Herlihy Lauren E, Walters Elizabeth M, D'Auria Jennifer P, Orgel Kelly, Jordan Katherine A
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
American Nurses Credentialing Center, Silver Spring, Maryland.
Pediatrics. 2023 Nov 1;152(5). doi: 10.1542/peds.2023-062371.
Peanut allergy in children is a population health problem. Evidence suggests early peanut introduction (EPI) for infants can reduce the development of peanut allergy. Primary care settings have not widely adopted guidelines recommending EPI. Peanut allergy prevention depends on primary care providers incorporating EPI guidelines into well-child check (WCC) encounters. We aimed to improve guideline adherence in a primary care setting by implementing a bundle of clinical decision support (CDS) tools.
Using quality improvement methodology, the team developed a standardized work protocol and CDS tools within an electronic medical record (EMR) at 4, 6, and 9-month WCC encounters. The team executed changes and modifications through plan-do-study-act cycles and analyzed results with statistical process control charts.
We collected data from 445 WCC encounters from baseline through sustainability. EMR documentation of EPI guidance at 4, 6, and 9-month WCCs shifted from 13.9% to 83.5% over 12 months. Provider adoption of smart lists and templates increased from 2% to 73%, the distribution of home peanut introduction handouts increased from 5.2% to 54.1%, and caregiver-reported peanut ingestion increased from 0% to 34.6%. Diphtheria-tetanus-acellular pertussis vaccination rates remained at 100% for 6-month visits, and patient in-room time remained at 65 minutes.
Quality improvement methodology improved documentation of EPI guidance and increased reported peanut ingestion at routine WCC encounters without impacting other measures. Broader use of bundled CDS tools and EMR standardization could further improve guideline adherence and increase early peanut introduction to prevent peanut allergy in infants.
儿童花生过敏是一个群体健康问题。有证据表明，婴儿早期引入花生（EPI）可降低花生过敏的发生率。基层医疗环境尚未广泛采用推荐EPI的指南。花生过敏的预防依赖于初级保健提供者将EPI指南纳入儿童健康检查（WCC）中。我们旨在通过实施一系列临床决策支持（CDS）工具来提高基层医疗环境中对指南的依从性。
利用质量改进方法，该团队在电子病历（EMR）中针对4、6和9个月的WCC会诊开发了标准化工作协议和CDS工具。该团队通过计划-执行-研究-改进循环来实施变更和修改，并使用统计过程控制图分析结果。
我们收集了从基线到可持续阶段445次WCC会诊的数据。在12个月的时间里，4、6和9个月WCC会诊中EPI指导的EMR记录从13.9%升至83.5%。提供者对智能列表和模板的采用率从2%增至73%，家庭花生引入手册的发放率从5.2%增至54.1%，照顾者报告的花生摄入量从0%增至34.6%。6个月就诊时白喉-破伤风-无细胞百日咳疫苗接种率保持在100%，患者在病房的时间保持在65分钟。
质量改进方法改善了EPI指导的记录，并在常规WCC会诊中增加了报告的花生摄入量，且未影响其他指标。更广泛地使用捆绑式CDS工具和EMR标准化可以进一步提高对指南的依从性，并增加早期花生引入以预防婴儿花生过敏。
