Pediatric Family-Centered Rounds and Humanism: A Systematic Review and Qualitative Meta-analysis.

CONTEXT: Pediatric family-centered rounds (FCRs) have been shown to have benefits in staff satisfaction, teaching, and rounding efficiency, but no systematic review has been conducted to explicitly examine the humanistic impact of FCRs. OBJECTIVE: The objective with this review is to determine if FCRs promote the core values of humanism in medicine by answering the question, "Do FCRs promote humanistic pediatric care?" DATA SOURCES: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a search of PubMed, Web of Science, Cumulative Index of Nursing and Allied Health Literature, and Dissertation Abstracts for peer-reviewed pediatric studies through January 1, 2020. We used search terms including FCRs, communication, humanism, and the specific descriptors in the Gold Foundation's definition of humanism. STUDY SELECTION: Abstracts (n = 1003) were assessed for 5 primary outcomes: empathy, enhanced communication, partnership, respect, and satisfaction and service. We evaluated 158 full-text articles for inclusion, reconciling discrepancies through an iterative process. DATA EXTRACTION: Data abstraction, thematic analysis, and conceptual synthesis were conducted on 29 studies. RESULTS: Pediatric family-centered rounds (FCRs) improved humanistic outcomes within all 5 identified themes. Not all studies revealed improvement within every category. The humanistic benefits of FCRs are enhanced through interventions targeted toward provider-family barriers, such as health literacy. Patients with limited English proficiency or disabilities or who were receiving intensive care gained additional benefits. CONCLUSIONS: Pediatric FCRs promote humanistic outcomes including increased empathy, partnership, respect, service, and communication. Limitations included difficulty in defining humanism, variable implementation, and inconsistent reporting of humanistic outcomes. Future efforts should include highlighting FCR's humanistic benefits, universal implementation, and adapting FCRs to pandemics such as coronavirus disease 2019.

Patient visits to a midwestern primary care practice-based research network: a comparison to two national primary care data sets.

BACKGROUND: Regional primary care practice-based research networks (PBRNs) have made important contributions to the primary care literature, but have not been well-described. This study compares pediatric patient characteristics within a new regional PBRN to pediatric patient characteristics from two previously published national data sets. METHODS: Descriptive patient data were collected by 25 Southwestern Ohio Ambulatory Research Network (SOAR-Net) clinicians between July 2003 and June 2004. These data were compared to pediatric patient characteristics from 57 Pediatric Research in Office Setting clinicians and 33 primary care pediatric clinicians who participated in the National Ambulatory Medical Care Survey. RESULTS: SOAR-Net patients were almost twice as likely to use Medicaid (41.9% vs 22.0%/22.4%, p = 0.0001). SOAR-Net patients also were more likely to be African-American (23.7% vs 7.5%/17.6%, p = 0.002). About one third of patients in each sample were seen for a well visit. CONCLUSION: Regional networks with unique characteristics, such as a large number of Medicaid patients and/or many underserved minority patients have the potential to make significant contributions to primary care research by focusing on problems experienced within those segments of a population (e.g., indigent children and their families).

Associations Between Parental Health Literacy, Use of Asthma Management Plans, and Child's Asthma Control.

BACKGROUND: There are some studies demonstrating the effectiveness of the provision of written asthma action plans in improving asthma outcomes. There exist little data on the ability of parents to use these plans to make asthma care decisions. OBJECTIVE: To assess the associations between parental health literacy (HL), parental ability to use a written asthma management plan (WAMP), and child's asthma control. METHODS: Parents completed a survey with questions related to WAMPs and child's asthma, a HL screening tool, and 5 asthma vignettes. For vignettes, parents identified asthma control zone and then made decisions about asthma management. WAMP scores were totaled (0-32) and converted to a percent correct score. Associations between parental HL, WAMP scores, child's asthma control, and demographics were determined with independent t tests or 1-way analysis of variance, and chi-square tests. Variables significantly associated with WAMP scores or asthma control were included in multiple logistic regression or multiple linear regression analyses. RESULTS: A total of 176 surveys were included; the mean ± SD WAMP score was 58.9% ± 22.2%, and 25% of respondents had limited HL. Of respondents' children, 38% had not well/poorly controlled asthma. In multiple regression analysis controlling for education level, limited HL was significantly associated with WAMP score (b = 11.3, standard error 3.8, P = .004). WAMP score was not associated with asthma control. Limited HL was associated with poor asthma control in univariate analysis, but not in a logistic regression model controlling for other significant variables. Only unmarried marital status (adjusted odds ratio 4.4, 95% CI 1.8-10.8, P = .001) was associated with asthma control. CONCLUSION: HL is associated with parental ability to use WAMPs to respond to asthma scenarios. Parental HL may play a role in parents' ability to appropriately use WAMPs.

