Care-pathway decision support improves non-specialist vet clinical decision making in dogs with myelopathy
Katie Fox, Lisa Alves, Georgina Harris, Susana Monforte Monteiro, Olivier Restif, An Vanhaesebrouck, Paul FreemanAbstract
Background
Non-specialist vets are often required to make decisions in the absence of specialist knowledge and support. Care pathways (CPs) use knowledge engineering to convert expert knowledge into a computer-interpretable format, delivered to clinicians at the point-of-care via patient-specific clinical decision recommendations.
Hypothesis/Objectives
Non-specialist vets make diagnostic and management decisions that are more consistent with specialists when they have access to CP decision support.
Animals
Clinical information from 8 historical cases of dogs with myelopathy presenting to a university referral hospital with para/tetra-paresis/plegia were used for the study.
Methods
A CP was developed to prioritize differential diagnoses and provide management recommendations for cases of dogs with myelopathy resulting in para/tetra-paresis/plegia. A crossover study was then performed comparing answers 45 non-specialist vets and 17 final-year vet students gave to case-based questions for 8 clinical cases, with and without the use of the CP. Each participant answered half the questions without any decision support (CP−) and half the questions with CP decision support (CP+), with the question order randomized each time. Participant answers were then scored against a pre-agreed expert consensus, represented by the full score of 100 points.
Results
Mean scores were improved by 40.4 points (95% CI [36.4, 44.4]), P < .05) for differential diagnosis listing and prioritization and 7.1 points (95% CI [2.3, 11.6]), P < .05) for management decisions when using the CP.
Conclusions and clinical importance
CP clinical decision support could be a useful adjunctive tool for non-specialist vets, particularly in supporting their ability to produce prioritized differential diagnoses.