BackgroundThe Analytic Hierarchy Process (AHP), developed by Saaty in the late 1970s, is one of the methods for multi-criteria decision making. The AHP disaggregates a complex decision problem into different hierarchical levels. The weight for each criterion and alternative are judged in pairwise comparisons and priorities are calculated by the Eigenvector method. The slowly increasing application of the AHP was the motivation for this study to explore the current state of its methodology in the healthcare context.MethodsA systematic literature review was conducted by searching the Pubmed and Web of Science databases for articles with the following keywords in their titles or abstracts: “Analytic Hierarchy Process,” “Analytical Hierarchy Process,” “multi-criteria decision analysis,” “multiple criteria decision,” “stated preference,” and “pairwise comparison.” In addition, we developed reporting criteria to indicate whether the authors reported important aspects and evaluated the resulting studies’ reporting.ResultsThe systematic review resulted in 121 articles. The number of studies applying AHP has increased since 2005. Most studies were from Asia (almost 30 %), followed by the US (25.6 %). On average, the studies used 19.64 criteria throughout their hierarchical levels. Furthermore, we restricted a detailed analysis to those articles published within the last 5 years (n = 69). The mean of participants in these studies were 109, whereas we identified major differences in how the surveys were conducted. The evaluation of reporting showed that the mean of reported elements was about 6.75 out of 10. Thus, 12 out of 69 studies reported less than half of the criteria.ConclusionThe AHP has been applied inconsistently in healthcare research. A minority of studies described all the relevant aspects. Thus, the statements in this review may be biased, as they are restricted to the information available in the papers. Hence, further research is required to discover who should be interviewed and how, how inconsistent answers should be dealt with, and how the outcome and stability of the results should be presented. In addition, we need new insights to determine which target group can best handle the challenges of the AHP.
Although a shift towards care that is more integrated is required, the concept of integrated care is ambiguous. Consequently, an instrument to systematically describe and measure integrated careis not yet available. The objective of this study was to develop a preliminary version of this instrument. We performed a systematic literature review and a 2-round Delphi study among Dutch scientific and field experts on integrated care. Based on this study 40 determinants were identified, operationalization of these determinants led to an instrument containing 89 items. A first assessment of the instruments usability and validity was executed on 15 reports, with a fixed format and predefined objectives, of integrated care projects from national programs on elderly care, community nurses and disease management. Assessment of this instrument showed the diverse nature of integrate care in practice. Also, it provided many suggestions for improving the instrument. The preliminary instrument is an important first step in specifying integrated care and making the concept measurable. Such an instrument can benefit policy makers as well as funding agencies and health insurers. Further development requires (international) validation and evidence. Therefore, application of the instrument in Singapore and Belgium is planned in the near future.
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