Applied Decision Analysis Research Articles

OARSI recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis

To recommend a consensus-derived set of performance-based tests of physical function for use in people diagnosed with hip or knee osteoarthritis (OA) or following joint replacement. An international, multidisciplinary expert advisory group was established to guide the study. Potential tests for consideration in the recommended set were identified via a survey of selected experts and through a systematic review of the measurement properties for performance-based tests. A multi-phase, consensus-based approach was used to prioritize and select performance-based tests by applying decision analysis methodology (1000Minds software) via online decision surveys. The recommended tests were chosen based on available measurement-property evidence, feasibility of the tests, scoring methods and expert consensus. Consensus incorporated the opinions of 138 experienced clinicians and researchers from 16 countries. The five tests recommended by the advisory group and endorsed by Osteoarthritis Research Society International (OARSI) were the 30-schair-stand test, 40m fast-paced walk test, a stair-climb test, timed up-and-go test and 6-min walk test. The first three were recommended as the minimal core set of performance-based tests for hip or knee OA. The OARSI recommended set of performance-based tests of physical function represents the tests of typical activities relevant to individuals diagnosed with hip or knee OA and following joint replacements. These tests are complementary to patient-reported measures and are recommended as prospective outcome measures in future OA research and to assist decision-making in clinical practice. Further research should be directed to expanding the measurement-property evidence of the recommended tests.

Policy Perspectives on National Security and Foreign Policy Decision Making

This article reviews major decision‐making models with an emphasis on basic theoretical perspectives as well as on how these models explain foreign policy decision making and national and international security decisions. Furthermore, we examine how these models have been utilized in explanations of various international crises. Specifically, for each model, we present examples drawn from the literature on applications of the respective model to foreign policy and national security decisions. The theories we have reviewed are as follows: rational choice, cybernetic model, prospect theory, poliheuristic theory, organizational and bureaucratic politics, groupthink and polythink, and analogical reasoning. We also review the Applied Decision Analysis method, and the concept of biases in decision making.

About the Authors

About the Authors

Examining the role of identity in negotiation decision making:the case of Cyprus

PurposeThis study aims to examine the effects of ethnic and social identities on negotiation decision making in the context of the Cyprus conflict.Design/methodology/approachThe author conducts a theory‐driven case study of the 1959 Zurich‐London agreements on Cyprus, analyzing the positions of Turkey, Greece, Britain, and the Turkish and Greek Cypriot communities during the negotiation process. The analytical method is the applied decision analysis procedure.FindingsThe analysis of the Zurich‐London negotiations over Cyprus suggests that even in the presence of adversarial ethnic ties, decision makers who have a shared (and salient) social identity are more likely to employ collective‐serving decision strategies and seek even‐handed solutions that will not jeopardize their mutual interests. Here, Turkey and Greece – both NATO members – decided to settle on a commonly agreed negotiation outcome despite their ethnicity‐driven, clashing interests over Cyprus. In contrast, decision makers with severe ethnic fragmentation with no shared social identity (as with the Turkish and Greek Cypriot communities) are more prone to employ self‐serving decision strategies and seek zero‐sum negotiation outcomes that will exclusively benefit them.Research limitations/implicationsRegarding the applied decision analysis procedure employed in this study, it is necessary to acknowledge the subjective nature of the construction of the decision matrices with respective values/ratings, even though such procedure is based on empirical and situational evidence.Originality/valueThe study introduces a novel theoretical and analytical framework to the literature on negotiation decision making in identity‐based conflicts by combining the social contextualist perspective with the polyheuristic decision model and using applied decision analysis. By anchoring the analysis in the historical context of the Cyprus conflict, the study also contributes to the relatively underdeveloped literature on conflict management in the Middle East.

Contributors

Contributors

Contributors

Contributors

Probabilistic Modeling for Decision Support in Integrated Operations

Summary We report work carried out within the project on collaborative decision support for integrated operations (CODIO). As one part of this project, we have designed a system to provide assistance in operational decisions based on real-time sensor readings in a typical scenario: While drilling close to the transition to a high-pressure formation, a gas influx is observed. The drilling team needs to decide whether to circulate, increase the mud weight, plug back, or set a casing. After a brief description of the technology we used to model decision problems [Bayesian networks, influence diagrams (IDs)], we describe our case study and discuss the particular challenge of applying decision analysis to the kind of operational decision that is central to the case study. We then proceed to apply the method of decision analysis to our case study. We discuss how the resulting ID was tested using a simulation and discuss challenges in applying the technology, as well as lessons learned in the process. We also give a list of desiderata to establish better decision-making practices in the petroleum industry.

