Pediatric Research in Inpatient Settings (PRIS) Network
The mission of PRIS is to improve the health of and healthcare delivery to hospitalized children and their families. This will be done by conducting large, multi-institutional studies in areas of inpatient pediatric care that are relevant to clinicians and the decisions they face when caring for children and their families in everyday clinical practice.
PRIS is a pediatric hospitalist research network. Hospitalists are physicians whose clinical practice is the care of hospitalized patients. Hospitalists are hospital-based physicians who want to ensure the system is delivering the highest quality of care for patients. The PRIS Network has a vision to be the premier research network and continually define what best practice is and how it should be implemented.
February 2012 Newsletter Article
PRIS Quarterly Update (October - December 2011)
Network Related Milestones
The PRIS Executive Council (EC) had its ninth in-person meeting October 4-6th in Seabeck, Washington. This meeting focused primarily on strategic planning and sustainability of infrastructure funding for the Network.
PRIS is currently open for new research proposal ideas from its membership. The PRIS Network Manager, Jaime Blank, works closely with the Chair and the Executive Council to meet the needs of PRIS member hospitals. Please contact Jaime if you have any new research ideas or questions related to PRIS (jaime.blank@hsc.utah.edu). Please also contact Jaime if you would like to be added to the PRIS listserv.
Membership
For those who are interested in becoming members but have not completed the membership survey yet, it can be found in the Become a Member section of our newly developed website www.prisnetwork.org or at http://www.academicpeds.org/ research/ research_pris.cfm. Thus far, interest has been overwhelming and we now have 76 member sites and over 600 members! We will be asking for the annual survey to be filled out in March of each year, until June. The four month window allows for more current information to be used for study planning and site selection purposes for new projects in the coming year. We will be using this information to improve communication with our past, current and future members and to create processes by which new ideas may be fostered through the network.
PRIS activities
Projects
PRIS has been fortunate to receive substantial infrastructure and specific project funding in recent months.
Infrastructure Funding + Prioritization Project
Grant Funding Period: March 1, 2010 - December 31, 2012
The aim of this project is to identify conditions that are prevalent, costly to the healthcare system, and demonstrate high inter-hospital variation in resource utilization, which signals either lack of high quality data upon which to base medical decisions, and/or an opportunity to standardize care across hospitals. This project will establish a priority list, focus on the highest ranking conditions that demonstrate the most variation of care, at a high cost/frequency, and that has actionable evidence that if followed in the inpatient setting, would lead to a decrease in unnecessary variation with no adverse or even superior patient outcomes.
The Prioritization phase of this project is complete and focus on the highest ranking conditions has been underway since the beginning of August. PRIS has begun work on 4 high ranking-conditions for drill-down analyses. The goals of each drill-down is to 1) discover the sources of variation in resource utilization across and within hospitals, 2) identify condition specific risk adjustment and outcomes, 3) identify potential quality measures and 4) understand the relationship between the variation in resource utilization, potential quality measures and condition-specific outcomes. Work on the first drill-down process on DKA has been continuing and we had a very productive project meeting in Philadelphia at the beginning of November. We anticipate wrapping up this first drill-down early in the New Year. Tonsillectomy has been chosen as the second drill-down condition and the project start was kicked-off in mid-December. PRIS will work with hospitals in order to have them weigh in more formally on the choice of the last two drill-downs.
PRIS met with the Quality and Safety Leaders at Child Health Corporation of America (CHCA) in October and with the CEOs in November to receive input on the next two drill-down conditions. The final decision on the last two conditions will be made early in the New Year and PRIS will have a more formal process by which hospitals may weigh in on the choice.
A manuscript describing the methods used to develop the priority condition list has been prepared and will be submitted early in the New Year.
PHIS+: Augmenting the Pediatric Health Information System (PHIS) with Clinical Data
Grant funding period: September 30, 2010 - September 29, 2013
The objective of the PHIS+ project is to build on the existing infrastructure provided by Child Health Corporation of America (CHCA)- -a business alliance networking 43 of North America's leading children's hospitals-- to augment its existing database (PHIS) with laboratory, microbiology and radiology data for children seen in the ambulatory and inpatient departments of 6 large children's hospitals.
