December 6, 2016

12716pediatricpilotawardinside900Dr. Jordan Orange, vice chair of research in the Department of Pediatrics, announced the winners of the 2016 Pediatric Pilot Awards Research Grant Program. Ten research applications were chosen by review committee members to receive grant funding in the amount of up to $50,000 for their projects.

The Pediatric Pilot Awards Research Grant Program provides initial start-up “seed funding” to support research projects. This grant program provides opportunities for new or less established researchers as well as experienced researchers who desire to expand their area of research. The grant projects are awarded based upon their scientific merit and the potential to generate the initial data necessary for a successful grant application submission to the National Institutes of Health or other external, peer-reviewed funding mechanisms.

The pilot award program is a collaborative effort between Texas Children’s Hospital and its academic partner, Baylor College of Medicine.

Congratulations to the following 2016 pilot grant awardees. View the names below to learn more about the research project being funded.

12716drsaurabhagarwal175Saurabh Agarwal, Ph.D.
Pediatrics – Hematology/Oncology
Epigenetic targeting of neuroblastoma cancer stem cells

More than half of the patients with high-risk neuroblastoma (NB) will relapse despite intensive multimodal therapy. Treatments for these patients are challenging due to disease heterogeneity, drug resistance, and toxicity. Thus, novel effective therapies are urgently required to specifically target those tumor cells which escape initial treatment and regenerate chemotherapy resistant recurrent disease.

We identified a G-CSF receptor expressing (CD114+) neuroblastoma cancer stem cell (CSC) subpopulation that is drug resistant, drives metastasis and may cause drug resistant relapse. These highly tumorigenic CSCs are distinguished by specific epigenetic alterations that lead to the expression of specific stem cell genes and maintenance of neuroblastoma CSCs.

We found that epigenetic modifiers MLL1 and JMJD3 increase the expression of G-CSF receptor gene (CSF3R) in NB CSCs by maintaining active histone modifications. Our pre-clinical studies show that blocking these epigenetic modifiers with specific small molecule inhibitors leads to neuroblastoma tumor regression and blockage of metastasis in vivo.

This pilot award will further enable us to test novel dual therapeutic approach by combining epigenetic inhibitors with standard chemotherapy for targeting both stem and non-stem neuroblastoma subpopulations. These studies will define specific epigenetic mechanisms contributing to the maintenance and tumorigenicity of NB CSCs, and pave the way for further clinical translation of our findings to block NB CSC-driven relapse and to advance a novel curative approach to neuroblastoma.
12716drwendyallenrhoades175Wendy Allen-Rhoades, M.D.
Pediatrics – Hematology/Oncology
Validation of a plasma microRNA panel as a biomarker for osteosarcoma

Osteosarcoma is the primary bone cancer in children and young adults. Currently, there are no reliable, non-invasive biological markers to detect the presence or progression of disease, assess therapy response or provide upfront prognostic insights. MicroRNAs (miRNAs) are evolutionarily conserved, stable, small non-coding RNA molecules that are key post-transcriptional regulators and are ideal candidates for circulating biomarker development due to their stability in plasma, ease of isolation and the unique expressions associated with specific disease states.

In our previous work, we analyzed more than 750 plasma miRNAs from a genetically engineered mouse model of osteosarcoma and identified a diagnostic panel of four plasma miRNAs. This diagnostic panel was able discriminate healthy from diseased animals. Subsequent analysis of 70 human patient samples corroborated these results and the diagnostic panel could discriminate healthy patients from patients with osteosarcoma. Furthermore, low plasma levels of miRNA-214 in metastatic patients at time of diagnosis were prognostic and conveyed a significantly better overall survival.

With the funding from the Pediatric Pilot Award, we will continue the necessary steps to fully validate this novel biomarker by completing validation of the diagnostic and prognostic miRNA biomarkers in 200 additional human samples. The long-term goal of this project is to test these new biomarkers in a prospective clinical trial.
12716drsaraanvari175Sara Anvari, M.D.
Pediatrics – Immunology, Allergy and Rheumatology
Defining biomarkers of successful peanut oral immunotherapy

Peanut allergy is one of the most common causes of severe and fatal allergic reactions related to food. The prevalence of peanut allergy has nearly tripled in the last 20 years and current standard of care for peanut allergy is strict avoidance of peanuts and ready access to emergency medications. While recent research has demonstrated that early introduction of peanuts, instead of avoidance, during infancy can greatly reduce the risk of a peanut allergy, this strategy is not applicable to individuals who have already developed an allergy.

