Making an Impact
More than a decade ago, the Department of Pediatrics at Children’s Hospital of Philadelphia (CHOP) began the Chair’s Initiatives to establish new models of care in pediatrics and tackle some of the most daunting challenges in healthcare.
The program provides internal grants to support innovation, improvement and collaboration throughout and beyond Children’s Hospital. The Chair’s Initiatives program was started in 2006 by Alan R. Cohen, MD, then-physician-in-chief and Chair of the Department of Pediatrics, and Alison Marx, Operating Officer for the Department of Pediatrics. Today, the program continues under the guidance of Joseph W. St. Geme III, MD, who joined CHOP in 2013 as Chairman of Department of Pediatrics and Physician-in-chief of the Hospital.A
It takes a team
Participants in the Chair’s Initiatives have included physicians, nurses, researchers, quality improvement advisors, data analysts, engineers, social workers, genetic counselors and others within many specialties and across many disciplines. These individuals provide an unflagging willingness to work diligently and collaboratively to move their initiatives forward and to find solutions to complex challenges.
The program represents an excellent opportunity for donors interested in helping incredibly bright, motivated teams quickly bring change that truly benefits patients and families and sustain their efforts to create lasting impact. For more information about how you can make a gift, visit Children’s Hospital of Philadelphia Foundation or call 267-426-5332.
Chair’s Initiatives awardees and key contacts
Since its inception, the Chair’s Initiatives program has helped 39 teams turn great ideas into reality. Reflecting the Hospital’s commitment to patient safety, we have chosen Initiatives focused on innovation, safety and quality of care.
Each initiative is given seed funding for two years. Ten Initiatives were funded in Round 1; six in Round 2; six in Round 3; five in Round 4; six in Round 5; and six are currently underway in Round 6.
Access Nurse Advisor
Awardees: Alison Marx, MBA; Mark Rodi, MHA
Key Contacts: Alexandra Lahm RN; BSN; Michelle Lizzi, RN, BSN
Referring Physician Communication and Care Coordination
Automated Appointment Reminders
Awardees: Alison Marx, MBA
Key Contacts: Larry Barnes, MBA; Eileen Drames, MBA
Center for Bone Health
Center for Pediatric Eosinophilic Disorders
ADHD in Primary Care
Multidisciplinary Cancer Survivorship Program
Office of Fellowship Training
Awardees: Catherine S. Manno, MD; Gail Slap, MD, MS
Sudden Cardiac Death Prevention
Awardees: Victoria Vetter, MD, FAAP, FACC
Anticoagulant Management Program
Awardees: Leslie Raffini, MD
Chemotherapy Tracking System
Awardees: Charles Bailey, MD, PhD
From Knowledge to Practice: Developing the Infrastructure to Create and Implement Collaborative Clinical Pathways
Intestinal Rehabilitation Program
Unit-Based Patient Safety Walk Rounds
Department of Pediatrics CHOPLink (EPIC) Implementation, Quality and Safety Team
Awardees: David A. Piccoli, MD
A Shared Decision-Making Portal for Pediatric Chronic Illness
Assuring Quality and Patient Safety at CHOP Community Pediatric Programs
Improving Hospital Care and Service Delivery for Individuals with Autism Spectrum Disorders
Transitioning from Pediatric to Adult Services: A Primary Care Based Model
Minds Matter: Improving Pediatric Concussion Management
Preventing Outpatient CLABSI
Awardees: Christina Bales, MD; Susan Coffin, MD, MPH; Allison Ballantine, MD, MEd; Millie Boettcher, MSN, CRNP; Joy Collins, MD; Lori Kramer; Mark Magnusson, MD, PhD; Maria Mascarenhas, MBBS; Anne Reilly, MD, MPH; Susan Rettig, RN, BSN
COMEDO: A Computerized System to Assess Acne and Develop Appropriate Treatment Recommendations
Awardees: Elena Bernardis, PhD; Albert Yan, MD, FAAP, FAAD
Enhancing Providers Ability to Respond Effectively to Peer Bullying and Victimization
