Dataset Information

Meta-analytic estimation of measurement variability and assessment of its impact on decision-making: the case of perioperative haemoglobin concentration monitoring.

ABSTRACT:

Background

As a part of a larger Health Technology Assessment (HTA), the measurement error of a device used to monitor the hemoglobin concentration of a patient undergoing surgery, as well as its decision consequences, were to be estimated from published data.

Methods

A Bayesian hierarchical model of measurement error, allowing the meta-analytic estimation of both central and dispersion parameters (under the assumption of normality of measurement errors) is proposed and applied to published data; the resulting potential decision errors are deduced from this estimation. The same method is used to assess the impact of an initial calibration.

Results

The posterior distributions are summarized as mean ± sd (credible interval). The fitted model exhibits a modest mean expected error (0.24 ± 0.73 (-1.23 1.59) g/dL) and a large variability (mean absolute expected error 1.18 ± 0.92 (0.05 3.36) g/dL). The initial calibration modifies the bias (-0.20 ± 0.87 (-1.99 1.49) g/dL), but the variability remains almost as large (mean absolute expected error 1.05 ± 0.87 (0.04 3.21) g/dL). This entails a potential decision error ("false positive" or "false negative") for about one patient out of seven.

Conclusions

The proposed hierarchical model allows the estimation of the variability from published aggregates, and allows the modeling of the consequences of this variability in terms of decision errors. For the device under assessment, these potential decision errors are clinically problematic.

SUBMITTER: Charpentier E

PROVIDER: S-EPMC4717612 | biostudies-literature | 2016 Jan

REPOSITORIES: biostudies-literature

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Publications

Meta-analytic estimation of measurement variability and assessment of its impact on decision-making: the case of perioperative haemoglobin concentration monitoring.

Charpentier Emmanuel E Looten Vincent V Fahlgren Björn B Barna Alexandre A Guillevin Loïc L

BMC medical research methodology 20160119

<h4>Background</h4>As a part of a larger Health Technology Assessment (HTA), the measurement error of a device used to monitor the hemoglobin concentration of a patient undergoing surgery, as well as its decision consequences, were to be estimated from published data.<h4>Methods</h4>A Bayesian hierarchical model of measurement error, allowing the meta-analytic estimation of both central and dispersion parameters (under the assumption of normality of measurement errors) is proposed and applied to ...[more]

PMID: 26787309

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Project description:Adaptive management involves learning-oriented decision making in the presence of uncertainty about the responses of a resource system to management. It is implemented through an iterative sequence of decision making, monitoring and assessment of system responses, and incorporating what is learned into future decision making. Decision making at each point is informed by a value or objective function, for example total harvest anticipated over some time frame. The value function expresses the value associated with decisions, and it is influenced by system status as updated through monitoring. Often, decision making follows shortly after a monitoring event. However, it is certainly possible for the cadence of decision making to differ from that of monitoring. In this paper we consider different combinations of annual and biennial decision making, along with annual and biennial monitoring. With biennial decision making decisions are changed only every other year; with biennial monitoring field data are collected only every other year. Different cadences of decision making combine with annual and biennial monitoring to define 4 scenarios. Under each scenario we describe optimal valuations for active and passive adaptive decision making. We highlight patterns in valuation among scenarios, depending on the occurrence of monitoring and decision making events. Differences between years are tied to the fact that every other year a new decision can be made no matter what the scenario, and state information is available to inform that decision. In the subsequent year, however, in 3 of the 4 scenarios either a decision is repeated or monitoring does not occur (or both). There are substantive differences in optimal values among the scenarios, as well as the optimal policies producing those values. Especially noteworthy is the influence of monitoring cadence on valuation in some years. We highlight patterns in policy and valuation among the scenarios, and discuss management implications and extensions.

Dataset Information

Meta-analytic estimation of measurement variability and assessment of its impact on decision-making: the case of perioperative haemoglobin concentration monitoring.

Background

Methods

Results

Conclusions

Publications

Meta-analytic estimation of measurement variability and assessment of its impact on decision-making: the case of perioperative haemoglobin concentration monitoring.

Similar Datasets

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