Objective. To determine the current prevalence and mean ages of onset pubertal characteristics in young girls seen pediatric practices United States. Methods. A cross-sectional study was conducted by 225 clinicians belonging to Pediatric Research Office Settings, a practice-based research network. After standardized training assessment maturation, practitioners rated level sexual maturation on 3 through 12 years who were undergoing complete physical examinations. Results. Data analyzed for...

Objective. A recent study conducted by the Pediatric Research in Office Settings network provided evidence that girls United States, especially black girls, are starting puberty at a younger age than earlier studies had found, but reasons for this not known. Because nutritional status is known to affect timing of and there clear trend increasing obesity US children during past 25 years, it was hypothesized onset could be attributable prevalence young girls. Therefore, objective reexamine...

Antimicrobial stewardship programs have been effective for inpatients, often through prescribing audit and feedback. However, most antimicrobial use occurs in outpatients with acute respiratory tract infections (ARTIs).To evaluate the effect of an intervention on antibiotic pediatric outpatients.Cluster randomized trial outpatient comparing between control practices using a common electronic health record. After excluding children chronic medical conditions, allergies, prior use, we...

Data from racially and ethnically diverse US boys are needed to determine ages of onset secondary sexual characteristics examine secular trends. Current international studies suggest earlier puberty in than previous studies, following recent trend girls.Two hundred twelve practitioners collected Tanner stage testicular volume data on 4131 seen for well-child care 144 pediatric offices across the United States. were analyzed prevalence mean maturity markers.Mean 2 genital development...

Objective: To determine whether pediatricians and dietitians can implement an office-based obesity prevention program using motivational interviewing as the primary intervention.Design: Nonrandomized clinical trial.Fifteen belonging to Pediatric Research in Office Settings, a national practice-based research network, 5 registered were assigned 1 of 3 groups: (1) control; (2) minimal intervention (pediatrician only); or (3) intensive dietitian).Setting: Primary care pediatric

BACKGROUND AND OBJECTIVE: Few studies have tested the impact of motivational interviewing (MI) delivered by primary care providers on pediatric obesity. This study efficacy MI and registered dietitians (RDs) to parents overweight children aged 2 through 8. METHODS: Forty-two practices from Pediatric Research in Office Settings Network American Academy Pediatrics were randomly assigned 1 3 groups. Group (usual care) measured BMI percentile at baseline 1- 2-year follow-up. (provider only) 4...

Acute respiratory tract infections account for the majority of antibiotic exposure in children, and broad-spectrum prescribing acute is increasing. It not clear whether treatment associated with improved outcomes compared narrow-spectrum treatment.To compare effectiveness children.A retrospective cohort study assessing clinical a prospective patient-centered children between ages 6 months 12 years diagnosed an infection prescribed oral January 2015 April 2016 network 31 pediatric primary...

Objective. To examine the changes in identification of pediatric psychosocial problems from 1979 to 1996. Research Design. Comparison clinician-identified and related risk factors among large primary care cohorts (Monroe County Study) 1996 (Child Behavior Study). Data were collected clinician visit questionnaires developed originally for study. Setting. Private practice offices 425 community-based pediatricians family practitioners across both studies. Patients. We enrolled all children 4 15...

The goals were to determine how frequently primary care clinicians reported suspected physical child abuse, the levels of suspicion associated with reporting, and what factors influenced reporting protective services.In this prospective observational study, 434 collected data on 15003 injury visits, including information about injury, child, family, likelihood that was caused by abuse (5-point scale), whether services. Data 327 indicating some for 1683 injuries analyzed.Clinicians 95 (6%)...

OBJECTIVE. The objective of this study was to determine whether patients' families' violence-prevention behaviors would be affected by their primary care practitioner's use a clinical intervention during the routine well-child examination. METHODS. In cluster-randomized, controlled trial (2002–2006), 137 Pediatric Research in Office Settings practices were randomly assigned and initiated patient recruitment for either an office-based or control group (educational handout on literacy...

To improve human papillomavirus (HPV) vaccination rates, we studied the effectiveness of targeting automated decision support to families, clinicians, or both.Twenty-two primary care practices were cluster-randomized receive a 3-part clinician-focused intervention (education, electronic health record-based alerts, and audit feedback) none. Overall, 22, 486 girls aged 11 17 years due for HPV vaccine dose 1, 2, 3 randomly assigned within each practice family-focused with educational telephone...

