Coronary Heart Diseases, Diabetes, Hypercholesterolemia, Hypertension, Vasculitis
Conditions
Brief summary
Aim: To investigate the quality of history taking by physician and computer-based system. Patients: 100 inpatients presenting at the RBK for the first time and treated in the departments of nephrology and cardiology. Methods: The information obtained by the computer based system is compared with the information acquired by conventional history taking. Study endpoint is the comparison of historical data organized according to the elements in a standard medical history on a patient-by-patient basis. Study procedure History taking is performed by physicians according to the guidelines of the RBK. Within 2 days thereafter the patient is interviewed with help of the CLEOS system with the support of a study nurse.
Detailed description
Aim: To compare the completeness of history taking by physicians and by a computerized system interacting directly with the patients. Historical data recorded in the patient record, including the discharge letter, were compared with the history acquired by computer-based interview of each patient. Patients: 100 inpatients presenting at the RBK for the first time and treated in the departments of nephrology and cardiology. Methods: The information obtained by the computer based system is compared with the information acquired by conventional history taking. Study endpoint is the comparison of historical data organized according to the elements in a standard medical history on a patient-by-patient basis. Study procedure After informed consent of the patients the procedure of history taking is performed by the physician according to the guidelines of the RBK. Within 2 days thereafter the patient is interviewed with help of the CLEOS system \[a computer-based, history-taking program\] with the support of a study nurse. The physician will be informed about the results immediately after completion of the questionnaire. Data of medical significance were extracted from the official hospital chart and the computerized history by clinically experienced physicians and tabulated on a patient-by-patient basis. data elements were compared across each category of the history for each patient interviewed. The relevance of the differences of the information obtained by the two systems was rated by an independent reviewer.
Interventions
DEVICEComputer-assisted history
Methods The intervention was use of an expert system to acquire medical histories by direct interview of patients. Description of the software program - The program tested in this study consisted of a data acquisition \[history-taking\] component and a data analysis component. The data acquisition component was constructed on the basis of established principles of pathophysiology. Medical knowledge was formalized as software algorithms that were machine-readable by representing the knowledge as branched chain decision trees.
PROCEDUREphysician taken history
Convential history taking by physicians
OTHERComputer-assisted history taking
Sponsors
Robert Bosch Gesellschaft für Medizinische Forschung mbH (RBMF)
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* All inpatients in a hospital environment
Exclusion criteria
* Inability to give an informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Detection of Medical Problems (by Number of Problems Reported by Computer Assisted History, That Were Not Reported by Physician Taken History) | participants were followed for the duration of hospital stay, an average of 8 days | Data were extracted from hospital charts by to experienced physicians.; data from the computer histories were extracted by a senior physician, who tabulated comparisons between the 2 sets of records. We used the number of problems reported by Computer Assisted History that were not reported by Physician. Nurses at Robert Bosch Krankenhaus do not take medical histories in regard to allergies or adverse drug reactions. Pharmacists make no entries into charts and have no separate records of drug allergies or history of adverse drug reactions. Data on these issues either are obtained only by physician interview of the patient. |
Countries
Germany
Participant flow
Recruitment details
Patients who were interviewed had been admitted emergently. Patient charts were not consulted prior to any interview; and the study nurse, who picked patients randomly for interview, had no knowledge of these patients before an interview and carried on no discussions with floor staff about a patient's clinical state.
Pre-assignment details
Acquisition of clinical data in the history-taking program is based on the principles of pathophysiology formalized as software algorithms representing medical knowledge as branched chain decision trees.
Participants by arm
| Arm | Count |
|---|---|
| Inpatients With the Need for History Taking Every patient, who needs to get a medical history taken | 98 |
| Total | 98 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Withdrawal by Subject | 53 |
Baseline characteristics
| Characteristic | Inpatients With the Need for History Taking |
|---|---|
| Age, Continuous | 58 years STANDARD_DEVIATION 16 |
| Region of Enrollment Germany | 98 participants |
| Sex: Female, Male Female | 41 Participants |
| Sex: Female, Male Male | 57 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 0 / 98 |
| serious Total, serious adverse events | 0 / 98 |
Outcome results
Primary
Detection of Medical Problems (by Number of Problems Reported by Computer Assisted History, That Were Not Reported by Physician Taken History)
Data were extracted from hospital charts by to experienced physicians.; data from the computer histories were extracted by a senior physician, who tabulated comparisons between the 2 sets of records. We used the number of problems reported by Computer Assisted History that were not reported by Physician. Nurses at Robert Bosch Krankenhaus do not take medical histories in regard to allergies or adverse drug reactions. Pharmacists make no entries into charts and have no separate records of drug allergies or history of adverse drug reactions. Data on these issues either are obtained only by physician interview of the patient.
Time frame: participants were followed for the duration of hospital stay, an average of 8 days
Population: The rest did not end the history tool
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Inpatients With the Need for History Taking | Detection of Medical Problems (by Number of Problems Reported by Computer Assisted History, That Were Not Reported by Physician Taken History) | 98 medical problems |