操作标准的应用不会改变临床医生对精神障碍诊断的看法:干预前后的有效性研究
Helio G Rocha Neto1,2, José Luiz Martins Lessa3, Luisa Mendez Koiller3
1Programa de Pós Graduação em Psiquiatria e Saúde Mental (PROPSAM), Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
应用国际疾病分类第10版 (ICD-10) 操作标准并没有显著改变精神病学住院医生的诊断. 然而,诊断变化中的性别差异需要进一步调查潜在的偏见.
科学领域:
- 精神病学是一个精神病学.
- 医学诊断 医学诊断 医学诊断
背景情况:
- 诊断标准不断发展,以提高临床效用.
- 国际疾病分类,第10次修订 (ICD-10) 引入了标准化诊断的操作标准.
- 这些标准在临床环境中的实际应用需要评估.
研究的目的:
- 评估应用ICD-10操作标准是否会在现实生活中的临床场景中改变非操作的,基于原型的诊断.
- 为了确定特定的诊断组是否更容易受到变化,当运行标准被应用.
主要方法:
- 精神病学专科医生将ICD-10的操作标准应用于现有的门诊病例,以原型为基础的诊断.
- 八十五个诊断对 (非操作与操作) 被审查.
- 统计测试 (斯图尔特-麦克斯韦尔) 用于分析意见变化.
主要成果:
- 在应用ICD-10操作标准 (χ2 = 5.25, p = 0.39) 后,没有观察到诊断意见的统计学意义上的变化.
- 大约30%的诊断显示出一些变化,其中20.2%可能会影响治疗决策.
- 没有一个特定的诊断组表现出更高的变化趋势 (χ2 = 11.6,p = 0.07),尽管女性性别与更大的变化有关.
结论:
- 应用ICD-10的操作标准并没有导致居民的诊断意见在统计上有显著的变化.
- 虽然在统计学上并不显著,但诊断中的变化可能会影响治疗,这表明潜在的临床相关性.
- 在诊断变化中观察到的与性别相关的差异可能表明沉没成本偏差,并需要进一步研究.
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