Project Summary

This implementation project is complete.

PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.

This PCORI-funded implementation project expanded the use of an alert system for detecting and reporting concerns of child maltreatment to Child Protective Services in two health systems using different electronic health record, or EHR, systems.

Child abuse is a leading cause of death and disability in children. Each year, Child Protective Services, or CPS, receives more than 3 million reports of child abuse. In addition, nearly 1,600 children die from child abuse each year.

What was the goal of this implementation project?

Often, doctors don’t recognize signs of child abuse and may not screen for it as part of the care they provide. A previous PCORI-funded project found that an alert system built into the EHR can identify children under 13 years old who may have experienced child abuse or neglect. The alert system can also help doctors assess patients, do the right tests, and report to CPS when needed.

The project team expanded the use of the alerts to two health systems in Wisconsin and New York. The health systems had different EHR systems. They also had different ways of providing care to children in the emergency department, or ED. For example, some hospitals had pediatric ED doctors while others did not.

What did this project do?

The project team worked with local information technology, or IT, staff to adapt the alerts for the two EHR systems. Next, the project team trained nearly 1,000 doctors, nurses, and other medical staff in how to use the alert system. The team also worked to improve the system during the project. The team created materials and guidance to help other health systems, with similar EHR systems, put alerts in place in the future.

What was the impact of this project?

The project successfully added the alerts to two EHR systems. After the alerts were put in place, nearly 60,000 children were screened for abuse across both health systems.

Providers in Wisconsin found the alerts helpful, agreed with the guidance the alerts provided, and followed alert recommendations more than 70% of the time. Providers in New York did not find the alerts as helpful and did not agree with the guidance as often. The project team is working to learn about ways to improve the acceptability of the alert system.

More about this implementation project:

Stakeholders Involved in This Project

  • Survivors of child abuse and family members of children who were abused
  • Representatives from the American Academy of Pediatrics, the Center for Children’s Justice, the Wisconsin Department of Children and Families, and the Children’s Advocacy Institute at the University of San Diego School of Law
  • A pediatrician specializing in child abuse from Dayton Children’s Hospital
  • Representatives from departments at each participating hospital, including social work, the ED, nursing, child advocacy, and IT (including the build team, the order set review team, the go-live announcement team, the data collection team, and the usability testing team)

Project Achievements 

  • Embedded a child abuse alert system into two different EHRs in two separate hospital systems. The alert systems differ significantly from each other in terms of the type of triggers that were used, the type of alert, the ability of the alert to link directly to child abuse-specific order sets, and the order sets themselves.
  • Developed a toolkit with guidance that healthcare systems can use to implement the alert system into Allscripts or Epic EHRs.
  • The project team received a PCORI-funded Engagement Award to address system-level barriers to uptake of the alert system.

Implementation Strategies

  • Used a clinical decision support tool.
  • Adapted the child abuse alert system to work for sites’ electronic health record, or EHR, capabilities, including use of triggers, alerts, and physical abuse order sets.
  • Integrated risk prediction and clinical decision support tools into sites’ EHR systems.
  • Used data warehousing techniques to develop site-specific reports for monitoring implementation and outcome measures.
  • Created and supported cross-disciplinary implementation teams at sites, including social work, emergency department, nursing, child advocacy, Child Protective Services, and IT.
  • Trained clinicians to use the alert system, using demonstration videos and references sheets.
  • Conducted cyclical small tests of change at sites.
  • Provided technical assistance to sites, including consultation.

Evaluation Outcome Measures:

To document implementation:

  • Number of children screened
  • Number of providers trained
  • Characteristics of cases in which there was a lack of compliance
  • Provider confidence in recognizing, evaluating, and reporting child physical abuse and using the EHR and alert system
  • Provider perceptions of how well colleagues evaluate children for physical abuse
  • How providers make decisions about when to evaluate for abuse
  • Provider satisfaction with alert system and EHR

To assess healthcare and health outcomes:

  • Number of reports of suspected maltreatmentabuse and neglectto CPS
  • Provider compliance with the American Academy of Pediatrics’ recommendations for evaluating suspected physical abuse in children under 2 years of age

Project Information

Rachel Berger, AB, MD, MPH
University of Pittsburgh School of Medicine
Disseminating Child Abuse Clinical Decision Support to Improve Detection, Evaluation, and Reporting

Key Dates

December 2017
December 2020

Study Registration Information

Initial PCORI-Funded Research Study

This implementation project focuses on putting findings into practice from this completed PCORI-funded research study: Using Computer Alert Systems in the Emergency Room to Screen for Child Abuse

Associated PCORI Engagement Award: Dissemination Initiative

This implementation project has an associated PCORI Engagement Award: Dissemination Initiative project: Addressing Barriers to Broad Dissemination of EHR-embedded Child Abuse Clinical Decision Support


Project Status
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Project Details Type
Last updated: March 14, 2024