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1.
Health Informatics J ; 26(3): 2193-2201, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31969050

RESUMO

Postoperative complications place a major burden on the healthcare systems. The type of hospital's ownership could be one factor associated with this adverse outcome. Using CMS's publicly available "Complications and Deaths-Hospitals" and "Hospital General Information" datasets, we analyzed the association between four postoperative complications (venous thromboembolism, joint replacement complications, wound dehiscence, postoperative sepsis) and hospital ownership. These data were collected by Medicare between April 2013 and March 2016. We found a significant association (p = 0.029) between ownership types and the postoperative complication score. A 6-percent drop in the share of not-for-profit ownership, accompanied by a 3-percent increase in each of the government and for-profit ownership, resulted in a 20-percent drop in postoperative complication scores (from 5.75 to 4.6). There is an association between hospital ownership type and postoperative complications. Creating this awareness in leadership should prompt for redesigning of hospitals' operations and workflows to become more compatible with safe and effective care delivery.

2.
JAMA Netw Open ; 2(8): e199609, 2019 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-31418810

RESUMO

Importance: Many believe a major cause of the epidemic of clinician burnout is poorly designed electronic health records (EHRs). Objectives: To determine which EHR design and use factors are associated with clinician stress and burnout and to identify other sources that contribute to this problem. Design, Setting, and Participants: This survey study of 282 ambulatory primary care and subspecialty clinicians from 3 institutions measured stress and burnout, opinions on EHR design and use factors, and helpful coping strategies. Linear and logistic regressions were used to estimate associations of work conditions with stress on a continuous scale and burnout as a binary outcome from an ordered categorical scale. The survey was conducted between August 2016 and July 2017, with data analyzed from January 2019 to May 2019. Main Outcomes and Measures: Clinician stress and burnout as measured with validated questions, the EHR design and use factors identified by clinicians as most associated with stress and burnout, and measures of clinician working conditions. Results: Of 640 clinicians, 282 (44.1%) responded. Of these, 241 (85.5%) were physicians, 160 (56.7%) were women, and 193 (68.4%) worked in primary care. The most prevalent concerns about EHR design and use were excessive data entry requirements (245 [86.9%]), long cut-and-pasted notes (212 [75.2%]), inaccessibility of information from multiple institutions (206 [73.1%]), notes geared toward billing (206 [73.1%]), interference with work-life balance (178 [63.1%]), and problems with posture (144 [51.1%]) and pain (134 [47.5%]) attributed to the use of EHRs. Overall, EHR design and use factors accounted for 12.5% of variance in measures of stress and 6.8% of variance in measures of burnout. Work conditions, including EHR use and design factors, accounted for 58.1% of variance in stress; key work conditions were office atmospheres (ß̂ = 1.26; P < .001), control of workload (for optimal control: ß̂ = -7.86; P < .001), and physical symptoms attributed to EHR use (ß̂ = 1.29; P < .001). Work conditions accounted for 36.2% of variance in burnout, where challenges included chaos (adjusted odds ratio, 1.39; 95% CI, 1.10-1.75; P = .006) and physical symptoms perceived to be from EHR use (adjusted odds ratio, 2.01; 95% CI, 1.48-2.74; P < .001). Coping strategies were associated with only 2.4% of the variability in stress and 1.7% of the variability in burnout. Conclusions and Relevance: Although EHR design and use factors are associated with clinician stress and burnout, other challenges, such as chaotic clinic atmospheres and workload control, explain considerably more of the variance in these adverse clinician outcomes.


Assuntos
Esgotamento Profissional/etiologia , Registros Eletrônicos de Saúde/organização & administração , Profissionais de Enfermagem/psicologia , Assistentes Médicos/psicologia , Médicos de Atenção Primária/psicologia , Atenção Primária à Saúde/organização & administração , Adaptação Psicológica , Adulto , Assistência Ambulatorial/organização & administração , Esgotamento Profissional/diagnóstico , Esgotamento Profissional/psicologia , Estudos Transversais , Feminino , Grupos Focais , Inquéritos Epidemiológicos , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Profissionais de Enfermagem/organização & administração , Assistentes Médicos/organização & administração , Médicos de Atenção Primária/organização & administração , Fatores de Risco , Carga de Trabalho
4.
J Am Med Inform Assoc ; 26(2): 106-114, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30517663

