REVIEWS Implementing combined decision models in healthcare settings: the Simon and Pauker (original) (raw)

Modeling of Processes and Decisions in Healthcare - State of the Art and Research Directions

The Practice of Enterprise Modeling Lecture Notes in Business Information Processing Volume 134, 2012, pp 101-116, 2012

In order to be able to deliver efficient and effective decision support technologies within healthcare, it is important to be able to understand and describe decision making in medical diagnosis, treatment and administrative processes. This paper outlines how information can be synthesized, interpreted and used during decision making in dynamic healthcare environments. We intend to develop a set of modeling constructs that describe the decision requirements forming the basis for adequate situation awareness in clinical processes. We propose that a separate decision perspective will 1) enhance the shared understanding of the decision context among clinical staff, and 2) provide a better understanding of how we can design information system support for complex cognitive tasks in dynamic work environments.

Application of Brim's and Simon's Sequential Decision Theories in Healthcare Administration

Journal of Biology, Agriculture and Healthcare, 2014

As part of the learning process, many episodes in life become routine and habitual with people no longer deliberately paying attention to their behaviors. When individuals come across situations they have encountered before, their response would be the one they have come to know as the best response from previous experience. However, when the situation is new or previous solutions cannot be applied successfully; routine selection of an action will not be possible. In such a case, a decision making process is applied to the identification of the problem and goes through a number of phases eventually ending with the performance of one or more actions based on the available information. Various decision making tools informed by decision theories exist and readily available for the healthcare administrator. This essay will describe the sequential decision theories of Simon (as cited in Hansson, 2005) and Brim et al. (1962) in healthcare decision making and discuss their application in health care settings. Key Words: Decision making, health care, Simon’s Decision theory, Brim’s Decision Theory, decision analysis

The art and science of medical decision making

The Journal of Pediatrics, 1984

TIlE IIALLMARK OF A GOOD PitYSICIAN iS the ability to make sound clinical judgments. Traditionally this has been considered an artful and intuitive process neither subject to theoretical analysis nor to be captured in a formal quantitative model. In 1959 Ledley and Lusted, ~ in a seminal article, introduced the idea that a science of medical decision making could be reasonably founded in symbolic logic, probabili!y theory, and value theory: They proposed that computer-based Statistical models could enhance the diagnostic and therapeutic skills of the physician. Subsequently, numerous authors ha~'e documented the deficiencies of the physician as an intuitive decision maker and have described formal quantitative models that in selected circumstances outperform physicians in clinical diagnosis. Widespread acceptance of these models did not occur. It was argued that the process Could only evaluate but not improye treatment, and could not adequately incorporate patient values into decision making. "In addition, physicians and their patients greatly value sound clinical judgment. Any attack on the quality of that skill may diminish the role of the physician in the diagnostic process. Recently, the iremendous growth of medical information, the demand for cost-effective solutions, and the growing need to explicitly justify clinical decisions to utilization review committees, third-party payers, and health policy makers have made medical decisions complex and, frequently, confounding. At the same time, computers and formal decision-making models have become more sophisticated and accessible to physicians. It has become apparent that the concept of the physician as an intuitive decision maker and the potential role of the computer in improving clinical decisions are compatible. We discuss (1) the interface between intuitive decision making and the use of computer-based models and data bases (collectively called deizision support systems); (2) the

Tracing the decision-making process of physicians with a Decision Process Matrix

BMC medical informatics and decision making, 2016

Decision-making processes in a medical setting are complex, dynamic and under time pressure, often with serious consequences for a patient's condition. The principal aim of the present study was to trace and map the individual diagnostic process of real medical cases using a Decision Process Matrix [DPM]). The naturalistic decision-making process of 11 residents and a total of 55 medical cases were recorded in an emergency department, and a DPM was drawn up according to a semi-structured technique following four steps: 1) observing and recording relevant information throughout the entire diagnostic process, 2) assessing options in terms of suspected diagnoses, 3) drawing up an initial version of the DPM, and 4) verifying the DPM, while adding the confidence ratings. The DPM comprised an average of 3.2 suspected diagnoses and 7.9 information units (cues). The following three-phase pattern could be observed: option generation, option verification, and final diagnosis determination...

Modeling Decision Making in Clinical Practice:A Cost-Effectiveness Approach

2012

Current medical research, focused on understanding the disease from a molecular level is exploring the correlation between various inflammatory markers (cytokines) and patient survival. Partially observable Markov decision processes (POMDPs) have recently been suggested as a suitable Model to formalizing the planning of Clinical Management over a prolonged period of time. In this paper, we show how the POMDP framework can be used to model and solve the problem of the management of patients, characterized by hidden disease states, investigative and treatment procedures. This model is significant because it provides a way to make a tradeoff between choosing the investigative actions and the diagnosis actions. The results in this paper demonstrate the potential value of inexpensive, accurate testing procedures as well as accurate interpretation of test results. The reported experiments show that (POMDPs) provide Clinically Reasonable and justifiable solutions. MSC: 90Β50, 65Κ05, 65Κ10,...

An Analytical Study of Health System Managers’ Decision-Making Models

Shiraz E-Medical Journal, 2015

Background: Cultural differences between countries may lead to different decision-making styles. This may contribute to varied style choices being used by managers (in diverse countries), who play key roles in organizations' decision-making processes. Objectives: The present study was conducted to analyze decision-making models used by health system managers in Iran. Patients and Methods: This was a qualitative research study conducted by interviews. The participants included 30 health system members employed at micro, intermediate and macro levels. In addition to the qualitative component of the research, after coding the responses were used. To gather qualitative data, participants were invited to illustrate their views and perceptions of how they processed allocation decisions in complex systems and what factors they applied. Data saturation was reached if an exaggerated response was found during analysis of the interview, and the response was removed from the sample. Results: The collaborative, authority submission and consultative decision-making styles were the most widely used among Iranian health system managers. The most widely used information sources for decision-making were official information, internal experts' opinions, mental background and regulations, and upper level documents. Furthermore, 16.7% of the managers believed that they always had freedom in decision-making. There was no significant association between managers' decision-making model and their position levels in the system, or their level of education. Conclusions: Crisis from inside or outside the organization can affect health system managers' decision-making processes. During the decision-making process, the most common restrictions can be attributed to a shortage of manpower and other sources.

SimCare: A Model for Studying Physician Decisionmaking Activity

PsycEXTRA Dataset

A major factor that contributes to the high rates of medical error in the treatment of patients with diabetes and other chronic diseases is the complexity of the tasks that physicians must complete. SimCare is a model of the clinical care setting for patients with type 2 diabetes. The model was designed to support investigation of physician cognition and decisionmaking activity. SimCare is dynamic and interactive and simulates diabetes management in the office-practice setting. SimCare presents a series of cases based on clinical situations representing task features that are thought to be the source of both realistic care decisions and medical errors. Once a simulated clinical case is initiated, physicians select treatment options (termed "moves") from an unguided set of choices similar to those available in routine office practice. The cumulative record of the chosen treatment moves is available for analysis and comparison with an expert's sequence of moves for each simulated patient. SimCare is potentially both an assessment and a teaching tool that enables the observation and analysis of decisionmaking in the simulated practice setting. This paper discusses the use of this tool to identify potential sources of medical errors and guide customized learning interventions designed to reduce them.