Project Summary

PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.

This PCORI-funded implementation project is using the validated Child Health Ratings Inventories (CHRIS) to self-report how treatments affect their quality of life.

About 165,000 children in the United States have type 1 diabetes. New treatments and technology, such as continuous glucose monitoring and insulin pumps, can improve blood sugar levels in children. But little is known about how treatments affect children’s quality of life.

What is the goal of this implementation project?

Patients often take surveys about their health or quality of life. Results from these surveys can help clinicians, such as doctors and nurses, understand how treatments affect patients’ quality of life. Young children can’t fill out surveys by themselves. Most often, parents or hospital staff read survey questions aloud, or parents answer the questions for their children. But this method may not give accurate results.

A PCORI funded study showed that CHRIS surveys were accurate and reliable measures of health and quality of life, even for young children. With CHRIS, a computer program reads the survey questions aloud. The surveys are animated, and answer choices appear as cartoons. CHRIS is available in English and Spanish.

This project will make the CHRIS part of healthcare visits for children with type 1 diabetes and their families. Clinicians and families can use the quality of life information children report using CHRIS to help make treatment decisions that work best for each child.

What will this project do?

The project team is putting CHRIS in place for diabetes care at three sites: two children’s hospitals in California and one children’s hospital with five clinics in Massachusetts. The team is

  • Working with sites to add CHRIS into their health record systems to set up email reminders for families about completing CHRIS
  • Setting up a system that collects and analyzes completed CHRIS surveys and makes the results available immediately to both patients and clinicians
  • Creating materials for families and clinicians, including tip-sheets and videos showing examples of how children, parents, and clinicians can discuss CHRIS
  • Training families and clinicians on how to use CHRIS during office visits
  • Setting up ways to track clinicians’ responses to CHRIS results
  • Providing clinicians with ongoing consults and troubleshooting

Children between the ages of 4 and 12 who have a recent diagnosis of type 1 diabetes or a change in treatment and their families will use the CHRIS to report on children’s quality of life.

What is the expected impact of this project?

The project will show what is required to put CHRIS in place at new healthcare sites. The project evaluation will look at whether CHRIS is working as intended to improve children’s health and quality of life. All sites plan to continue using CHRIS after the project ends.

Through this project, at least 800 families and their clinicians will receive new information on children’s self-reported health and quality of life to help in their decisions.

More about this implementation project:

Stakeholders Involved in This Project

  • Family Advisory Council at Children’s Hospital of Orange County (CHOC)
  • PADRE Foundation
  • American Diabetes Association, including the local New England and Los Angeles offices of the ADA
  • Diabetes Self-Management Education and Support program

Implementation Strategies

  • Adapt the CHRIS survey by incorporating it into an electronic system that includes clinical decision support.
  • Adapt the CHRIS system to work for sites’ existing resources and workflows.
  • Adapt sites’ electronic health record systems to support use of the CHRIS survey results.
  • Use data warehousing techniques to store, analyze, and access CHRIS survey information.
  • Provide sites with IT and other tools to support implementation, including algorithms to automate survey scoring, alerts and reminders for families to complete the CHRIS and for clinicians to view them, and communication scripts.
  • Provide educational materials to families, in person, as well as through videos.
  • Train clinicians, in-person and online, to use the CHRIS and discuss and interpret results.
  • Identify and prepare physician champions at sites.
  • Provide technical assistance to sites, including consultation.

Evaluation Outcomes

To document implementation:

  • Number of patients completing the CHRIS and frequency of completion
  • Clinician use of CHRIS portal, scores, and reports
  • Changes in clinician practice
  • Changes in patient-provider communication
  • Patient and clinician satisfaction
  • Additional measures of acceptability, feasibility, and fidelity
  • Implementation barriers and facilitators

To assess healthcare and health outcomes:

  • Glycemic control (HbA1c and time-in-target glucose values)
  • Children’s quality of life
  • Tailoring of diabetes treatment strategies
  • Emergency department and hospital visits for diabetes

Project Information

Sherrie H. Kaplan, PhD, MPH
University of California, Irvine

Key Dates

November 2019
April 2024

Initial PCORI-Funded Research Study

This implementation project focuses on putting findings into practice from this completed PCORI-funded research study: Developing and Testing Animated Computer Surveys for Measuring Young Children's Health



Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
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Last updated: March 15, 2024