RESUMO

Objective: To quantify how stress related to use of health information technology (HIT) predicts burnout among physicians. Methods: All 4197 practicing physicians in Rhode Island were surveyed in 2017 on their HIT use. Our main outcome was self-reported burnout. The presence of HIT-related stress was defined by report of at least 1 of the following: poor/marginal time for documentation, moderately high/excessive time spent on the electronic health record (EHR) at home, and agreement that using an EHR adds to daily frustration. We used logistic regression to assess the association between each HIT-related stress measure and burnout, adjusting for respondent demographics, practice characteristics, and the other stress measures. Results: Of the 1792 physician respondents (43% response rate), 26% reported burnout. Among EHR users (91%), 70% reported HIT-related stress, with the highest prevalence in primary care-oriented specialties. After adjustment, physicians reporting poor/marginal time for documentation had 2.8 times the odds of burnout (95% CI: 2.0-4.1; P < .0001), compared to those reporting sufficient time. Physicians reporting moderately high/excessive time on EHRs at home had 1.9 times the odds of burnout (95% CI: 1.4-2.8; P < .0001), compared to those with minimal/no EHR use at home. Those who agreed that EHRs add to their daily frustration had 2.4 times the odds of burnout (95% CI: 1.6-3.7; P < .0001), compared to those who disagreed. Conclusion: HIT-related stress is measurable, common (about 70% among respondents), specialty-related, and independently predictive of burnout symptoms. Identifying HIT-specific factors associated with burnout may guide healthcare organizations seeking to measure and remediate burnout among their physicians and staff.


Assuntos
Esgotamento Profissional/etiologia , Registros Eletrônicos de Saúde , Informática Médica , Médicos/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Satisfação no Emprego , Masculino , Medicina , Pessoa de Meia-Idade , Estresse Ocupacional , Rhode Island , Inquéritos e Questionários , Carga de Trabalho
5.
JAMIA Open ; 1(1): 49-56, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31093606

RESUMO

Objectives: Determine the specific aspects of health information and communications technologies (HICT), including electronic health records (EHRs), most associated with physician burnout, and identify effective coping strategies. Materials and methods: We performed a qualitative analysis of transcripts from 2 focus groups and a burnout assessment of ambulatory physicians-each at 3 different health care institutions with 3 different EHRs. Results: Of the 41 clinicians, 71% were women, 98% were physicians, and 73% worked in primary care for an average of 11 years. Only 22% indicated sufficient time for documentation. Fifty-six percent noted "a great deal of stress" because of their job. Forty-two percent reported "poor" or "marginal" control over workload. Even though 90% reported EHR proficiency, 56% indicated EHR time at home was "excessive" or "moderately high." Focus group themes included HICT "successes" where all patients' information is accessible from multiple locations. HICT "stressors" included inefficient user interfaces, unpredictable system response times, poor interoperability between systems and excessive data entry. "Adverse outcomes" included ergonomic problems (eg, eye strain and hand, wrist, and back pain) and decreased attractiveness of primary care. Suggested "organizational changes" included EHR training, improved HICT usability, and scribes. "Personal/resilience" strategies focused on self-care (eg, exercise, maintaining work-life boundaries, and positive thinking). Discussion and conclusion: HICT use, while beneficial in many ways for patients and providers, has also increased the burden of ambulatory practice with personal and professional consequences. HICT and clinic architectural and process redesign are likely necessary to make significant overall improvements.

6.
J Med Libr Assoc ; 103(1): 19-21, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25552940

RESUMO

OBJECTIVE: The research tested the accuracy of the VIVO Harvester software in identifying publications authored by faculty members affiliated with a National Institutes of Health Clinical and Translational Sciences Award (CTSA) site. METHODS: Health sciences librarians created "gold standard" lists of references for the years 2001 to 2011 from PubMed for twenty-five randomly selected investigators from one CTSA site. These gold standard lists were compared to the same twenty-five investigators' reference lists produced by VIVO Harvester. The authors subjected the discrepancies between the lists to sensitivity and specificity analyses. RESULTS: The VIVO Harvester correctly identified only about 65% of the total eligible PubMed references for the years 2001-2011 for the CTSA-affiliated investigators. The identified references produced by VIVO Harvester were precise yet incomplete. The sensitivity rate was 0.65, and the specificity rate was 1.00. CONCLUSION: While the references produced by VIVO Harvester could be confirmed in PubMed, the VIVO Harvester retrieved only two-thirds of the required references from PubMed. National Institutes of Health CTSA sites will need to supplement VIVO Harvester-produced references with the expert searching skills of health sciences librarians. IMPLICATIONS: Health sciences librarians with searching skills need to alert their CTSA sites about these deficiencies and offer their skills to advance their sites' missions.


