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Presentation at 2012 PAS Meeting

Added: May 14, 2012

Comparative Effectiveness Research in the EHR Tower of Babel: Creation of a Multi-Vendor EHR Practice-Based Research Network

Richard Wasserman, MD, MPH^1,2, Jennifer Steffes, MSW¹, Akiba Hollins-Thomas, BS¹, Banita McCarn, MEd¹, Alexander Fiks, MD, MSCE³, Eric Slora, PhD¹, Edward Gotlieb, MD^1,4 and Benyamin Margolis, PhD, MPH⁵.

¹Pediatric Research in Office Settings (PROS), American Academy of Pediatrics, Elk Grove Village, IL 60007, United States; ²Department of Pediatrics, University of Vermont, Burlington, VT 05405, United States; ³Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States; ⁴The Pediatric Center, Stone Mountain, GA 30083, United States and ⁵Maternal and Child Health Bureau, Health Resources and Services Administration, DHHS, Rockville, MD 20857, United States.

Background: Data from electronic health records (EHRs) represent a rich resource for primary care comparative effectiveness research (CER), but the heterogeneity of EHR systems complicates both data extraction and aggregation and limits the diversity of practices available to obtain an accurate picture of U.S. pediatric primary care.

Objective: To describe the complexity of the multi-EHR-system environment and the potential impact of an EHR practice-based research subnetwork (ePROS) using a vendor-based, multi-EHR-system data extraction model.

Design/Methods: Design: Network survey conducted from 2009-2010.
Subjects: Contact practitioners in 744 practices in Pediatric Research in Office Settings (PROS), the practice-based research network of the AAP.
Data collected: A survey sent to all PROS practices asked whether the practice currently used EHR and if so, the type of EHR and years in use.
Analysis: Data from the survey, combined with previously collected PROS practice data, were analyzed to determine selected practice factors (i.e., practice type, rural/urban, patient insurance) associated with use of EHR. Data were also analyzed to determine suitability for inclusion in ePROS based on concordance of EHR systems with the capabilities of the ePROS data extraction vendor.

Results: The survey had a 68% response rate (n=506). Forty-five percent of respondents (n=226) indicated they had an all-electronic EHR, 24% (n=120) indicated a part electronic and part paper system, and 31% (n=155) indicated no EHR. The two most prevalent EHR systems accounted for 10.5% and 9.6% of practices with only two other systems at ≥5% prevalence. The 19 systems used by at least 1% of practices accounted for 73% of practices. The only practice factor associated with EHR use was having >50% of patients with private insurance (X2 (3) = 15.42, p < .001). The 20 EHR systems compatible with ePROS data extraction vendor capability (incomplete overlap with the 19 cited above) are used by 217 (63%) of EHR practices in PROS.

Conclusions: Because of the plethora of EHR systems in use, CER based on single-EHR-system data could produce misleading results by failing to account for the diversity of primary care pediatrics. CER using the ePROS multi-system approach can better represent care delivered to a substantial proportion of children seen in U.S. pediatric practice.

MCH R40 Research Project Featured Article in JAMA

Added: May 3, 2012

Text Message Reminders Could Help Encourage Vaccinations

In a paper published in the April 25, 2012 issue of the Journal of the American Medical Association (JAMA), Dr. Melissa Stockwell and her colleagues found that text message reminders to low-income, urban parents helped to increase the rate of flu vaccinations among their children.

Traditional flu vaccine reminders have shown limited effectiveness among hard to reach, urban populations. This study examines the use of text messaging as a novel approach to reminding parents about the importance of flu vaccination, and providing information regarding the availability of Saturday flu clinics. In this randomized controlled trial, the parents of 9213 children and adolescents aged 6 months to 18 years who were receiving care at four community-based health clinics, were randomized prior to the start of the 2010-2011 flu season into intervention and usual-care control groups. Both groups received an automated telephone reminder, and access to informational flyers posted at study sites (usual care). In addition, parents of children assigned to the intervention received up to 5 weekly immunization registry-linked text messages that provided educational information and instructions regarding Saturday flu clinics. Receipt of a flu vaccine dose was recorded in the immunization registry.

