Amy A. Abbott

The relationship between physician practice characteristics and physician adoption of electronic health records

BACKGROUND Health information technologies, such as electronic health records (EHRs), can potentially improve patient safety in our health care system. The potential advantages include increased quality and more efficiency in the care of patients. Adoption of EHRs has been slow despite these advantages and a national call for EHR implementation. PURPOSES This article explores factors associated with the adoption of EHR systems using organizational theory to derive hypotheses as to why physicians would adopt EHRs. METHODOLOGY/APPROACH : A survey was administered to all office-based physicians in Nebraska and South Dakota using a modified Dillman technique between July and November 2007. The main outcome variable measured physician EHR adoption status at three levels: not planning to use an EHR, planning to use an EHR, and using an EHR. Factors associated with EHR status were analyzed using a multinomial logistic regression. FINDINGS Approximately 30% of physicians reported using an EHR in his or her practice. Physicians adopting EHRs were younger and had access to internal health information technologies support. In addition, working in an independent practice decreased the likelihood of physicians using and adopting EHRs. PRACTICE IMPLICATIONS This research provides further evidence of the barriers impeding EHR adoption. One such barrier includes the lack of access to internal information technology support staff versus having to outsource for technical support services. From a resource dependency perspective, barriers illustrated by this example may place undue dependencies on physicians if they pursue an EHR system. By addressing these barriers, physicians may be in a better position to adopt EHR system into his or her practice.

Exploring Care Transitions From Patient, Caregiver, and Health-Care Provider Perspectives

Care transitions involve coordination of patient care across multiple care settings. Many problems occur during care transitions resulting in negative patient outcomes and unnecessary readmissions. The purpose of this study was to describe the experience of care transitions from patient, caregiver, and health-care provider perspectives in a single metropolitan Midwest city. A qualitative descriptive design was used to solicit patients’, caregivers’, and health-care providers’ perceptions of care transitions, their role within the process, barriers to effective care transitions, and strategies to overcome these barriers. Five themes emerged: preplanned admissions are ideal; lack of needed patient information upon admission; multiple services are needed in preparing patients for discharge; rushed or delayed discharges lead to patient misunderstanding; and difficulties in following aftercare instructions. Findings illustrated provider difficulty in meeting multiple care needs, and the need for patient-centered care to achieve positive outcomes associated with quality measures, reduced readmissions, and care transitions.

Predictors of success on National Council Licensure examination for registered nurses for accelerated baccalaureate nursing graduates.

A ccelerated nursing curricula (ANC) were first offered in 1971, and the nursing shortage has fostered the development of additional programs across the country. Employers look favorably on ANC programs because they produce nurses more rapidly than traditional programs. Students are partial to them because they can reach their goal in a shorter period of time. Accelerated nursing curricula may have different prerequisites and admission criteria; however, they offer qualified, previous-degree students the opportunity to graduate with a bachelor of science in nursing in 1 year. Because of the unique characteristics of ANC students and programs, predictors for success on the National Council Licensure Examination for Registered Nurses (NCLEX-RN) may differ from those for traditional students. There are gaps in the literature concerning predictors of NCLEX-RN success in ANC students in the predictive value of pre-RN examinations, previous degree, and coursework. In an effort to evaluate a newly revised curriculum and address declining school NCLEX-RN pass rates, a retrospective study was conducted to identify variables that predicted NCLEX-RN in our graduates. Variables examined included the following: admission grade point average (GPA), previous degree (science or nonscience), senior complex care (SCC) grade, and pre-RN assessment score.

Patient Safety Perspectives of Providers and Nurses: The Experience of a Rural Ambulatory Care Practice Using an EHR With E‐prescribing

PURPOSE The purpose of this study was to identify and describe safety improvements and concerns indicated by providers and nurses in a rural community ambulatory care practice using an electronic health record with an e-prescribing feature (EHR with eRx). METHODS Two focus groups were conducted; 1 with providers and the other with nurses. Participants responded to questions and discussed their perceptions of safety improvements and concerns with use of an EHR with eRx. Transcripts were analyzed using sequential and continuous analytic methods. FINDINGS Three themes centered on efficiency and patient safety emerged from data analysis: (1) EHR with eRx adoption has led to new improvements and concerns for patient safety, (2) the EHR with eRx has affected efficiency in the clinic, and (3) EHR with eRx adoption has led to workarounds. CONCLUSIONS Concerns remain among providers and nurses regarding the use of EHR with eRx applications, although concerns differed between groups. Therefore, When EHR improvements are planned, it is important to consider the differing needs of the professionals who deliver care.

