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Kettlewell J, Radford K, Timmons S, Jones T, Fallon S, Westley R, White S, Kendrick D. What affects implementation of the UK major trauma rehabilitation prescription? A survey informed by the behaviour change wheel. Injury 2024; 55:111722. [PMID: 39019749 DOI: 10.1016/j.injury.2024.111722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/26/2024] [Accepted: 07/05/2024] [Indexed: 07/19/2024]
Abstract
OBJECTIVE Major trauma 'Rehabilitation Prescriptions' aim to facilitate continuity of care and describe patient needs following discharge from UK Major Trauma Centre (MTCs), however research suggests rehabilitation prescriptions are not being implemented as intended. We aimed to identify factors influencing completion and use of rehabilitation prescriptions using the Behaviour Change Wheel (BCW) and Theoretical Domains Framework (TDF). DESIGN Online survey informed by the TDF and BCW. SETTING UK trauma rehabilitation pathway. POPULATION Rehabilitation and trauma service providers involved in completing and/or using rehabilitation prescriptions (n = 78). ANALYSIS Mean scores were calculated for TDF behavioural domains, identifying facilitators (score ≥5) and barriers (≤3.5) to rehabilitation prescription implementation. Thematic analysis of free text data informed by the BCW/TDF identified further facilitators and barriers, plus potential behaviour change strategies. RESULTS Most respondents worked in UK MTCs (n = 63) and were physiotherapists (n = 34), trauma rehabilitation coordinators (n = 16) or occupational therapists (n = 15). 'Social/professional role and identity', 'knowledge' and 'emotion' (the highest-scoring TDF domains) were facilitators to implementing rehabilitation prescriptions. Qualitative data identified barriers to rehabilitation prescription completion, including 'seen as tick-box exercise','not a priority', lack of resources (IT and workforce), poor inter-service communication, limited knowledge/training. Facilitators included therapist buy-in, standardised training, easy inter-service rehabilitation prescription transfer, usefulness for sharing patient needs. CONCLUSIONS Although rehabilitation prescriptions are valued by some service providers, their effectiveness is hindered by negative attitudes, limited knowledge and poor communication. Uncertainties exist about whether rehabilitation prescriptions achieve their goals, particularly in documenting patient needs, engaging patients in rehabilitation, and informing onward referrals following MTC discharge. Improving IT systems, empowering patients, redirecting funding, and providing training might improve their usage. Further research should explore service provider and patient perspectives, and prospective long-term follow-up on outcomes of rehabilitation prescription recommendations.
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Affiliation(s)
- Jade Kettlewell
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, UK.
| | - Kate Radford
- Centre for Rehabilitation & Ageing Research, School of Medicine, University of Nottingham, UK
| | - Stephen Timmons
- Nottingham University Business School, University of Nottingham, UK
| | - Trevor Jones
- School of Medicine, University of Nottingham, UK
| | | | - Ryan Westley
- School of Medicine, University of Nottingham, UK
| | - Susan White
- School of Medicine, University of Nottingham, UK
| | - Denise Kendrick
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, UK
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Sasaki N, Yamaguchi N, Okumura A, Yoshida M, Sugawara H, Shin JH, Kunisawa S, Imanaka Y. Factors affecting the use of clinical practice guidelines by hospital physicians: the interplay of IT infrastructure and physician attitudes. Implement Sci 2020; 15:101. [PMID: 33239076 PMCID: PMC7687727 DOI: 10.1186/s13012-020-01056-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 10/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background Compliance with clinical practice guidelines (CPGs) remains insufficient around the world, despite frequent updates and continuing efforts to disseminate and implement these guidelines through a variety of strategies. We describe the current status of young resident physician practices towards CPGs and investigate the multiple factors associated with the active use of CPGs, including the physician’s knowledge, attitudes, behaviours, CPG-related education received, and the hospital’s IT infrastructures. The aim is to identify a more effective point for intervention to promote CPG implementation. Methods We conducted a questionnaire survey among resident physicians working at 111 hospitals across Japan in 2015 and used results with hospital IT score data collected from a prior survey. Multivariable logistic regression analysis was performed to examine the determinants of frequent use of CPGs (defined at least once per week). The independent variables were selected based on physician demographics, clinical speciality and careers, daily knowledge and behaviour items, CPG-related education received, digital preference, and hospital IT score (high/medium/low), with and without interaction terms. Results Responses from 535 resident physicians, at 61 hospitals, were analysed. The median hospital IT score was 6 out of a possible 10 points. Physicians who had learned about CPGs tended to work at hospitals with medium to high IT scores, had easier access to paywalled medical databases, and had better knowledge of the guideline network ‘Minds’. In addition, these physicians tended to use CPGs electronically. A physician’s behaviour towards using CPGs for therapeutic decision-making was strongly associated with frequent use of CPGs (odds ratio [95% CI] 6.1 [3.6–10.4]), which indicated that a physician’s habit strongly promotes CPG use. Moreover, CPG-related education was associated with active use of CPGs (OR1.7 [1.1–2.5]). The interaction effects between individual digital preferences and higher hospital IT score were also observed for frequent CPG use (OR2.9 [0.9–8.8]). Conclusions A physician’s habitual behaviours, CPG-related education, and a combination of individual digital preference and superior hospital IT infrastructure are key to bridging the gap between the use and implementation of CPGs. Supplementary information Supplementary information accompanies this paper at 10.1186/s13012-020-01056-1.
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Affiliation(s)
- Noriko Sasaki
- Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Naohito Yamaguchi
- Japan Council for Quality Health Care, 1-4-17, Toyo Bldg., Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan.,Saiseikai Research Institute of Health Care and Welfare, 1-4-28 Mita International Bldg 21st Floor, Mita, Minato-ku, Tokyo, 101-0061, Japan
| | - Akiko Okumura
- Japan Council for Quality Health Care, 1-4-17, Toyo Bldg., Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Masahiro Yoshida
- Japan Council for Quality Health Care, 1-4-17, Toyo Bldg., Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Hiroyuki Sugawara
- Japan Council for Quality Health Care, 1-4-17, Toyo Bldg., Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Jung-Ho Shin
- Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan. .,Japan Council for Quality Health Care, 1-4-17, Toyo Bldg., Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan.
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Lisi AJ, Salsbury SA, Hawk C, Vining RD, Wallace RB, Branson R, Long CR, Burgo-Black AL, Goertz CM. Chiropractic Integrated Care Pathway for Low Back Pain in Veterans: Results of a Delphi Consensus Process. J Manipulative Physiol Ther 2019; 41:137-148. [PMID: 29482827 PMCID: PMC6103526 DOI: 10.1016/j.jmpt.2017.10.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 10/25/2017] [Accepted: 10/26/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this study was to develop an integrated care pathway for doctors of chiropractic, primary care providers, and mental health professionals who manage veterans with low back pain, with or without mental health comorbidity, within Department of Veterans Affairs health care facilities. METHODS The research method used was a consensus process. A multidisciplinary investigative team reviewed clinical guidelines and Veterans Affairs pain and mental health initiatives to develop seed statements and care algorithms to guide chiropractic management and collaborative care of veterans with low back pain. A 5-member advisory committee approved initial recommendations. Veterans Affairs-based panelists (n = 58) evaluated the pathway via e-mail using a modified RAND/UCLA methodology. Consensus was defined as agreement by 80% of panelists. RESULTS The modified Delphi process was conducted in July to December 2016. Most (93%) seed statements achieved consensus during the first round, with all statements reaching consensus after 2 rounds. The final care pathway addressed the topics of informed consent, clinical evaluation including history and examination, screening for red flags, documentation, diagnostic imaging, patient-reported outcomes, adverse event reporting, chiropractic treatment frequency and duration standards, tailored approaches to chiropractic care in veteran populations, and clinical presentation of common mental health conditions. Care algorithms outlined chiropractic case management and interprofessional collaboration and referrals between doctors of chiropractic and primary care and mental health providers. CONCLUSION This study offers an integrative care pathway that includes chiropractic care for veterans with low back pain.
