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Touati N, Rodríguez C, Moreault MP, Sicotte C, Lapointe L. Maintaining a medical institution in a context of materiality change: Lessons from a Canadian university hospital. Health (London) 2023; 27:1135-1154. [PMID: 35791458 PMCID: PMC10588263 DOI: 10.1177/13634593221109680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
This research aimed to better understand how institutions are maintained, and the role of materiality in this institutional work. More specifically, the present qualitative case study analyzed how different actors in a large academic hospital in Canada worked together (i.e. accomplished institutional work) to maintain the institution of medical record keeping as a new clinical information system (computerized physician order entry-the material entity) was enacted. The study reveals that, to maintain the institution at stake, the intertwinement of processes of creating and maintaining institutions took place. In fact, different forms of institutional work interact Results also strongly suggest that the design of computerized physician order entry and its implementation (i.e. the materiality involved in this institutional change) played an important role in the maintenance of the institution of medical record keeping: on the one hand, it was particularly present in three types of institutional work, namely enabling, policing, and deterring; on the other hand, it appeared to be an essential component of the routinization of work by allowing a better fit between the new technology and the organization of work.
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Affiliation(s)
- Nassera Touati
- École nationale d’administration publique (ENAP), Canada
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Høyland SA, Holte KA, Islam K, Øygaarden O, Kjerstad E, Høyland SA, Waernes HR, Gürgen M, Conde KB, Hovland KS, Rødseth E, Carayon P, Fallon M, Ivins N, Bradbury S, Husebø SIE, Harding KG, Ternowitz T. A cross-sector systematic review and synthesis of knowledge on telemedicine interventions in chronic wound management-Implications from a system perspective. Int Wound J 2022; 20:1712-1724. [PMID: 36261052 PMCID: PMC10088836 DOI: 10.1111/iwj.13986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/09/2022] [Accepted: 10/09/2022] [Indexed: 11/29/2022] Open
Abstract
Based on initially identified needs for further telemedicine (TM) and chronic wound management research, the objective of this article is twofold: to conduct a systematic review of existing knowledge on TM interventions in chronic wound management-including barriers and opportunities-across the specialist and primary care sectors, and to incorporate the review findings into a system framework that can be further developed and validated through empirical data. We conclude that there is a pressing need for broader and more comprehensive empirical explorations into quality improvement and integration of TM in chronic wound management, including using system frameworks that can capture cross-sector system perspectives and associated implications. Of practical consideration, we suggest that the design and execution of TM improvement interventions and associated research projects should be conducted in close cooperation with managers and practitioners knowledgeable about barriers and opportunities that can influence the implementation of important interventions within chronic wound management.
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Affiliation(s)
- Sindre Aske Høyland
- Division for Health and Social Sciences, NORCE Norwegian Research Centre, Stavanger, Norway
| | - Kari Anne Holte
- Division for Health and Social Sciences, NORCE Norwegian Research Centre, Stavanger, Norway
| | - Kamrul Islam
- Division for Health and Social Sciences, NORCE Norwegian Research Centre, Stavanger, Norway
| | - Olaug Øygaarden
- Division for Health and Social Sciences, NORCE Norwegian Research Centre, Stavanger, Norway
| | - Egil Kjerstad
- Division for Health and Social Sciences, NORCE Norwegian Research Centre, Stavanger, Norway
| | | | | | - Marcus Gürgen
- Department for Dermatology, Stavanger University Hospital, Stavanger, Norway
| | | | | | - Eirin Rødseth
- Department for Personal E-Health, Norwegian Centre for E-health Research, Tromsø, Norway
| | - Pascale Carayon
- Department for Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Nicola Ivins
- Welsh Wound Innovation Centre WWIC, Ynysmaerdy, Wales
| | | | | | - Keith G Harding
- School of Medicine, Cardiff University, Cardiff, UK.,Skin Research Institute of Singapore (SRIS), Novena, Singapore
| | - Thomas Ternowitz
- Department for Dermatology, Stavanger University Hospital, Stavanger, Norway
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Field-Richards SE, Timmons S. A technical solution to a professional problem: The risk management functions of prognosticators in the context of prognostication post-cardiac arrest. FRONTIERS IN SOCIOLOGY 2022; 7:804573. [PMID: 36061262 PMCID: PMC9437292 DOI: 10.3389/fsoc.2022.804573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
Cardiac arrest (CA) is a major cause of mortality and morbidity globally. Two-thirds of deaths among patients admitted to intensive care units following out-of-hospital CA are due to neurological injury, with most as a consequence of withdrawing life-sustaining treatment, following prognostication of unfavorable neurological outcome. Given the ramifications of prognosis for patient outcome, post-cardiac arrest (P-CA) guidelines stress the importance of minimizing the risk of falsely pessimistic predictions. Although prognosticator use is advocated to this end, 100% accurate prognosticators remain elusive, therefore prognostication P-CA remains pervaded by uncertainty and risk. Bioethical discourse notwithstanding, when located within a wider socio-cultural context, prognostication can be seen to present risk and uncertainty challenges of a professional nature. Such challenges do not, however, subvert the medical profession's moral and ethical prognostication obligation. We interpret prognosticator use as an attempt to manage professional risk presented by prognostication P-CA and demonstrate how through performing "risk work," prognosticators serve professional functions, mediating tension between the professional duty to prognosticate, and risk presented. We draw on sociological analyses of risk and uncertainty, and the professions to explicate these (hitherto less enunciated) professional risk management functions of prognosticators. Accordingly, the use of prognosticators is conceived of as a professional response - a technical/scientific solution to the problem of professional risk, inherent within the P-CA prognostication process.