Symptom profiles of coronary artery bypass surgery patients at risk for poor functioning outcomes.

The purpose of this secondary analysis was to profile or cluster 226 patients, who had participated in a randomized controlled trial, on symptoms after coronary artery bypass surgery and to examine how these profiles could potentially be used by clinicians to identify groups at risk for impaired functioning during the first 6 months after surgery. Variables measured were symptom presence and burden and functioning. The model-based clustering method was used for cluster analysis of the symptom burden measure, and analyses of covariance were used to determine if there were differences on functioning (physical functioning and physical activity) by symptom burden group at 6 weeks and at 3 and 6 months after dismissal. The majority of the 226 subjects were married (86%), male (83%), and had a mean age of 71 (SD, 4.96) years. Eight symptoms were used in the model-based clustering method-shortness of breath, fatigue, depression, sleep disturbances, pain, swelling, anxiety, and appetite problems-and demonstrated that there were 3 patient clusters of symptom burden. Cluster 1 had low symptom burden on all 8 symptoms, cluster 3 had moderate symptom burden on all 8 symptoms, and cluster 2 had a combination of low (shortness of breath, fatigue, depression, pain, and anxiety) and moderate symptom burden (sleep problems, swelling, and appetite problems). Analyses of covariance revealed no significant cluster × time interactions for any of the variables. However, there were significant main effects (P < .01) for symptom burden groups for physical functioning (physical and vitality functioning) and physical activity (estimated energy expenditure and mean daily total activity counts). Significant main effects for time indicated physical functioning and physical activity measures, except bodily pain, improved over time (P < .05). Study results indicate that the use of profiling coronary artery bypass surgery patients on their symptoms prior to hospital discharge may assist health care providers to identify patients who could be at risk for having more difficulty with physical functioning and physical activity during the first 6 months after surgery.

Symptom burden clusters and their impact on psychosocial functioning following coronary artery bypass surgery

Although there is extensive literature on symptoms experienced by patients after coronary artery bypass surgery (CABS), there is a paucity of data on symptom clusters and their impact on functional outcomes. The purpose of these descriptive, secondary analyses was to identify and describe cluster subgroups of 226 elderly CABS patients at discharge and to examine the clusters impact on psychosocial functioning over time (baseline, 6 weeks, and 3 months) using the 36-item Medical Outcome Study Short Form subscales. Cluster analysis revealed a 3-cluster solution with low, low-moderate, and moderate symptom burden clusters. Significant differences were detected for Duke Activity Status Index (F2,223 = 5.12, P = .007), Barnason Efficacy Expectation Scale (F2,223 = 9.60, P < .0001), Hospital Anxiety and Depression Scale (F2,219 = 15.14, P < .0001), and New York Heart Association classification (χ2 = 17.44, P = .008). Significant differences were noted on all variables between the low and moderate symptom burden clusters with differences between the low-moderate and moderate clusters for only the Barnason Efficacy Expectation Scale and the Hospital Anxiety and Depression Scale. Those in the moderate symptom burden cluster had more symptoms, anxiety, and depression along with lower self-efficacy and physiological functioning than those in the other 2 clusters. There was no interaction or simple main effects for the role-emotional or social subscales as measured by the 36-item Medical Outcome Study Short Form. There was no significant interaction for mental functioning by time and cluster (F4,641 = .30, P = .88); however, there was a simple main effect for cluster (F2,641 = 4.11, P = .02). Follow-up analysis indicated significant differences between the low and low-moderate clusters, indicating that those with low symptom burden had significantly better mental health functioning than those with moderate symptom burden. Findings provide a foundation of knowledge on symptom clusters in CABS populations and may be useful to clinicians to identify patients at risk for slowed or delayed recovery and for early intervention.

