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

N.S. Bauer; A.E. Carroll; C. Saha; S.M. Downs

doi:10.4338/ACI-2014-09-RA-0084

Applied Clinical Informatics, Table of Contents

Appl Clin Inform 2015; 06(03): 454-465
DOI: 10.4338/ACI-2014-09-RA-0084

Research Article

Schattauer GmbH

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

Authors

N.S. Bauer

¹Indiana University School of Medicine, Department of Pediatrics, Section of Children’s Health Services Research, Indianapolis, Indiana, USA

³Regenstrief Institute for Healthcare, Indianapolis, Indiana, USA
A.E. Carroll

²Indiana University School of Medicine, Department of Pediatrics, Section of Pediatric and Adolescent Comparative Effectiveness Research, Indianapolis, Indiana, USA

³Regenstrief Institute for Healthcare, Indianapolis, Indiana, USA
C. Saha

⁴Indiana University School of Medicine, Department of Biostatistics
S.M. Downs

¹Indiana University School of Medicine, Department of Pediatrics, Section of Children’s Health Services Research, Indianapolis, Indiana, USA

³Regenstrief Institute for Healthcare, Indianapolis, Indiana, USA

Abstract

Summary

Objective: 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: 454–465

http://dx.doi.org/10.4338/ACI-2014-09-RA-0084

Keywords

computer-based decision support - pediatrics - clinical guidelines - autism spectrum disorder - primary care - screening

Full Text

References

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