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Comparative Effectiveness and Healthcare Quality


 

The Institute of Medicine (IOM) defines comparative effectiveness research (CER) as generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. The purpose is to assist consumers, clinicians, purchasers, and policy makers to make informed decisions that will improve health care at both the individual and population levels.

The federal Agency for Healthcare Research and Quality (AHRQ) notes that healthcare quality problems are reflected today in the wide variation in the use of health care services, the underuse and overuse of some services and the misuse of others. Disparities in healthcare quality have been associated with race and ethnicity and with socioeconomic status.

COR has partnered with COHO and its AHRQ-funded Comparative Effectiveness Research Core Unit to conduct patient-centered health outcomes and effectiveness research related to children. COR is also collaborating with clinical investigators at The Children’s Hospital through the hospital’s Center for Clinical and Operational Excellence to improve health care quality.

Dr. Morrato is leading the Comparative Effectiveness and Healthcare Quality research program at COR. She has received funding through the Agency for Health Care Research and Quality to develop interventions for accelerating the diffusion of new comparative effectiveness evidence in the medical community.  Dr. Morrato also serves as a member of the Food and Drug Administration’s Drug Safety and Risk Management Advisory Committee, which advises the FDA on pharmaceutical safety evidence and risk mitigation strategies.

Telephone and Internet Triage: COR researchers (Drs. Bunik and Kempe) published the first papers examining outcomes associated with algorithm-guided nurse triage phone services for after-hours acute care.  Previous work examined parental attitudes and level of satisfaction with such services, patient outcomes, including rehospitalizations and deaths, and health care system outcomes such as compliance with recommendations and number of visits generated.  Currently we are collaborating with Kaiser Permanente to assess the effectiveness of a web-based self-triage program developed to function in tandem with telephone management protocols.

Surgical Quality Improvement and Outcomes Research: COR researchers (Drs. Morrato and Kempe and Juliana Barnard) have conducted several qualitative evaluations of a clinical program in Musculoskeletal Surgery for patients undergoing scoliosis surgery who have complex medical problems, the "high risk pathway." In addition, COR researchers and analysts have examined national variability in the use of surgical procedures by hospital type and by region. Currently, COR is hiring two PhDs in conjunction with the Department of Surgery to aid in expanding surgical outcomes research.

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Current Grants

MUSCULOSKELETAL SURGICAL OUTCOMES

Pediatric Spinal Fusion Surgery at U.S. Children’s Hospitals (PHIS, 2000-2006)
Principal Investigator: Mark Erickson, MD
TCH Co-Investigators: Nancy Hadley-Miller, MD MS; Elise Benefield RN
COR Co-investigators: Elaine Morrato DrPH MPH, Allison Kempe, MD MPH
COR Staff: Brenda Beaty, MSPH
Funding Agency: The Children’s Hospital Research Institute
Status: Manuscript in preparation

Caregivers’ and Relatives’ Expectations for Spinal (CARES) Surgery Study
Principal Investigator: Elaine Morrato DrPH MPH
COR Co-investigators: Allison Kempe, MD MPH, Juliana Barnard, MA
TCH Co-investigators: Mark Erickson, MD, Nancy Hadley-Miller, MD MS, Elise Benefield RN BSN
Funding Agency: The Children’s Hospital Research Institute
Status: Manuscript submitted to Journal of Pediatric Orthopaedics; second manuscript in preparation

 General Surgical Outcomes National Variation in the Utilization of Laparoscopic Antireflux Surgery at US Children's Hospitals
Principal Investigator: David Partrick, MD
TCH Co-investigators: Jennifer Bruny, MD, David Fox, MD, Jonathan Roach, MD, Daksha Ranade, MPH
COR Co-investigators: Elaine Morrato DrPH MPH, Allison Kempe, MD MPH
COR Staff: Elizabeth Campagna, MS
Funding Agency: The Children’s Hospital Research Institute
Status: Manuscript under revision

National Rates of Fundoplication in Children with Neurological Impairment Undergoing Gastrostomy
Principal Investigator: David Fox, MD
COR Co-investigators: Allison Kempe, MD MPH; Elaine Morrato, DrPH MPH;
COR Staff: Elizabeth Campagna, MS
Funding Agency: The Children’s Hospital Research Institute
Status: Manuscript under revision

