Research on Child and

Adolescent Health Care

New Starts­Fiscal Year 2007

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 in fiscal

year 2007. Projects that include children

or children’s health care issues but do

not focus exclusively on children are

marked with an asterisk (*).

AHRQ committed to investing $14.2

million for these projects in FY 2007

and a total of $37.8 million over the

entire term of these multi­year projects.

Please note that guidelines for one or

more of these programs may have

changed since the projects described in

this fact sheet were funded in fiscal

year 2007. For current information on

programs, funding priorities, and other

aspects of the funding process, please

visit the “Funding Opportunities”

section of the AHRQ Web site at

www.ahrq.gov.

Research Grants and

Cooperative Agreements

Large Research Grants (R01)

Evaluation of Telemedicine for

Children with Special Health Care

Needs (CSHCN). Principal

Investigator: Kenneth McConnochie,

MD, University of Rochester, Rochester,

NY. Grant No. R01 HS16871; project

period July 1, 2007­June 30, 2010. This

project will (1) establish personal

computer­ and Web­based telehealth

networks to address acute care needs of

CSHCN in Rochester, NY and Akron,

OH; (2) assess the economic impact of

this network on key stakeholders; and

Advancing Excellence in Health Care • www.ahrq.gov

Agency for Healthcare Research and Quality
(3) determine the incremental costs and

technical, clinical, and organizational

requirements for system modifications

that will be critical in addressing chronic

problems in CSHCN. Minority

(Hispanic/Latino, Asian, and African

American) children and young adults,

ages6 weeks to 21 years, will be

included in this study.

Capitation Adjustment for Children

with Special Health Care Needs.

Principal Investigator: Hao Yu, PhD,

RAND Corporation, Santa Monica,

CA. Grant No. R01 HS16742; project

period September 30, 2007­September

29, 2009. This study addresses the need

to set adequate capitation rates for

children, especially CSHCN, by

developing risk­adjustment models.

CSHCN are particularly vulnerable in

the current health insurance

marketplace.

Health Services Research

Demonstration and Dissemination

Grants (R18)

Pharmaceutical Safety Tracking

(PhaST): Managing Medications for

Patient Safety. Principal Investigator:

William Gardner, PhD, Children’s

Research Institute, Columbus, OH.

Grant No. R18 HS17258; project

period September 4, 2007­August 31,

2008. PhaST isa health information

system that will assist clinician

management of medications in

ambulatory settings, specifically

pediatric use of antidepressants. PhaST

is an automated system for monitoring

medication adherence, side effects, and

patient symptoms. It will benefit

outpatients taking drugs that have

recognized side­effect risks, even when

those drugs are correctly prescribed. The

use of psychoactive medications in

children and adolescents has greatly

increased the public health relevance of

medication­related adverse events,

including suicidal ideation and manic

activation. PhaST will be compared

with usual care on measures of patient

and provider satisfaction, patient

outcomes, and measures of the quality

of medication management, such as the

rate of patient medication

nonadherence.

STEPStools: Developing Web

Services for Safe Pediatric Dosing.

Principal Investigator: Kevin B.

Johnson, MD, Vanderbilt University

Medical Center, Nashville, TN. Grant

No. R18 HS17216; project period

September 30, 2007­August 31, 2010.

This research will enable shared

decisionmaking and patient­clinician

communication, personal health

records, and integration of patient

information across transitions in care, as

well as patient self­management of

chronic conditions. The quality of every

decision made in health care facilities is

critically dependent on the availability

of accessible, accurate, relevant, and

current patient care information. This

study will strategically measure and

assessa design for culturally sensitive

patient­centered care through

accessibility to information technology

(IT) support systems.

Harnessing Health IT to Prevent

Medication­Induced Birth Defects.

Principal Investigator: Eleanor B.

Schwarz, MD, University of Pittsburgh

Medical College, Pittsburgh, PA. Grant

No. R18 HS17093; project period

September 7, 2007­August 31, 2010.

Each year, 150,000 infants (1­3 percent

of all U.S. births) are born with some

form of physical or mental birth defect.

Clinicians rarely counsel women about

contraception when prescribing

medications that increase the risk of

birth defects. This research will evaluate

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how physicians may be able to use

computers to help them discuss the

prevention of medication­related birth

defects with their female patients. The

project will provide information on how

health IT can be used to prevent

medication­induced birth defects

throughout the country.

