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

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Displaying records 1 through 97 (97 total).

Adams S, Nicholas D, Mahant S, Weiser N, Kanani R, Boydell K, Cohen E. Care maps and care plans for children with medical complexity. Child Care Health Dev. 2019 Jan;45(1):104-110. doi: 10.1111/cch.12632. PMID: 30462842.

Evidence Rating: Emerging

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

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

Evidence Rating: Emerging

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

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

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

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

Study Design: quality improvement project

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

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

Sample Size: 20 nurses

Age Range: 23-44

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Arbour, M. C., Floyd, B., Morton, S., Hampton, P., Sims, J. M., Doyle, S., Atwood, S., & Sege, R. (2021). Cross-Sector Approach Expands Screening and Addresses Health-Related Social Needs in Primary Care. Pediatrics, 148(5), e2021050152. https://doi.org/10.1542/peds.2021-050152

Evidence Rating: Moderate

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

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Arora, B. K., Klein, M. J., Yousif, C., Khacheryan, A., & Walter, H. J. (2023). Virtual Collaborative Behavioral Health Model in a Community Pediatric Network: Two-Year Outcomes. Clinical pediatrics, 62(11), 1414–1425. https://doi.org/10.1177/00099228231164478

Evidence Rating: Emerging

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

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Arrington LA, Edie AH, Sewell CA, Carter BM. Launching the Reduction of Peripartum Racial/Ethnic Disparities Bundle: A Quality Improvement Project. J Midwifery Womens Health. 2021 Jul;66(4):526-533. doi: 10.1111/jmwh.13235. Epub 2021 Apr 29. PMID: 33913616.

Evidence Rating: Emerging

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

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Banerji, A. I., Hopper, A., Kadri, M., Harding, B., & Phillips, R. (2022). Creating a small baby program: a single center's experience. Journal of perinatology : official journal of the California Perinatal Association, 42(2), 277–280. https://doi.org/10.1038/s41372-021-01247-8

Evidence Rating: Emerging

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.

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Barry S, Paul K, Aakre K, Drake-Buhr S, Willis R. Final Report: Developmental and Autism Screening in Primary Care. Burlington, VT: Vermont Child Health Improvement Program; 2012.

Evidence Rating: Emerging Evidence

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

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Bastani R, Berman BA, Belin TR, et al. Increasing cervical cancer screening among underserved women in a large urban county health system: can it be done? What does it take? Med Care. 2002;40(10):891-907.

Evidence Rating: Emerging Evidence

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

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Bell R, Glinianaia SV, van der Waal Z, Close A, Moloney E, Jones S et al. Evaluation of a complex healthcare intervention to increase smoking cessation in pregnant women: Interrupted time series analysis with economic evaluation. Tobacco Control: An International Journal 2018;27:90-8.

Evidence Rating: Moderate Evidence

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

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Berger-Jenkins, E., Monk, C., D’Onfro, K., Sultana, M., Brandt, L., Ankam, J., ... & Meyer, D. (2019). Screening for both child behavior and social determinants of health in pediatric primary care. Journal of developmental and behavioral pediatrics: JDBP, 40(6), 415.

Evidence Rating: Moderate

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

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Berger, J., Burnham, L., Nickel, N., Knapp, R., Gambari, A., Beliveau, P., & Merewood, A. (2023). Policies and Practices in a Cohort of Mississippi Birthing Hospitals During the COVID-19 Pandemic. Breastfeeding Medicine, 18(2), 138-148.

Evidence Rating: Emerging

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.

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Berns, H. M., & Drake, D. (2021). Postpartum depression screening for mothers of babies in the neonatal intensive care unit. MCN: The American Journal of Maternal/Child Nursing, 46(6), 323-329.

Evidence Rating: Emerging

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

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Bindiganavle, A., & Manion, A. (2022). Creating a sustainable pediatric diabetes transition program. Journal of pediatric nursing, 62, 188–192. https://doi.org/10.1016/j.pedn.2021.05.010

Evidence Rating: Moderate

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.

