Center for Child Health & Policy at UH Rainbow Babies & Children’s Hospital promotes an ambitious agenda
Innovations in Pediatrics - Summer 2016 - View Full PDF
LAWRENCE C. KLEINMAN, MD, MPH, FAAP
Director, Center for Child Health and Policy, UH Rainbow Babies & Children's Hospital; Frederick C. Robbins, MD Professor in Child and Adolescent Health, Vice Chair for Child Health and Policy, Case Western Reserve University School of Medicine
The Center for Child Health & Policy at University Hospitals Rainbow Babies & Children’s Hospital has a broad yet singular focus: to improve children’s health through better-informed local, state and national policy. On any given day, you’ll find its affiliated faculty and nine full-time staff working on a variety of projects, from strategies to reduce childhood obesity to quality measures for evaluating pediatric care, to mentoring programs training the next generation of pediatric clinicians – especially those who will treat disadvantaged children.
The organizational chart is complicated. The Center for Child Health & Policy has strong ties to Case Western Reserve University School of Medicine, with collaborators ranging from the New York State Department of Health to the Great Lakes Science Center. Funders include the Agency for Healthcare Research and Quality (AHRQ), the National Institutes of Health (NIH) and the State of Ohio Medicaid Technical Assistance and Policy Program (MEDTAPP), among others.
Pediatrician Lawrence Kleinman, MD, MPH, the Center for Child Health & Policy’s new director, arrived in Cleveland last July.
“The Center for Child Health & Policy serves as the home for health services and health policy research for the School of Medicine’s Department of Pediatrics, while serving as a primary source of program and policy evaluation for UH Rainbow Babies & Children’s Hospital and UH MacDonald Women’s Hospital,” he says. “We’re committed to better health for all children, through the generation, interpretation and implementation of evidence.”
Now in its ninth year, the Center for Child Health & Policy focuses on research, advocacy and education on conditions influencing children’s health. Areas of focus include social risk, obesity, diabetes, infant mortality, asthma and mental health disorders. It is engaged on these topics in Cleveland, Northeast Ohio, the state of Ohio and the nation, taking a multifaceted approach that considers population and public health, effective high-quality health care, and maternal-child, family and community health, all through a lens that promotes health equity for children.
One foundational center project demonstrated the power of implementing practice coaching to improve the quality of pediatric care provided by Northeast Ohio primary care clinicians. This approach was adapted for pediatric care by the center’s first director, the late Leona Cuttler, MD.
Dr. Kleinman looks to build on this work in his new role with the center.
“This is an exciting place for me to be,” he says. “UH Rainbow Babies & Children’s Hospital and Case Western Reserve University have a strong commitment to this work. I also get to build on foundations established by Dr. Cuttler. Her work and the team she has assembled are part of her special legacy.”
Dr. Kleinman joins UH Rainbow Babies & Children’s Hospital from Icahn School of Medicine at Mount Sinai in New York City, where he was Vice Chair for Research and Education in the Department of Population Health Science & Policy. He brings with him a nearly $8 million project funded by AHRQ to develop some of the pediatric quality measures called for in the 2009 Children’s Health Insurance Program Reauthorization Act (CHIPRA). As leaders of one of seven national Pediatric Quality asures Program (PQMP) Centers of Excellence,
Dr. Kleinman and his team have worked with more than 60 people from 10 partner organizations to define what quality care looks like for asthma, the follow-up after mental health admissions, pediatric medication reconciliation, inpatient perinatal care and the availability of high-risk obstetrical care.
“Current approaches to measuring pediatric care are not sufficient,” he says. “As a rule, they are difficult to make comparable for different populations of children or across states, providers and health care plans. Such lack of measurement lowers the overall quality of care received by children in the United States. Standardized measurements are essential for ensuring high-quality and equitable health care. For example, in terms of medication reconciliation, do you distribute a medication list to each patient? When do you do it? Do you have systems that communicate? We’ve developed an interesting survey that addresses that at the site level.”
One prominent, long-standing project of the Center for Child Health & Policy at UH Rainbow Babies & Children’s Hospital is the Childhood Obesity Prevention and Treatment Research (COPTR) program, launched at four centers nationwide in 2010 by the NIH’s National Heart, Lung and Blood Institute (NHLBI). Currently led by Elaine Borawski, PhD, and Shirley Moore, RN, PhD, from Case Western Reserve University, the project is gauging the effectiveness of different weight loss interventions among 360 Cleveland middle schoolers and their parents.
This project is a good example of what is possible through collaboration, Dr. Kleinman says.
“Our goal is to do well for kids,” he says. “Sometimes we are just the people to do that, but sometimes we know who the other people are. By working together, we can create a much greater product and project.”
The center has also played an important role in supporting CaseCAN, a project aimed at shoring up the clinical workforce treating disadvantaged children. Originating at Case Western Reserve University and funded by MEDTAPP’s Healthcare Access Initiative, the program provides structured educational programming, experiential learning and mentored support to residents, fellows and faculty. After three grants from the state, the project has now expanded to include training in how to provide optimal behavioral health care for children, especially when prescribing and managing psychotropic drugs. The center is providing this training to pediatric clinicians at UH Rainbow Babies & Children’s Hospital, as well as its cross-town collaborator, MetroHealth. Participants attend a three-day training session and then communicate by phone with their mentors for six months, reviewing cases and earning CME credit.
“It’s imperative to primary care providers to manage these medications safely in their practices,” Dr. Kleinman says. “This training accomplishes that. These are not everyday skills.”
A new project for the Center for Child Health & Policy is a collaboration with Nationwide Children’s Hospital to address Ohio’s stubbornly high infant mortality rate. This effort, also funded through MEDTAPP, aims to pinpoint which interventions have the greatest likelihood of success – and when they should occur.
“We’re looking to identify different times along the course of a pregnancy,” Dr. Kleinman says. “What can we pick up that suggests this person is high risk? What are the combinations that may not be recognized?
“The problems we face in children’s health are large, but we try to look internally and externally, at the city, the state and the world,” he adds. “Our center doesn’t fit into a normal bucket, but it also creates a lot of opportunities. We can support the hospital in ways that otherwise might not be possible. We can fill that gap. We are dreamers, but we’re also doers.”
For more information about the Center for Child Health & Policy at UH Rainbow Babies & Children’s Hospital, email Peds.Innovations@UHhospitals.org.Lawren