Evaluation of Knowledge, Attitude, Practise and Adoption Among Health Care Professionals for Informatics/Computerised Technology Systems.

This proposed study will be conducted in Telangana and Tamil Nadu states in India. Mapping of Health care Professionals by a web-based Delphi technique followed by Focus Group Discussion and Evaluation of Knowledge, Attitude, Practise and Adoption among Health Care Professionals for informatics/computerised technology systems by using structured questionnaire for knowledge and practice and for Attitudes toward Computers in Healthcare (P.A.T.C.H.) Scale will be used to collect the data. This study results will create evidence on present and relevant informatics/computerized technology systems needs and help the research team to develop informatics competencies list and design an online or offline skill up gradation programs for health professionals in India according to their diverse roles in the health care system. The researcher team believes these results will have National relevance to the current focus areas of Government of India and to strengthen the Health Informatics Program offered in IIPH, Hyderabad.

Mobile Usability Testing in Healthcare: Methodological Approaches.

The use of mobile devices and healthcare applications is increasing exponentially worldwide. This has lead to the need for the healthcare industry to develop a better understanding of the impact of the usability of mobile software and hardware upon consumer and health professional adoption and use of these technologies. There are many methodological approaches that can be employed in conducting usability evaluation of mobile technologies. More obtrusive approaches to collecting study data may lead to changes in study participant behaviour, leading to study results that are less consistent with how the technologies will be used in the real-world. Alternatively, less obstrusive methods used in evaluating the usability of mobile software and hardware in-situ and laboratory settings can lead to less detailed information being collected about how an individual interacts with both the software and hardware. In this paper we review and discuss several innovative mobile usability evaluation methods on a contiuum from least to most obtrusive and their effects on the quality of the usability data collected. The strengths and limitations of methods are also discussed.

Measuring Population Health Using Electronic Health Records: Exploring Biases and Representativeness in a Community Health Information Exchange.

Assessment is a core function of public health. Comprehensive clinical data may enhance community health assessment by providing up-to-date, representative data for use in public health programs and policies, especially when combined with community-level data relevant to social determinants. In this study we examine routinely collected and geospatially-enhanced EHR data to assess population health at various levels of geographic granularity available from a regional health information exchange. We present preliminary findings and discuss important biases in EHR data. Future work is needed to develop methods for correcting for those biases to support routine epidemiology work of public health.

Effect of the USPSTF Grade D Recommendation against Screening for Prostate Cancer on Incident Prostate Cancer Diagnoses in the United States.

PURPOSE: In October 2011 the USPSTF (U.S. Preventive Services Task Force) issued a draft guideline discouraging prostate specific antigen based screening for prostate cancer (grade D recommendation). We evaluated the effect of the USPSTF guideline on the number and distribution of new prostate cancer diagnoses in the United States. MATERIALS AND METHODS: We identified incident cancers diagnosed between January 2010 and December 2012 in NCDB (National Cancer Database). We performed an interrupted time series to evaluate the trend of new prostate cancers diagnosed each month before and after the draft guideline with colon cancer as a comparator. RESULTS: Incident monthly prostate cancer diagnoses decreased by -1,363 cases (12.2%, p<0.01) in the month after the USPSTF draft guideline and continued to decrease by 164 cases per month relative to baseline (-1.8%, p<0.01). In contrast monthly colon cancer diagnoses remained stable. Diagnoses of low, intermediate and high risk prostate cancers decreased significantly but new diagnoses of nonlocalized disease did not change. Subgroups of age, comorbidity, race, income and insurance showed comparable decreases in incident prostate cancer following the draft guideline. CONCLUSIONS: There was a 28% decrease in incident diagnoses of prostate cancer in the year after the USPSTF draft recommendation against prostate specific antigen screening. This study helps quantify the potential benefits (reduced harms of over diagnosis and overtreatment of low risk disease and disease found in elderly men) and potential harms (missed opportunities to diagnose important cancers in men who may benefit from treatment) of this guideline.

Participatory design for drug-drug interaction alerts.

