Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Prenatal Care Access, Access, Provider Training/Education, Telehealth/Virtual Care

Intervention Description: The intervention in the study on the transition of prenatal care to telehealth during the COVID-19 pandemic in New York City was the adoption and utilization of telehealth for prenatal care visits. The study aimed to evaluate the feasibility and effectiveness of telehealth for prenatal care during the COVID-19 pandemic, which necessitated a shift away from in-person visits to minimize the risk of viral transmission. The telehealth intervention involved the use of video conferencing technology to conduct prenatal care visits remotely. Patients were able to connect with their healthcare providers via video conferencing software, such as Zoom or Skype, to receive prenatal care services. The study analyzed the proportion of prenatal care visits that were conducted via telehealth compared to in-person visits over a 5-week period from March 9 to April 12, 2020, at Columbia University Irving Medical Center (CUIMC)-affiliated prenatal practices in New York City . The study also evaluated the challenges and successes associated with the adoption of telehealth for prenatal care, including provider attitudes towards telehealth, patient barriers to accessing telehealth, and operational considerations for clinics and healthcare systems . Overall, the intervention involved the rapid adoption and utilization of telehealth for prenatal care during the COVID-19 pandemic, with the aim of maintaining access to essential prenatal care services while minimizing the risk of viral transmission.

Intervention Results: The study on the transition of prenatal care to telehealth during the COVID-19 pandemic in New York City found that telehealth was rapidly adopted and utilized for prenatal care during the study period. The study analyzed 4,248 prenatal care visits over a 5-week period, of which approximately one-third were conducted via telehealth (n=1,352, 31.8%). By the fifth week, 56.1% of generalist visits, 61.5% of maternal-fetal medicine (MFM) visits, and 41.5% of clinic visits were conducted via telehealth . The study also found that providers generally had positive attitudes towards telehealth visits, and accessing technology and performing visits, documentation, and follow-up using the telehealth electronic medical record were all viewed favorably by providers . However, the study identified significant barriers to telehealth and in-person visits, including patient fear of COVID-19 infection, limited access to technology and connectivity, and language barriers . The study also found that the transition to virtual prenatal care was more challenging for patients with Medicaid insurance receiving care at health clinics than for women with commercial insurance in generalist and maternal-fetal medicine faculty practices. Factors related to differential care attendance included operational considerations such as requiring increased staffing in clinics and patient factors related to technological proficiency, language barriers, Wi-Fi and data access, child care, and fear of infection. Additional patient-level and operational supports were required to optimize access for patients with Medicaid . Overall, the study suggests that telehealth was feasible and associated with provider satisfaction for prenatal care during the COVID-19 pandemic. However, significant barriers to telehealth may be present for patients with Medicaid insurance, which may require additional support to resolve .

Conclusion: The conclusions drawn from the study on the transition of prenatal care to telehealth during the COVID-19 pandemic in New York City are as follows: 1. Rapid Transition Feasibility: The study demonstrated that a rapid transition to telehealth for prenatal care was feasible and associated with provider satisfaction. The adoption and utilization of telehealth for prenatal care were viewed favorably by healthcare providers . 2. Differential Uptake Based on Insurance: The study highlighted that telehealth uptake differed based on insurance, with patients with Medicaid insurance experiencing more challenges and barriers to accessing telehealth compared to those with commercial insurance. This finding underscores the need for additional patient-level and operational supports to optimize access for patients with Medicaid . 3. Operational Challenges: The transition to virtual prenatal care was more challenging for patients with Medicaid insurance receiving care at health clinics than for women with commercial insurance in generalist and maternal-fetal medicine faculty practices. Operational considerations, such as requiring increased staffing in clinics, were identified as significant barriers to the adoption of telehealth for prenatal care . 4. Patient Barriers: The study identified various patient-related barriers to telehealth, including technological proficiency, language barriers, Wi-Fi and data access, child care responsibilities, and fear of infection. These barriers need to be addressed to optimize access to telehealth for prenatal care, particularly for patients with Medicaid insurance . In summary, the study underscores the feasibility of rapid transition to telehealth for prenatal care and the need for additional support to address barriers faced by patients with Medicaid insurance. It emphasizes the importance of addressing operational challenges and patient-related barriers to ensure equitable access to telehealth for prenatal care during public health crises such as the COVID-19 pandemic .

Study Design: The study on the transition of prenatal care to telehealth during the COVID-19 pandemic in New York City utilized a mixed-methods approach, combining quantitative analysis and qualitative assessment. Quantitative Analysis: The study analyzed trends in whether prenatal care visits were conducted in-person or via telehealth over a 5-week period from March 9 to April 12 at Columbia University Irving Medical Center (CUIMC)-affiliated prenatal practices in New York City during the COVID-19 pandemic. The proportion of visits that were conducted via telehealth was analyzed by visit type by week . This quantitative analysis provided insights into the adoption and utilization of telehealth for prenatal care during the specified period. Qualitative Assessment: In addition to the quantitative analysis, the study conducted a survey and semistructured interviews of healthcare providers to evaluate resources and obstacles in the uptake of telehealth. The survey and interviews aimed to understand provider experiences, satisfaction, and challenges associated with the integration of telehealth into prenatal care. The qualitative assessment provided in-depth insights into the operational challenges and barriers faced by healthcare providers and clinics during the transition to telehealth for prenatal care . By employing both quantitative and qualitative methods, the study aimed to comprehensively assess the transition to telehealth for prenatal care during the COVID-19 pandemic, providing a multifaceted understanding of the challenges, successes, and provider attitudes related to this transition.

Setting: The setting for the study on the transition of prenatal care to telehealth during the COVID-19 pandemic is New York City. Specifically, the study focuses on the prenatal care facilities affiliated with the Columbia University Irving Medical Center (CUIMC) located in midtown Manhattan, Washington Heights in Upper Manhattan, Rockland County, and Westchester . These facilities provide care for patients with both Medicaid and commercial insurance, and the patients accessing prenatal care at these sites primarily deliver at NewYork Presbyterian Morgan Stanley Children’s Hospital of New York and NewYork Presbyterian/The Allen Hospital . The study provides insights into the adoption of telehealth for obstetric patients in a tertiary referral hospital and clinic system in New York City, offering valuable information on the implementation of telehealth in an urban setting during the COVID-19 pandemic.

Population of Focus: The target audience for the study on the transition of prenatal care to telehealth during the COVID-19 pandemic in New York City includes a wide range of stakeholders involved in maternal-fetal medicine, obstetrics and gynecology, public health, healthcare administration, and telehealth implementation. This may encompass: 1. Healthcare Providers: Obstetricians, gynecologists, maternal-fetal medicine specialists, and other healthcare professionals involved in prenatal care. 2. Healthcare Administrators: Hospital administrators, clinic managers, and healthcare system leaders responsible for implementing telehealth services and optimizing prenatal care delivery. 3. Public Health Officials: Professionals involved in public health policy, maternal and child health, and healthcare access initiatives. 4. Telehealth Practitioners: Individuals and organizations involved in the provision of telehealth services, including telemedicine companies and technology developers. 5. Researchers and Academics: Scholars and researchers interested in the impact of telehealth on prenatal care, healthcare delivery during crises, and healthcare disparities. 6. Policymakers: Government officials and policymakers involved in shaping healthcare regulations, reimbursement policies, and telehealth legislation. 7. Patient Advocacy Groups: Organizations advocating for improved access to prenatal care and maternal healthcare services. The study's findings are relevant to these stakeholders as they provide insights into the feasibility, challenges, and benefits of transitioning prenatal care to telehealth, particularly in an urban setting during a public health crisis. Additionally, the study's focus on provider attitudes and patient access issues makes it valuable for those interested in improving maternal healthcare delivery and access to early prenatal care.

Sample Size: Specifically, the study surveyed 36 healthcare providers and conducted interviews with 11 of them 8. While the exact sample size for the patient population is not provided, the study analyzed prenatal visits over a 5-week period from March 9, 2020, to April 12, 2020, during which time telehealth was adopted across clinical sites

Age Range: the study focused on prenatal care for pregnant individuals accessing care at the Columbia University Irving Medical Center (CUIMC)-affiliated obstetric ambulatory prenatal care facilities in New York City. As such, the patient population likely consisted of pregnant individuals of reproductive age, typically ranging from late teens to early 40s. Given the focus on prenatal care, the study's patient population would primarily include pregnant individuals seeking obstetric and gynecological care during the COVID-19 pandemic. The specific age range of these individuals was not explicitly stated in the available information.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Peer Counselor, Telephone Support, Educational Material, PROVIDER/PRACTICE, Community Health Workers (CHWs)

Intervention Description: To assess whether a theory-based, community health worker–delivered intervention for household smokers will lead to reduced secondhand smoke exposure to children in Chinese families.

Intervention Results: Of the 318 families randomized, 98 (60%) of 164 intervention group and 82 (53%) of 154 of controls completed 6-month follow-up assessment. At the 6-month follow-up, 62% of intervention and 45% of comparison group households adopted complete smoking restrictions at home (P = .022); total exposure (mean number of cigarettes per week ± standard deviation) from all smokers at home in the past 7 days was significantly lower among children in the intervention (3.29 ± 9.06) than the comparison (7.41 ± 14.63) group (P = .021); and mean urine cotinine level (ng/mL) was significantly lower in the intervention (0.030 ± .065) than the comparison (0.087 ± .027) group, P < .001). Participants rating of the overall usefulness of the intervention was 4.8 + 0.8 (1 standard deviation) on the 5 point scale (1 not at all and 5 = very useful). Conclusions

Conclusion: The findings of this very first study in China showed that smoking hygiene intervention was effective in reducing children's exposure to secondhand smoke. These findings have implications for the development of primary health care–based secondhand smoke exposure reduction and family oriented smoking cessation interventions as China moves toward a smoke-free society.

Study Design: RCT

Setting: Community (households)

Population of Focus: Smoking parents or caregivers who had a child aged 5 years or younger

Data Source: Health center records and parent selfreport.

Sample Size: 318 families

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Quality Improvement, EMR Reminder,

Intervention Description: The interventions included nurse-champion training, standardized screening using the Patient Health Questionnaire-9 (PHQ-9), a reminder system for nurses to conduct screenings, and a video training program for nursing staff. These interventions align with a discernable strategy of implementing evidence-based screening tools and providing education and training to healthcare providers to improve their knowledge and comfort level in addressing perinatal mood and anxiety disorders. The study analyzes a multicomponent intervention that includes the four interventions mentioned above. The study aimed to determine if these interventions improved the PPD screening rate, PPD screening positive rate, and related social work referrals and consultation rates at Cedars-Sinai’s postpartum and maternal-fetal care units. The study found that all four interventions were successful in achieving the main outcomes, and the program has improved depression screening and increased social work referral rates at Cedars-Sinai.

Intervention Results: The four interventions increased nurse-champion screening comfort and perinatal mood and anxiety disorder knowledge, PHQ-9 screening rates from 10% to 99%, and screen-positive rates from 0.04% to 2.9%, and rates of social work consultation from 1.7% to 8.4% . Before training, 43% of surveyed nurses felt “very comfortable” screening patients for depression. After training, overall comfort increased to 73%. Nurse champions showed increased comfort discussing perinatal mental health, facilitating mental health referrals, and providing information to patients . After completion of 5 months of video training, the screening rate remained at 99%. Of those screened, 19% screened positive and as many as 39% of them consulted with social work . The SPC chart showed that screening rates had a sharp increase between March 2017 and June 2017 from 0.01% to 59.54% . The program sustained progress achieved by the first 4 interventions detailed in the report, and data from the next 4 interventions are currently being analyzed.

Conclusion: Quality improvement results from the first 3 years of the program suggest that 4 interventions improved screening rates, screen-positive rates, and social work consultation rates. Future work will focus on method of screening, patients at highest risk of perinatal mood and anxiety disorders, and ongoing nurse training.

Study Design: The study design used the Standards for QUality Improvement Reporting Excellence 2.0 guidelines to report outcomes from the four interventions. The study aimed to evaluate the impact of the interventions on the postpartum depression screening, education, and referral program at Cedars-Sinai. The interventions included nurse-champion training, use of the 9-item Patient Health Questionnaire-9 in the postpartum unit, a series of brief in-service trainings, and a 10-minute video training. The study collected data including nurse feedback, screening rates, screen-positive rates, and social work consultation rates

Setting: The study was conducted at Cedars-Sinai, a nonprofit hospital located in Beverly Hills, California. The hospital has a postpartum and maternal-fetal care unit where the interventions were implemented to improve the screening, education, and referral program for postpartum depression. The study included a sample of 19,564 women who delivered their babies at Cedars-Sinai over the course of two years

Population of Focus: The target audience of this study appears to be healthcare professionals, specifically those working in the postpartum and maternal-fetal care units at Cedars-Sinai. The study aimed to improve the screening, education, and referral program for postpartum depression at Cedars-Sinai, and the interventions were targeted towards nursing staff and social workers. The study also reported on the outcomes of the interventions, including nurse feedback, screening rates, screen-positive rates, and social work consultation rates, which may be of interest to healthcare professionals working in similar settings.

Sample Size: The sample size for the study was 19,564 women who delivered their babies at Cedars-Sinai over the course of two years. This sample size was used to evaluate the outcomes of the interventions aimed at improving the screening, education, and referral program for postpartum depression at the hospital

Age Range: The study did not report a specific age range for the sample of women who delivered their babies at Cedars-Sinai. However, the study did report that the average patient age was 33.95 years old

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Provider Training/Education, Guideline Change and Implementation, Provider Tools

Intervention Description: Parents were interviewed and instructed on creating a care map. That map was then shared with HCP. Both parents and HCP were intereviewed to learn what their thoughts were about implementing both care maps and care plans.

Intervention Results: Two themes reflected two primary categories: (a) the utility of care plans and care maps, and (b) the intersection of care plans and care maps. results indicated that care maps are useful and should be created and discussed with HCP prior to creating a care plan.

Conclusion: No Conclusion: Results: Data analysis exploring the relationship and utility of care plans and care maps revealed six primary themes related to using care plans and care maps that were grouped into two primary categories: (a) utility of care plans and maps; and (b) intersection of care plans and care maps. Discussion: Care plans and care maps were identified as valuable complementary documents. Their integration offers context about family experience and respects the parents' experiential wisdom in a standard patient care document, thus promoting improved understanding and integration of the family experience into care decision making

Study Design: A qualitative design with thematic analysis

Setting: CMC: Hospital/Clinic - tertiary pediatric academic health sciences center, The Hospital for Sick Children (SickKids), and at a community hospital, North York General Hospital (NYGH), both located in Ontario, Canada.

Population of Focus: CMC - healthcare providers, including pediatricians, pediatric subspecialists, pediatric nurse practitioners, social workers, occupational and physiotherapists, pharmacists, and community nurses, who provide care for children with medical complexity.

Sample Size: 15 parents, 30 HCP - 15 parents of children with medical complexity who created care maps, and 30 healthcare providers who provided care to children with medical complexity.

Age Range: 1/17/2024

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Technology-Based Support,

Intervention Description: In the US, many individuals with diabetes do not have consistent access to endocrinologists and therefore rely on primary care providers (PCPs) for their diabetes management. Project ECHO (Extension for Community Healthcare Outcomes) Diabetes, a tele-education model, was developed to empower PCPs to independently manage diabetes, including education on diabetes technology initiation and use, to bridge disparities in diabetes.

Intervention Results: PCPs reported improvement in all domains of diabetes education and management. From baseline, PCPs reported improvement in their confidence to serve as the T1D provider for their community (pre vs post: 43.8% vs 68.8%, p=0.005), manage insulin therapy (pre vs post: 62.8% vs 84.3%, p=0.002), and identify symptoms of diabetes distress (pre vs post: 62.8% vs 84.3%, p=0.002) post-intervention. Compared to pre-intervention, providers reported significant improvement in their confidence in all aspects of diabetes technology including prescribing technology (41.2% vs 68.6%, p=0.001), managing insulin pumps (41.2% vs 68.6%, p=0.001) and hybrid closed loop (10.2% vs 26.5%, p=0.033), and interpreting sensor data (41.2% vs 68.6%, p=0.001) post-intervention.

Conclusion: PCPs who participated in Project ECHO Diabetes reported increased confidence in diabetes management, with notable improvement in their ability to prescribe, manage, and troubleshoot diabetes technology. These data support the use of tele-education of PCPs to increase confidence in diabetes technology management as a feasible strategy to advance equity in diabetes management and outcomes.

Study Design: Pre-post study

Setting: Health centers in underserved areas of California and Florida

Population of Focus: Primary care providers (PCPs) who were recruited from federally qualifying health centers and community health centers in underserved areas of California and Florida. The participants included physicians and advanced practice providers, with a focus on those who were responsible for managing diabetes care in these settings

Sample Size: 116 providers

Age Range: Adult providers serving pediatric populations

Intervention Components (click on component to see a list of all articles that use that intervention): Provider, Education; Hospital, Chart audit and feedback, Elective induction policy, Guideline change and implementation, Quality improvement , HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, HOSPITAL, Chart Audit and Feedback, Elective Induction Policy, Guideline Change and Implementation, Quality Improvement

Intervention Description: At a large Southern US women's hospital, new measures were made to reduce the rates of cesarian delivery at the facility. Endeavors were led by nurse / doctor leaders (VP & chief of staff). These included monitoring, benchmarking & disseminating information about CD at the facility; new protocols for oxytocin administration; Bishop's score assessment; elective CD performed only at 39 weeks; new protocols and intrapartum alternative positioning devices, the process of laboring down, and closed glottis pushing attempts in second-stage labor.

Intervention Results: Collectively, these interdisciplinary interventions have resulted in significant decreases in overall cesarean birth rates and comparable significant reductions in the NTSV cesarean rates.

Conclusion: Concerted efforts to reduce rates of nonmedically indicated cesarean birth have resulted in the development and implementation of comprehensive action plans aimed at effecting reductions and enhancing overall obstetric quality care.

Setting: One large obstetric hospital in the Southern USA

Population of Focus: NTSV births

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, PROFESSIONAL_CAREGIVER, Education/Training (caregiver), COMMUNITY, Presentation

Intervention Description: This study assessed the impact of the two-day Kansas Infant Death and SIDS (KIDS) Network Safe Sleep Instructor (SSI) train-the-trainer program on CPS staffs' knowledge of the American Academy of Pediatrics safe sleep recommendations. Training was attended by 43 participants, 27 (63%) of whom were employed by CPS. All participants completed a 10-item pre- and post-training knowledge assessment at the beginning of the training and immediately following the training, respectively. Following training, SSIs were certified to educate parents/caregivers, childcare providers, health care providers, and other members of their communities about safe sleep practices. SSIs were tasked with providing safe sleep training to at least 10 professionals and with hosting one Safe Sleep Community Baby Shower or Crib Clinic within 9 months of certification.

Intervention Results: Following SSI certification, CPS SSIs provided more safe sleep training to professionals than other SSIs (1051 vs. 165, respectively), and both groups of SSIs were able to significantly increase the knowledge of their trainees.

Conclusion: Overall, the KIDS Network SSI training was successful. The innovative partnership with CPS allowed for provision of training to a group not historically targeted for safe sleep education.

Setting: Kansas Department of Children and Families Child Protective Services (CPS)

Population of Focus: Child Protective Services staff

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

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider)

Intervention Description: To increase primary care providers' use of validated tools for developmental, social/emotional, maternal depression, and domestic violence screening and to increase early awareness of autism symptoms during pediatric well-child visits in children aged 0 to 3 years.

Intervention Results: Percentage of sites screening 85% of children by 12-month well-child visit increased from 0% at baseline to 68.8% at follow-up. Sites not reaching 85% screening screened 48-83% of children at follow-up. Percentage of sites conducting social/emotional screening for 85% of children by 18-month well-child visit increased from 6% at baseline to 46.7% at follow-up. Sites not reaching 85% screening screened 5-81% of children at follow-up. Percentage of sites screening 85% of children by 24-month well-child visit increased from 0% at baseline to 68.8% at follow-up. Sites not reaching 85% screening screened 18-84% of children at follow-up.

Conclusion: The Enhancing Developmentally Oriented Primary Care (EDOPC) project enhanced confidence and intent to screen among a large group of Illinois primary health care providers. Among a sample of primary care sites at which chart reviews were conducted, the EDOPC project increased developmental screening rates to the target of 85% of patients at most sites and increased social/emotional screening rates to the same target rate in nearly half of the participating practices.

Study Design: QE: pretest-posttest

Setting: Primary care medical homes (federally qualified health centers, residency training programs, private practices) primarily in Chicago, Illinois, metropolitan area

Population of Focus: Children ages 4 to 24 months

Data Source: Child medical record

Sample Size: Chart audits at 16 sites (n=25 per site)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Outreach (School Staff), Educational Material (Provider), Patient Navigation,

Intervention Description: The intervention in the study is described as a school-based outreach pilot program aimed at increasing access and participation in State-subsidized health insurance. The specific activities of the intervention include including State-subsidized insurance marketing material in the student registration packet and providing outreach material to develop sustainable strategies for identifying uninsured children and systematically incorporating child health outreach into routine school district operations

Intervention Results: The study's results indicate that the school-based outreach program was effective in identifying uninsured children and facilitating their enrollment in State-subsidized health insurance programs. The outreach efforts resulted in a significant response rate, with a notable number of children enrolled in the program as a result of the intervention. These findings suggest that incorporating health insurance outreach into routine school district operations can be a successful strategy for reaching uninsured children and increasing their access to State-subsidized health insurance

Conclusion: The conclusion of the study suggests that integrating the collection of health insurance status into routine school communication channels is an effective way to identify uninsured children who may be eligible for State subsidized benefits. The research, conducted in Van Buren County, MI, estimates that 70% of the 1,211 uninsured children are eligible for State subsidized health insurance. A survey distributed with free and reduced lunch applications and school registration identified 156 uninsured children, raising questions about the external validity of the research. The study proposes the extrapolation of results to the entire county or even the state, emphasizing the simplicity of the survey and the statewide management of the Free and Reduced Lunch Program. The approach, already successful in several states, could provide a sustainable and everyday method for effective outreach to identify uninsured children. Additionally, the study rejects Ho2, stating there is a statistical difference in the number of applications received from a school-based outreach program during the pilot period. The analysis of application data shows a positive relationship between time and the number of applications received, with a predicted increase of 5.6593 applications in each subsequent period. The model's strength is supported by a relatively strong R² of 77.58%. However, the study acknowledges that 23% of the error remains unexplained, possibly due to factors such as the pilot outreach intervention. The actual number of applications in May 2013 exceeded the predicted range, suggesting factors not accounted for in the model.

Study Design: The study is described as a cross-sectional pilot study designed to employ a school-based outreach effort utilizing existing school communications to identify children who are currently uninsured and may be eligible for State subsidized health insurance.

Setting: State of Michigan schools

Population of Focus: The target audience for the study includes K-12 students and their families, particularly those who are currently uninsured and may be eligible for State subsidized health insurance.

Sample Size: The study identifies 156 children as not having health insurance, representing more than 44% of the 358 children who are eligible for State subsidized health insurance in the participating school districts

Age Range: The age range of the children involved in the study is K-12, which typically includes children between the ages of 5 and 18 years old

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement, Educational Material (Provider)

Intervention Description: Increasing women's access to nonmedical interventions during labor, such as continuous labor support, also has been shown to reduce cesarean birth rates. External cephalic version for breech presentation and a trial of labor for women with twin gestations when the first twin is in cephalic presentation also can contribute to the safe lowering of the primary cesarean delivery rate.

Intervention Results: Variation in the rates of nulliparous, term, singleton, vertex cesarean births also indicates that clinical practice patterns affect the number of cesarean births performed. The most common indications for primary cesarean delivery include, in order of frequency, labor dystocia, abnormal or indeterminate (formerly, nonreassuring) fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected fetal macrosomia.

Conclusion: Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula. A Cochrane metaanalysis of 12 trials and >15,000 women demonstrated that the presence of continuous one-on-one support during labor and delivery was associated with improved patient satisfaction and a statistically significant reduction in the rate of cesarean delivery.111 Given that there are no associated measurable harms, this resource is probably underutilized.

Study Design: N/A

Setting: N/A

Data Source: N/A

Sample Size: N/A

Age Range: N/A

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

Intervention Description: Due to the pervasive shortage of behavioral health (BH) specialists, collaborative partnerships between pediatric primary care practitioners (PPCPs) and BH specialists can enhance provision of BH services by PPCPs. We aimed to create a new model of collaborative care that was mostly virtual, affordable, and scalable. The pilot program was implemented in 18 practices (48 PPCPs serving approximately 150 000 patients) in 2 consecutive cohorts. Outcomes were assessed by administering pre-program and post-program surveys.

Intervention Results: Across the 18 practices, PPCPs reported significantly increased confidence in their BH knowledge and skills, and significantly increased their provision of target BH services. Barriers to BH service provision (resources, time, and staff) were unchanged.

Conclusion: This compact, mostly virtual model of BH collaboration appears to be beneficial to PPCPs while also offering convenience to patients and affordability and scalability to the practice network.

Study Design: Pre-post observational study

Setting: 18 clinical practices (48 PPCPs serving approximately 150000 patients) in CA.

Population of Focus: Pediatric primary care provicers in clinic-based practices. The eligible population comprises approximately 200 PPCPs in 65 practices in a pediatric network affiliated with an academic medical center in Southern California. This report presents the findings from the first 2 groups of practices to enroll (cohorts 1 [7 practices, 23 PPCPs] and 2 [11 practices, 25 PPCPs]).

Sample Size: 18 practices, 48 pediatric primary care providers

Age Range: Providers seeing pediatric patients 0-17 years

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.

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Expert Support (Provider),

Intervention Description: The City of Dallas, TA, WIC program collaborated with 3 urban hospitals and developed a training of practical techniques and information for staff to use while working with breastfeeding patients. It recognizes the powerful role that health care workers have in successful BF and the need for competent, hands-on skills to support lactation. The goals of the new collaboration with WIC were to provide staff a supervised clinical experience in a workshop format and provide a venue to practice the information they gained from the didactic education.

Intervention Results: Since implementation, 1,600 workers were trained, 1 hospital achieved Baby-Friendly designation, and all have increased BF rates by 10%.

Conclusion: The City of Dallas, TX, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program collaborated with 3 urban hospitals and developed a training of practical techniques and information for staff to use while working with BF patients. Since implementation, 1,600 workers were trained, 1 hospital achieved Baby-Friendly designation, and all have increased BF rates by 10%.

Study Design: Evaluation data

Setting: Three hospitals in Dallas, TX, and the City of Dallas WIC program

Population of Focus: Physicians, midwives, dietitians, and staff from area hospitals and clinics

Sample Size: 1600 people over three years

Age Range: Adults

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Development/Improvement of Services, Continuing Education of Hospital Providers, HOSPITAL, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: Creation of a small baby program requires special resources and multidisciplinary engagement.

Intervention Results: While it took pre-planning to time routine exams with cares, this approach resulted in a significant decrease in apnea, bradycardia, and desaturation events than previously observed.

Conclusion: We have described benefits, challenges, and practical approaches to creating and maintaining a small baby program that could be a model for the development of special programs for other sub-populations within in the NICU.

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Residents/Medical Students, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: Six obstetricians with significant experience in operative deliveries supervised and taught residents on labor and delivery, including the use of forceps

Intervention Results: There were 5,201 live, term, singleton, vertex deliveries under the care of residents, 1,919 (36.9%) before December 2012 and 3,282 (63.1%) December 2012 or later. The rate of forceps deliveries significantly increased from 0.6% to 2.6% (adjusted odds ratio [OR] 8.44, 95% confidence interval [CI] 3.1–23.1), and the rate of cesarean deliveries significantly decreased from 27.3% to 24.5% (adjusted OR 0.68, 95% CI 0.55–0.83). There were no statistically significant differences in the rates of third- or fourth-degree lacerations or 5-minute Apgar scores less than 7. Among nulliparous women, the forceps rate increased from 1.0% to 3.4% (adjusted OR 4.87, 95% CI 1.74–13.63) and the cesarean delivery rate decreased from 25.6% to 22.7% (adjusted OR 0.69, 95% CI 0.53–0.89). The increase in forceps deliveries

Conclusion: Having senior obstetricians supervise resident deliveries is significantly associated with an increased rate of forceps deliveries and a decreased rate of cesarean deliveries.

Setting: Mt. Sinai Hospital

Population of Focus: All patients with term singleton vertex gestrations

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Participation Incentives, Quality Improvement/Practice-Wide Intervention, Expert Support (Provider), Modified Billing Practices, Data Collection Training for Staff, Screening Tool Implementation Training, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Engagement with Payers, STATE, POPULATION-BASED SYSTEMS, Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: The Vermont Child Health Improvement Program (VCHIP) at the University of Vermont collaborated with state agencies and professional societies to conduct a survey of Vermont pediatric and family medicine practices regarding their developmental screening and autism screening processes, referral patterns, and barriers. The survey was administered in 2009 to 103 primary care practices, with a 65% response rate (89% for pediatric practices, 53% for family medicine practices).

Intervention Results: The survey results revealed that while 88% of practices have a specific approach to developmental surveillance and 87% perform developmental screening, only 1 in 4 use structured tools with good psychometric properties. Autism screening was performed by 59% of practices, with most using the M-CHAT or CHAT tool and screening most commonly at the 18-month visit. When concerns were identified, 72% referred to a developmental pediatrician and over 50% to early intervention. Key barriers to both developmental and autism screening were lack of time, staff, and training. Over 80% of practices used a note in the patient chart to track at-risk children, and most commonly referred to child development clinics, audiology, early intervention, and pediatric specialists.

Conclusion: The survey conducted by VCHIP revealed wide variation in developmental and autism screening practices among Vermont pediatric and family medicine practices. While most practices conduct some form of screening, there is room for improvement in the use of validated tools, adherence to recommended screening ages, and implementation of office systems for tracking at-risk children. The survey identified knowledge gaps and barriers that can be addressed through quality improvement initiatives, which most respondents expressed interest in participating in.

Study Design: QE: pretest-posttest

Setting: Pediatric and family medicine practices in Vermont

Population of Focus: Children up to age 3

Data Source: Child medical record; ProPHDS Survey

Sample Size: Chart audits at 37 baseline and 35 follow-up sites (n=30 per site) Baseline charts (n=1381) - Children 19-23 months (n=697) - Children 31-35 months (n=684) Follow-up charts (n=1301) - Children 19-23 months (n=646) - Children 31-35 months (n=655)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, PROVIDER/PRACTICE, Provider Education, Provider Audit/Practice Audit, Quality Improvement/Practice-Wide Intervention, Designated Clinic/Extended Hours

Intervention Description: Evaluation of a 5-year demonstration project testing a multicomponent (provider, system, and patient) intervention to increase cervical cancer screening among women who receive their health care through the Los Angeles County Department of Health Services, the second largest County Health Department in the nation.

Intervention Results: At the Hospital and Comprehensive Health Center (CHC) levels a statistically significant intervention effect was observed after controlling for baseline screening rates and case mix. No intervention effect was observed at the Public Health Center (PHC) level.

Conclusion: An intensive multicomponent intervention can increase cervical cancer screening in a large, urban, County health system serving a low-income minority population of under screened women.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Los Angeles County Department of Health Services (LACDHS) facilities: 2 large hospitals, 2 feeder Comprehensive Health Centers, and 6 of the health center’s feeder Public Health Centers

Population of Focus: Women attending LACDHS facilities

Data Source: Medical records and computerized databases held by the Los Angeles County Department of Health Services

Sample Size: Total (N=18,642) Intervention (n=9,492); Control (n=9,150) Baseline (n=5,249) Year 2 (n=5,470) Year 3 (n=5,365) First 6 months of Year 4 (n=2,558)

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, HOSPITAL, Quality Improvement

Intervention Description: A hospital-wide safe sleep bundle, based on a hospital-acquired conditions (HAC) model, was implemented in September 2017. Interventions were chosen by team members during multidisciplinary team meetings. Four key time points and/or interventions across the study period were (1) nursing education on the safe sleep bundle; 2) policy update and implementation; (3) collection and sharing of audit data; and (4) peer-to-peer bundle checklist reviews during registered nurse shift handoffs and electronic medical record (EMR) input. Other notable education interventions included subject matter expert training by guest speakers from the University of Pennsylvania and education to parents through updating newborn video instruction and increased exposure to appropriate safe sleep modeling.

Intervention Results: Overall compliance improved from 9% to 72%. Head of bed flat increased from 62% to 93%, sleep space free of extra items increased from 52% to 81%, and caregiver education completed increased from 10% to 84%. The centerline for infant in supine position remained stable at 81%.

Conclusion: Using an HAC bundle safety prevention model to improve adherence to infant safe sleep guidelines is a feasible and effective method to improve the sleep environment for infants in all areas of a children's hospital.

Setting: Penn State Children's Hospital

Population of Focus: Hospital healthcare providers

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider)

Intervention Description: We modified the Enhancing Developmentally Oriented Primary Care (EDOPC) program to provide a formal curriculum to pediatric residents serving children in distressed neighborhoods.

Intervention Results: Percentage of ASQ screening at 12-month well-child visits increased from 11% at baseline to 100% at follow-up. Percentage of ASQ:SE screening at 18-month well-child visits increased from 0% at baseline to 95% in June 2008 and declined to 58% at last follow-up in Jan 2009. Percentage of ASQ screening at 24-month well-child visits increased from 0% at baseline to 88% at follow-up.

Conclusion: Chart audits 1 year after the intervention demonstrated increased use of screening tools and more referrals to community services. This article will discuss lessons about facilitators and barriers to teaching residents about vulnerable preschool children.

Study Design: QE: pretest-posttest

Setting: University of Chicago Pediatric Residency Program in Chicago, Illinois

Population of Focus: Children ages 6 to 24 months

Data Source: Child medical record

Sample Size: Chart audits - Baseline (n=27 of 50 selected) - Follow-up 1: (n=61 of 100 selected) - Follow-up 2: (n=82 of 100 selected) - Follow-up 3: (n=94 of 100 selected) - Follow-up 4: (n=74 of 100 selected)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Reminder/Recall Systems, Education/Training (caregiver), Social Media,

Intervention Description: Based on the concerns parents expressed through the survey, a program was designed and implemented that included reminder calls, parent education, proactive appointment scheduling, and social media reminders.

Intervention Results: After implementing a parent-driven quality-improvement program for 6 months during influenza season, the health center's pediatric influenza immunization rates rose to 57% compared with 44% during the year before.

Conclusion: Childhood immunization is a critical priority to protect the health and wellness of children. Increasing parent engagement in discussions about increasing immunization rates not only promotes awareness surrounding vaccines but also allows primary care providers to learn from parents to create a patient-centered immunization program. Programs that specifically target immunization efforts toward parental concerns have the potential for increased vaccine acceptance and improved health outcomes.

Study Design: The study utilized a randomized sampling method and conducted open-ended telephone surveys with parents of young children to identify key barriers to influenza immunization

Setting: a diverse, urban family health center

Population of Focus: The target audience for the study is parents of children aged 6 through 24 months at the urban family health center

Sample Size: The sample size is not explicitly mentioned in the provided text

Age Range: The age range of the children involved in the study is 6 through 24 months

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Educational Material (Provider), Residents/Medical Students,

Intervention Description: The intervention described by the article to increase postpartum screening was a 15-minute slide presentation with essential topics, including content on antepartum and postpartum depression focusing on signs, symptoms, screening, and treatment as well as antepartum maternal depression education highlighting the importance of understanding health literacy

Intervention Results: The results of the study showed that there was an increase in mean change over time for knowledge, self-efficacy, and motivation among medical and nurse practitioner students. The second null hypothesis was rejected, indicating that there was a significant increase in motivation levels from before to after the intervention. However, there was no significant difference between medical and nurse practitioner students, and student profession did not moderate the outcome effect

Conclusion: An intervention to influence health care students' knowledge, self-efficacy, and motivation for antepartum depression screening can be included in medical and nursing curricula and can also be used with currently practicing health care providers. Doing so could possibly benefit pregnant women by enhancing the antepartum care that they receive.

Study Design: The study design/type is a quasi-experimental study design

Setting: University of South Florida, College of Nursing and College of Medicine

Population of Focus: he target audience for the study was medical and nurse practitioner students who had completed the women's health/obstetric course within the curriculum, had self-identified ability to use the online technology platform/intervention, had access to an Internet-enabled device capable of accessing the online intervention, and were fluent in the English language

Sample Size: The sample size of this study was 71 participants, including 19 medical students and 52 nurse practitioner students

Age Range: The age group of the participants is not explicitly mentioned in the given texts. However, it is stated that medical students tended to be younger than nurse practitioner students

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

Intervention Description: To evaluate the effectiveness of a complex intervention to improve referral and treatment of pregnant smokers in routine practice, and to assess the incremental costs to the National Health Service (NHS) per additional woman quitting smoking.

Intervention Results: After introduction of the intervention, the referral rate increased more than twofold (incidence rate ratio=2.47, 95% CI 2.16 to 2.81) and the probability of quitting by delivery increased (adjusted OR=1.81, 95% CI 1.54 to 2.12). The additional cost per delivery was £31 and the incremental cost per additional quit was £952; 31 pregnant women needed to be treated for each additional quitter.