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Affiliation(s)
| | - Stephen Timmons
- Nottingham University Business School, University of Nottingham, Nottingham, United Kingdom
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Martins SR, Szklo AS, Bussacos MA, Prado GF, Paceli RB, Fernandes FLA, Lombardi EMS, Basso RG, Terra-Filho M, Santos UP. Knowledge of and attitudes toward the WHO MPOWER policies to reduce tobacco use at the population level: a comparison between third-year and sixth-year medical students. J Bras Pneumol 2021; 47:e20190402. [PMID: 33439961 PMCID: PMC7889324 DOI: 10.36416/1806-3756/e20190402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 09/26/2020] [Indexed: 11/19/2022] Open
Abstract
Objective: To evaluate third- and sixth-year medical students in Brazil in terms of their knowledge of and attitudes toward the WHO MPOWER policies to reduce tobacco use. Methods: The WHO Global Health Professions Student Survey was applied in five cohorts of medical students evaluated in their third and sixth years of medical school, between 2008 and 2015. Comparisons were drawn between the two years of medical school in terms of the proportions of students who experimented with or used tobacco products in the last 30 days prior to the survey; knowledge of and compliance with smoke-free policies on the university campus; formal training on smoking cessation strategies; and self-recognition as role models for patients/society. Results: Of the 943 students who completed the survey, approximately 6% had smoked cigarettes in the last 30 days prior to the survey. Comparing the third and sixth years of medical school, we observed a significant increase in the proportion of students who were knowledgeable about smoking cessation strategies (22.74% vs. 95.84%; p < 0.001) and in that of those who recognized their role as models for patients/society (84.5% vs. 89.7%; p = 0.023). Student knowledge of the smoking policies on the university campus was associated with an increase in self-recognition as role models (adjusted absolute difference = 6.7%; adjusted p = 0.050). Conclusions: Knowledge of smoking cessation strategies and self-recognition as role models for patients/society increase over the course of medical school and are associated with the implementation of smoke-free policies.
