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Chen FF, Chen SY, Pai HC. Self-reflection and critical thinking: the influence of professional qualifications on registered nurses. Contemp Nurse 2019; 55:59-70. [PMID: 30830839 DOI: 10.1080/10376178.2019.1590154] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Ensuring the delivery of quality care and patient safety requires that nurses improve their self-reflection and insight as well as their critical thinking. To understand the factors that influence self-reflection, insight, and critical thinking, more evidence-based research is needed. Purpose: The purpose of this study was to examine whether professional qualifications (i.e. age, years of job experience, and position on the clinical ladder) would affect self-reflection and critical thinking in the experienced registered nurses (RNs) group. Methods: This quantitative and correlational study included 597 RNs (297 novice nurses and 300 experienced nurses), recruited from one medical center hospital in central Taiwan, as participants. Data were collected on self-reflection and critical thinking, using the Chinese-version of the Self-Reflection and Insight Scale and the Taiwan Critical Thinking Disposition Inventory. A structural equation modeling approach was used to examine the relationships among variables. Findings: The results showed a non-significant mean difference in self-reflection with insight scores between the two groups. Experienced RNs had a significantly higher mean score for critical thinking. Further analysis of the data of experienced nurses revealed that self-reflection with insight significantly affected critical thinking (β = 0.24, t = 4.141, p < .001). Qualifications also affected self-reflection with insight (β = 0.11, t = 1.808, p > .05) and critical thinking (β = 0.18, t = 3.143, p < .001). The correlation between qualifications and self-reflection with insight, however, was non-significant. Discussion: Nurses who perceived that they had greater self-reflection and insight reported more critical thinking in clinical care practice. Nurses' qualifications had more of an effect on critical thinking than on self-reflection and insight.
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Affiliation(s)
- Fen-Fang Chen
- a Taichung Veterans General Hospital , Taichung City , Taiwan
| | - Shu-Yueh Chen
- b Department of Nursing , Central Taiwan University of Science and Technology (Adjunct Associate Professor) , Taiwan
| | - Hsiang-Chu Pai
- c Department of Nursing , Chung-Shan Medical University; Chung-Shan Medical University Hospital , No.110,Sec.1,Jianguo N.Rd., Taichung City 40201 , Taiwan, R.O.C
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Kent B, Redley B, Wickramasinghe N, Nguyen L, Taylor NJ, Moghimi H, Botti M. Exploring nurses’ reactions to a novel technology to support acute health care delivery. J Clin Nurs 2015; 24:2340-51. [DOI: 10.1111/jocn.12881] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | - Bernice Redley
- Epworth Healthcare and Deakin University; Richmond Vic. Australia
| | - Nilmini Wickramasinghe
- Epworth Chair in Health Information Management; Epworth HealthCare and Deakin University; Vic. Australia
| | - Lemai Nguyen
- Deakin Business School; Department of Information Systems and Business Analytics; Deakin University; VIC. Australia
| | | | - Hoda Moghimi
- Epworth Research Institute; RMIT University; Richmond Vic. Australia
| | - Mari Botti
- Epworth/Deakin Centre for Clinical Nursing Research Epworth Health Care; Richmond Vic. Australia
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Trick WE, Deamant C, Smith J, Garcia D, Angulo F. Implementation of an audio computer-assisted self-interview (ACASI) system in a general medicine clinic: patient response burden. Appl Clin Inform 2015; 6:148-62. [PMID: 25848420 DOI: 10.4338/aci-2014-09-ra-0073] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/26/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Routine implementation of instruments to capture patient-reported outcomes could guide clinical practice and facilitate health services research. Audio interviews facilitate self-interviews across literacy levels. OBJECTIVES To evaluate time burden for patients, and factors associated with response times for an audio computer-assisted self interview (ACASI) system integrated into the clinical workflow. METHODS We developed an ACASI system, integrated with a research data warehouse. Instruments for symptom burden, self-reported health, depression screening, tobacco use, and patient satisfaction were administered through touch-screen monitors in the general medicine clinic at the Cook County Health & Hospitals System during April 8, 2011-July 27, 2012. We performed a cross-sectional study to evaluate the mean time burden per item and for each module of instruments; we evaluated factors associated with longer response latency. RESULTS Among 1,670 interviews, the mean per-question response time was 18.4 [SD, 6.1] seconds. By multivariable analysis, age was most strongly associated with prolonged response time and increased per decade compared to < 50 years as follows (additional seconds per question; 95% CI): 50-59 years (1.4; 0.7 to 2.1 seconds); 60-69 (3.4; 2.6 to 4.1); 70-79 (5.1; 4.0 to 6.1); and 80-89 (5.5; 4.1 to 7.0). Response times also were longer for Spanish language (3.9; 2.9 to 4.9); no home computer use (3.3; 2.8 to 3.9); and, low mental self-reported health (0.6; 0.0 to 1.1). However, most interviews were completed within 10 minutes. CONCLUSIONS An ACASI software system can be included in a patient visit and adds minimal time burden. The burden was greatest for older patients, interviews in Spanish, and for those with less computer exposure. A patient's self-reported health had minimal impact on response times.
