Using computers and other forms of information technology (IT) in health care can improve the safety, quality, and effectiveness of care and reduce its cost.
Since its earliest incarnations, the Agency for Healthcare Research and Quality (AHRQ) has supported research into the application of IT to health care, including children's health care. An annotated list of current and past grants and contracts applying IT to children's health follows.
Efficacy and Reliability of Telemedicine in Routine Pediatric Practice
This study is investigating whether telemedicine, originally proposed for use in rural areas, might also enhance access and increase the efficiency of routine pediatric care in urban and suburban settings. Telemedicine represents an integrated system of healthcare delivery that employs telecommunications and computer technology as a substitute for in-person contact between provider and patient.
As a prelude to determining the clinical effectiveness of this approach in routine pediatric practice and its impact on cost, the study seeks to assess the reliability (reproducibility of diagnosis and treatment decisions) and efficacy (safety; time requirement; patterns of testing, consultation, and referral; understanding of parent concerns; and visit completion) of telemedicine for common, acute complaints of children presenting to the emergency department or primary care office setting.
For eight clinical problem groups, 100 childhood illness episodes presenting to an emergency department or a hospital-based primary care center will be evaluated, using a dual-evaluation crossover study design, by both telemedicine and in-person clinicians.
This efficacy and reliability study has been designed as a first step in preparation for several applications of the technique. For example, telemedicine might be used to replace a large proportion of emergency department and office visits, to enhance communication and reduce burdens associated with chronic childhood illness, and to strengthen home-based alternatives to inpatient care for children.
Principal Investigator: Kenneth M. McConnochie, University of Rochester School of Medicine and Dentistry, Rochester, NY. Grant No. R01 HS10753 (09/30/00-09/29/01).
Impact of a Telecommunication System in Childhood Asthma
This study is assessing the effectiveness of Telephone-Linked Communications for Asthma (TLC-Asthma) in the care of children with symptomatic asthma, one of the most common diseases of children and adults in the United States. TLC-Asthma is a computer-based telecommunication system that will monitor, educate, and counsel asthmatic children and their parents through regular, automated interactions.
Besides providing information to patients and their families, the system will measure outcomes in terms of:
In previous studies, researchers have demonstrated the usefulness of TLC technology in the care of adults with chronic disease (high blood pressure) and its effectiveness in improving related clinical outcomes. This study will advance the understanding of the applicability and usefulness of TLC technology in childhood disease.
Principal Investigator: Robert Friedman, Boston Medical Center, Boston, MA. Grant No. R01 HS10630. (09/30/99-09/29/03)
Evaluating a Decision Tool for Prenatal Testing
This study is pilot testing, refining, and evaluating an existing computer program to assist patients (and their partners) who are making decisions about whether and how to undergo prenatal testing for detection of fetal chromosome abnormalities. This project builds on previous research in prenatal diagnostic testing, including the researchers' development of the computer program and its translation into Spanish and Chinese.
The program will assist pregnant women and their partners in making choices about prenatal diagnostic testing, including the use of maternal serum screening, chorionic villus sampling, amniocentesis, ultrasonography, and no testing. This study will measure the effect of the program's use on knowledge about prenatal testing and its outcomes, satisfaction with decisionmaking, and the use of prenatal diagnostic testing.
Principal Investigator: Miriam Kupperman, University of California-San Francisco, San Francisco, CA. Grant No. R18 HS10214. (09/30/99-09/29/02)
Computer-Based Documentation and Provider Interations
This study is evaluating how physician use of computer-based documentation affects the quality of interations between physicians and patients during pediatric health maintenance visits. As computer-based documentation and computerized medical records are adopted by primary care clinical practices, the question remains of how the technology will affect the clinical encounter and the quality of patient care.
To investigate these questions, doctor-patient encounters in the pediatric outpatient clinic of an academic medical center were audiotaped before and after implementation of computer-based documentation; exit surveys provided additional data on satisfaction from both providers and patients. The computer-based patient record and data from the clinical residency program provide additional data on costs, the patient's prior visits, and the provider.
