Physician Behavior
Conditions
Brief summary
The investigators have developed a novel decision support system for implementing clinical guidelines in pediatric practice. CHICA (Child Health Improvement through Computer Automation) combines three elements: (1) pediatric guidelines encoded in Arden Syntax; (2) a dynamic, scannable paper user interface; and (3) an HL7-compliant interface to existing electronic medical record systems. The result is a system that both delivers just-in-time patient-relevant guidelines to physicians during the clinical encounter, and accurately captures structured data from all who interact with it. Preliminary work with CHICA has demonstrated the feasibility of using the system to implement and evaluate clinical guidelines. However, analyses have shown that physicians ignore a fair number of prompts. The investigators would like to experiment with changes to the system to see if they can increase physicians' response rates. This could include highlighting prompts, reordering them, or flagging them in other ways. The main outcome of interest in the rate at which physicians answer prompts.
Detailed description
We have developed a novel decision support system for implementing clinical guidelines in pediatric practice. CHICA (Child Health Improvement through Computer Automation) combines three elements: (1) pediatric guidelines encoded in Arden Syntax; (2) a dynamic, scannable paper user interface; and (3) an HL7-compliant interface to existing electronic medical record systems. The result is a system that both delivers just-in-time patient-relevant guidelines to physicians during the clinical encounter, and accurately captures structured data from all who interact with it. Preliminary work with CHICA has demonstrated the feasibility of using the system to implement and evaluate clinical guidelines. However, analyses have shown that physicians ignore a fair number of prompts. We would like to experiment with changes to the system to see if we can increase physicians' response rates. This could include highlighting prompts, reordering them, or flagging them in other ways. The main outcome of interest is the rate at which physicians answer prompts. This will be a randomized, controlled trial of the CHICA system to see if we can improve prompt response rates. We will randomize physicians or clinics to receive some form of prompt change, including highlighting them, reordering them, or flagging them. No other changes will be made to care. We will extract data from the CHICA system for all patients seen in our study clinics. This data will include a the clinic location, whether or not a physician responded to a prompt, the prompt's position on the form, the patient's gender, the rule priority of the prompt, rule title, patient insurance category, the patient's age in days, and the name of the provider. The main outcome of interest is whether or not a prompt was answered (discussed/not discussed).
Interventions
OTHERReceiving Highlighted Prompts
Prompts received by physicians were highlighted.
OTHERReceiving Non-highlighted Prompts
Prompts received by physicians were not highlighted.
Sponsors
Indiana University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* Physicians practicing in one of our four CHICA clinics who use CHICA
Exclusion criteria
* Not being a physician practicing in one of our four CHICA clinics who use CHICA
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The Number of Prompts That Were Responded to | 1 year | The main outcome of interest is whether or not a prompt was answered (discussed/not discussed). |
Countries
United States
Participant flow
Pre-assignment details
While physicians were the ones that received prompts, the prompts are the unit of analysis.
Participants by arm
| Arm | Count |
|---|---|
| Receiving Highlighted Prompts These patients received highlighted prompts. | 1,076 |
| Receiving Non-highlighted Prompts These patients received prompts that were not highlighted. | 1,161 |
| Total | 2,237 |
Baseline characteristics
| Characteristic | Receiving Highlighted Prompts | Receiving Non-highlighted Prompts | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 1076 Participants | 1161 Participants | 2237 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants |
| Sex/Gender, Customized Unknown | 1076 Participants | 1161 Participants | 2237 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 1,076 | 0 / 1,161 |
| serious Total, serious adverse events | 0 / 1,076 | 0 / 1,161 |
Outcome results
Primary
The Number of Prompts That Were Responded to
The main outcome of interest is whether or not a prompt was answered (discussed/not discussed).
Time frame: 1 year
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Receiving Highlighted Prompts | The Number of Prompts That Were Responded to | 672 Participants |
| Receiving Non-highlighted Prompts | The Number of Prompts That Were Responded to | 712 Participants |