Current Research and Scholarly Interests
The major emphasis of my work in the past 2decades has been focused on the future of academic pediatrics and pediatric rheumatology through providing training, research opportunities and environments to nurture and challenge future pediatric rheumatologists and subspecialists. Since 2012, my scope has expanded to include improving care for children with medical complexity and how to improve the resilience, well-being and sense of purpose in work for the clinical care team.
In the area of pediatric rheumatology, I am a founder of the pediatric rheumatology research network (Childhood Arthritis and Rheumatology Research Alliance -CARRA) in 2002, and currently the Chair of the Board of Directors. CARRA now includes the vast majority of practicing pediatric rheumatologists and trainees in the US and Canada with over 500 members and 110 sites. The network supports a broad variety of clinical, epidemiologic, translational research, biospecimen repository and clinical trials, with multiple funding sources from NIH, Arthritis Foundation, not-for-for profit foundations and biopharma. Through CARRA I have been the PI and co-PI of 2 major NIAMS funded innovative clinical trials (Atherosclerosis Prevention in Pediatric Lupus Erythematosus--APPLE and Randomized Placebo Phase of Rilonacept Treatment in systemic JIA (RAPPORT)) as well as site PI for multiple others. I was one of 4 PIs on a large ARRA Grant to develop a registry for pediatric rheumatic diseases. This Registry has grown into the largest registry for pediatric rheumatic diseases and is the platform for multiple pragmatic clinical trials, phase 4 clinical studies, linked biospecimens for translational research, and multiple epidemiologic studies. The Arthritis Foundation has been a generous supporter of the Registry for the past several years.
At Stanford, in addition to work with the research network, I have focused my scholarly work on the related areas of faculty and trainee career development and mentoring, and wellness and professional fulfillment for the entire clinical team. In the past 5-6 years I have participated in physician wellness projects and the Stanford WellMD Center. My interest in resilience, wellbeing and professional fulfilment for non physician staff at LPCH has led to a collaboration with Greg Souza, LPCH Chief Human Resource Officer on developing a resilient and engaged workforce as one of the 5 core goals for LPCH in the past 2 years.
Since early 2011, I have expanded my interest to encompass health care delivery, extending my interest in children with rheumatic chronic illness to broadly study the most complex and highest cost children across all diagnoses. . LPCH, a high quality tertiary and quaternary institution, provides an outstanding venue to study and test innovative models of care with an emphasis on the most complex and chronically ill children, with very high costs of care. The rich collaboration between pediatric faculty and researchers, LPCH Family Centered Care programs, and many others, has led to the design and implementation of the LPCH Complex Care Model, called CORE for "Coordinating and Optimizing Resources Effectively. The basic premise of the model is to create true partnerships between patients and families, providers --both subspecialty and primary care providers, and the community to improve the quality and outcomes while decreasing costs across the entire continuum of care. I was the site PI for a multicenter Children's Hospital Association Centers for Medicare and Medicaid innovation grant which demonstrated decreased hospitalizations and ED visits for children with high medical complexity. In addition self-efficacy and management skills for parents were improved as well as satisfaction and engagement in care.