September 13, 2016

91416biliaryatresia640Physicians at Texas Children’s Hospital and Baylor College of Medicine have found a way to detect biliary atresia and other neonatal liver diseases in newborns using a simple blood test. Infants with biliary atresia, a life-threatening and hard-to-detect disease of the liver and bile ducts, can now be diagnosed and treated earlier, which has the potential to reduce the number of infants needing liver transplantation.

“Biliary atresia is a particularly devastating disease and is the most common reason why children need a liver transplant,” said Dr. Sanjiv Harpavat, a pediatric gastroenterologist at Texas Children’s and assistant professor of pediatrics – gastroenterology, hepatology and nutrition at Baylor. “We know that diagnosing and treating biliary atresia earlier with an operation called the Kasai portoenterostomy could help children delay or even avoid transplant. However, we also know that biliary atresia is very challenging for clinicians to identify early.”

To address the problem of making an early diagnosis, Harpavat and his colleagues, including Dr. Benjamin Shneider, professor of pediatrics and George Peterkin Endowed Chair at Baylor and chief of the gastroenterology, hepatology and nutrition service at Texas Children’s, designed a study to test a simple way to screen infants for biliary atresia in the first 2 to 3 weeks of life. Their research appears in the August issue of the New England Journal of Medicine.

The population-screening study included all infants born in four hospitals around Houston during a 15-month period. The research now has been expanded to 10 hospitals in Houston and South Texas. The screening they developed is based on newborn direct or conjugated bilirubin measurements, a common test available in newborn nurseries. In previous research, Harpavat and colleagues showed that direct or conjugated bilirubin levels are elevated in all newborns with biliary atresia. This finding was somewhat unexpected as many believe the disease starts in the first few weeks of life.

All of the infants in the study were screened, and those identified as having bilirubin concentration exceeding the 95th percentile were rescreened at or before their first well-child visit. A total of 11 infants retested positive at the median age of 14 days.

“This new study presents preliminary data on a novel method for screening for biliary atresia in newborns, and shows that the test is very accurate,” Harpavat said. “If confirmed in larger studies, our screening method might be used to screen every infant born in the United States for biliary atresia, similar to the way newborns are routinely screened for other diseases.”

Biliary atresia accounted for about 60 percent of liver transplants in infants less than one year of age from 2005 to 2014, so developing a screening that can reduce the need for liver transplants in infants is a significant advancement, he said.

Researchers worked closely with primary care pediatricians throughout the city during the study, offering guidance and education when a patient tested positive initially, Harpavat said. Physicians have used the information and incorporated it into their own practice to identify infants with biliary atresia earlier who were not part of the screening protocol. “This was an unanticipated and very welcome benefit of the work. The landscape of biliary atresia in Houston has changed dramatically since these changes were instituted,” Shneider said.

Others who contributed to this work include Texas Children’s neonatologist Dr. Joseph A. Garcia-Prats, who also is a professor of pediatrics at Baylor College of Medicine. Research was supported by the Cade R. Alpard Foundation for Pediatric Liver Disease, the American Association for the Study of Liver Diseases Jan Albrecht Clinical and Translational Research Award and Baylor College of Medicine Junior Faculty Seed Award.

September 7, 2016

9716ChronicleCancerAd250Texas Children’s is the honored sponsor for every Tuesday’s “Houston Legends” series. We will showcase the legendary care Texas Children’s has provided since 1954, and focus on milestone moments in our unique history. Also, a complementary website offers a more detailed look at our past, our story and our breakthroughs.

On the right is the Texas Children’s ad that is featured in this week’s Chronicle. Click the ad to visit our companion website at texaschildrens.org/legendarycare. The website will change weekly to complement the newspaper ad, which will be published in section A of the Chronicle on Tuesdays for the next several weeks. We also will spotlight this special feature weekly on Connect, so stay tuned to learn and share our rich history.

August 30, 2016

83116chronicleadGI250Texas Children’s is the honored sponsor for every Tuesday’s “Houston Legends” series. We will showcase the legendary care Texas Children’s has provided since 1954, and focus on milestone moments in our unique history. Also, a complementary website offers a more detailed look at our past, our story and our breakthroughs.

On the right is the Texas Children’s ad that is featured in this week’s Chronicle. Click the ad to visit our companion website at texaschildrens.org/legendarycare. The website will change weekly to complement the newspaper ad, which will be published in section A of the Chronicle on Tuesdays for the next several weeks. We also will spotlight this special feature weekly on Connect, so stay tuned to learn and share our rich history.

