• health care
• scientific community

• Neonatology/standards
• Neonatology/organization & administration
• Humans
• Quality Improvement/organization & administration
• Infant, Newborn
• United States
• Cooperative Behavior

• Care models
• Co-management
• Medical careers
• Medical education
• Pediatric urology
• Pediatrics

• Humans
• Retrospective Studies
• Child
• Urology/education
• Urologic Diseases/therapy
• Pediatrics/education
• Male
• Female
• Curriculum
• Quality Improvement
• Urologists/education
• Fellowships and Scholarships
• Pilot Projects
• Canada

• Humans
• Child
• Arthritis, Juvenile/therapy
• Arthritis, Juvenile/drug therapy
• Rheumatology/methods
• Antirheumatic Agents/therapeutic use
• Quality Indicators, Health Care
• Outcome Assessment, Health Care

• AHRQ U19-HS-021114 ARTHFN
• AHRQ U19-HS-021114 ARTHFN
• RI-PCC-2017 Patient-Centered Outcomes Research Institute

• Humans
• Bipolar Disorder/therapy
• Bipolar Disorder/psychology
• Longitudinal Studies

• bloodstream infection
• mortality
• oncology
• pediatrics
• stem cell transplantation

• Discrimination
• developmental screening
• health care
• parent
• sexual and gender minority

• Female
• Child
• United States/epidemiology
• Humans
• Transgender Persons
• Developmental Disabilities/epidemiology
• Sexual and Gender Minorities
• Parents
• Healthcare Disparities
• Male

A surgical site infection (SSI) is an infection that occurs in the incision created by an invasive surgical procedure. Although most infections are treatable with antibiotics, SSIs remain a significant cause of morbidity and mortality after surgery and have a significant economic impact on health systems. Preventive measures are essential to decrease the incidence of SSIs and antibiotic abuse, but data in the literature regarding risk factors for SSIs in the pediatric age group are scarce, and current guidelines for the prevention of the risk of developing SSIs are mainly focused on the adult population. This document describes the current knowledge on risk factors for SSIs in neonates and children undergoing surgery and has the purpose of providing guidance to health care professionals for the prevention of SSIs in this population. Our aim is to consider the possible non-pharmacological measures that can be adopted to prevent SSIs. To our knowledge, this is the first study to provide recommendations based on a careful review of the available scientific evidence for the non-pharmacological prevention of SSIs in neonates and children. The specific scenarios developed are intended to guide the healthcare professional in practice to ensure standardized management of the neonatal and pediatric patients, decrease the incidence of SSIs and reduce antibiotic abuse.

• COVID-19
• Community networks
• community-based participatory research
• partnerships

Evidence for the central line-associated bloodstream infection (CLABSI) bundle effectiveness remains mixed, possibly reflecting implementation challenges and persistent ambiguities in how CLABSIs are counted and bundle adherence measured. In the context of a tertiary pediatric hospital that had reduced CLABSI by 30% as part of an international safety program, we aimed to examine unit-based socio-cultural factors influencing bundle practices and measurement, and how they come to be recognized and attended to by safety leaders over time in an organization-wide bundle implementation effort.

We used an interpretivist qualitative research approach, based on 74 interviews, approximately 50 h of observations, and documents. Data collection focused on hospital executives and safety leadership, and three clinical units: a medical specialty unit, an intensive care unit, and a surgical unit. We used thematic analysis and constant comparison methods for data analysis.

Participants had variable beliefs about the central-line bundle as a quality improvement priority based on their professional roles and experiences and unit setting, which influenced their responses. Nursing leaders were particularly concerned about CLABSI being one of an overwhelming number of QI targets for which they were responsible. Bundle implementation strategies were initially reliant on unit-based nurse education. Over time there was recognition of the need for centralized education and reinforcement tactics. However, these interventions achieved limited impact given the influence of competing unit workflow demands and professional roles, interactions, and routines, which were variably targeted in the safety program. The auditing process, initially a responsibility of units, was performed in different ways based on individuals’ approaches to the process. Given concerns about auditing reliability, a centralized approach was implemented, which continued to have its own variability.

Our findings report on a contextualized, dynamic implementation approach that required movement between centralized and unit-based approaches and from a focus on standardization to some recognition of a role for customization. However, some factors related to bundle compliance and measurement remain unaddressed, including harder to change socio-cultural factors likely important to sustainability of the CLABSI reductions and fostering further improvements across a broader safety agenda.