Awardees: Stephen Leff, PhD
Thrombosis Prevention and Treatment in Cardiac Patients
Development and Evaluation of THRIVE (Texting, Health Resources to Inform, MotiVate and Engage)
Identification, Remediation, and Prevention of a Chronic Glucocorticoid Therapy Adverse Effects
An Integrative and Educational Pediatric Genomics Initiative
Multidisciplinary Intervention Navigation Team (MINT) for Pediatric to Adult Care Transfers
Fostering Healthcare Coordination of Children in Foster Care
PATTERNS: Predictive Analytic Technology To Eliminate Repeat No Shows
Developing a Hospital Wide Fertility Preservation Program
iAPP: Integrating Apps in Pediatric Practice
Comprehensive Cancer Predisposition and Surveillance Program
Community Health Worker Initiative: Enhanced Care Management for Complex Patients
Center for Sepsis Excellence
Integrated Multi-disciplinary Hemophagocytic Syndromes Team of Excellence
Awardees: David Teachey, MD
Epidermolysis Bullosa Multidisciplinary Clinic
Awardees: Marissa Perman, MD
Integrating Lupus Care
Awardees: Jon (Sandy) Burnham, MD, MSCE
Adolescent Mobile Health Unit
Awardees: Marne Castillo, PhD, and team
Leveraging the Baldrige Performance Excellence Framework to Embed Evidenced Based Management Practices in Ambulatory Operations and Improve Patient Access to Care
Awardees: April M. Taylor, Melissa Muego, MD, Ashwini Reddy, MD, Flaura Winston, MD PhD, Larry Barnes, Maryann Chilkatowsky, Lynsey Cecere, Lena Leff, Tiruayer Battle, Zakiya Devine, James Won, PhD, Miriam Stewart, MD, Amy Kratchman, Gina Zappacosta, Lisa Biggs, Eli Lourie, Kate Fuller
Communicating and Connecting Mental Health Needs of Patients
Debriefing: Broken Down and Rebuilt
Awardees: Eron Friedlaender MD, MPH, Pamela Fazzio MD, Trish Janoff RN, Dawn DeBrocco PsyD, Heather Wolfe MD, Summer Elshenawy MD, Mary Haggerty DO, Theresa O’Connor RN, Shobha Natarajan MD, Maryam Naim MD, Meghan Galligan MD, Christina McClam MD
Endocrine Late Effects after Cancer Therapy (ELECT) Program
Pulmonary and Allergy Problematic Asthma (PAPA) Clinic
Doctor-to-Doctor Teledermatology: Leading the Way in High-Quality Pediatric Telemedicine
For more information about the Chair's Initiative or to contact the awardees, please contact Alison Marx.
Round 7 initiatives
The following seven Initiatives are currently underway:
- Adolescent Mobile Health Unit. This initiative will create an adolescent designed and focused Mobile Health Unit (MHU) which will provide an extension of clinical and adolescent sexual health services in the Philadelphia area, bringing mobile health care into youth communities that need it most, offer point of care services and refer to Title X funded CHOP clinics for on-going sexual health services, such as STI/HIV testing and reproductive health, provide health education sessions, clinical navigation services such as insurance support, referrals for behavioral and mental health support, referrals for homeless youth, and referrals to social/community support groups and programs, and create entry points to build long-term relationships for health care.
- Leveraging the Baldrige Performance Excellence Framework to Embed Evidenced Based Management Practices in Ambulatory Operations and Improve Patient Access to Care. The goal of this project is to successfully implement a bundle of evidence-based strategies to improve patient access in the ambulatory clinic environment using operations management, implementation science and the Baldrige performance excellence framework. This will include creating an ambulatory care innovation lab to accelerate operational improvements, and implementing and scalinh tests of change related to scheduling and visit cycle time optimization (e.g. scheduling template best practices, appointment smoothing), care model reconstruction (e.g. combined electronic and in-person consultation models), and pre-visit appointment information collection.