For older children, teens, and adults, peanut oral immunotherapy (pOIT) is one method by which peanut allergies can be treated through step-wise introduction of peanut protein. This introduction is an effort to manage and reduce the allergic reactions in patients. However, how pOIT alters patients’ immune systems to recognize peanut protein as benign instead of “dangerous” (the nature of severe allergy) is poorly understood. Additionally, biomarkers, or testable indicators of efficacy, for pOIT success in a given patient are also still unknown at this time.

Most current research is focused on how pOIT modifies a white blood cell population, called T regulatory cells, which help control the severity of inflammation caused by immune reactions inside the human body. But T regulatory cells are just one end point of a larger set of immune reactions to pOIT. My research program will focus upstream of T regulatory cells on another population of white blood cells, called dendritic cells, which can communicate with and modify T regulatory cell, as well as several other types of white blood cells.

Specifically, the research award will help (1) identify biomarkers to predict a patient’s success (i.e. peanut tolerance) or failure (i.e. persistent peanut allergy) early in the course of pOIT, without waiting to complete three years of therapy; (2) development of targeted therapies for peanut allergic individuals aimed at altering dendritic cell populations to better modulate T regulatory populations which aid in the reduction of severe inflammatory reactions which make peanut allergies so life threatening.
12716drevelinebarbieri175Eveline Barbieri, M.D.
Pediatrics – Hematology/Oncology
Targeting MYCN-amplified neuroblastoma through RORa activation

The MYCN oncogene is a transcription factor frequently upregulated in high-risk neuroblastoma, which is profoundly involved in neuroblastoma initiation and progression. Thus, strategies antagonizing MYCN activity are a vital need in neuroblastoma therapy and the focus of this proposal.

Our laboratory has discovered that MYCN-driven neuroblastoma has an increased dependence on glutamine and lipid metabolism. Recent findings in other tumor types suggest an important link between these metabolic pathways and the circadian clock, which is disrupted in aggressive malignancies.

This led us to investigate how MYCN oncogenic signaling, circadian clock, and neuroblastoma metabolic tumor reprogramming are interrelated. Intriguingly, we have found that RORα signaling, a central component of circadian clock, is lost in MYCN-amplified neuroblastoma and this contributes to aberrant tumor proliferation.

Our specific aims will: 1) determine the metabolic programs activated by RORα in MYCN-driven tumors, and 2) determine the in vivo anti-tumor effects of RORα reactivation in pre-clinical neuroblastoma models. These studies will offer insights into critical molecular and metabolic alterations, which will provide new and more sensitive targets that could be strategically deployed with currently available therapies to treat this highly aggressive disease. Moreover, many enzymes in this pathway are amenable to small molecule inhibitors and therapeutic targeting of RORα-mediated metabolism is moving to the clinic.
12716drjennydespotovic175Jenny Despotovic, D.O.
Pediatrics – Hematology/Oncology
Genetic variants and gene expression patterns in acute and chronic immune thrombocytopenia

Immune thrombocytopenia (ITP) is an autoimmune disorder and one of the most common causes of low platelets in children. Twenty-five percent of affected children develop chronic ITP and some have significant morbidity and mortality. Currently, it is impossible to predict an individual patient’s clinical course and likelihood of spontaneous remission at the time of diagnosis.

Identification of children more likely to develop chronic ITP at diagnosis would improve treatment decisions and could also help identify important mechanisms of disease that could lead to more tailored treatment. Based on strong preliminary data produced in our laboratory, we believe that acute and chronic ITP are distinct diseases that can be distinguished at diagnosis; and specific genetic changes and gene expression differences influence the development of chronic ITP.

