Use of a computerized decision aid for developmental surveillance and screening: A randomized clinical trial

Aaron Carroll, Nerissa Bauer, Tamara M. Dugan, Vibha Anand, Chandan Saha, Stephen Downs

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Importance Developmental delays and disabilities are common in children. Research has indicated that intervention during the early years of a child's life has a positive effect on cognitive development, social skills and behavior, and subsequent school performance. Objective To determine whether a computerized clinical decision support system is an effective approach to improve standardized developmental surveillance and screening (DSS) within primary care practices. Design, Setting, and Participants In this cluster randomized clinical trial performed in 4 pediatric clinics from June 1, 2010, through December 31, 2012, children younger than 66 months seen for primary care were studied. Interventions We compared surveillance and screening practices after adding a DSS module to an existing computer decision support system. Main Outcomes and Measures The rates at which childrenwere screened for developmental delay. Results Medical records were reviewed for 360 children (180 each in the intervention and control groups) to compare rates of developmental screening at the 9-, 18-, or 30-month well-child care visits. The DSS module led to a significant increase in the percentage of patients screened with a standardized screening tool (85.0%vs 24.4%, P.001). An additional 120 records (60 each in the intervention and control groups) were reviewed to examine surveillance rates at visits outside the screening windows. The DSS module led to a significant increase in the percentage of patients whose parents were assessed for concerns about their child's development (71.7%vs 41.7%, P = .04). Conclusions and Relevance Using a computerized clinical decision support system to automate the screening of children for developmental delay significantly increased the numbers of children screened at 9, 18, and 30 months of age. It also significantly improved surveillance at other visits. Moreover, it increased the number of children who ultimately were diagnosed as having developmental delay and who were referred for timely services at an earlier age. Trial Registration clinicaltrials.gov Identifier: NCT01351077.

Original languageEnglish
Pages (from-to)815-821
Number of pages7
JournalJAMA Pediatrics
Volume168
Issue number9
DOIs
StatePublished - Sep 1 2014

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Decision Support Techniques
Randomized Controlled Trials
Clinical Decision Support Systems
Primary Health Care
Developmental Disabilities
Control Groups
Social Behavior
Child Care
Child Development
Medical Records
Parents
Outcome Assessment (Health Care)
Pediatrics
Research

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)

Cite this

Use of a computerized decision aid for developmental surveillance and screening : A randomized clinical trial. / Carroll, Aaron; Bauer, Nerissa; Dugan, Tamara M.; Anand, Vibha; Saha, Chandan; Downs, Stephen.

In: JAMA Pediatrics, Vol. 168, No. 9, 01.09.2014, p. 815-821.

Research output: Contribution to journalArticle

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abstract = "Importance Developmental delays and disabilities are common in children. Research has indicated that intervention during the early years of a child's life has a positive effect on cognitive development, social skills and behavior, and subsequent school performance. Objective To determine whether a computerized clinical decision support system is an effective approach to improve standardized developmental surveillance and screening (DSS) within primary care practices. Design, Setting, and Participants In this cluster randomized clinical trial performed in 4 pediatric clinics from June 1, 2010, through December 31, 2012, children younger than 66 months seen for primary care were studied. Interventions We compared surveillance and screening practices after adding a DSS module to an existing computer decision support system. Main Outcomes and Measures The rates at which childrenwere screened for developmental delay. Results Medical records were reviewed for 360 children (180 each in the intervention and control groups) to compare rates of developmental screening at the 9-, 18-, or 30-month well-child care visits. The DSS module led to a significant increase in the percentage of patients screened with a standardized screening tool (85.0{\%}vs 24.4{\%}, P.001). An additional 120 records (60 each in the intervention and control groups) were reviewed to examine surveillance rates at visits outside the screening windows. The DSS module led to a significant increase in the percentage of patients whose parents were assessed for concerns about their child's development (71.7{\%}vs 41.7{\%}, P = .04). Conclusions and Relevance Using a computerized clinical decision support system to automate the screening of children for developmental delay significantly increased the numbers of children screened at 9, 18, and 30 months of age. It also significantly improved surveillance at other visits. Moreover, it increased the number of children who ultimately were diagnosed as having developmental delay and who were referred for timely services at an earlier age. Trial Registration clinicaltrials.gov Identifier: NCT01351077.",
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