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Affiliation(s)
- Stella Regina Martins
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - André Salem Szklo
- . Divisão de Pesquisa Populacional, Instituto Nacional de Câncer José Alencar Gomes da Silva - INCA - Rio de Janeiro (RJ) Brasil
| | - Marco Antônio Bussacos
- . Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho - FUNDACENTRO - São Paulo (SP) Brasil
| | | | | | - Frederico Leon Arrabal Fernandes
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Elisa Maria Siqueira Lombardi
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | - Mário Terra-Filho
- . Faculdade de Medicina da Universidade de São Paulo, São Paulo (SP) Brasil
| | - Ubiratan Paula Santos
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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Leslie M, Paradis E. Is health information technology improving interprofessional care team communications? An ethnographic study in critical care. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.xjep.2017.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Giménez N, Alcaraz J, Gavagnach M, Kazan R, Arévalo A, Rodríguez-Carballeira M. Profesionalismo: valores y competencias en formación sanitaria especializada. ACTA ACUST UNITED AC 2017; 32:226-233. [DOI: 10.1016/j.cali.2016.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/28/2016] [Accepted: 11/04/2016] [Indexed: 10/20/2022]
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Underman K, Hirshfield LE. Detached concern?: Emotional socialization in twenty-first century medical education. Soc Sci Med 2016; 160:94-101. [DOI: 10.1016/j.socscimed.2016.05.027] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 05/13/2016] [Accepted: 05/16/2016] [Indexed: 12/30/2022]
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Paul DL, McDaniel RR. Facilitating telemedicine project sustainability in medically underserved areas: a healthcare provider participant perspective. BMC Health Serv Res 2016; 16:148. [PMID: 27112268 PMCID: PMC4845495 DOI: 10.1186/s12913-016-1401-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 04/18/2016] [Indexed: 11/18/2022] Open
Abstract
Background Very few telemedicine projects in medically underserved areas have been sustained over time. This research furthers understanding of telemedicine service sustainability by examining teleconsultation projects from the perspective of healthcare providers. Drivers influencing healthcare providers’ continued participation in teleconsultation projects and how projects can be designed to effectively and efficiently address these drivers is examined. Methods Case studies of fourteen teleconsultation projects that were part of two health sciences center (HSC) based telemedicine networks was utilized. Semi-structured interviews of 60 key informants (clinicians, administrators, and IT professionals) involved in teleconsultation projects were the primary data collection method. Results Two key drivers influenced providers’ continued participation. First was severe time constraints. Second was remote site healthcare providers’ (RSHCPs) sense of professional isolation. Two design steps to address these were identified. One involved implementing relatively simple technology and process solutions to make participation convenient. The more critical and difficult design step focused on designing teleconsultation projects for collaborative, active learning. This learning empowered participating RSHCPs by leveraging HSC specialists’ expertise. Conclusions In order to increase sustainability the fundamental purpose of teleconsultation projects needs to be re-conceptualized. Doing so requires HSC specialists and RSHCPs to assume new roles and highlights the importance of trust. By implementing these design steps, healthcare delivery in medically underserved areas can be positively impacted.
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Affiliation(s)
- David L Paul
- Department of Business Information and Analytics, Daniels College of Business, University of Denver, Denver, Colorado, USA.
| | - Reuben R McDaniel
- McCombs School of Business, The University of Texas at Austin, Austin, Texas, USA
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Abstract
The health care system continues to evolve and develop new ways to provide for quality patient care. Many new platforms are being integrated into the current system, or will be implemented within the next few years, that will grossly change the way health care is performed and delivered. New data will emerge from these various avenues (i.e., computerized physician order entry, electronic health record [EHR], national health care) and provide a wealth of insights into pathological and epidemiological processes. Consequently, health care workers will need to be proficient in using these various platforms. Nursing educators must therefore have a strong understanding of the emerging technologies and be able to implement the use of research and EHRs as well as provide students with updated information on diseases and appropriate interventions. Data analytics will provide educators the necessary tools to teach nursing students the most current evidence-based practice. Transparency between all health care arenas will enable new information to be relayed quickly and appropriately.
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Tan CH, Macneill P. Globalisation, economics and professionalism. MEDICAL TEACHER 2015; 37:850-855. [PMID: 26075950 DOI: 10.3109/0142159x.2015.1045856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This paper presents an analysis of the effect of globalisation and attendant economic factors on the global practice of medicine, medical education, medical ethics and medical professionalism. The authors discuss the implications of these trends, citing case scenarios in the healthcare insurance, medical tourism, pharmaceutical industries, and the educational systems as well as in clinical practice, to illustrate the impact of globalisation and economics on professionalism. Globalisation, on the one hand, offers benefits for the global practice of medicine and for medical education. On the other, globalisation can have negative effects, particularly when the main driver is to maximise profitability across national boundaries rather than concern for human well-being. Appraising the effect of globalisation on professionalism involves assessing its effects at the intrapersonal, interpersonal, and institutional levels, and its effect on society at large.
