Funded Projects

Problem:

Injuries continue to be the leading cause of death and disability for Ohio children, causing more deaths than all other causes combined. Newborns to those 4 years of age are at greatest risk for unintentional injuries at home. SIDS is the leading cause of death for children 1 to 12 months of age.

Goals and Objectives:

Goal 1: From March 2015 through November 2015 the Injury Prevention Learning Collaborative will work to reduce unintentional injuries in children 1 year of age and under in 20 pediatric practices nationwide. Objective 1: By the end of the project in November 2015 providers will document that they addressed at least 90% of risks families are found to have based upon screening tool responses at first year well child visits. Objective 2: By the end of the project in November 2015 at least 30% of behaviors that families are determined to be at risk for will be changed based upon injury screen and discussions with pediatrician. Objective 3: At least 90% of families that are given a sleep sack at newborn to 2 month visits will have documentation of use at subsequent visits through 12 months of age through the end of the project in November 2015.

Methodology:

Pediatricians nationwide provide families with injury prevention (IP) anticipatory guidance (AG) at well child visits, yet many lack training and confidence. If they could provide IP AG in less time, were educated on how best to inform, and were given safety products (sleep sacks) for families, they might be able to discuss IP more effectively. Quality improvement (QI) programs are respected, highly effective approaches to training physicians. QI models not only provide knowledge and education, they can actively change physicians' behavior and play a significant role in facilitating organizational improvement through outcomes. Once a process is put into place, such as IP AG with a safety product, improvements can be measured by looking at long-term evaluation data on the reduction of injuries to children. The Ohio AAP has developed a two-part IP Screening Tool. Primary care practices are recruited to implement the tool in their offices. Parents complete surveys at well child visits from birth through the first year; physicians then provide targeted IP AG and measurably increase each parent's injury-related conversations with the physician. The surveys ask questions about IP and encourage parents to ask the physician questions relevant to their personal interests and concerns. Data on these conversations and changes made by parents as a result is tracked. Combining a QI model, safety products, and IP AG may increase the number of families that practice safer behaviors.

Coordination:

Nationwide Children's Hospital and Cincinnati Children's Hospital Medical Center (Employers of Medical Directors); Building Blocks Pediatrics, Children's Medical Center, Cornerstone Pediatrics, Elm Street Health Center, Grove City Family Health, Maternal Child Health Clinic, NHA Pediatrics, Rainbow Pediatrics (QI Participating Practices); Ohio Children's Trust Fund (Funded Safety Products); Krile Communications (Project Marketing); Ohio Department of Health (Developed Public Information Materials).

Evaluation:

Over 8 months teams will report data on the management of injury prevention in patients 1 year of age and younger at all well child visits by using a parental self-reporting screening tool. The first month will be baseline data and additional months track changes by randomly reviewing at least 10 charts per provider. Data is shared project-wide monthly. Repeat use of the same screening tool allows for measuring behavior change following anticipatory guidance at past well child visits.

Experience to Date:

The Ohio AAP recruited 7 primary care practices from throughout Ohio, including urban and suburban practices, and private and hospitalaffiliated practices, for participation in Wave 2 of the IPLC. All practices came together for a Learning Session on October 18, during which participating practitioners were provided training on QI techniques, using the revised screening tools, and discussing injury topics with families based on the results of the screening tools. The Learning Collaborative continued to meet monthly through action period calls through May 2014. Changes to screening tools following the pilot wave allowed for tracking of parental behavior change in Wave 2; this showed significant improvements in self-reported behavior as a result of the project. Prior to Wave 3, the screening tools were tested for reliability, and found to be highly reliable when completed by the same caregiver. Wave 3 maintains much of Wave 2's operations, but focuses on incorporating practices from outside Ohio into the project; recruitment yielded a total of 15 practices from 5 states, which attended a Learning Session on March 19, 2015 (either in person or electronically). During the project sleep sacks are also distributed at the newborn and 2-month well child visits. The Ohio AAP introduced a hospital-based safe sleep modeling QI project, enrolling a total of 12 hospitals through 2016, and media campaign that has made over 21 million impressions, to compliment the results of the IPLC.