Health Services Research
Health services and outcomes research in the Division of James M. Anderson Center for Health Systems Excellence has advanced this year in a range of areas: developing and testing of health systems interventions, pragmatic trials, use of ‘big data’ and measurement, and implementation science. Our researchers provide outstanding faculty development, with countless faculty participating in research and quality improvement training, fellowship, and mentoring programs.
A major evolution is fostering of a stronger collaboration among all stakeholders to co-produce health care system design. This has included studies of how to collaborate with patients, families, clinicians and health system leaders to set research agendas for future work. The division also hosted a major conference on health care co-production. Dr. Pat Brady, MD, MSc, led a team of researchers who received a Best Abstract award for “Partnering with families of children with medical complexity to better detect deterioration and improve hospital care.”
Learning Networks are organizational structures that facilitate collaboration at scale to improve health, care, and cost. Over the past eight years, The James M. Anderson Center for Health Systems Excellence and affiliated faculty received more than $50 million in federal research funding to develop and study Learning Networks; for clinical trials and other clinical and health services research that use the Learning Network infrastructure.
Learning Networks developed by the division have shown remarkable success in changing clinical outcomes: cutting serious safety events by 50%, decreasing mortality from hypoplastic left heart syndrome by 40% during the inter-surgery period, reducing elective preterm delivery by 75%, and increasing the proportion of children with inflammatory bowel disease in remission by 26%. Division Learning Networks are an object of study as well as a laboratory and platform (The New England Journal of Medicine) for researchers in the division, across Cincinnati Children's Hospital Medical Center, and across the country to collaborate with patients and clinicians on a wide range of clinical issues that matter most to patients and clinicians. During this same time-period, researchers published over 80 scientific journal articles .
Our greatest accomplishment over the last eight years has been to develop the infrastructure for the science and practice of Learning Networks. We are now poised to scale these, further transforming pediatric outcomes and guaranteeing data and laboratory infrastructure that will be highly competitive for research funding streams from National Institutes of Health (NIH) and other federal health research funders; from the National Science Foundation (NSF) and other federal science funders; and from foundations and industry.
This year we have realized a long-standing goal. All division faculty have been able to work together as a team using the network data and laboratory to demonstrate the utility of Learning Networks for science. Faculty are using networks as a platform for randomized trials (e.g. PCORI COMBINE and PRODUCE trials) and network ‘big data’ for large-scale health services research (e.g. PCORI PEDSnet Benchmarking in quality and safety). They are using the network data for advanced methods in complexity science. The network model has become an acknowledged standard across the country for transforming healthcare research and practice, as evidenced by our $9.3M award from PCORI to test how to scale up this model across disease networks within the PCORnet research transformation network.
Research on patient and staff safety continues to thrive at Cincinnati Children’s, through cross-divisional and interdisciplinary collaborations in many areas-patient engagement in safety, neonatal safety, and medication safety. Research in the outpatient safety includes visits to the homes of patients with chronic conditions to understand risk factors for errors in self-management, funded by AHRQ. In research funded by AHRQ, neonatal patient safety research includes the use of health IT to prevent administration errors, funded by the National Library of Medicine, and a study of clinician adherence to standardized care bundles, funded by NIH. Innovative research published by a team led by Dr. Nancy Daraiseh, PhD, explores types of injuries to hospital staff. Staff safety research also investigates the use of equipment to prevent injuries.
Research in medication safety is studying how to spread a novel intervention NINJA (Nephrotoxic Injury Negated with Just-In-Time Action) as part of the Solutions for Patient Safety (SPS) network. Observational studies are investigating the impact of antibiotics on hearing loss among children with cystic fibrosis and exploring types of injuries that occur among hospital staff.