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

This study has been completed.
Sponsor:
Collaborator:
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

June 9, 2009
December 22, 2011
January 2006
July 2009   (final data collection date for primary outcome measure)
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 ]
Same as current
Complete list of historical versions of study NCT00918944 on ClinicalTrials.gov Archive Site
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 ]
Same as current
Not Provided
Not Provided
 
Electronic Health Record (EHR) Decision Support to Improve Outpatient Asthma Care
EHR Decision Support to Improve Outpatient Asthma Care

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).

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.

Interventional
Not Provided
Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Health Services Research
Asthma
  • 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
  • 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
  • Control arm
    Practices with the EHR implemented will be randomized have the asthma disease management tools available passively (the control group).
    Intervention: Other: Control
  • Intervention arm
    The intervention sites will have decision support alerts and reminders activated to guide providers toward these tools in the appropriate situations.
    Intervention: Other: Intervention
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
12
August 2009
July 2009   (final data collection date for primary outcome measure)

Inclusion Criteria:

  • Known patients with asthma

Exclusion Criteria:

  • None
Both
Not Provided
No
Contact information is only displayed when the study is recruiting subjects
United States
 
NCT00918944
2005-11-4596
No
Children's Hospital of Philadelphia
Children's Hospital of Philadelphia
Agency for Healthcare Research and Quality (AHRQ)
Principal Investigator: Louis M Bell, MD Children's Hospital of Philadelphia
Children's Hospital of Philadelphia
December 2011

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP