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The Work of Recovery on Two Assertive Community Treatment Teams

AdMINISTRATION ANd POLICY IN MENTAL HEALTH ANd MENTAL HEALTH SERVICES RESEARCH 2011年第3期38卷 169-180页

作者： Salyers, Michelle P. Stull, Laura G. Rollins, Angela L. Hopper, Kim Roudebush VAMC VA HSR&D Ctr Implementing Evidence Based Practice Indianapolis IN 46202 USA ACT Ctr Indiana Indianapolis IN USA IUPUI Dept Psychol Indianapolis IN USA Columbia Univ Nathan Kline Inst Psychiat Res New York NY USA Columbia Univ Mailman Sch Publ Hlth New York NY USA Regenstrief Inst Inc Indianapolis IN 46202 USA

The compatibility of recovery work with the Assertive Community Treatment (ACT) model has been debated;and little is known about how to best measure the work of recovery. Two ACT teams with high and low recovery orientation were identified by expert consensus and compared on a number of dimensions. Using an interpretive, qualitative approach to analyze interview and observation data, teams differed in the extent to which the environment, team structure, staff attitudes, and processes of working with consumers supported principles of recovery orientation. We present a model of recovery work and discuss implications for research and practice.

关键词： Assertive Community Treatment Recovery Measurement Grounded theory

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Human Factors Education for Healthcare Audiences: Ideas for the Way Forward

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Proceedings of the Human Factors and Ergonomics Society Annual Meeting 2011年第1期55卷 808 - 812页

作者： Alissa L. Russ Laura G. Militello Jason J. Saleem Robert L. Wears Rollin J. Fairbanks Ben-Tzion Karsh VA HSR&D Center on Implementing Evidence-Based Practice Roudebush VAMC Indianapolis INRegenstrief Institute Inc. Indianapolis INIndiana University (IU) Center for Health Services & Outcomes Research Indianapolis INPurdue University School of Pharmacy Department of Pharmacy Practice West Lafayette IN Applied Decision Science Dayton OHUniversity of Dayton Research Institute Dayton OH VA HSR&D Center on Implementing Evidence-Based Practice Roudebush VAMC Indianapolis INRegenstrief Institute Inc. Indianapolis INIndiana University (IU) Center for Health Services & Outcomes Research Indianapolis INDepartment of Electrical & Computer Engineering IUPUI Indianapolis IN University of Florida City FLImperial College of London National Center for Human Factors Engineering in Healthcare Washington DCGeorgetown University Department of Emergency Medicine Washington DCUniversity of Buffalo Department of Industrial and Systems Engineering Buffalo NY University of Wisconsin Madison WI

Within the last decade, there has been a growing emphasis on applying human factors principles in the healthcare domain, and although human factors is a well-established scientific discipline, it is still a relatively new concept for the healthcare community. Educating healthcare audiences on the goals, history, and contributions of the human factors discipline may dispel misconceptions; preserve the integrity of this scientific discipline; inform healthcare stakeholders about the value of human factors research; and increase the uptake of human factors principles in the healthcare domain. Panel members will share their views on human factors education for healthcare audiences, including their past experiences, personal successes, and insights on the challenges that remain. Panelists will also engage the audience in an open discussion to generate novel ideas on how to advance the healthcare community’s understanding of the human factors discipline.

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Usability of an Atrial Fibrillation Anticoagulation decision-Support Tool

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JOURNAL OF PRIMARY CARE ANd COMMUNITY HEALTH 2011年第2期2卷 100-106页

作者： Wess, Mark L. Saleem, Jason J. Tsevat, Joel Luckhaupt, Sara E. Johnston, Joseph A. Wise, Ruth E. Kopke, Jonathan E. Eckman, Mark H. Univ Cincinnati Coll Med Dept Internal Med Div Gen Internal Med Cincinnati OH USA Univ Cincinnati Coll Med Dept Publ Hlth Sci Cincinnati OH USA Univ Cincinnati Coll Med Ctr Clin Effectiveness Cincinnati OH USA Roudebush VAMC VA HSR&D Ctr Implementing Evidence Based Practice Indianapolis IN USA Regenstrief Inst Inc Indianapolis IN USA Vet Affairs Med Ctr Hlth Serv Res & Dev Serv Cincinnati OH 45267 USA Eli Lilly Global Hlth Outcomes Indianapolis IN USA Collaborat Informat Syst Cincinnati OH USA

