Leveraging Electronic Health Record Tools to Improve the Evidence-Based Treatment of Children Hospitalized With Bronchiolitis

NCT06932341 | Recruiting

• 1 other identifier: IRB00456658
• Study Type: interventional
• Target: 800
• Locations: 1 country
• Sites: 3

Brief Summary

The goal of this experimental study is to learn whether different types of best practice advisories (BPAs) that direct clinicians to reference clinical guidelines embedded in the electronic health record (EHR) increase the delivery of evidence-based care in children presenting to the hospital with bronchiolitis. The main questions it aims to answer are:

• Do BPAs improve clinicians' delivery of guideline-concordant care in bronchiolitis?
• Do interruptive BPAs improve guideline-concordant care of bronchiolitis more than non-interruptive BPAs? Researchers will compare the treatment and outcomes of patients whose clinicians did not receive a BPA, to those whose clinicians received a non-interruptive BPA, to those whose clinicians received an interruptive BPA. Patients will continue to receive standard hospital care for bronchiolitis. Clinicians will:
• retain access to an EHR-embedded clinical guideline for bronchiolitis care
• be exposed to either no BPA, a non-interruptive BPA, or an interruptive BPA promoting the EHR-embedded clinical guideline (randomized per patient encounter)

Conditions

Bronchiolitis

Keywords

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

Outcome Measures

Primary Outcomes (1)

• Composite score of guideline-discordant care per hospital encounter

  Guideline-discordant care will be defined as a composite score incorporating number of chest X-rays, number of bronchodilator treatments, and numbers of hours spent on subtherapeutic rates of 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

Secondary Outcomes (8)

• Hospital length of stay (hours)

  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

• Duration of oxygen treatment (hours)

  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

• Duration of high-flow nasal cannula treatment (hours)

  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

• Number of Participants Transferred to intensive care unit

  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

• Number of chest X-rays

  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 (1)

• Number of clinician interactions with clinical guideline

  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 BPA

NO INTERVENTION

Clinicians will not be exposed to a BPA about the care of bronchiolitis. The participants will still have access to the EHR-embedded, evidence-based clinical guideline.

Interruptive BPA

EXPERIMENTAL

Clinicians will be exposed to an interruptive BPA directing the clinician to reference the EHR-embedded, evidence-based clinical guideline for the care of bronchiolitis.

Other: Interruptive

Non-interruptive BPA

EXPERIMENTAL

Clinicians will be exposed to an non-interruptive BPA directing the clinician to reference the EHR-embedded, evidence-based clinical guideline for the care of bronchiolitis.

Other: Non-interruptive

Interventions

Non-interruptive OTHER

Non-interruptive BPA (appears as a visual cue but does not require clinicians to alter workflows) directing clinicians to reference the EHR-embedded, evidence-based clinical guideline for the care of bronchiolitis.

Non-interruptive BPA

Interruptive OTHER

Interruptive BPA (requires clinicians to interact with the alert to continue the workflow) directing clinicians to reference the EHR-embedded, evidence-based clinical guideline for the care of bronchiolitis.

Interruptive BPA

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 bronchiolitis at one of three study sites.

You may not qualify if:

• Current encounter is birth-encounter
• Currently hospitalized in an ICU
• Hospitalized with length of stay \>14 days
• Physicians and advanced practice providers entering the patient's chart or orders entry activity for Emergency Department (ED) and inpatient encounters
• Physicians and advanced practice providers who do not enter the patient's chart or orders entry activity

Sponsors & Collaborators

• Johns Hopkins University: lead

Study Sites (3)

Johns Hopkins All Children's Hospital

St. Petersburg, Florida, 33701, United States

RECRUITING

Johns Hopkins Bayview Medical Center

Baltimore, Maryland, 21224, United States

RECRUITING

Johns Hopkins Children's Center

Baltimore, Maryland, 21287, United States

RECRUITING

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 Bodnar, MD

  Johns Hopkins University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Clea D Harris, MD

CONTACT

203-606-4322; charr163@jh.edu

Benjamin Bodnar, MD

CONTACT

410-614-4474; benjamin.bodnar@jhmi.edu

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: May 1, 2026
• Study Completion (Estimated): July 1, 2026
• Last Updated: May 8, 2025

Record last verified: 2025-05

Data Sharing

• IPD Sharing: Will not share

Locations

US (3)