MDM Policy and Practice最新文献

{"title":"Crisis Preparedness by Simulating Quality-Adjusted Life-Year Loss in Patients with End-Stage Renal Disease due to Kidney Transplantation Suspensions.","authors":"Vincent Bonnemains, Florent Le Borgne, Etienne Dantan, Myriam Pastural, Magali Giral, Cécile Couchoud, Yohann Foucher","doi":"10.1177/23814683261440974","DOIUrl":"https://doi.org/10.1177/23814683261440974","url":null,"abstract":"<p><p><b>Background.</b> Because of the COVID-19 pandemic, we realize that kidney transplantation (KT) suspension may become necessary. Although the impact of KT moratoriums on the mortality of candidates for KT has been reported, health-related quality of life (HRQoL) was usually not considered. For crisis preparedness, we aimed to include quality-adjusted life-years (QALYs) in the balance. <b>Methods.</b> We estimated 1) the health-state evolution of the French end-stage renal disease population using a semi-Markovian approach (76,980 French patients who began dialysis or were registered on the waitlist for KT between 2011 and 2019), 2) the post-KT evolution of HRQoL using a linear mixed-effects model (4,819 EQ-5D questionnaires from 2,835 French KT recipients), and 3) the HRQoL conversion for dialyzed patients according to Li's model. <b>Results.</b> For patients registered on the active waitlist at the beginning of the moratorium, we predicted a loss of 0.96 life-months in perfect health for a 7-mo moratorium (95% confidence interval [0.11, 1.78]). This loss was smaller for patients who become active candidates after a moratorium decision. Regardless, we reported higher losses of QALYs for patients younger than 60 y than for older patients, for every considered moratorium duration. <b>Conclusions.</b> KT moratoriums can be sustainable regarding both quantity and quality of life, provided they do not exceed a prolonged period. In case of future crisis with a long reduction of KT activity, we reported that priority may be proposed to the younger patients.</p><p><strong>Highlights: </strong>Our results provide arguments supporting the decision of suspending kidney transplantation activity in case of future crises, provided that the moratorium duration does not exceed a few months.We report that patients active on the waitlist at the beginning of the moratorium lose the most quality-adjusted life-years due to the suspension, particularly candidates younger than 60 y. Hence, if another crisis occurs with the possibility of maintaining only small kidney transplantation activity, giving priority to younger patients active on the list may be justified.Considering quality-adjusted life-years rather than raw survival time results in a more complete assessment of the effect of suspending kidney transplantation in patients with end-stage renal disease by taking their quality of life into account.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683261440974"},"PeriodicalIF":1.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Translation, Adaptation, and Validation of the French Version of the Low Literacy Decisional Conflict Scale in Adolescents.","authors":"Dehlia Moussaoui, Victoria L Crofts, Nicolas Silvestrini, Thomas Agoritsas, Arnaud Merglen, Michal Yaron","doi":"10.1177/23814683261438738","DOIUrl":"https://doi.org/10.1177/23814683261438738","url":null,"abstract":"<p><p><b>Purpose.</b> We aimed 1) to translate and adapt the English version of Low Literacy Decisional Conflict Scale (LL-DCS) into French and 2) to assess its psychometric properties in adolescents. <b>Methods.</b> The original LL-DCS was translated into French by 2 independent translators, with discrepancies resolved by a multidisciplinary team. The reconciled version was back-translated into English by 2 other translators to ensure accuracy. We tested the prefinal version among 14 adolescents, who evaluated the clarity of the items. Second, we conducted psychometric testing of the final version among 85 adolescents participating in a pilot study evaluating a decision aid for contraception and menstrual management. Participants completed the French version of LL-DCS before (T0) and after (T1) their clinical encounter. We assessed internal consistency with Cronbach's alphas and model fit with confirmatory factorial analyses. We evaluated discriminant validity by comparing scores at T0 and T1 based on participants' responses regarding treatment preference. <b>Results.</b> Internal consistency of the French LL-DCS was acceptable, with a Cronbach's alpha of 0.72 at both T0 and T1, although there was variability in reliability at the subscale level. Model fit was adequate at T0, indicating good factor validity. There was evidence for the original 4-factor model at T0, but exploratory analysis suggested a 3-factor solution with Informed and Values Clarity as one factor. Discriminant validity was strong, as the scale distinguished between adolescents who had decided on treatment and those who remained undecided. <b>Conclusion.