title: Targeted screening for pediatric conditions with the CHICA system.
abstract: OBJECTIVE
  The Child Health Improvement through Computer Automation (CHICA) system is a decision-support and electronic-medical-record system for pediatric health maintenance and disease management. The purpose of this study was to explore CHICA's ability to screen patients for disorders that have validated screening criteria--specifically tuberculosis (TB) and iron-deficiency anemia.
  
  
  METHODS
  Children between 0 and 11 years were randomized by the CHICA system. In the intervention group, parents were asked about TB and iron-deficiency risk, and physicians received a tailored prompt. In the control group, no screens were performed, and the physician received a generic prompt about these disorders.
  
  
  RESULTS
  1123 participants were randomized to the control group and 1116 participants to the intervention group. Significantly more people reported positive risk factors for iron-deficiency anemia in the intervention group (17.5% vs 3.1%, OR 6.6, 95% CI 4.5 to 9.5). In general, far fewer parents reported risk factors for TB than for iron-deficiency anemia. Again, there were significantly higher detection rates of positive risk factors in the intervention group (1.8% vs 0.8%, OR 2.3, 95% CI 1.0 to 5.0).
  
  
  CONCLUSIONS
  It is possible that there may be more positive screens without improving outcomes. However, the guidelines are based on studies that have evaluated the questions the authors used as sensitive and specific, and there is no reason to believe that parents misunderstood them.
  
  
  CONCLUSIONS
  Many screening tests are risk-based, not universal, leaving physicians to determine who should have a further workup. This can be a time-consuming process. The authors demonstrated that the CHICA system performs well in assessing risk automatically for TB and iron-deficiency anemia.
authors.affiliation: Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. aaecarro@iupui.edu
authors.forename: Aaron E
authors.initials: AE
authors.lastname: Carroll
authors.forename: Paul G
authors.initials: PG
authors.lastname: Biondich
authors.forename: Vibha
authors.initials: V
authors.lastname: Anand
authors.forename: Tamara M
authors.initials: TM
authors.lastname: Dugan
authors.forename: Meena E
authors.initials: ME
authors.lastname: Sheley
authors.forename: Shawn Z
authors.initials: SZ
authors.lastname: Xu
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Downs
mesh_terms: D000555:Ambulatory Care Information Systems; D018798:Anemia, Iron-Deficiency / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D020000:Decision Support Systems, Clinical; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening / Q000379:methods*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014376:Tuberculosis / Q000517:prevention & control*; D014481:United States; D014584:User-Computer Interface