Assessment of Diagnostic Technology in Health Care Rationale, Methods, Problems, and Directions (1989) / Chapter Skim
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1. Rationale for Assessment of Diagnostic Technology
1. Rationale for Assessment of Diagnostic Technology
Pages 8-22
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From page 8... ...
What are the consequences of Me medical profession's failure to evaluate diagnostic tests in a timely and rigorous manner? Why is such an evaluation important?
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From page 9... ...
This distinction is important when designing a technology assessment and interpreting its result; in the present discussion, however, we win refer only to efficacy. The efficacy of a diagnostic test should be measured in terms of the test's safety, its technical quality, its accuracy, its therapeutic impact, and its impact on the health of the patient (Fineberg et al.
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From page 10... ...
To can a test result a true positive or a true negative, one must determine the true state of the patient. This is usually accomplished by doing another test, called the "gold standard," which is considered sufficiently reliable to reveal He true state of the patient, and either confirm or refute Me study test result.
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From page 11... ...
In addition, some individuals have limited insurance coverage, and 35 million people in the United States have no health insurance (Annas 19861. The RAND health insurance experiment demonstrated that paying patients are sensilive to the costs of health care and that individuals responsible for almost ad of Heir health care costs incurred expenses about 50 percent less than individuals receiving free care (Newhouse et al.
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From page 12... ...
e Even if a test provides accurate information, the test result may have no impact on the therapeutic plan or on patient outcome. For example, randomized trials of emergency endoscopy for patients with upper gastrointestinal bleeding have shown that endoscopy provides additional diagnostic information, but that this information does not alter surgical rates, length of hospital stay, or patient mortality (Peterson et al.
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From page 13... ...
Missed diagnoses, which result from the use of tests win a high false-negative rate, may increase total health care costs if treatment that is begun at a later stage of the illness consumes more resources. Society's concern about the safety and efficacy of technology is matched by an equally strong interest in economic efficiency.
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From page 14... ...
As government has assumed a much larger role in financing heady care, the importance of efficient use of diagnostic procedures has also grown. Policymakers need accurate information about which technologies consume the least resources for a given outcome so that they can allocate limited health care
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From page 15... ...
For example, a patient usually undergoes a diagnostic procedure at the request of a physician, and therefore both have the same interest In knowing that a test is bow safe and efficacious. Tests are done when the pa-dent's history is consistent with a particular illness but the true disease state remains uncertain.
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Similarly, a recent comparative trial has demonstrated that even in high-r~sk pregnancies, auscultation yields equivalent results with EM in terms of both the fetus and the mother Mushy et al.
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For example, physicians play a large role in controlling the flow of society's health care resources. Our society expects physicians to make responsible decisions on how often and under what circumstances expensive diagnostic technologies win be used.
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The authors of the cooperative study on computed tomography, ultrasound, and gallium imaging in patients with fever stated: "We spent 17 months collecting data from two major teaching institutions [the Peter Bent Brigham and Johns Hopkins hospitals]
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From page 19... ...
The problems of conducting clinical teals of therapeutic technologies have been weD documented, and considerable research has been done with We aim of improving therapeutic teals (for example, see Meinert 1986~. Until recently, however, there has been less interest in teals of diagnostic technology.
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From page 20... ...
Dronfield, M.W., I-angrn an, M.~.S., Atkinson, M., et al. Outcome of endoscopy and barium radiography for acute upper gastrointestinal bleeding: Controlled tnal of 1,037 patients.
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A prospective study of computed tomography, ultrasound, and gallium imaging in patients with fever. Radiology 139:647-653, 1981.
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From page 22... ...
In Altman, S.H., and Blendon, R., eds., Medical Technology: The Culprit Behind Health Care Costs? Proceedings of the 1977 Sun Valley Forum on National Health, p.
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