DERIVED THRESHOLDS IN MEDICAL DECISION MAKING

我们已经开发了一种新的方法来研究 医疗决策。阈值是疾病发生的概率 临床医生将决定是使用诊断测试还是启动 心理治疗。阈值概念以前是作为一种手段提出来的 计算理论上的最优概率以指导决策。 这些阈值概率可以使用决策分析来获得 技巧。相反，我们描述了一种推导医生的 (或一组医生)指导临床决策的实际阈值，a 描述性方法而不是规范性方法。我们的初步研究已经 在诊断试验的使用上显示出差异 疑似冠状动脉疾病按专科医生分类。这个 门槛模型也应该有助于检验 不同类型的患者。 我们现在有一个独特的机会将门槛模型应用于决策 涉及疑似肺栓塞的患者。在指导下 尤金·桑格博士，核医学学会已经完成了一项 肺部扫描的临床应用价值研究。该数据库包括 超过2000名患者，并包含以下信息 应用阈值模型。因为桑格博士愿意 合作，我们可以将一个有用的模型应用到一个重要的问题上 临床数据已经收集完毕。我们将利用决策 研究患者特征在以下方面的作用的阈值 医生对疑似肺栓塞患者的处理。 具体地说，我们将测试医生有更高 检测和治疗的阈值： 1.老年患者与年轻患者相比， 2.已知癌症患者与未患癌症患者， 3.有轻度和重度肺栓塞症状的患者， 4.没有保险的患者比有保险的患者。 这项研究将为医生们的决定提供更多的理解 疑似病人诊断试验的制作和使用 肺栓塞。

We have developed a new method for investigating quantitative aspects of medical decision-making. Thresholds are the probabilities of disease at which a clinician will decide to use a diagnostic test or to initiate therapy. The threshold concept has previously been advanced as a means of calculating theoretically optimal probabilities to guide decision-making. These threshold probabilities can be obtained using decision analytic techniques. In contrast, we describe a method of deriving a physician's (or group of physicians) actual thresholds governing clinical decisions, a descriptive rather than normative approach. Our preliminary studies have shown differences in the use of diagnostic tests for patients with suspected coronary artery disease by specialty type of physicians. The threshold model should also be useful for examining the importance of different types of patients. We now have a unique opportunity to apply the threshold model to decisions involving patients with suspected pulmonary embolism. Under the direction of Dr. Eugene Saenger, the Society for Nuclear Medicine has completed a study of the clinical usefulness of lung scans. The data base includes over two thousand patients and contains the information that is needed for applying the threshold model. Because of the willingness of Dr. Saenger to collaborate, we can apply a useful model to an important problem for which the clinical data has already been collected. We will use decision making thresholds to investigate the role of patient characteristics in physicians' management of patients with suspected pulmonary embolism. Specifically, we will test the hypotheses that physicians have higher thresholds for testing and treating: 1. elderly patients compared to younger patients, 2. patients with known cancer versus those who do not have cancer, 3. patients with mild versus severe symptoms of pulmonary embolism, 4. patients without insurance than for those with insurance. This research will provide a greater understanding of physicians' decision making and their use of diagnostic tests for patients with suspected pulmonary embolism.