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Below are articles that support specific interventions to advance MCH National Performance Measures (NPMs) and Standardized Measures (SMs). Most interventions contain multiple components as part of a coordinated strategy/approach.

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Displaying records 1 through 43 (43 total).

Aita M, Héon M, Savanh P, De Clifford-Faugère G, Charbonneau L. Promoting Family and Siblings' Adaptation Following a Preterm Birth: A Quality Improvement Project of a Family-Centered Care Nursing Educational Intervention. J Pediatr Nurs. 2021 May-Jun;58:21-27. doi: 10.1016/j.pedn.2020.11.006. Epub 2020 Dec 5. PMID: 33285437.

Evidence Rating: Emerging

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Patient-Centered Medical Home, Quality Improvement/Practice-Wide Intervention,

Intervention Description: pre-test, training intervention and tool guide, post test

Intervention Results: After completing the educational intervention to promote family and sibling adaptation in the NICU, the nurses' knowledge and perceptions were more favorable, and they implemented more nursing practices.

Conclusion: Based on the findings of our quality improvement project, the educational intervention could be offered to all NICU nurses working with families, as the positive attitudes of nurses are central to the implementation of FCC (Maree & Downes, 2016). FCC should be encouraged in NICUs as parental presence, educational sessions and participating actively in the care of preterm infants have been recently reported to improve both infant and parental outcomes (O'Brien et al., 2018), as well as the infants' medical outcomes (Lv et al., 2019). Visitors' programs in hospital centers to support FCC have reported significant results for parents (Lee et al., 2014). Policies in the NICU should encourage the parents' presence and participation in care and also include siblings and extended families, such as grandparents (Craig et al., 2015; Lee et al., 2014). If necessary, the visitation policy could be modified to promote parental presence, participation and partnership in FCC (Griffin, 2013). The design of the NICU can also support FCC (Maree & Downes, 2016). With the goal of expanding the reach of our training intervention, this quality improvement project is currently being turned into an online training program in order to be offered to all NICU nurses across the province. This project should be replicated with a larger sample of NICU nurses. Future research could also evaluate the parents' satisfaction with the FCC in the NICU using an instrument that includes all FCC principles (Dall'Oglio et al., 2018). Using FCC guidelines, the effect of training or educational programs on the family members' psychological and wellness outcomes should be evaluated (Davidson et al., 2017). Comparing the effect of FCC on the adaptation of different sibling age groups (i.e., 3 to 8 years old vs. 12 to 16 years old), as well as grandparents or even others deemed to be significant others by families during NICU hospitalization, would also contribute to the body of knowledge about FCC. Finally, nurses' perceptions of the benefits of implementing FCC in their practice could be further explored through a qualitative study. The findings of our project reinforce the importance of offering NICU nurses educational training programs to support them in their practice, as part of quality improvement processes. Our results support the main objective of the educational intervention, which was to develop the nurses' competencies in intervening with siblings and families in the NICU. This FCC educational intervention can significantly contribute to the quality of care offered to family members, including siblings, who have a preterm infant hospitalized at the NICU

Study Design: quality improvement project

Setting: NICU: a level III NICU in Montreal, Canada, with a capacity of 40 beds designed in pods - a level III NICU in Montreal, Canada, with a capacity of 40 beds designed in pods (intermediate and intensive care) and single-family rooms, where approximately 110 nurses work

Population of Focus: NICU Nurses - the nurses working in the NICU. A convenience sample of 20 nurses initially participated in the project, and 13 completed the post-intervention evaluation .

Sample Size: 20 nurses

Age Range: 23-44

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Altman MR, Afulani PA, Melbourne D, Kuppermann M. Factors associated with person-centered care during pregnancy and birth for Black women and birthing people in California. Birth. 2023 Jun;50(2):329-338.

Evidence Rating: Moderate

Intervention Components (click on component to see a list of all articles that use that intervention): Patient-Centered Medical Home, Prenatal Care Access, Social Supports,

Intervention Description: it focused on examining the factors associated with experiences of person-centered care during pregnancy and birth among Black birthing people in California using the Person-Centered Prenatal Care (PCPC) and the Person-Centered Maternity Care (PCMC-US) scales. These validated measures were used to better understand how Black women and birthing people experience their care in relation to other aspects of their identity, social status, and care-related factors . The study aimed to identify factors associated with lower PCPC and PCMC-US scores, providing insights into the contributors to the experiences of care among Black birthing people in California

Intervention Results: The study identified several factors associated with lower person-centered care scores among Black birthing people in California. Factors associated with lower PCPC scores included having foreign-born parents, having public or no insurance, part-time employment, unstable housing, late start of prenatal care (in the second or third trimester), poorer self-rated health, and lack of continuity of care with prenatal providers. On the other hand, factors associated with lower PCMC-US scores included having public insurance, late start of prenatal care, longer length of stay in the facility following birth, poorer self-rated health, lack of continuity of care between prenatal care and birth providers, and racial discordance with the birth provider . These findings highlight the contributions of intersecting identities as well as health-related and care-related factors to Black birthing people's experiences of care in California. Continuity of care and provider racial concordance were shown to improve pregnancy and birth experiences

Conclusion: The study's conclusions emphasized the significant contributions of intersecting identities, health-related factors, and care-related factors to the experiences of care among Black birthing people in California. The findings underscored the importance of continuity of care and provider racial concordance in improving pregnancy and birth experiences for this population. Additionally, the study highlighted the need to address the intersecting effects of sociodemographic factors on experiences of care and the potential interventions to decrease healthcare disparities. The authors also noted that despite the relatively homogenous sample, the analysis revealed the impact of sociodemographic factors and intersecting identities on care experiences, consistent with the existing literature on factors influencing care experiences

Study Design: The study utilized a cross-sectional design to examine the factors associated with experiences of person-centered care during pregnancy and birth among Black birthing people in California. The cross-sectional design allowed the researchers to collect data at a single point in time, providing a snapshot of the experiences and characteristics of the participants within the specified timeframe. This design is commonly used to assess associations between variables and is suitable for investigating factors related to person-centered care experiences within a specific population

Setting: The setting for the study is California, United States. The research focuses on Black women and birthing people in California and aims to examine factors associated with experiences of person-centered care during pregnancy and birth within this specific demographic and geographic context. By conducting the study in California, the researchers provide insights that are relevant to the local healthcare landscape and can potentially inform targeted interventions and policies to improve the quality of care for Black women and birthing people in the state.

Population of Focus: The target audience for this study includes healthcare providers, policymakers, researchers, and advocates who are interested in improving the quality of care for Black women and birthing people during pregnancy and birth. The study provides valuable insights into factors associated with person-centered care during pregnancy and birth for this population, which can inform the development of targeted interventions and policies aimed at reducing disparities in birth outcomes. The findings of this study can also be of interest to individuals and organizations working to promote health equity and social justice in the United States.

Sample Size: The sample size for the study consisted of 234 Black women and birthing people who were recruited between January and September 2020 as part of a validation study for the Person-Centered Prenatal Care (PCPC) and the Person-Centered Maternity Care (PCMC-US) scales . This sample size was used for the analyses conducted to examine the factors associated with experiences of person-centered care during pregnancy and birth among Black birthing people in Californi

Age Range: The age range of the participants in the study was 15 years or older and less than 1 year postpartum . The study did not provide a specific age range for the participants. However, the study did report that the participants were predominantly aged 29-32 years

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Ashby, B. D., Ehmer, A. C., & Scott, S. M. (2019). Trauma-informed care in a patient-centered medical home for adolescent mothers and their children. Psychological services, 16(1), 67.

Evidence Rating: Emerging

Intervention Components (click on component to see a list of all articles that use that intervention): Enabling Services, Provider Training/Education, Patient-Centered Medical Home, PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: The Colorado Adolescent Maternity Program (CAMP) is an obstetric and pediatric medical home for pregnant and parenting adolescent girls through age 22 and their children located within Children’s Hospital Colorado. With the integration of behavioral health into CAMP, and given the prevalence of trauma histories among adolescent mothers reported in the literature, programmatic and operational changes to clinical care were made using the Substance Abuse and Mental Health Services Administration’s six key principles of a trauma-informed approach.

Intervention Results: Data showed that nearly 30% of participants reported a history of trauma. Following the inclusion of trauma-informed principles, patients had significantly higher rates of attendance at prenatal appointments (p < .001) and significantly lower rates of low birthweight babies (p = .02).

Conclusion: Future programmatic changes and long-term assessment outcomes of this trauma-informed approach in a PCMH are also discussed.

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Badgett, N. M., Sadikova, E., Menezes, M., & Mazurek, M. O. (2022). Emergency Department Utilization Among Youth with Autism Spectrum Disorder: Exploring the Role of Preventive Care, Medical Home, and Mental Health Access. Journal of Autism and Developmental Disorders, 1-9.

Evidence Rating: Emerging

Intervention Components (click on component to see a list of all articles that use that intervention): Patient-Centered Medical Home, Notification/Information Materials (Online Resources, Information Guide), Outreach (caregiver), PROFESSIONAL_CAREGIVER, PARENT_FAMILY, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: The 2016–2018 National Surveys of Children’s Health dataset was used to identify associations among preventive care, unmet health care needs, medical home access, and emergency department (ED) use among children and adolescents with autism spectrum disorder (ASD).

Intervention Results: Results indicated that youth with ASD had higher odds of using ED services if they had unmet mental health care needs (OR = 1.58, CI: 1.04–2.39) and lower odds of using ED services if they had access to a medical home (OR = 0.79, CI: 0.63–0.98).

Conclusion: Findings suggest the importance of access to coordinated, comprehensive, and patient-centered care to address health care needs and prevent ED utilization among children and adolescents with ASD.

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Banerjee J, Aloysius A, Mitchell K, Silva I, Rallis D, Godambe SV, Deierl A. Improving infant outcomes through implementation of a family integrated care bundle including a parent supporting mobile application. Arch Dis Child Fetal Neonatal Ed. 2020 Mar;105(2):172-177. doi: 10.1136/archdischild-2018-316435. Epub 2019 Jun 21. PMID: 31227521.

Evidence Rating: Moderate

Intervention Components (click on component to see a list of all articles that use that intervention): Training (Parent/Family), Family-Based Interventions, Patient-Centered Medical Home,

Intervention Description: In collaboration with veteran parents’ focus groups, we created an experienced co-designed care bundle including IFDC mobile application, which together with staff training programme comprised the IFDC programme. Infant outcomes were compared with retrospective controls in a prepost intervention analysis.

