Connecting needs and care in psychosis: an illustration of decision support in psychosis care

This thesis describes the development and evaluation of computerized clinical decision aid in psychosis care. Lentis psychiatric institute developed this aid named TReatment E-AssisT (TREAT) which combines routine outcome monitoring data with guideline and standards of care. TREAT is able to provide personalized treatment recommendations for people with a psychotic illness. A qualitative analysis revealed that most clinicians perceived TREAT as beneficial to their daily clinical practice. The graphic representation of ROM results made them easier to discuss. Opinions about the treatment recommendations varied, but all clinicians experienced an increase in shared decision making with their patients when using TREAT. These findings were not replicated in a quantitate analysis which showed no improvements in the levels of shared decision making between TREAT and treatment as usual. A care consumption analysis revealed that patients had on average 7.4 care needs per measurement of possible 23 care needs as identified by TREAT. Physical care needs were most present and persistent while symptomatic and psychosocial care needs were more transient. The use of TREAT significantly increased the discussion of these care needs during consultations while also significantly increasing the number of initiated evidence-based treatments. In sum, this thesis shows the benefit of decision support in psychosis care while also highlighting some of the shortcomings and recommendations for future improvements.