Volume 50 | Number 2 | April 2015

Abstract List

Alexander G. Fiks M.D., M.S.C.E., Peixin Zhang Ph.D., A. Russell Localio Ph.D., Saira Khan M.P.H., Robert W. Grundmeier M.D. , Dean J. Karavite M.S.I., Charles Bailey M.D., Ph.D., Evaline A. Alessandrini M.D., M.S.C.E.,, Christopher B. Forrest M.D., Ph.D.,


Substantial investment in electronic health records (s) has provided an unprecedented opportunity to use clinical decision support () to increase guideline adherence. To inform efforts to maximize adoption, we characterized the adoption of an otitis media () system, the impact of performance feedback on adoption, and the effects of adoption on guideline adherence.

Study Setting

A total of 41,391 visits with 108 clinicians at 16 pediatric practices between February 2009 and August 2010.

Study Design

Prospective cohort study of ‐based adoption during visits, comparing clinicians receiving performance feedback to none. was available to all physicians; use was voluntary.

Data Collection

Extraction from a common .

Principal Findings

Clinicians and practices used the system for a mean of 21 percent (range: 0–85 percent) and 17 percent (0–51 percent) of eligible visits, respectively. Clinicians who received performance feedback reports summarizing use and guideline adherence had a relative increase in use of 9.0 percentage points compared to others ( = .001). adoption was associated with increased guideline adherence. Effects were greatest among clinicians with the lowest adherence prior to the study.


Performance feedback increased adoption, but additional strategies are needed to integrate into primary care workflows.