Examining the Relationship between Clinical Decision Support and Performance Measurement

In concept and practice, clinical decision support (CDS) and performance measurement represent distinct approaches to organizational change, yet these two organizational processes are interrelated. We set out to better understand how the relationship between the two is perceived, as well as how they jointly influence clinical practice. To understand the use of CDS at benchmark institutions, we conducted semistructured interviews with key managers, information technology personnel, and clinical leaders during a qualitative field study. Improved performance was frequently cited as a rationale for the use of clinical reminders. Pay-for-performance efforts also appeared to provide motivation for the use of clinical reminders. Shared performance measures were associated with shared clinical reminders. The close link between clinical reminders and performance measurement causes these tools to have many of the same implementation challenges

Adoption of agricultural conservation practices in the United States: Evidence from 35 years of quantitative literature

This is a comprehensive review of all published, quantitative studies focused on adoption of agricultural conservation practices in the United States between 1982 and 2017. This review finds that, taken as a whole, few independent variables have a consistent statistically significant relationship with adoption. Analyses showed that variables positively associated with adoption include the farmer self-identifying primarily as stewardship motivated or otherwise nonfinancially motivated, environmental attitudes, a positive attitude toward the particular program or practice, previous adoption of other conservation practices, seeking and using information, awareness of programs or practices, vulnerable land, greater farm size, higher levels of income and formal education, engaging in marketing arrangements, and positive yield impact expected. Some variables often thought to be important, such as land tenure, did not emerge as consistently important in this cross-study review. Other variables, such as farmers\u27 sense of place, training, presence of institutional conditions supporting adoption, and the role of collective decision making are not measured in enough studies to draw conclusions but potentially have a relationship with adoption decisions. Implications for how to promote conservation adoption and directions for future research are discussed. Because positive attitudes and awareness of conservation programs or practices are positive predictors of adoption, practitioners should share benefits of specific practices and programs and leverage existing practice adoption. Further work to explore relationships between conservation adoption and the role of farmer identity, nuances of land tenure, and the influence of structural factors is needed. Moreover, we suggest that future research should focus on the impact of different messages and avenues of reaching farmers in order to continue to inform conservation practices. Future research should consider both individual and institutional factors that facilitate and constrain adoption

Redesign of a computerized clinical reminder for colorectal cancer screening: a human-computer interaction evaluation

<p>Abstract</p> <p>Background</p> <p>Based on barriers to the use of computerized clinical decision support (CDS) learned in an earlier field study, we prototyped design enhancements to the Veterans Health Administration's (VHA's) colorectal cancer (CRC) screening clinical reminder to compare against the VHA's current CRC reminder.</p> <p>Methods</p> <p>In a controlled simulation experiment, 12 primary care providers (PCPs) used prototypes of the current and redesigned CRC screening reminder in a within-subject comparison. Quantitative measurements were based on a usability survey, workload assessment instrument, and workflow integration survey. We also collected qualitative data on both designs.</p> <p>Results</p> <p>Design enhancements to the VHA's existing CRC screening clinical reminder positively impacted aspects of usability and workflow integration but not workload. The qualitative analysis revealed broad support across participants for the design enhancements with specific suggestions for improving the reminder further.</p> <p>Conclusions</p> <p>This study demonstrates the value of a human-computer interaction evaluation in informing the redesign of information tools to foster uptake, integration into workflow, and use in clinical practice.</p

Paper Persistence and Computer-based Workarounds with the Electronic Health Record in Primary Care

With the United States national goal and incentive program to transition from paper to electronic health records (EHRs), healthcare organizations are increasingly implementing EHRs and other related health information technology (IT). However, in institutions which have long adopted these computerized systems, such as the Veterans Health Administration, healthcare workers continue to rely on paper to complete their work. Furthermore, insufficient EHR design also results in computer-based workarounds. Using direct observation with opportunistic interviewing, we investigated the use of paper- and computer-based workarounds to the EHR with a multi-site study of 54 healthcare workers, including primary care providers, nurses, and other healthcare staff. Our analysis revealed several paper- and computer-based workarounds to the VA’s EHR. These workarounds, including clinician-designed information tools, provide evidence for how to enhance the design of the EHR to better support the needs of clinicians

A framework for power analysis using a structural equation modelling procedure

BACKGROUND: This paper demonstrates how structural equation modelling (SEM) can be used as a tool to aid in carrying out power analyses. For many complex multivariate designs that are increasingly being employed, power analyses can be difficult to carry out, because the software available lacks sufficient flexibility. Satorra and Saris developed a method for estimating the power of the likelihood ratio test for structural equation models. Whilst the Satorra and Saris approach is familiar to researchers who use the structural equation modelling approach, it is less well known amongst other researchers. The SEM approach can be equivalent to other multivariate statistical tests, and therefore the Satorra and Saris approach to power analysis can be used. METHODS: The covariance matrix, along with a vector of means, relating to the alternative hypothesis is generated. This represents the hypothesised population effects. A model (representing the null hypothesis) is then tested in a structural equation model, using the population parameters as input. An analysis based on the chi-square of this model can provide estimates of the sample size required for different levels of power to reject the null hypothesis. CONCLUSIONS: The SEM based power analysis approach may prove useful for researchers designing research in the health and medical spheres

A novel lineage of the Capra genus discovered in the Taurus Mountains of Turkey using ancient genomics

