The Effects of Malpractice Pressure and Liability Reforms on Physicians’ Perceptions of Medical Care

Considerable evidence suggests that the medical malpractice liability system neither provides compensation to patients who suffer negligent medical injury nor seeks to penalize physicians whose negligence causes patient injury. The relationship between liability reforms, malpractice pressure and physician perceptions of medical care is examined

A survey of orthopaedic journal editors determining the criteria of manuscript selection for publication

Background: To investigate the characteristics of editors and criteria used by orthopaedic journal editors in assessing submitted manuscripts. Methods: Between 2008 to 2009 all 70 editors of Medline listed orthopaedic journals were approached prospectively with a questionnaire to determine the criteria used in assessing manuscripts for publication. Results: There was a 42% response rate. There was 1 female editor and the rest were male with 57% greater than 60 years of age. 67% of the editors worked in university teaching hospitals and 90% of publications were in English.The review process differed between journals with 59% using a review proforma, 52% reviewing an anonymised manuscript, 76% using a routine statistical review and 59% of journals used 2 reviewers routinely. In 89% of the editors surveyed, the editor was able to overrule the final decision of the reviewers.Important design factors considered for manuscript acceptance were that the study conclusions were justified (80%), that the statistical analysis was appropriate (76%), that the findings could change practice (72%). The level of evidence (70%) and type of study (62%) were deemed less important. When asked what factors were important in the manuscript influencing acceptance, 73% cited an understandable manuscript, 53% cited a well written manuscript and 50% a thorough literature review as very important factors. Conclusions: The editorial and review process in orthopaedic journals uses different approaches. There may be a risk of language bias among editors of orthopaedic journals with under-representation of non-English publications in the orthopaedic literature

Computer-Assisted versus Oral-and-Written History Taking for the Prevention and Management of Cardiovascular Disease: a Systematic Review of the Literature

Background and objectives: CVD is an important global healthcare issue; it is the leading cause of global mortality, with an increasing incidence identified in both developed and developing countries. It is also an extremely costly disease for healthcare systems unless managed effectively. In this review we aimed to: – Assess the effect of computer-assisted versus oral-and-written history taking on the quality of collected information for the prevention and management of CVD. – Assess the effect of computer-assisted versus oral-and-written history taking on the prevention and management of CVD. Methods: Randomised controlled trials that included participants of 16 years or older at the beginning of the study, who were at risk of CVD (prevention) or were either previously diagnosed with CVD (management). We searched all major databases. We assessed risk of bias using the Cochrane Collaboration tool. Results: We identified two studies. One comparing the two methods of history-taking for the prevention of cardiovascular disease n = 75. The study shows that generally the patients in the experimental group underwent more laboratory procedures, had more biomarker readings recorded and/or were given (or had reviewed), more dietary changes than the control group. The other study compares the two methods of history-taking for the management of cardiovascular disease (n = 479). The study showed that the computerized decision aid appears to increase the proportion of patients who responded to invitations to discuss CVD prevention with their doctor. The Computer-Assisted History Taking Systems (CAHTS) increased the proportion of patients who discussed CHD risk reduction with their doctor from 24% to 40% and increased the proportion who had a specific plan to reduce their risk from 24% to 37%. Discussion: With only one study meeting the inclusion criteria, for prevention of CVD and one study for management of CVD we did not gather sufficient evidence to address all of the objectives of the review. We were unable to report on most of the secondary patient outcomes in our protocol. Conclusions: We tentatively conclude that CAHTS can provide individually-tailored information about CVD prevention. However, further primary studies are needed to confirm these findings. We cannot draw any conclusions in relation to any other clinical outcomes at this stage. There is a need to develop an evidence base to support the effective development and use of CAHTS in this area of practice. In the absence of evidence on effectiveness, the implementation of computer-assisted history taking may only rely on the clinicians’ tacit knowledge, published monographs and viewpoint articles

