Biliblanket Utilization for Outpatient Treatment of Newborn Jaundice.

Hyperbilirubinemia is a common neonatal diagnosis. Biliblankets have the potential to reduce readmission for hyperbilirubinemia. The study purpose was to characterize home biliblanket treatment for hyperbilirubinemia using retrospective medical record review of newborns with total serum bilirubin of 0.1 to 3 mg/dL below inpatient threshold seen at 9 pediatric clinics (N = 359). The main outcomes were whether a biliblanket was used and whether the usage impacted readmissions. Home biliblankets were used for 44% of newborns. Nine percent of newborns were readmitted for hyperbilirubinemia. Four percent of newborns treated with a biliblanket were readmitted compared with 13% of those not treated with a biliblanket (P = .002). Newborns treated with a biliblanket (odds ratio [OR] = 0.16; 95% confidence interval [CI] = 0.06-0.44) and newborns 3 days or older (OR = 0.16; 95% CI = 0.06-0.43) were less likely to be readmitted than newborns not treated with a biliblanket and 2-day-old newborns. We found that home biliblanket use was associated with lower odds of hospital readmission for newborn jaundice.

Motivational Advising Workshop: Utilizing Motivational Interviewing Theory to Facilitate and Engage Intrinsic Motivation to Change Learners' Behavior.

Introduction: Motivational interviewing (MI) is a counseling method that utilizes a patient's own motivation to effect personal change. MI has been applied routinely and successfully to managing medical conditions (e.g., substance abuse). Employing MI techniques to engage medical learners (termed motivational advising [MA]) may help them overcome professional and/or personal challenges limiting their career development. Methods: Medical educators from four academic medical centers developed a module focused on teaching fellow educators MI theory and techniques for MA using didactic and interactive components. Participants participated in facilitated role-plays to practice MA delivery techniques and observed videos of a traditional advisor-advisee interaction as well as an MA-focused engagement. A postworkshop survey was used to evaluate the workshop. Results: In a survey of 48 educators attending the workshop at two medical conferences, over 80% of respondents demonstrated an interest in learning more about MA. Additionally, over 60% indicated that they would seek opportunities to practice and/or implement MA with their advisees. Knowledge of the technical components of MA also increased significantly in pre- and posttest analysis. Discussion: This module introducing the concept of MA was well received by medical educators and was viewed as a valuable tool in advising medical learners. The provided components enable replication of this workshop in other settings with or without an expert in MI techniques. Although the workshop has been conducted with physicians involved in medical education, it would be applicable to other health professionals who advise trainees such as nursing, dentistry, pharmacy, or veterinary medicine.

Two-year longitudinal assessment of physicians' perceptions after replacement of a longstanding homegrown electronic health record: does a J-curve of satisfaction really exist?

This report describes a 2-year prospective, longitudinal survey of attending physicians in 3 clinical areas (family medicine, general pediatrics, internal medicine) who experienced a transition from a homegrown electronic health record (EHR) to a vendor EHR. Participants were already highly familiar with using EHRs. Data were collected 1 month before and 3, 6, 13, and 25 months post implementation. Our primary goal was to determine if perceptions followed a J-curve pattern in which they initially dropped but eventually surpassed baseline measures. A J-curve was not found for any measures, including workflow, safety, communication, and satisfaction. Only the reminders and alerts measure dropped and then returned to baseline (U-curve); a few remained flatlined. Most dropped and remained below baseline (L-curve). The only measure that remained above baseline was documenting in the exam room with the patient. This study adds to the literature about current controversies surrounding EHR adoption and physician satisfaction.

A Two-Year Longitudinal Assessment of Ophthalmologists' Perceptions after Implementing an Electronic Health Record System.

OBJECTIVES: To understand the attitudes and perceptions of ophthalmologists toward an electronic health record (EHR) system, before and after its clinical implementation. METHODS: Ophthalmologists at a single large academic ophthalmology department were surveyed longitudinally before and after implementation of a new EHR system. The survey measured ophthalmologists' attitudes toward implementation of a new EHR. Questions focused on satisfaction, efficiency, and documentation. All attending physicians (between 56 and 61 at various time points) in the University of Michigan Department of Ophthalmology and Visual Sciences were surveyed. We plotted positive responses to survey questions and assessed whether perceptions followed a J-curve with an initial decrease followed by an increase surpassing pre-implementation levels. RESULTS: Survey responses were received from 32 (52%) ophthalmologists pre-implementation, and 28 (46%) at 3 months, 35 (57%) at 7 months, 40 (71%) at 13 months and 39 (67%) at 24 months post-implementation. After EHR implementation respondents were more likely to express concerns about their ability to create high-quality documentation (p<0.01) and the impact of an electronic health record on meaningful patient interaction (p<0.01). Physicians did not report a significant change in the amount of time spent documenting outside of regular clinical work hours (p=0.54) or on their clinic efficiency and workflow (p=0.97). There was no significant change in overall job satisfaction during the study period (p=0.69). We did not observe a J-curve for any of the survey responses analyzed. CONCLUSIONS: As ophthalmology practices continue to transition to EHRs, adapting them to their specific culture and needs is important to maintain efficiency and user satisfaction. This study identifies areas of concern to ophthalmologists that may be addressed through education of physicians and customization of software as other practices move forward with EHR implementation.

Variation in establishing a diagnosis of obesity in children.

Consensus guidelines provide recommendations for the diagnosis and management of obesity. We conducted a medical record review of children initially diagnosed with obesity at a general pediatrics visit. The diagnosis was made most often at health maintenance visits (46%). Body mass index was documented in 5% of initial visits; 74% had documentation of obesity-related history; 64% had documentation of counseling. In multivariate analysis, male patients were more likely to have diet history documentation; female patients were more likely to have weight loss program referrals. Future research should assess pediatricians' perceptions about obesity to better understand clinical practice patterns.

The right not to hear: the ethics of parental refusal of hearing rehabilitation.

OBJECTIVE: To explore the ethics of parental refusal of auditory-oral hearing rehabilitation. STUDY DESIGN: Case study with medical ethical discussion and review. METHODS: Two young brothers present with severe-to-profound congenital sensorineural hearing loss. The parents, both of whom have normal hearing and work as sign language interpreters, have decided to raise their children with American Sign Language as their only form of communication. They have chosen not to pursue cochlear implantation nor support the use of hearing aids. DISCUSSION: This case raises significant questions concerning whether hearing rehabilitation should be mandated, and if there are circumstances in which parental preferences should be questioned or overridden with regard to this issue. In addition, legal concerns may be raised regarding the possible need to file a report with Child Protective Services. Although similar cases involving the Deaf community have historically favored parental rights to forego hearing rehabilitation with either cochlear implantation or hearing aids, we explore whether conclusions should be different because the parents in this case are not hearing impaired. CONCLUSIONS: The ethics of parental rights to refuse hearing rehabilitation are complex and strikingly context-dependent. A comprehensive appreciation of the medical, practical, and legal issues is crucial prior to intervening in such challenging situations.