AN EVIDENCE-BASED FRAMEWORK FOR COMPLEX DECISION MAKING AND QUALITY OF CARE

Purpose: High quality medical decision-making is the cornerstone of providing high quality care, and research is needed to better measure the quality of complex decision-making in order to enhance the quality of medical care. The purpose of this study was to systematically review the literature and present an evidence-based framework of key concepts relevant to measuring the quality of complex, shared medical decision-making. 

Method: We conducted a structured review of electronic databases, including Medline, Cochrane Library, Evidence-Based Medicine Reviews, Library of Congress, National Library of Medicine, PsychInfo, and Sociological Abstracts. We also searched reference lists of relevant articles, publication lists of key authors in the field, reviews of tools, and annotated bibliographies. We adapted search terms from related systematic reviews and conducted searches from 1980 to January 2010. We then developed an evidence-based framework through an iterative synthesis of key concepts identified by our search. 

Result: The best available evidence for assessing complex decision-making and quality of care included systematic reviews, interventions, and quantitative and qualitative observational studies. Key aspects identified through our search included patient and professional roles; patient, professional, and cultural competence; provider-patient relationships, including trust; communication; and information quality. Key patient outcomes included satisfaction; patient understanding; concordance between patient preferences and decisions; and adherence to treatment. These elements and other quality-relevant domains were included in the development of the evidence-based framework. 

Conclusion: Current evidence suggests that a number of key domains may be relevant to the evaluation of complex decision-making and quality of care. Our theoretical framework may be a useful guide for conceptualizing and developing quality measures, interventions, and decision aids for these complex concepts.