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Battling Antibiotic Resistance: Can Machine Learning Improve Prescribing? 对抗抗生素耐药性:机器学习能改善处方吗?
ERN: Health Care Policy (Sub-Topic) Pub Date : 2019-05-01 DOI: 10.2139/ssrn.3392196
Michael Allan Ribers, H. Ullrich
{"title":"Battling Antibiotic Resistance: Can Machine Learning Improve Prescribing?","authors":"Michael Allan Ribers, H. Ullrich","doi":"10.2139/ssrn.3392196","DOIUrl":"https://doi.org/10.2139/ssrn.3392196","url":null,"abstract":"Antibiotic resistance constitutes a major health threat. Predicting bacterial causes of infections is key to reducing antibiotic misuse, a leading cause of antibiotic resistance. We combine administrative and microbiological laboratory data from Denmark to train a machine learning algorithm predicting bacterial causes of urinary tract infections. Based on predictions, we develop policies to improve prescribing in primary care, highlighting the relevance of physician expertise and time-variant patient distributions for policy implementation. The proposed policies delay prescriptions for some patients until test results are known and give them instantly to others. We find that machine learning can reduce antibiotic use by 7.42 percent without reducing the number of treated bacterial infections. As Denmark is one of the most conservative countries in terms of antibiotic use, targeting a 30 percent reduction in prescribing by 2020, this result is likely to be a lower bound of what can be achieved elsewhere.","PeriodicalId":269392,"journal":{"name":"ERN: Health Care Policy (Sub-Topic)","volume":"106 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115315004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 14
A Model of a Randomized Experiment with an Application to the Prowess Clinical Trial 随机实验模型及其在勇猛临床试验中的应用
ERN: Health Care Policy (Sub-Topic) Pub Date : 2019-03-01 DOI: 10.1920/WP.CEM.2019.1119
Amanda E. Kowalski
{"title":"A Model of a Randomized Experiment with an Application to the Prowess Clinical Trial","authors":"Amanda E. Kowalski","doi":"10.1920/WP.CEM.2019.1119","DOIUrl":"https://doi.org/10.1920/WP.CEM.2019.1119","url":null,"abstract":"I develop a model of a randomized experiment with a binary intervention and a binary outcome. Potential outcomes in the intervention and control groups give rise to four types of participants. Fixing ideas such that the outcome is mortality, some participants would live regardless, others would be saved, others would be killed, and others would die regardless. These potential outcome types are not observable. However, I use the model to develop estimators of the number of participants of each type. The model relies on the randomization within the experiment and on deductive reasoning. I apply the model to an important clinical trial, the PROWESS trial, and I perform a Monte Carlo simulation calibrated to estimates from the trial. The reduced form from the trial shows a reduction in mortality, which provided a rationale for FDA approval. However, I find that the intervention killed two participants for every three it saved.","PeriodicalId":269392,"journal":{"name":"ERN: Health Care Policy (Sub-Topic)","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116730105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
Is the Appointee Procedure a Real Selection or a Mere Political Exchange? The Case of the Italian Health-Care Chief Executive Officers 委任程序是真正的选择还是纯粹的政治交换?意大利卫生保健首席执行官案例
ERN: Health Care Policy (Sub-Topic) Pub Date : 2019-02-15 DOI: 10.5947/JEOD.2018.008
R. Troisi, V. Guida
{"title":"Is the Appointee Procedure a Real Selection or a Mere Political Exchange? The Case of the Italian Health-Care Chief Executive Officers","authors":"R. Troisi, V. Guida","doi":"10.5947/JEOD.2018.008","DOIUrl":"https://doi.org/10.5947/JEOD.2018.008","url":null,"abstract":"One of the central aspects of the Italian health-care reform deals with the new position of a chief executive officer (CEO) selected through an appointment procedure. By drawing data from 164 Curriculum Vitae (CVs), a cluster analysis was carried out to investigate the typologies of CEOs that were selected and assess them by comparing their educational and professional characteristics. Three different categories of CEOs are defined and ranked: (i) “experienced CEO”, with the highest inter-organizational mobility and the highest number of triad-assignments; (ii) “experienced local directors”, with a better cultural background, medium mobility and medium number of triad assignments; and (iii) “business like professionals” with the lowest professional and educational profile. How these typologies are distributed over the Italian regions gathered in groups were then verified, considering the kind of organizational arrangements in the local appointment procedures. Finally, the overall results of the CEOs selection system in health-care lead to suboptimal appointments: when the organizational arrangements are better employed, they totally exclude the selection of the lowest category. On the contrary, when organizational arrangements are wrongly employed the first category decreases where the second increases.","PeriodicalId":269392,"journal":{"name":"ERN: Health Care Policy (Sub-Topic)","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130318041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
