Heather McPhillips

University of Washington Seattle, Seattle, Washington, United States

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Publications (27)131.32 Total impact

  • Academic Pediatrics 07/2014; 14(4):e6–e7. DOI:10.1016/j.acap.2014.05.029 · 2.23 Impact Factor
  • 06/2014; 6(2):380-2. DOI:10.4300/JGME-D-14-00087.1
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    ABSTRACT: An effective working relationship between chief residents and residency program directors is critical to a residency program's success. Despite the importance of this relationship, few studies have explored the characteristics of an effective program director-chief resident partnership or how to facilitate collaboration between the 2 roles, which collectively are important to program quality and resident satisfaction. We describe the development and impact of a novel workshop that paired program directors with their incoming chief residents to facilitate improved partnerships. The Accreditation Council for Graduate Medical Education sponsored a full-day workshop for residency program directors and their incoming chief residents. Sessions focused on increased understanding of personality styles, using experiential learning, and open communication between chief residents and program directors, related to feedback and expectations of each other. Participants completed an anonymous survey immediately after the workshop and again 8 months later to assess its long-term impact. Participants found the workshop to be a valuable experience, with comments revealing common themes. Program directors and chief residents expect each other to act as a role model for the residents, be approachable and available, and to be transparent and fair in their decision-making processes; both groups wanted feedback on performance and clear expectations from each other for roles and responsibilities; and both groups identified the need to be innovative and supportive of changes in the program. Respondents to the follow-up survey reported that workshop participation improved their relationships with their co-chiefs and program directors. Participation in this experiential workshop improved the working relationships between chief residents and program directors. The themes that were identified can be used to foster communication between incoming chief residents and residency directors and to develop a curriculum for chief resident development.
    12/2011; 3(4):593-7. DOI:10.4300/JGME-D-10-00226.1
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    ABSTRACT: Hospital quality improvement initiatives are becoming increasingly common. Little is known about the influence of these initiatives on resident learning and attitudes. Our objective was to assess whether training in a hospital committed to involving residents in hospital-initiated, continuous quality improvement (CQI), and to participation in such activities, would influence residents' attitudes toward CQI and engagement in the hospital community. We surveyed Seattle Children's Hospital pediatric residents, from residency graduation years 2002-2009. We included questions about participation in quality improvement activities during residency and measures of attitude toward CQI and of workplace engagement. We used descriptive statistics to assess trends in resident participation in hospital CQI activities, attitudes toward CQI and workplace engagement. The overall response rate was 84% (162 of 194). Among graduated residents, there was a significant trend toward increased participation in CQI activities (P  =  .03). We found no difference in attitude toward CQI between those who had and those who had not participated in such activities nor between residents who began training before and those who began after the hospital formally committed to CQI. Sixty-three percent of residents (25 of 40) who participated in CQI activities were engaged in the hospital community compared with 53% (57 of 107) who did not participate in CQI activities (P  =  .21). Training in a hospital committed to involving residents in CQI was associated with a high rate of participation in CQI activities. Although such training and participation in CQI were not associated with resident attitudes toward CQI or hospital engagement, it may allow residents to learn skills for practice-based learning and improvement and systems-based practice.
    09/2011; 3(3):315-9. DOI:10.4300/JGME-D-10-00179.1
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    ABSTRACT: Calcium channel blockers and beta-blockers (BBs) are widely used during pregnancy, but data on their safety for the developing infant are scarce. We used population-based data from 5 HMOs to study risks for perinatal complications and congenital defects among infants exposed in-utero. We studied women older than 15 years delivering an infant between 1/1/96 and 12/31/00, who had been continuously enrolled with prescription drug coverage for ≥ 1 year prior to delivery. Information on prescription drug dispensings, inpatient, and outpatient diagnoses and procedures was obtained from automated databases at each HMO. There were 584 full-term infants exposed during pregnancy to BBs and 804 full-term infants exposed to calcium-channel blockers, and over 75,000 unexposed mother-infant pairs with ≥ 30 days follow-up. Infants exposed to BBs in the third trimester of pregnancy had over threefold increased risk for hypoglycemia (RR 3.1; 95% CI 2.2, 4.2) and an approximately twofold increased risk for feeding problems (RR 1.8; 95% CI 1.3, 2.5). Infants exposed to calcium-channel blockers in the third trimester had an increased risk for seizures (RR 3.6 95% CI 1.3, 10.4). Chart review confirmed the majority of the exposed seizure and hypoglycemia cases. There were no increased risks for congenital anomalies among either group of infants, except for the category of upper alimentary tract anomalies; this increased risk was based on only two exposed cases. Infants whose mothers receive BBs are at increased risk for neonatal hypoglycemia, while those whose mothers take calcium-channel blockers are at increased risk for neonatal seizures.
