Decision analysis as a quality-assurance screening tool.
BACKGROUND
The purpose of this pilot study was to examine whether the technique of decision analysis, including sensitivity analysis, could be used in a clinical quality-assurance program.


METHODS
This research was performed in a family practice residency clinical practice. A computerized decision analysis model was developed for selection of initial drug therapy for hypertension. The medical records of 52 resident-managed patients with hypertension were then reviewed. The residents' drug prescribing was evaluated by faculty reviewers and also by the decision analysis model, including a sensitivity analysis.


RESULTS
Faculty reviewers rated the residents' drug choices as "most appropriate" or "acceptable" in 59.6% of cases. There was good agreement between faculty reviewers and the computerized decision analysis model. For example, in those cases in which the resident chose the computer model's first-choice drug, faculty deemed the management as "most appropriate" or "acceptable" 93.3% of the time. When residents selected the computer model's third or fourth choice, faculty judged the residents' therapy as "inappropriate" or "an alternate drug would have been more desirable" in 61.9% of cases.


CONCLUSIONS
The results suggest that computerized decision analysis techniques may be a useful adjunct to other clinical quality-assurance procedures in residency training programs.
Carter
B L
BL
College of Pharmacy, University of Illinois, Chicago.
Butler
C D
CD
Bakht
F
F
Miller
J W
JW
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use; D003198:Computer Simulation; D003658:Decision Making, Computer-Assisted; D003661:Decision Support Techniques; D005194:Family Practice / Q000193:education / Q000592:standards*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007396:Internship and Residency / Q000592:standards; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011785:Quality Assurance, Health Care
D000959:Antihypertensive Agents