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

中耳炎(OM)-中耳感染-是儿童第二常见的疾病，由 当孩子们进入学校时，十分之九的孩子至少经历过一次插曲。它占了50亿美元的医疗成本， 这也是美国医生开抗生素的头号原因。医生倾向于过度使用 抗生素治疗OM因为它可能很难诊断，医疗保健通常分散在多个地点和 临床医生，以及一些医生并不知道建议更明智地使用这些药物的国家指南 药物。这些质量问题将在费城S儿童医院(CHOP)内解决 初级保健网络，组织成儿科研究联盟，该联盟管理着18万名儿童 来自3个州28个诊所的300多名儿科医生。我们的干预将使用CHOP？S电子健康档案来 整合不同时间的护理，并为医生提供他们需要的知识，了解如何在 关爱的重点。全面干预包括：(1)一种将患者接受的所有服务 任何医生进入临床逻辑集群，称为护理事件，(2)对药物的临床决策支持 以及基于最佳可用科学证据的专家推荐，(3)对过去的反馈 向医生提供OM护理的绩效，以及(4)关于如何使用这些工具的医生培训。这项研究 将随机将28个初级保健做法分为常规护理、完全干预和完全干预 反馈。我们已经包括一个专门测试质量反馈的独立贡献的ARM， 因为支持其影响的证据喜忧参半。这个项目？S的具体目标是： 目标1 1：发展和 中试OM健康信息技术(IT)干预； 目标2 2：检查 卫生信息技术干预和医生反馈对质量(主要结果)的独立贡献； 和, 目的3：评估干预对资源利用和临床医生二次结局的影响 采用这项技术。项目完成后，我们将与我们的顾问委员会成员合作， 包括美国儿科委员会、NCQA和美国儿童健康公司，以传播 我们的工作面向全国的儿童健康专业人员。由于OM在儿童中是一种常见的疾病， 该项目成果的广泛采用有可能影响数百万儿童的生活。 ：

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. :