Performance Effects Related to the Sequence of Integration of Healthcare Technologies

There is a natural order to most events in life: Everything from learning to read to DNA sequences in molecular biology follows some predetermined, structured methodology that has been refined to yield improved results. Likewise, it would seem that firms could benefit by adopting and implementing technologies in some logical way so as to increase their overall performance. In this study of 555 hospitals, we investigate the order in which medical technologies are transformed into information technologies through a process of converting them from stand‐alone technologies to interoperable, integrated information systems and whether certain configurations of sequences of integration yield additional value. We find that sequence does matter and that hospitals that integrated foundational technologies first—which in this case are known to be more complex—tend to perform better. Theoretical and practical implications of this finding and others are discussed.     

Modeling marginal features in studies of recurrent events in the presence of a terminal event

We study models for recurrent events with special emphasis on the situation where a terminal event acts as a competing risk for the recurrent events process and where there may be gaps between periods during which subjects are at risk for the recurrent event. We focus on marginal analysis of the expected number of events and show that an Aalen–Johansen type estimator proposed by Cook and Lawless is applicable in this situation. A motivating example deals with psychiatric hospital admissions where we supplement with analyses of the marginal distribution of time to the competing event and the marginal distribution of the time spent in hospital. Pseudo-observations are used for the latter purpose.

     

A Swiss Longitudinal Study of the Prevalence of,and Overlap Between,Sexual Problems in Men and Women Aged 20 to 50 Years Old

The aim of this study was to obtain data on the development and course of sexual problems and their interrelationships by investigating a representative sample of men and women over a period of 30 years. A representative sample of 299 women selected from the complete electoral register and 292 men selected from screening lists for military service in Zurich, Switzerland, answered questions about their sexuality as part of a series of seven interviews between ages 20 (1979) and 50 (2008). Of the initial sample of 591 participants, 43% (57% of them male) were lost to follow-up. Interviews were conducted using the Structured Psychopathological Interview and Rating of the Social Consequences of Psychological Disturbances for Epidemiology (SPIKE), a semistructured interview. Sexual problems were identified on the basis of the study participants’ self-appraisal. One-year prevalence rates, lifetime risks, and overlap of functional, emotional, and sexual desire problems in men and women were evaluated. The findings confirmed higher lifetime risks in women than in men for any sexual problem (females 67.0%; males 46.0%) and for functional (39.3%; 22.1%), emotional (35.7%; 15.9%), and sexual desire problems (51.6%; 33.3%). While in general men's sexual problems increased with age, no such association was observed in women. The overlap of all three problems (functional, emotional, and sexual desire) was reported by 16.9% of women but only 5.0% of men. Although there are commonalities, the type but also the development and, in particular, the overlap of sexual problems in women and men are markedly different.     

Event dependent sampling of recurrent events

The effect of event-dependent sampling of processes consisting of recurrent events is investigated when analyzing whether the risk of recurrence increases with event count. We study the situation where processes are selected for study if an event occurs in a certain selection interval. Motivation comes from psychiatric epidemiology where repeated hospital admissions are studied for patients with affective disease, as seen in Kessing et al. (Acta Psychiatr Scand 109:339–344, 2004b). For the selected processes, either only disease course from selection and onwards is used in the analysis, or, both retrospective and prospective disease course histories are used. We examine two methods to correct for the selection depending on which data are used in the analysis. In the first case, the conditional distribution of the process given the pre-selection history is determined. In the second case, an inverse-probability-of-selection weighting scheme is suggested. The ability of the methods to correct for the bias due to selection is investigated with simulations. Furthermore, the methods are applied to affective disease data from a register-based study (Kessing et al. Br J Psychiatry 185:372–377, 2004a) and from a long-term clinical study (Kessing et al. Acta Psychiatr Scand 109:339–344, 2004b).     

Delegation and motivation

We investigate the determinants of decision rights transfer and its effects on the motivation of an agent. The study is based on a laboratory experiment conducted on 130 subjects playing an innovative principal–agent game. Interestingly, the results show that agents do not favour a delegation and a decision is considered rather burdensome. Although the experiment could not give support for the behavioural hypothesis of higher effort provided by participants who receive choice subsequently, the survey illuminates the interaction between delegation motives, effort motivators, goals and other perceptions of the agents.