Improving Otitis Media Care with EHR-based Clinical Decision Support and Feedback

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Otitis media (OM)?infection of the middle ear--is the second most common disease in childhood, and by the time children enter school, 9 in 10 will have had at least one episode. It accounts for $5 billion in medical costs, and is the number one reason why physicians in the U.S. prescribe antibiotics. Physicians tend to overuse antibiotics for OM because it can be hard to diagnose, healthcare is often fragmented across multiple sites and clinicians, and some physicians are not aware of national guidelines that recommend more judicious use of these medicines. These quality problems will be addressed within the Children?s Hospital of Philadelphia (CHOP) primary care network, organized into a Pediatric Research Consortium, which has >180,000 children managed by 300+ pediatricians from 28 practices in 3 states. Our intervention will use CHOP?s electronic health record to integrate care across time and to supply physicians with the knowledge they need about how to treat a patient at the point of care. The full intervention comprises (1) a method for linking all services a patient received from any physician into clinically logical clusters called episodes-of-care, (2) clinical decision support for medications and referrals to specialists that are based on the best available scientific evidence, (3) feedback on past performance of OM care provided to physicians, and (4) physician training on how to use the tools. The study will randomly allocate 28 primary care practices into usual care, full intervention, and full intervention without feedback. We have included an arm to specifically test the independent contribution of feedback on quality, because the evidence in support of its effects is mixed. The project?s specific aims are: Aim 1 1: To develop and pilot test the OM health Information Technology (IT) intervention; Aim 2 2: To examine the overall effect of the health IT intervention and the independent contribution of physician feedback on quality (primary outcomes); and, Aim 3 3: To assess the effects of the intervention on the secondary outcomes of resource use and clinician adoption of the technology. Upon project completion, we will work with members of our advisory board, including the American Board of Pediatrics, NCQA, and Child Health Corporation of America, to disseminate our work nationally to child health professionals. Because OM is such a common disorder in children, the widespread adoption of the results from this project has the potential for affecting lives of millions of children. :