Implementation

CPCE Implementation Activities

An important element of CPCE's mission is implementation of evidence-based practices and guidelines to improve the quality of care delivered to children at CHOP. The following are some examples of implementation activities that CPCE has successfully undertaken.

Reducing Inappropriate Prescribing of Antibiotics by Primary Care Clinicians

This initiative, a combined effort of CPCE and the Pediatric Research Consortium (PeRC) funded through the Agency for Healthcare Research and Quality (AHRQ), aims to improve antibiotic use within the pediatric primary care network through an antimicrobial stewardship program. Antibiotic overuse in the ambulatory setting promotes bacterial resistance, causes avoidable, drug-related adverse effects and leads to unnecessary increases in health care costs. Inappropriate antibiotic prescribing occurs both for viral infections for which antibiotics are not indicated and for bacterial infections amenable to narrow spectrum antibiotic therapy for which broad spectrum antibiotics are given. This antimicrobial stewardship program consists of physician education; guideline development with attention to potential barriers to adherence; and audit and feedback of physician prescribing with benchmarking. The effectiveness of the program is measured through a cluster randomization trial in which physicians in the network receive the bundled intervention or no intervention. Study results will be posted to this site as they become available.

Chair's Initiative — From Knowledge to Practice: Developing the Infrastructure to Create and Implement Collaborative Clinical Pathways

CPCE has partnered with the Division of Emergency Medicine to develop the infrastructure required to support the ongoing development, implementation, and evaluation of expert consensus and evidence-based practices for common and uncommon clinical conditions in patients whose care crosses multiple clinical settings and is provided by multiple clinical groups. As part of the initiative, the team has developed Emergency Division and Inpatient guidelines for the evaluation and treatment of neonatal fever and is in the process of monitoring its use and evaluating its effectiveness. Please check back to see results of these measures as they become available.

Evaluating the Use of Health Information Technology (HIT)-based Decision Support to Increase HPV Vaccination Rates

CPCE investigators, utilizing the PeRC and working in conjuction with the Center for Biomedical Infomatics (CBMI), will evaluate the impact of both clinician-focused and patient/family-focused HIT interventions on the rate of receipt of human papillomavirus vaccine (HPV) among adolescents. HPV vaccines are a promising approach for the primary prevention of cervical cancer and other HPV-related diseases, but achieving high rates of receipt presents an ongoing challenge both nationally and in the CHOP PeRC. The interventions to be employed for clinicians, utilizing a cluster-randomized design, include education, clinical decision support and audit and feedback on vaccination success. Family interventions, delivered as part of a two-arm, parallel group randomized study, will include vaccination reminders and educational information via phone calls and links to other educational information via the web. By evaluating the results of these approaches, investigators hope to inform future interventions aimed at improving health for adolescents. This work will advance understanding of how to use health IT to engage children and families along with clinicians in health decisions. This 2-year project is funded through a grant from AHRQ.