Direkli Cave, located in the Taurus Mountains of southern Turkey, was occupied by Late Epipaleolithic hunters-gatherers for the seasonal hunting and processing of game including large numbers of wild goats. We report genomic data from new and published Capra specimens from Direkli Cave and, supplemented with historic genomes from multiple Capra species, find a novel lineage best represented by a ~14,000 year old 2.59 X genome sequenced from specimen Direkli4. This newly discovered Capra lineage is a sister clade to the Caucasian tur species (Capra cylindricornis and Capra caucasica), both now limited to the Caucasus region. We identify genomic regions introgressed in domestic goats with high affinity to Direkli4, and find that West Eurasian domestic goats in the past, but not those today, appear enriched for Direkli4-specific alleles at a genome-wide level. This forgotten 'Taurasian tur' likely survived Late Pleistocene climatic change in a Taurus Mountain refuge and its genomic fate is unknown

Perfectionism and achievement goals in young Finnish ice-hockey players aspiring to make the Under-16 national team

Research on perfectionism suggests that is it useful to differentiate between perfectionistic strivings and perfectionistic concerns. Regarding the 2 x 2 achievement goal framework, the usefulness of this differentiation was recently demonstrated in a study with university student athletes (Stoeber, Stoll, Pescheck, & Otto, 2008, Study 2), in which it was found that perfectionistic strivings were associated with mastery-approach and performance-approach goals and perfectionistic concerns with mastery-avoidance, performance-approach, and performance-avoidance goals. Because the study was largely exploratory and only used non-elite athletes, the aim of the present research was to replicate and extend these findings by investigating a sample of 138 young, elite ice-hockey players, while adding further measures of perfectionism and using structural equation modelling (SEM) to confirm the relationships between perfectionistic strivings, perfectionistic concerns,and the 2 x 2 achievement goals. The SEM results showed that, in elite athletes also, perfectionistic strivings are associated with mastery-approach and performance-approach goals, whereas perfectionistic concerns are associated with masteryavoidance, performance-approach, and performance-avoidance goals. Our findings corroborate the importance of differentiating between perfectionistic strivings and perfectionistic concerns when studying perfectionism in sports, because only perfectionistic concerns (and not perfectionistic strivings) are associated with maladaptive patterns of achievement goals

Reciprocal relations between workplace bullying, anxiety and vigor: A two-wave longitudinal study

Background and Objectives: Workplace bullying has been classified as an extreme social stressor in work contexts and has been repeatedly linked to several negative consequences. However, little research has examined reversed or reciprocal relations of bullying and outcomes. Design: We conducted a two-wave longitudinal study with a time lag of six months. Methods: The study sample consisted of 348 employees of the Spanish workforce. The present study examined longitudinal relationships between workplace bullying, psychological health, and well-being. On the basis of conservation of resources theory, we hypothesized that we would find reciprocal relations among study variables over time. Results: Results of cross-lagged structural equation modeling analyses supported our hypotheses. Specifically, it was found that Time 1 (T1) workplace bullying was negatively related to Time 2 (T2) vigor and positively related to T2 anxiety. Additionally, T1 anxiety and vigor had an effect on T2 workplace bullying. Conclusions: Overall, these findings support the validity of the theoretical models postulating a reciprocal bullying–outcome relationship, rather than simple one-way causal pathways approaches

Adoption of agricultural conservation practices in the United States: Evidence from 35 years of quantitative literature

Copyright © 2019 Soil and Water Conservation Society. All rights reserved. This is a comprehensive review of all published, quantitative studies focused on adoption of agricultural conservation practices in the United States between 1982 and 2017. This review finds that, taken as a whole, few independent variables have a consistent statistically significant relationship with adoption. Analyses showed that variables positively associated with adoption include the farmer self-identifying primarily as stewardship motivated or otherwise nonfinancially motivated, environmental attitudes, a positive attitude toward the particular program or practice, previous adoption of other conservation practices, seeking and using information, awareness of programs or practices, vulnerable land, greater farm size, higher levels of income and formal education, engaging in marketing arrangements, and positive yield impact expected. Some variables often thought to be important, such as land tenure, did not emerge as consistently important in this cross-study review. Other variables, such as farmers’ sense of place, training, presence of institutional conditions supporting adoption, and the role of collective decision making are not measured in enough studies to draw conclusions but potentially have a relationship with adoption decisions. Implications for how to promote conservation adoption and directions for future research are discussed. Because positive attitudes and awareness of conservation programs or practices are positive predictors of adoption, practitioners should share benefits of specific practices and programs and leverage existing practice adoption. Further work to explore relationships between conservation adoption and the role of farmer identity, nuances of land tenure, and the influence of structural factors is needed. Moreover, we suggest that future research should focus on the impact of different messages and avenues of reaching farmers in order to continue to inform conservation practices. Future research should consider both individual and institutional factors that facilitate and constrain adoption

Work engagement and voluntary absence: The moderating role of job resources

The present study examined the moderating role of job resources, namely, organisational trust, the quality of employees’ relationship with their manager, and the motivating potential of jobs, on the negative relationship between work engagement and voluntary absence. Employee survey results and absence records collected from the Human Resources Department of a construction and consultancy organisation in the United Kingdom (n=325) showed that work engagement was negatively related to voluntary absence, as measured by the Bradford Factor. Further, the results showed that organisational trust and the quality of employees’ relationships with their line managers ameliorated the negative effect of relatively low levels of engagement on voluntary absence. Theoretical and practical implications of the findings are discussed