Download or read book Identifying Heterogeneity in Decision making written by Justin Lim and published by . This book was released on 2021 with total page 139 pages. Available in PDF, EPUB and Kindle. Book excerpt: Individuals often make different decisions when faced with the same problem. This variation arises naturally in decision-making processes due to differences in agent-specific factors, such as training, personal preference, and opinion. In many real-world scenarios, understanding where this variation occurs is critical to inform research and policy-making. For instance, in a clinical context, it is important to identify the types of patients on which the treatment they receive depends greatly on which doctor they visit. Identifying such regions of disagreement can reveal gaps in knowledge or opportunities where best practices can be clarified. In the medical context, it can directly assist the development of more comprehensive treatment guidelines, or suggest hypotheses to be tested in medical trials. In this thesis, we present algorithmic methods to identify heterogeneity in decision-making, by characterizing the regions of disagreement where variation can be attributed largely to the decision-maker. These methods range from approximate methods to exact solutions. We provide generalization bounds where possible and test each method's performance and computational efficiency using a comprehensive set of synthetic experiments. To demonstrate how these algorithms can be used to obtain insights in clinical decision-making, we present an extensive case study on decision-making for first-line diabetes patients, using an observational dataset from a large insurance provider. We identify subpopulations of patients where this first-line decision varies by provider, and evaluate the effect of this variation on downstream outcomes. Our algorithms are implemented in an easily-usable way and are available to the public.
Download or read book Developing a Protocol for Observational Comparative Effectiveness Research A User s Guide written by Agency for Health Care Research and Quality (U.S.) and published by Government Printing Office. This book was released on 2013-02-21 with total page 236 pages. Available in PDF, EPUB and Kindle. Book excerpt: This User’s Guide is a resource for investigators and stakeholders who develop and review observational comparative effectiveness research protocols. It explains how to (1) identify key considerations and best practices for research design; (2) build a protocol based on these standards and best practices; and (3) judge the adequacy and completeness of a protocol. Eleven chapters cover all aspects of research design, including: developing study objectives, defining and refining study questions, addressing the heterogeneity of treatment effect, characterizing exposure, selecting a comparator, defining and measuring outcomes, and identifying optimal data sources. Checklists of guidance and key considerations for protocols are provided at the end of each chapter. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews. More more information, please consult the Agency website: www.effectivehealthcare.ahrq.gov)
Download or read book Cochrane Handbook for Systematic Reviews of Interventions written by Julian P. T. Higgins and published by Wiley. This book was released on 2008-11-24 with total page 672 pages. Available in PDF, EPUB and Kindle. Book excerpt: Healthcare providers, consumers, researchers and policy makers are inundated with unmanageable amounts of information, including evidence from healthcare research. It has become impossible for all to have the time and resources to find, appraise and interpret this evidence and incorporate it into healthcare decisions. Cochrane Reviews respond to this challenge by identifying, appraising and synthesizing research-based evidence and presenting it in a standardized format, published in The Cochrane Library (www.thecochranelibrary.com). The Cochrane Handbook for Systematic Reviews of Interventions contains methodological guidance for the preparation and maintenance of Cochrane intervention reviews. Written in a clear and accessible format, it is the essential manual for all those preparing, maintaining and reading Cochrane reviews. Many of the principles and methods described here are appropriate for systematic reviews applied to other types of research and to systematic reviews of interventions undertaken by others. It is hoped therefore that this book will be invaluable to all those who want to understand the role of systematic reviews, critically appraise published reviews or perform reviews themselves.
