In This Issue
Research Spotlight:
The Possibilities Project
CPCE in the News:
Call for Applications
CPCE in the News:
The Electronic Health Record: A Pediatrician’s Best Friend or Worst Enemy
CPCE in the News:
COVID-19 News
Upcoming Events
Recent Publications
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The Possibilities Project |
The Possibilities Project (TPP), co-led by Alexander Fiks, MD, MSCE and Lisa Biggs, MD, is a unique collaboration of pediatricians, researchers, information services, and healthcare administrators that marries traditional research and quality improvement methodologies with innovation techniques in the CHOP Care Network. Established in 2017, TPP is both an innovation incubator and accelerator: it pilots small-scale data-driven projects to test a concept in the clinical environment before implementing it on a large scale. TPP uses 90-day pilot testing and 90-day implementation cycles based on the IHI Innovation Framework, which allows for the rapid development and testing of innovations and opens up opportunities for future research. Two examples of TPP projects are described below:
Flu Shot Text Message Reminders
This flu season, the CHOP Care Network launched a new model for flu shot delivery known as regional flu shot hubs which allow families to schedule and obtain their flu shots at their own office or at one of five regional flu shot hubs across the network. TPP engaged with the Care Network to develop five distinct flu shot reminder messages, which were sent to over 12,000 families in the network. The messages aimed to advertise the availability of the flu shots and identify which message framing works best for motivating parents to get a flu shot for their child. The team will measure which messages resonate most with families and will compare the flu shot rates between the participants of the pilot and families from the same practices who did not get a text reminder.
Adolescent Screener
TPP has worked closely with Care Network adolescent health leaders to develop and implement a 30-question adolescent screener, which streamlines and enhances the adolescent well child experience. We know that teens prefer screeners that are administered on tablets or other mobile devices compared to either paper screening or general questions asked by the clinician during a visit, and that teenagers are more likely to disclose their health risks with an electronic questionnaire, especially when combined with confidential time with their doctor. Through provider feedback, clinic observations and the iterative screener development process, the team developed and fielded a new adolescent screener that respects the communication preferences of teens while streamlining the adolescent visit from the provider side. In partnership with CPCE researchers, the TPP team is developing referral pathways for intervention for screened needs as we scale up this new model of care throughout the 31-site network.
Translating Research into Practice
TPP provides a model as CPCE implements its strategic plan to translate our Center’s cutting edge research into practice more broadly. If you have a project that is ready for translation into practice and you are interested in learning more about collaborating with TPP, contact Maura Powell. |
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Call for Applications
The CPCE is currently accepting applications for a T32-funded postdoctoral training program for the academic year beginning July 1, 2021. In an effort to enhance the diversity of our training programs, we are especially interested in identifying candidates from underrepresented minority backgrounds.
The Pediatric Hospital Epidemiology and Outcomes Research Training (PHEOT) program trains the next generation of clinical scientists who will understand how to best measure and improve outcomes, assure patient safety, and manage costs for hospitalized children. PHEOT is open to fellows in all clinical specialties, as long as their primary research is in hospital epidemiology and outcomes.
Note: At this stage funding for the academic year beginning July 2021 is not guaranteed, but we are optimistic that we will be able to offer positions. We expect to know with much greater certainty the likelihood of funding this month. Accordingly, applications for PHEOT will be accepted through November 15, but interviews will not be conducted until after greater certainty about funding, likely sometime in December or January.
The fellowship typically fund trainees for two years, and includes a stipend, tuition support, health insurance benefits, and some support for training related expenses such as books, software, or conference travel. Physicians who are United States citizens or permanent residents and have at least two years of postgraduate training are eligible to apply.
More information about the program, including how to apply, can be found here. |
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The Electronic Health Record: A Pediatrician's Best Friend or Worst Enemy
A study conducted outside of CHOP and published in Pediatrics sought to characterize pediatricians’ use of the electronic health record for outpatient encounters. The analysis included >20 million encounters by almost 30 thousand physicians from 417 health systems. The study confirmed that, like physicians who care for adult patients, pediatricians spend a large portion of their day using the EHR, on average 16 minutes per encounter. Chart review (31%), documentation (31%), and ordering (13%) functions accounted for most of the time. They found wide variation across specialties, although the time spent on each activity is similar across subspecialties.