The study children were primarily minority, 88% were publicly insured, and 58% were from Spanish-speaking families. By March, 2011, and again later in the fall of 2011, a slightly higher proportion of children in the intervention group compared with the usual care control group had received flu vaccinations. The authors conclude that a text message reminder may help to boost flu vaccination rates among low-income, urban populations. However, the overall flu vaccination rate remained low in this population.

Entitled "Effect of a text messaging intervention on influenza vaccination in an urban, low-income pediatric and adolescent population," this study is funded by grant R40 MC 17169 through the U.S. Department of Health & Human Services, Health Resources and Services Administration, Maternal and Child Health (MCH) Research Program. It has received media attention through ASPH and JAMA.

Publication:

• Stockwell MS, Kharbanda EO, Martinez RA, Vargas CY, Vawdrey DK, Camargo S. Effect of a text messaging intervention on influenza vaccination in an urban, low-income pediatric and adolescent population: a randomized controlled trial. JAMA. 2012 Apr 25;307(16):1702-8. http://jama.ama-assn.org/content/307/16/1702.full

View article in ASPH.

View videos related to this article:

• Author interview on JAMA or on YouTube
• JAMA News Report

Presentation at 2012 PAS Meeting

Added: May 3, 2012

Developing a consensus national research agenda for Developmental-Behavioral Pediatrics (DBP): Results from Delphi Study by MCH DBP Research Network (DBPNet)

Title: Consensus Research Priorities for Developmental-Behavioral Pediatrics: A DBPNet Delphi Study

Nathan J Blum, MD¹, Heidi M Feldman, MD, PhD², William J Barbaresi, MD³, David J Schonfeld, MD⁴, Robin L Hansen, MD⁵ and Christopher B Forrest, MD, PhD¹. ¹Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States; ²Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States; ³Pediatrics, Children's Hospital Boston, Boston, MA, United States; ⁴Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States and 5Pediatrics, MIND Institute, University of California at Davis, Sacramento, CA, United States.

Background: Developmental-Behavioral Pediatrics (DBP) is a relatively young subspecialty with many questions related to the most effective and efficient diagnostic and management strategies. The Developmental-Behavioral Pediatrics Research Network (DBPNet) is a collaboration among 12 academic DBP programs including 95 developmental-behavioral pediatricians and the Society for Developmental-Behavioral Pediatrics (SDBP) that was launched in September 2010 in order to facilitate investigation of these research questions. With many potential questions there is a need to identify the high priority questions.

Objective: To develop a consensus regarding the most important research questions for the field of DBP.

Design/Methods: Individuals from three stakeholder groups, 27 developmental-behavioral pediatricians, 16 psychologists, and 12 parents, participated in a 3-round Delphi survey. Participation was 100% in Rounds I and III and 96% in Round II. In Round I, each participant suggested up to 10 research questions important for DBP to address in the next 5 years. In Round II, participants rated the importance of each unique question on a 9-point likert scale. Questions were rated as consensus important questions if they had a median score of 7 and a coefficient of variation (CV) < 30 indicating low variation in scores (high agreement). Questions were rated as potentially important if they had a median of 7, but a CV>30 or if specific stakeholder group ratings suggested they were important. After providing participants the results from Round II, potentially important questions were rated a second time (Round III), and responses were evaluated using the same criteria as in Round II.

Results: In Round I, 216 unique research questions were identified. In Round II, 29 of these questions met the criteria for a consensus important question and 60 questions were rated as potentially important. In Round III, ten additional questions were rated as meeting the criteria for a consensus important question. Of the 39 consensus important research questions, 20 were efficacy, effectiveness, or comparative effectiveness studies; 8 related to epidemiology or analysis of risk factors; 5 related to assessing or developing methods to assess outcomes. The other six questions related to issues such as screening, diagnostic testing, identifying practice variation across DBP sites, and teaching DBP to residents. Approximately 40% of the questions related to autism spectrum disorders. Although the Delphi procedure developed a consensus around most questions, there were 7 in which 75% or more of parent participants rated the question as important, but the question did not reach consensus criteria. No other question that failed to reach consensus criteria was rated as important by more than 70% of a stakeholder group.

