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Clinical decision support based in electronic health records improved asthma care
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Implementing clinical decision support into electronic health records produced increased adherence to National Asthma Education Prevention Program guidelines.
Researchers from the Children’s Hospital of Philadelphia (CHOP) conducted a prospective, cluster-randomized trial in 12 primary care sites within the CHOP Research Consortium during a one-year period. Their goal was to determine if embedding clinical decision support in electronic health records would help primary care physicians offer asthma treatment consistent with NAEPP recommendations.
“Information systems that provide support to users at the time they make decisions may enable health clinicians to accelerate adoption of guidelines and eventually close the gap between optimal and actual practice,” the researchers wrote.
The study involved four urban teaching practices and eight suburban practices and included children aged 0 to 18 years with persistent asthma, according to the researchers. They incorporated interventions consisting of clinical decision support alerts and reminders that showed up in a patient’s electronic health records regarding the following asthma management tools:
- Pediatric asthma-control tool (PACT) for capturing asthma symptom frequency;
- Standardized documentation templates to help with severity classification;
- Order sets to assist in the ordering of controller medications and spirometry;
- An asthma action/care plan that can be given to families.
Results showed a 6% boost in the number of prescriptions for controller medications (P=.006) and a 3% increase for spirometry (P=.04) after intervention was implemented in the urban practices, according to the researchers. Suburban practices demonstrated a 14% improvement in filing up-to-date asthma care plans (P=.03) and a 6% improvement in spirometry (P=.003) after intervention.
Despite positive results, the researchers noted certain factors affecting the efficacy of clinical decision support, including the specific outcome being measured and the level of practice compliance with NAEPP guidelines before clinical decision support intervention.
Bell LM. Pediatrics. 2010;125:e770-e777.