Browsing by Author "Carlson, KA"

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Open Access
Improving the generation of decision objectives
(Decision Analysis, 2010-09-01) Bond, SD; Carlson, KA; Keeney, RL
Real decision makers exhibit significant shortcomings in the generation of objectives for decisions that they face. Prior research has illustrated the magnitude of this shortcoming but not its causes. In this paper, we identify two distinct impediments to the generation of decision objectives: not thinking broadly enough about the range of relevant objectives, and not thinking deeply enough to articulate every objective within the range that is considered. To test these explanations and explore ways of stimulating a more comprehensive set of objectives, we present three experiments involving a variety of interventions: the provision of sample objectives, organization of objectives by category, and direct challenges to do better, with or without a warning that important objectives are missing. The use of category names and direct challenges with a warning both led to improvements in the quantity of objectives generated without impacting their quality; other interventions yielded less improvement. We conclude by discussing the relevance of our findings to decision analysis and offering prescriptive implications for the elicitation of decision objectives. © 2010 INFORMS.
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Study protocol: home-based telehealth stroke care: a randomized trial for veterans.
(Trials, 2010-06-30) Chumbler, NR; Rose, DK; Griffiths, P; Quigley, P; McGee Hernandez, N; Carlson, KA; Vandenberg, P; Morey, MC; Sanford, J; Hoenig, H
BACKGROUND: Stroke is one of the most disabling and costly impairments of adulthood in the United States. Stroke patients clearly benefit from intensive inpatient care, but due to the high cost, there is considerable interest in implementing interventions to reduce hospital lengths of stay. Early discharge rehabilitation programs require coordinated, well-organized home-based rehabilitation, yet lack of sufficient information about the home setting impedes successful rehabilitation. This trial examines a multifaceted telerehabilitation (TR) intervention that uses telehealth technology to simultaneously evaluate the home environment, assess the patient's mobility skills, initiate rehabilitative treatment, prescribe exercises tailored for stroke patients and provide periodic goal oriented reassessment, feedback and encouragement. METHODS: We describe an ongoing Phase II, 2-arm, 3-site randomized controlled trial (RCT) that determines primarily the effect of TR on physical function and secondarily the effect on disability, falls-related self-efficacy, and patient satisfaction. Fifty participants with a diagnosis of ischemic or hemorrhagic stroke will be randomly assigned to one of two groups: (a) TR; or (b) Usual Care. The TR intervention uses a combination of three videotaped visits and five telephone calls, an in-home messaging device, and additional telephonic contact as needed over a 3-month study period, to provide a progressive rehabilitative intervention with a treatment goal of safe functional mobility of the individual within an accessible home environment. Dependent variables will be measured at baseline, 3-, and 6-months and analyzed with a linear mixed-effects model across all time points. DISCUSSION: For patients recovering from stroke, the use of TR to provide home assessments and follow-up training in prescribed equipment has the potential to effectively supplement existing home health services, assist transition to home and increase efficiency. This may be particularly relevant when patients live in remote locations, as is the case for many veterans. TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT00384748.