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

Evidence Rating: Moderate

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

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

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

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

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

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

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

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

Age Range: 1.9–20.3 - children

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Brown, C. M., Samaan, Z. M., Morehous, J. F., & Perkins, J. (2018). Improving preventative care delivery to underserved pediatric populations through bundled measures. BMJ Open Quality, 7(1), e000129. https://doi.org/10.1136/bmjoq-2017-000129 [Childhood Vaccination NPM]

Evidence Rating: Moderate

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.

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Brundrett, M., & Hart, L. C. (2023). Development, pilot implementation, and preliminary assessment of a transition process for youth living with HIV. Journal of pediatric nursing, 68, 93–98. https://doi.org/10.1016/j.pedn.2022.09.020

Evidence Rating: Emerging

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.

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Burnham, L., Knapp, R., Bugg, K., Nickel, N., Beliveau, P., Feldman-Winter, L., & Merewood, A. (2022). Mississippi CHAMPS: Decreasing racial inequities in breastfeeding. Pediatrics, 149(2).

Evidence Rating: Moderate

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.

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Cinko, C., Thrasher, A., Sawyer, C., Kramer, K., West, S., & Harris, E. (2023). Using the Project ECHO Model to Increase Pediatric Primary Care Provider Confidence to Independently Treat Adolescent Depression. Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, 47(4), 360–367. https://doi.org/10.1007/s40596-023-01800-x

Evidence Rating: Emerging

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

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

Evidence Rating: Emerging

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

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

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

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

Study Design: Difference in difference approach

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

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

Sample Size: 2,616 children

Age Range: Children ages 17 and younger

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Damiano E, Theiler R. Improved Value of Individual Prenatal Care for the Interdisciplinary Team. J Pregnancy. 2018 Sep 17;2018:3515302. doi: 10.1155/2018/3515302. PMID: 30310700; PMCID: PMC6166369.

Evidence Rating: Emerging

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 .

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Danesh, D. O., Peng, J., Hammersmith, K. J., Gowda, C., Maciejewski, H., Amini, H., ... & Meyer, B. D. (2022). Impact on Dental Utilization of the Integration of Oral Health in Pediatric Primary Care Through Quality Improvement. Journal of Public Health Management and Practice, 10-1097.

Evidence Rating: Moderate

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.

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Disabato JA, Mannino JE, Betz CL. Pediatric nurses' role in health care transition planning: National survey findings and practice implications. Journal of pediatric nursing. 2019 Nov 1;49:60-6. doi: 10.1016/j.pedn.2019.08.003

Evidence Rating: Emerging

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

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

Evidence Rating: Emerging

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

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

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

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

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

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

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

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

Age Range: college students

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Dorrington MS, Herceg A, Douglas K, Tongs J, Bookallil M. Increasing Pap smear rates at an urban Aboriginal Community Controlled Health Service through translational research and continuous quality improvement. Aust J Prim Health. 2015;21(4):417-22.

Evidence Rating: Emerging Evidence

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

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Feldman-Winter L, Ustianov J, Anastasio J, et al. Best Fed Beginnings: a nationwide quality improvement initiative to increase breastfeeding. Pediatrics. 2017;140(1):e1-e9.

Evidence Rating: Emerging Evidence

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

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Feldman-Winter, L., Ustianov, J., Anastasio, J., Butts-Dion, S., Heinrich, P., Merewood, A., ... & Homer, C. J. (2017). Best fed beginnings: a nationwide quality improvement initiative to increase breastfeeding. Pediatrics, 140(1).

Evidence Rating: Moderate Evidence

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

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Fenick, A. M., Leventhal, J. M., Gilliam, W., & Rosenthal, M. S. (2020). A Randomized Controlled Trial of Group Well-Child Care: Improved Attendance and Vaccination Timeliness. Clinical pediatrics, 59(7), 686–691. https://doi.org/10.1177/0009922820908582

Evidence Rating: Emerging

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

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Fisher-Borne, M., Preiss, A. J., Black, M., Roberts, K., & Saslow, D. (2017). Early outcomes of a multilevel human papillomavirus vaccination pilot intervention in federally qualified health centers. Academic Pediatrics, 17(8), S80-S83. [HPV Vaccination SM]

Evidence Rating: Moderate

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.