Assuntos
Distinções e Prêmios , Armazenamento e Recuperação da Informação/estatística & dados numéricos , Bibliotecas Médicas/organização & administração , MEDLINE/estatística & dados numéricos , Publicações Periódicas como Assunto/estatística & dados numéricos , Pesquisa Médica Translacional/estatística & dados numéricos , Pesquisa Biomédica , Humanos , Disseminação de Informação
8.
Med Ref Serv Q ; 32(4): 412-23, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24180649

RESUMO

Many health sciences librarians as well as other professionals attend conferences on a regular basis. This study sought to link an innovative peer review process of presented research papers to long-term conference outcomes in the peer-reviewed professional journal literature. An evidence-based conference included a proof-of-concept study to gauge the long-term outcomes from research papers presented during the program. Real-time peer review recommendations from the conference were linked to final versions of articles published in the peer-reviewed literature. The real-time peer review feedback served as the basis for further mentoring to guide prospective authors toward publishing their research results. These efforts resulted in the publication of two of the four research papers in the peer-viewed literature. A third presented paper appeared in a blog because the authors wanted to disseminate their findings more quickly than through the journal literature. The presenters of the fourth paper never published their study. Real-time peer review from this study can be adapted to other professional conferences that include presented research papers.


Assuntos
Prática Clínica Baseada em Evidências , Biblioteconomia , Revisão da Pesquisa por Pares , Autoria , Congressos como Assunto , Retroalimentação , Humanos , Disseminação de Informação , Mentores , Editoração/estatística & dados numéricos
9.
AMIA Annu Symp Proc ; 2013: 269-77, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24551336

RESUMO

Patient registries remove barriers to performing research by assembling patient cohorts and data in a systematic, efficient, and proactive manner. Consequently, registries are a valuable strategy for facilitating research and scientific discovery. Registries for rare diseases are arguably even more valuable since there is difficulty in assembling cohorts of adequate size for study. Recently, the NIH Office of Rare Diseases Research created a rare disease registry Standard to facilitate research across multiple registries. We implemented the Standard for the Oculopharyngeal Muscular Dystrophy patient registry created at the University of New Mexico Health Sciences Center. We performed a data element analysis for each Common Data Element defined in the Standard. Problems included the use of previous HL7 versions, non-structured data types, and a recent update to the Standard. Overall, the Standard is an excellent first step toward standardizing patient registries to facilitate work on broader questions and promote novel interdisciplinary collaborations.


Assuntos
Distrofia Muscular Oculofaríngea , Doenças Raras , Sistema de Registros/normas , Pesquisa Biomédica/estatística & dados numéricos , Nível Sete de Saúde , Humanos , Disseminação de Informação/métodos , National Institutes of Health (U.S.) , New Mexico , Estados Unidos , Vocabulário Controlado
10.
J Biomed Inform ; 45(4): 674-82, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22036696

RESUMO

Despite the existence of multiple standards for the coding of biomedical data and the known benefits of doing so, there remain a myriad of biomedical information domain spaces that are essentially un-coded and unstandardized. Perhaps a worse situation is when the same or similar information in a given domain is coded to a variety of different standards. Such is the case with cephalometrics - standardized measurements of angles and distances between specified landmarks on X-ray film used for orthodontic treatment planning and a variety of research applications. We describe how we unified the existing cephalometric definitions from 10 existing cephalometric standards to one unifying terminology set using an existing standard (LOINC). Using our example of an open and web-based orthodontic case file system, we describe how this work benefited our project and discuss how adopting or expanding established standards can benefit other similar projects in specialized domains.


