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Recovery Orientation in Hospital and Community Settings

JOURNAL OF BEHAVIORAL HEALTH SERVICES & RESEARCH 2010年第3期37卷 385-399页

作者： Tsai, Jack Salyers, Michelle P. Indiana Univ Purdue Univ Dept Psychol Indianapolis IN 46202 USA Roudebush VA Med Ctr ACT Ctr Indiana Indianapolis IN USA Roudebush VA Med Ctr Regenstrief Inst Inc Roudebush VAMC & IU Ctr Hlth Serv & Outcomes Res VA HSR&D Ctr Implementing Evidence Based Practice Indianapolis IN USA

There has been an increasing emphasis on community integration, consumer involvement, and recovery-focused treatment;but the extent to which these recovery-oriented principles have been adopted in state hospitals is unknown. This study surveyed 1,150 staff at three state hospitals and 230 staff at four community mental health centers on personal optimism, consumer optimism, and agency recovery orientation. Responses were obtained from 729 (63.4%) hospital staff and 181 (78.7%) community staff. Staff at state hospitals scored significantly lower on all three recovery measures even after controlling for background differences. Treatment setting may be an important factor in the dissemination of recovery-oriented care principles.

关键词： state hospital recovery optimism community mental health centers

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The state of the art in clinical knowledge management: An inventory of tools and techniques

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INTERNATIONAL JOURNAL OF MEdICAL INFORMATICS 2010年第1期79卷 44-57页

作者： Sittig, dean F. Wright, Adam Simonaitis, Linas Carpenter, James d. Allen, George O. doebbeling, Bradley N. Sirajuddin, Anwar Mohammad Ash, Joan S. Middleton, Blackford Univ Texas Sch Hlth Informat Sci UT Mem Hermann Ctr Healthcare Qual & Safety Houston TX 77030 USA Partners Healthcare Syst Boston MA USA Regenstrief Inst Inc Indianapolis IN USA Providence Hlth Syst Portland OR USA VA HSR&D Ctr Implementing Evidence Based Practice Indianapolis IN USA Mem Hermann Hosp Syst Houston TX USA Oregon Hlth & Sci Univ Portland OR 97201 USA

Purpose: To explore the need for, and use of, high-quality, collaborative, clinical knowledge management (CKM) tools and techniques to manage clinical decision support (CdS) content. Methods: In order to better understand the current state of the art in CKM, we developed a survey of potential CKM tools and techniques. We conducted an exploratory study by querying a convenience sample of respondents about their use of specific practices in CKM. Results: The following tools and techniques should be priorities in organizations interested in developing successful computer-based provider order entry (CPOE) and CdS implementations: (1) a multidisciplinary team responsible for creating and maintaining the clinical content;(2) an external organizational repository of clinical content with web-based viewer that allows anyone in the organization to review it;(3) an online, collaborative, interactive, Internet-based tool to facilitate content development;(4) an enterprise-wide tool to maintain the controlled clinical terminology concepts. Even organizations that have been successfully using computer-based provider order entry with advanced clinical decision support features for well over 15 years are not using all of the CKM tools or practices that we identified. Conclusions: If we are to further stimulate progress in the area of clinical decision support, we must continue to develop and refine our understanding and use of advanced CKM capabilities. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

关键词： decision support systems Clinical Medical informatics applications Medical order entry systems Clinical knowledge management

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A novel tool to track and analyze qualitative usability data: Lessons learned from the va's personal health record

A novel tool to track and analyze qualitative usability data...

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

ISBN: (纸本)9781617820885

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.

