Research that Spans the Translational Spectrum
In the Division of General and Community Pediatrics, faculty members are engaged in a wide variety of research that ultimately addresses improving the health of children from underserved communities. From environmental and social determinants of health to healthcare quality to community health, faculty conduct epidemiologic, educational, qualitative, implementation science, outcomes, and population health research. Current studies include the Health Outcomes and Measures of the Environment (HOME) Study, led by Dr. Kimberly Yolton, PhD, which is following a cohort of mothers and children from 16 weeks gestation to 12 years of life to quantify the impact of low-level prenatal and childhood exposures to environmental chemicals on health, growth and neurobehavioral outcomes. National Institutes of Health (NIH) funding for the HOME cohort now totals over $15 million in direct costs to Cincinnati Children's Hospital Medical Center over 17 years.
A growing portfolio of interventional studies aim to improve the following outcomes: increase family engagement in care, improve clinical competency of trainees, decrease vaccine hesitancy, increase breast feeding rates and duration, prevent and decrease obesity, decrease externalizing behaviors, improve the coordination of care for children with medical complexity, improve the health of foster youth, reduce neighborhood preterm birth rates, increase reading proficiency, decrease food insecurity, and reduce health disparities in the community. Interventions deploy a variety of innovative strategies, including virtual reality based education for clinicians and family members, group visits, web-based portal and mobile device applications to support chronic disease management, integration of mental health services with primary care practices and schools, new care management and payment models for children with medical complexity, identification of children from high risk neighborhoods using geospatial mapping software, and partnering with children, families, community and civic leaders, educators, social service providers, faith leaders, healthcare providers, and others through the All Children Thrive collaborative learning network. Drs. Robert Kahn, MD, MPH; Andrew Beck, MD, MPH; Courtney Brown, MD, MSc; and William Brinkman, MD, MEd, MSc, were among those recognized with Cincinnati Children's Research Team Award for their contributions to this and other learning networks.
Leading efforts to make Cincinnati’s Kids the Healthiest in the Nation
The hospital’s 2020 strategic plan for community health seeks to reduce excess inpatient admissions and ensure physical and behavioral health at age 5 among Cincinnati’s most vulnerable children. The division spearheaded many of these efforts in FY18. This involved clinical leadership from Drs. Mona Mansour, MD, MS; John Morehous, MD; Zeina Samaan, MD; Courtney Brown; Mary Carol Burkhardt, MD, MHA; Andrew Beck; and Lisa Crosby, DNP, APRN, CNP, and clinical nursing director, Amy Haering.
Research leadership came from Dr. Brinkman. Dr. Kahn provides overall co-leadership of the 2020 initiative. The division has collaborated closely with other divisions on these goals, including Drs. Lori Stark, PhD, ABPP; Robert Ammerman, PhD, ABPP; Lori Herbst, MD; and Jessica McClure, PSyD, in the Division of Behavioral Medicine and Clinical Psychology. The efforts, though still early, were recognized when Cincinnati Children's was named a finalist for Hearst Health Prize for Excellence in Population Health.
Innovations in Care Delivery
In addition to our engagement with the Community Health Strategic Plan, the division has actively engaged in additional efforts to redesign care delivery to better meet the needs of our patients and families while working to ensure better health and wellness outcomes for our at risk patient populations. All of our general pediatric primary care sites are recognized by the National Committee for Quality Assurance (NCQA) as Level 3 Patient Centered Medical Homes, and our Complex Care Center is in the process of achieving recognition status.
Innovations aimed at improving preventive service delivery have included integration of behavioral health into our primary care practice sites led by Drs. Burkhardt, Morehous and Samaan, as well as testing telehealth to connect with newborns, patients with asthma, and for nurse triage. Ms. Haering, Dr. Kahn, and Ms. Liz Hutzel-Dunham, RN, created a model to enroll newborns in telehealth services at their first clinic visit to allow mothers to subsequently outreach to clinic in real-time for advice. Drs. Samaan, Burkhardt, Morehous, and Nick DeBlasio, MD, led implementation of walk-in ill and well child care which improved access for our patients and families. This resulted in a reduction of low acuity emergency department visits and helping to close preventive care gaps for children who have difficulty accessing scheduled appointments due to transportation or other barriers.
