Abstract:
The wide variation in utilization of diagnostic resources has not been decreased by
the proliferation of new diagnostic technologies. We wish to test the hypothesis that
the introduction of a medical decision support system into clinical practice could
potentially lead to more efficient use of diagnostic information, and therefore lead
to a reduction in overall laboratory use and cost of care. We have devised and are
currently implementing a randomized controlled trial of a computer based decision
support system, the University of Pittsburgh version of Quick Medical Reference (QMR).The
main purpose of the study is to determine the effect of the QMR program on specific
outcome measures: length of hospital stay, number and types of diagnostic tests ordered,
and overall charges. An important part of this evaluation is relating the initial
level of diagnostic uncertainty expressed by the admitting housestaff team to utilization
of diagnostic resources. The purpose of this paper is to describe the methodology
for carrying out this controlled trial, and to describe our initial experiences with
its implementation.
Key-Words
Computer-Assisted Diagnosis - Differential Diagnosis - Randomized Controlled Trial
- Medical Care Evaluation - Outcomes Process and Assessment