Established Evidence Results

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, 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): 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): Quality Improvement, Care Coordination,

Intervention Description: The intervention is a previsit screening checklist that is completed by the patient prior to the medical encounter and covers areas such as nutrition, reproductive health, and social and nursing services. The checklist is then reviewed by the clinical assistant, who coordinates with other team members to provide same-day access to requested services. The intervention aligns with a discernable strategy of promoting teamwork during a medical visit through delegation of tasks among care team members and providing same-day access to existing medical services. The use of a previsit screening checklist is intended to help care teams anticipate patient needs for services and proactively coordinate access to requested services at the time of the visit. The article describes a study that analyzes a multicomponent intervention, which includes the previsit screening checklist, as well as previsit huddles, PDSA (Plan-Do-Study-Act) cycles focusing on workflow, regular care team meetings, and patients' and parents' advisory boards.

Intervention Results: The study reported several key results: 1. The majority of patients were receptive to the previsit screening checklist. 2. 85% of the requested services were provided at the time of the medical visit. 3. Nonclinician staff felt more involved in patient care. 4. Providers' satisfaction increased. Additionally, the study found that female patients accounted for the majority of the service requests, with reproductive health services being the most commonly requested type of service. These results suggest that the previsit screening checklist intervention improved teamwork and access to preventive services for adolescent and young adult patients in the medical home serving low-income populations.

Conclusion: The study concluded that the implementation of a previsit screening checklist in a primary care setting can optimize teamwork, increase patient access to preventive services, and support patient engagement in decision making. The checklist intervention was found to be easily incorporated into the clinic workflow, promoting a culture of teamwork and enhancing health care delivery. Despite some challenges, the study demonstrated that the use of the previsit screening checklist was associated with improved access to preventive services for adolescents and young adults in the primary care setting.

Study Design: The study utilized a quality improvement project design to evaluate the implementation of a previsit screening checklist in a primary care setting. The project involved a multidisciplinary team and incorporated input from advisory boards and key informants. The intervention was evaluated through a combination of quantitative and qualitative approaches, including iterative Plan-Do-Study-Act (PDSA) cycles to assess the needs and acceptance of the checklist prior to and during the intervention. The study design focused on process evaluation and outcome measures to assess the impact of the intervention on patient access to preventive services and teamwork within the clinic

Setting: The study was conducted in a primary care pediatrics and adolescents practice located in a low-income urban neighborhood of Boston. The practice is owned by a children's hospital and serves children, adolescents, and young adults through age 25 years. The majority of patients are first- or second-generation immigrants of Latino descent, and most are of low-income families, with an income level below the poverty line, and about 74% qualify for Medicaid .

Population of Focus: The target audience of the study was adolescent and young adult patients (ages 13-25) who received care at a primary care pediatrics and adolescents practice located in a low-income urban neighborhood of Boston. The majority of patients were first- or second-generation immigrants of Latino descent, and most were of low-income families, with an income level below the poverty line, and about 74% qualified for Medicaid

Sample Size: The sample size in the study consisted of 291 patients who completed the previsit screening checklist during an adolescent well visit. Additionally, 222 of these patients requested services based on the checklist. The study provided a breakdown of the sample characteristics, including age, gender, race, primary language, and type of insurance for the patients who completed the checklist

Age Range: The age range of the patients included in the study is 13 to 25 years old.

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Chart Audit and Feedback, Guideline Change and Implementation, Organizational Changes, Peer Review, Quality Improvement

Intervention Description: To improve quality and safety of care to our obstetric and neonatal patients (presenting between 34 0/7 and 36 6/7 weeks) by lowering the overall induction rate, lowering the elective induction rate less than 39 weeks, decreasing the unanticipated admissions of late preterm infants to the special care nursery (SCN), decreasing the number of transports out of our level II SCN to a higher level III neonatal intensive care unit, and increasing safety culture scores of the Family Birth Center staff at Mercy Hospital Anderson, Cincinnati, OH.

Intervention Results: Rate of CS among electively induced women at the level II hospital decreased from 37.4% (2005) to 31.5% (2006) to 25% (2007). From 2005 to 2006, one year after hospital review was launched, there was a 5.9% decrease in CS (p<0.05)2. From 2006 to 2007, two years after hospital review was launched and supplemental changes to elective induction policies and practices were made, there was a 6.5% decrease in CS (p<0.05)2.

Conclusion: In 2007, outcomes including total induction rate, elective induction rate for less than 39 weeks, cesarean birth rate for elective inductions among nulliparas, and SCN unanticipated admissions of infants 34 0/7 to 36 6/7 weeks' gestation (late preterm infants) were compared with these same measures in 2005.

Study Design: QE: pretest-posttest

Setting: 1 level-II maternity hospital in Ohio

Population of Focus: Nulliparous women who gave birth between January 2005 to December 20072

Data Source: Not specified

Sample Size: n=2,172

Age Range: Not Specified

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, Family-Based Interventions, Consultation (Parent/Family),

Intervention Description: During infancy, the American Academy of Pediatrics Bright Futures fourth edition health supervision guidelines recommend frequent well-child visits (WCVs) in which providers are expected to screen for and address maternal depression, intimate partner violence (IPV), and health-related social needs (HRSN). We spread an evidence-based approach that implements these recommendations (Developmental Understanding and Legal Collaboration for Everyone; DULCE) with 3 aims for 6-month-old infants and their families: 75% receive all WCVs on time, 95% are screened for 7 HRSNs, and 90% of families with concrete supports needs and 75% of families with maternal depression or IPV receive support. Between January 2017 and July 2018, five DULCE teams (including a community health worker, early childhood system representative, legal partner, clinic administrator, pediatric and behavioral health clinicians) from 3 communities in 2 states participated in a learning collaborative. Teams adapted DULCE using Plan-Do-Study-Act cycles, reported data, and shared learning monthly. Run charts were used to study measures. The main outcome was the percent of infants that received all WCVs on time.

Intervention Results: The percentage of families who completed all WCVs on time increased from 46% to 65%. More than 95% of families were screened for HRSNs, 70% had ≥1 positive screen, and 86% and 71% of those received resource information for concrete supports and maternal depression and IPV, respectively.

Conclusion: Quality improvement-supported DULCE expansion increased by 50% the proportion of infants receiving all WCVs on time and reliably identified and addressed families' HRSNs, via integration of existing resources.

Study Design: Program evaluation

Setting: Three communities from the Early Childhood Learning and Innovation Network for Communities recruited clinics serving predominantly Medicaid-insured patients

Population of Focus: Families with newborns up to 8 weeks of age

Sample Size: Five local DULCE site teams and 692 families with infants

Age Range: Families with infants 0-6 months

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): Quality Improvement/Practice-Wide Intervention,

Intervention Description: A community hospital implemented components of the Alliance for Innovation on Maternal Health Reduction of Peripartum Racial/Ethnic Disparities Patient Safety Bundle. The purpose was to collect and share perinatal disparities data, increase staff awareness of perinatal racial and ethnic disparities, and engage staff to address these disparities at the project site. Perinatal care data were reviewed by race and ethnicity and results were shared with staff. Staff were engaged through a series of activities including a Health Equity Party, implicit bias workshop, Snack and Learn sessions, online modules, 2 grand rounds, and the establishment of a Health Equity Committee.

Intervention Results: Racial and/or ethnic disparities were identified for perinatal outcomes and experience of care indicators including rates of cesarean birth, newborn mortality, and 30-day readmission. Of the staff 137 (65.9%) participated in project activities. The majority of participants were registered nurses (n = 82). Certified nurse-midwives (n = 10) were the profession with the highest rate of attendance (83.3%). Staff developed 26 new recommendations to address racial and ethnic disparities in care. After project implementation, mean scores of High Provider Attribution, an indicator of readiness to address health disparities, increased from preimplementation scores (P = .01). There was also a significant increase in the number of staff who reported engaging in activities to address the health care needs of racial and ethnic minority patients (P < .001).

Conclusion: This quality improvement project demonstrated that interventions at the health care organization level can be effective in influencing health care providers and staff to address racial and ethnic perinatal disparities.

Study Design: Qualitative

Setting: Community Hospital

Population of Focus: Perinatal care staff

Sample Size: 137

Age Range: Not disclosed

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

Intervention Description: N/A

Conclusion: 1. The transition from pediatric to adult care is associated with adverse health outcomes for many adolescents with chronic illness. 2. The review identified 169 quality indicators for transition, of which 56% were illness-specific, 43% were at the patient level of care, 44% related to transition processes, and 51% were patient-centered and 0% equity-focused. 3. Common indicator themes included education (12%), continuity of care (8%), satisfaction (8%), and self-management/self-efficacy (7%). 4. Although most quality indicators for transition were patient-centered outcomes, few were informed by youth and parents/caregivers, and none focused on equity. 5. Further work is needed to prioritize quality indicators across chronic illness populations while engaging youth and parents/caregivers in the process. 6. A key set of quality indicators for transition that can be applied to any clinical setting and disease population is needed to compare health-system performance across all clinical settings and jurisdictions.

Study Design: Systematic Review

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/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, 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, HEALTH_CARE_PROVIDER_PRACTICE, ,

Intervention Description: The aims of this study were to (1) assess changes to maternity care policies in response to COVID-19, and (2) compare hospital-level breastfeeding, skin-to-skin, and rooming-in rates, at cohort hospitals, before and during the pandemic, overall and stratified by race.

Intervention Results: Twenty-six hospitals responded to the May and September 2020 surveys. Hospitals used different sources to create maternity care policies, and policies differed between institutions. Trends in rates of any and exclusive breastfeeding in the hospital cohort plateaued during the pandemic, in comparison to previous gains, and rates of skin-to-skin and hospital rooming-in decreased. No differences were evident between races.

Conclusion: Policies (Aim 1) and practices in the quality improvement cohort hospitals were inconsistent during the COVID-19 pandemic, and changes measured to practices were detrimental (Aim 2). Ongoing monitoring is recommended.

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): Quality Improvement/Practice-Wide Intervention, Planning for Transition, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: A health care transition focused quality improvement project was implemented in a large urban pediatric endocrinology clinic to evaluate the effectiveness of the administration of the Transition Readiness Assessment Questionnaire (TRAQ) by identifying barriers to implementation and creating a more sustainable format.

Intervention Results: for improved documentation and achievement of transition focused goals. Results: Several barriers were identified that minimized the effectiveness of the TRAQ tool including lack of staff trained to assist with insulin pump and meter downloads and proximity of diabetes software. Additional staff were trained, and software was relocated to a more centrally located area with greater staff accessibility to allow for discussion of transition goals with patient and family. The new process resulted in a 100% increase in documentation of transition goals and met goals (p ≤0.001).

Conclusion: The TRAQ tool is valuable for directing transition needs if implementation barriers such as staff training and accessibility to software are monitored and addressed. Frequent evaluation of the administration of the TRAQ tool protocol in the clinic setting is recommended in order to support pediatric patients' successful transition to adult care.

Intervention Components (click on component to see a list of all articles that use that intervention): Midwifery, PROVIDER/PRACTICE, HOSPITAL, Chart Audit and Feedback, Organizational Changes, Quality Improvement, POPULATION-BASED SYSTEMS, Community — Outreach, Outreach, COMMUNITY, COMMUNITY

Intervention Description: To improve quality of care by offering more women a safe and attractive normal vaginal delivery. The target group was primarily nulliparous women at term with spontaneous onset of labor and cephalic presentation.

Intervention Results: The CS rate in nulliparous women at term with spontaneous onset of labor decreased from 10% in 2006 to 3% in 2015. During the same period the overall CS rate dropped from 20% to 11%. The prevalence of children born at the unit with umbilical cord pH <7 and Apgar score <4 at 5 min were the same over the years studied. At present, 95.2% of women delivering at our unit are satisfied with their delivery experience.

Conclusion: The CS rates have declined after implementing the nine items of organizational and cultural changes. It seems that a specific and persistent multidisciplinary activity with a focus on the Robson group 1 can reduce CS rates without increased risk of neonatal complications.

Study Design: Time trend analysis

Setting: 1 public, medium-sized tertiary level obstetric unit

Population of Focus: Nulliparous women who gave birth between January 2006 and October 2015

Data Source: Not specified

Sample Size: n=~900 (880-924) per year

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): 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): Quality Improvement/Practice-Wide Intervention, Planning for Transition, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: To describe the development and pilot implementation of a transition process for youth living with human immunodeficiency virus (HIV) and to assess the perceptions of the process among youth living with HIV (YLHIV), their caregivers, and clinical staff.

Intervention Results: Our transition process was informed by our goal to provide transition support that could respond to a variety of patient factors. We developed a process focused on four stages: 1. Introduction to Transition, 2. Building Knowledge and Skills, 3. Growing in Independence, and 4. Adult Care Ready. Each stage contains competencies for the patient and tasks for the care team. The pace of proceeding through the stages is determined by completion of competencies rather than patient age. Results from youth and staff showed that the transition process and informational material were helpful.

Conclusion: We developed a transition process for YLHIV and implemented this process in an HIV clinic. Initial survey data shows that youth, caregivers, and staff found this strategy helpful. Practice implications: This pilot process may serve as a source of guidance to other clinics seeking to establish their own transition process.

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

Intervention Description: The aims of Mississippi Communities and Hospitals Advancing Maternity Practices (CHAMPS) were to (1) increase breastfeeding initiation and exclusivity and (2) decrease racial disparities in breastfeeding by increasing the number of Baby-Friendly hospitals in the state from 2014 to 2020.

Intervention Results: Between 2014 and 2020, the number of Baby-Friendly hospitals in Mississippi rose from 0 to 22. Breastfeeding initiation in the hospitals increased from 56% to 66% (P < .05), and the disparity between Black and White dyads decreased by 17 percentage points, an average of 0.176 percentage points each month (95% confidence interval: −0.060 to −0.292). Exclusivity increased from 26% to 37% (P < .05). Skin-to-skin and rooming-in rates increased significantly for all dyads: 31% to 91% (P < .01) for skin-to-skin after vaginal birth, 20% to 86% (P < .01) for skin-to-skin after cesarean delivery, and 19% to 86% (P < .01) for rooming-in.

Conclusion: Over the course of the CHAMPS program, there were significant increases in breastfeeding initiation and exclusivity, and decreases in racial inequities in breastfeeding initiation.

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): Referrals, Administration/Practice Management, Quality Improvement, HOSPITAL, PATIENT_CONSUMER, Patient Reminder/Invitation, HEALTH_CARE_PROVIDER_PRACTICE, EMR Reminder

Intervention Description: Researchers implemented process changes in 3 phases: phase 1, changing the screening instrument and adding decision support; phase 2, adding automatic reminders; and phase 3, adding a referral option for autism evaluations in primary care. We analyzed the proportion of visits with autism screening at 2 intervention clinics before and after implementation of process changes versus 27 community clinics (which received only automatic reminders in phase 2) with χ2 test and interrupted time series.

Intervention Results: In 12 233 visits over 2 years (baseline and phased improvements), autism screening increased by 52% in intervention clinics (58.6%-88.8%; P < .001) and 21% in community clinics (43.4%-52.4%; P < .001). In phase 1, interrupted time series trend for screening in intervention clinics increased by 2% per week (95% confidence interval [CI]: 1.1% to 2.9%) and did not increase in community clinics. In phase 2, screening in the community clinics increased by 0.46% per week (95% CI: 0.03% to 0.89%). In phase 3, the intervention clinic providers referred patients for diagnostic evaluation 3.4 times more frequently (95% CI: 2.0 to 5.8) than at baseline.

Conclusion: We improved autism screening and referrals by changing the screening instrument, adding decision support, using automatic reminders, and offering autism evaluation in primary care in intervention clinics. Automatic reminders alone improved screening in community clinics.

Setting: Pediatric and community clinics

Population of Focus: Pediatricians and staff

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): Screening Tool Implementation, Educational Material (caregiver), Quality Improvement,

Intervention Description: The intervention described in the article is the implementation of the Edinburgh Postnatal Depression Scale (EPDS) screening tool at two primary care pediatric clinics in an urban, multicultural, low socioeconomic immigrant community in San Diego, United States of America. The EPDS screening was conducted at the 2-week weight check and 1-, 2-, and 4-month well-baby visits. For mothers with positive screens, providers referred them to mental health care and updated their child’s electronic health record diagnosis to prompt reassessment for future visits. Educational materials were also created for patients and clinic staff about the significant impact PPD can have on infants and their development.

Intervention Results: Of the 523 eligible visits, 437 (83.5%) were screened using the EPDS tool and documented into the EHR. The overall incidence rate of at-risk mothers for PPD was 9.5%. Of those mothers who screened positive, 73.1% had documentation demonstrating a referral to mental health services. 63.2% of mothers referred attended their mental health appointments.

Conclusion: This project successfully implemented the American Academy of Pediatrics PPD screening guidelines and could be applicable to other pediatric outpatient settings.

Study Design: The PDF file does not explicitly state the study design or type. However, it is described as an evidence-based practice (EBP) project, which suggests that it is a quality improvement initiative aimed at implementing a specific intervention (in this case, PPD screening) in a real-world clinical setting. The project used the Iowa Model, which is a framework for implementing evidence-based practice changes in healthcare settings.

Setting: The evidence-based practice project was implemented at two primary care pediatric clinics in an urban, multicultural, low socioeconomic immigrant community in San Diego, United States of America

Population of Focus: The target audience for this study is healthcare providers and professionals who work in pediatric primary care clinics, particularly those serving immigrant and low-income populations.

Sample Size: The PDF file does not provide a specific sample size for the study. However, it does mention that the clinics served a lower socioeconomic pediatric population, and the majority (85%) of infants were insured by Medicaid. Additionally, provides some data on the number of mothers who were screened and followed up at the clinics, but it does not provide a total sample size for the study.

Age Range: The study focuses on infants and their mothers in the postpartum period. The screening for postpartum depression (PPD) was conducted during well-child visits for infants aged 1-6 months, with a focus on the 2-week visit and deferral of screening at the 6-month visit. The follow-up data in Table 2 is presented for infants at 12 months of age, which suggests that the study followed infants and their mothers for at least a year.

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): Prenatal Care Access, Care Coordination, Quality Improvement/Practice-Wide Intervention,

Intervention Description: The intervention involved the implementation of a new model of prenatal care called PodCare. This model required changes to providers' schedules, including the extension of weekly resident physician didactic schedules to include one hour of Pod meetings. At these meetings, providers selected patients for discussion to ensure completeness of care and appropriate delivery planning. The model aimed to decrease the number of prenatal care visits while increasing continuity with providers and maintaining high-quality care .

Intervention Results: The results of the study showed that after the implementation of the PodCare model, the median number of prenatal care visits decreased from 13 to 10 (p < 0.00004) and the median number of providers seen decreased from 7 to 5 (p < 0.0000008). Additionally, more patients chose care with the low-risk physician team (42% compared to 26%). The model also performed well above national averages on measures of timeliness of care and percentage of deliveries receiving a postpartum visit. There were no significant differences in secondary outcomes such as mode of delivery, Group B strep testing, and diabetes screening

Conclusion: The study concluded that the PodCare model increased the value of individual prenatal care by decreasing the number of visits, increasing continuity, and providing care coordination. The model provides a robust experience in interdisciplinary care and may be successful at other academic institutions. The study also suggested that the PodCare model presents savings in opportunity cost given more available clinic visits for other obstetrical or gynecologic patients. The model also allows residents and associate providers to provide the bulk of care under the supervision of an attending physician, making it a cost-effective and resource-wise decision

Study Design: The study utilized a retrospective cohort design to compare the outcomes of prenatal care before and after the implementation of the PodCare model. Data were abstracted retrospectively from the electronic medical record for all patients initiating prenatal care in the one year before and after PodCare, and a washout period of six months on either side of the intervention was applied

Setting: The study was conducted in an academic setting at the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, USA .