Conclusions: This Delphi process has produced a set of high priority research topics for the field of DBP. These topics cover a broad range of DBP concerns, but focus on evaluating interventions and studying autism. Parents of children with disabilities prioritize some research topics that were not prioritized by most developmental-behavioral pediatricians or psychologists.

Mexican-American youth add pounds as they lose native eating

Added: March 6, 2012

In a paper published in February's Journal of Nutrition, Dr. Jihong Liu from the University of South Carolina (USC), an MCH Research Program SDAS grantee, and her colleagues at USC published the results of their analysis of the 1999-2004 National Health and Nutrition Examination Survey. Dr. Liu et al. found that among the 2300 children aged 12-19 years old, Mexican American youth born into the second- and third-generation families are more likely to be obese than those who were not born in the United States. Adolescents from the second and third generations have diets high in saturated fat and sodium and they consume high levels of sweetened beverages. Their consumption of fruits, vegetables, grains, meat and beans is lower than first-generation Mexican-American youth. The findings suggest that Mexican-American adolescents face challenges in terms of poorer diet and excessive weight gain associated with their immigration and acculturation experience. The study has received media attention through the American Society for Nutrition, MSN.com, Yahoo.com.

The paper entitled "Generation and acculturation status are associated with dietary intake and body weight in Mexican American adolescents" is funded by grant R40 MC 17167 through the U.S. Department of Health & Human Services, Health Resources and Services Administration, Maternal & Child Health Research Program.

Publication:
Liu J, Chu YH, Frongillo EA, Probst JC. Higher Generational and Acculturation Status are associated with Poorer Diet and Greater Body Weight Among Mexican American Adolescents. Journal of Nutrition. 2012 Feb; 142(2): 298-305. PMID: 22223572.

View article on Yahoo.com.

Grantee Publication Highlight

Added: January 24, 2012

The Developmental-Behavioral Pediatrics Research Network (DBPNet): Another Step in the Development of the Field
By Nathan J. Blum, MD and the DBPNet Steering Committee

The Developmental-Behavioral Pediatric Research Network (DBPNet) published its first paper in the January 2012 issue of the Journal of Developmental & Behavioral Pediatrics describing the creation and development of an innovative research infrastructure. Interest in the field now called developmental-behavioral pediatrics can be traced to early training programs related to aspects of behavioral pediatrics and developmental disabilities in the late 1950s and early 1960s. During the past two decades impressive advances related to diagnosis and management of many of the conditions frequently treated by developmental-behavioral pediatricians have occurred through research in the cognitive neurosciences, behavioral sciences, and genetics, among other fields. The DBPNet will stimulate multi-site research and effectively and efficiently investigate issues that will improve the scientific understanding and clinical practice in the field. The paper is now available online.

The Maternal and Child Health Bureau began to support DBPNet in the fall of 2010. Learn more about the DBPNet.

Grantee Publication Highlight

Added: December 9, 2011

A paper published in April 2010 issue of the Journal of Asthma by Dr. Gregory D. Stevens from the Keck School of Medicine of the University of Southern California was selected as one of the most important papers of 2010 for school health physicians by the members of the Physician Section of the American School Health Association and the American Academy of Pediatrics Council on School Health.

Dr. Stevens, an MCH Research Program SDAS grantee, along with colleagues Trevor Pickering and Sheila Laqui, used the 2007 National Survey of Children's Health to complete their analysis. The study demonstrated that among children aged 6-17 years with asthma, those with better medical home experiences--particularly the features of access, comprehensiveness, and family-centered care--had better daily life experiences, including better school engagement (e.g., fewer school days missed and a lower likelihood of repeating a grade since kindergarten) and greater after-school activity participation (e.g., more days with exercise and a higher likelihood of doing community service or volunteer work).

