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Decision Support Tools Strengthen Early Peanut Introduction Practices and Streamline Data Automation
Lauren E Herlihy1, Cristina Collins2, Kelly Reilly3
1Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, USA.
Insights
Early peanut introduction (EPI) significantly increased caregiver-reported peanut consumption in infants. This quality improvement initiative successfully expanded evidence-based guidelines for peanut allergy prevention through primary care providers.
Area of Science:
- Pediatric Allergy and Immunology
- Public Health
- Quality Improvement in Healthcare
Background:
- Peanut allergy remains a significant health concern for children in the United States.
- Early peanut introduction (EPI) is a proven strategy for peanut allergy prevention.
- Primary care providers (PCPs) are crucial for guiding caregivers on infant food introduction.
Purpose of the Study:
- To increase caregiver-reported peanut consumption among infants at key well-child checks (WCCs).
- To implement and spread an early peanut introduction (EPI) guideline across multiple outpatient clinics.
- To evaluate the effectiveness of a modified clinical decision support (CDS) toolkit for EPI.
Main Methods:
- A quality improvement (QI) team adapted an existing clinical decision support (CDS) toolkit.
- An automated electronic medical record (EMR) reporting tool was developed for data collection.
- Statistical Process Control Charts (SPCCs) were used to analyze data during intervention and sustainability.
Main Results:
- Caregiver-reported peanut consumption increased from 0% to 62.8% across 6-, 9-, and 12-month WCCs.
- Documentation of EPI guidance increased from 0% to 96% at 4-, 6-, and 9-month WCCs.
- Distribution of EPI handouts increased from 0% to 77.9% at 4-, 6-, and 9-month WCCs.
Conclusions:
- Adapting and spreading the CDS toolkit successfully increased EPI in diverse PCP clinics.
- The EMR-integrated reporting tool provides sustainable analytics for QI metrics.
- PCP partnerships and CDS toolkits can improve allergenic food introduction beyond peanuts.
Objective:
Peanut allergy prevalence in children persists in the United States. Early peanut introduction (EPI) is now recognized as an evidence-based guideline for preventing peanut allergy. EPI implementation relies on primary care providers (PCPs) guiding caregivers of young infants as they transition to solid foods. We aimed to increase caregiver-reported peanut consumption among infants at six-, nine-, and 12-month well-child checks (WCCs) across three physician-based outpatient clinics.
Methodology:
A quality improvement (QI) team adapted a clinical decision support (CDS) toolkit, initially developed as a pilot project at an academic residency clinic, for use at three additional outpatient clinics with distinct demographic profiles. Spreading the initiative involved developing an automated reporting tool that utilized the health system's electronic medical record (EMR) dashboard to pull data from provider note templates. The team analyzed data during the intervention and sustainability phases at all clinics using Statistical Process Control Charts (SPCCs).
Results:
Data from the automated report showed that caregiver-reported peanut consumption at the six-, nine-, and 12-month WCCs increased from 0 (0%) at baseline to 1,579 (62.8%) post-intervention. Documentation of EPI guidance at four-, six-, and nine-month WCCs increased from 0 (0%) at baseline to 1,667 (96%) post-intervention. Distribution of home peanut introduction handouts at four-, six-, and nine-month WCCs increased from 0 (0%) at baseline to 1,015 (77.9%) post-intervention. The mean in-room time was 48.8 minutes from baseline through sustainability.
Conclusions:
Modifying features of the pilot CDS toolkit performed well when spread to more diverse PCP clinics in the same health system. Adding an innovative reporting tool to the EMR dashboard can provide sustainable analytics for QI metrics. Continued partnerships with PCPs and the use of CDS toolkits, along with reporting tools, may improve outcomes for introducing allergenic foods beyond peanuts, an ongoing unmet need in primary care.
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