An evaluation of clinical decision support tools for Patient Health Questionnaire-9 administration.
An evaluation of clinical decision support tools for Patient Health Questionnaire-9 administration.
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DOI：
10.9740/mhc.2021.09.267
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发表时间：
2021-09
期刊：
影响因子：
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通讯作者：
Trinkley KE
中科院分区：
文献类型：
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作者：
Maten N;Kroehl ME;Loeb DF;Bhat S;Ota T;Billups SJ;Schilling LM;Heckman S;Reingardt C;Trinkley KE
许多卫生保健机构正在努力通过使用患者健康问卷9(PHQ-9)来改善抑郁症的筛查和管理。EHR中的临床决策支持(CDS)是一种策略，但人们对设计或实施此类CDS的有效方法知之甚少。这项研究的目的是比较两个版本的CDS工具的实施结果，以改善抑郁症患者的PHQ-9管理。这是一项回顾性的观察性研究，比较了CDS的两个版本。版本1中断了临床医生的工作流程，而版本2没有中断工作流程。感兴趣的结果包括覆盖范围、采用率和有效性。PHQ-9的给药采用图表复习的方法。使用卡方检验来评估PHQ-9给药与版本1和版本2之间的关系。版本1导致PHQ-9给药77次(504次独特相遇的15.3%)，而版本2(P = .011)的49次(502次独特相遇的9.8%)。中断性CDS工具在增加PHQ-9给药方面可能更有效，但非中断性CDS工具可能更适合于将警报疲劳降至最低，尽管有效性有所下降。
Many health care institutions are working to improve depression screening and management with the use of the Patient Health Questionnaire 9 (PHQ-9). Clinical decision support (CDS) within the EHR is one strategy, but little is known about effective approaches to design or implement such CDS. The purpose of this study is to compare implementation outcomes of two versions of a CDS tool to improve PHQ-9 administration for patients with depression. This was a retrospective, observational study comparing two versions of a CDS. Version 1 interrupted clinician workflow, and version 2 did not interrupt workflow. Outcomes of interest included reach, adoption, and effectiveness. PHQ-9 administration was determined by chart review. Chi-square tests were used to evaluate associations between PHQ-9 administration with versions 1 and 2. Version 1 resulted in PHQ-9 administration 77 times (15.3% of 504 unique encounters) compared with 49 times (9.8% of 502 unique encounters) with version 2 (P = .011). An interruptive CDS tool may be more effective at increasing PHQ-9 administration, but a noninterruptive CDS tool may be preferred to minimize alert fatigue despite a decrease in effectiveness.