We propose a three year continuation of our existing grant to develop systems for improved normative prescriptive decision making in an uncertain world beleaguered by conflicting perspectives and values. In particular we shall develop an environment for the construction and representation of deep decision models. We shall draw upon existing systems for building decision trees and influence diagrams. We shall provide both a computational environment and a nomenclature for describing relations in a decision space-relations that have traditionally remained hidden in both existing representations. We shall develop an explicit graphic representation for decision contexts and shall replace the pseudo-- programming representation of relations with high level descriptions. In developing the classification for modeling representation we shall draw on our existing library of over 400 decision analyses performed in individual patients and shall integrate this research with an array of application projects, now funded separately, which do not allow sufficient flexibility to explore the interesting conundrums they raise. We shall also develop an enhanced integrated environment for exploring decision problems on a commonly available family of microcomputers. Our system will be implemented in compatible versions of increasing complexity to allow utilization of the large installed base of moderate size (80286) machines. The enhanced environment will included facilities for limited-Memory Markov and Monte Carlo simulations. With those environments in hand, we shall explore the clinical utility of such complex models and the implications of using alterative distributions. We shall also develop an improved approach to multi-attribute decision problems. We shall explore the clinical and policy implications of different optimization rules. Finally we shall continue expanding our present tree critiquing system to capture those decisional errors now lurking invisibly within the pseudo-programing language. This research will improve the ability of other investigators to develop normative models, such as those associated with the recent national interest in outcome assessment and the establishment of guidelines to limit the growth of health care expenditures. The products of the research will be 1) a system for constructing and analyzing a broad class of decision problems, 2) a language and nomenclature for describing decision problems, and 3) a deeper understanding of the relations among decision variables and improved techniques for communicating the results of normative analyses to patients, physicians and the public.

Agency
National Institute of Health (NIH)
Institute
National Library of Medicine (NLM)
Type
Research Project (R01)
Project #
5R01LM004493-07
Application #
3373768
Study Section
Biomedical Library and Informatics Review Committee (BLR)
Project Start
1985-09-30
Project End
1993-09-29
Budget Start
1991-09-30
Budget End
1992-09-29
Support Year
7
Fiscal Year
1991
Total Cost
Indirect Cost
Name
Massachusetts Institute of Technology
Department
Type
Schools of Engineering
DUNS #
City
Cambridge
State
MA
Country
United States
Zip Code
02139
Katz, D; Payne, D; Pauker, S (2000) Early surgery versus conservative management of dissecting aneurysms of the descending thoracic aorta. Med Decis Making 20:377-93
Arbo, M D; Snydman, D R; Wong, J B et al. (2000) Cytomegalovirus immune globulin after liver transplantation: a cost-effectiveness analysis. Clin Transplant 14:19-27
Eckman, M H; Falk, R H; Pauker, S G (1998) Cost-effectiveness of therapies for patients with nonvalvular atrial fibrillation. Arch Intern Med 158:1669-77
Haimowitz, I J; Kohane, I S (1996) Managing temporal worlds for medical trend diagnosis. Artif Intell Med 8:299-321
Hunink, M G; Wong, J B; Donaldson, M C et al. (1995) Revascularization for femoropopliteal disease. A decision and cost-effectiveness analysis. JAMA 274:165-71
Sarasin, F P; Wong, J B; Levey, A S et al. (1995) Screening for acquired cystic kidney disease: a decision analytic perspective. Kidney Int 48:207-19
Wong, J B; Koff, R S; Tine, F et al. (1995) Cost-effectiveness of interferon-alpha 2b treatment for hepatitis B e antigen-positive chronic hepatitis B. Ann Intern Med 122:664-75
Haimowitz, I J; Le, P P; Kohane, I S (1995) Clinical monitoring using regression-based trend templates. Artif Intell Med 7:473-96
Hunink, M G; Wong, J B (1994) Meta-analysis of failure-time data with adjustment for covariates. Med Decis Making 14:59-70
Hunink, M G; Wong, J B; Donaldson, M C et al. (1994) Patency results of percutaneous and surgical revascularization for femoropopliteal arterial disease. Med Decis Making 14:71-81

Showing the most recent 10 out of 74 publications