Deciding without data.

Congenital Heart Disease
Jeffrey R DarstJames E Lock

Abstract

Physician decisions drive most of the increases in health care expenditures, yet virtually no published literature has sought to understand the types of evidence used by physicians as they make decisions in real time. Ten pediatric cardiologists recorded every clinically significant decision made during procedures, test interpretation, or delivery of inpatient and outpatient care during 5 full days and 5 half days of care delivery. The basis for each decision was assigned to one of 10 predetermined categories, ranging from arbitrary and anecdotal, to various qualities of published studies, to parental preference and avoiding a lawsuit. During the 7.5 days, 1188 decisions (158/day) were made. Almost 80% of decisions were deemed by the physicians to have no basis in any prior published data and fewer than 3% of decisions were based on a study specific to the question at hand. In this pilot study, physicians were unable to cite a formal evidence source for most of their real-time clinical decision making, including those that consumed medical resources. Novel approaches to building an evidence base produced from real-time clinical decisions may be essential for health care reform based on data.

References

Jan 1, 1990·International Journal of Technology Assessment in Health Care·M Dubinsky, J H Ferguson
Jan 1, 1997·Archives of Disease in Childhood·S E KennyD A Lloyd
Aug 14, 2002·Journal of Paediatrics and Child Health·V A MoyerE J Elliott
Apr 28, 2004·Journal of General Internal Medicine·Brian P LucasJeremy P Smith
Sep 6, 2005·Pediatrics·Jean Anne ConnorKathy J Jenkins
Feb 21, 2006·Journal of the American College of Cardiology·Roberta G WilliamsUNKNOWN National Heart, Lung, and Blood Institute Working Group on research in adult congenital heart disease

❮ Previous
Next ❯

Citations

Jan 26, 2013·Evidence-based Medicine·Katrien Oude RengerinkHester Vermeulen
Jun 16, 2012·The Journal of Thoracic and Cardiovascular Surgery·Sara K PasqualiUNKNOWN Pediatric Heart Network Investigators
Jan 1, 2012·Progress in Pediatric Cardiology·Sara K PasqualJeffrey P Jacobs
Dec 15, 2015·Seminars in Pediatric Surgery·Grace E Hsiung, Fizan Abdullah
Jul 29, 2015·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Spencer D Dorn
Apr 17, 2013·Journal of Hospital Medicine : an Official Publication of the Society of Hospital Medicine·Maireade E McSweeneyJenifer R Lightdale
Nov 8, 2014·Congenital Heart Disease·Diego A Lara, Keila N Lopez
Oct 27, 2015·Plastic and Reconstructive Surgery. Global Open·Stephanie A CatersonJeffery O Greenberg
Aug 5, 2015·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Spencer D Dorn
Oct 9, 2014·Academic Medicine : Journal of the Association of American Medical Colleges·Michael FariasRahul H Rathod
Nov 16, 2014·Journal of Oncology Practice·Kristen K McNiff, Joseph O Jacobson
Oct 18, 2014·World Journal for Pediatric & Congenital Heart Surgery·Erle H Austin
Oct 1, 2011·World Journal for Pediatric & Congenital Heart Surgery·Jeffrey Phillip JacobsRobert Vincent
Oct 1, 2011·World Journal for Pediatric & Congenital Heart Surgery·Jo WrayRodney Franklin
Apr 12, 2013·Journal of Child Neurology·Alan LevitonScott L Pomeroy
Dec 10, 2015·Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery·Stacey L IshmanRaouf S Amin
Jul 8, 2011·Journal of the Royal Society of Medicine·Mandy Bryon, Colin Wallis
Oct 30, 2018·Journal of the American Heart Association·Lauren G GilstrapAkshay S Desai
Jul 1, 2020·Postgraduate Medical Journal·J J CoughlanThomas J Kiernan
Sep 29, 2020·International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care·Karthik NathanSteven Frick
Feb 6, 2020·Current Opinion in Anaesthesiology·Stefano FaliniMaurizio Cecconi
Jun 29, 2021·Clinical Orthopaedics and Related Research·Casey Jo Humbyrd
Oct 4, 2021·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Kenneth P SeastedtLeo A Celi
Nov 4, 2021·Cardiology in the Young·Nelangi M PintoAngela Fagerlin

❮ Previous
Next ❯

Related Concepts

Related Feeds

Birth Defects

Birth defects encompass structural and functional alterations that occur during embryonic or fetal development and are present since birth. The cause may be genetic, environmental or unknown and can result in physical and/or mental impairment. Here is the latest research on birth defects.