Health Sciences Research

Health Services Research (HSR) at the University of Colorado, Section of Neonatology, includes a multidisciplinary group of investigators dedicated to identifying perinatal health disparities by race/ethnicity, primary language, rural-urban residence, and other social determinants of health. Critical to our research mission, we seek to go beyond identifying disparities by developing, implementing and investigating innovative approaches to reduce these disparities at hospital, community, and state policy levels.

Examples of HSR Study Designs and Projects:

•   Retrospective Cohort

-    Retrospective analysis of local level 4 regional children’s hospital NICU data related to regionalization of neonatal care and prevalence of back-transport of convalescing preterm infants

-    Retrospective analysis of national data from level 4 regional children’s hospital NICUs to evaluate predictors of home nasogastric tube vs. gastrostomy tube feeding in preterm infants

•   Prospective Cohort

-    Prospective recruitment of maternal-infant dyads in four Colorado NICUs to investigate factors associated with maternal visitation and engagement during prolonged NICU hospitalization

-    Prospective longitudinal evaluation of health, quality of life, and developmental outcomes of infants with severe bronchopulmonary dysplasia cared for by our Supporting Preemie Respiratory OUTcomes (SPROUT) team

•   Qualitative

-    Grounded theory methodology to understand family experience during prolonged NICU admission by distance from home to hospital

-    Qualitative study of NICU nurses and parents to understand barriers and facilitators to adherence to safe sleep practices in the NICU

•   Mixed Methods

-    Integration of quantitative and qualitative methodology to identify barriers and facilitators to provider-parent communication in the NICU

•   Population-based

-    Analysis of state and national PRAMS, Health eMoms, and vital statistics (birth and death certificate) data to investigate outcomes such as change in preterm birth during COVID, breastfeeding and safe sleep practices among mothers of preterm infants, impact of state policies on maternal infant care practices, factors associated with preterm infant mortality, cannabis use in the perinatal period

Trainee-initiated HSR publications with support from the Section of Neonatology:

Hannan KE, Bourque SL, Palmer C, Tong S, Hwang SS. Racial and Ethnic Disparities in Medical Complexity and In-Hospital Death Among US-Born VLBW Infants. Hosp Pediatr. 2022;12(5):463-474.

Hannan KE, Bourque SL, Palmer C, Tong S, Hwang SS. Prevalence and Predictors of Medical Complexity in a National Sample of VLBW Infants. Hosp Pediatr. 2021;11(5):525-535.

Shah PV, Tong S, Hwang SS, Bourque SL. Racial/Ethnic Differences in Prenatal and Postnatal Counseling About Maternal and Infant Health-Promoting Practices Among Teen Mothers. J Pediatr Adolesc Gynecol. 2021;34(1):40-46.

Truong C, Juhl A, Hwang SS. Risk factors for postpartum depressive symptoms among mothers of Colorado-born preterm infants.  J Perinatol. 2021 Aug;41(8):2028-2037.

Stein Y, Hwang S, Liu CL, Diop H, Wymore E. The Association of Concomitant Maternal Marijuana Use on Health Outcomes for Opioid Exposed Newborns in Massachusetts, 2003-2009. J Pediatr. 2020;218:238-242.

Hannan KE, Smith RA, Barfield WD, Hwang SS. Association between Neonatal Intensive Care Unit Admission and Supine Sleep Positioning, Breastfeeding, and Postnatal Smoking among Mothers of Late Preterm Infants. J Pediatr. 2020 Dec;227:114-120.

Bourque SL, Levek C, Melara DL, Grover TR, Hwang SS. Prevalence and Predictors of Back-Transport Closer to Maternal Residence After Acute Neonatal Care in a Regional NICU. Matern Child Health J. 2019;23(2):212-219.

Palau MA, Meier MR, Brinton JT, Hwang SS, Roosevelt GE, Parker TA. The impact of parental primary language on communication in the neonatal intensive care unit. J Perinatol. 2019;39(2):307-313.

Hannan KE, Juhl AL, Hwang SS. Impact of NICU admission on Colorado-born late preterm infants: breastfeeding initiation, continuation and in-hospital breastfeeding practices. J Perinatol. 2018 May;38(5):557-566.

Faculty Information and PubMed Bibliographies:

Available Resources, Databases, Education and Support:

Fellows interested in pursuing HSR research in Colorado have access to a multitude of databases and resources to be successful in their work.  This includes but is not limited to the following databases:

1. Colorado Department of Public Health and Environment (state databases)

• Health eMoms | Department of Public Health & Environment
• Pregnancy Risk Assessment Monitoring System (PRAMS) | Department of Public Health & Environment
• Birth, death, and other vital records | Department of Public Health & Environment

1. Children's Hospitals Neonatal Consortium (local and national database)
2. Vermont Oxford Network (local and national database)
3. Kids' Inpatient Database (KID) (national database)

Importantly, we recognize that few trainees and faculty have the statistical training to complete advanced analyses and programming. Thus, our section of neonatology has dedicated biostatisticians who work exclusively with our trainees and faculty. 

Masters of Science in Clinical Science (MSCS) - For fellows looking for immersive research training, enrollment in the University of Colorado’s MSCS program may be pursued. Trainees may also choose to take individual courses to augment their research skills during fellowship. Other degree and certificate programs, as appropriate for a trainee’s research interest, are also supported. [Clinical Science Graduate Program (CLSC)]

Neonatal Outcomes Research Alliance (NORA) - a weekly gathering of clinical providers, researchers, students, and trainees focused on perinatal clinical and health services research and quality improvement initiatives at local and state levels. Projects at various stages are shared, ranging from new ideas to completed and published studies. Consistent attendance by junior and senior faculty allow for timely feedback and support to students and trainees. 

Grant Support and Funding - Previous and current neonatal-perinatal fellows have been competitive and successful applicants for the following local and national research awards during training. Grant writing support for these and other awards is available to trainees. 

• Children’s Hospital Neonatal Database Mentored Fellow Research Award - Mentored Fellow Research Award | CHNC
• AAP Marshall Klaus Perinatal Research Award: Health Services Research Award - Marshall Klaus Perinatal Research Awards​
• Children’s Hospital Colorado Institute of Healthcare Quality, Safety, and Effectiveness Mentored Award