National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (1)
- Adverse Drug Events (ADE) (27)
- Adverse Events (12)
- Alcohol Use (1)
- Ambulatory Care and Surgery (2)
- Antibiotics (33)
- Antimicrobial Stewardship (11)
- Anxiety (3)
- Arthritis (1)
- Asthma (20)
- Behavioral Health (30)
- Blood Clots (1)
- Blood Pressure (2)
- Cancer (6)
- Caregiving (6)
- Care Management (4)
- Case Study (1)
- Children's Health Insurance Program (CHIP) (2)
- (-) Children/Adolescents (170)
- Chronic Conditions (9)
- Clinician-Patient Communication (3)
- Communication (2)
- Community-Acquired Infections (1)
- Comparative Effectiveness (10)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (1)
- COVID-19 (1)
- Critical Care (4)
- Dental and Oral Health (1)
- Depression (5)
- Diabetes (4)
- Diagnostic Safety and Quality (5)
- Disabilities (1)
- Disparities (4)
- Ear Infections (1)
- Education: Patient and Caregiver (3)
- Electronic Health Records (EHRs) (4)
- Emergency Department (9)
- Emergency Medical Services (EMS) (4)
- Evidence-Based Practice (6)
- Falls (1)
- Genetics (2)
- Guidelines (6)
- Healthcare-Associated Infections (HAIs) (5)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Costs (7)
- Healthcare Delivery (1)
- Healthcare Utilization (4)
- Health Information Technology (HIT) (7)
- Health Insurance (2)
- Health Literacy (1)
- Home Healthcare (1)
- Hospital Discharge (4)
- Hospitalization (7)
- Hospitals (4)
- Human Immunodeficiency Virus (HIV) (1)
- Imaging (1)
- Infectious Diseases (5)
- Injuries and Wounds (4)
- Inpatient Care (2)
- Intensive Care Unit (ICU) (9)
- Maternal Care (1)
- Medicaid (14)
- Medical Errors (5)
- Medical Expenditure Panel Survey (MEPS) (3)
- (-) Medication (170)
- Medication: Safety (24)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (6)
- Neurological Disorders (4)
- Newborns/Infants (5)
- Nutrition (1)
- Obesity (3)
- Obesity: Weight Management (1)
- Opioids (12)
- Outcomes (5)
- Pain (3)
- Palliative Care (1)
- Patient-Centered Healthcare (2)
- Patient-Centered Outcomes Research (13)
- Patient Adherence/Compliance (8)
- Patient Experience (1)
- Patient Safety (25)
- Patient Self-Management (1)
- Pneumonia (4)
- Policy (7)
- Practice Patterns (17)
- Pregnancy (1)
- Prevention (5)
- Primary Care (2)
- Provider (1)
- Provider: Physician (2)
- Public Health (1)
- Quality Measures (4)
- Quality of Care (4)
- Quality of Life (2)
- Racial and Ethnic Minorities (7)
- Registries (1)
- Respiratory Conditions (10)
- Risk (10)
- Rural Health (1)
- Screening (3)
- Sepsis (2)
- Shared Decision Making (2)
- Sickle Cell Disease (5)
- Skin Conditions (3)
- Substance Abuse (1)
- Surgery (3)
- Teams (1)
- Telehealth (2)
- Transitions of Care (1)
- Trauma (1)
- Treatments (4)
- U.S. Preventive Services Task Force (USPSTF) (1)
- Urban Health (1)
- Urinary Tract Infection (UTI) (1)
- Vaccination (2)
- Vulnerable Populations (7)
- Women (1)
- Young Adults (6)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 170 Research Studies DisplayedBrokamp C, Jones MN, Duan Q
Causal mediation of neighborhood-level pediatric hospitalization inequities.
This study’s objective was to estimate the total inequities in population-level hospitalization rates of children and determine how much is mediated by place-based exposures and community characteristics. The authors employed a population-wide, neighborhood-level study that included youth <18 years hospitalized between July 1, 2016 and June 30, 2022. They defined a causal directed acyclic graph a priori to estimate the mediating pathways by which marginalized population composition causes census tract-level hospitalization rates. They analyzed 50,719 hospitalizations experienced by 28,390 patients and calculated census tract-level hospitalization rates per 1000 children, which ranged from 10.9 to 143.0 across included tracts. For every 10% increase in the marginalized population, the tract-level hospitalization rate increased by 6.2%. After adjustment for tract-level community material deprivation, crime risk, English usage, housing tenure, family composition, hospital access, greenspace, traffic-related air pollution, and housing conditions, no inequity remained (0.2%). There were different results when considering subsets of asthma, type 1 diabetes, sickle cell anemia, and psychiatric disorders.
AHRQ-funded; HS027996.
