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Assessment of Diagnostic Technology in Health Care

Assessment of Diagnostic Technology in Health Care

Rationale, Methods, Problems, and Directions

  • Publisher: National Academies Press
  • ISBN: 9780309040990
  • eISBN Pdf: 9780309535885
  • Place of publication:  United States
  • Year of digital publication: 1989
  • Month: January
  • Pages: 152
  • DDC: 615
  • Language: English

Technology assessment can lead to the rapid application of essential diagnostic technologies and prevent the wide diffusion of marginally useful methods. In both of these ways, it can increase quality of care and decrease the cost of health care. This comprehensive monograph carefully explores methods of and barriers to diagnostic technology assessment and describes both the rationale and the guidelines for meaningful evaluation. While proposing a multi-institutional approach, it emphasizes some of the problems involved and defines a mechanism for improving the evaluation and use of medical technology and essential resources needed to enhance patient care.

  • Assessment of Diagnostic Technology in Health Care
  • Copyright
  • Preface
  • Contents
  • Introduction
    • REFERENCES
  • 1 Rationale for Assessment of Diagnostic Technology
    • THE PATIENT'S PERSPECTIVE
      • Safety
      • Efficacy
      • Economic Issues
      • The Benefits of High-Quality Studies
      • The Risks of Poor or Absent Assessment Data
      • Summary: The Patient's Perspective
    • SOCIETY'S PERSPECTIVE
      • Safety and Efficacy
      • Economic Issues
      • Summary: Society's Perspective
    • THE PHYSICIAN'S PERSPECTIVE
      • Safety and Efficacy
      • Economic Issues
      • Summary: The Physician's Perspective
    • SUMMARY
    • REFERENCES
  • 2 The Use of Diagnostic Tests: A Probabilistic Approach
    • FIRST PRINCIPLES
    • INTERPRETING TEST RESULTS: THE POSTTEST PROBABILITY
      • Important Definitions
      • The Assumptions of Bayes' Theorem
    • THE PRETEST PROBABILITY OF DISEASE
    • MEASURING THE PERFORMANCE CHARACTERISTICS OF DIAGNOSTIC TESTS
      • Designing Studies of Test Performance
    • EXPECTED-VALUE DECISIONMAKING
      • Setting Up the Decision Tree
      • Weighing the Outcomes for Quality of Life
      • Calculating the Expected Value of the Treatment Options
    • THE CHOICE AMONG DOING NOTHING, TESTING, OR STARTING TREATMENT
    • SUMMARY
    • Glossary Of Terms
    • REFERENCES
  • 3 Assessment: Problems and Proposed Solutions
    • MEASURES OF CLINICAL EFFICACY
      • Technical Capability
      • Sensitivity and Specificity
      • Diagnostic Impact
      • Therapeutic Impact
      • Impact on Clinical Outcomes
    • THE SYSTEM OF TECHNOLOGY ASSESSMENT IN THE UNITED STATES
      • The Pyramid
    • PROBLEMS WITH THE CURRENT SYSTEM
    • RANDOMIZED TRIALS OF DIAGNOSTIC TESTS
      • Limitations of Randomized Trials
      • Trial Design
    • "OFF THE GOLD STANDARD"
    • "ON THE GOLD STANDARD"
    • A PROPOSAL FOR MODEL-DRIVEN TECHNOLOGY ASSESSMENT
      • A Technology Should Be Compared with a Competing Technology
    • STUDIES SHOULD BE PLANNED BEFORE ENROLLING THE FIRST PATIENT
    • ALL THE DATA THAT ARE NEEDED FOR CLINICAL DECISION MAKING SHOULD BE COLLECTED
    • BIAS IN PATIENT SELECTION SHOULD BE AVOIDED
    • PATIENTS SHOULD BE OBSERVED FOR ADVERSE EFFECTS OF THE INDEX TEST
    • INTERPRETATION OF DATA SHOULD BE FREE OF BIAS
    • INTEROBSERVER DISAGREEMENT SHOULD BE MEASURED
    • THERE SHOULD BE ENOUGH PATIENTS TO REPORT THE RESULTS IN CLINICALLY USEFUL SUBGROUPS OF PATIENTS
    • SUMMARY
    • REFERENCES
  • 4 Primary Assessment of Diagnostic Tests: Barriers to Implementation
    • PLANNING AND PROTOCOL DEVELOPMENT
      • Choosing a Clinical Condition
      • Patient Population
      • Endpoints and Study Design
    • ACCURACY
    • OUTCOME
    • COMBINED STUDIES: ACCURACY AND OUTCOME
    • SHORT-TERM OUTCOMES: A SYNTHETIC APPROACH
      • Economic Analysis
      • Efficacy Versus Effectiveness
      • Comparative Assessment
      • Sample Size
      • Timing the Assessment
      • Obtaining Institutional Support
      • Summary: Planning and Protocol Development
    • RECRUITMENT
      • Referring Physicians
      • Patients and Informed Consent
      • Summary: Recruitment
    • IMPLEMENTATION
      • Logistics of Randomization
      • Obstacles to Data Gathering
    • COLLECTING INPUT DATA
    • PERFORMING THE STUDY TESTS
    • FOLLOW-UP STUDIES
      • Summary: Implementation
    • TEST INTERPRETATION
      • Accuracy
      • Consistency and Multiple-Test Interpretations
      • Objectivity
    • REPORTING
    • CONCLUSION
    • REFERENCES
  • 5 Costs and Sources of Funding
    • FACTORS THAT AFFECT STUDY COSTS
      • Planning and Protocol Development
    • PERSONNEL
    • PROTOCOL DEVELOPMENT
    • SAMPLE SIZE
      • Decision-Analytic Modeling
      • Implementation
    • PATIENT ACCRUAL
    • DATA COLLECTION
    • PATIENT FOLLOW-UP
    • ADDITIONAL MEDICAL EXPENSES
      • Data Interpretation
    • UNREIMBURSED PATIENT COSTS
    • EXAMPLES FROM ACTUAL STUDIES
      • Cost of Diagnostic Tests
      • Personnel Costs
      • Multi-Institutional Studies
    • SOURCES OF FUNDING
      • Proposals for Funding
    • SUMMARY AND CONCLUSIONS
    • REFERENCES
  • 6 A National Program for Assessing Diagnostic Technology
    • A MULTICENTER CONSORTIUM
    • CHARACTERISTICS OF THE CENTERS
      • Responding to Requests for a Technology Assessment
      • Choice of a Study Method
    • ESTIMATED TIMETABLE
    • REVIEW OF RESULTS AND RECOMMENDATIONS
    • STUDY PERSONNEL
    • BUDGET
    • MULTICENTER STUDIES—A CAUTION
    • ONGOING TECHNOLOGY ASSESSMENT BY MEDICAL INSTITUTIONS
    • REFERENCES
  • 7 Problems of Multi-Institutional Studies
    • STUDY STRUCTURE AND ORGANIZATION
      • Steering Committee
      • Coordinating Center
      • Advisory Committee
      • Central Observers
    • STUDY DESIGN AND PROTOCOL DEVELOPMENT
      • Focus and Compromise
      • Reproducibility Versus Generalizability
    • PATIENT RECRUITMENT
    • QUALITY CONTROL AND MONITORING
    • SUMMARY AND CONCLUSION
    • REFERENCES
  • The Authors

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