Clinical Decision-Making: Developing a 4 C Model Using Graph Theoretic Approach

Abstract

The purpose of this paper is to propose a graph-theoretic mathematical model to measure how conducive the environment of a hospital is for decision-making. We propose a 4-C model, developed from four interacting factors: confidence, complexity, capability, and customer. In this graph-theoretic model, abstract information regarding the system is represented by the directed edges of a graph (or digraph), which together depict how one factor affects another. The digraph yields a matrix model useful for computer processing. The net effect of different factors and their interdependencies on the hospital's decision-making environment is quantified and a single numerical index is generated. This paper categorizes all the major factors that influence clinical decision-making and attempts to provide a tool to study and measure their interactions with each other. Each factor and each interaction among factors are to be quantified by healthcare experts according to their best judgment of the magnitude of its effect in a local hospital environment.

A hospital case study is used to demonstrate how the 4-C model works. The graph-theoretic approach allows for the inclusion of new factors and generation of alternative environments by a combination of both qualitative and quantitative modeling. The 4-C model can be used to create both a database and a simple numerical scale that help a hospital set customized guidelines, ranging from patient admittance procedures to diagnostic and treatment processes, according to its specific situation. Implementing this methodology systematically can allow a hospital to identify factors that will lead to improved decision-making as well as identifying operational factors that present roadblocks.