Download or read book Comparative Effectiveness Review Methods written by U. S. Department of Health and Human Services and published by Createspace Independent Pub. This book was released on 2013-05-17 with total page 226 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Agency for Healthcare Research and Quality (AHRQ) commissioned the RTI International–University of North Carolina at Chapel Hill (RTI-UNC) Evidence-based Practice Center (EPC) to explore how systematic review groups have dealt with clinical heterogeneity and to seek out best practices for addressing clinical heterogeneity in systematic reviews (SRs) and comparative effectiveness reviews (CERs). Such best practices, to the extent they exist, may enable AHRQ's EPCs to address critiques from patients, clinicians, policymakers, and other proponents of health care about the extent to which “average” estimates of the benefits and harms of health care interventions apply to individual patients or to small groups of patients sharing similar characteristics. Such users of reviews often assert that EPC reviews typically focus on broad populations and, as a result, often lack information relevant to patient subgroups that are of particular concern to them. More important, even when EPCs evaluate literature on homogeneous groups, there may be varying individual treatment for no apparent reason, indicating that average treatment effect does not point to the best treatment for any given individual. Thus, the health care community is looking for better ways to develop information that may foster better medical care at a “personal” or “individual” level. To address our charge for this methods project, the EPC set out to answer six key questions (KQ). Key questions for methods report on clinical heterogeneity include: 1. What is clinical heterogeneity? a. How has it been defined by various groups? b. How is it distinct from statistical heterogeneity? c. How does it fit with other issues that have been addressed by the AHRQ Methods Manual for CERs? 2. How have systematic reviews dealt with clinical heterogeneity in the key questions? a. What questions have been asked? b. How have they pre-identified population subgroups with common clinical characteristics that modify their intervention-outcome association? c. What are best practices in key questions and how these subgroups have been identified? 3. How have systematic reviews dealt with clinical heterogeneity in the review process? a. What do guidance documents of various systematic review groups recommend? b. How have EPCs handled clinical heterogeneity in their reviews? c. What are best practices in searching for and interpreting results for particular subgroups with common clinical characteristics that may modify their intervention-outcome association? 4. What are critiques in how systematic reviews handle clinical heterogeneity? a. What are critiques from specific reviews (peer and public) on how EPCs handled clinical heterogeneity? b. What general critiques (in the literature) have been made against how systematic reviews handle clinical heterogeneity? 5. What evidence is there to support how to best address clinical heterogeneity in a systematic review? 6. What questions should an EPC work group on clinical heterogeneity address? Heterogeneity (of any type) in EPC reviews is important because its appearance suggests that included studies differed on one or more dimensions such as patient demographics, study designs, coexisting conditions, or other factors. EPCs then need to clarify for clinical and other audiences, collectively referred to as stakeholders, what are the potential causes of the heterogeneity in their results. This will allow the stakeholders to understand whether and to what degree they can apply this information to their own patients or constituents. Of greatest importance for this project was clinical heterogeneity, which we define as the variation in study population characteristics, coexisting conditions, cointerventions, and outcomes evaluated across studies included in an SR or CER that may influence or modify the magnitude of the intervention measure of effect (e.g., odds ratio, risk ratio, risk difference).
Download or read book Finding What Works in Health Care written by Institute of Medicine and published by National Academies Press. This book was released on 2011-07-20 with total page 267 pages. Available in PDF, EPUB and Kindle. Book excerpt: Healthcare decision makers in search of reliable information that compares health interventions increasingly turn to systematic reviews for the best summary of the evidence. Systematic reviews identify, select, assess, and synthesize the findings of similar but separate studies, and can help clarify what is known and not known about the potential benefits and harms of drugs, devices, and other healthcare services. Systematic reviews can be helpful for clinicians who want to integrate research findings into their daily practices, for patients to make well-informed choices about their own care, for professional medical societies and other organizations that develop clinical practice guidelines. Too often systematic reviews are of uncertain or poor quality. There are no universally accepted standards for developing systematic reviews leading to variability in how conflicts of interest and biases are handled, how evidence is appraised, and the overall scientific rigor of the process. In Finding What Works in Health Care the Institute of Medicine (IOM) recommends 21 standards for developing high-quality systematic reviews of comparative effectiveness research. The standards address the entire systematic review process from the initial steps of formulating the topic and building the review team to producing a detailed final report that synthesizes what the evidence shows and where knowledge gaps remain. Finding What Works in Health Care also proposes a framework for improving the quality of the science underpinning systematic reviews. This book will serve as a vital resource for both sponsors and producers of systematic reviews of comparative effectiveness research.
