Feldman Mitchell J, Hoffer Edward P, Barnett G Octo, Kim Richard J, Famiglietti Kathleen T, Chueh Henry C
J Grad Med Educ. 2012 Jun;4(2):227-31. doi: 10.4300/JGME-D-11-00180.1.
Computer-based medical diagnostic decision support systems have been used for decades, initially as stand-alone applications. More recent versions have been tested for their effectiveness in enhancing the diagnostic ability of clinicians.
To determine if viewing a rank-ordered list of diagnostic possibilities from a medical diagnostic decision support system improves residents' differential diagnoses or management plans.
Twenty first-year internal medicine residents at Massachusetts General Hospital viewed 3 deidentified case descriptions of real patients. All residents completed a web-based questionnaire, entering the differential diagnosis and management plan before and after seeing the diagnostic decision support system's suggested list of diseases. In all 3 exercises, the actual case diagnosis was first on the system's list. Each resident served as his or her own control (pretest/posttest).
For all 3 cases, a substantial percentage of residents changed their primary considered diagnosis after reviewing the system's suggested diagnoses, and a number of residents who had not initially listed a "further action" (laboratory test, imaging study, or referral) added or changed their management options after using the system. Many residents (20% to 65% depending on the case) improved their differential diagnosis from before to after viewing the system's suggestions. The average time to complete all 3 cases was 15.4 minutes. Most residents thought that viewing the medical diagnostic decision support system's list of suggestions was helpful.
Viewing a rank-ordered list of diagnostic possibilities from a diagnostic decision support tool had a significant beneficial effect on the quality of first-year medicine residents' differential diagnoses and management plans.
基于计算机的医学诊断决策支持系统已经使用了数十年，最初是作为独立应用程序。最近的版本已经在提高临床医生诊断能力方面的有效性进行了测试。
确定查看医学诊断决策支持系统提供的按优先级排序的诊断可能性列表是否能改善住院医师的鉴别诊断或管理计划。
马萨诸塞州总医院的20名一年级内科住院医师查看了3份真实患者的匿名病例描述。所有住院医师都完成了一份基于网络的问卷，在查看诊断决策支持系统建议的疾病列表之前和之后输入鉴别诊断和管理计划。在所有3个练习中，实际病例诊断在系统列表中排第一。每位住院医师都作为自己的对照（预测试/后测试）。
对于所有3个病例，相当大比例的住院医师在查看系统建议的诊断后改变了他们最初考虑的主要诊断，并且一些最初没有列出“进一步行动”（实验室检查、影像学检查或转诊）的住院医师在使用系统后增加或改变了他们的管理方案。许多住院医师（根据病例不同，比例在20%至65%之间）在查看系统建议前后改善了他们的鉴别诊断。完成所有3个病例的平均时间为15.4分钟。大多数住院医师认为查看医学诊断决策支持系统的建议列表是有帮助的。
查看诊断决策支持工具提供的按优先级排序的诊断可能性列表对一年级内科住院医师的鉴别诊断质量和管理计划有显著的有益影响。
