Miller P L, Frawley S J
Center for Medical Informatics, Yale University School of Medicine, New Haven, CT 06520-8009, USA.
J Am Med Inform Assoc. 1995 Jul-Aug;2(4):238-42. doi: 10.1136/jamia.1995.96010392.
This case study explored 1) how much online clinical data is required to obtain patient-specific recommendations from a computer-based clinical practice guideline, 2) whether the availability of increasing amounts of online clinical data might allow a higher specificity of those recommendations, and 3) whether that increased specificity is necessarily desirable. The "quick reference guide" version of the guideline for acute postoperative pain management in adults, developed by the Agency for Health Care Policy and Research, was analyzed. Patient-specific data items that might be used to tailor the computer's output for a particular case were grouped into rough categories depending on how likely they were to be available online and how readily they might be determined from online clinical data. The patient-specific recommendations were analyzed to determine to what degree the amount of text produced depended on the online availability of different categories of data. An examination of example recommendations, however, illustrated that high specificity may not always be desirable. The study provides a concrete illustration of how the richness of online clinical data can affect patient-specific recommendations, and describes a number of related design trade-offs in converting a clinical guideline into an interactive, computer-based form.
1）从基于计算机的临床实践指南中获得针对患者的建议需要多少在线临床数据；2）越来越多的在线临床数据是否能使这些建议具有更高的特异性；3）这种更高的特异性是否必然是可取的。分析了医疗保健政策与研究机构制定的成人急性术后疼痛管理指南的“快速参考指南”版本。根据特定患者的数据项在线可得的可能性以及从在线临床数据中确定这些数据项的难易程度，将可能用于为特定病例定制计算机输出的特定患者数据项大致分类。分析针对患者的建议，以确定生成的文本量在何种程度上取决于不同类别数据的在线可用性。然而，对示例建议的审查表明，高特异性并非总是可取的。该研究具体说明了在线临床数据的丰富程度如何影响针对患者的建议，并描述了在将临床指南转化为交互式基于计算机的形式时的一些相关设计权衡。
