迫使急诊室的临床医生减少不必要的诊断测试订单:一个基于多臂片的多臂实验
Lu Bai1, Shijia Gao1, Frada Burstein1
1Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Melbourne, Victoria, Australia.
Emergency medicine Australasia : EMA
|December 9, 2025
概括
临床决策支持推动并没有减少急诊室的整体测试订单. 然而,限制测试选择和提供建议的干预措施减少了非例行测试,特别是对经验较少的临床医生来说.
科学领域:
- 紧急医疗 紧急医疗
- 医疗信息学 医疗信息学
- 临床决策支持 临床决策支持
背景情况:
- 诊断测试的过度使用在急诊室普遍存在.
- 临床决策支持 (CDS) 系统可以减轻不必要的测试订单.
- 这项研究调查了基于nudge的CDS干预措施对临床医生的测试订购行为的影响.
研究的目的:
- 评估不同基于nudge的CDS干预措施在减少急诊室临床医生之间的诊断测试订单方面的有效性.
- 评估决策结构操纵和决策辅助对测试订单模式的影响.
主要方法:
- 一个三盲,四臂随机对照试验,涉及8个急诊部的243名临床医生.
- 临床医生们得到了一个标准化的病例列表,并被随机分配,接受不同的CDS点击 (不同的测试选择选项和建议) 或对照.
- 主要结局:订购的总检测的差异;次要结局:不包括普通血液工作 (全血检查和尿素/电解质) 的测试,根据临床经验分层.
主要成果:
- 在任何推动干预和对照组之间没有观察到测试订单总量的显著差异.
- 当常见的血液检测被排除在外时,Nudge #2 (直线建议) 和Nudge #3 (有限的测试范围) 与对照组相比显著减少了测试订单 (p<0.01).
- 观察到的测试订单减少主要是由经验不到10年的临床医生推动的.
结论:
- 改变决策结构并提供协助的基于nudge的CDS干预措施显示出在急诊室减少特定诊断测试 (不包括常规血液检查) 的潜力.
- 这些干预措施在经验较少的临床医生中似乎最有效.
- 需要进一步的研究来优化CDS策略,以更广泛地减少测试和影响所有经验水平.
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