Institute: ONC | Component: 2 | Unit: 4 | Lecture: c | Slide: 10

Institute:Office of National Coordinator (ONC) Workforce Training Curriculum

Component:The Culture of Health Care

Unit:Health Care Processes and Decision Making

Lecture:Gathering data and analyzing findings
Making a diagnosis
The impact of EHRs and technology on clinical decision-making

Slide content:Mathematical Approaches Bayes theorem Mnemonics: SpIN and SnOUT Decision Rules Wells criteria for pulmonary embolism Centor criteria for strep throat Decision analysis 10

Slide notes:Although not widely used in day-to-day clinical work, mathematical approaches to assist with diagnosis are employed informally in the clinic and formally in decision-support systems and guidelines. Bayes theorem has been widely used to help determine the probability of a condition given its prevalence in the population and the findings in a given patient. The mnemonics SpIN and SnOUT are reminders that the specificity of a test indicates how useful it is for ruling a condition in , and the sensitivity of the test indicates how useful it is for ruling a condition out . Mathematical approaches are also used to derive decision rules for determining the likelihood of conditions. An example is the use of Wells criteria for determining the likelihood of a pulmonary embolus [ em -buh-luhs ], or blood clot. Many clinicians use pocket calculators or online calculators to determine the Wells score to help them decide whether to do further testing for pulmonary embolus. Simple scoring rules ( Centor [ sen -tor] criteria) also help determine the probability of streptococcal [strep- tuh - kok -uh l] pharyngitis [far-in- jahy -tis] , which can lead to more appropriate antibiotic prescribing. Finally, formal decision analysis is applied to clinical problems in order to set policy and create guidelines. These techniques are especially amenable to providing decision support with computer systems because calculations that may be difficult to do in one's head are trivial for a computer if the correct data is available. 10