Evaluation of clinical decision‐aids, with an application to a system for dyspepsia

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Abstract
The evaluation of clinical decision‐aids is discussed both in general and in the particular case of a microcomputer‐based system designed to help general practitioners in deciding whether to refer patients with dyspepsia for specialist care. Parallels are drawn with the established framework for evaluating a new therapy, including a description of four phases of evaluation and the contrast between pragmatic and explanatory trials. Past studies are reviewed, emphasizing the difficulties of establishing a credible control group, and including some relevant examples from the areas of evaluating new diagnostic technology, medical information systems and audit procedures.