A computer consultation program for primary care physicians. Impact of decisionmaking model and explanation capability.

Primary care physicians treat far more individuals with psychologic problems than do psychiatrists or psychologists,' with depression the most common psychiatric problem seen by primary care clinicians.2'3 Several studies have shown that primary care physicians' diagnosis and treatment of psychiatric problems leaves a great deal to be desired.2 4 Weissman et al.,2 for example, judged that 83% of the depressed patients seen by a sample of primary care physicians were treated inappropriately, either receiving no treatment whatsoever or being given inappropriate medications. Diagnostic screening feedback can improve family physicians' recognition of depression,5 but this is not accompanied by a corresponding improvement in treatment selection, and feedback on treatment recommendations

[1]  J. Overall,et al.  Actuarial justification for choice of drug treatment for psychiatric patients. , 1976, Diseases of the nervous system.

[2]  E. Shortliffe,et al.  Explanatory Power for Medical Expert Systems: Studies in the Representation of Causal Relationships for Clinical Consultations , 1982, Methods of Information in Medicine.

[3]  Casimir A. Kulikowski,et al.  A Model-Based Method for Computer-Aided Medical Decision-Making , 1978, Artif. Intell..

[4]  I. D. Goldberg,et al.  The de facto US mental health services system: a public health perspective. , 1978, Archives of general psychiatry.

[5]  C Whitbeck,et al.  Criteria for evaluating a computer aid to clinical reasoning. , 1983, The Journal of medicine and philosophy.

[6]  J. Endicott,et al.  Can the computer assist clinicians in psychiatric diagnosis? , 1974, The American journal of psychiatry.

[7]  C. McDonald.  Protocol-based computer reminders, the quality of care and the non-perfectability of man. , 1976, The New England journal of medicine.

[8]  M. Weissman,et al.  Depression and its treatment in a US urban community-1975-1976. , 1981, Archives of general psychiatry.

[9]  I. Sletten,et al.  Computer assignment of psychotropic drugs. , 1973, The American journal of psychiatry.

[10]  E M McGirr,et al.  Doctors as Decision-makers: A Computer-assisted Study of Diagnosis as a Cognitive Skill , 1971, British medical journal.

[11]  D H Gustafson,et al.  Initial evaluation of a subjective Bayesian diagnostic system. , 1971, Health services research.

[12]  E. Shortliffe,et al.  An analysis of physician attitudes regarding computer-based clinical consultation systems. , 1981, Computers and biomedical research, an international journal.

[13]  P. Cleary,et al.  Estimated Prevalence of RDC Mental Disorder in Primary Medical Care , 1979 .

[14]  Jacob Cohen,et al.  Weighted kappa: Nominal scale agreement provision for scaled disagreement or partial credit. , 1968 .

[15]  J. Fleiss,et al.  Constraints on the validity of computer diagnosis. , 1974, Archives of general psychiatry.

[16]  J. F. Heiser,et al.  Design Considerations For A Clinical Psychopharmacology Advisor , 1978 .

[17]  I. Sletten,et al.  Clinical judgment vs. multivariate formulae in assignment of psychotropic drugs. , 1973, Journal of clinical psychology.

[18]  Edward H. Shortliffe,et al.  Computer-based medical consultations, MYCIN , 1976 .

[19]  Jacob Cohen.  A Coefficient of Agreement for Nominal Scales , 1960 .

[20]  J. Greist,et al.  Computer Consultation for Psychiatric Diagnosis. , 1980 .

[21]  Joel R. Levin,et al.  Type IV errors and interactions. , 1972 .

[22]  L. Linn,et al.  The effect of screening, sensitization, and feedback on notation of depression. , 1980, Journal of medical education.

[23]  B. J. Flehinger,et al.  HEME: a self-improving computer program for diagnosis-oriented analysis of hematologic diseases , 1975 .

[24]  G. Barnett.  The computer and clinical judgement. , 1982, The New England journal of medicine.

[25]  Richard W. Carlson,et al.  Pattern-Based Interactive Diagnosis of Multiple Disorders: The MEDAS System , 1980, IEEE Transactions on Pattern Analysis and Machine Intelligence.

[26]  L. Cronbach.  Coefficient alpha and the internal structure of tests , 1951 .

[27]  Gorry Ga,et al.  Computer-assisted clinical decision-making. , 1973 .

[28]  H. J. Einhorn,et al.  Linear regression and process-tracing models of judgment. , 1979 .

[29]  Jeffrey A. Stem,et al.  A computer-derived protocol to aid in the diagnosis of emergency room patients with acute chest pain. , 1982, The New England journal of medicine.

[30]  E.H. Shortliffe,et al.  Knowledge engineering for medical decision making: A review of computer-based clinical decision aids , 1979, Proceedings of the IEEE.

[31]  J. Overall,et al.  Decisions About Drug Therapy: III. Selection of Treatment for Psychiatric Inpatients , 1973 .

[32]  R. Grimm,et al.  Evaluation of patient-care protocol use by various providers. , 1975, The New England journal of medicine.

[33]  A. Dannenberg,et al.  Enhancement of Clinical Predictive Ability by Computer Consultation) , 1979, Methods of Information in Medicine.

[34]  D. Servan-Schreiber,et al.  Knowledge engineering: a daily activity on a hospital ward. , 1983, Computers and biomedical research, an international journal.

[35]  F. T. de Dombal,et al.  Human and Computer-aided Diagnosis of Abdominal Pain: Further Report with Emphasis on Performance of Clinicians , 1974, British medical journal.

[36]  H L Bleich,et al.  Computer evaluation of acid-base disorders. , 1969, Transactions of the Association of American Physicians.

[37]  S. G. Axline,et al.  Computer-based consultations in clinical therapeutics: explanation and rule acquisition capabilities of the MYCIN system. , 1975, Computers and biomedical research, an international journal.

[38]  I. Sletten,et al.  The relationship of diagnosis and target symptoms to psychotropic drug assignment. , 1974, Comprehensive psychiatry.