Office of Epidemiology and Research, Division of Research

Advancing Applied MCH Research

Primary Care Drug Therapeutics CER in a Pediatric EHR Network

Funded Projects Search


Project Number: R40MC24943
Grantee: Pediatric Research in Office Settings (PROS) Network of the American Academy of Pediatrics (AAP)
Department/Center: American Academy of Pediatrics
Project Date: 9/1/2012
Principal Investigator: Alexander Fiks

Final Report

Primary Care Drug Therapeutics CER in a Pediatric EHR Network Final Report (PDF) Exit Disclaimer


  • Perinatal/Infancy (0-12 months)
  • Toddlerhood (13-35 months)
  • Early Childhood (3-5 years)
  • Middle Childhood (6-11 years)
  • Adolescence (12-18 years)


PROBLEM: The nation lacks a system to employ routinely-collected electronic health record (EHR) data to conduct comparative effectiveness research (CER) on pediatric drug therapeutics. GOAL(S) AND OBJECTIVES: Pediatric Research in Office Settings (PROS) will take up the project goal of creating a fully elaborated system to employ clinical data in EHRs for conducting CER on pediatric drug therapeutics. PROS will link its own EHR-based ePROS network with experienced clinical informaticians at EHR-based networks at the Children's Hospital of Philadelphia, MetroHealth/Case Western Reserve, Boston University, and the American Academy of Family Physicians (AAFP). The "Comparative Effectiveness Research through Collaborative Electronic Reporting" (CER2) collaborators will undertake these objectives: (1) conduct four proof-of-concept CER studies on psychotropic and asthma medication use and side effects plus an additional full-scale CER study on treatment for pediatric hypertension (HTN); (2) advance the methodology of pediatric pharmacoepidemiological CER using EHR data; and (3) provide a platform for future CER studies in pediatric drug therapeutics and other topic areas. The CER2 collaborators will disseminate critical information on research findings on pediatric drug therapeutics to child health professionals, policy makers, and the public. METHODOLOGY: The CER2 collaborating sites will include 112 sites from around the country serving a racially and ethnically diverse group of over 800,000 children 0-18 years of age. EHR data definitions will be standardized across sites. Data will be locally extracted and deidentified and then transmitted securely to the data analysis team, where they will be stored on a secure server, aggregated, and analyzed. The proof-of-concept CER studies will provide new knowledge about the prevalence of atypical antipsychotic use and metabolic side effects, psychotropic polypharmacy, and prevalence and side effects of on and off-label use of asthma medications. The full-scale CER study of HTN will assess the prevalence of HTN, HTN diagnosis and medication management, and via a cluster randomized trial, test an EHR clinical decision support system to improve diagnosis and management of HTN, including the prescription of medication when indicated. DISSEMINATION OF RESULTS: Results from this work will be disseminated via publications and through collaborations with policymakers, educators, and leadership at both the AAP and AAFP in order to inform national guidelines, policies.


Listed is descending order by year published.

Czaja A, Fiks AG, Wasserman RC, Valuck RJ. Beyond the Label: Steering the Focus Towards Safe and Effective Prescribing. Pediatrics. 2017; 139(5): e20163518.

Daymont C, Ross ME, Russell Localio A, Fiks AG, Wasserman RC, Grundmeier RW. Automated identification of implausible values in growth data from pediatric electronic health records. J Am Med Inform Assoc. 2017; 24(6): 1080-7.

Fiks AG, Ross ME, Mayne SL, et al. Preschool ADHD diagnosis and stimulant use before and after the 2011 AAP practice guideline. PEDIATRICS. 2016;138(6):e20162025-e20162025.

Kaelber DC, Liu W, Ross M, et al. Diagnosis and medication treatment of pediatric hypertension: A retrospective cohort study. PEDIATRICS. 2016;138(6):e20162195-e20162195.

Mayne SL, Ross ME, Song L, et al. Variations in mental health diagnosis and prescribing across pediatric primary care practices. PEDIATRICS. 2016;137(5):e20152974-e20152974. doi:10.1542/peds.2015-2974.

Fiks AG, Grundmeier RW, Steffes J, et al. Comparative effectiveness research through a collaborative electronic reporting consortium. Pediatrics. 2015;136(1):e215-224.

Fiks AG. Centralized reminder/recall: collaboration to promote the effective use of technology. JAMA Pediatr. 2015;169(4):314-316.

Miller D, Noonan K, Fiks AG, Lehmann CU. Increasing pediatrician participation in EHR incentive programs. Pediatrics. 2015;135(1):e1-4.

Fiks AG, Grundmeier RW. Elucidating challenges and opportunities in the transition to ICD-10-CM. Pediatrics. 2014 Jul;134(1):169-70.

Grundmeier RW, Song L, Ramos MJ, Fiks AG, Elliott MN, Fremont A, Pace W, Wasserman RC, Localio R. Imputing Missing Race/Ethnicity in Pediatric Electronic Health Records: Reducing Bias with Use of U.S. Census Location and Surname Data. Health Serv Res. 2015 Mar 11.


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