Citation: Brokamp C, Jones MN, Duan Q .
Causal mediation of neighborhood-level pediatric hospitalization inequities.
Pediatrics 2024 Apr; 153(4):e2023064432. doi: 10.1542/peds.2023-064432..
Keywords: Children/Adolescents, Medication, Disparities, Hospitalization
De Castro GC, Slatnick LR, Shannon M
Impact of time-to-antibiotic delivery in pediatric patients with cancer presenting with febrile neutropenia.
Researchers abstracted episodes of febrile neutropenia (FN) in pediatric patients with cancer occurring at Vanderbilt Children's Hospital and Colorado Children's Hospital to capture time-to-antibiotic (TTA) metrics and clinical outcomes including major complications. Results showed that only 0.6% of episodes required immediate ICU management, with a median TTA of 28 minutes; for the remaining patients, the median TTA was 56 minutes. TTA was not associated with major nor any other complications in adjusted analysis. The researchers concluded that there was no clear evidence that a reduced TTA improves clinical outcomes in pediatric oncology FN and it should not be used as a primary quality measure.
AHRQ-funded; HS025696.
Citation: De Castro GC, Slatnick LR, Shannon M .
Impact of time-to-antibiotic delivery in pediatric patients with cancer presenting with febrile neutropenia.
JCO Oncol Pract 2024 Feb; 20(2):228-38. doi: 10.1200/op.23.00583..
Keywords: Children/Adolescents, Cancer, Antibiotics, Medication
Carroll AR, Johnson JA, Stassun JC
Health literacy-informed communication to reduce discharge medication errors in hospitalized children: a randomized clinical trial.
This study’s objective was to test a health literacy-informed communication intervention to decrease liquid medication dosing errors compared with standard counseling in hospitalized children. This parallel, randomized clinical trial was conducted from June 22, 2021, to August 20, 2022, at a tertiary care, US children's hospital. English- and Spanish-speaking caregivers of hospitalized children 6 years or younger prescribed a new, scheduled liquid medication at discharge were included in the analysis. Observed dosing errors were the main outcome measured, and secondary outcomes included caregiver-reported medication knowledge. Among 198 randomized caregivers (mean age 31.4 years; 186 women [93.9%]; 36 [18.2%] Hispanic or Latino and 158 [79.8%] White), the primary outcome was available for 151 (76.3%). The observed mean (SD) percentage dosing error was 1.0% (2.2 percentage points) among the intervention group and 3.3% (5.1 percentage points) among the standard counseling group (absolute difference, 2.3 percentage points). Twenty-four of 79 caregivers in the intervention group (30.4%) measured an incorrect dose compared with 39 of 72 (54.2%) in the standard counseling group. The intervention enhanced caregiver-reported medication knowledge compared with the standard counseling group for medication dose (71 of 76 [93.4%] vs 55 of 69 [79.7%]), duration of administration (65 of 76 [85.5%] vs 49 of 69 [71.0%], and correct reporting of 2 or more medication adverse effects (60 of 76 [78.9%] vs 13 of 69 [18.8%]).
AHRQ-funded; HS026122.
Citation: Carroll AR, Johnson JA, Stassun JC .
Health literacy-informed communication to reduce discharge medication errors in hospitalized children: a randomized clinical trial.
JAMA Netw Open 2024 Jan 2; 7(1):e2350969. doi: 10.1001/jamanetworkopen.2023.50969..
Keywords: Children/Adolescents, Health Literacy, Communication, Medication, Adverse Drug Events (ADE), Adverse Events, Medical Errors, Clinician-Patient Communication, Hospital Discharge, Medication: Safety
Jolliff A, Coller RJ, Kearney H
An mHealth design to promote medication safety in children with medical complexity.
This study describes an effort to design a health information technology tool to improve medication safety for children with medical complexity (CMC). The study engaged family caregivers, secondary caregivers, and clinicians who work with CMC in a co-design process to identify: 1) medication safety challenges experienced by CMC caregivers and, 2) design requirements for a mobile health application to improve medication safety for CMC in the home. Family caregivers, secondary caregivers, and clinicians from a children's hospital-based pediatric complex care program participated in virtual co-design sessions. During these sessions, the facilitator guided 16 co-designers in generating and converging upon medication safety challenges and design requirements. These sessions were recorded and reviewed after conclusion to confirm that all designer comments had been captured. An analysis yielded 11 challenges to medication safety and 11 corresponding design requirements that fit into three broader challenges: giving the right medication at the right time; communicating with others about medications; and accommodating complex medical routines.
AHRQ-funded; HS028409.
Citation: Jolliff A, Coller RJ, Kearney H .
An mHealth design to promote medication safety in children with medical complexity.
