MDM policy & practice最新文献

{"title":"Paths of Emergency Department Care: Development of a Decision Aid to Facilitate Shared Decision Making in Goals of Care Discussions in the Acute Setting.","authors":"Laura E Walker,&nbsp;M Fernanda Bellolio,&nbsp;Claudia C Dobler,&nbsp;Ian G Hargraves,&nbsp;Robert J Pignolo,&nbsp;Kevin Shaw,&nbsp;Jacob J Strand,&nbsp;Bjorg Thorsteinsdottir,&nbsp;Michael E Wilson,&nbsp;Erik P Hess","doi":"10.1177/23814683211058082","DOIUrl":"https://doi.org/10.1177/23814683211058082","url":null,"abstract":"<p><strong>Background: </strong>Goals of care (GOC) conversations in the emergency department (ED) are often a brief discussion of code status rather than a patient-oriented dialogue. We aimed to develop a guide to facilitate conversations between ED clinicians and patients to elicit patient values and establish goals for end-of-life care, while maintaining ED efficiency. <i>Paths of ED Care</i>, a conversation guide, is the product of this work.</p><p><strong>Design: </strong>A multidisciplinary/multispecialty group used recommended practices to adapt a GOC conversation guide for ED patients. ED clinicians used the guide and provided feedback on content, design, and usability. Patient-clinician interactions were recorded for discussion analysis, and both were surveyed to inform iterative refinement. A series of discussions with patient representatives, multidisciplinary clinicians, bioethicists, and health care designers yielded feedback. We used a process similar to the International Patient Decision Aid Standards and provide comparison to these.</p><p><strong>Results: </strong>A conversation guide, eight pages with each page 6 by 6 inches in dimension, uses patient-oriented prompts and includes seven sections: 1) evaluation of patient/family understanding of disease, 2) explanation of possible trajectories, 3) introduction to different pathways of care, 4) explanation of pathways, 5) assessment of understanding and concerns, 6) code status, and 7) personalized summary.</p><p><strong>Limitations: </strong>Recruitment of sufficient number of patients/providers to the project was the primary limitation. Methods are limited to qualitative analysis of guide creation and feasibility without quantitative analysis.</p><p><strong>Conclusions: </strong>Paths of ED Care is a guide to facilitate patient-centered shared decision making for ED patients, families, and clinicians regarding GOC. This may ensure care concordant with patients' values and preferences. Use of the guide was well-received and facilitated meaningful conversations between patients and providers.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"23814683211058082"},"PeriodicalIF":0.0,"publicationDate":"2021-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a7/08/10.1177_23814683211058082.PMC8593304.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39637810","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":"Intergenerational Decision Making: The Role of Family Relationships in Medical Decision Making.","authors":"Jody L Lin,&nbsp;Ellen A Lipstein,&nbsp;Eve Wittenberg,&nbsp;Djin Tay,&nbsp;Robert Lundstrom,&nbsp;Gari Lyn Lundstrom,&nbsp;Saadia Sediqzadah,&nbsp;Davene R Wright","doi":"10.1177/23814683211039468","DOIUrl":"https://doi.org/10.1177/23814683211039468","url":null,"abstract":"<p><p>A symposium held at the 42nd annual Society for Medical Decision Making conference on October 26, 2020, focused on intergenerational decision making. The symposium covered existing research and clinical experiences using formal presentations and moderated discussion and was attended by 43 people. Presentations focused on the roles of pediatric patients in decision making, caregiver decision making for a child with complex medical needs, caregiver involvement in advanced care planning, and the inclusion of spillover effects in economic evaluations. The moderated discussion, summarized in this article, highlighted existing resources and gaps in intergenerational decision making in four areas: decision aids, economic evaluation, participant perspectives, and measures. Intergenerational decision making is an understudied and poorly understood aspect of medical decision making that requires particular attention as our society ages and technological advances provide new innovations for life-sustaining measures across all stages of the lifespan.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"23814683211039468"},"PeriodicalIF":0.0,"publicationDate":"2021-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bc/24/10.1177_23814683211039468.PMC8559218.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39589327","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":"Dependence of COVID-19 Policies on End-of-Year Holiday Contacts in Mexico City Metropolitan Area: A Modeling Study.","authors":"Fernando Alarid-Escudero,&nbsp;Valeria Gracia,&nbsp;Andrea Luviano,&nbsp;Jorge Roa,&nbsp;Yadira Peralta,&nbsp;Marissa B Reitsma,&nbsp;Anneke L Claypool,&nbsp;Joshua A Salomon,&nbsp;David M Studdert,&nbsp;Jason R Andrews,&nbsp;Jeremy D Goldhaber-Fiebert","doi":"10.1177/23814683211049249","DOIUrl":"https://doi.org/10.1177/23814683211049249","url":null,"abstract":"<p><p><b>Background.