Programs

Center for Education and Research in Therapeutics (CERTs), Cincinnati Children’s Hospital Medical Center

Overview

The mission of the Cincinnati Children’s Hospital Medical Center's CERTs Program is to improve outcomes for children by optimizing the use of therapeutics. Additional sub-themes, with expected impact beyond pediatrics, are:

Patient safety
Quality improvement methodology
Pharmacogenomics and personalized medicine

Current activities include:

Reduction of Adverse Drug Events (ADEs)

Decreasing harm from adverse events through the use of reliability science

Objective: Determine whether automated trigger detection and implementation of high reliability strategies can decrease frequency of Adverse Drug Events

Status:

Tested naloxone as trigger for oversedation, glucose while on insulin as a trigger for hypoglycemia
Triggers detect 5-6 times the Ads detected by traditional methods
Predictive value of triggers = 0.60 (60% of the triggers were ADEs)
Interrupted time series desgin to test effect of high reliability interventions on reducting ADE rate
Years 2-4: Test additional triggers, diffuse this innovation to other children's hospitals

Implications for:

Generalizing knowledge about improvign pediatric patient safety
Testing new models for diffusing innovations

Subspecialty Networks

Improving care for children with chronic conditions through Subspecialty Networks

Status:

Pediatric Inflammatory Bowel Disease Network (PIBDNet) Trailblazer Collaborative

- 15 academic pediatric gastroenterology centers

- 1,628 patients enrolled

- Increased reliability of care delivery

JCCHD
Years 2-4: New networks currently in development - rheumatology, endocrinology, emergency medicine, cardiology, neonatology, and critical care medicine

Implications for:

Testing different models for diffusing innovations in pediatric subspecialties
Evaluating effectiveness of elements of chronic care models

Pharmacogenetics

Impact of pharmacogenetic testing on treatment of children with antipsychotics

Objective: Examine the potential role of pharmacogenetics in improving effectiveness and safety of antipsychotics

Status:

Feasibility study complete: Describe issues regarding translation of pharmacogenetic knowledge to clinical and public health impact and suggest research and policy remedies
Years 2-4: Test association between metabolizer status and outcome, design and test intervention to tailor dosing based on metabolizer status

Implications for:

Understanding how to move from clinical innovations to health impact
Developing a framework for future research on clinical, public health impact of pediatric pharmacogenetic

National Performance Measures

Assessing and Improving national performance measures to improve effective use of therapeutics

Objective: Evaluate the use of measures approved by National Quality Forum as a means to assess and improve effective use of therapeutics in children in primary care practice

Status:

Phase 1: Assess reliability and accuracy of the performance measures for Otitis media with Effusion in primary care practice
Phase 2: Use test measures as a part of quality improvement effort to improve care and ensure consistency with guidelines; identify effective tools and strategies
Working with the American Academy of Pediatrics Quality Improvement Innovation Network and the Cincinnati Pediatric Research group, both primary care practice networks
Years 2-4: Additional measures and strategies for improvement

Implications for:

Assessing accuracy and reliability of pediatric quality measures that impact use of therapeutics
Testing effect of quality measures on improving care in pediatric practices

Data Core

Objective: Use publicly available H-CUP (e.g. KID, MANCS, NIS) datasets and commercial datasets containing inpatient drug utilization data (e.g. Premier and CHCA) to further expand the four core CERTs projects and to identify other areas of emerging interest in pediatric therapeutics

Status:

Analyzing PIBDNet registry data to validate outcome measures in pediatric inflammatory bowel disease
Analyzing Premier dataset to assess changes in use of anesthetic in hospitalized pediatric inpatients after FDA labeling recommendations
Assessed national impact of an expansion of the "non-payment for error" policy to pediatrics
Years 2-4: multiple analyses and manuscripts

Implications for: