Patient-specific evidence-based care recommendations for diabetes mellitus: development and initial clinic experience with a computerized decision support system.
BACKGROUND
adherence with evidence-based recommendations for chronic disease management is often suboptimal. Providing patient-specific reminders at the time of clinical encounters has the potential to improve this situation. A necessary prerequisite for providing such reminders, however, is to have an efficient means of acquiring patient information that can be matched to an underlying knowledge base. The decision support system: we have developed a computer-based, self-administered questionnaire for diabetes care. The questionnaire assesses numerous diabetes-related topics. Patients complete the questionnaire using a touchscreen interface, and their responses are then matched to evidence-based guidelines so that patient-specific care suggestions can be provided for both the patients and their health care professionals. The guidelines are derived from a database of abstracts of studies of diabetes care that are screened for scientific merit and clinical relevance, supplemented by recommendations from diabetes organizations.


RESULTS
initial evaluation of the system included an assessment of the agreement of responses to the automated questionnaire with responses to similar questions administered during a structured, personal interview. Overall agreement was 92.5% and the majority of disagreements were minor. More recently, patients aged 18-69 years have been completing the automated questionnaire before appointments at a diabetes clinic. The average time required has been 10.9 min and a mean of 3.0 recommendations have been provided per patient. Patient and health care practitioner satisfaction with the questionnaire and the patient-specific feedback have been high.


CONCLUSIONS
evidence-based patient-specific diabetes care recommendations can be provided using a self-administered computer-based questionnaire.
Hunt
D L
DL
Graduate Program in Health Research Methodology, McMaster University, Health Sciences Centre, Hamilton, Ont., Canada.
Haynes
R B
RB
Hayward
R S
RS
Pim
M A
MA
Horsman
J
J
D020000:Decision Support Systems, Clinical; D003920:Diabetes Mellitus / Q000628:therapy*; D005069:Evaluation Studies as Topic; D019317:Evidence-Based Medicine; D006801:Humans; D011795:Surveys and Questionnaires