The Cincinnati Pediatric Research Group has completed more than twelve studies. These studies are summarized below and are grouped into the following categories:
See also our active studies, as well as the the publications and presentations resulting from these studies.
The obesity pilot project was designed to assess the ability of the practicing primary care physician to diagnose obesity in children aged 2 through 10 years. In addition, incidence of obesity in the practices of participants was determined. The current methods utilized in approaching and managing patients with obesity and potential barriers to diagnosis and treatment were identified. These goals were achieved via two electronic survey tools.
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Asking the question, "When is it appropriate for children to report for themselves?" this study sought to assess the acceptibility, feasibility and psychometric quality of administering asthma-related quality of life questionnaires to children. Funded by the National Heart, Lung and Blood Institute and the American Academy of Pediatrics (AAP), the study was conducted at Rush Medical Center in Chicage as well as the CPRG sites over a three-year period. Qualitative data was collected from 400 parent-child pairs (children will be 7-16 years old). Data was cleaned, analyzed and stored at the AAP.
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Funded by a grant from the American Academy of Pediatrics (AAP), this study sought to characterize the current management practices of children with ADD/ADHD in a large diversified pediatric community consisting of more than 200 community pediatricians. Study methods included a survey of all local pediatric providers and a detailed chart review of patients with ADD/ADHD for a sample of providers (CPRG members). A follow-up study will evaluate change in management after a guideline implementation program.
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The purpose of this study was to collect network-defining data in order to characterize our network practitioners and patient visits in a manner similar to the National Ambulatory Medical Care Survey (NAMCS). The study was designed to allow us to summarize our study population and benchmark with national data sets. In addition, it sought to clarify the generalizability of our studies to other practices and populations.
The study used scannable surveys, developed by AHRQ, to collect data from each network provider for one week. Questions pertained to general aspects of the practice and details regarding office visits and patient characteristics for every third patient seen, up to 30 per provider. Surveys were reviewed by the CPRG staff and then submitted to AHRQ for aggregation and analysis. Results of this analysis will be posted here soon.
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Treatment of Otitis Media with Observation and a Safety-Net Prescription
Funded by Whitehall-Robins, this study aimed to determine if treatment of Otitis Media in children with observation and a "safety-net" prescription (SNP) is acceptable to parents and leads to reduced antibiotic usage. The study enrolled 194 patients in 11 offices. Ninety percent completed follow-up interviews, and only 2.6% of parents approached refused to participate.
Sixty-nine percent of parents did not fill the antibiotic prescription provided, and 78% were willing to treat without antibiotics in the future. These findings suggest that parents consider a safety-net prescription and pain control approach acceptable for the treatment of otitis media, and that antibiotic usage can be significantly lowered with the SNP strategy.
Parental Attitudes about Antibiotic Use for Otitis Media
From October 1998 to August 1999, the CPRG collaborated with the American Academy of Pediatrics (AAP) in a study designed to validate a tool that measures how parents are coping with recurrent and chronic otitis media. The study required parents to complete an Ear Infection Survey (EIS) twice between one and sixth months. Nine CPRG practices participated in this study. At each visit, eligible parents would complete the EIS, which included questions on physical health, child and parent activities, child and parent emotional health, health care utilization and perceived need for antibiotics. The AAP, which funded the project with $28,000, anticipated that 250 completed EIS pairs would be needed to validate the tool and that 400 parents would be initiated to get the required number. Only 293 parents were needed to get 265 completed EIS pairs. Of interest, the study indicated that only seven percent of parents were comfortable managing otitis media without antibiotics.
One factor contributing to the success of the otitis media project was the identification and hiring of a highly motivated study coordinator. She visited the practices regularly and worked very closely with the office staffs. She also gave the staffs frequent rewards with lunches after enrolling a certain number of patients. Since the staff was earmarking potential enrollees and follow-ups, this in turn motivated the doctors.
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Screening for Domestic Violence in the Community Pediatric Setting
The study aimed to evaluate the potential benefits of screening for domestic violence (DV) in a pediatric office setting. Following the recommendations of the AAP Committee on Child Abuse and Neglect, women were screened in CPRG practitioners' offices for DV with a six-question tool. The study showed that 31% of women had experienced DV at some point and 17% were recent victims of DV. This study led to a national presentation (APA, May 1999) and a publication in the journal Pediatrics (Siegel, et al., 1999).
