National Center for Patient Safety, Ann Arbor, Michigan, USA.
J Am Med Inform Assoc. 2011 May 1;18(3):243-50. doi: 10.1136/amiajnl-2010-000063.
To evaluate the accuracy of a computerized clinical decision-support system (CDSS) designed to support assessment and management of pediatric asthma in a subspecialty clinic.
Cohort study of all asthma visits to pediatric pulmonology from January to December, 2009.
CDSS and physician assessments of asthma severity, control, and treatment step.
Both the clinician and the computerized CDSS generated assessments of asthma control in 767/1032 (74.3%) return patients, assessments of asthma severity in 100/167 (59.9%) new patients, and recommendations for treatment step in 66/167 (39.5%) new patients. Clinicians agreed with the CDSS in 543/767 (70.8%) of control assessments, 37/100 (37%) of severity assessments, and 19/66 (29%) of step recommendations. External review classified 72% of control disagreements (21% of all control assessments), 56% of severity disagreements (37% of all severity assessments), and 76% of step disagreements (54% of all step recommendations) as CDSS errors. The remaining disagreements resulted from pulmonologist error or ambiguous guidelines. Many CDSS flaws, such as attributing all 'cough' to asthma, were easily remediable. Pediatric pulmonologists failed to follow guidelines in 8% of return visits and 18% of new visits.
The authors relied on chart notes to determine clinical reasoning. Physicians may have changed their assessments after seeing CDSS recommendations.
A computerized CDSS performed relatively accurately compared to clinicians for assessment of asthma control but was inaccurate for treatment. Pediatric pulmonologists failed to follow guideline-based care in a small proportion of patients.
评估一个旨在支持儿科哮喘专科门诊评估和管理的计算机临床决策支持系统（CDSS）的准确性。
对 2009 年 1 月至 12 月期间所有儿科肺病学哮喘就诊的病例进行队列研究。
CDSS 和医生对哮喘严重程度、控制和治疗步骤的评估。
在 767/1032 名（74.3%）复诊患者中，临床医生和计算机化的 CDSS 都对哮喘控制进行了评估，在 100/167 名（59.9%）新患者中对哮喘严重程度进行了评估，在 66/167 名（39.5%）新患者中对治疗步骤提出了建议。临床医生在 543/767 名（70.8%）控制评估、37/100 名（37%）严重程度评估和 19/66 名（29%）治疗步骤建议中与 CDSS 达成一致。外部审查将 72%的控制分歧（所有控制评估的 21%）、56%的严重分歧（所有严重程度评估的 37%）和 76%的步骤分歧（所有步骤建议的 54%）归类为 CDSS 错误。其余的分歧是由于肺病学家的错误或指南不明确造成的。许多 CDSS 缺陷，如将所有“咳嗽”归因于哮喘，很容易得到纠正。在 8%的复诊患者和 18%的新患者中，儿科肺病学家未能遵循指南。
作者依赖图表记录来确定临床推理。医生在看到 CDSS 建议后可能会改变他们的评估。
与临床医生相比，计算机化的 CDSS 对哮喘控制的评估相对准确，但对治疗的评估不准确。儿科肺病学家在一小部分患者中未能遵循基于指南的治疗。
