A conceptual framework and protocol for defining clinical decision support objectives applicable to medical specialties.

BackgroundThe U.S. Centers for Medicare and Medicaid Services established the Electronic Health Record (EHR) Incentive Program in 2009 to stimulate the adoption of EHRs. One component of the program requires eligible providers to implement clinical decision support (CDS) interventions that can improve performance on one or more quality measures pre-selected for each specialty. Because the unique decision-making challenges and existing HIT capabilities vary widely across specialties, the development of meaningful objectives for CDS within such programs must be supported by deliberative analysis.DesignWe developed a conceptual framework and protocol that combines evidence review with expert opinion to elicit clinically meaningful objectives for CDS directly from specialists. The framework links objectives for CDS to specialty-specific performance gaps while ensuring that a workable set of CDS opportunities are available to providers to address each performance gap. Performance gaps may include those with well-established quality measures but also priorities identified by specialists based on their clinical experience. Moreover, objectives are not constrained to performance gaps with existing CDS technologies, but rather may include those for which CDS tools might reasonably be expected to be developed in the near term, for example, by the beginning of Stage 3 of the EHR Incentive program. The protocol uses a modified Delphi expert panel process to elicit and prioritize CDS meaningful use objectives. Experts first rate the importance of performance gaps, beginning with a candidate list generated through an environmental scan and supplemented through nominations by panelists. For the highest priority performance gaps, panelists then rate the extent to which existing or future CDS interventions, characterized jointly as "CDS opportunities," might impact each performance gap and the extent to which each CDS opportunity is compatible with specialists' clinical workflows. The protocol was tested by expert panels representing four clinical specialties: oncology, orthopedic surgery, interventional cardiology, and pediatrics

Misselling through agents

This paper analyzes the implications of the inherent conflict between two tasks performed by direct marketing agents: prospecting for customers and advising on the product's "suitability" for the specific needs of customers. When structuring sales-force compensation, firms trade off the expected losses from "misselling" unsuitable products with the agency costs of providing marketing incentives. We characterize how the equilibrium amount of misselling (and thus the scope of policy intervention) depends on features of the agency problem including: the internal organization of a firm's sales process, the transparency of its commission structure, and the steepness of its agents' sales incentives. JEL Classification: D18 (Consumer Protection), D83 (Search; Learning; Information and Knowledge), M31 (Marketing), M52 (Compensation and Compensation Methods and Their Effects)

Toward a Research Agenda to Promote Household Access to Food in Ethiopia

The objective of this report is to review available evidence on the potential to promote access to food for vulnerable groups in Ethiopia through two main methods: food transfer programs, and appropriate policies influencing the food marketing system. These issues are examined with a view to identifying priority issues for analysis under the MEDAC/MSU/USAID Food Security Project in Ethiopia. In particular, the report presents trends in food aid and food production in Ethiopia, and provides preliminary evidence of the possible disincentive effects of food aid on agricultural production incentives and investments in the food marketing system; discusses the costs and benefits of various food aid transfer programs, and highlights major unresolved issues requiring further analysis to guide Ethiopian policy makers' decisions on strategies to promote household food security; presents a set of "guiding principles" to minimize the trade-offs between meeting vulnerable groups' immediate food needs and promoting agricultural productivity growth over the long run; and identifies important unresolved issues for further analysis, in order to guide Ethiopian policy makers' decisions on ensuring household access to food through an appropriate mix of market and transfer mechanisms.food security, food policy, Ethiopia, food aid, food production, Food Security and Poverty, Research and Development/Tech Change/Emerging Technologies, Q18,

Benefits of and barriers to involving users in medical device technology development and evaluation

Objectives: This study investigated the benefits of, and barriers to user involvement in medical device technology development and evaluation. Methods: A structured review of published literature in peer-reviewed journals. Results: This review revealed that the main benefits of user involvement were an increased access to user needs, experiences and ideas; improvements in medical device designs and user interfaces; and an increase in the functionality, usability and quality of the devices. On the other hand, resource issues, particularly those of time and money were found the key impediments to involving users in the development and evaluation of medical device technologies. This study has categorised both the benefits and barriers to user involvement also. Conclusions: The involvement of users in MDTD&E requires resources, which are limited; however, it is essential from both users and manufacturers perspectives

Ingeniería de requerimientos orientado a objetivos en almacenes de datos: un estudio comparativo

Data warehouses provide historical information about the organization that needs to be analyzed by the decision makers; therefore, it is essential to develop them in the context of a strategic business plan. In recent years, a number of engineering approaches for goal-oriented requirements have been proposed, which can obtain the information requirements of a data warehouse using traditional techniques and the objectives of the modeling. This paper provides an overview and a comparative study of the treatment of the requirements in the existing approaches to serve as a starting point for further research.Los almacenes de datos proveen información histórica de la organización que requiere ser analizada por los tomadores de decisiones, por lo que es primordial desarrollarlos en el contexto del plan estratégicos del negocio. En los últimos años se han propuesto una serie de enfoques de ingeniería de requerimientos orientada a objetivos que permiten obtener los requisitos de información, a cubrir por el almacén de datos, mediante técnicas tradicionales y del modelado de objetivos. Este trabajo, ofrece una visión general y un estudio comparativo del tratamiento de los requisitos en los actuales enfoques con el fin de servir de punto de inicio a posteriores trabajos de investigación.This work was financed by the Universidad de La Frontera. DIU-FRO Project DI13-0047

Talking about routines in the field: the emergence of organizational capabilities in a new cellular phone network company

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