| Comparison of computer-aided and human review of general practitioners' management of hypertension. | |
| | |
MedLine Citation:
|
PMID: 1683929 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
Computer programs that automatically review decisions can help physicians provide better patient care. In the Netherlands, the ELIAS computer information system has replaced paper medical records in some general practices. We have written a computer program called 'HyperCritic' that audits general practitioners' management of patients with essential hypertension by taking patient-specific data from the ELIAS system. We investigated whether the computer-based medical records contain sufficient information to generate critiques, and compared the limitations of audit by hypercritic with those of review by a panel of eight physicians. Hypercritic and the physicians independently reviewed the medical records of 20 randomly selected patients with hypertension and commented on the decisions made at each of 243 patient visits. Of 468 comments on patient management, 260 were judged correct by six or more of the physicians; hypercritic also made 118 of these 260 comments. The main reasons why the program did not produce the other 142 comments were: insufficient data in the computer-based medical record; absence of sufficient medical consensus; and omissions in the database of hypercritic. Calculation of an "index of merit" ([sensitivity + specificity] - 1) for individual reviewers showed that hypercritic performed better (index of merit 0.62) in its limited domain than did physician reviewers (0.3-0.56). At least in hypertension management, automated review of computer-based medical records compares favourably with review by physicians. Further development of computer-aided clinical audit requires the introduction of computer-based medical records that capture the reasoning of physicians, and of widely accepted practice guidelines. |
| | |
Authors:
|
J van der Lei; M A Musen; E van der Does; A J Man in 't Veld; J H van Bemmel |
Related Documents
:
|
8358499 - Inferential knowledge acquisition. 7705069 - Mid-term report on the arden syntax in a clinical event monitor. 14664019 - The effect of a general lexicon in corpus-based identification of french-english medica... 17091849 - Numerical field intensity factor calculations for 1-3 piezocomposite structures. 16779029 - Identifying umls concepts from ecg impressions using knowledgemap. 1800599 - An assessment of the radiological module of neonate as an aid in interpreting chest x-r... 17941409 - Task scales performed and testing for scale differences among phlebotomy technicians, m... 11940989 - Electroconvulsive therapy in the medically ill elderly. 2335799 - Metabolics and biologicals in the workplace. |
Publication Detail:
|
Type: Clinical Trial; Comparative Study; Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
|
Title: Lancet Volume: 338 ISSN: 0140-6736 ISO Abbreviation: Lancet Publication Date: 1991 Dec |
Date Detail:
|
Created Date: 1992-01-15 Completed Date: 1992-01-15 Revised Date: 2007-11-14 |
Medline Journal Info:
|
Nlm Unique ID: 2985213R Medline TA: Lancet Country: ENGLAND |
Other Details:
|
Languages: eng Pagination: 1504-8 Citation Subset: AIM; IM |
Affiliation:
|
Department of Medical Informatics, Erasmus University, Rotterdam, Netherlands. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Aged Aged, 80 and over Antihypertensive Agents / therapeutic use Decision Making, Computer-Assisted* Family Practice / standards* Female Humans Hypertension / drug therapy* Male Medical Audit / methods* Middle Aged Netherlands Peer Review* Sampling Studies Sensitivity and Specificity Software Design |
| Grant Support | |
ID/Acronym/Agency:
|
LM05157/LM/NLM NIH HHS |
| Chemical | |
Reg. No./Substance:
|
0/Antihypertensive Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Evidence for related myopathies in exertional heat stroke and malignant hyperthermia.
Next Document: Achlorhydria and gastric carcinogenesis.