Preparing for a decision support system

The increasing pressure to reduce costs and improve outcomes is driving the health care industry to view information as a competitive advantage. Timely information is required to help reduce inefficiencies and improve patient care. Numerous disparate operational or transactional information systems with inconsistent and often conflicting data are no longer adequate to meet the information needs of integrated care delivery systems and networks in competitive managed care environments. This article reviews decision support system characteristics and describes a process to assess the preparedness of an organization to implement and use decision support systems to achieve a more effective, information-based decision process. Decision support tools included in this article range from reports to data mining.     

Quality assurance for a nutritional support service.

Quality assurance programs may significantly influence patient care by providing a systematic mechanism of self-assessment. An effective program should improve the level of care and have a positive effect on the fiscal base of a health care institution. The design of a useful quality assurance program is not a trivial matter. This report describes the details of a functioning quality assurance program developed for a multidisciplinary nutrition support service. The effect that such a program may have on patient care is also illustrated.     

Evaluation of a social support program for young unwed mothers

This research evaluated the effects of a social support program on young unwed mothers. Measures of social support, stress, affect, and life events were compiled by 15 program participants and 15 matched controls before and after the program six months later. The results showed significant increases in the size of the family and friend network for program participants relative to controls. Also, program participants reported more involvement in work and school and maintained a high level of positive affect significantly more than controls. The two groups did not differ in reported levels of stress. The implications of the findings for future research and program development were discussed.Christina E. Henninger is the Department of Applied Psychology, Ontario Institute for Studies in Education. Geoffrey Nelson is in the Department of Psychology, Wilfrid Laurier University.We would like to acknowledge several people who collaborated with us on this program: Phyllis Goodwins, Joan Meunier, Mary Harrison, and Mary-Jane Crusoe. We would also like to thank Gilles Charbonneau for his assistance with data analysis.     

Development of a decision support system for cost analysis.

Korean hospitals are experiencing an increasing amount of financial difficulty due to government control of hospital rates since national health insurance has been implemented. The decision support system (DSS) was developed to provide cost and revenue information for the services rendered by each department in an effort to reduce costs. This information may be used to identify the causes of financial loss if cost exceeds revenue and to develop budgets for the next year. The DSS was developed using a micromainframe interface approach where the mainframe computer collects and summarises daily cost data and the micro computer allocates the data to each department.     

Implementation of a clinical decision support system for antimicrobial stewardship

Clinical decision support systems (CDSSs) for antimicrobial stewardship require considerable human resources and financial investments. This pre-/postimplementation study evaluated the effect of a CDSS on performance of prospective audit with intervention and feedback and demonstrated an increase in interventions and recommendation acceptance countered by a substantial number of nonactionable alerts.     

Theoretical efficiency of a televisiting service for home care support

We have made a theoretical study of the potential for televisiting. All journeys made by the home care support team in an area of Madrid were reviewed to study the possibility of using televisiting. During the year 2000 the team provided an average of seven home visits a day. The home visits took 30 min on average, and the journey time was 30 min for urban areas and 45 min in the suburbs. We estimated that two of each day s visits could be carried out by telemedicine, with a mean duration of 15 min each. A model was used to calculate the resource demands and the potential cost-savings of televisiting compared with traditional home care. Using televisiting, 62% more suburban oncology patients could be managed and a cost reduction of euro;6 per visit could be achieved after 10 weeks.     

Evaluating a support program for children victim of domestic violence

INTRODUCTION: Domestic violence against children has been a subject of concern to many Brazilian institutions, though there are few studies about the services offered to the community. The aim of this study is to evaluate administrative and operational aspects of the SOS Crian?a and provide insight to similar programs with comparative data. METHODS: A cross-sectional study of 976 data sheets of investigated cases until 1993 was conducted. Study variables were: characteristics of the support program required, proceedings to investigate reported cases, follow-up duration of reported cases, and referrals to other institutions. RESULTS: Out of 976 data sheets analyzed, 587 involved domestic violence against children: 38.7% cases of physical abuse, 27.7% of neglect, 26.3% of psychological abuse and 7.3% of sexual abuse. Most of the complaints (32.5%) came from family members of victimized children. The program's investigation process took between 126 to 212 days. Each investigated case demanded an average of 2.7 to 4.6 procedures. The majority of the cases (44.0%) were referred to a law court. This study emphasizes the need of a computerized database for optimizing the services provided and the victims' follow-up. It also suggests the need of ongoing staff training and development of broader and stronger connections to the social and health services.     

