卫生决策支持系统设计与实现

本文基于健康医疗数据资源,以提升卫生决策水平为目的,设计了覆盖公共卫生、医疗服务、基层卫生、药品管理、医疗保障等业务领域的具备信息支持、监控预警、分析评价、趋势预测、综合优化等核心功能的卫生决策支持系统,以及包含数据层、业务层、表现层的系统架构和数据仓库、模型库、方法库、知识库等决策支持库;并以医疗保障(新农合)业务的决策支持应用为例,对部分决策支持的功能进行开发应用;最后提出了构建卫生决策支持系统的建议。     

A decision support system for hospital bed assignment

This article presents the use of a computer-based decision support system for hospital bed assignment. The specific computer application discussed involves the development of an expert system, which mimics the decision-making process typically used by experts in a field. Expert systems are useful as consultants for problems that are best approached from the perspective of an expert. The prototype expert system presented in this article can be used to efficiently assign hospital beds to specific patients at the time of hospital admission or during the hospital stay. This assignment is based on a matching process by the expert system of patient needs and hospital bed characteristics. Data needed for this assignment are routinely collected at admission and updated during the patient's stay in the hospital. Use of this computer-based decision support system in conjunction with existing hospital information systems will result in more effective management of physical and human resources. As may be expected, any improvement in efficiency of use of resources will have an associated reduction in cost. Implications of using expert systems for future practice are also discussed.     

Rethinking professional prerogative: managed mental health care providers

Managed care represents a response to the wider institutional demand for technical rationality and efficiency. In the US, managed care exemplifies the commodification of health and is governed by a technocratic-rationality that often conflicts with the professionally governed value rationality of providers. Providers must negotiate between contradictory institutional demands for cost containment and quality care in their everyday work practices, and consequently experience a series of ethical dilemmas. This paper examines the effect the commodification of health care has had upon the work of mental health care providers, their loss of professional prerogative, their concrete experience of the ethical dilemmas which result from the commodification of care, and evidence of countervailing power.     

How mental health providers see managed care

This paper reports findings from two focus groups on managed care conducted in a large U.S. city in 1989. Questions addressed included how managed care had affected mental health practice, specific experiences with managed care, the mechanisms of managed care, and how managed care could be improved. The practitioners complained of multiple problems, but clearly distinguished between “good” and “bad” firms. Firms seen as more positive struck a balance between quality care and cost containment, built ongoing relationships with providers, and negotiated with providers, rather than prescribing a treatment plan. The authors conclude that some of the poor reception by providers of managed care may have been created unnecessarily by firms which have not attended to those factors, and that attention to such factors might lead to a more ready acceptance of managed care.     

A prototype microcomputer-based decision support system for industrial hygienists

A prototype Industrial Hygiene Decision Support System (IH-DSS) was designed and implemented in a microcomputer environment using an integrated knowledge management system as the implementation vehicle. The heart of the system is a relational data base designed to minimize redundant data entry and to support flexible retrieval. An industrial hygienist's routine and ad hoc requirements for information retrieval and analysis support are met by screen displays, printed reports, and graphical summaries which may be presented on the screen, in a printed form, or as multicolored plots. A petroleum refinery was selected as the application environment for the prototype system because of the variety of processes, agents, and sampling methodologies involved in industrial hygiene support in that environment.     

Implementation of diagnosis-related mental health programs: impact on health care providers

Mental health services are in the midst of change in different countries. In Quebec (Canada), the government has adopted a Mental Health Action Plan (2005-2010). In this context, 2 psychiatric institutions have developed and implemented a mental health services organization model based on diagnosis-related mental health programs and support for frontline services. This article presents the impact on health care providers of implementation of diagnosis-related mental health programs in the context of transformation of mental health services.     

Selection criteria for choosing mental health service providers: a pilot study

Although there is an established literature concerned with the manner in which consumers select providers of general health care, far less attention has been given to the nature of the process used by consumers to select providers of mental health services. The present study provides further insight into this process by identifying dimensions used by consumers to differentiate among potential providers. A sample of 153 undergraduate college students was asked to read a scenario describing a situation in which they had decided that they were in need of mental health services and then to complete a questionnaire pertaining to the importance of a therapist possessing various characteristics. The results indicated that whereas demographic characteristics of potential providers were not heavily weighted as selection criteria, credentials, specific expertise, as well as personal characteristics of the therapist were of considerable importance.     

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.     

Assessing the accuracy of profiling methods for identifying top providers: performance of mental health care providers

Provider profiling as a means to describe and compare the performance of health care professionals has gained momentum in the past decade. As a key component of pay-for-performance programs profiling has been increasingly used to identify top-performing providers. However, rigorous examination of the performance of statistical methods for profiling when used to classify top-performing providers is lacking. The objective of this study was to compare the classification accuracy of three methods for identifying providers exceeding performance thresholds and to analyze data on satisfaction with mental health care providers at Group Health Cooperative using these methods. Questionnaire data on patient satisfaction with mental health care providers at Group Health Cooperative was collected between April 2008 and January 2010. Simulated data were used to compare the classification accuracy of alternative statistical methods. We evaluated sensitivity, specificity, and root mean squared error of alternative statistical methods using simulated data. For Group Health providers, we compared agreement of alternative approaches to classification. We found that when between-provider variability in performance was low, all three methods exhibited poor classification accuracy. When used to evaluate mental health care provider performance, we found substantial uncertainty in the estimates and poor agreement across methods. Based on these findings, we recommend providing uncertainty estimates for provider rankings and caution against the use of any classification method when between-provider variability is low.     

A shotgun wedding: business decision support meets clinical decision support

By effectively closing the loop between the data, analytics, processes, and methods supporting business and clinical decision making, a healthcare organization closes the loop between its knowledge generation activities and its actions at the bedside: knowledge guiding actions, actions generating knowledge.     

Managing mental health disability in the workplace

Jane is a 51-year-old customer-service representative for a utility company's customer-service call center. She has worked in this capacity for almost 10 years. She was considered an exemplary employee, received commendations at work, and was in line for a promotion to a supervisory position. Unexpectedly, she was assigned a new supervisor. Her performance began to decline, and her relationship with her supervisor became fraught with tension. A week later, Jane filed a grievance with her human resources department stating that her supervisor was verbally abusive, humiliated her in front of coworkers, and refused to accommodate her recently developing back pain.