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Purpose: To determine whether presenting pediatricians with the false positive rate of screening test affects their 1) estimate of disease probability, and 2) subsequent patient evaluation.
Methods: We sent a mailed survey to 1502 pediatricians practicing in the United States who were randomly selected from the AMA master list. Subjects were sent a four-page questionnaire, with up to four mailings sent to non-responders. The questionnaire presented a clinical case of a healthy 5-year old boy with persistent micro-hematuria detected by screening urinalysis. We randomized subjects to one of three decision support groups (control, technical or non-technical decision support). Controls received no additional information. The technical decision support group was presented the false positive rate of persistent micro-hematuria in detecting significant renal disease (96%). The non-technical decision support group was presented a non-technical explanation of this false positive rate. Subjects were asked to 1) chose the patient’s probability of serious renal disease, 2) refer the patient to nephrology or not, and 3) check his serum BUN and Cr, or not. We conducted chi-square to test the effect of decision support on these three outcomes.
Results: 653 subjects returned completed surveys: 208 in the control, 231 in the technical and 214 in the non-technical decision support groups. The estimated response rate was 52%. 81% of participants were board certified in pediatrics, 56% were female, and their mean age was 43 years. The only significant difference between the randomization groups was by gender. Subjects who received non-technical decision support were much more likely than controls to choose the correct disease likelihood (51% vs. 11%, p<0.001), while those who received technical decision support were not (16% vs. 11%, p = 0.10). Subjects who received non-technical decision support were more likely to refer the boy to nephrology (30% vs. 19%, p=0.01) and check his BUN and Cr (88% vs. 78%, p=0.01), but those who received technical decision support were not (22% vs. 19%, p=0.36; 75% vs. 78%, p=0.48, respectively). None of these findings were significantly altered after controlling for gender.
Conclusions: Presenting non-technical decision support about the false positive rate of screening urinalysis improved pediatricians’ estimations of disease probability and affected patient management, while technical decision support did not.
See more of Poster Session - Clinical Strategies; Judgment and Decison Making
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)