Use of Nomograms for Personalized Decision-Analytic Recommendations

A difficulty with applying decision analysis at the bedside is that it generally requires computer software for the calculations, which may render the method impractical. The purpose of this study was to illustrate the feasibility of developing a regression model that approximates the results from a published decision-analytic model for prostate cancer and permits bedside generation of personalized decision-analytic recommendations with a paper nomogram. The authors used the example of radical prostatectomy v. watchful waiting for patients with early-stage prostate cancer. First, they took a published decision analysis and generated recommendations using simulated data where patient baseline factors and preference scores for health states were systematically varied. Multivariable logistic regression was used to identify the parameters with strong associations with the recommendation. A reduced model was fit that excluded other preference scores except for watchful waiting. They compared the recommended management predictive accuracies from the full v. reduced model at the individual patient level for 63 men from another published study. Discrimination was assessed using receiver operating characteristic (ROC) curve analysis. A nomogram was constructed from the covariates in the reduced model. The reduced logistic regression model predicted the recommendations accurately for the 63 patients, with an area under the ROC curve of 0.92. Discrimination was excellent as demonstrated by histograms. The authors demonstrated that logistic regression modeling allows accurate reproduction of decision-analytic recommendations with simplified calculations, which can be accomplished using a graphic nomogram. This approach should facilitate clinical decision analysis at the bedside.

Comparación de tres estrategias de tamizaje para la prevención de la infección perinatal por VIH en Colombia: análisis de decisiones

To apply decision analysis to compare the cost-effectiveness of three strategies for HIV screening of pregnant women and to recommend the one most appropriate for the health care system of Colombia. An economic study applying decision analysis to three types of HIV screening of expectant women: voluntary, universal, and optional. All the women in Colombia with unknown HIV status who were admitted for child birth were included. The study included all the direct medical costs incurred from the time of testing through the first year following delivery, according to the General System for Healthcare Social Security. Cost-effectiveness ratio and the savings of each of the strategies were compared. For every 10,000 women, the universal strategy detected five cases more than the voluntary strategy and seven cases more than the optional. The universal strategy carried a cost of approximately US$ 17 for each HIV-positive newborn; that is, less than half of that of the voluntary strategy (US$ 38) and less than the optional (US$ 24). According to the bifactorial analysis, the universal screening strategy was less costly than the voluntary and more effective than both of the others, regardless of prevalence, the false-positive rate of each method, and the rate of maternal compliance with screening. The screening strategy currently in use in Colombia is more costly (in both the medium- and long-term), less effective, and less capable of prevention, than the universal screening strategy. The recommendation to the national health authorities of Colombia is to begin screening all pregnant women for HIV infection using third-generation testing.

Incorporating Path Dependency into Decision-Analytic Methods: An Application to Global Climate-Change Policy

Climate policy decisions are necessarily sequential decisions over time under uncertainty, given the magnitude of uncertainty in both economic and scientific processes, the decades-to-centuries time scale of the phenomenon, and the ability to reduce uncertainty and revise decisions along the way. Thus, an appropriate choice of analytical method is decision analysis. However, applying decision analysis in the context of idealized government decision makers over a century raises the question of how to deal with the fact that political systems tend to exhibit path dependency, a force that makes large policy shifts difficult and rare, and limits most decisions to small incremental changes. This paper explores the effect of considering path dependency in an application of decision analysis to climate-change policy decisions, presenting two alternative methods for modeling path dependency. I demonstrate that consideration of path dependence in the context of climate policy justifies greater near-term emissions reductions. The more general result of path-dependency is to shift the near-term strategy towards a more moderate hedging strategy, because drastic shifts later will be difficult.

Application of Poliheuristic Methodology to a Sequence of Boris Yeltsin's Decisions During the 1995 Hostage Crisis in Budyonnovsk

The Hostage Crisis in Budyonnovsk was a watershed of Chechen terrorist activity in the 1990's. Applied Decision Analysis (ADA) and Poliheuristic Theory of Decision (See Mintz - 2004, 2005) methodology is applied in this paper to a sequence of two decisions made by Boris Yeltsin during the Budyonnovsk hospital hostage crisis in 1995: 1. The decision to use force against the Chechen terrorists in an attempt to rescue the hostages. 2. Following the failure of the Russian Special Forces to avoid hostage casualties during their attempt to storm the hospital building, the decision to negotiate with the hostages was taken. Yeltsin authorized Prime Minster Chernomyrdin to conduct the negotiations. In order order to examine the sequential relationship, each decision is individually approached with the Poliheuristic perspective in the framework of the Applied Decision Analysis matrix. With this methodology, the paper examines the effects of the outcome of the first decision, on the dimensions, dimension strategies and the final choice of alternatives in the second decision.

