Michael A. Counte

Interdisciplinary health professional education : A historical review

A historical review was conducted to examine the advances made, nationally and internationally, in interdisciplinary health professional education since the mid-1960s. One hundred and nineteen articles were reviewed and divided by decade into the following subheadings: models, courses, communication/group process issues, and international perspectives. Twenty-seven articles, categorized as models, defined the conceptual field, described curriculum and program development, or provided a framework for evaluation.Thirty-two articles dealt with interdisciplinary courses, focusing on objectives, content areas, or innovative methods. Nine articles contributed contenton interdisciplinary communication and group process issues, from which guidelines were abstracted. Fifty-one articles contributed an international perspective, leading to the recognition that interdisciplinary health professional education, practice, and research is a global movement.

A Panel Study of Life Stress, Social Support and the Health Services Utilization of Older Persons.

Interest in the health care needs and medical care utilization patterns of older persons has steadily increased in recent years. The major goal of this study was to examine the extent to which specific factors moderate the relationship between life stress exposure and subsequent health services utilization. Two groups of older persons (health maintenance organization members and fee-for- service clients) participating in a multiyear panel study comprised the study sample. Time-ordered, multivariate analyses of links among life stress exposure, moderating variables, and subsequent health services utilization indicate that the process may not be direct or simple to explain. There was no indication in this study that social support had any direct moderating effects on the time-ordered relationship between life stress exposure and the utilization of medical care services. However, the interaction of high life stress exposure and low social support was consistently linked to increased rates of health services utilization.

COST-EFFECTIVENESS OF ADJUNCTIVE HYPERBARIC OXYGEN IN THE TREATMENT OF DIABETIC ULCERS

OBJECTIVES This study estimates the cost-effectiveness (CE) of the adjunctive use of hyperbaric oxygen (HBO2) therapy in the treatment of diabetic ulcers based on the payers and societal perspectives. METHODS The study population was a hypothetical cohort of 1,000 patients sixty years of age with severe diabetic foot ulcers. A decision tree model was constructed to estimate the CE of HBO2 therapy in the treatment of diabetic ulcers at years 1, 5, and 12. Scenario and one-way sensitivity analyses were also undertaken to identify parameters that may significantly influence the estimates. RESULTS The CE model estimated that the incremental cost per additional quality-adjusted life year (QALY) gained at years 1, 5, and 12, was dollar 27,310, dollar 5,166, and dollar 2,255, respectively. CONCLUSIONS The study results indicate that HBO2 therapy in the treatment of diabetic ulcers is cost-effective, particularly based on a long-term perspective. However, the results are limited by the clinical studies that provide the basis of the CE estimation.

Elderly health beliefs, attitudes, and maintenance☆

BACKGROUND Why older persons engage in varying amounts of health maintenance activity is becoming both an increasingly important policy issue and a topic of interest to health services researchers. Such activity may help the elderly to delay the onset of the health-related problems associated with aging, maintain if not improve their functional abilities, and perhaps improve their quality of life. METHODS Using a conceptual model largely based upon the health belief model, this study sought to examine predictors of variability of health maintenance activity among older persons. The project included cross-sectional data drawn from the first phase of a multiyear panel study of elderly community residents. RESULTS Results of ordinary least-squares and logistic regression analyses of seven types of health maintenance activity suggest that health beliefs are an important consideration but that other variables, namely, type of insurance plan and select sociodemographic factors, also had significant impacts. Another consistent finding was that each of the types of health maintenance activity was associated with different types of predictor variables. CONCLUSION These findings suggest that in order for levels of health maintenance activity to be increased, intervention programs need to be targeted toward specific types of health beliefs and need to take into account the importance of social differences.

Implementing Computerization in Hospitals: A Case Study of the Behavioral and Attitudinal Impacts of a Medical Information System

This study examines the impacts of a medical information system (MIS) upon select work related attitudes and reported work role behavior of a randomly selected group of hospital employees. Measures of attitude toward the MIS, job satisfaction, role tensions, and reports of work activities were administered at three points before and after implementation of the system. Results of analyses of the trends that were observed suggest that over time employee attitudes toward the system became less favorable, levels of job satisfaction increased, and that the system’s introduction affected several categories of reported work activity.

