Determinants of frequency and longevity of hospital encounters' data use

<p>Abstract</p> <p>Background</p> <p>The identification of clinically relevant information enables improvement in user interfaces and in data management. However, it is difficult to identify what information is important in daily clinical care, and what is used occasionally. This study aims to determine for how long clinical documents are used in a Hospital Information System (HIS).</p> <p>Methods</p> <p>The access logs of 3 years of usage of a HIS were analysed concerning report departmental source, type of hospital encounter, and inpatient encounter ICD-9-CM main diagnosis. Reports median life indicates the median time elapsed between information creation and its usage. The models that better explains report views over time were explored.</p> <p>Results</p> <p>The number of report views in the study period was 656 583. Fifty two percent of the reports viewed by medical doctors in emergency encounters were from previous encounters - 21% at outpatient attendance, 19% in inpatient (wards) and 12% during emergency encounters. In an inpatient setting, 20% of the reports viewed were produced in previous encounters. The median life of information in documents is 1.5 days for emergency, 4.8 days for inpatient and 37.8 days for outpatient encounters. Immune-haemotherapy reports reach their median lives faster (7 days) than clinical pathology (15 days), gastroenterology (80 days) and pathology (118 days). The median life of reports produced in inpatient encounters varied from 36 days for neoplasms as the main diagnosis to 0.7 days for injury and poisoning. The model with the best fit (R²> 0.9) was the exponential.</p> <p>Conclusions</p> <p>The usage of past patient information varied significantly according to patient age, type of information, type of hospital encounter and medical cause (main diagnosis) for the encounter. The exponential model is a good fit to model how the reports are seen over time, so the design of user interfaces and repository management algorithms should take it in consideration.</p

The Health Disparities Myth

Many experts today insist that bias in the doctor's office will lead to poorer treatment of minority patients. A new monograph by Jonathan Klick of Florida State University and AEI's Sally Satel, The Health Disparities Myth: Diagnosing the Treatment Gap (AEI Press, 2006) found no evidence to support the idea that racially biased doctors are a cause of poor minority health

Differences in Health Literacy and Healthcare Utilization for Uninsured Patients With Type II Diabetes

Un- and under-insured individuals have lower access and less health literacy than their insured counterparts. This is a major public health problem as lower health literacy leads to unhealthy communities which have higher chronic disease rates. This quantitative dissertation uses data from a public health hospital system to understand the relationship between health literacy and healthcare utilization. The Andersen Model has been applied to determine whether, or to what extent, health literacy explains the relationship between the identified predisposing and enabling factors and the outcomes of appropriate utilization of care by controlling for variables associated with health literacy. A sample from Cook County Health was extracted to assess for predisposing factors, enabling factors, and need of healthcare utilization and a regression was used. Results show that high health literacy has negative significant influence on ACHN visits (B= -0.129; p\u3c0.001) and negative influence on ED encounters (B= -0.012; p\u3e0.019) although not significant. This study allows for more investigation on health literacy among healthcare utilization and how best to address health literacy as an effort to increase health equity in the community

