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 seeks to improve child health and well-being. 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.

A growing portfolio of interventional studies aims to achieve the following outcomes:

• Increase family engagement in care.
• Improve clinical competency of trainees.
• Decrease vaccine hesitancy.
• Increase breastfeeding 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.
• Reduce barriers to high-quality child care.
• Reduce health disparities in the community.

Interventions deploy a variety of innovative strategies, including virtual reality based education for clinicians and family members, automated text messages, telehealth 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.

Researchers in the division were recipients of 15 new grant awards from internal, state and federal sources, totaling $6.3M in research awards in FY22. Across the division, our faculty published 134 manuscripts in peer-reviewed journals this year, a 31% increase over the previous 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

Cincinnati Children’s recent announcement of the Pursuing Our Potential Together (POPT) program recognizes many children in the Cincinnati community continue to experience poor health outcomes with experienced inequitably as a suboptimal outcome. POPT goals accelerate progress across community, care, cure and culture domains. Within the community pillar of this audacious program, our institution commits “to help make Cincinnati’s 66,000 children the healthiest in the nation through strong community partnerships.” Our division is playing a leading role. Indeed, given that >40% of Cincinnati children live in poverty, efforts focus on meeting the needs of the city’s highest-risk children, many of whom intersect with our primary care operations and those with whom we closely partner. Robert Kahn, MD, MPH, serves as the executive lead for these efforts, with several other faculty members bringing their leadership to key improvement initiatives: Andrew Beck, MD, MPH, Kristen Copeland, MD, and Zeina Samaan, MD.

Establishing three themes for the POPT-Community work by a broad coalition of partners will help ensure Cincinnati’s children are the healthiest in the nation. The first of the themes is entitled “Excellent and Equitable Health Outcomes.” North star metrics to guide this theme include the elimination of disparities in physical and mental health outcomes (morbidity and mortality). A second theme focuses on “Safe and Supported Families,” with metrics relating to cutting child food insecurity, child abuse and neglect, and addressing other social determinants of health-enhancing the positive and mitigating the negative. The final theme focuses on all children having a “Path to Full Potential.” This theme focuses on optimal development from prenatal to 5 years old with academic success from kindergarten through high school, explicitly aligning with Cincinnati Public Schools’ goals.

The division’s faculty play key roles across all three themes – leading health equity efforts, driving community partnerships to mitigate social determinants, leading primary care and early childhood education initiatives, and supporting social-emotional development in school. For example, Beck co-leads the institutional Health Equity Network (HEN). The HEN uses proven learning network methods to bring together clinical teams, each working on reducing inequities by addressing shared drivers. The division’s primary care centers have a history of meaningful points of connection to community resources. We are leveraging these connections to bolster the work of the HEN. Cincinnati Child Health-Law Partnership (Child HeLP) connects low-income families with legal advocacy. A recent high-impact Health Affairs journal publication describes how this connection addresses health-related social needs and reduces hospitalizations. The COVID-19 pandemic only exacerbated such needs and amplified the importance of such partnerships. The division was instrumental in obtaining two large grants to build upon and study these innovations. The first is to create an Asthma Learning Health System with clinical and community partners from across the institution and community, with funding from the Cincinnati Children’s Academic & Research Committee. The second is R01 funding through the Agency for Healthcare Research & Quality to create a medical-social response system to pursue equitable child health outcomes.

Innovations in Care Delivery

To closely align with our engagement in the community pillar of POPT, the division is redesigning 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. Mary Carol Burkhardt, MD, MHA, leads our primary care operations. All of our general pediatric primary care practices, school-based health centers, and our Complex Care Center are active participants in the Ohio Department of Medicaid Comprehensive Primary Care Program, under the leadership of Mona Mansour, MD, MS. This program incentivizes practices that deliver high-quality care while reducing the cost of care. Our primary care sites also partner with HealthVine, a Cincinnati Children’s Accountable Care Organization that aims to provide care more effectively and affordably for Greater Cincinnati children with Medicaid insurance. Mansour serves as medical director for community engagement, and Beck serves as medical director for population health research and innovation for HealthVine. Our pediatric primary care practices are inaugural members of HealthVine’s Pediatric Improvement Network for Quality (PINQ), a learning network aimed at providing excellent and equitable care in the primary care setting through strong partnerships. Also, many divisional members are actively engaged in developing a coordinated school strategy that will help fully leverage the resources, skills and talents of our division and the organization to support health and educational outcomes.

