Development and validation of software for Internet and PC SCID administration

描述(申请人提供)：在精神病学中，可能比在任何其他医学领域中，诊断更依赖于临床判断，因为很少有特定精神疾病的生理标记。结构化访谈方法，如DSM-IV-TR的结构化临床访谈(SCID)，比在临床环境中占主导地位的非结构化患者访谈类型产生更准确和可靠的诊断判断。然而，对于大多数临床医生来说，SCID仍然是一个没有吸引力的选择，部分原因是它是一种冗长而复杂的纸和铅笔工具，需要广泛的培训才能学习正确地使用它。此外，纸张SCID的复制和存储既昂贵又繁琐。计算机辅助的SCID管理可以缓解SCID的管理难度，以及其高昂的每次管理成本。因此，拟议项目的目标是开发一个计算机辅助版本的SCID(“Net SCID”)，使SCID更容易和更便宜地使用，从而促进这一黄金标准诊断工具的更广泛采用。在项目的第一阶段，我们使用存档和模拟的SCID数据开发了一个数据库驱动的、基于互联网的功能原型，该原型自动化了基于纸质的SCID的复杂分支和诊断逻辑。在第二阶段，我们将1)为网络SCID开发商业质量的用户界面和诊断报告工具；2)将纸质和Net SCID与现场患者的回应进行并列比较，以确定Net SCID用于现场访谈的可用性，并确保Net SCID对现场反应的诊断结果与现有纸质SCID相同；3)比较Net SCID和纸质SCID在访谈持续时间、管理简便性和用户满意度方面的表现。此外，我们将实施和测试SCID的计算机辅助版本(包括临床医生版本)，并对Net SCID进行多项改进，以增强其商业可行性，例如提供在线帮助功能，并能够存储符合HIPAA标准的项目响应和诊断数据库，以用于统计分析。公共卫生相关性： DSM-IV-TR(SCID)的结构化临床访谈是一种冗长而复杂的纸和铅笔工具，比在临床环境中占主导地位的非结构化患者访谈产生更准确和可靠的精神诊断。然而，对于大多数临床医生来说，SCID仍然是一个没有吸引力的选择，部分原因是学习正确使用它所需的广泛培训，以及因为它的复制和存储既昂贵又繁琐。因此，拟议项目的目标是开发基于互联网的SCID的计算机辅助版本(Net SCID)，通过使SCID更容易和更便宜地使用，促进这一黄金标准诊断工具的更广泛采用。

DESCRIPTION (provided by applicant): In psychiatry, perhaps more than in any other field of medicine, diagnosis depends on clinical judgment, as there exist few physiological markers of specific psychiatric illnesses. Structured interview methods, such as the Structured Clinical Interview for DSM-IV-TR (SCID), yield more accurate and reliable diagnostic judgments than do the type of unstructured patient interviews that predominate in clinical settings. The SCID, however, remains an unattractive option to most clinicians, in part because it is a lengthy and complex paper-and-pencil instrument that requires extensive training to learn to administer it correctly. Additionally, the paper SCID is costly and cumbersome to reproduce and store. Computer-assisted SCID administration can alleviate both the difficulty of administering the SCID, as well as its high cost per administration. The objective of the proposed project, therefore, is to develop a computer-assisted version of the SCID ("Net SCID") that will facilitate more widespread adoption of this gold-standard diagnostic instrument by making the SCID easier and less expensive to use. During Phase I of the project, we used archival and simulated SCID data to develop a database-driven, Internet-based functioning prototype that automates the complex branching and diagnostic logic of the paper-based SCID. In Phase II, we will 1) develop a commercial-quality user interface and diagnostic reporting tool for the Net SCID; 2) conduct side-by-side comparisons of the paper and Net SCIDs with live patient responses to establish the usability of the Net SCID for live interviewing, and assure that the Net SCID produces the same diagnoses in response to live responses as does the existing paper SCID; and 3) compare the performance of the Net SCID to that of the paper SCID with respect to interview duration, ease of administration, and user satisfaction. In addition, we will implement and test computer-assisted versions of variations of the SCID (including the Clinician Version) and make several improvements to the Net SCID that will enhance its commercial viability, such as providing an online help feature and the ability to store HIPAA- compliant databases of item responses and diagnoses for statistical analysis. PUBLIC HEALTH RELEVANCE: The Structured Clinical Interview for DSM-IV-TR (SCID), a lengthy and complex paper-and-pencil instrument, yields more accurate and reliable psychiatric diagnoses than do the type of unstructured patient interviews that predominate in clinical settings. The SCID, however, remains an unattractive option to most clinicians, in part because of the extensive training necessary to learn to administer it correctly, and because it is costly and cumbersome to reproduce and store. The objective of the proposed project, therefore, is to develop an Internet-based computer-assisted version of the SCID (Net SCID) that will facilitate more widespread adoption of this gold-standard diagnostic instrument by making the SCID easier and less expensive to use.