Pediatric critical care faculty in CHEAR have conducted several clinical studies evaluating the outcomes of children with critical illness, including those undergoing extracorporeal membrane oxygenation (ECMO). These faculty have also conducted health services research studies examining what happens to children after they are discharged from a hospitalization for critical illness.

For example, their studies have shown that:

• Among children hospitalized for acute respiratory failure, two-thirds missed school after discharge, with a median duration of absence of 2 weeks
• 1 in 5 children who survive a hospitalization for sepsis develop a new chronic medical condition or a worsening of a pre-existing condition

CHEAR faculty have national research expertise on the care of children with several rare conditions, including sickle cell disease, Crohn’s disease, chronic kidney disease, newborn screening conditions, disorders of sex development, and spina bifida.

Their studies have shown that:

• Only 18% of young children with sickle cell disease regularly receive antibiotic prophylaxis, which can prevent life-threatening blood infections.
• Rates of perianal fistulas – a debilitating complication of Crohn’s disease – are lower when young patients use steroid-sparing therapy.
• Young adults with severe kidney failure have an elevated risk of death due to cardiovascular disease.

CHEAR faculty have published multiples studies on the topics of vaccine cost-effectiveness, decision-making, and uptake.

For example, these studies have:

• Evaluated the cost-effectiveness of the COVID-19 vaccine.
• Compared patient preferences for pediatric and adult COVID-19 vaccination.
• Documented declines in routine childhood and adolescent immunizations during the COVID-19 pandemic.
• Documented low rates of HPV vaccination among U.S. young adults and low rates of COVID-19 vaccination among people with sickle cell disease.

Additionally, CHEAR faculty helped design Michigan’s statewide immunization registry and continue to play an integral role in maintaining this registry.

CHEAR faculty have made important methodological contributions to the field of pediatric health services research, including:

• Leading efforts to develop measures of the spillover effects of pediatric illness on families.
• Developing a validated algorithm to identify children with sickle cell disease in administrative data.
• Developing novel measures of low-value, unnecessary health care in pediatrics, including inappropriate antibiotic prescribing.

CHEAR faculty have conducted studies on the burden of pediatric health care both on society and on families.

These studies have found that:

• The average privately insured family pays $1,300 out-of-pocket for a pediatric hospitalization, but 1 in 7 families pay more than $3,000.
• The average privately insured family pays almost $3,000 for childbirth hospitalizations, a total that increases sharply when the infant requires neonatal intensive care.
• Health care spending for severe pediatric sepsis hospitalizations is high and rising, with an estimated burden of $7 billion per year.