This randomized controlled trial tests a computer-driven, patient-centered, expert system to improve the provision of evidence-based prevention for young pediatric patients. We propose to study the effectiveness of a real-time Parent-Initiated Prevention Program (PIPP) in changing primary providers' delivery of preventive care as well as parental preventive behaviors. PIPP has two components: a parent educational one and a provider feedback one. PIPP differs from other provider interventions (including other computerized interventions) in that it delivers age specific, evidence-based recommendations directly to parents at their own behest and under their control prior to well-child visits via the Internet, accessed either at home or while in the waiting room of their providers' offices. In addition, it has the capacity to inform providers of the topics that parents are interested in learning more about. Using a factorial design to assess the marginal benefit of both of its components, PIPP will be deployed in four clinics of a practice network that has a commercially available electronic medical record system. We hypothesize that this approach will improve parent-provider communication over preventive health care, and by empowering families, it may be sufficient in itself to improve preventive practices. We have chosen to focus on pre-adolescent children for the purposes of this study because we believe an adolescent-focused intervention would target adolescents directly (rather than their parents) and, therefore, could not easily be included in the proposed design. Our three specific aims and accompanying hypotheses are: ? ? (1) To increase the number of evidence-based prevention recommendations that are followed by parents of children aged 0-7 years.H1: Compared to controls, PIPP parents will be more likely to report behaviors consistent with evidence-based prevention for their children. ? ? (2) To increase the number of evidence-based prevention topics that are discussed by parents with their children's primary care providers.H2: Compared to controls, PIPP parents will be more likely to report discussing prevention topics with their providers. ? ? ? (3) To improve parental perceptions of the quality of care provided.H3: Compared to controls, PIPP parents will report higher scores on selected Consumer Assessment of Health Plans (CAHPS) items.
