About

Robert W. Grundmeier, MD, is a Professor of Pediatrics (General Pediatrics) at the Children's Hospital of Philadelphia. He completed his medical education at the University of Pennsylvania School of Medicine in 1997 and pediatric residency at The Children's Hospital of Philadelphia in 2000. Since then, he has been practicing as a pediatrician at the South Philadelphia location of The Children's Hospital of Philadelphia Care Network, primarily caring for underserved children from families who have recently immigrated to the United States. Dr. Grundmeier serves as the Director of Clinical Informatics in the Department of Biomedical and Health Informatics at CHOP, where he assists clinical researchers in obtaining pilot data for grant preparation, developing patient enrollment strategies, implementing clinical decision support interventions, and managing research data. He has supported numerous research projects on topics including documentation completeness, infant feeding, asthma, childhood development, psychiatric disease, prematurity, and trauma. With extensive experience in database programming and user-interface design within electronic health record (EHR) implementation, he has worked with physician groups and clinical leadership to establish consensus on key EHR data mining efforts. Currently, he collaborates with multiple academic organizations to replicate the successful use of the EHR as a research tool in new settings.

Research topics

• Medicine
• Internal medicine
• Political Science
• Medical emergency
• Genetics
• Biology
• Psychiatry
• Surgery
• Physical therapy
• Computational biology
• Pediatrics
• Emergency medicine
• Family medicine
• Virology

Selected publications

• Variation in Evaluation and Management of Febrile Infants 61 to 90 Days Old

  The Journal of Pediatrics · 2026-03-30

  articleOpen access
  PublisherOA PDFDOI

• An Electronic Health Record–Based Tobacco Treatment System for Parents in Pediatric Primary Care

  PEDIATRICS · 2026-03-17

  article

  BACKGROUND: Parental smoking is a leading source of secondhand smoke exposure for children, increasing risks of respiratory illness and future smoking. Cessation treatment delivery for parents remains rare in pediatrics. This study evaluates the population-level impact of an automated tobacco treatment system integrated into the electronic health record (EHR) in pediatric primary care. METHODS: We conducted a retrospective observational study of parents whose children received care at 12 pediatric practices in a cluster-randomized trial (June 2021-August 2024). Six practices implemented an automated EHR-linked parent tobacco treatment system (screening, motivational messaging, automatic treatment connection including nicotine replacement therapy, SmokefreeTXT, and quitline referral through a previsit questionnaire); 6 implemented screening only. This analysis included all parents who completed questionnaires during routine care, excluding parents enrolled in the trial. We analyzed self-reported cessation rates among parents who reported smoking during the study period. RESULTS: Among 55 567 parents with follow-up data (49 595 mothers; 5972 fathers), smoking rates were 4.3% vs 5.5% for mothers and 6.5% vs 8.3% for fathers receiving care with vs without the system. Among mothers who reported smoking during the study, cessation rates were significantly higher for those receiving care with the system (37.4% vs 33.5%, P = .044), representing a 3.9% improvement. Among fathers who smoked, there was no difference in cessation rates (29.6% vs 29.6%). CONCLUSIONS: An automated tobacco treatment system was associated with significantly increased maternal smoking cessation in pediatric settings while showing no effect for fathers. This scalable approach could enhance pediatric preventive care by reducing household tobacco use.

  PublisherDOI

• Prediction Rule to Identify Febrile Infants 61–90 Days at Low Risk for Invasive Bacterial Infections

