Healthcare Policy, Innovation and Digitalization

Contemporary Strategy and Approaches

Visit the link below to download the full version of this book:

https://medipdf.com/product/healthcare-policy-innovation-and-digitalization-cont
emporary-strategy-and-approaches/

Click Download Now

Eyüp Çetin · Hilal Özen
Editors

Healthcare Policy, Innovation

and Digitalization
Contemporary Strategy and Approaches

Foreword by Nobel Laureate Aziz Sancar

Editors
Eyüp Çetin Hilal Özen
Department of Quantitative Methods Department of Business Administration
School of Business, Istanbul University Faculty of Business Administration
Istanbul, Türkiye and Economics
Trakya University
Edirne, Türkiye

ISSN 2509-7873 ISSN 2509-7881 (electronic)

Accounting, Finance, Sustainability, Governance & Fraud: Theory and Application
ISBN 978-981-99-5963-1 ISBN 978-981-99-5964-8 (eBook)
https://doi.org/10.1007/978-981-99-5964-8

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Singapore Pte Ltd. 2023

This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specifically the rights of reprinting, reuse of illustrations,
recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or
information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar
methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or
the editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional affiliations.

This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721,
Singapore

Paper in this product is recyclable.

Foreword by Prof. Dr. Aziz Sancar, The Nobel
Prize Laureate in Chemistry 2015

Scientists possess a natural inclination to share the knowledge they have painstak-
ingly acquired. This instinct serves as a driving force behind countless scientific
research endeavors, including the creation of valuable edited works like this one.
Our world is evolving rapidly, bringing forth new challenges in the form of various
diseases on a daily basis. Simultaneously, digital technologies are increasingly inte-
grated into medicine and healthcare, influencing every facet of these critical fields.
As a result, healthcare has emerged as one of the foremost concerns of our century,
encompassing vital topics such as government healthcare policies, healthcare innova-
tion, pandemics, digital healthcare transformation, health informatics, data science,
telemedicine, and health economics. It is imperative that these subjects are thoroughly
explored through research, and their conclusions are disseminated to professionals,
scientists, and the general public.
It is with great pleasure that I pen this foreword for Healthcare Policy, Innovation,
and Digitalization: Contemporary Strategy and Approaches, published by Springer.
The significance of healthcare permeates all aspects of our lives, and this book
makes a comprehensive effort to address healthcare from a multifaceted perspective,
assembling numerous valuable contributions from the contemporary world. I firmly
believe that this book will serve as an invaluable reference for healthcare researchers,
professionals, students, and anyone with an interest in these critical topics. On a
personal note, I am delighted to extend my heartfelt congratulations and gratitude to
all the contributing authors for their invaluable contributions to this edited volume.
I reserve special commendation and gratitude for the editors, Professors Eyüp Çetin
and Hilal Özen, for their outstanding contribution to the literature.

2023 Prof. Dr. Aziz Sancar, M.D., Ph.D.

Department of Biochemistry and Biophysics
and Department of Biology
The University of North Carolina at Chapel Hill
Chapel Hill, NC, USA

v
vi Foreword by Prof. Dr. Aziz Sancar, The Nobel Prize Laureate …

Prof. Dr. Aziz Sancar is a distinguished Turkish Molecular Biologist renowned for his expertise
in DNA repair and circadian clock research. In 2015, he was honored with the Nobel Prize in
Chemistry, sharing this prestigious recognition with Tomas Lindahl and Paul L. Modrich for their
pioneering mechanistic studies of DNA repair. His groundbreaking work has led to significant
advancements in our understanding of photolyase and nucleotide excision repair, fundamentally
reshaping the landscape of his field.
Currently holding the esteemed position of Sarah Graham Kenan Professor of Biochemistry
and Biophysics at the University of North Carolina School of Medicine, he also serves as a valued
Member of the UNC Lineberger Comprehensive Cancer Center. Beyond his academic accom-
plishments, Prof. Dr. Sancar is Co-founder of the Aziz and Gwen Sancar Foundation, a non-profit
organization dedicated to promoting Turkish culture and providing support to Turkish students in
the United States.
Acknowledgements

We wish to extend our heartfelt gratitude for the inspiring Foreword provided by
Nobel Laureate Prof. Aziz Sancar of the University of North Carolina, Chapel Hill,
NC, USA. Our sincere appreciation goes out to all the contributors and authors, as
well as Nobel Laureate Prof. Aziz Sancar, whose collective efforts have brought this
edited book to life.
We also wish to express our deep appreciation to Series Editor Prof. Kıymet
Çalıyurt and the entire editorial team at Springer Nature for their unwavering support
in bringing this outstanding volume to publication.
Our aspiration is that readers, researchers, and practitioners will find the chapters
published in this book both insightful and valuable as they cover a wide range of
areas in healthcare policy, innovation, and digitalization.

