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T C Bailey

Publications and source records attributed to T C Bailey.

40 records · Page 3Linked to original sources

Statistical process control methods for expert system performance monitoring.

The literature on the performance evaluation of medical expert system is extensive, yet most of the techniques used in the early stages of system development are inappropriate for deployed expert systems. Because extensive clinical and informatics expertise and resources are required to perform evaluations, efficient yet effective methods of monitoring performance during the long-term maintenance phase of the expert system life cycle must be devised. Statistical process control techniques provide a well-established methodology that can be used to define policies and procedures for continuous, concurrent performance evaluation. Although the field of statistical process control has been developed for monitoring industrial processes, its tools, techniques, and theory are easily transferred to the evaluation of expert systems. Statistical process tools provide convenient visual methods and heuristic guidelines for detecting meaningful changes in expert system performance. The underlying statistical theory provides estimates of the detection capabilities of alternative evaluation strategies. This paper describes a set of statistical process control tools that can be used to monitor the performance of a number of deployed medical expert systems. It describes how p-charts are used in practice to monitor the GermWatcher expert system. The case volume and error rate of GermWatcher are then used to demonstrate how different inspection strategies would perform.

Evaluation Studies as Topic↗

Spatial statistical methods in health.

The study of the geographical distribution of disease incidence and its relationship to potential risk factors (referred to here as "geographical epidemiology") has provided, and continues to provide, rich ground for the application and development of statistical methods and models. In recent years increasingly powerful and versatile statistical tools have been developed in this application area. This paper discusses the general classes of problem in geographical epidemiology and reviews the key statistical methods now being employed in each of the application areas identified. The paper does not attempt to exhaustively cover all possible methods and models, but extensive references are provided to further details and to additional approaches. The overall aim is to provide a picture of the "current state of the art" in the use of spatial statistical methods in epidemiological and public health research. Following the review of methods, the main software environments which are available to implement such methods are discussed. The paper concludes with some brief general reflections on the epidemiological and public health implications of the use of spatial statistical methods in health and on associated benefits and problems.

Cluster Analysis↗

Evaluation and financial impact of imipenem/cilastatin dosing in elderly patients based on renal function and body weight.

OBJECTIVE: To evaluate the financial impact of adjusting imipenem/cilastatin (IC) dosages in elderly patients based on estimated creatinine clearance (Cl cr) and body weight. DESIGN: Retrospective cost-savings analysis. SETTING: A 500-bed, university-affiliated, tertiary-care hospital. MAIN OUTCOME MEASURES: All courses of IC administered to patients over age 60 during a four-month period were retrospectively assessed for appropriateness based on both dosing interval and dosage. Manufacturer's guidelines for adjusting the IC dosage based on estimated CL cr and body weight were used to define appropriate dosing. The cost savings that could have been realized by appropriately adjusting IC dosage was calculated for the study period and extrapolated to project an annual cost savings. RESULTS: Only 37 percent of patient days of therapy and 32 percent of therapy courses were judged as appropriate based on both dose amount and interval. The projected annual cost savings that could have been realized by appropriately adjusting IC dosage based on estimated Cl cr and body weight was $11,500. CONCLUSIONS: Adjustment of IC dosages in elderly patients based on estimated Cl cr and body weight can result in significant cost savings.

Age Factors↗

A randomized, prospective evaluation of an interventional program to discontinue intravenous antibiotics at two tertiary care teaching institutions.

To evaluate a program to discontinue intravenous antibiotics at two teaching hospitals, 102 inpatients meeting eligibility criteria were randomly assigned to two groups. In one group, patients' physicians were contacted by pharmacists with recommendations to discontinue intravenous antibiotic therapy; in the other, patients were simply observed. Measured outcomes were antibiotic costs, length of stay, need to restart intravenous antibiotics, in-hospital mortality, and 30-day readmissions. The intervention significantly reduced mean antibiotic costs per patient ($19.82 vs $35.84, p = 0.03), but related labor costs exceeded this benefit. Readmissions were significantly more frequent in the intervention group than in the control group (29% vs 9.8% p = 0.02), but they were not infection related. No impact was demonstrated on the other measured outcomes. Institutions considering such programs or with one in place should conduct similar evaluations.

Administration, Oral↗