A report suggests that the $2.5 billion program should focus more on continuous improvement than on scattershot activities.

Supporters of the bill say it would extend critical civil rights protections to more students. But opponents say it ignores parents' rights in schools and could lead to confusing situations for some children.

Are you smarter than a teacher in 1966? Take this real test, taken from the "Equality of Educational Opportunity" report, to find out how you fare.

This week, you'll hear from guest blogger and longtime reader favorite Heather Harding. Heather kicks off the week by discussing reforms to identify, retain, and prepare high-quality teachers—and why it's still important that we pay attention to these things.

The quality of the relationship between mother and child affects the child’s neurodevelopment, emotion regulation, and stress response. Extreme or sustained stress responses are associated with dysregulation of physiologic systems involved in energy balance, which could lead to obesity.

The prevalence of obesity in adolescence was more than twice as high among those youth who in early childhood had poor-quality relationships with their mothers compared with those with better relationships. (Read the full article)

Studies of the association between process and outcome measures of the quality of acute asthma care for children have been mixed. These studies are limited by small, single-institution settings or by examining the association at the aggregate level.

This first multicenter analysis of the process-outcome association in acute asthma care for children revealed no association. Because the validity of process measures depends on association with outcomes, further study is needed before implementing existing process measures as performance metrics. (Read the full article)

There are known gaps in quality measures for children. More clinical effectiveness research is needed. The patient-centered medical home may serve as a model to guide the development of quality measures, particularly for children with complex medical conditions.

This study combined systematic literature review and the Rand/University of California Los Angeles appropriateness method to develop quality measures for children with complex medical conditions. These are valid and feasible quality measures based on the patient-centered medical home framework that may be used to assess care. (Read the full article)

Comprehensive home visits conducted by Community Health Workers including environmental remediation and office-based nurse case management improve asthma outcomes.

Implementation of a comprehensive quality improvement program as part of enhanced care of pediatric asthma patients with a history of hospitalizations or emergency department visits can improve health outcomes and be cost-effective as well as reduce health disparities. (Read the full article)

Although developmental care in NICUs reduces the stress experienced by preterm infants, the actual level of developmental care may vary and little is known about how the level of developmental care relates to preterm infants’ neurobehavioral performance.

The study demonstrates the relationship between variations in developmental care in NICUs and the neurobehavior of preterm infants. Infants from NICUs with high-quality developmental care compared with infants from units with low quality of care evidenced a better neurobehavioral profile. (Read the full article)

There are limited cross-sectional data from observational studies of adolescents showing that regular participation in physical activity is associated with a higher quality of life status, whereas time spent in screen-based entertainment is associated with a poorer quality of life.

Adolescents who were physically active (particularly engaging in outdoor activity) over a 5-year period had higher quality of life than their less active peers. Conversely, high levels of screen-based entertainment over 5 years negatively affected quality of life status. (Read the full article)

Honey is recommended as a cough medication by the World Health Organization. To date, the efficacy of this treatment has been shown in 2 studies: one tested only buckwheat honey and the other study was not blinded.

In a randomized controlled trial, we compared 3 types of honey versus placebo as a treatment of upper respiratory tract infection–associated cough. These types of honey were superior to placebo in alleviating cough. (Read the full article)

The importance of and interest in childhood mental problems have increased worldwide. There are few population studies on child and adolescent mental health and health-related quality of life (HRQoL).

A social gradient was found in childhood mental health according to maternal education level and social class, but none was found in HRQoL, although children from disadvantaged social classes had somewhat lower HRQoL scores than their more advantaged counterparts. (Read the full article)

Asthma is a major reason for pediatric hospital admission. The Joint Commission requires freestanding children’s hospitals to report compliance with 3 Children’s Asthma Care quality measures. High compliance with these measures should result in decreased admissions and emergency department visits.

Implementation of a standardized care process model for hospitalized asthmatic children resulted in high compliance with all 3 measures. Measures 1 and 2 did not provide an opportunity for improvement. Compliance with measure 3 resulted in significant decreases in readmission. (Read the full article)

Medical advances have prolonged life for children and adolescents with Duchenne muscular dystrophy (DMD), the most common inherited pediatric neuromuscular disorder. Children with this progressive disease surviving to adulthood still face significant threats to their quality of life.