Improving Otitis Media Care with

EHR­Based Clinical Decision

Support and Feedback. Principal

Investigator: Christopher Forrest, MD,

PhD, Children’s Hospital of

Philadelphia, Philadelphia, PA. Grant

No. R18 HS17042; project period

September 12, 2007­February 28, 2010.

Researchers will use the Children’s

Hospital of Philadelphia’s (CHOP’s)

electronic health record (EHR) to

integrate care across time and to supply

physicians with the knowledge they

need to treat a patient at the point of

care. The full intervention comprises

four parts: (1) a method for linking all

services a patient receives from any

physician into clinically logical clusters

called episodes of care; (2) clinical

decision support for medications and

referrals to specialists that are based on

the best available scientific evidence; (3)

feedback to physicians on past

performance of otitis media (OM) care;

and (4) physician training on how to

use the tools. Twenty­eight primary care

practices will be randomly assigned to

usual care, full intervention, or full

intervention without feedback. The

three main aims are to: develop and

pilot test the OM health IT

intervention; examine the overall effects

of the intervention and the contribution

of physician feedback on quality; and

assess the effects of the intervention on

the secondary outcomes of resource use

and clinician adoption of the

technology.

*Medication Monitoring for

Vulnerable Populations via IT.

Principal Investigator: Christopher

Lehmann, MD, Johns Hopkins

University, Baltimore, MD. Grant No.

R18 HS17018; project period

September 21, 2007­August 31, 2009.

The goal of this project is to

demonstrate the ability of health

information technologies, including

EHRs, to provide quality and safety

measures for the vulnerable populations

served by an urban community health

center. The project includes a practicebased demonstration involving the

linking of EHRs, laboratory data, and

claims data to generate useful quality

and safety measures and evaluate the

utility of the measures.

Enabling Patient­Centered Care

through Health IT Grants (R18)

Conversational IT for Better, Safer

Pediatric Primary Care. Principal

Investigator: William Adams, MD,

Boston Medical Center, Boston, MA.

Grant No. R18 HS17248; project

period September 1, 2007­August 31,

2010. The goal of this project is to

improve preventive care in pediatric

primary care settings by focusing on

medication management. It involves

development and evaluation of an

integrated patient­centered health

information system (the Personal Health

Partner) that will use fully automated,

interactive conversations to gather

personal health data and counsel parents

before scheduled visits, exchange that

data with the child’s primary care

clinician via the electronic health record,

and offer personalized followup

assessment and counseling after visits.

By linking parents in their homes to

their primary care providers, the

researchers expect to inform and activate

parents, provide much richer data to

drive decision support at the point of

care, and provide ongoing support for

long­term behavior change following

primary care visits.

*Impact of a Wellness Portal on the

Delivery of Patient­Centered

Prospective Care. Principal

Investigator: James Mold, MD, MPH,

University of Oklahoma Health

Sciences Center, Oklahoma City, OK.

Grant No. R18 HS17188; project

period July 1, 2007­June 30, 2010. The

aims of this study are to (1) develop,

field test, and further refine an Internetbased wellness portal—the Preventive

Services Reminder System (PSRS)—for

patients in primary care settings to

facilitate patient­centered, preventive

care; (2) determine the impact of the

wellness portal on the process of

patient­centered preventive care by

examining the experiences of patients

and providers with care and

individualization of recommended

services; and (3) develop and describe

model wellness portal/PSRS practices,

produce a video of these model practices

and disseminate it to clinicians, and

distribute the knowledge derived from

the project through publications and

presentations. This study will include

women, the elderly, children, and

minorities (Hispanic).

Enabling Quality Measurement

Through Health IT Grants (R18)

Surveillance for Adverse Drug Events

in Ambulatory Pediatrics. Principal

Investigator: Peter Kilbridge, MD,

Washington University, St. Louis, MO.

Grant No. R18 HS17010; project

period July 1, 2007­June 30, 2009. The

aims of this project are to (1) implement

an automated surveillance system for

measuring the incidence of adverse drug

events (ADEs) occurring in the

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outpatient setting (including the

emergency department (ED) in

pediatric patients with specific chronic

diseases that involve ED care or

admission to the St. Louis Children’s

Hospital; (2) use the automated

surveillance system for measuring the

incidence of ADEs occurring in these

patient populations during the

transition in care from the outpatient to

inpatient setting, e.g., originating during

the admissions process; (3) use the

automated surveillance system for

measuring the incidence of ADEs in the

target pediatric populations within 4

weeks of discharge from the hospital;

and (4) evaluate the performance of the

event detection system as employed in

aims 1, 2, and 3. This study will include

African American pediatric patients in

the sickle cell disease population and

cystic fibrosis and cancer patients in all

racial and ethnic groups.