In our study, we are collecting DNA at enrollment on all patients with ITP, as well as RNA on patients with acute ITP at the time of diagnosis and at the time of disease resolution. For patients with chronic ITP, we are obtaining RNA at several time points. We will use the most current sequencing technologies to look for changes that may help explain differences between these two disorders with the eventual goal of identifying markers that could be used to distinguish the two disorders at diagnosis so that we could determine how to best approach each patient.
12716drjohnhollier175John Hollier, M.D.
Pediatrics – Gastroenterology
Efficacy of pre-recorded guided imagery session on pediatric gastrointestinal pain disorders managed in primary care

Up to 20 percent of school-age children and adolescents throughout the world are afflicted by recurring abdominal pain that cannot be explained by routine medical laboratory tests or procedures. These children miss more school and rank their general well-being much lower than their healthy counterparts. These disorders also may be associated with psychological distress like anxiety and depression.

One of the most effective treatments for these “functional gastrointestinal pain disorders” (FGIDs) fall under the category of cognitive behavioral therapy. However, access to this type of therapy often is not available due to lack of insurance coverage and/or scarcity of trained healthcare professionals.

Researchers have previously demonstrated the success of guided imagery, a type of cognitive behavioral therapy in treating FGIDs. Guided imagery can be delivered via using compact disc players so that patients can receive therapy at home. Our goal is to find out if audio-recorded guided imagery can be used to treat FGIDs when children are seen in the primary care setting (i.e., by their pediatrician or nurse practitioner). If so, we would be able to get treatment to these children sooner and likely decrease the need for them to be referred to a specialist (gastroenterologist). Our long term research goal is to use mobile cost effective technologies to improve the clinical care of patients with FGIDs and other pediatric diseases.
12716drandrewlandstrom175Andrew Landstrom, M.D.
Pediatrics – Cardiology
The role of junctophilin-2 in the regulation of cardiac nodal tissue

Diseases that impact the nodal tissue of the heart, such as the heart’s pacemaker, can be life-threatening. Children can suffer from these arrhythmias following surgery, through inheritance within families or for no identifiable reason. These arrhythmias can cause fainting, inability to play with the same energy as other children, or even death from collapse of the circulatory system. Despite how serious nodal disease can be, little is known about how these cells beat and how misbeats can occur. Since basic science has limited understanding of this specialized tissue, the therapies levied against nodal disease are toxic and can be ineffective.

A major reason for the lack of specialized therapies is the absence of experimental models which accurately reflect the arrhythmia. We have created an unparalleled mouse model with cardiac nodal disease that can be molecularly triggered to have arrhythmias from the nodal tissue of the heart. This mouse hosts a molecular switch which allows exposure to a pharmacological trigger to decrease the amount of a protein named junctophilin-2 (Jph2) specifically in the heart.

We have previously shown that reduction in the normal amount of Jph2 in the muscle cells of the heart causes calcium to leak into the cell. This causes a loss of contractile force and cardiac failure. We have also found that human mutations in the gene which encodes Jph2 can lead to cardiac hypertrophy as well as atrial fibrillation. All of these diseases are associated with early, and sometimes sudden, death. We have recently found that expression silencing of Jph2 specifically in the nodal tissue results in a rapid resting heart rate and an arrhythmia known as accelerated junctional rhythm. Our early studies have given strong evidence that this mouse has nodal disease that is very similar to many of the children which suffer from nodal dysrhythmias.

With support from pilot research grant, we hope to delve into the physiology of the cardiac pacemaker and to discover the molecular causes of nodal arrhythmias. We believe that the same calcium signaling that becomes perturbed in the muscle cells of the heart may be to blame for these arrhythmias. Careful interrogation of this possibility, and dissection of the molecular underpinnings of this mouse’s arrhythmias, will offer the first insights into the nodal diseases which remain unexplained and ineffectively treated.
12716drjennettemoreno175Jennette Moreno, Ph.D.
Pediatrics – Nutrition
Assessment of differences in children’s circadian rhythms during the school year and summer vacation

Consistent evidence indicates that school age children demonstrate improvements in their weight status during the school year, yet gain substantial weight during summer. These summertime increases in body mass index (BMI) increase children’s risk for becoming overweight or obese. Further, children at risk for developing chronic health conditions associated with obesity are more likely to demonstrate increases in BMI during summer. Preventing increases in children’s weight during summer may be an important opportunity to address the obesity epidemic in children.