- Communicating and Connecting Mental Health Needs of Patients. This project will improve patients’ access to mental health services by identifying and addressing unmet care coordination needs for mental health referrals. The project will assess the current state of mental health referral patterns, focusing first on primary care sites, develop consensus recommendations on appropriate practices for mental health referrals, and use quality improvement methods to conduct a gap analysis for what is needed to move from current practice to ideal practice, and implement a test of change towards achieving ideal practice.
- Debriefing: Broken Down and Rebuilt. This initiative will define and implement best practices for clinical event debriefing (CED) that can be spread throughout the institution. The initiative will conduct a comprehensive needs assessment, build partnerships with leaders in medical education rooted in simulation in which debriefing is elemental to the methodology, identify existing debriefing-like initiatives underway in the organization, including post-event reviews for safety events, stablish care-environment-targeted best practices highlighting the current model of debriefing in the MBU, integrate the ability to address education, emotional processing and QI/systems issues into the CED process, plan for wider adoption of cognitive simulations focused on developing clinical decision-making as a complement to simulations centered around adherence to guidelines and pathways, and change national practice and contribute to broadly generalizable interdisciplinary educational, QI and patient care improvements.
- Endocrine Late Effects after Cancer Therapy (ELECT) Program. This project will establish an Endocrine Late Effects program, to expand access and provide high-level and consistent endocrine care for a growing population of childhood cancer survivors. In addition to serving current patient needs from the Survivorship, Neuro Oncology, Bone Marrow Transplant, and general oncology referrals, serve the growing needs of programs such as the CAR T-cell Program, Bone Marrow Failure, Neurofibromatosis, and Langerhans Cell Histiocytosis (LCH).
- Pulmonary and Allergy Problematic Asthma (PAPA) Clinic. The goal of this project is to create personalized and improved care for children with problematic, difficult to treat asthma and their families by utilizing a multidisciplinary clinic approach to create an innovative model for care where the needs of patients are addressed in an organized step-wise strategy to implement personalized steps for improved understanding and adherence to their care, leveraging tools such as Healthy Planet and EPIC multi-disciplinary clinic (MDC) models, and further strengthening collaboration with our partners in this process including Primary Care, Asthma Population Health Workgroup, Community Asthma Prevention program, Emergency Medicine, Social Work, Community Relations, Primary Care etc.
- Doctor-to-Doctor Teledermatology: Leading the Way in High-Quality Pediatric Telemedicine. This initiative will Implement teledermatology services via EPIC eConsult to 5 total primary care sites within the CHOP Care Network which will optimize workflow for primary care and dermatology providers, complete development of a secure, provider-to-provider teledermatology platform via eConsult functionality in Epic 2018. This will include the development of a dashboard to track operational metrics, forge early partnership with insurers to establish interest and share data, and complete needs assessment survey of PCPs regarding curbside consultation and teledermatology.
Round 6 initiatives
The following six Initiatives were funded for 2017-2019:
- Developing a Comprehensive Cancer Predisposition and Surveillance Program. The goal of this project is to increase identification and surveillance of the predisposition to develop childhood cancer due to a heritable germline mutation in order to track, understand and improve outcomes.
- A Community Health Worker (CHW) Initiative: Enhanced Care Management for Complex Patients . This team will build evidence and infrastructure for enhanced care management through the development of a generalizable and scalable CHW role at CHOP.
- Creating a Children's Hospital of Philadelphia (CHOP) Pediatric Sepsis Program. This team will leverage existing clinical, research, and quality improvement initiatives to establish CHOP as the premier center for treatment of pediatric sepsis.
- Developing an integrated multi-disciplinary hemophagocytic syndromes (HS) team of excellence. The goal of this project is to develop a unique, internationally renowned, multidisciplinary team focused on the diagnosis and management of patients with hemophagocytic syndromes (HS).
- Creating an Epidermolysis Bullosa Multidisciplinary Clinic. The goal of this project is to provide coordinated, state-of-the art, and family-centered care for patients with epidermolysis bullosa (EB), a rare, inherited blistering disease that leads to skin fragility.
