The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: a qualitative study of Kaiser Permanente.

BackgroundPatient portals may lead to enhanced disease management, health plan retention, changes in channel utilization, and lower environmental waste. However, despite growing research on patient portals and their effects, our understanding of the organizational dynamics that explain how effects come about is limited.MethodsThis paper uses qualitative methods to advance our understanding of the organizational dynamics that influence the impact of a patient portal on organizational performance and patient health. The study setting is Kaiser Permanente, the world's largest not-for-profit integrated delivery system, which has been using a portal for over ten years. We interviewed eighteen physician leaders and executives particularly knowledgeable about the portal to learn about how they believe the patient portal works and what organizational factors affect its workings. Our analytical framework centered on two research questions. (1) How does the patient portal impact care delivery to produce the documented effects?; and (2) What are the important organizational factors that influence the patient portal's development?ResultsWe identify five ways in which the patient portal may impact care delivery to produce reported effects. First, the portal's ability to ease access to services improves some patients' satisfaction as well as changes the way patients seek care. Second, the transparency and activation of information enable some patients to better manage their care. Third, care management may also be improved through augmented patient-physician interaction. This augmented interaction may also increase the 'stickiness' of some patients to their providers. Forth, a similar effect may be triggered by a closer connection between Kaiser Permanente and patients, which may reduce the likelihood that patients will switch health plans. Finally, the portal may induce efficiencies in physician workflow and administrative tasks, stimulating certain operational savings and deeper involvement of patients in medical decisions. Moreover, our analysis illuminated seven organizational factors of particular importance to the portal's development--and thereby ability to impact care delivery: alignment with financial incentives, synergy with existing IT infrastructure and operations, physician-led governance, inclusive decision making and knowledge sharing, regional flexibility to implementation, continuous innovation, and emphasis on patient-centered design.ConclusionsThese findings show how organizational dynamics enable the patient portal to affect care delivery by summoning organization-wide support for and use of a portal that meets patient needs

Walking in a maze : community providers\u27 difficulties coordinating health care for homeless patients

BACKGROUND: While dual usage of US Department of Veterans Affairs (VA) and non-VA health services increases access to care and choice for veterans, it is also associated with a number of negative consequences including increased morbidity and mortality. Veterans with multiple health conditions, such as the homeless, may be particularly susceptible to the adverse effects of dual use. Homeless veteran dual use is an understudied yet timely topic given the Patient Protection and Affordable Care Act and Veterans Choice Act of 2014, both of which may increase non-VA care for this population. The study purpose was to evaluate homeless veteran dual use of VA and non-VA health care by describing the experiences, perspectives, and recommendations of community providers who care for the population. METHODS: Three semi-structured focus group interviews were conducted with medical, dental, and behavioral health providers at a large, urban Health Care for the Homeless (HCH) program. Qualitative content analysis procedures were used. RESULTS: HCH providers experienced challenges coordinating care with VA medical centers for their veteran patients. Participants lacked knowledge about the VA health care system and were unable to help their patients navigate it. The HCH and VA medical centers lacked clear lines of communication. Providers could not access the VA medical records of their patients and felt this hampered the quality and efficiency of care veterans received. CONCLUSIONS: Substantial challenges exist in coordinating care for homeless veteran dual users. Our findings suggest recommendations related to education, communication, access to electronic medical records, and collaborative partnerships. Without dedicated effort to improve coordination, dual use is likely to exacerbate the fragmented care that is the norm for many homeless persons

Patient Perspectives on Adherence to the New Hepatitis C Antiviral Medications: ‘A New Lease on Life’

This study explored patients’ perspectives about taking the new direct-acting antivirals (DAAs) for the treatment of Hepatitis C (i.e., sofosbuvir, simeprevir, ledipasvir/sofosbuvir, ombitasvir/paritraprevir/ritonavir and dasabuvir) to identify facilitators of medication adherence. The project was conducted using semi-structured interviews with 12 Veterans who successfully completed a treatment course on the new DAAs. The Veterans were recruited using purposive sampling. The data collected from the semi-structured interviews was analyzed using an adapted open coding method outlined by Auerbach and Silverstein (2003), with identification of relevant text sub-grouped into repeating ideas, and then creation of overarching themes and constructs. Results obtained provide insight into factors that influenced the Veterans’ medication adherence during the course of treatment. Key constructs, embodying major themes supported by repeating ideas, included recognizing the “burden of HCV,” the importance of the “treatment engagement process,” and anticipation of “positive outcomes.” Clinical implications are discussed

Integrated Care to Address the Physical Health Needs of People with Severe Mental Illness : A Mapping Review of the Recent Evidence on Barriers, Facilitators and Evaluations