    Pharmacoepidemiology and Drug Safety 02/2011; 20(2):138-45. DOI:10.1002/pds.2068 · 3.17 Impact Factor
  • Shaquita L. Bell, Heather A. McPhillips, Richard P. Shugerman
    Academic Pediatrics 07/2010; 10(4):e6. DOI:10.1016/j.acap.2010.04.008 · 2.23 Impact Factor
  • Heather A McPhillips
    The Journal of pediatrics 07/2010; 157(1):170-1. DOI:10.1016/j.jpeds.2010.05.008 · 3.74 Impact Factor
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    ABSTRACT: Background: While medication use to manage cardiovascular disease during pregnancy is widespread, data on its safety for the developing infant is scarce. We used population-based data from 5 HMOs to study risks for perinatal complications and congenital defects among infants exposed in-utero to beta -blockers and calcium-channel blockers. Methods: We studied women older than 15 years who delivered an infant between 1/1/96 to 12/31/00, and who had been continuously enrolled with prescription drug coverage for one year prior to delivery. We further limited our study to mother-infant pairs with 30 and 365 days follow-up for the evaluation of perinatal outcomes and congenital anomalies, respectively. Information on prescription drug dispensing, and inpatient and outpatient diagnoses and procedures was obtained from automated databases at each health plan. Results: There were a total of 87,407 mother-infant pairs with at least 30 days follow- up in the five health plans. Of these, a total of 405 full- term infants were exposed during pregnancy to beta-blockers and 721 full- term infants were exposed to calcium-channel blockers. Infants exposed to beta-blockers in the third trimester of pregnancy were at over three-fold increased risk for hypoglycemia (RR 3.1; 95% CI 2.2, 4.2), for feeding problems (RR 1.8; 95% CI 1.3, 2.5) and for prolonged hospitalization (RR 2.0; 95% CI 1.3, 3.1). Infants exposed to calcium-channel blockers in the third trimester had an increased risk for neonatal seizures (RR 3.6; 95% CI 1.3, 10.4), and for hematological disorders (RR 2.6; 95% 1.4, 5.1). A chart review confirmed the seizures and hypoglycemia cases but found no serious hematologic conditions common to the calcium-channel exposed infants. There were no increased risks for congenital anomalies among either group of infants. Conclusions: Infants whose mothers receive beta-blockers are at increased risk for neonatal hypoglycemia. Beta-blockers can cross the placenta, increasing insulin and decreasing glucagon in the newborn, leading to hypoglycemia. Infants whose mothers take calcium-channel blockers are at increased risk for neonatal seizures, although the mechanism leading to this increased risk is less clear. These data should be disseminated to the obstetric and neonatal community so that appropriate newborn management strategies may be developed.
