Journal of Cognitive Engineering and Decision Making最新文献

{"title":"Preface to the Special Issue on “The Role of Best Practices in Health Care Decision Making”","authors":"L. Militello, M. Weiner","doi":"10.1177/1555343418790084","DOIUrl":"https://doi.org/10.1177/1555343418790084","url":null,"abstract":"cussing the Role of Best Practices in Health Care Decision Making. The discussion began with a provocative article published in April 2016 in which Devorah Klein, David Woods, Gary Klein, and Shawna Perry raised the question, “Can we trust best practices?” (Klein, Woods, Klein, & Perry, 2016). Klein and her colleagues highlighted some of the challenges associated with using evidence-based medicine (EBM) to support clinical care and suggested naturalistic decision making (NDM) as an important perspective for addressing these challenges. Soon thereafter, Paul Falzer (2018) submitted a manuscript deepening and extending the discussion, pointing out that these challenges are well known in the health care community, and noting that effective solutions remain elusive. In this issue, Falzer’s article provides an in-depth discussion of the concept of decision making in this context and the unintended negative consequences of evidence-based recommendations. This article became the centerpiece for this special issue; commentators were asked to react to Falzer’s article. Because the topic of EBM and its impact on decision making and the quality of health care falls at the intersection of at least two important scientific disciplines (EBM and NDM), perspectives of experts who have been thinking about these issues in various contexts and from various traditions are important. We have been fortunate to obtain commentaries from a range of thought leaders representing both EBM and NDM for this special issue. As we reviewed the commentaries, it became clear that there is sometimes disagreement about what EBM really is and what it implies for health care. “Critics” tend to view EBM narrowly, whereas “proponents” have a broader and more multidimensional view of EBM. It is also worth noting that many commentators draw strong links between EBM and the “best practices regimen” (i.e., initiatives and interventions that define the quality of decision making by conformance to evidence-based practices). Other contributors note that these are distinct concepts, suggesting that while managed care, health services research, implementation research, and the best practices regimen are directly influenced by classical decision theory, EBM might be characterized as restoring decision making to its “rightful place.” In some ways, this confusion rooted in the language can be seen as encouraging: There might not be as much disagreement as it appears on the surface, if one begins to discuss concepts and approaches rather than relying on labels. Nonetheless, important points of divergence are found in the commentaries. Although many would agree that EBM was never intended to constrain clinician discretion and discount expertise, there is little agreement about how EBM should be implemented. We invite you to enjoy the following commentaries. Haynes, a member of the working group that articulated a vision for evidence-based medicine in 1992 (Evidence-Based Medicine Working Group, 1992)","PeriodicalId":46342,"journal":{"name":"Journal of Cognitive Engineering and Decision Making","volume":"12 1","pages":"175 - 177"},"PeriodicalIF":2.0,"publicationDate":"2018-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1555343418790084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43646876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reimagining the Humble but Mighty Pen: Quality Measurement and Naturalistic Decision Making","authors":"E. Schneider","doi":"10.1177/1555343418784372","DOIUrl":"https://doi.org/10.1177/1555343418784372","url":null,"abstract":"Much of the health system’s avoidable spending may be driven by doctors’ decision making. Past studies demonstrated potentially consequential and costly inconsistencies between the actual decisions that clinicians make in daily practice and optimal evidence-based decisions. This commentary examines the “best practices regimen” through the lens of the quality measurement movement.  Although quality measures have proliferated via public reporting and pay-for-performance programs, evidence for their impact on quality of care is scant; the cost of care has continued to rise; and the environment for clinical decisions may not have improved. Naturalistic decision making offers a compelling alternative conceptual frame for quality measurement. An alternative quality measurement system could build on insights from naturalistic decision making to optimize doctors’ and patients’ joint decisions, improve patients’ health outcomes, and perhaps slow the growth of health care spending in the future.","PeriodicalId":46342,"journal":{"name":"Journal of Cognitive Engineering and Decision Making","volume":"12 1","pages":"198 - 201"},"PeriodicalIF":2.0,"publicationDate":"2018-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1555343418784372","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43797034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EBM: Rationalist Fever Dreams","authors":"D. E. Klein, David D. Woods, Gary Klein, S. Perry","doi":"10.1177/1555343418779677","DOIUrl":"https://doi.org/10.1177/1555343418779677","url":null,"abstract":"In 2016, we examined the connection between naturalistic decision making and the trend toward best practice compliance; we used evidence-based medicine (EBM) in health care as an exemplar. Paul Falzer’s lead paper in this issue describes the historical underpinnings of how and why EBM came into vogue in health care. Falzer also highlights the epistemological rationale for EBM. Falzer’s article, like our own, questions the rationale of EBM and reflects on ways that naturalistic decision making can support expertise in the face of attempts to standardize practice and emphasize compliance. Our objectives in this commentary are first to explain the inherent limits of procedural approaches and second to examine ways to help decision makers become more adaptive.","PeriodicalId":46342,"journal":{"name":"Journal of Cognitive Engineering and Decision Making","volume":"12 1","pages":"227 - 