The specific aims of the project are: 1) to expand and modify an existing guidelines based computerized childhood preventive services decision support system (CHIP) for everyday use in pediatric office practices; 2) to evaluate the effect of the system on the process of patient care in private pediatric practices (specifically looking at adherence rates of screening protocols and the content of preventive counseling); 3) to evaluate the effect of the system on outcomes of patient care in private practices (specifically looking at rates of service delivery, reporting by parents about provider behaviors and their own knowledge about preventive services, and the knowledge and attitudes of the participating pediatricians). The independent variables of this project are practice characteristics, provider characteristics, and patient [children between the ages of 12 to 24 months] characteristics. The intervention is the introduction of the CHIP system into two practices, with two practices serving as controls. The project proposes to measure three categories of dependent variables, health care delivery outcomes, opportunities for preventive care, and physician, staff and patient (parent) knowledge and attitudes. The primary focus of the health care delivery outcomes is the completion rates for age-appropriate services, including immunizations, screenings for anemia, TB, lead, vision problems, etc., assessment and education about risk factors such as car safety seats, second-hand tobacco smoke exposure, etc. The project methodology begins with modification of an extant computerized childhood preventive services decision support system, developed as a prototype system for use at the University of North Carolina Hospital and the health department. Modifications will insure functionality in a primary care office setting. The study design for the evaluation component (aims 2 and 3) includes two sets of matched pediatric practices, to provide two experimental and two control practice sites, with a random sample of patients drawn from each. Generalized estimating equations (GEE) will be used to test the primary hypothesis. Data sources include medical record abstraction using computerized versions of forms developed for prior research at the principal investigator's parent institution, surveys of primary care providers and office staff, and surveys of parents of the pediatric patients. Surveys of the providers and staff will be administered prior to the evaluation to establish a baseline and twelve months post-intervention. Survey instruments will be similar to those previously used to provide primary evaluation on targeted effects of the CHIP system. Parents will also be surveyed, using telephone interviews, to collect baseline data and at the twelve months post-intervention period. However, according to the research plan, the sample size for parent contacts """"""""in each age group [will be] only large enough to detect differences across practices.""""""""
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