Obesity is conventionally considered a problem of imbalance in energy intake (diet) and expenditure (physical activity/sedentary behavior). There is growing awareness of the role of sleep and circadian rhythms in the development of obesity, yet differences in children’s sleep and circadian rhythms during the school year and summer have not been examined.

Circadian rhythms are internal processes present in all living things that operate on a roughly 24 hour cycle. Behavioral rhythms such as the timing of meals and going to bed and waking up at a consistent time are some of the behaviors known to promote stable circadian rhythms. Changes in sleep and behavioral rhythms may result in disruption of circadian rhythms. Because summer vacation is associated with changes in children’s sleep and behavioral rhythms, the school year and summer vacation paradigm offer an important opportunity to expand our scientific understanding of the role of disruptions in sleep and circadian rhythms on the development of obesity in children.

Little is known about differences in children’s sleep and circadian rhythms during the school year and summer. With the current proposal, we plan to address this gap in scientific knowledge by measuring differences in children’s sleep and circadian rhythms during the school year and summer. We will assess whether differences in sleep and circadian rhythms are related to changes in children’s weight during the school year and summer. These data will may lead to novel approaches to the prevention of obesity in children.
12716drrobinparihar175Robin Parihar, M.D.
Pediatrics –Hematology/Oncology
Testing a novel non-invasive method to assess efficacy of tumor microenvironment-directed immune therapy

Some children with cancer have solid tumors, or collections of abnormally growing cells, within their organs. These collections are made up of mostly cancer cells, but also of accessory cells that help the tumor hide from the body’s immune system and grow – collectively called the tumor microenvironment. Our laboratory created a new type of immune therapy to specifically target and destroy these accessory cells found within the tumor microenvironment so that they can’t help the cancer grow.

One of the main problems for testing our immune therapy in patients with solid tumors is that we can’t detect these accessory cells without performing a biopsy procedure of the tumor inside the body. In order to detect the accessory cells in patients at many different times during their therapy, we would have to perform repeated invasive biopsy procedures, which come with additional risks and costs. There is currently no non-invasive method by which to determine the effectiveness of therapies that target the tumor microenvironment. If strategies targeting the tumor microenvironment are to be tested in humans, non-invasive methods will need to be developed to evaluate their effectiveness, thereby circumventing the need for repeated invasive biopsies.

Our project involves the creation and testing of a new type of CAT scan that can indirectly detect the accessory cells of the tumor microenvironment. If successful, our new CAT scan can be used to detect changes in the number of accessory cells in patients receiving our new immune therapy, without the need for repeated invasive, risky, or costly procedures. This new CAT scan can be used in clinical trials of other immune therapies as well and may be applied to both children and adults with cancer. The long term goal of the project is to develop a clinical imaging tool that will allow doctors to follow changes within the tumor microenvironment induced by immune therapies.
12716drsarahsartain175Sarah Sartain, M.D.
Pediatrics – Hematology/Oncology
The linkage between hemostasis-thrombosis, complement, and inflammation in the pathophysiology of thrombotic microangiopathy

The goal of our research is to improve the health of patients with thrombotic microangiopathy, a group of disorders that cause anemia, low platelets, clots in the blood vessels, and blood vessel damage of the brain, heart, and kidneys. The mechanisms of small blood vessel damage in thrombotic microangiopathy are not precisely defined.

We will investigate the means by which thrombotic microangiopathy causes blood vessel injury and organ damage. We believe that the immune system is involved in the process of vessel injury in thrombotic microangiopathy. This is based on previous work showing that components of the immune system known as the “alternative complement pathway” bind to, and become activated on, long and sticky von Willebrand factor (VWF) strings secreted from blood vessel walls. These VWF strings normally attract platelets to initiate blood clot formation. We intend to determine if activated alternative complement components on these strings contribute to blood vessel injury. We will also determine if a powerful molecule produced during inflammation (known as “tumor necrosis factor”) controls activation of the alternative complement pathway on the VWF strings, contributing to heart, brain, and kidney blood vessel injury.

