Research
Project Profiles
The following are selected research projects which demonstrate the depth and breadth of our collaborative partnerships. Click on the title of the project for the full description.
Analyzing and Redesigning Medicaid for Children in the State of Georgia
This three-year initiative involves research and development activities that will significantly support and drive modernization of the Medicaid program for children in the State of Georgia. The research protocol is comprised of a comprehensive ten-step process of interrelated and coordinated activities and will be pursued and carried out jointly by a team of interdisciplinary researchers and clinicians at Children's Healthcare of Atlanta and Georgia Tech. This project will also serve as a model for other states to adopt.
Community Health Record
Systems engineers from the Health Systems Institute's Center for Pediatric Outcomes and Quality are working with Children's Healthcare of Atlanta (Children's) and Children's private practice physician community to build a Community Health Record (CHR). Through the CHR, providers will electronically share information to create a complete, integrated, longitudinal health record for each child. Having access to more complete medical information will enable providers to improve the quality of care they provide to patients. At the same time, it will streamline the information sharing process, enabling providers to achieve operational efficiencies. In addition to these benefits, the longitudinal health records in the CHR will enable researchers from Children's, Georgia Tech, Emory, and other groups to conduct innovative prevention, diagnosis, and treatment research that can dramatically effect the health of children not only in Georgia, but nationwide.
Comprehensive IT Solution for Quality & Patient Safety
In 2004, Children's Healthcare of Atlanta (Children's), the Health Systems Institute's (HSI) Center for Interactive Systems Engineering (CISE), and the Emory University Center on Health Outcomes and Quality were awarded a grant to study health information technologies (HIT) implemented to improve patient safety and quality. This collaborative research examines the effect that key components of an electronic medical record have on operations at Children's. These components include: an inpatient Pharmacy system, electronic Medication Administration Record (eMAR), and Computerized Provider Order Entry (CPOE). Because Children's is implementing these systems using a phased approach, the research will measure the incremental impact each component has at Children's.
Can Use of a Pediatric Call Center as an Extension of Pediatric Emergency Department Visits Improve Quality of Pediatric Care?
Pediatric Emergency Department (PED) overcrowding is a nationwide problem that negatively impacts the quality of pediatric care delivered. A subset of the patients who frequently visit and disproportionately utilize the resources of the PED, thus contributing to the burden of overcrowding, have been identified. While most of these patients were knowledgeable about alternative sources for healthcare advice, most went directly to the PED. This project proposes the use of an established pediatric call center, which triages over 250,000 calls per year, to extend PED services by offering subsequent follow-up advice and triage. The goal of this project is not only to decrease overall PED utilization by this population, but to improve the quality of care provided at the PED.
Comprehensive Analysis of Patient Triage in Urban Pediatric Emergency Departments
This project brings together researchers at the Georgia Institute of Technology and Children's Healthcare of Atlanta (CHOA) to investigate the efficacy of Emergency Severity Index (ESI) triage in determining resource utilization and short- and long-term staffing needs while maintaining a high quality of care. The Emergency Severity Index (ESI) system is patient triage model recently adopted at CHOA for implementation in two urban pediatric emergency departments (ED) starting in August 2007. The decision to use the ESI system is primarily due to the current four-tier model's poor reproducibility, poor correlation to resource utilization, and tendency to misclassify both critical and non-critical patients. To be able to provide quality-of-care and timeliness care to pediatric ED patients, it is critical to investigate effective patient triage as well as improve resource utilization.
Designing Healthcare of the Future: Multi-Disciplinary Approaches to Applying Innovation in the Design of a Pediatric Healthcare Center
Converting current research in the various disciplines of Systems Engineering, Architecture, Industrial Design, Computer Science and Nursing into practical applications in pediatric healthcare delivery requires real opportunities to evaluate, test and implement ideas. Most research and innovative thinking concerning facilities, furniture/fixtures, information/communication systems, and operations are focused on adults. Pediatric needs are unique and the environments of care and healing needs to redesigned or adapted to be effective.
Hughes Spalding Children's Hospital is in the beginning of plans to renovate/expand/restructure
the center to become more responsive to its providers and patients – providing
patient/family centered care as suggested by the IOM (Institute of Medicine).
