Automated attention flags in chronic disease care planning.
OBJECTIVE
To assess the value of computerised decision support in the management of chronic respiratory disease by comparing agreement between three respiratory specialists, general practitioners (care coordinators), and decision support software.


METHODS
Care guidelines for two chronic obstructive pulmonary disease projects of the SA HealthPlus Coordinated Care Trial were formulated. Decision support software, Care Plan On-Line (CPOL), was created to represent the intent of these guidelines via automated attention flags to appear in patients' electronic medical records. For a random sample of 20 patients with care plans, decisions about the use of nine additional services (eg, smoking cessation, pneumococcal vaccination) were compared between the respiratory specialists, the patients' GPs and the CPOL attention flags.


RESULTS
Agreement among the specialists was at the lower end of moderate (intraclass correlation coefficient [ICC], 0.48; 95% CI, 0.39-0.56), with a 20% rate of contradictory decisions. Agreement with recommendations of specialists was moderate to poor for GPs (kappa, 0.49; 95% CI, 0.33-0.66) and moderate to good for CPOL (kappa, 0.72; 95% CI, 0.55-0.90). CPOL agreement with GPs was moderate to poor (kappa, 0.41; 95% CI, 0.24-0.58). GPs were less likely than specialists or CPOL to decide in favour of an additional service (P<0.001). CPOL was 87% accurate as an indicator of specialist decisions. It gave a 16% false-positive rate according to specialist decisions, and flagged 61% of decisions where GPs said No and specialists said Yes.


CONCLUSIONS
Automated decision support may provide GPs with improved access to the intent of guidelines; however, further investigation is required.
Warren
J R
JR
Advanced Computing Research Centre, University of South Australia, Adelaide. warren@cs.unisa.edu.au
Noone
J T
JT
Smith
B J
BJ
Ruffin
R
R
Frith
P
P
van der Zwaag
B J
BJ
Beliakov
G V
GV
Frankel
H K
HK
McElroy
H J
HJ
D020000:Decision Support Systems, Clinical; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000628:therapy*; D016347:Medical Records Systems, Computerized / Q000592:standards*; D010347:Patient Care Planning / Q000592:standards*; D017410:Practice Guidelines as Topic; D017010:Reminder Systems; D012984:Software; D013021:South Australia