Accuracy of a computerized clinical decision-support system for asthma assessment and management
Accuracy of a computerized clinical decision-support system for asthma assessment and management
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DOI：
10.1136/amiajnl-2010-000063
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发表时间：
2011-05-01
影响因子：
6.4
通讯作者：
Horwitzi, Leora I.
中科院分区：
文献类型：
--
作者：
Hoeksema, Laura J.;Bazzy-Asaad, Alia;Horwitzi, Leora I.
目的评价计算机化临床决策支持系统（CDSS）在儿科哮喘评估和管理中的准确性，设计2009年1月至12月所有哮喘儿童肺科就诊的队列研究，测量CDSS和医生对哮喘严重程度、控制、结果1032例哮喘患者中，767例经临床医师和计算机CDSS评估均获得哮喘控制情况（74.3%）返回患者，100/167（59.9%）新患者的哮喘严重程度评估，66/167（39.5%）新患者的治疗步骤建议。在543/767（70.8%）的控制评估、37/100（37%）的严重程度评估和19/66（29%）的步骤建议中，临床医生同意CDSS。外部审查将72%的控制不一致（占所有控制评估的21%）、56%的严重度不一致（占所有严重度评估的37%）和76%的步骤不一致（占所有步骤建议的54%）归类为CDSS错误。其余的分歧是由于肺病学家的错误或模糊的指南。CDSS的许多缺陷，例如将所有“咳嗽”归因于哮喘，都很容易补救。儿科肺科医生未能遵循8%的回访和18%的新visits.Limitations的指南作者依靠图表说明，以确定临床推理。医生可能已经改变了他们的评估后，看到CDSS recommendations.Conclusions一个计算机化的CDSS进行相对准确的临床医生相比，评估哮喘控制，但不准确的治疗。儿科肺科医生未能遵循指南为基础的护理在一小部分患者。
Objective To evaluate the accuracy of a computerized clinical decision-support system (CDSS) designed to support assessment and management of pediatric asthma in a subspecialty clinic.Design Cohort study of all asthma visits to pediatric pulmonology from January to December, 2009.Measurements CDSS and physician assessments of asthma severity, control, and treatment step.Results Both the clinician and the computerized CDSS generated assessments of asthma control in 767/1032 (74.3%) return patients, assessments of asthma severity in 100/167 (59.9%) new patients, and recommendations for treatment step in 66/167(39.5%) new patients. Clinicians agreed with the CDSS in 543/767 (70.8%) of control assessments, 37/100 (37%) of severity assessments, and 19/66 (29%) of step recommendations. External review classified 72% of control disagreements (21% of all control assessments), 56% of severity disagreements (37% of all severity assessments), and 76% of step disagreements (54% of all step recommendations) as CDSS errors. The remaining disagreements resulted from pulmonologist error or ambiguous guidelines. Many CDSS flaws, such as attributing all 'cough' to asthma, were easily remediable. Pediatric pulmonologists failed to follow guidelines in 8% of return visits and 18% of new visits.Limitations The authors relied on chart notes to determine clinical reasoning. Physicians may have changed their assessments after seeing CDSS recommendations.Conclusions A computerized CDSS performed relatively accurately compared to clinicians for assessment of asthma control but was inaccurate for treatment. Pediatric pulmonologists failed to follow guideline-based care in a small proportion of patients.