• Central-line bundle
• Central-line-associated bloodstream infections
• Implementation
• Patient safety
• Qualitative research

Background and Aims: Intensifying therapy for Paediatric Crohn's Disease (CD) by early use of immunomodulators and biologics has been proposed for cases in which predictors of poor outcome (POPO) were present. We investigated therapy stratifying potential comparing POPO-positive and -negative CD patients from CEDATA-GPGE®, a German-Austrian Registry for Paediatric Inflammatory Bowel disease.

Methods: CD patients (1–18 years) registered in CEDATA-GPGE® (2004–2018) within 3 months of diagnosis and at least two follow-up visits were included. Disease course and treatments over time were analysed regarding positivity of POPO criteria and test statistical properties.

Results: 709/1084 patients included had at least one POPO criterion (65.4%): 177 patients (16.3%) had persistent disease (POPO2), 581 (53.6%) extensive disease (POPO3), 21 (1.9%) severe growth retardation POPO4, 47 (4.3%) stricturing/penetrating disease (POPO6) and 122 (11.3%) perianal disease (POPO7). Patients with persistent disease differed significantly in lack of sustained remission >1 year (Odd Ratio (OR) 1.49 [1.07–2.07], p = 0.02), patients with initial growth failure in growth failure at end of observation (OR 51.16 [19.89–131.62], p < 0.0001), patients with stricturing and penetrating disease as well as perianal disease in need for surgery (OR 17.76 [9.39–33.58], p < 0.001; OR 2.56 [1.58–4.15], p < 0.001, respectively). Positive Predictive Value for lack of sustained remission was >60% for patients with initial growth failure, persistent or stricturing/penetrating disease.

Conclusion: Predictors of poor outcome with complicated courses of disease were common in CEDATA-GPGE®. An early intensified approach for paediatric CD patients with POPO-positivity (POPO2-4, 6-7) should be considered, because they have an increased risk to fare poorly.

• big data
• outcome parameters
• patient registry
• pediatric Crohn's disease
• predictors of a poor prognosis

Supplemental Digital Content is available in the text.

Pediatric quality improvement (QI) collaboratives are multisite clinical networks that support cooperative learning. Our goal is to identify the contextual facilitators and barriers to implementing QI resuscitation interventions within a multicenter resuscitation collaborative.

A mixed-methods evaluation of the contextual facilitators and barriers to implementation of a resuscitation QI bundle. We administered a quantitative questionnaire, the Model for Understanding Success in Quality (MUSIQ), to the Pediatric Resuscitation Quality (pediRES-Q) Collaborative. Its primary goal is to optimize the care of children who experience in-hospital cardiac arrest through a resuscitation QI bundle. We also conducted semistructured phone interviews with site primary investigators adapted from the Consolidated Framework for Implementation Research qualitative interview guide.

All 13 actively participating US sites completed the MUSIQ questionnaire. Total MUSIQ scores ranged from 86.0 to 140.5 (median of 118.7, interquartile range 103.6–124.5). Evaluation of the QI team subsection noted a mean score of 5.5 for low implementers and 6.1 for high implementers (P = 0.02). We conducted 8 interviews with the local QI team leadership. Contextual facilitators included a unified institutional approach to QI, a fail forward climate, leadership support, strong microculture, knowledge of other organizations, and prioritization of goals. Contextual barriers included low team tenure, no specific allocation of resources, lack of formalized QI training, and lack of support and buy-in by leaders and staff.

Using mixed methods, we identified an association between the local QI team’s strength and the successful implementation of the QI interventions.

• Overuse
• Parsimonious care
• Patient safety
• Pediatrics
• Stewardship

• child health
• pediatrics
• primary care
• well child care
• wellness

• ACTION Learning Network
• Berlin Heart EXCOR
• pediatric mechanical circulatory support
• post-approval surveillance
• real-world data

• R01 HD094793 NICHD NIH HHS
• R01 HS024538 AHRQ HHS
• R01 HS024713 AHRQ HHS
• T32 HS026121 AHRQ HHS

• organizational studies
• pediatric health care quality
• positive deviance
• qualitative

• Patient Safety
• Pediatrics
• Quality Improvement
• Quality Improvement Collaborative

• P30 CA021765 NCI NIH HHS
• R24 GM115264 NIGMS NIH HHS

Learning Networks are distributed learning health systems that enable collaboration at scale to improve health and health care. A key requirement for such networks is having a way to create and share information and knowledge in furtherance of the work of the community.

