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Use of Patient Preferences Data Regarding Multiple Risks to Inform Regulatory Decisions. 使用关于多重风险的患者偏好数据为监管决策提供信息。
MDM Policy and Practice Pub Date : 2023-01-01 DOI: 10.1177/23814683221148715
J Felipe Montano-Campos, Juan Marcos Gonzalez, Timothy Rickert, Angelyn O Fairchild, Bennett Levitan, Shelby D Reed
{"title":"Use of Patient Preferences Data Regarding Multiple Risks to Inform Regulatory Decisions.","authors":"J Felipe Montano-Campos,&nbsp;Juan Marcos Gonzalez,&nbsp;Timothy Rickert,&nbsp;Angelyn O Fairchild,&nbsp;Bennett Levitan,&nbsp;Shelby D Reed","doi":"10.1177/23814683221148715","DOIUrl":"https://doi.org/10.1177/23814683221148715","url":null,"abstract":"<p><p><b>Background and Objectives.</b> Risk-tolerance measures from patient-preference studies typically focus on individual adverse events. We recently introduced an approach that extends maximum acceptable risk (MAR) calculations to simultaneous maximum acceptable risk thresholds (SMART) for multiple treatment-related risks. We extend these methods to include the computation and display of confidence intervals and apply the approach to 3 published discrete-choice experiments to evaluate its utility to inform regulatory decisions. <b>Methods.</b> We generate MAR estimates and SMART curves and compare them with trial-based benefit-risk profiles of select treatments for depression, psoriasis, and thyroid cancer. <b>Results.</b> In the depression study, SMART curves with 70% to 95% confidence intervals portray which combinations of 2 adverse events would be considered acceptable. In the psoriasis example, the asymmetric confidence intervals for the SMART curve indicate that relying on independent MARs versus SMART curves when there are nonlinear preferences can lead to decisions that could expose patients to greater risks than they would accept. The thyroid cancer application shows an example in which the clinical incidence of each of 3 adverse events is lower than the single-event MARs for the expected treatment benefit, yet the collective risk profile surpasses acceptable levels when considered jointly. <b>Limitations.</b> Nonrandom sample of studies. <b>Conclusions.</b> When evaluating conventional MARs in which the observed incidences are near the estimated MARs or where preferences demonstrate diminishing marginal disutility of risk, conventional MAR estimates will overstate risk acceptance, which could lead to misinformed decisions, potentially placing patients at greater risk of adverse events than they would accept. <b>Implications.</b> The SMART method, herein extended to include confidence intervals, provides a reproducible, transparent evidence-based approach to enable decision makers to use data from discrete-choice experiments to account for multiple adverse events.</p><p><strong>Highlights: </strong>Estimates of maximum acceptable risk (MAR) for a defined treatment benefit can be useful to inform regulatory decisions; however, the conventional metric considers one adverse event at a time.This article applies a new approach known as SMART (simultaneous maximum acceptable risk thresholds) that accounts for multiple adverse events to 3 published discrete-choice experiments.Findings reveal that conventional MARs could lead decision makers to accept a treatment based on individual risks that would not be acceptable if multiple risks are considered simultaneously.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"8 1","pages":"23814683221148715"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/71/fe/10.1177_23814683221148715.PMC9841858.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10604155","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}
引用次数: 1
Beyond High-Income Countries: Low Numeracy Is Associated with Older Adult Age around the World. 在高收入国家之外:世界各地的低计算能力与老年人有关。
MDM Policy and Practice Pub Date : 2023-01-01 DOI: 10.1177/23814683231174241
Wändi Bruine de Bruin, Aulona Ulqinaku, Jimena Llopis, Matteo Santangelo Ravà
{"title":"Beyond High-Income Countries: Low Numeracy Is Associated with Older Adult Age around the World.","authors":"Wändi Bruine de Bruin,&nbsp;Aulona Ulqinaku,&nbsp;Jimena Llopis,&nbsp;Matteo Santangelo Ravà","doi":"10.1177/23814683231174241","DOIUrl":"https://doi.org/10.1177/23814683231174241","url":null,"abstract":"<p><strong>Background: </strong>Numeracy, or the ability to understand and use numbers, has been associated with obtaining better health and financial outcomes. Studies in high-income countries suggest that low numeracy is associated with older age-perhaps especially among individuals with lower education. Here, we examined whether findings generalize to the rest of the world.</p><p><strong>Methods: </strong>Gallup surveyed >150,000 participants for the 2019 Lloyd's Register Foundation World Risk Poll, from 21 low-income, 34 lower-middle income, 42 upper-middle income, and 43 high-income countries. Low numeracy was operationalized as failing to correctly answer, \"Is 10% bigger than 1 out of 10, smaller than 1 out of 10, or the same as 1 out of 10?