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Results for “Utility Theory”

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At least 19 recordsLinked to original sources

PubMedDate not supplied

Current maternal age recommendations for prenatal diagnosis: a reappraisal using the expected utility theory.

The expected utility theory suggests eliminating an age-specific criterion for recommending prenatal diagnosis to patients. We isolate the factors which patients and physicians need to consider intelligently in prenatal diagnosis, and show that the sole use of a threshold age as a screening device is inadequate. Such a threshold fails to consider adequately patients' attitudes regarding many of the possible outcomes of prenatal diagnosis; in particular, the birth of a chromosomally abnormal child and procedural-related miscarriages. It also precludes testing younger women and encourages testing in patients who do not necessarily require or desire it. All pregnant women should be informed about their prenatal diagnosis options, screening techniques, and diagnostic procedures, including their respective limitations, risks, and benefits.

Congenital Abnormalities↗

PubMedDate not supplied

Do violations of the axioms of expected utility theory threaten decision analysis?

Research demonstrates that people violate the independence principle of expected utility theory, raising the question of whether expected utility theory is normative for medical decision making. The author provides three arguments that violations of the independence principle are less problematic than they might first appear. First, the independence principle follows from other more fundamental axioms whose appeal may be more readily apparent than that of the independence principle. Second, the axioms need not be descriptive to be normative, and they need not be attractive to all decision makers for expected utility theory to be useful for some. Finally, by providing a metaphor of decision analysis as a conversation between the actual decision maker and a model decision maker, the author argues that expected utility theory need not be purely normative for decision analysis to be useful. In short, violations of the independence principle do not necessarily represent direct violations of the axioms of expected utility theory; behavioral violations of the axioms of expected utility theory do not necessarily imply that decision analysis is not normative; and full normativeness is not necessary for decision analysis to generate valuable insights.

Bias↗

PubMed2003

Testing rank-dependent utility theory for health outcomes.

Systematic violations of expected utility theory (EU) have been reported in the context of both money and health outcomes. Rank-dependent utility theory (RDU) is currently the most popular and influential alternative theory of choice under circumstances of risk. This paper reports a test of the descriptive performance of RDU compared to EU in the context of health. When one of the options is certain, violations of EU that can be explained by RDU are found. When both options are risky, no evidence that RDU is a descriptive improvement over EU is found, though this finding may be due to the low power of the tests.

Choice Behavior↗

PubMed2001

Empirical comparisons of bilinear and nonbilinear utility theories.

Several bilinear and nonbilinear utility theories are evaluated using individual data from 144 informants. The nonbilinear models are best for 67% of the informants. The nonrational property of duplex decomposition linking joint receipts and mixed gambles of gains and losses is more adequate than the rational link of general segregation for 73% of the informants. The correlations are very high and linear, even in the worst fitting case. The weighting functions are mostly inverse-S-shaped and for 84% of the informants are fit best by the class of functions proposed by D. Prelec. These fits were generally excellent, with a minimum correlation of.81, a maximum of.99, and an average of.97.

Journal Article↗

PubMedDate not supplied

Is expected utility theory normative for medical decision making?

Expected utility theory is felt by its proponents to be a normative theory of decision making under uncertainty. The theory starts with some simple axioms that are held to be rules that any rational person would follow. It can be shown that if one adheres to these axioms, a numerical quantity, generally referred to as utility, can be assigned to each possible outcome, with the preferred course of action being that which has the highest expected utility. One of these axioms, the independence principle, is controversial, and is frequently violated in experimental situations. Proponents of the theory hold that these violations are irrational. The independence principle is simply an axiom dictating consistency among preferences, in that it dictates that a rational agent should hold a specified preference given another stated preference. When applied to preferences between lotteries, the independence principle can be demonstrated to be a rule that is followed only when preferences are formed in a particular way. The logic of expected utility theory is that this demonstration proves that preferences should be formed in this way. An alternative interpretation is that this demonstrates that the independence principle is not a valid general rule of consistency, but in particular, is a rule that must be followed if one is to consistently apply the decision rule "choose the lottery that has the highest expected utility." This decision rule must be justified on its own terms as a valid rule of rationality by demonstration that violation would lead to decisions that conflict with the decision maker's goals. This rule does not appear to be suitable for medical decisions because often these are one-time decisions in which expectation, a long-run property of a random variable, would not seem to be applicable. This is particularly true for those decisions involving a non-trivial risk of death.