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Affiliation(s)
- W E Trick
- Collaborative Research Unit, Department of Medicine, Cook County Health & Hospitals System , Chicago, Illinois
| | - C Deamant
- Division of General Medicine, Department of Medicine, Cook County Health & Hospitals System , Chicago, Illinois
| | - J Smith
- Collaborative Research Unit, Department of Medicine, Cook County Health & Hospitals System , Chicago, Illinois
| | - D Garcia
- Collaborative Research Unit, Department of Medicine, Cook County Health & Hospitals System , Chicago, Illinois
| | - F Angulo
- Collaborative Research Unit, Department of Medicine, Cook County Health & Hospitals System , Chicago, Illinois
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Spetz J, Burgess JF, Phibbs CS. The effect of health information technology implementation in Veterans Health Administration hospitals on patient outcomes. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2014; 2:40-7. [PMID: 26250088 DOI: 10.1016/j.hjdsi.2013.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/18/2013] [Accepted: 12/13/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND The impact of health information technology (HIT) in hospitals is dependent in large part on how it is used by nurses. This study examines the impact of HIT on the quality of care in hospitals in the Veterans Health Administration (VA), focusing on nurse-sensitive outcomes from 1995 to 2005. METHODS Data were obtained from VA databases and original data collection. Fixed-effects Poisson regression was used, with the dependent variables measured using the Agency for Healthcare Research and Quality Inpatient Quality Indicators and Patient Safety Indicators software. Dummy variables indicated when each facility began and completed implementation of each type of HIT. Other explanatory variables included hospital volume, patient characteristics, nurse characteristics, and a quadratic time trend. RESULTS The start of computerized patient record implementation was associated with significantly lower mortality for two diagnoses but significantly higher pressure ulcer rates, and full implementation was associated with significantly more hospital-acquired infections. The start of bar-code medication administration implementation was linked to significantly lower mortality for one diagnosis, but full implementation was not linked to any change in patient outcomes. CONCLUSIONS The commencement of HIT implementation had mixed effects on patient outcomes, and the completion of implementation had little or no effect on outcomes. IMPLICATIONS This longitudinal study provides little support for the perception of VA staff and leaders that HIT has improved mortality rates or nurse-sensitive patient outcomes. Future research should examine patient outcomes associated with specific care processes affected by HIT.
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Affiliation(s)
- Joanne Spetz
- University of California, Philip R. Lee Institute for Health Policy Studies, 3333 California Street, Suite 265, San Francisco, CA 94118, United States.
