Improving Food Allergy Management through an Electronic Physician Support Tool

描述（由申请人提供）：在美国，食物过敏是一个日益严重的潜在威胁生命的问题，影响了大约8%的儿童。初级保健临床医生通常是受影响家庭的第一资源，并在诊断儿童食物过敏方面发挥关键作用。因此，在初级保健环境中识别和适当管理食物过敏至关重要，并可能证明是挽救生命的。我们之前的工作表明，美国的初级保健临床医生对食物过敏管理有许多误解。此外，医生自己也表达了对他们有效管理食物过敏能力的担忧。此外，我们的研究表明，有令人信服的食物诱发反应史的儿童中，有三分之一从未接受过正式诊断。最近的图表回顾结果表明：1)医生经常在没有获得适当的临床病史和测试的情况下做出食物过敏的诊断；2)医生没有一贯开具注射肾上腺素处方；医疗记录中很少有关于食物过敏管理的咨询记录。目的：开发和评估电子临床决策支持工具的可行性和有效性，以提高初级保健机构对食物过敏的诊断和管理。我们假设开发一种基于证据的食物过敏临床决策支持工具，优化用于临床实践，将改善儿童食物过敏的初级保健临床实践。具体目的：本研究的具体目的是：1)根据最新的NIAID指南开发食物过敏支持工具（FAST），以改善初级保健环境中食物过敏的诊断和管理。FAST将包括提示症状识别、测试、药物、教育/咨询和过敏症专科医生转诊。它还将通过提供视频和打印格式的过敏原特异性材料，促进患者教育；2)通过快速循环流程改进将FAST整合到初级保健系统和流程中，并评估临床医生的满意度和易用性，在三家儿科初级保健诊所测试FAST使用的可行性；3)通过评估病历文件中的临床反应史、诊断测试和解释、药物处方和使用指导、对患者/护理人员的咨询和教育，以及转介给过敏专科医生，来确定FAST的有效性。下一步：该项目将开发一种基于证据的食物过敏支持工具（FAST），该工具将经过强有力的可行性测试，用于初级保健。该项目的结果将允许未来对家庭进行FAST干预的随机对照试验，以确定其改善食物过敏儿童护理质量和健康结果的能力。

DESCRIPTION (provided by applicant): Food allergy is a growing and potentially life-threatening concern in the United States that affects an estimated 8% of children. Primary care clinicians are often the first resource for affected families and play a critical role in the diagnsis of children with food allergy. Accordingly, recognition and proper management of food allergy in the primary care setting is critical and may prove life-saving. Our previous work suggests that primary care clinicians in the US have many misconceptions regarding food allergy management. In addition, physicians themselves expressed concern regarding their ability to manage food allergy effectively. Furthermore, our research shows that one in three children with a convincing history of food-induced reactions have never received a formal diagnosis. Recent results from chart reviews suggest that: 1) physicians are often making a diagnosis of food allergy without obtaining an appropriate clinical history and testing; 2) physicians are not consistently prescribing injectable epinephrine; and 3) little counseling about food allergy management is being documented in the medical record. Goal: To develop and evaluate the feasibility and efficacy of an electronic clinical decision support tool to improve the diagnosis and management of food allergy in the primary care setting. We hypothesize that the development of an evidence-based food allergy clinical decision support tool, optimized for use in clinical practice, will improve the primary care clinical practice of food allergy in children. Specific Aims: The specific aims of this study are to: 1) develop a Food Allergy Support Tool (FAST), based on the most recent NIAID guidelines, to improve the diagnosis and management of food allergy in the primary care setting. The FAST will include prompts for symptom recognition, testing, medications, education/counseling, and allergist referral. It will also faciltate patient education by making available allergen- specific materials, in both video and print formats; 2) Test the feasibility of use of the FAST in three pediatric primary care clinics by usin rapid cycle process improvement to integrate the FAST into the systems and processes of primary care, and assessing clinicians' satisfaction and ease of use; and 3) Determine the efficacy of the FAST by evaluating medical record documentation for clinical history of reactions, diagnostic testing and interpretation, medication prescription and instruction in use, counseling and education for patients/caregivers, and referral to an allergist. Next Steps: This project will result in the development of an evidence-based food allergy support tool (FAST) that will have undergone robust feasibility testing for use in primary care. The outcomes from this project will permit a future randomized control trial of a FAST intervention to families to determine its abilit to improve quality of care and health outcomes for children with food allergy.