The study titled "National Prevalence of A Quality Medical Home for Vulnerable Children and the Relationship with School Performance and After-School Activity Participation" was funded by grant R40MC11270-0 through the U.S. Department of Health & Human Services, Health Resources and Services Administration, Maternal & Child Health Research Program.

View the list of the selected papers.

DRTE Director receives the AAP's Dale Richmond/Justin Coleman Award

Added: October 13, 2011

MCHB's Director of the Division of Research, Training and Education (DRTE) - Laura Kavanagh, MPP - named the 2011 Recipient of the Dale Richmond/Justin Coleman Award, conferred by the American Academy of Pediatrics (AAP)!

This annual award of the Academy is given for "outstanding contributions in the field of Child Development and Behavior." Laura joins the ranks of notables in the field such as Jerome Kagan, Lee Schorr, Vince Hutchins,and Margaret Haggerty, among others. The letter nominating Laura noted her "leadership efforts that emphasize the importance of including family members as faculty in training programs…", as well as her "efforts to define leadership training for the field." Her nominator notes, "[Laura]…is an accessible and highly responsive federal official who has consistently worked to facilitate the development of the field of developmental-behavioral pediatrics and improve services for children and families."

This award is named for Dale Richmond, son of Julius and Rhee Richmond - Dr. Richmond was a founding member of the AAP Section on Developmental Behavioral Pediatrics, and Justin Coleman, son of Dr. William and Julie Coleman. Dr. Coleman is Professor of Pediatrics at the University of North Carolina, Chapel Hill. Dale and Justin were both "politically conscious and active individuals with a deep desire to improve the social condition through public service and acts of kindness." How fitting a tribute for Laura!

Physicians' communication of Down syndrome screening test results: The influence of physician numeracy

Added: August 4, 2011

Published in Genetics in Medicine, the Research Department at the American College of Obstetricians and Gynecologists (Jay Schulkin, PhD, an MCH Research Program grantee (Project number: UA6MC19010) and Britta Anderson, PhD) and colleagues (Natalie Obrecht, PhD, Gretchen Chapman, PhD, and Deborah Driscoll, MD) report results from a study assessing the association between obstetrician-gynecologists' health literacy and how these physicians communicate Down syndrome screening test results to their patients. Open-ended questions revealed that communication strategies vary greatly, with approximately one in three obstetrician-gynecologists providing numerical information. Those who rated themselves as having high ability with numbers (high health literacy) were more likely to use numbers to explain the test results to patients. The paper is now available online.

HHS Announces Proposal to Improve Rules Protecting Human Research Subjects

Added: July 27, 2011

The advance notice of proposed rulemaking (ANPRM) to enhance protections for research subjects and reduce burden, delay, and ambiguity for investigators was published in the Federal Register yesterday. Changes under consideration would ensure the highest standards of protections for human subjects involved in research, while enhancing effectiveness of oversight. The 30-day comment period is an opportunity for the research community to provide valuable input to update the current human subjects regulations which have been in place for over 20 years. To submit a comment, visit Regulations.gov , enter ID number: HHS-OPHS-2011-005, and click on "Submit a Comment."

Visit the HHS web site for additional information about the changes under consideration.

Shortened Nighttime Sleep Duration in Early Life and Subsequent Childhood Obesity

Added: May 3, 2011

In a paper published in September's Archives of Pediatric and Adolescent Medicine, Dr. Janice Bell from the University of Washington, an MCH Research Program SDAS grantee (Project #R40 MC 08965-01 "Exposure to Stress as a Mediator of Disparities in Childhood Obesity"), and her colleague Dr. Frederick Zimmerman published the results of their analysis of the Panel Survey of Income Dynamics Child Development Supplement. Drs. Bell and Zimmerman found that among the 1930 children surveyed in 1997, children whose parents reported them to be on the low end of nighttime sleep from infancy through their early preschool years (ages 0-4) had an 80% increased risk of having a body mass index (BMI) in the overweight or obese range at follow-up in 2002. This effect was found even when controlling for birth weight, parents' BMI, daily hours of TV viewing, birth order, race, sex, and family income, as well as other demographic variables. There was not a significant relationship between sleep and BMI in the children between 5 and 13 years old at baseline, and in both groups, napping had a minimal effect on later obesity. This study has received media attention domestically through the New York Times , CNN , NPR and internationally .

