Showing papers in "Journal of Medical Systems in 1996"
TL;DR: Both registries seem to be valuable study bases for epidemiological research in diabetes mellitus.
Abstract: To evaluate the data quality in the Danish National Registry of Patients (DNRP) and the Prescription Registry in the country of Northern Jutland (487,000 inhabitants) concerning insulin dependent diabetes mellitus (IDDM) and insulin treated diabetes mellitus, a comparison between data in the two registries was made. From the Regional Hospital Registry in the County of Northern Jutland, containing discharge diagnoses from all admissions to hospitals in the county, we identified all patients with the IDDM diagnosis between 1987 and 1993. From the Regional Prescription Registry all insulin prescriptions taken up at pharmacies in the county in 1993 were identified. All persons were identified by their individual identification number (CPR-number), and a record linkage between the two data sources was made. The predictive value of an IDDM-registration in the DNRP was 96% and the corresponding completeness 91%. In the Prescription Registry the completeness was 96%. Both registries seem to be valuable study bases for epidemiological research in diabetes mellitus.
67 citations
TL;DR: Asthma treatment received by Latino and African-American respondents was deficient compared to guidelines, and Latinos fared more poorly on the number of prednisone bursts taken, use of written crisis plans and dispensation of peak flow meters controlling for gender, practice site and severity.
Abstract: This study explores provider adherence to national guidelines in treating Latino and African-American asthmatics. We hypothesized that there would be more variations in asthma treatment existing for minorities as a result of variation in physician's adherent to the guidelines. A 96-item survey was administered to 138 Latino and African-American asthmatics attending a hospital emergency department. Data were obtained on demography, severity, access, patient satisfaction, and patient's assessment of physician asthma management. Results were analyzed by ethnicity, gender, practice site of regular provider, and severity. Variation in physician practice was found in these variables. Asthma treatment received by Latino and African-American respondents was deficient compared to guidelines. Regression analyses showed that Latinos fared more poorly on the number of prednisone bursts taken, use of written crisis plans and dispensation of peak flow meters controlling for gender, practice site and severity. African-Americans expressed less dissatisfaction in obtaining services, while both groups expressed high degrees of satisfaction with their providers.
37 citations
TL;DR: Data Envelopment Analysis suggests reduction of excessive resource use by all inefficient facilities would result in a $7.2 million dollar savings in operational expenses, a total of 1715 FTEs in labor reductions, and a reduction of 1129 beds.
Abstract: The purpose of this study was to assess the efficiency of psychiatric hospitals. Data Envelopment Analysis was used to examine the technical efficiency for sample of the 85 profit and not-for-profit psychiatric hospitals. Results suggests reduction of excessive resource use by all inefficient facilities would result, on average, in a $7.2 million dollar savings in operational expenses, a total of 1715 FTEs in labor reductions, and a reduction of 1129 beds.
35 citations
TL;DR: Two Danish population-based information systems, in which patients treated with strong analgesics are registered by using the patients' personal registration numbers as identifier, are assessed and it is concluded that the two systems form a valuable study base of patients treating with strong pain in epidemiological research.
Abstract: Pain is a significant health problem, and there is considerable need for clinical and epidemiological research in this topic. A prerequisite for doing research on patients treated with strong analgesics is that it is possible to identify the patients. We assessed two Danish population-based information systems, in which patients treated with strong analgesics are registered by using the patients' personal registration numbers as identifier. The two systems, which we compared, were (1) a surveillance system administered by the National Board of Health, and (2) the drug presciption register in the Danish National Health Service. During August 1994, 3787 patients were registered in the surveillance system and 3812 in the National Health Service in North Jutland County. Ninety-five persons were registered only in the surveillance system, and 120 only in the National Health Service register. A capture-recapture analysis showed a coverage of 96.9% for the surveillance system and 97.5% for the National Health Service. We thus conclude that the two systems form a valuable study base of patients treated with strong analgesics in epidemiological research.
