Research on Child and

Adolescent Health Care

New Starts­Fiscal Year 2008

F A C T S H E E T

Agency for Healthcare Research and Quality

The mission of AHRQ is to improve the quality,

safety, efficiency, and effectiveness of health

care by:

•	 Using evidence to improve health care.

•	 Improving health care outcomes through

research.

•	 Transforming research into practice.

Introduction

The mission of the Agency for

Healthcare Research and Quality is to

improve the safety, quality, efficiency,

and effectiveness of health care for all

Americans. Children are one of

AHRQ’s designated priority

populations. To help achieve the

Agency’s mission for children, AHRQ

supports extramural research grants and

contracts, research training, conference

grants, and intramural activities.

This fact sheet provides information on

extramural activities initiated during

fiscal year 2008, and information is

provided to help you access the funding

opportunities. AHRQ committed to

investing $3.7 million in the projects in

FY 2008 and a total of $9.2 million

over the entire term of these multi­year

projects. Projects that include children

or children’s health care issues but do

not focus exclusively on children are

marked with an asterisk (*).

Research Grants and

Cooperative Agreements

Research Demonstration and

Dissemination Projects (R18)

Ambulatory Safety and Quality

Program: Improving Management of

Individuals with Complex Health

Care Needs Through Health IT

•	 Improving Pediatric Cancer

Survivorship Care Through

SurvivorLink. Principal

Investigator: Ann C. Mertens, PhD,

Emory University School of

Medicine, Department of Pediatrics,

Atlanta, GA. Grant No. R18­

HS017831; project period

September 30, 2008­September 29,

2011. This project will develop a

health information technology

(health IT) system, SurvivorLink, to

support high quality health care for

pediatric cancer survivors in the long

term, by maintaining electronic

personal health records (PHRs).

Special attention will be given to

using this health IT system to

Advancing Excellence in Health Care • www.ahrq.gov

Agency for Healthcare Research and Quality
improve care for racially/ethnically

diverse, rural, and low­income

children in Georgia. SurvivorLink

will be used to increase patient and

provider awareness of survivor issues

and to track the percentage of

pediatric patients who receive the

recommended cancer survivor care.

Risk­Informed Intervention

Development and Implementation of

Safe Practices in Ambulatory Care •	 Risk­Informed In­Situ

Simulations for Pediatric

Emergency Transfers. Principal

Investigator: Jane L. Holl, MD,

MPH, Northwestern University

Institute for Healthcare Studies,

Evanston, IL. Grant No. R18­

HS017909; project period

September 30, 2008­September 29,

2011. This research builds ona

previous AHRQ­funded project that

assessed the risks involved in

transfers of pediatric patients from

one hospital’s emergency department

(ED) to that of another. The project

will developa simulation toolkit for

hospital ED teams of physicians,

nurses, and other health care

professionals who are involved in the

intake of pediatric emergency

patients being transferred from

another institution’s ED into their

own. Simulation training will take

place within the operational

environment of the ED itself and

health care units on the hospital’s

floors in order to address the risks

involved at the microsystem and

organizational levels in the process of

such transfers. The study will

integrate specific TeamSTEPPSTM

skill categories to address identified

clinician communication, teamwork,

and microsystem risks (for further

information on TeamSTEPPSTM,

see http://teamstepps.ahrq.gov/).

•	 Safe Passages:A Toolkit to Ensure

Quality Transitions from the

NICU to Ambulatory Care.

Principal Investigator: Virginia A.

Moyer, MD, MPH, Baylor College

of Medicine, Department of

Pediatrics, Houston, TX. Grant No.

R18­HS017889; project period

September 30, 2008­September 29,

2011. Infants born prematurely or

with complex congenital

abnormalities are surviving to

discharge in growing numbers. This

research project will develop and

implementa package of evidencebased interventions to address all the

necessary structural and process

elements needed to achievea safe

passage for the fragile infant from

the intensive care specialist in the

hospital’s neonatal intensive care unit

(NICU) to the primary care

pediatrician in ambulatory care. This

intervention package will include use

of an electronic personal health

record (PHR) to track the infant’s

health care and the communication

between the infant’s family,

community pediatrician, and

hospital specialists. The PHR will

include specific instructions for

recognizing and self­managing the

most common problems in this

pediatric patient population.

