Dr. Fiks is an urban primary care pediatrician at CHOP and an Assistant Professor of Pediatrics at Penn. His research focuses on improving the health of ambulatory patients through collaborative practice-based research. Over the past 5 years, Dr. Fiks has led a series of groundbreaking studies enlisting quantitative, qualitative, and informatics methods to demonstrate the strengths and limitations of health information technology (HIT) in improving medical decision making and child health outcomes.
Dr. Fiks focused on immunization delivery as a model for how to use HIT to understand and improve health. He launched an initial study that was the first to detail how ambulatory EHR-data could be used to predict future vaccination status. Building upon this foundation, Dr. Fiks has led or participated in multiple studies evaluating EHR-based clinical decision support systems (CDSS) or alerts. He co-developed a CDSS for routine childhood vaccines. Implementation of the system was associated with an 8% increase in immunization rates in the urban setting over 1 year and marked growth in the recommended practice of vaccinating at sick visits. This work was one of the first studies to document the potential benefit of CDSS in pediatric primary care. However, Dr. Fiks also found that families accepting vaccines at sick visits were much less likely to return for preventive care, a finding challenging an established paradigm. He subsequently conducted a trial involving over 20,000 children with asthma which concluded that vaccine alerts focused on clinicians were largely ineffective for influenza vaccination, an immunization many parents decline for their children. Dr. Fiks has also collaborated on 2 AHRQ-funded projects using CDSS to bolster evidence-based care for children with asthma and otitis media. He is also working with the American Academy of Pediatrics to create ePROS, the first national practice-based research network focused on improving children’s health and the effectiveness of pediatric primary care..
Dr. Fiks’s research results and experience in practice convinced him that decision support needs to engage both families and clinicians as partners in primary care decision making and treatment implementation. To study how to better integrate families, he has launched research in two areas: (1) examining the relative benefit of providing decision support to families, clinicians, or both to improve vaccination rates for the cancer preventing human papillomavirus vaccine and (2) developing strategies to enhance shared decision making (SDM) in ADHD and asthma by using HIT to concurrently provide decision support to families at home and clinicians. To inform the work in ADHD and asthma, Dr. Fiks used a national survey to show the benefit of open communication between families at home and clinicians on parent-reported SDM. Dr. Fiks also completed 2 qualitative studies examining how families and clinicians understand SDM in ADHD. He found that, while both view SDM favorably, clinicians use SDM to persuade parents to accept their preferred treatment while parents favor an unbiased presentation of information and distrust those who push one approach. This disagreement underscores the need for interventions to foster communication and improve SDM in practice. In terms of review articles, Dr. Fiks recently published a commentary in School Mental Health that outlines for non-physicians the perspective of pediatricians on partnership with families, schools, and across systems of care. To help others seeking to implement health IT in order to improve care, Dr. Fiks also wrote a detailed review of how to design decision support systems that benefit both clinicians and families.
Shared medical decision making
Health information technology and clinical decision support
Pediatric primary care practice-based research
Fiks AG, Gafen A, Hughes CC, Hunter KF, Barg FK, “Using Freelisting to Understand Shared Decision Making in ADHD: Parents’ and Pediatricians’ Perspectives,” Patient Education and Counseling, DOI 10.1016/j.pec.2010.07.035 (epub ahead of print).
Fiks AG, Alessandrini EA, Forrest CB, Khan S, Localio AR, Gerber A. “Electronic Medical Record Use in Pediatric Primary Care,” Journal of the American Medical Informatics Association, 2011, Vol. 18: 31-44.
Fiks AG, Hughes CC, Gafen A, Guevara JP, Barg FK. “Contrasting Parents’ and Pediatricians’ Perspectives on Shared Decision Making in ADHD,” Pediatrics, 2011, Vol. 127:e188-196.
Fiks AG, Localio AR, Alessandrini EA, Asch DA, Guevara JP, “Shared Decision Making in Pediatrics: A National Perspective,” Pediatrics, 2010, Vol. 126: 306-314.
Pati S, Feemster KA, Mohamad Z, Fiks A, Grundmeier RW, Cnaan A, “Maternal Health Literacy and Late Initiation of Immunizations in an Inner-City Birth Cohort,” Maternal and Child Health Journal, 2010: Feb 24 (epub ahead of print).
Fiks AG, Hunter, KF, Localio, AR, Grundmeier, RW, Bryant-Stephens, T, Luberti, AA, Bell, LM, Alessandrini, EA “Impact of Electronic Health Record-Based Primary Care Clinical Alerts on Influenza Vaccination for Children and Adolescents with Asthma: A Cluster Randomized Trial,” Pediatrics, 2009, Vol. 124: 159-169.
Feemster, KA, Winters, SE, Fiks, AG, Kinsman, S, Kahn, JA, “Pediatricians’ Intention to Recommend Human Papillomavirus (HPV) Vaccines to 11- to 12- Year-Old Girls Post-Licensing,” Journal of Adolescent Health, 2008. Vol. 43: 408-411.
Fiks AG, Hunter, KF, Localio, AR, Grundmeier, RW, Alessandrini, EA “The Impact of Immunization at Sick Visits on Well-Child Care,” Pediatrics, 2008. Vol. 121: 898-905.