  PEDIATRICS · 2025-08-26 · 3 citations

  articleOpen access

  OBJECTIVE: To derive and internally validate a clinical prediction rule to identify febrile infants aged 61-90 days at low risk of invasive bacterial infections (IBIs). METHODS: Using data from 17 Pediatric Emergency Care Applied Research Network Registry (PECARN) emergency departments, we included noncritically ill, previously healthy infants aged 61-90 days with temperatures greater than or equal to 38°C and urinalyses and blood cultures obtained between January 1, 2012, and April 30, 2024. Our outcome was IBI, defined as growth of pathogenic bacteria from blood or cerebrospinal fluid culture. Using recursive partitioning with 10-fold cross-validation, we derived and internally validated a prediction rule using age, temperature, urinalysis (negative/positive), and absolute neutrophil count (ANC) as candidate predictors. Limiting the analysis to infants with procalcitonin (PCT) and ANC results, we evaluated PCT as an additional predictor. RESULTS: Of 4952 infants included, 100 (2.0%) had IBIs, including 95 (1.9%) with bacteremia without meningitis and 5 (0.1%) with bacterial meningitis. The optimal prediction rule identified low-risk infants as those with negative urinalyses and highest temperatures less than or equal to 38.9°C, yielding a sensitivity of 86.0% (95% CI, 77.6-92.1) and specificity of 58.9% (95% CI, 57.5-60.3). In the subset of 1207 infants with PCT and ANC measurements, including 27 (2.2%) with IBIs (2 [0.2%] with bacterial meningitis), we identified PCT of 0.24 ng/mL or less and ANC of 10 710 cells/mm3 or less as low-risk predictors. This PCT-based rule demonstrated sensitivity of 100.0% (95% CI, 87.2-100.0) and specificity of 65.8% (95% CI, 63.0-68.5). CONCLUSIONS: We derived 2 accurate clinical prediction rules to identify febrile infants aged 61-90 days at low risk of IBIs when urine and blood testing are obtained. Prospective validation is needed.

  PublisherOA PDFDOI

• Demystifying Prolonged Antibiotic Use for Blood Culture-negative Sepsis Evaluations in the Neonatal Intensive Care Unit

  The Pediatric Infectious Disease Journal · 2025-04-28 · 2 citations

  article

  OBJECTIVE: This study aimed to determine the incidence and clinical characteristics of infants evaluated and treated with a prolonged course of antibiotics for culture-negative sepsis in a quaternary Neonatal Intensive Care Unit (NICU) over a 4-year period. STUDY DESIGN: Retrospective chart review of patients in the NICU at Children's Hospital of Philadelphia who had negative blood cultures and received ≥5 days of antibiotics. Data collection included demographics, clinical and laboratory data, and underlying diagnoses. Statistical analysis included Mann-Whitney and chi-square tests, and multivariable logistic regression. RESULTS: We identified 774 culture-negative sepsis evaluations where antibiotic treatment was continued ≥5 days. While the majority were attributed to a focal etiology, 146 had negative blood cultures and no focal source. Infants with no focal source were younger at the time of sepsis evaluation, of greater gestational age, and more frequently required extracorporeal membrane oxygenation ( P < 0.001). In multivariable analysis, evaluations for early-onset disease and need for extracorporeal membrane oxygenation were increased among infants with no focal source ( P < 0.01). Although rates of invasive ventilation, and central venous catheters were similar, length of stay and mortality were significantly higher in late-onset episodes ( P < 0.001 and P = 0.029, respectively). Consultation with the infectious disease team increased during the study period ( P = 0.002). CONCLUSIONS: Although it is challenging to limit the initiation of antibiotics in infants with complex underlying disease processes with concern for sepsis, minimizing antibiotic use can be achieved by timely discontinuation when cultures are negative. A robust antimicrobial stewardship program can identify valid reasons for prolonged antibiotic administration and suggest approaches to minimize antibiotic exposure.

  PublisherDOI

• Efficient Build of EHR Simulation for Research: A Template to Collect Clinician Cognitive Data

  Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care · 2025-08-19

  articleOpen accessSenior author

  Electronic Health Record simulation is a research method that offers valuable data on clinician cognitive processes like problem solving, information foraging, and in particular, decision making. Despite this, established paths to develop optimal EHR simulation to explore these processes only exist for education. No guide to develop efficient EHR simulation for research exists. We propose a six-part methodology to efficiently develop EHR simulations used for research and patient safety inquiry. Our approach produces high-fidelity simulations for challenging clinical scenarios, ideal for data collection of this type. This reproducible template addresses a critical gap, enabling EHR simulation as a research method to be stood up in any institution.

