Clinical Futures: A Legacy of Improved Pediatric Care Through Research

A longtime Center of Emphasis at Children’s Hospital of Philadelphia has a new name to reflect a growing identity within pediatric clinical research and care. What began as the Pediatric Generalist Research Group at CHOP to perform health services research evolved into the Center for Pediatric Clinical Effectiveness (CPCE) and PolicyLab in 2007. For more than 15 years, the CPCE has advanced pediatric effectiveness research and clinical best practices. The evolution continues, as CPCE becomes Clinical Futures, a CHOP Research Institute Center of Emphasis.

“As part of the center’s strategic planning initiative two years ago, we wanted to emphasize the strength of our research and related work in building foundational evidence and innovative interventions to help define the next generation of pediatric care,” said Alexander Fiks, MD, MSCE, director, Clinical Futures.

Clinical Futures investigators use a variety of approaches, research designs, statistical tools, and analytical models to conduct prospective and retrospective clinical effectiveness research. These methodological pillars — biostatistics, clinical epidemiology, clinical trials, comparative effectiveness, implementation science, and social science methods in healthcare delivery — guide investigators to develop effective, evidence-based findings that translate into improved clinical care and outcomes for children.

“This new name is expansive and communicates the breadth, depth, and diversity of research done in our center,” Dr. Fiks said. “As Clinical Futures, we will continue to build on this strength with programming that supports faculty success and methodological advancement and accelerates translation of findings into improved child health outcomes.”

Powering Progress Through Collaboration

Clinical Futures brings together faculty, physician-scientists, and staff from 23 divisions and four departments within CHOP. They partner with other groups and Centers of Emphasis at CHOP to implement best practices to improve the quality of care delivered to children.

Some recent projects highlight the clinical impact of this multidisciplinary group of researchers. For example, the Possibilities Project, which improves patient health outcomes by reimagining pediatric care delivery, is leading implementation of a Virtual Driving Assessment (VDA) program in CHOP’s Care Network with support from NJM Insurance to measure safe driving ability in patients 15 years and older. Elizabeth Walshe, PhD, a research scientist who investigates how cognitive development in young drivers may influence safety, and Flaura Winston, MD, PhD, founder of the Center for Injury Research and Prevention (CIRP) are leading the first study to leverage the VDA to evaluate and enhance driving safety for young adults. Decades of research within CIRP contributed to the development of the VDA.

“CHOP Primary Care is the first practice in the world to systematically evaluate teen driving,” said Dr. Fiks, who also serves as director for the Possibilities Project. “Our partnership with NJM enabled us to allow our patients to benefit from decades of CHOP research, and it is an exciting opportunity for novice drivers to participate in engaging, interactive virtual driving and assessment in preparation for safe driving.”

In a separate project supported with a pilot grant from Clinical Futures and PolicyLab, Kate Wallis, MD, MPH, and colleagues looked at the use of telehealth in developmental-behavioral pediatrics during the COVID-19 pandemic. Among the research team’s findings was that English-speaking patients were 1.8 times as likely to have a telehealth visit (compared to in-person visits) as Spanish-speaking patients during the study period.

Dr. Wallis, a developmental-behavioral pediatrician affiliated with Clinical Futures, PolicyLab, and the Center for Autism Research, was joined in this work by Sansanee Craig, MD, an attending physician and clinical informatician in the Department of Biomedical and Health Informatics; Katherine Kellom, qualitative methods program manager; and Priscilla Ortiz, PhD, language services program manager.

Future research will explore whether this disparity persisted, barriers and facilitators to telehealth care, and technology solutions to help bridge these gaps.

Shared Findings, Improved Outcomes

A crucial part of Clinical Futures’ mission is to disseminate knowledge gained from research findings to encourage widespread adoption of effective healthcare practices. Highlights of investigators’ recent presentations include participation in ID Week 2022, where Kathleen Chiotos, MD, MSCE; Brian Fisher, DO, MPH, MSCE; and Jeffrey Gerber, MD, PhD; shared their work on antibiotic stewardship, fever and neutropenia, and antibiotic treatment for group A streptococcus pharyngitis, respectively, and the 2022 American Academy of Pediatrics National Conference & Exhibition where Karen Puopolo, MD, PhD, discussed the impact of COVID during pregnancy.

Additionally, Clinical Futures-affiliated researchers published nearly 700 manuscripts in 2021, disseminating their findings and positioning CHOP scientists as thought leaders in safety, behavioral health, healthcare equity, and much more.

Experienced faculty also mentor fellows and junior faculty through training programs and fellowships designed to develop the next generation of investigators who will answer challenging questions to improve the effectiveness of healthcare on lifelong outcomes for children and adolescents.

The Academic General Pediatrics Fellowship prepares trainees to improve health and healthcare for underserved children through primary care research and leadership, and the Pediatric Hospital Epidemiology and Outcomes Research Training Program provides physicians with training in hospital epidemiology and outcomes research. Clinical Futures’ experienced faculty also provide guidance to junior investigators on research projects, career paths, and applying for career development grant funding.

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