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Biomedical subjects

D M Eddy

Publications and source records attributed to D M Eddy.

At least 91 records · Page 5Linked to original sources
PubMed1982

The costs and effects of screening for cancer among asbestos-exposed workers.

Several million workers previously exposed to asbestos are at risk each year for developing asbestosis or cancer as a result of this exposure. We have reviewed the data on the general effectiveness of screening for the two most common cancers found in these workers (lung cancer and colo-rectal cancer) and have compared the relative benefits expected from screening workers for colon or lung cancer 10, 15, 20 or 25 yr after their initial exposure. Although lung cancer is common, there is little evidence at present that screening for this disease is effective in reducing mortality. Colon cancer is less common, there is more evidence that screening is effective, and the relatively high risk of dying from this disease in asbestos workers makes screening useful. The cost per additional year of life extended by screening is only a few hundreds of dollars, making colon cancer screening programs for asbestos workers considerably more cost-effective than most other screening programs. We conclude that occupational safety agencies should consider implementing screening programs for colon cancer in workers exposed to asbestos over 10 yr ago.

Asbestos↗
PubMed1982

Timing of repeated monitoring tests.

This article describes a method for evaluating some of the medical, economic, and personal consequences of different policies of monitoring patients for various disorders. The problem is difficult because it is dynamic. Most conditions develop over time, and in many cases the sensitivity of the test as well as the cost of treatment and the prognosis of the patient depend on how far the disorder has progressed at the time the test is performed. This model incorporates all these factors and enables one to estimate the consequences of applying several tests in different orders and frequencies. The most important assumption in the model is that the outcomes are functions of the earliness of detection (as defined in Figure 3). Failure of this assumption can sometimes be corrected for, but the equations are considerably more complicated and the estimation of parameters more difficult. The progression assumption, that once a particular condition is detectable it is always detectable, is a strong assumption that does not admit the possibility of random false-negative test results. The presence of random false-negative results, however, can be tested for and a random false-negative rate can be included in the model if this is important. This model, like any model, is limited by how well the assumed functional forms (for example, the functional form of the occult interval) represent the actual functional relationships, and by the quality of the data used for estimation of parameters. In some cases, such as screening for breast cancer, good data are available and different functional forms can be tried. In the case of most monitoring tests, however, good data are not currently available. The strength of the model is that it can be used to analyze rather complicated problems. Its main role is to provide general insights, to identify what data should be collected, and to suggest how these data can be used.

Cost-Benefit Analysis↗
PubMed1981

The economics of cancer prevention and detection: getting more for less.

Economics has been described as the science of allocating scarce resources. Given the magnitude of the cancer problem and the obvious impracticality of eliminating every carcinogen or screening every person for every disease, our success in preventing cancer will depend greatly on our ability to use available resources efficiently. This paper will illustrate the principles of economics applied to the early detection of cancer of the lung, breast, colon, and cervix. The objective is to deliver the highest benefit possible. The available options include choice of the population to be screened (e.g., ages and risk factors), the tests to be used, and the frequency of examinations. The issues to be considered in making these choices include the expected benefits of early detection, the risks and side effects of the tests, the acceptibility of the program, the costs of the tests, the consequences of false positives, changes in therapy, and decrease in disability and lost earnings. The final choice of an "optimal" early detection protocol requires estimating and comparing these and other outcomes. This is a question of expectations and values; there is no "correct" answer or "best" program. These issues also have implications for the feasibility and prospects for third-party reimbursement for cancer prevention activities.

Adult↗
PubMed1980

Evaluation of a screening program in oncology.

As physicians and decision makers we constantly face difficult questions concerning screening tests for cancer. Unfortunately, we cannot determine the most effective and efficient screening program from clinical trials alone. One approach is to use a mathematical decision model that integrates and generalizes the information gained through clinical research and clinical judgment. The basic steps are to define the main components of the problem, identify the relationship between the components, and translate those relationships into quantitative terms. The model is a planning tool. It does not generate answers. It generates insights and understanding, which, when combined with existing research results and clinical experience, can help rationalize our current cancer screening policies and the design of future research.

Cost-Benefit Analysis↗
PubMed1978

Vitrectomy.

Explore the source record for details and available documents.

Diabetic Retinopathy↗
PubMedDate not supplied

Enhancing performance measurement: NCQA's road map for a health information framework. National Committee for Quality Assurance.

Measuring the quality of health care delivery is one of the most critical challenges facing US health care. Performance measurement can be used to track the quality of care that health plans and medical groups deliver, but effective performance measurement requires timely access to detailed and accurate data. In 1996, the National Committee for Quality Assurance (NCQA) commissioned a report to learn what actions would improve health plans' capacity to electronically report performance data for the Health Plan Employer Data and Information Set (HEDIS). Tracking clinical performance will require not just clinical data stored in information systems, but an integrated health information framework. Seven features are essential to this framework: (1) it specifies data elements; (2) it establishes linkage capability among data elements and records; (3) it standardizes the element definitions; (4) it is automated to the greatest possible extent; (5) it specifies procedures for continually assessing data quality; (6) it maintains strict controls for protecting security and confidentiality of the data; and (7) it specifies protocols for sharing data across institutions under appropriate and well-defined circumstances. Health plans should anticipate the use of computerized patient records and prepare their data management for an information framework by (1) expanding and improving the capture and use of currently available data; (2) creating an environment that rewards the automation of data; (3) improving the quality of currently automated data; (4) implementing national standards; (5) improving clinical data management practices; (6) establishing a clear commitment to protecting the confidentiality of enrollee information; and (7) careful capital planning. Health care purchasers can provide the impetus for implementing the information framework if they demand detailed, accurate data on the quality of care.

Forms and Records Control↗
PubMedDate not supplied

The value of screening for glaucoma with tonometry.

This paper estimates the value of performing Schiotz tonometry to detect glaucoma in an asymptomatic patient. About 9% of adults over 40 will be found on a single Schiotz tonometry test to have elevated intraocular pressure (IOP). On work-up, about 1 out of 50 of these individuals with high IOP will be found to have glaucoma. Tonometry, however, will miss about half of all patients with glaucoma because they do not have elevated IOPs at the time of the test. Pilocarpine or epinephrine are the most commonly used drugs to treat the disease, but they are not always effective in lowering a patient's IOP or in stopping the progression of field defects. From the available evidence it does not appear that earlier diagnosis makes a substantial difference in the patient's outcome. If all individuals over 40 years of age in a city of 1,000,000 were screened, the total cost of finding and treating about 484 people with chronic simple glaucoma would be on the order of $4,944,866 or about $13,000 per patient potentially benefited. Screening with tonometry does not appear to be warranted.

Adult↗
PubMedDate not supplied

The workup of the asymptomatic patient with a positive fecal occult blood test.

Twenty-two protocols for working up an asymptomatic patient who has a positive fecal occult blood test were evaluated using existing information on the prevalences of cancers, adenomas and other conditions in such patients; the natural history of colorectal cancer; the effectiveness of screening tests; risks; and costs. The authors estimate the impacts of the 22 workup strategies on outcomes such as the chance of finding an existing cancer or adenoma, risks (bleeding and perforation), and financial costs of different strategies involving rigid sigmoidoscopy, flexible sigmoidoscopy, barium enema, and colonoscopy. Two protocols were particularly effective. The first involves performing a barium enema study and following it with colonoscopy; if colonoscopy is negative, the barium enema study should be repeated. The second is to perform colonoscopy and if it is negative, follow it with a barium enema study.

Algorithms↗