通过基于计算机的咨询来增强临床医生的诊断推理:对2个系统的多站点研究
C P Friedman1, A S Elstein, F M Wolf
1Center for Biomedical Informatics and Department of Medicine, University of Pittsburgh, PA 15213, USA. cpf@cbmi.upmc.edu
JAMA
|November 26, 1999
概括
咨询诊断决策支持系统 (DSS) 改善了临床医生的诊断准确性. 医学学生的进步更大,这表明这些基于计算机的工具在临床推理中的教育效益更大.
科学领域:
- 医疗信息学 医疗信息学
- 临床决策 临床决策
- 健康 专业 教育 卫生 专业 教育
背景情况:
- 基于计算机的诊断决策支持系统 (DSS) 旨在通过为临床医生提供准确和及时的诊断信息来提高医疗保健质量.
- 以前的研究往往侧重于系统的准确性,忽视了临床医生作为直接用户的作用.
研究的目的:
- 评估咨询DSS如何影响临床医生在复杂医疗病例中的诊断假设.
- 评估DSS对医生和医学学生诊断推理的影响.
主要方法:
- 在实验室环境中进行了一项部分随机对照试验,具有平衡的实验设计.
- 来自三个学术医学中心的216名医生 (教师,住院医生,学生) 使用两个DSS (ILIAD和QMR) 评估了36个具有挑战性的病例.
- 参与者在使用DSS之前和之后生成诊断假设,通过假设列表和诊断质量评分来衡量诊断准确性.
主要成果:
- 咨询DSS使假设列表中的正确诊断的出现率从39.5%增加到45.4%.
- 平均诊断质量得分显著改善 (P<.001),科恩的d效应大小为0.32.
- 医学学生表现出比住院生和教师更大的改善 (P=.048),并且效果因DSS而异 (QMR显示出比ILIAD更大的效果).
结论:
- 诊断DSS的直接使用对临床医生的诊断推理过程产生了积极的影响.
- 对学生的增强影响表明,DSS在医学培训中具有宝贵的教育作用.
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