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.
(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
455
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.
Wake Forest University Health Sciences
Winston-Salem, North Carolina, United States
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
Time frame: 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
Time frame: 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
Time frame: 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
Time frame: 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.
Time frame: 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
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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.
Time frame: 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.
Time frame: After one year of of clinicians using CHICA-CN