  PublisherOA PDFDOI

• Risk of Bacterial Infections in Febrile Infants 61 to 90 Days Old With Respiratory Viruses

  PEDIATRICS · 2025-06-12 · 3 citations

  articleOpen access

  OBJECTIVE: The objective of this study was to describe the prevalence of urinary tract infections (UTIs), bacteremia, and bacterial meningitis among febrile infants aged 61 to 90 days with and without respiratory viral infections. METHODS: We used data from the Pediatric Emergency Care Applied Research Network (PECARN) Registry, comprised of pediatric visits from 17 emergency departments. Our cohort included infants aged 61 to 90 days with temperatures of at least 38°C, urinalyses/urine dipsticks and/or blood cultures, and respiratory viral testing performed between January 1, 2012, and April 30, 2024. We calculated the prevalence, with 95% CIs, of UTIs, bacteremia, and bacterial meningitis, stratified by presence and types of respiratory viral infections. RESULTS: We included 3678 visits; 1725 (46.9%) infants tested positive for respiratory viruses. Compared with viral-negative infants, respiratory viral-positive infants had a lower prevalence of UTIs (4.4% [95% CI 3.5-5.6%] vs 12.5% [95% CI 11.0-14.2%]) and bacteremia (1.0% [95% CI 0.5-1.8%] vs 3.0% [95% CI 2.1-4.1%]). No respiratory-viral positive infants had bacterial meningitis, whereas 4 viral-negative infants had meningitis. The prevalence of UTIs ranged from 2.2% to 5.2% in infants who tested positive for influenza, respiratory syncytial virus, or SARS-CoV-2, all lower than viral-negative infants. SARS-CoV-2 positive infants had a lower prevalence of bacteremia compared with SARS-CoV-2 negative infants (0.9% [95% CI 0.3-1.9%] vs 3.1% [95% CI 2.0-4.6%]). CONCLUSIONS: The prevalence of bacterial infections is lower in respiratory virus-positive febrile infants aged 61 to 90 days. These findings may help inform use of respiratory viral testing in the evaluation for UTIs, bacteremia, and meningitis in this age group.

  PublisherOA PDFDOI

• Automated Tobacco Cessation Intervention for Parents in Pediatric Primary Care

  JAMA Network Open · 2025-08-27 · 2 citations

  articleOpen access

  Importance: Treatment for tobacco use for parents in pediatric primary care settings is rarely provided but may support cessation and reduce childhood tobacco smoke exposure. Objective: To study the integration of the automated Clinical Effort Against Secondhand Smoke Exposure (eCEASE) tobacco cessation intervention into pediatric primary care via the electronic health record (EHR). Design, Setting, and Participants: This cluster-randomized clinical trial was conducted from July 16, 2021, to August 15, 2023, at 12 pediatric primary care practices in the Philadelphia, Pennsylvania, region. Participants included parents who used combusted tobacco in the past 7 days and attended a child's preventive health care visit. Intervention: In all practices, household members completed EHR previsit questionnaires about tobacco use. Parents in intervention practices were proactively offered eCEASE (automated delivery of nicotine replacement therapy [NRT], quitline and/or SmokefreeTXT enrollment, and navigator support). Control practice parents received usual care. Main Outcomes and Measures: The primary outcome was biochemically confirmed 7-day abstinence from combusted tobacco use by parents at the 1-year follow-up. Secondary outcomes included NRT and quitline and/or SmokefreeTXT use and recent quit attempts. Changes in cigarettes per day and smoking frequency (daily or nondaily) from baseline to 1-year follow-up were also examined. Results: Of 817 enrolled smoking parents (672 [82.3%] female), 323 of 408 (79.2%) in the intervention arm (6 practices) and 326 of 409 (79.7%) in the control arm (6 practices) were mothers; mean (SD) age was 36.17 (8.67) years. The follow-up survey was completed by 367 of 408 parents (90.0%) in the intervention arm and 368 of 409 (90.0%) in the control arm. Biochemically confirmed 7-day abstinence rates were 34 of 408 (8.3%) in the intervention arm vs 26 of 409 (6.4%) in the control arm (adjusted odds ratio, 1.34; 95% CI, 0.79-2.29). Among those who completed follow-up, 177 of 367 (48.2%) in the intervention arm vs 59 of 368 (16.0%) in the control arm reported using NRT; 93 of 367 (22.8%) and 8 of 368 (2.2%), respectively, reported using quitline and/or SmokefreeTXT messaging; and 294 of 367 (80.1%) vs 258 of 368 (70.1%), respectively, reported a quit attempt in the last 3 months. Compared with control practices, intervention practices reported a greater reduction in the mean (SD) number of cigarettes smoked daily (-3.32 [5.39] vs -1.81 [5.84]) and a greater reduction in the mean (SD) percentage of daily smokers (-35.2% [2.6%] vs -25.8% [2.6%]). Conclusions and Relevance: In this cluster-randomized clinical trial of an automated intervention to treat parental tobacco use in pediatric practices, the intervention did not significantly improve the primary outcome of quit rate at 1 year. Findings in this trial demonstrated increased treatment engagement and reductions in cigarette consumption, but additional strategies are needed to improve quit rates. Trial Registration: ClinicalTrials.gov Identifier: NCT04974736.

