Immunization
Maintenance of Increased Childhood Influenza Vaccination Rates 1 Year After an Intervention in Primary Care Practices
Influenza vaccination rates among some groups of children remain below the Healthy People 2020 goal of 70%. Multistrategy interventions to increase childhood influenza vaccination have not been evaluated recently.Developmental Screening Disparities for Languages Other than English and Spanish
Limited English proficiency (LEP) is a known barrier to preventive care. Children from families with LEP face socioeconomic circumstances associated with increased odds of developmental delays and decreased participation in early care and education programs. Little is known about developmental surveillance and screening for children from families who speak languages other than English and Spanish. We sought to compare developmental surveillance and screening at well-child visits (WCVs) by preferred parental language.Physician Perspectives on Medical Home Recognition for Practice Transformation for Children
To examine child-serving physicians' perspectives on motivations for and support for practices in seeking patient-centered medical home (PCMH) recognition, changes in practice infrastructure, and care processes before and after recognition, and perceived benefits and challenges of functioning as a PCMH for the children they serve, especially children with special health care needs.Provider Attitudes Regarding Vaccine Tracking Systems in Pediatric Practices
To assess among US pediatricians' systems for tracking vaccine administration and inventory and attitudes about these systems; and attitudes regarding and perceived barriers to adoption of a 2-dimensional bar code systems.Influenza Vaccination Among US Children With Asthma, 2005–2013
Children with asthma face higher risk of complications from influenza. Trends in influenza vaccination among children with asthma are unknown.Juvenile Incarceration and Health
Addressing the health status and needs of incarcerated youth represents an issue at the nexus of juvenile justice reform and health care reform. Incarcerated youth face disproportionately higher morbidity and higher mortality compared to the general adolescent population. Dental health, reproductive health, and mental health needs are particularly high, likely as a result of lower access to care, engagement in high-risk behaviors, and underlying health disparities. Violence exposure and injury also contribute to the health disparities seen in this population.Provider Preferences and Experiences With a Countywide Centralized Collaborative Reminder/Recall for Childhood Immunizations
To assess among providers in 7 Colorado counties where a collaborative centralized reminder/recall (CC-R/R) using the Colorado Immunization Information System (CIIS) was performed: 1) preferences about CC-R/R conducted by the public health department (PHD); 2) preferences for future CC-R/R for different vaccines with and without practice names; and 3) experiences with including their name on CC-R/R notices.School-Based Health Centers as Medical Homes: Parents' and Adolescents' Perspectives
Preventive health services are underutilized by US adolescents, especially those from low-income populations. School-based health centers (SBHCs) have been endorsed as primary medical homes for adolescents. This study was undertaken to determine how adolescent SBHC users and their parents perceive SBHCs, particularly whether SBHCs fulfill each of the elements of a medical home as defined by the American Academy of Pediatrics.Children With Autism Spectrum Disorder and Screen Time: Results From a Large, Nationally Representative US Study
To test the hypotheses that children with autism spectrum disorder (ASD) have higher screen time than other children on a US nationally representative sample and that children with ASD are overrepresented among children who exceed the American Academy of Pediatrics (AAP) screen time recommendation (2 hours or less a day).Validation of the Vaccination Confidence Scale: A Brief Measure to Identify Parents at Risk for Refusing Adolescent Vaccines
To validate a brief measure of vaccination confidence using a large, nationally representative sample of parents.A Comparison of Ambulatory Care Sensitive Hospitalizations Among Children With and Without Autism Spectrum Disorder
To compare the prevalence of hospitalizations for ambulatory care sensitive conditions (ACSC) in children with and without autism spectrum disorder (ASD) and to compare inpatient health care utilization (total charges and length of stay) for the same conditions in children with and without ASD.Free Vaccines for Parents Program: A Novel (and Successful) Pediatric Resident Advocacy Project
Advocacy education is a key component of pediatric residency training and its importance is emphasized in current Accreditation Council for Graduate Medical Education (ACGME) program requirements.1,2 Advocacy initiatives identify challenges and disparities that negatively affect child health and often involve parent and provider education to facilitate the development of strategies that improve community health. The multifaceted approach to advocacy training challenges medical educators to develop curricula to teach the skills, attitudes, and knowledge necessary for successful implementation of an advocacy program.Shared Decision Making in Pediatrics: A Systematic Review and Meta-analysis