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Affiliation(s)
- Anthony J Lisi
- Physical Medicine and Rehabilitation, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Stacie A Salsbury
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa
| | | | - Robert D Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa
| | - Robert B Wallace
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Richard Branson
- Department of Physical Medicine and Rehabilitation, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Cynthia R Long
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa
| | | | - Christine M Goertz
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa..
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McCamley J, Vivanti A, Edirippulige S. Dietetics in the digital age: The impact of an electronic medical record on a tertiary hospital dietetic department. Nutr Diet 2019; 76:480-485. [PMID: 31199071 DOI: 10.1111/1747-0080.12552] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/14/2019] [Accepted: 04/26/2019] [Indexed: 11/28/2022]
Abstract
AIM The present study aimed to assess the impact of a hospital-wide electronic medical record (EMR) on the way dietitians collect routine data for their assessments and its impact on their clinical documentation and service provision. METHODS Data were collected retrospectively from the following sources: interdepartmental chart audit, the EMR itself (nutrition diagnosis), National Health Roundtable database (admissions requiring nutrition events) and the hospital-wide Pressure Injury Prevention Audits (height, weight and malnutrition screening). RESULTS There were improvements in medical record accessibility (76.4% pre vs 100% post, P < 0.001), awareness of medical alerts (82.5% unaware pre vs 34.5% unaware post) and legibility of documentation (53.8% pre vs 99.2% post, P < 0.001). Improvements in accessing medical charts under 1 minute also occurred (65.8% pre vs 99.2% post, P < 0.001). The percentage of nutrition diagnoses resolved during admission increased from 20.0% in February 2016 to 34.0% in August 2017. A 72.0% increase in admissions requiring nutrition interventions was found with 4075 admissions pre- and 7035 post-EMR implementation. Time spent per nutrition event reduced by 22.0% (118 minutes pre and 92 minutes post). Hospital audit data revealed mean height and weight collected increased from 79.3 ± 3.8% (n = 8 audits totalling 3041/3834 patients) to 86.0 ± 2.6% (n = 5 audits totalling, 2544/2958 patients) post-EMR with malnutrition screening completion increasing from 57.5% to 74.0%. CONCLUSIONS Findings indicate that EMR implementation has the potential to benefit the dietetic profession due to the potential to enhance the capacity and efficiency of dietetic departments.
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Affiliation(s)
- Jordan McCamley
- Digital Hospital Adoption Service, Princess Alexandra Hospital, Queensland, Australia.,School of Public Health, University of Queensland, Queensland, Australia
| | - Angela Vivanti
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Queensland, Australia.,School of Human Movement and Nutrition Studies, University of Queensland, Queensland, Australia
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Sasaki N, Yamaguchi N, Okumura A, Yoshida M, Sugawara H, Imanaka Y. Does hospital information technology infrastructure promote the implementation of clinical practice guidelines? A multicentre observational study of Japanese hospitals. BMJ Open 2019; 9:e024700. [PMID: 31203235 PMCID: PMC6588970 DOI: 10.1136/bmjopen-2018-024700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES It remains unclear whether insufficient information technology (IT) infrastructure in hospitals hinders implementation of clinical practice guidelines (CPGs) and affects healthcare quality. The objectives of this study were to describe the present state of IT infrastructure provided in acute care hospitals across Japan and to investigate its association with healthcare quality. METHODS A questionnaire survey of hospital administrators was conducted in 2015 to gather information on hospital-level policies and elements of IT infrastructure. The number of positive responses by each respondent to the survey items was tallied. Next, a composite quality indicator (QI) score of hospital adherence to CPGs for perioperative antibiotic prophylaxis was calculated using administrative claims data. Based on this QI score, we performed a chi-squared automatic interaction detection (CHAID) analysis to identify correlates of hospital healthcare quality. The independent variables included hospital size and teaching status in addition to hospital policies and elements of IT infrastructure. RESULTS Wide variations were observed in the availability of various IT infrastructure elements across hospitals, especially in local area network availability and access to paid evidence databases. The CHAID analysis showed that hospitals with a high level of access to paid databases (p<0.05) and internet (p<0.05) were strongly associated with increased care quality in larger or teaching hospitals. CONCLUSIONS Hospitals with superior IT infrastructure may provide higher-quality care. This allows clinicians to easily access the latest information on evidence-based medicine and facilitate the dissemination of CPGs. The systematic improvement of hospital IT infrastructure may promote CPG use and narrow the evidence-practice gaps.
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Affiliation(s)
- Noriko Sasaki
- Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | | | | | | | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Paris BL, Hynes DM. Diffusion, implementation, and use of Research Electronic Data Capture (REDCap) in the Veterans Health Administration (VA). JAMIA Open 2019; 2:312-316. [PMID: 32537568 DOI: 10.1093/jamiaopen/ooz017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/19/2019] [Accepted: 05/15/2019] [Indexed: 11/14/2022] Open
Abstract
This case study describes the implementation of the Research Electronic Data Capture (REDCap) software at the United States Department of Veterans Affairs Veterans Health Administration (VA). VA REDCap enables secure and standardized data collection, fosters collaboration with external researchers through use of a widely used data management tool, facilitates multisite studies through use of data forms that can be shared across sites within and outside the VA, is well suited to health services research studies and quality improvement projects, and enables exporting data for analysis in the VA secure computing environment. Using a diffusion of innovation framework approach, authors explore organizational factors that shaped adoption of REDCap technology and constraints on its use within the VA. Lessons learned from the VA experience are discussed.
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Affiliation(s)
- Bonnie L Paris
- VA Information Resource Center (VIReC), Veterans Health Administration, Hines, Illinois, USA
| | - Denise M Hynes
- College of Public Health and Human Sciences and Health Data and Informatics (HDI), Center for Genome Research and Biocomputing (CGRB), Oregon State University, Corvallis, Oregon, USA.,Center to Improve Veteran Involvement in Care, Portland VA Healthcare System, Portland, Oregon, USA
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7
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Cohen DJ, Dorr DA, Knierim K, DuBard CA, Hemler JR, Hall JD, Marino M, Solberg LI, McConnell KJ, Nichols LM, Nease DE, Edwards ST, Wu WY, Pham-Singer H, Kho AN, Phillips RL, Rasmussen LV, Duffy FD, Balasubramanian BA. Primary Care Practices' Abilities And Challenges In Using Electronic Health Record Data For Quality Improvement. Health Aff (Millwood) 2019; 37:635-643. [PMID: 29608365 DOI: 10.1377/hlthaff.2017.1254] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Federal value-based payment programs require primary care practices to conduct quality improvement activities, informed by the electronic reports on clinical quality measures that their electronic health records (EHRs) generate. To determine whether EHRs produce reports adequate to the task, we examined survey responses from 1,492 practices across twelve states, supplemented with qualitative data. Meaningful-use participation, which requires the use of a federally certified EHR, was associated with the ability to generate reports-but the reports did not necessarily support quality improvement initiatives. Practices reported numerous challenges in generating adequate reports, such as difficulty manipulating and aligning measurement time frames with quality improvement needs, lack of functionality for generating reports on electronic clinical quality measures at different levels, discordance between clinical guidelines and measures available in reports, questionable data quality, and vendors that were unreceptive to changing EHR configuration beyond federal requirements. The current state of EHR measurement functionality may be insufficient to support federal initiatives that tie payment to clinical quality measures.
