PHYSICIAN USE OF DIAGNOSTIC DECISION SUPPORT SYSTEM DATA

拟议项目的目的是调查以下因素 可能会影响医生的诊断性能 诊断决策支持系统(DDSS)。这项研究将延长 首席调查员目前的研究。一项重大发现 目前的研究是，DDSS产生了不适当的诊断 由专家委员会判断的建议，即使在发展和社会保障制度也 包括正确的诊断。这些误导性的建议可能导致 不利的患者结果以及增加的诊断检查成本。 系统的研究可以指出医生用户对数据的反应 从DDSS来的。本提案是进行这项工作的一个计划 研究。 具体目标是：(1)考察质量之间的关系 由DDSS提供的信息，医疗案件的难度， 医生，使用DDSS的诊断性能，医生的临床 经验，医生；使用DDSS的经验，交互类型 医生对DDSS的态度，以及医生对DDSS的看法 以及，(2)进一步评估员工的心理测量学特性 用于测试DDSS的测试用例。 这项研究设计将是一项全国性的分层调查，调查对象是 每个人都将尝试使用DDSS来诊断八个医疗病例。这个 样本将包括120名来自美国的医生，他们现在是使用者 QMR。本研究共收集了24个病例。每个人 参赛者将收到一套8个案例，其中一半是 正确诊断不在QMR知识文库中。他们将使用QMR 以协助他们作出鉴别诊断。对于每一种情况 参与者将电子记录他们的差额、他们的 对QMR产生的诊断的相关性进行评估，其 QMR的案例难度和帮助评估，以及 他们与QMR互动的具体性质。他们的差异化 将使用评分为诊断的准确性和相关性评分 在本研究中开发的系统。两位临床专家 在前一项研究中审查的DDSS性能将评估 受试者的鉴别诊断。将使用多变量分析 考察案例难度、QMR的相关性之间的关系 建议，参与者；临床经验/专业知识， 参与者的不同诊断，以及参与者对 QMR的案例难度和帮助。这项研究将确定 影响医生使用数据的因素，这些数据来自于 并可为使用DDSS的实地试验奠定基础。

The purpose of the proposed project is to investigate the factors that might influence the diagnostic performance of physicians who use diagnostic decision support systems (DDSS). This study will extend the Principal Investigator's current research. A major finding of the current study was that the DDSS produced inappropriate diagnostic suggestion, as judged by an expert committee, even when the DDSS also included the correct diagnosis. The misleading suggestions could lead to adverse patient outcomes as well as increased cost of diagnostic work-up. Systematic research can indicate how physician users respond to the data from the DDSS. The present proposal is a plan for conducting such research. The specific aims ar to (1) examine the relationships among the quality of information provided by a DDSS, the difficulty of a medical case, physicians, diagnostic performance using a DDSS,physician's clinical experience, physicians; experience with the DDSS, type of interaction the physician has with the DDSS, and physicians's perceptions of DDSS helpfulness; and, (2) to further evaluate the psychometric properties of the test cases used for testing the DDSS. The study design will be a nationwide stratified survey of physicians who will each attempt to diagnose eight medical cases using a DDSS. The sample will consist of 120 physicians from the U.S. who are current users of QMR. A total of 24 cases from the current study will be used. Each participant will be sent a set 8 cases, half of which are cases where the correct diagnosis in not in the QMR knowledge base. They will use QMR to assist them in arriving at a differential diagnosis. For each case the participants will electronically record their differential, their assessments of the relevance of the diagnoses produced by QMR, their assessments of case difficulty and helpfulness of QMR, as well as the specific nature of their interaction with QMR. Their differential diagnoses will be scored for accuracy and relevance using the scoring systems developed in the present study. Two clinical experts who reviewed the DDSS performance in the previous study will evaluate the participants' differential diagnoses. Multivariate analyses will be used to examine the relationship among case difficulty, relevance of the QMR suggestions, the participants; clinical experience/expertise, participants differential diagnoses, and the participants perceptions of case difficulty and helpfulness of QMR. This research will identify the factors which influence physicians' use of the data they obtain from a DDSS and can lay the groundwork for field trials of the use of DDSS.