Research that Spans the Translational Spectrum

In the Division of General and Community Pediatrics, faculty members collaborate broadly and engage 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 Kimberly Yolton, PhD, which is following a cohort of mothers and children from 16 weeks gestation to age 12 to quantify the impact of 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 $16 million in direct costs to Cincinnati Children's over 18 years.

A growing portfolio of interventional studies aim to achieve 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 and social 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 behavioral 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.

Across the division, our faculty published 83 manuscripts in peer-reviewed journals this year, attesting to the dissemination of research, clinical, and education findings that are making a significant impact.

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. Robert Kahn MD, MPH, provides overall co-leadership of the 2020 initiative with clinical leadership from Mona Mansour, MD, MS; John Morehous, MD; Zeina Samaan, MD; Courtney Brown MD, MSc; Mary Carol Burkhardt, MD, MHA; Andrew Beck MD, MPH; Lisa Crosby, DNP, APRN, CNP; and Kristen Copeland, MD. The division collaborated closely with other divisions on these goals, including: Lori Stark, PhD, ABPP; Robert Ammerman, PhD, ABPP; Rachel Herbst, PhD; and Jessica McClure, PSyD, within the Division of Behavioral Medicine and Clinical Psychology (BMCP), and Carley Riley MD, MPP, MHS, in the Division of Critical Care Medicine. The James M. Anderson Center for Health Systems Excellence plays a pivotal role in leading and supporting the execution of the strategic plan.

Efforts, though early, are receiving national recognition. There were a number of peer-reviewed presentations at the 2019 Pediatric Academic Societies’ Annual Meeting, including an American Academy of Pediatrics Presidential Plenary talk by Dr. Beck on reductions in excess inpatient bed days.

Innovations in Care Delivery

Closely aligned with our engagement with the Community Health Strategic Plan, the division redesigned 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. The National Committee for Quality Assurance (NCQA) recognize all of our general pediatric primary care sites, and our Complex Care Center, as Level 3 Patient Centered Medical Homes. 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.

Open access in primary care, which allows families to walk-in without appointments for both urgent visits and routine checkups, continues to flourish and now accounts for 40% of patients seen in the Pediatric Primary Care Center (PPCC). This access resulted in a reduction of low acuity emergency department visits and is helping to close preventive care gaps for children who have difficulty accessing scheduled appointments due to transportation or other barriers.

Innovations include those focused on promoting healthy social-emotional development. Drs. Burkhardt, Morehous and Samaan led efforts with BMCP to integrate behavioral health into our primary care practice sites. Patients receive preventative behavioral health services during well child visits, promoting patient and caregiver resiliency and enhancing traditional anticipatory guidance. In addition, the Early Childhood Education Navigator Program, led by Dr. Copeland and Ms. Amy King, assisted 105 families newly enroll their child in a high quality preschool this past year.

Integration of critical community partners in our clinics to address social determinants of health is a long standing priority. Over the past years, Dr. Burkhardt and Stephanie Coffey, MS, LSW, 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 32,000 pounds of food in the first two years to 2700 individuals and connected children and families with in-clinic and community resources, as well as closed care gaps. Due to the program’s success, Nick DeBlasio MD, MEd; Melissa Klein, MD, MEd; and Julie Kleiman, RN, opened a second pantry at the PPCC. In the first five months of operation, the PPCC pantry served 870 children. Both locations seasonally offer fresh free produce markets as well.

Sheela Geraghty, MD, MSc, IBCLC, medical director for the Breastfeeding Medicine Clinic, led a lactation support service with certified lactation counselors and a lactation consultant which aims to increase the number of babies fed breast milk at our primary care practices. In addition, Julie Ware MD, MPH, IBCLC, developed the All Moms Empowered to Nurse (AMEN) project, comprised of mom-to-mom support groups in neighborhoods with low breastfeeding rates.

Dr. Crosby supported asthma care coordinators to implement telehealth to broaden their reach to patients at other clinic sites including our school based health centers.

Nicholas Newman DO, MS, medical director for the Environmental Health and Lead Clinic, developed a registry to improve care and follow-up provided to children.