Prof. Dr. Eyüp Çetin

Prof. Dr. Hilal Özen

vii
Contents

Part I Introduction
1 Contemporary Strategy and Approaches in Healthcare Policy,
Innovation and Digitalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Hilal Özen and Eyüp Çetin

Part II Healthcare Policy

2 Prioritization in Health Care: The Influence of Frames
on Accepting Prioritization Criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Adele Diederich and Marc Wyszynski
3 Using Pharmacoepidemiologic Studies to Inform Drug Policy
and Spending: A Health Economics Perspective . . . . . . . . . . . . . . . . . . 27
Konstantinos Zisis, Kostas Athanasakis, and Kyriakos Souliotis
4 Accelerating Personalized Medicine Adoption in Oncology:
Challenges and Opportunities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Fredrick D. Ashbury and Keith Thompson

Part III Innovation

5 Framework for Epidemic Risk Analysis . . . . . . . . . . . . . . . . . . . . . . . . . 53
Maryna Zharikova and Stefan Pickl
6 Transmissibility and Death Index from Pandemic COVID-19
Among Nations Across Continents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Ramalingam Shanmugam and Karan P. Singh
7 Assessing Health Inequalities of Diabetes Care Through
the Application of the Bio-ecology Theory . . . . . . . . . . . . . . . . . . . . . . . 105
Alan Shaw

ix
x Contents

8 The Computational Perspective on Internalized

and Simplex-Structured Motivation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Ali Ünlü
9 Recent Developments of Multiple Myeloma: Analysis
and Analytical Modeling Using Real Data . . . . . . . . . . . . . . . . . . . . . . . 155
Chris P. Tsokos and Lohuwa Mamudu

Part IV Digitalization
10 Refined Machine Learning Approaches for Mask Policy
Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Lincy Y. Chen and John Tuhao Chen
11 Allocating Capacity for Office and Virtual Visits in Chronic
Care Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Xiao Yu, Armağan Bayram, Yuchi Guo, and Gökçe Kahvecioğlu
12 Collaborative Systems Analytics to Advance Clinical Care:
Application to Congenital Cardiac Patients . . . . . . . . . . . . . . . . . . . . . . 231
Eva K. Lee

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Editors and Contributors

About the Editors

Prof. Dr. Eyüp Çetin is tenured Professor of Operations Research and Statistics in
the Department of Quantitative Methods in School of Business at Istanbul Univer-
sity and Affiliate Distinguished Professor at York University, Canada. He is also
affiliated with New York Business Global, USA. He has held some managerial
positions. He is Former and Founding Dean of the Faculty of Transportation and
Logistics and Former Vice Dean of the School of Business at Istanbul University.
He received a Ph.D. in quantitative methods from Istanbul University in 2004. He
has taught courses in management science, statistics, business analytics, stochastic
models, game theory, and health analytics to all level of business, engineering, and
healthcare management students: undergraduates, MBAs, and Ph.D. students. He
has been Consultant for numerous companies, and he has taught statistical and deci-
sion modeling and business analytics in even global companies such as Vodafone.
His current research focuses on business analytics, data science, digital business and
health, healthcare management science, mathematical medicine, operations research,
and mathematical and statistical modeling. He is also Founder and Editor-in-Chief
of prestigious international academic journals such as European Journal of Pure and
Applied Mathematics.

Prof. Dr. Hilal Özen holds an honors degree in Business Administration (B.S.)
from Hacettepe University (2004). She earned her M.S. degree in 2007 and her
Ph.D. in 2011, both in Marketing, from Istanbul University School of Business.
Currently, she serves as a Professor of Marketing at Trakya University. Her current
research interests are focused with great enthusiasm on various areas, including
digital marketing, e-health, social media marketing, tourism marketing, sustain-
ability, and consumer decision-making styles. She has published numerous articles
on these topics in reputable peer-reviewed journals and presented her research at
international conferences. Throughout her academic career, she has been actively
involved in teaching a wide range of courses, including principles of marketing,
marketing management, research methodology, marketing strategies, current issues

xi
xii Editors and Contributors

in marketing, digital marketing, and healthcare marketing. Her teaching experience

spans across all levels of business students, including undergraduate, MS, MBA, and
executive MBA students. In addition to her academic pursuits, Hilal is a Co-founder
of Coreborn Software and Digital Marketing Company, where she provides valuable
consultancy in the field of digital marketing to clients.