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Affiliation(s)
- Deborah J Cohen
- Deborah J. Cohen ( ) is a professor of family medicine and vice chair of research in the Department of Family Medicine at Oregon Health & Science University, in Portland
| | - David A Dorr
- David A. Dorr is a professor and vice chair of medical informatics and clinical epidemiology, both at Oregon Health & Science University
| | - Kyle Knierim
- Kyle Knierim is an assistant research professor of family medicine and associate director of the Practice Innovation Program, both at the University of Colorado School of Medicine, in Aurora
| | - C Annette DuBard
- C. Annette DuBard is vice president of Clinical Strategy at Aledade, Inc., in Bethesda, Maryland
| | - Jennifer R Hemler
- Jennifer R. Hemler is a research associate in the Department of Family Medicine and Community Health, Research Division, Rutgers Robert Wood Johnson Medical School, in New Brunswick, New Jersey
| | - Jennifer D Hall
- Jennifer D. Hall is a research associate in family medicine at Oregon Health & Science University
| | - Miguel Marino
- Miguel Marino is an assistant professor of family medicine at Oregon Health & Science University
| | - Leif I Solberg
- Leif I. Solberg is a senior adviser and director for care improvement research at HealthPartners Institute, in Minneapolis, Minnesota
| | - K John McConnell
- K. John McConnell is a professor of emergency medicine and director of the Center for Health Systems Effectiveness, both at Oregon Health & Science University
| | - Len M Nichols
- Len M. Nichols is director of the Center for Health Policy Research and Ethics and a professor of health policy at George Mason University, in Fairfax, Virginia
| | - Donald E Nease
- Donald E. Nease Jr is an associate professor of family medicine at the University of Colorado School of Medicine, in Aurora
| | - Samuel T Edwards
- Samuel T. Edwards is an assistant research professor of family medicine and an assistant professor of medicine at Oregon Health & Science University and a staff physician in the Section of General Internal Medicine, Veterans Affairs Portland Health Care System
| | - Winfred Y Wu
- Winfred Y. Wu is clinical and scientific director in the Primary Care Information Project at the New York City Department of Health and Mental Hygiene, in Long Island City, New York
| | - Hang Pham-Singer
- Hang Pham-Singer is senior director of quality improvement in the Primary Care Information Project at the New York City Department of Health and Mental Hygiene
| | - Abel N Kho
- Abel N. Kho is an associate professor and director of the Center for Health Information Partnerships, Northwestern University, in Chicago, Illinois
| | - Robert L Phillips
- Robert L. Phillips Jr is vice president for research and policy at the American Board of Family Medicine, in Washington, D.C
| | - Luke V Rasmussen
- Luke V. Rasmussen is a clinical research associate in the Department of Preventive Medicine, Northwestern University
| | - F Daniel Duffy
- F. Daniel Duffy is professor of medical informatics and internal medicine at the University of Oklahoma School of Community Medicine-Tulsa
| | - Bijal A Balasubramanian
- Bijal A. Balasubramanian is an associate professor in the Department of Epidemiology, Human Genetics, and Environmental Sciences, and regional dean of UTHealth School of Public Health, in Dallas, Texas
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Mellott M, Thatcher JB, Roberts N. Electronic medical record compliance and continuity in delivery of care: an empirical investigation in a combat environment. Health Syst (Basingstoke) 2017. [DOI: 10.1057/hs.2013.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Mark Mellott
- U.S. Army – Baylor University Fort Sam Houston TX U.S.A
| | | | - Nicholas Roberts
- Johnson College of Business and Economics, University of South Carolina Upstate Spartanburg SC U.S.A
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Marshall E, York J, Magruder K, Yeager D, Knapp R, De Santis ML, Burriss L, Mauldin M, Sulkowski S, Pope C, Jobes DA. Implementation of online suicide-specific training for VA providers. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2014; 38:566-574. [PMID: 24563240 DOI: 10.1007/s40596-014-0039-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 01/09/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Due to the gap in suicide-specific intervention training for mental health students and professionals, e-learning is one solution to improving provider skills in the Veterans Affairs (VA) health system. This study focused on the development and evaluation of an equivalent e-learning alternative to the Collaborative Assessment and Management of Suicidality (CAMS) in-person training approach at a Veteran Health Affairs medical center. METHODS The study used a multicenter, randomized, cluster, and three group design. the development of e-CAMS was an iterative process and included pilot testing. Eligible and consenting mental health providers, who completed a CAMS pre-survey, were randomized. Provider satisfaction was assessed using the standard VA evaluation of training consisting of 20 items. Two post training focus groups, divided by learning conditions, were conducted to assess practice adoption using a protocol focused on experiences with training and delivery of CAMS. RESULTS A total of 215 providers in five sites were randomized to three conditions: 69 to e-learning, 70 to in-person, 76 to the control. The providers were primarily female, Caucasian, midlife providers. Based on frequency scores of satisfaction items, both learning groups rated the trainings positively. In focus groups representing divided by learning conditions, participants described positive reactions to CAMS training and similar individual and institutional barriers to full implementation of CAMS. CONCLUSIONS This is the first evaluation study of a suicide-specific e-learning training within the VA. The e-CAMS appears equivalent to the in-person CAMS in terms of provider satisfaction with training and practice adoption, consistent with other comparisons of training deliveries across specialty areas. Additional evaluation of provider confidence and adoption and patient outcomes is in progress. The e-CAMS has the potential to provide ongoing training for VA and military mental health providers and serve as a tutorial for psychiatrists in preparation for specialty boards.
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Bezboruah KC, Paulson D, Smith J. Management attitudes and technology adoption in long-term care facilities. J Health Organ Manag 2014; 28:344-65. [PMID: 25080649 DOI: 10.1108/jhom-11-2011-0118] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to explore the attitudes of nursing home administrators and key managerial staff toward health information technology (health IT). DESIGN/METHODOLOGY/APPROACH This research is exploratory in nature, and applies qualitative case-study methodology to further understand health IT adoption by nursing homes through multiple in-depth semi-structured interviews of management, and direct observations of employee behavior at each participating facility. A modified Technology Acceptance Model is used to examine the attitudes and perceptions of administrators. FINDINGS This study finds that there are differences in the level of health IT adoption by nursing homes. While some administrators are aware of health IT and are implementing or updating their IT systems in a gradual but haphazard manner, others exhibited a lack of interest in implementing change. Overall, there is a lack of systematic planning and decision-making toward health IT adoption. Adoption is not evidence-based, instead driven primarily by real and perceived regulatory requirements combined with a lack of information about, or consideration of, the real costs and benefits of implementing health IT. RESEARCH LIMITATIONS/IMPLICATIONS Including six in-depth case studies, the sample for this study is small for generalizing the findings. Yet, it contributes to the literature on the slow process of health IT adoption by nursing homes. Moreover, the findings provide guidelines for future research. PRACTICAL IMPLICATIONS This study demonstrates that nursing home administrators must systematically plan the adoption of health IT, and such decision making should be evidenced-based and participatory so that employees can voice their opinions that could prevent future resistance. ORIGINALITY/VALUE This study is original and advances knowledge on the reasons for the slow adoption of health IT in nursing homes. It finds that lack of adequate information regarding the utility and benefits of health IT in management adoption decisions can result in haphazard implementation or no adoption at all. This finding has significant value for policy makers' practitioners for improving accessibility of information regarding the use of health IT in nursing homes that could address the health IT adoption challenge in this industry.
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Bright TJ. Transforming user needs into functional requirements for an antibiotic clinical decision support system: explicating content analysis for system design. Appl Clin Inform 2013; 4:618-35. [PMID: 24454586 DOI: 10.4338/aci-2013-08-ra-0058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 11/11/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Many informatics studies use content analysis to generate functional requirements for system development. Explication of this translational process from qualitative data to functional requirements can strengthen the understanding and scientific rigor when applying content analysis in informatics studies. OBJECTIVE To describe a user-centered approach transforming emergent themes derived from focus group data into functional requirements for informatics solutions and to illustrate these methods to the development of an antibiotic clinical decision support system (CDS). METHODS THE APPROACH CONSISTED OF FIVE STEPS: 1) identify unmet therapeutic planning information needs via Focus Group Study-I, 2) develop a coding framework of therapeutic planning themes to refine the domain scope to antibiotic therapeutic planning, 3) identify functional requirements of an antibiotic CDS system via Focus Group Study-II, 4) discover informatics solutions and functional requirements from coded data, and 5) determine the types of information needed to support the antibiotic CDS system and link with the identified informatics solutions and functional requirements. RESULTS The coding framework for Focus Group Study-I revealed unmet therapeutic planning needs. Twelve subthemes emerged and were clustered into four themes; analysis indicated a need for an antibiotic CDS intervention. Focus Group Study-II included five types of information needs. Comments from the Barrier/Challenge to information access and Function/Feature themes produced three informatics solutions and 13 functional requirements of an antibiotic CDS system. Comments from the Patient, Institution, and Domain themes generated required data elements for each informatics solution. CONCLUSION This study presents one example explicating content analysis of focus group data and the analysis process to functional requirements from narrative data. Illustration of this 5-step method was used to develop an antibiotic CDS system, resolving unmet antibiotic prescribing needs. As a reusable approach, these techniques can be refined and applied to resolve unmet information needs with informatics interventions in additional domains.