Laparoscopic Antireflux Surgery at U.S. Children’s Hospitals (PHIS, 2000-2008)
Principal Investigator: David Fox, MD
TCH Co-investigators: David Partrick, MD Jennifer Bruny, MD
COR Co-investigators: Miriam Dickinson, PhD: Allison Kempe, MD MPH; Elaine Morrato, DrPH MPH
COR Staff: Elizabeth Campagna, MS UCD Co-investigator: Daniel Rees, PhD
Funding Agency: The Children’s Hospital Research Institute
Status: Manuscript in preparation

Decision Making Around Pediatric Fundoplication: A Prospective Survey Study
Principal Investigator: David Fox, MD
COR Co-investigators: Allison Kempe, MD MPH; Elaine Morrato, DrPH MPH;
COR Staff: Juliana Barnard, MA; Elizabeth Campagna, MS
TCH Co-investigators: Jennifer Bruny, MD, David Partrick, MD
Funding Agency: The Children’s Hospital Research Institute
Status: Study in progress

Motion Capture Analysis of Pectus Excavatum Patients Treated with Nuss Bar Repair
Principal Investigator: Jennifer Bruny, MD
TCH Co-investigators: Jim Carollo, PhD; Tim Nicklas, MS
COR Staff: Juliana Barnard, MA
Funding Agency: Department of Surgery, AEF Seed Grant Committee
Amount: $25,000
Term: 08/2009 – 08/2011

Hirschsprung’s Associated Enterocolitis at U.S. Children’s Hospitals (2000-2008)
Principal Investigator: Stig Somme, MD
COR Co-investigators: Elaine Morrato, DrPH MPH, and Allison Kempe, MD MPH
COR Staff: Juliana Barnard, MA, Elizabeth Campagna, MS
Funding Agency: The Children’s Hospital Research Institute
Status: Study under development

Epidemiology of Pediatric Surgical Procedures (KID, 2003 and 2006)
Principal Investigator: Elaine Morrato, DrPH MPH
COR Staff: Brenda Beaty, MSPH
TCH Co-investigators: Moritz Ziegler, MD
Funding Agency: The Children’s Hospital Research Institute
Status: Study in progress

National trends in pediatric surgical cases for residents compared to national prevalence estimates in children’s and non-children’s hospitals Implementation of a Risk-Adjusted Outcomes Quality Improvement Program for Pediatric Surgery (NSQIP)
Principal Investigator: Moritz Ziegler, MD
TCH Co-investigator: Jennifer Bruny, MD; Debbie Liebrecht, RN
COR Co-investigators: Elaine Morrato, DrPH MPH, Allison Kempe, MD MPH
Funding Agency: School of Medicine AEF Fund; TCH Pediatric Surgery

2008- Surgical Quality Improvement Program: Data Coordinating Center
Principal Investigator: William Henderson, PhD COHO Co-investigator: Karl Hammermeister, MD
COR Co-investigator: Elaine H. Morrato, DrPH
Funding Agency: American College of Surgeons
Amount: $1,031,000
Term: 2006 - 2009

COMPARATIVE EFFECTIVENESS RESEARCH

Clinical and Health Outcomes Initiative in Comparative Effectiveness (CHOICE): Center for Mental Health
Principal Investigator: David West, PhD
TCH Co-Investigator: Marianne Wambolt, MD
COR Co-Investigators: Elaine Morrato, DrPH MPH and Allison Kempe, MD MPH
Funding Agency: AHRQ (R-01)
Status: Submission December 2009

The Children’s Hospital Network of Care Community Partnership to Improve Translation of Comparative Effectiveness Research for Vulnerable Populations
Principal Investigator: Elaine Morrato, DrPH MPH
Community Partner: TCH (Dan Hyman, MD MMM and Lalit Bajaj, MD MPH)
Funding Agency: AHRQ (R-18)
Status: Submission December 2009

CER Diffusion and Social Networking: Web-based Software Solutions
Small Business: mdlogix (Allen Tien, MD)
Project Leader: Eric Jones, PhD (iv North Carolina Greensboro
COR Co-Investigator: Elaine Morrato, DrPH MPH
Funding Agency: National Institute on Aging (SBIR)
Status: Submission December 2009

Adoption of Comparative Effective Research into Clinical Practice
Principal Investigator: Elaine Morrato, DrPH MPH CSPH Mentor: Richard Lindrooth, PhD
TCH Mentors: Allison Kempe, MD MPH and Psychiatry & Behavioral Sciences Community Partner: Missouri Medicaid and Dept. of Mental Health
Funding Agency: AHRQ or NIMH K-Award / TCH RI Research Scholar Award
Status: Submission February 2010