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Flower, K. B., Massie, S., Janies, K., Bassewitz, J. B., Coker, T. R., Gillespie, R. J., ... & Earls, M. F. (2020). Increasing early childhood screening in primary care through a quality improvement collaborative. Pediatrics, 146(3).

Evidence Rating: Moderate

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

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Franck LS, Axelin A, Van Veenendaal NR, Bacchini F. Improving Neonatal Intensive Care Unit Quality and Safety with Family-Centered Care. Clin Perinatol. 2023 Jun;50(2):449-472. doi: 10.1016/j.clp.2023.01.007. Epub 2023 Mar 21. PMID: 37201991.

Evidence Rating: Moderate

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 .

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Fu, L., Smith, A., Ciotoli, C., Dannenbaum, M., & Jacobs, M. (2021). An immunization quality improvement learning collaborative in the college health setting. Journal of American college health : J of ACH, 1–10. Advance online publication. https://doi.org/10.1080/07448481.2021.1979560

Evidence Rating: Moderate

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

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

Evidence Rating: Emerging

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

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

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

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

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

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

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

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

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Garg, A., Wilkie, T., LeBlanc, A., Lyu, R., Scornavacca, T., Fowler, J., Rhein, L., & Alper, E. (2022). Prioritizing Child Health: Promoting Adherence to Well-Child Visits in an Urban, Safety-Net Health System During the COVID-19 Pandemic. Joint Commission journal on quality and patient safety, 48(4), 189–195. https://doi.org/10.1016/j.jcjq.2022.01.008

Evidence Rating: Moderate Evidence

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.

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Gilkey, M. B., McRee, A. L., Terk, J., & Parks, R. M. (2018). Making human papillomavirus vaccine delivery sustainable in primary care settings. Pediatrics, 142(6), e20180920. https://doi.org/10.1542/peds.2018-0920 [HPV Vaccination SM]

Evidence Rating: Moderate

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.

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Goddard, A. T., Borkowski, V., Konesky, A., & Bennhoff, A. (2019). Taking Action on Asthma: Increasing Influenza Vaccination Rates in Pediatric Asthma Through Quality Improvement. Journal of Pediatric Health Care, 33(6), 653-662. https://doi.org/10.1016/j.pedhc.2019.04.016 [Flu Vaccination SM]

Evidence Rating: Moderate

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.

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Green, L. A., & Ailey, S. H. (2021). Increasing Childhood Asthma Care Appointments on a Mobile Asthma Van. The Journal of school nursing : the official publication of the National Association of School Nurses, 37(3), 209–219. https://doi.org/10.1177/1059840519857143

Evidence Rating: Emerging

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

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

Evidence Rating: Emerging

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

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

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

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

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

Setting: London clinic

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

Sample Size: 69 clinicians

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

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Hermosillo, D., Cygan, H. R., Lemke, S., McIntosh, E., & Vail, M. (2022). Achieving Health Equity for LGBTQ+ Adolescents. Journal of continuing education in nursing, 53(8), 348–354. https://doi.org/10.3928/00220124-20220706-05

Evidence Rating: Emerging

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

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Hoff, A., Hughes-Reid, C., Sood, E., & Lines, M. (2020). Utilization of Integrated and Colocated Behavioral Health Models in Pediatric Primary Care. Clinical pediatrics, 59(14), 1225–1232. https://doi.org/10.1177/0009922820942157

Evidence Rating: Emerging

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

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Hwang SS, Rybin DV, Heeren TC, Colson ER, Corwin MJ. Trust in sources of advice about infant care practices: the SAFE study. Matern Child Health J. 2016:1-9.

Evidence Rating: Emerging Evidence

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

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Imboden, A., & Lawson, R. (2021). Improving breastfeeding duration through creation of a breastfeeding-friendly pediatric practice. Journal of the American Association of Nurse Practitioners, 33(12), 1273-1281.

Evidence Rating: Moderate Evidence

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

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

Evidence Rating: Emerging Evidence

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

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

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

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

Study Design: Not specified

Setting: Not specified

Population of Focus: Not specified

Data Source: Not specified

Sample Size: Not specified

Age Range: Not specified

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Kawan, M., Gregory, E. F., & Spatz, D. L. (2022). Improving breastfeeding care & support in a large, urban, pediatric primary care practice. Journal of pediatric nursing.

