Driving with Roadmaps and Dashboards: Using Information Resources to Structure the Decision Models in Service Organizations

Department of Psychology, University of Hawaii at Mānoa, 2430 Campus Road, Honolulu, HI 96822, USA.
Administration and Policy in Mental Health and Mental Health Services Research (Impact Factor: 3.44). 04/2008; 35(1-2):114-23. DOI: 10.1007/s10488-007-0151-x
Source: PubMed


This paper illustrates the application of design principles for tools that structure clinical decision-making. If the effort to implement evidence-based practices in community services organizations is to be effective, attention must be paid to the decision-making context in which such treatments are delivered. Clinical research trials commonly occur in an environment characterized by structured decision making and expert supports. Technology has great potential to serve mental health organizations by supporting these potentially important contextual features of the research environment, through organization and reporting of clinical data into interpretable information to support decisions and anchor decision-making procedures. This article describes one example of a behavioral health reporting system designed to facilitate clinical and administrative use of evidence-based practices. The design processes underlying this system-mapping of decision points and distillation of performance information at the individual, caseload, and organizational levels-can be implemented to support clinical practice in a wide variety of settings.

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Available from: Adam Bernstein, Jun 07, 2015
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    • "Continual feedback is critical, as it may optimize intervention effectiveness. In this manner, the tracking of individual progress, fidelity to protocol, and organizational program results, can be used to inform and maximize the benefits of treatment (Schmidt 2012; Chorpita et al. 2008). Importantly, research suggests that objective feedback may improve child outcomes (e.g. Warren et al. 2009). "
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    ABSTRACT: The Child and Adolescent Functional Assessment Scale (CAFAS) is widely used for outcome management, for providing real time client and program level data, and the monitoring of evidence-based practices. Methods of reliability training and the assessment of rater drift are critical for service decision-making within organizations and systems of care. We assessed two approaches for CAFAS training: external technical assistance and internal technical assistance. To this end, we sampled 315 practitioners trained by external technical assistance approach from 2,344 Ontario practitioners who had achieved reliability on the CAFAS. To assess the internal technical assistance approach as a reliable alternative training method, 140 practitioners trained internally were selected from the same pool of certified raters. Reliabilities were high for both practitioners trained by external technical assistance and internal technical assistance approaches (.909–.995, .915–.997, respectively). 1 and 3-year estimates showed some drift on several scales. High and consistent reliabilities over time and training method has implications for CAFAS training of behavioral health care practitioners, and the maintenance of CAFAS as a global outcome management tool in systems of care.
    Journal of Child and Family Studies 09/2014; 23(1). DOI:10.1007/s10826-012-9694-x · 1.42 Impact Factor
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    • "Interactive decision dashboards are being increasingly used in business settings [13]. In healthcare, dashboards have been used to advance quality improvement [14-17], medication safety [18], intensive care unit patient management [19], implementation and monitoring of mental health care guidelines [20], and patient wellness [21]. "
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    ABSTRACT: Background: For many healthcare decisions, multiple alternatives are available with different combinations of advantages and disadvantages across several important dimensions. The complexity of current healthcare decisions thus presents a significant barrier to informed decision making, a key element of patient-centered care.Interactive decision dashboards were developed to facilitate decision making in Management, a field marked by similarly complicated choices. These dashboards utilize data visualization techniques to reduce the cognitive effort needed to evaluate decision alternatives and a non-linear flow of information that enables users to review information in a self-directed fashion. Theoretically, both of these features should facilitate informed decision making by increasing user engagement with and understanding of the decision at hand. We sought to determine if the interactive decision dashboard format can be successfully adapted to create a clinically realistic prototype patient decision aid suitable for further evaluation and refinement. Methods: We created a computerized, interactive clinical decision dashboard and performed a pilot test of its clinical feasibility and acceptability using a multi-method analysis. The dashboard summarized information about the effectiveness, risks of side effects and drug-drug interactions, out-of-pocket costs, and ease of use of nine analgesic treatment options for knee osteoarthritis. Outcome evaluations included observations of how study participants utilized the dashboard, questionnaires to assess usability, acceptability, and decisional conflict, and an open-ended qualitative analysis. Results: The study sample consisted of 25 volunteers - 7 men and 18 women - with an average age of 51 years. The mean time spent interacting with the dashboard was 4.6 minutes. Mean evaluation scores on scales ranging from 1 (low) to 7 (high) were: mechanical ease of use 6.1, cognitive ease of use 6.2, emotional difficulty 2.7, decision-aiding effectiveness 5.9, clarification of values 6.5, reduction in decisional uncertainty 6.1, and provision of decision-related information 6.0. Qualitative findings were similarly positive. Conclusions: Interactive decision dashboards can be adapted for clinical use and have the potential to foster informed decision making. Additional research is warranted to more rigorously test the effectiveness and efficiency of patient decision dashboards for supporting informed decision making and other aspects of patient-centered care, including shared decision making.
    BMC Medical Informatics and Decision Making 04/2013; 13(1):51. DOI:10.1186/1472-6947-13-51 · 1.83 Impact Factor
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    • "Complementary tools include accessible descriptions of each practice element, decision-flow charts to guide care planning, and a tracking system to monitor use of elements and track client progress (Chorpita et al., 2008; Daleiden et al., 2006; Nakamura et al., 2011). Ongoing maintenance, product development and marketing of these resources is now being managed privately by PracticeWise (Nakamura et al., 2011). "
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    ABSTRACT: Purpose – Young people receiving services for substance use problems often experience high rates of other psychosocial problems in addition to mental disorders. This has implications for design of effective interventions. There is a lack of concisely organised practical information to help organisations serving this population establish contextually relevant and rigorous approaches to the design of evidence-based interventions. This paper aims to focus on these issues. Design/methodology/approach – Drawing on literature from clinical and implementation science, this paper describes a new approach to the development and implementation of evidence-based practice (EBP). Contributions of innovators, early adopters, evaluators, and other scholars are reviewed and synthesized. Findings – Traditional approaches to EBP relying on manualised programs targeting discrete diagnoses have not yielded meaningful progress in the dissemination of EBP to services that specialise in treatment and support for young people experiencing complex psychosocial needs. Recent initiatives are moving away from reliance on manualised programs and adopting a modular practice elements approach that enables maximum flexibility in responding to the unique needs of individual clients. This approach has potential to mitigate barriers to implementation of EBP in resource poor environments. Originality/value – The complexity of needs presented by young people with dual mental health and substance use problems is increasingly recognised, but there is little information available that supports the formulation evidence-based interventions that directly address this complexity. This paper applies knowledge from research to the practical challenges faced by practice leaders in real-world services.
    08/2012; 5(3):122-136. DOI:10.1108/17570971211253702
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