 The Children’s Hospital Network of Care Community Partnership to Improve Translation of Comparative Effectiveness Research for Vulnerable Populations
Principal Investigator: Elaine Morrato, DrPH MPH
Community Partner: TCH (Dan Hyman, MD MMM and Lalit Bajaj, MD MPH)
Funding Agency: CCTSI Community Development Pilot Grant
Status: Under review

Comparing Effectiveness in Mental Health: The Missouri Medicaid Partnership
Principal Investigator: Elaine Morrato, DrPH MPH
COR Co-Investigator: Allison Kempe, MD MPH
COR Staff: Juliana Barnard, MA; Elizabeth Campagna, MS
Co-Investigator: John Newcomer, MD (Washington University in St. Louis)
Community Partner: Missouri Medicaid and Dept. of Mental Health
Funding Agency: NIMH (RC-1)
Status: Not funded

Collaborative Group for Reducing Cardiometabolic Risk in the Mentally Ill
Principal Investigator: John Newcomer, MD (Washington University in St. Louis)
COR Co-investigators: Elaine Morrato, DrPH MPH Co-investigators: Ginger Nicol, MD (Washington University in St. Louis), Mark Johnson, MD (BJC Behavioral Health)
Funding Agency: Barnes-Jewish Hospital Foundation/Washington University Institute of Clinical and Translational Sciences
Status: Not funded

Eliminating Healthcare Disparities Colorado Children’s Healthcare Access Program (CCHAP) Evaluation
Principal Investigator: Allison Kempe, MD, MPH
COR Co-Investigator: Elaine Morrato, DrPH
TCH Co-Investigator: Steven Poole, MD
Funding Agency: The Colorado Trust
Amount: $14,000

EMERGENCY DEPARTMENT QUALITY OF CARE

Measuring children’s hospitals’ reactions to periods of high inpatient occupancy
Principal Investigator: Marion Sills, MD MPH
COR Co-Investigator: Elaine Morrato, DrPH, MPH

Establishing pediatric norms for the Shock Index, and validating it in a pediatric ED population
Principal Investigator: Marion Sills, MD MPH
TCH/COR Co-Investigator: Lara Rappaport, MD, MPH
Funding Agency: grant application to APA/AHRQ pending
Amount: $10,000/yr for 1 year
Term: 2010-2011

Physician Disaster Preparedness Initiative Evaluation
Principal Investigator: Marion Sills, MD MPH COHO Co-Investigator: David West, PhD
Funding Agency: Colorado Medical Society/Department of Health and Human Services
Amount: $25,000
Term: 6/20/09–8/08/09

Emergency Department Overcrowding and Quality of Acute Asthma Care for Children
Principal Investigator: Marion Sills, MD, MPH
Funding Agency: Children’s Hospital Research Institute Bridge Grant
Amount: $32,080
Term: 6/1/08-5/31/10

Emergency Department Overcrowding and Quality of Acute Asthma Care for Children
Principal Investigator: Marion Sills, MD, MPH
Funding Agency: Agency for Healthcare Research and Quality, 1 3 HS016418-01A1
Amount: $80,000
Term: 7/1/07-6/30/10

The Association between Emergency Department Resources and Pediatric Asthma-Related Quality Indicators
Principal Investigator: Marion Sills, MD, MPH
Funding Agency: American Lung Association Social Behavioral Research Grant SB-35832-N
Amount: $100,000
Term: 7/1/07-6/30/10

Descriptive epidemiology of resource utilization in children’s hospital EDs during the Spring 2009 H1N1 Flu outbreak
Principal Investigator: Marion Sills, MD, MPH
COHO Co-Investigators: Anne Libby, PhD, Heather Orton, PhD
Funding Agency: R01 application pending
Amount: $500,000/yr for 5 years
Term: 2010-2015

Abstracts

Barnard JG, Erickson MA, Morrato EH, Hadley-Miller NA, Benefield EM, Nowels CT, and Kempe A. Managing surgical risk and post-discharge needs in special needs children with neuromuscular scoliosis: The High-Risk Pathway. Poster presentation at the 2009 Pediatric Academic Society Meeting, Baltimore, MD. May 5, 2009. [also submitted for presentation at the 2010 Annual Meeting of the Pediatric Orthopedic Surgeons of North America]

Barnard JG, Morrato EH, Benefield EM, Nowels CT, Hadley-Miller NA, Kempe A, and Erickson MA. Quality of Life for Children with Neuromuscular Scoliosis. Poster presentation at the 2009 International Society of Quality of Life Research Meeting, New Orleans, LA. October 31, 2009. [also submitted for presentation at the 2010 Annual Meeting of the Pediatric Orthopedic Surgeons of North America]

Erickson M, Miller N, Kempe A, Morrato EH, Benefield E. Benton K. Variability in spinal surgery outcomes among children’s hospitals in the U.S. Oral presentation at the 2009 American Academy of Orthopedic Surgeons (AAOS) Annual Meeting, Las Vegas, NV, February 25-28, 2009.