</b> The French version of the LL-DCS demonstrates satisfactory psychometric properties, including internal consistency, factor validity, and discriminant validity. However, caution should be exercised when interpreting individual subscales, as their internal consistency is somewhat lower than the original English version of LL-DCS.</p><p><strong>Highlights: </strong>We translated, adapted, and tested the French version of Low Literacy Decisional Conflict Scale in adolescents.The French version of the Low Literacy Decisional Conflict Scale is adapted to people with limited literacy skills.We hope that it might facilitate the participation of vulnerable populations in clinical research projects.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683261438738"},"PeriodicalIF":1.7,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147677171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing a Colorectal Cancer Screening Decision Aid via Text Messaging in a Large Massachusetts Health Care System.","authors":"Kim Ariyabuddhiphongs, Timothy Carey, Emily A Wolfson, Spencer Rittner, Jonathan Li, Maëlys Amat, Mara A Schonberg","doi":"10.1177/23814683261425607","DOIUrl":"10.1177/23814683261425607","url":null,"abstract":"<p><p><b>Background.</b> The use of colorectal cancer (CRC) screening decision aids (DAs) increases patient knowledge and engagement in decision making. Thus, we aimed to implement a CRC DA in a Boston-area health system informed by the Theory of Change quality improvement framework. <b>Methods.</b> Following international standards, an interdisciplinary working group developed a 2-page CRC screening DA, readable on smartphones, for adults ages 45 to 75 y. Prior to DA implementation, we texted a study survey to 8,641 adults age 45 to 75 y seen in primary care at our health system (baseline). Between January 2022 and April 2023, we texted the DA to 21,522 patients due for CRC screening and scheduled with their primary care provider (PCP). In August 2022 and in May 2023 (follow-up), we texted a study survey to patients who had been texted the DA in prior months. We used linear regression to examine the DA's effects on shared decision-making (SDM) quality (using the 4-item SDM Process Scale, for which scores range from 0-4), knowledge (2 questions), and reported discussions with PCPs of screening modalities. <b>Results.</b> Of 30,163 texted study surveys, 1,692 (5.6%, 697 baseline and 995 follow-up) were completed; 77.1% of participants were non-Hispanic White and 45.3% were aged 60 to 75 y. Overall, 30.6% (<i>n</i> = 304) of follow-up survey respondents reported reviewing the DA. Compared with baseline participants, these patients reported higher SDM quality (SDM process scores = 2.5 v. 2.1, <i>P</i> < 0.001) and more knowledge about CRC screening and were more likely to have discussed stool-based testing with PCPs. <b>Limitations.</b> Low response rate with no sociodemographic data for nonresponders. <b>Conclusions/Implications.</b> Patients who read a CRC screening DA texted to them before primary care visits may experience improved SDM quality. However, a more intensive implementation strategy may be needed for more patients to read DAs.</p><p><strong>Highlights: </strong>It is feasible for large health systems to automatize text messaging of colorectal cancer (CRC) screening decision aids (DAs) to patients due for CRC screening before a visit with their primary care practitioner.Patients who review a texted CRC screening DA report higher shared decision-making quality and knowledge about CRC screening.Use of CRC DAs may decrease screening via colonoscopy but not overall screening rates.A more intensive intervention than text messaging is likely needed to increase the number of patients who review a CRC screening DA.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683261425607"},"PeriodicalIF":1.7,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12966531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147378813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating Lifetime Drinking Trajectories for Alcohol Use from Adolescence to Older Adulthood in the United States: A Three-Step Approach.","authors":"Md Zubab Ibne Moid, Jeremy W Bray, Martijn Van Hasselt, Carolina Barbosa","doi":"10.1177/23814683261421957","DOIUrl":"https://doi.org/10.1177/23814683261421957","url":null,"abstract":"<p><p><b>Background.</b> Understanding drinking trajectories from adolescence to old age is crucial for assessing the long-term effects of intervention programs for adolescent drinking. This study estimates transition probabilities between alcohol consumption levels to understand the long-term drinking trajectories of adolescents in the United States. <b>Methods.</b> We used Bayesian simulation and simulated annealing to compute age- and sex-specific transition probabilities from age 12 to 65 y in the United States for 4 drinking risk levels (low, medium, high, very high), abstinence, and alcohol dependence. We simulated a cohort from age 12 to 65 y through these matrices to capture long-term trajectories. <b>Results.