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The article discusses the importance of empowering pediatric providers in managing common complaints in children's healthcare. It highlights the barriers that pediatric providers face, such as a lack of knowledge and time constraints, which can lead to unnecessary referrals and testing. The article suggests three action items to improve patient care, including the development of curricula to educate healthcare trainees on best practices, quality improvement initiatives to reduce unnecessary testing and referrals, and collaboration among subspecialists, pediatric providers, and institutions to enhance communication and access to up-to-date information and guidelines. The article emphasizes the need for effective communication with families to alleviate anxiety and reduce unnecessary referrals. It also mentions the role of subspecialists in reducing unnecessary testing and referrals and the importance of open lines of communication between providers. Overall, the article emphasizes the importance of clinical practice guidelines, education, quality improvement initiatives, and inter-provider communication in improving pediatric care. [Extracted from the article]

Objective: To identify characteristics of acute otitis media (AOM) at primary care presentation associated with TT placement and outcomes. Methods: A retrospective cohort study of pediatric patients (birth—12 years old) with AOM at an academic primary care pediatric practice and affiliated tertiary referral free‐standing Children's hospital from August 1, 2017 to December 31, 2019 was performed. The outcomes measured were TT placement, postoperative otorrhea, need for additional tube placement, and other complications (i.e., perforation and/or granulation). Results: The 3189 patients were included, 484 of whom were referred to otolaryngology. Multivariate logistic regression analysis revealed that a greater number of AOM episodes diagnosed at primary care was associated with tube placement (OR = 1.21; 95% CI, 1.04–1.41, p =.02). Of the 336 patients who received tubes, older age at first AOM diagnosis was associated with postoperative otorrhea (OR = 1.02; 95% CI, 1.01–1.03; p =.001) and additional tube placement (OR = 1.03; 95% CI, 1.02–1.04; p <.001). Older age was also associated with other complications (OR = 1.02; 95% CI, 1.01–1.03; p =.001) by univariate analysis. Additionally, postoperative otorrhea was more common among patients who first received an AOM diagnosis at primary care in the spring (OR = 2.69; 95% CI, 1.37–5.29; p =.004), summer (OR = 2.88; 95% CI, 1.46–5.69; p =.002), and fall (OR = 2.18; 95% CI, 1.20–3.96; p =.01) seasons. Conclusions: Clinical data from pediatric primary care visits found older age at first AOM diagnosis and having a first AOM diagnosis outside of winter to be associated with a more complicated eventual disease course. Level of evidence: 3—cohort study. [ABSTRACT FROM AUTHOR]

Background: Our goal was to improve pediatric residents' advanced communication skills in the setting of referral to address the entrustable professional activity of subspecialty referral identified by the American Board of Pediatrics. To accomplish this aim, we created a referral and consultation curriculum to teach and assess core communication skills in subspecialty referral involving an adolescent with syncope, an anxiety-provoking symptom that is rarely associated with serious pathology. Methods: We utilized blended multimodal educational interventions to improve resident communication skills in referral of patients. Trainees participated in 1) an interactive online module on syncope focusing on "red-flag" symptoms that would warrant a subspecialty cardiology referral and 2) a 4-h intervention with Standardized Parents (SPs), focusing on the case-based application of communication skills. Communication skills were assessed by two pre- and post- Objective Structured Clinical Examination encounters of patients with syncope, with an SP evaluation using a 20-item checklist. Analysis was performed with Sign test and McNemar's test. Trainees provided feedback on a Critical Incident Questionnaire, which was analyzed qualitatively. Results: Sixty-four residents participated. There was an overall improvement in communication skills based on SP scores (82.7 ± 10.9% to 91.7 ± 5.0%, p < 0.001), and 13/20 items demonstrated significant improvement post-intervention. Residents' improved performance enabled them to address patient/family emotions, explain referral logistics, and clarify concerns to agree on a plan. Conclusions: By participating in this curriculum, residents' communication skills improved immediately post-intervention. Further research is needed to assess if this intervention improves patient care by providing residents with enduring skills to judiciously manage the referral process. [ABSTRACT FROM AUTHOR]

Objective: To decrease referrals to cardiology of patients ages 7 to 21 years with low-probability cardiac pathology who presented to primary care with chest pain by 50% within 24 months. Study Design: A multidisciplinary team designed and implemented an initiative consisting of 1) a decision support tool (DST), 2) educational sessions, 3) routine feedback to improve use of referral criteria, and 4) patient family education. Four pediatric practices, comprising 34 pediatricians and 7 nurse practitioners, were included in this study. We tracked progress via statistical process control charts. Results: A total of 421 patients ages 7 to 21 years presented with chest pain to their pediatrician. The utilization of the DST increased from baseline of 16% to 68%. Concurrently, the percentage of low-probability cardiology referrals in pediatric patients ages 7 to 21 years who presented with chest pain decreased from 17% to 5% after our interventions. At a median follow-up time of 0.9 years (interquartile range, 0.3–1.6 years), no patient had a life-threatening cardiac event. Conclusion: Our health care improvement initiative to reduce low-probability cardiology referrals for children presenting to primary care practices with chest pain was feasible, effective, and safe. [ABSTRACT FROM AUTHOR]