Heterogeneity in asthma care in a statewide collaborative: the Ohio Pediatric Asthma Repository.

BACKGROUND AND OBJECTIVE: Asthma heterogeneity causes difficulty in studying and treating the disease. We built a comprehensive statewide repository linking questionnaire and medical record data with health outcomes to characterize the variability of clinical practices at Ohio children's hospitals for the treatment of hospitalized asthma. METHODS: Children hospitalized at 6 participating Ohio children's hospitals for asthma exacerbation or reactive airway disease aged 2 to 17 were eligible. Medical, social, and environmental histories and past asthma admissions were collected from questionnaires and the medical record. RESULTS: From December 2012 to September 2013, 1012 children were enrolled. There were significant differences in the population served, emergency department and inpatient practices, intensive care unit usage, discharge criteria, and length of stay across the sites (all P < .0001, total n = 1012). Public insurance was highest in Cleveland and Cincinnati (72 and 65%). In the emergency department, Cincinnati and Akron had the highest intravenous magnesium sulfate use (37% and 33%); Columbus administered the most intramuscular epinephrine (15%). Cleveland and Columbus had the highest intensive care unit admittance (44% and 41%) and proportion of long-stay patients (95% and 85%). Moderate/severe asthma severity classification was associated with discharge prescription for inhaled corticosteroids (odds ratio = 2.7; 95% confidence interval: 1.6-4.5; P = .004) but not stay length. CONCLUSIONS: These data highlight the need for standardization of treatment practices for inpatient asthma care. There is considerable opportunity for personalized care plans that incorporate a patient's asthma impairment, risk, and treatment response history into hospital practices for asthma exacerbation treatment. The Ohio Pediatric Asthma Repository is a unique statewide resource in which to conduct observational, comparative effectiveness, and ultimately intervention studies for pediatric asthma.

Children and firearms in the home: a Southwestern Ohio Ambulatory Research Network (SOAR-Net) study.

BACKGROUND: To ascertain the prevalence of gun ownership, gun safety education, and parental attitudes on gun counseling in a Midwestern sample. METHODS: Parents seeking care at participating practices in the Southwestern Ohio Ambulatory Research Network were recruited to complete a survey about gun ownership, gun safety education, and gun counseling attitudes. Attitudes and beliefs were compared between gun owners and non-gun owners. RESULTS: Twenty-four percent of respondents had at least 1 gun in the home. Military families were more likely to own a gun than civilian families (28% vs 18%, P = .001). Fifty-two percent of sample children have received gun safety education. Eight percent indicated that a physician had asked about guns or discussed gun safety issues during an office visit. A majority of parents indicated that physicians should ask about guns in the home (69%) and advise parents on safe storage (75%), but they should not advise parents to remove guns from the home (12% of gun owners, 42% of non-gun owners). CONCLUSIONS: Despite the morbidity and mortality associated with guns, physicians in this study do not seem to be addressing this risk with families. A majority of gun owners do not agree that physicians should counsel the removal of guns from the home but agree that they should discuss safe gun storage information.

Poor readability of written asthma management plans found in national guidelines.

OBJECTIVE: Written asthma management plans (WAMPs) for patients constitute a key component of current national asthma guidelines, but it is not known whether these plans meet the readability standards (of fifth-grade level or lower) recommended by health education experts. The objective of this study was to assess whether WAMPs presented in national guidelines are written at or below a fifth-grade reading level. METHODS: We used readability software to analyze 10 WAMPs. These included 7 from the national guidelines, 1 from the World Health Organization, and 2 local ones. RESULTS: The grade levels for the WAMPs ranged from 4.9 to 9.2. None of the national plans achieved a grade level equal to or below the fifth grade. However, the other plans had grade levels of 4.9, 5.7, and 5.9. The mean grade level for the national plans was 8.1, whereas the mean for the other 3 plans was 5.5. The difference between these 2 sets of WAMPs was significant. CONCLUSION: WAMPs presented as part of the national guidelines are not written at or below a fifth-grade reading level. However, it is clear from this study that it is possible to achieve this level of readability. Increasing the availability and use of plans that meet recognized readability standards may help to improve asthma outcomes, especially in poor populations in which there is both low literacy and the greatest prevalence and severity of asthma.