Threshold setting and the cycling of a decision threshold

Weaver, Elise A.; Richardson, George P.

doi:10.1002/sdr.327

Cited by 20 publications

(17 citation statements)

References 11 publications

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“…We do not mean to imply that physicians actually perceive patients’ symptoms and outcomes in precisely this manner, only that this can be a parsimonious way to model their influence on referral processes. Consistent with regret theory [46, 47] and the approach of a prior SD model of policy threshold oscillations [48], our model focuses only on the influence of errors and does not explicitly incorporate correct decisions. As originally described by Peirce [49], the net benefit associated with a decision can be defined as a function of the number and marginal utility of TP and FP outcomes.…”

Section: Methodsmentioning

confidence: 99%

A system dynamics model of clinical decision thresholds for the detection of developmental-behavioral disorders

et al. 2016

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BackgroundClinical decision-making has been conceptualized as a sequence of two separate processes: assessment of patients’ functioning and application of a decision threshold to determine whether the evidence is sufficient to justify a given decision. A range of factors, including use of evidence-based screening instruments, has the potential to influence either or both processes. However, implementation studies seldom specify or assess the mechanism by which screening is hypothesized to influence clinical decision-making, thus limiting their ability to address unexpected findings regarding clinicians’ behavior. Building on prior theory and empirical evidence, we created a system dynamics (SD) model of how physicians’ clinical decisions are influenced by their assessments of patients and by factors that may influence decision thresholds, such as knowledge of past patient outcomes. Using developmental-behavioral disorders as a case example, we then explore how referral decisions may be influenced by changes in context. Specifically, we compare predictions from the SD model to published implementation trials of evidence-based screening to understand physicians’ management of positive screening results and changes in referral rates. We also conduct virtual experiments regarding the influence of a variety of interventions that may influence physicians’ thresholds, including improved access to co-located mental health care and improved feedback systems regarding patient outcomes.ResultsResults of the SD model were consistent with recent implementation trials. For example, the SD model suggests that if screening improves physicians’ accuracy of assessment without also influencing decision thresholds, then a significant proportion of children with positive screens will not be referred and the effect of screening implementation on referral rates will be modest—results that are consistent with a large proportion of published screening trials. Consistent with prior theory, virtual experiments suggest that physicians’ decision thresholds can be influenced and detection of disabilities improved by increasing access to referral sources and enhancing feedback regarding false negative cases.ConclusionsThe SD model of clinical decision-making offers a theoretically based framework to improve understanding of physicians’ behavior and the results of screening implementation trials. The SD model is also useful for initial testing of hypothesized strategies to increase detection of under-identified medical conditions.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0517-0) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

A system dynamics model of clinical decision thresholds for the detection of developmental-behavioral disorders

et al. 2016

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“…Green and Swets, 1966;Hammond, 1996), which can be used to decide an appropriate threshold for that safety indicator; and the system dynamics model (e.g. Forrester, 1961;Swets et al, 1991;Weaver and Richardson, 2002), a computer simulation tool that can be used to investigate a regulatory structure to allow for changes to the indicator threshold over time and across contexts.…”

Section: Discussesmentioning

confidence: 99%

Performance-based building regulation: current situation and future needs

Meacham¹,

Bowen

Traw³

et al. 2005

Building Research & Information

107

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Although performance-based building regulations are in use or under development in numerous countries worldwide, there remain significant challenges in adequately identifying and defining performance, in understanding and addressing diverse societal expectations, and in establishing robust performance-based regulatory systems. These challenges become intensified as the building construction market becomes increasingly global, with the resulting expectation that building regulatory instruments remain valid across borders and do not create barriers to trade, while at the same time address local and national needs without compromising local cultural and societal norms. Many of these issues are just now beginning to be explored, and there is significant opportunity and need for future research and development in these areas.Bien que les réglementations concernant les bâ timents axés sur la performance soient déjà appliquées ou en cours d'élaboration dans de nombreux pays, de graves difficultés persistent lorsqu'il s'agit de cerner et de définir comme il convient la performance, de comprendre et de répondre aux diverses attentes de la société et d'établir de solides systèmes de réglementation basés sur la performance. Ces difficultés s'accroissent à mesure que le marché du bâ timent se mondialise; il faut alors espérer que les moyens réglementaires propres au secteur du bâ timent seront applicables dans tous les pays, ne feront pas obstacle aux échanges tout en permettant de satisfaire les exigences locales et nationales sans compromettre les normes culturelles et sociétales locales. Pour l'heure, bon nombre de ces questions ne sont qu'effleurées; d'immenses possibilités s'offrent à la recherche et au développement dans ce domaine où les besoins sont nombreux.

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“…Consequently, one would expect an adaptation of the decision threshold in order to reduce the number of false positives. This mechanism would, in other words, give rise to ''cycling of decision thresholds'' (Weaver and Richardson 2006). From an efficiency point of view, it would be better to avoid this mechanism.…”

Section: Discussionmentioning

confidence: 99%

The economics of pre-crime interventions

Wijck

2011

Eur J Law Econ

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Several observers suggest that we may have undergone a shift from a post-crime to a pre-crime society in which the principal focus has become the pursuit of security by anticipating and forestalling future harms, rather than responding retrospectively to harms that have actually happened. This paper is about the economics of pre-crime interventions. It investigates the welfare consequences of risk assessment and early interventions to prevent individuals from engaging in criminal activities. Furthermore, it deals with the question of what constitutes an optimal application of risk assessment and early intervention. Finally, it presents three rules of thumb to identify conditions where pre-crime intervention may be welfare enhancing.

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Threshold setting and the cycling of a decision threshold

Cited by 20 publications

References 11 publications

A system dynamics model of clinical decision thresholds for the detection of developmental-behavioral disorders

A system dynamics model of clinical decision thresholds for the detection of developmental-behavioral disorders

Performance-based building regulation: current situation and future needs

The economics of pre-crime interventions

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