Frailty in hospitalized adults

The purpose of this cross-sectional, retrospective, descriptive study was to characterize frailty in hospitalized adults 55 years of age and older admitted to medical units at one large academic medical center during a 15-month time frame and determine if level of frailty on admission predicted length of stay (LOS) and 30-day readmission. Frailty is a syndrome characterized by multisystem physiologic dysregulation due to intrinsic and extrinsic stressors resulting in decreased compensatory reserve and ability to effectively respond to destabilizing health events. Stressors associated with hospitalization may increase risk for frailty or accelerate its development. Frailty is a significant concern as it is associated with morbidity, functional decline, long LOS, readmission, institutionalization, and mortality. There is scant research on frailty in acutely-ill hospitalized adults, especially those ¡Ý 65 years of age. Understanding frailty in this population is imperative because frailty is potentially preventable, treatable, and reversible. Frailty was operationalized as 14 evidence-based frailty components defined by 26 indicator variables. Frailty components were Nutrition, Weakness, Fatigue, Chronic Pain, Dyspnea, Falls, Vision, Depression, Cognition, Social Support, low Hemoglobin, low Albumin, high C-reactive protein (CRP) or hs-CRP, and abnormal WBC count. Each frailty component was scored as one point if at least one indicator variable was present on admission, and summed to derive a Frailty Score, where a higher Frailty Score suggests greater level of frailty (range, 0 to 14). Sociodemographic, clinical, and laboratory data were retrieved from the electronic medical record through web-based data query tools and record review (N = 278). Mean age was 70.2 (SD = 1.3; range, 55¨C98), slightly over half were female, 64% were White, one-third were Black. The mean comorbidity count was 13 (SD = 4.56; range. 1¨C26) and medication count was 12 (SD = 5.2; range, 0¨C31). The most prevalent frailty components (&gt; 81%) were Fatigue, Weakness, Nutrition, Hemoglobin, Albumin, and CRP or hs-CRP. The mean Frailty Score was 9.03 (SD = 1.98; range, 2¨C13). Multiple linear regression was performed with 20 predictor variables and the Frailty Score and then with 14 of the 20 predictor variables that were significant in bivariate linear regression with the Frailty Score using the ENTER and STEPWISE method. All multiple regression models yielded seven significant predictor variables. Six predictors were common to all models: comorbidity, acute pain, ADL assistance, urinary incontinence, Braden Scale score, current tobacco use. In multiple regression with 20 predictors, age was a significant predictor however in multiple regression using ENTER and STEPWISE for 14 predictors, female gender was significant but not age. Results from STEPWISE regression yielded seven significant predictors that explained 27% of the variance in the Frailty Score (adj. R2 = .266, df (14, 263), F = 8.163, p = .000). Mean LOS was 9.92 days (SD = 9.58; range, 1¨C72; median, 7; mode, 5). Simple linear regression for the Frailty Score and log10 transformed LOS was statistically significant (adj. R2 = .090, df (1, 276), F = 29.293, p = .000). Twelve percent experienced 30-day readmission. Logistic regression conducted for the Frailty Score and 30-day readmission was not statistically significant (X 2 = 4.121, df (5), p = .532; ¦Â coefficient = .100, df (1), 95% CI = .913¨C1.1337, p = .307). The Frailty Score characterized this hospitalized population as acutely ill with high comorbidity, symptom burden, nutrition deficits and evidence of physiologic vulnerability and inflammation. Study findings have implications for nursing practice, interdisciplinary collaboration, education, research, and public policy

A COMPREHENSIVE ASSESSMENT OF CRISIS IN INDIVIDUALS WITH INTELLECTUAL DISABILITIES AND ITS IMPLICATIONS FOR PHYSICAL THERAPY

Advancements in medicine, policy, and societal attitudes have improved life expectancy, socialization, and participation for individuals with intellectual and developmental disabilities (IDD). However, inconsistent or a lack of services may drive healthcare utilization toward expensive emergency care services. This can negatively impact health outcomes and disrupt physical therapy treatment plans, limiting their effectiveness and further placing individuals with IDD at risk for crisis episodes. Because of its subjective nature, quantifying crisis is challenging using current definitions. Rehabilitation professionals are often active members of the care team for individuals with IDD, however no evidence currently exists regarding how the profession can positively impact crisis intervention. Because these clinicians often develop long-term relationships with patients and work with them on a consistent basis, they are well-positioned to recognize early signs of crisis and make timely referrals to the appropriate health and social service providers but currently lack resources to guide in this decision-making. A better understanding of characteristics of this population related to crisis is needed in order to develop accessible and useful screening tools and to improve clinical reasoning. The purpose of this dissertation was to identify pertinent risk factors related to crisis for individuals with IDD using a novel, objective crisis definition. Using a mixed methods approach, a revised definition of crisis was developed through surveying of expert clinicians and healthcare administrators at a specialty care clinic for individuals with IDD. The addition of four crisis-related events were included in the definition: (1) unplanned hospital utilization; (2) involvement with the criminal justice system; (3) abuse/victimization; (4) unplanned change in living environment. Using retrospective chart review, these four crisis-related events were further analyzed and validated by comparing their occurrence in patients who did (N=41) and did not (N=144) receive formal crisis intervention services at the clinic between January 1, 2014 and March 1, 2019. The risk for unplanned hospital utilization was 3.4 times higher for crisis patients. The risk for involvement with the police or criminal justice system was 13.86 times higher for crisis patients. The risk for abuse and/or victimization was 6.21 times higher for crisis patients. The risk for unplanned change(s) in living environment was 12.7 times higher for crisis patients. Overall, 90% of crisis patients experienced at least one of the four crisis-related events during the study period, compared to 54.2% of non-crisis patients. Five additional risk factors were identified that increased crisis risk: hypothyroidism, bipolar disorder, intermittent explosive disorder, personality disorder, and have multiple psychiatric disorders. No statistically significant differences were found between crisis and non-crisis patients for intellectual disability severity level, mobility status, communication status, neurodevelopmental diagnosis, age, race/ethnicity, or living environment. To the best of our knowledge, the identification of hypothyroidism as a potential crisis risk factor was a novel discovery not previously reported in the literature. The findings of this dissertation have multiple implications for clinical practice and add to the body of knowledge regarding crisis experiences for individuals with IDD. First and foremost, over a fifth of our study sample (22%) utilized formal crisis management services during the study period. This suggests that crisis episodes are common in the IDD population. As the majority of individuals with IDD are community-dwelling and life expectancy continues to increase, the likelihood of physical therapists encountering adults with IDD in clinical practice will subsequently increase. However, physical therapists and physical therapy students routinely report feeling unconfident and uncomfortable treating individuals with disabilities, including individuals with IDD. There is a need, then, to improve clinician confidence and skills to ensure that individuals with IDD receive optimal care, especially into adulthood. The findings of these studies provide foundational knowledge and point toward trends in crisis experiences that can help guide physical therapists and other rehabilitation clinicians

