Robert Seidman

The keys to successful online continuing education programs for nurses.

Asynchronous online tutorials that award continuing education units without cost and provide knowledge about computers and nursing informatics were made available to registered nurses in Southern California. Four hundred seventy-three nurses enrolled; 52% (246) completed tutorials. Nonsignificant differences in the number of tutorials completed were found across characteristics of participants, meaning that nurses were similarly disposed to participate regardless of age, educational preparation, experience, practice setting, or ethnicity. They tended to overestimate their computer capabilities at the time of enrollment and abandoned the tutorials when they encountered technical problems. Nurses need live workshops teaching computer basics, Internet skills, and how to enroll in and run asynchronous programs. Marketing of online programs should be multifaceted, including live and electronic strategies.

Implementing a seventh grade vaccination law: school factors associated with completion of required immunizations.

OBJECTIVES We investigated school factors associated with successful implementation of a seventh grade vaccination requirement. METHODS The proportion of students vaccinated with hepatitis B vaccine and measles containing vaccine was determined from records of schools in San Diego County, California. A school survey identified compliance strategies. Analysis identified factors associated with coverage. RESULTS In October 1999, 67.2% of 38,875 students had received the required vaccine doses. Of 315 schools, coverage was less than 40% in 60 schools and exceeded 80% in 111 schools. Factors associated with high coverage included private schools, early and frequent notice to parents, and, for public schools, higher overall socioeconomic status of students. CONCLUSIONS In preparation for a middle school vaccination requirement, early and frequent notification of parents improves coverage. Schools with a high percentage of low socioeconomic status students may require extra resources to support implementation.

Health Promotion Workshops for Seniors: Predictors of Attendance and Behavioral Outcomes

Abstract The effectiveness of health promotion educational programs in enhancing the elderlys health status and health behaviors is dependent upon their willingness to participate in such programs. The identification of factors that predict their participation is therefore essential. Of equal importance is determining which components of health promotion programs result in enhanced health status through modified health behaviors in order to design future programs for maximum effectiveness. The research reported here focuses on the use and effect of health promotion educational workshops designed to enhance both the physical and psychological well being of a Medicare Health Maintenance Organization population. Sixty-seven percent of eligible participants attended five or more health promotion workshops, while 14 percent failed to attend one workshop. A multivariate regression analysis revealed increasing age and smoking behavior as significant predictors of absenteeism in this group. Limited behavioral ch...

Preventive Services in a Medicare Managed Care Environment

The results of a four year demonstration project of preventive services for Medicare managed care enrollees suggest that health promotion programs can impact health behaviors and outcomes. The study provided selected preventive services to 1,800 Medicare enrollees in a managed care environment. Participants were randomly assigned to control and experimental groups with the experimental group receiving an intervention service package and the control group usual care. The results included enhanced health behavior practices, lower depression, and higher immunization rates among those individuals in the experimental group. This study suggests that selected preventive services can be provided in a managed care environment to Medicare enrollees with likely positive health status and utilization outcomes.

Physician-Targeted Financial Incentives and Primary Care Physicians’ Self-Reported Ability to Provide High-Quality Primary Care

Objective: High-quality primary care is envisaged as the centerpiece of the emerging health care delivery system under the Affordable Care Act. Reengineering the US health care system into a primary care–driven model will require widespread, rapid changes in the management and organization of primary care physicians (PCPs). Financial incentives to influence physician behavior have been attempted with various approaches, without empirical evidence of their effectiveness in improving care quality. This study examines the above research question adjusting for the patient-centeredness of the practice climate, a major contextual factor affecting PCPs’ ability to provide high-quality care. Methods: Secondary data on a sample of salaried PCPs (n = 1733) from the nation-wide Community Tracking Study Physician Survey 2004-2005 were subject to generalized multinomial logit modeling to examine associations between financial incentives and PCPs’ self-reported ability to provide quality care. Results: After adjusting for patient-centered medical home (PCMH)–consistent practice environment, financial incentive aligned with care quality/care content is positively associated with PCPs’ ability to provide high-quality care. An encouraging finding was that financial incentives aligned with clinic productivity/profitability do not to impede high-quality care in a PCMH practice environment. Conclusion: Financial incentives targeted to care quality or content indicators may facilitate rapid transformation of the health system to a primary care–driven system. The study provides empirical evidence of the utility of practically deployable financial incentives to facilitate high-quality primary care.

