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The benefits of implementing a computerized Intervention-Management-System (IMS) on delivering integrated dementia care in the primary care setting

Published online by Cambridge University Press:  09 May 2014

Tilly Eichler ,
Jochen René Thyrian ,
Daniel Fredrich ,
Leonore Köhler ,
Diana Wucherer ,
Bernhard Michalowsky ,
Adina Dreier  and
Wolfgang Hoffmann
Tilly Eichler*
Affiliation:
German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, Greifswald D-17489, Germany
Jochen René Thyrian
Affiliation:
German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, Greifswald D-17489, Germany
Daniel Fredrich
Affiliation:
Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstrasse 1-2, Greifswald D-17487, Germany
Leonore Köhler
Affiliation:
German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, Greifswald D-17489, Germany
Diana Wucherer
Affiliation:
German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, Greifswald D-17489, Germany
Bernhard Michalowsky
Affiliation:
German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, Greifswald D-17489, Germany
Adina Dreier
Affiliation:
Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstrasse 1-2, Greifswald D-17487, Germany
Wolfgang Hoffmann
Affiliation:
German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, Greifswald D-17489, Germany Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstrasse 1-2, Greifswald D-17487, Germany
*
Correspondence should be addressed to: Dr. Tilly Eichler, German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, Greifswald D-17489, Germany. Phone: +49(0)3834 86 7591; Fax: +49(0)3834 86 19551. Email: [email protected].
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Abstract

Background:

A computerized Intervention-Management-System (IMS) has been developed and implemented to facilitate dementia care management. IMS is a rule-based expert decision support system that matches individual patient characteristics to a computerized knowledge base. One of the most important functionalities of IMS is to support the compilation of the individual intervention plan by systematically identifying unmet needs and suggesting the corresponding specific interventions for recommendation to the general practitioner (GP). The present analysis aimed to determine if the implementation of IMS improves the identification of unmet needs and the recommendation of adequate specific interventions. In addition, the feasibility and acceptability of the IMS were evaluated.

Methods:

Delphi-MV is an on-going GP-based, cluster-randomized, controlled intervention trial to implement and evaluate a collaborative dementia care management program for community-dwelling PWDs and their caregivers. IMS was developed and implemented over the course of the DelpHi-trial. The identified unmet needs and the interventions that were recommended to the GP before and after the implementation of IMS were compared. To evaluate the feasibility and acceptability of the IMS, a survey was conducted among the current users of IMS.

Results and Conclusions:

After the implementation of IMS, the number of specific interventions recommended to the GP increased by 85%. Our findings provide evidence that IMS improves the systematic identification of unmet needs and the subsequent recommendation of interventions to address these needs. The users evaluated IMS as very helpful and would like to use it for their future work. However, the usability could be further improved.

Keywords

Intervention-Management-System (IMS)dementia care managementcomplex interventionidentification of unmet needsindividualized intervention plandecision support system (DSS)
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 8 , August 2014 , pp. 1377 - 1385
Copyright
Copyright © International Psychogeriatric Association 2014 

