Study: Decision support app increased nurse practitioner diagnoses

By Aditi Pai
08:57 am
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Doctor breaking cigaretteUsing mobile apps that help clinicians follow evidence-based guidelines when making treatment decisions increases the chances that nurses will identify patients with chronic health issues, including obesity, smoking, and depression, according to a study from Columbia University School of Nursing published in the Journal for Nurse Practitioners.

The study analyzed the rate that registered nurses, enrolled in nurse practitioner programs at Columbia University School of Nursing, screened patients with tobacco use, adult and pediatric depression, and obesity. The nurses conducted 34,349 patient exams during the study.

"What clinicians need is decision support tools that fit into their workflow and remind them of evidence-based practices," Suzanne Bakken, lead study author and alumni professor of nursing at Columbia Nursing said in a statement. "Our app focused specifically on the work that nurse practitioners do to identify health problems, counsel patients, and coordinate care plans, resulting in higher diagnosis rates and more opportunities for intervention.”

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Nurse practitioner students were randomly assigned mobile devices with preloaded app that either had the decision support features or didn't. The app with the evidence-based decision support features prompted nurse practitioner students to document care plans, while the other app offered students simple tools for recording results from a patient exam. 

Researchers found that the rate of diagnosis of obesity when using the decision support app was 33.9 percent while students with the bare bones app diagnosed 4.8 percent of their patients with obesity. Students with the more advanced app also identified 11.9 percent of patients as tobacco users while those with the other app identified 2.3 percent. Students with the decision support app diagnosed 8.8 percent of patients with adult depression and 4.6 percent of patients with pediatric depression versus .2 percent and 1.1 percent, respectively, for the group who used the app without decision support tools.

Bakken added that the app with decision support features may have worked better because software for physicians often focuses on diagnostic codes needed for medical billing and the app, instead, encouraged nurse practitioners to start detailed conversations with the patient.

"For tobacco screening, for example, the app prompted nurses to ask not just about cigarettes but also about other products such as chewing tobacco," researchers wrote. "To diagnose patients who are overweight or obese, the app calculated body-mass-index to quickly pinpoint people who might benefit from weight-loss counseling and other interventions. And with depression, the app prompted nurses to ask a series of questions to make it easier to identify patients with depressive symptoms."

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