MDM Policy and Practice最新文献

{"title":"Development, Testing, and Calibration of LINCS: A New Microsimulation Model of Maternal and Fetal Cytomegalovirus Infection in the United States.","authors":"Aaron S Wu, Elif Coskun, Malavika Prabhu, Emily M Santos, Fatima Kakkar, Clare F Flanagan, Caitlin M Dugdale, Megan Pesch, Andrea L Ciaranello, John C Giardina","doi":"10.1177/23814683261444049","DOIUrl":"10.1177/23814683261444049","url":null,"abstract":"<p><p><b>Background.</b> Congenital cytomegalovirus (cCMV) is a leading cause of birth defects and the most common cause of nongenetic sensorineural hearing loss in children. There is a lack of decision-modeling frameworks that can project cytomegalovirus (CMV)-related patient outcomes and inform health policy. We created, tested, and calibrated a model of CMV acquisition and transmission in pregnancy using linked mother-infant dyads. <b>Methods.</b> We developed the <b>L</b>inking <b>IN</b>fants and Mothers in <b>C</b>ytomegalovirus <b>S</b>imulation (LINCS) dyad-level Monte Carlo microsimulation model of CMV infection among pregnant people and fetuses throughout pregnancy. We parameterized the model with data from North America and Europe from the existing literature, implemented rigorous code-testing procedures, and calibrated a key set of parameters to match the model output to external data on cCMV prevalence and symptom risk. <b>Results.</b> A fully parameterized model for CMV among pregnant people and fetuses was developed, and the model code was confirmed to perform as specified. The calibration procedure identified parameter sets that generated model output closely matching the target values from the available data on cCMV prevalence and symptom risk. <b>Conclusions.</b> The LINCS model's ability to simulate the natural history of CMV infection during pregnancy was described and demonstrated, and the model was tested and calibrated to ensure proper functioning. Base-case parameters were derived for CMV infection natural history to be used in future decision analyses of CMV testing and treatment strategies.</p><p><strong>Highlights: </strong>Congenital cytomegalovirus (cCMV) is a leading cause of birth defects, but there are limited empirical data available and conflicting guidelines around the best approach to prevention, screening, and treatment. The <b>L</b>inking <b>IN</b>fants and Mothers in <b>C</b>ytomegalovirus <b>S</b>imulation (LINCS) model is a comprehensive decision analytic model for cCMV, capturing the full dynamics of the incidence and transmission of CMV among both pregnant people and infants using a microsimulation model centered around the mother-infant dyad.Despite limited data around cCMV, key parameters in the LINCS model were successfully calibrated to available estimates of cCMV prevalence and symptom risk.The LINCS model can be used to project outcomes under available strategies to prevent, screen for, and treat cCMV, providing a robust framework to conduct decision analyses, including cost-effectiveness and comparative effectiveness analyses, and inform better policy and clinical guidelines to reduce the impact of cCMV.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683261444049"},"PeriodicalIF":1.7,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943137","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":"Medicare Part D Beneficiaries' Experiences with Making Complex Insurance Plan Choices: A Qualitative Interview Study.","authors":"Wändi Bruine de Bruin, Nathan Hodson, Lila Rabinovich, Joachim Winter","doi":"10.1177/23814683261441269","DOIUrl":"10.1177/23814683261441269","url":null,"abstract":"<p><p><b>Background.</b> The Medicare Part D program provides stand-alone prescription drug insurance to US residents aged ≥65 y and those with disabilities. Annually, they can choose to stay with their plan or to switch to one of the many alternative plans. Behavioral decision-making research has proposed various strategies for tackling such complex choices. Here, we interviewed Medicare Part D beneficiaries to understand their real-world experiences with making their plan choices and examined quotes from those who stayed with their first plan and those who had switched. <b>Method.</b> In July 2023, we conducted phone interviews with 20 Medicare Part D beneficiaries aged 57 to 86 y who were recruited through the US-wide Understanding America Study. <b>Results.</b> Eleven interviewees had stayed with their first plan, and 9 had switched. Stayers and switchers applied similar strategies, with mixed success. Using decision-support tools such as the Medicare plan-finder Web site, booklet, and mailers could be time-consuming and confusing. Recommendations were taken from insurance brokers, agents, and pharmacists, often without questioning their advice. Interviewees varied widely in the amount of information they considered, with some using heuristics to reduce their choice set and others considering only 1 recommended option. Few beneficiaries made annual plan comparisons, and while some deferred choices until necessary, others did not act even after being confronted with plan changes or negative experiences - due to knowledge and time constraints. <b>Discussion.</b> Medicare beneficiaries use various strategies known from the behavioral decision-making research literature for tackling complex choices between Medicare Part D stand-alone plans. Each strategy posed its own challenges. We discuss our findings in light of the behavioral decision-making literature and recommend policies for helping beneficiaries with their plan choices.</p><p><strong>Highlights: </strong>We interviewed Medicare Part D beneficiaries about how they tackled drug insurance plan choices with many options and complicated features.Interviewees reported using decision-support tools, seeking help, applying heuristics, and relying on choice deferral, but with mixed success.Qualitatively, similar experiences were described by interviewees who stayed with their initial plan and those who had switched.We recommend policies for addressing the difficulties beneficiaries had in applying these strategies.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683261441269"},"PeriodicalIF":1.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147933741","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":"Current Diagnostic Approaches and Challenges in the General Emergency Department Evaluation of Suspected Pediatric Appendicitis: A Qualitative Study.","authors":"Courtney W Mangus, Sarah J Parker, Brian J Zikmund-Fisher, Anupam Kharbanda, Melissa Brooks, Helene M Epstein, Timothy C Guetterman, Emma Griffin, Aparna Joshi, Bryan Judge, Heather Orman-Lubell, Milisa Manojlovich, Brigid Rice, Gul R Sachwani-Daswani, Suz Schrandt, Karen Elizabeth Speck, Prashant Mahajan, Elizabeth M Schoenfeld","doi":"10.1177/23814683261438831","DOIUrl":"10.1177/23814683261438831","url":null,"abstract":"<p><p><b>Background.