  PublisherOA PDFDOI

• P-1640. Antibiotic prescribing guideline-concordance for sinusitis in adult and pediatric primary care practices

  Open Forum Infectious Diseases · 2025-01-29

  articleOpen access

  Abstract Background Antibiotics are only sometimes indicated for acute sinusitis, a commonly diagnosed infection in the ambulatory setting and an important target for antibiotic stewardship. However, assessment of the appropriateness of antibiotic use for sinusitis is based on clinical signs and symptoms, and therefore requires manual chart abstraction. We present a study assessing the appropriateness of antibiotic prescribing in adult and pediatric sinusitis visits. Methods Outpatient encounters for sinusitis in adult and pediatric primary care practices within two health systems with an antibiotic prescribed from July 1, 2017 through June 30, 2021 were identified by ICD-10 code (J01 and J32). Of these, 600 encounters were randomly selected for review (300 from adult practices; 300 from pediatric practices). Five trained physician annotators reviewed prescriber notes from these encounters and identified relevant signs/symptoms, duration of illness, and disease trend and severity; annotators used these findings to assess overall guideline concordance of antibiotic prescribing using definitions adapted from clinical guidelines (table 1). Two physicians performed adjudication for disagreements (LD, KWH). Results Demographics and characteristics of included encounters are reported in Table 2. In adults, 19 encounters were excluded after review due to a note being unrelated to the sinusitis encounter; of the remaining 281, 37 (13.2%) were considered guideline concordant, 157 (55.9%) were considered not guideline-concordant, and 87 (31.0%) were potentially guideline concordant but with insufficient information. In pediatrics, 184 (61.3%) were considered guideline concordant, 99 (33.0%) were considered not guideline-concordant, and 17 (5.7%) were potentially guideline concordant but with insufficient information. Common reasons for guideline non-concordance are described in Table 3. Conclusion Antibiotic prescribing forsinusitis was frequently not concordant with guidelines. Prescribing was more frequently concordant in pediatric compared to adult-care settings. In both groups, duration of symptoms was frequently documented as fewer than 10 days, suggesting a potential target for antibiotic stewardship interventions. Disclosures All Authors: No reported disclosures

  PublisherDOI

• A Comprehensive Approach to Clinical Decision Support in the Return of Genome Informed Risk Assessments to Primary Care Pediatricians

