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Those who study how to improve pediatric health care in America know that it takes almost seventeen years for evidence to make its way into clinical practice. “We have considerable room for improvement,” says Carole Lannon, MD, MPH, Director of Learning Networks in the James M. Anderson Center for Health Systems Excellence at Cincinnati Children’s. Now researchers at the Anderson Center are using a $4.25 million federal grant recently awarded by the Agency for Healthcare Research and Quality (AHRQ) to help close the gap between evidence and practice. The Center for Education and Research on Therapeutics (CERTs) grant is one of only six awarded nationwide – and the only one awarded to a pediatric medical center. “Overall, our aim is to take the evidence we learn from clinical trials and other research and get it into practice,” says Lannon, principal investigator for the grant. “Each of the projects involves a junior faculty as a key member, so this is a great way to develop new knowledge and train the next generation of implementation researchers”.
Every day, Cincinnati Children’s admits up to 30 children who need medications that could cause acute kidney injury (AKI). Every day, six or seven of these children actually suffer AKI.
In most cases, clinicians can quickly stop the damage. But outcomes can range from immediately life-threatening kidney failure to long-term risks of high blood pressure and heart disease.
One CERT project, led by Stuart Goldstein, MD, and Eric Kirkendall, MD, seeks to build tools into the hospital’s electronic medical records system to alert clinicians about patients most at risk of suffering kidney damage and routinely screen those at risk. Faster, more consistent identification will allow physicians to adjust medications or increase how often they test such patients for signs of damage.
As Goldstein’s team perfects these tools, the plan is to share these results with a network of nephrologists at academic medical centers
Patrick Brady, MD, has coined the acronym “UNSAFE transfer” to describe Unrecognized Situation Awareness Failure Events, which occur when a patient admitted to the ICU from a ward unit requires aggressive therapy within the first hour of arrival.
Brady and his patient safety colleagues at Cincinnati Children’s have developed protocols that have reduced these transfers by 28 percent. They believe they can decrease this number further by developing methods to better identify patients at risk of deterioration.
The kidney injury and ICU projects focus on developing predictive tools to prevent adverse events from happening within the hospital setting.
“We’ve been using various trigger tools for several years, but the way we were using them was after-the-fact,” Lannon says. “What we’re trying to do now is develop predictive trigger tools that allow clinicians to act before serious side effects develop.”
The Ohio Perinatal Quality Collaborative, formed in 2007, includes 24 neonatal intensive care units that serve about 96 percent of all preterm infants in Ohio. It also includes 20 of the state’s largest maternity hospitals, which deliver about 50 percent of all infants statewide.
This network already has decreased the number of infections in preterm infants and helped decrease the number of scheduled near-term births without medical indication, thus reducing the number of infants needlessly suffering the complications of preterm birth.
The Perinatal Collaborative is taking on new projects to increase the use of human milk in preterm infants and to encourage more consistent use of antenatal steroids, which help with lung development in premature babies. Heather Kaplan, MD, MSCE, will lead a project to evaluate the best ways to disseminate the group’s findings to the 95 maternity hospitals in Ohio that are not collaborative members.
“For example, what types of toolkits are effective?” Lannon says. “Do hospital teams learn just as well from webinars as from site visits by trained quality coordinators? Is one method better or do you need both?”
Childhood arthritis is the sixth most common childhood disease. Rheumatologists can use a variety of medications to control the condition, but the drugs come with a range of side effects.
One CERT project, led by Esi Morgan DeWitt, MD, MSCE, and Bill Brinkman, MD, MEd, seeks to encourage adherence to treatment by improving how clinicians communicate with families and patients. This project will involve 12 medical centers that have joined a rheumatology learning network.
“We are evaluating a shared decision-making process that encourages more focused discussions about treatment plans,” Lannon says. “What are the patients concerned about? What are the parents concerned about? What worries the doctors? Openly discussing these issues allows families to be more involved in the care plan. That in turn makes it more likely that patients will follow recommended therapies.”
All four of these projects have the potential to extend their impact through learning networks. Such networks are becoming valuable tools for scaling up the effect of medical research.
“Through learning networks, clinical teams can collaborate, accelerate the dissemination of evidence into practice, and innovate to develop new strategies,” Lannon says.
Carole Lannon, MD, MPH.
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