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Affiliation(s)
- T J Bright
- Columbia University, Biomedical Informatics, New York , New York, United States
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12
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Behavioral medicine perspectives on the design of health information technology to improve decision-making, guideline adherence, and care coordination in chronic pain management. Transl Behav Med 2013; 1:35-44. [PMID: 24073031 DOI: 10.1007/s13142-011-0022-6] [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: 10/18/2022] Open
Abstract
Development of clinical decision support systems (CDSs) has tended to focus on facilitating medication management. An understanding of behavioral medicine perspectives on the usefulness of a CDS for patient care can expand CDSs to improve management of chronic disease. The purpose of this study is to explore feedback from behavioral medicine providers regarding the potential for CDSs to improve decision-making, care coordination, and guideline adherence in pain management. Qualitative methods were used to analyze semi-structured interview responses from behavioral medicine stakeholders following demonstration of an existing CDS for opioid prescribing, ATHENA-OT. Participants suggested that a CDS could assist with decision-making by educating providers, providing recommendations about behavioral therapy, facilitating risk assessment, and improving referral decisions. They suggested that a CDS could improve care coordination by facilitating division of workload, improving patient education, and increasing consideration and knowledge of options in other disciplines. Clinical decision support systems are promising tools for improving behavioral medicine care for chronic pain.
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Zaidi STR, Thursky KA. Using formative evaluation to improve uptake of a web-based tool to support antimicrobial stewardship. J Clin Pharm Ther 2013; 38:490-7. [DOI: 10.1111/jcpt.12093] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 07/29/2013] [Indexed: 12/30/2022]
Affiliation(s)
- S. T. R. Zaidi
- School of Pharmacy; University of Tasmania; Hobart Tasmania Australia
| | - K. A. Thursky
- Peter MacCallum Cancer Centre & Royal Melbourne Hospital; Melbourne Victoria Australia
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Hyman CK. In memory of my brother. J Am Psychiatr Nurses Assoc 2013; 19:213-4. [PMID: 23950545 DOI: 10.1177/1078390313496274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Puntil C, York J, Limandri B, Greene P, Arauz E, Hobbs D. Competency-based training for PMH nurse generalists: inpatient intervention and prevention of suicide. J Am Psychiatr Nurses Assoc 2013; 19:205-10. [PMID: 23950543 DOI: 10.1177/1078390313496275] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Suicide is the tenth leading cause of death in the United States. Approximately 90,000 psychiatric mental health (PMH) nurse generalists work in hospitals in the United States, mostly on inpatient psychiatric units where the most acutely suicidal patients are hospitalized. Although competencies have been developed for mental health clinicians in assessing and managing suicide risk, there are no standard competencies for PMH nurse generalists. Widely accepted nursing practices do not meet suicide-specific standards of care or evidence-based criteria. Although both the Commission on Collegiate Nursing Education Essentials for Baccalaureate Education and the Quality and Safety Education for Nurses competencies stress the necessity for comprehensive assessment, safe clinical practices, patient-centered care, evidence-based interventions, and interprofessional communication and collaboration, there are no specific requirements for suicide prevention training in educational and clinical programs. The American Psychiatric Nurses Association has an opportunity to provide leadership in developing, implementing, and evaluating competency-based training for nurses and partner with the national effort to increase the competencies in suicide prevention in the behavioral health workforce.
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Affiliation(s)
- Cheryl Puntil
- Resnick Neuropsychiatric Hospital at UCLA, Los Angeles, CA 90095, USA.
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Singh H, Spitzmueller C, Petersen NJ, Sawhney MK, Smith MW, Murphy DR, Espadas D, Laxmisan A, Sittig DF. Primary care practitioners' views on test result management in EHR-enabled health systems: a national survey. J Am Med Inform Assoc 2012; 20:727-35. [PMID: 23268489 PMCID: PMC3721157 DOI: 10.1136/amiajnl-2012-001267] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Context Failure to notify patients of test results is common even when electronic health records (EHRs) are used to report results to practitioners. We sought to understand the broad range of social and technical factors that affect test result management in an integrated EHR-based health system. Methods Between June and November 2010, we conducted a cross-sectional, web-based survey of all primary care practitioners (PCPs) within the Department of Veterans Affairs nationwide. Survey development was guided by a socio-technical model describing multiple inter-related dimensions of EHR use. Findings Of 5001 PCPs invited, 2590 (51.8%) responded. 55.5% believed that the EHRs did not have convenient features for notifying patients of test results. Over a third (37.9%) reported having staff support needed for notifying patients of test results. Many relied on the patient's next visit to notify them for normal (46.1%) and abnormal results (20.1%). Only 45.7% reported receiving adequate training on using the EHR notification system and 35.1% reported having an assigned contact for technical assistance with the EHR; most received help from colleagues (60.4%). A majority (85.6%) stayed after hours or came in on weekends to address notifications; less than a third reported receiving protected time (30.1%). PCPs strongly endorsed several new features to improve test result management, including better tracking and visualization of result notifications. Conclusions Despite an advanced EHR, both social and technical challenges exist in ensuring notification of test results to practitioners and patients. Current EHR technology requires significant improvement in order to avoid similar challenges elsewhere.
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Affiliation(s)
- Hardeep Singh
- Department of Medicine, Houston VA HSR&D Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center and Section of Health Services Research, Baylor College of Medicine, Houston, Texas 77030, USA.
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Dünnebeil S, Sunyaev A, Blohm I, Leimeister JM, Krcmar H. Determinants of physicians' technology acceptance for e-health in ambulatory care. Int J Med Inform 2012; 81:746-60. [PMID: 22397989 DOI: 10.1016/j.ijmedinf.2012.02.002] [Citation(s) in RCA: 179] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 01/13/2012] [Accepted: 02/05/2012] [Indexed: 01/08/2023]
Abstract
BACKGROUND Germany is introducing a nation-wide telemedicine infrastructure that enables electronic health services. The project is facing massive resistance from German physicians, which has led to a delay of more than five years. Little is known about the actual burdens and drivers for adoption of e-health innovations by physicians. OBJECTIVE Based on a quantitative study of German physicians who participated in the national testbed for telemedicine, this article extends existing technology acceptance models (TAM) for electronic health (e-health) in ambulatory care settings and elaborates on determinants of importance to physicians in their decision to use e-health applications. METHODS This study explores the opinions, attitudes, and knowledge of physicians in ambulatory care to find drivers for technology acceptance in terms of information technology (IT) utilization, process and security orientation, standardization, communication, documentation and general working patterns. We identified variables within the TAM constructs used in e-health research that have the strongest evidence to determine the intention to use e-health applications. RESULTS The partial least squares (PLS) regression model from data of 117 physicians showed that the perceived importance of standardization and the perceived importance of the current IT utilization (p<0.01) were the most significant drivers for accepting electronic health services (EHS) in their practice. Significant influence (p<0.05) was shown for the perceived importance of information security and process orientation as well as the documentation intensity and the e-health-related knowledge. CONCLUSIONS This study extends work gleaned from technology acceptance studies in healthcare by investigating factors which influence perceived usefulness and perceived ease of use of e-health services. Based on these empirical findings, we derive implications for the design and introduction of e-health services including suggestions for introducing the topic to physicians in ambulatory care and incentive structures for using e-health.