This is a great opportunity to implement and evaluate ideas for better pediatric
care. Last year Georgia Tech and Emory jointly implemented a highly successful
multidisciplinary course – Designing an Inpatient Room of the Future. This
brought together leading researchers and practitioners from Emory School of
Nursing, Emory Healthcare, Steelcase, and Georgia Tech to guide this laboratory
class. Twenty seven graduate students pursued seven unique solutions to a better
inpatient room. Patents have been filed on three novel projects as an outcome
of this class. One of the projects is under consideration for development and
production. Using the Laboratory Course with a real life project (Hughes Spalding)
should seed many great
ideas.
We will repeat this fall the laboratory/course "Designing the Healthcare of the Future" alongside Hughes Spalding Children's Hospital to focus on "Innovations in the Design of a Pediatric Healthcare Center" We believe that the best ideas will represent new knowledge, and possibly new products/processes that will make better pediatric healthcare environments. We want to focus additional resources on the follow-up of the best ideas. Research teams will be assigned to work with Hughes Spalding to test and implement these ideas. This project will develop new knowledge in pediatric environments of care and will speed ideas into production.
Development of a Novel Fluid Management System for Accurate Continuous Hemofiltration in Extracorporeal Membrane Oxygenation (ECMO)
Failure of the cardiac or respiratory system is a common problem in the pediatric and neonatal intensive care unit. Extracorporeal life support such as extracorporeal membrane oxygenation (ECMO) can serve to provide life-saving temporary heart and lung support. Renal failure is often a complication, leading to accumulation of fluid and volume overload that can worsen heart and lung disease. Continuous venovenous hemofiltration (CVVH) is a renal replacement therapy that allows control of fluid balance, electrolyte, and toxin clearance. This project proposes to develop and test novel, automated, and accurate fluid management systems as well as implement a lumped parameter computational model of CVVH on ECMO to computationally study the effect of design parameters and failure scenarios.
Early Diagnosis of Cardiovascular Health via a Clinically Deployable Noninvasive Measurement of Vascular Function
One third of the US population has one or more cardiovascular risk factors which are associated with endothelial dysfunction, an important factor in the pathogenesis of hypertension, diabetes and atherosclerosis. There is a strong correlation of endothelial dysfunction in one vascular bed to another. A non-invasive test to detect abnormal endothelial function would lead to earlier detection and treatment before disease progression, and would save lives as well as reduce healthcare costs. While standard techniques (ultrasound and MRI) exist to quantify endothelial dysfunction, high costs and a significant degree of operator training preclude such diagnoses from being deployed in a routine clinical setting.
The objective of this investigation is to refine and validate a non-invasive, electrical impedance-based system prototype that can be operated with minimal operator training. This system will be evaluated in a clinical trial aimed at demonstrating the efficacy of electrical impedance measurements for measurement of vascular function as compared to "gold standard" ultrasound-based measurements. The proposed system is expected to provide an enhanced diagnostic capability with improved reliability and at a significantly lower cost than other non-invasive ultrasonic or MRI systems. If successful, future work will focus on developing a system that can be operated by a minimally trained clinical healthcare provider.
Evaluating the Efficacy and Efficiency of Competing Approaches to Reducing Nosocomial Infection Rates
In the U.S. alone, nosocomial (hospital-acquired) infections occur at the rate of approximately two million per year, with one hundred thousand of these leading to death. The suffering, loss of productivity, expenditure of scarce health-care resources, coupled with the rising resistance of many pathogens, make this issue urgent and important.
Since it is difficult or expensive to observe colonization and ascertain whether a patient was infected prior to, or during hospitalization, and the process by which pathogens spread depends on the behavior of patients, health-care workers, visitors and the community at large, the best strategy to reduce nosocomial infection rates is unknown. Two possible approaches to reduction include: screening for isolation and improved hygiene approaches. The costs involved are not yet clear, and in particular, the non-health-care productivity costs need to be included in any cost-benefit analysis of policies. This proposed research uses simulation to model how different strategies may impact rates of nosocomial infections, their costs in the long and short term, as well as the overall interaction between hospitals and the community.
