Improving Clinical Guidelines with Logic and Decision-table Techniques

Abstract

Clinical practice guidelines can be clarified, verified, and simplified by the use of logical analysis and the application of decision-table techniques. This methodology is applied to a CDC guideline for the prevention of perinatal transmission of hepatitis B by immunization. Relevant clinical variables are identified and possible values for each variable are defined. An exhaustive enumeration of value combinations is generated. Logically impossible com binations are identified and eliminated. The guideline's recommendations are next translated into a set of rules and compared with the remaining value combinations. Variable combi nations that are not covered by guideline recommendations represent incomplete guideline specifications. Inconsistency can be identified by finding identical condition sets in two or more rules. The procedure demonstrates that the hepatitis guideline is incomplete. Logical analysis can improve the quality of clinical practice guidelines by assuring comprehensive- ness and consistency. Key words: clinical guidelines; decision table; logic, verification; hep atitis B; immunization. (Med Decis Making 1994;14:245-254)