Decision analysis in pediatric cardiology outcomes research

Selection of clinical strategies to manage heart disease in infants, children, and adolescents is central to the pediatric cardiologist's job. Decision analysis is a mathematically rigorous approach to understanding the outcomes of a medical choice, and so has a role in the application 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 be attached to those results. Research into outcomes in pediatric cardiology is fueled by the high level of interest of its three constituencies - physicians who wish to provide good outcomes, patients who wish to enjoy them, and payers who demand a return of good outcomes for their investment. Despite the observation that the decision analytical construct for handling outcomes data has shortcomings for each of the three constituencies, decision analysis is beginning to flourish. It has been applied to define optimal diagnostic and treatment strategies, to expose hidden issues relevant to improving outcomes, to divide patient populations into subsets for which the ideal management differs, to guide outcomes researchers toward fruitful fields of investigation, and to identify ways in which changes in health care delivery would improve outcome. As outcomes research defines the survival and functional status of children with heart disease with greater precision and scope, decision analysis may assume a prominent role in pediatric cardiology as a mechanism through which the data are understood and applied.