At the Core of CORES – Improving Patient-Centered Surgical Outcomes Research

By Kate Knab

Although surgical conditions account for roughly 30% of the global burden of disease, funded research to support new knowledge in pediatric surgery is vastly underrepresented. With the fundamental mission to improve outcomes for children with surgical conditions, Children’s Hospital of Philadelphia made strides to close this gap in knowledge with the launch of the Center for Outcomes in REsearch in Surgery (CORES) led by Gregory Tasian, MD, MSCE.

“The more we can conduct research that reflects real-world care, the greater impact we will have,” Dr. Tasian said.

Typically, outcomes research follows a linear model that begins with a question asked by a clinician. Years go into designing a study and publishing results in a high impact journal, but the amount of time this process takes before it impacts clinical care is often long with marginal effects.

CORES seeks to upend this model by beginning with questions generated from patients and their caregivers. In creating a partnership with patients throughout the research process, researchers will be better positioned to understand patients’ priorities and integrate results back into clinical care more directly.

The Center is at the hub of existing groups at CHOP that will combine expertise to advance this mission. Partners include the Data Science and Biostatistics Unit run by Heather Griffis, PhD, which provides valuable data analysis, and Clinical Futures, a Research Institute Center of Emphasis, which offers access to data sets and grants writing support.

“Creating relationships across not only the Research Institute, but between the Research Institute and the Hospital improves our ability to apply outcomes back into care,” Dr. Tasian said. “We have so much to learn as a department from each other. Right now, everyone exists in clinical and research silos, so the more we can break down those barriers and facilitate communication, the greater benefit there will be to our patients.”

CORES welcomes collaboration throughout the many divisions in the Department of Surgery at CHOP, from otolaryngology and urology, neurosurgery, plastic surgery, and orthopaedics. Each group is or will be represented by a CORES patient and family partner – individuals who are either patients living with a surgical condition, or the caregivers of these patients to reflect a broad spectrum of patient priorities and inform patient-centered practices.

A current project involved with CORES includes a larger-scale comparative effectiveness trial from the Division of Otolaryngology (also known as Ear, Nose, and Throat) to understand the role of adjuvant adenoidectomy for patients who require tubes for recurrent otitis media, an infection of the middle ear that causes inflammation and a build-up of fluid behind the eardrum.

“What is exciting to me is not one project in particular,” Dr. Tasian said, “but rather the diversity of what they reflect in terms of scope, scale, and impact. One of our strengths is our ability to meet the needs of surgeon investigators with either small, discrete projects or larger ones that draw in multiple resources CORES can provide.”

As CORES grows, they plan to launch a pilot grant program in two phases aimed to reduce barriers faced by surgeons, usually in the form of access to data support, time to perform research, and writing grant applications. The initial phase will offer two $25,000 awards to generate preliminary data that can support future extramural grant applications. The second phase will be larger pilot grants for larger scale patient-centered comparative effectiveness research.