OBJECTIVES Peanut allergy in children is a population health problem. Evidence suggests early peanut introduction (EPI) for infants can reduce the development of peanut allergy. Primary care settings have not widely adopted guidelines recommending EPI. Peanut allergy prevention depends on primary care providers incorporating EPI guidelines into well-child check (WCC) encounters. We aimed to improve guideline adherence in a primary care setting by implementing a bundle of clinical decision support (CDS) tools. METHODS Using quality improvement methodology, the team developed a standardized work protocol and CDS tools within an electronic medical record (EMR) at 4, 6, and 9-month WCC encounters. The team executed changes and modifications through plan-do-study-act cycles and analyzed results with statistical process control charts. RESULTS We collected data from 445 WCC encounters from baseline through sustainability. EMR documentation of EPI guidance at 4, 6, and 9-month WCCs shifted from 13.9% to 83.5% over 12 months. Provider adoption of smart lists and templates increased from 2% to 73%, the distribution of home peanut introduction handouts increased from 5.2% to 54.1%, and caregiver-reported peanut ingestion increased from 0% to 34.6%. Diphtheria-tetanus-acellular pertussis vaccination rates remained at 100% for 6-month visits, and patient in-room time remained at 65 minutes. CONCLUSIONS Quality improvement methodology improved documentation of EPI guidance and increased reported peanut ingestion at routine WCC encounters without impacting other measures. Broader use of bundled CDS tools and EMR standardization could further improve guideline adherence and increase early peanut introduction to prevent peanut allergy in infants.

中文翻译：

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婴儿早期引入花生：通过 EMR 标准化提高指南依从性。

目标 儿童花生过敏是一个人口健康问题。有证据表明，婴儿早期引入花生（EPI）可以减少花生过敏的发生。初级保健机构尚未广泛采用推荐 EPI 的指南。花生过敏的预防取决于初级保健提供者将 EPI 指南纳入儿童健康检查 (WCC) 中。我们的目标是通过实施一系列临床决策支持 (CDS) 工具来提高初级保健机构对指南的遵守情况。方法 使用质量改进方法，团队在 4、6 和 9 个月的 WCC 就诊时在电子病历 (EMR) 中开发了标准化工作协议和 CDS 工具。该团队通过计划-实施-研究-行动循环执行变更和修改，并使用统计过程控制图分析结果。结果 我们从 445 次 WCC 遭遇中收集了从基线到可持续性的数据。EMR 文档中 4、6 和 9 个月 WCC 的 EPI 指导在 12 个月内从 13.9% 转变为 83.5%。提供者对智能列表和模板的采用率从 2% 增加到 73%，家庭花生介绍讲义的分发从 5.2% 增加到 54.1%，护理人员报告的花生摄入量从 0% 增加到 34.6%。6 个月就诊期间，白喉、破伤风、无细胞百日咳疫苗接种率保持在 100%，患者在诊时间保持在 65 分钟。结论 质量改进方法改进了 EPI 指南的记录，并增加了例行 WCC 会议中报告的花生摄入量，而不影响其他措施。更广泛地使用捆绑式 CDS 工具和 EMR 标准化可以进一步提高指南的遵守率，并增加早期花生引入，以预防婴儿花生过敏。