Understanding the Effect of Physicians’ Practice on the Use of Healthcare IS

Healthcare information systems (IS) such as Computerized Physician Order Entry (CPOE) systems have the potential to improve efficiency of healthcare, lower costs, and reduce medication errors. However, previous studies have also described various issues arising from the use of these systems. A key issue pertains to physician resistance to CPOE, causing low usage or the abandonment of system implementations. Despite considerable research on CPOE, there is still a lack of understanding about the acceptance and use of these systems by physicians. This paper aims to address this gap by applying the theoretical perspective of professionalism, a type of institutional logic to understand this phenomenon. We thereby develop a model to explain the impact of physicians’ professional practice arrangements and seniority on their usage of CPOE. The model will be tested using the survey method by collecting data from physicians on their use of CPOE. Objective measures to determine system usage will be utilized if available. In this manner, this study intends to contribute to research and practice on the use of healthcare IS

Advanced Practice Registered Nurses and Healthcare Disparities: Understanding the Impact of Implicit Bias

Introduction: Disparities in healthcare have long been a challenge for physicians, advanced practice providers, nurses, and other interdisciplinary team members. More recently, population health-focused efforts have been implemented to manage everincreasing rates of diabetes, hypertension, and obesity, as well as lack of transportation, limited access to care, and poverty (North Carolina Department of Health and Human Services [NCDHHS], 2019). Racism, sexism, ageism, sizeism, etc., are present in the healthcare setting and manifests in implicit bias during care delivery. This can manifest as beliefs, behaviors/practices, and emotions of the provider (Paradies et al., 2014). Research is limited related to the impact of the use of training targeted at advanced practice nurses recognizing implicit bias, its impact on clinical decision-making, and its relationship to disparities in healthcare. This Quality Improvement Project evaluates if advanced practice registered nursing (APRN) students in the project setting demonstrate an increased understanding of implicit bias, its effect on healthcare disparities, and its impact on clinical decision-making after participating in targeted anti-bias education and training. Methods: The Project utilized a virtual video platform with participant access being an independent study process. The project utilized is a quantitative 10-question Likert-scale survey upon completion of the Education Module. There were 68 APRN students who received the Education Module link with a Qualtrics survey. Data analysis was performed using descriptive statistics. Results: Data analysis of responses indicated participants agreement/strong agreement related to gains in understanding of microaggressions, identifying areas for practice 4 improvement, recognizing a need for more APRN training related to implicit bias and healthcare disparities, and improved understanding of the impact on patient-providertrust. Conclusions: It appears targeted education about implicit bias and healthcare disparities related to clinical decision-making can improve APRNS’s understanding and potentially impact provider practice. Most participants indicated improved knowledge in these areas. Areas where there were lower scores involved questions related to personal insight and reflection. Due to the small size of the study, results are not generalizable to the APRN population. Further research is needed into the area for future knowledge and practice change

From recommendation to action: psychosocial factors influencing physician intention to use Health Technology Assessment (HTA) recommendations

BACKGROUND: Evaluating the impact of recommendations based upon health technology assessment (HTA) represents a challenge for both HTA agencies and healthcare policy-makers. Using a psychosocial theoretical framework, this study aimed at exploring the factors affecting physician intention to adopt HTA recommendations. The selected recommendations were prioritisation systems for patients on waiting lists for two surgical procedures: hip and knee replacement and cataract surgery. METHODS: Determinants of physician intention to use HTA recommendations for patient prioritisation were assessed by a questionnaire based upon the Theory of Interpersonal Behaviour. A total of 96 physicians from two medical specialties (ophthalmology and orthopaedic surgery) responded to the questionnaire (response rate 44.2%). A multiple analysis of variance (MANOVA) was performed to assess differences between medical specialties on the set of theoretical variables. Given the main effect difference between specialties, two regression models were tested separately to assess the psychosocial determinants of physician intention to use HTA recommendations for the prioritisation of patients on waiting lists for surgical procedures. RESULTS: Factors influencing physician intention to use HTA recommendations differ between groups of specialists. Intention to use the prioritisation system for patients on waiting lists for cataract surgery among ophthalmologists was related to attitude towards the behaviour, social norms, as well as personal normative beliefs. Intention to use HTA recommendations for patient prioritisation for hip and knee replacement among orthopaedic surgeons was explained by: perception of conditions that facilitated the realisation of the behaviour, personal normative beliefs, and habit of using HTA recommendations in clinical work. CONCLUSION: This study offers a model to assess factors influencing the intention to adopt recommendations from health technology assessment into professional practice. Results identify determinant factors that should be considered in the elaboration of strategies to support the implementation of evidence-based practice, with respect to emerging health technologies and modalities of practice. However, it is important to emphasise that behavioural determinants of evidence-based practice vary according to the specific technology considered. Evidence-based implementation of HTA recommendations, as well as other evidence-based practices, should build on a theoretical understanding of the complex forces that shape the practice of healthcare professionals

Paying for Quality: Understanding and Assessing Physician Pay-for-Performance Initiatives

