Eagon J C, Hurdle J F, Lincoln M J
Department of Medical Informatics, University of Utah, USA.
Proc AMIA Annu Fall Symp. 1996:130-4.
To better understand how VA clinicians use medical vocabulary in every day practice, we set out to characterize terms generated in the Problem List module of the VA's DHCP system that were not mapped to terms in the controlled-vocabulary lexicon of DHCP. When entered terms fail to match those in the lexicon, a note is sent to a central repository. When our study started, the volume in that repository had reached 16,783 terms. We wished to characterize the potential reasons why these terms failed to match terms in the lexicon. After examining two small samples of randomly selected terms, we used group consensus to develop a set of rating criteria and a rating form. To be sure that the results of multiple reviewers could be confidently compared, we analyzed the inter-rater agreement of our rating process. Two rates used this form to rate the same 400 terms. We found that modifiers and numeric data were common and consistent reasons for failure to match, while others such as use of synonyms and absence of the concept from the lexicon were common but less consistently selected.
为了更好地理解退伍军人事务部（VA）的临床医生在日常实践中如何使用医学词汇，我们着手对VA的动态健康护理计划（DHCP）系统的问题列表模块中生成的、未映射到DHCP控制词汇词典中的术语进行特征描述。当输入的术语与词典中的术语不匹配时，一条注释会被发送到一个中央存储库。当我们的研究开始时，该存储库中的术语数量已达到16783个。我们希望找出这些术语与词典中的术语不匹配的潜在原因。在检查了两个随机选择的小样本术语后，我们通过小组共识制定了一套评级标准和一份评级表。为确保能够可靠地比较多个评审者的结果，我们分析了评级过程中的评分者间一致性。两名评分者使用此表格对相同的400个术语进行评级。我们发现，修饰词和数字数据是不匹配的常见且一致的原因，而其他原因，如使用同义词和词典中不存在该概念等则很常见，但选择的一致性较低。
