2015年7月11日土曜日

オンライン・アプリの診断の正確性

オンライン徴候チェッカーという名の自己診断  


iPhoneのApple app storeや AndroidなどのGoogle Playで「Symptom checker"や"medical diagnosis"と検索されたアプリの検証

Evaluation of symptom checkers for self diagnosis and triage: audit study
BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h3480 (Published 08 July 2015)

45の標準化された患者ビグネットをコンパイルし、緊急性トリアージのカテゴリー3区分としたもので、例えば肺塞栓のような緊急ケア必要なもの、中耳炎のような非緊急性なもの、ウィルス性上気道感染のような自己管理可能なものに分ける。

診断を提供する徴候チェッカーによる主要アウトカムが初期20の候補診断を正確に当てられるか?本来の意味から言えば正確に緊急状態を篩い分けられるか?


Evaluation of symptom checkers for self diagnosis and triage: audit study
BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h3480 (Published 08 July 2015)


23の徴候チェッカーは、標準化患者評価の正診率 34%(95%信頼区間 31%〜37%)、トップ20に限れば58%(55%〜62%)、適正なトリアージ助言比率としては57% (52%〜61%)

状況によりトリアージパフォーマンスばらつき
緊急事態では、助言適正比率 80%(95%信頼区間、 75%〜86%)
非緊急性では、55% (47%〜63%)
自己管理疾患では、 33% (28%〜40%)
P<0 .001="" p="">

23の個別徴候チェッカー横断的には、適切なトリアージ助言パフォーマンスは 33% (95% 信頼区間19% to 48%) 〜78%(64% to 91%)の範囲




Symptom checker
Description
Maximum No of diagnoses*
Triage options provided
AskMD (USA)
Online health and wellness platform from Sharecare (www.sharecare.com/askmd/get-started)
15
Not available
BetterMedicine (USA)
Health resource from HealthGrades; symptom checker provides possible diagnoses and information about these conditions (www.bettermedicine.com/symptom-checker/)
46
Not available
DocResponse (USA)
Symptom checker started by a group of certified physicians; user can choose from internal medicine, dermatology, and orthopedic views (www.docresponse.com/)
5
Not available
Doctor Diagnose (USA)
App offered on Google Play; provides potential diagnoses and triage advice in some cases
3
Seek immediate care; call your doctor now; speak with your doctor; home care
Drugs.com (USA)
Online resource for drug and related health information; uses content from Harvard Health Publications (www.drugs.com/symptom-checker/)
10
Emergency department; primary care doctor; home care
EarlyDoc (Netherlands)
For triage criteria, uses Dutch College of General Practitioners (NHG) TriageWijzer and the Australian Triage Scale (used in Australia and New Zealand to assess urgency) (www.earlydoc.com/en/)
3
Don’t wait, and call a doctor now; call a doctor preferably today; see your doctor preferably on a weekday; your complaints don’t seem urgent
Esagil (USA)
Provides list of likely diagnoses (based on number of entered symptoms that are congruent with diagnosis); user can also enter blood and urine lab results along with symptoms (http://esagil.org/)
65
Not available
Family Doctor (USA)
Displays flow chart to track symptoms to diagnosis and triage option; created by American Academy of Physicians (http://familydoctor.org/familydoctor/en/health-tools/search-by-symptom.html)
7
Emergency room; see your doctor; home care
FreeMD (USA)
Takes user through a series of questions in a “check-up” to finish with “what might be wrong with you” and “where to go for care”; owned by DSHI Systems, which provides triage decision support solutions from emergency medicine physicians to the US government (Department of Veteran Affairs) and private sector companies; program called TriageXpert (www.freemd.com/)
3
Emergency department; urgent care; doctor’s office; doctor e-visit; retail clinic; dentist; home care
Harvard Medical School Family Health Guide (USA)
From Harvard Health Publications; available both online and in print.† (www.health.harvard.edu/fhg/symptoms/symptoms.shtml)
4
Emergency department; general practice; home care
Healthline (USA)
Health and wellness website that licenses content to employers, health providers, and health plans (www.healthline.com/symptom-checker)
76
Not available
Healthwise (USA)
Non-profit provider for health content and patient education; symptom checker licensed to other organizations; we accessed using Province of Alberta’s website (https://myhealth.alberta.ca/health/pages/symptom-checker.aspx)
Not available
Call 911 now; seek care now; seek care today; try home care
Healthy Children (USA)
From American Academy of Pediatrics; use’s Barton D Schmitt’s “Pediatric HouseCalls Symptom Checker” triage protocol (www.healthychildren.org/English/tips-tools/symptom-checker)
Not available
Call 911 now; call your doctor now (night or day); call your doctor within 24 hours; call your doctor during weekday office hours; parent care at home
Isabel (UK)
10
Walk-in care; family doctor; emergency services
iTriage (USA)
Owned by Aetna; provides clinical sites in user’s region with addresses and phone numbers (www.itriagehealth.com/avatar)
5
Emergency department, urgent care, retail clinic, family practice, internal medicine, specialties, prescription medication, over the counter medication
Mayo Clinic (USA)
20
Not available
MEDoctor (USA)
Free differential diagnosis system (www.medoctor.com/)
3
Not available
NHS Symptom Checkers (UK)
Available through England’s National Health Services (NHS) Choices website (www.nhs.uk/symptomcheckers/pages/symptoms.aspx)
Not available
Emergency department; general practitioner; home care
Steps2Care (USA)
iPhone and Android app; provides symptom care guides from Barton D Schmitt’s pediatric telephone triage guidelines and David A Thompson’s adult telephone triage guidelines
Not available
Call 911 now; go to emergency room now; call doctor now or go to emergency room; call doctor within 24 hours; call doctor during office hours; self care at home
Symcat (USA)
Triage tool uses data linking specific patient symptoms and physician diagnoses across visits seen in the National Ambulatory Medical Care Survey (NAMCS) (www.symcat.com/)
6
Primary care; retail clinic; emergency room; urgent care
Symptify (USA)
Online self assessment tool and other health services, including, for example, emergency contact list, consultation list (https://symptify.com/)
9
Emergency room; urgent care; home care; inconclusive
Symptomate (Poland)
Uses bayesian network methodology and medical database for diagnoses (https://symptomate.com/)
5
Emergency room; specialist; general practitioner
WebMD (USA)
Medical reference and healthcare resource website (http://symptoms.webmd.com)
99
Not available

0 件のコメント:

コメントを投稿

noteへ実験的移行

禁煙はお早めに! 米国における人種・民族・性別による喫煙・禁煙での死亡率相違|Makisey|note 日常生活内の小さな身体活動の積み重ねが健康ベネフィットをもたらす:VILPA|Makisey|note