Financial Incentives as Signals: Experimental Evidence from the Recruitment of Village Promoters in Uganda 财政激励作为信号:来自乌干达乡村推广人员招募的实验证据
ERN: Health Care Policy (Sub-Topic) Pub Date : 2017-11-01 DOI: 10.2139/ssrn.3126459
Erika Deserranno
{"title":"Financial Incentives as Signals: Experimental Evidence from the Recruitment of Village Promoters in Uganda","authors":"Erika Deserranno","doi":"10.2139/ssrn.3126459","DOIUrl":"https://doi.org/10.2139/ssrn.3126459","url":null,"abstract":"I study the role of financial incentives as signals of job characteristics when these are unknown to potential applicants. To this end, I create experimental variation in expected earnings and use that to estimate the effect of financial incentives on candidates’ perception of a brand-new health-promoter position in Uganda and on the resulting size and composition of the applicant pool. I find that more lucrative positions are perceived as entailing a lower positive externality for the community and discourage agents with strong pro-social preferences from applying. While higher financial incentives attract more applicants and increase the probability of filling a vacancy, the signal they convey reduces the ability to recruit the most socially motivated agents, who are found to stay longer on the job and to perform better. (JEL D82, I18, J31, J63, M52, O15)","PeriodicalId":269392,"journal":{"name":"ERN: Health Care Policy (Sub-Topic)","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124400273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 133
The Effect of Insurance Expansions on Smoking Cessation Medication Prescriptions: Evidence from ACA Medicaid Expansions 保险扩张对戒烟药物处方的影响:来自ACA医疗补助扩张的证据
ERN: Health Care Policy (Sub-Topic) Pub Date : 2017-05-01 DOI: 10.3386/W23450
C. MacLean, M. Pesko, S. Hill
{"title":"The Effect of Insurance Expansions on Smoking Cessation Medication Prescriptions: Evidence from ACA Medicaid Expansions","authors":"C. MacLean, M. Pesko, S. Hill","doi":"10.3386/W23450","DOIUrl":"https://doi.org/10.3386/W23450","url":null,"abstract":"We explore the effects of recent Medicaid expansions on Medicaid-financed prescriptions for evidence-based smoking cessation medications. We estimate differences-in-differences models using administrative data on the universe of prescription medications sold in retail and online pharmacies for which Medicaid was a third-party payer. Our findings suggest that expansions increased smoking cessation prescriptions by 36% with heterogeneity across medication class. We provide evidence that these prescriptions were primarily financed by Medicaid programs and not patients, and that our estimates reflect increases in prescriptions among newly eligible populations and not other populations that enrolled in Medicaid due to Affordable Care Act-related changes. Overall our findings suggest that the recent Medicaid expansions allowed newly insured low-income smokers to access efficacious cessation medications.","PeriodicalId":269392,"journal":{"name":"ERN: Health Care Policy (Sub-Topic)","volume":"2021 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114201747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 13
Quality Gap of Family Health Care Services in Kashan Health Centers: An Iranian Viewpoint 卡尚保健中心家庭保健服务的质量差距:伊朗的观点
ERN: Health Care Policy (Sub-Topic) Pub Date : 2016-06-01 DOI: 10.18052/WWW.SCIPRESS.COM/ILSHS.70.14
M. S. Bidgoli, A. Kebriaei, Sayed Gholamabas Moosavi
