Abstract
Decisions, which are responses to questions such as “What shall we do?” and scientific conclusions, which are responses to questions such as “What are the facts?” are sufficiently different to justify the development of a decision methodolgy different from the classical Scientific Method which guides scientific research.
The environment in which health care decisions are embedded, i.e., the life cycle of a health program or project, imposes requirements for a capability to communicate, discuss, review, and track the factors on which decisions are based. The information elements needed for decision making (alternatives, states, outcomes, risk, values), as well as the process needed to generate these decision elements, are described and the additional requirements which they impose on a decision methodology (rationality and the early formulation of an evaluation model) are identified.
Decision and utility theory provide a philosophical framework plus two essential ingredients for explicitly implementing the decision process: (1) a rational basis for explicitly measuring preferences (value judgments) on a “utility” scale and (2) a rational rule for making decisions when outcomes are uncertain, i.e., maximize expected utility.
A general objective function which combines measures of value (utility) and estimates of risk (probability) into an expression representing the computation of expected utility is presented and discussed. The objective function and the relationships of its elements to the activities of the decision process are illustrated with a relatively simple example. Some implications of simplified special cases of the general objective function are pointed out.
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References
Asimow, Morris. Introduction to design. Englewood Cliffs, New Jersey: Prentice-Hall, 1962.
Bentham, Jeremy. An introduction to the principles of morals and legislation. New York: Hafner Publishing Co., 1948.
Betaque, N. E., andG. A. Gorry. Automating judgmental decision making for a serious medical problem.Management Science, 1971,17, B421-B434.
Borel, E. Probability and certainty. New York: Walker and Co., 1963.
Cutler, R. S., and Martino, V. A. Biomedical research relevance criteria. National Bureau of Standards, NBS Project 4314560, NBS Report 10423. June 30, 1971.
Dalkey, N., and Rourke, D. L. Experimental assessment of delphi procedures with group value judgments. Santa Monica, Calif.: Rand Report R-612-ARPA, February 1971.
De Neufville, R., andKeeney, R. L. Use of decision analysis in airport development for Mexico City. In A. W. Drake, R. L. Keeney, and P. M. Morse (Eds.),Analysis of public systems. Cambridge, Mass.: MIT Press. 1972.
Du Charme, W. M. A response bias explanation of conservative human inference. Ann Arbor Mich.: Department of Psychology, Human Performance Center, University of Michigan, Tech. Report No. 19, December 1969.
Edgeworth, Francis Y. Mathematical physica. London: Kegan Paul, 1881.
Edwards, Ward. The Theory of decision making.Psychological Bulletin 1954,51, 380–417.
Edwards, W., Lindman, H., andSavage, L. J., Bayesian statistical reference for psychological research.Psychological Review 1963,70, 193–242.
Ginsberg, A. S., andOffensend, F. L. An Application of decision theory to a medical diagnosistreatment problem.IEEE Trans. Systems Science and Cybernetics 1968,SSC-4, 355–362.
Goerke, Lenor S., and Stebbins, Ernest L. Mustard's introduction to public health (Fifth ed.). New York: The MacMillan Company.
Goldberg, L. R. Simple models or simple processes? Some research on clinical judgments.American Psychologist 1968,23, 483–496.
Goodman, B. C. Risky decisions by individuals and groups. Ann Arbor, Mich.: Human Performance Center, Department of Psychology, University of Michigan, Tech. Report No. 21, June 1970.
Hahn, G. J., andShapiro, S. S., Statistical models in engineering. New York: Wiley, 1967.
Hall, A. D. Three-dimensional morphology of systems engineering.IEEE Trans. Systems Science and Cybernetics. 1969,SSC-5, 156–160.
Kahneman, D. andA. Tversky. Subjective probability: a judgment of representativeness.Cognitive Psychology, 1972,3, 430–454.
Kauder, E. Genesis of the marginal utility theory from Aristotle to the end of the Eighteenth Century.Economics Journal 1953,63, 638–650.
Keller, W. F. Development of an evaluation model for mass transit. Ph.D. dissertation, UCLA School of Engineering and Applied Science. Los Angeles. 1972.
Leonardz, B., andvon Holstein, C. S. Stael. A comparison between Bayesian and classical methods for estimating unknown probabilities. Providence, RI: Brown University Division of Applied Mathematics. Tech. Rep. No. 3, March 1967.
Lifson, M. W.. Decision and risk analysis. Boston: Cahners, 1972.
Luce, R. Duncan, andRaiffa, H. Games and decisions. New York: Wiley, 1958.
Lusted, L. B. Introduction to medical decision making. Springfield, Ill.: Charles C. Thomas, 1968.
Lusted, L. B. Computer techniques for decision making in diagnostic radiology. XII International Congress of Radiology. Tokyo, Japan: October 1969.
Lusted, L. B. Decision-making studies in patient managment.New England Journal of Medicine 284, 1971,25, 416–424.
Masse, P. Optimal investment decisions: rules for action and criteria for choice. Englewood Cliffs: Prentice-Hall, 1962.
Milnor, John. Games against nature. In R. M. Thrall, C. H. Coombs, and R. L. Davis. (Eds.)Decision process. New York: Wiley, 1954, pp. 49–59.
Northrop, G. M. et al. A cost effectiveness methodology for environmental data collection systems. U.S. Department of Commerce, National Oceanic and Atmospheric Administration, NDBPM Wo 130-1, 31 December 1970.
Raiffa, H. Decision analysis. Reading, Mass.: Addison-Wesley, 1968.
Rosenstein, A. E. A national professions of statistics. New York: Wiley, 1954.
Savage, Leonard J. The foundations of statistics. New York: Wiley, 1954.
Slovic, P., andLichtenstein, S. Comparison of Bayesian and regression approaches to the study of information processing in judgment. Eugene, Oregon: Oregon Research Institute, Research Monograph10, No. 1, 1970.
Smith, David E. History of mathematics. Boston: Ginn and Co., 1925, Vol. 11.
Stigler, G. J. The development of utility theory.Journal of Political Economy 1950, Part I, p. 307–327; Part II, p. 373–396.
Swalm, R. O. Utility theory—insights into risk taking.Harvard Bus. Review 1966, Nov.–Dec.
Tribus, Myron, Physical view of cloud seeding.Science 1970,168, No. 3928.
Tukey, J. W. Conclusions vs. decisions.Technometrics 1960,2, 423–433.
von Neumann, J., andMoggenstern, O. Theory of games and economic behavior. Princeton: Princeton University Press, 1953.
Websters Third New International Dictionary. Springfield, Mass.: G. & C. Merriam Co., 1961.
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Lifson, M.W. Decisions, decisions, decisions. Ann Biomed Eng 1, 285–315 (1973). https://doi.org/10.1007/BF02407671
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DOI: https://doi.org/10.1007/BF02407671