Child and Adolescent Health Research Design and Support (CAHRDS)Unit of the Department of Pediatrics of the University of Louisville School of Medicine exists to improve effectiveness, quality, safety and delivery of health care and prevention/health promotion services to children. This is accomplished through application of the best evidence and research methods into these areas and related aspects of health and health care.
The efforts and products of this Unit will support all facets of the mission of the Department of Pediatrics (4/26/2006), which exists to contribute to the University of Louisville’s quest to become a nationally recognized metropolitan research university by:
- Excelling in the education of physicians who care for children,
- Providing evidence-based healthcare services to children and their families, and
- Bringing new clinical and basic science pediatric knowledge to the bedside.
The faculty and staff of the CAHRDS Unit are guided by values of 1) improving child health and well-being through developing evidence that identifies best practices, 2) pursuing scientific rigor with integrity and accountability, and 3) building collaborative and inclusive University and community partnerships.
With the mindset of "what is best for children," the CAHRDS Unit expects to produce excellent research that serves the health and well-being of children, their families, and their communities and our colleagues who provide health care services to them.
The CAHRDS Unit provides an opportunity for faculty members of all pediatric medical and surgical disciplines with predominant clinical and teaching duties to collaborate with core faculty and others for the design, analysis, and other supports needed to maximize their scholarly productivity within the limited times available to them for these activities.
Research in health care must go beyond discovery in the laboratory and proof of efficacy in clinical trials to proof of effectiveness, cost-effectiveness, and utility to patients in real-life circumstances. Research into how "best evidence" is disseminated into and implemented by health care systems to improve health care delivery also is crucial. Redesign of health systems to better deliver high quality preventive and health care services that are safe will often be required, but evidence of need for change and evidence of success that will come from change must be developed. Studies of these aspects of medical care fall under the umbrella of Health Services Research, also known as Outcomes Research.
In addition to these types of research, there is great need for research into medical education processes to better train the next generations of health care providers of multiple types and disciplines. Competent providers must manage growing volumes and types of information and be able to effectively appraise and apply information to provide the highest quality of care in a cost-effective manner. Faculty must have mastery of these skills in order to transmit them to trainees.
The disciplines of Health Services Research, Medical Education Research, and Evidence-Based Medicine practice methodologies have substantial overlap in required skill sets and are also amenable to participation by faculty members with work assignments heavily weighted towards clinical care and education rather than traditional research.
Thus, establishing a group of core faculty members and support personnel to conduct and support research in these areas will lead to improvements in:
- Health outcomes for patients;
- Delivery of the most effective and evidence-based health care;
- Efficiency and cost reductions in delivery of care;
- Educational methods and processes to achieve the above goals;
- Evidentiary skills and learning habits among the providers we train.
Additionally, through focus on these research and educational means, the resulting improvements in the clinical and academic capacity and culture of the Department of Pediatrics of the University of Louisville School of Medicine will:
- Support the financial health of the hospitals and other health care entities with whom we partner;
- Facilitate the success of basic science research and clinical trials and other translational research undertakings within the Department, the School of Medicine, and our hospital partners;
- Expand more rapidly the national reputation of the Department and Kosair Children’s Hospital.
Domains of Research and Effort to Be Developed by the Unit
The CAHRDS Unit will work to establish research activities in the following domains:
- Comparative effectiveness studies (e.g., What interventions are most effective for which individuals under specific conditions?)
- Economic/cost analysis studies (e.g., Can we deliver high quality care with less cost or resource use? What is the best option when costs to systems and patients of various types are considered?)
- Patient-centered outcomes (e.g., What outcomes matter to patients and families, in terms of quality of life and how health providers interact with them? How do we help patients adopt behaviors that prevent disease or adhere to regimens that reduce the progression or impacts of disease?)
- Medical informatics, including decision support (e.g., How can we provide physicians with ready access to information specific to their patient at the point of care to make effective and cost effective treatment plans?)
- Implementation/Dissemination research (e.g., How do we implement new recommendations effectively within a particular system of health care? What types of communication to and education of providers is required to accomplish needed change?)
- Epidemiological and other studies of risk factors for disease and opportunities for prevention
- Quality improvement analyses, including patient safety, focusing both on local issues and broad questions for which solutions identified in Louisville will be useful in other centers across the country
- Medical education research (e.g., How can content and technology be combined to improve physician learning at all levels of training and practice? What are the best proportions of multiple facets of curriculum design for specific content areas, including patient simulation?)
- Clinical trials (e.g., local investigator-initiated, prospective studies that involve direct contact with patients, with or without retrospective components, that seek to answer questions regarding efficacy of therapeutic or preventive interventions, validity of diagnostic tests, or prognosis of medical conditions; the unit will work closely with the faculty and staff of the Kosair Charities Pediatric Clinical Research Unit to coordinate support efforts needed for design, implementation, and analysis of such studies.)
Many of these areas require assembly of multidisciplinary teams (health professionals [physicians, nurses, pharmacists, health care administrators, and ancillary service providers and technicians] working also with faculty members in other disciplines such as engineering, computer science, social work, anthropology, law, economics, marketing, and even the fine arts—and patients/patient advocates) to conceive and validate the systems changes that will be needed.
The CAHRDS Unit is not designed, at this time, to have the capacity to provide informatics services such as software application design for clinical, research, or educational projects. However, core faculty may serve to mediate needed collaborations with other faculty across the University or entities beyond the University to meet these needs when they arise.
The CAHRDS Unit will work with the Information Technology groups of University of Louisville Physicians, Norton Healthcare, and others to develop databases of local health services and test results needed for research projects. This will include working with these groups to develop policies and procedures for data integrity of final databases relative to original data sources.
Quality improvement and patient safety projects will be supported from design and data analysis perspectives. Development of a robust quality improvement program that both identifies gaps in quality and closes the gaps will require the efforts of many departmental and hospital personnel and resources and probably stepwise growth of informatics and analytical capacities of both organizations, in addition to collaboration with regional expert organizations such as Cincinnati Children’s Hospital.
Educational Efforts of Unit Faculty Members
The core faculty of the CAHRDS Unit will be involved in the following educational and support activities:
- Teaching evidence-based medicine methods of information retrieval, appraisal, and appropriate application to patient needs to multiple types of health care providers in training and in practice
- Faculty development and trainee education in study design, data management and analysis, results dissemination, and regulatory compliance, as well as specific issues related to each of the above research domains.
- Assistance with design and planning for investigator-initiated clinical trials and other studies, including data monitoring and safety analyses.