Intervention Results: Infants in the IFDC group were discharged earlier: median corrected GA (36+0 (IQR 35+0–38+0) vs 37+1 (IQR 36+3–38+4) weeks; p=0.003), with shorter median LOS (41 (32–63) vs 55 (41–73) days; p=0.022)

Conclusion: This is the first reported study from a UK tertiary neonatal unit demonstrating significant benefits of family integrated care programme. The IFDC programme has significantly reduced LOS, resulted in the earlier achievement of full enteral and suck feeds

Study Design: Implemented the Integrated Family Delivered Care (IFDC) program to a subset of infants while also having a control group. Compared infant outcomes.

Setting: NICU - London

Population of Focus: Families of NICU patients - healthcare providers and professionals working in neonatal intensive care units, as well as parents of preterm infants who are receiving care in these units.

Sample Size: 89 families - 89 infants who were admitted to the neonatal units of the participating healthcare facility. However, for the purpose of the outcome analysis, infants were included if they were less than 34 weeks gestational age, admitted for at least 14 days, and received the entire period of care in the neonatal units. This resulted in a sample size of 37 infants .

Age Range: Parents of infants

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Bogetz JF, Revette A, DeCourcey DD. Clinical Care Strategies That Support Parents of Children With Complex Chronic Conditions. Pediatr Crit Care Med. 2021 Jul 1;22(7):595-602. doi: 10.1097/PCC.0000000000002726. PMID: 33813549.

Evidence Rating: Moderate

Intervention Components (click on component to see a list of all articles that use that intervention): Patient-Centered Medical Home, Provider Training/Education, Quality Improvement/Practice-Wide Intervention,

Intervention Description: The survey instrument, “Caring for Children with Complex Chronic Conditions,” was adapted from a previously validated instrument (20). The survey consisted of 183-items, including 21 open-ended response items

Intervention Results: Informational themes included providing clear communication, with subthemes of: 1) be honest and open and 2) coordinate interdisciplinary care and provide consistent messaging with other clinicians working with our family. Relational themes were as follows: 1) include parents’ experiences and recognize their expertise about their children, with subthemes of: a) be caring and sensitive toward parents and b) be accommodating and flexible to demonstrate respect and provide comfort and 2) maintain relationships with families throughout their child’s medical journey and into bereavement.

Conclusion: Clinical care strategies that support parents of children with complex chronic conditions reflect the unique needs of this group of children. Relational strategies such as including parents as experts in their child’s care were paramount to parents of children with complex chronic conditions throughout their child’s medical journey and at end of life.

Study Design: This study reports findings from a cross-sectional survey of bereaved parents of children with CCCs.

Setting: CMC: Hospital - a single children's hospital

Population of Focus: CMC - bereaved parents of children with complex chronic conditions (CCCs) who had received care at Boston Children's Hospital (BCH) and had passed away between January 2006 and December 2015.

Sample Size: 110 - The study had a total of 211 eligible participants, and 110 of those eligible parents completed the survey and at least one open-response item, yielding a 52% participation rate.

Age Range: 1.9–20.3 - children

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Brown, C. M., Perkins, J., Blust, A., & Kahn, R. (2015). A neighborhood-based approach to population health in the pediatric medical home. Journal of Community Health, 40(1), 1–11.

Evidence Rating: Emerging Evidence

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Patient-Centered Medical Home, CAREGIVER, Home Visit (caregiver), PATIENT/CONSUMER, Home Visits, Outreach (caregiver), Nurse/Nurse Practitioner, Enabling Services

Intervention Description: (1) To improve connections to the medical home for infants from one low-income neighborhood (2) To increase the number of families enrolled in a local home visiting program, and (3) To improve communication between medical staff and home visitors.

Intervention Results: Outcomes were timeliness of well child care and enrollment in home visiting. Time series analyses compared patients from the intervention neighborhood with a demographically similar neighborhood. Mean age at newborn visit decreased from 14.4 to 10.1 days of age. Attendance at 2- and 4-month well child visits increased from 68 to 79% and 35 to 59 %, respectively. Rates did not improve for infants from the comparison neighborhood. Confirmed enrollment in home visiting increased. After spread to 2 more clinics, 43 % of infants in the neighborhood were reached.

Conclusion: Neighborhood-based newborn registries, proactive nursing outreach, and collaboration with a home visiting agency aligned multiple clinics in a low-income neighborhood to improve access to health-promoting services.

Study Design: Quasi-experimental: Nonequivalent control group

Setting: Primary care clinics and a home visiting program in a neighborhood defined by two zip codes

Population of Focus: All children born in the intervention and comparison neighborhoods

Data Source: Data from the local children’s hospital’s Emergency Department was used to identify the most common primary medical providers for children from the study zip codes • Newborn registry data (maintained manually with a Microsoft Excel spreadsheet) • Electronic health record data (with an automated newborn registry) • Manual chart review • Automated report of appointment data • Outcome measures using clinic data • Process measures using clinic and home visiting agency data

Sample Size: n=237 (cumulative number of babies on a registry); n=30 (cumulative number of families enrolled in home visiting)

Age Range: Not specified

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Cole, J. M., Weigel, J., Albrecht, S., Ren, D., Reilly, A. K., & Danford, C. A. (2019). Setting Kids Up for Success (SKUFS): Outcomes of an Innovation project for promoting healthy lifestyles in a pediatric patient-centered medical home. Journal of Pediatric Health Care, 33(4), 455-465.

Evidence Rating: Emerging

Intervention Components (click on component to see a list of all articles that use that intervention): Notification/Information Materials (Online Resources, Information Guide), Other Education, Patient-Centered Medical Home, PATIENT_CONSUMER, PARENT_FAMILY, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: The purpose of this study was to establish a healthy weight management support group in a pediatric patient-centered medical home.

Intervention Results: There was a significant improvement in fruit and vegetable intake and dining out (p = <.05), and a clinical improvement in physical activity and sugar sweetened beverage intake.

Conclusion: Setting Kids Up For Success provides a framework for patient-centered medical home's to provide a healthy lifestyle support group for SA children and their families.

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Cole, M. B., Qin, Q., Sheldrick, R. C., Morley, D. S., & Bair-Merritt, M. H. (2019). The effects of integrating behavioral health into primary care for low-income children. Health services research, 54(6), 1203–1213. https://doi.org/10.1111/1475-6773.13230

Evidence Rating: Emerging

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Quality Improvement/Practice-Wide Intervention, Patient-Centered Medical Home,

Intervention Description: To evaluate the impact of TEAM UP-an initiative that fully integrates behavioral health services into pediatric primary care in three Boston-area Community Health Centers (CHCs)-on health care utilization and costs.

Intervention Results: After 1.5 years, TEAM UP was associated with a relative increase in the rate of primary care visits (IRR = 1.15, 95% CI 1.04-1.27, or 115 additional visits/1000 patients/quarter), driven by children with a MH diagnosis at baseline. There was no significant change in avoidable health care utilization or cost.

Conclusion: Expanding the TEAM UP behavioral health integration model to other sites has the potential to improve primary care engagement in low-income children with MH needs.

Study Design: Difference in difference approach

Setting: Three Boston-area pediatric medical home community health center (CHC) sites that serve low-income and demographically diverse patient populations.

Population of Focus: Children age 17 and younger with Medicaid coverage, who were enrolled in BMC HealthNet, and who had a PCP visit within the last 18 months

Sample Size: 2,616 children

Age Range: Children ages 17 and younger

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Doherty RF, Knab M, Cahn PS. Getting on the same page: an interprofessional common reading program as foundation for patient-centered care. J Interprof Care. 2018 Jul;32(4):444-451. doi: 10.1080/13561820.2018.1433135. Epub 2018 Feb 20. PMID: 29461137.

Evidence Rating: Emerging

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Patient-Centered Medical Home, Quality Improvement/Practice-Wide Intervention,

Intervention Description: common reading program in their first year. 12-16 months later, participate in focus groups discussions

Intervention Results: 5 primary themes - seeing family members as stakeholders, establishing common ground with peers and affirming the larger reason for graduate school, applying lessons from clinical practice that see the parient as a person, experiencing an emotional connections with a story and its characters, taking alternative perspectives/stepping into the shoes of the patient

Conclusion: Story can be a global way to construct meaning. In health care, health professionals must piece together the illness narrative to fully appreciate their client’s illness experience (Clark, 2014; Kleinman, 1988). A common reading program provides a means for helping interprofessional learners construct this narrative. Through shared reading and reflection on a fictional account, health professions students better understand the dimensions of illness, what it means to give and receive care, and the uncertainty of the human condition. This narrative, experiential approach for socializing entering graduate students to the health professions can serve to impart the values of patient-centered care from day one. When implemented in an integrative and comprehensive inter-professional education curriculum, it has the potential to encourage students to embrace the dual identity entailed by interprofessional professionalism. Facilitation of a common reading follows best practices in interprofessional learning by creating and sustaining group culture and role modeling reflection, values, and challenges to stereotypes (Barr, 2013; Bridges, Davidson, Odegard, Maki, & Tomkowiak, 2011; Carpenter & Dickerson, 2016; Interprofessional Education Collaborative, 2016; Institute of Medicine, 2015; Oandasan & Reeves, 2005). Although no known studies to date have evaluated the staying power of common reading programs, our findings mirror research in liberal arts education that suggest first-year seminars are best practice in the development of a holistic student, citizen, and lifelong learner (Association of American Colleges and Universities, 2007; Padgett, Keup, & Pascarella, 2013). A common reading appears to be a relatively low-cost, high-yield interprofessional educational activity that serves to develop health professions students’ knowledge, attitudes, and behaviors in patient-centered care. It is easily introduced into educational programs and bridges both uniprofessional and interprofessional learning. A common reading program can curtail typical alignment challenges between programs, timetables, and faculty (Barr, Helme, & D’Avray, 2014) since students complete the reading pre-matriculation and reflect on the reading during program orientation. It facilitates meaningful conversations across a variety of backgrounds and experiences, and translates contexts from academic to clinical education settings along the continuum of learning. A common reading may be an effective and lasting way for educators to establish a patient-centered, perspective-taking approach to care in pre-licensure health professions students. Assigning and facilitating discussion on a common reading imparts the message to students that the institution values the human aspects of care. It is an effective way to foster interprofessionalism and make patient-centered care explicit for novice health professionals. Themes elicited from this research suggest the staying power of this pedagogy in regard to perspective-taking, understanding family as stakeholders, and the importance of seeing the patient as a person. A common reading program allows the learner to engage with an illness narrative, connecting learner to patient and preparing students for collaborative practice.

