Quantitative Aspects of Clinical Decision Making

Abstract

March 2006

Section Clinical Essentials

VIII Quantitative Aspects of Clinical Decision Making

Bryan Haynes, M.D., Ph.D.
Professor of Clinical Epidemiology and Medicine and Chair, Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Centre

Harold Sox, M.D.
Editor, Annals of Internal Medicine

Health care research has yielded an increasing amount of useful quantitative evidence for practitioners addressing such important clinical topics as screening and diagnostic tests, preventive and therapeutic interventions, prognosis, risk of adverse outcomes, improvement in quality of care, and cost-effectiveness. Clinical application of this evidence, however, has lagged, despite the fact that the current health care environment increasingly demands that physicians be able to justify clinical policies and decisions with an evidence-based, quantitative approach. This chapter discusses how to critically evaluate research reports and apply the results to patient care, and it provides a table that serves as an abbreviated users' guide for appraising medical journal articles. Reports of treatment effects in randomized, controlled trials are important starting points that help determine whether a treatment has merit, but the decision whether to offer a given patient a particular treatment is complex and must take into account each patient's specific clinical circumstances and individual wishes. Models of medical decision analysis are presented, including the treatment threshold model of decision making, measures of expected-outcome decision making, and cost-effectiveness analysis, with figures that show examples of the application of each method. This chapter contains 27 references.

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