Transforming clinical practice guidelines and clinical pathways into fast-and-frugal decision trees to improve clinical care strategies.

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Clinical Guidelines
Authored By
Djulbegovic B, Hozo I, Dale W
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Internal/Family Medicine
Speciality
Internal/Family Medicine
Book Detail
volume
24
ISSN
1365-2753
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ISSN
1365-2753
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true
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Additional Info
["Djulbegovic B, Hozo I, Dale W","Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 9609066 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1365-2753 (Electronic) Linking ISSN: 13561294 NLM ISO Abbreviation: J Eval Clin Pract Subsets: MEDLINE","Journal Article","2018-10-01","Journal of evaluation in clinical practice [J Eval Clin Pract] 2018 Oct; Vol. 24 (5), pp. 1247-1254. Date of Electronic Publication: 2018 Feb 27.","English","1365-2753","Decision Support Techniques* , Decision Trees* , Quality Improvement*, Critical Pathways\/*standards, Cardiovascular Diseases\/prevention & control ; Evidence-Based Medicine ; Hydroxymethylglutaryl-CoA Reductase Inhibitors\/therapeutic use ; Quality Assurance, Health Care","Cardiovascular Diseases prevention & control, Evidence-Based Medicine, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Quality Assurance, Health Care, Critical Pathways standards, Decision Support Techniques, Decision Trees, Quality Improvement","Journal of evaluation in clinical practice","24"]
Description
Background: Contemporary delivery of health care is inappropriate in many ways, largely due to suboptimal Q5 decision-making. A typical approach to improve practitioners' decision-making is to develop evidence-based clinical practice guidelines (CPG) by guidelines panels, who are instructed to use their judgments to derive practice recommendations. However, mechanisms for the formulation of guideline judgments remains a "black-box" operation-a process with defined inputs and outputs but without sufficient knowledge of its internal workings.<br />Methods: Increased explicitness and transparency in the process can be achieved by implementing CPG as clinical pathways (CPs) (also known as clinical algorithms or flow-charts). However, clinical recommendations thus derived are typically ad hoc and developed by experts in a theory-free environment. As any recommendation can be right (true positive or negative), or wrong (false positive or negative), the lack of theoretical structure precludes the quantitative assessment of the management strategies recommended by CPGs/CPs.<br />Results: To realize the full potential of CPGs/CPs, they need to be placed on more solid theoretical grounds. We believe this potential can be best realized by converting CPGs/CPs within the heuristic theory of decision-making, often implemented as fast-and-frugal (FFT) decision trees. This is possible because FFT heuristic strategy of decision-making can be linked to signal detection theory, evidence accumulation theory, and a threshold model of decision-making, which, in turn, allows quantitative analysis of the accuracy of clinical management strategies.<br />Conclusions: Fast-and-frugal provides a simple and transparent, yet solid and robust, methodological framework connecting decision science to clinical care, a sorely needed missing link between CPGs/CPs and patient outcomes. We therefore advocate that all guidelines panels express their recommendations as CPs, which in turn should be converted into FFTs to guide clinical care.<br /> (© 2018 John Wiley & Sons, Ltd.)
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