title: Use of decision analysis to evaluate the delivery method of veterinary health care on dairy farms as measured by correction of left displaced abomasum.
abstract: OBJECTIVE
  To use decision and sensitivity analysis to examine the delivery of health care on US dairy farms as measured by correction of left displaced abomasum (LDA).
  
  
  METHODS
  5 journal articles evaluating outcomes from veterinarian- or herd personnel-delivered correction of LDA via laparotomy or a roll-and-toggle procedure.
  
  
  METHODS
  Economic analysis.
  
  
  METHODS
  A decision tree was constructed on the basis of published outcome data for correction of LDAs performed by veterinarians and herd personnel. Sensitivity of the model to changing input assumptions was evaluated via an indifference curve and tornado graph.
  
  
  RESULTS
  Decision tree analysis revealed that correction of an LDA provided by herd personnel had an expected economic advantage of $76, compared with correction provided by a veterinarian. Sensitivity of this analysis to variations in inputs indicated that changes of 2 input levels would shift the advantage to veterinarian-provided correction: a reduction (from 0.74 to 0.62) in the probability of success for correction provided by herd personnel or an increase (from 0.78 to 0.87) in the probability of success for correction provided by a veterinarian.
  
  
  CONCLUSIONS
  In this model, LDA correction by herd personnel had a significant economic advantage, compared with veterinarian-provided correction. Continued absorption of traditional veterinary tasks by unlicensed herd personnel may threaten the veterinarian-client-patient relationship (VCPR), which could have profound economic and regulatory impacts. Food animal veterinarians need to evaluate their business model to ensure they continue to provide relevant, sustainable services to their clients within the context of a valid VCPR.
authors.affiliation: Section of Animal Production Systems, Center for Animal Health and Productivity, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA 19348, USA. remsburg@vet.upenn.edu
authors.forename: Darren W
authors.initials: DW
authors.lastname: Remsburg
authors.forename: David T
authors.initials: DT
authors.lastname: Galligan
authors.forename: James D
authors.initials: JD
authors.lastname: Ferguson
mesh_terms: D000018:Abomasum / Q000473:pathology*; D000818:Animals; D002417:Cattle; D002418:Cattle Diseases / Q000191:economics / Q000628:therapy*; D003612:Dairying; D003661:Decision Support Techniques; D003695:Delivery of Health Care; D013272:Stomach Diseases / Q000191:economics / Q000473:pathology / Q000628:therapy / Q000662:veterinary*; D014730:Veterinary Medicine / Q000191:economics / Q000592:standards*