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Additional file 6: Supplement 6. Guideline SummaryR0.docx

Additional file 8: Supplement 8. Patient Activation Guide Pre-Testing R0.docx

Additional file 4: Supplement 4. Needs Assessment - Med ReconciliationR0.docx

Additional file 5: Supplement 5. Matrices of Change ObjectivesR0.docx

Additional file 10: Supplement 10. Anticoagulation Nurse ProtocolsR0.docx

Additional file 3: Supplement 3. Needs Assessment - Literature ReviewR0.docx

Additional file 9: Supplement 9. Patient Activation GuideR0.docx

Additional file 7: Supplement 7. Clinician Letter TemplatesR0.docx

Additional file 1: Supplement 1. STARI Statement R0.docx

Additional file 2: Supplement 2. Needs Assessment Patient InterviewsR0.docx

Authors’ original file for figure 1

OBJECTIVE: To assess the economic effect and cost effectiveness of a targeted catheter-associated urinary tract infection (CAUTI) prevention intervention in the nursing home (NH) setting. DESIGN: Randomized clinical trial. SETTING: Community-based NHs (N=12). PARTICIPANTS: NH residents with indwelling urinary catheters (N=418). INTERVENTION: Standard care versus infection prevention program involving barrier precautions, active surveillance, and NH staff education. MEASUREMENTS: Costs of the intervention, costs of disease, and health outcomes were used to calculate an incremental cost-effectiveness ratio for the intervention. Data came from intervention results and the literature and outcomes were analyzed over one year. RESULTS: A 120-bed NH would have program costs of $20,279/year. The cost of disease treatment would be reduced by $54,316 per year, resulting in a $34,037 net cost savings. Most of this savings would come from fewer CAUTI hospitalizations ($39,180), with $15,136 in savings from CAUTI care within the NH. The intervention also yielded a gain of 0.197 quality-adjusted life-years (QALYs). Taking into account uncertainty in all parameters suggests there is an 85% chance that the intervention is cost-saving. CONCLUSIONS: The CAUTI prevention program is expected to benefit payers by reducing costs and improving health outcomes. Because the savings accrue to payers and not to NHs, payers such as Medicare and private insurers may want to provide incentives for NHs to implement such programs.

Background: Communication failures between physicians and nurses are one of the most common causes of adverse events for hospitalized patients, as well as a major root cause of all sentinel events. Communication technology (ie, the electronic medical record, computerized provider order entry, email, and pagers), which is a component of health information technology (HIT), may help reduce some communication failures but increase others because of an inadequate understanding of how communication technology is used. Increasing use of health information and communication technologies is likely to affect communication between nurses and physicians. Objective: The purpose of this study is to describe, in detail, how health information and communication technologies facilitate or hinder communication between nurses and physicians with the ultimate goal of identifying how we can optimize the use of these technologies to support effective communication. Effective communication is the process of developing shared understanding between communicators by establishing, testing, and maintaining relationships. Our theoretical model, based in communication and sociology theories, describes how health information and communication technologies affect communication through communication practices (ie, use of rich media; the location and availability of computers) and work relationships (ie, hierarchies and team stability). Therefore we seek to (1) identify the range of health information and communication technologies used in a national sample of medical-surgical acute care units, (2) describe communication practices and work relationships that may be influenced by health information and communication technologies in these same settings, and (3) explore how differences in health information and communication technologies, communication practices, and work relationships between physicians and nurses influence communication. Methods: This 4-year study uses a sequential mixed-methods design, beginning with a quantitative survey followed by a two-part qualitative phase. Survey results from aim 1 will provide a detailed assessment of health information and communication technologies in use and help identify sites with variation in health information and communication technologies for the qualitative phase of the study. In aim 2, we will conduct telephone interviews with hospital personnel in up to 8 hospitals to gather in-depth information about communication practices and work relationships on medical-surgical units. In aim 3, we will collect data in 4 hospitals (selected from telephone interview results) via observation, shadowing, focus groups, and artifacts to learn how health information and communication technologies, communication practices, and work relationships affect communication. Results: Results from aim 1 will be published in 2016. Results from aims 2 and 3 will be published in subsequent years. Conclusions: As the majority of US hospitals do not yet have HIT fully implemented, results from our study will inform future development and implementation of health information and communication technologies to support effective communication between nurses and physicians. [JMIR Res Protoc 2015;4(2):e72]