Improving Children's Health Through Health Services Research
NACHRI/Centers for Disease Control & Prevention (CDC) Cooperative Agre
NACHRI/Centers for Disease Control & Prevention (CDC) Cooperative Agreement
Improving Children's Health Through Health Services Research was a special 1-day meeting held June 26, 1999, in Chicago. The state of the science in children's health services research was explored, including public and private funding opportunities, networks for conducting research, and uses of research in policy and practice. The meeting was co-sponsored by the National Association of Children's Hospitals and Related Institutions (NACHRI), with the Agency for Health Care Policy and Research (AHCPR), the American Academy of Pediatrics (AAP), the David and Lucille Packard Foundation, the Association for Health Services Research (AHSR), the Robert Wood Johnson Foundation, and Data Harbor, Inc.
The Centers for Disease Control (CDC) identified the need for specific information about pediatric infection control (IC) issues, particularly those related to nosocomial infections (NI) and antimicrobial resistance (AMR). Although information was available about these concerns for adults, little was known about these issues in pediatric care.
Recognizing the unique needs of hospitalized children, CDC issued a call for proposals for a cooperative agreement. NACHRI's IC "Focus Group," a benchmarking activity of the Association, formed the initial group working with NACHRI staff to develop the successful proposal.
The network was established in October of 1997. Sixty-two children's hospitals and related institutions are participating in this, the first national effort to address prevention and control of NI and AMR. NACHRI member hospitals were invited to join the network through their chief executive officers (CEOs). The CEOs' commitment and support of the IC practitioners were critical to the future success of the project. Other hospitals were also able to join the network. Participation was solicited at national meetings and through notification in IC journals.
In responding to the call for proposals, consideration was given to the following:
- Who is doing what?
- Are there clear goals/purposes for the collaborative effort?
- Who will play what role?
- What resources are needed?
- What will be done with the knowledge gained?
The goals of the project, a 3-year, CDC-funded cooperative agreement, were to:
- Develop pediatric-specific infection surveillance and control programs.
- Identify cost-effective IC and prevention interventions.
- Design systems to improve antimicrobial use.
- Develop national benchmarks.
Governance for the project involves specific roles for all participating in the collaborative. NACHRI provides project leadership, facilitation, coordination, and infrastructure support. CDC also provides project leadership and IC expertise. A five-member steering committee is responsible for oversight and advises NACHRI and CDC. The research activities of the project are the responsibility of a committee that provides technical assistance and oversight. To address quality and performance measurement and improvement, a committee was formed to specifically address these concerns.
Hospital participation in each of the project's activities varies from project to project and is voluntary. Funding for the project includes the CDC grant and in-kind support from NACHRI and the participating hospitals. Hospital leadership and IC practitioners also identified the importance of IC research and the need to provide relevant information to consumers and purchasers and for purposes of quality improvement. Hospitals are motivated to participate in the collaborative because they recognize that reducing NI and AMR will save time and money, conserve resources and, most importantly, improve child health outcomes.
To date, the collaborative has conducted a survey of IC structures and processes and presented theses findings at a number of national meetings. Five publications, based on the initial survey, are in process. To maintain interest, all participants receive quarterly reports. An antibiotic utilization survey and NI prevalence study have begun.
Future studies and activities include:
- A study of NI in pediatric intensive care units.
- A profile of vancomycin use.
- An AMR study.
- A project to improve blood steam infection surveillance.
- The development and adoption of computerized IC training programs.
Collaborative efforts have many challenges such as:
- Multiple and competing goals.
- Governance and management with multiple stakeholders.
- Maintaining interest and participation.
The benefits of this collaborative effort include:
- The expertise and diversity of children's hospitals.
- NACHRI's organizational abilities and existing infrastructure.
- Potential impact thorough multiple sites and wide dissemination of information and adoption of best practices.
- Access to data.
- Use of common methods and procedures.
- Have a clear purpose and goals.
- Identify all possible stakeholders early and involve them to greatest extent possible and communicate!
- Early and clearly identify structure, governance, and roles; nurture and change as needed.
- Provide infrastructure to support participants to reduce demands on resources and be sensitive to demands made on participants in relation to time, money data, etc.
- Identify all resources needed: knowledge, people, money, etc.
- Disseminate knowledge/information to right people in a way they can easily and effectively use.
- These types of efforts represent an important resource and are an appropriate role for associations.
- To facilitate research and dissemination and adoption of knowledge gained, a clear infrastructure is critical.
- Allow ample time for developing the network and the collaborative before initiating major projects or research.
- These types of research networks and collaboratives can work and can make major contributions to our understanding of the best way to organize and deliver quality health care services to children and their families.
Girouard S. NACHRI/Centers for Disease Control & Prevention (CDC) Cooperative Agreement. Presentation Summary, Improving Children's Health Through Health Services Research, Chicago, June 26, 1999. http://www.ahrq.gov/research/cdcnetwk.htm