J Am Med Inform Assoc - The case for randomized controlled trials to assess the impact of clinical information systems.

Tópicos

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{ ehr(2073) health(1662) electron(1139) }
{ patient(2837) hospit(1953) medic(668) }
{ model(2656) set(1616) predict(1553) }
{ age(1611) year(1155) adult(843) }
{ medic(1828) order(1363) alert(1069) }
{ signal(2180) analysi(812) frequenc(800) }
{ sampl(1606) size(1419) use(1276) }
{ gene(2352) biolog(1181) express(1162) }
{ first(2504) two(1366) second(1323) }
{ activ(1138) subject(705) human(624) }
{ time(1939) patient(1703) rate(768) }
{ patient(1821) servic(1111) care(1106) }
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{ detect(2391) sensit(1101) algorithm(908) }

Resumo

There is a persistent view of a significant minority in the medical informatics community that the randomized controlled trial (RCT) has a limited role to play in evaluating clinical information systems. A common reason voiced by skeptics is that these systems are fundamentally different from drug interventions, so the RCT is irrelevant. There is an urgent need to promote the use of RCTs, given the shift to evidence-based policy and the need to demonstrate cost-effectiveness of these systems. The authors suggest returning to first principles and argue that what is required is clarity about how to match methods to evaluation questions. The authors address common concerns about RCTs, and the extent to which they are fallacious, and also discuss the challenges of conducting RCTs in informatics and alternative study designs when randomized trials are infeasible. While neither a perfect nor universal evaluation method, RCTs form an important part of an evaluator's toolkit.

Resumo Limpo

persist view signific minor medic informat communiti random control trial rct limit role play evalu clinic inform system common reason voic skeptic system fundament differ drug intervent rct irrelev urgent need promot use rcts given shift evidencebas polici need demonstr costeffect system author suggest return first principl argu requir clariti match method evalu question author address common concern rcts extent fallaci also discuss challeng conduct rcts informat altern studi design random trial infeas neither perfect univers evalu method rcts form import part evalu toolkit

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