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首页> 外文期刊>The European journal of general practice. >Reducing diagnostic errors in primary care. A systematic meta-review of computerized diagnostic decision support systems by the LINNEAUS collaboration on patient safety in primary care
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Reducing diagnostic errors in primary care. A systematic meta-review of computerized diagnostic decision support systems by the LINNEAUS collaboration on patient safety in primary care

机译：减少初级保健中的诊断错误。 LINNEAUS关于初级保健患者安全的协作对计算机诊断决策支持系统进行了系统的元审查

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Background: Computerized diagnostic decision support systems (CDDSS) have the potential to support the cognitive task of diagnosis, which is one of the areas where general practitioners have greatest difficulty and which accounts for a significant proportion of adverse events recorded in the primary care setting.Objective: To determine the extent to which CDDSS may meet the requirements of supporting the cognitive task of diagnosis, and the currently perceived barriers that prevent the integration of CDDSS with electronic health record (EHR) systems.Methods: We conducted a meta-review of existing systematic reviews published in English, searching MEDLINE, Embase, PsycINFO and Web of Knowledge for articles on the features and effectiveness of CDDSS for medical diagnosis published since 2004. Eligibility criteria included systematic reviews where individual clinicians were primary end users. Outcomes we were interested in were the effectiveness and identification of specific features of CDDSS on diagnostic performance.Results: We identified 1970 studies and excluded 1938 because they did not fit our inclusion criteria. A total of 45 articles were identified and 12 were found suitable for meta-review. Extraction of high-level requirements identified that a more standardized computable approach is needed to knowledge representation, one that can be readily updated as new knowledge is gained. In addition, a deep integration with the EHR is needed in order to trigger at appropriate points in cognitive workflow.Conclusion: Developing a CDDSS that is able to utilize dynamic vocabulary tools to quickly capture and code relevant diagnostic findings, and coupling these with individualized diagnostic suggestions based on the best-available evidence has the potential to improve diagnostic accuracy, but requires evaluation.
机译：背景：计算机诊断决策支持系统（CDDSS）有潜力支持诊断的认知任务，这是全科医生最困难的领域之一，占初级保健机构中记录的不良事件的很大比例。目的：确定CDDSS在多大程度上可以满足支持诊断的认知任务的要求，以及目前认为阻碍CDDSS与电子健康记录（EHR）系统集成的障碍。现有的以英语发表的系统评价，搜索MEDLINE，Embase，PsycINFO和Web of Knowledge，以查找自2004年以来发表的有关CDDSS用于医学诊断的功能和有效性的文章。资格标准包括系统评价，其中个别临床医生是主要的最终用户。我们感兴趣的结果是CDDSS对诊断性能的有效性和鉴定。结果：我们鉴定了1970项研究，并排除了1938项研究，因为它们不符合我们的纳入标准。总共确定了45篇文章，其中12篇适合进行元审查。提取高层次的需求表明，需要一种更加标准化的可计算方法来表示知识，随着获取新知识可以很容易地对其进行更新。此外，还需要与EHR进行深度集成，以便在认知工作流中的适当位置触发。结论：开发能够利用动态词汇工具快速捕获和编码相关诊断结果并将其与个性化诊断结合的CDDSS基于最佳证据的建议可能会提高诊断准确性，但需要进行评估。

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