CITE: Clinical Inference Tethered to Evidence - a Retrieve-and-verify Layer for AI Care Plans (CITE)
2026年7月16日 更新者：Sanjay Basu、Waymark
A Randomized Controlled Trial of CITE (Clinical Inference Tethered to Evidence), an Evidence-Grounding Retrieve-and-Verify Layer That Flags Unsupported and Inappropriate Recommendations in AI-Generated Care Plans, Versus AI With Safety Guardrails Alone and Unassisted Care, in Medicaid Primary Care
This trial evaluates CITE, a retrieve-and-verify layer that audits an AI-generated care plan against a full-text evidence corpus and flags patient-specific codifiable safety hazards to the clinician.
The co-primary outcomes are how accurately CITE flags these hazards (sensitivity and specificity versus blinded clinician adjudication) and its clinician alert burden and acceptance, compared with AI care plans using safety guardrails alone and with unassisted clinician care, in Medicaid primary care.
研究概览
地位
尚未招聘
详细说明
Patients are randomized 1:1:1 to (1) unassisted clinician care; (2) AI-generated care plan with safety guardrails; (3) AI-generated care plan with safety guardrails plus CITE.
CITE audits the finalized plan against a frozen, versioned evidence corpus and returns physician-facing flags for patient-specific codifiable safety hazards (a recommended drug contraindicated by this patient's diagnosis or laboratory value; a drug-allergy conflict; a dropped high-risk medication; a guideline-indicated therapy omitted for an active diagnosis; a stated quantity refuted by the corpus), each with a verbatim quote and citation; the clinician retains decision authority.
Randomization uses a deterministic HMAC permuted-block scheme; outcome assessors are blinded to arm.
The co-primary outcomes are (1) the diagnostic accuracy (sensitivity and specificity) of CITE against blinded clinician adjudication, and (2) clinician alert burden (flags per encounter) and acceptance, comparing the CITE arm with the guardrail arm; both are estimable at the enrolled sample size because they do not depend on a rare between-arm event.
The unresolved codifiable-hazard rate by arm is reported as a descriptive secondary: codifiable hazards are infrequent, so the trial is not powered for a between-arm efficacy contrast on hazard reduction.
A prior trial of a different mechanism (a generic deterministic rule-corpus that surfaced roughly 30 or more flags per encounter and was uninformative) was completed with null results and is registered separately; this trial evaluates a materially different, patient-specific intervention and set of outcomes.
Determined exempt by WCG IRB (low risk).
Analysis is pre-registered on OSF (https://doi.org/10.17605/OSF.IO/ENXCW).
研究类型
介入性
注册 (估计的)
240
阶段
- 不适用
参与标准
研究人员寻找符合特定描述的人，称为资格标准。这些标准的一些例子是一个人的一般健康状况或先前的治疗。
资格标准
适合学习的年龄
- 成人
- 年长者
接受健康志愿者
不
描述
INCLUSION CRITERIA:
- Age 18 years or older.
- Medicaid-enrolled and attributed to a participating Waymark primary care site.
- Primary care encounter that requires clinical reasoning (not administrative-only).
- English-language clinical documentation.
EXCLUSION CRITERIA:
- Age less than 18 years.
- Hospice or palliative-care-exclusive care plan.
- Administrative-only or pharmacy-only encounter that does not surface a clinical decision to the supervising clinician.
- Encounter where the supervising clinician is the principal investigator.
- Enrollment in a competing AI-safety study within the prior 90 days.
学习计划
本节提供研究计划的详细信息，包括研究的设计方式和研究的衡量标准。
研究是如何设计的？
设计细节
- 主要用途：卫生服务研究
- 分配：随机化
- 介入模型：并行分配
- 屏蔽：单身的
武器和干预
参与者组/臂 |
干预/治疗 |
|---|---|
|
无干预：Arm 1: Unassisted care
Clinician develops the care plan without AI assistance.
|
|
|
有源比较器：Arm 2: AI with safety guardrails
AI-generated care plan produced with a safety-guardrail system prompt; no CITE.
|
AI-generated care plan produced under a safety-guardrail system prompt.
|
|
实验性的：Arm 3: AI with safety guardrails plus CITE
AI-generated care plan with safety guardrails, then passed through CITE, which flags unsupported/inappropriate recommendations with evidence citations for the clinician.
|
AI-generated care plan produced under a safety-guardrail system prompt.
