Featured Research

AHRQ-CMS CHIPRA Pediatric Quality Measurement Center and Testing Laboratory

Funded by the Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid Services
Principal Investigator: Jeffrey H. Silber, MD, PhD
The AHRQ-CMS CHIPRA Laboratory at the Children’s Hospital of Philadelphia (CHOP) is one of seven Centers of Excellence (CoE) for the national Pediatric Quality Measures Program.  This program was established by the Children’s Health Insurance Program Reauthorization Act to foster the development of evidence-based pediatric quality measures, which have lagged significantly behind adult quality measures.  The CHOP CoE is currently focusing on studies related to continuity of insurance coverage, risk adjustment methodology in Medicaid and the Children’s Health Insurance Program, and patient reported outcomes.  CHOP has formed an organizational architecture for a new CoE that builds on a strong, existing infrastructure already in place including investigators with breadth and depth in leadership and methodological expertise in quality and outcome assessment, unique data resources, and strategic partnerships. The CoE will include five methodological cores: (1) Quality Informatics-using the tools of informatics to adapt quality metrics to the electronic health record (EHR); (2)Multivariate Matching Laboratory--The lab will provide a unique analytic strength that will augment traditional analytic approaches to create scientifically rigorous pediatric risk adjustment models, produce better assessment of health and healthcare disparities, and improve validation of new quality measures; (3) Hospital Metrics-development of measures that focus on inpatient quality; (4) Medical Home-measurement of the performance of the medical home and community services that connect to it; and, (5) Health Plans-a special emphasis on measurement of plan enrollment duration and stability.


The Financing of Obstetrical Care in the U.S.

Funded by the Centers for Disease Control and Precention
Principal Investigator: Scott A. Lorch, MD, MSCE
The financing of obstetric care remains controversial. Obstetric care can be broken up into 3 areas:  prenatal care; intrapartum care; and postpartum care.  The vast amount of resources devoted to obstetric care centers on intrapartum care, with higher reimbursement typically for operative, or Cesarean section deliveries, compared to vaginal births.  Prenatal and postpartum care is funded through a variety of mechanisms, including bundled payments for the hospital and providers providing intrapartum care, specific prenatal or postpartum visit codes, or standard outpatient visit codes with a 1-5 scale of medical complexity. The aims of this project are to (1) describe the variation in obstetric funding across the United States, using Medicaid Physician Fee Schedules publicly available for 50 of 51 states (excluding Tennessee), (2) describe how these fee schedules changed in response to Medicaid Expansion and the enactment of the Affordable Care Act in the United States, and (3) identify the association between obstetric funding mechanisms, total compensation of health care providers by the Medicaid system per patient, delivery location, and neonatal outcomes using MAX data from 2007-2010.


Using Patient Outcomes to Inform Surgical Education

Funded by the National Institute on Aging
Study Principal Investigator: Rachel Kelz, MD, MSCE (University of Pennsylvania)
CHOP Principal Investigator: Jeffrey H. Silber, MD, PhD
Over the past decade, the surgical training process has undergone a period of unprecedented change due to extensive education reforms, a change in the nature of surgical care, and heightened public awareness of surgical outcomes. Significant concerns regarding the ability to successfully prepare new surgeons in the modern environment along with a recent increase in the new surgeon failure rate on the oral board certification exam mandate a thorough examination of the effects of training in the modern era on the outcomes of patients treated by new surgeons. We aim to examine the clinical and economic outcomes of patients treated by new surgeons who trained in the modern era and have now entered independent practice.


Predicting and Preventing Pediatric Hospital Readmissions

Funded by the Agency for Healthcare Research and Quality
Principal Investigator: Scott A Lorch, MD, MSCE
The prevention of hospital readmissions, particularly preventable or unnecessary readmissions, has become an area of interest for public policy makers, health insurers, and providers. Medicare has begun a readmission reduction program to reduce payments to hospitals with higher-than-expected readmission rates.  A similar interest is seen in pediatric medicine.  While the estimated readmission rate within 30 days among the 2.4 million admissions annually in the United States is approximately 6.5%, many conditions such as surgery, sickle cell disease, and prematurity have rates between 15 and 20%. Children with publicly-financed insurance have higher rates of readmission, with rates of prematurely-born infants in some states as high as 30%. Most methods to predict the risk of readmission for both adult and pediatric patients frequently misclassify patients, thus the principal goal of this study is to develop a real-time predictor of readmission risk for pediatric patients. 
See the Research page for additional ongoing research projects.