69 research outputs found
Exploring Different Assumptions about Outcome-Related Risk Perceptions in Discrete Choice Experiments
Environmental outcomes are often affected by the stochastic nature of the environment and ecosystem, as well as the effectiveness of governmental policy in combination with human activities. Incorporating information about risk in discrete choice experiments has been suggested to enhance survey credibility. Although some studies have incorporated risk in the design and treated it as either the weights of the corresponding environmental outcomes or as a stand-alone factor, little research has discussed the implications of those behavioural assumptions under risk and explored individualsâ outcome-related risk perceptions in a context where environmental outcomes can be either described as improvement or deterioration. This paper investigates outcome-related risk perceptions for environmental outcomes in the gain and loss domains together and examines differences in choices about air quality changes in China using a discrete choice experiment. Results suggest that respondents consider the information of risk in both domains, and their elicited behavioural patterns are best described by direct risk aversion, which states that individuals obtain disutility directly from the increasing risk regardless of the associated environmental outcomes. We discuss the implication of our results and provide recommendations on the choice of model specification when incorporating risk
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Cigarette packaging, warnings, prices, and contraband: A discrete choice experiment among smokers in Ontario, Canada
In Canada, despite substantial decline, tobacco use remains the leading risk factor responsible for mortality and morbidity. There is overwhelming evidence that higher tobacco taxes reduce tobacco use, even if high taxes create an incentive to avoid or evade tobacco taxes. Recently, in addition to taxes, plain and standardized packaging and printing a warning on each cigarette have been lauded to reduce tobacco use. In November 2019, Canada became the country with the most comprehensive cigarette packaging regulations; and in June 2022, Canada proposed to print health warnings on individual cigarettes, the first jurisdiction to ever do so. The regulations came into force on August 1, 2023, and are being implemented through a stepwise approach. Our objective was to examine the effects of plain and standardized packaging, warning on cigarettes, price, and the availability of illicit cigarettes on intention to purchase and risk perceptions. We conducted a discrete choice experiment, and examined heterogeneity in preferences using latent class models among smokers in Ontario, Canada. We found that using latent class analyses was essential in quantifying preferences for attributes of cigarettes and cigarette packs. First, nearly half of smokers stated a preference for cheaper illicit cigarettes in a branded pack without any health warnings, regardless of the licit cigarette alternatives. For about 20% of respondents, plain packaging and especially warning on cigarette sticks decreased the probability of stating a purchasing preference for these alternatives. Third, about a third of respondents chose competing alternatives with mostly one attribute in mind, price. Lastly, none of the products and attributes seem to have significantly influenced risk perception. Our findings attest to the importance of prices and taxes, to the potential of warnings on cigarette sticks to control tobacco use, and indicate that efforts to restrict the availability of illicit cigarettes may yield substantial benefits
Automated analysis of free-text comments and dashboard representations in patient experience surveys: a multimethod co-design study
BACKGROUND: Patient experience surveys (PESs) often include informative free-text comments, but with no
way of systematically, efficiently and usefully analysing and reporting these. The National Cancer Patient
Experience Survey (CPES), used to model the approach reported here, generates > 70,000 free-text
comments annually. MAIN AIM: To improve the use and usefulness of PES free-text comments in driving health service changes that improve the patient experience. SECONDARY AIMS: (1) To structure CPES free-text comments using rule-based information retrieval (IR) (âtext
engineeringâ), drawing on health-care domain-specific gazetteers of terms, with in-built transferability to
other surveys and conditions; (2) to display the results usefully for health-care professionals, in a digital toolkit
dashboard display that drills down to the original free text; (3) to explore the usefulness of interdisciplinary
mixed stakeholder co-design and consensus-forming approaches in technology development, ensuring that
outputs have meaning for all; and (4) to explore the usefulness of Normalisation Process Theory (NPT) in
structuring outputs for implementation and sustainability. DESIGN: A scoping review, rapid review and surveys with stakeholders in health care (patients, carers,
health-care providers, commissioners, policy-makers and charities) explored clinical dashboard design/patient
