First name
Jennifer
Last name
Whittaker

Title

Mixed-methods process evaluation of a respiratory-culture diagnostic stewardship intervention.

Year of Publication

2023

Number of Pages

1-9

Date Published

01/2023

ISSN Number

1559-6834

Abstract

OBJECTIVE: To conduct a process evaluation of a respiratory culture diagnostic stewardship intervention.

DESIGN: Mixed-methods study.

SETTING: Tertiary-care pediatric intensive care unit (PICU).

PARTICIPANTS: Critical care, infectious diseases, and pulmonary attending physicians and fellows; PICU nurse practitioners and hospitalist physicians; pediatric residents; and PICU nurses and respiratory therapists.

METHODS: This mixed-methods study was conducted concurrently with a diagnostic stewardship intervention to reduce the inappropriate collection of respiratory cultures in mechanically ventilated children. We quantified baseline respiratory culture utilization and indications for ordering using quantitative methods. Semistructured interviews informed by these data and the Consolidated Framework for Implementation Research (CFIR) were then performed, recorded, transcribed, and coded to identify salient themes. Finally, themes identified in these interviews were used to create a cross-sectional survey.

RESULTS: The number of cultures collected per day of service varied between attending physicians (range, 2.2-27 cultures per 100 days). In total, 14 interviews were performed, and 87 clinicians completed the survey (response rate, 47%) and 77 nurses or respiratory therapists completed the survey (response rate, 17%). Clinicians varied in their stated practices regarding culture ordering, and these differences both clustered by specialty and were associated with perceived utility of the respiratory culture. Furthermore, group "default" practices, fear, and hierarchy were drivers of culture orders. Barriers to standardization included fear of a missed diagnosis and tension between practice standardization and individual decision making.

CONCLUSIONS: We identified significant variation in utilization and perceptions of respiratory cultures as well as several key barriers to implementation of this diagnostic test stewardship intervention.

DOI

10.1017/ice.2022.299

Alternate Title

Infect Control Hosp Epidemiol

PMID

36594433
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Title

Integrating the Built and Social Environment into Health Assessments for Maternal and Child Health: Creating a Planning-Friendly Index.

Year of Publication

2020

Number of Pages

Date Published

2020 Dec 10

ISSN Number

1660-4601

Abstract

<p>Environmental and community context earliest in the life course have a profound effect on life-long health outcomes. Yet, standard needs assessments for maternal and child health (MCH) programs often overlook the full range of influences affecting health in-utero and early childhood. To address this, we developed a methodology for assessing community risk in MCH based on six domains integrating 66 indicators across community, environment, socioeconomic indicators, and MCH outcomes. We pilot this methodology in Pennsylvania, and share examples of how local governments, planners, and public health officials across the geographic spectrum can integrate this data into community planning for improved maternal and child health.</p>

DOI

10.3390/ijerph17249224

Alternate Title

Int J Environ Res Public Health

PMID

33321736
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Title

A Community Capitals Framework for Identifying Rural Adaptation in Maternal-Child Home Visiting.

Year of Publication

2019

Number of Pages

Date Published

2019 Jul 03

ISSN Number

1550-5022

Abstract

<p><b>OBJECTIVE: </b>To understand how maternal and child home-visiting programs are adapted, enhanced, and expanded to meet the unique needs of rural communities.</p><p><b>DESIGN: </b>We explored factors shaping the role of home visiting with data from a 2013-2015 statewide evaluation of Maternal, Infant, and Early Childhood Home Visiting-funded programs. Features unique to a rural experiences were mapped onto the Community Capitals Framework.</p><p><b>SETTING: </b>Individual, semistructured interviews were conducted at 11 of 38 home-visiting sites across Pennsylvania.</p><p><b>PARTICIPANTS: </b>Program administrators, home visitors, and clients.</p><p><b>MAIN OUTCOME MEASURE: </b>Program adaptation.</p><p><b>RESULTS: </b>Our analysis represents 150 interviews with 11 program sites serving 14 counties. We document how rural home-visiting programs address community-wide limitations to maternal and child health by adapting program content to better meet the needs of families in rural areas. Data demonstrate how rural home-visiting program's provision of economic and social services reach beyond maternal child health care, building the capacity of individual families and the broader community.</p><p><b>CONCLUSIONS: </b>Home-visiting programs should be viewed as a vehicle for improving community well-being beyond health outcomes. These programs have become an integral part of our public health framework and should be leveraged as such.</p>

DOI

10.1097/PHH.0000000000001042

Alternate Title

J Public Health Manag Pract

PMID

31274703
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Title

A Mixed Methods Evaluation of Early Childhood Abuse Prevention Within Evidence-Based Home Visiting Programs.

Year of Publication

2018

Number of Pages

Date Published

2018 May 31

ISSN Number

1573-6628

Abstract

<p>Objectives In this large scale, mixed methods evaluation, we determined the impact and context of early childhood home visiting on rates of child abuse-related injury. Methods Entropy-balanced and propensity score matched retrospective cohort analysis comparing children of Pennsylvania Nurse-Family Partnership (NFP), Parents As Teachers (PAT), and Early Head Start (EHS) enrollees and children of Pennsylvania Medicaid eligible women from 2008 to 2014. Abuse-related injury episodes were identified in medical assistance claims with ICD-9 codes. Weighted frequencies and logistic regression odds of injury within 24 months are presented. In-depth interviews with staff and clients (n = 150) from 11 programs were analyzed using a modified grounded theory approach. Results The odds of a healthcare encounter for early childhood abuse among clients were significantly greater than comparison children (NFP: 1.32, 95% CI [1.08, 1.62]; PAT: 4.11, 95% CI [1.60, 10.55]; EHS: 3.15, 95% CI [1.41, 7.06]). Qualitative data illustrated the circumstances of and program response to client issues related to child maltreatment, highlighting the role of non-client caregivers. All stakeholders described curricular content aimed at prevention (e.g. positive parenting) with little time dedicated to addressing current or past abuse. Clients who reported a lack of abuse-related content supposed their home visitor's assumption of an absence of risk in their home, but were supportive of the introduction of abuse-related content. Approach, acceptance, and available resources were mediators of successfully addressing abuse. Conclusions for Practice Home visiting aims to prevent child abuse among high-risk families. Adequate home visitor capacity to proactively assess abuse risk, deliver effective preventive curriculum with fidelity to caregivers, and access appropriate resources is necessary.</p>

DOI

10.1007/s10995-018-2530-1

Alternate Title

Matern Child Health J

PMID

29855837
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