Multi-Criteria Clinical Decision Support
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Current models of healthcare quality recommend that patient management decisions be evidence based and patient centered. Evidence-based decisions require a thorough understanding of current information regarding the natural history of disease and the anticipated outcomes of different management options. Patient-centered decisions incorporate patient preferences, values, and unique personal circumstances in the decision-making process, and actively involve both patients and healthcare providers as much as possible. Fundamentally, therefore, evidence-based, patient-centered decisions are multi-dimensional and typically involve multiple decision makers.
Advances in the decision sciences have led to the development of a number of multiple-criteria decision-making methods. These multi-criteria methods are designed to help people make better choices when faced with complex decisions involving several dimensions. They are especially helpful when there is a need to combine ‘hard data’ with subjective preferences, to make trade-offs between desired outcomes, and to involve multiple decision makers. Evidence-based, patient-centered clinical decision making has all of these characteristics. This close match suggests that clinical decision-support systems based on multi-criteria decision-making techniques have the potential to enable patients and providers to carry out the tasks required to implement evidence-based, patient-centered care effectively and efficiently in clinical settings.
The goal of this article is to give readers a general introduction to the range of multi-criteria methods available and show how they could be used to support clinical decision making. Methods discussed include the balance sheet, the ‘even swap’ method, ordinal ranking methods, direct weighting methods, multi-attribute decision analysis, and the analytic hierarchy process.
KeywordsAnalytic Hierarchy Process Balance Sheet Conjoint Analysis Analytic Network Process Criterion Priority
This work was supported by grant 5K24HL093488-02 from the National Heart Lung and Blood Institute (NHLBI), US National Institutes of Health. The NHLBI played no other part in the preparation of this manuscript.
The author has no conflicts of interest that are relevant to the content of this article.
- 1.Institute of Medicine. Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press, 2001Google Scholar
- 2.Agency for Healthcare Research and Quality. National healthcare quality report, 2008: key themes from the national healthcare quality report [online]. Available from URL: http://www.ahrq.gov/qual/nhqr08/Key.htm [Accessed 2010 Aug 11]Google Scholar
- 7.Figueira J, Greco S, Ehrgott M. Multiple criteria decision analysis: state of the art surveys. New York: Springer, 2005Google Scholar
- 20.Few S. Information dashboard design: the effective visual communication of data. Sebastopol (CA): O’Reilly Media, Inc., 2006Google Scholar
- 25.Hastie R, Dawes RM. Rational choice in an uncertain world. Thousand Oaks (CA): Sage Publications, Inc., 2001Google Scholar
- 27.Hammond JS, Keeney RL, Raiffa H. Smart choices: a practical guide to making better decisions. Boston (MA): Harvard Business School Press, 1999Google Scholar
- 29.SMART-SWAPS: smart choices with the even swaps method [online]. Available from URL: http://www.smart-swaps.hut.fi/ [Accessed 2010 Jul 29]Google Scholar
- 30.McCaffrey JD. Using the Multi-Attribute Global Inference of Quality (MAGIQ) technique for software testing. Sixth International Conference on Information Technology: New Generations; 2009 Apr 27–29; Las Vegas (NV)Google Scholar
- 35.WEB-HIPRE: global decision support [online]. Available from URL: http://www.hipre.hut.fi/ [Accessed 2010 Jul 29]Google Scholar
- 36.café Annalisa [online]. Available from URL: http://www. cafeannalisa.org.uk/index.php [Accessed 2010 Jul 29]Google Scholar
- 37.Von Winterfeldt D, Edwards W. Decision analysis and behavioral research. Cambridge: Cambridge University Press, 1986Google Scholar
- 45.Saaty TL. Decision making for leaders. Pittsburgh (PA): RWS Publications, 2001Google Scholar
- 46.Gass SI. Model world: when is a number a number? Interfaces 2001; 31(5): 93–103Google Scholar
- 47.Super Decisions Software for Decision-Making [online]. Available from URL: http://www.superdecisions.com [Accessed 2010 Jul 29]Google Scholar