François Sainfort

Development and Application of a Model to Estimate the Impact of Type 1 Diabetes on Health-Related Quality of Life

OBJECTIVE To develop a simulation model to assess the impact of type 1 diabetes and its associated complications on health-related quality of life of a population. RESEARCH DESIGN AND METHODS The methodology builds upon 1) an existing population model of type 1 diabetes progression, 2) an empirical study designed to measure state- and age-specific health statuses of type 1 diabetes, and 3) existing literature to quantify quality of life of the corresponding health status. Health statuses were measured in a group of type 1 diabetic patients using the Medical Outcomes Study short form 36 (SF-36). A published empirical regression equation was then used to predict corresponding Quality of Well-Being Index (QWB) scores from these assessments. The QWB scores were incorporated into a previously developed type 1 diabetes progressionand cost simulation model. Sensitivity analyses on key parameters were performed, and the model was found to be robust. RESULTS The augmented model can estimate quality-adjusted life years (QALYs) as well as costs associated with type 1 diabetes on any population of interest over any period of time. The model is used to compare intensive versus conventional treatment strategies using a simplified set of assumptions regarding the relative effects of these alternative treatments. With these assumptions, intensive strategy produces more QALYs than does conventional strategy and is cost-beneficial after 5 years. CONCLUSIONS The model enables health planners to perform cost-effectiveness analyses to compare alternative treatment strategies for type 1 diabetes and support subsequent decision making.

Decision support systems effectiveness: Conceptual framework and empirical evaluation

Abstract Decision Support Systems (DSS) are designed to help human beings in solving problems more efficiently or making better decisions. While an increasing number of DSS have been and are developed, the effectiveness of such systems has not yet been demonstrated. This study proposes a conceptual framework for measuring the effectiveness of DSS and reports the results of a before-and-after study designed to compare two experimental groups of problem solvers assisted by one of two technologies for conflict resolution with a control group without any technology. The two technologies that are examined in this paper consist of a computerized DSS for conflict resolution, Resolve(!), and a videotape on conflict resolution, Video. Various measures of the problem solving episode were recorded, including both process and outcome measures. Overall, the groups with access to the technologies perceived a significantly better resolution of the problem they addressed than their control group counterpart. The two technologies differed essentially on two out of 11 variabales: subjects assigned to the computerized DSS technology generated more alternative solutions to the problem they tried to solve and reported a higher perceived progress in the resolution of the problem, than did subjects who were assigned to the videotape technology.

Macroergonomics and total quality management: how to improve quality of working life?

In this paper, we present a macroergonomic model of work design that is applied and tested to examine Total Quality Management (TQM) in the public sector. According to the model, TQM can influence different aspects of work design and quality of working life (QWL). Questionnaire data collected in 2 public sector organizations in the USA show that TQM can have both positive and negative impact on work design and QWL. The main positive impact of TQM was found on job content, job control and participation, and social relationships. The main negative impact of TQM was on workload, uncertainty, and clarity of job duties. The impact of TQM on QWL was mixed. Our results show that the impact of TQM on work design and QWL varied very much across the 6 participating departments, as well as within the departments. Further research is warranted to assess the human impact of TQM, in particular research on the linkage between various aspects of TQM, on one hand, and work design and QWL, on the other hand.

Toward a new conceptualization and operationalization of risk perception within the genetic counseling domain

The purpose of this paper is twofold. First, it provides an historical overview of studies of risk, risk perception, and decision making under risk within the genetic counseling domain. Second, it proposes an alternative conceptualization and operationalization for the study of risk perception. The conceptualization involves probability, adversity, incompleteness, and ambiguity. Prior studies of risk perception focus on the recurrence risk and operationalize risk perception by asking for interpretations of the magnitude of the probability of the outcome. Their focus is on the probability of a particular outcome. We formulate the problem in terms of a gamble and suggest that risk perception be operationalized in terms of the riskiness of the gamble. Our focus is on the riskiness of a decision option which entails two or more outcomes.

An Empirical Test of the Structure, Process, and Outcome Quality Paradigm Using Resident-Based, Nursing Facility Assessment Data

