The GUIDES checklist: development of a tool to improve the successful use of guideline-based computerised clinical decision support

Background: Computerised decision support (CDS) based on trustworthy clinical guidelines is a key component of a learning healthcare system. Research shows that the effectiveness of CDS is mixed. Multifaceted context, system, recommendation and implementation factors may potentially affect the success of CDS interventions. This paper describes the development of a checklist that is intended to support professionals to implement CDS successfully. Methods: We developed the checklist through an iterative process that involved a systematic review of evidence and frameworks, a synthesis of the success factors identified in the review, feedback from an international expert panel that evaluated the checklist in relation to a list of desirable framework attributes, consultations with patients and healthcare consumers and pilot testing of the checklist. Results: We screened 5347 papers and selected 71 papers with relevant information on success factors for guideline-based CDS. From the selected papers, we developed a 16-factor checklist that is divided in four domains, i.e. the CDS context, content, system and implementation domains. The panel of experts evaluated the checklist positively as an instrument that could support people implementing guideline-based CDS across a wide range of settings globally. Patients and healthcare consumers identified guideline-based CDS as an important quality improvement intervention and perceived the GUIDES checklist as a suitable and useful strategy. Conclusions: The GUIDES checklist can support professionals in considering the factors that affect the success of CDS interventions. It may facilitate a deeper and more accurate understanding of the factors shaping CDS effectiveness. Relying on a structured approach may prevent that important factors are missed

Integrating Multiobjective Optimization With The Six Sigma Methodology For Online Process Control

Over the past two decades, the Define-Measure-Analyze-Improve-Control (DMAIC) framework of the Six Sigma methodology and a host of statistical tools have been brought to bear on process improvement efforts in today’s businesses. However, a major challenge of implementing the Six Sigma methodology is maintaining the process improvements and providing real-time performance feedback and control after solutions are implemented, especially in the presence of multiple process performance objectives. The consideration of a multiplicity of objectives in business and process improvement is commonplace and, quite frankly, necessary. However, balancing the collection of objectives is challenging as the objectives are inextricably linked, and, oftentimes, in conflict. Previous studies have reported varied success in enhancing the Six Sigma methodology by integrating optimization methods in order to reduce variability. These studies focus these enhancements primarily within the Improve phase of the Six Sigma methodology, optimizing a single objective. The current research and practice of using the Six Sigma methodology and optimization methods do little to address the real-time feedback and control for online process control in the case of multiple objectives. This research proposes an innovative integrated Six Sigma multiobjective optimization (SSMO) approach for online process control. It integrates the Six Sigma DMAIC framework with a nature-inspired optimization procedure that iteratively perturbs a set of decision variables providing feedback to the online process, eventually converging to a set of tradeoff process configurations that improves and maintains process stability. For proof of concept, the approach is applied to a general business process model – a well-known inventory management model – that is formally defined and specifies various process costs as objective functions. The proposed iv SSMO approach and the business process model are programmed and incorporated into a software platform. Computational experiments are performed using both three sigma (3σ)-based and six sigma (6σ)-based process control, and the results reveal that the proposed SSMO approach performs far better than the traditional approaches in improving the stability of the process. This research investigation shows that the benefits of enhancing the Six Sigma method for multiobjective optimization and for online process control are immense

Altering a computerized laboratory test order form rationalizes ordering of laboratory tests in primary care physicians

Peer reviewe

The use of health information technology in the follow-up of patient test results: an exploration of the experiences and views of primary care staff in the North East of England

Background Computerisation in general practices in the UK over the last 30 years has enabled paperless clinical record keeping but the process of ordering tests and receiving results electronically from hospital systems has been a relatively recent development. The Integrated Clinical Environment System (ICE) provides an electronic link between general practices and hospital-based facilities, facilitating the timely transfer of test results across healthcare boundaries. Whilst the existing literature covers the technical aspects of such systems, there is a paucity of information about how these systems function in real life and what views healthcare staff have of using them. Aims and Objectives This research sought to ascertain the experiences and views of health care staff in general practice about their use of health information technology (HIT) systems for the ordering, processing and follow-up of test results. The research described the test ordering processes and the subsequent actions taken by healthcare professionals. It provided an understanding of different staff roles in this process, including what obstacles GPs and administrative staff faced and their views on the possible subsequent impact these obstacles had on patient care. The human element in the process of requesting and dealing with test results has not been previously described in detail. Methodology The programme of work comprises, in the first section, a narrative and systematic review of the literature, initially from the UK and then, because of a paucity of data, the global setting, on using HIT to order and act on test results. This was followed by a description of the established Donabedian model for evaluating healthcare processes through the stages of structure, process and outcome, with a description of how these components applied to this research. The third section of the thesis consisted of empirical qualitative research project involving semi-structured interviews with 18 staff members from 13 general practices within the North East of England, to ascertain and explore their experiences, views and perceptions around using HIT systems for the follow-up of test results. A conceptual framework was generated by which these data were labelled and sorted. The analysis process involved identifying recurring themes and concepts. Results The reviews indicated that users found the HIT systems easy to use and felt that these systems improved their efficiency compared with the previous paper-based systems, which was confirmed in this study. A new finding, reflecting aspects of the literature, was that results’ management was also perceived to be associated with increased workload, sometimes due to receiving multiple warning alerts about abnormal findings and because of results received from tests done elsewhere. A further, new finding, was the blurring of responsibility and duties about who should review, interpret and act on certain test results received. This task was sometimes left to administrative staff, whose role was to file ‘normal’ results but often found themselves in a position of not knowing whether such results had clinical significance. This factor appeared to be related to GP workload and the delegation of tasks. Participants also felt that the numbers of tests ordered and received had increased, an issue highlighted recently in the literature. There also appeared to be an increasing level of dis-continuity in the clinical care provided in practices, related in part to the use of locum and sessional doctors. Tests ordered were not necessarily designated for follow-up by a specific doctor. These factors may also be contributing to the increasing number of tests ordered. Conclusions and Discussion This study found that whilst the new HIT systems for tests have been associated with ease of use and efficiency in the transfer and availability of results, there appears to be a number of challenges in processing and actioning these results. Applying the Donabedian model for evaluating healthcare processes through the stages of structure, process and outcome shows how the components of the differing procedures have potential drawbacks and could contribute to compromised patient care. This is largely related to the changing structures of general practice whereby continuity of care can be a problem. There appeared to be no standardised procedures for dealing with tests and a standardised approach might be a necessary way forward. This work revealed the importance of human factors in the structure and process of tests results’ management, and how clarification of responsibilities and maintenance of continuity of care are crucial elements in delivering high quality care

