title: Actionable recommendations in the Bright Futures child health supervision guidelines.
abstract: BACKGROUND
  With the growing use of electronic health record systems, there is a demand for an electronic version of the leading American pediatric preventive care guideline, Bright Futures. As computer implementation requires actionable recommendations, it is important to assess to what degree Bright Futures meets criteria for actionability.
  
  
  OBJECTIVE
  We aimed to 1) determine the number of actionable recommendations in the current edition of Bright Futures and 2) to recommend a specific format for representing an important class of guidelines in a way that better facilitates computer implementation.
  
  
  METHODS
  We consolidated all action statements in Bright Futures into recommendations. We then used two dimensions (decidability and executability) in the Guideline Implementability Appraisal v 2.0 (GLIA) to determine the actionability of the recommendations. Decidability means the recommendation states precisely under what conditions to perform those actions. Executability means actions are stated specifically, unambiguously and in sufficient detail. The results were presented in a figure titled Service Interval Diagram (SID), describing actionable recommendations, age intervals during which they are applicable, and how frequently they should occur in that interval.
  
  
  RESULTS
  We consolidated 2161 action items into 245 recommendations and identified 52 that were actionable (21%). Almost exclusively, these recommendations addressed screening, such as newborn metabolic screening, or child safety, such as car seat use. A limited number (n=13) of recommendations for other areas of anticipatory guidance were also actionable. No recommendations on child discipline, family function or mental health met our criteria for actionability. The SID representing these recommendations is presented in a figure.
  
  
  CONCLUSIONS
  Only a portion of the Bright Futures Guidelines meets criteria for actionability. Substantial work lies ahead to develop most recommendations for anticipatory guidance into a computer implementable format.
authors.affiliation: Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine , Indianapolis, Indiana ; Regenstrief Institute Inc. , Indianapolis, Indiana.
authors.forename: S M E
authors.initials: SM
authors.lastname: Finnell
authors.affiliation: Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine , Indianapolis, Indiana.
authors.forename: J L
authors.initials: JL
authors.lastname: Stanton
authors.affiliation: Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine , Indianapolis, Indiana ; Regenstrief Institute Inc. , Indianapolis, Indiana.
authors.forename: S M
authors.initials: SM
authors.lastname: Downs
mesh_terms: D002648:Child; D002669:Child Welfare; D004282:Documentation / Q000592:standards*; D006801:Humans; D033181:Information Dissemination; D010372:Pediatrics / Q000592:standards*; D017410:Practice Guidelines as Topic; D011315:Preventive Medicine / Q000592:standards*; D014481:United States
keywords: Bright futures; GLIA; child; clinical decision support; guidelines; preventive medicine