\"</p><p><strong>Results: </strong>Regressions controlling for participants' education, income, and other characteristics found that, worldwide, low numeracy was associated with older age, lower education, and their interaction. Findings held in each country-income category, although low numeracy was more common in low-income countries than in high-income countries.</p><p><strong>Limitations: </strong>Age differences may reflect cohort effects and life span-developmental changes.</p><p><strong>Discussion: </strong>Low numeracy is more common among people who are older and less educated. We discuss the need for education and interventions outside of the classroom.</p><p><strong>Highlights: </strong>We analyzed a global survey conducted in 21 low-income, 34 lower-middle income, 42 upper-middle income, and 43 high-income countries.Low numeracy was associated with older adult age, even after accounting for age differences in education.Low numeracy was more common in older people with lower education.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"8 1","pages":"23814683231174241"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b4/6f/10.1177_23814683231174241.PMC10363889.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9875711","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}
引用次数: 0
Infliximab Pricing in International Economic Evaluations in Inflammatory Bowel Disease to Inform Biologic and Biosimilar Access Policies: A Systematic Review. 英夫利昔单抗定价在炎症性肠病的国际经济评估中为生物和生物仿制药准入政策提供信息:一项系统综述。
MDM Policy and Practice Pub Date : 2023-01-01 DOI: 10.1177/23814683231156433
Naazish S Bashir, Avery Hughes, Wendy J Ungar
{"title":"Infliximab Pricing in International Economic Evaluations in Inflammatory Bowel Disease to Inform Biologic and Biosimilar Access Policies: A Systematic Review.","authors":"Naazish S Bashir,&nbsp;Avery Hughes,&nbsp;Wendy J Ungar","doi":"10.1177/23814683231156433","DOIUrl":"https://doi.org/10.1177/23814683231156433","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background.&lt;/b&gt; Policies mandating the use of lower cost biosimilars in patients with inflammatory bowel disease (IBD) have created concerns for patients who prefer their original biologic. &lt;b&gt;Purpose.&lt;/b&gt; To inform the cost-effectiveness of biosimilar infliximab treatment in IBD by systematically reviewing the effect of infliximab price variation on cost-effectiveness for jurisdictional decision making. &lt;b&gt;Data Sources.&lt;/b&gt; MEDLINE, Embase, Healthstar, Allied and Complementary Medicine, Joanna Briggs Institute EBP Database, International Pharmaceutical Abstracts, Health and Psychosocial Instruments, Mental Measurements Yearbook citation databases, PEDE, CEA registry, HTA agencies. &lt;b&gt;Study Selection.&lt;/b&gt; Economic evaluations of infliximab for adult or pediatric Crohn's disease and/or ulcerative colitis published from 1998 through 2019 in which drug price was varied in sensitivity analysis were included. &lt;b&gt;Data Extraction.&lt;/b&gt; Study characteristics, main findings, and results of drug price sensitivity analyses were extracted. Studies were critically appraised. The cost-effective price of infliximab was determined based on the stated willingness-to-pay (WTP) thresholds for each jurisdiction. &lt;b&gt;Data Synthesis.&lt;/b&gt; Infliximab price was examined in sensitivity analysis in 31 studies. Infliximab showed favorable cost-effectiveness at a price ranging from CAD $66 to $1,260 per vial, depending on jurisdiction. A total of 18 studies (58%) demonstrated cost-effectiveness ratios above the jurisdictional WTP threshold. &lt;b&gt;Limitations.&lt;/b&gt; Drug prices were not always reported separately, WTP thresholds varied, and funding sources were not consistently reported. &lt;b&gt;Conclusion.&lt;/b&gt; Despite the high cost of infliximab, few economic evaluations examined price variation, limiting the ability to infer the effects of biosimilar introduction. Alternative pricing strategies and access to treatment could be considered to enable IBD patients to maintain access to their current medications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Highlights: &lt;/strong&gt;In an effort to reduce public drug expenditures, Canadian and other jurisdictional drug plans have mandated the use of lower cost, but similarly effective, biosimilars in patients with newly diagnosed inflammatory bowel disease or require a nonmedical switch for established patients. This switch has created concerns for patients and clinicians who want to maintain the ability to make treatment decisions and remain with the original biologic.It is customary for economic evaluations to assess the robustness of results to variations in high-cost items such as medications. In the absence of economic evaluations of biosimilars, examining biologic drug price in sensitivity analysis provides insight into the cost-effectiveness of biosimilar alternatives. A total of 31 economic evaluations of infliximab for the treatment of inflammatory bowel disease varied the infliximab price in sensitivity analysis.The infliximab price deemed to be cost-effect","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"8 1","pages":"23814683231156433"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bd/a3/10.1177_23814683231156433.PMC9969457.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9368940","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}