*Massachusetts Quality E­Measure

Validation Study. Principal

Investigator: Eric Schneider, MD, MSc,

Harvard University, Boston, MA. Grant

No. R18 HS17048; project period

September 1, 2007­August 31, 2009.

The aims of this project are to (1)

recruit a cohort of adult ambulatory

patients from three communities that

are piloting community­wide

implementation of structured EHRs to

compare a quality measurement method

based on data from a structured EHR

to a hybrid method involving a

combination of aggregated claims data

and medical records review; and (2) use

secondary data sets on adult and

pediatric patients in the same three

communities to compare a

measurement method based on

structured EHR data to a claims­only

method based on a novel database that

aggregates claims data from commercial

health plans and Medicare. This study

will include both male and female

patients and racial and ethnic minorities

(Hispanic/Latino, African­American,

and Asian).

*Automating Assessment of Asthma

Care Quality. Principal Investigator:

Brian Hazlehurst, PhD, Kaiser

Foundation Research Institute,

Oakland, CA. Grant No. R18

HS17022; project period November 1,

2007­October 31, 2009. The aims of

this project are to (1) refine asthma care

quality measures from the RAND

Quality Assessment Tools study for use

as a quality measure set to evaluate

ambulatory asthma care performance;

(2) develop and validate an automated

(generalizable and scalable) method for

applying the measures identified, using

comprehensive electronic medical record

(EMR) data; (3) apply the method to

assess ambulatory asthma care quality in

two distinct health plans representing

diverse patient populations and care

practices; and (4) evaluate the

association between these automated

measures of adherence to recommended

asthma care processes and measures of

clinical outcomes. This study will

include asthma patients older than age

5, including minority patients.

Centers for Education and

Research on Therapeutics (CERTs)

Program Awards (U18)

Pursuing Perfection in Pediatric

Therapeutics. Principal Investigator:

Carole Lannon, MD, MPH, Children’s

Hospital Medical Center,

Cincinnati, OH. Grant No. U18

HS16957; project period August 1,

2007­July 31, 2011. This project

involves four studies to improve

outcomes for children by optimizing the

use of therapeutics, pharmacogenomics

and personalized medicine, patient

safety, and quality improvement

methodology. The studies will: (1)

examine the impact of pharmacogenetic

testing on the treatment of children

taking risperidone; (2) decrease harm

from adverse drug events using highreliability methods; (3) improve

outcomes for children with chronic

illness through collaborative networks in

subspecialty care by working initially

with the Pediatric Inflammatory Bowel

Disease Network to improve medication

management; and (4) pilot and

disseminate resources that facilitate the

use of optimal therapeutics by working

with the American Academy of

Pediatrics. Minority children (infants to

18 years of age) will be included in these

studies.

*The Vanderbilt Center for

Education and Research on

Therapeutics. Principal Investigator:

Wayne Ray, PhD, Vanderbilt University,

Nashville, TN. Grant No. U18

HS16974; project period October 1,

2007­September 30, 2011. This project

involves eight new studies to promote

optimal pharmacotherapy in Medicaid

and Veterans’ Health Administration

(VHA) populations and reduce the

occurrence of medication­related

gastropathy. Four studies will investigate

the effects of frequently used drugs in

priority populations (fetus, children,

chronically ill) and study priority

diseases (cardiovascular, gastrointestinal).

Three educational programs will focus

on improving the use of therapy to

prevent stroke/sepsis in children with

sickle cell disease, gastroprotection in

high­risk nonsteroidal antiinflammatory drug (NSAID) users in

the VHA, and gastroprotection in highrisk Medicaid NSAID users. The one

policy evaluation study will examine the

effect of Medicaid disenrollment of

patients with serious mental illness to

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inform future insurance coverage

policies for this vulnerable population.

Women, minorities, and children

(African Americans) will be included in

this study.

*HMO Research Network CERT III.

Principal Investigator: Richard Platt,

MD, Harvard Pilgrim Health Care,

Boston, MA. Grant No. U18 HS16955;

September 30, 2007­September 29,

2011. This project involves four new

studies to enhance the collective ability

of the HMO Research Network and

other collaborating health plans to

advance therapeutics knowledge by

leveraging unique data sources within a

very large, generalizable population.

