Clinical guidelines can assist in the management of asthma. Decision support
systems (DSSs) can enhance adherence to clinical guidelines but tend not to
provide clinicians with cues for behavioral change strategies to promote patient
self-management. The Stop Asthma Clinical System (SACS) is a DSS designed for
this purpose. To assess feasibility, seven clinicians used SACS to guide well
visits with 26 predominantly persistent pediatric asthma patients. Data were
collected via survey and in-depth semi-structured interviews. SACS improved
assessment of asthma severity and control, classification of and intervention in
medicine and environmental trigger management problems, and development of an
action plan (allp< 0.05). Clinician-patient communication was enhanced. The primary
challenge was that SACS increased clinic visit time. SACS can enhance clinician
behavior to improve patient asthma self-management, but more studies are
indicated to mitigate temporal constraints and evaluate impact on clinician and
patient communication and behavior as well as clinical outcomes.
Prevention NAEA.Morbidity and Mortality: 2000 Chart Book on Cardiovascular, Lung, and Blood
Diseases.
Bethesda, MD: National Heart, Lung, and Blood Institute
, 2000.
2.
Mannino D M
,
Moorman J E
,
Kingsley B
,
Rose D
,
Repace J.Health effects related to environmental tobacco smoke exposure in children
in the United States: data from the Third National Health and Nutrition
Examination Survey
. Archives of Pediatrics & Adolescent Medicine2001; 155 (1);
36-41
.
3.
Farber H J
,
Wattigney W
,
Berenson G.Trends in asthma prevalence: the Bogalusa Heart Study
. Annals of Allergy Asthma & Immunology1997; 78 (3);
265-269
.
4.
Slezak J A
,
Persky V W
,
Kviz F J
,
Ramakrishnan V
,
Byers C.Asthma prevalence and risk factors in selected Head Start sites in Chicago
. Journal of Asthma1998; 35 (2);
203-212
.
5.
Christiansen S C
,
Martin S B
,
Schleicher N C
,
Koziol J A
,
Mathews K P
,
Zuraw B L.Current prevalence of asthma-related symptoms in San Diego’s
predominantly Hispanic inner-city children
. Journal of Asthma1996; 33 (1);
17-26
.
6.
National Heart, Lung
, and
Blood Institute
. National Asthma Education and Program Expert Report. Guidelines for the
Diagnosis and Management of Asthma. Report no. 91-3042.
Bethesda, MD: NIH
, 1991.
7.
National Heart, Lung
, and
Blood Institute
. National Institutes of Health: Global Strategy for Asthma Management
and Prevention.
Bethesda, MD: NIH
, 1995.
8.
British Thoracic Society
.
Statement by the British Thoracic Society, Research Unit of the Royal
College of Physicians of London, King’s Fund Centre, National
Asthma Campaign. Guidelines for management of asthma in adults. I. Chronic
persistent asthma
. British Medical Journal1990; 301;
797-800
.
9.
Woolcock A
,
Rubinfeld A R
,
Searle J P.Thoracic Society of Australia and New Zealand asthma action plan
. Medical Journal of Australia1989; 151;
650-653
.
10.
Spector S L
,
Nicklas R A.Practice parameters for the diagnosis and treatment of asthma
. Journal of Allergy & Clinical Immunology1995; 96;
707-870
.
11.
Creer T L
,
Winder J A
,
Tinkelman D.Guidelines for the diagnosis and management of asthma: accepting the challenge
. Journal Asthma1999; 36 (5);
391-407
.
12.
National Heart, Lung
, and
Blood Institute
. National Asthma Education and Prevention Program, Expert Panel 2:
Guidelines for the Diagnosis and Management of Asthma. Report no. 97-4051.
Bethesda, MD: NIH
, 1997.
13.
National Heart, Lung
, and
Blood Institute
. Guidelines for the Diagnosis and Management of Asthma. Update on
Selected Topics. Report no. 02-5074.
