The Division is a part of the Department of Medicine at Tufts Medical Center and the Tufts University School of Medicine, where its members are involved in clinical practice, education, research, and the development and delivery of clinically relevant information. As such, its activities involve the following:
Clinical Activities
Education
Health Policy
Research
Decision Making
Handy Downloads
Clinical Activities
The Division of Clinical Decision Making, Informatics and Telemedicine began as a collaboration between computer scientists at the Massachusetts Institute of Technology and physicians at the Tufts Medical Center. Under the guidance of Drs Stephen Pauker and Jerome Kassirer, it was formally established in 1980 to conduct research, teach, train physicians and provide consultations. The Clinical Decision Consultation Service responds to requests from physicians who are uncertain as to the optimal management strategy for an individual patient. The service provides advice based on literature review and formal decision analysis explicitly weighing the risks and benefits of the alternatives. Typical consults involve complex clinical problems or unusual problems that involve difficult tradeoffs.
Examples include:
1) decisions for patients with combinations of problems that make traditional strategies of care problematic,
2) the interpretation of conflicting information, and
3) decisions that need to reflect strongly individual patient preferences. The staff of the Division also provides the clinical infrastructure for the hospital's local and international telemedicine activities.
The Division also has a Clinical Hypnosis Consultation Service to provide consultation on the application of medical hypnosis for a wide varied of conditions including habits, anxiety, sleep disorders, chronic pain, and chemotherapy-related nausea.
Education
We offer one-, two- and three-year fellowships in clinical informatics (funded by the National Library of Medicine, National Institutes of Health), sabbaticals for faculty of other medical schools, rotations for house staff, and electives for medical students. Many of our former fellows or visitors have moved on to leadership positions in informatics, policy making, teaching or their clinical specialty. Former trainees include general internists and physicians in cardiology, nephrology, infectious diseases, hepatology, gastroenterology, hematology, oncology, pediatrics, cardiothoracic surgery, pathology, radiology, psychiatry, and neurology. Funding for coursework and for meeting travel is provided. Click on this link for a list of our current and former fellows (and their current positions) and for a list of recent publications by our fellows. CDMIT Fellowship Application send to:
Claire Wong
Tufts Medical Center
800 Washington St. #302
Boston, MA 02111
617-636-5934
Health Policy
Our Division has been involved with technology assessment, guideline development, health outcome analysis, consensus conferences, expert panels and guideline development processes for the National Institutes of Health (NIH), Office of Medical Applications Research (OMAR), Institute of Medicine (IOM), American College of Chest Physicians (ACCP), American College of Physicians (ACP), and Agency for Health Care Policy and Research (AHCPR, now the AHRQ Agency for Healthcare Research and Quality) sponsored Patient Outcome Research Teams (PORTs) on Chronic Ischemic Heart Disease (IHD) and Diabetes Mellitus. Most recently, we are a part of the Tufts Medical Center Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center awarded to Dr Joseph Lau.
Research
Applying decision analysis, utility assessment, literature synthesis, medical informatics, and artificial intelligence in medicine, the Division focuses on clinical decision analysis, cost-effectiveness and health policy analysis at institutional and policy levels. The Division has been involved with clinical informatics, clinical decision support, quality of care assessment, theory of constraints and telemedicine. These skills enable fellows to pursue clinical research questions examining the thorough and efficient evaluation of diagnostic possibilities, the value or information content of the medical history, physical examination and diagnostic tests, determination of the optimal diagnostic test or test sequence, selection of the optimal therapy, and evaluation of new medical technologies (tests, devices or drugs). The Division uses the following techniques for decision analysis in medical decision making: decision tree construction, Markov model development, Monte Carlo simulation, Bayesian interpretation of diagnostic tests, the measurement of patient preferences, cost-effectiveness analysis, literature review, meta-analysis and discrete event simulation.
Our current projects include treatment of viral hepatitis, osteoporosis treatment, coronary heart disease, anticoagulation for atrial fibrillation or prosthetic heart valves, screening for cancer, therapy for rheumatoid arthritis, HIV treatment, immunization policy, inflammatory bowel disease, rheumatoid arthritis, prenatal genetic testing, and antifungal treatments, but these methods can and have been applied to any subspecialty clinical problem, and fellows are encouraged to pursue independent research in their own fields of interest. Members of the Division are actively involved in exploring and developing platforms for decision support and decision analysis, as well as techniques for assessing patient preferences and incorporating them into clinical decision making.
Recent publications
Decision Making
This program for performing decision analyses on MS-DOS computers has been in use for over a decade. The current version is 7.07. Using Decision Maker, the decision analyst can analyze simple decision trees or Markov cohort models. Monte Carlo simulation is also supported. The program performs sensitivity analyses (one-way, two-way, or three-way) and displays the results graphically or in tabular form. Thresholds may be calculated. Cost-effectiveness analyses, including the calculation of willingness-to-pay thresholds, are supported. Inquiries and requests for technical support can be directed to decision.maker@cor.cdm.nemc.org.
Handy downloads
PGP public key
PGP Shell
MIT distribution site for PGP