INTRODUCTION: Physician decisions drive most of the increases in health care expenditures, yet virtually no published literature has sought to understand the types of evidence used by physicians as they make decisions in real time. METHODS: Ten pediatric cardiologists recorded every clinically significant decision made during procedures, test interpretation, or delivery of inpatient and outpatient care during 5 full days and 5 half days of care delivery. The basis for each decision was assigned to one of 10 predetermined categories, ranging from arbitrary and anecdotal, to various qualities of published studies, to parental preference and avoiding a lawsuit. RESULTS: During the 7.5 days, 1188 decisions (158/day) were made. Almost 80% of decisions were deemed by the physicians to have no basis in any prior published data and fewer than 3% of decisions were based on a study specific to the question at hand. CONCLUSIONS: In this pilot study, physicians were unable to cite a formal evidence source for most of their real-time clinical decision making, including those that consumed medical resources. Novel approaches to building an evidence base produced from real-time clinical decisions may be essential for health care reform based on data.
INTRODUCTION: Physician decisions drive most of the increases in health care expenditures, yet virtually no published literature has sought to understand the types of evidence used by physicians as they make decisions in real time. METHODS: Ten pediatric cardiologists recorded every clinically significant decision made during procedures, test interpretation, or delivery of inpatient and outpatient care during 5 full days and 5 half days of care delivery. The basis for each decision was assigned to one of 10 predetermined categories, ranging from arbitrary and anecdotal, to various qualities of published studies, to parental preference and avoiding a lawsuit. RESULTS: During the 7.5 days, 1188 decisions (158/day) were made. Almost 80% of decisions were deemed by the physicians to have no basis in any prior published data and fewer than 3% of decisions were based on a study specific to the question at hand. CONCLUSIONS: In this pilot study, physicians were unable to cite a formal evidence source for most of their real-time clinical decision making, including those that consumed medical resources. Novel approaches to building an evidence base produced from real-time clinical decisions may be essential for health care reform based on data.
Authors: Brian P Lucas; Arthur T Evans; Brendan M Reilly; Yuri V Khodakov; Kalyani Perumal; Louis G Rohr; Joseph A Akamah; Tunji M Alausa; Christopher A Smith; Jeremy P Smith Journal: J Gen Intern Med Date: 2004-05 Impact factor: 5.128
Authors: Roberta G Williams; Gail D Pearson; Robyn J Barst; John S Child; Pedro del Nido; Welton M Gersony; Karen S Kuehl; Michael J Landzberg; Merle Myerson; Steven R Neish; David J Sahn; Amy Verstappen; Carole A Warnes; Catherine L Webb Journal: J Am Coll Cardiol Date: 2006-01-26 Impact factor: 24.094
Authors: Diego Porras; David W Brown; Rahul Rathod; Kevin Friedman; Kimberly Gauvreau; James E Lock; Jesse J Esch; Lisa Bergersen; Audrey C Marshall Journal: Congenit Heart Dis Date: 2013-10-15 Impact factor: 2.007
Authors: Michael Farias; Kathy Jenkins; James Lock; Rahul Rathod; Jane Newburger; David W Bates; Dana G Safran; Kevin Friedman; Josh Greenberg Journal: Health Aff (Millwood) Date: 2013-05 Impact factor: 6.301
Authors: Sara K Pasquali; Richard G Ohye; Minmin Lu; Jonathan Kaltman; Christopher A Caldarone; Christian Pizarro; Carolyn Dunbar-Masterson; J William Gaynor; Jeffrey P Jacobs; Aditya K Kaza; Jane Newburger; John F Rhodes; Mark Scheurer; Eric Silver; Lynn A Sleeper; Sarah Tabbutt; James Tweddell; Karen Uzark; Winfield Wells; William T Mahle; Gail D Pearson Journal: J Thorac Cardiovasc Surg Date: 2012-06-12 Impact factor: 5.209
Authors: Karthik Nathan; Maechi Uzosike; Uriel Sanchez; Alexander Karius; Jacinta Leyden; Nicole Segovia; Sara Eppler; Katherine G Hastings; Robin Kamal; Steven Frick Journal: Int J Qual Health Care Date: 2020-12-15 Impact factor: 2.038
Authors: Kenneth P Seastedt; Dana Moukheiber; Saurabh A Mahindre; Chaitanya Thammineni; Darin T Rosen; Ammara A Watkins; Daniel A Hashimoto; Chuong D Hoang; Jacques Kpodonu; Leo A Celi Journal: Eur J Cardiothorac Surg Date: 2022-01-24 Impact factor: 4.191
Authors: Stephanie A Caterson; Mansher Singh; Dennis Orgill; Roya Ghazinouri; Elizabeth Han; George Ciociolo; Karl Laskowski; Jeffery O Greenberg Journal: Plast Reconstr Surg Glob Open Date: 2015-09-09