Center for Pediatric Clinical Effectiveness

CPCE administers two training programs:

1. The Pediatric Hospital Epidemiology and Outcomes Research Training program
2. The Pediatric Pharmacoepidemiology Training Program

Pediatric Hospital Epidemiology and Outcomes Research Training Program (PHEOT)

The Pediatric Hospital Epidemiology and Outcomes Research Training program (PHEOT) is a 2-year research fellowship designed to provide physicians with training in hospital epidemiology and outcomes research. PHEOT is funded by a Eunice Kennedy Shriver National Institute of Child Health and Human Development training grant. Through a combination of formal coursework and mentored research projects, trainees will develop expertise in comparative effectiveness research, quality measurement, severity adjustment and economic evaluation as they relate to pediatric hospital care. The PHEOT program will train the next generation of clinical scientists who will help us to understand how to best measure and improve outcomes, assure patient safety, and manage costs for hospitalized children. Trainees will benefit from the combined resources of the Center for Outcomes Research (COR) and the Center for Pediatric Clinical Effectiveness (CPCE), as well as a rich array of "laboratories" for evaluating and improving health care processes and outcomes, including the Pediatric Advanced Care Service, the General Pediatrics Inpatient Service, the Center for Simulation, Advanced Education and Innovation, and the Center for Quality and Patient Safety (CQPS). All fellows will complete Masters level coursework in study design and biostatistics as part of either the Masters of Science in Clinical Epidemiology (MSCE) degree offered through the Center for Clinical Epidemiology and Biostatistics, or the Masters of Science in Health Policy Research (MSHP) degree offered through the RWJ Clinical Scholars Program and the Leonard Davis Institute of Health Economics at Penn. Fellows will be assigned an advisory team consisting of seasoned methodology, content, and biostatistics mentors who will supervise the trainee in the successful completion and publication of at least one research project. PHEOT fellows will also benefit from a host of professional development activities, including works-in-progress sessions, a seminar series to teach academic medicine skills, a methods lecture series specifically tailored to pediatric epidemiology and outcomes research, and opportunities to present research at national meetings.

TRAINING PROGRAM CO-DIRECTORS

Jeffrey H Silber MD PhD
Professor of Pediatrics
Director, Center for Outcomes Research
Suite 1029, 3535 Market Street
Philadelphia PA
(215) 590-2540
silber@email.chop.edu

Ron Keren MD MPH
Associate Professor of Pediatrics and Epidemiology
Director, Center for Pediatric Clinical Effectiveness
Room 1524, 3535 Market Street
Philadelphia PA
(215) 590-0167
keren@email.chop.edu
Master of Science in Clinical Epidemiology Program

The Master of Science in Clinical Epidemiology (MSCE) degree program provides comprehensive clinical research training. Students enrolled in the MSCE degree program are assigned to a faculty mentor at the CCEB based on the student's research interest. The mentor will act in an advisory capacity throughout that student's course of study, particularly regarding the development of the required research project.

All students must complete a required core of courses, generally taken in the first year of study. The core of required courses for the MSCE degree program is as follows:

• Introduction to epidemiology
• Biostatistics for epidemiologic methods I
• Biostatistics for epidemiologic methods II
• Database management
• Measurement of health in epidemiology
• Issues in research protocol development
• Critical appraisal of epidemiologic methods

Additional courses are required, some of which may be electives, depending on the track in which the student is enrolled (epidemiology, clinical trials, human genetics, bioethics or pharmacoepidemiology). In total, 14 course units of credit are required for the completion of the MSCE degree.

Students also are required to plan a research project in detail, complete this project and write up the results in the form of a thesis. Finally, students are required to participate in a series of programs for which course unit credits are not awarded. These requirements include: participation for at least one year in the weekly CCEB Research Seminar, which runs from September through June annually; completion of an online seminar on the ethics of biomedical research and completion of the School of Medicine's online Patient Oriented Certification Program.

