Abstract

The Division of Computer Medicine at Boston's Beth Israel Hospital has developed a clinical computing system which has accumulated data on more than 500,000 patients. I propose to develop medical decision support computer programs which help select test and management strategies in a variety of medical conditions. When possible, these programs will be based on data from our large patient database. The techniques of decision analysis (1,2) will be used to help structure and evaluate clinical problems. By having a large patient database linked to decision analysis programs, local population bias will be accounted for, and local clinical expertise will be factored into the decision analysis, rather than diluted out of the analysis. It is my hypothesis that the evailability of flexible decision analysis programs on our hospital systems will spur the development of a library of decision trees of common clinical problems, developed and approved by expert clinicians. These analyses could then be the basis of decision support aids on our hospital-wide system. I believe that the use of decision-supported test strategy selection will reduce the number of diagnostic tests ordered for many medical problems and consequently reduce patient morbidity, mortality, and hospitalization costs. These programs will have the additional benefit of teaching house staff how to order and interpret diagnostic tests.

  Funding Agency

Agency
National Institute of Health (NIH)
Institute
National Library of Medicine (NLM)
Type
Unknown (R23)
Project #
5R23LM004260-02
Application #
3449501
Study Section
Biomedical Library Review Committee (BLR)
Project Start
1984-08-01
Project End
1987-07-31
Budget Start
1985-08-01
Budget End
1986-07-31
Support Year
2
Fiscal Year
1985
Total Cost
Indirect Cost

  Institution

Name
Beth Israel Deaconess Medical Center
Department
Type
DUNS #
076593722
City
Boston
State
MA
Country
United States
Zip Code

  Publications

Herrmann, F R; Safran, C; Levkoff, S E et al. (1992) Serum albumin level on admission as a predictor of death, length of stay, and readmission. Arch Intern Med 152:125-30
Safran, C; Porter, D; Rury, C D et al. (1990) ClinQuery: searching a large clinical database. MD Comput 7:144-53
Seward, S J; Safran, C; Marton, K I et al. (1990) Does the mean corpuscular volume help physicians evaluate hospitalized patients with anemia? J Gen Intern Med 5:187-91
Phillips, R S; Safran, C; Aronson, M D et al. (1989) Should women be tested for gonococcal infection of the cervix during routine gynecologic visits? An economic appraisal. Am J Med 86:297-302
Safran, C; Phillips, R S (1989) Interventions to prevent readmission. The constraints of cost and efficacy. Med Care 27:204-11
Safran, C; Porter, D; Lightfoot, J et al. (1989) ClinQuery: a system for online searching of data in a teaching hospital. Ann Intern Med 111:751-6
Levkoff, S E; Safran, C; Cleary, P D et al. (1988) Identification of factors associated with the diagnosis of delirium in elderly hospitalized patients. J Am Geriatr Soc 36:1099-104
Safran, C; Greenes, R A; Bynum, T E et al. (1988) Diagnosis of cholestasis: an analytic view. Med Decis Making 8:102-9
Barbash, G I; Safran, C; Ransil, B J et al. (1987) Need for better severity indexes of acute myocardial infarction under diagnosis-related groups. Am J Cardiol 59:1052-6
Safran, C; Porter, D; Slack, W V et al. (1987) Diagnosis-related groups. A critical assessment of the provision for comorbidity. Med Care 25:1011-4

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