Study Design: An exploratory case study approach using focus groups and thematic analysis was used to evaluate whether students’ attitudes about a literary account of illness endured a year after clinical and professional education

Setting: MGH Institute of Health Professions, an independent graduate school in Boston, Massachusetts, - second-year students in nursing, physical therapy, occupational therapy, and communication sciences and disorders (i.e., speech-language pathology) entry-level programs .

Population of Focus: second-year students in nursing, occupational therapy, physical therapy, and speech-language pathology - second-year students in nursing, physical therapy, occupational therapy, and communication sciences and disorders (i.e., speech-language pathology) entry-level programs .

Sample Size: 316 students from the four participating health professions programs, with representation from nursing, physical therapy, occupational therapy, and speech-language pathology . Additionally, 24 students agreed to participate in the focus group discussions, with the four professions represented as follows: nursing (n = 4), occupational therapy (n = 5), physical therapy (n = 8), and speech-language pathology (n = 7) .

Age Range: college students

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Espeleta, H. C., Bakula, D. M., Sharkey, C. M., Reinink, J., Cherry, A., Lees, J., ... & Gillaspy, S. R. (2020). Adapting pediatric medical homes for youth in foster care: Extensions of the American academy of pediatrics guidelines. Clinical Pediatrics, 59(4-5), 411-420.

Evidence Rating: Emerging

Intervention Components (click on component to see a list of all articles that use that intervention): Enabling Services, Provider Training/Education, Patient-Centered Medical Home, HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: This article provides recommendations for adapting the pediatric medical home (PMH) model for health care needs of youth in foster care.

Intervention Results: Preliminary evidence suggests that the PMH model of care may be ideal for addressing the complex and often underserved needs of youth in foster care and their families. The present recommendations provide a logistical framework for establishing a clinic that thoughtfully considers the unique needs of this population.

Conclusion: Future research is needed to examine best practices for implementation.

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Gafni-Lachter L, Ben-Sasson A. Promoting Family-Centered Care: A Provider Training Effectiveness Study. Am J Occup Ther. 2022 May 1;76(3):7603205120. doi: 10.5014/ajot.2022.044891. PMID: 35605168.

Evidence Rating: Emerging

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Patient-Centered Medical Home, Quality Improvement/Practice-Wide Intervention,

Intervention Description: We developed BBetter Together on the basis of adult learning theory to prepare providers to implement best practices in FCC. The training was delivered as six consecutive in-person workshops (30-hr total over 10 wk).

Intervention Results: Observed changes included improved reports of FCC implementation and increased self-efficacy in all MPOC domains, with medium effect sizes. These outcomes were positively interrelated.

Conclusion: BT training can enhance health care providers’ perceptions of FCC implementation and self-efficacy and minimize differences in FCC implementation by providers across expertise levels and practice settings. This study can inform the development of future FCC training interventions for providers, managers, educators, and researchers

Setting: Continuing education centers in Israel - The research was conducted in northern Israel

Population of Focus: medical professionals - occupational therapists, speech-language pathologists, physical therapists, and art therapists working in outpatient or school-based pediatric practices in Israel

Sample Size: 82 providers - 82 participants, including 68 occupational therapists, 9 speech-language pathologists, 2 physical therapists, and 3 art therapists .

Age Range: adults who provided care to children - The participants had a mean age of 37.3 years, with a range from 24 to 55 years .

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Garcia-Huidobro D, Shippee N, Joseph-DiCaprio J, O'Brien JM, Svetaz MV. Effect of patient-centered medical home on preventive services for adolescents and young adults. Pediatrics. 2016;137(6).

Evidence Rating: Moderate Evidence

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Patient-Centered Medical Home

Intervention Description: To determine the association between enrollment in patient-centered medical homes (PCMHs) and the receipt of preventive services among adolescents and young adults.

Intervention Results: No significant difference in odds of receiving a preventive visit for the total sample (ages 10-24), comparing patients enrolled in patient-centered medical homes with patients not enrolled (aOR=1.10; CI=0.93-1.29). Decreased odds of having a visit for adolescents ages 10-18 comparing patients rolled in patient-centered medical homes with patients not enrolled (aOR=0.63; 99% CI=0.51-0.79).

Conclusion: Overall, patients enrolled in PCMHs had higher odds of receiving multiple preventive services.

Study Design: Retrospective cohort design

Setting: Clinics in the Hennepin County Medical Center network in Minneapolis, Minnesota

Population of Focus: Young adults ages 10-24

Data Source: Medical record review

Sample Size: Intervention (n=729) Control (n=20,975)

Age Range: Not specified

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Gold, K. J., Garrison, B., Garrison, S., & Armbruster, P. (2020). A Novel Model for a Free Clinic for Prenatal and Infant Care in Detroit. Maternal and Child Health Journal, 24, 817-822.

Evidence Rating: Emerging

Intervention Components (click on component to see a list of all articles that use that intervention): Patient-Centered Medical Home, Enabling Services, PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: We report on a unique model of patient care focused on providing patient-centered care and building trusting relationships.

Intervention Results: In the first 2 years of operation, demand for services rose rapidly and there were stellar clinical outcomes, despite the fact that Luke patients are among the medically and socially highest risk populations in the nation.

Conclusion: While marginalized populations have worse birth outcomes and far more infant deaths, making care accessible and responsive to patient needs while focusing on building patient relationships is an important strategy to improve outcomes.

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Hayes D, Edbrooke-Childs J, Martin K, Reid J, Brown R, McCulloch J, Morton L. Increasing person-centred care in paediatrics. Clin Teach. 2020 Aug;17(4):389-394. doi: 10.1111/tct.13100. Epub 2019 Nov 10. PMID: 31710178; PMCID: PMC7497256.

Evidence Rating: Emerging

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Patient-Centered Medical Home, Quality Improvement/Practice-Wide Intervention,

Intervention Description: attended ‘Me first’ training (‘Me first’ is a 1-day masterclass focused on understanding and promoting effective communication through a six-step model as well as tackling barriers to effective communication) and completed questionnaires across three time points: (1) prior to attending the training; (2) at the end of the training; and (3) 4–6 weeks later.

Intervention Results: A total of 28 training sessions of ‘Me first’ took place between March 2015 and May 2017. The Friedman test showed a statistically significant improvement in participants’ attitudes towards partnership working with PPs across the three time points. There were statistically significant increases in all four communication domains when comparing scores at time point 1 (prior to the masterclass) with scores at time point 3 (4–6 weeks later)

Conclusion: Future research should focus on whether ‘Me first’ training results in changes to shared decision making and satisfaction with care. Longer term follow-up should also be considered to examine whether improvements in attitude and behaviour are maintained for certain groups. Finally, intervention developers may wish to examine which behaviour-change techniques may be contributing to change.

Study Design: Attitude was measured using the Leeds Attitudes to Concordance II (LATCon II) scale, and communication skills were measured using the Effective Listening and Interactive Communication Scale (ELICS).

Setting: London clinic

Population of Focus: medical staff - 69 clinicians who participated in the 'Me first' training programme

Sample Size: 69 clinicians

Age Range: Adult medical staff providing care in pediatrics - The study focused on paediatric patients, defined as individuals up to the age of 18 years .

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Heo YJ, Oh WO. The effectiveness of a parent participation improvement program for parents on partnership, attachment infant growth in a neonatal intensive care unit: A randomized controlled trial. Int J Nurs Stud. 2019 Jul;95:19-27. doi: 10.1016/j.ijnurstu.2019.03.018. Epub 2019 Apr 2. PMID: 31005676.

Evidence Rating: Moderate

Intervention Components (click on component to see a list of all articles that use that intervention): Training (Parent/Family), Family-Based Interventions, Patient-Centered Medical Home,

Intervention Description: Created a Parent Participation Improvement Program. Then offered it to the study group while maintaining a control group

Intervention Results: A Mann-Whitney U test was performed to compare parents’ partnership scores between the intervention and control groups. The difference between the partnership scores of the two groups was significant (MannWhitney U = 99.50, p<.001).

Conclusion: The aim of this study was to develop the Parent Participation Improvement Program for parents in neonatal care and to evaluate its effects. This program was proven effective for increasing attachment and partnership in both mothers and fathers. The program, developed in accordance with King’s goal attainment theory, will serve as a useful reference in developing standardized guidelines for promoting parent participation in neonatal care, and it is expected to bridge the gap between theory and practice by applying family-centered care to the practical base of neonatal care.

Study Design: This study consisted of two phases. The first phase was developing the Parent Participation Improvement Program. The second phase, a parallel, 2-group randomized controlled trial with a prospective pretest-posttest experimental design, was conducted to evaluate the program’s effectiveness.

Setting: NICU South Korea - neonatal intensive care unit (NICU). The Parent Participation Improvement Program was implemented in this NICU to promote parent participation in clinical activities and evaluate its effects on parents' partnerships with nurses, attachment to infants, and infants' body weight

Population of Focus: Parent dyads of Premature infants - parents of infants in neonatal intensive care units, healthcare professionals working in neonatal care, and researchers interested in family-centered care and parent participation in clinical activities.

Sample Size: 124 parents - The sample size for the study consisted of 66 premature infants and their 132 parents (66 mothers and 66 fathers) . The infants were randomly assigned to either the intervention group or the control group, with 62 infants and their 124 parents included in the final analysis . The sample size was calculated to ensure the study had sufficient power to detect the estimated effect size .

Age Range: parents of infants - the parents showed that their mean age was 34.6 years in the intervention group and 34.97 years in the control group . The infants included in the study were premature, with a mean gestational age of 28.42 weeks in the intervention group and 29.75 weeks in the control group .

