lliance Health System is an integrated delivery system comprising five hospitals, multiple ambulatory care sites, and a closed-panel medical staff of nearly 700 employed physicians. Its South Suburban Hospital has been a subject of much controversy, due to the large number of breast and cervical cancer deaths among patients who are regularly treated by the hospital’s medical staff. In fact, the case-fatality rate of breast and cervical cancers is twice that of the rest of the state and three times that of the United States. As CEO, you are particularly concerned about the adverse publicity and notoriety the hospital is receiving. The most recent press release from the regional office of the American Cancer Society has highlighted these facts. You have convened the leaders of the hospital’s medical staff for an explanation. The chief of staff has hypothesized that the high case-fatality rate is due to either underuse of mammography and Pap smear screening among hospital patients or in accuracy of screening tests. The chief of staff has informed you that reductions in mortality from breast and cervical cancer depend on early detection and treatment. The idea of underuse particularly upsets you because of a community-based outreach and education program on commonly occurring cancers launched a year ago by Alliance Health System. In conjunction with the community-based program, the hospital began a physician awareness program to inform the medical staff of the availability and benefits of hospital-based cancer screening programs. The chief of staff assures you that any underuse must be patient-created, because the hospital’s medical staff is the best-trained and most up-to-date group of health care professionals in the entire state. You are concerned about the possibility that the hospital may be using tests with questionable accuracy. The chief of staff recommends that the accuracy of screening tests be determined before evaluating the impact of the community-based outreach and physician awareness programs. You hire an epidemiologist to determine the validity of the hospital’s screening tests for breast and cervical cancer. The results of the investigation are presented in Table 6.4.
a. What are the sensitivity, specificity, and predictive values of the mammography screening?
b. What are the sensitivity, specificity, and predictive values of the Pap smear screening?
c. What are the clinical and managerial implications of a false positive screening test result?
d. What are the clinical and managerial implications of a false negative screening test result?
e. As the prevalence of breast or cervical cancer increases, how are the sensitivity and specificity of the screening tests affected? As the prevalence of breast or cervical cancer increases, how are the predictive values of test results affected?
f. What can be concluded from your testing analysis?
