Implementing a clinical decision support tool to increase early peanut introduction guidance.

Autor: Rowland AF; Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga., Nguyen TH; Division of Immunology, Boston Children's Hospital, Boston, Mass., Cunha PP; Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga., Ezhuthachan I; Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga., Orenstein E; Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga; Division of Hospital Medicine, Children's Healthcare of Atlanta, Atlanta, Ga., Kandaswamy S; Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga., Lee T; Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga. Electronic address: tricia.lee2@emory.edu.
Jazyk: angličtina
Zdroj: The Journal of allergy and clinical immunology [J Allergy Clin Immunol] 2024 Oct; Vol. 154 (4), pp. 988-995.e5. Date of Electronic Publication: 2024 Jul 10.
DOI: 10.1016/j.jaci.2024.07.005
Abstrakt: Background: General pediatric providers are the front line for early peanut introduction discussions, but many providers believe that they are ill-equipped to handle such discussions, as the guidelines have changed quickly.
Objective: We hypothesized that a clinical decision support (CDS) tool could improve discussions of peanut introduction.
Methods: CDS tools were designed by stakeholders, improved through usability testing, and integrated into the current note templates. On the basis of queries of electronic health records, we did a preperformance versus postperformance evaluation of conversations regarding peanut introduction, barriers to peanut introduction, and percentage of 12-month well-child checkups (WCCs) that resulted in successful introduction of peanut. Providers completed surveys before and after intervention to assess their awareness of early peanut introduction and comfort using the CDS tools.
Results: Providers' awareness of early peanut introduction guidelines increased from 17.8% to 66.7% after the CDS tool was implemented; 79.1% of the providers were comfortable using the tool. The CDS tool improved peanut introduction conversations at the 4-month WCC from 2.4% to 81.2%, at the 6-month WCC from 3.0% to 84.2%, and at the 12-month WCC from 2.7% to 82.9%. In all, 56.6% of families had a plan to introduce peanut at the 4-month WCC. Of those who did not have a plan, the most common barrier was the family's unawareness of the benefits of early peanut introduction. At the 12-month WCC, 62.8% of families had introduced peanut without concerns.
Conclusion: A point-of-care CDS tool encouraged more discussions of early peanut introduction between general pediatric providers and all patients. CDS tools should be considered in quality improvement projects as an implementation method for the most up-to-date guidelines.
Competing Interests: Disclosure statement Disclosure of potential conflict of interest: E. Orenstein is a cofounder of Phrase Health, a company that provides clinical decision support analytics, and holds equity in the company but does not receive any direct revenue; in addition, he serves as the principal investigator for a phase 1 and phase 2 small business technology transfer grant awarded to Phrase Health by the National Library of Medicine and the National Center for Advancing Translational Science. The rest of the authors declare that they have no relevant conflicts of interest.
(Copyright © 2024 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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