Optimal Timing of Medical Decisions

医疗决策的最佳时机

• 批准号: 341415-2012
• 负责人: Shechter, Steven
• 金额: $ 1.53万
• 依托单位: University of British Columbia
• 依托单位国家: 加拿大
• 项目类别: Discovery Grants Program - Individual
• 财政年份: 2015
• 资助国家: 加拿大
• 起止时间: 2015-01-01 至 2016-12-31
• 项目状态: 已结题
• 来源: https://www.nserc-crsng.gc.ca/ase-oro/Details-Detailles_eng.asp?id=572248
• 关键词: Optimal; Timing; Medical; Decisions

Questions regarding the proper timing of various medical interventions arise frequently in health care. How often should patients go for laboratory tests to measure the progress of an existing disease? What is the optimal time to initiate a therapy or to switch therapies when one appears to lose its effectiveness? These are difficult decisions because of the need to trade off costs and benefits under uncertainty. My research program aims to develop and apply advanced analytical techniques from the field of operations research (OR) to aid decision making for these types of clinical timing questions. The methodological tools of OR were designed specifically to deal with complex decision making under uncertainty, and have been applied for over 50 years in a variety of application areas. As medical decision making has become increasingly complex and costly, and patient medical data has become more readily available, these techniques have become extremely relevant for seeking cost-effective solutions to health care problems. Clinical timing decisions alone provide a large class of difficult decisions that are well suited for study using these analytical techniques. Two specific projects will involve key timing decisions concerning patients with chronic kidney disease (CKD): 1) when is the optimal time to prepare an arteriovenous (AV) fistula for patients who eventually start dialysis, and 2) how often should patients on the kidney transplant waitlist be screened for comorbidities that may put them at increased surgical risks should a donation become available? Investigating these questions will require the development of validated, data-driven decision models, and their solutions will require the development of advanced OR methods. This reseach has the potential to benefit the many patients living with CKD as well as the health care organizations that treat them.

关于各种医疗干预的适当时机的问题在卫生保健中经常出现。患者应该多久去一次实验室检查，以衡量现有疾病的进展？什么是开始治疗或转换治疗的最佳时间，当一个似乎失去了它的有效性？这些都是困难的决定，因为需要在不确定的情况下权衡成本和收益。 我的研究计划旨在开发和应用运筹学（OR）领域的先进分析技术，以帮助这些类型的临床时机问题的决策。OR的方法工具是专门为处理不确定性下的复杂决策而设计的，并且已经在各种应用领域应用了50多年。随着医疗决策变得越来越复杂和昂贵，并且患者医疗数据变得更加容易获得，这些技术对于寻求医疗保健问题的经济有效的解决方案变得极其相关。临床时机决策本身就提供了一大类非常适合使用这些分析技术进行研究的困难决策。 两个具体项目将涉及慢性肾脏病（CKD）患者的关键时间决策：1）何时为最终开始透析的患者准备动静脉（AV）瘘的最佳时间，以及2）肾移植等待名单上的患者多久应该筛查一次合并症，如果捐赠可用，可能会增加他们的手术风险？ 调查这些问题将需要开发经过验证的数据驱动的决策模型，其解决方案将需要开发先进的OR方法。 这项研究有可能使许多CKD患者以及治疗他们的医疗保健组织受益。