Download PDF
Methods Inf Med 2011; 50(05): 435-444
DOI: 10.3414/ME10-01-0028
Original Articles
Schattauer GmbH

Analytic Hierarchy Process (AHP) for Examining Healthcare Professionals’ Assessments of Risk Factors

The Relative Importance of Risk Factors for Falls in Community-dwelling Older People
L. Pecchia
1   Department of Biomedical, Electronic and Telecommunication Engineering, University Federico II of Naples, Naples, Italy
2   Health Informatics Research Group and Centre for Health Information Management Research (CHIMR), Information School, University of Sheffield, Sheffield, United Kingdom
,
P. A. Bath
2   Health Informatics Research Group and Centre for Health Information Management Research (CHIMR), Information School, University of Sheffield, Sheffield, United Kingdom
,
N. Pendleton
3   School of Translational Medicine, University of Manchester, Manchester, United Kingdom
,
M. Bracale
1   Department of Biomedical, Electronic and Telecommunication Engineering, University Federico II of Naples, Naples, Italy
› Author Affiliations
Further Information

Publication History

received: 06 April 2010

accepted: 25 October 2010

Publication Date:
18 January 2018 (online)

    Permissions and Reprints

Summary

Background: A gap exists between evidence-based medicine and clinical-practice. Every day, healthcare professionals (HCPs) combine empirical evidence and subjective experience in order to maximize the effectiveness of interventions. Consequently, it is important to understand how HCPs interpret the research evidence and apply it in everyday practice. We focused on the prevention of falls, a common cause of injury-related morbidity and mortality in later life, for which there is a wide range of known risk factors.

Objectives: To use the Analytic Hierarchy Process (AHP) to investigate the opinions of HCPs in prioritizing risk factors for preventing falls.

Methods: We used the AHP to develop a hierarchy of risk factors for falls based on the knowledge and experience of experts. We submitted electronic questionnaires via the web, in order to reach a wider number of respondents. With a web service, we pooled the results and weighted the coherence and the experience of respondents.

Results: Overall, 232 respondents participated in the study: 32 in the technical pilot study, nine in the scientific pilot study and 191 respondents in the main study. We identified a hierarchy of 35 risk factors, organized in two categories and six sub-categories.

Conclusions: The hierarchy of risk factors provides further insights into clinicians’ perceptions of risk factors for falls. This hierarchy helps understand the relative importance that clinicians place on risk factors for falls in older people and why evidence-based guidelines are not always followed. This information may be helpful in improving intervention programs and in understanding how clinicians prioritize multiple risk factors in individual patients. The AHP method allows the opinions of HCPs to be investigated, giving appropriate weight to their coherence, background and experience.