{"title":"Quality Gap of Family Health Care Services in Kashan Health Centers: An Iranian Viewpoint","authors":"M. S. Bidgoli, A. Kebriaei, Sayed Gholamabas Moosavi","doi":"10.18052/WWW.SCIPRESS.COM/ILSHS.70.14","DOIUrl":"https://doi.org/10.18052/WWW.SCIPRESS.COM/ILSHS.70.14","url":null,"abstract":"Background and Aim: Patients' viewpoints are commonly used to assess quality of care in diverse healthcare organizations. This permits managerial decisions to be made based on knowledge rather than conjecture. The purpose of the current study is to investigate quality gap of family health care through measuring differences between clients’ perceptions and expectations at Kashan city health centers in Iran. Methodology: A cross-sectional design was applied in 2013. The study sample was composed of 384 women clients of family health services randomly selected from Kashan city health centers. The SERVQUAL questionnaire was used for data collection. Service quality gap was measured by computing the difference between the rating respondents assign to expectations and perceptions statements. For pair wise comparison of the expectations and perceptions the Wilcoxon Signed Rank test was used. Internal consistency of the scale was confirmed with Cronbach's Alpha coefficients (.81 for expectations and .84 for perceptions). Findings: In all dimensions of the services a significant (P<0.001) negative quality gap was observed. The maximum quality gap was in the tangibility (-0.60±0.37) and the minimum one was in the responsiveness (-0.41±0.31) dimension. Conclusions: The findings of the research demonstrated that there was negative gap between clients’ expectations and perceptions in all dimensions of the services. Thus, family health care managers should apply improvements in all five dimensions of the services.","PeriodicalId":269392,"journal":{"name":"ERN: Health Care Policy (Sub-Topic)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122600730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Estimating the Willingness to Pay for Community Healthcare Insurance in Rural Nigeria 估计尼日利亚农村社区医疗保险的支付意愿
ERN: Health Care Policy (Sub-Topic) Pub Date : 2008-05-01 DOI: 10.2139/ssrn.3171544
J. Ataguba, E. Ichoku, W. Fonta
{"title":"Estimating the Willingness to Pay for Community Healthcare Insurance in Rural Nigeria","authors":"J. Ataguba, E. Ichoku, W. Fonta","doi":"10.2139/ssrn.3171544","DOIUrl":"https://doi.org/10.2139/ssrn.3171544","url":null,"abstract":"Health care financing in Nigeria is dominated by private out-of-pocket payment that is not affordable to the poor. This has greatly reduced access to quality health care for the predominantly rural poor. Insurance schemes as options for increasing access to health care services have not received considerable attention in Nigeria. In this regard, a community health prepayment scheme is proposed, and the Contingent Valuation Method is used to investigate the willingness of rural households to pay for this scheme. Contributing through agricultural commodities produced statistically higher estimates than through direct cash. Also, by incorporating uncertainty in responses using the Random Valuation Model, higher contribution amounts were obtained. This provides an option for its use in healthcare contingent valuation studies where respondents are uncertain about their true responses. The groups that are willing to pay lesser amounts into the scheme as compared with their counterparts are women, the less educated, and the less wealthy households.","PeriodicalId":269392,"journal":{"name":"ERN: Health Care Policy (Sub-Topic)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121654069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 54
The Illusion of Sustainability 可持续性的错觉
ERN: Health Care Policy (Sub-Topic) Pub Date : 2004-02-01 DOI: 10.2139/ssrn.1111721
M. Kremer, E. Miguel
{"title":"The Illusion of Sustainability","authors":"M. Kremer, E. Miguel","doi":"10.2139/ssrn.1111721","DOIUrl":"https://doi.org/10.2139/ssrn.1111721","url":null,"abstract":"This brief summarizes the results of a gender impact evaluation study, entitled The illusion of sustainability, conducted during the time period 1998 to 2001 in Kenya. The study observed that deworming is a public good since much of its social benefit comes through reduced disease transmission. People were less likely to take deworming if their direct first-order or indirect second-order social contacts were exposed to deworming. The introduction of a small fee for deworming drugs led to an 80 percent reduction in treatment rates. Take-up was not sensitive to the exact price level, suggesting that it is particularly counter-productive to charge small positive prices for the treatment of infectious diseases. An intensive school health education had no impact on worm prevention. Funding for the study derived from World Bank, NIH Fogarty International Center, Berkeley Center for Health Research.","PeriodicalId":269392,"journal":{"name":"ERN: Health Care Policy (Sub-Topic)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2004-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127960182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 710
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