期刊文章%@ 2291- 9694% I JMIR出版物%V 8% N卡塔尔世界杯8强波胆分析 1% P e16912% T临床决策支持系统与BMJ最佳实践辅助诊断集成的准确性和效果:间断时间序列研究%陶a，张丽媛，陈a，朱林A，李胜荣，李楠，张伟，赵华A，詹一鸣，纪思燕，红+北京大学第三医院临床流行病学研究中心，北京市海淀区学院路38号，86 1082265732，siyan-zhan@bjmu.edu.cn %K BMJ最佳实践%K人工智能%K临床决策支持系统%K辅助诊断%K准确性和效果%D 2020 %7 20.1.2020 %9原始论文%J JMIR Med Inform %G英文%X背景:临床决策支持系统(CDSS)是健康信息技术的一个组成部分，可以协助疾病的解释、诊断、治疗和预后。然而，CDSS在临床中的应用仍然存在争议。目的:评估CDSS与英国医学杂志(BMJ)最佳实践辅助诊断集成在现实研究中的效果。方法:这是一项回顾性、纵向观察性研究，使用常规从电子病历中收集的临床诊断数据。先后抽取2016年12月至2019年2月6个临床科室住院患者病历34113份。CDSS的诊断准确性在实施前得到了验证。然后应用自我对照比较来检测CDSS实施的效果。采用多变量logistic回归和单组间断时间序列分析探讨CDSS的影响。 The sensitivity analysis was conducted using the subgroup data from January 2018 to February 2019. Results: The total accuracy rates of the recommended diagnosis from CDSS were 75.46% in the first-rank diagnosis, 83.94% in the top-2 diagnosis, and 87.53% in the top-3 diagnosis in the data before CDSS implementation. Higher consistency was observed between admission and discharge diagnoses, shorter confirmed diagnosis times, and shorter hospitalization days after the CDSS implementation (all P<.001). Multivariable logistic regression analysis showed that the consistency rates after CDSS implementation (OR 1.078, 95% CI 1.015-1.144) and the proportion of hospitalization time 7 days or less (OR 1.688, 95% CI 1.592-1.789) both increased. The interrupted time series analysis showed that the consistency rates significantly increased by 6.722% (95% CI 2.433%-11.012%, P=.002) after CDSS implementation. The proportion of hospitalization time 7 days or less significantly increased by 7.837% (95% CI 1.798%-13.876%, P=.01). Similar results were obtained in the subgroup analysis. Conclusions: The CDSS integrated with BMJ Best Practice improved the accuracy of clinicians’ diagnoses. Shorter confirmed diagnosis times and hospitalization days were also found to be associated with CDSS implementation in retrospective real-world studies. These findings highlight the utility of artificial intelligence-based CDSS to improve diagnosis efficiency, but these results require confirmation in future randomized controlled trials. %M 31958069 %R 10.2196/16912 %U http://medinform.www.mybigtv.com/2020/1/e16912/ %U https://doi.org/10.2196/16912 %U http://www.ncbi.nlm.nih.gov/pubmed/31958069