Dr. Greg Szumlas, MD, FAAP, and Ms. Tiana Henry have spearheaded literacy programs in our clinics including our Reach out and Read programs, as well as the Imagination Library program which has provided over 250,000 books to almost 13,000 children since its inception. Preliminary results show that Imagination Library children do 8% better on the literacy component of the kindergarten entry test – and that is only with two or less years of exposure. Subjective measures show a significant increase in parent engagement and ownership of early childhood education.
Drs. Mansour and Crosby, in partnership with numerous patient services colleagues, have implemented care management and community health worker models that support children in our practices with complex medical and social needs. Integration of critical community partners in our clinics to address social determinants of health has been a long standing priority. Over the past year, Dr. Burkhardt and Ms. Stephanie Coffey, LISW, in collaboration with the FreeStore FoodBank, implemented the Food As Medicine Family Market to provide shelf stable food for food insecure families during their primary care visits. This program has distributed over 13,000 pounds of food in the first year and connected children and families with in-clinic and community resources, as well as closed care gaps. Due to the program’s success, a second pantry is scheduled to open at the Pediatric Primary Care Center (PPC) under the leadership of Drs. DeBlasio, Melissa Klein, MD, MEd, and Ms. Julie Kleiman, RN. Under the leadership of Dr. Mansour, our clinics are active participants in the Ohio Department of Medicaid Comprehensive Primary Care Program that incentivizes practices that deliver high quality care while reducing cost of care.
Recognition for Excellence in Medical Educational
The Division of General and Community Pediatrics has a strong history of leadership and innovation in medical education. Our primary care sites serve as continuity clinic for over 120 pediatric residents and as 3rd year outpatient clerkship site for 125 medical students annually.
Several faculty members received recognition with institutional and national leadership roles and awards for their achievements in education.
Drs. F. Joe Real, MD, MEd, and Nick DeBlasio received an induction to the new Cincinnati Children's Medical Student Education Committee.
Dr. Roohi Kharofa, MD, MPH, named as the Co-Director of the Longitudinal Primary Care Clerkship at the UC College of Medicine.
Drs. Kristen Copeland, MD, and Kim Yolton continue to lead the General Pediatrics Research Fellowship which has been funded by a National Research Service Award (NRSA T32) from the Health Resources Service Administration since 1998.
Dr. Melissa Klein transitioned to the Director of the Academic Pediatric Association’s (APA) Educational Scholars Program, an application-based, national educator development program.
Dr. Nick DeBlasio won both the Cincinnati Children's Faculty Mentorship Award and the Faculty Teacher of the Year Award from the residency program.
Dr. Mary Carol Burkhardt won the Ray Baker Teaching Award from the Cincinnati Pediatrics Society.
Dr. Andrew Beck won the Excellence in Mentoring Award from the University of Cincinnati College of Medicine.
Drs. F. Joe Real and Melissa Klein served as mentors to Dr. Margot Lazow’s innovative virtual tour of underserved neighborhoods that was funded by the APA Resident Investigator Award and won the Ohio American Academy of Pediatrics’ (AAP) Shark Tank Award.
Collectively, divisional educators were involved (as PI, Co-I or Mentor) in five grants to promote educational innovations from national organizations including, Academic Pediatric Association, Patient Centered Outcomes Research Institute and Council of Medical Student Education in Pediatrics with over 10 publications.
Andrew F. Beck, MD, MPH
Dr. Andrew F. Beck, MD, MPH, focuses on improving child health outcomes through our identification and response to key social and environmental determinants of health. He has developed experience in place-based social determinants of health, health disparities and population health, and academic-community partnerships. With respect to his place-based work, he used geography to inform clinical care delivery, targeting interventions in ways that could improve outcomes for children across conditions while simultaneously reducing disparities. Academic-community partnerships are at the heart of such disparity reduction efforts, including collaborations with the local foodbank, with Health Department sanitarians, and through our local medical-legal partnership. Finally, Dr. Beck leads the population health work through the Cincinnati Children’s Hospital Medical Center and the All Children Thrive Learning Network that seeks to reduce disparities in inpatient bed-day rates across neighborhoods within Greater Cincinnati.
