CHOC recognized as one of nation’s best children’s hospitals

CHOC is one of a select group of pediatric facilities nationwide to have been ranked today as a best children’s hospital by U.S. News & World Report.

The following CHOC specialties are honored in the 2020-21 Best Children’s Hospitals rankings: neonatology; cancer; diabetes and endocrinology; neurology and neurosurgery; orthopaedics; pulmonology; and urology. Both orthopaedics and diabetes and endocrinology earned a “Top 20” spot.

“At CHOC, we are committed to the highest standards of care, safety and service – and this honor reflects that unwavering dedication,” said Dr. James Cappon, CHOC’s vice president, chief quality and patient safety officer and interim chief medical officer. “Not only does this recognition of our excellence in these subspecialties, including two on the top 20 lists, validate our efforts, but it also offers our patients and families additional assurance of our commitment to their health and safety.”

The Best Children’s Hospitals rankings were introduced by U.S. News in 2007 to help families of children with rare or life-threatening diseases find the best medical care available. Only the nation’s top 50 pediatric facilities are distinguished in 10 pediatric specialties, based on survival rates, nurse staffing, procedure and patient volumes, reputation and additional outcomes data. The availability of clinical resources, infection rates and compliance with best practices are also factored into the rankings.

The U.S. News Best Children’s Hospitals rankings rely on clinical data and on an annual survey of pediatric specialists. The rankings methodology factors in patient outcomes, such as mortality and infection rates, as well as available clinical resources and compliance with best practices.

Learn more about Best Children’s Hospitals rankings.

CHOC recognized as one of nation’s best children’s hospitals

CHOC is one of only 50 pediatric facilities in the nation to earn recognition as a best children’s hospital by U.S. News & World Report. The following CHOC specialties are honored in the 2019-20 Best Children’s Hospitals rankings: diabetes/endocrinology, cancer, neonatology, neurology/neurosurgery, pulmonology and urology. Cancer ranked in the “top 20.”

“The national recognition for CHOC’s cancer program is well-deserved. There’s nowhere else I’d rather have gone through treatment than CHOC,” says 17-year-old Sydney Sigafus, CHOC patient and cancer survivor. “Everyone who works at CHOC cares about you as a person, not just a patient. I was included in every decision and conversation about my care.”

The Best Children’s Hospitals rankings were introduced by U.S. News in 2007 to help families of children with rare or life-threatening diseases find the best medical care available. Only the nation’s top 50 pediatric facilities are distinguished in 10 pediatric specialties, based on survival rates, nurse staffing, procedure and patient volumes, reputation and additional outcomes data. The availability of clinical resources, infection rates and compliance with best practices are also factored into the rankings.

“We understand how scary it can be for parents whose children are dealing with life-threatening illnesses or injuries. That’s why we are committed to the highest standards of care, safety and service,” says Dr. James Cappon, CHOC’s chief quality officer. “While we are proud of our accolades, including being named a best children’s hospital, we remain focused on preserving the magic of childhood for all kids, whether they are seriously ill or healthy, or somewhere in between.”

More information about the Best Children’s Hospitals rankings can be found here.

Meet Dr. Amy Harrison

CHOC wants its referring physicians to get to know its specialists. Today, meet Dr. Amy Harrison, a pediatric pulmonologist.

Amy Harrison, M.D.
Amy Harrison, M.D.

Q: What is your education and training?

A: I attended Indiana University School of Medicine. I completed both my pediatrics residency and fellowship in pediatric pulmonology at the University of Minnesota Children’s Hospital.

Q: What are your administrative appointments?

A: I am the co-director of CHOC’s Cystic Fibrosis Center.

Q: What are your special clinical interests?

A:  Cystic fibrosis (CF), muscle weakness (muscular dystrophy and spinal muscular atrophy), asthma and general pulmonary health, chronic disease.

Q: Are you working on any current research?

A: Our CF program was awarded the CF Fundamentals Learning and Leadership Collaborative in June 2015, which has allowed us to improve our CF care processes and clinical outcomes for people with cystic fibrosis.  We are currently studying ways to improve our patients’ knowledge of, and adherence to, prescribed pulmonary therapies.

 Q: How long have you been on staff at CHOC?

A: 5 years.

Q: Are there any new programs or developments within your specialty?

A:  Our CF program was awarded a mental health grant through the Cystic Fibrosis Foundation to develop and implement a depression and anxiety screening program for patients with CF and their caregivers. Funds will enable the team to expand its social worker’s availability and have a designated psychologist to help patients and caregivers. They will provide screenings, evidence-based guidelines and follow-up care for depression and anxiety, as well as develop a community referral network of mental health providers. CHOC’s CF model, if successful, could be replicated in other specialty clinics.