Evidence Rating: Emerging

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.

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Kawatu, J., Clark, M., Saul, K., Quimby, K. D., Whitten, A., Nelson, S., Potter, K., & Kaplan, D. L. (2022). Increasing access to single-visit contraception in urban health care settings: Findings from a multi-site learning collaborative. Contraception, 108, 25–31. https://doi.org/10.1016/j.contraception.2021.12.005

Evidence Rating: Emerging

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

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King TM, Tandon SD, Macias MM, et al. Implementing developmental screening and referrals: lessons learned from a national project. Pediatrics. 2010;125(2):350-360.

Evidence Rating: Emerging Evidence

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

Access Abstract

Kiser, L. H., & Butler, J. (2020). Improving Equitable Access to Cervical Cancer Screening and Management. The American journal of nursing, 120(11), 58–67. https://doi.org/10.1097/01.NAJ.0000721944.67166.17

Evidence Rating: Emerging

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

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Knutson, J., & Butler, J. (2022). Providing equitable postpartum breastfeeding support at an urban academic hospital. Nursing for Women's Health, 26(3), 184-193.

Evidence Rating: Emerging

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.

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Krantz, L., Ollberding, N. J., Burdine, A. F., & Burrell, M. C. (2017). Increasing HPV vaccination coverage through provider-based interventions. Pediatrics, 140(3), e20161764. [HPV Vaccination SM]

Evidence Rating: Moderate

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

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Lannon CM, Flower K, Duncan P, Moore KS, Stuart J, Bassewitz J. The Bright Futures Training Intervention Project: implementing systems to support preventive and developmental services in practice. Pediatrics. 2008;122(1):e163-171.

Evidence Rating: Emerging Evidence

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

Access Abstract

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

Evidence Rating: Moderate

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

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

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

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

Study Design: a prospective, observational cohort study

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

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

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

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

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Lestishock, L., Nova, S., & Disabato, J. (2021). Improving Adolescent and Young Adult Engagement in the Process of Transitioning to Adult Care. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 69(3), 424–431. https://doi.org/10.1016/j.jadohealth.2021.01.026

Evidence Rating: Moderate

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.

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

Evidence Rating: Emerging

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

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

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

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

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

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

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

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

Age Range: children - pediatric population

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Lipper J. Advancing Oral Health through the Women, Infants, and Children Program: A New Hampshire Pilot Project. (2016). Center for Health Care Strategies.

Evidence Rating: Emerging Evidence

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.

Access Abstract

Lipper J. Advancing Oral Health through the Women, Infants, and Children Program: A New Hampshire Pilot Project. (2016). Center for Health Care Strategies.

Evidence Rating: Emerging Evidence

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.

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Mackie BR et al., Application of the READY framework supports effective communication between health care providers and family members in intensive care, Australian Critical Care, https://doi.org/10.1016/j.aucc.2020.07.010

Evidence Rating: Moderate

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

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Mackrain M, Dworkin PH, Harden BJ, Arbour M. HV CoIIN: Implementing quality improvement to achieve breakthrough change in developmental promotion, early detection, and intervention. MIECHV TACC, April 2015.

Evidence Rating: Moderate Evidence

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

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Mackrain M, Fitzgerald E, Fogerty S, Martin J, O'Connor R, Arbour M. The HV CoIIN: implementing quality improvement to achieve breakthrough change in exclusive breastfeeding rates within MIECHV home visiting. MIECHV TACC, June 2015.

Evidence Rating: Emerging Evidence

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

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Malik F, Booker JM, Brown S, McClain C, McGrath J. Improving developmental screening among pediatricians in New Mexico: findings from the developmental screening initiative. Clin Pediatr. 2014;53(6):531-538.

Evidence Rating: Emerging Evidence

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

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Margolis PA, McLearn KT, Earls MF, et al. Assisting primary care practices in using office systems to promote early childhood development. Ambul Pediatr. 2008;8(6):383-387.

