Ament A, Hasman A
Department of Health Economics, University of Limburg, Maastricht, The Netherlands.
Int J Biomed Comput. 1993 Nov;33(3-4):179-97. doi: 10.1016/0020-7101(93)90034-4.
Decision-making, especially about test performance, is very complex in nature. Clinical decision analysis can provide tools for doctors which can be used in improving the ordering of laboratory tests. This article describes an approach which is relevant for medical practice and easy to understand, with the goal of obtaining better decisions rather than optimal solutions. The methodology enables a clear understanding of the possibilities and restrictions of test use and needs very little calculation. The cornerstone of the methodology is a graphical representation, by which the benefits of test use are evaluated. Furthermore, a simple algorithm has been developed that can be used to find the optimal solution in the case of two tests. In each step decision rules can be used. In a graphical representation the effect of combining tests can be easily evaluated. If a test combination is chosen one has to decide which sequence is optimal. Finally one has to choose between parallel and series testing. The gain in time of the parallel procedure (and possible gain in effectiveness of treatment) should be compared with the efficiency gain of series testing. The authors conclude that the developed methodology is closer to the intuitive decision-making process than the traditional decision-making techniques and therefore can be used in order to improve the rather intuitive decisions of doctors.
决策，尤其是关于检查执行的决策，本质上非常复杂。临床决策分析可以为医生提供工具，这些工具可用于改进实验室检查的医嘱开具。本文描述了一种与医学实践相关且易于理解的方法，其目标是获得更好的决策而非最优解决方案。该方法能让人清楚了解检查使用的可能性和限制，且计算量极小。该方法的基石是一种图形表示法，通过它来评估检查使用的益处。此外，还开发了一种简单算法，可用于在两项检查的情况下找到最优解决方案。在每一步都可使用决策规则。在图形表示中，可轻松评估联合检查的效果。如果选择了检查组合，就必须决定哪种顺序是最优的。最后，必须在平行检查和系列检查之间做出选择。应将平行程序的时间增益（以及治疗效果可能的增益）与系列检查的效率增益进行比较。作者得出结论，所开发的方法比传统决策技术更接近直观的决策过程，因此可用于改进医生相当直观的决策。
