Receiver operating characteristic analysis of fracture and pneumonia detection: comparison of laser-digitized workstation images and conventional analog radiographs.

Forty pneumonia and 40 fracture cases were matched by patient age and gender with normal cases. Pediatric cases constituted 25% of this sample. All 160 examinations were laser-digitized at a spot size of 210 microns, a contrast resolution of 12 bits, and a spatial resolution of 2.35 line pairs per millimeter. The digitized images were transmitted 5 miles over a dedicated telephone line at a T1 rate from Francis Scott Key Hospital to Johns Hopkins Hospital (both in Baltimore, Md). At Johns Hopkins Hospital, eight radiologists interpreted the original analog radiograph and corresponding soft-copy display (1,280 x 1,024 pixels). Findings, confidence ratings, and image quality were reported for each reading. A receiver operating characteristic (ROC) analysis was conducted to compare observer performance under the analog and digital reading conditions. The overall sensitivity of the analog method was 89% versus 78% for the digital method (P < .001), while the specificity values were 96% and 92%, respectively (P > .20). ROC analysis similarly indicated a statistically significant difference in favor of analog radiographs (P = .028).

The integrated health-care system: reflection and projection.

This paper presents a personal view of the development of integrated, comprehensive health-care systems in the United States. The influence of Federal legislation is described, beginning with the 1950-60s policy objective of Hill-Burton Program administrators to create a number of community-based regional medical centers, each consisting of a range of health services organized by and around community hospitals. Later variations of the concept appeared in such programs as Medicare-Medicaid, Comprehensive Health Planning, the Regional Medical Programs, and the new Agency for Health Care Policy and Research. Based on the cumulative experience of the past, the economic, professional and social climate of the present, with its increasing involvement of the patient/payer/consumer in decisions, and the enhanced inter-organizational coordination emerging from technologies of computers and communication science, the goal of creating comprehensive integrated systems as conceived in the 1950s and 60s may finally be achieved in the 1990s, but in a different form from that envisioned earlier. By judicious exploitation of computer and communication capabilities and the massive knowledge bases evolving from research, the way is eased for patient-centered integration and coordination of services without demanding integration in the sense of ownership or formal control of all the providers within a central organization.

Full-text medical literature retrieval by computer. A pilot test.

A pilot test of a full-text, medical literature retrieval service demonstrated its capabilities for on-line search and retrieval of references, abstracts, and/or full-text journal articles. During a three-month test period, more than 500 health care professionals conducted 9,377 searches using computer terminals located in seven different health care sites. Searches were initiated for purposes of patient care, medical education, research, or for browsing. The majority of responders to a questionnaire given during the test period said they would continue to use the service during the pilot test, and only about 1% reported the search process difficult to use or not "user-friendly." It is predictable that with a comprehensive data base, full-text medical literature retrieval can be very useful for medical practice, medical education, and research.

30. Common problems of current data systems for long-term care.

This article reviews the varied long-term care data systems now being developed in the United States in the framework of a matrix derived from systems analysis and systems theory. Some common problems that emerge are that incentives are coming largely from the societal level; feedback to the institutional and patient care levels is lacking; little attention is being given to the individual level of decision making at one end of the spectrum and the national policy level at the other; and ideas and procedures developed in the acute care setting are being transferred to services traditionally lower in resources and determined more often by levels of patient functioning than by disease. The dominant instrument that emerges in long-term care is the periodic assessment form, in contrast to a hospital discharge abstract or ambulatory care encounter form; however, the data requirements appear to be more voluminous than in the case of acute hospital care, although less manpower is available to respond.