According to Job van Palen, health care providers should take
advantage of new research methodologies such as computerized
adaptive testing. Using these methods, specialists would be better
able to assess individual patients' risk profiles. 'Personalized
management' would also be facilitated. Job van der Palen spoke on
these topics on 11 February 2010 during his inauguration as
Professor of the endowed chair in Evaluation and Assessment in
Health Research at the University of Twente. He is a clinical
epidemiologist at the Twente Medical Spectrum (MST).
The establishment of the new chair is a real win-win situation
for MST and the University of Twente, according to Van der Palen.
"The department of Research Methodology, Measurement Methods and
Data Analysis (OMD) at the University of Twente has expended
considerable effort applying advanced statistical methods and
techniques in the field of teaching. These are techniques that can
also be applied in the field of health care. In turn, hospitals
need better methods to better predict how individual patients will
fare during their illnesses. This has now been made possible thanks
to a number of research and measurement methods that OMD has
developed further - such as Item Response Theory (IRT) en
Computerized Adaptive Testing (CAT)."
Consider, for example, patients who run the risk of being
hospitalized within a year because of the pulmonary disorder COPD,
or whose condition may be fatal. Patients who visit the pulmonary
department are first given a respiratory function test. The results
of this test are fed directly into the hospital's computer systems.
The patient then goes to the waiting room to fill in a
questionnaire. It's not a long, paper questionnaire. Computerized
Adaptive Testing makes it possible to glean relevant information
about the patient's condition using as few questions as possible.
These results are also fed directly into the hospital's computer
systems. It is only then that the patient sees the pulmonologist.
The doctor consults the patient's electronic medical record and can
see at a glance what the chance is that the patient will be
hospitalized within a year or whether the patient's condition could
potentially be fatal. Furthermore, specific factors that contribute
to the patient's prognosis can also be consulted immediately. The
pulmonologist can then adjust therapy accordingly. The doctor also
does not have to ask the same questions over and over in the
limited time available; the pulmonologist can zero in on relevant
points based on the patient's responses to the questionnaire.
These research and measurement techniques may also be used to
develop more accurate risk profiles for other patients, such as
those with a heart condition. Some patients may be candidates for
defibrillator implantation. If they suffer an repeated infarction,
their chances of survival will increase thanks to the electrical
shock given by the implant. Many people currently have a
defibrillator implant, even though only a small minority will ever
suffer a repeated infarction. Improved risk assessment will make it
easier to determine which patients are the most likely candidates
for an implant.
Or take patients who undergo open heart surgery. Twenty to
twenty-five percent develops delirium, further degrading their
condition and extending their stay in the hospital. Using reliable
predictions about who will develop delirium, interventions can be
considered for this risk group consisting of medication or
psychological resistance training, for example.
"Improved individual care and personalized management - these
are the goals of this new chair for MST and the University of
Twente", according to Van der Palen.
The inaugural speech "Beter weten door beter
meten" ('Knowing more through better measurements') is
available in electronic format on request.