Examining the Relationship between Health Locus of Control and the Use of Medical Care Services

Health locus of control, the extent to which one believes he or she can affect his or her health status, usually is viewed as one of the factors that predisposes individuals to use medical services. However, some social theorists outside the area of utilization studies suggest that locus of control beliefs also are consequences of health-related behaviors and events such as utilization. The authors address this issue by investigating the relationship between health locus of control and utilization of medical services in a sample of 298 elderly community-dwellers surveyed at three points in time. They found that health locus of control was affected by serious medical care encounters and that, for two dimensions of health locus of control, there was a reciprocal relationship between control beliefs and utilization.

Development of a Healthcare Quality Improvement Measurement Tool: Results of a Content Validity Study

Abstract Current methods of measuring continuous quality improvement (CQI) implementation are too long and not comprehensive. A new survey for CQI implementation was developed and tested for content validity using a panel of 8 experts—7 from the United States and 1 from England. The survey was reduced from 70 items to 22. The resultant survey had a clarity interrater agreement (IR) of .91, a representativeness IR of .93, a clarity content validity index (CVI) of .73, and a representativeness CVI of .91. Content validity served as an excellent data reduction method in building a valid, concise, and comprehensive measure of CQI implementation.

Implementation of a medical information system: evaluation of adaptation.

A study was conducted to explain variability in hospital employee responses to the implementation of a medical information system. Results showed that 28 to 35 percent of the variance in adaptation was explained by the predictor variables, and that the significant variables were attitudes toward computers in general, role ambiguity, personality attributes, the persons work shift and previous history of job mobility.

Assessment of patient safety research from an organizational ergonomics and structural perspective

The aim of this study is to review patient safety improvement initiatives within a conceptual framework that builds upon principles of organizational ergonomics and emphasizes structural factors that influence patient safety. The literature review included 131 English language published studies of patient safety improvement strategies extracted using Medline, Ovid Healthstar, PubMed and CINAHL searches. Keywords for the search included: ‘patient safety’; ‘medical errors’; ‘adverse event’; ‘iatrogenic’; and truncated options for ‘improve’. The multilevel, hierarchical framework offered in this paper integrates quality management principles and organizational ergonomics theory and organizes patient safety initiatives according to sociotechnical system elements within three structural levels: health policies and associated health care organizations; health care delivery organizations; and health care microsystems. Utilizing the conceptual framework, this review of patient safety improvement initiatives highlights the need for consideration of the impact of all improvement proposals on each structural component within health care systems. The review also supports the need for patient safety research to evolve from exploratory, 1-D reporting to multi-level, integrated research.

HYPERBARIC OXYGEN TECHNOLOGY: AN OVERVIEW OF ITS APPLICATIONS, EFFICACY, AND COST-EFFECTIVENESS

OBJECTIVES To examine the growing evidence and the consensus in the medical community concerning the efficacy and cost-effectiveness of hyperbaric oxygen therapy (HBO2T) and to suggest future research areas to ensure the appropriate use of this technology. METHODS A literature search of articles published between 1985 and 2000 was conducted using PubMed to describe the growth of HBO2T-related articles published over the past fifteen years. In addition, articles involving the qualitative synthesis of the efficacy and cost-effectiveness of HBO2T in thirteen major application areas were identified and compared with the changing view of the medical community toward the evidence of HBO2T. RESULTS The total number of HBO2T-related articles published annually has steadily increased over the past fifteen years. This increase has gradually contributed to a consensus in the medical community concerning the evidence of efficacy in its major application areas. However, information regarding the cost-effectiveness of HBO2T is still extremely limited. CONCLUSIONS Although evidence concerning the efficacy of HBO2T has been growing in the past, more evidence is still needed for some of its major application areas. Moreover, there is an urgent need to shift part of the research focus on HBO2T to its cost-effectiveness to provide decision makers with relevant information to evaluate this technology objectively.