The time-efficiency principle: time as the key diagnostic strategy in primary care

Abstract

The test and retest opportunity afforded by reviewing a patient over time substantially increases the total gain in certainty when making a diagnosis in low-prevalence settings (the time-efficiency principle). This approach safely and efficiently reduces the number of patients who need to be formally tested in order to make a correct diagnosis for a person. Time, in terms of observed disease trajectory, provides a vital mechanism for achieving this task. It remains the best strategy for delivering near-optimal diagnoses in low-prevalence settings and should be used to its full advantage.

Keywords: Continuity of care; diagnostic tests; patient safety; primary care; quality of care..

Figure 1

The effect of prevalence on predictive summary index for an excellent sign, symptom or laboratory test. Figure constructed using data presented by Sackett et al.

Figure 2

The effect of prevalence on number needed to predict for an excellent sign, symptom or laboratory test. Figure constructed using data presented by Sackett et al.