Invited commentary

The authors are to be commended for applying decision analysis to the vexing problem of how to measure the efficacy of treatment for symptomatic lower extremity atherosclerosis and for the choice to include in this analysis the majority of such patients—those with milder symptoms. Despite the limited data available to calibrate the outcome-based probability parameters, the authors’ model was fairly accurate in predicting the quality of life (QOL) and walking status of patients at 1 year. The truly disappointing findings were the actual QOL data: (1) significant benefit was noted only for those with the most severe disease who had surgical intervention and (2) medical therapy had no impact on QOL metrics. While one can quibble about whether other QOL questionnaires may have shown different results in this cohort, the data are sobering. Data like these have led health care payers, regulatory agencies, and patients themselves to question the efficacy of management approaches crafted over decades by vascular specialists. They also challenge our claim to superior knowledge and expertise in this arena. How should vascular surgeons respond? First, we must accept that our traditional objective end points of patency, ankle pressure, and rates of limb salvage and survival may not capture the outcomes most important to our patients, especially those with mild disease. Second, we must be committed to prospective analysis of outcomes of our patients with lower extremity atherosclerosis across the full spectrum of disease and apply the most modern methods of analysis to this task. The authors point out that better risk-adjusted outcomes data are needed to more accurately calibrate models such as theirs. It may be that accurate prospective QOL data on percutaneous treatments will provide a valid rationale for the application of these techniques to subsets of patients with earlier stages of disease. Third, we must take an active role in the development and testing of new methods of treatment for patients with mild disease. The ineffectiveness of current noninterventional therapy from the patient’s perspective is clear from this study. Finally, vascular surgeons must be open to the idea of incorporating data from a model such as this into actual clinical decision making. Such an application is premature at this point, but data-driven management protocols or guidelines are on the way, and vascular experts must contribute fundamentally to their development for the benefit of both our patients and our specialty. Prospective decision analysis for peripheral vascular disease predicts future quality of lifeJournal of Vascular SurgeryVol. 46Issue 4PreviewDecision making for peripheral vascular disease can be quite complex as a result of pre-existing compromise of patient functional status, anatomic considerations, uncertainty of favorable outcome, medical comorbidities, and limitations in life expectancy. The ability of prospective decision-analysis models to predict individual quality of life in patients with lower extremity arterial occlusive disease was tested. Full-Text PDF Open Archive

Decision Analysis in Planning for a Polio Outbreak in the United States

Global eradication of poliomyelitis may soon be achieved, but circulating polioviruses could reemerge years after eradication by reversion of live attenuated oral vaccine virus to a virulent form, laboratory stock mishandling, or bioterrorism. If a poliomyelitis outbreak occurs in the United States, access to a vaccine stockpile to interrupt viral spread will be necessary. Options for the stockpile include the inactivated polio vaccine and the live-attenuated trivalent and monovalent oral poliovirus vaccines. With differences in immunogenicity, adverse effects, availability, and other issues, the optimal vaccine choice for the stockpile is not clear. We sought to compare vaccine interventions for poliomyelitis outbreak control. We applied decision analysis to 8 strategies for outbreak control: no intervention, 1 or 2 inactivated polio vaccine doses, 1 or 2 trivalent oral poliovirus vaccine doses, 1 or 2 monovalent oral poliovirus vaccine doses, and sequential inactivated polio vaccine-monovalent oral poliovirus vaccine. Historical data from outbreaks in developed countries were used to estimate the risk of paralytic disease after a hypothetical reintroduction of circulating polioviruses. The outcome measure was cases of paralytic poliomyelitis. Monovalent oral poliovirus vaccine provided optimal outbreak control in most scenarios because of high seroconversion rates with 1 dose. Control provided by trivalent oral poliovirus vaccine and inactivated polio vaccine was equivalent at high vaccine coverage rates. At low intervention rates, trivalent oral poliovirus vaccine produced fewer paralytic cases than inactivated polio vaccine in highly immune populations but more cases than inactivated polio vaccine in poorly immunized groups because of secondary transmission of oral poliovirus vaccine virus and vaccine-derived viruses. This model suggests that monovalent oral poliovirus vaccine would be the most advantageous vaccine for outbreak control. If a monovalent oral poliovirus vaccine stockpile is impractical, the optimal vaccine choice depends on the previous immunity and the anticipated intervention rates.

Listening to the Salmon People: Coastal First Nations' Objectives Regarding Salmon Aquaculture in British Columbia

ABSTRACT The growth of salmon aquaculture on British Columbia's Pacific Coast is a source of substantial public controversy. Coastal indigenous people (First Nations), who have derived their culture and livelihood from wild salmon fisheries for thousands of years, have much at stake regarding salmon farm development in their traditional territories. This article considers the values of First Nations people regarding salmon aquaculture. It uses value-focused thinking, a problem-structure method from applied decision analysis, to characterize First Nations values about salmon aquaculture sites and facilities. It draws on interviews with First Nations people in four coastal communities, each of which has a different level of involvement in salmon aquaculture. The results can be used to create more attractive alternatives and to define information requirements for aquaculture decisions. The findings are an attempt to identify the criteria that should matter from the views of Coastal First Nations when making decisions about aquaculture development.

