Document Detail


Sequential decision making with continuous disease states and measurements: I. Theory.
MedLine Citation:
PMID:  2233155     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The question of whether to perform a continuous valued test to assess a continuous valued health state such as blood pressure or serum cholesterol is explored by decision analysis. Principal assumptions are that the underlying health state and measurement variability are both normally distributed, and that the impact of treatment on the utility of outcomes varies linearly with the underlying health state. Using Bayes' theorem, an expression for the expected utility of performing the test is derived and compared with immediate treatment or decision to withhold treatment. The calculations can be carried out with a pocket calculator and a table of the normal distribution. Iterating the analysis, a sequential decision making process is developed, leading to a series of no treat/test again and test again/treat thresholds with which a running average of independently obtained measurements can be compared to produce stepwise optimal results. The thresholds are readily calculated on a microcomputer. Finally, the conjugate-normal-linear model is extended to encompass the correlated observations that may be made on a single visit. This paper concentrates on the mathematics of decision making with continuous variables. The companion paper illustrates its application to diastolic blood pressure.
Authors:
C B Schechter
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Medical decision making : an international journal of the Society for Medical Decision Making     Volume:  10     ISSN:  0272-989X     ISO Abbreviation:  Med Decis Making     Publication Date:    1990 Oct-Dec
Date Detail:
Created Date:  1990-12-21     Completed Date:  1990-12-21     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8109073     Medline TA:  Med Decis Making     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  242-55     Citation Subset:  IM    
Affiliation:
Department of Community Medicine, Mt. Sinai School of Medicine, New York, New York 10029.
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MeSH Terms
Descriptor/Qualifier:
Bayes Theorem*
Decision Making*
Diagnosis, Computer-Assisted*
Diastole / physiology
Humans
Hypertension / diagnosis*,  therapy
Mathematical Computing
Microcomputers
Models, Cardiovascular*
Software

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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