Clinical Decision-Making Tools Flashcards
Novice clinicians:
Black and white
Prone to CDM errors due to:
> Limited knowledge
> Limited recall
Expert clinicians:
Gray.”it depends”
Purposeful management of information:
> Broad and structured knowledge
> If/then production rules
> Pattern recognition
> Working diagnosis
Directive factors of clinical decision making:
> 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
Informative factors of clinical decision making:
> Academic content and faculty mentorship
> Anticipated patient performance
> Personal experiences
> Reflection-on-specific action
> Reflection-on-professional experience
Informative & Directive factors of clinical decision making:
> Mentorship
> Information from the literature
> Continuing education
> Clinical experience
> Critical thinking
Enablement/Disablement Models:
Explain the complex interrelationships between health, disability and function
> Nagi Model
ICF
Patient/Client Management Model:
> Framework for the process of our patient care
> Guide to PT Practice
HOAC II:
Informs the process of data gathering and problem solving through development and testing of hypothesis
Unwanted clinical variation:
Unproven/unnecessary treatment leads to inefficient healthcare spending
Sub-standard care
Wanted clinical variation:
Adjustments for precision/patient specific care
In order to consistently produce valued outcomes, we must limit unwanted variation =
Everyone applying the best standards, custom tailored to the specific patient in the specific context
What is our profession doing to reduce unwanted variability?
Push for EBP in DPT education, continuing education, board certification
Standardizing care:
> Standards
> Guidelines
> Expert opinion
> Opinions
Standards:
Informed Consent:
> nature of treatment
> alternatives
> benefits
> opportunity for questions
> risks
Tools in CDM:
patient specific context
standards and guidelines
CDM
Bias in Decision-making:
Confirmation Bias
Follow-up Bias
Spectrum Bias
Value-induced
Ease of recall
Confirmation Bias =
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
PT example: confirmation bias
when we personally prefer a controversial treatment, we may take greater note of times when the treatment was successful than when it was not
Follow-Up Bias:
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
PT example: follow-up bias
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
Spectrum Bias:
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?
PT example: Spectrum Bias
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
Value-Induced Bias:
tendency to form beliefs or make decisions based on what is most desired instead of by appealing to the best advice
Value-Induced Bias: 2 types
self centered: this is the best intervention in my hands
optimism: this can’t happen to me
PT example: Value-Induced Bias
we should not let what we want most for out patients color our objective evaluation of the pros and cons of various interventions
correlation vs causation
post hoc ergo propter hoc
the fallacy that because x followed y, event y must have been caused by x
Ease of Recall Bias:
tendency for the ease of recalling similar circumstances of an event to unduly influence our estimate of its likelihood
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
Ease of Recall Bias
potential reasons:
more weight in the most recent
large impact of the outcome (good or bad)
