Health Policy

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Ongoing Projects

Using Patient Outcomes to Inform Surgical Education

Funded by the National Institute on Aging
Study Principal Investigator: Rachel Kelz, MD, MSCE (University of Pennsylvania)
CHOP Principal Investigator: Jeffrey H. Silber, MD, PhD

Over the past decade, the surgical training process has undergone a period of unprecedented change due to extensive education reforms, a change in the nature of surgical care, and heightened public awareness of surgical outcomes. Significant concerns regarding the ability to successfully prepare new surgeons in the modern environment along with a recent increase in the new surgeon failure rate on the oral board certification exam mandate a thorough examination of the effects of training in the modern era on the outcomes of patients treated by new surgeons. We aim to examine the clinical and economic outcomes of patients treated by new surgeons who trained in the modern era and have now entered independent practice.

AHRQ-CMS CHIPRA Pediatric Quality Measurement Center and Testing Laboratory

Funded by the Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid Services
Principal Investigator: Jeffrey H. Silber, MD, PhD

The AHRQ-CMS CHIPRA Laboratory at the Children’s Hospital of Philadelphia (CHOP) is one of seven Centers of Excellence (CoE) for the national Pediatric Quality Measures Program.  This program was established by the Children’s Health Insurance Program Reauthorization Act to foster the development of evidence-based pediatric quality measures, which have lagged significantly behind adult quality measures.  The CHOP CoE is currently focusing on studies related to continuity of insurance coverage, risk adjustment methodology in Medicaid and the Children’s Health Insurance Program, and patient reported outcomes. 

iCOMPARE (Individualized Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education)

Funded by the Accreditation Council for Graduate Medical Education
Study Principal Investigator: James A. Tonascia, PhD (Bloomberg School of Public Health at Johns Hopkins University)
CHOP Principal Investigator: Jeffrey H. Silber, MD, PhD

The iCOMPARE study will conduct a cluster randomized trial in a sample of internal medicine (IM) training programs that are randomly assigned to either the current duty hour standards or less restricted flexible duty hour standards. Outcomes focus on patient safety assessed through claims data and education assessed through surveys. 

Improving the Framework for Health Care Public Reporting

Funded by the Agency for Healthcare Research and Quality
Principal Investigator: Jeffrey H. Silber, MD, PhD
 
Any effort to improve the science of public reporting must include an approach that ensures that guidance provided to the public is accurate, informative, relevant and understandable. Through the use of Bayesian models (a form of statistical modeling that is ideally suited to compare risks), this project aims to develop a better method to present information to the public about hospital quality, a better model for predicting and comparing outcomes across hospitals, and better methods to select and improve future models that may be used to aid the public in hospital selection. 

Recently Completed Projects

Impact of Resident Work Hour Rules on Errors and Quality

Funded by the National Heart, Lung and Blood Institute
Principal Investigator:  Kevin G. Volpp, MD, PhD; Co-Principal Investigator:  Jeffrey H. Silber, MD, PhD

The Accreditation Council for Graduate Medical Education (ACGME) released rules effective July 1, 2003 that affected duty hours for all ACGME-accredited residency programs in all specialties.  This project is evaluating the effect of the duty hour rules on patient safety and quality of care, utilizing national data available though Medicare and pre-validated measures of quality including the Agency for Healthcare Research and Quality (AHRQ) Quality Indicators. 

Scope of Services for Fetal Mortality: Epidemiology and Performance Measurement

Funded by the Centers for Disease Control and Prevention
Principal Investigator: Scott A. Lorch, MD, MSCE

Neonatal mortality rates have been proposed as a measure of the quality of neonatal care. There has been little validation of the correct metric for their use. The purpose of this project was to calculate several separate hospital mortality statistics to characterize fetal deaths and determine the importance of fetal deaths when using mortality as a measure of the performance of neonatal or perinatal care. 

Impact of Resident Work Hours on Errors and Quality in VA Hospitals

Funded by the US Department of Veterans Affairs
Principal Investigator:  Kevin G. Volpp, MD, PhD; Co-Principal Investigator:  Jeffrey H. Silber, MD, PhD

The overall goal of this project was to improve patient safety and quality of care by creating an evidence base of the positive and negative effects of the 2003 ACGME duty hour reforms at Veterans Affairs hospitals, 70 percent of which are teaching hospitals where much of hte direct care provided to patients is the responsibility of medical and surgical residents.