首页> 外文期刊>Journal of evaluation in clinical practice >Transforming clinical practice guidelines and clinical pathways into fast‐and‐frugal decision trees to improve clinical care strategies
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Transforming clinical practice guidelines and clinical pathways into fast‐and‐frugal decision trees to improve clinical care strategies

机译:将临床实践指南和临床途径转化为快速节俭决策树,以改善临床护理策略

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Abstract Background Contemporary delivery of health care is inappropriate in many ways, largely due to suboptimal Q5 decision‐making. A typical approach to improve practitioners' decision‐making is to develop evidence‐based clinical practice guidelines (CPG) by guidelines panels, who are instructed to use their judgments to derive practice recommendations. However, mechanisms for the formulation of guideline judgments remains a “black‐box” operation—a process with defined inputs and outputs but without sufficient knowledge of its internal workings. Methods Increased explicitness and transparency in the process can be achieved by implementing CPG as clinical pathways (CPs) (also known as clinical algorithms or flow‐charts). However, clinical recommendations thus derived are typically ad hoc and developed by experts in a theory‐free environment. As any recommendation can be right (true positive or negative), or wrong (false positive or negative), the lack of theoretical structure precludes the quantitative assessment of the management strategies recommended by CPGs/CPs. Results To realize the full potential of CPGs/CPs, they need to be placed on more solid theoretical grounds. We believe this potential can be best realized by converting CPGs/CPs within the heuristic theory of decision‐making, often implemented as fast‐and‐frugal (FFT) decision trees. This is possible because FFT heuristic strategy of decision‐making can be linked to signal detection theory, evidence accumulation theory, and a threshold model of decision‐making, which, in turn, allows quantitative analysis of the accuracy of clinical management strategies. Conclusions Fast‐and‐frugal provides a simple and transparent, yet solid and robust, methodological framework connecting decision science to clinical care, a sorely needed missing link between CPGs/CPs and patient outcomes. We therefore advocate that all guidelines panels express their recommendations as CPs, which in turn should be converted into FFTs to guide clinical care.
机译:摘要在许多方面,医疗保健的当代交付不合适,主要是由于Q5决策次优。提高从业者决策的典型方法是通过指导方案制定基于证据的临床实践指南(CPG),该公司被指示使用其判断来衍生实践建议。但是,制定指南判断的机制仍然是“黑匣子”操作 - 一个具有定义输入和输出的过程,但没有足够了解其内部运作。方法可以通过实施CPG作为临床途径(CPS)(也称为临床算法或流程图)来实现过程中的显性性和透明度。然而,由此导出的临床建议通常是临时和由理论环境中的专家开发的。由于任何建议都可以是正确的(真正的积极或负面),或错误(假正或负面),缺乏理论结构阻止了CPGS / CPS推荐的管理策略的定量评估。结果实现CPGS / CPS的全部潜力,他们需要放置在更稳定的理论场上。我们认为,通过将CPGS / CP转换在决策的启发式理论中,可以最好地实现这一潜力,通常被实施为快速和节俭(FFT)决策树。这是可能的,因为决策的FFT启发式战略可以与信号检测理论,证据积累理论和决策的阈值模型相关联,反过来允许定量分析临床管理策略的准确性。结论快速和节俭提供了一种简单透明,但坚固且坚固的方法框架将决策科学提供给临床护理,这是CPGS / CPS和患者结果之间的荒谬缺失的联系。因此,我们倡导所有指南小组将其建议表达为CPS,这反过来应转换为FFT以指导临床护理。

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