Conclusion: The implementation of a system-wide complex healthcare intervention was associated with significant increase in rates of quitting by delivery.

Study Design: Quasi experimental Crosssectional and Cost-benefit analysis

Setting: National Health Service(NHS) antenatal clinics

Population of Focus: Health records of singleton births to mothers who smoked and did not smoke

Data Source: Electronic health records

Sample Size: 37726

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, HOSPITAL, Guideline Change and Implementation, Quality Improvement

Intervention Description: This quality improvement initiative used a systematic approach to reduce nulliparous cesarean birth rates, aligning with recommendations developed by the Council on Patient Safety in Women's Health Care: Patient Safety Bundle on the Safe Reduction of Primary Cesarean Births. Health care providers and nurses received education on contemporary labor management guidelines developed by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine Obstetric Care Consensus regarding safe prevention of primary cesarean deliveries and nurses were instructed on labor support techniques. The preguideline implementation period was January 1, 2015, to June 30, 2015. The postguideline implementation period was July 1, 2016, to December 31, 2016. The primary outcome measured was the nulliparous, term, singleton, vertex cesarean birth rate.

Intervention Results: There were 434 women identified in the preguideline period and 401 women in the postguideline period. The nulliparous, term, singleton, vertex cesarean birth rate decreased from 27.9% to 19.7% [odds ratio (OR) 0.63, CI 0.46-0.88]. There were improvements in health care provider compliance with following the labor management guidelines from 86.2% to 91.5% (OR 1.73, 95% CI 1.11-2.70), the use of maternal position changes from 78.7% to 87.5% (OR 1.86, 95% CI 1.29-2.68), and use of the peanut birthing ball from 16.8% to 45.2% (OR 3.83, 95% CI 2.84-5.16) as provisions for labor support.

Conclusion: Implementing a systematic approach for care of nulliparous women is associated with a decrease in term, singleton, vertex cesarean birth rates.

Setting: Two rural community hospitals and one urban community hospital in North Carolina

Population of Focus: Nulliparous women with term singleton vertex gestations

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, HEALTH_CARE_PROVIDER_PRACTICE, Data Collection Training for Staff , Provider Training/Education, Audit/Attestation (Provider)

Intervention Description: Quality improvement (QI) methodology was used to implement routine screening using an adapted version of the Survey of Well Being of Young Children (SWYC), a child behavior and social screen, for all children ages 6 months to 10 years. Rates of screen administration and documentation were assessed for 18 months. Medical records of a convenience sample (N=349) were reviewed to track referrals and follow-up for positive screens.

Intervention Results: Over 18 months, 2028 screens were administered. Screening rates reached 90% after introducing a tablet for screening. Provider documentation of screens averaged 62%. In the convenience sample, 28% scored positive for a behavioral problem, and 25% reported at least 1 social stressor. Of those with positive child behavior or social stressor screens, approximately 80% followed up with their primary medical doctor, and approximately 50% completed referrals to the clinic social worker. Further analysis indicated that referral and follow-up rates varied depending on whether the family identified child behavior or social issues. Logistic regression revealed that parental concern was independently associated with child behavior symptoms (p = 0.001) and social stressors (p = 0.002).

Conclusion: Implementing a comprehensive psychosocial screen is feasible in pediatric primary care and may help target referrals to address psychosocial health needs.

Setting: Community health center

Population of Focus: Primary care peditricians

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

Intervention Description: The intervention is the implementation of a screening protocol for postpartum depression using the Edinburgh Postnatal Depression Scale (EPDS) and referral to a licensed professional clinical counselor for mothers who score 10 or higher on the EPDS . The intervention aligns with a discernable strategy of using the Institute for Healthcare Improvement’s (IHI) Plan-Do-Study-Act cycle as a guiding framework to plan, implement, evaluate, and modify changes to achieve outcome objectives .

Intervention Results: The study found that the implementation of the PPD screening and referral process resulted in a 24% detection rate for postpartum depression, which is approximately double that of the general population . The project reduced common barriers to PPD treatment, such as cost, transportation, and childcare issues . The RNs who participated in the project reported that the educational content provided them with the necessary information to successfully implement the PPD screening and referral process . The study also found that 80% of RNs reviewed the slide presentation by the project start date .

Conclusion: This project recognizes the importance of an interdisciplinary care approach and highlights the need for early identification and treatment for PPD among mothers with babies in the NICU. The project can guide future initiatives to increase the use of screening in the inpatient setting, to detect PPD during its early and more treatable stages.

Study Design: The study design used in the research is not explicitly stated, but it appears to be a quality improvement project aimed at implementing a routine postpartum depression (PPD) screening protocol in the Neonatal Intensive Care Unit (NICU) . The study used a one-group, posttest-only design to evaluate outcome objectives

Setting: The setting for the study is not explicitly stated in any of the given texts. However, it is mentioned that IRB review and waiver were obtained from both the academic institution and the hospital site . Additionally, the study focuses on screening mothers of babies in the Neonatal Intensive Care Unit (NICU)

Population of Focus: The target audience for the study appears to be healthcare providers who work with mothers of babies in the Neonatal Intensive Care Unit (NICU) and are interested in implementing a routine postpartum depression (PPD) screening protocol. The study provides information on the use of the Edinburgh Postnatal Depression Scale (EPDS) for identifying mothers at risk for PPD, as well as recommendations for education and referral to licensed professional clinical counselors

Sample Size: The sample size for the study is 25 mothers who received the screening

Age Range: The age group of the mothers who received the screening is not mentioned in the given texts

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, HEALTH_CARE_PROVIDER_PRACTICE, ,

Intervention Description: This case study describes an innovative practice model informed by the Collective Impact Model (CIM) designed to promote breastfeeding continuity of care and community support in Central Illinois.

Intervention Results: Numerous breastfeeding support improvements were made at and between CIBPN sites. Breastfeeding rates at the birthing hospital and health center were stable, including during the COVID-19 pandemic.

Conclusion: This article contributes to the practice-based evidence for breastfeeding support by strengthening continuity of care through a successful application of the CIM by public health practitioners.

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Hospital Policies, Provider Training/Education

Intervention Description: Despite policy and guideline recommendations to support planned, effective postnatal care, national surveys of women's views of maternity care have consistently found in-patient postnatal care, including support for breastfeeding, is poorly rated.

Intervention Results: Post intervention there were statistically significant differences in the initiation (p = 0.050), duration of any breastfeeding (p = 0.020) and duration of exclusive breastfeeding to 10 days (p = 0.038) and duration of any breastfeeding to three months (p = 0.016). Post intervention, women were less likely to report physical morbidity within the first 10 days of birth, and were more positive about their in-patient care.

Conclusion: It is possible to improve outcomes of routine in-patient care within current resources through continuous quality improvement.

Study Design: QE: pretest-posttest

Setting: Large maternity unit in the south of England

Population of Focus: Women on the postnatal ward who were >16 years old, able to speak and read English, and who had not experienced a stillbirth or neonatal death

Data Source: Mother self-report

Sample Size: Pretest (n=751/741)3 Posttest (n=725/725)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Home Visit (caregiver), Educational Material (caregiver), Oral Health Product, Patient Navigation (Assistance), PROVIDER/PRACTICE, Outreach (Provider), Education/Training (caregiver)

Intervention Description: The aim of this study was to determine the effect of a dental care coordinator intervention on increasing dental utilization by Medicaid-eligible children compared with a control group.

Intervention Results: Dental utilization during the study period was significantly higher in the intervention group (43 percent) than in the control group (26 percent). The effect was even more significant among children living in households well below the Federal Poverty Level. The intervention was effective regardless of whether the coordinator was able to provide services in person or via telephone and mail.

Conclusion: The dental care coordinator intervention significantly increased dental utilization compared with similar children who received routine Medicaid member services. Public health programs and communities endeavoring to reduce oral health disparities may want to consider incorporating a dental care coordinator along with other initiatives to increase dental utilization by disadvantaged children.

Study Design: RCT

Setting: Jefferson County in Louisville, KY

Population of Focus: Children aged 4-15 years who currently or for 2 years prior had Medicaid insurance but have not had Medicaid dental claims filed for the previous 2 years

Data Source: Medicaid claims

Sample Size: Intervention (n=68) Control (n=68)

Age Range: not specified

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

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement, Provider Training/Education,

Intervention Description: The intervention involved a QI program that included teaching essential QI principles, providing strategies to deliver a strong provider vaccine recommendation, reviewing system changes to facilitate vaccination, and engaging all office staff in the effort

Intervention Results: The QI program resulted in increases in HPV vaccine series initiation and completion rates among children aged 11–12 years, well above the goal of 10%, even when replicated with a second group of practices

Conclusion: The conclusion highlighted the success of the QI program in optimizing patient care and workflow efficiency in busy primary care practices, emphasizing the importance of basic quality improvement education and strategies to deliver a strong provider vaccine recommendation

Study Design: The study design involved a Quality Improvement (QI) program that included teaching essential QI principles and providing examples of workflow-focused strategies to improve HPV vaccination rates among children aged 11–12 years

Setting: The setting for the Quality Improvement (QI) initiative was pediatric practices in AAP NY Chapter 1, mostly large, private practices serving suburban communities

Population of Focus: The target audience included pediatric providers and staff from the participating practices in AAP NY Chapter 1

Sample Size: The article does not explicitly mention the sample size. However, it states that eight different pediatric practices from AAP NY Chapter 1, each employing between 1 and 10 providers, were recruited for participation in the QI initiative

Age Range: The age range targeted by the QI initiative was 11–12 years old

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Continuing Education of Hospital Providers, POPULATION-BASED SYSTEMS, STATE, Policy/Guideline (State), Funding Support, Perinatal Committees/Councils

Intervention Description: Vital records data (1971 to 1978) were used to assess the change in neonatal and fetal mortality in Colorado in relationship to the regionalization of perinatal health care within the state.

Intervention Results: There has been a decrease in neonatal mortality rate from 13.4 to 6.9 during a period of time when there was a minimal decrease in the incidence of low-birth weight infants. The improved neonatal mortality has been associated with a shift in the frequency of birth of very low-birth weight (VLBW) infants to hospitals with level II and III perinatal services and relatively greater survival rates of VLBW infants born in these hospitals as compared to those born in level I hospitals. There was no decrease in fetal mortality in the same period of time.

Conclusion: These date suggest that outreach education in perinatal medicine should now emphasize current knowledge and methods for reducing antepartum deaths.

Study Design: QE: pretest-posttest

Setting: All Colorado hospitals Three level III, seven level II, remaining level I

Population of Focus: Infants born weighing greater than one lb.

Data Source: Data from the Bureau of Vital Records, Colorado State Health Department.

Sample Size: Pretest: 1.8% (n=2,818) Posttest: 1.8% (n=2,967) Infants born weighing one to four lbs.

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER, Training/Education, PROFESSIONAL_CAREGIVER, Education/Training (caregiver), Educational Material (caregiver)

Intervention Description: A quality improvement project was implemented at a pediatric primary care practice to improve screening for infant safe sleep practices. The screening form was updated to include questions from the Pregnancy Risk Assessment Monitoring System (PRAMS) that better capture actual sleeping practices and allow for a more targeted response from providers. Based on individual survey responses, the providers offered and documented their specific educational feedback. Any changes/improvements reported during a 2-week callback were also documented. Study participation was encouraged by offering a chance to win a $50 Amazon gift card and a free board book, Sleep Baby, Safe and Snug, covering the basics of safe sleep in a format that can be read to the child (Charlie's Kids Foundation, 2017).

Intervention Results: This updated screening better captured actual sleeping practices, allowing for more targeted education.

Conclusion: This article describes a quality improvement project implemented at a pediatric primary care practice to improve screening for infant safe sleep.

Setting: A single pediatric primary care practice

Population of Focus: Parents/caregivers of infants 0-6 months

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Lactation Consultant, PROVIDER/PRACTICE, Provider Training/Education

Intervention Description: To evaluate the efficacy of an intervention program to increase breast-feeding in a low-income, inner-city population.

Intervention Results: There was a markedly higher incidence of breast-feeding in the intervention group, as compared with that of the control group (61% vs 32%, respectively; P = .002). The duration of breast-feeding was also significantly longer in the intervention group (P = .005).

Conclusion: This lactation program increased the incidence and duration of breast-feeding in our low-income cohort. We suggest that similar efforts that are applied to analogous populations may increase the incidence and duration of breast-feeding in low-income populations in the United States.

Study Design: RCT

Setting: Maternal-Infant Lactation Center of Pittsburgh (PA)

Population of Focus: Women attending the prenatal clinic of The Mercy Hospital of Pittsburgh, English-speaking, and nulliparous

Data Source: Mother self-report

Sample Size: Intervention (n=51) Control (n=57)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Health_Care_Provider_Practice, Screening Tool Implementation Training, Provider Training/Education

Intervention Description: Twenty-eight pediatricians completed an in-person meeting, monthly webinars, and individualized feedback from an Expert Work Group on progress across a 3-month action period.

Intervention Results: Statistically significant increases were observed in rates of autism screening, discussions of screening results with families, and referral following abnormal results. There was no statistically significant change in rates of general developmental screening. Comparing self-report with record review, pediatricians overestimated the extent to which they conducted discussion and referral.

Conclusion: Universal screening for all children has yet to be achieved. The current project supports that practice-based improvements can be made and delineates some of the routes to success.

Setting: Clinical practice

Population of Focus: Primary care peditricians

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Access to Provider through Hotline, HOSPITAL, Continuing Education of Hospital Providers, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, STATE, Policy/Guideline (State), Consultation Systems (Inter-Hospital Systems), Consultation Systems (Hospital), Telemedicine Systems (Inter-Hospital Systems), Telemedicine Systems (Hospital)

Intervention Description: To examine the factors associated with delivery of preterm infants at neonatal intensive care unit (NICU) hospitals in Arkansas during the period 2001–2006, with a focus on the impact of a Medicaid supported intervention, Antenatal and Neonatal Guidelines, Education, and Learning System (ANGELS), that expanded the consulting capacity of the academic medical center's maternal fetal medicine practice.

Intervention Results: Perceived risk, age, education, and prenatal care characteristics of women affected the likelihood of use of the NICU. The perceived availability of local expertise was associated with a lower likelihood that preterm infants would deliver at the NICU. ANGELS did not increase the overall use of NICU, but it did shift some deliveries to the academic setting.

Conclusion: Perinatal regionalization is the consequence of a complex set of provider and patient decisions, and it is difficult to alter with a voluntary program.

Study Design: Time trend analysis

Setting: All Arkansas hospitals Five level III hospitals from 2001- 2005, six in 2006

Population of Focus: Infants born at <35 weeks GA

Data Source: Data from Medicaid claims for pregnancy linked to birth certificates for women covered by Medicaid in Arkansas

Sample Size: Total (n= 5,150) 2001 (n= 812) 2002 (n= 1,105) 2003 (n= 824) 2004 (n= 824) 2005 (n= 887) 2006 (n= 698) Infants born at <35 weeks GA

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Access to Provider through Hotline, HOSPITAL, Continuing Education of Hospital Providers, STATE, Policy/Guideline (State)

Intervention Description: In this longitudinal observational study, linked vital records and Medicaid claims records for 29,124 preterm births (April 2001–December 2012) to Medicaid covered women were used to examine factors predicting whether deliveries occurred at hospitals with neonatology-staffed NICUs. The factors associated with delivery are estimated and compared for baseline and three post-implementation periods.

Intervention Results: Rates for NICU preterm deliveries increased from 28 to 37% over the time period. Compared to baseline, adjusted NICU delivery rates in the middle and late implementation periods were statistically significant (p < 0.001). Negative impacts of long travel times were reduced, while impacts of obstetrician prenatal care changed from negative to positive association.

Conclusion: Findings validate the ANGELS initiative premise: academic specialists, working with community-based care providers, can improve perinatal regionalization.

Setting: Hospitals in Arkansas

Population of Focus: Medicaid-covered women in Arkansas

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

Intervention Description: The study used a bundled measure that includes immunizations, lead screening, and use of screening tools to improve preventative care service delivery. The interventions included staff education on measure components, introduction of exam room-based phlebotomy to address lead screening completion rates, and population management strategies, including development of a patient registry and use of reminders and visit tracking to increase attendance at well-child visits.

Intervention Results: The percent of bundle completion by 14 months of age increased from a baseline of 58% to 77% following implementation of the QI initiatives. A mean shift was identified after the population manager began proactive targeted outreach for the 12-month visit.

Conclusion: Targeted systems for outreach aimed at bringing patients into the clinic and patient-centred strategies for visit completion are effective at ensuring timely delivery of comprehensive preventative care to an underserved paediatric population.

Study Design: The study is a quality improvement (QI) study that used plan-do-study-act (PDSA) cycles to optimize results.

Setting: The study was conducted at a community-based academic primary care clinic.

Population of Focus: Underserved pediatric patients under 2 years old.

Sample Size: The study does not provide a specific sample size.

Age Range: The target audience is pediatric patients under 2 years old.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, Other Person-to-Person Education, CAREGIVER, Education/Training (caregiver), PROVIDER/PRACTICE, Nurse/Nurse Practitioner, Motivational Interviewing, Motivational Interviewing/Counseling

Intervention Description: Intervention (INT) was a home-based asthma follow-up after ED visit and two visits for an environmental control educational program delivered by trained nurses and nurse practitioners to the child and caregiver. For caregivers of children with positive cotinine results, brief motivational interviewing sessions were conducted to implement total home smoking ban.

Intervention Results: Over half of children in the study tested positive for SHS. Targeting SHS exposure was major component of the intervention [but] no significant reduction in cotinine exposures was associated with the intervention at 12 months.

Conclusion: In this study, a home-based EC intervention was not successful in reducing asthma ED revisits in children with poorly controlled asthma with SHS exposure. Allergic sensitization, young age, and increased controller medication use were important predictors of asthma ED visits.

Study Design: Prospective randomized controlled trial

Setting: Home-based (following ED visit)

Population of Focus: Children with physician diagnosed persistent asthma, having two or more ED asthma visits or more than one hospitalization over the past 12 months and residing in the Baltimore metropolitan area

Data Source: For SHS exposure, child saliva samples collected during the ED visit and at 6- and 12-month follow up visits.

Sample Size: 222 inner city children ages 3-12

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Other Education, Provider Training/Education, Development/Improvement of Services, Patient Reminder/Invitation

Intervention Description: This intervention presents a toolkit developed by the March of Dimes, California Maternal Quality Care Collaborative, and the California Department of Public Health, aimed at eliminating non-medically indicated (elective) deliveries before 39 weeks of gestation. The toolkit provides guidance and strategies for healthcare providers, hospitals, and policymakers to reduce early elective deliveries (EEDs), which are associated with neonatal morbidities and increased healthcare costs. It identifies common barriers to reducing EEDs, such as lack of effective policies, provider resistance, lack of patient awareness, and data collection challenges. The toolkit offers recommendations to overcome these barriers through policy changes, hard-stop policies, provider and patient education, data collection guidance, and measurement strategies using The Joint Commission's PC-01 measure for EEDs.

Intervention Results: The toolkit highlights several successful quality improvement (QI) interventions implemented by healthcare organizations to reduce early elective deliveries. Intermountain Healthcare, through a multidisciplinary team approach, data-driven interventions, and strict enforcement of policies, reduced elective deliveries before 39 weeks from 28% to less than 3% within six years. Additionally, they observed a decrease in stillbirth rates and no significant increase in maternal morbidity. Magee Women's Hospital achieved a significant reduction in elective inductions before 39 weeks and lower cesarean section rates among nulliparous women after implementing induction guidelines, involving key physician and nursing leaders, and establishing a chain of support for enforcement. The Ohio Perinatal Quality Collaborative reported a decrease in elective deliveries from 25% to less than 5% within 14 months among participating hospitals, along with a decline in stillbirth rates and fewer NICU admissions for infants born between 36 and 38 weeks.

Conclusion: Despite efforts to curb early elective deliveries, the toolkit acknowledges that some areas still face difficulties in achieving desired results. It emphasizes the need for a coordinated effort from various stakeholders, including healthcare providers, hospitals, professional organizations, patient advocates, and policymakers. The toolkit serves as a comprehensive resource, offering evidence-based strategies, educational tools, and case studies to support the elimination of non-medically indicated deliveries before 39 weeks. By addressing barriers, promoting policy changes, enhancing data collection and measurement, and increasing awareness among providers and patients, the toolkit aims to facilitate sustainable improvements in maternal and neonatal health outcomes.

Study Design: N/A

Setting: N/A

Data Source: N/A

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, HOSPITAL, Chart Audit and Feedback, Guideline Change and Implementation, Quality Improvement, Policy/Guideline (State), STATE, Collaboration with Local Agencies (Health Care Provider/Practice), Collaboratives, Policy/Guideline (Hospital)

Intervention Description: Hospitals participating in the MDPQC (Maryland Perinatal-Neonatal Quality Care Collaborative) agreed to implement practices from the "Safe Reduction of Primary Cesarean Births" patient safety bundle, developed by the Council on Patient Safety in Women's Health Care. As a requirement of participation, hospital teams sent at least one team member to each collaborative event. Activities included a June 2016 in-person kick off meeting for two to three representatives from each hospital to familiarize them with the cesarean delivery bundle and the requirements of participation, followed by conference calls that occurred every month in the first year and every 2 months in the second year. Additional in-person meetings for all hospital teams took place at 12 months and at the end of the collaborative (November 2018). Nice webinars on related clinical topics were presented throughout the 30-month period. The collaborative director provided facilitation support to site teams through calls and visits when requested by the site team or when site participation lapsed.

Intervention Results: Among the 26 bundle practices that were assessed, participating hospitals reported having a median of seven practices (range 0-23) already in place before the collaborative and implementing a median of four (range 0-17) new practices during the collaborative. Across the collaborative, the cesarean delivery rates decreased from 28.5% to 26.9% (P=.011) for all nulliparous term singleton vertex births and from 36.1% to 31.3% (P<.001) for nulliparous, term, singleton, vertex inductions. Five hospitals had a statistically significant decrease in nulliparous, term, singleton, vertex cesarean delivery rates and four had a significant increase. Nulliparous, term, singleton, vertex cesarean delivery rates were significantly lower across hospitals that implemented more practices in the "Response" domain of the bundle.

Conclusion: The MDPQC was associated with a statewide reduction in cesarean delivery rates for nulliparous, term, singleton, vertex births.

Setting: 31 Maryland birthing hospitals

Population of Focus: Among the 26 bundle practices that were assessed, participating hospitals reported having a median of seven practices (range 0–23) already in place before the collaborative and implementing a median of four (range 0–17) new practices during the collaborative. Across the collaborative, the cesarean delivery rates decreased from 28.5% to 26.9% (P5.011) for all nulliparous term singleton vertex births and from 36.1% to 31.3% (P,.001) for nulliparous, term, singleton, vertex inductions. Five hospitals had a statistically significant decrease in nulliparous, term, singleton, vertex cesarean delivery rates and four had a significant increase. Nulliparous, term, singleton, vertex cesarean delivery rates were significantly lower across hospitals that implemented more practices in the “Response” domain of the bundle.

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Continuing Education of Hospital Providers, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Follow-Up Given On Transferred Patients, STATE, Perinatal Committees/Councils, NICU Bed Registry/Electronic Bulletin Board

Intervention Description: To determine whether perinatal care in southwestern Ontario is regionalized, to identify trends over time in referral patterns, to quantify trends in perinatal death rates and to identify trends in perinatal death rates that give evidence of regionalization.

Intervention Results: Between 1982 and 1985 the antenatal transfer rate increased from 2.2% to 2.8% (p less than 0.003). The proportion of births of infants weighing 500 to 1499 g increased from 49% to 69% at the level III hospital. The neonatal transfer rate increased from 26.2% to 47.9% (p less than 0.05) for infants in this birth-weight category and decreased from 10.2% to 7.1% (p less than 0.03) for infants weighing 1500 to 2499 g. The death rate among infants of low birth weight was lowest among those born at the level III centre and decreased at all centres between 1982 and 1985.

Conclusion: Perinatal care in southwestern Ontario is regionalized and not centralized; regionalization in southwestern Ontario increased between 1982 and 1985.

Study Design: QE: pretest-posttest

Setting: Southwestern Ontario One level III, one modified level III and 30 level II or I

Population of Focus: Births greater than 500 gm

Data Source: Data obtained from hospital delivery room books and for 31 of the 32 hospitals, from hospital charts of women and neonates.

Sample Size: Pretest: 1.17% (n= 194) Posttest: 1.31% (n= 211) Infants born weighing 500-1499 gm

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, PROFESSIONAL_CAREGIVER, Education/Training (caregiver)

Intervention Description: Research staff from a single maternity ward recruited 184 mothers and their term newborns to participate in this randomized controlled trial to assess whether a patient portal could be used to provide personalized safe sleep care. The portal is capable of supporting two-way information sharing and communication between providers and families. Feasibility of the study was measured by a) the proportion of consenting mothers who enrolled in the portal and b) maternal adherence to prompts to submit photographs of their infant sleeping to the research team through the patient portal. Efficacy was determined via research assistant review of submitted photographs. The assistants were trained to detect sudden unexplained infant death risk factors, including sleep position, based on AAP guidelines. Standardized feedback was returned to mothers through the patient portal.

Intervention Results: One hundred nine mothers (59%) enrolled in the patient portal and were randomized to intervention (N = 55) and control (N = 54) groups. 21 (38, 95% CI 25-52%) intervention group participants sent photographs at 1 month and received personalized feedback. Across both groups at 2 months, 40 (37, 95% CI 28-46%) sent photographs; 56% of intervention group participants who submitted photographs met all safe sleep criteria compared with 46% of controls (difference 0.10, 95% CI - 0.26 to 0.46, p = .75). Common reasons for guideline non-adherence were sleeping in a room without a caregiver (43%), loose bedding (15%) and objects (8%) on the sleep surface.

Conclusion: Utilizing the patient portal to individualize safe infant sleep is possible, however, we encountered numerous barriers in this trial to assess its effects on promoting safe infant sleep. Photographs of infants sleeping showed substantial non-adherence to AAP guidelines, suggesting further needs for improvement to promote safe infant sleep practices.

Setting: Single maternity ward, Penn State Milton S. Hershey Medical Center

Population of Focus: Mothers and their term newborns

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Hospital Policies, POPULATION-BASED SYSTEMS, COMMUNITY, Community Health Services Policy, Provider Training/Education

Intervention Description: To assess the effectiveness of the Baby Friendly Community Initiative (BFCI) on exclusive breast feeding at 6 months.

Intervention Results: The crude rates of exclusive breast feeding at discharge, 3 and 6 months, and of any breast feeding at 6 and 12 months increased at each round of data collection after baseline in the early and late intervention groups. At the end of the project, 10% of infants were exclusively breast fed at 6 months and 38% were continuing to breast feed at 12 months. However, the comparison by adjusted rates and logistic regression failed to show statistically significant differences between groups and rounds of data collection in the intention-to-treat analysis, as well as when compliance with the intervention and training coverage was taken into account.

Conclusion: The study failed to demonstrate an effect of the BFCI on the rates of breast feeding. This may be due, among other factors, to the time needed to observe an effect on breast feeding following this complex intervention.

Study Design: QE: pretest-posttest time-lagged nonequivalent control group

Setting: 18 Local Health Authorities (LHAs) in 9 regions of Italy

Population of Focus: Women living in the area covered by LHA, with infants > 2000g, who spoke Italian, English, French, or Spanish (or who had a relative who spoke these languages), and without a postpartum condition that required admission to the NICU

Data Source: Mother self-report

Sample Size: Early Intervention Group5 • Enrolled (n=2846) • 12-month follow-up (n=2474) Late Intervention Group • Enrolled (n=2248) • 12-month follow-up (n=1931)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Hospital Policies, Baby Friendly Hospital Initiative, Provider Training/Education

Intervention Description: Breastfeeding rates and related hospital practices need improvement in Italy and elsewhere.

Intervention Results: No statistically significant differences in both groups, before and after training, of exclusive breastfeeding at 6 months

Conclusion: Training for at least three days with a course including practical sessions and counselling skills is effective in changing hospital practices, knowledge of health workers, and breastfeeding rates.

Study Design: QE: pretest-posttest time-lagged nonequivalent control group

Setting: 8 hospitals (3 general hospitals and 1 teaching hospital in southern Italy, 3 general hospitals and 1 teaching hospital in central and northern Italy)

Population of Focus: Women with healthy infants > 2000g

Data Source: Mother self-report

Sample Size: Group 1 • Phase 1 (n=529) • Phase 2 (n=515) • Phase 3 (n=516) Group 2 • Phase 1 (n=483) • Phase 2 (n=342) • Phase 3 (n=284)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid Reform, Provider Training/Education, Media Campaign (Print Materials, Public Address System, Social Media),

Intervention Description: We estimate the association of the Delaware Contraceptive Access Now (DelCAN) initiative with use of postpartum Long-Acting Reversible Contraception (LARC). DelCAN included Medicaid payment reform for immediate postpartum LARC use, provider training and technical assistance in LARC provision, and a public awareness campaign.

Intervention Results: Relative to the comparison states, postpartum LARC use in Delaware increased by 5.26 percentage points (95% CI 2.90-7.61, P < 0.001) during the 2015-2017 DelCAN implementation period. This increase was the largest among Medicaid-covered women, and grew over the first three implementation years. By the third year of the DelCAN initiative (2017), the relative increase in postpartum LARC use for Medicaid women exceeded that for non-Medicaid women by 7.24 percentage points (95% CI 0.12-14.37, P = 0.046).

Conclusion: The DelCAN initiative was associated with increased LARC use among postpartum women in Delaware. During the first 3 years of the initiative, LARC use increased progressively and to a greater extent among Medicaid-enrolled women. Comprehensive initiatives that combine Medicaid payment reforms, provider training, free contraceptive services, and public awareness efforts may reduce unmet demand for highly effective contraceptives in the postpartum months.

Study Design: Difference in differences design

Setting: Delaware (statewide compared to 15 other states)

Sample Size: 4815 women in Delaware; 88470 women in 15 comparison states

Age Range: 15-50

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Home Visit (caregiver), PROFESSIONAL_CAREGIVER, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: This study evaluated the efficacy of a program to train home visitors to talk to clients about infant safe sleep using Motivational Interviewing and cultural sensitivity.

Intervention Results: Home visitors showed significant improvement in MI skill use and cultural sensitivity from pre- to post-test. Regarding client outcomes, our results indicate a significant group by time interaction when predicting changes in client knowledge such that the treatment group showed larger gains than the control group. There were no significant differences between groups when predicting changes in client attitudes or behavior.

Conclusion: MI may be an effective technique for home visitors to help increase families' safe sleep knowledge. Additional research is needed to examine whether such training can translate to changes in families' safe sleep behavior.

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, PROFESSIONAL_CAREGIVER, Education/Training (caregiver), Home Visit (caregiver)

Intervention Description: This study evaluated the efficacy of a program to train home visitors to talk to clients about infant safe sleep using Motivational Interviewing and cultural sensitivity. Conducted as part of the initiative by Cradle Kalamazoo initiative to decrease racial disparities in infant mortality, home visitors attended a 2-day training that incorporated MI skills, cultural sensitivity, and safe sleep information. The MI training was conducted by a licensed Ph.D.-level psychologist as well as a second-year doctoral student in clinical psychology with 1 year of experience conducting clinical work. Home visitor outcomes were assessed using a pre-post design that included self reporting (based on a 16-question safe sleep knowledge questionnaire) and an observational rating by a paid “community mother.” When assessing client outcomes, a quasi-experimental design was used to examine changes in knowledge, attitudes, and safe sleep practices (Fig. 1). The home visitors administered the safe sleep survey to two different groups. The intervention group included 31 clients of home visitors who completed the training. The control group included 44 clients of home visitors who had not completed the training.

Intervention Results: Home visitors showed significant improvement in MI skill use and cultural sensitivity from pre- to post-test. Regarding client outcomes, our results indicate a significant group by time interaction when predicting changes in client knowledge such that the treatment group showed larger gains than the control group. There were no significant differences between groups when predicting changes in client attitudes or behavior.

Conclusion: MI may be an effective technique for home visitors to help increase families' safe sleep knowledge. Additional research is needed to examine whether such training can translate to changes in families' safe sleep behavior.

Setting: Cradle Kalamazoo initiative in Kalamazoo, Michigan

Population of Focus: Home visitors and their clients

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Nurse/Nurse Practitioner, PATIENT/CONSUMER, Patient Reminder/Invitation, Educational Material, CAREGIVER, Educational Material (caregiver)

Intervention Description: The aim of this study was to evaluate the effectiveness of a nursing educational intervention with mothers of sick children to decrease passive smoking exposure.

Intervention Results: Baseline comparison showed no significant differences between the two groups in the mothers’ actions to protect the children from passive smoking exposure. More mothers in the intervention group than the control group had always moved the children away when they were exposed to the fathers’ smoke at home at 3‐month follow up (78·4% vs. 71·1%; P = 0·01) but became non‐significant at 6 and 12 months.

Conclusion: A simple health education intervention provided by nurses to the mothers in a busy clinical setting can be effective in the short-term to motivate the mothers to take actions to protect the children from exposure to passive smoking produced by the fathers.

Study Design: RCT

Setting: Hospital (pediatric ward/outpatient departments)

Population of Focus: Non-smoking mothers of sick children admitted to the pediatric ward/smoking husbands living in the same household

Data Source: Parental self-report.

Sample Size: 1483 mothers of sick children

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), Educational Material (Provider), Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Nurse/Nurse Practitioner, PROFESSIONAL_CAREGIVER, Patient Navigation (Assistance), Care Coordination, STATE, Multicomponent Approach

Intervention Description: The Healthy Beginnings system of care in Atlanta, GA connects children and their families to health insurance and a medical home model of care to support children’s health and development. The main components are care management + education and parent engagement + collaborative partnerships. A registered nurse, known as the health navigator, supports parents and helps them learn how to work with health care professionals on behalf of their children; they also connect parents to the Center for Working Families to ensure that they receive public benefits for which they are eligible.

Intervention Results: Healthy Beginnings coordinated care approach has ensured that participating children and families have health insurance (97%) and receive regular immunizations (92%), ongoing health care from a primary care physician and dental health provider, and regular developmental screenings (98%) and follow-up care. Healthy Beginnings has dramatically increased children’s access to health care and forms the basis for a cost-effective approach that can be replicated in other communities.

Conclusion: By building upon the partnerships formed through the foundation’s community change effort, Healthy Beginnings has dramatically increased neighborhood children’s access to health care and forms the basis for a cost-effective approach that can be replicated in other communities.

Study Design: Program evaluation

Setting: Community (Community-based organizations in Atlanta, Georgia)

Population of Focus: Low-income young children and families

Data Source: Questionnaire data

Sample Size: 279 children

Age Range: 0-10 years

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education,

Intervention Description: The intervention in the study was the "Watch Me!" training program, which aimed to increase childcare providers' knowledge and impact attitudes related to developmental monitoring and referral practices. The "Watch Me!" training program is designed to provide childcare providers with the necessary knowledge and tools to conduct developmental monitoring and make recommended referrals when there is a concern about a child's development. The training program covers five key components of developmental monitoring, including tracking development, recognizing delays, talking to parents about development, talking to parents about concerns, and making referrals. The program is designed to equip childcare providers with the knowledge and skills to effectively carry out these components of developmental monitoring and referral practices. The training program utilizes web-based surveys to assess the impact of the training on knowledge and attitudes related to developmental monitoring and referral practices. It also includes pretest-posttest design to evaluate the effectiveness of the training program in improving childcare providers' knowledge and attitudes. Overall, the "Watch Me!" training program is designed to increase awareness, knowledge, and skills among childcare providers to support early identification and intervention for children with developmental concerns.

Intervention Results: Childcare providers demonstrated a significant pre-post increase in perceived knowledge and access to the tools to engage in five core components of developmental monitoring after completing "Watch Me!" training. There was also a significant pre-post increase in childcare providers' ability to list the child's doctor as an appropriate referral (39 pre-63% post), but not in the ability to list Part C/Part B programs as an appropriate referral (56 pre-58% post). CONCLUSIONS FOR PRACTICE: "Watch Me!" training may be effective at impacting targeted areas of knowledge and attitude about developmental monitoring among childcare providers in the short term.

Conclusion: Yes, the study found statistically significant findings related to the impact of the "Watch Me!" training program on childcare providers' knowledge and attitudes related to developmental monitoring and referral practices. The study found that completing the training program had a significant immediate impact on childcare providers' perception that they had the knowledge and could access tools needed to carry out the five components of developmental monitoring, including tracking development, recognizing developmental delays, talking to parents about development, talking to parents about developmental concerns, and making referrals when there was a concern about a child's development. The study also found that there was a significant pre-post increase in childcare providers' ability to list the child's doctor as an appropriate referral when there was a concern about their development. However, there was no significant pre-post increase in the ability to list Part C/Part B programs as an appropriate referral. Overall, the study suggests that the "Watch Me!" training program may be effective at impacting targeted areas of knowledge and attitude about developmental monitoring among childcare providers in the short term.

