A consensus-based decision model for assessing the health systems

Abstract

Many countries and international organisations have been developing health system performance assessment frameworks and indicators to support healthcare management and inform public health policy. Effectiveness, accessibility, safety and patient-centeredness were four dimensions that were most commonly measured. This paper develops a new consensus-based decision model to assess the health systems, in which different stakeholders of healthcare systems are identified by different decision approaches, i.e., the coefficient variation approach, the Shannon entropy approach and the distance-based approach, respectively. The consensus result is obtained by minimizing the total deviation from the ideal point. A numerical illustration with simulated data is presented to show the effectiveness of our model.

A Framework for Assessing the Impact of Accelerated Approval

“…The framework proposed here differs from decision science based methods that have been described previously in that stakeholders decide on a course of action that reflects stakeholder-specific values by an objective, transparent, and reproducible process that differs among stakeholders only with respect to the stakeholder-specific actions and values. Stakeholders could reach different action decisions, possibly at different points in time, so that there may be no immediate determination of ‘consensus’ (as opposed to the decision model described by Xu et al [13]). It also has a different aim from methods that focus on sponsor decisions about confirmatory or post-POC study designs, and how these design options could affect outcomes, utility, and future (post-approval) decisions by stakeholders.…”

“…At its most basic level, the decision process amounts to generating an action about treatment, e.g., a1 = "Refuse treatment", a2 = "Accept treatment", a3 = "Delay/defer treatment", p. 13 The third possibility, "Delay/defer treatment" allows for some hedging, e.g., to obtain further information about the anticipated effect of treatment by consultation with other specialists, or to consider further the implications about the uncertainty of the predicted outcome due to the limited information from the AA trials. The action taken depends on the information that efficacy and toxicity findings from the AA trials provide and the anticipated relevance for the individual patient.…”

“…The specificity of the values for different stakeholders means that the stakeholders could reach different action decisions, possibly at different points in time, so that there may be no immediate determination of 'consensus'. Consequently, the common framework approach described here differs from the consensus-based decision model for assessing health systems described by Xu et al [13] in which different statistical decision methods employed by stakeholders with a common objective are integrated to reach a consensus. It also differs from previous applications of decision science methods that focus on sponsor decisions about confirmatory or post-POC study designs, and how these design options could affect outcomes, utility, and future (post-approval) decisions by stakeholders.…”

A framework for assessing the impact of accelerated approval

“…The framework proposed here differs from decision science based methods that have been described previously in that stakeholders decide on a course of action that reflects stakeholderspecific values by an objective, transparent, and reproducible process that differs among stakeholders only with respect to the stakeholder-specific actions and values. Stakeholders could reach different action decisions, possibly at different points in time, so that there may be no immediate determination of 'consensus' (as opposed to the decision model described by Xu et al [13]). It also has a different aim from methods that focus on sponsor decisions about confirmatory or post-POC study designs, and how these design options could affect outcomes, utility, and future (post-approval) decisions by stakeholders.…”

“…The specificity of the values for different stakeholders means that the stakeholders could reach different action decisions, possibly at different points in time, so that there may be no immediate determination of 'consensus'. Consequently, the common framework approach described here differs from the consensus-based decision model for assessing health systems described by Xu et al [13] in which different statistical decision methods employed by stakeholders with a common objective are integrated to reach a consensus. It also differs from previous applications of decision science methods that focus on sponsor decisions about confirmatory or post-POC study designs, and how these design options could affect outcomes, utility, and future (postapproval) decisions by stakeholders [14][15][16][17][18].…”