MDM Policy and Practice最新文献

{"title":"Effects of Booking Horizon Reduction on Cancellation Rates: An Experimental Analysis in Pediatric Outpatient Care.","authors":"Benjamin Ravenscroft, Hossein Abouee Mehrizi, Brendan Wylie-Toal","doi":"10.1177/23814683241298673","DOIUrl":"10.1177/23814683241298673","url":null,"abstract":"<p><p><b>Background.</b> The time between booking an appointment and the appointment taking place, known as lead time, has been identified as a predictor of cancellation and no-show probability in health care settings. Understanding the impact of reducing permissible lead times, that is, the booking horizon, at a policy level in an outpatient care setting is important when mitigating costly cancellation and no-show rates. Few studies have researched this in an observational or experimental setting. <b>Methods.</b> We leveraged longitudinal observational data from an outpatient pediatric rehabilitation organization in Ontario, Canada, consisting of 73,482 visits between June 2021 and October 2023. This organization reduced its booking horizon at the policy level from 12 to 4 wk in February 2023. Using 2 interrupted time-series approaches, we estimated the change in level, slope, and variance of the weekly combined last-minute cancellation and no-show rate associated with the policy change. <b>Results.</b> It is estimated that reducing the booking horizon is associated with an absolute reduction in the weekly rate of last-minute cancellations and no-shows of 1.02% to 1.85% (a relative reduction of 8.07%-15.70%). Furthermore, the variance dropped by 48.18%. <b>Conclusion.</b> Reducing the appointment booking horizon is associated with a significant reduction in the rate and variance of costly last-minute cancellations and no-shows. The reduced variance can also help enable effective usage of strategies such as overbooking for organizations seeking further approaches to mitigating the negative effects of no-shows.</p><p><strong>Highlights: </strong>This study uses interrupted time-series approaches to assess the effects of reducing the appointment booking horizon at a policy level on last-minute cancellations and no-shows in a pediatric outpatient care setting.Reducing the permissible booking horizon from up to 3 mo to up to 4 wk is associated with a significant reduction in the rate of last-minute cancellations and no-shows.The shortened booking horizon policy is associated with a significant drop in the variance of last-minute cancellations and no-show rates, which is valuable in settings where overbooking occurs.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"9 2","pages":"23814683241298673"},"PeriodicalIF":1.9,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677128","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":"Is Lung Cancer Screening Knowledge Associated with Patient-Centered Outcomes? A Multi-institutional Cohort Study.","authors":"Liana Schweiger, Sara E Golden, Donald R Sullivan, Ian Ilea, Sean P M Rice, Anne C Melzer, Santanu Datta, James M Davis, Christopher G Slatore","doi":"10.1177/23814683241286884","DOIUrl":"10.1177/23814683241286884","url":null,"abstract":"<p><p><b>Introduction.</b> The Centers for Medicare and Medicaid Services mandate that clinicians use a shared decision-making interaction to provide information about the harms and benefits of lung cancer screening (LCS). <b>Methods.</b> We enrolled patients from 3 geographically diverse medical centers after a decision-making interaction about undergoing LCS but before receiving a low-dose computed tomography (CT) scan. We performed the primary analysis based on the primary knowledge question, \"Which of these conditions do you think that the CT scan screens for?\" We used the knowledge summary score in secondary analyses. We evaluated LCS care experience by using validated instruments to measure participant-reported communication quality (Consultation Care Measure), perception of the primary LCS clinician (Consumer Assessment of Health Care Providers and Systems), and decision conflict (Decisional Conflict Scale). <b>Results.</b> Of the 409 participants, 44% correctly answered the primary LCS knowledge question. Clinician communication quality was rated positively by 93% of participants. Most (93%) participants rated their LCS clinician as good. Only 14% reported decision conflict. Correctly answering the primary LCS knowledge question was associated with higher patient-clinician communication quality scores (b = 0.4; 95% confidence interval [CI] [0.1, 0.7]; <i>R</i> ² change = 0.03) and higher LCS clinician ratings (b = 0.4; 95% CI [0.0, 0.7]; <i>R</i> ² change = 0.02) but not with decision conflict. In secondary analyses, higher total LCS knowledge score was associated with lower Decisional Conflict Scale scores (b = -2.2; 95% CI [-3.4, -0.9]; <i>R</i> ² change = 0.24), indicating lower decision conflict. <b>Conclusions.