Nguyen Thinh Hoang, Cunha Priscila Pereira, Rowland Annabelle Friedman, Orenstein Evan, Lee Tricia, Kandaswamy Swaminathan
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States.
Division of Immunology, Boston Children's Hospital, Boston, MA, United States.
JMIR Form Res. 2023 Aug 22;7:e47574. doi: 10.2196/47574.
Peanut allergy has recently become more prevalent. Peanut introduction recommendations have evolved from suggesting peanut avoidance until the age of 3 years to more recent guidelines encouraging early peanut introduction after the Learning Early about Peanut Allergy (LEAP) study in 2015. Guideline adherence is poor, leading to missed care opportunities.
In this study, we aimed to develop a user-centered clinical decision support (CDS) tool to improve implementation of the most recent early peanut introduction guidelines in the primary care clinic setting.
We edited the note template of the well-child check (WCC) visits at ages 4 and 6 months with CDS prompts and point-of-care education. Formative and summative usability testing were completed with pediatric residents in a simulated electronic health record (EHR). We estimated task completion rates and perceived usefulness of the CDS in summative testing, comparing a test EHR with and without the CDS.
Formative usability testing with the residents provided qualitative data that led to improvements in the build for both the 4-month and 6-month WCC note templates. During summative usability testing, the CDS tool significantly improved discussion of early peanut introduction at the 4-month WCC visit compared to scenarios without the CDS tool (9/15, 60% with CDS and 0/15, 0% without CDS). All providers except one at the 4-month WCC scenario gave at least an adequate score for the ease of use of the CDS tool for the history of present illness and assessment and plan sections. During the summative usability testing with the 6-month WCC new build note template, providers more commonly provided comprehensive care once obtaining a patient history concerning for an immunoglobulin E-mediated peanut reaction by placing a referral to allergy/immunology (P=.48), prescribing an epinephrine auto-injector (P=.07), instructing on how to avoid peanut products (P<.001), and providing an emergency treatment plan (P=.003) with CDS guidance. All providers gave at least an adequate score for ease of use of the CDS tool in the after-visit summary.
User-centered CDS improved application of early peanut introduction recommendations and comprehensive care for patients who have symptoms concerning for peanut allergy in a simulation.
花生过敏近来愈发普遍。花生引入建议已从建议在3岁前避免接触花生，演变为在2015年“早期了解花生过敏”（LEAP）研究之后的最新指南鼓励早期引入花生。指南的依从性较差，导致错失护理机会。
在本研究中，我们旨在开发一种以用户为中心的临床决策支持（CDS）工具，以改善基层医疗诊所环境中最新早期花生引入指南的实施情况。
我们使用CDS提示和即时护理教育编辑了4个月和6个月大儿童健康检查（WCC）访视的记录模板。在模拟电子健康记录（EHR）中与儿科住院医师完成了形成性和总结性可用性测试。我们在总结性测试中估计了任务完成率以及CDS的感知有用性，比较了有和没有CDS的测试EHR。
与住院医师进行的形成性可用性测试提供了定性数据，促使4个月和6个月WCC记录模板的构建得到改进。在总结性可用性测试期间，与没有CDS工具的情况相比，CDS工具在4个月大的WCC访视中显著改善了对早期花生引入的讨论（有CDS时为9/15，60%；没有CDS时为0/15，0%）。在4个月大的WCC场景中，除一名提供者外，所有提供者对CDS工具在现病史以及评估和计划部分的易用性至少给出了足够的评分。在使用6个月大的WCC新建记录模板进行总结性可用性测试期间，提供者在通过转诊至过敏/免疫学专科（P = 0.48）、开具肾上腺素自动注射器处方（P = 0.07）、指导如何避免花生制品（P < 0.001）以及在CDS指导下提供应急治疗计划（P = 0.003）获得有关免疫球蛋白E介导的花生反应的患者病史后，更普遍地提供了全面护理。所有提供者对CDS工具在访视后总结中的易用性至少给出了足够的评分。
以用户为中心的CDS在模拟中改善了早期花生引入建议的应用以及对有花生过敏相关症状患者的全面护理。
