A qualitative analysis of parents' beliefs about portable pool safety behaviours.

The aim of this study was to develop an in-depth understanding of the beliefs parents hold regarding portable pool safety behaviours using the theory of planned behaviour (TPB). Semi-structured interviews were conducted with parents (N = 15) of children aged 5 years and younger who owned a portable pool. Interviews examined three key safety behaviours: supervising within arms' reach, fencing portable pools deeper than 30 cm, and emptying and storing portable pools safely after use. Parents identified a range of advantages, disadvantages, normative influences, and facilitators and barriers towards the three behaviours. The identification of these salient behavioural, normative, and control beliefs enrich limited understandings of portable pool safety behaviours of parents with young children. Current findings fill a knowledge gap in portable pool safety and provide potential targets for messages to improve parents' behaviours for their young children around portable pools in the hope of preventing loss of life.

Telemedicine for urban uninsured: a pilot framework for specialty care planning for sustainability.

A national approach to medical care for the uninsured is for the provision of primary and preventive care through Community Health Centers. Access to specialty care for both Medicaid and uninsured patients is in decline even though specialty care has been shown to be cost-effective and improve outcomes. The consequences could result in further deterioration of the health of the uninsured and underinsured populations and increasing costs born by the insured and safety net providers. Telemedicine can provide specialty services efficiently if planned with a business model to sustain the program. This paper outlines a pilot framework to plan and cost-justify telemedicine specialty care for the uninsured and marginally insured. This potential framework is supported by data from an urban community with the highest concentration of uninsured in the country: Houston, Texas. Further study and evaluation will be needed once the framework and tools are implemented to empirically prove the sustainability of telemedicine specialty care for the urban uninsured.

Building blocks to adopting a pay-for-performance model.

Pay for performance (P4P) is a payment approach used in healthcare that is based on clinical information-driven reform. The fundamental concept of this method is to tie payment to how well providers comply to practice standards. This article will analyze those concepts including the essential building blocks, models, and selected programs of P4Ps, as well as information technology's impact on P4Ps. The nurse manager and nurse executive need to be familiar with this method to participate in the evaluation and implementation of such plans.

Deaf/Hearing Research Partnerships.

Deaf individuals typically are seen through the lens of the dominant hearing society's perception, i.e., that being deaf is an impairment. Today, a small but growing number of Deaf and hearing researchers are challenging this perception. The authors examined perceptions of what components are necessary for a successful Deaf/hearing research partnership, and propose that it is essential for Deaf and hearing researchers to embrace a Deaf epistemology. The authors found that a core category of equity is the key to effective teams. This equity is based in part on the mutual understanding that American Sign Language is the lingua franca of the team, as it provides full and easy access between Deaf and hearing team members. Additionally, a transformative paradigm, as a research frame, was found to be necessary to focus on leveling the playing field for Deaf researchers.

Commercial clinical data warehouses: from wave of the past to the state of the art.

This article provides an overview of clinical data warehousing and its historical perspective from the early 1990s to present. It uses a survey of five Houston-area healthcare leaders to answer questions such as why commercially available solutions may be more suitable as their enterprise information systems vs. developing them in-house. Which products and vendors are servicing these organizations? What are these organizations looking for when making such strategic purchases? In general, this work is intended as a guideline for healthcare entities to further investigate the commercial clinical data warehousing market and get a feel for industry trends.

Cost-effectiveness analysis of telemedicine to evaluate diabetic retinopathy in a prison population.

OBJECTIVE: A cost-effectiveness analysis was conducted to investigate the clinical and economic impact of teleophthalmology in evaluating diabetic retinopathy in prison inmates with type 2 diabetes. RESEARCH DESIGN AND METHODS: Based on a hypothetical teleophthalmology system to evaluate diabetic retinopathy patients with type 2 diabetes in a prison care setting, a Markov decision model was developed with probability and cost data derived primarily from published epidemiological and outcome studies. A 40-year-old African-American man with type 2 diabetes was used as a reference case subject. The number of quality-adjusted life-years (QALYs) gained was used as the clinical outcome, and the cost in U.S. dollars from the year 2003 was used as the economic outcome. Teleophthalmology and nonteleophthalmology strategies were compared using an expected QALYs calculation and two types of sensitivity analyses: probabilistic and traditional n-way sensitivity analyses. RESULTS: The teleophthalmology strategy dominates in the cost-effectiveness analysis for the reference case subject: 16,514/18.73 dollars QALYs for teleophthalmology and 17,590/18.58 dollars QALYs for nonteleophthalmology. Ninety percent of the Monte Carlo simulations showed cost effectiveness (annual cost/QALYs < or = 50,000 dollars) in the teleophthalmology strategy based on an assumed inmate population. Teleophthalmology is the better strategy if the number of diabetic inmates in the prison community is >500. CONCLUSIONS: Our cost-effectiveness analysis demonstrates that teleophthalmology holds great promise to reduce the cost of inmate care and reduce blindness caused by diabetic retinopathy in type 2 diabetic patients.

