<p><strong>PURPOSE: </strong>Despite American Academy of Pediatrics recommendations that adolescents receive healthcare transition (HCT) services starting at age 12, few do. Electronic health record-based clinical decision support (CDS) tools are effective at promoting healthcare provider adherence to clinical guidelines. This study's purpose was to increase provider HCT services engagement through implementation of a transition-specific CDS and participation in a transition-focused Learning Collaborative (LC).</p>

<p><strong>DESIGN AND METHODS: </strong>Three pediatric primary care sites of an urban, academic medical center implemented a transition CDS tool for ≥14-year-olds. Previously, one site had a version for ≥16-year-olds. Two sites participated in a LC with Plan-Do-Study-Act cycles targeting HCT services engagement, measured by CDS use and practice-level guideline implementation.</p>

<p><strong>RESULTS: </strong>From July 2018 through June 2019, providers at LC-participating sites engaged in HCT services at 8.0% (n&nbsp;=&nbsp;480) and 5.3% (n&nbsp;=&nbsp;145) of eligible patient visits compared to the control's 3.1% (n&nbsp;=&nbsp;69). Engagement was highest for ≥18-year-olds at the LC-participating sites, 26.0% (n&nbsp;=&nbsp;263) and 12.0% (n&nbsp;=&nbsp;80), compared to the control's 7.2% (n&nbsp;=&nbsp;31). After expanding from ≥16 to ≥14-year-olds, engagement decreased by 9.5% at ≥16-year-old visits. LC-participating sites reported increased HCT guideline adherence.</p>

<p><strong>CONCLUSIONS: </strong>Implementation of a transition-specific CDS with LC participation increased provider HCT services engagement and practice-level guideline implementation. Expansion to younger adolescents contributed to decreased engagement for older patients. Future research should assess opportunities to improve uptake and patient outcomes of transition CDS engagement.</p>

<p><strong>PRACTICE IMPLICATIONS: </strong>Quality improvement activities and transition clinical decision supports can improve provider engagement in recommended transition services for adolescents and young adults.</p>

<p><strong>OBJECTIVE: </strong>To estimate the effect of a 1% lidocaine paracervical nerve block on pain during intrauterine device (IUD) insertion compared with a sham block in adolescents and young women.</p>

<p><strong>METHODS: </strong>We conducted a multisite, single-blind, sham-controlled randomized trial in adolescents and young women having a 13.5-mg levonorgestrel IUD inserted. Enrollment occurred at three family planning clinics in Philadelphia, Pennsylvania. Eligible adolescents and young women were aged 14-22 years, nulliparous, not currently or recently pregnant, and English-speaking. Participants were randomized using computer-generated allocation in block sizes of four to receive a 10-mL 1% lidocaine paracervical block or a sham block (1 cm depression of the vaginal epithelium at paracervical block sites with a wooden cotton-tipped applicator). Only patients were blinded. The primary outcome was pain after IUD insertion measured with a 100-mm visual analog scale. Using a two-sided t test and assuming a 20-mm difference in visual analog scale scores, a SD of 28 mm, an α of 0.05, and 90% power, a sample of 43 participants per group was estimated.</p>

<p><strong>RESULTS: </strong>Between March 2015 and July 2016, 95 participants enrolled (47 lidocaine block group; 48 sham block group). All were included in the analysis. Forty-four percent were white, 36% black, 65% privately insured, and 79% previously used contraception. The median visual analog scale score after IUD insertion was 30.0 (95% CI 20.0-58.0) in the lidocaine block group and 71.5 (95% CI 66.0-82.0) in the sham block (P&lt;.001).</p>

<p><strong>CONCLUSION: </strong>A 10-mL 1% lidocaine paracervical nerve block reduces pain during IUD insertion in adolescents and young women compared with a sham block with pressure on the vaginal epithelium.</p>

<p><strong>CLINICAL TRIAL REGISTRATION: </strong>ClinicalTrials.gov, NCT02352714.</p>