Researchers at the Indiana University School of Medicine and Regenstrief Institute are using a computerized clinical decision support system (CDS) to improve pediatric care for children with developmental delays.
The researchers conducted a study of four primary care pediatric clinics in the Indianapolis-based Eskenazi Medical Group and found that a computerized automation system can help pediatricians comply with clinical guidelines to test children with possible developmental delays at 9, 18, and 30 months of age. They used the tablet-based Child Health Improvement through Computer Automation system (CHICA), which prioritizes the 20 most important questions for a specific patient based on the child's age, medical history and outcomes of past appointments. The answers to the questions are on the stored in the child's electronic health record and pushed to the pediatrician for follow-up.
The effectiveness of the CDS system is significant. In a randomized clinical trail of 360 patients who hadn't been exposed to any kind of support system, only 24 percent receiving the usual care were screened for developmental delay at the American Academy of Pediatrics-mandated ages. When the physicians used CHICA, 85 percent of patients were screened at these ages. Further, only 42 percent of parents in the control clinics were asked about concerns regarding their children's development outside of the 9-, 18- and 30-month, visits while 72 percent were queried by physicians with access to the CHICA developmental surveillance module.
"In our experience, even though parents voice concerns, they often aren't addressed by pediatricians in an optimal manner," stated study first author Aaron Carroll, M.D., professor of pediatrics at the Indiana University School of Medicine. "Screening and surveillance reassures parents and helps the child. If developmental delay is suspected, a full evaluation is done. If the child is diagnosed as developmentally delayed, CHICA helps the family get plugged into the resources their child needs. Evidence is mounting that early intervention has a positive effect on the child and subsequent school performance."
The findings were published in a recent issue of the Journal of the American Medical Association (JAMA) Pediatrics.