A unique collaboration
The Division of Clinical Decision Making began as a collaboration between computer scientists at the Massachusetts Institute of Technology and physicians at Tufts Medical Center and Tufts University School of Medicine. Under the guidance of Drs. Stephen Pauker and Jerome Kassirer, it was formally established within the Department of Medicine in 1980 to conduct research, teach, train physicians and provide consultations.
“Even with all of the competition in greater Boston, [Tufts Medical Center] stands out for many reasons… One example is the Division of Clinical Decision Making, the only unit in the world that ties the principles of logical decision analysis to the care of individual patients. It is concerned with identifying strategies of patient care that minimize unnecessary tests and procedures, increase patients' participation in decisions affecting their care, and decrease the cost of medical care." - The Best Hospitals in America: The Authoritative Reference Guide for Patients, Their Families and Medical Professionals
A new approach to improving patient care
The Clinical Consultation Service responds to requests from physicians who are uncertain as to the optimal management strategy for a given individual patient and provides advice based on literature review and formal decision analysis explicitly weighing the risks and benefits of the alternatives. Typical consults involve patients with multiple co-morbidities facing possible surgery, an invasive procedure or a medication such as warfarin for which the benefits of anticoagulation must be weighed against the risks of bleeding.
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. It has been involved with technology assessment, guideline development, health outcome analysis, consensus conferences, and expert panels, as well as clinical informatics, clinical decision support, quality of care assessment and theory of constraints.
The Division uses the following techniques for computerized decision analysis in medical decision making:
- Decision tree construction
- Markov model development
- Monte Carlo simulation
- Bayesian interpretation of diagnostic tests
- Measurement of patient preferences
- Cost-effectiveness analysis
- Literature review
- Discrete event simulation.