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Pediatric Research in Inpatient Settings (PRIS) Network

Research

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.

April 2013 Newsletter Article

PRIS Activities

Annual PRIS Executive Council Meeting
February 13-14
Park City, UT
We were joined by Jacqueline Kueser and Matt Hall (CHA), Benard Dryer (APA), Lynn Olson (AAP), and Michael Burke (SHM)

Network-wide Site
Participation Opportunities Still Available!!

Global Assessment of Pediatric Patient Safety (GAPPS): Improve methods for detecting inpatient harm due to medical care by validating a pediatric trigger tool. Contact michaela.tracy@childrens.harvard.edu

PRIS Point Prevalence Study
Contact jaime.blank@hsc.utah.edu

PRIS Events at the Pediatric Academic Societies Meeting, May 4-7th

Meet the Professor
Chris Landrigan
Building Safer Hospital Care for Residents and Patients: Challenges and Opportunities

APA Hospital Medicine SIG
PRIS Presentation
Attendance of PRIS Executive Council Members

Workshop
Chris Landrigan
The I-PASS Handoff Process: Teaching and Evaluating Standardized Approaches to Transitions of Care

Platform Presentation
Sanjay Mahant
Tonsillectomy Care and Outcomes in Children's Hospitals

Workshop
Ron Keren
Getting Your Articles Accepted

State of the Art Plenary
Chris Landrigan, Raj Srivastava, Nate Kupperman, Patrick Conway, Mike Dean, Charlie Homer
Dissemination and Implementation Science: Spreading Evidence from High-Quality Studies across Institutions to Improve Inpatient Outcomes

Workshop
Flory Nkoy, Tiffany Glasgow, Chris Maloney, Bernhard Fassl, Bryan Stone, Raj Srivastava
Organizational Elements for the Successful Implementation of Evidence Into Routine Clinical Practice

(A detailed schedule will be sent out just prior to PAS)

Upcoming Events
Pediatric Academic Societies Conference
May 4-7, 2013
Washington, D.C.

PRIS Executive Council Meeting
August 2, 2013
New Orleans, LA

Pediatric Hospital Medicine Conference
August 1-4, 2013
New Orleans, LA

Project Updates

Comparative Effectiveness of Intravenous v. Oral Antibiotic Therapy for Serious Bacterial Infections
This is the newest funded project in PRIS! The aims are to compare the effectiveness of oral antibiotics vs. intravenous antibiotics delivered via a PICC and to compare patient and caregiver reported quality of life and adherence to therapy for oral antibiotics vs. IV antibiotics delivered via a PICC in children who require prolonged home antibiotic therapy after hospitalization for a serious bacterial infection.

Work has just begun on the project and we will be working with and contacting hospitals involved in contributing data to the PHIS database soon.

Watch for more updates to come!

Infrastructure Funding + Prioritization Project
The DKA (Diabetic Ketoacidosis) project team, led by Joel Tieder, MD, MPH, has submitted a manuscript to Pediatrics, titled "Variation in Resource Utilization and Readmission for Diabetic Ketoacidosis in Children's Hospitals", and is awaiting a determination. In this manuscript, the team characterizes variation in hospital resource utilization and readmission rates across children's hospitals and concludes that there is wide variation in both and that readmission is common in the first year. The study highlights the need for further research on the effectiveness of high cost management strategies used to improve outcomes. A second manuscript is in progress focusing on the predictive probability of patient factors for readmission.

Work has continued to progress on the tonsillectomy drilldown, which is led by Sanjay Mahant MD, MSc. The two major questions to be explored in this drill-down are: 1) the relationship between perioperative care processes and revisits in the first 30 days, and 2) the relationship between perioperative costs and revisits in the first 30 days.

The appendectomy drilldown team, which is led by Shawn Rangel, MD, MSCE and Samir Shah, MD, MSCE, has spent the past several months working to develop and finalize its plan for dealing with data quality issues, such as decimal and other questionable units and outlier charges. They have developed a comprehensive, well-justified plan and are now ready to move on to apply the calculated costs to the appendectomy cohort and beginning data analysis. They are in the midst of developing preliminary graphs and figures to present to the prioritization team. Many of the data quality resolutions proposed by the appendectomy team will be valuable to others performing research using PHIS data, as the same issues will impact their studies as well.