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Hanney S, Boaz A, Jones T, Soper B. Engagement in research: an innovative three-stage review of the benefits for health-care performance. HEALTH SERVICES AND DELIVERY RESEARCH 2013. [DOI: 10.3310/hsdr01080] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThere is a widely held assumption that research engagement improves health-care performance at various levels, but little direct empirical evidence.ObjectivesTo conduct a theoretically and empirically grounded synthesis to map and explore plausible mechanisms through which research engagement might improve health services performance. A review of the effects on patients of their health-care practitioner's or institution's participation in clinical trials was published after submission of the proposal for this review. It identified only 13 relevant papers and, overall, suggested that the evidence that research engagement improves health-care performance was less strong than some thought. We aimed to meet the need for a wider review.MethodsAn hourglass review was developed, consisting of three stages: (1) a planning and mapping stage; (2) a focused review concentrating on the core question of whether or not research engagement improves health care; and (3) a wider (but less systematic) review of papers identified during the two earlier stages. Studies were included inthe focused review if the concept of ‘engagementinresearch’ was an input and some measure of ‘performance’ an output. The search strategy covered the period 1990 to March 2012. MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and other relevant databases were searched. A total of 10,239 papers were identified through the database searches, and 159 from other sources. A further relevance and quality check on 473 papers was undertaken, and identified 33 papers for inclusion in the review. A standard meta-analysis was not possible on the heterogeneous mix of papers in the focused review. Therefore an explanatory matrix was developed to help characterise the circumstances in which research engagement might improve health-care performance and the mechanisms that might be at work, identifying two main dimensions along which to categorise the studies:the degree of intentionalityandthe scope of the impact.ResultsOf the 33 papers in the focused review, 28 were positive (of which six were positive/mixed) in relation to the question of whether or not research engagement improves health-care performance. Five papers were negative (of which two were negative/mixed). Seven out of 28 positive papers reported some improvement in health outcomes. For the rest, the improved care took the form of improved processes of care. Nine positive papers were at a clinician level and 19 at an institutional level. The wider review demonstrated, for example, how collaborative and action research can encourage some progress along the pathway from research engagement towards improved health-care performance. There is also evidence that organisations in which the research function is fully integrated into the organisational structure out-perform other organisations that pay less formal heed to research and its outputs. The focused and wider reviews identified the diversity in the mechanisms through which research engagement might improve health care: there are many circumstances and mechanisms at work, more than one mechanism is often operative, and the evidence available for each one is limited.LimitationsTo address the complexities of this evidence synthesis of research we needed to spend significant time mapping the literature, and narrowed the research question to make it feasible. We excluded many potentially relevant papers (though we partially addressed this by conducting a wider additional synthesis). Studies assessing the impact made on clinician behaviour by small, locally conducted pieces of research could be difficult to interpret without full knowledge of the context.ConclusionsDrawing on the focused and wider reviews, it is suggested that when clinicians and health-care organisations engage in research there is the likelihood of a positive impact on health-care performance. Organisations that have deliberately integrated the research function into organisational structures demonstrate how research engagement can, among other factors, contribute to improved health-care performance. Further explorations are required of research networks and schemes to promote the engagement of clinicians and managers in research. Detailed observational research focusing on research engagement within organisations would build up an understanding of mechanisms.Study registrationPROSPERO: CRD42012001990.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- S Hanney
- Health Economics Research Group, Brunel University, Uxbridge, UK
| | - A Boaz
- Faculty of Health, Social Care and Education, St George's, University of London and Kingston University, London, UK
| | - T Jones
- Health Economics Research Group, Brunel University, Uxbridge, UK
| | - B Soper
- Health Economics Research Group, Brunel University, Uxbridge, UK
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Hornberger J. Assigning value to medical algorithms: implications for personalized medicine. Per Med 2013; 10:577-588. [PMID: 29776198 DOI: 10.2217/pme.13.55] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Genomic algorithms are typically multiple variable, mathematical equations that assign a score or probability to an event of clinical interest. Debate about the valuation of multianalyte algorithm assays highlights the gaps in best practices for valuing technologies. Decisions about valuation are partly about resolving scientific uncertainty, but also involve issues of social norms and political processes. More transparent discussion and understanding of beliefs about the valuation of algorithms would help reduce uncertainty and drive optimal investment in development and adoption of algorithms that improve social welfare; that is, affordably improving population health. Techniques have been evolving for greater public participation and engagement in such deliberations, which are to be encouraged in determining the valuation of genomic algorithms.
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Affiliation(s)
- John Hornberger
- Cedar Associates, 3715 Haven Avenue, Menlo Park, CA 94025, USA and Department of Medicine, School of Medicine, Stanford University, Stanford, CA 94305, USA.