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Institute for Child Health Policy at the University of Florida. Florida Pediatric Medical Home Demonstration Project Evaluation. https://www.healthmanagement.com/wp-content/uploads/florida-pediatric-medical-home-demonstration-report-year-4.pdf

Evidence Rating: Emerging Evidence

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Parent Engagement, PROVIDER/PRACTICE, Maintenance of Certification Credits, Provider Training/Education, Patient-Centered Medical Home, Quality Improvement/Practice-Wide Intervention

Intervention Description: The Florida Pediatric Medical Home Demonstration Project, funded through the Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant, aimed to implement and evaluate a Patient-Centered Medical Home (PCMH) model in selected pediatric practices. The project was carried out in two rounds, with Round 1 practices participating from 2011-2014 and Round 2 practices from 2013-2014. The American Academy of Pediatrics (AAP) provided quality improvement activities to the practices, which included learning sessions, monthly calls, quarterly reports, and listserv communication. Practices were eligible if they accepted Medicaid and CHIP and served at least 100 children with special health care needs.

Intervention Results: The evaluation results showed that over the course of the project, the Medical Home Index (MHI) scores increased for both Round 1 and Round 2 practices, indicating progress towards becoming PCMHs. Practices reported being able to make changes, improve teamwork, and enhance efficiency. However, staff turnover, communication with specialists, and maintaining parent partner relationships remained challenging. Physician-reported outcomes such as job satisfaction were higher than those reported by non-physician staff. Community stakeholders indicated room for improvement in communication with the practices. A cost study component with Round 2 practices revealed that the perceived costs of PCMH transformation varied greatly due to differences in activities undertaken by practices.

Conclusion: The Florida Pediatric Medical Home Demonstration Project evaluation showed that participating pediatric practices made significant progress in their PCMH transformation, as evidenced by increased MHI scores. Practices experienced successes in implementing changes, improving teamwork, and increasing efficiency. However, challenges persisted in areas such as staff turnover, specialist communication, and parent partnerships. Physician staff reported more positive outcomes compared to non-physician staff. Opportunities exist to further improve communication between practices and community stakeholders. Finally, the cost study highlighted the varying perceptions and experiences of practices regarding the financial implications of PCMH transformation.

Study Design: Not specified

Setting: Not specified

Population of Focus: Not specified

Data Source: Not specified

Sample Size: Not specified

Age Range: Not specified

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Jaudes, K. P., Champagne, V., Harden, A., Masterson, J., Bilaver, L. A. (2012). Expanded medical home model works for children in foster care. Child Welfare, 91(1), 9–33.

Evidence Rating: Emerging Evidence

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Outreach (Provider), Patient-Centered Medical Home, Expert Support (Provider), STATE, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Continuity of Care (Caseload)

Intervention Description: The Illinois Child Welfare Department implemented a statewide health care system to ensure that children in foster care obtain quality health care by providing each child with a medical home.

Intervention Results: These children used the health care system more effectively and cost-effective as reflected in the higher utilization rates of primary care and well-child visits and lower utilization of emergency room care for children with chronic conditions.

Conclusion: This study demonstrates that the Medical Home model works for children in foster care providing better health outcomes in higher immunization rates.

Study Design: Observational: Cohort study; Survey

Setting: Illinois statewide health system

Population of Focus: Children in foster care between July 2001 and June 2009

Data Source: • Medicaid paid claims data

Sample Size: n=28934

Age Range: Not specified

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Lemmon ME, Glass HC, Shellhaas RA, Barks MC, Bansal S, Annis D, Guerriero JL, Pilon B, Wusthoff CJ, Chang T, Soul JS, Chu CJ, Thomas C, Massey SL, Abend NS, Rau S, Rogers EE, Franck LS; Neonatal Seizure Registry. Family-Centered Care for Children and Families Impacted by Neonatal Seizures: Advice From Parents. Pediatr Neurol. 2021 Nov;124:26-32. doi: 10.1016/j.pediatrneurol.2021.07.013. Epub 2021 Jul 30. PMID: 34509000; PMCID: PMC8523194.

Evidence Rating: Moderate

Intervention Components (click on component to see a list of all articles that use that intervention): Patient-Centered Medical Home, Quality Improvement/Practice-Wide Intervention, Provider Training/Education, Clinic Reorganization

Intervention Description: One parent or other legal guardian per family completed surveys near the time of discharge from the NICU and when their child reached 12, 18 and 24 months corrected age. Parents completed the surveys online or by telephone interview with a trained research assistant. Parents could complete surveys in English or Spanish.

Intervention Results: Three main themes were identified: (1) communicate information effectively, (2) understand and validate our experience and (3) provide support and resources

Conclusion: Data from this multicenter sample of parents provide actionable advice to healthcare teams caring for children and families impacted by neonatal seizures. Parents offered advice in three key themes: (1) communicating effectively, (2) understanding and validating parents’ experiences and (3) providing support and resources (Figure 1). Domains of advice persisted over time, suggesting that these concepts remain salient to parents long after the initial hospitalization. Clinicians, educators, and researchers can leverage these insights to inform interventions.(22) The majority of parents identified ways in which the healthcare team could more effectively communicate amidst crises. Many of these suggestions are consistent with existing literature; parents value when communication is transparent, accessible, and coordinated.(11, 15, 23) When predicting the potential for future impairment, parents appreciated when clinicians provided balanced information that included a clear spectrum of neurodevelopmental outcomes. Parent emphasis on providing balanced information, including positive information, may seem at odds with concurrent requests for transparency. While this incongruence could result from sample heterogeneity, it is also consistent with existing data from parents of premature infants suggesting that parents are able to process grim prognostic information concurrently with maintaining hope for an alternative outcome. (24) Taken together, these findings suggest that clinicians should not avoid disclosure of negative prognostic information due to concerns about removing hope. When appropriate, clinicians should disclose not only information about expected impairments, but also information about expected function. Framing the discussion as the best, worst, and most likely outcomes is one evidence-based strategy to discuss a range of potential outcomes. (15, 25) Prognostic uncertainty is a common feature of care for children with neurologic undermine a clinician’s ability to sustain these ideals.(34, 35) Interventions to enhance parent support must also address provider well-being.(36) Parent responses expand on the existing literature and comments shared by this cohort at discharge, which emphasize the importance of parent involvement in clinical care.(12, 13, 37) Our findings underscore the value of supporting and encouraging parents to safely hold their child despite critical illness at every opportunity, including during therapeutic hypothermia.(38) Finally, parents highlighted the need for increased support and access to resources. Data from this cohort and others highlight an urgent need to screen for and address parent mental health symptoms.(2) Parents also desired access to training and resources that extended beyond education associated with seizures and seizure treatment, including helping families navigate the healthcare system and connect with peer support. Parents in this study described the potential benefits of having access to sleeping options, financial resources, and psychological counselling. These findings highlight that interventions to improve parent well-being should incorporate a broad range of psychosocial needs outside of typical medical management.(3, 12)These findings should be considered in the context of this study’s strengths and limitations. Although the sample was large and geographically diverse, only approximately one-third of parents completed the optional open-ended response questions to offer advice to the healthcare team. Because the etiologies of neonatal seizures are heterogeneous, parent responses are likely informed by their infant’s underlying diagnosis, not the presence of neonatal seizures alone. The phrasing of the survey itself may have decreased responsiveness from parents who had a positive experience with the healthcare team. Questions were presented in a single order, and may have resulted in priming or order bias. Surveys were available exclusively in English and Spanish and cannot be generalized beyond these populations. Our study design aimed for a single parent or caregiver to be enrolled per family; this strategy may have decreased participation by fathers. The paternal perspective is an important focus of future work. Parent demographic data were limited, and we were unable to assess the relationship between themes and parent sociodemographic factors.The results of this contemporary and multicenter study identified modifiable behaviors and family-centered care strategies for clinicians to address the needs of parents caring for children impacted by neonatal seizures. Future work should focus on building structures to reinforce these priorities into healthcare delivery to better support parent well-being. conditions and clinician approaches are variable; parents appreciated when clinicians were honest about this uncertainty.(25, 26) Interventions to improve communication skills have been effective in many disciplines and should be adapted to this context.(27–33) Most parents emphasized the need for clinicians to understand and validate their experiences. Their recommendation was clear – parents appreciated when clinicians showed compassion, empathy, and patience. Clinicians aspire to treat patients and families with empathy and compassion; however, clinician fatigue, moral distress, and burnout may

Study Design: a prospective, observational cohort study

Setting: nine sites of the United States-based Neonatal Seizure Registry - nine sites of the United States-based Neonatal Seizure Registry

Population of Focus: Parent of children who experienced acute sysmptomatic seizures as neonates - healthcare professionals, clinicians, educators, and researchers who provide care for neonates with acute symptomatic seizures and their families .

Sample Size: 310 parents - The study enrolled 310 parents of 305 infants for the research on family-centered care for children impacted by neonatal seizures . Among the 310 parents who completed surveys, 118 (38%) shared advice for clinicians .

Age Range: parents of infants - The inclusion criteria specified that neonates were considered for inclusion if their seizures were due to an acute symptomatic cause and had onset before 44 weeks postmenstrual age . The study collected data at various time points, including near the time of discharge from the NICU and when the children reached 12, 18, and 24 months corrected age . Therefore, the age range of the children included in the study spanned from the neonatal period up to 24 months corrected age.

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Lewandowski RA, Lewandowski JB, Ekman I, Swedberg K, Törnell J, Rogers HL. Implementation of Person-Centered Care: A Feasibility Study Using the WE-CARE Roadmap. Int J Environ Res Public Health. 2021 Feb 24;18(5):2205. doi: 10.3390/ijerph18052205. PMID: 33668083; PMCID: PMC7956736.

Evidence Rating: Emerging

Intervention Components (click on component to see a list of all articles that use that intervention): Patient-Centered Medical Home, Quality Improvement/Practice-Wide Intervention, Provider Training/Education, Clinic Reorganization

Intervention Description: Implementation of the WECARE Roadmap to provide the infrastructure for high quality FCC, then implement three routines of PCC - Creating a partnership, Jointly creating care plans, Safeguarding the partnership. Followed by interviews with those involved

Intervention Results: each type of health care professional contributed a narrative summary to the open-ended field in the EMR in the overwhelming majority of their patients, between 92% and 100%. This indicates the healthcare professionals’ success at the first PCC of initiating a partnership with the child/adolescent and family regarding goals, preferences, limitations and capabilities. A high proportion of PCC patients, 86%, had a documented treatment plan.

Conclusion: In summary, this pilot feasibility study indicates that the PCC approach used in Sweden can be successfully transferred to a rehabilitation hospital in Poland and that the application of the WE-CARE Roadmap helped to facilitate the implementation process [1,23]. As a result, professionals, patients and their families expressed favorable perceptions of implementation. They regarded the PCC approach as feasible and endorsed it as beneficial. Future phases of implementation will improve monitoring and feedback and incorporate new enablers into the implementation strategy with improved measurement systems to capture care quality and costs throughout the care continuum.

