Eight-step method to build the clinical content of an evidence-based care pathway: the case for COPD exacerbation

Abstract Background Optimization of the clinical care process by integration of evidence-based knowledge is one of the active components in care pathways. When studying the impact of a care pathway by using a cluster-randomized design, standardization of the care pathway intervention is crucial. This methodology paper describes the development of the clinical content of an evidence-based care pathway for in-hospital management of chronic obstructive pulmonary disease (COPD) exacerbation in the context of a cluster-randomized controlled trial (cRCT) on care pathway effectiveness. Methods The clinical content of a care pathway for COPD exacerbation was developed based on recognized process design and guideline development methods. Subsequently, based on the COPD case study, a generalized eight-step method was designed to support the development of the clinical content of an evidence-based care pathway. Results A set of 38 evidence-based key interventions and a set of 24 process and 15 outcome indicators were developed in eight different steps. Nine Belgian multidisciplinary teams piloted both the set of key interventions and indicators. The key intervention set was judged by the teams as being valid and clinically applicable. In addition, the pilot study showed that the indicators were feasible for the involved clinicians and patients. Conclusions The set of 38 key interventions and the set of process and outcome indicators were found to be appropriate for the development and standardization of the clinical content of the COPD care pathway in the context of a cRCT on pathway effectiveness. The developed eight-step method may facilitate multidisciplinary teams caring for other patient populations in designing the clinical content of their future care pathways.</p

Enabling Personalized Composition and Adaptive Provisioning of Web Services

The proliferation of interconnected computing devices is fostering the emergence of environments where Web services made available to mobile users are a commodity. Unfortunately, inherent limitations of mobile devices still hinder the seamless access to Web services, and their use in supporting complex user activities. In this paper, we describe the design and implementation of a distributed, adaptive, and context-aware framework for personalized service composition and provisioning adapted to mobile users. Users specify their preferences by annotating existing process templates, leading to personalized service-based processes. To cater for the possibility of low bandwidth communication channels and frequent disconnections, an execution model is proposed whereby the responsibility of orchestrating personalized processes is spread across the participating services and user agents. In addition, the execution model is adaptive in the sense that the runtime environment is able to detect exceptions and react to them according to a set of rules

The all-pay-auction with complete information

In a (first price) all-pay auction, bidders simultaneously submit bids for an item. All players forfeit their bids, and the high bidder receives the item. This auction is widely used in economics to model rent seeking, R&D races, political contests, and job promotion tournaments. We fully characterize equilibrium for this class of games, and show that the set of equilibria is much larger than has been recognized in the literature. When there are more than two players, for instance, we show that even when the auction is symmetric there exists a continuum of asymmetric equilibria. Moreover, for economically important configurations of valuations, there is no revenue equivalence across the equilibria; asymmetric equilibria imply higher expected revenues than the symmetric equilibrium