    Clinical Medicine &amp Research 03/2010; 8(1):57. DOI:10.3121/cmr.8.1.57-a
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    ABSTRACT: To determine the prevalence of persistent pulmonary hypertension of the newborn (PPHN) among infants whose mothers were exposed to antidepressants in the third trimester of pregnancy compared to the prevalence among infants whose mothers were not exposed to antidepressants in the third trimester. A retrospective study was conducted using the automated databases of four health plans participating in the HMO Research Network Center for Education and Research on Therapeutics. Women who delivered an infant in a hospital from 1 January 1996 through 31 December 2000 were identified. The administrative databases were used to identify full-term infants whose mothers received an antidepressant during the third trimester of pregnancy and unexposed infants whose mothers did not receive an antidepressant during the third trimester. Hospitalization data were used to identify diagnoses or procedure codes potentially indicative of PPHN. Among 1104 infants exposed to antidepressants in the third trimester and a matched sample of 1104 unexposed infants, five infants were classified by the expert reviewers as having PPHN. Among those infants whose mothers were exposed to selective serotonin reuptake inhibitors (SSRIs) in the third trimester, the prevalence of PPHN was 2.14 per 1000 (95% confidence interval (CI) 0.26, 7.74), while the prevalence among infants whose mothers were not exposed was 2.72 per 1000 (95%CI 0.56, 7.93). We did not find an association between SSRI use in late pregnancy and PPHN. Limitations of the present study, including the small number of confirmed cases, suggest further research in this area may be warranted.
    Pharmacoepidemiology and Drug Safety 03/2009; 18(3):246-52. DOI:10.1002/pds.1710 · 3.17 Impact Factor
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    ABSTRACT: The National Residency Matching Program allows match participants to recruit each other and try to influence future ranking decisions in their favor, but it also states that participants "must not make statements implying commitment." The National Residency Matching Program cautions against statements such as, "We plan to rank you very highly on our list," because they can be misinterpreted as an informal commitment. To avoid issues around miscommunication, the University of Washington Pediatric Residency Program instituted a postinterview no-call policy with applicants. The purpose of this study was to determine this policy's impact on applicants. A Web-based, anonymous survey was sent after the National Residency Matching Program deadline for submitting rank lists but before match day to applicants who interviewed at our program from 2003 to 2006. Applicants were asked whether our program's position on their rank list would have been influenced more favorably, less favorably, or not at all had they received a telephone call from our program. The survey response rate was 53% (n = 468). A total of 10.3% (n = 48) of the applicants to our program would have been favorably influenced by a telephone call after their interview. Significantly more applicants reported that a recruiting call from our program would have caused them to rank our program more favorably in 2006 (17.2%) than in 2003-2005 combined (8.4%). We identified a vulnerable applicant population whose rank lists are potentially influenced by questionable postinterview communication from residency programs. To protect the integrity and fairness of the match, we call for more explicit guidelines regarding postinterview communication with applicants.
    PEDIATRICS 11/2007; 120(4):e826-31. DOI:10.1542/peds.2006-3189 · 5.30 Impact Factor
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    ABSTRACT: To determine factors associated with satisfaction and burnout in pediatric department chairs. A 1-time online survey of 250 current and former pediatric chairs who were members of Association of Medical School Pediatric Department Chairs anytime between 1993 and 2005. The questionnaire included demographics, satisfaction levels, stress experienced, and time spent on various work activities. We also included the Maslach Burnout Inventory-Human Services Survey and the abbreviated Workplace Climate Questionnaire. Burnout was defined as high scores on the depersonalization or emotional exhaustion subscales of the Maslach Burnout Inventory-Human Services Survey. Our response rate was 62%; most chairs (65%) reported being very satisfied with their job. Approximately 30% of chairs for <5 years experienced burnout, compared with 15% of chairs who held their positions for >5 years (P < .05). Factors associated with burnout included years as chair (odds ratio [OR], 0.9; 95% CI, 0.80-0.99), >1 night worked per week (OR, 5.9; 95% CI, 1.5-22.9), high workload (OR, 3.0; 95% CI, 1.3-6.7), and lack of supportive work environment (OR, 2.2; 95% CI, 1.1-4.2). Steps should be taken to decrease burnout in chairs, including policies that promote physician well being as integral to successful departments.
    The Journal of pediatrics 10/2007; 151(4):425-30. DOI:10.1016/j.jpeds.2007.03.016 · 3.74 Impact Factor
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    ABSTRACT: To evaluate risks for perinatal complications and congenital defects among infants exposed in utero to antidepressants. We identified 2201 women who were prescribed an antidepressant during pregnancy and who delivered an infant within one of five large managed care organizations (HMO). Prescription drug dispensings and inpatient and outpatient diagnoses were obtained from automated databases at each HMO. Antidepressants were categorized into tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs), and medication timing was assessed by trimester. Rates of congenital anomalies or perinatal complications were compared to infants whose mothers were not prescribed antidepressants during pregnancy. Infants exposed to SSRIs or TCAs during pregnancy had a significant increase in preterm delivery risk. Fullterm infants exposed to SSRIs during the third trimester had an increased risk for respiratory distress syndrome, endocrine and metabolic disturbances, hypoglycemia, temperature regulation disorders, and convulsions. Third-trimester exposure to TCAs was also associated with an increased risk for respiratory distress syndrome, endocrine and metabolic disturbances, and temperature regulation disorders. There were 182 infants exposed to Paroxetine, and these infants did not have an increased risk of cardiac septal defects. SSRIs and TCAs did not show a consistent link with congenital anomalies. Paroxetine exposure was not linked with an increased risk for cardiovascular anomalies, although our study power to detect a moderate increase in risk was limited. Infants exposed to antidepressants were at increased risk for preterm delivery. Both SSRIs and TCAs used during the third trimester appeared to increase the risk for perinatal complications and their use should be managed carefully among pregnant women with depression.
    Pharmacoepidemiology and Drug Safety 10/2007; 16(10):1086-94. DOI:10.1002/pds.1462 · 3.17 Impact Factor
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    ABSTRACT: The objective was to determine baseline characteristics of pediatric residency training programs and academic departments in regard to family-friendly work environments as outlined in the Report of the Task Force on Women in Pediatrics. We conducted Web-based anonymous surveys of 147 pediatric department chairs and 203 pediatric program directors. The chair's questionnaire asked about child care, lactation facilities, family leave policies, work-life balance, and tenure and promotion policies. The program director's questionnaire asked about family leave, parenting, work-life balance, and perceptions of "family-friendliness." The response rate was 52% for program directors and 51% for chairs. Nearly 60% of chairs reported some access to child care or provided assistance locating child care; however, in half of these departments, demand almost always exceeded supply. Lactation facilities were available to breastfeeding faculty in 74% of departments, although only 57% provided access to breast pumps. A total of 78% of chairs and 90% of program directors reported written maternity leave policies with slightly fewer reporting paternity leave policies. The majority (83%) of chairs reported availability of part-time employment, whereas only 27% of program directors offered part-time residency options. Most departments offered some flexibility in promotion and tenure. Although progress has been made, change still is needed in many areas in pediatric departments and training programs, including better accessibility to quality child care; improved lactation facilities for breastfeeding mothers; clear, written parental leave policies; and flexible work schedules to accommodate changing demands of family life.
    PEDIATRICS 04/2007; 119(3):e596-602. DOI:10.1542/peds.2006-2397 · 5.30 Impact Factor
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    ABSTRACT: PURPOSE: To estimate the prevalence of use of prescription drugs with a potential for fetal harm among pregnant women in the United States. METHODS: A retrospective study was conducted using the automated databases of eight health maintenance organizations involved in the HMO Research Network Center for Education and Research on Therapeutics (CERT). Women who delivered an infant from January 1996 to December 2000 were identified. The frequency of use of prescription drugs with a potential for fetal harm was based upon the expert review of a clinical teratologist and the U.S. Food and Drug Administration (FDA) risk classification system, assuming a gestational duration of 270 days. RESULTS: Among the 114 165 women with no documentation of a diagnosis suggesting potential pre-term birth or dispensing of ovulation stimulants in the 270 days before delivery, 1305 (1.1%) received a teratogenic drug during the 270 days before delivery, based upon the expert review of a clinical teratologist. A larger proportion of women received U.S. FDA category D or X drugs (5.8%; N = 6600). However, the general patterns of use were similar, with higher use in early pregnancy compared to later trimesters. The proportion of women dispensed a teratogen during pregnancy was substantially higher among women who received a teratogen in the 90 days before pregnancy compared to women who did not (adjusted RR = 38.9, 95%CI, 33.5, 45.3). CONCLUSIONS: Our results suggest that further efforts directed at physicians to counsel women or at the women themselves about the potential risks of particular medications appear warranted. Copyright 2006 John Wiley & Sons, Ltd.
