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.

NCT06932341 | Completed

• 1 other identifier: IRB00456658
• Study Type: interventional
• Target: 2,965
• Locations: 1 country
• Sites: 3

Brief Summary

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.

Conditions

Bronchiolitis

Keywords

best practice advisory; clinical decision support; clinical guideline; clinical pathway; practice advisory; EHR alert

Outcome Measures

Primary Outcomes (1)

• Proportion of encounters provider utilizes EHR-integrated clinical decision support tool

  Use of the EHR-integrated Clinical Decision Support Guideline. The proportion of encounters in which a provider utilizes the EHR-integrated clinical decision support tool for the care of bronchiolitis during a given encounter.

  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

Secondary Outcomes (2)

• Proportion of encounters providers utilize the EHR-integrated clinical decision support tool for the care of bronchiolitis

  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

• Proportion of encounters a provider enters orders via the EHR-integrated clinical decision support tool

  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

Other Outcomes (4)

• Proportion of patients who receive any subtherapeutic high flow nasal cannula (HFNC) treatment

  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

• The average number of hours during which a patient received subtherapeutic high flow nasal cannula (HFNC) treatment

  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

• Proportion of patients who receive any treatment with high flow nasal cannula

  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

Study Arms (3)

No EHR-Alert

NO INTERVENTION

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.

Interruptive EHR-Alert

EXPERIMENTAL

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.

Other: Interruptive

Non-interruptive EHR-Alert

EXPERIMENTAL

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.

Other: Non-interruptive

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.

Non-interruptive EHR-Alert

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.

Interruptive EHR-Alert

Eligibility Criteria

• Age: Up to 24 Months
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Children \<=24 months of age presenting to the emergency room and/or hospitalized (under observation or inpatient status) with EHR-indicators of bronchiolitis at one of three study sites. EHR-indicators of bronchiolitis include the use of bronchiolitis-specific order sets, or specific combinations of ED chief complaint, infection or isolation status, and the receipt of disease-relevant therapies (such as oxygen supplementation)

You may not qualify if:

• Current encounter is birth-encounter
• Currently hospitalized in an ICU
• Hospitalized with length of stay \>14 days

Sponsors & Collaborators

• Johns Hopkins University: lead

Study Sites (3)

Johns Hopkins All Children's Hospital

St. Petersburg, Florida, 33701, United States

Location

Johns Hopkins Bayview Medical Center

Baltimore, Maryland, 21224, United States

Location

Johns Hopkins Children's Center

Baltimore, Maryland, 21287, United States

Location

MeSH Terms

Conditions

Bronchiolitis

Condition Hierarchy (Ancestors)

Bronchitis; Respiratory Tract Infections; Infections; Bronchial Diseases; Respiratory Tract Diseases; Lung Diseases, Obstructive; Lung Diseases

Study Officials

• Benjamin E Bodnar, MD

  Johns Hopkins University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: April 10, 2025
• First Posted: April 17, 2025
• Study Start: May 5, 2025
• Primary Completion: June 12, 2026
• Study Completion: July 12, 2026
• Last Updated: July 17, 2026

Record last verified: 2026-07

Data Sharing

• IPD Sharing: Will not share

Locations

US (3)