Child Health Improvement Through Computer Automation - Child Neurology (CHICA-CN) Evaluation

CHICA-CN Evaluation - Evaluation of a Computer Decision Support System in Child Neurology

The study will evaluate a computer decision support system for child neurology, Child Health Improvement through Computer Automation - Child Neurology (CHICA-CN) using patient chart review, family phone surveys, and physician interviews in a before-after study design.

Study Overview

• Status: Completed
• Conditions: Neurologic Disorder
• Intervention / Treatment: Other: Computer decision support for physician

Detailed Description

(CHICA-CN) Child Health Improvement through Computer Automation - Child Neurology is software that works with the electronic health record (EHR) to improve the efficiency and quality of care in the outpatient setting. Built in partnership with the Child Neurology Foundation, CHICA's guidance is based on authoritative guidelines from the American Academy of Neurology and others. The plan is to implement CHICA-CN in the Child Neurology Clinics at Wake Forest Baptist Health. To evaluate CHICA-CN the proposal is to look at data derived from three sources:

1. Chart Review to evaluate quality of care based on measures derived from four algorithms developed from American Academy of Neurology quality measures and typically documented in the medical record. This will be a before-after study design in which measurements will be obtained before and after the installation of CHICA-CN.
2. Parent Phone Surveys to Document the parent experience in terms of physician-patient communication, parent engagement, and satisfaction with use of the patient facing tablet interface. These data will be collected from families of patients identified for the chart review after the intervention.
3. Physician user satisfaction measures, including perceived value of the system and ease of use in general and as regards individual clinical issues. Surveys will be administered to physicians and clinic staff who used CHICA-CN.

• Study Type: Observational
• Enrollment (Actual): 455

Contacts and Locations

Study Locations

• United States
  • North Carolina
    • Winston-Salem, North Carolina, United States, 27157
      • Wake Forest University Health Sciences

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: No older than 18 years (Child, Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

All children under 18 years of age who attend one of two participating child neurology clinics who qualify for one of the four cohorts and who have at least three visits to that clinic and at least one visit during the study period

Description

Inclusion Criteria:

• Must be patients in the participating clinical practices meeting inclusion criteria for one of the four cohorts

Exclusion Criteria:

• N/A

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

4

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Adolescent Depression Screening; > 3 visits to clinic; Diagnosis of epilepsy - International Classification of Diseases, Tenth Revision - Epilepsy and recurrent seizures (ICD-10:G40); Age > 12 years at last visit (before CHICA-CN) Computer assistant depression screening and management	Other: Computer decision support for physician; The Child Health Improvement through Computer Automation - Child Neurology (CHICA-CN) system will screen patients for needed services and provide reminders to physicians to provide the needed services.
Genetic Testing; > 3 visits to clinic; Diagnosis of global developmental delay - International Classification of Diseases, Tenth Revision - autistic disorder (ICD-10: F84); Age < 6 years at last visit (before CHICA-CN) Computer reminders to test for genetic disorders	Other: Computer decision support for physician; The Child Health Improvement through Computer Automation - Child Neurology (CHICA-CN) system will screen patients for needed services and provide reminders to physicians to provide the needed services.
Rescue seizure therapy; > 3 visits to clinic; Diagnosis of epilepsy - International Classification of Diseases, Tenth Revision - Epilepsy and recurrent seizures (ICD-10: G40); Age < 18 years at last visit (before CHICA-CN) Computer reminders to prescribe and adjust rescue anti-seizure medications	Other: Computer decision support for physician; The Child Health Improvement through Computer Automation - Child Neurology (CHICA-CN) system will screen patients for needed services and provide reminders to physicians to provide the needed services.
Adolescent Transition; > 3 visits to clinic; Age > 13 years at last visit (before CHICA-CN) Computer supported screening and counseling regarding transition to adult care	Other: Computer decision support for physician; The Child Health Improvement through Computer Automation - Child Neurology (CHICA-CN) system will screen patients for needed services and provide reminders to physicians to provide the needed services.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Chart Abstraction Outcomes - Transitions of Care	Transitions of Care - the number of charts that document that the service was provided divided by the number of charts reviewed	Visits will be extracted for the year before implementation of CHICA-CN and for a one year period after implementation of CHICA-CN
Chart Abstraction Outcomes - Rescue Seizure Therapy for Children with Epilepsy	Rescue Seizure Therapy for Children with Epilepsy - the number of charts that document that the service was provided divided by the number of charts reviewed	Visits will be extracted for the year before implementation of CHICA-CN and for a one year period after implementation of CHICA-CN
Chart Abstraction Outcomes - Genetic Testing for Global Developmental Delay	Genetic Testing for Global Developmental Delay - the number of charts that document that the service was provided divided by the number of charts reviewed	Visits will be extracted for the year before implementation of CHICA-CN and for a one year period after implementation of CHICA-CN
Chart Abstraction Outcomes - Adolescent Depression Screening	Adolescent Depression Screening - the number of charts that document that the service was provided divided by the number of charts reviewed	Visits will be extracted for the year before implementation of CHICA-CN and for a one year period after implementation of CHICA-CN
Physician-patient communication Survey Score	Communication subscale of the Ambulatory Care Experiences (ACE) Survey - includes 4 items like "How often did your personal doctor explain things in a way that was easy to understand" or "How would you rate your personal doctor's knowledge of your medical history." - Single score (0-12), higher score indicates better communication.	Eligible patients will be identified as they have encounters, starting 6 months after implementation of CHICA-CN and continuing for 12 months, assessed for the identified visit, within 2 weeks of the visit
Patient engagement Survey Score	Patient Activation Measure Short Form (PAM) - 13 item scale assesses whether the parent believes an active role in the child's care is important; if the parent has the confidence and knowledge to take action, e.g., medications, bringing concerns to the provider; if the parent has taken action, e.g., lifestyle changes, to improve child's health; and whether the parent stays on course under stress, e.g., being able to handle child's health condition at home. 13 items, single score (0-39), higher score indicates greater patient/parent engagement.	Eligible patients will be identified as they have encounters, starting 6 months after implementation of CHICA-CN and continuing for 12 months, assessed for the identified visit, within 2 weeks of the visit
Physician Satisfaction Survey	Clinician user satisfaction measures, including perceived value of the system and ease of use in general and as regards individual clinical issues. Surveys will be administered to physicians and clinic staff who used CHICA-CN. The survey includes a series of statements with which the respondent will mark their level of agreement on a Likert scale. There is no summary score, but we will calculate and report a mean, median, and range for each item.	After one year of of clinicians using CHICA-CN

Collaborators and Investigators

• Sponsor: Wake Forest University Health Sciences
• Collaborators: Indiana University; Norton Healthcare; Child Neurology Foundation
• Investigators: Principal Investigator: Jaclyn M Martindale, DO, Wake Forest University Health Sciences

Study record dates

Study Major Dates

• Study Start (Actual): August 18, 2022
• Primary Completion (Actual): August 30, 2024
• Study Completion (Actual): September 17, 2024

Study Registration Dates

• First Submitted: November 17, 2021
• First Submitted That Met QC Criteria: December 13, 2021
• First Posted (Actual): December 30, 2021

Study Record Updates

• Last Update Posted (Actual): October 17, 2024
• Last Update Submitted That Met QC Criteria: October 16, 2024
• Last Verified: August 1, 2024

More Information

Terms related to this study

• Keywords: Quality of Care; Child Health Improvement
• Additional Relevant MeSH Terms: Nervous System Diseases
• Other Study ID Numbers: IRB00078610

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: There is no plan to make individual participant data available to other researchers.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No