CPCE and CHOP Department of Biomedical and Health Informatics (DBHi) core faculty member Naveen Muthu, MD, provided commentary on this study, along with co-author Raj Ratwani, PhD. Drs. Muthu and Ratwani outline the benefits of EHRs (guideline adherence, reduced errors, other measures of healthcare quality), and a major drawback: poor usability. They praise the study’s inclusion of a broad range of ambulatory pediatric settings, and the focus on measuring time on different tasks, but they note the importance of cognitive effort and workload as measures of usability, aspects that are missing from the study. In spite of this limitation, Drs. Muthu and Ratwani express optimism that the study will catalyze further work in pediatric EHR usability and safety.
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COVID-19 News
Cases are on the rise around the U.S. and the world. Brian Fisher, DO, MSCE discussed the situation with South Florida news outlets the Sun Sentinel and WINK News.
Susan Coffin, MD, MPH discussed the importance of immunizations, especially for the flu, in the context of keeping newborns healthy despite the pandemic. She also discussed ways to mitigate risk if gathering for fall and winter holidays.
Although cases are less common in children relative to adults, Latinx children are impacted by COVID-19 disproportionately. Dr. Coffin discussed these disparities with Generocity. “Black and brown children are more likely to get infected, require hospitalization if infected, and even require intensive care unit care,” she said.
Even with the fall surge in cases, data continues to indicate that schools, at least at the elementary level, can operate safely with the proper safety protocols in place. David Rubin, MD, MSCE talked with Boston public radio station WBUR about these protocols.
It is important to note, though, that the situation is highly dynamic. Whether Election Day earlier this week exacerbated increasing case counts across most of the country remains to be seen, as the Philadelphia Inquirer reported.
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Upcoming Events
Stanford Maternal & Child Health Research Institute Symposium
Date: November 6, 2020
Time: 11:30 am - 7:30 pm EST
This annual research symposium will bring together faculty, trainees, students, and postdocs from Stanford and beyond to explore the latest developments and innovations in maternal and child health research. The keynote speaker is David A. Williams, MD, the Senior Vice President and Chief Scientific Officer at Boston Children’s Hospital’s, and internationally-recognized pediatric hematologist and oncologist. Learn more and register here.
Post-Election Panel: What’s Next for Health Care Reform?
Date: November 6, 2020
Time: 12:00 - 1:00 pm
2020 has been an unprecedented year in health care, politics, and public health. Join a panel of Penn LDI Senior Fellows as they reflect on the outcomes of the presidential and congressional races and discuss the possible ramifications for health care reform in 2021. Learn more and register here.
The COVID-19 Pandemic and K-12 Schools: Updates From the Field
Date: November 9, 2020
Time: 12:00 - 1:30 pm
This webinar explores what we are learning about health and epidemiological issues as schools reopen for in-person education. Learn more and register here.
Pediatric KIDney Stone (PKIDS) Care Improvement Network Fall 2020 Engagement Symposium
Date: November 11, 2020
Time: 12:00 - 4:00 pm
This Symposium is an opportunity to learn about the experience of children and adolescents with kidney stones, the work PKIDS is doing to improve patient outcomes, and the importance of partner-based research projects in generating knowledge that improve outcomes that matter the most to patients. Learn more or register for this free event.
CPCE/PolicyLab Virtual Seminar Series
Date: Friday, November 13, 2020
Time: 12:00 noon - 1:00 pm
James Guevara, MD, MPH will present “Diversity in Pediatric Research: trends and interventions.” Attend via BlueJeans.
Harnessing Implementation Science to Promote Health Equity
Date: November 19, 2020
Time: 1:00 - 3:00 pm
This event is sponsored by the Consortium for Implementation Science, a joint endeavor of UNC Gillings School of Global Public Health and RTI International. Join virtually for a discussion on the intersection of implementation science and health equity. Learn more and register here. |
Recent Publications
Adolescent e-cigarette use has revealed a new phenomenon of e-cigarette vaping-associated lung injury (EVALI). It is important to better characterize EVALI in critically ill adolescents as this is a vulnerable and rapidly growing demographic. Brian Jenssen, MD, MSHP and his colleagues ran a single-center retrospective case series of patients <21 years old with confirmed or probable EVALI in a pediatric intensive care unit setting. Their results show nuanced differences in the presentation and management of the critically ill adolescent, and raise many questions about the long term implications on lung health, morbidity, and mortality.