</b> Heavier drinking states carried greater risk of forward progression. Crucially, however, the lifetime average probability of remaining in dependence is only 0.49, implying a 0.51 chance of recovery-most frequently to abstinence (27%). Moreover, annual backward transitions occur at substantial rates: on average, 23% of high-risk drinkers transition to medium risk, and 25% of medium-risk drinkers transition to low risk across the life course. <b>Limitations.</b> This study lacks prior data on transitioning from alcohol dependence to other drinking states among adolescents, leading to some potentially inaccurate transition probabilities. In addition, although transition probabilities were estimated by age and sex, other factors such as race, geography, and religion were not considered, limiting generalizability. <b>Conclusion.</b> Transition probabilities for alcohol use states are essential to understanding the progression of alcohol use over a lifetime. These transition probabilities can also be used as inputs to model the long-term effects of intervention programs for adolescent drinking. <b>Implications.</b> These findings provide a framework for the long-term evaluation of intervention programs and guiding health care resource allocation to reduce adolescent alcohol consumption.</p><p><strong>Highlights: </strong>This study estimates lifetime drinking trajectories from adolescence to old age in the United States.The model uses national survey datasets to simulate real-world alcohol use patterns over time.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683261421957"},"PeriodicalIF":1.7,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12949772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Divergence in Perceptions of Shared Decision Making in Pediatric Neuromuscular Scoliosis.","authors":"Jody L Lin, Angela Zhu, Marla L Clayman, Kimberly A Kaphingst, Kaleb G Eppich, Greg Stoddard, Lindsay Andras, Unni G Narayanan, Heather T Keenan, Tamara D Simon, Steven M Asch, Angela Fagerlin","doi":"10.1177/23814683261422234","DOIUrl":"10.1177/23814683261422234","url":null,"abstract":"<p><p><b>Background.</b> Shared decision making (SDM) is a promising but poorly understood approach toward improving care for children with medical complexity. The objective of this study is to assess the quality of SDM using self-reported and observer-based measures in pediatric orthopedic clinic visits for neuromuscular scoliosis (NMS) surgical treatment decisions. <b>Methods.</b> We recruited 18 children with NMS at ≥8 y old, a Cobb angle of ≥50°, and no prior spine surgery at a quaternary children's hospital; their caregivers; and spine surgeons (<i>n</i> = 3). We video-recorded visits and administered postencounter surveys to assess SDM quality via the DEEP-SDM coding scheme and SDM-Q-9 (parent) and SDM-Q-Doc (provider) validated survey measures (0 = <i>poor-quality</i> to 100 = <i>high-quality SDM</i>). DEEP-SDM consists of 11 binary variables measuring whether a behavior occurred. We used convergent mixed methods to triangulate DEEP-SDM with survey outcomes and calculated caregiver-provider interrater reliability via prevalence-adjusted and bias-adjusted kappa for survey outcomes. <b>Results.</b> Only 1 child-caregiver-provider triad met all DEEP-SDM criteria (Cohen's kappa = 0.78). All visits discussed treatment rationale, provider preferences, and caregiver understanding. Few visits assessed patient self-efficacy (4/18) and defined treatment options (8/18). Providers led most conversations except for those around caregiver preferences/values and caregiver understanding. Median (interquartile range) SDM-Q-9 and SDM-Q-Doc scores were 75.6 (66.7-91.6) and 80 (72.6-81.7), respectively. However, interrater reliability was poor for many items, including clarifying a need for decision making and eliciting caregiver preferences for decision involvement, both with kappa = 0 (confidence interval 0-0.35). <b>Conclusions.</b> In NMS treatment decisions, providers could more actively elicit parent preferences/values and self-efficacy. The poor caregiver-provider interrater reliability of SDM measures suggests current levels of SDM may be insufficient.</p><p><strong>Highlights: </strong>Both observer- and self-rated measures overestimate and inadequately capture the quality of shared decision making for children with medical complexity.Better provider-driven elicitation of family preferences and values is needed.Assessment of decisional self-efficacy is often missed.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683261422234"},"PeriodicalIF":1.7,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12929890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147291249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Discrete-Event Simulation Model to Configure Operating Rooms for Robotic Cardiac Surgery.","authors":"Martina Doneda, Elena Elzi, Alfonso Agnino, Ascanio Graniero, Laura Giroletti, Matteo Parrinello, Giovanni Albano, Gabriele Tunesi, Ettore Lanzarone","doi":"10.1177/23814683251410133","DOIUrl":"https://doi.org/10.1177/23814683251410133","url":null,"abstract":"<p><p><b>Background.