Using experience to improve clinical decision making

Patients with chronic illnesses, such as coronary artery disease, have long periods of time between their disease onset, intervention, and eventual outcome. The physician's inability to couple long term outcomes to the process of patient care confuses the evaluation of therapeutic options and testing procedures. At the Duke University Medical Center, the computer has been used to capture the experience of patients with coronary artery disease and establish the feedback loop necessary for using experience to improve clinical decision making. Methods currently being used for quantitating the diagnostic and prognostic information added by a noninvasive test for an individual patient suspected of having coronary artery disease are described.