Study Design: The study design used in this research is a pretest-posttest design. The study aimed to evaluate the impact of the "Watch Me!" training program on childcare providers' knowledge and attitudes related to developmental monitoring and referral practices. The participants completed a web-based pretest before the training program and a web-based posttest after completing the training program. The study used a purposeful sampling strategy to recruit childcare programs for program-wide implementation to ensure participation of programs representing the following predetermined important criteria: geographic diversity, center- and home-based, regulated and unregulated, national accreditation status, and QRIS participation and rating level. The data collected from the pretest and posttest were analyzed using generalized linear mixed models.

Setting: The study was conducted in childcare settings, specifically targeting childcare providers. The "Watch Me!" training program was implemented to assess its impact on childcare providers' knowledge and attitudes related to developmental monitoring and referral practices. The participants in the study were childcare providers who completed the "Watch Me!" training program, and the data collection involved web-based surveys to evaluate the impact of the training on the participants' knowledge and attitudes. The study aimed to assess the effectiveness of the training program in increasing knowledge and changing attitudes related to developmental monitoring and referral practices among childcare providers. Therefore, the setting for the study was within the context of childcare facilities and providers who play a crucial role in early childhood development and care.

Population of Focus: The target audience for the study is childcare providers who work in childcare settings. The study aimed to evaluate the impact of the "Watch Me!" training program on childcare providers' knowledge and attitudes related to developmental monitoring and referral practices. The participants in the study were childcare providers who completed the "Watch Me!" training program, and the data collection involved web-based surveys to evaluate the impact of the training on the participants' knowledge and attitudes. The study's findings suggest that the "Watch Me!" training program may be effective at impacting targeted areas of knowledge and attitude about developmental monitoring among childcare providers in the short term. Therefore, the study's target audience is childcare providers who play a crucial role in early childhood development and care and can benefit from the "Watch Me!" training program to improve their knowledge and attitudes related to developmental monitoring and referral practices.

Sample Size: The sample size for the study was 127 childcare providers who completed the "Watch Me!" training program and participated in the web-based surveys to evaluate the impact of the training on their knowledge and attitudes related to developmental monitoring and referral practices. The participants were from various types of childcare programs, including Head Start/Early Head Start, regulated centers, regulated homes, unregulated centers, and other/unknown programs. The study used a pretest-posttest design to assess the impact of the training program on the participants' knowledge and attitudes, and the data were analyzed using generalized linear mixed models.

Age Range: The study did not focus on a specific age range of children. Instead, the study aimed to evaluate the impact of the "Watch Me!" training program on childcare providers' knowledge and attitudes related to developmental monitoring and referral practices. The training program focuses on five key components of developmental monitoring, including tracking development, recognizing delays, talking to parents about development, talking to parents about concerns, and making referrals. These components are relevant for children of all ages, from infancy to early childhood. Therefore, the study's findings are applicable to childcare providers who work with children of all ages and can benefit from the "Watch Me!" training program to improve their knowledge and attitudes related to developmental monitoring and referral practices.

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, PATIENT_CONSUMER, Community Events, COMMUNITY, Nurse/Nurse Practitioner, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: The study aimed to evaluate the effectiveness of a cervical cancer prevention education program for rural Korean immigrant women. A total of 46 Korean immigrant women who had not been screened in the past three years participated. The experimental group participated in the intervention program once a week for four weeks and completed a post-program survey in week 12.

Intervention Results: The experimental group participated in the intervention program once a week for four weeks and completed a post-program survey in week 12. Compared to the control group, significant increases were detected in level of knowledge of cervical cancer prevention (p = .001), behavioral attitude toward cervical cancer prevention (p = .029) and behavioral intention regarding cervical cancer prevention (p = .005) in the experimental group. Pap screening rate of the experimental group was significantly increased (p = .029), but the rate of change in the selection of primary care providers was not significant.

Conclusion: The results suggest the need for a multilevel approach to address cultural and systemic barriers to Korean immigrant women in promotion of cervical cancer prevention behavior.

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Educational Material (Provider),

Intervention Description: Training health professionals for the skills and capacity to respond adequately to children and adults who have been exposed to adverse childhood experiences is recognized as an essential need in health care. Accessible opportunities to educate physicians and physician-trainees are limited. Four computer-based e-modules were created focusing on addressing childhood adversity and implementing trauma-informed care in the pediatric primary care setting. These childhood adversity and trauma-informed care (CA-TIC) e-modules were designed as an individualized, self-directed experience to allow for distance learning with flexibility to be embedded into existing coursework. To foster an engaging learning environment, we narrated the modules, prioritized images, and included the opportunity for participant interaction via multiple-choice and short-answer questions. Twenty-eight pediatric residents, two medical students, four attending physicians, and one fellow at Children's National Hospital completed the e-modules.

Intervention Results: Overall, participants rated the CA-TIC e-modules 4.6 (SD = 0.5) out of 5 for design and quality. Using paired t tests and Wilcoxon signed rank tests, we found statistically significant score increases from presession to postsession for participants' knowledge, attitudes, practice, and confidence related to CA-TIC. The most commonly cited learning points and practice changes included asking about trauma in practice and the seven C's of resilience.

Conclusion: A trauma-informed, strengths-based approach to care can assist health care providers in mitigating the link between adversity and related poor health outcomes. The CA-TIC e-modules provide an opportunity to train health professionals using an innovative, self-directed, and low-resource mechanism.

Study Design: Pre-post study

Setting: Pediatric primary care practices in connection with Children’s National Hospital

Population of Focus: Pediatric health care providers (pediatric residents, medical students, attending physicians, and fellows)

Sample Size: 35 pediatric health care providers 28 pediatric residents, 2 medical students, 4 attending physicians, and 1 fellow

Age Range: Adults who take care of pediatric populations

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

Intervention Description: The model for the Extension for Community Healthcare Outcomes (Project ECHO®) was used to extend specialist support to the pediatric medical home for the treatment of adolescent depression by taking a comprehensive, disease-specific approach. Child and adolescent psychiatrists constructed a course to train community pediatric primary care providers (PCPs) to screen patients for depression, initiate evidence-based interventions, and provide ongoing management. Participants were assessed for changes in clinical knowledge and self-efficacy. Secondary measures included self-reported practice change and emergency department (ED) mental health referrals 12 months pre- and post-course completion.

Intervention Results: Sixteen out of 18 participants in cohort 1 and 21 out of 23 participants in cohort 2 completed the pre- and post-assessments. Clinical knowledge and self-efficacy showed statistically significant improvement pre- and post-course completion. ED mental health referrals from participant PCPs decreased by 34% (cohort 1) and 17% (cohort 2) after course completion.

Conclusion: These findings indicate that utilizing the Project ECHO format to provide subspecialist support and education on the treatment of depression can improve pediatric PCPs' clinical knowledge and confidence in their ability to independently treat depression. Secondary measures suggest that this can translate into practice change and improved treatment access with decreased ED referrals for mental health assessments by participant PCPs. Future directions include more robust outcomes measurement and developing more courses with an in-depth approach to a single or similar cluster of mental health diagnoses such as anxiety disorders.

Study Design: Pre-post study

Setting: Pediatric primary care offices connected to a large midwestern academic children's hospital

Population of Focus: Pediatric primary care providers, including medical doctors, nurse practitioners, and other healthcare professionals working in pediatric primary care settings

Sample Size: 41 providers

Age Range: Primary care providers serving pediatrics patients 0-17

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.

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Technology-Based Support,

Intervention Description: The intervention involved an educational intervention for providers and the integration of an MI-based communication tool called MOTIVE (MOtivational Interviewing Tool to Improve Vaccine AcceptancE)

Intervention Results: Statistically significant differences were observed between the groups for age and ethnicity, with a larger proportion of younger age groups and more patients of Hispanic/Latino ethnicity in the intervention period

Conclusion: Use of an MI-based communication tool may decrease vaccine refusals and improve childhood vaccination coverage rates, particularly for IIV.

Study Design: The study utilized a pre-post intervention design, with data collected retrospectively from the electronic health record (EHR) during two time periods: a baseline period and an intervention perio

Setting: the Rocking Horse Community Health Center (RHCHC) in the United States

Population of Focus: Children aged 0–6 years and their parents or guardians

Sample Size: A total of 2504 patients were included in the baseline period, and 1954 patients were included in the intervention period

Age Range: Children aged 0–6 years

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

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, HOSPITAL, Continuing Education of Hospital Providers, Policy/Guideline (Hospital), Educational Material (Provider), Guideline Change and Implementation

Intervention Description: We hypothesized that a pragmatic, multilevel treatment model including (ask, advise, refer [AAR]) coupled with individualized, telephone-based behavioral counseling promoting child tobacco smoke exposure (TSE) reduction would demonstrate greater child TSE reduction than would standard AAR.

Intervention Results: Complete case analysis demonstrated that compared with control parents (29.9%), significantly more parents in the experimental condition (45.8%) eliminated their children’s exposure to all sources of tobacco smoke both inside and outside their homes at 3-month follow-up. In addition, more parents in AAR/counseling than in AAR/attention control eliminated all sources of TSE (45.8% vs. 29.9%) and quit smoking (28.2% vs. 8.2%).

Conclusion: The results indicate that the integration of clinic- and individual-level smoking interventions produces improved TSE and cessation outcomes relative to standalone clinic AAR intervention. Moreover, this study was among the first in which researchers demonstrated success in embedding AAR decision aids into electronic health records and seamlessly facilitated TSE intervention into routine clinic practice.

Study Design: RCT

Setting: Community (home)

Population of Focus: Tobacco-smoking parents living in low-income, urban communities with children <11 years old exposed daily to tobacco smoke in the home. Additional inclusion criteria: daily smoker, >17 years old, and speaking English

Data Source: Structured telephone interviews for baseline data collection and 3-month follow-up.

Sample Size: 334 providers. 327 participants (n=163 AAR and counseling, n=164 AAR and control)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education

Intervention Description: To determine whether an educational intervention to change nursery practice would result in more inner-city parents placing their infants in the supine position for sleep.

Intervention Results: Infant observations showed that 20% and 99% of the infants in the well-newborn nursery were placed in the supine position before and after the intervention respectively (p<0.05). Parents reported that 37% and 88% of nursery staff exclusively placed infants to sleep in the supine position before and after the intervention respectively (OR=12.5, 95% CI: 5.7-27.7). Parent report showed that 42% and 75% of parents usually placed infants to sleep in the supine position at home before and after the intervention respectively (OR=4.2, 95% CI: 2.1-7.9).

Conclusion: After an educational intervention to change practice in a well-newborn nursery, many more parents reported placing their infants in the supine position for sleep,

Study Design: QE: pretest-posttest

Setting: Yale-New Haven Hospital (New Haven, CT); Pediatric Primary Care center of the Yale-New Haven Hospital

Population of Focus: Infants in the well-newborn nursery during the postpartum stay; Parents of infants at the infants’ 2-week health supervision visit

Data Source: Infant observation and Parent report

Sample Size: Baseline (n=100) Follow-up (n=100)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, HEALTH_CARE_PROVIDER_PRACTICE, ,

Intervention Description: To increase consistency of breastfeeding care and interventions across a large primary care network, we established an Ambulatory Breastfeeding Consortium (ABC) focused on information sharing and discussion centered on care of breastfeeding and lactating families.

Intervention Results: The ABC has been effective in engaging primary care nurses and other clinicians and disseminating information while encouraging discussion on the importance of providing informed care to breastfeeding families.

Conclusion: Although more breastfeeding-specific education is recommended for clinicians, the ABC serves as a model for primary care clinicians to improve their knowledge and provide support for families through education, shared experience, and awareness across many pediatric primary care network sites.

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Enabling Services, Expert Support (Provider), HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: This study sought to describe the PPCC's approach to care, their guiding principles and the roles, knowledge and skills that enable them to provide exemplary care.

Intervention Results: Findings include the PPCC's position within the healthcare system, guiding principles, goals, roles and responsibilities, and knowledge and skills. Two figures enhance the understanding of the PPCCs approach to creating a safe space for the family, supporting the interdisciplinary team and facilitating coordinated birth planning.

Conclusion: Every perinatal palliative care programme should include a PPCC. Future research on clinical training could examine the effectiveness of an educational intervention, using the detailed knowledge and skills learned in this study as a curriculum.

Intervention Components (click on component to see a list of all articles that use that intervention): Education on Disease/Condition, Planning for Transition, HEALTH_CARE_PROVIDER_PRACTICE, YOUTH

Intervention Description: This study aimed to evaluate the transition to adult care program instituted for liver transplant recipients (LTRs) at a large tertiary pediatric hospital in Melbourne, Australia.

Intervention Results: Twenty-eight LTRs participated in the study; 20 received the transition intervention and 8 served as controls. Within the intervention group, all domains of transition competency and reported anxiety regarding transferring had significantly improved at the conclusion of the intervention and all reported satisfaction with the transition program with most (81%) reporting readiness to transfer. There were no significant differences in rejection rates or failure to attend rates between those who did and did not receive the transition intervention.

Conclusion: A longitudinal holistic transition program has the potential to positively impact the competencies and readiness of LTRs to successful transition and transfer to adult care.

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Nurse/Nurse Practitioner, CAREGIVER, Motivational Interviewing/Counseling, Assessment (caregiver), PATIENT/CONSUMER, Educational Material, Online Material/Education/Blogging, Motivational Interviewing, PARENT/FAMILY, Consultation (Parent/Family), Notification/Information Materials (Online Resources, Information Guide)

Intervention Description: A study was undertaken to determine the effectiveness of two brief multi-strategic child health nurse delivered interventions in: decreasing the prevalence of infants exposed to SHS; decreasing the prevalence of smoking amongst parent/carers of infants and increasing the prevalence of household smoking bans.

Intervention Results: When compared to the Control group at 12 months, no significant differences in the prevalence of infant exposure to SHS were detected from baseline to follow-up for Treatment condition 1 or Treatment condition 2. Similarly, no significant differences were detected in the proportion of parent/care givers who reported that they were smokers, or in the proportion of households reported to have a complete smoking ban.

Conclusion: Further research is required to identify effective interventions that can be consistently provided by child health nurses if the potential of such settings to contribute to reductions in child SHS exposure is to be realised.

Study Design: Cluster randomized controlled trial

Setting: Community well-child health clinics

Population of Focus: s Infants exposed to second hand smoke

Data Source: Data was collected via computer during the visit, child health clinic records

Sample Size: 1424 parents of children aged 0 to 4 years attending well-child health checks

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation, Educational Material, PROVIDER/PRACTICE, Designated Clinic/Extended Hours

Intervention Description: Evaluate the effectiveness of an invitation letter on cervical screening participation among unscreened women 30 to 69 years of age.

Intervention Results: Women who were sent an invitation letter were significantly more likely to have had a Pap test in the next 6 months compared with women who were not sent an invitation letter (odds ratio [OR]=2.60, 95% confidence interval [CI] 2.09-3.35, p<0.001).

Conclusion: Sending invitation letters increased cervical screening participation but because the overall effect was small, additional strategies that remove barriers to screening for unscreened women are also necessary.

Study Design: Cluster RCT

Setting: Manitoba

Population of Focus: Women who had no Pap smear reported since 2001 and had been registered in the screening registry for at least 5 years (as of June 2010), with no history of gynecological cancer or hysterectomy, and who were covered by provincial health care insurance

Data Source: Cervical cancer screening registry

Sample Size: Total (N=31,452) Intervention (n=17,068); Control (n=14,384)

Age Range: 30-69

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

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation, Educational Material, PROVIDER/PRACTICE, Provider Reminder/Recall Systems, Quality Improvement/Practice-Wide Intervention, Designated Clinic/Extended Hours, Female Provider, Needs Assessment, PATIENT_CONSUMER, HOSPITAL

Intervention Description: Translational research (TR) and continuous quality improvement (CQI) processes used to identify and address barriers and facilitators to Pap smear screening within an urban Aboriginal Community Controlled Health Service (ACCHS).

Intervention Results: There was a statistically significant increase in Pap smear numbers during Plan-Do-Study-Act (PDSA) cycles, continuing at 10 months follow up.

Conclusion: he use of TR with CQI appears to be an effective and acceptable way to affect Pap smear screening. This model is transferrable to other settings and other health issues.

Study Design: QE: pretest-posttest

Setting: An urban Aboriginal Community Controlled Health Service (ACCHS)

Population of Focus: All women within eligible age range

Data Source: Electronic medical records

Sample Size: Total (N=213)

Age Range: 18-70

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Participation Incentives, Modified Billing Practices, Data Collection Training for Staff, Screening Tool Implementation Training, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Engagement with Payers, STATE, POPULATION-BASED SYSTEMS, Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: Early identification of children with developmental and behavioral delays is important in primary care practice, and well-child visits provide an ideal opportunity to engage parents and perform periodic screening. Integration of this activity into office process and flow is necessary for making screening a routine and consistent part of primary care practice.

Intervention Results: In the North Carolina Assuring Better Child Health and Development Project, careful attention to and training for office process has resulted in a significant increase in screening rates to >70% of the designated well-child visits. The data from the project prompted a change in Medicaid policy, and screening is now statewide in primary practices that perform Early Periodic Screening, Diagnosis, and Treatment examinations.

Conclusion: Although there are features of the project that are unique to North Carolina, there are also elements that are transferable to any practice or state interested in integrating child development services into the medical home.

Study Design: QE: pretest-posttest

Setting: Partnership for Health Management, a network within Community Care of North Carolina

Population of Focus: Children ages 6 to 60 months receiving Early Periodic Screening, Diagnosis, and Treatment services

Data Source: Child medical record

Sample Size: Unknown number of charts – screening rates tracked in 2 counties (>20,000 screens by 2004)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Continuing Education of Hospital Providers, Development/Improvement of Services

Intervention Description: In the Thames Valley region of the UK in 2012-2014, covering 27 000 births per annum, about 50% of extremely premature babies were born in a specialist centre. Audit showed a number of potential areas for improvement. We used regional place of birth data and compared the place of birth of extremely premature babies for 2 years before our intervention and for 4 years (2014-2018) after we started. We aimed to improve the proportion of neonates born in a specialist centre with three interventions: increasing awareness and education across the region, by improving and simplifying the referral pathway to the local specialised centre, and by developing region-wide guidelines on the principal precursors to preterm birth: preterm labour and expedited delivery for fetal growth restriction.

Intervention Results: There were 147 eligible neonates born within the network in the 2 years before the intervention and 80 (54.4%) were inborn in a specialised centre. In the 4 years of and following the intervention, there were 334 neonates of whom 255 were inborn (76.3%) (relative risk of non-transfer 0.50 (95% CI 0.39 to 0.65), p<0.001). Rates showed a sustained improvement.

Conclusion: The proportion of extremely premature babies born in specialist centres can be significantly improved by a region-wide quality improvement programme. The interventions and lessons could be used for other areas and specialties.

Setting: Network of hospitals in the Thames Valley region of UK

Population of Focus: Extremely premature babies born within network

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education

Intervention Description: The aim of the study was to evaluate the effects of process-oriented training in supportive breastfeeding counseling for midwives and postnatal nurses on the time lapse between the initial breastfeeding session, introduction of breastmilk substitutes and solids, and the duration of breastfeeding.

Intervention Results: The IG mothers had a significantly longer duration of exclusive breastfeeding, even if the initial breastfeeding session did not occur within 2 hours after birth, than the corresponding group of CGA mothers (p=0.01). Fewer infants in the IG received breastmilk substitutes (in the first week of life) without medical reasons compared with the control groups (p=0.01). The IG infants were significantly older (3.8 months) when breastmilk substitutes were introduced (after discharge from the hospital) compared with the infants in the control groups (CGA, 2.3 months, p=0.01; CGB, 2.5 months, p=0.03).

Conclusion: A process-oriented training program for midwives and postnatal nurses was associated with a reduced number of infants being given breastmilk substitutes during the 1st week without medical reasons and delayed the introduction of breastmilk substitutes after discharge from the hospital.

Study Design: Cluster RCT

Setting: 10 municipalities in southwest Sweden

Population of Focus: First time, Swedish-speaking mothers with singleton, healthy, full-term births delivered spontaneously, by vacuum extraction, or by cesarean section, and who had been cared for by a healthcare professional in one of 10 municipalities

Data Source: Mother self-report

Sample Size: 3 Days Postpartum3 • Intervention (n=206/172) • Control Group A (n=162/148) • Control Group B (n=172/160)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Training/Education, Educational Material (provider), Audit/Attestation (provider), PROFESSIONAL_CAREGIVER, Education/Training (caregiver), HOSPITAL, Quality Improvement, Crib Card

Intervention Description: This quality improvement project used an interprofessional, multimodal approach to improve sleep safety for hospitalized infants. The working group for this project included the Director of Quality Improvement for the Department of Pediatrics, a Pediatric Hospitalist, a Senior Advanced Practice Nurse in Pediatrics, Senior Associate Counsel for the Office of Counsel, and a medical student with a background in social work. The interdisciplinary group met to review and discuss improvements to communication and facilitated the development of five family interventions: a designated safe sleep web page, a clear bedside guide to safe sleep, additional training for nursing staff in motivational interviewing, a card audit system, and electronic health record smart phrases. A short survey was conducted to assess how the safe sleep toolkit has been useful to care providers in the Children’s Hospital. 

Intervention Results: With the initial pilot implementation of the K-cards, staff reported increased ease of audits. Adherence to recommended safer sleep measures was a major barrier in previous attempts to improve institutional sleep safety (1). By making adherence easier, providers may be more likely to both participate in quality improvement tracking measures and follow-up with families directly.

Conclusion: These coordinated interventions reflect advantages of an interprofessional and family-centered approach: building rapport and achieving improvements to infant sleep safety.

Setting: Golisano Children’s Hospital

Population of Focus: Hospital healthcare providers

Intervention Components (click on component to see a list of all articles that use that intervention): Other Person-to-Person Education, PATIENT_CONSUMER, Educational Material, Provider Training/Education, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: This study was a controlled trial study with longitudinal design. The sample consisted of 156 women (intervention = 78, control = 78) who registered in hearing-impaired associations in Izmir, Turkey. The education about cervical cancer and Pap smear test was given to intervention group with face-to-face interviews by using Turkish sign language. Three months later, the women were contacted and asked whether they have had a Pap smear test, and the total knowledge score of intervention groups was evaluated.

Intervention Results: There was not a statistically significant difference between the mean total score of knowledge about cervical cancer and Pap smear test in intervention (0.6 ± 1.6) and control (1.1 ± 1.9) groups. After 3 months, having a Pap smear test was found to be statistically significantly higher between groups (intervention = 29.5%, control = %1.2), and the mean cervical cancer and Pap smear knowledge score of the intervention group (9.2 ± 1.4) was found to be statistically significantly higher than the score before education (0.6 ± 1.6).

Conclusion: Education of cervical cancer and Pap smear test increased knowledge level and behaviour of Pap smear test of the women.

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.

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Navigation , Referrals, PATIENT_CONSUMER, Educational Material (Provider), HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: We pilot tested a Perinatal Wellness Navigator (PWN) program for a group of high-risk perinatal women (N = 50; n = 42 with OUD) that consisted of (a) one-on-one tobacco treatment, (b) comprehensive assessment of cessation barriers, and (c) linkage to clinical/social services.

Intervention Results: Outcome measures were assessed at baseline and postintervention. Participants smoked 10 fewer cigarettes per day (p = .05) at postintervention and were less dependent on nicotine (p < .01). Mean postnatal depression scores (p = .03) and perceived stress (p = .03) decreased postintervention. Participants received at least one referral at baseline (n = 106 total), and 10 participants received an additional 18 referrals at postintervention to address cessation barriers.

Conclusion: The PWN program was minimally effective in promoting total tobacco abstinence in a high-risk group of perinatal women, but participants experienced reductions in cigarettes smoked per day, nicotine dependence, stress, and depression.

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment, Referrals, YOUTH, PATIENT_CONSUMER, Educational Material (Provider), HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: To develop, implement, and assess implementation outcomes for a developmental monitoring and referral program for children in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Intervention Results: In both phases, all surveyed staff (n = 46) agreed the program was easy to use. Most (≥ 80%) agreed that checklists fit easily into clinic workflow and required ≤ 5 min to complete. Staff (≥ 55%) indicated using checklists with ≥ 75% of their clients. 92% or more reported referring one or more children with potential developmental concerns. According to 80% of staff, parents indicated checklists helped them learn about development and planned to share them with healthcare providers. During the second phase, 18 of 20 staff surveyed indicated the program helped them learn when to refer children and how to support parents, and 19 felt the program promoted healthy development. Focus groups supported survey findings, and all clinics planned to sustain the program.

Conclusion: Initial implementation outcomes supported this approach to developmental monitoring and referral in WIC. The program has potential to help low-income parents identify possible concerns and access support.

Intervention Components (click on component to see a list of all articles that use that intervention): Enabling Services, Expert Support (Provider), Provider Training/Education, HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: This article discusses a multidisciplinary, family-centered medical home designed to address the needs of this special population.

Intervention Results: The NSP has become a primary referral source for local NICUs, with a total of 549 medically fragile infants enrolled from its inception in 2011 through 2016. Caregivers and patients experience psychosocial stressors at averages statistically significantly higher than the rest of the Commonwealth of Pennsylvania and the US. Although patients in the program use medical resources beyond that of typically developing infants, hospital utilization among this patient cohort is trending down.

Conclusion: Caring for medically fragile NICU graduates can be daunting for families given the array of necessary services, supports, and resources to maximize their potential. A multidisciplinary primary care medical home, such as the NSP, is a successful model of patient care demonstrating favorable associations with health care utilization, care coordination, and addressing/improving family functioning and their experience.

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Baby Friendly Hospital Initiative, Quality Improvement/Practice-Wide Intervention, Hospital Policies, Provider Training/Education

Intervention Description: To conduct a national quality improvement initiative between 2011 and 2015. The initiative was entitled Best Fed Beginnings and enrolled 90 hospitals in a nationwide initiative to increase breastfeeding and achieve Baby-Friendly designation.

Intervention Results: Overall breastfeeding increased from 79% to 83% (t = 1.93; P = .057), and exclusive breastfeeding increased from 39% to 61% (t = 9.72; P < .001).

Conclusion: A nationwide initiative of maternity care hospitals accomplished rapid transformative changes to achieve Baby-Friendly designation. These changes were accompanied by a significant increase in exclusive breastfeeding.

Study Design: QE: pretest-posttest

Setting: 90 hospitals from 3 geographic regions

Population of Focus: Hospitals with low breastfeeding rates, readiness for change, establishment of a BabyFriendly/breastfeeding steering committee, data about sociodemographic characteristics of population served, geographic location based on regions with low breastfeeding rates and BFHI accreditation, commitment of senior leadership, and experience with quality improvement methods

Data Source: Medical record review

Sample Size: Intervention (N=89) N=hospitals

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Quality Improvement/Practice-Wide Intervention, Baby Friendly Hospital Initiative,

Intervention Description: The Best Fed Beginnings (BFB) initiative was specifically aimed to enable 90 hospitals to earn Baby-Friendly USA assessment scheduled by the end of the collaborative project. Given the size of this initiative, BFB was conducted as 3 simultaneous Breakthrough Series collaborative projects comprising hospitals from 3 geographic regions. Hospitals assembled multidisciplinary teams that included parent partners and community representatives. Three in-person learning sessions were interspersed with remote learning and tests of change, and a Web-based platform housed resources and data for widespread sharing.

Intervention Results: By April 2016, a total of 72 (80%) of the 90 hospitals received the Baby-Friendly designation, nearly doubling the number of designated hospitals in the United States. Participation in the Best Fed Beginnings initiative had significantly high correlation with designation compared with hospital applicants not in the program (Pearson’s r [235]: 0.80; P < .01). Overall breastfeeding increased from 79% to 83% (t = 1.93; P = .057), and exclusive breastfeeding increased from 39% to 61% (t = 9.72; P < .001).

Conclusion: A nationwide initiative of maternity care hospitals accomplished rapid transformative changes to achieve Baby-Friendly designation. These changes were accompanied by a significant increase in exclusive breastfeeding.

Study Design: Evaluation data

Setting: Hospitals nationwide

Population of Focus: Hospitals across the country seeking to achieve Baby-Friendly designation

Sample Size: 90 Baby-Friendly Hospitals

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment (patient/consumer), Assessment (Provider), Education on Disease/Condition,

Intervention Description: The study evaluated the impact of a community-based mobile crisis service intervention in Connecticut, which provides crisis stabilization and support, screening and assessment, suicide assessment and prevention, brief, solution-focused interventions, and referral and linkage to ongoing care.

Intervention Results: Youths who received mobile crisis services had a significant reduction in odds of a subsequent behavioral health ED visit compared with those who did not receive mobile crisis services.

Conclusion: The study provides evidence suggesting that community-based mobile crisis services, such as Mobile Crisis, reduce ED use among youths with behavioral health service needs.

Study Design: Quasi-experimental study

Setting: Connecticut, United States

Population of Focus: Healthcare providers, policymakers, and researchers interested in improving behavioral health services for youths.

Sample Size: Not specified

Age Range: Youths who were age 18 and younger, as well as older youths who were still attending high school.

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), Educational Material (Provider), PARENT_FAMILY, Training (Parent/Family), PROFESSIONAL_CAREGIVER, Outreach (caregiver), PATIENT_CONSUMER, Peer Counselor, Parent Mentors

Intervention Description: The aim of the Kids’ Health Insurance by Educating Lots of Parents (Kids’ HELP) study was to evaluate the effects of parent mentors – Latino parents with children covered by Medicaid or the Children’s Health Insurance Program (CHIP) – on insuring Latino children in a community-based trial of uninsured children from 2011-2015. Parent mentors were trained to assist families in getting insurance coverage, accessing health care, and addressing social determinants of health. The intervention group was assigned parent mentors – trained, fluently bilingual Latino parents who had at least one child insured by Medicaid or CHIP for at least one year. Parent mentors attended a two-day training and received training manuals in English and Spanish with 9 training topics and one on sharing experiences. Parents mentors provided 8 services to intervention children and families (e.g., teaching about types of insurance programs and application processes; helping parents complete and submit children’s insurance applications; acting as family advocates by liaising between families and Medicaid or CHIP agencies; and helping parents complete and submit applications for coverage renewal).

Intervention Results: The study found that parent mentors were more effective than traditional methods in insuring children (95% vs. 69%), achieving faster coverage and greater parental satisfaction, reducing unmet health care needs, providing children with primary care providers, and improving the quality of well-child and subspecialty care. Children in the parent-mentor group had higher quality of overall and specialty care, lower out-of-pocket spending, and higher rates of coverage two years after the end of the intervention (100% vs. 70%). Parent mentors are highly effective in insuring uninsured Latino children and eliminating disparities. Parent mentors, as a special category of community health workers, could be an excellent fit with and complement to current state community health worker models. This RCT documented that the Kids’ HELP intervention is significantly more efficacious than traditional Medicaid and CHIP methods of insuring Latino children. Kids’ HELP eliminates coverage disparities for Latino children, insures children more quickly and with greater parental satisfaction than among control parents, enhances health care access, reduces unmet needs, improves the quality of well-child and subspecialty care, reduces out-of-pocket spending and family financial burden, empowers parents, ad creates jobs.

Conclusion: Parent mentors are highly effective in insuring uninsured Latino children and eliminating disparities.

Study Design: RCT

Setting: Community (Communities in Dallas County, Texas with the highest proportions of uninsured and low-income minority children)

Population of Focus: Uninsured children 0-18 years old whose primary caregiver identified them as Latino and uninsured and reported meeting Medicaid/CHIP eligibility criteria for the child

Data Source: Kids’ HELP trial data; questionnaires

Sample Size: 155 subjects (children and parents); 75 in the control group and 80 in the intervention group

Age Range: 0-18 years

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), Educational Material (Provider), PARENT_FAMILY, Training (Parent/Family), PROFESSIONAL_CAREGIVER, Outreach (caregiver), PATIENT_CONSUMER, Peer Counselor, Parent Mentors

Intervention Description: This study examined the effects of parent mentors on insuring minority children in the Kids’ Health Insurance by Educating Lots of Parents (Kids’ HELP) program. Parent mentors were experienced parents with ≥1 Medicaid/CHIP-covered child who received 2 days of training, then assisted families for 1 year with insurance applications, retaining coverage, medical homes, and social needs; controls received traditional Medicaid/CHIP outreach. Parent mentors received monthly stipends for each family mentored. Parents mentors and intervention participants were matched by race/ethnicity and zip code, whenever possible. Latino families were matched with fluently bilingual Latino parent mentors. Session content for the 2-day training was based on training provided to community case managers in the research team’s previous successful RCT and addressed 9 topics (e.g., why health insurance is so important; being a successful parent mentor; parent mentor responsibilities; Medicaid and CHIP programs and the application process; the importance of medical homes).

Intervention Results: In the Kids’ HELP trial, the intervention was more effective than traditional outreach/enrollment in insuring uninsured minority children, resulting in 95% of children obtaining insurance vs. 68% of controls. The intervention also insured children faster, and was more effective in renewing coverage, improving access to medical and dental care, reducing out-of-pocket costs, achieving parental satisfaction and quality of care, and sustaining insurance after intervention cessation. This is the first RCT to evaluate the effectiveness of parent mentors in insuring uninsured children. Kids’ HELP could possibly save $12.1 to $14.1 billion. Parent mentors were more effective in improving access to primary, dental, and specialty care; reducing unmet needs, achieving parental satisfaction with care, and sustaining long-term coverage. Parent mentors resulted in lower out-of-pocket costs for doctor and sick visits, higher well-child care quality ratings, and higher levels of parental satisfaction and respect from children’s physicians.

Conclusion: PMs are more effective than traditional Medicaid/CHIP methods in insuring uninsured minority children, improving health care access, and achieving parental satisfaction, but are inexpensive and highly cost-effective.

Study Design: RCT

Setting: Community (Communities in Dallas County, Texas with the highest proportions of uninsured and low-income minority children)

Population of Focus: Primary caregiver had ≥1 child 0 to 18 years old who lacked health insurance but was Medicaid/CHIP eligible, and the primary caregiver self-identified the child as Latino/Hispanic or African-American

Data Source: Kids’ HELP trial data; questionnaires; national, state, and regional surveys

Sample Size: 237 participants; 114 in the control group and 123 in the intervention group

Age Range: 0-18 years

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Office Systems Assessments And Implementation Training, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider), Data Collection Training for Staff , Provider Training/Education

Intervention Description: This 1-year national quality improvement collaborative involved 19 pediatric primary care practices. Supported by virtual and in-person learning opportunities, practice teams implemented changes to early childhood screening. Monthly chart reviews were used to assess screening, discussion, referral, and follow-up for development, ASD, maternal depression, and SDoH. Parent surveys were used to assess parent-reported screening and referral and/or resource provision. Practice self-ratings and team surveys were used to assess practice-level changes.

Intervention Results: Participating practices included independent, academic, hospital-affiliated, and multispecialty group practices and community health centers in 12 states. The collaborative met development and ASD screening goals of >90%. Largest increases in screening occurred for maternal depression (27% to 87%; +222%; P < .001) and SDoH (26% to 76%; +231%; P < .001). Statistically significant increases in discussion of results occurred for all screening areas. For referral, significant increases were seen for development (53% to 86%; P < .001) and maternal depression (23% to 100%; P = .008). Parents also reported increased screening and referral and/or resource provision. Practice-level changes included improved systems to support screening.

Conclusion: Practices successfully implemented multiple screenings and demonstrated improvement in subsequent discussion, referral, and follow-up steps. Continued advocacy for adequate resources to support referral and follow-up is needed to translate increased screening into improved health outcomes.

Setting: Pediatric primary care practices

Population of Focus: Physician leader, staff and parent partner

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Provider Training/Education, Guideline Change and Implementation, Provider Tools

Intervention Description: Participants were asked to complete the Family-Centered Care Questionnaire—Revised (FCCQ-R), a 45-item measure of healthcare professionals’ perceptions of the practice and importance of 9 core dimensions of family-centered care.

Intervention Results: Six main themes emerged from the analysis of the concerns and recommendations for family-centered care described in the comments: language translation; communication between staff and families; staffing and workflow; team culture and leadership; staff and parent education, and the NICU physical environment

Conclusion: No Conclusion: Implications for Practice: The NICU healthcare professionals identified a range of issues that support or impede delivery of family-centered care and provided actionable recommendations for improvement. Implications for Research: Future research should include economic analyses that will enable determination of the return on investment so that NICUs can better justify the human and capital resources needed to implement high-quality family-centered care.

Study Design: Data for this qualitative analysis were obtained from a multicenter survey of family-centered care practices completed by NICU healthcare professionals from 6 geographically and demographically diverse NICUs in California during the baseline (familycentered care) phase of a study comparing usual family-centered NICU care with mobile-enhanced family integrated care (mFICare) (NCT03418870)

Setting: NICU - six geographically and demographically diverse neonatal intensive care units (NICUs) in California

Population of Focus: NICU Professionals - NICU healthcare professionals, such as registered nurses, physicians, and neonatal nurse practitioners, who provided care in the NICUs involved in the study .

