IMPROVING THE COST-EFFECTIVENESS OF MEDICAL DIAGNOSIS

提高医疗诊断的成本效益

• 批准号: 3074627
• 负责人: PETER M DOUBILET
• 金额: $ 5.39万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 1985
• 资助国家: 美国
• 起止时间: 1985-08-01 至 1989-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3074627
• 关键词: adrenal disorder; cardiovascular stress test; computed axial tomography; computer assisted diagnosis; coronary disorder; decision making; diagnosis quality /standard; endocrine disorder diagnosis; health care cost /financing; heart disorder diagnosis; mass screening; mathematical model; neoplasm /cancer diagnosis; noninvasive diagnosis; prenatal diagnosis; radionuclide diagnosis; ultrasonography

Recent efforts and incentives designed to contain rising health-care costs, coupled with the goal of providing high-quality medical care, underline the importance of practicing medicine in a cost-effective fashion. Several projects, involving the use of computers and mathematical techniques to manipulate available sources of data, will seek to improve the selection, sequencing, and interpretation of diagnostic tests. A theoretical model of sequential testing will be developed and implemented on computer. This will extend algebraic techniques used previously to analyze single tests. It will be applied to specific diagnostic problems, including the use of computed tomography and ultrasound in the diagnosis of adrenal disease. The cost-effectiveness of the exercise tolerance test and thallium scan, used alone or in sequence to evaluate patients with suspected coronary artery disease, will be assessed. An interactive computer program to aid the physician in the workup of patients with chest pain will be developed. Using a Markov statistical model of sequential testing, the benefits and costs of screening for cancer in patients exposed to carcinogens will be evaluated, so that guidelines for screening such patients can be established. Techniques to maximize the accuracy of diagnostic test interpretation will be developed, using chest radiography and obstetrical ultrasound as examples. Receiver operating characteristic (ROC) analysis will be used to study perceptual mechanisms underlying the effect of clinical information on chest x-ray interpretation, and to determine how such information can best be used by the radiologist. The use of mathematical models to improve predictions based on radiographic measurements will be examined, with fetal age and weight estimation from obstetrical ultrasonic measurements as a prototype. On a more general level, because medical decisions must frequently be made in the face of imprecise information, computer-implemented statistical techniques will be developed to assess how uncertainty in available data affects the confidence in decisions based on those data.

最近旨在遏制不断上涨的医疗成本的努力和激励措施， 再加上提供高质量医疗服务的目标，强调 以具有成本效益的方式行医的重要性。几个 项目，涉及使用计算机和数学技术来 操纵可用的数据来源，将寻求改进选择， 对诊断测试进行排序和解释。一种理论模型 序贯测试将在计算机上开发和实施。这 将扩展以前用于分析单项测试的代数技术。 它将应用于特定的诊断问题，包括使用 CT和超声在肾上腺疾病诊断中的应用。 运动耐量试验和铊扫描的成本效益， 单独或按顺序用于评估疑似冠心病患者 动脉疾病，将被评估。一种交互式计算机程序，以帮助 内科医生在对胸痛患者的体检中会有所发展。 使用序贯测试的马尔可夫统计模型，好处和 在接触致癌物的患者中进行癌症筛查的费用将是 评估，以便筛查这类患者的指南可以 已经成立了。最大限度提高诊断测试准确性的技术 将使用胸部X光检查和产科检查进行解释 以超声波为例。接收器工作特性(ROC)分析 将被用于研究潜在的感知机制的影响 关于胸部X光解释的临床信息，以及如何确定 这样的信息最适合放射科医生使用。对.的使用 改进基于射线照相的预测的数学模型 测量将被检查，胎儿年龄和体重估计从 以产科超声测量为原型。在更一般的情况下 水平，因为医疗决定必须经常在面对 不准确的信息，计算机实施的统计技术将是 开发用于评估可用数据中的不确定性如何影响 对基于这些数据的决策的信心。