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Beckfield J, Olafsdottir S, Sosnaud B. Healthcare Systems in Comparative Perspective: Classification, Convergence, Institutions, Inequalities, and Five Missed Turns. ANNUAL REVIEW OF SOCIOLOGY 2013; 39:127-146. [PMID: 28769148 PMCID: PMC5536857 DOI: 10.1146/annurev-soc-071312-145609] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
This essay reviews and evaluates recent comparative social science scholarship on healthcare systems. We focus on four of the strongest themes in current research: (1) the development of typologies of healthcare systems, (2) assessment of convergence among healthcare systems, (3) problematization of the shifting boundaries of healthcare systems, and (4) the relationship between healthcare systems and social inequalities. Our discussion seeks to highlight the central debates that animate current scholarship and identify unresolved questions and new opportunities for research. We also identify five currents in contemporary sociology that have not been incorporated as deeply as they might into research on healthcare systems. These five "missed turns" include an emphasis on social relations, culture, postnational theory, institutions, and causal mechanisms. We conclude by highlighting some key challenges for comparative research on healthcare systems.
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Adler-Milstein J, Ronchi E, Cohen GR, Winn LAP, Jha AK. Benchmarking health IT among OECD countries: better data for better policy. J Am Med Inform Assoc 2013; 21:111-6. [PMID: 23721983 DOI: 10.1136/amiajnl-2013-001710] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To develop benchmark measures of health information and communication technology (ICT) use to facilitate cross-country comparisons and learning. MATERIALS AND METHODS The effort is led by the Organisation for Economic Co-operation and Development (OECD). Approaches to definition and measurement within four ICT domains were compared across seven OECD countries in order to identify functionalities in each domain. These informed a set of functionality-based benchmark measures, which were refined in collaboration with representatives from more than 20 OECD and non-OECD countries. We report on progress to date and remaining work to enable countries to begin to collect benchmark data. RESULTS The four benchmarking domains include provider-centric electronic record, patient-centric electronic record, health information exchange, and tele-health. There was broad agreement on functionalities in the provider-centric electronic record domain (eg, entry of core patient data, decision support), and less agreement in the other three domains in which country representatives worked to select benchmark functionalities. DISCUSSION Many countries are working to implement ICTs to improve healthcare system performance. Although many countries are looking to others as potential models, the lack of consistent terminology and approach has made cross-national comparisons and learning difficult. CONCLUSIONS As countries develop and implement strategies to increase the use of ICTs to promote health goals, there is a historic opportunity to enable cross-country learning. To facilitate this learning and reduce the chances that individual countries flounder, a common understanding of health ICT adoption and use is needed. The OECD-led benchmarking process is a crucial step towards achieving this.
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Affiliation(s)
- Julia Adler-Milstein
- School of Public Health, Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan, USA
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Waring J, Bishop S. McDonaldization or Commercial Re-stratification: Corporatization and the multimodal organisation of English doctors. Soc Sci Med 2013; 82:147-55. [DOI: 10.1016/j.socscimed.2012.12.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 12/17/2012] [Accepted: 12/18/2012] [Indexed: 11/29/2022]
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Jain SH, Seidman J, Blumenthal D. How health plans, health systems, and others in the private sector can stimulate 'meaningful use'. Health Aff (Millwood) 2013; 29:1667-70. [PMID: 20820024 DOI: 10.1377/hlthaff.2010.0766] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Provisions of the American Recovery and Reinvestment Act authorize incentive payments to hospitals and clinicians who become "meaningful users" of health information technology (IT). We argue that various private-sector entities--commercial payers, employers, consumer groups, health care ratings organizations, large provider organizations, and regulatory bodies--can further accelerate health IT adoption by implementing strategies that are complementary to the Medicare and Medicaid incentive programs. This paper describes these strategies and potential approaches to implementation.
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Affiliation(s)
- Sachin H Jain
- U.S. Department of Health and Human Services, Washington, DC, USA.
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Wilson I, Cowin LS, Johnson M, Young H. Professional identity in medical students: pedagogical challenges to medical education. TEACHING AND LEARNING IN MEDICINE 2013; 25:369-73. [PMID: 24112208 DOI: 10.1080/10401334.2013.827968] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND Professional identity, or how a doctor thinks of himself or herself as a doctor, is considered to be as critical to medical education as the acquisition of skills and knowledge relevant to patient care. SUMMARY This article examines contemporary literature on the development of professional identity within medicine. Relevant theories of identity construction are explored and their application to medical education and pedagogical approaches to enhancing students' professional identity are proposed. The influence of communities of practice, role models, and narrative reflection within curricula are examined. CONCLUSIONS Medical education needs to be responsive to changes in professional identity being generated from factors within medical student experiences and within contemporary society.