People with mental health conditions have a lower life expectancy and poorer physical health outcomes than the general population. Evidence suggests this is due to a combination of clinical risk factors, socioeconomic factors, and health system factors, notably a lack of integration when care is required across service settings. Several recent reports have looked at ways to better integrate physical and mental health care for people with severe mental illness (SMI). We built on these by conducting a mapping review that looked for the most recent evidence and service models in this area. This involved searching the published literature and speaking to people involved in providing or using current services. Few of the identified service models were described adequately and fewer still were evaluated, raising questions about the replicability and generalisability of much of the existing evidence. However, some common themes did emerge. Efforts to improve the physical health care of people with SMI should empower staff and service users and help remove everyday barriers to delivering and accessing integrated care. In particular, there is a need for improved communication among professionals and better information technology to support them, greater clarity about who is responsible and accountable for physical health care, and greater awareness of the effects of stigmatisation on the wider culture and environment in which services are delivered

Building Cohesion in Distributed Telemedicine Teams Findings from the Department of Veterans Affairs National Telestroke Program

Background: As telemedicine adoption increases, so does the importance of building cohesion among physicians in telemedicine teams. For example, in acute telestroke services, stroke specialists provide rapid virtual stroke assessment and treatment to patients at hospitals without stroke specialty care. In the National Telestroke Program (NTSP) of the U.S. Department of Veterans Affairs, a virtual (distributed) hub of stroke specialists throughout the country provides 24/7 consultations nationwide. We examined how these specialists adapted to distributed teamwork, and we identied cohesion-related factors inprogram development and support. Methods: We conducted a case study of the stroke specialists employed by the NTSP. Semi-structured, condential interviews with stroke specialists in the virtual hub were recorded and transcribed. We explored the extent to which these specialists had developed a sense of shared identity and teamcohesion, and we identied factors in this development. Using a qualitative approach with constant comparison methods, two researchers coded each interview transcript independently using a shared codebook. We used matrix displays to identify themes, with special attention to team cohesion, communication, trust, and satisfaction. Results: Of 13 specialists with at least 8 months of NTSP practice, 12 completed interviews; 7 had previously practiced in telestroke programs in other healthcare systems. Interviewees reported high levels of trust and team cohesion, sometimes even more with their virtual colleagues than with local colleagues. Factors facilitating perceived team cohesion included a weekly case conference call, a sense of transparency in discussing challenges, engagement in NTSP development tasks, and support from the NTSP leadership. Although lack of in-person contact was associated with lower cohesion, annual in-person NTSP meetings helped mitigate this issue. Despite technical challenges in establishing a new telehealth system within existing national infrastructure, providers reported high levels of satisfaction with the NTSP.Conclusion: A virtual telestroke hub can provide a sense of team cohesion among stroke specialists at a level comparable with a standard co-located practice. Engaging in transparent discussion of challenging cases, reviewing new clinical evidence, and contributing to program improvements may promotecohesion in distributed telemedicine teamsThis work was funded by the Veterans Health Administration (VHA) Office of Rural Health (016ORH), VHA Office of Specialty Care, VA Health Services Research and Development (HSR&D) Precision Monitoring Quality Enhancement Research Initiative (QUE 15-280). Funding sources had no role in study design, data collection, data analysis, data interpretation, or manuscript writing. The views expressed herein are those of the authors and do not necessarily reflect the views of the U.S. Department of Veterans Affairs

Quality and efficiency improvements in the health care administration system of Mauritius

Purpose: The purpose of this research was to develop quality and efficiency improvements in the health care administration system of Mauritius. The aim of the study is to describe how the health care services of Mauritius could be improved based on the results obtained during this investigation. Methodology: The health care executives, board members, search firm executives, and health administration managers, as well as several patients, were selected by stratified sampling 1802 participants (quantitative) and by purposive sampling method nine focus groups of nine participants each (qualitative). The population for the qualitative research was comprised of patients and health care professionals selected by the purposive sampling technique. The population was comprised of patients and health care professionals for quantitative phase selected by stratified and the health care professionals for qualitative part selected through purposive sampling technique. Findings: The participants showed a preference for Patients’ Satisfactions, ISO Quality Standards Compliance, workforce efficiency, infrastructure fitness, and adaptability principally experience a better quality of care. Moreover, there was no statistical difference between financial cost and quality of health care was depicted. The outcome of the study: A common aspect, recognised empirically, is the approach regarding enhanced external pressure on the healthcare administrators in their work. Higher administration decisions, patient pressure and judgments made by policymakers have impacted and established the choices prepared by health care managers regarding where to concentrate attempts of growth. In the context of practical implications, health care administrators must properly make new management control systems so that they help healthcare systems in their work. Implications for the healthcare leader’s perceptions are that knowledge from the environment is normally complicated and not easy to define and also transmitted from particular stakeholders.Health StudiesD. Litt. et Phil. (Health Studies

Delivering on Open Government: The Obama Administration's Unfinished Legacy

This report examines progress made during President Obama's first term toward open government goals outlined in a comprehensive set of recommendations that the open government community issued in November 2008, titled Moving Toward a 21st Century Right-to-Know Agenda. We examine activity in the three main areas of the 2008 report: creating an environment within government that is supportive of transparency, improving public use of government information, and reducing the secrecy related to national security issues

