• Health services research · Apr 2015

    Adoption of electronic medical record-based decision support for otitis media in children.

    • Alexander G Fiks, Peixin Zhang, A Russell Localio, Saira Khan, Robert W Grundmeier, Dean J Karavite, Charles Bailey, Evaline A Alessandrini, and Christopher B Forrest.
    • The Pediatric Research Consortium, PolicyLab, and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA; Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA; Center for Biomedical Informatics (CBMI), The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA.
    • Health Serv Res. 2015 Apr 1; 50 (2): 489-513.

    ObjectiveSubstantial investment in electronic health records (EHRs) has provided an unprecedented opportunity to use clinical decision support (CDS) to increase guideline adherence. To inform efforts to maximize adoption, we characterized the adoption of an otitis media (OM) CDS system, the impact of performance feedback on adoption, and the effects of adoption on guideline adherence.Study SettingA total of 41,391 OM visits with 108 clinicians at 16 pediatric practices between February 2009 and August 2010.Study DesignProspective cohort study of EHR-based CDS adoption during OM visits, comparing clinicians receiving performance feedback to none. CDS was available to all physicians; use was voluntary.Data CollectionExtraction from a common EHR.Principal FindingsClinicians and practices used the CDS system for a mean of 21 percent (range: 0-85 percent) and 17 percent (0-51 percent) of eligible OM visits, respectively. Clinicians who received performance feedback reports summarizing CDS use and guideline adherence had a relative increase in CDS use of 9.0 percentage points compared to others (p = .001). CDS adoption was associated with increased OM guideline adherence. Effects were greatest among clinicians with the lowest adherence prior to the study.ConclusionsPerformance feedback increased CDS adoption, but additional strategies are needed to integrate CDS into primary care workflows.© Health Research and Educational Trust.

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