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References

Bryan, C. and Boren, S. A. (2008). The use and effectiveness of electronic clinical decision support tools in the ambulatory/primary care setting: a systematic review of the literature. Informatics in Primary Care, 16, 79–91.Google Scholar
Bundesministerium der Justiz (1994). Gesetz über Medizinprodukte (Medizinproduktegesetz - MPG). Available at: http://www.gesetze-im-internet.de/bundesrecht/mpg/gesamt.pdf; last accessed 15 January 2014.Google Scholar
Calabrese, P. and Kessler, J. (2000). Screening for cognitive impairment in dementia - the DemTect procedure. European Neuropsychopharmacology, 10, 369.Google Scholar
DEGAM (Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin e.V.) (2008). DEGAM-Leitlinie Nr 12: Demenz. Düsseldorf: omikron.Google Scholar
DGPPN and DGN (Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde und Deutsche Gesellschaft für Neurologie) (2009). S-3 Leitlinie “Demenzen.” Available at: http://www.dgppn.de/fileadmin/user_upload/_medien/download/pdf/kurzversion-leitlinien/s3-leitlinie-demenz-lf.pdf; last accessed 15 January 2014.Google Scholar
Doerner, D. and Schaub, H. (1994). Errors in planning and decision-making and the nature of human information processing. Journal of Applied Psychology, 43, 433–453.Google Scholar
Downs, M. et al. (2006). Effectiveness of educational interventions in improving detection and management of dementia in primary care: cluster randomised controlled study. British Medical Journal, 332, 692–696.CrossRefGoogle ScholarPubMed
Dreier, A. and Hoffmann, W. (2013). Dementia care manager for patients with dementia: determination of the requirements and qualifications contents for nurses in the DelpHi-MV study. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, 56, 1398–409. doi:10.1007/s00103-013-1796-0.Google Scholar
Dreier, A., Thyrian, J. R. and Hoffmann, W. (2011). Dementia Care Manager in der ambulanten Demenzversorgung: entwicklung einer innovativen Qualifizierung für Pflegefachkräfte. Pflege & Gesellschaft, 16, 53–64.Google Scholar
Eichler, T. et al. (2014). Dementia care management: going new ways in ambulant dementia care within a GP-based randomized controlled intervention trial. International Psychogeriatrics, 26, 247–256. doi:10.1017/S1041610213001786.Google Scholar
Garg, A. X. et al. (2005). Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. Journal of the American Medical Association, 293, 1223–1238.CrossRefGoogle ScholarPubMed
Kessler, J., Markowitsch, H. J. and Denzler, P. (1990). Mini-Mental-Status-Test (MMST) [German Version]. Göttingen: Beltz Test GmbH.Google Scholar
Lindgren, H. and Eriksson, S. (2010). Sociotechnical integration of decision support in the dementia domain. Studies in Health Technology and Informatics, 157, 79–84.Google Scholar
Lindgren, H., Eklund, P. and Eriksson, S. (2002). Clinical decision support system in dementia care. Studies in Health Technology and Informatics, 90, 568–571.Google Scholar
Meyer, J., Fredrich, D., Piegsa, J., Habes, M., van den, B. N. and Hoffmann, W. (2012). A mobile and asynchronous electronic data capture system for epidemiologic studies. Computer Methods and Programs in Biomedicine, 107, 369–379.Google Scholar
Miller, G. A. (1994). The magical number seven, plus or minus two: some limits on our capacity for processing information, 1956. Psychological Review, 101, 343–352.CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence (NICE) (2012). Dementia: Supporting People with Dementia and Their Carers in Health and Social Care. Available at: http://www.nice.org.uk/nicemedia/live/10998/30318/30318.pdf; last accessed 15 January 2014.Google Scholar
Riepe, M. W. and Fellgiebel, A. (2012). Dementia guidelines: what should come to general practice-an interdisciplinary consensus of physicians in private practice. Deutsche medizinische Wochenschrift, 137, 1499–1504. doi:10.1055/s-0032-1305171.Google Scholar
Roshanov, P. S. et al. (2011). Computerized clinical decision support systems for chronic disease management: a decision-maker-researcher partnership systematic review. Implementation Science, 6, 92. doi:10.11861748-5908-6-92.Google Scholar
Sahota, N. et al. (2011). Computerized clinical decision support systems for acute care management: a decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes. Implementation Science, 6, 91. doi:10.1186/1748-5908-6-91.Google Scholar
Somme, D., Trouve, H., Drame, M., Gagnon, D., Couturier, Y. and Saint-Jean, O. (2012). Analysis of case management programs for patients with dementia: a systematic review. Alzheimer's & Dementia, 8, 426–436. doi:10.1016/j.jalz.2011.06.004.Google Scholar
StataCorp (2009). Stata Statistical Software: Release 11. College Station, TX: StataCorp LP.Google Scholar
Thyrian, J. R. and Hoffmann, W. (2012). Dementia care and general physicians-a survey on prevalence, means, attitudes and recommendations. Central European Journal of Public Health, 20, 270–275.Google Scholar
Thyrian, J. R. et al. (2012). Life- and person-centred help in Mecklenburg-Western Pomerania, Germany (DelpHi): study protocol for a randomised controlled trial. Trials, 13, 56. doi:10.1186/1745-6215-13-56.CrossRefGoogle ScholarPubMed
Vollmar, H. C. et al. (2010). Knowledge transfer for the management of dementia: a cluster randomised trial of blended learning in general practice. Implementation Science, 5, 1. doi:10.1186/1748-5908-5-1.Google Scholar