Haug P J, Warner H R, Clayton P D, Schmidt C D, Pearl J E, Farney R J, Crapo R O, Tocino I, Morrison W J, Frederick P R
Comput Biomed Res. 1987 Apr;20(2):193-207. doi: 10.1016/0010-4809(87)90045-0.
We have developed a computer-administered history designed to directly interview hospitalized patients with pulmonary disease. A frame-based decision system is used to direct the history and to generate a one- to five-member differential diagnostic list based on this history. This system incorporates a cognitive model of question selection and a Bayesian scoring algorithm. Structures to control the choice of questions are embedded in the diagnostic frames and in a QUERY program that makes the final choice of questions. We have compared the behavior of this decision-driven approach with a history taken using a paper questionnaire. The paper-based history presents 182 questions to every patient and captured 75% of 85 pulmonary diseases in its differential lists. The decision-driven system asks 50.7 +/- 31.0 (mean +/- standard deviation) and captured 74% of 61 pulmonary diseases. Our experience suggests that the use of a computerized diagnostic knowledge base to direct the selection of pertinent questions can substantially reduce the number of questions necessary to collect a diagnostically useful patient history.
我们开发了一种计算机管理的病史采集程序，旨在直接对住院的肺部疾病患者进行问诊。基于框架的决策系统用于引导病史采集，并根据采集到的病史生成一个包含一至五个疾病的鉴别诊断列表。该系统结合了一个问题选择的认知模型和一个贝叶斯评分算法。控制问题选择的结构嵌入在诊断框架和一个做出最终问题选择的查询程序中。我们将这种决策驱动方法的表现与使用纸质问卷进行的病史采集进行了比较。纸质病史问卷向每位患者提出182个问题，其鉴别诊断列表涵盖了85种肺部疾病中的75%。决策驱动系统提出的问题数量为50.7±31.0（均值±标准差），涵盖了61种肺部疾病中的74%。我们的经验表明，使用计算机化的诊断知识库来指导相关问题的选择，可以大幅减少为收集具有诊断价值的患者病史所需的问题数量。
