Bankowitz R A, Lave J R, McNeil M A
Section of Medical Informatics, Medical Center, University of Pittsburgh, PA.
Methods Inf Med. 1992 Feb;31(1):3-10.
The wide variation in utilization of diagnostic resources has not been decreased by the proliferation of new diagnostic technologies. We wish to test the hypothesis that the introduction of a medical decision support system into clinical practice could potentially lead to more efficient use of diagnostic information, and therefore lead to a reduction in overall laboratory use and cost of care. We have devised and are currently implementing a randomized controlled trial of a computer based decision support system, the University of Pittsburgh version of Quick Medical Reference (QMR). The main purpose of the study is to determine the effect of the QMR program on specific outcome measures: length of hospital stay, number and types of diagnostic tests ordered, and overall charges. An important part of this evaluation is relating the initial level of diagnostic uncertainty expressed by the admitting housestaff team to utilization of diagnostic resources. The purpose of this paper is to describe the methodology for carrying out this controlled trial, and to describe our initial experiences with its implementation.
新诊断技术的不断涌现并未减少诊断资源利用方面的巨大差异。我们希望检验这样一个假设：将医疗决策支持系统引入临床实践可能会提高诊断信息的使用效率，从而减少总体实验室检查的使用以及护理成本。我们已经设计并正在实施一项基于计算机的决策支持系统——匹兹堡大学版快速医学参考（QMR）的随机对照试验。该研究的主要目的是确定QMR程序对特定结果指标的影响：住院时间、所开具诊断检查的数量和类型以及总费用。此次评估的一个重要部分是将住院医护团队表示的初始诊断不确定性水平与诊断资源的利用联系起来。本文的目的是描述开展这项对照试验的方法，并介绍我们在实施过程中的初步经验。
