Corporate decision-making: A case study of decision support systems and financial performance in health care organizations

The purpose of this study was twofold: (1) To describe the relation of the intensity of DSS implementation to financial performance as an empirical exploration of improved performance at the organizational level. (2) To describe the relation of the intensity of DSS implementation to the type of organizational decision culture. A multiple case study design was utilized to compare three groups of paired cases. A pattern matching strategy was applied in this study. Four predictions were specified and compared to the empirical data. A progressively upward trend in the scores was predicted for the following theoretical relationships. (1) The greater the number of DSSs, the higher the sophistication index. (2) The greater the number of DSSs, the higher the financial ratios. (3) The greater the number of DSSs, the higher the culture score. (4) The higher the culture score, the higher the financial ratios. The data did not support any of the predicted trends except the relation between the number of DSSs and the financial ratios. The Income/Revenue ratio indicates the efficiency of a company's operations. One would expect that this ratio would be most affected by the operational and financial decision support systems. The majority of the systems measured in the study supported decisions tangential to the patient service areas. The evidence suggested that the type and number of decision support systems affects the bottom line. ^

Decision evaluation in complex risk network systems (DecernsSDSS) demo and Black River case study

The selection of metrics for ecosystem restoration programs is critical for improving the quality of monitoring programs and characterizing project success. Moreover it is oftentimes very difficult to balance the importance of multiple ecological, social, and economical metrics. Metric selection process is a complex and must simultaneously take into account monitoring data, environmental models, socio-economic considerations, and stakeholder interests. We propose multicriteria decision analysis (MCDA) methods, broadly defined, for the selection of optimal sets of metrics to enhance evaluation of ecosystem restoration alternatives. Two MCDA methods, a multiattribute utility analysis (MAUT), and a probabilistic multicriteria acceptability analysis (ProMAA), are applied and compared for a hypothetical case study of a river restoration involving multiple stakeholders. Overall, the MCDA results in a systematic, unbiased, and transparent solution, informing restoration alternatives evaluation. The two methods provide comparable results in terms of selected metrics. However, because ProMAA can consider probability distributions for weights and utility values of metrics for each criteria, it is suggested as the best option if data uncertainty is high. Despite the increase in complexity in the metric selection process, MCDA improves upon the current ad-hoc decision practice based on the consultations with stakeholders and experts, and encourages transparent and quantitative aggregation of data and judgement, increasing the transparency of decision making in restoration projects. We believe that MCDA can enhance the overall sustainability of ecosystem by enhancing both ecological and societal needs.

Hydrologic models for emergency decision support using Bayesian networks

In the presence of a river flood, operators in charge of control must take decisions based on imperfect and incomplete sources of information (e.g., data provided by a limited number sensors) and partial knowledge about the structure and behavior of the river basin. This is a case of reasoning about a complex dynamic system with uncertainty and real-time constraints where bayesian networks can be used to provide an effective support. In this paper we describe a solution with spatio-temporal bayesian networks to be used in a context of emergencies produced by river floods. In the paper we describe first a set of types of causal relations for hydrologic processes with spatial and temporal references to represent the dynamics of the river basin. Then we describe how this was included in a computer system called SAIDA to provide assistance to operators in charge of control in a river basin. Finally the paper shows experimental results about the performance of the model.

Engineering Agent Systems for Decision Support

This paper discusses how agent technology can be applied to the design of advanced Information Systems for Decision Support. In particular, it describes the different steps and models that are necessary to engineer Decision Support Systems based on a multiagent architecture. The approach is illustrated by a case study in the traffic management domain.

Data Processing Modeling in Decision Support Systems.