experience themes. The findings informed the rules for the draft rule-based IR [developed using half of the
2013 Wales CPES (WCPES) data set] and prototype toolkit dashboards summarising PES data. These were
refined following mixed stakeholder, concept-mapping workshops and interviews, which were structured to
enable consensus-forming âco-designâ work. IR validation used the second half of the WCPES, with comparison
against its manual analysis; transferability was tested using further health-care data sets. A discrete choice
experiment (DCE) explored which toolkit features were preferred by health-care professionals, with a simple
costâbenefit analysis. Structured walk-throughs with NHS managers in Wessex, London and Leeds explored
usability and general implementation into practice. KEY OUTCOMES: A taxonomy of ranked PES themes, a checklist of key features recommended for digital
clinical toolkits, rule-based IR validation and transferability scores, usability, and goal-oriented, costâbenefit
and marketability results. The secondary outputs were a survey, scoping and rapid review findings, and
concordance and discordance between stakeholders and methods. RESULTS: (1) The surveys, rapid review and workshops showed that stakeholders differed in their
understandings of the patient experience and priorities for change, but that they reached consensus on
a shortlist of 19 themes; six were considered to be core; (2) the scoping review and one survey explored
the clinical toolkit design, emphasising that such toolkits should be quick and easy to use, and embedded
in workflows; the workshop discussions, the DCE and the walk-throughs confirmed this and foregrounded
other features to form the toolkit design checklist; and (3) the rule-based IR, developed using noun and
verb phrases and lookup gazetteers, was 86% accurate on the WCPES, but needs modification to improve
this and to be accurate with other data sets. The DCE and the walk-through suggest that the toolkit would
be well accepted, with a favourable costâbenefit ratio, if implemented into practice with appropriate
infrastructure support. LIMITATIONS: Small participant numbers and sampling bias across component studies. The scoping review
studies mostly used top-down approaches and focused on professional dashboards. The rapid review of
themes had limited scope, with no second reviewer. The IR needs further refinement, especially for
transferability. New governance restrictions further limit immediate use. CONCLUSIONS: Using a multidisciplinary, mixed stakeholder, use of co-design, proof of concept was shown
for an automated display of patient experience free-text comments in a way that could drive health-care
improvements in real time. The approach is easily modified for transferable application. FUTURE WORK: Further exploration is needed of implementation into practice, transferable uses and
technology development co-design approaches. FUNDING: The National Institute for Health Research Health Services and Delivery Research programme
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Priority setting in the German healthcare system: results from a discrete choice experiment
Worldwide, social healthcare systems must face the challenges of a growing scarcity of resources and of its inevitable distributional effects. Explicit criteria are needed to define the boundaries of public reimbursement decisions. As Germany stands at the beginning of such a discussion, more formalised priority setting procedures seem in order. Recent research identified multi-criteria decision analysis (MCDA) as a promising approach to inform and to guide decision-making in healthcare systems. In that regard, this paper aims to analyse the relative weight assigned to various criteria in setting priority interventions in Germany. A discrete choice experiment (DCE) was employed in 2015 to elicit equity and efficiency preferences of 263 decision makers, through six attributes. The experiment allowed us to rate different policy interventions based on their features in a composite league table (CLT). As number of potential beneficiaries, severity of disease, individual health benefits and cost-effectiveness are the most relevant criteria for German decision makers within the sample population, the results display an overall higher preference towards efficiency criteria. Specific high priority interventions are mental disorders and cardiovascular diseases
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Discrete choice experiment exploring women's preferences in a novel device designed to monitor the womb environment and improve our understanding of reproductive disorders
Objectives: The study aims to determine the relative importance of key attributes of a novel intrauterine device. The device monitors uterine oxygen, pH and temperature in real time with the aim of improving our understanding and treatment of reproductive disorders.
Design: A discrete choice experiment was used to elicit preferences in this novel investigative tool. The attributes and levels used in the choice scenarios were length of time using the device (7, 14 or 28 days), information obtained to guide treatment (limited, majority or all cases), risk of complications (1% or 10%) and discreteness (completely discrete, moderately discrete or indiscrete).
