A randomized controlled trial of screening for maternal depression with a clinical decision support system

Carroll, Aaron E.; Biondich, Paul G.; Anand, Vibha; Dugan, Tamara M.; Downs, Stephen M.

doi:10.1136/amiajnl-2011-000682

Cited by 50 publications

(63 citation statements)

References 21 publications

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“…27 From 2004 through 2010, CHICA used 2 questions derived from the validated Patient Health Questionnaire-2 (PHQ-2) 28 to screen for PPD: "Parents often get depressed. In the past month, how often have you felt down, depressed, or hopeless?"…”

Section: Ppdmentioning

confidence: 99%

Child Exposure to Parental Violence and Psychological Distress Associated With Delayed Milestones

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: It has previously been shown that exposure to intimate partner violence and/or parental depression or anxiety may increase a child' s risk for specific adverse health outcomes.WHAT THIS STUDY ADDS: By using a large pediatric primary care sample, this study examined associations of child exposure to intimate partner violence and parental psychological distress with developmental milestone attainment by analyzing their combined and separate effects while adjusting for other family factors.abstract OBJECTIVE: To examine the association between parental report of intimate partner violence (IPV) and parental psychological distress (PPD) with child attainment of developmental milestones.METHODS: By using data collected from a large cohort of primary care patients, this cross-sectional study examined the relationship between parental report of IPV and/or PPD and the attainment of developmental milestones within the first 72 months of a child' s life. Multivariate logistic regression analyses were used to adjust for parental report of child abuse concern and sociodemographic characteristics. RESULTS:Our study population included 16 595 subjects. Children of parents reporting both IPV and PPD (n = 88; 0.5%) were more likely to fail at least 1 milestone across the following developmental domains: language (adjusted odds ratio [aOR] 2.1; 95% confidence interval [CI] 1.3-3.3), personal-social (aOR 1.9; 95% CI 1.2-2.9), and gross motor (aOR 3.0; 95% CI 1.8-5.0). Significant associations for those reporting IPV-only (n = 331; 2.0%) were found for language (aOR 1.4; 95% CI 1.1-1.9), personal-social (aOR 1.7; 95% CI 1.4-2.2), and fine motor-adaptive (aOR 1.7; 95% CI 1.0-2.7). Significant associations for those reporting PPD-only (n = 1920; 11.6%) were found for: language (aOR 1.5; 95% CI 1.3-1.7), personal-social (aOR 1.6; 95% CI 1.5-1.8), gross motor (aOR 1.6; 95% CI 1.4-1.8), and fine-motor adaptive (aOR 1.6; 95% CI 1.3-2.0). CONCLUSIONS:Screening children for IPV and PPD helps identify those at risk for poor developmental outcomes who may benefit from early intervention.

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Section: Ppdmentioning

confidence: 99%

Child Exposure to Parental Violence and Psychological Distress Associated With Delayed Milestones

et al. 2013

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“…Health information technology (HIT) such as CHICA can facilitate and support healthcare delivery at the point of care, improve physicians' decision-making and help prevent medical errors [12]. Indeed, previous work done by our group has shown CHICA's effectiveness in improving physicians' adherence to clinical practice guidelines for ADHD, smoking cessation, maternal depression and developmental screening [13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Computer decision support changes physician practice but not knowledge regarding autism spectrum disorders

Bauer¹,

Carroll²,

Saha³

et al. 2015

Appl Clin Inform

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SummaryObjective: To examine whether adding an autism module promoting adherence to clinical guidelines to an existing computer decision support system (CDSS) changed physician knowledge and self-reported clinical practice.Methods: The CHICA (Child Health Improvement through Computer Automation) system, a CDSS, was enhanced with a module to improve management of autism in 2 of the 4 community pediatric clinics using the system. We examined the knowledge and beliefs of pediatric users using cross-sectional surveys administered at 3 time points (baseline, 12 months and 24 months post-implementation) between November 2010 and January 2013. Surveys measured knowledge, beliefs and self-reported practice patterns related to autism.Results: A total of 45, 39, and 42 pediatricians responded at each time point, respectively, a 95-100% response rate. Respondents’ knowledge of autism and perception of role for diagnosis did not vary between control and intervention groups either at baseline or any of the two post-intervention time points. At baseline, there was no difference between these groups in rates in the routine use of parent-rated screening instruments for autism. However, by 12 and 24 months post-implementation there was a significant difference between intervention and control clinics in terms of the intervention clinics consistently screening eligible patients with a validated autism tool. Physicians at all clinics reported ongoing challenges to community resources for further work-up and treatment related to autism.Conclusions: A CDSS module to improve primary care management of ASD in pediatric practice led to significant improvements in physician-reported use of validated screening tools to screen for ASDs. However it did not lead to corresponding changes in physician knowledge or attitudes.Citation: Bauer NS, Carroll AE, Saha C, Downs SM. Computer decision support changes physician practice but not knowledge regarding autism spectrum disorders. Appl Clin Inform 2015; 6: 454–465http://dx.doi.org/10.4338/ACI-2014-09-RA-0084

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“…We have found previously that randomization at the patient level can lead to irritation and inconvenience for both physicians and clinic staff. 18 …”

Section: Methodsmentioning

confidence: 99%

“…19,20 In short, CHICA is a CDSS coupled with an electronic medical record (EMR) that can be used for pediatric well care and chronic disease management. 18,19,21 CHICA produces 2 tailored and scannable paper forms. The prescreener form contains 20 questions that parents answer while in the waiting room.…”

Section: Chica Systemmentioning

confidence: 99%

Use of a Computerized Decision Aid for ADHD Diagnosis: A Randomized Controlled Trial

Carroll

Bauer²,

Dugan³

et al. 2013

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: Despite the existence of authoritative guidelines to assist primary care physicians in identifying and managing attention-deficit/hyperactivity disorder (ADHD), ample evidence demonstrates that they continue to diagnose and treat this disorder suboptimally. WHAT THIS STUDY ADDS:The introduction of a clinical decision support module resulted in higher quality of care with respect to ADHD diagnosis including a prospect for higher quality of ADHD management in children. abstract OBJECTIVE: To determine if implementing attention-deficit/hyperactivity disorder (ADHD) diagnosis and treatment guidelines in a clinical decision support system would result in better care, including higher rates of adherence to clinical care guidelines. METHODS:We conducted a cluster randomized controlled trial in which we compared diagnosis and management of ADHD in 6-to 12-year-olds after implementation of a computer decision support system in 4 practices. RESULTS:Eighty-four charts were reviewed. In the control group, the use of structured diagnostic assessments dropped from 50% in the baseline period to 38% in the intervention period. In the intervention group, however, it rose from 60% to 81%. This difference was statistically significant, even after controlling for age, gender, and race (odds ratio of structured diagnostic assessment in intervention group versus control group = 8.0, 95% confidence interval 1.6-40.6). Significant differences were also seen in the number of ADHD core symptoms noted at the time of diagnosis. Our study was not powered to detect changes in care and management, but the percent of patients who had documented medication adjustments, mental health referrals, and visits to mental health specialists were higher in the intervention group than the control. CONCLUSIONS:The introduction of a clinical decision support module resulted in higher quality of care with respect to ADHD diagnosis including a prospect for higher quality of ADHD management in children. Future work will examine how to further develop the ADHD module and add support for other chronic conditions. Pediatrics 2013;132:e623-e629 AUTHORS:

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A randomized controlled trial of screening for maternal depression with a clinical decision support system

Abstract: Clinical decision support systems like CHICA can improve the screening of maternal depression.

Cited by 50 publications

References 21 publications

Child Exposure to Parental Violence and Psychological Distress Associated With Delayed Milestones

Child Exposure to Parental Violence and Psychological Distress Associated With Delayed Milestones

Computer decision support changes physician practice but not knowledge regarding autism spectrum disorders

Use of a Computerized Decision Aid for ADHD Diagnosis: A Randomized Controlled Trial

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