Performance Measures Using Electronic Health Records: Five Case Studies

Presents the experiences of five provider organizations in developing, testing, and implementing four types of electronic quality-of-care indicators based on EHR data. Discusses challenges, and compares results with those from traditional indicators

Studies in Trade and Investment: The Development Impact of Information Technology in Trade Facilitation

Section A of this chapter deals with the role of SMEs in exports while section B details evolution in the use of IT for cargo clearance. Section C examines the impact of IT trade facilitation measures on SMEs. Section D presents stakeholder interviews on the impact of information technology automation in trade facilitation. Section E concludes the chapter and proposes some recommendations.Trade facilitation, ICT, IT, SMEs, export, customs, India

Doctor of Philosophy

DissertationHealth information technology (HIT) in conjunction with quality improvement (QI) methodologies can promote higher quality care at lower costs. Unfortunately, most inpatient hospital settings have been slow to adopt HIT and QI methodologies. Successful adoption requires close attention to workflow. Workflow is the sequence of tasks, processes, and the set of people or resources needed for those tasks that are necessary to accomplish a given goal. Assessing the impact on workflow is an important component of determining whether a HIT implementation will be successful, but little research has been conducted on the impact of eMeasure (electronic performance measure) implementation on workflow. One solution to addressing implementation challenges such as the lack of attention to workflow is an implementation toolkit. An implementation toolkit is an assembly of instruments such as checklists, forms, and planning documents. We developed an initial eMeasure Implementation Toolkit for the heart failure (HF) eMeasure to allow QI and information technology (IT) professionals and their team to assess the impact of implementation on workflow. During the development phase of the toolkit, we undertook a literature review to determine the components of the toolkit. We conducted stakeholder interviews with HIT and QI key informants and subject matter experts (SMEs) at the US Department of Veteran Affairs (VA). Key informants provided a broad understanding about the context of workflow during eMeasure implementation. Based on snowball sampling, we also interviewed other SMEs based on the recommendations of the key informants who suggested tools and provided information essential to the toolkit development. The second phase involved evaluation of the toolkit for relevance and clarity, by experts in non-VA settings. The experts evaluated the sections of the toolkit that contained the tools, via a survey. The final toolkit provides a distinct set of resources and tools, which were iteratively developed during the research and available to users in a single source document. The research methodology provided a strong unified overarching implementation framework in the form of the Promoting Action on Research Implementation in Health Services (PARIHS) model in combination with a sociotechnical model of HIT that strengthened the overall design of the study

Impact of IT related Trade Facilitation Measures on SMEs: An Overview of Indian Experience

This paper examine the extent of automation of trade facilitation in India and to assess the impact of automation on SMEs in the country.Impace of Information Techonology, SMEs, India

Master of Science

thesisThere is increasing competition in the field of community pharmacy practice from chain pharmacies and other providers. There is also a lack of available studies which examine pharmacists' attitudes toward marketing and the actual use of marketing in a pharmacy; there is however, literature on "how" to market. It is first necessary to examine the current practices of pharmacists with regard to marketing before the "how" can be implemented. A questionnaire was mailed to 154 independent community pharmacies in the state of Utah. Of these pharmacies, 110 responded; however, only 83 questionnaires (53.9%) were determined to be complete for analysis. The pharmacy managers were asked to provide personal information regarding their education, number of years at present position, and their self-perception of their marketing knowledge. The pharmacy managers were also asked for specific information on the pharmacies in which they work such as professional services offered and marketed, the perceived competition, prescription volume as percent of total sales and the average menthe expenditure on marketing. The pharmacists were also asked about their attitude toward different marketing tools and the frequency of use of these tools for marketing their pharmacy and professional services. Also examined were the possible effects of factors such as attitudes, perceived competition, and volume of business in a pharmacy on the extent of marketing. On the average almost 22% of the respondents perceived the various marketing tools as being "extremely effective" and another 47% felt that these tools were "effective." However, these marketing tools were used by a much lower proportion of pharmacist who thought that they were effective. Exceptions to the rule were word-of-mouth which was used by a large percentage (95.2%) and billboard advertising which was perceived as being effective by a low percentage (19.3%). The yellow pages were perceived as being "ineffective," but were used by a relatively large percentage (92.8%) of the respondents. The average monthly marketing expenditure was $181.7 ±$186.7. This skew to the left is primarily due to the fact that 30% of the pharmacist spent less than $50.00 per month on marketing. Results indicate that the attitudes of pharmacists toward marketing and perceived competition have very little apparent influence on average monthly marketing expenditures and the frequency of use of different marketing tools. Few pharmacists reported using competition surveys and analysis of pharmacy strengths and weaknesses relative to the average number of prescriptions dispensed per day and the extent of marketing. The variables examined in this study suggest that there may be very little influence on the extent of marketing from pharmacists' attitudes towards marketing, perceived competition, and volume of prescription as a percent of total sales. To better understand the marketing decisions of pharmacists in an independent computing pharmacy, factors such as cost of marketing, time required for marketing activities, the perception for the need to market, and differentiation between pharmacies based on geographical location may also be necessary

