title: Adoption of electronic medical record-based decision support for otitis media in children.
abstract: OBJECTIVE
  Substantial investment in electronic health records (EHRs) has provided an unprecedented opportunity to use clinical decision support (CDS) to increase guideline adherence. To inform efforts to maximize adoption, we characterized the adoption of an otitis media (OM) CDS system, the impact of performance feedback on adoption, and the effects of adoption on guideline adherence.
  
  
  METHODS
  A total of 41,391 OM visits with 108 clinicians at 16 pediatric practices between February 2009 and August 2010.
  
  
  METHODS
  Prospective cohort study of EHR-based CDS adoption during OM visits, comparing clinicians receiving performance feedback to none. CDS was available to all physicians; use was voluntary.
  
  
  METHODS
  Extraction from a common EHR.
  
  
  RESULTS
  Clinicians and practices used the CDS system for a mean of 21 percent (range: 0-85 percent) and 17 percent (0-51 percent) of eligible OM visits, respectively. Clinicians who received performance feedback reports summarizing CDS use and guideline adherence had a relative increase in CDS use of 9.0 percentage points compared to others (p = .001). CDS adoption was associated with increased OM guideline adherence. Effects were greatest among clinicians with the lowest adherence prior to the study.
  
  
  CONCLUSIONS
  Performance feedback increased CDS adoption, but additional strategies are needed to integrate CDS into primary care workflows.
authors.affiliation: The Pediatric Research Consortium, PolicyLab, and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA; Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA; Center for Biomedical Informatics (CBMI), The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Fiks
authors.forename: Peixin
authors.initials: P
authors.lastname: Zhang
authors.forename: A Russell
authors.initials: AR
authors.lastname: Localio
authors.forename: Saira
authors.initials: S
authors.lastname: Khan
authors.forename: Robert W
authors.initials: RW
authors.lastname: Grundmeier
authors.forename: Dean J
authors.initials: DJ
authors.lastname: Karavite
authors.forename: Charles
authors.initials: C
authors.lastname: Bailey
authors.forename: Evaline A
authors.initials: EA
authors.lastname: Alessandrini
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Forrest
mesh_terms: D002675:Child, Preschool; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005246:Feedback; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010033:Otitis Media / Q000175:diagnosis / Q000628:therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies
keywords: Decision support; electronic medical record; feedback; otitis media; quality of care