scholarly journals PMU66 US Payer Decision Making Priorities: A Cohort Analysis across Eight Disease Categories

2020 ◽  
Vol 23 ◽  
pp. S613-S614
Author(s):  
N. Lodowski ◽  
J. Sander Kirschenbaum ◽  
N. White ◽  
S. Okoro
Keyword(s):  
Decision Making ◽  
Cohort Analysis

scholarly journals Composer—Visual Cohort Analysis of Patient Outcomes

2019 ◽  
Vol 10 (02) ◽  
pp. 278-285 ◽  
Author(s):  
Jen Rogers ◽  
Nicholas Spina ◽  
Ashley Neese ◽  
Rachel Hess ◽  
Darrel Brodke ◽  
...  
Keyword(s):  
Decision Making ◽  
Patient Outcomes ◽  
Visual Analysis ◽  
Treatment Options ◽  
Cohort Analysis ◽  
Analysis Tool ◽  
Electronic Health Record Data ◽  
Patient Cohort ◽  
Orthopedic Surgeons ◽  
Patient Reported

Objective Visual cohort analysis utilizing electronic health record data has become an important tool in clinical assessment of patient outcomes. In this article, we introduce Composer, a visual analysis tool for orthopedic surgeons to compare changes in physical functions of a patient cohort following various spinal procedures. The goal of our project is to help researchers analyze outcomes of procedures and facilitate informed decision-making about treatment options between patient and clinician. Methods In collaboration with orthopedic surgeons and researchers, we defined domain-specific user requirements to inform the design. We developed the tool in an iterative process with our collaborators to develop and refine functionality. With Composer, analysts can dynamically define a patient cohort using demographic information, clinical parameters, and events in patient medical histories and then analyze patient-reported outcome scores for the cohort over time, as well as compare it to other cohorts. Using Composer's current iteration, we provide a usage scenario for use of the tool in a clinical setting. Conclusion We have developed a prototype cohort analysis tool to help clinicians assess patient treatment options by analyzing prior cases with similar characteristics. Although Composer was designed using patient data specific to orthopedic research, we believe the tool is generalizable to other healthcare domains. A long-term goal for Composer is to develop the application into a shared decision-making tool that allows translation of comparison and analysis from a clinician-facing interface into visual representations to communicate treatment options to patients.

scholarly journals Therapeutic Decision Making in Hepatocellular Carcinoma According to Age and Child–Pugh Class: A Nationwide Cohort Analysis in South Korea

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Sunmin Park ◽  
Chai Hong Rim ◽  
Young Kul Jung ◽  
Won Sup Yoon
Keyword(s):  
Hepatocellular Carcinoma ◽  
Decision Making ◽  
Liver Function ◽  
South Korea ◽  
Surgical Resection ◽  
Cohort Analysis ◽  
Treatment Preference ◽  
Therapeutic Decision ◽  
Pugh Class ◽  
Therapeutic Decision Making

Background. We sought to analyze the preferred treatment modality by age and liver function in South Korea. Methods. The Korean Liver Cancer Study Group randomly extracted the data of patients with hepatocellular carcinoma (HCC) enrolled in the Korean Central Cancer Registry from 2008 to 2014 from approximately 50 hospitals nationwide. After excluding distant and lymphatic metastases, the treatment preference for patients with a single lesion (excluding PVT (portal vein thrombosis), hepatic vessels, and bile duct invasion) and with PVT was evaluated in 7559 patients. Patients were grouped by age, and baseline liver function was divided based on the Child–Pugh class (CPC) A, B, and C. Results. For a single HCC, the majority of patients selected transarterial therapy as the initial treatment, followed by surgical resection and local ablative therapy. The surgical resection rate decreased significantly with age ( p < 0.001 ), and the transarterial therapy rate significantly increased ( p < 0.001 ). For CPC C, liver transplantation was significantly increased to 11.5%, and 36.3% of patients received no treatment. In HCC with PVT, the transarterial therapy rate was the highest, followed by the rate of abandonment of treatment. The proportion of no treatment significantly increased with age ( p < 0.001 ). In CPC C, transarterial therapy and systemic therapy were attempted in 15.4% and 5.8% of patients, respectively. Conclusions. Age and liver function have a significant impact on the therapeutic decision-making of HCC patients in Korea. In unfavorable conditions, surgical resection was less favored in patients with single tumors, and no treatment was preferred in patients with PVT.