August 9, 2016

For most of Kaitlyn Ennis’ 12-year life she has been in physical pain due to pancreatitis, a disease doctors diagnosed her with when she was just 18 months old.

In the beginning the condition and the pain were acute, coming and going in spurts. The past year or so however, Kaitlyn has endured chronic pain on an almost daily basis, causing her to miss school and spend more time than she would have liked in the hospital.

“It makes me irritable,” Kaitlyn said of the pain she feels when her pancreas becomes inflamed. “I just want it to go away.”

In January 2015, Texas Children’s Hospital launched an interdisciplinary pain medicine clinic to treat patients like Kaitlyn, who suffer from chronic pain, a condition that affects 20 percent to 30 percent of children worldwide. The clinic is part of the Pain Medicine Division of the Department of Pediatric Anesthesiology and is one of the only clinics of its kind in the Greater Houston area.

“By the time patients arrive to the pain clinic, they often have seen multiple physicians and specialists and are often frustrated with feeling neglected by the health care system or are feeling a sense of diagnostic ambiguity, as there is often not a clear cut anatomical explanation for chronic pain,” said Grace Kao, a pediatric pain psychologist with the pain clinic and assistant professor at Baylor College of Medicine.

“Meeting families where they are and offering hope and support comprises a substantial part of our role as a pain clinic team.”

In a patient’s initial intake evaluation, members of the pain clinic team provide a thorough pain history assessment, psychosocial interviews and thorough physical exams by pain physicians and physical therapist. All of this information is used to help develop a comprehensive treatment plan which is shared with the family in a joint feedback session at the end of the appointment.

Knowing pain can affect so many parts of life, the pain clinic team typically provides recommendations in multiple arenas: medication management, medical procedures, lifestyle changes, physical and occupational therapy, school accommodation and pain psychology.

“The interdisciplinary clinic model provides the valuable benefit of combining multiple services within the same appointment and creates the opportunity for clinicians to inform each other’s recommendations on the spot,” Kao said. “Patients often return for follow up with multiple team providers to target different parts of their pain picture.”

When Kaitlyn and her family first came to the pain clinic, they were looking for a way to manage the girl’s chronic pain without admitting her into the hospital.

“We wanted to be able to manage her pain at home,” said Kaitlyn’s mother, Sara Ennis. “Admitting her into the hospital every month or so was not working.”

After examining Kaitlyn, the team at the pain clinic put her on a medication regime and armed her with tools in pain psychology, including guided imagery. Soon thereafter, Kaitlyn and her family were managing her episodes of acute pain in the comfort of their home instead of taking her to the hospital. Kaitlyn’s chronic pain was nearly gone.

“The treatment they provided was life changing,” Sara Ennis said. “I am so impressed with the team; nothing is trivial to them and as a result, they made life easier for a lot of us.”

Dr. Caro Monico, a member of the pain medicine clinic team and an assistant professor of pain management at Baylor College of Medicine, said the foundation of the clinic’s treatment is to reintegrate children into school, physical activity and normal life.

“Simply put,” she said, “we want our patients to feel normal and for many we can accomplish that goal.”

Since opening, the pain clinic has seen thousands of patients from around the United States. A director will be coming on board in September and the staff has grown to nine inpatient pain medicine physicians, four chronic pain physicians, two nurse practitioners, two physical therapists, one pain psychologist and one pain registered nurse.

For more information about the clinic, click here.

June 28, 2016

62916usnews640It’s one of parents’ worst fears – their child has a complex or life-threatening illness. How do they decide where to go for the comprehensive care their child needs?

Over the years, the U.S. News & World Report Best Children’s Hospitals rankings have helped thousands of parents identify top sources of care for children with the most difficult medical problems. And Texas Children’s Hospital has consistently been among them.

On the 2015–16 Best Children’s Hospitals Honor Roll, which recognizes pediatric centers that are highly ranked in multiple specialties, Texas Children’s, working closely with academic partner Baylor College of Medicine, ranked no. 4 in the nation for the fifth consecutive year. It is the only children’s hospital in Texas on the Honor Roll.

“We’re rightfully proud of the great work that Texas Children’s does day in and day out on behalf of sick children and their families, but we know we have room for improvement,” said Texas Children’s Physician-in-Chief Dr. Mark W. Kline. “To the degree that the U.S. News survey can help us develop a blueprint for being the world’s best and highest quality pediatric health care institution, we are pursuing that.”

In a process that has become increasingly rigorous and data driven, the U.S. News rankings enable hospitals to look in the mirror and scrutinize themselves.

