The candidate is completing fellowship training in Pediatric Critical Care Medicine and is dedicated to a career in Pediatric Health Services Research. This grant application proposes a comprehensive program of academic training and research that will allow the candidate to become an independent investigator in the area of Pediatric Health Services Research. The Center for Outcomes Research at the Children?s Hospital of Philadelphia (CHOP) and the University of Pennsylvania School of Medicine will provide an excellent environment for the candidate to accomplish these goals. The training program will include continued formal graduate education in clinical research and medical economics and will lead to a Master of Science degree in Clinical Epidemiology (MSCE). The research project is a retrospective cohort study that will demonstrate the effect of medication errors on the outcomes of patients admitted to the Pediatric Intensive Care Unit (PICU) at CHOP. Patients designated as exposed to a medication error, as identified by a voluntary reporting system, will be compared to a sample of unexposed patients from the cohort. Unexposed patients will be chosen by multivariable matching such that the group is as similar as possible to the exposed group on measurable factors that are available in the PICU clinical database. Detailed data collection by medical record review will allow for an analysis of the difference in resource utilization, morbidity, and mortality attributable to exposure to a medication error using ordinary least squared and conditional logistic regression.
The specific aims for the study are: 1) To calculate the increase in resource utilization attributable to exposure to a medication error in patients admitted to the pediatric intensive care unit; 2) To determine the risk of mortality attributable to exposure to a medication error in patients admitted to the pediatric intensive care unit; and 3) To determine the risk of requiring inpatient rehabilitation or technology dependence associated with exposure to a medication error. This study will advance our current knowledge regarding the effect of medication errors on the morbidity, mortality, and costs of care of the population of patients in the pediatric ICU. It will also provide a methodological advancement in the study of the effect of the process of care on outcomes by combining voluntary reporting of medical errors, a clinical database, multivariable matching, and detailed chart review.