Our proposed research has long-term biomedical significance because determining the mechanisms of blood vessel/organ injury in thrombotic microangiopathy will lead to the development of therapies to improve the outcomes in this disorder and may be applicable to more common types of blood vessel injury in the general population.

October 18, 2016

101916toss640On October 6, more than 500 guests donned their boots and Texas-chic apparel at Houston Polo Club for the 4th annual Toss for Texas Children’s Heart Center. The tailgate meets Great Gatsby-themed event under the stars raised $180,000 for Texas Children’s Heart Center, which is ranked Number 2 in cardiology and heart surgery by U.S. News & World Report.

The bean bag tournament featured light bites and cocktails by A Fare Extraordinaire and a special performance by country music singer, Gary P. Nunn. The event was chaired by Staci & John Donovan and Brooke & Scott Hutson, both of whom have children who received expert care from Texas Children’s Heart Center. The “Toss” trophy was presented at a special awards ceremony to conclude the evening’s festivities.

October 4, 2016

angelagooden175Angela Gooden of Texas Children’s Heart Center is the latest Texas Children’s Super Star leader. “In order to provide quality family-centered care, we all have to commit to taking the lead and finding new and innovative ways to be the best at what we do,” Gooden said. Read more of her interview below and find out how you can nominate a Super Star.

Your name, title and department. How long have you worked here?
Angela Gooden, certified pediatric nurse practitioner and manager of Advanced Practice Providers in Cardiology. I started my career at Texas Children’s Hospital as a graduate registered nurse in the Pediatric Intensive Care Unit 17 years ago and transitioned into a nurse practitioner role 8 years ago.

What month are you Super Star for?
October – December 2016

Tell us how you found out you won a super star award.
My team members planned a surprise reception that included my family and other members of the Cardiology department that I work closely with on a daily basis.

What does it mean to be recognized for the hard work you do?
I’m really very honored and honestly a little bit embarrassed. However, this recognition lets me know that I am doing something right and that’s a great feeling.

How has the organization helped you achieve your personal and professional goals?
I’ve been the recipient of great leadership during my time at Texas Children’s. The encouragement and feedback I have received along the way gave me confidence to explore new opportunities. One of the things I love about Texas Children’s Hospital is professional development is expected.

What do you think makes someone at Texas Children’s a super star?
One of the comments submitted from my team referred to me as a servant leader. I was extremely honored by this statement because it’s exactly what I aim to achieve on a daily basis. I believe actions speak louder than words and we work better side by side.

What is your motivation for going above and beyond every day at work?
I truly enjoy the work that I do and the people I get to do it with. The experience and knowledge I’ve gained as a nurse practitioner in the Cardiology department has been priceless. I enjoy the people, patients, and families that I work with on a daily basis and care about their quality of life.

What is the best thing about working at Texas Children’s?
Definitely the people! I have made so many great friends with whom I’ve shared countless experiences over the years. I’ve grown (and continue to grow) up here and more days than not I leave knowing that I made a difference.

What does it mean to you that everyone at Texas Children’s is considered a leader? What is your leadership definition?
We’re tasked as Texas Children’s employees with providing quality family-centered care. In order to do this we all have to commit to taking the lead and finding new and innovative ways to be the best at what we do.

Anything else you want to share?
I’m grateful to my team for the recognition and happy to be working with people I genuinely like.

August 23, 2016

82416thorasicsurgeryinside640Texas Children’s Hospital’s congenital heart surgery program recently earned a three star rating from the Society of Thoracic Surgeons (STS), the highest possible distinction.

Star ratings are based on the STS Congenital Heart Surgery Database (CHSD) mortality risk model. One hundred and seventeen congenital heart surgery programs nationwide participated in the Spring 2016 STS CHSD Feedback Report. Texas Children’s is among only eight hospitals in the U.S. to earn a three star rating.

