Eric Slora

American Academy of Pediatrics, Elk Grove Village, Illinois, United States

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Publications (35)118.16 Total impact

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    ABSTRACT: Purpose: This study evaluates the translation of CheckpointsTM, an evidence-based parent-directed intervention that encourages parents to set limits on and monitor their novice teen’s driving, for delivery via brief intervention by pediatric practitioners (PEDs) caring for teens. The brief intervention refers parents to the website “” and encourages them to register and use the interactive CheckpointsTM agreement and other materials. Methods: In collaboration with Pediatric Research in Office Settings (PROS), the American Academy of Pediatrics practice-based research network, and its practitioners, study methods included developing: 1) PED intervention protocol (scripted) and materials (e.g, keychains); 2) PED recruiting plan and materials; 3) CheckpointsTM website with state-specific teen driver information; and 4) PED training plan and promotional materials. The website’s fidelity to CheckpointsTM was verified, and pilot-testing the PED intervention was completed. Recruitment resulted in 228 participating PEDs from 16 targeted states, with each PED completing IRB requirements and implementation training. Each PED delivers the two-minute intervention and distributes keychains (imprinted with and other materials to 35 families who meet eligibility criteria (parents of teens ages 14-17), and completes a post-study survey. Evaluation of the translation effort involves assessing distribution and fidelity from PEDs, and dissemination (reach, exposure, exploration, and access) and implementation (initiation, adoption, and maintenance) from parents. Google Analytics software collects website traffic information. Results: To date, 119 PEDs have completed training and are delivering interventions (41 have finished) to the required 35 families, with remaining PEDs soon to complete training and deliver interventions. A total of 2,803 parents have been reached by PEDs to date. Of 1,140 website visits, visitor engagement averaged 4.5 pages and 4.2 minutes, with a 44.6% bounce rate, results better than on comparable websites. Content/pages viewed most were teen driving risks, account registration, and state-specific teen driving laws. Twelve percent of visitors (127) registered; 119 agreements were created; and the printable agreement was accessed 266 times. Final, complete study data will be reported. Conclusions: PEDs are willing and able to deliver a brief intervention regarding teen driving safety to parents, and encourage them to use the CheckpointsTM website. The short message from a credible professional resource gets parents to the website, where they use proven-effective resources more than they might otherwise. Significance & Contribution: With motor vehicle crashes the leading cause of death among teens, effective prevention above and beyond graduated driver licensing is needed. Teen drivers who have parents actively engaged in monitoring their driving, are less risky drivers. Having PEDs deliver a brief intervention that guides parents to an evidence-based intervention on a website has the potential to reach many families and greatly enhance teen driver safety. * Funded by CDC’s National Center for Injury Prevention and Control
    No preview · Conference Paper · Oct 2013
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    Full-text · Conference Paper · Mar 2013
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    ABSTRACT: Background: Data from racially and ethnically diverse US boys are needed to determine ages of onset of secondary sexual characteristics and examine secular trends. Current international studies suggest earlier puberty in boys than previous studies, following recent trend in girls. Methods: Two hundred and twelve practitioners collected Tanner stage and testicular volume data on 4131 boys seen for well-child care in 144 pediatric offices across the United States. Data were analyzed for prevalence and mean ages of onset of sexual maturity markers. Results: Mean ages for onset of Tanner 2 genital development for non-Hispanic white, African American, and Hispanic boys were 10.14, 9.14, and 10.04 years and for stage 2 pubic hair, 11.47, 10.25, and 11.43 years respectively. Mean years for achieving testicular volumes of ≥ 3 mL were 9.95 for white, 9.71 for African American, and 9.63 for Hispanic boys; and for ≥ 4 mL were 11.46, 11.75, and 11.29 respectively. African American boys showed earlier (P < .0001) mean ages for stage 2 to 4 genital development and stage 2 to 4 pubic hair than white and Hispanic boys. No statistical differences were observed between white and Hispanic boys. Conclusions: Observed mean ages of beginning genital and pubic hair growth and early testicular volumes were 6 months to 2 years earlier than in past studies, depending on the characteristic and race/ethnicity. The causes and public health implications of this apparent shift in US boys to a lower age of onset for the development of secondary sexual characteristics in US boys needs further exploration.
