Improving Otitis Media Care with Electronic Health Record (EHR)-based Clinical Decision Support and Feedback (Pennsylvania)


In this project, a clinical decision support (CDS) tool was developed for Otitis Media (OM), and then studied in a cluster randomized controlled trial to evaluate its impact on the quality of care of OM. Physician adoption patterns and reasons for adoption were also studied. The tool included visual displays of prior OM events and treatments, a data collection form, recommendations based on guidelines for OM, facilitated order entry, and OM specific patient instructions. The main objectives of the project were to:

  • Develop and pilot test the OM health information technology (IT) intervention.
  • Examine the overall effect of the health IT intervention and the independent contribution of physician feedback on quality.
  • Assess the effects of the intervention on the secondary outcomes of resource use and clinician adoption of the technology.
  • Work with members of the advisory board, including the American Board of Pediatrics, National Committee for Quality Assurance, and the Child Health Corporation of America to disseminate the resultant work to child health professionals nationally.

The project team successfully developed the OM CDS tool and completed its evaluation. The study found that those practices which used the CDS tool had significantly greater adherence to OM guidelines than those practices which did not use the tool. However, the rates of physician adoption of the tool varied markedly and overall were approximately 20 percent. The team is working to make changes based on feedback from physicians about the tool to improve adoption rates. The project team noted that there were significant resources used in order to create the tool with substantial investment in clinical informatics. They thus concluded that the need to understand and overcome barriers to physician adoption is critical.

Grant Number: 
R18 HS017042
Funding Mechanism: 
Ambulatory Safety and Quality Program: Improving Quality through Clinician Use of Health IT (R18)
AHRQ Funded Amount: 
Principal Investigator: 
Forrest, Christopher
The Children's Hospital of Philadelphia
Project Dates: 
September 12, 2007 to February 28, 2011
Project Status: 

Project Categories

Type of Health Information Technology: 
Clinical Decision Support (CDS) System
Computerized Provider Order Entry (CPOE)
Data Warehouse/Data Repository
Electronic Medical Record (EMR)/Electronic Health Record (EHR)
Care Setting: 
Outpatient Clinic
Aspect of Care: 
Primary Care
Quality Measurement/Quality Improvement
Target Population: 
Other Conditions
Other Conditions: Otitis Media
Last Modified: August 2015

News and Publications

Forrest C. Improving Otitis Media Care with Electronic Health Record (EHR)-based Clinical Decision Support and Feedback - Final Report. (Prepared by The Children's Hospital of Philadelphia under Grant No. R18 HS017042). Rockville, MD: Agency for Healthcare Research and Quality, 2011. (PDF, 1.15 MB)
The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

Project Activities