Most Popular Books by Thomas Ryan

Roald Cabot, a modern-day solo explorer made famous by his daring attempts to cross remote landscapes, is attacked by what he thinks is a Polar bear in the Arctic night. Critically injured and alone, he is forced to accept the help of a bizarre clan of nomadic huntsmen claiming to be tracking the Yeti.

Abstract A Case Study: The Influence of Incentives on the Use of Clinical Information Technology in Physician Organizations by Thomas Ryan Williams Doctor of Public Health University of California, Berkeley Professor James C. Robinson, Chair Background: The Institute of Medicine has called for increased adoption of information technology in U.S. healthcare to improve its quality and efficiency. In response, U.S. public and private purchasers of healthcare have developed pay for performance and other incentive programs to encourage physicians and physician organizations to implement Clinical Information Technology (CIT). Most notable, the American Recovery and Reinstatement Act (ARRA) of 2009 created a landmark program of Medicare and Medicaid payment incentives to encourage implementation of CIT by physicians in the form of electronic medical records, yet research about the influence of incentives on CIT use by physicians and physician organizations is scant. Objectives: This study examines the nation's largest private pay for performance program and the response of its participating physician organizations to incentives for CIT use. The objectives of the study include determining the characteristics of physician organizations associated with the use of CIT; their response to direct and indirect financial incentives for its use; and the perceptions attributed to different types of CIT and to financial incentives by the leadership of physician organizations. Study Design, Setting and Participants: A mixed-methods, retrospective case study of a pay for performance program from 2003 to 2007 including 206 physician organizations (POs) (2007) with individual physician association (IPA), medical group and foundation organizational structures. Forty-six percent (2003) to sixty-four percent (2007) of POs responded to an annual survey reporting use of 11 CITs and EHR use. A multi-variant regression analysis tested PO characteristics associated with CIT and EHR use and PO response to both direct and indirect incentives. A structured survey of PO leadership using a purposive sample of 35 POs (17%) in 2007 tested the perceived attributes of PO leaders regarding different types of CIT and financial incentives. Main Outcome Measures: The extent of CIT use by POs (e.g., e-prescribing) on the basis of summary indices including population management CIT (0-3), point of care CIT (0-8), all CIT (0-11), electronic health record (EHR) use and PO characteristics associated with CIT and EHR use. The response to direct and indirect financial incentives by POs for CIT use using IT survey response and self-reporting of clinical results. The perceptions of PO leaders attributed to direct and indirect financial incentives and the CIT innovations examined in the study. Results: Multi-variant regression analysis indicates the early use of population management CIT by POs is associated with PO geography, relative advantage and size. Early use of point of care CIT and EHR by POs is associated with PO geography, relative advantage and more highly structured organizational type. This analysis further indicates the early response by POs to direct financial incentives for CIT use is associated with PO size, relative advantage and social networking. The early response by POs to indirect financial incentives for CIT use is associated with PO size, relative advantage, more highly structured organizational type and lower Medicaid payer mix. The qualitative analysis of data collected from the PO Leadership Survey indicates that for most POs direct financial incentives for CIT use were not an important stimulus for new investments in CIT; however, these incentives did influence the types of CIT implemented. Conversely, this analysis indicates indirect financial incentives did stimulate earlier use of CIT by POs. The PO Leadership Survey also indicates that the perceived operational risk of CIT innovations had a negative correlation with CIT use, and point of care CIT is perceived as more operationally risky than population management CIT. Furthermore, the perceived attributes including relative clinical advantage, relative financial advantage and trialability had a strong positive correlation with population management CIT innovations. These results suggest that financial incentives influence the sequence and pace of CIT adoption by physician organizations.

Reprint of some documents fro various Iowa State Baptist Conventions with a synopsis of the history of the establishment of a Baptist university in Pella, Iowa.

This paper studies a class of ranking and selection problems faced by a company that wants to identify the most preferred product out of a finite set of alternatives when consumer preferences are a priori unknown. The only information available is that consumer preferences satisfy two key properties: (i) they are consistent with some unknown true ranking of the alternatives and (ii) they are strict, namely, no two products are equally preferred. To learn the unknown ranking, the company is able to sample consumer preferences by sequentially showing different subsets of products to different consumers and asking them to report their top preference within the displayed set. The objective of the company is to design a display policy that minimizes the expected number of samples needed to identify the top-ranked product with high probability. We prove an instance-specific lower bound on the sample complexity of any policy that identifies the top-ranked version within a given (probabilistic) confidence. We also propose a robust formulation of the company's problem and derive a sampling policy (Myopic Tracking Policy), which is both worst-case asymptotically optimal and intuitive to implement. Roughly speaking, the Myopic Tracking Policy randomly alternates between two extreme types of displaying strategies: (i) full display that shows a consumer the entire menu so as to learn something about every version and (ii) pair display that shows a consumer only two versions so as to maximize the informativeness of the choice made by the consumer. To assess the performance of our proposed Myopic Tracking Policy, we conduct a comprehensive set of computational studies and compare it to alternative methods in the literature.