| | - James F Burgess
- VA Boston Healthcare System, 150 S Huntington Ave, Jamaica Plain, MA 02130, United States; Boston University, Boston, MA 02215, United States
| | - Ciaran S Phibbs
- VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, United States; Stanford University, 450 Serra Mall, Stanford, CA 94305, United States
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Robbins GK, Lester W, Johnson KL, Chang Y, Estey G, Surrao D, Zachary K, Lammert SM, Chueh HC, Meigs JB, Freedberg KA. Efficacy of a clinical decision-support system in an HIV practice: a randomized trial. Ann Intern Med 2012; 157:757-66. [PMID: 23208165 PMCID: PMC3829692 DOI: 10.7326/0003-4819-157-11-201212040-00003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Data to support improved patient outcomes from clinical decision-support systems (CDSSs) are lacking in HIV care. OBJECTIVE To test the efficacy of a CDSS in improving HIV outcomes in an outpatient clinic. DESIGN Randomized, controlled trial. (ClinicalTrials.gov registration number: NCT00678600) SETTING Massachusetts General Hospital HIV Clinic. PARTICIPANTS HIV care providers and their patients. INTERVENTION Computer alerts were generated for virologic failure (HIV RNA level >400 copies/mL after a previous HIV RNA level ≤400 copies/mL), evidence of suboptimal follow-up, and 11 abnormal laboratory test results. Providers received interactive computer alerts, facilitating appointment rescheduling and repeated laboratory testing, for half of their patients and static alerts for the other half. MEASUREMENTS The primary end point was change in CD4 cell count. Other end points included time to clinical event, 6-month suboptimal follow-up, and severe laboratory toxicity. RESULTS Thirty-three HIV care providers followed 1011 patients with HIV. In the intervention group, the mean increase in CD4 cell count was greater (0.0053 vs. 0.0032 × 109 cells/L per month; difference, 0.0021 × 109 cells/L per month [95% CI, 0.0001 to 0.004]; P = 0.040) and the rate of 6-month suboptimal follow-up was lower (20.6 vs. 30.1 events per 100 patient-years; P = 0.022) than those in the control group. Median time to next scheduled appointment was shorter in the intervention group than in the control group after a suboptimal follow-up alert (1.71 vs. 3.48 months; P < 0.001) and after a toxicity alert (2.79 vs. >6 months; P = 0.072). More than 90% of providers supported adopting the CDSS as part of standard care. LIMITATION This was a 1-year informatics study conducted at a single hospital subspecialty clinic. CONCLUSION A CDSS using interactive provider alerts improved CD4 cell counts and clinic follow-up for patients with HIV. Wider implementation of such systems can provide important clinical benefits. PRIMARY FUNDING SOURCE National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Gregory K Robbins
- Massachusetts General Hospital, Division of Infectious Diseases, 55 Fruit Street, Cox 5, Boston, MA 02114, USA.
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Benin AL, Fenick A, Herrin J, Vitkauskas G, Chen J, Brandt C. How good are the data? Feasible approach to validation of metrics of quality derived from an outpatient electronic health record. Am J Med Qual 2011; 26:441-51. [PMID: 21926280 DOI: 10.1177/1062860611403136] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although electronic health records (EHRs) promise to be efficient resources for measuring metrics of quality, they are not designed for such population-based analyses. Thus, extracting meaningful clinical data from them is not straightforward. To avoid poorly executed measurements, standardized methods to measure and to validate metrics of quality are needed. This study provides and evaluates a use case for a generally applicable approach to validating quality metrics measured electronically from EHR-based data. The authors iteratively refined and validated 4 outpatient quality metrics and classified errors in measurement. Multiple iterations of validation and measurement resulted in high levels of sensitivity and agreement versus the "gold standard" of manual review. In contrast, substantial differences remained for measurement based on coded billing data. Measuring quality metrics using an EHR-based electronic process requires validation to ensure accuracy; approaches to validation such as those described in this study should be used by organizations measuring quality from EHR-based information.
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Fetter MS. Baccalaureate nursing students' information technology competence--agency perspectives. J Prof Nurs 2009; 25:42-9. [PMID: 19161962 DOI: 10.1016/j.profnurs.2007.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Indexed: 11/16/2022]
Abstract
Baccalaureate nurses must meet information technology (IT) competencies expectations for employment and future professional development. Unfortunately, educational programs and accrediting groups have not identified specific outcomes, and IT is not integrated formally into many undergraduate program curricula. Meanwhile, nursing students and faculty are practicing in clinical agencies undergoing an informatics and technology revolution. Adding courses and content, hardware, software, and strategies such as distance learning and simulation have been recommended to improve competency development. However, little is known regarding nursing students' experiences with IT in clinical practice. Agencies used as sites for one undergraduate program were surveyed and asked to identify barriers and facilitators to students' IT competencies attainment. Ten agency, program, and policy factors affecting the quality of the learning experience in clinical agencies were identified. Results underscored that leadership to improve collaboration and communication between nursing practice, education, and policy groups is necessary to improve clinical environments for IT learning.
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Affiliation(s)
- Marilyn S Fetter
- Villanova University, College of Nursing, Villanova, PA 19085, USA.
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Abstract
Using a standardized instrument, graduating baccalaureate nurses reported moderate information technology skills. The students were most confident in their Internet, word processing, and systems operations skills; the students' rated themselves lowest on care documentation and planning, valuing informatics knowledge, skills development, and data entry competencies. Exposure to the latest informatics systems was a priority. Students want fair access to informatics and technology-rich clinical settings; more realistic informatics and technology simulations; enthusiastic and capable faculty; and better hardware, software, and literature-searching support in agencies, classrooms, laboratories, and residences. Nursing programs, clinical agencies, and policy makers need to recognize that students are advancing beyond acquiring informatics skills to integrating health information literacy into practice. To facilitate current and future skills attainment and innovation, nursing informatics education and evaluation must keep pace.