Choice Behavior↗

PubMed1976

Toward a utility theory foundation for health status index models.

The axioms of utility theory are restated in terms of health outcomes, and some additional assumptions, consistent with the assumptions implicit in health status index models, are adduced to develop a consistent theory of the utility of health states. On the basis of the axioms and specific assumptions, techniques for measuring the health utility functions of individuals are described, and it is shown how these axioms and assumptions may be used to determine the utility to the individual of health programs that will affect him in various ways.

Health↗

PubMed1996

Comparison between the Health Belief Model and Subjective Expected Utility Theory: predicting incontinence prevention behaviour in post-partum women.

A small-scale study was undertaken to test the relative predictive power of the Health Belief Model and Subjective Expected Utility Theory for the uptake of a behaviour (pelvic floor exercises) to reduce post-partum urinary incontinence in primigravida females. A structured questionnaire was used to gather data relevant to both models from a sample antenatal and postnatal primigravida women. Questions examined the perceived probability of becoming incontinent, the perceived (dis)utility of incontinence, the perceived probability of pelvic floor exercises preventing future urinary incontinence, the costs and benefits of performing pelvic floor exercises and sources of information and knowledge about incontinence. Multiple regression analysis focused on whether or not respondents intended to perform pelvic floor exercises and the factors influencing their decisions. Aggregated data were analysed to compare the Health Belief Model and Subjective Expected Utility Theory directly.

Adult↗

PubMed1998

Sickness absence: a review of performed studies with focused on levels of exposures and theories utilized.

BACKGROUND: Despite the major impact sickness absence has on society, companies and individuals, surprisingly little scientific knowledge has been accumulated, and the studies that have been performed vary greatly. AIM AND METHOD: Examination of about 320 studies of sickness absence regarding structural levels of exposures studied and theories utilized. RESULTS: Theories concerning sickness absence were found to vary greatly. Along with exposures and factors explaining sickness absence these theories were categorized with respect to different structural levels, i.e. they were deemed national, occupational, or individual. A classification of different types of absences is presented. CONCLUSION: Although most of the reviewed studies were performed within the realm of medicine, only a few of the investigators used medical explanatory models or even considered the health status of individuals. Moreover, it is known that factors at "higher" structural levels have a substantial effect on sickness absence, but these were seldom taken into account, or even mentioned, in the reports scrutinized.

Absenteeism↗

PubMed2006

Improving clinical productivity in the academic setting: a novel incentive plan based on utility theory.

PURPOSE: Academic internal medicine practices face growing challenges to financial viability due to high overhead, competing institutional missions, and suboptimal physician productivity. The authors describe the development of a clinical incentive plan for a group of academic subspecialty physicians at the Dana Clinic, an outpatient setting at Yale School of Medicine, and report on results of the first year's experience under the plan. METHOD: Utility theory was used to assess the risk profile of clinic faculty and identify incentive payments that would optimize faculty benefit or "utility" while minimizing departmental costs. Under the plan, physicians who reached a productivity target based on work Relative Value Units (wRVUs) between October 2003 and November 2004 had overhead costs covered and received a fixed payment to support salary; additional incentive payments were available for those exceeding the target. Physicians failing to reach the target were responsible for their own overhead costs and received no fixed payment. Physician productivity as measured by wRVU per full-time equivalent (FTE) was compared for the year prior to, and the year following, incentive plan introduction. RESULTS: Forty-seven members of eight academic sections were included in the analysis. Median productivity improved by 34%, with 42 of 47 physicians showing improvement. Significant improvements were also noted in collections (62%) and visit volume (23%), and shifts were observed in coding patterns. CONCLUSIONS: The unique threshold-based structure of the incentive plan, as determined through utility theory modeling, as well as permitting physicians to choose how to achieve the wRVU target were key features of its success, resulting in improved productivity without increasing practice resources or faculty salaries.

Costs and Cost Analysis↗

PubMed2005

A simple test of expected utility theory using professional traders.