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Affiliation(s)
- Sebastian Dünnebeil
- Department of Informatics, Technical University of Munich, Bolzmannstrasse 3, 85748 Garching bei München, Germany
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19
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Lapointe L, Mignerat M, Vedel I. The IT productivity paradox in health: A stakeholder's perspective. Int J Med Inform 2011; 80:102-15. [DOI: 10.1016/j.ijmedinf.2010.11.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 09/20/2010] [Accepted: 11/11/2010] [Indexed: 11/30/2022]
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Shanahan M, Herrington A, Herrington J. Professional reading and the Medical Radiation Science Practitioner. Radiography (Lond) 2010. [DOI: 10.1016/j.radi.2010.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Chen C, Chen K, Hsu CY, Chiu WT, Li YCJ. A guideline-based decision support for pharmacological treatment can improve the quality of hyperlipidemia management. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2010; 97:280-285. [PMID: 20061045 DOI: 10.1016/j.cmpb.2009.12.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 11/19/2009] [Accepted: 12/15/2009] [Indexed: 05/28/2023]
Abstract
INTRODUCTION The Institute of Medicine has identified both Computerized Physician Order Entry (CPOE) and Electronic Prescription (EP) as key in reducing medication errors and improving safety. Many computerized clinical decision support systems (CDSSs) improve practitioner performance. However, the development of CDSSs involves a long cycle time that makes it difficult to apply in a wider scope. METHODS In this study, we integrated the hyperlipidemia treatment guideline ATP III (Adult Treatment Panel III) in a CPOE of a medical center. The first 200 consecutive patients followed up more than 1 year were recorded for analysis. RESULTS Our study revealed that 130 (65%) patients reached the LDL-C (low density lipoprotein-cholesterol) goal in 1 year. For those who with CDSS finished, 74% reached the LDL-C goal. For those who with CDSS exited, 57% reached the LDL-C goal. The odds ratio is 2.1 (1.2, 3.8) (p=0.022), which means for those who with CDSS finished can have 2 times of chance to reach the LDL-C goal. The mean of days to attain the LDL-C goal level after initiation of antihyperlipidemia therapy was 175+/-98 days. 11,806 prescribing records from 8023 patients were collected for analyzing the reasons of prematurely exiting the CDSS. The most frequent reason for exiting the system is "too busy to use". CONCLUSION We conclude that a CPOE with CDSS integrated may let more hyperlipidemia patients reach the LDL-C goal. However, data also showed the total prescribing time may increase. The results of a preliminary evaluation are presented to illustrate that the CDSSs can improve the quality of hyperlipidemia management.
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Affiliation(s)
- Chiehfeng Chen
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, 250, Taiwan
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22
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Post EP, Kilbourne AM, Bremer RW, Solano FX, Pincus HA, Reynolds CF. Organizational factors and depression management in community-based primary care settings. Implement Sci 2009; 4:84. [PMID: 20043838 PMCID: PMC2813228 DOI: 10.1186/1748-5908-4-84] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Accepted: 12/31/2009] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Evidence-based quality improvement models for depression have not been fully implemented in routine primary care settings. To date, few studies have examined the organizational factors associated with depression management in real-world primary care practice. To successfully implement quality improvement models for depression, there must be a better understanding of the relevant organizational structure and processes of the primary care setting. The objective of this study is to describe these organizational features of routine primary care practice, and the organization of depression care, using survey questions derived from an evidence-based framework. METHODS We used this framework to implement a survey of 27 practices comprised of 49 unique offices within a large primary care practice network in western Pennsylvania. Survey questions addressed practice structure (e.g., human resources, leadership, information technology (IT) infrastructure, and external incentives) and process features (e.g., staff performance, degree of integrated depression care, and IT performance). RESULTS The results of our survey demonstrated substantial variation across the practice network of organizational factors pertinent to implementation of evidence-based depression management. Notably, quality improvement capability and IT infrastructure were widespread, but specific application to depression care differed between practices, as did coordination and communication tasks surrounding depression treatment. CONCLUSIONS The primary care practices in the network that we surveyed are at differing stages in their organization and implementation of evidence-based depression management. Practical surveys such as this may serve to better direct implementation of these quality improvement strategies for depression by improving understanding of the organizational barriers and facilitators that exist within both practices and practice networks. In addition, survey information can inform efforts of individual primary care practices in customizing intervention strategies to improve depression management.
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Affiliation(s)
- Edward P Post
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- National VA Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
- Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
| | - Amy M Kilbourne
- National VA Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
- Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert W Bremer
- Department of Psychiatry, University of Colorado Medical School, Denver, Colorado, USA
| | - Francis X Solano
- Community Medicine Inc and Center for Quality Improvement and Innovation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Harold Alan Pincus
- RAND-University of Pittsburgh Health Institute, Pittsburgh, Pennsylvania, USA
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Departments of Neurology and Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Flanagan ME, Ramanujam R, Doebbeling BN. The effect of provider- and workflow-focused strategies for guideline implementation on provider acceptance. Implement Sci 2009; 4:71. [PMID: 19874607 PMCID: PMC2777118 DOI: 10.1186/1748-5908-4-71] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Accepted: 10/29/2009] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The effective implementation of clinical practice guidelines (CPGs) depends critically on the extent to which the strategies that are deployed for implementing the guidelines promote provider acceptance of CPGs. Such implementation strategies can be classified into two types based on whether they primarily target providers (e.g., academic detailing, grand rounds presentations) or the work context (e.g., computer reminders, modifications to forms). This study investigated the independent and joint effects of these two types of implementation strategies on provider acceptance of CPGs. METHODS Surveys were mailed to a national sample of providers (primary care physicians, physician assistants, nurses, and nurse practitioners) and quality managers selected from Veterans Affairs Medical Centers (VAMCs). A total of 2,438 providers and 242 quality managers from 123 VAMCs participated. Survey items measured implementation strategies and provider acceptance (e.g., guideline-related knowledge, attitudes, and adherence) for three sets of CPGs--chronic obstructive pulmonary disease, chronic heart failure, and major depressive disorder. The relationships between implementation strategy types and provider acceptance were tested using multi-level analytic models. RESULTS For all three CPGs, provider acceptance increased with the number of implementation strategies of either type. Moreover, the number of workflow-focused strategies compensated (contributing more strongly to provider acceptance) when few provider-focused strategies were used. CONCLUSION Provider acceptance of CPGs depends on the type of implementation strategies used. Implementation effectiveness can be improved by using both workflow-focused as well as provider-focused strategies.
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Affiliation(s)
- Mindy E Flanagan
- VA Health Services Research & Development Center on Implementing Evidence-Based Practice, Roudebush VAMC, Indianapolis, Indiana, USA
- IU Center for Health Services & Outcomes Research, Regenstrief Institute, Inc., Indiana University, Indianapolis, Indiana, USA
| | - Rangaraj Ramanujam
- Owen Graduate School of Management, Vanderbilt University Nashville, Tennessee, USA
| | - Bradley N Doebbeling
- VA Health Services Research & Development Center on Implementing Evidence-Based Practice, Roudebush VAMC, Indianapolis, Indiana, USA
- IU Center for Health Services & Outcomes Research, Regenstrief Institute, Inc., Indiana University, Indianapolis, Indiana, USA
- Division of General Medicine & Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Lee NJ, Chen ES, Currie LM, Donovan M, Hall EK, Jia H, John RM, Bakken S. The effect of a mobile clinical decision support system on the diagnosis of obesity and overweight in acute and primary care encounters. ANS Adv Nurs Sci 2009; 32:211-21. [PMID: 19707090 DOI: 10.1097/ans.0b013e3181b0d6bf] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of the study was to compare the proportion of obesity-related diagnoses in clinical encounters (N = 1874) documented by nurses using a personal digital assistant-based log with and without obesity decision support features. The experimental group encounters in the randomized controlled trial had significantly more (P = .000) obesity-related diagnoses (11.3%) than did the control group encounters (1%) and a significantly lower false negative rate (24.5% vs 66.5%, P = .000). The study findings provide evidence that integration of a decision support feature that automatically calculates an obesity-related diagnosis increases diagnoses and decreases missed diagnoses and suggest that such systems have the potential to improve the quality of obesity-related care.