Population of Focus: The target audience of the study was healthcare providers and clinic staff who provide prenatal care to pregnant women. The study aimed to test the hypothesis that a new model of prenatal care, PodCare, would increase the value of traditional prenatal care by decreasing the number of visits while increasing continuity with providers and maintaining current high-quality care .

Sample Size: The study included 85 women in 2013 and 165 women in 2014 as study subjects . These women were included in the analysis to evaluate the impact of the PodCare model on prenatal care visits and provider interactions.

Age Range: The age range of the participants in the study was 18.8 to 42.6 years .

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

Intervention Description: To evaluate child-level dental utilization and expenditure outcomes based on if and where children received fluoride varnish (FV) at quality improvement (QI) medical practices, at non-QI medical practices, at dental practices, or those who never received FV from any practice.

Intervention Results: The QI group had a significantly higher incidence of preventive dental visits than the dental (incidence rate ratio [IRR] = 0.93; 95% confidence interval [CI], 0.91-0.96) or non-QI groups (IRR = 0.86; 95% CI, 0.84-0.88). Compared with the QI group, the non-QI (adjusted odds ratio [aOR] = 2.6; 95% CI, 2.4-2.9) and dental (aOR = 2.9; 95% CI, 2.6-3.3) groups were significantly more likely to have caries-related treatment visits. The dental group children were significantly more likely to have dental treatment under GA than the QI group (aOR = 5.3; 95% CI, 2.0-14.4).

Conclusion: Children seen at QI practices appear to have an increased uptake of preventive dental services, which may explain the lower incidence of dental caries visits and GA treatment.

Intervention Components (click on component to see a list of all articles that use that intervention): Expanded Insurance Coverage, Guideline Change and Implementation, Quality Improvement,

Intervention Description: Oregon’s Medicaid expansion provided an opportunity to investigate a potential causal relationship between insurance coverage for parents and their children. This expansion, often referred to as the Oregon Experiment, gave a subset of uninsured, low-income adults access to Medicaid through a randomized selection process. In 2008, Oregon’s Medicaid program, the Oregon Health Plan (OHP), sought to enroll 10,000 non–categorically eligible (i.e., not meeting federally mandated Medicaid eligibility criteria) low-income adults into its expansion program (OHP Standard), which had been closed to new enrollment since 2004. During a random selection process, uninsured, low-income adults were encouraged to put their names on a reservation list. From this list, there were 8 random drawings; individuals selected in these drawings were invited to apply for OHP coverage. The reservation list included more than 90,000 registrants; of these, approximately 30,000 were randomly selected to apply and about 10,000 were ultimately enrolled in OHP. Not everyone selected to apply completed an application, and not all applicants met enrollment eligibility criteria. This study of the Oregon Experiment examined the longitudinal effect of parents randomly selected to apply for Medicaid on their child’s Medicaid or CHIP coverage. The objective was to estimate the effect on a child’s health insurance coverage status when (1) a parent randomly gains access to health insurance and (2) a parent obtains coverage.

Intervention Results: Children whose parents were randomly selected to apply for Medicaid had 18% higher odds of being covered in the first 6 months after parent’s selection compared with children whose parents were not selected. In the immediate period after selection, children whose parents were selected to apply for Medicaid significantly increased from 3830 (61.4%) to 4152 (66.6%) compared with a non-significant change from 5049 (61.8%) to 5044 (61.7%) for children whose parents were not selected to apply. Children whose parents were randomly selected to apply for Medicaid had 18% higher odds of being covered in the first 6 months after parent’s selection compared with children whose parents were not selected (adjusted odds ratio [AOR] = 1.18; 95% CI, 1.10–1.27). The effect remained significant during months 7 to 12 (AOR = 1.11; 95% CI, 1.03–1.19); months 13 to 18 showed a positive but not significant effect (AOR = 1.07; 95% CI, 0.99–1.14). Children whose parents were selected and obtained coverage had more than double the odds of having coverage compared with children whose parents were not selected and did not gain coverage.

Conclusion: Children whose parents were randomly selected to apply for coverage through the Oregon Experiment had higher rates of OHP coverage than children whose parents were not selected. Among children whose parents were selected, those whose parents obtained coverage benefited the most. This study demonstrates a causal link between Medicaid coverage for parents and their children. To maximize children’s health insurance coverage rates, parents must also have opportunities to obtain coverage

Study Design: Randomized natural experiment; generalized estimating equation models

Setting: Policy (Oregon Medicaid expansion program)

Population of Focus: Parents and Children

Sample Size: 14,409 children

Age Range: 2-18 years

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Nurse/Nurse Practitioner, Planning for Transition, Pediatric to Adult Transfer Assistance, Care Coordination, Quality Improvement/Practice-Wide Intervention

Intervention Description: This quantitative descriptive study used a survey questionnaire to investigate nurses' role and responsibilities in health care transition planning (HCTP) for youth and young adults with chronic illness and/or disability. The survey looked at respondents' role in health care transition planning (HCTP), inclusion of HCTP in job description, levels of HCTP knowledge, and ratings of importance of HCTP elements.

Intervention Results: Over 64% of respondents performed HCTP activities related to complex chronic illness management. Only 18% reported specialized training in HCTP. The highest-ranking items in regard to perceived importance were educating and supporting disease self-management and speaking with families about complex needs. Predictors of perceived importance were role, inclusion of transition planning in a job description, percentage of time in direct care, caring for those aged 14 years and older, and level of knowledge about HCTP.

Conclusion: The findings highlight key aspects of the pediatric nurse role in HCTP and identify specific elements that can be addressed to support future HCTP role development.

Study Design: Quantitative descriptive methodology

Setting: Hospitals/Clinics

Population of Focus: Pediatric nurses

Sample Size: 1814

Age Range: Adults

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): 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): 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): Quality Improvement/Practice-Wide Intervention, Social Network/Peer, Consultation (Parent/Family),

Intervention Description: Well-child care has suboptimal outcomes regarding adherence to appointments and recall of guidance, especially among families facing structural barriers to health. Group well-child care (GWCC) aims to improve these outcomes by enhancing anticipatory guidance discussions and peer education. We conducted a randomized controlled trial, comparing GWCC with traditional, individual well-child care (IWCC) and assessed health care utilization, immunization timeliness, recall of anticipatory guidance, and family-centered care. Ninety-seven mother-infant dyads were randomized to GWCC or IWCC.

Intervention Results: Compared with IWCC infants, GWCC infants attended more of the 6 preventive health visits (5.41 vs 4.87, P < .05) and received more timely immunization at 6 months and 1 year but did not differ in emergency or hospital admission rates. There were no differences in mothers' reports of anticipatory guidance received or family-centered care.

Conclusion: As primary care is redesigned for value-based care and structural vulnerabilities are considered, GWCC may be a key option to consider.

Study Design: Randomized controlled trial

Setting: Group well-child care at Yale University in New Haven, CT

Population of Focus: English-speaking mother-infant dyads whose babies were born in the Yale New Haven Hospital's well newborn nursery

Sample Size: 97 mother-infant dyads

Age Range: Infants birth to 12 months old and their mothers

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

Intervention Description: The intervention involved quality improvement interventions, provider training and education, capacity assessment, and measurement of HPV baseline rates. It also included modifications to electronic health records (EHRs) to support the HPV vaccination project.

Intervention Results: The study showed a substantial increase in HPV vaccine series initiation rates in the first 6 months of the intervention. Meningococcal and Tdap vaccination rates also increased significantly.

Conclusion: The study concluded that the intervention led to a substantial early success in increasing HPV vaccine series initiation rates in FQHCs. The intervention also appeared to affect the systems and processes around adolescent vaccination in general.

Study Design: The study utilized a multilevel human papillomavirus vaccination pilot intervention in FQHCs.

Setting: The setting of the study is federally qualified health centers (FQHCs) across the United States.

Population of Focus: The target audience includes adolescents at a disproportionate risk of HPV-related cancers who are served by the FQHCs.

Sample Size: The study involved 30 FQHC systems, with 20 systems forming the study sample for outcome evaluation.

Age Range: The study focused on 11- to 12-year-old patients.

Intervention Components (click on component to see a list of all articles that use that intervention): Parent Mentors, Policy/Guideline (Hospital), Quality Improvement,

Intervention Description: Six million children are uninsured, despite two-thirds being eligible for Medicaid/CHIP, and minority children are at especially high-risk. The study team conducted a randomized trial of the effects of parent mentors on insuring minority children. 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 were recruited from June 2011 to August 2013 at a hospitalbased Resident Continuity Clinic, charter school, and via established parent mentor referrals. Interviews were conducted to identify optimal candidates characterized by reliability, timeliness, persistence, and desire to help families with uninsured children. From 31 candidates interviewed, 15 parent mentors were chosen. 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-ofpocket costs for doctor and sick visits, higher well-child care quality ratings, and higher levels of parental satisfaction and respect from children’s physicians. Findings suggest that parent mentors and analogous peer mentors for adults might prove to be highly costeffective interventions for reducing or eliminating insurance disparities and insuring all Americans.

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: Parents and Children

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): 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): 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): HEALTH_CARE_PROVIDER_PRACTICE, Labor Support, Midwifery, HOSPITAL, Peer Review, Quality Improvement

Intervention Description: In efforts to help reduce the primary C-section rate, the hospital participated in the American College of Nurse-Midwives Healthy Birth Initiative. Strategies employed included use of intermittent auscultation, upright labor positioning, an early labor lounge, one-to-one labor support, and team huddles.

Intervention Results: The baseline nulliparous, term, singleton, vertex cesarean rate in 2015 was 29.3%. In 2016, after 1 year of implementation of the project, the hospital decreased nulliparous, term, singleton, vertex cesarean rate to 26.1%-a reduction of 10%. In 2017, the rate was decreased to 25.3%-a reduction by 3.7%.

Conclusion: The multicomponent bundle incorporated proven quality improvement strategies and engaged numerous champions and stakeholders, including midwifery students.

Setting: Urban academic hospital in the Midwest

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

Intervention Description: After discovering racial/ethnic disparities in adherence to well-child visits, UMass Memorial Health worked to identify and mitigate barriers to adherence for patients and families across 53 primary care practices in central Massachusetts.

Intervention Results: For patients who identified as Hispanic/Latinx, adherence rose from 64.3% at baseline to 74.1% (p < 0.001); and for patients who identified as Black/African American, adherence rose from 58.7% at baseline to 71.9% (p < 0.001). The gap in adherence to well-child visits for Black/African American and Hispanic/Latinx children compared to White children narrowed (12.4 percentage points to 5.1; p < 0.001; 6.8 percentage points to 2.9; p < 0.001).

Conclusion: Through a unique partnership between health system leaders, frontline staff, and the system's informatics team and by engaging caregivers to identify and address barriers to well-child visits, UMass Memorial Health was able to improve adherence to well-child visits among patients who identify as Black/African American or Hispanic/Latinx.

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Prolonged Second Stage of Labor, HOSPITAL, Guideline Change and Implementation, Quality Improvement, Collaboratives, Policy/Guideline (Hospital)

Intervention Description: Standardized second-stage labor evidence-based practice recommendations were structured into an interdisciplinary “5 Ps practice bundle” (patience, positioning, physiologic resuscitation, progress, preventing urinary harm) and implemented across 34 birthing hospitals. The second-stage labor practices were derived from the Association of Women's Health, Obstetric and Neonatal Nurses and the American College of Nurse-Midwives professional guidelines. The recommendations are designed to support the laboring woman's normal physiologic processes and avoid unnecessary interventions.

Intervention Results: Significant improvements were observed in second-stage practices. Association of Women's Health, Obstetric and Neonatal Nurses' perinatal nursing care quality measure Second-Stage of Labor: Mother-Initiated Spontaneous Pushing significantly improved [pre-implementation 43% (510/1,195), post-implementation 76% (1,541/2,028), p < .0001]. Joint Commission Perinatal Care-02: nulliparous, term, singleton, vertex cesarean rate significantly decreased (p = 0.02) with no differences in maternal morbidity, or negative newborn birth outcomes. Unexpected complications in term births significantly decreased in all newborns (p < 0.001), and for newborns from vaginal births (p = 0.03). Birth experience satisfaction rose from the 69th to the 81st percentile.

Conclusion: Clinical implications: Implementing 13 evidence-based second-stage labor practices derived from the Association of Women's Health, Obstetric and Neonatal Nurses and the American College of Nurse-Midwives professional guidelines achieved our goals of safely reducing primary cesarean birth among low-risk nulliparous women, and optimizing maternal and fetal outcomes associated with labor and birth. By minimizing routine interventions, nurses support physiologic birth and improve women's birth satisfaction.

Setting: 34 birthing hospitals in the Trinity Health System

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, 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, 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): Quality Improvement/Practice-Wide Intervention,

Intervention Description: The intervention involved a locally adapted quality improvement (QI) program that included physician training, assessment and feedback, and communication vignettes.

Intervention Results: The QI program achieved excellent reach to physicians and small improvements in HPV vaccination coverage among adolescents.

Conclusion: The study suggests that adapting existing materials and harnessing local talent are feasible ways to extend reach and improve HPV vaccination coverage.

Study Design: The study used a pre-post design with a comparison group.

Setting: The study was conducted in a large, not-for-profit pediatric healthcare system in Texas, USA.

Population of Focus: The target audience of the study was physicians who provide care to adolescents.

Sample Size: The study included 18 clinics and 49 physicians.

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): Quality Improvement/Practice-Wide Intervention,

Intervention Description: The QI initiative involved training staff on QI, defining objectives, targeting areas for improvement, developing aim statements, creating objectives, assessing barriers, and using a prioritization matrix tool to guide the QI efforts

Intervention Results: The results of the QI initiative included improvements in flu vaccination rates and asthma preventative services for children with asthma

Conclusion: The conclusion of the study is not explicitly mentioned in the provided excerpts.

Study Design: The study design involves a quality improvement (QI) initiative implemented over three academic years

Setting: The setting of the study is a school-based health center (SBHC) program in the New London school district

Population of Focus: The target audience includes pediatric patients with asthma enrolled in the SBHC program

Sample Size: The specific sample size is not mentioned in the provided excerpts.

Age Range: The age range of the pediatric patients is not explicitly mentioned in the provided excerpts.

Intervention Components (click on component to see a list of all articles that use that intervention): Mobile Programs, Quality Improvement/Practice-Wide Intervention, Care Coordination,

Intervention Description: Children in two communities of a large city in the Midwestern United States have higher rates of asthma than other areas of the city. The communities have barriers to accessing care, including high rates of unemployment and being uninsured and undocumented. A mobile van provides no-cost asthma care to children at schools in these communities, but use of these services has decreased more than 50% over the past 5 years. School nurses have the potential to improve asthma outcomes by collaborating with health-care providers. The purpose of the program was to increase the number of appointments scheduled and attended on the asthma van at both schools. For this program, we (a) implemented an unaccompanied minor consent, (b) enhanced care coordination, and (c) improved a respiratory health survey tool.

Intervention Results: Results showed an increased number of appointments scheduled and attended on the asthma van.

Conclusion: The program was successful even though community-specific barriers existed.

Study Design: Pre-post intervention study

Setting: Two communities in a large city in the Midwestern United States

Population of Focus: Children in two communities in a large city in the Midwestern United States who have higher rates of asthma compared to other areas in the city

Sample Size: 718 students for Community A School and 267 students for Community B School

Age Range: Children aged 6-11 years old

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

Intervention Description: The specific intervention involves the addition of gender-related questions to clinic intake forms in a primary care setting. The intervention aligns with a discernible strategy aimed at improving healthcare for transgender youth by creating a more inclusive and supportive environment. The study does not analyze a multicomponent intervention; rather, it focuses on the impact of adding gender-related questions to intake forms on documentation in the electronic health record and patient experiences.

Intervention Results: In interviews, the new questions were acceptable and interpretable to adolescents of diverse gender identities. Participants described the questions as beneficial to all patients and perceived them as an indicator of a welcoming clinic environment. The retrospective chart review found that provider documentation of gender identity in the EHR significantly increased after the form change from 51.3% to 66.3% (p < .0001).

Conclusion: This intervention was acceptable to adolescents and associated with a significant increase in EHR documentation. Future studies should investigate how the form change may have facilitated discussion about gender and health and implications for provider training and support.

Study Design: The study design is a mixed-methods approach that includes both qualitative and quantitative components. The study used a plan-do-study-act (PDSA) approach to quality improvement . The first phase of the study was qualitative and involved cognitive interviews with 21 adolescents to examine gender-related questions and assess their acceptability and interpretability . The second phase was a retrospective chart review of patients who came to the clinic for a physical examination visit three months before and after the form change to examine the differences in electronic health record documentation of gender identity . Descriptive analyses were used to explore potential differences in gender documentation by patient demographics and provider type . Finally, qualitative interviews were conducted to identify key themes related to the acceptability and benefits of gender questions on intake forms, as well as concerns related to confidentiality and privacy . The mixed-methods approach allowed the study to evaluate the impact of the intervention on both documentation practices and patient experiences in the primary care setting.

Setting: The study was conducted in an urban adolescent/young adult medicine primary care clinic . This setting allowed for the evaluation of the impact of gender-related questions on clinic forms in a real-world healthcare environment.

Population of Focus: The target audience of the study is healthcare providers and administrators in primary care settings who are interested in improving the collection of gender identity information and documentation practices in electronic health records. The study also provides insights for researchers and policymakers interested in understanding the experiences and perspectives of adolescents and young adults related to gender identity questions on intake forms.

Sample Size: The study involved 21 adolescents who participated in cognitive interviews . The retrospective chart review included 1,442 patients who came to the clinic for a physical examination visit three months before and after the form change

Age Range: The study included participants aged 13 to 25 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: 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): 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): Quality Improvement/Practice-Wide Intervention,

Intervention Description: Integrating behavioral health services within pediatric primary care may help address barriers to these services for youth, especially the underserved. Models of primary care behavioral health include coordinated, colocated, integrated, and collaborative care. This study began exploring the comparative utility of these models by investigating differences in the demographics and diagnoses of patients seen for a behavioral health warm handoff (integrated model) and a scheduled behavioral health visit (colocated model) across 3 pediatric primary care sites.

Intervention Results: The 3 sites differed in their rates of warm handoff usage, and there were differences in certain diagnoses given at warm handoffs versus scheduled visits. Depression diagnoses were more likely to be given in warm handoffs, and disruptive behavior, trauma/adjustment, and attention-deficit/hyperactivity disorder-related diagnoses were more likely to be given in scheduled visits.

Conclusion: These results have implications for the influence of office structure and standardized procedures on behavioral health models used in pediatric primary care.