Masters of Science Program in Health Policy Research

The Masters of Science Program in Health Policy Research (MSHP) is a two-year training program in health services research. The program is based in the School of Medicine as a collaborative effort with the Wharton School and a joint venture of the Leonard Davis Institute (LDI) and the Robert Wood Johnson Clinical Scholars Program (RWJ CSP). The program is closely affiliated with the Annenberg School for Communication, the School of Arts and Sciences, the School of Social Policy and Practice, and the School of Nursing.

The Masters of Science in Health Policy Research prepares graduates for health services research and health policy research careers in academic, government, community, and industry settings. Health policy research investigates the organization, management, financing, and delivery of health care and the social forces that shape health in the US and the world.

The degree requires seven core courses, three elective courses, and a supervised Masters Thesis. The core courses are:

• Economics of Health Care Delivery
• Health Services and Policy Research Methods I
• Introduction to Statistics for Health Policy
• Health Services and Policy Research Methods II
• Applied Regression Analysis for Health Policy Research
• Fundamentals of Health Policy
• Research in Progress

Electives include courses in: Health Policy, Health Economics, Statistics, Epidemiology, Psychology, Sociology, Anthropology, Communication and Management.

Other Conferences for PHEOT Trainees

PHEOT fellows will join academic general pediatric fellows in the Fellows' Seminar Series, which offers practical lectures on the "nuts and bolts" of academic medicine, covering topics such as writing and presenting scientific abstracts, writing scientific papers and responding to reviewer comments, funding streams for junior investigators,finding and negotiating for an academic job; and time management and managerial skills.

In addition, PHEOT fellows will be required to attend CPCE works-in-progress sessions held Friday afternoons from 12noon-1pm approximately 2-3 times each month. At these sessions, researchers present their projects in various stages of development before their peers, mentors and faculty in an environment conducive to constructive criticism and learning. Research methods are discussed and suggestions are made to further the fellow's knowledge and enhance his/her project. Each PHEOT fellow will be required to present at a works-in-progress session twice per academic year.

Clinical Responsibilities

In order to maintain their clinical skills and continue to practice in the setting where their research ideas arise and protocols may be implemented, the PHEOT program directors will arrange for appropriate clinical experiences for PHEOT fellows. Clinical activities will comprise no more than 20% of the PHEOT fellow's time. Clinical experiences may include time spent as an attending physician on CHOP's General Pediatric Inpatient Service, the pediatric or neonatal ICU, or the Pediatric Advanced Care Team, among other units.

Underrepresented Minority Recruitment

In keeping with CHOP's commitment to building and maintaining a diverse research community, PHEOT/PPTP recruitment effort will focus on underrepresented minority candidates, including those from all racial, ethnic, religious, or gender groups, as well as those of disadvantaged or disabled status. We have created a Minority Recruitment Panel that consists of prominent underrepresented minority faculty members and former trainees. These panel members will advise the PHEOT & PPTP Executive Committee on recruitment issues and be a valuable asset to potential recruits as they share their experiences and familiarize them with the resources and environment available to them at CHOP. CHOP also maintains an Office of Diversity and Inclusion and a Multicultural Physician's Alliance which works to ensure that CHOP's vision is upheld and interwoven into all facets of its work environment. You can find us at the Race in Medicine Special Interest Group Meeting at the Pediatric Academic Societies (PAS) annual meeting and the Disparities Panels at the Academy Health Annual Research Meeting. Please contact the CPCE Program Office if you would like to get in contact with one of the Minority Recruitment Panel members.

Research Partners at CHOP and the University of Pennsylvania

• The Center for Clinical Epidemiology and Biostatistics
• The Leonard Davis Institute of Health Economics
• The Pediatric Advanced Care Team at CHOP
• CHOP General Pediatrics Inpatient Service
• CHOP Center for Simulation, Advanced Education and Innovation
• Center for Quality and Patient Safety

Additional information about the PHEOT Program

• PHEOT Faculty
• How to Apply

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Pediatric Pharmacoepidemiology Training Program (PPTP)