Study Design: semi-structured interviews were analyzed to determine if and how each of the three core routines in PCC had been implemented and the perceptions of changes compared to usual care from both professionals and patients.

Setting: rehab hospital for children in Poland - rehabilitation hospital in Poland

Population of Focus: Patients in the scoliosis clinic with moderate scoliosis - healthcare professionals at the rehabilitation hospital in Poland, as well as patients and their families receiving care at the hospital

Sample Size: 51 patients - 51 new patients with moderate scoliosis who were treated using the person-centered care approach at the Voivodeship Rehabilitation Hospital for Children in Poland. Additionally, semi-structured interviews were conducted with nine healthcare professionals involved in the pilot study, as well as three patients and their parents receiving care at the hospital , .

Age Range: children - pediatric population

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Lewis H, Trowbridge A, Jonas D, Rosenberg AR, Bogetz JF. A Qualitative Study of Clinicians and Parents of Children with Severe Neurological Impairment on Tools to Support Family-Centered Care. J Palliat Med. 2022 Sep;25(9):1338-1344. doi: 10.1089/jpm.2021.0579. Epub 2022 May 20. PMID: 35593900; PMCID: PMC9639233.

Evidence Rating: Emerging

Intervention Components (click on component to see a list of all articles that use that intervention): Patient-Centered Medical Home, Parent Engagement, Provider Training/Education,

Intervention Description: All participants completed a one-time recorded semistructured interview in a private area on the hospital campus or by phone with either a trained clinical research coordinator or the study lead

Intervention Results: Parent and clinician perspectives were organized into three themes, each paired with an innovative tool to promote family-centered care. Themes and corresponding tools included: (1) continuity of decision-making conversations and the decision roadmap tool, (2) maintaining family communication preferences and the relational handoff tool, and (3) recognizing the abilities of each individual child and the developmental inventory tool.

Conclusion: Family-centered care for parents of children with SNI may be bolstered by continuity in decision making, maintaining parents’ communication preferences, and appreciating the child’s individual abilities. Clinical tools may provide opportunities to promote these concepts.

Study Design: data analysis included three steps: (1) inductive thematic analysis to determine themes related to familycentered care; (2) identification of ideas for tools to promote family-centered care volunteered by parents and clinicians during interviews; and (3) interpretive deductive analysis of the potential opportunities and limitations of each proposed tool by the study team

Setting: CMC: single tertiary pediatric hospital in the Northwestern United States - single tertiary children's hospital in the United States.

Population of Focus: Parents and providers of children with severe neurological impairment - parents of children with severe neurological impairment and interprofessional clinicians at a single tertiary children's hospital in the United States.

Sample Size: 50 participants: 25 parents/legal guardians of children with SNI and 25 clinicians - 50 participants, including 25 parents/legal guardians of children with severe neurological impairment and 25 interprofessional clinicians.

Age Range: children - The age range of the children with severe neurological impairment included in the study was 6 months to 25 years old.

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Lewis, C., Riese, A., Davis, G., Lakhiani, C., Brindle, A., & Flanagan, P. (2018). Transformation: Patient-Centered Medical Home-Kids in a Predominantly Medicaid Teaching Site. RHODE ISLAND, 28.

Evidence Rating: Emerging Evidence

Intervention Components (click on component to see a list of all articles that use that intervention): Continuity of Care (Caseload), Patient-Centered Medical Home, Other Education, HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: NCQA’s PCMH Recognition Program is the most widely adopted PCMH evaluation program in the country. Required elements for recognition include demonstrating team-based care, population care management and accountability, patient access and engagement and the skills to do performance measurement and improvement.

Intervention Results: These services allow our trainees, staff and faculty to ask the hard questions about food security and housing stability as they feel they have onsite support for families.

Conclusion: The unique needs of our families, including the social determinants that accompany poverty, and our responsibility as the primary teaching site for future pediatricians, presents challenges. However, these factors also provide us with great incentives: to assure optimal health and development for our high-risk population and provide trainees with solid training in patient-centered, team-based care, quality measurement, accountability for costs and outcomes, a focus on population health and dedication to data-driven system improvement.

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Lynch, S. (2018). Culturally competent, integrated behavioral health service delivery to homeless children. American journal of public health, 108(4), 434.

Evidence Rating: Emerging

Intervention Components (click on component to see a list of all articles that use that intervention): Access, Patient-Centered Medical Home, Policy/Guideline (State)

Intervention Description: In recent years, families with children have become one of the faster-growing subpopulation groups of homeless individuals, both in the United States and in Europe.1 In the United States, families made up almost one third of the 1.5 million people who were homeless in 2009, and more than half of this group were children (60%).1,2 Children who are homeless experience higher levels of stress and domestic violence compared with those who are not, and research suggests that the vast majority of homeless children have problems with their behavior, encounter difficulties in school, or have a mental health disorder.3

Intervention Results: Three models of care were developed to meet patients at their locations in homeless shelters, providing access to care.

Conclusion: Although children from homeless families are at risk for mental health disorders and developmental delays, flexible service delivery models have been developed to meet their needs. These models need to be rigorously evaluated. Culturally competent care is a crucial aspect of care delivery to “meet families where they are” and establish the kind of trust and mutual respect that is necessary for effective care provision. Timely care coordination is an important aspect of service delivery that may help break down access barriers to developmental and behavioral health care to mitigate the risks for the conditions that homeless children experience.

Setting: New York City

Population of Focus: healthcare providers, policymakers, social workers

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Marsh M, Lauden SM, Mahan JD, Schneider L, Saldivar L, Hill N, Diaz C, Abdel-Rasoul M, Reed S. Family-centered communication: A pilot educational intervention using deliberate practice and patient feedback. Patient Educ Couns. 2021 May;104(5):1200-1205. doi: 10.1016/j.pec.2020.09.033. Epub 2020 Sep 28. PMID: 33020005.

Evidence Rating: Emerging

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Patient-Centered Medical Home, Quality Improvement/Practice-Wide Intervention,

Intervention Description: The educational intervention was a 3-part curriculum delivered over a 6-month period. The curriculum included: 1) monthly interactive in-person workshops 2) monthly emails outlining communication skills, tips for success and reminders about inperson training, 3) individualized family feedback from CAT data including average composite scores related to their peers scores suitable for self-reflection. In-person workshops were scheduled with attention to resident work hours

Intervention Results: In this pilot study, we found that an educational intervention using family feedback and deliberate practice over a 6-month period improved advanced communication skills in pediatric residents. CAT assessments demonstrated improvement in performance for all residents, but those who received our unique multimodal communications intervention demonstrated statistically significant change from pre to post assessment testing.

Conclusion: There are patient and self-identified performance gaps in communication skills for pediatric residents, underscoring the need for formalized curricula dedicated to these skills. Practice implications: Our study highlights the value of deliberate practice and the integration of family feedback as an educational tool in communication skills development.

Study Design: Pediatric residents at a large academic center were randomized into 2 groups. The intervention group received 6 educational sessions from 2019 to 2020, parent feedback of performance via the Communication Assessment Tool (CAT), and monthly communication tips. Communication skills of both groups were assessed at the end of the intervention

Setting: pediatric residents at a large academic center - pediatric residency program

Population of Focus: pediatric residents - first-year pediatric residents, with 38 residents participating in the research .

Sample Size: 38 students

Age Range: first year residents

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Matiz, L. A., Kostacos, C., Robbins-Milne, L., Chang, S. J., Rausch, J. C., & Tariq, A. (2021). Integrating nurse care managers in the medical home of children with special health care needs to improve their care coordination and impact health care utilization. Journal of Pediatric Nursing, 59, 32-36.

Evidence Rating: Emerging

Intervention Components (click on component to see a list of all articles that use that intervention): Nurse/Nurse Practitioner, Patient-Centered Medical Home, Notification/Information Materials (Online Resources, Information Guide), PARENT_FAMILY, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: We aimed to integrate nurse care managers to coordinate care for such patients, and then evaluate, if this improved health care utilization.

Intervention Results: Three medical home-based nurse care managers were integrated into four pediatric hospital affiliated practices in a large, urban center. The number of ED visits and inpatient admissions were statistically significantly decreased post-intervention (p < 0.05).There was also a decrease in the number of subspecialty visits, but it was close to the threshold of significance (p = 0.054). There was no impact noted on primary care visits.

Conclusion: This quality improvement project demonstrates that nurse care managers who are integrated into the medical home of CSHCN can potentially decrease the utilization of ED visits and hospital admissions as well as subspecialty visits. Practice implications Nurse care managers can play a pivotal role in medical home redesign for the care of CSHCN.

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Michael, L., Brady, A. K., Russell, G., Rhodes, S. D., Namak, S., Cody, L., ... & Linton, J. M. (2019). Connecting refugees to medical homes through multi-sector collaboration. Journal of immigrant and minority health, 21, 198-203.

Evidence Rating: Emerging

Intervention Components (click on component to see a list of all articles that use that intervention): Collaboration with Local Agencies (State), Patient-Centered Medical Home, Enabling Services, STATE, HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: This study assessed the Collaborative’s impact on access to coordinated care within patient-centered medical homes (PCMH).

Intervention Results: After algorithm implementation, there has been a significant decrease in the time required to establish care in PCMHs, increased provider acknowledgment of refugee status, and decreased emergency department (ED) visits. Multi-disciplinary, organized collaboration can facilitate enhanced access to care for refugee families at the population level.

Conclusion: After algorithm implementation, there has been a significant decrease in the time required to establish care in PCMHs, increased provider acknowledgment of refugee status, and decreased emergency department (ED) visits. Multi-disciplinary, organized collaboration can facilitate enhanced access to care for refugee families at the population level.

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Parikh, M. R., O'Dell, S. M., Cook, L. A., Corlis, M., Sun, H., & Gass, M. (2021). Integrated care is associated with increased behavioral health access and utilization for youth in crisis. Families, systems & health : the journal of collaborative family healthcare, 39(3), 426–433. https://doi.org/10.1037/fsh0000620

Evidence Rating: Emerging

Intervention Components (click on component to see a list of all articles that use that intervention): Collaboration with Local Agencies (Health Care Provider/Practice), Community Health Workers (CHWs), Patient-Centered Medical Home,

Intervention Description: The intervention involved comparing outcomes for youth in crisis who received a crisis evaluation in a primary care behavioral health (PCBH) setting to those presenting to the emergency department at the main hospital campus.

