DEPRESSION CARE USING COMPUTERIZED DECISION SUPPORT

描述：#年提出的随机对照试验(RCT)的目标 这个应用程序是为了：开发一个计算机化的决策支持系统 (CDSS)，这将促使初级保健医生实施治疗 基于AHCPR抑郁症实践指南的建议；比较 240名抑郁症患者的临床结果和护理费用；以及 研究传播计算机化指南对医生的影响 实践、态度和知识。 基于文献，该应用假定成功的 计算机化决策支持系统具有以下特点： 包含基于证据、专家小组派生的、量身定做的实践指南 供本地使用；使用患者特定信息定制反馈； 提供允许使用临床判断的选择；提供在线 具有访问更详细信息的选项的指令；启用 行动；并提供简短的具体治疗 对病人和医生的提醒。国际贸易组织的发展 本文描述了抑郁症的计算机决策支持系统 应用程序，并提供了屏幕示例。这个系统将被放置在 在现有的电子病历中，逻辑医生，这是集成的 使用医疗档案系统(MARS)。遇到表单的一个示例 从逻辑师附加到应用程序。初级保健的设置是 之所以选择这个项目是因为那里是大多数抑郁症病例的发源地 治疗过了。 主要的假设是抑郁症患者的比例越高 由医生使用计算机化决策支持系统进行护理 与接受以下治疗的患者相比，在确诊后六个月内康复 没有接触到完整系统的医生。其他假设是 使用该系统的医生将更快地启动抑郁症治疗， 更有可能提供符合AHCPR指南的治疗， 更多地增加对实践指南的了解，并实现 以较低的平均成本获得类似的临床结果。 研究中主要感兴趣的变量和协变量涉及 患者从抑郁中恢复以及治疗的数量、类型和费用。 恢复将由等于或低于哈密尔顿等级评定(A)来确定 7，和(B)在三个月和六个月后显著下降 治疗。治疗费用(利用率问卷和MARS)将 以医生市场统计和平均批发为基础 药品价格。六个月期间的所有费用将合计为 确定每个病人的护理总费用。这些数据和相关数据 将在测试后使用单变量和多变量技术进行分析 关于它们的分布和关系的潜在假设。

Description: The aims of the randomized controlled trial (RCT) proposed in this application are to: develop a computerized decision support system (CDSS) that will prompt primary care physicians to implement treatment recommendations based upon AHCPR practice guidelines for depression; compare the clinical outcomes and costs of care for 240 depressed patients; and examine the impacts of disseminating computerized guidelines on physician practices, attitudes, and knowledge. Based on the literature, the application posits that a successful computerized decision support system has the following characteristics: contains evidence-based, expert-panel-derived practice guidelines tailored for local use; uses patient-specific information to customize feedback; presents choices that allow for use of clinical judgment; provides online instruction with the option of accessing more detailed information; enables action at the time of the encounter; and provides brief specific treatment reminders both to patients and physicians. The development of the computerized decision support system for depression is described in this application with examples of screens presented. This system will be placed in the existing electronic medical record, Logician, which is integrated with the Medical ARchival System (MARS). An example of an encounter form from Logician is appended to the application. The primary care setting was chosen for the project since that is where most depression cases are treated. The primary hypothesis is that a higher proportion of depressed patients cared for by physicians using the computerized decision support system will recover within six months of diagnosis compared with patients cared for by physicians not exposed to the complete system. Other hypotheses are that physicians using the system will initiate depression treatment sooner, be more likely to provide treatment consistent with the AHCPR guidelines, have a greater increase in knowledge about the practice guidelines, and achieve similar clinical outcomes at a lower average cost. The variables and covariates of chief interest in the study relate to patient recovery from depression and amounts, types, and costs of treatment. Recovery will be determined by Hamilton Scale ratings (a) equal to or below 7, and (b) that decrease significantly after three and six months of treatment. The costs of treatment (Utilization Questionnaire and MARS) will be based on the Physician Marketplace Statistics and average wholesale prices for drugs. All costs for the six-month period will be summed to ascertain the total cost of care for each patient. These and related data will be analyzed with univariate and multivariate techniques after testing underlying assumptions about their distributions and relationships.