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

Correspondence to:

Levon Utidjian
3535 Market St, Suite 1024, Room 1080
Department of Biomedical and Health Informatics
The Children’s Hospital of Philadelphia
Philadelphia, PA 19104
Phone: 215–300–4248   

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.


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Conflicts of interest

Dr. Grundmeier and Dr. Fiks are co-inventors of the Care Assistant decision support framework, which was used to implement portions of the intervention evaluated in this manuscript. No patent or licensing agreement exists for this technology and the invention has generated no revenue. As co-inventors of the Care Assistant, Dr. Grundmeier and Dr. Fiks may have a perceived conflict of interest. However, statisticians on the study team who have no conflicts of interest reviewed all study data and analyses.


Correspondence to:

Levon Utidjian
3535 Market St, Suite 1024, Room 1080
Department of Biomedical and Health Informatics
The Children’s Hospital of Philadelphia
Philadelphia, PA 19104
Phone: 215–300–4248