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Verella JT, Patek SD. Toward an agent-based patient-physician model for the adoption of continuous glucose monitoring technology. J Diabetes Sci Technol 2009; 3:353-62. [PMID: 20144367 PMCID: PMC2771527 DOI: 10.1177/193229680900300217] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Health care is a major component of the U.S. economy, and tremendous research and development efforts are directed toward new technologies in this arena. Unfortunately few tools exist for predicting outcomes associated with new medical products, including whether new technologies will find widespread use within the target population. Questions of technology adoption are rife within the diabetes technology community, and we particularly consider the long-term prognosis for continuous glucose monitoring (CGM) technology. We present an approach to the design and analysis of an agent model that describes the process of CGM adoption among patients with type 1 diabetes mellitus (T1DM), their physicians, and related stakeholders. We particularly focus on patient-physician interactions, with patients discovering CGM technology through word-of-mouth communication and through advertising, applying pressure to their physicians in the context of CGM device adoption, and physicians, concerned about liability, looking to peers for a general level of acceptance of the technology before recommending CGM to their patients. Repeated simulation trials of the agent-based model show that the adoption process reflects the heterogeneity of the adopting community. We also find that the effect of the interaction between patients and physicians is agents. Each physician, say colored by the nature of the environment as defined by the model parameters. We find that, by being able to represent the diverse perspectives of different types of stakeholders, agent-based models can offer useful insights into the adoption process. Models of this sort may eventually prove to be useful in helping physicians, other health care providers, patient advocacy groups, third party payers, and device manufacturers understand the impact of their decisions about new technologies.
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Affiliation(s)
- J Tipan Verella
- University of Virginia, Department of Systems and Information Engineering, Charlottesville, Virginia, USA
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Smith MW, Barnett PG. The role of economics in the QUERI program: QUERI Series. Implement Sci 2008; 3:20. [PMID: 18430199 PMCID: PMC2390584 DOI: 10.1186/1748-5908-3-20] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Accepted: 04/22/2008] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The United States (U.S.) Department of Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) has implemented economic analyses in single-site and multi-site clinical trials. To date, no one has reviewed whether the QUERI Centers are taking an optimal approach to doing so. Consistent with the continuous learning culture of the QUERI Program, this paper provides such a reflection. METHODS We present a case study of QUERI as an example of how economic considerations can and should be integrated into implementation research within both single and multi-site studies. We review theoretical and applied cost research in implementation studies outside and within VA. We also present a critique of the use of economic research within the QUERI program. RESULTS Economic evaluation is a key element of implementation research. QUERI has contributed many developments in the field of implementation but has only recently begun multi-site implementation trials across multiple regions within the national VA healthcare system. These trials are unusual in their emphasis on developing detailed costs of implementation, as well as in the use of business case analyses (budget impact analyses). CONCLUSION Economics appears to play an important role in QUERI implementation studies, only after implementation has reached the stage of multi-site trials. Economic analysis could better inform the choice of which clinical best practices to implement and the choice of implementation interventions to employ. QUERI economics also would benefit from research on costing methods and development of widely accepted international standards for implementation economics.
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Affiliation(s)
- Mark W Smith
- Health Economics Resource Center, US Department of Veterans Affairs, Menlo Park, California, USA
- Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Palo Alto, California, USA
| | - Paul G Barnett
- Health Economics Resource Center, US Department of Veterans Affairs, Menlo Park, California, USA
- Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Health Research and Policy, Stanford University School of Medicine, Palo Alto, California, USA
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Koivunen M, Hätönen H, Välimäki M. Barriers and facilitators influencing the implementation of an interactive Internet-portal application for patient education in psychiatric hospitals. PATIENT EDUCATION AND COUNSELING 2008; 70:412-419. [PMID: 18079085 DOI: 10.1016/j.pec.2007.11.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Revised: 10/11/2007] [Accepted: 11/01/2007] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The purpose of this study was to identify barriers and facilitators influencing the implementation of an interactive Internet-portal application for patient education in psychiatric hospitals. METHODS The data were collected from nurses by means of a questionnaire with thematic open-ended questions. The data was analysed using qualitative content analysis. RESULTS Four main categories were formed to describe barriers and facilitators of portal implementation in psychiatric wards. These categories were organisational resources, nurses' individual characteristics, patient-related factors and portal-related factors. Some major barriers were identified restricting the use of the portal in patient education: lack of computers, lack of time for patients, nurses' negative attitudes towards computer use and lack of education. The main facilitators for portal use were appropriate technological resources, easy Internet access, enough time for portal use, and level of motivation among staff to use computers. CONCLUSION The specific challenge in achieving patient education with the computer in psychiatric care is to ensure technological resources and that the staff are motivated to use computers. At the same time, attention should be paid the relationship between patient and nurse. PRACTICE IMPLICATIONS It is important to examine the patient-nurse relationship in the education process and also to define the usability of the application from the patients' point of view.
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Affiliation(s)
- Marita Koivunen
- Satakunta Hospital District and University of Turku, Department of Nursing Science, Turku, Finland.
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Ploeg J, Davies B, Edwards N, Gifford W, Miller PE. Factors influencing best-practice guideline implementation: lessons learned from administrators, nursing staff, and project leaders. Worldviews Evid Based Nurs 2008; 4:210-9. [PMID: 18076464 DOI: 10.1111/j.1741-6787.2007.00106.x] [Citation(s) in RCA: 213] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Clinical practice guidelines are promising tools for closing the research evidence-practice gap, yet effective and timely implementation of guidelines into practice remains fragmented and inconsistent. Factors influencing effective guideline implementation remain poorly understood, particularly in nursing. A sound understanding of barriers and facilitators is critical for development of effective and targeted guideline implementation strategies. AIM This paper reports the perceptions of administrators, staff, and project leaders about factors influencing implementation of nursing best practice guidelines. METHODS Twenty-two organizations, in clusters of two to five, implemented one of seven guidelines in acute, community and long-term care settings. The topics were client centered care, crisis intervention, healthy adolescent development, pain assessment, pressure ulcers, supporting and strengthening families and therapeutic relationships. Fifty-nine administrators, 58 staff and 8 project leaders participated in post implementation semi-structured telephone interviews. Qualitative thematic analysis was conducted. FINDINGS Factors at individual, organizational and environmental levels were identified as influencing guideline implementation. Facilitators included learning about the guideline through group interaction, positive staff attitudes and beliefs, leadership support, champions, teamwork and collaboration, professional association support, and inter-organizational collaboration and networks. Barriers included negative staff attitudes and beliefs, limited integration of guideline recommendations into organizational structures and processes, time and resource constraints, and organizational and system level change. Similarities and differences in perceptions of these factors were found among staff, project leaders and administrators. IMPLICATIONS/CONCLUSIONS Best practice guideline implementation strategies should address barriers related to the individual practitioner, social context, and organizational and environmental context, and should be tailored to different groups of stakeholders (i.e., nursing staff, project leaders and administrators). Health care administrators need to recognize the "real" costs and complexity associated with successful implementation of guidelines and the need to ensure corporate commitment at the onset.
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Affiliation(s)
- Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, ON, Canada.
