PURPOSE:Computerized decision support systems (CDSS) help practitioners conform to practice guidelines. A CDSS designed specifically for the Global Initiative for Asthma (GINA) guidelines was able to discern mild from severe asthma in a manner similar to expert asthma clinicians in a previous investigation. In this previous study, expert asthma clinicians were the default reference standard. This study was designed to determine if the CDSS could outperform an expert asthma clinician in applying the GINA guidelines.
METHODS:This study compared the fidelity of the CDSS versus pulmonologists for adhering to the GINA guidelines when determining asthma severity. 100 case scenarios were developed by a medical resident coinciding with one of the three degrees of asthma severity according to the GINA guidelines: controlled, partly controlled, and uncontrolled. These case scenarios were then presented to one of 10 practicing pulmonologists who were asked to classify asthma severity. The case scenarios were also entered into the web based CDSS (see https://www.mdadvisor.org). Kappa was used to test for agreement. Sensitivity and specificity were calculated by combining “partly controlled” and “uncontrolled” into one level of severity, and comparing it to “controlled”. “Partly controlled” / “uncontrolled” were considered “disease present” for the calculation of sensitivity and specificity.
RESULTS:99 of the 100 case scenarios were returned completed by both the pulmonologists and the CDSS. According to the GINA guidelines, 25 case scenarios described asthma that was controlled, 49 partly controlled, and 25 uncontrolled. Agreement between GINA guidelines and the computer was perfect (Kappa=1.00). The Kappa comparing the pulmonologist to the GINA guidelines was equal to 0.672 with three severity levels: controlled, partly controlled, and uncontrolled. The sensitivity of the pulmonologist using two levels of severity was 94.2% and the specificity was 70.0%. The Kappa for the two levels of severity was 0.674.
CONCLUSION:The CDSS outperformed pulmonologists in classifying asthma severity according to the GINA guidelines.
CLINICAL IMPLICATIONS:Further investigation is warranted to determine if improved GINA guidelines adherence translates into improved asthma outcomes.
DISCLOSURE:Thomas Stern, No Financial Disclosure Information; No Product/Research Disclosure Information