Appl Clin Inform - Actionable recommendations in the Bright Futures child health supervision guidelines.

Tópicos

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Resumo

CKGROUND: With the growing use of electronic health record systems, there is a demand for an electronic version of the leading American pediatric preventive care guideline, Bright Futures. As computer implementation requires actionable recommendations, it is important to assess to what degree Bright Futures meets criteria for actionability.OBJECTIVES: We aimed to 1) determine the number of actionable recommendations in the current edition of Bright Futures and 2) to recommend a specific format for representing an important class of guidelines in a way that better facilitates computer implementation.METHODS: We consolidated all action statements in Bright Futures into recommendations. We then used two dimensions (decidability and executability) in the Guideline Implementability Appraisal v 2.0 (GLIA) to determine the actionability of the recommendations. Decidability means the recommendation states precisely under what conditions to perform those actions. Executability means actions are stated specifically, unambiguously and in sufficient detail. The results were presented in a figure titled Service Interval Diagram (SID), describing actionable recommendations, age intervals during which they are applicable, and how frequently they should occur in that interval.RESULTS: We consolidated 2161 action items into 245 recommendations and identified 52 that were actionable (21%). Almost exclusively, these recommendations addressed screening, such as newborn metabolic screening, or child safety, such as car seat use. A limited number (n=13) of recommendations for other areas of anticipatory guidance were also actionable. No recommendations on child discipline, family function or mental health met our criteria for actionability. The SID representing these recommendations is presented in a figure.CONCLUSION: Only a portion of the Bright Futures Guidelines meets criteria for actionability. Substantial work lies ahead to develop most recommendations for anticipatory guidance into a computer implementable format.

Resumo Limpo

ckground grow use electron health record system demand electron version lead american pediatr prevent care guidelin bright futur comput implement requir action recommend import assess degre bright futur meet criteria actionabilityobject aim determin number action recommend current edit bright futur recommend specif format repres import class guidelin way better facilit comput implementationmethod consolid action statement bright futur recommend use two dimens decid execut guidelin implement apprais v glia determin action recommend decid mean recommend state precis condit perform action execut mean action state specif unambigu suffici detail result present figur titl servic interv diagram sid describ action recommend age interv applic frequent occur intervalresult consolid action item recommend identifi action almost exclus recommend address screen newborn metabol screen child safeti car seat use limit number n recommend area anticipatori guidanc also action recommend child disciplin famili function mental health met criteria action sid repres recommend present figureconclus portion bright futur guidelin meet criteria action substanti work lie ahead develop recommend anticipatori guidanc comput implement format

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