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Affiliation(s)
- Marilyn S Fetter
- Villanova University, College of Nursing, 850 Lancaster Avenue, Villanova, PA 19085, USA.
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Fetter MS. Curriculum Strategies to Improve Baccalaureate Nursing Information Technology Outcomes. J Nurs Educ 2009; 48:78-85. [DOI: 10.3928/01484834-20090201-06] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Fetter MS. Improving information technology competencies: implications for psychiatric mental health nursing. Issues Ment Health Nurs 2009; 30:3-13. [PMID: 19148816 DOI: 10.1080/01612840802555208] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
While substantial evidence links information technology (IT) with improved patient safety, care quality, access, and efficiency, nurses must demonstrate competencies in computers, informatics, and information literacy in order to use IT for practice, education, and research. The nursing profession has established IT competencies for all nurses at beginning and experienced levels. Newly revised standards also articulate role-specific expectations for advanced practice nurses. Unfortunately, there is a concern that many nurses may not possess these capabilities and that nurse educators are not prepared to teach them. IT competency evaluations, which have focused predominately on nursing education, indicate novice skill levels for most faculty and students. In numerous studies, again conducted largely in nursing education, significant improvement in IT competencies has been achieved only with intensive interventions. Deficits in IT competencies are a significant concern, because the federal government has mandated full implementation of Electronic Health Records (EHR) by 2014. EHR will require all nurses to use IT to deliver, document, and obtain reimbursement for patient care. In response to these concerns, two recent initiatives, the "Health Information Technology Scholars (HITS)" and "Technology Informatics Guiding Education Reform (TIGER)" projects, have been launched. By enhancing IT competencies, these projects will enable nurses to use evidence-based practice and other innovations to transform clinical care, education, and research. This report updates psychiatric-mental health nurses on the IT competencies literature, recent enhancement initiatives and innovations, and their implications for the specialty.
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Affiliation(s)
- Marilyn S Fetter
- College of Nursing, Villanova University, Villanova, Pennsylvania 19085, USA.
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Bakken S, Currie LM, Lee NJ, Roberts WD, Collins SA, Cimino JJ. Integrating evidence into clinical information systems for nursing decision support. Int J Med Inform 2007; 77:413-20. [PMID: 17904897 PMCID: PMC2426954 DOI: 10.1016/j.ijmedinf.2007.08.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Revised: 08/05/2007] [Accepted: 08/16/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE To illustrate approaches for providing decision support for evidence-based nursing practice through integration of evidence into clinical information systems (CISs) with examples from our experience at Columbia University Medical Center. ORGANIZING CONSTRUCT Examples are organized according to three types of decision support functions: information management, focusing attention, and patient-specific consultation. METHODS Three decision support tools that are integrated into three types of CISs are discussed: (1) infobuttons that provide context-specific access to digital sources of evidence; (2) automated Fall-Injury Risk Assessment; and (3) personal digital assistant-based screening reminders, screening assessments, and tailored documentation templates for the identification and management of obesity, depression, and tobacco cessation. The informatics infrastructure for implementing these decision support tools is described from the perspective of components identified in the published literature. CONCLUSIONS Efforts to facilitate application of evidence into nursing practice are unlikely to be successful unless the approaches used are integrated into the clinical workflow. Our approaches use a variety of informatics methods to integrate evidence into CISs as a mechanism for providing decision support for evidence-based practice in a manner consistent with nursing workflow.
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Affiliation(s)
- Suzanne Bakken
- Columbia University, 630 W. 168 Street, Mailbox 6, New York, NY 10032
| | | | - Nam-Ju Lee
- Columbia University School of Nursing, e-mail:
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Abstract
The wealth and value of organizations are increasingly based on intellectual capital. Although acquiring talented individuals and investing in employee learning adds value to the organization, reaping the benefits of intellectual capital involves translating the wisdom of employees into reusable and sustained actions. This requires a culture that creates employee commitment, encourages learning, fosters sharing, and involves employees in decision making. An infrastructure to recognize and embed promising and best practices through social networks, evidence-based practice, customization of innovations, and use of information technology results in increased productivity, stronger financial performance, better patient outcomes, and greater employee and customer satisfaction.