Mary Greiner MD, MS, medical director of the CHECK (Comprehensive Health Evaluations for Cincinnati’s Kids) Foster Care Center, developed the Integrated Data Environment to eNhance ouTcomes in cusTody Youth (IDENTITY) data-sharing platform for children in protective custody (i.e. foster care) in Hamilton County, Ohio. IDENTITY supports access to integrated records for more than 600 child welfare and healthcare providers to improve healthcare delivery for more than 2200 children in Hamilton County Job and Family Services (HCJFS) custody. An Epic "FYI flag" alerts Cincinnati Children's users that a child is in HCJFS custody and directs them to IDENTITY to learn custody status, maltreatment history, and placement stability as well as current contact information and Medicaid ID number. Sharing important health information, such as diagnoses, medications, and upcoming appointments with HCJFS child welfare workers through IDENTITY to caregivers at the time of placement prevents gaps in healthcare. Information shared between HCJFS and Cincinnati Children's through IDENTITY totals more than 300 children each month. Expansion to Dayton Children’s Hospital and Montgomery County Children’s Services is underway with the goal to take IDENTITY statewide to improve outcomes for the 16,000 children in foster care in Ohio.

Recognition for Excellence in Medical Education

There is a strong history of leadership and innovation in medical education within the division. Our primary care sites serve as the continuity clinic for over 120 pediatric residents and as the 3rd year outpatient clerkship site for 125 medical students annually.

Dr. Klein, in collaboration with Daniel Schumacher, MD, MEd, from the Division of Emergency Medicine, received an Academic and Research Committee (ARC) Award to build the Cincinnati Education Research Unit. In addition, as part of this award, they will launch the Education Scholars Research Program to provide junior faculty with training and mentorship to launch successful educational research careers.

Several faculty members received recognition with institutional and national leadership roles and awards for their achievements in education. Drs. Copeland and Yolton continue to lead the General Pediatrics Research Fellowship that since 1998 receives funding by a National Research Service Award (NRSA T32) from the Health Resources Service Administration.

Jessica Walters, MD, won the Ray Baker Teaching Award from the Cincinnati Pediatrics Society.

Dr. Beck won the Junior Mentoring Achievement Award. Joseph Real, MD, MEd, and Thomas DeWitt, MD, won the Junior and Senior Faculty Educational Achievement Awards respectively at the Annual Cincinnati Children’s Faculty Awards.

Dr. DeBlasio graduated from the Academic Pediatric Association’s (APA) Educational Scholars Program after completion of a three year faculty development program with publication of his final project. Dr. Klein continues to serve as the director of the APA’s Educational Scholars Program.

Collectively, divisional educators had eight publications and has involvement (as PI, Co-I or Mentor) in five grants to promote educational innovations from national organizations including the Academic Pediatric Association, Patient Centered Outcomes Research Institute and Council of Medical Student Education in Pediatrics.

General and Community Pediatrics

Andrew F. Beck, MD, MPH
Dr. Beck focuses on improving child health outcomes through our identification and response to key social and environmental determinants of health. His expertise is in place-based social determinants of health, health disparities and population health, and academic-community partnerships. With respect to his place-based work, he uses 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. As part of this work, he seeks to develop a cross-division and cross-sector equity collaborative to ensure a continued move toward better outcomes and narrowed gaps.

William Brinkman, MD, MEd, MSc
Dr. Brinkman directs the division 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 receives funding from the National Institute of Mental Health. He also collaborates to develop interventions to facilitate shared decision-making across a wide-range of clinical contexts.

Scott R. Callahan, MD
Dr. Callahan serves as the medical director of the Complex Care Center since 2017. He investigates relationships between the systematic application of patient centric health care delivery and patient experience, population health, value, and provider satisfaction as it relates to children with chronic complex medical conditions and their families.

Kristen Copeland, MD
Dr. Copeland is a general pediatrician and researcher committed to equity and eliminating health disparities. She focuses on children’s early learning experiences at home and early care and education (ECE) settings as the key predictors of long term health and wellbeing. Dr. Copeland leads efforts to improve 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, as well as special education resources as needed. As a researcher with over 15 years’ experience in conducting community-engaged research with low-income populations and persons of color, she studies ways to prevent and treat childhood obesity outside of the primary care clinic. She studies 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. 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 is co-chair of the obesity SIG (Special Interest Group) of the Academic Pediatric Association. She is director of the NRSA T32 General Pediatrics Research Fellowship.

