Eliciting taxpayer preferences increases tax compliance

Two experiments show that eliciting taxpayer preferences on government spending—providing taxpayer agency--increases tax compliance. We first create an income and taxation environment in a laboratory setting to test for compliance with a lab tax. Allowing a treatment group to express nonbinding preferences over tax spending priorities, leads to a 16% increase in tax compliance. A followup online study tests this treatment with a simulation of paying US federal taxes. Allowing taxpayers to signal their preferences on the distribution of government spending, results in a 15% reduction in the stated take-up rate of a questionable tax loophole. Providing taxpayer agency recouples tax payments with the public services obtained in return, reduces general anti-tax sentiment, and holds satisfaction with tax payment stable despite increased compliance with tax dues. With tax noncompliance costing the US government $385billion annually, providing taxpayer agency could have meaningful economic impact. At the same time, giving taxpayers a voice may act as a two-way "nudge," transforming tax payment from a passive experience to a channel of communication between taxpayers and government

Ultrasonic attenuation estimation of the pregnant cervix: a preliminary report

Estimates of ultrasonic attenuation (the loss of energy as an ultrasonic wave propagates through tissue) have been used to evaluate the structure and function of tissues in health and disease. The purpose of this research was to develop a method to estimate ultrasonic cervical attenuation during human pregnancy using a clinical ultrasound system. Forty women underwent a cervical scan once during pregnancy with the Zonare® z.one clinical ultrasound system using a 4–9-MHz endovaginal transducer. This ultrasound system provides access to radiofrequency (RF) image data for processing and analysis. In addition, a scan of a tissue-mimicking phantom with a known attenuation coefficient was acquired and used as a reference. The same settings and transducer used in the clinical scan were used in the reference scan. Digital data of the beam-formed image were saved in Digital Imaging and Communications in Medicine (DICOM) format on a flash drive and converted to RF data on a personal computer using a Matlab® program supplied by Zonare. Attenuation estimates were obtained using an algorithm that was independently validated using tissue-mimicking ultrasonic phantoms. RF data were acquired and analyzed to estimate attenuation of the human pregnant cervix. Regression analysis revealed that attenuation was: a predictor of the interval from ultrasound examination to delivery (β = 0.43, P = 0.01); not a predictor of gestational age at time of examination (β = − 0.23, P = 0.15); and not a predictor of cervical length (β = 0.077, P = 0.65). Ultrasonic attenuation estimates have the potential to be an early and objective non-invasive method to detect interval between examination and delivery. We hypothesize that a larger sample size and a longitudinal study design will be needed to detect gestational age-associated changes in cervical attenuation.This is a manuscript of an article from Ultrasound in Obstetrics & Gynecology 36 (2010): 218, doi:10.1002/uog.7643. Posted with permission.</p

Abstract 211: Subjective Judgments of Physicians and Nurses Are More Accurate Than Formal Clinical Scales in Predicting Functional Outcome After Intracerebral Hemorrhage

Introduction: Providing an accurate prognosis is a fundamental responsibility of care providers for patients with intracerebral hemorrhage (ICH). The ICH and FUNC Scores are common clinical scales designed to predict functional outcome and mortality for ICH patients. Hypothesis: The ICH Score and FUNC Score have superior accuracy, compared to the early clinical judgment of physicians and nurses, with regards to the prediction of the Modified Rankin Scale (mRS) achieved by ICH patients at 3 months. Methods: We conducted a prospective study at 5 centers. For each consecutive adult patient admitted with primary ICH, one physician and one nurse on the treatment team were asked for prediction of mRS at 3 months. All predictions were collected within 24 hours of admission. ICH and FUNC Scores on admission and blinded outcome at 3 months were obtained for each patient, in part using data collected for the ongoing Ethnic/Racial Variations with ICH (ERICH) project. Predictive ability was measured by Spearman’s rank correlation (r). Results: For a total of 100 patients, 100 physicians (75 attendings, 25 trainees) and 100 nurses gave predictions. In order of strength of association with actual 3-month mRS, correlations were attending physicians r = 0.81, nurses r = 0.72, and trainees r = 0.66. Although suggestive, none of these groups were statistically superior (p > 0.10). However, nurses (p = 0.015) and attending physicians (p = 0.002), but not trainees (p = 0.57), were superior in their predictive ability over ICH Score (r = 0.55). Similarly, nurses (p = 0.0003) and attending physicians (p < 0.0001), but not trainees (p = 0.27), were superior over FUNC Score (r = -0.46). This accuracy advantage remained when examining predictions for (1) only those patients alive at 3 months (n = 65), and (2) only those patients for whom providers indicated that they would not recommend comfort care within the first 24 hours (n = 82). Conclusions: The ICH Score and FUNC Score did not have superior accuracy, compared to subjective clinical judgment, with regards to prediction of 3-month ICH outcome