“Do we like the reflection? Are we as good as we think we are?” asked Dr. Angelo P. Giardino, senior vice president and chief quality officer at Texas Children’s. “In many cases, we are, and we’re thrilled because we are a really great children’s hospital. But there are opportunities where we look in the mirror and we say, ‘We could really do that better.’”

Rankings evolve

Beginning in 1990, as part of the Best Hospitals list, the pediatric rankings were 100 percent reputational for more than 15 years, based entirely on a survey of pediatricians and pediatric specialists across the country, asking them to identify the best children’s hospitals.

When U.S. News decided to rank pediatric hospitals separately from adult hospitals, the publication faced a challenging absence of data. While adult hospital rankings were drawn from Medicare data, no comparable source of information about children’s hospitals was available. As a result, U.S. News enlisted RTI International, a nonprofit research and consulting firm that was already the contractor for the Best Hospitals rankings, to develop a methodology for obtaining data directly from the hospitals and to analyze the results.

The first rankings incorporating such data were published in 2007 as General Pediatrics. Texas Children’s Hospital was listed among the top 30 children’s centers.

In 2008, rankings in six specialties, including cancer and neonatal care, were added to the children’s hospital rankings. In 2009, a newly created Honor Roll listed the 10 children’s hospitals out of 160 surveyed that were ranked in all the specialties, which had been increased from six to 10.

The 2015-16 Honor Roll required a hospital to rank in the top 10 percent in three or more specialties. Only 12 pediatric hospitals qualified among 184 surveyed nationwide. Texas Children’s has appeared on every Honor Roll.

In 2015, Texas Children’s ranked no. 2 in three specialties: cardiology/heart surgery, neurology/neurosurgery and pulmonology. Texas Children’s ranked among the top five hospitals in six specialties and in the top 30 hospitals in all 10 specialties.

“The original purpose of the Best Hospitals rankings was to inform patients and families and help them make decisions,” said Health Rankings Editor Avery Comarow, who has directed the Best Hospitals projects since their beginnings. “I now recognize that we don’t necessarily have to just reflect performance. We can also drive it by incorporating metrics that reflect that goal. Every year, our contractor, RTI International, meets with medical experts to evolve the methodology in ways that not only reflect what children’s hospitals are doing, but ways in which they could and should be doing better.”

Quality framework

Today, the U.S. News Best Children’s Hospitals rankings use a well-accepted framework for evaluating the quality of health care:

Structure: hospital resources related to patient care, such as the ratio of nurses to patients, specialized clinics and programs, and certification by external organizations.

Process: compliance with best practices in diagnosis, treatment, prevention and patient education. As a part of the process, reputation now counts as 16.7 percent of the overall score, down from the original 100 percent.

Outcomes: factors such as rates of survival, infection, mobility and cure.

The increasing emphasis on quality measures had strong support from the late Dr. Bernadine Healy, a former director of the National Institutes of Health, who was health editor of U.S. News before her death in 2011.

“Her expertise and perspective were invaluable,” Comarow said. “She had such a strong sense of the things that were important to patients and families. She brought that same perspective to some of the choices that we made in trying to decide which measures to highlight, what sort of weight to give them, how many hospitals we should assign rankings to, and where we would run out of meaningful data as opposed to numbers that looked OK but were not terribly reliable statistically.”

As U.S. News shifted the emphasis toward quality measures, Texas Children’s shifted coordination of the survey response from its Marketing/PR Department to its Quality and Safety Department.

Team effort

The evolution into quality led us to bring all the chiefs of medical and surgical services to the table,” said Mary Jo Andre, senior vice president and chief nursing officer and former senior vice president of Quality and Safety. “The more that quality and best practices were built into the survey, the more accountability of the survey shifted from an administrative standpoint to the medical staff.”

To help build physician engagement, Giardino and Thomas Luerssen, chief quality officer – surgery, were appointed quality officers for Pediatrics and Surgery, respectively, in 2013. The next year, Giardino was named to his present position as chief quality officer of Texas Children’s, and Eric Williams, succeeded him as quality officer for Pediatrics. They work closely with teams of physician section chiefs, practice administrators and data specialists.

Although only 10 clinical areas are ranked, a total of about 20 different services contribute to the survey, such as Radiology, Emergency Services, Intensive Care, Social Work and Nutrition. For example, nursing certification, attention to safe practices and increasing specialty roles of nurses appear in each section of the survey. Texas Children’s receives points for safety because of the hospital’s Magnet certification by the American Nurses Credentialing Center.

“Any outcome is a partnership of nursing and physicians,” Andre said. “The question directly related to nursing is about staffing. Seeing how we compared to the rest of the country has been a good thing for nursing, because it’s driven us to have higher standards as well.”