Intervention Results: The results indicated that youth evaluated in the PCBH setting were more likely to receive a psychiatric admission, had a shorter latency to the next behavioral health appointment, and had higher rates of completing at least one visit in the year following the evaluation.

Conclusion: Opportunities for future research on cost-effectiveness of care and continuous improvement aligned with quadruple aim outcomes are discussed. Overall, this study is among few others investigating the potential for pediatric integrated care models to contribute to youth suicide prevention and the study demonstrated promising increases in access and engagement with timely behavioral health care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Study Design: The study utilized a retrospective cohort study design.

Setting: Large, predominantly rural health system, comparing outcomes for youth who received a crisis evaluation in a primary care behavioral health (PCBH) setting to those presenting to the emergency department at the main hospital campus.

Population of Focus: The target audience includes healthcare providers, policymakers, and researchers interested in pediatric integrated care and youth mental health services.

Sample Size: The study compared outcomes for 171 youth who received a crisis evaluation in a PCBH setting to 171 youth presenting to the emergency department.

Age Range: The study focused on adolescents and young adults, as it discussed crisis evaluations for individuals aged 10–24 who were at risk for suicide

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Park, J., Wu, X., Frogner, B. K., & Pittman, P. (2018). Does the patient-centered medical home model change staffing and utilization in the community health centers?. Medical care, 56(9), 784-790.

Evidence Rating: Emerging

Intervention Components (click on component to see a list of all articles that use that intervention): Patient-Centered Medical Home, Nurse/Nurse Practitioner, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: To examine the workforce transformation occurring in community health centers that have achieved PCMH status, and to assess the relationship of those changes to utilization, as measured by the number of visits.

Intervention Results: We found that adopting a PCMH model was significantly associated with a growth in use of advanced practice staff (nurse practitioners and physician assistants) [0.53 full-time equivalent (FTE), 8.77%; P<0.001], other medical staff (medical assistants, nurse aides, and quality assurance staff) (1.23 FTE, 7.46%; P=0.001), mental health/substance abuse staff (0.73 FTE, 17.63%; P=0.005), and enabling service staff (case managers and health educators) (0.36 FTE, 6.14%; P=0.079), but not primary care physicians or nurses. We did not observe a significant increase in utilization, as measured in total number of visits per year. However, the visits marginally attributed to advanced practice staff (539 FTE, 0.89%; P=0.037) and mental health/substance abuse staff (353 FTE, 0.59%; P=0.051) significantly increased.

Conclusion: Our findings suggest that the implementation of PCMH actively reengineers staff composition and this, in turn, results in changes in marginal utilization by each staff type.

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Patricia Flanagan, M. D., & Carol Lewis, M. D. (2018). Patient-Centered Medical Home–Kids (PCMH-Kids): Creating a Statewide Pediatric Care Transformation Initiative. Rhode Island Medical Journal, 101(10), 19-19.

Evidence Rating: Emerging

Intervention Components (click on component to see a list of all articles that use that intervention): Collaboration with Local Agencies (State), Patient-Centered Medical Home, STATE, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: This issue of the Rhode Island Medical Journal (RIMJ) chronicles the development and implementation of a statewide initiative, Patient-Centered Medical Homes for Kids (PCMH-Kids), which now impacts the health care of nearly 100,000, or half of the children living in Rhode Island.

Intervention Results: integration of behavioral health (BH) into pediatric primary care was a key focus of PCMH-Kids. BH needs in children present as pre-clinical or subclinical findings, and presents emerging social-emotional challenges for children and parents.

Conclusion: This issue of the Rhode Island Medical Journal (RIMJ) chronicles the development and implementation of a statewide initiative, Patient-Centered Medical Homes for Kids (PCMH-Kids), which now impacts the health care of nearly 100,000, or half of the children living in Rhode Island.

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Patricia Flanagan, M. D., & Elizabeth Lange, M. D. (2018). A statewide pediatric care transformation journey. Rhode Island Medical Journal, 101(10), 20-23.

Evidence Rating: Emerging

Intervention Components (click on component to see a list of all articles that use that intervention): Collaboration with Local Agencies (State), Patient-Centered Medical Home, HEALTH_CARE_PROVIDER_PRACTICE, STATE

Intervention Description: Each participating practice was paired with a transformation coach who assessed the practice and, with the office team, crafted a work plan to facilitate practice transformation. Plans included clarification of roles/job descriptions, team building, data capturing and reporting systems, behavioral health integration plans and care coordination needs and capabilities. All practices reported their quality metrics quarterly, uploading their data to a shared data repository. Additionally, all practices participated in collaborative learning, sharing best practices and lessons learned in quarterly meetings for care coordination, data reporting, integrated behavioral health and practice transformation.

Intervention Results: Through shared learning and practice coaching the cohort 1 practices implemented work flows and data and analysis metrics that address the contracted measures. Supported by strong transformation coaching and support, all practices achieved NCQA 3 recognition within the first contract year. In year two, 100% of the cohort 1 practices met both quality metrics for developmental screening and growth monitoring and counseling and posted improvement over time. [Figures 1 and 2] Patient and family satisfaction was high at baseline and 67% of the practices met the improvement benchmarks for customer service measure for access, communication and office staff. PCMH-Kids practices successfully decreased Emergency Department (ED) utilization and had a 2.5% reduction in ED usage compared to the peer group (rate for 1,000-member-months, excluding ERISA members).

Conclusion: PCMH-Kids practices successfully decreased Emergency Department (ED) utilization and had a 2.5% reduction in ED usage compared to the peer group (rate for 1,000-member-months, excluding ERISA members).

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Petersen, D. J., Bronstein, J., & Pass, M. A. (2002). Assessing the extent of medical home coverage among Medicaid-enrolled children. Maternal and Child Health Journal, 6(1), 59–66.

Evidence Rating: Emerging Evidence

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Patient-Centered Medical Home, Continuity of Care (Caseload), PATIENT/CONSUMER, Enabling Services

Intervention Description: In light of the transition of the Alabama Medicaid program to a primary care case management model, we assessed the level to which children had access to a medical home before and after implementation of that model.

Intervention Results: In general, Medicaid-enrolled children in Alabama did not meet our definition of medical home either before or after implementation of a primary care case management model. Only 11.8% of children saw a single provider and had a well child visit from that provider during the baseline year. A majority of children (49.9%) however had both a primary care provider and received a well child visit. Sixteen percent of children saw a primary care physician but received no identifiable well visit, while 11% had well child care but did not see a primary care physician. Of particular concern, 23% neither saw a primary care physician nor had a well child visit during the baseline year. These figures changed only slightly in the 26 counties examined before and after implementation of the primary care case management model.

Conclusion: State Maternal and Child Health programs are required to report as a performance measure “the percent of children with special health care needs in the state who have a medical/health home” as part of their Block Grant application. Using Medicaid data, this simple measurement strategy can provide an indication of the extent to which at least one population of children receive care through a medical home.

Study Design: Quasi-experimental: Pretestposttest

Setting: Alabama Medicaid-financed primary care

Population of Focus: Children with Medicaid in 26 counties

Data Source: Medicaid administrative/claims data

Sample Size: n=60752 (enrolled during baseline); n=64789 (enrolled during postimplementation period)

Age Range: Not specified

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Pfeifauf KD, Snyder-Warwick AK, Scheve S, Grellner CL, Skolnick GB, Wilkey A, Foy J, Naidoo SD, Patel KB. One Multidisciplinary Cleft and Craniofacial Team's Experience in Shifting to Family-Centered Care. Cleft Palate Craniofac J. 2020 Jul;57(7):909-918. doi: 10.1177/1055665619899518. Epub 2020 Jan 17. PMID: 31950854; PMCID: PMC7299812.

Evidence Rating: Emerging

Intervention Components (click on component to see a list of all articles that use that intervention): Patient-Centered Medical Home, Quality Improvement/Practice-Wide Intervention, Provider Training/Education, Clinic Reorganization

Intervention Description: Followed a Team Reorganization Model: Gather data, Brainstorm challenges with stakeholder, brainstorm solutions with stakeholders, implement, follow up & troubleshoot, implement

Intervention Results: clinic efficiency metrics: clinic capacity (i.e., mean number of patients seen per clinic day), mean number of minutes families spent waiting to see providers per clinic day, and mean clinic duration. Using preintervention (2016) data as a baseline to measure change, these data reveal improvements in clinic fficiency.

Conclusion: In light of the importance and recognized advantages of family-centered care, multidisciplinary cleft and craniofacial teams undertaking reorganizations aimed at quality and process-of care improvement should consider a family-centered approach. It is our hope that sharing our own team’s experience in family-centered reorganization will serve as a starting point and path forward for other teams striving for similar improvements. We anticipate other teams will refine our model on the basis of their own needs and experiences.

Study Design: Team Reorganization Model

Setting: cleft and craniofacial center in the Midwest - cleft and craniofacial center in the Midwest, with over 5000 active patients.

Population of Focus: children / families - healthcare professionals and teams involved in cleft and craniofacial care, as well as those interested in implementing family-centered care in multidisciplinary healthcare settings.

Sample Size: 20 families + providers - The sample size for the study was 20 families, representing 21 patients, two of whom were siblings. The participants were selected by team coordinators familiar with the families, with an eye to including a range of patient diagnoses and ages, as well as perceived likelihood of participating actively in the interview.

Age Range: ages 4-14 - the participants included a range of patient diagnoses and ages, and patients were invited to participate in the interviews as appropriate to their age and cognition .

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Price, J., Brandt, M. L., Hudak, M. L., Berman, S. K., Carlson, K. M., Giardino, A. P., ... & COMMITTEE ON CHILD HEALTH FINANCING. (2020). Principles of financing the medical home for children. Pediatrics, 145(1).

Evidence Rating: Emerging

Intervention Components (click on component to see a list of all articles that use that intervention): Collaboration with Local Agencies (State), Patient-Centered Medical Home, STATE, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: This article summarizes the key, consensus-based financing elements to providing quality, effective, comprehensive care in the pediatric medical home: (1) first dollar coverage without deductibles, copays, or other cost-sharing for necessary preventive care services as recommended by Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents; (2) adoption of a uniform definition of medical necessity across payers that embraces services that promote optimal growth and development and prevent, diagnose, and treat the full range of pediatric physical, mental, behavioral, and developmental conditions, in accord with evidence-based science or evidence-informed expert opinion; (3) payment models that promote appropriate use of pediatric primary care and pediatric specialty services and discourage inappropriate, inefficient, or excessive use of medical services; and (4) payment models that strengthen the patient- and family-physician relationship and do not impose additional administrative burdens that will only erode the effectiveness of the medical home.

