Clinical Decision-Making Tools Flashcards

1
Q

Novice clinicians:

A

Black and white

Prone to CDM errors due to:
> Limited knowledge
> Limited recall

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2
Q

Expert clinicians:

A

Gray.”it depends”

Purposeful management of information:
> Broad and structured knowledge
> If/then production rules
> Pattern recognition
> Working diagnosis

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3
Q

Directive factors of clinical decision making:

A

> Information from medical record

> Protocols

> Observation of patients movement behavior and problem solving

> Observation of patients psych-emotional and cognitive perceptual abilities

> Reflection in action

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4
Q

Informative factors of clinical decision making:

A

> Academic content and faculty mentorship

> Anticipated patient performance

> Personal experiences

> Reflection-on-specific action

> Reflection-on-professional experience

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5
Q

Informative & Directive factors of clinical decision making:

A

> Mentorship

> Information from the literature

> Continuing education

> Clinical experience

> Critical thinking

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6
Q

Enablement/Disablement Models:

A

Explain the complex interrelationships between health, disability and function

> Nagi Model
ICF

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7
Q

Patient/Client Management Model:

A

> Framework for the process of our patient care

> Guide to PT Practice

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8
Q

HOAC II:

A

Informs the process of data gathering and problem solving through development and testing of hypothesis

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9
Q

Unwanted clinical variation:

A

Unproven/unnecessary treatment leads to inefficient healthcare spending

Sub-standard care

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10
Q

Wanted clinical variation:

A

Adjustments for precision/patient specific care

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11
Q

In order to consistently produce valued outcomes, we must limit unwanted variation =

A

Everyone applying the best standards, custom tailored to the specific patient in the specific context

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12
Q

What is our profession doing to reduce unwanted variability?

A

Push for EBP in DPT education, continuing education, board certification

Standardizing care:
> Standards
> Guidelines
> Expert opinion
> Opinions

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13
Q

Standards:

A

Informed Consent:
> nature of treatment
> alternatives
> benefits
> opportunity for questions
> risks

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14
Q

Tools in CDM:

A

patient specific context

standards and guidelines

CDM

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15
Q

Bias in Decision-making:

A

Confirmation Bias

Follow-up Bias

Spectrum Bias

Value-induced

Ease of recall

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16
Q

Confirmation Bias =

A

tendency to search for or interpret new information in a way that confirms one’s prior beliefs and to avoid or discount information that contradicts one’s preconceptions

17
Q

PT example: confirmation bias

A

when we personally prefer a controversial treatment, we may take greater note of times when the treatment was successful than when it was not

18
Q

Follow-Up Bias:

A

tendency to assume that people who do not return for follow-up have the same distribution of outcomes as those who do return

be cautious:
> do not assume
> make sure explanations are appropriate

19
Q

PT example: follow-up bias

A

in the absence of real outcome measures for all patients, we may believe that those patients we follow over time have success rates similar to those we do not follow

20
Q

Spectrum Bias:

A

tendency to forget that a given patient may not be representative of the entire spectrum of patients who present for diagnosis or treatment

What are the things that will most likely influence the outcome?

21
Q

PT example: Spectrum Bias

A

when we know the sensitivity and specificity of a given diagnostic test, we must remember that these values typically come from biased groups of patients

intermediate-range groups are often not used in calculating these test characteristics

22
Q

Value-Induced Bias:

A

tendency to form beliefs or make decisions based on what is most desired instead of by appealing to the best advice

23
Q

Value-Induced Bias: 2 types

A

self centered: this is the best intervention in my hands

optimism: this can’t happen to me

24
Q

PT example: Value-Induced Bias

A

we should not let what we want most for out patients color our objective evaluation of the pros and cons of various interventions

25
correlation vs causation
post hoc ergo propter hoc the fallacy that because x followed y, event y must have been caused by x
26
Ease of Recall Bias:
tendency for the ease of recalling similar circumstances of an event to unduly influence our estimate of its likelihood
27
PT example: Ease of Recall Bias
we should not place unjustified confidence in a particularly dramatic or recent success (or failure) when designing a treatment plan for our patient
28
Ease of Recall Bias potential reasons:
more weight in the most recent large impact of the outcome (good or bad)