The Relationship Between New Nurses Who Volunteer and the Caring Behavior New Nurses Exhibit in the Practice Setting, One Year Post Graduation

Volunteering is engaged in by millions world-wide and nurses comprise a significant portion of those who provide their professional talents, unpaid, to the underserved in local, national and international efforts. Nurses who have engaged in volunteer activities anecdotally describe personally transforming experiences gained through their efforts and for many nurses volunteering becomes part of their professional mandate. Although many social disciplines have studied volunteering, to date there has been a paucity of research on nurses who volunteer. The purpose of this study was to describe the characteristics of novice nurses who volunteer and determine the influence of volunteering and associated characteristics on their self-reported caring behaviors and their satisfaction with career choice. This was a quantitative survey study with several open-ended questions. A descriptive, correlational design was used to determine the effect of spirituality, altruism and pro-socialness on nurse volunteerism and how volunteerism mediates caring behavior and satisfaction with career choice in the new nurse. Those in the final data set were mainly young, White non-Hispanic female novice nurses who attained baccalaureate degrees as their basic nursing education (n= 1023). Nearly two thirds of respondents reported as having volunteered and mostly at the local level. Significant findings include that volunteering is positively influenced by participation in non-school related, voluntary volunteer activity and negatively influenced by required volunteer activity. Caring behavior was positively influenced by local volunteer activity that was non-school related, voluntary volunteer activity. Volunteering did not influence satisfaction with career choice, although the measurement tool did not yield adequate internal consistency and reliability. Spirituality, altruism and pro-socialness were each positively correlated with caring behavior and satisfaction with career choice. Volunteerism in nursing was not found to mediate the relationship between spirituality, altruism and pro-socialness and either caring behavior or satisfaction with career choice. The sixth Caritas Process of Watson’s Theory of Transpersonal Caring (2012) requires the creative use of self. The findings of this study reveal that the novice nurse who engages in purely voluntary volunteer activity may be able to nurture caring behaviors through that interaction. Education may need to revisit how undergraduate service learning is done. Practice should not only consider previous volunteer experience of prospective RN staff but also provide ongoing opportunities to engage in volunteer activities. Further research should focus on other outcome variables of volunteering in nursing such as job satisfaction, career mobility and mentoring

Analysis of the quality of hospital information systems Audit Trails.