    No preview · Article · Oct 2012 · PEDIATRICS
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    ABSTRACT: Background: Primary care interventions to address pediatric obesity have had limited success. It is unclear whether Motivational Interviewing (MI) could impact behavioral outcomes. Objective: Assess the impact of brief MI counseling on family diet, activity and media use for children at risk for obesity over a 1-year period. Methods: Data were collected as part of a 2-year national trial in 39 PROS and 15 DPBRN sites to test use of MI vs. usual care of children ages 2-8 in 85th-97th percentile for body mass index (BMI). Endpoints include changes in BMI percentile and parent reported grades of their child’s diet, activity, and media-use (grading on an A-F scale). The 3-arm design include usual care (Group (G) 1; n=150); MI by pediatricians (G2; n=109); or MI by pediatricians plus registered dietitians (G3; n=97). Analyses compared the 1-year change in parent-reported grades across groups. A positive outcome at 1 year is defined as: 1) positive grade change(s) for those with baseline grades B-F; or 2) maintenance of an A grade, for those with baseline A grades. Data were analyzed using logistic regression adjusting for child age, gender, parent income and education. Results: G2 MI number of visits ranged from 1-3 (mean=2.4, SD=0.7) and G3 visits ranged from 1-8 (mean=4.2, SD=1.4). For G2, parents indicated positive change in snack foods. G3 parents indicated positive change for snack foods, eating out, fruits and video/computer games. The odds of a positive outcome are presented below. Group 1=Reference. *p<.05, **p<.01, ***p<.001 Variable Group 2: Pediatricians Group 3: Pediatricians & Dietitians Eating out 1.1(0.7,1.9) 1.9(1.1,3.3)* Fruits 1.6(1.0,2.7) 2.7(1.5,4.9)** Physical activity 1.2(0.7,2.0) 1.7(1.0,2.9) Snack foods 2.3(1.4,3.8)** 2.8(1.6,5.0)*** Sweetened beverages 0.9(0.5,1.5) 1.3(0.7,2.4) Screen time 1.4(0.8,2.3) 1.4(0.8,2.4) Vegetables 1.2(0.7,2.0) 1.7(1.0,2.9) Video/computer games 1.2(0.7,2.0) 2.1(1.1,3.8)* Conclusions: A brief MI intervention was associated with positive changes to selected health behaviors at 1 year. Results suggest MI may hold promise for such changes in overweight children.
    No preview · Conference Paper · Apr 2012
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    ABSTRACT: This study will test the efficacy of motivational interviewing (MI) conducted by primary care providers and dieticians among children ages 2-8 years old with a body mass index (BMI) ≥ 85th and ≤ 97th percentile. Forty-two practices from the American Academy of Pediatrics, Pediatric Research in Office Settings Network were assigned to one of three groups. Group 1 (usual care) measures BMI percentile at baseline, and at 1- and 2-year follow-ups and receives standard health education materials. Group 2 providers deliver three proactive MI counselling sessions with a parent of the index child in Year 1 and one additional 'booster' visit in Year 2. Group 3 adds six MI counselling sessions from a trained dietician. The primary outcome is the child's BMI percentile at 2-year follow-up. Secondary outcomes include parent report of the child's screen time, physical activity, intake of fruits and vegetables, and sugar-sweetened beverages. We enrolled 633 eligible children whose mean BMI percentile was 92.0 and mean age of 5.1. The cohort was 57% female. Almost 70% of parents reported a household income of ≥ $40,000 per year, and 39% had at least a college education. The cohort was 63% white, 23% Hispanic, 7% black and 7% Asian. Parent self-reported confidence that their child will achieve a healthy weight was on average an 8 (out of 10). To date, several aspects of the study can inform similar efforts including our ability to use volunteer clinicians to recruit participants and their willingness to dedicate their time, without pay, to receive training in MI.
