Nemours Biomedical Research
Nemours’ Center for Healthcare Delivery Science (CHDS) studies the many influences that can affect the outcomes, quality, cost, safety and value of children’s health care. Our goal is to build a strong base of scientific evidence about how health care can best be delivered so that children get exactly the care they need, right when they need it — and families feel that they have had an active role in that care.
We can achieve real gains in children’s health by learning how existing or new treatments can be selected and delivered efficiently to improve access, children’s outcomes and family satisfaction.
Researchers with the Center for Healthcare Delivery Science have been awarded research grants for a range of studies:
The Psychosocial Assessment Tool (PAT) is a parent report screener of psychosocial risk for families in pediatric health care. This project studies English and Spanish versions of the PAT in pediatric cancer to describe changes over time in risk, particularly for Spanish-speaking families, in an effort to identify factors related to health disparities in this population. The study is being conducted at Nemours/Alfred I. duPont Hospital for Children, The Children’s Hospital of Philadelphia (CHOP) and MD Anderson Cancer Center.
This is a senior scientist mentor award that provides for mentorship of multidisciplinary cancer researchers working on projects related to psychological intervention research.
Studies show that teens with diabetes benefit less than adults from new technologies such as insulin pumps and continuous glucose monitors. In this study, we will be developing and testing Web-delivered resources that are designed to help parents and teens with diabetes make better decisions about whether to add these devices to their care.
This project will plan and test automated feedback supports as part of the electronic medical record system to help doctors make the best decisions about children’s care.
Data collection has just been completed for this study that evaluates the effects of a training program for community primary care pediatricians on their practices in screening adolescents for depression and suicide risks.
Nemours is one of eight major pediatric care organizations comprising PedsNet that together were selected by the Patient-Centered Outcomes Research Institute (PCORI) as one of its 11 Clinical Data Research Networks. Nemours’ partners in PedsNet include Children’s Hospital of Philadelphia (the lead institution), Cincinnati Children’s Hospital and Medical Center, Boston Children’s Hospital, St. Louis Children’s Hospital, Nationwide Children’s Hospital, Children’s Hospital of Colorado and Seattle Children’s Hospital. PedsNet has combined de-identified electronic medical record data comprising 4.7 million clinical encounters and 2.3 million children from all eight organizations to create an exceptionally valuable resource for comparative effectiveness research on children’s health conditions.
During the 18-month Phase I of this grant support, which is complete, PEDSNet achieved a variety of technical and administrative milestones. In October 2015, PEDSNet was awarded Phase II funding that will enable completion of several research studies to demonstrate the network’s capabilities, to illustrate how other researchers can make use of this unique resource and to implement a sustainability plan over the next 3 years.
PedsNet Principal Investigator: Christopher B. Forrest, MD, PhD, Children’s Hospital of Philadelphia
Taking care of children with type 1 diabetes who are under 6 years old is a huge challenge, and parental coping is a strong predictor of child health outcomes. In this three-year study, funded by the National Institutes of Health (NIH), principal investigators Tim Wysocki, PhD, ABPP, and Jessica Pierce, PhD, will coordinate the design and evaluation of a "social media portal" that will provide medically accurate, "parent to parent" guidance and support in coping with the daily hurdles that parents must somehow handle. The project will use "crowdsourcing" to obtain input from a 200-member Parent Crowd and a 30-member Health Care Provider Crowd over time to gradually design and build this internet resource for parents. Once the social media portal has been built and is working, the team will complete a randomized controlled trial to evaluate effects of using this resource on child health and behavioral outcomes and on parents' coping, distress and quality of life. Parents' patterns of using the social media portal and their thoughts about how it could be improved will also be measured periodically during the trial.
Previous research suggests that siblings of children with cancer experience various negative emotions including guilt, loss, fear, grief, anger and helplessness These symptoms are not unexpected — childhood cancer in the family is an extreme stressor — and, with time, most siblings find ways to cope with their negative reactions and return to their previous levels of functioning. For some, however, these symptoms persist and can develop into troublesome emotional and behavioral problems. In this two-year study funded by the Andrew McDonough B+ Foundation, principal investigator Melissa A. Alderfer, PhD, will partner with SuperSibs, a program of the Alex's Lemonade Stand Foundation, to recruit 200 families of children with cancer from across the nation into a longitudinal study of sibling adjustment. Data will be collected at three points, approximately six months apart. Findings from this study will lead to a better understanding of the adjustment of siblings of children with cancer, and will distinguish early in the adjustment process those siblings who will prove to be resilient without intervention from those who require more support and assistance. Offering a rare contribution for this underserved and often unacknowledged population, this information is vital to embracing and promoting Nemours' commitment to family-centered care — ensuring that siblings of children with cancer are getting the right level of care to meet their unique needs.
Spinal muscular atrophy (SMA) poses significant challenges to families. Research documents that the burden of this disease is high and escalates throughout the child’s life as functional abilities decline and complications increase. The psychosocial needs of these families, however, are not systematically assessed, leading to gaps in the delivery of psychosocial care. Melissa Alderfer, PhD, and her co-investigators Matthew Butchbach, MD, head of the Motor Neuron Diseases Research Group, and Mena Scavina, MD, attending pediatric neurologist, received a one-year Clinical Care Pilot award from CureSMA to develop a brief, standardized measure of family psychosocial risks and resources, based upon the Psychosocial Assessment Tool (PAT) and tailored to the challenges and demands associated with SMA. This tool will eventually provide a way to screen families in an effective and inclusive manner, systematically identifying those in need so that appropriate psychosocial care can be provided.