关键词： Query languages

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Staff Turnover in Statewide Implementation of ACT: Relationship with ACT Fidelity and Other Team Characteristics

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AdMINISTRATION ANd POLICY IN MENTAL HEALTH ANd MENTAL HEALTH SERVICES RESEARCH 2010年第5期37卷 417-426页

作者： Rollins, Angela L. Salyers, Michelle P. Tsai, Jack Lydick, Jennifer M. Indiana Univ Purdue Univ Dept Psychol ACT Ctr Indiana Indianapolis IN 46204 USA Regenstrief Inst Inc Roudebush VAMC VA HSR&D Ctr Implementing Evidence Based Practice Indianapolis IN 46202 USA Yale Univ Sch Med Dept Psychiat Natl Ctr Homelessness Vet West Haven CT 06516 USA Indiana Univ Purdue Univ Dept Psychol ACT Ctr Indiana Indianapolis IN 46202 USA

Staff turnover on assertive community treatment (ACT) teams is a poorly understood phenomenon. This study examined annual turnover and fidelity data collected in a statewide implementation of ACT over a 5-year period. Mean annual staff turnover across all observations was 30.0%. Turnover was negatively correlated with overall fidelity at Year 1 and 3. The team approach fidelity item was negatively correlated with staff turnover at Year 3. For 13 teams with 3 years of follow-up data, turnover rates did not change over time. Most ACT staff turnover rates were comparable or better than other turnover rates reported in the mental health and substance abuse literature.

关键词： Staffing Assertive community treatment Turnover Fidelity Implementation

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Recovery-Oriented Training and Staff Attitudes over Time in Two State Hospitals

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PSYCHIATRIC QUARTERLY 2010年第4期81卷 335-347页

作者： Tsai, Jack Salyers, Michelle P. Lobb, Angela L. Yale Univ Dept Psychiat West Haven CT 06516 USA Natl Ctr Homelessness Vet W Haven West Haven CT 06516 USA ACT Ctr Indiana Indianapolis IN USA Roudebush VAMC VA HSR&D Ctr Implementing Evidence Based Practice Indianapolis IN USA Regenstrief Inst Hlth Care IU Ctr Hlth Serv & Outcomes Res Indianapolis IN USA Indiana Univ Purdue Univ Dept Psychol Indianapolis IN 46205 USA Madison State Hosp Madison IN USA

Recovery attitudes and concepts are often promoted to community mental health staff through educational and in-service trainings, but no study found has examined this in state hospitals. The current observational study aimed to examine the types of recovery-oriented trainings that occurred at two state hospitals over 1 year and subsequent changes in staff recovery attitudes. A total of 184 state hospital staff completed questionnaires assessing their personal optimism, consumer optimism, and agency recovery orientation at baseline and 1 year later. The types of recovery-oriented trainings staff received were categorized as general/inspirational or specific/practical training. Results found that the majority of staff at the two state hospitals received some recovery-oriented training, mostly general/inspirational training. Staff who received specific/practical training had a greater increase in agency recovery attitudes than staff who received only general/inspirational training or no training. However, the more trainings staff had, the higher their consumer optimism. These results suggest state hospitals are incorporating recovery-oriented staff trainings, but more specific trainings may be needed and all staff involved in different levels of care need to be included.

关键词： Recovery Staff training State hospitals Psychiatric rehabilitation

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The workflow of computerized medication ordering in primary care is not prescriptive

The workflow of computerized medication ordering in primary ...

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作者： Russ, Alissa L. Saleem, Jason J. McManus, M. Sue Frankel, Richard M. Zillich, Alan J. 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 Department of Nephrology Roudebush VAMC Indianapolis IN United States Department of Medicine IU School of Medicine Indianapolis IN United States Purdue University School of Pharmacy Department of Pharmacy Practice West Lafayette IN United States

ISBN: (纸本)9781617820885

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.

关键词： decision making

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Integrating Assertive Community Treatment and Illness Management and Recovery for Consumers with Severe Mental Illness

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COMMUNITY MENTAL HEALTH JOURNAL 2010年第4期46卷 319-329页

作者： Salyers, Michelle P. McGuire, Alan B. Rollins, Angela L. Bond, Gary R. Mueser, Kim T. Macy, Veronica R. Roudebush VA Med Ctr VA HSR&D Ctr Implementing Evidence Based Practice Indianapolis IN 46202 USA ACT Ctr Indiana Indianapolis IN USA Indiana Univ Purdue Univ Dept Psychol Indianapolis IN 46205 USA Regenstrief Inst Inc Indianapolis IN USA Dartmouth Coll Hitchcock Med Ctr Dartmouth Med Sch Dept Psychiat Hanover NH 03756 USA Dartmouth Psychiat Res Ctr Lebanon NH USA Dartmouth Coll Hitchcock Med Ctr Dartmouth Med Sch Dept Community & Family Med Hanover NH 03756 USA Recovery Network Unlimited Indianapolis IN USA

