Denice Cora-Bramble

Improving the Quality of Immunization Delivery to an At-Risk Population: A Comprehensive Approach

OBJECTIVE: Immunization quality improvement (QI) interventions are rarely tested as multicomponent interventions within the context of a theoretical framework proven to improve outcomes. Our goal was to study a comprehensive QI program to increase immunization rates for underserved children that relied on recommendations from the Centers for Disease Control and Prevention’s Task Force on Community Preventive Services and the framework of the Chronic Care Model. METHODS: QI activities occurred from September 2007 to May 2008 at 6 health centers serving a low-income, minority population in Washington, DC. Interventions included family reminders, education, expanding immunization access, reminders and feedback for providers, and coordination of activities with community stakeholders. We determined project effectiveness in improving the 4:3:1:3:3:1:3 vaccination series (4 diphtheria-tetanus-pertussis vaccines, 3 poliovirus vaccines, 1 measles-mumps-rubella vaccine, 3 Haemophilus influenzae type b vaccines, 3 hepatitis B vaccines, 1 varicella vaccine, and three 7-valent pneumococcal conjugate vaccines) compliance. RESULTS: We found a 16% increase in immunization rates overall and a 14% increase in on-time immunization by 24 months of age. Improvement was achieved at all 6 health centers and maintained beyond 18 months. CONCLUSION: We were able to implement a comprehensive immunization QI program that was sustainable over time.

Starting early: A life-course perspective on child health disparities - Research recommendations

On November 6–7, 2008, a multidisciplinary group of 70 researchers, practitioners, and funders gathered in Washington, DC, to develop this research agenda for eliminating child health disparities. The meeting focused on disparities, defined as “differences in health, health care, and developmental outcomes, particularly among racial and ethnic minority groups.” Led by the DC-Baltimore Research Center on Child Health Disparities, a collaboration of Howard University, Johns Hopkins University, and Children’s National Medical Center, the conference was sponsored by the National Center on Minority Health and Health Disparities, Eunice Kennedy Shriver National Institute of Child Health and Human Development, American Academy of Pediatrics, Agency for Healthcare Quality and Research, The Commonwealth Fund, Academic Pediatric Association, Lucile Packard Foundation for Children’s Health, and Robert Wood Johnson Foundation.

Graduate Medical Education Financing and Governance Reform: How Does the Institute of Medicine's Report Impact Pediatrics?

T he Institute of Medicine’s (IOM) recently published report, Graduate Medical Education that Meets the Nation’s Health Needs, recommends significant changes in the

The pediatrician's role in community pediatrics

15 billion per year, taxpayer funded graduate medical education (GME) program. An interdisciplinary, diverse, and ideologically disparate 21-member IOM Committee on the Governance and Financing of GME was charged with developing recommendations for policies to improve GME. They strived to critically review the empirical evidence and answer the overarching question: “To what extent is the current GME system producing an appropriately balanced physician workforce ready to provide high-quality, patient-centered, and affordable health care?” The committee concluded almost 2 years of deliberations by issuing a 209-page report in July 2014, which contains 5 bold recommendations to be phased-in over a 10-year period: (1) maintain Medicare GME funding at the current aggregate amount while transitioning to a performance-based system and a phase out of the current Medicare GME payment system; (2) build a GME policy and financing infrastructure, to include a new GME Policy Council in the Office of the Secretary of the US Department of Health and Human Services and a GME Center within the Centers for Medicare and Medicaid Services; (3) create 1 Medicare GME fund with 2 subsidiary operational and transformational funds; (4) modernize GME payment methodology to include replacing the current indirect and direct GME funding streams with 1 payment based on a national per-resident amount (PRA); and (5) maintain Medicaid GME funding at the state’s discretion. The report embeds cross-cutting themes of transparency and accountability while seeking to transform a dated, inpatient-based GME payment methodology to one that reflects the increasingly important ambulatory and community-based clinical and education sites. The report also implicitly recognizes that the publicly funded GME program must be responsive to the nation’s workforce needs in an evolving health care delivery system. Although adapting the current GME program may result in incremental change, the committee emphasized the need for transformational change.