Effect of written and computerized decision support aids for the U.S. Agency for Health Care Policy and Research depression guidelines on the evaluation of hypothetical clinical scenarios

Mitchell A. Medow, Timothy J. Wilt, Signe Dysken, Steve D. Hillson, Sharon Woods, Steven J. Borowsky

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Objective. The objective of this study was to compare the effects of written and computerized decision support aids (DSAs) based on U.S. Agency for Health Care Policy and Research depression guidelines. Methods. Fifty-six internal medicine residents were randomized to evaluate clinical scenarios using either a written or a computerized DSA after first assessing scenarios without a DSA. The paired difference between aided and unaided scores was determined for diagnostic accuracy, treatment selection, severity and subtype classification, antipsychotic use, and mental health consultations. Results. Diagnostic accuracy with the written DSA increased from 64 % to 73%, and with the computerized DSA decreased from 67% to 64% (P=0.0065). Residents using the computerized DSA (vs. no DSA) requested fewer consultations (65% vs. 52%, P=0.028). In post hoc analysis, the written DSA increased sensitivity (66% to 89%, P < 0.001) and the computerized DSA improved specificity (66% to 86%, P = 0.0020) but reduced sensitivity (67% to 49%, P = 0.011). Conclusions. A written DSA improved diagnostic accuracy, whereas a computerized DSA did not. However, the computerized DSA improved specificity and reduced mental health consultations.

Original languageEnglish (US)
Pages (from-to)344-356
Number of pages13
JournalMedical Decision Making
Volume21
Issue number5
DOIs
StatePublished - 2001

Bibliographical note

Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.

Keywords

  • Computer decision support aids
  • Depression
  • Guideline implementations
  • Practice guidelines
  • U.S. agency for health care policy and research

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