Little is known about the impact of interventions to support shared decision making (SDM) with pediatric patients.Alabama's Perspective of the Child Health Insurance Program
The articles in this supplement report on a Congressionally mandated evaluation of the Children's Health Insurance Program (CHIP) and highlight the effects of the program on insurance coverage and access to care in 10 study states. Here, we provide some insights on how CHIP has found success in Alabama by providing coverage to uninsured children and ensuring they have access to quality health care.Effect of Provider Prompts on Adolescent Immunization Rates: A Randomized Trial
Adolescent immunization rates are suboptimal. Experts recommend provider prompts at health care visits to improve rates. We assessed the impact of either electronic health record (EHR) or nurse- or staff-initiated provider prompts on adolescent immunization rates.Table of Contents
117 Outside Looking In, Inside Looking Out—Expanding the Concept of Health Karen HeinA Successful Program for Training Parent Mentors to Provide Assistance With Obtaining Health Insurance for Uninsured Children
Seven million US children lack health insurance. Community health workers are effective in insuring uninsured children, and parent mentors (PMs) in improving asthmatic children's outcomes. It is unknown, however, whether a training program can result in PMs acquiring knowledge/skills to insure uninsured children. The study aim was to determine whether a PM training program results in improved knowledge/skills regarding insuring uninsured minority children.The Research Home: Partnering with Families
I want to express my gratitude to the members of the Research Committee for considering me suitable to receive this prestigious award.Education in Quality Improvement for Pediatric Practice: An Online Program to Teach Clinicians QI
Education in Quality Improvement for Pediatric Practice (EQIPP) is an online program designed to improve evidence-based care delivery by teaching front-line clinicians quality improvement (QI) skills. Our objective was to evaluate EQIPP data to characterize 1) participant enrollment, use patterns, and demographics; 2) changes in performance in clinical QI measures from baseline to follow-up measurement; and 3) participant experience.Addressing Electronic Clinical Information in the Construction of Quality Measures
Electronic health records (EHR) and registries play a central role in health care and provide access to detailed clinical information at the individual, institutional, and population level. Use of these data for clinical quality/performance improvement and cost management has been a focus of policy initiatives over the past decade. The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA)-mandated Pediatric Quality Measurement Program supports development and testing of quality measures for children on the basis of electronic clinical information, including de novo measures and respecification of existing measures designed for other data sources.Table of Contents
425 Policy, Politics, and Procedure: Our Role in Building Systems That Improve the Health of Children David M. KellerUptake of Human Papillomavirus Vaccine Among Adolescent Males and Females: Immunization Information System Sentinel Sites, 2009–2012
The Advisory Committee on Immunization Practices (ACIP) has recommended routine human papillomavirus (HPV) vaccination at age 11 or 12 years for girls since 2006 and for boys since 2011. We sought to describe adolescent HPV vaccination coverage, doses administered from 2009 to 2012, and age at first vaccination by sex.School-Located Influenza Vaccination With Third-Party Billing: Outcomes, Cost, and Reimbursement
To assess rates of immunization; costs of conducting clinics; and reimbursements for a school-located influenza vaccination (SLIV) program that billed third-party payers.School-Located Influenza Vaccination With Third-Party Billing: What Do Parents Think?
School-located influenza vaccination (SLIV) may be instrumental in achieving high vaccination rates among children. Sustainability of SLIV programs may require third-party billing. This study assessed, among parents of elementary school students, the attitudes about SLIV and billing at school, as well as factors associated with being supportive of SLIV.Novel Immunization Reminder/Recall Approaches: Rural and Urban Differences in Parent Perceptions
To assess the following among parents of young children: 1) preferences about the source of immunization reminder/recall (R/R) messages, 2) the degree of acceptability of different R/R modalities, and 3) factors that influence preferences, including rural and urban characteristics.Children and the Patient Protection and Affordable Care Act: Opportunities and Challenges in an Evolving System
The Patient Protection and Affordable Care Act (ACA), passed in 2010, focused primarily on the problems of adults, but the changes in payment for and delivery of care it fosters will likely impact the health care of children. The evolving epidemiology of pediatric illness in the United States has resulted in a relatively small population of medically fragile children dispersed through the country and a large population of children with developmental and behavioral health issues who experience wide degrees of health disparities.School-Located Influenza Vaccination: Can Collaborative Efforts Go the Distance?