Background Quality improvement (QI) activities are required to maintain board certification in pediatrics. However, because of lack of training and resources, pediatricians may feel overwhelmed by the need to implement QI activities. Pediatricians also face challenges when caring for overweight and obese children. Objective To create a virtual (online) QI learning collaborative through which pediatric practices could easily develop and implement a continuous QI process. Design Prospective cohort. Participants Pediatric practices that were part of the Children's National Health Network were invited to participate, with the option to receive continuing medical education and maintenance of certification credits. Intervention(s) Practices conducted baseline and monthly chart audits, participated in educational webinars and selected monthly practice changes, using Plan-Do-Study-Act cycles. Practices reported activities monthly and periodic feedback was provided to practices about their performance. Main Outcome Measure(s) Improvement in (i) body mass index (BMI) percentile documentation, (ii) appropriate nutritional and activity counseling and (iii) follow-up management for high-risk patients. Results Twenty-nine practices (120 providers) participated, and 24 practices completed all program activities. Monthly chart audits demonstrated continuous improvement in documentation of BMI, abnormal weight diagnosis, nutrition and activity screening and counseling, weight-related health messages and follow-up management of overweight and obese patients. Impact of QI activities on visit duration and practice efficiency was minimal. Conclusion A virtual learning collaborative was successful in providing a framework for pediatricians to implement a continuous QI process and achieve practice improvements. This format can be utilized to address multiple health issues. [ABSTRACT FROM AUTHOR]

Objective To determine whether office-based interventions change adolescents' alcohol beliefs and alcohol use. Design Randomized, controlled trial. Setting Five managed care group practices in Washington, DC. Participants Consecutive 12- to 17-year-olds (N = 409) seeing primary care providers (N = 26) for general check-ups. Most of the adolescents (79%) were African American, 44% were male, and 16% currently drank. Interventions Usual care (Group I), adolescent priming with alcohol self-assessment just prior to check-up (Group II), adolescent priming and provider prompting with adolescent self-assessment and brochure (Group III). Main Outcome Measures Adolescent alcohol beliefs at exit interview and self-reported behaviors at 6- and 12-month follow-up. Results At exit interview, Groups II and III reported that less alcohol was needed for impaired thinking and a greater intent to drink alcohol in the next 3 months than Group I. At 6 months, Group III reported more resistance to peer pressure to drink, and Groups II and III reported more bingeing than Group I. At 1-year follow-up, controlling for baseline levels, Groups II (odds ratio [OR], 3.44; 95% confidence interval [CI], 1.44-6.24) and III (OR, 2.86; CI, 1.13-7.26) reported more bingeing in the last 3 months than Group I. Group II reported more drinking in the last 30 days (OR, 2.31; CI, 1.31-4.07) and in the last 3 months (OR, 1.76; CI, 1.12-2.77) than Group I. Conclusion Brief office-based interventions were ineffective in reducing adolescent alcohol use but may increase adolescent reporting of alcohol use. [ABSTRACT FROM AUTHOR]

Objective: To determine whether priming adolescent patients to discuss alcohol with their primary care providers and prompting providers to discuss alcohol increases adolescent-provider communication about alcohol. Design: Randomized controlled trial. Setting: Five managed care group practices in Washington, DC. Participants: Consecutive patients aged 12 to 17 years who were seeing primary care providers (n = 26) for health checkups. Of 892 eligible adolescents, 444 (50%) were randomized and completed data collection. Most adolescents (80%) were African American, 55% were male, and 17% currently drank alcohol. Intervention: Usual care (group 1) vs adolescent priming with alcohol self-assessment and education just before their health checkups (group 2) vs adolescent priming and provider prompting with the adolescent's selfassessment and a patient education brochure (group 3). Main Outcome Measures: This exploratory substudy of a longitudinal study on adolescent alcohol behaviors examined adolescent-provider communication by adolescent exit survey, researcher observation, and audiotapes of a subsample of visits. Results: More adolescents in group 3 (96%) than group 1 (87%) reported that their provider talked about alcohol (adjusted odds ratio [OR], 1.10; 95% confidence interval [CI], 1.04-1.17). More adolescents in group 3 (18%) than group 1 (10%) reported asking about alcohol (adjusted OR, 1.08; 95% CI, 1.00-1.16). The mean ± SD number of minutes adolescents were with their providers without parents being present was greater for group 3 (10.8 ± 7.6) than group 1 (8.8 ± 8.0). Adolescents in group 2 spent more time with their provider and reported initiating more discussion not specific to alcohol than did group 1 adolescents. Conclusion: Adolescent priming and provider prompting increases adolescent-provider communication about alcohol. [ABSTRACT FROM AUTHOR]