</b> Robotic cardiac surgery (RCS) has emerged as a promising alternative in clinical practice to overcome the limitations of minimally invasive techniques. However, the integration of RCS with surgical process management is key in taking full advantage of its benefits. <b>Aim.</b> We assess the performance of RCS interventions as a function of operating room (OR) layout, using a discrete-event simulation (DES) tool, which allows the simulation of different RCS procedures in different layouts. <b>Methods.</b> A DES model was developed for 2 types of RCS, atrial fibrillation ablation and mitral valve repair, to analyze them in the presence of different OR layouts. Data on the activities and timings of all operators in the OR, used to feed the DES, were collected on site at Humanitas Gavazzeni Hospital, Bergamo, Italy, through direct recording during RCS procedures. <b>Results.</b> The advantages and disadvantages of different OR layouts were highlighted and quantified through a series of key performance indicators and qualitative outcomes, including the overall duration of the entire surgical process, the distance covered by the surgical team, and their utilization. Specifically, the characteristics of a new, larger OR in the considered hospital were assessed prior to the actual transfer of the RCS department in the new OR. <b>Conclusion.</b> This work provided valuable insights and recommendations to RCS operators, which were put in practice, specifically tailoring OR configurations to RCS procedural characteristics.</p><p><strong>Highlights: </strong>Discrete event simulation (DES) is used for the first time to improve the performance of robotic cardiac surgery (RCS), an application that presents unique challenges.The flexible DES model for RCS can parametrize various factors related to both operating rooms and procedures.The impact of these factors is evaluated on a set of KPIs.New insights into the positioning of equipment and personnel in the OR are provided, allowing to formulate informed recommendations for RCS providers.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683251410133"},"PeriodicalIF":1.7,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12923941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147272184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Influencing the Adoption of a Patient Decision Aid Development Platform: A Qualitative Study.","authors":"Julie Bélanger, Carissa Bonner, Paulina Bravo, Émilie Dionne, Katherine Hastings, France Légaré, Karina Prévost, Kevin Selby, Dawn Stacey, Sharon E Straus, Brett D Thombs, Anik Giguere","doi":"10.1177/23814683251409185","DOIUrl":"10.1177/23814683251409185","url":null,"abstract":"<p><p><b>Background.</b> Developing patient decision aids (PtDAs) requires considerable resources. We aimed to create a digital platform to streamline the process and investigate stakeholder perceptions of factors influencing the adoption of a mock-up of the platform. <b>Methods.</b> Using the Framework for Innovation, a design team developed an alpha version of the platform, with support from an advisory panel. A convenience sample of key stakeholders involved in the development of PtDAs, who were fluent in English, French, or Spanish, reviewed the mock-up in think-aloud sessions and answered open-ended questions structured along Normalization Process Theory constructs: Coherence, Cognitive Participation, Collective Action, and Reflective Monitoring. A thematic qualitative analysis was conducted by 3 researchers, iteratively improving the mock-up until no major issues emerged. <b>Results.</b> We recruited 20 participants, mainly women (<i>n</i> = 11), from 4 continents, including clinician-researchers (<i>n</i> = 15), patients (<i>n</i> = 4), and a health care manager (<i>n</i> = 1). Their experience in developing PtDAs ranged from none (<i>n</i> = 2) to more than 10 PtDAs (<i>n</i> = 1), with most having developed 2 to 5 PtDAs (<i>n</i> = 9). Participants noted that the platform could enhance the shared understanding of processes and roles (Coherence), support input from different stakeholders (Cognitive Participation), and streamline development and revision, recommending features such as version tracking (Collective Action). They also emphasized the need for customizable PtDA templates, training, and PtDA certification (Reflective Monitoring). <b>Limitations.</b> Few participants were from middle- or low-income countries, limiting the findings' transferability to these populations. <b>Conclusions.</b> Next steps include developing and evaluating a minimum viable version of the platform incorporating these findings. <b>Implications.</b> This innovation has the potential to scale the development of PtDAs and ultimately support evidence-based and preference-sensitive clinical decisions.