We compare behavior across students and professional traders from the Chicago Board of Trade in a classic Allais paradox experiment. Our experiment tests whether independence, a necessary condition in expected utility theory, is systematically violated. We find that both students and professionals exhibit some behavior consistent with the Allais paradox, but the data pattern does suggest that the trader population falls prey to the Allais paradox less frequently than the student population.

Behavior↗

PubMed1992

Psychology and decision making: modelling health behavior with multiattribute utility theory.

The success of much of dental practice is linked to patient behavior. Understanding the issues that influence patients' decisions when they choose to not follow preventive or therapeutic dental recommendations is instrumental to improving adherence, and ultimately, to improving dental health outcomes. Multiattribute Utility Theory (MAU) provides a methodology for systematically exploring these issues. It is based on a well-established body of knowledge in the psychological literature, and currently represents a state-of-the-art model for predicting behavior and delineating potentially modifiable behavioral determinants. Two examples are presented to illustrate how MAU can be used in clinical settings. In the first example, MAU is used to identify key reasons why nearly 70 percent high-risk patients did not obtain flu shots, a behavioral problem comparable to many confronted in dentistry. MAU correctly predicted the vaccination behavior of 82 percent of patients, and an intervention based on MAU findings nearly doubled vaccination rates. The second example used MAU to identify physician behaviors that influenced patients' satisfaction with an ambulatory care visit. MAU findings from this study identified specific behaviors in a provider's style that if modified may improve patient satisfaction. These MAU applications also emphasize the importance of soliciting the patient's perspective in clinical interactions since some of the most important determinants of patient behavior are not represented in traditional clinical decision models.

Decision Making↗

PubMed2000

Measuring Nursing Practice Models using Multi-Attribute Utility theory.

Nursing Practice Models (NPMs) represent the structural and contextual features that exist within any group practice of nursing. Currently, measurement of NPMs relies on costly and nonreproducible global judgments by experts. Quantitative measurement techniques are needed to provide a useful evaluation of nursing practice. Guided by Multi-Attribute Utility theory (MAU theory), an expert panel identified 24 factors representative of N PMs. The factors became elements in a computational index that, when summed, assigns a score to a given nursing unit reflecting the extent to which that unit's nursing practice model achieves the nursing professional ideal. Initial validation of the index and its elements consisted of comparing assessments of 40 nursing units generated by the index with a global evaluation provided by each of the expert panelists who proposed the model factors. Pearson correlations between the index-generated scores and the global assigned scores provided evidence supporting the preliminary validation of the index.

Delivery of Health Care↗

PubMedDate not supplied

Application of multi-attribute utility theory to measure social preferences for health states.

A four-attribute health state classification system designed to uniquely categorize the health status of all individuals two years of age and over is presented. A social preference function defined over the health state classification system is required. Standard multi-attribute utility theory is investigated for the task, problems are identified and modifications to the standard method are proposed. The modified methods is field tested in a survey research project involving 112 home interviews. Results are presented and discussed in detail for both the social preference function and the performance of the modified method. A recommended social preference function is presented, complete with a range of uncertainty. The modified method is found to be applicable to the task--no insurmountable difficulties are encountered. Recommendations are presented, based on our experience, for other investigators who may be interested in reapplying the method in other studies.

Adolescent↗

PubMed1989

Expected utility theory and risky choices with health outcomes.

Studies of people's attitude towards risk in the health sector often involve a comparison of the desirability of alternative medical treatments. Since the outcome of a medical treatment cannot be known with certainty, patients and physicians must make a choice that involves risk. Each medical treatment may be characterized as a gamble (or risky option) with a set of outcomes and associated probabilities. Expected utility theory (EUT) is the standard method to predict people's choices under uncertainty. The author presents the results of a survey that suggests people are very risk averse towards gambles involving health-related outcomes. The survey also indicates that there is significant variability in the risk attitudes across individuals for any given gamble and that there is significant variability in the risk attitudes of a given individual across gambles. The variability of risk attitudes of a given individual suggests that risk attitudes are not absolute but are functions of the parameters in the gamble.

Adult↗

PubMed2004

Using utility theory to optimize a salary incentive plan for grant-funded faculty.

