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National Academy of Medicine Elects Christopher Forrest, MD, PhD
Editor's Note: Join us in congratulating two outstanding individuals from CHOP Research Institute elected to the National Academy of Medicine class of 2023. Read more below about the visionary work of Christopher Forrest, MD, PhD, Director of the Center for Applied Research at CHOP. And then learn about the accomplishments of Susan Furth, MD, PhD, Executive Vice President and Chief Scientific Officer.
Working with Children's Hospital of Philadelphia's Homeless Health Initiative in the 1990s, Christopher Forrest, MD, PhD, and fellow CHOP residents would visit West Philadelphia's women and children's homeless shelters. Though he had not yet become an expert in outcomes research, it was evident to Dr. Forrest that a fragmented healthcare system prevented the city's most vulnerable children from receiving health services that they required.
Over two decades later, Dr. Forrest has led a remarkable evolution in how healthcare systems are studied and structured to provide the best possible outcomes for children. This year, the National Academy of Medicine (NAM) elected Dr. Forrest, who is Director of the Center for Applied Research at CHOP, to its class of 2023.
Considered one of the highest honors in health and medicine, the election reflects the breadth and depth of Dr. Forrest's work pioneering new fields in health services research and establishing multicenter, large-scale networks to support pediatric science.
"If healthcare organizations want to improve, we can't work alone," Dr. Forrest said. "I believe this [election] is the culmination of collaborations that I've had over 25 years with thousands of different people, so it's truly an honor that reflects a joint effort."
As a NAM member, Dr. Forrest will take his visionary leadership further, joining a legacy of influential medical and scientific professionals who are shaping health research, practice, and policies to improve outcomes and achieve equity for millions around the world.
Creating Health Systems That 'Learn'
Within the wider health services research field, Dr. Forrest played a pivotal role in pioneering the science of learning health systems (LHS) and applying it to pediatrics. Through LHS, clinicians and researchers turn their organizations into "learning systems," working within a collaborative infrastructure of gathering data, generating new knowledge, and then applying that knowledge to improve outcomes.
Arguably the best and biggest example of Dr. Forrest's transformative LHS work is his development of PEDSnet, a national, pediatric-specific consortium combining clinical data from nine U.S. children's hospitals and several specialty disease networks.
PEDSnet was born out of a meeting Dr. Forrest hosted in 2009 at the NAM (then called the Institute of Medicine), where 25 institutions gathered to discuss "a world where [institutions] work together, share data, and advance knowledge." The meeting led to funding from the Patient-Centered Outcomes Research Institute (PCORI) to flesh out the concept of a large-scale pediatric clinical research network.
Today, PEDSnet is the largest pediatric data set in the world, providing its researchers and clinicians access to diverse, nationally representative health information from millions of children. On any given day, 10 percent of all children in the U.S. visit a PEDSnet institution.
"Because we capture that data, we're truly understanding what is happening to U.S. children in a real-time way, and it completely changes how research is conducted," Dr. Forrest said.
PEDSnet has immense impact in rare disease research, where a single institution likely does not have enough patients to generate participants for a study.
"There are close to 10,000 different diseases that are cared for at CHOP, and you can imagine there aren't enough patients to understand what's going on for all of those rare diseases," Dr. Forrest said. "[PEDSnet] has a database of about 13 million kids. When you go from a couple hundred patients to millions, the kinds of questions that you can ask are very different. And because the numbers are so large, the ability to change the way that kids receive care goes up, too."
In CHOP's Division of Nephrology, investigators work with PEDSnet to break down the barriers of clinical studies for pediatric chronic kidney disease.
"If I am a nephrologist who wants to study a rare disease in children, I will be able to use the information synthesized from electronic health records across these hospitals to identify children who have that diagnosis," said Susan Furth, MD, PhD, Executive Vice President and Chief Scientific Officer at CHOP Research Institute, in a 2019 Cornerstone story. "And then for observational studies, I potentially could look at how they were treated at these hospitals and how those treatments affected outcomes."
In addition to PEDSnet, Dr. Forrest was appointed to the chair of the research committee of PCORnet, another national patient-centered clinical research network, in 2016. Also funded by PCORI, it's wider "net" of 80 million participants includes adults and combines data from 33 smaller networks (including PEDSnet). During the COVID-19 pandemic, Dr. Forrest was one of the designers and leads for the Healthcare Worker Exposure Response and Outcomes Registry, an initiative that utilized PCORnet data to understand the needs and concerns of healthcare workers during the pandemic.
Learning Across the Lifespan
Today, Dr. Forrest continues to work with colleagues across the nation to develop yet another novel field in health services research: life course health science (LCHS). LCHS examines how an individual's dynamic interactions with their environments can affect their health over the lifespan.
"PEDSnet is gratifying, but we're not done yet," Dr. Forrest said. "We need to figure out how to create communities that enable children and families who live healthier lives so that they don't require the healthcare services to begin with. Through LCHS, we are moving outside the boundaries of the healthcare system and looking at the developmental ecosystems in which children grow, learn, play, and make friends so that we can invest in them to become healthier adults."
In what has become another gratifying dimension of his career, Dr. Forrest has taken a leadership role in training and educating healthcare professionals in these new research fields. In 2017, Dr. Forrest co-authored a founding paper for the Agency for Healthcare Research and Quality outlining the unique skills that LHS researchers need to be successful and identifying core competencies to guide their future training requirements and curricula.
"Over the last five years, we've trained 30 faculty from across the country in LHS science using a very innovative education model national in scope," Dr. Forrest said.
More recently, Dr. Forrest co-edited the new Handbook of Life Course Health Development, which has been downloaded over 900,000 times from the publisher's website. Dr. Forrest plans to continue catalyzing LCHS in the coming years, offering a modern perspective on health and wellbeing that combines medicine with public health and guides future practice and policies in Pediatrics.
"Dr. Forrest is an internationally recognized investigator and has made transformative contributions to the fields of learning health system science, patient-reported outcomes, and health services research," said Joseph W. St. Geme, III, MD, Physician-in-Chief and Chair of the Department of Pediatrics at CHOP. "Among other major accomplishments, he founded PEDSnet, a national network of children's hospitals devoted to sharing electronic health record data to support multi-institutional clinical research, developing data science and statistical methods for learning health system research, and driving health system improvements. His election to the National Academy of Medicine is a reflection on his enormous impact on improving child and adolescent health."