The Pediatric Pharmacoepidemiology Training Program (PPTP) is a 2-3 year research fellowship designed to train pediatricians to be rigorous, independent academic investigators able to use the range of approaches available in epidemiology to study the use and effects of medications in pediatric patients. PPTP is funded by a Eunice Kennedy Shriver National Institute of Child Health and Human Development training grant. This multidisciplinary training program consists of core courses in epidemiology, clinical research methodology, and biostatistics; required courses in pharmacoepidemiology and pharmacokinetics; elective courses in advanced methods for epidemiology and biostatistics, and/or pharmacology; a required clinical experience in pediatric pharmacoepidemiology; a teaching seminar series; instruction in the responsible conduct of research and regulatory affairs; extensive independent readings and attendance at research seminars at CHOP and the Center for Clinical Epidemiology and Biostatistics (CCEB); and applied research in pediatric pharmacoepidemiology under the close supervision of a senior mentor.

Trainees will benefit from the combined resources of the CHOP Division of Pharmacology and Therapeutics, the CCEB and the Center for Pediatric Clinical Effectiveness (CPCE), as well as a rich array of additional CHOP and Penn assets such as the Clinical and Translational Science Award (CTSA) which funds the Clinical and Translational Research Centers at CHOP and Penn, and a wealth of databases available for pharmacoepidemiologic analysis. All PPTP fellows will complete Masters level coursework in study design and biostatistics as part of the Masters of Science in Clinical Epidemiology (MSCE) degree offered through the CCEB. PPTP fellows will also benefit from a host of professional development activities, including works-in-progress sessions, a seminar series to teach academic medicine skills, a methods lecture series, and opportunities to present research at national meetings.

TRAINING PROGRAM CO-DIRECTORS

Peter Adamson MD
Professor of Pediatrics and Pharmacology
Chief, Division of Clinical Pharmacology and Therapeutics
Director, Office of Clinical and Translational Research
Room 9161, Abramson Research Center
3615 Civic Center Blvd
Philadelphia PA
(215) 590-5448
Adamson@email.chop.edu

Brian Strom MD MPH
Professor of Biostatistics and Epidemiology
Director, CCEB
824 Blockley Hall
215-898-2368
bstrom@exchange.upenn.edu

Theoklis Zaoutis MD MSCE
Associate Professor of Pediatrics and Epidemiology
Associate Director, Center for Pediatric Clinical Effectiveness
Associate Chief, Division of Infectious Diseases
Room 1527, 3535 Market Street
Philadelphia PA
(267) 426-5570
zaoutis@email.chop.edu

Master of Science in Clinical Epidemiology Program

The Master of Science in Clinical Epidemiology (MSCE) degree program provides comprehensive clinical research training. Students enrolled in the MSCE degree program are assigned to a faculty mentor at the CCEB based on the student's research interest. The mentor will act in an advisory capacity throughout that student's course of study, particularly regarding the development of the required research project.

All students must complete a required core of courses, generally taken in the first year of study. The core of required courses for the MSCE degree program is as follows:

• Introduction to epidemiology
• Biostatistics for epidemiologic methods I
• Biostatistics for epidemiologic methods II
• Database management
• Measurement of health in epidemiology
• Issues in research protocol development
• Critical appraisal of epidemiologic methods

Additional courses are required, some of which may be electives, depending on the track in which the student is enrolled (epidemiology, clinical trials, human genetics, bioethics or pharmacoepidemiology). In total, 14 course units of credit are required for the completion of the MSCE degree.

Students also are required to plan a research project in detail, complete this project and write up the results in the form of a thesis. Finally, students are required to participate in a series of programs for which course unit credits are not awarded. These requirements include: participation for at least one year in the weekly CCEB Research Seminar, which runs from September through June annually; completion of an online seminar on the ethics of biomedical research and completion of the School of Medicine's online Patient Oriented Certification Program.

Clinical Epidemiology/Health Services Research Seminar

Fellows in the PPTP program will attend a monthly 1-hour seminar series customized to provide advanced topics related to a broad range of methodology and analytic issues, including epidemiologic methods, selected advanced topics in biostatistics, and detailed and critical reviews of the epidemiology of selected illnesses.

