Clinical Decision-Making Tools

Question 1

Novice clinicians:

Answer 1

Black and white

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

Question 2

Expert clinicians:

Answer 2

Gray.”it depends”

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

Question 3

Directive factors of clinical decision making:

Answer 3

> 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

Question 4

Informative factors of clinical decision making:

Answer 4

> Academic content and faculty mentorship

> Anticipated patient performance

> Personal experiences

> Reflection-on-specific action

> Reflection-on-professional experience

Question 5

Informative & Directive factors of clinical decision making:

Answer 5

> Mentorship

> Information from the literature

> Continuing education

> Clinical experience

> Critical thinking

Question 6

Enablement/Disablement Models:

Answer 6

Explain the complex interrelationships between health, disability and function

> Nagi Model
ICF

Question 7

Patient/Client Management Model:

Answer 7

> Framework for the process of our patient care

> Guide to PT Practice

Question 8

HOAC II:

Answer 8

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

Question 9

Unwanted clinical variation:

Answer 9

Unproven/unnecessary treatment leads to inefficient healthcare spending

Sub-standard care

Question 10

Wanted clinical variation:

Answer 10

Adjustments for precision/patient specific care

Question 11

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

Answer 11

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

Question 12

What is our profession doing to reduce unwanted variability?

Answer 12

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

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

Question 13

Standards:

Answer 13

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

Question 14

Tools in CDM:

Answer 14

patient specific context

standards and guidelines

CDM

Question 15

Bias in Decision-making:

Answer 15

Confirmation Bias

Follow-up Bias

Spectrum Bias

Value-induced

Ease of recall

Question 16

Confirmation Bias =

Answer 16

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

Question 17

PT example: confirmation bias

Answer 17

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

Question 18

Follow-Up Bias:

Answer 18

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

Question 19

PT example: follow-up bias

Answer 19

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

Question 20

Spectrum Bias:

Answer 20

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?

Question 21

PT example: Spectrum Bias

Answer 21

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

Question 22

Value-Induced Bias:

Answer 22

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

Question 23

Value-Induced Bias: 2 types

Answer 23

self centered: this is the best intervention in my hands

optimism: this can’t happen to me

Question 24

PT example: Value-Induced Bias

Answer 24

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

Question 25

correlation vs causation

Answer 25

post hoc ergo propter hoc

the fallacy that because x followed y, event y must have been caused by x

Question 26

Ease of Recall Bias:

Answer 26

tendency for the ease of recalling similar circumstances of an event to unduly influence our estimate of its likelihood

Question 27

PT example: Ease of Recall Bias

Answer 27

we should not place unjustified confidence in a particularly dramatic or recent success (or failure) when designing a treatment plan for our patient

Question 28

Ease of Recall Bias
potential reasons:

Answer 28

more weight in the most recent

large impact of the outcome (good or bad)