Indiana Children's Health Services Research
Indiana University School of Medicine
Riley Hospital for Children
CHSR Research
Parental Risk Attitudes Medical decision making often involves
choosing from among alternatives with different risks and benefits, for
example, choosing between medical or surgical therapy. Patterns of
decision making under uncertainty have been described in the psychology
and economic literature for decades, but little is known about parents;
attitudes about risk taking when they make medical decisions for their
children. We are studying how tolerance or aversion to risk affects the
decisions parents make on behalf of their children.
Wheezing in Infancy and Subsequent Asthma Children who have
bronchiolitis or other wheezing conditions in infancy are at greater risk
to develop asthma. However, the magnitude of this risk and which children
are at greatest risk is not well known. Using the Regenstrief Medical
Record system, we are examining over 10 years of combined clinical
experience to study these questions.
PESERO: Physical Environments, Social Environments, and Risk of Obesity - This project examines neighborhood-level environmental factors as they relate to diet and physical activity behaviors, as well as prevalence of overweight. We hope to build models of community assets and vulnerabilities related to obesity risk using geographic information systems and spatial analysis. Our long term goal is to use and share these models to design and implement environmental interventions that prevent obesity.
Decision Analysis and Cost Effectiveness Analysis Our group conducts cost-effectiveness and decision analysis on a broad range of clinical topics. Recent and ongoing areas of interest are:
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Diagnosis and treatment of urinary tract infections in young children
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Prophylactic erythromycin in newborns exposed to chlamydia
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Rotavirus vaccination
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Newborn screening with tandem mass spectrometry
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Screening for celiac disease among children with Down Syndrome
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Dental sealants and fluoride varnish to prevent cavities .
Chronic Disease Management In collaboration with the Regenstrief Institute, the Indiana Office of Medicaid Policy and Planning, and the Indiana State Department of Health, we are conducting an evaluation of a statewide program of care management (the Indiana Chronic Disease Management Program) for Medicaid enrollees with chronic heart failure, diabetes, or asthma. We also help develop scripted, motivational telephonic dialogues and other educational materials for these populations.
Child
Health Improvement through Computer Automation (CHICA) CHICA is a
computer based decision support system to improve the quality of pediatric
primary care. The system uses standard care guidelines, encoded in logic
rules (Medial Logic Modules, MLM) to analyze data stored in an electronic
medical record. The system generates questions for patients and advice
for physicians. This information is provided on tailored forms (Adaptive
Turnaround Documents, ADT) on which patients can record answers and
physicians can document care. The ADTs are optically scanned so the data
collected from patients and physicians are automatically entered into the
electronic medical record. The system supports well child care, but
ongoing work will apply the methodology to disease management as well.
Data
Mining and Knowledge Discovery Researchers in ICHSR are exploring
methods of mining childhood clinical data in the Regenstrief Medical
Record System to provide clinically useful insight for clinical decision
support. Methods under investigation include Bayesian belief networks and
statistical association rules.
Partnerships for Change, Dyson Community Pediatrics Training Initiative
as part of the Ann E. Dyson Initiative, investigators in CHSR are
developing and evaluating methods for training pediatric residents in
concepts of community pediatrics and medical home. Residents learn to
view their patients from a public health perspective, appreciating the
impact that family, culture and community have on their patients health
and the effectiveness of their care. They also learn continuous quality
improvement, cultural competency, and techniques and systems-based models
of care.