DECISION-ANALYSIS IN PEDIATRIC CARDIOLOGY OUTCOMES RESEARCH

Selection of clinical strategies to manage heart disease in infants, c hildren, and adolescents is central to the pediatric cardiologist's jo b. Decision analysis is a mathematically rigorous approach to understa nding the outcomes of a medical choice, and so has a role in the appli cation of outcomes research in pediatric cardiology. Decision analysis models a clinical decision as the proverbial 'fork in the road,' and evaluates comprehensively the potential consequences of a decision in terms of probabilities of specific end results, and values which may b e attached to those results. Research into outcomes in pediatric cardi ology is fueled by the high level of interest of its three constituenc ies - physicians who wish to provide good outcomes, patients who wish to enjoy them, and payers who demand a return of good outcomes for the ir investment. Despite the observation that the decision analytical co nstruct for handling outcomes data has shortcomings for each of the th ree constituencies, decision analysis is beginning to flourish. It has been applied to define optimal diagnostic and treatment strategies, t o expose hidden issues relevant to improving outcomes, to divide patie nt populations into subsets for which the ideal management differs, to guide outcomes researchers toward fruitful fields of investigation, a nd to identify ways in which changes in health care delivery would imp rove outcome. As outcomes research defines the survival and functional status of children with heart disease with greater precision and scop e, decision analysis may assume a prominent role in pediatric cardiolo gy as a mechanism through which the data are understood and applied. ( C) 1997 Elsevier Science Ireland Ltd.