Fieldston E, Hall M, Sills M, Slonim A, Myers A, Cannon C, Pati S, Shah SS. Children’s hospitals do not acutely react to high occupancy. Pediatric Hospital Medicine meeting, Tampa, July 2009.

Fieldston E, Hall M, Sills M, Slonim A, Myers A, Cannon C, Pati S, Shah SS. Children’s hospitals do not acutely react to high occupancy. Academy Health Annual Research Meeting, June 2009, Chicago.

Fieldston ES, Hall M, Sills MR et al. Do Children's Hospitals Respond to Predictable Fluctuations in Patient Volume? Pediatric Academic Societies’ Annual Meeting, Baltimore, May 2009. PAS2009:65: 5514.253.

Fieldston ES, Hall M, Sills MR, et al. Addressing children’s hospital crowding by smoothing occupancy. (In review Pediatrics

Fox D, Campagna E, Reese D, Dickinson M, Morrato E, and Kempe A. Laparoscopic Fundoplication in Children’s Hospitals: 2005-2008. Submitted for presentation at the Pediatric Academic Society Annual Meeting. May, 2010. Vancouver, BC

Morrato EH, Druss B, Hartung DM, Valuck RJ, Thomas D, Allen RR, Campagna E, Newcomer JW. Determinants of metabolic testing for patients treated with second-generation antipsychotics after the FDA diabetes Warning. Oral presentation at the 25th Anniversary International Conference on Pharmacoepidemiology and Therapeutic Risk Management, Providence, RI, August 16-19, 2009. Pharmacoepidemiology and Drug Safety. 2009.

Morrato EH, Druss, B, Hartung DM, Valuck RJ, Allen RR, Campagna E, Newcomer JW. Metabolic testing rates in three state Medicaid programs after FDA Warnings on Antipsychotic Drugs and Diabetes. Poster presentation at the 2009 APA Annual Meeting, San Francisco, CA, May 16-19, 2009.

Morrato EH, Nicol G, Druss B, Hartung DM, Valuck RJ, Allen RR, Campagna E, Newcomer JW. Metabolic risk mitigation in children receiving antipsychotics. Poster presentation at the 25th Anniversary International Conference on Pharmacoepidemiology and Therapeutic Risk Management, Providence, RI, August 16-19, 2009. Pharmacoepidemiology and Drug Safety. 2009.

Partrick DA, Morrato EH, Ranade D, Campagna E, Kempe A Ziegler MM. National Variation in the Utilization of Laparascopic Antireflux Surgery at US Children’s Hospitals Submitted for presentation at the American Academy of Pediatrics 2009 Pediatric National Conference and Exhibition , October 2009, Washington DC [Was not accepted]

Rappaport LD, Siparsky G, Wathen J, Kuch BA, Carcillo JA, Sills MR Establishing Age-Specific Normal Values for Shock Index in Children. Pediatric Academic Societies’ Annual Meeting, Baltimore, May 2009. PAS2009:65: 3884.463.

Raval, MV and Dillon, PW; on behalf of the ACS NSQIP-Pediatric Steering Committee. Pediatric ACS NSQIP: Feasibility of a Novel Real-Time Assessment of Surgical Outcomes - a Phase I Report. Submitted for presentation at American Pediatric Surgical Association. May, 2010. Orlando, FL

Sills MR, Ranade D, Kahn MG, Fairclough DL. Crowding and time-related outcome measures for patients presenting to a pediatric emergency department for acute asthma exacerbations. Pediatric Academic Societies’ Annual Meeting, Baltimore, May 2009. PAS2009:65: 2814.118.

Presentations

Barnard JG “Caregivers’ And Relatives’ Expectations for Spinal) Surgery (CARES) Study” Colorado Health Outcomes Research Seminar, University of Colorado Denver, Aurora, CO (February 2009).

 Morrato EH “Influences of Individual and Geographic Factors on Drug Safety Practices: Applications for Antipsychotics and Diabetes Risk”, Colorado Health Outcomes Methods and Applications Seminar, University of Colorado Denver, Aurora, CO (January 2009).