Self-reported psychosocial quality of life was impaired in a significant number (57%) of boys with DMD, unrelated to their need for mobility aids. Concordance between the perceptions of parents and their sons related to psychosocial functioning was fair to poor. (Read the full article)

The effect of substandard housing on children’s risk of diseases such as asthma has been studied; little is known about how it affects child injury risk. Pediatricians actively promote injury prevention but typically without regard to housing quality.

Low-income children are likely living in substandard homes, which is significantly associated with not having working smoke alarms and safe hot water temperatures. Pediatricians can use these results to inform anticipatory guidance. (Read the full article)

The medical home likely plays a positive role in outpatient health outcomes. Asthma is a common and frequent reason for pediatric hospitalization. It is unknown whether having a quality medical home can prevent readmission in children hospitalized for asthma exacerbations.

Poor access to a medical home was associated with increased readmission for asthma, whereas other measured aspects of medical home were not. Children with private insurance and good access to care had the lowest rates of readmission within a year. (Read the full article)

Previous studies suggest that hospitals under the greatest financial strain may be more prone to adverse events because they have limited resources to invest in quality and safety.

The patient population served, rather than hospital category, best predicts measured quality, underscoring the need for robust risk adjustment when incentivizing quality or comparing hospitals. Thus, problems of quality may not be systemic across hospital categories. (Read the full article)

Quality urban playgrounds that are accessible and safe support physical activity and decrease injury rates. Little is known about the quality and accessibility of playgrounds in Chicago public parks.

Most playgrounds in Chicago are in fair condition, yet access to quality playgrounds varies by neighborhood. Public/private collaboration can lead to improved playgrounds, and failing playgrounds can be improved with modest investment. (Read the full article)

Rapid initiation of effective chest compressions (CCs) for patients in cardiac arrest improves outcomes, yet even trained rescuers fail to provide consistently effective CCs. Pediatric data on CC quality and objective measures of CC work are limited.

CC quality deteriorates similarly in pediatric and adult models, and overall work done to compress the pediatric chest is similar to that in adults. Power output during CC performance is analogous to that generated during intense exercise such as running. (Read the full article)

Of more than 2 million children infected with HIV, almost 90% live in resource-limited settings where pediatric HIV care is often suboptimal. Implementing electronic health records with computerized decision support offers a potential tool for improving care.

This randomized, controlled trial demonstrates that computer-generated clinical reminders can significantly improve clinician compliance with HIV care guidelines for children in a resource-limited setting. This intervention is scalable as developing countries implement electronic health record systems. (Read the full article)

The Supplemental Nutrition Assistance Program (SNAP) is the largest federal nutrition assistance program. Studies among adults suggest that SNAP participation may be associated with suboptimal diets. Few studies have extensively examined these associations among children.

SNAP participation was not associated with childhood obesity. SNAP children consumed diets poorer in some aspects than nonparticipants, but intake of some micronutrients was higher. The diets of both groups of low-income children were far from meeting dietary guidelines. (Read the full article)

In the only previous cross-sectional study, the quality of pediatric guidelines was rated low on the AGREE-II (Appraisal of Guidelines for Research and Evaluation II) scale. The levels of evidence used in pediatric clinical practice guidelines have never been described.

American Academy of Pediatrics guidelines score low on the AGREE-II scale. Approximately one-quarter of recommendations are based on expert opinion or no reference. These findings support the adoption of standards for guideline development and research targeted toward unsupported recommendations. (Read the full article)

Readmissions have been identified as a priority area for pediatric inpatient quality measurement nationally. However, it is unknown whether readmission rates vary meaningfully across hospitals and how many hospitals would be identified as high- or low-performers.

