Dolan James G
Department of Community and Preventive Medicine, University of Rochester, Rochester, New York, USA.
Patient. 2010;3(4):229-248. doi: 10.2165/11539470-000000000-00000.
Current models of healthcare quality recommend that patient management decisions be evidence-based and patient-centered. Evidence-based decisions require a thorough understanding of current information regarding the natural history of disease and the anticipated outcomes of different management options. Patient-centered decisions incorporate patient preferences, values, and unique personal circumstances into the decision making process and actively involve both patients along with health care providers as much as possible. Fundamentally, therefore, evidence-based, patient-centered decisions are multi-dimensional and typically involve multiple decision makers.Advances in the decision sciences have led to the development of a number of multiple criteria decision making methods. These multi-criteria methods are designed to help people make better choices when faced with complex decisions involving several dimensions. They are especially helpful when there is a need to combine "hard data" with subjective preferences, to make trade-offs between desired outcomes, and to involve multiple decision makers. Evidence-based, patient-centered clinical decision making has all of these characteristics. This close match suggests that clinical decision support systems based on multi-criteria decision making techniques have the potential to enable patients and providers to carry out the tasks required to implement evidence-based, patient-centered care effectively and efficiently in clinical settings.The goal of this paper is to give readers a general introduction to the range of multi-criteria methods available and show how they could be used to support clinical decision-making. Methods discussed include the balance sheet, the even swap method, ordinal ranking methods, direct weighting methods, multi-attribute decision analysis, and the analytic hierarchy process (AHP).
当前的医疗质量模型建议，患者管理决策应以证据为基础且以患者为中心。基于证据的决策需要全面了解有关疾病自然史的当前信息以及不同管理选项的预期结果。以患者为中心的决策将患者的偏好、价值观和独特的个人情况纳入决策过程，并尽可能让患者和医疗服务提供者积极参与。因此，从根本上讲，基于证据、以患者为中心的决策是多维度的，通常涉及多个决策者。
决策科学的进展促使了多种多标准决策方法的发展。这些多标准方法旨在帮助人们在面对涉及多个维度的复杂决策时做出更好的选择。当需要将“硬数据”与主观偏好相结合、在期望的结果之间进行权衡以及让多个决策者参与时，它们尤其有用。基于证据、以患者为中心的临床决策具有所有这些特征。这种紧密匹配表明，基于多标准决策技术的临床决策支持系统有可能使患者和医疗服务提供者能够在临床环境中有效且高效地执行实施基于证据、以患者为中心的护理所需的任务。
本文的目的是向读者大致介绍可用的多标准方法的范围，并展示它们如何用于支持临床决策。讨论的方法包括资产负债表法、等额交换法、序数排序法、直接加权法、多属性决策分析和层次分析法（AHP）。