230"},"PeriodicalIF":2.0,"publicationDate":"2018-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1555343418779677","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41544019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three Observations","authors":"L. Beach","doi":"10.1177/1555343418775288","DOIUrl":"https://doi.org/10.1177/1555343418775288","url":null,"abstract":"Invited commentary on “Naturalistic Decision Making and the Practice of Health Care,” by Paul R. Falzer for the Journal of Cognitive Engineering and Decision Making.","PeriodicalId":46342,"journal":{"name":"Journal of Cognitive Engineering and Decision Making","volume":"12 1","pages":"206 - 208"},"PeriodicalIF":2.0,"publicationDate":"2018-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1555343418775288","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47433274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician Judgment and Clinical Practice Guidelines","authors":"R. Hamm, Zsolt J. Nagykaldi","doi":"10.1177/1555343418782850","DOIUrl":"https://doi.org/10.1177/1555343418782850","url":null,"abstract":"Decision Making and the Practice of Health Care” by Paul R. Falzer in this special issue. Falzer (2018) and Klein, Woods, Klein, and Perry (2016) have called attention to the fact that external payers (insurance companies, government programs) may reward or penalize individual physicians or clinical groups depending on whether their behavior accords with the recommendation of an evidence-based clinical practice guideline (EB-CPG). (Klein et al. [2016] call this the “best practices regimen,” but to avoid confusion with a methodology focused on design of exemplary and successful approaches for accomplishing clinic tasks [Mold & Gregory, 2003], we will refer to “enforced conformance” to EB-CPG). Clinic administration may then institute a system to measure and reward individual physician performance to assure the group practice overall meets the stated standard. Falzer identifies flaws in the logic behind making reward contingent on meeting guideline-related standards and reviews the varied responses physicians have to enforced conformance. Although we concur with many aspects of the critique, we value the science and wisdom embodied in the guidelines and recognize that at times physicians may need external motivation to heed them. The focus is CPGs that in good faith address the health needs of patients and society. There are three frameworks for these. Guidelines can be based on the judgments of expert clinicians and other stakeholders (Crownover & Unwin, 2005), on studies providing justified evidence that clinical practices are likely to have beneficial effects (Alonso-Coello et al., 2016), or on broader analyses that consider the money needed to produce those beneficial effects so that society’s resources may be allocated to the most cost-effective practices (Mandelblatt, Fryback, Weinstein, Russell, & Gold, 1997; Pandya, 2018). Interestingly, the expert judgment recommendations are correlated with the cost-effectiveness analysis recommendations (Kuntz, Tsevat, Weinstein, & Goldman, 1999). CPGs from any of these frameworks can experience the problems Falzer (2018) identifies when recommendations become requirements and nonconformance with them is penalized. However, physicians cannot simply be ordered to behave in a way that maximizes rewards or optimizes outcomes. The way they manage patients is based on long-established habit (Hamm, 2009a). Hearing about, reading, or studying an EB-CPG endorsed by a respected authority does not make physicians immediately change behavior, even if they intend to. They have to learn the recommended alternative behavior, recognize when the guideline describes something different from what they usually do, and make the conscious choice to change behavior. This must be done consciously until it can become a new habit (Abernathy & Hamm, 1995). This situation is more complex when the current habitual practice involves multiple actors (Ackerman, Gonzales, Stahl, & Metlay, 2013; Gonzales, Steiner, Lum, & Barrett, 1999),","PeriodicalId":46342,"journal":{"name":"Journal of Cognitive Engineering and Decision Making","volume":"12 1","pages":"209 - 214"},"PeriodicalIF":2.0,"publicationDate":"2018-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1555343418782850","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45495868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Some Reflections on Naturalistic Decision Making and the Practice of Health Care","authors":"P. Falzer","doi":"10.1177/1555343418790715","DOIUrl":"https://doi.org/10.1177/1555343418790715","url":null,"abstract":"","PeriodicalId":46342,"journal":{"name":"Journal of Cognitive Engineering and Decision Making","volume":"12 1","pages":"231 - 234"},"PeriodicalIF":2.0,"publicationDate":"2018-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1555343418790715","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46178728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-Based Medicine, Best Practices, Transductive Models, and Naturalistic Decision Making: Commentary on Paul R. Falzer, Naturalistic Decision Making and the Practice of Health Care","authors":"R. Haynes","doi":"10.1177/1555343418789831","DOIUrl":"https://doi.org/10.1177/1555343418789831","url":null,"abstract":"Expert and informed decision making is an essential process in all of health care. Evidence-Based Medicine (EBM) purports to support and enhance this process by the timely infusion of high-quality, pertinent evidence from health research, tailored as closely as possible to the individual and their health problem. Doing so is not an easy task for many reasons, beginning with imperfections and incompleteness in the evidence and ending with the complexities of the dual decision making required by individuals and their care providers. EBM needs a lot of help supporting decision-making processes and welcomes further interdisciplinary collaboration. The “conformist principle,” “best practice regimens,” and “transductive models” should not be considered as barriers to such collaboration: These are not part of EBM. Rather, EBM has always seen evidence from health research as but one of many inputs to decision making by providers and patients. An overarching problem for collaboration to address is understanding the decision-making process well enough to develop effective means to bolster it, so that people are consistently offered the current best options for their problems in a way that fits their circumstances and that they can understand and judge.","PeriodicalId":46342,"journal":{"name":"Journal of Cognitive Engineering and Decision Making","volume":"12 1","pages":"194 - 197"},"PeriodicalIF":2.0,"publicationDate":"2018-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1555343418789831","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48802814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NDM and Healthcare Guidelines: More Attention to the Current Status, Complexity, and Context Is Needed","authors":"D. Matlock, R. Glasgow","doi":"10.1177/1555343418778703","DOIUrl":"https://doi.org/10.1177/1555343418778703","url":null,"abstract":"Evidence-based medicine and guidelines cannot solve all problems in healthcare (Kemm, 2006). Indeed, it can be exceedingly frustrating for a clinician when the quality of his or her care gets measured based on adherence to guidelines that do not apply to a given patient (Boyd et al., 2005). Common examples of this are blood pressure and diabetes treatments for older adults. Lowering both blood pressure and glucose levels are important but can also be quite harmful for individual patients who are at higher risk for falls, incontinence, hypoglycemia, and cognitive impairment if either is controlled too aggressively. In this issue, Dr. Falzer (2018) contributes an article titled “Naturalistic Decision Making (NDM) and the Practice of Health Care.” He argues that the “best practices regimen”—an approach based on evidence and guidelines—has not worked due to a fundamental fallacy that they are overly simplistic and do not account for the nuances of modern medicine in the way that NDM could. He further asserts that implementation science approaches have not helped because they only serve to support and perpetuate the flawed “best practices regimen” approach. His point is well taken that some of the evidence and some (generally older) guidelines fall far short of providing guidance for the complex patient. However, the argument has important weaknesses. The reasoning seems to begin with a conclusion that is supported by an argument based on older thinking about implementation science and guidelines that support the a priori conclusion. This type of reasoning is a classic example of confirmation bias— a common risk when people are left to NDM approaches (Nickerson, 1998). One weakness of this paper is that it appears to be based on an outdated understanding of implementation science. Since the Lomas (Lomas et al., 1989) definition, the field of implementation science has evolved extensively and includes an understanding of how treatments reach the maximum number of eligible patients, how they are adapted to fit into different clinical contexts, how they are sustained, and how both changes in context and potential unintended consequences can be anticipated and avoided (Brownson, Colditz, & Proctor, 2017; Chambers, Glasgow, & Stange, 2013; Glasgow et al., 2012; Stirman et al., 2012). Since the articles referenced within the manuscript, there have been multiple advances in our understanding of both how to disseminate 778703 EDMXXX10.1177/1555343418778703Journal of Cognitive Engineering and Decision MakingNdm and Healthcare Guidelines 2018","PeriodicalId":46342,"journal":{"name":"Journal of Cognitive Engineering and Decision Making","volume":"12 1","pages":"202 - 205"},"PeriodicalIF":2.0,"publicationDate":"2018-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1555343418778703","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49605475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Controlling Versus Supporting in a Sociotechnical System: A Commentary on Falzer (2018)","authors":"Yan Xiao, P. Gorman","doi":"10.1177/1555343418777342","DOIUrl":"https://doi.org/10.1177/1555343418777342","url":null,"abstract":"","PeriodicalId":46342,"journal":{"name":"Journal of Cognitive Engineering and Decision Making","volume":"12 1","pages":"215 - 218"},"PeriodicalIF":2.0,"publicationDate":"2018-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1555343418777342","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48337403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Industrial Conceptualization of Health Care Versus the Naturalistic Decision-Making Paradigm: Work as Imagined Versus Work as Done","authors":"K. Catchpole, Myrtede C. Alfred","doi":"10.1177/1555343418774661","DOIUrl":"https://doi.org/10.1177/1555343418774661","url":null,"abstract":"Quality and safety concerns in health care over the past 20 years precipitated the need to move beyond the traditional view of health care as an artisanal process toward a sociotechnical systems view of performance. The adoption of industrial approaches placed a greater emphasis on standardization of processes and outcomes, often treating humans as the “weak” part of the system rather than valuing their role in holding together complex, opaque, and unpredictable clinical systems. Although some health care tasks can be modeled linearly, others are much more complex. Efforts to reduce variation in clinical reasoning through evidence-based practices have proven problematic by failing to provide a means for context-specific adaptation or to account for the complex and adaptive nature of clinical work. We argue that the current, highly empirical approach to clinical decision making reflects clinical reasoning “as imagined,” whereas the application of the naturalistic decision-making (NDM) paradigm can help reveal clinical reasoning “as done.” This approach will have benefits for improving the conditions for diagnosis; the design of acute, time-pressured clinical work; the identification of deteriorating patients; the development of clinical decision support systems; and many more clinical tasks. Health care seems ready to accept NDM approaches.","PeriodicalId":46342,"journal":{"name":"Journal of Cognitive Engineering and Decision Making","volume":"12 1","pages":"222 - 226"},"PeriodicalIF":2.0,"publicationDate":"2018-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1555343418774661","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42145498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}