Study Design: Retrospective EHR review

Setting: Pediatric primary care facilities in Delaware

Population of Focus: Health care professionals working in pediatric primary care settings

Sample Size: 1359 patients at 3 pediatric primary care clinics

Age Range: Health care professionals treating pediatric patients ages 0-17

Intervention Components (click on component to see a list of all articles that use that intervention): Care Coordination, Quality Improvement, Shared Plans of Care

Intervention Description: The intervention described in the study is the Compass Care Program, which is a consultative complex care program designed to address the needs of children with medical complexity (CMC) receiving specialty care at the institution. The program provides complex care consultation for children across inpatient and outpatient settings, with the goals of proactively coordinating care, improving the quality of care for CMC, and enhancing caregiver satisfaction . The program aims to achieve these goals through a multidisciplinary approach that involves care coordination, specialized services, and ongoing support for the patients and their families.

Intervention Results: Participants had significant decreases in hospital admis- sions per patient month, length of stay per admission, hospital days per patient month, and charges per patient month following enroll- ment (P<0.01) without a tandem increase in readmissions within 7 days of discharge. There was no statistically significant difference in ED visits. Caregiver satisfaction scores improved in all domains.

Conclusion: Participation in a consultative complex care program can improve utilization patterns and cost of care for CMC, as well as experience of care for patients and families.

Study Design: The study utilized a pre-post design to evaluate the impact of the Compass Care Program for children with medical complexity (CMC) and their families. It compared baseline data for each patient from the 12 months before enrollment with post-enrollment data for all months after enrollment . This design allowed for the assessment of changes in utilization metrics and caregiver satisfaction after program enrollment.

Setting: The study was conducted in a tertiary care setting. The Compass Care Program, a consultative complex care program for children with medical complexity (CMC) and their families, was implemented across inpatient and outpatient settings within the tertiary care institution. This indicates that the program was designed to address the complex medical and social needs of CMC in both the hospital and outpatient care settings.

Population of Focus: The target audience for the study includes healthcare professionals, administrators, and researchers involved in the care of children with medical complexity (CMC) and their families. Specifically, pediatricians, pediatric specialists, hospital administrators, and researchers interested in complex care programs, care coordination, and improving outcomes for CMC would find the study relevant. Additionally, professionals and organizations involved in the development and implementation of consultative complex care programs in tertiary care settings may also benefit from the insights provided in the study.

Sample Size: The study enrolled 105 new patients into the Compass Care Program between June 1, 2015, and September 1, 2017. This sample size represents the population of children with medical complexity (CMC) who were enrolled in the program during the specified time frame.

Age Range: The study reports that at the time of enrollment, roughly half of the patients were between 0 and 1 year of age, while over 90% of patients were 9 years of age or younger.

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): Assessment, Quality Improvement/Practice-Wide Intervention, Sleep Environment Modification

Intervention Description: (1) Determine the prevalence of maternal trust in advice sources on infant care practices; (2) Investigate the association of maternal and infant characteristics with trust in advice sources on infant care practices. Using probability sampling methods, we recruited mothers from 32 U.S. maternity hospitals with oversampling of Black and Hispanic women resulting in a nationally representative sample of mothers of infants aged 2-6 months. Survey questions assessed maternal trust in advice sources (physicians, nurses, family, friends, and media) regarding infant care practices including infant sleep practices (sleep position, bed sharing, and pacifier use), feeding, and vaccination.

Intervention Results: Mothers had the greatest trust in doctors for advice on all infant care practices (56-89 %), while trust was lowest for friends (13-22 %) and the media (10-14 %). In the adjusted analyses, there were significant associations of maternal race/ethnicity, education, and age with trust in advice sources.

Conclusion: for Practice Maternal trust in advice about infant care practices varied significantly by source. A better understanding of which advice sources are most trusted by mothers, as well as the factors associated with maternal trust, may guide the development of more effective strategies to improve adherence to health promoting infant care practices.

Study Design: Survey

Setting: Maternity Hospitals

Data Source: Recruited Mothers from Maternity Hospitals

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Guideline Change and Implementation, Organizational Changes, Quality Improvement, POPULATION-BASED SYSTEMS, NATIONAL, Policy/Guideline (National)

Intervention Description: To determine the success of a program designed to reduce the cesarean section rate in a rural community hospital, to identify reasons for any reduction in the rate and to identify any accompanying increases in the maternal and neonatal morbidity and mortality rates.

Intervention Results: The overall cesarean section rate decreased from 23% in 1985 to 13% in 1989 (p = 0.001). Among the nulliparous women the rate decreased from 23% to 12%, but the difference was insignificant (p = 0.069); this decrease was due to a drop in the number of dystocia-related cesarean sections. The rate among vaginal birth after cesarean section (VBAC) -eligible multiparous women decreased from 93% to 36% (p less than 0.001) because of an increased acceptance of VBAC by the patients and the physicians. The rate among multiparous women ineligible for VBAC was virtually unchanged.

Conclusion: The program was accompanied by a significant decrease in the cesarean section rate. Rural hospitals with facilities and personnel for emergency cesarean sections should consider the introduction of a similar program.

Study Design: Time trend analysis

Setting: 1 small, rural hospital

Population of Focus: Nulliparous women who gave birth between January 1985 and December 19892

Data Source: Not specified

Sample Size: n=456

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): Screening Tool Implementation, Training, Quality Improvement,

Intervention Description: The intervention described in the article is an evidence-based PPD screening guide implemented in a federally qualified health care facility (FQHC) to assess feasibility/sustainability and address the gap in practice. The screening was done using the Edinburgh Postpartum Depression Scale (EPDS) during the first to 6-month infant well checkups. Compliance with screening and feasibility of the referral protocol were assessed.

Intervention Results: During the trial period, 34 patients were seen between 27 days and 11 months of age, with 97% of mothers being scored on the EPDS. Of these, one mother of a 6-month-old Caucasian scored 13, and with her permission, a social worker . Compliance with screening and feasibility of the referral protocol were assessed. Mothers of patients aged 0 to 12 months in the study period were offered PPD screening 97% of the time. Providers and certified medical assistants agreed screening is important and generated a small increase in visit time. Screen scores identified one positive screen

Conclusion: PPD demands screening during the first year of the mother/infant relationship. Pediatric providers have the ideal scheduling of well visits in which to incorporate PPD screening. A barrier for some pediatric practices may be time to follow up after referring a mother to mental health for evaluation of compliance with outside appointments. Having mental health services as a part of the FQHC team allows immediate evaluation/treatment resources when needed.

Study Design: The study design/type is a blinded descriptive quantitative analysis using an implementation research design

Setting: The study was conducted at a FQHC (Federally Qualified Health Center)

Population of Focus: The target audience for the study is pediatric providers

Sample Size: During the trial period, 34 patients were seen between 27 days and 11 months of age

Age Range: The age group is between 27 days and 11 months 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, 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): Quality Improvement/Practice-Wide Intervention, HEALTH_CARE_PROVIDER_PRACTICE, ,

Intervention Description: Our specific aims were two-fold: 1) Accurately measure breastfeeding indicators and 2) Implement AAP Breastfeeding-Friendly Pediatric Office Practice Recommendations.

Intervention Results: Since initiation of the data analytic tool, breastfeeding data has been analyzed from over 30,000 visits (86% Medicaid-insured, 82% Black race). Currently, 80% of providers use default templates that allow standardized data capture. At first newborn visit, 74% of infants were breastfed. At six months, 36% of infants were breastfed; 23% exclusively. Standardized documentation of infant feeding status improved and has remained consistent. Breastfeeding duration did not significantly improve despite practice interventions.

Conclusion: Pediatric primary care measurement tools are feasible and critical to understand breastfeeding continuation. Increased resources and interventions to support breastfeeding in Primary Care are necessary to improve outcomes.

Intervention Components (click on component to see a list of all articles that use that intervention): Multicomponent Approach, Quality Improvement/Practice-Wide Intervention, Motivational Interviewing/Counseling,

Intervention Description: From 2015 to 2018 we convened 2 learning collaboratives, named the Quality Improvement Network for Contraceptive Access, with 17 teams (representing 40 sites) from New York City-based hospitals and health centers using an adaptation of the Institute for Healthcare Improvement's Breakthrough Series Learning Collaborative model. Participating teams sought to implement evidence-informed recommendations to increase access.

Intervention Results: Learning collaborative teams successfully implemented all 4 of the recommendations in 95% of the participating sites. Patients who chose and received a most or moderately effective method increased from 22% to 38% in primary care, and from 0% to 17% in the immediate postpartum period. Patients who chose and received a long-acting-reversible contraceptive increased from 5% to 11% in primary care, and from 0% to 3% in immediate postpartum. Facilitating factors included the involvement of interdisciplinary teams, consideration of costs, utilization of peers to demonstrate change, and champions to drive change.

Conclusion: The application of evidence-informed recommendations using a structured quality improvement initiative increases contraceptive access.

Study Design: Pre-post intervention

Setting: New York City, NY

Sample Size: 17 organization representing 40 care delivery sites

Age Range: NA

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): 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): Consensus Guideline Implementation, Quality Improvement, Shortened Appointment Interval

Intervention Description: The addition of a 2-3 week postpartum visit in addition to a 6 week visit, in keeping with guidelines from the American College of Obstetricians and Gynecologists (ACOG. This quality improvement (QI) project was guided by the Quality Implementation Framework, a process model with a systematic and practical approach to implementation. The model has four phases: initial considerations regarding the host setting, creating a structure for implementation, ongoing structure once implementation begins, and improving future applications by learning from experience. The intervention is based on the assumption that adding an earlier prescheduled postpartum appointment would increase the likelihood that women would attend at least one postpartum appointment.

Intervention Results: During the first 4 months of the 5-month project implementation phase, 14 of the 20 (70%) women who gave birth attended postpartum visits. The attendance at postpartum visits in the last month of the project was 100% (all five women). Days to first postpartum visit decreased from a mean of 40.7 in the baseline year to a mean of 21.8 by the last month of project implementation.

Conclusion: Despite the small scope of this project, our outcomes support continuing the practice of scheduling an earlier postpartum clinic appointment. The timing for when to preschedule postpartum appointments and contextual factors, such as the availability and use of telehealth technology and COVID-19 pandemic challenges, should be considered when implementing similar projects in other settings.

Study Design: Quality improvement project consisting of four rapid Plan-Do-Study-Act (PDSA) cycles

Setting: Small nurse practitioner maternity care clinic in an academic health center

Population of Focus: Publlicly-insured women

Sample Size: 25

Age Range: Childbearing age

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): Screening Tool Implementation, Quality Improvement, Educational Material,

Intervention Description: The intervention used in the study was a screening, brief intervention, referral, and treatment/follow-up (SBIRT) model, which was used to screen eligible patients, provide treatment options, and appropriately refer for follow-up to mental health services. The study analyzed a multicomponent intervention that included PMAD screening, maternal engagement/brief intervention, referral to mental health services, and clinic follow-up to ensure mental health care uptake.

Intervention Results: The study concluded that the use of the SBIRT (screening, brief intervention, referral, and treatment/follow-up) model to implement a safety bundle may contribute to improved mental health outcomes for individuals receiving perinatal care in a private-practice outpatient health care setting. The authors emphasized that education and engagement among clinicians, staff, and patients are key to the successful implementation of a safety bundle for perinatal mental health care. The study also highlighted the importance of maternal engagement, brief intervention, shared decision-making, and closed-loop referral processes in improving help-seeking behaviors and providing evidence-based care for perinatal mood and anxiety disorders (PMAD)

Conclusion: Use of the SBIRT model to implement a safety bundle may contribute to improved mental health outcomes for individuals receiving perinatal care in a private-practice outpatient health care setting. Education and engagement among clinicians, staff, and patients are key to successful implementation of a safety bundle.

Study Design: The study design was a rapid-cycle quality improvement model using four plan-do-study-act (PDSA) cycles over the course of 90 days. The study aimed to improve screening and care for perinatal mood and anxiety disorders (PMAD) in a private-practice women's health clinic. The interventions included screening with a validated tool, brief intervention, referral, and treatment/follow-up (SBIRT) model, and team engagement via weekly meetings. The study used measurements such as pre-post maternal and team engagement survey results, biweekly chart review, and run chart analysis to evaluate the effectiveness of the interventions

Setting: The study was conducted in a suburban, private-practice women's health clinic. The setting involved health care providers, staff, and eligible patients at a private-practice women's health clinic. The study aimed to address the local problem of low rates of PMAD screening and standardized PMAD care practices among health care providers in this specific setting

Population of Focus: The target audience for the study included health care providers (n=2), staff (n=4), and eligible patients (n=78) at a private-practice women's health clinic. The initiative aimed to improve screening and care for perinatal mood and anxiety disorders (PMAD) in this specific setting, making the health care providers, staff, and eligible patients the primary target audience for the intervention

Sample Size: The sample size for the study was 78 eligible patients who were screened for perinatal mood and anxiety disorders (PMAD) using the Edinburgh Postnatal Depression Scale (EPDS)

Age Range: The age range of the study participants was not explicitly mentioned in the article. However, as the study focused on perinatal mood and anxiety disorders (PMAD), it can be inferred that the participants were women in the perinatal period, which includes pregnancy and the postpartum period. Therefore, the age range of the participants would likely be between 18 and 45 years old, which is the typical age range for women in the perinatal period

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Elective Induction Policy, Guideline Change and Implementation, Quality Improvement, POPULATION-BASED SYSTEMS, NATIONAL, Policy/Guideline (National)

Intervention Description: Estimate the frequency of failure to follow the French consensus guidelines for elective induction, and assess how failure affects the rate of cesarean delivery.

Intervention Results: Women with electively induced and spontaneous labor had identical cesarean rates (4.1%). The guidelines were not followed in 23.2% of elective inductions. The risk of cesarean was higher after induction with a Bishop score <5, than after spontaneous labor (adjusted OR = 4.1, 95% CI [1.3–12.9]), while elective induction with a favourable cervix did not increase the cesarean risk. In nulliparas, failure to follow the guidelines tripled the risk of cesarean (adjusted OR = 3.2 [1.0–10.2]). On the other hand, elective induction of labor for women with a favourable cervix did not increase the risk of cesarean over the risk with spontaneous labor.

Conclusion: Elective induction does not appear to increase the cesarean rate when the guidelines are met. Electively inducing labor with a low Bishop score increased the risk of cesarean, especially in nulliparas.

Study Design: Retrospective cohort

Setting: 138 maternity units

Population of Focus: Nulliparous women who gave birth between June 2001 and May 20022

Data Source: Not specified

Sample Size: Total (n=2,052) Intervention (n=69) Control (n=1,983)

Age Range: Not Specified

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): Quality Improvement/Practice-Wide Intervention, , HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: The aim of this quality improvement project (QIP) was to improve the engagement of adolescents and young adults (AYAs), aged 14-20, in the process of transitioning from pediatric to adult care.

Intervention Results: Eighty-five AYAs and 40 parents/caregivers completed readiness assessments twice. Scores improved overall, reaching statistical significance with a small change in AYA mean scores for importance (.94) and confidence (.75). Provision of a transition policy and completion of readiness assessments by AYAs and parents/caregivers met the 70% goal. Patient portal enrollments increased from 4.2% to 12.5%, although did not meet the 30% goal.

Conclusion: Engagement of AYAs and parents/caregivers was improved as a result of this QIP. Successful routine implementation of transition process measures demonstrated improved clinic-wide communication.

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): Care Coordination, Telemedicine Systems (Inter-Hospital Systems), Quality Improvement, Targeting Interventions to Focused Groups

Intervention Description: N/A

Intervention Results: Those with No USC and Facility USCs increased 10 and 18 percent, respectively, while those with Person USCs decreased by 43 percent. Compared to those in the lowest income bracket, those in the highest income bracket were less likely to have a Facility USC. Among those with low incomes, individuals with No USC, Person, in Facility, and Facility USCs were more likely to have ED visits than those with Person USCs.

Conclusion: A growing number are reporting facilities as their USCs or none at all. The impact of these trends is uncertain, although we found that some USC types are associated with ED visits and hospital admissions. Tracking USCs will be crucial to measuring progress toward enhanced care efficiency.

Study Design: We stratified each USC category, by age, region, gender, poverty, insurance, race/ethnicity, and education and used regression to determine the characteristics associated with USC types, ED visits, and hospital admissions.

Setting: 1996-2014 Medical Expenditure Panel Surveys

Population of Focus: Low income individuals, those with no USC

Sample Size: 559762

Age Range: All ages, five categories

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): 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): 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): PATIENT/CONSUMER, Home Visits, PROVIDER/PRACTICE, Quality Improvement/Practice-Wide Intervention

Intervention Description: To measure progress toward the collaborative aim, the HV CoIIN developed a common group of measures that local implementing agencies (LIAs) report and analyze monthly. HV CoIIN measures were selected to capture steps in the process of promotion, early detection, and intervention.

Intervention Results: Within the first 9 months, the HV CoIIN is generating promising movement toward breakthrough change across indicators, for example: By instituting mechanisms to track and provide ongoing surveillance of developmental and behavioral well-being, home visitors are asking over 80% of parents about their child’s development, behavior, or learning at every home visit. By standardizing and measuring efficacy of processes for developmental and behavioral screening, programs are screening approximately 70% of children at appropriate intervals. By incorporating protocol and practice for intentionally supporting children with a positive screen or parental concerns, home visitors are providing 80% or more of families with individualized support related to their child’s development, behavior, or learning within regularly scheduled home visits.

Conclusion: The HV CoIIN’s theory of change includes a comprehensive approach for the development and implementation of reliable and effective systems for surveillance, screening, referral, follow-up, and intervention, with the goal of supporting all children’s development and getting vulnerable children access to appropriate and timely supports.

Study Design: Quality improvement time series design

Setting: Maternal, Infant, and Early Childhood Home Visiting Programs within 8 states and one Tribe: AR, MI, IN, NJ, GA, OH, PA, FL and White Earth Home Health Agency

Population of Focus: Prenatal to age 5 children and families

Data Source: Local team data registries

Sample Size: • Phase I – 11 sites (n≈1019) • Phase II – 5 sites (n≈676) N=families per month

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, Quality Improvement/Practice-Wide Intervention

Intervention Description: To measure progress towards the SMART aim, the HV CoIIN developed a common group of measures that LIAs report and analyze monthly. HV CoIIN measures were selected to capture key steps in the process of breastfeeding.

Intervention Results: The HV CoIIN’s theory of change includes a comprehensive approach to increasing the percentage of mothers that exclusively breastfeed their infants until they are three and six months of age by redesigning the ways we engage mothers, provide breastfeeding support in home visits, and ensure seamless linkages for mothers to access and engage in peer and community breastfeeding supports. Within the first eleven months, the HV CoIIN is generating promising movement toward breakthrough change across indicators, On average, 74% of all home visitors within the breastfeeding collaborative across 11-months, are being trained in lactation and infant feeding, with a trend in the data towards meeting our overall Process AIM. Over the last four months, the average has increased to more than 89%. On average, 69% of mothers with an identified need for breastfeeding support are receiving professional or peer breastfeeding support across the collaborative. Efforts in Action period three will aim to strengthen community and peer supports for families. The average percent of women exclusively breastfeeding is 16%, up 13 percentage points from the baseline of 3% of women.

Conclusion: The HV CoIIN’s theory of change includes a comprehensive approach for the development and implementation of reliable and effective systems for surveillance, screening, referral, follow-up, and intervention, with the goal of supporting all children’s development and getting vulnerable children access to appropriate and timely supports.