•	 Risk­Informed Clinical

Information Network for Safe

Pediatric Emergency Transfers.

Principal Investigator: Donna M.

Woods, PhD, Northwestern

University, Institute for Healthcare

Studies, Evanston, IL. Grant No.

R18­HS017912; project period

September 30, 2008­September 29,

2011. This project will developa

“Clinical Information Network for

Safe Pediatric Emergency Transfers”

that will directly address the risks

involved in these transitions through

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the design of a standardized process

and tools for effective

communication for use in transitions

involving pediatric emergency

patients.

Research

Demonstration/Cooperative

Agreements (U18)

• *Comparative Safety and

Effectiveness of Antipsychotics.

Principal Investigator: Stephen

Crystal, PhD, Rutgers State

University, New Brunswick, NJ.

Cooperative Agreement No. U18­

HS017918; project period

September 30, 2008­March 31,

2010. In recent years, the use of

atypical antipsychotic medications

(AAPs) for non­labeled

indications—particularly for

vulnerable children, adolescents, and

the elderly—has sharply increased.

This increase in usage has occurred

despite the fact that basic questions

have not yet been answered

regarding the comparative safety and

effectiveness of AAPs for these

groups. This cooperative agreement

will build on data from past AHRQfunded Centers for Education and

Research on Therapeutics (CERTs)

projects, the expertise of

methodological leaders, and other

prior research on antipsychotic use

and outcomes to identify evidence

that is critically needed to guide

optimal use of antipsychotic drugs in

vulnerable populations.

Small Research Project Grants

• Comorbidities Among Children

with Emotional, Developmental,

and Behavioral Conditions.

Principal Investigator: Timothy D.

McBride, PhD, Washington

University in St. Louis, St. Louis,

MO. Grant No. R03­HS017368;

project period September 30, 2008­

September 29, 2009. This research

project involves children ages 2 to 17

who have emotional, developmental,

and behavioral problems and

physical special health care needs.

The study will focus on the use of

health care services and access to care

for such children, with an assessment

of whether families may be forced to

curtail some of the medical care

needed by their children due to

affordability constraints.

• Factors Affecting Racial

Disparities in SIDS. Principal

Investigator: Rachel Y. Moon, MD,

Children’s Research Institute of the

Children’s National Medical Center,

Washington, DC. Grant No. R03­

HS016892; project period July 1,

2008­June 30, 2010. This project

will investigate the disproportionate

incidence of sudden infant death

syndrome (SIDS) among African

Americans. The incidence of SIDS is

higher in this population, despite a

marked decrease in the overall

incidence of SIDS following the

vigorous American Academy of

Pediatrics (AAP) campaign for

change in infant sleeping position.

Infant sleep position will be

investigated among African

Americans of both higher and lower

socioeconomic status to determine

how parental decisions are made

about infant care and sleep position

in particular. Health care providers

will be able to use this information

to provide more effective advice

about safe infant sleep environments

to African American families.

For more information about AHRQ’s

small research project grant

opportunities, visit http://grants.

nih.gov/grants/guide/pa­files/PAR­06­

448.html and the timeline amendment

at NOT­HS­08­010

(http://grants.nih.gov/grants/

guide/notice­files/NOT­HS­08­

010.html).

Research Training and

Education

Career Scientist Awards (K

Awards)

• Barriers and Facilitators of Health

Care: Transitioning Youth with

Special Needs. Principal

Investigator: Megumi J. Okumura,

MD, University of California, San

Francisco, School of Medicine, San

Francisco, CA. Grant No. K08­

HS017716; project period

September 30, 2008­September 29,

2013. Dr. Okumura is boardcertified both in internal medicine

and in pediatrics; in addition, she

has completed a Robert Wood

Johnson Clinical Scholar Program

focusing on health services research.

