A better approach to clinical decision support?

Differential diagnostic decision support tools generally are built to identify a single correct diagnosis, while focusing instead on the value of information they provide might better achieve the goals of shared-decision making to improve care and cut costs, according to a BMC Medical Informatics & Decision Making article.

In a scenario in which a 64-year-old man comes to the emergency department with acute chest pain, a tool would be most useful in paring the potentially hundreds of diagnoses to a subgroup with clear paths of action. These actions would aim to decrease morbidity and mortality, while lack of action would increase these. Such clear-cut paths, however, might include diagnostic errors of omission, according to the article.

If the pain does not provide a clear course of action, the more useful tool would rule out those paths and rule in a non-actionable diagnosis that is incompatible with the other paths, the authors say.

This more useful tool would guide test orders and at times provide vital information faster. Just ordering all the tests at once would not improve the expected value of information because of the time and costs involved and the potential patient anguish from false positives, the authors say.

Whether a CDS tool gets the diagnosis right might not be as important as whether the tool is able to reduce preventable morbidity and mortality by reducing errors of omission. Focusing on the value of information might be a better way to minimize harm and unnecessary expenditures by pointing out a more favorable strategy, they say.

Technology including CDS, clinical workflow support and care coordination can improve patient outcomes, the Agency for Healthcare Research and Quality concluded from an evaluation of 24 research projects it had funded.

Meanwhile, Group Health, an integrated system in Seattle, found that shared decision-making between physicians and patients produced significant reductions in elective surgery and costs.

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