Relative Importance Of Quality Research Articles

Parent Priorities in End-of-Life Care for Children With Cancer

Robust quality measures to benchmark end-of-life care for children with cancer do not currently exist; 28 candidate patient-centered quality measures were previously developed. To prioritize quality measures among parents who lost a child to cancer. This survey study was conducted using an electronic, cross-sectional discrete choice experiment (DCE) with maximum difference scaling from January to June 2021 in the US. In each of 21 questions in the DCE, participants were presented with a set of 4 quality measures and were asked to select the most and least important measures within each set. All 28 quality measures were presented an equal number of times in different permutations. In the volunteer sample, 69 eligible bereaved parents enrolled in the study; 61 parents completed the DCE (participation rate, 88.4%). Using choices participants made, a hierarchical bayesian multinomial logistic regression was fit to derive mean importance scores with 95% credible intervals (95% Crs) for each quality measure, representing the overall probability of a quality measure being selected as most important. Importance scores were rescaled proportionally from 0 to 100, with the sum of scores for all quality measures adding up to 100. This enabled interpretation of scores as the relative importance of quality measures. Participants included 61 bereaved parents (median [range] age, 48 [24-74] years; 55 individuals self-identified as women [90.2%]; 1 American Indian or Alaska Native [1.6%], 1 Asian [1.6%], 2 Black or African American [3.3%], 1 Native Hawaiian or Pacific Islander, and 58 White [91.8%]; 58 not Hispanic or Latinx [95.1%]). Highest-priority quality measures by mean importance score included having a child's symptoms treated well (9.25 [95% Cr, 9.06-9.45]), feeling that a child's needs were heard by the health care team (8.39 [95% Cr, 8.05-8.73]), and having a goal-concordant end-of-life experience (7.45 [95% Cr, 6.84-8.05]). Lowest-priority quality measures included avoiding chemotherapy (0.33 [95% Cr, 0.21-0.45]), provision of psychosocial support for parents (1.01 [95% Cr, 0.57-1.45]), and avoiding the intensive care unit (1.09 [95% Cr, 0.74-1.43]). Rank-ordering measures by mean importance revealed that symptom management was 9 times more important to parents than psychosocial support for themselves. This study found that bereaved parents prioritized end-of-life quality measures focused on symptom management and goal-concordant care while characterizing quality measures assessing their own psychosocial support and their child's hospital resource use as substantially less important. These findings suggest that future research should explore innovative strategies to measure care attributes that matter most to families of children with advanced cancer.

Patient-defined goals and preferences among adults with advanced neuroendocrine tumors.

509 Background: Patient values toward treatment goals and competing health outcomes among adults with neuroendocrine tumors (NETs) are not well understood. The goal of this study was to identify NET patient values towards treatment goals and health outcomes. Methods: Patients with well-differentiated, grade 1/2, advanced NETs starting a new systemic therapy were recruited at a National Cancer Institute-designated cancer center. Patients completed four tools: 1) Health Outcomes Tool: ranks importance of four outcomes (survival, function, freedom from pain, freedom from symptoms); 2) Attitude Scale: identifies the extent to which patients agree with statements related to health outcomes; 3) Now versus Later Tool: ranks relative importance of quality of life (QOL) now, one year from now, and five years from now; and 4) Prognosis and Treatment Perceptions Questionnaire: identifies the amount of information patients prefer to receive about their disease and treatment, patient’s goal of treatment, physician’s goal of treatment (patient’s perception), and self-reported health status. Results: Sixty patients (50.0% ≥65 years) completed the questionnaires. Ninety-seven percent had stage IV disease. Primary tumor locations included gastrointestinal tract (41.7%), pancreas (30.0%), and lung (21.7%). Sixty percent of patients had received at least one prior systemic therapy. Only 30.0% of patients chose survival as their most important treatment outcome on the Health Outcomes Tool. The remaining 70.0% chose maintaining independence (46.7%), freedom from pain (11.7%), and freedom from symptoms (11.7%) as their most important health outcome. Similarly, on the Attitude Scale, 66.7% of patients agreed with: “I would rather live a shorter life than lose my ability to take care of myself”; 85.0% agreed with: “It is more important to me to maintain my thinking ability than to live as long as possible.” Ninety-three percent of patients agreed with: “I am willing to have side effects right now if it means I could have a better quality of life in the future.” Moreover, on the Now versus Later Tool, 48.3% of patients considered QOL one year in the future more important than their current QOL; 40.0% considered QOL five years in the future more important than their current QOL. On the Prognosis and Treatment Perceptions Questionnaire, only 30.0% of patients chose “To extend my life as long as possible” as their primary treatment goal, but 40.0% believed survival was their oncologist’s primary treatment goal. Furthermore, only 51.7% of patients believed they had the same treatment goal as their oncologist. Across all questionnaires, there were no significant differences between the responses of younger and older patients. Conclusions: NET patients value independence more than survival. More communication between NET patients and physicians is needed to ensure patient preferences and values are incorporated into treatment plans.