Setting: Secondary care hospital in Hampshire, UK.
Participants: 361 women of reproductive age.
Primary and secondary outcome measures: Conditional logit and latent class logit regression models to determine the preference for each attribute.
Results: Conditional logit coefficients allow comparison between attributes; women placed most importance on obtaining information to guide treatment in all cases (2.771), followed by having a completely discrete device (1.104), reducing risk of complications by 1% (0.184) and decreased length of time by 1 day (0.0150). All coefficients p<0.01. Latent class conditional logit assigns participants to two classes with 27.4% in class 1 who are less likely to have higher education or qualify for National Health Service-funded in vitro fertilisation compared with class 2. Those in class 2 placed 1.7 times more importance on a device whose information guided treatment in all cases and a 1% decrease in complications risk was nearly 15 times more attractive.
Conclusions: Women placed most importance on having a device that obtains information to guide treatment and are willing to use the device for a longer, have a device with higher risk of complications and an indiscrete device if it is able to provide answers and direction for treatment of their reproductive disorder
Patient preferences and willingness-to-pay for a home or clinic based program of chronic heart failure management: findings from the which? trial
BACKGROUND Beyond examining their overall cost-effectiveness and mechanisms of effect, it is important to understand patient preferences for the delivery of different modes of chronic heart failure management programs (CHF-MPs). We elicited patient preferences around the characteristics and willingness-to-pay (WTP) for a clinic or home-based CHF-MP. METHODOLOGY/PRINCIPAL FINDINGS A Discrete Choice Experiment was completed by a sub-set of patients (n = 91) enrolled in the WHICH? trial comparing home versus clinic-based CHF-MP. Participants provided 5 choices between hypothetical clinic and home-based programs varying by frequency of nurse consultations, nurse continuity, patient costs, and availability of telephone or education support. Participants (aged 71±13 yrs, 72.5% male, 25.3% NYHA class III/IV) displayed two distinct preference classes. A latent class model of the choice data indicated 56% of participants preferred clinic delivery, access to group CHF education classes, and lower cost programs (p<0.05). The remainder preferred home-based CHF-MPs, monthly rather than weekly visits, and access to a phone advice service (p<0.05). Continuity of nurse contact was consistently important. No significant association was observed between program preference and participant allocation in the parent trial. WTP was estimated from the model and a dichotomous bidding technique. For those preferring clinic, estimated WTP was âAU15-105). CONCLUSIONS/SIGNIFICANCE Patient preferences for CHF-MPs were dichotomised between a home-based model which is more likely to suit older patients, those who live alone, and those with a lower household income; and a clinic-based model which is more likely to suit those who are more socially active and wealthier. To optimise the delivery of CHF-MPs, health care services should consider their patientsâ preferences when designing CHF-MPs.Jennifer A. Whitty, Simon Stewart, Melinda J. Carrington, Alicia Calderone, Thomas Marwick, John D. Horowitz, Henry Krum, Patricia M. Davidson, Peter S. Macdonald, Christopher Reid, Paul A. Scuffha
Exploring the feasibility of Conjoint Analysis as a tool for prioritizing innovations for implementation
Background: In an era of scarce and competing priorities for implementation, choosing what to implement is a key decision point for many behavioural change projects. The values and attitudes of the professionals and managers involved inevitably impact the priority attached to decision options. Reliably capturing such values is challenging. Methods: This paper presents an approach for capturing and incorporating professional values into the prioritization of healthcare innovations being considered for adoption. Conjoint Analysis (CA) was used in a single UK Primary Care Trust to measure the priorities of healthcare professionals working with women with postnatal depression. Rating-based CA data was gathered using a questionnaire and then mapped onto 12 interventions being considered as a means of improving the management of postnatal depression. Results: The âimpact on patient careâ and the âquality of supporting evidenceâ associated with the potential innovations were the most influential in shaping priorities. Professionals were least influenced by whether an innovation was an existing national or local priority, or whether current practice in the Trust was meeting minimum standards. Ranking the 12 innovations by the preferences of potential adopters revealed âguided self helpâ was the top priority for implementation and âscreening questions for post natal depressionâ the least. When other factors were considered (such as the presence of routine data or planned implementation activity elsewhere in the Trust), the project team chose to combine the eight related treatments and implement these as a single innovation referred to as âpsychological therapiesâ. Conclusions: Using Conjoint Analysis to prioritise potential innovation implementation options is a feasible means of capturing the utility of stakeholders and thus increasing the chances of an innovation being adopted. There are some practical barriers to overcome such as increasing response rates to conjoint surveys before routine and unevaluated use of this technique should be considered
Eliciting health state utilities for Dupuytren's contracture using a discrete choice experiment
Background and purpose An internet-based discrete choice
experiment (DCE) was conducted to elicit preferences for a wide
range of Dupuytrenâs contracture (DC)-related health states. An
algorithm was subsequently developed to convert these preferences
into health state utilities that can be used to assess DCâs
impact on quality of life and the value of its treatments.
