Child Health Improvement Through Computer Automation - Child Neurology (CHICA-CN) Evaluation

Study Overview
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Brief Summary
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The study will evaluate a computer decision support system for child neurology, Child Health Improvement through Computer Automation - Child Neurology (CHICA-CN) using patient chart review, family phone surveys, and physician interviews in a before-after study design.

Detailed Description
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(CHICA-CN) Child Health Improvement through Computer Automation - Child Neurology is software that works with the electronic health record (EHR) to improve the efficiency and quality of care in the outpatient setting. Built in partnership with the Child Neurology Foundation, CHICA's guidance is based on authoritative guidelines from the American Academy of Neurology and others. The plan is to implement CHICA-CN in the Child Neurology Clinics at Wake Forest Baptist Health. To evaluate CHICA-CN the proposal is to look at data derived from three sources: Chart Review to evaluate quality of care based on measures derived from four algorithms developed from American Academy of Neurology quality measures and typically documented in the medical record. This will be a before-after study design in which measurements will be obtained before and after the installation of CHICA-CN. Parent Phone Surveys to Document the parent experience in terms of physician-patient communication, parent engagement, and satisfaction with use of the patient facing tablet interface. These data will be collected from families of patients identified for the chart review after the intervention. Physician user satisfaction measures, including perceived value of the system and ease of use in general and as regards individual clinical issues. Surveys will be administered to physicians and clinic staff who used CHICA-CN.

Official Title
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CHICA-CN Evaluation - Evaluation of a Computer Decision Support System in Child Neurology

Conditions
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Neurologic Disorder

Intervention / Treatment
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* Other: Computer decision support for physician


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Must be patients in the participating clinical practices meeting inclusion criteria for one of the four cohorts Exclusion Criteria: N/A

Ages Eligible for Study
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Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Adolescent Depression Screening<br>> 3 visits to clinic Diagnosis of epilepsy - International Classification of Diseases, Tenth Revision - Epilepsy and recurrent seizures (ICD-10:G40) Age > 12 years at last visit (before CHICA-CN) Computer assistant depression screening and management | Other: Computer decision support for physician<br>* The Child Health Improvement through Computer Automation - Child Neurology (CHICA-CN) system will screen patients for needed services and provide reminders to physicians to provide the needed services.<br>|
| Genetic Testing<br>> 3 visits to clinic Diagnosis of global developmental delay - International Classification of Diseases, Tenth Revision - autistic disorder (ICD-10: F84) Age < 6 years at last visit (before CHICA-CN) Computer reminders to test for genetic disorders | Other: Computer decision support for physician<br>* The Child Health Improvement through Computer Automation - Child Neurology (CHICA-CN) system will screen patients for needed services and provide reminders to physicians to provide the needed services.<br>|
| Rescue seizure therapy<br>> 3 visits to clinic Diagnosis of epilepsy - International Classification of Diseases, Tenth Revision - Epilepsy and recurrent seizures (ICD-10: G40) Age < 18 years at last visit (before CHICA-CN) Computer reminders to prescribe and adjust rescue anti-seizure medications | Other: Computer decision support for physician<br>* The Child Health Improvement through Computer Automation - Child Neurology (CHICA-CN) system will screen patients for needed services and provide reminders to physicians to provide the needed services.<br>|
| Adolescent Transition<br>> 3 visits to clinic Age > 13 years at last visit (before CHICA-CN) Computer supported screening and counseling regarding transition to adult care | Other: Computer decision support for physician<br>* The Child Health Improvement through Computer Automation - Child Neurology (CHICA-CN) system will screen patients for needed services and provide reminders to physicians to provide the needed services.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Chart Abstraction Outcomes - Transitions of Care | Transitions of Care - the number of charts that document that the service was provided divided by the number of charts reviewed | Visits will be extracted for the year before implementation of CHICA-CN and for a one year period after implementation of CHICA-CN | 
| Chart Abstraction Outcomes - Rescue Seizure Therapy for Children with Epilepsy | Rescue Seizure Therapy for Children with Epilepsy - the number of charts that document that the service was provided divided by the number of charts reviewed | Visits will be extracted for the year before implementation of CHICA-CN and for a one year period after implementation of CHICA-CN | 
| Chart Abstraction Outcomes - Genetic Testing for Global Developmental Delay | Genetic Testing for Global Developmental Delay - the number of charts that document that the service was provided divided by the number of charts reviewed | Visits will be extracted for the year before implementation of CHICA-CN and for a one year period after implementation of CHICA-CN | 
| Chart Abstraction Outcomes - Adolescent Depression Screening | Adolescent Depression Screening - the number of charts that document that the service was provided divided by the number of charts reviewed | Visits will be extracted for the year before implementation of CHICA-CN and for a one year period after implementation of CHICA-CN | 
| Physician-patient communication Survey Score | Communication subscale of the Ambulatory Care Experiences (ACE) Survey - includes 4 items like How often did your personal doctor explain things in a way that was easy to understand or How would you rate your personal doctor's knowledge of your medical history. - Single score (0-12), higher score indicates better communication. | Eligible patients will be identified as they have encounters, starting 6 months after implementation of CHICA-CN and continuing for 12 months, assessed for the identified visit, within 2 weeks of the visit | 
| Patient engagement Survey Score | Patient Activation Measure Short Form (PAM) - 13 item scale assesses whether the parent believes an active role in the child's care is important; if the parent has the confidence and knowledge to take action, e.g., medications, bringing concerns to the provider; if the parent has taken action, e.g., lifestyle changes, to improve child's health; and whether the parent stays on course under stress, e.g., being able to handle child's health condition at home. 13 items, single score (0-39), higher score indicates greater patient/parent engagement. | Eligible patients will be identified as they have encounters, starting 6 months after implementation of CHICA-CN and continuing for 12 months, assessed for the identified visit, within 2 weeks of the visit | 
| Physician Satisfaction Survey | Clinician user satisfaction measures, including perceived value of the system and ease of use in general and as regards individual clinical issues. Surveys will be administered to physicians and clinic staff who used CHICA-CN. The survey includes a series of statements with which the respondent will mark their level of agreement on a Likert scale. There is no summary score, but we will calculate and report a mean, median, and range for each item. | After one year of of clinicians using CHICA-CN | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Quality of Care, Child Health Improvement