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Proceedings of the AMIA Annual Fall Symposium logoLink to Proceedings of the AMIA Annual Fall Symposium
. 1997:173–177.

Decision-analytic valuation of clinical information systems: application to an alerting system for coronary angiography.

D S Bell 1
PMCID: PMC2233285  PMID: 9357611

Abstract

BACKGROUND: Many patients who need coronary angiography fail to get it and they have decreased survival as a result. This study demonstrates the use of decision analysis to predict the survival value of an alerting system for necessary angiography. METHODS: Data on the use of angiography and survival after myocardial infarction (MI) were taken from a published cohort study. The expected value of information (EVI) was calculated for alerts that angiography is necessary. Maximal EVI was estimated by assuming that alert advice is always followed. Sensitivity analysis relaxed that assumption. Hypothetical data were generated to demonstrate EVI analysis for narrower subcohorts. RESULTS: A maximally effective alerting system would increase survival in this cohort by 2.2% over 1-4 years after MI. The system would therefore need to be applied to 46 people to prevent one death. Its effectiveness would decrease linearly with decreasing adherence to its advice. Given sufficiently detailed outcome and prevalence data, EVI analysis could also predict the survival value of the system's individual data elements. CONCLUSIONS: An alerting system that ensures necessary angiography post-MI should have a survival value comparable to the value of t-PA over streptokinase. EVI analysis provides a framework for predicting the overall effectiveness of information systems and for understanding the contribution of individual features to a system's effectiveness.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brook R. H., Chassin M. R., Fink A., Solomon D. H., Kosecoff J., Park R. E. A method for the detailed assessment of the appropriateness of medical technologies. Int J Technol Assess Health Care. 1986;2(1):53–63. doi: 10.1017/s0266462300002774. [DOI] [PubMed] [Google Scholar]
  2. Evidence-Based Medicine Working Group Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA. 1992 Nov 4;268(17):2420–2425. doi: 10.1001/jama.1992.03490170092032. [DOI] [PubMed] [Google Scholar]
  3. Freemantle N., Drummond M. Should clinical trials with concurrent economic analyses be blinded? JAMA. 1997 Jan 1;277(1):63–64. [PubMed] [Google Scholar]
  4. Gorry G. A., Barnett G. O. Sequential diagnosis by computer. JAMA. 1968 Sep 16;205(12):849–854. [PubMed] [Google Scholar]
  5. Laupacis A., Sackett D. L., Roberts R. S. An assessment of clinically useful measures of the consequences of treatment. N Engl J Med. 1988 Jun 30;318(26):1728–1733. doi: 10.1056/NEJM198806303182605. [DOI] [PubMed] [Google Scholar]
  6. Mark D. B., Hlatky M. A., Califf R. M., Naylor C. D., Lee K. L., Armstrong P. W., Barbash G., White H., Simoons M. L., Nelson C. L. Cost effectiveness of thrombolytic therapy with tissue plasminogen activator as compared with streptokinase for acute myocardial infarction. N Engl J Med. 1995 May 25;332(21):1418–1424. doi: 10.1056/NEJM199505253322106. [DOI] [PubMed] [Google Scholar]
  7. Pauker S. G., Kassirer J. P. Decision analysis. N Engl J Med. 1987 Jan 29;316(5):250–258. doi: 10.1056/NEJM198701293160505. [DOI] [PubMed] [Google Scholar]
  8. Phelps C. E., Mushlin A. I. Focusing technology assessment using medical decision theory. Med Decis Making. 1988 Oct-Dec;8(4):279–289. doi: 10.1177/0272989X8800800409. [DOI] [PubMed] [Google Scholar]
  9. Selby J. V., Fireman B. H., Lundstrom R. J., Swain B. E., Truman A. F., Wong C. C., Froelicher E. S., Barron H. V., Hlatky M. A. Variation among hospitals in coronary-angiography practices and outcomes after myocardial infarction in a large health maintenance organization. N Engl J Med. 1996 Dec 19;335(25):1888–1896. doi: 10.1056/NEJM199612193352506. [DOI] [PubMed] [Google Scholar]
  10. Shiffman R. N., Leape L. L., Greenes R. A. Translation of appropriateness criteria into practice guidelines: application of decision table techniques to the RAND criteria for coronary artery bypass graft. Proc Annu Symp Comput Appl Med Care. 1993:248–252. [PMC free article] [PubMed] [Google Scholar]
  11. Thompson M. S. Decision-analytic determination of study size. The case of electronic fetal monitoring. Med Decis Making. 1981;1(2):165–179. doi: 10.1177/0272989X8100100206. [DOI] [PubMed] [Google Scholar]
  12. Weinstein M. C., Siegel J. E., Gold M. R., Kamlet M. S., Russell L. B. Recommendations of the Panel on Cost-effectiveness in Health and Medicine. JAMA. 1996 Oct 16;276(15):1253–1258. [PubMed] [Google Scholar]

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