Varied patient / family outreach methods are increasingly important as many children have fallen behind on preventive care services during the pandemic. Innovations include conducting randomized controlled trials to test different methods of outreach (i.e., automated text messages, personal phone calls, MyChart messaging, etc.) to increase visit scheduling and completion and on-time vaccination. The result of these innovations is a standardized outreach schedule to those overdue for care. Primary care has vaccinated eligible youth, and interested household members, against COVID-19 since May 2021. Primary care administered over 7,000 COVID-19 vaccines, and our publication in the Journal of Pediatrics described the efforts to include household members. Although widespread vaccination against COVID-19 across communities requires multilayered approaches, we see our primary care offices playing an important role in bringing access and trust to a situation that needs both.

Greg Szumlas, MD, led efforts to expand the impact of our literacy promotion programs to reach children throughout Hamilton County. Ohio First Lady Fran DeWine and others shared proclamations at celebrating one million books distributed in Hamilton County by our Imagination Library team. Literacy promotion continues to be an active area of research. John Hutton, MD, MS, is the recipient of research funding to conduct a randomized trial of a structured approach to parent-infant reading and limiting screen time during pediatric well-visits (NICHD R21) and to study the implementation of his reading house literacy screener in primary care, preschool and community settings (Cincinnati Children's Place Outcomes Research Award).

Integration of critical community partners in our clinics to address social determinants of health is a long-standing priority. Burkhardt, Melissa Klein MD, MEd, Nick DeBlasio MD, MEd, Stephanie Coffey, MSW, LSW, and Julie Kleiman, BSN, RN, continue to collaborate with the FreeStore FoodBank, and Amy Mahan MSW, LISW, collaborates with Shared Harvest to provide shelf stable food for food insecure families during their primary care visits. In addition, Kim Brown, a social worker who serves as our community resource liaison, Child HeLP and psychology services, connects with many of these families to address and mitigate the underlying causes of food insecurity. Pantries now stock toiletries and other non-food essentials, which have been critical to families during the pandemic.

Scott Callahan, MD, serves as medical director for the Complex Care Center. In continued collaboration with the Cincinnati Children's telehealth team, who received a large grant from the Federal Communications Commission, our team deployed more than 400 Tytocare medical kits in the homes of complex care patients to enhance telehealth visits. Collaboration with Patrick Brady, MD, MS, in the Division of Hospital Medicine fueled additional innovation. The completion of more than 30 transition huddles occurred as part of a research study entitled “Improving Hospital to Home Transitions for Children with Medical Complexity.” This pilot data fueled a successful grant application to the Patient Centered Outcomes Research Institute to conduct a randomized controlled trial. Arielle Randolph, MD, led a quality improvement team focusing on social needs screening. Collaboration with our primary care food pantry and the HealthVine community health workers addressed food insecurity. Randolph shared the results from this project through an oral presentation at the Pediatric Academic Societies’ Annual Meeting.

Sheela Geraghty, MD, MSc, IBCLC, serves as medical director for the Breastfeeding Medicine Clinic, which continues to operate in four Cincinnati Children's neighborhood locations. Last year exceptional teamwork led to the filling of 99% of available appointments, ensuring that breastfeeding mothers and their babies receive the help they need. The team also supports our primary care practices with the goal of helping to feed more infants breast milk. In addition, Julie Ware, MD, MPH, IBCLC, continues to lead mom-to-mom support groups in neighborhoods with low breastfeeding rates and is now on a weekly virtual platform making it accessible to all. The program, entitled All Moms Empowered to Nurse (AMEN), is on its fourth cycle of funding from various sources (CCTST, AAP CATCH, Ohio Department of Medicaid, and Ohio Department of Health). Funding from the National Association of City and County Health Officials through the Continuity of Care in Breastfeeding Support grant enhanced community breastfeeding efforts. A multidisciplinary team is working on improving support for families in the workplace, businesses and childcare, as well as improving "Warm Handoff" care from newborn discharge to home. New funding from the Ohio Department of Health Innovations to Advance Breastfeeding and Health Equity will help to launch a Community Breastfeeding Ambassador Program.

