| It is well-known that there is a large gap between evidence-based best-practice guidelines and outcomes researchers use to define "optimal care" and the medical care patients actually receive. The gap between actual and desired birth outcomes is a particular concern that may be remediable. The purpose of this study is to implement a computerized clinical management and support system that will improve the identification of psychosocial and medical issues in an adolescent prenatal clinic. This system will ultimately improve the quality of prenatal health care teenagers receive in this clinic.;The study hypotheses were: (1) That the introduction of a new computerized clinical support and management system; the Electronic Report on Adolescent Pregnancy (ERAP) will be met with social, technical, and physical barriers. Customized educational sessions that address the identified barriers, include education on ERAP use, provide evidence-based justification of how its use will improve patient care, and incorporate user suggestions and modifications will remedy these barriers. (2) Provider assessment of the value, reliability, and socio-technical affects of the ERAP system will improve over the duration of the study. (3) Throughout the implementation period, entry of requisite data in a timely manner, retrieval of pertinent reports, and feedback regarding unresolved patient problems will improve provider efficiency and follow-up of patients without up-to-date care plans. (4) Development of care plans for patients with outstanding problems will improve as provider-specific problem lists are generated and reviewed at weekly team meetings. (5) During the post-implementation period, provider efficiency and care plan development will remain at the same (implementation period) level.;Results indicated that barriers to the implementation were identified and resolved. The implementation was successful with providers performing the required data entry and report retrieval and that visit provision was efficient and improved over the study period. Providers increasingly felt that the use of the system improved the care they provided. The success of the implementation of the ERAP system was in large part due to involving the clinic staff in the process, listening to user concerns, incorporating their suggestions into the system, and providing intensive support during the implementation process. |
