Between 2006 to 2008, COR faculty and collaborators presented 87 abstracts to national meetings and published 76 manuscripts in peer-reviewed journals. There were 31 funded grants and contracts received or ongoing during 2006-2008. Grant funding increased steadily during the three-year period, from $1.33 million to $2.3 million. COR also provided consultation to investigators in many areas outside of our major focus areas of research. Drs. Allison Kempe and Elaine Morrato provide approximately 100 hours of outcomes research consultation each year to clinicians from approximately 18 specialties. Major areas of research focus for COR are detailed below.
Preventive Care for Children
- Immunization Delivery: COR’s research initiatives focused on immunization delivery have been well-funded and have a track record for influencing national vaccine policy. During 2006 to 2008, 44 abstracts were presented at national meetings, 17 manuscripts were published, and 10 ongoing grants were funded in this area. The CDC-funded Vaccine Policy Collaborative Initiative, a national, rapid-response survey program of physicians regarding new vaccines, new vaccine recommendations, and policy issues related to vaccination has been funded for the past four years and was refunded through 2010. Work from this grant has routinely been presented at the Advisory Committee for Immunization Practices. Two other CDC-funded grants assessed vaccination reminder/recall systems for the adolescent patient in different practice sites and the feasibility and acceptability of adolescent vaccination in non-traditional medical settings. Since 2007, COR has been involved in the CDC-funded Vaccine Safety Datalink, which rigorously investigates issues related to actual or potential adverse events following immunization. Dr. Simon Hambidge, supported by an RWJ Faculty Scholar Award, completed several studies of strategies to improve immunization rates for disadvantaged children. Most recently, COR, in collaboration with Denver Health and the Denver Public Schools, was awarded two grants to evaluate immunization delivery for the school-based adolescent and for influenza. We were the only recipient of the adolescent grant in the country and one of two for the influenza grant.
- Pediatric Preventive Oral Health: COR faculty have been involved in studies evaluating the value of incorporating hygienists into pediatrician practices where disparities in oral health are high with funding from The Delta Dental Foundation of Colorado. Another study, conducted in collaboration with TCH Pediatric Dentistry and the Barbara Davis Center for Childhood Diabetes and funded by the Proctor and Gamble Company, is investigating the prevalence of periodontal disease in adolescents with diabetes with the goal of testing preventive dental care interventions. COR faculty were also involved in the newly NIH-funded Center for Native Oral Health Research (CNOHR), which will focus on reducing oral health disparities in vulnerable populations.
Prevention of Pediatric Obesity/CV Disease
This is an emerging priority area for COR and one that is being pursued collaboratively with COHO. Drs. Christina Kim, Allison Kempe, and Nancy Krebs have been involved in three obesity-prevention projects, one involving a clinic-based educational intervention, one a community-based intervention, and the other assessing reasons for lack of response to an obesity-prevention intervention. Dr. Kim is part of a collaborative grant proposal with COHO and Kaiser Permanente to establish population obesity registries in order to better understand environmental factors contributing to this problem. Dr. Matthew Haemer, in collaboration with Dr. Krebs, has been studying implementation of a practice-based educational intervention to identify and prevent obesity. Dr. Maya Bunik has been involved in a project also involving Dr. David Olds assessing the protective effect of breastfeeding on prevention of obesity in young children. She is also collaborating with Dr. Margaret Neville (Department of Obstetrics and Gynecology, UCSOM) on a proposal to evaluate the effect of breastfeeding problems on subsequent infant weight gain.
Surgical Outcomes Research
The Musculoskeletal and General Pediatric Surgery Departments have been actively collaborating with COR to develop surgical outcomes research at TCH. Because so little outcomes research has been done nationally in these surgical areas, COR’s strategic approach has been to first investigate the general epidemiology of selected procedures by using national secondary datasets. This has allowed us to generate pilot data to inform future prospective research and to achieve early success in meeting publication and scientific dissemination goals. We have also begun the process of planning both ongoing prospective data collection efforts and qualitative research efforts in both areas. There are currently eight research projects underway focusing on outcomes of spinal fusion musculoskeletal surgery and the High-Risk Clinical Pathway for scoliosis surgery at TCH. In addition, several new initiatives examining quality of life, exercise tolerance, and cardiopulmonary functioning in children with pectus excavatum are underway. In General Pediatric Surgery, six projects are focusing on variation in fundoplication surgical practices between different types of hospitals and regions of the country using the Pediatric Health Information System (PHIS) and AHRQ Kids’ Inpatient Database (KID). COR has also supported the development of the Pediatric National Surgical Quality Improvement Program (NSQIP), through its collaboration with COHO. NSQIP is the preeminent adult surgical outcomes improvement and research program in the U.S., and COHO serves as the coordinating center for the Department of Veterans Affairs and the American College of Surgeons public- and private-sector initiatives. Under the leadership of Dr. Moritz Ziegler, TCH has also been selected as an alpha center for the Pediatric NSQIP program expansion, and COR will be assisting. The development of this database with TCH in the center of the development effort will provide substantial opportunities for research for surgical faculty.
Health Care Delivery for Low-Income Children
COR has been assisting Dr. Steven Poole in evaluating the Colorado Children’s Healthcare Access Program (CCHAP), a program aimed at increasing private pediatrician’s involvement in providing care to low-income children. The Colorado Department of Health-Care Policy and Financing (HCPF) and 28 CCHAP-associated practices in the Denver area have partnered to conduct a demonstration program from July 2007 through June 2008 to evaluate a new program model designed to increase provider participation in the Early and Periodic Screening Diagnosis and Treatment (EPSDT) program and provide a quality medical home for underserved children enrolled in Medicaid.
Developing Areas of Focus
- Asthma Management: COR has consulted on a number of projects that focus on asthma care in pediatrics, including prevention and chronic management in the primary care setting and emergency management. Drs. Maya Bunik and Monica Federico have been evaluating an educational and quality improvement intervention at the Child Health Clinic. They are also participating in a federally-funded project assessing the effect of different levels of cigarette smoking on asthma outcomes. In addition, Dr. Marion Sills has focused on the emergency management of asthma and has succeeded in obtaining three grants during the last year.
- Telephone and Internet Triage: Drs. Maya Bunik, Allison Kempe, and Barton Schmitt, in collaboration with Kaiser Permanente, are studying a self-triage internet program that Dr. Schmitt has developed in tandem with his telephone management protocols.
- Drug Safety: Dr. Elaine Morrato is focusing on the adoption of drug safety recommendations into clinical practice. In 2007, she had eight publications in this area and currently is leading research evaluating the adoption of diabetes screening recommendations for patients taking second-generation antipsychotics. COR’s drug safety research will receive a big boost from a new AHRQ grant to COHO that has pediatric components.