William Brinkman, MD, MEd, MSc
Dr. William Brinkman, MD, MEd, MSc, directs the division’s Research Section and our practice-based research network, the Cincinnati Pediatric Research Group. His research focuses on shared decision-making between patients, parents, and clinicians to promote high value care that is evidence-based and family-centered. His research on shared decision-making in the care of children and adolescents with attention-deficit/hyperactivity disorder is funded by the National Institute of Mental Health. He also collaborates to develop interventions to facilitate shared decision-making across a wide-range of clinical contexts.
Courtney M. Brown, MD, MSc
Dr. Courtney Brown, MD, MSc, conducts quality improvement research in pediatric primary care. Her particular area of interest is in promoting behavioral health and school readiness for children under 5 years of age. Her research focuses on the interface between primary care and community organizations to promote healthy development and address behavioral health problems. She has also worked extensively on developing primary care quality metrics retrieved from clinical data in electronic health records.
Kristen Copeland, MD
Dr. Kristen Copeland, MD, researches ways to prevent childhood obesity outside of the primary care clinic. She studied nutrition and physical activity environments in child-care settings, and currently is principal investigator of a USDA-sponsored national evaluation of the Child and Adult Care Food Program(https://www.fns.usda.gov/cacfp/child-and-adult-care-food-program). She is also studying ways to use wearable technologies (Fitbits) and group peer-to-peer sessions to encourage families to be more active and eat healthier. Dr. Copeland has taken on a leadership role in improving the school readiness of Cincinnati’s children under 6-years of age. With funding from PNC Trust, she directs the Early Childhood Education navigator in Pediatric Primary Care Center (PPCC) which helps link families to quality early childhood programs including preschool, Head Start, and home visiting programs. She is co-chair of the obesity
SIG (Special Interest Group) of the
Academic Pediatric Association. She is director of the
NRSA General Pediatrics Research Fellowship.
Nick DeBlasio, MD, MEd
Dr. Nick DeBlasio’s is the associate medical director and the resident continuity clinic director of the Pediatric Primary Care Center. His major academic interest focuses on medical education of both residents and medical students and care of underserved populations. He is currently enrolled in the
Academic Pediatric Association’s Educational Scholars Program.
Thomas G. DeWitt, MD
Dr. Thomas DeWitt, MD, is the director of the Division of General and Community Pediatrics and oversees medical education at Cincinnati Children's as the ACGME designated institutional Official and chair of the Graduate Medical Education Committee. He is primarily interested in innovation and research linked to outcomes in educator development, education systems, and early childhood reading and literacy.
Sheela R. Geraghty, MD, MS, IBCLC
Dr. Sheela Geraghty’s academic interests focus on barriers to successful breastfeeding. Dr. Geraghty participates in ongoing studies with lactation researchers at
Nationwide Children’s Hospital and
Cornell University. Dr. Geraghty established the Cincinnati Children’s Breastfeeding Medicine Clinic Research Registry which allows for the review of patient data in the electronic medical record as well as for follow-up after the clinic visit to determine patient satisfaction as well as improvement with breastfeeding outcomes. Dr. Geraghty is coordinating the effort to have a lactation consultant in the general pediatric clinics help improve breastfeeding rates.
Camille Graham, MD
Dr. Camille Graham, MD, research interests are health care disparities in minority children; asthma; and care coordination in primary care. Dr. Graham is collaborating with the
Center for Breastfeeding Medicine to reduce racial disparities in breastfeeding; with the
Division of Pulmonary Medicine to use community-engaged research to improve coordination between the family, the medical home, and the school for children who receive care at Cincinnati Health Department health centers; and with the
Division of Hospital Medicine to improve communication between primary care providers and residents during hospital admissions.
Mary V. Greiner, MD, MS
Dr. Mary Greiner, MD, MS, directs the Comprehensive Health Evaluations for Cincinnati’s Kids (CHECK) Center and focuses her research evaluating innovative approaches to delivering healthcare for children in protective custody (e.g. foster care). Current research projects include examining health risks among youth preparing to age out of foster care, analyzing the impact of the opioid crisis on child welfare, and developing and evaluating Integrated Data Environment to eNhance ouTcomes in custody Youth (IDENTITY), an automated and integrated platform to support near-real-time sharing of child welfare and Cincinnati Children’s electronic health record data.
