Grant Funds Building Clinical Infrastructure for Pediatric Comparative Effectiveness Research


Ron Keren, M.D., M.P.H., director of the Center for Pediatric Clinical Effectiveness, recently received a $9 million grant award from the Agency for Healthcare Research and Quality (AHRQ) to build a database that receives clinical data from six of the largest children’s hospitals in the country, and to use the database to perform several comparative effectiveness studies. Comparative effectiveness research compares therapies and treatment strategies to provide clinicians with the evidence needed to provide the highest quality care.

In the past, pediatric comparative effectiveness research was hampered by a lack of clinical data required to assemble large cohorts to study rare conditions, adjust for severity of illness, and measure important outcomes. However, with the implementation of electronic health records at many of the nation’s largest hospitals, the necessary clinical data are now routinely collected in large searchable databases. Today’s challenge is to connect data collected in hospitals’ proprietary databases by establishing a common format.

Working with medical informatics experts at the University of Utah and other members of the Pediatric Research in Inpatient Settings research network, Dr. Keren will coordinate an effort to “map” clinical data from different hospitals into one common database. This clinical database will be an extension of the existing data-sharing collaboration of the Pediatric Health Information System (PHIS), an administrative database created by Child Health Corporation of America for 42 of North America’s leading children’s hospitals. The expanded database containing clinical data will be called PHIS+.

Since 1999, PHIS has collected administrative data on 20.5 million patient encounters from a full spectrum of ages, races, ethnicities, and geographic regions in the United States. Augmenting PHIS’s detailed administrative data with clinical data from a variety of clinical settings will enable researchers to generate new high quality evidence on the comparative effectiveness of healthcare interventions for children. The data will be also be useful for measuring and improving the quality of pediatric healthcare.

The AHRQ grant will also fund four studies that use the PHIS+ database to learn more about the effectiveness of treatments commonly used in pediatric hospital care. The study team will compare the effectiveness of antibiotics in children hospitalized with community-acquired pneumonia, gastroesophageal reflux disease treatments in neurologically impaired children, single versus multi-drug antibiotic treatments after surgery for advanced appendicitis, and antibiotics with and without MRSA activity for acute osteomyelitis.

“Variation in the processes and outcomes of care in pediatric hospitals can be attributed in part to the paucity of comparative effectiveness evidence available to inform evidence-based guidelines,” says Dr. Keren. “The PHIS+ database will provide us with the clinical data to perform the kind of comparative effectiveness research that is needed to improve the health and healthcare of all children.”