Improving influenza vaccination coverage in the pediatric asthma population: the case for combined methodologies.

The Advisory Committee on Immunization Practices recommends annual influenza vaccine for pediatric asthma patients. Despite considerable risk for influenza complications in pediatric asthma patients, including hospitalization and death, influenza vaccination among children with asthma remains low, especially among low-income pediatric asthma patients. Multiple interventions have been attempted to increase immunization in the pediatric asthma population, including recall and reminders, parent/patient education, and physician education. More recently, information technology methods have been employed, including electronic alerts and computerized physician order entry/clinical decision support interventions. Each of these interventions, as well as a recent legislative intervention, has evidence of effectiveness, but none achieved the Healthy People 2020 vaccination goals of 80 percent for this population. This goal may be achievable with a combination of these methodologies and strategies that increase access to care for underserved patients.

Clinical decision support: effectiveness in improving quality processes and clinical outcomes and factors that may influence success.

The use of electronic health records has skyrocketed following the 2009 HITECH Act, which provides financial incentives to health care providers for the "meaningful use" of electronic medical record systems. An important component of the "Meaningful Use" legislation is the integration of Clinical Decision Support Systems (CDSS) into the computerized record, providing up-to-date medical knowledge and evidence-based guidance to the physician at the point of care. As reimbursement is increasingly tied to process and clinical outcomes, CDSS will be integral to future medical practice. Studies of CDSS indicate improvement in preventive services, appropriate care, and clinical and cost outcomes with strong evidence for CDSS effectiveness in process measures. Increasing provider adherence to CDSS recommendations is essential in improving CDSS effectiveness, and factors that influence adherence are currently under study.

Studying Readiness for Clinical Decision Support for Worker Health Using the Rapid Assessment Process and Mixed Methods Interviews.

To determine how the Rapid Assessment Process (RAP) can be adapted to evaluate the readiness of primary care clinics for acceptance and use of computerized clinical decision support (CDS) related to clinical management of working patients, we used a unique blend of ethnographic methods for gathering data. First, knowledge resources, which were prototypes of CDS content areas (diabetes, lower back pain, and asthma) containing evidence-based information, decision logic, scenarios and examples of use, were developed by subject matter experts. A team of RAP researchers then visited five clinic settings to identify barriers and facilitators to implementing CDS about the health of workers in general and the knowledge resources specifically. Methods included observations, semi-structured qualitative interviews and graphic elicitation interviews about the knowledge resources. We used both template and grounded hermeneutic approaches to data analysis. Preliminary results indicate that the methods succeeded in generating specific actionable recommendations for CDS design.