Lau L M, Warner H R
Department of Medical Informatics, University of Utah.
Proc Annu Symp Comput Appl Med Care. 1991:104-8.
Quality Assurance improves health care through detection of quality problems and feedback to the care giver. Current review procedures employed by the Peer Review Organizations (PROs), however, appear to underdetect quality problems, particularly those arising from diagnostic errors. We studied the use of an expert diagnostic system, Iliad, to detect quality problems arising from diagnostic errors. 100 cases were selected from among those Medicare cases reviewed by the Utah PRO (UPRO) and which contained diagnoses recognized by Iliad. Iliad flagged 28 cases out of the 100 as containing diagnostic errors, and a gold standard physician review confirmed quality problems in 17 cases (60.7%). The UPRO review found 28 cases with quality problems, mostly treatment and documentation errors. The quality problems detected by Iliad appeared to be more serious than those detected by the UPRO review. Among the six cases with quality problems detected by both the UPRO and Iliad review, there was none for which the same quality problem was detected by the two procedures. The two review procedures were therefore complementary.
质量保证通过发现质量问题并向护理人员反馈来改善医疗保健。然而，同行评审组织（PROs）目前采用的评审程序似乎未能充分发现质量问题，尤其是那些由诊断错误引起的问题。我们研究了使用专家诊断系统Iliad来发现由诊断错误引起的质量问题。从犹他州PRO（UPRO）评审的医疗保险病例中选取了100例，这些病例包含Iliad识别出的诊断。Iliad在100例病例中标记出28例存在诊断错误，一项金标准医师评审确认其中17例（60.7%）存在质量问题。UPRO评审发现28例存在质量问题，主要是治疗和记录错误。Iliad检测到的质量问题似乎比UPRO评审检测到的更严重。在UPRO和Iliad评审都检测到存在质量问题的6例病例中，两种程序检测到的相同质量问题一例也没有。因此，这两种评审程序是互补的。
