Fiscal Year 2007 (continued)
Research on Child and Adolescent Health Care: New Starts
Conference Grants (R13)
- International Meeting on Indigenous Child Health (April 20-22, 2007, Montreal, Ontario, Canada). Principal Investigator: Sunnah Kim, MS, RN, American Academy of Pediatrics, Elk Grove Village, IL. Grant No. R13 HS16753; project period December 1, 2006-November 30, 2007. This conference will focus on innovative clinical care models and community-based public health approaches for children and youth in First Nations, Inuit, M�tis, American Indian, and Alaska Native communities. The conference objectives are to: (1) demonstrate increased awareness of the unique situations and changing health needs of children in indigenous populations; (2) examine knowledge and experiences of those working in child health about the provision of culturally effective care in indigenous communities; (3) describe scholarly and community participatory research findings about the health and health care of indigenous populations; (4) increase collaboration and exchange information among child health workers and trainees about the health of indigenous children in rural and urban communities; and (5) exhibit strengthened collaborative partnerships with indigenous health organizations around issues related to child health.
- Evidence Standards for Child Health Promotion (Spring 2007). Principal Investigator: Robert Sege, MD, PhD, Tufts-New England Medical Center, Boston, MA. Grant No. R13 HS16760; project period January 1, 2007-December 31, 2007. This conference will bring together stakeholders to discuss a new set of evidence standards for child health promotion that will guide future research, policy, and practice in health care for U.S. children. Discussions will focus on (1) the scientific basis for the use of evidence in recommending child heath promotion in clinical settings; (2) the attitudes, opinions, beliefs, and needs of a variety of stakeholders regarding child health promotion in clinical settings; (3) proposed methods for evaluating the 8 evidence supporting child health promotion in clinical settings; and (4) implementation of the strategies developed during this conference, including dissemination of conference results, to a broad group of interested professionals from a variety of related disciplines.
- EBP Leadership Summit: Improving Health Outcomes for High-Risk Children and Teens (2007, Phoenix, AZ). Principal Investigator: Bernadette Melnyk, PhD, RN, Arizona State University, Tempe, AZ. Grant No. R13 HS16758; project period February 21, 2007-August 31, 2007. This summit of evidence-based practice (EBP) experts/nurse researchers from 10 children's hospitals throughout the United States will develop a strategic action plan to launch a national EBP research network to improve the care and outcomes of high-risk children and adolescents. The conference goals are to (1) identify priorities and action strategies to accelerate the translation of research findings into clinical practice in children's hospitals throughout the nation; (2) identify high priorities for research to guide clinical practice in areas where evidence does not currently exist (based on a review of existing evidence); and (3) disseminate the outcomes and action strategies from the summit in a pediatric nursing journal.
- 2007 Child Health Services Research Meeting (June 2, 2007, Orlando, FL). Principal Investigator: Jennifer Muldoon, MS, AcademyHealth, Washington, DC. Grant No. R13 HS16887; project period April 1, 2007-October 21, 2007. This conference will provide a forum for the child health services research community to achieve the following objectives: (1) disseminate the results of child health services research; (2) inform policy and clinical decisionmaking on child health services; (3) build researchers' skills with new methods and data sources for child health services research; (4) create networking opportunities for those interested in child health services; and (5) nurture the professional development of students and early careerists interested in child health services research.
- 6th Annual Forum for Improving Children's Health Care—Purging Harm from Children (March 19-21, 2007, San Francisco, CA). Principal Investigator: Charlie Homer, MD, MPH, National Initiative for Children's Healthcare Quality, Cambridge, MA. Grant No. R13 HS16879; project period March 7, 2007-December 31, 2007. This forum will play a critical role in initiating and accelerating improvement in the quality of children's health care. The objectives of this meeting include (1) building goodwill for improvement by highlighting successful evidence-based models and interventions; (2) disseminating strategies for implementing valid findings of health services research; (3) inspiring collaboration and information sharing among provider organizations and stakeholders; and (4) mobilizing efforts to provide better health care for children.
