title: Computer Decision Support Changes Physician Practice But Not Knowledge Regarding Autism Spectrum Disorders.
abstract: OBJECTIVE
  To examine whether adding an autism module promoting adherence to clinical guidelines to an existing computer decision support system (CDSS) changed physician knowledge and self-reported clinical practice.
  
  
  METHODS
  The CHICA (Child Health Improvement through Computer Automation) system, a CDSS, was enhanced with a module to improve management of autism in 2 of the 4 community pediatric clinics using the system. We examined the knowledge and beliefs of pediatric users using cross-sectional surveys administered at 3 time points (baseline, 12 months and 24 months post-implementation) between November 2010 and January 2013. Surveys measured knowledge, beliefs and self-reported practice patterns related to autism.
  
  
  RESULTS
  A total of 45, 39, and 42 pediatricians responded at each time point, respectively, a 95-100% response rate. Respondents' knowledge of autism and perception of role for diagnosis did not vary between control and intervention groups either at baseline or any of the two post-intervention time points. At baseline, there was no difference between these groups in rates in the routine use of parent-rated screening instruments for autism. However, by 12 and 24 months post-implementation there was a significant difference between intervention and control clinics in terms of the intervention clinics consistently screening eligible patients with a validated autism tool. Physicians at all clinics reported ongoing challenges to community resources for further work-up and treatment related to autism.
  
  
  CONCLUSIONS
  A CDSS module to improve primary care management of ASD in pediatric practice led to significant improvements in physician-reported use of validated screening tools to screen for ASDs. However it did not lead to corresponding changes in physician knowledge or attitudes.
authors.affiliation: Indiana University School of Medicine, Department of Pediatrics, Section of Children's Health Services Research , Indianapolis, Indiana, USA ; Regenstrief Institute for Healthcare , Indianapolis, Indiana, USA.
authors.forename: N S
authors.initials: NS
authors.lastname: Bauer
authors.affiliation: Indiana University School of Medicine , Department of Pediatrics, Section of Pediatric and Adolescent Comparative Effectiveness Research, Indianapolis, Indiana, USA ; Regenstrief Institute for Healthcare , Indianapolis, Indiana, USA.
authors.forename: A E
authors.initials: AE
authors.lastname: Carroll
authors.affiliation: Indiana University School of Medicine , Department of Biostatistics, Indianapolis, Indiana, USA.
authors.forename: C
authors.initials: C
authors.lastname: Saha
authors.affiliation: Indiana University School of Medicine, Department of Pediatrics, Section of Children's Health Services Research , Indianapolis, Indiana, USA ; Regenstrief Institute for Healthcare , Indianapolis, Indiana, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Downs
mesh_terms: D000293:Adolescent; D000067877:Autism Spectrum Disorder / Q000175:diagnosis* / Q000628:therapy*; D002675:Child, Preschool; D002983:Clinical Competence / Q000706:statistics & numerical data*; D020000:Decision Support Systems, Clinical; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010820:Physicians / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D057566:Self Report
keywords: autism spectrum disorder; clinical guidelines; computer-based decision support; pediatrics; primary care; screening