Robert Harper, EdD
Dr. Robert Harper, EdD, research interests include multiple aspects of online learning, educational assessments and outcomes, and the professional development needs of health care professionals. He serves as the co-director of the online masters of education and certificate program.
John S. Hutton, MD, MS
Dr. John Hutton, MS, MD, is a primary care pediatrician and conducts research primarily in the Cincinnati Children's Reading and Literacy Discovery Center. His research involves the application of MRI to better understand the influence of modifiable aspects of home reading environment and shared reading behaviors on brain structure and function supporting emergent literacy, and his work was the first to document such effects prior to kindergarten. He is also exploring the effect of screen-based media on the developing brain, specifically language, attention and imagery networks. Other major areas of research are the development and application of children’s books for pediatric health literacy promotion, and clinic-based screening of emergent literacy skills and risk factors. Dr. Hutton’s goal is to more clearly frame shared reading as a critical health issue in pediatric primary care, especially in disadvantaged populations, and to help improve early interventions such as
Reach Out and Read.
Robert Kahn, MD, MPH
Dr. Robert Kahn, MD, MPH, studies social and biologic mechanisms that lead to child health disparities. He also co-leads the hospital’s community health strategic plan(http://www.actnowcincy.org/) to ensure that Cincinnati’s 66,000 children have the best chance to be healthy and thriving. To reduce child health disparities and address the pathways that cause them, Dr. Kahn has helped found and foster many partnerships between pediatric care and effective community partners, such as the Legal Aid Society, the Freestore Foodbank, United Way and the Cincinnati Public Schools. He is particularly interested in ‘precision’ tools to
map population health problems and improvement in science methods to collectively achieve better child outcomes. Dr. Kahn is the associate division director for the Division of General and Community Pediatrics and the associate chair for Community Health for the UC Department of Pediatrics.
Roohi Kharofa, MD, MPH
Dr. Roohi Kharofa's research focuses on the management of children with overweight and obesity in the primary care setting. Her long-term goal is to identify modifiable parent, provider, and healthcare system barriers to clinic attendance for obesity treatment in order to enhance care delivery and improve parent/child engagement, both of which are critical to improving obesity-related health outcomes. She is currently leading a quality improvement project in the primary care clinics focusing on physician prescription of weight management follow-up after routine well child checks.
Melissa Klein, MD, MEd
Dr. Melissa Klein, MD, MEd, is a general pediatrician, medical educator, and researcher. She is the director of the education section in the Division of General and Community Pediatrics. Dr. Klein is the director of the
General Pediatrics Master Educator Fellowship, an innovative fellowship focused on educational scholarship and leadership, the director of the Primary Care Pathway of the
Pediatric Residency Program and the medical director of the online Masters of Education Degree program. Her main research interest focuses on improving provider screening and management of the social determinants of health during routine well-child care through innovative educational experiences. She serves as the educational physician champion of for Child HeLP (Health Law Partnership) and is one the founding members of the KIND (Keeping Infants Nourished and Developing) partnership aimed at eliminating infant hunger. On the national level, she co-led the education committee of the
Academic Pediatric Association’s Poverty Task Force and led the development of a national curriculum on poverty that is available on the American Academy of Pediatrics
website. She also serves as the associate editor of
Education for Academic Pediatrics. In 2017, Dr. Klein became the director of the
APA’s Educational Scholar’s Program, a national educator development course focused on enhancing educational scholarship.
Mona Mansour, MD, MS
Dr. Mona Mansour, MD, MS, is actively engaged in research, QI, and operational efforts focused on the redesign of health care systems to support the patient/family centered medical home model. She is also working to ensure success in the changing health care landscape of value based care. She is Cincinnati Children's Hospital Medical Center’s physician leader for
Ohio Department of Medicaid’s Comprehensive Primary Care Program. Dr. Mansour co-leads a component of the community health strategic plan supporting community connected primary care. She received a promotion to professor of clinical pediatrics. Dr. Mansour is the associate division director for clinical activities.
Michelle L. McGowan, PhD
Dr. Michelle McGowan, PhD, specializes in researching ethical, regulatory, and social implications of reproductive, genomic, and mobile health technologies. Her recent research focuses the ethical and social implications of the rhetorical shift from personalized to precision medicine and precision health and genomic research taking place outside of traditional research contexts. Dr. McGowan's newest project on ethical, legal, and social implications of unregulated health research using mobile technologies is funded by the National Institute of Health.