Millennials and Generation Z: a generational cohort analysis of Indian consumers

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Packiaraj Thangavel ◽  
Pramod Pathak ◽  
Bibhas Chandra
Keyword(s):  
Decision Making ◽  
Factor Analysis ◽  
Generational Differences ◽  
Online Shopping ◽  
Cohort Analysis ◽  
Empirical Work ◽  
Generational Cohort ◽  
Content Type ◽  
Generation Z ◽  
Decision Styles

PurposeYoung consumers are recognized as an important and lucrative segment for the businesses across the globe. While initial steps have been taken to understand them, majority of the existing works consider both Millennials and Generation Z as a single and homogeneous market segment. The purpose of this study is to explore the consumer decision-making styles which are prevalent among Indian Millennials and Generation Z e-shoppers, and how significantly they differ from one another on each of those decision-making attributes.Design/methodology/approachThis exploratory study used the generational cohort theory (GCT) as a framework. The psychographic statements (Questionnaire items) employed were adopted from several past researches on store orientation and catalog orientation, and they were rephrased to suit to the context of Indian online shopping. The principal components factor analysis with promax rotation has been used to unearth the underlying decision-styles among 503 survey participants. Subsequently, the ANOVA model was run to examine the mean differences between the cohorts.FindingsThe factor analysis has revealed that frugality (Price), convenience (Home) and social desirableness are the most dominant shopping orientations (decision-styles) that prevail among Indian (Millennials and Generation Z) online shoppers though in varying degrees. The probing of ANOVA results suggested that, though both the cohorts favor e-shopping, Generation Z are more enthusiastic about online shopping than their Millennial counterparts do.Practical implicationsThough Generation Z and Millennials share few characteristics between them, they exhibit different consumer behaviors. Marketers need to customize their value offerings and marketing communications that resonate well with each generational cohort.Originality/valueAlmost all the existing research works that have been conducted so far on generational cohorts are from Western and European countries and one could confidently say that those findings cannot be applied for the developing nations such as India which is a complex and diverse country in terms of its language, custom, religion and practices with troublesome pasts. Moreover, this is the first empirical work to be conducted to unearth the generational differences that exist between Generation Z and Millennials to the best of authors' knowledge.

Influence of the revision of surgical fee schedule on surgeons’ productivity in Japan: A cohort analysis of 7602 surgical procedures in 2013–2016

2017 ◽  
Vol 31 (1) ◽  
pp. 51-56 ◽  
Author(s):  
Yoshinori Nakata ◽  
Yuichi Watanabe ◽  
Hiroto Narimatsu ◽  
Tatsuya Yoshimura ◽  
Hiroshi Otake ◽  
...  
Keyword(s):  
Decision Making ◽  
Surgical Procedures ◽  
Technical Change ◽  
Cohort Analysis ◽  
University Hospital ◽  
Academic Rank ◽  
Efficiency Change ◽  
Surgical Operation ◽  
Decision Making Unit ◽  
Fee Schedule

The goal of this study is to evaluate the pure impact of the revision of surgical fee schedule on surgeons’ productivity. We collected data from the surgical procedures performed by the surgeons working in Teikyo University Hospital from 1 April through 30 September in 2013–2016. We employed non-radial and non-oriented Malmquist model. We defined the decision-making unit as a surgeon with the highest academic rank in surgery. Inputs were defined as (1) the number of doctors who assisted surgery and (2) the time of surgical operation. The output was defined as the surgical fee for each surgery. We focused on the revisions in 2014 and 2016. We first calculated each surgeon’s natural logarithms of the changes in productivity, technique and efficiency in 2013–2014, in 2014–2015 and in 2015–2016. Then, we subtracted the changes in 2014–2015 from the changes in 2013–2014 and in 2015–2016. We analyzed 62 surgeons who performed 7602 surgical procedures. The productivity changes were not significantly different from 0. Their efficiency change was significantly greater than 0, while their technical change was smaller than 0 in revision 2014. Their efficiency change was significantly smaller than 0, while their technical change was greater than 0 in revision 2016 (p < 0.05). This finding suggests that we could increase overall productivity through revision if we could increase both efficiency and technique.

