J Am Med Inform Assoc - Formative evaluation of the accuracy of a clinical decision support system for cervical cancer screening.

Tópicos

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Resumo

JECTIVES: We previously developed and reported on a prototype clinical decision support system (CDSS) for cervical cancer screening. However, the system is complex as it is based on multiple guidelines and free-text processing. Therefore, the system is susceptible to failures. This report describes a formative evaluation of the system, which is a necessary step to ensure deployment readiness of the system.MATERIALS AND METHODS: Care providers who are potential end-users of the CDSS were invited to provide their recommendations for a random set of patients that represented diverse decision scenarios. The recommendations of the care providers and those generated by the CDSS were compared. Mismatched recommendations were reviewed by two independent experts.RESULTS: A total of 25 users participated in this study and provided recommendations for 175 cases. The CDSS had an accuracy of 87% and 12 types of CDSS errors were identified, which were mainly due to deficiencies in the system's guideline rules. When the deficiencies were rectified, the CDSS generated optimal recommendations for all failure cases, except one with incomplete documentation.DISCUSSION AND CONCLUSIONS: The crowd-sourcing approach for construction of the reference set, coupled with the expert review of mismatched recommendations, facilitated an effective evaluation and enhancement of the system, by identifying decision scenarios that were missed by the system's developers. The described methodology will be useful for other researchers who seek rapidly to evaluate and enhance the deployment readiness of complex decision support systems.

Resumo Limpo

jectiv previous develop report prototyp clinic decis support system cdss cervic cancer screen howev system complex base multipl guidelin freetext process therefor system suscept failur report describ format evalu system necessari step ensur deploy readi systemmateri method care provid potenti endus cdss invit provid recommend random set patient repres divers decis scenario recommend care provid generat cdss compar mismatch recommend review two independ expertsresult total user particip studi provid recommend case cdss accuraci type cdss error identifi main due defici system guidelin rule defici rectifi cdss generat optim recommend failur case except one incomplet documentationdiscuss conclus crowdsourc approach construct refer set coupl expert review mismatch recommend facilit effect evalu enhanc system identifi decis scenario miss system develop describ methodolog will use research seek rapid evalu enhanc deploy readi complex decis support system

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