{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T21:57:00Z","timestamp":1772143020419,"version":"3.50.1"},"reference-count":0,"publisher":"Georg Thieme Verlag KG","issue":"03","license":[{"start":{"date-parts":[[2018,9,5]],"date-time":"2018-09-05T00:00:00Z","timestamp":1536105600000},"content-version":"vor","delay-in-days":66,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:p>\n            Background\u2003The overuse of cranial computed tomography (CT) to diagnose potential traumatic brain injuries (TBIs) exposes children with minor blunt head trauma to unnecessary ionizing radiation. The Pediatric Emergency Care Applied Research Network and the Clinical Research on Emergency Services and Treatments Network implemented TBI prediction rules via electronic health record (EHR) clinical decision support (CDS) to decrease use of CTs in children with minor blunt head trauma.<\/jats:p><jats:p>\n            Objective\u2003This article aims to facilitate implementation and dissemination of a CDS alert into emergency departments around the country.<\/jats:p><jats:p>\n            Methods\u2003We evaluated the EHR CT CDS tool through a mixed-methods analysis of 38 audio-recorded interviews with health care stakeholders and quantitative data sources, using the Reach, Efficacy, Adoption, Implementation, and Maintenance framework.<\/jats:p><jats:p>\n            Results\u2003Reach\n            \u2014The demographics of participants enrolled in the clinical trial were consistent with national estimates of TBI prevalence. Efficacy\u2014There was a variable and modest reduction in CT rates for the 8,067 children with minor head trauma whose clinicians received CDS. Adoption\n            \u2014The EHR CT CDS tool was well matched with the organizational mission, values, and priorities of the implementation sites. Implementation\u2014 The most important predisposing factors for successful implementation were the presence of an approachable clinical champion at each site and belief that the tool was a relevant, reusable knowledge asset. Enabling factors included an effective integration within the clinical workflow, organizational investment in user training, and ease of use. Maintenance\n            \u2014 Reinforcing factors for the EHR CT CDS tool included a close fit with the institutional culture, belief that it was useful for providers and families, and a good educational and informational tool. As such, the EHR CT CDS tool was maintained in clinical practice long after study completion.<\/jats:p><jats:p>\n            Conclusion\u2003Data from this mixed-methods study complement findings from the efficacy trial and provide critical components for consideration prior to integration and subsequent dissemination of the EHR CT CDS tool.<\/jats:p><jats:p>\n            Trial Registration\u2003NCT01453621, Registered September 27, 2011<\/jats:p>","DOI":"10.1055\/s-0038-1669460","type":"journal-article","created":{"date-parts":[[2018,9,5]],"date-time":"2018-09-05T23:06:46Z","timestamp":1536188806000},"page":"693-703","source":"Crossref","is-referenced-by-count":17,"title":["Applying the RE-AIM Framework for the Evaluation of a Clinical Decision Support Tool for Pediatric Head Trauma: A Mixed-Methods Study"],"prefix":"10.1055","volume":"09","author":[{"given":"Ruth","family":"Masterson Creber","sequence":"additional","affiliation":[{"name":"Division of Health Informatics, Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York, United States"}]},{"given":"Peter","family":"Dayan","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, United States"}]},{"given":"Nathan","family":"Kuppermann","sequence":"additional","affiliation":[{"name":"Davis School of Medicine, University of California, Sacramento, California, United States"}]},{"given":"Dustin","family":"Ballard","sequence":"additional","affiliation":[{"name":"Kaiser Permanente, San Rafael Medical Center, San Rafael, California, United States"},{"name":"Kaiser Permanente Division of Research, Oakland, California, United States"}]},{"given":"Leah","family":"Tzimenatos","sequence":"additional","affiliation":[{"name":"Davis School of Medicine, University of California, Sacramento, California, United States"}]},{"given":"Evaline","family":"Alessandrini","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, James M. Anderson Center for Health Systems Excellence and Emergency Medicine, Cincinnati Children's Hospital and Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States"}]},{"given":"Rakesh","family":"Mistry","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children's Hospital Colorado, University of Colorado Denver, Aurora, Colorado, United States"}]},{"given":"Jeffrey","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, United States"}]},{"given":"David","family":"Vinson","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Division of Research, Oakland, California, United States"},{"name":"Kaiser Permanente, Roseville Medical Center, Roseville, California, United States"}]},{"given":"Suzanne","family":"Bakken","sequence":"additional","affiliation":[{"name":"School of Nursing, Columbia University, New York, New York, United States"},{"name":"Department of Biomedical Informatics, Columbia University, New York, New York, United States"}]},{"name":"for the Pediatric Emergency Care Applied Research Network (PECARN) and the Clinical Research on Emergency Services and Treatments (CREST) Network","sequence":"additional","affiliation":[]}],"member":"194","published-online":{"date-parts":[[2018,9,5]]},"container-title":["Applied Clinical Informatics"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0038-1669460.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,5,6]],"date-time":"2019-05-06T20:46:03Z","timestamp":1557175563000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0038-1669460"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7]]},"references-count":0,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2018,7,3]]},"published-print":{"date-parts":[[2018,7]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0038-1669460","relation":{},"ISSN":["1869-0327"],"issn-type":[{"value":"1869-0327","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,7]]}}}