- National Immunization Partnership with the APA (NIPA). As a part of this grant, the APA is working with CORNET and the National Improvement Partnership Network (NIPN) to implement a large-scale practice-based quality improvement (QI) program to prioritize HPV vaccination at every adolescent visit. Participating practices can implement at least one of the following strategies: standing orders, provider prompts, and reminder-recall. In Wave 1, 14 CORNET and 38 NIPN practices participated. In Wave 2, 15 CORNET and 60 NIPN practices participated. Wave 3 is set to begin in early 2017.
NIPA Virtual Toolkit
Studies in Development
- Play Nicely Seth Scholer, MD lead the submission of a grant application for this pilot study of a interactive DVD/web based video on discipline strategies and methods to decrease aggressive behavior in young children. Susan Feigelman, MD is the lead CORNET Steering Committee member. This is a pilot in 4 CORNET practices determining the best way to implement Play Nicely for a larger RCT.
- Childhood Obesity Prevention, Treatment, and Evaluation in Residency (COPTER): Quality Improvement targeting obesity using Bright Futures concept emerged from a series of CORNET workshops at the last few PAS meetings, lead by Dr. Bill Stratbucker. It is anticipated that this will lead to a to a national QI project.
- Preventive Services Improvement Project - State Spread (PreSIPS2). . PreSIPS2 was one component of many ongoing efforts to enhance Bright Futures implementation at the state, community, practice, and family levels. With participation from AAP National, AAP chapters, CORNET academic programs, and national and state partners, PreSIPS2 was a 17-month quality improvement (QI) state-based learning collaborative designed to create sustainable state to local improvement infrastructure to achieve awareness and improvement in the preventive health outcomes of children based on Bright Futures. Four CORNET practices participated in the project.
- National Partnership for Adolescent Immunization (NPAI). This project focused on enhancing adolescent immunization delivery through the implementation of quality improvement activities in primary care practices and pediatric resident training programs. During the learning collaborative stages of this project, participating practices were asked to choose one of two strategies to improve their HPV vaccine immunization rates. The two strategies included a point of care prompt (either nurse or EMR) or standing orders. The selected strategy was implemented in each participating practice for 12 months, during which faculty/resident/staff champions participated in monthly learning collaborative conference calls. Thirteen practices participated, with five choosing standing orders as their strategy and eight utilizing prompts. Findings were presented in two platforms and two posters at PAS 2016, in addition to a workshop on involving pediatric residents in QI in continuity clinics, using adolescent immunizations as a template. Three manuscripts are currently underway.
- Initial results from the Bright Futures Oral Health study funded by the Maternal and Child Health Bureau (Hank Bernstein, PI) were presented at the 2011 Denver PAS meeting. Twenty-seven pediatric training programs (143 residents) participated. This RCT was very successful in showing that residents improved in confidence and knowledge about BF concepts, and were able to incorporate preventive health strategies into their practices. Two manuscripts are underway. This was a very intensive and important CORNET study. Thanks to everyone who participated!
- Secondary Sexual Characteristics in Boys Study (SSCIB). Seven CORNET practices, including 10 CORNET faculties, collaborated with the PROS network in this study that examined the onset of secondary sexual characteristics in boys. Marcia Giddens, DrPh, PA served as the PI. CORNET contributed data on 300 minority and underserved boys, increasing the generalizability of study results. Results have been presented at the last two PAS meetings.
- The Survey of Pediatric Asthma Care Education in Residency (SPACER) study was completed in 2009. This study, with Sande Okelo, MD as PI, and Terry Hetzler and Cindy Ferrell as CORNET co-investigators, was a cross-sectional survey to assess asthma management and incorporation of national practice guidelines by pediatric residents. Ten pediatric training programs participated and surveys were obtained from 369 residents. Two PAS abstracts were presented in 2009 and 2010 and a manuscript is under revision. Future analysis will compare resident responses to those of practitioners from a similar study Dr. Okelo conducted within the American Academy of Pediatrics and practicing pediatricians.
- Health Care of Pediatric Residents and their Families. This cross-sectional study funded by East Carolina University was led by Kristina Simeonsson, MD and John Olsson, MD and examined pediatric residents' perceived access to health care for themselves and their families, self-prescribing practices, whether colleagues provide care and the care their families receive. Nineteen pediatric training programs participated, with 834 residents providing data. Results were presented in two posters at the PAS meeting. Manuscript preparation has begun. The results from this study will help to inform the Residency Review Committee (RRC) and the Accreditation Council for Graduate Medical Education (ACGME).
- How is Continuity Defined in Continuity Clinics? Paul Darden, MD, MPH was the principal investigator for this CORNET-APA Continuity SIG collaboration which surveyed pediatric continuity directors to determine how they measure and define continuity, an important concept to the Residency Review Committee. Results from 170 programs (over 75% of all pediatric training programs nationally) were presented at the 2011 Denver PAS.
- Bright Futures, Preventive Services Improvement Project (PreSIP). Paula Duncan, MD, the PI on this project, obtained funding from HRSA and MCHB for a collaborative project based in four CORNET sites and several practices participating in the QUINN program. The goal is to determine if Bright Futures can be easily implemented in a busy clinical setting, targeting children birth to 3 years. The methodology is a quality improvement project to develop and test specific changes, using rapid cycle change strategies. Results from the project are now in the analysis phase.
- Adolescent Immunizations within Medical Homes Initiative (AIMHI). This 3-phase study, funded by the Centers for Disease Control, is a quality improvement study to increase adolescent immunization rates, and a collaboration between CORNET and the Rochester practice-based network (GR-PBRN). Peter Szilagyi, MD, MPH is PI. Phase 1 was a survey of 47 CORNET practitioners that determined potential interventions, barriers, strategies and critical components of interventions to enhance immunization of adolescents. Results were presented at the 2011 PAS meeting. The second phase has consisted of a series of focus group discussions using a modified Delphi technique. Participants have discussed the most feasible and sustainable strategy to enhance adolescent immunizations. Use of an EMR and nurse prompts were the most promising tools. In Phase 3, 12 CORNET sites participated in a trial of 3 different strategies in order to measure the effectiveness of the selected strategies in increasing adolescent vaccination rates and impact on utilization of services in the medical homes.
- Pediatric Residency Integrated Survey: Mental Health in Primary Care (PRISM-PC). The PI for this 2-phase study is Maya Bunik, MD, MPSH. The first phase, funded by University of Colorado, was a cross-sectional survey of continuity directors focusing on mental health patient access, resident education of mental health issues, and whether practices have integrated mental health models at their sites. Surveys were completed by 54 programs and results were presented at the 2011 PAS meeting. Funding is being secured for the second phase, which will be a comparative study examining patient and resident educational outcomes among different mental health integration models.