BCBSA Blue Annual 2004

BCBSA Blue Annual 2004

Adequacy and Effectiveness of Logistics Services in Nepal: Implication for Export Performance

This study examines the adequacy and effectiveness of delivery of logistic services and their implication for export performance of Nepal. It provides a detailed assessment of the current trade facilitation and logistics situation in Nepal, including on transportation, storage and handling services.Logistic Services, Export Performance, Nepal

Mental Health in the Workplace: Situation Analyses, Germany

[From Introduction] The ILO’s primary goals regarding disability are to prepare and empower people with disabilities to pursue their employment goals and facilitate access to work and job opportunities in open labour markets, while sensitising policy makers, trade unions and employers to these issues. The ILO’s mandate on disability issues is specified in the ILO Convention 159 (1983) on vocational rehabilitation and employment. No. 159 defines a disabled person as an individual whose prospects of securing, retaining, and advancing in suitable employment are substantially reduced as a result of a duly recognised physical or mental impairment. The Convention established the principle of equal treatment and employment for workers with disabilities

Non-Psychiatric Hospitalization For Patients With Psychotic Disorders: A Mixed-Methods Study

Patients with psychotic disorders face a multitude of medical health disparities in addition to psychological symptoms. They have a higher medical disease burden than the general population and are more likely to have a non-psychiatric hospitalization. In the hospital, these patients have an increased risk of adverse events, readmission and extended length-of-stay. Working with a Health Equity lens and the Quality Health Outcomes Model, we reviewed the literature on adverse events during medical-surgical hospitalizations for these patients and identified differences at the patient, provider and system levels between these patients and the general population. Next, a mixed methods, exploratory sequential study was conducted to: 1) explore the experience of patients with psychotic disorders hospitalized on medical-surgical unit; 2) examine patient characteristics and care processes associated with length-of-stay (primary outcome), adverse events and readmissions (secondary outcomes), among patients with psychotic disorders during non-psychiatric hospitalizations; and 3) integrate qualitative and quantitative data to contextualize factors associated with hospital outcomes among patients with psychotic disorders during non-psychiatric hospitalizations. For Phase 1, interviews were conducted with twenty patients with psychotic disorders on medical-surgical units. Five themes were developed through thematic analysis: 1) managing through hard times, 2) ignored and treated unfairly, 3) actively involved in health, 4) appreciation of caring providers and 5) violence: expected and experienced. In Phase 2, information from these interviews guided variable selection for an analysis of patient hospital records. A general linear model was conducted to examine length-of-stay’s relationship with patient characteristics and care processes. Of patient characteristics, only medical comorbidities were significantly related to length-of-stay. Certain processes of care highlighted by patients from the qualitative sample were found to be associated with length-of-stay like physical restraints (64% longer), psychiatrist consult (20% longer) and outpatient appointment in the previous six months (10% shorter). Results suggest specific patient characteristics and care processes are highly related to length-of-stay and that many of these were important to the patients in the qualitative portion. The use of mixed methods research for hospital outcomes research in this population creates valuable information for educational and clinical settings to improve care for patients with psychotic disorders