Sample Size: 382 NICU staff - The study involved 382 NICU healthcare providers from 6 NICUs who completed the survey, and 68 of them (18%) provided 89 free-text comments/recommendations about family-centered care , .

Age Range: adult professionals in NICU settings - The study reported that 65% of the sample were 50 years of age or younger, and 35% of the sample were older than 50 years .

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, HOSPITAL, Quality Improvement, Visual Display (Hospital)

Intervention Description: The purpose of this study was to improve safe sleep practice (SSP) adherence by healthcare providers working with infants admitted to an inpatient pediatric unit in an urban academic center, specifically increasing compliance on five core SSP (supine, alone in the crib, no objects in crib, appropriate bundling, and flat crib). Targeted pediatric hospitalists (attending physicians who exclusively work in the hospital setting), residents, and nurses working on the general pediatric wards were invited to complete a safe sleep survey prior to receiving a brief educational intervention tailored to their specific provider group. All participants received the same basic information on the current rates of SIDS, associated disparities, current hospital practices, AAP-endorsed safe sleep practices, and the impact of healthcare provider practices on caregivers. In-person presentations, handouts, posters, and “Ask me about safe sleep” buttons for nursing staff were among the teaching tools used. Efficacy of the intervention was assessed by comparing audits of sleeping infants in hospital rooms prior to (baseline) and following (post-intervention) the education sessions.

Intervention Results: This Quality Improvement project evaluated a staff education intervention using a pre- and post-design. Surveys of providers determined baseline SSP knowledge. Adherence to SSP in the hospital was audited before and after education. One hundred pre-intervention infant sleep placement observations were recorded and 123 were collected post-intervention.

Conclusion: This quality improvement project suggests that the inpatient setting provides opportunities for providers to demonstrate SSP but that healthcare providers often do not follow SSP in practice. Continued education can lead to improvements in SSP adherence ensuring that hospitals are modeling SSP for the families of infants.

Setting: The University of Chicago Medicine Comer Children’s Hospital

Population of Focus: Pediatric healthcare providers

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Childbirth Education Classes, PROVIDER/PRACTICE, Active Management of Labor, Labor Support, Midwifery

Intervention Description: Active management of labor is a multifaceted program that, as implemented at the National Maternity Hospital in Dublin, is associated with a lower rate of cesarean delivery than the rate usually found in the United States. We conducted a randomized trial to evaluate the efficacy of this approach in lowering the rate of cesarean section among women delivering their first babies.

Intervention Results: Rate of CS among protocol-eligible women lower in AMOL group vs. control group (10.9% vs. 11.5%; p>0.05) after adjustment for epidural use and adoption of final protocol (three hours for second stage of labor with epidural); (OR=0.9, 95% CI: 0.4–1.9)

Conclusion: Active management of labor did not reduce the rate of cesarean section in nulliparous women but was associated with a somewhat shorter duration of labor and less maternal fever.

Study Design: RCT

Setting: 1 women’s hospital

Population of Focus: Nulliparous women who gave birth between June 10, 1991 and October 17, 1993

Data Source: Not specified

Sample Size: Total (n=1,915) Intervention (n=1,009) Control (n=906)

Age Range: Not Specified

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

Intervention Description: Teams participated in a 7-month virtual learning collaborative to implement immunization delivery best practices at their SHCs. A pre-post-intervention design was used to compare vaccination coverage in May 2017 to May 2018 among students who were unvaccinated at the start of the academic year.

Intervention Results: Data were compared from 29 SHCs and 152,648 students (2017) and from 18 SHCs and 122,315 students (2018). Percent of newly vaccinated students increased for ≥1 dose of flu vaccine by 14.3 percentage points to 32.3% (p < .01), ≥1 dose of HPV vaccine by 3.9 points to 7.8% (p < .05) and ≥3 doses of HPV vaccine by 0.7 points to 1.5% (p < .05).

Conclusion: Participating in a learning collaborative may help SHCs improve vaccination delivery.

Setting: Student health clinics

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), PROFESSIONAL_CAREGIVER, Education/Training (caregiver), Collaboration with Local Agencies (State), Educational Material (caregiver), STATE, Multicomponent Approach

Intervention Description: In New York, to maximize comprehensive insurance coverage for CYSHCN, a Service Integration Model was formed between the Office of Health Insurance Services and the Early Intervention Program. The 3 key components include educational messaging (jointly prepared messages about health insurance benefits and enrollment assistance offered by the Office of Health Insurance Services through the Early Intervention Program) + data from program databases (data matching with the Early Intervention Program) + individual counseling using program staff (incorporation of the Office of Health Insurance Services program staff—child benefit advisors—to work directly with parents of children in the Early Intervention Program to facilitate enrollment and renewal. The model overcomes enrollment barriers by using consumer friendly enrollment materials and one-on-one assistance, and shows the benefits of a comprehensive and collaborative approach to assisting families with enrollment into public health insurance.

Intervention Results: Since 2008, more than 5,000 children in the Early Intervention Program have been successfully enrolled and coverage renewed in Medicaid through the Service Integration Model. In 2008, the study team found that children in the Early Intervention Program had a 34% churning rate for Medicaid because of enrollment barriers and misconception of the Early Intervention Program as a replacement for Medicaid. By 2010, the churning rate for clients assisted through Office of Health Insurance Services was reduced from 34% to 8%. The Office of Health Insurance Services will modify the Service Integration Model to respond to New York State’s implementation of the Health Insurance Exchange required by the 2010 ACA. Partnerships across government programs and agencies offer opportunities to enroll hard-to-reach populations into public health insurance. The model reflects how government programs can work together to improve rates of enrollment and retention in public health insurance. The key elements of integration of program messages, data matching, and staff involvement allow for the model to be tailored to the specific needs of other government programs.

Conclusion: The model overcomes enrollment barriers by using consumer-friendly enrollment materials and one-on-one assistance, and shows the benefits of a comprehensive and collaborative approach to assisting families with enrollment into public health insurance.

Study Design: Program evaluation

Setting: Community (New York City Department of Health and Mental Hygiene's Office of Health Insurance Services and the Early Intervention Program)

Population of Focus: Uninsured and underinsured young children with special health care needs in New York City participating in the Early Intervention Program

Data Source: Evaluation data

Sample Size: 6,500 children in early intervention with a Medicaid number

Age Range: 0-3 years

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 .

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Provision of Safe Sleep Item, Assessment (Provider), HOSPITAL, Quality Improvement, Policy/Guideline (Hospital), Crib Card, CAREGIVER, Education/Training (caregiver), Assessment (caregiver), Educational Material (caregiver)

Intervention Description: The aims of this project were to increase the percentage of infants following safe sleep practices in the NICU before discharge and to determine if improving compliance with these practices would influence parent behavior at home.

Intervention Results: Audit data showed that there was a significant increase in the rate of supine positioning from 39% at baseline to 83% at follow-up (p<0.001). Parental surveys showed that there was a significant increase in the rate of supine position from 73% at baseline to 93% at follow-up (p<0.05).

Conclusion: Multifactorial interventions improved compliance with safe sleep practices in the NICU and at home.

Study Design: QE: pretest-posttest

Setting: Children’s Memorial Hermann Hospital NICU in Houston, TX

Population of Focus: Infants in open cribs eligible for safe sleep practices; Parents of infants after discharge

Data Source: Crib audit/infant observation; Parent report

Sample Size: Baseline (n=62) Follow-up (n=79); Baseline (n=66) Follow-up (n=98)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider)

Intervention Description: The aims of this project were to increase the percentage of infants following safe sleep practices in the NICU before discharge and to determine if improving compliance with these practices would influence parent behavior at home. An algorithm detailing when to start safe sleep practices, a "Back to Sleep" crib card, educational programs for nurses and parents, a crib audit tool, and postdischarge telephone reminders were developed as quality improvement intervention strategies.

Intervention Results: NICU compliance with supine positioning increased from 39% to 83% (P < .001), provision of a firm sleeping surface increased from 5% to 96% (P < .001), and the removal of soft objects from the bed improved from 45% to 75% (P = .001). Through the use of a postdischarge telephone survey, parental compliance with safe sleep practices was noted to improve from 23% to 82% (P < .001).

Conclusion: Multifactorial interventions improved compliance with safe sleep practices in the NICU and at home.

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, HOSPITAL, Quality Improvement, Policy/Guideline (Hospital), Crib Card, Sleep Environment Modification, Promotional Event, POPULATION-BASED SYSTEMS, COMMUNITY, Social Media, CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), Visual Display (Community)

Intervention Description: To improve sleep environment safety for inpatient infants.

Intervention Results: The proportion of infant cribs without loose objects in them increased (32-72%, p = .025), and safe sleep positioning remained stable (82% vs. 95%, p = .183).

Conclusion: Staff education, swaddle sleep sacks, and bedside storage containers were associated with improved sleep safety among pediatric inpatients at our institution and may help at other institutions.

Study Design: QE: pretest-posttest

Setting: University of Iowa Children’s Hospital

Population of Focus: Infants less than 1 year of age developmentally ready for a crib and asleep

Data Source: Crib audit/infant observation

Sample Size: Baseline (n=22) Follow-up 1 (not reported) Follow-up 2 (n=37) Follow-up 3 (n=18)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Provider Reminder/Recall Systems,

Intervention Description: The multi-level, multi-component intervention included provider education, electronic health record (EHR) modifications, patient education, and reminder/recall systems. The intervention was designed to be practical and scalable, and strategies were implemented at multiple levels.

Intervention Results: The intervention was associated with a significant increase in HPV vaccine initiation (adjusted odds ratio [aOR] = 2.17, 95% confidence interval [CI] = 1.47-3.21) and completion (aOR = 2.23, 95% CI = 1.47-3.38) compared to the non-equivalent comparison group.

Conclusion: The multi-level, multi-component intervention was effective in improving HPV vaccine initiation and completion rates in a FQHC setting.

Study Design: The study used a quasi-experimental design with a non-equivalent comparison group.

Setting: The study was conducted in a Federally Qualified Health Center (FQHC) in Los Angeles, California, USA.

Population of Focus: The target audience of the study was primary care providers, nurses/medical assistants, and parents/patients.

Sample Size: The study included a total of 1,200 patients aged 9-26 years who were eligible for the human papillomavirus (HPV) vaccine.

Age Range: The study included patients aged 9-26 years

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, Other Person-to-Person Education, PROVIDER/PRACTICE, Outreach (Provider)

Intervention Description: This article describes the smoking behavior outcomes of a feasibility project testing a proactive approach, utilizing Māori voluntary community health workers to identify and reach Māori pregnant women who smoke and provide cessation support.

Intervention Results: The majority of women were Māori, 20-30 years old, had their first cigarette within 30 minutes of waking and 58% had not tried to quit during the current pregnancy. Of the participants who completed a follow-up interview 33% had stopped smoking while they were pregnant and 57% had cut down. There was an increase at follow-up of people who had used cessation support or products.

Conclusion: Aunties are well-placed to find pregnant women and provide cessation support and referral in a way consistent with traditional Māori knowledge and practices. This study suggests such an intervention could increase quit attempts and increase use of effective cessation methods. A more robust study is warranted to develop an enhanced Aunties intervention.

Study Design: Prospective intervention trial- evaluation

Setting: Home-based culturally tailored community health smoking cessation support

Population of Focus: Pregnant Māori women smokers

Data Source: In person questionnaires, interviews, and hospital birth records

Sample Size: 67

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Consultation Systems (Inter-Hospital Systems), Educational Material (Provider),

Intervention Description: The DC Mental Health Access in Pediatrics (DC MAP) program is a child psychiatry access program (CPAP) that provides telephonic consultation services to primary care providers (PCPs) in Washington, DC. The program aims to increase access to mental health services for children and adolescents by providing PCPs with real-time access to child psychiatry experts who can offer guidance on diagnosis, treatment, and care coordination. The program also provides PCPs with information about community resources and referral options available to their patients. The program is staffed by a team of child psychiatrists, psychologists, and social workers who provide consultation services to PCPs on a range of mental health concerns, including depression, anxiety, ADHD, and behavioral problems,.

Intervention Results: DC MAP consult volume increased 349.3% over the first 5 years. Services requested included care coordination (85.8%), psychiatric consultation (21.4%), and psychology/social work consultation (9.9%). Of psychiatry-involved consultations, PCPs managed patient medication care with DC MAP support 50.5% of the time. Most (94.1%) PCPs said they would recommend colleagues use DC MAP, and 29.6% reported diverting patients from the emergency departments using DC MAP.

Conclusion: Yes, the study reported statistically significant findings, including a significant increase in consultation volume over the first 5 years of the program, as well as a significant difference between baseline and 1 year of participation in PCPs' ability to receive more timely care coordination services for their patients with mental health needs,,. Additionally, paired t-tests were conducted to analyze self-report data about PCP beliefs related to mental health services collected at baseline and again 1 year later, indicating statistically significant changes in PCP beliefs over time.

Study Design: The study design is a retrospective analysis of data collected from the DC Mental Health Access in Pediatrics program between May 2015 and May 2020. The study used a mixed-methods approach, including descriptive statistics and paired t-tests to analyze self-report data about PCP beliefs related to mental health services collected at baseline and again 1 year later.

Setting: The study was conducted in the primary care setting, specifically in pediatric primary care practices in Washington, D.C.. The DC Mental Health Access in Pediatrics program was designed to provide consultation services to primary care providers in order to enhance their ability to meet the mental health needs of their pediatric patients.

Population of Focus: The target audience for the study includes primary care providers (PCPs) who care for pediatric patients, as well as professionals involved in pediatric mental health care, such as child psychiatrists, psychologists, and other mental health specialists. The study aims to evaluate the effectiveness of the Child Psychiatry Access Program (CPAP) in supporting PCPs in addressing the mental health needs of children and adolescents in the primary care setting.

Sample Size: The study received 3,389 consultation requests from primary care providers (PCPs) between May 2015 and May 2020. This indicates a substantial sample size for evaluating the effectiveness of the Child Psychiatry Access Program (CPAP) in Washington, D.C.

Age Range: According to the PDF file, the DC Mental Health Access in Pediatrics program provides mental health consultation services for youth aged 0-21 years.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Enabling Services, Educational Material, Community-Based Group Education, Designated Clinic/Extended Hours, PROVIDER/PRACTICE

Intervention Description: This paper summarizes impacts of a breast and cervical cancer screening intervention spearheaded by a Native Hawaiian community.

Intervention Results: Women in intervention community significantly more likely to be compliant with Pap smear guidelines than women in control community (X2=5.73. p=.02)

Conclusion: Positive changes in screening activities among women aware of the intervention support the importance of information diffusion by community consumers. Diffusion may occur beyond the boundaries of the community as defined.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Oahu, HI

Population of Focus: Native Hawaiian women

Data Source: Telephone survey

Sample Size: Total (N=1,260) Analysis (n=678) Intervention (n=318); Control (n=360)

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): Notification/Information Materials (Online Resources, Information Guide), Referrals, Educational Material (Provider), HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: To improve Early Head Start/Head Start (EHS/HS) screening, referral, and enrollment for children from diverse, low-income communities.

Intervention Results: The preintervention group included 223 patients. The postintervention group included 235 patients. EHS/HS screening improved significantly after the intervention, rising from 8% in the preintervention period to 46% in the postintervention period (odds ratio [OR] 10.5, 95% confidence interval [CI] [5.9, 19.4]). EHS/HS documented referral rates increased from 1% in the preintervention period to 20% in the postintervention period (OR 18.3, 95% CI [5.7, 93.6]). Thirty-two of the 42 patients in the postintervention group referred to EHS/HS were reached to determine enrollment status. Six children (14%) had enrolled in EHS/HS.

Conclusion: With use of existing resources, a medical home–Head Start partnership can build an integrated system that significantly improves screening and referral rates to early learning programs.

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Expert Support (Provider), Modified Billing Practices, Screening Tool Implementation Training, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool, Engagement with Payers, STATE, POPULATION-BASED SYSTEMS, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: This report evaluates the impact of Phase II of Maine's First STEPS initiative

Intervention Results: Average percentage of documented use of a developmental screening tool increased substantially from baseline to followup for all three age groups (46% to 97% for children under one; 22% to 71% for children 18-23 months; and 22% to 58% for children 24-35 months). Rate of developmental screening based on MaineCare claims increased from the year prior to intervention implementation to the year after implementation for all three age groups (5.3% to 17.1% for children age one; 1.5% to 13.3% for children age two; and 1.2% to 3.3% for children age 3).

Conclusion: The authors summarize lessons learned in implementing changes in practices and challenges in using CHIPRA and IHOC developmental, autism, and lead screening measures at the practice-level to inform quality improvement.

Study Design: QE: pretest-posttest

Setting: Pediatric and family practices serving children with MaineCoverage

Population of Focus: Children ages 6 to 35 months

Data Source: Child medical record; MaineCare paid claims

Sample Size: Unknown number of chart reviews from 9 practice sites completing follow-up

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Outreach (caregiver), PROVIDER/PRACTICE, POPULATION-BASED SYSTEMS, STATE, Medicaid Reform, Education/Training (caregiver), Provider Training/Education

Intervention Description: This study aimed to determine the Washington State's Access to Baby and Child Dent stry (ABCD) Program's effect on children's dental utilization and dental fear, and on parent satisfaction and knowledge.

Intervention Results: Children in the ABCD program had a mean of 10.27 preventive dental services compared to 0.24 among children not in the ABCD program (p=0.00).

Conclusion: The authors conclude that the ABCD Program was effective in increasing access for preschool children enrolled in Medicaid, reducing dental fear, and increasing parent satisfaction.

Study Design: QE: nonequivalent control group

Setting: Spokane County in WA

Population of Focus: Children aged 12-36 months enrolled in Medicaid as of August 31, 1997

Data Source: Parent survey

Sample Size: Intervention (n=228) Control (n=237)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, CAREGIVER, Educational Material (caregiver), Motivational Interviewing/Counseling, Motivational Interviewing, Patient Reminder/Invitation, PROVIDER/PRACTICE, Nurse/Nurse Practitioner

Intervention Description: To determine if mothers receiving a smoking cessation intervention emphasizing health risks of environmental tobacco smoke (ETS) for their children have a higher quit rate than 1) mothers receiving routine smoking cessation advice or 2) a control group.

Intervention Results: Complete data (baseline and both follow-ups) were available for 166 subjects. There was no impact of group assignment on the quit rate, cigarettes/day, or stage of change. The Child Health Group intervention had a sustained effect on location where smoking reportedly occurred (usually outside) and on improved knowledge of ETS effects.

Conclusion: Further research is needed to devise more effective methods of using the pediatric health care setting to influence adult smoking behaviors.

Study Design: RCT

Setting: Primary care center in a large urban children’s hospital

Population of Focus: Female caregivers (16 years and older) who accompanied a child (under 12 years) to the Primary Care Center of Columbus Children’s Hospital for a health care visit for any chief complaint or well-child examination

Data Source: Baseline data on demographics and smoking topics collected by questionnaire; and 1- and 6-month follow-ups.

Sample Size: 479 mothers

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education

Intervention Description: The purpose of this study was to determine whether educating practitioners affected breastfeeding initiation and exclusivity rates at hospitals with low breastfeeding rates.

Intervention Results: An overall increase in exclusive breastfeeding rates was not statistically significant. In multivariate logistic regression for all hospitals combined, infants born postintervention were significantly more likely to initiate breastfeeding than infants born preintervention (adjusted OR 1.32, 95% CI 1.03-1.69).

Conclusion: Intensive breastfeeding education for health care practitioners can increase breastfeeding initiation rates.

Study Design: QE: pretest-posttest

Setting: 4 MA hospitals

Population of Focus: Women with infants born 3-5 months before the intervention and women with infants born 2-4 months after the intervention7

Data Source: Medical record review

Sample Size: Preintervention (n=668) Postintervention (n=679)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Continuing Education of Hospital Providers, Assessment,

Intervention Description: To evaluate the effectiveness of a bespoke short training programme, which incorporated interactive and didactic teaching with printed and electronic resources.

Intervention Results: Training was associated with significant improvements in the specificity of depression judgements (52.0% for the intervention group and 47.2% for the control group, P = 0.039), and there was a non-significant increase in sensitivity (64.5% compared to 61.5% P = 0.25). Nurses’ knowledge about depression improved (standardised mean difference = 0.97 [95% CI 0.58 to 1.35], P < 0.001); and confidence about their professional role in relation to depression increased.

Conclusion: This school nurse development programme, designed to convey best practice for the identification and care of depression, delivered significant improvements in some aspects of depression recognition and understanding, and was associated with increased confidence in working with young people experiencing mental health problems.

Study Design: Cluster randomized controlled trial

Setting: School nurse services from 13 Primary Care Trusts in London

Population of Focus: School nurses

Sample Size: 146 school nurses

Age Range: School pupils (aligns with ages 12-17)

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Access to Provider through Hotline, HOSPITAL, Continuing Education of Hospital Providers, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Consultation Systems (Inter-Hospital Systems), Consultation Systems (Hospital), Telemedicine Systems (Inter-Hospital Systems), Telemedicine Systems (Hospital), STATE, Policy/Guideline (State)

Intervention Description: Telemedicine has been used successfully for medical care and education but it has never been utilized to modify patterns of delivery in an established state network.

Intervention Results: Medicaid deliveries at the regional perinatal centers increased from 23.8% before the intervention to 33% in neonates between 500 and 999 grams (p<0.05) and was unchanged in neonates between 2001-2500 grams.

Conclusion: Telemedicine is an effective way to translate evidence based medicine into clinical care when combined with a general educational conference. Patterns of deliveries appear to be changing so that those newborns at highest risk are being referred to the regional perinatal centers.

Study Design: Time trend analysis

Setting: All Arkansas hospitals

Population of Focus: Infants born weighing 500-2499 gm. Data not given for other study years.

Data Source: Data from Arkansas Vital Statistics Data System linked with corresponding hospitalization records from Arkansas Hospital Discharge Data System.

Sample Size: Total (n= 12,258) 2001 (n= 2,965) 2004 (n= 3,154)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), PROFESSIONAL_CAREGIVER, Educational Material (caregiver), Patient Navigation (Assistance), Outreach (Provider), Enrollment Assistance

Intervention Description: Community Health Centers (CHCs) serving low-income populations are well-positioned to support patients navigating the complexities of the public health insurance application process and prevent lapses in coverage. Specialized staff, called enrollment assistants, can help to determine insurance eligibility and/or guide patients through application processes, including assistance with completing application forms, understanding requirements, and providing appropriate documentation.

Intervention Results: Enrollment assistants are valuable resources, and CHCs are effective at helping patients with public health insurance. The enrollment assistants helped families understand the process and avoid mistakes and delays while patients valued their advice and their pragmatic, hands-on application assistance.

Conclusion: Patients’ understanding of eligibility status, reapplication schedules, and how to apply, were major barriers to insurance enrollment. Clinic staff addressed these barriers by reminding patients when applications were due, assisting with applications as needed, and tracking submitted applications to ensure approval. Families trusted clinic staff with insurance enrollment support, and appreciated it. CHCs are effective at helping patients with public health insurance. Access to insurance expiration data, tools enabling enrollment activities, and compensation are needed to support enrollment services in CHCs.

Study Design: Observational cross-case comparison

Setting: Community (Community-health centers in Oregon)

Population of Focus: Practice members (e.g., managers, clinical and non-clinical staff, enrollment assistants) and families using community health centers

Data Source: Observations and interviews

Sample Size: 4 Community Health Centers (CHCs) in Oregon; 26 practice members; 18 adult family members who had at least one pediatric patient

Age Range: Parents and children; specific ages not stated

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Labor Support, POPULATION-BASED SYSTEMS, State — Place of Birth, STATE, Place of Birth, Childbirth Education Classes, Midwifery, PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: We evaluated the effect on perinatal outcomes of an interdisciplinary program designed to promote physiologic birth and encourage active involvement of women and their families in maternity care.

Intervention Results: Compared with women receiving standard care, those in the birth program were more likely to be delivered by a midwife (41.9% v. 7.4%, p < 0.001) instead of an obstetrician (35.5% v. 69.6%, p < 0.001). The program participants were less likely than the matched controls to undergo cesarean delivery (relative risk [RR] 0.76, 95% confidence interval [CI] 0.68-0.84) and, among those with a previous cesarean delivery, more likely to plan a vaginal birth (RR 3.22, 95% CI 2.25-4.62). Length of stay in hospital was shorter in the program group for both the mothers (mean ± standard deviation 50.6 ± 47.1 v. 72.7 ± 66.7 h, p < 0.001) and the newborns (47.5 ± 92.6 v. 70.6 ± 126.7 h, p < 0.001). Women in the birth program were more likely than the matched controls to be breastfeeding exclusively at discharge (RR 2.10, 95% CI 1.85-2.39).

Conclusion: Women attending a collaborative program of interdisciplinary maternity care were less likely to have a cesarean delivery, had shorter hospital stays on average and were more likely to breastfeed exclusively than women receiving standard care.

Study Design: Retrospective cohort

Setting: 1 women’s hospital

Population of Focus: Nulliparous women who gave birth between April 2004 to October 20102

Data Source: Not specified

Sample Size: Total (n=1,660) Intervention (n=830) Control (n=830)

Age Range: Not Specified

Intervention Components (click on component to see a list of all articles that use that intervention): Education on Disease/Condition, Notification/Information Materials (Online Resources, Information Guide), Planning for Transition, PARENT_FAMILY, YOUTH, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: This quality improvement project focused on improving transition to adult health care by creating varied supports for the patient, family, and the health care team and putting them into action within a pediatric medical practice that serves over 250 adolescent and young adult patients with autism spectrum disorder.

Intervention Results: Before the supports were put into place, patients and families received limited and inconsistent communication to help them with transition. While the supports helped increase the amount and quality of help patients and families received, medical providers skipped or put off transition discussion in approximately half of well visits for targeted patients. Challenges in implementing the transition process included finding time to discuss transition-related issues with patients/families, preference of medical providers to have social workers discuss transition, and difficulty identifying adult health care providers for patients.

Conclusion: This suggests more work is needed to both train and partner with patients, families, and health staff to promote smooth and positive health transitions.

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 .

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Patient Reminder/Invitation, Incentives, HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Residents/Medical Students

Intervention Description: Phase 1 lasted 9 months and implemented CCS patient outreach, patient financial incentives, and clinic staff education. Phase 2 lasted 9 months and involved a workflow change in which MAs identified candidates for CCS during patient check-in. Feedback spanned the entire study period.

Intervention Results: After interventions, the average number of monthly Pap tests increased from 35 to 56 in phase 1 and to 75 in phase 2. Of 385 patients contacted in phase 1, 283 scheduled a Pap test and 115 (41%) completed it. Compared to baseline, both interventions improved cervical cancer screening (phase 1 relative risk, 1.86; 95% CI, 1.64–2.10; P < 0.001; phase 2 relative risk, 2.70; 95% CI, 2.40–3.02; P < 0.001). Our clinic’s CCS rate improved from 70% to 75% after the 18-month intervention.

Conclusion: The rate of CCS increased by 5% after a systematic 2-phase organizational intervention that empowered MAs to remind, identify, and prepare candidates during check-in for CCS.

Setting: Urban academic internal medicine clinic

Population of Focus: Women ages 21-64 eligible for cervical cancer screening

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Development/Improvement of Services, Continuing Education of Hospital Providers, Needs Assessment, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Agreement for Level III Hospital to Accept All Patients, STATE, Funding Support, Perinatal Committees/Councils

Intervention Description: A major objective was to develop and maintain a regionalized system of care. Such a system has been developed but differed from traditional systems by using regional level II centers. Iowa's low population density necessitated this modification.

Intervention Results: Level I hospitals currently manage low-risk patients and report very low mortality rates. Level II facilities receive high-risk referrals, but selective referral occurs since the tertiary center accounts for a disproportionate number of fetal and neonatal deaths, and births weighting less than 1500 g.

Conclusion: Other regions may benefit from similar approaches to development of regionalized systems of care and evaluation of the same.

Study Design: QE: pretest-posttest

Setting: All Iowa hospitals Pretest: 129 level I, 11 level II, and one level III hospital Posttest: 118 level I, 11 level II, and one level III hospital

Population of Focus: All infants born at ≥20 weeks GA and ≤1500 gm

Data Source: Data from Iowa State Health Department matched birth and infant death certificates.

Sample Size: Pretest (n= 432) Posttest (n= 343)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Development/Improvement of Services, Continuing Education of Hospital Providers, Needs Assessment, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Agreement for Level III Hospital to Accept All Patients, Perinatal Committees/Councils, STATE

Intervention Description: A voluntary system of regionalized perinatal health care was developed in Iowa to provide accessible services for a rural population.

Intervention Results: The intervention in Iowa focused on increasing both level III and level II VLBW births due to population density concerns in Iowa. Among all VLBW infants, there were changes in the birth location distribution. Of these infants, there was a statistically significant increase in percentage born in level III hospitals from 6.7% to 22.6% (p<0.05)1 and an increase in births in level II hospitals from 26.9% to 35.6%. The percentage born in level I centers decreased from 68.2% to 41.8%.

Conclusion: The concept of a mortality risk ratio (neonatal deaths/<1,500 gm live births) is suggested as a method of reviewing mortality data from the perspective of risks inherent in the population served.

Study Design: QE: pretest-posttest

Setting: All Iowa hospitals Pretest: 130 level I, 10 level II, and one level III hospital Posttest: 122 level I, 10 level II, and one level III hospital

Population of Focus: All live births <1500 gm

Data Source: Data from Iowa State Health Department matched birth and infant death certificates.

Sample Size: Pretest (n= 440) Posttest (n= 402)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Other Education, Continuity of Care (Caseload), HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: Mosquera et al provide us with pre–coronavirus disease 2019 data to reassure us that adding telemedicine access to an existing complex care medical home can be effective in improving both clinical and financial outcomes. This population of children all had ≥2 hospitalizations or ≥1 PICU admission in the previous year and a likely risk of future hospitalization at the time they were enrolled into the complex care clinic. Families were randomly selected to receive comprehensive care (experienced primary care physicians, 24/7 access by phone, same-day illness care on weekdays in clinic, hospital consult when inpatient) or comprehensive care plus audio-video telemedicine access. CMC with telemedicine access had 4 fewer days of care outside of the home per child-year, lower rates of serious illness, reduced hospital admissions, and reduced PICU admissions. The authors went further and documented a reduction in mean total health system costs of $7563 per child-year compared with a cost of only $308 per child-year to set up and conduct telemedicine visits.

Intervention Results: Experienced primary care providers who have an existing relationship with CMC and their caregivers do make a difference in the health of their most vulnerable patients. Adding telemedicine to their pediatric medical home can enhance that value even more.

Conclusion: Yet telemedicine in primary care continues to face challenges. Patients face 3 overlapping barriers to accessing telehealth: the absence of technology, digital literacy, and reliable Internet coverage. Together, these barriers comprise the digital divide, which disproportionately affects people of color, people living in rural areas, and those with low socioeconomic status. As we identify and debate solutions to the digital divide for vulnerable populations, we must partner with community agencies, schools, Internet service companies, and government leaders to overcome barriers to both technology access and digital literacy.

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

Intervention Description: The lesbian, gay, bisexual, transgender, and queer (LGBTQ+) adolescent population experiences health disparities due to barriers to care, including lack of access to culturally competent health care providers. The purpose of this quality improvement project was to increase access to culturally competent care through continuing education, a physical makeover of clinic space, and a social marketing campaign.

Intervention Results: The impact of the project on the number of LGBTQ+ adolescent patients at the clinic and the rate of documentation of sexual orientation and gender identity data was evaluated via a chart audit. Changes in nurses' and health care providers' knowledge as a result of the continuing education were evaluated with a pretest and a posttest. The number of LGBTQ+ patients and provider knowledge increased following the continuing education. Sexual orientation and gender identity data were documented during 87.5% of visits. The participants' knowledge increased by 4.7% following the continuing education. Further, five physical changes to the clinic were completed and a social marketing campaign was launched.

Conclusion: By addressing barriers such as fear of non-welcoming environments, previous negative experiences, and low health literacy among LGBTQ+ individuals , the intervention aims to create a more inclusive and affirming healthcare setting. Research has shown that individuals within the LGBTQ+ community often avoid seeking needed care due to various barriers, including discriminatory behaviors and limited availability of culturally competent providers. By enhancing staff knowledge, altering the physical clinic space to be more inclusive, and launching a social marketing campaign, the intervention seeks to overcome these barriers and create a welcoming environment for LGBTQ+ adolescents seeking healthcare services. While the direct impact on decreasing the number of children with forgone health care may not be explicitly stated in the document, the overall goal of the intervention to increase access to culturally competent care for LGBTQ+ adolescents could potentially contribute to reducing barriers to care and improving healthcare utilization among this population. The success of the intervention was measured by conducting a post-intervention chart audit to determine if there was an increase in the percentage of LGBTQ+ adolescents receiving care at the clinic . The audit showed an increase in the percentage of LGBTQ+ adolescent patients receiving care at the clinic from 7% to 10% post-intervention, indicating a positive impact on healthcare utilization among this vulnerable population. Therefore, while the direct impact on healthcare utilization is not explicitly stated in the document, the intervention's focus on improving access to culturally competent care for LGBTQ+ adolescents suggests that it has the potential to increase healthcare utilization for this vulnerable population.

Study Design: Pre-post intervention study

Setting: Clinic located on the West Side of Chicago

Population of Focus: The study participants included clinic staff and LGBTQ+ adolescents seeking healthcare services

Age Range: Adolescents and young adults 0-25; Adult providers

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Chart Audit and Feedback, Quality Improvement

Intervention Description: The aim of this study was to evaluate pregnancy outcomes before, during, early post and late post introduction of the nine‐item list. The list included the following: 1) monitoring of obstetric results, 2) a midwife coordinator, 3) risk 4) classification of women according to the Robson Classification, 5) three midwife-competence levels, 6) obstetric morning round, 7) fetal monitoring skills, 8) obstetric skills training, and 9) teamwork with a midwife, obstetrician and nurse working together with the common goal of a normal delivery. The target group for the intervention was nulliparous women at term with spontaneous onset of labor and cephalic presentation (Robson group 1).

Intervention Results: Apgar score <7 at 5 minutes, Apgar score <4 at 5 minutes and umbilical cord arterial pH <7 did not differ significantly between the four time periods. Between before introduction and early post introduction, instrumental vaginal delivery decreased from 19.8% to 12.2% and cesarean section from 9.6% to 4.5%. The late post introduction period showed a maintained effect with 10.7% instrumental deliveries and 3.9% cesarean sections. Obstetric anal sphincter injury grade III decreased instantly during the introduction of the nine-item list from 7.8% to 5.1% and thereafter remained unchanged.

Conclusion: Implementation of the nine-item list increased the proportion of spontaneous vaginal deliveries by reducing the number of instrumental deliveries and cesarean sections without affecting the neonatal outcomes in nulliparous women with spontaneous onset of labor. The nine-item list intervention seems to provide long-term sustainable results.

Setting: Delivery unit in Linköping, Sweden

Population of Focus: Nulliparous women at term with spontaneous onset of labor and cephalic presentation

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Provision of Safe Sleep Item, POPULATION-BASED SYSTEMS, NATIONAL, Campaign, Mass Media, CAREGIVER, Education/Training (caregiver), Educational Material (caregiver)

Intervention Description: To assess parental risk behaviour before and after a sudden infant death syndrome (SIDS) information campaign with special emphasis on associations with maternal age, education, marital status and birth order.

Intervention Results: The prevalence of non-supine sleep position decreased significantly from 33.7% before the campaign to 13.6% after (RR=0.40, 95% CI: 0.37-0.44). The decrease was significant by maternal education, cohabitation, birth order, and maternal age.

Conclusion: Non-supine sleeping decreased to a level that has never been reported before. In future campaigns, subgroup-specific measures may be needed.

Study Design: QE: pretest-posttest

Setting: N/A

Population of Focus: All mothers registered with the Medical Birth Registry of Norway as having given birth between Oct and Nov 1998 and Oct and Nov 1999 without a pathological condition

Data Source: Mother report

Sample Size: Baseline (n=5539) Follow-up (n=4143)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Other Education, HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education

Intervention Description: Patient-centered medical homes (PCMHs) seek to provide primary care that is comprehensive, patient-centered, coordianted, accessible, and high quality. PCMHs have the potential to improve receipt of preventive services by automating reminders to patients, measuring adherence to recommended services, giving feedback to physicians about adherence rates, using clinical decision support embedded in electronic health record (EHR) systems, and other quality-related activities. The objective of this study was to measure pediatric preventive counseling at PCMHs compared with practices that reported undertaking some or no quality-related activities. We focus on 2 activities most directly related to the provision of recommended counseling by physicians: 1) whether the practice regularly gave physicians reports on the clinical quality of their care, and 2) if the practice had an EHR system, whether the system routinely reminded practitioners to provide guideline-based care or screening tests.