引用次数: 0
Investigating and Supporting Patient and Caregiver Sensemaking in Complex Medical Decisions Using Participatory Design. 使用参与式设计调查和支持复杂医疗决策中的患者和护理人员感知。
MDM Policy and Practice Pub Date : 2023-01-01 DOI: 10.1177/23814683231164988
Sarah Fadem
{"title":"Investigating and Supporting Patient and Caregiver Sensemaking in Complex Medical Decisions Using Participatory Design.","authors":"Sarah Fadem","doi":"10.1177/23814683231164988","DOIUrl":"https://doi.org/10.1177/23814683231164988","url":null,"abstract":"<p><p><b>Background.</b> Patients and caregivers facing complex health decisions must make sense of unfamiliar, emotionally challenging information and experiences. For patients with hematological malignancy, bone marrow transplant (BMT) may be the best chance for a cure but has significant risk of morbidity and mortality. This study aimed to investigate and support patient and caregiver sensemaking as they consider BMT. <b>Methods.</b> Ten BMT patients and 5 caregivers engaged in remote participatory design (PD) workshops. Participants drew timelines of their memorable experiences leading up to BMT. Then, they used transparency paper to annotate their timelines and design improvements to this process. <b>Results.</b> Thematic analysis of drawings and transcripts revealed a 3-phase sensemaking process. In phase 1, participants were introduced to BMT and understood it as a possibility, not an inevitability. In phase 2, they focused on meeting prerequisites including remission and donor identification. Participants came to believe they needed transplant, consequently describing BMT not as a decision between viable options, but that transplant was their \"only chance\" for survival. In phase 3, participants attended an orientation detailing the extensive risks of transplant, leading to anxiety and doubt. Participants designed solutions that provided reassurance to those grappling with the life-altering impacts of transplant. <b>Conclusions.</b> For patients and caregivers navigating complex health decisions, sensemaking is a dynamic, ongoing process that affects expectations and emotional well-being. Interventions targeting reassurance alongside risk information can alleviate emotional impact and facilitate expectation development. The integration of PD and sensemaking methodologies enables participants to create holistic, tangible representations of experiences while empowering stakeholder engagement in intervention design. This method could be applied to other complex medical contexts to understand lived experiences and develop effective support interventions.</p><p><strong>Highlights: </strong>Bone marrow transplant patients and caregivers experienced an evolving, emotionally challenging process of gradually understanding the transplant procedure and its risks.The solutions that participants designed centered on providing reassurance alongside risk information, suggesting future interventions could target emotional support as patients attempt to meet prerequisites and grapple with the risks of the potentially curative procedure.By viewing the challenges of complex medical decisions in terms of sensemaking and applying visual methods such as participatory design, researchers can facilitate expression of the dynamic, multifaceted, emotional components of experience and empower stakeholder involvement in intervention design.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"8 1","pages":"23814683231164988"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ca/a5/10.1177_23814683231164988.PMC10107376.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9753403","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}
引用次数: 0
Evaluation of Strategies to Improve Uptake of Expedited Partner Therapy for Chlamydia trachomatis Treatment in Minnesota: A Decision Analytic Model. 明尼苏达州沙眼衣原体治疗中提高快速伴侣治疗的策略评价:决策分析模型。
MDM Policy and Practice Pub Date : 2023-01-01 DOI: 10.1177/23814683221150446
Emily A Groene, Christy M Boraas, M Kumi Smith, Sarah M Lofgren, Meghan K Rothenberger, Eva A Enns
