A comparison of the effects of computer and manual reminders on compliance with a mental health clinical practice guideline

Abstract

Objective: To evaluate the relative effectiveness of computer and manual reminder systems on the implementation of a clinical practice guideline.

Design: Seventy-eight outpatients in a mental health clinic were randomly assigned within clinician to one of the two reminder systems. The computer system, called CaseWalker, reminded clinicians when guideline-recommended screening for mood disorder was due, ensured the fidelity of the diagnosis of major depressive disorder to criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), and generated a progress note. The manual system was a checklist inserted in the paper medical record.

Measures: Screening rates for mood disorder and the completeness of the documentation of which DSM-IV criteria were met by patients who were said to have major depressive disorder were compared.

Results: The CaseWalker, compared with the paper checklist, resulted in a higher screening rate for mood disorder (86.5 vs. 61 percent, P = 0.008) and a higher rate of complete documentation of DSM-IV criteria (100 vs. 5.6 percent, P < 0.001).

Conclusions: In an outpatient mental health clinic, computer reminders were shown to be superior to manual reminders in improving adherence to a clinical practice guideline for depression.

Figure 1

Reminder for patients requiring initial screening and assessment.

Figure 2

Checklist for initial screening for mood disorder.

Figure 3

First section of the checklist of DSM-IV criteria for major depressive disorder.

Figure 4

Percentage of cases screened for mood disorder in the CaseWalker and paper conditions.

Figure 5

Percentage of cases in which major depressive disorder criteria were documented in the CaseWalker and paper conditions. Black indicates complete documentation; hatching, incomplete documentation.