TheDukeStrokePolicyModel(SPM).pptVIP

The Duke Stroke Policy Model (SPM) Developers David Matchar, MD -- principal investigator Greg Samsa, PhD -- project director, statistician Giovanni Parmigiani, PhD -- statistician, software developer Joe Lipscomb, PhD -- health economist Greg Hagerty, MS -- software developer Outline Rationale for modeling (*) SPM described Applying the SPM to a randomized trial Extensions Rationale for modeling Why model? Arguments for modeling Arguments against modeling Discussion Conclusions Application to stroke Why model? (cont’d) “To me, decision analysis is just the systematic articulation of common sense: Any decent doctor reflects on alternatives, is aware of uncertainties, modifies judgements on the basis of accumulated evidence, balances risks of various kinds, . . .” Why model? (cont’d) “ considers the potential consequences of his or her diagnoses and treatments, and synthesizes all of this in making a reasoned decision that he or she decrees right for the patient…” (cont’d) Why model? “… All that decision analysis is asking the doctor to do is to do this a lot more systematically and in such a way that others can see what is going on and can contribute to the decision process.” -- Howard Raiffa, 1980 Advantages of modeling Clarifies decision-making Simplifies decision-making Provides comprehensive framework Allows best data to be applied Extrapolates short-term observations into long-term Encourages “what if” analyses Disadvantages of modeling Ignores subjective nuances of patient-level decision-making Problem may be incorrectly specified Inputs may be incorrect / imprecise Usual outputs are difficult to interpret or irrelevant to decision-makers Individual decision-making is subjective For individual decision-making, primary benefit of modeling is clarification. As normative process, decision-making works better for groups. Most applications involve group-, rather than individual-level, decisions (e.g., CEA, purcha