scholarly journals Second Surgery for Progressive Glioblastoma: A Multi-Centre Questionnaire and Cohort-Based Review of Clinical Decision-Making and Patient Outcomes in Current Practice

2021 ◽  
Author(s):  
Paul Brennan ◽  
R Borchert ◽  
C Coulter ◽  
G Critchley ◽  
B Hall ◽  
...  
Keyword(s):  
Decision Making ◽  
Patient Outcomes ◽  
Clinical Decision Making ◽  
Performance Status ◽  
Treatment Options ◽  
Cohort Analysis ◽  
Methylation Status ◽  
Clinical Decision ◽  
Extent Of Resection ◽  
Second Surgery

Abstract PurposeGlioblastoma prognosis is poor. Treatment options are limited at progression. Surgery may benefit, but no quality guidelines exist to inform patient selection. We sought to describe variations in surgical management at progression, highlight where further evidence is needed, and build towards a consensus strategy. MethodsCurrent practice in selection of patients with progressive GBM for second surgery was surveyed online amongst specialists in the UK and Europe. We complemented this with an assessment of practice in a retrospective cohort study from six United Kingdom neurosurgical units. We used descriptive statistics to analyse the data. Results234 questionnaire responses were received. Maintaining or improving patient quality of life was key to decision making, with variation as to whether patient age, performance status or intended extent of resection was relevant. MGMT methylation status was not important. Half considered no minimum time after first surgery. 288 patients were reported in the cohort analysis. Median time to second surgery from first surgery 390 days. Median overall survival 815 days, with no association between time to second surgery and time to death (p=0.874). ConclusionThis is the most wide-ranging examination of contemporaneous practice in management of GBM progression. Without evidence-based guidelines, the variation is unsurprising. We propose consensus guidelines for consideration, to reduce heterogeneity in decision making, support data collection and analysis of factors influencing outcomes, and to inform clinical trials to establish whether second surgery improves patient outcomes, or simply selects to patients already performing well.

Why are low-risk prostate cancers (PCa) treated aggressively? A population-based cohort analysis.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 127-127
Author(s):  
Ramsankar Basak ◽  
Deborah S Usinger ◽  
Paul Alphonso Godley ◽  
Ronald C. Chen
Keyword(s):  
Decision Making ◽  
Cohort Analysis ◽  
Multivariable Analysis ◽  
Population Based ◽  
Low Risk ◽  
Accurate Information ◽  
Aggressive Treatment ◽  
Patient Goals ◽  
Cancer Aggressiveness ◽  
Risk Patients

127 Background: Per AUA guidelines, active surveillance (AS) is the best option for very low-risk PCa and preferred for all low-risk patients. However, AS continues to be underused. This study examines decision-making factors in low risk patients. Methods: Using Rapid Case Ascertainment of the North Carolina (NC) Cancer Registry, 1,456 patients were enrolled from 2011-13 across NC soon after diagnosis. NCCN risk group and treatments received (or AS) were determined using medical records and registry data. Phone survey asked patients about their perceived cancer aggressiveness, most important decision-making factor (i.e., cure, quality of life, family burden, cost, daily activity), and desire to be involved in the decision process. Results: Of 585 low-risk patients, 38% pursued AS. Multivariable analysis showed that patient desire to pursue aggressive treatment and perceived cancer aggressiveness were significantly associated with aggressive treatment instead of AS (Table). Further, patients indicating primary decision was self (instead of physician) were more likely to receive aggressive treatment (Odds ratio [OR] 1.76). In the subgroup of 346 very low-risk patients, 48% received AS; patient desire for aggressive treatment and perceived aggressiveness remained significant factors. Conclusions: Patient desire for aggressive treatment and (mis)perception of cancer aggressiveness were dominant factors for low-risk patients receiving aggressive treatment instead of AS. Ascertaining patient goals for treatment and more accurate information about low-risk PCa may improve physician counseling and reduce underutilization of AS. [Table: see text]