This K08 award will enable Dr.

Okumura to conduct research into

the study and formulation of

interventions addressing the barriers

to and facilitators of chronic illness

care for children with special health

care needs as they transition from

the pediatric to adult health care

setting. Her research agenda seeks to

generate rigorous evidence to

improve the quality of health care

for adolescents and young adults

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with complex chronic conditions by

means of improved linkages between

the patients, health care providers,

health care systems, and community

organizations.

AHRQ makes use of three types of K

grant awards: (1) K01, the Mentored

Research Scientist Development Award

(see http://grants.nih.gov/grants/guide/

pa­files/PAR­08­022.html); (2) K02,

Independent Scientist Award (see

http://grants.nih.gov/grants/guide/

pa­files/PAR­07­444.html); and (3)

K08, Mentored Clinical Scientist

Development Award (see http://grants.

nih.gov/grants/guide/pa­files/PAR­09­

087.html).

Dissertation Grants (R36)

•	 Low Maternal Health Literacy: An

Obstacle to Pediatric Health Care

Utilization. Principal Investigator:

Rosemary Frasso­Jaramillo;

University of Pennsylvania, School

of Social Policy and Practice,

Philadelphia, PA. Grant No. R36­

HS017471; project period February

1, 2008­January 31, 2009. This

doctoral research project will

investigate the degree to which the

children of mothers with low health

literacy differ from the children of

mothers without low health literacy

in meeting established pediatric

preventive care and immunization

guidelines, including the timing and

number of well­child visits and

receipt of vaccinations. The

association of maternal health

literacy with variables such as race,

ethnicity, and socioeconomic status

will be investigated. Mixed

quantitative and qualitative research

methods will be employed in

conjunction with primary and

secondary data sources. Examining

the mediating and moderating

influences of health literacy in the

context of predisposing, enabling,

and needs factors will provide a

foundation on which to identify

specific at­risk populations so that

appropriately targeted health literacy

interventions can be developed that

have potential to decrease disparities

in the use of pediatric health care,

especially in vulnerable populations.

•	 Mechanisms Linking Child

Health Care Use and Maternal

Depression. Principal Investigator:

Margaret Langford Holland;

University of Rochester Medical

Center, Community and Public

Health Department, Rochester, NY.

Grant No. R36­HS017737; project

period September 30, 2008­

February 28, 2010. This dissertation

research focuses on how maternal

depression, which is prevalent

among low­income minority

women, is associated with increased

use of problem­oriented child health

care services, including sick­child

visits, emergency department (ED)

visits, and hospitalizations. Mothers

will be interviewed during

pregnancy and at the child’s ages of

36 weeks, 6 months, 12 months,

and 24 months. Medical records for

the children, up to 24 months of

age, will be collected. All analyses

will be risk­adjusted for children’s

chronic conditions and birthweight.

Understanding the specific

mechanisms between maternal

depression and child health care use

will allow for the design of more

successful interventions, resulting in

more efficient use of health care

resources and healthier families.

•	 Translating Cultures of Care:

Integrating Behavioral Health

Services in Pediatric Practice.

Principal Investigator: Sean Lynch;

University of California, Los

Angeles, School of Public Policy and

Social Research, Department of

Social Welfare, Los Angeles, CA.

Grant No. R36­HS017749; project

period September 30, 2008­June 30,

2009. Over the last 10 years,

pediatricians’ use of psychiatric

medications to treat children has

increased significantly, prompting

concern that these children are being

over­medicated. One of the

disconnects in this situation is the

general lack, at this time, of

collaboration and communication

between the health system (the

pediatrician) and the mental health

system (the social worker). This

doctoral dissertation research will

study communication between these

two groups of health care providers

in the delivery of mental health

services in primary care. The

promotion of children’s emotional

well­being and the treatment of

mental health disorders, this

investigator argues, can be achieved

through the integration of mental

health consultation by the social

worker as part of children’s primary

care. A greater public awareness of

children’s behavioral health issues

could help to prevent milder

disorders from worsening and

improve children’s mental health

outcomes over their lifetime.