“We are honored to be recognized for our outcomes, which are among the best in the nation,” said Dr. Charles D. Fraser Jr., surgeon-in-chief and chief of congenital heart surgery. “Since 1995, our congenital heart surgery program has carefully tracked patient outcomes and continues to be committed to transparency. Information about our performance is a driver of innovation and critical to elevating the quality of care we provide to our patients every day.”

Texas Children’s Heart Center is comprised of an expert team of congenital heart surgeons, pediatric cardiologists, pediatric cardiovascular anesthesiologists and pediatric critical care physicians, among others. In 2015, Texas Children’s congenital heart surgery program’s overall risk-adjusted mortality rate was 1.6 percent, well below the STS national benchmark of 2.9 percent. Outcomes for atrial septal defect repairs, ventricular septal defect repairs, atrioventricular canal repairs, tetralogy of Fallot repairs and arterial switch operations were also below STS national benchmarks last year.

Texas Children’s is ranked No. 2 nationally in cardiology and heart surgery by U.S. News & World Report. To learn more about Texas Children’s Heart Center outcomes visit the website. For more information about STS Congenital Heart Surgery Public Reporting click here.

July 19, 2016

72016WayneFranklin175Wayne Franklin, MD, director and founder of the Adult Congenital Heart Disease Program, was recently selected to participate in The Aspen Institute Fellowship, a two-year fellowship focused on strengthening the leadership of innovators across the U.S. health care ecosystem.

Called the Health Innovators Partnership and in conjunction with South Carolina’s largest non-profit healthcare system, Greenville Health System, the Aspen Institute’s primary objective for the fellowship is to create meaningful change in health care with the help of 21 newly appointed fellows, including Franklin.

Franklin and his associate fellows were selected to innovate change and improve the health and well-being of all Americans. The team – made up of experts in pharmaceuticals, public health, biotechnology, insurance, mental health and government – will collaborate to institute the advancements of America’s health.

Rima Cohen, the managing director of the fellowship, described her excitement about the fellow’s various backgrounds, energy, and expertise as being united to “tackle our nation’s most pressing health care challenges.”

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

62216jjwatt640When 8-year-old Texas Children’s patient Jeston Adams woke up June 12, he could barely contain his excitement. It was the moment he had been waiting for; the day he was going to meet his hero – J.J. Watt.

Jeston, whose wide smile and personality light up a room, spent more than three hours having lunch, sharing stories, playing video games and talking about his road to a heart transplant with the larger-than-life Houston Texans defensive end.

In January, congenital heart surgeon Dr. Iki Adachi and his team implanted the HeartWare® HVAD® into Jeston’s small chest, connecting the device to his heart. A red pack filled with the VAD’s controller and battery is now a fixture on Jeston’s back, allowing him to enjoy his childhood as he awaits a much-needed transplant. He is closely monitored by pediatric cardiologist Dr. Aamir Jeewa, VAD coordinator Barb Elias, and the Heart Center’s heart failure team.

“Giving patients like Jeston an opportunity to meet a hero and be inspired by someone like J.J. is really uplifting,” said Dr. Jeff Dreyer, medical director of the Heart Transplant Program. “His positive attitude and moments like this keep him going on the long road ahead.”

After the visit, Watt had one more surprise for Jeston before they said goodbye – an Xbox. Jeston was thrilled, and without hesitation wrapped his arms around Watt’s waist for a big hug. The starstruck patient now calls Watt his brother and hopes this is just the beginning of their friendship.

“Thank you for everything!,” Jeston said grinning from ear to ear. “I hope I see you again one day.”

Jeston and his mom weren’t the only ones who had a memorable day. Watt posted a photo and video of his time with Jeston on social media and received an overwhelming, supportive response.

“He is one of the nicest, kindest, funniest kids that I have ever met. He has an old soul combined with the energy and enthusiasm of a child,” Watt wrote about Jeston. “He spoke openly about his condition and the pain that he endures, but he never complained about it or used it as an excuse. He never stopped smiling the entire day and he, without question, has inspired me to attack each day with a smile and a positive mentality.”

Click here to watch highlights from Jeston’s special day.