scholarly journals Second surgery for progressive glioblastoma: a multi‐centre questionnaire and cohort‐based review of clinical decision‐making and patient outcomes in current practice

2021 ◽  
Author(s):  
P. M. Brennan ◽  
R. Borchert ◽  
C. Coulter ◽  
G. R. Critchley ◽  
B. Hall ◽  
...  
Keyword(s):  
Decision Making ◽  
Patient Outcomes ◽  
Current Practice ◽  
Clinical Decision Making ◽  
Performance Status ◽  
Treatment Options ◽  
Cohort Analysis ◽  
Methylation Status ◽  
Clinical Decision ◽  
Second Surgery

Abstract Purpose Glioblastoma prognosis is poor. Treatment options are limited at progression. Surgery may benefit, but no quality guidelines exist to inform patient selection. We sought to describe variations in surgical management at progression, highlight where further evidence is needed, and build towards a consensus strategy. Methods Current practice in selection of patients with progressive GBM for second surgery was surveyed online amongst specialists in the UK and Europe. We complemented this with an assessment of practice in a retrospective cohort study from six United Kingdom neurosurgical units. We used descriptive statistics to analyse the data. Results 234 questionnaire responses were received. Maintaining or improving patient quality of life was key to decision making, with variation as to whether patient age, performance status or intended extent of resection was relevant. MGMT methylation status was not important. Half considered no minimum time after first surgery. 288 patients were reported in the cohort analysis. Median time to second surgery from first surgery 390 days. Median overall survival 815 days, with no association between time to second surgery and time to death (p = 0.874). Conclusions This is the most wide-ranging examination of contemporaneous practice in management of GBM progression. Without evidence-based guidelines, the variation is unsurprising. We propose consensus guidelines for consideration, to reduce heterogeneity in decision making, support data collection and analysis of factors influencing outcomes, and to inform clinical trials to establish whether second surgery improves patient outcomes, or simply selects to patients already performing well.

Discarding optimality: Throwing out the baby with the bathwater?

2018 ◽  
Vol 41 ◽  
Author(s):  
Patrick Simen ◽  
Fuat Balcı
Keyword(s):  
Decision Making ◽  
Perceptual Decision Making ◽  
Reward Rate ◽  
Perceptual Decision ◽  
Standard Observer ◽  
Rate Maximization ◽  
Reward Rate Maximization ◽  
Descriptive Standard ◽  
Observer Model

AbstractRahnev & Denison (R&D) argue against normative theories and in favor of a more descriptive “standard observer model” of perceptual decision making. We agree with the authors in many respects, but we argue that optimality (specifically, reward-rate maximization) has proved demonstrably useful as a hypothesis, contrary to the authors’ claims.

LPCD framework: Analytical tool or psychological model?

2018 ◽  
Vol 41 ◽  
Author(s):  
David Danks
Keyword(s):  
Decision Making ◽  
Analytical Tool ◽  
Mathematical Framework ◽  
Bayesian Decision ◽  
Perceptual Decision Making ◽  
Psychological Model ◽  
Psychological Reality ◽  
Psychological Theories ◽  
Target Article ◽  
Bayesian Decision Making

AbstractThe target article uses a mathematical framework derived from Bayesian decision making to demonstrate suboptimal decision making but then attributes psychological reality to the framework components. Rahnev & Denison's (R&D) positive proposal thus risks ignoring plausible psychological theories that could implement complex perceptual decision making. We must be careful not to slide from success with an analytical tool to the reality of the tool components.

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