Enhancing Healthcare Decisions: Key Elements and Protocols

1. Chapter 9 Treatment Guidelines and Evidence-Based Decision Making

2. Critical Decision Making • The Quality of Health Care Is Determined by Two Main Factors • The quality of the decisions that determine what actions are taken • The quality of the way in which those actions are executed—what to do and how to do it

3. Critical Decision Making • Clinical Decision Making • Components of judging and evaluating; decision making implies not just contemplation but also action based on choices • Establishing goals and taking risks beyond what is thought of as critical thinking

4. Critical Thinking

5. Critical Thinking • Observable Behaviors of Critical Thinkers • Distinguish between observation and inference and facts and claims • Determine the reliability of a claim or source • Determine the accuracy of statements • Differentiate relevant and irrelevant data • Differentiate warranted and unwarranted claims • Recognize ambiguous or equivocal claims/arguments • Discern inconsistencies in reasoning • Determine the strength of an argument • Draw inferences

6. Critical Thinking • Outcomes of the Critical Thinking Process (see Box 9-1) • Synthesis of relevant information • Prediction of outcomes • Examination of assumptions • Generation of options • Identification of patterns • Choice of actions (Jacobs PM et al, 1997)

7. Decision Making

8. Decision Making • Critical Decision Making Regarding Pharmacologic Therapy • Confirm diagnosis • Determine whether a medication will be prescribed, and then determine how aggressive the therapy is going to be • Select the drug and start it • Determine the effectiveness of the prescribed drug once the patient has begun taking the product

9. Decision Making • New Products: How to Determine Which Drugs to Prescribe • Is the new product clearly more efficacious than existing drugs? • Does the new dosage or formulation of an older product offer significant advantages? • What does the new drug cost? • Is the new drug safe for this particular patient?

10. Evidence-Based Medicine • Training for Uncertainty • The Traditional Decision-Making Paradigm • What Is Evidence-Based Health Care? • Growth of Evidence-Based Medicine as a Decision-Making Process • Barriers to the Implementation of Evidence-Based Decision Making

11. Evidence-Based Medicine • Evidence-Based Medicine Ignores Clinical Experience and Clinical Intuition • Understanding of Basic Investigation and Pathophysiology Plays No Part in Evidence-Based Medicine • Evidence-Based Medicine Ignores Standard Aspects of Clinical Training, Such as the Physical Examination

12. Evidence-Based Medicine • Does Evidence-Based Medicine Improve Patient Outcomes?

13. Clinical Guidelines • What Are Clinical Practice Guidelines? • Process for Guideline Development • Limitations in the Use of Clinical Practice Guidelines • Using Guidelines to Modify Clinical Practice • Long-Term Consequences of Clinical Guideline Use