Abstract：
OBJECTIVE:Diagnostic errors (DEs), which encompass failures of accuracy, timeliness, or patient communication, cause appreciable morbidity but are understudied in pediatrics. Pediatricians have expressed interest in reducing high-frequency/subacute DEs, but their epidemiology remains unknown. The objective of this study was to investigate the frequency of two high-frequency/subacute DEs and one missed opportunity for diagnosis (MOD) in primary care pediatrics. METHODS:As part of a national quality improvement collaborative, 25 primary care pediatric practices were randomized to collect 5 months of retrospective data on one DE or MOD: elevated blood pressure (BP) and abnormal laboratory values (DEs), or adolescent depression evaluation (MOD). Relationships between DE or MOD proportions and patient age, gender, and insurance status were explored with mixed-effects logistic regression models. RESULTS:DE or MOD rates in pediatric primary care were found to be 54% for patients with elevated BP (n = 389), 11% for patients with abnormal laboratory values (n = 381), and 62% for adolescents with an opportunity to evaluate for depression (n = 400). When examining the number of times a pediatrician may have recognized an abnormal condition but either knowingly or unknowingly did not act according to recommended guidelines, providers did not document recognition of an elevated BP in 51% of patients with elevated BP, and they did not document recognition of an abnormal laboratory value without a delay in 9% of patients with abnormal laboratory values. CONCLUSIONS:DEs and MODs occur at an appreciable frequency in pediatric primary care. These errors may contribute to care delays and patient harm.
journal_name
Acad Pediatrjournal_title
Academic pediatricsauthors
Rinke ML,Singh H,Heo M,Adelman JS,O'Donnell HC,Choi SJ,Norton A,Stein REK,Brady TM,Lehmann CU,Kairys SW,Rice-Conboy E,Thiessen K,Bundy DGdoi
10.1016/j.acap.2017.08.005subject
Has Abstractpub_date
2018-03-01 00:00:00pages
220-227issue
2eissn
1876-2859issn
1876-2867pii
S1876-2859(17)30463-1journal_volume
18pub_type
杂志文章abstract：OBJECTIVE:The aim of this study was to determine the percentage of hospitals with adequate sample size to meaningfully compare performance by using the Agency for Healthcare Research and Quality (AHRQ) pediatric quality indicators (PDIs), which measure pediatric inpatient adverse events such as decubitus ulcer rate and...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2010.04.025
更新日期：2010-07-01 00:00:00
abstract：OBJECTIVE:Unhealthy behaviors are a major cause of chronic disease. Preappointment screening has been suggested as one way to improve preventive care delivery related to these behaviors by specifying risks to be addressed. We aimed to determine whether screening for health-related behaviors before the clinical encounte...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2018.01.008
更新日期：2018-01-01 00:00:00
abstract：BACKGROUND:Provider elicitation of parent developmental and behavioral (DB) concerns is the foundation of DB surveillance. Language differences may affect whether providers assess parental DB concerns. OBJECTIVE:The aim of this study was to compare children in English versus Spanish primary language households by risk...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2008.12.006
更新日期：2009-03-01 00:00:00
abstract：OBJECTIVE:A cluster randomized trial was performed to evaluate an educational intervention to improve parental attitudes and vaccine uptake in vaccine-hesitant parents. METHODS:Two primary care sites were randomized to provide families with either usual care or an intervention (video and written information) for vacci...
journal_title：Academic pediatrics
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.acap.2013.03.011
更新日期：2013-09-01 00:00:00
abstract：OBJECTIVE:The objective of this study is to provide a comprehensive epidemiological profile detailing food allergy (FA) prevalence and related correlates among Medicaid-enrolled children. METHODS:The 2012 Medicaid Analytic eXtract person-level 100% files for 50 states and the District of Columbia were analyzed. The an...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2020.03.005
更新日期：2021-01-01 00:00:00
abstract：OBJECTIVE:To estimate the prevalence of use of fetal-harm drugs among women who received postpartum care in hospitals in Haiti and to identify groups of women at higher risk for potentially harmful medication exposures. METHODS:Women who received postpartum care in 2 large hospitals in Port-au-Prince, Haiti, from Augu...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2010.09.003
更新日期：2010-11-01 00:00:00
abstract：OBJECTIVE:To determine if parents' self-efficacy in communicating with their child's pediatrician is associated with African American mothers' disclosure of psychosocial concerns during pediatric primary care visits. METHODS:Self-identified African American mothers (n = 231) of children 2 to 5 years were recruited fro...
