EFFECTS OF DECISION SUPPORT SYSTEMS ON CLINICAL REASONIN

说明(改编自摘要)： 自1993年以来，我们一直致力于开发一种实用的评估方法 决策支持系统(DSS)对诊断推理的影响 临床医生是这些系统的最终用户。我们的研究考察了这些影响 四个独立因素：受试者的临床经验水平， 地理位置、指定的临床病例和使用的特定决策支持系统。几个 解决我们最初提案中概述的问题的文件已经 提交或出版；其他正在审查中。随着这项工作的展开， 我们越来越意识到， 研究材料本身和我们研究产生的数据集 研究对象。我们开发了一个包含36个案例的资料库，涵盖了广泛的 内科。在我们的研究中，每个受试者评估了九个案例，首先 在没有直接资助计划咨询的情况下，然后与直接资助计划磋商。在每个阶段，受试者都被问到 列出最多六个诊断假设和最多三个后续步骤 对呈现的患者进行评估。生成的数据库是 最大的集会，以解决医学中的临床推理，包括216 三个地理位置的三个级别的临床医生，他们 总共完成了1994起案件。 我们提议的工作表现为两个目标，这两个目标共同产生了充分的好处 来自已经完成的研究。通过第一个目标，我们建议采用 我们现有的数据集，以探索一系列研究问题 认知心理学和医学信息学的交叉。这些问题 解决基本的心理问题，这在我们的原著中没有解决 研究，这也将有助于临床信息资源的设计。 这些问题包括：数据解释和问题表述方面的错误， 临床医生信心对DSS的判断力、依赖性的影响 会诊效果对临床医生特征、会诊效果和就诊效果的影响 案例特点，以及一系列衡量和方法问题。在……下面 我们提议的工作的第二个目标是，我们将创建并维护我们的36个 临床病例作为其他研究人员可重复使用的、经过校准的资源。

DESCRIPTION (adapted from the Abstract): Since 1993, we have been engaged in developing a practical method to evaluate the impact of Decision Support Systems (DSSs) on the diagnostic reasoning of clinicians as end-users of these systems. Our research examined the effects of four independent factors: level of subject's clinical experience, geographic site, clinical cases assigned, and specific DSS employed. Several papers addressing the questions outlined in our original proposal have been presented or published; others are under review. As this work has unfolded, we have become increasingly aware of the potential broader value of the research materials themselves and the data set generated by our research subjects. We developed a library of 36 cases, covering a broad spectrum of internal medicine. In our study, each subject evaluated nine cases, first without and then with DSS consultation. At each stage the subject was asked to list up to six diagnostic hypotheses and up to three next steps in the evaluation of the patient presented. The resulting database is one of the largest assembled to address clinical reasoning in medicine encompassing 216 clinicians, at three levels of experience across three geographic sites, who in aggregate completed 1994 cases. Our proposed work is expressed as two aims that together derive full benefit from the research already completed. Via the first aim, we propose to employ our existing data set to explore a collection of research questions at the intersection of cognitive psychology and medical informatics. These questions address issues of basic psychological import, not addressed in our original study, that will also inform the design of clinical information resources. These issues include: errors in data interpretation and problem formulation, effects of clinician confidence on judgment, the dependence of DSS consultation effects on clinician characteristics, consultation effects and case characteristics, and a set of measurement and methodology issues. Under the second aim of our proposed work, we will create and maintain our set of 36 clinical cases as a reusable, calibrated resource for other researchers.