John Morehous, MD
Dr. John Morehous, MD, interests include developing improved models for the delivery of primary care and supporting population health, as well as improving care delivery and coordination for children with complex health care needs. He helps oversee the divisional quality improvement portfolio, serves as a QI coach for a Rapid Cycle Improvement Collaborative team, and serves and medical director of the Fairfield primary care location.
Nicholas Newman, DO, MS, FAAP
Dr. Nicholas Newman, DO, MS, FAAP, directs the
Pediatric Environmental Health Specialty Unit (PEHSU) at Cincinnati Children’s and studies the effect of indoor and outdoor air quality on children’s health. He collaborates with environmental health and pulmonary researchers to develop interventions to improve indoor air quality. He works with health care providers, public health, and community members to bring environmental health research into practice through collaborative partnerships. Dr. Newman’s goal is to identify and eliminate environmental health threats to children.
Christopher Peltier, MD
Dr. Christopher Peltier’s research involves community based education of medical students and residents. His interests include what motivates community preceptors to teach and how best to train them to become better educators. He also collaborates to develop best practices in how to recognize community preceptors and how medical centers can effectively support the needs of community based teachers. He serves as the director of the division's community section and leads the
Faculty and Health Care Educator Program.
Judith R. Ragsdale, MDiv, PhD
Dr. Judith Ragsdale’s interests include the use of religion/spirituality in healthcare, specifically in the areas of finding meaning, coping, and medical decision-making. She is currently the principal investigator for a study of the use of religion by Arabic-speaking Muslim parents of children receiving blood and marrow transplant. She is collaborating on a study of the use of religion/spirituality for medical decision-making by parents choosing for/against bone marrow transplant with children with immunodeficiency disorders and by parents choosing for/against DNR (do not resuscitate) in palliative care.
Francis J. Real, MD, Med
Dr. Francis J. Real, MD, MEd, is a general pediatrician and medical education researcher. He is interested in curriculum development aimed at improving care for underserved populations and use of technology specifically virtual reality (VR) in medical education. He recently completed a study using VR to teach residents best-practice communication strategies in cases of influenza vaccine hesitancy. His VR curriculum resulted in a decrease in influenza vaccine refusal among residents that participated. This work earned him the Academic Pediatric Association's Ray E. Helfer Award in 2017 for creative, scholarly work in pediatric education.
Zeina Samaan, MD
Dr. Zeina Samaan, MD, has served as the medical director of the
Pediatric Primary Care Center (PPCC) since 2004 and as the associate director of Clinical Integration since 2016. Her main focus is in the area of primary care redesign. She collaborates with other primary care leaders in redesigning the system of care delivery to improve health promotion and prevention, access to medical care, outcomes for children with chronic disease, and patient and family experience, while decreasing the cost of care at a population level. She focuses on improving primary care preventive service delivery to the low income patient population served at the PPCC and she co-leads the Thrive By Five improvement initiative, a SP2020 Community Health Pillar goal, that aims at ensuring all five year olds have a healthy body and mind at Kindergarten entry.
Gregory A. Szumlas, MD
Dr. Gregory Szumlas, MD, has a special interest in kindergarten readiness, and early childhood literacy. He is director of the Cincinnati Reach Out and Read Coalition, coordinating Reach Out and Read at 24 clinics throughout Cincinnati. He is also coordinating the pilot of the Cincinnati affiliate of Dolly Parton’s Imagination Library, bringing books to the homes of children living in poverty within the
Cincinnati Public School District and observing the effect on kindergarten readiness. Dr. Szumlas is collaborating on several kindergarten readiness and literacy initiatives and studies in the community and Cincinnati Children's Hospital Medical Center clinics.
Kimberly Yolton, PhD
Dr. Kimberly Yolton, PhD, conducts epidemiological research on the impact of exposure to common environmental toxicants during gestation and childhood on health, development, and behavior outcomes from infancy through adolescence. She also collaborates on several studies of typical development in children.
NIH R01 grants support the majority of Dr. Yolton's work. She is associate director of the
NRSA General Pediatrics Research Fellowship. She is the section editor for the human neurotoxicology and epidemiology section of the Journal
Neurotoxicology and Teratology.
