Balas E A, Su K C, Solem J F, Li Z R, Brown G
Health Management and Informatics, School of Medicine, University of Missouri, Columbia, USA.
Stud Health Technol Inform. 1998;52 Pt 2:845-8.
To enhance clinical decision support, presented messages are increasingly supplemented with information from the medical literature. The goal of this study was to identify types of evidence that can lead to the biggest difference.
Seven versions of a questionnaire were mailed to randomly selected active family practice physicians and internists across the United States. They were asked about the perceived values of evidence from randomized controlled trials, locally developed recommendations, no evidence, cost-effectiveness studies, expert opinion, epidemiologic studies, and clinical studies. Analysis of variance and pairwise comparisons were used for statistical testing.
Seventy-six (52%) physicians responded. On a Likert scale from one to six, randomized controlled clinical trial was the highest rated evidence (mean 5.07, SD +/- 1.14). Such evidence was significantly superior to locally developed recommendations and no evidence at all (P < .05). The interaction was also strong between the types of evidence and clinical areas (P = .0001).
While most health care organizations present data without interpretation or simply try to enforce locally developed recommendations, such approaches appear to be inferior to techniques of reporting data with pertinent controlled evidence from the literature. Investigating physicians' perceptions is likely to benefit the design of computer generated messages.
为加强临床决策支持，所呈现的信息越来越多地辅以医学文献中的信息。本研究的目的是确定能产生最大差异的证据类型。
向美国随机选取的在职家庭医生和内科医生邮寄了七个版本的调查问卷。询问他们对来自随机对照试验、本地制定的建议、无证据、成本效益研究、专家意见、流行病学研究和临床研究的证据的感知价值。采用方差分析和两两比较进行统计检验。
76名（52%）医生做出了回应。在1至6的李克特量表上，随机对照临床试验是评分最高的证据（平均5.07，标准差±1.14）。此类证据明显优于本地制定的建议和完全没有证据（P < 0.05）。证据类型与临床领域之间的交互作用也很强（P = 0.0001）。
虽然大多数医疗保健组织呈现数据时不做解释，或只是试图执行本地制定的建议，但这种方法似乎不如用文献中相关对照证据报告数据的技术。调查医生的看法可能有助于计算机生成信息的设计。
