ISU ICHR and St. Luke’s Applied Research Division Postdoctoral Fellow Program
The ISU ICHR and St. Luke’s Applied Research (AR) Division postdoctoral fellow program is a two-year postdoctoral position is designed to facilitate medical research between both institutions. Historically, the position has focused on research regarding pediatric complex care, such as care coordination for children with special health care needs. The AR Division at SLHS and ISU ICHR are working to establish positions for Lifestyle and Community Health and Pediatric Audiology.
St. Luke's provides state-of-the-art pediatric care designed to better serve the needs of children with medical complexity.
ISU's Idaho Center for Health Research helps St. Luke's evaluate and optimize those services.
Hillary E. Swann-Thomsen, PhD, is the current Post-Doctoral Fellow.
Validation of the St. Luke’s Children’s Acuity Tool
A Retrospective Chart Review to Validate the St. Luke’s Children’s Acuity Tool
The purpose of this project was to validate the St. Luke’s Children’s Acuity Tool (SLCAT) as a stratification and identification instrument in a pediatric population for both healthy children and children with special health care needs (CSHCN). Current acuity tiering methods have three distinct limitations when categorizing CSHCN by acuity: 1) lack validation for use in pediatric populations, 2) fail to properly incorporate behavioral health diagnosis, and 3) eschew variables that drive utilization but are difficult to collect (e.g. family challenges). The SLCAT is a novel approach to acuity tiering because it includes behavioral health data in the tiering process. In addition, the SLCAT uniquely conceptualizes acuity for CSHCN by including important but often ignored variables like facilitating the integration of a child into the school system or family challenges. With 1% of pediatric patients accounting for over 30% of health care costs for the pediatric population, the cost data from this study will significantly improve understanding of the costs of care and resource utilization by acuity level. Taken together, the findings from this study will lay the foundation to build a comprehensive model of care coordination which includes the SLCAT.
To further develop the predictive power of the SLCAT, this study examined how well the SLCAT scoring predicted health outcomes in a patient panel. To benchmark the SLCAT performance against current acuity tiering methods, the goodness of fit and predictive strength of the tool was compared and contrasted with the Pediatric Complex Medical Conditions Classification system (CCC v2) and the Care Coordination Measurement tool (CCMT). As a secondary focus, this project aimed to identify patient information within the electronic health record that may be useful in characterizing medically complex pediatric patients or predicting future health outcomes.
Validation of the St. Luke’s Children’s Acuity Tool II
A Retrospective Chart Review to Validate the St. Luke’s Children’s Acuity Tool II
The purpose of this study is to explicate the St. Luke’s Children’s Care Coordination Model (SLCCCM) by describing the duration, frequency, and type of care coordination encounters and identify the relationship between patient characteristics (e.g. disease status, diagnoses, age, etc.), care coordination activities (e.g. appoint coordination, multiple sedation coordination, etc.), and utilization (e.g. number of hospital admissions, Emergency Department (ED) visits, subspecialty visits, etc.).
The importance of providing care coordination to children and youth with special health care needs (CYSHCN) is widely recognized, however there is a dearth of cohesive models available for implementation that have undergone rigorous investigation and development. Therefore, this study will provide an opportunity improve understanding of care coordination activities and how those activities are related to individual patient characteristics, and utilization of healthcare services. The results from this study will also provide a basis to further refine elements of the SLCCCM to improve the impact and efficiency of care coordination services. This is an expansion of the previous study listed above, including more patients over a longer period of time.
Acuity Tool: Study of Inter-rater Reliability
St. Luke’s Acuity Tool: Study of Inter-rater Reliability
The “St. Luke’s Acuity Tool: Inter-rater Reliability Study” will serve as foundational understanding of the SLCAT’s reliability and usability as an acuity tool. Pediatric physicians from within the St. Luke’s Health System will use the SLCAT to stratify by acuity using simulated case studies created by physicians specializing in CSHCN patients. The consensus and accuracy of provider ratings will be assessed to determine the clarity of SLCAT scoring schemes and identify ways to strengthen usability of the SLCAT in clinical settings. The literature clearly states that there is a paucity of empirically established acuity tools to use in care coordination for CSHCN. Data from this study will provide valuable insight to St. Luke’s Health System’s pediatric care and findings may also add to the broader endeavor to produce valid care coordination tools. In addition, communication between multiple providers and subsystems within a health network are a mainstay of quality care for CSHCN, therefore, findings from this study may improve such communication through the use of the SLCAT.
Health Care Utilization and Cost Outcomes
A Retrospective Chart Review to Evaluate the Health Care Utilization and Cost Outcomes of the St. Luke’s Children’s Multiple Procedure Workgroup
The purpose of this study is to examine the impact of the St. Luke’s Children’s Multiple Procedure Workgroup (SLC-MPW) program on the cost of care and health care utilization of children with special health care needs (CSHCN). CSHCN are a health care resource-intensive population, and have more surgical procedures, diagnostic tests, and are a greater need for medical technology assistance than healthy patients. To help CSHCN, the SLC-MPW consolidates multiple surgical procedures and diagnostic tests into a single anesthetic sedation. The SLC-MPW is now an established program that has coordinated over 332 procedures into 156 sedations at St. Luke’s since 2016. This study will describe and evaluate the SLC-MPW program by 1) creating an implementation narrative that describes the purpose, design, and evolution of the program, 2) perform cost-identification and cost-benefit analyses examining the SLC-MPW financial costs, and potential costs savings, and non-monetary benefits to patients and SLHS, and 3) perform an analysis of health care utilization before and immediately after receiving services from SLC-MPW.