Clinical Decision Support to Promote Immigrant Child Health Screening

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Project Summary The majority of non-refugee immigrant children entering the US receive limited or no screening for infectious conditions. Delays in the diagnosis and treatment of infectious conditions in immigrant children can result in increased adverse patient outcomes and increased spread of communicable diseases. There is publically available, evidence-based guidance for clinicians in the form of an American Academy of Pediatrics’ (AAP) Immigrant Child Health Toolkit. However, most clinicians have only cursory familiarity with this resource or the needs of immigrant children. With the expansion of electronic health records (EHR) into primary care, one of the most promising strategies for increasing awareness of and standardizing infectious disease screening for immigrant child populations is the use of clinical decision support (CDS). CDS that is evidence-based, developed in concordance with local workflows, and tested by representative users is more likely to have a positive impact on patient care. CDS developed to be shareable holds great promise for reaching populations—like immigrant children—who are seen by a large number of geographically-dispersed health care providers, many of whom practice in safety- net settings where resources are more limited. The process of translating evidence into shareable CDS is still evolving, and this project will help to identify drivers and barriers to implementation of infectious disease screening recommendations. Involvement of multiple representative users during the design phase of CDS development can enhance acceptability and usability of CDS. Drs. Yun and Michel have developed a comprehensive plan for translating evidence-based recommendations for infectious disease screening during the care of immigrant children into shareable CDS. They build upon a previous collaboration to complete a similar task for refugee children. During this award period, they will apply user-centered design to create CDS based upon the American Academy of Pediatrics’ immigrant health screening recommendations and then confirm that this CDS meets the needs of diverse primary care providers and immigrant families through user-tests. For this project they will draw upon a broad user base including clinicians, immigrant families, and language services professionals in order to capture the functional requirements for CDS from numerous viewpoints. This rigorous implementation development and testing will support their planned submission of a follow up project to test the impact of this application on clinical outcomes and to support dissemination of this CDS broadly.