Electronic health record-based decision support to improve asthma care: a cluster-randomized trial.
OBJECTIVE
Asthma continues to be 1 of the most common chronic diseases of childhood and affects approximately 6 million US children. Although National Asthma Education Prevention Program guidelines exist and are widely accepted, previous studies have demonstrated poor clinician adherence across a variety of populations. We sought to determine if clinical decision support (CDS) embedded in an electronic health record (EHR) would improve clinician adherence to national asthma guidelines in the primary care setting.


METHODS
We conducted a prospective cluster-randomized trial in 12 primary care sites over a 1-year period. Practices were stratified for analysis according to whether the site was urban or suburban. Children aged 0 to 18 years with persistent asthma were identified by International Classification of Diseases, Ninth Revision codes for asthma. The 6 intervention-practice sites had CDS alerts imbedded in the EHR. Outcomes of interest were the proportion of children with at least 1 prescription for controller medication, an up-to-date asthma care plan, and the performance of office-based spirometry.


RESULTS
Increases in the number of prescriptions for controller medications, over time, was 6% greater (P = .006) and 3% greater for spirometry (P = .04) in the intervention urban practices. Filing an up-to-date asthma care plan improved 14% (P = .03) and spirometry improved 6% (P = .003) in the suburban practices with the intervention.


CONCLUSIONS
In our study, using a cluster-randomized trial design, CDS in the EHR, at the point of care, improved clinician compliance with National Asthma Education Prevention Program guidelines.
Pediatric Research Consortium, Pediatric Generalist Research Group, Division of General Pediatrics, 12th Floor Northwest Tower, Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA. belll@email.chop.edu
Louis M
LM
Bell
Robert
R
Grundmeier
Russell
R
Localio
Joseph
J
Zorc
Alexander G
AG
Fiks
Xuemei
X
Zhang
Tyra Bryant
TB
Stephens
Marguerite
M
Swietlik
James P
JP
Guevara
D000293:Adolescent; D001249:Asthma / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D020000:Decision Support Systems, Clinical / Q000592:standards* / Q000639:trends; D057286:Electronic Health Records / Q000592:standards* / Q000639:trends; D006801:Humans; D011446:Prospective Studies