Decision and diagnostic support

Question 1

Give examples of decision and diagnostic support systems that are used in clinical practice

Answer 1

  1. Reminder systems
  2. Decision systems (diagnosis and treatment)
  3. Prescribing
  4. Condition management

Question 2

Examples of when reminder systems are used

Answer 2

Screening
Vaccination
Testing
Medication use
Identification of risky behaviour

Question 3

What is the role of diagnostic systems?

Answer 3

• Model individual patient data against epidemiological date (which may be held in a computer database)
• Often match patient signs and symptoms to database
• Can provide hypotheses or estimates of probability of different potential diagnoses

Question 4

What are Ottawa ankle rules?

Answer 4

• Patient with sprained ankles are common
• Data suggest that 15% sprains are fractures
• If all patients with sprained ankle are send for x-ray, 85% will show no fracture
• Can a decision aid reduce the number of unnecessary x-rays?

Ottawa ankle rules = decision aid for excluding fractures of the ankle and mid-foot, showed sensitivity of almost 100% and modest specificity, its use should reduce the number of unnecessary radiographs by 30-40%

Question 5

What is the definition of sensitivity?

Answer 5

Proportion of people with the target disorder who have a positive test.

Question 6

What is the definition of specificity?

Answer 6

Proportion of people without the target disorder who have a negative test

Question 7

Do clinical decision aids work?

Answer 7

So using a CDSS can improve practitioner performance in diagnosis, disease management, prescribing/drug dosing, rates of vaccination, screening etc

But. evidence for effects on patient outcomes not so robust so they may not succeed in practice, remember that there is no single ‘best choice’ because individuals vary in their preferences for different treatments

Question 8

Patient decision aids intent to enable patients to do what?

Answer 8

1. Understand probable outcomes of options by providing information relevant to the decision
2. Consider the personal value they place on benefits vs harm, by helping clarify preferences
3. Feel supported in decision making
4. Move through the steps in making a decision
5. Participate in decision about their health care

Question 9

What sort of information can patients gain from patient decision aids?

Answer 9

Information regarding:

• The disease/condition
• Costs
• Probability of outcomes, tailored to personal health risk factors
• An explicit values-clarification exercise
• Other people’s opinions
• A personalised recommendation, from clinical characteristics and expressed preferences
• Guidance or coaching in decision making and communicating with others

Question 10

What may hinder the use of clinical decision diagnostic systems

Answer 10

1. Earlier negative experience of IT
2. Potential harm to doctor-patient relationship
3. Obscured responsibilities (loss of autonomy or reasoning)
4. Reminders increase workload