Skip to main content

Using evidence-based algorithms to improve clinical decision making: the case of a first-time anterior shoulder dislocation.

Publication ,  Journal Article
Federer, AE; Taylor, DC; Mather, RC
Published in: Sports Med Arthrosc Rev
September 2013

Decision making in health care has evolved substantially over the last century. Up until the late 1970s, medical decision making was predominantly intuitive and anecdotal. It was based on trial and error and involved high levels of problem solving. The 1980s gave way to empirical medicine, which was evidence based probabilistic, and involved pattern recognition and less problem solving. Although this represented a major advance in the quality of medical decision making, limitations existed. The advantages of the gold standard of the randomized controlled clinical trial (RCT) are well-known and this technique is irreplaceable in its ability to answer critical clinical questions. However, the RCT does have drawbacks. RCTs are expensive and can only capture a snapshot in time. As treatments change and new technologies emerge, new expensive clinical trials must be undertaken to reevaluate them. Furthermore, in order to best evaluate a single intervention, other factors must be controlled. In addition, the study population may not match that of another organization or provider. Although evidence-based medicine has provided powerful data for clinicians, effectively and efficiently tailoring it to the individual has not yet evolved. We are now in a period of transition from this evidence-based era to one dominated by the personalization and customization of care. It will be fueled by policy decisions to shift financial responsibility to the patient, creating a powerful and sophisticated consumer, unlike any patient we have known before. The challenge will be to apply medical evidence and personal preferences to medical decisions and deliver it efficiently in the increasingly busy clinical setting. In this article, we provide a robust review of the concepts of customized care and some of techniques to deliver it. We will illustrate this through a personalized decision model for the treatment decision after a first-time anterior shoulder dislocation.

Duke Scholars

Published In

Sports Med Arthrosc Rev

DOI

EISSN

1538-1951

Publication Date

September 2013

Volume

21

Issue

3

Start / End Page

155 / 165

Location

United States

Related Subject Headings

  • Shoulder Dislocation
  • Precision Medicine
  • Patient Preference
  • Patient Participation
  • Orthopedics
  • Humans
  • Evidence-Based Medicine
  • Decision Support Techniques
  • Algorithms
  • 3202 Clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Federer, A. E., Taylor, D. C., & Mather, R. C. (2013). Using evidence-based algorithms to improve clinical decision making: the case of a first-time anterior shoulder dislocation. Sports Med Arthrosc Rev, 21(3), 155–165. https://doi.org/10.1097/JSA.0b013e31829f608c
Federer, Andrew E., Dean C. Taylor, and Richard C. Mather. “Using evidence-based algorithms to improve clinical decision making: the case of a first-time anterior shoulder dislocation.Sports Med Arthrosc Rev 21, no. 3 (September 2013): 155–65. https://doi.org/10.1097/JSA.0b013e31829f608c.
Federer AE, Taylor DC, Mather RC. Using evidence-based algorithms to improve clinical decision making: the case of a first-time anterior shoulder dislocation. Sports Med Arthrosc Rev. 2013 Sep;21(3):155–65.
Federer, Andrew E., et al. “Using evidence-based algorithms to improve clinical decision making: the case of a first-time anterior shoulder dislocation.Sports Med Arthrosc Rev, vol. 21, no. 3, Sept. 2013, pp. 155–65. Pubmed, doi:10.1097/JSA.0b013e31829f608c.
Federer AE, Taylor DC, Mather RC. Using evidence-based algorithms to improve clinical decision making: the case of a first-time anterior shoulder dislocation. Sports Med Arthrosc Rev. 2013 Sep;21(3):155–165.

Published In

Sports Med Arthrosc Rev

DOI

EISSN

1538-1951

Publication Date

September 2013

Volume

21

Issue

3

Start / End Page

155 / 165

Location

United States

Related Subject Headings

  • Shoulder Dislocation
  • Precision Medicine
  • Patient Preference
  • Patient Participation
  • Orthopedics
  • Humans
  • Evidence-Based Medicine
  • Decision Support Techniques
  • Algorithms
  • 3202 Clinical sciences