A quality improvement program in pediatric practices to increase tailored injury prevention counseling and assess self-reported changes made by families

Gittelman, Michael A.; Carle, Adam C.; Denny, Sarah; Anzeljc, Samantha; Arnold, Melissa Wervey

doi:10.1186/s40621-018-0145-z

Cited by 8 publications

(6 citation statements)

References 19 publications

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“…Putting resources toward the use of a standard injury prevention screening tool has been shown to improve injury prevention in primary care offices. (Gittelman et al 2018) It stands to reason that the ED may be another setting for this type of tool to be utilized.…”

Section: Discussionmentioning

confidence: 99%

Child passenger safety education in the emergency department: teen driving, car seats, booster seats, and more

et al. 2020

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Background: The leading cause of death in children less than 19 years old is motor vehicle crashes (MVC). Non-use or improper use of motor vehicle car seats significantly adds to the morbidity and mortality. Emergency department (ED) encounters provide an opportunity for caregiver education. Our objective was to determine the effect of an educational intervention on knowledge and counseling behaviors of pediatric ED nurses regarding child passenger safety (CPS). Methods: A pre/post educational intervention study was conducted with nursing staff in an urban ED. Responses to CPS related knowledge and counseling behaviors were collected using surveys administered before and after the intervention. The ED nurse education intervention was a one-hour lecture based on the American Academy of Pediatrics (AAP) CPS guidelines and Alabama state law regarding ages for each car seat type and teen driving risky behaviors. Individual data from pre and post surveys were matched, and nominal variables in pre-post matched pairs were analyzed using McNemar's test. To compare categorical variables within pre or post test data, we used the Chi-square test. Results: Pretests were administered to 83/110 ED nurses; 64 nurses received the educational intervention and posttest. On the pretests, nurses reported "never" or "occasionally" counseling about CPS for the following: 56% car seats, 62% booster seat, 56% teen driving, 32% seat belts. When comparing the pretest CPS knowledge between nurses working 0-1 year vs. ≥ 2 years there was no statistically significant difference. Two CPS knowledge questions did not show significance due to a high correct baseline knowledge rate (> 98%), including baseline knowledge of MVC being the leading cause of death. Of the remaining 7 knowledge questions, 5 questions showed statistically significant improvement in knowledge: age when children can sit in front seat, state GDL law details, seat belt state law for back seat riders, age for booster seat, and rear facing car seat age. All four counseling behavior questions showed increases in intent to counsel families; however, only intent to counsel regarding teen driving reached statistical significance.

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Section: Discussionmentioning

confidence: 99%

Child passenger safety education in the emergency department: teen driving, car seats, booster seats, and more

et al. 2020

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“…A hybrid tool to screen for high-risk behaviors, using a previously established IP screening tool (Gittelman et al, 2018) as well as the SEEK screening tool for SDH risks was created (tool available upon request). A test-retest study has shown the injury tool has good reliability (Gittelman et al, 2018). Age-appropriate unintentional injury prevention questions were developed for each age specific category (birth-1 year and 1–5 years).…”

Section: Methodsmentioning

confidence: 99%

“…Although past literature clearly supports that tailored screening by PCPs, with individualized, custom messaging, helps to address specific needs, changes behaviors, and saves health care dollars, this approach is not used consistently by PCP offices (Nansel et al, 2002; Gittelman et al, 2018). By implementing standardized tools into pediatric offices using Quality Improvement (QI) methodology, PCPs are able to screen for and discuss high-risk injury and social topics in a more pertinent and efficient manner (Gittelman et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Pilot of primary care physician discussion and resource allocation after screening for unintentional injuries and social determinants of health

et al. 2019

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Background Standardized screening tools used by pediatric providers can help determine a child’s injury and social risks. This study determined if an office-based quality improvement program could increase targeted anticipatory guidance and community resource distribution to families. Methods Practices recruited from the Ohio Chapter, American Academy of Pediatrics’ database self-selected to participate in a quality improvement project. Two age-appropriate screening tools, corresponding talking points and local resources for birth–1 year and 1–5 year aged children were developed for unintentional injury and social health determinant topics. After a one-day learning session, practice teams implemented the tools into well-child care visits for children < 5 years of age. Two months of retrospective baseline data was collected for each participating clinician. During the 6-month collaborative, physicians randomly reviewed 5 screening tools monthly for each age category to identify injury and social risk discussions and to determine if resources were provided. Frequencies of counseling and resource distribution were calculated. Participating providers received Maintenance of Certification IV credit. Results Ten practices (18 providers) participated and 667 tools ( n = 313, birth-1 year, n = 354, 1–5 year) were collected. For birth–1 year, the most common risky behaviors were related to unintentional injuries: no CPR training 164(52%), car seat not checked 149(48%) and home furniture not secured 117 (37%). For 1–5 year screens, unintentional injuries were also most common: no CPR training 222(63%), car seat not checked 203(57%) and access to choking hazards 198(56%). Families practiced riskier behaviors for unintentional injuries compared to social risks for both age groups (birth – 1 year, social 189/4801 (4%) vs. unintentional injury questions 999/6260 (16%) and 1–5 years, social 271/5451 (5%) vs unintentional injury questions 1140/6372 (18%). From baseline, discussions increased from 31% to 83% for birth – 1 year and 24% to 86% for 1–5 year families. Resource distribution increased by 63% for birth-1 year and 69% for 1–5 year families by pilot conclusion. Conclusions Using standardized screening tools in an office setting shows that families often practice unintentional injury risks more than having social concerns. After screening, appropriate resources can be provided to families to encourage behavior change.

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“…11 The use of quality improvement (QI) initiatives to provide counseling about other preventive concerns during infancy has encouraged caregivers to practice safer behaviors. 12 Similarly, TSE reduction and cessation counseling by primary care providers (PCPs) may be successful in prompting caregivers to change their tobacco behavior to improve their child’s health. 9,10…”

Section: Introductionmentioning

confidence: 99%

Types of Tobacco Products Used by Caregivers of Newborns in the Primary Care Setting

Gittelman

Southworth

Carle

et al. 2022

Clin Pediatr (Phila)

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This study determined the types of tobacco products used by caregivers who presented to infant well-child visits (WCVs), tobacco product use by other household members, and caregivers’ readiness to quit. The Ohio Chapter of the American Academy of Pediatrics conducted a 10-month quality improvement collaborative to improve providers’ tobacco screening and cessation counseling practices. A sub-analysis of the initial screenings was performed to determine types of tobacco products used and caregivers’ readiness to quit. Fourteen practices (60 providers) participated, and 3972 initial screens were analyzed; 320 (8.1%) caregivers and 490 (12.4%) household members used tobacco products. Most smoking caregivers and household members exclusively used cigarettes (79% and 72%, respectively). There was no difference in caregiver intention to quit by tobacco type, yet 53% of smoking caregivers were ready to quit. Providers should provide screening and cessation counseling to caregivers of infants at WCVs since many are ready to quit.

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A quality improvement program in pediatric practices to increase tailored injury prevention counseling and assess self-reported changes made by families

Cited by 8 publications

References 19 publications

Child passenger safety education in the emergency department: teen driving, car seats, booster seats, and more

Child passenger safety education in the emergency department: teen driving, car seats, booster seats, and more

Pilot of primary care physician discussion and resource allocation after screening for unintentional injuries and social determinants of health

Types of Tobacco Products Used by Caregivers of Newborns in the Primary Care Setting

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