August 30, 2019
In This Issue

Research Spotlight: CPCE Research Reveals Feasibility of Shared Clinical Decision Support

CPCE In the News:
Interventions to Reduce Mental Health Problems, Drug Use, and Violence Exposure in Sexual and Gender Minority Youth

CPCE In the News:
PCORI Board approves $29 million for studies of ways to reduce suicide risk, treat type 2 diabetes, remove kidney stones in children, and treat childhood asthma

Upcoming Events

Recent Publications
CPCE Research Reveals Feasibility of Shared Clinical Decision Support
Sharing Clinical Decision Support (CDS) across institutions is feasible, at least in the case of health screening for newly arrived refugees, according to a recent report in JAMIA.

The research team included Evan Orenstein, MD (former CHOP Informatics Fellow and now Assistant Professor of Pediatrics at Emory University School of Medicine), Katherine Yun, MD, MHS, Dean Karavite, MS (CHOP Department of Biomedical and Health Informatics), and Jeremy Michel, MD, MHS.

CDS development and dissemination followed a 9-step process:

  1. Convene a working group of refugee health providers from institutions using the most commonly used electronic health record (EHR) vendor and public health stakeholders from state refugee health programs.
  2. Conduct a single-site user and task analysis of a typical immigrant health screening session which resulted in a workflow diagram.
  3. Remote validate the single-site workflow diagram across the working group using webinars and REDCap; identify common targets for process improvement using CDS.
  4. Develop working group consensus on the format, content, and acceptability of potential CDS interventions.
  5. Test for quality assurance and usability.
  6. Pilot test the CDS locally with refugee health providers and revise based on observation by informaticists and feedback from providers. Develop a technical procedure document for implementation.
  7. Pilot test the CDS at a remote site; revise the CDS and technical procedure guide based on feedback from lead clinician and lead analyst at the remote site.
  8. Disseminate the CDS via the vendor and through CDS Connect, an AHRQ-sponsored repository.
  9. Monitor activity on CDS Connect post-dissemination and conduct periodic outreach.

As a result of the post-dissemination monitoring, the team found that an additional external site implemented the CDS. The amount of staff time required for implementation diminished with each external site beyond the initial local implementation.

“Although there remain technical barriers to disseminating and implementing shared CDS, these appear to be diminishing over time as technological advancements continue,” the authors wrote. “This process suggests that even as technical barriers are overcome, the majority of the effort to develop shared CDS will need to focus on ensuring adequate matches between the shared CDS and local workflows.” 
Interventions to Reduce Mental Health Problems, Drug Use, and Violence Exposure in Sexual and Gender Minority Youth

CPCE Core Faculty member Nadia Dowshen, MD, MSHP and Carol A. Ford, MD, Chief of the Craig-Dalsimer Division of Adolescent Medicine at CHOP, were invited by Pediatrics to provide commentary on a review of interventions addressing mental health, substance abuse, and violence exposure among sexual and gender minority youth (SGMY). The review looked at over a decade of studies and found only 9 published interventions addressing mental health, 2 for substance use, and 1 for reducing violence victimization. Drs. Dowshen and Ford advocated for more research to guide care of SGMY, particularly to address fundamental questions such as optimal timing of interventions, longitudinal metabolic effects of treatment, appropriate guidance related to preservation of biological fertility, and how clinicians can best support SGMY and their families. Because these youth are often marginalized, Drs. Dowshen and Ford encouraged interventions and policies that leverage schools, community centers, and social media.

PCORI Board approves $29 million for studies of ways to reduce risk, treat type 2 diabetes, remove kidney stones in children, and treat childhood asthma

A project proposed by CPCE Core Faculty member Gregory Tasian, MD, MSc, MSCE is among 11 studies that were recently approved by the Patient-Centered Outcomes Research Institute (PCORI) Board of Governors. The project will compare three approaches to remove kidney stones in children: ureteroscopy (an endoscopic outpatient procedure), shockwave lithotripsy (a noninvasive outpatient procedure) or percutaneous nephrolithotomy (a minimally invasive surgery with a short hospital stay). This proposal arises from patients’ expressed need to better understand the effectiveness of different surgical approaches to remove kidney stones, the impact of surgery on their lives, and how long it takes to recover from surgery. CPCE Core Faculty member Michelle Denburg, MD, MSCE is a co-investigator.