Nick DeBlasio, MD, Med
Dr. DeBlasio is the medical director of the Pediatric Primary Care Center (PPCC). He also serves as the resident continuity clinic director and medical student site director for the PPCC. Dr. DeBlasio’s main areas of interest include medical education of residents and students, clinical operations and care of underserved populations. Over the past year, Dr. DeBlasio worked with a team to help open an in-clinic food pantry and worked with the team to evaluate the impact of the food pantry on the overall medical care of children seen in the PPCC. Dr. DeBlasio graduated from the Academic Pediatric Association’s Educational Scholars Program this year after completing a project evaluating the impact of parental feedback on resident communication skills in the continuity clinic setting.

Thomas G. DeWitt, MD
Dr. DeWitt is the co-director of Cincinnati Children’s Pediatric Education Center and oversees medical education at Cincinnati Children's as the ACGME designated institutional official and chair of the Graduate Medical Education Committee. His interest is primarily 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. Geraghty co-directs the Cincinnati Children’s Center for Breastfeeding Medicine. Dr. 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 primarily focused on pumping breast milk and sharing milk. Dr. Geraghty coordinates the General and Community Lactation Support Service within the outpatient primary care clinics in which the goal is to increase the breast milk feeding rates of infants at the 2 month well child visit.

Mary V. Greiner, MD, MS
Dr. Greiner 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. Harper's 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.

Tzipi Horowitz-Kraus, PhD
Dr. Horowitz-Kraus has a main goal to define the foundations for typically developing reading abilities, vs atypically developing ones. In other words, how can we determine who is suffering from reading difficulties and what are the reasons for this struggle vs typically developing brains. Dr. Horowitz-Kraus plans to continue using objective measures such as functional MRI, EEG eye tracking data and genetics to help diagnose reading difficulty caused by dyslexia, attention difficulties, epilepsy or environmental factors such as screen exposure, and to point at ways to nurture the young brain vs exposure to books and reading.

John S. Hutton, MD, MS
Dr. Hutton is a primary care pediatrician and director of the Reading and Literacy Discovery Center at Cincinnati Children's. His research involves application of MRI to better understand the influence of modifiable aspects of home reading environment, shared reading practices and screen-based media on the developing brain, and his work was the first to document effects prior to kindergarten. He also developed and validated innovative approaches to screening emergent literacy skills and risk factors in pediatric clinical settings, and providing targeted guidance to families. Another active area of research involves the development and application of children’s books for pediatric health literacy promotion and anticipatory guidance, including safe sleep, breastfeeding, congenital heart differences and reading with infants. Dr. Hutton’s goals are to more clearly frame literacy as a brain-based developmental domain and social determinant of health, and to improve interventions and guidance provided to families. He currently serves as “spokes-doctor” for the Read Aloud 15 Minutes national campaign, on the national medical advisory board of Reach Out and Read, as an advisor to the national Imagination Library program, and as affiliated faculty of Every Child Succeeds. In 2019, he collaborated in the launch of Blue Manatee Literacy Project, the first non-profit children’s bookstore in the US with a mission to provide literacy experiences to underserved children, where he now serves as an advisor.

Robert Kahn, MD, MPH
Dr. Kahn studies social and biologic mechanisms that lead to child health disparities. He also leads the hospital’s community health strategic plan 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 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 has a particular interest 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. Kharofa is a general pediatrician with special expertise in weight management. Her research focuses on the management of overweight and obese children 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. She is also the co-course director of the Longitudinal Primary Care Clerkship at the University of Cincinnati College of Medicine. The design on this core/mandatory course is to introduce every medical student to the fundamentals of doctoring, moving from learning the concepts to practicing the specific skills and capacities.

Melissa Klein, MD, Med
Dr. Klein, associate division director, Career Development and Education, is a general pediatrician, medical educator, and researcher. She serves as the medical director of the Online Masters of Education program and the director of the Primary Care Pathway of the Pediatric Residency Program. Her main research interest focuses on improving provider identification and mitigation of the social determinants of health during routine well-child care through innovative educational experiences. She serves as the education physician champion of Child HeLP, our medical legal partnership, and is a key leader of both the KIND (Keeping Infants Nourished and Developing) program and the new Pediatric Primary Care food pantry aimed at eliminating child hunger. On the national level, she is the director of the Academic Pediatric Association’s (APA) Educational Scholars Program and serves as an associate editor of Education for Academic Pediatrics.