{"title":"Evaluation of Strategies to Improve Uptake of Expedited Partner Therapy for <i>Chlamydia trachomatis</i> Treatment in Minnesota: A Decision Analytic Model.","authors":"Emily A Groene,&nbsp;Christy M Boraas,&nbsp;M Kumi Smith,&nbsp;Sarah M Lofgren,&nbsp;Meghan K Rothenberger,&nbsp;Eva A Enns","doi":"10.1177/23814683221150446","DOIUrl":"https://doi.org/10.1177/23814683221150446","url":null,"abstract":"<p><p><b>Background.</b> Despite the established effectiveness of expedited partner therapy (EPT) in partner treatment of bacterial sexually transmitted infections (STI), the practice is underutilized. <b>Objective.</b> To estimate the relative effectiveness of strategies to increase EPT uptake (numbers of partners treated for chlamydia). <b>Methods.</b> We developed a care cascade model of cumulative probabilities to estimate the number of partners treated under strategies to increase EPT uptake in Minnesota. The care cascade model used data from clinical trials, population-based studies, and Minnesota chlamydia surveillance as well as in-depth interviews of health providers who regularly treat STI patients and a statewide survey of health providers across Minnesota. <b>Results.</b> Several strategies could improve EPT uptake among providers, including facilitating treatment payment (additional 1,932 partners treated) and implementing electronic health record reminders (additional 1,755 partners treated). Addressing concerns about liability would have the greatest effect, resulting in 2,187 additional partners treated. <b>Conclusions.</b> Providers expressed openness to offering EPT under several scenarios, which reflect differences in knowledge about EPT, its legality, and potential risks to patients. While addressing concerns about provider liability would have the greatest effect on number of partners treated, provider education and procedural changes could make a substantial impact.</p><p><strong>Highlights: </strong>Addressing provider concerns about expedited partner therapy (EPT) legality and its potential risks would result in the most partners treated for chlamydia.EPT alerts and electronic EPT prescriptions may also streamline partner treatment.Provider education about the legality of EPT and its potential risks and training in counseling patients on EPT could also increase uptake.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"8 1","pages":"23814683221150446"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4c/f5/10.1177_23814683221150446.PMC9880578.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9152183","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}
引用次数: 0
Translating an Economic Analysis into a Tool for Public Health Resource Allocation in Cancer Survivorship. 将经济分析转化为癌症幸存者公共卫生资源分配的工具。
MDM Policy and Practice Pub Date : 2023-01-01 DOI: 10.1177/23814683231153378
Zachary Rivers, Joshua A Roth, Winona Wright, Sun Hee Rim, Lisa C Richardson, Cheryll C Thomas, Julie S Townsend, Scott D Ramsey
{"title":"Translating an Economic Analysis into a Tool for Public Health Resource Allocation in Cancer Survivorship.","authors":"Zachary Rivers,&nbsp;Joshua A Roth,&nbsp;Winona Wright,&nbsp;Sun Hee Rim,&nbsp;Lisa C Richardson,&nbsp;Cheryll C Thomas,&nbsp;Julie S Townsend,&nbsp;Scott D Ramsey","doi":"10.1177/23814683231153378","DOIUrl":"https://doi.org/10.1177/23814683231153378","url":null,"abstract":"<p><p><b>Background.</b> The complexity of decision science models may prevent their use to assist in decision making. User-centered design (UCD) principles provide an opportunity to engage end users in model development and refinement, potentially reducing complexity and increasing model utilization in a practical setting. We report our experiences with UCD to develop a modeling tool for cancer control planners evaluating cancer survivorship interventions. <b>Design.</b> Using UCD principles (described in the article), we developed a dynamic cohort model of cancer survivorship for individuals with female breast, colorectal, lung, and prostate cancer over 10 y. Parameters were obtained from the National Program of Cancer Registries and peer-reviewed literature, with model outcomes captured in quality-adjusted life-years and net monetary benefit. Prototyping and iteration were conducted with structured focus groups involving state cancer control planners and staff from the Centers for Disease Control and Prevention and the American Public Health Association. <b>Results.</b> Initial feedback highlighted model complexity and unclear purpose as barriers to end user uptake. Revisions addressed complexity by simplifying model input requirements, providing clear examples of input types, and reducing complex language. Wording was added to the results page to explain the interpretation of results. After these updates, feedback demonstrated that end users more clearly understood how to use and apply the model for cancer survivorship resource allocation tasks. <b>Conclusions.</b> A UCD approach identified challenges faced by end users in integrating a decision aid into their workflow. This approach created collaboration between modelers and end users, tailoring revisions to meet the needs of the users. Future models developed for individuals without a decision science background could leverage UCD to ensure the model meets the needs of the intended audience.</p><p><strong>Highlights: </strong>Model complexity and unclear purpose are 2 barriers that prevent lay users from integrating decision science tools into their workflow.Modelers could integrate the user-centered design framework when developing a model for lay users to reduce complexity and ensure the model meets the needs of the users.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"8 1","pages":"23814683231153378"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cb/68/10.1177_23814683231153378.PMC9926380.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10741983","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}