Other Conferences for PPTP Trainees

PPTP fellows will join academic general pediatric and Pediatric Epidemiology and Outcomes Research Training Program (PHEOT) fellows in the Fellows' Seminar Series, which offers practical lectures on the "nuts and bolts" of academic medicine, covering topics such as writing and presenting scientific abstracts, writing scientific papers and responding to reviewer comments, funding streams for junior investigators, funding and negotiating for an academic job; and time management and managerial skills.

In addition, PPTP fellows will be required to attend CPCE works-in-progress sessions held Friday afternoons from 12noon-1pm approximately 2-3 times each month. At these sessions, researchers present their projects in various stages of development before their peers, mentors and faculty in an environment conducive to constructive criticism and learning. Research methods are discussed and suggestions are made to further the fellow's knowledge and enhance his/her project. Each PPTP fellow will be required to present at a works-in-progress session twice per academic year.

Clinical Responsibilities

In order to maintain their clinical skills and continue to practice in the setting where their research ideas arise and protocols may be implemented, the PPTP trainees will participate in clinical activities comprising no more than one half day per week or the equivalent.

Underrepresented Minority Recruitment

In keeping with CHOP's commitment to building and maintaining a diverse research community, PHEOT/PPTP recruitment effort will focus on underrepresented minority candidates, including those from all racial, ethnic, religious, or gender groups, as well as those of disadvantaged or disabled status. We have created a Minority Recruitment Panel that consists of prominent underrepresented minority faculty members and former trainees. These panel members will advise the PHEOT & PPTP Executive Committee on recruitment issues and be a valuable asset to potential recruits as they share their experiences and familiarize them with the resources and environment available to them at CHOP. CHOP also maintains an Office of Diversity and Inclusion and a Multicultural Physician's Alliance which works to ensure that CHOP's vision is upheld and interwoven into all facets of its work environment. You can find us at the Race in Medicine Special Interest Group Meeting at the Pediatric Academic Societies (PAS) annual meeting and the Disparities Panels at the Academy Health Annual Research Meeting. Please contact the CPCE Program Office if you would like to get in contact with one of the Minority Recruitment Panel members.

Research Partners at CHOP and the University of Pennsylvania

• The Center for Clinical Epidemiology and Biostatistics at UPENN
• The Division of Pharmacology and Therapeutics at CHOP
• UPENN Center for Education and Research on Therapeutics (CERTS)
• CHOP Therapeutic Standards Committee (TSC) and Drug Use Evaluation Subcommittee (DUE)

Additional information about PPTP

• PPTP Faculty
• How to Apply

Mentoring

CPCE's mission extends beyond improving best practices for managing pediatric disease. It encompasses teaching residents, fellows and junior faculty clinical effectiveness research methods and tools for determining current best practices in pediatric clinical care. The following are some of the educational programs used by CPCE to fulfill this mission.

Teaching Evidence-based Medicine

CPCE is committed to teaching healthcare providers and students how to integrate clinical knowledge with current best evidence to make judicious decisions about patient care. CPCE members lead monthly teaching sessions in which pediatric residents learn to use electronic resources for searching the medical literature in order to answer clinical questions.

During EBM education sessions, teams of pediatric residents work with their CPCE mentors to identify important clinical questions, research the available medical literature, and produce a critically appraised topic (CAT) file. The CAT file includes background information, conclusions drawn, a summary of the evidence, and search strategies used. CAT files are compiled into a CAT Bank accessible on the PhillyPeds website at http://www.phillypeds.com/medicine.html. All healthcare providers nationwide who have an interest in the topic can view this resource.

Mentoring Junior Faculty and Fellows

CPCE actively seeks out junior faculty and fellows from all divisions and departments who are interested in pursuing clinical effectiveness research projects and fosters mentoring collaborations with experienced CPCE mentors. In addition to offering advice and support throughout all stages of a research project, CPCE mentors provide assistance in negotiations for the first job after fellowship, advice on career development awards (K23s), and informal guidance regarding the promotions process.

