Maine IHOC Master List of Pediatric Measures with Numerators and Denominators

The Master List of Pediatric Measures was developed as part of the Maine CHIPRA Quality Demonstration Grant. Through intensive stakeholder engagement, key stakeholders from across the state worked together to develop a comprehensive list of pediatric measures that includes the CHIPRA Initial Core Set of Children’s Health Care Quality Measures as well as additional clinically relevant pediatric quality measures. Measures are based on clinical guidelines and a broad base of support. To encourage adoption of child health quality measures across a variety of measurement and quality improvement activities, this Master List also reflects IHOC’s emphasis on alignment. Examples of national alignment include the CHIPRA Initial Core Set; CMS priority areas related to Medicaid’s Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefit, obesity, oral health, and behavioral health; the American Academy of Pediatrics’ Bright Futures guidelines; the National Committee on Quality Assurance; the National Quality Forum; and the CMS EHR Incentive Program for Meaningful Use

Children's and Parents' Perspectives About Activity Performance and Participation After Spinal Cord Injury: Initial Development of a Patient-Reported Outcome Measure

OBJECTIVE. To report on a cognitive testing study on newly constructed items designed to evaluate clientreported outcomes of activity performance and participation after spinal cord injury (SCI). METHOD. Thirty-three children with SCI and 13 caregivers participated in cognitive testing interviews. Open-ended questions were used to gain a better understanding of activity performance and participation. The interviews were transcribed verbatim. A thematic analysis was carried out independently by 2 researchers, and key sentences and phrases from both analyses were merged. RESULTS. Four themes were defined: (1) apprehension related to activity performance and participation, (2) reference point, (3) missing out, and (4) autonomy

Foot and ankle experience in orthopaedic residency

Dedicated orthopaedic residency training in the musculoskeletal discipline of foot and ankle is an important contribution to the development of a well-rounded orthopaedic surgeon. Current residency training guidelines are vague and do not require specific experience or proficiency in this discipline. A one-page questionnaire on commitment to foot and ankle education in American Orthopaedic Surgery residency training programs was completed by all 148 program directors. Eighty of the programs (54.1%) had a single faculty member dedicated to foot and ankle orthopaedics, while 21 (14.2%) did not have a faculty member with a specific interest or commitment to problems related to the foot and ankle. Fifteen programs (10.1%) did not have a committed faculty member, nor did their residents have a clinical rotation dedicated to foot and ankle. Ninety-six programs (64.9%) had at least one clinical rotation dedicated to foot and ankle. Fifty-two (35.1%) did not. Thirty-three (34.7%) of those programs with a dedicated foot and ankle experience assigned residents during at least two periods of their training. Of those programs with a single foot-specific rotation, the most common year for training was in the PGY3 year (27 of 63, 42.9%). Of the 60 months' duration of most orthopaedic residency programs, 39 of 96 (40.6%) programs with a dedicated clinical foot and ankle rotation allocated an average of 12 weeks to foot and ankle. Twenty-six (27.1%) allocated less than 3 total months, and 31 (32.3%) allocated 16 to 24 weeks of dedicated foot and ankle experience. Current residency training in the United States does not universally require a commitment to foot and ankle education. A large number of residency programs do not have a faculty member committed to foot and ankle education, and almost one-third have no time specifically allocated to foot and ankle education

Pediatric Trauma and Posttraumatic Symptom Screening at Well-child Visits

UNLABELLED: Adverse childhood experiences (ACEs), including abuse or neglect, parental substance abuse, mental illness, or separation, are public health crises that require identification and response. We aimed to increase annual rates of trauma screening during well-child visits from 0% to 70%, post-traumatic stress disorder (PTSD) symptom screening for children with identified trauma from 0% to 30%, and connection to behavioral health for children with symptoms from 0% to 60%. METHODS: Our interdisciplinary behavioral and medical health team implemented 3 plan-do-study-act cycles to improve screening and response to pediatric traumatic experiences. Automated reports and chart reviews measured progress toward goals as we changed screening methods and provider training. RESULTS: During plan-do-study-act cycle 1, a chart review of patients with positive trauma screenings identified various trauma types. During cycle 2, a comparison of screening methods demonstrated that written screening identified trauma among more children than verbal screening (8.3% versus 1.7%). During cycle 3, practices completed trauma screenings at 25,287 (89.8%) well-child visits. Among screenings, 2,441 (9.7%) identified trauma. The abbreviated Post Traumatic Stress Disorder Reaction Index was conducted at 907 (37.2%) encounters and identified 520 children (57.3%) with PTSD symptoms. Among a sample of 250, 26.4% were referred to behavioral health, 43.2% were already connected, and 30.4% had no connection. CONCLUSIONS: It is feasible to screen and respond to trauma during well-child visits. Screening method and training implementation changes can improve screening and response to pediatric trauma and PTSD. Further work is needed to increase rates of PTSD symptomology screening and connection to behavioral health