Assuntos
Cefalometria , Logical Observation Identifiers Names and Codes , Terminologia como Assunto , Pontos de Referência Anatômicos , Humanos , Armazenamento e Recuperação da Informação , Crânio/anatomia & histologia , Integração de Sistemas
11.
PLoS One ; 6(8): e23986, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21897865

RESUMO

Health and socioeconomic disparities tend to be experienced along racial and ethnic lines, but investigators are not sure how individuals are assigned to groups, or how consistent this process is. To address these issues, 1,919 orthodontic patient records were examined by at least two observers who estimated each individual's race and the characteristics that influenced each estimate. Agreement regarding race is high for African and European Americans, but not as high for Asian, Hispanic, and Native Americans. The indicator observers most often agreed upon as important in estimating group membership is name, especially for Asian and Hispanic Americans. The observers, who were almost all European American, most often agreed that skin color is an important indicator of race only when they also agreed the subject was European American. This suggests that in a diverse community, light skin color is associated with a particular group, while a range of darker shades can be associated with members of any other group. This research supports comparable studies showing that race estimations in medical records are likely reliable for African and European Americans, but are less so for other groups. Further, these results show that skin color is not consistently the primary indicator of an individual's race, but that other characteristics such as facial features add significant information.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Análise de Variância , Feminino , Humanos , Funções Verossimilhança , Masculino , Variações Dependentes do Observador , Razão de Chances
13.
BMC Psychiatry ; 10: 3, 2010 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-20064210

RESUMO

BACKGROUND: A growing body of literature shows that patients accept the use of computers in clinical care. Nonetheless, studies have shown that computers unequivocally change both verbal and non-verbal communication style and increase patients' concerns about the privacy of their records. We found no studies which evaluated the use of Electronic Health Records (EHRs) specifically on psychiatric patient satisfaction, nor any that took place exclusively in a psychiatric treatment setting. Due to the special reliance on communication for psychiatric diagnosis and evaluation, and the emphasis on confidentiality of psychiatric records, the results of previous studies may not apply equally to psychiatric patients. METHOD: We examined the association between EHR use and changes to the patient-psychiatrist relationship. A patient satisfaction survey was administered to psychiatric patient volunteers prior to and following implementation of an EHR. All subjects were adult outpatients with chronic mental illness. RESULTS: Survey responses were grouped into categories of "Overall," "Technical," "Interpersonal," "Communication & Education,," "Time," "Confidentiality," "Anxiety," and "Computer Use." Multiple, unpaired, two-tailed t-tests comparing pre- and post-implementation groups showed no significant differences (at the 0.05 level) to any questionnaire category for all subjects combined or when subjects were stratified by primary diagnosis category. CONCLUSIONS: While many barriers to the adoption of electronic health records do exist, concerns about disruption to the patient-psychiatrist relationship need not be a prominent focus. Attention to communication style, interpersonal manner, and computer proficiency may help maintain the quality of the patient-psychiatrist relationship following EHR implementation.


Assuntos
Assistência Ambulatorial/psicologia , Atitude Frente a Saúde , Registros Eletrônicos de Saúde/estatística & dados numéricos , Transtornos Mentais/psicologia , Satisfação do Paciente , Relações Médico-Paciente , Adulto , Atitude Frente aos Computadores , Comunicação , Segurança Computacional , Confidencialidade , Feminino , Humanos , Internet , Masculino , Sistemas Computadorizados de Registros Médicos , Pessoa de Meia-Idade , Pacientes Ambulatoriais/psicologia , Inquéritos e Questionários
14.
Ann Fam Med ; 7(3): 245-8, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19433842

RESUMO

PURPOSE: The advent of Web-based survey tools has provided the investigator with an alternative to paper-based survey methods that in many instances may be less expensive to implement than traditional paper-based surveys. Newer technology, however, does not diminish the importance of obtaining an adequate response rate. METHODS: We analyzed response rate data obtained from a survey implemented across 3 practice-based research networks (PBRNs) in which the survey was first implemented electronically with 5 rounds of electronic solicitation for an Internet-based questionnaire and then by 2 rounds of a paper-based version mailed only to nonresponders. RESULTS: Overall, 24% of the total survey responses received were in the paper mode despite intense promotion of the survey in the electronic phase. CONCLUSIONS: Our results suggest there is still an important role for the use of paper-based methods in PBRN survey research. Both hard copy and electronic survey collection methods may be required to enhance clinician response rates in PBRNs.