Teledentistry and its use in dental education.

BACKGROUND: Teledentistry is a relatively new field that combines telecommunication technology and dental care. Most dentists and dental educators are unaware that teledentistry can be used not only for increased access to dental care, but also for advanced dental education. TYPE OF STUDIES REVIEWED: The authors describe teledentistry as it is applied worldwide, as well as its uses in education. Teledentistry in education can be divided into two main categories: self-instruction and interactive videoconferencing. Both of these methods have been used in several studies and countries. RESULTS: The type of network connectivity used greatly affects the feasibility of teledentistry education. Furthermore, no optimal type exists, but health care professionals should choose the mode based on budget, geography and technical support available. Of the two main categories of teledentistry in education, the interactive videoconferencing method has had better results because of its ability to provide immediate feedback. CLINICAL IMPLICATIONS: Teledentistry can extend care to underserved patient populations, such as those in rural areas, at a reasonable cost. Teledentistry provides an opportunity to supplement traditional teaching methods in dental education, and will provide new opportunities for dental students and dentists.

Understanding public health informatics competencies for mid-tier public health practitioners: a web-based survey.

The literature suggests that there is a need for measuring public health informatics (PHI) competency to further understand whether current educational modules and modalities meet the needs of PHI practitioners and researchers to perform their jobs more effectively, particularly for mid-tier practitioners that constitute the majority of public health workers in the USA. The present study seeks to update current knowledge of the perceptions and experiences of PHI competencies proposed by the U.S. Council on Linkage in Public Health specifically for mid-tier PH practitioners and researchers. The results were collected and analyzed by using a Web-based survey (WBS) method administered among both practitioners and researchers. Researchers first compiled a draft list of candidate competency set by incorporating existing competency areas provided by: 1) the Council on Linkage; and by 2) those proposed by the USA's Centers for Disease Control CDC Public Health Informatics Work Group. Nine sets of competency statements with 120 competency items and demographic information of respondents were included in the WBS. The online survey instruments were pilot-tested accordingly to incorporate feedback from respondents of the pilot. Fifty-six subjects were recruited from PH experts who were: 1) members of the Health Informatics Information Technology (HIIT) group of American Public Health Association; and, 2) members from the Community of Science (COS) Website who were the first authors published in the PHI field from PubMed. The sample included diverse backgrounds of PHI workers. They expressed an increased need for training to improve their PHI competencies. Respondents agreed that four competency sets should be adequately represented, including Leadership and System Thinking Skills (82%), followed by Financial Planning and Management Skills (79%), Community Dimensions of Practice Skills (77%), and Policy Development/Program Planning Skills (63%). The findings parallel current literature indicating that there exists an expressed need for clarification of the public health practitioner's job-specific informatics competency. Findings of expressed needs for basic computer literacy training and community-based practice were consistent with those of the literature. Additional training and resources should be allocated to address the competency of leadership, management, community-based practice and policy advocacy skills for mid-tier public health practitioners to perform their jobs more effectively. Only when healthcare organizations properly identify PHI competency needs will public health practitioners likely improve their overall informatics skills while improving diversification for contribution across multiple settings.

Performance factors of mobile rich media job aids for community health workers.

OBJECTIVE: To study and analyze the possible benefits on performance of community health workers using point-of-care clinical guidelines implemented as interactive rich media job aids on small-format mobile platforms. DESIGN: A crossover study with one intervention (rich media job aids) and one control (traditional job aids), two periods, with 50 community health workers, each subject solving a total 15 standardized cases per period per period (30 cases in total per subject). MEASUREMENTS: Error rate per case and task, protocol compliance. RESULTS: A total of 1394 cases were evaluated. Intervention reduces errors by an average of 33.15% (p = 0.001) and increases protocol compliance 30.18% (p < 0.001). Limitations Medical cases were presented on human patient simulators in a laboratory setting, not on real patients. CONCLUSION: These results indicate encouraging prospects for mHealth technologies in general, and the use of rich media clinical guidelines on cell phones in particular, for the improvement of community health worker performance in developing countries.