This study examined the integration of two evidence-based practices for adults with severe mental illness: Assertive community treatment (ACT) and illness management and recovery (IMR) with peer specialists as IMR practitioners. Two of four ACT teams were randomly assigned to implement IMR. Over 2 years, the ACT-IMR teams achieved moderate fidelity to the IMR model, but low penetration rates: 47 (25.7%) consumers participated in any IMR sessions and 7 (3.8%) completed the program during the study period. Overall, there were no differences in consumer outcomes at the ACT team level;however, consumers exposed to IMR showed reduced hospital use over time.

关键词： Illness management and recovery Assertive community treatment Fidelity Mental illness evidence-based practice

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Investigating the Role of Ischemia vs. Elevated Hydrostatic Pressure Associated with Acute Obstructive Uropathy

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ANNALS OF BIOMEdICAL ENGINEERING 2009年第7期37卷 1415-1424页

作者： Russ, Alissa L. dadarlat, Iunia A. Haberstroh, Karen M. Rundell, Ann E. Purdue Univ Weldon Sch Biomed Engn W Lafayette IN 47907 USA Roudebush VAMC VA HSR&D Ctr Implementing Evidence Based Practice Indianapolis IN USA Brown Univ Div Engn Providence RI 02912 USA

Obstructive uropathy can cause irreversible renal damage. It has been hypothesized that elevated hydrostatic pressure within renal tubules and/or renal ischemia contributes to cellular injury following obstruction. However, these assaults are essentially impossible to isolate in vivo. Therefore, we developed a novel pressure system to evaluate the isolated and coordinated effects of elevated hydrostatic pressure and ischemic insults on renal cells in vitro. Cells were subjected to: (1) elevated hydrostatic pressure (80 cm H2O);(2) ischemic insults (hypoxia (0% O-2), hypercapnia (20% CO2), and 0 mM glucose media);and (3) elevated pressure + ischemic insults. Cellular responses including cell density, lactate dehydrogenase (LdH) release, and intracellular LdH (LdHi), were recorded after 24 h of insult and following recovery. data were analyzed to assess the primary effects of ischemic insults and elevated pressure. Unlike pressure, ischemic insults exerted a primary effect on nearly all response measurements. We also evaluated the data for insult interactions and identified significant interactions between ischemic insults and pressure. Altogether, findings indicate that pressure may sub-lethally effect cells and alter cellular metabolism (LdHi) and membrane properties. Results suggest that renal ischemia may be the primary, but not the sole, cause of cellular injury induced by obstructive uropathy.

关键词： Kidney tubules proximal LLC-PK1 cells Pressure system In vitro

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On Improving Provider decision Making with Enhanced Computerized Clinical Reminders

On Improving Provider Decision Making with Enhanced Computer...

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2nd International Conference on digital Human Modeling held at the HCI International 2009

作者： Wu, Sze-jung Lehto, Mark Yih, Yuehwern Saleem, Jason J. doebbeling, Bradley Purdue Univ Sch Ind Engn W Lafayette IN 47906 USA Richard L Roudebush Vet Affairs Med Ctr VA HSR&D Ctr Implementing Evidence based Practice Indianapolis IN 46202 USA

ISBN: (纸本)9783642028083

A computerized clinical reminder (CCR) system is a type of decision support tool to remind healthcare providers of recommended actions. In our prior Study, we found a linear correlation between resolution time and adherence rate. This correlation implies a potentially biased clinical decision making. This study aimed to redesign the Veterans Affairs (va) CCR system in order to improve providers' situation awareness and decision quality. The CCR redesign incorporated a knowledge-based risk factor repository and a prioritization mechanism. Both CCR designs were prototyped and tested by 16 physicians in a controlled lab in the Indianapolis va Medical center. The results showed that 80% of the subjects changed their prioritization decisions after being introduced to the modified design. Moreover, with the modified design, the correlation between resolution time and adherence rate was no longer found. The redesign improved the subjects' situation awareness and assisted them in making more informed decisions.