Scoping a vision for formative e-assessment: a project report for JISC

Assessment is an integral part of teaching and learning. If the relationship between teaching and learning were causal, i. e. if students always mastered the intended learning outcomes of a particular sequence of instruction, assessment would be superfluous. Experience and research suggest this is not the case: what is learnt can often be quite different from what is taught. Formative assessment is motivated by a concern with the elicitation of relevant information about student understanding and / or achievement, its interpretation and an exploration of how it can lead to actions that result in better learning. In the context of a policy drive towards technology-enhanced approaches to teaching and learning, the question of the role of digital technologies is key and it is the latter on which this project particularly focuses. The project and its deliverables have been informed by recent and relevant literature, in particular recent work by Black andIn this work, they put forward a framework which suggests that assessment for learning their term for formative assessment can be conceptualised as consisting of a number of aspects and five keystrategies. The key aspects revolve around the where the learner is going, where the learner is right now and how she can get there and examines the role played by the teacher, peers and the learner. Language: English Keywords: assessments, case studies, design patterns, e-assessmen

Managing inappropriate utilization of laboratory resource

Background The inappropriate use of laboratory resources, due to excessive number of tests not really necessary for patient care or by failure to order the appropriate diagnostic test, may lead to wrong, missed or delayed diagnosis, thus potentially jeopardizing patient safety. It is estimated that 5-95% of tests are currently used inappropriately, depending on the appropriateness criteria, thus significantly contributing to the potential of generating medical errors, the third leading cause of death in the US. Content In this review, we discuss the reasons as well as the medical and financial consequences of inappropriate utilization of laboratory tests. We then provide demand management (DM) tools as a means for overcoming this issue and also discuss their benefits, challenges, limitations and requirements for successful implementation. Summary and outlook When based on current evidence, adapted to local conditions and developed in close collaboration with clinicians, DM is a reasonable strategy for progressing toward better management of over- and underuse of laboratory resources

Technical Debt Prioritization: State of the Art. A Systematic Literature Review

Background. Software companies need to manage and refactor Technical Debt issues. Therefore, it is necessary to understand if and when refactoring Technical Debt should be prioritized with respect to developing features or fixing bugs. Objective. The goal of this study is to investigate the existing body of knowledge in software engineering to understand what Technical Debt prioritization approaches have been proposed in research and industry. Method. We conducted a Systematic Literature Review among 384 unique papers published until 2018, following a consolidated methodology applied in Software Engineering. We included 38 primary studies. Results. Different approaches have been proposed for Technical Debt prioritization, all having different goals and optimizing on different criteria. The proposed measures capture only a small part of the plethora of factors used to prioritize Technical Debt qualitatively in practice. We report an impact map of such factors. However, there is a lack of empirical and validated set of tools. Conclusion. We observed that technical Debt prioritization research is preliminary and there is no consensus on what are the important factors and how to measure them. Consequently, we cannot consider current research conclusive and in this paper, we outline different directions for necessary future investigations

The role of the individual in the coming era of process-based therapy

For decades the development of evidence-based therapy has been based on experimental tests of protocols designed to impact psychiatric syndromes. As this paradigm weakens, a more process-based therapy approach is rising in its place, focused on how to best target and change core biopsychosocial processes in specific situations for given goals with given clients. This is an inherently more idiographic question than has normally been at issue in evidence-based therapy over the last few decades. In this article we explore methods of assessment and analysis that can integrate idiographic and nomothetic approaches in a process-based era.Accepted manuscrip

Psychometrics in Practice at RCEC

A broad range of topics is dealt with in this volume: from combining the psychometric generalizability and item response theories to the ideas for an integrated formative use of data-driven decision making, assessment for learning and diagnostic testing. A number of chapters pay attention to computerized (adaptive) and classification testing. Other chapters treat the quality of testing in a general sense, but for topics like maintaining standards or the testing of writing ability, the quality of testing is dealt with more specifically.\ud All authors are connected to RCEC as researchers. They present one of their current research topics and provide some insight into the focus of RCEC. The selection of the topics and the editing intends that the book should be of special interest to educational researchers, psychometricians and practitioners in educational assessment