Decision Analysis in Clinical Patient Management with an Application to the Pleural-Effusion Syndrome

by Allen S. Ginsberg

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Patient management is defined as the sequential decision problem faced by the clinical physician or other health worker when a course of action must be chosen for a patient exhibiting some set of abnormal symptoms. The proposed approach relies heavily on the concepts of decision analysis. It considers (1) the uncertainties and risks inherent in the decision problem, i.e., dollar costs and risks of complications associated with a diagnostic test or treatment, including death; (2) the diagnostic value of the tests; (3) patient characteristics; and (4) changes in the state of the patient with the passage of time. A model and set of data are presented for the syndrome of pleural effusion. The data include the 43 disease states related to pleural effusion, more than 50 associated diagnostic tests, and the deterministic and probabilistic data necessary for solution of the model. Suggestions are offered for implementing the proposal as a clinical tool, and techniques for validating the methods are described.

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