A Qualitative Analysis of Innovation Adoption in the Olive Oil Extraction Process

Pressures on the Italian olive oil sector have increased over the past few years due to seasons of bad weather, small innovation capacity and limited long-term investment plans. Thus, it is of interest to explore signs of positive attitude towards innovation investment in the agricultural sector. The focus has been on technologies employed in the extraction process, since yield and quality of olive oil are mostly affected by this stage. To define the determinants of innovation adoption, 13 managers were interviewed. Questions covered organisation factors, personal factors, social factors, the impact of the olive oil value chain and the cost of the extraction machinery. The results of the thematic analysis showed that determinants of innovation adoption were: perceived usefulness, personal innovativeness, prior experience, influence of peers, training and managerial support, and the relative importance of quality, while major challenges are the lack of financial funds, demand pressure from customers, and lack of early warning systems to tackle bad weather conditions.

Insights into the Antecedents of Fast-Food Purchase Intention and the Relative Positioning of Quality

ABSTRACTThis research develops and tests a theoretical framework that posits and examines factors affecting purchase intention in the fast-food industry. This study proposes a research model and investigates the complex interrelationships portrayed in the model after extracting relevant antecedents from the extant literature and contextualizing them to the fast-food restaurant industry. Anchored in the theoretical framework of social identity theory (Tajfel and Turner 1979), the theory of reasoned action (Fishbein and Ajzen 1975), and signaling theory (Spence 1973), this article evaluates the relationships among antecedents by using a survey to explore the consumer decision-making process and then by evaluating the proposed framework through partial least squares structural equation modeling (PLS-SEM).This study contributes to the extant literature by: a) identifying antecedent constructs of purchase intention within the fast-food industry; b) integrating these constructs into the first fast-food purchase intention model; c) providing practitioners an opportunity to tailor their marketing initiatives to specific consumer segments using importance-performance map analysis at both the construct and indicator levels; d) supporting a unique platform for benchmarking against existing brands in the same industry and brands from other industries. Findings also suggest that though quality is important, other antecedents account for more variation in why consumers intend to purchase fast food. Such a finding is actually positive if it implies a relatively high level of quality is homogeneous and expected within the industry, but the relative importance of quality has important implications for future research directions and provides insights for quality professionals.

Platform or Wholesale? A Strategic Tool for Online Retailers to Benefit from Third-Party Information

Online retailing is dominated by a channel structure in which a retailer either buys products from competing manufacturers and resells to consumers (wholesale scheme) or lets manufacturers directly sell to consumers on its platform for a commission (platform scheme). Easy access to publicly available third-party information such as product reviews which facilitate consumers' purchase decisions is another distinctive and ubiquitous characteristic of online retailing. We show that retailers can use the upstream pricing scheme, wholesale or platform, as a strategic tool to benefit from third-party information. Information on the quality dimension homogenizes consumers' perceived utility differences between competing products and increases the upstream competition, which benefits the retailer under the wholesale scheme but hurts the retailer under the platform scheme. Information on the fit dimension heterogenizes consumers' estimated fits to the products and softens the upstream competition, which hurts the retailer under the wholesale scheme but benefits the retailer under the platform scheme. Consequently, when the precision of the third-party information is high (low), a retailer can benefit from third-party information by adopting the wholesale (platform) scheme if the quality dimension plays a dominant role and by adopting the platform (wholesale) scheme if the fit dimension plays a dominant role. Furthermore, the effect of precision improvement on the retailer's profit depends on pricing scheme choice and relative importance of quality and fit attributes in consumers' evaluation of products. For instance, when the fit dimension plays a dominant role, increasing the precision can hurt the retailer under wholesale scheme but benefit under platform scheme.