    Full-text · Article · Feb 2012 · Pediatric Obesity
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    ABSTRACT: This study examined the validity of primary health care providers' (PHCPs) assessment of suspicion that an injury was caused by child abuse and their decision to report suspected child abuse to child protective services (CPS). By using a subsample of injuries drawn from the 15,003 childhood injuries evaluated in the Child Abuse Recognition and Evaluation Study, PHCPs completed telephone interviews concerning a stratified sample (no suspicion of abuse; suspicious but not reported; and suspicious of abuse and reported) of 111 injury visits. Two techniques were used to validate the PHCPs' initial decision: expert review and provider retrospective self-assessment. Five child abuse experts reviewed clinical vignettes created by using data prospectively collected by PHCPs about the patient encounter. The PHCPs' opinions 6 weeks and 6 months after the injury-related visits were elicited and analyzed. PHCPs and experts agreed about the suspicion of abuse in 81% of the cases of physical injury. PHCPs did not report 21% of injuries that experts would have reported. Compared with expert reviewers, PHCPs had a 68% sensitivity and 96% specificity in reporting child abuse. A PHCP's decision to report suspected child abuse to CPS did not reduce the frequency of primary care follow-up in the 6 months after the index visit. PCHPs received information from their state CPS in 70% of the reported cases. Child abuse experts and PHCPs are in general agreement concerning the assessment of suspected child physical abuse, although experts would have reported suspected abuse to CPS more frequently than the PHCPs. Future training should focus on clear guidance for better recognition of injuries that are suspicious for child abuse and state laws that mandate reporting.
    Full-text · Article · Nov 2011 · Academic pediatrics
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    ABSTRACT: Twenty-five years ago, Robert Haggerty, MD, then newly elected as President of the American Academy of Pediatrics (AAP), made the formation of a national pediatric practice-based research network an integral part of his presidency. His reasons for promoting this idea were compelling. Family medicine already had begun recruiting and maintaining stable cohorts of practices to examine issues of importance in primary care. In pediatrics, however, primary care issues were being addressed largely by academic medical center investigators who did not have access to typical pediatric populations and who did their studies on samples drawn from the urban inner city environment. Inspired by the early work of a handful of family medicine networks, Dr Haggerty foresaw a stable network of pediatric practices to conduct research in "real world" settings, rather than in the academic settings where condition severity and comorbidity, as well as available technology and treatments, were atypical, limiting the generalizability of findings.1 The envisioned end product was the generation of new, compelling, and generalizable research to improve the health of the nation's children. From Dr Haggerty's vision sprang Pediatric Research in Office Settings (PROS)-a network that began with a modest 100 practices, and 25 years later, includes over 700 practices, active in every state, as well as in the District of Columbia, 2 Canadian provinces, and the Commonwealth of Puerto Rico (Fig 1-PROS map). The mission of PROS is to improve the health of children by conducting collaborative practice-based research to enhance primary care practice. In the service of that mission, with core support from the AAP and the Health Resources and Services Administration Maternal and Child Health Bureau, PROS has conducted more than 30 national studies, changed policy and practice, and contributed to the betterment of children's health. This article reviews the policy and practice changes realized, discusses key lessons learned along the way, and describes new horizons for the network, as it embarks on its next quarter century.