For additional information about

AHRQ’s R36 Grants for Health Services

Research Dissertation, see http://grants.

nih.gov/grants/guide/pa­files/PAR­06­

118.html. Also see the Notice (NOTHS­09­005) at http://grants.nih.gov/

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grants/guide/notice­files/NOT­HS­09­

005.html which extended the expiration

date of PAR­06­118 to May 10, 2010.

National Research Service

Awards— Health Services

Research Institutional Training

Programs (T32) • Harvard Pediatric Health Services

Research (HSR) Fellowship

Program. Principal Investigator:

Donald Goldmann, MD, Harvard

University, Boston, MA. Grant No.

T32 HS00063; project period July

1, 2008­June 30, 2013. This

program seeks to train researchers

who can fundamentally improve the

capacity of the U.S. health care

system to meet the needs of children

and families, including

socioeconomically disadvantaged

populations. This mature program,

first funded in 1994 by AHRQ, is

now fully integrated across its three

core sites: Children’s Hospital

Boston, Massachusetts General

Hospital for Children, and the

Harvard Department of Ambulatory

Care and Prevention. New

components include new initiatives

in frontier areas in child health

services research, including use of

genetic information in pediatrics; IT

innovations in personal health

records to promote family­centered

care; comparative effectiveness

research using large integrated

databases to inform clinical and

policy decisions; approaches to

improving population health

through collaborations among health

care and public health systems,

payers, and community partners;

quasi­experimental methods for

evaluating quality improvement

interventions (including initiatives to

reduce disparities); and new methods

for detecting and preventing medical

errors.

• *Indiana Health Services Research

Training Program. Principal

Investigator: Stephen M. Downs,

MD, Indiana University School of

Medicine, Department of Pediatrics,

Indianapolis, IN. Grant No. T32

HS017588; project period July 1,

2008­June 30, 2013. Indiana

University will be developing and

implementing the Indiana Health

Services Research (I­HSR) training

program for the purpose of

preparing clinical and

interdisciplinary investigators to

conduct research to improve the

health of children and adults. This

program will support four

postdoctoral trainees in its first year:

two in the Pediatric I­HSR program

and two in the Adult I­HSR

program. By the completion of

either I­HSR training program,

trainees will have developed core

competencies in health services and

clinical research methods,

biostatistics, medical informatics,

clinical trials, system redesign,

research ethics, translational research,

scientific writing, and grant

application preparation. In years 2

through 5 of this T32 grant, three or

four additional trainees will be

selected so that at any one point in

time after year 1, a maximum of

seven trainees will be participating in

the AHRQ­funded Indiana Health

Services Research (I­HSR) training

program at Indiana University.

• Postdoctoral Training Program in

Family Health Services Research.

Principal Investigator: Anne K.

Duggan, ScD, Johns Hopkins

University School of Medicine,

Pediatrics Department, Baltimore,

MD. Grant No. T32 HS017596;

project period July 1, 2008­June 30,

2013. The Hopkins Department of

Pediatrics will be expanding the

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School of Medicine’s Family Health

Services Research Program to

includea focus on ambulatory care

for families with children. The goal

of this expansion is the training of

the next generation of health services

researchers in academic pediatrics.

To accomplish this, the program will

be designed to attract highly

qualified individuals who have

already completed an accredited

professional degree relevant to

pediatric health services research

(i.e.,a pediatrics, medicine, family

medicine, or combined medicinepediatrics residency or a doctoral

[PhD] program), particularly those

who have the intellectual curiosity

and research motivation that are in

concordance with research interests

of Hopkins’ core faculty and other

program resources.

For programmatic information on the

28 Institutional Training Awards (T32)

funded by AHRQ as of October, 2008,

visit http://www.ahrq.gov/fund/

training/t32.htm). For further

information on all AHRQ’s research

training programs, including the T32

projects, see http://www.ahrq.gov/

fund/training/rsrchtng.htm.

