Computerized Decision Support System for Depression

描述(由申请人提供)：这项研究建议测试计算机决策支持系统(CDSS-D)在改善严重抑郁障碍(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，小组成员包括全国抑郁症专家、当地医生、消费者和倡导者。CDSS-D旨在确保在公共卫生部门治疗MDD时高度遵守成熟的药理学算法。在为CDSS-D应用程序开发了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在两家公共精神卫生诊所使用CDSS-D计划的精神病学家。现场研究证明了CDSS-D的可行性和可接受性。这项拟议的研究将需要在三个精神卫生设施(Bluebonnet Trails社区MHMR中心、Parkland纪念医院门诊诊所和德克萨斯州狭长地带MHMR中心)实施，以评估CDSS-D系统的有效性。精神病学家将被随机分配到计算机化算法(CDSS-D)、治疗抑郁症的纸笔算法(PPA-D)或抑郁症的常规护理(UC-D)。被随机分配到算法治疗组的医生将参加关于实施治疗算法的额外讲习班，他们将接受使用计算机化算法平台或使用纸笔版本的算法的培训。共有540名患有严重抑郁障碍的参与者将被纳入研究，他们要么正在接受治疗，要么需要改变治疗方式。CDSS-D、PPA-D和UC-D的患者结果将根据临床症状、功能和生活质量(目标1)由评估者评估，不考虑治疗分配，每3个月评估一次，共12个月。这项研究的主要目的是：1)评估CDSS-D在患者结果(症状减轻、功能水平变化和生活质量测量)方面的实施情况；2)对CDSS-D在公共精神卫生部门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；以及4)比较患者结果的差异和CDSS-D的成本差异。将CDSS-D、PPA-D和UC-D进行比较。

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.