关键词： Computerized clinical reminders decision Support system situation awareness

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Study protocol: home-based telehealth stroke care: a randomized trial for veterans

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TRIALS 2010年第1期11卷 74-74页

作者： Chumbler, Neale R. Rose, dorian K. Griffiths, Patricia Quigley, Patricia McGee-Hernandez, Nancy Carlson, Katherine A. vandenberg, Phyllis Morey, Miriam C. Sanford, Jon Hoenig, Helen Richard L Roudebush VA Med Ctr Ctr Excellence Implementing Evidence Based Practi Dept Vet Affairs Hlth Serv Res & Dev HSR&D Indianapolis IN USA Richard L Roudebush VAMC VA HSR&D Stroke Qual Enhancement Res Initiat QUER Indianapolis IN USA Indiana Univ Purdue Univ Dept Sociol Indiana Univ Sch Liberal Arts Indianapolis IN 46202 USA Regenstrief Inst Hlth Care Indianapolis IN USA Univ Florida Coll Publ Hlth & Hlth Profess Dept Phys Therapy Gainesville FL USA N Florida S Georgia Vet Hlth Syst Rehabil Res & Dev RR&D Brain Rehabil Res Ctr Gainesville FL USA Atlanta VAMC Atlanta VA Rehab R&D Ctr Decatur GA USA Emory Univ Sch Med Div Geriatr & Gerontol Atlanta GA USA James A Haley Vet Adm Med Ctr HSR&D RR&D Res Ctr Excellence Maximizing Rehabil Tampa FL 33612 USA Durham VAMC Phys Med & Rehabil Serv Durham NC USA Durham VAMC Geriatr Res Educ & Clin Ctr Durham NC USA Duke Univ Med Ctr Dept Med Durham NC 27710 USA Duke Univ Med Ctr Ctr Study Aging & Human Dev Durham NC 27710 USA Duke Univ Med Ctr Older Amer Independence Ctr Durham NC 27710 USA Georgia Inst Technol Coll Architecture Atlanta GA 30332 USA

Background: Stroke is one of the most disabling and costly impairments of adulthood in the United States. Stroke patients clearly benefit from intensive inpatient care, but due to the high cost, there is considerable interest in implementing interventions to reduce hospital lengths of stay. Early discharge rehabilitation programs require coordinated, well-organized home-based rehabilitation, yet lack of sufficient information about the home setting impedes successful rehabilitation. This trial examines a multifaceted telerehabilitation (TR) intervention that uses telehealth technology to simultaneously evaluate the home environment, assess the patient's mobility skills, initiate rehabilitative treatment, prescribe exercises tailored for stroke patients and provide periodic goal oriented reassessment, feedback and encouragement. Methods: We describe an ongoing Phase II, 2-arm, 3-site randomized controlled trial (RCT) that determines primarily the effect of TR on physical function and secondarily the effect on disability, falls-related self-efficacy, and patient satisfaction. Fifty participants with a diagnosis of ischemic or hemorrhagic stroke will be randomly assigned to one of two groups: (a) TR;or (b) Usual Care. The TR intervention uses a combination of three videotaped visits and five telephone calls, an in-home messaging device, and additional telephonic contact as needed over a 3-month study period, to provide a progressive rehabilitative intervention with a treatment goal of safe functional mobility of the individual within an accessible home environment. dependent variables will be measured at baseline, 3-, and 6-months and analyzed with a linear mixed-effects model across all time points. discussion: For patients recovering from stroke, the use of TR to provide home assessments and follow-up training in prescribed equipment has the potential to effectively supplement existing home health services, assist transition to home and increase efficiency. This may

关键词： Stroke Patient Veteran Health Administration Usual Care Group Exercise Adherence Veteran Affair Medical center

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