Computerized algorithms and pediatricians' management of common problems in a community clinic

Authors: 
Margolis CZ, Warshawsky SS, Goldman L, Dagan O, Wirtschafter D, Pliskin JS
Journal: 
Acad Med
Publication Date: 
1992 Apr
Volume: 
67
Issue: 
4
Pages: 
282-4
  • HIT Description: Computerized algorithm/decision-support system More info...
  • Purpose of Study: To determine whether pediatricians would be able to use computerized algorithms for the care of common problems, and the impact on quality and efficiency of care
  • Years of study: 1987
  • Study Design: Pre-post with randomization of patients in post-phase
  • Outcomes: Attitudes and use of computerized algorithm system by pediatricians, completeness of data capture and documentation, compliance with recommended management plans, incorrect usage of antibiotics.
Summary:
  • Settings: Community pediatrics clinic in Israel
  • Intervention:  Implementation of a computerized algorithm system
  • Evaluation Method: Audit of chart-based documentation, and interview of physician users of computer system
  • HIT System: Computerized algorithm system developed and implemented specifically for this study, which runs on a microcomputer and supports physician documentation via a step-wise computer-aided algorithm (intervention) vs. a computer generation paper form (control)
  • Strategy: volunteer pediatrician involved in the construction of pediatric care algorithms.
  • System Penetration: Group of six community pediatricians
  • Facilitators: Involvement of physician users in developing computer-aided algorithms
  • Barriers: Forcing physicians to follow a lock-step protocol that was cumbersome and tiring for each visit.
  • HIT System Sustainability: Not sustained due to physician refusal to use.
  • Healthcare Utilization: Decreased inappropriate use of antibiotics for otitis media (p<0.001) and pharyngitis (p<0.01)
  • Quality of Care and Patient Safety Outcome: Increased capture of complete documentation for otitis media, pharyngitis and upper respiratory infection. Increased adherence to protocol recommendations
  • Changes in efficiency and productivity: no increase in overall visit length
  • Time needed to accrue benefit: Data collected within 2 months of system implementation