Children presenting with musculoskeletal pain to pediatric rheumatology clinics are very heterogeneous and on a continuum from those with localized pain to total body pain. Many report intermittent, rather than constant, pain. Maitry Sonagra, MPH, Sabrina Gmuca, MD, MSCE and their team performed a retrospective, cross-sectional cohort study to examine clinical and psychological characteristics of these children at presentation and specifically those who fulfilled the criteria for fibromyalgia. Most children who presented to our clinic did not fulfill criteria for fibromyalgia but nonetheless had significant symptoms and disability. Studies focusing on fibromyalgia may miss the full extent of childhood amplified pain.
Concerns have been raised about the health effects of surface mining in the United States, particularly mountaintop removal mining where coal is mined upon steep mountaintops by removing the mountaintop through clearcutting forests and explosives. Researchers including Molly Passarella, Scott Lorch, MD, MSCE, and Heather Burris, MD, MPH used a control group design to assess the associations of surface mining in Central Appalachia with low birth weight and other adverse birth outcomes. Their observational study showed evidence in secondary analyses that surface mining was associated with low birth weight in the 2012-2017 time period and potentially beginning in the early to mid 2000s. Evidence for an association was not found prior to 2000.
While select cervicovaginal microbiota and psychosocial factors have been associated with spontaneous preterm birth, their effect on the risk of recurrence remains unclear. It is also unknown whether psychosocial factors amplify underlying biologic risk. Heather Burris, MD, MPH and her team ran a secondary analaysis of a prospective pregnancy cohort to determine the effect of nonoptimal cervicovaginal microbiota and perceived stress on the risk of recurrent spontaneous preterm birth. They found that, among a predominantly non-Hispanic Black cohort of women with a prior spontaneous preterm birth, a nonoptimal cervicovaginal microbiota is associated with increased odds of recurrent spontaneous preterm birth.
Adolescence and early adulthood are a high-risk period for non-adherence with treatment regimens in solid organ transplant recipients, leading to high rates of rejection and graft loss. Preventing medication non-adherence is the holy grail of transplant adolescent care. Sandra Amaral, MD, MHS contributed to this review of recent literature from the last 5 years on the topic of adherence in transplant recipients, highlighting insights and opportunities to promote adherence at the individual patient level, family level, healthcare system level, and community level. The recent work that is highlighted suggests that adherence interventions for prevention and treatment must be multifaceted, individualized, and longitudinal to be effective.
Disparities in sleep health are important but under-recognized contributors to health disparities. Ariel Williamson, PhD and her colleagues review the importance of understanding the factors contributing to sleep heath disparities and developing effective interventions as they are critical to improving all aspects of heath. Sleep heath disparities are impacted by socio-economic status, racism, discrimination, neighborhood segregation, geography, social patterns and access to healthcare as well as by cultural beliefs. Tapping the vast potential of technology in improving sleep health access may be an underutilized tool to reduce sleep heath disparities. Identifying, implementing, replicating and disseminating successful interventions to address sleep disparities have the potential to reduce overall disparities in health and quality of life.
There is an increasing recognition that structural abnormalities and functional changes in the placenta can have deleterious effects on the development of the fetal heart. Jill Savla, MD, MSCE and colleagues review the role of the placenta and the potential impact of placental insufficiency on fetuses with congenital heart disease. Placental disease is more common in pregnancies carrying a fetus with congenital heart disease and the fetal response to placental insufficiency may lead to the postnatal persistence of cardiac remodeling. The mechanisms underlying this placental-fetal axis of interaction potentially include genetic factors, oxidative stress, chronic hypoxia, and/or angiogenic imbalance.
Alexander Fiks, MD, MSCE discusses the future of Pediatric Primary Care (PPC). Although one PPC future may resemble its present state, a more innovative future is likely to include clinics and practices more oriented toward and linked to communities and directed at the social determinants of health. In addition, the rise in physical, behavioral, and social problems in practice call for a growing focus on wellness that promises to reorient the PPC future in productive new directions. The half-way technology of current electronic health record (EHR) systems will ideally be spun into electronic hubs that facilitate teamwork between PPC, specialists, and community groups.
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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.
CPCE E-News is edited by Holly Burnside. Please feel free to contact us with questions or feedback. |
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