A Value-of-Information Framework for Personalizing the Timing of Surveillance Testing

2021 ◽  
pp. 0272989X2110492
Author(s):  
Aasthaa Bansal ◽  
Patrick J. Heagerty ◽  
Lurdes Y. T. Inoue ◽  
David L. Veenstra ◽  
Charles J. Wolock ◽  
...  
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Value Of Information ◽  
Patient Monitoring ◽  
Cost Effective ◽  
A Value ◽  
Novel Method ◽  
Frequent Testing ◽  
Personalized Risk ◽  
Time Point

Background Patient surveillance using repeated biomarker measurements presents an opportunity to detect and treat disease progression early. Frequent surveillance testing using biomarkers is recommended and routinely conducted in several diseases, including cancer and diabetes. However, frequent testing involves tradeoffs. Although surveillance tests provide information about current disease status, the complications and costs of frequent tests may not be justified for patients who are at low risk of progression. Predictions based on patients’ earlier biomarker values may be used to inform decision making; however, predictions are uncertain, leading to decision uncertainty. Methods We propose the Personalized Risk-Adaptive Surveillance (PRAISE) framework, a novel method for embedding predictions into a value-of-information (VOI) framework to account for the cost of uncertainty over time and determine the time point at which collection of biomarker data would be most valuable. The proposed sequential decision-making framework is innovative in that it leverages the patient’s longitudinal history, considers individual benefits and harms, and allows for dynamic tailoring of surveillance intervals by considering the uncertainty in current information and estimating the probability that new information may change treatment decisions, as well as the impact of this change on patient outcomes. Results When applied to data from cystic fibrosis patients, PRAISE lowers costs by allowing some patients to skip a visit, compared to an “always test” strategy. It does so without compromising expected survival, by recommending less frequent testing among those who are unlikely to be treated at the skipped time point. Conclusions A VOI-based approach to patient monitoring is feasible and could be applied to several diseases to develop more cost-effective and personalized strategies for ongoing patient care. Highlights In many patient-monitoring settings, the complications and costs of frequent tests are not justified for patients who are at low risk of disease progression. Predictions based on patient history may be used to individualize the timing of patient visits based on evolving risk. We propose Personalized Risk-Adaptive Surveillance (PRAISE), a novel method for personalizing the timing of surveillance testing, where prediction modeling projects the disease trajectory and a value-of-information (VOI)–based pragmatic decision-theoretic framework quantifies patient- and time-specific benefit-harm tradeoffs. A VOI-based approach to patient monitoring could be applied to several diseases to develop more personalized and cost-effective strategies for ongoing patient care.

scholarly journals Discovery of Several New Families of Saturable Absorbers for Ultrashort Pulsed Laser Systems

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Syed Asad Hussain
Keyword(s):  
Modulation Depth ◽  
Laser System ◽  
Ultrashort Pulses ◽  
Cost Effective ◽  
Saturable Absorbers ◽  
A Value ◽  
Plastic Materials ◽  
Laser Systems ◽  
Novel Method ◽  
Mode Locked Laser

AbstractSaturable Absorber (SA) is a key element of any passive mode-locked laser system to provide ultrashort laser system. So far various materials have been proposed that could be used for this purpose. However, the field is still looking for new ways to make the fabrication process easier and cost-effective. Another challenge in testing mode-locked laser systems using various SA samples is the lack of knowledge in preparing these by laser physicists given this is outside their remit of expertise. In this study, we have proposed a novel method to produce these SAs from plastic materials and glycol. Our new method relies upon increase in thickness up to a value where the modulation depth is enough to give stable ultrashort pulses. Although we have shown this method for four materials; similar approach could be applied to any material. This will open the door of unlimited families of SAs that could be easily prepared and applied without any prior knowledge in material sciences.

Information and Its Value

2020 ◽  
pp. 3-31
Author(s):  
J. Michael Dunn ◽  
Amos Golan
Keyword(s):  
Decision Making ◽  
Information Processing ◽  
Decision Process ◽  
Value Of Information ◽  
A Value ◽  
Concept Of Information

In this chapter, we are interested in understanding the nature of information and its value. We focus on information that is used for making decisions, including related activities such as constructing models, performing inferences, and making predictions. Our discussion is mostly qualitative, and it touches on certain aspects of information as related to the sender, receiver, and a possible observer. Although our emphasis is on shedding more light on the concept of information for making decisions, we are not concerned here with the exact details of the decision process, or information processing itself. In addition to discussing information, our expedition takes us through the traditional notions of utility, prices, and risk, all of which, under certain conditions, relate to the value of information. Our main conclusion is that the value of information (used in decision making) is relative and subjective. Since information is relative, it can have more than one value, say a value for the sender, a value for the receiver, or even different values for different senders and receivers, and various values for various “eavesdroppers.” Of course, the value might be zero for any of these. Importantly, that value is inversely related to risk when the information is used for decision making. Although this conclusion is likely expected, we did argue for it in a way that relies on some fundamentals about both value and information.

