Elstein A S, Friedman C P, Wolf F M, Murphy G, Miller J, Fine P, Heckerling P, Miller T, Sisson J, Barlas S, Biolsi K, Ng M, Mei X, Franz T, Capitano A
Department of Medical Education, University of Illinois at Chicago 60612, USA.
J Am Med Inform Assoc. 1996 Nov-Dec;3(6):422-8. doi: 10.1136/jamia.1996.97084515.
To assess the effects of incomplete data upon the output of a computerized diagnostic decision support system (DSS), to assess the effects of using the system upon the diagnostic opinions of users, and to explore if these effects vary as a function of clinical experience.
Experimental pilot study. Four clusters of nine cases each were constructed and equated for case difficulty. Definitive findings were omitted from the case abstracts. Subjects were randomly assigned to one of four clusters and were trained on the DSS prior to use.
The study involved 16 physicians at three levels of clinical experience (six general internists, four residents in internal medicine, and six fourth-year medical students), from three academic medical centers.
Each subject worked up nine cases, first without and then with ILIAD consultation. They were asked to offer up to six potential diagnoses and to list up to three steps that should be the next items in the diagnostic workup. Effects of DSS consultation were measured by changes in the position of the correct diagnosis in the lists of differential diagnoses, pre- and post-consultation.
The DSS lists of diagnostic possibilities contained the correct diagnosis in 38% of cases, about midway between the levels of accuracy of residents and attending general internists. In over 70% of cases, the DSS output had no effect on the position of the correct diagnosis in the subjects' lists. The system's diagnostic accuracy was unaffected by the clinical experience of the users.
评估不完整数据对计算机化诊断决策支持系统（DSS）输出结果的影响，评估使用该系统对用户诊断意见的影响，并探讨这些影响是否因临床经验而异。
实验性试点研究。构建了四个集群，每个集群有九个病例，并使病例难度相等。病例摘要中省略了确定性的诊断结果。受试者被随机分配到四个集群之一，并在使用前接受DSS培训。
该研究涉及来自三个学术医学中心的16名具有三个临床经验水平的医生（六名普通内科医生、四名内科住院医师和六名四年级医学生）。
每位受试者分析九个病例，先不使用ILIAD咨询，然后进行咨询。要求他们提供多达六个潜在诊断，并列出多达三个应作为诊断检查下一步的步骤。通过比较咨询前后鉴别诊断列表中正确诊断的位置变化来衡量DSS咨询的效果。
DSS列出的诊断可能性在38%的病例中包含正确诊断，大约处于住院医师和普通内科主治医师的准确率之间。在超过70%的病例中，DSS的输出对受试者列表中正确诊断的位置没有影响。该系统的诊断准确性不受用户临床经验的影响。
