PHP143 Exploratory Test of Stakeholder Theory in the Implementation Process of It-Innovations in Hospital Care

Objectives The main hypothesis in this study is that stakeholders have different preferences concerning IT innovations in hospitals, and these preferences are caused by perceived cost/benefit ratios. This will translate in disagreement between stakeholders on which innovations to implement first, possibly explaining the slow diffusion of innovations in health care. Methods Analytic Hierarchy Process (AHP) was used to quantify stakeholders positions in their priority of nine IT innovations. These innovations were selected after a systematic literature review and expert interviews. In the AHP, decision criteria related to costs and benefits of the innovations were defined: improvement in efficiency, health gains, satisfaction with care process, and required investments. Stakeholders judged the importance of the decision criteria and prioritized the selected IT innovations according to their expectations of how well the innovations would perform on these decision criteria. Results Sixty-two respondents, including patients, nurses, physicians, managers, health care insurers and policy makers showed significant differences in their expectations about their respective costs and benefits of the innovations, resulting in diverging preferences for the health care innovations. For instance, self tests are one of the most preferred innovations by health care insurers and managers, due to its expected positive impacts on efficiency and health gains. However, physicians, nurses and patients strongly doubt the health gains of self tests, and accordingly rank self tests as the least preferred innovation. Conclusions We found clear differences in expectations of different stakeholder groups on IT innovations. The differences can be understood from the perspective of costs and benefits per stakeholder for each innovation. This study gives a first quantitative insight in stakeholder differences and presents a novel way to study stakeholder differences. The results may be used by decision makers to include alignment of stakeholder positions in implementation processes

PP1 - A systematic review of the analytic hierarchy process in health care decision making

OBJECTIVES:\ud The analytic hierarchy process (AHP), a technique for multi-criteria decision analysis, is increasingly being used to support health care decision making. These decisions mainly relate to the application and coverage of health care technologies, and its use as a patient-reported outcome measure. The objective of this study is to review the use of this upcoming technique in health care; the Analytic Hierarchy Process.\ud \ud METHODS:\ud We conducted a systematic review of the relevant medical, health-economical, psycho-sociological, managerial, and applied mathematical literature. We used the keywords “Analytic Hierarchy Process” AND (“patient” OR “patients” OR “health” OR “health care” OR “medical” OR “clinical” OR “hospital”) to search in the general topic of the articles within in the databases PubMed and Web of Science. RESULTS: We found 57 distinctive AHP applications in health care. Of the retrieved applications, 13 % focus on shared decision-making between patient and clinician, 25 % on the development of clinical practice guidelines, 5 % on the development of medical devices and pharmaceuticals, 44 % on management decisions in health care organizations, and 13 % on the development of national health care policy.\ud \ud CONCLUSIONS:\ud From the review it is concluded that the AHP is frequently used and provides valuable support in complex health care decisions. The AHP is suitable to apply in case of complex health care decision problems, a need to improve decision making instead of explain decision outcomes, a need to share information among experts or between clinicians and patients, and in case of a limited availability of informed respondents. We also foresee the use of the AHP in conducting comprehensive Health Technology Assessments involving multiple stakeholders. Only for these specific types of decision problems, we recommend the use of the AHP

Comparison of trace metal bioavailabilities in European coastal waters using mussels from Mytilus edulis

Mussels from Mytilus edulis complex were used as biomonitors of the trace metals Fe, Mn, Pb, Zn, and Cu at 17 sampling sites to assess the relative bioavailability of metals in coastal waters around the European continent. Because accumulated metal concentrations in a given area can differ temporally, data were corrected for the effect of season before large-scale spatial comparisons were made. The highest concentration of Fe was noted in the North Sea and of Mn in the Baltic. Increased tissue concentrations of Pb were recorded in the mussels from the Bay of Biscay and the Baltic Sea. Low concentrations of metals were determined in the mussels from the Mediterranean Sea and the Northern Baltic. Relatively low geographic variations of Cu and Zn indicate that mussels are able to partially regulate accumulated body concentrations, which means Cu and Zn are, to some extent, independent of environmental concentrations

Assessment of the added value of the Twente Photoacoustic Mammoscope in breast cancer diagnosis\ud

