2023 Department of Pediatrics Academic Annual Report

PARTICIPATION IN NATIONAL AND REGIONAL RESEARCH COLLABORATIVES, QUALITY-IMPROVEMENT PROJECTS AND LEARNING NETWORKS Claudette Poole, M.D., leads several funded initiatives grounded in community-engaged participatory research methods to support improved health outcomes in underserved communities. The goal of these programs is to improve coordination between relevant stakeholders and agencies, to leverage resources, and to improve outcomes. Dr. Poole has been leading efforts related to addressing social determinants of health in the Alabama Black Belt, a region of the state that is rural with high rates of households living in poverty. SANITATION HEALTH STUDIES PROGRAM Since 2018, with funding from the Center for Disease Control and Prevention, Dr. Poole has established a public health program focusing on educating health providers and the public regarding the health hazards associated with failing sanitation across the Alabama Black Belt, as well as establishing ongoing disease surveillance and linking communities to resources. This team is part of a larger collaboration of academic institutions, non-profits, private parties, and a government sector called the Consortium of Alabama Rural Water and Wastewater. Several projects related to public health, environmental health, and health and environmental policy have emerged from the Consortium. UAB FAMILY CLINIC In 2023, Dr. Poole became the Medical Director of UAB Family Clinic and Principal Investigator of the Ryan White Part D and Part B funded programs supporting care and outreach for women, infants, children and youth affected by HIV. This service has been in existence since the 1990s at UAB Family Clinic. This is one of only two clinics providing care for pediatric patients affected by HIV in the state of Alabama, with the other caring for patients in Mobile and Baldwin Counties and the remainder referred to UAB Family Clinic. UAB Family Clinic supports the care of women and youth affected by HIV in Huntsville and its surrounding counties through support of Thrive, based in Huntsville. Additionally, UAB Family Clinic provides care for infants exposed to HIV perinatally via a telehealth clinic in Montgomery and Dothan, where mothers receive care at Five Horizons at these locations. UAB Family Clinic collaborates with several researchers focusing on HIV care and prevention in women, children and youth. RURAL HEALTH CARE COORDINATION FOR CHILDREN In 2023, Dr. Poole secured funding from HRSA to support the development of a care coordination focusing on asthma in network in the Alabama Black Belt to improve care for children. This program developed from research demonstrating the high burden of asthma affecting children in the region together with the limited resources to provide adequate asthma care and access to subspecialty care. This funding is to support the establishment of a sustainable program to endure beyond the life of the grant, to leverage resources of the Alabama Medicaid-supported care coordination networks, the community action agencies, telehealth services and establishment of school-based preventative healthcare, which can then expand to other pediatric chronic health conditions. PARTICIPATION IN NATIONAL AND REGIONAL RESEARCH COLLABORATIVES, QUALITY-IMPROVEMENT PROJECTS AND LEARNING NETWORKS ANTIMICROBIAL STEWARDSHIP PROGRAM (ASP) • The Antimicrobial Stewardship Program (ASP) team includes two infectious diseases trained medical directors (Drs. Ross and Boppana), an infectious disease pharmacist, a data analyst, six physicians that represent the various specialties within the department, hospital nurses and representation from Children’s of Alabama performance improvement and administration. • The goal of the Children’s of Alabama ASP is to provide a collaborative, yet evidence-based approach to managing infections in children. This means using the right antimicrobial at the correct dose for the appropriate duration to cure or prevent infection while minimizing adverse drug events and emergence of resistance. • The ASP team participates in the Solutions for Patient Safety ASP collaborative with the goal of reducing antimicrobial use in the hospital and infections with multi-drug-resistant organisms (MDRO). • The ASP is in full compliance with the Joint Commission and CMS antimicrobial stewardship standards. The ASP monitors antimicrobial use by reviewing days of therapy, bug and drug mismatches, as well as high-risk antimicrobials and MDRO infections. For the last 24 months, antimicrobial usage and MDRO infection rates have decreased by more than 10%. • The ASP regularly reports antimicrobial use and MDRO data to the National Healthcare Safety Network (NHSN). • The ASP provides daily monitoring of duplicate antimicrobials (with no indication), non-formulary antibiotics, high-risk antimicrobial use (such as vancomycin and meropenem) and candida isolates. The pharmacist monitors more than 500 antimicrobial-related activities each month and makes an average of five to eight interventions per day based on this monitoring that results in appropriate antimicrobial therapy. • The ASP prepares and publishes the Children’s of Alabama hospital antibiograms annually to help guide practitioners on appropriate antibiotic use. • A C. diff diagnosis and treatment pathway was implemented with >90% adherence to the pathway, resulting in a decrease in the rates of C. diff to the target range over the past two years. • The Children’s of Alabama ASP received the designation as an IDSA Antimicrobial Stewardship Center of Excellence. The Center of Excellence program recognizes institutions that have created stewardship programs led by infectious diseases (ID) physicians and ID-trained pharmacists who are of the highest quality and have achieved standards aligned with evidence-based national guidelines. Children’s of Alabama is one of only 10 children’s hospitals in the US that have received this designation.

2023 Academic Annual Report

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