title: Clinical Decision Support and Palivizumab: A Means to Protect from Respiratory Syncytial Virus.
abstract: OBJECTIVE
  Palivizumab can reduce hospitalizations due to respiratory syncytial virus (RSV), but many eligible infants fail to receive the full 5-dose series. The efficacy of clinical decision support (CDS) in fostering palivizumab receipt has not been studied. We sought a comprehensive solution for identifying eligible patients and addressing barriers to palivizumab administration.
  
  
  METHODS
  We developed workflow and CDS tools targeting patient identification and palivizumab administration. We randomized 10 practices to receive palivizumab-focused CDS and 10 to receive comprehensive CDS for premature infants in a 3-year longitudinal cluster-randomized trial with 2 baseline and 1 intervention RSV seasons.
  
  
  RESULTS
  There were 356 children eligible to receive palivizumab, with 194 in the palivizumab-focused group and 162 in the comprehensive CDS group. The proportion of doses administered to children in the palivizumab-focused intervention group increased from 68.4% and 65.5% in the two baseline seasons to 84.7% in the intervention season. In the comprehensive intervention group, proportions of doses administered declined during the baseline seasons (from 71.9% to 62.4%) with partial recovery to 67.9% during the intervention season. The palivizumab-focused group improved by 19.2 percentage points in the intervention season compared to the prior baseline season (p < 0.001), while the comprehensive intervention group only improved 5.5 percentage points (p = 0.288). The difference in change between study groups was significant (p = 0.05).
  
  
  CONCLUSIONS
  Workflow and CDS tools integrated in an EHR may increase the administration of palivizumab. The support focused on palivizumab, rather than comprehensive intervention, was more effective at improving palivizumab administration.
authors.affiliation: Departments of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biomedical and Health, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: L H
authors.initials: LH
authors.lastname: Utidjian
authors.affiliation: Departments of Pediatrics, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, Pennsylvania.
authors.forename: A
authors.initials: A
authors.lastname: Hogan
authors.affiliation: Department of Biomedical and Health, The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania.
authors.forename: J
authors.initials: J
authors.lastname: Michel
authors.affiliation: Departments of Biostatics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, Pennsylvania.
authors.forename: A R
authors.initials: AR
authors.lastname: Localio
authors.affiliation: Department of Biomedical and Health, The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania.
authors.forename: D
authors.initials: D
authors.lastname: Karavite
authors.affiliation: Healthcare Analytics Unit, The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania.
authors.forename: L
authors.initials: L
authors.lastname: Song
authors.affiliation: Department of Biomedical and Health, The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania.
authors.forename: M J
authors.initials: MJ
authors.lastname: Ramos
authors.affiliation: Departments of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biomedical and Health, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: A G
authors.initials: AG
authors.lastname: Fiks
authors.affiliation: Departments of Pediatrics, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, Pennsylvania.
authors.forename: S
authors.initials: S
authors.lastname: Lorch
authors.affiliation: Departments of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biomedical and Health, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: R W
authors.initials: RW
authors.lastname: Grundmeier
mesh_terms: D020000:Decision Support Systems, Clinical; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D000069455:Palivizumab / Q000008:administration & dosage / Q000494:pharmacology*; D018579:Patient Selection; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D018357:Respiratory Syncytial Virus Infections / Q000517:prevention & control*; D012136:Respiratory Syncytial Viruses / Q000502:physiology*; D012621:Seasons; D057188:Workflow
chemical_list: D000069455:Palivizumab
keywords: Respiratory syncytial virus; clinical decision support; electronic health records; palivizumab