    No preview · Article · Nov 2011 · Current problems in pediatric and adolescent health care
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    ABSTRACT: Background: Literature documents that cigarette smoking in cars leads to intense exposure of occupants to tobacco smoke toxins. According to The Surgeon General's 2006 report, there is 'no safe level' of exposure. Objective: To determine parent self-reported prevalence of tobacco smoke exposure in cars among their children and to examine the factors associated with a strictly enforced car smoking ban. Design/Methods: As part of a cluster randomized controlled trial to address parental smoking (Clinical Effort Against Secondhand Smoke Exposure-CEASE), research assistants completed post-visit exit interviews with parents whose children had been seen in 7 control Pediatric Research in Office Settings (PROS) practices in 6 states. Parents who smoked were asked if they had a car, smoking rules in their car, smoking behavior, child's age, and if the pediatrician advised them to have a smoke-free car. Parents were considered to have a strictly enforced car smoking ban if they reported having a smoke-free car rule and that no one had smoked in their car for the past 3 months. Chi-square tests and logistic regression were used to assess factors associated with strictly enforced car smoking bans. Results: Of the 697 smoking parents enrolled, 528 (76%) reported having a car and answered questions about smoking rules in the car. Of those 528 parents, 146 (28%) reported having a smoke-free car rule, and only 114 (22%) reported having a strictly enforced car smoking ban. Of the parents who reported smoking in their car, 52% reported that smoking occurred with children present. Few parents who smoke (14%) were advised by a pediatric health care provider to have a smoke-free car. Multivariable logistic regression controlling for parent age, education, race and ethnicity showed that younger child age (OR 0.93; 95%CI 0.88, 0.99) and smoking fewer cigarettes per day (OR 0.91; 95%CI 0.88, 0.95) were associated with having a strictly enforced car smoking ban. Conclusions: This study demonstrated that the majority of smoking parents expose their children to tobacco smoke in their cars. Coupled with the finding of very low rates of pediatric intervention for smoking in cars, this study highlights the need for improved pediatric interventions, public health campaigns, and health policy regarding smoke-free car laws to protect children from tobacco smoke toxins.
    Full-text · Conference Paper · May 2011
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    ABSTRACT: The recently renewed Best Pharmaceuticals for Children and Pediatric Research Equity Acts (BPCA/PREA) have continued industry incentives and opportunities for pediatric drug trials (PDTs). However, there is no current assessment of the capacity to perform PDTs. The aim of this study was to deepen understanding of the capacity for US PDTs by assessing PDT infrastructure, present barriers to PDTs, and potential approaches and solutions to identified issues. Pediatric clinical research experts participated in semi-structured interviews on current US pediatric research capacity (February-July 2007). An initial informant list was developed using purposive sampling, and supplemented and refined to generate a group of respondents to explore emerging themes. Each phone interview included a physician researcher and two health researchers who took notes and recorded the calls. Health researchers produced detailed summaries, which were verified by the physician researcher and informants. We then undertook qualitative analysis of the summaries, employing multiple coding, with the two health researchers and the physician researcher independently coding each summary for themes and subthemes. Coding variations were resolved by physician researcher/health researcher discussion and consensus achieved on themes and subthemes. The 33 informants' primary or secondary roles included academia (n = 21), federal official (5), industry medical officer (8), pediatric research network leader (10), pediatric specialist leader (8), pediatric clinical pharmacologist (5), and practitioner/research site director (9). While most experts noted an increase in PDTs since the initial passage of BPCA/PREA, a dominant theme of insufficient US PDT capacity emerged. Subthemes included (i) lack of systems for finding, incentivizing, and/or maintaining trial sites; (ii) complexity/demands of conducting PDTs in clinical settings; (iii) inadequate numbers of qualified pediatric pharmacologists and clinician investigators trained in FDA Good Clinical Practice; and (iv) poor PDT protocol design resulting in operational and enrollment difficulties in the pediatric population. Suggested potential solutions for insufficient PDT capacity included (i) consensus-building among stakeholders to create PDT systems; (ii) initiatives to train more pediatric pharmacologists and educate clinicians in Good Clinical Practice; (iii) advocacy for PDT protocols designed by individuals sensitive to pediatric issues; and (iv) physician and public education on the importance of PDTs. Conclusions: Insufficient US PDT capacity may hinder the development of new drugs for children and limit studies on the safety and efficacy of drugs presently used to treat pediatric conditions. Further public policy initiatives may be needed to achieve the full promise of BPCA/PREA.