The PHIS+ project is making headway and achieving the milestones set forth in the grant application. Over the last quarter, all three project streams have taken shape. The laboratory component is in the final stages of being mapped into the PHIS+ database. The initial stage of the laboratory backfill of data has started, and is expected to be complete in the first few months of 2012. A one-month sample of microbiology data has been collected from each site and will be mapped by the bioinformatics core at the University of Utah. The next step is for the hospitals to extract one year of microbiology data, which is expected to be assigned in early January. A one year radiology data extract is expected to be submitted in early January. The backfills for microbiology and radiology will take place after the lab backfill is complete.
The Child Health Corporation of America (CHCA) will be operationalizing the PHIS+ database once it's received from the University of Utah. The first few months of 2012 will be dedicated to testing the software, building the necessary architecture and validating the data to get ready for the comparative effectiveness research (CER) projects. The CER project PIs will begin their studies as soon as the appropriate IRB protocols are in place and the data is available to be queried. We anticipate the projects to begin in the spring.
Over the next month the PHIS+ team will be preparing for the second annual in-person meeting in Park City, Utah. The meeting will be held over two days in February and will be used to discuss the status of the project to date and identify next steps for short- and long-term sustainability.
I-PASS: IIPE-PRIS Accelerating Safer Signouts
Grant Funding Period: September 21, 2010 - August 31, 2013
This study is examining the effectiveness of a "resident handoff bundle" in accelerating adoption of safer communication practices in nine pediatric hospitals across the US and Canada, and was developed within the PRIS network and endorsed by the Initiative for Innovation in Pediatric Education.
The I-PASS Study Group continues to meet targets in studying the effectiveness of a "resident handoff bundle" to accelerate the adoption of safer communication practices in pediatric hospitals. Baseline data collection has been completed at the first wave of sites, which includes Lucile Packard Children's Hospital (Palo Alto, CA) and UCSF Benioff Children's Hospital (San Francisco, CA). The second wave of sites - Cincinnati Children's Hospital Medical Center (Cincinnati, OH), St. Louis Children's Hospital (St. Louis, MO), and Primary Children's Medical Center (Salt Lake City, UT) - will complete baseline data collection in December 2011. A third wave of sites - Hospital for Sick Children (Toronto, ON, Canada), St. Christopher's Hospital for Children (Philadelphia, PA), National Capital Consortium (Washington, DC), and Doernbecher Children's Hospital (Portland, OR) began six months of baseline data collection in November 2011. During baseline data collection, trained research nurses and research assistants collect data on patient safety outcomes and resident workflow, work processes, and satisfaction. Initial reports have suggested that research staff have collected an expected number of medical errors and that there were remarkably high response rates (90%+) to resident surveys.
Post-intervention data collection will begin at the first wave of sites in January 2012. The team training intervention and other aspects of the resident handoff bundle have been implemented at these sites during the six-month wash-in period that began in June 2011. To this end, representatives from all sites have been deeply involved in developing a team training intervention which features a verbal mnemonic, printed handoff tool, and drawing on key aspects of the TeamSTEPPSTM program developed jointly by the Department of Defense and the Agency for Healthcare Research and Quality. Study working groups are participating in weekly teleconferences to coordinate implementation of the study protocol, plan for data analysis and validation, and various aspects of the curriculum. Preliminary dissemination efforts are underway, including workshop and plenary presentations at the 2012 Pediatric Academic Societies meeting and an article in Pediatrics which will be published early in the new year.
In the coming months, implementation of the resident handoff bundle intervention will continue and post-intervention data collection will begin, coincident with ongoing data analysis and dissemination activities.
Submitted by
Jaime Blank
Research Associate, Network Coordinator
Jaime.Blank@hsc.utah.edu
