Susan A. Kohler

Patient Activation Is Associated With Healthy Behaviors and Ease in Managing Diabetes in an Indigent Population

Purpose The purpose of this study is to assess the validity of the patient activation construct as measured by the Patient Activation Measure (PAM) survey by correlating PAM scores with diabetes self-management behaviors, attitudes, and knowledge in a predominantly minority and uninsured population. Methods A convenience sample of patients presenting to an urban public hospital diabetes clinic was surveyed and contacted by phone 6 months later. The survey included questions about activation, health behaviors, and health care utilization. Results A total of 287 patients agreed to participate. Most were African American, female, and uninsured. Most respondents (62.2%) scored in the highest category of activation according to the PAM. Activated patients were more likely to perform feet checks, receive eye examinations, and exercise regularly. Activation was consistently associated with less reported difficulty in managing diabetes care but not with A1C knowledge. PAM scores at the initial interview were highly correlated with scores at 6-month follow-up. Activation level did not predict differences in health care utilization during the 6 months following the survey. Conclusions Higher scores on the PAM were associated with higher rates of self-care behaviors and ease in managing diabetes; however, the indigent urban population reported higher activation scores than found in previous studies. The relationship between activation and outcomes needs to be explored further prior to expanding use of this measure in this patient population.

Facilitators and Barriers to 10 National Quality Forum Safe Practices

The objective of this study was to identify facilitators and barriers to the implementation of 10 National Quality Forum (NQF) medication processes and the culture of safety practices in Georgia hospitals. In-depth interviews with hospital administrators were conducted to identify facilitators and barriers to the implementation of programs that support the NQF safe practices. Hospitals identified significant as well as other key factors that resulted in the adoption and/or nonadoption of medication and culture of safety practices. Informants also identified strategies used to overcome barriers that were experienced. Facilitators to both practices include administrative leadership support and education and training. The resistance to change was the most significant barrier identified in both the safe medication process interviews and the culture of safety interviews. Implementing safety practices can be a difficult process, replete with organizational, financial, and professional barriers. Strategies identified by our informants to overcome these barriers may assist other hospitals currently facing this challenge.

Measuring Immunization Registry Costs Promises and Pitfalls

INTRODUCTION The medical and public health communities advocate the use of immunization registries as one tool to achieve national goals for immunization. Despite the considerable investment of resources into registry development, little information is available about the costs of developing or maintaining a registry. METHODS The objective of this study was to measure the direct costs of maintaining one immunization registry. Cost and resource-use data were collected by interviewing registry personnel and staff at participating pediatric practices, collecting available financial records, and direct observation. RESULTS The estimated direct cost for maintaining the registry during the 3 calendar years 1995 through 1997 was

The cost to providers of participating in an immunization registry.

439,232. In 1997, this represented an annual cost of

Implementing a Pharmacy System: Facilitators and Barriers

5.26 per child immunized whose record was entered into the registry. In all years, personnel expenses represented at least three fourths of the total costs, with the majority of administrative effort donated. Yearly costs increased over time largely because of growing administrative personnel requirements as the registry became fully operational. CONCLUSION Considerable resources are required to establish and maintain immunization registries. Because personnel costs, particularly nontechnical personnel, represent a large portion of total registry costs, it is important to accurately account for donated effort. Recommendations for future registry cost studies include prospective data collection and focusing upon the costs of providing specific outreach or surveillance functions rather than overall registry costs. In addition, registry effectiveness evaluations are needed to translate registry costs into cost-effectiveness ratios.

Nurses' Perceptions and Experiences With the Implementation of a Medication Administration System

INTRODUCTION The medical and public health communities advocate immunization registries as one tool to achieve national immunization goals. Although substantial resources have been expended to establish registries across the nation, minimal research has been conducted to evaluate provider participation costs. METHODS The objective of this study was to identify the direct costs to participate in an immunization registry. To estimate labor and equipment costs, we conducted interviews and direct observation at four sites that were participating in one of two immunization registries. We calculated mean data-entry times from direct observation of clinic personnel. RESULTS The annual cost of participating in a registry varied extremely, ranging from

Use of Paper Medical Records Versus Administrative Data for Measuring and Improving Health Care Quality: Are We Still Searching for a Gold Standard?

6083 to

Adopting National Quality Forum medication safe practices: Progress and barriers to hospital implementation

24,246, with the annual cost per patient ranging from

Performance Improvement Interventions to Improve Delivery of Screening Services in Diabetes Care

0.65 to

Physician and Patient Characteristics Associated with Adherence to Preventive Care Guidelines

7. 74. Annual per-patient costs were lowest in the site that used an automated data-entry interface. Of the sites requiring a separate data-entry step, costs were lowest for the site participating in the registry that provided more intensive training and had a higher proportion of the target population entered into the registry. CONCLUSIONS Ease of registry interface, data-entry times, and target population coverage affect provider participation costs. Designing the registry to accept electronic transfers of records and to avoid duplicative data-entry tasks may decrease provider costs.