University of California, San Francisco, Department of Emergency Medicine, San Francisco, California ; KidsCareEverywhere - Vietnam, Berkeley, California.
West J Emerg Med. 2013 Sep;14(5):471-6. doi: 10.5811/westjem.2013.4.15090.
Global health agencies and the Vietnam Ministry of Health have identified pediatric emergency care and health information technology as high priority goals. Clinical decision support (CDS) software provides physicians with access to current literature to answer clinical queries, but there is limited impact data in developing countries. We hypothesized that Vietnamese physicians will demonstrate improved test performance on common pediatric emergencies using CDS technologies despite being in English.
This multicenter, prospective, pretest-posttest study was conducted in 11 Vietnamese hospitals enrolled a convenience sample of physicians who attended an 80-minute software training on a pediatric CDS software (PEMSoft). Two multiple-choice exams (A, B) were administered before and after the session. Participants, who received Test A as a pretest, received Test B as a posttest, and vice versa. Participants used the CDS software for the posttest. The primary outcome measure was the mean percentage difference in physician scores between the pretest and posttest, as calculated by a paired, two-tailed t-test.
For the 203 participants, the mean pretest, posttest, and improvement scores were 37% (95% CI: 35-38%), 70% (95% CI: 68-72%), and 33% (95% CI: 30-36%), respectively, with p<0.0001. This represents an 89% improvement over baseline. Subgroup analysis of practice setting, clinical experience, and comfort level with written English and computers showed that all subgroups equivalently improved their test scores.
After brief training, Vietnamese physicians can effectively use an English-based CDS software based on improved performance on a written clinical exam. Given this rapid improvement, CDS technologies may serve as a transformative tool in resource-poor environments.
全球卫生机构和越南卫生部已将儿科急救护理和健康信息技术确定为优先重点目标。临床决策支持（CDS）软件为医生提供获取当前文献以回答临床查询的途径，但在发展中国家，其影响数据有限。我们假设，尽管是英文的，越南医生在使用 CDS 技术时，在常见儿科急症方面的测试表现会有所提高。
这是一项多中心、前瞻性、预测试-后测试研究，在越南的 11 家医院进行，采用便利抽样方法招募参加了 80 分钟儿科 CDS 软件（PEMSoft）培训的医生。在培训前后进行了两次多项选择题测试（A、B）。接受测试 A 作为预测试的参与者接受测试 B 作为后测试，反之亦然。参与者在后测试中使用 CDS 软件。主要观察指标是通过配对、双侧 t 检验计算出的医生在预测试和后测试之间的分数差异的平均百分比。
对于 203 名参与者，平均预测试、后测试和提高分数分别为 37%（95%置信区间：35-38%）、70%（95%置信区间：68-72%）和 33%（95%置信区间：30-36%），p<0.0001。这代表了 89%的基线提高。根据实践环境、临床经验以及对书面英语和计算机的舒适度进行的亚组分析表明，所有亚组的测试分数都得到了同等提高。
经过简短的培训，越南医生可以有效地使用基于英语的 CDS 软件，因为他们在书面临床考试中的表现得到了提高。鉴于这种快速的改进，CDS 技术可能成为资源匮乏环境中的变革性工具。
