• Health Services Research Projects

    The James M. Anderson Center for Health Systems Excellence seeks out health services research projects in which effective healthcare system interventions are disseminated into real-world practice settings and result in improved healthcare delivery and health outcomes. The following projects, led by our faculty, exemplify both the innovative and translational foci of health services research.

  • The Collaborative Chronic Care Network (C3N) is funded by the NIH through a Transformative TR01 grant.  This project is using an open-science framework to link researchers, clinicians and patient / family communities in the process and innovation of improving health. The C3N is a collaborative community with a shared purpose, common values and a flexible set of tools, including human (QI, leadership training, motivational interviewing, social networks, incentives) and information technologies

    Partners collaborating on C3N include:

    • Wondros, a nonprofit media and design firm with expertise in creating networked healing communities, viral communications and story-telling. The website Lybba.org was created by Wondros founder Jesse Dylan, a filmmaker whose “Yes We Can” video in support of the 2008 Obama campaign has more than 22 million YouTube hits.
    • Science Commons, which designs strategies and tools for faster, more efficient web-enabled scientific research
    • The MIT Center for Collective Intelligence, which studies the development of collaborative innovation networks and has cutting-edge tools for dynamic social network analysis
    • Ron Burt, PhD, a sociologist known for his work in social networks and social capital, and his colleagues at the University of Chicago Booth School of Business

    C3N is testing multiple innovative approaches to improve chronic illness.  The lessons learned will be applicable not only to the care of children with chronic disease but also to other improvement networks, extending their impact.

    Cincinnati Children’s has been awarded the honor of serving as the only pediatric Center for Education & Research on Therapeutics (CERTs) research center in the United States.  Funded by the federal Agency for Healthcare Research and Quality, the aim of the Cincinnati Children’s CERTs is to improve care and outcomes for children by optimizing the use of therapeutics. Subthemes are quality and safety.

    With a core infrastructure at Cincinnati Children’s and regional and national partnerships to enhance spread and translation into practice and policy, this center is focused on achieving significant innovations in patient safety, comparative effectiveness research and improvements in care.

    Four projects are under way in the current funding cycle:

    • Developing, testing and implementing a hydroxyurea (HU) patient-centered, technology-enhanced decision support intervention through the use of video narratives and visit decision aids
    • Determining huddle behaviors associated with improved treatment of patient deterioration and employing videotaped feedback to bring all Cincinnati Children’s huddles to the highest possible performance
    • Evaluating diffusion and implementation strategies to prevent prematurity and related lung problems by using antenatal corticosteroids and 17-hydroxyprogesterone in a statewide perinatal network
    • Developing processes to enable Learning Networks to produce, implement, and measure the outcomes that accrue from reliable use of shared decision-making (SDM) aids 

    The Cincinnati Children’s CERTs makes use of Learning Networks (multisite collaborations of patients / families, clinicians and researchers) as the innovation engines and laboratories that can help standardize care so that new approaches can be evaluated effectively and efficiently to improve therapeutic care and health outcomes for children. The Cincinnati Children’s CERTs also engages in activities that explore planned experimentation in complex health systems and the ethics and data sharing policies needed to enable large registry studies. Carole Lannon, MD, MPH, is the principal investigator. 

    For additional information, contact CERTs project manager Christina Bennett Farrell, MPH.

    The Cincinnati Home Injury Prevention (CHIP) and Literacy Promotion Study is a five-year study funded by the National Institute of Child Health and Human Development (NICHD), building upon the findings of the Health Outcomes and Measures of the Environment (HOME) Study. This randomized control trial will test the efficacy of the installation of multiple passive measures (cabinet locks, stairgates, smoke detectors) to reduce exposure to injury hazards in the homes of young children. Additionally, the CHIP Study aims to identify subgroups of mothers and children who benefit most from the intervention by examining potential moderators of maternal depressive symptoms, the intensity of supervisory behavior and child temperament and activity on the intervention and injury outcomes.   

    Mothers who participate in the Every Child Succeeds (ECS) home visitation program and have a child less than 5 months of age will be enrolled in the study.  Participants will be randomized to either receive injury prevention measures or be a part of a literacy effort that provides developmentally appropriate books and encourages mothers to gain interest in reading with their child.  Index children will be followed until they are approximately 24 months of age.  Measures of maternal and child psychology, child behavior and temperament will be obtained during home visits.  Maternal supervision and childhood injuries will be assessed repeatedly during quarterly phone questionnaires and home visits. The project PI is Kieran Phelan, MD, associate professor of pediatrics in the Anderson Center for Health Systems Excellence.  For additional information, contact project manager Stacey Liddy.

    The Ohio Perinatal Quality Collaborative (OPQC) is a statewide consortium of perinatal clinicians, hospitals and policy makers that aims, through the use of improvement science, to reduce preterm births and improve outcomes of preterm newborns. OPQC is a learning network that uses data for both improvement and research. Initial projects resulted in: 1) a 20 percent sustained decrease in bloodstream infections in premature infants among 24 NICUs, and 2) 16,000 fewer near-term deliveries without medical indications (20 OB units). This resulted in 12,000 fewer than expected Ohio births at 36-38 weeks, and 150 to 250 fewer near-term infants admitted to the NICU per year. Together, the reductions in infections and NICU admissions created estimated savings of at least $11 million annually. OPQC has now begun interventions to increase the use of antenatal corticosteroids to reduce the incidence of respiratory distress syndrome and mortality in preterm infants.  Quality improvement and project management support for OPQC is provided by faculty and staff within the Anderson Center for Health Systems Excellence; Carole Lannon, MD, MPH, professor of pediatrics, is the improvement design and implementation lead, and Barbara Rose, RN, MPH, is program director for OPQC.  For additional information, contact project manager Alyson Roeding.

    The Model for Understanding Success in Quality (MUSIQ) was developed as part of a research study funded by the Robert Wood Johnson Foundation.  MUSIQ is a conceptual model created to advance the understanding of the role of context in the evaluation and execution of quality improvement (QI) efforts. 

    Variation in the success of QI efforts has led to an appreciation of the importance of context in the effective implementation of QI methods. Characteristics of the organization, the environment, the individual and his or her role within the organization and QI team must be considered when studying and using QI methods in healthcare. 

    Developed using knowledge gained from a systematic review of the literature and engagement from a panel of QI experts, MUSIQ identifies 25 key contextual factors that influence QI success, organizes these factors based on the level of the healthcare system in which they are believed to operate, and outlines the mechanism of action by which these factors are believed to affect QI outcomes. MUSIQ was developed to align research and help practitioners manage the aspects of context that are influencing their QI efforts.

    Heather Kaplan, MD, MSCE, and Peter Margolis, MD, PhD, were the principal investigators. Key collaborators included Craig Froehle, PhD, and Lloyd Provost, MS.

    Publications and presentations related to the development of MUSIQ include:

    We have also created preliminary versions of an Excel tool and questionnaire that can be used to assess factors in MUSIQ. We welcome both researchers and those participating in QI efforts to use and adapt these tools to assess context in their QI efforts. 

    For additional information, contact Heather Kaplan.

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