Artificial Intelligence and Patient-Centered Decision-Making

Advanced AI systems are rapidly making their way into medical research and practice, and, arguably, it is only a matter of time before they will surpass human practitioners in terms of accuracy, reliability, and knowledge. If this is true, practitioners will have a prima facie epistemic and professional obligation to align their medical verdicts with those of advanced AI systems. However, in light of their complexity, these AI systems will often function as black boxes: the details of their contents, calculations, and procedures cannot be meaningfully understood by human practitioners. When AI systems reach this level of complexity, we can also speak of black-box medicine. In this paper, we want to argue that black-box medicine conflicts with core ideals of patient-centered medicine. In particular, we claim, black-box medicine is not conducive for supporting informed decision-making based on shared information, shared deliberation, and shared mind between practitioner and patient

Segregation and the Black-White Test Score Gap

The mid-1980s witnessed breaks in two important trends related to race and schooling. School segregation, which had been declining, began a period of relative stasis. Black-white test score gaps, which had also been declining, also stagnated. The notion that these two phenomena may be related is also supported by basic cross-sectional evidence. We review existing literature on the relationship between neighborhood- and school-level segregation and the test score gap. Several recent studies point to a statistically significant causal relationship between school segregation and the test score gap, though in many cases the magnitude of the relationship is small in economic terms. Experimental studies, as well as methodologically convincing non-experimental studies, suggest that there is little if any causal role for neighborhood segregation operating through a mechanism other than school segregation.

False Consensus Voting and Welfare Reducing Polls

We consider a process of costly majority voting where people anticipate that others have similar preferences. This perceived consensus of opinion is the outcome of a fully rational Bayesian updating process where individuals consider their own tastes as draws from a population. We show that the correlation in preferences lowers expected turnout. The intuition is that votes have a positive externality on those who don’t participate, which reduces incentives to participate. We study the effects of the public release of information (“polls”) on participation levels. We find that polls raise expected turnout but reduce expected welfare because they stimulate the “wrong” group to participate. As a result, polls frequently predict the wrong outcome. While this lack of prediction power is usually attributed to an imperfect polling technology, we show it may result from the reaction of rational voters to the poll’s accurate information.Majority Voting; Correlated Preferences; False Consensus; Pre-election Polls

Toward more realistic analytic models of the heliotail: Incorporating magnetic flattening via distortion flows

Both physical arguments and simulations of the global heliosphere indicate that the tailward heliopause is flattened considerably in the direction perpendicular to both the incoming flow and the large-scale interstellar magnetic field. Despite this fact, all of the existing global analytical models of the outer heliosheath's magnetic field assume a circular cross section of the heliotail. To eliminate this inconsistency, we introduce a mathematical procedure by which any analytically or numerically given magnetic field can be deformed in such a way that the cross sections along the heliotail axis attain freely prescribed, spatially dependent values for their total area and aspect ratio. The distorting transformation of this method honors both the solenoidality condition and the stationary induction equation with respect to an accompanying flow field, provided that both constraints were already satisfied for the original magnetic and flow fields prior to the transformation. In order to obtain realistic values for the above parameters, we present the first quantitative analysis of the heliotail's overall distortion as seen in state-of-the-art three-dimensional hybrid MHD-kinetic simulations.Comment: 15 pages, 8 figures. Published in The Astrophysical Journa

Testing the Effect of a Short Cheap Talk Script in Choice Experiments

The application of stated preference methods rests on the assumption that respondents act rationally and that their demand for the non-market good on the hypothetical market is equal to what their real demand would be. Previous studies have shown that this is not the case and this gap is known as hypothetical bias. The present paper attempts to frame the description of the hypothetical market so as to induce more “true market behaviour” in the respondents by including a short Cheap Talk script. The script informs respondents that in similar studies using stated preference methods, people have a tendency to overestimate how much they are willing to pay compared to their actual (true) willingness to pay. Applying a two-split sample approach to a Choice Experiment study focusing on preferences for reducing visual disamenities from offshore wind farms, the Cheap Talk script is found to be a preference mover, but does not affect preferences significantly. Significant effects are found when relating the effect of the Cheap Talk script to the cost levels of the alternatives, in that female respondents are found to choose higher cost alternatives less frequently when presented with the Cheap Talk script, while male respondents are not affected.Cheap Talk, Stated Preferences, Choice Experiment, Hypothetical Bias, Gender

How can health care organizations create value? : business model explorations

Background: The Triple Aim posits that health care should strive to improve patient experience, improve population health, and maintain or lower costs. However, most organizations are not organized to achieve the Triple Aim. Attempts to improve the ability of health care organizations to deliver increased value through the introduction of management concepts, most recently Value-based Health Care (VBHC), have led to the emergence of a pattern of pseudoinnovation, where concepts are frequently replaced with similar content, but in new “packaging”. This suggests that organizations and their ability to adapt to their environment and integrate new management concepts could potentially be explored by looking at how the concepts themselves are understood and at how organizations deliver care. In management terms, the latter can be described as the business model (i.e., how an organization creates, delivers, and captures value). Aim: The overall aim of this thesis is to understand how management concepts about value are understood and to explore how health care organizations in a publicly financed health care system are organized so that they create, deliver, and capture value. Methodology: In Study I, citation registry data and literature were sequentially analyzed qualitatively and quantitatively to assess diffusion and understanding of VBHC as a nascent management concept in the literature. Study II, a systematic review, employed an explanatory synthesis approach to understand how business model frameworks have been applied in health care. Studies III and IV apply the Business Model Canvas (BMC) framework in a deductive content analysis of interviews with top managers (Study III) and with multiple data sources (Study IV) to conceptualize a hospital business model and to compare perinatal clinics’ business models in a publicly financed, Swedish health care setting. Findings: VBHC and business model frameworks are commonly and increasingly used to improve value in health care. VBHC is superficially understood in the literature (Study I). Business model frameworks are primarily applied in e-health. They include a broad range of elements and have been used to identify essential elements, assess finances, and classify, analyze, develop, and evaluate organizations (Study II). Managers conceptualized the hospital business model differently, primarily related to customer segments. A tension between espoused and de facto value propositions was identified (Study III). Four distinct perinatal business models were identified within the same regional health system (New Thinkers, a Local Service Provider, Continuous Capacity Keepers, and a Hybrid) (Study IV). Conclusions: The superficial understanding of VBHC and the ambiguity and lack of empirical data in business model applications risk diluting the potential benefits of both these management approaches. The multiple, co-existing business models within the same organization or health care system raise questions about how organizations are aligned and how we should view the role of different stakeholders in creating, delivering, and capturing value