    No preview · Article · Apr 2011 · Paediatric Drugs
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    ABSTRACT: The goals were (1) to describe and to characterize pediatric clinical research networks (PCRNs) in the United States and Canada, (2) to identify PCRN strengths and weaknesses, (3) to evaluate the potential for collaboration among PCRNs, and (4) to assess untapped potential interest in PCRN participation. Data collection included (1) initial identification of PCRNs through an Internet search and word of mouth, (2) follow-up surveys of PCRN leaders, (3) telephone interviews with 21 PCRN leaders, and (4) a survey of 43 American Academy of Pediatrics specialty leaders regarding untapped interest in network research. Seventy exclusively pediatric networks were identified. Of those, specialty care networks constituted the largest proportion (50%), followed by primary care (28.6%) and disease-specific (21.4%) networks. A network profile survey (response rate: 74.3%) revealed that ∼90% held infrastructure funding. Nearly 75% of respondents viewed cross-network collaborations positively. In-depth telephone interviews corroborated the survey data, with cross-network collaboration mentioned consistently as a theme. American Academy of Pediatrics specialty leaders indicated that up to 30% of current nonparticipants might be interested in research involvement. Pediatric networks exist across the care continuum. Significant numbers of uninvolved practitioners may be interested in joining PCRNs. A strong majority of network leaders cited potential benefits from network collaboration.
    No preview · Article · Oct 2010 · PEDIATRICS
  • Eric J Slora · Richard C Wasserman

    No preview · Article · Jun 2010 · Pediatric Annals

  • No preview · Article · Feb 2010 · Journal of Adolescent Health
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    ABSTRACT: To describe the process and outcomes of local institutional review board (IRB) review for 2 Pediatric Research in Office Settings (PROS) studies. Pediatric Research in Office Settings conducted 2 national studies concerning sensitive topics: (1) Child Abuse Recognition Experience Study (CARES), an observational study of physician decision making, and (2) Safety Check, a violence prevention intervention trial. Institutional review board approval was secured by investigators' sites, the American Academy of Pediatrics, and practices with local IRBs. Practices were queried about IRB rules at PROS enrollment and study recruitment. Pediatric Research in Office Settings practices in 29 states. Eighty-eight PROS practices (75 IRBs). Main Exposure Local IRB presence. Local IRB presence, level of PROS assistance, IRB process, study participation, data collection completion, and minority enrollment. Practices requiring additional local IRB approval agreed to participate less than those that did not (CARES: 33% vs 52%; Safety Check: 41% vs 56%). Of the 88 practices requiring local IRB approval, 55 received approval, with nearly 50% needing active PROS help, many requiring consent changes (eg, contact name additions, local IRB approval stamps), and 87% beginning data collection. Median days to obtain approval were 81 (CARES) and 109 (Safety Check). Practices requiring local IRB approval were less likely to complete data collection but more likely to enroll minority patients. Local IRB review was associated with lower participation rates, substantial effort navigating the process (with approval universally granted without substantive changes), and data collection delays. When considering future reforms, the national human subject protections system should consider the potential redundancy and effect on generalizability, particularly regarding enrollment of poor urban children, related to local IRB review.
