title: Use of a computerized decision aid for developmental surveillance and screening: a randomized clinical trial.
abstract: OBJECTIVE
  Developmental delays and disabilities are common in children. Research has indicated that intervention during the early years of a child's life has a positive effect on cognitive development, social skills and behavior, and subsequent school performance.
  
  
  OBJECTIVE
  To determine whether a computerized clinical decision support system is an effective approach to improve standardized developmental surveillance and screening (DSS) within primary care practices.
  
  
  METHODS
  In this cluster randomized clinical trial performed in 4 pediatric clinics from June 1, 2010, through December 31, 2012, children younger than 66 months seen for primary care were studied.
  
  
  METHODS
  We compared surveillance and screening practices after adding a DSS module to an existing computer decision support system.
  
  
  METHODS
  The rates at which children were screened for developmental delay.
  
  
  RESULTS
  Medical records were reviewed for 360 children (180 each in the intervention and control groups) to compare rates of developmental screening at the 9-, 18-, or 30-month well-child care visits. The DSS module led to a significant increase in the percentage of patients screened with a standardized screening tool (85.0% vs 24.4%, P < .001). An additional 120 records (60 each in the intervention and control groups) were reviewed to examine surveillance rates at visits outside the screening windows. The DSS module led to a significant increase in the percentage of patients whose parents were assessed for concerns about their child's development (71.7% vs 41.7%, P = .04).
  
  
  CONCLUSIONS
  Using a computerized clinical decision support system to automate the screening of children for developmental delay significantly increased the numbers of children screened at 9, 18, and 30 months of age. It also significantly improved surveillance at other visits. Moreover, it increased the number of children who ultimately were diagnosed as having developmental delay and who were referred for timely services at an earlier age.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01351077.
authors.affiliation: Children's Health Services Research, Indiana University School of Medicine, Indianapolis2The Regenstrief Institute for Health Care, Indianapolis, Indiana.
authors.forename: Aaron E
authors.initials: AE
authors.lastname: Carroll
authors.affiliation: Children's Health Services Research, Indiana University School of Medicine, Indianapolis.
authors.forename: Nerissa S
authors.initials: NS
authors.lastname: Bauer
authors.affiliation: Children's Health Services Research, Indiana University School of Medicine, Indianapolis.
authors.forename: Tamara M
authors.initials: TM
authors.lastname: Dugan
authors.affiliation: Children's Health Services Research, Indiana University School of Medicine, Indianapolis2The Regenstrief Institute for Health Care, Indianapolis, Indiana.
authors.forename: Vibha
authors.initials: V
authors.lastname: Anand
authors.affiliation: Department of Biostatistics, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Indianapolis.
authors.forename: Chandan
authors.initials: C
authors.lastname: Saha
authors.affiliation: Children's Health Services Research, Indiana University School of Medicine, Indianapolis2The Regenstrief Institute for Health Care, Indianapolis, Indiana.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Downs
mesh_terms: D002657:Child Development; D002675:Child, Preschool; D003201:Computers; D003661:Decision Support Techniques; D002658:Developmental Disabilities / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007196:Indiana; D007223:Infant; D008297:Male; D008403:Mass Screening / Q000379:methods*; D011320:Primary Health Care