Clinical Decision Analysis

Attempts have been made for almost two decades to use computers to make clinical diagnoses. Interest in such techniques persists despite little practical success in their application to routine patient care. The explanation of this lack of success is complex and includes (i) lack of understanding of the decisionmaking process itself and (ii) the need for a theoretical framework within which such systems can be developed. A major objective of this paper is to illustrate the contribution that the concepts and techniques associated with Decision Theory can make to both of these problems.

After attempting to analyse the deficiencies of current approaches to computer-assisted diagnosis the paper discusses some of the basic concepts of decision theory. It then illustrates the role of decision theory in studies using different forms of clinical decision analysis.

Finally the paper indicates the relevance of decision analysis to medical education and to the provision of health care.

Seit fast zwei Jahrzehnten wird versucht, Computer bei der klinischen Diagnosestellung einzusetzen. Trotz geringer praktischer Erfolge bei ihrer Anwendung in der routinemäßigen Patientenversorgung hat das Interesse an derartigen Techniken nicht nachgelassen.

Die Erklärung für den Mangel an Erfolg ist schwierig und betrifft 1. mangelndes Verständnis für den Prozeß der Entscheidungsfindung selbst und 2. die Notwendigkeit eines theoretischen Rahmens, in dem solche Systeme entwickelt werden können. Es ist ein wesentliches Ziel dieser Arbeit darzulegen, welchen Beitrag die mit der Entscheidungstheorie verbundenen Begriffe und Techniken bei der Lösung dieser beiden Probleme liefern können.

Im Anschluß an den Versuch, die Schwächen der üblichen Methoden computerunterstützter Diagnostik zu analysieren, werden einige grundlegende Begriffe der Entscheidungstheorie erörtert. Die Rolle der Entscheidungstheorie in Studien, in denen andere Formen klinischer Entscheidungsanalysen benutzt werden, wird sodann dargelegt.

Letztlich wird auf die Bedeutung der Entscheidungsanalyse für die medizinische Ausbildung und die Gesundheitsfürsorge hingewiesen.

Key-Words:

Decision Analysis; Computer-assisted Diagnosis; Medical Education; Health Care

Schlüssel-Wörter:

Entscheidungsanalyse - Computer-unterstützte Diagnostik - medizinische Ausbildung - Gesundheitsfürsorge

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