Appl Clin Inform 2024 Jan; 15(1):45-54. doi: 10.1055/a-2214-8000..
Keywords: Children/Adolescents, Medication: Safety, Medication, Health Information Technology (HIT), Chronic Conditions, Telehealth, Caregiving
Wolf RM, Hall M, Williams DJ
Disparities in pharmacologic restraint for children hospitalized in mental health crisis.
This retrospective cohort study examined associations between pharmacologic restraint use and race and ethnicity among children (aged 5-≤18 years) admitted for mental health conditions to acute care nonpsychiatric children's hospitals. Study period was 2018 to 2022 and was conducted at 41 US children’s hospitals and included a cohort of 61,503 hospitalizations. Compared with non-Hispanic Black children, children of non-Hispanic White (adjusted odds ratio [aOR], 0.81), Asian (aOR, 0.82), or other race and ethnicity (aOR, 0.68) were less likely to receive pharmacologic restraint, with no significant difference with Hispanic children. When stratified by sex, racial/ethnic differences were magnified in males, except for Hispanic males, and not found in females. Sensitivity analysis revealed amplified disparities for all racial/ethnic groups, including Hispanic youth.
AHRQ-funded; HS026122.
Citation: Wolf RM, Hall M, Williams DJ .
Disparities in pharmacologic restraint for children hospitalized in mental health crisis.
Pediatrics 2024 Jan; 153(1). doi: 10.1542/peds.2023-061353..
Keywords: Disparities, Children/Adolescents, Behavioral Health, Inpatient Care, Hospitals, Medication
Armstrong M, Groner JI, Samora J
Impact of opioid law on prescriptions and satisfaction of pediatric burn and orthopedic patients: an epidemiologic study.
This retrospective chart review study’s goal was to determine the reduction in prescribed opioid pain dosage units to pediatric patients experiencing acute pain and to assess patient satisfaction with pain control 90-day post discharge following the 2017 Ohio opioid prescribing cap law. The cohort included 960 pediatric (age 0-18 years) burn injury and knee arthroscopy patients treated between August 1, 2015-August 31, 2019. In addition, legal guardians prospectively completed a survey for a convenience sample of 50 patients. From pre-law to post-law, there was a significant decrease within the burn and knee cohorts in the median days (1.7 to 1.0 and 5.0 to 3.8, respectively) and median total morphine milligram equivalents (MMEs) prescribed (15.0 to 2.5 and 150.0 to 90.0, respectively). Results from the prospective survey showed that more than half of participants were satisfied (72% burn and 68% knee) with their pain control and felt they received the right amount of medication (84% burn and 56% knee).
AHRQ-funded; HS029183.
Citation: Armstrong M, Groner JI, Samora J .
Impact of opioid law on prescriptions and satisfaction of pediatric burn and orthopedic patients: an epidemiologic study.
PLoS One 2023 Nov 16; 18(11):e0294279. doi: 10.1371/journal.pone.0294279..
Keywords: Children/Adolescents, Opioids, Policy, Medication
Keith A, Jenkins TC, O'Leary S
Reducing length of antibiotics for children with ear infections: protocol for a cluster-randomized trial in the USA.
The objective of the planned study described in this article will be to evaluate two low-cost interventions to increase guideline-concordant antibiotic durations in children with acute otitis media (AOM). The authors will explore differences in implementation effectiveness by patient population, clinician type, clinical setting, and organization as well as by intervention type. They will also conduct formative qualitative interviews with clinicians and administrators and focus groups with the parents of patients. The results of the study will provide a framework for healthcare systems to address the problem of excessive durations of therapy for AOM and to inform national antibiotic stewardship policy development.
AHRQ-funded; HS029153.
Citation: Keith A, Jenkins TC, O'Leary S .
Reducing length of antibiotics for children with ear infections: protocol for a cluster-randomized trial in the USA.
J Comp Eff Res 2023 Nov; 12(11):e230088. doi: 10.57264/cer-2023-0088..
Keywords: Children/Adolescents, Antibiotics, Medication, Ear Infections
Bushnell G, Lloyd J, Olfson M
Antipsychotic medication use in Medicaid-insured children decreased substantially between 2008 And 2016.
In the early 2000s there was a rapid growth of pediatric antipsychotic prescribing, especially in the Medicaid population, and concerns grew about the safety and appropriateness of such prescribing. Numerous states implemented policy and educational programs focused on safer and more stringent utilization of antipsychotics. Antipsychotic utilization leveled off toward the end of the 2000s, but no recent national trend estimates of antipsychotic utilization in children enrolled in Medicaid exist. The authors of this study report a substantial decrease in antipsychotic use among children ages 2-17 between 2008 and 2016. Declines existed across foster care status, age, sex, and racial and ethnic groups studied. The rate of children with an antipsychotic prescription who received any diagnosis related to a pediatric indication that was approved by the Food and Drug Administration increased from 38 percent in 2008 to 45 percent in 2016.
