Karen A. Paschal

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.

Test-retest reliability of the physical performance test for persons with Parkinson disease.

Background and Purpose: Reliable measures are needed to document functional status and disease progression for people with Parkinson disease (PD). We, therefore, evaluated the reliability of the Physical Performance Test (PPT) for people with PD. Methods: Fourteen community‐dwelling subjects with PD participated: 8 males, 6 females; modified Hoehn and Yahr Stages 2 and 2.5; mean age 62.4 years (±6.3). The test was administered twice, 1 week apart. The 7‐item and 9‐item summary scores of the PPT were each compared between sessions using repeated measures analysis of variance (ANOVA). The intraclass correlation coefficient (ICC) and method error (ME) were calculated to further assess reliability. Results: Between sessions, 7‐ and 9‐item summed scores were not statistically different. The range of summed scores fell in the midst of the available score range for both the 7‐ and 9‐item tests suggesting resistance to floor and ceiling effects. The ICCs showed good agreement (7‐item = 0.818; 9‐item = 0.895) indicating test reliability for this population. Based on the ME, an examiner can expect a 6% variation for the 7‐item summary score and a 4% variation for the 9‐item score summary between testing sessions. Conclusions: The 7‐ and 9‐item PPTs were demonstrated to be reliable objective measures in individuals with PD. Simple props and brief administration time (10–15 minutes) make the test practical to use.

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.

Functional outcomes of adult patients with West Nile virus admitted to a rehabilitation hospital.

Background and Purpose:The clinical manifestation of West Nile Virus (WNV) varies in individuals from mild flu-like symptoms to acute flaccid paralysis. Advanced age is the most significant risk factor for developing severe neurological disease and for death. The broad range of neurologic symptoms associated with WNV infection leads to varied body structure and function limitations and participation restrictions that may require rehabilitation. The purpose of this study is to describe the functional impairments upon admission and the functional outcomes at discharge of 48 adult patients admitted with WNV to a rehabilitation facility in the Midwest from 2002 to 2009. Methods:A retrospective chart review was completed on 48 patients (29 male, 19 female) with mean age 67.8 (SD = 16.6, range = 24–91) years and median age 72.5 years, admitted to inpatient rehabilitation with a diagnosis of WNV after January 1, 2002, and discharged prior to December 31, 2009. General information (sex, age, social history, employment, and living environment), past medical history, and information specific to the current hospitalization (medical conditions, functional status and activity level on admission and discharge as measured by the Functional Independence Measure [FIM], lengths of stay [LOSs] in the acute care and rehabilitation hospital, physical therapy care, discharge destination, and follow-up care provisions) were gathered. The standardized response mean (SRM) was calculated for total, motor, and cognitive FIM scores to provide insight into the effect size and the responsiveness of the FIM for the patients with WNV in this study. Results:All patients were admitted to the rehabilitation hospital from acute care hospitals following LOSs ranging from 1 to 62 days. The rehabilitation hospital LOS ranged from 2 to 304 days. These patients had significant comorbidities including hypertension (43.75%), diabetes mellitus (41.67%), acute respiratory failure (37.5%), ventilator dependency/tracheostomy (33.33%), and pneumonia (29.17%). Their admission FIM scores ranged from 13 to 116 (mean = 45.8 ± 28.2) and discharge FIM scores ranged from 18 to 121 (mean = 75.1 ± 34.2). The change in FIM during inpatient rehabilitation was statistically significant (P < .001). The calculated SRM for the total (1.06) and motor (1.12) FIM indicate a large effect size, whereas the SRM for the cognitive FIM (0.79) indicates a moderate effect. The majority of patients were discharged home or to a nursing facility (46%), skilled or extended care (38%) with a need for continued rehabilitation services. Discussion and Conclusions:The manifestation of the WNV and functional outcomes after comprehensive rehabilitation vary from patient to patient. Higher numbers of comorbid conditions lead to more complex presentation and challenge rehabilitation professionals to design individualized plans of care to enable these patients to achieve the highest functional outcomes. Most patients require follow-up physical therapy care after discharge from rehabilitation.

Description and evaluation of an interprofessional patient safety course for health professions and related sciences students

Objectives: The structure, process, and outcomes associated with planning, developing, and offering an interprofessional course on the foundations of patient safety is described, including how organizational, structural, cultural, and attitudinal barriers were overcome. Methods: Seventeen faculty members from 7 colleges and schools and medical center participated-from the fields of decision sciences and systems, dentistry, medicine, law, nursing, occupational therapy, pharmacy, physical therapy, social work, health care administration, and outcomes management in health systems. Student assessment included theme analysis of open-ended questions, descriptive analysis of multiple- response option questionnaires, and criterion-based assessment of student performance on case studies. Triangulation of student comments, final course evaluation, and student performance evaluations were performed to learn overarching themes of student experience with the course. Results: The students learned a different way of thinking, found the instructional design and active learning methods useful to learning, and felt prepared to solve problems in the future. Students believed that the content was an essential core knowledge for all health professionals (87%) and should be required for all health professions students (78%). Students achieved an application level of learning (77%) within the cognitive domain and the valuing level within the affective domain. Students agree (96%) that they can define and apply the basic principles and tenets of patient safety, including identification of tools needed to work effectively within the health system and to improve safety and strongly agree (100%) that they value patient safety as a professional practice framework. Conclusion: The universitywide implementation case may offer important lessons to others nationally in health care education.