  Applied Clinical Informatics · 2025-01-01 · 1 citations

  articleOpen accessSenior author

  BACKGROUND: Primary care pediatricians play an important role in genetic testing, including referrals, test ordering, responding to results, assessing risk, treatment, and managing care. As genetic testing rapidly evolves to include new tests identifying patients at risk for certain conditions, alert-based clinical decision support is insufficient in assisting pediatric primary care providers in working with patients, parents, genetics, and other specialties. Supporting pediatricians in the return of these results requires addressing gaps in genetics training and integrating genetics into practice with education, information resources, and specialized tools. OBJECTIVES: This study aimed to capture requirements for developing systems and processes to support primary care pediatricians in the return of genome-informed risk assessments. METHODS: We performed a requirements analysis to inform the design of clinical decision support tools and processes for pediatric providers of patients who received a genome informed risk assessment, a novel test that combines polygenic risk scores with patient and family histories to deliver a risk assessment for common medical conditions. We developed an interview guide consisting of scenario presentations, questionnaires, and semi-structured questions to elicit provider responses on a broad set of requirements to manage results with patients and caregivers. RESULTS: Twenty providers from 10 primary care pediatric practices within a single health system participated in the study. The findings demonstrated that providers feel responsible to be involved in the process of returning results but require a support system that integrates education, provider and patient information resources, effective communication with genetics, and electronic health record decision support tools that can accommodate a range of clinical scenarios and provider workflow preferences. CONCLUSION: Supporting providers with the return of genetic testing results such as the genome informed risk assessment requires a comprehensive approach to decision support consisting of education, communication, and a comprehensive and integrated set of electronic health record tools.

  PublisherOA PDFDOI

• Audit and Feedback on Pediatric Emergency Department Performance Measures: A Stepped-Wedge Trial

  Hospital Pediatrics · 2025-10-09

  article

  BACKGROUND: Audit and feedback can prompt clinician improvements. The benefit of this approach in pediatric emergency department (PED) systems is unclear. We evaluated the feasibility of a multisite, monthly automated report card and its effect on quality performance within and across emergency department sites. METHODS: We conducted a stepped-wedge randomized trial across 4 academic and 3 affiliated PEDs in the Pediatric Emergency Care Applied Research Network between January 2013 and April 2016. The intervention consisted of monthly site-level quality performance reports featuring bar charts with benchmarks, visit counts, and 12-month trends derived from electronic health record (EHR) data. Measures included initial care documentation (weight, vital signs) and throughput (time to clinician, time to imaging results, left without being seen rate, and length of stay). We evaluated the intervention's effect on performance measures and slope changes at implementation. RESULTS: We included 1 426 109 encounters (864 940 during the preintervention period, 561 169 during the postintervention period). We observed improved performance for 4 measures: weight for all visits (+0.2%), documentation of all vitals (+10.1%), time to vitals documentation (-12.0%), and time to plain film radiology report (-3.5%). We observed a decline in performance measures related to throughput, with increases in time to clinician, mean length of stay, and the proportion of patients leaving without being seen. CONCLUSIONS: We demonstrate the feasibility of providing quality performance report cards to hospital leaders using EHR data. We found mixed results in terms of the effectiveness of improving site-level metrics. Future efforts may facilitate further refinement of these interventions prior to dissemination.

  PublisherDOI

Recent grants

• NIH Grant RC1LM010471

  NIH · $823k · 2012

Frequent coauthors

• Alexander G. Fiks

  Children's Hospital of Philadelphia

  164 shared

• Jeffrey S. Gerber

  Children's Hospital of Philadelphia

  94 shared

• Elizabeth R. Alpern

  Lurie Children's Hospital

  86 shared

• Scott A. Lorch

  58 shared

• Lalit Bajaj

  57 shared

• Dean Karavite

  Children's Hospital of Philadelphia

  56 shared

• Evaline A. Alessandrini

  48 shared

• Jonathan M. Spergel

  Children's Hospital of Philadelphia

  44 shared

Labs

• Robert W Grundmeier LabPI

Education

• MD, School of Medicine

  University of Pennsylvania

  1997

• SB, Aeronautical and Astronautical Engineering

  Massachusetts Institute of Technology

  1991