Do online information retrieval systems help experienced clinicians answer clinical questions?
Do online information retrieval systems help experienced clinicians answer clinical questions?
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DOI：
10.1197/jamia.m1717
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发表时间：
2005-05-01
影响因子：
6.4
通讯作者：
Gosling, AS
中科院分区：
文献类型：
--
作者：
Westbrook, JI;Coiera, EW;Gosling, AS
目的：评估临床医生使用在线信息检索系统对其回答临床问题的影响。设计：干预前/干预后实验设计。测量：在计算机实验室中，75 名临床医生（26 名医院医生、18 名家庭医生和 31 名临床护士顾问）在使用在线信息检索系统之前和之后针对 8 个临床场景提供了 600 个答案。我们检查了干预前后正确答案的比例、答案变化的方向以及专业组之间的差异。结果：系统使用使临床医生的答案提高了 21%，从系统使用前的 29%（95% 置信区间 [CI] 25.432.6）正确率提高到系统使用后的 50%（95% Cl 46.0-54.0）。 33% (95% Cl 29.1-36.9) 的答案从错误改为正确。 21% (95% Cl 17.1-23.9) 的正确预测试答案得到了使用系统发现的证据的支持，而 7% (95% Cl 4.9-9.1) 的正确预测试答案被错误地更改了。对于 40% (35.4-43.6) 的场景，系统使用后未纠正不正确的预测试答案。尽管专业组的预测试分数存在显着差异[家庭医生：41% (95% Cl 33.0-49.0)、医院医生：35% (95% Cl 28.5-41.2)、临床护士顾问：17% (95% Cl 12.3-21.7; X 2 = 29.0, df = 2, p < 0.01)]，但没有考后成绩的差异。 (x(2) = 2.6，df = 2，p = 0.73）。结论：在线信息检索系统的使用与临床医生对典型临床问题提供的答案质量的显着提高相关。在一小部分情况下，系统的使用会产生错误。虽然临床组在独立回答问题时的表现存在差异，但在使用系统后，表现没有显着差异。在线信息检索系统可以成为提高临床医生回答临床问题准确性的有效工具。
Objective: To assess the impact of clinicians' use of an online information retrieval system on their performance in answering clinical questions.Design: Pre-/post-intervention experimental design.Measurements: In a computer laboratory, 75 clinicians (26 hospital-based doctors, 18 family practitioners, and 31 clinical nurse consultants) provided 600 answers to eight clinical scenarios before and after the use of an online information retrieval system. We examined the proportion of correct answers pre- and post-intervention, direction of change in answers, and differences between professional groups.Results: System,use resulted in a 21% improvement in clinicians' answers, from 29% (95% confidence interval [CI] 25.432.6) correct pre- to 50% (95% Cl 46.0-54.0) post-system use. In 33% (95% Cl 29.1-36.9) answers were changed from incorrect to correct. In 21% (95% Cl 17.1-23.9) correct pre-test answers were supported by evidence found using the system, and in 7% (95% Cl 4.9-9.1) correct pre-test answers were changed incorrectly. For 40% (35.4-43.6) of scenarios, incorrect pre-test answers were not rectified following system use. Despite significant differences in professional groups' pre-test scores [family practitioners: 41% (95% Cl 33.0-49.0), hospital doctors: 35% (95% Cl 28.5-41.2), and clinical nurse consultants: 17% (95% Cl 12.3-21.7; X 2 = 29.0, df = 2, p < 0.01)], there was no difference in post-test scores. (x(2) = 2.6, df = 2, p = 0.73).Conclusions: The use of an online information retrieval system was associated with a significant improvement in the quality of answers provided by clinicians to typical clinical problems. In a small proportion of cases, use of the system produced errors. While there was variation in the performance of clinical groups when answering questions unaided, performance did not differ significantly following system use. Online information retrieval systems can be an effective tool in improving the accuracy of clinicians' answers to clinical questions.