Rethinking Impact: Understanding the complexity of poverty and change

Summary of workshop on Rethinking Impact: Understanding the complexity of poverty and change. March 26–28, 2008, Cali, ColombiaImpact, CGIAR, Workshop, Agricultural and Food Policy, Food Security and Poverty, Research and Development/Tech Change/Emerging Technologies,

The Genomic Medicine Model: An Integrated Approach to Implementation of Family Health History in Primary Care

As an essential tool for risk stratification, family health history (FHH) is a central component of personalized medicine; yet, despite its widespread acceptance among professional societies and its established place in the medical interview, its widespread adoption is hindered by three major barriers: quality of FHH collection, risk stratification capabilities and interpretation of risk stratification for clinical care. To overcome these barriers and bring FHH to the forefront of the personalized medicine effort, we developed the genomic medicine model (GMM) for primary care. The GMM, founded upon the principles of the Health Belief Model, Adult Learning Theory and the implementation sciences, shifts responsibility for FHH onto the patient, uses information technology (MeTree©) for risk stratification and interpretation, and provides education across multiple levels for each stakeholder, freeing up the clinical encounter for discussion around personalized preventive healthcare plans. The GMM has been implemented and optimized as part of an implementation-effectiveness hybrid pilot study for breast/ovarian cancer, colon cancer and thrombosis, and risk for hereditary cancer syndromes in two primary care clinics in NC, USA. This paper describes the conceptual development of the model and key findings relevant for broader uptake and sustainability in the primary care community

The Impact of Hospital Information Technology Adoption Process on Quality of Care

Business: 2nd Place (The Ohio State University Edward F. Hayes Graduate Research Forum)We look at the impact of two important dimensions of the process of adoption (sequence and intensity) for Electronic Medical Record (EMR) technologies on cost and quality of care at hospitals. Sequence of adoption is captured in terms of two approaches: the depth-first approach which adopts department level integrative technologies first and the breadth-first approach which adopts organization wide integrative technologies before completing department level integration. Intensity of adoption represents the pace of addition of technologies. Results indicate that the depth-first approach performs better at lower intensity of adoption while the breadth-first approach performs better at higher intensity of adoption.A one-year embargo was granted for this item

Risks, alternative knowledge strategies and democratic legitimacy: the conflict over co-incineration of hazardous industrial waste in Portugal.

The decision to incinerate hazardous industrial waste in cement plants (the socalled ‘co-incineration’ process) gave rise to one of the most heated environmental conflicts ever to take place in Portugal. The bitterest period was between 1997 and 2002, after the government had made a decision. Strong protests by residents, environmental organizations, opposition parties, and some members of the scientific community forced the government to backtrack and to seek scientific legitimacy for the process through scientific expertise. The experts ratified the government’s decision, stating that the risks involved were socially acceptable. The conflict persisted over a decade and ended up clearing the way for a more sustainable method over which there was broad social consensus – a multifunctional method which makes it possible to treat, recover and regenerate most wastes. Focusing the analysis on this conflict, this paper has three aims: (1) to discuss the implications of the fact that expertise was ‘confiscated’ after the government had committed itself to the decision to implement co-incineration and by way of a reaction to the atmosphere of tension and protest; (2) to analyse the uses of the notions of ‘risk’ and ‘uncertainty’ in scientific reports from both experts and counter-experts’ committees, and their different assumptions about controllability and criteria for considering certain practices to be sufficiently safe for the public; and (3) to show how the existence of different technical scientific and political attitudes (one more closely tied to government and the corporate interests of the cement plants, the other closer to the environmental values of reuse and recycling and respect for the risk perception of residents who challenged the facilities) is closely bound up with problems of democratic legitimacy. This conflict showed how adopting more sustainable and lower-risk policies implies a broader view of democratic legitimacy, one which involves both civic movements and citizens themselves

Co-operative Entrepreneurship : Co-operate for growth

Published with the support of the Scottish Government and the Economic & Social Research CouncilPublisher PD

Electronic prescribing systems in hospitals to improve medication safety: a multimethods research programme.