Evidence Rating: Emerging Evidence

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

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

Evidence Rating: Emerging

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

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

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

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

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

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

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

Sample Size: 38 students

Age Range: first year residents

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Mason CL, Collier CH, Penny SC. Perinatal quality collaboratives and birth equity. Curr Opin Anaesthesiol. 2022 Jun 1;35(3):299-305. doi: 10.1097/ACO.0000000000001143. PMID: 35671016.

Evidence Rating: Moderate

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

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Matiz, L. A., Kostacos, C., Robbins-Milne, L., Chang, S. J., Rausch, J. C., & Tariq, A. (2021). Integrating Nurse Care Managers in the Medical Home of Children with Special Health Care needs to Improve their Care Coordination and Impact Health Care Utilization. Journal of pediatric nursing, 59, 32–36. https://doi.org/10.1016/j.pedn.2020.12.018

Evidence Rating: Moderate

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

Access Abstract

Meine, K. (2018, October). Pregnancy unshackled: Increasing equity through implementation of perinatal depression screening, shared decision making, and treatment for incarcerated women. In Nursing Forum (Vol. 53, No. 4, pp. 437-447).

Evidence Rating: Emerging

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.

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Merewood, A., Burnham, L., Berger, J., Gambari, A., Safon, C., Beliveau, P., ... & Nickel, N. (2022). Assessing the impact of a statewide effort to improve breastfeeding rates: A RE‐AIM evaluation of CHAMPS in Mississippi. Maternal & Child Nutrition, 18(3), e13370.

Evidence Rating: Moderate

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.

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Meurer, J., Rohloff, R., Rein, L., Kanter, I., Kotagiri, N., Gundacker, C., & Tarima, S. (2022). Improving Child Development Screening: Implications for Professional Practice and Patient Equity. Journal of primary care & community health, 13, 21501319211062676. https://doi.org/10.1177/21501319211062676

Evidence Rating: Emerging

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.

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Miles, T. A., Granger, L. V., & Gately, C. L. (2019). Improving the accuracy of ACIR data and increasing vaccination rates. Commun Dis Intell, 43. https://doi.org/10.33321/cdi.2019.43.46 [Childhood Vaccination NPM]

Evidence Rating: Moderate

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

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Milinco, M., Cattaneo, A., Macaluso, A., Materassi, P., Di Toro, N., & Ronfani, L. (2021). Prevalence of breastfeeding in a baby-friendly pediatric practice in Trieste, Italy: follow up to 36 months of age. International Breastfeeding Journal, 16, 1-3.

Evidence Rating: Emerging

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.

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Moon, R. Y., Hauck, F. R., Colson, E. R., Kellams, A. L., Geller, N. L., Heeren, T., & Corwin, M. J. (2017). The effect of nursing quality improvement and mobile health interventions on infant sleep practices: a randomized clinical trial. Jama, 318(4), 351-359.

Evidence Rating: Moderate Evidence

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.

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Mosquera, R. A., Avritscher, E. B. C., Pedroza, C., Lee, K. H., Ramanathan, S., Harris, T. S., Eapen, J. C., Yadav, A., Caldas-Vasquez, M., Poe, M., Martinez Castillo, D. J., Harting, M. T., Ottosen, M. J., Gonzalez, T., & Tyson, J. E. (2021). Telemedicine for Children With Medical Complexity: A Randomized Clinical Trial. Pediatrics, 148(3), e2021050400. https://doi.org/10.1542/peds.2021-050400

Evidence Rating: Emerging

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

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Mulchan, S. S., Hinderer, K. A., Walsh, J., McCool, A., & Becker, J. (2022). Feasibility and use of a transition process planning and communication tool among multiple subspecialties within a pediatric health system. Journal for specialists in pediatric nursing : JSPN, 27(1), e12355. https://doi.org/10.1111/jspn.12355

Evidence Rating: Moderate

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.

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Perkins RB, Zisblatt L, Legler A, Trucks E, Hanchate A, Sheinfeld Gorin S. Effectiveness of a provider-focused intervention to improve HPV vaccination rates in boys and girls. Vaccine, 2015;33(9):1223-1229.