Small Grant Program for

Conference Support (R13) •	 Third Annual Pediatric Telehealth

Colloquium. Principal Investigator:

James P. Marcin, MD, University of

California, Davis, Davis, CA. Grant

No. R13 HS017785­01; project

period July 1, 2008­December 21,

2008. These pediatric clinical

telehealth conferences target

practitioners providing health care to

children in rural and underserved

communities. Health care providers,

hospital administrators, and health

information technology (health IT)

specialists share, disseminate, and

train these practitioners in clinical

telemedicine programs that have

been shown to be successful, thus

increasing access to care, reducing

disparities in care, and increasing the

overall quality of care delivered to

children in rural and underserved

communities ina financially

sustainable framework.

For information about AHRQ’s R13

Small Grant Program for Conference

Support (see http://grants.nih.gov/

grants/guide/pa­files/pa­06­074.html).

AHRQ also supports an R13/U13

Grant Program for Large Conference

Support (see http://grants.nih.gov/

grants/guide/pa­files/PA­06­378.html).

Contracts and Requisitions

Academic Pediatric Association

Young Investigator Awards

(Requisition No. 08R00094) •	 Baumgartner, Jill; University of

Wisconsin at Madison. Effects of

environmental tobacco smoke

exposure on blood pressure in

children and adolescents.

•	 Boynton­Jarrett, Renee; Boston

Medical Center. The social ecology

of adolescent obesity: The role of

adverse social settings and social

stress.

•	 Farst, Karen; Arkansas Children’s

Hospital; Little Rock. Trends in

child maltreatment hospitalizations

in young children from 1997­2005.

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Accelerating Evidence into Practice

for the Benefit of Children with Early

Hearing Loss. Expert Workshop.

January 2008. Logistics support.

Accelerating Evidence into Practice

for the Benefit of Children with Early

Hearing Loss: Preparation of

manuscript for publication and

report to HHS Office on Disability.

Shirley Russ, MD, MPH, Los Angeles,

CA.

Pediatric Asthma Hospitalizations

and the Quality of Ambulatory Care.

Robert W. Grundmeier, MD, The

Children’s Hospital of Philadelphia. Task

order under the Practice­Based Research

Network (PBRN) contract (RFTO #8).

Report and Recommendations from

the 2008 National Initiative for

Children’s Healthcare Quality

(NICHQ) Innovations Nursery

Symposium. National Initiative for

Children’s Healthcare Quality. Charles

Homer, MD; Professional services

contract.

Starting Early:A Life Course

Perspective on Child Health

Disparities: Support for Development

of Five White Papers for the

November 2008 Conference. Lynn

Olson, PhD; American Academy of

Pediatrics, Elk Grove Village, IL.

*MRSA Reservoirs in Hospitals and

Nursing Homes. Don Berlowitz,

Harvard Pilgrim Health Care. Boston,

MA.

*Developinga Health Literacy

Universal Precautions Toolkit. Leigh

Callahan, North Carolina Network

Consortium; Chapel Hill, NC, and

Durham, NC.

The Web site for information on

AHRQ’s contracting process is

http://www.ahrq.gov/fund/contraix.htm.

FedBizOpps (Federal Business

Opportunities at https://www.fbo.gov/

index?cck=1&au=&ck=) is the single

point­of­entry Web site for Federal

Government contract procurement

opportunities.

Other AHRQ Activities that

Address Children’s Issues

U.S. Preventive Services Task Force.

The U.S. Preventive Services Task Force

is supported by AHRQ. The Task Force

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 well­being of

children. The Web site for this activity is

www.childstats.gov.

Publications based on AHRQ­supported

extramural and intramural work on

children’s issues are listed, on an

ongoing basis, at http://www.ahrq.gov/

child/childpubs.htm.

More Information

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

E­mail: denise.dougherty@ahrq.hhs.gov

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www.ahrq.gov

AHRQ Pub. No. 09­PB007

February 2009