Mobile devices loaded with a custom app prompting clinicians to follow evidence-based guidelines makes nurses significantly more likely to identify health issues such as obesity, smoking, and depression during routine exams.

That is the finding of a study from the Columbia University School of Nursing published in the Journal for Nurse Practitioners. The study evaluated diagnosis rates for tobacco use, adult and pediatric depression, and obesity during 34,349 patient exams conducted by 363 registered nurses enrolled in nurse practitioner programs at Columbia. Students were randomly assigned 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 percent versus 4.8 percent)

*Five times more tobacco use (11.9 percent versus 2.3 percent)

*Forty-four times more adult depression (8.8 percent versus 0.2 percent)

*Four times more pediatric depression (4.6 percent versus 1.1 percent)

The app may 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, lead author Suzanne Bakken said.

"What clinicians need is decision support tools that fit into their work flow and remind them of evidence-based practices," said Bakken. "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 is available here.

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