A Comparison of the Effects of Computer and Manual Reminders on Compliance with a Mental Health Clinical Practice Guidelines

Objective: To evaluate the relative effectiveness of computer and manual reminder systems on the implementation of a clinical practice guideline. Design: Seventy-eight outpatients in a mental health clinic were randomly assigned within clinician to one of the two reminder systems. The computer system, called CaseWalker, reminded clinicians when guideline-recommended screening for mood disorder was due, ensured the fidelity of the diagnosis of major depressive disorder to criteria of the Diagnostic and Statistical Manual of Mental Disorders , 4th edition (DSM-IV), and generated a progress note. The manual system was a checklist inserted in the paper medical record. Measures: Screening rates for mood disorder and the completeness of the documentation of which DSM-IV criteria were met by patients who were said to have major depressive disorder were compared. Results: The CaseWalker, compared with the paper checklist, resulted in a higher screening rate for mood disorder (86.5 vs. 61 percent, P = 0.008) and a higher rate of complete documentation of DSM-IV criteria (100 vs. 5.6 percent, P < 0.001). Conclusions: In an outpatient mental health clinic, computer reminders were shown to be superior to manual reminders in improving adherence to a clinical practice guideline for depression.