journal_title：Academic pediatrics
pub_type： 杂志文章,多中心研究
doi：10.1016/j.acap.2014.03.002
更新日期：2014-07-01 00:00:00
abstract：BACKGROUND:Novel approaches to reduce sugar-sweetened beverage (SSB) consumption during the first 1000 days-pregnancy through age 2 years-are urgently needed. OBJECTIVE:To examine perceptions of SSB consumption and acceptability of potential intervention strategies to promote SSB avoidance in low-income families in th...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2019.01.004
更新日期：2019-01-01 00:00:00
abstract：:Neonatal intensive care unit networks that encompass regions, states, and even entire countries offer the perfect platform for implementing continuous quality improvement initiatives to advance the health care provided to vulnerable neonates. Through cycles of identification and implementation of best available eviden...
journal_title：Academic pediatrics
pub_type： 杂志文章,评审
doi：10.1016/j.acap.2013.04.014
更新日期：2013-11-01 00:00:00
abstract：:Though the use of mobile devices (e.g., tablets, smartphones) by young children is pervasive and increasing, research relating children's use of mobile devices to their development is only beginning to emerge. Learning, language development, and self-regulation skills among children aged zero to five are of particular...
journal_title：Academic pediatrics
pub_type： 杂志文章,评审
doi：10.1016/j.acap.2021.01.007
更新日期：2021-01-21 00:00:00
abstract：:Population health is associated with the socioeconomic characteristics of neighborhoods. There is considerable scientific and policy interest in community-level interventions to alleviate child poverty. Intergenerational poverty is associated with inequitable access to opportunities. Improving opportunity structures w...
journal_title：Academic pediatrics
pub_type： 杂志文章,评审
doi：10.1016/j.acap.2016.01.013
更新日期：2016-04-01 00:00:00
abstract：:The effect of child poverty and related early life experiences on adult health outcomes and patterns of aging has become a central focus of child health research and advocacy. In this article a critical review of this proliferating literature and its relevance to child health programs and policy are presented. This li...
journal_title：Academic pediatrics
pub_type： 杂志文章,评审
doi：10.1016/j.acap.2016.01.014
更新日期：2016-04-01 00:00:00
abstract：:All medical educators have experienced "teachable moments" during their career, and most can likely share examples of these moments from both training and their role as educators. In addition, most if not all have faced a situation in which an educational opportunity fell short or was missed entirely. This View from t...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2020.08.011
更新日期：2020-08-20 00:00:00
abstract：OBJECTIVE:The number of pediatric Global Health (GH) tracks has more than doubled in less than 10 years. The goal of this study was to describe the characteristics of the pediatric GH tracks to identify commonalities and differences in track structure, funding, and education. In addition, we also identified demographic...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2018.03.009
更新日期：2018-08-01 00:00:00
abstract：OBJECTIVE:To examine general dental and orthodontic utilization and expenditures by health insurance status, public health insurance eligibility, and sociodemographic characteristics among children aged 0 to 17 years using data from 2010-2012. METHODS:Nationally representative data from the Medical Expenditure Panel S...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2016.02.013
更新日期：2016-05-01 00:00:00
abstract：:Over the past 30 years, there have been major expansions in public health insurance for low-income children in the United States through Medicaid, the Children's Health Insurance Program (CHIP), and other state-based efforts. In addition, many low-income parents have gained Medicaid coverage since 2014 under the Affor...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2015.12.011
更新日期：2016-04-01 00:00:00
abstract：OBJECTIVE:To describe the delivery of well-child care and its components; to compare that delivery with recommendations in Bright Futures; and to compare delivery of well-child care for children with special health care needs with that for children without special needs. METHODS:Over a 10-week period, 2 medical studen...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2010.12.008
更新日期：2011-01-01 00:00:00
abstract：BACKGROUND:Picky eating is common in children. Few studies have examined predictors of picky eating, and the association of picky eating with weight status and dietary quality is inconsistent in the literature. We aimed to identify predictors of picky eating and to test the association of picky eating with child body m...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2017.08.014
更新日期：2018-04-01 00:00:00