</b> Mexico City Metropolitan Area (MCMA) has the largest number of COVID-19 (coronavirus disease 2019) cases in Mexico and is at risk of exceeding its hospital capacity in early 2021. <b>Methods.</b> We used the Stanford-CIDE Coronavirus Simulation Model (SC-COSMO), a dynamic transmission model of COVID-19, to evaluate the effect of policies considering increased contacts during the end-of-year holidays, intensification of physical distancing, and school reopening on projected confirmed cases and deaths, hospital demand, and hospital capacity exceedance. Model parameters were derived from primary data, literature, and calibrated. <b>Results.</b> Following high levels of holiday contacts even with no in-person schooling, MCMA will have 0.9 million (95% prediction interval 0.3-1.6) additional COVID-19 cases between December 7, 2020, and March 7, 2021, and hospitalizations will peak at 26,000 (8,300-54,500) on January 25, 2021, with a 97% chance of exceeding COVID-19-specific capacity (9,667 beds). If MCMA were to control holiday contacts, the city could reopen in-person schools, provided they increase physical distancing with 0.5 million (0.2-0.9) additional cases and hospitalizations peaking at 12,000 (3,700-27,000) on January 19, 2021 (60% chance of exceedance). <b>Conclusion.</b> MCMA must increase COVID-19 hospital capacity under all scenarios considered. MCMA's ability to reopen schools in early 2021 depends on sustaining physical distancing and on controlling contacts during the end-of-year holiday.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"23814683211049249"},"PeriodicalIF":0.0,"publicationDate":"2021-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/18/70/10.1177_23814683211049249.PMC8512280.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39527184","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":"Educating Pharmacists on the Risks of Strong Opioids With Descriptive and Simulated Experience Risk Formats: A Randomized Controlled Trial.","authors":"Odette Wegwarth,&nbsp;Stefan Wind,&nbsp;Eva Goebel,&nbsp;Claudia Spies,&nbsp;Joerg J Meerpohl,&nbsp;Christine Schmucker,&nbsp;Erika Schulte,&nbsp;Edmund Neugebauer,&nbsp;Ralph Hertwig","doi":"10.1177/23814683211042832","DOIUrl":"https://doi.org/10.1177/23814683211042832","url":null,"abstract":"<p><p><b>Objectives.</b> High opioid prescription rates in the United States and Europe suggest miscalibrated risk perceptions among those who prescribe, dispense, and take opioids. Findings from cognitive decision science suggest that risk perceptions and behaviors can differ depending on whether people learn about risks by experience or description. This study investigated effects of a descriptive versus an experience-based risk education format on pharmacists' risk perceptions and counseling behavior in the long-term administration of strong opioids to patients with chronic noncancer pain. <b>Methods.</b> In an exploratory, randomized controlled online trial, 300 German pharmacists were randomly assigned to either a descriptive format (fact box) or a simulated experience format (interactive simulation). <b>Primary Outcome Measures.</b> 1) Objective risk perception, 2) subjective risk perception, and 3) intended and 4) actual counseling behavior. <b>Results.</b> Both risk formats significantly improved pharmacists' objective risk perception, but pharmacists exposed to the fact box estimated the benefit-harm ratio more accurately than those exposed to the simulation. Both formats proved equally effective in adjusting pharmacists' subjective risk perception toward a better recognition of opioids' harms; however, pharmacists receiving the simulation showed a greater change in their actual counseling behavior and higher consistency between their intended and actual counseling than pharmacists receiving the fact box. <b>Conclusion.</b> The simulated experience format was less effective than the descriptive format in improving pharmacists' objective risk perception, equally effective in motivating pharmacists to counsel patients on less risky treatment alternatives and more effective in changing the reported actual counseling behavior. <b>Implications.</b> These exploratory findings provide important insights into the relevance of the description-experience gap for drug safety and raise questions for future research regarding the specific mechanisms at work.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"23814683211042832"},"PeriodicalIF":0.0,"publicationDate":"2021-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8482350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39484579","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 an Electronic Clinical Decision Support Tool Into Routine Care: A Qualitative Study of Stakeholders' Perceptions of a Post-Mastectomy Breast Reconstruction Tool.","authors":"Jessica Boateng,&nbsp;Clara N Lee,&nbsp;Randi E Foraker,&nbsp;Terence M Myckatyn,&nbsp;Kimi Spilo,&nbsp;Courtney Goodwin,&nbsp;Mary C Politi","doi":"10.1177/23814683211042010","DOIUrl":"https://doi.org/10.1177/23814683211042010","url":null,"abstract":"<p><p><b>Objective.</b> To explore barriers and facilitators to implementing an evidence-based clinical decision support (CDS) tool (BREASTChoice) about post-mastectomy breast reconstruction into routine care. <b>Materials and Methods.