Health Information Technology and Accountable Care Organizations: A Systematic Review and Future Directions

Background: Since the inception of Accountable Care Organizations (ACOs), many have acknowledged the potential synergy between ACOs and health information technology (IT) in meeting quality and cost goals. Objective: We conducted a systematic review of the literature in order to describe what research has been conducted at the intersection of health IT and ACOs and identify directions for future research. Methods: We identified empirical studies discussing the use of health IT via PubMed search with subsequent snowball reference review. The type of health IT, how health IT was included in the study, use of theory, population, and findings were extracted from each study. Results: Our search resulted in 32 studies describing the intersection of health IT and ACOs, mainly in the form of electronic health records and health information exchange. Studies were divided into three streams by purpose; those that considered health IT as a factor for ACO participation, health IT use by current ACOs, and ACO performance as a function of health IT capabilities. Although most studies found a positive association between health IT and ACO participation, studies that address the performance of ACOs in terms of their health IT capabilities show more mixed results. Conclusions: In order to better understand this emerging relationship between health IT and ACO performance, we propose future research should consider more quasi-experimental studies, the use of theory, and merging health, quality, cost, and health IT use data across ACO member organizations

Patterns of rod and cone dysfunction in Bardet-Biedl syndrome

We studied visual function in 16 patients with the Bardet-Biedl syndrome. Visual acuity, kinetic perimetry, and electroretinography results indicated a severe loss of central and peripheral vision and rod and cone function by the second or third decade of life. Light- and dark-adapted static perimetry in patients 10 to 15 years of age with early involvement showed a parallel and marked loss of rod and cone sensitivity across the visual field. Patients with more advanced disease and no measurable peripheral visual field showed different patterns of central visual dysfunction: an island of only cone function centered in a bull's-eye lesion; patches of rod function surrounding geographic atrophy; or a central island of excellent rod sensitivity but severely impaired cones. In the two least-affected patients, a 13-year-old boy and the asymptomatic 45-year-old sibling of a patient, there were more rod than cone abnormalities as determined by electroretinography and static perimetry

Rod or cone dysfunction: uniocular presentations

Two patients presented with unusual uniocular electroretinographic (ERG) phenomena. One patient showed the ERG characteristics of stationary night blindness in one eye only and the other patient presented with ERG evidence of uniocular cone dysfunction. In both patients, however, further electrophysiological and psychophysical studies and serial testing provided evidence for dysfunction of both receptor systems and relatively subtle involvement of the fellow eyes

Are They Aligned? An Analysis of Social Media-Based Nurse Well-Being Concerns and Well-Being Programs

# Background Nurse burnout and distress pose patient safety risks due to impaired nurse attention, increased likelihood of medical error, and increased nurse turnover leading to a reduction in the number of nurses available to deliver care. Some healthcare facilities have launched well-being programs in response to increasing rates of burnout. Many of these programs are based on survey data which may be incomplete, resulting in programs that are not as comprehensive as they should be. We sought to identify nurse concerns related to burnout and well-being through analysis of social media data. We aligned these concerns with well-being program leader perceptions of factors contributing to burnout and well-being program initiatives. # Methods We conducted a qualitative study composed of two parts: social media analysis and semistructured interviews with well-being leaders. The social media analysis focused on 120 nurse comments on Reddit that were retrieved based on a keyword search using the terms "burnout," "stress," and "wellbeing." The interviews were conducted with nine well-being leaders from seven different healthcare systems. Well-being program leaders were asked about factors contributing to burnout and lack of well-being, initiatives to address these factors, and metrics used to evaluate their programs. The social media comments and interview data were reviewed by two experts to identify topics, themes, and subthemes grounded in wellness models. # Results Of the 120 social media comments analyzed, the most frequent topic was Lack of Meaningful Recognition, Compensation, and Influence (n=46 of 120, 38.3%), followed by Work Environment (n=43, 35.8%) and Uninformed or Misinformed Public (n=31, 25.8%). Several themes emerged and the most prevalent was Constrained Professional Agency with the most prevalent subtheme of health system or macrosystem policies or regulations that limit nurses' ability to respond effectively to patient care needs. Of the seven healthcare systems interviewed, the most common topics that emerged from asking about the factors contributing to the lack of nurse well-being were the Work Environment (n=6 of 7, 85.7%), followed by Lack of Meaningful Recognition, Compensation, and Influence (n=4, 57.1%), and Inadequate or Inaccessible Well-Being Resources (n=3, 42.9%). Several novel initiatives were identified, and most healthcare systems relied on surveys as their key metric. # Conclusions The social media analysis revealed nurse concerns that may not be identified as factors contributing to lack of well-being by well-being program leaders. There is an opportunity to optimize our understanding of nurse concerns around well-being through social media, and an opportunity to better align nurse concerns with the focus of well-being programs