Medical decision making : an international journal of the Society for Medical Decision Making
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The area under the receiver operating characteristic (ROC) curve of a diagnostic test can be used as a summary measure for its discriminative ability. If only a single point of an ROC curve is available, then the entire form of the ROC curve is unknown and the area under it cannot be calculated. ⋯ From these bounds, the minmax approximations are obtained. Compared to only assuming monotonicity, assuming that the unknown ROC curve is concave renders a higher minmax approximation for the area under it, with tighter bounds.
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Health plans, employer groups, and medical providers offer telephone-based nurse triage services to provide ready access to medical advice and information to assist patients in making decisions about their medical needs. The purpose of this study is to assess patient adherence to nurse triage recommendations. ⋯ The reported adherence levels are lower than those obtained from self-reported data reported elsewhere. Given the inherent limitations of both types of data, actual telephone-based nurse triage adherence may lie between the 2 levels.
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Comparative Study
A comparison of Bayesian methods for profiling hospital performance.
There is a growing interest in the use of Bayesian methods for profiling institutional performance. In the literature, several studies have compared different frequentist methods for classifying hospitals as performance outliers. The purpose of this study was to compare 4 different Bayesian methods for classifying hospitals as outcomes outliers, using 30-day hospital-level mortality rates for a cohort of acute myocardial infarction patients as a test case. ⋯ In only 4 of 19 comparisons, was there good agreement between the different methods (0.40 < or = kappa < or = 0.75). Methods based on ranking institutions were relatively insensitive to differences between hospitals. These inconsistencies raise questions about the choice of methods for classifying hospital performance, and they suggest a need for urgent research into which methods are best able to discriminate between institutions and which are most meaningful to decision makers.
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Comparative Study
Predicting elderly outpatients' life-sustaining treatment preferences over time: the majority rules.
This study describes longitudinal changes in the composition and accuracy of modal life-sustaining treatment preferences as predictors of patients' treatment preferences. ⋯ Models using modal preferences are useful to patients, surrogates, and physicians when trying to accurately discern end-of-life treatment choices, but the models must be updated periodically.