Literature Collection

In recent years, neonatal abstinence syndrome (NAS) rates have increased rapidly across the United States, rising from 1.2 (2000) to 5.8 (2012) per 1000 hospital births annually. Because most NAS infants are treated in an intensive care setting, associated hospital charges are high and continue to escalate, rising on average from $39,400 in 2000 to $66,700 in 2012. An innovative NAS treatment program, which includes early-initiated methadone therapy, rooming-in, and combined inpatient/outpatient weaning in a low-acuity nursery, has been in place since 2003 at a large Southeastern hospital. The program has proven safe, effective and low cost for treating infants of >/=35 weeks gestational age whose mothers used long-acting opioids. Given that 81% of NAS cases in the United States are funded by Medicaid programs and that the cost burden is rising rapidly, researchers considered the potential saved charges associated with implementing the same program in other hospitals state- and nationwide. Researchers used regression models to project state and national NAS birth rates from 2015-2025 and to predict future NAS charges under current treatment protocols. Three scenarios were developed to compare the potential saved charges of implementing the innovative NAS treatment program across the state and nation with assumptions related to the percent of NAS infants eligible for the program, percent funded by Medicaid, and fluctuations in average length of stay. The potential saved charges are substantial, creating a compelling case for policy makers and hospitals in the pursuit of safe, effective, and cost-conscious NAS care.

BACKGROUND: To synthesise recent empirical evidence for the prevention and management of respiratory function in children. METHODS AND FINDINGS: We searched the PubMed, Cochrane Library, Embase and Web of Science databases for studies published from inception to 16 September 2024. Two authors independently selected eligible studies, evaluated the quality of the included studies and assessed bias based on the Cochrane Collaboration tool for assessing the risk of bias. First, 968 studies that met the inclusion criteria were selected. We stratified all studies into three groups: asthma (n=50), pneumonia (n=4) and other respiratory diseases (n=15). We performed bias evaluations and summarised the paediatric respiratory function on a pathway based on probable aetiology. We determined that household and communal management schemes for different age groups were based on different types of diseases. We divided the children into the infant group (0-3 years old), preschool age (4-6 years old), school-going age (7-13 years old) and adolescents (14-18 years old) and summarised the appropriate management schemes according to the different characteristics of each group. CONCLUSION: Effective prevention and management strategies implemented at both the family and community levels can significantly enhance the quality of life for children with respiratory disorders. Our summary highlights the importance of these strategies throughout the preadult lifecycle. We emphasise the need for future research employing rigorous and advanced methodologies to explore and address prevention and management practices across varying severity levels of respiratory conditions.

BACKGROUND: Quality improvement programmes (QIPs) are designed to enhance patient outcomes by systematically introducing evidence-based clinical practices. The CONQUEST QIP focuses on improving the identification and management of patients with COPD in primary care. The process of developing CONQUEST, recruiting, preparing systems for participation, and implementing the QIP across three integrated healthcare systems (IHSs) is examined to identify and share lessons learned. APPROACH AND DEVELOPMENT: This review is organized into three stages: 1) development, 2) preparing IHSs for implementation, and 3) implementation. In each stage, key steps are described with the lessons learned and how they can inform others interested in developing QIPs designed to improve the care of patients with chronic conditions in primary care.Stage 1 was establishing and working with steering committees to develop the QIP Quality Standards, define the target patient population, assess current management practices, and create a global operational protocol. Additionally, potential IHSs were assessed for feasibility of QIP integration into primary care practices. Factors assessed included a review of technological infrastructure, QI experience, and capacity for effective implementation.Stage 2 was preparation for implementation. Key was enlisting clinical champions to advocate for the QIP, secure participation in primary care, and establish effective communication channels. Preparation for implementation required obtaining IHS approvals, ensuring Health Insurance Portability and Accountability Act compliance, and devising operational strategies for patient outreach and clinical decision support delivery.Stage 3 was developing three IHS implementation models. With insight into the local context from local clinicians, implementation models were adapted to work with the resources and capacity of the IHSs while ensuring the delivery of essential elements of the programme. CONCLUSION: Developing and launching a QIP programme across primary care practices requires extensive groundwork, preparation, and committed local champions to assist in building an adaptable environment that encourages open communication and is receptive to feedback.