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Affiliation(s)
- Ian Wilson
- a Medical Education , University of Western Sydney School of Medicine , Campbelltown , Australia
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Bian J, Bennett CL, Fisher DA, Ribeiro M, Lipscomb J. Unintended consequences of health information technology: evidence from veterans affairs colorectal cancer oncology watch intervention. J Clin Oncol 2012; 30:3947-52. [PMID: 23045582 DOI: 10.1200/jco.2011.39.7448] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE We evaluated the Colorectal Cancer (CRC) Oncology Watch intervention, a clinical reminder implemented in Veterans Integrated Service Network 7 (including eight hospitals) to improve CRC screening rates in 2008. PATIENTS AND METHODS Veterans Affairs (VA) administrative data were used to construct four cross-sectional groups of veterans at average risk, age 50 to 64 years; one group was created for each of the following years: 2006, 2007, 2009, and 2010. We applied hospital fixed effects for estimation, using a difference-in-differences model in which the eight hospitals served as the intervention sites, and the other 121 hospitals served as controls, with 2006 to 2007 as the preintervention period and 2009 to 2010 as the postintervention period. RESULTS The sample included 4,352,082 veteran-years in the 4 years. The adherence rates were 37.6%, 31.6%, 34.4%, and 33.2% in the intervention sites in 2006, 2007, 2009, and 2010, respectively, and the corresponding rates in the controls were 31.0%, 30.3%, 32.3%, and 30.9%. Regression analysis showed that among those eligible for screening, the intervention was associated with a 2.2-percentage point decrease in likelihood of adherence (P < .001). Additional analyses showed that the intervention was associated with a 5.6-percentage point decrease in likelihood of screening colonoscopy among the adherent, but with increased total colonoscopies (all indicators) of 3.6 per 100 veterans age 50 to 64 years. CONCLUSION The intervention had little impact on CRC screening rates for the studied population. This absence of favorable impact may have been caused by an unintentional shift of limited VA colonoscopy capacity from average-risk screening to higher-risk screening and to CRC surveillance, or by physician fatigue resulting from the large number of clinical reminders implemented in the VA.
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Affiliation(s)
- John Bian
- Associate Professor, Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, 715 Sumter St, Columbia, SC 29208, USA.
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Denis JL, Forest PG. Real reform begins within: an organizational approach to health care reform. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2012; 37:633-645. [PMID: 22466053 DOI: 10.1215/03616878-1597457] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Health care systems are under pressure to control their increasing costs, to better adapt to evolving demands, to improve the quality and safety of care, and ultimately to ameliorate the health of their populations. This article looks at a battery of organizational options aimed at transforming health care systems and argues that more attention must be paid to reforming the delivery mechanisms that are so crucial for health care systems' overall performance. To support improvement, policies can rely on organizational assets in two ways. First, reforms can promote the creation of new organizational forms; second, they can employ organizational levers (e.g., capacity development, team-based organizations, evidence-informed practices) to achieve specific policy goals. In both cases organizational assets are mobilized with a view to creating complete health care organizations -- that is to say, organizations that have the capacity to function as high-performing systems. The challenges confronting the development of more complete health care organizations are significant. Real health care system reforms may likewise require implementing ecologies of complex innovation at the clinical, organizational, and policy levels. Policies play a determining role in shaping these new spaces for action so that day-to-day practices may change.
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Bogdan-Lovis E, Fleck L, Barry HC. It's NOT FAIR! Or is it? The promise and the tyranny of evidence-based performance assessment. THEORETICAL MEDICINE AND BIOETHICS 2012; 33:293-311. [PMID: 22825592 DOI: 10.1007/s11017-012-9228-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Evidence-based medicine (EBM), by its ability to decrease irrational variations in health care, was expected to improve healthcare quality and outcomes. The utility of EBM principles evolved from individual clinical decision-making to wider foundational clinical practice guideline applications, cost containment measures, and clinical quality performance measures. At this evolutionary juncture one can ask the following questions. Given the time-limited exigencies of daily clinical practice, is it tenable for clinicians to follow guidelines? Whose or what interests are served by applying performance assessments? Does such application improve medical care quality? What happens when the best interests of vested parties conflict? Mindful of the constellation of socially and clinically relevant variables influencing health outcomes, is it fair to apply evidence-based performance assessment tools to judge the merits of clinical decision-making? Finally, is it fair and just to incentivize clinicians in ways that might sway clinical judgment? To address these questions, we consider various clinical applications of performance assessment strategies, examining what performance measures purport to measure, how they are measured and whether such applications demonstrably improve quality. With attention to the merits and frailties associated with such applications, we devise and defend criteria that distinguish between justice-sustaining and justice-threatening performance-based clinical protocols.