Upcoming Events

Innovative and Efficient Trials Recruitment
Date: September 24, 2019
Time: 12:00 - 1:00 PM
Location: Colket Translational Research Building, Room 1200A
Panelists from: Clinical Research Information Services (UPenn), Recruitment Enhancement Core (CHOP), Clinical Reporting Unit (DBHi), and the Pediatric Research Consortium (PeRC), will share their expertise and experience with innovative and efficient trial recruitment. For more information and to RSVP, e-mai l ClinicalTrialsRAG@email.chop.edu.

Youth Mental and Behavioral Summit
Date: September 24, 2019
Time: 9:00 AM - 4:00 PM
Location: Community Behavioral Health, 801 Market Street, 11th Floor
The summit is intended to to help equip providers and caretakers of youth to engage in a trauma-informed, community-based system of care by identifying and addressing youth mental and behavioral health needs. All physical and behavioral providers and caretakers of youth across multiple sectors are welcome to attend. This event is supported by a CHOP Cares Community Fund grant, the Department of Behavioral Health and Intellectual disAbility Services, and Philadelphia University + Thomas Jefferson University. Register here.

Third Annual Integrative Health Symposium-From Pathogenesis to Salutogenesis: A Wellness Perspective for Patients and Their Healthcare Team
Date: September 27, 2019
Time: 8:00 AM - 4:00 PM
Location: Colket Translational Research Building
Salutogenesis is an approach that seeks to build on strengths and to support health in all the domains of a person’s life. In this one-day symposium, attendees will learn about salutogenesis and the relationship between stress, coping and health. Lectures will focus on how to manage provider stress and burnout and how to support a patient’s well-being through nutrition, mind-body techniques, positive psychology, trauma-informed care and other integrative modalities. Learn more and register here.

Global Health in Our Own Backyard: Controversies, Initiatives, and Innovations for Our Local Underserved Populations
Date: October 4-5, 2019.
Location: Colket Translational Research Building
Registration is now open for the 11th Annual CHOP Global Health Conference "Global Health in Our Own Backyard." This Philadelphia-based Conference will explore the intersections between domestic, local and international global pediatric health to better reach the underserved here in the United States. We will take inspiration from innovative programs in the U.S. and from around the world, and think critically about how to apply both South-North and national lessons to provide better, more equitable care in the United States. For more information, click here.
Recent Publications

There is limited research available for pediatric palliative care (PPC) interventions, practices, and programs in the United States. With the Pediatric Palliative Care Research Network, Chris Feudtner, MD, PhD, MPH, conducted a workshop in order to clarify challenges and priorities for PPC, focusing on PPC research topics and methods. Common challenges included patient diversity and small population size, workforce and infrastructure limitations, and presumed burden of PPC research for participants. Priorities included strengthened training for PPC investigators, developing core resources, improving communication, and more. The framework that emerged from this workshop can help guide individual investigators and research funders to further the field of PPC research. 

Many states have responded to an increase in non-medical vaccine exemptions (NME) by adopting education mandates (EM) that require vaccine education for parents requesting NMEs for their school-age children. However, these EMs vary widely in implementation. Kristen Feemster, MD, MPH, MSHP, contributed to a study to better understand the administrative aspects of each state’s EM, interviewing health department officials from nine states with EMs. The team found that states with EMs had a positive view of them, and recommended that other states adopt EMs as well, despite great variation in implementation. Tracking vaccine status after exemption requests and education will provide quantitative evidence of the effectiveness of EM programs.

HIV care is a complex and often non-linear process. Adolescents and young adults living with HIV have the lowest rates of retention in care of any demographic of people living with HIV. Youth living with HIV (YLWH) miss an estimated 1/3 of scheduled appointments, and of the youth who initiate antiretroviral therapy, 57% are later lost to care. In addition, differing definitions of “retention” make it difficult to synthesize the available research. Seeking to achieve greater understanding of the varying definitions of retention in care, Nadia Dowshen, MD, MSHP, and Sarah Wood, MD, MSHP, conducted analysis of YLWH who initiated care at CHOP. Using a variety of established definitions for retention in care, they tested whether retention variables were significantly correlated with one another, to assess whether the definitions were comparable. They found that most retention definitions were correlated, but not all, and recommend that researchers, clinicians, and policymakers consider the impact of differing definitions of retention. 

About CPCE

We are a pediatric research center dedicated to discovering and sharing knowledge about best practices in pediatric care by facilitating, organizing and centralizing the performance of clinical effectiveness research -- research aimed at understanding the best ways to prevent, diagnose and treat diseases in children. CPCE’s multidisciplinary team conducts research on a diverse range of clinical effectiveness topics.

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