Evidence map›Paper›PMID 33260212›Full record

Trial reportJournal of the American Medical Informatics Association : JAMIA2021

Impact of digitally acquired peer diagnostic input on diagnostic confidence in outpatient cases: A pragmatic randomized trial.

Elaine C Khoong, Valy Fontil, Natalie A Rivadeneira, Mekhala Hoskote, Shantanu Nundy, Courtney R Lyles, Urmimala Sarkar

Abstract readPragmatic Clinical TrialRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of the American Medical Informatics Association : JAMIA, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Experimental evidence for structured information-sharing networks reducing medical errors.Proceedings of the National Academy of Sciences of the United States of America · 2023
    Article
  2. [Digital diagnostic support in rheumatology].Zeitschrift fur Rheumatologie · 2021
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Elaine C KhoongDivision of General Internal Medicine, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
Valy FontilDivision of General Internal Medicine, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
Natalie A RivadeneiraDivision of General Internal Medicine, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
Mekhala HoskoteBerkeley School of Public Health and UCSF School of Medicine, University of California, Berkeley-University of California, San Francisco Joint Medical Program, Berkeley, California, USA.
Shantanu NundyMilken Institute School of Public Health, Department of Health Policy and Management, George Washington University, Washington, DC, USA.
Courtney R LylesDivision of General Internal Medicine, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
Urmimala SarkarDivision of General Internal Medicine, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.

Funding

Institutional Career Development Core SupplementKL2TR001870 · NCATS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI KANAYA, ALKA M., SARKAR, URMIMALA · 2016 to 2025
$19.7M
UCSF Career Development Program in Implementation Research in Heart and Lung DiseasesK12HL138046 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI BIBBINS-DOMINGO, KIRSTEN, CATTAMANCHI, ADITHYA · 2017 to 2021
$2.9M
Bring it Down San Francisco: Harnessing cloud-based technology to improve hypertension management in a low-income underserved populationK23HL136899 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI FONTIL, VALY · 2018 to 2022
$887k
Improving Survivorship Care for Diverse Cancer Patients Cared for in Safety-net SettingsK24CA212294 · NCI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI SARKAR, URMIMALA · 2017 to 2021
$831k
NCATS NIH HHS KL2 TR001870NCI NIH HHS K24 CA212294NHLBI NIH HHS K12 HL138046NHLBI NIH HHS K23 HL136899
6 · The paper itself

Abstract

objectiveThe study sought to evaluate if peer input on outpatient cases impacted diagnostic confidence. MATERIALS AND

methodsThis 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.

resultsAmong 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).

conclusionsPeer input increased diagnostic confidence primarily in high-uncertainty cases, consistent with findings that clinicians desire input primarily in cases with continued uncertainty.

Indexed as

Ambulatory CareDiagnosis, Computer-AssistedPeer ReviewAdultAgedFemaleHumansMaleMiddle AgedNurse PractitionersOdds RatioPhysiciansclinical decision makingcomputer-assisted medical decision makingdiagnostic confidenceinformation technologypeer reviewpragmatic clinical trial

Identifiers

PMID33260212
PMCPMC7936511

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.