“…the creation of this journal … the annual summer PHM conference … finishing the “Clinical Manual of PHM” … close to starting PREP: PHM … In short, we’ve been busy.” — Daniel Rauch
Report from the Section Chair
Daniel Rauch, MD
One of the best perks of leading the Section on Hospital Medicine (SOHM) is being able to take part in the great activities of the section. Case in point, the creation of this journal. Once again I must give credit to Jennifer Daru for leading the way to this auspicious debut, as well as all the co-editors of the previous incarnation as the news-journal (please see their names under the ‘Founding Editorial Board’ on the masthead). The journal is now in the able hands of Shawn Ralston, who expresses her take on the role for this journal in her editorial. I wholly agree with her that the hope is for this journal to be the avenue for questioning what we do and advancing the care of hospitalized children. Having said that, I think this journal will evolve to be something different from just another peer-reviewed research journal in much the same way Pediatric Hospital Medicine is now a full-fledged field, different from other aspects of Pediatrics. And let’s be clear, our ongoing thoughtful deliberations about applying for American Board of Pediatrics sub-board designation notwithstanding, PHM is a field. The Core Competencies probably best encapsulate the heart of the field and why this journal will be different. PHM is about more than bench to bedside; it’s more like the whole furniture store to bedside. It’s engaging the C-suite, reaching across specialties, partnering with families, working with nurses, child life specialists, mid-level providers, and so much more than what we learned in medical school. Improving systems of care, rigorous review of our processes, patient safety efforts, administration and leadership are all parts of our field and this journal promises to be a unique resource in that all these topics will be covered because that represents PHM. Of course, the journal must also be responsive to you who are reading this. So let us know what you want and what you need so this can become the journal for PHM.
This is also my last update as section chair and I would like to review some of the section achievements over the last few years besides this journal. Most of you are familiar with the annual summer PHM conference which has rapidly become the cornerstone PHM event. The continued cooperation of the AAP, APA, and SHM has made the PHM conference a truly unique event in many ways and has provided a blueprint for codifying an overlying structure for PHM that will foster the ongoing interaction of these organizations. The Joint Council of Pediatric Hospital Medicine will in no way limit the activities of the section. It is designed to ensure that the PHM as a whole remains coordinated and integrated. This fall will see the first PHM Fellows Conference, an event designed to help the fellows become the PHM leaders of tomorrow. The section now also helps with regional meetings for those who can’t make the national gatherings or hunger for more content. We are finishing the “Clinical Manual of PHM” that will hopefully not just take up space on your bookshelf but become an important point-of-care reference. We are very close to starting PREP: PHM, an extension of the AAP’s PREP products that will be field specific and useful in recertifying. We have helped foster the VIP network, under the guidance of Steve Narang, by joining the AAP’s QuIIN and may also be a resource for recertifying. Our section membership continues to grow, despite the economic times, a real tribute to the interest and engagement of pediatric hospitalists. We provide grants to residents to attend the PHM conference, grants to members to attend the AAP legislative conference, a visiting professor consultation, and an award for the best abstract submission at the AAP NCE section program. I have been asked to serve on several committees and task forces to represent PHM and, more and more, PHM is being solicited for participation in AAP activities. In short, we’ve been busy. It has been an honor and pleasure to serve as SOHM chair. I am grateful and indebted to the other Executive Committee members I have served with over the years and especially to our AAP staff person, Niccole Alexander, who makes all SOHM activities happen. Jennifer Daru will be your next section chair and I am sure her last report will be filled with an equally long list of accomplishments.
VIP Network Update 2011
The Value in Inpatient Pediatrics (VIP) Network has witnessed tremendous growth and development over the past year. Founded in 2008 with a mission to improve the value of healthcare delivered to hospitalized children, the organization initially focused its efforts on a Benchmarking Bronchiolitis initiative. Benchmarking Bronchiolitis is now in its fourth year of data collection, and is preparing to assess factors that have led to consistent improvement in participating centers. In addition, a learning collaborative within the network has reported on its positive work to decrease resource utilization and is actively looking to spread this work.
This collaborative work was originally commissioned by the quality improvement arm of Pediatric Hospital Medicine (PHM) Roundtable that met in February 2009. During the past 12 months, VIP absorbed the two other collaborative improvement efforts that emerged from this strategic planning session. These initiatives were designed to demonstrate that PHM can quickly improve the quality of our care and increase the capacity of pediatric hospitalists to lead and participate in such efforts. Along with the collaborative project within Benchmarking Bronchiolitis, all three projects demonstrated successful improvement, and more importantly, learned lessons applicable to future efforts. Paul Hain, MD, and Shannon Phillips, MD, led a project that dramatically improved patient identification band accuracy at participating institutions and are preparing for a second effort. Mark Shen, MD, and Julia Shelburne, MD, cochaired a collaborative to improve the timeliness of discharge communication to primary care providers; participating hospitalist groups achieved 90% communication within 2 days of discharge. David Cooperberg, MD, and Dan Coghlin, MD, are leading phase 2 of this effort to improve the content of discharge communication to primary care providers.
As a result of the immediate success of these initiatives, VIP has undergone recent restructuring to include a new vision that articulates a desire to become the premier inpatient pediatric quality improvement collaborative network in the United States and Canada. The aforementioned initiatives are now housed at three separate branches of VIP: Clinical Conditions, Patient Safety, and Health Care Systems. These branches will provide an umbrella under which to coordinate both current and future activity. Discussions have also been ongoing with participating institutions as well as the Pediatric Research in Inpatient Settings (PRIS) network for new projects that will be rolled out this year.
