Appl Clin Inform 2015; 06(04): 769-784
DOI: 10.4338/ACI-2015-08-RA-0096
Research Article
Schattauer GmbH

Clinical Decision Support and Palivizumab

A Means to Protect from Respiratory Syncytial Virus
L.H. Utidjian
1  Departments of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
3  Department of Biomedical and Health, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
,
A. Hogan
1  Departments of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
,
J. Michel
3  Department of Biomedical and Health, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
,
A.R. Localio
2  Departments of Biostatics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
,
D. Karavite
3  Department of Biomedical and Health, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
,
L. Song
4  Healthcare Analytics Unit, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
,
M.J. Ramos
3  Department of Biomedical and Health, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
,
A.G. Fiks
1  Departments of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
3  Department of Biomedical and Health, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
,
S. Lorch
1  Departments of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
,
R.W. Grundmeier
1  Departments of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
3  Department of Biomedical and Health, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
› Author Affiliations
Further Information

Publication History

received: 07 August 2015

accepted: 08 November 2015

Publication Date:
19 December 2017 (online)

Summary

Background and Objectives: Palivizumab can reduce hospitalizations due to respiratory syncytial virus (RSV), but many eligible infants fail to receive the full 5-dose series. The efficacy of clinical decision support (CDS) in fostering palivizumab receipt has not been studied. We sought a comprehensive solution for identifying eligible patients and addressing barriers to palivizumab administration.

Methods: We developed workflow and CDS tools targeting patient identification and palivizumab administration. We randomized 10 practices to receive palivizumab-focused CDS and 10 to receive comprehensive CDS for premature infants in a 3-year longitudinal cluster-randomized trial with 2 baseline and 1 intervention RSV seasons.

Results: There were 356 children eligible to receive palivizumab, with 194 in the palivizumab-focused group and 162 in the comprehensive CDS group. The proportion of doses administered to children in the palivizumab-focused intervention group increased from 68.4% and 65.5% in the two baseline seasons to 84.7% in the intervention season. In the comprehensive intervention group, proportions of doses administered declined during the baseline seasons (from 71.9% to 62.4%) with partial recovery to 67.9% during the intervention season. The palivizumab-focused group improved by 19.2 percentage points in the intervention season compared to the prior baseline season (p < 0.001), while the comprehensive intervention group only improved 5.5 percentage points (p = 0.288). The difference in change between study groups was significant (p = 0.05).

Conclusions: Workflow and CDS tools integrated in an EHR may increase the administration of palivizumab. The support focused on palivizumab, rather than comprehensive intervention, was more effective at improving palivizumab administration.