User-Centered Design and Evaluation of Clinical Decision Support to Improve Early Peanut Introduction: Formative Study

• Published in: JMIR formative research 2023-08, Vol.7, p.e47574
• Main Authors: Nguyen, Thinh Hoang, Cunha, Priscila Pereira, Rowland, Annabelle Friedman, Orenstein, Evan, Lee, Tricia, Kandaswamy, Swaminathan
• Format: Article
• Language: English
• Subjects: Anaphylaxis; Clinical decision making; Documentation; Electronic health records; Emergency medical care; Feedback; Food allergies; Immunology; Low income groups; Original Paper; Patients; Peanuts; Pediatrics; Primary care; Quality of life; Usability testing; User-centered design
• ISSN: 2561-326X; 2561-326X
• DOI: 10.2196/47574

Peanut allergy has recently become more prevalent. Peanut introduction recommendations have evolved from suggesting peanut avoidance until the age of 3 years to more recent guidelines encouraging early peanut introduction after the Learning Early about Peanut Allergy (LEAP) study in 2015. Guideline adherence is poor, leading to missed care opportunities. In this study, we aimed to develop a user-centered clinical decision support (CDS) tool to improve implementation of the most recent early peanut introduction guidelines in the primary care clinic setting. We edited the note template of the well-child check (WCC) visits at ages 4 and 6 months with CDS prompts and point-of-care education. Formative and summative usability testing were completed with pediatric residents in a simulated electronic health record (EHR). We estimated task completion rates and perceived usefulness of the CDS in summative testing, comparing a test EHR with and without the CDS. Formative usability testing with the residents provided qualitative data that led to improvements in the build for both the 4-month and 6-month WCC note templates. During summative usability testing, the CDS tool significantly improved discussion of early peanut introduction at the 4-month WCC visit compared to scenarios without the CDS tool (9/15, 60% with CDS and 0/15, 0% without CDS). All providers except one at the 4-month WCC scenario gave at least an adequate score for the ease of use of the CDS tool for the history of present illness and assessment and plan sections. During the summative usability testing with the 6-month WCC new build note template, providers more commonly provided comprehensive care once obtaining a patient history concerning for an immunoglobulin E-mediated peanut reaction by placing a referral to allergy/immunology (P=.48), prescribing an epinephrine auto-injector (P=.07), instructing on how to avoid peanut products (P