Source of values and preferences
To operationalize this question, we divided values and preferences into following levels based on their sources:
1. Utilities or patient values, which can be further divided into:
a. Utilities or patient values from different measurement techniques including standard gamble, time trade off, rating scales;
b. Multi-attribute utility, e.g. utility based on Health Utility Index (HUI);
c. Mapping results based on Health-Related Quality of Life Measurement.
2. Direct Choice
3. Health States Averseness Measurement.
4. Qualitative preferences.
Utilities or patient values measured based on instruments
Different techniques have been developed to measure patient values and utilities. The three most widely used techniques to measure directly the individual preferences for health outcomes are the rating scale and its variants (e.g., visual analogue scale (VAS), feeling thermometer, etc.), the standard gamble, and the time trade off (TTO). [10,11] According to the response method and whether the measurement deal with uncertainty or not, the measurements could be divided into different categories (see Table 1).
Table. Different measurement of patient preference [12]
Response Method Question framing
Certainty (value) Uncertainty (utility)
Scaling Rating scale
Visual analogue scale choice Time Trade-off
Paired comparison
Equivalence
Person trade-off Standard Gamble
Rating scale and its variants
Rationale
Rating scale is a measurement based on psychometric theory and it consists of a single line. Respondents are asked to place health state on the line to reflect their perceived values of different health states. Usually, researcher would ask patients to score each outcome on a scale with the anchors 0 (death o...
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...ore the variation and reasons of values and preferences in decision making process. The example of qualitative narrative preference was Borres et al reported nasal sprays were not used daily by patients because their use was inconvenient and embarrassing.[32] Cronin and colleague used a purposive sample of 22 partially dentate patients to gather information on patient preferences for the partially dentate management in Ireland and they concluded that “patients are likely to seek a service based on conservation and restoration of missing teeth by fixed prostheses”. They also revealed the factors related to the increasing expectation.[33]
Conclusion
Taking patient values and preferences is essential in healthcare decision making. A methodologically rigorous and consistent securitize on what information we should gather and how to interpret the information is needed.
Nerenz, D. R. & Neil, N. (2001). Performance measures for health care systems. Commissioned paper for the center for Health management research. [PDF document]. Retrieved from Systemswww.hret.org/chmr/resources/cp19b.pdf
Pearlman, R. A. & Jonsen, A. (1985). The use of quality-of-life considerations in medical decision making. J AM Geriatr Sociology, 33(5), 344-352.
If patients constantly have to wait an excessive amount of time they will either leave before they receive care or could end up becoming sicker as a result. Donabedian’s three-element model structure, process and outcome have become the gold standard for defining quality measurement (Varkey, 2010). Structure relates to the health care setting, which includes the hospital policies, procedures and design. Process evaluates if the right actions were taken for an intended outcome and how well the actions were executed to achieve the outcome. Outcome focuses on the patient, it measures the patient’s condition, behavior, and response to or satisfaction with care (Varkey, 2010). Although each of these measures focus on different areas, they indicate areas that need improvement. Also, the measurement from structure and process plays an important role in the patient’s outcome. If the hospital has the right staff, equipment and
The Rothman Index is a patient acuity score founded by the summation of excess risk functions that utilize additional data from the electronic medical record (Finlay, Rothman, & Smith, 2014). RI data is presented on a graph laid out over three horizontal bars of color which represent the patient 's risk for poor outcome: blue represents least risk for poor outcome; yellow indicates moderate risk for poor outcome; and red represents high risk for poor outcome (PeraHealth, 2015). Data is represented by a dot on a vertical axis, posted hourly as new results are entered. Healthcare providers can then select multiple dots or points of data on the graph to compare the scores as well as see what contributed to that calculated
All these tools are useful in assessing the risk of a patient, it is easy to assess a person for risk, but the problem is how to prioritize what risk is greater. The only way that we can prioritize their safety is when the risk of them coming to harm is greater than their ability to manage the risk (Lloyd 2010). These tools are very good to risk assess Julie’s for any violence problems, once these assessments are completed it will help nurse's come up with a plan to help reduce the risk
Healthcare providers must make their treatment decisions based on many determining factors, one of which is insurance reimbursement. Providers always consider whether or not the organization will be paid by the patients and/or insurance companies when providing care. Another important factor which affects the healthcare provider’s ability to provide the appropriate care is whether or not the patient has been truthful, if they have had access to health, and are willing to take the necessary steps to maintain their health.