引用次数: 1
Factors Influencing Physician Prognosis: A Scoping Review. 影响医生预后的因素:一项范围综述。
IF 1.9
MDM Policy and Practice Pub Date : 2022-12-22 eCollection Date: 2022-07-01 DOI: 10.1177/23814683221145158
Amaryllis Ferrand, Jelena Poleksic, Eric Racine
{"title":"Factors Influencing Physician Prognosis: A Scoping Review.","authors":"Amaryllis Ferrand, Jelena Poleksic, Eric Racine","doi":"10.1177/23814683221145158","DOIUrl":"10.1177/23814683221145158","url":null,"abstract":"<p><p><b>Introduction.</b> Prognosis is an essential component of informed consent for medical decision making. Research shows that physicians display discrepancies in their prognostication, leading to variable, inaccurate, optimistic, or pessimistic prognosis. Factors driving these discrepancies and the supporting evidence have not been reviewed systematically. <b>Methods.</b> We undertook a scoping review to explore the literature on the factors leading to discrepancies in medical prognosis. We searched Medline (Ovid) and Embase (Ovid) databases for peer-reviewed articles from 1970 to 2017. We included articles that discussed prognosis variation or discrepancy and where factors influencing prognosis were evaluated. We extracted data outlining the participants, methodology, and prognosis discrepancy information and measured factors influencing prognosis. <b>Results.</b> Of 4,723 articles, 73 were included in the final analysis. There was significant variability in research methodologies. Most articles showed that physicians were pessimistic regarding patient outcomes, particularly in early trainees and acute care specialties. Accuracy rates were similar across all time periods. Factors influencing prognosis were clustered in 4 categories: patient-related factors (such as age, gender, race, diagnosis), physician-related factors (such as age, race, gender, specialty, training and experience, attitudes and values), clinical situation-related factors (such as physician-patient relationship, patient location, and clinical context), and environmental-related factors (such as country or hospital size). <b>Discussion.</b> Obtaining accurate prognostic information is one of the highest priorities for seriously ill patients. The literature shows trends toward pessimism, especially in early trainees and acute care specialties. While some factors may prove difficult to change, the physician's personality and psychology influence prognosis accuracy and could be tackled using debiasing strategies. Exposure to long-term patient outcomes and a multidisciplinary practice setting are environmental debiasing strategies that may warrant further research.</p><p><strong>Highlights: </strong>Literature on discrepancies in physician's prognostication is heterogeneous and sparse.Literature shows that physicians are mostly pessimistic regarding patient outcomes.Literature shows that a physician's personality and psychology influence prognostic accuracy and could be improved with evidence-based debiasing strategies.Medical specialty strongly influences prognosis, with specialties exposed to acutely ill patients being more pessimistic, whereas specialties following patients longitudinally being more optimistic.Physicians early in their training were more pessimist than more experienced physicians.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"7 2","pages":"23814683221145158"},"PeriodicalIF":1.9,"publicationDate":"2022-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/96/e3/10.1177_23814683221145158.PMC9793048.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10821647","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}
引用次数: 0
Developing the Breast Utility Instrument to Measure Health-Related Quality-of-Life Preferences in Patients with Breast Cancer: Selecting the Item for Each Dimension. 开发 "乳房效用工具 "以测量乳腺癌患者与健康相关的生活质量偏好:为每个维度选择项目。
IF 1.9
MDM Policy and Practice Pub Date : 2022-12-08 eCollection Date: 2022-07-01 DOI: 10.1177/23814683221142267
Teresa C O Tsui, Maureen E Trudeau, Nicholas Mitsakakis, Murray D Krahn, Aileen M Davis
