Design and implementation of a multicriteria medical decision support system for diagnosis and treatment

Health care providers face the problem of trying to make decisions with inadequate information and also with an overload of (often contradictory) information. Physicians often choose treatment long before they know which disease is present. Indeed, uncertainty is intrinsic to the practice of medicine. Decision analysis can help physicians structure and work through a medical decision problem, and can provide reassurance that decisions are rational and consistent with the beliefs and preferences of other physicians and patients. ^ The primary purpose of this research project is to develop the theory, methods, techniques and tools necessary for designing and implementing a system to support solving medical decision problems. A case study involving “abdominal pain” serves as a prototype for implementing the system. The research, however, focuses on a generic class of problems and aims at covering theoretical as well as practical aspects of the system developed. ^ The main contributions of this research are: (1) bridging the gap between the statistical approach and the knowledge-based (expert) approach to medical decision making; (2) linking a collection of methods, techniques and tools together to allow for the design of a medical decision support system, based on a framework that involves the Analytic Network Process (ANP), the generalization of the Analytic Hierarchy Process (AHP) to dependence and feedback, for problems involving diagnosis and treatment; (3) enhancing the representation and manipulation of uncertainty in the ANP framework by incorporating group consensus weights; and (4) developing a computer program to assist in the implementation of the system. ^

Exploring professional orientations to community voice in professional practice settings: The IMAP process

The tension between technical experts and the populations they seek to serve is well established in the literature examining professional social problem solving. In this piece, I examine this tension as one between the distinct discursive worlds of technical expertise and community voice. I develop an analytic process, IMAP, for exploring this tension by looking at a wide variety of professional orientations around a relatively fixed concept of community voice. IMAP involves I&barbelow;dentifying social problem solvers, M&barbelow;apping social problem solvers' claims, A&barbelow;nalyzing professional orientations that arise from this mapping, and P&barbelow;redicting, diagnosing, and remediating conflicts. IMAP can be used by analysts external to social problem solving settings or by social problem solvers themselves. The use of IMAP by external experts poses questions of expert alignment with either of the discursive worlds. I examine two cases in public health practice settings: a mobile immunization service and the efforts of a foundation to improve health in an inner-city neighborhood. I develop four modal types that can be anticipated in social problem solving settings or, more specifically, in public health practice. Understanding of these “world views” can enhance mutual understanding between public health professionals and between public health professionals and the communities they seek to serve. IMAP might also address ongoing conflicts to clarify differences in unspoken normative commitments and the impact of these on social problem solving. I discuss implications of the research for public health practice and further research in the area. ^