Computerized Decision Support System for Depression

抑郁症计算机化决策支持系统

• 批准号: 6681108
• 负责人: MADHUKAR H. TRIVEDI
• 金额: $ 60.41万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-05-12 至 2008-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6681108
• 关键词: clinical research; computer assisted medical decision making; health care cost /financing; health care service evaluation; health care service utilization; health services research tag; human subject; major depression; patient care management; patient oriented research; therapy compliance

DESCRIPTION (provided by applicant): This study proposes to test the clinical effectiveness of a Computerized Decision Support System for Depression (CDSS-D) in improving treatment outcomes for patients with a major depressive disorder (MDD). The Texas Medication Algorithm Project (TMAP) MDD algorithm provides the framework for the clinical content in the CDSS-D. The algorithm is an evidence-based algorithm that was developed by an expert consensus panel that included national experts in depression, local physicians, consumers and advocates. The CDSS-D is designed to ensure a high degree of adherence to a well-developed pharmacological algorithm for the treatment of MDD in the public health sector. After the initial database and rules engine for the CDSS-D application were developed, reliability testing was conducted. The last phase of testing involved psychiatrists using the CDSS-D program in two public mental health clinics. The field study demonstrated feasibility and acceptability of the CDSS-D. The proposed study will entail implementation at three mental health facilities (Bluebonnet Trails Community MHMR Center, Parkland Memorial Hospital Outpatient Clinic, and Texas Panhandle MHMR Center) in order to assess the effectiveness of the CDSS-D system. Psychiatrists will be randomized either to the computerized algorithm (CDSS-D), the paper and pencil algorithm for the treatment of depression (PPA-D), or Usual Care for Depression (UC-D). Physicians randomized to an algorithm treatment group will attend an additional workshop on the implementation of treatment algorithms, and they will be trained in the use of either the computerized algorithm platform or the use of a paper-pencil version of the algorithm. A total of 540 participants will be enrolled into the study who have major depressive disorder and are either entering treatment or are requiring a change in their treatment. The patient outcomes in the CDSS-D, PPA-D, and UC-D will be evaluated in terms of clinical symptoms, function, and quality of life (aim 1) assessed by an evaluator, blind to treatment assignment, every 3 months for a total of 12 months. The primary aims of the study are to: 1) assess the of CDSS-D implementation in terms of patient outcomes (reduction of symptoms, changes in level of functioning, and quality of life measures); 2) conduct an assessment of cost and utilization of the CDSS-D in a the public mental health sector; 3) directly assess the extent that the CDSS-D influences physician behavior; and 4) To compare the difference in patient outcomes with the difference in cost in the CDSS-D. Comparisons will be made between CDSS-D, PPA-D, and UC-D.

描述（由申请人提供）：本研究旨在测试抑郁症计算机决策支持系统（CDSS-D）在改善重度抑郁症（MDD）患者治疗结果方面的临床有效性。德克萨斯药物算法项目（TMAP） MDD算法为CDSS-D中的临床内容提供了框架。该算法是一种基于证据的算法，由一个专家共识小组开发，该小组包括全国抑郁症专家、当地医生、消费者和倡导者。CDSS-D旨在确保高度遵守公共卫生部门为治疗重度抑郁症而制定的完善的药理学算法。在开发了CDSS-D应用的初始数据库和规则引擎后，进行了可靠性测试。测试的最后阶段涉及精神病学家在两家公共精神卫生诊所使用CDSS-D项目。实地研究证明了CDSS-D的可行性和可接受性。为了评估CDSS-D系统的有效性，拟议的研究将需要在三家精神卫生机构（Bluebonnet Trails社区MHMR中心，Parkland纪念医院门诊诊所和Texas Panhandle MHMR中心）实施。精神科医生将被随机分配到计算机算法（CDSS-D）、纸笔算法（PPA-D）或抑郁症常规治疗（UC-D）。随机分配到算法治疗组的医生将参加关于治疗算法实施的额外研讨会，他们将接受使用计算机化算法平台或使用纸笔版本算法的培训。共有540名参与者将被纳入这项研究，他们患有重度抑郁症，要么正在接受治疗，要么需要改变治疗方法。CDSS-D、PPA-D和UC-D中的患者结果将由评估者根据临床症状、功能和生活质量（目标1）进行评估，不考虑治疗分配，每3个月评估一次，共12个月。该研究的主要目的是：1)评估CDSS-D实施的患者结果（症状减轻、功能水平改变和生活质量测量）；2)对公共精神卫生部门CDSS-D的成本和使用情况进行评估；3)直接评估CDSS-D对医生行为的影响程度；4)比较CDSS-D中患者预后差异与成本差异。将CDSS-D、PPA-D和UC-D进行比较。