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Randomized Controlled Trial
. 2011 Jul-Aug;18(4):485-90.
doi: 10.1136/amiajnl-2011-000088.

Targeted screening for pediatric conditions with the CHICA system

Aaron E Carroll  1 , Paul G Biondich, Vibha Anand, Tamara M Dugan, Meena E Sheley, Shawn Z Xu, Stephen M Downs
Affiliations
Randomized Controlled Trial

Targeted screening for pediatric conditions with the CHICA system

Aaron E Carroll et al. J Am Med Inform Assoc. 2011 Jul-Aug.

Abstract

Objective: The Child Health Improvement through Computer Automation (CHICA) system is a decision-support and electronic-medical-record system for pediatric health maintenance and disease management. The purpose of this study was to explore CHICA's ability to screen patients for disorders that have validated screening criteria--specifically tuberculosis (TB) and iron-deficiency anemia.

Design: Children between 0 and 11 years were randomized by the CHICA system. In the intervention group, parents were asked about TB and iron-deficiency risk, and physicians received a tailored prompt. In the control group, no screens were performed, and the physician received a generic prompt about these disorders.

Results: 1123 participants were randomized to the control group and 1116 participants to the intervention group. Significantly more people reported positive risk factors for iron-deficiency anemia in the intervention group (17.5% vs 3.1%, OR 6.6, 95% CI 4.5 to 9.5). In general, far fewer parents reported risk factors for TB than for iron-deficiency anemia. Again, there were significantly higher detection rates of positive risk factors in the intervention group (1.8% vs 0.8%, OR 2.3, 95% CI 1.0 to 5.0).

Limitations: It is possible that there may be more positive screens without improving outcomes. However, the guidelines are based on studies that have evaluated the questions the authors used as sensitive and specific, and there is no reason to believe that parents misunderstood them.

Conclusions: Many screening tests are risk-based, not universal, leaving physicians to determine who should have a further workup. This can be a time-consuming process. The authors demonstrated that the CHICA system performs well in assessing risk automatically for TB and iron-deficiency anemia.

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Conflict of interest statement

Competing interests: None.

Figures

Figure 1
Figure 1
Child Health Improvement through Computer Automation (CHICA) prescreening form (tuberculosis screening questions have been highlighted).
Figure 2
Figure 2
Child Health Improvement through Computer Automation (CHICA) physician worksheet.
See this image and copyright information in PMC

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References

    1. Woodwell DA, Cherry DK. National Ambulatory Medical Care Survey: 2002 summary. Adv Data 2004;346:1–44 - PubMed
    1. . Recommendations for preventive pediatric health care. Committee on Practice and Ambulatory Medicine. Pediatrics 1995;96:373–4 - PubMed
    1. US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau Child Health USA 2003. Rockville, Maryland: US Department of Health and Human Services, 2003
    1. United States. Agency for Healthcare Research and Quality, US Preventive Services Task Force Guide to Clinical Preventive Services: Recommendations of the US Preventive Services Task Force. Washington, DC: Agency for Healthcare Research and Quality, 2005
    1. United States. Public Health Service Healthy People 2000: National Health Promotion and Disease Prevention Objectives: Full Report, with Commentary. Washington, DC: US Department of Health and Human Services For sale by Supt. of Docs., USG.P.O., 1991

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