Integrating a health-related-quality-of-life module within electronic health records: a comparative case study assessing value added

<p>Abstract</p> <p>Background</p> <p>Health information technology (HIT) applications that incorporate point-of-care use of health-related quality of life (HRQL) assessments are believed to promote patient-centered interactions between seriously ill patients and physicians. However, it is unclear how willing primary care providers are to use such HRQL HIT applications. The specific aim of this study was to explore factors that providers consider when assessing the value added of an HRQL application for their geriatric patients.</p> <p>Methods</p> <p>Three case studies were developed using the following data sources: baseline surveys with providers and staff, observations of staff and patients, audio recordings of patient-provider interactions, and semi-structured interviews with providers and staff.</p> <p>Results</p> <p>The primary factors providers considered when assessing value added were whether the HRQL information from the module was (1) duplicative of information gathered via other means during the encounter; (2) specific enough to be useful and/or acted upon, and; (3) useful for enough patients to warrant time spent reviewing it for all geriatric patients. Secondary considerations included level of integration of the HRQL and EHR, impact on nursing workflow, and patient reluctance to provide HRQL information.</p> <p>Conclusions</p> <p>Health-related quality of life modules within electronic health record systems offer the potential benefit of improving patient centeredness and quality of care. However, the modules must provide benefits that are substantial and prominent in order for physicians to decide that they are worthwhile and sustainable. Implications of this study for future research include the identification of perceived "costs" as well as a foundation for operationalizing the concept of "usefulness" in the context of such modules. Finally, developers of these modules may need to make their products customizable for practices to account for variation in EHR capabilities and practice workflows.</p

Feasibility of pharmacy-initiated pharmacogenetic screening for CYP2D6 and CYP2C19

PURPOSE: Our purpose was to investigate the feasibility of pharmacy-initiated pharmacogenetic (PGt) screening in primary care with respect to patient willingness to participate, quality of DNA collection with saliva kits, genotyping, and dispensing data retrieved from the pharmacy. METHODS: Polypharmacy patients aged >60 years who used at least one drug with Anatomical Therapeutic Chemical (ATC) code N06AA01-N06AX19 (antidepressants), A02BC01-A02BC05 (proton-pump inhibitors), N05AA01-N05AH04 (antipsychotics), or C07AB02 (metoprolol) in the preceding 2 years were randomly selected. DNA was collected with saliva kits and genotyped for CYP2D6 and CYP2C19 with the AmpliChip. Pharmacy dispensing records were retrieved and screened for drugs interacting with the patient's CYP2D6 and CYP2C19 genotype by using the evidence-based PGt guidelines from the Dutch Pharmacogenetics Working Group. RESULTS: Out of the 93 invited patients, 54 (58.1%) provided informed consent. Nine saliva samples (16.7%) contained too little DNA. Call rates for CYP2D6 and CYP2C19 were 93.3% and 100%, respectively. Frequencies of genotype-predicted phenotype were 2.4%, 38.1%, 54.8%, and 4.8% for CYP2D6 poor metabolizers (PM), intermediate metabolizers (IM), extensive metabolizers (EM), and ultrarapid metabolizers (UM) respectively. For CYP2C19 genotype-predicted phenotype, frequencies were 2.2%, 15.6%, and 82.2% for PM, IM, and EM, respectively. CONCLUSIONS: This study shows that pharmacy-initiated PGt screening is feasible for a primary care setting

Feasibility and acceptance of electronic quality of life assessment in general practice: an implementation study

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Imaging of the spleen in malaria

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Effect of structured feedback to teachers on the quality of multiple choice examinations

[english] Background: In order to allow a meaningful interpretation of multiple choice (MC) assessment data, MC examinations have to be highly valid on the one hand and represent a reliable measure on the other. The aim of this study was to evaluate the effect of structured feedback given to teachers by assessment experts on the validity and reliability of subsequent MC examinations. Methods: This feedback was introduced in the 3rd year of undergraduate medical training at the University of Zurich in 2007 and applied to nearly all teachers. Various validity and reliability criteria (relevance of content, taxonomic level, psychometric characteristics) of all end-of-term examinations one year before and one year after this intervention were compared. Other factors such as objectivity and representativeness were kept constant. Results: After the introduction of structured feedback the multiple choice questions revealed a trend toward higher relevance. Taxonomic levels remained unchanged. However, selectivity and reliability coefficients increased significantly and the number of items eliminated from examination scoring due to insufficient psychometric properties decreased. Conclusion: Structured feedback by assessment experts to teachers is a valuable tool for quality improvement of MC examinations, in particular regarding reliability. [german] Hintergrund: Damit Multiple Choice Prüfungen über die reinen Prüfungsergebnisse hinausgehende Schlussfolgerungen zulassen, müssen sie für die jeweiligen Interpretationsabsichten inhaltlich gültig sein und hinreichend zuverlässig messen. Die vorliegende Studie geht der Frage nach, ob von Prüfungsexperten mit Dozierenden geführte Itemanalysebesprechungen eine Steigerung der Validität und Reliabilität nachfolgender Prüfungen bewirken. Methoden: Diese Itemanalysebesprechungen wurden im dritten Studienjahr Humanmedizin an der Universität Zürich 2007 erstmalig flächendeckend eingeführt. Um deren Einfluss auf spätere Prüfungen zu untersuchen, wurden die Semesterabschlussprüfungen vor und nach dieser Intervention hinsichtlich verschiedener Validitäts- und Reliabilitätskriterien (inhaltliche Relevanz, taxonomische Stufe, psychometrische Kennwerte) miteinander verglichen. Andere Bedingungen wie beispielsweise Objektivität und inhaltliche Repräsentativität wurden konstant gehalten. Ergebnisse: Nach Einführung der Itemanalysebesprechungen wiesen die Prüfungsfragen einen Trend zu höherer Relevanz auf. Die taxonomische Einstufung blieb unverändert. Hingegen stiegen sowohl die Trennschärfen als auch die Reliabilitätskoeffizienten signifikant an und es mussten weniger Prüfungsfragen wegen ungünstiger psychometrischer Eigenschaften aus der Prüfungsbewertung eliminiert werden. Schlussfolgerung: Von Prüfungsexperten angeleitete Itemanalysebesprechungen mit Dozierenden stellen ein wertvolles Instrument zur Qualitätsverbesserung von Multiple Choice Prüfungen insbesondere hinsichtlich der Reliabilität dar