Purpose: Photoacoustic (PA) imaging is a recently developed breast cancer imaging technique. In order to enhance successful clinical implementation, we quantified the potential clinical value of different scenarios incorporating PA imaging by means of multi-criteria analysis. From this analysis, the most promising area of application for PA imaging in breast cancer diagnosis is determined, and recommendations are provided to optimize the design of PA imaging. - \ud Methods: The added value of PA imaging was assessed in two areas of application in the diagnostic track. These areas include PA imaging as an alternative to x-ray mammography and ultrasonography in early stage diagnosis, and PA imaging as an alternative to Magnetic Resonance Imaging (MRI) in later stage diagnosis. The added value of PA imaging was assessed with respect to four main criteria (costs, diagnostic performance, patient comfort and risks). An expert panel composed of medical, technical and management experts was asked to assess the relative importance of the criteria in comparing the alternative diagnostic devices. The judgments of the experts were quantified based on the validated pairwise comparison technique of the Analytic Hierarchy Process, a technique for multi-criteria analysis. Sensitivity analysis was applied to account for the uncertainty of the outcomes. - \ud Results: Among the considered alternatives, PA imaging is the preferred technique due to its non-invasiveness, low cost and low risks. However, the experts do not expect large differences in diagnostic performance. The outcomes suggest that design changes to improve the diagnostic performance of PA imaging should focus on the quality of the reconstruction algorithm, detector sensitivity, detector bandwidth and the number of wavelengths used. - \ud Conclusion: The AHP method was useful in recommending the most promising area of application in the diagnostic track for which PA imaging can be implemented, this being early diagnosis, as a substitute for the combined use of x-ray mammography and ultrasonography

Using the analytic hierarchy process to support teams in defining new product objectives

Defining new product objectives is a critical problem solving activity to new product success. The analytic hierarchy process appears to be an adequate technique for multi-criteria decision analysis to support the definition of new product objectives. To illustrate this support, we applied this technique to a project focused on the development of a liver perfusion system to preserve donor livers. It quantitatively supported discussions between technological developers and clinical practitioners focused on the product requirements and the pursued performance of the liver perfusion system relative to an envisaged competitor. The discussions significantly reduced disagreements about the new product objectives between the group members. They resulted in a quantitative overview of the importance of the product requirements and the relative performance of the alternatives with regard to these requirements. Furthermore, research activities necessary to fulfil these objectives were discerned. The group members were committed to these outcomes. This application shows the value of introducing the AHP as a means to steer new products to solve problems to a higher extent than competing products do

PHP47 - Early assessment of highly innovative medical technology: clinical and economical gains of point-of-care applications for measuring potassium concentrations

OBJECTIVES:\ud Innovative point-of-care diagnostics are likely to be having a strong impact on health care. The aim of this study is to conduct an early assessment of point-of-care chips. These chips can detect many particles and, consequently, many product-market combinations can be developed. This study investigates the impact of potential point-of-care applications in health care and to quantify the impact in terms of their likely cost-effectiveness.\ud \ud METHODS:\ud The Analytic Hierarchy Process (AHP); a technique for multi-criteria analysis, and Markov modeling were applied in this early assessment. The AHP was used to prioritize six potentially attractive product-market combinations (PCM’s). For estimating the future cost-effectiveness of the most attractive PMC’s, Markov health state transition models were developed. Two Markov models were constructed; models for a potassium chip for both stage 5 CKD patients as well as heart failure (HF) patients which suffer from edemas.\ud \ud RESULTS:\ud AHP identified clinical gain as being the most important criterion to assess the attractiveness of a PMC, followed by market potential, attitude of professionals, R&D barriers and implementation barriers. Regarding these criteria, a potassium-chip for Chronic Kidney Disease (CKD) and Heart Failure (HF) patients was calculated to be the most attractive alternative. Markov model cohort simulation yielded incremental cost-effectiveness ratios (ICERs). The point-of-care chip appeared not to be cost-effective for preventing hyperkalemia in stage 5 CKD patients. For HF patients suffering from edemas the chip was estimated to be cost-effective and could provide a valuable asset to current treatment.\ud \ud CONCLUSIONS:\ud The AHP is valuable in supporting the identification of potentially attractive product-market combinations. For the best combinations, Markov modeling can subsequently provide a more in-depth analysis of the future cost-effectiveness

Detached-Eddy Simulation of the Vortical Flowfield about the VFE-2 DeltaWing

The numerical simulation of the flow around a 65° delta wing configuration with rounded leading edges is presented. For the numerical simulation the Cobalt Code uses a cell-centered unstructured hybrid mesh approach. Several numerical results are presented for the steady RANS equations as well as for DES and DDES hybrid approaches. The simulations are done as part of the NATO RTO/AVT 113 working group focusing on experimental and numerical research on delta wing configurations with rounded leading edges. Within this paper the focus is related to the dual primary vortex flow topology, especially the sensitivity of the flow to angle of attack and Reynolds number effects. Reasonable results are obtained with both steady RANS and SA-DDES simulations. The results are compared and verified by experimental data, including surface pressure and pressure sensitive paint results. The impact of transition is assessed, and recommendations for improving future simulations are made