Download or read book Sharing Clinical Trial Data written by Institute of Medicine and published by National Academies Press. This book was released on 2015-04-20 with total page 236 pages. Available in PDF, EPUB and Kindle. Book excerpt: Data sharing can accelerate new discoveries by avoiding duplicative trials, stimulating new ideas for research, and enabling the maximal scientific knowledge and benefits to be gained from the efforts of clinical trial participants and investigators. At the same time, sharing clinical trial data presents risks, burdens, and challenges. These include the need to protect the privacy and honor the consent of clinical trial participants; safeguard the legitimate economic interests of sponsors; and guard against invalid secondary analyses, which could undermine trust in clinical trials or otherwise harm public health. Sharing Clinical Trial Data presents activities and strategies for the responsible sharing of clinical trial data. With the goal of increasing scientific knowledge to lead to better therapies for patients, this book identifies guiding principles and makes recommendations to maximize the benefits and minimize risks. This report offers guidance on the types of clinical trial data available at different points in the process, the points in the process at which each type of data should be shared, methods for sharing data, what groups should have access to data, and future knowledge and infrastructure needs. Responsible sharing of clinical trial data will allow other investigators to replicate published findings and carry out additional analyses, strengthen the evidence base for regulatory and clinical decisions, and increase the scientific knowledge gained from investments by the funders of clinical trials. The recommendations of Sharing Clinical Trial Data will be useful both now and well into the future as improved sharing of data leads to a stronger evidence base for treatment. This book will be of interest to stakeholders across the spectrum of research-from funders, to researchers, to journals, to physicians, and ultimately, to patients.
Download or read book Distributional Cost Effectiveness Analysis written by Richard Cookson and published by Handbooks in Health Economic Evaluation. This book was released on 2020-09-30 with total page 385 pages. Available in PDF, EPUB and Kindle. Book excerpt: Health inequalities blight lives, generate enormous costs, and exist everywhere. This book is the definitive all-in-one guide for anyone who wishes to learn about, commission, and use distributional cost-effectiveness analysis to promote both equity and efficiency in health and healthcare.
Download or read book Network Meta Analysis for Decision Making written by Sofia Dias and published by John Wiley & Sons. This book was released on 2018-03-19 with total page 484 pages. Available in PDF, EPUB and Kindle. Book excerpt: A practical guide to network meta-analysis with examples and code In the evaluation of healthcare, rigorous methods of quantitative assessment are necessary to establish which interventions are effective and cost-effective. Often a single study will not provide the answers and it is desirable to synthesise evidence from multiple sources, usually randomised controlled trials. This book takes an approach to evidence synthesis that is specifically intended for decision making when there are two or more treatment alternatives being evaluated, and assumes that the purpose of every synthesis is to answer the question "for this pre-identified population of patients, which treatment is 'best'?" A comprehensive, coherent framework for network meta-analysis (mixed treatment comparisons) is adopted and estimated using Bayesian Markov Chain Monte Carlo methods implemented in the freely available software WinBUGS. Each chapter contains worked examples, exercises, solutions and code that may be adapted by readers to apply to their own analyses. This book can be used as an introduction to evidence synthesis and network meta-analysis, its key properties and policy implications. Examples and advanced methods are also presented for the more experienced reader. Methods used throughout this book can be applied consistently: model critique and checking for evidence consistency are emphasised. Methods are based on technical support documents produced for NICE Decision Support Unit, which support the NICE Methods of Technology Appraisal. Code presented is also the basis for the code used by the ISPOR Task Force on Indirect Comparisons. Includes extensive carefully worked examples, with thorough explanations of how to set out data for use in WinBUGS and how to interpret the output. Network Meta-Analysis for Decision Making will be of interest to decision makers, medical statisticians, health economists, and anyone involved in Health Technology Assessment including the pharmaceutical industry.
Download or read book Crossing the Quality Chasm written by Institute of Medicine and published by National Academies Press. This book was released on 2001-07-19 with total page 359 pages. Available in PDF, EPUB and Kindle. Book excerpt: Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.
