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Biomedical subjects

C E Phelps

Publications and source records attributed to C E Phelps.

At least 19 recordsLinked to original sources
PubMed2001

Children's responses to overt and relational aggression.

Investigated children's responses for coping with overt and relational aggression. Children in Grades 3 through 6 (N = 491) in a rural Midwestern public school district completed a survey designed to assess how students cope when they are the targets of peer aggression. Children endorsed greater use of internalizing and distancing strategies for coping with relational aggression and greater use of externalizing strategies for coping with overt aggression. In addition, older children reported greater use of externalizing and less use of internalizing and distancing strategies than younger children. Significant differences were also found between boys and girls. Regardless of type of aggression, girls endorsed greater use of problem-solving and support strategies and less use of externalizing strategies than boys. Coping of high target children and of children who frequently received prosocial treatment from peers were also examined.

Adaptation, Psychological↗
PubMed1997

Economic foundations of cost-effectiveness analysis.

To address controversies in the applications of cost-effectiveness analysis, we investigate the principles underlying the technique and discuss the implications for the evaluation of medical interventions. Using a standard von Neumann-Morgenstern utility framework, we show how a cost-effectiveness criterion can be derived to guide resource allocation decisions, and how it varies with age, gender, income level, and risk aversion. Although cost-effectiveness analysis can be a useful and powerful tool for resource allocation decisions, a uniform cost-effectiveness criterion that is applied to a heterogeneous population level is unlikely to yield Pareto-optimal resource allocations.

Cost-Benefit Analysis↗
PubMed1997

The cost-effectiveness of magnetic resonance imaging for patients with equivocal neurological symptoms.

OBJECTIVE: To determine the incremental cost-effectiveness of magnetic resonance imaging (MRI) and computed tomography (CT) in young adults presenting with equivocal neurological signs and symptoms. DESIGNS AND METHODS: A decision analysis of long-term survival using accuracy data from a diagnostic technology assessment of MRI and CT in patients with suspected multiple sclerosis, information from the medical literature, and clinical assumptions. MAIN RESULTS: In the baseline analysis, at 30% likelihood of an underlying neurologic disease, MRI use has an incremental cost of $101,670 for each additional quality-adjusted life-year saved compared with $20,290 for CT use. As the probability of disease increases, further MRI use becomes a cost-effective alternative costing $30,000 for each quality-adjusted life-year saved. If a negative MRI result provides reassurance, the incremental costs of immediate MRI use decreases and falls below $25,000 for each quality-adjusted life-year saved no matter the likelihood of disease. CONCLUSIONS: For most individuals with neurological symptoms or signs, CT imaging is cost-effective while MR imaging is not. The cost-effectiveness of MRI use, however, improves as the likelihood of an underlying neurological disease increases. For selected patients who highly value diagnostic information, MRI is a reasonable and cost-effective use of medical resources when even the likelihood of disease is quite low (5%).

Adult↗
PubMed1994

Cost-effectiveness of screening for hereditary hemochromatosis.

BACKGROUND: Recent studies have estimated the prevalence of hereditary hemochromatosis to be 3 to 8 per 1000. Early detection and treatment can prevent disease manifestations and normalize life expectancy. We used decision analysis techniques to determine whether screening the population at large for hereditary hemochromatosis would be cost-effective. METHODS: We constructed a model to compare the cost and outcome of a strategy of performing screening transferrin saturation tests on cohorts of 30-year old men with that of awaiting symptomatic disease. Baseline estimates of disease prevalence and complication rates were based on the published literature. Costs of treatment were estimated based on prevailing local costs. Sensitivity analyses were then conducted to determine which variables had the most significant impact on the decision to screen. RESULTS: At our baseline estimates, the decision to screen was found to be a dominant strategy and resulted in cost saving. Sensitivity analysis showed that four variables had the most significant impact on the decision to screen: (1) the prevalence of hereditary hemochromatosis, (2) the probability of developing disease manifestations, (3) the cost of the screening test, and (4) the discount rate. Screening was a dominant strategy for asymptomatic men provided that the prevalence of hereditary hemochromatosis was at least 3 per 1000, the probability of developing disease manifestations was greater than 0.4, the test cost was less than $12, and the discount rate was less than 3%. Using more pessimistic estimates, the cost per life year saved was still less than that considered acceptable for many common medical interventions. CONCLUSION: Screening for hereditary hemochromatosis has a favorable cost-effectiveness ratio over a wide range of assumptions. We recommend that practitioners consider including a serum transferrin saturation test in their routine screening for asymptomatic white men.

Adult↗
PubMed1994

The value of diagnostic information to patients with suspected multiple sclerosis. Rochester-Toronto MRI Study Group.