Mentoring MSCE Students

CPCE's Associate Director, Dr. Zaoutis, is the Deputy Director of the Masters of Science in Clinical Epidemiology Degree Program of the Center for Clinical Epidemiology and Biostatistics (CCEB) at the University of Pennsylvania, and CPCE faculty members act as mentors for students enrolled in the program These mentors advise students throughout their time in the program, and provide assistance in the development of their research project and completion of their master's theses.

Acquiring Training Grant Support

As part of its effort to foster the training and career development of fellows and junior faculty interested in clinical effectiveness research, CPCE obtains T32 grants to fund the training of fellows from across divisions and departments at Children's Hospital in the performance of clinical effectiveness research.

Seminar Series

CPCE invites nationally recognized clinical effectiveness researchers, as well as local researchers, epidemiologists and biostatisticians, to speak about methods, policies and concepts related to clinical effectiveness research. For a schedule of upcoming CPCE Seminars, please check the CPCE calendar.

For a schedule of upcoming lectures by visiting speakers, please check the CPCE calendar.

Visiting Lecturers

CPCE invites national leaders in clinical effectiveness research from outside institutions to present their research as part of a quarterly Visiting Lecturer Series. The goal of the series is to educate CHOP faculty and staff on state of the art knowledge of best practices in the management of pediatric conditions. Visiting lecturers may also be invited to share insight on strategies and research designed to improve patient safety, quality, and outcomes. Category 1 CME credit is available for attending the visiting lecture series. Documentation of Category 1 CME can be obtained through the CME office Web site on the Children's Hospital intranet.

You can view slides from past visiting speaker presentations by clicking on the topic below:

1. Amitai Ziv MD MHA, "Simulation-based Education & High-Stakes Assessment as a Cultural Change Vehicle in Healthcare Quality & Safety Education" November 4, 2011
2. Anne Zajicek, MD, PharmD, "NICHD Translational Research in Pediatric and Obstetric Pharmacology" January 14, 2011
3. Christopher P. Landrigan MD MPH, "Implementing Evidence-Based Resident Work Schedules: Work to Date and Future Directions" November 12, 2010
4. Patrick Conway MD MSc, "Comparative Effectiveness Research: Perspectives from the Federal Coordinating Council" July 13, 2009
5. Rod Hayward MD , "EBM Redux: Tailoring Treatments to Individual Patients" January 30, 2009
6. Raj Srivastava MD MPH, "GERD in Children With Neurological Impairment", December 5, 2008
7. Peter Szilagyi MD MPH, "SCHIP, Children, and Lessons in Academic Pediatrics", October 22, 2008
8. Paul Sharek MD MPH, "Moving Closer to High Reliability: Understanding and Improving Patient Safety in Pediatrics"
9. Grace Lee MD MPH, The Economics of Vaccine Policy", Feb. 8, 2008
10. David Bertoch MHA and Matt Hall PhD, "Strengths and Limitations of Using Administrative and Billing Data for Research: The Pediatric Health Information System (PHIS)", February 1, 2008
1. Articles Published Utilizing PHIS Data (2002-2008)
2. Posters/Presentations Utilizing PHIS Data at Annual Pediatric Academic Societies Meeting (2003-2007)
11. Don Goldmann MD, "Getting to Zero and Other Possible Dreams," Jan. 18, 2008

Faculty Seminar Series

The CPCE Faculty Research Seminars provide a forum for CHOP faculty to present their research to the CHOP community. The goals of the Seminars are (1) To educate CHOP faculty and staff on state of the art knowledge of best practices in the management of pediatric conditions, and (2) To introduce some methodologic concepts used in research elucidating best practices (e.g. basic statistical and study design issues).