    Full-text · Article · Dec 2009 · JAMA Pediatrics
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    ABSTRACT: Few studies have systematically assessed the reliability of pubertal markers; most are flawed by limited numbers of markers and ages studied. To conduct a comprehensive examination of inter-rater reliability in the assessment of boys' sexual maturity. Eight pairs of practitioners independently rated 79 consecutive boys aged 8-14 years. Two raters in each of eight practices independently rated boys aged 8-14 years, presenting for physical examinations, on key pubertal markers: pubic hair and genitalia (both on 5-point Tanner scales), testicular size (via palpation and comparison with a four-bead Prader orchidometer), and axillary hair (via a three-point scale). Intraclass correlations assessing degree of inter-rater reliability for pubertal markers ranged from 0.61 to 0.94 (all significant at p < 0.001). Rater Kappas for signs of pubertal initiation ranged from 0.49 to 0.79. Practitioners are able to reliably stage key markers of male puberty and identify signs of pubertal initiation.
    No preview · Article · Apr 2009 · Journal of pediatric endocrinology & metabolism: JPEM

  • No preview · Article · Jan 2009
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    ABSTRACT: Primary care clinicians participating in the Child Abuse Reporting Experience Study did not report all suspected physical child abuse to child protective services. This evaluation of study data seeks (1) to identify factors clinicians weighed when deciding whether to report injuries they suspected might have been caused by child abuse; (2) to describe clinicians' management strategies for children with injuries from suspected child abuse that were not reported; and (3) to describe how clinicians explained not reporting high-suspicion injuries. From the 434 pediatric primary care clinicians who participated in the Child Abuse Reporting Experience Study and who indicated they had provided care for a child with an injury they perceived as suspicious, a subsample of 75 of 81 clinicians completed a telephone interview. Interviewees included 36 clinicians who suspected child abuse but did not report the injury to child protective services (12 with high suspicion and 24 with some suspicion) and 39 who reported the suspicious injury. Interviews were analyzed for major themes and subthemes, including decision-making regarding reporting of suspected physical child abuse to child protective services and alternative management strategies. Four major themes emerged regarding the clinicians' reporting decisions, that is, familiarity with the family, reference to elements of the case history, use of available resources, and perception of expected outcomes of reporting to child protective services. When they did not report, clinicians planned alternative management strategies, including active or informal case follow-up management. When interviewed, some clinicians modified their original opinion that an injury was likely or very likely caused by abuse, to explain why they did not report to child protective services. Decisions about reporting to child protective services are guided by injury circumstances and history, knowledge of and experiences with the family, consultation with others, and previous experiences with child protective services.
    No preview · Article · Sep 2008 · PEDIATRICS
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    ABSTRACT: 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 to child protective services. In this prospective observational study, 434 clinicians collected data on 15003 child injury visits, including information about the injury, child, family, likelihood that the injury was caused by child abuse (5-point scale), and whether the injury was reported to child protective services. Data on 327 clinicians indicating some suspicion of child abuse for 1683 injuries were analyzed. Clinicians reported 95 (6%) of the 1683 patients to child protective services. Clinicians did not report 27% of injuries considered likely or very likely caused by child abuse and 76% of injuries considered possibly caused by child abuse. Reporting rates were increased if the clinician perceived the injury to be inconsistent with the history and if the patient was referred to the clinician for suspected child abuse. Patients who had an injury that was not a laceration, who had >1 family risk factor, who had a serious injury, who had a child risk factor other than an inconsistent injury, who were black, or who were unfamiliar to the clinician were more likely to be reported. Clinicians who had not reported all suspicious injuries during their career or who had lost families as patients because of previous reports were more likely to report suspicious injuries. Clinicians had some degree of suspicion that approximately 10% of the injuries they evaluated were caused by child abuse. Clinicians did not report all suspicious injuries to child protective services, even if the level of suspicion was high (likely or very likely caused by child abuse). Child, family, and injury characteristics and clinician previous experiences influenced decisions to report.