The utilization of decision support systems, in the point of care, to alert drug-drug interactions has been shown to improve quality of care. Still, the use of these systems has not been as expected, it is believed, because of the difficulties in their knowledge databases; errors in the generation of the alerts and the lack of a suitable design. This study expands on the development of alerts using participatory design techniques based on user centered design process. This work was undertaken in three stages (inquiry, participatory design and usability testing) it showed that the use of these techniques improves satisfaction, effectiveness and efficiency in an alert system for drug-drug interactions, a fact that was evident in specific situations such as the decrease of errors to meet the specified task, the time, the workload optimization and users overall satisfaction in the system.

Using the NASA Task Load Index to Assess Workload in Electronic Medical Records.

Electronic medical records (EMRs) has been expected to decrease health professional workload. The NASA Task Load Index has become an important tool for assessing workload in many domains. However, its application in assessing the impact of an EMR on nurse's workload has remained to be explored. In this paper we report the results of a study of workload and we explore the utility of applying the NASA Task Load Index to assess impact of an EMR at the end of its lifecycle on nurses' workload. It was found that mental and temporal demands were the most responsible for the workload. Further work along these lines is recommended.

The value of all-payer claims databases to states.

All-payer claims databases are being developed in states across the nation to fill gaps in information about the health care system. The value of such databases is becoming more apparent as these databases mature and are used more frequently to help states better understand their health care utilization and costs.

Department redesign frees up CMs to coordinate care.

At Riverside Medical Center in Kankakee, IL, a dedicated team of nurses handles utilization review, freeing up case managers to work with patients and physicians. Case managers are assigned to physicians and work closely with them to manage the care of patients who have complex treatment or discharge needs. Post-acute care coordinators handle referrals to post-acute providers and set up services such as durable medical equipment. The pending discharge list alerts the entire healthcare team when patients are likely to leave the next day.

Causes of unplanned hospital admissions: implications for practice and policy.

Unplanned hospitalizations among home health patients were reviewed to identify preventable hospital admissions and their causes. Study methods included treatment record review; interviews with home health visit staff, supervisors, and managers; and review of orientation materials and policies. Findings from this study suggest focus areas for home health agencies and other stakeholders to reduce acute care hospitalization rates and in other quality improvement initiatives.

Care management redesign: increasing care manager time with patients and providers while improving metrics.

In many hospitals, addressing increasing financial and regulatory requirements has resulted in a decline in care managers' time spent communicating directly with patients, families, and healthcare providers. The authors discuss the redesign of a hospital care management model that increased the time care managers spend with patients, families, and other care professionals, while patient satisfaction increased, labor cost remained neutral, length of stay decreased, and the payment denial rate remained among the country's lowest.

The collaborative method: an effective performance improvement tool for reducing inappropriate admissions.

TMF Health Quality Institute (TMF) is the Medicare quality improvement organization for Texas. Under its contract with the Centers for Medicare and Medicaid Services, an agency of the U.S. Department of Health and Human Services, TMF undertook an initiative to reduce unnecessary Medicare 1-day hospital admissions in Texas. The initiative used the Institute for Healthcare Improvement's collaborative model design for improvement. Hospitals in the collaborative focused on the admission process in combination with education of physicians, utilization managers, and case managers, resulting in a 19% decrease in 1-day stays among participant hospitals and demonstrating that the collaborative model can be used successfully to improve utilization management.

Comparing diagnosis-related group systems to identify design improvements.

The objective of this research was to compare the casemix systems used in the United Kingdom (UK), Australia and the United States of America (USA) to identify possible improvements in the design of the UK Healthcare Resource Groups. The data consisted of over 12 million inpatient and day case discharge records from 574 National Health Service acute hospitals in England for 2001-2002. These data were grouped into four casemix systems, namely Versions 3.1 and 3.5 of Healthcare Resource Groups, the United States-based All Patient Diagnosis Related Groups, and the Australian Refined Diagnosis Related Groups. The statistical performance of the groups was measured using the reduction in variance (RIV) statistic. The Australian Refined Diagnosis Related Groups produced the best RIV overall but this grouper had the advantage of more groups than the others. The comparison of the performance of the chapters within each grouper showed that each had some chapters with a better RIV than the other groupers. Comparing the performance of these groupers was successful in identifying changes to the Healthcare Resource Groups that improved its performance. Further revision of the Healthcare Resource Groups should be focused on the chapters with the best potential for improved performance.