Assessing Medical Technologies (1985) / Chapter Skim
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1. Introduction
1. Introduction
Pages 16-31
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From page 16... ...
Moses and Frederick Mosteller based on a document drafted by David Banta and Donald Young. David Banta contributed the material for the examples on electronic fetal monitoring, the computed tomography scanner, drug treatment for hypertension, and hysterectomy.
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From page 17... ...
Barsamian (1977) points out that as a treatment for angina pectoris the surgical procedure of internal mammary artery ligation was rapidly introduced by surgeons in Italy and the United States, theorizing that the operation would reduce pain by shunting blood into the coronary circulation.
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Gittelsohn and Wennberg (1977) find that small similar areas of a state have great variation in the frequency of performance of such surgical procedures as tonsillectomy, appendecASSESSING MEDICAL TECHNOLOGY tomy, and hysterectomy.
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From page 19... ...
Concerns about preventable perinatal mortality and brain damage led investigators to seek a more reliable and valid method of following fetal status during labor (Banta and Thacker, 1979~. Advances in electronics during World War II made electronic fetal monitors feasible, as first demonstrated by a team at Yale University.
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(These studies however do not include the possible benefits of preventing necrologic damage. ~ Electronic fetal monitoring is a good example of inadequate evaluation.
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The drug treatment was remarkably effective for men with diastolic pressures higher than 105 mm of mercury. For example, strokes were reduced by 75 percent, and congestive heart failure, renal failure, and dissecting aneurysm occurred only in the control group (Veterans Administration, 1967, 1970~.
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The drug industry's promotion of drug treatment for mild hypertension also has been criticized. In short, drug treat ment for hypertension is one of the most important medical advances of this cen tury.
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The increase of 4.5 percent in support costs per patient was, nevertheless, unexTABLE 1-1 Partial Impact of TMIS (Excluding Its Cost) on Three Measures of Cost at E1 Camino Hospital, by Department Change in Cost Change in Cost Change in Cost Department per Patient per Patient Day per Month Nursing _ 5.0a - 2.0 5.3 Ancillary - 2.4 1.1 7.7a Support 4.5 7.5a 14.3a All departments - O.6 2.3 9.2 a Statistically significant beyond the 5 percent level.
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From page 24... ...
Tracing the consequences is a difficult task. SOPHIE LESSONS FROM THE EXAMPLES It can be seen that medical technology is a term that embraces quite a range of acTABLE 1-2 Overall and Partial Impact of TMIS on Annual Expense of All Departments at E1 Camino Hospital During 1975, by Two Methods Unit of Measurement TMIS Impact Including TMIS Cost (%)
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From page 25... ...
, which uses the term to refer to "techniques, drugs, equipment, and procedures used by health-care professionals in delivering medical care to individuals, and the systems within which such care is delivered." The five examples illustrate some of the dimensions along which medical technology varies. Two examples, electronic fetal monitoring (EFM)
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From page 26... ...
3~: Medical technology assessment is, in a narrow sense, the evaluation or testing of a medical technology for safety and efficacy. In a broader sense, it is a process of policy research that examines the short and long-term consequences of individual medical technologies and thereby becomes the source of information needed by policymakers in formulating regulations and legislation, by industry in developing products, by health professionals in treating and serving patients, and by consumers in making personal health decisions.
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From page 27... ...
Hospitals and health maintenance organizations (HMOs) often look at new medical technologies as possible major investments, including both capital costs and costs of operation.
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From page 28... ...
The AHA program evaluates diagnostic systems, therapeutic systems, computer technologies, and the like, but evaluates medical procedures only as they relate to equipment purchase or nonmedical hospital personnel. The evaluations focus on: cost and organizational implications; installation costs; staffing and training requirements; · probable number of patients affected; · effects on other hospital resources, such as the extent to which a technology will enable the replacement of existing resources, or the extent to which it will necessitate the addition of new resources; · clinical effectiveness: not patient outcomes as such, but process outcomes such as inpatient versus outpatient application, average length of stay, etc.
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From page 29... ...
Some additional priorities are consumer education so that the general public might use "proper personal health care" including prevention; cost containment and the "adoption of uniform cost accounting and simplified reimbursement"; and activities to "achieve needed improvement in the quality of health services." Federal Medicare reimbursement for the capital portions of the hospital bill are denied to health care institutions that expand beds or certain programs without a certificate of need. The 1975 law approached cost containment primarily through institutional coordination, regionalization, the sharing of services, and nonhospital alternatives.
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From page 30... ...
ASSESSING MEDICAL TECHNOLOGY 1958. Evaluation of internal mammary artery ligation and sham procedure in angina pectoris.
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From page 31... ...
1983. The Dublin Randomized Controlled Trial of Intrapartum Electronic Fetal Heart Rate Monitoring.
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