Using a Decision Support Tool for Pediatric Diarrhea – Medscape

Report on Clinical Decision Support Tools in Pediatric Care and Sustainable Development Goals

Introduction: Advancing Global Health Targets

A recent qualitative study investigated the implementation of a clinical decision support tool for pediatric diarrhea, highlighting critical intersections between healthcare innovation and global sustainability objectives. The effective diagnosis and management of childhood illnesses are fundamental to achieving Sustainable Development Goal 3 (SDG 3): Good Health and Well-being. This report analyzes the study’s findings, focusing on how such tools can either support or hinder progress towards creating equitable, effective, and sustainable health systems.

The development of multiplex polymerase chain reaction (PCR) panels enables the rapid identification of numerous pathogens. However, the absence of clear clinical guidelines for their use presents a challenge, potentially leading to misuse. This can result in inappropriate antibiotic administration, contributing to antimicrobial resistance, and creating excess financial burdens, which directly conflicts with the principles of SDG 12: Responsible Consumption and Production by misallocating vital healthcare resources.

Study Methodology and Participant Demographics

The study engaged key stakeholders to ensure a comprehensive understanding of the tool’s potential impact. The research aligns with SDG 10: Reduced Inequalities by including a diverse participant base to capture varied perspectives on healthcare delivery.

Participant Groups

• Parents/Guardians: 44 parents who had sought care for a child with diarrhea were interviewed.
• Clinicians: 16 clinicians, including physicians, nurse practitioners, and physician associates, who treat children with diarrhea participated.

Demographic Overview

The study included participants from diverse racial and ethnic backgrounds, reflecting a commitment to inclusive research.

1. Parent Demographics: Participants identified as Asian (2%), Black or African American (5%), Hispanic or Latin (34%), and White (50%), with the remainder being of unknown race and ethnicity.
2. Clinician Demographics: The majority of clinicians (88%) self-identified as White.

Key Findings: Stakeholder Perspectives

The research identified a significant divergence in expectations between parents and clinicians, which must be addressed to build the strong and accountable institutions promoted by SDG 16: Peace, Justice and Strong Institutions.

Parental Expectations and Concerns

Parents sought clinical care with three primary motivations:

• To receive reassurance and validation for their home care efforts.
• To gain insight into the specific etiology of their child’s illness.
• To obtain appropriate treatment and symptom relief for their child.

However, parents expressed significant concerns that a decision support tool could lead to generalized care rather than patient-centered treatment, and that clinicians might over-rely on algorithms instead of their own clinical judgment. This highlights a potential barrier to achieving patient-centric goals within SDG 3.

Clinician Perspectives and Challenges

Clinicians acknowledged the tool’s potential to improve evidence-based decision-making and facilitate clearer communication with families. They noted that such a tool could help build trust and support shared decision-making models, reinforcing the principles of SDG 16. Despite this, they expressed skepticism regarding the necessity of diagnostic testing for etiology in most cases, as management often remains unchanged. A key challenge identified was pressure from families, with clinicians admitting to sometimes ordering tests that were not medically indicated to meet parental expectations. This practice undermines the goals of diagnostic stewardship and SDG 12.

Implications for Sustainable Development Goals

The study’s findings have direct implications for the advancement of several SDGs within the healthcare sector.

Alignment with SDG 3: Good Health and Well-being

• Improved Diagnostics: The tool has the potential to standardize care and improve diagnostic accuracy, contributing to better health outcomes for children.
• Antimicrobial Stewardship: By guiding appropriate testing, the tool can help reduce unnecessary antibiotic use, a critical component in the global fight against antimicrobial resistance.
• Enhanced Communication: Effective use of the tool can reduce diagnostic errors linked to communication breakdowns, promoting patient safety.

Supporting SDG 10 and SDG 16: Equity and Strong Institutions

• A successful implementation requires that the tool is designed to be equitable and does not perpetuate biases, thereby supporting SDG 10.
• By promoting evidence-based, transparent, and patient-inclusive diagnostic processes, the tool can help build more accountable and effective healthcare institutions as envisioned in SDG 16.

Conclusion and Recommendations for Sustainable Implementation

For clinical decision support tools to effectively contribute to the Sustainable Development Goals, their implementation must be carefully managed. The tension between parental expectations for definitive diagnoses and the clinical need for diagnostic stewardship must be resolved. To achieve this, the following strategies are recommended:

1. Promote Transparency: Healthcare systems must be transparent with parents about the capabilities and limitations of diagnostic tools and the rationale behind clinical decisions.
2. Incorporate Shared Decision-Making: The design and use of such tools should be adapted to incorporate parental expectations and facilitate patient engagement in the diagnostic process.
3. Emphasize Clinical Judgment: It must be stressed that these tools are intended to support, not replace, the provider’s clinical judgment and consideration of the individual patient’s context.

By adopting these approaches, healthcare providers can leverage technology to optimize care, foster trust, and advance the global agenda for good health, well-being, and responsible resource management.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

SDG 3: Good Health and Well-being

• The article’s central theme is the diagnosis and management of pediatric diarrhea, a significant childhood illness. It explores methods to improve diagnostic accuracy, patient care, and health outcomes for children, which is the core mission of SDG 3.

SDG 9: Industry, Innovation, and Infrastructure

• The discussion revolves around a “clinical decision support tool,” which is a technological innovation designed to enhance healthcare services. The article analyzes the development, potential implementation, and impact of this technology in a clinical setting, aligning with SDG 9’s focus on fostering innovation and upgrading technological capabilities in various sectors, including healthcare.

