
L. J. Meltzer ◽  
C. Johnson ◽  
J. Crosette ◽  
M. Ramos ◽  
J. A. Mindell
Keyword(s):  
Primary Care ◽  
Sleep Disorders ◽  
Pediatric Primary Care ◽  
Care Practices ◽  
Primary Care Practices

Differences in Frequency of Visits to Pediatric Primary Care Practices and Emergency Departments by Body Mass Index

2020 ◽  
Vol 20 (4) ◽  
pp. 532-539 ◽  
Author(s):  
Olga Kovalerchik ◽  
Emily Powers ◽  
Margaret L. Holland ◽  
Mona Sharifi ◽  
Melissa L. Langhan
Keyword(s):  
Primary Care ◽  
Body Mass Index ◽  
Body Mass ◽  
Emergency Departments ◽  
Pediatric Primary Care ◽  
Care Practices ◽  
Primary Care Practices

scholarly journals Practice-Level Variation in Telemedicine Use in a Pediatric Primary Care Network During the COVID-19 Pandemic: Retrospective Analysis and Survey Study

10.2196/24345 ◽  
2020 ◽  
Vol 22 (12) ◽  
pp. e24345
Author(s):  
Kelsey Schweiberger ◽  
Alejandro Hoberman ◽  
Jennifer Iagnemma ◽  
Pamela Schoemer ◽  
Joseph Squire ◽  
...  
Keyword(s):  
Primary Care ◽  
Race And Ethnicity ◽  
Pediatric Primary Care ◽  
Office Visits ◽  
Level Variation ◽  
Practice Level ◽  
Practice Characteristics ◽  
Care Practices ◽  
Primary Care Practices ◽  
Clinician Attitudes

Background Telehealth, the delivery of health care through telecommunication technology, has potential to address multiple health system concerns. Despite this potential, only 15% of pediatric primary care clinicians reported using telemedicine as of 2016, with the majority identifying inadequate payment for these services as the largest barrier to their adoption. The COVID-19 pandemic led to rapid changes in payment and regulations surrounding telehealth, enabling its integration into primary care pediatrics. Objective Due to limited use of telemedicine in primary care pediatrics prior to the COVID-19 pandemic, much is unknown about the role of telemedicine in pediatric primary care. To address this gap in knowledge, we examined the association between practice-level telemedicine use within a large pediatric primary care network and practice characteristics, telemedicine visit diagnoses, in-person visit volumes, child-level variations in telemedicine use, and clinician attitudes toward telemedicine. Methods We analyzed electronic health record data from 45 primary care practices and administered a clinician survey to practice clinicians. Practices were stratified into tertiles based on rates of telemedicine use (low, intermediate, high) per 1000 patients per week during a two-week period (April 19 to May 2, 2020). By practice tertile, we compared (1) practice characteristics, (2) telemedicine visit diagnoses, (3) rates of in-person visits to the office, urgent care, and the emergency department, (4) child-level variation in telemedicine use, and (5) clinician attitudes toward telemedicine across these practices. Results Across pediatric primary care practices, telemedicine visit rates ranged from 5 to 23 telemedicine visits per 1000 patients per week. Across all tertiles, the most frequent telemedicine visit diagnoses were mental health (28%-36% of visits) and dermatologic (15%-28%). Compared to low telemedicine use practices, high telemedicine use practices had fewer in-person office visits (10 vs 16 visits per 1000 patients per week, P=.005) but more total encounters overall (in-office and telemedicine: 28 vs 22 visits per 1000 patients per week, P=.006). Telemedicine use varied with child age, race and ethnicity, and recent preventive care; however, no significant interactions existed between these characteristics and practice-level telemedicine use. Finally, clinician attitudes regarding the usability and impact of telemedicine did not vary significantly across tertiles. Conclusions Across a network of pediatric practices, we identified significant practice-level variation in telemedicine use, with increased use associated with more varied telemedicine diagnoses, fewer in-person office visits, and increased overall primary care encounter volume. Thus, in the context of the pandemic, when underutilization of primary care was prevalent, higher practice-level telemedicine use supported pediatric primary care encounter volume closer to usual rates. Child-level telemedicine use differed by child age, race and ethnicity, and recent preventive care, building upon prior concerns about differences in access to telemedicine. However, increased practice-level use of telemedicine services was not associated with reduced or increased differences in use, suggesting that further work is needed to promote equitable access to primary care telemedicine.

