Using Electronic Health Records to Support Decision-Making in Pediatric Obesity Care

项目总结/摘要 尽管有大量的国家关注和研究，儿童肥胖症仍然是一个非常普遍的公共健康 威胁并导致严重的短期和长期不良健康结果。然而，儿科初级保健 临床医生经常不能遵循儿童肥胖症护理的可用专家指导。电子健康记录 （EHR）有可能通过提供以下工具来改善临床医生对肥胖症的诊断和治疗， 提醒和临床决策支持。然而，很少有人知道的有效性EHR为基础的 决策支持系统在整个医疗保健设置和具体因素，影响采用和 这些工具的影响。本K 08应用程序的总体目标是支持Mahnoosh（莫纳）Sharifi博士 实现她的职业目标，对系统级方法进行高影响力的研究，以促进 临床医生以及患者和家属做出循证决策，以支持慢性病 预防和减少儿童初级保健中的危险行为。Sharifi医生是儿童健康服务机构的 研究员，被任命为哈佛医学院普通学术部讲师 儿科在马萨诸塞州总医院，并在董事会认证的全科儿科医生执业 波士顿儿童医院初级保健中心。她利用自己作为儿科医生的临床经验 以及她在卫生服务研究方面的严格培训，以进行先前的研究，证明 基于EHR的临床决策支持工具用于修改临床实践。然而，为了实现 提出的目标和过渡到一个独立的研究生涯，她需要这个K 08的支持 在（1）实用的临床试验方法，（2）医学信息学，和（3）方面的额外培训奖 传播和实施科学。她的培训活动将包括教学课程， 通过儿童肥胖研究、临床领域国家领导人的大力指导进行体验式学习 信息系统、质量改进和传播/实施科学。科学目标 拟议的K 08奖将使Sharifi博士通过以下方式在这些关键领域发展关键技能：（1）进行 一项群集随机对照试验，以评估两种基于EHR的工具的比较有效性， 儿童初级保健中的肥胖管理;（2）利用调查和半调查的混合方法研究， 与两个卫生系统的临床医生进行结构化定性访谈，以检查 关于临床医生意识、知识和遵守指南的EHR工具，以及 影响工具的采用;（3）开发一个知情的实施工具包，以促进 基于EHR的工具的传播和具体实践实施，以支持儿科肥胖症护理 primary.这项工作是高度响应AHRQ的研究重点卫生信息技术（HIT） 设计、实施、使用和对结果的影响（NOT-HS-13-011）以及翻译、实施 并将以患者为中心的比较有效性研究证据推广到实践中（NOT-HS-13-010）。

PROJECT SUMMARY/ABSTRACT Despite significant national attention and research, childhood obesity remains a highly prevalent public health threat and contributes to significant short- and long-term adverse health outcomes. Yet, pediatric primary care clinicians often fail to follow available expert guidance for childhood obesity care. Electronic health records (EHRs) have the potential to improve clinicians' diagnosis and treatment of obesity by providing tools such as reminders and clinical decision support. However, little is known regarding the effectiveness of EHR-based decision support systems across health care settings and the specific factors that influence the adoption and impact of these tools. The overall goals of this K08 application are to support Dr. Mahnoosh (Mona) Sharifi attain her career goal of conducting high-impact research on systems-level approaches for facilitating evidence-informed decision making by clinicians, as well as patients and families, to support chronic disease prevention and risk behavior reduction in pediatric primary care. Dr. Sharifi is a child health services researcher, appointed as an Instructor at Harvard Medical School in the Division of General Academic Pediatrics at Massachusetts General Hospital, and a board-certified general pediatrician practicing at the Boston Children's Hospital Primary Care Center. She has drawn on her clinical experience as a pediatrician and her rigorous training in health services research to conduct prior studies demonstrating the potential of EHR-based clinical decision support tools in modifying clinical practice. However, in order to achieve the proposed aims and transition toward an independent research career, she requires the support of this K08 award for additional training in (1) pragmatic clinical trial methods, (2) medical informatics, and (3) dissemination and implementation science. Her training activities will consist of didactic coursework and experiential learning through strong mentorship from national leaders in pediatric obesity research, clinical information systems, quality improvement, and dissemination/implementation science. The scientific objectives of the proposed K08 award will allow Dr. Sharifi to develop critical skills in these key areas by: (1) conducting a cluster randomized controlled trial to assess the comparative effectiveness of two EHR-based tools to support obesity management in pediatric primary care; (2) utilize mixed methods research with surveys and semi- structured qualitative interviews with clinicians in two health systems to examine the contextual impact of the EHR tools on clinician awareness, knowledge and adherence to guidelines and the barriers and facilitators that influence adoption of the tools; and (3) develop a stakeholder-informed Implementation Toolkit to facilitate dissemination and practice-specific implementation of EHR-based tools to support obesity care in pediatric primary. This work is highly responsive to AHRQ research priorities of health information technology (HIT) design, implementation, use and impact on outcomes (NOT-HS-13-011) and the translation, implementation and diffusion of patient-centered, comparative effectiveness research evidence into practice (NOT-HS-13-010).