Determining business models for financial sustainability in regional health information organizations (RHIOs): a review.

Regional health information organizations (RHIOs) have the potential to alleviate today's health care problems by granting providers access to a supported body of clinical information for all patients in a given region. While the promise of and enthusiasm for RHIOs is immense, the issue of their financial sustainability remains unclear. It has been said that the business model supporting a regional or national health information network is as essential, if not more essential, than the technology that makes it feasible. Currently, there is a clear lack of concrete business models implemented in RHIOs' projects. This article reports the results of a literature review of the current status of the adaptation and implementation of business models by RHIOs for successful financial sustainability. Based on the review, this article also attempts to evaluate the existing financial situation of RHIOs to determine and recommend the best models of economic sustainability. Significant findings include RHIOs' present financial environment, planning, and self-sustainability methods. Future studies will be needed as RHIOs continue to grow and move toward the implementation phase of their development.

Determining business models for financial sustainability in regional health information organizations: a literature review.

While the promise and enthusiasm for regional health information organizations (RHIOs) are immense, a significant issue regarding this type of health information exchange, (HIE) remains unclear: financial sustainability. As of today, there is a clear lack of concrete business models implemented in RHIOs' projects. The purpose of this study is to conduct a literature review of the current state of RHIOs adaptation and implementation of business models for successful financial sustainability, as well as evaluate existing RHIOs financial situation to determine and recommend best models for economic uphold. This literature review will be the starting point for thorough analysis and understanding of the economic factors required for RHIOs to generate a return on investment (ROI) and become self-sustainable.

Triangulation analysis of tele-palliative care implementation in a rural community area in Japan.

We conducted a comprehensive evaluation of tele-palliative care by triangulation method. This consisted of qualitative analyses of 2 patients and then performing quantitative analysis of a simulated model for tele-palliative care based on that experience. Semistructured interviews with 2 patients were conducted for qualitative analysis. The recorded conversations were analyzed using traditional categorization and coding techniques, looking for patterns and themes both within and across the interviews. A state-transition process was modeled using a Markov model to compare the costs for three different options for patients requiring palliative care: admission to the palliative care unit, home care only (8 physician visits), and tele-palliative care. The cost data were mainly derived from the reimbursement scale of the Japanese Health Insurance System. Sensitivity analysis was used to assess the influence of particular conditions or costs. The qualitative assessment identified some positive concepts, such as "expectation," "convenience," "reliance," and "communication." In the cost analysis, the reference case yielded the annual costs as follows: (1) costs for admission to the palliative care unit were 1,137,000 dollars; (2) costs for home care were 521,000 dollars; and (3) costs for telepalliative care were 478,000 dollars. One-way sensitivity analyses showed that home care was the most cost-saving strategy if the care was continued for more than 4 months or the number of physician visits during tele-palliative care could be reduced to less than 6 physician visits per month. The important issues in reducing the cost of tele-palliative care were (1) having adequate patient numbers, (2) reducing the number of physicians' visits, and (3) offsetting the costs of telemedicine against cost savings to the system to sustain the program. In addition, the qualitative analysis demonstrated patients positive views of tele-palliative care.

Outcomes and methods in telemedicine evaluation.

One hundred and four articles, published from 1966 to 2000, were reviewed to investigate telemedicine evaluation studies in terms of methods and outcomes. A total of 112 evaluations were reported in these 104 articles. Two types of evaluations were evaluated: clinical and nonclinical. Within the clinical evaluations, three were on clinical effectiveness, 26 on patient satisfaction, 49 on diagnostic accuracy, and nine on cost. In the non-clinical evaluations, 15 articles discussed technical issues relating to digital images, such as bandwidth, resolution, and color, and 10 articles assessed management issues concerning efficiency of care, such as avoiding unnecessary patient transfer, or saving time. Of the 112 evaluations, 72 were descriptive in nature. The main methods used in the remaining 40 articles used quantitative methods. Nineteen articles employed statistical techniques, such as receiver operating characteristics curve (three evaluations) and kappa values (seven evaluations). Only one article utilized a qualitative approach to describe a telemedicine system. Currently, there are a number of good reports on diagnostic accuracy, satisfaction, and technological evaluation. However, clinical effectiveness and cost-effectiveness are important parameters, and they have received limited attention. Since telemedicine evaluations tend to explore various outcomes, it may be appropriate to evaluate from a multidisciplinary perspective, and to utilize various methodologies.