Documenting diagnosis in child and adolescent mental healthcare: A content analysis of diagnostic statements in a psychiatric case register
Children and Youth Services Review(2020)
摘要
•Little research explores diagnostic practice in child and adolescent mental healthcare.•This study analyses the contexts in which diagnostic terms appear in clinical notes.•Nearly half of mentions of diagnostic terms involved confirmations of that diagnosis.•A range of strategies were used to qualify and exclude diagnoses.•Results highlight the complex and contingent nature of diagnostic decision making.
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关键词
Diagnosis,Child and adolescent mental healthcare,Electronic health records,Content analysis
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