Intervention Results: Compared with other practices, PCMHs were generally associated with greater likelihood of receiving preventive counseling. Estimates varied with the quality-related activities of the comparison practices. Counseling against smoking in the home was 10.4 to 18.7 percentage points (both P < .01) more likely for PCMHs. More associations were statistically significant for PCMHs compared with practices that undertook 1 of 2 quality-related activities examined. Among children ages 2 to 5, compared with practices undertaking both quality-related activities, those with PCMHs were more likely to receive counseling on 3 of 5 topics. Among adolescents, compared with practices undertaking both quality-related activities, those with PCMHs were more likely to receive counseling on smoking, exercise, and eating healthy.

Conclusion: PCMHs were associated with substantially greater receipt of pediatric preventive counseling. Evaluations of PCMHs need to account for the quality-related activities of comparison practices.

Study Design: Secondary data analysis

Setting: Patient-centered medical homes

Population of Focus: Children and adolscents who visited their office-based usual sources of care

Sample Size: 4814 children and adolescents

Age Range: Ages 0-17

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Expert Support (Provider), Enabling Services, HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: We evaluated the benefit of embedded diagnostic consultation within primary care clinics.

Intervention Results: Diagnostic clarity was determined through streamlined assessment for 59% of the children, while others required follow-up. Latency from first concern to diagnosis was 55 days and median age at diagnosis was 32 months: considerably lower than national averages or comparable tertiary clinics.

Conclusion: Findings support that embedded processes for effective triage and diagnosis within the medical home is a viable mechanism for efficient access to diagnostic services and assists in bypassing a common barrier to specialized services.

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Continuing Education of Hospital Providers, Peer-Review of Provider Decisions, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Consultation Systems (Inter-Hospital Systems), Consultation Systems (Hospital), Agreement for Level III Hospital to Accept All Patients, Medical Staff Integration

Intervention Description: Not available

Intervention Results: After the intervention, there was a statistically significant decrease in the number of VLBW infants born in a level II hospital (p<0.01).

Conclusion: Not available

Study Design: QE: pretest-posttest

Setting: Minnesota: Abbott-Northwestern/ Minneapolis Children’s Perinatal Center and Fairview-Southdale Hospital (Level II)

Population of Focus: All births at level II hospital

Data Source: Data source not provided.

Sample Size: Pretest (n= 2,573) Posttest (n= 2,722)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visits, Other Education, Expert Support (Provider), HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: A social worker coordinated medical care for children in foster care in a foster care medical home (FCMH) and tracked care coordination (CC) activities using a modified Care Coordination Measurement Tool© (mCCMT).

Intervention Results: The CC prevented 11 emergency department (ED) visits, 9 placement disruptions, and 42 patient privacy violations.

Conclusion: Children assigned to a FCMH have diverse CC needs and benefit from social workers’ specialized skills.

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation

Intervention Description: Use of formal developmental screening tools in the pediatric medical home improves early identification of children with developmental delays and disorders, including Autism Spectrum Disorders.

Intervention Results: Percentage of screening at 18-month well-child visits increased (P<.05) in all intervention practices. Average screening percentages were 70.8% for intervention practices, 46% for control practices. One intervention practice had a lower screening % than matched control practice (P=.37). Number of screens performed on the same day as a well-child visit increased from 3,442 in 2008 to 12,533 in 2009.

Conclusion: These pilot study results indicate the potential of academic detailing as an effective strategy for improving rates of developmental screening.

Study Design: QE: pretest-posttest nonequivalent control group

Setting: Pediatric and family medicine practice (5 intervention and 5 control) sites in Connecticut

Population of Focus: Children at 18-month well-child visits

Data Source: Child medical record; Medicaid claims

Sample Size: Baseline Chart Audits3 : - Intervention (n=200) - Control (n=100) Follow-Up Chart Audits: - Intervention (n=196) - Control (n=100)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement, Provider Training/Education, Crib Card, HOSPITAL, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: This project aimed to improve infant sleep practices in a 10-bed level I nursery using visual cues (crib cards) and nursing education.

Intervention Results: safe sleep practices improved from 32% (30/95) preintervention to 75% (86/115) postintervention (P < 0.01).

Conclusion: This study demonstrates that implementing a quality improvement initiative to improve infant sleep practices in a low-volume nursery is feasible and impactful.

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Nurse/Nurse Practitioner, YOUTH, Adult-led Support/Counseling/Remediation, PARENT/FAMILY, Training (Parent/Family), Notification/Information Materials (Online Resources, Information Guide), CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), Home Visit (caregiver)

Intervention Description: A 2-year randomized, controlled trial involving 95 children measured the impact of a comprehensive home and ambulatory program for pediatric asthma management using objective outcome measures.

Intervention Results: There were no significant differences in medical visits, theophylline levels, or records of asthma symptomsOne year after discontinuing the intervention, a marked "washout" effect was observed.

Conclusion: Comprehensive ambulatory programs of childhood asthma management can improve objective measures of illness severity but must be sustained.

Study Design: RCT

Setting: Homes and well-child clinics

Population of Focus: Patients admitted to the Izaak Walton Killam Children’s Hospital with a diagnosis of asthma in the preceding 5 years

Data Source: Medical personnel

Sample Size: 95 children

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, HOSPITAL, Crib Card, Visual Display (Hospital), CAREGIVER, Education/Training (caregiver)

Intervention Description: To increase the percentage of eligible infants engaging in safe sleep practices (SSP) in two level III neonatal intensive care units (NICUs) in the Boston, Massachusetts area.

Intervention Results: Of 755 cases, 395 (52.3%) were assessed to be eligible for SSP. From the pre- to post-intervention period, there was a significant improvement in overall compliance with SSP (25.9 to 79.7%; P-value<0.001). Adherence to each component of SSP also improved significantly following the intervention.

Conclusion: Safe infant sleep practices can be integrated into the routine care of preterm infants in the NICU. Modeling SSP to families far in advance of hospital discharge may improve adherence to SSP at home and reduce the risk of sleep-related morbidity and mortality in this vulnerable population of infants.

Study Design: QE: pretest-posttest

Setting: Two level III NICUs at South Shore Hospital and St Elizabeth’s Medical Center in MA

Population of Focus: Infants eligible for safe sleep practices as determined by an algorithm and clinical status of the infant

Data Source: Crib audit/infant observation

Sample Size: Baseline (n=112) Follow-up (n=118)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational material, HEALTH_CARE_PROVIDER_PRACTICE, Quality Improvement/Practice-Wide Intervention, Hospital Policies, Provider Training/Education,

Intervention Description: The purpose of this system-wide quality improvement project was to create a breastfeeding-friendly pediatric practice. This breastfeeding support initiative was implemented at a multisite rural Illinois pediatric practice. The policy included: (a) breastfeeding promotion recommendations; (b) provider, nurse, and staff roles; (c) patient education and resources; and (d) breastfeeding-friendly atmosphere guidelines. An evidence-based breastfeeding policy was developed, staff education sessions were conducted, private lactation rooms were created, and breastfeeding photographs/posters were displayed throughout the offices. Lactation support services were publicized throughout the offices. Lactation support services were publicized via signs and social media postings.

Intervention Results: Overall breastfeeding rates were higher at each time point after implementation. Statistically significant increases occurred at the newborn and 1-month visits, with a modest improvement at 2 and 4 months.

Conclusion: This project demonstrated an improvement in breastfeeding duration rates. It is anticipated that this practice-wide standard of care change will promote breastfeeding throughout the first 12 months of life.

Study Design: Pre-post intervention

Setting: Multisite rural IL pediatric practice

Population of Focus: Mothers with breastfeeding infants from newborn to 4 months seen for well-child visits at a pediatric practice

Sample Size: 71 infants preintervention and 18 infants postintervention

Age Range: Newborn to infants 4 months old

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

Intervention Components (click on component to see a list of all articles that use that intervention): Continuing Education of Hospital Providers, , HOSPITAL

Intervention Description: To implement developmental care accurately, neonatal intensive care unit nurses should have a proper understanding and sufficient knowledge in this field.

Intervention Results: The Developmental Care perception scores before the intervention in the control and intervention groups were 83.40 ± 11.36 and 84.53 ± 9.48, respectively, showing no statistically significant difference (P = 0.67). Also, Developmental Care perception scores after the intervention in the control and intervention groups were 83.16 ± 13.73, and 94.70 ± 6.89, respectively, showing a statistically significant difference (P < 0.001). The results of paired t-test showed that the mean knowledge score in the control group before and after the intervention was not statistically significant (P < 0.903), while in the intervention group there was a statistically significant difference between the mean knowledge score before and after the intervention (P < 0.001). The Developmental Care Knowledge scores before the intervention in the control and intervention groups were 52.66 ± 18.08 and 77.16 ± 17.20, respectively, showing a statistically significant difference (P = 0.001). Also, Developmental Care Knowledge scores after the intervention in the control and intervention groups were 53.66 ± 26.55and 90.33 ± 13.82, respectively, showing a statistically significant difference (P < 0.001). The results of paired t-test showed that the mean knowledge score in the control group before and after the intervention was not statistically significant, while in the intervention group there was a statistically significant difference between the mean knowledge score before and after the intervention. The results of this study showed that virtual education for the developmental care of premature infants plays an effective role in the perception and knowledge of nurses working in the neonatal intensive care unit.

Conclusion: The development of e-learning packages for developmental care and their availability for nurses can be a step to improve the quality of nursing care for infants admitted to the NICU.

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

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), Provider Training/Education, Nurse/Nurse Practitioner, CLASSROOM_SCHOOL, Teacher/Staff Training, PROFESSIONAL_CAREGIVER, Outreach (caregiver), Outreach (School Staff)

Intervention Description: Healthy and Ready to Learn is a targeted, school-based CHIP and Medicaid outreach initiative for identifying and enrolling eligible and uninsured children entering kindergarten in North Carolina’s highest need counties. School nurses and administrative staff attend regional trainings on how to use a required health assessment form, submitted at school entry, to identify uninsured children who could be eligible but are not enrolled in public insurance. Continuous community-based outreach (e.g., attending community events, providing outreach materials in various languages, contacting local organizations and leaders to help inform families about CHIP and Medicaid) is also utilized.

Intervention Results: With increased enrollment rates and well-child exam rates, findings demonstrate the potential benefits of using schools as a point of intervention in enrolling young children in public health insurance and as a source of trusted information for parents from low-income backgrounds. The initiative increased enrollment rates by 12.2% points and increased well-child exam rates by 8.6% points in the regression discontinuity design models, but not differences-in-differences, and did not significantly increase well-child visits. Findings demonstrate the potential benefits of using schools as a point of intervention in enrolling young children in public health insurance and as a source of trusted information for low-income parents.

Conclusion: Findings demonstrate the potential benefits of using schools as a point of intervention in enrolling young children in public health insurance and as a source of trusted information for low-income parents.

Study Design: Quasi-experimental difference-in-difference and regression discontinuity

Setting: Schools (Elementary schools in North Carolina)

Population of Focus: Uninsured kindergarten-aged children in high economic need counties in North Carolina

Data Source: Medicaid and CHIP administrative data, focus groups, key informant interviews

Sample Size: 300 children; 16 counties were selected as intervention sites that included 278 elementary schools in 22 districts; in the second year, expanded to 32 counties

Age Range: 4-6 years

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education,

Intervention Description: Novel teaching curricula using simulated patients (SP) and a team-based approach are needed to teach pediatric residents how to approach behavioral health (BH) conditions in an integrated care setting. This mixed-methods study evaluated a pilot curriculum on BH integration in pediatric primary care. Two 1-hour didactic sessions and 3 hours of SP encounters focused on attention-deficit/hyperactivity disorder (ADHD) and anxiety, followed by facilitated debriefings that included interdisciplinary team members. Residents completed pre- and postcurriculum surveys on self-efficacy in patient assessment and management. A subset of residents participated in semistructured interviews, reviewing video recordings of their SP encounters to facilitate reflection on their learning. We conducted qualitative analysis of interview transcripts until we reached thematic saturation.

Intervention Results: Residents (n = 31) reported significantly improved self-efficacy in the majority of BH skills (p ≤ .05 to p ≤ .0001), including assessing and discussing concerns with families, using screening tools, developing management plans, prescribing medications, and performing warm handoffs with BH clinicians. In analysis of 15 interviews, four themes emerged: shared experiences, mutual engagement, contextual meaning, and behavioral change, which aligned with the components of the communities of practice framework. Sharing experiences within an integrated BH-pediatric primary care learning community enhanced activated, self-reflective learning and consequent behavioral change that contributed to identity formation.

Conclusion: Resident participation in the integrated BH-pediatric curriculum improved self-efficacy in patient care for anxiety and ADHD. Curricula implemented in integrated learning communities could help promote reflection and improve integrated pediatric-BH care, including warm handoffs from pediatric to BH providers.

Study Design: Pre-post study

Setting: Two integrated pediatric primary care residency training sites at the University of Rochester Medical Center and at Rochester Regional Health

Population of Focus: Pediatric residents, BH providers, nurses, pediatric primary care providers, and social workers

Sample Size: 34 eligible pediatric residents participated in the integrated behavioral health (BH) and pediatric primary care curriculum. Of these, 31 residents completed all pre- and post-workshop survey evaluations for the fall 2015 and spring 2016 sessions. Additionally, 15 residents participated in face-to-face semistructured interviews 3-6 months after participating in the curriculum to reflect on their communication and interprofessional collaboration skills demonstrated during the simulation.

Age Range: Adult providers caring for pediatric patients

Intervention Components (click on component to see a list of all articles that use that intervention): Education on Disease/Condition, Notification/Information Materials (Online Resources, Information Guide), Planning for Transition, HEALTH_CARE_PROVIDER_PRACTICE, PARENT_FAMILY, YOUTH

Intervention Description: This study evaluated the impact of establishing a transition clinic in a regional Australian setting on the lives of young adults living with severe chronic kidney disease and their families.

Intervention Results: Four key themes were identified as follows: The Model of Care; Peer support; Transition towards self-management: Building life skills; Suggestions for improvement and limitations of the service model. The non-institutional, informal clinic setting and social/educational activities facilitated engagement, self-management and peer support for young people and parents. Suggestions for improvement included involvement of older peers, additional life skills sessions and a youth worker.

Conclusion: This regional transition clinic is valued by the young people and their parents for generating peer support, building self-management and life skills. Sustainability of the clinic depends upon having the appropriate expertise available, access to a suitable venue and offering a program that meets the needs of young people.

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Quality Improvement, Policy/Guideline (State)

Intervention Description: A quality improvement course was introduced to reduce the caesarean section rate among nulliparas women and to find out which group of women reduced the cesarean section rate following attendance at the course. The course was dedicated to delivery-related staff from all Lithuanian hospitals providing obstetrical care. All hospitals had their representatives attending the course. They included not only obstetricians and gynecologists but also midwives, neonatologists and nurses. The aim of the course was to ensure that all Lithuanian hospitals providing obstetrical care had the same obstetrical knowledge and provided standardized care in managing the same obstetrical situations. The course consisted of educational sessions and practice drills. The core of educational sessions was a file of evidence-based obstetrical guidelines that were distributed nationally.

Intervention Results: Nulliparas accounted for 43% (3746/8718) and 44.6% (3585/8046) of all the deliveries in 2012 and 2014 years, respectively. The CS rate among nulliparas decreased from 23.9% (866/3626) in 2012 to 19.0% (665/3502) in 2014 (p < 0.001).The greatest decrease in absolute contribution to the overall CS rate was recorded in groups 1 (p = 0.005) and 2B (p < 0.001). Perinatal mortality was 3.5 in 2012 and 3.1 in 2014 per 1000 deliveries (p = 0.764).

Conclusion: The TGCS can work as an audit intervention that could help to reduce the CS rate without a negative impact on perinatal mortality.

Setting: Lithuanian hospitals

Population of Focus: Nulliparous low risk women

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Quality Improvement, Policy/Guideline (State)

Intervention Description: A quality improvement course was introduced to reduce the caesarean section rate among nulliparas women and to find out which group of women reduced the cesarean section rate following attendance at the course. The course was dedicated to delivery-related staff from all Lithuanian hospitals providing obstetrical care. All hospitals had their representatives attending the course. They included not only obstetricians and gynecologists but also midwives, neonatologists and nurses. The aim of the course was to ensure that all Lithuanian hospitals providing obstetrical care had the same obstetrical knowledge and provided standardized care in managing the same obstetrical situations. The course consisted of educational sessions and practice drills. The core of educational sessions was a file of evidence-based obstetrical guidelines that were distributed nationally.

Intervention Results: Nulliparas accounted for 44.6% (3585/8046) and 42.9% (3628/8460) of all the deliveries in 2014 and 2016 years, respectively. The CS rate among nulliparas decreased from 19.0% (665/3502) in 2014 to 16.8% (593/3526) in 2016 (p = 0.018). The greatest decrease in absolute contribution to the overall CS rate was recorded in group 1 (p = 0.08). Perinatal mortality was 3.1 in 2014 and 3.9 in 2016 per 1000 deliveries (p = 0.569).

Conclusion: The QIC has helped to reduce the CS rate among nulliparas without a negative influence on perinatal mortality. The greatest decrease in the overall CS rate was recorded among nulliparous women who were treated with oxytocin and managed to reach a full cervical dilatation.

Setting: Lithuanian hospitals

Population of Focus: Nulliparous low risk women

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation, Educational Material, PROVIDER/PRACTICE, Provider Reminder/Recall Systems, Financial Incentives, Nurse/Nurse Practitioner

Intervention Description: Before-and-after comparisons of the time-appropriate delivery rates of cervical and breast cancer screening using the automated and NP-augmented strategies of the P-PROMPT reminder and recall system.

Intervention Results: Before-and-after comparisons of time-appropriate delivery rates (< 30 months) of cancer screening showed the rates of Pap tests and mammograms for eligible women significantly increased over a 1-year period by 6.3% (P < .001) and 5.3% (P < .001), respectively. The NP-augmented strategy achieved comparable rate increases to the automated strategy alone in the delivery rates of both services.

Conclusion: The use of provider and patient reminders and pay-for-performance incentives resulted in increases in the uptake of Pap tests and mammograms among eligible primary care patients over a 1-year period in family practices in Ontario.

Setting: Eight primary care network practices and 16 family health network practices in southwestern Ontario

Population of Focus: Practicing physicians from the participating primary care network and family health network groups

Data Source: CytoBase (consortium of main laboratories in Ontario), combined with rosters of eligible patients

Sample Size: Total (N=246) Analysis (n=232) N=physicians

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Hospital Policies, Baby Friendly Hospital Initiative, Provider Training/Education, Expert Support (Provider),

Intervention Description: In 2010, the Hawaii State Department of Health received support from the CDC to launch the Baby-Friendly Hawaii Project to increase the number of Hawaii hospitals that provide maternity care consistent with the Ten Steps to Successful Breastfeeding and increase the rate of women who remain exclusively breastfeeding throughout their hospital stay. The BFHP employed six strategies based on a model developed by the New York City Department of Health and Mental Hygiene: engage hospitals, enlist support, recruit champions, assess hospitals, conduct site visits and trainings, and monitor outcomes. Populations targeted for BFHP were registered nurses, lactation consultants, and other hospital staff, as well as expectant mothers at all 11 Hawaii maternity hospitals during the project period.

Intervention Results: Since 2010, 52 hospital site visits, 58 trainings, and ongoing technical assistance were administered, and more than 750 staff and health professionals from BFHP hospitals were trained. Hawaii’s overall quality composite Maternity Practices in Infant Nutrition and Care score increased from 65 (out of 100) in 2009 to 76 in 2011 and 80 in 2013, and Newborn Screening Data showed an increase in statewide exclusive breastfeeding from 59.7% in 2009 to 77.0% in 2014.

Conclusion: Implementation and findings from the BFHP can inform future planning at the state and federal levels on maternity care practices that can improve breastfeeding.

Study Design: Program evaluation

Setting: Maternity hospitals in Hawaii

Population of Focus: Registered nurses, lactation consultants, and other hospital staff and expectant mothers at all 11 Hawaii maternity hospitals

Sample Size: 750 staff and health professionals

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): Referrals, Provider Training/Education, Outreach (caregiver), PATIENT_CONSUMER, PROFESSIONAL_CAREGIVER, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficked children.

Intervention Results: Serving 62 youth during its first year, the medical home has begun to improve access to high-quality healthcare to a very vulnerable population.

Conclusion: Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research.

Intervention Components (click on component to see a list of all articles that use that intervention): Telephone Support, Adult-led Spport/Counseling/Remediation, PATIENT_CONSUMER, Educational Material (Provider), HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: The purpose of this study is to conduct moderator analyses using pooled data from three randomized controlled trials of the intervention conducted in collaboration with 2-1-1 contact centers in Atlanta, North Carolina and Houston. 2-1-1 is a strategic partner for tobacco control as it connects over 15 million clients, largely socio-economically disadvantaged, to social and health resources each year.

Intervention Results: Intervention effectiveness was not moderated by race/ethnicity, education, income, children in the home or number of smokers in the home. Smoking status of the participant, however, did moderate program effectiveness, as did time to first cigarette. Number of cigarettes per day and daily versus nondaily smoking did not moderate intervention effectiveness.

Conclusion: The intervention was effective across socio-demographic groups and was effective without respect to daily versus nondaily smoking or number of cigarettes smoked per day, although smoking status and level of nicotine dependence did influence effectiveness.

Intervention Components (click on component to see a list of all articles that use that intervention): Transition Assistance, PATIENT/CONSUMER, HOSPITAL, Continuing Education of Hospital Providers, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Neonatal Back-Transport Systems, Consultation Systems (Inter-Hospital Systems), Consultation Systems (Hospital), Telemedicine Systems (Inter-Hospital Systems), Telemedicine Systems (Hospital)

Intervention Description: Assessed a telemedicine (TM) network's effects on decreasing deliveries of very low birth weight (VLBW, <1500 g) neonates in hospitals without Neonatal Intensive Care Units (NICUs) and statewide infant mortality.

Intervention Results: Deliveries of VLBW neonates in targeted hospitals decreased from 13.1 to 7.0% (P=0.0099); deliveries of VLBW neonates in remaining hospitals were unchanged. Mortality decreased in targeted hospitals (13.0% before TM and 6.7% after TM). Statewide infant mortality decreased from 8.5 to 7.0 per 1000 deliveries (P=0.043).

Conclusion: TM decreased deliveries of VLBW neonates in hospitals without NICUs and was associated with decreased statewide infant mortality.

Study Design: QE: pretest-posttest

Setting: All Arkansas hospitals (Nine selected as telemedicine hospitals due to high patient volume)

Population of Focus: Infants born weighing <1500 gm

Data Source: Medicaid data for VLBW infants as indicated by ICD-9 diagnosis codes from hospital and physician claims for pregnancy. Data infant with birth and infant death certificates.

Sample Size: Pretest (n= 383) Posttest (n= 384)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Participation Incentives, Quality Improvement/Practice-Wide Intervention, Data Collection Training for Staff, Screening Tool Implementation Training, Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: To assess the degree to which a national sample of pediatric practices could implement American Academy of Pediatrics (AAP) recommendations for developmental screening and referrals, and to identify factors that contributed to the successes and shortcomings of these efforts.

Intervention Results: At the project's conclusion, practices reported screening more than 85% of patients presenting at recommended screening ages. They achieved this by dividing responsibilities among staff and actively monitoring implementation. Despite these efforts, many practices struggled during busy periods and times of staff turnover. Most practices were unable or unwilling to adhere to 3 specific AAP recommendations: to implement a 30-month visit; to administer a screen after surveillance suggested concern; and to submit simultaneous referrals both to medical subspecialists and local early-intervention programs. Overall, practices reported referring only 61% of children with failed screens. Many practices also struggled to track their referrals. Those that did found that many families did not follow through with recommended referrals.

Conclusion: A diverse sample of practices successfully implemented developmental screening as recommended by the AAP. Practices were less successful in placing referrals and tracking those referrals. More attention needs to be paid to the referral process, and many practices may require separate implementation systems for screening and referrals.

Study Design: QE: interrupted timeseries design

Setting: Sixteen pediatric primary care practices from 15 different states

Population of Focus: Children ages 8 to 36 months at wellchild visits

Data Source: Child medical record

Sample Size: Chart audits: - Baseline and Follow-Up: (n=30) per practice in July 2006 and March 2007; total charts audited (n= 960) - Intervention period: (n=10) per practice per month for 7 months; total charts audited (n=1,120)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Patient Reminder/Invitation, HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Quality Improvement/Practice-Wide Intervention, Nurse/Nurse Practitioner

Intervention Description: Improving cervical cancer screening rates was identified as a priority in a federally qualified health center when only 40% of eligible women were properly screened in 2016. Forty-five percent of the population the clinic serves is uninsured and 60% are Hispanic. The aim of this quality improvement project was to have 75% of the women 21 to 65 years of age who sought care at this clinic during the 60-day project period receive Pap test eligibility screening, enrollment in a state and federal screening program, and case management. Four rapid plan–do–study–act cycles were used. Tests of change included team engagement, patient engagement, eligibility screening, and case log management. Data were analyzed using run charts to evaluate the impact of interventions on outcomes. The interventions consisted of team meetings, a patient engagement tool, an eligibility screening tool, and case log management.

Intervention Results: Among the women who completed care at the clinic during the 60-day project period, 80% were uninsured and 86% were Hispanic. A total of 87% of women received effective care, which consisted of same-day Well Woman Health Care Program enrollment and a same-day Pap test or an appointment to return for a well-woman visit.

Conclusion: A multicomponent approach led to underserved women receiving equitable access to cervical cancer screening and timely enrollment in a cervical cancer screening program.

Setting: Federally qualified health center (FQHC) in Tucson, Arizona,

Population of Focus: Uninsured and underserved women ages 21-65

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

Intervention Description: To equitably increase exclusive breastfeeding at hospital discharge among obstetrician/gynecologist resident service clients by 20% over 8 weeks. Design

Intervention Results: Rates of exclusive breastfeeding at hospital discharge were 7% at baseline and 13% after implementation. Rates of exclusive breastfeeding among Black clients were 0% at baseline and 16% after implementation. Clients demonstrated Baby-Friendly knowledge (teach-back average, 89%) but continued to supplement with formula, most often related to supply concerns (65%).

Conclusion: Intentionally equitable implementation of the Baby-Friendly steps may ameliorate racial disparities in breastfeeding during the early postpartum period. Preparing families to exclusively breastfeed should begin prenatally.

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education

Intervention Description: Data was collected electronically from over 3400 pregnant women during a three-month period in 2017.

Intervention Results: Dental appointments were upheld by 87.3% of referred women and by 56.9% of those without a referral (OR = 5.20 (4.05–6.67); p < 0.001). Among those who were referred, dental appointments were upheld in 91.7% of cases when further asked to provide oral health feedback and in 83.5% of cases in absence of such further request (OR = 2.19 (1.3–3.66); p = 0.003).

Conclusion: It was determined that referrals from a gynaecologist, and associated oral health feedback requests increase the frequency of abiding to dental appointments during pregnancy. As such, it is necessary to increase the involvement of gynaecologists in the promotion and maintenance of perinatal oral health.

Setting: Clinic/Medical provider office

Population of Focus: Pregnant people

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visit (caregiver), Motivational Interviewing/Counseling, Provider Training/Education,

Intervention Description: Identified in this article are 5 pillars for implementing CBPPC care in cases involving ethical considerations: (1) identification of biases, (2) utilization of a culturally safe approach, (3) communication, (4) assessment and support, and (5) knowledge of community resources.

Intervention Results: successful intervention

Conclusion: By facilitating the communication of patient and family needs and goals and by connecting patients and families with community resources to improve quality of life, CBPPC and hospice nurses play an essential role in decreasing stressors and suffering. The implementation of palliative care improves patient outcomes, enhances interprofessional and family communication, and reduces end-of-life cost burdens both to families and to health care systems; however, the time it takes a nurse to develop trusting relationships, consider family-centered education needs, connect families with accessible specialists, and address their own needs and possible biases is not easily coded for compensation in the current health care system. Without substantial CBPPC nurse involvement in this case, the outcome might have been far less satisfactory for the family. It is recommended that nurses and interprofessional teams implement the 5 crucial pillars discussed for providing ethical and safe palliative care.

Study Design: case review

Setting: CMC: community-based palliative care - a case study involving a family with a child who has a life-limiting genetic disease and the community-based pediatric palliative care (CBPPC) team that provided care in the family's home.

Population of Focus: CMC - healthcare professionals, particularly those involved in community-based pediatric palliative care.

Sample Size: 1 family

Age Range: children

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid Reform, Provider Training/Education,

Intervention Description: The intervention involved the implementation of an Immediate Postpartum LARC Program at a large, urban, tertiary medical center in St. Louis, Missouri, in preparation for the Missouri Medicaid reimbursement policy change in October 2016. This program included placing levonorgestrel and copper IUDs and the etonogestrel implant on hospital formulary, stocking the devices on Labor and Delivery and Postpartum for ease of access, and providing educational talks and hands-on training for healthcare providers involved in deliveries at the institution.

Intervention Results: A total of 6,233 eligible patients delivered during the study period: 3105 before and 3128 after the change in reimbursement for immediate postpartum LARC. Patients delivering after the policy change were more likely to be Hispanic, have commercial insurance or be uninsured, and have a BMI >30. Placement of immediate postpartum LARC increased from 0.7% pre- to 9.7% postpolicy change (aOR 15.6; 95% CI 10.1-24.2). In our stratified analysis, immediate postpartum LARC uptake increased for patients with Medicaid (aOR 15.8; 95% CI 9.9-25.4) and commercial insurance (aOR 9.7; 95% CI 3.0-31.8).

Conclusion: The change in Missouri Medicaid reimbursement for placement of immediate postpartum LARC had systemic impact with an increase in postpartum LARC uptake in all patients, regardless of insurance provider.

Study Design: Retrospective cohort

Setting: Barnes-Jewish Hospital (large academic medical center) St Louis, Missouri

Sample Size: 6233 eligible patients, 3105 patients delivered before the policy changes, 3128 patients delivered after

Age Range: Not stated; Mean age for pre policy group was 27.4 years, mean age for post policy change group was 27.9

Intervention Components (click on component to see a list of all articles that use that intervention): Parent Engagement, Care Coordination, Provider Training/Education,

Intervention Description: This study evaluates the impact of a 6-month care management intervention for 206 children diagnosed with comorbid attention deficit hyperactivity disorder (ADHD) from a sample of 321 five- to 12-year-old children recruited for treatment of behavior problems in 8 pediatric primary care offices. Practices were cluster-randomized to Doctor Office Collaboration Care (DOCC) or Enhanced Usual Care (EUC). Chart reviews documented higher rates of service delivery, prescription of medication for ADHD, and titration in DOCC (vs EUC).

Intervention Results: Based on complex conditional models, DOCC showed greater acute improvement in individualized ADHD treatment goals and follow-up improvements in quality of life and ADHD and oppositional defiant disorder goals. Medication use had a significant effect on acute and follow-up ADHD symptom reduction and quality of life. Medication continuity was associated with some long-term gains.

Conclusion: A collaborative care intervention for behavior problems that incorporated treatment guidelines for ADHD in primary care was more effective than psychoeducation and facilitated referral to community treatment.

Study Design: Cluster-randomized trial

Setting: Eight pediatric primary care practices in the United States, including seven Children's Community Pediatric practices and one general academic pediatric practice affiliated with Children's Hospital of Pittsburgh

Population of Focus: Children with behavior problems who were receiving care in pediatric primary care practices

Sample Size: 321 children

Age Range: Children ages 5-12 years

Intervention Components (click on component to see a list of all articles that use that intervention): Planning for Transition, Pediatric to Adult Transfer Assistance, Integration into Adult Care, PROVIDER/PRACTICE, YOUTH, Education on Disease/Condition

Intervention Description: Adolescents with a kidney transplant (KT) require special attention during the transition of care. Few longitudinal studies have assessed the effect of transition models (TM) on patient outcomes. Between 1986 and 2013, 239 pediatric patients underwent KT in Finland, of whom 132 have been transferred to adult care. In 2005, a TM was developed following international recommendations. We compared patient (PS) and graft survival (GS) rates before and after the introduction of the TM.

Intervention Results: PS and GS at 10 years were similar before and after the implementation of the TM (PS 85% and 90% respectively, P = 0.626; GS 60% and 58%, respectively, P = 0.656). GS was lower in patients transplanted at age 10-18 than in patients transplanted at a younger age in the TM cohort (79% vs 95%, P < 0.001). During the first five years after transfer, 63% of patients had stable KT function, 13% had deteriorating function and 24% lost their KT. Altogether 32 out of 132 patients lost their kidney allograft within five years after transfer to adult care (13 before and 19 after TM implementation, P = 0.566).

Conclusion: The implementation of this TM had no effect on PS or GS. Further measures to improve our TM are in progress.

Study Design: Quasi- experimental retrospective prepost design

Setting: Hospital/clinicbased

Population of Focus: Adolescents who received kidney transplants

Data Source: Finnish Registry of Kidney Diseases: date of transplant, demographics, etiology of kidney disease, number of operations, type of donor, rejection episodes, date/age of transition, and health/ morbidity/death data

Sample Size: 132

Age Range: 18 years (at time of study)

Intervention Components (click on component to see a list of all articles that use that intervention): Expert Support (Provider), Educational Material

Intervention Description: Sites were randomly assigned to receive an experimental intervention (n = 16) modeled on the Baby-Friendly Hospital Initiative of the World Health Organization and United Nations Children's Fund, which emphasizes health care worker assistance with initiating and maintaining breastfeeding and lactation and postnatal breastfeeding support, or a control intervention (n = 15) of continuing usual infant feeding practices and policies.

Intervention Results: Infants from the intervention sites were significantly more likely than control infants to be breastfed to any degree at 12 months (19.7% vs 11.4%; adjusted odds ratio [OR], 0.47; 95% confidence interval [CI], 0.32-0.69), were more likely to be exclusively breastfed at 3 months (43.3% vs 6.4%; P<.001) and at 6 months (7.9% vs 0.6%; P =.01), and had a significant reduction in the risk of 1 or more gastrointestinal tract infections (9.1% vs 13.2%; adjusted OR, 0.60; 95% CI, 0.40-0.91) and of atopic eczema (3.3% vs 6.3%; adjusted OR, 0.54; 95% CI, 0.31-0.95), but no significant reduction in respiratory tract infection (intervention group, 39.2%; control group, 39.4%; adjusted OR, 0.87; 95% CI, 0.59-1.28).

Conclusion: Our experimental intervention increased the duration and degree (exclusivity) of breastfeeding and decreased the risk of gastrointestinal tract infection and atopic eczema in the first year of life. These results provide a solid scientific underpinning for future interventions to promote breastfeeding.

Study Design: The Promotion of Breastfeeding Intervention Trial (PROBIT), a cluster-randomized trial conducted June 1996-December 1997 with a 1-year follow-up.

Setting: Thirty-one maternity hospitals and polyclinics in the Republic of Belarus.

Data Source: N/A

Sample Size: 17 046 mother-infant pairs 16491 (96.7%) of which completed the entire 12 months of follow-up

Age Range: mother-infant pairs consisting of full-term singleton infants weighing at least 2500 g and their healthy mothers who intended to breastfeed

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Education/Training (caregiver), Provider Reminder/Recall Systems,

Intervention Description: The interventions included an educational seminar covering HPV prevalence, morbidity, clinic-specific obstacles, dosing intervals, and vaccine recommendation messaging. Subsequent interventions provided targeted feedback to providers, individualized audits, and monthly trend monitoring

Intervention Results: The study showed a significant increase in HPV vaccination rates after educational and reminder interventions, with the mean percentage of vaccinated adolescents increasing from 77.5% to 89.4% of eligible visits

Conclusion: Quality improvement methods were found to be effective in improving HPV vaccine delivery in a primary care center, leading to better protection against HPV-associated disease

Study Design: The study utilized quality improvement methods to improve HPV vaccine delivery in a primary care center, employing educational seminars, targeted feedback, and manual review of patient visits

Setting: The setting for the study was a single mid-size academic-based pediatric health center

Population of Focus: Physicians, residents, nurses, and medical assistants were the target audience for the educational seminar and subsequent interventions

Sample Size: The study involved a total of 975 visits for adolescents aged 13 to 17 years

Age Range: The study focused on adolescents aged 13 to 17 years

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Community Health Workers (CHWs), PATIENT/CONSUMER, Home Visits, Educational Material, Other Person-to-Person Education, Peer Counselor, Motivational Interviewing, CAREGIVER, Home Visit (caregiver), Education/Training (caregiver), Educational Material (caregiver), Motivational Interviewing/Counseling

Intervention Description: We assessed the effectiveness of a community health worker intervention focused on reducing exposure to indoor asthma triggers.

Intervention Results: The high-intensity group improved significantly more than the low-intensity group in its pediatric asthma caregiver quality-of-life score (P=.005) and asthma-related urgent health services use (P=.026). Asthma symptom days declined more in the high-intensity group, although the across-group difference did not reach statistical significance (P= .138). Participant actions to reduce triggers generally increased in the high-intensity group. The projected 4-year net savings per participant among the high-intensity group relative to the low-intensity group were $189–$721.

