| Description |
The objective of this study was to evaluate the relative effectiveness of a computerized decision support system and a manual reminder system on the implementation of a Major Depressive Disorder clinical practice guideline in an outpatient mental health clinic. The study was a randomized clinical trail in which 76 patients were randomly assigned within clinician to one of the two experimental conditions. The first condition was a checklist inserted in the paper medical record, and the second was a computerized decision support system entitled the CaseWalker. The Case Walker reminded clinicians when guideline-recommended screening for mood disorder was due, ensured the fidelity of the diagnosis of Major Depressive Disorder with the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) criteria, and generated a progress note. The CaseWalker, compared to the paper checklist, resulted in higher screening rate for mood disorder (86.5% vs. 64.1%, p= .018) and more consistent application of DSM-IV criteria (100% vs. 5.6%, p< .001). Clinician acceptance of the CaseWalker was good, with three of four clinicians strongly preferring it to the paper checklist. Thus, computer reminders were shown to be superior to manual reminders in supporting the implementation of a depression clinical practice guideline in an outpatient mental health clinic. A previous review of the literature on reminder systems concluded there is insufficient evidence for the superiority of computer reminders over manual reminders. However, the results of the present study provide further empirical evidence that computer reminders are more effective than manual reminders. Further, this study is believed to be the first randomized controlled trial of the efficacy of computerized reminders in a mental health clinic. |
