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There are no standardised decision criteria, and physicians' decisions to admit emergency department patients to hospital have been found to differ substantially.
The two CT-RAP examples on tuberculosis and meningococcal disease shown in figures 3 and 4 illustrate how this new tool offers a highly standardised decision algorithm where evidence allows, but also remains open for consideration of other factors.
The commonly held view that care pathways are useful tools to support standardised decision leading to the delivery of care which is appropriate, timely and informed by evidence needs to be revisited as does the salutary lack of robust evaluation to accompany the introduction of pathways into practice.
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As the inclusion of cost variables such as for gym hire, equipment and the salaries of site health personnel are not standardised, decision-makers confronted with the question of whether or not to transfer and implement the programme need to be fully informed about the cost items included in the total programme costs.
However, greater attention should be paid to establishing where possible standardised thresholds for decisions on when a sign is or is not present, as appropriate, to delineate a particular condition.
The multivariate models have two important advantages over the gestalt of physicians; they combine variables in a mathematically optimal manner by weighing the importance of each variable based on evidence (derived from the training data), and they provide a standardised tool for decision-making.
"When the government said it wasn't ready to make a decision on standardised packaging of cigarettes the tobacco industry thought it had killed it stone dead.
The Mexican priority-setting experience describes how standardised analytical approaches to decision making, mainly burden of disease and cost-effectiveness analyses, combine with other criteria eg, being responsive to the legitimate non-health expectations of patients and ensuring fair financing across households to design and implement a set of three differentiated health intervention packages.
E-health improves health surveillance, health system management, health decision making, standardised sharing of health information; and promotes equity in healthcare delivery [ 2– 5].
13 Further claims to improve DNACPR decision-making were the implementation of a standard process in trust policies to record patients' wishes at admission 9 while Kim do et al 14 called for a systematic standardisation of DNACPR decisions in terms of standardised forms to improve end-of life decisions in the early stage of patients with terminal cancer.
15 Aspects for the successful implementation of a standardised approach to DNACPR decision-making were reported in the prehospital setting in two states in the USA.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com