Karen Wilson, MD, MPH is leading the fourth and final drilldown for pneumonia which was chosen in August. Dr. Wilson has spent significant time developing the study framework and organizing the study team. The full team, including data analysts and statisticians, began meeting in early October and is currently working on defining the study cohort and looking at preliminary data.

PHIS+: Augmenting the Pediatric Health Information System (PHIS) with Clinical Data
Grant funding period: September 30, 2010 - September 29, 2013

This project is linking clinical data from six hospitals to a common administrative database to conduct comparative effectiveness research (CER) studies.

Over the last few months we made significant progress with the laboratory and radiology data. Both sets of data were processed at the Children's Hospital Association (CHA), and validation efforts commenced in December. The lab data are validated at all six hospitals. Analyses using lab data will begin in the coming weeks for the CER projects.

Radiology data are being validated at five of the six hospitals. To date, one site completed their validation. We are experiencing some issues with the radiology data and are working hard to correct and reprocess the data so validation can be done. Once the radiology data are successfully validated, natural language processing (NLP) will be applied to those reports that meet study criteria for pneumonia, appendicitis and osteomyelitis.

We are starting to conceptualize the microbiology data validation model. Since there are 16 data elements to validate (the lab and radiology data only validated two data elements), we anticipate the process will be more complex. We plan to use REDCap or Access to conduct the data validation.

In February, the team gathered in Park City, UT for our third annual in-person meeting. Upon arriving in UT, we received devastating news that James E. Levin MD, PhD, the site PI at Children's Hospital of Pittsburgh, passed away unexpectedly the night before. As an infectious diseases doctor and chief medical information officer, he had a unique set of skills and knowledge that made all the work on this project possible. Jim was an integral and cherished member of our team who will be sorely missed. The group proceeded with the planned meeting agenda as we believed Jim would have wanted the meeting to carry on. Some of the topics discussed during the two-day conference included CHA's Data Integration Strategy, Data Governance, Data Quality and Future Data Transmission / Processing.

Since the fall, the CER project teams have been working on portions of their projects that could begin before the clinical data become available. We are adjusting project timelines based on the validation delay we are experiencing, however we do not anticipate this delay to pose a serious issue as substantial pre-work is being done on the projects in the meantime. We also expect to work into a no cost extension year.

I-PASS Study PRIS Network Project Update
This study is examining the effectiveness of the I-PASS Handoff Bundle in accelerating the adoption of safer communication practices in pediatric hospitals. It was developed within the Pediatric Research in Inpatient Settings (PRIS) network and is endorsed by the Initiative for Innovation in Pediatric Education (IIPE).

Over the past quarter, The I-PASS Study progressed as planned across all study sites. Data collection and analysis were major priorities. Wave 2 sites recently completed data collection in December 2012 and subsequently spent January-March transferring clean, collated data to the Data Coordinating Center (DCC), Brigham and Women's Hospital (Boston, MA). The Coordinating Center (CC), Boston Children's Hospital (Boston, MA) helped to organize the transmission of Wave 2 data to the DCC and supported post-intervention data collection at Wave 3 sites. The DCC and CC met weekly via teleconference and worked closely to organize the analysis of baseline data, including a major effort to initiate the rating of baseline medical error data by I-PASS investigators across all study sites.

Overseen by the Coordinating Council and Education Executive Committee, the I-PASS Study Group continued dissemination efforts this past quarter. Work groups met regularly via teleconference to prepare plenaries and workshops for major conferences as well as several manuscripts for publication. A suite of curricular materials entitled The I-PASS Core Resident Workshop was published by MedEdPORTAL in January. This peer-reviewed resource is now available at https://www.mededportal.org/publication/9311. The I-PASS Study Group presented a mini-course entitled, The I-PASS Handoff Process: Teaching and Evaluating Standardized Approaches to Transitions of Care, at the 2013 Accreditation Council for Graduate Medical Education (ACGME) Annual Educational Conference in March. To date, The I-PASS Study Group has received requests for curricular materials and information from over 376 individuals from 46 states, and 12 countries outside of the United States through the website, www.ipasshandoffstudy.com. Additionally, several members of the I-PASS Study Group are developing ancillary studies to broaden the application and scope of the I-PASS curriculum. The I-PASS Study Group plans to continue to focus on dissemination and data analysis in coming months.