Commitment to Research

To advance pediatric medicine and better serve children and adolescents and their families, the PPOC plans and conducts its own stringently controlled research projects. We place our primary focus on areas that we determine are most in need of solutions and better clinical approaches.

Below are examples of recent PPOC research projects:

Quality improvement program to reduce unnecessary referrals for adolescent scoliosis

This PPOC quality improvement program addressed adolescent idiopathic scoliosis (AIS), a relatively common reason for referral to orthopedic surgery — although most referred patients ultimately do not require surgery or bracing. Through physician education, decision support at the point of care, and data feedback, the program led to a sustained reduction in unnecessary specialty referrals for AIS, and can serve as a model for other programs that seek to shift the locus of care from specialists to primary care providers. The findings were published in February 2013 by Pediatrics, the official journal of the American Academy of Pediatrics.

Asthma exacerbations among children 5-17 years of age: definition and risk factors

This innovative research project was designed primarily to test the association of a variety of processes of asthma care with improved health outcomes. The results of this study allows the PPOC to develop asthma quality improvement programs that guide physicians toward providing optimal care for their patients with asthma. The study was presented at the 2011 Pediatric Academic Societies’ meeting and later published by Pediatrics, the official journal of the American Academy of Pediatrics.

Ambulatory sub-specialty visits in a large pediatric primary-care network

Ambulatory specialty care represents a large proportion of the overall cost of pediatric care and more rational use of specialists may lead to cost savings and improved quality. This research project analyzed the patterns of sub-specialty utilization within the PPOC network with the goal of identifying potential areas for improvement in the interface of primary and specialty care. Results of this study were presented at the 2009 Pediatric Academic Societies’ meeting and the primary manuscript is currently in submission.

Healthcare costs for a pediatric population across the spectrum of care

This analytic study was designed to gain an understanding of the pattern and distribution of total medical costs across the PPOC population. In the context of rising health care costs, such analyses are critical to designing rational approaches to cost containment. The results of this study were presented at the 2011 Pediatric Academic Societies’ meeting and will serve as an important foundation for the PPOC’s ongoing efforts to design high quality and efficient care for our patients.

Xylitol syrup for the prevention of acute otitis media in otitis-prone children

Acute otitis media (also called middle ear infection) is one of the most common diseases in childhood and is the number one reason for antibiotic prescriptions for U.S. children. This study, funded by the National Institute on Deafness and Other Communication Disorders of the NIH, is a practice-based randomized trial of xylitol syrup for the prevention of acute otitis media in children 6 months to 5 years of age who have a history of recurrent ear infections. Xylitol is a naturally occurring sugar with proven antibacterial properties and has been shown to prevent ear infections in preliminary studies in Europe. This first major study of xylitol in the U.S. is being fielded in a number of PPOC practices as well as non-PPOC pediatric practices throughout country.

Hepcidin-based screening for infantile iron deficiency

Iron deficiency affects a large proportion of U.S. infants and is associated with delayed cognitive development. Current guidelines recommend that all infants be routinely screened for iron deficiency, but existing tests are less than ideal. Hepcidin, a liver protein that appears to be a very sensitive marker of iron levels in the body, may provide a better screening test than those currently available. The PPOC is collaborating with investigators from the Boston Children’s Hospital departments of pathology and hematology in this study, funded by the National Heart Lung, and Blood Institute of the NIH in the hopes of developing a better screening test for this important pediatric condition.