Randomized Controlled Trial

. 2018 May 25;20(5):e194.

doi: 10.2196/jmir.9126.

Computer-Based Driving in Dementia Decision Tool With Mail Support: Cluster Randomized Controlled Trial

Mark J Rapoport^{1

2}, Carla Zucchero Sarracini¹, Alex Kiss^{3

4}, Linda Lee⁵, Anna Byszewski^{6

7}, Dallas P Seitz^{8

9}, Brenda Vrkljan¹⁰, Frank Molnar^{6

7}, Nathan Herrmann^{1

2}, David F Tang-Wai^{11

12}, Christopher Frank^{13

14}, Blair Henry^{15

16}, Nicholas Pimlott^{16

17}, Mario Masellis^{18

19}, Gary Naglie^{20

21}

Affiliations

¹ Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
² Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
³ Department of Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, ON, Canada.
⁴ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
⁵ Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
⁶ Division of Geriatric Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
⁷ Division of Geriatric Medicine, University of Ottawa, Ottawa, ON, Canada.
⁸ Seniors Mental Health Program, Providence Care, Kingston, ON, Canada.
⁹ Department of Psychiatry, Queen's University, Kingston, ON, Canada.
¹⁰ School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
¹¹ Memory Clinic, University Health Network, Toronto, ON, Canada.
¹² Division of Neurology, Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada.
¹³ Specialized Geriatric Services, Providence Care, Kingston, ON, Canada.
¹⁴ Division of Geriatric Medicine, Queen's University, Kingston, ON, Canada.
¹⁵ Clinical Ethics Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹⁶ Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
¹⁷ Department of Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada.
¹⁸ Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹⁹ Division of Neurology, University of Toronto, Toronto, ON, Canada.
²⁰ Department of Medicine, Baycrest Health Sciences, Toronto, ON, Canada.
²¹ Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada.

PMID: 29802093
PMCID: PMC5993977
DOI: 10.2196/jmir.9126

Randomized Controlled Trial

Computer-Based Driving in Dementia Decision Tool With Mail Support: Cluster Randomized Controlled Trial

Mark J Rapoport et al. J Med Internet Res. 2018.

. 2018 May 25;20(5):e194.

doi: 10.2196/jmir.9126.

Authors

Affiliations

¹ Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
² Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
³ Department of Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, ON, Canada.
⁴ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
⁵ Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
⁶ Division of Geriatric Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
⁷ Division of Geriatric Medicine, University of Ottawa, Ottawa, ON, Canada.
⁸ Seniors Mental Health Program, Providence Care, Kingston, ON, Canada.
⁹ Department of Psychiatry, Queen's University, Kingston, ON, Canada.
¹⁰ School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
¹¹ Memory Clinic, University Health Network, Toronto, ON, Canada.
¹² Division of Neurology, Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada.
¹³ Specialized Geriatric Services, Providence Care, Kingston, ON, Canada.
¹⁴ Division of Geriatric Medicine, Queen's University, Kingston, ON, Canada.
¹⁵ Clinical Ethics Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹⁶ Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
¹⁷ Department of Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada.
¹⁸ Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹⁹ Division of Neurology, University of Toronto, Toronto, ON, Canada.
²⁰ Department of Medicine, Baycrest Health Sciences, Toronto, ON, Canada.
²¹ Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada.

PMID: 29802093
PMCID: PMC5993977
DOI: 10.2196/jmir.9126

Abstract

Background: Physicians often find significant challenges in assessing automobile driving in persons with mild cognitive impairment and mild dementia and deciding when to report to transportation administrators. Care must be taken to balance the safety of patients and other road users with potential negative effects of issuing such reports.

Objective: The aim of this study was to assess whether a computer-based Driving in Dementia Decision Tool (DD-DT) increased appropriate reporting of patients with mild dementia or mild cognitive impairment to transportation administrators.

Methods: The study used a parallel-group cluster nonblinded randomized controlled trial design to test a multifaceted knowledge translation intervention. The intervention included a computer-based decision support system activated by the physician-user, which provides a recommendation about whether to report patients with mild dementia or mild cognitive impairment to transportation administrators, based on an algorithm derived from earlier work. The intervention also included a mailed educational package and Web-based specialized reporting forms. Specialists and family physicians with expertise in dementia or care of the elderly were stratified by sex and randomized to either use the DD-DT or a control version of the tool that required identical data input as the intervention group, but instead generated a generic reminder about the reporting legislation in Ontario, Canada. The trial ran from September 9, 2014 to January 29, 2016, and the primary outcome was the number of reports made to the transportation administrators concordant with the algorithm.

Results: A total of 69 participating physicians were randomized, and 36 of these used the DD-DT; 20 of the 35 randomized to the intervention group used DD-DT with 114 patients, and 16 of the 34 randomized to the control group used it with 103 patients. The proportion of all assessed patients reported to the transportation administrators concordant with recommendation did not differ between the intervention and the control groups (50% vs 49%; Z=-0.19, P=.85). Two variables predicted algorithm-based reporting-caregiver concern (odds ratio [OR]=5.8, 95% CI 2.5-13.6, P<.001) and abnormal clock drawing (OR 6.1, 95% CI 3.1-11.8, P<.001).

Conclusions: On the basis of this quantitative analysis, in-office abnormal clock drawing and expressions of concern about driving from caregivers substantially influenced physicians to report patients with mild dementia or mild cognitive impairment to transportation administrators, but the DD-DT tool itself did not increase such reports among these expert physicians.

Trial registration: ClinicalTrials.gov NCT02036099; https://clinicaltrials.gov/ct2/show/NCT02036099 (Archived by WebCite at http://www.webcitation.org/6zGMF1ky8).

Keywords: automobile driving; decision support systems, clinical; dementia; mild cognitive impairment.

©Mark J Rapoport, Carla Zucchero Sarracini, Alex Kiss, Linda Lee, Anna Byszewski, Dallas P Seitz, Brenda Vrkljan, Frank Molnar, Nathan Herrmann, David F Tang-Wai, Christopher Frank, Blair Henry, Nicholas Pimlott, Mario Masellis, Gary Naglie. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 25.05.2018.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: DPS has participated in clinical trials sponsored by Roche Pharmaceuticals.

Figures

**Figure 1**
Consolidated Standards of Reporting Trials (CONSORT) diagram of recruitment, randomization, allocation, follow-up, and analysis.

See this image and copyright information in PMC

References

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Computer-Based Driving in Dementia Decision Tool With Mail Support: Cluster Randomized Controlled Trial

Affiliations

Computer-Based Driving in Dementia Decision Tool With Mail Support: Cluster Randomized Controlled Trial

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Associated data

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Miscellaneous