Only a few hospitals that care for children are high- or low-performers when their condition-specific revisit rates are compared with average rates across hospitals. This limits the usefulness of condition-specific readmission or revisit measures in pediatric quality measurement. (Read the full article)

Payment arrangements that blend global budgets with pay-for-performance are proliferating. However, little is known about how these contracts affect pediatric health care quality and spending for children with and without special health care needs receiving care from large provider organizations.

A prototypical global budget contract significantly improved preventive care quality measures tied to pay-for-performance, especially for children with special health care needs. It did not alter trends for spending or for quality measures that were not tied to pay-for-performance. (Read the full article)

Tonsillectomy is one of the most commonly performed surgeries in children and is one of the most cumulatively expensive conditions in pediatric hospital care. Little is known about how the quality of tonsillectomy care varies across hospitals.

In a large cohort of low-risk children undergoing same-day tonsillectomy, there was substantial variation in quality measures of process, dexamethasone and antibiotic use, and outcome, revisits to the hospital within the first 30 days after surgery. (Read the full article)

Income inequality is positively associated with several adverse child health and well-being outcomes. There is no existing research investigating the relationship between income inequality and child maltreatment rates.

This study is the first to demonstrate that increases in income inequality are associated with increases in child maltreatment rates at the county level. (Read the full article)

Existing literature indicates relationships between BMI, physical activity, sleep patterns, eating behavior, and health-related quality of life in children and adolescents. However, many previous studies have used non–preference-based instruments, which are not suitable for application within economic evaluation.

The Child Health Utility 9D, a new preference-based health-related quality of life instrument for application in economic evaluation in children and adolescents, revealed stronger associations between utilities and sleep patterns or eating behavior than with BMI, physical activity, or sedentary behavior. (Read the full article)

Initial studies in children and young adults have identified higher levels of anxiety and lower quality of life scores in patients with implantable cardioverter–defibrillators. Few studies are available looking at the same questions in young patients with pacemakers.

Anxiety is highly prevalent in young patients with ICDs, but the higher rates can be attributed to medical disease severity and age at implantation rather than type of device. Patients with pacemakers have depression and anxiety but at lower rates. (Read the full article)

Administrative health insurance claims have limitations when measuring care quality.

Children’s care quality measures assessed using administrative claims alone may not accurately reflect care quality. Use of electronic health record data in combination with administrative claims data provides an opportunity for more complete measurement. (Read the full article)

The traditional process-focused approach to quality improvement has not remedied NICUs’ inconsistency in quality of care delivery across clinically important measures. Global measurement of quality may induce broad, systems-based improvement, but must be formally studied.

We present a systematically developed and robust composite indicator, the Baby-MONITOR, to assess the quality of care delivered to very low birth weight infants in the NICU setting. (Read the full article)

Quality improvement (QI) studies generally do not account for concurrent trends of improvement and it is difficult to distinguish the impact of a multihospital collaborative QI project without a contemporary control group.

A multihospital collaborative QI model led to greater declines in hypothermia and invasive ventilation rates in the delivery room compared with an individual NICU QI model and NICUs that did not participate in formal QI activities. (Read the full article)

American Public Health Association reported >3.2 million students in the United States are bullied each year; 160 000 students skip school every day for fear of bullying. Little is known about whether bullying affects health-related quality of life (HRQOL) among college students.

Different types of bullying experiences affected different domains of HRQOL. Precollege bullying had long-term effects on HRQOL. Verbal/relational bullying-victimization experiences, mediated via depression, affected psychological HRQOL. Findings inform preventive and clinical practice to ameliorate the impact of bullying. (Read the full article)

Pediatric obstructive sleep apnea syndrome (OSAS) has been associated with decreased health-related quality of life (QoL). Observational studies suggest that adenotonsillectomy for pediatric OSAS improves QoL, but these studies did not use a randomized study design or a control group of children with OSAS managed nonsurgically.

A prospective, randomized controlled study of adenotonsillectomy for pediatric OSAS showed significantly greater QoL and symptom improvements in children undergoing adenotonsillectomy than in the nonsurgical control arm. The extent of improvement was not appreciably influenced by baseline OSAS severity or obesity. (Read the full article)

Application of antenatal corticosteroids to mothers before delivery is highly beneficial to very low birth weight infants. Yet despite widespread quality improvement efforts, many eligible infants fail to receive this therapy.