SDG 10: Reduced Inequalities

• The study methodology explicitly includes demographic data on the race and ethnicity of both parent and clinician participants. For example, it notes that “15 (34%) [parents identified] as Hispanic or Latin, and 22 (50%) as White individuals.” While the article does not analyze health disparities, the practice of collecting and reporting such data is a foundational step in identifying and addressing potential inequalities in healthcare access, treatment, and outcomes, which is relevant to SDG 10.

SDG 16: Peace, Justice, and Strong Institutions

• The article addresses the need for effective and accountable healthcare systems. It highlights the lack of “clear guidelines specific to the use of multiplex PCR panels” and discusses how the decision support tool could promote “evidence-based decision-making.” Furthermore, it emphasizes improving communication, building trust between clinicians and families through a “shared decision-making model,” and engaging patients in the diagnostic process, all of which contribute to building more effective, accountable, and inclusive institutions as envisioned by SDG 16.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. SDG 3: Good Health and Well-being

   • Target 3.2: End preventable deaths of newborns and children under 5 years of age. The article focuses on improving the diagnosis and management of pediatric diarrhea, a common and potentially fatal illness in young children. Better diagnostic tools and treatment protocols directly contribute to reducing child morbidity and mortality.
   • Target 3.3: End the epidemics of… water-borne diseases and other communicable diseases. The article discusses using multiplex PCR panels to “identify up to 22 different pathogens from stool samples” in cases of infectious diarrhea, which is a communicable, often water-borne, disease. The goal is to improve the management of these infectious diseases.
   • Target 3.8: Achieve universal health coverage, including… access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines. The article touches on this by highlighting the risks of misusing diagnostics, which “can lead to inappropriate antibiotic use and excess financial burdens,” thereby affecting the quality, safety, and financial accessibility of care.

2. SDG 9: Industry, Innovation, and Infrastructure

   • Target 9.5: Enhance scientific research, upgrade the technological capabilities of industrial sectors in all countries… and encouraging innovation. The entire article is an evaluation of a “clinical decision support tool,” a technological innovation in healthcare. The study itself is a form of scientific research aimed at understanding how to best implement this tool to improve healthcare processes.

3. SDG 10: Reduced Inequalities

   • Target 10.2: Empower and promote the social, economic and political inclusion of all, irrespective of… race, ethnicity… or other status. The study’s methodology, which involves collecting and reporting data disaggregated by race and ethnicity for both parents and clinicians, is a practice that supports the monitoring and eventual reduction of inequalities in health services.

4. SDG 16: Peace, Justice, and Strong Institutions

   • Target 16.6: Develop effective, accountable and transparent institutions at all levels. The article discusses the lack of “clear guidelines” and the potential for the tool to promote “evidence-based care.” This effort to standardize and improve clinical practices contributes to making healthcare institutions more effective and accountable.
   • Target 16.7: Ensure responsive, inclusive, participatory and representative decision-making at all levels. The article heavily emphasizes the importance of the patient-doctor relationship, the need to “engage patients and their families in the diagnostic process,” and the use of the tool to facilitate a “shared decision-making model.” This directly reflects the principles of inclusive and participatory decision-making.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Indicators for SDG 3 Targets

   • Rate of inappropriate antibiotic use: The article explicitly mentions that misusing diagnostics “can lead to inappropriate antibiotic use.” Tracking this rate would be a direct indicator of progress in providing safe and effective care (Target 3.8).
   • Incidence of diagnostic errors: The article notes that “communication breakdowns in the patient-doctor relationship are a leading contributor to diagnostic errors.” A reduction in such errors would indicate improved healthcare quality (Targets 3.2, 3.8).
   • Financial burden of unnecessary testing: The article warns of “excess financial burdens” from misusing diagnostics. Measuring the costs associated with unnecessary tests serves as an indicator for financial risk protection in healthcare (Target 3.8).

2. Indicators for SDG 9 Targets

   • Adoption rate of clinical decision support tools: The study’s context, involving recruitment from “five urgent care sites and one emergency department,” implies that the adoption and implementation of such innovative tools across healthcare facilities is a key measure of technological upgrading (Target 9.5).

3. Indicators for SDG 10 Targets

   • Availability of health data disaggregated by demographic characteristics: The study’s practice of collecting and reporting the race and ethnicity of participants is itself an indicator. Progress would be measured by the routine collection and analysis of such data in all healthcare settings to identify disparities (Target 10.2).

4. Indicators for SDG 16 Targets

   • Adherence to evidence-based clinical guidelines: The tool is proposed to help with “evidence-based decision-making.” Measuring the degree to which clinical decisions align with established best practices would be an indicator of institutional effectiveness (Target 16.6).
   • Level of patient engagement in decision-making: The article discusses parents’ and clinicians’ views on a “shared decision-making model.” Patient satisfaction surveys or observational studies measuring the extent of patient involvement in care decisions could serve as an indicator for participatory processes (Target 16.7).
   • Patient trust in healthcare providers/systems: A stated goal of the tool is to “build trust and rapport with the patient’s family.” Measuring levels of patient trust would be an indicator of the quality and inclusivity of the healthcare institution (Target 16.7).

4. Create a table with three columns titled ‘SDGs, Targets and Indicators” to present the findings from analyzing the article. In this table, list the Sustainable Development Goals (SDGs), their corresponding targets, and the specific indicators identified in the article.

Source: medscape.com