受診前の問診アプリは救急外来の診断精度を向上させるか？：DASIクラスターランダム化比較試験

In urgent care settings, efficient medical history-taking is paramount for making timely and accurate treatment decisions. Medical history-taking apps have emerged as a means to streamline this process but their effectiveness in enhancing diagnostic accuracy remains unclear. We aimed to investigate whether using a medical history-taking app before consultation improves diagnostic accuracy. In two German out-of-hours practices (OOHP), patients were recruited over a 12-months period. Within each practice, weeks were randomized to either an intervention or control group, resulting in a cluster-randomized trial (CRT) with clustering in weeks within the same practice. Patients in the intervention group used an app to report their complaints before their consultation, enabling physicians to review their medical history details beforehand. In contrast, patients in the control group used the app after their consultation, and no summary of their medical history was available to the physician. Diagnostic accuracy was defined as the agreement between the OOHP physician's diagnoses and those determined by an expert committee (EC) after reviewing patient files. As a secondary outcome, we compared OOHP and EC physicians' treatment recommendations against patients' self-reported actual treatment (e.g., specialist care, hospital admissions) from a follow-up survey. We analyzed data from 986 patients and found no significant intervention effect on diagnostic accuracy (Odds Ratio 0.94 (95%CI 0.73 - 1.21), 57.6% in intervention vs 59.1% in control group). Additionally, the app had no significant effect on the prediction of further treatment. The only significant factors affecting these outcomes were the number of diagnoses (positively associated with diagnostic accuracy) and a self-reported severe condition (associated with higher likelihood of requiring further treatment). Individual differences between physicians were more pronounced than those between the intervention and control group for the secondary outcome. The study's findings suggest that this medical history-taking app does not enhance diagnostic accuracy in urgent care settings.