Contributors

Fredrick D. Ashbury Department of Oncology, University of Calgary, Calgary,

AB, Canada;
Dalla Lana School of Public Health, University of Toronto, Toronto, Canada;
VieCure, Denver, CO, USA
Kostas Athanasakis Department of Public Health Policy, School of Public Health,
University of West Attica, Athens, Greece
Armağan Bayram Industrial and Manufacturing Systems Engineering, University
of Michigan at Dearborn, Dearborn, USA
Eyüp Çetin Department of Quantitative Methods, School of Business, Istanbul
University, Istanbul, Türkiye
John Tuhao Chen Department of Mathematics and Statistics, Bowling Green State
University, Bowling Green, OH, US
Lincy Y. Chen School of Industrial and Labor Relations, Cornell University, Ithaca,
NY, US
Adele Diederich Department of Psychology, Carl Von Ossietzky University of
Oldenburg, Oldenburg, Germany
Yuchi Guo Industrial and Manufacturing Systems Engineering, University of
Michigan at Dearborn, Dearborn, USA
Gökçe Kahvecioğlu Supply Chain Optimization Technologies, Amazon, Seattle,
WA, USA
Eva K. Lee Center for Operations Research in Medicine and HealthCare, The Data
and Analytics Innovation Institute, Tbilisi, Georgia;
USA NSF I/UCRC Center for Health Organization Transformation, Washington,
USA;
Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta,
Georgia
Lohuwa Mamudu Department of Public Health, California State University,
Fullerton, CA, USA
Editors and Contributors xiii

Hilal Özen Department of Business Administration, Faculty of Business Admin-

istration and Economics, Trakya University, Edirne, Türkiye
Stefan Pickl Institut für Theoretische Informatik, Mathematik und Operations
Research, Universität der Bundeswehr München, Neubiberg, Germany
Ramalingam Shanmugam Honorary Professor of International Studies and Statis-
tics, School of Health Administration, Texas State University San Marcos, San
Marcos, TX, USA
Alan Shaw Chair of the Retail Institute Special Interest Research Group and Health
Research Lead for the Business School, Leeds Business School, Leeds Beckett
University, Leeds, UK
Karan P. Singh Department of Epidemiology and Biostatistics, School of
Medicine, The University of Texas at Tyler, Tyler, TX, USA
Kyriakos Souliotis Department of Social and Education Policy, University of Pelo-
ponnese, Corinth, Greece;
Health Policy Institute, Athens, Greece
Keith Thompson VieCure, Denver, CO, USA;
Faculty of Medicine, University of Alabama, Birmingham, AL, USA;
Montgomery Cancer Center, Montgomery, AL, USA
Chris P. Tsokos Distinguished University Professor Department of Mathematics
and Statistics, University of South Florida, Tampa, FL, USA
Ali Ünlü School of Social Sciences and Technology, Technical University of
Munich, Munich, Germany
Marc Wyszynski Department of Mathematics and Computer Science, University
of Bremen, Bremen, Germany
Xiao Yu Industrial and Manufacturing Systems Engineering, University of
Michigan at Dearborn, Dearborn, USA
Maryna Zharikova Institut für Theoretische Informatik, Mathematik und Opera-
tions Research, Universität der Bundeswehr München, Neubiberg, Germany;
Program Tools and Technologies Department, Kherson National Technical Univer-
sity, Kherson, Ukraine
Konstantinos Zisis Department of Public Health Policy, School of Public Health,
University of West Attica, Athens, Greece;
Institute for Health Economics, Athens, Greece
List of Figures

Fig. 5.1 Risk management cycle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

Fig. 5.2 Spatial model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Fig. 5.3 People’s mobility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Fig. 5.4 Fragment of the network . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Fig. 5.5 Framework for epidemic risk analysis . . . . . . . . . . . . . . . . . . 67
Fig. 6.1 Nonlinear configuration of mean in terms of odds . . . . . . . . 74
Fig. 6.2 Configuration of z = x(1+dx) sx2
−1 ...................... 75
Fig. 6.3 a Expected number of COVID-19 cases b Volatility
of COVID-19 cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Fig. 6.4 a Oddscase , r > 1 contracting COVID-19
b Oddscase , r = 1 contracting
 COVID-19 . . . . . . . . . . . . . . 77
Fig. 6.5 Expected value, E YX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
 