34 citations
TL;DR: It is suggested that public health instructors employ a variety of teaching methods and evaluative opportunities when class composition is initially assessed as having diverse learning styles to facilitate learning, maximize participation, and permit multiple pathways for students to demonstrate educational performance.
Abstract: Objectives
The learning style preferences of public health students are investigated. Learning styles, as defined by Kolb,(3) refer to the four distinct manners of processing information.
31 citations
TL;DR: This study-based on in-depth interviews with immigrant women who had recently given birth in Chicago-examines women's experiences seeking prenatal care, paying particular attention to the impact of migration and communication in prenatal care.
Abstract: National studies indicate that Mexican immigrant women tend to have more positive birth outcomes than other groups, despite receiving relatively low levels of medical prenatal care. Our study-based on in-depth interviews with immigrant women who had recently given birth in Chicago-examines women's experiences seeking prenatal care. Qualitative findings contribute to understanding why many of these women received less than optimal care during pregnancy. The study also offers modest evidence that, despite overall positive birth outcomes and low levels of prenatal care, adequate prenatal care may make a difference in birth outcomes in this group. Suggestions are made concerning ways to improve access to adequate care, paying particular attention to the impact of migration and communication in prenatal care.
28 citations
TL;DR: Some of the issues and challenges involved in conducting health and medical outcomes research on the Latino population in the U. S. are discussed and some solutions or strategies to overcome some of the most common problems are provided.
Abstract: Outcomes research studies the impact of the health and medical interventions on the health status and quality of life of the population. This paper discusses some of the issues and challenges involved in conducting health and medical outcomes research on the Latino population in the U. S., and also provides some solutions or strategies to overcome some of the most common problems in studying this population.
28 citations
TL;DR: A prototype decision support system for asthma management targeted at the primary care setting and based on the British Thoracic Society guidelines is developed, and the further work needed on the prototype is described.
Abstract: Asthma is a chronic disease estimated to affect 6-7% of the total UK population. In addition, a number of studies have shown that asthma has become commoner since the 1970s, especially in children. The diagnosis of asthma can be difficult and its management requires the involvement of patients in a long-term treatment plan, something which general practitioners may be unable to achieve easily in the average 10-min consultation. As a consequence, asthma is underdiagnosed and undertreated. Deaths from the disease are often avoidable with timely and sufficient use of the available medication. In order to support this, the British Thoracic Society (BTS) has published guidelines for asthma management based upon a stepwise approach, in which a patient is categorized as being on one of five steps according to the severity of his or her asthma. The guidelines give "rules of thumb" for deciding when the patient should move up or down the steps. The most recent version of the guidelines also included special rules for children. Within a recent European Community project on Advanced Informatics in Medicine (AIM), we developed a prototype decision support system for asthma management targeted at the primary care setting and based on the British Thoracic Society guidelines. This paper reports this development, and describes the further work needed on the prototype. Plans for evaluation of the knowledge bases and for future full application production are also described.
27 citations
TL;DR: Diabetes education was available in Spanish, and patients appeared to have a basic knowledge of the disease process, however, recommended clinical follow-up was not uniformly provided and may be related to sub-optimal management among at least some of these patients.
Abstract: Non-insulin-dependent diabetes mellitus (NIDDM) is a major health problem among Latinos, yet the quality of diabetes treatment among them has not been fully examined.Goals: A pilot study was conducted with adult diabetic patients for the purposes of describing their diabetes-related knowledge and behaviors and evaluating whether these patients were receiving effective outpatient care.
24 citations
TL;DR: The results suggest increased volume of data and of patient compliance in reporting bladder symptoms and events using CV, and that order of use is not an important factor in determining patient impressions of the two methods.