Study Design: Quality improvement time series design

Setting: Maternal, Infant, and Early Childhood Home Visiting Programs within FL, MI, OH, PA, RI, VA, WI

Population of Focus: Prenatal to age 3 children and families

Sample Size: • Phase 1 – 11 local teams (n≈1074) • Phase II – 9 sites (n≈873) N=families per month

Age Range: Not specified

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

Intervention Description: HV CoIIN used the Breakthrough Series Collaborative model to teach home visiting agencies strategies to improve breastfeeding practices. Key intervention components included training home visitors on breastfeeding competencies, establishing policies and practices to support breastfeeding, building community linkages, engaging families, and using data for continuous quality improvement. Local agencies tested and implemented various interventions aligned with these components over a 24-month period.

Intervention Results: HV CoIIN improved home visitors' breastfeeding competencies and use of data to inform practice. Breastfeeding initiation increased from 47% to 61%. Exclusive breastfeeding of 3-month-old babies increased from 10% to 13.5%, and for babies 6 months old it increased from 5% to 8%.

Conclusion: This HV QI collaborative had a demonstrable positive effect on breastfeeding rates, including small but measurable increases in the duration of exclusive breastfeeding. Lessons from the HV CoIIN suggest that future work should fortify and complement HV efforts to improve breastfeeding by integrating into broader breastfeeding promotion strategies to 1) address cultural norms, 2) ensure prompt and agile responses to families in need of breastfeeding support, and 3) champion workplace policies that support breastfeeding. The Breakthrough Series Collaborative model holds promise for realizing the potential of home visiting programs to optimize breastfeeding outcomes of vulnerable populations and for enhancing the implementation of federal public health programs.

Study Design: Quality improvement collaborative using the Breakthrough Series Collaborative model

Setting: Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN)

Sample Size: HV CoIIN enrolled 16 local implementing agencies (LIAs) in 7 states, with around 1000 families (pregnant women and women with children newborn to 2 years old) enrolled across the participating LIAs at any given time

Age Range: The families served included pregnant women and women with children from newborn to 2 years old.

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): 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): 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): , Quality Improvement/Practice-Wide Intervention

Intervention Description: The purpose of this review is to discuss how state perinatal quality collaboratives are addressing birth equity to reduce disparities in maternal morbidity and mortality.

Intervention Results: Perinatal quality collaboratives are adopting core practices to advance birth equity, reduce disparities and confront racism and bias in obstetric care including securing leadership commitments to equity, providing education on the causes of inequities and mitigation strategies, collecting accurate race/ethnicity data, addressing social determinants of health, and integrating patient and community knowledge, experiences, and narratives in the quality improvement work.

Conclusion: Inequities in maternal morbidity and mortality particularly affecting Black birthing people are driven by racism, inequities in the social determinants of health, and variations in care practices and quality. Perinatal quality collaboratives are an important resource for driving improvement changes to mitigate these factors and improve outcomes.

Study Design: Multicomponent

Setting: Community-based

Population of Focus: Black birthing people

Sample Size: Not disclosed

Age Range: Not disclosed

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Care Coordination, Nurse/Nurse Practitioner,

Intervention Description: There is a rising number of children with special health care needs (CSHCN) in the pediatric medical home anThis quality improvement project evaluated the impact on CSHCN of the integration of nurse care managers in the pediatric medical home. From October 2015 through February 2019, 673 children received longitudinal care coordination support from a care manager. Health care utilization for primary, subspecialty, emergency department (ED) and inpatient care was reviewed using pre and post design.d their care coordination is complicated and challenging. We aimed to integrate nurse care managers to coordinate care for such patients, and then evaluate, if this improved health care utilization.

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

Conclusion: This quality improvement project demonstrates that nurse care managers who are integrated into the medical home of CSHCN can potentially decrease the utilization of ED visits and hospital admissions as well as subspecialty visits.

Study Design: Pre-post study

Setting: Four pediatric hospital-affiliated practices in a large, urban center in the United States

Population of Focus: Children with special health care needs who were enrolled in the four pediatric hospital-affiliated practices in a large, urban center in the United States

Sample Size: 673 patients who received the nurse care manager intervention across the four medical homes

Age Range: CYSHCN 0-18 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, 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): Quality Improvement/Practice-Wide Intervention, Screening Tool Implementation,

Intervention Description: The interventions included staff and patient engagement, screening process changes, and referral and treatment process changes. These interventions were implemented using the Plan-Do-Study-Act (PDSA) method and rapid cycles of iterative change. The study analyzed a multicomponent intervention that aimed to increase equity in perinatal depression screening, shared decision making, and treatment for incarcerated women. The intervention described aligns with a discernable strategy of using a quality improvement approach to implement evidence-based practices in correctional settings.

Intervention Results: The results of the study on perinatal depression screening and treatment for incarcerated women in the Milwaukee County Jail are as follows: 1. Staff Engagement: By the end of the implementation, eight out of 10 providers were competent in screening and engaging women, indicating an improvement in staff engagement . 2. Patient Engagement: Of the 93 women offered screening, 9% refused care, down from the 22% refusal rate at baseline. For women who screened positive and worked with the shared decision-making tool, the refusal rate decreased to 14% . 3. Screening and Treatment: A total of 101 women were seen, 93 were offered screening, 76 were screened, 43 were positive, and 37 started treatment within the facility. This indicates successful implementation of the screening and treatment process . 4. Overall Outcome: The project exceeded its aim, with 91% of pregnant and postpartum women housed at the Milwaukee County Jail being screened and provided treatment options for perinatal depression. The study revealed perinatal depression rates for incarcerated women that are more than double the national average estimates . These results demonstrate the effectiveness of the multicomponent intervention in standardizing perinatal depression screening and treatment, as well as the successful engagement of both staff and patients in the process.

Conclusion: Rapid cycle QI was effective in standardizing PD screening and treatment. Replication of this project across correctional systems would help to bridge a gap of equitable care for incarcerated women.

Study Design: The study design utilized the Plan-Do-Study-Act (PDSA) method of quality improvement (QI) with four rapid cycles. This method involves iterative changes and continuous evaluation of the impact of interventions on outcomes. The study employed a time series design with baseline data obtained from two months preceding the implementation to track changes over time, looking for shifts and trends. Additionally, the study utilized run charts to evaluate the impact of interventions on outcomes. These approaches allowed for the assessment of the effectiveness of the interventions and the measurement of various outcomes throughout the implementation process.

Setting: The study on perinatal depression screening and treatment for incarcerated women was conducted in the Milwaukee County Jail and House of Corrections in Milwaukee, Wisconsin, United States. The study setting is a correctional facility that houses both male and female inmates, but the focus of the study was on pregnant and postpartum women who were incarcerated in the facility. The study aimed to improve the quality of care for this population by implementing perinatal depression screening, shared decision-making, and treatment within the facility

Population of Focus: The target audience of the study on perinatal depression screening and treatment for incarcerated women in the Milwaukee County Jail is healthcare providers and administrators working in correctional facilities, particularly those caring for pregnant and postpartum women who are incarcerated. The study aims to increase equity in care for this vulnerable population by implementing perinatal depression screening, shared decision-making, and treatment. The findings of the study may also be of interest to researchers, policymakers, and advocates working to improve the health and well-being of incarcerated women and their children.

Sample Size: The sample size for the study on perinatal depression screening and treatment for incarcerated women in the Milwaukee County Jail was a total of 101 women who were seen during the project. Out of these women, 93 were offered screening, and 76 were screened. Additionally, 43 women had positive screens, and 37 of them started treatment within the facility

Age Range: The provided document does not explicitly mention the specific age range of the women included in the study on perinatal depression screening and treatment in the Milwaukee County Jail. However, it focuses on pregnant and postpartum women who were incarcerated, indicating that the age range likely corresponds to the reproductive age group. Typically, this encompasses women between the ages of 15 to 49 years. For precise details on the age range of the participants, it would be necessary to refer to the original study or contact the authors for further information.

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

Intervention Description: Using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, this study assessed CHAMPS, which used a Quality Improvement intervention at hospitals, and engaged intensively with local community partners.

Intervention Results: Average hospital breastfeeding initiation rates rose from 56% to 66% (p < 0.05), the proportion of hospitals designated Baby-Friendly or attaining the final stages thereof rose from 15% to 90%, and 80% of Mississippi Special Supplemental Programme for Women, Infants, and Children districts engaged with CHAMPS. CHAMPS also maintains a funded presence in Mississippi, and all designated hospitals have maintained Baby-Friendly status. These findings show that a breastfeeding-focused public health initiative using broad-based strategic programming involving multiple stakeholders and a range of evaluation criteria can be successful.

Conclusion: More breastfeeding promotion and support programmes should assess their wider impact using evidence-based implementation frameworks.

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): Quality Improvement/Practice-Wide Intervention,

Intervention Description: The intervention involved a quality improvement activity aimed at following up all 9-10 month children said to be overdue by ACIR, with the program commencing in January 2014 with the April 2013 birth cohort

Intervention Results: The study showed that the intervention led to improved timeliness of vaccination and vaccination rates, with Central Coast rates consistently remaining above NSW rates

Conclusion: The authors concluded that the intervention improved both timeliness of vaccination and the proportion of fully vaccinated children.

Study Design: The study utilized a quality improvement activity to assess the effectiveness of the intervention, focusing on vaccination rates and accuracy of ACIR data

Setting: The setting of the study is the Central Coast region of New South Wales, Australia

Population of Focus: The target audience includes children aged 9-10 months in the Central Coast region of New South Wales, Australia

Sample Size: The study involved a total of 841 children, with 112 records that could not be viewed on the Australian Childhood Immunisation Register (ACIR)

Age Range: The age range of the children included in the study was 9-10 months

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

Intervention Description: A breastfeeding-friendly physician’s office that applies the 13 recommendations of the Academy of Breastfeeding Medicine can help increase the exclusivity and duration of breastfeeding. Having already published the results up to five months of age of this intervention in our pediatric practice, we now report on the follow up to 36 months.

Intervention Results: The rates of any breastfeeding at discharge and at 1, 3 and 5 months (n = 252) were 95.2, 95.8, 89.3 and 86.5%, respectively. At 8, 12, 18, 24 and 36 months of age, the rates of breastfeeding were 70.6% (163/231), 59% (135/229), 35% (78/224), 24.6% (55/224) and 7.2% (16/224), respectively.

Conclusion: The rates of any breastfeeding recorded in our pediatric practice up to age 36 months, are much higher than those reported elsewhere in high income countries and are likely to be associated with our baby-friendly and biological nurturing approach.

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): 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): Telemedicine Systems (Hospital), Quality Improvement/Practice-Wide Intervention,

Intervention Description: Telemedicine is widely used but has uncertain value. We assessed telemedicine to further improve outcomes and reduce costs of comprehensive care (CC) for medically complex children.

Intervention Results: Between August 22, 2018, and March 23, 2020, we randomly assigned 422 medically complex children (209 to CC with telemedicine and 213 to CC alone) before meeting predefined stopping rules. The probability of a reduction with CC with telemedicine versus CC alone was 99% for care days outside the home (12.94 vs 16.94 per child-year; Bayesian rate ratio, 0.80 [95% credible interval, 0.66-0.98]), 95% for rate of children with a serious illness (0.29 vs 0.62 per child-year; rate ratio, 0.68 [0.43-1.07]) and 91% for mean total health system costs (US$33 718 vs US$41 281 per child-year; Bayesian cost ratio, 0.85 [0.67-1.08]).

Conclusion: The addition of telemedicine to CC likely reduced care days outside the home, serious illnesses, other adverse outcomes, and health care costs for medically complex children.

Study Design: Randomized clinical trial

Setting: The High-Risk Children's Clinic (HRCC) at the University of Texas Health Science Center at Houston (UTH).

Population of Focus: Medically complex children who received care at the High-Risk Children's Clinic (HRCC) at the University of Texas Health Science Center at Houston (UTH)

Sample Size: 422 children

Age Range: Children 0-21 years of age

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

Intervention Description: The purpose of this study was to develop and implement a transition process planning and communication tool to facilitate transition planning among multiple, pediatric subspecialties within a system-wide transition program.

Intervention Results: Implementation of the tool was feasible and corresponded with increased transition planning documentation post-implementation. Nurses represented 33% of the sample that utilized the tool. Survey results revealed barriers to documentation and utilization of the tool, along with strategies for improvement.

Conclusion: This study demonstrates that health professionals, especially pediatric nurses and nurse practitioners, are willing to adopt new, electronic documentation tools to enhance multidisciplinary transition planning consistent with best practices. Future studies should address identified barriers, assess the effectiveness of the tool on improving transition outcomes, and consider implications for integration into global health care models. System-wide implementation of such tools may improve multidisciplinary communication and coordination of care for youth with special health care needs.

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

Intervention Description: The "Playbook for the Successful Elimination of Early Elective Deliveries" developed by the National Quality Forum (NQF) Maternity Action Team in 2014 outlines strategies and guidance for healthcare providers, hospitals, and policymakers to reduce the rate of early elective deliveries (EED), which are defined as deliveries before 39 weeks of gestation without medical indication. The playbook identifies common barriers to reducing EED, such as lack of effective policies, provider resistance, lack of patient awareness, and data collection challenges. It provides recommendations to overcome these barriers through policy changes, hard-stop policies, provider education, patient education resources, data collection guidance, and measurement strategies using The Joint Commission's PC-01 measure for EED.

Intervention Results: Step 1 — Count the number of patients that delivered babies between 37 and 38 6/7 weeks gestation. Step 2 — Next, subtract the number of patients that meet exclusion criteria listed in Appendix A, Table 11.07 (found in The Joint Commission Specifications Manual) from Step 1. Then, subtract any patients less than 8 years of age, greater than or equal to 65 years of age, length of stay >120 days, or enrolled in clinical trials,. This is your DENOMINATOR. Step 3 — Now, take your DENOMINATOR from Steps 1 and 2 and out of these cases, subtract the number of nonelective deliveries. (Note: Deliveries that do not meet the elective delivery definition are considered nonelective. Elective deliveries are defined as a medical induction of labor or a c-section and all of the following: not in labor or and no history of a Prior uterine Surgery.) This is your NUMERATOR. Step 4 — Divide your NUMERATOR by your DENOMINATOR to calculate your EED rate. The difference between the numerator and the denominator is that the NUMERATOR contains only those cases in which the mother delivered electively between 37 and 38 6/7 weeks without a medical indication that is on the list provided in Appendix A, Table 11.07; the DENOMINATOR contains ALL cases in which the mother delivered between 37 and 38 6/7 weeks, either spontaneously or electively, minus the indications on the list in Appendix A, Table 11.07 or other exclusion.

Conclusion: Despite significant progress in reducing early elective delivery rates across the country, the playbook acknowledges that some areas still face difficulties in achieving desired results. It emphasizes the importance of a concerted effort from various stakeholders, including healthcare providers, hospitals, professional organizations, patient advocates, and policymakers. The playbook serves as a comprehensive resource, offering evidence-based strategies, educational tools, and exemplars to support the elimination of early elective deliveries. By addressing barriers, promoting policy changes, enhancing data collection and measurement, and increasing awareness among providers and patients, the playbook 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, 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): 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): 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): 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/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): Care Coordination, Consultation Systems (Hospital), Quality Improvement,

Intervention Description: For more efficient and timelier enrollment into our care coordination program, we created a best practice alert within our electronic medical record to help overcome the challenges in timely identification of CSHCN. The best practice alert has helped us to provide care coordination benefits to our patients earlier in their hospital course. The purpose of this paper is to describe a quality improvement initiative to improve the early identification of CSHCN on hospital admission through the development of a best practice alert.

Intervention Results: The BPA was turned on in May of 2020. The BPA fired 259 times between May 2020 and February 2021. Of the total BPA activations, 22% (57) were accepted by a provider and resulted in a consult for care coordination. On further evalua- tion of the 22% compliant with accepting the BPA, we discovered that many providers were choosing to “snooze” the order or were writing in a comment stating that COC is not applicable for this patient. If the admitting physician “snoozes” the order, this merely suppresses the BPA for that specific provider for 1 hr. If any other providers enter the EMR during that same hour, they are presented with the BPA. If no other providers are in the chart and 1-hr passes, the original provider will see the BPA again once they sign into the patient’s EMR. There is currently no limit to the num- ber of times a BPA can be “snoozed” by a provider. Our aim to achieve timely identification of CSHCN who may benefit from care coordination on admission was only partially met. Compliance of 22% of successful consults for COC after BPA activation suggests an opportunity for improvement in this process. In addition to providing more focused educational opportunities about the importance and benefits of the BPA, discussions with providers to learn about their reasons for not accepting the BPA also needs to occur. Evaluation of the timing of the BPA, number of times allowed to “snooze,” and other operational characteristics of the workflow will be evaluated. We will persist with a goal of initiating care coordination for > 50% of the CSHCN who meet the criteria on admission. Further improvements will be made to reach our quality improvement project goal to expedite care coordination and improve care for CSHCN during the hospital admission process. This quality improvement process which enhanced our current pediatric complexity tool to better identify CSHCN on admission who may require care coordination services through the development of a BPA, will continue to need refinement and evaluation over time. Further development and evaluation of the workbench reports will assist us in understanding additional benefits to connecting appropriate patients with care coordination. For example, analysis of timely enrollment into the program and readmission rate within 30 days is an important aspect to track. Ongoing evaluation and fine-tuning will help identify additional gaps in our care coordination system.

Conclusion: Classifying children with complex medical conditions according to the level of complexity can be complicated. Although experienced care coordination programs may be able to identify some patients who would benefit from these services, creating a complexity tool with a BPA in the EMR is helping a Midwestern children’s hospital streamline the process to increase sensitivity and specificity for CSHCN. Despite the tool’s limitations and the potential need for ongoing revisions, the usage of complexity tools and BPAs will become critical to target pediatric patient populations that have high usage of resources and services requiring the need for care coordination ongoing. Creating and imple- menting new ways to assist with the early identification of CSHCN requires new and innovative thinking to help achieve more comprehensive, individualized, and focused care. CSHCN requires focused care coordination now and in the future. With further development of care coordination programs across the country and the development of identi- fication tools, including BPAs, we would hope to see a more streamlined connection for successful care coordination services for CSHCN. The traditional systems of care may not be fully meeting the needs of CSHCN. The coexistence of a care coordination program with a complexity tool to include a BPA for enrollment is an approach that is impor- tant in capturing the need for early services. The creation of this coexistence is essential for enhancing outcomes and providing a smooth transition from hospital to home. By identifying this specific patient population on admission, navigation of a complex and ever-changing medical system with the assistance of a care coordinator earlier can help maintain our commitment to improving the health and well- being of CSHCN. CSHCN at our children’s hospital continues to benefit from COC and the care coordination team. The BPA is successful at identifying the potential beneficiaries of care coordination at an early stage, as identified by our recent audit; however, we will need to continue to refine the pro- cess. In addition, there will always be a need for the contin- ued presence of care coordinators at daily medical rounds and huddles to provide that consistent assessment and abil- ity to identify CSHCN who may not be acknowledged by an automated process. The definition of CSHCN is ever-chang- ing as well, and opportunities and strategies to identify those who will most benefit from care coordination will continue to evolve.

Study Design: The provided document does not explicitly state a study design for the quality improvement initiative described. The document describes the implementation of the initiative, the outcomes, and the ongoing evaluation and refinement of the process. Therefore, the study design is likely a quality improvement initiative or program evaluation, rather than a traditional research study with a specific study design.