Studies of the relationship weight status with timing puberty in boys have been mixed. This study examined whether overweight and obesity are associated differences US boys.We reanalyzed recent community-based pubertal data from American Academy Pediatrics' Pediatric Research Office Settings which trained clinicians assessed 6 to 16 years for height, weight, Tanner stages, testicular volume (TV), other variables. We classified children based on BMI as normal overweight, or obese compared...

Pediatric clinicians frequently must offer support (eg, reassurance) to anxious, stressed parents. Supportive clinician behaviors were studied determine their impact on Forty initial health supervision visits a pediatric clinic videotaped through oneway mirror. Mothers interviewed immediately before and 1 week after the ascertain changes in concerns, opinions of clinicians, perceptions infants, self-confidence. also completed postvisit satisfaction questionnaire. Coders blinded these...

To determine whether racial differences exist in antibiotic prescribing among children treated by the same clinician.Retrospective cohort study of 1,296,517 encounters 208,015 to 222 clinicians 25 practices 2009. Clinical, prescribing, and demographic data were obtained from a shared electronic health record. We estimated within-clinician associations between patient race (black versus nonblack) (1) or (2) acute respiratory tract infection diagnosis after adjusting for potential...

Large electronic health record (EHR) datasets are increasingly used to facilitate research on growth, but measurement and recording errors can lead biased results. We developed tested an automated method for identifying implausible values in pediatric EHR growth data.Using deidentified data from 46 primary care sites, we algorithm identify weight height that should be excluded analysis, including were recorded repeatedly without remeasurement. The foundation of the is a comparison each...

<h3>Objective</h3> To determine the predictors and results of urine testing young febrile infants seen in office settings. <h3>Design</h3> Prospective cohort study. <h3>Setting</h3> Offices 573 pediatric practitioners from 219 practices American Academy Pediatrics Pediatric Research Office Settings' research network. <h3>Subjects</h3> A total 3066 3 months or younger with temperatures 38°C higher were evaluated treated according to judgment their practitioners. <h3>Main Outcome Measures</h3>...

To determine the relative impact of parental characteristics, provider behavior, and provision free vaccines through state-sponsored vaccine volume programs (VVPs) on immunization status children followed by private pediatricians.Retrospective cross-sectional surveys data.The offices 15 pediatricians, from 11 states, who were members Pediatric Research in Office Settings network. Seven these physicians used provided VVPs.Children 2 to 3 years old participating physicians.The was assessed two...

In this cross-sectional study, the vision-screening process is described for 8417 children aged 3 to 5 seen health supervision in a group of 102 pediatric practices 23 states and Puerto Rico. Three hundred forty who failed screening (63% those failed) were followed up 2 months after initial screening. The sample was 52% male, 86% white, 9% black, 3% Hispanic, 1% Asian. Vision attempted on 66% overall. Pediatricians' reasons not "not routine" (44%), "too young" (40%), "screening done...

To 1) determine the frequency of identification attentional and hyperactivity problems (AHPs) by clinicians, 2) examine whether minority children or from less well-educated, lower-income, lower-functioning families would be more likely to identified as having AHPs.Prospective cohort study 22 059 consecutive 4 15 years age being seen for acute, chronic, health supervision visits.Practices 401 pediatric family practice clinicians in 44 states, Puerto Rico, Canadian provinces.Parent...

OBJECTIVE. Effective communication between primary care and specialty physicians is essential for comanagement when children are referred to care. We sought determine rates of physician-reported specialists, the clinical impact or its absence, patient- practice system–level determinants a cohort METHODS. enrolled 179 patients newly from general pediatricians in 30 community practices 15 pediatric medical specialists 5 specialties. Primary completed questionnaires at first visit 6 months...

Clinician-patient interactions are an important, but poorly understood, feature of our personal health care system. Attributes these have been shown to affect the process and appear as well be amenable change, furnishing a rationale for their study. Communications theory provides useful guidelines systematic analysis. Systems interaction analysis should take account information transfer occurring on different levels through variety behaviors, incorporate context sequence into categorization...

To test whether routine pediatric outpatient practice can be transformed to assist parents in quitting smoking.

It is unclear which specific well-child visits (WCVs) are most frequently missed and whether age-specific patterns of attendance differ by race or insurance type.