An Electronic Decision Support Tool to Improve Outpatient Asthma Care
Condition: Asthma
MeSH terms: Asthma
Study type: Interventional

Summary: 
      The Children's Hospital of Philadelphia's ambulatory network uses an electronic health record
      (EHR) to document clinical information. Using the EHR, a clinical decision support tool will
      be designed to help the primary care physician's in caring for children with asthma. The goal
      will be to improve the primary care physician's use of the national Institutes of Health
      guidelines for the best care for asthma. To study this EHR decision support tool, it will be
      introduced into 5 practices while 5 other practices will have the existing asthma care
      information. It will be determined whether the physicians in the practices with the decision
      support tool are better at following the asthma guidelines. If the decision support tool
      works...then it will be offered to others to use with their EHR systems.
    

Detailed description: 
      National Asthma Education and Prevention Program guidelines (NAEPP) exist, but are under used
      in Primary Care. In addition, implementation of the guidelines has been shown to be vary
      according to the location of practice and other contextual factors.

      The Children's Hospital of Philadelphia Pediatric Research Consortium (PeRC), a
      practice-based research network will determine whether an innovative clinical decision
      support system embedded in an existing electronic health record (EHR) will improve provider
      adherence to the existing NAEPP guidelines.

      After receiving a standardized education module based on NAEPP guidelines, 10 primary care
      pediatric practices (both urban and suburban) will be randomized to receive either a passive
      EHR (control sites) or an interactive decision support sytem (intervention sites).

      The primary outcome of interest will be the proportion of patient son appropriate asthma
      controller medication compared over time. Secondary outcomes include the proportion of asthma
      patients with: 1) an updated asthma action plan 2) documentation of spirometry performed (6
      to 17years) and 3) an updated problem list reflecting current asthma severity. After hours
      calls to providers and types of office visits related to to asthma will be tracked.
      Contextual factors at the clinic and patient level will be examined to assess their
      association with the outcomes of interest. In addition, measurement of asthma-related quality
      of life and missed school and work in a sample of 200 subjects from each group will be
      performed

      If shown to be successful, this type of clinical decision support, embedded within the EHR,
      has the potential to be a powerful tool to improve the implementation of asthma guidelines
      and clinical practice guidelines for other conditions and illnesses.
    

Intervention name(s): Computerized Decision support
Intervention type(s): Behavioral
Intervention description(s): Using a clustered randomized method, computerized decision support, embedded in the electronic health record, was offered to selected primary care practices and outcomes of asthma care were compared to those practices without the computerized decision support.
Other intervention name(s): electronic health record
Intervention model: Single Group Assignment
Masking: None (Open Label)