In addition, we are excited to offer many cutting-edge therapies for CF patients including Orkambi and Kalydeco, medications that help the defective protein in CF function more normally, thus treating the underlying cause of CF.

Q: What are your most common diagnoses?

A: I see patients with a range of conditions, including asthma, chronic cough, recurrent pneumonia, cystic fibrosis, muscular dystrophy and spinal muscular atrophy.

Q: What would you most like community/referring providers to know about you/your division at CHOC?

A: The pulmonary division at CHOC offers comprehensive care for all patients with lung disease and sleep disorders from extensive lung function testing to sleep studies and diagnostic procedures such as bronchoscopy. We also have comprehensive services for patients with sleep apnea, sleep breathing disorders including apnea monitors and BIPAP data analysis for clinical management. In addition, we also offer services in Huntington Beach, Mission Viejo, Corona and Pomona Valley.

Q: What inspires you most about the care being delivered here at CHOC?  

A: I enjoy caring for children with chronic conditions and helping them to find ways of living normal fulfilling lives.  I take great pride in my patient’s accomplishments and find their stories inspiring.  I most enjoy creating a true partnership with my patients and their families to find ways to improve their care.

 Q: Why did you decide to become a pediatric pulmonologist?

A: I was always interested in science from a very young age and pursued a medical education due to my own fascination with learning more about how our bodies work.  During my training, I developed asthma myself and found my strong relationships with my own medical professionals enormously helpful in empowering me to deal with a chronic disease.

Q: If you weren’t a physician, what would you be and why?  

A: I would probably set up my own Etsy shop and sell things I create! I often make homemade gifts for friends and family members for birthdays and holidays.  I also love to travel and exposing my children to new cultures.

Q: What are your hobbies/interests outside of work?

A: I love spending time with my family and my three children, ages 2, 6 and 10.  In addition, I enjoy reading, visiting museums and traveling.

Q: What have you learned from your patients?

A:  I am continuously amazed by how strong and resilient my patients can be. I learn so much from them, and I have now had three patients tell me they were inspired to pursue a career in medicine because of our relationship and their disease.

Depression and Anxiety in Cystic Fibrosis Patients and Parents

A recent study of over 6,000 cystic fibrosis patients 12 years through adulthood, and over 4,000 parents, found that depression and anxiety were two to three times more elevated in patients with cystic fibrosis (CF) and in parents of children with CF. Although depression and anxiety are common in CF, the stigma associated with mental health issues often make people less likely to talk to about them.

To address this issue, the Cystic Fibrosis Foundation (CF Foundation) announced newly developed guidelines for screening and treating depression and anxiety. These guidelines are not a mandate from the CF Foundation to care centers, and they recognize that it will take time and effort for care center teams to adopt the recommendations.

CHOC  —  one of only a few affiliated care centers of the CF Foundation in Southern California and the only CF treatment center in Orange County — is one of the first care centers to adopt the recommended guidelines. At CHOC, we understand that living with CF and other chronic diseases can be emotionally challenging. We also know that depression and anxiety can have negative effects on physical health and the ability to follow a recommended treatment plan.

Dr. Amy Harrison, CHOC pulmonologist and CF specialist.
Dr. Amy Harrison, CHOC pulmonologist and CF specialist.

“The psychology component of our cystic fibrosis program really makes CHOC stand out,” said Amy Harrison, pulmonologist and CF specialist at CHOC. “Our multidisciplinary approach allows our care team to manage all aspects of CF from diagnosis to physical and mental health.”

CHOC is committed to ensure that every child in Orange County has access to mental health treatment without stigma or barriers, and we are pleased to be a recipient of the CF Foundation’s grant, Implementation of the Depression and Anxiety Guidelines: Award for a Mental Health Coordinator. The grant was offered to qualified care centers and allows the CF Foundation to collect best practices and disseminate them among all care centers.

The grant provides CHOC the opportunity to have a psychologist at every CF clinic to help patients and families. They will provide annual screenings, evidence-based interventions and follow-up care for depression and anxiety, as well as develop a community referral network of mental health providers.

Guideline Recommendations

The guidelines propose that just as measuring height, weight and PFTs are part of CF care, screening and treating depression and anxiety should become a routine part of CF care too. The screening consists of completing a couple of short questionnaires and is completely voluntary.

