Bilicurves: Using Information Technology to Improve the Management of Neonatal Hyperbilirubinemia
| Status: | Completed |
|---|---|
| Conditions: | Gastrointestinal |
| Therapuetic Areas: | Gastroenterology |
| Healthy: | No |
| Age Range: | Any |
| Updated: | 4/21/2016 |
| Start Date: | November 2008 |
| End Date: | December 2011 |
Bilicurves: Using Information Technology to Integrate Clinical Practice Guidelines Into the Management of Neonatal Hyperbilirubinemia
We will use information technology to integrate the 2004 American Academy of Pediatrics
guidelines for management of neonatal hyperbilirubinemia with laboratory reporting of
newborn bilirubin test results to improve physician adherence to the guidelines and quality
of care.
guidelines for management of neonatal hyperbilirubinemia with laboratory reporting of
newborn bilirubin test results to improve physician adherence to the guidelines and quality
of care.
In 2004, the American Academy of Pediatrics disseminated clinical practice guidelines for
the management of neonatal hyperbilirubinemia. Using the infant's age in hours, serum
bilirubin levels are applied to hour-specific nomograms to assess risk of developing
significant hyperbilirubinemia as well as the necessity for treatment. Prior guidelines did
not include nomograms for either. A systems approach to managing neonatal
hyperbilirubinemia, including use of the nomograms, has been shown to improve outcomes and
patient safety.
Despite the existence of these guidelines, decision support does not exist within MGH
clinical information systems for managing neonatal hyperbilirubinemia. We propose to create
BiliCurves, an application that integrates perinatal information from the obstetrical health
record with that of the newborn's, providing seamless reporting of neonatal bilirubin
results in the context of the practice guidelines and relevant obstetrical data. BiliCurves
will graphically superimpose bilirubin results onto hour-specific guideline nomograms that
providers can view when viewing bilirubin results. We propose to randomize BiliCurves access
to pediatric providers, and study its effects on management of hyperbilirubinemia both
during birth hospitalization as well as in the outpatient setting after discharge. We
hypothesize infants treated by physicians with BiliCurves access will receive birth
hospitalization phototherapy at a higher rate and readmission for hyperbilirubinemia at a
lower rate than that of the control group. We also hypothesize that physicians with
BiliCurves access will report greater ease and confidence in nomogram use and providing
evidence-based care as BiliCurves obviates the provider having to have access to paper based
versions of the nomogram (usual care) as well decreases potential errors in plotting test
results on the nomograms.
the management of neonatal hyperbilirubinemia. Using the infant's age in hours, serum
bilirubin levels are applied to hour-specific nomograms to assess risk of developing
significant hyperbilirubinemia as well as the necessity for treatment. Prior guidelines did
not include nomograms for either. A systems approach to managing neonatal
hyperbilirubinemia, including use of the nomograms, has been shown to improve outcomes and
patient safety.
Despite the existence of these guidelines, decision support does not exist within MGH
clinical information systems for managing neonatal hyperbilirubinemia. We propose to create
BiliCurves, an application that integrates perinatal information from the obstetrical health
record with that of the newborn's, providing seamless reporting of neonatal bilirubin
results in the context of the practice guidelines and relevant obstetrical data. BiliCurves
will graphically superimpose bilirubin results onto hour-specific guideline nomograms that
providers can view when viewing bilirubin results. We propose to randomize BiliCurves access
to pediatric providers, and study its effects on management of hyperbilirubinemia both
during birth hospitalization as well as in the outpatient setting after discharge. We
hypothesize infants treated by physicians with BiliCurves access will receive birth
hospitalization phototherapy at a higher rate and readmission for hyperbilirubinemia at a
lower rate than that of the control group. We also hypothesize that physicians with
BiliCurves access will report greater ease and confidence in nomogram use and providing
evidence-based care as BiliCurves obviates the provider having to have access to paper based
versions of the nomogram (usual care) as well decreases potential errors in plotting test
results on the nomograms.
Inclusion Criteria:
- Providers who care for infants in the newborn nursery.
- All newborns in the newborn nursery that are 35 weeks or more weeks of gestation will
be study eligible.
Exclusion Criteria:
- Infants less than 35 weeks gestation.
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