Child Health Improvement Through Computer Automation (CHICA) Highlighting Study

Increasing Prompt Response Rates in the CHICA System

The investigators have developed a novel decision support system for implementing clinical guidelines in pediatric practice. CHICA (Child Health Improvement through Computer Automation) combines three elements: (1) pediatric guidelines encoded in Arden Syntax; (2) a dynamic, scannable paper user interface; and (3) an HL7-compliant interface to existing electronic medical record systems. The result is a system that both delivers "just-in-time" patient-relevant guidelines to physicians during the clinical encounter, and accurately captures structured data from all who interact with it. Preliminary work with CHICA has demonstrated the feasibility of using the system to implement and evaluate clinical guidelines.

However, analyses have shown that physicians ignore a fair number of prompts. The investigators would like to experiment with changes to the system to see if they can increase physicians' response rates. This could include highlighting prompts, reordering them, or flagging them in other ways. The main outcome of interest in the rate at which physicians answer prompts.

Study Overview

• Status: Completed
• Conditions: Physician Behavior
• Intervention / Treatment: Other: Receiving Highlighted Prompts; Other: Receiving Non-highlighted Prompts

Detailed Description

We have developed a novel decision support system for implementing clinical guidelines in pediatric practice. CHICA (Child Health Improvement through Computer Automation) combines three elements: (1) pediatric guidelines encoded in Arden Syntax; (2) a dynamic, scannable paper user interface; and (3) an HL7-compliant interface to existing electronic medical record systems. The result is a system that both delivers "just-in-time" patient-relevant guidelines to physicians during the clinical encounter, and accurately captures structured data from all who interact with it. Preliminary work with CHICA has demonstrated the feasibility of using the system to implement and evaluate clinical guidelines.

However, analyses have shown that physicians ignore a fair number of prompts. We would like to experiment with changes to the system to see if we can increase physicians' response rates. This could include highlighting prompts, reordering them, or flagging them in other ways. The main outcome of interest is the rate at which physicians answer prompts.

This will be a randomized, controlled trial of the CHICA system to see if we can improve prompt response rates. We will randomize physicians or clinics to receive some form of prompt change, including highlighting them, reordering them, or flagging them. No other changes will be made to care.

We will extract data from the CHICA system for all patients seen in our study clinics. This data will include a the clinic location, whether or not a physician responded to a prompt, the prompt's position on the form, the patient's gender, the rule priority of the prompt, rule title, patient insurance category, the patient's age in days, and the name of the provider. The main outcome of interest is whether or not a prompt was answered (discussed/not discussed).

• Study Type: Interventional
• Enrollment (Actual): 2237
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Indiana
    • Indianapolis, Indiana, United States, 46202
      • IUMG Clinic System

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Physicians practicing in one of our four CHICA clinics who use CHICA

Exclusion Criteria:

• Not being a physician practicing in one of our four CHICA clinics who use CHICA

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Receiving Highlighted Prompts; Prompts received by physicians were highlighted.	Other: Receiving Highlighted Prompts; Prompts received by physicians were highlighted.
Active Comparator: Receiving Non-highlighted Prompts; Prompts received by physicians were not highlighted.	Other: Receiving Non-highlighted Prompts; Prompts received by physicians were not highlighted.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The Number of Prompts That Were Responded to	The main outcome of interest is whether or not a prompt was answered (discussed/not discussed).	1 year

Collaborators and Investigators

• Sponsor: Indiana University
• Investigators: Principal Investigator: Aaron E Carroll, MD, MS, Indiana University School of Medicine

Study record dates

Study Major Dates

• Study Start: April 1, 2012
• Primary Completion (Actual): October 1, 2012
• Study Completion (Actual): October 1, 2012

Study Registration Dates

• First Submitted: April 18, 2012
• First Submitted That Met QC Criteria: April 19, 2012
• First Posted (Estimate): April 23, 2012

Study Record Updates

• Last Update Posted (Actual): May 15, 2017
• Last Update Submitted That Met QC Criteria: April 10, 2017
• Last Verified: April 1, 2017

More Information

Terms related to this study

• Other Study ID Numbers: CHICA_Highlight_Study

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO