Dig Deep and Discover What Works: Q&A With Alex Fiks, MD, MSCE

“What works?” in healthcare is the driving question for the Clincal Futures’ multidisciplinary research team and their new director Alex Fiks, MD, MSCE. The research Center at Children’s Hospital of Philadelphia is dedicated to facilitating, organizing, and centralizing the performance of clinical effectiveness research to discover and share knowledge about best practices in pediatric care.

We sat down with Dr. Fiks, a primary care pediatrician, associate professor of Pediatrics and holder of the Distinguished Endowed Chair in the Department of Pediatrics in the Perelman School of Medicine at the University of Pennsylvania, to learn about his plans for the continued evolution and success of the Center, including ways it can enhance CHOP’s care delivery model by leveraging advanced analytics, informatics, and general clinical effectiveness questions into patient care.

You’ve been a member of Clinical Futures since its inception in 2007. How has the Center evolved since then?

The center has grown a lot in terms of the number of faculty and staff, research funding, and the range of scholarship. I can think of few groups at CHOP who come from as broad a range of disciplines as Clinical Futures. We have representation from 14 divisions, extending from Adolescent Medicine, to Critical Care, to General Pediatrics, to Radiology, and Urology. With that breadth of expertise, it’s not surprising that Center faculty have been so successful with 86 current federally funded studies, nearly 40 foundation grants, and many industry-sponsored projects.

In what ways do you see Clinical Futures’ continued evolution and success enhancing its four primary areas of research: healthcare quality and process improvement, care of chronically ill children, infectious disease, and community health?

As Clinical Futures has grown, our research has made concrete, lasting changes to pediatric clinical practice, improving healthcare quality at CHOP and beyond. Our research focus on preventative care has allowed us to address long-term community healthcare needs. With Clinical Futrures' success, our experts also have had more leadership roles in national groups in each of these four primary areas of research, giving a voice to our work on chronically ill children, infectious diseases, and more.

As a new director, what are your initial goals for Clinical Futures?

My initial goal as the new director for Clinical Futures is to help lead our upcoming strategic planning process. This is an opportunity to address Clinical Futures' continued growth as a Center and how we can best enhance both our research as well as care delivery at CHOP. Clinical Futures expertise in advanced clinical effectiveness evaluation, epidemiology, and informatics provides a firm foundation for this work. I look forward to seeing how the planning initiative will further develop Clinical Futures' research program and even potentially create new commercial partnerships.

What challenges do you foresee?

Clinical Futures has always prided itself on being a diverse center. Over the past 12 years, our faculty and staff have grown in numbers and in range of backgrounds. The diversity of our research has been one of our greatest strengths as a Center and has helped us produce work that speaks to the range of pediatric care. It also means that we must prioritize bringing people together around common needs and goals.

What excites you most about your new position?

In my new role as director of Clinical Futures, I am most looking forward to the chance to build upon our strengths to benefit child health and healthcare at CHOP, across the United States, and beyond. I am committed with the support of the Research Institute to building collaboration within and beyond our Center so that our faculty and staff have the satisfaction of working together to understand how to make pediatric care, both here at CHOP and outside, as effective as possible.

As a primary care pediatrician who has a practice-based research interest in how electronic health record data may best be used to improve primary care, medication use, and child health more broadly, tell us about a research project you’ve worked on that has helped to increase pediatric clinical effectiveness?

One of the interventions I have worked on that has featured my interest in using electronic medical health (EHR) data to improve care and pediatric clinical effectiveness was the Give Teens Vaccines intervention, which has been added to the National Cancer Institute’s Research-Tested Intervention Programs repository.

In 2006, the national Advisory Committee on Immunization Practices recommended the HPV vaccination for all girls ages 11 to 12 years, and extended that recommendation to boys ages 11 to 12 years in 2011. However, parents’ beliefs about the vaccine may influence clinicians’ intentions to vaccinate; clinicians can be reluctant to recommend vaccination due to perceived parental concerns. Using this information, my colleagues and I designed and tested an intervention using EHR data to improve HPV vaccination rates.

The clinician-focused intervention had three components:

• Electronic alerts for routine adolescent vaccinations when a patient’s electronic medical record was opened
• A one-hour educational presentation about vaccine safety, efficacy, and strategies for overcoming barriers to vaccine receipt, with site-specific HPV vaccination rates
• Three quarterly feedback reports on individual, practice, and network rates

The family-focused intervention featured automated reminder calls about well-visit or follow-up appointments. The calls also emphasized that the vaccine was recommended by the clinician and referred families to a website containing information on adolescent vaccines.

After 12 months, the combined clinician and family-focused intervention resulted in significantly higher HPV vaccination rates compared to usual care, and it reduced delays in initiating vaccination. This work provides a foundation for a current trial being conducted on a national scale.

How did this become your research interest, and why do you enjoy your work?

Like many of my fellow researchers at Clinical Futures, my research interests are often informed by the problems that I see as a clinician in practice. In clinic, I see families one at a time to work past barriers to improve health outcomes. Through research, I want to be able to develop interventions that reach as many families and clinicians as possible. There are many health problems we see as clinicians that we cannot address without system level interventions. Being a clinical effectiveness researcher allows me to expand my care for patients into improving systems across practices.