在医生决策过程中定偏见的证据
Dan P Ly1,2, Paul G Shekelle1, Zirui Song3,4,5
1Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles, California.
JAMA internal medicine
|June 26, 2023
概括
医生不太可能为患有充血性心力衰竭 (CHF) 的患者订购肺栓塞 (PE) 测试,当CHF在分拣笔记中被提及时,出现呼吸短促. 这种定偏差可能会延迟PE诊断.
科学领域:
- 医疗决策的制定 医疗决策的制定
- 医疗保健服务研究 医疗服务研究
背景情况:
- 认知偏见,如定偏见,可以影响医生的决策.
- 关于这些偏见在临床实践中的影响,存在有限的大规模证据.
研究的目的:
- 为了调查医生是否不太可能对患有充血性心力衰竭 (CHF) 患者进行肺栓塞 (PE) 测试,当CHF在分拣笔记中记录时,出现呼吸短促 (SOB).
- 评估在分组时记录的CHF与PE的及时性和诊断之间的关联.
主要方法:
- 使用2011-2018年国家退伍军人事务数据进行的横截面研究.
- 包括108,019名患有CHF的患者,他们呈现了SOB.
- 分析了在分组文档中提到CHF与PE检测率,检测时间和PE诊断之间的关联.
主要成果:
- 患有CHF和SOB的患者接受PE测试的可能性较低 (减少4.6个百分点),如果CHF在分拣中被提及,则测试延迟了 (15.5分钟长).
- 在这个群体中,BNP测试增加 (6.9个百分比).
- 在ED中观察到急性PE诊断的可能性较低 (0.15个百分点的减少),但与最终的PE诊断没有显著的关联.
结论:
- 医生对初始分拣信息 (CHF提及) 进行定可能会导致肺栓塞减小和延迟的肺栓塞检测,患有充血性心力衰竭的患者.
- 这种偏见可能会影响诊断工作,并可能及时诊断PE.
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