TY - JOUR
KW - Decision Support Systems, Clinical/standards
KW - Depressive Disorder, Major/diagnosis/drug therapy
KW - Diagnosis, Computer-Assisted/standards
KW - Documentation
KW - Hospitals, Veterans
KW - Humans
KW - Internal Medicine/education
KW - Internship and Residency/standards
KW - Minnesota
KW - Practice Guidelines as Topic
KW - Referral and Consultation/utilization
KW - Sensitivity and Specificity
KW - United States
KW - United States Agency for Healthcare Research and Quality
AU - M. A. Medow
AU - T. J. Wilt
AU - S. Dysken
AU - S. D. Hillson
AU - S. Woods
AU - S. J. Borowsky
A1 - 
AB - 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.
BT - Medical decision making : an international journal of the Society for Medical Decision Making
C5 - HIT & Telehealth
CP - 5
CY - United States
IS - 5
JF - Medical decision making : an international journal of the Society for Medical Decision Making
N2 - 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.
PP - United States
PY - 2001
SN - 0272-989X; 0272-989X
SP - 344
EP - 356
EP - 
T1 - 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
T2 - Medical decision making : an international journal of the Society for Medical Decision Making
TI - 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
U1 - HIT & Telehealth
VL - 21
VO - 0272-989X; 0272-989X
Y1 - 2001
ER -