Data quality of general practice electronic health records: the impact of a program of assessments, feedback, and training. (33/160)

OBJECTIVE: The aim of this study was to investigate the impact of a program of repeated assessments, feedback, and training on the quality of coded clinical data in general practice. DESIGN: A prospective uncontrolled intervention study was conducted in a general practice research network. MEASUREMENTS: Percentage of recorded consultations with a coded problem title and percentage of patients receiving a specific drug (e.g., tamoxifen) who had the relevant morbidity code (e.g., breast cancer) were calculated. Annual period prevalence of 12 selected morbidities was compared with parallel data derived from the fourth National Study of Morbidity Statistics from General Practice (MSGP4). RESULTS: The first two measures showed variation between practices at baseline, but on repeat assessments all practices improved or maintained their levels of coding. The period prevalence figures also were variable, but over time rates increased to levels comparable with, or above, MSGP4 rates. Practices were able to provide time and resources for feedback and training sessions. CONCLUSION: A program of repeated assessments, feedback, and training appears to improve data quality in a range of practices. The program is likely to be generalizable to other practices but needs a trained support team to implement it that has implications for cost and resources.  (+info)

Human factors barriers to the effective use of ten HIV clinical reminders. (34/160)

OBJECTIVE: Substantial variations in adherence to guidelines for human immunodeficiency virus (HIV) care have been documented. To evaluate their effectiveness in improving quality of care, ten computerized clinical reminders (CRs) were implemented at two pilot and eight study sites. The aim of this study was to identify human factors barriers to the use of these CRs. DESIGN: Observational study was conducted of CRs in use at eight outpatient clinics for one day each and semistructured interviews were conducted with physicians, pharmacists, nurses, and case managers. MEASUREMENTS: Detailed handwritten field notes of interpretations and actions using the CRs and responses to interview questions were used for measurement. RESULTS: Barriers present at more than one site were (1) workload during patient visits (8 of 8 sites), (2) time to document when a CR was not clinically relevant (8 of 8 sites), (3) inapplicability of the CR due to context-specific reasons (9 of 26 patients), (4) limited training on how to use the CR software for rotating staff (5 of 8 sites) and permanent staff (3 of 8 sites), (5) perceived reduction of quality of provider-patient interaction (3 of 23 permanent staff), and (6) the decision to use paper forms to enable review of resident physician orders prior to order entry (2 of 8 sites). CONCLUSION: Six human factors barriers to the use of HIV CRs were identified. Reducing these barriers has the potential to increase use of the CRs and thereby improve the quality of HIV care.  (+info)

Searching for evidence-based medicine in wound care: an introduction. (35/160)

During the last 10 years, wound care knowledge and treatment options, as well as the amount of information in the literature pertaining to wound and patient treatment options, have expanded rapidly. As a result, clinicians need to be able to review the existing literature with knowledge of the steps involved in evidence-based medicine. By identifying search strategies to improve information retrieval, time can be saved, new knowledge can be obtained, and with an understanding of clinical experience and patient-centered concerns, the best evidence for decision making can be utilized. The information retrieved can be categorized according to the level of evidence and clinical practice guidelines (documents in which an expert panel has reviewed the evidence and interpreted it for patient care) can be measured by the Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument. Learning how to find and interpret the literature not only enhances clinical decision making, but it also may inspire additional inquiries that will add to the existing evidence base.  (+info)

Informatics competencies pre-and post-implementation of a Palm-based student clinical log and informatics for evidence-based practice curriculum. (36/160)

The purpose of this paper is to describe the implementation and evaluation of a two-part approach to achieving informatics competencies: 1) Palm-based student clinical log for documentation of patient encounters; and 2) informatics for evidence-based practice curriculum. Using a repeated-measures, non-equivalent control group design, self-reported informatics competencies were rated using a survey instrument based upon published informatics competencies for beginning nurses. For the class of 2002, scores increased significantly in all competencies from admission to graduation. Using a minimum score of 3 on a scale of 1=not competent and 5=expert to indicate competence, the only area in which it was not achieved was Computer Skills: Education. For 2001 graduates, Computer Skills: Decision Support was also below 3. There were no significant differences in competency scores between 2001 and 2002 graduates. Computer Skills: Decision Support neared significance. Subsequently, the approaches were refined for implementation in the class of 2003.  (+info)

The TEAM evaluation approach to Project FAMUS, a pan-Canadian risk register for primary care. (37/160)

The application of the TEAM--Total Evaluation and Acceptance Methodology--to the development of Project FAMUS--Family Medicine, University of Sherbrooke--is described. Project FAMUS is concerned with the establishment of a pan-Canadian risk register, the data being provided from a network of 800 family physicians distributed across Canada. Emphasis is on the first phase of the project and the overall evaluation strategy.  (+info)

Computer literacy enhancement in the Teaching Hospital Olomouc. Part I: project management techniques. Short communication. (38/160)

Information explosion and globalization make great demands on keeping pace with the new trends in the healthcare sector. The contemporary level of computer and information literacy among most health care professionals in the Teaching Hospital Olomouc (Czech Republic) is not satisfactory for efficient exploitation of modern information technology in diagnostics, therapy and nursing. The present contribution describes the application of two basic problem solving techniques (brainstorming, SWOT analysis) to develop a project aimed at information literacy enhancement.  (+info)

Not so fast! The dark side of computers in health care. (39/160)

There are now computers in numerous health care devices, from thermometers to ventilators, and there are pitfalls to avoid in our increasing dependence on computers. To be useful, information must be delivered in the right context. Computer systems must be protected from worms, viruses, and other harmful code, and they must prevent unauthorized access to data. The source of all underlying decision algorithms must be known and appropriate for the population being served. And there must be contingency plans to mitigate losses caused by system unavailability.  (+info)

Electronic reporting to improve patient safety. (40/160)

BACKGROUND: Limited data are available on the experiences of voluntary event reporting systems to improve patient safety. OBJECTIVE: Development and implementation of educational initiatives to facilitate the use of an electronic reporting system (ERS) in an academic medical center to measure the impact on knowledge of the ERS on reporting behavior and safety attitudes and to evaluate the accuracy of the information being reported. METHODS: A voluntary internal confidential electronic system for reporting safety events was implemented which involved patients and visitors. A multifaceted educational program was developed to promote safety awareness and use of the ERS system. The safety event detail reported for the calendar year 2002 was tracked and trended and central event analyses were performed for five high event clinical areas. A survey was administered to assess safety knowledge and attitudes of patient care personnel. RESULTS: 2843 safety events were entered into the ERS during 2002 with an increase during the course of the year (p = 0.055, linear trend) for all events. Nurses entered 73% of the events and physicians only 2%. 453 events (16%) were unsafe conditions or near misses and 623 (22%) were associated with patient harm. System factors were considered by the reporter as contributing to the event in only a few cases (5%). Central event analysis revealed that 39% of events had coding errors either in event classification, level of impact, or location; significant underreporting was also present. Although survey response rates were low (10.3%), responders showed a high degree of knowledge on general questions of patient safety and an increase in knowledge on use of the ERS (p = 0.0015, linear trend). CONCLUSIONS: Knowledge on the use of the reporting system and the frequency of reported events increased over the first year of the study. More work is needed to involve physicians in reporting, to improve the accuracy of submitted information, and to better prioritize, organize, and streamline event analysis.  (+info)