ParentLink: Better and Safer Emergency Care for Children

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DESCRIPTION (provided by the applicant): The proposed work is informed by a mandate from the Institute of Medicine's Committee on Data Standards for Patient Safety which urges health systems to provide complete patient information and decision support to clinicians and their patients. This application, ParentLink: Better and Safer Emergency Care for Children, focuses on two specific areas highlighted in this Request for Applications (RFA) published by the Agency for Healthcare Research and Quality: 1) topic 1.9, the advantages and disadvantages of HIT use amongst stakeholders; and 2) topic 5.1, the generation of new knowledge and evidence for HIT. The emergency department (ED) constitutes a high-risk environment for errors and poor quality of care. Pediatric patients are at increased risk of medical errors. This applicant postulates that implementation of a patient-centered health information technology, ParentLink, can address system-level deficiencies and the unique "just-in-time" information needs of ED physicians and the parents of ill children. The proposed work delivers an innovative product: an electronic interface linked to a pediatric knowledge base that integrates parent-derived data with best practices for safe and effective emergency care across five common pediatric disease conditions. These disease conditions include: 1) occult bacteremia; 2) otitis media; 3) urinary tract infections; 4) asthma; and 5) head trauma. The study has two aims, the first of which addresses critical gaps in data capture: this project will evaluate the completeness and accuracy of information on symptoms, disease condition, medications and allergies generated by parents using ParentLink versus information documented by ED physicians and nurses, using structured telephone interviews as a gold standard. The second aim measures the ParentLink's impact on ED patient safety and quality, specifically: a) the error rate for ordering and prescribing of medications during ED care; and b) the percent of ED visits that adhere to national evidence-based guidelines. ParentLink will be rigorously evaluated in a clinical trial at two diverse ED sites, using a sequential, non-randomized observational design with two intervention and two control periods to measure effects of ParentLink on data capture and the safety and quality of patient care.