NACHRI/Centers for Disease Control & Prevention (CDC) Cooperative Agreement
Improving Children's Health
Through Health Services Research was a special 1-day meeting held June 26, 1999, in Chicago. The state of the science in children's health services research
was explored, including public and private funding opportunities, networks for
conducting research, and uses of research in policy and practice. The meeting
was co-sponsored by the National Association of Children's Hospitals and Related
Institutions (NACHRI), with the Agency for Health Care Policy and Research (AHCPR),
the American Academy of Pediatrics (AAP), the David and Lucille Packard Foundation, the
Association for Health Services Research (AHSR), the Robert Wood Johnson Foundation, and Data
Harbor, Inc.
The Centers for Disease Control
(CDC) identified the need for specific information about pediatric infection
control (IC) issues, particularly those related to nosocomial infections (NI)
and antimicrobial resistance (AMR). Although information was available about
these concerns for adults, little was known about these issues in pediatric
care.
Recognizing the unique needs
of hospitalized children, CDC issued a call for proposals for a cooperative
agreement. NACHRI's IC "Focus Group," a benchmarking activity of the Association,
formed the initial group working with NACHRI staff to develop the successful
proposal.
The network was established
in October of 1997. Sixty-two children's hospitals and related institutions
are participating in this, the first national effort to address prevention and
control of NI and AMR. NACHRI member hospitals were invited to join the network
through their chief executive officers (CEOs). The CEOs' commitment and support
of the IC practitioners were critical to the future success of the project.
Other hospitals were also able to join the network. Participation was solicited
at national meetings and through notification in IC journals.
In responding to the call for
proposals, consideration was given to the following:
- Who is doing what?
- Are there clear goals/purposes
for the collaborative effort?
- Who will play what role?
- What resources are needed?
- What will be done with the
knowledge gained?
The goals of the project, a
3-year, CDC-funded cooperative agreement, were to:
- Develop pediatric-specific
infection surveillance and control programs.
- Identify cost-effective
IC and prevention interventions.
- Design systems to improve
antimicrobial use.
- Develop national benchmarks.
Governance for the project
involves specific roles for all participating in the collaborative. NACHRI provides
project leadership, facilitation, coordination, and infrastructure support.
CDC also provides project leadership and IC expertise. A five-member steering
committee is responsible for oversight and advises NACHRI and CDC. The research
activities of the project are the responsibility of a committee that provides
technical assistance and oversight. To address quality and performance measurement
and improvement, a committee was formed to specifically address these concerns.
Hospital participation in each
of the project's activities varies from project to project and is voluntary.
Funding for the project includes the CDC grant and in-kind support from NACHRI
and the participating hospitals. Hospital leadership and IC practitioners also
identified the importance of IC research and the need to provide relevant information
to consumers and purchasers and for purposes of quality improvement. Hospitals
are motivated to participate in the collaborative because they recognize that
reducing NI and AMR will save time and money, conserve resources and, most importantly,
improve child health outcomes.
To date, the collaborative
has conducted a survey of IC structures and processes and presented theses findings
at a number of national meetings. Five publications, based on the initial survey,
are in process. To maintain interest, all participants receive quarterly reports.
An antibiotic utilization survey and NI prevalence study have begun.
Future studies and activities
include:
- A study of NI in pediatric
intensive care units.
- A profile of vancomycin
use.
- An AMR study.
- A project to improve blood
steam infection surveillance.
- The development and adoption
of computerized IC training programs.
Collaborative efforts have
many challenges such as:
- Multiple and competing goals.
- Governance and management
with multiple stakeholders.
- Control.
- Infrastructure.
- Funding.
- Trust.
- Maintaining interest and
participation.
The benefits of this collaborative
effort include:
- The expertise and diversity
of children's hospitals.
- NACHRI's organizational
abilities and existing infrastructure.
- Potential impact thorough
multiple sites and wide dissemination of information and adoption of best
practices.
- Access to data.
- Use of common methods and
procedures.
Lessons learned:
- Have a clear purpose and
goals.
- Identify all possible stakeholders
early and involve them to greatest extent possible and communicate!
- Early and clearly identify
structure, governance, and roles; nurture and change as needed.
- Provide infrastructure to
support participants to reduce demands on resources and be sensitive to demands
made on participants in relation to time, money data, etc.
- Identify all resources needed:
knowledge, people, money, etc.
- Disseminate knowledge/information
to right people in a way they can easily and effectively use.
Implications:
- These types of efforts represent
an important resource and are an appropriate role for associations.
- To facilitate research and
dissemination and adoption of knowledge gained, a clear infrastructure is
critical.
- Allow ample time for developing
the network and the collaborative before initiating major projects or research.
- These types of research
networks and collaboratives can work and can make major contributions
to our understanding of the best way to organize and deliver quality health
care services to children and their families.
Internet Citation:
Girouard S. NACHRI/Centers
for Disease Control & Prevention (CDC) Cooperative Agreement. Presentation
Summary, Improving Children's Health Through Health Services Research, Chicago,
June 26, 1999. http://www.ahrq.gov/research/cdcnetwk.htm
540 Gaither Road Rockville, MD 20850