Assuntos
Coleta de Dados/métodos , Inquéritos Epidemiológicos , Internet/estatística & dados numéricos , Serviços Postais/estatística & dados numéricos , Atitude do Pessoal de Saúde , Hepatite C/diagnóstico , Hepatite C/psicologia , Hepatite C/terapia , Humanos , Internet/economia , Serviços Postais/economia , Atenção Primária à Saúde , Inquéritos e Questionários , Estados Unidos
15.
Med Ref Serv Q ; 28(3): 221-34, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20183018

RESUMO

This program evaluation reports on the curricular development and integration of library, biomedical informatics, and scholarly communications (LBS) skills into a required informatics course for a new graduate degree program in the University of New Mexico's Clinical and Translational Sciences Center (CTSC). The course built on the opportunity presented by the new degree program to integrate LBS competencies rarely included in most traditional clinical research training programs. This report tracks the experiences and evaluations of two cohorts of graduate students who have completed the course. This article presents lessons learned on curricular integration and offers thoughts for future work.


Assuntos
Currículo , Armazenamento e Recuperação da Informação , Bibliotecas Médicas , Informática Médica/educação , Avaliação de Programas e Projetos de Saúde , New Mexico , Estudos de Casos Organizacionais , Desenvolvimento de Programas
16.
J Dent Educ ; 72(9): 989-97, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18768441

RESUMO

The science of cephalometry has been invaluable for guiding orthodontic diagnosis, treatment planning, and outcomes tracking. Though software packages easily calculate most cephalometric measurements, the ability to exchange cephalometric data between software packages is poorly developed. Hindering this effort is the lack of an agreed-upon standard for electronic exchange of cephalometric measurements. Unlike more technological issues, the problem of creating such a standard is one of formalizing decisions already established through historical precedent. Solving this problem will require education, cooperation, and consensus in order to reap the potential improvements to patient care, dental education, and research. The first step in overcoming these remaining issues is awareness. This article reviews those factors that place cephalometric measurements in an excellent position for standardization, outlines those decisions that must be made in order to realize the goal of electronic exchange of cephalometric information, and describes some of the options for these decisions as well as some advantages and disadvantages of each.


Assuntos
Cefalometria/normas , Informática Odontológica/normas , Pesquisa em Odontologia/normas , Ortodontia/normas , Terminologia como Assunto , Redes de Comunicação de Computadores/normas , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Interpretação de Imagem Assistida por Computador/normas , Disseminação de Informação , Desenvolvimento Maxilofacial , Radiografia Dentária/métodos , Radiografia Dentária/normas , Vocabulário Controlado
18.
AMIA Annu Symp Proc ; : 444-8, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-17238380

RESUMO

OBJECTIVE: To assess the effect of a computerized decision support system (CDSS) on the accuracy of patient temperature recording at the bed side. DESIGN: This is a randomized, controlled trial comparing nurses assigned to an intervention group that received CDSS whenever they attempted to store a low temperature (

Assuntos
Temperatura Corporal , Sistemas de Apoio a Decisões Clínicas , Monitorização Fisiológica/instrumentação , Sistemas Automatizados de Assistência Junto ao Leito , Sistemas de Alerta , Humanos , Recursos Humanos de Enfermagem no Hospital
19.
AMIA Annu Symp Proc ; : 1011, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16779298

RESUMO

The value of human biospecimens available for research dramatically increases when linked with their accumulated clinical and molecular (genomic, proteomic, subcellular modeling) data. Further, informatics tools make it possible for researchers (both intra- and inter-institutionally) to locate tissue needed for research faster and more reliably. We are developing a virtual human biospecimen repository to both inventory and link all human biospecimens with clinical and genomics data to optimize their value for research, while satisfying all privacy and human subjects protections regulations.


Assuntos
Bancos de Espécimes Biológicos/organização & administração , Bases de Dados como Assunto , Humanos , Aplicações da Informática Médica
20.
AMIA Annu Symp Proc ; : 1122, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16779409

RESUMO

The impending implementation of an electronic medical record (EMR) within Behavioral Health facilities at the University of New Mexico (UNM) offers a unique opportunity to study the effects of EMR usage on a psychiatric patient population. A pre-test and post-test design using a satisfaction survey will test for changes to the patient-psychiatrist relationship before and after implementation. To date, 48 subjects have participated in the pre-implementation portion of the study.


Assuntos
Sistemas Computadorizados de Registros Médicos , Relações Médico-Paciente , Psiquiatria , Atitude Frente aos Computadores , Humanos , Satisfação do Paciente
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