JMIR Publications

ABSTRACT

Background:

Peanut allergy has become more prevalent recently. Peanut introduction recommendations have evolved from suggesting peanut avoidance until 3 years of age to more recent guidelines encouraging early peanut introduction after the LEAP study in 2015. Guideline adherence is poor leading to missed care opportunities.

Objective:

We developed user-centered clinical decision support (CDS) to improve implementation of the most recent early peanut introduction guidelines in the primary care clinic setting.

Methods:

We edited the note template of the well child check (WCC) visit at 4 and 6 months of age with CDS prompts and point-of-care education. Formative and summative usability testing were completed with pediatric residents in a simulated electronic health record (EHR). We estimated task completion rates and perceived usefulness of the CDS in summative testing comparing a test EHR with and without the CDS.

Results:

Formative usability testing with the residents provided qualitative data that led to improvements in the build for both the 4-month-old and 6-month-old WCC note templates. During summative usability testing, the CDS tool significantly improved discussion of early peanut introduction at the 4-month-old WCC visit compared to scenarios without the CDS tool (60% with CDS and 0% without CDS). All providers except one at the 4-month-old WCC scenario gave at least an adequate score for the ease of use of the CDS tool in the HPI and A/P. During the summative usability testing with the 6-month-old WCC new build note templates, providers more commonly provided comprehensive care once obtaining a patient history concerning for an IgE-mediated peanut reaction by placing a referral to allergy/immunology (p = 0.48), prescribing an epinephrine auto injector (EAI) (p = 0.07), instructing on how to avoid peanut products (p< 0.05), and providing an emergency treatment plan (p< 0.05) with CDS guidance. All providers gave at least an adequate score for ease of use of CDS tool in the AVS.

Conclusions:

User-centered CDS improved application of early peanut introduction recommendations and comprehensive care for patients who have symptoms concerning for peanut allergy in simulation.