Due to the advancement of both, information technology in general, and databases in particular; data storage devices are becoming cheaper and data processing speed is increasing. As result of this, organizations tend to store large volumes of data holding great potential information. Decision Support Systems, DSS try to use the stored data to obtain valuable information for organizations. In this paper, we use both data models and use cases to represent the functionality of data processing in DSS following Software Engineering processes. We propose a methodology to develop DSS in the Analysis phase, respective of data processing modeling. We have used, as a starting point, a data model adapted to the semantics involved in multidimensional databases or data warehouses, DW. Also, we have taken an algorithm that provides us with all the possible ways to automatically cross check multidimensional model data. Using the aforementioned, we propose diagrams and descriptions of use cases, which can be considered as patterns representing the DSS functionality, in regard to DW data processing, DW on which DSS are based. We highlight the reusability and automation benefits that this can be achieved, and we think this study can serve as a guide in the development of DSS.

A Structure of Problem Solving Methods for Real Time Decision Support in Traffic Control

This article describes a knowledge-based application in the domain of road traffic management that we have developed following a knowledge modeling approach and the notion of problem-solving method. The article presents first a domain-independent model for real-time decision support as a structured collection of problem solving methods. Then, it is described how this general model is used to develop an operational version for the domain of traffic management. For this purpose, a particular knowledge modeling tool, called KSM (Knowledge Structure Manager), was applied. Finally, the article shows an application developed for a traffic network of the city of Madrid and it is compared with a second application developed for a different traffic area of the city of Barcelona.

Patient-oriented computerized clinical guidelines for mobile decision support in gestational diabetes

The risks associated with gestational diabetes (GD) can be reduced with an active treatment able to improve glycemic control. Advances in mobile health can provide new patient-centric models for GD to create personalized health care services, increase patient independence and improve patients’ self-management capabilities, and potentially improve their treatment compliance. In these models, decision-support functions play an essential role. The telemedicine system MobiGuide provides personalized medical decision support for GD patients that is based on computerized clinical guidelines and adapted to a mobile environment. The patient’s access to the system is supported by a smartphone-based application that enhances the efficiency and ease of use of the system. We formalized the GD guideline into a computer-interpretable guideline (CIG). We identified several workflows that provide decision-support functionalities to patients and 4 types of personalized advice to be delivered through a mobile application at home, which is a preliminary step to providing decision-support tools in a telemedicine system: (1) therapy, to help patients to comply with medical prescriptions; (2) monitoring, to help patients to comply with monitoring instructions; (3) clinical assessment, to inform patients about their health conditions; and (4) upcoming events, to deal with patients’ personal context or special events. The whole process to specify patient-oriented decision support functionalities ensures that it is based on the knowledge contained in the GD clinical guideline and thus follows evidence-based recommendations but at the same time is patient-oriented, which could enhance clinical outcomes and patients’ acceptance of the whole system.

Design evaluation of a prototype user interface to support a guideline-based decision support system in gestational diabetes

Gestational Diabetes (GD) has increased over the last 20 years, affecting up to 15% of pregnant women worldwide. The complications associated can be reduced with the appropriate glycemic control during the pregnancy.

Evaluating a web-based clinical decision support system for language disorders screening in a nursery school

Background: Early and effective identification of developmental disorders during childhood remains a critical task for the international community. The second highest prevalence of common developmental disorders in children are language delays, which are frequently the first symptoms of a possible disorder. Objective: This paper evaluates a Web-based Clinical Decision Support System (CDSS) whose aim is to enhance the screening of language disorders at a nursery school. The common lack of early diagnosis of language disorders led us to deploy an easy-to-use CDSS in order to evaluate its accuracy in early detection of language pathologies. This CDSS can be used by pediatricians to support the screening of language disorders in primary care. Methods: This paper details the evaluation results of the ?Gades? CDSS at a nursery school with 146 children, 12 educators, and 1 language therapist. The methodology embraces two consecutive phases. The first stage involves the observation of each child?s language abilities, carried out by the educators, to facilitate the evaluation of language acquisition level performed by a language therapist. Next, the same language therapist evaluates the reliability of the observed results. Results: The Gades CDSS was integrated to provide the language therapist with the required clinical information. The validation process showed a global 83.6% (122/146) success rate in language evaluation and a 7% (7/94) rate of non-accepted system decisions within the range of children from 0 to 3 years old. The system helped language therapists to identify new children with potential disorders who required further evaluation. This process will revalidate the CDSS output and allow the enhancement of early detection of language disorders in children. The system does need minor refinement, since the therapists disagreed with some questions from the CDSS knowledge base (KB) and suggested adding a few questions about speech production and pragmatic abilities. The refinement of the KB will address these issues and include the requested improvements, with the support of the experts who took part in the original KB development. Conclusions: This research demonstrated the benefit of a Web-based CDSS to monitor children?s neurodevelopment via the early detection of language delays at a nursery school. Current next steps focus on the design of a model that includes pseudo auto-learning capacity, supervised by experts.