We demonstrate improvement in antenatal corticosteroid use during the study period. However, significant regional variation persists, which network-level quality improvement efforts might help eliminate. (Read the full article)

Accountable care organizations are expanding. In pediatrics, however, there is no information on cost savings or quality generated by such organizations.

Partners for Kids is a pediatric accountable care organization that increased value for Medicaid children in 34 Ohio counties, primarily through cost savings. This slowing in cost growth was achieved without diminishing the overall quality or outcomes of care. (Read the full article)

Patients with sickle cell disease frequently express dissatisfaction with emergency department treatment of painful crises. Time to opioid administration has been suggested as a quality of care measure for painful crises.

Although not associated with hospital admission, time to opioid administration in sickle cell disease painful crises was associated with secondary outcomes including improvement between the first 2 pain scores, decreased pain score area under the curve at 4 hours, decreased emergency department length of stay, and increased total opioids. (Read the full article)

Hospital quality-of-care measures are publicly reported to inform consumer choice and stimulate quality improvement. The number of hospitals and states with a sufficient number of pediatric hospital discharges to detect worse-than-average pediatric inpatient care quality remains unknown.

Most children are admitted to hospitals in which all-condition measures of inpatient quality are powered to show differences in performance from average, but most condition-specific measures are not. Policy on incentives for pediatric inpatient quality should take these findings into account. (Read the full article)

Digital curricula repositories are helping to fill the growing need for more and better multimedia content.

This interactive map offers a quick way to examine state-by-state grades and summary data.

There’s always been massive inequality in South Africa, but those who have the money and power still aren’t getting it, says Carmen Williams.

New research has found that inequality in SA has increased, with wealth becoming ever more concentrated among the rich.

When Celtic arrived home after their defeat by Feyenoord on May 6, 1970, everyone at Parkhead was understandably deflated, while the fans were in mourning for the lost chance of glory.

Jeffrey D. Horbar
Jan 1, 2001; 107:14-22
ARTICLES

Apple's new $4,999 Pro Display XDR monitor (and its $1,000 stand) may sound mighty expensive on the surface. It has the potential to upend a whole industry, however—it's made to compete with panels five to ten times the price. We have one in-house, and here are our first impressions.

The detrimental impact of Covid-19 and the lockdown measures imposed on people across Scotland is to be investigated by MSPs.

The majority of pediatric hospitalization costs are associated with the room; improvement projects that address room costs could have the most financial impact.

OM Chile celebrates Christmas with the boys and girls of two children's homes in Santiago.

Delaware timber harvests achieved a 93 percent rate of compliance with best management practices (BMPs) designed to protect water quality and limit soil erosion, according to a new report. Dr. Anne Hairston-Strang, a forest hydrologist with the Maryland DNR Forest Service, assessed the use and effectiveness of BMPs by surveying a total of 72 sites in Maryland and Delaware from 2014 to 2016. Selected sites were locations with waterway crossings and buffers with the greatest potential for water quality impacts. Effects were expected to be larger than normal because high rainfall during the 2014-2016 period represented an increase of 20 percent above the 30-year average. Final data indicated that the average sediment delivery across all locations was less than one cubic foot per site—indicating that proper use of BMPs was successful at protecting water quality during harvest operations.

Order will create subcommittee focused on bettering health care spending, quality across the state WILMINGTON, Del. – Governor Carney on Tuesday signed Executive Order #25 establishing health care spending and quality benchmarks. This Executive Order will form a subcommittee of the Delaware Economic and Financial Advisory Council to focus on reducing the cost of health […]

NEW CASTLE (Sept. 3, 2019) – Department of Health and Social Services (DHSS) Secretary Dr. Kara Walker announced the appointment of Yrene Waldron, former Executive Director of the Delaware Health Care Facilities Association, to lead the Division of Health Care Quality. She will begin her duties Sept. 16. “I am thrilled that Yrene is joining […]