{"title":"Developing the Breast Utility Instrument to Measure Health-Related Quality-of-Life Preferences in Patients with Breast Cancer: Selecting the Item for Each Dimension.","authors":"Teresa C O Tsui, Maureen E Trudeau, Nicholas Mitsakakis, Murray D Krahn, Aileen M Davis","doi":"10.1177/23814683221142267","DOIUrl":"10.1177/23814683221142267","url":null,"abstract":"<p><p><b>Introduction</b>. Generic preference-based instruments inadequately measure breast cancer (BrC) health-related quality-of-life preferences given advances in therapy. Our overall purpose is to develop the Breast Utility Instrument (BUI), a BrC-specific preference-based instrument. This study describes the selection of the BUI items. <b>Methods.</b> A total of 408 patients from diverse BrC health states completed the EORTC QLQ-C30 and BR45 (breast module). For each of 10 dimensions previously assessed with confirmatory factor analysis, we evaluated data fit to the Rasch model based on global model and item fit, including threshold ordering, item residuals, infit and outfit, differential item functioning (age), and unidimensionality. Misfitting items were removed iteratively, and the model fit was reassessed. From items fitting the Rasch model, we selected 1 item per dimension based on high patient- and clinician-rated item importance, breadth of item thresholds, and clinical relevance. <b>Results.</b> Global model fit was good in 7 and borderline in 3 dimensions. Separation index was acceptable in 4 dimensions. Item selection criteria were maximized for the following items: 1) physical functioning (trouble taking a long walk), 2) emotional functioning (worry), 3) social functioning (interfering with social activities), 4) pain (having pain), 5) fatigue (tired), 6) body image (dissatisfied with your body), 7) systemic therapy side effects (hair loss), 8) sexual functioning (interest in sex), 9) breast symptoms (oversensitive breast), and 10) endocrine therapy symptoms (problems with your joints). <b>Conclusions</b>. We propose 10 items for the BUI. Our next steps include assessing the measurement properties prior to eliciting preference weights of the BUI.</p><p><strong>Highlights: </strong>A previous confirmatory factor analysis established 10 dimensions of the European Organisation for Research and Treatment of Cancer (EORTC) core quality of life questionnaire (QLQ-C30) and its breast module (BR45).In this study, we selected 1 item per dimension based on fit to the Rasch model, patient- and clinician-rated item importance, breadth of item thresholds, and clinical relevance.These items form the core of the future Breast Utility Instrument (BUI).The future BUI will be a novel breast cancer-specific preference-based instrument that potentially will better reflect women's preferences in clinical decision making and cost utility analyses.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"7 2","pages":"23814683221142267"},"PeriodicalIF":1.9,"publicationDate":"2022-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7d/81/10.1177_23814683221142267.PMC9747890.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10460772","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}
引用次数: 0
Modeling the Impact of Nonpharmaceutical Interventions on COVID-19 Transmission in K-12 Schools. 模拟非药物干预对 K-12 学校 COVID-19 传播的影响。
IF 1.9
MDM Policy and Practice Pub Date : 2022-12-03 eCollection Date: 2022-07-01 DOI: 10.1177/23814683221140866
Yiwei Zhang, Maria E Mayorga, Julie Ivy, Kristen Hassmiller Lich, Julie L Swann
{"title":"Modeling the Impact of Nonpharmaceutical Interventions on COVID-19 Transmission in K-12 Schools.","authors":"Yiwei Zhang, Maria E Mayorga, Julie Ivy, Kristen Hassmiller Lich, Julie L Swann","doi":"10.1177/23814683221140866","DOIUrl":"10.1177/23814683221140866","url":null,"abstract":"<p><p><b>Background.</b> The novel coronavirus SARS-CoV-2 spread across the world causing many waves of COVID-19. Children were at high risk of being exposed to the disease because they were not eligible for vaccination during the first 20 mo of the pandemic in the United States. While children 5 y and older are now eligible to receive a COVID-19 vaccine in the United States, vaccination rates remain low despite most schools returning to in-person instruction. Nonpharmaceutical interventions (NPIs) are important for controlling the spread of COVID-19 in K-12 schools. US school districts used varied and layered mitigation strategies during the pandemic. The goal of this article is to analyze the impact of different NPIs on COVID-19 transmission within K-12 schools. <b>Methods.</b> We developed a deterministic stratified SEIR model that captures the role of social contacts between cohorts in disease transmission to estimate COVID-19 incidence under different NPIs including masks, random screening, contact reduction, school closures, and test-to-stay. We designed contact matrices to simulate the contact patterns between students and teachers within schools. We estimated the proportion of susceptible infected associated with each intervention over 1 semester under the Omicron variant. <b>Results.</b> We find that masks and reducing contacts can greatly reduce new infections among students. Weekly screening tests also have a positive impact on disease mitigation. While self-quarantining symptomatic infections and school closures are effective measures for decreasing semester-end infections, they increase absenteeism. <b>Conclusion.