Introduction: In individuals with nonvalvular atrial fibrillation, anticoagulant therapy with warfarin reduces the rate of thromboembolic events but increases the risk of bleeding. Treatment decisions frequently are inconsistent with guidelines. A new web-based atrial fibrillation decision-support tool (AF-dST) provides patient-specific information on the risk-benefit tradeoff of anticoagulation. Methods: The authors performed a pilot usability testing study of the AF-dST with 4 medical house officers and 4 attending physicians by simulating 9 outpatient clinical encounters involving tradeoffs between risks and benefits of anticoagulation. They recorded positive and negative critical incidents in the simulations and assessed satisfaction with use of the AF-dST by the Computer System Usability Questionnaire (CSUQ;score range on each item: 1 = strongly disagree to 7 = strongly agree). Results: Users found the AF-dST to be helpful and had high CSUQ scores (mean item score, 6.3). Usability testing identified 6 positive and 14 negative critical incidents. Participants felt that the AF-dST guided them toward the correct decision. Nevertheless, they desired more information on the "black box" calculations and ignored alerts. Training level appeared to affect how the AF-dST was used, in particular, how users interacted with the AF-dST. Conclusions: Overall satisfaction with the AF-dST was high and the tool effectively communicated recommendations and uncertainty. Usability testing identified design issues and potential errors caused by decision-support tool use;these gaps should be addressed prior to clinical implementation.

关键词： atrial fibrillation decision support anticoagulation decision aid usability testing

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Paper persistence and computer-based workarounds with the electronic health record in primary care

Paper persistence and computer-based workarounds with the el...

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55th Human Factors and Ergonomics Society Annual Meeting, HFES 2011

作者： Saleem, Jason J. Flanagan, Mindy Militello, Laura G. Arbuckle, Nicole Russ, Alissa L. Burgo-Black, A. Lucile doebbeling, Bradley N. VA HSR and D Center on Implementing Evidence-Based Practice Roudebush VAMC Indianapolis IN United States Regenstrief Institute Inc. Indianapolis IN United States Center for Health Services and Outcomes Research Indianapolis IN United States Department of Electrical and Computer Engineering IUPUI Indianapolis IN United States Applied Decision Science Kettering OH United States University of Dayton Research Institute Dayton OH United States Department of Pharmacy Practice Purdue University College of Pharmacy West Lafayette IN United States VA Connecticut Healthcare System United States Yale University School of Medicine New Haven CT United States Department of Medicine IU School of Medicine Indianapolis IN United States

ISBN: (纸本)9780945289395

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.

关键词： Paper

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The Burden of Illness in the First Year Home: do Male and Female va Users differ in Health Conditions and Healthcare Utilization? (vol 21, pg 94, 2011)

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WOMENS HEALTH ISSUES 2011年第4期21卷 327-327页

作者： Haskell, Sally G. Mattocks, Kristin Goulet, Joseph L. Krebs, Erin E. Skanderson, Melissa Leslie, douglas Justice, Amy C. Yano, Elizabeth M. Brandt, Cynthia [a] VA Connecticut Healthcare System West Haven Connecticut [b] Yale University School of Medicine Department of Internal Medicine New Haven Connecticut [c] Roudebush VA Center on Implementing Evidence-Based Practice Indianapolis Indiana [d] Indiana University School of Medicine Indianapolis Indiana [e] Regenstrief Institute Inc. Indianapolis Indiana [f] VA Pittsburgh Healthcare System Pittsburgh Pennsylvania [g] Pennsylvania State University Hershey Pennsylvania [h] Yale Center for Medical Informatics New Haven Connecticut [i] VA Greater Los Angeles Health Services Research and Development Center of Excellence Los Angeles California [j] Department of Health Services UCLA School of Public Health Los Angeles California