Setting: The study was conducted at the University of Iowa Stead Family Children's Hospital in Iowa City, IA. The setting for the study was within the Care Coordination Division and Department of Nursing at the children's hospital.

Population of Focus: The target audience for the study is healthcare providers and administrators who work with children with special health care needs (CSHCN) in hospital settings.

Sample Size: The provided document does not explicitly state a sample size for the study. However, it does say that the best practice alert (BPA) tool (i.e. the intervention) was turned on in May of 2020 and fired 259 times between May 2020 and February 2021. Of the total BPA activations, 22% (57) were accepted by a provider and resulted in a consult for care coordination.

Age Range: The document does not explicitly mention a specific age range for the study. However, it does indicate that the BPA looks for required elements in the patient’s EMR on admission, and that one of the elements that trigger an inpatient BPA to fire included aged ≤ 18 years.

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): Community Health Services Policy, Quality Improvement, Screening Tool Implementation,

Intervention Description: The intervention involved universal screening for postpartum depression (PPD) using the Edinburgh Postnatal Depression Scale (EPDS) at multiple obstetric and pediatric practices in Houston, Texas. The EPDS is a 10-item self-report questionnaire that screens for symptoms of PPD. The intervention also included facilitating referrals for evaluation and treatment for women who screened positive for PPD. The study reports that the intervention was designed to increase access to perinatal mental health services. The intervention described in the study aligns with a discernable strategy of universal screening for PPD and facilitating referrals for evaluation and treatment. The study reports that the intervention was based on the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) guidelines for perinatal mental health.

Intervention Results: The study reports that a total of 102,906 screens for postpartum depression (PPD) were completed between May 2014 and July 2018. Of those, 6.3% screened positive for PPD. The obstetric practices completed 18,919 screens, and the pediatric practices completed 83,987 screens. The study also reports that 2,222 referrals were made, with 1,702 (76.6%) completed appointments. The remaining pediatric practices had 4,608 positive screens resulting in 1,390 (30.2%) referrals and 278 (20.0%) completed appointments. The study does not report on the women who received mental health care outside the TCH system.

Conclusion: This project demonstrated that with planning, systems review and trained staff, PPD screening can be integrated into obstetric and pediatric practices and high screening and referral rates can be achieved.

Study Design: The study design/type is a quality improvement project. The project was designed to increase access to perinatal mental health services through universal screening for postpartum depression (PPD) and facilitating referrals for evaluation and treatment, at a multi-site, integrated system of pediatric and obstetric practices in Houston, Texas. The study reports on the results of the project, including the number of screens completed, positive screens identified, referrals made, and appointments completed.

Setting: The study was conducted in an integrated multi-site pediatric and obstetric setting, which includes three hospitals and a Pavilion for Women (PFW) that provides inpatient and outpatient services in obstetric and gynecologic care. The Women’s Place—Center for Reproductive Psychiatry (The Women’s Place) is also located within the PFW and is dedicated to the treatment of women’s mental health

Population of Focus: The target audience for the study is healthcare providers, particularly those working in obstetric and pediatric practices, who are interested in implementing routine screening and referrals for perinatal mood disorders. The study provides a successful model for increasing access to perinatal mental health services in an integrated multi-site setting.

Sample Size: The sample size for the study is not explicitly stated in the given texts. However, the study reports that a total of 102,906 screens for postpartum depression were completed between May 2014 and July 2018, and 6487 (6.3%) of those screens were positive. The study also involved multiple obstetric and pediatric practices in Houston, Texas.

Age Range: The age group is not explicitly stated in the given texts. However, the study involved perinatal mental health services, which typically refers to the period during pregnancy and up to one year postpartum. The study also involved pediatric practices that screened women at the 2 week and 2, 4, and 6-month well-baby visit. Therefore, it can be inferred that the study focused on women who were pregnant or had recently given birth, as well as their infants.

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): Quality Improvement,

Intervention Description: The headspace centre model represents a multicomponent intervention that aligns with a discernable strategy. The intervention is designed to provide early intervention and holistic healthcare for young people aged 12 to 25 years who are at risk of developing mental health problems or who are already showing early symptoms and sub-syndromal mental disorders . The model includes 16 core components, which articulate the 10 service components and 6 enabling components that underpin a headspace centre. These components reflect best practice to reorientate youth mental healthcare to meet the needs of young people at this critical and vulnerable stage of life through an enhanced primary care platform . The intervention is implemented through a comprehensive approach that includes elements such as workforce capacity building, continuous quality improvement, and a focus on early intervention and appropriate care tailored to the stage of illness, stage of life, and complexity of presenting issues , , . The model emphasizes the importance of providing a welcoming environment, non-judgmental and personalized staff response, and a youth-friendly, socially, and culturally inclusive service . Additionally, the model incorporates ongoing monitoring and evaluation to ensure that the intervention is responsive to the local community context and to identify areas for service improvement . The strategy is underpinned by the population health premise that intervening early will reduce the burden of mental illness over time and is in the best interests of young people, their families, and communities . The intervention is designed to be flexible in its delivery to ensure responsiveness to local community needs while adhering to the core components required for licensing to operate . The described intervention aligns with a discernable strategy that emphasizes early intervention, holistic healthcare, continuous quality improvement, and inclusivity, making it a comprehensive multicomponent intervention aimed at addressing the mental health needs of young people.

Intervention Results: The study provides a detailed overview of the 16 core components of the headspace centre model, which aims to intervene early in the development of mental ill-health for young people aged 12 to 25 years by breaking down the barriers to service access and providing holistic healthcare . The study outlines the 10 service components and 6 enabling components that underpin a headspace centre, reflecting best practice to reorientate youth mental healthcare to meet the needs of young people at this critical and vulnerable stage of life through an enhanced primary care platform . The study also emphasizes the importance of ongoing monitoring and evaluation to ensure that the intervention is responsive to the local community context and to identify areas for service improvement . Additionally, the model incorporates workforce capacity building, continuous quality improvement, and a focus on early intervention and appropriate care tailored to the stage of illness, stage of life, and complexity of presenting issues , , . The results of the study demonstrate that the headspace centre model is designed to be flexible in its delivery to ensure responsiveness to local community needs while adhering to the core components required for licensing to operate . The model has been progressively implemented over the past 12 years and is expected to apply a consistent model of integrated youth healthcare . Overall, the study provides a comprehensive overview of the headspace centre model and its core components, highlighting its potential to address the mental health needs of young people and increase access to appropriate and effective services within a sustainable service system ,

Conclusion: The study concludes that the headspace centre model represents a key example of innovation and best practice in youth mental healthcare. It emphasizes the importance of early intervention and holistic healthcare for young people aged 12 to 25 years who are at risk of developing mental health problems or who are already showing early symptoms and sub-syndromal mental disorders , . The model is designed to remove the barriers to service access and increase the propensity for young people to seek help at this critical and vulnerable stage of life , . Furthermore, the study highlights the ongoing monitoring and evaluation processes that are integral to the model, ensuring that the intervention is responsive to the local community context and identifying areas for service improvement . The model's flexibility in delivery is also noted, allowing for responsiveness to local community needs while adhering to the core components required for licensing to operate . The conclusions also point to the potential for the headspace centre model to evolve as the initiative matures, expands, and continues to innovate to better meet the needs of young people in Australia. Future model extensions are expected to include provisions for supporting young people with more severe and complex presentations and to increase the reach of services through innovations in service delivery modes, such as outreach . Overall, the study underscores the significance of the headspace centre model as a comprehensive multicomponent intervention aimed at addressing the mental health needs of young people and increasing access to appropriate and effective services within a sustainable service system.

Study Design: The study does not explicitly mention a specific study design. However, it provides a comprehensive description of the essential components of the headspace centre model, drawing on over 10 years of practice and evaluation . The study outlines the 16 core components of the headspace centre model, which aims to intervene early in the development of mental ill-health for young people aged 12 to 25 years by breaking down the barriers to service access and providing holistic healthcare . Additionally, the study emphasizes the importance of ongoing monitoring and evaluation to ensure that the intervention is responsive to the local community context and to identify areas for service improvement . The model's flexibility in delivery is also noted, allowing for responsiveness to local community needs while adhering to the core components required for licensing to operate . While the study does not explicitly state a specific study design, it presents a comprehensive overview of the headspace centre model, drawing on years of practice and evaluation to describe its essential components and the principles that underpin its implementation.

Setting: The study setting is Australia, where the headspace centre model has been developed and implemented over the past 12 years . The headspace centre model is a national network of enhanced primary care, youth mental health centres that aim to intervene early in the development of mental ill-health for young people aged 12 to 25 years by breaking down the barriers to service access and providing holistic healthcare . The study describes the essential components of the headspace centre model, drawing on over 10 years of practice and evaluation . The model has been progressively implemented across Australia, and there are currently over 110 headspace centres operating across the country . Therefore, the study setting is Australia, where the headspace centre model has been developed, implemented, and evaluated.

Population of Focus: The target audience of the study is likely to be mental health professionals, policymakers, and researchers interested in youth mental health care and early intervention. The study provides a detailed overview of the headspace centre model, which is Australia's innovation in youth mental healthcare and comprises the largest national network of enhanced primary care, youth mental health centres worldwide . The study aims to describe the essential components of the headspace centre model as a key example of innovation in youth mental healthcare . Therefore, mental health professionals, policymakers, and researchers interested in developing and implementing effective early intervention strategies for young people with mental health problems may find the study informative and useful. Additionally, the study may be of interest to individuals and organizations involved in the provision of mental health services to young people, including community organizations, schools, and healthcare providers.

Sample Size: The study does not provide a specific sample size as it is not reporting on a single research study. Instead, it describes the headspace centre model, which is a national network of enhanced primary care, youth mental health centres in Australia . The model has been progressively implemented over the past 12 years, and there are currently over 110 headspace centres operating across Australia . The headspace centre network collects a national minimum data set, which is routinely gathered from headspace centre clients and service providers, and used to monitor and evaluate service activity and outcomes. The data set includes information on the characteristics and outcomes of young people accessing the centres and the level and types of service activity. Therefore, while the study does not provide a specific sample size, it describes a national network of over 110 headspace centres that have been progressively implemented over the past 12 years, serving young people aged 12 to 25 years old. The study also highlights the importance of ongoing monitoring and evaluation to ensure that the intervention is responsive to the local community context and to identify areas for service improvement.

Age Range: The study focuses on the headspace centre model, which is designed to intervene early in the development of mental ill-health for young people aged 12 to 25 years , . Therefore, the age range of interest in the study is individuals between 12 and 25 years old. The model aims to address the mental health needs of this specific age group, recognizing it as a critical and vulnerable stage of life for the emergence of mental health problems

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): HOSPITAL, Chart Audit and Feedback, Guideline Change and Implementation, Organizational Changes, Quality Improvement

Intervention Description: Our purpose was to determine whether completion of the medical audit cycle in labor ward practice could safely reduce cesarean section rates.

Intervention Results: After management change the overall cesarean section rate was decreased (9.5% vs 12%, p < 0.0001). In our population spontaneously laboring nulliparous women with a singleton, cephalic, term pregnancy contributed a significant number of cesarean sections 1982 to 1988 (19.7% of all cesarean sections). Applying principles of early diagnosis and treatment of dystocia in these women resulted in a decrease in the cesarean section rate (2.4% vs 7.5%, p < 0.0001). This was primarily responsible for the overall decrease in the cesarean section rate.

Conclusion: Effective medical audit of labor management can reduce cesarean section rates.

Study Design: Prospective cohort

Setting: 1 private hospital

Population of Focus: Nulliparous women who gave birth between 1984 and 1988 and between September 1989 and August 1992

Data Source: Not specified

Sample Size: Total (n=9,207) 1984-1988 (n=5,622) 1989-1992 (n=3,585)

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): Quality Improvement/Practice-Wide Intervention, Educational Material, Technology-Based Support,

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.

Study Design: Prospective cohort study

Setting: Community-based primary care practices serving pediatric Medicaid beneficiaries. These practices were geographically distributed throughout central and southeast Ohio, with a mix of urban and rural locations.

Population of Focus: Community-based primary care practices in Ohio, specifically those providing care to pediatric Medicaid recipients. These practices were actively engaged with Partners For Kids (PFK) and were involved in the Healthy Children Initiative, a quality improvement effort aimed at increasing well care visit rates for pediatric Medicaid patients.

Sample Size: 10 community-based primary care practices that were actively engaged in the Healthy Children Initiative. These practices served more than 26,000 pediatric Medicaid beneficiaries.

Age Range: The patient population served by these practices included pediatric Medicaid beneficiaries, with a focus on children aged 3-6 years and adolescents.

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): 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): Screening Tool Implementation, Quality Improvement, EMR Reminder,

Intervention Description: The intervention aligns with the strategy of improving screening and referral rates for postpartum depression in the pediatric primary care setting. The article describes a quality improvement project that analyzes a multicomponent intervention, including education and preparation, EMR adaptations, and stakeholder engagement and collaboration.

Intervention Results: The results of the intervention showed a significant increase in the clinic's screening rate from 33% to 80% and an improvement in referral rates from 66% to 79% . These findings indicate that the implementation of the standardized screening schedule and referral algorithm had a positive impact on the clinic's ability to identify and refer mothers with symptoms of postpartum depression for further evaluation and care.

Conclusion: By standardizing PPD screening and implementing a referral algorithm in the ambulatory pediatric setting, more PPD cases can be identified, further evaluated, and, hopefully, treated to improve maternal and infant health outcomes.

Study Design: The study design is a quality improvement (QI) project that standardized the postpartum depression (PPD) screening schedule and implemented a novel referral algorithm in a rural primary care pediatric practice The project aimed to assess the impact of these interventions on the clinic's screening and referral rates for postpartum depression. The study utilized a pre-post intervention design to evaluate the changes in screening and referral rates before and after the implementation of the standardized screening schedule and referral algorithm.

Setting: The study took place in a rural primary care pediatric practice that serves patients up to 21 years of age . This setting reflects a real-world healthcare environment where the interventions and changes in practice were implemented and evaluated. The rural context of the pediatric practice is also an important consideration, as it may have implications for the generalizability of the study's findings to similar healthcare settings.

Population of Focus: The target audience for the study includes healthcare providers in pediatric primary care settings, particularly pediatricians, pediatric nurse practitioners, and pediatric nurses. The interventions and findings of the study are relevant to healthcare professionals involved in the care of infants, children, and adolescents, as well as their mothers. Additionally, the study's insights may also be of interest to professionals involved in maternal mental health, quality improvement initiatives, and those seeking to enhance postpartum depression screening and referral practices in pediatric primary care.

Sample Size: The specific sample size for the study is not explicitly mentioned in the provided excerpts. However, the study collected baseline data from 109 well visits during a 1-month time period before the project's implementation . This information provides insight into the scale of the initial data collection. For a more detailed understanding of the sample size and its implications for the study's findings, it may be necessary to refer to the complete article.

Age Range: The study took place in a rural primary care pediatric practice that serves patients up to 21 years of age . Therefore, the age range of the patients included in the study spans from newborns up to 21 years old. This broad age range reflects the pediatric focus of the primary care practice and the potential impact of the interventions on a diverse patient population.

Intervention Components (click on component to see a list of all articles that use that intervention): Screening Tool Implementation, Quality Improvement, EMR Reminder,

Intervention Description: The intervention aligns with the strategy of improving screening and referral rates for postpartum depression in the pediatric primary care setting. The article describes a quality improvement project that analyzes a multicomponent intervention, including education and preparation, EMR adaptations, and stakeholder engagement and collaboration.

Intervention Results: The results of the intervention showed a significant increase in the clinic's screening rate from 33% to 80% and an improvement in referral rates from 66% to 79% . These findings indicate that the implementation of the standardized screening schedule and referral algorithm had a positive impact on the clinic's ability to identify and refer mothers with symptoms of postpartum depression for further evaluation and care.

Conclusion: By standardizing PPD screening and implementing a referral algorithm in the ambulatory pediatric setting, more PPD cases can be identified, further evaluated, and, hopefully, treated to improve maternal and infant health outcomes.

Study Design: The study design is a quality improvement (QI) project that standardized the postpartum depression (PPD) screening schedule and implemented a novel referral algorithm in a rural primary care pediatric practice The project aimed to assess the impact of these interventions on the clinic's screening and referral rates for postpartum depression. The study utilized a pre-post intervention design to evaluate the changes in screening and referral rates before and after the implementation of the standardized screening schedule and referral algorithm.

Setting: The study took place in a rural primary care pediatric practice that serves patients up to 21 years of age . This setting reflects a real-world healthcare environment where the interventions and changes in practice were implemented and evaluated. The rural context of the pediatric practice is also an important consideration, as it may have implications for the generalizability of the study's findings to similar healthcare settings.

Population of Focus: The target audience for the study includes healthcare providers in pediatric primary care settings, particularly pediatricians, pediatric nurse practitioners, and pediatric nurses. The interventions and findings of the study are relevant to healthcare professionals involved in the care of infants, children, and adolescents, as well as their mothers. Additionally, the study's insights may also be of interest to professionals involved in maternal mental health, quality improvement initiatives, and those seeking to enhance postpartum depression screening and referral practices in pediatric primary care.

Sample Size: The specific sample size for the study is not explicitly mentioned in the provided excerpts. However, the study collected baseline data from 109 well visits during a 1-month time period before the project's implementation . This information provides insight into the scale of the initial data collection. For a more detailed understanding of the sample size and its implications for the study's findings, it may be necessary to refer to the complete article.

Age Range: The study took place in a rural primary care pediatric practice that serves patients up to 21 years of age . Therefore, the age range of the patients included in the study spans from newborns up to 21 years old. This broad age range reflects the pediatric focus of the primary care practice and the potential impact of the interventions on a diverse patient population.

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement, Policy/Guideline (Hospital), HOSPITAL

Intervention Description: The purpose of this quality improvement (QI) project was to implement a safe sleep bundle and evaluate its effectiveness in improving caregiver compliance to safe sleep practices in a level III NICU at a large joint military medical facility.

Intervention Results: Postintervention assessment after the implementation resulted in a significant improvement of overall safe sleep compliance modeled by NICU staff, increasing to 100% from a baseline of 18% pre-intervention (P = .029).

Conclusion: Role-modeling behaviors of clinical staff may reduce the risk of sleep-related infant deaths upon discharge. A multifactorial approach can leverage successful strategies for improving safe sleep compliance in a NICU setting.

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

Intervention Description: This was a pre/post quality improvement study conducted at a single quaternary care medical center from 2015 to 2019. Infants <12 months were observed in their sleeping environment pre- and post-implementation of multiple hospital-wide interventions to improve the sleep safety of hospitalized infants. Following baseline data collection, a multidisciplinary team reviewed the hospital’s infant sleep practices and developed and implemented a care bundle that included the following: A new safe sleep hospital policy; online-learning modules for all hospital staff who interact with infants; educational updates to physicians; an educational handout for volunteers; infant safe sleep education in the nursing admission and/or discharge education for infants; infant safe sleep education in the electronic health record; and various forms of education for families/caregivers in English and Spanish. The primary outcome measure was adherence to the ABCs of safe sleep (Alone in the sleep environment, on their Back on a firm sleep surface, and in an empty Crib).

