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Personnel decisions have the potential to influence an entire organization. The effects of these decisions are more credible and relevant when quantified. Historically, benefits were defined in correlational statistics, i.e., validity coefficients. But the increasing demand is for a bottom-line or dollar-value definition. The utility concept presents a methodology for providing the dollar value impact on performance of a personnel intervention program. One parameter of a utility analysis model is the standard deviation of job performance in dollars (SDy). This research develops a SDy value for the yearly production contribution of a first level line accounting supervisor to be used in a utility model. It is the hypothesis of this paper that the resultant estimated dollar value of yearly productivity for accounting supervisors should be consistent across all organization types, indicating generalizability. Sixty Florida-­based organizations were surveyed to develop the SDy estimate. The resulting SDy estimates are presented for four organization types. The results support the conclusion that the type of organization does not affect the SDy estimate. Therefore, SDy estimates can be generalized across organization types.

In Sweden, three principles prescribed by law compose the ethical platform aiming to ensure a fair distribution of healthcare resources. The goals of each of the three principles are to 1: ensure equal care, regardless of personal characteristics or social function; 2: give priority to patients of bad health; 3: base priority decisions on cost-effectiveness. The weights given to the last two principles yield different implications on which pharmaceuticals and medical procedures to subsidize and can be seen as an equity-efficiency trade-off. Knowledge of the Swedish public's views on this balance has been stated to be of large value to decision-makers, to be used as a basis for priority decisions. However, no such information exists to date. A large share of studies from other countries has moreover provided counter-intuitive estimates, possibly indicating a need for methodological development. In this thesis, I provide a suggestion on a discrete choice approach to quantify opinions on how to weight disease severity and cost-effectiveness in healthcare prioritization. In addition, I present a novel method to use the estimates to rank treatments. The design is furthermore tested in a pilot study, being the first to investigate this question in a Swedish setting. The results indicate that the population values both the amount and distribution of health created, favoring individuals suffering from severe conditions, which is seen as in line with a priori expectations. The thesis contributes to the literature aiming to quantify opinions on healthcare prioritization.

<p>BACKGROUND</p> <p>For ST-segment elevation myocardial infarction (STEMI) patients received by emergency medical services (EMS), prehospital identification with 12-lead electrocardiogram/cardiography (ECG) and advanced notification of the receiving centre may increase access to primary reperfusion and reduce mortality, compared to standard cardiac monitoring. The lifetime benefits and costs of upgrading to a 12-lead ECG system are uncertain.</p> <p>OBJECTIVE</p> <p>To determine the cost-effectiveness of prehospital identification with 12-lead ECG and advanced notification vs. no prehospital identification and no advanced notification.</p> <p>METHODS</p> <p>A probabilistic Markov model was designed from a government payer perspective. Outcomes were lifetime incremental quality-adjusted life-years (QALYs) and healthcare costs. Type of primary reperfusion, 30-day and one-year mortality were from a cohort study conducted in Ontario. Reinfarction, stroke and revascularization rates were derived from the literature. Inpatient costs and professional fees came from the Ontario government; follow-up costs from published literature. The analysis was stratified by eligibility to bypass to a percutaneous coronary intervention (PCI) centre.</p> <p>RESULTS</p> <p>In bypass eligible settings, prehospital identification and advanced notification led to an average 0.23 additional QALYs and $1,501 additional costs over no prehospital identification and no advanced notification. In bypass ineligible settings, it led to an average 0.15 fewer QALYs and $130 additional costs. It was a cost-effective strategy 87% and 40% of the time in bypass eligible and ineligible settings, respectively, at a willingness-to-pay of $50,000/QALY.</p> <p>CONCLUSIONS</p> <p>In bypass eligible settings, prehospital identification with 12-lead ECG and advanced notification is a cost-effective intervention. In bypass ineligible settings, there is no evidence of cost-effectiveness.</p> / Master of Science (MSc)

In an effort to validate a predictive (as opposed to a traditional formative or summative) cost-effectiveness model, a study was conducted to evaluate Kearsley and Compton's (1981) Benefits Model. Costs were input into the model as they applied to the design, development, and dissemination of two training programs on the topic of teaching individuals how to detect the level of drowsiness of their colleagues during team operations. The benefits of the training programs were identified, classified, and quantified as they applied to two media: lecture and computer-based multimedia. The experimenter identified the training system parameters, training benefits, and operational benefits. Then, for the predictive approach, the relationships between training system parameters, training benefits, and operational benefits were classified based on expert opinion. Quantification concerned the assignment of values (-1 or +1) based on expert opinion. The costs to design, develop, and disseminate the training programs were determined based on the parameters of the project. Finally, based on all information present, experts determined which of two training programs would be the most cost-effective to disseminate. To determine the accuracy of the Benefits Model as a predictive assessment tool, the same identified training system parameters, training benefits, and operational benefits were evaluated from a traditional formative evaluation approach. An empirical evaluation was conducted for the two training programs and a determination of the most cost-effective training medium was made. The data collected in the traditional formative evaluation approach was then compared to the experts' ratings and choice of training programs. For both the predictive and formative evaluation approach to determining cost-effectiveness, the computer-based multimedia was chosen as the most cost-effective training medium. However, for the predictive approach, the experts’ choice was based either solely or heavily on dollar amounts associated with design, development, and dissemination, while the data obtained through the validation process were given little or no weight. All experts stated that it would not have been possible to use the information gathered through application of the Benefits Model to determine cost-effectiveness with any confidence. / Ph. D.