Abstract: Objective: We have previously described an electronic voiding diary, “Compu-Void” (Copyright, 1990) developed to automate recording of bladder symptoms (Rabinet al., 1993). Our objectives in this, the second phase of this study, were to examine a group of subject and control patients' preference and compliance with regard to the “Compu-Void” (CV) compared to the standard written voiding diary (WD), to compare the two methods with respect to the amount and type of information obtained and to determine whether or not the order of use of each recording method influenced results in the subject group.Methods: Thirty-six women between the ages of 20 and 84 with bladder symptomatology were compared to a group of 36 age-matched women.Results: In 100% of subjects and 95% of control patients, CV entries exceeded the number made with the WD in voiding events and in subjects, in incontinent episodes recorded (p<0.0005 andp<0.005, respectively). Over 98% of subjects and over 80% of control patients preferred CV over the WD (p<0.0005). The order of use of each recording method in subjects made no significant difference with regard to the volume of information obtained (p<0.407), number of urinary leakage events recorded (p<0.494), and fluid intake patterns (p<0.410). Patient impressions of, and compliance with each method were not affected by order of use.
23 citations
TL;DR: The process of development, installation, and initial use of the technology in one nation of the post-Soviet world is reported.
Abstract: Telemedicine, an electronic mode of transmitting medical information interactively between remote sites, was launched as an educational support for a 3-year-old medical partnership between Boston University School of Medicine and Emergency Hospital, of Yerevan, Armenia. Emergency Hospital is the first site in Armenia to have an audiographic teleconference capability linking it to a major medical center. Emergency Hospital and Boston University School of Medicine share the remote connection in order to allow educational conferences, peer consultations, and distance learning to take place, thus enhancing the partnership's aims to improve the emergency and trauma care system of Yerevan. To date, eight teleconferences have been transmitted linking 100 physicians, nurses and hospital administrators. The teleconference program provides, in effect, a formal continuing medical education program for Emergency Hospital. It is a key tool of low-cost technology transfer with the potential of broadening resources over the wide territory of the 15 republics of the former Soviet Union. The telemedicine system is comprised of Optel Communications' Remote Viewing System computer hardware and software plus two dedicated AT&T telephone lines. The system has been in use at Boston University School of Medicine for live voice and still image transmission between international sites since 1987. This level of technology suited environmental conditions in Armenia, marked by frequent power outages and unreliability of local telephone connections. A protocol for presentations was established governing length of time, number of visuals per session, visual format, compatibility with interpretive services, congruence with project mission, and adaptability to local conditions that was shown to provide clear and concise delivery of the information necessary. This paper reports the process of development, installation, and initial use of the technology in one nation of the post-Soviet world.
TL;DR: Critically assesses the important elements of the Latino/Hispanic community's participation in health services research and the known barriers to effective collaboration, and provides suggestions that may contribute toward a meaningful partnership among health care providers, researches and the community.
Abstract: This paper critically assesses the important elements of the Latino/Hispanic community's participation in health services research and the known barriers to effective collaboration, and provides suggestions that may contribute toward a meaningful partnership among health care providers, researchers and the community. The discussion focuses on central strategies for community participation to help improve existing health care services' effectiveness, specifically for low-income Latino/Hispanic groups. It reviews current approaches for including communities in health care delivery and health services research and draws examples from the author's experiences of working with Latino/Hispanic communities for almost 20 years. The data implies that mutual benefits can be derived from forging alliances and meaningful partnerships between the health services research community and the Latino/Hispanic community.
TL;DR: A literature review of risk factors and their association with invasive cervical cancer was conducted using MEDLINE and PsychINFO databases to determine if ethnic differences in risk factors explain observed differences in morbidity and mortality.
