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Fortney JC, Davis A, Hedrick R, Steven C, Raney W, Smith J, Pyne J. A Decision Support System for Depression Care Management. Presented at: National Institute of Mental Health Mental Health Services Research Annual Conference; 2007 Jul 23; Washington, DC.
Background - Numerous effectiveness studies have demonstrated that depression care management improves outcomes for primary care patients treated for depression. However, fidelity to the evidence-base has been poor during implementation studies. Moreover, few primary care practices offer evidence-based depression care management to their patients, partly due to the lack of clinical information systems that provide efficient decision support. NetDCMS (http://netdcms.net) is a web-based decision support system that was developed to support depression care manager activities and to facilitate the dissemination of depression care management models that maintain high fidelity to the evidence-base. Methods - NetDCMS was based on intervention materials used for the Telemedicine Enhanced Antidepressant Management study, which increased adherence, treatment response/remission, health related quality of life, and patient satisfaction. NetDCMS was developed jointly by a cross-functional design team of psychiatrists, depression care managers, information technology specialists, technical writers, and researchers. NetDCMS was designed during two years of rapid prototype-test-prototype product development cycles. Results - NetDCMS has the following functional capabilities: patient registry and panel management, trial management, encounter scheduler, encounter decision support system, progress note generator, and workload/outcomes report generator. NetDCMS guides the care manager through a self-documenting patient encounter using evidence-based scripts and self-scoring instruments which support patient education and activation, barrier assessment, comorbidity assessment, depression severity monitoring, adherence monitoring, side-effect monitoring and self-management activities. NetDCMS has been used by five care managers in three separate implementation studies. Usability tests indicate that NetDCMS is user friendly and efficient. Results indicate that care managers are able to maintain high fidelity to the evidence-base and primary care providers refer large numbers of patients to NetDCMS-supported care management programs. Summary/Implications - Depression care management study protocols can be successfully converted to web-based decision support systems that can effectively facilitate the implementation of evidence-based treatments in routine care with high fidelity.