Bethesda, MD: NIH
, 2002.
14.
Grant E N
,
Moy J N
,
Turner-Roan K
,
Daugherty S R
,
Weiss K B.Asthma care practices, perceptions, and beliefs of Chicago-area
primary-care physicians. Chicago Asthma Surveillance Initiative Project Team
. Chest1999; 116 (4 Suppl 1);
145S-154S
.
15.
Gregson R K
,
Warner J O
,
Radford M.Assessment of the continued supervision and asthma management knowledge of
patients possessing home nebulizers
. Respiratory Medicine1995; 89 (7);
487-493
.
16.
Lieu T A
,
Quesenberry Jr C P
,
Capra A M
,
Sorel M E
,
Martin K E
,
Mendoza G R.Outpatient management practices associated with reduced risk of pediatric
asthma hospitalization and emergency department visits
. Pediatrics1997; 100 (3);
334-341
.
17.
Dawson K P
,
Van Asperen P
,
Higgins C
,
Sharpe C
,
Davis A.An evaluation of the action plans of children with asthma
. Journal of Paediatrics & Child Health1995; 31 (1);
21-23
.
18.
Legorreta A P
,
Christian-Herman J
,
O’Connor R D
,
Hasan M M
,
Evans R
,
Leung K M.Compliance with national asthma management guidelines and specialty care: a
health maintenance organization experience
. Archives of Internal Medicine1998; 158 (5);
457-464
.
19.
Finkelstein J A
,
Lozano P
,
Farber H J
,
Miroshnik I
,
Lieu T A.Underuse of controller medications among Medicaid-insured children with asthma
. Archives of Pediatrics & Adolescent Medicine2002; 156 (6);
562-567
.
20.
Hunt D L
,
Haynes R B
,
Hanna S E
,
Smith K.Effects of computer-based clinical decision support systems on physician
performance and patient outcomes: a systematic review
. Journal of the American Medical Association1998; 280 (15);
1339-1346
.
21.
Shiffman R N
,
Liaw Y
,
Brandt C A
,
Corb G J.Computer-based guideline implementation systems: a systematic review of
functionality and effectiveness
. Journal of the American Medical Informatics Association1999; 6;
104-114
.
22.
Creer, T L.Medication compliance and childhood asthma. In
Krusnejer C A
,
Epstein L
,
Johnson S B
,
Yafti, S J
eds Developmental Aspects of Health Compliance Behavior.
Hillsdale, NJ: Erlbaum
, 1993.
23.
Johnston M E
,
Langton K B
,
Haynes R B
,
Mathieu A.Effects of computer-based clinical decision support systems on clinician
performance and patient outcome. A critical appraisal of research
. Annals of Internal Medicine1994; 120 (2);
135-142
.
24.
de Clerq P A
,
Blom J A
,
Korsten H H
,
Hasman A.Approaches for creating computer-interpretable guidelines that facilitate
decision support
. Artificial Intelligence Medicine2004; 31 (1);
1-27
.
25.
Staggers N
,
Thompson C B
,
Snyder-Halpern R.History and trends in clinical information systems in the United States
. Journal of Nursing Scholarship2001; 33 (1);
75-81
.
26.
Lehmann E D.Computerized decision-support tools in diabetes care: hurdles to implementation
. Diabetes Technology & Therapeutics2004; 6 (3).
27.
Schneider E C
,
Eisenberg J M.Strategies and methods for aligning current and best medical practices. The
role of information technologies
. Western Journal of Medicine1998; 168;
311-318
.
28.
Austin T
,
Iliffe S
,
Leaning M
,
Modell M.A prototype computer decision support system for the management of asthma
. Journal of Medical Systems1996; 20 (1);
45-55
.
29.
Shiffman R N
,
Freudigman K A
,
Brandt C
,
Liaw Y
,
Navedo D D.A guideline implementation system using handheld computer for office
management of asthma: effects on adherence and patient outcomes
. Pediatrics2000; 105 (4).