Abstract: Most invasive cervical cancer research in the United States has been conducted on non-Latino-White (NLW) and African-American women. Incidence, mortality, stage at diagnosis and survival indicators for invasive cervical cancer in Latino women in California are compared to NLW and African-American women. A model is presented which depicts structural, behavioral, genetic and biological risk factors for invasive cervical cancer. A literature review of risk factors and their association with invasive cervical cancer was conducted using MEDLINE and PsychINFO databases to determine if ethnic differences in risk factors explain observed differences in morbidity and mortality. Latino women experience a significantly higher incidence and mortality associated with invasive cervical cancer than NLW women. The review of risk factors found that rate differences of cervical cancer screening, early detection and human papilloma virus (HPV) type-specific infection explain much of the disparity in disease burden. Further research must clarify if ethnic differences exist in risk factors associated with ethnic variation in HPV-type prevalence in both cases and their sexual partners, in host immune responses, and multiparity.
TL;DR: In a prospective study ART was successful in learning treatment strategies and performed under supervision similar to experts and showed no difference between decisions regarding treatment by the ART network and by the experts.
Abstract: A modified neural network based on adaptive resonance theory (ART) was trained with the records of 211 psychiatric inpatients (74 schizophrenic, 50 unipolar depressed, 34 bipolar depressed, 20 bipolar manic, 33 other) who improved by at least 40 points of the GAFS during 8 weeks of treatment. Thereafter, a comparison was made between the clinical response of another 26 schizophrenic patients and 28 unipolar depressed inpatients, to treatment suggestd by the trained ART (N=21) and by the consensus of two senior psychiatrists (N=33). The patients were allocated blindly and randomly to the two treatment groups. The BPRS (for the schizophrenic patients) or the HDRS (for the unipolar depressed patients) was completed weekly for 5 weeks. Results showed no difference between decisions regarding treatment by the ART network and by the experts. Length of hospital stay was also similar. All ART suggestions included supportive psychotherapy. High potency antipsychotics were suggested for 7 schizophrenic inpatients, clozapine for one and the addition of community therapy for another. Depressed patients got a variety of treatment suggestions. No contraindicated treatment was suggested by ART; however, two incomplete treatment suggestions were dropped from the study. In conclusion, in a prospective study ART was successful in learning treatment strategies and performed under supervision similar to experts.
TL;DR: Although the original HL7 specifications had to be modified, it was found that HL7 can be adopted in a client-server HIS, especially in the area of order entry and record-oriented query.
Abstract: In developing a large-scale Hospital Information System (HIS), a client-server architecture has been gaining in popularity. It is important to introduce a standard message protocol that is independent both on the database structure and on the vender's proprietary platform. We introduced Health Level Seven (HL7) to our hospital information system. From our experiences, although we had to modify the original HL7 specifications in order to introduce the protocol to a client-server HIS especially in the area of order entry and record-oriented query, it was found that HL7 can be adopted in a client-server HIS.
TL;DR: The tools to correct the human brain's inability to store, update, and recall what is currently available and it should be standard practice to implement a sophisticated computer-based pharmacy system for every outpatient in the United States.
Abstract: Primary care demands a continuous flow of current pharmaceutical information to the front lines of patient services. With a wide spectrum of drugs to prescribe and a continuous production of new drug-related information, the practicing physician is faced with a social and professional mandate to deliver the most acceptable drug in a safe and efficacious manner. The legal implications of this product and knowledge explosion have exposed the human brain's inability to store, update, and recall what is currently available. Physicians can no longer trust their memory or their paper-based medical record to protect them from potential liability. The tools to correct this mental imbalance are now available and it should be standard practice to implement a sophisticated computer-based pharmacy system (CBPS) for every outpatient in the United States.
TL;DR: Results indicate that the gap in oral health between Whites and ethnic minority groups is pervasive across research locations and age cohorts, and variation in regional dental care delivery systems and the varying effects of race-ethnicity and age cohort suggest that alternative health promotion strategies will be needed for improving oral health in diverse populations.