This study evaluates the cost-effectiveness of alternative Integrated Pest Management (IPM) training methods and programs aimed at diffusing IPM innovations to farmers in Bangladesh. Various IPM innovations are categorized as being simple, intermediate or complex, while dissemination methods used to extend these innovations are classified as being less intense, moderately intense, or more intense. Examples of less intense diffusion methods include mass media and field day demonstrations, and moderately intense methods include visits from agents. A "farmer field school" (FFS) is considered a more intense type of training method. The study evaluates the effectiveness of these IPM diffusion methods based on a number of criteria such as a methods ability to reach the greatest number of farmers with a given budget, their capability of reaching farmers quickly, and their ability to influence adoption of IPM. Additional components of effectiveness include influencing appropriate use of IPM, influencing retention of IPM, providing a level knowledge that participants can adapt to other areas on the farm, and providing accessibility to limited resource farmers. Data used in the analysis come from a field survey conducted on 350 rice and vegetable farmers in Bangladesh during July and August of 2004. Three ordered probit models are used to measure adoption of simple, intermediate and complex technologies. Results from these models indicate that FFS participants are more likely than non-participants to adopt simple, intermediate and complex practices, while farmers visited by agents are more likely than non-participants to adopt simple and intermediate practices. Field day attendees are more likely to adopt intermediate and complex practices than non-participants. These results may be influenced by endogeneity of unobserved factors that influence participation in FFS but also affect adoption. The study uses a binary probit model to measure appropriate use, but it does not detect any significant differences among farmers trained through different methods, nor does it find any significant differences in retention rates among farmers who have been to different training programs. Another probit model identifies farmers who have been visited by an agent as being more likely to discover an IPM practice through their own experimentation, indicating that farmers who have been visited by an agent have received enough knowledge to adapt IPM to different problems on their farm. Results of the study indicate that limited resource farms are well represented by their participation in the various training methods, but that a higher percentage of large farmers than small farmers in the sample have been visited by an agent or been to FFS. Informal diffusion of IPM information is found to be occurring among people in FFS villages for simple practices. However, for intermediate and complex practices, farmers who participated in FFS are no more likely to spread information to other people in their villages than are less intense formal training methods such as field days and agent visits. This result indicates that while FFS graduates may be likely to share simple practices with others, they should not be relied upon as the primary means of informally diffusing more complex practices to other farmers. The cost-effectiveness estimation incorporates components of the effectiveness evaluation along with the cost of administering the methods. The study calculates that agent visits are the most cost-effective method for diffusing simple and complex technologies and practices, while field days are the most cost-effective methods for extending intermediate technologies and practices. / Master of Science

Forest roads and stream crossings have the potential to be sources of sediment from forest operations. Recent litigation has renewed interest in furthering research related to forest road Best Management Practices (BMPs). Three legacy (100 year old) forest road stream crossings were monitored for suspended sediment for nine months before and six months after upgrading three unimproved ford crossings with one bridge, one culvert, and one improved ford. During construction, rainfall simulation was utilized to estimate the sediment contribution of each crossing with minimal BMPs (BMP-), BMPs equal to state recommendations (BMP), and BMPs beyond state recommendations (BMP+). Construction costs were recorded to quantify the change in cost with a change in BMP level. Three levels of rainfall simulation were used on each BMP treatment for each crossing resulting in 27 rainfall simulations. Water samples collected by an automatic sampler downstream of the crossings were analyzed for suspended sediment. Pre - and post- construction time periods were compared to assess how the improved crossings altered total suspended sediment concentrations downstream of the crossings. The number of stream crossings constructed per year in Virginia was also estimated using satellite imagery on 400 harvest tracts. Site visits were conducted on 240 harvest tracts where data were collected on the presence of crossings, the types of crossings, and the level of BMP implementation. Rainfall simulation experiments showed decreased sediment with increased BMP level and daily total suspended sediment concentrations measured over 15 months showed a decrease in mean daily sediment concentration after construction of the bridge and culvert crossings. There was no decrease in sediment concentration for the ford crossing. Statewide crossing construction and BMP implementation rates were estimated. Approximately 67% of the audited stream crossings were characterized as having BMPs that were equal to or beyond state recommendations. Increased BMPs and upgrading of stream crossings resulted in decreased total suspended sediment. However, increased BMP implementation also increased stream crossing construction costs. Effectiveness of increased levels of BMPs and the pre and post construction analysis suggests the improvement of a legacy stream crossing may reduce total suspended sediment concentrations. / Ph. D.