An Electronic Decision Support Tool to Improve Outpatient Asthma Care

This study has been completed.
Sponsor:
Collaborator:
Children's Hospital of Philadelphia
Information provided by (Responsible Party):
lbell, Agency for Healthcare Research and Quality (AHRQ)
ClinicalTrials.gov Identifier:
NCT01522144
First received: January 19, 2012
Last updated: January 27, 2012
Last verified: January 2012
  Purpose

The Children's Hospital of Philadelphia's ambulatory network uses an electronic health record (EHR) to document clinical information. Using the EHR, a clinical decision support tool will be designed to help the primary care physician's in caring for children with asthma. The goal will be to improve the primary care physician's use of the national Institutes of Health guidelines for the best care for asthma. To study this EHR decision support tool, it will be introduced into 5 practices while 5 other practices will have the existing asthma care information. It will be determined whether the physicians in the practices with the decision support tool are better at following the asthma guidelines. If the decision support tool works...then it will be offered to others to use with their EHR systems.


Condition Intervention
Asthma
Behavioral: Computerized Decision support

Study Type: Interventional
Study Design: Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Official Title: EHR Decision Support to Improve Outpatient Asthma Care

Further study details as provided by Agency for Healthcare Research and Quality (AHRQ):

Primary Outcome Measures:
  • The proportion of patients on appropriate asthma controller medication at the end of the trial [ Time Frame: assessed at each visit ] [ Designated as safety issue: No ]
    each patient who is classified as having persistant asthma should be on at least one appropriate controller medication for asthma.


Secondary Outcome Measures:
  • 1) an updated asthma action plan [ Time Frame: updated at least once per year ] [ Designated as safety issue: No ]
    Each patient should have an asthma care plan updated once per year

  • 2)documentation of spirometry(6 to 18 yrs)in those with asthma [ Time Frame: spirometry should be done once per year ] [ Designated as safety issue: No ]
    Each patient should have had spirometry at least once per year.

  • 3) an updated problem list that reflects an assessment of asthma severity [ Time Frame: tthe asthma severity should be on the problem list ] [ Designated as safety issue: No ]
    each patient should have their asthma severity classification on the thier chart


Enrollment: 1030
Study Start Date: July 2006
Study Completion Date: August 2008
Primary Completion Date: April 2008 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Asthma clinical decision support
decision support compared to no decision support in a cluster-randomized trial by practise
Behavioral: Computerized Decision support
Using a clustered randomized method, computerized decision support, embedded in the electronic health record, was offered to selected primary care practices and outcomes of asthma care were compared to those practices without the computerized decision support.
Other Name: electronic health record

Detailed Description:

National Asthma Education and Prevention Program guidelines (NAEPP) exist, but are under used in Primary Care. In addition, implementation of the guidelines has been shown to be vary according to the location of practice and other contextual factors.

The Children's Hospital of Philadelphia Pediatric Research Consortium (PeRC), a practice-based research network will determine whether an innovative clinical decision support system embedded in an existing electronic health record (EHR) will improve provider adherence to the existing NAEPP guidelines.

After receiving a standardized education module based on NAEPP guidelines, 10 primary care pediatric practices (both urban and suburban) will be randomized to receive either a passive EHR (control sites) or an interactive decision support sytem (intervention sites).

The primary outcome of interest will be the proportion of patient son 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 17years) and 3) an updated problem list reflecting current asthma severity. After hours calls to providers and types of office visits related to to asthma will be tracked. Contextual factors at the clinic and patient level will be examined to assess their association with the outcomes of interest. 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

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.

  Eligibility

Ages Eligible for Study:   1 Year to 18 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Children with the diagnosis of asthma
  • Children enrolled in one of 10 selected primary care practices in the PeRC practice-based research network
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01522144

Locations
United States, Pennsylvania
The Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States, 19104
Sponsors and Collaborators
Children's Hospital of Philadelphia
Investigators
Principal Investigator: Louis M Bell, MD Children's Hospital of Philadelphia
  More Information

Publications:
Responsible Party: lbell, Medical Director of PeRC, Agency for Healthcare Research and Quality (AHRQ)
ClinicalTrials.gov Identifier: NCT01522144     History of Changes
Other Study ID Numbers: r21hs14873
Study First Received: January 19, 2012
Last Updated: January 27, 2012
Health Authority: United States: Federal Government

Additional relevant MeSH terms:
Asthma
Bronchial Diseases
Hypersensitivity
Hypersensitivity, Immediate
Immune System Diseases
Lung Diseases
Lung Diseases, Obstructive
Respiratory Hypersensitivity
Respiratory Tract Diseases

ClinicalTrials.gov processed this record on October 28, 2014