Simulation Model Refinement for Decision Making Via a Value-of-Information Based Metric

2006 ◽  
Author(s):  
Jitesh H. Panchal ◽  
Christiaan J. J. Paredis ◽  
Janet K. Allen ◽  
Farrokh Mistree
Keyword(s):  
Decision Making ◽  
Simulation Model ◽  
Value Of Information ◽  
Design Space ◽  
Simulation Models ◽  
Model Refinement ◽  
Physical Behavior ◽  
Additional Information ◽  
A Value ◽  
The Difference

Since no simulation model is perfect, any simulation model for modeling a system’s physical behavior can be refined further. Hence, the question faced by a designer is — “How much refinement of a simulation model is adequate for a particular design problem?” To answer this question, we present a value-of-information based approach for determining the appropriate extent of refinement of simulation models. The value of additional information obtained via refinement of simulation models is measured as the difference between the maximum payoff that could possibly be achieved throughout the design space and the minimum possible payoff at the point in the design space selected using the simple model. The approach is presented using two examples — design of a pressure vessel and the design of a material.

scholarly journals Influence of response shift and disposition on patient-reported outcomes may lead to suboptimal medical decisions: a medical ethics perspective

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Iris D. Hartog ◽  
Dick L. Willems ◽  
Wilbert B. van den Hout ◽  
Michael Scherer-Rath ◽  
Tom H. Oreel ◽  
...  
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Patient Reported Outcomes ◽  
Medical Decision Making ◽  
Response Shift ◽  
Cost Effective ◽  
Medical Decision ◽  
Medical Decisions ◽  
Patient Reports ◽  
Patient Reported

Abstract Background Patient-reported outcomes (PROs) are frequently used for medical decision making, at the levels of both individual patient care and healthcare policy. Evidence increasingly shows that PROs may be influenced by patients’ response shifts (changes in interpretation) and dispositions (stable characteristics). Main text We identify how response shifts and dispositions may influence medical decisions on both the levels of individual patient care and health policy. We provide examples of these influences and analyse the consequences from the perspectives of ethical principles and theories of just distribution. Conclusion If influences of response shift and disposition on PROs and consequently medical decision making are not considered, patients may not receive optimal treatment and health insurance packages may include treatments that are not the most effective or cost-effective. We call on healthcare practitioners, researchers, policy makers, health insurers, and other stakeholders to critically reflect on why and how such patient reports are used.

scholarly journals Estimating the Societal Benefits of Satellite Instruments: Application to a Break-even Analysis of the GeoXO Hyperspectral IR Sounder

2021 ◽  
Vol 9 ◽  
Author(s):  
Christopher Lauer ◽  
Joseph Conran ◽  
Jeffery Adkins
Keyword(s):  
Value Of Information ◽  
Systems Approach ◽  
Cost Effective ◽  
Lessons Learned ◽  
Satellite Constellations ◽  
Satellite Systems ◽  
Complex Information ◽  
A Value ◽  
Information Studies ◽  
Direct Use

This paper describes the process, and lessons learned in a preliminary benefits study of a proposed infrared hyperspectral sounder (HSS) for NOAA’s next generation geostationary satellite program (GeoXO). The valuation of government-owned satellite systems providing a public good with a complex array of instruments is a nascent field of study. Many different sensor configurations are possible, but there are restrictions due to physical and budget constraints. Accounting for economic considerations during the design and planning phase for satellite constellations helps to ensure that the most cost effective instruments are selected. To assess whether the HSS instrument should be included on GeoXO, we applied a value of information approach and found the benefits associated with this instrument are likely to substantially outweigh the costs. Value of information studies often focus on data and information that has a direct use case. Estimating benefits for the HSS is especially challenging because data are not used directly by decision makers. Instead these data along with information from other Earth observing (EO) satellites play a key role in producing the inputs necessary for modern numerical hydrometeorological modeling. We describe strategies to assess the marginal (i.e., incremental) contribution of an instrument that is part of a complex information production process. We make several recommendations that, if implemented, would improve the quality of future studies of this kind. This includes (1) a systems approach to observing system planning, (2) improving the design of observing system experiments (OSSE and OSE), and (3) better tracking of the decisions and needs of end-users, especially those external to the agency.

Teletinnitus Program at the VA Gulf Coast Veterans Health Care System

2014 ◽  
Vol 4 (1) ◽  
pp. 23-29
Author(s):  
Constance Hilory Tomberlin
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Patient Care ◽  
Health Care System ◽  
Gulf Coast ◽  
New Technology ◽  
Cost Effective ◽  
Veterans Health ◽  
Potential Benefits ◽  
Care System

There are a multitude of reasons that a teletinnitus program can be beneficial, not only to the patients, but also within the hospital and audiology department. The ability to use technology for the purpose of tinnitus management allows for improved appointment access for all patients, especially those who live at a distance, has been shown to be more cost effective when the patients travel is otherwise monetarily compensated, and allows for multiple patient's to be seen in the same time slots, allowing for greater access to the clinic for the patients wishing to be seen in-house. There is also the patient's excitement in being part of a new technology-based program. The Gulf Coast Veterans Health Care System (GCVHCS) saw the potential benefits of incorporating a teletinnitus program and began implementation in 2013. There were a few hurdles to work through during the beginning organizational process and the initial execution of the program. Since the establishment of the Teletinnitus program, the GCVHCS has seen an enhancement in patient care, reduction in travel compensation, improvement in clinic utilization, clinic availability, the genuine excitement of the use of a new healthcare media amongst staff and patients, and overall patient satisfaction.

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

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