No. 26: Social Media, The Internet and Diasporas for Development

The recent focus on diasporas by policy-makers researchers has highlighted the rich potential of migrants as a force for shaping development activities in their countries of origin. The study of diasporas in development presents researchers a number of significant challenges. As Vertovec and Cohen suggest, ‘one of the major changes in migration patterns is the growth of populations anchored … neither at their places of origin nor at their places of destination’. The fluid, multi-sited and multi-generational nature of diaspora groupings poses considerable methodological challenges of definition, identification, location, sampling and interviewing. As the nature of African diasporas are constantly in flux so too should the methodologies we use to study them. In practice, traditional approaches lead to the same methodological roadblocks. Census and immigration data (particularly from destination countries) can provide an overall picture of diaspora stocks, flows and locations. However, privacy issues generally preclude these sources from providing disaggregated data at the level of the individual migrant or migrant household. Surveys of diaspora members have therefore become the standard means of collecting information on diaspora characteristics, identities, activities and linkages. This immediately raises a set of problems and challenges. Census data can tell us the size of the population to sample but not who the individuals are, where they live and how to contact them. Without a sampling frame, researchers tend to rely instead on ‘snowball’, ‘purposive’ or ‘convenience’ sampling. This has produced a disproportionate number of studies that rely on key informant and focus group interviews in order to create a profile of diasporas and their development-related activities. Diasporas are often geographically dispersed within a country and across different countries. Cost and time constraints and the bias of snowball and convenience sampling lead to a focus on sub-sets. Studies of diaspora members in particular cities or regions are especially common. While sample sizes vary considerably, there is a marked reliance on very small samples, which raises obvious questions about the representativeness and generalizability of the findings. The mail-out survey is still the preferred method of reaching members of a geographically dispersed diaspora, although response rates remain stubbornly low. To contact members of the diaspora, mailing lists are compiled from organizations that keep, and are willing to share, membership lists (such as diaspora organizations, embassies, alumni associations, immigrant service agencies and religious organizations). However, this means an inherent sampling bias since data collected from these individuals and groups has the potential to be skewed towards diaspora members actively engaged with their origin country. This method of ‘accessing the diaspora through the diaspora’ is also unlikely to provide much information on ‘hidden’ members of a diaspora whose immigration status may be undocumented or uncertain and who are wary of disclosing personal information directly to researchers. Researchers have also noted that members of vulnerable populations such as asylum seekers and refugees might be reluctant to provide personal information due to fear and trust issues. To identify and connect with larger numbers, different strategies need to be adopted. In this context, the potential of the internet has rarely been considered. Since the advent of the internet age, more than one billion people have become connected to the World Wide Web (WWW), creating seemingly limitless opportunities for communication. The past decade has also seen a major increase in the use of the internet by diaspora individuals and groupings. The internet has not only facilitated remittance transfers, but has increased communication among and between diasporas and influenced the formation of diasporic identities. In this context, the potential of web-based methodologies in diaspora research appears promising. The aim of this paper is twofold. First, we argue for supplementing conventional approaches with new methodologies that embrace the connectivity of diasporas, the emergence of social media and the potential of online surveys. Second, we illustrate the potential of this approach through discussion of the methods adopted in our current research on the African diaspora in Canada

Sleep apnoea and its impact on public health

In 1997 we published a systematic review on the health effects of obstructive sleep apnoea and the effectiveness of treatment with CPAP. This generated much controversy and considerable correspondence. About half the letters received by the authors suggested that the paper was just stating the obvious, the other half that the paper was completely inaccurate. To help clarify our findings this paper will discuss the public health impact of sleep apnoea and the rationale behind systematic reviews

Hospital implementation of health information technology and quality of care: are they related?

Recently, there has been considerable effort to promote the use of health information technology (HIT) in order to improve health care quality. However, relatively little is known about the extent to which HIT implementation is associated with hospital patient care quality. We undertook this study to determine the association of various HITs with: hospital quality improvement (QI) practices and strategies; adherence to process of care measures; risk-adjusted inpatient mortality; patient satisfaction; and assessment of patient care quality by hospital quality managers and front-line clinicians.This work was supported by a grant from the Commonwealth Fund. We are indebted to Anthony Shih and Anne-Marie Audet of the Fund for their advice, support, and constructive suggestions throughout the design and conduct of the study. We thank our colleagues - Raymond Kang, Peter Kralovec, Sally Holmes, Frances Margolin, and Deborah Bohr - for their valuable contributions to the development of the QAS, the CPS, and the database on which the analytic findings reported here were based. We also thank 3 M (TM) Health Information Systems' for use of its All Patient Refined Diagnosis Related Groups (APR-DRGs) software. We especially wish to thank Jennifer Drake for her contributions not only to survey development, but also to earlier analysis of survey findings relevant to this paper. (Commonwealth Fund)Published versio

Evolution of the Governmental Accounting Reform implementation in Greek Public Hospitals: Testing the institutional framework

Purpose – In an attempt to promote efficiency, effectiveness and economy in health service production, the Greek government imposed in 2003 an accrual basis financial and cost accounting system in all public hospitals of the National Health System (NHS). The purpose of this study is not to investigate thoroughly the accounting reform implementation and adoption in specific organizations, but rather to obtain an overall idea of the reform adoption process in Greek public hospitals by identifying major areas of non-compliance with the mandatory legislative accounting framework and various organisational contingencies that influence the level of reform adoption within a broad institutional framework. Design/methodology/approach – Our analysis is based on the results of an empirical survey that took place during 2009. For the purposes of this survey, a compliance index is constructed and applied on a sample of 94 Greek public hospitals using a structured questionnaire and semi-structured interviews with six public hospital Financial and Accounting executives. Findings – The empirical evidence reveals that the level of accrual basis financial and especially cost accounting adoption in Greek public hospitals is realized only to a limited extent. In particular, results show that the relationship between the institutional isomorphic pressures and accounting reform implementation process is restricted by organizational capability factors (i.e., the quality of existing Information Technology systems, the education level of finance and accounting staff, the extent of reform related training, and the professional support of consultants). Research limitations/implications – Although this study takes into consideration the work of previous researchers in the health care area, it acknowledges that empirical research on the subject in the Greek environment is limited. Therefore this study should be viewed as an initial step to address this limitation. Originality/value – This study draws on the information systems change, management accounting innovation, and public sector reform literatures to contribute to the current knowledge in public sector accounting by examining a number of factors that are expected to influence the implementation and adoption process of accrual and cost accounting practises in the Greek public healthcare sector within a broad institutional framework. Contribution - This study contributes to the international literature of New Public Management (NPM) initiatives in public health sector by providing, to our knowledge, the first large cross-sectional assessment of accrual accounting reform adoption and implementation in Greek public hospitals. Additionally, the empirical evidence of this study can enhance researchers’ and managers’ understanding of major implementation processes and challenges and thus help them refine models of effective implementation process and improve systems and processes on similar future projects.Accrual Accounting, Public Sector Accounting, Compliance Index, Public Hospitals, Isomorphism.

