Trial of an Electronic Decision Support System to Facilitate Shared Decision Making in Community Mental Health

Ann Arbor Department of Veterans Affairs, Serious Mental Illness Treatment, Research, and Evaluation Center, Health Services Research and Development, P.O. Box 13017, Ann Arbor, MI 48105, USA.
Psychiatric services (Washington, D.C.) (Impact Factor: 2.41). 01/2011; 62(1):54-60. DOI: 10.1176/
Source: PubMed


Involvement of community mental health consumers in mental health decision making has been consistently associated with improvements in health outcomes. Electronic decision support systems (EDSSs) that support both consumer and provider decision making may be a sustainable way to improve dyadic communication in a field with approximately 50% workforce turnover per year. This study examined the feasibility of such a system and investigated proximal outcomes of the system's performance.
A cluster randomized design was used to evaluate an EDSS at three urban community mental health sites. Case managers (N=20) were randomly assigned to the EDSS-supported planning group or to the usual care planning group. Consumers (N=80) were assigned to the same group as their case managers. User satisfaction with the care planning process was assessed for consumers and case managers (possible scores range from 1 to 5, with higher summary scores indicating more satisfaction). Recall of the care plan was assessed for consumers. Linear regression with adjustment for grouping by worker was used to assess satisfaction scores. A Wilcoxon rank-sum test was used to examine knowledge of the care plan.
Compared with case managers in the control group, those in the intervention group were significantly more satisfied with the care planning process (mean ± SD score=4.0 ± .5 versus 3.3 ± .5; adjusted p=.01). Compared with consumers in the control group, those in the intervention group had significantly greater recall of their care plans three days after the planning session (mean proportion of plan goals recalled=75% ± 28% versus 57% ± 32%; p=.02). There were no differences between the clients in the intervention and control groups regarding satisfaction.
This study demonstrated that clients can build their own care plans and negotiate and revise them with their case managers using an EDSS.

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Available from: Gregory J Mchugo, Oct 28, 2015
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    • "Issues related to responsibilities arose throughout the design processes. Our assessment of similar tools [10,19,20] found that they were mainly used at clinics either from pre-consultation kiosks and/or during consultations. To our knowledge, the information generated during these encounters remains accessible to service users only when they are together with their clinician, who is responsible for quality and data protection. "
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    • "In recent years, the ethics of such medical paternalism have been called into question [4]. To better prepare patients for meetings with their clinician, tools have recently been developed to support shared decision making [5] [6], which is considered an ethical imperative [7]. Shared decision making is an approach in which patient and clinician are equal participants in deciding the treatment plan. "
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