Reviews the structure, prevalence, measurement issues, perception, and impact of current quality incentive programs, and discusses how much and under what circumstances they will improve quality of care. Includes descriptions of select programs

The Patient-Physician Relationship: Overcoming Language and Cultural Barriers

The patient-physician relationship governs the field of medicine, forming the basis for all relationships, interactions, and procedures in medicine. The degree to which a patient trusts his physician and thus is willing to be receptive to medical advice and adhere to assigned treatment is dependent on the quality of his relationship with his physician. The method of relationship chosen will dictate how the patient feels he is perceived and thus to what extend he will participate in his healthcare. A patient-centered approach to medicine will increase this confidence and lead to improved clinical results. Additionally, the rise of physician burnout has also had an effect on this foundational relationship, creating division between the patient and his physician primarily due to complaints against the excessive use of EHRs (electronic health records) and time constraints. Furthermore, in a country of immigrants, the differences in not only language but also between separate cultures and levels of health literacy divides physicians and large populations of their limited English proficiency (LEP) patients. This is a huge detriment to the patient-physician relationship. Lawmakers have created federal and state laws in an effort to install legal action to remedy this, but significant work is still needed to fully bridge the gap. Several solutions have been proposed to do this with the hopeful effect of finally providing equal and better care to all

An integrative model of the management of hospital physician relationships

Hospital Physician Relationships (HPRs) are of major importance to the health care sector. Drawing on agency theory and social exchange theory, we argue that both economic and noneconomic integration strategies are important to effective management of HPRs. We developed a model of related antecedents and outcomes and conducted a systematic review to assess the evidence base of both integration strategies and their interplay. We found that more emphasis should be placed on financial risk sharing, trust and physician organizational commitment

Efficiency as a determinant of loyalty among users of a community of clinical practice: a comparative study between the implementation and consolidation phases

A community of clinical practice called the Online Communication Tool between Primary and Hospital Care (ECOPIH) was created to enable primary care and specialist care professionals to communicate with each other in order to resolve real clinical cases, thereby improving communication and coordination between care levels. The present work seeks to analyse whether ECOPIH makes it possible to reduce the number of referrals. To that end, the objectives are: (1) To find out the degree of loyalty among ECOPIH users, by comparing the medical professionals' profiles in the tool's implementation phase to those in its consolidation phase. (2) To evaluate the degree of fulfilment of users' expectations, by establishing the determining factors that had an influence on the physicians' intention to use ECOPIH in the implementation phase and observing whether its use had an effective, direct impact on the number of patient referrals that primary care physicians made to specialist care professionals. Two studies were conducted. Based on a survey of all the physicians in a Primary Care area, Study 1 was a descriptive study in ECOPIH's implementation phase. Study 2 was a randomised intervention study of ECOPIH users in the tool's consolidation phase. The results from both studies were compared. Various bivariate and multivariate statistical techniques (exploratory factor analysis, cluster analysis, logistic regression analysis and ANOVA) were used in both studies, which were conducted on a sample of 111 and 178 physicians, respectively. We confirmed the existence of an ECOPIH user profile stable across both phases: under-50-year-old women. Regarding the second objective, there were two particular findings. First, the discriminant factors that had an influence on greater ECOPIH use were habitual Social media website and app use and Perceived usefulness for reducing costs. Second, PC professionals who were ECOPIH members made fewer referrals to SC professionals in Cardiology, Endocrinology and Gastroenterology than older PC professionals who were not ECOPIH members. The use of a community of clinical practice by primary care and specialist care professionals helps to reduce the number of referrals among medical professionals

An Updated Rounds Checklist to Increase Appropriate Use of Telemetry Monitoring

Background: Telemetry monitoring is an essential tool to monitor cardiac electrical activity. Its overuse is costly in time and resources and leads to subsequent testing and treatments that are not necessary for the patient and, in addition, healthcare staff is burdened with work that is potentially not clinically useful. Aim: The global aim of increasing efficiency in telemetry use starts with the local improvement to facilitate nurse-physician communication of telemetry patients during Methods: This study with pre and post data collection looked at the results of quantitative data, collected in May-July 2015, on the number of patients with telemetry and the corresponding clinical indication before and after implementation of a modified rounds checklist which included telemetry as a discussion point. The new checklist was initiated on June 22, 2015 and post intervention data was gathered to determine if there was a decrease in the overuse of and increase in the appropriate use of telemetry. Results: With the implementation of the checklist the use of telemetry decreased, however the clinical indication for use did not improve. Conclusion and implications for CNL practice: After the implementation of the checklist criteria there has been a consistent decrease in telemetry use. This may attributable to improve nurse-physician communication, however, there is still a lack of appropriate clinical indication of use and the CNL, as lateral integrator, in future improvement projects, should support further modifications to the clinical indication set to improve appropriateness of telemetry use

Delivery System Reform Tracking: A Framework for Understanding Change

Proposes a framework for tracking progress on delivery system reforms such as patient-centered medical homes and accountable care organizations by assessing structures, capabilities, incentives, and outcomes. Outlines challenges for data collection