Intervention Results: Some programs are demonstrating positive results.43 On the other hand, pay-for-performance programs are still evolving. Many adult programs have features that are not pertinent to improving care provided to children or that cannot easily be translated into pediatric equivalents.

Conclusion: For a medical home for children to be both effective and fiscally viable, payers must adequately finance the full range of services required to optimize the physical, developmental, emotional, and behavioral well-being of children, which critically influence health throughout the life course. Some support is required to engage families initially with the medical home. Once engaged, appropriate support is needed for encounters, care coordination, continuous quality improvement, implementation of an effective electronic health record system, and innovative efforts to improve community health. This support should not impose additional administrative burdens that will erode the effectiveness of the medical home. Payers should consider how best to achieve better health care value without encouraging fragmented care outside the medical home.

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Reeder J, Morris J. Becoming an empowered parent. How do parents successfully take up their role as a collaborative partner in their child's specialist care? J Child Health Care. 2021 Mar;25(1):110-125. doi: 10.1177/1367493520910832. Epub 2020 Mar 6. PMID: 32141316.

Evidence Rating: Moderate

Intervention Components (click on component to see a list of all articles that use that intervention): Patient-Centered Medical Home, Provider Training/Education, Quality Improvement/Practice-Wide Intervention, Clinic Reorganization

Intervention Description: semi-structured interviews with 14 participants. Once a main category/theory had emerged, data collection/analysis continued until no new properties could be added (Cresswell, 2013). It was felt that this point was reached after 12 interviews with 14 participants.

Intervention Results: Conceptual categories are presented including excerpts from the raw data, to make more transparent the process by which they have emerged from and are therefore grounded in the data. These categories are then drawn together in a novel model which illustrates how the power im/balance and the state of the therapeutic relationship might influence how a parent takes up their position in the collaborative partnership.

Conclusion: Conceptual categories are presented including excerpts from the raw data, to make more transparent the process by which they have emerged from and are therefore grounded in the data. These categories are then drawn together in a novel model which illustrates how the power im/balance and the state of the therapeutic relationship might influence how a parent takes up their position in the collaborative partnership.

Study Design: This study employed a constructivist grounded theory (CGT) methodology

Setting: children’s services from a single NHS trust - within a single NHS trust in the UK

Population of Focus: population of parents of children with long-term disabilities - parents of children with long-term disabilities accessing specialist children’s services in the hosting NHS trust

Sample Size: 14 parents

Age Range: parents of children

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Riley, M., Laurie, A. R., Plegue, M. A., & Richardson, C. R. (2016). The adolescent “expanded medical home”: School-based health centers partner with a primary clinic to improve population health and mitigate social determinants of health. Journal of the American Board of Family Medicine, 29(3), 339–347.

Evidence Rating: Emerging Evidence

Intervention Components (click on component to see a list of all articles that use that intervention): SCHOOL, School-Based Health Centers, PROVIDER/PRACTICE, Patient-Centered Medical Home, Nurse/Nurse Practitioner, PATIENT/CONSUMER, Referrals, Peer Counselor

Intervention Description: We describe the implementation of an "expanded medical home" partnering a primary care practice (the Ypsilanti Health Center [YHC]) with local school-based health centers (the Regional Alliance for Healthy Schools [RAHS]), and to assess whether this model improves access to and quality of care for shared patients.

Intervention Results: At baseline, patients seen at YHC/RAHS had higher compliance with most quality metrics compared with those seen at YHC only. The proportion of shared patients significantly increased because of the intervention (P < .001). Overall, patients seen in the expanded medical home had a higher likelihood of receiving quality metric services than patients in YHC only (odds ratio, 1.8; 95% confidence interval, 1.57-2.05) across all measures.

Conclusion: Thoughtful and intentional implementation of an expanded medical home partnership between primary care physicians and school-based health centers increases the number of shared high-risk adolescent patients. Shared patients have improved compliance with quality measures, which may lead to long-term improved health equity.

Study Design: Quasi-experimental: Nonequivalent control group; Qualitative

Setting: Michigan primary care and consortium of school-based health centers

Population of Focus: Adolescents

Data Source: • Record review of preventive health measures • University of Michigan Health System Quality Management Program quality measures • Qualitative data

Sample Size: n=2200 adolescents; 9338 visits

Age Range: Not specified

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Soffer, M. D., Rekawek, P., Pan, S., Overbey, J., & Stone, J. (2023). Improving Postpartum Attendance among Women with Gestational Diabetes Using the Medical Home Model of Care. American journal of perinatology, 40(3), 313–318. https://doi.org/10.1055/s-0041-1727216

Evidence Rating: Mixed

Intervention Components (click on component to see a list of all articles that use that intervention): Patient-Centered Medical Home, Concurrent Infant/Mother Checkups

Intervention Description: Jointly scheduling PP visits and the 2-month well infant visits.

Intervention Results: Of the 74 patients enrolled, 41.9% were Hispanic and 17.6% were Black, mean age was 31.6 years, and 58.1% delivered vaginally. Attendance at the 6-week PP visit was 68.9%, and attendance at the infant visit was 55.1%. PP glucose testing was ordered for 76.5% of attendees at the PP visit, and of those ordered, 43.6% of attendees completed testing. All patients had joint visits requested, though only 70.3% of visits were scheduled jointly. Among those who were jointly scheduled, 71.2% of women attended, 57.7% of infants attended, and 7.7% of pairs attended on the same day. The PP visit attendance rate was not significantly different than the prior attendance rate (p = 0.84)

Conclusion: This study was unable to improve PP visit attendance among women with GDM by jointly scheduling the 6-week PP visit and the 2-month well-infant visit. Future research could be directed toward a shared space where both women and children can be seen to attempt to increase PP visit attendance and monitoring for women with GDM.

Study Design: Cohort study

Setting: New York City-based publicly insured hospital clinic

Population of Focus: Patients with gestational diabetes (GDM)

Sample Size: 74

Age Range: Reproductive age

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Spazzapan M, Vijayakumar B, Stewart CE. A bit about me: Bedside boards to create a culture of patient-centered care in pediatric intensive care units (PICUs). J Healthc Risk Manag. 2020 Feb;39(3):11-19. doi: 10.1002/jhrm.21387. Epub 2019 Aug 26. PMID: 31452293.

Evidence Rating: Moderate

Intervention Components (click on component to see a list of all articles that use that intervention): Visual Display (Hospital), Patient-Centered Medical Home, Quality Improvement, Provider Tools

Intervention Description: After the introduction of the “A Bit About Me” boards, staff and parents were surveyed again over the course of 3 weeks. Items from the preintervention questionnaire were used after the intervention to measure for changes across the parameters of interest.

Intervention Results: There was a significant increase in whether nurses felt they knew what comforts their patients and their patients’ favorite toy (P < .005). A significant improvement in whether doctors felt they knew their patients well (P < .5) and could recognize them outside the hospital (P < .005) was also observed Table 2). Moreover, the perception of the PICU as a welcoming environment improved (P < .05); following our intervention, both doctors and parents felt that nurses know their patients well (P < .05). Improvements in all other questionnaire items were also noted; however, these did not demonstrate statistical significance (Table 3). These results were further supported by improved parents’ views regarding whether HCPs knew what comforts their child (pre, 77%; post, 100%) (Figure 3A and B), their favorite toy (pre, 45%; post, 100%) (Figure 3C and D), and if they could recognize their child outside the hospital (pre, 66%; post, 100%) (Figure 3E and F).

Conclusion: Personalized bedside boards significantly improved how well HCPs knew their patients across various elements. Patient-centered care and, in turn, patient safety in PICUs can be promoted by using personalized bedside boards containing nonmedical information to help HCPs understand their patients’ individual needs and tailor their treatment.

Study Design: An unpaired, two-tailed Student’s t-test was used to analyze and compare the pre- and postintervention results.

Setting: PICU in London - 13-bed Pediatric Intensive Care Unit (PICU) of St. Mary’s Hospital, London, United Kingdom

Population of Focus: families of children in PICU - healthcare professionals (doctors, nurses, physiotherapists, and pharmacists) working in the PICU, as well as the parents of children in the PICU

Sample Size: 36 - combination of parents, doctors, nurses, others - The project collected 38 questionnaires to obtain baseline data, while 36 questionnaires were completed after the introduction of the personalized bedside boards .

Age Range: parents of children in the PICU

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Suen, C. G., Campbell, K., Stoddard, G., & Carbone, P. S. (2021). Patient-centered outcomes in an interdisciplinary clinic for complex children with autism. Journal of developmental and behavioral pediatrics: JDBP, 42(3), 182.

Evidence Rating: Emerging

Intervention Components (click on component to see a list of all articles that use that intervention): Enabling Services, Patient-Centered Medical Home, Expert Support (Provider), HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: To compare perspectives of caregivers of children with autism receiving care at the Neurobehavior Healthy Outcomes Medical Excellence (HOME) Program, an interdisciplinary clinic that provides primary care and behavioral/mental health services for patients with autism and other developmental disabilities, with those responding to the 2016 National Survey of Children’s Health (NSCH). We focused on ratings related to shared decision making, care coordination, family-centered care, and care within a medical home.

Intervention Results: Compared with the NSCH cohort (n=1,151), children enrolled in HOME (n=129) were older, more often female, had severe autism, and had co-occurring intellectual disability. Caregivers perceived that children receiving care within HOME more often received family-centered, coordinated care within a medical home compared with a national sample of children with autism. HOME enrollees also reported increased access to behavioral treatments and adult transition services with less financial burden compared to the national sample.

Conclusion: An interdisciplinary clinic model may best serve children with autism, especially those with higher severity symptoms and co-occurring conditions.

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Tataw, D. B., Bazargan-Hejazi, S., & James, F. (2011). Health services utilization, satisfaction, and attachment to a regular source of care among participants in an urban health provider alliance. Journal of Health and Human Services Administration, 34(1), 109–141.

