Search

Objective: To determine whether the Plan of Action for a Case (PACE) tool improved identification of workers at risk of delayed return to work. Design: Prospective cohort of workers with accepted workers' compensation claims in the state of New South Wales, Australia. Interventions: The 41-item PACE tool was completed by the case manager within the first two weeks of a claim. The tool gathered information from the worker, employer and treating practitioner. Multivariate logistic regression models predicted work time loss of at least one and three months. Results: There were 524 claimants with complete PACE information. A total of 195 (37.2%) had work time loss of at least one month and 83 (15.8%) had time loss of at least three months. Being male, injury location, an Orebro Musculoskeletal Pain Screening Questionnaire–Short Form score >50, having a small employer, suitable duties not being available, being certified unfit, and the worker having low one-month recovery expectations predicted time loss of over one month. For three months, injury location, a Short Form Orebro score >50, no return-to-work coordinator, and being certified unfit were significant predictors. The model incorporating PACE information provided a significantly better prediction of both one- and three-month outcomes than baseline information (area-under-the-curve statistics—one month: 0.85 and 0.68, respectively; three months: 0.85 and 0.69, respectively; both P < 0.001) Conclusion: The PACE tool improved the ability to identify workers at risk of ongoing work disability and identified modifiable factors suited to case manager–led intervention. [ABSTRACT FROM AUTHOR]

Abstract The Clinical Information Access Program (CIAP), an online evidence retrieval system, provides NSW health professionals in public hospitals with 24 h access to information supporting evidence-based practice. To assess the frequency and type of CIAP usage by senior and junior medical staff and doctors’ attitudes to CIAP. A convenience sample of 25% of doctors from 65 randomly selected public hospitals completed a survey. Junior ( n = 392) and senior ( n = 684) doctors’ responses were compared usingχ2 analyses and t-tests. Most doctors had heard of CIAP (71.8%) and 60.6% had used it. More junior (72.4%) than senior (53.8%) doctors had used CIAP and junior doctors found it easier to use. Of the users 93.5% believed CIAP had the potential to improve patient care; 55.2% had directly experienced this. Most usage (61.5%) occurred at point-of-care; 74% of users found all/most of the information they sought and 71.6% found the search time to be‘good/excellent’. Users had increased their usage in the past year and predicted increased future usage. The most popular databases were Medline and MIMS. Age, access to other evidence, and lack of training, time and computer skills were associated with non-usage. Junior and senior users differed in 4 of 15 reasons for using CIAP. CIAP is used and valued by the majority of doctors. Patterns of usage, online experiences and the attitudes toward CIAP of senior doctors who use CIAP are relatively similar to those of junior doctors. (Intern Med J 2005; 35: 399–404) [ABSTRACT FROM AUTHOR]

Background: Online evidence retrieval systems are a potential tool in supporting evidence-based practice. Effective and tested techniques for assessing the impact of these systems on care delivery and patient outcomes are limited., Purpose and Methods: In this study we applied the critical incident (CI) and journey mapping (JM) techniques to assess the integration of an online evidence system into everyday clinical practice and its impact on decision making and patient care. To elicit incidents semi-structured interviews were conducted with 29 clinicians (13 hospital physician specialists, 16 clinical nurse consultants (CNCs)) who were experienced users of the online evidence system. Clinicians were also asked questions about how they had first used the system and how their use and experiences had changed over time. These narrative accounts were then mapped and scored using the journey mapping technique., Results: Clinicians generated 85 critical incidents. Three categories of impact were identified: impact on clinical practice, impact on individual clinicians and impact on colleagues through the dissemination of information gained from the online evidence system. One quarter of these included specific examples of system use leading to improvements in patient care. Clinicians obtained an average journey mapping score of 22 out of a possible score of 36, demonstrating a good level of system integration. Average scores of doctors and CNCs were similar. However individuals with the same scores often had very different journeys in system integration., Conclusions: The CI technique provided clear examples of the way in which system use had influenced practice and care delivery. The JM technique was found to be a useful method for providing a quantification of the different ways and extent to which, clinicians had integrated system use into practice, and insights into how system use can influence organisational culture. The development of the journey mapping stages provides a structure by which the program logic of a clinical information system and its desired outcomes can be made explicit and be based upon users' experiences in everyday practice. Further work is required using this technique to assess its value as an evaluation method.