PHYSICIAN USE OF DIAGNOSTIC DECISION SUPPORT SYSTEM DATA

拟议项目的目的是调查 可能会影响医生的诊断性能， 诊断决策支持系统（DDSS）。 这项研究将扩大 主要研究者目前的研究。 一个主要的发现， 目前的研究是，DDSS产生不适当的诊断 建议，由专家委员会判断，即使DDSS也 包括正确的诊断。误导性的建议可能会导致 不利的患者结果以及增加的诊断检查成本。 系统研究可以表明医生用户如何对数据作出反应 从DDSS。 目前的建议是一个计划， research. 具体的目的是：（1）研究质量与环境的关系， DDSS提供的信息，医疗案例的难度， 医生，使用DDSS的诊断性能，医生的临床 经验，医生; DDSS的经验， 医生对DDSS的看法 帮助;和，（2）进一步评估的心理测量特性， 用于测试DDSS的测试用例。 研究设计将是一个全国性的分层调查的医生， 每人将尝试使用DDSS诊断八个医疗病例。 的 样本将由来自美国的120名医生组成，他们目前是用户 的QMR。 将使用当前研究中的共24例病例。 每个 参与者将被发送一组8个案例，其中一半是案例， 正确的诊断不在QMR知识库中。 他们将使用QMR 帮助他们做出鉴别诊断 对于每种情况 参与者将以电子方式记录他们的差异， 评估QMR诊断的相关性， 评估病例难度和QMR的帮助，以及 它们与QMR相互作用的具体性质。 其差分 将使用评分对诊断的准确性和相关性进行评分， 本研究中开发的系统。 两位临床专家 回顾了DDSS在先前研究中的表现，将评估 参与者的鉴别诊断。 将使用多变量分析 检查病例难度、QMR相关性之间的关系 建议，参与者;临床经验/专业知识， 参与者的鉴别诊断，以及参与者对 QMR的病例难度和帮助性。 这项研究将确定 影响医生使用他们从一个 为DDSS的田间试验奠定了基础.

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.