Journal of veterinary internal medicine · 2026
Care-pathway decision support improves non-specialist vet clinical decision making in dogs with myelopathy.
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Fox Katie, Alves Lisa, Harris Georgina, Monforte Monteiro Susana, Restif Olivier, Vanhaesebrouck An, Freeman Paul
Аннотация
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.
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.