Roerdink, E.M. (2013) Development of a clinical decision support system for diagnosis and management of allergy patients in primary care. thesis, Medicine.
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Abstract
Aim: To support General Practioners (GPs) in diagnosis and management of allergy patients, the University Medical Center Groningen (UMCG), in collaboration with Labnoord, developed a clinical decisison support system for allergy patients. The aim of this study was to develop a classification of allergic diseases, as well as a list with allergy medication. Also, to develop a diagnostic decision tool, answers on the diagnostic questionnaire and IgE-results should be matched to an allergic diagnosis. Finally, the aim was to determine the agreement between a golden standard and a diagnosis made by the diagnostic decision tool. Methods: The diagnostic questionnaire was tested for patients visiting the clinic of the (pediatric) allergology and dermatology departments of the UMCG. The questionnaire was checked for missing or redundant questions. A classification of allergic diseases was formulated, based on NHG (“Nederlands Huisartsen Genootschap”) clinical practice guidelines and expert opinion. Using the “Pharmacotherapeutic Compass” (“Farmacotherapeutisch Kompas”) the allergy medication was classified. An allergy specialist matched the answers on the questionnaire to allergic diagnoses, which together with the IgE-results resulted in a diagnostic tool with decision rules. Two allergy specialists and two dermatology specialists made a diagnosis (the golden standard) using information available in “Poliplus”. Two researchers made a diagnosis using the decision tool. Agreement between the golden standard and the diagnosis based on the decision tool was calculated by defining the true-positive and false-negative diagnoses. The inter-rater reliability between the two allergy specialists, the two dermatology specialists, and the two researchers was calculated using Cohen’s kappa. Results: The allergic diseases were classified and the decision tool with decision rules was constructed. A list with indicated and contra-indicated allergy medication was formulated. In 69.2% of the cases there was agreement between the golden standard and the diagnosis based on the decision tool. Three questions on the questionnaire were redundant and one question was missing. There was moderate agreement found between the allergy specialists and moderate agreement between the dermatologists. Only regarding treatment of eczema of the body, poor agreement was found. Between the two researchers very good agreement was found. Conclusion: The agreement between the golden standard and the diagnostic tool IDEAL was fairly good and the inter-rater reliability was varying. The questionnaire and the decision tool have to be adjusted based on the findings of this pre-testing. Next, the questionnaire has to be validated and the IDEAl system has to be tested in a pilot study for effectiveness.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Dubois, Prof. dr. A.E.J. and Flokstra- de Blok, Dr. B.M.J. and Brakel, Drs. T.M. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:01 |
| Last Modified: | 25 Jun 2020 11:01 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2125 |
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