title: A Mobile Clinical Decision Support Tool for Pediatric Cardiovascular Risk-Reduction Clinical Practice Guidelines: Development and Description.
abstract: BACKGROUND
  Widespread application of research findings to improve patient outcomes remains inadequate, and failure to routinely translate research findings into daily clinical practice is a major barrier for the implementation of any evidence-based guideline. Strategies to increase guideline uptake in primary care pediatric practices and to facilitate adherence to recommendations are required.
  
  
  OBJECTIVE
  Our objective was to operationalize the US National Heart, Lung, and Blood Institute's Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents into a mobile clinical decision support (CDS) system for healthcare providers, and to describe the process development and outcomes.
  
  
  METHODS
  To overcome the difficulty of translating clinical practice guidelines into a computable form that can be used by a CDS system, we used a multilayer framework to convert the evidence synthesis into executable knowledge. We used an iterative process of design, testing, and revision through each step in the translation of the guidelines for use in a CDS tool to support the development of 4 validated modules: an integrated risk assessment; a blood pressure calculator; a body mass index calculator; and a lipid management instrument.
  
  
  RESULTS
  The iterative revision process identified several opportunities to improve the CDS tool. Operationalizing the integrated guideline identified numerous areas in which the guideline was vague or incorrect and required more explicit operationalization. Iterative revisions led to workable solutions to problems and understanding of the limitations of the tool.
  
  
  CONCLUSIONS
  The process and experiences described provide a model for other mobile CDS systems that translate written clinical practice guidelines into actionable, real-time clinical recommendations.
authors.affiliation: Digital Health and Clinical Informatics, RTI International, Research Triangle Park, NC, United States.
authors.forename: Robert D
authors.identifier: http://orcid.org/0000-0002-3803-1879
authors.initials: RD
authors.lastname: Furberg
authors.affiliation: Center for Communication Science, RTI International, Research Triangle Park, NC, United States.
authors.forename: Pamela
authors.identifier: http://orcid.org/0000-0002-6040-6972
authors.initials: P
authors.lastname: Williams
authors.affiliation: Digital Health and Clinical Informatics, RTI International, Research Triangle Park, NC, United States.
authors.forename: Jacqueline
authors.identifier: http://orcid.org/0000-0002-2210-8843
authors.initials: J
authors.lastname: Bagwell
authors.affiliation: Division for Health Services and Social Policy Research, RTI International, Research Triangle Park, NC, United States.
authors.forename: Kenneth
authors.identifier: http://orcid.org/0000-0001-9040-1956
authors.initials: K
authors.lastname: LaBresh
keywords: cardiovascular risk reduction; clinical decision support; clinical practice guidelines; mHealth; pediatrics