Interactive financial decision support for clinical research trials

The purpose of this article is to describe a decision support approach useful for evaluating proposals to conduct clinical research trials. Physicians often do not have the time or background to account for all the expenses of a clinical trial. Their evaluation process may be limited and driven by factors that do not indicate the potential for financial losses that a trial may impose. We analyzed clinical trial budget templates used by hospitals, health science centers, research universities, departments of medicine, and medical schools. We compiled a databank of costs and reviewed recent research trials conducted by the Department of Cardiothoracic Surgery in a major academic health science center. We then developed an interactive spreadsheet-based budgetary decision support approach that accounts for clinical trial income and costs. It can be tailored to provide quick and understandable data entry, accurate cost rates per subject, and clear go/no-go signals for the physician.

Integrated healthcare resource planning and management

Management information systems (MIS) and decision support systems (DSS), used as part of broader healthcare technology management, are considered to be health technologies. As such, they should meet the criteria of affordability, appropriateness, cost-effectiveness, ease of use and sustainability if they are to be implementable and have a lasting impact on healthcare service delivery. They should also facilitate and support improved quality of healthcare. We have developed a suite of management-support tools around a concept of integrated healthcare resource planning and management (iHRPM). We believe that these tools meet the above-mentioned criteria and therefore lend themselves to widespread applicability in diverse healthcare and socio-economic contexts, not least in supporting performance monitoring and benchmarking.

The STRATEGY project: decision tools to aid sustainable restoration and long-term management of contaminated agricultural ecosystems

The STRATEGY project (Sustainable Restoration and Long-Term Management of Contaminated Rural, Urban and Industrial Ecosystems) aimed to provide a holistic decision framework for the selection of optimal restoration strategies for the long-term sustainable management of contaminated areas in Western Europe. A critical evaluation was carried out of countermeasures and waste disposal options, from which compendia of state-of-the-art restoration methods were compiled. A decision support system capable of optimising spatially varying restoration strategies, that considered the level of averted dose, costs (including those of waste disposal) and environmental side effects was developed. Appropriate methods of estimating indirect costs associated with side effects and of communicating with stakeholders were identified. The importance of stakeholder consultation at a local level and of ensuring that any response is site and scenario specific were emphasised. A value matrix approach was suggested as a method of addressing social and ethical issues within the decision-making process, and was designed to be compatible with both the countermeasure compendia and the decision support system. The applicability and usefulness of STRATEGY outputs for food production systems in the medium to long term is assessed.

Usefulness and effects on costs and staff management of a nursing resource management information system

While administrative information systems can assist nurse managers to improve cost containment and resource management of their units, such effects cannot be known without rigorous evaluations. This article presents evaluation results of CLASSICA, an information system designed to provide decision support for nurse managers in financial management, resource allocation, and activity planning. CLASSICA demonstrated a 41% reduction in expenditures for overtime and extra hours during the evaluation period as compared with a 1.8% reduction in control units that did not use the system. Nurse managers reported a substantial improvement in management information and stated that they had gained control over costs. The system helped them analyse the relationships between patient activity, staffing and costs of nursing care. Nurse managers also reported high satisfaction with the system, the information and decision support provided, and its ease of use. These results suggest that CLASSICA is a decision support system that can successfully assist nurse managers in effectively managing their units.

Nurse managers' use of a computer decision support system. Differences in nursing labor costs per patient day

To control nursing labor cost, nurse managers (NMs) need access to productivity indicators and financial performance information on a daily basis. Labor cost and hour reports after the fact are no longer acceptable for making crucial management/labor decisions. The purpose of this study was to determine if there was a mean difference in nursing labor cost per patient day (PPD) when a nurse manager used a labor computer decision support system (CDSS) compared to an NM who did not use this system. This descriptive study was implemented on a study and comparison unit in both a psychiatric and a medical hospital. The CDSS provided the NMs with daily labor cost information on which to base labor decisions. Study findings indicate that with the use of the labor CDSS, nurse managers achieved better cost performance per patient day compared to the nurse managers who did not use the labor CDSS.

Doe's quality system program: cooperative development and implementation

Implementation of a Quality Systems approach to making defensible environmental program decisions depends upon multiple, interrelated components. Often, these components are developed independently and implemented at various facility and program levels in an attempt to achieve consistency and cost savings. The U.S. Department of Energy, Office of Environmental Management (DOE-EM) focuses on three primary system components to achieve effective environmental data collection and use. (1) Quality System guidance, which establishes the management framework to plan, implement, and assess work performed; (2) A Standardized Statement of Work for analytical services, which defines data generation and reporting requirements consistent with user needs; and (3) A laboratory assessment program to evaluate adherence of work performed to defined needs, e.g., documentation and confidence. This paper describes how DOE-EM fulfills these requirements and realizes cost-savings through participation in interagency working groups and integration of system elements as they evolve.