</b> After an LCS decision-making interaction, many patients do not retain basic knowledge about LCS but nevertheless had low levels of decision conflict. Primary LCS knowledge may be important but insufficient to ensure high-quality, patient-centered LCS care.</p><p><strong>Highlights: </strong>Survey of patients with a lung cancer screening (LCS) decision-making interaction.Only 44% of patients correctly answered the knowledge question about LCS.Primary LCS knowledge was not associated with decision conflict.Patient knowledge about LCS may not equate to high-quality patient-centered care.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"9 2","pages":"23814683241286884"},"PeriodicalIF":1.9,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559049","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":"\"I Just Had to Do What I Had to Do\": Characterizing Direct and Indirect Prostate Cancer Treatment Costs for Black Survivors and Their Caregivers.","authors":"Hannah E Rice, Allison J L'Hotta, Amela Siječić, Bettina F Drake, Su-Hsin Chang, Eric H Kim, Robin Wright-Jones, Mellve Shahid, Camille Neal, Ashley J Housten","doi":"10.1177/23814683241282413","DOIUrl":"10.1177/23814683241282413","url":null,"abstract":"<p><p><b>Introduction.</b> Financial hardship is prevalent among Black prostate cancer survivors and exacerbates health disparities. Characterizing and sharing cost information with patients can facilitate well-informed treatment decision making. Our research explored the direct and indirect costs associated with prostate cancer treatment among Black men and their caregivers. Direct costs included out-of-pocket and insurance-related fees, and indirect costs included the unforeseen costs of care, including patient time, caregiver time, lost wages, and transportation. <b>Methods.</b> We conducted semi-structured interviews with Black prostate cancer survivors and their caregivers to learn about the experience of direct and indirect costs. The interview guide and data analysis were informed by the Measures of Financial Wellbeing framework to gain a better understanding of the material, behavioral, and psychosocial aspects of care-related costs. Guided by a qualitative descriptive approach, we used inductive and deductive coding for our thematic analysis. <b>Results.</b> Eleven prostate cancer survivors with a median age of 68 y (interquartile range [IQR] 62.0-71.5 y) and 11 caregivers with a median age of 64 y (IQR 58.5-70.5 y) participated. We grouped themes into 3 domains and their intersections (i.e., material, behavioral, psychosocial). Participants reported their work and insurance had a significant influence on their finances, treatment costs required rearranging of household budgets, and the weight of indirect costs varied. Ultimately, participants emphasized the significant impact of care costs and the adjustments needed to adapt to them. <b>Discussion.</b> The complexities of material, behavioral, and psychosocial domains of direct and indirect costs of prostate cancer are critical to address when supporting those diagnosed with prostate cancer when making preference-sensitive treatment decisions. The interconnectedness between indirect costs highlights the wide-ranging impact financial well-being has on prostate cancer survivors and caregivers.</p><p><strong>Highlights: </strong>Direct and indirect costs have a wide-ranging impact on the material, behavioral, and psychosocial aspects of financial well-being of Black prostate cancer survivors and their caregivers.These results emphasize the need for sharing cost information to support medical decision making.Future research should focus on the design of cost-sharing interventions that target the complexities of direct and indirect costs collectively, rather than separately.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"9 2","pages":"23814683241282413"},"PeriodicalIF":1.9,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11459478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394017","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":"Barriers and Facilitators for Implementing Shared Decision Making in Differentiated Antiretroviral Therapy Service in Northwest Ethiopia: Implications for Policy and Practice.","authors":"Yihalem Abebe Belay, Mezgebu Yitayal, Asmamaw Atnafu, Fitalew Agimass Taye","doi":"10.1177/23814683241281385","DOIUrl":"https://doi.org/10.1177/23814683241281385","url":null,"abstract":"<p><p><b>Background.</b> Shared decision making (SDM) for patients enrolling in differentiated antiretroviral therapy (DART) is crucial. Empirical evidence is lacking regarding factors promoting or hindering SDM implementation in DART provision in Ethiopia. Hence, this study aimed to explore the barriers and facilitators to implementing SDM for patients enrolled in DART in Northwest Ethiopia. <b>Methods.</b> A qualitative descriptive study using semi-structured interviews among 17 patients and 15 providers at health facilities providing DART service was conducted. The MAXQDA version 20 software was used for inductive coding. Interviews were analyzed using thematic analysis. <b>Results.