We describe a Learning Exchange—a bespoke, scalable knowledge management and exchange platform initially built and tested for improving pediatric inflammatory bowel disease outcomes in the ImproveCareNow (ICN) Network—and assess evidence of its acceptability, feasibility, and utility in facilitating creation and sharing of information in furtherance of the work of the community and as a model for other communities.

Acceptability was assessed via growth in active users and activity. Feasibility was measured in terms of the percentage of users with a log-in who became active users as well as user surveys and a case study. Utility was measured in terms of the type of work that the Learning Exchange facilitated for the community.

The ICNExchange has over 1000 users and supported sharing of resources across all care centers in ICN. Users reported that the Learning Exchange has facilitated their work and resulted in increased ability to find resources relevant to local information needs.

The ICNExchange is acceptable, feasible, and useful as a knowledge management and exchange platform in service of the work of ICN. Experience with the ICNExchange suggests that the design principles are extensible to other chronic care Learning Networks.

• community networks
• database management systems
• intersectoral collaboration
• knowledge management
• patient-centered care
• quality improvement

• Asthma length of stay
• CPOE asthma pathway
• quality improvement

• Part 4 Maintenance of Certification (MOC)
• Performance Improvement Module (PIM)
• quality improvement (QI)

• Perinatal Quality Collaborative
• Population Health
• Public Health States
• Quality Improvement

• Cooperative Behavior
• Female
• Humans
• Infant, Newborn
• Maternal Health Services/standards
• Outcome and Process Assessment, Health Care
• Perinatal Care/standards
• Pregnancy
• Program Evaluation
• Quality Assurance, Health Care
• Quality Improvement
• Regional Medical Programs/standards
• United States

• CC999999 Intramural CDC HHS

• orchestrated testing
• patient safety
• planned experimentation
• quality improvement
• statistical process control

• Medical errors
• Multidisciplinary approach
• Patient safety
• Pediatric hospital medicine
• Quality

• Child
• Hospital Medicine/standards
• Hospitals, Pediatric/standards
• Humans
• Medical Errors
• Michigan
• Patient Safety
• Quality Assurance, Health Care
• Safety Management/methods

• Implementation science
• Medical errors
• Patient safety
• Quality improvement
• Translational research

• Child
• Humans
• Patient Safety
• Pediatrics/standards
• Quality Assurance, Health Care
• Quality Improvement
• Quality of Health Care/standards

• quality improvement
• healthcare delivery
• patient outcome assessment
• rheumatology
• pediatric

• Biomedical Research
• Child
• Delivery of Health Care/standards
• Disease Management
• Education, Medical, Continuing/organization & administration
• Humans
• Outcome and Process Assessment, Health Care/methods
• Quality Improvement
• Quality of Life
• Rheumatic Diseases/therapy
• Rheumatology/education

• U19 HS021114 AHRQ HHS
• U19HS021114 AHRQ HHS

• Bronchopulmonary dysplasia
• Neonatal free radical disease
• Oxygen saturation
• Randomized controlled trial
• Retinopathy of prematurity
• Very preterm infant

There is growing appreciation that process improvement holds promise for improving quality and efficiency across the translational research continuum but frameworks for such programs are not often described. The purpose of this paper is to present a framework and case examples of a Research Process Improvement Program implemented at Tufts CTSI. To promote research process improvement, we developed online training seminars, workshops, and in‐person consultation models to describe core process improvement principles and methods, demonstrate the use of improvement tools, and illustrate the application of these methods in case examples. We implemented these methods, as well as relational coordination theory, with junior researchers, pilot funding awardees, our CTRC, and CTSI resource and service providers. The program focuses on capacity building to address common process problems and quality gaps that threaten the efficient, timely and successful completion of clinical and translational studies.

• clinical research
• process improvement
• quality improvement
• recruitment and retention

• Community system
• Learning health system
• Population health
• Process improvement
• Quality improvement

• Delivery of Health Care/standards
• Humans
• Medical Assistance
• Population Health
• Quality Improvement
• Quality of Health Care