Intervention Results: Only 1.3% of 221 infants observed preintervention met all ABCs of safe sleep; 10.6% of 237 infants met the ABCs of safe sleep postintervention. Significant improvements in the post-intervention cohort included sleeping in a crib (94% versus 80% preintervention; P < 0.001), avoidance of co-sleeping (3% versus 15% preintervention; P < 0.001), absence of supplies in the crib (58% versus 15% preintervention; P < 0.001), and presence of an empty crib (13% versus 2% preintervention; P < 0.001).

Conclusion: Most infants hospitalized at our institution do not sleep in a safe environment. However, the implementation of a care bundle led to improvements in the sleep environment in the hospital. Further research is necessary to continue improving in-hospital safe sleep and to assess whether these practices impact the home sleep environment.

Setting: A single quaternary care medical center

Population of Focus: Hospital healthcare providers

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement, Community Health Workers (CHWs), EMR Reminder,

Intervention Description: The intervention aimed at optimizing community-based referrals in primary care using Quality Improvement (QI) methodology. The intervention involved several components, including: Dedicating space for Community Health Workers (CHWs) near providers. Creating electronic CHW schedules and warm handoff blocks, Improving communication with providers using email and huddle reminders, Posting informative signs in exam rooms, Co-locating services with medical providers, Creating scheduled warm handoff blocks. Improving leadership involvement and communication with providers. These interventions align with a discernible strategy of optimizing workflows to increase warm handoffs with CHWs, with a focus on co-locating services, creating scheduled warm handoff blocks, and improving leadership involvement and communication with providers. The article presents a study that analyzes a multicomponent intervention aimed at optimizing community-based referrals in primary care using QI methodology. The intervention involved multiple strategies and components to improve the warm handoff rate between families with unmet social needs and CHWs, demonstrating a comprehensive approach to addressing social determinants of health in a primary care setting

Intervention Results: The CHW warm handoff rate increased two-fold from a monthly median of 11% to 24% in the intervention period. The number of social needs screenings completed and CHW referrals increased during the intervention period. Of all patients screened in the intervention period, 8.4% were referred to a CHW, significantly higher than the referral rate in the baseline period. Of all referrals made in the intervention period, 22% had a warm handoff, also significantly higher than the warm handoff rate in the baseline period. The Ages and Stages Questionnaire Third Edition (ASQ-3) screening rate at the 12-month well-baby visit showed an increase from a baseline median rate of 83% to 92% in the intervention period . These results indicate the effectiveness of the QI intervention in increasing the CHW warm handoff rate and improving the social needs screening and referral process in the primary care setting.

Conclusion: The results illustrate that QI methods can be used to optimize workflows to increase warm handoffs with CHWs. This is important as health centers work to improve their social needs screening and referral programs.

Study Design: The study design used in the article is a Quality Improvement (QI) methodology. The authors used the Model for Improvement as the QI framework to increase Community Health Worker (CHW) warm handoffs. They conducted several Plan, Do, Study, Act (PDSA) cycles, which is a key quality improvement model used for rapid change testing and process improvement. The study analyzed the impact of the intervention on process measures, outcome measures, and balancing measures

Setting: The study was conducted at an academic-affiliated federally qualified health center (FQHC) located in the South Bronx, New York. The FQHC has been established since 1967 and is located in congressional district 15, which is the poorest in the nation . The study was conducted in a single site, which may limit the generalizability of the findings to other healthcare settings. However, the study provides insights into the effectiveness of quality improvement methods in optimizing community-based referrals and warm handoffs in a primary care setting.

Population of Focus: The target audience for this study includes healthcare professionals, particularly those involved in primary care and community health settings. This may encompass physicians, nurses, community health workers, social workers, and other healthcare providers who are interested in improving the identification and referral of patients with unmet social needs. Additionally, individuals and organizations involved in quality improvement initiatives within healthcare settings may also find the study relevant. The findings and methodologies presented in the article are likely to be of interest to those seeking to optimize community-based referrals and warm handoffs in primary care using quality improvement methodology.

Sample Size: The article does not explicitly mention the sample size in terms of the number of patients involved in the study. However, it does provide specific data points related to the number of patients screened for social needs in both the baseline and intervention periods, as well as the number of CHW referrals placed. These data points indicate the scale of the study, but the exact sample size in terms of the number of patients is not explicitly stated.

Age Range: The article does not specify a specific age range for the patients involved in the study. However, it does mention that the screening was conducted most often by a parent or guardian prior to the medical exam at new patient visits and annual well-child visits from birth through age 21 . Therefore, it can be inferred that the study involved patients from birth through age 21.

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

Intervention Description: We aimed to improve the prevalence of EIBF among teenage mothers to at least 90% through a quality improvement (QI) initiative.

Intervention Results: The prevalence of EIBF among adolescent mothers was 28.5% during the pre-intervention baseline phase. QI team meeting was held and the barriers to EIBF among the adolescent mothers were discussed and depicted in the form of a fish-bone analysis model. The prevalence of EIBF increased during each intervention cycle to 50%, 60%, 62.5%, 72.7%, 88%, and 100%. At the end of six months follow-up phase, the prevalence of EIBF sustained at around 100%.

Conclusion: This QI initiative has proven to be effective in improving the prevalence of EIBF with simple but effective measures. Adolescent women comprise of a vulnerable sub-population of high-risk mothers. Proper counseling and respectful maternity care will help them face the challenges of motherhood boldly.

Intervention Components (click on component to see a list of all articles that use that intervention): Nurse/Nurse Practitioner, Quality Improvement/Practice-Wide Intervention, Motivational Interviewing,

Intervention Description: The American Academy of Pediatrics (AAP) recommends primary care-based health promotion for obesity prevention at all visits, focusing on nutrition and activity. In this quality improvement project, a primary care innovation was developed to support parents in promoting healthy habits in their children ages 2 to 5 years old. Nurse-led telephone support using motivational interviewing was implemented during two follow-up phone calls aimed at helping parent-child dyads reach self-created activity or nutrition goals.

Intervention Results: Parent-rated confidence and motivation related to meeting these goals showed significant increases. During the second call, 80% self-reported goal completion and high satisfaction with the visits. Registered nurses reported a significant increase in their self-efficacy of communication with parents.

Conclusion: This project showed the feasibility of using nurse telephone visits in an urban low-income primary care setting to improve parental recognition and understanding of healthy habits that align with American Academy of Pediatrics recommendations for obesity prevention.

Study Design: Program evaluation

Setting: An urban pediatric primary care clinic within a large academic institution in the U.S. Midwest. The clinic served as the medical home for approximately 7,000 children, with a predominantly low-income and diverse patient population. The healthcare team consisted of registered nurses, medical assistants, attending physicians, and pediatric residents.

Population of Focus: Parent-child dyads with children who were identified as overweight, obese, or at risk for overweight/obesity based on their body mass index (BMI) or parent-identified nutrition or physical activity habits.

Sample Size: 50 parent-child dyads

Age Range: Children aged 24 to 67 months

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provision of Safe Sleep Item, Provider Training/Education, HOSPITAL, Quality Improvement, Policy/Guideline (Hospital), Visual Display (Hospital), Sleep Environment Modification, CAREGIVER

Intervention Description: This quality improvement study aimed to increase adherence to SSPs for infants admitted to a children's hospital general care unit between October 2013 and December 2014.

Intervention Results: Audit data showed that there was a non-significant increase in supine position from 81.0% to 84.3% from baseline to follow-up (p=0.54). Caregiver report showed that there was a non-significant increase in supine position from 89.3% to 93.8% (p=0.42).

Conclusion: Sustained improvements in hospital SSPs were achieved through this quality improvement initiative, with opportunity for continued improvement. Nurse knowledge increased during the intervention. It is uncertain whether these findings translate to changes in caregiver home practices after discharge.

Study Design: QE: pretest-posttest

Setting: American Family Children’s Hospital in WI

Population of Focus: Infants <12 months admitted to medical and surgical units; Caregivers of infants <6 months after hospital discharge

Data Source: Crib audit/infant observation; Caregiver report

Sample Size: Baseline (n=59) Follow-up (n=257); Baseline (n=56) Follow-up (n=48)

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, Quality Improvement, Policy/Guideline (Hospital), CAREGIVER, Educational Material (caregiver)

Intervention Description: The authors describe a 4-year demonstration project (2004-2007) to reduce infant deaths related to sleep environments by changing attitudes and practices among nurses who work with African American parents and caregivers in urban Michigan hospitals.

Intervention Results: Across all 7 sites, among infants in cribs at the time of the audits, there was a significant increase in the percentage on their backs from 80.7% to 91.9% (p<0.05).

Conclusion: Following the policy change effort, nurses changed their behavior and placed infants on the back to sleep.

Study Design: QE: pretest-posttest

Setting: Seven urban hospitals in MI

Population of Focus: Healthy newborn infants in cribs at the time of the audit B

Data Source: Crib audit/infant observation

Sample Size: Baseline (n=579) Follow-up (n=692)

Age Range: Not specified

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

Intervention Description: We used quality improvement (QI) methodology to increase adherence to infant safe sleep practices, with a goal to improve the proportion of infants sleeping in an environment that would be considered 'perfect sleep' to 70% within a 1-year period.

Intervention Results: While we did not meet our goal, the percentage of infants with 'perfect sleep' increased from a baseline of 41.9% to 67.3%, and we also saw improvement in each of the individual components that contribute to this composite measure. Improvements were sustained over 12 months later, suggesting that QI interventions targeting infant safe sleep in this inpatient setting can have long-lasting results.

Conclusion: This project also suggests that infant safe sleep QI initiatives and preparation towards Baby Friendly Hospital Certification can be complementary.

Intervention Components (click on component to see a list of all articles that use that intervention): PROFESSIONAL_CAREGIVER, Educational Material (caregiver), Provision of Safe Sleep Item, HOSPITAL, Quality Improvement, Crib Card, Policy/Guideline (Hospital), HEALTH_CARE_PROVIDER_PRACTICE, Educational Material (Provider), Nurse/Nurse Practitioner, Audit/Attestation, Audit/Attestation (Provider)

Intervention Description: This hospital quality improvement initiative performed a series of Plan-Do-Study-Act cycles designed to increase the proportion of infants placed in a “perfect sleep” environment that met all of the American Academy of Pediatrics’ infant safe sleep guidelines. The initiative took place while the hospital was preparing for Baby Friendly certification, with increased emphasis on rooming in and skin to skin at the same time. Initial cycles targeted nurse and parental education, while later cycles focused on providing sleep sacks/wearable blankets for the infants. The goal was to achieve 70% “perfect sleep” compliance among infants cared for in the hospital.

Intervention Results: While we did not meet our goal, the percentage of infants with 'perfect sleep' increased from a baseline of 41.9% to 67.3%, and we also saw improvement in each of the individual components that contribute to this composite measure. Improvements were sustained over 12 months later, suggesting that QI interventions targeting infant safe sleep in this inpatient setting can have long-lasting results.

Conclusion: This project also suggests that infant safe sleep QI initiatives and preparation towards Baby Friendly Hospital Certification can be complementary.

Population of Focus: Hospital healthcare providers

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 high prevalence of child and adolescent psychiatric disorders in the United States, coupled with the severe and pervasive shortage of child and adolescent psychiatrists, has led 46 states and territories to launch programs providing child psychiatry consultation to pediatricians. Although these programs aim to increase access to psychiatric expertise, evidence of favorable program outcomes beyond user satisfaction has been limited.

Intervention Results: Child psychiatry access programs for pediatricians play a key role in expanding access to psychiatric expertise for children and adolescents. Findings presented from one such program suggest that consultation with child psychiatrists enabled pediatricians to manage a majority of cases referred for consultation, including cases with moderate severity and some degree of complexity. If pediatricians can manage mild to moderate psychiatric disorders in the primary care setting with consultative support, the services of child and adolescent psychiatrists can be reserved for the most severe and complex cases.

Conclusion: Findings from the authors' child psychiatry consultation program suggest that such programs may enable pediatricians to manage most cases referred for consultation, thereby extending the behavioral health workforce to the primary care setting.

Study Design: Restrospective study

Setting: A Child Psychiatry Access Program

Population of Focus: Pediatric primary care practitioners and child and adolecent psychiatrists

Sample Size: 109 pediatric primary care providers

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

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

Intervention Description: The Six Core Elements of Transition have been advocated to guide transition, but little is published about their use with liver transplant patients. We started a liver transplant transition program in August 2015 using quality improvement (QI) methods and by linking the Six Core Elements of Transition to process measures.

Intervention Results: Overall RTQ scores improved from 23.7 to 30.5 (+28.7%, P = .009) prior to transfer. Nearly two-thirds (63%) of patients were seen by adult transplant hepatology within 6 months, and one patient was lost to follow-up after the first adult visit. Tacrolimus-level standard deviations were <2.0 in 45% of patients in pediatric care and 72% of patients in adult care. Three patients had undergone immunosuppression withdrawal in pediatric care, with one restarted on immunosuppression prior to transfer to adult care due to late acute rejection.

Conclusion: The Six Core Elements of Transition can be translated into patient- and system-level transition milestones to serve as potential quality metrics in the implementation of transition programs.

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

Intervention Description: Research supports integrated pediatric behavioral health (BH), but evidence gaps remain in ensuring equitable care for children of all ages. In response, an interdisciplinary team codeveloped a stepped care model that expands BH services at 3 federally qualified health centers (FQHCs). FQHCs reported monthly electronic medical record data regarding detection of BH issues, receipt of services, and psychotropic medications. Study staff reviewed charts of children with attention-deficit/hyperactivity disorder (ADHD) before and after implementation.

Intervention Results: Across 47 437 well-child visits, >80% included a complete BH screen, significantly higher than the state's long-term average (67.5%; P < .001). Primary care providers identified >30% of children as having BH issues. Of these, 11.2% of children <5 years, 53.8% of 5-12 years, and 74.6% >12 years were referred for care. Children seen by BH staff on the day of referral (ie, "warm hand-off") were more likely to complete an additional BH visit than children seen later (hazard ratio = 1.37; P < .0001). There was no change in the proportion of children prescribed psychotropic medications, but polypharmacy declined (from 9.5% to 5.7%; P < .001). After implementation, diagnostic rates for ADHD more than doubled compared with baseline, follow-up with a clinician within 30 days of diagnosis increased (62.9% before vs 78.3% after; P = .03) and prescriptions for psychotropic medication decreased (61.4% before vs 43.9% after; P = .03).

Conclusion: Adding to a growing literature, results demonstrate that integrated BH care can improve services for children of all ages in FQHCs that predominantly serve marginalized populations.

Study Design: Pre-post study

Setting: Federally Qualified Health Centers (FQHCs) located in Massachusetts and New York

Population of Focus: Pediatric patients and their families who received care at the Federally Qualified Health Centers (FQHCs)

Sample Size: 47,437 unique well-child visits for children

Age Range: Children aged 30 days through 18.99 years of age

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

Intervention Description: he implementation of information technology prompts within the electronic medical record to improve influenza vaccination during specialty clinic visits for pediatric patients with inflammatory bowel disease. The customized prompts were designed to remind healthcare providers to offer influenza vaccination to eligible patients and to document vaccination status in the electronic medical record. The prompts were tailored to the specific needs of the pediatric patients with inflammatory bowel disease and were implemented during specialty clinic visits.

Intervention Results: ndicated significant improvements in influenza vaccination documentation and vaccine counseling following the implementation of information technology prompts within the electronic medical record. The proportion of patients with yearly influenza vaccination documentation improved from 10% at baseline to 39% by Year 1 and further to 61% by Year 2 following the implementation of the intervention. Additionally, vaccine counseling for unvaccinated patients improved from 27% to 77% by Year 2. Importantly, patients seen by gastroenterology nurses had higher vaccination documentation and vaccine counseling compared to those seen by a physician alone. These findings suggest that the use of customized prompts within the electronic medical record was effective in improving influenza vaccination rates and vaccine counseling for pediatric patients with inflammatory bowel disease

Conclusion: concluded that the implementation of information technology prompts within the electronic medical record was effective in improving influenza vaccination rates and vaccine counseling for pediatric patients with inflammatory bowel disease. The use of customized prompts tailored to the specific needs of the pediatric patients with inflammatory bowel disease was associated with significant improvements in influenza vaccination documentation and vaccine counseling. The study highlights the potential benefits of utilizing information technology to improve vaccination rates and underscores the importance of healthcare providers in offering and documenting influenza vaccination for eligible patients

Study Design: intervention study or a quality improvement initiative aimed at implementing information technology prompts within the electronic medical record to improve influenza vaccination during specialty clinic visits for pediatric patients with inflammatory bowel disease.

Setting: Johns Hopkins Childrens Center, Baltimore, MD

Population of Focus: Uptake for pediatric patients with additional illness/disease

Sample Size: 533

Age Range: Age range not specified, but within pediatric clinic

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Peer Review, Quality Improvement

Intervention Description: This study examined the cesarean section rates at a university hospital before and after the implementation of a quality improvement effort that included weekly review conferences to discuss all cesarean deliveries. The conferences, which began in 2010 and continued throughout the study period (2013) were attended by obstetric care providers, anesthesiology, and labor and delivery nurses. Of the deliveries included in the study, 1,677 occurred in the prereview period and 3,864 occurred in the postreview period.

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 and the decrease in cesarean deliveries were seen only in daytime hours (7 AM to 7 PM), that is, the shift that was covered by senior obstetricians.

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: Oregon Health & Science University Hospital

Population of Focus: women with term singleton vertex gestations

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

Intervention Description: We empaneled patients to PCPs, reduced provider floating, implemented continuity-promoting scheduling guidelines, scheduled future WCC visits for patients ≤15 months during check-in for their current one, and encouraged online scheduling.

Intervention Results: Patient empanelment increased from 0% to >90% (P < .001). Patient-provider WCC continuity increased from 25.6% to 54.7% (P < .001). A 20.5% decrease in ED utilization rate was associated with continuity project initiation. Empaneled patients demonstrated higher show rates (76.9%) versus unempaneled patients (71.4%; P < .001). WCC completion rates increased from 52.6% to 60.7%.

Conclusion: WCC continuity more than doubled after interventions and was associated with decreased ED utilization, higher show rates, and increased timely WCC completion.

Study Design: Nationwide Children's Hospital Primary Care Network cares for >120,000 mostly Medicaid-enrolled patients across 13 offices. Before 2017, patients were empaneled to an office, not individual PCPs. We empaneled patients to PCPs, reduced provider floating, implemented continuity-promoting scheduling guidelines, scheduled future WCC visits for patients ≤15 months during check-in for their current one, and encouraged online scheduling. We tracked the percentage of all WCC visits that were scheduled with the patient's PCP and the percentage of subsequent WCC visits for patients ≤15 months that were scheduled during the current visit, and provided feedback to schedulers. We followed emergency department (ED) utilization and visit show rates. WCC visit completion rates were tracked using HEDIS metrics.

