Differential Diagnosis Assessment in Ambulatory Care with a Digital Health History Device: Pseudo-randomized Study (Preprint)

Abstract

Digital health history devices (DHHDs) represent a promising wave of digital tools with the potential to enhance the quality and efficiency of medical consultations. They achieve this by providing physicians with standardized, high-quality patient history summaries and facilitating the development of differential diagnoses (DD) prior to consultation and make the patient feel involved in this process.

This study focuses on evaluating the efficacy of one such DHHD, 'DIANNA,' in compiling appropriate lists of DDs within the outpatient setting.

A pseudo-randomized controlled trial involved 101 patients seeking care at the University Hospital Geneva emergency outpatient department, presenting a range of conditions affecting the limbs, back, and chest. The initial 51 patients were assigned to the control group, while the subsequent 50 formed the intervention group. In the control group, physicians were tasked with establishing an extensive DD list based on traditional history-taking and clinical examination. Conversely, in the intervention group, physicians had the advantage of reviewing the DIANNA report, which included suggested DDs, before interacting with the patient. In both groups, a senior physician independently reviewed the patient and formulated a DD list, serving as the 'gold standard' for comparison.

The study findings showcased a notable improvement in DD accuracy when DIANNA was employed (mean 79.3%, SD 24%), as compared to the control group (mean 70.5%, SD 33%; P=.014). Subgroup analysis further elucidated this enhancement, with an 8% difference in favor of the intervention group for low complexity cases (1-2 possible DDs; P=.08). This advantage expanded to 17% for intermediate complexity cases (3 possible DDs; P=.03), while high complexity cases (4-5 possible DDs) saw a 15% increase (P=.92). DIANNA was found to effectively determine appropriate DDs in 81.6% of cases, and physicians recognized its assistance in establishing the correct DD in 26% of instances.

The study conclusively affirms the effectiveness of DIANNA in supporting physicians to formulate more precise DDs. This underscores the potential of DHHDs like DIANNA to enhance clinical decision-making and improve the accuracy of patient diagnoses in the medical field.

This trial was registered on clinical trials (NCT03901495).