Elaine C Khoong1,2, Valy Fontil1,2, Natalie A Rivadeneira1,2, Mekhala Hoskote3, Shantanu Nundy4,5, Courtney R Lyles1,2, Urmimala Sarkar1,2. 1. Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, San Francisco, California, USA. 2. Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA. 3. Berkeley School of Public Health and UCSF School of Medicine, University of California, Berkeley-University of California, San Francisco Joint Medical Program, Berkeley, California, USA. 4. Milken Institute School of Public Health, Department of Health Policy and Management, George Washington University, Washington, DC, USA. 5. Accolade, Inc. Plymouth Meeting, Pennsylvania, USA.
Abstract
OBJECTIVE: The study sought to evaluate if peer input on outpatient cases impacted diagnostic confidence. MATERIALS AND METHODS: This randomized trial of a peer input intervention occurred among 28 clinicians with case-level randomization. Encounters with diagnostic uncertainty were entered onto a digital platform to collect input from ≥5 clinicians. The primary outcome was diagnostic confidence. We used mixed-effects logistic regression analyses to assess for intervention impact on diagnostic confidence. RESULTS: Among the 509 cases (255 control; 254 intervention), the intervention did not impact confidence (odds ratio [OR], 1.46; 95% confidence interval [CI], 0.999-2.12), but after adjusting for clinician and case traits, the intervention was associated with higher confidence (OR, 1.53; 95% CI, 1.01-2.32). The intervention impact was greater in cases with high uncertainty (OR, 3.23; 95% CI, 1.09- 9.52). CONCLUSIONS: Peer input increased diagnostic confidence primarily in high-uncertainty cases, consistent with findings that clinicians desire input primarily in cases with continued uncertainty.
RCT Entities:
OBJECTIVE: The study sought to evaluate if peer input on outpatient cases impacted diagnostic confidence. MATERIALS AND METHODS: This randomized trial of a peer input intervention occurred among 28 clinicians with case-level randomization. Encounters with diagnostic uncertainty were entered onto a digital platform to collect input from ≥5 clinicians. The primary outcome was diagnostic confidence. We used mixed-effects logistic regression analyses to assess for intervention impact on diagnostic confidence. RESULTS: Among the 509 cases (255 control; 254 intervention), the intervention did not impact confidence (odds ratio [OR], 1.46; 95% confidence interval [CI], 0.999-2.12), but after adjusting for clinician and case traits, the intervention was associated with higher confidence (OR, 1.53; 95% CI, 1.01-2.32). The intervention impact was greater in cases with high uncertainty (OR, 3.23; 95% CI, 1.09- 9.52). CONCLUSIONS: Peer input increased diagnostic confidence primarily in high-uncertainty cases, consistent with findings that clinicians desire input primarily in cases with continued uncertainty.
Authors: Jerome A Osheroff; Jonathan M Teich; Blackford Middleton; Elaine B Steen; Adam Wright; Don E Detmer Journal: J Am Med Inform Assoc Date: 2007-01-09 Impact factor: 4.497
Authors: Olga Kostopoulou; Andrea Rosen; Thomas Round; Ellen Wright; Abdel Douiri; Brendan Delaney Journal: Br J Gen Pract Date: 2015-01 Impact factor: 5.386
Authors: Valy Fontil; Kate Radcliffe; Helena C Lyson; Neda Ratanawongsa; Courtney Lyles; Delphine Tuot; Kaeli Yuen; Urmimala Sarkar Journal: JAMIA Open Date: 2019-02-01