</p><p><strong>Highlights: </strong>This formative research presents an innovative infrastructure designed to scale patient decision aids through capacity-building tools and standardized templates.Stakeholder feedback suggests that the platform could enable more timely and resource-efficient development of decision aids, although its effectiveness has yet to be evaluated.The platform's collaborative features could foster partnerships between developers, clinicians, and patients by promoting a shared understanding of the process and making roles and decisions about content more transparent.To increase confidence in the quality of decision aids, future work should introduce a validation process for decision aids and integrate evidence-synthesis guidance into the platform.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683251409185"},"PeriodicalIF":1.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12864716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"The Doctor Only Knows What He Knows, but I Know What I Know:\": Parent Perspectives on Shared Decision Making with Adolescents.","authors":"Isabella K Pallotto, Adam C Carle, Chelsey B Anderson, Naana Ennin, Mary Anne Ammon, Ellen A Lipstein","doi":"10.1177/23814683251409819","DOIUrl":"10.1177/23814683251409819","url":null,"abstract":"<p><p><b>Background.</b> Shared decision making (SDM) involving adolescents with chronic conditions is a triadic process that requires engaging adolescent patients, their parent(s), and their health care provider. We sought to understand the perspectives of parents about these interactions and the parents' role in SDM. <b>Methods.</b> We conducted semi-structured qualitative interviews with parents of adolescents (aged 12-17 y) with chronic conditions. The interviews focused on parents' experiences of medical decision making related to their adolescent's care, followed by experiences of SDM. We specifically addressed key aspects of SDM including information exchange, options, values, and preferences. We coded and analyzed the interviews using thematic content analysis. <b>Results.</b> Twenty-one parents completed an interview (median age 44 y, 91% female, 53% non-White). We identified 4 themes from the data: <i>parents want an executive role</i>, <i>parents as experts</i>, <i>parents' perceptions of others' roles</i>, and <i>parents' necessities for SDM</i>. Parents described wanting to control the level to which their adolescent is involved in SDM based on their perceived knowledge of their adolescent's capabilities. Parents reported feeling pressure to understand all aspects of potential decisions. Finally, parents underscored the need for trusting relationships between all members of the triad. <b>Conclusions.</b> Parents identify key roles for themselves and others in triadic SDM. By understanding these perspectives, health care providers may be better prepared to promote SDM in the care of adolescents with chronic conditions. <b>Implications.</b> This research has implications for how decisions are shared between providers and families. Valuing parents and including them in decision making has the potential to establish stronger relationships between the family and the care team and reduce parents' anxiety about their child's health.</p><p><strong>Highlights: </strong>This study is the first to explore parents' perspectives of triadic SDM involving an adolescent with a chronic condition.We identify situations (e.g., non-life-threatening treatment decisions, before an impending transition to adult medicine) in which parents may be more amenable to including their adolescent in the decision process.Understanding parents' perspectives on decision making can help providers establish strong relationships with the families, which may improve care for adolescents with chronic conditions.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683251409819"},"PeriodicalIF":1.7,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12861352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146107220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness of Metoclopramide, Paracetamol, and Ceftriaxone for the Prevention of Infections and Fever in Elderly Patients with Acute Stroke.","authors":"Mathyn Vervaart, Jeroen C de Jonge, Philip M Bath, Hans Olav Melberg, Hendrik Reinink, Wouter M Sluis, Lisa J Woodhouse, H Bart van der Worp, Anne Hege Aamodt","doi":"10.1177/23814683251386472","DOIUrl":"10.1177/23814683251386472","url":null,"abstract":"<p><p><b>Objective.</b> Infections and fever after stroke are associated with poor functional outcome and death. We compared the cost-effectiveness of prophylactic metoclopramide, paracetamol, and ceftriaxone, either as monotherapies or in combination, with standard of care for reducing complications in older patients with acute stroke. <b>Methods.</b> We conducted a model-based analysis estimating expected lifetime costs, quality-adjusted life-years (QALYs), and net monetary benefit (NMB) from a Dutch health care perspective, given a willingness-to-pay threshold of 50,000 euros per QALY gained. The model synthesized patient-level data from the PREvention of Complications to Improve OUtcome in older patients with acute Stroke (PRECIOUS) trial with data from long-term observational studies. We conducted a value-of-information analysis to quantify the expected value of reducing decision uncertainty through additional data collection on key input parameters. <b>Results.