The primary outcome variables under study are the content of the encounter as measured by the Roter Interactional Analysis (RIAS), measures of quality of the encounter, the duration of the encounter, and parent and provider satisfaction with the encounter.
Principal Investigator: Kevin B. Johnson, Johns Hopkins University School of Medicine, Baltimore, MD. Grant No. R03 HS10363. (09/30/99-09/29/00)
Evaluating Computer Decision Support for Preventive Care
This study is adapting a prototype preventive services decision-support system for everyday use in private practice. The system will track preventive services and provide reminders to physicians in the form of a worksheet used in the care of the patient. It will also capture data by document scanning, and generate tailored educational literature for parents.
The study will evaluate changes in physicians' and parents' knowledge of preventive services, and parents' reported adherence to preventive care. In the project's final year, the system will also be adapted to North Carolina's state-wide Medicaid and immunization-tracking networks.
Principal Investigator: Stephen Downs, University of North Carolina, Chapel Hill, NC. Grant No. R01 HS09507. (09/30/96-09/29/00)
Office Systems to Improve Preventive Care for Children
This study is conducting a randomized trial in 48 practices in North Carolina. The private pediatrics practices will be implementing an office system for prevention with four preventive services (immunizations and screening for anemia, tuberculosis, and lead), and components of preventive care.
The study will measure the levels of immunizations and screening for anemia and lead in all infants at 1 year of age. Physicians will develop practice-specific "office systems" involving members of the office staff as a team to provide preventive care and patient education. Children on Medicaid, who are less likely to receive needed preventive services, will receive special attention.
Principal Investigator: Peter Margolis, University of North Carolina at Chapel Hill, Chapel Hill, NC. Grant No. R01 HS08509. (09/30/96-09/29/00)
Family Linkages Supporting Hyperbilirubin (Neonatal Jaundice) Guidelines
This study is seeking to establish a computer-based decision-support system to help providers in different types of settings (pediatric hospital primary and emergency care units, and private, community-based practices) identify and treat infants at risk for developing hyperbilirubinemia by providing better access to obstetric and neonatal patient records and clinical guidelines.
This study seeks to demonstrate the feasibility of developing software that allows sharing of important patient information among different electronic medical record systems while maintaining a high level of security, and also highlight barriers to implementing such systems in a real-time, clinical care setting. Finally, the study hopes to provide insight on the use of computer-based decision-support systems to promote the application of clinical guidelines to reducing differences in care, improving care quality, and reducing care cost.
Principal Investigator: Charles Homer, Children's Hospital, Boston, MA. Grant No. R01 HS09390. (09/30/96-09/29/00)
Improving Children's Health Outcomes: Negotiated Care
This study is seeking to compare the effects of a three-part intervention for parents, children, and physicians aimed at changing a dysfunctional, passive approach to health care by children with chronic disease (juvenile onset diabetes or inflammatory bowel disease) and their parents, with outcomes for children and parents not receiving the intervention.
The children's intervention included an animated, computer-assisted interactive video game whose content reflects aspects of their disease's management; the parents' intervention included a board game to be played with the children, plus a videotape, designed to help them reinforce children's negotiation and disease management skills; and the physicians' intervention included an interactive computer program designed to improve physicians' skills in negotiating with children and parents.
A successful intervention could be integrated into routine pediatric practices to enhance the effectiveness of care for children with chronic disease.
Principal Investigator: Sherrie Kaplan, New England Medical Center, Boston, MA. Grant No. R01 HS06897. (09/30/91-12/31/95)
AHRQ Publication No. 00-P074
Current as of September 2000
Internet Citation:
Information Technology and Children's Health Care. Fact Sheet. AHRQ Publication No. 00-P074, September 2000. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/child/itchild.htm
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