PHYSICIAN USE OF DIAGNOSTIC DECISION SUPPORT SYSTEM DATA

描述（摘自申请摘要）：减少健康的努力 医疗费用导致初级保健医生的压力， 明智地使用辅助服务、住院和转诊， 从而增加了对有效诊断决策支持的需求。 现在可被视为初级保健提供者的产科医生/妇科医生 会更强烈地感受到这种压力。 该项目将 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。 我们将 检查（1）使用QMR对诊断准确性的影响，以及（2） QMR培训和QMR使用量对医生诊断的影响 使用QMR的性能和技能。 该项目包括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，研究使用QMR对 诊断准确性。 受试者将被随机分为两组， 接受了使用QMR的培训，并在自己的患者身上使用了四个月 （第1组）。 在此期间，另一组将无法访问QMR 期间（组2）。 使用一组测试用例，我们将估计独立的 诊断准确性，然后将比较诊断准确性， 除了文本之外，医生还使用QMR进行决策支持，或者 仅使用传统的文本信息源。 研究2也是一个 一项随机对照试验，将检查广泛的QMR的影响 与通常的QMR分布方式相比， 组I 第二组将接受广泛的培训， 在头四个月后接受QMR，无需特殊培训， 成为普通的分销商。 我们会比较诊断的准确性， 以及使用频率、使用QMR的技能和 这两组之间的QMR。 在研究3中，我们将研究 在临床环境中使用QMR的频率影响使用QMR的技能 QMR的感知有用性和两组的诊断准确性。

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.