AHRQ-funded; HS02600.
Citation: Bushnell G, Lloyd J, Olfson M .
Antipsychotic medication use in Medicaid-insured children decreased substantially between 2008 And 2016.
Health Aff 2023 Jul; 42(7):973-80. doi: 10.1377/hlthaff.2022.01625..
Keywords: Children/Adolescents, Medication, Medicaid, Behavioral Health
Kim KC, Khouja T, Burgette JM
Trends in dispensed prescriptions for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children by general dentists, 2012-2019.
This study examined trends in prescription fills for opioids, benzodiazepines, gabapentin, and stimulants to children <18 years from 2012 to 2019 in a national dataset comprising 92% of dispensed outpatient prescriptions by dentists. During this time, 3.8 million children filled prescriptions for high-alert drugs from general dentists. Opioids accounts for 69.4% of high-alert prescriptions, however from 2012 to 2019 fills for opioids, sedatives, benzodiazepines, and stimulants decreased by 65.2%, 43.4%, 43.6% and 89.3%, respectively. Gabapentin prescriptions increased by 8.1%. Older teenagers (15-17 years) received 42.5% of high-alert prescriptions. Low-income counties in Southern states were overrepresented among top-prescribing areas in 2019.
AHRQ-funded; HS025177.
Citation: Kim KC, Khouja T, Burgette JM .
Trends in dispensed prescriptions for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children by general dentists, 2012-2019.
Pharmacoepidemiol Drug Saf 2023 Jun; 32(6):625-34. doi: 10.1002/pds.5589..
Keywords: Children/Adolescents, Dental and Oral Health, Opioids, Medication, Practice Patterns
Orth LE, Feudtner C, Kempe A
A coordinated approach for managing polypharmacy among children with medical complexity: rationale and design of the Pediatric Medication Therapy Management (pMTM) randomized controlled trial.
Pediatric polypharmacy (the use of 5 concurrent medications or more) is widespread and increases the risk of medication-related problems (MRPs). Although MRPs are related with pediatric morbidity and healthcare use, polypharmacy is rarely evaluated during typical clinical care for CMC. The purpose of this randomized controlled trial will be to examine whether a pharmacist-led Pediatric Medication Therapy Management (pMTM) intervention decreases MRP counts, as well as symptom burden and acute healthcare use, and will test the hypotheses that a patient-centered medication optimization intervention delivered by pediatric pharmacists will result in lower MRP counts, stable or improved symptom burdens, and fewer cumulative acute healthcare encounters at 90 days following pMTM compared to usual care. Eligible participants include all children ages 2 to 18 years old, with more than 1 complex chronic condition, and with 5 or more active medications, as well as their primary caregivers. Child participants and their primary caregivers will be randomized to pMTM or usual care before a non-acute primary care visit and followed for 90 days. Secondary outcomes include Parent-Reported Outcomes of Symptoms (PRO-Sx) symptom burden scores and acute healthcare visit counts. Costs of program replication will be evaluated using time-driven activity-based scoring.
AHRQ-funded; HS028979.
Citation: Orth LE, Feudtner C, Kempe A .
A coordinated approach for managing polypharmacy among children with medical complexity: rationale and design of the Pediatric Medication Therapy Management (pMTM) randomized controlled trial.
BMC Health Serv Res 2023 Apr 29; 23(1):414. doi: 10.1186/s12913-023-09439-y..
Keywords: Children/Adolescents, Medication, Patient-Centered Healthcare
Carroll AR, Schlundt D, Bonnet K
Caregiver and clinician perspectives on discharge medication counseling: a qualitative study.
This study’s objective was to explore the perspectives of multidisciplinary clinicians and caregivers regarding discharge medication counseling for children and to develop a conceptual model to inform intervention efforts to reduce discharge medication dosing errors. The authors conducted a qualitative analysis using results from focus groups and individual interviews with 17 caregivers and 16 clinicians. Domains and subthemes included: (1) infrastructure of healthcare delivery, including supplies for counseling, content and organization of discharge instructions, clinician training and education, roles and responsibilities of team members, and hospital pharmacy delivery and counseling program; (2) processes of healthcare delivery, including medication reconciliation, counseling content, counseling techniques, and language barriers and health literacy; and (3) measurable outcomes, including medication dosing accuracy and caregiver understanding and adherence to discharge instructions. The conceptual model that resulted from this analysis can be applied to the development and evaluation of interventions to reduce discharge medication dosing errors following a hospitalization.
AHRQ-funded; HS026122.
