Research and Projects: AHRQ THQIT and SRD Portfolio

Massachusetts

Improving Pediatric Safety and Quality with Health Care IT

Description:  Systematically assess improvements in patient safety and experience of care associated with implementation of four decision support function embedded in an electronic health record: 1) the influence of weight based dosing on pediatric adverse drug events; 2) the influence of a test result tracking system on appropriate followup of ordered tests; 3) the influence of automated reminders on symptom monitoring and medications for children with asthma and attention deficit disorder.

Abstract:  DESCRIPTION (provided by applicant): The electronic health record (E.H.R.) is a cornerstone of improved safety and quality of health care. Many of the benefits from an EHR involve a computerized decision support system (CDSS). While significant research has been conducted on CDSSs, gaps remain. Little research has addressed CDSS in pediatrics and the added value of CDSS has yet to be quantified. This information is important for making decisions regarding value and trade-offs of specific functionalities within an E.H.R. We propose systematic assessment of the improvements in patient safety and experience of care associated with the implementation of four embedded CDSS functions in pediatric practices. In controlled trials and taking advantage of a set of natural experiments, the applicant will assess changes in adverse drug events and patient reports of care experience associated with the implementation of a CDSS in a large integrated delivery system. The four CDSS aids include: 1) weight-based dosing; 2) diagnosis-based medication choice prompts; 3) test result tracking; and 4) reminders for guideline adherence in children with chronic conditions. Specific aims include assessment of: 1) the influence of weight based dosing on pediatric adverse drug events; 2) the influence of a test result tracking system on appropriate follow-up of ordered tests; 3) the influence of automated reminders on symptom monitoring and medications for children with asthma and attention deficit disorder. The applicant will assess changes in patient experience of care using a modified pediatric CAHPS survey. As pediatricians increasingly adopt E.H.R.s, they will be faced with making decisions about the value of specific types of decision support. They will base their decisions on evidence of the effect of the decision support on patient safety, service delivery, physician work, and patient's experience of care. The proposed research will provide quantitative information on the value of CDSS in terms of patient safety, adherence to guidelines, and patient experience of care.

Year 1 Funding:  $496,239

Estimated Total Funding:  $1,489,826

Principal Investigator:  Timothy Ferris

Applicant Institution:  Massachusetts General Hospital

City/Town:  Boston, Massachusetts

State:  Massachusetts

Grant Number:  R01 HS15002

Category:  Value Grants (THQIT)

Thesaurus Terms:  automated medical record system, health care quality, patient safety /medical error, pediatric pharmacology, decision making, dosage, drug adverse effect, pediatrics, clinical research, data collection, health services research tag, human subject

Project Start Date:  Sep 30, 2004

Project End Date:  Sep 29, 2007