Evidence-based Practice Center (EPC) Child-Focused Activities
Under AHRQ's Evidence-based Practice Center (EPC) program, 5-year contracts are awarded to institutions to serve as EPCs. The EPCs review all relevant scientific literature on clinical, behavioral, and organizational topics and health care financing issues to produce evidence reports and technology assessments. These reports are used for informing and developing coverage decisions, quality measures, educational materials and tools, guidelines, and research agendas. AHRQ launched the EPC program in 1997; currently, there are 14 EPCs in the United States and Canada.
Nearly 200 EPC reports have been produced since the program's inception. Go to http://www.ahrq.gov/clinic/epcindex.htm for a list of available reports organized by clinical categories and topics. The reports described here focus on child health topics.
- Diabetes Education and Medical Nutrition Therapy Education for Families with Children Who Have Type 1 Diabetes Mellitus. Principal Investigator: Robert Couch, University of Alberta Evidence-based Practice Center. Contract No. 290-02-0023; project period November 6, 2006-December 5, 2007. This EPC report focuses on the effectiveness of education relating to diabetes and to medical nutrition therapy on the daily management of diabetes and on the improvement of metabolic control and values of glycosylated hemoglobin (HbA1c). Available at http://www.ahrq.gov/clinic/tp/diabedtp.htm; accessed February 19, 2009.
- * Hydroxyurea Treatment of Sickle Cell Disease. Principal Investigator: Jodi B. Segal, MD, MPH, Johns Hopkins Evidence-based Practice Center. Contract No. 290-02-0018; project period February 23, 2007-February 22, 2008. Sickle cell disease causes damage to most organs including the spleen, kidneys, and liver. Damage to the spleen makes sickle cell disease patients, especially young children, easily overwhelmed by certain bacterial infections. Droxia, the prescription form of hydroxyurea, was approved by the FDA in 1998 and is now available for adult patients with sickle cell anemia. This task order will investigate specifically the efficacy and effectiveness of hydroxyurea for patients with sickle cell disease. In addition, it will systematically study if hydroxyurea treatment has short- and/or long-term harms for patients. Also studied will be barriers to the following: (1) therapies that increase hemoglobin F (the form of hemoglobin that exists in the fetus and small infants); (2) well-established therapies for disease-management; and (3) the use of bone marrow transplantation. Available at http://www.ahrq.gov/clinic/tp/hydscdtp.htm; accessed February 19, 2009.
- * Adverse Maternal & Child Health Outcomes Associated with Maternal Weight Gain. Principal Investigator: Meera Viswanathan, PhD, RTI-UNC Evidence-based Practice Center. Contract No. 290-02-0016; project period January 15, 2007-February 14, 2008. This Task Order will result in a report on evidence about whether total weight gain or rate of weight gain are causal factors in infant and/or maternal health outcomes. Available at http://www.ahrq.gov/clinic/tp/admattp.htm; accessed February 19, 2009.
- * Elective Induction of Labor. Principal Investigator: Vandana Sundaram, MPH (Stanford) and Aaron Caughey, MD, PhD (UCSF), Stanford University-University of California at San Francisco Evidence-based Practice Center. Contract No. 290-02-0017; project period March 1, 2007-March 31, 2008. This Task Order provides for an investigation of the following: (1) maternal risks related to elective induction vs. expectant management of labor and elective induction vs. elective cesarean section; (2) fetal/neonatal risks of elective induction vs. expectant management and elective induction vs. elective cesarean section. Researchers also will examine the evidence to determine whether certain physical conditions or patient characteristics (e.g., parity, cervical dilation, or previous pregnancy outcome) are predictive of a successful induction of labor.
