A Computerized Asthma Management System in the Pediatric Emergency Department

This study has been completed.
Sponsor:
Information provided by:
Vanderbilt University
ClinicalTrials.gov Identifier:
NCT01070147
First received: February 10, 2010
Last updated: March 21, 2011
Last verified: March 2011
  Purpose

The primary goal of this study is that the combination of a computerized asthma reminder system with implementation of an guideline will increase utilization and adherence of guideline-driven care, leading to improved patient outcomes.

Hypothesis: An automatic, computerized reminder system for detecting asthma patients in the pediatric ED will increase guideline adherence compared to paper-based guideline.

The specific aims of the study are:

Aim 1: Develop, implement, and integrate the asthma guideline in the ED information system infrastructure.

Aim 2: Evaluate the effect of the asthma detection system combined with the computerized guideline versus the asthma detection system combined with the paper-based guideline.


Condition Intervention
Asthma
Other: Computerized Asthma Management System

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Supportive Care
Official Title: A Computerized Asthma Management System in the Pediatric Emergency Department

Resource links provided by NLM:


Further study details as provided by Vanderbilt University:

Primary Outcome Measures:
  • length of stay [ Time Frame: 48 hours (or patient discharged from emergency department) ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • guideline adherence [ Time Frame: during ED visit (48 hours or less) ] [ Designated as safety issue: No ]
  • number of asthma scores [ Time Frame: during ED visit (48 hours or less) ] [ Designated as safety issue: No ]

Estimated Enrollment: 2400
Study Start Date: October 2010
Study Completion Date: February 2011
Primary Completion Date: February 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Control
The control group will receive a paper-based printed asthma guideline.
Other: Computerized Asthma Management System
The intervention group's clinicians will receive prompts via the computerized management system to prompt them for scoring, assessments, and disposition decisions.

Detailed Description:

Asthma is the leading chronic childhood disease affecting 9 million children (12.5%) under 18 years of age (1). Asthma exacerbations cause an estimated 14 million missed school days (2) and more than 1.8 million emergency department (ED) visits annually (2), and account for >60% of asthma-related costs (3). The chronic characteristic of asthma carries a considerable economic burden.

Uncontrolled asthma can lead to exacerbations requiring the patient to seek immediate care, frequently in an ED setting. Several asthma guidelines, including the nationally accepted guideline from the National Heart, Lung, and Blood Institute (NHLBI), exist to support clinicians in providing adequate treatment. Utilization of and adherence with asthma guidelines improves patients' clinical care (4, 5). However, guideline adherence remains suboptimal. In the ED, early recognition and accurate assessment of the severity of airway obstruction and response to therapy are fundamental to the improvement of health for patients with asthma. The NHLBI guidelines emphasize early recognition and treatment of asthma exacerbations, as well as appropriate treatment stratified by severity.

Computer applications for patient care can address barriers to optimal medical care. Computer systems have improved the use and adherence to practice guidelines, provide clinical alerts and reminders, and generate patient-specific treatment recommendations and educational material. Implementation of guideline-driven decision support is frequently paper-based or computerized. In either form a major barrier remains on the busy clinicians to remember to initiate the guideline a process and to embed the guideline tasks in the clinical workflow of the care team (5). The proposed study examines the benefits of a novel approach for reminding clinicians in an ED setting to use guideline-driven care. The approach will apply a workflow-embedded process taking advantage of an advanced information technology infrastructure. The informatics approach will include two elements: a) a computerized, real-time reminder system, which will automatically detect guideline-eligible patients without requiring additional data entry, and b) a computerized, workflow-embedded guideline implementation.

  Eligibility

Ages Eligible for Study:   2 Years to 28 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • all patients aged 2-18 years
  • Emergency Severity Index 2 to 5
  • availability of completed computerized triage documentation.

Exclusion Criteria:

  • critically ill patients (Emergency Severity Index 1)
  • patients who leave-without-being seen
  • patients who leave against-medical-advice
  • patients whose final diagnosis was not asthma (false positive identification by the detection system) or were determined not to be eligible for the guideline.
  Contacts and Locations
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Please refer to this study by its ClinicalTrials.gov identifier: NCT01070147

Locations
United States, Tennessee
Vanderbilt Children's Hospital
Nashville, Tennessee, United States, 37232
Sponsors and Collaborators
Vanderbilt University
Investigators
Study Director: Judith W Dexheimer, MS Vanderbilt University
Principal Investigator: Dominik Aronsky, MD, PhD Vanderbilt University
  More Information

Publications:
Responsible Party: Judith W Dexheimer, Vanderbilt University
ClinicalTrials.gov Identifier: NCT01070147     History of Changes
Other Study ID Numbers: 100189
Study First Received: February 10, 2010
Last Updated: March 21, 2011
Health Authority: United States: Institutional Review Board

Keywords provided by Vanderbilt University:
asthma
emergency medicine
medical informatics
computerized reminder systems

Additional relevant MeSH terms:
Asthma
Emergencies
Bronchial Diseases
Respiratory Tract Diseases
Lung Diseases, Obstructive
Lung Diseases
Respiratory Hypersensitivity
Hypersensitivity, Immediate
Hypersensitivity
Immune System Diseases
Disease Attributes
Pathologic Processes

ClinicalTrials.gov processed this record on August 26, 2014