IMPROVING THE COST-EFFECTIVENESS OF MEDICAL DIAGNOSIS

提高医疗诊断的成本效益

• 批准号: 3074629
• 负责人: PETER M DOUBILET
• 金额: $ 5.48万
• 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/3074629
• 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.

最近为控制不断上升的保健费用而作出的努力和采取的激励措施， 结合提供高质量医疗保健的目标，强调 以具有成本效益的方式行医的重要性。 几 项目，涉及使用计算机和数学技术， 操纵现有的数据来源，将寻求改善选择， 测序和诊断测试的解释。 的理论模型 将在计算机上开发和实施顺序测试。 这 将扩展以前用于分析单个测试的代数技术。 它将被应用于具体的诊断问题，包括使用 CT和超声在肾上腺疾病诊断中的应用。 运动耐量测试和铊扫描的成本效益， 单独或依次用于评估疑似冠状动脉病变患者 将评估动脉疾病。 一个交互式计算机程序， 医生在胸痛患者的检查将被开发。 使用马尔可夫统计模型的序贯测试， 暴露于致癌物的患者的癌症筛查费用将是 评估，以便筛选这些患者的指南可以 确立了习 最大限度提高诊断测试准确性的技术 将利用胸部X线摄影和产科X线摄影， 以超声波为例。 受试者工作特征分析 将被用来研究感知机制的影响， 胸部X线片解释的临床信息，并确定如何 这样的信息可以由放射科医师最好地使用。 使用 数学模型，以改善基于射线照相的预测 将检查测量结果，并根据胎儿年龄和体重估计 产科超声测量作为原型。 更广泛 水平，因为医疗决定必须经常在面对 不精确的信息，计算机实现的统计技术将 开发的目的是评估现有数据的不确定性如何影响 基于这些数据的决策的信心。