Improving the quality of surgeons' treatment decisions: a comparison of clinical decision making with a computerised evidence based decision analytical model.
OBJECTIVE
The purpose of this study is to demonstrate to what extent an evidence based decision model can improve physicians' decisions and whether a selective use of the decision model is feasible.


METHODS
Four experienced vascular surgeons were asked to make a treatment decision for 137 "paper patient" cases with asymptomatic abdominal aneurysms. Their decisions were compared with the optimal treatment as calculated by a computerised evidence based decision analytical model.


RESULTS
Surgeons agreed with the model's advice based on life expectancy in 81% of the cases, and decided to operate in only 12% of the cases for which there was no agreement. Surgeons' decisions differed from the decision model's calculated optimal treatment, in particular, for older patients with aneurysms of intermediate size and with many risk factors, and for younger patients with small aneurysms and few risk factors. Not all these decisions, however, were reported to be more difficult.


CONCLUSIONS
Use of a decision analytical model might lead to more appropriate decisions and a better quality of care. Selective use of the decision tool for difficult decisions only would be more efficient but is not yet feasible because reported decision difficulty is not strongly related to disagreement with the decision tool.
Medical Decision Making Unit, Leiden University Medical Center, K6-R, PO Box 9600, 2300 RC Leiden, The Netherlands. DRM.Timmermans.EMGO@med.vu.nl
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D
Timmermans
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van Bockel
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J
Kievit
D000368:Aged; D001014:Aortic Aneurysm / Q000601:surgery*; D003657:Decision Making; D020000:Decision Support Systems, Clinical; D019317:Evidence-Based Medicine; D006785:Hospitals, University; D006801:Humans; D008017:Life Expectancy; D008297:Male; D009426:Netherlands; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012307:Risk Factors; D014656:Vascular Surgical Procedures / Q000401:mortality / Q000592:standards* / Q000706:statistics & numerical data