Pursuing Perfection in Pediatric Therapeutics

描述（由申请人提供）：我们提议建立一个CERTs研究中心（RC），其主题是通过优化治疗方法的使用来改善儿童的预后。预期影响超出儿科的其他子主题是药物基因组学和个性化医疗、患者安全和质量改进方法。RC将连接辛辛那提儿童医院医疗中心（在创新和改进方面公认的领导者），一个在评估科学、改进科学和教育方面熟练的研究核心（由CCHMC的医疗质量中心领导）；以及能够将研究和教育项目传播给全国绝大多数儿科医生和三级医疗机构的合作伙伴（美国儿科委员会（ABP；一个认证机构）、全国儿童医院和相关机构协会（NACHRI）、美国儿童医院公司（CHCA）、俄亥俄州医疗补助计划、辛辛那提大学药学院、联合健康集团和一些家长组织）。在这个框架内，我们的具体目标是：1)创建一个研究核心，将在评估、卫生服务研究、质量改进方法、大型数据库分析、生活质量、慢性疾病和药物依从性方面具有广泛专业知识的个人聚集在一起；2)开发和实施一系列教育方法，从而在儿科人群中广泛改善治疗方法的使用。这些具体目标将部分通过在创新和推广的不同阶段的四个试点项目来实现，这些项目将：1)测试药物遗传测试对使用利培酮治疗儿童的影响；2)采用高可靠性方法减少药物不良事件的危害；3)通过与儿科炎症性肠病网络（PIBDNet）合作，通过亚专科护理合作网络改善慢性疾病儿童的预后，改善药物管理；4)通过与美国儿科学会（AAP）合作，试点和传播促进最佳治疗方法使用的资源。虽然这些项目都关注儿童护理，但所产生的方法和知识将远远超出儿科人群，并将通过创造关于如何将药物遗传信息有效地整合到临床实践中的新知识，将高可靠性方法纳入护理系统，以及如何使用质量改进方法和协作学习来测试和加速创新向实践的传播，从而推动治疗学领域的发展。

DESCRIPTION (Provided by the Applicant): We propose a CERTs Research Center (RC) with the theme of improving outcomes for children by optimizing the use of therapeutics. Additional sub-themes, with expected impact beyond pediatrics, are pharmacogenomics and personalized medicine, patient safety, and quality improvement methodology. The RC will link Cincinnati Children's Hospital Medical Center (an acknowledged leader in innovation and improvement), a research core skilled in evaluation science, improvement science, and education (led by the Center for Health Care Quality at CCHMC); and partners capable of disseminating research and education programs to the vast majority of the nation's pediatric practitioners and tertiary care settings (the American Board of Pediatrics (ABP; a certifying body), the National Association of Children's Hospitals and Related Institutions (NACHRI), Children's Hospital Corporation of America (CHCA), Ohio Medicaid, the University of Cincinnati School of Pharmacy, UnitedHealth Group, and several parent organizations). Within this framework, our specific aims are to: 1) Create a research core that brings together individuals with broad expertise in evaluation, health services research, quality improvement methods, analysis of large databases, quality of life, chronic illness, and medication adherence and, 2) Develop and implement a range of educational approaches that will result in broad improvements in the use of therapeutics in the pediatric population. These specific aims will be accomplished, in part, through four pilot projects at different stages of innovation and dissemination that will: 1) test the impact of pharmacogenetic testing on the treatment of children on risperidone; 2) decrease harm from adverse drug events using high reliability methods; 3) improve outcomes for children with chronic illness through collaborative networks in subspecialty care by working initially with the Pediatric Inflammatory Bowel Disease Network (PIBDNet) to improve medication management, and 4) pilot and disseminate resources that facilitate the use of optimal therapeutics by working with the American Academy of Pediatrics (AAP). Although these projects all focus on care for children, the methods and knowledge generated will go far beyond the pediatric population and will advance the field of therapeutics by creating new knowledge about how to integrate pharmacogenetic information effectively into clinical practice, high reliability methods into care systems, and how to use quality improvement methods and collaborative learning to test and accelerate the diffusion of innovations into practice.