Transforming clinical practice guidelines and clinical pathways into fast-and-frugal decision trees to improve clinical care strategies

Journal of Evaluation in Clinical Practice
Benjamin DjulbegovicWilliam Dale

Abstract

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. 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. 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 heuristi...Continue Reading

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Citations

Jul 17, 2018·Journal of Evaluation in Clinical Practice·Mathew Mercuri, Amiram Gafni
Aug 31, 2018·Journal of Evaluation in Clinical Practice·Michael LoughlinStephen Buetow
Jun 22, 2018·Journal of Evaluation in Clinical Practice·Ross E G Upshur
Nov 22, 2018·Journal of Evaluation in Clinical Practice·Benjamin DjulbegovicGordon Guyatt
Jul 26, 2018·Oncotarget·Isa MambetsarievRavi Salgia
Jul 9, 2020·JCO Oncology Practice·Ravi SalgiaBenjamin Djulbegovic
Dec 24, 2018·Journal of Evaluation in Clinical Practice·Benjamin DjulbegovicGordon Guyatt
Nov 27, 2020·Journal of Evaluation in Clinical Practice·Robert Mugerauer
Nov 3, 2020·SN Comprehensive Clinical Medicine·David S SmithWendy L Brunetto
Apr 22, 2021·Chinese Medical Journal·Xiaomei YaoBenjamin Djulbegovic
Aug 28, 2021·International Journal of Environmental Research and Public Health·Per Magnus MæhleSigbjørn Smeland

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