"Improving Pediatric Safety and Quality with Health Car*

描述（由申请人提供）：电子健康记录（E.H.R.）是提高医疗安全和质量的基石。 EHR的许多好处都涉及计算机化的决策支持系统（CDSS）。 虽然对CDSS进行了大量研究，但差距仍然存在。 关于儿科CDSS的研究很少，CDSS的附加值尚未量化。 这些信息对于E.H.R.中特定功能的价值和权衡决策非常重要。 我们建议系统评估与儿科实践中四个嵌入式CDSS功能的实施相关的患者安全和护理经验的改善。 在对照试验中，并利用一组自然实验，申请人将评估与在大型综合给药系统中实施CDSS相关的药物不良事件和患者报告的护理经验的变化。 CDSS的四个辅助工具包括：1）基于体重的给药; 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）基于体重的给药对儿科药物不良事件的影响; 2）测试结果跟踪系统对有序测试适当随访的影响; 3）自动提醒对哮喘和注意力缺陷障碍儿童症状监测和药物治疗的影响。 申请人将使用改良的儿科CAHPS调查评估患者护理体验的变化。 随着越来越多的儿科医生采用E.H.R.s，他们将面临对特定类型的决策支持的价值做出决定。 他们将根据决策支持对患者安全、服务提供、医生工作和患者护理体验的影响的证据做出决策。 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价值的定量信息。

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.