Gill James M, Chen Ying Xia, Grimes Angela, Diamond James J, Lieberman Michael I, Klinkman Michael S
Delaware Valley Outcomes Research, Newark, New Jersey, USA.
Prim Care Companion CNS Disord. 2012;14(1). doi: 10.4088/PCC.11m01191. Epub 2012 Feb 2.
To assess the utility of an electronic clinical decision support tool for management of depression in primary care.
This prospective study was conducted in a national network of ambulatory practices over a 1-year period (October 2007-October 2008). A clinical decision support tool was embedded into the electronic health record of 19 primary care practices with 119 providers. The main components included (1) the 9-item Patient Health Questionnaire (PHQ-9), with 9 questions paralleling the 9 DSM-IV criteria for the diagnosis of major depressive disorder; (2) a suicide assessment form; and (3) brief patient and provider education. Use of each component was tracked in the electronic health record. Providers completed baseline and postintervention surveys regarding their depression management practices and their perceptions of the clinical decision support tool.
According to electronic health record tracking, the PHQ-9 form was used in 45.6% of the 16,052 adult patients with depression and in 73.7% of the 1,422 patients with new depression. The suicide assessment form was used in 62.0% of patients with possible suicidality. Education modules were rarely used. From before to after the study, providers reported increased use of standardized tools for depression diagnosis (47% to 80%, P < .001) and monitoring (27% to 85%, P < .001). The majority of providers reported often using the PHQ-9 and suicide forms and felt them to be very helpful in patient care, with 85% planning to continue their use after the study.
The electronic health record-based clinical decision support tool was extensively used and perceived as very helpful for assessment of patients' symptoms but not for provider education. These findings can help guide national efforts incorporating clinical decision support for quality improvement.
评估一种电子临床决策支持工具在基层医疗中管理抑郁症的效用。
这项前瞻性研究在一个全国性的门诊医疗网络中进行，为期1年（2007年10月至2008年10月）。将一种临床决策支持工具嵌入到19个基层医疗机构的119名医护人员的电子健康记录中。主要组成部分包括：（1）9项患者健康问卷（PHQ - 9），其9个问题与《精神疾病诊断与统计手册》第四版（DSM - IV）中重度抑郁症的9条诊断标准相对应；（2）一份自杀评估表；（3）简短的患者及医护人员教育内容。通过电子健康记录追踪每个组成部分的使用情况。医护人员完成了关于其抑郁症管理实践以及对临床决策支持工具看法的基线调查和干预后调查。
根据电子健康记录追踪，在16052名成年抑郁症患者中，45.6%使用了PHQ - 9表格，在1422名新发抑郁症患者中，73.7%使用了该表格。在可能有自杀倾向的患者中，62.0%使用了自杀评估表。教育模块很少被使用。从研究开始到结束，医护人员报告称用于抑郁症诊断的标准化工具的使用有所增加（从47%增至80%，P <.001），用于监测的标准化工具的使用也有所增加（从27%增至85%，P <.001）。大多数医护人员报告经常使用PHQ - 9和自杀评估表，并认为它们对患者护理非常有帮助，85%的医护人员计划在研究结束后继续使用。
基于电子健康记录的临床决策支持工具得到了广泛使用，且被认为对评估患者症状非常有帮助，但对医护人员教育没有帮助。这些发现有助于指导全国为提高医疗质量而纳入临床决策支持的工作。