Fig. 6.6 Volatility, Var YX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Fig. 6.7 Pattern of the index,  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Fig. 6.8 Proximity of the African nations’ performance
dealing with COVID-19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Fig. 6.9 Proximity of the American nations’ performance
dealing with COVID-19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Fig. 6.10 Proximity of the Asian nations’ performance dealing
with COVID-19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Fig. 6.11 Proximity of the European nations’ performance
dealing with COVID-19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Fig. 6.12 Proximity of the Oceanic nations’ performance
dealing with COVID-19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Fig. 7.1 The nested levels of the ecology theory (adapted
from Bronfenbrenner (1977)) . . . . . . . . . . . . . . . . . . . . . . . . . 109
Fig. 8.1 Basic psychological needs and motivation . . . . . . . . . . . . . . 131
Fig. 8.2 Numerical example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Fig. 8.3 Decomposition and autonomous motivation . . . . . . . . . . . . . 144
Fig. 8.4 Decomposition and non-autonomous motivation . . . . . . . . . 144

xv
xvi List of Figures

Fig. 9.1 Log-rank test for difference in survival time of gender . . . . 160
Fig. 9.2 Histogram showing the distribution of survival time
(to the nearest month) of multiple myeloma cancer . . . . . . . 161
Fig. 9.3 Cumulative distribution function plot for the survival
time of MMC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Fig. 9.4 Survival estimate for the survival time of MMC . . . . . . . . . . 163
Fig. 9.5 Ranking of prognostic effect of risk factors
on the patient’s survival . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Fig. 9.6 Survival estimate Ŝ(t) from the proposed Cox-PH
model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
Fig. 9.7 Evaluation of linearity of the proposed statistical model . . . 177
Fig. 9.8 Test for multivariate normal probability distribution . . . . . . 178
Fig. 9.9 Residual plot of the proposed statistical model . . . . . . . . . . . 178
Fig. 9.10 Probability distribution function of survival time, t ∗
of multiple myeloma cancer . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Fig. 9.11 Cumulative distribution function of survival time, t ∗
of multiple myeloma cancer . . . . . . . . . . . . . . . . . . . . . . . . . . 186
Fig. 9.12 Survival function of the survival times, t ∗ of multiple
myeloma cancer patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Fig. 9.13 Algorithmic flowchart for the development
of the survival function of the nonlinear statistical
model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
Fig. 9.14 Survival function of Cox-PH versus survival function
nonlinear statistical model of MMC . . . . . . . . . . . . . . . . . . . 189
Fig. 10.1 OLS regression on warmth to mask wearing (R-square
= 0.000359) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
Fig. 10.2 Plot on perceived warmth to non-mask (R-square =
0.129) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Fig. 10.3 Range regression warmth to mask wearing (R-square
= 0.530) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Fig. 10.4 Range regression on perceived warmth to no-mask
(R-square = 0.749) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
Fig. 10.5 Decision tree on the perceived warmth scores related
to mask policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210
Fig. 10.6 Histogram of perceived warmth scores
across categories for range regression . . . . . . . . . . . . . . . . . . 210
Fig. 11.1 Illustration of the methodology . . . . . . . . . . . . . . . . . . . . . . . 217
Fig. 11.2 Migration network model . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
Fig. 12.1 The flowchart illustrates the seven steps that comprise
the collaborative learning process . . . . . . . . . . . . . . . . . . . . . 245
Fig. 12.2 We captured this figure from an interactive visualized
process map that we built. The tool allows users
to drill down (using mouse clicks) at each level
as the figure expands to reveal details . . . . . . . . . . . . . . . . . . 248
List of Figures xvii

Fig. 12.3 This figure shows nine important steps

for postoperative processes and their sequences
at each site . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Fig. 12.4 LOS clusters from pre-CPG are used to identify
pattern characteristics of patients. We list each surgery
along the x-axis. The y-axis corresponds to the length
of stay in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Fig. 12.5 a The graph illustrates potential gains of early
extubation, and its systems influence on the overall
LOS. b The graph illustrates potential gains of early
extubation and its systems effects on various clinical
outcome metrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254
Fig. 12.6 The graph shows the flow of our clinical study design . . . . . 255
Fig. 12.7 This figure summarizes the postoperative clinical
outcomes for all patients studied. We compare
the median before and after CPG . . . . . . . . . . . . . . . . . . . . . . 256
Fig. 12.8 a The figures compare the pre-CPG versus post-CPG
early extubation rates (left). b The median duration
of intubation 240 patients (right) . . . . . . . . . . . . . . . . . . . . . . 258
Fig. 12.9 a The figure shows the cost reductions for the TOF
cohort and the CoA cohort. b The graph breaks
down cost savings into various categories for cohort
TOF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Fig. 12.10 The early extubation clinical practice guidelines
facilitate best practice dissemination . . . . . . . . . . . . . . . . . . . 266
Diagram 10.1 A decision tree followed by weighted KNN algorithm . . . . 205
List of Tables

