Disseminating Child Abuse Clinical Decision Support to Improve Detection, Evaluation and Reporting

NCT03840798 | Completed

• 2 other identifiers: PRO18010135DI-2017C1-6215
• Study Type: observational
• Target: 351
• Locations: 1 country
• Sites: 2

Brief Summary

Child maltreatment is a leading cause of death and disability in children. More than 3 million reports to Child Protective Services are made every year in the US and almost 1,600 children die annually due to maltreatment. Children who are victims of maltreatment often have significant lifelong adverse health, social, and economic consequences. Accurate and timely recognition of the early signs of child maltreatment is critical to decreasing morbidity and mortality. A significant proportion of children who suffer severe morbidity and/or mortality from maltreatment had been previously evaluated by physician(s) who did not recognize the abuse. The American Academy of Pediatrics has evidence-based recommendations for the testing which should be done as part of the medical evaluation of children with suspected physical abuse. However, despite these evidence-based recommendations, physicians fail to consistently screen for and evaluate for abuse even in high-risk situations. The investigators have developed and evaluated what the investigators believe to be the first, comprehensive electronic health record (EHR) based child abuse clinical decision support (CA-CDS). This EHR-based CA-CDS system informs medical care at multiple points during the care for a potentially maltreated child, beginning with identification of suspected abuse to the handing off of information to CPS which has a mandate to protect children who are victims of suspected maltreatment. The investigators are disseminating the following aspects of the Electronic Health Record (EHR) based child abuse- clinical decision support (CA-CDS) system which they developed as part of the investigator's initial PCORI grant.

1. 1.a universal child abuse screen (CAS) - supports identification of maltreatment
2. 2.an embedded child abuse alert system - supports identification of maltreatment
3. 3.alerts to physicians and advanced practice providers - supports identification of maltreatment
4. 4.physical abuse order set - supports proper evaluation of suspected physical abuse
5. 5.documentation assistance for making reports of suspected maltreatment to Child Protective Services - supports mandated reporting

Conditions

Child Abuse; Physical Abuse; Trauma; Child Maltreatment

Outcome Measures

Primary Outcomes (2)

• Change in the number of reports made to Child Protective Services (CPS)

  Number of reports to CPS made in baseline compared to go-live periods

  Up to 52 weeks for the baseline period, up to 52 weeks for the go-live period

• Change in the compliance with American Academy of Pediatrics guidelines for evaluation of suspected abuse in patients <2 years of age

  Percent compliance with American Academy of Pediatrics guidelines for evaluation of suspected abuse in patients \<2 years of age during the baseline period compared to go-live period

  Up to 52 weeks for the baseline period, up to 52 weeks for the go-live period

Study Arms (2)

Pretest/Baseline period

Posttest/go-live period

Other: Child Abuse Clinical Decision Support system

Interventions

Child Abuse Clinical Decision Support system OTHER

The investigators are implementing the following aspects of the Electronic Health Record (EHR) based child abuse- clinical decision support (CA-CDS) system. 1. a universal child abuse screen (CAS) 2. an embedded child abuse alert system 3. alerts to physicians and advanced practice providers 4. physical abuse order sets

Posttest/go-live period

Eligibility Criteria

• Age: Up to 13 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)
• Sampling Method: Non-Probability Sample

Study Population

Children who present to one of the participating emergency departments during the baseline or go-live periods

You may qualify if:

• Presenting to one of the partner hospitals AND age less than 10 years old at Wisconsin site OR age less than 13 at Northwell site

You may not qualify if:

• None

Sponsors & Collaborators

• University of Pittsburgh: lead
• Patient-Centered Outcomes Research Institute: collaborator
• University of Wisconsin, Madison: collaborator
• Northwell Health: collaborator

Study Sites (2)

Northwell Health

Manhasset, New York, 11030, United States

Location

University of Wisconsin

Madison, Wisconsin, 53715, United States

Location

MeSH Terms

Conditions

Wounds and Injuries

Study Officials

• Rachel Berger, MD

  University of Pittsburgh

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: OTHER
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor of Pediatrics and Clinical and Translational Science, Chief, Division of Child Advocacy

Study Record Dates

• First Submitted: January 7, 2019
• First Posted: February 15, 2019
• Study Start: March 26, 2019
• Primary Completion: April 15, 2020
• Study Completion: December 1, 2020
• Last Updated: January 22, 2021

Record last verified: 2021-01

Locations

US (2)