</b> A stakeholder advisory group of cancer survivors, clinicians who discuss and/or perform breast reconstruction in women with cancer, and informatics professionals helped design and review the interview guide. Based on the Consolidated Framework for Implementation Research (CFIR), we conducted qualitative semistructured interviews with key stakeholders (patients, clinicians, informatics professionals) to explore intervention, setting characteristics, and process-level variables that can impact implementation. Interviews were transcribed, coded, and analyzed based on the CFIR framework using both inductive and deductive methods. <b>Results.</b> Fifty-seven potential participants were contacted; 49 (85.9%) were eligible, and 35 (71.4%) were enrolled, continuing until thematic saturation was reached. Participants consisted of 13 patients, 13 clinicians, and 9 informatics professionals. Stakeholders thought that BREASTChoice was useful and provided patients with an evidence-based source of information about post-mastectomy breast reconstruction, including their personalized risks. They felt that BREASTChoice could support shared decision making, improve workflow, and possibly save consultation time, but were uncertain about the best time to deliver BREASTChoice to patients. Some worried about cost, data availability, and security of integrating the tool into an electronic health record. Most acknowledged the importance of showing clinical utility to gain institutional buy-in and encourage routine adoption. <b>Discussion and Conclusion.</b> Stakeholders felt that BREASTChoice could support shared decision making, improve workflow, and reduce consultation time. Addressing key questions such as cost, data integration, and timing of delivering BREASTChoice could build institutional buy-in for CDS implementation. Results can guide future CDS implementation studies.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"23814683211042010"},"PeriodicalIF":0.0,"publicationDate":"2021-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/07/6c/10.1177_23814683211042010.PMC8450551.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39462434","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":"Risk Communication After Health Care Exposures: An Experimental Vignette Survey With Patients.","authors":"A Rani Elwy, Elizabeth M Maguire, Thomas H Gallagher, Steven M Asch, Janet M Durfee, Richard A Martinello, Barbara G Bokhour, Allen L Gifford, Thomas J Taylor, Todd H Wagner","doi":"10.1177/23814683211045659","DOIUrl":"10.1177/23814683211045659","url":null,"abstract":"<p><p><b>Purpose.</b> We investigated how health care systems should communicate with patients about possible exposures to blood-borne pathogens that may have occurred during their care. Our goal was to determine how best to communicate uncertain risk information in a way that would minimize harm to patients, maintain their trust, and encourage patients to seek follow-up treatment. <b>Methods.</b> Participants (<i>N</i> = 1103) were randomized to receive one of six vignette surveys; 997 (98.4%) responded. All vignettes described the same event, but differed by risk level and recommendations (lower risk v. higher risk) and by communication mode (telephone, letter, social media). We measured participants' perceived risk of blood-borne infection, trust in the health care system, and shared decision making about next clinical steps. Open-ended questions were analyzed using grounded thematic analysis. <b>Results.</b> When the vignette requested patients to undergo testing and practice certain health behaviors (higher risk), participants' likelihood of seeking follow-up testing for blood-borne pathogens and their understanding of health issues increased. Perceived trust was unaffected by risk level or communication processes. Qualitative data indicated a desire for telephone communication from providers known to the patient. <b>Limitations.</b> It is not clear whether higher risk language or objective risk levels in vignettes motivated patients' behavioral intentions. <b>Conclusion.</b> Using higher risk language when disclosing large-scale adverse events increased participants' willingness to seek follow-up care. <b>Implications.</b> Health care organizations' disclosures should focus on the next steps to take after health care exposures. This communication should involve helping patients to understand their personal health issues better, make them feel that they know which steps to take following the receipt of this information, and encouraging them to seek follow-up infectious disease testing in order to better take care of themselves.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"23814683211045659"},"PeriodicalIF":1.7,"publicationDate":"2021-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9d/33/10.1177_23814683211045659.PMC8451260.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39462435","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":"Measuring Meaningful Benefit-Risk Tradeoffs to Promote Patient-Focused Drug Development in Prader-Willi Syndrome: A Discrete-Choice Experiment.","authors":"Jui-Hua Tsai,&nbsp;Norah L Crossnohere,&nbsp;Theresa Strong,&nbsp;John F P Bridges","doi":"10.1177/23814683211039457","DOIUrl":"https://doi.org/10.1177/23814683211039457","url":null,"abstract":"<p><p><b>Background.