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https://hdl.handle.net/2440/9953
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Type: | Journal article |
Title: | Automated attention flags in chronic disease care planning |
Author: | Warren, J. Noone, J. Smith, B. Ruffin, R. Frith, P. Van Der Zwaag, B. Beilakov, G. Frankel, H. McElroy, H. |
Citation: | Medical Journal of Australia, 2001; 175(17 September 2001):308-312 |
Publisher: | Australasian Med Publ Co Ltd |
Issue Date: | 2001 |
ISSN: | 0025-729X 1326-5377 |
Statement of Responsibility: | J.R. Warren, J.T. Noone, B.J. Smith, R. Ruffin, P. Frith, B.J. van der Zwaag, G.V. Beliakov, H.K. Frankel and H.J. McElroy |
Abstract: | OBJECTIVES: 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. |
Keywords: | Humans Lung Diseases, Obstructive Medical Records Systems, Computerized Reminder Systems Software Decision Support Systems, Clinical Patient Care Planning South Australia Practice Guidelines as Topic |
Description: | © Australasian Medical Publishing |
DOI: | 10.5694/j.1326-5377.2001.tb143588.x |
Published version: | http://dx.doi.org/10.5694/j.1326-5377.2001.tb143588.x |
Appears in Collections: | Aurora harvest 4 Medicine publications |
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