Yu Feliciano, Houston Thomas K, Ray Midge N, Garner Duriel Q, Berner Eta S
UAB Center for Outcomes and Effectiveness Research and Education (COERE), Birmingham, Alabama, USA.
Med Decis Making. 2007 Nov-Dec;27(6):744-53. doi: 10.1177/0272989X07305321. Epub 2007 Sep 14.
To assess the patterns of use of handheld clinical decision support tools by internal medicine residents in clinical settings.
Eighty-two internal medicine residents were given personal digital assistants (PDAs) containing a suite of clinical decision support (CDS) programs. A tracking program was used to prospectively track program use during the study period, and a follow-up survey regarding self-reported program use was administered after the study period. Patterns of program use from the tracking data were compared to the data from the self-report survey.
Sixty-eight residents were followed using the tracking data. Residents used an average of 1.81 CDS programs (SD: 1.57; range, 0-5) per month. Forty-nine residents completed the self-report survey. Residents reported using an average of 3.15 (SD: 1.61) and 3.92 (SD: 1.40) CDS programs during a typical clinic session and inpatient day, respectively. In both inpatient and outpatient settings and for both methods of assessing program use, 2 programs (Epocrates and MedCalc) were used more often than the other programs. No association was observed between age, gender, race, and PGY level with the use of handheld clinical decision support tools for either tracked or self-report data. The self-report data show higher estimates of CDS program use than the tracking data in the clinical setting.
The data show that physicians prefer to use certain handheld CDS tools in clinical settings. Drug references and medical calculators have been consistently used more than clinical prediction rules and diagnostic systems. Self-report survey instruments may overestimate recorded use of CDS programs.
评估内科住院医师在临床环境中使用手持式临床决策支持工具的模式。
给82名内科住院医师配备了装有一套临床决策支持（CDS）程序的个人数字助理（PDA）。在研究期间使用一个跟踪程序前瞻性地跟踪程序使用情况，并在研究期结束后进行了一项关于自我报告程序使用情况的随访调查。将跟踪数据中的程序使用模式与自我报告调查的数据进行比较。
利用跟踪数据对68名住院医师进行了跟踪。住院医师每月平均使用1.81个CDS程序（标准差：1.57；范围，0 - 5）。49名住院医师完成了自我报告调查。住院医师报告在典型的门诊会诊和住院日期间分别平均使用3.15个（标准差：1.61）和3.92个（标准差：1.40）CDS程序。在住院和门诊环境中，以及对于两种评估程序使用的方法，有2个程序（Epocrates和MedCalc）的使用频率高于其他程序。无论是跟踪数据还是自我报告数据，均未观察到年龄、性别、种族和住院医师培训年数与手持式临床决策支持工具的使用之间存在关联。自我报告数据显示在临床环境中CDS程序使用的估计值高于跟踪数据。
数据表明医生在临床环境中更喜欢使用某些手持式CDS工具。药物参考和医学计算器的使用一直多于临床预测规则和诊断系统。自我报告调查工具可能高估了CDS程序的记录使用情况。