Keywords

Falls - falls prevention - older people - community-dwelling - AHP
 

  • References

  • 1 Devereaux PJ, Bhandari M, Clarke M. et al. Need for expertise based randomised controlled trials. British Medical Journal 2005; 330 7482 88-91.
    CrossrefPubMedGoogle Scholar
  • 2 Sackett DL, Haynes RB. Evidence base of clinical diagnosis – the architecture of diagnostic research. British Medical Journal 2002; 324 7336 539-541.
    CrossrefPubMedGoogle Scholar
  • 3 Tonelli MR. The limits of evidence-based medicine. Respir Care 2001; 46 (12) 1435-1440. discussion 1440-1441. Review. PubMed PMID: 11728302.
    PubMedGoogle Scholar
  • 4 King MB, Tinetti ME. Falls in Community- Dwelling Older Persons. J Am Geriatr Soc 1995; 43: 1146-1154.
    CrossrefPubMedGoogle Scholar
  • 5 Nevitt MC, Cummings SR, Kidd S, Black D. Risk factors for recurrent non-syncopal falls. A prospective study. JAMA 1989; 261: 2663-2668.
    CrossrefPubMedGoogle Scholar
  • 6 Parry SW, Steen N, Galloway SR, Kenny RA, Bond J. Falls and confidence related quality of life outcome measures in an older British cohort. Postgrad Med J 2001; 77: 103-108.
    CrossrefPubMedGoogle Scholar
  • 7 Lord SR, Sherrington C, Menz HB, Close JCT. Falls in older people: risk factors and strategies for prevention. 2nd edition. Cambridge University Press; 2007
    Google Scholar
  • 8 Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age and Ageing 2006; 35 Supplement (02) ii37-ii41.
    CrossrefPubMedGoogle Scholar
  • 9 Tinetti ME, McAvay G, Claus E. Does multiple risk factor reduction explain the reduction in fall rate in the Yale FICSIT trial. Am J Epidemiol 1996; 144: 389-399.
    CrossrefPubMedGoogle Scholar
  • 10 Tinetti ME, Baker DI, McAvay G. et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med 1994; 331: 821-827.
    CrossrefPubMedGoogle Scholar
  • 11 AGS/BGS/AAOS Panel on Falls Prevention.. Guideline for the prevention of falls in older persons. J Am Geriatr Soc 2001; 49: 664-672.
    CrossrefPubMedGoogle Scholar
  • 12 Gillespie LD, Gillespie WJ, Cumming R, Lamb SE, Rowe BH. Interventions for preventing falls in the elderly. Cochrane Database Syst Rev 2000; 2: CD000340.
    PubMedGoogle Scholar
  • 13 Nuffield Institute for Health, University of Leeds and NHS Centre for Reviews and Dissemination.. Preventing falls and subsequent injury in older people. Effective Healthcare 1996; 2 (04) 1-16.
    PubMedGoogle Scholar
  • 14 Rubenstein LZ, Josephson KR. Falls. In: Kenny RA. (ed). Syncope in the Older Patient. London:: Chapman and Hall; 1996
    Google Scholar
  • 15 Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age and Ageing 2006; 35-S2: ii37 – ii41.
    PubMedGoogle Scholar
  • 16 Masud T, Morris RO. Epidemiology of falls. Age and Ageing 2001; 30-S4: 3-7.
    PubMedGoogle Scholar
  • 17 Martin FC, Treml J, Husk J, Grant R, Spencer M. Williams (2009) National Audit of the Organisation of Services for Falls and Bone Health of Older People. Royal College of Physicians.. London.: Available at: http://www.rcplondon.ac.uk (accessed July 5, 2010)
    PubMedGoogle Scholar
  • 18 Saaty TL. The Analytic Hierarchy Process: Planning, Priority Setting, Resource Allocation. McGraw-Hill; 1980
    Google Scholar
  • 19 Saaty TL. An essay on how judgment and measurement are different in science and in decision making. International Journal of the Analytic Hierarchy Process 2009; 1 (01) 61-62.
    PubMedGoogle Scholar
  • 20 Liberatore JM, Nydick RL. The analytic hierarchy process in medical and health care decision making: A literature review. European Journal of Operational Research 2008; 189 (01) 194-207.
    CrossrefPubMedGoogle Scholar
  • 21 Sloane EB, Liberatore MJ, Nydick RL, Luo W, Chung QB. Using the analytic hierarchy process as a clinical engineering tool to facilitate an iterative, multidisciplinary, microeconomic health technology assessment. Computers & Operations Research 2003; 30 (10) 1447.
    CrossrefPubMedGoogle Scholar
  • 22 Chatburn RL, Priamano FP. Decision analysis for large capital purchases: How to buy a ventilator. Respiratory Care 2001; 46 (10) 1038-1053.
    PubMedGoogle Scholar
  • 23 Turri JJ. Program eases decision making. Health Progress 1988; 69 (08) 40-44.
    PubMedGoogle Scholar
  • 24 Kaplan B, Shaw NT. Future Directions in Evaluation Research: People, Organizational, and Social Issues. Methods Inf Med 2004; 43 (03) 215-231.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Raible F, Brand M. Divide et Impera – the mid-brain-hindbrain boundary and its organizer. Trends in Neurosciences 2004; 27 (12) 727-734.
    CrossrefPubMedGoogle Scholar
  • 26 Pecchia L, Mirarchi L, Torino S, Bracale M. Assessment of quality control in US: a web service for preventive maintenance”. International Journal of CARS 2008; 3 (01) S9-S10.
    PubMedGoogle Scholar
  • 27 Finan JS, Hurley WJ. Transitive calibration of the AHP verbal scale. European Journal of Operational Research 1999; 112: 367-372.
    CrossrefPubMedGoogle Scholar
  • 28 Ji P, Jiang R. Scale transitivity in the AHP. Journal of the Operational Research Society 2003; 54: 896-905.
    CrossrefPubMedGoogle Scholar
  • 29 Lootsma FA. Scale sensitivity in the multiplicative AHP and SMART. Journal of Multi-Criteria Decision Analysis 1993; 2: 87-110.
    CrossrefPubMedGoogle Scholar
  • 30 Salo AA, Hamalainen RP. On the measurement of preferences in the analytic hierarchy process. Journal of Multi-Criteria Decision Analysis 1997; 6: 309-319.
    CrossrefPubMedGoogle Scholar
  • 31 Dong YC, Xu YF, Li HY. et al. A comparative study of the numerical scales and the prioritization methods in AHP. European Journal of Operational Research 2008; 186 (01) 229-242.
    CrossrefPubMedGoogle Scholar
  • 32 Saaty TL. A scaling method for priorities in hierarchical structures. Journal of Mathematical Psychology 1977; 15: 234-281.
    CrossrefPubMedGoogle Scholar
  • 33 Saaty TL. The Analytic Hierarchy Process. Pittsburgh, PA: RWS Publications; 1996
    Google Scholar
  • 34 Pecchia L, Bath PA, Pendleton N, Bracale M. AHP and risk management: a case study for assessing risk factors for falls in community-dwelling older patients. In: Proceedings of the ISAHP 2009 Symposium, July 29-August 1, 2009, Pittsburgh, Pennsylvania, USA; 2009. pp 1-15.
    Google Scholar
  • 35 Saaty TL, Peniwati K. Group Decision Making: Drawing Out and Reconciling Differences. RWS; 2007
    Google Scholar
  • 36 Meissner I, Wiebers DO, Swanson JW. et al. The natural history of drop attacks. Neurology 1986; 36: 1029-1034.
    CrossrefPubMedGoogle Scholar
  • 37 Pope C, Ziebland S, Mays N. Qualitative research in health care – Analysing qualitative data (reprinted from Qualitative Research in Health Care). BMJ 2001; 320 7227 114-116.
    PubMedGoogle Scholar
  • 38 Leys M. Health care policy: Qualitative evidence and health technology assessment. Health Policy 2003; 65 (03) 217-226.
    CrossrefPubMedGoogle Scholar
  • 39 Upshur RE, Van Den Kerkhof EG, Goel V. Meaning and measurement: an inclusive model of evidence in health care. Journal of Evaluation and Clinical Practice 2001; 07 (02) 91-96.
    PubMedGoogle Scholar
  • 40 Saaty TL. Highlights and critical points in the theory and application of the analytic hierarchy process. European Journal of Operational Research 1994; 74: 426-447.
    CrossrefPubMedGoogle Scholar