Electronic Health Record (EHR) Decision Support to Improve Outpatient Asthma Care

This study has been completed.

Sponsor:

Collaborator:

Agency for Healthcare Research and Quality (AHRQ)

Information provided by (Responsible Party):

Children's Hospital of Philadelphia

ClinicalTrials.gov Identifier:

NCT00918944

First received: June 9, 2009

Last updated: December 22, 2011

Last verified: December 2011

History of Changes

Purpose

To determine whether an innovative clinical decision support system embedded in an existing electronic health record (EHR) will improve provider adherence to the existing National Asthma Education and Prevention Program (NAEPP) guidelines.

12 primary care pediatric practices at The Children's Hospital of Philadelphia(both urban and suburban sites) will be randomized to receive either a passive EHR (control sites) or an interactive decision support system (intervention sites).

Condition	Intervention
Asthma	Other: Control Other: Intervention

Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Health Services Research
Official Title:	EHR Decision Support to Improve Outpatient Asthma Care

Resource links provided by NLM:

MedlinePlus related topics: Asthma

U.S. FDA Resources

Further study details as provided by Children's Hospital of Philadelphia:

Primary Outcome Measures:

The primary outcome measure is the proportion of persistent asthmatic patients with at least one prescription for a controller medication in each period. There are two periods of study: baseline and intervention. [ Time Frame: 6 months ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:

Secondary outcomes include the proportion of persistent asthmatic patients with 1)an updated asthma action plan, 2)spirometry as needed 3)problem list with current asthma severity 4)asthma-related quality of life scores 5)absent school and work days. [ Time Frame: 6 months ] [ Designated as safety issue: No ]

Enrollment:	12
Study Start Date:	January 2006
Study Completion Date:	August 2009
Primary Completion Date:	July 2009 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Control arm Practices with the EHR implemented will be randomized have the asthma disease management tools available passively (the control group).	Other: Control The asthma disease management toolkit available to all practices in the EHR will consist of four elements: A data entry tool for capturing asthma control data Standardized documentation templates to facilitate severity classification Order sets to facilitate ordering controller medications An asthma care plan that can be supplied to families
Intervention arm The intervention sites will have decision support alerts and reminders activated to guide providers toward these tools in the appropriate situations.	Other: Intervention Three alerts and two reminders will be programmed: Alert providers to enter asthma severity classification if none is on file Alert providers to prescribe controller medications for persistent asthma if none on file Alert providers to complete an asthma care plan if none on file Remind providers to review the asthma care plan if it is already on file by providing a link to the form Remind providers that educational content is available on-line by providing a web link

Arms

Assigned Interventions

Control arm

Practices with the EHR implemented will be randomized have the asthma disease management tools available passively (the control group).

Other: Control

The asthma disease management toolkit available to all practices in the EHR will consist of four elements:

A data entry tool for capturing asthma control data
Standardized documentation templates to facilitate severity classification
Order sets to facilitate ordering controller medications
An asthma care plan that can be supplied to families

Intervention arm

The intervention sites will have decision support alerts and reminders activated to guide providers toward these tools in the appropriate situations.

Other: Intervention

Three alerts and two reminders will be programmed:

Alert providers to enter asthma severity classification if none is on file
Alert providers to prescribe controller medications for persistent asthma if none on file
Alert providers to complete an asthma care plan if none on file
Remind providers to review the asthma care plan if it is already on file by providing a link to the form
Remind providers that educational content is available on-line by providing a web link

Detailed Description:

After receiving a standardized education module based on NAEPP guidelines, 12 primary care pediatric practices (both urban and suburban sites) will be randomized to receive either a passive EHR (control sites) or an interactive decision support system (intervention sites).

The primary outcome of interest will be the proportion of patients on appropriate asthma controller medication compared over time. Secondary outcomes include the proportion of asthma patients with: 1) an updated asthma action plan 2) documentation of spirometry performed (6 to 17 yrs) and 3) an updated problem list reflecting current asthma severity. After hours calls to providers and types of office visits related to asthma will be tracked. 4) In addition, measurement of asthma-related quality of life and missed school and work in a sample of 200 subjects from each group will be performed. Contextual factors at the clinic and patient level will be examined to assess their association with outcomes of interest.

If shown to be successful, this type of clinical decision support, embedded within the EHR, has the potential to be a powerful tool to improve the implementation of asthma guidelines and clinical practice guidelines for other conditions and illnesses in the primary setting.

Eligibility

Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Known patients with asthma

Exclusion Criteria:

None

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00918944

Locations

United States, Pennsylvania
The Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States, 19104

Sponsors and Collaborators

Children's Hospital of Philadelphia

Agency for Healthcare Research and Quality (AHRQ)

Investigators

Principal Investigator:

Louis M Bell, MD

Children's Hospital of Philadelphia

More Information

No publications provided

Responsible Party:	Children's Hospital of Philadelphia
ClinicalTrials.gov Identifier:	NCT00918944 History of Changes
Other Study ID Numbers:	2005-11-4596
Study First Received:	June 9, 2009
Last Updated:	December 22, 2011
Health Authority:	United States: Federal Government United States: Institutional Review Board

Keywords provided by Children's Hospital of Philadelphia:

clinical decision support tool
electronic health record
control tool

spirometry
quality of life survey
provider survey

Additional relevant MeSH terms:

Asthma
Bronchial Diseases
Respiratory Tract Diseases
Lung Diseases, Obstructive
Lung Diseases

Respiratory Hypersensitivity
Hypersensitivity, Immediate
Hypersensitivity
Immune System Diseases

ClinicalTrials.gov processed this record on May 23, 2013

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