Recommendations include:

  • All patients 12 years and older should receive annual screening for depression and anxiety.
  • Parents of caregivers of patients aged 0-17 years should be offered annual screening for depression and anxiety.
  • A stepped process for prevention, screening, assessment and intervention. This can include talk therapy, medication or a combination of the two.

Referral to the CHOC Cystic Fibrosis Center

When a child is diagnosed or is suspected to have CF, a referral to an accredited CF care center can ensure that the child gets diagnosed properly, lives a long and healthy life, and receives treatment based on the most advanced research available. With access to a full range of CHOC pediatric subspecialists, the CHOC Cystic Fibrosis Center offers a number of life-enhancing technologies and treatments.

Our multidisciplinary CF clinic includes a board-certified pulmonologist and gastroenterologist, respiratory and physical therapist, nutritionist, nurse specialists, social worker and a psychologist. An endocrinologist and other specialists are also available to attend the appointment, if needed. Genetic testing and counseling can also be provided.

If you have a patient diagnosed with CF, or who has symptoms of CF, a pre-referral sweat test can be ordered at CHOC to confirm the diagnosis and refer for treatment. (CF Foundation guidelines recommend diagnosis confirmation by an approved CF Foundation care center.)

For appointments, please call the Patient Access Center at 888-770-2462 (888-770-CHOC).

Complete the CHOC Specialists Pulmonology Referral Request form located at http://www.choc.org/referralguidelines.

Fax ALL pertinent medical records to 855-246-2329 (855-CHOC-FAX).

To speak with a CHOC Specialists in Pulmonology, please call 714-509-8622.

In the Spotlight: Neal Nakra, M.D.

Dr. Neal NakraAs medical director of the CHOC pediatric sleep program, Dr. Neal Nakra is examining sleep study data to further analyze the relationships between sleep and obesity, metabolic syndrome and other pediatric conditions.

Dr. Nakra’s initial interests in sleep medicine deepened during his pulmonary medicine fellowship at Yale-New Haven Hospital, in Connecticut. Already well aware of the respiratory issues associated with obesity, his research found that the presence of obstructive sleep apnea was associated with obesity and markers for metabolic syndrome.

He focused his interests in obesity, sleep apnea and metabolic syndrome, and became board certified in pulmonology, pediatrics and sleep medicine. A few years later, Dr. Nakra was co-director of the Cystic Fibrosis Center and associate director of the pediatric residency program at St. Joseph Children’s Hospital in New Jersey, when he heard about an opportunity at CHOC.

The CHOC Sleep Center had recently doubled in size, becoming one of the largest programs in the state. Dr. Nakra was drawn by the opportunity to grow the program further and to work with CHOC pediatric subspecialties.

“Sleep inherently deserves multidisciplinary treatment with other pediatric subspecialties,” said Dr. Nakra, who is working with CHOC otolaryngologists, plastic surgeons and endocrinologists. “One of the joys of practicing sleep medicine at CHOC is the ability to collaborate on a multidisciplinary platform, pick the brains of the best and brightest in the fields, and work together to help the kids of Orange County.”

Dr. Nakra has quickly become an integral part of that team. At a recent CHOC Grand Rounds presentation, he discussed screening guidelines for obesity, metabolic syndrome and obstructive sleep apnea. The American Academy of Pediatrics recommends during routine office visits for pediatricians to ask families about how the patient sleeps at night and for the presence of multiple nighttime awakenings, difficulty breathing, loud snoring and pauses in breathing. This is especially true for overweight and obese children.

“We’re trying to break the cycle of obstructive sleep apnea and obesity,” he said. “Often, the families do not volunteer this information, but when asked, will confirm symptoms of obstructive sleep apnea. In this case, further evaluation by a sleep physician or referral for an overnight sleep study would be warranted.”

Dr. Nakra advises physicians to ask about sleeping when evaluating other symptoms, such as hyperactivity and behavioral disorders in elementary or middle school-age kids. For teens, improved sleep has been shown to improve academic performance and reduce motor vehicle crashes.

When to Refer

An overnight sleep study is recommended for patients with concerns for:

  • Nighttime snoring
  • Persistent mouth breathing
  • Witnessed pauses in breathing while sleeping at night
  • Frequent nighttime awakenings

Further evaluation in the pediatric sleep clinic is warranted based on the results of the sleep study or prior to the study based on pediatrician or parental concerns.

Dr. Nakra sees patients at CHOC Hospital; CHOC Health Center, Mission Viejo; and CHOC Health Center, Huntington Beach. For more information or to schedule a consultation, call 714-509-8622.