Community, Health Outcomes & Intervention Research
(CHOIR Program)

Director:  Michele Kipke, PhD

Emerging Research Initiative

Diagnoses of autism have increased dramatically with one in 150 children being impacted.  Currently, it is more common than pediatric cancer, diabetes, and AIDS combined.  

Michele Kipke, PhD, is determined to change this.  Armed with the Las Madrinas Endowment for Autism Research, Interventions and Outcomes, which was awarded in 2007, she will work to develop a diagnostic and intervention research laboratory.  

Early diagnosis and intervention are crucial because they allow children to gain maximal benefit from existing therapiest for autism. 

Dr. Kipke's next steps: 

• Recruit nationally recognized scientists with expertise in early diagnosis and treatment
• Develop tools for screening for autism and related disorders in community settings, such as pediatricians' offices, clinics, and schools. 
• Track short and long-term outcomes

Program Description

The Community, Health Outcomes and Intervention Research (CHOIR) program of The Saban Research Institute was established in September 2001 to promote the health and wellbeing of children, adolescents, and families through prevention of illness and injury, health promotion, health services, and health outcomes research. In addition to initiating new research, CHOIR contributes to the research infrastructure at Childrens Hospital Los Angeles by supporting the research needs and efforts of trainees (residents, fellows and post-docs) and faculty.
 
The CHOIR Program conducts, facilitates, and coordinates research designed to:

1. prevent childhood and lifelong health problems
2. promote healthy development
3. reduce disparities in children’s health that may be associated with socioeconomic status
4. health coverage and insurance, access to care, and race/ethnicity and immigration status
5. restore function and prevent disability among children with special needs
6. ensure the delivery of quality care through health outcomes research

This is accomplished by conducting research that is interdisciplinary, collaborative, applied, and closely linked to policy and practice.   Research initiated to date falls within one of the following thematic areas:

• Maternal Health and Early Childhood Development
• Prevention, Health Promotion & Community Health
• Intervention & Evaluation Research
• Quality of Care
• Health Policy & Community Translation
• Autism and Other Neurodevelopmental Disorders
• Translational Research to Promote the Delivery of High Quality Pediatric Care

• Center for Community Translation.

Projects

Research on the Health and Well-Being of Newborns, Children, and Families in Los Angeles County
Principal Investigators:  Drs. Michele Kipke and Istvan Seri
Community-based First 5 LA has provided funding to develop a new clinical information system that will integrate clinical, perinatal, and neonatal service delivery data across five hospitals. Information gathered will include maternal and birth outcomes, predictors of birth outcomes and outcomes associated with the delivery of different standards of care.

Improving the Quality of Pediatric Care by Reducing Medical Errors and Adverse Drug Events
Principal Investigators:  Drs. Glenn Takata, Wilbert Mason and Michele Kipke
A new surveillance system in five California children’s hospitals is being developed to identify rates, causes and consequences of pediatric medical errors, as well as interventions that can reduce and/or eliminate such errors.

Child Health and Human Development
Principal Investigator:  Dr. Alex Chen
Dr. Chen is examining the social and cultural factors associated with disparities in access to care among children with chronic illness and special health care needs.

Healthy Young Men's Study
Principal Investigators:  Drs. Michele Kipke, Ellen Iverson, Justeen Hyde and Robert Appleby
This study will examine the use of drugs and involvement in HIV risk and protective behaviors by young men. These behaviors will be examined in the context of individual experiences and the family, which in turn will be scrutinized both in context of the youths’ interpersonal relationships and of the community.

Community Diabetes Prevention Program
Principal Investigators:  Drs. Francine Kaufman and Anne Harmel
This collaborative effort involves a two-year needs assessment and planning for an obesity and diabetes prevention intervention in two local communities, East Los Angeles and South Central Los Angeles. The focus is on preventing obesity and diabetes type 2.

Preventing Youth Violence
Principal Investigators:  Dr. Michele Kipke
This evidence-based " commissioned by the National Institutes of Health (NIH) " focuses onthe prevention of violence and other health-risking behaviors among adolescents. The report was presented at the NIH’s State-of-the-Science Conference in October 2004.

Research to Define and Track Child Health in Los Angeles County
Principal Investigator:   Dr. Michele Kipke
This project aims to facilitate a process of community consensus-building to identify and track a core set of child health indicators for Los Angeles County.

Accomplishments

Tracking Medical Error
In the fall of 2002, Childrens Hospital Los Angeles received funding from the California HealthCare Foundation to develop and implement a system in five Children’s Hospitals to track medical errors and adverse events, and to use the resulting data to develop tools and strategies for reducing or eliminating these incidents. During this past year, Drs. Glenn Takata, Wilbert Mason, and Jordana Signer developed, pilot tested, and implemented a data collection system to capture data for six patient safety indicators -- patient identification band audits, sentinel events, nosocomial infections, medication errors identified through pharmacy interventions, voluntarily reported adverse drug events, and adverse drug events identified through Trigger Tool chart review -- at the five participating hospitals.  The findings from this research are now being presented and published, and the tracking system has already resulted in performance improvement activities at several of the sites, leading to improved rates of armband compliance.

Indicators of Quality of Life
The federal Agency for Healthcare Research and Quality (AHRQ) is making ongoing efforts to develop publicly available indicators of the quality of health care, with the goals of helping health organizations identify and target potential problems, and assisting patients in their health care decisions. Dr. Korst and her colleagues, including Dr. Philippe Friedlich, are actively contributing to this literature, in the development of methodologies to identify and validate hospital-specific indicators of the quality of maternal and neonatal care. Their methods have been used by healthgrades.com and have been presented in a national webcast sponsored by the Center for Disease Control.  Together with the California Perinatal Quality Care Collaborative, they are slated this year to develop a network of California hospitals that share their experience with these indicators and work toward the improvement of obstetrical and neonatal care.

Social and Cultural Factors Associated with Disparities in Access to Healthcare
Dr. Alex Chen was awarded a 5-year K23 Career Development Award from the National Institute on Child Health and Human Development (NICHD) of the National Institutes of Health to conduct research to examine the social and cultural factors associated with disparities in access to care among children with chronic illness and special health care needs. Secondary analysis will first be conducted with data from the 2001 National Survey of Children with Special Health Care Needs, followed by qualitative research to further contextualize the findings from the secondary analyses. Dr. Chen was the recipient of the Saban Research Institute’s Faculty Development Award; the findings from this research were presented in June at the Academy Health annual research meeting. Dr. Chen was also recently accepted this year into the Western Society for Pediatric Research.

Child Abuse and Neglect among Adolescents in Foster Care
Dr. Justeen Hyde was awarded a 5-year K01 Career Development Award from the NICHD of the National Institutes of Health to conduct ethnographic research to examine the consequences of child abuse and neglect among adolescents in the foster care system in Los Angeles. The specific aims are to: 1) document the histories of maltreatment among adolescents entering foster care for the first time, particularly the age at which maltreatment was first experienced and the types and frequencies of abuse; 2) characterize maltreated adolescents’ experiences entering and adapting to foster care; 3) identify mediating factors among maltreated adolescents that influence variations in behavioral, emotional and psychological adaptations to foster care placement; and 4) explore, from multiple perspectives, the most pressing needs of adolescents entering foster care for the first time and appropriate strategies for addressing these needs. 

Members