- Effectiveness of Weight Reduction Programs in Children. Principal Investigator: Evelyn Whitlock, MD, MPH, Oregon Health Sciences University. Contract No. 290-02-0024-8; project period May 1, 2007-August 31, 2008. This task order provides for an investigation of the effectiveness of weight reduction programs that promote behavioral change for treatment of overweight or obese children for short-term, long-term, and sustained weight loss. Other goals are to determine the safety of drug and surgical therapies for treatment of overweight or obese children and to assess the safety of weight reduction programs to promote behavioral change for treatment of overweight or obese children. Available at http://www.ahrq.gov/clinic/tp/chwghttp.htm; accessed February 19, 2009.
Developing Evidence to Inform Decisions about Effectiveness: The DEcIDE Network of Research Centers
The DEcIDE Network, which comprises 13 institutions, is a collaborative research and practice-based program. It assists AHRQ and other Federal agencies with implementation of Section 1013 of the Medicare Modernization Act of 2003 (MMA). Network members hold task order contracts; FY 2007 task orders are described here.
- * A Multi-Center, Observational Cohort Study to Assess the Cardiovascular Risks of Medications Prescribed for Attention Deficit Hyperactivity Disorder (ADHD). Principal Investigator:William Cooper, MD, MPH, Vanderbilt University DEcIDE Center. Contract No. 290-05-0042; project period September 1, 2007-August 31, 2009. The purpose of this task order is the estimation of the cardiovascular risks associated with medications used to treat ADHD in both adults and children. The study cohorts will be constructed by combining enrollees of some HMOs across the country and the Tennessee Medicaid program that have been exposed to ADHD drugs. The Medicaid sample includes a substantial number of lower income and racial/ethnic minority children.
- Effect of Angiotensin-Converting Enzyme Inhibitor (ACEI) Prescription Drug Use in Pregnancy. Richard Platt, MD, Harvard Pilgrim Health Care; HMO Research Network (HMORN) DEcIDE Center. Contract No. 290-05-0033; project period June 1, 2007-June 1, 2009. This project involves a population-based cohort study to examine the association of congenital anomalies with maternal use of ACE Inhibitors (ACEIs) during the first trimester of pregnancy. The study is more representative of the U.S. population than previous studies in this area, including all racial and ethnic groups without addressing any specific income or racial/ethnic group.
Accelerating Change and Transforming Organizations and Network (ACTION) Program: Field Partnerships for Applied Research
AHRQ's Accelerating Change and Transforming Organizations and Network (ACTION) program is a 5-year implementation model of field-based research that fosters public-private collaboration in rapid-cycle, applied studies. The purpose of the ACTION program is to promote innovation in health care delivery by accelerating the development, implementation, dissemination and uptake of demand-driven and evidence-based products, tools, strategies and findings. ACTION includes 15 large partnerships, each including a number of collaborating institutions with demonstrated capacities to "turn research into practice" for proven interventions targeting those who manage, deliver, or receive health care services.
- Implementing Evidence-Based Quality Improvement Strategies to Improve Asthma Care for Children: A Practical Model to Transform Childhood Asthma Care. Principal Investigator: James W. Stout, MD, MPH, University of Washington, Seattle,WA. Contract No. 290-06-0022-2, with Health Research & Educational Trust; project period July 16, 2007-February 16, 2009. In response to an ACTION program call for the implementation and evaluation of evidence-based quality improvement strategies in childhood asthma, the contractor, Health Research & Educational Trust (HRET), and the University of Washington will work with primary care providers in New York State to facilitate online and phone-based training in use of spirometry as part of a comprehensive asthma diagnosis, severity assessment, and treatment plan (Phase I), and the use of asthma action plans and other related evidence-based management strategies (Phase II). Practices in Phase I will be randomly assigned to one of two matched waves of implementation. If effective, as measured by increased use of spirometry and action plans following Phase II, findings will be disseminated through HRET, the New York Asthma Learning Network, the National Initiative for Children's Healthcare Quality, journal publications, and other venues.
Academic Pediatric Association Young Investigator Awards
- Stephen Pont, MD; University of Texas Medical Branch: Health Care Encounters Due to Diarrheal Illness in Children.
