Characteristics of knowledge content in a curated online evidence library.

Autor:	Varada S; Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA., Lacson R; Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA., Raja AS; Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA.; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA., Ip IK; Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA., Schneider L; Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA., Osterbur D; Harvard Medical School, Boston, MA, USA.; Countway Library of Medicine, Boston, MA, USA., Bain P; Harvard Medical School, Boston, MA, USA.; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA., Vetrano N; Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA., Cellini J; Harvard Medical School, Boston, MA, USA.; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA., Mita C; Harvard Medical School, Boston, MA, USA.; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA., Coletti M; Agoos Medical Library/Knowledge Services, Beth Israel Deaconess Medical Center, Boston, MA, USA., Whelan J; Agoos Medical Library/Knowledge Services, Beth Israel Deaconess Medical Center, Boston, MA, USA., Khorasani R; Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA.
Jazyk:	angličtina
Zdroj:	Journal of the American Medical Informatics Association : JAMIA [J Am Med Inform Assoc] 2018 May 01; Vol. 25 (5), pp. 507-514.
DOI:	10.1093/jamia/ocx092
Abstrakt:	Objective: To describe types of recommendations represented in a curated online evidence library, report on the quality of evidence-based recommendations pertaining to diagnostic imaging exams, and assess underlying knowledge representation. Materials and Methods: The evidence library is populated with clinical decision rules, professional society guidelines, and locally developed best practice guidelines. Individual recommendations were graded based on a standard methodology and compared using chi-square test. Strength of evidence ranged from grade 1 (systematic review) through grade 5 (recommendations based on expert opinion). Finally, variations in the underlying representation of these recommendations were identified. Results: The library contains 546 individual imaging-related recommendations. Only 15% (16/106) of recommendations from clinical decision rules were grade 5 vs 83% (526/636) from professional society practice guidelines and local best practice guidelines that cited grade 5 studies (P < .0001). Minor head trauma, pulmonary embolism, and appendicitis were topic areas supported by the highest quality of evidence. Three main variations in underlying representations of recommendations were "single-decision," "branching," and "score-based." Discussion: Most recommendations were grade 5, largely because studies to test and validate many recommendations were absent. Recommendation types vary in amount and complexity and, accordingly, the structure and syntax of statements they generate. However, they can be represented in single-decision, branching, and score-based representations. Conclusion: In a curated evidence library with graded imaging-based recommendations, evidence quality varied widely, with decision rules providing the highest-quality recommendations. The library may be helpful in highlighting evidence gaps, comparing recommendations from varied sources on similar clinical topics, and prioritizing imaging recommendations to inform clinical decision support implementation.
Databáze:	MEDLINE
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