Mona Mansour, MD, MS
Dr. Mansour is actively engaging in research on 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 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. Dr. Mansour is the associate division director for population health.

Michelle McGowan, PhD
Dr. McGowan 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. The National Institute of Health funds Dr. McGowan's newest project on ethical, legal, and social implications of unregulated health research using mobile technologies.

John Morehous, MD
Dr. Morehous is a pediatrician and serves as the medical director of the Fairfield primary care location. His interests include developing improved models for the delivery of primary care and supporting population health, especially as it relates to perception of value for both care teams and families. He helps oversee the divisional quality improvement portfolio, especially its relation to the All Children Thrive Network and the effort to ensure that Cincinnati’s children are the healthiest in the country.

Nicholas Newman, DO, MS, FAAP
Dr. Newman 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. Peltier’s research involves community based education of medical students and residents. His interests include what motivates community preceptors to teach, how best to train them to become better educators, and the identity of 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. 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 developing a theory for chaplaincy based on the research in this field: religiously informed, relationally skillful chaplaincy theory. She is also co-investigator on a study underway at our College Hill campus: Understanding Religious and Spiritual Struggle Among Adolescents Admitted to an Inpatient Psychiatric Unit.

Francis J. Real, MD, Med
Dr. Real is a general pediatrician and medical education researcher. His interest is in curriculum development aimed at improving care for underserved populations and use of technology specifically virtual reality (VR) in medical education. He leads VR work related to provider communication around the influenza and HPV vaccines as well as patient education on asthma management. His work led to decreased rates of influenza vaccine refusal as well as improved asthma control among patients at the PPCC. Dr. Real won the Cincinnati Children's Faculty Educational Achievement Award this year for his innovative curricula aimed at improving patient outcomes.

Zeina Samaan, MD
Dr. Samaan is a general pediatrician who actively engages in quality improvement initiatives aimed at redesigning primary care delivery to better meet the needs of our underserved population with focus on improving primary care preventive service delivery to the low income vulnerable patient population served at our primary care centers. She leads the Thrive at Five improvement initiative: a SP2020 Community Health Pillar goal that aims at ensuring all 5-year olds have a healthy body and mind at kindergarten entry. Also, she is actively engaging in the behavioral health integration into our primary care practice sites.

Gregory A. Szumlas, MD,FAAP
Dr. Szumlas and Ms. Tiana Henry, with the help of Brandon Alvarez, spearheaded our “Prescription for Reading” literacy program, a unique combination of Reach Out and Read and Dolly Parton’s Imagination Library, targeting children living in poverty in the Cincinnati Public School District. This program educates families of preschoolers on the importance of reading at well child visits and sends monthly books directly to their homes, shows improved performance on the literacy portion of the kindergarten readiness test by 15% in its participants entering kindergarten when compared to children at the program’s start. Prescription for Reading operates at all Cincinnati Children's primary care sites and 20 other partner clinics in the community, serving over 15,000 children and sending over 400,000 books into the homes of children in need since its inception in July of 2015. Feedback from parents shows a significant increase in parent engagement and ownership of early childhood education and engagement in reading activities in the home. Recent fundraising success will allow us to expand the program to Mt Healthy, St Bernard/Elmwood place, and Lockland school districts.

Kimberly Yolton, PhD
Dr. Yolton 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 directs the Health Outcomes and Measures of the Environment (HOME) Study, a pregnancy and birth cohort study that began enrolling pregnant women in 2003 and recently completed follow-on on adolescents at age 12 years. She also collaborates on studies of typical development in childhood and the impact of prenatal opiate exposure on infant and child neurobehavior. NIH R01 grants support the majority of Dr. Yolton's work. She is director of research for the division and associate director of the NRSA General Pediatrics Research Fellowship. She is the editor for the Human Neurotoxicology and Epidemiology section of the Journal Neurotoxicology and Teratology.