This study also entails development and

implementation of new multi­faceted

methods for disseminating and

promoting best therapeutic practices.

The third project will focus on children:

“Antipsychotic Medication Use in

Children and Risk of Diabetes

Mellitus.” The aims of this study are to

(1) describe the characteristics of

children receiving atypical antipsychotic

medications, including demographics,

specific indications of antipsychotic

therapy, preexisting diabetes mellitus,

prior glucose monitoring, and relevant

comorbidities and medications; (2)

assess and compare the incidence of

diabetes mellitus among children

receiving and not receiving atypical

antipsychotic medications; and (3)

determine whether the incidence of

diabetes mellitus varies among children

receiving different atypical antipsychotic

medications.

*Center for Education and Research

on Therapeutics and the University of

Pennsylvania. Principal Investigator:

Brian Strom, MD, MPh, University of

Pennsylvania, Philadelphia, PA. Grant

No. U18 HS16946; project period

September 1, 2007­August 31, 2011.

This project involves research to

improve the underlying evidence base

for decisions about the use and effects of

anti­infective drugs, as well as the

implementation and evaluation of

interventions aimed at improving the

use of anti­infectives in outpatient and

inpatient settings, locally, regionally, and

nationally. New features of the

PennCERT include an increased focus

on pediatrics, with new faculty and a

major emphasis planned at the

Children’s Hospital of Philadelphia.

Research Infrastructure

Development Awards (P20)

Ambulatory Care Patient Safety

Proactive Risk Assessment Grants

*Oral Chemotherapy Safety in

Ambulatory Oncology: A Proactive

Risk Assessment. Principal Investigator:

Saul Weingart, MD, PhD, Dana­Farber

Cancer Institute, Boston, MA. Grant

No. P20 HS17123; project period

September 1, 2007­August 31, 2009. A

failure modes and effects analysis will be

conducted for five oral chemotherapy

agents, and an improvement plan will

be developed to address the hazards

associated with these classes of

medications used by adult and pediatric

outpatients at New England’s largest

cancer center. The results of this study

will be integrated into an improvement

plan that includes a portfolio of

interventions to address high­priority

failure modes.

Risk Assessment of Pediatric

Emergency Transfers. Principal

Investigator: Jane Holl, MD, Institute

for Healthcare Studies, Chicago, IL.

Grant No. P20 HS17125; project

period July 1, 2007­June 30, 2008. This

study has four goals. The first goal is to

use failure modes and effects analysis to

conduct a set of proactive risk

assessments of communication,

documentation, and transfer processes

involving pediatric patients between

referring EDs from six hospitals with

pediatric inpatient services that make up

the Pediatric Patient Safety Consortium

in the Chicago area. The second goal is

to condense the results of these analyses

into a single set of specific

communication, documentation,

coordination, and systemic risk factors

in emergency transfers. The third goal is

to create a standardized process and

tools to address communication,

documentation, and coordination

during transfers. The fourth goal is to

develop a toolkit and disseminate it to a

sample of EDs in the hospitals receiving

inpatient pediatric referrals to elicit

feedback about its generalizability and

potential for implementation. The study

population will include up to 70

clinicians, including minority clinicians.

Crossing an Invisible Quality Chasm:

From the NICU to Ambulatory Care.

Virginia Moyer, MD, MPH, Baylor

College of Medicine, Houston, TX.

Grant No. P20 HS17122; project

period July 1, 2007­June 30, 2008. This

project includes a prospective risk

assessment using Health Care Failure

Modes and Effect AnalysisTM

(HFMEA) to identify potential highimpact error points and their origins in

the care transition from the neonatal

intensive care unit (NICU) and

intermediate care nurseries to

ambulatory followup. The researchers

will use a combination of methods,

including focused case reviews and

questionnaires to conduct a retrospective

risk assessment and identify errors to

corroborate and add to the findings

from HFMEA. Women, minorities, and

parent/caregivers of infants being

discharged from nurseries will be

included in this study.

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LEARN (Leveraging Existing

Assessments of Risk Now) for

Pediatric Patient Safety. Donna

Woods, EdM, PhD, Northwestern

University, Chicago, IL. Grant No. P20

HS17114; project period September 1,

2007­August 31, 2009. The aims of this

project are to: (1) adapt the U.S.