Setting: Nationwide Children's Hospital Primary Care Network; United States

Population of Focus: Medicaid enrollees

Sample Size: >120,000 across 13 offices

Age Range: 15 month olds and younger

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

Intervention Description: Although patient-provider continuity improves care delivery and satisfaction, poor continuity with primary care providers (PCP) often exists in academic centers. We aimed to increase patient empanelment from 0% to 90% and then increase the percent of well-child care (WCC) visits scheduled with the PCP from 25.6% to 50%, without decreasing timely access that might result if patients waited for PCP availability. Nationwide Children's Hospital Primary Care Network cares for >120,000 mostly Medicaid-enrolled patients across 13 offices. Before 2017, patients were empaneled to an office, not individual PCPs. We empaneled patients to PCPs, reduced provider floating, implemented continuity-promoting scheduling guidelines, scheduled future WCC visits for patients ≤15 months during check-in for their current one, and encouraged online scheduling. We tracked the percentage of all WCC visits that were scheduled with the patient's PCP and the percentage of subsequent WCC visits for patients ≤15 months that were scheduled during the current visit, and provided feedback to schedulers. We followed emergency department (ED) utilization and visit show rates. WCC visit completion rates were tracked using HEDIS metrics.

Intervention Results: Patient empanelment increased from 0% to >90% (P < .001). Patient-provider WCC continuity increased from 25.6% to 54.7% (P < .001). A 20.5% decrease in ED utilization rate was associated with continuity project initiation. Empaneled patients demonstrated higher show rates (76.9%) versus unempaneled patients (71.4%; P < .001). WCC completion rates increased from 52.6% to 60.7%.

Conclusion: WCC continuity more than doubled after interventions and was associated with decreased ED utilization, higher show rates, and increased timely WCC completion.

Study Design: Program evaluation

Setting: Nationwide Children's Hospital (NCH) Primary Care Network (PCN) with a group of 13 urban offices in Columbus, Ohio

Population of Focus: Patients of the Nationwide Children's Hospital (NCH) Primary Care Network (PCN) in Columbus, Ohio serving a diverse population of over 120,000 patients, most of whom are Medicaid-enrolled.

Sample Size: 13 primary care offices

Age Range: Pediatric practices serving children 0-17 years of age

Intervention Components (click on component to see a list of all articles that use that intervention): Screening Tool Implementation, Quality Improvement, Expert Feedback Using the Plan-Do-Study-Act-Tool, Screening in Nontraditional Settings

Intervention Description: The intervention includes a standardized postpartum depression screening tool into pediatric primary care practice to increase postpartum depression screening rates.

Intervention Results: The study found that postpartum depression screening practices improved from 83% to 88% after the implementation of the standardized screening tool, although this improvement was not statistically significant . The study also found that certain infant and family characteristics, such as male gender, Medicaid or sliding-scale payment for services, and Hispanic ethnicity, were associated with higher rates of positive postpartum depression screens, although again, these associations were not statistically significant . Another study mentioned in the text found that the implementation of a standardized screening tool increased the rate of screening for postpartum depression from 83% to 100%

Conclusion: Pediatric health care providers can effectively screen for postpartum depression. Certain infant and family characteristics may alert the provider to higher risks for mothers.

Study Design: The study design/type is not explicitly mentioned in the given texts. However, the study is a quality improvement project that aimed to improve postpartum depression screening in a pediatric primary care clinic . The study used pre- and post-intervention data to compare the screening rates before and after the implementation of a standardized screening tool . Therefore, it can be classified as a quasi-experimental study.

Setting: The quality improvement project took place in a nurse-led, rural FQHC (Federally Qualified Health Center) in north-central Indiana that offers primary care services, including pediatrics, family health, women's health, and behavioral health

Population of Focus: The target audience for this study is pediatric health care providers who are interested in improving postpartum depression screening in their practice

Sample Size: The sample size for this study was 116 women

Age Range: The age group is not specified in the given texts. However, since the study is about postpartum depression screening, it can be inferred that the sample consists of women who have recently given birth

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Midwifery, HOSPITAL, Quality Improvement, Collaboratives

Intervention Description: Midwives provide intrapartum care to low-risk nulliparous women in hospital settings where obstetricians also care for women during childbirth. This model of care is one of the measurable components of the Obstetrical Care Outcomes Assessment Program, a quality improvement initiative that uses clinical data from maternal and newborn medical records to evaluate the care given to pregnant women during labor, delivery and the postpartum period as the basis for exploring actionable and sustainable improvements. The program uses health care provider specific, chart-abstracted data for quality improvement from all births at participating sites. Multiple hospitals in the Northwest United States, including urban, suburban, and rural centers supported by I, II, III, and IV levels of maternal care participate in this quality improvement collaborative.

Intervention Results: The study cohort comprised 23,100 births (3,816 midwife and 19,284 obstetrician). Compared with obstetricians, midwifery patients had significantly lower intervention rates, an approximately 30% lower risk of cesarean delivery in nulliparous patients (adjusted relative risk [aRR] 0.68; 95th% CI 0.57-0.82), and an approximately 40% lower risk of cesarean in multiparous patients (aRR 0.57; 95th% CI 0.36-0.89). Operative vaginal birth was also less common in nulliparous patients (aRR 0.73; 95th% CI 0.57-0.93) and multiparous patients (aRR 0.30; 95th% CI 0.14-0.63). Shoulder dystocia was more common in multiparous patients receiving midwifery care (aRR 1.42; 95th% CI 1.04-1.92).

Conclusion: In low-risk pregnancies, midwifery care in labor was associated with decreased intervention, decreased cesarean and operative vaginal births, and, in multiparous women, an increased risk for shoulder dystocia. Greater integration of midwifery care into maternity services in the United States may reduce intervention in labor and potentially even cesarean delivery, in low-risk pregnancies. Larger research studies are needed to evaluate uncommon but important maternal and newborn outcomes.

Setting: Hospitals participating in a multi-center quality improvement collaborative (the Obstetrical Care Outcomes Assessment Program)

Population of Focus: Low-risk nulliparous pregnant women

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

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

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

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

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

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

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

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

Age Range: parents of children in the PICU

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, Midwifery

Intervention Description: We explored breast feeding outcomes of women having a First Nations infant at three sites that introduced a culturally specific continuity of midwife care model.

Intervention Results: Most women (298, 87%) received the culturally specific model. Breast feeding initiation (96%, 95% CI 0.93 to 0.98) was high. At 3 months, 71% were giving ‘any’ (95% CI 0.65 to 0.78) and 48% were giving ‘only’ breast milk (95% CI 0.41 to 0.55). Intending to breast feed 6 months (Adj OR ‘any’: 2.69, 95% CI 1.29 to 5.60; ‘only’: 2.22, 95% CI 1.20 to 4.12), and not smoking in pregnancy (Adj OR ‘any’: 2.48, 95% CI 1.05 to 5.86; ‘only’: 4.05, 95% CI 1.54 to 10.69) were associated with higher odds. Lower education (Adj OR ‘any’: 0.36, 95% CI 0.13 to 0.98; ‘only’: 0.50, 95% CI 0.26 to 0.96) and government benefits as the main household income (Adj OR ‘any’: 0.26, 95% CI 0.11 to 0.58) with lower odds.

Conclusion: Breast feeding rates were high in the context of service-wide change. Our findings strengthen the evidence that culturally specific continuity models improve breast feeding outcomes for First Nations women and infants. We recommend implementing and upscaling First Nations specific midwifery continuity models within mainstream hospitals in Australia as a strategy to improve breast feeding.

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

Intervention Description: The Interventions to Minimize Preterm and Low Birth Weight Infants through Continuous Improvement Techniques (IMPLICIT) Network, a family medicine maternal child health learning collaborative of the Family Medicine Education Consortium, created a model of intercconception care (ICC) that addresses barriers to care by screening women during well-child visits (WCVs). The IMPLICIT Network develops, implements, evaluates, and optimizes new and existing models of care focused on improving birth outcomes and the health of women, infants, and families. In this model, clinicians assessed pregnancy status, intent, and current method of contraception and offered counseling and interventions. Mothers were also screened for depression. Clinicians screened mothers at well-child visits from 2 to 24 months. Mothers received screening and advice regardless of whether or not she received primary care from the same provider or practice. A variety of services were available to the participating clinicians on site, including case management, social workers, community health workers, substance abuse counselors, and office-based pharmacists. Each family medicine practice offered patients access to mental health counseling, with 6 of the 11 sites reporting availability of colocated, integrated behavioral health models.

Intervention Results: Mothers accompanied their babies to 92.7% of WCVs. At more than half of WCVs (69.1%), mothers were screened for presence of ICC behavioral risks, although significant practice variation existed. Risk factors were identified at significant rates (tobacco use, 16.2%; depression risk, 8.1%; lack of contraception use, 28.2%; lack of multivitamin use, 45.4%). Women screened positive for 1 or more ICC risk factor at 64.6% of WCVs. Rates of documented interventions for women who screened positive were also substantial (tobacco use, 80.0%; depression risk, 92.8%; lack of contraception use, 76.0%; lack of multivitamin use, 58.2%).

Conclusion: Based on the findings of this study and the clinical experiences of participating sites with the IMPLICIT ICC model, several key recommendations can be offered to clinical practices seeking to implement this model for interconception care. Practices should develop standardized screening protocols, tools for point-of-care intervention for women who screen positive in any of the four key behavior risk areas, such as patient education materials and clinical management algorithms, and linkages with local community agencies so they may refer women needing additional resources not offered on site, such as depression care or contraception access. Practices should also strive to use quality improvement techniques to improve both screening and intervention rates. Practices that serve populations with limited resources such as uninsured, undocumented, or immigrant communities would gain particular benefit from implementing IMPLICIT ICC as a way to reach women not seeking care. Based on their particular population's needs, clinical practices might consider expanding the IMPLICIT ICC model to include additional risk factors for poor birth outcomes, such as domestic violence, food insecurity, obesity, or substance abuse. However, adding additional screening targets could limit the feasibility of screening and intervention in the context of the well-child visit. The use of the WCV is one of many strategies that providers may use to deliver the full breadth of comprehensive interconception care that women should receive. Future effectiveness studies are needed to assess rates of prematurity and other birth outcomes in populations who received interconception care through the IMPLICIT ICC model, especially at sites who have implemented the model for several years, to inform the growing literature on preconception care.

Study Design: Descriptive statistics; Feasibility study

Setting: Eleven eastern US family medicine residency programs

Population of Focus: Mothers accompanying their babies at well-child checkups

Sample Size: Varies across sites

Age Range: <15--≥24

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Educational Material (Provider), Collaboration with Local Agencies (Health Care Provider/Practice),

Intervention Description: The study used quality improvement (QI) as part of a collaborative learning system approach to improve access and flow within Child and Adolescent Mental Health Services (CAMHS). Seven separate teams across five CAMHS services in the trust identified a local issue related to flow in their system and developed QI projects to tackle these. Each team developed a family of measures containing outcome, process, and balancing measures.

Intervention Results: Improvements in outcome measures were seen by three teams; City and Hackney ADHD, Tower Hamlets Triage, and Luton Emotional and Behavioural Team. Improvements in process measures were seen by two teams. One team did not see an improvement in outcome or process measures.

Conclusion: The study shows that the use of quality improvement (QI) as part of a collaborative learning system approach can lead to improvements in access and flow within Child and Adolescent Mental Health Services (CAMHS).

Study Design: Quality improvement (QI) as part of a collaborative learning system approach.

Setting: Child and Adolescent Mental Health Services (CAMHS) in East London NHS Foundation Trust (ELFT), England

Population of Focus: Mental health professionals, healthcare providers, policymakers, and researchers interested in improving access and flow within CAMHS.

Sample Size: Seven separate teams across five CAMHS services in the trust participated in the study.

Age Range: The study focused on Child and Adolescent Mental Health Services (CAMHS), which serves individuals up to the age of 18.

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

Intervention Description: To facilitate implementation, clinical nurses were educated as Subject Matter Experts (SMEs) to empower them to transform and sustain outcomes-driven QI for infant safe sleep nursing practice.

Intervention Results: Immediate posteducation surveys completed by SMEs indicated that over 98% of respondents strongly agreed or agreed they were able to effectively demonstrate communication strategies, identify SME role components, provide environment surveillance, and demonstrate best practices in infant safe sleep. To allow time for assimilation of the of SME role, a survey was initiated at 6 months to capture progress made. Seventy-eight SMEs responded to the survey and reported exceptional or substantial progress in 10 areas for SME responsibilities.

Conclusion: Use of the SME role for program implementation led to highly favorable SME-reported outcomes in leading a hospital-based QI program.

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, Audit/Attestation

Intervention Description: This descriptive study examined outcomes from 268 clinical nurses who received comprehensive education on infant safe sleep and their role as subject matter experts (SMEs). SME nurses completed two interactive learning modules addressing safe sleep guidelines and teaching strategies and attended a workshop to acquire skills for program implementation. Key competencies included data collection and dissemination, policy development, and communication techniques. Likert-type scale surveys measured knowledge gained and progress made in practice following education.

Intervention Results: Immediate posteducation surveys completed by SMEs indicated that over 98% of respondents strongly agreed or agreed they were able to effectively demonstrate communication strategies, identify SME role components, provide environment surveillance, and demonstrate best practices in infant safe sleep. To allow time for assimilation of the of SME role, a survey was initiated at 6 months to capture progress made. Seventy-eight SMEs responded to the survey and reported exceptional or substantial progress in 10 areas for SME responsibilities.

Conclusion: Use of the SME role for program implementation led to highly favorable SME-reported outcomes in leading a hospital-based QI program.

Setting: 25 birthing hospitals in Pennsylvania

Population of Focus: Nurses trained as subject matter experts (SMEs)

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Labor Support, Continuity of Care (Caseload), HOSPITAL, Chart Audit and Feedback, Quality Improvement

Intervention Description: Using data from Robson classification, a novel labor–ward management protocol termed Comprehensive Management (CM) was carried out at the Obstetric Unit of the Cà Granda Niguarda Hospital in Milan, Italy, from 1 January 2012 to 31 December 2013. CM included regular labor monitoring, documentation of events, audit and feedback, the use of intrapartum ultrasound, mobility in labor and birth posture of choice, a partograph conceived as a screening tool, continuity of care; respectful labor and childbirth care; oral fluid and food intake, and emotional support from a person of choice. The CM “framework” provides tools to make medical interventions performed during childbirth quantitatively measurable and comparable.

Intervention Results: Following CM a substantial reduction was observed in the Overall Treatment Ratio, as well as in the ratios for augmentation (amniotomy and synthetic oxytocin use) and for caesarean section ratio, without any increase in neonatal and maternal adverse outcomes. The key component of this reduction was the dramatic decline in the proportion of women progressing to augmentation, which resulted not only the most practiced intervention, but also the main door towards further treatments.

Conclusion: The proposed framework, once combined with Robson Classification, provides useful tools to make medical interventions performed during childbirth quantitatively measurable and comparable. The framework allowed to identifying the key components of interventions reduction following CM. In its turn, CM proved useful to reduce the number of medical interventions carried out during childbirth, without worsening neonatal and maternal outcomes.

Setting: Obstetric Unit of the Cà Granda Niguarda Hospital in Milan, Italy

Population of Focus: Nulliparous or multiparous women, at term, with single cephalic baby in either spontaneous or induced labor

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

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

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

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

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

Setting: e Emma Children's Hospital Amsterdam UMC

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

Sample Size: 23 adolescents

Age Range: aged 12-18 years

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

Intervention Description: The aim of this initiative was to implement an evidence-based bundle at an urban community teaching hospital in at least 50% of labors in 60 days in order to reduce early labor admissions and increase adherence to evidence-based labor management guidelines shown to decrease cesarean birth. Chart audits, root-cause analysis, and staff engagement informed bundle development. An early labor triage guide, labor walking path, partograph, and pre-cesarean checklist were implemented to drive change. Four Rapid Cycle Plan Do Study Act cycles were conducted over 8 weeks

Intervention Results: The bundle was implemented in 58% of births. The bundle reduced early labor admissions labor from 41% to 25%. Team knowledge reflecting current guidelines in labor management increased 35% and 100% of cesareans for labor arrest met criteria. Patient satisfaction scores exceeded 98%.

Conclusion: Implementing an evidenced-based bundle was effective in reducing early labor admissions and increasing utilization of and adherence to labor management guidelines.

Setting: Urban community teaching hospital

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, Provider Training/Education, Guideline Change and Implementation, Provider Tools

Intervention Description: We collected parent demographic information via survey and infant characteristics via medical record review. Study staff interviewed parents at 3 distinct time points: (1) following recorded family conferences, (2) at discharge from the hospital, and (3) 6 months following hospital discharge.

Intervention Results: We present parent-driven recommendations for the provision of information about neurologic prognosis. ALIGN represents a novel, inductively-derived framework that centers the voices and lived experiences of parents caring for critically ill children. These recommendations are organized by key phases of information delivery and can guide clinicians as they navigate conversations with caregivers of critically ill infants and support interventions to improve prognostic communication.

Conclusion: No Conclusion section - Discussion: The ALIGN framework offers a novel, parent-informed strategy to effectively communicate neurologic prognosis. Although ALIGN represents key elements of a conversation about prognosis, each clinician can adapt this framework to their own approach. Future work will assess the effectiveness of this framework on communication quality and prognostic understanding.

Study Design: Interviews were audio recorded. Each interview was transcribed and deidentified. We analyzed qualitative data using a conventional content analysis inductive approach.

Setting: NICU: Intensive care unit (ICU) with parents of infants with neurologic conditions. Duke Hospital

Population of Focus: parents of critically ill infants with neurologic conditions - healthcare professionals, particularly those working in neonatal and pediatric neurology contexts, who are involved in communicating information about neurologic prognosis to parents of critically ill infants.

Sample Size: 61 parents - The study enrolled 61 parents (40 mothers and 21 fathers) of 40 infants with neurologic conditions in the ICU. Of these, 52 parents (37 mothers and 15 fathers) completed 123 interviews.

Age Range: parents (>18) of infants - The median age of the parents who participated in the study was 31 years, with a range from 19 to 46 years. This indicates that the parents included in the study were primarily in their late teens to mid-forties, reflecting a broad range of ages within the parent population .

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Active Management of Labor, HOSPITAL, Guideline Change and Implementation, Quality Improvement

Intervention Description: Hospital protocol was modified to align with the new consensus recommendations from the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM). In the new protocol, the cutoff point between the latent and active phases of the first stage of labor was changed from 4 to >6 cm and the definitions of arrest of labor, lack of progress, and failed induction were revised to allow laboring women more time to progress before additional medical interventions were indicated.

Intervention Results: This study included 3283 and 3068 women in the before and after periods, respectively. The groups had similar general and obstetric characteristics. The global cesarean delivery rate decreased significantly from 9.4% in the preguideline to 6.9% in the postguideline period (odds ratio, 0.71; 95% confidence interval, 0.59–0.85; P < .01). The cesarean delivery rate for arrest of first-stage labor fell by half, from 1.8% to 0.9% (odds ratio, 0.51; 95% confidence interval, 0.31–0.81; P < .01) but was significant only among nulliparous women. The cesarean delivery rate for second-stage arrest of labor decreased but not significantly between periods (1.3% vs 1.0%; odds ratio, 0.73; 95% confidence interval, 0.44–1.22; P = .2), and the cesarean delivery rate for failure of induction remained similar (3.7% vs 3.5%; odds ratio, 1.06; 95% confidence interval, 0.06–13.24; P = .88). The median duration of labor before cesarean delivery also became significantly longer among nulliparous women during the later period. Maternal and neonatal outcomes did not differ between the 2 periods, except that the rate of 1 minute Apgar score <7 fell significantly in the later period (8.4% vs 6.9%; odds ratio, 0.80; 95% confidence interval, 0.66–0.97; P = .02).