</b> Ten themes emerged at 4 levels related to SDM in the provision of DART: patient, provider, organizational, and health system. At the patient level, 1) trust in providers (facilitator) and 2) patient's level of education (barrier) emerged as themes. At the provider level, 3) lack of familiarity with DART models (barrier) and 4) patient-provider relationship (barrier and facilitator) were emerged themes. At the organizational level, 5) workload (barrier) and 6) resources (barrier and facilitator) emerged as themes. At the health system level, 7) availability of DART models (facilitator), 8) not involving providers while initiating DART models (barrier), 9) other providers' involvement (facilitator), and 10) presence of other implementing partners (barrier) emerged as themes. <b>Conclusions.</b> Numerous barriers and facilitators influence the implementation of SDM in the provision of DART. Based on these findings, the following steps are recommended. Providing access to patient decision aids shall be in place to assist patients in making decisions about their preferred DART models. Health care workers shall be trained, and patients shall be given education to enhance the SDM process. Policy makers and program managers shall consider the resource context (training and size of human resources and convenience of rooms) for the delivery of ART service to have an appropriate implementation of SDM in clinical practice.</p><p><strong>Highlights: </strong>Shared decision making in DART is influenced by various barriers and facilitators present at the patient, provider, organizational, and health system levels.Patients need education, and health care staff need regular training to improve SDM in DART service provision.Patient access to decision support tools that aid in the selection of the preferred DART model in health facilities is critical.Policy makers and program managers shall consider the availability of adequate and trained human resources as well as provide adequate space and private rooms for SDM in the implementation of DART.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"9 2","pages":"23814683241281385"},"PeriodicalIF":1.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11412211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297464","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":"Examining the Role of Stress and Team Support in Decision Making under Uncertainty and Time Pressure.","authors":"Sana Younas, Saeeda Khanum","doi":"10.1177/23814683241273575","DOIUrl":"10.1177/23814683241273575","url":null,"abstract":"<p><p><b>Background.</b> Previous research has examined the individual effects of uncertainty, time pressure, perceived stress, and team support on decision making. However, scant research has investigated how team support and perceived stress collectively influence providers' perception of decision conflict and satisfaction with decision. <b>Objectives.</b> The present study aims to fill this void by examining the potential mediating role of perceived stress and team support in the relationship between time pressure, uncertainty, decision satisfaction, and decision conflict. <b>Methods.</b> Obstetrics and gynecology (Obs and Gynae) physicians (<i>N</i> = 347) working in tertiary care hospitals were approached through snowball and purposive convenient sampling. Self-reported data were collected in the form of questionnaires. <b>Results.</b> Structural equation modeling was used to uncover the complex linkages. Perceived stress was found to be a significant mediator between uncertainty and decision conflict (<i>b</i> = -0.033, <i>P</i> < 0.05). In addition, team support was also found to be a significant mediator between uncertainty and decision satisfaction (<i>b</i> = 0.082, <i>P</i> < 0.05) as well as between time pressure and decision satisfaction (<i>b</i> = 0.086, <i>P</i> < 0.05). <b>Conclusion.</b> Team support acts as a bridge between uncertainty and decision satisfaction and also between time pressure and decision satisfaction, underscoring its critical role in provider perceptions of decision making in the Obs and Gynae context. <b>Implications.</b> This study highlights the significance of managing stress, enhancing team support, and giving priority to patient-centered care. These findings provide insights into risk and uncertainty management in medical decision making, advancing patient-centered care, and optimizing health care outcomes.</p><p><strong>Highlights: </strong>Stressors in hospital settings such as the complexity and uncertainty of tasks create stress among physicians, potentially leading to decision conflicts.Team support plays a fundamental role in mitigating the negative effects of stressors such as time pressure and uncertainty.Implementing stress management and team support interventions such as cognitive-behavioral therapy and mindfulness may enhance decision making among Obs and Gynae physicians.