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To investigate the appropriateness of decisions to prescribe or withhold antibiotics for nursing home (NH) residents with infections of the urinary tract (UTI), respiratory tract (RTI), and skin (SI).
Our key outcome measure focused on appropriateness of decisions during diagnostic workup rather than accuracy in identifying the correct diagnosis.
Our data support the appropriateness of decisions to potentially limit life-sustaining treatment in a cohort of term infants with severe HIE who did not receive therapeutic hypothermia.
The criticisms that NHS 111 sends more patients than necessary to A&E departments therefore appears correct, though we were not able in this study to assess the appropriateness of decisions made by either the GPs or the call handlers.
A randomized controlled trial design is needed to examine decision-making further with higher validity, and continuing research dealing with substitute decision makers who made decisions about tube feeding is needed to clarify the long-term appropriateness of decisions reached using the decision aid.
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These important differences may preclude the appropriateness of decision follow-through as a measure of effectiveness in this context.
Debate is ongoing about the appropriateness of decision quality measures such as decisional conflict and satisfaction, which have typically been used to assess the effectiveness of decision aids.
Unfortunately, design limitations, most notably the small sample size and the response rate of only 30.5%, seriously limit the study's primary conclusion that there was no difference in the appropriateness of decision-making between GPs who made recommendations after calculating CHD risk (N = 52) and those who made recommendations without calculating risk (N = 26, P = 0.21).
For a study to be categorised as having assessed decision appropriateness, the appropriateness of the decisions made must have been explicitly assessed in reference to some standard, or scenarios must have been designed according to some standard such that the appropriate decision was evident.
To measure the appropriateness of medical decisions, we also defined compliance with criteria which included therapeutic decisions as opposed to diagnostic or organisational elements (criteria 1, 2, 6, 15, 18, 20).
Computerised DSSs (also called 'decision aids' [ 10]) are fundamentally no different from paper algorithms, nomograms, reminders or other aids to clinical decision-making, because they all aim to improve the appropriateness of clinical decisions, actions and patient health outcomes.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com