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Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

To facilitate follow-up of critical test results across transitions in patient care settings, we implemented an electronic discharge module that enabled care providers to include follow-up recommendations in the discharge instructions. We assessed the impact of this module on documentation of follow-up recommendations for critical imaging findings in Emergency Department (ED) discharge instructions. We studied 240 patients with critical imaging findings discharged from the ED before (n = 80) and after (n = 160) implementation of the module. We manually reviewed hand-written forms and electronic discharge instructions to determine if follow-up recommendations were documented. Follow-up recommendations in ED discharge instructions increased from 60.0% (48/80) to 73.8% (118/160) post-module implementation (p = 0.03), a relative increase of 23%. There was no significant change in the rate of documented critical imaging findings in the discharge instructions (77.5% [62/80] before the intervention and 76.9% [123/160] after the intervention; p = 0.91). Implementation of a discharge module was associated with increased documentation of critical imaging finding follow-up recommendations in ED discharge instructions. However, one in four patients still did not receive adequate follow-up recommendations, suggesting further opportunities for performance improvement exist.

As evidence-based design (EBD) emerges as a model of design practice, considerable attention has been given to its research component. However, this overshadows another essential component of EBD-the change agent, namely the designer. EBD introduced a new skill set to the practitioner: the ability to interact with scientific evidence. Industry sources suggest adoption of the EBD approach across a large number of design firms. How comfortable are these designers in integrating research with design decision making? Optimizing the interaction between the primary change agent (the designer) and the evidence is crucial to producing the desired outcomes. Preliminary to examining this question, an architectural design studio was used as a surrogate environment to examine how designers interact with evidence. Twelve students enrolled in a healthcare EBD studio during the spring of 2009. A three-phase didactic structure was adopted: knowing a hospital, knowing the evidence, and designing with knowledge and evidence. Products of the studio and questionnaire responses from the students were used as the data for analysis. The data suggest that optimization of the research-design relationship warrants consideration in four domains: (1) a knowledge structure that is easy to comprehend; (2) phase-complemented representation of evidence; (3) access to context and precedence information; and (4) a designer-friendly vocabulary.

Objective: In 2002 buprenorphine (Suboxone or Subutex) was approved by the U.S. Food and Drug Administration for office-based treatment of opioid addiction. The goal of office-based pharmacotherapy is to bring more opiate-dependent people into treatment and to have more physicians address this problem. This study examined prescribing practices for buprenorphine, including facilitators and barriers, and the organizational settings that facilitate its being incorporated into treatment., Methods: Addiction specialists and other psychiatrists in four market areas were surveyed by mail and Internet in fall 2005 to examine prescribing practices for buprenorphine. Respondents included 271 addiction specialists (72% response rate) and 224 psychiatrists who were not listed as addiction specialists but who had patients with addictions in their practice (57% response rate)., Results: Three years after approval of buprenorphine for office-based addiction treatment, nearly 90% of addiction specialists had been approved to prescribe it and two-thirds treated patients with buprenorphine. However, fewer than 10% of non-addiction specialist psychiatrists prescribed it. Regression-adjusted factors predicting prescribing of buprenorphine included support of training and use of buprenorphine by the physician's main affiliated organization, less time in general psychiatry compared with addictions treatment, more time in group practice rather than solo, ten or more opiate-dependent patients, belief that drugs play a large role in addiction treatment, and patient demand., Conclusions: Office-based pharmacotherapy offers a promising path to improved access to addictions treatment, but prescribing has expanded little beyond the addiction specialist community.