Evidence Rating: Moderate Evidence

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), PROVIDER/PRACTICE, Patient-Centered Medical Home, Educational Material (Provider), Continuity of Care (Caseload), CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), PATIENT/CONSUMER, Referrals, Other Education

Intervention Description: This study examines the effect of a provider alliance on service utilization, satisfaction , self efficacy, and attachment to a regular source of care for participating low income urban children and their families.

Intervention Results: The use of Physician Assistants and community health workers to expand community outreach, primary care services, pediatric sub-specialty care, and service coordination within and between care settings improved health services utilization, satisfaction with health services, parental self efficacy in navigating the health care system for their children, and service convenience for an at-risk population. Also, the use of Physician Assistants to provide pediatric sub-specialty services did not have a negative effect on parental satisfaction with a child's care.

Conclusion: Parents were slightly more satisfied with services received from a Physician Assistant in comparison with the physician sub- specialists in cardiology and nephrology clinics.

Study Design: Prospective quasiexperimental; Survey

Setting: South Central Los Angeles primary and specialty care clinics

Population of Focus: Children between the ages of 0-18 (“or are adolescents”) who reside within the geographic area of South Los Angeles

Data Source: A 30 item parent survey to assess parents’ perceived difficulty in accessing services and their satisfaction with the services received • Patient database was used to collect service utilization and financial data from operational and administrative tracking instruments and reports at both the primary and specialty care sites

Sample Size: Estimated 727,000 children in the service area; n=11,533 children reach during outreach events; n=80,000 (10% of children in service area) children attached to a medical home; n=8545 children enrolled in available payer sources

Age Range: Not specified

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Teela L, Verhagen LE, Gruppen MP, Santana MJ, Grootenhuis MA, Haverman L. Including the voice of paediatric patients: Cocreation of an engagement game. Health Expect. 2022 Aug;25(4):1861-1871. doi: 10.1111/hex.13530. Epub 2022 Jun 24. PMID: 35751406; PMCID: PMC9327851.

Evidence Rating: Moderate

Intervention Components (click on component to see a list of all articles that use that intervention): Parent Engagement, Patient-Centered Medical Home, Quality Improvement/Practice-Wide Intervention,

Intervention Description: This youth panel consists of adolescents with a chronic condition, who contributed with ideas and suggestions to several projects aiming to improve social engagement in health care. All representative users were involved in all phases of the design process—from writing the project plan to the final version of the game.

Intervention Results: In total, 15 adolescents (mean age: 15.0 years, range 12–18 years, 60% female) participated in four focus groups and four interviews (Table 1). Ten major themes for adolescents regarding their illness, treatment and hospital care were identified: visiting the hospital, participating, disease and treatment, social environment, feelings, dealing with staff, acceptation, autonomy, disclosure and chronically ill peers (Table 2). The opinion of 13 adolescents (mean age: 15.5 years, range: 13–18 years, 61.5% female, Table 1) was asked about the draft version (Figure 2) of the engagement game in three focus groups and five interviews. Overall, the adolescents were positive about the game as it gave them the opportunity to get involved and it helped them to express their views. The pilot version (Figure 2) of the game was tested for usability by four patients (mean age: 14.5 years, range: 13–16 years, 50% female; Table 1) in clinical practice. At the end of the workshop, the adolescents gave their opinion about the engagement game. All adolescents were enthusiastic about the game and enjoyed giving their opinion.

Conclusion: In conclusion, we developed a patient engagement game called All Voices Count, working together with all stakeholders. This game lowers the barrier to include the voice of adolescents in decision‐making about hospital care, research and policy.

Study Design: A user‐centred design, as described in the literature by Gulliksen et al.,25 was used. Key principles of an user‐centred design include user‐focused and active user involvement throughout the entire development process. These principles were guaranteed by actively involving all representative users, including adolescents with a chronic condition, clinicians, researchers, the Patient Alliance for Rare and Genetic Diseases (VSOP), the Dutch Childhood Cancer Organization (VKN) and a youth panel of Fonds NutsOhra (FNO).

Setting: e Emma Children's Hospital Amsterdam UMC

Population of Focus: Adolescents with chronic conditions - adolescents aged 12-18 years with a chronic condition who were under treatment at the Emma Children's Hospital Amsterdam UMC in the Netherlands.

Sample Size: 23 adolescents

Age Range: aged 12-18 years

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Toivonen M, Lehtonen L, Löyttyniemi E, Ahlqvist-Björkroth S, Axelin A. Close Collaboration with Parents intervention improves family-centered care in different neonatal unit contexts: a pre-post study. Pediatr Res. 2020 Sep;88(3):421-428. doi: 10.1038/s41390-020-0934-2. Epub 2020 May 7. PMID: 32380505; PMCID: PMC7478938.

Evidence Rating: Emerging

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Patient-Centered Medical Home, Quality Improvement/Practice-Wide Intervention,

Intervention Description: Pre-test for families and providers, provide Close Collaboaration with Parents training program to staff, post test by famliles and providers

Intervention Results: An educational intervention, Close Collaboration with Parents, succeeded in improving all elements of FCC in eight NICUs as reported by both staff and parents. This intervention was able to define and apply elements of FCC, such as decision making and mutual partnership, which have been challenging to capture and implement in earlier studies.

Conclusion: The educational intervention, which developed the receptive listening capacity and negotiation skills of the multi-professional NICU staff, increased the quality of all elements of FCC and enabled mutual partnership between parents and staff. In the future, more attention should be paid to involving all doctors in the FCC intervention. Based on our findings, systematic training is an effective way to facilitate implementation of FCC in entire NICU care. Importantly, this makes the benefits of the FCC available for all infants and families cared in a unit

Study Design: mixed-method pre–post intervention study in eight NICUs in Finland.

Setting: NICU: eight neonatal intensive care units (NICUs) in Finland

Population of Focus: NICU famlies and providers - medical staff in neonatal units, including managers (doctors and head nurses) and nurses, who participated in the Close Collaboration with Parents training program. In addition, parents who were available during the days of research visits were also invited to participate in the study .

Sample Size: 300+ - The number of staff members and patients in each unit varied, and the proportion of trained staff ranged from 46% to 100%. The total number of admissions per year across all eight units was 4,181 .

Age Range: NICU age - newborn infants

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Tornivuori A, Tuominen O, Salanterä S, Kosola S. A systematic review on randomized controlled trials: Coaching elements of digital services to support chronically ill adolescents during transition of care. J Adv Nurs. 2020 Jun;76(6):1293-1306. doi: 10.1111/jan.14323. Epub 2020 Feb 19. PMID: 32030792.

Evidence Rating: Scientifically Rigorous

Intervention Components (click on component to see a list of all articles that use that intervention): Patient-Centered Medical Home,

Intervention Description: N/A

Conclusion: The key findings of the systematic review on coaching elements of digital services for chronically ill adolescents include: 1. Digital health services incorporated into usual care provide efficient and accessible care for chronically ill adolescents. 2. E-coaching that includes human and social support shows a positive impact on transition outcomes for chronically ill adolescents. 3. Tailored digital health services have positive effects on health outcomes and show great potential to develop care during the transition from children's hospitals to adult sites. 4. Personal goal setting and active participation in communication with coaches and peers have a positive impact on transition outcomes. 5. The coaching elements identified in the review include the need for human support, interactive means, social support, and a theoretical basis 1, 11, 4. These findings suggest that digital health services, particularly those incorporating e-coaching elements, have the potential to positively impact the transition of care for chronically ill adolescents.

Study Design: Systematic Review

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Wolski, T. P., Jr, Jamerino-Thrush, J., Bigham, M. T., Kline-Krammes, S., Patel, N., Lee, T. J., Pollauf, L. A., Joyce, C. N., Kunka, S., McNinch, N. L., Jacobs, M., & White, P. C. (2022). Redirecting Nonurgent Patients From the Pediatric Emergency Department to Their Pediatrician Office for a Same-Day Visit-A Quality Improvement Initiative. Pediatric emergency care, 38(12), 692–696. https://doi.org/10.1097/PEC.0000000000002879

Evidence Rating: Moderate

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement, Guideline Change and Implementation, Patient-Centered Medical Home,

Intervention Description: Providing high-quality care in the appropriate setting to optimize value is a worthy goal of an efficient health system. Consequences of managing nonurgent complaints in the emergency department (ED) have been described including inefficiency, loss of the primary care-patient relationship, and delayed care for other ED patients. The purpose of this initiative was to redirect nonurgent patients arriving in the ED to their primary care office for a same-day visit, and the SMART AIM was to increase redirected patients from 0% of those eligible to 30% in a 12-month period. The setting was a pediatric ED (PED) and primary care office of a tertiary care pediatric medical system. The initiative utilized the electronic health record to identify and mediate the redirection of patients to the patient's primary care office after ED triage. The primary measurement was the percentage of eligible patients redirected. Additional measures included health benefits during the primary care visit (vaccines, well-visits) and a balancing measure of patients returned to the PED.

Intervention Results: The SMART AIM of >30% redirection was achieved and sustained with a final redirection rate of 46%. In total, 216 of 518 eligible patients were redirected, with zero untoward outcomes. The encounter time for redirected patients was similar for those who remained in the PED, and additional health benefits were appreciated for redirected patients.

Conclusion: This initiative redirected nonurgent patients efficiently from a PED setting to their primary care office. The process is beneficial to patients and families and supports the patient-centered medical home. The balancing measure of no harm done to patients who accepted redirect reinforced the reliability of PED triage. The benefits achieved through the project highlight the value of the primary care-patient relationship and the continued need to improve access for patients and families.

Study Design: Evaluation of a quality improvement initiative

Setting: A tertiary care pediatric medical system with more than 100,000 annual visits at its two pediatric emergency departments (PEDs). The system includes 50 urgent, primary, and subspecialty locations with over 1 million visits per year. The initiative was based at the Akron Children's Main Campus PED, which has more than 65,000 patient visits per year. The adjoining LP primary care office is a 5-minute walk from the PED via a connected indoor walkway. The primary care office has 7919 patients in the panel.

Population of Focus: Nonurgent patients who presented to the pediatric emergency department (PED) and were eligible for redirect to their primary care office.

Sample Size: 518 eligible pediatric patients

Age Range: Children and adolescents 0-17 years

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The MCH Digital Library is one of six special collections at Geogetown University, the nation's oldest Jesuit institution of higher education. It is supported in part by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under award number U02MC31613, MCH Advanced Education Policy with an award of $700,000/year. The library is also supported through foundation and univerity funding. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.