Methods Health state preferences for varying levels of DC
hand severity were elicited via an internet survey from a sample
of the UK adult population. Severity levels were deined using a
combination of contractures (0, 45, or 90 degrees) in 8 proximal
interphalangeal and metacarpophalangeal joints of the index,
middle, ring, and little ingers. Right-handed, left-handed, and
ambidextrous respondents indicated which hand was preferable
in each of the 10 randomly-selected hand-pairings comparing
different DC severity levels. For consistency across comparisons,
anatomically precise digital hand drawings were used. To anchor
preferences onto the traditional 0â1 utility scale used in health
economic evaluations, unaffected hands were assigned a utility
of 1.0 whereas the utility for a maximally affected hand (i.e., all
8 joints set at 90 degrees of contracture) was derived by asking
respondents to indicate what combination of attributes and levels
of the EQ-5D-5L proile most accurately relects the impact of
living with such hand. Conditional logistic models were used to
estimate indirect utilities, then rescaled to the anchor points on
the EQ-5D-5L.
Results Estimated utilities based on the responses of 1,745
qualiied respondents were 0.49, 0.57, and 0.63 for completely
affected dominant hands, non-dominant hands, or ambidextrous
hands, respectively. Utility for a dominant hand with 90-degree
contracture in t h e metacarpophalangeal joints of the ring and
little ingers was estimated to be 0.89. Separately, reducing the
contracture of metacarpophalangeal joint for a little inger from
50 to 12 degrees would improve utility by 0.02.
Interpretation DC is associated with substantial utility decrements.
The algorithms presented herein provide a robust and lexible
framework to assess utility for varying degrees of DC severity
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Powered Respirators Are Effective, Sustainable, and Cost-Effective Personal Protective Equipment for SARS-CoV-2
Objectives: The provision of high-quality personal protective equipment (PPE) has been a critical challenge during the COVID-19 pandemic. We evaluated an alternative strategy, mass deployment of a powered air-purifying respirator (PeRSo), in a large university hospital.
Methods: We performed prospective user feedback via questionnaires sent to healthcare workers (HCWs) issued PeRSos, economic analysis, and evaluated the real-world impact.
Results: Where paired responses were available, PeRSo was preferred over droplet precautions for comfort, patient response, overall experience, and subjective feeling of safety. For all responses, more participants reported the overall experience being rated âVery goodâ more frequently for PeRSo. The primary limitation identified was impairment of hearing. Economic simulation exercises revealed that the adoption of PeRSo within ICUis associated with net cost savings in the majority of scenarios and savings increased progressively with greater ITU occupancy. In evaluation during the second UK wave, over 3,600 respirators were deployed, all requested by staff, which were associated with a low staff absence relative to most comparator hospitals.
Conclusions: Health services should consider a widespread implementation of powered reusable respirators as a safe and sustainable solution for the protection of HCWsas SARS-CoV-2 becomes an endemic viral illness
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