Enhancement of clinicians' diagnostic reasoning by computer-based consultation: a multisite study of 2 systems

• HIT Description: Computerized decision support. More info...
  
• Purpose of Study: Evaluate the extent to which consultations with computer-based diagnostic decision support systems (DSSs) improve clinicians' diagnostic hypotheses in a set of diagnostically challenging cases.
  
• Years of study: 1995-1998
  
• Study Design: RCT
  
• Outcomes: Impact on health care effectivness/quality
  

• Settings: Two hundred-sixteen physicians (including internal medicine faculty members, senior residents, and fourth-year medical students) participated in this study conducted at three academic medical centers, none of which were involved in the development of the DSSs.
• Intervention: The use of the DSS in the diagnostic evaluation of cases by physicians was compared to not using the DDS for evaluation of cases.
• Evaluation Method: Measures of diagnostic accuracy.
• Description:  The two decision support systems (DSSs) used were the ILIAD (version 4.2) and the Quick Medical Reference (QMR; version 3.7.1). None of academic medical centers that participated in the study were involved in the development of the DSSs.
• Quality of Care and Patient Safety Outcome: Correct diagnoses appeared in subjects' hypothesis lists for 39.5% of cases prior to consultation and 45.4% of cases after consultation. Subjects' mean diagnostic quality scores increased from 5.7 (95% confidence interval [CI], 5.5-5.9) to 6.1 (95% CI, 5.9-6.3) (effect size: Cohen d = 0.32; 95% CI, 0.23-0.41; P.001). Larger increases (P = .048) were observed for students than for residents and faculty. Effect size varied significantly (P.02) by DSS (Cohen d = 0.20; 95% CI, 0.08-0.32 for ILIAD vs. Cohen d = 0.45; 95% CI, 0.31-0.59 for QMR).