MS

thesisImplementation of evidence-based techniques, such as computerized protocols, has achieved limited success owing to a behavioral bottleneck"" among clinicians. We describe the development and validation of an instrument, for assessing critical care clinicians' perceptions about use of computerized protocols. We developed a 35-item instrument based on the constructs of a cognitive model we previously proposed. Following minor revisions to ensure content and semantic validity the instrument was administered to 240 clinicians (132 nurses, 53 physicians and 55 respiratory therapists), in three health-care institutions. Principal components analysis was used for extraction of factors. We report the clinicians' perceived likelihoods of 15 outcomes related to use of computerized protocols. Principal components analysis identified nine factors, explaining 66% of the total variance. Beliefs regarding Self-Efficacy' ((3 = 0.185, p<0.001) was the most important predictor of the outcome (Behavioral Intention) and explained 26% of the total variance. Other factors contributing to this outcome were Environmental Support, Role Relevance, Work Identity, Beliefs regarding Control, Information Quality, Social Pressure and Culture. Results supported the reliability and construct validity of each of the above scales. Clinicians' identified 'Improvement of data collection' (Mean±SD) (73.45±22.44), 'Uniformity of care' (71.83±20.64), 'Dependence on computers' (71.49±26.40), ability to 'Track logic of protocol' (68.56±22.44) and 'Improve patients' quality of care' (68.49±22.75) as the most important factors. Clinicians' perceptions are critical predictors of computerized protocol adoption in routine practice. Development of instruments for measurement of clinician attributes that predict computerized protocol use should help us to design and implement computerized protocols that meet the needs of critical care medicine."

THE TIME LAG IN ANNUAL HOUSEHOLD-BASED INCOME MEASURES: ASSESSING AND CORRECTING THE BIAS

Annual income data are typically provided with a time lag. This article reviews several ways of dealing with this time lag in the construction of annual household-based income measures for individual economic well-being. It also proposes an alternative method that yields better estimates for equivalized household income, especially in the case of household composition change. Next, the two most commonly applied income measures are compared to this alternative measure with empirical income data from the European Community Household Panel. This comparison reveals that ignoring the time lag and household changes leads to substantial bias in income and poverty estimates and to erroneous conclusions about the determinants of poverty entry. The evidence in this article will be useful to researchers who want to make a well-informed choice between different annual income measures. Copyright 2008 The Authors.