Barnard JG, Erickson MA, Morrato EH, Hadley-Miller NA, Benefield EM, Nowels CT, and Kempe A. Managing surgical risk and post-discharge needs in special needs children with neuromuscular scoliosis: The High-Risk Pathway. Poster presentation at the 2009 Quality, Patient Safety and Clinical Informatics Poster Session, The Children’s Hospital, 10-16-2009

Fieldston E, Hall M, Sills M, Slonim A, Myers A, Cannon C, Pati S, Shah SS. Do children’s hospitals respond to predictable fluctuations in patient volume? Eastern Society for Pediatric Research Annual Meeting, March 2009.

Morrato EH, Newcomer JW, Kamat S, Baser O, Harnett J, Cuffel B. Impact of the atypical antipsychotic FDA Warning on risk of hyperglycemia and diabetes and metabolic monitoring practices. NCDEU CME Poster Session 2008. Best research posters presented at the 2008 NCDEU (New Clinical Drug Evaluation Unit) Meeting. CME Institute, Physicians Postgraduate Press, Inc., The Journal of Clinical Psychiatry (October 2008)

Morrato EH, Nicol GE, Druss BG, Hartung DM, Valuck RJ, Allen RR, Campagna E, and Newcomer JW. Metabolic Risk Mitigation in Children Receiving Antipsychotics. Poster presentation at the 2009 Quality, Patient Safety and Clinical Informatics Poster Session, The Children’s Hospital, 10-16-2009

Publications

Banta JE, Morrato EH, Lee SW, Haviland MG. Retrospective Analysis of Diabetes Care in California Medicaid Patients with Mental Illness Journal of General Internal Medicine. May 5 2009 [Epub ahead of print]

Barnard JG, Erickson MA, Morrato EH, Hadley-Miller NA, Benefield EM, Nowels CT, and Kempe A. Management of Surgical Risk in High Risk Pediatric Patients: Provider and Family Caregiver Experiences of Spinal Fusion Surgery and Care Program (under review: Journal of Pediatric Orthopaedics)

Fieldston ES, Hall M, Sills MR, et al. Children’s hospitals do not acutely react to high occupancy. Pediatrics (in press).

Fox, D, Partrick, D, Morrato, EH, Bruny, J, Benton, K, Kempe, A. National Trends Regarding Fundoplication in Neurologically Impaired Children (submitted to Academic Pediatrics)

Miller NH, Benefield EM, Hastings L, Carry P, Pan Z, and Erickson MA. Evaluation of High Risk Patients Undergoing Spinal Surgery: A Matched Case Series. (under review: Journal of Pediatric Orthopaedics)

 Morrato EH, Cuffel B, Newcomer JW, Lombard I, Kamat S, Barron J. Metabolic risk status and second-generation antipsychotic drug selection: A retrospective study of commercially insured patients. Journal of Clinical Psychopharmacology; 2009; 29(1): 26-32.

Morrato EH, Druss, B, Hartung DM, Valuck RJ, Allen RR, Campagna E, Newcomer JW. Metabolic testing rates in three state Medicaid programs after FDA Warnings and ADA/APA Recommendations for Second-Generation Antipsychotic Drugs. Arch Gen Psych (in press)

Morrato EH, Newcomer JW, Kamat S, Baser O, Harnett J, Cuffel B. Metabolic screening after the ADA’s Statement on antipsychotic drugs and diabetes Diabetes Care 2009; 32(6): 1037-1042.

Morrato EH, Nicol G, Maahs D, Druss B, Hartung DM, Valuck RJ, Allen RR, Campagna E, Newcomer JW. Metabolic risk monitoring in children receiving second-generation antipsychotic drugs Arch Ped and Adolesc Med, (in press)

Morrato EH, Druss B, Hartung DM, Valuck RJ, Thomas D, Allen RR, Campagna E, Newcomer JW. Small Area Variation in Metabolic Risk Management for Patients Initiating Second-Generation Antipsychotics (under review: Pharmacoepidemiology and Drug Safety).

Morrato EH, Allen RR, Kempe A. “Colorado Children’s Healthcare Access Program (CCHAP): Preliminary Evaluation of the Program (July 1, 2007 – December 31, 2007)” for the Colorado Department of Health Care Policy and Financing. October 31, 2008

Morrato EH, Allen RR, Kempe A. “Colorado Children’s Healthcare Access Program (CCHAP): 12-Month Evaluation of the Program (July 1, 2007 – June 30, 2008)” for the Colorado Department of Health Care Policy and Financing. March 19, 2009

Sills MR, Fairclough D, Ranade D, Kahn MG. Emergency Department Crowding is Associated with Decreased Quality of Care for Children. (in review Pediatrics)