Automated attention flags in chronic disease care planning

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dc.contributor.authorWarren, J.
dc.contributor.authorNoone, J.
dc.contributor.authorSmith, B.
dc.contributor.authorRuffin, R.
dc.contributor.authorFrith, P.
dc.contributor.authorVan Der Zwaag, B.
dc.contributor.authorBeilakov, G.
dc.contributor.authorFrankel, H.
dc.contributor.authorMcElroy, H.
dc.date.issued2001
dc.description© Australasian Medical Publishing
dc.description.abstractOBJECTIVES: 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.
dc.description.statementofresponsibilityJ.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
dc.identifier.citationMedical Journal of Australia, 2001; 175(17 September 2001):308-312
dc.identifier.doi10.5694/j.1326-5377.2001.tb143588.x
dc.identifier.issn0025-729X
dc.identifier.issn1326-5377
dc.identifier.urihttp://hdl.handle.net/2440/9953
dc.language.isoen
dc.publisherAustralasian Med Publ Co Ltd
dc.source.urihttps://doi.org/10.5694/j.1326-5377.2001.tb143588.x
dc.subjectHumans
dc.subjectLung Diseases, Obstructive
dc.subjectMedical Records Systems, Computerized
dc.subjectReminder Systems
dc.subjectSoftware
dc.subjectDecision Support Systems, Clinical
dc.subjectPatient Care Planning
dc.subjectSouth Australia
dc.subjectPractice Guidelines as Topic
dc.titleAutomated attention flags in chronic disease care planning
dc.typeJournal article
pubs.publication-statusPublished

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