Amidst all of this progress, the VIP Network Steering Committee has acknowledged a need for resources to support and sustain continued growth and development. Recently, the VIP Network has been in discussions regarding a formal partnership with the American Academy of Pediatrics (AAP) and its Quality Improvement and Innovation Network (QuIIN). This partnership, formalized July 2011, will lay the groundwork necessary for the VIP Network to be the organizational ‘home’ for all pediatric hospitalists. This partnership will help all those seeking a collaborative community to improve the delivery of safe, effective, efficient, timely, patient centered and equitable care for their patients.
Finally, the network has continued to build a community through face-to-face engagement and celebration at the always-popular annual dinner at the PHM conference, from July 28 to 31, 2011, in Kansas City this year. This yearly dinner provides a unique opportunity for our members to tell stories, share secrets, and celebrate each other’s success and challenges in their journey toward improvement.
For more information, please visit our Web site at www.vipnetwork.webs.com or email us at
PRIS Network Update
Raj Srivastava, MD, FRCP(C), MPH
Pediatric Research in Inpatient Settings (PRIS) Network is pleased to be able to contribute to the inaugural edition of Hospital Pediatrics. As this important new contribution to the pediatric inpatient medicine literature base is being launched, we wanted to take the opportunity to reflect on the last 2 years of work in the PRIS Network, and focus on what the future will bring to our research.
The PRIS network is involved in three funded multicenter studies that are germane to pediatric inpatient care. The first study is called the Prioritization Project and is funded by the Child Health Corporation of America (CHCA). The chief executive officers of 42 children’s hospitals in the United States partnered with PRIS to use data from more than 4.5 million admissions in the Pediatric Health Information System (PHIS). The goal of this initial study was to guide PRIS set priorities for future studies in the field of pediatric hospital medicine. This project aimed 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 on which to base medical decisions, and/or an opportunity to standardize care across hospitals. The project will establish a priority list, focus on the highest ranking conditions that demonstrate the most variation of care, have a high cost/frequency, and show 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. By creating a standardized cost master list for all of the resource utilization in these children’s hospitals, PRIS will be able to detect when the differences in costs for the same condition are more likely to reflect the differences in resource utilization. By then performing drill-downs into high priority medical and surgical conditions, we will discover why this difference in resource utilization is occurring, whether adjusting for disease-specific severity is necessary, and if differences in comparative treatments result in different patient outcomes. Members of the executive council received additional funding to investigate community settings using the same prioritization methodology because most children are hospitalized outside large children’s hospitals. By using data sources for academic and community hospitals, PRIS will be able to examine conditions accounting for more 20% of the children hospitalized in the United States.
The second study, PHIS+, is funded by the Agency for Healthcare Research and Quality (AHRQ). This study is augmenting the CHCA PHIS database, which currently houses administrative data, with clinical data (laboratory, microbiology, and radiology) to complete pediatric comparative effectiveness research studies. By using six hospitals to pilot this study, PRIS is able to better understand how clinical data from different electronic medical records may be mapped to a common administrative database. This new resource will allow for more accurate patient cohort creation in future comparative effectiveness studies with more clinically relevant outcomes.
The third study, I-PASS: IIPE-PRIS Accelerating Safer Signouts, is a partnership between PRIS and the Initiative for Innovation in Pediatric Education (IIPE), another large entity. This study is funded by AHRQ and is examining the effectiveness of a “resident handoff bundle” in accelerating adoption of safer communication practices in pediatric hospitals. The study will measure the effect of the new resident handoff bundle on patient medical errors and other secondary process measures across eight sites.
PRIS has created a new membership structure with some minimal but important new requirements, such as having the hospitalist group join (and not needing individuals to sign up on their own), having the ability for sites to protect human subjects, (eg, an Institutional Review Board), and having the ability to receive funding. These are important criteria for our member hospitals to participate in federally funded multicenter studies, and these would be minimal requirements. In addition, we are collecting information from our members to estimate the number of children hospitalized annually, the ethnic and racial percentages, and ages of children at these admissions. This information is critical for the network to demonstrate both the generalizability and external validity of potential patient recruitment in PRIS. At the time of this writing, PRIS has more than 60 hospitals and more than 500 hospitalists from these programs across the United States and Canada that have joined the network, .
We are also excited to announce the new PRIS Web site www.prisnetwork.org launched on June 1, 2011. Although much of the information will be available to the public, PRIS members will have their own section pertinent to participants in the network. In addition, there is a link for a hospitalist group to become a member of PRIS.
As PRIS undertakes various new multicenter studies, in addition to the current ones, the challenges facing the network include stable infrastructure funding to support sufficient capacity for studies relevant to practicing hospitalists who care for children. In addition, PRIS is interested in studying how best to implement research findings at the bedside and what effect these comparative effectiveness studies have on patient outcomes. If PRIS is to accomplish its mission of improving the health of and healthcare delivery to hospitalized children and their families, then each research study will need an implementation plan that is designed in parallel. Once results of these studies are known, practicing hospitalists can be studied in their academic and community settings with their patients, and the effectiveness of translating these results from research to the bedside can be evaluated. It is critical to understand the effect of these implementation methods on patient outcomes to identify methods to ensure that our hospitalized children and their families receive the highest quality care that our system can deliver.
- Copyright © 2011 by the American Academy of Pediatrics