Bone Health: Defining Standards to Guide Care
Children with chronic medical conditions such as cerebral palsy and kidney disease often lose bone strength and face increased risk of fractures. However, identifying children with compromised bone first requires understanding the normal trajectory of bone accrual and bone density in healthy, typically growing children. Heidi Kalkwarf, PhD, and colleagues have been characterizing these trajectories and investigating factors that affect bone accrual as children grow. They published findings this year regarding age-specific trends in bone density in infants and toddlers up to age 3. They also documented the impact of growth, breastfeeding, gender and racial differences in bone accrual. Over the next few years they will investigate how growth, body composition, gross motor skills, and physical activity affect bone accrual in young children. Understanding the factors affecting bone density will help inform the design of interventions to enhance bone accrual and prevent fractures. Kalkwarf and a national team of investigators have published eight papers in the past six years detailing reference standards for older children and adolescents.
Transforming Delivery of Pediatric Primary Care
Anticipating dramatic changes in the health care landscape, Mona Mansour, MD, leads a team focused on redesigning primary care for low-income children. The goal is to achieve measurable improvements in health outcomes and quality of care while reducing costs for a population of patients. The initiative includes our Pediatric Primary Care Center, the Hopple Street Health Center, and Fairfield Primary Care sites, which had 60,000 visits last year. The initiative seeks to transform delivery of preventive services, access for acute illness, and management of common chronic illnesses.
Bundling Preventive Services
As part of the overall redesign, the team focused last year on improving delivery of preventive services. While many practices improve single measures of preventive care, reliably delivering a bundle of care measures requires significant systems change. Our pediatric practices developed a bundle focused on children up to 2 years old that includes risk factor screening (assessment of gestational age, food insecurity and maternal depression), routine immunizations, flu vaccination, and developmental and lead screening. The percentage of children receiving this bundle at our primary care sites has jumped from a baseline of 58 percent to sustained performance above 95 percent. Given the high-risk profiles of many patients cared for in our primary care sites, earlier identification of developmental delay and lead toxicity can have lifelong impacts. Community outreach activities also have begun to engage families who have no-show appointments, have had gaps in care services, or have not completed a recommended service. The system redesign will become the framework for additional initiatives. Lessons learned from our primary care system redesign will provide valuable insights for the Health Network by Cincinnati Children’s.