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Affiliation(s)
- Elizabeth Bogdan-Lovis
- Center for Ethics and Humanities in the Life Sciences, Michigan State University, East Fee Hall, 965 Fee Road, Room C222, East Lansing, MI 48824, USA.
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Rao S, Brammer C, McKethan A, Buntin MB. Health information technology: transforming chronic disease management and care transitions. Prim Care 2012; 39:327-44. [PMID: 22608869 DOI: 10.1016/j.pop.2012.03.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Adoption of health information technology (HIT) is a key effort in improving care delivery, reducing costs of health care, and improving the quality of health care. Evidence from electronic health record (EHR) use suggests that HIT will play a significant role in transforming primary care practices and chronic disease management. This article shows that EHRs and HIT can be used effectively to manage chronic diseases, that HIT can facilitate communication and reduce efforts related to transitions in care, and that HIT can improve patient safety by increasing the information available to providers and patients, improving disease management and safety.
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Affiliation(s)
- Shaline Rao
- Office of the National Coordinator for Health Information Technology, US Department of Health and Human Services, 200 Independence Avenue SW, Suite 729-D, Washington, DC 20201, USA.
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Ricketts T, Naiditch M, Bourgueil Y. Advancing Primary Care in France and the United States. J Prim Care Community Health 2012; 3:221-5. [DOI: 10.1177/2150131911434205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Primary care has been identified as key to improving health care delivery systems across the globe. France and the United States have been ranked low on scales of primary care orientation. However, each nation has developed significant approaches to structuring primary care and organizing primary care-focused systems. This article reviews those efforts and finds that both nations face similar barriers to implementing many primary care initiatives.
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Affiliation(s)
- Thomas Ricketts
- Professor of Health Policy and Management and Social Medicine, The University of North Carolina at Chapel Hill, NC, USA
| | - Michel Naiditch
- Institute for Research and Information in Health Economics (IRDES), Paris, France
| | - Yann Bourgueil
- Institute for Research and Information in Health Economics (IRDES), Paris, France
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Bonacina S, Marceglia S, Pinciroli F. Barriers Against Adoption of Electronic Health Record in Italy. JOURNAL OF HEALTHCARE ENGINEERING 2011. [DOI: 10.1260/2040-2295.2.4.509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Apesoa-Varano EC, Barker JC, Hinton L. Curing and caring: the work of primary care physicians with dementia patients. QUALITATIVE HEALTH RESEARCH 2011; 21:1469-83. [PMID: 21685311 PMCID: PMC3581606 DOI: 10.1177/1049732311412788] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The symbolic framework guiding primary care physicians' (PCPs) practice is crucial in shaping the quality of care for those with degenerative dementia. Examining the relationship between the cure and care models in primary care offers a unique opportunity for exploring change toward a more holistic approach to health care. The aims of this study were to (a) explore how PCPs approach the care of patients with Alzheimer's disease (AD), and (b) describe how this care unfolds from the physicians' perspectives. This was a cross-sectional study of 40 PCPs who completed semistructured interviews as part of a dementia caregiving study. Findings show that PCPs recognize the limits of the cure paradigm and articulate a caring, more holistic model that addresses the psychosocial needs of dementia patients. However, caring is difficult to uphold because of time constraints, emotional burden, and jurisdictional issues. Thus, the care model remains secondary and temporary.