Department of Energy risk assessment

methodology and criteria for analysis of

multiple existing risk assessments for use

in health care; (2) apply the adapted

methods and criteria to existing risk

assessments about emergency medical

care systems and processes; (3) identify

significant generic risks and contributors

to risk related to children’s emergency

medical care; and (4) disseminate results

through the National Association of

Children’s Hospitals and Related

Institutions and other mechanisms,

including information about the

identified generic risks, risk

contributors, and potential safety

interventions for children’s emergency

care and a toolkit of the adapted

methods and criteria for analysis of

existing risk assessments.

Small Research Grants (R03)

Developing an Integrated

Engineering­Based Model to Reduce

Infections in ICUs. Principal

Investigator: Christina Mastrangelo,

PhD, University of Washington, Seattle,

WA. Grant No. R03 HS15732; project

period March 1, 2007­May 31, 2008.

The goal of this project is to develop an

engineering­based, systems­level

methodology that models the likelihood

of infection transmission within

pediatric intensive care units (PICUs).

The aims of this study include: (1)

characterizing the current system in

PICUs; (2) creating a systems model of

PICUs; (3) developing a cognitive

model to be incorporated into the

systems model; (4) using risk analysis to

develop a ‘risk of infection’ measure;

and (5) evaluating alternatives to reduce

the risk of infection transmission in the

PICU. The study population will reflect

the composition of pediatric PICUs.

Effect of a Restrictive Formulary on

Low­Income Children. Principal

Investigator: Julie Urmie, PhD,

University of Iowa City, IA. Grant No.

R03 HS15605; project period May 1,

2007­October 31, 2008. The aims of

this project are to (1) determine the

effect of the Iowa State Children’s

Health Insurance Program’s (SCHIP)

restrictive prescription drug formulary

on children with depression by

comparing antidepressant utilization

and health outcomes during the year

before and 1­1/2 years after the

restrictive formulary was implemented

on July 1, 2002; and (2) control for

historical trends in depression treatment

by comparing antidepressant utilization

and health outcomes between Iowa’s

SCHIP population, a comparison group

of privately insured children, and a

comparison group of children in the

Iowa Medicaid program during the year

before and 1­1/2 years after the

restrictive formulary was implemented.

This study will use retrospective claims

data, so the minority composition is

predetermined based on the minority

composition of the children enrolled in

the three study groups.

The Impact of the FDA

Antidepressant Black Box Warning

on Psychiatric Practice. Principal

Investigator: Hua Chen, University of

Houston, Houston, TX. Grant No. R03

HS16802; project period March 1,

2007­June 30, 2008. The goal of this

study is to investigate the impact of the

U.S. Food and Drug Administration’s

antidepressant black box warning on the

quality of psychiatric practice. This

project will examine and compare the

use of psychotherapy, psychotropic

medications, and antidepressant

followup care among Medicaid enrollees

6 to 18 years of age before and after

FDA published the Public Health

Advisory on antidepressants in March

2004.

Emergency Department

Overcrowding and Quality of Acute

Asthma Care for Children. Principal

Investigator: Marion Sills, MD, MPH,

University of Colorado at Denver and

Health Sciences Center, Denver, CO.

Grant No. R03 HS16418; project

period June 1, 2007­May 31, 2009.

This study will examine the association

between ED overcrowding and quality

of care in a pediatric population (ages 2­

18 years), using asthma as the disease

model. The aims of the project are to

model the association between ED

overcrowding and several process and

outcome measures of pediatric acute

asthma care quality and test for

mediation by process measures and

moderation by patient and provider

characteristics within the

overcrowding/quality model.

Overweight in Children: A New View

Using the Population Attributable

Fraction (PAF). Principal Investigator:

Deborah Rosenberg, PhD, MPH,

University of Illinois at Chicago,

Chicago, IL. Grant No. R03 HS16899;

project period July 1, 2007­June 30,

2009. This project will use data for

Illinois and Florida from the 2003

National Survey of Children’s Health to

(1) extend and refine methods for

estimating multi­factorial PAFs by

assessing various numerical alternatives;

(2) apply the PAF methods to child

overweight, illustrating the way in

which PAFs can be used to identify a set

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of risk factors that, if addressed, would

have the greatest impact on reducing an

outcome in the population; and (3)

disseminate the methods, including

guidelines, programming code, and

other documentation, to practitioners

engaged in priority­setting and program

development.