Evidence Rating: Moderate Evidence

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

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

Evidence Rating: Emerging

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

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

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

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

Study Design: Team Reorganization Model

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

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

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

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

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

Evidence Rating: Moderate

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

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

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

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

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

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

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

Sample Size: 14 parents

Age Range: parents of children

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Riley M, Patterson V, Lane JC, Won KM, Ranalli L. The Adolescent Champion Model: Primary Care Becomes Adolescent-Centered via Targeted Quality Improvement. J Pediatr. 2018 Feb;193:229-236.e1. doi: 10.1016/j.jpeds.2017.09.084. Epub 2017 Nov 29. PMID: 29198766.

Evidence Rating: Moderate

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 .

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Riley, M., Patterson, V., Lane, J. C., Won, K. M., & Ranalli, L. (2018). The Adolescent Champion Model: Primary Care Becomes Adolescent-Centered via Targeted Quality Improvement. The Journal of pediatrics, 193, 229–236.e1. https://doi.org/10.1016/j.jpeds.2017.09.084

Evidence Rating: Moderate

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.

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Roberts, M. D., Christiansen, A., O'Hagan, B., Jansen, E., & Augustyn, M. (2023). Developmentally-Trained Primary Care Clinicians: A Pipeline to Improved Access?. Journal of developmental and behavioral pediatrics : JDBP, 44(5), e350–e357. https://doi.org/10.1097/DBP.0000000000001178

Evidence Rating: Emerging

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

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Rose M, Maciejewski H, Nowack J, Stamm B, Liu G, Gowda, C. (2021). Promoting pediatric preventive visits through quality improvement initiatives in the primary care setting. The Journal of Pediatrics, 228, 220-227.

Evidence Rating: Moderate Evidence

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

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Rose, M., Maciejewski, H., Nowack, J., Stamm, B., Liu, G., & Gowda, C. (2021). Promoting Pediatric Preventive Visits Through Quality Improvement Initiatives in the Primary Care Setting. The Journal of pediatrics, 228, 220–227.e3. https://doi.org/10.1016/j.jpeds.2020.08.081

Evidence Rating: Moderate

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.

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Sarkar, A., Selvam, S. P., Raj, A., Wadhawan, I., & Chandra, R. (2022). Early Initiation of Breastfeeding Among Adolescent Mothers: A Quality Improvement Study. Cureus, 14(11).

Evidence Rating: Moderate

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.

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Schlottmann, H., Broome, M., Herbst, R., Burkhardt, M. C., & Mescher, A. (2019). Nurse-Led Telephone Follow-Up to Improve Parent Promotion of Healthy Behaviors in Young Children With Motivational Interviewing Techniques. Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners, 33(5), 545–554. https://doi.org/10.1016/j.pedhc.2019.02.003

Evidence Rating: Moderate

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

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Shaligram, D., & Walter, H. J. (2023). Utilization and Outcomes of Direct Consultation in a Child Psychiatry Access Program. Psychiatric services (Washington, D.C.), 74(1), 100–103. https://doi.org/10.1176/appi.ps.20220093

Evidence Rating: Moderate

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

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Shapiro, J. M., Himes, R., Khaderi, S., Economides, J., & El-Serag, H. B. (2021). A multidisciplinary approach to improving transition readiness in pediatric liver transplant recipients. Pediatric transplantation, 25(2), e13839. https://doi.org/10.1111/petr.13839

Evidence Rating: Moderate

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.

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Sheldrick, R. C., Bair-Merritt, M. H., Durham, M. P., Rosenberg, J., Tamene, M., Bonacci, C., Daftary, G., Tang, M. H., Sengupta, N., Morris, A., & Feinberg, E. (2022). Integrating Pediatric Universal Behavioral Health Care at Federally Qualified Health Centers. Pediatrics, 149(4), e2021051822. https://doi.org/10.1542/peds.2021-051822

Evidence Rating: Moderate

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

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Shores, D., Wilson, L., & Oliva-Hemker, M. (2019). Utilizing Information Technology to Improve Influenza Vaccination in Pediatric Patients With Inflammatory Bowel Disease. Gastroenterology Nursing, 42(4), 370-374. doi: 10.1097/SGA.0000000000000321. [Flu Vaccination SM]

Evidence Rating: Scientifically Rigorous

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

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Snyder DA, Schuller J, Ameen Z, Toth C, Kemper AR. Improving Patient-Provider Continuity in a Large Urban Academic Primary Care Network. Acad Pediatr. 2022 Mar;22(2):305-312. doi: 10.1016/j.acap.2021.11.005. Epub 2021 Nov 12. PMID: 34780999.