Table 2.1 Allocation criteria framed in terms of receiving

and withholding the health resource . . . . . . . . . . . . . . . . . . . . . . 19
Table 5.1 Advantages and disadvantages of the evidence-based
and precautionary approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Table 5.2 Parameter values for various objects . . . . . . . . . . . . . . . . . . . . . . 64
Table 6.1 Summary of accumulation parameter, Odds of COVID-19
cases and deaths, correlation, and index (Africa) . . . . . . . . . . . . 82
Table 6.2 Mean and variance of the number of new COVID-19
cases and deaths (America) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Table 6.3 Mean and variance of the number of new COVID-19
cases and deaths (Asia) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Table 6.4 Mean and variance of the number of new COVID-19
cases and deaths (Europe) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Table 6.5 Mean and variance of the number of new COVID-19
cases and deaths (Oceanic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Table 7.1 Type 1 structured education delivery profile . . . . . . . . . . . . . . . . 111
Table 7.2 Type 2 structured education delivery profile . . . . . . . . . . . . . . . . 112
Table 7.3 Descriptive analysis of the patient participants . . . . . . . . . . . . . . 113
Table 7.4 A summary of the axial and core themes associated
with why individuals chose not to engage with diabetes
structured education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Table 7.5 The range of type 1 structured education courses
delivered in England . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Table 7.6 The range of type 2 structured education courses
delivered in England . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Table 8.1 Motivation continuum and the basic concepts
of self-determination theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Table 8.2 Mean subscale scores in motivation variables for four
fictitious subjects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Table 8.3 Internalization of science learning motivation . . . . . . . . . . . . . . 147

xix
xx List of Tables

Table 9.1 Descriptive statistics of survival time (to the nearest

month) of multiple myeloma cancer . . . . . . . . . . . . . . . . . . . . . . 161
Table 9.2 Goodness-of-fit test of the 3P-log-normal distribution
of the survival time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
Table 9.3 Parameter estimates for the three-parameter log-normal
probability distribution of the survival time of multiple
myeloma cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
Table 9.4 Kaplan–Meier ( ŜK M (t)) versus parametric
(3P-log-normal, Ŝ P (t)) survival function estimate
of the survival times . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Table 9.5 Ranking of the significant contributing covariates (risk
factors) based on prognostic effect on the survival time
using the hazard ratios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
Table 9.6 Global statistical significance of the model . . . . . . . . . . . . . . . . 172
Table 9.7 First ten baseline hazard estimates . . . . . . . . . . . . . . . . . . . . . . . 173
Table 9.8 Comparison of prediction of the survival time of multiple
myeloma cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Table 9.9 Rank of contribution of attributing risk factors to survival
time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
Table 9.10 Rank of significant attributable risk factors by the Cox-PH
model and the nonlinear statistical model . . . . . . . . . . . . . . . . . . 183
Table 9.11 Descriptive statistics of survival times t ∗ of multiple
myeloma cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
Table 9.12 Parameter estimates for the 3p-log-normal pdf for t ∗ . . . . . . . . 184
Table 9.13 Kruskal–Wallis rank-sum test of the difference
between t and t ∗ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
Table 10.1 Output of range regression on perceived warmth toward
no mask wearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
Table 10.2 Output of range regression on perceived warmth toward
mask wearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Table 11.1 Summary of the contributions . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Table 12.1 Summarizes ICU and step-down unit similarities
and differences based on protocols and observations . . . . . . . . . 247
Table 12.2 Compares machine-learning results to identify
the smallest set of discriminatory factors that predict
patient LOS. We performed feature selections
on the training set. Once we established a rule, we used it
to blind predict a new set of patients to test its accuracy . . . . . . 252
Table 12.3 Shows the Gini coefficient for each factor in predicting
the LOS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252
Table 12.4 Summarizes the distributions (based on observations,
historical data, and interviews) used for each process
at each site . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Table 12.5 Lists early extubation CPG implementation strategies
used at four sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
 Part I
Introduction