Influence of case and physician characteristics on perceptions of decision support systems.
Influence of case and physician characteristics on perceptions of decision support systems.
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病例和医生特征对决策支持系统认知的影响。
DOI：
10.1136/jamia.1999.0060428
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发表时间：
1999
期刊：
影响因子：
--
通讯作者：
Maisiak,RS
中科院分区：
文献类型：
--
作者：
Berner,ES;Maisiak,RS
目的：本研究探讨如何特点的临床病例和医生用户涉及到用户的看法的有用性的快速医疗参考（QMR）和他们的信心，在他们的诊断时，支持决策支持system.Methods：一个国家的样本（N= 108）的67内科医生，35个家庭医生，和6个其他美国医生使用QMR，以协助诊断书面临床病例。使用了三组8例病例，根据诊断难度和QMR产生高质量信息的潜力进行分层。采用2 × 2重复测量方差分析检验这些因素是否与QMR的感知有用性和使用QMR后医生的诊断信心相关。相关性之间的医生的特点，评级QMR有用，和医生的信心，在自己的诊断，有用性或信心和实际的诊断performance.Results：分析表明，QMR被认为是更有用的（P< 0.05），在困难的情况下，QMR可以提供高质量的信息，由非董事会认证的医生，当诊断信心较低。当使用某些QMR功能的舒适度较高时，诊断信心较高。有用性或诊断信心的评级不一致与诊断performance.Conclusions：结果表明，用户的诊断信心和QMR有用性的看法可能与他们的决策支持的需要比他们的实际诊断性能时，使用该系统。如果只测试简单的病例，如果正确的诊断不在系统的知识库中，或者只有训练有素的医生使用该系统，评估者可能无法找到有用的诊断决策支持系统。
Objective:This study examines how characteristics of clinical cases and physician users relate to the users' perceptions of the usefulness of the Quick Medical Reference (QMR) and their confidence in their diagnoses when supported by the decision support system.Methods:A national sample (N= 108) of 67 internists, 35 family physicians, and 6 other U.S. physicians used QMR to assist in the diagnosis of written clinical cases. Three sets of eight cases stratified by diagnostic difficulty and the potential of QMR to produce high-quality information were used. A 2 × 2 repeated-measures analysis of variance was used to test whether these factors were associated with perceived usefulness of QMR and physicians' diagnostic confidence after using QMR. Correlations were computed among physician characteristics, ratings of QMR usefulness, and physicians' confidence in their own diagnoses, and between usefulness or confidence and actual diagnostic performance.Results:The analyses showed that QMR was perceived to be significantly more useful (P< 0.05) on difficult cases, on cases where QMR could provide high-quality information, by non-board-certified physicians, and when diagnostic confidence was lower. Diagnostic confidence was higher when comfort with using certain QMR functions was higher. The ratings of usefulness or diagnostic confidence were not consistently correlated with diagnostic performance.Conclusions:The results suggest that users' diagnostic confidence and perceptions of QMR usefulness may be associated more with their need for decision support than with their actual diagnostic performance when using the system. Evaluators may fail to find a diagnostic decision support system useful if only easy cases are tested, if correct diagnoses are not in the system's knowledge base, or when only highly trained physicians use the system.