- Sheela Sathyanarayana, MD; University of Washington: Is ambient air pollutant exposure associated with preterm and small for gestational age birth in the Puget Sound air basin?
- Srilakshmi Gnansekaran, MD, MPH; Massachusetts General Hospital: Child Health Policy and Asthma Outcomes: A Multi-Level Analysis.
- Knowledge Transfer to Improve Followup and Care for Infants with Early Hearing Loss—Expert Meeting. B.L. Seamon Corporation, Greenbelt, MD. Contract No. 290-07-10046; project period May 17, 2007-March 30, 2008. This project provided logistical and technical support for an expert meeting to bring together experts in knowledge transfer and quality improvement in order to develop strategies for reducing gaps in followup for early childhood hearing loss. Meeting participants heard about current and past efforts to close the gaps and were asked to develop recommendations for building on past and current successes.
- Technical Assistance for HIT (Health Information Technology) and HIE (Health Information Exchange) in Medicaid and SCHIP. Principal Investigator: Linda Dimitropolis, Research Triangle Institute, Research Triangle Park, NC. Contract No. 290-07-10079; project period September 28, 2007-September 27, 2010. RTI has received the first task order to establish and implement the first rounds of technical assistance. This is a 3-year, $3 million task order to gather, synthesize, and disseminate information about the challenges and solutions State Medicaid and SCHIP agencies are currently experiencing as they attempt to implement and/or expand health IT and participate in HIE to improve the quality, safety, efficiency, and effectiveness of care; provide one-on-one consultative and technical assistance services that help address these challenges in selected Medicaid and SCHIP programs; and develop educational and dissemination programs, tools, and information resources that provide useful information about health IT and HIE participation to all Medicaid and SCHIP programs and their stakeholder organizations.
- Technical Assistance for HIT (Health Information Technology) and HIE (Health Information Exchange) in Medicaid and SCHIP. Daniel S. Gaylin, National Opinion Research Center (NORC),Washington, DC. Contract No. 290-07-10039; project period September 28, 2007-September 27, 2010. The second of two task orders was awarded to NORC to provide technical assistance for health IT and HIE related to Medicaid and SCHIP.
- Improving Quality Through Health IT: Testing the Feasibility and Assessing the Impact of Using the Existing Health IT Infrastructure for Better Care Delivery. Principal Investigator: Allen Hsiao, MD, Yale New Haven Health Services Corp. Contract No. 290-06-00015; project period September 28, 2007-September 30, 2009. This project involves the implementation and evaluation of a secure messaging system called Clinical Messenger as a communication mechanism for pediatric patients and their parents and providers at the Yale New Haven Children's Hospital Respiratory Medicine Clinic. Variables will include provider-time spent and qualitative satisfaction by the patients and clinicians.
- Pediatric Quality Improvement Research. Principal Investigator: Jeanne Van Cleave, MD, Massachusetts General Hospital for Children, Boston, MA. Requisition No. 07R000192; project period September 30, 2007-August 30, 2008. This professional services contract provides for a review of the challenges and opportunities for pediatric quality improvement research methods and designs.
Other AHRQ Activities that Address Children's Issues
U.S. Preventive Services Task Force. The U.S. Preventive Services Task Force, which is supported by AHRQ, makes recommendations regarding adoption of clinical preventive services based on rigorous evidence reviews. More information on the Task Force can be found at http://www.ahrq.gov/clinic/uspstfix.htm.
Federal Interagency Forum on Child and Family Statistics. AHRQ helps to support this Forum which produces annual reports on the well-being of children. The Web site for this activity is http://www.childstats.gov.
Publications. Publications based on AHRQ-supported extramural and intramural work on children's issues are listed, on an ongoing basis, at http://www.ahrq.gov/child/childpubs.htm.
For additional information on AHRQ's child health activities, please contact:
Denise Dougherty, Ph.D.
Senior Advisor, Child Health and Quality Improvement
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850
* Projects that include children or children's health care issues, but do not focus exclusively on children, are marked with asterisks.