# Taking a closer look: Can an app improve diagnostic accuracy in urgent care? Cluster-randomized interventional trial DASI

## TL;DR

A study tested if a medical history app improves diagnosis accuracy in urgent care but found no significant benefit.

## Contribution

The study is the first to evaluate a medical history app's impact on diagnostic accuracy in urgent care through a cluster-randomized trial.

## Key findings

- The app did not significantly improve diagnostic accuracy compared to the control group.
- Physician variability had a greater impact on outcomes than the app's use.
- Self-reported severe conditions increased the likelihood of further treatment.

## Abstract

In urgent care settings, efficient medical history-taking is paramount for making timely and accurate treatment decisions. Medical history-taking apps have emerged as a means to streamline this process but their effectiveness in enhancing diagnostic accuracy remains unclear. We aimed to investigate whether using a medical history-taking app before consultation improves diagnostic accuracy. In two German out-of-hours practices (OOHP), patients were recruited over a 12-months period. Within each practice, weeks were randomized to either an intervention or control group, resulting in a cluster-randomized trial (CRT) with clustering in weeks within the same practice. Patients in the intervention group used an app to report their complaints before their consultation, enabling physicians to review their medical history details beforehand. In contrast, patients in the control group used the app after their consultation, and no summary of their medical history was available to the physician. Diagnostic accuracy was defined as the agreement between the OOHP physician’s diagnoses and those determined by an expert committee (EC) after reviewing patient files. As a secondary outcome, we compared OOHP and EC physicians’ treatment recommendations against patients’ self-reported actual treatment (e.g., specialist care, hospital admissions) from a follow-up survey. We analyzed data from 986 patients and found no significant intervention effect on diagnostic accuracy (Odds Ratio 0.94 (95%CI 0.73 – 1.21), 57.6% in intervention vs 59.1% in control group). Additionally, the app had no significant effect on the prediction of further treatment. The only significant factors affecting these outcomes were the number of diagnoses (positively associated with diagnostic accuracy) and a self-reported severe condition (associated with higher likelihood of requiring further treatment). Individual differences between physicians were more pronounced than those between the intervention and control group for the secondary outcome. The study’s findings suggest that this medical history-taking app does not enhance diagnostic accuracy in urgent care settings.

Medical history-taking apps allow patients to report their symptoms and related information before seeing a doctor, which can help doctors make more informed decisions. However, it remains unclear whether these apps enhance the accuracy of diagnoses. To investigate this, we compared the accuracy of diagnoses made with and without the use of a medical history-taking app in a setting where timely and accurate diagnoses are particularly crucial. The study took place in two out-of-hour practices, characterized by limited time and diagnostic capacities, and with changing staff with different medical specialties. In most encounters, physicians and patients met for the first time, making it a challenging environment for diagnosis. Our assumption was that the app could be particularly valuable in this setting, as it could provide physicians with essential information before the consultation. However, our findings suggest that the app did not improve the accuracy of diagnoses. This study contributes to our understanding of the potential benefits and limitations of medical history-taking apps. Although our app did not enhance diagnostic accuracy, it may still be useful in other ways, such as helping patients prepare for their appointments, providing doctors with additional information to consider or reducing th documentation burden. Further research could explore these potential benefits of medical history apps to improve patient care in urgent care settings.