Despite a large amount of publicity about universal pediatric influenza vaccination, nationally, influenza vaccination rates among school-aged children remain low. Only 59% of 5- to 12-year-old children and 43% of 13- to 17-year-old adolescents were vaccinated during the 2012 to 2103 flu vaccination season.1 It is time to consider new paradigms to complement traditional influenza vaccinations in primary care. One “new” paradigm involves school-located influenza vaccination (SLIV), about which there is a great deal of confusion.Table of Contents
219 School-Located Influenza Vaccination: Can Collaborative Efforts Go the Distance? Sharon G. Humiston, Katherine A. Poehling, and Peter G. SzilagyiProvider Attitudes Toward Public-Private Collaboration to Improve Immunization Reminder/Recall: A Mixed-Methods Study
To assess primary care providers' current reminder/recall practices, preferences for collaboration with health departments in reminder/recall efforts, attitudes toward practice-based and population-based reminder/recall, and experiences with a population-based reminder/recall intervention.Evaluating Washington State’s Immunization Information System as a Research Tool
Immunization information systems (IISs) are powerful public health tools for vaccination activities. To date, however, their use for public health research has been limited, in part as a result of insufficient understanding on accuracy and quality of IIS data. We evaluated the completeness and accuracy of Washington State IIS (WAIIS) data, with particular attention to data elements of research interest.Table of Contents
1 Educating for Quality: Quality Improvement as an Activity of Daily Learning to Improve Educational and Patient Outcomes John Patrick T. CoThe American Academy of Pediatrics and Quality Improvement
Quality is 1 of the 3 main pillars supporting the American Academy of Pediatrics (AAP) Agenda for Children. The AAP has developed and promoted quality improvement (QI) programs to its membership for several decades. For more than 20 years, the AAP has maintained a committee of pediatrician leaders who have demonstrated an expertise in the area of QI and quality measurement, currently named the Steering Committee on Quality Improvement and Management. This committee works on developing pediatric QI measures, identifying patient safety programmatic and educational opportunities, reviewing evidence-based clinical practice guidelines, writing QI-related policy statements, and determining methodologies for implementing QI in both primary care and specialty pediatric practices.The National Improvement Partnership Network: State-Based Partnerships That Improve Primary Care Quality
Improvement partnerships (IPs) are a model for collaboration among public and private organizations that share interests in improving child health and the quality of health care delivered to children. Their partners typically include state public health and Medicaid agencies, the local chapter of the American Academy of Pediatrics, and an academic health care organization or children's hospital. Most IPs also engage other partners, including a variety of public, private, and professional organizations and individuals.Nine States' Use of Collaboratives to Improve Children's Health Care Quality in Medicaid and CHIP
We examine quality improvement (QI) collaboratives underway in 9 states participating in the Children’s Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program. A total of 147 diverse, child-serving practices were participating in the collaboratives. We conducted 256 semistructured interviews with key stakeholders from March to August 2012—2 years into the 5-year demonstration projects—and analyzed states’ grant applications, operating plans, and progress reports.Considering Context in Quality Improvement Interventions and Implementation: Concepts, Frameworks, and Application
Growing consensus within the health care field suggests that context matters and needs more concerted study for helping those who implement and conduct research on quality improvement interventions. Health care delivery system decision makers require information about whether an intervention tested in one context will work in another with some differences from the original site. We aimed to define key terms, enumerate candidate domains for the study of context, provide examples from the pediatric quality improvement literature, and identify potential measures for selected contexts.Quality Improvement Initiatives in Neonatal Intensive Care Unit Networks: Achievements and Challenges
Neonatal intensive care unit networks that encompass regions, states, and even entire countries offer the perfect platform for implementing continuous quality improvement initiatives to advance the health care provided to vulnerable neonates. Through cycles of identification and implementation of best available evidence, benchmarking, and feedback of outcomes, combined with mutual collaborative learning through a network of providers, the performance of health care systems and neonatal outcomes can be improved.HPV Vaccination of Boys in Primary Care Practices