    Pharmacoepidemiology and Drug Safety 08/2006; 15(8):546-54. · 3.17 Impact Factor
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    ABSTRACT: To estimate the prevalence of use of prescription drugs with a potential for fetal harm among pregnant women in the United States. A retrospective study was conducted using the automated databases of eight health maintenance organizations involved in the HMO Research Network Center for Education and Research on Therapeutics (CERT). Women who delivered an infant from January 1996 to December 2000 were identified. The frequency of use of prescription drugs with a potential for fetal harm was based upon the expert review of a clinical teratologist and the U.S. Food and Drug Administration (FDA) risk classification system, assuming a gestational duration of 270 days. Among the 114 165 women with no documentation of a diagnosis suggesting potential pre-term birth or dispensing of ovulation stimulants in the 270 days before delivery, 1305 (1.1%) received a teratogenic drug during the 270 days before delivery, based upon the expert review of a clinical teratologist. A larger proportion of women received U.S. FDA category D or X drugs (5.8%; N = 6600). However, the general patterns of use were similar, with higher use in early pregnancy compared to later trimesters. The proportion of women dispensed a teratogen during pregnancy was substantially higher among women who received a teratogen in the 90 days before pregnancy compared to women who did not (adjusted RR = 38.9, 95%CI, 33.5, 45.3). Our results suggest that further efforts directed at physicians to counsel women or at the women themselves about the potential risks of particular medications appear warranted.
    Pharmacoepidemiology and Drug Safety 08/2006; 15(8):546-54. DOI:10.1002/pds.1235 · 3.17 Impact Factor
  • Teodor Butiu, Heather McPhillips
    Critical Care Medicine 12/2005; 33. DOI:10.1097/00003246-200512002-00247 · 6.15 Impact Factor
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    ABSTRACT: To determine the prevalence of potential dosing errors of medication dispensed to children for 22 common medications. Using automated pharmacy data from 3 health maintenance organizations (HMOs), we randomly selected up to 120 children with a new dispensing prescription for each drug of interest, giving 1933 study subjects. Errors were defined as potential overdoses or potential underdoses. Error rate in 2 HMOs that use paper prescriptions was compared with 1 HMO that uses an electronic prescription writer. Approximately 15% of children were dispensed a medication with a potential dosing error: 8% were potential overdoses and 7% were potential underdoses. Among children weighing <35 kg, only 67% of doses were dispensed within recommended dosing ranges, and more than 1% were dispensed at more than twice the recommended maximum dose. Analgesics were most likely to be potentially overdosed (15%), whereas antiepileptics were most likely potentially underdosed (20%). Potential error rates were not lower at the site with an electronic prescription writer. Potential medication dosing errors occur frequently in outpatient pediatrics. Studies on the clinical impact of these potential errors and effective error prevention strategies are needed.
    Journal of Pediatrics 12/2005; 147(6):761-7. DOI:10.1016/j.jpeds.2005.07.043 · 3.74 Impact Factor
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    ABSTRACT: Language barriers may lead to medical errors by impeding patient-provider communication. The objective of this study was to determine whether hospitalized pediatric patients whose families have language barriers are more likely to incur serious medical errors than patients whose families do not have language barriers. A case-control study was conducted in a large, academic, regional children's hospital in the Pacific Northwest. Case patients (n = 97) included all hospitalizations of patients who were younger than 21 years and had a reported serious medical event from January 1, 1998, to December 31, 2003. Control patients (n = 475) were chosen from hospitalizations without a reported serious medical event and were matched with case patients on age, admitting service, admission to intensive care, and date of admission. The main exposure was a language barrier defined by self- or provider-reported need for an interpreter. Serious medical events were defined as events that led to unintended or potentially adverse outcomes identified by the hospital's quality improvement staff. Fourteen (14.4%) of the case patients and 53 (11.2%) of the control patients were assigned an interpreter during their hospitalization. Overall, we found no increased risk for serious medical events in patients and families who requested an interpreter compared with patients and families who did not request an interpreter (odds ratio: 1.36; 95% confidence interval: 0.73-2.55). Spanish-speaking patients who requested an interpreter comprised 11 (11.3%) of the case patients and 26 (5.5%) of the control patients. This subgroup had a twofold increased risk for serious medical events compared with patients who did not request an interpreter (odds ratio: 2.26; 95% confidence interval: 1.06-4.81). Spanish-speaking patients whose families have a language barrier seem to have a significantly increased risk for serious medical events during pediatric hospitalization compared with patients whose families do not have a language barrier.