Read more »

The Exposure to Stress as a Mediator of Disparities in Childhood Obesity is funded by grant R40 MC 08965 through the U.S. Department of Health & Human Services, Health Resources and Services Administration, Maternal & Child Health Research Program.

Health Insurance and Access to Care for Children and Adolescents Knowledge Path

Added: May 3, 2011

The Maternal and Child Health Library released a new edition of the knowledge path, Health Insurance and Access to Care for Children and Adolescents. The knowledge path points to resources that analyze data, describe effective programs, and report on policy and research aimed at advancing health coverage and improving health care access for children and adolescents. Emphasis is placed on Medicaid and the Children's Health Insurance Program (CHIP). Separate sections present resources for professionals (health professionals, program administrators, policymakers, and researchers) and for families. A special topics section points to resources that address health reform, outreach and enrollment, and school-based and school-linked care. View the Health Insurance and Access to Care for Children and Adolescents Knowledge Path page. For more knowledge paths on other maternal and child health (MCH) topics, visit the The Maternal and Child Health Library web site.

Oral Health for Infants, Children, Adolescents, and Pregnant Women Knowledge Path

Added: May 3, 2011

The Maternal and Child Health Library released a new edition of the knowledge path, Oral Health for Infants, Children, Adolescents, and Pregnant Women. View the Oral Health for Infants, Children, Adolescents, and Pregnant Women Knowledge Path page. For more knowledge paths on other maternal and child health (MCH) topics, visit the The Maternal and Child Health Library web site.

Physical Activity and Children and Adolescents Knowledge Path

Added: May 3, 2011

The Maternal and Child Health Library released a new edition of the knowledge path, Physical Activity and Children and Adolescents. View the Physical Activity and Children and Adolescents Knowledge Path page. For more knowledge paths on other maternal and child health (MCH) topics, visit the The Maternal and Child Health Library web site.

Announcing the Cultural and Linguistic Competence Family Organization Assessment

Added: May 3, 2011

The Cultural and Linguistic Competence Family Organization Assessment Instrument (CLCFOA) was developed to specifically address the unique functions of family organizations concerned with children and youth with behavioral-emotional disorders, special health care needs, and disabilities. Organizational self-assessment is a necessary, effective, and systematic way to plan for and incorporate cultural and linguistic competency. An assessment should address the attitudes, behaviors, policies, structures and practices of an organization, including those of its board, staff, and volunteers.

New and Improved National Center for Medical Home Implementation Web Site

Added: May 3, 2011

The National Center for Medical Home Implementation has launched a new and improved Web site! The new site features a plethora of resources and information designed to help you learn more about family-centered medical home and how practices, families, communities and states are working on implementation. Informational destinations on the Web site include:

• Medical Homes@Work e-Newsletter: Spotlights timely information and resources related to implementing medical home.
• How to Implement Tools/Resources: Features an extensive list of user-friendly tools and resources for implementation of medical home in the pediatric practice. Visit this section to see how you can adapt these tools to best meet the needs of your patient, client, or child.
• Training Resources: Houses a variety of tools and resources targeted towards pediatricians and the medical home care team that may also be of interest and/or use for families, youth, communities, and states.
• State Pages: Highlights information on state pediatric medical home initiatives, key contacts, partners, and related grant activities and initiatives.
• Quick Links: Contains links to valuable resources and information including the Building Your Medical Home toolkit , upcoming conferences, emerging issues and marketing materials.
• For Families: Presents links to tools and resources aimed at assisting families including the Building Your Care Notebook, Family-to-Family Health Information Centers, tips for partnering with your physician, and Title V.
• National Initiatives: Consists of information that the National Center tracks on the many national medical home initiatives, including multi-payor demonstration projects and state grant initiatives that are rapidly increasing across the country.

For additional information about the Web site or the National Center for Medical Home Implementation, please contact Heather Stob at 847-434-4902 or hstob@aap.org.

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