What are the differences between quantum random number generator methods, and are there consequences to using them for decision-making?

I have two related questions.

The first is that there are multiple ways to get quantum random numbers. But is there a difference between a method that extracts the prevalent quantum fluctuations from the vacuum, versus a more sophisticated method that uses a Hadamard gate in a quantum computer to get a 0 or 1 bit from a prepared pure state. I feel the later is a more valid quantum random number but I also feel wrong about that.

Second, are there consequences to using a quantum random number to decide what action to take in the macro world? For ex, if measuring the Hadamard gate returns a 0 then I will take the left route on my drive towards my destination, but if I get a 1 then I will take the other route. This rapid upscaling of a single quantum fluctuation seems impactful since it bypasses the usual noise and washing that all other quantum fluctuations have to go through before they can affect the macro world. This increase in the rate/quantity of decoherence in the world seems like it needs consideration and examination. Or am I over-reacting?