Decision Aid Implementation and Patients' Preferences for Hip and Knee Osteoarthritis Treatment: Insights from the High Value Healthcare Collaborative.

Background:Shared decision making (SDM) research has emphasized the role of decision aids (DAs) for helping patients make treatment decisions reflective of their preferences, yet there have been few collaborative multi-institutional efforts to integrate DAs in orthopedic consultations and primary care encounters. Objective:In the context of routine DA implementation for SDM, we investigate which patient-level characteristics are associated with patient preferences for surgery versus medical management before and after exposure to DAs. We explored whether DA implementation in primary care encounters was associated with greater shifts in patients' treatment preferences after exposure to DAs compared to DA implementation in orthopedic consultations. Design:Retrospective cohort study. Setting:10 High Value Healthcare Collaborative (HVHC) health systems. Study participants:A total of 495 hip and 1343 adult knee osteoarthritis patients who were exposed to DAs within HVHC systems between July 2012 to June 2015. Results:Nearly 20% of knee patients and 17% of hip patients remained uncertain about their treatment preferences after viewing DAs. Older patients and patients with high pain levels had an increased preference for surgery. Older patients receiving DAs from three HVHC systems that transitioned DA implementation from orthopedics into primary care had lower odds of preferring surgery after DA exposure compared to older patients in seven HVHC systems that only implemented DAs for orthopedic consultations. Conclusion:Patients' treatment preferences were largely stable over time, highlighting that DAs for SDM largely do not necessarily shift preferences. DAs and SDM processes should be targeted at older adults and patients reporting high pain levels. Initiating treatment conversations in primary versus specialty care settings may also have important implications for engagement of patients in SDM via DAs

Prudence and Robustness as Explanations for Precautionary Savings; an Evaluation

This paper evaluates approximation methods to make manageable the numerical solution of overlapping generation models with aggregate risk. The paper starts with a model in which households maximize expected utility over their life cycle. Instantaneous utility is characterized by constant relative risk aversion. Prudence, a characteristic of the utility function, leads to precautionary saving. The first-order conditions include expectations. One source of uncertainty is not prohibitive for numerical integration of the expectation term. Because of its accuracy numerical integration results are used as a bench mark. Taylor series approximations can lead to the same results dependent on the linearization point. A linear quadratic approximation of the household model is evaluated subsequently. Alternatively, precautionary saving effects can be the result of robust decision making. This approach leads to linear policy functions and gives a rather good approximation of the bench mark model, although not as good as the Taylor series approximation.

External technology sourcing: The effect of uncertainty on governance mode choice

This study examines the effect of external and relational uncertainty on the governance choice for inter-organizational technology sourcing. We develop a number of hypotheses about the impact of environmental turbulence, technological newness, technological distance and prior cooperation on the choice between different governance modes. Data about external technology sourcing transactions in the pharmaceutical industry do not provide evidence for a continuum from less to more integrated sourcing modes. However, we find that the ranking depends on the type of uncertainty, indicating that firms tackle different types of uncertainty with different governance modes.Open Innovation, Corporate Venture Capital, Mergers and Acquisitions

An exploratory study of factors influencing make-or-buy of sales activities

Purpose This paper aims to explore how sales managers make resourcing decisions with particular focus on their perceptions of outsourcing. Design/methodology/approach This paper is based on in-depth interviews with 29 senior sales managers from a variety of industry sectors based in the UK. All had more than five years’ experience of making resourcing decisions. Findings The findings are that resourcing decisions are prompted by cost pressure, the need to access skills or to improve flexibility. Outsourcing preferences are strongly moderated by perceived reputational risk. Availability of suitable suppliers and the ability to manage outsourcing are also practical moderators. Research limitations/implications The sample was purposeful in identifying and accessing senior respondents in substantial companies with extensive experience, but it was not random. Practical implications Respondents reported a lack of information available when making resourcing decisions; the model proposed provides a framework by which sales managers can identify the factors which should be taken into account and the information they need to make objective evaluations of resourcing options. Originality/value It has been acknowledged in prior literature that there is relatively little outsourcing of sales activities. This is the first exploratory study of the perceptions of sales managers about resourcing options and the first conceptualisation of how sales resourcing decisions are made

Development of Interactive Support Systems for Multiobjective Decision Analysis under Uncertainty

This paper presents interactive multiobjective decision analysis support systems, called MIDASS, which is a newly developed interactive computer program for strategic use of expected utility theory. Decision analysis based on expected utility hypothesis is an established prescriptive approach for supporting business decisions under uncertainty, which embodies an effective procedure for seeking the best choice among alternatives. It is usually difficult, however, for the decision maker (DM) to apply it for the strategic use in the realistic business situations. MIDASS provides an integrated interactive computer system for supporting multiobjective decision analysis under uncertainty, which assists to derive an acceptable business solution for DM with the construction of his/her expected multiattribute utility fuction (EMUF).expected multiobjective decision analysis, MIDASS, expected multiattribute utility function (EMUF), intelligent decision support systems (IDSS).