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Child & Adolescent Health

Stewardship program improves antimicrobial use among hospitalized children.

Use of an antimicrobial stewardship program (ASP)—in which an infectious disease consultant controls use of antimicrobials (antibiotics, antifungals, and antivirals) by hospital staff—can improve the appropriate use of these agents, according to this study. During the 4-month study period, physicians placed 652 calls to the ASP at one children’s hospital. Nearly half of the calls required an intervention by the ASP to resolve drug-bug mismatches, minimize unnecessary use of broad spectrum antibiotics, prevent duplicate therapy, and improve dosing. Metjian, Prasad, Kogon, et al., Pediatr Infect Dis J 27(2):106-111, 2008 (AHRQ grant HS10399).

Routine screening is the best way to detect the majority of Chlamydia infections in adolescent girls.

Untreated Chlamydia trachomatis (CT) infections can lead to pelvic inflammatory disease, ectopic pregnancy, and infertility. Despite recommendations for annual screening, screening rates remain low among all sexually active adolescents and young adults under age 26. Since there usually are no symptoms with these infections, screening is the only way to detect them. These researchers describe an intervention in a California HMO that improved CT screening during urgent care. As a result of the intervention, the change in the proportion of adolescent girls screened for CT increased by almost 16 percent in the five intervention clinics compared with a decrease of 2 percent in the comparison clinics. Tebb, Wibbelsman, Neuhaus, and Shafer, Arch Pediatr Adolesc Med 163(6):559-564, 2009 (AHRQ grant HS10537).

Hospital rates for intussusception declined 25 percent from 1993 to 2004.

Rotavirus is the most common cause of severe gastroenteritis in young children, and a new rotavirus vaccine was introduced in 2006. A previous vaccine was withdrawn in 1999 after it was associated with intussusception in infants. Researchers compared annual intussusception hospitalization rates before and after introduction of the new vaccine, and found that the rates have remained stable since 2000, with about 35 cases per 100,000 infants. They note that the downward trend might reflect a true reduction in the incidence of severe intussusceptions, but it also could reflect changes in medical management that do not require hospitalization. Tate, Simonsen, Viboud, et al., Pediatrics 121, 2008 (AHRQ Publication No. 08-R071)* (Intramural).

Parental visits to preventive health Web sites may enhance preventive care provided to children.

Due to time and other constraints, pediatricians spend less than 10 minutes of well-child visits discussing preventive care. This study found that access to a prevention-focused Web site can prompt parents to bring up prevention topics with their child’s provider during well-child visits and also can increase parental and physician adoption of preventive measures. Christakis, Zimmerman, Rivara, and Ebel, Pediatrics 118(3):1157-1166, 2006 (AHRQ grant HS13302).

Distance-based quality improvement approach shows promise for improving pediatric immunization rates.

Researchers randomly assigned 29 pediatric research network-based practices into year-long paper-based education or distance-based QI groups to examine differences in immunization rates at the end of the year. Baseline immunization rates of 88 percent or less for children aged 8 to 15 months were similar for the two groups. Practices in the paper-based group received only mailed educational materials. Those in the distance-based group participated in monthly conference calls, logged into E-mail discussion groups, and made use of a Web site that shares best practices and other information. Pediatricians in the QI group boosted their immunization rates by 4.9 percent compared with 0.8 percent for the paper-based education group. Slora, Steffes, Harris, et al., Clin Pediatr 47(1):25-36, 2008 (AHRQ grant HS13512).


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