abstract：OBJECTIVE:To evaluate how parents and physicians perceive the utility of a comprehensive, electronic previsit screener, and to assess its impact on the visit. METHODS:A mixed methods design was used. English-speaking parents were recruited from 3 primary care systems (urban MD and rural NY and VT) when they presented ...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2013.04.005
更新日期：2013-07-01 00:00:00
abstract：OBJECTIVE:We examined changes in insurance coverage and health care utilization associated with the Affordable Care Act (ACA) among subgroups of Asian youth relative to non-Latino white youth. METHODS:Data were from the 2010 to 2017 American Community Survey and National Health Interview Survey. Difference-in-differen...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2019.11.004
更新日期：2020-07-01 00:00:00
abstract：OBJECTIVE:Primary care providers (PCPs) and hospitalists endorse the importance of effective communication yet studies illustrate critical communication problems between these 2 provider types. Our objective was to develop deeper insight into the dimensions of and underlying reasons for communication issues and determi...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2016.03.003
更新日期：2016-07-01 00:00:00
abstract：:Electronic medical records (EMRs) are increasingly common in pediatric patient care. EMR data represent a relatively novel and rich resource for clinical research. The fact, however, that pediatric EMR data are collected for the purposes of clinical documentation and billing rather than research creates obstacles to t...
journal_title：Academic pediatrics
pub_type： 杂志文章,评审
doi：10.1016/j.acap.2011.02.007
更新日期：2011-07-01 00:00:00
abstract：OBJECTIVE:To determine pediatric resident training and preparation for 14 Accreditation Council for Graduate Medical Education (ACGME)-required procedures. METHODS:We included a national, random sample of 1000 graduating pediatric residents in 2015. For each of the ACGME-required procedures, residents were asked if th...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2017.08.001
更新日期：2018-01-01 00:00:00
abstract：OBJECTIVE:The stress associated with adverse childhood experiences (ACEs) has immediate and long-lasting effects. The objectives of this study were to examine 1) how often pediatricians ask patients' families about ACEs, 2) how familiar pediatricians are with the original ACE study, and 3) physician/practice characteri...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2015.08.002
更新日期：2016-03-01 00:00:00
abstract：OBJECTIVE:To develop and validate a computable phenotype algorithm for identifying patient populations with sickle cell disease. METHODS:In this retrospective study we used electronic health record data from the Children's Hospital of Wisconsin to develop a computable phenotype algorithm for sickle cell disease. The a...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2016.12.005
更新日期：2017-04-01 00:00:00
abstract：:Management of referral and consultation is an entrustable professional activity for pediatric residents; however, few tools exist to teach these skills. We designed and implemented tools to prompt discussion, feedback, and reflection about the process of referral, notably including the family's perspective. ...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2018.01.010
更新日期：2018-04-01 00:00:00
abstract：OBJECTIVE:We aimed to examine abusive head trauma (AHT) incidence before, during and after the recession of 2007-2009 in 3 US regions and assess the association of economic measures with AHT incidence. METHODS:Data for children <5 years old diagnosed with AHT between January 1, 2004, and December 31, 2012, in 3 region...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2015.05.008
更新日期：2016-04-01 00:00:00
abstract：OBJECTIVE:Reach Out and Read (ROR) is a primary care-based intervention supported by considerable evidence regarding its efficacy. Implementation of ROR, however, varies across participating sites. The objective of this study was to identify practice attributes associated with variability in ROR implementation. METHOD...
journal_title：Academic pediatrics
pub_type： 杂志文章,多中心研究
doi：10.1016/j.acap.2008.10.004
更新日期：2009-01-01 00:00:00
abstract：:Primary care pediatricians and psychology practitioners who comanage mental health problems can develop interdisciplinary communication and collaborative skills from joint standardized patient encounters and debriefings, combined with brief didactics. Learners showed increased confidence in shared management of behavi...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2017.06.014
更新日期：2018-01-01 00:00:00
abstract：OBJECTIVE:To explore the potential benefits and challenges of involving adolescents in the education of medical students and residents from the perspectives of adolescents who are hospitalized with chronic health conditions. METHODS:We conducted qualitative interviews with adolescents at a Canadian pediatric hospital....
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2018.05.007
更新日期：2019-01-01 00:00:00