Abstract: Racial-ethnic group differences are assessed using a standardized set of oral health indicators, as well as various predisposing, enabling and need characteristics collected in the International Collaborative Study of Oral Health Outcomes (ICS-II) USA research locations. The unique data set contains comparable data on African-American, Native American, Hispanic, primarily Mexican-American, and White adults. Age group differences in oral health indicators are also compared in two adult age cohorts (35–44 and 65–74 years). Since data were collected from geographically diverse regions of the United States, differences in oral health indicators are considered within the context of different dental care delivery systems and external environments. Results indicate that the gap in oral health between Whites and ethnic minority groups is pervasive across research locations and age cohorts. Variation in regional dental care delivery systems and the varying effects of race-ethnicity and age cohort suggest that alternative health promotion strategies will be needed for improving oral health in diverse populations.
TL;DR: In this study, diastolic heart sounds recorded from both normal and diseased patients were analyzed using the AR modeling, which is computationally the most efficient parametric spectral analysis method.
Abstract: Previous studies demonstrated that spectral analysis of diastolic heart sounds may provide valuable information for the detection of coronary artery disease Although parametric modeling methods were successfully used to achieve this goal, and showed considerable performance, the accuracy and precision of the analysis is strongly dependent on the model order selected In order to investigate the effects of model order selection on the analysis, diastolic heart sounds recorded from both normal and diseased patients were analyzed using the AR modeling, which is computationally the most efficient parametric spectral analysis method The model orders were determined by using four different model order selection criteria The results showed that the four criteria yielded different orders for the same data set On the other hand, different criteria showed different performance in different measurement conditions Effect of arbitrary order selection was also discussed As a result, an optimal AR model order that may be used for every case was determined
TL;DR: The MDX diagnostic decision support system contains a multitude of clinical facts as reported in a variety of medical textbooks and national medical journals, which offers users the widest range of diagnostic knowledge available from a single source in the industry.
Abstract: The MDX diagnostic decision support system contains a multitude of clinical facts as reported in a variety of medical textbooks and national medical journals. The database was custom designed for the medical diagnostic process and offers users the widest range of diagnostic knowledge available from a single source in the industry. The database consists of diseases, conditions, chemicals, drugs, and toxins that are known database consists of diseases, conditions, chemicals, drugs, and toxins that are known to cause medical illness. Each causal element has an asociated file for signs, symptoms and findings. This fully referenced source of encoded clinical knowledge used in MDX comes from the world's experts as they transmit their experience in the written word of books and journals.
TL;DR: A 15-item spreadsheet instrument for evaluating computerized medical records is proposed, and it is demonstrated how it was experimentally applied to a 6-year long experience at three sites.
Abstract: Information and communication technologies are presumed to play a critical role in improving effectiveness and efficiency of clinical care. Although the most promising directions of technological development are microcomputer-generated computerized medical record systems, documenting their value has been a major challenge for health care providers. This paper proposes a 15-item spreadsheet instrument for evaluating computerized medical records, and demonstrates how it was experimentally applied to a 6-year long experience at three sites. In conclusion, preliminary implications and guidelines are drawn with regard to practice and research in this area.
TL;DR: Clinical data is modeled to easily express and manipulate time and a concept learning system is extended to utilize a time-centered clinical data model based on the themessage-value method rather than the traditionalattribute- value method.
Abstract: A concept learning system is expected to be a powerful tool for filtering and analyzing a large amount of data in a variety of scientific fields. A simple application of it to clinical data, however, fails to mine medical information and knowledge. One of the major obstacles in mining a clinical database is time, which is a very important concept in clinical medicine. To be successful in data mining in clinical medicine, an efficient model of clinical data with time and a flexible concept learning system augmented to handle the model are both necessary. Herein we modeled clinical data to easily express and manipulate time and extended a concept learning system to utilize a time-centered clinical data model. The modified concept learning system is based on the message-value method rather than the traditional attribute-value method. The object-oriented technology was of great help in modeling time-centered clinical data and in developing a modified concept learning system.
