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Biomedical subjects

C H Altshuler

Publications and source records attributed to C H Altshuler.

15 recordsLinked to original sources
PubMed1994

Data utilization, not data acquisition, is the main problem.

Previous studies focusing on the value of laboratory testing have sometimes been flawed because they had not always determined whether the data generated had been appropriately used by clinicians. It has been well documented that neither clinicians nor administrators always use objective data effectively. When data are not used appropriately by clinicians, not only are morbidity and mortality increased, but also care costs are higher. Failures by administrators result in lost opportunities to identify and correct system deficiencies. To provide information support to assure good data utilization, a prototype desktop workstation has been developed and partially implemented. Experience with such a system suggests that not only may it help provide better care more economically, but it can also aid in implementation of Practice Guidelines (Agency for Health Care Policy and Research) and Clinical Indicator (Joint Commission on Accreditation of Healthcare Organizations) programs. Laboratorians can be influential in this effort and promote the use of new knowledge in patient care in a timely and responsible manner.

Chemistry, Clinical↗
PubMed1985

Use of comprehensive laboratory data as a management tool.

Studies of the use of laboratory data in cost-control management yield the following conclusions: (1) Comprehensive medical information is a valuable medical resource; (2) problems in practice frequently involve poor data utilization, and difficulties with data acquisition are frequently secondary phenomena; (3) current regulations limiting the acquisition of data may be counterproductive in worsening care while raising costs. If continued, the long-term effects on knowledge generation can be expected to be devastating; (4) good medicine is cost effective; (5) poor medicine is expensive, both in human and economic terms; and (6) good medical care requires a patient-oriented data base, a clinical decision-support system, a feed-back mechanism so that effectiveness of the system may be evaluated on an ongoing basis, and adequately trained medical technology personnel.

Clinical Laboratory Techniques↗
PubMed1983

Building a data base for monitoring and facilitating health care.

Our experience suggests that (1) comprehensive objective information is a valuable medical resource; (2) the systematic acquisition of objective information in a form suitable for computers is a necessary first step to building a useful data base; (3) when appropriately utilized, objective medical information may permit a study of medical practice, cost of care, and operational efficiency; (4) analysis of costs divorced from outcome and rehospitalization experiences may be misleading; (5) for some desired studies, the information required may be obtainable within a single institution. For others, however, community-wide studies may be the only possible way to obtain the information needed; (6) useful computer systems will be developed only if the health professionals become more knowledgeable (and demanding) and administrators are persuaded to provide effective support; and (7) effective hospital support for adequate medical information systems will probably come when criteria evaluating hospital performance are altered to reflect society's needs. Our experience with computer evaluation of care has been a sobering one. Still, it is obvious that the technology offers considerable hope that many inefficiencies in practice can be corrected. Considering all the current jeremiads about what we can afford in health care, it is reassuring to learn that good medicine is cost effective.

Computers↗
PubMed1981

Cost effectiveness of multiphasic screening: old controversies and a new rationale.

The cost effectiveness of multiphasic screening is evaluated from a conceptual as well as from a practical viewpoint. Conceptual analysis includes a consideration of the technical sensitivity and specificity of the tests used, of the prevalences of the screened diseases, and of the costs and values associated with different outcomes of screening. Practical considerations include the potential of multiphasic screening for increasing productivity, for reassuring patients, and for reducing morbidity and mortality. Although all these issues can be cogently formulated, at present none can be documented by a comprehensive set of data leading to irrefutable conclusions. Therefore, the issue of who should be screened continues to be obfuscated by controversy and prejudice. To resolve this dilemma a new rationale for the use of multiphasic screening is developed. This is based on a small number of uncontroversial facts and leads to practical proposals relating to how standards for useful test batteries can be constructed.

Clinical Laboratory Techniques↗