scholarly journals Practice-Level Variation in Telemedicine Use in a Pediatric Primary Care Network During the COVID-19 Pandemic: Retrospective Analysis and Survey Study (Preprint)

2020 ◽  
Author(s):  
Kelsey Schweiberger ◽  
Alejandro Hoberman ◽  
Jennifer Iagnemma ◽  
Pamela Schoemer ◽  
Joseph Squire ◽  
...  
Keyword(s):  
Primary Care ◽  
Race And Ethnicity ◽  
Pediatric Primary Care ◽  
Office Visits ◽  
Level Variation ◽  
Practice Level ◽  
Practice Characteristics ◽  
Care Practices ◽  
Primary Care Practices ◽  
Clinician Attitudes

BACKGROUND Telehealth, the delivery of health care through telecommunication technology, has potential to address multiple health system concerns. Despite this potential, only 15% of pediatric primary care clinicians reported using telemedicine as of 2016, with the majority identifying inadequate payment for these services as the largest barrier to their adoption. The COVID-19 pandemic led to rapid changes in payment and regulations surrounding telehealth, enabling its integration into primary care pediatrics. OBJECTIVE Due to limited use of telemedicine in primary care pediatrics prior to the COVID-19 pandemic, much is unknown about the role of telemedicine in pediatric primary care. To address this gap in knowledge, we examined the association between practice-level telemedicine use within a large pediatric primary care network and practice characteristics, telemedicine visit diagnoses, in-person visit volumes, child-level variations in telemedicine use, and clinician attitudes toward telemedicine. METHODS We analyzed electronic health record data from 45 primary care practices and administered a clinician survey to practice clinicians. Practices were stratified into tertiles based on rates of telemedicine use (low, intermediate, high) per 1000 patients per week during a two-week period (April 19 to May 2, 2020). By practice tertile, we compared (1) practice characteristics, (2) telemedicine visit diagnoses, (3) rates of in-person visits to the office, urgent care, and the emergency department, (4) child-level variation in telemedicine use, and (5) clinician attitudes toward telemedicine across these practices. RESULTS Across pediatric primary care practices, telemedicine visit rates ranged from 5 to 23 telemedicine visits per 1000 patients per week. Across all tertiles, the most frequent telemedicine visit diagnoses were mental health (28%-36% of visits) and dermatologic (15%-28%). Compared to low telemedicine use practices, high telemedicine use practices had fewer in-person office visits (10 vs 16 visits per 1000 patients per week, <i>P</i>=.005) but more total encounters overall (in-office and telemedicine: 28 vs 22 visits per 1000 patients per week, <i>P</i>=.006). Telemedicine use varied with child age, race and ethnicity, and recent preventive care; however, no significant interactions existed between these characteristics and practice-level telemedicine use. Finally, clinician attitudes regarding the usability and impact of telemedicine did not vary significantly across tertiles. CONCLUSIONS Across a network of pediatric practices, we identified significant practice-level variation in telemedicine use, with increased use associated with more varied telemedicine diagnoses, fewer in-person office visits, and increased overall primary care encounter volume. Thus, in the context of the pandemic, when underutilization of primary care was prevalent, higher practice-level telemedicine use supported pediatric primary care encounter volume closer to usual rates. Child-level telemedicine use differed by child age, race and ethnicity, and recent preventive care, building upon prior concerns about differences in access to telemedicine. However, increased practice-level use of telemedicine services was not associated with reduced or increased differences in use, suggesting that further work is needed to promote equitable access to primary care telemedicine.

