OBJECTIVE: To describe the impact of a national interventional collaborative on pediatric readiness within General Emergency Departments. STUDY DESIGN: A prospective, multicenter, interventional study measured pediatric readiness in general emergency departments before and after participation in a pediatric readiness improvement intervention. Pediatric readiness was assessed using the weighted pediatric readiness score (WPRS) on a 100-point scale. The study protocol extended over six months and involved three phases: 1) a baseline on-site assessment of pediatric readiness and simulated quality of care, 2) pediatric readiness interventions, and 3) a follow-up on-site assessment of WPRS. The intervention phase included a benchmarking performance report, resources toolkits, and ongoing interactions between general emergency departments and academic medical centers. RESULTS: Thirty-six general emergency departments were enrolled, and 34 (94%) completed the study. Four EDs (11%) were located in Canada, and the rest were in the U.S. The mean improvement in WPRS was 16.3 (p<0.001) from a baseline of 62.4 (SEM=2.2) to 78.7 (SEM=2.1), with significant improvement in the domains of administration/coordination of care; policies, protocol and procedures; and quality improvement. Six EDs (17%) were fully adherent to the protocol timeline. CONCLUSION: Implementing a collaborative intervention model including simulation and quality improvement initiatives is associated with improvement in weighted pediatric readiness scores (WPRS) when disseminated to a diverse group of general emergency departments partnering with their regional pediatric academic medical centers. This work provides evidence that innovative collaboration facilitated by academic medical centers can serve as an effective strategy to improve pediatric readiness and processes of care.
High Body Mass Index in Infancy May Predict Severe Obesity in Early Childhood.
Creator
Smego Allison; Woo Jessica G; Klein Jillian; Suh Christina; Bansal Danesh; Bliss Sherri; Daniels Stephen R; Bolling Christopher; Crimmins Nancy A
Publisher
The Journal of pediatrics
Date
2017
2017-04
Description
OBJECTIVE: To characterize growth trajectories of children who develop severe obesity by age 6 years and identify clinical thresholds for detection of high-risk children before the onset of obesity. STUDY DESIGN: Two lean (body mass index [BMI] 5th to /=99th percentile) groups were selected from populations treated at pediatric referral and primary care clinics. A population-based cohort was used to validate the utility of identified risk thresholds. Repeated-measures mixed modeling and logistic regression were used for analysis. RESULTS: A total of 783 participants of normal weight and 480 participants with severe obesity were included in the initial study. BMI differed significantly between the severely obese and normal-weight cohorts by age 4 months (P \textless .001), at 1 year before the median age at onset of obesity. A cutoff of the World Health Organization (WHO) 85th percentile for BMI at 6, 12, and 18 months was a strong predictor of severe obesity by age 6 years (sensitivity, 51%-95%; specificity, 95%). This BMI threshold was validated in a second independent cohort (n = 2649), with a sensitivity of 33%-77% and a specificity of 74%-87%. A BMI \textgreater/=85th percentile in infancy increases the risk of severe obesity by age 6 years by 2.5-fold and the risk of clinical obesity by age 6 years by 3-fold. CONCLUSIONS: BMI trajectories in children who develop severe obesity by age 6 years differ from those in children who remain at normal weight by age 4-6 months, before the onset of obesity. Infants with a WHO BMI \textgreater/=85th percentile are at increased risk for developing severe obesity by age 6 years.
Subject
*BMI percentile; *Body Mass Index; *infant growth; *obese; *weight for length; Age Factors; Body Mass Index; Case Control Studies; Case-Control Studies; Child; Comparative Studies; Evaluation Research; Female; Human; Humans; Incidence; Infant; Logistic Models; Logistic Regression; Male; Morbid – Diagnosis; Morbid – Epidemiology; Morbid/*diagnosis/*epidemiology; Multicenter Studies; Newborn; Obesity; Obesity – Diagnosis; Obesity – Epidemiology; Obesity/diagnosis/epidemiology; Predictive Value of Tests; Preschool; Reference Values; Reproducibility of Results; Risk Assessment; Scales; Sex Factors; Validation Studies; Weight Gain