Mobile devices loaded with a custom app that prompts clinicians to follow evidence-based guidelines to make treatment decisions and document care plans make nurses significantly more likely to identify obesity, smoking and depression during routine exams, according to a study.
Findings from the study, conducted by researchers with the Columbia University School of Nursing in New York City, were published in the November/December 2014 issue of the Journal for Nurse Practitioners.
“What clinicians need is decision support tools that fit into their workflow and remind them of evidence-based practices,” lead study author Suzanne Bakken, PhD, FAAN, FACMI, alumni professor of nursing and professor of biomedical informatics at Columbia Nursing, said in a news release.
“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.”
The study evaluated diagnosis rates for tobacco use, adult and pediatric depression and obesity during 34,349 patient exams conducted by 363 RNs enrolled in nurse practitioner programs at Columbia Nursing.
Students were assigned randomly to use mobile apps with or without decision support for guideline-based care.
For each of the health issues studied, mobile apps with decision-support features resulted in significantly higher diagnosis rates than apps with only bare-bones tools for recording results from a patient exam. Increased diagnosis rates with decision support were:
- Seven times more obese and overweight (33.9% vs. 4.8%)
- Five times more tobacco use (11.9% vs. 2.3%)
- Forty-four times more adult depression (8.8% vs. 0.2%)
- Four times more pediatric depression (4.6% vs. 1.1%)
The app might have worked because, unlike software aimed at physicians that focuses more on diagnostic codes needed for medical billing, it prompted nurse practitioners to follow evidence-based clinical guidelines to screen, diagnose and manage specific conditions and encouraged detailed conversations with patients about their health, Bakken said in the release.
For tobacco screening, the app prompted nurses to ask not only about cigarettes but also about other products such as chewing tobacco. 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. The app also prompted RNs to ask a series of questions to make it easier to identify patients with depressive symptoms.
Co-authors include Columbia Nursing associate professors Haomiao Jia, PhD, and Rita John, DNP, EdD.
Funding for the research was provided by the National Institute of Nursing Research.