Citation: Carroll AR, Schlundt D, Bonnet K .
Caregiver and clinician perspectives on discharge medication counseling: a qualitative study.
Hosp Pediatr 2023 Apr; 13(4):325-42. doi: 10.1542/hpeds.2022-006937..
Keywords: Children/Adolescents, Medication, Hospital Discharge, Education: Patient and Caregiver, Caregiving
Antoon JW, Grijalva CG, Carroll AR
Parental perceptions of penicillin allergy risk stratification and delabeling.
The purpose of this study was to explore parental perceptions of the PCN allergy evaluation and removal process, especially in the hospital setting. Investigators conducted focus groups consisting of parent of children and adolescents with a PCN allergy label discharged from a large academic children’s hospital between January 1, 2019, and April 15, 2020. The focus groups answered questions about PCN allergy testing and evaluation, accuracy of the PCN allergy diagnosis, amoxicillin oral challenges, delabeling process, and preferred setting for PCN allergy delabeling evaluation (outpatient clinic, hospital, etc). The study concluded family concerns remained even after children passed an oral challenge, and that some parents preferred testing in a hospital setting and thought it was a safer location for the procedure.
AHRQ-funded; HS026122.
Citation: Antoon JW, Grijalva CG, Carroll AR .
Parental perceptions of penicillin allergy risk stratification and delabeling.
Hosp Pediatr 2023 Apr; 13(4):300-08. doi: 10.1542/hpeds.2022-006737..
Keywords: Children/Adolescents, Antibiotics, Medication, Risk
Olmeda K, Trautner BW, Laytner L
Prevalence and predictors of using antibiotics without a prescription in a pediatric population in the United States.
This study assessed the prevalence of antibiotic use in children in the previous 12 months, storage of antimicrobials, and intended use of non-prescription antibiotics (professed intention for future non-prescription antibiotic use). A diverse sample of caregivers of children under 18 years were surveyed in English and Spanish at two safety net clinics in Texas from January 2021 to April 2022. There was an 82% response rate, with 17% surveyed in Spanish. Approximately 21% reported storing antibiotics in their home, specifically amoxicillin (n = 52), clindamycin (n = 10), cephalexin (n = 5), penicillin (n = 3), and trimethoprim/sulfamethoxazole (n = 3). Nearly 15% reported intention to give non-prescription antibiotics to their children, with three Spanish-speaking caregivers reporting giving non-prescription antibiotics to their child in the previous 12 months. Younger caregivers were associated with storage and intended use of non-prescription antibiotics.
AHRQ-funded; HS027869.
Citation: Olmeda K, Trautner BW, Laytner L .
Prevalence and predictors of using antibiotics without a prescription in a pediatric population in the United States.
Antibiotics 2023 Mar;12(3). doi: 10.3390/antibiotics12030491..
Keywords: Children/Adolescents, Antibiotics, Medication, Antimicrobial Stewardship
Chiotos K, Blumenthal J, Boguniewicz J
Antibiotic indications and appropriateness in the pediatric intensive care unit: a 10-center point prevalence study.
The purpose of this study was to describe indications and appropriateness of antibiotic orders in pediatric intensive care unit (PICU) patients. The study found that of 1462 patients admitted to participating PICUs, 58% had at least 1 antibiotic order, with 1277 antibiotic orders being reviewed. Common indications were empiric therapy for suspected bacterial infections without sepsis or septic shock, nonoperative prophylaxis, empiric therapy for sepsis or septic shock, community-acquired pneumonia, and post-operative prophylaxis. Appropriateness was evaluated for 985 orders for which an evidence-based heading for appropriateness could be created. Of these, 34% were categorized as inappropriate. Indications with the most orders classified as inappropriate were empiric therapy for suspected bacterial infection without sepsis or septic shock, sepsis or septic shock, CAP, ventilator-associated infections, and post-operative prophylaxis. The proportion of antibiotics classified as inappropriate differed across institutions.
AHRQ-funded; HS026393.
Citation: Chiotos K, Blumenthal J, Boguniewicz J .
Antibiotic indications and appropriateness in the pediatric intensive care unit: a 10-center point prevalence study.
Clin Infect Dis 2023 Feb 8; 76(3):e1021-e30. doi: 10.1093/cid/ciac698..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Antibiotics, Medication, Antimicrobial Stewardship, Sepsis
Chiotos K, Marshall D, Kellom K
Mixed-methods process evaluation of a respiratory-culture diagnostic stewardship intervention.