Abstract W P126: Accurate Outcome Predictions for Intracerebral Hemorrhage Patients Are More Likely Than Inaccurate Predictions to Be Influenced by Co-morbidities Not Included in Clinical Scales

Introduction: Clinical scales for intracerebral hemorrhage (ICH), such as the ICH and FUNC Scores, utilize a limited number of variables for outcome prediction. The variables that physicians incorporate into subjective predictions of ICH outcome and how they relate to predictive accuracy are unknown. Hypothesis: Accurate physician predictions of functional outcome for ICH patients are more likely than inaccurate predictions to incorporate decision-making factors outside of the variables comprising the ICH and FUNC Scores. Methods: For each consecutive adult patient admitted with primary ICH at 5 centers, one physician on the treatment team was surveyed for a prediction of modified Rankin Scale (mRS) at 3 months. All predictions were prospectively collected within 24 hours of admission. Physicians were also asked to indicate up to 10 factors influencing their prediction. Accuracy was defined as an exact prediction of the mRS obtained for each patient at 3 months. The frequency of recurring factors listed by physicians were calculated for both the accurate and inaccurate predictions and compared using Fisher’s exact test. Results: We collected 38 accurate and 86 inaccurate predictions for 124 ICH patients. There was no difference between groups with regards to the proportion of respondents listing age, ICH volume, or general clinical exam on admission as factors. However, 16 (42.1%) of the accurate surveys listed the patient’s general co-morbidities as a factor in prediction, compared to 20 (23.3%) of inaccurate surveys (p = 0.05). Listing of pre-morbid functional status as a factor also trended towards a higher percentage in the accurate survey group (n = 7, 18.4%, versus n = 6, 7.0%; p = 0.11). Of note, all surveys that cited the etiology of the bleed (n = 5), the initial blood pressure (n= 4), and the presence or absence of an extraventricular drain (n = 7) as influencing factors contained either overly optimistic or pessimistic predictions. Conclusions: Accurate predictions of ICH outcome are more likely than inaccurate predictions to factor in general patient co-morbidities, which are not included in ICH or FUNC Score calculation

Factors Considered by Clinicians when Prognosticating Intracerebral Hemorrhage Outcomes

The early subjective clinical judgment of clinicians outperforms formal prognostic scales for accurate determination of outcome after intracerebral hemorrhage (ICH), with the judgment of physicians and nurses having equivalent accuracy. This study assessed specific decisional factors that physicians and nurses incorporate into early predictions of functional outcome. This prospective observational study enrolled 121 ICH patients at five US centers. Within 24 h of each patient's admission, one physician and one nurse on the clinical team were each surveyed to predict the patient's modified Rankin Scale (mRS) at 3 months and to list up to 10 subjective factors used in prognostication. Factors were coded and compared between (1) physician and nurse and (2) accurate and inaccurate surveys, with accuracy defined as an exact prediction of mRS. Aside from factors that are components of the ICH or FUNC scores, surveys reported pre-existing comorbidities (40.0%), other clinical or radiographic factors not in clinical scales (43.0%), and non-clinical/radiographic factors (21.9%) as important. Compared to physicians, nurses more frequently listed neurologic examination components (Glasgow Coma Scale motor, 27.3 vs. 5.8%, p < 0.0001; GCS verbal, 12.4 vs. 0.0%, p < 0.0001) and non-clinical/radiographic factors (31.4 vs. 12.4%, p = 0.0005). Physicians more frequently listed neuroimaging factors (ICH location, 33.9 vs. 7.4%, p < 0.0001; intraventricular hemorrhage, 13.2 vs. 2.5%, p = 0.003). There was no difference in listed factors between accurate versus inaccurate surveys. Clinicians frequently utilize factors outside of the components of clinical scales for prognostication, with physician and nurses focusing on different factors despite having similar accuracy