A Comparative analysis of two computerized methods for patient history collection.

The goal of this thesis is to compare a decision-driven data acquisition questionnaire (DDA) and a hierarchical branching questionnaire to see which format can obtain a history more effectively. Both questionnaires start with a few broad questions relevant to presenting the patient's region of illness. The DDA questionnaire then selects questions to ask the patient depending on the likelihood of the patient having a specific disease state. The hierarchical branching questionnaire uses a branching pattern whereby positive responses lead to more detailed questions on those topics. The histories were given to the patients. After collecting the patient histories, the following features were examined: the number of questions each history asked, the amount of time each history took, the accuracy of the history, and the patient reaction to using a computerized history. The best report format possible was designed for the physician's report. The physician's reaction to the history was requested. This process took place within the Help (Health Evaluation through Logical Processing) computer system at LDS Hospital. The patient histories were collected from July of 1985 through July of 1986. Forty-one patients participated in the computer-directed history study. Twenty-one of the patients used the hierarchical questionnaire and 20 patients took the DDA history. Three incomplete histories had to be excluded. Fourteen patients returned the paper questionnaire with their opinion of taking a computerized history. Three physician comments were received. In examining the number of questions each history asked and the amount of time each took, it was found there was a significant difference between the DDA and hierarchical methods. The DDA took a mean time of 12 minutes and asked an average of 91 questions, while it only asked on average 56 NO response questions per patient. The hierarchical method took a mean time of 22 minutes, asked of 181 questions, and asked an average of 145 NO response questions per patient. The reduction in the number of questions asked to the patient taking the DDA history is due to fewer number of NO response questions being asked (89 ± 15). For 42% of the patients who took the history, there was not a help frame to For the 22 discharge diagnosis where there was a frame available, the program was correct 11 times or 50% (45% with the hierarchical). There was no significant difference in having the discharge diagnosis on the diagnostic list between DDA and branching methods. The Chief Complaint area obtained with the patient history programs agreed with the discharge diagnosis chief complaint 87% of the time with the DDA program and 61% if the time with the hierarchical method. This shows although the history only had the patient's discharge diagnosis on its diagnostic list 50% of the time, it was able to identify the area of the patient's major problem to focus its questioning. In summary, the goal of obtaining a computerized history for a patient chart was achieved. It has been shown the DDA process took significantly less time and asked fewer questions than the hierarchical method, while marinating the same level of accuracy. The patient response to the computerized history was favorable.