Trends in hospital deductions from revenue. Increases in uncompensated care and payment adjustments.

The 1980s produced tighter restrictions on Medicaid eligibility, greater reluctance among insurers to cover small groups, and increased price competition, resulting in a larger percentage of unreimbursed charges. Here the authors use financial data from a cross-section of California hospitals to explore the extent and variation of such deductions from revenue.

Country and regional variations in purchase prices for essential cancer medications

BackgroundAccessibility to essential cancer medications in low- and middle-income countries is threatened by insufficient availability and affordability. The objective of this study is to characterize variation in transactional prices for essential cancer medications across geographies, medication type, and time.MethodsDrug purchase prices for 19 national and international buyers (representing 29 total countries) between 2010 and 2014 were obtained from Management Sciences for Health. Median values for drug pricing were computed, to address outliers in the data. For comparing purchase prices across geographic units, medications, and over time; Mann-Whitney U tests were used to compare two groups, Kruskal Wallis H tests were used to compare more than two groups, and linear regression was used to compare across continuous independent variables.ResultsDuring the five-year data period examined, the median price paid for a package of essential cancer medication was

Impact of Information Technology, Clinical Resource Constraints, and Patient-Centered Practice Characteristics on Quality of Care

12.63. No significant differences in prices were found based on country-level wealth, country-level disease burden, drug formulation, or year when medication was purchased. Statistical tests found significant differences in prices paid across countries, regions, individual medications, and medication categories. Specifically, countries in the Africa region appeared to pay more for a package of essential cancer medication than countries in the Latin America region, and cancer medications tended to be more expensive than anti-infective medications and cardiovascular medications.ConclusionsThough preliminary, our study found evidence of variation in prices paid by health systems to acquire essential cancer medications. Primarily, variations in pricing based on geographic location and cancer medication type (including when comparing to essential medicines that treat cardiovascular and infectious diseases) indicate that these factors may impact availability, affordability and access to essential cancer drugs. These factors should be taken into consideration when countries assess formulary decisions, negotiate drug procurement terms, and when formulating health and cancer policy.

The design, marketing, and implementation of online continuing education about computers and nursing informatics.

Objective: Factors in the practice environment, such as health information technology (IT) infrastructure, availability of other clinical resources, and financial incentives, may influence whether practices are able to successfully implement the patient-centered medical home (PCMH) model and realize its benefits. This study investigates the impacts of those PCMH-related elements on primary care physicians’ perception of quality of care. Methods: A multiple logistic regression model was estimated using the 2004 to 2005 CTS Physician Survey, a national sample of salaried primary care physicians (n = 1733). Results: The patient-centered practice environment and availability of clinical resources increased physicians’ perceived quality of care. Although IT use for clinical information access did enhance physicians’ ability to provide high quality of care, a similar positive impact of IT use was not found for e-prescribing or the exchange of clinical patient information. Lack of resources was negatively associated with physician perception of quality of care. Conclusion: Since health IT is an important foundation of PCMH, patient-centered practices are more likely to have health IT in place to support care delivery. However, despite its potential to enhance delivery of primary care, simply making health IT available does not necessarily translate into physicians’ perceptions that it enhances the quality of care they provide. It is critical for health-care managers and policy makers to ensure that primary care physicians fully recognize and embrace the use of new technology to improve both the quality of care provided and the patient outcomes.

Utilization and Cost Analysis of a Chronically Ill, Newly Insured Indigent Population

Asynchronous online tutorials using PowerPoint slides with accompanying audio to teach practicing nurses about computers and nursing informatics were designed for this project, which awarded free continuing education units to completers. Participants had control over the advancement of slides, with the ability to repeat when desired. Graphics were kept to a minimum; thus, the program ran smoothly on computers using dial-up modems. The tutorials were marketed in live meetings and through e-mail messages on nursing listservs. Findings include that the enrollment process must be automated and instantaneous, the program must work from every type of computer and Internet connection, marketing should be live and electronic, and workshops should be offered to familiarize nurses with the online learning system.