Utility assessment based on individualized patient perspectives

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 1998.Includes bibliographical references (p. 203-211).The feasibility of using the terminology of the individual patient to capture and express the individual's particular, perhaps unique, value system for healthiness is explored as a means to evaluate the quality of life. The hypothesis is that a systematic approach that treats the patient as a competent expert on a patient's perception of what it means to be healthy is a viable approach to his or her values. It is anticipated that eliciting such knowledge in a form that health care providers can use will enhance medical decision making. A systematic and rigorous protocol is described consisting of a reconstruction of utility assessment using traditional methodological building blocks applied to the descriptors elicited from the individual. The representation of values is multidimensional. Ordered nominal scales are constructed from the words of the individual's description of familiar people in a structured interview. A complete list of comprehensive scales is composed as indicated by the responses of the individual to hypothetical decisions involving tradeoffs. The result is a scoring system for health state descriptions suitable to represent values for the outcomes in medical decision models constructed by the medical community. The output is a patient preference model referred to as an Individualized Multidimensional Quality of Life (IMQOL) model. This model also provides a means to describe and rank potential outcomes from the same individualized perspective. Feasibility is explored by empirical evaluation of sixteen interviews of dialysis patients with the IMQOL protocol and applying the resulting model to the patient's own health as well as four other states of health common in dialysis therapy. Comparison is made to results of quality of life assessment with standard gamble and time tradeoff methods in the same patients for the same described outcomes. Qualitative responses from patients regarding their confidence in the representation of their values are rewarding. Results are quantitatively comparable to traditional utility assessment. A prototypic computer program is used to substantiate the programmability and potential for automation. The protocol expands the information contributing to understanding by both the health care provider and the patient. Future evaluation and extension are discussed.by Duane A. Steward.Ph.D

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action

Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or “golden rules,” for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice

Using Expert Systems for Simulation Modeling of Patient Scheduling

Modeling the scheduling of patient appointments is an important issue in simulating a health care delivery facility. A simulation model must include the control logic of appointment scheduling software and the explicit and implicit decision rules used by the human scheduler in selecting an appointment time. Expert systems provide one way of modeling such control logic and decision rules. We describe a structure for an expert system that models patient appointment scheduling and the integration of such an expert system within a simulation model. An example expert system for a small animal veterinary clinic is presented

Utility Assessment Based on Individualized Patient Perspectives

A novel approach to utility assessment is presented which enables the elicitation of an individualized understanding of the patients' perspective. The result illuminates what dimensions of health are regarded as important in the patient's own terms. This approach is in contrast to traditional utility assessment, which is conducted in prescribed terms, is difficult to apply with confidence on an individual basis and solicits a nonreusable single value for a specific outcome of a decision context. This paper discusses a method which attempts to elicit a complete, comprehensive and operational system of attribute scales to describe the relevant attributes of health in an individual's personal perspective. The result is a personalized model that can be used to score any health in those terms with re-usable components. Piloting investigations with this fundamental approach reveal potential as a foundation for simple or complex multiattribute modeling and as promising with r..

The Role Of Simulation And Modeling In Disaster Management

The threat of pandemic disaster has motivated many collaborative exercises for the purpose of preparation and evaluation. The nature of these exercises depends upon the status of pre-existing expectations for system behavior and the aims of the exercise stakeholders. The contents of this article argue that these exercises may be developed using the same approach as simulation modeling to advantage. Four levels of maturity are outlined as a guide to understanding reasonable expectations for such activity. © 2007 Springer Science+Business Media, LLC

A Method For Understanding Some Consequences Of Bringing Patient-Generated Data Into Health Care Delivery

Objective. The consequences of personal health record (PHR) phenomena on the health care system are poorly understood. This research measures one aspect of the phenomena-the time-cost impact of patient-generated data (PGD) using discrete event model (DEM) simulation. Background/Significance. Little has been written about the temporal and cognitive burden associated with new workflows that include PGD. This pilot study reports the results for time-cost and resource utilization of a typical ambulatory clinic under varying conditions of PGD burden. Methods. PGD effects are modeled with DEM simulation reflecting the sequential relationships, temporal coupling, and impact assumptions within a virtual clinic. Three simulation scenarios of ever-increasing PGD impact are compared to a baseline case of no PGD use. Results. Introduction of PGD resulted in expected increases in cost and resource utilization along with a few key exceptions and unanticipated consequences. Direct and indirect impacts were observed with notable nonlinear, nonadditive, disproportionate, heterogeneous aspects and interactions among consequent labor cost, visit length, workday length, and resource utilization. The middle-impact simulations showed a 29% increase in daily labor costs and 28% shrinkage of the margin between revenues and labor costs. Lengths of both workday and patient visit were extended and less predictable with PGD use. Utilization rates of most staff positions rose. Nurse utilization rates showed greatest increases. Physicians\u27 utilization rates paradoxically stayed relatively unchanged. Conclusion. This analysis contributes to an understanding of the effects of PGD on time and cognitive burdens of physicians, staff, and physical resources. It illustrates the usefulness of DEM simulation for the purpose. Avoidable consequences are exposed quantifiably for both the patient and the clinic. More realistic ways to respond to PGD impact are needed