This study distinguishes between organizational char acteristics, regarded as exogenous structural indicators of quality, and those identified as endogenous indica tors of structural care (SC), and investigates the degree to which measures of SC vary by ownership mode (defined by four combinations of chain affiliation and profit status) for 142 certified and licensed nursing facilities (NFs) in a southern state. Structural care mea sures include: licensed and unlicensed staffing, licensed therapists, and case mix-adjusted direct care expendi tures. In addition, seven (four process and three out come) facility-level, risk-adjusted process, and outcome quality scales are developed from 39 resident-level qual ity indicators. A causal model of NF quality arranged according to the structure, process and outcome para digm is specified and estimated using path analysis. Or ganizational data derive from the 1991 Medicaid Cost Report; process and outcome quality measures were de veloped from the Minimum Data Set Plus Resident As sessment Instrument. Using the percentage of Medicaid and private pay residents as covariates, there was a significant overall multivariate effect due to ownership mode on the SC measures. Although there were several significant direct effects, the overall path model was disconfirmed. The multivariate results suggest that some organizational characteristics of structure quality may be more appropriately considered exogenous to causal quality models and therefore have indirect (ver sus direct) effects on process or outcome quality indica tors. The path analysis implies that the structure-pro cess-outcome paradigm may not accurately capture the way NF health care is delivered. Research which consid ers alternate NF quality paradigms needs to be done with samples that are more representative of national proportions of each ownership mode.

A First Step in Total Quality Management of Nursing Facility Care: Development of an Empirical Causal Model of Structure, Process and Outcome Dimensions

While the structure, process, and outcome taxon omy has long been used in the field of health care quality measurement and evaluation, it has not been used in a true causal model which assesses facility level quality. Total quality management and contin uous quality improvement call for routinely assessing facility and resident level quality in a causal frame work. This paper presents a causal modeling meth odology as a more appropriate method for assessing and understanding the inter-relatedness among each of the quality dimensions of Nursing Facility care, and presents how such a causal model directly relates to the notion of continuous quality improvement. The methodology consists of five steps: (1) sample defini tion and data collection, (2) data reduction through factor analysis, (3) development and testing of a causal model through path analysis, (4) identification of patterns of care through cluster analysis, and (5) integration of the model to both continuous quality improvement and to complex relationships involving quality and organizational variables. The methodol ogy is fully illustrated by using a sample of 104 nursing facilities in Wisconsin in which quality di mensions have been captured through the Quality Assessment Index. The analysis demonstrates that nursing facilities may be substantially benefited by having access to causal linkages which materially affect outcome quality. Management would then have first-hand knowledge of the structural characteris tics and the process activities that they may pursue in order to improve outcome quality.

Evaluating the desirability of meals: an illustrative multiattribute decision analysis procedure to assess portfolios with interdependent items

This paper presents an exploratory study designed to address complex scaling problems in applying value/utility theory to measuring preferences over alternative combinations (or portfolios) of multiattributed items. This application considers meals served to nursing home residents as portfolios of food items and seeks to maximize meal appeal. We consider food interrelation and link single food measurements to overall meal measurements in the process of constructing meal desirability scales. We test the resulting scales to capture one experts professional judgments and discuss issues raised in this specific application in the context of general portfolio evaluation problems.

Self-assessment of VDT operator health: hierarchical structure and validity analysis of a health checklist

The underlying hierarchical structure and validity of a health checklist that assesses Video Display Terminal (VDT) operator health was examined. This checklist has been used in many studies of VDT workers (Smith, Cohen, Stammerjohn, & Happ, 1981; Piotrkowski, Cohen, & Coray, 1992). Two hundred sixty‐two office employees from three public service organizations provided the data to identify the underlying structure and assess the validity of the health checklist. Factor analyses of the health checklist were performed to identify all meaningful factor solutions. The convergent and discriminant validity of the nine‐factor solution was examined. The factor analyses led to the identification of a hierarchical structure of the health checklist. This empirical structure is shown to be conceptually sound and useful and offers flexibility in constructing various scales.

Decomposition of Utility Functions on Subsets of Product Sets

The standard decomposition theorem for additive and multiplicative utility functions Pollak [Pollak, R. O. 1967. Additive von Neumann-Morgenstern utility functions. Econometrica35 485-494.], Keeney [Keeney, R. L. 1974. Multiplicative utility functions. Opns. Res.22 22-34.] assumes that the outcome set is a whole product set. In this paper this assumption is relaxed, and the question of whether or not a natural revision of this theorem necessarily holds is investigated. This paper proves that two additional conditions are needed for the decomposition theorem to hold in the context where the outcome set is a subset of a Cartesian product. It is argued that these two new conditions are satisfied by a large family of subsets corresponding to significant real-world problems. Further research avenues are suggested including a generalization of this new decomposition result to nonexpected utility theories.

Total Quality Management in the Public Sector: A Comparison between the USA and France

This paper examines the development and applications of TQM in the public sector, in particular in the USA and in France. Issues related to the implementation process and the content of TQM in the public sector are discussed. Two cases provide data on actual implementations of TQM in the public sector. Both cases are local government agencies, one located in the State of Wisconsin, USA, and the other one in the Eastern region of France. Using Hofstedes model (1997), similarities and differences between the cases are discussed in light of cross-cultural characteristics.