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Published on: January 26, 2019
Clinical Decision Support and Palivizumab: A Means to Protect from Respiratory Syncytial Virus
L H Utidjian1, A Hogan2, J Michel3
1Departments of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biomedical and Health, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Insights
A palivizumab-focused clinical decision support (CDS) tool significantly improved palivizumab administration for infants at risk of respiratory syncytial virus (RSV). Comprehensive CDS was less effective, highlighting the benefit of targeted interventions.
Area of Science:
- Pediatrics
- Infectious Diseases
- Health Informatics
Background:
- Palivizumab (Synagis) reduces hospitalizations from respiratory syncytial virus (RSV) in eligible infants.
- Many infants eligible for palivizumab do not receive the complete 5-dose series.
- The impact of clinical decision support (CDS) on palivizumab administration is not well-studied.
Purpose of the Study:
- To develop and evaluate a comprehensive solution for identifying eligible patients for palivizumab.
- To assess the effectiveness of workflow and CDS tools in addressing barriers to palivizumab administration.
- To compare palivizumab-focused CDS with comprehensive CDS in improving palivizumab receipt.
Main Methods:
- A 3-year longitudinal cluster-randomized trial was conducted across 20 practices.
- Ten practices received palivizumab-focused CDS, and ten received comprehensive CDS for premature infants.
- The study included 2 baseline RSV seasons and 1 intervention RSV season.
Main Results:
- The palivizumab-focused CDS group saw an increase in administered doses from 68.4% to 84.7%.
- The comprehensive CDS group experienced a decline in administered doses from 71.9% to 67.9% during the intervention season.
- Palivizumab-focused CDS demonstrated a significant improvement of 19.2 percentage points (p < 0.001) compared to 5.5 percentage points (p = 0.288) for comprehensive CDS.
Conclusions:
- Integrated workflow and CDS tools within an Electronic Health Record (EHR) can enhance palivizumab administration.
- Palivizumab-specific CDS was more effective than a comprehensive CDS approach in increasing palivizumab uptake.
- Targeted CDS interventions are crucial for optimizing preventive therapy administration in at-risk populations.
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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