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"9 2","pages":"23814683241273575"},"PeriodicalIF":1.9,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11367605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120795","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":"Patients' Preferences for Antiretroviral Therapy Service in Northwest Ethiopia: A Discrete Choice Experiment.","authors":"Yihalem Abebe Belay, Mezgebu Yitayal, Asmamaw Atnafu, Fitalew Agimass Taye","doi":"10.1177/23814683241273635","DOIUrl":"10.1177/23814683241273635","url":null,"abstract":"<p><p><b>Objective.</b> We aim to evaluate patients' preferences for antiretroviral therapy (ART) to enhance shared decision making in clinical practice in Northwest Ethiopia. <b>Methods.</b> A discrete choice experiment approach was used among adult patients from 36 randomly selected public health facilities from February 6, 2023, to March 29, 2023. A literature review, qualitative work, ranking and rating surveys, and expert consultation were used to identify the attributes. Location, provider, frequency of visit, appointment modality, refill time, and cost of visit were the 6 ART service features chosen. Participants were given the option of choosing between 2 hypothetical differentiated ART delivery models. Mixed logit and latent class analysis were used. <b>Results:</b> Four hundred fifty-six patients completed the choice task. Respondents preferred to receive ART refills alone at health facilities by health care workers without having to have frequent visits and with reduced cost of visit. Overall, the participants valued the cost of the visit the most while they valued the timing of ART refill the least. Participants were willing to pay only for the attributes of frequency of visit and medication refill time. The latent class model with 3 classes provided the best model fit. Location, cost, and frequency were the most important attributes in class 1, class 2, and class 3, respectively. Income and marital status significantly predicted class membership. <b>Conclusions.</b> Respondents preferred to receive refills at health facilities, less frequent visits, individual appointments, service provision by health care workers, and reduced cost of visit. The cost attribute had the greatest impact on the choice of patients. Health care workers should consider the preferences of patients while providing ART services to meet patients' expectations and choices.</p><p><strong>Highlights: </strong>A discrete choice experiment was used to elicit patient preferences.People living with HIV preferred receiving medication refills at health facilities, less frequent visits, individual appointments, service delivery by health care workers, and lower visit costs.Health care workers should consider the preferences of patients while providing ART service to meet their expectations and choices.Scaling up differentiated HIV treatment services is crucial for patient-centered care.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"9 2","pages":"23814683241273635"},"PeriodicalIF":1.9,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11367608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120796","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":"Young Adult and Parent Willingness to Pay for Meningococcal Serogroup B Vaccination.","authors":"Liping Huang, Amit Srivastava, Angelyn Fairchild, Dale Whittington, Reed Johnson","doi":"10.1177/23814683241264280","DOIUrl":"10.1177/23814683241264280","url":null,"abstract":"<p><p><b>Introduction.</b> Serogroup B (MenB) is the leading cause of invasive meningococcal disease among adolescents and young adults in the United States. The US Advisory Committee on Immunization Practices (ACIP) recommends MenB vaccination based on shared clinical decision making between patients and providers. However, suboptimal understanding of these recommendations could contribute to low vaccination awareness and coverage. Understanding young adult and parent expectations of their health care providers (HCPs) and the value they place on vaccine information could help inform a consistent approach to HCP MenB vaccination discussions and recommendations. <b>Methods.</b> Data collected via a discrete-choice experiment online survey were used to evaluate preferences and willingness to pay regarding MenB vaccination among US parents and young adults in 2019. <b>Results.</b> Of 2,388 respondents with valid data, 1,185 were parents of children aged 12 to 25 y, and 1,203 were young adults aged 18 to 25 y. Approximately 70% of parents and young adults indicated that they would react negatively if their HCP chose not to initiate a discussion with them about MenB vaccines. Neither parents nor young adults were willing to pay for additional time for MenB vaccine discussions with their HCP but were willing to pay an average of $416 and $282, respectively, for the vaccine. For parents and young adults, greater willingness to pay was associated with a provaccination attitude and the opinion that the HCP has a moral obligation to discuss the MenB vaccine with them. <b>Conclusion.