OBJECTIVE: To determine the value of diagnostic information to patients with suspected multiple sclerosis (MS). Because treatment choices would be only minimally affected by earlier diagnosis for most patients with this clinical problem, this study assessed the "nondecisional" value of diagnosis. DESIGN: Prospective survey of patients before and after diagnostic workup, including imaging with magnetic resonance scanning. We assessed the effect of diagnostic information on patients' sense of well-being, as well as direct measures of the utility of information (using time trade-off and willingness-to-pay techniques). SETTING: Patients referred from primary care practices for diagnostic workup for suspected MS to neurology clinics and practices. PATIENTS: Sixty-eight individuals, mean age 37.5 years, 53 female and 15 male. Thirty-one patients were classified as having "probable MS," and 37 were classified as having "possible MS" by the examining neurologist before workup. MEASUREMENTS: Present and future health perception, uncertainty about diagnosis-prognosis, and level of anxiety. Willingness to pay for diagnostic information, quality of life as measured by the time trade-off technique, and psychological state of the patient before and after diagnosis. RESULTS: Diagnostic uncertainty fell significantly as a result of the diagnostic workup. Most patients (59/62) said that they were better off having received diagnostic information. Although anxiety seemed to be reduced by testing, overall anxiety levels did not decrease as much as anticipated. Patients also became less optimistic about their future health after testing. On average, patients were willing to forgo 4.5 quality-adjusted life days to receive an earlier diagnosis and their quality of life after diagnosis improved slightly. Subgroups of patients differed in their response to diagnostic information. Those in whom no definitive diagnosis emerged tend to be more anxious rather than being reassured by the "negative" workup. Individuals with "positive" workups became less anxious and expressed favorable feelings about the diagnostic workup even though they often faced a chronic disease. CONCLUSIONS: Overall, the diagnostic workup seemed to benefit patients and improve their sense of well-being. However, whether the effects were beneficial or not depended on the results of the diagnostic workup itself. In clinical practice the decision to undergo testing in situations in which definitive treatment is unavailable should be individualized. The potential for negative as well as positive consequences should be recognized.

Adult↗
PubMed1992

The association between interdisciplinary collaboration and patient outcomes in a medical intensive care unit.

We prospectively studied the relationship between interdisciplinary collaboration and patient outcomes in the medical intensive care unit (MICU) using nurses' and residents' reports of amount of collaboration involved in making decisions about transferring patients from the MICU to a unit with a less intense level of care. Either readmission to the MICU or death was considered a negative patient outcome. Nurses' reports of collaboration were significantly (p = 0.02) and positively associated with patient outcome, controlling for severity of illness. Patient predicted risk of negative outcome decreased from 16%, when the nurse reported no collaboration in decision making, to 5% when the process was fully collaborative. There was an interaction of collaboration with availability of alternative choices in the transfer decision-making situation. When alternatives were available, collaboration was more strongly associated with patient outcome. There was no significant relationship between residents' reports of collaboration and patient outcomes. The correlation between amount of collaboration reported by nurses and residents about the same decisions was quite low (r = 0.10).

Adult↗
PubMed1991

On the (near) equivalence of cost-effectiveness and cost-benefit analyses.

Many people believe that cost-effectiveness (CE) and cost-benefit (CB) analyses require different assumptions. However, when CE analysis supports decisions to use medical resources, it makes the same assumptions that CB analysis requires. They are mathematically equivalent. Differences between CE and CB hinge more on reporting style than on fundamental assumptions.

Cost-Benefit Analysis↗
PubMed1990

Regulatory intensity and hospital cost growth.

This article parameterizes and examines the regulatory intensity of New York's all-payer rate setting system. The model, using hospital level data, compares the effects of specific features of rate-setting designed to promote cost containment. Two indicators measuring regulatory intensity were examined; the extent of hospital-specific disallowances, and how frequently the base year was adjusted (the degree of prospectivity). The results indicate that both the degree of prospectivity and the extent of disallowances importantly affect cost growth. Hospitals, when constrained, primarily achieved cost savings through reductions in non-medical personnel.

Cost Control↗
PubMed1990

Priority setting in medical technology and medical practice assessment.

This study seeks to assist in setting priorities for assessing medical practices and technologies when assessment resources are scarce. It develops an objective index of expected gain from technology assessment, using modified DRG-level data on hospitalizations in NY State. The index uses standard economic concepts to combine measures of resource use, the coefficient of variation in use rates across regions, and the rate at which the incremental value of a medical intervention changes as its rate of use changes, providing a dollar-valued welfare loss from variations. For the entire US in 1987, the highest index occurred for coronary artery bypass graft ($0.95 billion per year), but most of the high-index interventions were nonsurgical, including hospitalizations for psychosis ($0.74 billion per year), cardiac catheterization ($0.62 billion per year), chronic obstructive lung disease ($0.55 billion per year), angina pectoris ($0.46 billion per year), adult gastroenteritis ($0.38 billion per year), adult pneumonia ($0.32 billion per year) and medical back problems ($0.28 billion per year). The top 25 interventions create an annual welfare loss of exceeding $7 billion. The present value of convincingly assessing the correct way to use these interventions sums many years of annual gains from eliminating these welfare losses. The gains from eliminating unexplained variation in medical practices appear greatly larger than costs of necessary studies.

Bias↗
PubMed1989

Bug/drug resistance. Sometimes less is more.

Increased use of antibiotics in any community increases the risks that future bacterial strains will resist the effects of current antibiotics. The consequences of a resistant bacterial strain include costs for more expensive and powerful drugs, additional hospital days, and on rare occasion, death. A key to understanding the importance of this problem is better knowledge about the rate that resistance increases and persists as antibiotic use rates increase. Using the scant evidence available in the literature, this study conducts a sensitivity analysis to calculate the unrecognized costs of antibiotic use annually in the United States under various possible circumstances. For the estimated 150 million annual antibiotic prescriptions, the unrecognized costs appears to be at least $.1 billion, and they may exceed $30 billion in the worst case. The estimates of the burden caused by bacterial resistance to antibiotics depend heavily on unknown parameters, including the rate that resistance occurs, the dose-resistance patterns through time, the frequency of inappropriate use of antibiotics, and the frequency with which death occurs due to a resistant bacterial infection. New studies in each of these areas are needed to improve our understanding of the extent of the resistance problem.

Bacteria↗