TY - JOUR T1 - Does a decision aid help physicians to detect chronic obstructive pulmonary disease? JF - British Journal of General Practice JO - Br J Gen Pract SP - e674 LP - e679 DO - 10.3399/bjgp11X601398 VL - 61 IS - 591 AU - Berna DL Broekhuizen AU - Alfred Sachs AU - Kristel Janssen AU - Geert-Jan Geersing AU - Karel Moons AU - Arno Hoes AU - Theo Verheij Y1 - 2011/10/01 UR - http://bjgp.org/content/61/591/e674.abstract N2 - Background Numerous decision aids have been developed recently, but the value they add above that of the initial clinical assessment is not well known.Aim To quantify whethera formal decision aid for chronic obstructive pulmonary disease (COPD) adds diagnostic information, above the physician's clinical assessment.Design and setting Subanalysis of a diagnostic study in Dutch primary care.Method Sixty-five primary care physicians included 357 patients who attended for persistent cough and were not known to have COPD. The physicians estimated the probability of COPD after short history taking and physical examination. After this, the presence or absence of COPD was determined using results of extensive diagnostic work-up. The extent to which an 8-item decision aid for COPD, which included only symptoms and signs, added diagnostic value above the physician's estimation was quantified by the increase of the area under the receiver operating characteristic curve (ROC area), and the improvement in diagnostic risk classification across two classes: ‘low probability of COPD’ (<20%) and ‘possible COPD’ (≥20%).Results One hundred and four patients (29%) had COPD. Adding the decision aid to the clinical assessment increased the ROC area from 0.75 (95% confidence interval [CI] = 0.70 to 0.81) to 0.84 (95% CI = 0.80 to 0.89) (P<0.005), and improved the diagnostic risk classification of the patients, such that 35 fewer patients needed spirometry testing and eight fewer COPD cases were missed.Conclusion A short decision aid for COPD added diagnostic value to the physician's clinical assessment. ER -