</b> Pediatric abdominal pain accounts for more than 1 million emergency department (ED) visits annually, and appendicitis is the most common surgical emergency. Guidelines recommend ultrasound as the initial imaging study for diagnosing pediatric appendicitis. However, because of the variability in both the availability and interpretation of pediatric ultrasounds in general EDs, clinicians may potentially overuse computed tomography (CT). Shared decision making (SDM) and clinical decision support (CDS) tools may help avoid unnecessary CTs; however, it is not clear to what extent such tools are used. Our objective was to describe the current diagnostic approaches and challenges faced by physicians in general EDs when assessing potential pediatric appendicitis. Understanding the nuances specific to this context may help inform the creation of more universally applicable diagnostic guidelines and CDS tools. <b>Methods.</b> We conducted semi-structured interviews with physicians practicing in general EDs to assess the current approaches and challenges in diagnosing pediatric appendicitis. We sought input on the use of existing CDS tools such as the pediatric appendicitis risk calculator (pARC) and the role of SDM. We analyzed interview transcripts using a thematic approach. <b>Results.</b> We conducted 15 interviews and identified 5 themes: 1) the limited availability of ultrasound often precludes routine use, 2) physicians tend to rely on gestalt over CDS tools, 3) guidelines regarding the transfer of patients to pediatric centers are needed, 4) the pARC could be improved with the integration of general ED-specific recommendations, and 5) physicians described using SDM frequently, but conceptualization and execution varied. <b>Conclusion.</b> Physicians in general EDs identified challenges in the current approaches to diagnosing pediatric appendicitis. A diagnostic pathway that incorporates validated CDS and general ED-specific recommendations could optimize the process, enhance SDM, and potentially reduce unnecessary CTs.</p><p><strong>Highlights: </strong>Diagnosing pediatric appendicitis is challenging, especially in general EDs where pediatric resources are often limited.Physicians in general EDs reported that current imaging techniques and clinical decision support tools often fail to meet the needs of their setting.Physicians often rely on their own experience and often incorporate family preferences (via shared decision making) into their diagnostic planning.Physicians in general EDs reported that better guidelines and community-specific diagnostic algorithms and clinical decision support tools would improve patient care.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683261438831"},"PeriodicalIF":1.7,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13153542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147869781","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":"Development of a Patient Decision Aid for the DAHANCA 35 Proton Radiotherapy Trial: An Iterative Development Process with User-Centered Design Elements.","authors":"Anne Wilhøft Kristensen, Annesofie Lunde Jensen, Kenneth Jensen, Susanne Oksbjerg Dalton, Jeppe Friborg, Cai Grau, Hilary L Bekker","doi":"10.1177/23814683261441513","DOIUrl":"10.1177/23814683261441513","url":null,"abstract":"<p><p><b>Background.</b> Deciding whether to participate in a radiotherapy trial is complex for patients with head and neck cancer. Standard patient information leaflets meet ethical requirements but do not provide balanced comparisons, value clarification, or structured decision support. Few patient decision aids (PtDAs) have been developed for clinical trial participation. <b>Objective.</b> To develop a PtDA to support decisions about participation in a randomized trial comparing proton versus photon radiotherapy (DAHANCA 35). <b>Methods.</b> Following the Medical Research Council framework for complex interventions, an iterative development process incorporating elements of user-centered design was undertaken, informed by the Ottawa Decision Support Framework (ODSF), International Patient Decision Aid Standards (IPDAS), and Measure of User- and Human-Centred Design for Personal Health Tools (UCD-11). Five steps were conducted: 1) scoping informed by 3 preceding studies and a workshop with clinicians, 2) drafting of an initial prototype, 3) iterative refinement in a multidisciplinary development group, 4) alpha testing using think-aloud interviews with patients (<i>n</i> = 5) and clinicians (<i>n</i> = 8), and 5) finalization. Data from workshops, written feedback, group discussions, and interviews informed revisions. <b>Results.</b> The final iteration of the PtDA provides balanced, plain-language information; value clarification; and decision support regarding participation in DAHANCA 35, including an explicit presentation of the decision between standard photon radiotherapy and the trial option. Visual elements, a comparison table, a decision tree, and tools from the Ottawa Personal Decision Guide were integrated to support comprehension and deliberation. Alpha testing confirmed usability and informed refinements that improved clarity and navigation. <b>Conclusions.</b> This iterative development process, incorporating elements of user-centered design, resulted in a PtDA that addressed decision-making needs within the trial context. Future research will assess the feasibility and implementation of this approach. The development approach may serve as a foundation for adapting PtDAs to other radiotherapy clinical trials.</p><p><strong>Highlights: </strong>A patient decision aid (PtDA) was developed to support individuals with head and neck cancer in deciding whether to participate in a proton radiotherapy trial.The PtDA was developed through an iterative, theory-informed, and user-centered process with input from clinicians and trial-eligible patients.The PtDA provides structured, balanced information and explicit comparisons between standard photon radiotherapy and the trial option.This development approach may be adapted to support decision making in other radiotherapy trials and clinical trial contexts.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"11 1","pages":"23814683261441513"},"PeriodicalIF":1.7,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13153567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147869747","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":"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":"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":"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":"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":"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}