Automated attention flags in chronic disease care planning

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...

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Bibliographic Details
Published in:Medical journal of Australia 2001-09, Vol.175 (6), p.308-312
Main Authors: Warren, James R, Noone, Joseph T, Smith, Brian J, Ruffin, Richard, Frith, Peter, Zwaag, Berend J, Beliakov, Gleb V, Frankel, Heath K, McElroy, Heather J
Format: Article
Language:English
Subjects:
Biological and medical sciences
Chronic obstructive pulmonary disease, asthma
Decision Support Systems, Clinical
Humans
Lung Diseases, Obstructive - therapy
Medical Records Systems, Computerized - standards
Medical sciences
Patient Care Planning - standards
Pneumology
Practice Guidelines as Topic
Reminder Systems
Software
South Australia
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Summary: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 (κ, 0.49; 95% CI, 0.33–0.66) and moderate to good for CPOL (κ, 0.72; 95% CI, 0.55–0.90). CPOL agreement with GPs was moderate to poor3 (κ, 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
ISSN:0025-729X
1326-5377
DOI:10.5694/j.1326-5377.2001.tb143588.x