Evaluation and Modeling of Redox Regulation of NF-kappaB in Acute Lymphoblastic Leukemia cells: Role in Drug Resistance
There has been increasing interest in the relationship between the NF-kB anti-apoptosis signaling pathway and the generation of reactive oxygen species (ROS) in pediatric acute lymphoblastic leukemia (ALL) post-therapy. Our previous results suggest that ALL cells with high levels of constitutively activated NF-kB have increased resistance to ROS-generating chemotherapeutic agents like doxorubicin. In particular, we have studied two patient-derived ALL cells lines which show differential regulation of NF-kB-activation levels post-treatment with doxorubicin: EU-1 (drug-resistant line) shows high levels of activated NF-kB post-therapy in contrast to EU-3 (drug-sensitive).
We hypothesize that key redox buffering components protect ALL cells from ROS-generating agents by preventing ROS-mediated downregulation of NF-kB. This hypothesis is supported by studies showing increased intracellular glutathione is associated with poor prognosis in pediatric lymphoblastic leukemias. We will evaluate the effect of redox-buffering components on the level of ROS induced by doxorubicin in the two patient-derived cell lines (EU-1 and EU-3). We then will use differences between the cell lines to generate redox-balance computational models of dox-sensitive and dox-insensitive cells. This will permit cell-line specific simulation of redox-conditions and identification of variations in key redox enzyme levels involved in regulating NF-kB activation in the two model cell lines. These results may have clinical significance in elucidating the role of redox-regulatory components in creating resistance to important ROS-generating chemotherapeutic agents used to treat acute lymphoblastic leukemia.
Integrating Medical and Laboratory Information Systems for Discovering and Analyzing Risk Factors for Resistant Bacterial Infection
This project involves a two-phase study to address the high rates of infection by a specific resistant staphylococcal bacterium in children who live in the Atlanta area. The first phase involves looking at children who received care from Children's Healthcare of Atlanta (CHOA) at Egleston, Hughes Spalding, and Scottish Rite hospitals and have a positive culture due to methicillin resistant Staphylococcus aureus (MRSA). These children will then be compared with those who have a methicillin sensitive Staphylococcus aureus culture (MSSA). In the first phase of the study, a methodology, model, and monitoring process will be developed to address these cases. In the second phase, using geographic information system tools, there is a plan to geocode all children who have positive cultures for Staphylococcus aurezrs to determine which risk factors may contribute to infection by these resistant staphylococcal strains.
Rapid Identification and Monitoring of Patients with Acute Respiratory Distress Syndrome Using Carbon Nanotube-Based Sensors
This project involves development of a novel, real-time detector and monitor for glutathione using carbon nanotube-based sensors. Unlike current glutathione measurement procedures which are time consuming, expensive, and cannot be used on a daily basis, the sensor technique will allow routine rapid monitoring of alcoholic patients to assess their level of risk to acute respiratory distress syndrome (ARDS) and will identify patients who require special therapy. In addition, this new approach will identify other patients with similar antioxidant deficiencies such as cystic fibrosis and HIV who may be at risk for ARDS.
Robust People Following via RFID for Assistive Mobile Robots
The proposed research will advance the state of the art in robotics and assistive technology by developing sensing technology and algorithms that will enable an assistive mobile robot to robustly follow a person with ALS in everyday settings.
Mobile companion robots that remain in close proximity to a specific person would be a valuable platform for personalized health care services such as non-invasive monitoring and assistive manipulation. Currently, robots are unable to robustly follow a specific user through everyday situations and environments due to sensing limitations. In particular, robots have great difficulty detecting and recognizing specific people, which is likely to lead to errors when multiple people are in the presence of the robot. We will address this fundamental challenge by developing novel sensing technology that makes use of an RFID wristband worn by the user, and novel robotic behaviors that make use of this information to unambiguously identify and follow a specific user. This system will function by tracking the data signal emitted from the RFID wristband to provide both identifying information and information about the location of the user relative to the robot. As a proof of concept, we will develop and test this technology in the context of an assistive mobile manipulator for people with ALS.
Standardized, Evidence-Based Care Pathways to Improve Health Outcomes in Patients with Cystic Fibrosis
This research initiative combines clinical expertise from the Emory Cystic Fibrosis Center and the Affiliate Center at Scottish Rite with measurement, analytical, and technical expertise from Georgia Tech's Health Systems Institute. The objective is to develop and implement evidence-based pulmonary and nutrition pathways for the care of Cystic Fibrosis (CF) patients. This involves analyzing patient outcomes and care pathway utilization to determine the effectiveness of treatment and leverage the existing CF Registry to develop a CF outcomes measurement and reporting system that can be used to analyze the effectiveness of future quality improvement initiatives.