More than 100 people at Texas Children’s contribute to the survey each year, submitting more than 1,500 survey elements in all. Texas Children’s also is represented in four of the working groups that RTI consults each year in continuing to refine the methodology. Involvement in quality improvement at Texas Children’s is even more far-reaching. More than 400 staff members have been trained in Advanced Quality Improvement.

“Quality improvement, which Texas Children’s is passionate about, extends everywhere,” said Dr. Charles D. Fraser, Jr., chief of Congenital Heart Surgery and surgeon-in-chief at Texas Children’s. “Quality starts immediately when the patient or family arrives here. Everyone is important, whether you’re in housekeeping or food services, the cardiac intensive care unit or are an administrative executive. Everyone is responsible for quality.”

Gap analysis

Texas Children’s analytics team provides data to each section chief with a detailed analysis of the gaps between the section and comparable data from top-ranked peer institutions in the Best Children’s Hospitals rankings. The service chiefs and their clinical and administrative teams review the data closely and objectively, identifying gaps and opportunities to improve quality, access or outcomes.

For example, in Texas Children’s Diabetes and Endocrinology section, gap analysis revealed several opportunities for improvement that are being addressed. To help deal with limited patient access, four new pediatric endocrinologists have been hired. To reduce disease complications, timely alerts now appear on physicians’ computers, reminding them to schedule their patients for tests for thyroid problems, kidney complications and early signs of diabetic retinopathy, which is associated with blindness.

“The U.S. News rankings are a wonderful opportunity to shine a light on potential problem areas and to allow us to make the care that we deliver better, more effective and more patient centered,” said Dr. Jake Kushner, chief of Diabetes and Endocrinology at Texas Children’s.

The rankings not only help identify gaps where improvements are needed, but also provide data to build the case for needed changes.

“Many of the service chiefs and practitioners have said, ‘We’ve been wanting this – this process, this equipment, this type of clinic – for years, and here it is in the survey,’” said Terri Brown, assistant director of Clinical Outcomes and Data. “So they are able to leverage the survey to help achieve what they already know to be good ideas.”

As the Best Children’s Hospitals survey focuses more and more on ways to improve outcomes, the transparency and accountability of the published rankings are helping to improve children’s health care nationally.

“If you look at the hospitals on the Honor Roll, we’re all delivering great care to children and families,” Giardino said. “Everybody’s working hard to get better. So the bar keeps moving higher. And that’s the whole point.”

June 21, 2016

62216globalhealth640Texas Children’s global health initiative recently expanded its services in Europe and Africa, enabling more children and adults across the globe to receive quality medical care. Two of the initiatives will help children in Africa who are suffering from cancer. The third effort will aid both adults and children living in Romania with HIV, hepatitis and tuberculosis.

Romania

The Romania initiative occurred June 6 when Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital (BIPAI) formally opened the expansion of its center of excellence in Constanta, Romania, a port city hit hard by the AIDS epidemic.

“The addition of a third floor to our center of excellence marks an important milestone in our life-saving work here in Romania,” said Dr. Mark W. Kline, Texas Children’s Hospital physician-in-chief and BIPAI president. “What began as a center for children with HIV now has transitioned to a center for the long-term care of adults with HIV, along with the identification and care of patients with hepatitis and tuberculosis.”

AbbVie and the AbbVie Foundation (formerly Abbott and Abbott Fund) have been the lead sponsor of the BIPAI Romania program since its launch 15 years ago in 2001, investing $7.7 million in its HIV/AIDS and hepatitis programs, and providing $35.9 million in medications in partnership with AmeriCares.

“We are grateful for the opportunity to partner with BIPAI in Constanta for the past 15 years,” said Melissa Walsh, vice president of the AbbVie Foundation. “The program has become the model for many pediatric HIV/AIDS centers of excellence around the world, and we are proud to support the broadening of its life-saving work for patients, including liver disease.”

Malawi

The AbbVie Foundation, along with the Abbott Fund, also helped fund the recent cancer initiative in Malawi. On June 9, BIPAI, the AbbVie Foundation and the Malawi Ministry of Health reopened two renovated pediatric wards and dedicated a new pediatric hematology/oncology unit at Kamuzu Central Hospital.

“We are honored to celebrate this milestone for the Baylor College of Medicine and Texas Children’s Hospital,” Walsh said. “The Malawi program has transformed the lives of thousands of children and their families living with HIV/AIDS and we are so proud to support the expansion of that work into the pediatric cancer space.”