Organizational culture predicts job satisfaction and perceived clinical effectiveness in pediatric primary care practices

2010 ◽  
Vol 35 (4) ◽  
pp. 365-371 ◽  
Author(s):  
Kevin Brazil ◽  
Dorothy B. Wakefield ◽  
Michelle M. Cloutier ◽  
Howard Tennen ◽  
Charles B. Hall
Keyword(s):  
Primary Care ◽  
Job Satisfaction ◽  
Organizational Culture ◽  
Clinical Effectiveness ◽  
Pediatric Primary Care ◽  
Care Practices ◽  
Primary Care Practices

Determinants of Health and Pediatric Primary Care Practices

PEDIATRICS ◽  
2016 ◽  
Vol 137 (3) ◽  
pp. e20153673 ◽  
Author(s):  
Andrew F. Beck ◽  
Megan M. Tschudy ◽  
Tumaini R. Coker ◽  
Kamila B. Mistry ◽  
Joanne E. Cox ◽  
...  
Keyword(s):  
Primary Care ◽  
Determinants Of Health ◽  
Pediatric Primary Care ◽  
Care Practices ◽  
Primary Care Practices

scholarly journals Variations in Mental Health Diagnosis and Prescribing Across Pediatric Primary Care Practices

PEDIATRICS ◽  
2016 ◽  
Vol 137 (5) ◽  
pp. e20152974-e20152974 ◽  
Author(s):  
S. L. Mayne ◽  
M. E. Ross ◽  
L. Song ◽  
B. McCarn ◽  
J. Steffes ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Pediatric Primary Care ◽  
Mental Health Diagnosis ◽  
Care Practices ◽  
Primary Care Practices ◽  
Health Diagnosis

The design and conduct of Project RedDE: A cluster-randomized trial to reduce diagnostic errors in pediatric primary care

2019 ◽  
Vol 16 (2) ◽  
pp. 154-164 ◽  
Author(s):  
David G Bundy ◽  
Hardeep Singh ◽  
Ruth EK Stein ◽  
Tammy M Brady ◽  
Christoph U Lehmann ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Controlled Trial ◽  
Diagnostic Errors ◽  
Outcome Data ◽  
Pediatric Primary Care ◽  
Quality Improvement Collaborative ◽  
Care Practices ◽  
Cluster Randomized ◽  
Primary Care Practices

Background: Diagnostic errors contribute to the large burden of healthcare-associated harm experienced by children. Primary care settings involve high diagnostic uncertainty and limited time and information, creating ideal conditions for diagnostic errors. We report on the design and conduct of Project RedDE, a stepped-wedge, cluster-randomized controlled trial of a virtual quality improvement collaborative aimed at reducing diagnostic errors in pediatric primary care. Methods: Project RedDE cluster-randomized pediatric primary care practices into one of three groups. Each group participated in a quality improvement collaborative targeting the same three diagnostic errors (missed diagnoses of elevated blood pressure and adolescent depression and delayed diagnoses of abnormal laboratory studies), but in a different sequence. During the quality improvement collaborative, practices worked both independently and collaboratively, leveraging general quality improvement strategies (e.g. process mapping) in addition to error-specific content (e.g. pocket guides for blood pressure norms) delivered during the intervention phase for each error. The quality improvement collaborative intervention included interactive learning sessions and webinars, quality improvement coaching at the team level, and repeated evaluation of failures via root cause analyses. Pragmatic data were collected monthly, submitted to a centralized data aggregator, and returned to the practices in the form of run charts comparing each practice’s progress over time to that of the group. The primary analysis used patients as the unit of analysis and compared diagnostic error proportions between the intervention and baseline periods, while secondary analyses evaluated the sustainability of observed reductions in diagnostic errors after the intervention period ended. Results: A total of 43 practices were recruited and randomized into Project RedDE. Eleven practices withdrew before submitting any data, and one practice merged with another participating practice, leaving 31 practices that began work on Project RedDE. All but one of the diverse, national pediatric primary care practices that participated ultimately submitted complete data. Quality improvement collaborative participation was robust, with an average of 63% of practices present on quality improvement collaborative webinars and 85% of practices present for quality improvement collaborative learning sessions. Complete data included 30 months of outcome data for the first diagnostic error worked on, 24 months of outcome data for the second, and 16 months of data for the third. Lessons learned and limitations: Contamination across study groups was a recurring concern; concerted efforts were made to mitigate this risk. Electronic health records played a large role in teams’ success. Conclusion: Project RedDE, a virtual quality improvement collaborative aimed at reducing diagnostic errors in pediatric primary care, successfully recruited and retained a diverse, national group of pediatric primary care practices. The stepped-wedge, cluster-randomized controlled trial design allowed for enhanced scientific efficiency.

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