Some basic concepts concerning classification of studies evaluating diagnostic procedures are given. The specific problem of assessment of routine preoperative tests is discussed: actual knowledge and methodological criticisms of previous studies, hypothesis for further evaluations, difficulties in the choice of a design and realization of a clinical study to assess a protocol for selective ordering of preoperative tests during one year in a teaching hospital. 3866 consecutive patients were included. The protocol led to perform only 33 per cent of all potential tests and did not apparently produce major adverse effects on the quality of care as appreciated by a clinical decision analysis.

Designing a study for evaluating a protocol for the selective performance of preoperative tests.

ELIAS: Support of the Dutch General Practitioner.- Computer in the Doctor's Office in the Federal Republic of Germany - Legal, Economic and Functional Aspects of Computer Support in Ambulatory Care.- Primary Provider Groups An Alternative Prepaid Health Care Delivery and Financing System.- Experiences with a Comprehensive Computer Based Information System for Primary Care in Finland.- Videotex and General Practice.- The Characterization Frame: A Tool to Describe General Practice Office Information Systems.- An Approach to Evaluation of Number, Duration and Cost of the Disability Pensions Granted for Rheumatic Diseases.- The Use of Computers in Outpatient Medical Care in the GDR.- Computer Systems and Services in South Africa.- Problems of Co-ordinating and Standardizing Information for the Monitoring of Primary Medical Care. The Case of Bavaria.- Expert Systems in Primary Care.- Obstacles in Computer-Aided Diagnosis.- New Ways and Possibilities of Primary Preventive Health Care by Computer-Supported Psychophysiological System-Analysis.- The Use and Relevance of the International Classification of Primary Care (ICPC) in Structuring Patient Information.- The Impact of Computers on Ambulatory Health Care.- Integrating Expert Systems with Primary Care Information Systems.- A System for the Generation of a Production Rules Network for Medical Expert Systems.- Presentation of a Multi-User System for Office Based Patient Drug Interaction.- Medical Treatment Assistance with an Interactive Drug Information System.- Development and Implementation of a Longterm Medical Documentation for Primary Care.- A Data Management System in Assistance to Hypertension Treatment in Primary Health Care.- The Continuous Morbidity Registration Nijmegen A Database for Longitudinal Epidemiology in Primary Care.- Workshop on New Technologies in Primary Health Care and in Education for Doctors and Patients - Report.- Workshop on Networking and Standardization in Communication - Report.- Workshop on Expert Systems and User Needs resp. Patient Records - Report.- Concluding Considerations.- Author Index.- Authors Addresses.

Present Status of Computer Support in Ambulatory Care

Information systems and health statistics deal with data which have been ordered and received a name, so that they can be counted. What has no name, cannot be counted and consequently has no impact. ICPC, together with its manual provides the best available tool to order and to name essential elements of primary care. It offers a widely tested, comprehensive classification system which can be used in three modes: 


as a Reason for Encounter classification


as a Diagnostic classification


as a Process classification.

The Use and Relevance of the International Classification of Primary Care (ICPC) in Structuring Patient Information

Medical technology is a concept which is perhaps best left undefined. Or at least, I am happy to leave to others the task of defining it. At its widest, it can include not only the wide range of equipment, devices, drugs and procedures employed in the care of patients, but also buildings and human investments. What I intend to talk about in the current context are the markets for medical equipment and for pharmaceuticals. However, it should be remembered that the greatest costs arising out of the use of new medical technology may be generated through the staff needed to operate it, leaving aside the psychological burdens which may fall on patients and their families.

The Marketplace for Medical Technology

More magnetic resonance scanners

Numbers are the stuff of science. They are necessary but are rarely sufficient for many personal and political decisions about the credibility of both medical and economic claims, findings, recommendations, and generalizations. Numbers apart, however, there is little in any scientific endeavor that is value free. Indeed, the values of scientists are major determinants of the problems they choose to examine or the questions they choose to ask. In turn, these choices initiate the application of the scientific process. Values also influence the assumptions underlying the investigators’ analytical or experimental designs and the conclusions they draw. In these respects, medicine and economics are alike in that both aspire to become more scientific by applying the laws of logic, the rules of evidence, and, to an increasing extent, the power of numbers to evaluate critically their hypotheses and improve their predictive powers. And it is predictability with respect to individual benefits and personal well-being as well as public policies and collective choices that we seek. As means to these ends, we use numbers to measure outcomes and attach relative values to the many complex issues that surround notions of health, disease, illness, and medicine.

K. L. White

Papers

Evaluation and Medicine