    Full-text · Article · Sep 2008 · PEDIATRICS
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    ABSTRACT: The objective of this study was to determine whether patients' families' violence-prevention behaviors would be affected by their primary care practitioner's use of a violence-prevention clinical intervention during the routine well-child examination. In this 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 violence-prevention intervention or a control group (educational handout on literacy promotion provided). Primary caregivers of children who were aged 2 to 11 years and presented for a well-child visit were surveyed at baseline and 1 and 6 months. Practitioners were trained to (1) review a parent previsit summary regarding patient-family behavior and parental concern about media use, discipline strategies, and children's exposure to firearms, (2) counsel using brief principles of motivational interviewing, (3) identify and provide local agency resources for anger and behavior management when indicated, and (4) instruct patient-families on use of tangible tools (minute timers to monitor media time/timeouts and firearm cable locks to store firearms more safely where children live or play). Main outcomes were change over time in self-reported media use <120 minutes per day, use of timeouts, and use of firearm cable locks. Generalized estimating equation analysis revealed a significant effect at 6 months for decreased media use and safer firearm storage. The intervention group compared with the control group showed an increase in limiting media use to <120 minutes per day. There was no significant effect for timeout use. There was a substantial increase in storing firearms with cable locks for the intervention group versus a decrease for the control group. This randomized, controlled trial demonstrated decreased media exposure and increased safe firearm storage as a result of a brief office-based violence-prevention approach.
    Full-text · Article · Aug 2008 · PEDIATRICS
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    ABSTRACT: Regional primary care practice-based research networks (PBRNs) have made important contributions to the primary care literature, but have not been well-described. This study compares pediatric patient characteristics within a new regional PBRN to pediatric patient characteristics from two previously published national data sets. Descriptive patient data were collected by 25 Southwestern Ohio Ambulatory Research Network (SOAR-Net) clinicians between July 2003 and June 2004. These data were compared to pediatric patient characteristics from 57 Pediatric Research in Office Setting clinicians and 33 primary care pediatric clinicians who participated in the National Ambulatory Medical Care Survey. SOAR-Net patients were almost twice as likely to use Medicaid (41.9% vs 22.0%/22.4%, p = 0.0001). SOAR-Net patients also were more likely to be African-American (23.7% vs 7.5%/17.6%, p = 0.002). About one third of patients in each sample were seen for a well visit. Regional networks with unique characteristics, such as a large number of Medicaid patients and/or many underserved minority patients have the potential to make significant contributions to primary care research by focusing on problems experienced within those segments of a population (e.g., indigent children and their families).
    No preview · Article · Jul 2008 · Southern medical journal
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    ABSTRACT: The feasibility and effectiveness of a distance-based quality improvement model were examined in a cohort of Pediatric Research in Office Settings (PROS) practices, with the goal of improving immunization rates and practitioner behaviors and attitudes. Of an initially assessed 82 practices, 29 with baseline rates of < or =88% for children 8 to 15 months of age were randomized into year-long paper-based education or distance-based quality improvement intervention groups. Outcomes were utility/helpfulness of quality improvement modalities, immunization rate change, and behavior/attitude change. Quality improvement participants attended approximately 75% of monthly conference calls but used the quality improvement Listserv and Web site infrequently (mean 1.09 and 0.92 uses, respectively). Helpfulness ratings of quality improvement modalities mirrored usage. Analyses revealed a 4.9% increase in quality improvement group immunization rates (P = .061), a 0.8% education group increase (P = .752), and a 4.1% difference between groups (P = .261). More quality improvement practices adopted systems identifying children behind in immunizations. A distance-based quality improvement model is feasible and may improve immunization rates.
    No preview · Article · Jan 2008 · Clinical Pediatrics

Publication Stats

2k Citations
118.16 Total Impact Points


  • 1996-2013
    • American Academy of Pediatrics
      Elk Grove Village, Illinois, United States
  • 2008
    • University of Vermont
      • Department of Pediatrics
      Burlington, Vermont, United States
  • 2006
    • University of Chicago
      Chicago, Illinois, United States
  • 2001
    • University of North Carolina at Chapel Hill
      • Department of Maternal and Child Health
      North Carolina, United States