You can view slides from some past Faculty Seminars by clicking on the link to the topics below:

1. Jeffrey Gerber MD PhD MSCE "Antibiotic Prescribing for Acute Respiratory Tract Infections by Primary Care Pediatricians" September 30, 2011
2. Chris Bonafide MD, "Predicting, detecting and responding to clinical deterioration on the wards: Is there room for improvement?", June 10, 2011
3. Kristen Feemster MD MPH MSHP, "Community Epidemiology of Respiratory Pathogens: Pneumococcus and Influenza", June 3, 2011
4. Evan Fieldston, MD, MBA, MSHP, "Patient Flow, Workload, Workforce, and Quality of Care in Pediatrics — Health Services Research Meets Operations" October 29, 2010
5. James Guevara MD MPH, "Translating Evidence-based Developmental Screening (TEDS) Into Pediatric Primary Care" October 3, 2008
6. Samir Shah MD MSCE, "Can We Simplify the Management of Complicated Pneumonia?" September 19, 2008
7. Richard Aplenc MD MSCE, "Pharmacogenetics of Leukemia Treatment Response" May 2, 2008
8. Mary Leonard MD MSCE, "Whole body vibration as an anabolic bone therapy in children" April 18, 2008
9. Ron Keren MD MPH, "Prophylactic Antibiotics for Vesicoureteral Reflux Diagnosed after UTI: Recent Findings and Implications for Care" March 7, 2008
10. Theoklis Zaoutis MD MSCE, "Prolonged IV vs Early Conversion to Oral Antibiotic Therapy for Osteomyelitis: Is it Time for a Change?" January 4, 2008
11. Pamela Weiss MD, "Henoch Schonlein Purpura: A Role for Corticosteroids during Hospitalization" November 30, 2007

Other Seminars

1. Carole Marcus, M.B.B.Ch., Co-Director, The Clinical and Translational Research Award (CTSA) "The Role of the CTSA and the resources it provides" March 18, 2011
2. Marianne Chilutti and Jeff Pennington of the Center for Biomedical Informatics (CBMI), "REDCap (Research Electronic Data Capture) Information Session" April 1, 2011

Center for Simulation, Advanced Education and Innovation

CPCE members utilize the resources provided by The Center for Simulation, Advanced Education and Innovation at CHOP, which operates within the division of Anesthesiology and Critical Care Medicine. The Center facilitates the translation of scientific discoveries into practical implementation for both research and clinical care. The center is directed by Vinay Nadkarni, MD, and Evelyn Lengetti, RN, MSN., and is administered by Stephanie Tuttle, MBA.

Centralized classroom and skills lab training, satellite skills labs, and unit-based "virtual" lab exercises adjacent to patient care settings are routinely conducted. More than 250 teaching sessions are offered with at least 4,500 attendees, including:

• education encompassing recognition of shock and/or cardiac/respiratory failure
• vascular access, chest tube care and hemodynamic monitoring
• advanced and difficult airway assessment and intervention
• pacemaker evaluation
• EKG interpretation
• critical incident debriefing
• crew resource management

The education scope is expanding and includes basic and advanced life support training, simulation "boot camps" for orientation and training. This Center is supported by CHOP, and additional funding is supplemented with a federal Agency for Healthcare Research Quality (AHRQ) grant to study "training to excellence" using "just-in-time" and "just-in-place" simulation resuscitation education techniques for sharp end providers. The center staff includes multidisciplinary center directors, full-time administrative staff, a full-time clinical educator, as well as additional volunteer faculty (e.g. physicians, nurse, therapists, educators) to conduct training. The center also has non-overlapping research coordinator and research assistant support through funding from the AHRQ and Laerdal Foundation for Acute Medicine.

The is equipped with more than $500,000 of equipment in the form of:

• flat screen simulators
• virtual reality technology
• simulation mannequins with software
• task trainers
• defibrillators
• video monitoring and programming equipment
• 10-12 PCs and monitors
• a network server with secure storage
• video editing hardware and software
• disposable supplies

In addition, there are collaborative links with the 7,000 square foot Brunner Technology Center at the Penn School of Nursing, which trains more than 8,000 simulation encounters annually, and the Measey Medical Simulation Center at the Penn School of Medicine. Both of these centers provide adjunctive expertise, equipment and personnel to accomplish training and research objectives. These resources have been mobilized and committed to support the evolving Laerdal-funded CHOP Center of Excellence for Resuscitation Research.