TL;DR: A biotelemetry system based on digital data processing and transmission is implemented that shows a stable and high performance within a distance of 100 m.
Abstract: A biotelemetry system based on digital data processing and transmission is implemented. The transmitter digitizes analog physiological signal, converts into serial form, forms a digital data packet by summing data and synchronization information and transmits the packets via an FM transmitter. The receiver side amplifies and pulse-shapes the received data packet, separates the data and synchronization information, converts serial data into 8-bit parallel form and then into analog signal. A special coding method provides high noise immunity and proper synchronization between transmitter and receiver. The system shows a stable and high performance within a distance of 100 m.
TL;DR: The “statistic” approach to pruning gave the most compact and still most clinically relevant decision-tree, which was compared with a previously published preliminary essential data set for the ear-nose-and-throat realm in primary health care and discussed as a possible decision support system for variousPrimary health care groups in a practice setting.
Abstract: In the primary health care center of Mjolby a sample of case notes in the ear-nose-and-throat realm (N=425) was computer processed using an inductive rule-based decision-tree generating program. As a result of incomplete information in the case-files, the decision trees were “noisy,” e.g., had branches and leaves without meaning. This led to a need for “pruning.” Various methods were tried. The effects of different methods of decision-tree generating and pruning are discussed. The choice of root argument and branching of the decision-trees suggested by the software was the most clinically applicable. The “statistic” approach to pruning gave the most compact and still most clinically relevant decision-tree. The pruned and edited decision trees are compared with a previously published preliminary essential data set for the ear-nose-and-throat realm in primary health care and then discussed as a possible decision support system for various primary health care groups in a practice setting.
TL;DR: A project was designed to compare two commonly used types of kinematic recording techniques, i.e., the 6 df electromagnetic tracker system and the video motion analysis system and it was demonstrated that for rigid body inanimate objects the two systems produce nearly identical values under stationary conditions and are comparable under moving conditions.
Abstract: Kinematics, the study of motion, is employed in numerous biomechanics and human performance investigations. The types of instrumentation used in these studies vary at fundamental technical levels, making it difficult to relate results from studies carried out at different laboratories using different instrumentation. A project was designed to compare two commonly used types of kinematic recording techniques, i.e., the 6 df electromagnetic tracker system and the video motion analysis system. A four-level testing and comparison method was conducted involving static and dynamic inanimate objects, as well as human subjects under static and dynamic conditions. It was demonstrated that for rigid body inanimate objects the two systems produce nearly identical values under stationary conditions and are comparable under moving conditions. The systems show only trivial discrepancies in static human body measurements, and perform in qualitatively similar ways on human motion.
TL;DR: A mathematical model for flexible staff planning when patient demands are uncertain and adjustable is presented so that the nursing workforce can accommodate patient needs efficiency and economically with quality assurance in an uncertain demand environment.
Abstract: The objective of this paper is to present a mathematical model for flexible staff planning when patient demands are uncertain and adjustable. The demand level before adjustment is considered a distribution on a daily basis. The adjustment is done by increasing or decreasing the average and the standard deviation of the daily demand level, with the assumption that the total patient demands for a week are identical. The adjustment of patient demands can be achieved by cooperating with an inpatient admission system to control the patient mix and the variation of an admitted census. Then, the nursing workforce can accommodate patient needs efficiency and economically with quality assurance in an uncertain demand environment.
TL;DR: An overview of the computer tools developed and/or employed to support the re-engineering process, and the findings obtained as the work of patient care was defined and analyzed at VUH/TVC are presented.
Abstract: In November 1993 The Vanderbilt University Hospital and Clinic (VUH/TVC) convened a 10-member Collaborative Organization Design (COD) team comprised of a multi-disciplinary team representing a diagonal slice through the organization. This team, lead by Gelinas * James, Inc. a consulting firm specializing in restructuring, was charged to develop, recommend, and implement a new organizational design that would promote stronger patient focus, increased efficiency, and lower cost. The COD process is structured to inspire and enable employees to rebuild their organization to respond to the challenges and opportunities that exist within their environment, to customer needs, and their own aspirations. This manuscript presents an overview of (1) the computer tools developed and/or employed to support the re-engineering process, and (2) the findings obtained as the work of patient care was defined and analyzed at VUH/TVC.
