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Using Designed Experiments to Shrink Health Care Costs

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Although applicability of Design of Experiments (DoE) is periodically mentioned in this text, health care is not discussed much until the eighth chapter of nine, and by that point the inexperienced reader ahould already know that DoE can be used for far more than just health care problems - Sloan points out the wide applicability of DoE in his preface, and I mention this because the title of the book is a bit misleading. One interesting characteristic of this work is that the teaching sequence was inspired by a designed experimentation course at the Center for Quality and Productivity Improvement at the University of Wisconsin at Madison. At the start of each chapter, learning objectives are laid out, and there is some overlap between each chapter to reinforce the learning process. After Sloan argues his case that "logic supports the use of math and science in health care and in every aspect of business management", and that "a well educated person uses the language of science, statistical reasoning, on a daily basis", he offers a brief history of DoE followed by a discussion of gestalting quality. The performance of an ANOVA (Analysis of Variance) is then discussed step-by-step - even though modern statistical software will perform these steps automatically, Sloan seems determined to make sure the reader understands the background behind this process. Simple mathematical formulas are presented very clearly. Throughout the central portion of this book, experiments performed by a fictitious company, Corrugated Copters, are used to discuss qualities and comparing qualities. Introductions to factorial and fractional factorial experiments are then presented, and Sloan prefaces this discussion by pointing out that "trial-and-error learning makes the sequential and iterative acquisition of knowledge an expensive proposition", and that "if you think an education is expensive, try ignorance". Although brief, this discussion is well written, especially if the reader is attempting to understand some of the finer details behind DoE design using such statistical tools as MINITAB. In the ninth chapter, "Summing it Up", Sloan lays out the steps that he suggests the reader use if they choose to promote the use of science and statistical reasoning in health care. Overall, this book is very well-written, and the author's enthusiasm for the subject matter is very apparent. Note that this book is currently available free of charge as a PDF document download at the author's evidence-based-decisions website.