Actionable recommendations in the Bright Futures child health supervision guidelines

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)651-659
Number of pages9
JournalApplied Clinical Informatics
Volume5
Issue number3
DOIs
StatePublished - 2014

Fingerprint

Computability and decidability
Health
Guidelines
Screening
Pediatrics
Electronic guidance systems
Seats
Preventive Medicine
Family Health
Electronic Health Records
Railroad cars
Mental Health
Newborn Infant
Safety
Child Health

Keywords

  • Bright futures
  • Child
  • Clinical decision support
  • GLIA
  • Guidelines
  • Preventive medicine

ASJC Scopus subject areas

  • Health Informatics
  • Computer Science Applications
  • Health Information Management
  • Medicine(all)

Cite this

Actionable recommendations in the Bright Futures child health supervision guidelines. / Finnell, S. Maria; Stanton, J. L.; Downs, Stephen.

In: Applied Clinical Informatics, Vol. 5, No. 3, 2014, p. 651-659.

Research output: Contribution to journalArticle

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