Measuring Experienced Utility in the Context of Health Economic Evaluation:A Narrative Overview

Background and Aims: Expected utility is deeply ingrained in the field of health economic evaluation, but critics highlight its theoretical flaws, including assumptions of complete information, bounded rationality, and stable preferences. They propose incorporating experienced utility for greater accuracy and suggest certain measurement methods. However, the applicability of these measurement methods in health economic evaluation remains uncertain. Therefore, this article examines the advantages, disadvantages and potential use of these measurement methods in the context of health economic evaluation. Methods: The measurement methods suggested in the literature include assessing physiological indicators, peak-end perceptions, approach-avoidance tendencies, and retrospective impact. The advantages, disadvantages, and potential use of these measurement methods in the context of health economic evaluation are analyzed using the discourse dialectic method. Results: Evaluation of physiological indicators is minimally intrusive and relatively objective, but it relies on laboratory data collection, limits comparability across scales, and emphasizes direct experiences. Assessment of peak-end perceptions enhances memory accuracy, yet elicits exaggerated recollections, neglects experience duration, promotes faded peak or overvalued end experiences, and disregards experiences without end. Measurement of approach-avoidance tendencies detects implicit experiences but similarly depends on laboratory conditions, fixates on immediate automatic emotional associations, overlooks unavoidable events or states, and remains indifferent to approach-avoidance conflicts. Evaluation of retrospective impact fosters holistic reflection and highlights temporally extended experiences, yet it fails to account for external information contamination, disregards individual rationalization processes, and overlooks constraints on reflective capabilities. Conclusion: Each proposed measurement method had drawbacks affecting its suitability for health economic evaluation. However, retrospective impact assessment emerged as the most promising one, although further scholarly inquiry is warranted to examine the theoretical and practical complexities of this approach within health economic evaluation.</p

An overview of innovative living arrangements within long-term care and their characteristics: a scoping review

Abstract Background Within long-term care, a culture change (e.g. focus on increasing autonomy in everyday life) is leading to the development of innovative living arrangements for older adults. Insight into characteristics of innovative living arrangements, which are described as an alternative to regular nursing homes, is lacking. This review aims to provide an overview of innovative living arrangements and to describe their defining characteristics. Methods A scoping review was performed following the framework of Arksey and O’Malley. The preferred reporting items for systematic reviews and meta-analyses with extension, for scoping reviews (PRISMA-ScR) was also followed. The databases PubMed, PsycInfo, CINAHL, and Web of Science were searched. Articles, published between 2012 and 2023 were included when they presented an innovative living arrangement as an alternative to regular nursing homes. A thematic analysis was performed, describing the physical, social, and organizational environment of the innovative living arrangements. Results Fifty-six articles were identified describing seven types of distinct innovative living arrangements: small-scale living, the green house model, shared housing arrangements, green care farms, dementia villages, group homes, intergenerational living, and an ‘other’ category. The themes included supporting autonomy and creating a small-scale and/or homelike environment, which were emphasized in most innovative living arrangements. Other themes, such as involvement of the community, focus on nature, integration of work tasks, and involvement of family members, were emphasized in a subsection of the described living arrangements. Twenty-eight articles reported on the effects of the innovative living environment on residents, family members, or staff members. Most articles (N = 22) studied resident-related outcomes, focusing mainly on quality of life and aspects of daily life. Conclusion More insight into the mechanisms of the social and organizational environments is needed, which may lead to greater transparency and homogeneity regarding the description of living arrangements. This review shows that more knowledge is needed about the potential key elements of innovative living arrangements, especially related to their social and organizational environment. This may provide a better guide for developers within long-term care

Deploying predictive analytics to enhance patient agility and patient value in hospitals: A position paper and research proposal

Patient value in hospital care has become increasingly important over the last decade. This paper argues that patient value could be ameliorated by investing in patient agility. Patient agility constitutes the capabilities that enable hospitals to sense the health service needs of their patients and respond to the changing health service demands of these patients. This paper further posits that hospitals’ current sensing and responding capabilities are inherently reactive as they detect, act upon and pursue occurrences and patterns in the needs and demands of patients after these have already manifested themselves. Hence, we assert that this reactive nature thwarts hospitals in preventing negative trends or capitalizing on positive trends necessitating a shift to sensing and responding capabilities that are more predictive. We postulate that this necessary organizational shift can be facilitated by implementing and utilizing the power of predictive analytics and that this particular issue has not yet been adequately addressed by existing scientific literature. Based on this argument, an initial research proposal is established centering around the role of predictive analytics in fostering patient agility and patient value in hospitals. The initial research proposal sets out to examine this topic in an inclusive, integrated and comprehensive manner as it outlines a coherent conceptual model, incorporates a multi-stakeholder perspective and integrates biomedical as well as health service needs and demands. The initial proposal is meant to serve as a conceptual framework for future research as well as an initial point of departure for further refinement, improvement, elaboration, and discussion

Determining the Appropriate Support for Older Adults with Different Levels of Vitality and Health-Related Quality of Life:An Explanatory Study

Vitality and health-related quality of life are often assessed in older adults. However, these assessments do not provide guidance on support for older adults with different levels of vitality and health-related quality of life. This guidance can be established through segmentation. The Subjective Health Experience model segments individuals and indicates support for each segment. By examining how older adults with different levels of vitality and health-related quality of life correspond with each segment and by specifying the indicated support to older adults, guidance can be established. This was examined by administering a questionnaire to 904 older adults and interviewing 8. Analysis was performed using one-way ANOVA and the matrix method. In segment 1, older adults sustained higher levels of vitality and health-related quality of life relative to other segments. They need information and certainty. In segment 2, older adults sustained lower levels of vitality and health-related quality of life relative to segment 1, and higher levels relative to segment 3 or 4. They need planning and structure. In segment 3, older adults sustained lower levels of vitality and health-related quality of life relative to segment 1 or 2, and higher levels relative to segment 4. They need emotive assistance. In segment 4, older adults sustained lower levels of vitality and health-related quality of life relative to other segments. They need personal coaching. As levels of vitality and health-related quality of life correspond with the segments, deploying vitality and health-related quality of life measures together with the model might be beneficial.</p