Browsing by Author "Dugan, Tamara M."

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Pediatric decision support using adapted Arden Syntax
    (Elsevier, 2015-10-01) Anand, Vibha; Carroll, Aaron E.; Biondich, Paul G.; Dugan, Tamara M.; Downs, Stephen M.; Department of Pediatrics, School of Medicine
    BACKGROUND: Pediatric guidelines based care is often overlooked because of the constraints of a typical office visit and the sheer number of guidelines that may exist for a patient's visit. In response to this problem, in 2004 we developed a pediatric computer based clinical decision support system using Arden Syntax medical logic modules (MLM). METHODS: The Child Health Improvement through Computer Automation system (CHICA) screens patient families in the waiting room and alerts the physician in the exam room. Here we describe adaptation of Arden Syntax to support production and consumption of patient specific tailored documents for every clinical encounter in CHICA and describe the experiments that demonstrate the effectiveness of this system. RESULTS: As of this writing CHICA has served over 44,000 patients at 7 pediatric clinics in our healthcare system in the last decade and its MLMs have been fired 6182,700 times in "produce" and 5334,021 times in "consume" mode. It has run continuously for over 10 years and has been used by 755 physicians, residents, fellows, nurse practitioners, nurses and clinical staff. There are 429 MLMs implemented in CHICA, using the Arden Syntax standard. Studies of CHICA's effectiveness include several published randomized controlled trials. CONCLUSIONS: Our results show that the Arden Syntax standard provided us with an effective way to represent pediatric guidelines for use in routine care. We only required minor modifications to the standard to support our clinical workflow. Additionally, Arden Syntax implementation in CHICA facilitated the study of many pediatric guidelines in real clinical environments.
  • Thumbnail Image
    Item
    Use of a computerized decision aid for developmental surveillance and screening: a randomized clinical trial
    (American Medical Association, 2014) Carroll, Aaron E.; Bauer, Nerissa S.; Dugan, Tamara M.; Anand, Vibha; Saha, Chandan; Downs, Stephen M.; Biostatistics and Health Data Science, School of Medicine
    Importance: Developmental delays and disabilities are common in children. Research has indicated that intervention during the early years of a child's life has a positive effect on cognitive development, social skills and behavior, and subsequent school performance. Objective: To determine whether a computerized clinical decision support system is an effective approach to improve standardized developmental surveillance and screening (DSS) within primary care practices. Design, setting, and participants: In this cluster randomized clinical trial performed in 4 pediatric clinics from June 1, 2010, through December 31, 2012, children younger than 66 months seen for primary care were studied. Interventions: We compared surveillance and screening practices after adding a DSS module to an existing computer decision support system. Main outcomes and measures: The rates at which children were screened for developmental delay. Results: Medical records were reviewed for 360 children (180 each in the intervention and control groups) to compare rates of developmental screening at the 9-, 18-, or 30-month well-child care visits. The DSS module led to a significant increase in the percentage of patients screened with a standardized screening tool (85.0% vs 24.4%, P < .001). An additional 120 records (60 each in the intervention and control groups) were reviewed to examine surveillance rates at visits outside the screening windows. The DSS module led to a significant increase in the percentage of patients whose parents were assessed for concerns about their child's development (71.7% vs 41.7%, P = .04). Conclusions and relevance: Using a computerized clinical decision support system to automate the screening of children for developmental delay significantly increased the numbers of children screened at 9, 18, and 30 months of age. It also significantly improved surveillance at other visits. Moreover, it increased the number of children who ultimately were diagnosed as having developmental delay and who were referred for timely services at an earlier age.