</b> Combination therapy with metoclopramide, ceftriaxone, and paracetamol yielded the highest expected NMB and was the most cost-effective treatment option. When compared with standard care, this treatment option decreased costs by €6,438 and increased QALYs by 0.10, resulting in an incremental NMB of €11,721. The value-of-information analysis indicated that decision uncertainty was driven by uncertainty about the treatment effects on poststroke disability, measured by the modified Rankin Scale (mRS). Moreover, the analysis suggested that the expected value of reducing uncertainty through additional data collection on acute phase mRS scores far exceeds the expected costs. <b>Conclusion.</b> Our economic evaluation suggests that combination therapy with metoclopramide, paracetamol, and ceftriaxone may be the most cost-effective option for treating older patients with stroke in the Netherlands. However, there is likely great value in reducing uncertainty by conducting a new study that collects additional data on acute phase mRS scores.</p><p><strong>Highlights: </strong>Prophylactic combination therapy with metoclopramide, paracetamol, and ceftriaxone may be the most cost-effective strategy for preventing infections and fever in elderly patients with acute stroke.There is substantial decision uncertainty, primarily driven by uncertainty regarding the treatment effects on functional outcome (modified Rankin Scale, mRS).Value-of-information analysis indicates that the value of reducing uncertainty through a new study on acute phase mRS scores is very high.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683251386472"},"PeriodicalIF":1.7,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12812187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146004027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness of Risk-Based Screening for Asymptomatic Carotid Artery Stenosis.","authors":"Jinyi Zhu, Janice Jhang, Hanxuan Yu, Alvin I Mushlin, Hooman Kamel, Nathaniel Alemayehu, John C Giardina, Ajay Gupta, Ankur Pandya","doi":"10.1177/23814683251409213","DOIUrl":"10.1177/23814683251409213","url":null,"abstract":"<p><p><b>Background.</b> Extracranial internal carotid artery stenosis (50%-99% arterial narrowing) is an important risk factor for ischemic stroke. Yet, the benefits and harms of targeted screening for asymptomatic carotid artery stenosis (ACAS) have not been assessed in population-based studies. We aimed to estimate the cost-effectiveness of one-time, targeted ACAS screening stratified by atherosclerotic cardiovascular disease (ASCVD) risk using the American Heart Association's pooled cohort equations. <b>Methods.</b> We developed a lifetime microsimulation model of ACAS and stroke for a hypothetical cohort representative of US adults aged 50 to 80 y without stroke history. Model parameters were derived from multiple cohort studies and the published literature. Outcomes included estimated stroke events prevented, lifetime costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) associated with ACAS screening. Costs (2023 USD) and QALYs were discounted at 3% annually. Cost-effectiveness was assessed from the health care sector perspective using a $100,000/QALY threshold. <b>Results.</b> We found that screening individuals with a 10-y ASCVD risk >30% was the most cost-effective strategy, with an ICER of $89,000/QALY. This strategy would make approximately 11.9% of the population eligible for screening, averting an estimated 24,084 strokes over the cohort's lifetime. In probabilistic sensitivity analysis, screening those in lower ASCVD risk groups (0%-20%) had only a 0.6% chance of being cost-effective. If the ongoing CREST-2 trial shows that revascularization reduces stroke risk by less than 30% (relative risk >0.7), it may shift the balance against any screening. <b>Conclusions.</b> ACAS screening may be cost-effective only for adults at relatively high ASCVD risk. These findings provide a flexible decision-analytic framework that can inform clinical and policy guidance as future trial results refine the role of revascularization and intensive medical therapy.</p><p><strong>Highlights: </strong>Targeted screening for asymptomatic carotid artery stenosis may be cost-effective only for adults aged 50 to 80 y at high atherosclerotic cardiovascular disease (ASCVD) risk.Screening individuals with a 10-y ASCVD risk greater than 30% could substantially reduce lifetime stroke burden while remaining within accepted US cost-effectiveness thresholds.Screening lower-risk (0%-20% 10-y ASCVD risk) adults provides minimal health gains at significantly higher costs and should not be recommended.Findings offer a decision-analytic framework to inform future screening guidelines and policy decisions as results from ongoing trials, such as CREST-2, become available.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683251409213"},"PeriodicalIF":1.7,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12811569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}