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

Abstract

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

Effect of a Computer-Based Decision Support Intervention on Autism Spectrum Disorder Screening in Pediatric Primary Care Clinics

“…The weak point in the process appears to be the clinical response to screening results, as evidenced by the apparent nonresponse of physicians to almost half of positive M-CHAT results. 30 This finding is consistent with previous work on clinical decision support systems. 37,38 In fact, the greater than 50% response rate achieved by CHICA is high compared with other types of physician alerts, which may be ignored more than 90% of the time.…”

“…This method also has the advantage of ensuring that scoring is done correctly. The weak point in the process appears to be the clinical response to screening results, as evidenced by the apparent nonresponse of physicians to almost half of positive M-CHAT results . This finding is consistent with previous work on clinical decision support systems .…”

“…23 The AAP ASD guidance was encoded in the CHICA ASD module by creating rules that directed both surveillance and screening. 30,31 To conduct surveillance (as defined in the AAP guideline 25 ), CHICA's prescreening form asked parents whether they were concerned about the child's development or whether the child had a sibling with ASD. If both of these were true or if 1 was true and the clinician had expressed developmental concerns in CHICA at an earlier visit, then CHICA produced an alert to the clinician that the child should be referred immediately for an ASD evaluation.…”

“…23 The AAP ASD guidance was encoded in the CHICA ASD module by creating rules that directed both surveillance and screening. 30,31 To conduct surveillance (as defined in the AAP guideline 25 ), CHICA's prescreening form asked parents whether they were concerned about the child's development or whether the child had a sibling with ASD. If both of these were true or if 1 was true…”

Information and Communication Technologies to Support Early Screening of Autism Spectrum Disorder: A Systematic Review

“…Three studies reported on the use of automated EHR [ 22 , 32 , 35 ] to facilitate screening procedures within pediatric clinics. Both Bauer et al [ 22 ] and Downs et al [ 32 ] (see also [ 59 ], not included in this review) implemented the Child Health Improvement Through Computer Automation system (CHICA). CHICA is a computer decision support system developed to facilitate surveillance and screening for ASD in primary pediatric care services by implementing automated administration and scoring of the M-CHAT.…”