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This paper contributes to the evidence base on the impact of the COVID‐19 on child marriage prevalence and on the protective potential of girl‐centred, community‐level interventions in buffering communities against aggregate shocks. Drawing on data from repeat cross‐sectional surveys completed with adolescent girls aged 12–19 in 609 villages in four states in India as a part of the More Than Brides Alliance impact evaluation, we examine whether the intervention appears to have impacted child marriage prevalence over its 5‐year implementation period, whether the onset of COVID‐19 affected ongoing trends in child marriage prevalence, and whether the intervention appeared to have buffered against increased child marriage risk resulting from the pandemic. Results show that significant differences emerged between treatment and control villages between midline and endline—and these differences were larger following the onset of COVID‐19—suggesting both that the treatment was successful in preventing child marriage and that the intervention had a protective effect. Results suggest that girl‐centred, community‐based interventions can help communities to weather environmental shocks and protect girls against potential increased child marriage risk during times of acute crisis. [ABSTRACT FROM AUTHOR]

Despite increases at age at first birth in the United States, we have little research on how individuals conceptualize the ideal age to have a child. Using qualitative interviews with male and female young adults in greater New York City, we examined individuals' responses to questions about the ideal age at first birth. We find factors associated with an age being ideal tend to fall in four main domains: structural/social position factors, interpersonal factors, fertility and health-related factors, and aspirational factors. This research suggests that the ideal age is higher than the actual age at first birth, and both males and females consider a number of factors when choosing an ideal age, including education and career. We find that interpersonal and aspirational factors are also important considerations. Understanding ideal age at first birth is important for understanding family formation decision making in relation to age and may have important implications in other areas. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether a new documentation-based clinical decision support system (CDSS) is effective in addressing deficiencies in the care of patients with coronary artery disease (CAD) and diabetes mellitus (DM)., Study Design: Controlled trial randomized by physician., Methods: We assigned primary care physicians (PCPs) in 10 ambulatory practices to usual care or the CAD/DM Smart Form for 9 months. The primary outcome was the proportion of deficiencies in care that were addressed within 30 days after a patient visit., Results: The Smart Form was used for 5.6% of eligible patients. In the intention-to-treat analysis, patients of intervention PCPs had a greater proportion of deficiencies addressed within 30 days of a visit compared with controls (11.4% vs 10.1%, adjusted and clustered odds ratio =1.14; 95% confidence interval, 1.02-1.28; P = .02). Differences were more pronounced in the "on-treatment" analysis: 17.0% of deficiencies were addressed after visits in which the Smart Form was used compared with 10.6% of deficiencies after visits in which it was not used (P <.001). Measures that improved included documentation of smoking status and prescription of antiplatelet agents when appropriate., Conclusions: Overall use of the CAD/DM Smart Form was low, and improvements in management were modest. When used, documentation-based decision support shows promise, and future studies should focus on refining such tools, integrating them into current electronic health record platforms, and promoting their use, perhaps through organizational changes to primary care practices.

Objective: To examine whether the Acute Respiratory Infection (ARI) Quality Dashboard, an electronic health record (EHR)-based feedback system, changed antibiotic prescribing., Study Design: Cluster randomized, controlled trial., Methods: We randomly assigned 27 primary care practices to receive the ARI Quality Dashboard or usual care. The primary outcome was the intent-to-intervene antibiotic prescribing rate for ARI visits. We also compared antibiotic prescribing between ARI Quality Dashboard users and nonusers., Results: During the 9-month intervention, there was no difference between intervention and control practices in antibiotic prescribing for all ARI visits (47% vs 47%; P = .87), antibiotic-appropriate ARI visits (65% vs 64%; P = .68), or non–antibiotic-appropriate ARI visits (38% vs 40%; P = .70). Among the 258 intervention clinicians, 72 (28%) used the ARI Quality Dashboard at least once. These clinicians had a lower overall ARI antibiotic prescribing rate (42% vs 50% for nonusers; P = .02). This difference was due to less antibiotic prescribing for non-antibiotic-appropriate ARIs (32% vs 43%; P = .004), including nonstreptococcal pharyngitis (31% vs 41%; P = .01) and nonspecific upper respiratory infections (19% vs 34%; P = .01)., Conclusions: The ARI Quality Dashboard was not associated with an overall change in antibiotic prescribing for ARIs, although when used, it was associated with improved antibiotic prescribing. EHR-based quality reporting, as part of "meaningful use," may not improve care in the absence of other changes to primary care practice.

Organizational complexity and interruptive workflows present challenges to communication in clinical workspaces, compromising healthcare quality and cost, and potentially leading to negative patient outcomes. To understand how information communication technology (ICT) could be improved, we reviewed the literature on inter-clinician communication problems, impacts on clinical workflows, ICT usage and barriers to communication. Our search yielded more than 300 articles; 98 met our inclusion criteria. In general, we found that clinical communication tends to flow along synchronous channels and is highly interruptive. Both electronic and non-electronic solutions to communication problems have met with mixed results. Implementation failures have been linked to barriers to technology adoption, including such factors as age, gender and computer experience. More research is needed to understand how improved communication reduces adverse clinical events and healthcare costs. Cost-effective ICTs to improve communication efficiency and workflow patterns in healthcare settings have great potential to enhance quality of care and reduce medical costs.

Acute Respiratory Infections (ARIs) are the number one reason for antibiotic prescribing in the United States, and much antibiotic prescribing for ARIs is inappropriate. We designed an electronic health record-integrated, documentation-based clinical decision support system for the care of patients with ARIs, the ARI Smart Form. To evaluate the ARI Smart Form and assess the feasibility of performing a larger trial, we conducted a pilot study with 10 clinicians who used the ARI Smart Form with 26 patients. Clinicians prescribed antibiotics to 6 of 6 patients with antibiotic-appropriate diagnoses and to 3 of 20 (15%) patients with antibiotic-inappropriate diagnoses. The average duration of use of the ARI Smart Form was 7.5 (SD+/-4.5) minutes. Eight of 10 respondents reported that the ARI Smart Form was either time-neutral or timesaving. The ARI Smart Form requires further evaluation but has the potential to improve workflow and reduce inappropriate antibiotic prescribing.

Results of a pilot study suggest that the Coronary Artery Disease and Diabetes Mellitus Smart Form may help clinicians in managing diet and exercise in patients with chronic diseases by making patient handouts and exercise prescriptions readily available at the time of the visit.

The effectiveness of electronic health record (EHR)-based clinical decision support is limited when clinicians do not interact with the EHR during patient visits. To assess EHR use during ambulatory visits and determine barriers to such use, we performed a cross-sectional survey of 501 primary care clinicians. Of 225 respondents, 53 (24%) never or only sometimes used any EHR functionality during patient visits. Non-physician clinicians (e.g., nurse practitioners) were marginally more likely to be EHR non-users than physicians (39% versus 21%, respectively; p = .05). The most commonly reported barriers to using the EHR during patient visits were loss of eye contact with patients (62%), falling behind schedule (52%), computers being too slow (49%), inability to type quickly enough (32%), feeling that using the computer in front of the patient is rude (31%), and preferring to write long prose notes (28%). EHR developers and healthcare system leaders must address social, workflow, technical, and professional barriers if clinicians are to use EHRs in the presence of patients and realize the full potential of ambulatory clinical decision support.