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Biomedical subjects

E A Balas

Publications and source records attributed to E A Balas.

43 records · Page 3Linked to original sources
PubMed1992

The Columbia Registry of Controlled Clinical Computer Trials.

Numerous reports on randomized controlled clinical trials of computer-based interventions have been published. These trials provide useful evaluations of the impact of information technology on patient care. Unfortunately, several obstacles make access to the trial reports difficult. Barriers include the large variety of publications in which reports may appear, non-standard descriptors, and incomplete indexing. Some analyzers indicate inadequate testing of computer methods. The purpose of establishing a registry of randomized controlled clinical computer trials was to assist the identification of computer services with demonstrated ability to improve the process or outcome of patient care. A report collection, selection, information extraction, and registration method was developed and implemented. One hundred and six reports on computer trials have been collected. A large variety of computer-assisted interventions have been tested in the registered trials (40% reminder, 15% feedback, 14% dose planning, 14% patient education, 12% medical record). 76% of the registered reports were published in the United States and most of the remainder in various European countries. In reporting computer trial results, 77% of the authors did not use both the "computer" and "trial" keywords in the title or abstract of their papers. We conclude that a major obstacle to adequate computer technology assessment is inadequate access to the published results.

Computer-Assisted Instruction↗
PubMed1991

A computer method for visual presentation and programmed evaluation of labor.

Manual graphing of the progress of labor is considered useful but is not often done. The early detection of some deviations requires special graphics aids. Our objective was to develop an easy-to-use computer program for the integrated visual presentation of information characterizing the progress of labor. Through the use of inexpensive personal computers equipped with graphics monitors, the program provides a combined graphics display of timed progressive cervical dilatation, fetal station, and stimulation of uterine activity (oxytocin infusion). For the early detection of abnormalities, phase-specific normal ranges (reference areas) are displayed. In addition, protraction/arrest as well as precipitate labor disorders are highlighted and computer messages are displayed. The program was evaluated through the assessment of 405 labors entered into a local area network of computers. On average, the program identified 1.5 abnormalities per recorded labor (2.0 for labors resulting in vaginal delivery). The graphic presentation of the labor curve, produced within 3 seconds, displayed 27% more information than the tabular format on the same screen area and provided a single-screen display of the labor curve even for patients with excessive data. The computer-generated display of labor curves facilitates visual presentation and interpretation of labor progress and can also help to translate quality assurance criteria into clinical practice.

Computer Graphics↗
PubMedDate not supplied

The Columbia Registry of Information and Utilization Management Trials.

OBJECTIVE: T systematically locate, register, and abstract information used in comparing effects of various information services (computerized and noncomputerized) and utilization management interventions on the process and outcome of patient care. DESIGN: Manual and electronic database searches located reports that met three main criteria: 1) randomized controlled trial; 2) information or utilization management intervention in the study group with no similar intervention in the control group; and 3) effect of the intervention on the process and/or outcome of patient care had been measured. Published reports were registered in the Columbia Registry. RESULTS: Nearly 600 reports were collected from 24 countries and 189 different publications. Frequently tested interventions included patients or physician education, telephone follow-up, patient or physician reminders, and home care services. Frequently reported effect variables included hospitalization rate, length of stay, immunization rate, and mortality rate. Standardized formal tools were developed for the separation and abstraction of practical information and methodologic details from the collected trial reports. CONCLUSIONS: The registry provides a new source of information for meta-analyses, traditional reviews, and executive summaries of quality improvement of health services. The streamlined knowledge engineering process of quality evaluation and abstraction of critical information can generate helpful information for practitioners and researchers simultaneously.

Cost-Benefit Analysis↗
PubMedDate not supplied

An expert system for performance-based direct delivery of published clinical evidence.

OBJECTIVE: To develop a system for clinical performance improvement through rule-based analysis of medical practice patterns and individualized distribution of published scientific evidence. METHODS: The Quality Feedback Expert System (QFES) was developed by applying a Level-5 expert system shell to generate clinical direct reports for performance improvement. The system comprises three data and knowledge bases: 1) a knowledge base of measurable clinical practice parameters; 2) a practice pattern database of provider-specific numbers of patients and clinical activities; and 3) a management rule base comprising "redline rules" that identify providers whose practice styles vary significantly. Clinical direct reports consist of a table of practice data highlighting individual utilization vs recommendation and selected pertinent statements from medical literature. RESULTS: The QFES supports integration of recommendations from several guidelines into a comprehensive and measurable quality improvement plan, analysis of actual practice patterns and comparison with accepted recommendations, and generation of a confidential individualized direct report to those who significantly deviate from clinical recommendations. The feasibility of the practice pattern analysis by the QFES was demonstrated in a sample of 182 urinary tract infection cases from a primary care clinic. In a set of clinical activities, four questions/procedures were associated with significant (p < 0.001) and unexplained variation. CONCLUSION: The QFES provides a flexible tool for the implementation of clinical practice guidelines in diverse and changing clinical areas without the need for special program development. Preliminary studies indicate utility in the analysis of clinical practice variation and deviations. Using data obtained through a retrospective chart audit, the QFES was able to detect overutilization, and to identify nonrandom differences in practice patterns.

Databases, Factual↗
PubMedDate not supplied

Advanced information support. Abstracting evidence from clinical practice research.

Suzanne M. Austin, M.H.A., and E. Andrew Balas, M.D., Ph.D., of the Health Services Management Program at the University of Missouri-Columbia, present research on exchange of information in clinical practices. Their findings have led them to develop an integrated knowledge base aimed at enhancing cognition and supporting action rather than increasing confusion and indecision.

Expert Systems↗
PubMedDate not supplied

Profitable capitation requires accurate costing.

In the name of costing accuracy, nurses are asked to track inventory use on per treatment basis when more significant costs, such as general overhead and nursing salaries, are usually allocated to patients or treatments on an average cost basis. Accurate treatment costing and financial viability require analysis of all resources actually consumed in treatment delivery, including nursing services and inventory. More precise costing information enables more profitable decisions as is demonstrated by comparing the ratio-of-cost-to-treatment method (aggregate costing) with alternative activity-based costing methods (ABC). Nurses must participate in this costing process to assure that capitation bids are based upon accurate costs rather than simple averages.

Capitation Fee↗