Impacts of a support intervention for low-income women who smoke

The objective of this pilot study was to implement and evaluate the impact of a support intervention tailored to the assessed support needs, resources and preferences of low-income women who smoke in three Canadian cities. The support intervention, informed by theoretical foundations, provided holistic one-to-one and group support over 14 weeks. The support intervention was facilitated by trained professional and peer facilitators. The impact was evaluated through analysis of qualitative and quantitative data collected at pre-, post-, and delayed post-test contacts. This analysis revealed that the intervention exerted positive impacts on smoking reduction/cessation, social networks, coping, and health behaviors. Participants reported satisfaction with the intervention.     

Parenthood: towards a framework for education and support

Whilst parent education is attracting increasing interest and debate, a review of current initiatives in schools, in antenatal services and in support services for families reveals considerable confusion with regard to aims, objectives and methodology. Schemes and services tend to be limited in number, piecemeal and uncoordinated, with little thought being given either to content or to the most appropriate stages of an individual's life at which to offer education, preparation, support, or where necessary, intervention. A more coordinated approach is suggested, offering parents and prospective parents a range of services which build upon their own parenting skills, rather than undermining their self-confidence with 'professional expertise'.     

Humanized support in emergency: a challenge for nursing

This experience report describes the humanized support given by the nurse in the attendance to patients in eminently critical health situation in the Emergency Hospital of Porto Alegre (Brasil). The proposal was based on Jean Watson theory. The experience gave moments for personal and professional self-knowledge, and thoughts concerning the possibilities of construction of interpersonal humanist process in the emergency environment as well. Yet, it was possible to identify some limitations of the theory options referent to its practical applicability.     

Special commentary: a call for intensive metabolic support

PURPOSE OF REVIEW: This special commentary addresses recent clinical reviews regarding appropriate nutrition and metabolic support in the critical care setting. RECENT FINDINGS: There are divergent approaches between North America and Europe for the use of early nutrition support and combined enteral nutrition and parenteral nutrition support possibly due to the commercial availability of specific parenteral nutrients. The advent of intensive insulin therapy has changed the landscape of metabolic support in the intensive care unit, and previous notions about infective risk of parenteral nutrition will need to be re-addressed. Patients with brain failure may benefit from an intensive insulin therapy with a blood glucose target that is higher than that used in patients without brain failure. Patients with heart failure may benefit from the addition of nutritional pharmacology that targets proximate oxidative pathophysiological pathways. Intradialytic parenteral nutrition may be viewed as another form of supplemental parenteral nutrition when enteral nutrition is insufficient in patients on hemodialysis in the intensive care unit. SUMMARY: It is proposed that intensive metabolic support be routinely implemented in the intensive care unit based on the following steps: intensive insulin therapy with an appropriate blood glucose target, nutrition risk assessment, early and if needed combined enteral nutrition and parenteral nutrition to target 20-25 kcal/kg/day and 1.2-1.5 g protein/kg/day, and nutritional and metabolic monitoring.     

Parenthood: towards a framework for education and support

Whilst parent education is attracting increasing interest and debate, a review of current initiatives in schools, in antenatal services and in support services for families reveals considerable confusion with regard to aims, objectives and methodology. Schemes and services tend to be limited in number, piecemeal and uncoordinated, with little thought being given either to content or to the most appropriate stages of an individual's life at which to offer education, preparation, support, or where necessary, intervention. A more coordinated approach is suggested, offering parents and prospective parents a range of services which build upon their own parenting skills, rather than undermining their self‐confidence with ‘professional expertise’.     

Decision support: a paradigm addition for patient safety

The creation of a decision culture that matches the "decision intensity" of the healthcare field is not a paradigm shift but rather a paradigm addition that properly addresses all aspects of information, from how it is delivered to how it is managed. These changes will take healthcare beyond its current emphasis on efficient transaction systems to reach safe and effective clinical decision environments, which cannot be achieved with transaction mentalities and processes.     

Economic evaluation of a support program for caregivers of demented elderly

An economic evaluation was undertaken concurrently with a randomized trial comparing a Caregiver Support Program (CSP) with existing conventional community nursing care for those caring for elderly relatives at home. The differences in resource consumption were compared with changes in caregiver quality of life, as measured by the Caregiver Quality of Life Instrument (CQLI). A 20% difference from baseline in the CQLI favored the experimental (CSP) group, although this did not reach conventional levels of statistical significance. A comparison of improvement in quality of life with costs implies an incremental cost per quality-adjusted life year gained of Canadian $20,000 for the CSP, which compares favorably with other health care interventions. Further, larger studies are required to confirm this result.