BACKGROUND: Audit Trails (AT) are fundamental to information security in order to guarantee access traceability but can also be used to improve Health information System's (HIS) quality namely to assess how they are used or misused. This paper aims at analysing the existence and quality of AT, describing scenarios in hospitals and making some recommendations to improve the quality of information. METHODS: The responsibles of HIS for eight Portuguese hospitals were contacted in order to arrange an interview about the importance of AT and to collect audit trail data from their HIS. Five institutions agreed to participate in this study; four of them accepted to be interviewed, and four sent AT data. The interviews were performed in 2011 and audit trail data sent in 2011 and 2012. Each AT was evaluated and compared in relation to data quality standards, namely for completeness, comprehensibility, traceability among others. Only one of the AT had enough information for us to apply a consistency evaluation by modelling user behaviour. RESULTS: The interviewees in these hospitals only knew a few AT (average of 1 AT per hospital in an estimate of 21 existing HIS), although they all recognize some advantages of analysing AT. Four hospitals sent a total of 7 AT - 2 from Radiology Information System (RIS), 2 from Picture Archiving and Communication System (PACS), 3 from Patient Records. Three of the AT were understandable and three of the AT were complete. The AT from the patient records are better structured and more complete than the RIS/PACS. CONCLUSIONS: Existing AT do not have enough quality to guarantee traceability or be used in HIS improvement. Its quality reflects the importance given to them by the CIO of healthcare institutions. Existing standards (e.g. ASTM:E2147, ISO/TS 18308:2004, ISO/IEC 27001:2006) are still not broadly used in Portugal.publishersversionpublishe

Sedation, Analgesia, and Paralysis during Mechanical Ventilation of Premature Infants

To characterize administration of sedatives, analgesics, and paralytics in a large cohort of mechanically ventilated, premature infants

INTERPERSONAL COMMUNICATION, DEMOGRAPHIC VARIABLES AND RELATIONAL MAINTENANCE AMONG UNMARRIED POSTGRADUATE STUDENTS OF OBAFEMI AWOLOWO UNIVERSITY, ILE-IFE, NIGERIA

The study ascertained the level of relational maintenance among unmarried postgraduate students of Obafemi Awolowo University, Ile-Ife and as well as the relationship between interpersonal communication and relational maintenance among the postgraduate students of Obafemi Awolowo University Ile-Ife. Finally, it also examined the relationship between demographic variables and relational maintenance among the postgraduate students. These were with a view to providing useful information on relational maintenance among the unmarried postgraduate students. The study adopted survey design. The sample size comprised 600 postgraduate students selected from six selected faculties out of the thirteen Faculties in Obafemi Awolowo University, Ile-Ife, using multistage sampling technique. Thereafter, a total of 100 students were selected in each faculty using purposive sampling technique for those that were into dating relationship. One adapted and one self-constructed instruments were used to elicit information from the respondents. The adapted instrument was Relational Maintenance Scale (RMS) while Interpersonal Communication Inventory (ICI) was self-constructed. Percentages, frequency counts Pearson correlation and Chi-square were employed to analyze the data. The results showed that 24.8%, 52.5% and 22.7% of postgraduate students of Obafemi Awolowo Universities Ile-Ife demonstrated low, moderate and high levels of relational maintenance respectively. The study also indicated that there was a significant positive relationship between interpersonal communication and relational maintenance (r = 0.676, p &gt; 0.05). Furthermore, the results showed significant relationship between sex of the students and relational maintenance (x2 =24.271; df = 564, p &gt; 0.05). Finally, the results showed significant relationship between age of the students and relational maintenance (x2 = 47.837a; df = 564, p &gt; 0.05). It was concluded that irrespective of the age of the students, most unmarried postgraduate students in the study area had moderate level of relational maintenance

Stay Beautiful -- Stay Alive: Assessing the Receptivity of African American Beauty Salon Owners to the Integration of Breast Cancer Intervention Programs into Salon Operations

The lower incidence rate of breast cancer in African American women is dwarfed by the excessive number of deaths due to late diagnosis and treatment. Lack of screening, socioeconomic factors, fatalistic beliefs and inequality of care are major contributing factors. Studies have suggested that those who had more knowledge about breast cancer are more likely to have reduced fatalistic attitudes and engage in screening behaviors. This study investigated beauty salons as sustainable and viable venues to reach women with health intervention programs because they fit the prescriptions of the principles of adult learning. In a mixed-method, descriptive study involving 115 salon owners, the study concluded that salon owners are moderately interested in integrating breast cancer education in their salon operations