Parent-driven technology for decision support in pediatric emergency care.
BACKGROUND
A quasi-experimental intervention study composed of control and intervention periods was conducted to determine if a parent-driven health information technology influenced completeness of documentation and adherence to evidence-based emergency care for children.


METHODS
Structured chart abstraction was used to assess documentation and correctness of clinical actions at test ordering, medication prescribed for disease, and medication ordered for pain in a tertiary care pediatric emergency department and a suburban general emergency department. During the intervention periods, parents of children who presented with complaints related to otitis media, urinary tract infection, head trauma, or asthma entered data into a health information technology (ParentLink), which produced treatment plans in the context of evidence-based guidelines.


RESULTS
Of 1,410 subjects analyzed, 1,072 (76%) were assigned to one of four disease categories: urinary tract infection (22%), otitis media (20%), asthma (11%) and head trauma (47%). During ParentLink use, documentation of pain significantly improved (28% incomplete [control] versus 15% [intervention], p = .003). Incorrect actions for pain treatment decreased, but not significantly (33% [control] versus 24% [intervention], p = .13). ParentLink did not influence actions for test ordering or prescribing for disease.


CONCLUSIONS
Parent-driven health information technology intended to translate parents' knowledge into clinical practice and to support evidence-based care suggested a trend toward modest impact on pain management but did not demonstrate broad effects across diseases or care processes. The emergence and proliferation of personally controlled health records (PCHRs) presents opportunities for patients and parents to control their medical profiles. Although ParentLink is not a comprehensive PCHR, it represents a step in incorporating parent-derived information into medical decision making.
Fine
Andrew M
AM
Division of Emergency Medicine, Children's Hospital, Boston, USA. andrew.fine@childrens.harvard.edu
Kalish
Leslie A
LA
Forbes
Peter
P
Goldmann
Donald
D
Mandl
Kenneth D
KD
Porter
Stephen C
SC
D001249:Asthma / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000150:complications / Q000628:therapy; D020000:Decision Support Systems, Clinical; D004636:Emergency Service, Hospital; D005260:Female; D006764:Hospitals, Community; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D008404:Massachusetts; D008485:Medical Audit; D010033:Otitis Media / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010290:Parents; D010817:Physician-Patient Relations; D011446:Prospective Studies; D014552:Urinary Tract Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy