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 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.

Chronic disease coordinated care planning: flexible, task-centered decision support.

SA HealthPlus is a trial of coordinated care enrolling 4000 high-use patients in South Australia in 10 groups including diabetes, cardiac, aged care and lung disease. These patients each have a designated general practitioner (GP) care coordinator who formulates an individualized care plan designed to keep them as healthy as possible. An on-line interface to SA HealthPlus has been developed for the care coordinators. The Care Plan On-Line (CPOL) system provides a single coherent source whereby the GP can review the available information on a HealthPlus patient in the context of devising a care plan of prospective services and medications. In the same application environment CPOL provides access to care guidelines tailored for SA HealthPlus.