Entry-level physical therapist education in the United States of America

Abstract Schools for physical therapist education in the US began in the latter part of the 19th century. The American Physical Therapy Association was formed in 1921 and has assumed a leadership role in fostering the quality and consistency of physical therapist education and practice. Growth in the number and complexity of physical therapist educational programmes during the first half of the 20th century was driven, in large part, by the need for rehabilitation of injured military personnel and by the polio epidemics. Physical therapist education in the US is now firmly embedded in an academic model of higher education and is rapidly converting to the doctoral entry-level degree, similar to other US educational tracks that produce autonomous healthcare practitioners. The future trends in US physical therapist education are seen in the establishment of organised residencies and fellowships. This, in turn, fosters autonomous practice and clinical specialisation.

Effects of a Thoracic Mobility and Respiratory Exercise Program on Pulmonary Function and Functional Capacity in Older Adults

The purposes of this study were to describe a home exercise program (HEP) consisting of respiratory exercise and stretching thoracic muscles and to determine how regular participation in this program affected pulmonary function, chest wall excursion, physical function, and quality of life in community-dwelling older adults. Thirty-seven volunteers (mean age 80.5 years) participated in a twice daily HEP for 6 weeks. Twenty-two subjects completed the program. Pulmonary function, chest wall excursion (CWE), the 6-minute walk test (6MWT), the physical performance test (PPT), and RAND SF-36 quality of life survey (SF-36) were administered before and after the exercise program. Increases in CWE, 6MWT, and PPT were statistically significant. In conclusion, community-dwelling older adults participating in a 6-week stretching and respiratory exercise program demonstrated improved CWE and function.

Examining barriers to health information technology adoption

Results of a previous study showed that use of health information technology (HIT) significantly reduced potential medication prescribing errors. However, the results also revealed a less than 100% rate of HIT adoption by primary care physicians. The current study reports on personal interviews with participating physicians that explored the barriers they faced when attempting to fully adopt a particular HIT. Content analysis of qualitative interviews revealed three barrier themes: time, technology, and environment. Interviews also revealed two other areas of concern; specifically, the compatibility of the HIT with the physicians patient mix and the physicians own attitude toward the use of HIT. A theoretical model of technology acceptance and use is used to discuss and further explain the data derived from the physician interviews. With a better understanding of these issues, health care administrators can develop successful strategies for adoption of HIT across their health care organizations.

Promoting awareness and understanding of occupational therapy and physical therapy in young school aged children: an interdisciplinary approach

SUMMARY Public awareness and understanding of the professions of occupational therapy and physical therapy are limited. In this study, we examined perceptions of young school-aged children about occupational therapy and physical therapy as part of a larger grant project funded by the National Institute on Drug Abuse (R25 DA 12168 and R25 DA13522). One hundred three elementary school children (55 boys and 48 girls), grades 3 to 7, from local schools attended a one-day neuroscience and allied health profession exposition held at a local Boys & Girls Club. Childrens understanding of occupational therapy and physical therapy was assessed through a pre/post questionnaire prior to and immediately after attending the exposition. At five of the 18 exhibition booths, faculty members and students from occupational therapy and physical therapy introduced and explained what occupational and physical therapists do at their work through interactive demonstrations. The results of the current study revealed that prior to attending the exposition, childrens understanding of occupational therapy and physical therapy was limited. On pre-test, children reported they have some understanding of occupational therapy (18.6%) and physical therapy (34.9%). Childrens understanding of occupational therapy and physical therapy, however, dramatically increased after the exposition (75.6% vs. 18.6%, 98.9% vs. 34.9%, respectively). Furthermore, the scope and depth of childrens understanding also improved considerably. This finding suggests that an interactive neuroscience exposition including occupational therapy and physical therapy is an effective way to promote childrens awareness and understanding of the professions. Implications for practice and future research directions are discussed in the study.

Privacy, security and the national health information network: A mixed methods case study of state-level stakeholder awareness

This mixed methods multiple case study examines the knowledge, understanding, and awareness of 25 health board/facility oversight managers and 20 health professional association directors about privacy and security issues important to achieving health information exchange (HIE) in the state of Nebraska. Within case analyses revealed that health board/facility oversight managers were unaware of key elements of the federal agenda; their concerns about privacy encompassed broad definitions both of what constituted a “health record” and “regulations centeredness.” Alternatively, health professional association leaders were keenly aware of national initiatives. Despite concerns about HIE, they supported information exchange believing that patient care quality and safety would improve. Cross-case analyses revealed a perceptual disconnect between board/facility oversight managers and professional association leaders; however, both favored HIE. Understanding state-level stakeholder perceptions helps us further understand our progress toward achieving the national health information interoperability goal. There is an ongoing need to assure adequate patient privacy protection. Licensure and facility boards at the state level are likely to have a major role in the assurance of patient protections through facility oversight and provider behavior. The need for these boards to take an active role in oversight of patient rights and protections is imminent. Similarly, professional associations are the major vehicles for post-graduate education of practicing health professionals. Their engagement is essential to maintaining health professions knowledge. States will need to understand and engage both of these key stakeholders to make substantial progress in moving the HIE agenda forward.