- Integrating Lupus Care at CHOP. This initiative will support patients with pediatric systemic lupus erythematosus (pSLE) and their caregivers to improve the value of pSLE healthcare delivery.
Round 5 initiatives
The following six initiatives were funded for 2015-2017:
- An Integrative and Educational Pediatric Genomics Initiative. The goal of this project is to improve access, use and efficiency of genomic testing, and to help patients, families and healthcare providers better understand test results. The team will develop web-based interactive education modules on genomic medicine for professionals and families, and recruit staff champions to promote it.
- Developing a Hospital-wide Fertility Preservation Program. This team will support the creation of a comprehensive fertility preservation program for patients, families and providers at The Children’s Hospital of Philadelphia. The program will support identification of all at-risk patients, and offer timely referrals, clinical consultations, patient care plans and educational resources. Financial support will also accelerate the pace of research discoveries.
- Integrating Apps in Pediatric Practice (iApp). This team will develop a process to integrate evidence-based and clinically evaluated health apps for families into pediatric care at CHOP in order to improve outcomes.
- Fostering Healthcare Coordination of Children in Foster Care. This team will establish a healthcare coordination model for children placed into foster care by providing comprehensive screening and evaluation upon entry into foster care to ensure access to a medical home, sharing information across health and child protection systems, and identifying practices that can be used in the primary care setting and expanded through telemedicine.
- Leveraging Predictive Analytics and Technology to Decrease Missed Appointments. This team will use data from CHOP’s electronic medical record system (EPIC) and predictive analytics to identify patients that are more likely to cancel the same day or fail to show for scheduled appointments. This information will be shared with staff who can reach out to patients and find more effective was to improve attendance rates.
- Multidisciplinary Intervention Navigation Team (MINT) for Pediatric to Adult Medical System Transitions. This team will create a centralized CHOP service to assist with difficult transitions to adult care involving multiple specialists. The new service will develop care plans; assess patients’ psychosocial, self-care, and health insurance needs; and identify adult providers – coordinating care between CHOP and the University of Pennsylvania Health System.
Round 4 initiatives
Five initiatives were funded for 2013-2015:
- COMEDO: A Mobile Computerized System to Assess Acne Patients and Develop Treatment Recommendations Adapted From Standardized, Expert Treatment Guidelines. Acne is one of the most common reasons for a visit to the doctor in ages 13-21. This team refined a computer program that can recommend treatment through analysis of the patient’s skin through photos taken from a smartphone and other data. The goal was to pilot the tool at primary care practices.
- Enhancing Providers’ Ability to Respond Effectively to Peer Bullying and Victimization. This team surveyed patients, parents and providers about the effects of bullying, and then designed tools, such as sets of recommendations in Epic, to help providers identify bullying and respond in ways that will help.
- Identification, Remediation and Prevention of Chronic Glucocorticoid Therapy Effects. More than 1,500 CHOP patients are on long-term glucocorticoid (steroid) therapy to prevent organ damage and other effects of immune diseases such as systemic lupus erythematosus. This team worked on standards to identify, monitor, remediate and prevent side effects such as weight gain and high blood pressure.
- Thrombosis Prevention and Treatment in Cardiac Patients. Children with heart disease account for a high proportion of CHOP’s acquired venous thromboembolisms (blood clots). This team developed strategies to reduce the incidence and complications of thrombosis in cardiac patients.
- Proof of Concept of an Infrastructure for Text Messaging Interventions at CHOP: Development and Evaluation of THRIVE (Texting, Health Resources to Inform, MotiVate and Engage). This team studied the effectiveness of texting in improving care, adherence, and well-being of adolescents and young adults (ages 12 to 25) completing cancer treatment. One group received daily text messages for 16 weeks, including education, encouragement and appointment reminders; the control group did not. The project also aimed to evaluate whether texting software and interventions could be applied to care of and research with other diagnoses.
Round 3 initiatives
Six initiatives were funded from 2011–2013:
- A Shared Decision-making Portal for Pediatric Chronic Illness. For conditions such as asthma, communication between families and clinicians about goals, concerns, and the child’s condition and progress is key. This team created a computer portal where both sides can share information, track progress and make decisions about care.
