Chapter 9 Treatment Guidelines and Evidence Based Decision

Chapter 9 Treatment Guidelines and Evidence. Based Decision Making Mosby items and derived items © 2009, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. 1

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 Ø The quality of the way in which those actions are executed—what to do and how to do it Ø Mosby items and derived items © 2009, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. 2

Critical Decision Making Clinical Decision Making Components of judging and evaluating; decision making implies not just contemplation but also action based on choices Ø Establishing goals and taking risks beyond what is thought of as critical thinking Ø Mosby items and derived items © 2009, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. 3

Critical Thinking Mosby items and derived items © 2009, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. 4

Critical Thinking Observable Behaviors of Critical Thinkers Distinguish between observation and inference and facts and claims Ø Determine the reliability of a claim or source Ø Determine the accuracy of statements Ø Differentiate relevant and irrelevant data Ø Differentiate warranted and unwarranted claims Ø Recognize ambiguous or equivocal claims/arguments Ø Discern inconsistencies in reasoning Ø Determine the strength of an argument Ø Draw inferences Ø Mosby items and derived items © 2009, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. 5

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) Ø Ø Ø Mosby items and derived items © 2009, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. 6

Decision Making Mosby items and derived items © 2009, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. 7

Decision Making Critical Decision Making Regarding Pharmacologic Therapy Confirm diagnosis Determine whether a medication will be prescribed, and then determine how aggressive therapy is going to be Ø Select the drug and start it Ø Determine the effectiveness of the prescribed drug once the patient has begun taking the product Ø Ø Mosby items and derived items © 2009, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. 8

Decision Making New Products: How to Determine Which Drugs to Prescribe Is the new product clearly more efficacious than existing drugs? Ø Does the new dosage or formulation of an older product offer significant advantages? Ø What does the new drug cost? Ø Is the new drug safe for this particular patient? Ø Mosby items and derived items © 2009, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. 9

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 Mosby items and derived items © 2009, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. 10

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 Ignores Standard Aspects of Clinical Training, Such as the Physical Examination Mosby items and derived items © 2009, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. 11

Evidence-Based Medicine Does Evidence-Based Medicine Improve Patient Outcomes? Mosby items and derived items © 2009, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. 12

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 Mosby items and derived items © 2009, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. 13