Reads the AI care-plan text and verifies each recommendation/claim against a full-text evidence corpus; returns physician-facing flags (commission/confabulation/unsupported/omission) with verbatim quotes and citations.
Clinician retains decision authority.
|
研究衡量的是什么？
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Diagnostic accuracy of CITE against clinician adjudication
大体时间：Day 1 (index primary care encounter)
|
Sensitivity and specificity (with positive and negative predictive values) of the CITE checker for clinically consequential codifiable safety hazards, using blinded clinician adjudication of the plan as the reference standard.
Every plan contributes, so the estimate does not depend on a rare between-arm event.
Exact-binomial 95% confidence intervals; reported overall and by hazard family.
|
Day 1 (index primary care encounter)
|
|
Clinician alert burden (flags surfaced per encounter)
大体时间：Day 1 (index primary care encounter)
|
Number of safety flags surfaced to the clinician per encounter in the CITE arm versus the guardrail arm, with clinician acceptance rate.
Co-primary usability outcome: a verifier that surfaces an unmanageable number of flags is not deployable regardless of sensitivity (the prior-trial mechanism surfaced a median of about 30 per encounter).
Pre-registered acceptability ceiling: median CITE flags per encounter at or below three.
|
Day 1 (index primary care encounter)
|
次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Clinician action on CITE flags
大体时间：Day 1 (index primary care encounter)
|
Proportion of CITE flags accepted vs overridden by the clinician, by flag type (commission, confabulation, unsupported, omission).
|
Day 1 (index primary care encounter)
|
|
Unresolved codifiable safety-hazard rate by arm (descriptive)
大体时间：Day 1 (index primary care encounter)
|
Proportion of patient-specific codifiable-hazard checkpoints with an unresolved hazard in the finalized plan, by arm, with the Arm 3 minus Arm 2 difference and 95% confidence interval.
Pre-specified as descriptive and hypothesis-generating: codifiable hazards are infrequent, so the trial is not powered for a between-arm efficacy contrast on this measure at the enrolled sample size.
|
Day 1 (index primary care encounter)
|
|
Correction of codifiable hazards within 30 days
大体时间：Up to 30 days after the index encounter
|
Among checkpoints with a hazard in the finalized plan, the proportion acted on and corrected within 30 days (documented resolution, completed referral, or corrected order).
Proximal clinical effectiveness measure.
|
Up to 30 days after the index encounter
|
|
Completed referrals within 30 days
大体时间：Up to 30 days after the index encounter
|
Proportion of initiated referrals completed within 30 days.
|
Up to 30 days after the index encounter
|
|
Clinical safety composite (exploratory)
大体时间：Day 1 (index primary care encounter)
|
Four-component clinical safety composite carried from the prior trial.
Pre-specified as exploratory; underpowered at the planned sample size.
|
Day 1 (index primary care encounter)
|
|
30-day acute care utilization (exploratory)
大体时间：Up to 30 days after the index encounter
|
Emergency department visits and hospitalizations within 30 days.
Exploratory.
|
Up to 30 days after the index encounter
|
合作者和调查者
在这里您可以找到参与这项研究的人员和组织。
研究记录日期
这些日期跟踪向 ClinicalTrials.gov 提交研究记录和摘要结果的进度。研究记录和报告的结果由国家医学图书馆 (NLM) 审查，以确保它们在发布到公共网站之前符合特定的质量控制标准。
研究主要日期
学习开始 (估计的)
2026年9月1日
初级完成 (估计的)
2027年6月1日
研究完成 (估计的)
2027年9月1日
研究注册日期
首次提交
2026年7月13日
首先提交符合 QC 标准的
2026年7月16日
首次发布 (实际的)
2026年7月22日
研究记录更新
最后更新发布 (实际的)
2026年7月22日
上次提交的符合 QC 标准的更新
2026年7月16日
最后验证
2026年7月1日
更多信息
与本研究相关的术语
其他研究编号
- CITE-2026-02
药物和器械信息、研究文件
研究美国 FDA 监管的药品
不
研究美国 FDA 监管的设备产品
不
在美国制造并从美国出口的产品
不
此信息直接从 clinicaltrials.gov 网站检索，没有任何更改。如果您有任何更改、删除或更新研究详细信息的请求，请联系 register@clinicaltrials.gov. clinicaltrials.gov 上实施更改，我们的网站上也会自动更新.