Nicholas Newman, DO, MS, medical director for the Environmental Health and Lead Clinic, is widely recognized for his technical and research expertise through membership on a World Trade Center Health Program Scientific & Technical Advisory Committee, membership on the Ohio Governor’s Lead Advisory Committee, holding chair of the Ohio Department of Health Lead Advisory Committee, and leadership of the Community Engagement Core for the National Institute of Environmental Health Sciences (NIEHS) funded Center for Environmental Genetics at the University of Cincinnati. This past year, he was elected to the AAP Council on Environmental Health and Climate Change and is completing his coursework to obtain a climate change and health certificate from Yale School of Public Health. In addition, Newman, with colleagues from the University of Cincinnati, applied to NIEHS to renew the Environmental Health Sciences Core Center at UC.

Mary Greiner, MD, MS, is the medical director of the CHECK (Comprehensive Health Evaluations for Cincinnati’s Kids) Foster Care Center, which provides healthcare to youth in protective custody. The CHECK program includes CHECK-IN, a co-located service at Hamilton County Job and Family Services, providing over 400 medical consultations per month and healthcare education to child welfare professionals. The Integrated Data Environment to eNhance ouTcomes in cusTody Youth (IDENTITY) data-sharing platform, which created integrated health and child welfare records for more than 3,000 children in protective custody, is licensed to a commercial partner, Cordata Healthcare Innovations. Cordata is currently in talks with over 35 health institutions and child welfare organizations in efforts to spread IDENTITY statewide and nationwide. IDENTITY is the recent topic of a funded Place Outcomes Research Award to measure impacts on clinical care delivery. Finally, the CHECK Center’s Child Welfare Research Lab recently received a nearly $5 million five-year grant from Substance Use and Mental Health Services Administration (SAMHSA) to implement a substance use screening, brief intervention and referral to treatment programs for adolescents in protective custody.

Recognition for Excellence in Medical Education

The Division of General and Community Pediatrics has a strong history of leadership and innovation in medical education. Our primary care sites serve as the continuity clinic for over 120 pediatric residents and as the third-year outpatient clerkship site for approximately 100 medical students annually.

The online master's degree in education (MEd) and certificate programs, led by Robert Harper, EdD, and Klein, reached new heights in enrollment despite the COVID-19 pandemic. The MEd program graduated 246 students, including 35 Cincinnati Children's employees. Currently, there are 115 students (81 MEd; 34 certificate) with 13 Cincinnati Children's faculty and 25 Cincinnati Children's fellows currently enrolled in both programs.

In collaboration with Daniel Schumacher, MD, PhD, MEd, PhD (Co-PI, Division of Emergency Medicine), Klein led the Cincinnati Education Research Unit with support from the Academic and Research Committee (ARC) Award. The embedded Education Scholars Research Program has six scholar graduates, Matthew Zackoff, MD, MEd (Division of Critical Care), Benjamin Kinnear, MD, MEd (Division of Hospital Medicine), Paria Wilson, MD, MEd (Division of Emergency Medicine), Lisa Herrmann, MD, MEd (Division of Hospital Medicine), Matthew Kelleher, MD, MEd (Division of Hospital Medicine) and Jennifer Cully, DDS, MEd (Division of Pediatric Dentistry). Through advanced training and mentorship, the faculty, including F. Joe Real, MD, MEd (Co-I), and the scholar team achieved success in funding and dissemination with over 160 peer-reviewed publications over the past three years.

Real and Brittany Rosen, PhD, MEd, CHES, from the Division of Adolescent and Transition Medicine, are innovators in medical education research, specifically assessing the role of virtual reality (VR) in supporting providers' communication. With funding from an R21 from the National Cancer Institute, a novel VR curriculum focused on addressing HPV vaccine hesitancy demonstrated an 18% increase in HPV vaccine initiation rates among participating providers compared to a control group, with results published in the American Journal of Preventive Medicine. Real and Rosen expanded their work to focus on COVID-19 vaccination with a new VR curriculum currently undergoing implementation at Cincinnati Children's.

Sarah Beal, PhD, and Kimberly Yolton, PhD, co-direct the general pediatrics research fellowship with funding from a National Research Service Award (NRSA T32) from the Health Resources Service Administration since 1998, with 45 fellows program graduates to date.