Accountable care organizations (ACOs) have emerged as an effective healthcare delivery model for managing quality and cost at a population level. Within ACOs, pharmacists are critical for the delivery of high-value health care, offering patients and health care providers medication-related training, resources, and guidance that can improve quality of care at lower costs. Partners For Kids (PFK), one of the oldest and largest pediatric ACOs in the country, has successfully leveraged pharmacists to provide population health management and medication management to promote health outcomes for individual patients and the overall population it serves. This review explores how the inclusion of pharmacists in the development and execution of various quality improvement initiatives within PFK has positively impacted outcomes for patients while also lowering overall spend. A catalog of interventions is provided to offer various ways that pharmacists can intersect as providers in the triad of patient/family, payor, and provider. By providing enhanced training and education, on-site guidance, medication management, and population-level data analysis, pharmacists are able to identify and improve inefficiencies in care. Moving forward, ongoing engagement of pharmacists in health care operations will be a necessary feature to maximize health care value.

OBJECTIVES: Provision of reproductive health preventive services to adolescents is critical given their high rates of sexually transmitted infections and unintended pregnancies. Pediatricians are well positioned to provide these services but often face barriers. With this project, we aimed to build quality improvement (QI) capacity within pediatric practices to improve adherence to national guidelines for adolescent reproductive health preventive services. METHODS: In 2016, an accountable care organization overseeing health care delivery for low-income children in the Midwestern United States used practice facilitation, a proven approach to improve health care quality, to support pediatric practices in implementing reproductive health QI projects. Interested practices pursued projects aimed at providing (1) sexual risk reduction and contraceptive counseling (reproductive health assessments [RHAs]) or (2) etonogestrel implants. QI specialists helped practices build key driver diagrams and implement interventions. Outcome measures included the proportion of well-care visits with RHAs completed and number of etonogestrel insertions performed monthly. RESULTS: Between November 1, 2016, and December 31, 2019, 6 practices serving >7000 adolescents pursued QI projects. Among practices focused on RHAs, the proportion of well-care visits with completed RHAs per month increased from 0% to 65.8% (P < .001) within 18 months. Among practices focused on etonogestrel implant insertions, overall insertions per month increased from 0 to 8.5 (P < .001). CONCLUSIONS: Practice facilitation is an effective way to increase adherence to national guidelines for adolescent reproductive health preventive services within primary care practices. Success was driven by practice-specific customization of interventions and ongoing, hands-on support.

INTRODUCTION: Moyamoya arteriopathy can be idiopathic (moyamoya disease, MMD) or associated with other diseases, i.e., Down syndrome (moyamoya syndrome, MMS). The prevalence of Down syndrome in patients admitted for moyamoya has been estimated using the National Inpatient Sample to be 3.8%. However, the prevalence of moyamoya in Down Syndrome is not well-quantified.METHODS: This retrospective study used the Sie Center for Down Syndrome and Stroke Program databases at Children's Hospital Colorado to identify moyamoya patients aged 30 days to 18 years at diagnosis. Demographics, clinical presentation, treatment, and outcome were compared among patients with DS, those with idiopathic MMD, and the entire group.RESULTS: Sixty-five patients (30 idiopathic, 14 MMS with DS, 21 MMS without DS). Prevalence of MMS in the DS population was 0.4%. Gender and age at presentation did not differ significantly between populations. 47% of idiopathic moyamoya patients initially presented with transient ischemic attacks (TIAs) versus 14% of DS patients (P < 0.05). This is compared to 34% of the total population that presented with TIAs. DS patients were more likely to present with stroke (57%) compared to idiopathic (37%) and total patient populations (40%) although these results were not significant. 23% of idiopathic patients presented with basal ganglia strokes compared to 7% in the DS population (P < 0.05).CONCLUSIONS: In this study, the prevalence of moyamoya in DS was 0.4%. Patients with DS were less likely to present with TIAs and more likely to present with stroke, with different stroke locations, than were other moyamoya populations.

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