Conclusion: Community health workers reduced asthma symptom days and urgent health services use while improving caregiver quality-of-life score. Improvement was greater with a higher-intensity intervention.

Study Design: RCT

Setting: Community (home)

Population of Focus: Families in low-income households with children with asthma

Data Source: In-home interviewing, dust sample and standardized home inspection

Sample Size: 274 randomized participants

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education,

Intervention Description: The interventions included education for nurses and providers, changes to nursing workflow, and the use of reminder systems to ensure timely administration of the vaccine. The project did not specifically target parent education about vaccines beyond that briefly provided by nurses and providers during the initial newborn hospital course.

Intervention Results: The study found significant improvement in the timing and rates of hepatitis B vaccine administration in both nurseries. The majority of newborns who received the vaccine prior to discharge did so within 24 hours. A few parents who initially declined the vaccine subsequently agreed to give it once additional education was provided.

Conclusion: Interventions that facilitated workflow had additional benefit beyond education alone to improve timing and rates of hepatitis B vaccine administration in both a university medical centre and community hospital nursery

Study Design: The study used quality improvement (QI) methodologies and Plan-Do-Study-Act (PDSA) cycles to improve the timing and rates of hepatitis B vaccine administration to newborn infants.

Setting: The study was conducted in two nurseries, one in a university medical center and the other in a community hospital, both located in the United States.

Population of Focus: The target audience was newborn infants and their parents.

Sample Size: The study included all newborn infants who were eligible to receive the hepatitis B vaccine at the two nurseries during the study period.

Age Range: The age range of the newborn infants included in the study was not specified.

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Provision of Safe Sleep Item, HOSPITAL, Policy/Guideline (Hospital), Sleep Environment Modification, CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation

Intervention Description: The purpose of this study was to improve safe sleep practices for infants in nonneonatal pediatric units with implementation of specific interventions.

Intervention Results: Safe sleep was observed for 4.9% of 264 infants at baseline and 31.2% of 234 infants postintervention (P<.001). Extra blankets, the most common of unsafe items, were present in 77% of cribs at baseline and 44% postintervention. However, the mean number of unsafe items observed in each sleeping environment was reduced by >50% (P=.001).

Conclusion: Implementation of site-specific interventions seems to improve overall safe sleep in inpatient pediatric units, although continued improvement is needed. Specifically, extra items are persistently left in the sleeping environment.

Study Design: QE: pretest-posttest

Setting: Eight children’s hospitals

Population of Focus: Infants aged 0 to 6 months admitted to the general pediatric unit (excluding infants in the NICUs, PICUs, and maternal fetal units)

Data Source: Crib audit/infant observation

Sample Size: Baseline (n=234) Follow-up (n=210)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Participation Incentives, Data Collection Training for Staff

Intervention Description: To explore rates of screening and identification and treatment for behavioral problems using billing data from Massachusetts Medicaid immediately following the start of the state's new court-ordered screening and intervention program.

Intervention Results: Major increase from 16.6% of all Medicaid well-child visits coded for behavioral screens in the first quarter of 2008 to 53.6% in the first quarter of 2009. Additionally, the children identified as at risk increased substantially from about 1600 in the first quarter of 2008 to nearly 5000 in quarter 1 of 2009. The children with mental health evaluations increased from an average of 4543 to 5715 per month over a 1-year period.

Conclusion: The data suggest payment and a supported mandate for use of a formal screening tool can substantially increase the identification of children at behavioral health risk. Findings suggest that increased screening may have the desired effect of increasing referrals for mental health services.

Study Design: Observational pretestposttest design

Setting: Massachusetts

Population of Focus: Children enrolled in Medicaid

Data Source: Medicaid data prepared for Rosie D. v Romney (Patrick) court case

Sample Size: Well-child visits - Baseline/first quarter 2008 (n=122,494)4 - Follow-up/first quarter 2009 (n=118,573)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Quality Improvement/Practice-Wide Intervention, Data Collection Training for Staff, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool, POPULATION-BASED SYSTEMS, STATE, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: The objectives of this study were to assess the feasibility of implementing a bundle of strategies to facilitate the use of Bright Futures recommendations and to evaluate the effectiveness of a modified learning collaborative in improving preventive and developmental care.

Intervention Results: Office system changes most frequently adopted were use of recall/reminder systems (87%), a checklist to link to community resources (80%), and systematic identification of children with special health care needs (80%). From baseline to follow-up, increases were observed in the use of recall/reminder systems, the proportion of children's charts that had a preventive services prompting system, and the families who were asked about special health care needs. Of 21 possible office system components, the median number used increased from 10 to 15. Comparing scores between baseline and follow-up for each practice site, the change was significant. Teams reported that the implementation of office systems was facilitated by the perception that a component could be applied quickly and/or easily. Barriers to implementation included costs, the time required, and lack of agreement with the recommendations.

Conclusion: This project demonstrated the feasibility of implementing specific strategies for improving preventive and developmental care for young children in a wide variety of practices. It also confirmed the usefulness of a modified learning collaborative in achieving these results. This model may be useful for disseminating office system improvements to other settings that provide care for young children.

Study Design: QE: pretest-posttest

Setting: Primary care practices (15 at baseline, 8 at follow- up) throughout the US (9 states total), with most in the Midwest

Population of Focus: Children from birth through 21 years of age

Data Source: Child medical record

Sample Size: Unknown number of chart audits from 8 practice sites completing follow-up

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Baby Friendly Hospital Initiative, HEALTH_CARE_PROVIDER_PRACTICE, Hospital Policies, Other Education

Intervention Description: Identify practices associated with breastfeeding maintenance, examine breastfeeding-related hospital practices by hospital designation level (Baby Friendly vs. Gift vs. none), and assess racial disparities in hospital practices and breastfeeding maintenance.

Intervention Results: Breastfeeding in the hospital, infant only receiving breast milk, and breastfeeding within one hour after birth were positively associated and receiving a gift pack with formula was negatively associated with breastfeeding maintenance in both NHW and NHB women. Associations were stronger in NHW compared to NHB mothers.

Conclusion: We identified several practices significantly associated with breastfeeding maintenance. However, racial disparities indicate a need for population-specific supportive practices.

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.

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Quality Improvement, Crib Card, HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Nurse/Nurse Practioner, Audit/Attestation

Intervention Description: A multi-pronged, safe sleep quality improvement initiative was introduced in three inpatient pediatric hospitals. The intervention included: 1) nursing education, 2) identification of nurse "safe sleep" champions, 3) crib cards, 4) crib audits, and 5) weekly reporting of data showing nursing unit ABC compliance via tracking boards. A pre/post analysis of infants <12 months old was performed using a convenience method of sampling. The goal was ABC compliance of ≥25% for the post-intervention period.

Intervention Results: There were 204 cribs included pre-intervention and 274 cribs post-intervention. Overall, there was not a significant change in sleep position/location (78.4 to 76.6%, p = 0.64). There was a significant increase in the percent of infants sleeping in a safe sleep environment following the intervention (5.9 to 39.8%, p < 0.01). Overall ABC compliance, including both sleep position/location and environment, improved from 4.4% pre-intervention to 32.5% post-intervention (p < 0.01). There was no significant variability between the hospitals (p = 0.71, p = 1.00).

Conclusion: The AAP's safe sleep recommendations are currently not upheld in children's hospitals, but safer sleep was achieved across three children's campuses in this study. Significant improvements were made in sleep environment and overall safe sleep compliance with this multi-pronged initiative.

Setting: Three children's hospital campuses

Population of Focus: Hospital staff

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Professional Support, HEALTH_CARE_PROVIDER_PRACTICE, Baby Friendly Hospital Initiative, COMMUNITY, Individual Supports,

Intervention Description: The Westside Healthy Start Program (WHS), located in Chicago, Illinois, developed an ongoing multilevel approach to breastfeeding promotion. Key elements of the WHS breastfeeding model include individual education and counseling from pregnancy to 6 months postpartum and partnership with a local safety-net hospital to implement the Baby Friendly Hospital Initiative and provide lactation support to delivering patients. All WHS participants receive general breastfeeding education from case managers throughout pregnancy (such as information about breastfeeding benefits) and one face-to-face visit from a BFC in the third trimester for more personalized and comprehensive support. WHS collaborates with the largest delivering hospital in the service area, a safety-net provider, to improve the breastfeeding environment and systems of care.

Intervention Results: In the year our model was implemented, 44.6% (49/110) of prenatal WHS participants reported that they planned to breastfeed, and 67.0% (183/273) of delivered partici- pants initiated. Among participants reaching 6 months postpartum, 10.5% (9/86) were breastfeeding. WHS also had 2667 encounters with women delivering at our partner hospital during breastfeeding rounds, with 65.1% of contacts initiating. Community data was not available to assess the efficacy of our model at the local level. However, WHS participants fared better than all delivering patients at our partner hospital, where 65.0% initiated in 2015.

Conclusion: Healthy Start programs are a promising vehicle to improve breastfeeding initiation at the individual and community level. Additional evaluation is necessary to understand barriers to duration and services needed for this population.

Study Design: Evaluation data

Setting: Westside Healthy Start program located in Chicago, IL

Population of Focus: Low-income, African-American women who are pregnant

Sample Size: 652 women

Age Range: Women <17 to 45 years old

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

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.

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Nurse/Nurse Practitioner, Group Education,

Intervention Description: A continuing education program for perinatal nursing staff working in the labor and delivery unit, postpartum unit, and nursery was developed. The program was based on a review of literature and consisted of the incidence and prevalence of PPD and issues surrounding stigma associated with PPD. It also included a discussion of the symptoms, risk factors, diagnosis, and treatment of PPD, guidelines for screening, and resources for referral. The role of the nurse in the provision of PPD patient education related to patient teaching and anticipatory guidance was also included.

Intervention Results: For this study, a 10-question PPD knowledge-based pre- and posttest was administered. A paired-samples t test was calculated to compare the mean pretest score to the mean final exam score. The mean score on the pretest was 68.88 (SD = 10.25), and the mean score on the posttest was 94.14 (SD = 8.68). Nurses had a significant increase in PPD knowledge from pretest to posttest, t(24) = −9.690, p < .001.One hundred nine postpartum patients were discharged during the 4-week time prior to the intervention; 0.9% (P1) received postpartum depression (PPD) education prior to discharge. One hundred twenty-nine postpartum patients were discharged over the course of 4 weeks postintervention; 93.8% (P2) received PPD education.

Conclusion: Patient education is an essential component of nursing practice. This study found that perinatal nurses are more likely to provide PPD education to patients when they are more knowledgeable about the condition. It highlights the importance of a needs assessment and continuing education and professional development for nursing staff. Results support the use of continuing education to improve nurses’ confidence in their ability to provide patient education and to increase their knowledge of PPD. The outcomes of this study support research by providing strategies to increase nurses’ ability to educate patients on PPD.

Study Design: Quasi-experimental study

Setting: 150-bed regional hospital with 1,600 annual births

Sample Size: 26 nurses; 49% survey response

Age Range: 24-66

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.

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education,

Intervention Description: The intervention in the "Project VACCINATE" study involved training pharmacists and pharmacy technicians from eight Quality Food Centers (QFC) Pharmacies in Seattle, Washington, to enhance their immunization care for adults. The study compared the impact of a whole-staff training strategy with a train-the-trainer strategy on the number of vaccines administered, staff confidence, and fidelity to the intervention. The whole-staff training group had all staff members attend a live, 2-hour training, while the train-the-trainer group sent 1 pharmacist and 1 pharmacy technician champion to attend the live training and then return to their pharmacy to train the other staff members ,[object Object],.

Intervention Results: The results of the "Project VACCINATE" study indicated that both the whole-staff training and train-the-trainer approaches were associated with an improvement in the number of vaccines administered, staff confidence, and fidelity to the intervention. Specifically, the number of total influenza, pneumococcal, herpes zoster, and pertussis vaccines administered increased by 12.6% in the whole-staff training group and 15.2% in the train-the-trainer group. Additionally, both training strategies increased confidence in identifying patients eligible for vaccines, talking to patients about vaccine needs, and using the bidirectional immunization platform. Pharmacy staff members in both groups indicated fidelity to key steps in the intervention process. The study concluded that community pharmacy organizations could use either training strategy when implementing enhancements to an existing patient care service, with the train-the-trainer strategy potentially being less resource-intensive ,[object Object],.

Conclusion: In conclusion, the available information provides insights into the impact of different training strategies on the immunization care provided by community pharmacists and pharmacy technicians. The "Project VACCINATE" study compared the impact of a whole-staff training strategy with a train-the-trainer strategy on the number of vaccines administered, staff confidence, and fidelity to the intervention. The results indicated that both training strategies were associated with an improvement in the number of vaccines administered, staff confidence, and fidelity to the intervention. Community pharmacy organizations could use either training strategy when implementing enhancements to an existing patient care service, with the train-the-trainer strategy potentially being less resource-intensive ,[object Object],,[object Object],.

Study Design: The study design for the comparison of two training methods in community pharmacy, "Project VACCINATE," involved a comparison of the impact of a whole-staff training strategy with a train-the-trainer strategy on the number of influenza, pneumococcal, herpes zoster, and pertussis vaccines administered by community pharmacists to adults, staff confidence, and fidelity to the intervention. The study was conducted at eight Quality Food Centers (QFC) Pharmacies in Seattle, Washington, and involved the implementation of different training approaches at these pharmacy locations ,[object Object],.

Setting: The setting in the comparison of two training methods in community pharmacy, specifically in "Project VACCINATE," is eight Quality Food Centers (QFC) Pharmacies in Seattle, Washington. QFC Pharmacy is a grocery store division of The Kroger Co. with 30 pharmacies located in Washington State. The QFC pharmacies provide routine and travel vaccines to adolescents and adults and have a culture of improving vaccine access to the community ,[object Object],.

Population of Focus: The target audience in the comparison of two training methods in community pharmacy, specifically in "Project VACCINATE," includes pharmacists and pharmacy technicians from eight Quality Food Centers (QFC) Pharmacies in Seattle, Washington. The study aimed to enhance the immunization care for adults provided by these pharmacy staff members ,[object Object],.

Sample Size: The sample size in the comparison of two training methods in community pharmacy, "Project VACCINATE," involved pharmacists and pharmacy technicians from eight Quality Food Centers (QFC) Pharmacies in Seattle, Washington. Specifically, the entire staff from four pharmacies received whole-staff training, and staff members from the other four pharmacies received a train-the-trainer approach ,[object Object],. The specific number of participants in the study is not provided in the excerpt.

Age Range: The age range of the participants in the comparison of two training methods in community pharmacy, "Project VACCINATE," is not specified in the available information.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Oral Health Education, Oral Health Supplies, PROVIDER/PRACTICE, Designated Clinic/Extended Hours, Quality Improvement/Practice-Wide Intervention

Intervention Description: The state of New Hampshire created a pilot project to integrate preventive oral health care for low-income women and children through local sites of the Women, Infants and Children (WIC) program.

Intervention Results: Preliminary data suggest promising results. Among the approximately 3,900 children served by the three pilot locations, 573 children (14 percent) received an oral health screening; 175 (31 percent) of those children were under age one. Of those screened, 48 children (8 percent) had untreated decay, 490 (86 percent) received a fluoride varnish application, and 80 (14 percent) received a dental sealant. A total of 857 pregnant women are served in the WIC program across all three pilot locations. Out of those women, 123 (14 percent) received an oral health screening. Of those screened, 88 (72 percent) showed untreated decay, and 46 (37 percent) were referred to a dentist for urgent needs. Out of the women who received an oral health screening, 114 (93 percent) received a fluoride varnish application, and 92 (75 percent) received sealants.

Conclusion: This profile details New Hampshire’s experiences and offers considerations for state agencies, federal policymakers, and other interested stakeholders to explore alternative channels for reaching low-income populations with oral health care and education.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Oral Health Education, Oral Health Supplies, PROVIDER/PRACTICE, Designated Clinic/Extended Hours, Quality Improvement/Practice-Wide Intervention

Intervention Description: The state of New Hampshire created a pilot project to integrate preventive oral health care for low-income women and children through local sites of the Women, Infants and Children (WIC) program.

Intervention Results: Preliminary data suggest promising results. Among the approximately 3,900 children served by the three pilot locations, 573 children (14 percent) received an oral health screening; 175 (31 percent) of those children were under age one. Of those screened, 48 children (8 percent) had untreated decay, 490 (86 percent) received a fluoride varnish application, and 80 (14 percent) received a dental sealant. A total of 857 pregnant women are served in the WIC program across all three pilot locations. Out of those women, 123 (14 percent) received an oral health screening. Of those screened, 88 (72 percent) showed untreated decay, and 46 (37 percent) were referred to a dentist for urgent needs. Out of the women who received an oral health screening, 114 (93 percent) received a fluoride varnish application, and 92 (75 percent) received sealants.

Conclusion: This profile details New Hampshire’s experiences and offers considerations for state agencies, federal policymakers, and other interested stakeholders to explore alternative channels for reaching low-income populations with oral health care and education.

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Nurse/Nurse Practitioner, Educational Material (Provider),

Intervention Description: The intervention was an online educational program that included information on PD screening and treatment, interviewing skills, screening tools, and treatment options. The intervention was designed based on the Theory of Planned Behavior (TPB) constructs, which include attitudes toward behavior, perceived behavioral control, subjective norms, perceived behavioral intention, and behavioral outcome. The study analyzed the impact of this specific intervention on participants' PD-related perceptions and intentions. Therefore, the intervention described aligns with a discernable strategy based on the TPB constructs.

Intervention Results: The results of the study showed positive gains in several key areas related to perinatal depression (PD) screening and treatment. Specifically, the intervention resulted in positive gains in PD-related perceived behavioral control (PBC), attitudes, subjective norms, knowledge, intention to screen and treat PD, and perceived importance of screening and treating PD from pre- to post-intervention . The findings indicated improvements in PD-related attitudes, knowledge, and the perceived importance of PD screening and treatment after the intervention . Additionally, the Theory of Planned Behavior Scale (TPBS) scores showed significant improvements from pre- to post-intervention, indicating a positive impact of the educational intervention on participants' perceptions and intentions related to PD screening and treatment . Overall, the results suggested that the PD online educational intervention was effective in improving participants’ PD-related PBC, attitudes, subjective norms, knowledge, and intention to screen and treat PD

Conclusion: PBC demonstrated a small-to-moderate positive association with perceived importance of screening and treating PD at post-intervention. Results from the current study suggest that the PD online educational intervention is effective in improving participants’ PD-related PBC, attitudes, subjective norms, knowledge, and intention to screen and treat PD.

Study Design: The study utilized a quasi-experimental, repeated-measures design. The study included a single group of participants, and data were collected at two time points: pre-intervention and post-intervention. The pre-intervention assessments occurred online directly prior to the participants engaging in the training, while the post-intervention assessments occurred online directly after the participants engaged in the training . This design allowed for the evaluation of changes in participants' perceptions and intentions related to perinatal depression (PD) screening and treatment before and after the educational intervention. The use of pre-post measures enabled the researchers to assess the impact of the intervention on participants' PD-related knowledge, attitudes, and intention to screen and treat PD, as well as their perceived importance of screening and treating PD. While the study did not include a control group, the use of a repeated-measures design allowed for the evaluation of changes within the same group of participants, which can provide valuable information about the impact of the intervention on participants' perceptions and intentions related to PD screening and treatment.

Setting: The study setting was not explicitly mentioned in the provided excerpts. However, the study was conducted with graduate nursing students, and the intervention was implemented and assessed online via Qualtrics . Therefore, it can be inferred that the study setting for the educational intervention and data collection was an online platform, likely associated with the academic institution where the graduate nursing program was located.

Population of Focus: The target audience of the study was graduate nursing students. The researchers chose nursing students as the participant population for several reasons. First, educational interventions for healthcare profession students have been well received and effective in improving student comfort with addressing postpartum depression. Second, nursing is the largest of the healthcare professions, with almost 3 million nurses practicing in the United States, indicating their potential impact on patient care. Third, the nursing profession has shifted to providing evidence-based care to patients; as such, this study aimed to improve perinatal depression-related evidence-based care

Sample Size: The study included a sample of 59 graduate nursing students

Age Range: The study did not provide a specific age range for the participants. However, the study included graduate nursing students, and the average age of the participants was 33.83 years (SD = 7.35)

Intervention Components (click on component to see a list of all articles that use that intervention): PROFESSIONAL_CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Home Visit (caregiver), Audit/Attestation

Intervention Description: The Maternal Infant Health Outreach Worker (MIHOW) program is an early-childhood home visiting program that uses community health workers (CHWs) to improve health outcomes in underserved communities. To be a MIHOW home visitor, women must be from the target community, be of the same culture and/or language group of families served, have completed all MIHOW training, and use the MIHOW curriculum. This randomized clinical trial evaluated the impact of MIHOW’s use of CHWs on selected maternal/infant outcomes up to 15 months postpartum. All study participants received the minimal education intervention (MEI), which consisted of printed educational materials about health and child development, compared to the intervention group that also received MIHOW home visitation services. Data was collected during interviews conducted by trained data collectors who were fluent in Spanish, also spoke English, and were from the same community.

Intervention Results: Enrolled women (N = 132) were randomly assigned, with 110 women completing the study (MEI = 53; MIHOW = 57). Positive and statistically significant (p < .01) effects of MIHOW were observed on breastfeeding duration, safe sleep practices, stress levels, depressive symptoms, emotional support, referral follow through, parental confidence, and infant stimulation in the home.

Conclusion: Findings provided strong evidence of the effectiveness of MIHOW for improving health outcomes in this sample. Using trained CHWs makes programs such as MIHOW a viable option for providing services to immigrant and underserved families.

Population of Focus: Pregnant Hispanic women living in middle Tennessee

Intervention Components (click on component to see a list of all articles that use that intervention): Nurse/Nurse Practitioner, Planning for Transition, Pediatric to Adult Transfer Assistance, Integration into Adult Care, YOUTH, Education on Disease/Condition, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: A cluster randomized clinical trial was conducted of a nurse-led transition intervention for 16- to 17-year-olds with moderate or complex CHD versus usual care. The intervention group received two 1-h individualized sessions targeting CHD education and self-management skills. The primary outcome was excess time to adult CHD care, defined as the interval between the final pediatric and first adult cardiology appointments, minus the recommended time interval, analyzed by using Cox proportional hazards regression accounting for clustering. Secondary outcomes included scores on the MyHeart CHD knowledge survey and the Transition Readiness Assessment Questionnaire.

Intervention Results: A total of 121 participants were randomized to receive the intervention (n = 58) or usual care (n = 63). At the recommended time of first adult appointment (excess time = 0), intervention participants were 1.8 times more likely to have their appointment within 1 month (95% confidence interval: 1.1 to 2.9; Cox regression, p = 0.018). This hazard increased with time; at an excess time of 6 months, intervention participants were 3.0 times more likely to have an appointment within 1 month (95% confidence interval: 1.1 to 8.3). The intervention group had higher scores at 1, 6, 12, and 18 months on the MyHeart knowledge survey (mixed models, p < 0.001) and the Transition Readiness Assessment Questionnaire self-management index (mixed models, p = 0.032).

Conclusion: A nurse-led intervention reduced the likelihood of a delay in adult CHD care and improved CHD knowledge and self-management skills.

Study Design: Cluster randomizedclinical trial

Setting: Clinic-based (Outpatient clinic)

Population of Focus: Adolescents attending outpatient clinics in 1 of 2 tertiary care pediatric cardiology programs in Canada

Data Source: Questionnaires

Sample Size: 121 (58 intervention, 63 control)

Age Range: 16-17 years

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Provider Training/Education, Guideline Change and Implementation, Provider Tools

Intervention Description: The training intervention was delivered by the research team and a parent representative during a half-day face-to-face workshop. Real-life case studies were discussed, and the parent representative described his/her own journey of receiving different news and the impact of the news on his/her family nit, during the workshop. Data were collected through pretraining and post-training questionnaires (5-point Likert scale, ranging from 1, indicating strongly disagree, to 5, indicating strongly agree) on participants' skills, knowledge, and attitudes related to delivering different news, as well as emistructured interviews.

Intervention Results: There was a significant improvement in domain 1 (of the TDF), which related to knowledge, skills, and beliefs about capabilities. Specifically, there were increased mean postworkshop scores relating to understanding of the effect of different news, importance of empathy when delivering different news, confidence to deliver different news, and skills to deliver different news (p < .001). Domain 2 related to social/professional roles and identity and social influences. All participants believed that HCPs who deliver different news needed appropriate training; however, only 30.8% (n ¼ 8) of the participants had received formal training in delivering different news. Domain 3 was related to environmental context and resources, wherein it was recorded almost all participants (96.2%; n ¼ 25) agreed that the training covered topics relevant to their practice. Domain 4 was optimism, wherein there was a significant improvement in understanding how to provide a balanced description of a condition (p < .001). Domain 5 related to beliefs and consequences. All participants stated they would recommend the training to colleagues. Domain 6 was emotion. There was a significant improvement (p < .001) with participants' rating being better able to manage their emotions related to delivering different news.

Conclusion: Communication between family members and HCPs is routine practice and influences all aspects of patient care and how families cope during their relatives' stay in the ICU. Critical illness and recovery is difficult for both patients and family members, which is why honest, accurate, PFCC-focused communication is fundamental. The READY framework allows HCPs to prepare themselves to deliver information in a supportive family-focused manner to minimise the distress, anxiety, and depression associated with receiving distressing information. The effectiveness of this framework should be examined further in the ICU context and include both economic and family member evaluation.

Study Design: sequential mixed-methods design

Setting: ICU England - National Health Service in South East England

Population of Focus: HCP - healthcare providers who deliver different news to parents, specifically those working in the National Health Service in South East England.

Sample Size: 26 multidisciplinary HCPs - 26 multidisciplinary healthcare providers who delivered different news to parents within the National Health Service in South East England. Eight of these healthcare providers were interviewed as part of the study .

Age Range: patients were children to adults

Intervention Components (click on component to see a list of all articles that use that intervention): Nurse/Nurse Practitioner, Education on Disease/Condition, Planning for Transition, HEALTH_CARE_PROVIDER_PRACTICE, YOUTH

Intervention Description: To evaluate the impact of a novel nurse-led transition intervention program designed for young adolescents (age 13-14 years) with congenital heart disease (CHD). We hypothesized that the intervention would result in improved self-management skills and CHD knowledge.

Intervention Results: We randomized 60 participants to intervention (n = 30) or usual care (n = 30). TRANSITION-Q score (range 0-100) increased from 49 ± 10 at baseline to 54 ± 9.0 at 6 months (intervention) vs 47 ± 14 to 44 ± 14 (usual care). Adjusted for baseline score, TRANSITION-Q scores at 1 and 6 months were greater in the intervention group (mean difference 5.9, 95% CI 1.3-10.5, P = .01). MyHeart score (range 0-100) increased from 48 ± 24 at baseline to 71 ± 16 at 6 months (intervention) vs 54 ± 24 to 57 ± 22 (usual care). Adjusted for baseline score, MyHeart scores at 1 and 6 months were greater in the intervention group (mean difference 19, 95% CI 12-26, P < .0001). Participants aged 14 years had a greater increase in TRANSITION-Q score at 6 months compared with 13-year-old participants (P < .05).

Conclusion: A nurse-led program improved transition readiness and CHD knowledge among young adolescents. This simple intervention can be readily adopted in other healthcare settings.

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, HOSPITAL, Quality Improvement, Policy/Guideline (Hospital), Sleep Environment Modification, CAREGIVER, Education/Training (caregiver)

Intervention Description: This project assessed the change in infant safe sleep practices within 6 children's hospitals after the implementation of a statewide quality improvement program.

Intervention Results: At baseline, only 279 (32.6%) of 856 of the sleeping infants were observed to follow AAP recommendations, compared with 110 (58.2%) of 189 (P < .001) at the project's conclusion. The presence of empty cribs was the greatest improvement (38.1% to 67.2%) (P < .001). Removing loose blankets (77.8% to 50.0%) (P < .001) was the most common change made. Audits also showed an increase in education of families about safe sleep practices from 48.2% to 75.4% (P < .001).

Conclusion: Multifactorial interventions by hospitalist teams in a multi-institutional program within 1 state's children's hospitals improved observed infant safe sleep behaviors and family report of safe sleep education. These behavior changes may lead to more appropriate safe sleep practices at home.

Study Design: QE: pretest-posttest

Setting: Six children’s hospitals without internal maternity centers or wellbaby nurseries (academic tertiary or quaternary care institutions) in OH

Population of Focus: Infants ≤1 year of age admitted to the general medical/surgical units who were not awake during the audit (excluding those in the ICUs, with tracheostomies, ventilator or noninvasive ventilator dependence, recent spinal surgeries, or upper airway anatomic abnormalities)

Data Source: Crib audit/infant observation

Sample Size: Baseline (n=856) Follow-up (n=189)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Training/Education, PROFESSIONAL_CAREGIVER, Education/Training (caregiver), HOSPITAL, Quality Improvement, Promotional Event, Audit/Attestation (Provider)

Intervention Description: Physicians from various units within the hospital system created and led multidisciplinary safe sleep teams. After attending a kickoff event to learn more about infant mortality and sleep related deaths, safe sleep champions from four teams were encouraged to work with their teams to tailor interventions, both specific to the needs of their areas and to address the global aim of county-wide sleep-related death reduction. The teams collaborated and produced a hospital-wide key driver diagram, highlighting the importance of screening, family education, staff education, and hospital reporting interventions. They were encouraged to complete as many Plan-Do-Study-Act (PDSA) cycles as necessary to improve safe sleep practices in both hospital and home settings.

Intervention Results: Our teams have significantly increased compliance with safe sleep practices in the inpatient and neonatal intensive care unit settings (P < 0.01). We have also increased screening and education on appropriate safe sleep behaviors by ED and primary care providers (P < 0.01). Our county's sleep-related death rate has not significantly decreased during the collaborative.

Conclusion: Our collaborative has increased American Academy of Pediatrics-recommended safe sleep practices in our institution, and we decreased sleep-related deaths in our primary care network. We have created stronger ties to our community partners working to decrease infant mortality rates. More efforts will be needed, both within and outside of our institution, to lower our community's sleep-related death rate.

Setting: Nationwide Children’s Hospital and delivery hospitals throughout Columbus Ohio

Population of Focus: Hospital healthcare providers

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Audit/Attestation (provider), PROFESSIONAL_CAREGIVER, Education/Training (caregiver), HOSPITAL, Quality Improvement

Intervention Description: This study evaluates a quality improvement program to improve compliance with appropriate safe sleep practices in both children’s and birthing hospitals. Hospitalists from both settings were recruited to join the Ohio American Academy of Pediatrics’ EASE (Education and Sleep Environment) injury prevention collaborative to increase admitted infant safe sleep behaviors. The collaborative leadership team required hospitalist physician champions at each institution to form and lead multidisciplinary groups composed of other physicians and trainees, nursing leadership, hospital administrators, child life specialists, and other health care providers as deemed necessary. The leadership team educated participating hospital teams about safe sleep evidence-based guidelines, local statistics, quality improvement principles, and the use of Plan Do-Study-Act cycles within their institutions via interactive exercises. Multidisciplinary interventions in the areas of physician and/or nursing staff education, environmental management strategies, policy creation/revisions, and parental support and education were among the interventioned encourages. The Ohio AAP chapter instructed teams to collect data by conducting random audits, using a standardized tool (available by request).

Intervention Results: A total of 37.0% of infants in children's hospitals were observed to follow the current American Academy of Pediatrics recommendations at baseline; compliance improved to 59.6% at the project's end (P < .01). Compliance at birthing centers was 59.3% and increased to 72.5% (P < .01) at the collaborative's conclusion.

Conclusion: This study demonstrates that a quality improvement program in different hospital settings can improve safe sleep practices. Infants in birthing centers were more commonly observed in appropriate sleep environments than infants in children's hospitals.

Setting: 3 Children's hospitals and 6 birthing hospitals in Ohio

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Active Management of Labor, Labor Support, HOSPITAL, STATE, Quality Improvement, Policy/Guideline (State), Collaboratives, Policy/Guideline (Hospital)

Intervention Description: California hospitals whose nulliparous, term, singleton, vertex cesarean delivery rates were above the Healthy People 2020 goal of 23.9% in 2015 were invited to participate in the Supporting Vaginal Birth collaborative led by the California Maternal Quality Care Collaborative (CMQCC). The participating hospitals were organized into small teams of six to eight hospitals each led by a physician and a nurse mentor who provided clinical expertise and quality-improvement coaching. The mentors were from other hospitals and had experience in prior CMQCC quality collaboratives. The collaborative focused on implementation of ACOG–SMFM guidelines for labor management and on increasing nursing labor support. A modified Institute for Healthcare Improvement Breakthrough Series collaborative model was used with monthly team check-in phone calls and sharing of implementation ideas and materials. Hospitals received training materials, Grand Rounds for physicians and nurses, educational webinars, and on-site assistance from their mentors.

Intervention Results: Among collaborative hospitals, the nulliparous, term, singleton, vertex cesarean delivery rate fell from 29.3% in 2015 to 25.0% in 2017 (2017 vs 2015 adjusted OR [aOR] 0.76, 95% CI 0.73-0.78). None of the six safety measures showed any difference comparing 2017 to 2015. As a sensitivity analysis, we examined the tercile of hospitals with the greatest decline (31.2%-20.6%, 2017 vs 2015 aOR 0.54, 95% CI 0.50-0.58) to evaluate whether they had greater risk of poor maternal and neonatal outcomes. Again, no measure was statistically worse, and the severe unexpected newborn complications composite actually declined (3.2%-2.2%, aOR 0.71, 95% CI 0.55-0.92).

Conclusion: Mothers and neonates participating in a large-scale Supporting Vaginal Birth collaborative had no evidence of worsened birth outcomes, even in hospitals with large cesarean delivery rate reductions, supporting the safety of efforts to reduce primary cesarean delivery using American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine guidelines and enhanced labor support.

Setting: 56 California hospitals

Population of Focus: Nulliparous women with term singleton vertex gestations

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Participation Incentives, Quality Improvement/Practice-Wide Intervention, Data Collection Training for Staff, Expert Feedback Using the Plan-Do-Study-Act-Tool, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), STATE, POPULATION-BASED SYSTEMS, Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: Seven pediatric primary care practices participated in New Mexico's Developmental Screening Initiative in a year-long quality improvement project with the goal of implementing standardized developmental screening tools.

Intervention Results: At baseline, there were dramatic differences among the practices, with some not engaged in screening at all.

Conclusion: Overall, the use of standardized developmental screening increased from 27% at baseline to 92% at the end of the project.

Study Design: QE: pretest-posttest

Setting: Seven primary care practices in a large urban area and small regional community in New Mexico

Population of Focus: Children ages 1 through 60 months

Data Source: Child medical record

Sample Size: Total medical records reviewed at baseline and follow-up (n=1139)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material (Provider), Educational Material, Media Campaign (Print Materials, Public Address System, Social Media)

Intervention Description: HBWW is a multi-dimensional, community-based approach to preventing preventable preterm births. In HBWW sites, community health leaders, including hospitals, health departments and local March of Dimes staff partner to work together to implement multiple (bundled) interventions known to impact preterm birth; to improve systems of care in their community so that these interventions reach the patients who need them; and to promote awareness of preterm birth across all the community, including providers, patients and the public. The pilot/demonstration project was built on an innovative, ecological model designed to work in real world settings, where a multitude of factors—not a single intervention— influence outcomes. Like other public health problems, prematurity must be addressed in communities with broader approaches than just medical care. Working with providers, the goal of the project was to move research to practice quickly and effectively. With patients, the teams worked to improve networks of support services that addressed patient needs. For the public, the goal was that everyone, whether grandmothers, friends or business leaders, understood the impact of prematurity on families and the community.

Intervention Results: (In the pilot study in Kentucky) Real world implementation of HBWW in Kentucky provided potential for “contamination” due to a high likelihood that comparison sites were exposed to HBWW and other prematurity prevention messages due to overall state and national publicity regarding the HBWW program. Such contamination is an important consideration when interpreting HBWW evaluation results. Additionally, comparison site knowledge that its performance was being scrutinized (the Hawthorne Effect [Landsberger, 1958]) may have influenced its activities and outcomes. Population Objective Patients Create positive changes in knowledge, attitudes and behavior regarding preterm birth circumstances and modifiable risk factors, with a focus on late preterm birth. Perinatal providers Bring the latest research to everyday practice, particularly regarding late preterm infants; create positive changes in knowledge, attitudes and behaviors regarding adherence to professional guidelines on preterm birth prevention (especially late preterm birth) and elective inductions and cesareans. Public (community) Increase awareness of the importance of preventing preterm birth and the risks associated with late preterm birth. Chapter 3: The HBWW Initiative marchofdimes.com 21 The HBWW evaluation used an ecological design. This design means that the unit of analysis was the aggregated results of the intervention and comparison groups rather than individual hospitals, patients or providers. The HBWW Evaluation Team (including an independent program evaluator hired for the project and March of Dimes and Kentucky Department for Public Health staff) used data collected from the state vital records system prior to project implementation and at follow-up. They compared data over time and between intervention and comparison sites. March of Dimes staff tracked process data, and the program evaluator gathered additional data via surveys and interviews. Outcome data was collected through two methods: 1) consumer and perinatal provider surveys on knowledge, attitudes and behaviors related to preterm birth, and 2) analyses of extant vital records and birth certificate data (on preterm birth rates and other outcomes) provided by the Kentucky Department for Public Health. The HBWW logic model in Figure 3.4 has more information on inputs (resources), principle strategies, outputs, and intended behavioral, policy, health status and cost outcomes of the project. Before the HBWW initiative, Kentucky had increasing preterm birth rates. A year after HBWW implementation, Kentucky had the largest drop in preterm birth rates of any of its contiguous states. There were no other major, new initiatives addressing preterm birth in the state during this time. Both survey and birth outcome data provide exciting evidence about the success of the HBWW Kentucky pilot. Some of the most compelling outcomes are anecdotes from women and perinatal providers. HBWW successfully built relationships, partnerships and collaborations that resulted in enhancement of services and patient care. Many of these anecdotes are shared throughout this manual.

