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Bar-Lev, S., and Harrison, M.I. (2006, January). "Negotiating time scripts during implementation of an electronic medical record." Health Care Management Review 31(1), pp. 1-7.
This article examined tensions at one hospital between clinical work processes and norms and the time use that management and electronic medical record (EMR) designers embedded in the EMR. The negotiations that flowed from these tensions ultimately led to closer alignment between EMR requirements and traditional clinical work patterns. Clinical practice is non-linear and situational and not easily modeled by the predictable, linear sequences favored by software designers. To benefit from health information technology (HIT) projects, managers need to make their expectations for process redesign explicit and compare these to the process scripts embedded in the HIT software. They also need to collaborate with nurse and physician leaders in planning process redesign. Reprints (AHRQ Publication No. 06-R021) are available from AHRQ Publication Clearinghouse.
Bogart, L.M., Collins, R.L., Cunningham, W., and others (2005, September). "The association of partner abuse with risky sexual behaviors among women and men with HIV/AIDS." (AHRQ grant HS08578). AIDS and Behavior 9(3), pp. 325-333.
About 13 percent of people living with HIV/AIDS have experienced relationship violence since their diagnosis. This study found that, among men and women with HIV/AIDS, both perpetrating abuse and being a victim of partner abuse were significantly associated with having unprotected intercourse. Also, any effects of abuse on unprotected sexual behavior may be worsened by substance use. These findings underscore the need for multi-pronged general prevention interventions focusing on reducing sexual risk as well as substance use and violence for all men and women with HIV, conclude the authors. Their findings were based on analysis of data for the Risk and Prevention Survey from the HIV Cost and Services Utilization Study sample of 726 sexually active individuals in 3 gender/orientation groups (286 women, 148 heterosexual men, and 292 gay/bisexual men).
Gallagher, T.H. and Levinson, W. (2005, September). "Disclosing harmful medical errors to patients: A time for professional action." (AHRQ grants HS11898 and HS14012). Archives of Internal Medicine 165, pp. 1819-1824.
The authors of this commentary point out that patients want full disclosure of harmful medical errors, and they recommend steps that the medical profession can take to achieve this goal. First, physicians can reconsider the relationship between malpractice and disclosure, and physicians can seek opportunities to practice disclosure skills. Second, hospitals and other health care organizations can enhance disclosure policies, address disclosure content and timing, and train clinicians in disclosure. Local medical societies and voluntary specialty organizations can educate physicians about malpractice, develop evidence-based guidelines for disclosure, and create and disseminate disclosure training materials. Certifying boards can include patient safety and disclosure in continuing professional development and should test disclosure skills on certification exams. Medical educators can include disclosure education and skills training in required curriculum.
Lyons, K.D., Tickle-Degnen, L., and DeGroat, E.J. (2005, October). "Inferring personality traits of clients with Parkinson's disease from their descriptions of favorite activities." (AHRQ grant HS13292). Clinical Rehabilitation 19, pp. 799-809.
Clients with Parkinson's disease appear to express their personality in their descriptions of favorite activities. Health care practitioners make use of expressive verbal cues to form accurate impressions of the personality of these patients, concludes this study. Six men and six women with Parkinson's disease completed a self-report measure of personality and were individually interviewed regarding their favorite activities. Ninety-nine nurses; doctors; and occupational, physical, or speech therapists viewed 2-minute segments of the videotaped interviews and provided judgments of each individual's personality. Practitioners appropriately used the personality cues found in the clients' favorite activity descriptions to assess the traits of openness to experience and agreeableness and conscientiousness. They used less effective cue strategies for the traits of neuroticism and extraversion.
Roberto, P.N., Mitchell, J.M., and Gaskin, D.J. (2005, Summer). "Plan choice and changes in access to care over time for SSI-eligible children with disabilities." (AHRQ grant HS10912). Inquiry 42, pp. 145-159.
Researchers in this study analyzed data obtained from interviews with about 1,000 caregivers of children with disabilities who were eligible for Supplemental Security Income. The children were enrolled in either a fee-for-service (FFS) or partially capitated District of Columbia Medicaid plan, Health Services for Children with Special Needs, Inc. (HSCSN). Researchers asked the caregivers about problems their children had accessing specialists' care, hospital care, emergency room care, and a regular doctor during the previous 6 months.
More than 70 percent of children in both plans encountered no access problems in all four areas. However, more children in the HSCSN than children in the FFS plan easily obtained specialty care (79 vs. 71 percent) and children in the HSCSN had more consistent access to a regular doctor (84.4 vs. 75.6 percent). More children in the FFS plan experienced persistent problems in obtaining specialty care (more than 9 percent vs. less than 6 percent), care from a regular doctor (6.7 vs. 2.3 percent), and emergency care (5 vs. 2.6 percent).
Slutsky, J.R. and Clancy, C.M. (2005, November). "The Agency for Healthcare Research and Quality's effective health care program: Creating a dynamic system for discovering and reporting what works in health care." American Journal of Medical Quality 20(6), pp. 358-360.
This paper describes the Effective Health Care Program of the Agency for Healthcare Research and Quality, which was launched in 2005. The new program will provide clear and unbiased information about what is known and not known about the effectiveness of existing treatments, including pharmaceutical products. This information will allow consumers, clinicians, payers, and other health care decisionmakers to make informed decisions about treatments. Priority conditions include arthritis and nontraumatic joint disorders, cancer, chronic obstructive pulmonary disease/asthma, dementia (including Alzheimer's disease), depression and other mood disorders, diabetes, ischemic heart disease, peptic ulcer/dyspepsia, pneumonia, and stroke (including control of hypertension). A new Clinical Decisions and Communications Science Center was created to ensure that the program's findings are usable by all those who need them. The program will issue 10 reports on review topics ranging from new diagnostic technologies for evaluation of abnormal breast cancer screening to off-label use of atypical antipsychotic medications. Reprints (AHRQ Publication No. 06-R0212 are available from AHRQ Publication Clearinghouse.
Stone, P., Pastor, D.K., and Harrison, M.I. (2006, January). "Organizational climate: Implications for the home healthcare workforce." Journal for Healthcare Quality 28(1), pp. 4-11.
Organizational climate generally refers to staff members' perceptions of organizational features like decisionmaking, leadership, and norms about work. This article provides a brief review of evidence on organizational factors and employees' perceived organizational climate as they relate to employee and patient outcomes. These relationships are discussed first in broad terms and then in more detail for home health care. The authors highlight similarities and differences in home health care and other health care settings. They also discuss a model of organizational climate that was developed and tested across health care settings, including home health care, along with potential applications for the home health care industry. Reprints (AHRQ Publication No. 06-R020) are available from AHRQ.
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AHRQ Publication No. 06-0035
Current as of April 2006