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Wibe T, Hellesø R, Slaughter L, Ekstedt M. Lay people’s experiences with reading their medical record. Soc Sci Med 2011; 72:1570-3. [DOI: 10.1016/j.socscimed.2011.03.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 03/01/2011] [Accepted: 03/06/2011] [Indexed: 11/28/2022]
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Elder KT, Wiltshire JC, Rooks RN, Belue R, Gary LC. Health information technology and physician career satisfaction. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2010; 7:1d. [PMID: 20808606 PMCID: PMC2921302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE Health information technology (HIT) and physician career satisfaction are associated with higher-quality medical care. However, the link between HIT and physician career satisfaction, which could potentially reduce provider burnout and attrition, has not been fully examined. This study uses a nationally representative survey to assess the association between key forms of HIT and career satisfaction among primary care physicians (PCPs) and specialty physicians. METHODS We performed a retrospective, cross-sectional analysis of physician career satisfaction using the Community Tracking Study Physician Survey, 2004-2005. Nine specific types of HIT as well as the overall adoption of HIT in the practice were examined using multivariate logistic regression. RESULTS Physicians who used five to six (odds ratio [OR] = 1.46) or seven to nine (OR = 1.47) types of HIT were more likely than physicians who used zero to two types of HIT to be "very satisfied" with their careers. Information technology usages for communicating with other physicians (OR = 1.31) and e-mailing patients (OR = 1.35) were positively associated with career satisfaction. PCPs who used technology to write prescriptions were less likely to report career satisfaction (OR = 0.67), while specialists who wrote notes using technology were less likely to report career satisfaction (OR = 0.75). CONCLUSIONS Using more information technology was the strongest positive predictor of physicians being very satisfied with their careers. Toward that end, healthcare organizations working in conjunction with providers should consider exploring ways to integrate various forms of HIT into practice.
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Affiliation(s)
- Keith T Elder
- School of Health Professions, University of Alabama, Birmingham, AL, USA
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Affiliation(s)
- Gayle Restall
- Department of Occupational Therapy, School of Medical Rehabilitation, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.
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Mechanic D, McAlpine DD. Sociology of health care reform: building on research and analysis to improve health care. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2010; 51 Suppl:S147-S159. [PMID: 20943579 DOI: 10.1177/0022146510383497] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Health reform efforts in the United States have focused on resolving some of the fundamental irrationalities of the system whereby costs and services utilization are often not linked to improved patient outcomes. Sociologists have contributed to these efforts by documenting the extent of problems and by confronting central questions around issues of accountability, reimbursement, and rationing that must be addressed in order to achieve meaningful reform that controls costs, expands access, and improves quality. Major reform rarely occurs without "paying off" powerful interests, a particularly difficult challenge in the context of a large and growing deficit. Central to achieving increased coverage and access, high quality, and cost control is change in reimbursement arrangements, increased accountability for both costs and outcomes, and criteria for rationing based on the evidence and accepted as legitimate by all stakeholders. Consensus about health reform requires trust. The traditional trust patients have in physicians provides an important base on which to build.
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Affiliation(s)
- David Mechanic
- Rutgers, The State University of New Jersey, Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ 08901, USA.
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Timmermans S, Oh H. The continued social transformation of the medical profession. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2010; 51 Suppl:S94-S106. [PMID: 20943586 DOI: 10.1177/0022146510383500] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A pressing concern in contemporary health policy is whether the medical profession's mandate to take care of clients has been undermined by the influx of money into health care. We examine the medical profession's transformation over the past decades. First, we review how sociologists have viewed the medical profession over the past half-century as one stakeholder among other stakeholders vying for market share and power in the health care field. We then examine three recent challenges to the profession that exemplify the tension between self-interest and collective altruism to act in the best interest of patients: (1) the rise of patient consumerism, (2) the advent of evidence-based medicine, and (3) the increasing power of the pharmaceutical industry. We show the resilience of the medical profession as it adapts and transforms in response to these challenges. We conclude with implications to help inform policy makers' assessments of how the medical profession will react to policy initiatives.
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Kahn JS, Aulakh V, Bosworth A. What It Takes: Characteristics Of The Ideal Personal Health Record. Health Aff (Millwood) 2009; 28:369-76. [DOI: 10.1377/hlthaff.28.2.369] [Citation(s) in RCA: 157] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Fisher ES, McClellan MB, Bertko J, Lieberman SM, Lee JJ, Lewis JL, Skinner JS. Fostering accountable health care: moving forward in medicare. Health Aff (Millwood) 2009; 28:w219-31. [PMID: 19174383 DOI: 10.1377/hlthaff.28.2.w219] [Citation(s) in RCA: 183] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To succeed, health care reform must slow spending growth while improving quality. We propose a new approach to help achieve more integrated and efficient care by fostering local organizational accountability for quality and costs through performance measurement and "shared savings" payment reform. The approach is practical and feasible: it is voluntary for providers, builds on current referral patterns, requires no change in benefits or lock-in for beneficiaries, and offers the possibility of sustained provider incomes even as total costs are constrained. We simulate the potential expenditure impact and show that significant Medicare savings are possible.
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Affiliation(s)
- Elliott S Fisher
- Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA.
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