On the identity of broad-shelled mussels (Mollusca, Bivalvia, Mytilus) from the Dutch delta region

Late Quaternary (Eemian) deposits of the Netherlands contain shells that resemble those of living Mytilus galloprovincialis. Similar broad-shelled mytilids also occur in estuaries of the southwestern Netherlands together with slender individuals typical of M. edulis. We sampled living mussels along a depth gradient in the Oosterschelde to a) investigate whether a relation exists between shell shape and depth, b) test if the broadshelled specimens might represent M. galloprovincialis (or a hybrid with M. edulis) and c) assess by inference if the Quaternary specimens might be attributed to M. galloprovincialis as well. In order to do so, we compared genetic (length polymorphism of Me 15/16, COIII sequences and AFLPs) and shellmorphological characteristics (juvenile L/W ratios and socalled Verduin parameters) of the same specimens. The obtained dataset indicates that all studied mussels from the Oosterschelde should be attributed to M. edulis, including those with broad shell outlines. No correlation of shell-morphology and depth-distribution was found. The worn and generally damaged state of the Eemian specimens precluded measurement of the Verduin parameters, while juvenile L/W ratios turned out not to be diagnostic. Therefore the shell characters examined in this study are insufficient to demonstrate the possible presence of M. galloprovincialis shells in Quaternary deposits of the Netherlands.

A Review and Classification of Approaches for Dealing with Uncertainty in Multi-Criteria Decision Analysis for Healthcare Decisions

Multi-criteria decision analysis (MCDA) is increasingly used to support decisions in healthcare involving multiple and conflicting criteria. Although uncertainty is usually carefully addressed in health economic evaluations, whether and how the different sources of uncertainty are dealt with and with what methods in MCDA is less known. The objective of this study is to review how uncertainty can be explicitly taken into account in MCDA and to discuss which approach may be appropriate for healthcare decision makers. A literature review was conducted in the Scopus and PubMed databases. Two reviewers independently categorized studies according to research areas, the type of MCDA used, and the approach used to quantify uncertainty. Selected full text articles were read for methodological details. The search strategy identified 569 studies. The five approaches most identified were fuzzy set theory (45 % of studies), probabilistic sensitivity analysis (15 %), deterministic sensitivity analysis (31 %), Bayesian framework (6 %), and grey theory (3 %). A large number of papers considered the analytic hierarchy process in combination with fuzzy set theory (31 %). Only 3 % of studies were published in healthcare-related journals. In conclusion, our review identified five different approaches to take uncertainty into account in MCDA. The deterministic approach is most likely sufficient for most healthcare policy decisions because of its low complexity and straightforward implementation. However, more complex approaches may be needed when multiple sources of uncertainty must be considered simultaneousl

PMD80 Preferences for a New Imaging Technique to Detect Breast Cancer

Objectives Currently, new techniques for the detection of breast cancer are being developed that cause less patient discomfort than X-ray mammography. These techniques might increase screening attendance, and therefore increase the health gains of the population of women in the Netherlands. One of these techniques is photo acoustic mammography (PAM). However, it is still unknown how important attributes such as discomfort, risks and health gains are to its implementation in breast cancer screening. Methods The Analytic Hierarchy Process (AHP), a technique for multi-criteria analysis, was used to estimate patient and health care professionals' preferences for three scenarios of PAM. These scenarios differed in the diagnostic performance that could be achieved by PAM. Preferences for the scenarios of PAM were compared with the preferences for X-ray mammography. Criteria related to the efficiency in applying the technique, diagnostic performance, patient comfort and safety. We elicited preferences of around 30 health care professionals and 300 patients. Results Health care professionals considered the sensitivity of the imaging technique to be the criterion of utmost importance in the selection of a new imaging technique to detect breast cancer. Advantages of less discomfort have relatively less meaning according to the laboratory workers and radiologists involved. However, preferences among patients and health care providers differed. Conclusions New techniques to detect breast cancer in screening programs should at least equal the diagnostic performance of X-ray mammography. Additional advantages could slightly increase screening attendance. X-ray mammography has a relatively lower diagnostic performance for patients with dense breasts. This subpopulation of patients could be the most promising area for new detection techniques with a working principle that differs from X-ray mammograph