30.
Clark N M
,
Nothwehr F
,
Gong M
,
Evans D
,
Maiman L A
,
Hurwitz M E
,
Roloff D
,
Mellins R B.Physician-patient partnership in managing chronic illness
. Academic Medicine1995; 70 (11);
957-959
.
31.
Glanz K
,
Lewis F M
,
Rimer B K
eds. Health Behavior and Health Education: Theory, Research, and Practice2nd edn.San Francisco: Jossey-Bass
.
32.
Rogers E M.Diffusion of Innovations, 4th edn.New York: Free
, 1995.
33.
Helitzer, D
,
Heath D
,
Maltrud K
,
Sullivan E
,
Alverson D.Assessing or predicting adoption of telehealth using the diffusion of
innovations theory: a practical example from a rural program in New Mexico
. Telemedicine Journal and e-Health2003; 9 (2);
179-187
.
34.
Dixon D R
,
Dixon B J.Adoption of information technology enabled innovations by primary care
physicians: model and questionnaire development
. Journal of the American Medical Informatics Association,
Symposium on Computer Applications in Medical Care1994:
631-635
.
35.
Davis F D.Perceived usefulness, perceived ease of use, and user acceptance of
information technology
. MIS Quarterly1989;
319-340
.
36.
Shegog R
,
Shegog R
,
Bartholomew L K
,
Czyzewski D I
,
Sockrider M M
,
Craver J
,
Pilney S
,
Mullen P D
,
Koeppl K
,
Gold R S
,
Fernandez M
,
Abramson S L.Development of an expert system knowledge base: a novel approach to promote
guideline congruent asthma care
. Journal of Asthma2004; 41 (4);
385-402
.
Robohelp®. eHelp Corporation, San Diego, CA.
http://www.ehelp.com/. 2003.
40.
Powerbuilder®. Sybase Corp., Dublin, CA.
http://www.sybase.com/contact_us/worldwide/. 2003.
41.
Gadd C S
,
Baskaran P
,
Lobach D F.Identification of design features to enhance utilization and acceptance of
systems for Internet-based decision support at the point of care
. Proceedings of the AMIA Symposium1998;
91-95
.
42.
Prochaska J O
,
DiClemente C C
,
Norcross J C
(1997) In search of how people change: applications to
addictive behaviors. In
Marlatt G
,
Van den Bos G R
eds Addictive Behaviors: Readings on Etiology, Prevention, and Treatment671-696.
Washington, DC: American Psychological Association
.
43.
American Academy of Allergy, Asthma
, and
Immunology
. Pediatric Asthma: Promoting Best Practice. Guide for Managing Asthma in
Children.
Milwaukee, WI: AAAI Inc.
, 1999.
44.
Seckman C A
,
Romano C A
,
Marden S.Evaluation of clinician response to wireless technology
. Proceedings of the AMIA Symposium2001;
612-616
.
45.
Cork R D
,
Detmer W M
,
Friedman C P.Development and initial validation of an instrument to measure
physicians’ use of knowledge about, and attitudes toward computers
. Journal of the American Medical Informatics Association1998; 5;
164-176
.
46.
Dansky K H
,
Gamm L D
,
Vasey J J
,
Barsukiewicz C K.Electronic medical records: are physicians ready
? Journal of Healthcare Management1999; 44 (6);
440-454
.
47.
Forsythe D.Using ethnography to build a working system: rethinking basic design assumptions
. In Proceedings of the 15th Annual Symposium on Computer
Applications in Medical Care, American Medical Informatics Association,
505-509
. New York: McGraw-Hill, 1993.
48.
Aydin, C.Survey methods for assessing social impacts of computers in health care
organizations. In
Anderson J C
,
Aydin C E
,
Jay S J
eds Evaluating Health Care Information Systems69-115.
Thousand Oaks, CA: Sage
, 1994.