Conclusion: The modification of our protocol by implementing the new consensus recommendations was associated with a reduction of the rate of primary cesarean delivery performed for arrest of labor with no apparent increase in immediate adverse neonatal outcomes in nulliparous women at term with singleton pregnancies in vertex presentation and with epidural anesthesia. Further studies are needed to assess the long-term maternal and neonatal safety of these policies.

Setting: University referral hospital in Poissy, France

Population of Focus: All women with a singleton pregnancy at term (!37 weeks of gestation), in vertex presentation, with spontaneous or induced labor, and with epidural anesthesia

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

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

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

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

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

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

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

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

Age Range: NICU age - newborn infants

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

Intervention Description: The intervention includes development of an educational video for maternity care providers, initiation of screening for postpartum anxiety using the anxiety subscale of the Edinburgh Postnatal Depression Scale (EPDS) 3. Implementation of a counseling tool to guide conversations with postpartum women who screen positive for postpartum anxiety 4. Provision of treatment and referral resources for postpartum anxiety, including lists of postpartum mental health specialists specific to their area. The intervention described aligns with a discernable strategy, which is to improve the screening, treatment, and referral of women with postpartum anxiety in the birth center environment. The study is a quality improvement project that analyzed a multicomponent intervention aimed at improving healthcare quality

Intervention Results: Among all screened participants, 12.58% had a positive EPDS-3A score of greater than six, indicating a positive screening for postpartum anxiety . 2. 6.98% of the participants had a EPDS score of less than 12 and an EPDS-3A score greater than six, indicating a positive anxiety screen and would have not received follow-up care if only screened for postpartum depression . 3. 9.7% of the participants were lost to follow-up and did not return for a postpartum visit when screening for postpartum anxiety would have been conducted . 4. The study demonstrated an overall postpartum anxiety screening rate of 86.3%, indicating increased awareness of the need for routine screening for postpartum anxiety among midwives . 5. The study also highlighted the importance of further modification of the Perinatal Data Registry to include the nature of treatment for patients who screen positive for postpartum anxiety, as well as the need for consideration of counseling and treatment for these patients . These results provide insights into the prevalence of postpartum anxiety among the screened participants and the challenges related to follow-up and treatment for those who screen positive for postpartum anxiety

Conclusion: The Edinburgh Postpartum Depression Scale -3A is a valid, easy-to-use tool which should be considered for use in clinical practice. Modification of the electronic health record can serve as an important impetus triggering screening and treatment. It is important that clinicians are educated on the prevalence of postpartum anxiety, its risk factors, symptoms and implications.

Setting: The setting for the study was 10 geographically diverse birth centers, and all members of the American Association of Birth Centers . These birth centers are largely staffed by certified nurse-midwives (CNMs) and certified professional midwives (CPMs) and primarily serve low-risk patients of varied race/ethnicity

Population of Focus: The target audience for the study includes healthcare professionals, particularly midwives and maternity care providers, as well as researchers and policymakers interested in postpartum mental health screening and interventions. Additionally, the findings may be relevant to organizations involved in maternal and child health, such as birth centers and midwifery associations

Sample Size: The study initially involved 11 birth centers, with a total of 387 participants across 9 participating sites. However, data from two sites were later removed due to lack of participation, resulting in a final sample size of 387 participants across 9 sites

Age Range: The age group of the participants in the study was not explicitly mentioned in the provided excerpts. Therefore, the specific age range of the participants is not available in the provided information.

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Assessment (provider), Provider Training/Education, Nurse/Nurse Practitioner, PARENT/FAMILY, Education/Training (caregiver), Provision of Safe Sleep Item, HOSPITAL, Quality Improvement

Intervention Description: The purpose of our safe sleep initiative was to improve parental and staff knowledge of safe sleep practices and to achieve increased compliance with infant safe sleep in the hospital setting. A multidisciplinary team of health professionals was created to address poor compliance with safe sleep guidelines, investigate barriers, and identify primary drivers for improvement. Subsequent interventions included parent education, staff education, and improvements in system processes. Members of the hospitals nurse residency program conducted multidisciplinary surveys before and after the quality improvement initiative to assess staff knowledge of safe sleep practices. The data were collected prospectively.

Intervention Results: Compliance with safe sleep improved to >80% in both units. Tracking of process measures revealed NICU parents received safe sleep education 98-100% of the time. No change was observed in the balancing measures. Transfers from the NN to the NICU for temperature instability did not increase. Parent satisfaction with discharge preparedness did not change (98.2% prior to and 99.6% after).

Conclusion: We achieved improved compliance with safe sleep practices in our NN and NICU through education of staff and parents and improved system processes. We believe this will translate to improved safe sleep practices used by parents at home.

Setting: Truman Medical Center in Kansas City

Population of Focus: Infants admitted to newborn nursery and NICU

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, Sleep Environment Modification, Crib Card, Visual Display, Audit/Attestation

Intervention Description: A quality improvement (QI) model was developed to introduce the AAP guidelines on safe sleep (SS) practices into the NICU nursing practice in a consistent and sustainable method. The project team included the NICU hospitalist, a neonatologist, the Director of Newborn Services at the Wakefield Division, the nurse manager, two nurses, and a nurse practitioner. The team members met at monthly QI meetings to discuss progress for the duration of the project. Key drivers were identified, and the team used PDSA cycles to target interventions, which included a crib check tool and presentations by SS experts. One of the team’s main concerns during the initial deliberation sessions was the suboptimal temperature control in the NICU, and after meeting with the engineering staff, more sensors were placed in the NICU to eliminate the wide variations of temperatures throughout the day. The primary aim of the project was a 20% improvement in the SS compliance rates (from 7% to 27%) by December, 2017.

Intervention Results: Approximately 600 crib checks (CC) were performed over the duration of this project. At baseline, 7% of infants were placed in a SS position in the NICU. Following the QI project, SS position increased to 96% of infants.

Conclusion: Multifactorial interventions significantly improved SS compliance among NICU nurses. Cultivating personal motivation among nurses, consistent empowerment and dedication to culture change by the entire team was crucial for the sustainability of the project.

Setting: Wakefield neonatal service, Montefiore Medical Center

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, HOSPITAL, Chart Audit and Feedback, Quality Improvement,

Intervention Description: From 2008 through 2015, a multi-strategy approach that included provider education, provider feedback, and implementation of new policies was used to target evidence-based and inferred factors that influence the cesarean delivery rate among nulliparous patients with term singleton vertex gestations. This quality improvement initiative included the standardization of fetal heart rate tracing, provider training based on consensus guidelines, and the implementation of audits and provider feedback.

Intervention Results: More than 20,000 NTSV deliveries were analyzed, including more than 15,000 during the intervention period. The NTSV cesarean delivery rate declined from 35% to 21% over eight years. The total cesarean delivery rate declined as well. Increase in meconium aspiration syndrome and maternal transfusion were observed.

Conclusion: Quality improvement initiatives can decrease the NTSV cesarean delivery rate. Any increased incidence of fetal or maternal complications associated with decreased NTSV cesarean delivery rate should be considered in the context of the risks and benefits of vaginal delivery compared to cesarean delivery.

Setting: A single tertiary care academic medical center

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): HEALTH_CARE_PROVIDER_PRACTICE, Quality Improvement/Practice-Wide Intervention

Intervention Description: Researchers designed a multi-pronged pilot intervention to address barriers to care for pregnant women and young children in dental safety net settings. Pilot intervention components were: (1) Business assessment to evaluate and enhance safety net dental practice financial stability; (2) Quality improvement (QI) training to test and implement improved office access and efficiency; and (3) Evidence-based education for dental providers on care for pregnant women and young children.

Intervention Results: All mean measures improved, including: higher monthly revenue ($28,380–$33,102, p = 0.37), decreased no-show rate (17.7–14.3%, p = 0.11), higher monthly dental health encounters (283–328, p = 0.08), and higher monthly encounters for young children (8.8–10.5, p = 0.65), and pregnant women (2.8–9.7, p = 0.29). Results varied by practice, with some demonstrating largest increases in encounters for young children and others pregnant women. Focus group participants reported that the collaborative improved access for pregnant women and young children, and that QI methods were often new and difficult.

Conclusion: A learning collaborative among dental practices increased dental encounters and access for young children and pregnant women. Participation by safety net dental practices in a QI collaborative is feasible and acceptable. Individual sites saw greater improvements in different outcomes areas, based on their own structures and needs. Future efforts should focus on specific needs of each dental practice and should offer additional QI training.

Setting: Safety net dental practices

Population of Focus: Pregnant people

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

Intervention Description: The specific intervention described in the study involves the implementation of an educational intervention to increase screening for depression during prenatal care. The intervention aimed to address barriers to screening, such as time limitations, patient perceptions of stigma regarding treatment, and the lack of a protocol to ensure every patient is screened . The educational intervention provided to the healthcare providers at the practice site included training on the importance of screening for antenatal depression and the use of evidence-based screening tools, such as the Patient Health Questionnaire (PHQ-9) . Additionally, a protocol was put into place for the routine screening of all patients presenting for prenatal care, with plans to extend this protocol to partnering clinics that provide medical care to pregnant women . The intervention described aligns with a discernible strategy of addressing barriers to screening through education, training, and protocol implementation. While the study does not explicitly mention a multicomponent intervention, it does involve a combination of educational training, protocol development, and implementation of evidence-based screening tools, which can be considered a multicomponent approach to increasing antenatal depression screening.

Intervention Results: The study found that before the educational intervention, the rate of prenatal depression screening during that period was 0%. However, after the intervention, screenings increased significantly (p < .001) to 27.56%. Screening rates increased from 0% in the first month following the intervention to 20% in the second month, and 80% in the third month, indicating a positive time–rate correlation. Of the post-intervention population, 35 of 127 patients (27.6%) were screened for depression. Of these patients, 40% scored negative for depression, with scores between 0 and 4. In addition, 51% had scores between 5 and 9, indicating mild depression; 5.7% of screens indicated moderate depression, with scores between 10 and 15. One patient, 2.8% of those screened, scored positive for moderate–severe depression with a score between 15 and 20. The percentage of patients scoring positive for moderate to moderate–severe depression was 8.5%, which is close to the 9–13% range cited in the literature for the prevalence of prenatal depression

Conclusion: Education and training improves provision of prenatal depression screening, but further work is needed to improve the accurate and timely identification of depression, as well as its appropriate treatment, referral, and follow-up.

Study Design: The study design was a quality improvement initiative that used a pre- and post-intervention comparison of health records of patients presenting for prenatal care during a 3-month period before and after the educational intervention . The study did not include a control group and did not randomize patients or providers. The primary outcome measured was the presence of screening at least one time during prenatal care, and the secondary outcomes measured included the percentage of prenatal patients enrolled in psychotherapy following a diagnosis of depression and staff understanding of and attitudes toward antenatal depression and its management . The study also included qualitative data collection through written surveys to assess provider perceptions of addressing depression before the educational intervention .

Setting: The setting of the study described in the PDF is an obstetrics and gynecology (OB-GYN) practice located in a large Midwestern city, serving primarily low-income, African American patients . The study analyzed health records of patients presenting for prenatal care during a 3-month period from May 2019 to July 2019, following an educational intervention for the providers and office staff at the site . The intervention was carried out over two sessions provided at the clinical site, with face-to-face education and conversation between the lead researcher and the staff . Therefore, the setting of the study is an OB-GYN practice in a large Midwestern city.

Population of Focus: The target audience for the study described in the PDF appears to be healthcare providers, specifically those involved in prenatal care, including obstetricians, gynecologists, and other healthcare professionals working in obstetrics and gynecology (OB-GYN) practices. The study aimed to evaluate and improve current practices for screening and treating prenatal depression, with a focus on assisting staff at the clinical site to gain a more thorough understanding of evidence-based recommendations for screening and treatment during the antenatal period . Additionally, the study sought to increase utilization of pharmacotherapy and/or psychosocial support for pregnant women with depression by encouraging consultation with a social worker and/or enrollment in individual or group psychotherapy . Therefore, the target audience likely includes healthcare providers involved in prenatal care, as well as those interested in antenatal depression screening and treatment.

Sample Size: The sample size for the study was 219 patients, with a pre-intervention sample size of 92 patients and a post-intervention sample size of 127 patient

Age Range: The age range of the study participants was not explicitly mentioned in the provided excerpts. However, the study focused on prenatal care and antenatal depression screening, indicating that the participants were likely pregnant women receiving prenatal care. The study included demographic factors such as maternal age, gravidity, and parity, but the specific age range of the participants was not explicitly stated in the excerpts provided from the PDF. If you need further details or specific information, it may be necessary to refer to the full text of the study.

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

Intervention Description: The dual aims of this project were to develop a safe sleep educational model for our neonatal intensive care unit (NICU), and to increase the percentage of eligible infants in a safe sleep environment.

Intervention Results: At baseline, 21% of eligible infants were in a safe sleep environment. After education and reported observation, safe sleep compliance increased to 88%.

Conclusion: With formal staff and family education, optional wearable blanket, and data sharing, safe sleep compliance increased and patient safety improved.

Study Design: QE: pretest-posttest

Setting: The Children’s Mercy Hospital NICU in MO

Population of Focus: Safe sleep eligible infants (medically stable and transitioned to open cribs)

Data Source: Crib audit/infant observation

Sample Size: Baseline (n=28) Follow-up (n=26)

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: In Tennessee, a statewide, multidisciplinary development team reviewed evidence from the "Ten Steps to Successful Breastfeeding" to create a consensus toolkit of process indicators. The Tennessee Initiative for Perinatal Quality Care (TIPQC) is a statewide perintatal quality collaborative seeking to improve health outcomes for mothers and infants through large-scale quality improvement (QI) initiatives. All teams met in monthly webinar huddles (online group discussions), semiannual regional learning sessions, and an annual statewide TIPQC collaborative meeting. Monthly webinar meetings for the participating hospitals were held online, hosted and led by TIPQC and state leaders.

Intervention Results: Thirteen hospitals accounting for 47% of live births in Tennessee submitted data on 31,183 mother–infant dyads from August 1, 2012, to December 31, 2013. Aggregate monthly mean PC-05 demonstrated “special cause” improvement increasing from 37.1% to 41.2%, an 11.1% relative increase. Five hospitals reported implementation of ≥5 of the Ten Steps and two hospitals reported ≥90% reliability on ≥5 of the Ten Steps using locally designed process audits.

Conclusion: Using large-scale improvement methodology, a successful statewide collaborative led to >10% relative increase in breastfeeding exclusivity at discharge in participating Tennessee hospitals. Further opportunities for improvement in implementing breastfeeding supportive practices were identified.

Study Design: Evaluation data

Setting: Hospitals in TN

Population of Focus: Hospitals located in the Mississippi River Delta or Appalachia in TN

Sample Size: 13 hospitals with data on 31,183 mother-infant dyads

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Designated Clinic/Extended Hours,

Intervention Description: Since the Institute of Medicine's 2001 charge to reform health care, there has been a focus on the role of the medical home. Access to care in the proper setting and at the proper time is central to health care reform. We aimed to increase the volume of patients receiving care for acute illnesses within the medical home rather than the emergency department or urgent care center from 41% to 60%. We used quality improvement methods to create a separate nonemergency care stream in a large academic primary care clinic serving 19,000 patients (90% Medicaid). The pediatric primary care (PPC) walk-in clinic opened in July 2013 with service 4 hours per day and expanded to an all-day clinic in October 2013. Statistical process control methods were used to measure the change over time in the volume of ill patients and visits seen in the PPC walk-in clinic.

Intervention Results: Average weekly walk-in nonemergent ill-care visits increased from 61 to 158 after opening the PPC walk-in clinic. The percentage of nonemergent ill-care visits in the medical home increased from 41% to 45%. Visits during regular clinic hours increased from 55% to 60%. Clinic cycle time remained unchanged.

Conclusion: Implementation of a walk-in care stream for acute illness within the medical home has allowed us to provide ill care to a higher proportion of patients, although we have not yet achieved our predicted volume. Matching access to demand is key to successfully meeting patient needs.

Study Design: Program evaluation

Setting: Academic Pediatrics Walk-In Access for Ill Care (PPCWIC) in a large urban academic clinic at Cincinnati Children's Hospital Medical Center in Cincinnati, Ohio

Population of Focus: Children within the population registry of the academic clinic where the Academic Pediatrics Walk-In Access for Ill Care (PPCWIC)

Sample Size: 158 children and youth

Age Range: Children and youth ages 0-19 years

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, School-Based Health Centers, Planning for Transition, HEALTH_CARE_PROVIDER_PRACTICE, Pediatric to Adult Transfer Assistance, Care Coordination, Quality Improvement/Practice-Wide Intervention

Intervention Description: This pilot study implemented and assessed the use of a structured HCT process, the Six Core Elements of HCT, in two school-based health centers (SBHCs) in Washington, DC. The pilot study examined the feasibility of incorporating the Six Core Elements into routine care and identified self-care skill gaps among students. Quality improvement methods were used to customize, implement, and measure the Six Core Elements and HCT supports.

Intervention Results: After the pilot, both SBHCs demonstrated improvement in their implementation of the structured HCT process. More than half of the pilot participants reported not knowing how to find their doctor’s phone number and not knowing what a referral is.

Conclusion: These findings indicate the need for incorporating HCT supports into SBHCs to help students build self-care skills necessary for adulthood.

Study Design: Cohort pilot evaluation

Setting: Schools

Population of Focus: High school students

Sample Size: 560

Age Range: Grades 9-12

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

Intervention Description: This pilot study implemented and assessed the use of a structured HCT process, the Six Core Elements of HCT, in two school-based health centers (SBHCs) in Washington, DC. The pilot study examined the feasibility of incorporating the Six Core Elements into routine care and identified self-care skill gaps among students.

Intervention Results: After the pilot, both SBHCs demonstrated improvement in their implementation of the structured HCT process. More than half of the pilot participants reported not knowing how to find their doctor's phone number and not knowing what a referral is.

Conclusion: These findings indicate the need for incorporating HCT supports into SBHCs to help students build self-care skills necessary for adulthood.

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

Intervention Description: This quality improvement project was planned, implemented, and evaluated over an 8‐month time period from July 2018 through March 2019. Within this time frame, 7 weeks from October through December were devoted to four plan‐do‐study‐act (PDSA) cycles. The tests of change implemented during the PDSA cycles included both team engagement (interdisciplinary team huddles) and process changes (pilot of a best practices checklist (based on evidence-based guidelines) and audits of unplanned cesarean births). Interdisciplinary teams met regularly (53 times during the study period) to review individual cases, checklists, and audit data, and contribute to the decision-making process with the aim of reducing C-section rates.

Intervention Results: Over 7 weeks, 13 of 55 NTSV patients gave birth by cesarean, resulting in an NTSV CB rate of 23.6%. Fifty-three huddles were held by 218 staff members for 28 patients. Team engagement scores improved from 85% to 98%. Although the effective care CB scores trended upward, the overall mean was 51%.

Conclusion: Interdisciplinary team huddles, coupled with the use of a best practices checklist and feedback from audits, achieved a more effective use of CB in the NTSV patient population.

Setting: Community hospital in Mid-atlantic state

Population of Focus: Nulliparous patients with term singleton vertex gestations

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

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

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

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

Study Design: Evaluation of a quality improvement initiative

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

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

Sample Size: 518 eligible pediatric patients

Age Range: Children and adolescents 0-17 years