</b> Prader-Willi syndrome (PWS) is a rare neurodevelopmental disorder causing quality of life impairments such as insatiable hunger (hyperphagia) and obesity. We explored caregivers' willingness to assume treatment risk in exchange for reduced hyperphagia according to a PWS-validated observer-reported outcome measure. <b>Methods.</b> We partnered with PWS patient organizations to develop a discrete-choice experiment exploring caregivers' benefit-risk tradeoffs for emerging PWS treatments. The treatment benefit was a reduction in hyperphagia (as measured by a 0-, 5-, or 10-point change on the Hyperphagia Questionnaire for Clinical Trials [HQ-CT]). Treatment risks included weight gain (none, 5%, 10%), added risk of skin rash (none, 10%, 20%), and risk of liver damage (none, 1 in 1000, 10 in 1000). Preference models were estimated using mixed logistic regression and maximum acceptable risk. We explored differences in preferences across familial caregivers of patients with and without hyperphagia. <b>Results.</b> Four hundred sixty-eight caregivers completed the online survey. The majority of caregivers reported that patients experienced hyperphagia (68%) and half of patients experienced obesity (52%). Caregivers of patients without hyperphagia were willing to accept greater weight gain (16.4% v. 8.1%, <i>P</i> = 0.004) and a higher risk of skin rash (11.7% v. 6.2% <i>P</i> = 0.008) as compared to caregivers of patients with hyperphagia. Caregivers of patients with hyperphagia would accept a higher risk of liver damage as compared to caregivers of patients without hyperphagia (11.9 out of 1000 v. 6.4 out of 1000, <i>P</i> = 0.04). <b>Conclusions.</b> This research demonstrates that caregivers are willing to accept risk in exchange for a five-point improvement on the HQ-CT, a smaller marginal improvement than had been previously classified as meaningful. Patient experience with hyperphagia is a modifier in how much risk caregivers will accept.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"23814683211039457"},"PeriodicalIF":0.0,"publicationDate":"2021-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ae/82/10.1177_23814683211039457.PMC8419554.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39396940","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":"Using Mixed Methods With Multiple Stakeholders to Inform Development of a Breast Cancer Screening Decision Aid for Women With Limited Health Literacy.","authors":"Christine M Gunn,&nbsp;Ariel Maschke,&nbsp;Michael K Paasche-Orlow,&nbsp;Ashley J Housten,&nbsp;Nancy R Kressin,&nbsp;Mara A Schonberg,&nbsp;Tracy A Battaglia","doi":"10.1177/23814683211033249","DOIUrl":"https://doi.org/10.1177/23814683211033249","url":null,"abstract":"<p><p><b>Background.</b> When stakeholders offer divergent input, it can be unclear how to prioritize information for decision aids (DAs) on mammography screening. <b>Objectives.</b> This analysis triangulates perspectives (breast cancer screening experts, primary care providers [PCPs], and patients with limited health literacy [LHL]) to understand areas of divergent and convergent input across stakeholder groups in developing a breast cancer screening DA for younger women with LHL. <b>Design.</b> A modified online Delphi panel of 8 experts rated 57 statements for inclusion in a breast cancer screening DA over three rounds. Individual interviews with 25 patients with LHL and 20 PCPs from a large safety net hospital explored informational needs about mammography decision making. Codes from the qualitative interviews and open-ended responses from the Delphi process were mapped across stakeholders to ascertain areas where stakeholder preferences converged or diverged. <b>Results.</b> Four themes regarding informational needs were identified regarding 1) the benefits and harms of screening, 2) different screening modalities, 3) the experience of mammography, and 4) communication about breast cancer risk. Patients viewed pain as the primary harm, while PCPs and experts emphasized the harm of false positives. Patients, but not PCPs or experts, felt that information about the process of getting a mammogram was important. PCPs believed that mammography was the only evidence-based screening modality, while patients believed breast self-exam was also important for screening. All stakeholders described incorporating personal risk information as important. <b>Limitations.</b> As participants came from one hospital, perceptions may reflect local practices. The Delphi sample size was small. <b>Conclusions.</b> Patients, experts, and PCPs had divergent views on the most important information needed for screening decisions. More evidence is needed to guide integration of multiple stakeholder perspectives into the content of DAs.