PHYSICIAN USE OF DIAGNOSTIC DECISION SUPPORT SYSTEM DATA

说明(摘自申请摘要)：减少健康的努力 医疗费用给初级保健医生带来了压力，要求他们 明智地使用辅助服务、住院和转介， 从而增加了对有效诊断决策支持的需求。 现在可以被认为是初级保健提供者的产科/妇科医生 可能会更加强烈地感受到这种压力。这个项目将 检查使用QMR诊断决策支持系统的影响， 初级保健产科医生/妇科医生的诊断技能。我们会 检查(1)使用QMR对诊断准确性的影响和(2) QMR培训和QMR使用量对医生诊断能力的影响 使用QMR的表现和技巧。 该项目包含三项高度相互关联的调查研究。 研究I是一项随机对照试验，研究了QMR对患者的影响 诊断准确率。受试者将被随机分成两组，一组 接受了使用QMR的培训，并对自己的患者使用了四个月 (第1组)。在此期间，另一组将无法访问QMR 期间(第2组)。使用一组测试用例，我们将估计没有辅助的 诊断准确率，然后将比较 医生在决策支持文本之外使用QMR或 仅使用传统的文本信息源。研究2也是一项 一项随机对照试验，将检验广泛QMR的效果 培训与通常的QMR分发方式进行了比较。第I组 如上所述将接受广泛的培训，第二组将 在前四个月后接受QMR，无需特殊培训，将 成为通常的分发组。我们将比较诊断的准确性， 以及使用频率、使用QMR的技巧和感知的有用性 这两组之间的QMR。在第三项研究中，我们会研究 QMR在临床环境中的使用频率影响使用QMR的技能 感知QMR的有用性，以及两组中的诊断准确性。

DESCRIPTION (Taken from application abstract): Efforts at reducing health care costs have led to pressure on primary care physicians to be more judicious in the use of ancillary services, hospitalization, and referrals, thus increasing the need for effective diagnostic decision support. Obstetrician/gynecologists who now can be considered primary care providers are likely to feel this pressure even more intensely. This project will examine the impact of using QMR a diagnostic decision support system, on primary care obstetrician/ gynecologists' diagnostic skills. We will examine (1) the effect of using QMR on diagnostic accuracy and (2) the effects of QMR training and amount of QMR use on physicians' diagnostic performance and skill in using QMR. The project contains three highly interconnected investigational studies. Study I is a randomized controlled trial of the effect Of Using QMR on diagnostic accuracy. Subjects will be randomized into two groups, one that is trained on using QMR and uses it with their own patients for four months (Group 1). The other group will not have access to QMR during that time period (Group 2). Using a set of test cases, we will estimate the unaided diagnostic accuracy and will then compare the diagnostic accuracy of physicians using either QMR in addition to texts for decision support or using only traditional text sources of information. Study 2 is also a randomized controlled trial that will examine the effects of extensive QMR training compared with the usual way that QMR is distributed. Group I described above will receive extensive training and Group 2, who will receive QMR after the first four months and without special training, will be the usual distribution group. We will compare the diagnostic accuracy, as well as frequency of use, skill in using QMR and perceived usefulness of QMR between these two groups. In Study 3 we will examine whether the frequency of use of QMR in the clinical setting affects skill in using QMR perceived usefulness of QMR, and diagnostic accuracy in both groups.