Background. Electronic decision support systems (EDSS) using a shared decision making framework may be a new technology to facilitate service planning in public sector mental health care. The case management context is a ripe testing ground for such technology, given the quality of life decisions involved in case management. Honoring consumer preferences for services has been associated with improvements in outcomes in decades of studies.
Methods. Three studies were conducted from one single cluster-randomized experiment. An analysis of the usability of the EDSS was conducted using electronic questionnaires and the automated recording of user interaction with the systems (N=40 dyads). The primary experiment examined the effect of the EDSS on case managers‘ and clients‘ satisfaction with the care planning process, and on client recall of their care plans three days later (n=80 dyads). OLS regression with adjustment for intra-worker clustering was used to test for differences in satisfaction scores (on a five point scale) and knowledge. A qualitative investigation was embedded in the larger study to better understand how shared decision making works in this clinical context (N=16 dyads).
Results. This set of studies has demonstrated that consumers can build their own care plans, and edit them with their case managers. The experimental results indicated that case managers in the experimental group were significantly more satisfied with the EDSS process than in the control group (mean score=4.0 (SD .54) versus 3.3 (SD .53)). There were no differences between the client EDSS and control groups regarding satisfaction, but the EDSS participants were significantly more knowledgeable about the contents of their care plans 3 days later (mean proportion of plan goals recalled=75% (SD=28%) versus 57% (SD=32%)). The qualitative study indicated that the differences between the two groups were that the dyads in the EDSS group had more frequent (worker-led) discussions of areas of disagreement, role definition, and negotiation of decisions. Case managers also reported learning more about their clients using the process.
Conclusions and Implications. The amplification of client preferences using the EDSS was clearly present. Further research is needed to understand if this insight transfers to action longitudinally.
|Advisor:||Drake, Robert E.|
|Commitee:||Llewellyn-Thomas, Hilary, McHugo, Gregory J., Whitley, Rob|
|Department:||Evaluative Clinical Sciences|
|School Location:||United States -- New Hampshire|
|Source:||DAI-B 71/05, Dissertation Abstracts International|
|Subjects:||Mental health, Health care management|
|Keywords:||Community mental health, Electronic decision support systems, Shared decision making|
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