Erie Family Health Center, 1701 W. Superior Street, Chicago, IL 60622 USA ; Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL USA.
Transl Behav Med. 2011 Mar;1(1):103-7. doi: 10.1007/s13142-011-0019-1.
Overweight and obesity are common challenges facing pediatric clinicians. Electronic health records (EHRs) can impact clinician behavior through the presentation of relevant, patient-specific information during clinical encounters, potentially improving clinician recognition and management of overweight/obesity in children. Little research has been published evaluating the impact of EHR-facilitated decision support on the treatment of obesity in children. The main objectives of our community clinician-led project are: 1) to build customized, evidence-based decision support into an EHR; 2) To evaluate the impact of decision support on the identification and treatment of overweight and obese children; and 3) to improve behavior around screening for obesity-related comorbidities. Through a clinician-led consensus process, we customized end user templates in the commercially-available EHR at an urban community health center with a known high prevalence of childhood overweight and obesity. Evidence based decision support was build into the screens to prompt clinicians to identify and address overweight and obesity, as well as for related comorbidities. Pre/post measures will be used to evaluate the impact of these tactics on clinician behavior. The customized EHR templates took longer than anticipated to develop, but are now being used by pediatric clinicians at the health center. Feedback to date suggests that clinicians find the evidence based decision support useful at the point of care, especially around ordering recommended screening tests. Clinicians must be active participants in the design of decision support in order for it to impact their behavior. Off-the-shelf EHR products do not automatically come with comprehensive functionality to support evidence-based interventions around clinician behavior. Modifications are needed to achieve the full promise of health information technology as it relates to delivering high quality, patient-centered, for underserved populations.
超重和肥胖是儿科临床医生面临的常见挑战。电子健康记录 (EHR) 通过在临床就诊期间呈现相关的、特定于患者的信息，可以影响临床医生的行为，从而有可能提高临床医生对超重/肥胖儿童的识别和管理能力。但是，很少有研究发表评估 EHR 促进的决策支持对儿童肥胖治疗的影响。我们的社区临床医生主导的项目的主要目标是：1) 将基于证据的决策支持构建到 EHR 中；2) 评估决策支持对识别和治疗超重和肥胖儿童的影响；3) 改善与肥胖相关的合并症筛查行为。通过临床医生主导的共识过程，我们在一家城市社区卫生中心的商业上可用的 EHR 中定制了最终用户模板，该卫生中心已知有很高的儿童超重和肥胖患病率。在屏幕中构建了基于证据的决策支持，以提示临床医生识别和解决超重和肥胖问题，以及相关的合并症。将使用前后测量来评估这些策略对临床医生行为的影响。定制的 EHR 模板的开发时间比预期的要长，但现在已被卫生中心的儿科临床医生使用。迄今为止的反馈表明，临床医生发现基于证据的决策支持在护理点非常有用，尤其是在订购推荐的筛查测试方面。为了使决策支持对其行为产生影响，临床医生必须积极参与决策支持的设计。现成的 EHR 产品不一定具有全面的功能来支持基于临床医生行为的循证干预措施。需要进行修改，以充分发挥与为服务不足人群提供高质量、以患者为中心的医疗保健相关的健康信息技术的全部潜力。