Evidence Rating: Moderate

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

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Snyder, D. A., Schuller, J., Ameen, Z., Toth, C., & Kemper, A. R. (2022). Improving Patient-Provider Continuity in a Large Urban Academic Primary Care Network. Academic pediatrics, 22(2), 305–312. https://doi.org/10.1016/j.acap.2021.11.005

Evidence Rating: Moderate

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

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Springall, T., Forster, D. A., McLachlan, H. L., McCalman, P., & Shafiei, T. (2023). Rates of breast feeding and associated factors for First Nations infants in a hospital with a culturally specific caseload midwifery model in Victoria, Australia: a cohort study. BMJ open, 13(1), e066978.

Evidence Rating: Moderate

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.

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Srinivasan, S., Schlar, L., Rosener, S. E., Frayne, D. J., Hartman, S. G., Horst, M. A., Brubach, J. L., & Ratcliffe, S. (2018). Delivering Interconception Care During Well-Child Visits: An IMPLICIT Network Study. Journal of the American Board of Family Medicine : JABFM, 31(2), 201–210. https://doi.org/10.3122/jabfm.2018.02.170227

Evidence Rating: Emerging

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

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Stafford, J., Shah, A., & Calaminus, P. (2020). Collaborative learning system to improve access and flow across child and adolescent mental health services: A mixed-methods study. BMJ Open Quality, 9, e000832.

Evidence Rating: Emerging

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.

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

Evidence Rating: Moderate

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

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

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

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

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

Setting: e Emma Children's Hospital Amsterdam UMC

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

Sample Size: 23 adolescents

Age Range: aged 12-18 years

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The ALIGN Framework A Parent-Informed Approach to Prognostic Communication for Infants With Neurologic Conditions Monica E. Lemmon, Mary C. Barks, Simran Bansal, Sarah Bernstein, Erica C. Kaye, Hannah C. Glass, Peter A. Ubel, Debra Brandon, Kathryn I. Pollak Neurology Feb 2023, 100 (8) e800-e807; DOI: 10.1212/WNL.0000000000201600

Evidence Rating: Moderate

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 .

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

Evidence Rating: Emerging

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

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

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

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

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

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

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

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

Age Range: NICU age - newborn infants

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Vander Schaaf, E. B., Quinonez, R. B., Cornett, A. C., Randolph, G. D., Boggess, K., & Flower, K. B. (2018). A pilot quality improvement collaborative to improve safety net dental access for pregnant women and young children. Maternal and child health journal, 22(2), 255-263.

Evidence Rating: Emerging Evidence

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

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Ware, J. L., Schetzina, K. E., Morad, A., Barker, B., Scott, T. A., & Grubb, P. H. (2018). A statewide quality improvement collaborative to increase breastfeeding rates in Tennessee. Breastfeeding Medicine, 13(4), 292-300.

Evidence Rating: Moderate Evidence

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

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Warrick, S., Morehous, J., Samaan, Z. M., Mansour, M., Huentelman, T., Schoettker, P. J., & Iyer, S. (2018). Walk-in Model for Ill Care in an Urban Academic Pediatric Clinic. Academic pediatrics, 18(3), 281–288. https://doi.org/10.1016/j.acap.2017.10.004

Evidence Rating: Emerging

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

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White PH, Ilango SM, Caskin AM, et al. Health Care Transition in School-Based Health Centers: A Pilot Study. The Journal of school nursing : the official publication of the National Association of School Nurses. 2020 08 Dec:1059840520975745. doi: 10.1177/1059840520975745

Evidence Rating: Emerging

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

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White, P. H., Ilango, S. M., Caskin, A. M., la Guardia, M. G. A., & McManus, M. A. (2022). Health Care Transition in School-Based Health Centers: A Pilot Study. The Journal of school nursing : the official publication of the National Association of School Nurses, 38(6), 526–532. https://doi.org/10.1177/1059840520975745

Evidence Rating: Moderate

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.

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