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Lorence DP, Park H, Fox S. Racial disparities in health information access: resilience of the Digital Divide. J Med Syst 2006; 30:241-9. [PMID: 16978003 DOI: 10.1007/s10916-005-9003-y] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Policy initiatives of the late 1990s were believed to have largely eliminated the information "Digital Divide." For healthcare consumers, access to information is an essential part of the consumer-centric framework outlined in the recently proposed national health information initiative. This study sought to examine how racial/ethnic characteristics are associated with Internet use and online health information. Using a cross-sectional nationwide study of reported Internet use and information search in 2000 and 2002, we studied a stratified sample of computer users from the Pew Internet and American Life Project surveys. Adjusted estimates of race/ethnicity and income effects on Internet use and search behaviors were derived from generalized estimating equations. Results show wide gaps in the use of computers between Hispanics and Whites (OR = 0.593 [0.440, 0.798]) and between African-Americans and Whites (OR = 0.554 [0.427, 0.720]) in 2000 significantly narrowed in 2002 (OR of Hispanic to white = 1.250 [0.874, 1.789]; OR of African-American to Whites = (0.793 [0.551, 1.141]). Gaps in access to the Internet, however, remained consistent between 2000-2002. Differences in health information seeking between Hispanics and Whites existed in both 2000 and 2002. 56% of White Internet users at some time searched for online health information, whereas 42% of Hispanic Internet users did so in 2000. By 2002, these percentages had increased to 13.4 and 15.8%, respectively. Data highlight the persistence of "Digitally Underserved Groups," despite recent Divide reduction strategies.
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Affiliation(s)
- Daniel P Lorence
- Department of Health Policy and Administration, School of Information Science and Technology, Pennsylvania State University, 114 Henderson HHD, University Park, PA 16802, USA.
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Abstract
In today's complex and rapidly changing health care environments, patient harm may result if important patient information is not communicated from one health care provider to another during handoffs in care. Issues involving communication, continuity of care, and care planning are cited as a root cause in more than 80% of reported sentinel events. In light of the inherent risks associated with handoffs in care, the use of strategies that reduce the impact of human factors on effective communication and standardize the communication process is essential to ensure appropriate communication patient information and that a plan of care is continued through the process.
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Affiliation(s)
- Kim Streitenberger
- Department of Quality & Risk Management, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada.
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Abstract
Resources of Internet system are widely popularized in most of all human activities in the society. This paper aims to identify and to describe major modalities of Internet utilization in nursing areas of Education, Care, and Research. This is a bibliographic review which data source was MEDLINE database, using pertinent descriptors for the focused areas. From referred publications, it was selected 63 articles. Major utilization in Education area is the development of applications to promote distance education; in Patient Education area is the development of applications to make health information available; in Care area are the applications to make care protocols available to promote evidence-based practice, and in Research area is online data collection. It was concluded that nursing is using Internet resources in a satisfactory way, and it has contributed for the profession evolution.
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Abstract
Leaders in health care and national health policy recommend information technology information technology as a strategy to promote patient safety. Technology enables error prevention, surveillance, and analysis. Although there is little research about technology and safety in perinatal care, nurses in the specialty can use current evidence about the electronic health record, decision support systems, and medication safety devices to guide practice. This article includes key issues and general recommendations for the use of information technology to promote patient safety, the most common applications relevant to perinatal care, and strategies for perinatal nurses who implement information technology to promote patient safety.
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Affiliation(s)
- Patricia Robin McCartney
- School of Nursing, University at Buffalo, The State University of New York, Buffalo, NY 14214, USA.
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Doebbeling BN, Chou AF, Tierney WM. Priorities and strategies for the implementation of integrated informatics and communications technology to improve evidence-based practice. J Gen Intern Med 2006; 21 Suppl 2:S50-7. [PMID: 16637961 PMCID: PMC2557136 DOI: 10.1111/j.1525-1497.2006.00363.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The U.S. health care system is one of the world's most advanced systems. Yet, the health care system suffers from unexplained practice variations, major gaps between evidence and practice, and suboptimal quality. Although information processing, communication, and management are key to health care delivery and considerable evidence links information/communication technology (IT) to improvements in patient safety and quality of care, the health care system has a longstanding gap in its investment. In the Crossing the Quality Chasm and Building a Better Delivery System reports, The Institute of Medicine and National Academy of Engineering identified IT integration as critical to improving health care delivery systems. This paper reviews the state of IT use in the U.S. health care system, its role in facilitating evidence-based practices, and identifies key attributes of an ideal IT infrastructure and issues surrounding IT implementation. We also examine structural, financial, policy-related, cultural, and organizational barriers to IT implementation for evidence-based practice and strategies to overcome them.
