AUPHA and Globalization: A Perspective on the Future.

The Association of University Programs in Health Administration (AUPHA) celebrated its 70th year in 2018 with a publication of a book on its history (Looking Back to Look Forward: AUPHA at 70) (1). As part of that reflection, we engaged in a fundamental reconsideration of our current and future leadership role in supporting healthcare management education. The consideration gets to the core of why any association exists and how does an association best serve the needs of its constituencies. The purpose is to determine what lessons AUPHA's evolution has for healthcare management education associations globally. This perspective will address three questions: 1) What is AUPHA and what is its role in the US healthcare system? 2) What is the value proposition for AUPHA? 3) What lessons learned does AUPHA have to share about the contribution of an association to global health management education?

Improving ambulatory prescribing safety with a handheld decision support system: a randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of a personal digital assistant (PDA)-based clinical decision support system (CDSS) on nonsteroidal anti-inflammatory drug (NSAID) prescribing safety in the outpatient setting. DESIGN: The design was a randomized, controlled trial conducted in a university-based resident clinic. Internal medicine residents received a PDA-based CDSS suite. For intervention residents, the CDSS included a prediction rule for NSAID-related gastrointestinal risk assessment and treatment recommendations. Unannounced standardized patients (SPs) trained to portray musculoskeletal symptoms presented to study physicians. Safety outcomes were assessed from the prescriptions given to the SPs. Each prescription was reviewed by a committee of clinicians blinded to participant, intervention group assignment, and baseline or follow-up status. MEASUREMENTS: Prescriptions were judged as safe or unsafe. The main outcome measure was the differential change in unsafe prescribing of NSAIDs for the intervention versus the control group. RESULTS: At baseline, the mean proportion of cases per physician with unsafe prescriptions for the two groups was similar (0.27 vs. 0.29, p > 0.05). Controlling for baseline performance, intervention participants prescribed more safely than controls after receiving the CDSS (0.23 vs. 0.45 [F = 4.24, p < 0.05]). With the CDSS, intervention participants documented more complete assessment of patient gastrointestinal risk from NSAIDs. CONCLUSION: PARTICIPANTS provided with a PDA-based CDSS for NSAID prescribing made fewer unsafe treatment decisions than participants without the CDSS.

Problems and associated feelings experienced by family caregivers of stroke survivors the second and third month postdischarge.

This study identified problems and associated feelings experienced by family caregivers of stroke survivors during the second and third month after discharge from a rehabilitation facility to home. Safety was the most frequent problem identified by family caregivers. Other problems were managing activities of daily living (ADLs) and cognitive, behavioral, and emotional changes by stroke survivors. About half of caregivers expressed more positive feelings toward managing these problems by week 8 and the majority expressed these feelings by week 12.

Caregiving problems and feelings experienced by family caregivers of stroke survivors the first month after discharge.

The purpose of this study was to identify the major problems and associated feelings experienced by family caregivers of stroke survivors during the first month after returning home. Safety, difficulty in managing activities of daily living, and cognitive, behavioral and emotional changes of stroke survivors (for example, mood swings, lack of motivation, forgetfulness and memory loss, depression and calling the caregiver often) were the three most common problems experienced by caregivers during the first month. Other problems were loss of caregiver independence, confinement, tiredness and inadequate time to do caregiving tasks as well as managing stroke survivor physical symptoms, for example, pain, not eating and skin problems. The first month of caregiving is very dynamic and distressful for caregivers of stroke survivors and telephone contacts appear to be beneficial in assisting caregivers to cope with the caregiving process.

Physician opinions of the importance, accessibility, and quality of health information and their use of the information.

This study compared physicians' perceptions of the importance, accessibility, and quality of different types of patient information that could potentially be available with Health Information Exchange (HIE) with how they use patient information. The results showed that while the physicians rated the majority of 11 data types as very important, accessible, and of high quality, they regularly used only a few data types before having access to a new HIE system. The three major types of information regularly used by the physicians were diagnoses, current medication lists, and allergy information. This study provides new data about how opinions on the importance of information relate to reported information use. Our findings suggest that having important, accessible, and high quality information does not necessarily lead to routine use, but that much of the early value of HIE may lie in improving access to a few data areas.

Social support, social problem-solving abilities, and adjustment of family caregivers of stroke survivors.

OBJECTIVE: To determine contributions of social support and social problem-solving abilities in prediction of adjustment of family caregivers of stroke survivors. DESIGN: Descriptive. SETTING: Two rehabilitation facilities (1 private, 1 state) in the southeastern United States. PARTICIPANTS: Fifty-two family caregivers (46 women, 6 men) of stroke survivors (28 women, 24 men). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Predictor variables were social support and social problem-solving abilities. Outcome measures of caregiver adjustment were depressive symptomatology, well-being, and general health. Participants completed these measures 1 to 2 days before discharge from inpatient rehabilitation and at 5, 9, and 13 weeks postdischarge in the home. RESULTS: Trajectory analysis indicated higher levels of social support were associated with lower levels of caregiver depressive symptomatology and higher levels of well-being and general health, independent of social problem solving. A greater negative problem orientation was associated with higher levels of depressive symptomatology and lower levels of well-being. A more positive problem orientation was associated with greater increases in general health. The strength or slope of this positive relation lessened over time. CONCLUSIONS: Social support and the emotion-focused component of social problem solving, problem orientation, independently contribute to caregiver adjustment. Interventions that provide social support and assist caregivers to develop more adaptive abilities toward problem solving may be beneficial.