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"23814683211033249"},"PeriodicalIF":0.0,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/23814683211033249","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39285853","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":"Nonurgent Patients' Preferences for Emergency Department Versus General Practitioner and Effects of Incentives: A Discrete Choice Experiment.","authors":"Yuliu Su,&nbsp;Shrutivandana Sharma,&nbsp;Semra Ozdemir,&nbsp;Wai Leng Chow,&nbsp;Hong-Choon Oh,&nbsp;Ling Tiah","doi":"10.1177/23814683211027552","DOIUrl":"https://doi.org/10.1177/23814683211027552","url":null,"abstract":"<p><p><b>Objective.</b> This study investigates potential of a new financial incentive policy, the GP-referral discount scheme introduced in Singapore, in reducing nonurgent emergency department (ED) visits, and compares it with alternative interventions. <b>Methods.</b> A discrete choice experiment (DCE) was designed to elicit patients' preferences for ED and general practitioner (GP) under hypothetical nonurgent medical conditions. Through latent class multinomial logistic regression, choice models were estimated to quantify how patients' choices are influenced by GP-referral discount, other ED/GP attributes (waiting time, test facilities, and payment), patient demographics, and their perception of severity. The choice models were used to predict uptake of the GP-referral discount scheme and other countermeasures suggested by these models. <b>Results.</b> Survey responses from 849 respondents recruited from a public hospital in Singapore were included in the study. The choice model identified two prominent classes of patients, one of which was highly sensitive to GP-referral discount and the other to test-facility-availability. Patients' perceptions of severity (\"critical\" v. \"not critical\" enough to go to ED directly) were highly significant in influencing preference heterogeneity. Predictive analysis based on the choice model showed that GP-referral discount is more effective when patients visit ED expecting \"shorter\" waits, as opposed to test-facility provision at GPs and perception-correction measures that showed stronger effects under \"longer\" expected waits. <b>Conclusions.</b> The new GP-referral financial incentive introduced in Singapore can be effective in reducing nonurgent ED visits, if it reasonably covers the (extra) cost of visiting a GP. It may serve as a complement to test-facility provision at GPs or perception-correction measures, as the financial incentive and the latter two measures appear to influence distinct classes (discount-sensitive and facility-sensitive) of patients.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"23814683211027552"},"PeriodicalIF":0.0,"publicationDate":"2021-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/23814683211027552","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39208809","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":"Do You Prefer Safety to Social Participation? Finnish Population-Based Preference Weights for the Adult Social Care Outcomes Toolkit (ASCOT) for Service Users.","authors":"Lien Nguyen,&nbsp;Hanna Jokimäki,&nbsp;Ismo Linnosmaa,&nbsp;Eirini-Christina Saloniki,&nbsp;Laurie Batchelder,&nbsp;Juliette Malley,&nbsp;Hui Lu,&nbsp;Peter Burge,&nbsp;Birgit Trukeschitz,&nbsp;Julien Forder","doi":"10.1177/23814683211027902","DOIUrl":"https://doi.org/10.1177/23814683211027902","url":null,"abstract":"<p><p><b>Introduction.</b> The Adult Social Care Outcomes Toolkit (ASCOT) was developed in England to measure people's social care-related quality of life (SCRQoL). <b>Objectives.</b> The aim of this article is to estimate preference weights for the Finnish ASCOT for service users (ASCOT). In addition, we tested for learning and fatigue effects in the choice experiment used to elicit the preference weights. <b>Methods.</b> The analysis data (<i>n</i> = 1000 individuals) were obtained from an online survey sample of the Finnish adult general population using gender, age, and region as quotas. The questionnaire included a best-worst scaling (BWS) experiment using ASCOT. Each respondent sequentially selected four alternatives (best, worst; second-best, second-worst) for eight BWS tasks (<i>n</i> = 32,000 choice observations). A scale multinomial logit model was used to estimate the preference parameters and to test for fatigue and learning. <b>Results.</b> The most and least preferred attribute-levels were \"I have as much control over my daily life as I want\" and \"I have no control over my daily life.\" The preference weights were not on a cardinal scale. The ordering effect was related to the second-best choices. Learning effect was in the last four tasks. <b>Conclusions.</b> This study has developed a set of preference weights for the ASCOT instrument in Finland, which can be used for investigating outcomes of social care interventions on adult populations. The learning effect calls for the development of study designs that reduce possible bias relating to preference uncertainty at the beginning of sequential BWS tasks. It also supports the adaptation of a modelling strategy in which the sequence of tasks is explicitly modelled as a scale factor.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"23814683211027902"},"PeriodicalIF":0.0,"publicationDate":"2021-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/23814683211027902","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39208810","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}