In addition to AbbVie, the Chevron Corporation also supports the Malawi program, funding its only pediatric oncologist, Dr. Peter Wasswa of Baylor College of Medicine and Texas Children’s Cancer Center.

“Today’s ceremony provides further evidence of our continued commitment to the children of Malawi,” said Michael Mizwa, chief operating officer, BIPAI, and director, Texas Children’s Global Health. “We look forward to another decade of expanding our programs to meet the needs of sick children, including care and treatment, professional education for physicians and other healthcare professionals, and ground-breaking research.”

Botswana

The second effort dedicated to helping children in Africa with cancer occurred on June 13 in Botswana when the Botswana-Baylor Children’s Center of Excellence and the government of Botswana signed a memorandum of agreement to build the first children’s hematology and cancer center of excellence in Gaborone.

“Approximately 40,000 children a year are diagnosed with cancer in sub-Saharan Africa and 20 percent of those children survive, compared with 80 percent in the U.S.,” said Dr. David Poplack, director of Texas Children’s Cancer and Hematology Centers. “This COE (Center of Excellence), in partnership with the Botswana Ministry of Health, will change those numbers in favor of the children of Botswana.”

When pediatric oncologists from Texas Children’s Hospital began working at Princess Marina Hospital in Gaborone, it was the first pediatric oncology program on the continent. The recent agreement between the Botswana-Baylor Children’s Center of Excellence and the government of Botswana expands that commitment to include the first stand-alone cancer center of excellence devoted exclusively to the treatment of children with cancer and blood diseases.

“The purpose of this agreement is to provide finance, design, construction, operation and maintenance of the state-of-the-art Botswana Children’s Hematology and Cancer Center which will be built next to the teaching hospital at the University of Botswana,” said Shenaaz el Halabi, permanent secretary at the Ministry of Health. “The Ministry of Health has had good relations with BIPAI dating as far back as 1999, which gave birth to the Baylor Children’s Center of Excellence in 2003. Since 2006, pediatric oncologists from Texas Children’s have been working at Princess Marina Hospital.”

The partnership responsible for the development and management of the Children’s Cancer Center includes: the Botswana Ministry of Health, Baylor College of Medicine Pediatric AIDS Initiative (BIPAI) and Texas Children’s.

62216journal640The third issue of The Journal of Texas Children’s Hospital was recently released along with its companion website for online readers. Visit the site here to get a look at the third issue, which features a special section on the separation of conjoined twins Knatalye Hope and Adeline Faith Mata.

The special section is organized into three main parts: pre-surgery, surgery and post-surgery, all of which demonstrate the expertise, talent and comprehensive care available at Texas Children’s. The section lays out the extent to which our team nurtured a trusting rapport with the family, and skillfully cared for and thoughtfully treated the Mata babies from the time they were born until a little more than a year later when they were discharged to their home in west Texas.

Additional features of this edition’s The Journal include:

  • A column from Texas Children’s President and CEO Mark A. Wallace detailing how we have grown as an organization in size, staff and programming in order to continue to meet our ever increasing demand and to be the court of last resort for so many in need.
  • An in-depth look at the U.S. News and World Report rankings, what they mean, how they are formed and whether they have made Texas Children’s, which is ranked the 4th best children’s hospital in the nation, a better, stronger health care institution.
  • A story about the opening of the Special Isolation Unit at Children’s Hospital West Campus and how it demonstrates how Texas Children’s runs toward problems instead of away from them when it comes to the wellbeing of children and their families.
  • An intriguing piece about the research Texas Children’s is doing on a promising treatment using fecal bacteriotherapy to treat inflammatory bowel disease in children.
  • A spotlight on the successful care of morbidly adherent placenta, a potentially fatal condition, in pregnant women.
  • A column from Dr. Stanley Spinner, the chief medical officer of Texas Children’s Pediatrics, about retail-based after-hours care and Texas Children’s efforts to fill that gap by opening quality pediatric urgent care center across the Houston area.

The Journal launched in January 2013, replacing Shine magazine as the organization’s flagship publication. The magazine shares Texas Children’s advancements with intelligent, compelling stories featuring our people, our patients and timely, broadly relevant topics. Along with a philanthropic audience of about 30,000 recipients, the twice-yearly Journal is distributed to another 20,000 recipients, including:

  • CEOs and clinical leaders at all U.S. children’s hospitals and women’s hospitals
  • All U.S. medical school deans and chairs of pediatrics, pediatric surgery, OB/GYN and genetics
  • Physicians in pediatrics, 25 pediatric sub-specialties and women’s health services in Texas and four contiguous states