Measuring the benefit of performance improvement and decision support

In an effort to provide high quality care in a more cost-effective manner, health care providers have found it necessary to implement a series of decision support strategies designed to improve outcomes of care. While each of these strategies has measurable benefits, each comes along with additional costs. As more and more technology becomes available and more labor resources are devoted to these efforts, it becomes crucial to be able to assess the costs and benefits of these programs. A return-on-investment methodology is used to assess the financial impact of service-related operating expenses compared to revenue gains from service delivery. However, unlike traditional return-on-investment models, in health care, benefits are frequently gained from cost avoidance rather than from revenue enhancement activities. This article will describe a methodology for measuring the direct and indirect costs and qualitative and quantitative benefits of decision support activities.

PAYOFF@InfoTech. NOW

Why shouldn't your computer system earn its keep? Tracking the return on investment is simply good business discipline. But some insist that traditional cost/benefit analyses don't apply.

Linking cost control measures to health care services by using activity-based information

Canada's health care institutions are under pressure to limit expenditures, maintain or increase productivity, and assimilate new technology. Even though more than 75% of hospital operating expenditures are controllable, according to a study by the Economic Council of Canada, cost systems are needed to provided essential management information. The new Canadian Management Information System (MIS) Guidelines for health care are designed to provide accurate cost measurement of patient treatment and to help managers evaluate the impact of planned program changes on areas of operational responsibility. Other potential benefits of implementing the MIS guidelines include correcting dysfunctional funding of health care units with benchmarking and setting high reporting standards for resource use at the patient level (MIS, 1991). This paper focuses on one important aspect of bringing these costs under control by examining the relation between cost deviations (variances) and underlying cost drivers. Our discussion will lead to the conclusion that incompatibility of DRG methodology and traditional cost accounting models may be an important source of cost variability within diagnostically-related disease groupings.

Reducing health care delivery costs using clinical paths: a case study on improving hospital profitability

The process of merging and benchmarking clinical and financial data is pivotal to the development of appropriate clinical pathways. Bristol Regional Medical Center (BRMC), facing the challenge of managed care organizations (MCOs), instituted this process and achieved significant cost savings, largely because of the working partnership between the administration and its medical staff. In DRG 89, Simple Pneumonia and Pleurisy, Age Greater than 17 with CC, data adjusted for severity of illness and cost of living were furnished to BRMC by HCIA Inc. Major benchmark or "best practice" variations were incorporated into new clinical pathways, leading to decreased resource use, no compromise in the quality of care, and a beneficial halo effect on other unrelated DRGs.

The real costs of computerisation

In the NHS hospital environment, people tend to be discouraged by the seemingly unsupported cost figures associated with IT. After the successful implementation of an IT system at the Wirral Hospital NHS Trust, IT Manager, Alan Spours, argues that cost figures have to be seen in the context of deliverable cost benefits and the ability of IT to offer significant returns in the form of improved levels of care.

Development of information-based planning in Niger

The authors present their experiences in assisting the government of Niger to develop automated information systems for health care management. They discuss the structure of the health system, the role of donor assistance, the process of initiating automated systems, and the technical requirements and costs of the system. Finally, they draw general conclusions that may be useful for those attempting similar efforts.

Decision-support systems in health care. Factors influencing the development and transfer of technology

National concern about escalating health care costs and inefficiencies in delivery systems has created demand for informatics technology such as decision-support systems. This paper discusses the pressing need for better cost information in health care and how decision-support technology meets this need. Future directions for the technology also are discussed.

Using decision support systems to market prepaid medical plans

A decision support system (DSS) is described that enables executives quickly and easily to (1) manage relevant marketing information and (2) convert the information into market-effective health plans. Because the system primarily uses available records and routine transactions, it can be implemented cost efficiently.

Senior management must champion business intelligence programs

Business leaders in Japan, Western Europe, and Latin America believe that the chief executives who lead their companies into the twenty‐first century will have to be fluent in several languages, have extensive international business experience, and will have to cope with an increasing level of international competition. The Japanese leaders considered foreign competition as the primary threat—hence, their emphasis on the importance of language skills and global experience.