TL;DR: An ECG storage and retrieval system embedded in the client server HIS utilizing object-oriented database to take the first step in dealing with digitized signal, schema and image data and show waves, graphics, and images directly to physicians by the client servers HIS.
Abstract: In the University of Tokyo Hospital, the improved client server HIS has been applied to clinical practice and physicians can order prescription, laboratory examination, ECG examination and radiographic examination, etc. directly by themselves and read results of these examinations, except medical signal waves, schema and image, on UNIX workstations. Recently, we designed and developed an ECG storage and retrieval system embedded in the client server HIS utilizing object-oriented database to take the first step in dealing with digitized signal, schema and image data and show waves, graphics, and images directly to physicians by the client server HIS. The system was developed based on object-oriented analysis and design, and implemented with object-oriented database management system (OODMS) and C++ programming language. In this paper, we describe the ECG data model, functions of the storage and retrieval system, features of user interface and the result of its implementation in the HIS.
TL;DR: A medical partnership program between Boston University School of Medicine and the Emergency Hospital, of Yerevan, armenia, has been developed to improve the care of the injured in that city and it is found that management issues are the most resistant to change.
Abstract: A medical partnership program between Boston University School of Medicine and the Emergency Hospital, of Yerevan, armenia, has been developed to improve the care of the injured in that city. The Emergency Hospital, a trauma center, was site-visited by experts from a Level I trauma center who evaluated prehospital and hospital-based emergency and trauma services and made system-wide recommendations. Recognizing local limitations, the hospital was found to have the leadership commitment, staff complement, and basic infrastructure to meet the American College of Surgeons' criteria for Level II trauma centers. The goal of integration of the academic, clinical, and research roles of a medical center consistent with Level I-type trauma centers was formulated. After 36 months, several issues raised in the assessment are being addressed notwithstanding political and economic turbulence. The Emergency Hospital has established an accredited residency program in emergency medicine; implemented programs for postgraduate medical education of its staff; begun to develop medical information systems; expanded the scope of its activities to other institutions; and restructured the emergency admissions area. Management systems remain largely undeveloped as the discipline lacks recognition as an analytic tool for institutional improvement. Conclusions: The use of existing published resources for assessment and improvement of health services in dissimilar health-care systems has been validated as a systematic approach. For system advances to be well-founded, a combination of education, management, and clinical approaches needs to be addressed. Of these, our experience is that management issues are the most resistant to change.
TL;DR: A general approach to a participative HIS development, where users are full members of the development team, and an application to the particular context of a Greek hospital is described.
Abstract: User participation in HIS development is considered essential for achieving systems implementation success. Realizing a participative HIS development, where users are full members of the development team, requires not only choosing an appropriate methodology but also organizing the participation process in a way that is tailored to the particular situation in order to achieve the desired results. A general approach to this problem is presented in this paper. An application of the approach to the particular context of a Greek hospital is described.
TL;DR: The manuscript demonstrates that some small-scale retrospective analyses may negatively affect net income and suggests that risk aversion increases the value of information and therefore the optimum expenditure on a project evaluation.
Abstract: This manuscript extends the classical models of the value of information to ask whether a hospital's net financial return is ever maximized by a cost-effectiveness analysis of retrospective data when watchful waiting and a full randomized clinical trial are alternative methodologies. The manuscript demonstrates that (1) some small-scale retrospective analyses may negatively affect net income and (2) under some conditions, larger-scale retrospective analyses may maximize net income. The manuscript also suggests that risk aversion increases the value of information and therefore the optimum expenditure on a project evaluation.