While unreliable medical tests often must be repeated, the value of such repetitions may be elusive. This paper attempts to clarify some influences upon the diagnostic usefulness of repeated tests. Reliability is a complex factor whose effect varies with patient heterogeneity and with the decision rule used to resolve conflicts in test results. Two informal rules and one formal statistical method are examined in this paper. In all of these cases, differences in reliability which depend on the disease status of the patient appear to be critical. These differences may alter the value of tests and provide important information that can help us to distinguish between persons with and without a disease. Illustrations of this phenomenon are provided from published data on the hemoccult test in silent colon cancer and the platelet monoamine oxidase test in chronic schizophrenia. These findings may provide heuristics to refine clinical intuition about the value of repeated tests. They also clarify the need to estimate test reliabilities for both disease and nondisease groups.

Clinical Enzyme Tests↗

PubMed1982

How decisions are reached: physician and patient.

How can physicians consider patient preferences in reaching medical decisions? Physicians may intuitively agree about the importance of considering all significant aspects of alternative therapies, including patient preferences. However, it may be difficult to resolve or quantitate critical trade-offs between benefit and risk, and quality and quantity of life. One way to do this is decision analysis, a systematic approach to decision making under conditions of uncertainty. Behavioral research involving the assessment of values and probabilities may bear on the adequacy of decision analysis and help us to better understand patient preferences in clinical decisions.

Costs and Cost Analysis↗

PubMed1982

Accreditation: chance for education as well as evaluation.

The accreditation process of the Joint Commission on Accreditation of Hospitals not only is a mechanism for evaluation of hospital operations but also can be en educational experience for hospital leadership. The Joint Commission encourages trustees to participate actively in the on-site survey, to be aware of survey findings, to help correct problems identified in the survey, and to participate in their hospital's quality assurance program.

Accreditation↗

PubMed1981

Decision analysis and clinical judgment. A re-evaluation.

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Clinical Competence↗