Was an explicit and sensible process used to consider the relative values of different outcomes?
Any treatment decision involves tradeoffs, and tradeoffs imply value judgements. Ideally, process-of-care criteria will state the source of the values they used, and the nature of those values. When, as is usually the case, the investigators are silent on this issue, one can assume that the values of those developing the criteria determined the decisions they made. The results of the randomized trials of CABG versus PTCA that were ultimately done highlight this issue. PTCA appears to have a slightly lower early mortality, along with lower initial costs and more rapid recovery from the procedure. However, longer-term mortality data are similar, and CABG patients appear to achieve better symptom relief, have decreased use of medication, and require fewer subsequent procedures [8] [9] [10] [11]. When panelists in the RAND study were rating the appropriateness of different case scenarios for PTCA, they were presumably weighing trade-offs between early and late effects of PTCA and CABG. How
Related Questions
- For physician hand-offs, does the same process have to be used throughout the hospital. Can different specialties use different methods of communication within their call group?
- Was an explicit and sensible process used to identify, select and combine the evidence into probabilities?
- Was an explicit and sensible process used to consider the relative value of different outcomes?
