Effect of written and computerized decision support aids for the U.S. Agency for Health Care Policy and Research depression guidelines on the evaluation of hypothetical clinical scenarios.
OBJECTIVE
The objective of this study was to compare the effects of written and computerized decision support aids (DSAs) based on U.S. Agency for Health Care Policy and Research depression guidelines.


METHODS
Fifty-six internal medicine residents were randomized to evaluate clinical scenarios using either a written or a computerized DSA after first assessing scenarios without a DSA. The paired difference between aided and unaided scores was determined for diagnostic accuracy, treatment selection, severity and subtype classification, antipsychotic use, and mental health consultations.


RESULTS
Diagnostic accuracy with the written DSA increased from 64% to 73%, and with the computerized DSA decreased from 67% to 64% (P=0.0065). Residents using the computerized DSA (vs. no DSA) requested fewer consultations (65% vs. 52%, P=0.028). In post hoc analysis, the written DSA increased sensitivity (66% to 89%, P<0.001) and the computerized DSA improved specificity (66% to 86%, P=0.0020) but reduced sensitivity (67% to 49%, P = 0.011).


CONCLUSIONS
A written DSA improved diagnostic accuracy, whereas a computerized DSA did not. However, the computerized DSA improved specificity and reduced mental health consultations.
Medow
M A
MA
The Ohio State University, Columbus, USA. medow.1@osu.edu
Wilt
T J
TJ
Dysken
S
S
Hillson
S D
SD
Woods
S
S
Borowsky
S J
SJ
D020000:Decision Support Systems, Clinical / Q000592:standards*; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy; D003936:Diagnosis, Computer-Assisted / Q000592:standards*; D004282:Documentation; D006787:Hospitals, Veterans; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency / Q000592:standards*; D008910:Minnesota; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D014481:United States; D016270:United States Agency for Healthcare Research and Quality