Qualities Perceived by Israeli Psychiatric Residents to Be Most Important to Them in a Mentor and a Mentoring Relationship

Introduction Residency is a crucial period in the medical education continuum. Studies have shown the importance of a good developmental relationship (mentoring) as a key factor for professional success in medicine. Israeli organizational culture at academic health centers does not support a formal mentoring program. Objectives This study is part of a research program aimed at improving residency in Israel by understanding the characteristics of Israeli residents. Aims Identify the personal, academic and organizational qualities perceived by Israeli residents to be most important in a mentor. Methods Israeli psychiatric residents were asked to complete 2 anonymous questionnaires that assess the relative importance of qualities for a good mentor on a five-point Likert scale: the 34-item Ideal Mentor Scale(IMS) and the 40-item Qualities of a Good Mentor Scale (QGMS). Results A total of 63 residents from 13 programs completed the questionnaires. In the IMS most emphasis was on the Integrity subscale representing a mentoring style that embodies respectfulness, empowers to make deliberate, conscious choices, exhibits virtue and principled action and is worthy of emulation as a role model over an academic guide, supervisor, researcher or friend. This tendency was marked in centrally located training programs over peripheral ones. QGMS shows this tendency increase the more years the resident in residency. Conclusions The Israeli resident seems to need a nurturing parental mentor, someone to believe in him and see his unique potential over an academic mentor promoting research. This tendency is discussed as a part of the historical change in medical education.

Platform or Wholesale? Different Implications for Retailers of Online Product Reviews

Online retailing is dominated by a channel structure in which a retailer either buys products from competing manufacturers and resells to consumers (wholesale scheme) or lets manufacturers directly sell to consumers on its platform for a commission (platform scheme). Easy access to publicly available third-party information such as product reviews which facilitate consumers' purchase decisions is another distinctive and ubiquitous characteristic of online retailing. We show that retailers can use the upstream pricing scheme, wholesale or platform, as a strategic tool to benefit from third-party information. Information on the quality dimension homogenizes consumers' perceived utility differences between competing products and increases the upstream competition, which benefits the retailer under the wholesale scheme but hurts the retailer under the platform scheme. Information on the fit dimension heterogenizes consumers' estimated fits to the products and softens the upstream competition, which hurts the retailer under the wholesale scheme but benefits the retailer under the platform scheme. Consequently, when the precision of the third-party information is high (low), a retailer can benefit from third-party information by adopting the wholesale (platform) scheme if the quality dimension plays a dominant role and by adopting the platform (wholesale) scheme if the fit dimension plays a dominant role. Furthermore, the effect of precision improvement on the retailer's profit depends on pricing scheme choice and relative importance of quality and fit attributes in consumers' evaluation of products. For instance, when the fit dimension plays a dominant role, increasing the precision can hurt the retailer under wholesale scheme but benefit under platform scheme.

The Relative Importance of Quality of Care Information When Choosing a Hospital for Surgical Treatment: A Hospital Choice Experiment

The Relative Importance of Quality of Care Information When Choosing a Hospital for Surgical Treatment: A Hospital Choice Experiment

Update on Anemia Management in Nephrology, Including Current Guidelines on the Use of Erythropoiesis-Stimulating Agents and Implications of the Introduction of “Biosimilars”

Several million patients with chronic kidney disease (CKD) have benefited from the use of erythropoiesis-stimulating agents (ESAs) to correct severe anemia. However, mortality data now suggest that treating CKD patients to achieve a hemoglobin (Hb) level >13 g/dl can be harmful. For levels of 11.5-13 g/dl, there is no evidence of either harm or benefit compared with a lower Hb level. Quality of life studies are variable in quality but do suggest superior outcomes and functional status. In the 9 years following 1997, the target Hb level recommended by international guidelines tended to increase, especially for patients without accompanying cardiovascular disease. However, strangely enough, the most recent target level of the Kidney Disease Outcomes Quality Initiative is 11-12 g/dl, which is exactly the range advocated by the same group a decade earlier. The relative importance of quality of life compared with other outcomes, the use of iron, and the impact of venous thrombotic events continue to be debated. In addition, new issues have arisen from the introduction of "biosimilar" erythropoietins, biopharmaceuticals that refer to the existing agents and are submitted for marketing authorization after the existing agents' protection expires. Biosimilars can resemble the agents on which they are modeled but cannot fully copy their properties. The complexity in molecular structure, the possible presence of impurities (which may include bacterial endotoxins), and the inherent immunogenicity of such agents have required authorities to develop a sophisticated regulatory framework.