Evaluation of the Impact of EHR-Alerts on Clinical Decision Support Pathway Use in Bronchiolitis, and the Impact of Pathway Use on the Prescription of High Flow Nasal Cannula and Other Elements of High Value Care.

Part of paid clinical trials in St. Petersburg, Florida.

Sponsor
Johns Hopkins University
Study ID
NCT06932341
Status
Recruiting
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Conditions

  • Bronchiolitis

Eligibility Criteria

Sex
ALL
Age
N/A - 24 Months
Healthy Volunteers
Not accepted

Interventions

  • Non-interruptive — OTHER
    The non-interruptive EHR alert appears as a visual cue but does not require clinicians to alter workflows. The alert directs clinicians to reference the EHR-embedded, evidence-based clinical guideline for the care of bronchiolitis.
  • Interruptive — OTHER
    The interruptive EHR alert requires clinicians to interact with the alert to continue the workflow. The alert directs clinicians to reference the EHR-embedded, evidence-based clinical guideline for the care of bronchiolitis.

Study Details

The goal of this experimental study is to learn whether different types of Electronic Health Record (EHR) alerts that direct clinicians to reference clinical guidelines embedded in the increase the use of these guidelines and the delivery of evidence-based care in children presenting to the hospital with bronchiolitis. The main questions it aims to answer are: * Do EHR-alerts increase clinicians' us of evidence-based EHR-integrated Clinical Decision Support (CDS) guidelines for the care of bronchiolitis and * Is the use of EHR-integrated CDS-guidelines for the care of bronchiolitis associated with deceases in low-value use of High Flow Nasal Cannula (HFNC) and improvement in other aspects of high-value care for this disease Patients will be randomized on the encounter-level to have the patient's treating providers receive no EHR-alert or one of two types of EHR-alert (non-interruptive or interruptive) reminding the provider that the EHR-integrated CDS guideline is available for the care or bronchiolitis. Researchers will compare the rate of use of EHR-integrated CDS guidelines in patients whose clinicians did not receive any EHR-alerts, to those whose clinicians received a non-interruptive alert and to those whose clinicians received an interruptive Best Practice Advisory (BPA). In addition, the study will evaluate whether the utilization of the EHR-integrated CDS guideline in a given encounter was associated with less low-value HFNC use, and differences in other elements of low-value care for bronchiolitis. Patients in all groups will continue to receive standard hospital care for bronchiolitis as determined by the patient's treating clinicians.

Key Dates

Start date
May 5, 2025
Status verified
May 2026
Primary completion
Jun 14, 2026
Completion
Jul 14, 2026

Study Design

Enrollment
8,000 participants (estimated)
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT

Arms

  • No Intervention: No EHR-Alert
    Clinicians will not be exposed to a any EHR-alert about the care of bronchiolitis. The participants will still have access to the EHR-embedded, evidence-based clinical guideline.
  • Experimental: Interruptive EHR-Alert
    Clinicians will be exposed to an interruptive EHR-alert directing the clinician to reference the EHR-embedded, evidence-based clinical guideline for the care of bronchiolitis.
  • Experimental: Non-interruptive EHR-Alert
    Clinicians will be exposed to an non-interruptive EHR-Alert directing the clinician to reference the EHR-embedded, evidence-based clinical guideline for the care of bronchiolitis.

Primary Outcome Measure

Proportion of encounters provider utilizes EHR-integrated clinical decision support tool [ Time Frame: From enrollment to the end of ED encounter (approximately <24 hours) for non-hospitalized patients; End of hospital stay (approximately 2-4 days) for hospitalized patients ]

Central Contacts

Locations (3)

FacilityCityStateZIPSite coordinators
Johns Hopkins All Children's HospitalSt. PetersburgFlorida33701
Johns Hopkins IRB Office
[email protected]
410-502-2092
Johns Hopkins Bayview Medical CenterBaltimoreMaryland21224
Johns Hopkins IRB Office
[email protected]
410-502-2092
Johns Hopkins Children's CenterBaltimoreMaryland21287
Johns Hopkins IRB Office
[email protected]
410-502-2092

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