Featured Research

iCOMPARE (Individualized Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education)

Funded by the Accreditation Council for Graduate Medical Education
Study Principal Investigator: James A. Tonascia, PhD (Bloomberg School of Public Health at Johns Hopkins University)
CHOP Principal Investigator: Jeffrey H. Silber, MD, PhD
The iCOMPARE study will conduct a cluster randomized trial in a sample of internal medicine (IM) training programs that are randomly assigned to either the current duty hour standards or less restricted flexible duty hour standards. Outcomes focus on patient safety assessed through claims data and education assessed through surveys. 
 
 

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.