- Attending Physician, Pediatric Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago
- Associate Professor of Surgery (Pediatric Surgery) and Pediatrics, Northwestern University Feinberg School of Medicine
Mehul V. Raval, MD, MS, grew up in a small town in North Carolina and from a young age was mesmerized by science and medicine. Dr. Raval completed his undergraduate studies as the University of North Carolina at Chapel Hill and his medical education at Wake Forest University School of Medicine. During medical school, he participated in a one-year Doris Duke Clinical Research Fellowship. Dr. Raval trained in General Surgery at Northwestern University. During this time, he completed a 2-year Clinical Scholars Program at the American College of Surgeons in Chicago, IL and earned an MS in Clinical Investigation from Northwestern University. After his general surgery training, he completed a 2-year pediatric surgical clinical training fellowship at Nationwide Children’s Hospital and The Ohio State University. From 2014 to 2018 Dr. Raval was an Assistant Professor of Surgery and Pediatrics at Children’s Healthcare of Atlanta and Emory University where he served as the Division of Pediatric Surgery’s Director of Research, Director of the Center for Outcomes Research and Public Health, and Co-Director of the Atlantic Pediatric Device Consortium. Dr. Raval joined the faculty at Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University in July of 2018 as an Associate Professor with appointments in the Department of Surgery and Department of Pediatrics. He currently serves as a Faculty Principal Investigator in the Northwestern University Surgical Outcomes and Quality Improvement Center. He is the Program Director of the Pediatric Surgery Research Fellowship Program for the Division of Pediatric Surgery.
Education and Background
- MBA, Northwestern University Kellogg School of Management in progress
- Fellow, Nationwide Children’s Hospital, The Ohio State University, Pediatric Surgery 2014
- Resident, Northwestern University, McGaw Medical Center, Surgery 2011
- MS, Northwestern University 2010
- Resident, American College of Surgeons, Clinical Scholar in Residence 2010
- Postdoctoral Fellow, American College of Surgeons, Clinical Scholar 2008
- MD, Wake Forest University School of Medicine 2005
- Resident, Doris Duke Clinical Research Fellowship 2004
- BS, University of North Carolina at Chapel Hill 2000
A PITFALL OF USING GENERAL EQUIVALENCE MAPPINGS TO ESTIMATE NATIONAL TRENDS OF SURGICAL UTILIZATION FOR PEDIATRIC PATIENTS
General equivalence mappings (GEMs) were developed to facilitate a transition from International Classification of Diseases, Ninth Revision (ICD-9) to ICD, Tenth Revision (ICD-10). Validation of GEMs is suggested as coding errors have been reported for adult populations. The purpose of this study was to illustrate limitations of the GEMs for pediatric surgical procedures. Using the 2014 to 2016 National Inpatient Sample, we evaluated all patients undergoing inguinal hernia repair. ICD-9 codes for the repair were independently classified as laparoscopic or open approach by two surgeons. Conversions of the ICD-9 to ICD-10 codes were compared between the GEMs strategy and surgeons' manual mapping. National trends were compared for overall, adult, and pediatric populations. We found significant inconsistencies in the proportion of laparoscopic inguinal hernia repair based on mapping strategies employed. For adults, the comparison of the proportions in 2016 was 17.79% (GEMs) versus 21.44% (Manual). In pediatric population, the contrast was 0.45% (GEMs) versus 17.75% (Manual), and no laparoscopic repair cases were found using GEMs in the last quarter of 2015. Some conversions of ICD-9 and ICD-10 using the current GEMs are not valid for certain populations and procedures. Clinical validation of coding conversions is essential.
ENHANCING RECOVERY IN CHILDREN UNDERGOING SURGERY (ENRICH-US) STUDY
Initiated in the 1990s, perioperative Enhanced Recovery Protocols (ERPs) have progressively gained traction in a wide range of adult surgical disciplines and resulted in decreased hospital length of stay (LOS), in-hospital costs, complications, and markedly improved patient care experience that mitigates the physiologic stress of surgery and hastens recovery. However, it is estimated that it takes nearly 20 years for evidence to make its way into clinical practice, and failure rates for implementing complex innovations range from 30% to 90%. Implementation of ERPs in pediatric surgery is lagging and concerted efforts to demonstrate both clinical effectiveness and to examine obstacles to implementation are needed. Over the past four years, our study team modified existing adult ERPs to meet the needs of pediatric patients undergoing elective GI surgery. Based on the positive results of a pilot study, we proposed the ENRICH-US Study. The trial is designed to evaluate the effectiveness of ERPs while assessing implementation fidelity, sustainability, and site-specific adaptations. The cluster randomized trial design is ideally suited for this type of pragmatic intervention implementation. The study was funded by the NIH/NICHD in October 2019 and is currently ongoing.
THE VALUE OF CHILDREN'S HOSPITALS—ARE INCREASED COSTS JUSTIFIED BY IMPROVED OUTCOMES OR DRIVEN BY INTERNAL AND EXTERNAL ECONOMIC FORCES?
This project is the first to directly assess the value of children's surgical care using payment data at children's hospitals (CH) as compared to non-children's hospitals (NCH) in the United States for commonly performed surgical procedures. We will first test for any quality or price differentials across CH and NCH and then examine the sources of any such differentials, with particular interest in the role of hospital market structure and competition as potential drivers of high-cost care. Our results will inform patients, physicians, hospitals, and payers by encouraging pricing transparency and cultivating a high quality, value-centric healthcare system for children in the US. This project is funded by the AHRQ.