Wolf F M, Friedman C P, Elstein A S, Miller J G, Murphy G C, Heckerling P, Fine P, Miller T, Sisson J, Barlas S, Capitano A, Ng M, Franz T
University of Washington, Seattle, USA.
Proc AMIA Annu Fall Symp. 1997:263-7.
We examined the degree to which attending physicians, residents, and medical students' stated desire for a consultation on difficult-to-diagnose patient cases is related to changes in their diagnostic judgments after a computer consultation, and whether, in fact, their perceptions of the usefulness of these consultations are related to these changes. The decision support system (DSS) used in this study was ILIAD (v4.2). Preliminary findings based on 16 subjects' (6 general internists, 4 second-year residents in internal medicine, and 6 fourth-year medical students) workup of 136 patient cases indicated no significant main effects for 1) level of experience, 2) whether or not subjects indicated they would seek a diagnostic consultation before using the DSS, or 3) whether or not they found the DSS consultation in fact to be helpful in arriving at a diagnosis (p > .49 in all instances). Nor were there any significant interactions. Findings were similar using subjects or cases as the unit of analysis. It is possible that what may appear to be counter-intuitive, and perhaps irrational, may not necessarily be so. We are currently examining potential explanatory hypotheses in our ongoing current, larger study.
我们研究了主治医生、住院医师和医学生表示希望就难以诊断的患者病例进行会诊的程度，与他们在计算机会诊后诊断判断的变化之间的关系，以及实际上他们对这些会诊有用性的认知是否与这些变化相关。本研究中使用的决策支持系统（DSS）是ILIAD（v4.2）。基于16名受试者（6名普通内科医生、4名内科二年级住院医师和6名四年级医学生）对136例患者病例的检查结果显示，在以下方面没有显著的主效应：1）经验水平；2）受试者在使用DSS之前是否表示会寻求诊断会诊；3）他们是否实际上发现DSS会诊有助于做出诊断（在所有情况下p>.49）。也没有任何显著的交互作用。以受试者或病例作为分析单位时，结果相似。可能看似违反直觉且或许不合理的情况，未必如此。我们目前正在正在进行的更大规模研究中检验潜在的解释性假设。