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Affiliation(s)
- Bradley N Doebbeling
- Health Services Research & Development Center of Excellence on Implementing Evidence-Based Practice, Roudebush Veterans Affairs Medical Center, Indianapolis, IN 46202, USA.
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Demner-Fushman D, Few B, Hauser SE, Thoma G. Automatically identifying health outcome information in MEDLINE records. J Am Med Inform Assoc 2005; 13:52-60. [PMID: 16221937 PMCID: PMC1380197 DOI: 10.1197/jamia.m1911] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Understanding the effect of a given intervention on the patient's health outcome is one of the key elements in providing optimal patient care. This study presents a methodology for automatic identification of outcomes-related information in medical text and evaluates its potential in satisfying clinical information needs related to health care outcomes. DESIGN An annotation scheme based on an evidence-based medicine model for critical appraisal of evidence was developed and used to annotate 633 MEDLINE citations. Textual, structural, and meta-information features essential to outcome identification were learned from the created collection and used to develop an automatic system. Accuracy of automatic outcome identification was assessed in an intrinsic evaluation and in an extrinsic evaluation, in which ranking of MEDLINE search results obtained using PubMed Clinical Queries relied on identified outcome statements. MEASUREMENTS The accuracy and positive predictive value of outcome identification were calculated. Effectiveness of the outcome-based ranking was measured using mean average precision and precision at rank 10. RESULTS Automatic outcome identification achieved 88% to 93% accuracy. The positive predictive value of individual sentences identified as outcomes ranged from 30% to 37%. Outcome-based ranking improved retrieval accuracy, tripling mean average precision and achieving 389% improvement in precision at rank 10. CONCLUSION Preliminary results in outcome-based document ranking show potential validity of the evidence-based medicine-model approach in timely delivery of information critical to clinical decision support at the point of service.
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Affiliation(s)
- Dina Demner-Fushman
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, Bethesda, MD 20894, USA.
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McBride AB. Nursing and the informatics revolution. Nurs Outlook 2005; 53:183-91; discussion 192. [PMID: 16115510 DOI: 10.1016/j.outlook.2005.02.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2004] [Revised: 02/08/2005] [Accepted: 02/19/2005] [Indexed: 10/23/2022]
Abstract
The Institute of Medicine's quality initiatives have collectively emphasized the importance of information technology to the transformation of health care. Not coincidentally, federal initiatives in 2004 have signaled the start of "the decade of health information technology." Building on those reports, this article describes the informatics revolution in process, and nursing's readiness to move in that direction. The promise of informatics in reshaping practice is sketched out in terms of seven aims for improvement, followed by a listing of some of the issues that must be addressed for nursing to realize those possibilities. In similar fashion, changes in academia are discussed both in terms of the promise of informatics applications and the barriers to achieving that preferred future. The article ends with some policy recommendations and reflections on opportunities at hand, particularly the growing emphasis on patient self-management support.
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Wang BB, Wan TTH, Burke DE, Bazzoli GJ, Lin BYJ. Factors Influencing Health Information System Adoption in American Hospitals. Health Care Manage Rev 2005; 30:44-51. [PMID: 15773253 DOI: 10.1097/00004010-200501000-00007] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To study the number of health information systems (HISs), applicable to administrative, clinical, and executive decision support functionalities, adopted by acute care hospitals and to examine how hospital market, organizational, and financial factors influence HIS adoption. METHODS A cross-sectional analysis was performed with 1441 hospitals selected from metropolitan statistical areas in the United States. Multiple data sources were merged. Six hypotheses were empirically tested by multiple regression analysis. RESULTS HIS adoption was influenced by the hospital market, organizational, and financial factors. Larger, system-affiliated, and for-profit hospitals with more preferred provider organization contracts are more likely to adopt managerial information systems than their counterparts. Operating revenue is positively associated with HIS adoption. CONCLUSION The study concludes that hospital organizational and financial factors influence on hospitals' strategic adoption of clinical, administrative, and managerial information systems.
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Affiliation(s)
- Bill B Wang
- Department of Medical Research and Public Health, National Defense Medical Center, Taipei, Taiwan.
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Vahey DC, Swan BA, Lang NM, Mitchell PH. Measuring and improving health care quality: nursing's contribution to the state of science. Nurs Outlook 2004; 52:6-10. [PMID: 15014374 DOI: 10.1016/j.outlook.2003.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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