Conclusion: A lesson learned through the HBWW Kentucky pilot is that data has the power to influence behavior and, therefore, directly affect program success. For example, KDMC staff recognized a problem—a substantial number of pregnant women had substance abuse problems, illustrated by the number of newborns with positive toxicology screens. To address this issue, KDMC staff developed a “plan” to appoint a perinatal social worker to address prenatal substance abuse. The site applied for a March of Dimes community chapter grant and received funding for the perinatal social worker position. The social worker’s objectives (the “do” step) included screening women for tobacco, alcohol and drug use during pregnancy; providing appropriate referrals; and providing continuity of care for high-risk prenatal patients by improving communication between the social services department and private physician practices at the hospital. Staff examined toxicology screens at a woman’s entry into prenatal care and at delivery. Once the social worker was established at the site, women with positive toxicology screens at prenatal care enrollment were less likely to deliver infants with positive toxicology screens than prior to the social worker being available. These findings (“study”) and supporting anecdotal evidence encouraged the hospital system to continue funding the social work position beyond the grant funding period. In addition, the social worker was validated and felt empowered to continue work to reduce substance use during pregnancy. Both of these results are part of the “act” stage in PDSA. As new HBWW programs move forward, program staff should share stories and data with partners to celebrate program success. Outcome measurement and process tracking provide program staff with information on accomplishments. Defining measurable objectives for each HBWW core component in a project’s implementation workplan offers opportunities to track success. Although barriers and roadblocks may exist, small and large wins along the way provide reasons to acknowledge and celebrate project successes. Program staff can share these successes with partners, collaborators and the community and thank them for their support through media efforts and during community outreach activities. Each person working on prematurity prevention makes life better for children, their families and the communities in which they live.

Study Design: Ecological Design Study

Setting: Pilot Study based in Kentucky.

Data Source: data collected from the state vital records system prior to project implementation and at follow-up

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Expert Support (Provider), Quality Improvement/Practice-Wide Intervention, Data Collection Training for Staff, Office Systems Assessments and Implementation Training

Intervention Description: The aim of this study was to use family-centered measures to estimate the effect of a collaborative quality improvement program designed to help practices implement systems to promote early childhood development services.

Intervention Results: The number of care delivery systems increased from a mean of 12.9 to 19.4 of 27 in collaborative practices and remained the same in comparison practices (P=.0002). The proportion of children with documented developmental and psychosocial screening among intervention practices increased from 78% to 88% (P<.001) and from 22% to 29% (P=.002), respectively. Compared with control practices, there was a trend toward improvement in the proportion of parents who reported receiving at least 3 of 4 areas of care.

Conclusion: The learning collaborative was associated with an increase in the number of practice-based systems and tools designed to elicit and address parents' concerns about their child's behavior and development and a modest improvement in parent-reported measures of the quality of care.

Study Design: QE: pretest-posttest nonequivalent control group

Setting: Pediatric and family primary care practices (17 collaborative education, 18 comparison practices) in Vermont and North Carolina

Population of Focus: Children ages 0-48 months receiving well-child visits

Data Source: Child medical record

Sample Size: Unknown number of chart audits

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Hospital Policies, Baby Friendly Hospital Initiative, HOSPITAL, Policy/Guideline (Hospital)

Intervention Description: The Baby-Friendly Hospital Initiative (BFHI), developed by the World Health Organization (WHO) and United Nations Children's fund, is a global program aimed at promoting, protecting, and supporting breastfeeding. Hospitals in the BFHI community must develop clear policies related to staff training and breastfeeding promotion from pregnancy until hospital discharge following childbirth. The aim of this study was to compare women in non-BFHI-accredited hospitals in a socio-economically homogeneous region of southern Italy (Campania region) with a "baby-friendly hospital," as recognized by UNICEF, in Verbania in the Piedmont region of northern Italy (Castelli Hospital) in terms of 1) breastfeeding in the days following childbirth; 2) the information provided by health personnel before and after childbirth; 3) knowledge about breastfeeding before and during hospitalizations; and 4) participation in antenatal classes.

Intervention Results: In general, both groups showed good basic knowledge about different aspects of breastfeeding. In both regions, about 90% reported that the information received during the antenatal classes simplified the breastfeeding experience.

Conclusion: Our study confirms the importance of systematic promotion of breastfeeding and subsequent delivery of adequate support to maternity departments, in accordance with international guidelines.

Study Design: Evaluation data

Setting: Ten accredited and non-accredited hospitals in the Piedmont region of northern Italy

Population of Focus: Women receiving care at the ten participating hospitals

Sample Size: 786 women (580 in Campania + 206 women in Piedmont)

Age Range: Not reported

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

Intervention Components (click on component to see a list of all articles that use that intervention): Health_Care_Provider_Practice, Screening Tool Implementation Training, Provider Training/Education

Intervention Description: The ECHO Autism STAT model was designed to provide diagnostic training for PCPs. At the outset of the program, participants attended a 1.5 day training, which included an orientation to the program, an overview of autism symptoms, and specific interactive and hands-on training on administration and interpretation of the STAT. Following the in-person training, PCPs participated in bimonthly 90-min ECHO Autism STAT clinics for 12 months, during which additional training in diagnosis and management of autism was provided through didactics and case-based learning, with an emphasis on evidence-based care and best-practice guidelines for screening, diagnosis, and management.

Intervention Results: Results indicated improvements in PCP practice and self-efficacy, and feasibility of the model for enhancing local access to care.

Conclusion: By combining hands-on training in standardized techniques with ongoing virtual mentorship and practice, the program emphasized both timely diagnosis and appropriate referral for more comprehensive assessment when necessary.

Setting: Pediatric practice

Population of Focus: Primary care peditricians

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Expert Support (Provider),

Intervention Description: Transition-age youth and young adults with autism spectrum disorder have complex healthcare needs, yet the current healthcare system is not equipped to adequately meet the needs of this growing population. Primary care providers lack training and confidence in caring for youth and young adults with autism spectrum disorder. The current study developed and tested an adaptation of the Extension for Community Healthcare Outcomes model to train and mentor primary care providers (n = 16) in best-practice care for transition-age youth and young adults with autism spectrum disorder. The Extension for Community Healthcare Outcomes Autism Transition program consisted of 12 weekly 1-h sessions connecting primary care providers to an interdisciplinary expert team via multipoint videoconferencing. Sessions included brief didactics, case-based learning, and guided practice.

Intervention Results: Measures of primary care provider self-efficacy, knowledge, and practice were administered pre- and post-training. Participants demonstrated significant improvements in self-efficacy regarding caring for youth/young adults with autism spectrum disorder and reported high satisfaction and changes in practice as a result of participation. By contrast, no significant improvements in knowledge or perceived barriers were observed.

Conclusion: Overall, the results indicate that the model holds promise for improving primary care providers' confidence and interest in working with transition-age youth and young adults with autism spectrum disorder. However, further refinements may be helpful for enhancing scope and impact on practice.

Study Design: Program evaluation

Setting: Nationwide Extension for Community Healthcare Outcomes (ECHO) Autism Transition program delivered via videoconferencing

Population of Focus: Primary care providers from across the country

Sample Size: 16 providers

Age Range: Adult providers serving pediatric populations 0 to 17 years

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Motivational Interviewing, Technology-Based Support,

Intervention Description: The aim of this study is to test the effects of an electronic screening and feedback tool and training for primary care clinicians on care and adolescent health behaviors. We conducted a stepped-wedge cluster randomized trial with six clinics randomly assigned to sequential crossover from control to intervention periods with clinician training between periods. Adolescents (ages 13-18) with a well visit during the control periods (n = 135) received usual care, while adolescents during the intervention periods (n = 167) received the electronic screening and feedback tool prior to their well visit, with results sent to their clinicians. Adolescents completed surveys at baseline, 1 day, 3 months, 6 months, and 12 months. Linear mixed effects models were used to examine associations between outcomes and treatment, controlling for time as a fixed effect and clinic as a random effect. All analyses employed intent-to-treat analyses and utilized multiple imputations for missing data.

Intervention Results: Adolescents who received the intervention had a higher rate of counseling for their endorsed risk behaviors during the well visit (45% vs. 33%, Wald's T = 2.29, p = .02). There were no significant intervention effects on adolescent satisfaction with the clinician or perception of patient centeredness. The intervention was associated with a small but statistically significant reduction in overall risk score relative to control at 3 months (-.63, 95% confidence interval [-1.07, -.19], Cohen's d = .21), but not at 6 or 12 months.

Conclusion: The results suggest that electronic screening and feedback may be associated with small reductions in risk behaviors at 3 months but that changes do not persist at longer term follow-up.

Study Design: Stepped-wedge cluster randomized trial

Setting: Six Puget Sound Pediatric Research Network Clinics located in Western Washington

Population of Focus: Adolescents aged 13-18 who had a scheduled well-child visit at a participating clinic were invited

Sample Size: 302 participants (135 adolescents in the control group and 167 adolescents in the intervention group)

Age Range: Adolescents aged 13-18

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Development/Improvement of Services, Continuing Education of Hospital Providers, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Consultation Systems (Inter-Hospital Systems), Consultation Systems (Hospital), STATE, Policy/Guideline (State), Funding Support

Intervention Description: This report summarizes the evaluation of a national demonstration program of such regionalization that was funded by the Robert Wood Johnson Foundation (RWJF) in 1975.

Intervention Results: In both funded regions and comparison areas, the neonatal mortality rates decreased sharply over the decade of the 1970s. This decline was linked to shifts in the hospital of delivery that indicated antepartum risk identification and transfer of management of high-risk pregnancies to tertiary centers for delivery, a change in service pattern consistent with some aspects of regionalization. The centralization of high-risk deliveries appeared so widespread that the special effect of the RWJF program could not be detected.

Conclusion: Surveys of surviving 1-year-old infants showed that the decrease in neonatal mortality was accompanied by a decrease in selected morbidity.

Study Design: QE: pretest-posttest nonequivalent control group

Setting: Eight regions and eight comparison regions

Population of Focus: Infants born weighing ≤1500

Data Source: Data from reproduced computer tapes of births and matched infant death and birth certificates obtained from state and local health offices in several states.

Sample Size: Intervention group: Pretest (n≈ 4080) Intervention (n≈ 3416) Posttest: (n≈ 4033) Comparison: Pretest: (n≈ 5221) Intervention: (n≈ 4297) Posttest: (n≈ 4596)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Provision of Safe Sleep Item, HOSPITAL, Quality Improvement, Policy/Guideline (Hospital), Crib Card, Visual Display (Hospital), Sleep Environment Modification, Promotional Event, CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), Attestation (caregiver), HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation

Intervention Description: The purpose of this quality improvement project was to promote the AAP safe sleep recommendations and provide appropriate role modeling of these recommendations for hemodynamically stable infants throughout their hospital stay.

Intervention Results: Observations noted an improvement from 70% to 90% (p< 0.01) of infants in a safe sleep position when comparing pre- and postintervention results. There were some improvements in knowledge of and agreement with the AAP guidelines after the educational intervention, but not as much as expected.

Conclusion: There was inconsistency between nursing knowledge and practice about safe infant sleep. Nurses were aware of the AAP recommendations, but it took time to achieve close to full compliance in changing clinical practice. Observation was an important part of this initiative to reinforce knowledge and role model best practice for parents.

Study Design: QE: pretest-posttest

Setting: Golisano Children’s Hospital at the University of Rochester in NY

Population of Focus: Hemodynamically stable infants less than 1 year of age in the mother-baby unit and nine pediatric units

Data Source: Crib audit/infant observation

Sample Size: Baseline (n=65) Follow-up (n=60)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Health_Care_Provider_Practice, Screening Tool Implementation Training, Provider Training/Education

Intervention Description: Each EAE Hub, including clinicians and staff, participated in an on-site multiday intensive training on ASD evaluation. Included in the didactic curriculum were education on developmental screening, structured developmental history and interviewing techniques (including the assessment of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5] ASD symptoms), medical and psychological differential diagnosis and common comorbid concerns, communication skills for delivery of diagnosis, and current evidence regarding ASD interventions.

Intervention Results: Our findings suggest that developing a tiered system of developmental screening and early ASD evaluation is feasible in a geographic region facing health care access problems. Through targeted delivery of education, outreach, and intensive practice-based training, large numbers of young children at risk for ASD can be identified, referred, and evaluated in the local primary care setting.

Conclusion: The EAE Hub model has potential for dissemination to other states facing similar neurodevelopmental health care system burdens. Implementation lessons learned and key system successes, challenges, and future directions are reviewed.

Setting: Intervention sites ranged from large health systems to private pediatric practices

Population of Focus: Clinicians and staff of pediatric practices

Intervention Components (click on component to see a list of all articles that use that intervention): Residents/Medical Students, Provider Training/Education, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: Medical personnel play a critical role in caregiver safe infant sleep education. However, training outcomes in the safe infant sleep training literature have been mixed. Promising approaches that warrant further investigation are the use of behavioral skills training and pyramidal training. The current study consisted of two experiments.

Intervention Results: Experiment 1 extended Carrow et al. (2020) and Vladescu et al. (2020) by teaching medical students safe infant sleep practices using behavioral skills training. Discriminated responding was examined across trained and untrained environmental arrangements using a multiple-baseline design. All participants arranged safe sleep environments following behavioral skills training. In Experiment 2, we used pyramidal behavioral skills training to train medical students to teach others safe sleep practices. Results indicated high procedural integrity scores following training and generalization of skills.

Conclusion: All participants arranged safe sleep environments following behavioral skills training. In Experiment 2, we used pyramidal behavioral skills training to train medical students to teach others safe sleep practices. Results indicated high procedural integrity scores following training and generalization of skills.

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Residents/Medical Students, PROFESSIONAL_CAREGIVER, Education/Training (caregiver)

Intervention Description: This study consisted of two experiments: 1) Medical students were taught safe sleep practices using behavioral skills training (BST) with an emphasis on sleep positioning (supine), surface, and items in the crib). The training included instruction, modeling, rehearsal, and feedback. 2) Using a pyramidal BST, medical students were trained to teach others safe sleep practices.

Intervention Results: Results indicated high procedural integrity scores following training and generalization of skills.

Conclusion: Pyramidal BST participants were provided with a training manual that included a written protocol of the training procedures, a checklist of the training components, data sheets, a safe infant sleep brochure, and a list of common questions about safe infant sleep with corresponding answers. Responses were examined pre- and post-training using a multiple-baseline design.

Setting: Urban university

Population of Focus: Medical students

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

Intervention Description: A pediatric group with 25 clinics and 150 providers used multifaceted approaches to implement workflow processes and an electronic health record (EHR) flowsheet to improve child developmental screening.

Intervention Results: Within 25 months, screening rates improved from 60% to >95% within the 3 preventive visit age groups for a total of more than 30 000 children. Professionals valued the team process improvements. Children enrolled in Medicaid, black children, and those living in lower income zip codes had lower screening rates than privately insured, white children, and those living in higher income areas. Ages and Stages Questionnaire 3rd edition results were significantly different by gender, race/ethnicity, insurance, and income categories across all groups. Referral rates varied by race/ethnicity and zip code of residence.

Conclusion: This project resulted in an effective and efficient process to improve child developmental screening that was valued by pediatric professionals. Analyses of patient demographics revealed disparities in services for the most vulnerable families. Ongoing quality improvement, health services research, and advocacy offer hope to improve health equity.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, PROVIDER/PRACTICE, Educational Material (Provider), Online Material/Education/Blogging

Intervention Description: This study examined the degree to which the pregnant or postpartum women, in the process of quitting smoking, felt that writing in a blog about their smoking cessation journeys helped them in their efforts to become or remain smoke free.

Intervention Results: Participants were asked to complete an online survey, which had closed-ended questions regarding their sociodemographic and smoking characteristics. Once they completed the survey, semistructured qualitative interviews were conducted over the phone. Findings suggest that blogging might combine several evidence-based behavioral strategies for tobacco cessation, such as journaling and getting support from others who use tobacco.

Conclusion: Being part of a blogging community of women who have experienced or are experiencing similar challenges can be therapeutic and help women gain confidence in their ability to quit smoking. In conclusion, blogging may help pregnant and postpartum women quit smoking by increasing their social support and promoting self-reflection.

Study Design: Quasi experimental cross sectional - survey

Setting: Online forum for pregnant women

Population of Focus: Pregnant women in an online forum

Data Source: Survey, phone interview

Sample Size: 5

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Screening Tool Implementation Training, Office Systems Assessments and Implementation Training, Data Collection Training for Staff

Intervention Description: To determine the impact of the Healthy Steps for Young Children Program on quality of early childhood health care and parenting practices.

Intervention Results: Percentage of children with developmental assessments was 83.1% for intervention and 41.4% for control group (OR=8.00; 95% CI=6.69, 9.56; P<.001)

Conclusion: Universal, practice-based interventions can enhance quality of care for families of young children and can improve selected parenting practices.

Study Design: RCT and QE: nonequivalent control group

Setting: Pediatric practices in 14 states (6 randomization sites: San Diego, CA; Iowa City, IA; Allentown, PA; Pittsburgh, PA; Florence, SC; Amarillo, TX. 9 QE sites: Birmingham, AL/Chapel Hill, NC; Grand Junction, CO/Montrose, CO; Chicago, IL; Kansas City, KS; Boston, MA; Detroit, MI; Kansas City, MO; New York, NY; Houston, TX/Richmond, TX)

Population of Focus: Children ages 0-36 months

Data Source: Child medical record

Sample Size: Randomization Sites: - Intervention (n=832) - Control (n=761) - Total (n=1593) Quasi-Experimental Sites: - Intervention (n=1189) - Control (n=955) - Total (n=2144) Total: - All families (n=3737) - Intervention: (n=2021) - Control (n=1716)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, PROFESSIONAL_CAREGIVER, Education/Training (caregiver), Provision of Safe Sleep Item, HOSPITAL, Quality Improvement, Sleep Environment Modification, Policy/Guideline (Hospital), Audit/Attestation

Intervention Description: The hospital’s safe sleep task force (SSTF) implemented targeted interventions using the American Academy of Pediatrics (AAP) policy statement as the gold standard and based on hospital data/crib audits to address areas of greatest nonadherence to recommendations. The SSTF created a standalone Infant Safe Sleep Policy for all infants admitted to the hospital; provided education on safe sleep to health care providers; created a patient education video for parents of all hospitalized infants; increased its Halo sleep sack allotment; and revised the room set-up to encourage adherence to AAP’s safe sleep guidelines. A safe sleep audit tool was used by clinical assistant or nurse (per hospitalized sleeping session) to assess adherence to safe sleep guidelines. The overall aim of the initiative was to increase the average weekly adherence to the AAP-recommended safe sleep practices for hospitalized infants to ≥95% over 12 months.

Intervention Results: There was a significant improvement in overall adherence to safe sleep recommendations from baseline (M = 70.8%, SD 21.6) to end of study period (M = 94.7%, SD 10.0) [t(427) = -15.1, P ≤ 0.001]. Crib audits with 100% adherence increased from a baseline (M = 0%, SD 0) to the end of the study period M = 70.4%, SD = 46) [t(381)= -21.4, P ≤ 0.001]. This resulted in two trend shifts on the p-chart using Institute for Healthcare Improvement control chart rules.

Conclusion: Targeted interventions using QI methodology led to significant increases in adherence to safe sleep guidelines. Notable improvements in behavior indicated significant changes in safe sleep culture. We also noted continued adherence in follow-up audits reflecting sustainability.

Setting: Tertiary children's hospital

Population of Focus: Hospital healthcare providers

Intervention Components (click on component to see a list of all articles that use that intervention): Parent Engagement, Educational Material (caregiver), Provider Reminder/Recall Systems,

Intervention Description: - Intervention description: Culturally tailored evidence-based HPV vaccine educational intervention, including community outreach, education sessions, and personalized reminders

Intervention Results: - Results: HPV vaccine initiation and completion rates increased significantly after the intervention, with higher completion rates among children compared to adults. Psychosocial factors such as knowledge, awareness, and intention to vaccinate also improved significantly after the intervention.

Conclusion: - Conclusion: The Tiempo de Vacunarte program was successful in improving HPV vaccination rates and psychosocial factors in a predominantly Hispanic community. Culturally tailored educational interventions and community outreach can be effective in increasing vaccination rates in underserved populations.

Study Design: - Study design: Prospective community-based intervention utilizing a pre-post design

Setting: - Setting: El Paso County, Texas, located on the US-Mexico border

Population of Focus: - Target audience: Individuals aged 18-26 years or parents/guardians of children aged 9-17 years who had not completed the HPV vaccine series

Sample Size: - Sample size: 2,380 participants were eligible and recruited into the program, with 1,796 unique surveys included in the analysis

Age Range: - Age range: 9-26 years

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education

Intervention Description: The goal was to evaluate, through an American Academy of Pediatrics demonstration project, the effectiveness of a curriculum and train-the-trainer model in changing child care providers' behaviors regarding safe infant sleep practices.

Intervention Results: Provider awareness of the American Academy of Pediatrics infant supine sleep position recommendation increased from 59.7% (both groups) to 64.8% (control) and 80.5% (intervention). Exclusive use of the supine position in programs increased from 65.0% to 70.4% (control) and 87.8% (intervention). Observed supine placement increased from 51.0% to 57.1% (control) and 62.1% (intervention).

Conclusion: A sudden infant death syndrome risk reduction curriculum using a train-the-trainer model is effective in improving the knowledge and practices of child care providers.

Study Design: Cluster RCT

Setting: California, Louisiana, Montana, and Pennsylvania

Population of Focus: Child care professionals (child care facility directors and child care providers)

Data Source: Infant observation

Sample Size: Intervention  Initial (n=328)  Follow-up (n=282) Control  Initial (n=285)  Follow-up (n=253)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Education/Training (caregiver), PROVIDER/PRACTICE, Nurse/Nurse Practitioner, Quality Improvement/Practice-Wide Intervention

Intervention Description: To assess the effectiveness of 2 interventions separately and combined to promote infant safe sleep practices compared with control interventions.

Intervention Results: The primary outcome was maternal self-reported adherence to 4 infant safe sleep practices of sleep position (supine), sleep location (room sharing without bed sharing), soft bedding use (none), and pacifier use (any); data were collected by maternal survey when the infant was aged 60 to 240 days. The independent effect of the nursing quality improvement intervention was not significant for all outcomes. Interactions between the 2 interventions were only significant for the supine sleep position.

Conclusion: Among mothers of healthy term newborns, a mobile health intervention, but not a nursing quality improvement intervention, improved adherence to infant safe sleep practices compared with control interventions. Whether widespread implementation is feasible or if it reduces sudden and unexpected infant death rates remains to be studied.

Intervention Components (click on component to see a list of all articles that use that intervention): Adult-led Support/Counseling/Remediation, Referrals, Educational Material, YOUTH, PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE, Screening Tool Implementation

Intervention Description: The obective of this study was to describe innovations added to the CEASE intervention and to track 2 year post-intervention implementation data on families who were screened for tobacco use.

Intervention Results: Electronic screening was used to routinely identify tobacco users, leading to increased potential for offering cessation assistance to all household members who smoke.

Conclusion: Improved delivery of smoking cessation services to families may be achieved by integrating technological innovations into routine pediatric practice.

Intervention Components (click on component to see a list of all articles that use that intervention): School-Based Dental Services, CLASSROOM_SCHOOL, HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education

Intervention Description: This community intervention study compared the changes in oral health knowledge, attitude, practices (KAP), and oral health indicators among 12-14-year-old children who received a school based oral health promotion delivered by auxiliaries in a rural setting in India.

Intervention Results: The improvement in total KAP score, oral hygiene, and gingival bleeding from baseline to follow up was higher in the intervention arm (p < 0.05). The prevented fraction for net caries increment were 23.33% and 20.51% for DMFT and DMFS, respectively. Students in the intervention group had a higher dental attendance (OR 2.92, p < 0.001). The change in treatment index, restorative index, and care index were significantly higher in the intervention arm (p < 0.001).

Conclusion: Inclusion of available primary care auxiliaries like school health nurses and teachers in oral health promotion is a novel, effective, and sustainable strategy to improve oral health indicators and utilization in rural areas in low resource settings.

Intervention Components (click on component to see a list of all articles that use that intervention): Continuing Education of Hospital Providers, , HOSPITAL

Intervention Description: We aimed to assess the impact of a multidisciplinary high-fidelity simulation curriculum on teamwork during resuscitation and transport of EP infants.

Intervention Results: Overall, time of completion of key resuscitation and transport tasks decreased, with significant decreases in the time to attach the pulse oximeter, transfer of the infant to the transport isolette, and exit the DR. There was no significant difference in CTS scores from Scenario 1 to 3. Scenarios led by first-year fellows showed a trend towards improvement in all CTS categories. A comparison of teamwork scores pre- and post-simulation curriculum during direct observation of high-risk deliveries in real time revealed a significant increase in each CTS category.

Conclusion: A high-fidelity teamwork-based simulation curriculum decreased time to complete key clinical tasks in the resuscitation and transport of EP infants, with a trend towards increased teamwork in scenarios led by junior fellows. There was improvement of teamwork scores during high-risk deliveries on pre-post curriculum assessment.

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Development/Improvement of Services, Continuing Education of Hospital Providers, Needs Assessment

Intervention Description: This was a prospective population-based cohort study of perinatal outcomes before and after 1 full year of implementation of the preterm birth prevention program.

Intervention Results: In the state overall, the rate of singleton preterm birth was reduced by 7.6% and was lower than in any of the preceding 6 years. This reduction amounted to 196 cases relative to the year before the introduction of the initiative and the effect extended from the 28-31 week gestational age group onward. Within the tertiary level center, the rate of preterm birth in 2015 was also significantly lower than in the preceding years.

Conclusion: A comprehensive and multifaceted preterm birth prevention program aimed at both health care practitioners and the general public, operating within the environment of a government-funded universal health care system can significantly lower the rate of early birth. Further research is now required to increase the effect and to determine the relative contributions of each of the interventions.

Setting: Hospitals in Western Australia

Population of Focus: Pregnant women in Western Australia

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, PROVIDER/PRACTICE, Provider Reminder/Recall Systems, Provider Education

Intervention Description: A three‐year intervention targeting Vietnamese physicians in solo practice in California.

Intervention Results: After the intervention, performance rates increased significantly for smoking cessation counseling (p = 0.02), Pap testing (p = 0.004), and pelvic examinations (p = 0.01).

Conclusion: The results demonstrate the efficacy of an intervention targeting Vietnamese primary care physicians in promoting smoking cessation counseling, Pap testing, and pelvic examinations, but not other cancer prevention activities.

Study Design: RCT

Setting: Private practices with physicians who were members of the Vietnamese Physicians’ Associations in Northern and Southern CA

Population of Focus: Physicians in solo practice who had received their medical training in Vietnam

Data Source: Physicians’ medical records

Sample Size: Total (N=48) Analysis (n=20) Intervention (n=9); Control (n=11) N=physicians

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Community-Based Group Education, Patient Navigation, Enabling Services, PROVIDER/PRACTICE, Provider Reminder/Recall Systems, Provider Education, Designated Clinic/Extended Hours, Female Provider, COMMUNITY, Television Media, Other Media, POPULATION-BASED SYSTEMS

Intervention Description: Development and implementation of a multifaceted intervention using community-based participatory research (CBPR) methodology and evaluated with a quasi-experimental controlled design with cross-sectional pre-intervention (2000) and post-intervention (2004) telephone surveys. Data were analyzed in 2005.

Intervention Results: Significantly greater odds of Pap smear for women in intervention county than in control county (OR=2.02, 95% CI: 1.37-2.99)

Conclusion: A multifaceted community-based participatory research (CBPR) intervention was associated with increased Pap test receipt among Vietnamese-American women in one community.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Santa Clara County, CA and Harris County, TX

Population of Focus: Vietnamese women living in either county

Data Source: Computer-assisted telephone interviewing system

Sample Size: Baseline(n=1,566) Intervention (n=798); Control (n=768) Follow-up (n=2,009) Intervention (n=1,004); Control (n=1,005)

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Nurse/Nurse Pratitioners, HOSPITAL, Quality Improvement, Crib Card, Audit/Attestation

Intervention Description: This quality improvement pilot program used a bundle approach to create a safe sleep program that consisted of safe sleep education for NICU nurses, the creation and implementation of safe sleep cards, and revision of the institution’s safe sleep policy. To assess safe sleep practices, sleep environment audits were completed pre- and post-safe sleep program. To assess nurses’ safe sleep knowledge, a safe sleep questionnaire was delivered pre- and post-education.

Intervention Results: The change in SSP (ΔSSP) following safe sleep program implementation and change in nurses' safe sleep knowledge (ΔKnowledge) following education.

Conclusion: SSP increased from 25 percent to 61 percent compliance, and nurses' knowledge scores increased from 83 percent to 97 percent.

Setting: Level III NICU

Population of Focus: Hospital staff

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Labor Support, Midwifery, HOSPITAL, Chart Audit and Feedback, Peer Review, Quality Improvement

Intervention Description: This quality improvement initiative involved multiple interventions that were monitored over time by statistical process control charts. Components included a nested case-control review of local risk factors, provider and patient education, multidisciplinary reviews based on published guidelines with feedback, provider report cards, commitment to labor duration guidelines, and a focus on natural labor. The nursing team received training and certification in holistic nursing, and certified nurse-midwives were employed and given delivery privileges. The six-bed Karmanos Center for Natural Birth (NBC) was opened in November 2014 for low-risk women who were managed without continuous fetal monitoring, epidural analgesia, and obstetrical interventions.

Intervention Results: Control chart analysis demonstrated that the institutional cesarean delivery rate was due to culture and not "outlier" obstetricians. The primary singleton vertex cesarean rate decreased from 23.4% to 14.1% and the NTSV rate decreased from 34.5% to 19.2% (both p < .0001). There was a decrease in NICU admission but no significant changes in postpartum hemorrhage, chorioamnionitis, stillbirth, or neonatal mortality.

Conclusion: Structured quality improvement initiatives may decrease primary cesarean deliveries without increasing maternal or perinatal morbidity.

Setting: Beaumont Hospital, Royal Oak, an academic-community hybrid facility in southeastern Michigan

Population of Focus: Nulliparous women with term singleton vertex gestations

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Motivational Interviewing, PROVIDER/PRACTICE, Provider Training/Education

Intervention Description: We assessed whether smoking cessation improved among pregnant smokers who attended Women, Infants and Children (WIC) Supplemental Nutrition Program clinics trained to implement a brief smoking cessation counseling intervention, the 5As: ask, advise, assess, assist, arrange.

Intervention Results: Of 71,526 pregnant smokers at WIC enrollment, 23% quit. Odds of quitting were higher among women who attended a clinic after versus before clinic staff was trained (adjusted odds ratio, 1.16; 95% confidence interval, 1.04–1.29). The adjusted mean infant birth weight was, on average, 96 g higher among women who reported quitting (P < 0.0001), regardless of clinic training status.

Conclusion: Training all Ohio WIC clinics to deliver the 5As may promote quitting among pregnant smokers, and thus is an important strategy to improve maternal and child health outcomes.

Study Design: Quasi experimental cross sectional

Setting: Women, Infants and Children clinics in Ohio

Population of Focus: All pregnant women in their first trimester who reported smoking attending a Women, Infants and Children clinic in Ohio that was trained to use the 5A’s smoking cessation package

Data Source: Self-report, medical records

Sample Size: 71526

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Labor Support, Provider Training/Education, HOSPITAL, Guideline Change and Implementation, Quality improvement

Intervention Description: This was a quality improvement project and practice change was part of the Reducing Primary Cesarean Learning Collaborative from the American College of Nurse-Midwives. It was designed to increase nurse self-efficacy and the use of continuous labor support and to reduce the rate of primary cesarean births among nulliparous women with low-risk pregnancies. The multi-component intervention, called the “Comfort in Labor Safety Bundle,” included updating existing labor policies, providing nurse education and training workshops, modifying the documentation of care, and procuring labor support equipment. Nurse confidence and skill in labor support techniques was measured using the Self-Efficacy Labor Support Scale. The study also tracked how many women were provided continuous labor support and the primary cesarean birth rate among women who were nulliparous and low risk.

Intervention Results: Nurses' mean self-efficacy scores increased from 76.67 in 2016 to 86.96 in 2019 (p < .001). The proportion of women who were provided continuous labor support increased from a baseline of 4.38% (47/1,074) in January 2015 through March 2016 to 18.06% (82/454) in July through December 2019 (p < .001). The primary cesarean birth rate for nulliparous women with low-risk pregnancies remained stable, at approximately 18% from 2015 to 2019.

Conclusion: Implementation of the Comfort in Labor Safety Bundle improved nurse self-efficacy in labor support techniques and increased the frequency of continuous labor support.

Setting: Level II regional hospital in Virginia

Population of Focus: Nulliparous women with low risk pregnancies

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education,

Intervention Description: Adverse cross-cultural interactions are a persistent problem within medicine impacting minority patients' use of services and health outcomes. To test whether 1) enhancing the evidence-based Physician Asthma Care Education (PACE), a continuing medical education program, with cross cultural communication training (PACE Plus) would improve the asthma outcomes of African American and Latino/Hispanic children; and 2) whether PACE is effective in diverse groups of children. A three-arm randomized control trial was used to compare PACE Plus, PACE, and usual care. Participants were primary care physicians (n = 112) and their African American or Latino/Hispanic pediatric patients with persistent asthma (n = 867). The primary outcome of interest included changes in emergency department visits for asthma overtime, measured at baseline, and 9 and 21 months following the intervention. Other outcomes included hospitalizations, asthma symptom experience, caregiver asthma-related quality of life, and patient-provider communication measures.

Intervention Results: Over the long term, PACE Plus physicians reported significant improvements in confidence and use of patient-centered communication and counseling techniques (p < 0.01) compared to PACE physicians. No other significant benefit in primary and secondary outcomes was observed in this trial.

Conclusion: PACE Plus did not show significant benefit in asthma-specific clinical outcomes. More trials and multi-component strategies continue to be needed to address complex risk factors and reduce disparities in asthma care.

Study Design: Randomized controlled trial

Setting: Nine Michigan (MI) rural and urban cities, Bronx, New York (NY), and Atlanta, Georgia (GA)

Population of Focus: Primary care physicians (PCPs) and their African American or Latino/Hispanic pediatric patients with persistent asthma. The PCPs were board-certified in pediatrics or family medicine, treated children with asthma, practiced full-time in either MI, NY, or GA, and were not self-reporting Hispanic/Latino or African American racial identity. The caregivers of the children also needed to self-identify as African American or Hispanic/Latino, have primary responsibility for the child's care, and have access to a telephone.

Sample Size: 112 primary care physicians and 867 families of children with asthma

Age Range: Adult providers and children ages 1 to 16 years of age

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Nurse/Nurse Practitioner, PROFESSIONAL_CAREGIVER, Education/Training (caregiver), HOSPITAL, Quality Improvement, Crib card, Audit/Attestation

Intervention Description: A multidisciplinary team developed a quality improvement initiative to create a hospital-based safe sleep environment for all newborns and infants prior to discharge. The safe sleep initiative included two key elements: (1) parent education about safe infant sleep that included verifying their understanding of safe sleep, and (2) modeling of safe infant sleep environment by hospital staff. To monitor compliance, documentation of parent education, caregiver surveys, and hospital crib check audits were tracked monthly. A visual safe sleep “crib ticket”—a checklist of safe sleep guidelines-- was placed at the bedside of newborns who were ready for supine positioning. Investigators used Plan-Do-Study-Act (PDSA) cycles to evaluate the impact of the initiative from October 2015 through February 2018.

Intervention Results: Safe sleep education was documented for all randomly checked records (n = 440). A survey (n = 348) revealed that almost all caregivers (95.4%) reported receiving information on safe infant sleep. Initial compliance with all criteria in WBN (n = 281), NICU (n = 285), and general pediatric inpatient units (n = 121) was 0%, 0%, and 8.3%, respectively. At 29 months, WBN and NICU compliance with all criteria was 90% and 100%, respectively. At 7 months, general pediatric inpatient units' compliance with all criteria was 20%.