How to Influence Physicians to Use Electronic Medical Records (EMR)? Social Influence Tactics and Their Effects on EMR Implementation Effectiveness

Theoretical and practical knowledge of the important role of social influence tactics as a managerial tool used by system implementers to persuade individuals to make use of an information system (IS) is very limited. I integrate elements from the theory of interpersonal influence and leadership with the theory of attitude change and innovation implementation to investigate the role of various leadership tactics that could be used in IS implementations to persuade physicians to use EMR in large hospitals. I define three types of behavioral responses to IS implementations: compliance, commitment and resistance. I show how different leadership tactics could be used during IS implementations in order to impact behavioral change (foster compliant or committed use) and avoid resistance. I propose hypotheses to investigate direct and interaction effects of these tactics on EMR implementation effectiveness. This research contributes to the IS field by “doing IT research that matters.

Computer-assisted versus oral-and-written dietary history taking for diabetes mellitus

Background: Diabetes is a chronic illness characterised by insulin resistance or deficiency, resulting in elevated glycosylated haemoglobin A1c (HbA1c) levels. Diet and adherence to dietary advice is associated with lower HbA1c levels and control of disease. Dietary history may be an effective clinical tool for diabetes management and has traditionally been taken by oral-and-written methods, although it can also be collected using computer-assisted history taking systems (CAHTS). Although CAHTS were first described in the 1960s, there remains uncertainty about the impact of these methods on dietary history collection, clinical care and patient outcomes such as quality of life. Objectives: To assess the effects of computer-assisted versus oral-and-written dietary history taking on patient outcomes for diabetes mellitus. Search methods: We searched The Cochrane Library (issue 6, 2011), MEDLINE (January 1985 to June 2011), EMBASE (January 1980 to June 2011) and CINAHL (January 1981 to June 2011). Reference lists of obtained articles were also pursued further and no limits were imposed on languages and publication status. Selection criteria: Randomised controlled trials of computer-assisted versus oral-and-written history taking in patients with diabetes mellitus. Data collection and analysis: Two authors independently scanned the title and abstract of retrieved articles. Potentially relevant articles were investigated as full text. Studies that met the inclusion criteria were abstracted for relevant population and intervention characteristics with any disagreements resolved by discussion, or by a third party. Risk of bias was similarly assessed independently. Main results: Of the 2991 studies retrieved, only one study with 38 study participants compared the two methods of history taking over a total of eight weeks. The authors found that as patients became increasingly familiar with using CAHTS, the correlation between patients' food records and computer assessments improved. Reported fat intake decreased in the control group and increased when queried by the computer. The effect of the intervention on the management of diabetes mellitus and blood glucose levels was not reported. Risk of bias was considered moderate for this study. Authors' conclusions: Based on one small study judged to be of moderate risk of bias, we tentatively conclude that CAHTS may be well received by study participants and potentially offer time saving in practice. However, more robust studies with larger sample sizes are needed to confirm these. We cannot draw on any conclusions in relation to any other clinical outcomes at this stage

Resistance of multiple stakeholders to e-health innovations: Integration of fundamental insights and guiding research paths

Consumer/user resistance is considered a key factor responsible for the failure of digital innovations. Yet, existing scholarship has not given it due attention while examining user responses to e-health innovations. The present study addressed this need by consolidating the existing findings to provide a platform to motivate future research. We used a systematic literature review (SLR) approach to identify and analyze the relevant literature. To execute the SLR, we first specified a stringent search protocol with specific inclusion and exclusion criteria to identify relevant studies. Thereafter, we undertook an in-depth analysis of 72 congruent studies, thus presenting a comprehensive structure of findings, gaps, and opportunities for future research. Specifically, we mapped the relevant literature to elucidate the nature and causes of resistance offered by three key constituent groups of the healthcare ecosystem—patients, healthcare organizational actors, and other stakeholders. Finally, based on the understanding acquired through our critical synthesis, we formulated a conceptual framework, classifying user resistance into micro, meso, and macro barriers which provide context to the interventions and strategies required to counter resistance and motivate adoption, continued usage, and positive recommendation intent. Being the first SLR in the area to present a multi-stakeholder perspective, our study offers fine-grained insights for hospital management, policymakers, and community leaders to develop an effective plan of action to overcome barriers that impede the diffusion of e-health innovations.publishedVersionPaid open acces