John R et al. 2007 "Development and evaluation of a PDA-based decision support system for pediatric depression screening."
Reference
John R, Buschman P, Chaszar M, et al. Development and evaluation of a PDA-based decision support system for pediatric depression screening. Stud Health Technol Inform 2007;129 Pt 2:1382-1386.
Abstract
"Depression is under recognized in a variety of pediatric settings. The purpose of this paper is to describe the development and initial evaluation of a personal digital assistant (PDA)-based decision support system (DSS) for pediatric advanced practice nurse (APN) students. Three aspects are described: selection of depression screening instrument; integration of the instrument into the PDA; and quantitative (usage) and qualitative (focus group) evaluation. Only one third of eligible patients were screened. Twenty percent of those screened were identified as at risk for mood disorder. The barriers to screening identified through focus groups included a lack of time, knowledge, intervention protocol, referral resources, PDA usability issues, preceptor motivation and comfort, as well as perceived or real cultural barriers. Suggestions for educational, research, and interventions to integrate clinical based PDA-based screening are discussed."
Objective
"To describe the development and initial evaluation of the [personal digital assistant-based decision support system] for pediatric depression screening in ages 8 to 18 years of age by pediatric [advanced practice nursing] students."
Tools Used
Type Clinic
Primary care
Size
unknown
Geography
Urban
Type of Health IT
Decision support system
Type of Health IT Functions
The system screens pediatric patients for risk of depression or suicide.
Context or other IT in place
The context varied across practices.
Workflow-Related Findings
"Most students felt [the PDA] interfered with the therapeutic relationship by creating a barrier between the patient and the student." As one student said "the screening did not stimulate discussion. When I am done, there is not a transitional step." In addition, "you can ask the questions, but you must know what your next step is."
"Even though the [users] felt that screenings should take place in a well visit, in 8.4% of the encounters in which no screening occurred, the diagnosis was a well child. In addition, only one third of eligible children or adolescents were screened."
Study Design
Only postintervention (no control group)
Study Participants
The study participants included 25 nursing students attending Columbia University School of Nursing: eight were fourth semester students and 17 were first semester students. The students worked in various clinics.