Conclusion: WBN, NICU and general pediatric inpatient unit collaboration with content experts led to unit-specific strategies that improved safe sleep practices.

Setting: Well-baby nursery (WBN) and NICU in an academic, quaternary care, regional referral center

Population of Focus: Hospital staff

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Nurse/Nurse Practitioner, HOSPITAL, Quality Improvement

Intervention Description: The primary goals of the initiative were to improve nurses' adherence to the 2016 AAP safe sleep recommendations, including the supine infant sleep position, and to increase role modeling of a safe infant sleep environment. The initiative included a slide-show presentation on SUID, the AAP 2016 recommendations for infant safe sleep, rationale behind the recommendations, and common barriers to following the safe sleep guidance. The post-intervention evaluation included testing of nurses' knowledge, infant crib audits, and nurses' evaluation of the intervention.

Intervention Results: A significant improvement was found in overall nurse education scores. Crib audits demonstrated a significant improvement in the following elements: use of multiple blankets, swaddling of the infant, and parent teaching. Nursing surveys reported an increase in confidence to practice safe sleep recommendations and educate and redirect parents.

Conclusion: Implementing a safe sleep initiative can increase nurses' knowledge, improve adherence to recommendations with modeling safe sleep practices, and increase parent awareness of safe sleep recommendations, potentially positively affecting adherence after discharge.

Setting: Community hospital in a women's services unit

Population of Focus: Full-time nurses and infant care technicians

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Nurse/Nurse Practitioner

Intervention Description: The purpose of this quality improvement initiative was to increase the percentage of eligible infants being placed in safe sleep environments by registered nurses in a NICU. An evidence-based safe sleep bundle was developed and implemented in a level IV NICU at an academic medical center in the Southeastern United States. Data were subsequently collected for 5 months via biweekly crib audits.

Intervention Results: Of the 744 infants audited in the QI period, 604 were observed in a safe sleep environment. From the pre- to postintervention period, SSPs increased by 68% (preintervention: 13%, postintervention: 81%, P value < .001). Adherence to the varying components of SSPs also reflected statistically significant improvements.

Conclusion: SSPs should be endorsed and modeled in all NICUs. Introducing proper SSPs in the hospital setting may lead to better compliance at home by the infants' caregivers.

Setting: Academic medical institution in Southeast U.S.

Population of Focus: Registered nurses in NICU

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement, Provider Training/Education, HOSPITAL, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: The purpose of this QI initiative was to increase the percentage of eligible infants being placed in safe sleep environments by registered nurses in a NICU.

Intervention Results: Of the 744 infants audited in the QI period, 604 were observed in a safe sleep environment. From the pre- to postintervention period, SSPs increased by 68% (preintervention: 13%, postintervention: 81%, P value < .001). Adherence to the varying components of SSPs also reflected statistically significant improvements.

Conclusion: SSPs should be endorsed and modeled in all NICUs. Introducing proper SSPs in the hospital setting may lead to better compliance at home by the infants' caregivers.

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Provider Reminder/Recall Systems,

Intervention Description: The intervention included a Systems and Strategies Inventory, provider-focused training, and implementation of evidence-based strategies to increase HPV vaccination rates, such as client reminders and recall, provider prompts, standing orders, and provider assessment and feedback.

Intervention Results: The intervention led to a significant increase in HPV vaccination rates, with a 25.9% increase in the proportion of adolescents who received at least one dose of the vaccine.

Conclusion: The multilevel intervention using national partnerships was effective in improving HPV vaccination rates among adolescents in FQHCs. - Primary outcomes: HPV vaccination rates among adolescents aged 13 years

Study Design: Multilevel quality improvement intervention using national partnerships

Setting: Federally Qualified Health Centers (FQHCs) in Alabama, Louisiana, and Texas

Population of Focus: Adolescents aged 13 years

Sample Size: 488 FQHCs and their active 13-year-old medical patient population

Age Range: 13 years

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Education, Quality Improvement/Practice-Wide Intervention, Provider Incentives (Maintenance of Certification)

Intervention Description: A provider-focused intervention that included repeated contacts, education, individualized feedback, and strong quality improvement incentives to raise HPV vaccination rates at two federally qualified community health centers.

Intervention Results: Girls and boys in intervention practices significantly increased HPV vaccine initiation during the active intervention period relative to control practices (girls OR 1.6, boys OR 11; p<0.001 for both). Boys at intervention practices were also more likely to continue to initiate vaccination during the post-intervention/maintenance period (OR 8.5; p<0.01). Girls and boys at intervention practices were more also likely to complete their next needed HPV vaccination (dose 1, 2 or 3) than those at control practices (girls OR 1.4, boys OR 23; p<0.05 for both). These improvements were sustained for both boys and girls in the post-intervention/maintenance period (girls OR 1.6, boys OR 25; p<0.05 for both).

Conclusion: Provider-focused interventions including repeated contacts, education, individualized feedback, and strong quality improvement incentives have the potential to produce sustained improvements in HPV vaccination rates.

Study Design: Cluster RCT

Setting: 1 outpatient pediatric/adolescent department at a major urban academic medical center and 7 affiliate federally qualified community health centers

Population of Focus: Females who received primary care (>1 well visit) in the pediatric/adolescent department at a participating practice during the 2-year study period, excluding females who were pregnant during the study period and patients who received care in both an intervention and control practice5

Data Source: Electronic medical records

Sample Size: Total (n=3,961)6

Age Range: 11/21/2022

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 .

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Continuing Education of Hospital Providers, STATE, Policy/Guideline (State)

Intervention Description: Viewing the 1001-1500 gm regional cohort of fetuses as a potential "market" for center delivery, and measuring a center's penetration into this market, quantitates how well a center draws to itself these small, high-risk fetuses for delivery.

Intervention Results: An Illinois center's annual penetration rate into its regional market for the years 1973-1983 is presented and significant increases are found. The penetration rates of nine Illinois perinatal centers are calculated and wide discrepancies are found. Defining a high-risk regional cohort as a market stresses a perinatal center's obligation to its region.

Conclusion: The penetration rate into a defined market measures how well a center fulfills this obligation.

Study Design: Time trend analysis

Setting: Illinois North Central Perinatal Region: 31 hospitals including one tertiary center

Population of Focus: Infants born weighing 1001 to 1500 gm

Data Source: Data from 1973-1982 obtained from the Illinois Department of Public Health live birth files. Data from 1983 from an Illinois Department of Public Health administered monthly hospital reporting system.

Sample Size: 1973 (n= 100) 1974 (n= 104) 1975 (n= 102) 1976 (n= 88) 1977 (n= 102) 1978 (n= 97) 1979 (n= 101) 1980 (n= 85) 1981 (n= 100) 1982 (n= 83) 1983 (n= 81)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Patient Reminder/Invitation, Standing Order

Intervention Description: The intervention included training in giving a strong HPV vaccination recommendation, provider prompts, feedback on missed opportunities, and the optional implementation of standing orders and/or reminder-recall strategies

Intervention Results: The multicomponent intervention led to a reduction in missed opportunities for HPV vaccination in both community practices and continuity clinics, with an overall improvement in HPV vaccination rates

Conclusion: The study concluded that the multicomponent intervention, including training in giving a strong HPV vaccination recommendation, provider prompts, and feedback on missed opportunities, effectively reduced missed opportunities for HPV vaccination in both community practices and continuity clinics

Study Design: The study utilized a quality improvement (QI) intervention approach over a 9-month period, involving a multicomponent intervention to reduce missed opportunities for HPV vaccination

Setting: The study was conducted in 33 community practices and 14 pediatric continuity clinics across multiple states, including Alabama, Maine, New Hampshire, New Jersey, Tennessee, and Vermont

Population of Focus: The target audience included healthcare providers in community practices and pediatric continuity clinics, focusing on adolescents aged 11-17 years

Sample Size: The study involved a total of 47 practices, with 33 community practices and 14 pediatric continuity clinics

Age Range: The study focused on adolescents aged 11-17 years

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education,

Intervention Description: The multifaceted intervention targeted two groups of providers: nursing staff and medical providers (including physicians, advanced practice providers, and residents). The interventions were implemented on admission, during the hospital stay, and at discharge. The nursing interventions included screening and documenting a child’s influenza vaccination status on admission, best practice advisories in the electronic health record (EHR), mandatory web-based interactive teaching modules, and ongoing reminders. The medical provider interventions included documentation of influenza vaccination status in the admission note, inclusion of influenza vaccine orders in admission and discharge order sets, best practice advisory prompts in the EHR, and team-based vaccination status weekly reports ,[object Object],.

Intervention Results: The intervention was associated with a significant increase in vaccine ordering rates, with a 24 percentage point increase in vaccine ordering and approximately a 9 percentage point increase in overall vaccination rates. The highest increase was observed for the inpatient general medical teams, where the interventions were more targeted, and led to a decrease in time from admission to a vaccine order placed. The intervention was also associated with higher odds of appropriate vaccination screening on admission, higher odds of a vaccination being ordered, and higher odds of a child being vaccinated against influenza at discharge. The vaccine ordering rate among eligible children was 28.8% in the pre-intervention season versus 50.2% in the intervention season (p < 0.001) ,[object Object],,[object Object],.

Conclusion: A multifaceted intervention targeting nurses, residents and providers comprising education, visual reminders, vaccination reports and financial incentives is an effective way of improving influenza vaccine ordering, resulting in higher inpatient influenza vaccination rates.

Study Design: The study design was a pre-post interventional study conducted on medical inpatient units at Children’s Hospital Colorado. The pre-intervention period was from September 2016 to April 2017, and the intervention period was from September 2017 to April 2018 ,[object Object],.

Setting: The study was conducted at Children’s Hospital Colorado (CHCO) Anschutz Medical Center in Aurora, Colorado. CHCO is a large academic quaternary care center primarily serving children in the Denver metropolitan area, greater Colorado, and the seven surrounding states. The main campus in Aurora and its six satellite locations have 479 beds and admit over 15,000 inpatients per year ,[object Object],.

Population of Focus: The target audience of the study was medical and nursing providers caring for patients aged 6 months of age or older on the general and subspecialty medical pediatric inpatient units at Children’s Hospital Colorado ,[object Object],.

Sample Size: The study included a total of 8,573 pediatric inpatients admitted from September 2016 to April 2018, with 4,050 inpatients in the pre-intervention season (2016-2017) and 4,523 inpatients in the intervention season (2017-2018) ,[object Object],.

Age Range: The study included pediatric inpatients aged 6 months of age or older ,[object Object],. The mean age of the patients in the study was 7.6 years ,[object Object],.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Telephone Support, PROVIDER/PRACTICE, Nurse/Nurse Practitioner, Educational Material, Other Education, Other Person-to-Person Education

Intervention Description: Nurse-delivered telephone support, relapse prevention training, and information about the adverse effects of smoking and ETS.

Intervention Results: At 6 months postpartum, 36% remained abstinent; 26% smoking; and 38% smoking daily. At 12 months postpartum, 78.5% reported no difficulties in making homes smoke- free. By 12 months this % increased to 86.9%.

Conclusion: While regional legislative activity has been effective in reducing ETS in many public places,12 private homes cannot be easily regulated. Public health education remains the most effective means to protect children from ETS in their homes. While there is growing appreciation for the importance of smoke-free homes,133 there remain significant misperceptions about effective ways to enact this protection.

Study Design: RCT

Setting: Hospital (time of birth) and Community (telephone)

Population of Focus: Mothers who had quit smoking during pregnancy

Data Source: Interview data collection at birth and at 6 and 12 months postpartum.

Sample Size: 251 mothers

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Education on Disease/Condition, YOUTH, Planning for Transition, Pediatric to Adult Transfer Assistance, Integration into Adult Care, Care Coordination, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: Children's hospitals must provide developmentally appropriate care to increasing numbers of young adults with complex healthcare needs as they transition to adult-oriented care. This article describes the patients, service, and short-term outcomes of an interprofessional healthcare transition (HCT) consult team comprised of nurses, social workers, a community health worker, and physicians. The Adult Consult Team's tiered population framework stratifies patients by medical complexity. The team coordinates HCT services for patients with the highest complexity. Patients at least 18 years old are eligible if they have at least two specialists or an intellectual or developmental disability (IDD). Through a comprehensive medical and psychosocial assessment, the team prepares patients/families for adult-oriented healthcare.

Intervention Results: The Adult Consult Team received 197 referrals from July 2017 to June 2018. Patients had at least two specialists (73%), IDD (71%), technology dependence (e.g., gastrostomy tube, 37%) and Medicaid insurance (57%). The team assisted patients seen in its outpatient clinic with navigating mental health services (39%), insurance issues (13%), IDD services (15%), and the guardianship process (37%) and creating comprehensive care plans.

Conclusion: The Adult Consult Team transferred 30 patients with medical complexity to adult primary and specialty care, significantly improving pediatric inpatient and outpatient capacity for pediatric-aged patients. A broad range of young adult medical, psychosocial, legal, educational, and vocational needs were addressed.

Study Design: Cohort pilot evaluation

Setting: Hospital/clinicbased (Large tertiary-care children’s hospital and ambulatory) network located in an East Coast urban community

Population of Focus: Patients aged 18 and older who had not transitioned from pediatric to adult care who need specialty care from at least two specialties and/or had an intellectual or developmental disability

Data Source: Medical records

Sample Size: 197 patient referrals; at analysis, 97 were seen in consultation

Age Range: Mean age 20.4 years

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education,

Intervention Description: Through an Advanced Nursing Workforce grant by the Health Re-sources and Services Administration, a partnership was established with the Institute for Perinatal Quality Improve-ment to provide training for health care clinicians and stu-dents on ways to SPEAK UP against implicit and explicit bias with an emphasis on maternal health.

Intervention Results: Dismantling racism is a continuous process. Activities included self-re-flection, small group meetings, antiracism and bias training, and community engagement.

Conclusion: Acknowledging that racism and health inequities exist and directly contrib-ute to the rise in maternal and infant mortality is only the beginning. Rethinking nursing education, curriculum, and clinical care to train culturally responsive health care clini-cians is required to address systemic and structural racism in health care.

Study Design: Qualitative

Setting: Community-based

Population of Focus: Healthcare clinicians

Sample Size: 80

Age Range: Not disclosed

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

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material (Provider), Consultation (Parent/Family), Education on Disease/Condition,

Intervention Description: The intervention consisted of a five-component toolkit aimed at improving healthcare providers' communication skills about HPV vaccination. The components included: (1) making presumptive and strong recommendations, (2) using motivational interviewing techniques, (3) providing a fact sheet, (4) showing disease images, and (5) using a website.

Intervention Results: - Providers in the intervention group reported higher use of the intervention components, including making presumptive and strong recommendations and using motivational interviewing techniques. - Use of the fact sheet was significantly correlated with high parental acceptance of the HPV vaccine. - Providers in the intervention group did not report spending more time discussing the vaccine with hesitant parents than control providers. - Providers in the intervention group reported greater improvement in parental HPV vaccine acceptance than control providers. The study found that the intervention resulted in substantial improved HPV vaccine series initiation and completion among adolescents in the intervention arm compared to controls. Providers in the intervention group reported greater improvement in parental HPV vaccine acceptance than control providers. However, the change in parental vaccine acceptance over time was not statistically significant between groups.

Conclusion: Communication-based interventions, such as the five-component toolkit used in this study, have the potential to increase HPV vaccination rates among adolescents. - Future research should examine the effectiveness of a streamlined version of the intervention, focusing on communication skills training and fact sheets.

Study Design: The study used a randomized controlled trial design.

Setting: The study was conducted in a central Colorado practice-based research network.

Population of Focus: Healthcare providers who work with adolescent patients.

Sample Size: The study included 187 providers from 16 practices (8 intervention, 8 control).

Age Range: The study focused on adolescent patients who were eligible for HPV vaccination.

Intervention Components (click on component to see a list of all articles that use that intervention): Education on Disease/Condition, Planning for Transition, YOUTH, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: We assessed the efficacy of our transition clinic on patient education and empowerment and identified correlates of successful transition.

Intervention Results: Overall, 592 patients were seen at least once in our transition service between 2015 and 2022 (age 15.2 ± 1.8 years, 47.5% female). Most adolescents (53%) had moderate CHD, followed by simple (27.9%) and severe (19.1%) CHD. Learning disability (LD) was present in 18.9% and physical disability (PD) in 4.7%. In patients without LD, knowledge of their cardiac condition improved significantly from the first to the second visit (naming their condition: from 20 to 52.3%, P < 0.0001; describing: 14.4-42.7%, P < 0.0001; understanding: 26.1-60.7%, P < 0.0001), and from the second to the third (naming: 67.4%, P = 0.004, describing: 61.4%, P < 0.001, understanding: 71.1%, P = 0.02;). Patients with LD did not improve their disease knowledge over time (all P > 0.05). Treatment adherence and management involvement, self-reported anxiety, and dental care awareness did not change over time. Successful transition (attendance of ≥ 2 clinics) was achieved in 49.3%. Younger age at the first visit, simpler CHD, and absence of PD were associated with successful transition.

Conclusion: A transition service positively impacts on patient education and empowerment in most CHD adolescents transitioning to adult care. Strategies to promote a tailored support for patients with LD should be sought, and earlier engagement should be encouraged to minimize follow-up losses.

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Motivational Interviewing, Screening Tool Implementation,

Intervention Description: Health risk behaviors are the most common sources of morbidity among adolescents. Adolescent health guidelines (Guidelines for Preventive Services by the AMA and Bright Futures by the Maternal Child Health Bureau) recommend screening and counseling, but the implementation is inconsistent. This study aims to test the efficacy of electronic risk behavior screening with integrated patient-facing feedback on the delivery of adolescent-reported clinician counseling and risk behaviors over time. This was a randomized controlled trial comparing an electronic tool to usual care in five pediatric clinics in the Pacific Northwest. A total of 300 participants aged 13-18 years who attended a well-care visit between September 30, 2016, and January 12, 2018, were included. Adolescents were randomized after consent by employing a 1:1 balanced age, sex, and clinic stratified schema with 150 adolescents in the intervention group and 150 in the control group. Intervention adolescents received electronic screening with integrated feedback, and the clinicians received a summary report of the results. Control adolescents received usual care. Outcomes, assessed via online survey methods, included adolescent-reported receipt of counseling during the visit (measured a day after the visit) and health risk behavior change (measured at 3 and 6 months after the visit).

Intervention Results: Of the original 300 participants, 94% (n=282), 94.3% (n=283), and 94.6% (n=284) completed follow-up surveys at 1 day, 3 months, and 6 months, respectively, with similar levels of attrition across study arms. The mean risk behavior score at baseline was 2.86 (SD 2.33) for intervention adolescents and 3.10 (SD 2.52) for control adolescents (score potential range 0-21). After adjusting for age, gender, and random effect of the clinic, intervention adolescents were 36% more likely to report having received counseling for endorsed risk behaviors than control adolescents (adjusted rate ratio 1.36, 95% CI 1.04 to 1.78) 1 day after the well-care visit. Both the intervention and control groups reported decreased risk behaviors at the 3- and 6-month follow-up assessments, with no significant group differences in risk behavior scores at either time point (3-month group difference: β=-.15, 95% CI -0.57 to -0.01, P=.05; 6-month group difference: β=-.12, 95% CI -0.29 to 0.52, P=.57).

Conclusion: Although electronic health screening with integrated feedback improves the delivery of counseling by clinicians, the impact on risk behaviors is modest and, in this study, not significantly different from usual care. More research is needed to identify effective strategies to reduce risk in the context of well-care.

Study Design: Randomized controlled trial

Setting: Five pediatric clinics in the Pacific Northwest

Population of Focus: Adolescents aged 13-18 years who attended a well-care visit at the pediatric clinics in Washington State

Sample Size: 300 adolescents (150 in intervention group and 150 in control group)

Age Range: Adolescents aged 13-18 years

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Provider Training/Education, Guideline Change and Implementation, Provider Tools

Intervention Description: Nine primary care sites from pediatrics, family medicine, and medicine-pediatrics implemented the Adolescent Champion model. Each site identified a multidisciplinary champion team to undergo training on adolescent-centered care, deliver prepackaged trainings to other staff and providers, make youth-friendly site changes, implement a standardized flow to confidentially screen for risky behaviors, and complete a quality improvement project regarding confidentiality practices. Adolescent patients, staff, and providers were surveyed at baseline, year-end, and 1-year follow-up to assess changes.

Intervention Results: Adolescent patients’ perceived experience with both their provider and the clinic overall significantly improved from baseline to year-end across every survey measure, and this improvement was consistently sustained at 1-year follow-up

Conclusion: Implementing the Adolescent Champion model successfully helped primary care sites become more adolescent-centered. Further studies are needed to evaluate the effects of this model on patient outcomes.

Study Design: Over the first 6 months of implementing the model, Adolescent Champion teams gathered to attend 3 2-hour trainings (Continuing Medical Education credits provided). Clinic staff at the Adolescent Champion sites administered baseline and year-end paper surveys to (1) adolescent patients aged 12-21 years to assess satisfaction with the site and providers (with a goal of 50 surveys per site per collection period), (2) providers to assess attitudes and usual practice when caring for adolescents, and (3) staff members to assess the clinic climate related to the care of adolescents.

Setting: Primary care sites in MI - nine primary care sites, including pediatrics, family medicine, and medicine-pediatrics

Population of Focus: Providers of adolescent care & their patients - primary care providers with an interest in adolescent health

Sample Size: The sample size varied across the different surveys and time points. For example, the adolescent patient surveys had 474 respondents at baseline, 386 at year-end, and 331-343 at 1-year follow-up . The staff survey had 121 respondents at baseline and 109 at year-end . However, it's important to note that the exact number of unique adolescent patients, providers, and staff who completed the surveys at all three time points is unknown .

Age Range: 12-21 year old patients - The research focused on adolescent patients aged 12-21 years . This age range is consistent with the World Health Organization's definition of adolescence, which spans from 10 to 19 years of age .

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

Intervention Description: The objective is to evaluate the effects of implementing the Adolescent Champion model, a novel quality improvement program targeted at helping primary care sites become more adolescent-centered. Nine primary care sites from pediatrics, family medicine, and medicine-pediatrics implemented the Adolescent Champion model. Each site identified a multidisciplinary champion team to undergo training on adolescent-centered care, deliver prepackaged trainings to other staff and providers, make youth-friendly site changes, implement a standardized flow to confidentially screen for risky behaviors, and complete a quality improvement project regarding confidentiality practices. Adolescent patients, staff, and providers were surveyed at baseline, year-end, and 1-year follow-up to assess changes.

Intervention Results: Adolescent patients' experiences with both their provider and the site overall significantly improved (P values from <.0001 to .004, N = 474 baseline, 386 year-end). Staff perceived an improvement in clinic practices relating to adolescents and in their ability to make institutional and personal change (P < .0001, N = 121 baseline, 109 year-end). The majority of changes were sustained 1-year postintervention. Frequently noted site improvements included: (1) initiating a method to gather feedback from adolescent patients; (2) adding trainings on confidentiality, cultural humility, and using a nonjudgmental approach; (3) updating immunizations at every visit; and (4) training providers in long acting reversible contraception via implant training.

Conclusion: Implementing the Adolescent Champion model successfully helped primary care sites become more adolescent-centered. Further studies are needed to evaluate the effects of this model on patient outcomes.

Study Design: Pre-post study

Setting: Nine primary care sites from pediatrics, family medicine, and medicine-pediatrics. These sites were located in urban and suburban areas in the northeastern United States.

Population of Focus: Multidisciplinary champion teams from each site, as well as adolescent patients, staff members, and providers at these primary care sites.

Sample Size: 1. Providers: 85 providers completed the survey at baseline, 59 at year-end, and 56 at 1-year follow-up. 2. Staff members: 121 staff members completed the survey at baseline, 109 at year-end, and 112 at 1-year follow-up. 3. Adolescent patients: The exact sample size for adolescent patients was not provided, but the study mentioned that 474 adolescent patients were included at baseline and 386 at year-end.

Age Range: Adolescents aged 12-21 years who received care at the participating primary care sites; Adult providers and staff members.

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

Intervention Description: The purpose of this study is to decrease wait time and improve access to developmental-behavioral pediatric (DBP) evaluation in children 4 years of age and younger as part of a quality improvement (QI) initiative in an urban safety-net hospital. A primary care pediatrician received DBP minifellowship training 6 hours per week for 1 year to become a developmentally-trained primary care clinician (DT-PCC). DT-PCCs then conducted developmental evaluations that consisted of using a Childhood Autism Rating Scale and Brief Observation of Symptoms of Autism to evaluate children 4 years and younger referred within the practice. Baseline standard practice involved a 3-visit model: DBP advanced practice clinician (DBP-APC) intake visit, neurodevelopmental evaluation by a developmental-behavioral pediatrician (DBP), and feedback by a developmental-behavioral pediatrician. Two QI cycles were completed to streamline the referral and evaluation process.

Intervention Results: Seventy patients with a mean age of 29.5 months were seen. The average days to initial developmental assessment decreased from 135.3 days to 67.9 days with a streamlined referral to the DT-PCC. Of the 43 patients who required further evaluation by a DBP, the average days to developmental assessment reduced from 290.1 to 120.4 days.

Conclusion: Developmentally-trained primary care clinicians allowed for earlier access to developmental evaluations. Further research should explore how DT-PCCs can improve access to care and treatment for children with developmental delays.

Study Design: Program evaluation

Setting: An urban safety-net hospital

Population of Focus: Children aged 4 years and younger who were referred for developmental assessment within the practice setting

Sample Size: 70 children

Age Range: Children ages 0 to 4 years

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), HOSPITAL, Crib Card, Visual Display (Hospital), CAREGIVER, Education/Training (caregiver), Educational Material (caregiver)

Intervention Description: To determine the impact, at 60 days of life, of an educational intervention conducted in maternity centers aimed at improving adherence to the recommendations on safe infant sleep.

Intervention Results: After the intervention, a 35% increase in the supine sleeping position (p < 0.0001) was observed; exclusive breastfeeding increased by 11% (p= 0.01); and co-sleeping decreased from 31% to 18% (p< 0.0005).

Conclusion: The educational intervention was useful to improve adherence to the recommendations on safe sleep at 60 days of life: using the supine position and breastfeeding improved, and the rate of co-sleeping decreased. No changes were observed in the number of household members who smoke, bedroom sharing, and pacifier use.

Study Design: QE: pretest-posttest

Setting: Hospital Municipal Comodoro Meisner and Hospital Universitario Austral

Population of Focus: Live newborns with >36 gestation weeks born in two hospitals whose mothers lived in the District of Pilar without major congenital malformations and/or hospitalization in the NICU for more than 10 days

Data Source: Caregiver report

Sample Size: Baseline (n=251) Follow-up (n=248)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Residents/Medical Students, Provider Training/Education,

Intervention Description: Implementation of an annual influenza immunization workshop including immunization education, simulated practice, and peer influenza immunization

Intervention Results: Participants were more likely to report confidence in immunization skills than nonparticipants. Resident-administered immunizations increased from 1 in the 3 years preceding workshop implementation to 74 during the 2019 to 2020 academic year. Significantly, more ACGME survey respondents reported preparedness to immunize after workshop implementation.

Conclusion: Implementation of an influenza immunization workshop provides an innovative opportunity to increase resident preparedness performing an ACGME-required procedure while also helping ensure programs remain compliant with influenza requirements.

Study Design: Prospective cohort study

Setting: Pediatric residency program in a tertiary academic center

Population of Focus: Pediatric residents

Sample Size: 59 residents participated in the workshop - Age range: Not specified

Age Range: Not specified

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

Intervention Description: Partners For Kids (PFK) is an accountable care organization caring for pediatric Medicaid beneficiaries in Ohio. PFK QI specialists recruited practices to develop QI projects around increasing well care visit rates (proportion of eligible children with well care visits during calendar year) for children aged 3-6 years and adolescents. The QI specialists supported practice teams in implementing interventions and collecting data through monthly or bimonthly practice visits.

Intervention Results: Ten practices, serving more than 26 000 children, participated in QI projects for a median of 8.5 months (IQR 5.3-17.6). Well care visit rates in the QI-engaged practices significantly improved from 2016 to 2018 (P < .001 for both age groups). Over time, well care visit rates for 3- to 6-year-old children increased by 11.8% (95% CI 5.4%-18.2%) in QI-engaged practices, compared with 4.1% (95% CI 0.1%-7.4%) in non-engaged practices (P = .233). For adolescents, well care visit rates increased 14.3% (95% CI −2.6% to 31.2%) compared with 5.4% (95% CI 1.8%-9.0%) in QI-engaged vs non-engaged practices over the same period (P = .215). Although not statistically significant, QI-engaged practices had greater magnitudes of rate increases for both age groups.

Conclusion: Through practice facilitation, PFK helped a diverse group of community practices substantially improve preventive visit uptake over time. QI programs in primary care can reach patients early to promote preventive services that potentially avoid costly downstream care.

Setting: Clinic/Medical provider office

Population of Focus: Patients in participating pediatric practices, ages 3-6 and 12-18

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education

Intervention Description: To determine changes in breastfeeding support by prenatal care providers over a 20 year period.

Intervention Results: We had 164 participants (response rate 80%). More current participants, compared to 1993, reported discussing (97% vs. 86%, p < .001) and recommending (93% vs. 80%, p = .001) breastfeeding. Only 10% of 2015 participants gave infant formula samples, compared with 34% in 1993 (p < .0001). Improvement in the support score was seen, with 98% of current participants having high scores compared to 87% in 1993 (p < .001). Similar numbers reported receiving breastfeeding education, though more reported that the education was inadequate (54% vs. 19%, p < .0001).

Conclusion: Breastfeeding support improved significantly over time, even though breastfeeding education has not improved in quality or quantity. Improving education of prenatal care providers may help future providers be more prepared to support breastfeeding.

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE, Educational Material (Provider), Peer Counselor

Intervention Description: To evaluate changes in referrals to Women, Infants, and Children’s Supplemental Nutrition Program peer counselors, reported prenatal provider education and support, and breastfeeding outcomes (intention, initiation, 1-month duration of any and exclusive breastfeeding) after a prenatal breastfeeding promotion intervention.

Intervention Results: Pre-intervention (n = 71) and post-intervention (n = 70) participants were 49% Black, 61% publicly insured, and 16% uninsured. More post-intervention participants had > 1 Toolkit use (76%), peer counselor program referrals (60.0% post vs. 36.6% pre, p < .01), reported any breastfeeding intention (89% vs. 72%, p = .013), and intended to breastfeed for > 1 year (31% vs. 14%, p = .014). Post-intervention breastfeeding initiation and exclusivity were higher, but not significantly different. Post-intervention participants reported better prenatal breastfeeding supp

Conclusion: Implementing a prenatal Breastfeeding Toolkit, including facilitating peer counselor referral, was associated with increases in provider counseling, participants’ breastfeeding intentions, and uptake of peer counselors. Replicating this approach may reinforce efforts to support breastfeeding in similar practices serving women with lower incomes.

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, HOSPITAL, Chart Audit and Feedback, Quality Improvement, Policy/Guideline (Hospital), Collaboratives

Intervention Description: This was a multifaceted quality improvement initiative designed to decrease the cesarean delivery rates for NTSV births in California. From 2016 to 2019, the California Maternal Quality Care Collaborative partnered with Smart Care California to implement multiple approaches to decrease the rates of cesarean delivery. Guided by the Consolidated Framework for Implementation Research, efforts were aimed at both the internal (hospital level) and the external (statewide) environment. Hospitals with rates of cesarean delivery greater than 23.9% for NTSV births were invited to join 1 of 3 cohorts for an 18-month quality improvement collaborative between July 2016 and June 2019. Within the collaborative, multidisciplinary teams implemented multiple strategies supported by mentorship, shared learning, and rapid-cycle data feedback. Partnerships among nonprofit organizations, state governmental agencies, purchasers, and health plans addressed the external environment through transparency, award programs, and incentives.

Intervention Results: A total of 7 574 889 NTSV births occurred in the US from 2014 to 2019, of which 914 283 were at 238 hospitals in California. All California hospitals were exposed to the statewide actions to reduce the rates of cesarean delivery, including the 149 hospitals that had baseline rates of cesarean delivery greater than 23.9% for NTSV births, of which 91 (61%) participated in the quality improvement collaborative. The rate of cesarean delivery for NTSV births in California decreased from 26.0% (95% CI, 25.8%-26.2%) in 2014 to 22.8% (95% CI, 22.6%-23.1%) in 2019 (relative risk, 0.88; 95% CI, 0.87-0.89). The rate of cesarean delivery for NTSV births in the US (excluding California births) was 26.0% in both 2014 and 2019 (relative risk, 1.00; 95% CI, 0.996-1.005). The difference-in-differences analysis revealed that the reduction in the rate of cesarean delivery for NTSV births in California was 3.2% (95% CI, 1.7%-3.5%) higher than in the US (excluding California). Compared with the hospitals and the periods not exposed to the collaborative activities, and after adjusting for patient characteristics and time using a modified stepped-wedge analysis, exposure to collaborative activities was associated with a lower odds of cesarean delivery for NTSV births (24.4% vs 24.6%; adjusted odds ratio, 0.87 [95% CI, 0.85-0.89]).

Conclusion: In this observational study of NTSV births in California from 2014 to 2019, the rates of cesarean delivery decreased over time in the setting of the implementation of a coordinated hospital-level collaborative and statewide initiatives designed to support vaginal birth.

Setting: 238 nonmilitary hospitals providing maternity services in California

Population of Focus: Nulliparous women with term singleton vertex gestations

Intervention Components (click on component to see a list of all articles that use that intervention): Referrals, Provider Training/Education, HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: To determine, among a sample of young CSHCN with developmental conditions, (1) characteristics associated with receipt of both patient-centered medical home (PCMH) and Part C early intervention, (2) the association between each PCMH criterion and receipt of Part C generally, and (3) for CSHCN with disabilities versus delays.

Intervention Results: 19% of our sample received both PCMH and Part C. Black, non-Hispanic children had lower odds [OR 0.44, 95% CI (0.20, 0.97)] and CSHCN with more severe developmental conditions had higher odds [OR 2.13, 95% CI (1.22, 3.17)] of receiving both services. CSHCN with a PCMH were no more likely to be receiving Part C than those without a PCMH [OR 0.85, 95% CI (0.49, 1.49)]. Receiving any one of the PCMH criterion was not associated with receiving Part C, with one exception. Among CSHCN with delays, effective care coordination was associated with lower odds of Part C [OR 0.46, 95% CI (0.21, 0.97)].

Conclusion: Concurrent PCMH and Part C access was low for young CSHCN with developmental conditions affecting their function. Given the overlapping mandates for PCMH and Part C, integrated efforts are warranted to identify if lack of concurrent services in fact reflects unmet service needs.

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, HOSPITAL, Quality Improvement, Policy/Guideline (Hospital), Sleep Environment Modification, CAREGIVER, Educational Material (caregiver), HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation

Intervention Description: A quality improvement project for implementing safe sleep practices (SSP) was conducted at a large, U.S children's hospital.

Intervention Results: Audit data showed that 72% and 77% of infants were asleep supine at baseline and follow-up respectively (p=0.07).

Conclusion: Infant safe sleep practices have the potential to reduce infant mortality.

Study Design: QE: pretest-posttest

Setting: A tertiary care children’s hospital in AR

Population of Focus: Infants 0-12 months in intensive care and medical-surgical units caring asleep at the time of the audit

Data Source: Crib audit/infant observation

Sample Size: Baseline (n=398) Follow-up (n=498)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment, Educational Material (Provider), Screening Tool Implementation Training

Intervention Description: Prevention programs serve those at high risk by removing external risk factors, providing enriching environments, training parents on responsiveness and positive redirection to build skills for optimal development. Remediation programs are for children diagnosed with developmental disturbances, attempting to maximize competence and minimize delays. Compensation services target established disorders like cerebral palsy or Down syndrome, aiming to maximize overall functioning through aids and behavioral techniques. This article states that intervention programs tend to have a positive moderate effect on developmental attainment, with structured, intense programs providing family support being more effective. Earlier intervention in infancy may lead to better outcomes, though evidence is unclear. Appropriate early intervention services can help optimize development for delayed children.

Intervention Results: The resource presents several key results related to intervention programs for children with developmental delays. It states that intervention programs have been shown to have a positive moderate effect on eventual developmental attainment, improving intellectual, academic achievement, and scores on developmental outcomes measures. Prevention services specifically have been found to have significant lasting effects into adulthood, with children who participated being less likely to fail grades, be assigned to special programs, have higher achievement scores, be more likely to graduate high school and seek higher education, and have higher earning wages as adults. The Ypsilanti Perry Preschool Project calculated savings to society of $100,000 per child who participated. For biologically at-risk populations, intervention facilitated short-term gains in growth, development, and improved parenting skills.

Conclusion: This resource concludes that while more methodologically sound longitudinal studies are needed, the available evidence suggests that early intervention programs can benefit children with or at risk of developmental delays. It proposes that for intervention to be effective, programs should be structured, intense, involve family support services, and begin as early as possible in a child's life. The passage endorses developmental screening as a crucial step to identify delayed children early so they can receive appropriate intervention services to maximize their developmental potential.

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