O1073: Evaluation of a Developmental Dysplasia of the Hip (DDH) Appropriate Use Criteria Management Tool Among Pediatric Primary Care Providers

Background: Hips with Developmental Dysplasia (DDH) that are identified after 6 months of age are at a higher risk for requiring complex treatment and developing early degenerative arthritis and skeletal deformities. DDH risk factors include family history, female sex, and breech presentation. DDH risk significantly increase with more than one risk factor. The American Academy of Orthopaedic Surgeons published Appropriate Use Criteria (AUC) for general pediatricians to guide management of DDH in infants ≤6 months of age. The DDH AUC and its accompanying online tool was created through expert orthopaedic consensus supported by literature. Our objective was to evaluate the current regimens pediatricians use to manage DDH, awareness of the DDH AUC, and willingness to implement the tool into clinic flow to assist in management.

Methods: In partnership with the Lurie Children’s Pediatric Practice Research Group, a regional practice-based research group comprised of >58 practices in the Chicagoland area, a survey was distributed. The survey evaluated how primary care physicians (PCPs) are managing DDH and if they were aware of DDH AUC tool and how to access it. The survey collected demographic information (training, practice size, DDH knowledge, and management), answers to case study questions about management and referrals. We also surveyed familiarity of and likelihood of using the tool, and ideas for implementation in a primary care setting.

Results: 111/320 (35%) providers completed the survey representing 42 unique practices. 91.0% (101/111) were pediatricians, seeing a mean of 80 patients weekly. 37.3% (41/110) of providers collect information about family history of DDH most or all the time. In four case studies queried, 1. 94.0% (104/111), 2. 60.4% (67/111), 3. 54.1% (60/111), 4. 41.0% (45/111) of providers answered correctly when compared to the “preferred” regimen found in the DDH AUC. 0 providers were previously aware of the tool. However, 89.0% (97/109) were highly or extremely likely to utilize DDH AUC in their daily practice if it were incorporated into the Electronic Medical Record (EMR).

Conclusion: Implementation of AUC DDH tool into EMR as a clinical decision-making aid may lead to improved patient management and resultant patient outcomes and will be accepted by pediatric providers. The tool would assist PCPs in ordering diagnostic imaging (x-ray, ultrasound) and making referrals to specialists in line with current literature and expert opinions. Due to lack of consistency in appropriate referrals shown by the case study questions, the DDH AUC need to be more known and more accessible to have an impact.