- Assuring Quality and Safety at CHOP Community Pediatric Programs. The CHOP Care Network includes affiliations with numerous local hospitals. This team designed and implemented a quality monitoring system to ensure that all CHOP-affiliated sites offered the same quality of care.
- Improving Hospital Care for and Service Delivery to Individuals with Autism Spectrum Disorders. Children with autism have different reactions to care and require different approaches. This team piloted strategies to promote patient comfort and minimize safety concerns during routine procedures such as sedation before a CT scan.
- Minds Matter: Improving Pediatric Concussion Management. Early recognition of concussion signs and symptoms and early implementation of cognitive and physical rest are key to management of acute concussion. This team analyzed current practice across the institution and recommended improvements in primary care, emergency care, sports medicine, trauma and other areas.
- Reducing the Incidence of Outpatient CLABSI (Central Line Associated Bloodstream Infections). Long-term IV lines called central lines, used to give patients medication and nutrients, bring increased risk of dangerous bloodstream infections. This team worked to translate safety improvements CHOP had made on the inpatient side into the outpatient realm.
- Transitioning from Pediatric to Adult Services: A Primary Care Based Model. Good primary care doctors are important to young adults with complicated healthcare needs, but many don’t make it a priority to find one after they outgrow their pediatrician. This team designed tools to help patients find and maintain primary care providers.
Round 2 initiatives
Six initiatives were funded from 2008–2010:
- Anticoagulant Management Program. Improved monitoring and care for children taking “blood thinners”
- Chemotherapy Tracking Project. Computerized records of cancer patients’ drug regimens
- CHOPLink Implementation, Quality and Patient Safety. Linked clinicians with computer specialists to ensure technology improves care
- Collaborative Clinical Pathways. Established a framework for care guidelines to be created more easily
- Intestinal Rehabilitation Program. Coordinated and improved care for children with intestinal failure
- Unit-based Patient Safety Walk-rounds. Provided a forum for safety concerns of families and staff
Round 1 initiatives
Ten initiatives were funded from 2006–2008:
- Access Nurse Advisor and Care Coordination. Nursing roles, systems and tools were created to support patients, families and providers in coordinating both access and care.
- ADHD in Primary Care. A team created computer tools, conferences and other supports to help primary care pediatricians learn and manage patients with ADHD.
- Automated Appointment Reminders. A computerized system was implemented to place standardized reminder calls across specialties to help families remember appointments and support continuity of care.
- Center for Bone Health. A team provides specialized care for children with poor bone health and helped establish international care guidelines.
- Center for Pediatric Eosinophilic Disorders. A team provides specialized care for rare allergic disorders, attracting patients from across the United States and becoming a model for other hospitals.
- Database Development. A team developed databases and Web-based applications to support physicians in research and care.
- Multidisciplinary Cancer Survivorship Program. A team created a monthly clinic where cancer survivors see oncologists, endocrinologists, cardiologists and other specialists, resulting in better care coordination for their many needs.
- Office of Fellowship Programs. A team coordinates and streamlines application, evaluation, curriculum development and accreditation processes for all fellowship programs in the Department of Pediatrics.
- Pediatric Knowledgebase. A team created a Web-based application that combined data about drugs with data about individual patients to help improve outcomes.
- Sudden Cardiac Death Prevention. A cardiologist and staff provide screenings for undiagnosed heart irregularities in children and teens, and training in CPR and automated external defibrillator use for schools.
Learn more about the Chair's Initiatives
- The Chair's Initiatives of the Department of Pediatrics - Round 5 (PDF)
- The Chair's Initiatives of the Department of Pediatrics - Round 4 (PDF)
- The Chair’s Initiatives of the Department of Pediatrics – Round 3 (PDF)
- The Chair’s Initiatives of the Department of Pediatrics – Round 2 (PDF)
- The Chair’s Initiatives of the Department of Pediatrics – Round 1 (PDF)