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Brown AH, Cohen AN, Chinman MJ, Kessler C, Young AS. EQUIP: implementing chronic care principles and applying formative evaluation methods to improve care for schizophrenia: QUERI Series. Implement Sci 2008; 3:9. [PMID: 18279505 PMCID: PMC2278162 DOI: 10.1186/1748-5908-3-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Accepted: 02/15/2008] [Indexed: 11/10/2022] Open
Abstract
Background This paper presents a case study that demonstrates the evolution of a project entitled "Enhancing QUality-of-care In Psychosis" (EQUIP) that began approximately when the U.S. Department of Veterans Affairs' Quality Enhancement Research Initiative (QUERI), and implementation science were emerging. EQUIP developed methods and tools to implement chronic illness care principles in the treatment of schizophrenia, and evaluated this implementation using a small-scale controlled trial. The next iteration of the project, EQUIP-2, was further informed by implementation science and the use of QUERI tools. Methods This paper reports the background, development, results and implications of EQUIP, and also describes ongoing work in the second phase of the project (EQUIP-2). The EQUIP intervention uses implementation strategies and tools to increase the adoption and implementation of chronic illness care principles. In EQUIP-2, these strategies and tools are conceptually grounded in a stages-of-change model, and include clinical and delivery system interventions and adoption/implementation tools. Formative evaluation occurs in conjunction with the intervention, and includes developmental, progress-focused, implementation-focused, and interpretive evaluation. Results Evaluation of EQUIP provided an understanding of quality gaps and how to address related problems in schizophrenia. EQUIP showed that solutions to quality problems in schizophrenia differ by treatment domain and are exacerbated by a lack of awareness of evidence-based practices. EQUIP also showed that improving care requires creating resources for physicians to help them easily implement practice changes, plus intensive education as well as product champions who help physicians use these resources. Organizational changes, such as the addition of care managers and informatics systems, were shown to help physicians with identifying problems, making referrals, and monitoring follow-up. In EQUIP-2, which is currently in progress, these initial findings were used to develop a more comprehensive approach to implementing and evaluating the chronic illness care model. Discussion In QUERI, small-scale projects contribute to the development and enhancement of hands-on, action-oriented service-directed projects that are grounded in current implementation science. This project supports the concept that QUERI tools can be useful in implementing complex care models oriented toward evidence-based improvement of clinical care.
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Affiliation(s)
- Alison H Brown
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, California, USA.
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Abstract
BACKGROUND In populations with chronic illness, outcomes improve with the use of care models that integrate clinical information, evidence-based treatments, and proactive management of care. Health information technology is believed to be critical for efficient implementation of these chronic care models. Health care organizations have implemented information technologies, such as electronic medical records, to varying degrees. However, considerable uncertainty remains regarding the relative impact of specific informatics technologies on chronic illness care. OBJECTIVE To summarize knowledge and increase expert consensus regarding informatics components that support improvement in chronic illness care. DESIGN A systematic review of the literature was performed. "Use case" models were then developed, based on the literature review, and guidance from clinicians and national quality improvement projects. A national expert panel process was conducted to increase consensus regarding information system components that can be used to improve chronic illness care. RESULTS The expert panel agreed that informatics should be patient-centered, focused on improving outcomes, and provide support for illness self-management. They concurred that outcomes should be routinely assessed, provided to clinicians during the clinical encounter, and used for population-based care management. It was recommended that interactive, sequential, disorder-specific treatment pathways be implemented to quickly provide clinicians with patient clinical status, treatment history, and decision support. CONCLUSIONS Specific informatics strategies have the potential to improve care for chronic illness. Software to implement these strategies should be developed, and rigorously evaluated within the context of organizational efforts to improve care.
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Brown LL, Lustria MLA, Rankins J. A review of web-assisted interventions for diabetes management: maximizing the potential for improving health outcomes. J Diabetes Sci Technol 2007; 1:892-902. [PMID: 19885163 PMCID: PMC2769687 DOI: 10.1177/193229680700100615] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Current endeavors in diabetes care focus on helping patients and providers deal successfully with the complexities of the disease by improving the system of care, expanding the reach of interventions, and empowering patients to engage in self-care behaviors. Internet technologies that combine the broad reach of mass media with the interactive capabilities of interpersonal media provide a wide range of advantages over standard modes of delivery. The technical affordances of Web delivery enable individualization or tailoring, appropriately timed reinforcement of educational messages, social support, improved feedback, and increased engagement. In turn, these have been significantly correlated with improved health outcomes.This article is a narrative review of Web-based interventions for managing type 2 diabetes published from 2000 to 2007 that utilize Web sites, Web portals, electronic medical records, videoconference, interactive voice response, and short messaging systems. The most effective systems link medical management and self-management. Patient satisfaction is highest when the Web-based system gives them the ability to track blood glucose, receive electronic reminders, schedule physician visits, email their health care team, and interact with other diabetic patients. However, comprehensive medical and self-management programs have not been implemented widely outside of systems funded by government agencies. The cost of developing and maintaining comprehensive systems continues to be a challenge and is seldom measured in efficacy studies. Lack of reimbursement for Web-based treatments is also a major barrier to implementation. These barriers must be overcome for widespread adoption and realization of subsequent cost savings.
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Affiliation(s)
- Linda Lockett Brown
- College of Human Sciences, Florida State University, Tallahassee, Florida 32306-2100, USA.
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Wu SJ, Lehto M, Yih Y, Saleem JJ, Doebbeling BN. Relationship of estimated resolution time and computerized clinical reminder adherence. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2007; 2007:334-8. [PMID: 18693853 PMCID: PMC2655890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Revised: 07/20/2007] [Accepted: 10/11/2007] [Indexed: 05/26/2023]
Abstract
Electronic decision support systems are an important tool for improving performance and improving quality of care. We investigated the relationship between physicians' estimated resolution times for computerized clinical reminders and adherence rates in VA outpatient settings. We surveyed 10 expert physician users to assess the resolution times of four targeted CCRs for three cases: pessimistic (worst case), expected (average), and optimistic times (best case). ANOVA test shows that physicians' adherence rates for the four CCRs differed significantly (p = 0.01). CCR adherence rate and resolution time were highly linearly correlated (R-square= 0.876 for the best case, R-square= 0.997 for the average case, and R-square= 0.670 for the worst case). This study suggested that future efforts in designing CCRs need to take resolution time into consideration during design, usability testing and implementation phases.
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Affiliation(s)
- Sze-Jung Wu
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
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Clancy TR, Delaney CW, Segre A, Carley K, Kuziak A, Yu H. Predicting the impact of an electronic health record on practice patterns using computational modeling and simulation. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2007:145-9. [PMID: 18693815 PMCID: PMC2813672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/04/2007] [Revised: 07/14/2007] [Accepted: 10/11/2007] [Indexed: 05/26/2023]
Abstract
The overall purpose of this research study is to discover and apply new knowledge regarding methods to predict the impact of an electronic health record (EHR) on clinical practice guidelines in complex systems such as hospitals. Specifically, the aims of this study are: 1) to build, simulate and validate the accuracy of a computational model representing the current practice patterns in a sample of patients diagnosed with heart failure (HF) and treated in a community hospital; and 2) using computational modeling and simulation, develop a method to predict the effects of best practice guidelines on practice patterns after implementation of an EHR.
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Vishwanath A, Scamurra SD. Barriers to the adoption of electronic health records: using concept mapping to develop a comprehensive empirical model. Health Informatics J 2007; 13:119-34. [PMID: 17510224 DOI: 10.1177/1460458207076468] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The study attempts to unify prior research and develop a comprehensive, empirically based conceptual model of the barriers to EHR adoption among community physicians. The model uses concept mapping, which taps the shared expertise of a group and provides reliable estimates with relatively small sample sizes. The methodology includes brainstorming of barrier statements and sorting and rating of issue statements. The model illuminates the larger structure of barriers as well as the finer details of constituent issues. Core issues are standardization and interoperability; also important are technical issues and the cost-benefit of adopting EHRs. However, psychosocial issues, the main focus of diffusion research, seem relatively peripheral. We believe the development of this model is an important first step in creating effective and measurable interventions that enhance the adoption of EHRs in healthcare.
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Affiliation(s)
- Arun Vishwanath
- School of Informatics, State University of New York at Buffalo, 333 Baldy Hall, Buffalo, NY 14260-1060, USA.