BackgroundWe sought to describe gender differences in medical and mental health conditions and health care utilization among veterans who used Veterans Health Administration (va) services in the first year after combat in Iraq and *** is an observational study, using va administrative and clinical data bases, of 163,812 Operation Enduring Freedom/Operation Iraqi Freedom veterans who had enrolled in va and who had at least one visit within 1 year of last *** veterans were slightly younger (mean age, 30 years vs. 32 for men; p <.0001), twice as likely to be African American (30% vs. 15%; p <.0001), and less likely to be married (32% vs. 49%; p < .0001). Women had more visits to primary care (2.6 vs. 2.0; p < .001) and mental health (4.0 vs. 3.6; p < .001) clinics and higher use of community care outside the va (14% vs. 10%; p < .001). After adjustment for significant demographic differences, women were more likely to have musculoskeletal and skin disorders, mild depression, major depression, and adjustment disorders, whereas men were more likely to have ear disorders and posttraumatic stress disorder. Thirteen percent of women sought care for gynecologic examination, 10% for contraceptive counseling, and 7% for menstrual *** veterans had similar rates of physical conditions, but higher rates of some mental health disorders and additionally, used the va for reproductive health needs. They also had slightly greater rates of health care service use. These findings highlight the complexity of female Veteran health care and support the development of enhanced comprehensive women’s health services within the va.

关键词： ANALYSIS of variance CHI-squared test CONFIdENCE intervals VETERANS MEdICAL care MENTAL health services PROBABILITY theory SEX distribution (demography) REPROdUCTIVE health

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Human factors education for healthcare audiences: Ideas for the way forward

Human factors education for healthcare audiences: Ideas for ...

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55th Human Factors and Ergonomics Society Annual Meeting, HFES 2011

作者： Russ, Alissa L. Militello, Laura G. Saleem, Jason J. Wears, Robert L. Fairbanks, Rollin J. Karsh, Ben-Tzion VA HSR and D Center on Implementing Evidence-Based Practice Roudebush VAMC Indianapolis IN United States Regenstrief Institute Inc. Indianapolis IN United States Center for Health Services and Outcomes Research Indianapolis IN United States Purdue University School of Pharmacy Department of Pharmacy Practice West Lafayette IN United States Applied Decision Science Dayton OH United States University of Dayton Research Institute Dayton OH United States Department of Electrical and Computer Engineering IUPUI Indianapolis IN United States University of Florida FL United States Imperial College of London United Kingdom National Center for Human Factors Engineering in Healthcare Washington DC United Kingdom Georgetown University Department of Emergency Medicine Washington DC United States University of Buffalo Department of Industrial and Systems Engineering Buffalo NY United States University of Wisconsin Madison WI United States

ISBN: (纸本)9780945289395

Within the last decade, there has been a growing emphasis on applying human factors principles in the healthcare domain, and although human factors is a well-established scientific discipline, it is still a relatively new concept for the healthcare community. Educating healthcare audiences on the goals, history, and contributions of the human factors discipline may dispel misconceptions;preserve the integrity of this scientific discipline;inform healthcare stakeholders about the value of human factors research;and increase the uptake of human factors principles in the healthcare domain. Panel members will share their views on human factors education for healthcare audiences, including their past experiences, personal successes, and insights on the challenges that remain. Panelists will also engage the audience in an open discussion to generate novel ideas on how to advance the healthcare community's understanding of the human factors discipline.

关键词： Health care

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Response to Letter by dr. Sciascia

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Pain Medicine 2011年第11期12卷 1693-1693页

作者： MATTHEW J. BAIR Md, MS MARIANNE S. MATTHIAS Phd VA HSR&D Center on Implementing Evidence-Based Practice Roudebush Veterans Affairs Medical Center Indianapolis Indiana Regenstrief Institute Inc. Department of Medicine Indiana University Indianapolis Indiana USA Department of Communication Studies Indiana University-Purdue University Indianapolis

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The Patient-Provider Relationship in Chronic Pain Management: Where do We Go From Here?

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PAIN MEdICINE 2010年第12期11卷 1747-1749页

作者： Matthias, Marianne S. Bair, Matthew J. Richard L Roudebush Vet Affairs Med Ctr VA HSR&D Ctr Implementing Evidence Based Practice Indianapolis IN 46202 USA Indiana Univ Purdue Univ Indianapolis Dept Commun Studies Indianapolis IN USA Indiana Univ Dept Med Bloomington IN 47405 USA

The authors reflect on the study concerning the views of the patients for management and primary care of chronic pain. The authors mention that the study heightens the knowledge of the patients on the troubles associated to chronic pain care. The authors state that the primary care patients determined the negative as well as positive prospects of their relations with the primary care providers. Moreover, the authors say that the study exhibits the problems in patient-provider communication.

