Anderson Center Research
The James M. Anderson Center for Health Systems Excellence’s research portfolio includes a wide variety of projects related to health services research, learning network based research, and patient and employee safety research.
This year, Adam Carle, MA, PhD, is leading a project on the Patient Reported Outcomes Measurement Information System (PROMIS), a National Institutes of Health-funded initiative to develop and validate patient reported outcomes for clinical research and practice. This study will address impediments to the inclusion of pediatric PROMIS measures in clinical settings. It will develop and provide evidence for the validity of new computerized adaptive testing methods and establish recommendations that will increase the use and utility of PROMIS measures in pediatric clinical settings. He receives funding for his work from the National Institute of Arthritis and Musculoskeletal and Skin Diseases as part of the Pediatric Patient Reported Outcomes in Chronic Diseases Consortium.
Over the past year, David M. Hartley, PhD, MPH, continued his research into the global distribution and epidemiology of antibiotic-resistant infections and performed a review of the literature on Internet-based surveillance for biodefense. In addition, he participated as both a parent member and a researcher on the Improving Pediatric Quality Outcomes Committee of the American Society for Transplantation and Cellular Therapy, which is developing a new learning network.
The Anderson Center also offers educational programs for researchers in order to help build capacity for systems thinking and improvement science. The design of the Quality Scholars Program in healthcare transformation, under the leadership of Sarah Corathers, MD, is to develop researchers and leaders to transform pediatric health and healthcare delivery through faculty who will advance scholarship of health care improvement. We are proud of recent graduates: Mike Tchou, MD; Charles Varnell, Jr, MD, MA; Eric Robinette, MD; Adam Nelson, MD; and Nathan Pajor, MD.
Learning Networks Based Research
A healthcare system must deliver the right care to the right person at the right time, every time, in order to improve care. Over the past two decades, Anderson Center researchers worked to achieve that goal by helping to pioneer several learning networks, a type of learning healthcare system that facilitates collaboration to improve health, care, and cost. Our learning networks research focuses on understanding and optimizing these networks.
As learning networks continue to scale and multiply, Anderson Center researchers are working closely with a variety of partners to better understand the governance, technological, economic, and social conditions that will constitute the most hospitable ecosystem for the networks. Our researchers developed and are validating a conceptual and computational model of learning networks in order to better understand their mechanisms of action. They are working to understand more about the role of “engagement” in learning networks and how peoples’ energies accelerate both the development of those networks and also, potentially, impact outcomes. They are working to develop a way to measure engagement and scale that measurement, as well as developing interventions to increase engagement across stakeholders.
In addition, Anderson Center researchers are helping to extend the notion of learning networks towards clinical and translational research. New clinical research is underway through the network ImproveCareNow, funded by the Patient-Centered Outcomes Research Institute. Anderson Center faculty will also be collaborating with Eileen King, PhD; Maurizio Macaluso, MD, DPH; and Peter White, PhD, as part of the engagement and dissemination core for the NIH’s Rare Disease Clinical Research Network as Cincinnati Children’s steps into the role of data management and coordinating center for the research network.
Patient and Employee Safety Research
Our NIH, Agency for Healthcare Research and Quality (AHRQ), PCORI, and foundation-funded research on safety continues to contribute nationally, with patient and staff safety projects in hospital medicine, patient-centered care, ambulatory care, occupational safety, neonatal care, and others.
Healthcare has one of the highest rates of non-fatal occupational injuries. To address this issue at Cincinnati Children’s and in the wider healthcare community, Nancy Daraiseh, PhD, is leading an effort to establish an Employee Safety Learning Laboratory. The laboratory aims to align employee safety research and operations with three main objectives: 1) improve injury surveillance and develop predictive models to assist operational leadership with deploying effective preventive interventions; 2) leverage employee safety issues identified by hospital operations to inform new research into prevention strategies; and 3) develop evidence-based interventions which will receive rigorous testing in research projects and subsequent deployment through quality improvement efforts. The expectation is that implementation will positively impact employee experience and retention, quality of patient care, and hospital operating costs.
A multidisciplinary team including Dr. Corathers; Jennifer Ehrhardt, MD, MPH; Dr. Daraiseh; Patrick Brady, MD, MSc; Richard Ruddy, MD; Gary Geiss, MD; Steven Muething, PhD, and led by Eric Kirkendall, MD, received funding from AHRQ to study ambulatory patient safety and design and test interventions in collaboration with parents. This Ambulatory Patient Safety Learning Lab seeks to reduce diagnostic and medication errors in the ambulatory setting, leveraging the expertise of a transdisciplinary team that includes parents, clinicians, human factors engineers, design experts, and researchers and health system leaders in an innovative operations-research collaboration.
Dr. Brady and his team, including Carole Lannon, MD, MPH, and Dr. Walsh, worked with families of children with medical complexity to develop and test tools to improve communication and safety in the hospital. This work leverages the abundant and nuanced expertise that families know about their children in health and disease. Presently families are sharing—and measuring success against—family-stated care goals and are also using their child’s personalized vital sign norms so clinicians can better identify changes from the child’s usual health status.
Amanda Schondelmeyer, MD, whose work receives funding by a Place Outcomes Research Award, received publication in Hospital Pediatrics and the Journal of Hospital Medicine. Her team, which includes Drs. Brady and Daraiseh, contributes to the body of literature around alarm fatigue in the hospital setting, including aspects of how staff perceive alarms from continuous monitors to be helpful and how nurses infrequently respond to alarms by changing clinical management.