In October 2011, the Advisory Committee on Immunization Practices (ACIP) recommended the quadrivalent human papillomavirus vaccine (HPV4) for the routine immunization schedule for 11- to 12-year-old boys. Before October 2011, HPV4 was permissively recommended for boys. We conducted a study in 2010 to provide data that could guide efforts to implement routine HPV4 immunization in boys. Our objectives were to describe primary care physicians': 1) knowledge and attitudes about human papillomavirus (HPV)-related disease and HPV4, 2) recommendation and administration practices regarding HPV vaccine in boys compared to girls, 3) perceived barriers to HPV4 administration in boys, and 4) personal and practice characteristics associated with recommending HPV4 to boys.A Randomized Trial to Increase Acceptance of Childhood Vaccines by Vaccine-Hesitant Parents: A Pilot Study
A cluster randomized trial was performed to evaluate an educational intervention to improve parental attitudes and vaccine uptake in vaccine-hesitant parents.A Mixed Methods Study of Parental Vaccine Decision Making and Parent–Provider Trust
To describe parental vaccine decision making behaviors and characterize trust in physician advice among parents with varying childhood vaccination behaviors.Communicating With Parents About Immunization Safety: Messages for Pediatricians in the IOM Report “The Childhood Immunization Schedule and Safety: Stakeholder Concerns, Scientific Evidence, and Future Studies”
The report, “The Childhood Immunization Schedule and Safety: Stakeholder Concerns, Scientific Evidence, and Future Studies,” released by the Institute of Medicine (IOM) in January 2013, is highly relevant for the pediatric community.1 Although many studies have assessed the safety of immunizations, to our knowledge, this is the first study to address the childhood immunization schedule as a whole. The purpose of this commentary is to highlight the report's most pertinent findings and recommendations for the pediatric community.Importance of Mixed Methods in Pragmatic Trials and Dissemination and Implementation Research
With increased attention to the importance of translating research to clinical practice and policy, recent years have seen a proliferation of particular types of research, including pragmatic trials and dissemination and implementation research. Such research seeks to understand how and why interventions function in real-world settings, as opposed to highly controlled settings involving conditions not likely to be repeated outside the research study. Because understanding the context in which interventions are implemented is imperative for effective pragmatic trials and dissemination and implementation research, the use of mixed methods is critical to understanding trial results and the success or failure of implementation efforts.Table of Contents
387 Communicating With Parents About Immunization Safety: Messages for Pediatricians in the IOM Report “The Childhood Immunization Schedule and Safety: Stakeholder Concerns, Scientific Evidence, and Future Studies” Gerry Fairbrother, Elena Fuentes-Afflick, Lainie Friedman Ross, and Pauline A. ThomasImproving Immunization Delivery using an Electronic Health Record: The ImmProve Project
Though an essential pediatric preventive service, immunizations are challenging to deliver reliably. Our objective was to measure the impact on pediatric immunization rates of providing clinicians with electronic health record–derived immunization prompting.Correlates of Patient Portal Enrollment and Activation in Primary Care Pediatrics
To identify the demographic, practice site, and clinical predictors of patient portal enrollment and activation among a pediatric primary care population.The Challenge of Reaching Adolescents to Promote Health Care
The challenge of providing appropriate preventive health services to adolescents is one familiar to all pediatricians who care for this population. Adolescents have fewer recommended preventive health medical visits than young children and may not have regular contact with the health care system. In recent years, new adolescent vaccines have been developed and recommended to provide protection against pertussis (TdaP), meningococcal meningitis (MCV4), and human papillomavirus (HPV), increasing the need for appropriate preventive health care.A Randomized Trial of the Effect of Centralized Reminder/Recall on Immunizations and Preventive Care Visits for Adolescents
To assess the impact of a managed care-based patient reminder/recall system on immunization rates and preventive care visits among low-income adolescents.