Electronic prescribing (ePrescribing) systems allow health-care professionals to enter prescriptions and manage medicines using a computer. We set out to find out how these ePrescribing systems are chosen, set up and used in English hospitals. Given that these systems are designed to improve medication safety, we looked at whether or not these systems affected the number of prescribing errors made (mistakes such as ordering the wrong dose of medication). We also tried to see whether or not the systems were good value for money (or more cost-effective). Finally, we made recommendations to help hospitals choose, set up and use ePrescribing systems. We found that setting up ePrescribing systems was very difficult because there is a need to take into consideration how different pharmacists, nurses and doctors work, and the different work that needs to be carried out for different diseases and medical conditions. We recorded a link between the implementation of ePrescribing systems and a reduction in some high-risk prescribing errors in two out of three study sites. Given that the error reductions corresponded to the warnings triggered by the system, we concluded that the system is likely to have caused the error reduction. Prescribing errors may lead to adverse events that lead to death, impaired quality of life and longer hospital stays. The cost of an ePrescribing system increased in proportion to reduced errors, reaching £4.31 per patient per year for the site that experienced the greatest reduction in prescribing errors (i.e. site S). This estimate is based on assumptions in the model and how much a health service is willing to pay for a unit of health benefit. To help professionals choose, set up and use ePrescribing systems in the future, we produced an online ePrescribing Toolkit (www.eprescribingtoolkit.com/; accessed 21 December 2019) that, with support from NHS England, is becoming widely used internationally

Health Information Technology in the United States: Driving Toward Delivery System Change, 2012

Examines progress on electronic health record adoption, health information exchange under the HITECH Act, and models for meaningful delivery system reform through health information technology. Includes interview with former national HIT coordinator

A literature review of the training offered to qualified prescribers to use electronic prescribing systems: why is it so important?

Objectives A key element of the implementation and ongoing use of an electronic prescribing (ePrescribing) system is ensuring that users are, and remain, sufficiently trained to use the system. Studies have suggested that insufficient training is associated with suboptimal use. However, it is not clear from these studies how clinicians are trained to use ePrescribing systems or the effectiveness of different approaches. We sought to describe the various approaches used to train qualified prescribers on ePrescribing systems and to identify whether users were educated about the pitfalls and challenges of using these systems. Methods We performed a literature review, using a systematic approach across three large databases: Cumulative Index Nursing and Allied Health Literature, Embase and Medline were searched for relevant English language articles. Articles that explored the training of qualified prescribers on ePrescribing systems in a hospital setting were included. Key findings Our search of ‘all training’ approaches returned 1155 publications, of which seven were included. A separate search of ‘online’ training found three relevant publications. Training methods in the ‘all training’ category included clinical scenarios, demonstrations and assessments. Regarding ‘online’ training approaches; a team at the University of Victoria in Canada developed a portal containing simulated versions of electronic health records, where individuals could prescribe for fictitious patients. Educating prescribers about the challenges and pitfalls of electronic systems was rarely discussed. Conclusions A number of methods are used to train prescribers; however, the lack of papers retrieved suggests a need for additional studies to inform training methods

A Narrative Review of Medication-Related Clinical Decision Support

Objectives: A key element of the implementation and on-going use of an electronic prescribing (ePrescribing) system is ensuring that users are, and remain, sufficiently trained to use the system. Studies have suggested that insufficient training is associated with suboptimal use. However, it is not clear from these studies how clinicians are trained to use ePrescribing systems or the effectiveness of different approaches. We sought to describe the various approaches used to train qualified prescribers on ePrescribing systems and to identify whether users were educated about the pitfalls and challenges of using these systems. Methods: We performed a literature review, using a systematic approach across three large databases: Cumulative Index Nursing and Allied Health Literature (CINAHL), Embase and Medline were searched for relevant English language articles. Articles that explored the training of qualified prescribers on ePrescribing systems in a hospital setting were included. Key Findings: Our search of ‘all training’ approaches returned 1,155 publications, of which seven were included. A separate search of ‘online’ training found three relevant publications. Training methods in the ‘all training’ category included clinical scenarios, demonstrations and assessments. Regarding ‘online’ training approaches; a team at the University of Victoria in Canada developed a portal containing simulated versions of electronic health records, where individuals could prescribe for fictitious patients. Educating prescribers about the challenges and pitfalls of electronic systems was rarely discussed. Conclusions: A number of methods are used to train prescribers; however the lack of papers retrieved suggests a need for additional studies to inform training methods