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Effect of Written and Computerized Decision Support Aids for the U.S. Agency for Health Care Policy and Research Depression Guidelines on the Evaluation of Hypothetical Clinical Scenarios

Ohio State University, Columbus, Ohio

Timothy J. Wilt, MD, MPH

Minneapolis VA Medical Center, Minneapolis, Minnesota

Signe Dysken, MD

Minneapolis VA Medical Center, Minneapolis, Minnesota

Steve D. Hillson, MD, MPH

Hennepin County Medical Center, Minneapolis, Minnesota

Sharon Woods, MD

Minneapolis VA Medical Center, Minneapolis, Minnesota

Steven J. Borowsky, MD, MPH

Minneapolis VA Medical Center, Minneapolis, Minnesota

Objective. The objective of this study was to compare the effects of written and computerized decision support aids (DSAs) based on U.S. Agency for Health Care Policy and Research depression guidelines. Methods. Fifty-six internal medicine residents were randomized to evaluate clinical scenarios using either a written or a computerized DSA after first assessing scenarios without a DSA. The paired difference between aided and unaided scores was determined for diagnostic accuracy, treatment selection, severity and subtype classification, antipsychotic use, and mental health consultations.Results. Diagnostic accuracy with the written DSA increased from 64% to 73%, and with the computerized DSA decreased from 67% to 64% (P = 0.0065). Residents using the computerized DSA (vs. no DSA) requested fewer consultations (65% vs. 52%, P = 0.028). In post hoc analysis, the written DSA increased sensitivity (66% to 89%, P < 0.001) and the computerized DSA improved specificity (66% to 86%, P = 0.0020) but reduced sensitivity (67% to 49%, P = 0.011). Conclusions. A written DSA improved diagnostic accuracy, whereas a computerized DSA did not. However, the computerized DSA improved specificity and reduced mental health consultations.

Key Words: depression • practice guidelines • U.S. Agency for Health Care Policy and Research • guideline implementations • computer decision support aids

Medical Decision Making, Vol. 21, No. 5, 344-356 (2001)
DOI: 10.1177/0272989X0102100501


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