Creation and validation of a citywide pediatric asthma registry for the District of Columbia.

OBJECTIVE: To create and validate a citywide pediatric Asthma Registry to improve the care and outcomes of children and adolescents in Washington, DC through data-driven quality improvement (QI). METHODS: All available electronic health record data from inpatient and outpatient domains of Children's National Hospital were aggregated from an existing enterprise data warehouse. Inclusion criteria included asthma relevant ICD-10 codes over the prior 24 months. Available Asthma Registry measures include patient demographics, ambulatory visits, hospital admissions, persistent asthma diagnoses, and prescription of controller medications. Data capture was validated using US Census data and current asthma prevalence estimate of the Behavioral Risk Factor Surveillance System (BRFSS). RESULTS: The registry identified 15,991 DC children and adolescents with asthma aged 0-17 years, inclusive, at the end of 2020. This was 14.2% higher than the estimate of 14,001 children derived from BRFSS. Characteristics of those in the registry included: mean age of 9.5 (1.4) years, 57.9% male, 72.3% Black, and 66.7% publicly insured. Over the prior 24 months, 30.3% had ≥1 emergency department visit, and 10.5% had ≥1 hospital admission. Controller medications were prescribed for 59.6% of children with persistent asthma. Rates varied by sampled primary care practice sites. CONCLUSIONS: A population-level pediatric asthma registry captures more children and adolescents with asthma in DC then a BRFSS-derived estimate, and provides city-wide measures of asthma-related utilization. The registry allows for stratification by primary care practice locations and asthma characteristics, supporting the design, implementation, and evaluation of QI projects at the practice, health system, and population levels.Supplemental data for this article can be accessed at publisher's website.

Is the "July Effect" Real? Pediatric Trainee Reported Medical Errors and Adverse Events.

INTRODUCTION: The "July Effect" suggests an increase in patient adverse events in July compared with other months due to the introduction of new providers throughout the training continuum. The aim of this initiative was to analyze reported pediatric trainee medical errors from May through September 2015 at a tertiary care free-standing academic children's hospital to determine if there were more reported medical errors and more adverse events from those errors in July. METHODS: An error surveillance system is used to report and track near misses, adverse events, and medical errors. Three of the authors reviewed each report, which was electronically collected in the institution during the time period of interest. The reported medical error incidence per 1,000 trainee-days was compared against those in July for a significant difference. RESULTS: There are a total of 282 trainees (86 pediatric residents, 81 nonpediatric residents, and 115 fellows) who are clinically active in the hospital at any given month. Pediatric residents had more reported medical errors in July (31) compared with May (16; P = 0.015), June (16; P = 0.019), and August (19; P = 0.046). There was no significant difference in the number of adverse events from reported medical errors by trainees in July (7) compared with May (5), June (8), August (4), or September (8; P > 0.2). CONCLUSION: In this single-center evaluation, there is an increase in reported medical errors involving pediatric residents in July compared with the months surrounding July. However, there is no difference in numbers of adverse events from those errors between these months.

A 17-Year-Old With Chest Pain.

A 17-year-old male subject with a history of deep venous thrombosis presented with acute unilateral severe chest pain. His examination was nonspecific, and vital signs were normal. His initial laboratory evaluation revealed mild thrombocytopenia, elevated troponin levels, and critically elevated activated partial thromboplastin time. A computed tomography angiogram of the chest revealed a pulmonary embolus, and anticoagulation therapy was initiated. His course was complicated by the development of multiple thrombi and respiratory failure. Extensive evaluation revealed a rare, underlying diagnosis in time for life-saving treatment to be initiated.

State challenges to child health quality measure reporting and recommendations for improvement.

OBJECTIVE: The Children's Health Insurance Program (CHIP) was re-authorized in 2009, ushering in an unprecedented focus on children's health care quality one of which includes identifying a core set of performance measures for voluntary reporting by states' Medicaid/CHIP programs. However, there is a wide variation in the quantity and quality of measures states chose to report to the Center's for Medicare & Medicaid Services (CMS). The objective of this study is to assess reporting barriers and to identify potential opportunities for improvement. METHODS: From 2013 to 2014 a questionnaire developed in coordination with CMS and the Agency for Healthcare Research and Quality (AHRQ) was sent to state Medicaid and CHIP officials to assess barriers to child health quality reporting for Federal Fiscal Year 2012. States were categorized as high, medium, or low reporting for comparative analysis. RESULTS: Twenty-five of the 50 states and the District of Columbia agreed to participate in the study and completed the questionnaire. States placed a high priority on children's health care quality reporting (4.2 of 5 point Likert Scale, SD 0.99) and 96% plan to use measurement results to further improve their quality initiatives. However, low reporting states believed they had inadequate staffing and that data collection and extraction was too time-consuming than high reporting states. CONCLUSION: Based on state responses, possible solutions to improve reporting includes funding and staff support, refining the technical assistance provided, and creating venues for state-to-state interaction. Realistic and tangible improvements are within reach and opportunities for CMS and states to collaborate to improve child health care quality.

Nutritional status of refugee children entering DeKalb County, Georgia.

This study determines the nutritional status among refugee children entering one of the largest resettlement counties in the United States and identifies differences between incoming populations. Medical records of all newly arriving pediatric refugees (0-18 years) entering DeKalb County, Georgia between October 2010 and July 2011 were reviewed. Refugee children were grouped as African, Bhutanese, or Burmese (resettling from either Thailand or Malaysia) for comparative analysis. Approximately one in five refugees were anemic or malnourished, while a quarter had stool parasites, and nearly half had dental caries. African refugees had the highest anemia but the lowest underweight prevalence (p < 0.05). Compared to Burmese resettling from Malaysia, Burmese children from Thailand had a higher prevalence of anemia, underweight, and stool parasites (p < 0.05). Clinicians should use CDC medical screening guidelines for newly arriving pediatric refugees, as well as ensure proper nutritional support and follow-up care.