Thesis (M.S.)--West Virginia University, 2006. / Title from document title page. Document formatted into pages; contains vii, 83 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 80-82).

Thesis (Ph. D. in Biomedical Engineering)--Vanderbilt University, May 2006. / Title from title screen. Includes bibliographical references.

Thesis (M. S.)--Mechanical Engineering, Georgia Institute of Technology, 2008. / Janet K. Allen, Committee Member ; David McDowell, Committee Member ; Jye-Chyi Lu, Committee Member ; Jitesh Panchal, Committee Member ; Farrokh Mistree, Committee Chair.

Proefschrift Universiteit van Tilburg. / Met lit. opg. - Met samenvatting in het Nederlands.

Proefschrift Erasmus Universiteit Rotterdam.

Proefschrift Erasmus Universiteit Rotterdam.

Proefschrift Maastricht. / Auteursnaam op omslag: Frits van Merode. Met lit. opg. - Met samenvatting in het Nederlands.

The purpose of this paper is to introduce a decision support system to prioritize needs that are anchored in an organization. We build on a systems-thinking approach and develop a weighted additive index which considers different viewpoints of organizational stakeholders. First, we briefly review the literature about identifying and prioritizing needs from various scientific disciplines. Then, we use boundary critique to identify critical stakeholders that lead to three different viewpoints in the decision support system. The internal view reflects needs that members of the organization find important and urgent to be satisfied. The external view considers knowledge of outsiders, i.e. who do not work in the organization but are acquainted with it (e.g. experts, customers, facilitators). The systemic view considers system inherent interrelations of needs as perceived by decision makers in the organization. These stakeholder views get assessed by different dimensions, which are subsequently combined and weighted. Based on a method to identify needs, we apply this index in an case study conducted in Austria and discuss implications for theory and practice.

Aim: To examine the adoption of CCDS by paramedics, including the impact of CCDS on paramedic role and practice. Methods: Systematic review of CCDS in emergency care followed by a cluster-randomised controlled trial (C-RCT) of CCDS with a qualitative component involving 42 paramedics at two study sites. Results: 19/20 studies identified for inclusion in the systematic review were from the Emergency Department setting, with no studies from prehospital care. The focus of the studies was on process of care (19/20) rather than patient outcomes (5/20). Positive impacts were reported in 15/19 (79%) process of care studies. Only two patient outcome studies were able to report findings (one positive, one negative). Results relating to CCDS implementation were reported as an ad hoc response to problems encountered. In this C-RCT paramedics used CCDS with 12% of eligible patients (site one: 2%; site two: 24%). Intervention paramedics were twice as likely to refer patients to a falls service as those in the control group (usual care) (relative risk = 2.0; 95% Cl 1.1 to 3.7) although conveyance rates were unaltered (relative risk = 1.1; 95% Cl 0.8 to 1.5) and episode of care was unchanged (-5.7 minutes; 95% Cl -38.5 to 27.2). When CCDS was used patient referral to falls services was three times as likely (relative risk = 3.1; 95% Cl 1.4 to 6.9), and non-conveyance was twice as likely (risk = 2.1; 95% Cl 1.1 to 3.9) and overall episode of care fell by 114 minutes (95% Cl from 77.2 to 150.3). Reasons given for not using CCDS included technical problems, lack of integration, it was not sophisticated enough to influence decision making. Paramedics adapted when and how they used CCDS to suit context and patient condition. Conclusion: There is little existing evidence in relation to CCDS use in the emergency care setting, and the prehospital emergency care setting in particular. Studies of CCDS undertaken in emergency departments have shown benefit, particularly in relation to process of care. The C-RCT found that CCDS use by paramedics was low, particularly at site one, but use was associated with higher rates of patient referral and non-conveyance, and shorter episodes of care. There were encouraging signs that CCDS can support a new decision making role for paramedics. The study provides useful lessons for policy makers, practitioners and researchers about the potential benefits of CCDS and the challenges to adoption of new technology in emergency prehospital care.

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