Actionable Recommendations in the Bright Futures Child Health Supervision Guidelines
14 February 2014
accepted: 02 June 2014
19 December 2017 (online)
Background: With the growing use of electronic health record systems, there is a demand for an electronic version of the leading American pediatric preventive care guideline, Bright Futures. As computer implementation requires actionable recommendations, it is important to assess to what degree Bright Futures meets criteria for actionability.
Objectives: We aimed to 1) determine the number of actionable recommendations in the current edition of Bright Futures and 2) to recommend a specific format for representing an important class of guidelines in a way that better facilitates computer implementation.
Methods: We consolidated all action statements in Bright Futures into recommendations. We then used two dimensions (decidability and executability) in the Guideline Implementability Appraisal v 2.0 (GLIA) to determine the actionability of the recommendations. Decidability means the recommendation states precisely under what conditions to perform those actions. Executability means actions are stated specifically, unambiguously and in sufficient detail. The results were presented in a figure titled Service Interval Diagram (SID), describing actionable recommendations, age intervals during which they are applicable, and how frequently they should occur in that interval.
Results: We consolidated 2161 action items into 245 recommendations and identified 52 that were actionable (21%). Almost exclusively, these recommendations addressed screening, such as newborn metabolic screening, or child safety, such as car seat use. A limited number (n=13) of recommendations for other areas of anticipatory guidance were also actionable. No recommendations on child discipline, family function or mental health met our criteria for actionability. The SID representing these recommendations is presented in a figure.
Conclusion: Only a portion of the Bright Futures Guidelines meets criteria for actionability. Substantial work lies ahead to develop most recommendations for anticipatory guidance into a computer implementable format.
Citation: Finnell SME, Stanton JL1, Downs SM. Actionable recommendations in the bright futures child health supervision guidelines. Appl Clin Inf 2014; 5: 651–659
KeywordsBright futures - child - clinical decision support - GLIA - guidelines - preventive medicine
- 1 Hagan J, Shaw J, Duncan P. Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents. 3rd edition ed. Elk Groove Village, IL: American Academy of Pediatrics; 2008
- 2 Tierney WM. Improving clinical decisions and outcomes with information: a review. Int J Med Inform 2001; 62 (01) 1-9.
- 3 Downs SM, Anand V, Dugan TM, Carroll AE. You can lead a horse to water: physicians’ responses to clinical reminders. AMIA Annu Symp Proc 2010; 2010: 167-171.
- 4 van der Sijs H, Aarts J, Vulto A, Berg M. Overriding of drug safety alerts in computerized physician order entry. J Am Med Inform Assoc 2006; 13 (02) 138-147.
- 5 Carroll AE, Biondich PG, Anand V, Dugan TM, Sheley ME, Xu SZ, Downs SM. Targeted screening for pediatric conditions with the CHICA system. J Am Med Inform Assoc 2011; 18 (04) 485-490.
- 6 Anand V, Carroll AE, Downs SM. Automated primary care screening in pediatric waiting rooms. Pediatrics 2012; 129 (05) e1275-e1281.
- 7 Carroll AE, Biondich P, Anand V, Dugan TM, Downs SM. A randomized controlled trial of screening for maternal depression with a clinical decision support system. J Am Med Inform Assoc 2013; 20 (02) 311-316.
- 8 Biondich PG, Downs SM, Carroll AE, Shiffman RN, McDonald CJ. Collaboration between the medical informatics community and guideline authors: fostering HIT standard development that matters. AMIA Annu Symp Proc 2006: 36-40.
- 9 GuideLine Implementability Appraisal (GLIA) instrument.. http://gem.med.yale.edu/egliahome.php. Accessed March 23, 2012, 2012.
- 10 Shiffman RN, Dixon J, Brandt C, Essaihi A, Hsiao A, Michel G, O’Connell R. The GuideLine Implementability Appraisal (GLIA): development of an instrument to identify obstacles to guideline implementation. BMC Med Inform Decis Mak 2005; 5: 23.
- 11 Hill KM, Lalor EE. How useful is an online tool to facilitate guideline implementation? Feasibility study of using eGLIA by stroke clinicians in Australia. Qual Saf Health Care 2009; 18 (02) 157-159.
- 12 Peleg M, Garber JR. Extending the GuideLine Implementability Appraisal (GLIA) instrument to identify problems in control flow. AMIA Annu Symp Proc 2010; 2010: 627-631.
- 13 Nagler EV, Webster AC, Bolignano D, Haller MC, Nistor I, van der Veer SN, Fouque D, Van Biesen W. European Renal Best Practice (ERBP) Guideline development methodology: towards the best possible guidelines. Nephrol Dial Transplant; 2013
- 14 van Dijk LJ, Nelen WL, D’Hooghe TM, Dunselman GA, Hermens RP, Bergh C, Nygren K, Simons A, de Sutter P, Marshall C, Burgers J, Kremer J. The European Society of Human Reproduction and Embryology guideline for the diagnosis and treatment of endometriosis: an electronic guideline implementability appraisal. Implement Sci 2011; 6: 7.
- 15 Chan W. S89 Implementation of GLIA Assessment in Kaiser Permanente and NHLBI to improve implementability of recommendation. Otolaryngol Head Neck Surg. 2010 143(1 suppl. 59).
- 16 Pediatrics AAo.. http://pediatrics.aappublications.org/content/suppl/2007/12/03/120.6.1376. DC1/Preventive_Health_Care_Chart.pdf. Accessed June 28, 2012.
- 17 Bull MJ. Health supervision for children with Down syndrome. Pediatrics. 2011; 128 (02) 393-406.
- 18 Tessier K. Effectiveness of hands-on education for correct child restraint use by parents. Accid Anal Prev 2010; 42 (04) 1041-1047.
- 19 Winston FK, Chen IG, Elliott MR, Arbogast KB, Durbin DR. Recent trends in child restraint practices in the United States. Pediatrics 2004; 113 (05) e458-e464.
- 20 Belamarich PF, Gandica R, Stein RE, Racine AD. Drowning in a sea of advice: pediatricians and American Academy of Pediatrics policy statements. Pediatrics 2006; 118 (04) e964-e978.