View source for Computer-based decision support for pediatric asthma management: description and feasibility of the Stop Asthma Clinical System (SACS)

== Review ==

Computer-based decision support for pediatric asthma management: 
description and feasibility of the Stop Asthma Clinical System (SACS) 
Ross et al. HEALTH INFORMATICS J 2006; 12; 259 

== Question ==

This article describes a DSS in pediatric asthma, a small trial of its implementation and use in a real clinic setting.  The authors describe the first use of such systems to address behavioral issues important in successful asthma treatment using established practice guidelines.

== Data Sources==

Only source is a review of this specific article and their data and findings.  

== Study selection and assessment ==

7 physicians and one nurse educator and 29 pediatric asthma children they evaluated over a given period were chosen for evaluation.  SACS was used using the same data gathered from the same visit and the evaluation before and after SACS were analyzed.

The clinicians were then interviewed for perceived usefulness and ease of SACS.

== Outcomes ==

NIHBL guidelines in the care of asthma and outcomes measures improved significantly in the major areas evaluated, p<0.05 when SACS was used.

== Main results==

All clinicians rated SACS over usual care higher and scores were statistically significant.   SACS was perceived as useful and easy to use.

However, the average length of time per visit of 15 minutes was significantly lengthened, and was found undesirable.

The authors surmised that with the increase in interactions, came better clinician-patient enhancement of communication.

== Conclusion & Commentary ==

I agree with the authors that objective measures and tasks did improve, and this would be expected with DSS EMR.

Their main premise of improving asthma through improved patient behavior as a result of SACS was not shown.  

The authors imply that this will occur with the increased in clinician-patient time of interaction, but is also a negative for the clinician perception and use of SACS.  I see nothing on the SACS design and use, and their small study, that will improve patient behavior outcomes related to asthma, without identifying a specific behavior, identifying it during a SACS use, and subsequent prospective evaluation comparison. They do plan on a larger scale study, but I believe they need to re-design this study.

I commend the authors for identifying patient behavior, and in my words psychosocial issues as important in quantifying, documenting, and subsequently, manage in a HIS, through DSS.  Prompts would be to the clinician to behave or ask certain questions, or identify certain patient dysfunctional coping skills such as denial.  Chronic disease evaluation and treatment in an HIS setting let alone DSS is a major undertaking, and this paper, simply re-iterates the need, but failed to implement such a system.

Dan Dalan

[[Category:BMI-512-W-08]]