*Using MEPS Data to Inform PublicPlan Consumerism. Principal

Investigator: Matthew Davis, MD,

University of Michigan, Ann Arbor, MI.

Grant No. R03 HS16544; project

period July 1, 2007­June 30, 2008. This

study will (1) identify the

socioeconomic and demographic

characteristics and health care utilization

of children and adults enrolled in

Medicaid whose expenditure patterns in

the Medical Expenditure Panel Survey

(MEPS) indicate that they would havea

lower likelihood of exceeding their

health opportunity account (HOA)

allocations than other beneficiaries; (2)

use the 2­year longitudinal panel format

of the MEPS to follow individuals on

Medicaid over time, in order to model

the risk of exceeding the HOA

allocations for hypothetical cohorts of

beneficiaries with the characteristics

identified in step 1; and (3) estimate the

net fiscal impact of HOA initiatives for

Medicaid programs for the models of

hypothetical cohorts in step 2. Women,

minorities, and children will be included

in this study.

*The Impact of the Pneumococcal

Conjugate Vaccine on Pneumonia

Hospitalizations. Principal Investigator:

Carlos Grijalva, MD, MPH, Vanderbilt

University, Nashville, TN. Grant No.

R03 HS16784; project period March 1,

2007­February 28, 2008. The

Nationwide Inpatient Sample (NIS)

database sponsored by AHRQ will be

used in this study to: (1) examine

changes in pneumonia hospitalization

trends for adults and children after the

introduction of pneumococcal conjugate

vaccines in selected NIS participating

States, after accounting for the activity

of respiratory winter viruses; (2)

examine changes in pneumonia

hospitalization trends after the

introduction of pneumococcal conjugate

vaccines in the United States using NIS

national estimates and accounting for

the activity of respiratory winter viruses;

and (3) developa reproducible

methodology to monitor trends and

evaluate interventions on this outcome

as available information is updated.

DVT Prevention in Pediatric and

Adolescent Trauma Patients: Safety

and Costs. Principal Investigator: Sarah

H. O’Brien, MD, MSc, Children’s

Research Institute, Columbus, OH.

Grant No. R03 HS17344; project

period September 30, 2007­September

29, 2009. This study will identify

which, if any, young trauma patients

with multiple injuries may truly benefit

from receiving deep venous thrombosis

(DVT) prophylaxis strategies that have

become the standard of care for adults.

The results will be used to create childand adolescent­specific treatment

guidelines, thereby allowing clinicians to

maximize patient safety and minimize

costs when considering

thromboprophylaxis with lowmolecular­weight heparin (LMWH) for a young trauma patient.

Pediatric Medication Safety. Principal

Investigator: David G. Bundy, MD,

Johns Hopkins University, Baltimore,

MD. Grant No. R03 HS16774;

September 30, 2007­September 29,

2008. This study will advance the

knowledge of pediatric medication

errors by identifying which medications

and which children are associated with

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high harm and near harm medication

errors among high health care burden

pediatric conditions and will

systematically explore the causes of such

errors. The products of this study will

be directly useful in developing targeted

solutions and policies to prevent harm

to children from medication errors.

Research Training and

Education

Minority Research Infrastructure

Support Program (R24)

*Expansion of Rural Health Care

Research Infrastructure Through the

ECHO Model. Principal Investigator:

Sanjeev Arora, MD, University of New

Mexico, Albuquerque, NM. Grant No.

R24 HS16510; project period

September 21, 2007­August 31, 2010.

The goal of this project is to train

primary care providers from

underserved areas, such as rural

communities, to develop knowledge and

skill in “best practice” care for complex

health conditions and to improve

clinical outcomes for patients with such

conditions. One component of this

project will focus on overweight in

children and adolescents.

Dissertation Awards (R36)

Encouraging Eligible Children’s

Participation in Public Health

Insurance: The Role of National

Awareness Campaigns. Principal

Investigator: Jeanette Ziegenfuss,

University of Minnesota, Minneapolis,

MN. Grant No. R36 HS16565; project

period June 1, 2007­May 31, 2008. The

aims of this dissertation award are to (1)

document the change in children’s

enrollment in public health insurance

between 1996­2005, including the time

span since the passage of SCHIP in

1997; (2) estimate the relative

contribution of each of the two national

awareness campaigns in the enrollment

levels of public health insurance for

children while controlling for State

variation in programs and the

demographic composition of those who

are potentially eligible; (3) estimate the

relative effectiveness of these campaigns

for subgroups of SCHIP and Medicaideligible children, including age of child

and parent, race/ethnicity, household

income, etc; and (4) provide

recommendations for future data

collection with respect to all public

insurance education and outreach to

enable future research to estimate the

total impact of these techniques in

encouraging enrollment.

