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Editor's Note
September 23, 2013

Integrating Prediction Rules Into Clinical Work Flow

JAMA Intern Med. 2013;173(17):1591. doi:10.1001/jamainternmed.2013.8971

If a clinical prediction rule falls off the shelf of a physician’s office, does it make a sound? I think not.

Many clinical prediction rules to improve the quality and efficiency of medical care have been developed and published, but they are not widely used. There are many complicated reasons for their underuse. First, not all clinical prediction rules have been validated on independent samples in diverse clinical settings; therefore, physicians have reason to question the reproducibility of the results. Second, even when validated clinical prediction rules are available, physicians tend to favor their own judgment when caring for a specific patient. Perhaps most important, physicians do not use clinical prediction rules because most of them are time-consuming and cumbersome, requiring entering data into a calculator or computer, interrupting the flow of our clinical encounter and thought processes.