Download or read book Systematic Reviews in Health Care written by Matthias Egger and published by John Wiley & Sons. This book was released on 2008-04-15 with total page 512 pages. Available in PDF, EPUB and Kindle. Book excerpt: The second edition of this best-selling book has been thoroughly revised and expanded to reflect the significant changes and advances made in systematic reviewing. New features include discussion on the rationale, meta-analyses of prognostic and diagnostic studies and software, and the use of systematic reviews in practice.
Download or read book Decision Making in Health and Medicine written by M. G. Myriam Hunink and published by Cambridge University Press. This book was released on 2014-10-16 with total page 447 pages. Available in PDF, EPUB and Kindle. Book excerpt: A guide for everyone involved in medical decision making to plot a clear course through complex and conflicting benefits and risks.
Download or read book Introduction to Meta Analysis written by Michael Borenstein and published by John Wiley & Sons. This book was released on 2011-08-24 with total page 350 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book provides a clear and thorough introduction to meta-analysis, the process of synthesizing data from a series of separate studies. Meta-analysis has become a critically important tool in fields as diverse as medicine, pharmacology, epidemiology, education, psychology, business, and ecology. Introduction to Meta-Analysis: Outlines the role of meta-analysis in the research process Shows how to compute effects sizes and treatment effects Explains the fixed-effect and random-effects models for synthesizing data Demonstrates how to assess and interpret variation in effect size across studies Clarifies concepts using text and figures, followed by formulas and examples Explains how to avoid common mistakes in meta-analysis Discusses controversies in meta-analysis Features a web site with additional material and exercises A superb combination of lucid prose and informative graphics, written by four of the world’s leading experts on all aspects of meta-analysis. Borenstein, Hedges, Higgins, and Rothstein provide a refreshing departure from cookbook approaches with their clear explanations of the what and why of meta-analysis. The book is ideal as a course textbook or for self-study. My students, who used pre-publication versions of some of the chapters, raved about the clarity of the explanations and examples. David Rindskopf, Distinguished Professor of Educational Psychology, City University of New York, Graduate School and University Center, & Editor of the Journal of Educational and Behavioral Statistics. The approach taken by Introduction to Meta-analysis is intended to be primarily conceptual, and it is amazingly successful at achieving that goal. The reader can comfortably skip the formulas and still understand their application and underlying motivation. For the more statistically sophisticated reader, the relevant formulas and worked examples provide a superb practical guide to performing a meta-analysis. The book provides an eclectic mix of examples from education, social science, biomedical studies, and even ecology. For anyone considering leading a course in meta-analysis, or pursuing self-directed study, Introduction to Meta-analysis would be a clear first choice. Jesse A. Berlin, ScD Introduction to Meta-Analysis is an excellent resource for novices and experts alike. The book provides a clear and comprehensive presentation of all basic and most advanced approaches to meta-analysis. This book will be referenced for decades. Michael A. McDaniel, Professor of Human Resources and Organizational Behavior, Virginia Commonwealth University
Download or read book Doing Meta Analysis with R written by Mathias Harrer and published by CRC Press. This book was released on 2021-09-15 with total page 500 pages. Available in PDF, EPUB and Kindle. Book excerpt: Doing Meta-Analysis with R: A Hands-On Guide serves as an accessible introduction on how meta-analyses can be conducted in R. Essential steps for meta-analysis are covered, including calculation and pooling of outcome measures, forest plots, heterogeneity diagnostics, subgroup analyses, meta-regression, methods to control for publication bias, risk of bias assessments and plotting tools. Advanced but highly relevant topics such as network meta-analysis, multi-three-level meta-analyses, Bayesian meta-analysis approaches and SEM meta-analysis are also covered. A companion R package, dmetar, is introduced at the beginning of the guide. It contains data sets and several helper functions for the meta and metafor package used in the guide. The programming and statistical background covered in the book are kept at a non-expert level, making the book widely accessible. Features • Contains two introductory chapters on how to set up an R environment and do basic imports/manipulations of meta-analysis data, including exercises • Describes statistical concepts clearly and concisely before applying them in R • Includes step-by-step guidance through the coding required to perform meta-analyses, and a companion R package for the book
