Abstract
Objective
To prevent missed cases and standardize care, health systems are beginning to implement
EHR-based screens (EHR-CA-S) and clinical decision supports systems (EHR-CA-CDSS)
for the identification and management of child maltreatment. This study aimed to 1)
document the existing research evidence on the performance of EHR-CA-S and EHR-CA-CDSS
and 2) examine clinical perspectives regarding the use of such tools and factors that
affect uptake.
Methods
We searched MEDLINE, Embase, EBSCO, Scopus, and CINAHL databases for English language
articles published prior to November 2021 that describe and/or evaluated an EHR-CA-S
and/or EHR-CA-CDSS involving 0 to 18-year olds. We performed semistructured interviews
with 20 individuals who have experience in identifying, evaluating, and/or treating
child maltreatment and/or conducting research on these topics.
Results
Our search identified 574 articles; 16 met inclusion criteria. Studies examined screening,
alerts and triggers, and quality improvement. None evaluated long-term clinical outcomes.
Sensitivity ranged from 0.14 to 1.00, specificity from 0.865 to 1.00, positive predictive
value from 0.03 to 1.00 and negative predictive value from 0.55 to 1.00. A variety
of EHR-CA-S and/or EHR-CA-CDSS have been implemented at institutions in our sample.
Interviewees cited missed cases, policy requirements, and the lack of standardization
of care as impetuses for adopting these tools, yet expressed concerns regarding insufficient
evidence, bias, and time-intensiveness of implementation.
Conclusions
Interviewees and the literature agree that current evidence does not support adoption
of a particular CA-S or CA-CDSS. Further refinement and research on EHR-CA-S and EHR-CA-CDSS
is necessary for these tools to be feasibly implemented and sustained, reliable for
clinical practice, and not cause any unintentional harms.
Keywords
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Article Info
Publication History
Published online: February 04, 2022
Accepted:
January 29,
2022
Received:
August 5,
2021
Publication stage
In Press Journal Pre-ProofFootnotes
The authors have no conflicts of interest to disclose.
Identification
Copyright
Copyright © 2022 by Academic Pediatric Association
