Julie A. Meek

FACULTY AND ORGANIZATIONAL CHARACTERISTICS ASSOCIATED WITH INFORMATICS/HEALTH INFORMATION TECHNOLOGY ADOPTION IN DNP PROGRAMS

Nursing informatics/health information technology are key components of graduate nursing education and an accreditation requirement, yet little is known about the extent to which doctor of nursing practice (DNP) curricula include these content domains. The purpose of this descriptive study was to elicit perceptions of DNP program directors relative to (a) whether and how the American Association of Colleges of Nursings (AACNs) Essential IV standard has been met in their DNP programs; (b) whether the Technology Informatics Guiding Educational Reform Initiative Foundations Phase II competencies have been integrated in their programs; and (c) the faculty and organizational characteristics associated with the adoption of the AACNs Essential IV. In 2011, an electronic survey was sent to all 138 DNP program directors identified on the AACN Web site with an 81.2% response rate. Findings include variation in whether and how programs have integrated informatics/health information technology content, a lack of informatics-certified and/or masters-prepared faculty, and a perceived lack of faculty awareness of informatics curricular guidelines. DNP program director and dean awareness and support of faculty informatics education, use of informatics competency guidelines, and national policy and stimulus funding support are recommended to promote curricular inclusion and the engagement of nurses in strong informatics practices.

Targeting High Utilisers: Predictive Validity of a Screening Questionnaire

AbstractObjective: To examine the utility of a self-reported health perception assessment as a screening tool to predict high near-term utilisation of healthcare services. Design and setiing: Prospective cohort study in a Midwest US commercial managed-care population. Participants completed a 70-question/126-response item paper-based health perception assessment (including demographic items) in late August 1997. Healthcare claims data were subsequently obtained from the health plan for the next 6 months and converted to total number of encounters and total dollars for each respondent. The dependent variable was the total number of encounters re-coded to a dichotomous variable with the cut-off set at 6 or more encounters as a subsequent high care user. All health perception assessment variables were dichotomised as well and then evaluated as independent variables for their ability to predict the probability that a member would become a high care user over the next 6 months.A split-half technique was used to identify the predictive model from the first half of the sample using logistic regression analysis. A formula was subsequently developed from that defined logistic model and then tested on the first split-half for levels of sensitivity and specificity. The chosen predictive formula was then tested using data from the other half of the sample. Study participants: A sample of 4210 non-institutionalised enrollees of the health plan, ranging in age from 18 to 65 years, who responded to an initial health perception assessment and were continuously enrolled in the health plan for the next 6 months. Main outcome measures and results: Using logistic regression for the first split-half of the sample, the resulting predictive model included 39 health perception assessment variables, correctly predicting 68.1% of the high care users and 61.9% of the low care users. The final logistic model was converted to a formula resulting in a probability score for each member, which indicates the likelihood the person will become a high utiliser in the near term. This formula was tested on both split-halves of the population yielding 66.7% sensitivity and 63.4% specificity on the first split-half and 59.4% sensitivity and 53.3% specificity on the second split-half. The predictive model permitted the number of health perception assessment survey questions to be lowered to 48 with 74 responses. Conclusions: Easily ascertained self-reported factors predict an adult’s probability of becoming a near term high care user. Utilising a powerful self-report survey overcomes many of the limitations of using less predictive traditional health risk/status models or cumbersome claims stratification methods.

Creating a Faculty Community That Values Curricular Assessment and Improvement: One DNP Program's Experience

Developing faculty ownership of ongoing curricular improvement presents educational and management challenges for schools of nursing, yet little has been published about which components help build a faculty community that values curricular assessment and improvement. The purpose of this case study was to describe key features of and faculty satisfaction with one school of nursings doctor of nursing practice curricular assessment process, with a description of key considerations for developing an ePortfolio-supported curricular assessment process. ePortfolio matrices were used as a curricular organizing structure for mapping and scoring each completed student assignment to an American Association of Colleges of Nursing Essential descriptor using a rubric that measured evidence of student learning. Faculty satisfaction with the process was also evaluated. First-year results indicated high levels of faculty satisfaction with the assessment process. The initial findings led to four actions for curricular improvement and agreement to continue the assessment process biannually. The curricular assessment was successful in generating faculty satisfaction, identifying needed areas to improve the curriculum, and obtaining faculty agreement to continue the process. A faculty community supportive of curricular assessment is essential to a transformational learning environment that prepares future nursing leaders.

Bedside Interprofessional Rounding: The View From the Patient's Side of the Bed

Background: Bedside interprofessional rounding is gaining ground as a means to improve collaboration and patient outcomes, yet little is known regarding patients’ perceptions of the practice. Methods: This descriptive study used individual patient interviews to elicit views on interprofessional rounding from 35 patients at a large, urban hospital. Results: The findings identified three major categories: 1) about the rounding process; 2) clinical information; and 3) the impact/value of bedside inter-professional rounding. Discussion: Intentionally eliciting and responding to our patients’ views of interprofessional rounding may help us design methods that are patient centered and effective.

Effective Employer-Vendor Partnerships: Encouraging Positive Disruptive Innovations in Healthcare

US employers are facing an unprecedented opportunity to contribute toward positive, disruptive innovations in healthcare. The convergence of major trends will enable employers to exercise significant leverage in controlling healthcare costs and improving quality.US healthcare is ripe for disruptive innovations — cheaper, simpler, more convenient products or services that start by meeting the needs of less demanding customers. Employers view the healthcare system as overbuilt and off-focus for the needs of the average employer and employee. There are powerful driving forces and some restraining forces on employer leverage over employee health initiatives. On balance, employers have an interest in and an opportunity to leverage disruptive innovations in healthcare.One option that employers can use to leverage disruptive innovations in healthcare is partnership with health management vendors. While traditionally this association has been an arms-length customer/supplier relationship, there is an effective process for development of strategic partnerships that employers can use to better exert their latent influence on healthcare.There are at least 5 critical success factors for effective employer-vendor partnerships: (i) establish a formalized strategic planning process; (ii) gain commitment and support early in the process; (iii) identify specific goals, objectives, and accountabilities; (iv) clearly define the partner selection process; and (v) clarify partner roles and expectations.

Can You Find the People You Can Help? Can You Help the People that You Find?

Because of recent upsurges in medical costs, health plans, employers, and the government will increasingly demand solutions that stretch performance boundaries with regard to quality of care, provider and member satisfaction, and near term cost benefits.The health management industry is awakening to three trends that will revolutionize the way we provide healthcare: (i) what we look with and what we look for determines how we view health and subsequently how we choose interventions and solution sets; (ii) finding the people we can help requires us to broaden our thinking to include non-disease-based factors as drivers of care-seeking behavior; and (iii) the convergence of new knowledge and new technologies sets the stage for disruptive innovation in the way care is delivered, thereby providing an unprecedented opportunity to extend performance boundaries.This article details the rationale behind the three trends listed above, which are shaking the traditional foundations of health management and which, taken together, will usher in a dramatic improvement in quality of care and financial outcomes for entities that manage the health and care of populations.