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This Month in Archives of Pediatrics and Adolescent Medicine
June 01, 2009

This Month in Archives of Pediatrics & Adolescent Medicine

Arch Pediatr Adolesc Med. 2009;163(6):503. doi:10.1001/archpediatrics.2009.89
Effect of Telephone Calls From Primary Care Practices After Pediatric Emergency Department Visits

One of the ways to control health care costs is to decrease inappropriate use of the emergency department (ED) and to increase use of the medical home. This randomized trial was designed to test whether a telephone call from a primary care provider to families after an ED visit would decrease subsequent ED use. The intervention unfortunately resulted in only a small, nonsignificant reduction in the number of subsequent ED visits overall, though there was a 24% reduction in the number of subsequent ED visits in adolescents. However, among subjects who had a follow-up visit, there was a 12% reduction in the number of subjects going to the ED. Brief follow-up telephone calls from practices should be further explored as a method of improving patient care and decreasing overall health care costs.

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Sports Practice Among Adolescents With Chronic Health Conditions

Physical activity is increasingly recognized as an important component of health, with effects on physical, mental, and emotional health. There are a number of factors that affect sports participation among adolescents, but one that has not been well explored is chronic health conditions. In this large study of 16- to 20-year-olds from Switzerland, males with chronic conditions were less likely to participate in sports than males without, though among females, there was no effect from having a chronic health condition. Adolescents with chronic health conditions did view this as a barrier, though not the main barrier, to sports participation; lack of time for sports was cited as a barrier for sports participation by many. Encouraging sports participation among all adolescents, including those with chronic conditions, is appropriate.

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Quality Improvement Strategies for Children With Asthma: A Systematic Review

Despite clear evidence-based guidelines for the management of pediatric asthma, a significant gap remains between accepted best practices for pediatric asthma care and actual care delivered to patients in the United States. Quality improvement strategies have the potential to improve outpatient pediatric asthma care. This systematic review examined the effect of 79 different studies on asthma care and outcome. Most of the 26 self-monitoring or self-management studies found at least 1 significant improvement in outcomes in the intervention group, including reduction in the number of days with symptoms and school absenteeism. Educational interventions that were focused on parents were most likely to be associated with significant improvement in clinical outcomes. Changes in how health care is organized and delivered to children with asthma were successful in decreasing school absenteeism. The greater the number of quality improvement strategies used, the better the clinical outcomes were. The key will now be to ensure that these effective strategies are implemented.

Mean hospitalizations per year are decreased in the caregiver education studies. The upper panel presents the difference in the postintervention rate of hospital days per year in the intervention and control groups from the studies that used quality improvement strategies other than caregiver education. The studies to the left of 0 indicate fewer hospital days per year in the intervention group than in the control group.

Mean hospitalizations per year are decreased in the caregiver education studies. The upper panel presents the difference in the postintervention rate of hospital days per year in the intervention and control groups from the studies that used quality improvement strategies other than caregiver education. The studies to the left of 0 indicate fewer hospital days per year in the intervention group than in the control group.

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Access to Pediatric Trauma Care in the United States

Injury is the most common cause of death of children in the United States, and trauma center care has been shown to reduce the risk of death for severely injured patients. Timeliness of access to trauma centers is key to reducing mortality and improving outcomes. In this study, Nance and colleagues inventoried pediatric trauma centers and examined access to pediatric-specific trauma care. Overall, 71.5% of children younger than 15 years lived within 60 minutes of a pediatric trauma center by ground or air transport. However, less than 25% of children in 12 states lived within 60 minutes of a pediatric trauma center. Access was most limited in children living in the least densely populated areas of the country. More than 17 million children were found to not have timely access to pediatric trauma care.

Geographic representation of access within 60 minutes of a verified pediatric trauma center (PTC).

Geographic representation of access within 60 minutes of a verified pediatric trauma center (PTC).

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