Srinivasan Suresh1, Richard A Saladino1, Janet Fromkin1, Emily Heineman1, Tom McGinn2, Rudolph Richichi3, Rachel P Berger1. 1. Department of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 2. Department of Medicine, Hofstra Northwell School of Medicine, Manhasset, NY, USA. 3. Statistical Analysis and Measurement Consultants Inc., Alexandria, VA, USA.
Abstract
Objective: To evaluate the effect of a previously validated electronic health record-based child abuse trigger system on physician compliance with clinical guidelines for evaluation of physical abuse. Methods: A randomized controlled trial (RCT) with comparison to a preintervention group was performed. RCT-experimental subjects' providers received alerts with a direct link to a physical abuse-specific order set. RCT-control subjects' providers had no alerts, but could manually search for the order set. Preintervention subjects' providers had neither alerts nor access to the order set. Compliance with clinical guidelines was calculated. Results:Ninety-nine preintervention subjects and 130 RCT subjects (73 RCT-experimental and 57 RCT-control) met criteria to undergo a physical abuse evaluation. Full compliance with clinical guidelines was 84% pre-intervention, 86% in RCT-control group, and 89% in RCT-experimental group. The physical abuse order set was used 43 times during the 7-month RCT. When the abuse order set was used, full compliance was 100%. The proportion of cases in which there was partial compliance decreased from 10% to 3% once the order set became available (P = .04). Male gender, having >10 years of experience and completion of a pediatric emergency medicine fellowship were associated with increased compliance. Discussion/ Conclusion: A child abuse clinical decision support system comprised of a trigger system, alerts and a physical abuse order set was quickly accepted into clinical practice. Use of the physical abuse order set always resulted in full compliance with clinical guidelines. Given the high baseline compliance at our site, evaluation of this alert system in hospitals with lower baseline compliance rates will be more valuable in assessing the efficacy in adherence to clinical guidelines for the evaluation of suspected child abuse.
RCT Entities:
Objective: To evaluate the effect of a previously validated electronic health record-based child abuse trigger system on physician compliance with clinical guidelines for evaluation of physical abuse. Methods: A randomized controlled trial (RCT) with comparison to a preintervention group was performed. RCT-experimental subjects' providers received alerts with a direct link to a physical abuse-specific order set. RCT-control subjects' providers had no alerts, but could manually search for the order set. Preintervention subjects' providers had neither alerts nor access to the order set. Compliance with clinical guidelines was calculated. Results: Ninety-nine preintervention subjects and 130 RCT subjects (73 RCT-experimental and 57 RCT-control) met criteria to undergo a physical abuse evaluation. Full compliance with clinical guidelines was 84% pre-intervention, 86% in RCT-control group, and 89% in RCT-experimental group. The physical abuse order set was used 43 times during the 7-month RCT. When the abuse order set was used, full compliance was 100%. The proportion of cases in which there was partial compliance decreased from 10% to 3% once the order set became available (P = .04). Male gender, having >10 years of experience and completion of a pediatric emergency medicine fellowship were associated with increased compliance. Discussion/ Conclusion: A child abuse clinical decision support system comprised of a trigger system, alerts and a physical abuse order set was quickly accepted into clinical practice. Use of the physical abuse order set always resulted in full compliance with clinical guidelines. Given the high baseline compliance at our site, evaluation of this alert system in hospitals with lower baseline compliance rates will be more valuable in assessing the efficacy in adherence to clinical guidelines for the evaluation of suspected child abuse.
Authors: Kaveh G Shojania; Alison Jennings; Alain Mayhew; Craig R Ramsay; Martin P Eccles; Jeremy Grimshaw Journal: Cochrane Database Syst Rev Date: 2009-07-08
Authors: Braja G Patra; Mohit M Sharma; Veer Vekaria; Prakash Adekkanattu; Olga V Patterson; Benjamin Glicksberg; Lauren A Lepow; Euijung Ryu; Joanna M Biernacka; Al'ona Furmanchuk; Thomas J George; William Hogan; Yonghui Wu; Xi Yang; Jiang Bian; Myrna Weissman; Priya Wickramaratne; J John Mann; Mark Olfson; Thomas R Campion; Mark Weiner; Jyotishman Pathak Journal: J Am Med Inform Assoc Date: 2021-11-25 Impact factor: 7.942
Authors: Thomas McGinn; David A Feldstein; Isabel Barata; Emily Heineman; Joshua Ross; Dana Kaplan; Safiya Richardson; Barbara Knox; Amanda Palm; Francesca Bullaro; Nicholas Kuehnel; Linda Park; Sundas Khan; Benjamin Eithun; Rachel P Berger Journal: Int J Med Inform Date: 2020-12-10 Impact factor: 4.730