The Washington Healthcare Improvement Network (WHIN) offers training, technical assistance and quality improvement supports to primary care teams working to establish or refine patient and family-centered medical homes. WHIN is an initiative of the Washington State Department of Health. WHIN serves all interested primary care practice teams and is committed to being responsive to the needs of pediatric teams, in addition to family and internal medicine. The emphasis is on practical, tangible tools and examples from peer teams with successful improvements.
WHIN works with clinics in specific regions and communities and is currently kicking off work in Whatcom County working with Whatcom Alliance for Health Advancement. An initiative in Thurston, Mason and Lewis counties will begin this spring, and WHIN is partnering with CHOICE Regional Health Network in this region. Regional and community work will continue to cycle around the state, with tentative plans to add new regions in fall, 2013.
For the state regions not currently being served by WHIN's community-based approach, a self-paced pathway to medical home called WHIN Institute offers a package of services to support medical home development. Resources are continually being developed to add to the platform. Resources available to all Institute participants include:
Children may encounter pesticides daily in air, food, dust, soil and on surfaces in the home or outdoor areas. Seventy-four percent of American households use some sort of pesticides, including insecticides and pet products (Pesticide Industry Sales and Usage, EPA).
While high dose/frank poisoning episodes in U.S. children are declining, a new AAP policy statement and accompanying technical report (Pesticide Exposure in Children) highlights the concerning accumulation of evidence linking low-level, chronic exposure to pesticides with some of the major health concerns facing children today. Among these are attention and learning problems, low birth weight and pediatric cancer.
Recognizing common signs of poisoning due to pesticide ingredients remains important, but pediatricians must also be able to provide effective prevention advice to families. Asking about pesticide use and storage in the home or recognizing occupational exposures a child or teen may have allows pediatricians to give families guidance on this issue.
Tips to Share with Parents
Reducing a child's exposure to pesticides can easily be achieved by the following:
For additional information, see the following resources:
Adolescent Health in Pediatric Practice (AHIPP) is actively recruiting practitioners and practices that see a fair number of adolescent patients, some of whom smoke tobacco. The study was very recently granted the ability to award MOC Part 4 credits to the American Board of Pediatrics (ABP) for practitioners completing the study.
The aims of the study include demonstrating providers' fidelity to guidelines for tobacco counseling and delivering cessation interventions. Practitioners will be randomized by practice to receive training about tobacco screening along with a brief counseling intervention OR training about media use screening along with a brief counseling intervention based on AAP guidelines on media use.
Practices will be asked to recruit and obtain consent from at least 100 adolescents (14 years of age or older). The adolescents will then fill out a baseline questionnaire at the time of the visit. All self-reported smokers and 10 percent of non-smokers will be asked to participate in three follow-up phone calls after the initial visit, at: 1) Four to six weeks, 2) six months, and 3) 12 months. These phone calls will be made by PROS staff/contractors, not by the practice or practitioner.
This is the first PROS study to be endorsed by the ABP for MOC Part 4 credit. AHIIP has been developed, extensively tested and refined over a number of years. Both the study arm and control groups will receive the credit since the control is actually an intervention.
Here in Washington State there are a number of counties where the teen smoking rate is over 15 percent. There is no implied commitment to remain in PROS after completion of the study. Please contact Judy Gorzkowski, Program Assistant, American Academy of Pediatrics (1-800-433-9016, ext. 7126, or email email@example.com) to enroll in the program or for more information. Information can also be obtained by visiting PROS online.
A fully developed QA intervention for MOC Part 4 credit already vetted in practice, with follow-up calls and data analysis by PROS - what a deal! On the PROS home page there is an audio-visual description of the study as well as the aims, methodology and design.
This newsletter series is adapted from a presentation by Dr. Andrew Garner reviewing Developmental Science. See wcaap.org for the entire series.Part 2: Emotional Buffers Mitigate the Effects of Toxic Stress
The National Scientific Council on the Developing Child has proposed the following categories of stress based on the measurable, physiologic response to the stress:
It is the physiologic response to that stress that can make it tolerable or toxic. Social-emotional buffers allow a return to baseline or reduce the long-lasting effects of toxic stress. The social-emotional buffers are when caregivers respond to the child's non-verbal cues, offer consolation, reassurance, or assistance in planning. The hallmark of toxic stress is the inability to return to baseline due to insufficient social-emotional buffering.
To read more about a pediatrician addressing ACEs to improve her patient's health see this article.
The American Board of Pediatrics (ABP) Maintenance of Certification (MOC) process is more than just renewing your certificate - it's about staying current with medical knowledge, continuously growing and developing professionally, and committing to improving care for your patients through Quality Improvement (QI).
Part 4 of the MOC process is your opportunity to make changes - big or small - in your practice, measure the outcomes and improve how you deliver care to children. It facilitates improvement through systematic measurement in a variety of activities and collaborative efforts.
There are three options for getting involved:
Don't wait to get started on making an impact and tracking your progress - some Part 4 activities take six weeks to one year to complete!