Comparison of Clinical Decision Support Tools to Improve Pediatric Lipid Screening

Area of Science:

• Pediatric Health
• Clinical Decision Support Systems
• Preventive Cardiology

Background:

• Guideline-recommended lipid screening in children is underutilized.
• Effective strategies are needed to improve adherence to screening guidelines.
• Clinical decision support (CDS) tools integrated into electronic health records (EHRs) show promise.

Purpose of the Study:

• To evaluate the effectiveness of different CDS tools in increasing clinician orders and patient completion of lipid screening in pediatric patients.
• To compare the impact of passive care gap listings versus active alerts, and their combination, against standard practice.

Main Methods:

• A pragmatic, patient-randomized clinical trial involving 13,346 children aged 9-11 years was conducted within the Geisinger Health System.
• Four arms were compared: passive care gap listing, active alert panel, combined care gap and alert, and a control group with standard practice.
• Outcomes measured included clinician orders for lipid screening and patient completion of tests within one week.

Main Results:

• Patients in active CDS arms (care gap and/or alert) were significantly more likely to have lipid screening ordered and completed compared to the control arm (ORs 1.67-5.73 for orders, 1.54-2.90 for completions).
• Active alerts, with or without care gap listings, demonstrated superior performance over care gaps alone for increasing screening orders (ORs 2.92-3.43).

Conclusions:

• Electronic health record-based alerts are effective in increasing both the ordering and completion of lipid screening in pediatric populations.
• CDS tools, particularly active alerts, can significantly improve guideline-concordant preventive care.
• Patient randomization within EHRs offers a robust method for assessing the comparative effectiveness of different clinical support interventions.