"Improving Pediatric Safety and Quality with Health Car*

描述(申请人提供)：电子健康记录(E.H.R.)是提高卫生保健安全和质量的基石。电子病历的许多好处都涉及计算机决策支持系统(CDSS)。虽然已经对CDSS进行了重大研究，但仍存在差距。很少有研究涉及CDSS在儿科的应用，CDSS的附加值还有待量化。这些信息对于在电子病历中做出关于特定功能的价值和权衡的决策非常重要。 我们建议对儿科实践中实施四种嵌入式CDSS功能在患者安全性和护理体验方面的改善进行系统评估。在对照试验中，申请人将利用一系列自然试验，评估与在大型综合递送系统中实施CDSS相关的不良药物事件和患者护理经验的变化。CDSS的四个辅助工具包括：1)基于重量的剂量；2)基于诊断的药物选择提示；3)测试结果跟踪；以及4)提醒患有慢性病的儿童遵守指南。具体目标包括评估：1)基于体重的剂量对儿科不良药物事件的影响；2)测试结果跟踪系统对有序测试的适当后续行动的影响；3)自动提醒对哮喘和注意力缺陷障碍儿童的症状监测和药物治疗的影响。申请人将使用修改后的儿科CAHPS调查来评估患者护理经验的变化。 随着儿科医生越来越多地采用急诊室，他们将面临关于特定类型决策支持的价值的决策。他们的决定将基于决策支持对患者安全、服务交付、医生工作和患者护理经验的影响的证据。这项拟议的研究将提供有关CDSS在患者安全性、遵守指南和患者护理体验方面的价值的量化信息。

DESCRIPTION (provided by applicant): The electronic health record (E.H.R.) is a cornerstone of improved safety and quality of health care. Many of the benefits from an EHR involve a computerized decision support system (CDSS). While significant research has been conducted on CDSSs, gaps remain. Little research has addressed CDSS in pediatrics and the added value of CDSS has yet to be quantified. This information is important for making decisions regarding value and trade-offs of specific functionalities within an E.H.R. We propose systematic assessment of the improvements in patient safety and experience of care associated with the implementation of four embedded CDSS functions in pediatric practices. In controlled trials and taking advantage of a set of natural experiments, the applicant will assess changes in adverse drug events and patient reports of care experience associated with the implementation of a CDSS in a large integrated delivery system. The four CDSS aids include: 1) weight-based dosing; 2) diagnosis-based medication choice prompts; 3) test result tracking; and 4) reminders for guideline adherence in children with chronic conditions. Specific aims include assessment of: 1) the influence of weight based dosing on pediatric adverse drug events; 2) the influence of a test result tracking system on appropriate follow-up of ordered tests; 3) the influence of automated reminders on symptom monitoring and medications for children with asthma and attention deficit disorder. The applicant will assess changes in patient experience of care using a modified pediatric CAHPS survey. As pediatricians increasingly adopt E.H.R.s, they will be faced with making decisions about the value of specific types of decision support. They will base their decisions on evidence of the effect of the decision support on patient safety, service delivery, physician work, and patient's experience of care. The proposed research will provide quantitative information on the value of CDSS in terms of patient safety, adherence to guidelines, and patient experience of care.