关键词： PAIN management CHRONIC pain PRIMARY care (Medicine) MEdICAL care

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A Novel Tool to Track and Analyze Qualitative Usability data: Lessons Learned from the va's Personal Health Record

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Proceedings of the Human Factors and Ergonomics Society Annual Meeting 2010年第16期54卷 1264 - 1268页

作者： Scott A. Russell Jason J. Saleem david A. Haggstrom Alissa L. Russ Neale R. Chumbler VA HSR&D Center on Implementing Evidence-Based Practice Roudebush VAMC Indianapolis IN VA HSR&D Center on Implementing Evidence-Based Practice Roudebush VAMC Indianapolis INIndiana University (IU) Center for Health Services & Outcomes Research Regenstrief Institute Inc. VA HSR&D Center on Implementing Evidence-Based Practice Roudebush VAMC Indianapolis INIndiana University (IU) Center for Health Services & Outcomes Research Regenstrief Institute Inc.Department of Medicine IU School of Medicine Indianapolis IN VA HSR&D Center on Implementing Evidence-Based Practice Roudebush VAMC Indianapolis INDepartment of Sociology IU School of Liberal Arts Indianapolis IN.

We developed a User-Testing database to be able to process a greater amount of user data, from multiple sources of data, at a much finer level of granularity, and to be able to aid in a more sophisticated analysis, including specific queries of usability data than a typical “manual”-based usability analysis. In this paper, we demonstrate our User-Testing database as applied to a usability assessment of the Veterans Affairs (va) My HealtheVet personal health record. The usability test included 24 Veterans who completed a series of scenarios in the usability lab at a Midwest Veterans Affairs Medical center (vaMC). The User-Testing database facilitated reduction of data gathered from video review, facilitator notes, and debrief notes into 1160 observations that were sorted into conceptual bins and summarized for the designers of the personal health record. From creation of the database to completion of the reports took four months and did not require extensive knowledge of qualitative analysis techniques. We argue a User-Testing database can allow other usability studies to increase the number of participants and the granularity of the data without prohibitively increasing the amount of time and experience required to process the data gathered.

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The Workflow of Computerized Medication Ordering in Primary Care is Not Prescriptive

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Proceedings of the Human Factors and Ergonomics Society Annual Meeting 2010年第12期54卷 840 - 844页

作者： Alissa L. Russ Jason J. Saleem M. Sue McManus Richard M. Frankel Alan J. Zillich VA HSR&D Center on Implementing Evidence-Based Practice Roudebush VAMC Indianapolis INIndiana University (IU) Center for Health Services & Outcomes Research Indianapolis IN VA HSR&D Center on Implementing Evidence-Based Practice Roudebush VAMC Indianapolis INDepartment of Electrical & Computer Engineering IUPUI Indianapolis IN Department of Nephrology Roudebush VAMC Indianapolis IN VA HSR&D Center on Implementing Evidence-Based Practice Roudebush VAMC Indianapolis INIndiana University (IU) Center for Health Services & Outcomes Research Indianapolis INDepartment of Medicine IU School of Medicine Indianapolis IN VA HSR&D Center on Implementing Evidence-Based Practice Roudebush VAMC Indianapolis INIndiana University (IU) Center for Health Services & Outcomes Research Indianapolis INPurdue University School of Pharmacy Department of Pharmacy Practice West Lafayette IN.

While the potential benefits of computerized provider order entry (CPOE) are well recognized, little is known about how prescribers have integrated electronic medication ordering into other aspects of patient care. As part of a larger investigation of computerized medication alerts, we observed and opportunistically interviewed 20 primary care prescribers at a major Veterans Affairs Medical center (vaMC). Participants were recruited from each of the vaMC's 5 primary care clinics and included physicians, nurse practitioners, and clinical pharmacists. Prescribers were observed as they ordered mediations via the CPOE system during routine patient care. In total, observations included 91 routine patient encounters across 66.5 hrs of observation. This paper provides illustrative case examples of how prescribers have integrated CPOE into medication decision-making processes and other patient care tasks. Results demonstrate that CPOE workflow varies widely among prescribers. In addition, results indicate that there are trade-offs associated with using CPOE with the patient in the exam room versus outside of the exam room. Findings may have implications for provider-patient relationships, workflow efficiency, and medication safety, and may ultimately enhance the effectiveness of CPOE in primary care.

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