    PEDIATRICS 10/2005; 116(3):575-9. DOI:10.1542/peds.2005-0521 · 5.30 Impact Factor
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    ABSTRACT: Although children are prescribed medications in 30 percent to 50 percent of clinic visits, little is known about medication errors in ambulatory pediatrics. In the process of completing a study to determine the prevalence of outpatient dosing errors, we identified a number of barriers to understanding the epidemiology of medication errors in children. These barriers include prescribing medication that is not labeled for use in children, discrepancies in published dosing recommendations for many medications, unclear guidelines on use of adult dosing recommendations for children of different ages and weights, and the lack of readily available documented weights to determine appropriate weight-based doses for children. In our study of pediatric medication errors, we found a wide range of doses prescribed to children for every medication we studied. Before we can truly understand medication errors in children and begin developing systems-based approaches to eliminating these errors, we need better national standards of medication doses that are appropriate for children and an improved ability to determine errors through databases that include children's weights as well as prescription information.
    Advances in Patient Safety: From Research to Implementation (Volume 2: Concepts and Methodology), Edited by Kerm Henriksen, James B Battles, Eric S Marks, David I Lewin, 01/2005; Agency for Healthcare Research and Quality (US).
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    ABSTRACT: The purpose of this study was to provide information on the prevalence of the use of prescription drugs among pregnant women in the United States. A retrospective study was conducted with the use of the automated databases of 8 health maintenance organizations that are involved in the Health Maintenance Research Network Center for Education and Research on Therapeutics. Women who delivered of an infant in a hospital from January 1, 1996, through December 31, 2000, were identified. Prescription drug use according to therapeutic class and the United States Food and Drug Administration risk classification system was evaluated, with the assumption of a gestational duration of 270 days, with three 90-day trimesters of pregnancy, and with a 90-day period before pregnancy. Nonprescription drug use was not assessed. During the period 1996 through 2000, 152,531 deliveries were identified that met the criteria for study. For 98,182 deliveries (64%), a drug other than a vitamin or mineral supplement was prescribed in the 270 days before delivery: 3595 women (2.4%) received a drug from category A; 76,292 women (50.0%) received a drug from category B; 57,604 women (37.8%) received a drug from category C; 7333 women (4.8%) received a drug from category D, and 6976 women (4.6%) received a drug from category X of the United States Food and Drug Administration risk classification system. Overall, 5157 women (3.4%) received a category D drug, and 1653 women (1.1%) received a category X drug after the initial prenatal care visit. Our finding that almost one half of all pregnant women received prescription drugs from categories C, D, or X of the United States Food and Drug Administration risk classification system highlights the importance of the need to understand the effects of these medications on the developing fetus and on the pregnant woman.
    American Journal of Obstetrics and Gynecology 09/2004; 191(2):398-407. DOI:10.1016/j.ajog.2004.04.025 · 3.97 Impact Factor

Publication Stats

1k Citations
131.32 Total Impact Points

Institutions

  • 2007–2014
    • University of Washington Seattle
      • Department of Pediatrics
      Seattle, Washington, United States
    • Seattle Children's Hospital
      • Children's Hospital and Regional Medical Center
      Seattle, Washington, United States
    • Wayne State University
      • Department of Pediatrics
      Detroit, Michigan, United States
    • Group Health Cooperative
      • Group Health Research Institute
      Seattle, Washington, United States
  • 2005
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2001
    • Institute for Child Health Policy (ICHP)
      • Department of Pediatrics
      Seattle, Washington, United States