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Published on: January 11, 2020
Use of a computerized decision aid for developmental surveillance and screening: a randomized clinical trial
Aaron E Carroll1, Nerissa S Bauer2, Tamara M Dugan2
1Children's Health Services Research, Indiana University School of Medicine, Indianapolis2The Regenstrief Institute for Health Care, Indianapolis, Indiana.
Insights
A computerized clinical decision support system significantly improved developmental screening and surveillance in young children. This system increased early detection and timely referrals for developmental delays, enhancing pediatric care outcomes.
Area of Science:
- Pediatric Health
- Health Informatics
- Developmental Pediatrics
Background:
- Early intervention is crucial for children with developmental delays, positively impacting cognitive, social, and behavioral development.
- Standardized developmental surveillance and screening (DSS) in primary care is essential for early identification.
Purpose of the Study:
- To evaluate the effectiveness of a computerized clinical decision support system (DSS) in enhancing developmental surveillance and screening within pediatric primary care settings.
Main Methods:
- A cluster randomized clinical trial involving 4 pediatric clinics and children under 66 months.
- Comparison of developmental screening and surveillance rates before and after implementing a DSS module into an existing system.
Main Results:
- The DSS module significantly increased standardized developmental screening rates at key well-child visits (85.0% vs 24.4%).
- The system also significantly improved the assessment of parental concerns regarding child development during non-screening visits (71.7% vs 41.7%).
Conclusions:
- Computerized clinical decision support systems effectively enhance developmental screening and surveillance in primary care.
- This technology leads to earlier diagnosis and referral for children with developmental delays, improving access to timely services.
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 children were 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.
