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Child Health Improvement Through Computer Automation (CHICA) Highlighting Study

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ClinicalTrials.gov Identifier: NCT01583101
Recruitment Status : Completed
First Posted : April 23, 2012
Results First Posted : March 23, 2017
Last Update Posted : May 15, 2017
Sponsor:
Information provided by (Responsible Party):
Aaron Carroll, Indiana University

Study Description
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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.


Condition or disease Intervention/treatment Phase
Physician Behavior Other: Receiving Highlighted Prompts Other: Receiving Non-highlighted Prompts Not Applicable

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).

Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 2237 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Health Services Research
Official Title: Increasing Prompt Response Rates in the CHICA System
Study Start Date : April 2012
Actual Primary Completion Date : October 2012
Actual Study Completion Date : October 2012

Resource links provided by the National Library of Medicine


Arms and Interventions
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Arm Intervention/treatment
Experimental: Receiving Highlighted Prompts
Prompts received by physicians were highlighted.
 Other: Receiving Highlighted Prompts
Prompts received by physicians were highlighted.
Active Comparator: Receiving Non-highlighted Prompts
Prompts received by physicians were not highlighted.
 Other: Receiving Non-highlighted Prompts
Prompts received by physicians were not highlighted.


Outcome Measures
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Primary Outcome Measures :
  1. The Number of Prompts That Were Responded to [ Time Frame: 1 year ]
    The main outcome of interest is whether or not a prompt was answered (discussed/not discussed).


Eligibility Criteria
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Information from the National Library of Medicine

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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

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
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01583101


Locations
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United States, Indiana
IUMG Clinic System
Indianapolis, Indiana, United States, 46202
Sponsors and Collaborators
Indiana University
Investigators
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Principal Investigator: Aaron E Carroll, MD, MS Indiana University School of Medicine
More Information
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Responsible Party: Aaron Carroll, Assoc. Prof of Pediatrics, Indiana University
ClinicalTrials.gov Identifier: NCT01583101    
Other Study ID Numbers: CHICA_Highlight_Study
First Posted: April 23, 2012    Key Record Dates
Results First Posted: March 23, 2017
Last Update Posted: May 15, 2017
Last Verified: April 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No