Personal Health Record Design: Qualitative Exploration of Issues Inhibiting Optimal Use

Personal health records (PHRs) have been purported to enhance patients’ self-management of diabetes (1). However, few studies have examined the barriers to PHR use resulting from design issues identified by actual users (2). To address this gap, interviews were conducted with 59 patients 3 to 6 months after receiving hands-on training in the use of the Microsoft Health Vault for PHRs to manage their diabetes-related health information. Health Vault was selected because of its universal accessibility and functionalities meeting the greatest number of patient desires (3). The central question guiding the interviews was “How have you used the PHR to manage your diabetes-related health information?” Data were analyzed through a process of coding, category development of similar codes, and overarching theme development. Twenty-three of the 59 participants (39%) sustained PHR use. Table 1 displays the demographic, clinical, and thematic comparisons between PHR users and nonusers. Three themes describing barriers to use from patients’ perspectives could be traced back to PHR design considerations. View this table: Table 1 Demographic characteristics …

A Qualitative Case Study Exploring Nurse Engagement With Electronic Health Records and E-Prescribing:

There is a national focus on the adoption and use of electronic health records (EHRs) with electronic prescribing (e-Rx) for the goal of providing safe and quality care. Although there is a large body of literature on the benefits of adoption, there is also increasing evidence of the unintentional consequences resulting from use. As little is known about how use of EHR with e-Rx systems affects the roles and responsibilities of nurses, the purpose of this qualitative case study was to describe how nurses adapt to using an EHR with e-Rx system in a rural ambulatory care practice. Six themes emerged from the data. Findings revealed that nurses adjust their routine in response to providers’ preferential behavior about EHR with e-Rx systems yet retained focus on the patient and care coordination. Although perceived as more efficient, EHR with e-Rx adoption increased workload and introduced safety risks.

Ensuring effective medication reconciliation in home healthcare

A patient was readmitted two days after discharge with severe hypoglycemia. The treating team discharged the patient on a new insulin regimen without realizing that the patient also had insulin 70/30 at home. The patient continued to take her previous regimen as well as the new one, and was found unresponsive by her husband. The patient was in the ICU with the incident likely resulting in permanent neurological deficits. (Fernandes & Shojania, 2012)A patient was admitted to a hospital from a home health agency. The list of medications provided by the agency did not completely match the list provided by the patients family physician (i.e., the antihypertensive agent metoprolol tartrate [Lopressor] was not listed by the agency as one of the medications that the patient was currently taking). Therefore, metoprolol tartrate was not initially ordered. The patient developed atrial fibrillation shortly after hospital admission and required a transfer to the ICU [intensive care unit]. A diltiazem (Cardizem) infusion was started and the patients family physician became aware that the patient had not been receiving their antihypertensive medication and initiated an order for the metoprolol tartrate (United States Pharmacopeia, 2005)

Predictors of success on national council licensure examination for registered nurses for accelerated baccalaureate nursing graduates.

A ccelerated nursing curricula (ANC) were first offered in 1971, and the nursing shortage has fostered the development of additional programs across the country. Employers look favorably on ANC programs because they produce nurses more rapidly than traditional programs. Students are partial to them because they can reach their goal in a shorter period of time. Accelerated nursing curricula may have different prerequisites and admission criteria; however, they offer qualified, previous-degree students the opportunity to graduate with a bachelor of science in nursing in 1 year. Because of the unique characteristics of ANC students and programs, predictors for success on the National Council Licensure Examination for Registered Nurses (NCLEX-RN) may differ from those for traditional students. There are gaps in the literature concerning predictors of NCLEX-RN success in ANC students in the predictive value of pre-RN examinations, previous degree, and coursework. In an effort to evaluate a newly revised curriculum and address declining school NCLEX-RN pass rates, a retrospective study was conducted to identify variables that predicted NCLEX-RN in our graduates. Variables examined included the following: admission grade point average (GPA), previous degree (science or nonscience), senior complex care (SCC) grade, and pre-RN assessment score.