Assessing the level of healthcare information technology adoption in the United States: a snapshot

BACKGROUND: Comprehensive knowledge about the level of healthcare information technology (HIT) adoption in the United States remains limited. We therefore performed a baseline assessment to address this knowledge gap. METHODS: We segmented HIT into eight major stakeholder groups and identified major functionalities that should ideally exist for each, focusing on applications most likely to improve patient safety, quality of care and organizational efficiency. We then conducted a multi-site qualitative study in Boston and Denver by interviewing key informants from each stakeholder group. Interview transcripts were analyzed to assess the level of adoption and to document the major barriers to further adoption. Findings for Boston and Denver were then presented to an expert panel, which was then asked to estimate the national level of adoption using the modified Delphi approach. We measured adoption level in Boston and Denver was graded on Rogers' technology adoption curve by co-investigators. National estimates from our expert panel were expressed as percentages. RESULTS: Adoption of functionalities with financial benefits far exceeds adoption of those with safety and quality benefits. Despite growing interest to adopt HIT to improve safety and quality, adoption remains limited, especially in the area of ambulatory electronic health records and physician-patient communication. Organizations, particularly physicians' practices, face enormous financial challenges in adopting HIT, and concerns remain about its impact on productivity. CONCLUSION: Adoption of HIT is limited and will likely remain slow unless significant financial resources are made available. Policy changes, such as financial incentivesto clinicians to use HIT or pay-for-performance reimbursement, may help health care providers defray upfront investment costs and initial productivity loss

Assessing the level of healthcare information technology adoption in the United States: a snapshot

BACKGROUND: Comprehensive knowledge about the level of healthcare information technology (HIT) adoption in the United States remains limited. We therefore performed a baseline assessment to address this knowledge gap. METHODS: We segmented HIT into eight major stakeholder groups and identified major functionalities that should ideally exist for each, focusing on applications most likely to improve patient safety, quality of care and organizational efficiency. We then conducted a multi-site qualitative study in Boston and Denver by interviewing key informants from each stakeholder group. Interview transcripts were analyzed to assess the level of adoption and to document the major barriers to further adoption. Findings for Boston and Denver were then presented to an expert panel, which was then asked to estimate the national level of adoption using the modified Delphi approach. We measured adoption level in Boston and Denver was graded on Rogers' technology adoption curve by co-investigators. National estimates from our expert panel were expressed as percentages. RESULTS: Adoption of functionalities with financial benefits far exceeds adoption of those with safety and quality benefits. Despite growing interest to adopt HIT to improve safety and quality, adoption remains limited, especially in the area of ambulatory electronic health records and physician-patient communication. Organizations, particularly physicians' practices, face enormous financial challenges in adopting HIT, and concerns remain about its impact on productivity. CONCLUSION: Adoption of HIT is limited and will likely remain slow unless significant financial resources are made available. Policy changes, such as financial incentivesto clinicians to use HIT or pay-for-performance reimbursement, may help health care providers defray upfront investment costs and initial productivity loss

Athletic Identity in Youth Athletes: A Systematic Review of the Literature

Athletic identity (AI), the degree of personal connection to sport, is well-described in adult research; however, this social trait has been less studied in younger age groups. This systematic review describes epidemiological characteristics of AI in youth athletes. PubMed, Embase and PsycInfo were searched to identify AI studies involving quantitative athlete identity outcomes and cohorts 22 years and younger. The search strategy was developed for each database using the Boolean method. PRISMA guidelines and the Appraisal Tool for Cross-Sectional Studies (AXIS) were utilized. Ten out of ninety-one studies met inclusion criteria. AI scores differed by race/ethnicity. Two studies found increased AI during adolescence compared to later in ones’ training. Mental health-focused studies revealed higher AI levels protect against burnout, but in injured athletes, increased depression risk. Transitioning to a higher level of play during adolescence can correlate with stronger senses of AI. Further research should explore the concept of athletic identity saliency as one moves through an athletic career or training program and how thoughts of perceived success, professional progression, recruitment prospect or injury affect levels of athletic identity

Adolescent differences in knee stability following computer-assisted anterior cruciate ligament reconstruction

<div class="page" title="Page 1"><div class="section"><div class="layoutArea"><div class="column"><p><span>Anterior cruciate ligament (ACL) surgery is being increasingly performed in the adolescent population. Computer navigation offers a reliable way to quantitatively measure knee stability during ACL reconstruction. A retrospective review of all adolescent patients (&lt;18 years old) who underwent computer-assisted primary single bundle ACL reconstruction by a single surgeon from 2007 to 2012 was performed. The average age was 15.8 years (SD 3.3). Female adolescents were found to have higher internal rotation than male adolescents both pre- (25.6° </span><em>vs </em><span>21.7°, P=0.026) and post-reconstruction (20.1° </span><em>vs </em><span>15.1°, P=0.005). Compared to adults, adolescents demonstrated significantly higher internal rotation both pre- (23.3° </span><em>vs </em><span>21.5°, P=0.047) and post-reconstruction (17.1° </span><em>vs </em><span>14.4°, P=0.003). They also had higher total rotation both pre- (40.9° </span><em>vs </em><span>38.4°, P=0.02) and post-reconstruction when compared to adults (31.56° </span><em>vs </em><span>28.67°, P=0.005). In adolescent patients, anterior translation was corrected more than rotation. Females had higher pre- and residual post-reconstruction internal rotation compared to males. When compared to adults, adolescents had increased internal rotation and total rotation both pre- and post-reconstruction. </span></p></div></div></div></div

Stability Outcomes following Computer-Assisted ACL Reconstruction

Purpose. The purpose of this study was to determine whether intraoperative prereconstruction stability measurements and/or patient characteristics were associated with final knee stability after computer-assisted ACL reconstruction. Methods. This was a retrospective review of all patients who underwent computer-assisted single-bundle ACL reconstruction by a single surgeon. Prereconstruction intraoperative stability measurements were correlated with patient characteristics and postreconstruction stability measurements. 143 patients were included (87 male and 56 female). Average age was 29.8 years (SD ± 11.8). Results. Females were found to have significantly more pre- and postreconstruction internal rotation than males (P < 0.001 and P = 0.001, resp.). Patients with additional intra-articular injuries demonstrated more prereconstruction anterior instability than patients with isolated ACL tears (P < 0.001). After reconstruction, these patients also had higher residual anterior translation (P = 0.01). Among all patients with ACL reconstructions, the percent of correction of anterior translation was found to be significantly higher than the percent of correction for internal or external rotation (P < 0.001). Conclusion. Anterior translation was corrected the most using a single-bundle ACL reconstruction. Females had higher pre- and postoperative internal rotation. Patients with additional injuries had greater original anterior translation and less operative correction of anterior translation compared to patients with isolated ACL tears