美国医疗保健政策与研究机构抑郁症指南的书面及计算机化决策支持辅助工具对假设临床情景评估的影响

Effect of written and computerized decision support aids for the U.S. Agency for Health Care Policy and Research depression guidelines on the evaluation of hypothetical clinical scenarios.

作者信息

Medow M A, Wilt T J, Dysken S, Hillson S D, Woods S, Borowsky S J

机构信息

The Ohio State University, Columbus, USA.

出版信息

Med Decis Making. 2001 Sep-Oct;21(5):344-56. doi: 10.1177/0272989X0102100501.

DOI:10.1177/0272989X0102100501

PMID:11575484

Abstract

OBJECTIVE

The objective of this study was to compare the effects of written and computerized decision support aids (DSAs) based on U.S. Agency for Health Care Policy and Research depression guidelines.

METHODS

Fifty-six internal medicine residents were randomized to evaluate clinical scenarios using either a written or a computerized DSA after first assessing scenarios without a DSA. The paired difference between aided and unaided scores was determined for diagnostic accuracy, treatment selection, severity and subtype classification, antipsychotic use, and mental health consultations.

RESULTS

Diagnostic accuracy with the written DSA increased from 64% to 73%, and with the computerized DSA decreased from 67% to 64% (P=0.0065). Residents using the computerized DSA (vs. no DSA) requested fewer consultations (65% vs. 52%, P=0.028). In post hoc analysis, the written DSA increased sensitivity (66% to 89%, P<0.001) and the computerized DSA improved specificity (66% to 86%, P=0.0020) but reduced sensitivity (67% to 49%, P = 0.011).

CONCLUSIONS

A written DSA improved diagnostic accuracy, whereas a computerized DSA did not. However, the computerized DSA improved specificity and reduced mental health consultations.

摘要

目的

本研究旨在比较基于美国医疗保健政策与研究机构抑郁症指南的书面和计算机化决策支持辅助工具（DSA）的效果。

方法

56名内科住院医师在首次评估无DSA的临床病例后，被随机分配使用书面或计算机化DSA来评估临床病例。确定辅助和未辅助评分之间的配对差异，以评估诊断准确性、治疗选择、严重程度和亚型分类、抗精神病药物使用以及心理健康咨询情况。

结果

使用书面DSA时诊断准确性从64%提高到73%，而使用计算机化DSA时从67%降至64%（P = 0.0065）。使用计算机化DSA的住院医师（与无DSA相比）要求的咨询较少（65%对52%，P = 0.028）。在事后分析中，书面DSA提高了敏感性（从66%提高到89%，P < 0.001），计算机化DSA提高了特异性（从66%提高到86%，P = 0.0020），但降低了敏感性（从67%降至49%，P = 0.011）。