The purpose of this study was to perform an evaluation of a diagnostic stewardship initiative for respiratory culture in the healthcare setting within a pediatric intensive care unit (PICU) in a tertiary-care center. The study found that the frequency of culture collection per day of service differed among attending physicians, ranging from 2.2 to 27 cultures per 100 days. A total of 14 interviews were conducted, and 87 clinicians (response rate: 47%) along with 77 nurses or respiratory therapists (response rate: 17%) participated in the survey. There was a variation in clinicians' stated practices concerning culture ordering, which was influenced by both their specialty and their perception of the respiratory culture's usefulness. Additionally, group "default" practices, fear, and hierarchy affected the decision to order cultures. Obstacles to standardization encompassed concerns about missing a diagnosis and the conflict between standardized practices and individual judgment.
AHRQ-funded; HS026393.
Citation: Chiotos K, Marshall D, Kellom K .
Mixed-methods process evaluation of a respiratory-culture diagnostic stewardship intervention.
Infect Control Hosp Epidemiol 2023 Feb; 44(2):191-99. doi: 10.1017/ice.2022.299..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Antibiotics, Medication, Antimicrobial Stewardship, Intensive Care Unit (ICU)
Wolf RM, Hall M, Williams DJ
Pharmacologic restraint use for children experiencing mental health crises in pediatric hospitals.
This study’s objective was to determine hospital-level incidence and variation of pharmacologic restraint use among children admitted for mental health conditions in children's hospitals. The authors examined data for children (5 to ≤18 years) admitted to children's hospitals with a primary mental health condition from 2018 to 2020 using the Pediatric Health Information System database. Of 29,834 included encounters, 12.6% had pharmacologic restraint use, with three hospitals the highest utilizers of all drug classes. Adjusted hospital rates ranged from 35 to 389 pharmacologic restraint use days per 1000 mental health bed days with a mean of 175. There were no significant differences in pharmacologic restraint use found in the hospital-level analysis.
AHRQ-funded; HS026122.
Citation: Wolf RM, Hall M, Williams DJ .
Pharmacologic restraint use for children experiencing mental health crises in pediatric hospitals.
J Hosp Med 2023 Feb; 18(2):120-29. doi: 10.1002/jhm.13009..
Keywords: Children/Adolescents, Behavioral Health, Hospitals, Medication
McNeil JC, Sommer LM, Vallejo JG
Going back in time: Increasing penicillin susceptibility among methicillin-susceptible staphylococcus aureus osteoarticular infections in children.
Researchers investigated the prevalence of penicillin susceptibility (PSSA) among pediatric methicillin susceptible S. aureus (MSSA) acute hematogenous osteoarticular infection (OAI) isolates; the isolates were obtained through surveillance studies at Texas Children's and St. Louis Children's Hospitals. Overall, PSSA isolates were found to be associated with a similar clinical presentation as penicillin-resistant isolates. The researchers concluded that potential for use of penicillin treatment in PSSA OAI merits further study.
AHRQ-funded; HS026896'HS021736' HS024269.
Citation: McNeil JC, Sommer LM, Vallejo JG .
Going back in time: Increasing penicillin susceptibility among methicillin-susceptible staphylococcus aureus osteoarticular infections in children.
Antimicrob Agents Chemother 2023 Jan 24; 67(1):e0119622. doi: 10.1128/aac.01196-22..
Keywords: Children/Adolescents, Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs), Medication, Prevention
Treadwell JR, Kessler SK, Wu M
Pharmacologic and dietary treatments for epilepsies in children aged 1-36 months: a systematic review.
The purpose of this systematic review study was to assess the effectiveness and harms of pharmacologic and dietary treatments for epilepsy in children aged 1-36 months without infantile spasms. The researchers searched EMBASE, MEDLINE, PubMed, and the Cochrane Library for studies published from 1/1/1999 to 8/19/21 to identify studies reporting data on children aged 1-36 months receiving pharmacologic or dietary treatments for epilepsy. Twenty-three studies met the inclusion criteria. The study found that Levetiracetam leads to seizure freedom in some infants but the data on 6 other medications (lamotrigine, phenytoin, rufinamide, stiripentol, topiramate, and vigabatrin) were too limited to allow conclusions about their effectiveness. Three medications (lamotrigine, levetiracetam, and topiramate) were rarely discontinued due to adverse effects, and severe events were also rare. In the category of diets, the ketogenic diet lead to seizure freedom in some infants and both the ketogenic diet and modified Atkins diet reduced average seizure frequency.
AHRQ-funded; 75Q80120D00002.
Citation: Treadwell JR, Kessler SK, Wu M .
Pharmacologic and dietary treatments for epilepsies in children aged 1-36 months: a systematic review.
Neurology 2023 Jan 3;100(1):e16-e27. doi: 10.1212/wnl.0000000000201026..