Introducción de criterios de sostenibilidad en la elección de emplazamientos industriales mediante modelos multicriterio

(SPA) La elección de localizaciones para la implantación de actividades industriales es un problema complejo, donde a los criterios de coste y eficiencia se han ido añadiendo otros nuevos relativos tanto al impacto en el medio ambiente como a la imagen de la empresa reflejada en la Responsabilidad Social Empresarial. Los criterios medioambientales han ido adquiriendo gran relevancia en la decisión final, hasta convertirse, gracias a la obligación de someter los proyectos a evaluación ambiental, en elementos clave en la decisión final. Por ello, resulta relativamente frecuente que los promotores consulten previamente con la Administración sobre la viabilidad de sus proyectos antes de iniciar un dilatado procedimiento administrativo. En este trabajo se plantea la utilización de indicadores de sostenibilidad y su aplicación, a través de un modelo de decisiones multicriterio, para la ordenación de las distintas opciones de ubicación inicialmente consideradas, de tal forma que se conviertan en instrumento de tanteo y ayuda en la toma de estas decisiones. Para mostrar su utilidad se propone la utilización de la herramienta de apoyo basada en la metodología PROMETHEE y su aplicación en la ordenación de cinco emplazamientos alternativos para la instalación de una cementera en la Comunidad de Madrid según criterios de sostenibilidad. (ENG) The choice of locations for the implementation of industrial activities is a complex problem where the cost and efficiency criteria have been adding new ones relating to the environment impact and the company’s corporate image reflected in Corporate Social Responsability. The environmental criteria have been getting big importance in the final decision, to become key elements in the final decision, due to the duty of submit of environmental assessment projects. Therefore, promoters, quite often, ask previously to the Administration about the viability of their projects before starting a lengthy administrative procedure. This paper proposes the use of sustainability indicators and their application through a multi-criteria decision model for managing the establishment options initially considered, so that they become an help instrument of estimation in order to making these decisions. To show its usefulness we propose the use of the support tool for decision making based on the PROMETHEE methodology and its application in the management of 5 alternative sites for the installation of a cement factory in the Community of Madrid under sustainability criteria.

TITIM GIS-tool: A GIS-based decision support system for measuring the territorial impact of transport infrastructures

To achieve sustainability in the area of transport we need to view the decision-making process as a whole and consider all the most important socio-economic and environmental aspects involved. Improvements in transport infrastructures have a positive impact on regional development and significant repercussions on the economy, as well as affecting a large number of ecological processes. This article presents a DSS to assess the territorial effects of new linear transport infrastructures based on the use of GIS. The TITIM ? Transport Infrastructure Territorial Impact Measurement ? GIS tool allows these effects to be calculated by evaluating the improvement in accessibility, loss of landscape connectivity, and the impact on other local territorial variables such as landscape quality, biodiversity and land-use quality. The TITIM GIS tool assesses these variables automatically, simply by entering the required inputs, and thus avoiding the manual reiteration and execution of these multiple processes. TITIM allows researchers to use their own GIS databases as inputs, in contrast with other tools that use official or predefined maps. The TITIM GIS-tool is tested by application to six HSR projects in the Spanish Strategic Transport and Infrastructure Plan 2005?2020 (PEIT). The tool creates all 65 possible combinations of these projects, which will be the real test scenarios. For each one, the tool calculates the accessibility improvement, the landscape connectivity loss, and the impact on the landscape, biodiversity and land-use quality. The results reveal which of the HSR projects causes the greatest benefit to the transport system, any potential synergies that exist, and help define a priority for implementing the infrastructures in the plan