Interpreting Ambiguity in Sexual Dating Encounters: Social Information Processing Differences in Men and Women

Research has shown date/acquaintance rape to be the most prevalent type of rape. Dating and social interactions provide a context influenced by social factors (e.g., relationship with perpetrator, relationship expectation, peer influences) and personal factors (e.g., social perceptions, goals, learning history), many of which have been suggested to complicate decision making in reference to communicating sexual boundaries. Social Information Processing Theory (SIP) suggests individuals follow successive cognitive stages in determining how to respond to social stimuli. These stages are influenced by biological predisposition, environment, and learning history. The SIP model involves 6 stages: encoding of cues, interpretation of cues, goal clarification, response construction, response decision, and response implementation. Crick and Dodge (1994) proposed individual memory, social knowledge, and social schema affect each stage of social information processing resulting in a process that is unique to each individual. In order to examine male and female differences in decision making processes during a date rape situation, undergraduate college men and women listened to an audio tape of a male and female couple on a date engaged in the early stages of sexual negotiations (e.g., kissing). The woman expressed resistance to the man\u27s attempts to have additional sexual contact (e.g., touching breasts and buttocks). The male acknowledges her resistance, but continues making sexual advances. Participants imagined themselves as the same sex vignette actor and responded to an SIP measure designed to assess five SIP cognitive processing stages related to the sexual situation: interpretation of cues (causal and intent interpretation), goal clarification, response decision, response evaluation, and response efficacy. Additionally, emotional reactions to the situation were assessed. Participants were also administered a measure to assess past sexual perpetration and victimization. A series of Chi-square tests were conducted and results indicated males and females significantly differed in all SIP stages: causal and intent interpretation, goal clarification, and response decision. To evaluate the predictive ability of prior SIP stage responses on response decision making, a multinomial logistic regression analysis was performed, and emotional reaction was found to be a significant predictor of responses decision highlighting the importance of emotion processing integration into social information processing research

Making Healthcare Safe

This unique and engaging open access title provides a compelling and ground-breaking account of the patient safety movement in the United States, told from the perspective of one of its most prominent leaders, and arguably the movement’s founder, Lucian L. Leape, MD. Covering the growth of the field from the late 1980s to 2015, Dr. Leape details the developments, actors, organizations, research, and policy-making activities that marked the evolution and major advances of patient safety in this time span. In addition, and perhaps most importantly, this book not only comprehensively details how and why human and systems errors too often occur in the process of providing health care, it also promotes an in-depth understanding of the principles and practices of patient safety, including how they were influenced by today’s modern safety sciences and systems theory and design. Indeed, the book emphasizes how the growing awareness of systems-design thinking and the self-education and commitment to improving patient safety, by not only Dr. Leape but a wide range of other clinicians and health executives from both the private and public sectors, all converged to drive forward the patient safety movement in the US. Making Healthcare Safe is divided into four parts: I. In the Beginning describes the research and theory that defined patient safety and the early initiatives to enhance it. II. Institutional Responses tells the stories of the efforts of the major organizations that began to apply the new concepts and make patient safety a reality. Most of these stories have not been previously told, so this account becomes their histories as well. III. Getting to Work provides in-depth analyses of four key issues that cut across disciplinary lines impacting patient safety which required special attention. IV. Creating a Culture of Safety looks to the future, marshalling the best thinking about what it will take to achieve the safe care we all deserve. Captivatingly written with an “insider’s” tone and a major contribution to the clinical literature, this title will be of immense value to health care professionals, to students in a range of academic disciplines, to medical trainees, to health administrators, to policymakers and even to lay readers with an interest in patient safety and in the critical quest to create safe care

Use of wearable technology in the treatment of mental health difficulties and chronic pain

This portfolio thesis has three parts: a Systematic Literature Review followed by an empirical research study and finally, a set of appendices. This thesis explored the potential uses of wearable technology in the treatment of mental health difficulties and in the management of chronic pain.The systematic literature review explored recent mental health care research that utilised wearable technology. From this body of literature, three potential areas of use for wearable technology in mental health care were synthesised. Consideration is given to the clinical implications and limitations of the research. Potential areas of future research are also discussed.The empirical section describes a study aimed to investigate the utility of incorporating activity tracking technology into a pain management programme (PMP). This pilot study employed mixed methodology in order to investigate both whether being provided with an activity tracker is beneficial to individuals experiencing chronic pain. No significant improvements on outcome measures for various domains (including sleep, pain levels and mental wellbeing) were found for a group with trackers compared to a group without. However those in the tracker group provided positive feedback about benefits of the trackers. The implications for the findings of this study and avenues for future research are discussed.The appendices section contains a set of appendices for both the preceding sections. It also contains an epistemological statement and reflective statement in order to provide context about the researcher’s experience of conducting the research and the philosophical position from which the design of the research was approached