PURPOSE: Few salary incentive plans for academic health center faculty funded primarily by research grants exist, and hence the optimal structure for such plans is uncertain. The author examined the impact of incentives and the optimal structure for a salary incentive plan for a group of research faculty at the Yale University School of Medicine (Yale). METHOD: A three-part instrument was delivered to a convenience sample of 40 faculty to determine the impact of their risk aversion on two salary plans. Utility theory was used to quantify their preferences for the Expense Model (salary bonuses are paid from direct costs of the research award) and the No Expense Model (salary increases are funded from another source). Outcomes were projected for both models over a range of funding probabilities. RESULTS: In all, 27 faculty responded. On average, Yale faculty had risk-averse (and therefore unfavorable) attitudes towards the Expense Model, with substantial variability in response depending on rank. In contrast, Yale faculty had more homogeneous risk seeking (and therefore favorable) responses to the No Expense Model. Cost recoveries were greatest for the No Expense Model. CONCLUSIONS: Utility modeling demonstrated that the optimal incentive payment for the Expense Model is substantially greater than for the No Expense Model, and increases as the probability of obtaining funding with diligent effort declines. For purposes of both equity and efficacy, the No Expense Model appears preferable to the Expense Model. Modeling can be used to determine optimal incentive-plans and bonus-payment magnitudes for research faculty.

Academic Medical Centers↗

PubMedDate not supplied

Measurement of nursing practice models using multiattribute utility theory: relationship to patient and organizational outcomes.

Workforce shortages are challenging administrators in the health care environments to examine existing models of providing care. Although characteristics of nursing care delivery contribute in important ways to the success or failure of hospital care, factors common to all practice models have not been identified nor have measurement strategies been designed that assess the impact of care on patient and organizational outcomes. The purpose of this study was to test a measurement model of nursing practice that was developed using multiattribute utility theory. A total of 24 factors identified by expert nurse administrators as being common to all nursing practice models were mathematically formulated into a multidimensional composite index that represented the degree to which a practice model on a nursing unit approached the professional ideal. The index was tested with 298 registered nurses working on 28 medical surgical nursing units in 3 hospitals. The model was evaluated in 2 ways: first by comparing the composite index scores to a qualitative appraisal of the nursing unit's practice model and patient and organizational outcomes. Secondly, individual factors in the model were evaluated in the same manner. While the composite index was not fully validated, there is strength in the evidence of the relationship between individual factors and outcomes. Specifically, factors that addressed interactions among health care team members were most often related to outcomes.

Adult↗

PubMed1999

Evidence against Rank-Dependent Utility Theories: Tests of Cumulative Independence, Interval Independence, Stochastic Dominance, and Transitivity.

This study tests between two modern theories of decision making. Rank- and sign-dependent utility (RSDU) models, including cumulative prospect theory (CPT), imply stochastic dominance and two cumulative independence conditions. Configural weight models, with parameters estimated in previous research, predict systematic violations of these properties for certain choices. Experimental data systematically violate all three properties, contrary to RSDU but consistent with configural weight models. This study also tests whether violations of stochastic dominance can be explained by violations of transitivity. Violations of transitivity may be evidence of a dominance detecting mechanism. Although some transitivity violations were observed, most choice triads violated stochastic dominance without violating transitivity. Judged differences between gambles were not consistent with the CPT model. Data were not consistent with the editing principles of cancellation and combination. The main findings are interpreted in terms of coalescing, the principle that equal outcomes can be combined in a gamble by adding their probabilities. RSDU models imply coalescing but configural weight models violate it, allowing configural weighting to explain violations of stochastic dominance and cumulative independence. Copyright 1999 Academic Press.

Journal Article↗

PubMed1986

The flu shot study: using multiattribute utility theory to design a vaccination intervention.

Differences between the multiattribute utility (MAU) profiles of participants who had previously gotten flu shots and those who had not done so were used to design an informational brochure urging influenza vaccination. The effectiveness of the MAU brochure was evaluated in a VA ambulatory care clinic with a long-standing influenza vaccination program. The target population for the intervention was high-risk clinic patients who had not gotten a shot the previous year. Participants received either a letter urging them to get a flu shot, or a letter plus the informational brochure. A significantly larger proportion of the patients who received the brochure got shots; 36% versus 23% for the letter only. While a 13 percentage point increase is modest, influenza and related complications (preventable through vaccination) are the fourth-leading killers of older persons. Adding a MAU-based brochure to an ongoing vaccination program is inexpensive and may save additional lives.

Aged↗