From the Editors…

This issue contains two articles on sequential decision making and dynamic programming, and two on military applications. Lim, Bearden, and J. C. Smith extend a typical search model to consider multiattribute options, while Bickel and J. E. Smith develop a novel method for finding the optimal policy in an oil exploration problem. Ewing, Tarantino, and Parnell describe an application of decision analysis that guided part of the U.S. Base Realignment and Closure program, and Klimack and Kloeber apply decision analysis to develop recommendations for improving the U.S. Army’s basic training program.

An Analysis of a Strategic Decision in the Sport of Curling

We apply decision analysis to an important decision in the sport of curling. In particular, we examine the choice between taking a single point or blanking an end in the latter stages of a curling game. There are benefits and drawbacks associated with each alternative. Taking a single point provides the team with an additional point but transfers the last-shot advantage to the opposition. Blanking an end foregoes an additional point but retains the last-shot advantage. Based on the observation of world-class competitions, North American curlers will always attempt to blank an end, while their European counterparts have been known to opt for the single point. We develop a decision tree to conceptualize the choices. Then, we use data from over 900 national championship curling games to empirically determine the expected values of each alternative. Our results indicate that blanking the end is the better alternative.

Applied Decision Analysis: Utilizing Poliheuristic Theory to Explain and Predict Foreign Policy and National Security Decisions

In recent years, more than 40 articles and chapters have utilized Poliheuristic Theory to analyze critical decisions made by foreign leaders and U.S. presidents. In this paper, I introduce the Poliheuristic Procedure—a series of steps that one can use to explain or predict decisions by world leaders. Subsequent articles in this Symposium present examples of poliheuristic analyses of decisions made by Presidents Carter, Clinton, Gorbachev, Mussaref and Saddam Hussein. These case studies provide strong support for Poliheuristic Theory: leaders use a two-stage process in making decisions: they first use simple heuristics to eliminate alternatives based on the avoid-major-political-loss principle, and then use more analytic calculations in selecting an alternative from a subset of surviving alternatives.

Learning as an objective within a structured risk management decision process.

Social learning through adaptive management holds the promise of providing the basis for better risk management over time. Yet the experience with fostering social learning through adaptive management initiatives has been mixed and would benefit from practical guidance for better implementation. This paper outlines a straightforward heuristic for fostering improved risk management decisions: specifying learning for current and future decisions as one of several explicit objectives for the decision at hand, drawing on notions of applied decision analysis. In keeping with recent guidance from two important U.S. advisory commissions, the paper first outlines a view of risk management as a policy-analytic decision process involving stakeholders. Then it develops the concept of the value of learning, which broadens the more familiar notion of the value of information. After that, the concepts and steps needed to treat learning as an explicit objective in a policy decision are reviewed. The next section outlines the advantages of viewing learning as an objective, including potential benefits from the viewpoint of stakeholders, the institutions involved, and for the decision process itself. A case-study example concerning water use forfisheries and hydroelectric power in British Columbia, Canada is presented to illustrate the development of learning as an objective in an applied risk-management context.

On the statistical foundations of non-linear utility theory: The case of status quo-dependent preferences

An account of non-expected utility is given which resumes concepts of μ– σ-analysis from statistical decision theory and combines them with standard principles of preference theory such as weak order, continuity and stochastic dominance. A three-parameter family of probability-dependent utility functions is specified, which is governed by the decision maker's aspiration level, distribution of present wealth, or status quo, and discount parameter for future risks. The approach offers a simple resolution of the Allais Paradox and explains basic patterns of probability-dependent risk attitudes arising in theoretical and applied decision analysis.

Health economics of a hexavalent meningococcal outer-membrane vesicle vaccine in children: potential impact of introduction in the Dutch vaccination program

The cost-effectiveness of universal vaccination of infants with a new hexavalent meningococcal B outer-membrane vesicle vaccine is projected for The Netherlands by applying decision analysis. The societal perspective is taken and direct and productivity costs (friction costs method) are considered. Future costs and effects are discounted at 4% (base year 1998). In this simulation model, vaccination would prevent 19 deaths and eight cases with severe long-term sequelae per year, rendering 526 additional quality adjusted life years (QALYs) per year. Yearly costs of acute phase of illness due to meningococcal infections in children are estimated at ▪ 1,426,634, while the future costs due to sequelae are estimated at ▪ 3,801,121 per year. Of all these costs, the vaccination program could prevent ▪ 3,334,052 per year. The program costs of meningococcal vaccination are estimated at ▪ 11,601,356, resulting in a cost-effectiveness ratio (CER) of ▪ 15,721 per QALY. These results are sensitive to the vaccine dose price (conservatively estimated at ▪ 10), efficacy, and coverage of meningococcal sero-subtypes.