Children’s Hospitals and Clinics of Minnesota and HealthPartners Awarded National Institutes of Health Grant to improve appendicitis care for pediatric patients

NIH R01 Grant Will Focus on Emergency Room Diagnosis Using Web-Based Clinical Decision Support

MINNEAPOLIS/ST. PAUL, Minn. – July 14, 2015 – Anupam Kharbanda, MD, MSc, Children’s Hospitals and Clinics of Minnesota and Elyse Kharbanda, MD, MPH from HealthPartners Institute for Education and Research, recently received a $3.1 million, five-year grant from the National Institutes of Health (NIH) to help emergency department clinicians quickly and correctly diagnose appendicitis in pediatric patients. The project represents the first NIH R01 grant awarded to a Children’s researcher and one of the first implementation studies funded by the NIH for pediatric emergency medicine.

Abdominal pain is one of the most common reasons children visit the emergency department and appendicitis is the most frequent surgical emergency in pediatrics. Computed tomography (CT) is one of the most common ways clinicians diagnose appendicitis, with a recent survey of 40 U.S. children’s hospitals demonstrating that CT scans were performed in up to 50 percent of children with appendicitis. CT scans are not only costly, but can also put pediatric patients at risk for radiation-induced injuries, especially because their bodies are smaller and organs more sensitive than adults.

Over the five-year course of the grant, Dr. Anupam Kharbanda and Dr. Elyse Kharbanda, co-Principal Investigators, will work with Health Partners Emergency Departments (Minnesota) and Kaiser Permanente Northern California to implement sophisticated, electronic clinical decision support tools for children with possible appendicitis across 14 general emergency departments.

“This grant allows us to build on more than a decade of work by developing and implementing an interactive, evidence-based, clinical decision support program to optimize care for pediatric patients presenting with acute abdominal pain,” said Dr. Anupam Kharbanda. “Especially at general and non-pediatric emergency departments, it’s essential to arm clinical teams with tools to help diagnose appendicitis in children without use of CT whenever possible. Diagnosing appendicitis without a CT scan is safe, makes economic sense for families and health systems, and most importantly, it protects children’s health.”

A pilot version of this intervention, developed by Dr. Anupam Kharbanda, was implemented at Children’s over a 3 year time period with successful outcomes – CT utilization decreased by approximately 25% after implementation, without any significant negative impacts on the care delivered. After the success at Children’s, this new study will implement similar support tools at general, non-pediatric focused facilities within HealthPartners and Kaiser Permanente Northern California, as most emergency care is provided to children in general emergency departments and these clinicians typically aren’t as familiar diagnosing pediatric patients.

The team at HealthPartners, led by Dr. Elyse Kharbanda, has extensive experience in developing and implementing sophisticated clinical decision support tools. “Much more than just computer prompts, these tools provide clinicians with sophisticated, patient-specific recommendations at multiple touch points throughout the care continuum,” said Dr. Elyse Kharbanda. “More importantly, if successful, we built these tools to be scalable and low-cost to implement, so this could positively impact care for millions of children across the country.”

After the study concludes, researchers will examine whether CT use decreased and if so, expand these tools to hospitals and systems across the country electronically to standardize and personalize care for pediatric patients presenting with symptoms of appendicitis. Further, it will allow researchers to understand the clinical return of EHR-based investments both financially and in terms of quality of care.

More information about appendectomies and this grant, including videos, patient stories and more, can be found at childrensmn.org/appendicitis.

This grant was made possible by The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The NICHD sponsors research on development, before and after birth, maternal, child and family health, reproductive biology and population issues and medical rehabilitation.