</b> The model provides a useful tool for evaluating the impact of a variety of NPIs on disease transmission in K-12 schools. While the model is tested under Omicron variant parameters in US K-12 schools, it can be adapted to study other populations under different disease settings.</p><p><strong>Highlights: </strong>A stratified SEIR model was developed that captures the role of social contacts in K-12 schools to estimate COVID-19 transmission under different nonpharmaceutical interventions.While masks, random screening, contact reduction, school closures, and test-to-stay are all beneficial interventions, masks and contact reduction resulted in the greatest reduction in new infections among students from the tested scenarios.Layered interventions provide more benefits than implementing interventions independently.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"7 2","pages":"23814683221140866"},"PeriodicalIF":1.9,"publicationDate":"2022-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/10/14/10.1177_23814683221140866.PMC9720473.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9936804","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}
引用次数: 0
Use of Modeling to Inform Decision Making in North Carolina during the COVID-19 Pandemic: A Qualitative Study. 北卡罗来纳州在 COVID-19 大流行期间利用建模为决策提供信息:定性研究。
IF 1.9
MDM Policy and Practice Pub Date : 2022-07-29 eCollection Date: 2022-07-01 DOI: 10.1177/23814683221116362
Karl Johnson, Caitlin B Biddell, Kristen Hassmiller Lich, Julie Swann, Paul Delamater, Maria Mayorga, Julie Ivy, Raymond L Smith, Mehul D Patel
{"title":"Use of Modeling to Inform Decision Making in North Carolina during the COVID-19 Pandemic: A Qualitative Study.","authors":"Karl Johnson, Caitlin B Biddell, Kristen Hassmiller Lich, Julie Swann, Paul Delamater, Maria Mayorga, Julie Ivy, Raymond L Smith, Mehul D Patel","doi":"10.1177/23814683221116362","DOIUrl":"10.1177/23814683221116362","url":null,"abstract":"<p><p><b>Background.</b> The COVID-19 pandemic has popularized computer-based decision-support models, which are commonly used to inform decision making amidst complexity. Understanding what organizational decision makers prefer from these models is needed to inform model development during this and future crises. <b>Methods.</b> We recruited and interviewed decision makers from North Carolina across 9 sectors to understand organizational decision-making processes during the first year of the COVID-19 pandemic (<i>N</i> = 44). For this study, we identified and analyzed a subset of responses from interviewees (<i>n</i> = 19) who reported using modeling to inform decision making. We used conventional content analysis to analyze themes from this convenience sample with respect to the source of models and their applications, the value of modeling and recommended applications, and hesitancies toward the use of models. <b>Results.</b> Models were used to compare trends in disease spread across localities, estimate the effects of social distancing policies, and allocate scarce resources, with some interviewees depending on multiple models. Decision makers desired more granular models, capable of projecting disease spread within subpopulations and estimating where local outbreaks could occur, and incorporating a broad set of outcomes, such as social well-being. Hesitancies to the use of modeling included doubts that models could reflect nuances of human behavior, concerns about the quality of data used in models, and the limited amount of modeling specific to the local context. <b>Conclusions.</b> Decision makers perceived modeling as valuable for informing organizational decisions yet described varied ability and willingness to use models for this purpose. These data present an opportunity to educate organizational decision makers on the merits of decision-support modeling and to inform modeling teams on how to build more responsive models that address the needs of organizational decision makers.</p><p><strong>Highlights: </strong>Organizations from a diversity of sectors across North Carolina (including public health, education, business, government, religion, and public safety) have used decision-support modeling to inform decision making during COVID-19.Decision makers wish for models to project the spread of disease, especially at the local level (e.g., individual cities and counties), and to help estimate the outcomes of policies.Some organizational decision makers are hesitant to use modeling to inform their decisions, stemming from doubts that models could reflect nuances of human behavior, concerns about the accuracy and precision of data used in models, and the limited amount of modeling available at the local level.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"7 2","pages":"23814683221116362"},"PeriodicalIF":1.9,"publicationDate":"2022-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9340948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10311764","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}
引用次数: 0
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