The Effects of Maternal Labor

Supply on Child Health. Principal

Investigator: Melinda Sandler Morrill,

University of Maryland, College Park,

MD. Grant No. R36 HS17375; project

period September 4, 2007­June 3,

2008. This research will provide an

estimate of the causal effect of maternal

labor supply on the health of school­age

children. It will contribute to the

understanding of the public health

burden of children’s poor health that

may result from increasing the supply of

maternal labor. Policies that are aimed at

mitigating the strain on working

mothers and helping women combine

work and family life can be informed by

quantitative research such as this study

on the impact on children of maternal

labor.

Conference Grants (R13)

International Meeting on Indigenous

Child Health (April 20­22, 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, 2006­November 30, 2007.

This conference will focus on innovative

clinical care models and communitybased public health approaches for

children and youth in First Nations,

Inuit, Métis, 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,

Tufts­New 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

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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 High­Risk

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,

2007­August 31, 2007. This summit of

evidence­based 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 high­risk 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 19­21,

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, 2007­December 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 evidence­based 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.

Contracts

Evidence­based Practice Center

(EPC) Child­Focused Activities

Under AHRQ’s Evidence­based Practice

Center (EPC) program, 5­year 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 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 Evidence­based Practice

Center. Contract No. 290­02­0023;

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 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 Evidence­based Practice

Center. Contract No. 290­02­0018;

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

9
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 long­term

harms for patients. Also studied will be

barriers to the following: (1) therapies

that increase hemoglobinF (the form of

hemoglobin that exists in the fetus and

small infants); (2) well­established

therapies for disease­management; and

(3) the use of bone marrow

transplantation. Available at

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, RTI­UNC

Evidence­based Practice Center.

Contract No. 290­02­0016; project

period January 15, 2007­February 14,

2008. This Task Order will result ina

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

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 UniversityUniversity of California at San Francisco

Evidence­based Practice Center.

Contract No. 290­02­0017; project

period March 1, 2007­March 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 ofa

successful induction of labor.

Effectiveness of Weight Reduction

Programs in Children. Principal

Investigator: Evelyn Whitlock, MD,

MPH, Oregon Health Sciences

University. Contract No. 290­02­0024­

8; project period May 1, 2007­August

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 short­term, long­term, 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 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, isa

collaborative research and practice­based

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.

10
 
*A Multi­Center, 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. 290­05­

0042; project period September 1,

2007­August 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 Angiotensin­Converting

Enzyme Inhibitor (ACEI)

Prescription Drug Use in Pregnancy.

Richard Platt, MD, Harvard Pilgrim

Health Care; HMO Research Network

(HMORN) DEcIDE Center. Contract

No. 290­05­0033; project period June

1, 2007­June 1, 2009. This project

involves a population­based 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

5­year implementation model of fieldbased research that fosters public­private

collaboration in rapid­cycle, 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 demanddriven and evidence­based 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 Evidence­Based

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. 290­06­

0022­2, with Health Research &

Educational Trust; project period July

16, 2007­February 16, 2009. In

response to an ACTION program call

for the implementation and evaluation

of evidence­based 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

phone­based 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 evidence­based 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 Multi­Level

Analysis.

Other Contracts

Knowledge Transfer to Improve

Followup and Care for Infants with

Early Hearing Loss—Expert Meeting.

B.L. Seamon Corporation, Greenbelt,

MD. Contract No. 290­07­10046;

project period May 17, 2007­March 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.

11
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

07­10079; project period September 28,

2007­September 27, 2010. RTI has

received the first task order to establish

and implement the first rounds of

technical assistance. This is a 3­year, $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 one­on­one

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. 290­07­10039; project

period September 28, 2007­September

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. 290­06­00015; project period

September 28, 2007­September 30,

2009. This project involves the

implementation and evaluation of a

secure messaging system called

ClinicalMessenger 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 provider­time 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, 2007­August 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 well­being of

children. The Web site for this activity is

www.childstats.gov.

Publications. 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.ht

m.

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

www.ahrq.gov

AHRQ Pub. No. 09­PB006

April 2009 12