Keywords: Children/Adolescents, Neurological Disorders, Newborns/Infants, Medication, Nutrition, Treatments, Evidence-Based Practice
Encinosa W, Moon K, Figueroa J
AHRQ Author: Encinosa W
Complications, adverse drug events, high costs, and disparities in multisystem inflammatory syndrome in children vs COVID-19.
This cross-sectional study’s goal was to determine outcomes from multisystem inflammatory syndrome in children (MIS-C) after COVID-19. Outcomes examined were 50 complications, adverse medication events, costs, and the Social Vulnerability Index. An analysis was conducted using data from the 2021 HCUP in individuals younger than 21 years from 31 states. There were 4107 individuals hospitalized with MIS-C (median age 9 years, 59.5% male, 38.1% White) and 23,686 hospitalizations for COVID-19 without MIS-C (median age 15 years, 54.5% female, 44.1% White). Hospitalization rate for MIS-C was 1.48 per 100,000 children, ranging from 0.97 hospitalizations per 100 for White and 1.99 hospitalizations per 100 for Black children. Outcomes were worse when organ dysfunction increased from 2 to 8 organs, with deaths increasing from less than 1% to 5.8% for MIS-C, and 1% to 17.2% for COVID-19. Median length of stay increased from 4 to 8 days for MIS-C, and 3 to 16 days for COVID-19. Median costs for MIS-C increased from $16,225 to $53 359 and from $6474 to $98,643 for COVID-19. The percentage of MIS-C cases in Black children doubled from 16.2% to 31.7% as organ dysfunction increased, remaining unchanged with COVID-19.
AHRQ-authored.
Citation: Encinosa W, Moon K, Figueroa J .
Complications, adverse drug events, high costs, and disparities in multisystem inflammatory syndrome in children vs COVID-19.
JAMA Netw Open 2023 Jan;6(1):e2244975. doi: 10.1001/jamanetworkopen.2022.44975..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, COVID-19, Medication, Adverse Drug Events (ADE), Adverse Events, Healthcare Costs, Disparities, Racial and Ethnic Minorities
Ramsden SC, Pergjika A, Janssen AC
A systematic review of the effectiveness and safety of droperidol for pediatric agitation in acute care settings.
This systematic review evaluated the effectiveness and safety of droperidol for the management of acute, severe agitation in children in acute care settings. The authors conclude that existing data indicate that droperidol is both effective and safe; however, data are limited by study designs that may introduce bias.
AHRQ-funded; HS026385.
Citation: Ramsden SC, Pergjika A, Janssen AC .
A systematic review of the effectiveness and safety of droperidol for pediatric agitation in acute care settings.
Acad Emerg Med 2022 Dec;29(12):1466-74. doi: 10.1111/acem.14515..
Keywords: Children/Adolescents, Medication, Medication: Safety, Intensive Care Unit (ICU), Patient Safety
Toce MS, Michelson KA, Chen KY
Trends in dispensing of controlled medications for US adolescents and young adults, 2008 to 2019.
This retrospective cohort analysis examined pharmacy insurance claims for trends in dispensation of controlled medications to adolescents and young adults. The subjects were youths aged 13 to 25 years and enrolled in a commercial health insurance company covering individuals in all fifty states. The results showed that the prevalence of dispensed stimulants increased significantly among youths with commercial insurance; by contrast, the prevalence of dispensed depressants and narcotics decreased, although it remained higher in young adults than in adolescents under 18. The authors noted that use of a commercial insurance data set may affect generalizability to other populations, and that pronounced differences in the dispensing of controlled substances based on sex offered opportunities for further investigation.
AHRQ-funded; HS026503.
Citation: Toce MS, Michelson KA, Chen KY .
Trends in dispensing of controlled medications for US adolescents and young adults, 2008 to 2019.
JAMA Pediatr 2022 Dec;176(12):1265-66. doi: 10.1001/jamapediatrics.2022.3312.
Keywords: Children/Adolescents, Young Adults, Medication, Practice Patterns
Mackie TI, Schaefer AJ, Palatucci JS
The role of formal policy to promote informed consent of psychotropic medications for youth in child welfare custody: a national examination.
The purpose of this sequential multi-method study was to propose a classification for the procedural elements of informed consent policies based upon existing child welfare policies and then explored whether formal state policies across the United States authorized these elements. The researchers conducted interviews with 58 key informants primarily from state child welfare agencies to identify a classification of procedural elements for informed consent of psychotropic medications. A legislative review of the 50 states and D.C. was then conducted to characterize whether formal policies endorsed each procedural element. Key informants reported five procedural elements in policy, and 23 states endorsed relevant legislation. Only two states specified all five procedural elements, and the content of any procedural elements varied considerably across policies.
AHRQ-funded; HS02198501; HS026001
Citation: Mackie TI, Schaefer AJ, Palatucci JS .