Download or read book Improving the Quality of Health Care for Mental and Substance Use Conditions written by Institute of Medicine and published by National Academies Press. This book was released on 2006-03-29 with total page 528 pages. Available in PDF, EPUB and Kindle. Book excerpt: Each year, more than 33 million Americans receive health care for mental or substance-use conditions, or both. Together, mental and substance-use illnesses are the leading cause of death and disability for women, the highest for men ages 15-44, and the second highest for all men. Effective treatments exist, but services are frequently fragmented and, as with general health care, there are barriers that prevent many from receiving these treatments as designed or at all. The consequences of this are seriousâ€"for these individuals and their families; their employers and the workforce; for the nation's economy; as well as the education, welfare, and justice systems. Improving the Quality of Health Care for Mental and Substance-Use Conditions examines the distinctive characteristics of health care for mental and substance-use conditions, including payment, benefit coverage, and regulatory issues, as well as health care organization and delivery issues. This new volume in the Quality Chasm series puts forth an agenda for improving the quality of this care based on this analysis. Patients and their families, primary health care providers, specialty mental health and substance-use treatment providers, health care organizations, health plans, purchasers of group health care, and all involved in health care for mental and substanceâ€"use conditions will benefit from this guide to achieving better care.
Download or read book How Doctors Think written by Jerome Groopman and published by HarperCollins. This book was released on 2008-03-12 with total page 325 pages. Available in PDF, EPUB and Kindle. Book excerpt: On average, a physician will interrupt a patient describing her symptoms within eighteen seconds. In that short time, many doctors decide on the likely diagnosis and best treatment. Often, decisions made this way are correct, but at crucial moments they can also be wrong—with catastrophic consequences. In this myth-shattering book, Jerome Groopman pinpoints the forces and thought processes behind the decisions doctors make. Groopman explores why doctors err and shows when and how they can—with our help—avoid snap judgments, embrace uncertainty, communicate effectively, and deploy other skills that can profoundly impact our health. This book is the first to describe in detail the warning signs of erroneous medical thinking and reveal how new technologies may actually hinder accurate diagnoses. How Doctors Think offers direct, intelligent questions patients can ask their doctors to help them get back on track. Groopman draws on a wealth of research, extensive interviews with some of the country’s best doctors, and his own experiences as a doctor and as a patient. He has learned many of the lessons in this book the hard way, from his own mistakes and from errors his doctors made in treating his own debilitating medical problems. How Doctors Think reveals a profound new view of twenty-first-century medical practice, giving doctors and patients the vital information they need to make better judgments together.
Download or read book Methods of Meta Analysis written by John E Hunter and published by SAGE. This book was released on 2004-04-07 with total page 620 pages. Available in PDF, EPUB and Kindle. Book excerpt: Covering the most important developments in meta-analysis from 1990 to 2004, this text presents new patterns in research findings as well as updated information on existing topics.
Download or read book Naturalistic Decision Making written by Caroline E. Zsambok and published by Psychology Press. This book was released on 2014-01-02 with total page 435 pages. Available in PDF, EPUB and Kindle. Book excerpt: If you aren't using the term naturalistic decision making, or NDM, you soon will be. Even as a very young field, NDM has already had far-reaching applications in areas as diverse as management, aviation, health care, nuclear power, military command and control, corporate teamwork, and manufacturing. Put simply, NDM is the way people use their experience to make decisions in the context of a job or task. Of particular interest to NDM researchers are the effects of high-stake consequences, shifting goals, incomplete information, time pressure, uncertainty, and other conditions that are present in most of today's work places and that add to the complexity of decision making. Applications of NDM research findings target decision aids and training that help people in their decision-making processes. This book reports the findings of top NDM researchers, as well as many of their current applications. In addition, the book offers a historical perspective on the emergence of this new paradigm, describes recent theoretical and methodological advancements, and points to future developments. It was written for people interested in decision making research and applications relative to a diverse array of work settings and products such as human-computer interfaces, decision support systems, individual and team training, product designs, and organizational development and planning.
