Children exhibiting conduct problems comprise the largest source of referrals to children's mental health services in this county. Significant research has been conducted in an attempt to identify specific risk factors that result in increased vulnerability of a child developing conduct problems. Knowledge of these factors increases our ability to identify young children who are at greater risk for developing conduct problems. The treatment for conduct problems that possesses the greatest amount of empirical support is behavioral parent training. Yet behavioral parent training fails to address behaviors and risk factors that are present during a child's early development. Preventative behavioral parent training is a very brief primary prevention strategy designed to prevent the development of chronic and age-inappropriate display of conduct problems. This project was an initial longitudinal assessment examining the merits of preventative behavioral iv parent training as a primary prevention strategy for young children at-risk of developing conduct problems. Results demonstrated that prevention participants were engaging in normative rates of noncompliance and tantruming at 6-month follow-up, whereas comparison children showed a general worsening in their disruptive behaviors over time.(163 pages) v ACKNOWLEDGMENTS
BackgroundThe American Academy of Neurology Headache Quality Measures seek to improve care delivery and outcomes by addressing gaps in care. Our practice identified underperformance in 3 of the 7 measures that apply to children and adolescents. We expected that improved performance on these measures would lead to a reduction in emergency department (ED) visits and improvement in the average disability grade of established patients.MethodsAn interdisciplinary workgroup used the Institute for Healthcare Improvement's Model for Improvement. Quality improvement (QI) interventions focused on the use of Pediatric Migraine Disability Assessment (PedMIDAS), headache action plans (HAPs), nurse triage, and infusion center order sets.ResultsProvider use of PedMIDAS increased from 15% to 55% (p <0 .0001) of patient visits during the comparison period. Generation of HAP letters increased from 10% to 15% (p < 0.0003), but these gains were not sustained. ED visits for headache decreased by 32% (p < 0.0001). The average migraine disability grade remained unchanged.ConclusionsQI efforts using team-based strategies and electronic medical record (EMR) integration can improve performance on headache quality measures, although it may be difficult to demonstrate improved patient outcomes. The project's time frame and disability assessment strategy were likely insufficient to detect a change in disability. Optimization of nurse triage and EMR workflows enabled more patients with status migrainosus to receive their treatment in the infusion center rather than the ED with a favorable revenue benefit for the hospital.
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