</b> Both parents and young adults felt their HCP is responsible for initiating a discussion about MenB vaccination and disease risk and were willing to pay for the vaccine. These findings should help inform ACIP recommendations for meningococcal vaccination.</p><p><strong>Highlights: </strong>ACIP recommends shared clinical decision making for MenB vaccination.Data were collected from young adults and parents of adolescents by online survey.We measured values and consultation preferences on MenB disease and vaccination.Young adults/parents strongly preferred doctor-initiated MenB vaccine discussion.Respondents were willing to pay for a MenB vaccine.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"9 2","pages":"23814683241264280"},"PeriodicalIF":1.9,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11320402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976866","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 Utility Values for Health States of Nigerian Individuals with Stroke or Epilepsy Using the SF-36: A Brief Report on the Results of a Cross-Sectional Survey.","authors":"T Gebrye, C O Akosile, E C Okoye, U V Okoli, F Fatoye","doi":"10.1177/23814683241266193","DOIUrl":"10.1177/23814683241266193","url":null,"abstract":"<p><p><b>Background.</b> Stroke and epilepsy are the most common neurologic conditions affecting individuals. The Short Form Six-Dimension Health Index (SF-6D) is a preference-based measure of health developed to estimate utility values from the SF-36. This study estimated utility values for health states of Nigerian individuals with stroke or epilepsy using the SF-36. <b>Methods.</b> SF-36 responses from 125 and 69 individuals with stroke and persons with epilepsy, respectively, were transformed into health state utility values using the SF-6D algorithm. The Excel program developed by Brazier and colleagues was used to generate the SF-6D utility score estimated using a set of parametric preference weights. The health state utility values were determined using ordinal health state and standard gamble valuation techniques. <b>Results.</b> Mean (<i>s</i>) ages of the stroke and epilepsy participants were 63.1 (11) and 39.6 (16) y, respectively. The mean (<i>s</i>) utility scores for stroke and epilepsy were 0.52 (0.10) and 0.65 (0.1) for standard gamble and 0.48 (0.13) and 0.68 (0.11), respectively, using the ordinal health state paradigm. The mean (<i>s</i>) utility of stroke (female = 0.46 [0.15]; male = 0.50 [0.12]) and epilepsy (female = 0.65 [0.13], male = 0.69 [0.11]) participants were reported. The mean (<i>s</i>) annual episodes of seizure was 18.7 (39). <b>Conclusions.</b> To our knowledge, this is the first study to suggest that females with stroke and those with epilepsy considered their health to be poorer than that of their male counterparts. The significance of our findings is that they may be helpful for researchers, policy makers, and clinicians by providing input into economic evaluations to facilitate resource allocation for stroke survivors and people living with epilepsy to improve their health outcomes and reduce the huge burden associated with the conditions.</p><p><strong>Highlight: </strong>We estimated a health state utility value for stroke and epilepsy to aid researchers and public health policy makers in conducting health economic analysis and outcomes research.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"9 2","pages":"23814683241266193"},"PeriodicalIF":1.9,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11297505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894520","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":"Modeling the Impact of COVID-19 Mitigation Strategies in Pennsylvania, USA.","authors":"Mary G Krauland, Mark S Roberts","doi":"10.1177/23814683241260744","DOIUrl":"10.1177/23814683241260744","url":null,"abstract":"<p><p><b>Purpose.</b> To estimate the impact on mortality of nonpharmaceutical interventions (NPIs) implemented early in the COVID-19 pandemic. <b>Methods.</b> We implemented an agent-based modified SEIR model of COVID-19, calibrated to match death numbers reported in Pennsylvania from January 2020 to April 2021 and including representations of NPIs implemented in Pennsylvania. To investigate the impact of these strategies, we ran the calibrated model with no interventions and with varying combinations, timings, and levels of interventions. <b>Results.</b> The model closely replicated death outcomes data for Pennsylvania. Without NPIs, deaths in the early months of the pandemic were estimated to be much higher (67,718 deaths compared to actual 6,969). Voluntary interventions alone were relatively ineffective at decreasing mortality. Delaying implementation of interventions led to higher deaths (∼9,000 more deaths with just a 1-week delay). School closure was insufficient as a single intervention but was an important part of a combined intervention strategy. <b>Conclusions.