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Subramanian U, Sutherland J, McCoy KD, Welke KF, Vaughn TE, Doebbeling BN. Facility-level factors influencing chronic heart failure care process performance in a national integrated health delivery system. Med Care 2007; 45:28-45. [PMID: 17279019 DOI: 10.1097/01.mlr.0000244531.69528.ee] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Gaps between evidence and practice in the care of patients with chronic heart failure (CHF) in the United States suggest major opportunities for improvement. However, the organizational factors and implementation approaches that influence adherence to national guidelines are poorly understood. OBJECTIVES The objectives of this study were to explore the degree to which providers in the Veterans Health Administration system adhere to CHF clinical practice guidelines, and to identify facility-level factors influencing adherence. DESIGN In a national cross-sectional study, facility quality managers were surveyed regarding quality improvement efforts, guideline implementation, and context. These data were linked to organizational structure data and provider adherence data from chart reviews. The unit of analysis was the facility. The data were adjusted for the average number of comorbidities per CHF patient. Multivariate logistic regression models were constructed to model factors affecting adherence to CHF guidelines. SAMPLE The sample consisted of 143 Veterans Administration Medical Centers with ambulatory care clinics. RESULTS The quality manager survey included data from 91% of facilities. Facility-level estimates of provider adherence measures were, on average, 85% or more for most measures. In multivariate analyses, facilities with higher levels of adherence were more likely to have: (1) providers who had been given a brief guideline summary, (2) providers receptive to the guidelines, (3) guideline-specific task forces to support implementation, and 4) a well-planned implementation process. CONCLUSIONS Healthcare organizations should adapt implementation to meet local conditions, including creating guideline-specific task forces, developing a well-planned implementation process, fostering provider buy-in, and providing guideline summaries to providers.
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Affiliation(s)
- Usha Subramanian
- Center on Implementing Evidence-based Practice, Richard L. Roudebush VA Medical Center, and Department of Medicine, Indiana University School of Medicine (IUSM), Indianapolis, Indiana 46202, USA
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Popernack ML. A critical change in a day in the life of intensive care nurses: rising to the e-challenge of an integrated clinical information system. Crit Care Nurs Q 2006; 29:362-75. [PMID: 17063103 DOI: 10.1097/00002727-200610000-00009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Critical care nurses in a large academic, tertiary care trauma center have adapted to a major system change since the implementation of a fully integrated Computerized Provider Order Entry (CPOE) system, an automated process of order entry. Working in a rapidly changing environment, clinicians are accustomed to viewing real-time discrete data and then using that data to provide safe, effective, and efficient intensive care to critically ill patients. This article describes how the implementation of the CPOE system from a major healthcare software vendor has changed the life of critical care nurses and the perceptions of the experience 1 year after the new technology was initiated. Through experience sharing, perhaps others may gain knowledge to ease their transition to CPOE.
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Affiliation(s)
- Myra L Popernack
- Pediatric Intensive Care Unit, Penn State Children's Hospital, Penn State University/Milton S. Hershey Medical Center, Hershey, PA 17033, USA.
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Hysong SJ, Best RG, Pugh JA. Audit and feedback and clinical practice guideline adherence: making feedback actionable. Implement Sci 2006; 1:9. [PMID: 16722539 PMCID: PMC1479835 DOI: 10.1186/1748-5908-1-9] [Citation(s) in RCA: 236] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Accepted: 04/28/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As a strategy for improving clinical practice guideline (CPG) adherence, audit and feedback (A&F) has been found to be variably effective, yet A&F research has not investigated the impact of feedback characteristics on its effectiveness. This paper explores how high performing facilities (HPF) and low performing facilities (LPF) differ in the way they use clinical audit data for feedback purposes. METHOD Descriptive, qualitative, cross-sectional study of a purposeful sample of six Veterans Affairs Medical Centers (VAMCs) with high and low adherence to six CPGs, as measured by external chart review audits. One-hundred and two employees involved with outpatient CPG implementation across the six facilities participated in one-hour semi-structured interviews where they discussed strategies, facilitators and barriers to implementing CPGs. Interviews were analyzed using techniques from the grounded theory method. RESULTS High performers provided timely, individualized, non-punitive feedback to providers, whereas low performers were more variable in their timeliness and non-punitiveness and relied on more standardized, facility-level reports. The concept of actionable feedback emerged as the core category from the data, around which timeliness, individualization, non-punitiveness, and customizability can be hierarchically ordered. CONCLUSION Facilities with a successful record of guideline adherence tend to deliver more timely, individualized and non-punitive feedback to providers about their adherence than facilities with a poor record of guideline adherence. Consistent with findings from organizational research, feedback intervention characteristics may influence the feedback's effectiveness at changing desired behaviors.
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Affiliation(s)
- Sylvia J Hysong
- Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Department of Medicine – Health Services Research Section, Baylor College of Medicine, Houston, Texas, USA
| | - Richard G Best
- Healthcare Solutions Division, Lockheed Martin Information Technology, San Antonio, Texas, USA
| | - Jacqueline A Pugh
- Veterans Evidence-Based Research Dissemination and Implementation Center, South Texas Veterans Health Care System, San Antonio, Texas, USA
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, 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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Doebbeling BN, Vaughn TE, McCoy KD, Glassman P. Informatics implementation in the Veterans Health Administration (VHA) healthcare system to improve quality of care. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2006; 2006:204-8. [PMID: 17238332 PMCID: PMC1839610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
We describe VHA's information technology (IT) implementation from the providers' perspective, and identify factors influencing its effective implementation to improve care. We surveyed a stratified random national sample of 4227 clinicians from three VHA primary care provider groups: 1) physicians; 2) nurse practitioners, physician assistants; and 3) nurses. Facility-level IT support availability was rated across six dimensions: 1) access to literature/evidence, 2) computerized decision support, 3) computerized clinical data, 4) error reduction, 5) provider communication, and 6) patient communication. Factor analysis identified a 5-item scale (IT clinical support, á = 0.76). Generalized estimating equation models identified factors influencing IT clinical support. Complete data from 123 hospitals (1777 providers) were included. IT clinical support was higher in urban hospitals (p<0.05) and those with cooperative cultures (p<0.01). Opportunities exist to enhance effective use of IT to support clinical decision making, electronic communication with patients and access to recommendations while delivering care.
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Affiliation(s)
- Bradley N Doebbeling
- VA HSR&/D Center on Implementing Evidence-based Practice, Roudebush, VAMC, Indianapolis, IN, USA
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Sequist TD, Gandhi TK, Karson AS, Fiskio JM, Bugbee D, Sperling M, Cook EF, Orav EJ, Fairchild DG, Bates DW. A randomized trial of electronic clinical reminders to improve quality of care for diabetes and coronary artery disease. J Am Med Inform Assoc 2005; 12:431-7. [PMID: 15802479 PMCID: PMC1174888 DOI: 10.1197/jamia.m1788] [Citation(s) in RCA: 167] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2004] [Accepted: 03/23/2005] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the impact of an integrated patient-specific electronic clinical reminder system on diabetes and coronary artery disease (CAD) care and to assess physician attitudes toward this reminder system. DESIGN We enrolled 194 primary care physicians caring for 4549 patients with diabetes and 2199 patients with CAD at 20 ambulatory clinics. Clinics were randomized so that physicians received either evidence-based electronic reminders within their patients' electronic medical record or usual care. There were five reminders for diabetes care and four reminders for CAD care. MEASUREMENTS The primary outcome was receipt of recommended care for diabetes and CAD. We created a summary outcome to assess the odds of increased compliance with overall diabetes care (based on five measures) and overall CAD care (based on four measures). We surveyed physicians to assess attitudes toward the reminder system. RESULTS Baseline adherence rates to all quality measures were low. While electronic reminders increased the odds of recommended diabetes care (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.01-1.67) and CAD (OR 1.25, 95% CI 1.01-1.55), the impact of individual reminders was variable. A total of three of nine reminders effectively increased rates of recommended care for diabetes or CAD. The majority of physicians (76%) thought that reminders improved quality of care. CONCLUSION An integrated electronic reminder system resulted in variable improvement in care for diabetes and CAD. These improvements were often limited and quality gaps persist.
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Affiliation(s)
- Thomas D Sequist
- Division of General Medicine, Brigham and Women's Hospital, Harvard Medcal School, 1620 Tremont Street, Boston, MA 02120, USA
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Affiliation(s)
- Robert E Drake
- New Hampshire-Dartmouth Psychiatric Center, Lebanon, NH, USA.
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