ISSN:1527-974X    

DOI:10.1136/jamia.1995.96010389

出版商:BMJ Group    

年代:1995

数据来源: BMJ

摘要:

AbstractA Usenet newsgroup,sci.med.informatics, has been created to serve as an international electronic forum for discussion of issues related to medical informatics. The creation process follows a set of administrative rules set out by the Usenet administration on the Internet and consists of five steps: 1) informal discussion, 2) request for formal discussion, 3) formal discussion, 4) voting, and 5) posting of results. The newsgroup can be accessed using any news reader via the Internet.

ISSN:1527-974X    

DOI:10.1136/jamia.1995.96010390

出版商:BMJ Group    

年代:1995

数据来源: BMJ

摘要:

AbstractObjective: Predict the behavior and estimate the telecommunication cost of a wide-area message store-and-forward network for health care providers that uses the telephone system.Design: A tool with which to perform large-scale discrete-event simulations was developed. Network models for star and mesh topologies were constructed to analyze the differences in performances and telecommunication costs. The distribution of nodes in the network models approximates the distribution of physicians, hospitals, medical labs, and insurers in the Province of Saskatchewan, Canada. Modeling parameters were based on measurements taken from a prototype telephone network and a survey conducted at two medical clinics. Simulation studies were conducted for both topologies.Results: For either topology, the telecommunication cost of a network in Saskatchewan is projected to be less than $100 (Canadian) per month per node. The estimated telecommunication cost of the star topology is approximately half that of the mesh. Simulations predict that a mean end-to-end message delivery time of two hours or less is achievable at this cost. A doubling of the data volume results in an increase of less than 50% in the mean end-to-end message transfer time.Conclusion: The simulation models provided an estimate of network performance and telecommunication cost in a specific Canadian province. At the expected operating point, network performance appeared to be relatively insensitive to increases in data volume. Similar results might be anticipated in other rural states and provinces in North America where a telephone-based network is desired.

ISSN:1527-974X    

DOI:10.1136/jamia.1995.96010391

出版商:BMJ Group    

年代:1995

数据来源: BMJ

摘要:

AbstractThis case study explored 1) how much online clinical data is required to obtain patient-specific recommendations from a computer-based clinical practice guideline, 2) whether the availability of increasing amounts of online clinical data might allow a higher specificity of those recommendations, and 3) whether that increased specificity is necessarily desirable. The “quick reference guide” version of the guideline for acute postoperative pain management in adults, developed by the Agency for Health Care Policy and Research, was analyzed. Patient-specific data items that might be used to tailor the computer's output for a particular case were grouped into rough categories depending on how likely they were to be available online and how readily they might be determined from online clinical data. The patient-specific recommendations were analyzed to determine to what degree the amount of text produced depended on the online availability of different categories of data. An examination of example recommendations, however, illustrated that high specificity may not always be desirable. The study provides a concrete illustration of how the richness of online clinical data can affect patient-specific recommendations, and describes a number of related design trade-offs in converting a clinical guideline into an interactive, computer-based form.

ISSN:1527-974X    

DOI:10.1136/jamia.1995.96010392

出版商:BMJ Group    

年代:1995

数据来源: BMJ

摘要:

AbstractAdjusting for risk factors, severity of illness, and complexity of care is important when comparing and interpreting outcomes. Current and future approaches for examining risk factors, severity of illness, and complexity of care are described within the contexts of administrative, economic, and clinical outcomes. Reasons why the current standardized instruments, computerized severity systems, and workload/intensity measurements, when used alone, are inadequate for outcomes monitoring are proposed. A more comprehensive model for outcomes monitoring is required, one that adjusts outcomes for risk factors, severity of illness, and complexity of care.

ISSN:1527-974X    

DOI:10.1136/jamia.1995.96010393

出版商:BMJ Group    

年代:1995

数据来源: BMJ

摘要:

AbstractThis article explores the application of normative decision theory (NDT) to the challenge of facilitating and measuring patient satisfaction. Patient satisfaction is the appraisal, by an individual, of the extent to which the care provided has met that individual's expectations and preferences. Classic decision analysis provides a graphic and computational strategy to link patient preferences for outcomes to the treatment choices likely to produce the outcomes. Multiple criteria models enable the complex judgment task of measuring patient satisfaction to be decomposed into elemental factors that reflect patient preferences, thus facilitating evaluation of care in terms of factors relevant to the individual patient. Through the application of NDT models, it is possible to use patient preferences as a guide to the treatment planning and care monitoring process and to construct measures of patient satisfaction that are meaningful to the individual. Nursing informatics, with its foundations in both information management and decision sciences, provides the tools and data necessary to promote care provided in accord with patient preferences and to ensure appraisal of satisfaction that aptly captures the complex, multidimensional nature of patient preferences.

ISSN:1527-974X    

DOI:10.1136/jamia.1995.96010394

出版商:BMJ Group    

年代:1995

数据来源: BMJ

摘要:

AbstractThis article begins with a summary of the trend toward a person-based health record, and the need to integrate data from a variety of sources to achieve this. A project is described that demonstrated problems with the structure of nursing care plans. These problems affected the ability to integrate care plan data into a clinical database capable of analysis to link control of process with clinical outcome. A second project is described that focused on the development of data sets holding higher-level descriptions suitable for the maintenance of a person-based record, but at a summarized level and with no clinical detail. Finally, a prototype care planning system is described that, while maintaining the data required by the Nursing Process, was more flexibly structured to support analysis and hierarchical levels of description.

ISSN:1527-974X    

DOI:10.1136/jamia.1995.96010395

出版商:BMJ Group    

年代:1995

数据来源: BMJ

ISSN:1527-974X    

DOI:10.1136/jamia.1995.96010396

出版商:BMJ Group    

年代:1995

数据来源: BMJ

ISSN:1527-974X    

DOI:10.1136/jamia.1995.96010397

出版商:BMJ Group    

年代:1995

数据来源: BMJ