</b> NPIs were effective at reducing deaths early in the COVID-19 pandemic. Agent-based models can incorporate substantial detail on infectious disease spread and the impact of mitigations. <b>Policy Implications.</b> The model supports the importance and effectiveness of NPIs to decrease morbidity from respiratory pathogens. This is particularly important for emerging pathogens for which no vaccines or treatments exist, but such strategies are applicable to a variety of respiratory pathogens.</p><p><strong>Highlights: </strong>Nonpharmaceutical interventions were used extensively during the early period of the COVID-19 pandemic, but their use has remained controversial.Agent-based modeling of the impact of these mitigation strategies early in the COVID-19 pandemic supports the effectiveness of nonpharmaceutical interventions at decreasing mortality.Since such interventions are not specific to a particular pathogen, they can be used to protect against any respiratory pathogen, known or emerging. They can be applied rapidly when conditions warrant.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"9 1","pages":"23814683241260744"},"PeriodicalIF":1.9,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11191394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443476","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":"Screening and Treatment of Posttraumatic Stress Disorder in Wildfire Evacuees: A Cost-Utility Analysis.","authors":"Michael Lebenbaum, S Ahmed Hassan","doi":"10.1177/23814683241260423","DOIUrl":"10.1177/23814683241260423","url":null,"abstract":"<p><p><b>Background.</b> Global climate change is resulting in dramatic increases in wildfires. Individuals exposed to wildfires experience a high burden of posttraumatic stress disorder (PTSD), and the cost-effectiveness of the treatment options to address PTSD from wildfires has not been studied. The objective of this study was to conduct a cost-utility analysis comparing screening followed by treatment with paroxetine or trauma-focused cognitive behavioral therapy (TF-CBT) versus no screening in Canadian adult wildfire evacuees. <b>Methods.</b> Using a Markov model, quality-adjusted life-years (QALYs) and costs were evaluated over a 5-y time horizon using health care and societal perspectives. All costs and utilities in the model were discounted at 1.5%. Probabilistic and deterministic sensitivity analyses examined the uncertainty in the incremental net monetary benefit (INMB) under a willingness-to-pay threshold of $50,000. <b>Results.</b> From a societal perspective, no screening (NMB = $177,641) was dominated by screening followed by treatment with paroxetine (NMB = $180,733) and TF-CBT (NMB = $181,787), with TF-CBT having the highest likelihood of being cost-effective at a willingness-to-pay threshold of $50,000 per QALY (probability = 0.649). The initial prevalence of PTSD, probability of acceptance of treatment, and costs of productivity had the largest impact on the INMB of both paroxetine or TF-CBT versus no screening. Neither intervention was cost-effective at a willingness-to-pay threshold of $50,000 per QALY from a health care perspective. <b>Interpretation.</b> Screening followed by treatment with paroxetine or TF-CBT compared with no screening was found to be cost-saving while providing additional QALYs in wildfire evacuees. Governments should consider funding screening programs for PTSD followed by treatment with TF-CBT for wildfire evacuees.</p><p><strong>Highlights: </strong>Two prior studies examined the cost-effectiveness of screening followed by treatment for PTSD among individuals exposed to other disaster-type events (i.e., terrorist attack and Hurricane Sandy) and found screening followed by treatment (i.e., cognitive behavioral therapy [CBT]) to be highly cost-effective.Among wildfire evacuees, screening followed by treatment with paroxetine or trauma-focused (TF)-CBT provides additional quality-adjusted life-years (QALYs) and is cost-saving from a societal perspective. TF-CBT was the treatment option found most likely to be cost-effective.Neither treatment option was cost-effective at a willingness-to-pay threshold of $50,000 per QALY from a health care perspective.Screening programs for PTSD should be considered for wildfire evacuees, and individuals diagnosed with PTSD could be prescribed either TF-CBT or paroxetine depending on their preference and resources availability.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"9 1","pages":"23814683241260423"},"PeriodicalIF":1.9,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11189003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141433048","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}