Rational choice theory, developed by Ronald Clarke and Derek Cornish in 1985, is a revival of Cesare Becca...
The patients should receive safe and appropriate care in return for payment equal to the level of care received (“What is Value-Based Care”, 2016). For providers, this means using affordable and proven treatments while also catering to the patient’s needs (“What is Value-Based Care”, 2016). Additionally, this model is built upon measurement which when relayed to the patient will inform them of the scope and cost of their care. Examples of measures that are tracked, provided by the article “What is Value-Based Care,” include: procedural complications, hospital-acquired infections, and readmissions; providers face penalties if these metrics are unacceptable (“What is Value-Based Care”,
Studies used a mixture of measures and with different phrases to address the process or the outcome of patient satisfaction (Laith Alrubaiee, 2011).
In the medical field, there are many ethical dilemmas that a person could face. One of the major dilemmas in the medical field comes from being a doctor. While attending to a patient/ client the doctor may not know the best treatment or course of action to take because of the many options there could be. The values and beliefs of a doctor can’t interfere with the treatment of a patient/client. Their job is to be honest, benevolent, respectful, and to maintain confidentiality of the patient/client.
The debate is still going on today about what can and cannot be done legitimately with patients health information. There are worries about who should be able to access the patient’s information and for what reasons do they have to be accessing the patient’s health information. While on the other side there is an increasing need for performance assessments, efficient health guard, and a proficient administration for more and better information. Health care services are now starting to realize that they have a lot of work to do to be in compliance with the current health laws on the state and federal level guidelines when it comes to dealing with protecting patient data.
The development of knowledge requires a number of processes in order to establish credible data to ensure the validity and appropriateness of how it can be used in the future. For the healthcare industry, this has provided the ability to create and form new types of interventions in order to give adequate care across a of number of fields within the system. Research then, has been an essential part in providing definitive data, either by disproving previous beliefs or confirming newly found data and methods. Moreover, research in itself contains its own process with a methodological approach. Of the notable methods, quantitative research is often used for its systemic approach (Polit & Beck, 2006). Thus, the use of the scientific method is used, which also utilizes the use of numerical data (Polit & Beck). Here, researches make use of creating surveys, scales, or placing a numerical value on it subjects (Polit & Beck). In the end the resulting data is neutral and statistical. However, like all things its approach is not perfect, yet, it has the ability to yield valuable data.
Lovaglio, P.G. (2011, November 29). Benchmarking strategies for measuring the quality of healthcare: Problems and prospects. The Scientific World Journal, 2012, 2-3. doi:10.1100/2012/606154
In order for these three data sets to work there needs to be a standard that they all use to keep discrepancies to a minimum. The types of data collected are very important. There needs to be patient identifiers to help link data. This needs to be a unique patient identifier or registry identification number. Depending on the registries some patient identifiers may not be used due to privacy regulations treatments (Gliklich & Dreyer, 2017. Patient selection criteria are another category. Eligibility criteria in a protocol or study plan determined what group will be included in the registry. This information can be very restricted or very broad depending on what it’s being used for. Treatment and test are also important to describe the history
There will always be a need for healthcare as people are always sick in some way or they are out of balance with their health in some way. There are so many specialty areas in the healthcare field that it allows for a variety of specialists to be apart of a patient’s decision making process. It does pay to be knowledgable. Take the time to read each one of the patient’s rights and under-stand what it means to have a choice.