Computer Automated Developmental Surveillance and Screening (CADSS)

描述（由申请人提供）：在美国，12%至16%的儿童有发育障碍。早期干预计划可以改善这些儿童的结果，并且具有成本效益。儿科医学界一直在努力尽早识别发育迟缓或残疾的儿童，使用包括发育监测和筛查在内的标准化方法。然而，医生们列举了实施这些建议的几个障碍。现代计算机决策支持策略（CDSS）为克服这些障碍提供了最好的希望。我们开发了一种新的CDSS，用于在儿科实践中实施临床指南。CHICA（通过计算机自动化改善儿童健康）结合了三个要素：（1）以Arden格式编码的儿科指南;（2）动态、可扫描的纸质用户界面;以及（3）与现有电子病历系统兼容的HL 7接口。其结果是一个系统，既提供了“及时”的病人相关的指导方针，医生在遇到，并准确地捕捉结构化的数据，从所有谁与it. CHICA的初步工作已经证明了使用该系统来实施和评估临床指南的可行性。我们建议扩大CHICA，以包括一个发育监测和筛查模块。本申请的具体研究目的是：（1）扩展和修改现有的基于计算机的决策支持系统（CHICA），以纳入2006年美国儿科学会（AAP）发育监测和筛查算法;（2）评估CHICA系统对四家儿科诊所发育监测和筛查实践的影响;（3）评估CHICA系统在转介发展和医疗评估方面的效果，以及为那些被确定有有关发展筛查结果的儿童提供早期发展干预/幼儿服务;以及（4）建立一个可以随时间跟踪的具有已确定的发育障碍的儿童队列，以观察发育筛查的最终结果/效果。本研究将包括一项随机试验，以比较CHICA系统实施前后发育障碍的监测、筛查、诊断和管理方面的变化。为了衡量CHICA系统对发育监测和筛查实践的影响（目标2），我们将从医疗记录和CHICA系统中收集数据。目标2关注的主要结局是9、18和30个月访视时接受发育筛查的儿童比例。对于目标3，我们将评估儿童发育障碍管理计划的各个组成部分，以确定CHICA对发育障碍患者管理的影响。我们还将探讨儿童管理计划的质量方面，包括家庭参与治疗决策/计划，治疗决策是否基于初步评估并使用数据驱动的决策不断修改，以及管理策略是否建立在儿童的优势上。 公共卫生相关性：研究人员和医生组织，如美国儿科学会，呼吁儿科初级保健提供者制定一个标准化的方法来识别发育迟缓，包括发育监测和筛查，以促进早期识别和干预儿童发育障碍。然而，医生在实践中引用了一些实施这些建议的障碍。计算机决策支持系统，如我们开发的通过计算机自动化改善儿童健康（CHICA）系统，提供了解决这些障碍的最佳希望，并使发育监测和筛查能够适应忙碌儿科实践的工作流程。

DESCRIPTION (provided by applicant): Between 12 and 16% of children in the United States have a developmental disability. Early intervention programs improve outcomes in these children, and are also cost-effective. The pediatric medical community has pushed to identify children with developmental delays or disabilities as early as possible, using a standardized approach that includes both developmental surveillance and screening. Physicians, however, cite several barriers to the implementation of these recommendations. Modern computer decision support strategies (CDSS) offer the best hope of overcoming these barriers. We have developed a novel CDSS for implementing clinical guidelines in pediatric practice. CHICA (Child Health Improvement through Computer Automation) combines three elements: (1) pediatric guidelines encoded in Arden Syntax; (2) a dynamic, scannable paper user interface; and (3) an HL7-compliant interface to existing electronic medical record systems. The result is a system that both delivers "just-in-time" patient-relevant guidelines to physicians during encounters, and accurately captures structured data from all who interact with it. Preliminary work with CHICA has demonstrated the feasibility of using the system to implement and evaluate clinical guidelines. We propose to expand CHICA to include a developmental surveillance and screening module. The specific research aims of this application are to (1) expand and modify an existing computer-based decision support system (CHICA) to include the 2006 American Academy of Pediatrics (AAP) developmental surveillance and screening algorithm; (2) evaluate the effect of the CHICA system on the developmental surveillance and screening practices of four pediatric clinics; (3) evaluate the effect of the CHICA system on referrals for developmental and medical evaluations as well as early developmental intervention/early childhood services for those children identified as having concerning developmental screening results; and (4) develop a cohort of children with identified developmental disabilities that can be followed over time in order to look at the end results/effects of developmental screening. This study will include a randomized trial to compare changes in surveillance, screening, diagnosis, and management of developmental disorders before and after implementation of the CHICA system. To measure the effect of the CHICA system on developmental surveillance and screening practices (aim 2), we will collect data from medical records and the CHICA system. The primary outcome of interest for aim 2 is the proportion of children at 9, 18, and 30 month visits who undergo developmental screening. For aim 3, we will evaluate the individual components of a child's developmental disorder management program in order to determine CHICA's effect on the management of patients with developmental disorders. We will also explore qualitative aspects of a child's management plan, including family involvement in treatment decisions/planning, whether treatment decisions are based on an initial assessment and are continuously modified using data-driven decision-making, and whether the management strategies build on the strengths of the child. PUBLIC HEALTH RELEVANCE: Project Narrative Researchers and physician organizations such as the American Academy of Pediatrics have called on pediatric primary care providers to institute a standardized approach for the identification of developmental delays that includes both developmental surveillance and screening in order to facilitate early identification and intervention for children with developmental disorders. Physicians, however, cite several barriers to the implementation of these recommendations within their practices. Computer decision support systems, such as the Child Health Improvement through Computer Automation (CHICA) system we have developed, offer the best hope of addressing these barriers and enabling developmental surveillance and screening to fit within the workflow of busy pediatric practices.