User needs elicitation via analytic hierarchy process (AHP). A case study on a Computed Tomography (CT) scanner

Background: The rigorous elicitation of user needs is a crucial step for both medical device design and purchasing. However, user needs elicitation is often based on qualitative methods whose findings can be difficult to integrate into medical decision-making. This paper describes the application of AHP to elicit user needs for a new CT scanner for use in a public hospital. Methods: AHP was used to design a hierarchy of 12 needs for a new CT scanner, grouped into 4 homogenous categories, and to prepare a paper questionnaire to investigate the relative priorities of these. The questionnaire was completed by 5 senior clinicians working in a variety of clinical specialisations and departments in the same Italian public hospital. Results: Although safety and performance were considered the most important issues, user needs changed according to clinical scenario. For elective surgery, the five most important needs were: spatial resolution, processing software, radiation dose, patient monitoring, and contrast medium. For emergency, the top five most important needs were: patient monitoring, radiation dose, contrast medium control, speed run, spatial resolution. Conclusions: AHP effectively supported user need elicitation, helping to develop an analytic and intelligible framework of decision-making. User needs varied according to working scenario (elective versus emergency medicine) more than clinical specialization. This method should be considered by practitioners involved in decisions about new medical technology, whether that be during device design or before deciding whether to allocate budgets for new medical devices according to clinical functions or according to hospital department

Use of Discrete Choice Experiments in health economics: An update of the literature

The vast majority of stated preference research in health economics has been conducted in the random utility model paradigm using discrete choice experiments (DCEs). Ryan and Gerard (2003) have reviewed the applications of DCEs in the field of health economics. We have updated this initial work to include studies published between 2001 and 2007. Following the methods of Ryan and Gerard, we assess the later body of work, with respect to the key characteristics of DCEs such as selection of attributes and levels, experimental design, preference measurement, estimation procedure and validity. Comparisons between the periods are undertaken in order to identify any emerging trends.discrete choice experiments, health economics

Trust and Privacy Permissions for an Ambient World

Ambient intelligence (AmI) and ubiquitous computing allow us to consider a future where computation is embedded into our daily social lives. This vision raises its own important questions and augments the need to understand how people will trust such systems and at the same time achieve and maintain privacy. As a result, we have recently conducted a wide reaching study of people’s attitudes to potential AmI scenarios with a view to eliciting their privacy concerns. This chapter describes recent research related to privacy and trust with regard to ambient technology. The method used in the study is described and findings discussed

Provider Perspectives on the Influence of Family on Nursing Home Resident Transfers to the Emergency Department: Crises at the End of Life.

Background. Nursing home (NH) residents often experience burdensome and unnecessary care transitions, especially towards the end of life. This paper explores provider perspectives on the role that families play in the decision to transfer NH residents to the emergency department (ED). Methods. Multiple stakeholder focus groups (n = 35 participants) were conducted with NH nurses, NH physicians, nurse practitioners, physician assistants, NH administrators, ED nurses, ED physicians, and a hospitalist. Stakeholders described experiences and challenges with NH resident transfers to the ED. Focus group interviews were recorded and transcribed verbatim. Transcripts and field notes were analyzed using a Grounded Theory approach. Findings. Providers perceive that families often play a significant role in ED transfer decisions as they frequently react to a resident change of condition as a crisis. This sense of crisis is driven by 4 main influences: insecurities with NH care; families being unprepared for end of life; absent/inadequate advance care planning; and lack of communication and agreement within families regarding goals of care. Conclusions. Suboptimal communication and lack of access to appropriate and timely palliative care support and expertise in the NH setting may contribute to frequent ED transfers

Incremental willingness to pay: a theoretical and empirical exposition

Applications of willingness to pay (WTP) have shown the difficultly to discriminate between various options. This reflects the problem of embedding in both its specific sense, of options being nested within one another, and its more-general sense, whereby respondents cannot discriminate between close substitutes or between more-disparate rivals for the same budget. Furthermore, high proportions of reversals between WTP-value and simple preference based rankings of options are often highlighted. Although an incremental WTP approach was devised to encourage more differentiated answers and a higher degree of consistency among respondents, a theoretical basis for this approach has not been elucidated, and there is little evidence to show that this approach might indeed achieve greater consistency between explicit and implicit rankings inferred from WTP values.We address both these issues. Following our theoretical exposition, standard and incremental approaches were compared with explicit ranking in a study assessing preferences for different French emergency care services. 280 persons, representative of the French adult population, were interviewed. Half received the incremental version, the other half the standard version. Results suggest that the incremental approach provides a ranking of options fully in line with explicit ranking. The standard approach was reasonably consistent with explicit ranking but proved unable to differentiate between the five most preferred providers, as predicted by theory. Our findings suggest that the incremental approach provides results which can be used in priority-setting contexts

Nuclear emergency decision support : a behavioural OR perspective

Operational researchers, risk and decision analysts need consider many behavioural issues. Despite many OR applications in nuclear emergency decision support, the literature has not paid sufficient attention to behavioural matters. In working on designing decision support processes for nuclear emergency management, we have encountered many behavioural issues. In this paper we synthesise the findings in the literature with our experience and identify a number of behavioural challenges to nuclear emergency decision support. In addition to challenges in model-building and interaction, we pay attention to a behavioural issue that is often neglected: the analysis itself and the communication of its implications may have behavioural consequences. We introduce proposals to address these challenges. First, we propose the use of models relying on incomplete preference information, outlining a framework and illustrating it with data from a previous decision analysis for the Chernobyl Project. Moreover, we reflect on the responsibility that rests on the analyst in addressing behavioural issues sensitively in order to lessen the effects on public stress. In doing so we make a distinction between System 1 Societal Deliberation and System 2 Societal Deliberation and discuss how this can help structure societal deliberation in the context of nuclear emergencies

Analytic Input to Societal Emergency Management - On the Design of Methods

Information from performed risk and vulnerability analyses, evaluation of responses in relation to actual emergencies etcetera can be very useful in efforts directed at preventing, mitigating and/or preparing for future emergencies. This thesis focuses on the development of methods for such analysis and evaluation. A general process for systematic design of methods is introduced and discussed and some of the main types of analytic input to societal emergency management are examined in terms of how methods for analysis should be constructed to fulfil their purpose. Furthermore, the importance of values and preferences in any design process is emphasised and two descriptive studies directed at investigating people’s preferences regarding potential negative outcomes of unwanted events are presented

QUANTIFYING AND MANAGING RISK IN AGRICULTURE

Risk and Uncertainty,

Measuring the Value of a Statistical Life: Problems and Prospects

Tradeoffs between monetary wealth and fatal safety risks are summarized in the value of a statistical life (VSL), a measure that is widely used for the evaluation of public policies in medicine, the environment, and transportation safety. This paper demonstrates the widespread use of this concept and summarizes the major issues, both theoretical and empirical, that must be confronted in order to provide a credible estimate of a VSL. The paper concludes with an application of these issues to a particular study of speed limits and highway safety.