Melissa A. Alderfer, PhD
The delivery of psychosocial care to youth undergoing hematopoietic stem cell transplantation (HSCT) and their families lags behind existing scientific knowledge about the challenges experienced by patients and their families. This project will validate an adaptation of a brief parent report screener of family psychosocial risk — the Psychosocial Assessment Tool (PAT) for the particularly high-risk group of patients undergoing intensive treatments associated with HSCT, and integrate families in the development of clinical pathways of care for this high-risk population. This three-year project is funded by Alex’s Lemonade Stand and will be conducted at three sites: Nemours/Alfred I. duPont Hospital for Children, Cincinnati Children’s Hospital Medical Center and the University of Alabama-Birmingham's Division of Pediatric Hematology/Oncology at Children’s of Alabama Hospital.
Anne E. Kazak, PhD, ABPP
The Nemours Center for Healthcare Delivery Science (CHDS) is a research center across the Nemours Children’s Health System co-directed by Anne E. Kazak, PhD, ABPP, in Wilmington, Del., and Tim Wysocki, PhD, ABPP, in Jacksonville, Fla. Founded in 2012, the center consists of an interdisciplinary team of research scientists, physicians and pediatric psychologists who apply scientific methods and principles to the analysis of variables and processes that affect the delivery, safety, outcomes, cost, quality and value of pediatric health care.
Key areas of research include clinical decision making, family adaptation to pediatric chronic medical conditions, health informatics, transition from pediatric to adult care, cancer care delivery research and family adjustment, including psychosocial risk screening in pediatric illness. Funding is provided by grants and contracts from the National Institutes of Health, Patient-Centered Outcomes Research Institute, American Cancer Society, the Department of Defense, Substance Abuse and Mental Health Services Administration, and private foundations.
A number of research studies are joint efforts with the Center for Pediatric Traumatic Stress (CPTS), a Center within the National Child Traumatic Stress Network that focuses on the development of empirically based screening and intervention for children and families who have experienced traumatic stress due to pediatric illness and injury. Center investigators provide mentoring and consultation to colleagues who may wish to conduct research in health care delivery science.
The Center for Healthcare Delivery Science helps Nemours to be among the top 5 percent of all U.S. pediatric health care organizations by:
A number of studies are joint efforts with the Center for Pediatric Traumatic Stress (CPTS), founded in 2002 to address medical trauma in the lives of children and families. The center is colocated at Nemours/Alfred I. duPont Hospital for Children and Children’s Hospital of Philadelphia.
The Center for Pediatric Traumatic Stress (CPTS) addresses health-related trauma in the lives of children and families. The center's mission is to reduce medical traumatic stress by promoting trauma-informed health care, integrating practical evidence-based tools into pediatric medical care, and ensuring that health care providers are knowledgeable and skilled in trauma-informed care for culturally diverse youth and their families. CPTS has developed and evaluated acute and brief family-focused interventions, which can be integrated within pediatric health care.
The center’s current goals are to:
Activities to achieve these goals include:
The Center for Pediatric Traumatic Stress is codirected by Nancy Kassam-Adams, PhD, at Children’s Hospital of Philadelphia and Anne Kazak, PhD, ABPP, at Nemours/Alfred I. duPont Hospital for Children.
Anne E. Kazak, PhD, ABPP, is co-director of the Center for Healthcare Delivery Science at Nemours Children’s Health System, based at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del. She is also the co-director of the Center for Pediatric Traumatic Stress, a Treatment and Services Adaptation Center in the National Child Traumatic Stress Network, the editor-in-chief of Health Psychology and the editor-in-chief of American Psychologist. Dr. Kazak is a licensed psychologist (in Delaware and Pennsylvania), Professor of Pediatrics at the Sidney Kimmel Medical School of Thomas Jefferson University, and Adjunct Professor of Psychology at the University of Delaware. Dr. Kazak’s experience as a clinician, researcher and administrator have helped to advance integrated (medical and behavioral) care for children and families from a systems perspective. She is a frequent consultant and reviewer on national and international projects related to pediatric psychology. Dr. Kazak is the recipient of many research grants and several awards, including the Cummings American Psychological Cummings PSYCHE Prize (2009) for integrated care. Dr. Kazak received her PhD in Clinical-Community Psychology from the University of Virginia and completed her internship training at Yale University School of Medicine, Department of Psychiatry. Her undergraduate degree was awarded by Smith College.
Board-certified by the American Board of Professional Psychology, Tim Wysocki, PhD, ABPP, has been with Nemours since 1992 as a pediatric psychologist and researcher. His roles include chief of the Division of Psychology and Psychiatry (1997-2004), director of the Center for Pediatric Psychology Research (1992-2013) and chair of two Nemours Institutional Review Boards (2000-present). He is president-elect of the Society of Pediatric Psychology.
Dr. Wysocki also has received numerous external research grants for his studies, most of which focus on family coping with Type 1 diabetes in children and adolescents. He has received national awards for this research and served on many editorial boards and research grant review panels on both the national and federal foundation levels. Dr. Wysocki did his undergraduate training at the University of Texas, his PhD at Western Michigan University and his postdoctoral fellowship at Johns Hopkins School of Medicine.
Chief, Division of Neurology
Nemours Children’s Hospital, Orlando
Associate Chief, Division of Gastroenterology
Nemours Children’s Hospital, Orlando
Operational Vice President, Research
Nemours Children's Health System
Chief, Division of Cardiology
Nemours/Alfred I. duPont Hospital for Children, Wilmington
Vice President, Quality and Safety
Chief Medical Information Officer
Chair, Department of Pediatrics
Nemours Children's Specialty Care, Jacksonville
Chief, General Pediatrics
Nemours/Alfred I. duPont Hospital for Children, Wilmington
Chief, Division of General Pediatrics
Nemours Children’s Hospital, Orlando
If you are a researcher, the Center for Healthcare Delivery Science (CHDS) can offer you a wide range of assistance: