Medical Decision Making

How health professionals and patients make treatment decisions, and the barriers to, and facilitators of, effective decision making.

Nerve Block Use after Hip Fracture Versus Elective Hip or Knee Arthroplasty: Retrospective Analysis

Meghan Lane-Fall, MD, MSHP
Mar. 3, 2020

Mark D. Neuman, Nabil M. Elkassabany, Jason Ochroch, Craig Newcomb, Colleen Brensinger, Samir Mehta, Lakisha J. Gaskins, Meghan B. Lane‐Fall

Abstract [from journal]

Objectives: Although peripheral nerve blocks are associated with improved pain control and end outcomes among older adults with hip fracture, their current utilization among US hip fracture patients is not well understood. We characterized contemporary use of peripheral nerve blocks after hip fracture over time and identified predictors of nerve block receipt.

Design: Retrospective cohort study of claims data from one large national private US insurer.

Setting: US acute care hospitals.


Association of Cognitive Biases with Human Papillomavirus Vaccine Hesitancy: A Cross-Sectional Study

Dec. 20, 2019

Tiffany D. Poares, Alison M. Buttenheim, Avnika B. Amin, Caroline M. Joyce, Rachael M. Porter, Robert A. Bednarczyk, Saad B. Omer

Abstract [from journal]

Given the link between vaccine hesitancy and vaccine-preventable disease outbreaks, it is critical to examine the cognitive processes that contribute to the development of vaccine hesitancy, especially among parents of adolescents. We conducted a secondary analysis of baseline data from a two-phase randomized trial on human papillomavirus to investigate how vaccine hesitancy and intent to vaccinate are associated with six decision-making factors: base rate neglect, conjunction fallacy, sunk cost bias, present bias


Advance Care Planning Claims and Health Care Utilization Among Seriously Ill Patients Near the End of Life

Nov. 1, 2019

Deepshikha Ashana, Xiaoxue Chen, Abiy Agiro, Gayathri Sridhar, Ann Nguyen, John Barron, Kevin Haynes, Michael Fisch, David Debono, Scott D. Halpern, Michael O. Harhay

Abstract [from journal]

Importance: Although advance care planning is known to increase patient and caregiver satisfaction, its association with health care utilization is not well understood.

Objective: To examine the association between billed advance care planning encounters and subsequent health care utilization among seriously ill patients.

Design, Setting, and Participants: This retrospective cohort study conducted from October 1, 2015, to May 31, 2018, used a national commercial insurance claims database


Can Machine Learning Improve Cancer Care?

Oct. 25, 2019

“How long do I have?”

It is the first question many patients ask after a cancer diagnosis. It is also among the hardest to answer. For decades, predicting cancer survival was more art than science. But now, unprecedented computing power and access to digital health information offer a tantalizing opportunity: can machine learning (ML) algorithms succeed where others fail?

Performance of a Clinical Decision Support Tool to Identify PICU Patients at High Risk for Clinical Deterioration

Heather Wolfe, MD
Oct. 2, 2019

Maya Dewan, Naveen Muthu, Eric Shelov, Christopher Bonafide, Patrick Brady, Daniela Davis, Eric Kirkendall, Dana Niles, Robert Sutton, Danielle Traynor, Ken Tegtmeyer, Vinay Nadkarni, Heather Wolfe

Abstract [from journal]

Objectives: To evaluate the translation of a paper high-risk checklist for PICU patients at risk of clinical deterioration to an automated clinical decision support tool.

Design: Retrospective, observational cohort study of an automated clinical decision support tool, the PICU Warning Tool, adapted from a paper checklist to predict clinical deterioration events in PICU patients within 24 hours.

Setting: Two quaternary care medical-surgical PICUs—The Children’s Hospital of Philadelphia and...

Opioid Prescribing After Surgery in the United States, Canada, and Sweden

Mark D. Neuman, MD
Sep. 4, 2019

Karim S. Ladha, Mark D. Neuman, Gabriella Broms, Jennifer Bethell, Brian T. Bateman, Duminda N. Wijeysundera, Max Bell, Linn Hallqvist, Tobias Svensson, Craig W. Newcomb, Colleen M. Brensinger, Lakisha J. Gaskins, Hannah Wunsch

Abstract [from journal]

Importance: Small studies and anecdotal evidence suggest marked differences in the use of opioids after surgery internationally; however, this has not been evaluated systematically across populations receiving similar procedures in different countries.

Objective: To determine whether there are differences in the frequency, amount, and type of opioids dispensed after surgery among the United States, Canada, and Sweden.

Design, Setting, and Participants: This cohort study included patients...

Cognitive Biases Influence Decision-Making Regarding Postacute Care in a Skilled Nursing Facility

Aug. 21, 2019

Robert E Burke, Chelsea Leonard, Marcie Lee, Roman Ayele, Ethan Cumbler, Rebecca Allyn, S Ryan Greysen

Abstract [from journal]

Background: Decisions about postacute care are increasingly important as the United States population ages, its use becomes increasingly common, and payment reforms target postacute care. However, little is known about how to improve these decisions.

Objective: To understand whether cognitive biases play an important role in patient and clinician decision-making regarding postacute care in skilled nursing facilities (SNFs) and identify the most impactful biases.

Design: Secondary analysis of...

What Are the Costs of Cervical Radiculopathy Prior to Surgical Treatment?

Jul. 1, 2019

Cameron Barton, Piyush Kalakoti, Nicholas Bedard, Nathan Hendrickson, Comron Saifi, Andrew Pugely

Abstract [from journal]

Study Design: Retrospective, observational study.

Objective: To examine the costs associated with nonoperative management (diagnosis and treatment) of cervical radiculopathy in the year prior to anterior cervical discectomy and fusion (ACDF).

Summary of Background Data: While the costs of operative treatment have been previously described, less is known about nonoperative management costs of cervical radiculopathy leading up to surgery.

Methods: The Humana claims


Impact of Public Reporting of Cardiovascular Outcomes on a Non-Reported Procedure

Apr. 26, 2019

Public reporting of cardiovascular outcomes remains controversial, 20 years after New York became the first state to mandate reporting of mortality data for percutaneous coronary intervention (PCI). It has been associated with a lower likelihood of performing potentially lifesaving procedures, perhaps reflecting an avoidance of intervening in high-risk cases.

Factors Affecting Fertility Decision-Making Among Transgender Adolescents and Young Adults

Apr. 15, 2019

Diane Chen, Moira A. Kyweluk, Afiya Sajwani, Elisa J. Gordon, Emilie K. Johnson, Courtney A. Finlayson, and Teresa K. Woodruff

Abstract [from journal]

Purpose: This study aimed to identify factors affecting transgender adolescents' and young adults' (AYA) decisions to pursue fertility preservation (FP).