Enhancing Guideline-based decision support with distributed computation through local mobile application

We introduce the need for a distributed guideline-based decision sup-port (DSS) process, describe its characteristics, and explain how we implement-ed this process within the European Union?s MobiGuide project. In particular, we have developed a mechanism of sequential, piecemeal projection, i.e., 'downloading' small portions of the guideline from the central DSS server, to the local DSS in the patient's mobile device, which then applies that portion, us-ing the mobile device's local resources. The mobile device sends a callback to the central DSS when it encounters a triggering pattern predefined in the pro-jected module, which leads to an appropriate predefined action by the central DSS, including sending a new projected module, or directly controlling the rest of the workflow. We suggest that such a distributed architecture that explicitly defines a dialog between a central DSS server and a local DSS module, better balances the computational load and exploits the relative advantages of the cen-tral server and of the local mobile device.

Is building renovation truly sustainable? The need for applying a multi-criteria assessment through life cycle approach

The aim of the present research is to characterise the international scene in the field of building refurbishment, by thoroughly reviewing the literature relating to building renovation and systematising the results according to the different aspects considered by the authors. Even though there is certain consensus with respect to the criteria for the selection of energy efficiency measures, the assessment criteria differ broadly and widely. The present work highlights the lack of consensus on the assessment criteria and the need of harmonization. A holistic view is required in order to identify the most sustainable strategies in each particular case, considering social, environmental and economic impacts from a life cycle perspective.

Sustainability assessment of energy saving measures: A multi-criteria approach for residential buildings retrofitting—A case study of the Spanish housing stock

The building sector is well known to be one of the key energy consumers worldwide. The renovation of existing buildings provides excellent opportunities for an effective reduction of energy consumption and greenhouse gas emissions but it is essential to identify the optimal strategies. In this paper a multi-criteria methodology is proposed for the comparative analysis of retrofitting solutions. Life Cycle Assessment (LCA) and Life Cycle Cost (LCC) are combined by expressing environmental impacts in monetary values. A Pareto optimization is used to select the preferred strategies. The methodology is exemplified by a case study: the renovation of a representative housing block from the 1960s located in Madrid. Eight scenarios have been proposed, from the Business as Usual scenario (BAU), through Spanish Building Regulation requirements (for new buildings) up to the Passive House standard. Results show how current renovation strategies that are being applied in Madrid are far from being optimal solutions. The required additional investment, which is needed to obtain an overall performance improvement of the envelope compared with the common practice to date, is relatively low (8%) considering the obtained life cycle environmental and financial savings (43% and 45%, respectively).

Multicriteria decision analysis applied to cover crop species andcultivars selection

Cover crop selection should be oriented to the achievement of specific agrosystem benefits. The covercrop, catch crop, green manure and fodder uses were identified as possible targets for selection. Theobjective was to apply multi-criteria decision analysis to evaluate different species (Hordeum vulgareL., Secale cereale L., ×Triticosecale Whim, Sinapis alba L., Vicia sativa L.) and cultivars according to theirsuitability to be used as cover crops in each of the uses. A field trial with 20 cultivars of the five specieswas conducted in Central Spain during two seasons (October?April). Measurements of ground cover, cropbiomass, N uptake, N derived from the atmosphere, C/N, dietary fiber content and residue quality werecollected. Aggregation of these variables through utility functions allowed ranking species and cultivarsfor each usage. Grasses were the most suitable for the cover crop, catch crop and fodder uses, while thevetches were the best as green manures. The mustard attained high ranks as cover and catch crop the firstseason, but the second decayed due to low performance in cold winters. Mustard and vetches obtainedworse rankings than grasses as fodder. Hispanic was the most suitable barley cultivar as cover and catchcrop, and Albacete as fodder. The triticale Titania attained the highest rank as cover and catch crop andfodder. Vetches Aitana and BGE014897 showed good aptitudes as green manures and catch crops. Thisanalysis allowed comparison among species and cultivars and might provide relevant information forcover crops selection and management.