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Improving Fast and Frugal Modeling in Relation to Regression Analysis: Test of 3 Models for Medical Decision Making

Center for Family and Community Medicine, Karolinska Institutet, Huddinge, Sweden

Johan Bring, PhD

Center for Family and Community Medicine, Karolinska Institutet, Huddinge, Sweden

Ylva Skånér, MD, PhD

Center for Family and Community Medicine, Karolinska Institutet, Huddinge, Sweden

Lars-Erik Strender, MD, PhD

Center for Family and Community Medicine, Karolinska Institutet, Huddinge, Sweden

Henry Montgomery, PhD

Center for Family and Community Medicine, Karolinska Institutet, Huddinge, Sweden

Background . A matching heuristic (MH) model of decision making has been evaluated previously in a series of studies on medical decision making. The authors' purpose is to evaluate an extended MH model that considers the prevalence of cue values. Methods. Data from 2 previous studies were reanalyzed, one on judgments regarding drug treatment of hyperlipidemia and the other on diagnosing heart failure. The original MH model and the extended MH model were compared with logistic regression (LR) in terms of fit to actual judgments, number of cues, and the extent to which the cues were consistent with clinical guidelines. Results. There was a slightly better fit with LR compared with MH. The extended MH model gave a significantly better fit than the original MH model in the drug treatment task. In the diagnostic task, the number of cues was significantly lower in the MH models compared to LR, whereas in the therapeutic task, LR could be less or more frugal than the matching heuristic models depending on the significance level chosen for inclusion of cues. For the original MH model, but not for the extended MH model or LR, the most important cues in the drug treatment task were often used in a direction contrary to treatment guidelines. Conclusions . The extended MH model represents an improvement in that prevalence of cue values is adequately taken into account, which in turn may result in better fit and in better agreement with medical guidelines in the evaluation of cues.

Key Words: Key words: medical decision making • fast and frugal • matching heuristic • judgment analysis. (Med Decis Making 2009 • 29:140—148)

This version was published on January 1, 2009

Medical Decision Making, Vol. 29, No. 1, 140-148 (2009)
DOI: 10.1177/0272989X08326091


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