Screening for Domestic Violence in the Pediatric Office: A Multi-Practice Experience
This follow-up study aimed to determine whether the proportion of women reporting domestic violence in a pediatric office setting can be generalized to other office settings. Over a 15-month period, 436 women were screened at four practices: a hospital-owned practice with a mix of privately insured and Medicaid patients, two community health centers (Medicaid) and a pediatric office (privately insured). Of these women, 86 (20%) described DV at some point in their lives. The proportion of women reporting violence did not differ significantly by site, but the proportion of patients reporting new violence was significantly lower at the private practice site (by chi-square analysis).
These results suggest that women screened in a variety of pediatric settings will disclose DV. Although it appears that recent abuse is more likely to be reported in settings with indigent patients, all pediatricians should be screening for DV and have protocols in place to offer women the services they need if DV is revealed.
Barriers to Domestic Violence Screening in the Pediatric Setting
In a study designed to gain a greater understanding of barriers to DV screening in the pediatric setting, a third year pediatric resident and a mentor from the CPRG surveyed all pediatric practitioners in the Cincinnati area on their DV screening practices, their education on DV and their perceived barriers to DV screening. The study showed that practitioners grossly underestimate the incidence of DV in their practices and that lack of education including knowledge of screening recommendations is a barrier to DV screening by pediatricians.
The Impact of Disclosing Mandated Reporting When Screening Women for Domestic Violence in the Pediatric Setting
The purpose of this study was to compare the impact of prior information of mandatory state reporting on the reported prevalence of domestic violence (DV) by women. Women accompanying their children to well care visits at a hospital-based suburban practice in Kentucky were eligible for the study. The women were screened with a six-question tool to discern whether or not they had prior knowledge of mandatory state reporting. Two-hundred-ninety women were screened, with 154 and 136 in the two groups. The overall incidence of DV in the groups (31% vs. 21%) was not significantly different, but the incidence of recent abuse (events occuring within 24 months) was significantly lower in women who were informed of mandated reporting (17% vs. 6%, p < 0.01).
These findings suggest that when women are informed of mandatory reporting, they are less likely to reveal recent DV when screened. This is of particular concern as this group of women is at greatest risk for ongoing abuse. These results suggest that mandated reporting has a potentially negative impact on DV screening in the pediatric setting.
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Beginning in the winter of 1998, the CPRG collaborated with researchers from Cincinnati Children's Hospital Medical Center on a study of maternal perceptions of overweight preschool children. This study compared mother-child pairs in a primary care setting with mother-child pairs from WIC offices. More than 260 pairs were enrolled by the CPRG. The study demonstrated that while mothers could accurately assess their own level of obesity, less than a quarter of mothers accurately judged their overweight child as being overweight. Mothers with low education were less likely to perceive their children as being overweight.
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This initial study was done to gain a greater understanding of why parents call pediatric offices after-hours. More than 1000 parents were surveyed in two months. The results indicated that there was a need for parent education in the management of fever, ear pain, diarrhea and constipation. The time from development of the study idea to presentation of the final data at a national meeting (Ambulatory Pediatric Association, 1997) was only 18 months.
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Neonatal herpes can lead to serious complications and death in the untreated neonate, requiring anticipatory screening of new parents. Improving communication between physicians and parents when there is a possible neonatal exposure to HSV will potentially reduce distress among thousands of patients each year.
Accordingly, 20 physicians (primary care, subspecialists and residents) were interviewed regarding their experiences with neonatal herpes. The interviews were coded for relevant themes. The physicians' responses ranged from a medical approach to a separate consideration of medical and psychological concerns to an integrated approach. Generally, interview responses demonstrated that physicians experience unique and complicated issues associated with the diagnosis of neonatal herpes and the taking of sexual histories.
The results of this study support the importance of developing ways to improve the psychological management of suspected neonatal herpes. Pediatric psychologists can work with physicians to help improve medical education and training when communicating with patients about this difficult diagnosis.
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Using the Delphi technique (Dalkey, 1967; Dalkey N & Helmer O, 1962; Helmer O, 1967, 1983, 1994) an iterative process designed to query an interest group of experts assembled around a specific topic for the purposes of reaching consensus, pediatricians around the United States ranked the ten most common issues they dealt with in practice, the ten most important clinical research issues and the ten most important specific research questions. Among the common issues pediatricians deal with in their offices are otitis media, upper respiratory infections, vaccinations, fever, asthma and child behavior issues. Pediatricians felt that the most important clinical research issues were child behavior, asthma, and attention deficit disorder. (DeWitt, et al, unpublished data)
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