A taxonomy of generic clinical questions: classification study

doi:10.1136/bmj.321.7258.429

BMJ 2000;321:429-432 ( 12 August )

Information in practice

A taxonomy of generic clinical questions: classification study

John W Ely, associate professor, ^a Jerome A Osheroff, director of informatics, ^b Paul N Gorman, assistant professor, ^c Mark H Ebell, associate professor, ^d M Lee Chambliss, assistant clinical professor, ^e Eric A Pifer, assistant professor of medicine, ^f P Zoe Stavri, assistant professor. ^g

^a Department of Family Medicine, 01291-D PFP, University of Iowa College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242-1097, USA, ^b Praxis Press, 36 W 25th Street, 7th Floor, New York, NY 10010, USA, ^c Division of Medical Informatics and Outcomes Research, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97201, USA, ^d Department of Family Practice, Michigan State University, B101 Clinical Center, East Lansing, MI 48824-1315, USA, ^e Moses Cone Family Medicine Residency, 1125 N Church Street, Greensboro, NC 27401, USA, ^f Presbyterian Medical Center, 39th and Market Streets, Medical Arts Building, Suite 102, Philadelphia, PA 19104, USA, ^g School of Information Resources and Library Science, University of Arizona, 1515 East First Street, Tucson, AZ 85719, USA

Correspondence to: J W Ely john-ely{at}uiowa.edu

Objective: To develop a taxonomy of doctors' questionsabout patient care that could be used to help answer suchquestions.
Design: Use of 295 questions asked by Oregon primarycare doctors to modify previously developed taxonomy of 1101 clinicalquestions asked by Iowa familydoctors.
Setting: Primary care practices in Iowa andOregon.
Participants: Random samples of 103 Iowa family doctorsand 49 Oregon primary caredoctors.
Main outcome measures: Consensus among seven investigators on a meaningfultaxonomy of generic questions; interrater reliability among 11individuals who used the taxonomy to classify a random sampleof 100 questions: 50 from Iowa and 50 fromOregon.
Results: The revised taxonomy, which comprised 64 genericquestion types, was used to classify 1396 clinical questions.The three commonest generic types were "What is the drug of choicefor condition x?" (150 questions, 11%); "What is the cause ofsymptom x?" (115 questions, 8%); and "What test is indicated insituation x?" (112 questions, 8%). The mean interrater reliabilityamong 11 coders was moderate ( $kappa$ =0.53, agreement 55%).
Conclusions: Clinical questions in primary care can becategorised into a limited number of generic types. A moderatedegree of interrater reliability was achieved with the taxonomydeveloped in this study. The taxonomy may enhance our understandingof doctors' information needs and improve our ability to meetthoseneeds.

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