The role of formal policy to promote informed consent of psychotropic medications for youth in child welfare custody: a national examination.
Adm Policy Ment Health 2022 Nov;49(6):986-1003. doi: 10.1007/s10488-022-01212-3..
Keywords: Children/Adolescents, Vulnerable Populations, Medication, Behavioral Health, Policy
McNeil JC, Sommer LM, Vallejo JG
Reduced ceftaroline susceptibility among invasive mrsa infections in children: a clinical and genomic investigation.
The purpose of this study was to assess the frequency of reduced susceptibility (RS) to ceftaroline among pediatric methicillin-resistant Staphylococcus aureus (MRSA) infections. The researchers evaluated MRSA isolates at a tertiary children's hospital for ceftaroline RS. Ceftaroline RS occurred only among health care associated infections in 2.9% of isolates, and were more often clindamycin-resistant.
AHRQ-funded; HS026896.
Citation: McNeil JC, Sommer LM, Vallejo JG .
Reduced ceftaroline susceptibility among invasive mrsa infections in children: a clinical and genomic investigation.
Antimicrob Agents Chemother 2022 Oct 18;66(10):e0074522. doi: 10.1128/aac.00745-22..
Keywords: Children/Adolescents, Medication, Methicillin-Resistant Staphylococcus aureus (MRSA), Infectious Diseases, Genetics
Bowden CF, Simmel C, Mendez A
The complexity of psychotropic medication prescription and treating trauma among youth in foster care: perspectives from the lived experience.
The purpose of this study was to examine stakeholders' perspectives of the relationship between psychotropic medications and trauma informed care (TIC) for youth in foster care. The researchers recruited foster caseworkers, prescribing clinicians, caregivers, and alumni of the foster care system and conducted semi-structured individual and group interviews. Data were recorded and transcribed verbatim and analyzed using a directed content analysis approach. Five themes emerged across the recorded and transcribed data within stakeholder groups: 1) acknowledging trauma; 2) role of psychotropic medication; 3) psychosocial resources; 4) additional supports; and, 5) training and education. Stakeholders identified TIC as an important component of mental health services for youth in foster care. Most stakeholders felt that psychotropic medication was overused in treating trauma. Respondents suggested including additional supportive team members to help guide youth through the mental health treatment system and stated the importance of support from individuals with common lived experiences. The study concluded that there is a need for: improved training and education for stakeholders, additional sources of support for youth in foster care, and an overall system that emphasizes trauma-sensitive clinical interactions and psychosocial supports.
AHRQ-funded; HS02600101A1.
Citation: Bowden CF, Simmel C, Mendez A .
The complexity of psychotropic medication prescription and treating trauma among youth in foster care: perspectives from the lived experience.
Adm Policy Ment Health 2022 Sep;49(5):821-33. doi: 10.1007/s10488-022-01203-4..
Keywords: Children/Adolescents, Vulnerable Populations, Behavioral Health, Trauma, Medication
Woods-Hill CZ, Colantuoni EA, Koontz DW
Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative.
The purpose of this AHRQ-funded prospective study was to assess the relationship between a 14-site PICU blood culture collaborative, the Bright STAR (Testing Stewardship for Antibiotic Reduction) collaborative, and culture rates, antibiotic use, and patient outcomes. The researchers collected data from each participating PICU across the United States and from the Children’s Hospital Association Pediatric Health Information System. The main outcome was blood culture rates, with secondary outcomes including: broad-spectrum antibiotic use and PICU rates of central line-associated bloodstream infection (CLABSI), Clostridioides difficile infection, readmission, length of stay, sepsis, severe sepsis/septic shock, and mortality. The study found that the blood culture rate preimplementation across the 14 PICUs was 149.4 per 1000 patient days per month, and the rate postimplementation was 100.5 for a 33% relative reduction postimplementation. For those same periods, the rate of antibiotic use decreased from 506 days per 1000 patient-days per month preimplementation to 440 days per 1000 patient-days per month postimplementation, which reflects a 13% relative reduction. Rates of CLABSI decreased from 1.8 to 1.1 per 1000 central venous line days per month, a 36% relative reduction. The variables of length of stay, readmission, sepsis, severe sepsis/septic shock, and mortality were similar before and after implementation. The researchers concluded that collaborative interventions can reduce blood culture and antibiotic use in the PICU.
AHRQ-funded; HS025642.
Citation: Woods-Hill CZ, Colantuoni EA, Koontz DW .
Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative.
JAMA Pediatr 2022 Jul;176(7):690-98. doi: 10.1001/jamapediatrics.2022.1024..
Keywords: Children/Adolescents, Sepsis, Critical Care, Antibiotics, Medication, Diagnostic Safety and Quality, Antimicrobial Stewardship