title: Impact of a spirometry expert system on general practitioners' decision making.
abstract: The present study assessed the impact of computerised spirometry interpretation expert support on the diagnostic achievements of general practitioners (GPs), and on GPs' decision making in diagnosing chronic respiratory disease. A cluster-randomised controlled trial was performed in 78 GPs who each completed 10 standardised paper case descriptions. Intervention consisted of support for GPs' spirometry interpretation either by an expert system (expert support group) or by sham information (control group). Agreement of GPs' diagnoses was compared with an expert panel judgement, which served as the primary outcome. Secondary outcomes were: additional diagnostic test rates; width of differential diagnosis; certainty of diagnosis; estimated severity of disease; referral rate; and medication or nonmedication changes. Effects were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). There were no differences between the expert support and control groups in the agreement between GPs and expert panel diagnosis of chronic obstructive pulmonary disease (OR (95% CI) 1.08 (0.70-1.66)), asthma (1.13 (0.70-1.80)), and absence of respiratory disease (1.32 (0.61-2.86)). A higher rate of additional diagnostic tests was observed in the expert support group (2.5 (1.17-5.35)). Computerised spirometry expert support had no detectable benefit on general practitioners' diagnostic achievements and the decision-making process when diagnosing chronic respiratory disease.
authors.affiliation: Dept of General Practice (117), Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. p.j.p.poels@hag.umcn.nl
authors.forename: P J P
authors.initials: PJ
authors.lastname: Poels
authors.forename: T R J
authors.initials: TR
authors.lastname: Schermer
authors.forename: D P A
authors.initials: DP
authors.lastname: Schellekens
authors.forename: R P
authors.initials: RP
authors.lastname: Akkermans
authors.forename: P F
authors.initials: PF
authors.lastname: de Vries Robbé
authors.forename: A
authors.initials: A
authors.lastname: Kaplan
authors.forename: B J A M
authors.initials: BJ
authors.lastname: Bottema
authors.forename: C
authors.initials: C
authors.lastname: van Weel
mesh_terms: D003657:Decision Making; D020000:Decision Support Systems, Clinical; D003936:Diagnosis, Computer-Assisted; D005103:Expert Systems; D005194:Family Practice / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010821:Physicians, Family; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012984:Software; D013147:Spirometry / Q000295:instrumentation / Q000379:methods*