Search

Introduction: Differences in after-hours capability or performance of ST-elevation myocardial infarction (STEMI) centers has the potential to impact outcomes of patients presenting outside of regular hours. Methods: Using a prospective observational study, we analyzed all 1,247 non-transfer STEMI patients treated in 15 percutaneous coronary intervention (PCI) facilities in Dallas, Texas, during a 24-month period (2010-2012). Controlling for confounding factors through a variety of statistical techniques, we explored differences in door-to-balloon (D2B) and in-hospital mortality for those presenting on weekends vs. weekdays and business vs. after hours. Results: Patients who arrived at the hospital on weekends had larger D2B times compared to weekdays (75 vs. 65 minutes; KW=48.9; p16 minutes longer than those who arrived during business hours and a higher likelihood of mortality (OR 2.23, CI [1.15-4.32], p

Introduction: This study examines barriers and disparities in the intentions of American citizens, when dealing with stroke symptoms, to call 911. This study hypothesizes that low socioeconomic populations are less likely to call 911 in response to stroke recognition. Methods: The study is a cross-sectional design analyzing data from the Centers for Disease Control’s 2009 Behavioral Risk Factor Surveillance Survey, collected through a telephone-based survey from 18 states and the District of Columbia. The study identified the 5 most evident stroke-warning symptoms based on those given by the American Stroke Association. We conducted appropriate weighting procedures to account for the complex survey design. Results: A total of 131,988 respondents answered the following question: “If you thought someone was having a heart attack or a stroke, what is the first thing you would do?” A majority of those who said they would call 911 were insured (85.1%), had good health (84.1%), had no stroke history (97.3%), had a primary care physician (PCP) (81.4%), and had no burden of medical costs (84.9%). Those less likely to call 911 were found in the following groups: 65 years or older, men, other race, unmarried, less than or equal to high school degree, less than $25,000 family income, uninsured, no PCP, burden of medical costs, fair/poor health, previous history of strokes, or interaction between burden of medical costs and less than $50,000 family income (p

Objective: To assess academic emergency medicine (EM) chairs’ perceptions of quality improvement (QI) training programs.Methods: A voluntary anonymous 20 item survey was distributed to a sample of academic chairs of EM through the Association of Academic Chairs of Emergency Medicine. Data was collected to assess the percentage of academic emergency physicians who had received QI training, the type of training they received, their perception of the impact of this training on behavior, practice and outcomes, and any perceived barriers to implementing QI programs in the emergency department.Results: The response rate to the survey was 69% (N = 59). 59.3% of respondents report that their hospital has a formal QI program for physicians. Chairs received training in a variety of QI programs. The type of QI program used by respondents was perceived as having no impact on goals achieved by QI (χ2 = 12.382; p = 0.260), but there was a statistically significant (χ2 = 14.383; p = 0.006) relationship between whether or not goals were achieved and academic EM chairs’ perceptions about return on investment for QI training. Only 22% of chairs responded that they have already made changes as a result of the QI training. 78.8% of EM chairs responded that quality programs could have a significant positive impact on their practice and the healthcare industry. Chairs perceived that QI programs had the most potential value in the areas of understanding and reducing medical errors and improving patient flow and throughput. Other areas of potential value of QI include improving specific clinical indicators and standardizing physician care.Conclusion: Academic EM chairs perceived that QI programs were an effective way to drive needed improvements. The results suggest that there is a high level of interest in QI but a low level of adoption of training and implementation.[West J Emerg Med. 2010; 11(5):479-485.]

Byline: Jungyoon Kim, Jami L. DelliFraine, Kathryn H. Dansky, Karl J. McCleary The purpose of this study is to compare two theories of technology adoption, the technology acceptance model and the theory of planned behaviour, to explain and predict physicians' acceptance and use of the telehomecare technology. We administered a two-part survey to 40 physicians using telemedicine. We constructed two structural equation models to examine the association between perceived ease of use, perceived usefulness, social norms, attitudes, perceived behavioural control, intentions, and actual use of telemedicine. The results of this study suggest that the theory of planned behaviour better explains physicians' actual use of telemedicine.

Byline: Jami L. DelliFraine, James R. Langabeer II Organisational quality improvement techniques have been gaining acceptance in industry over the last few decades, although the extent of their utilisation is highly variable. Most of the evidence of their potential has been within the manufacturing sector, and it is unclear whether they have scope or value outside of manufacturing. We examine two quality improvement initiatives, Lean and Six Sigma, to assess adoption from an institutional theory perspective in the healthcare industry. Findings from our survey of 118 organisations suggest that these quality initiatives have higher levels of rhetoric than actual results. From an institutional theory perspective, results suggest that early adopters of these quality techniques will have a different focus or emphasis than late adopters, and that the focus changes overtime from clinical projects to administrative projects. Implications suggest a need for greater emphasis on change management to mitigate the perceived internal sources of resistance.

Byline: Jami L. DelliFraine, Kathryn H. Dansky, Jill S. Rumberger This study investigates the relationship between telemedicine Knowledge Management (KM) activities and nurses' perceived efficiency and effectiveness of telemedicine in home health. Drawing from KM concepts, we propose that nurses who engage more frequently in telemedicine KM activities perceive telemedicine to contribute to efficiency and effectiveness of care. Primary data were collected from 917 nurses from 2004-2005. Results indicate a significant association between combined explicit and tacit KM activities using telemedicine and perceived efficiency and effectiveness of telemedicine. We conclude that telemedicine KM activities have a positive impact on perceived efficiency and effectiveness of care in home health.

Background: Human resource (HR) practices, such as training and communication, have been linked to positive employee job commitment and lower turnover intent for direct care workers (DCWs). Not many studies have looked at the combined interaction of HR practices and organizational structure. Purpose: The aim of this study is to examine the relationship between organizational structure (centralization, formalization, and span of control) and HR practices (training, horizontal communication, and vertical communication) on DCW's job satisfaction and turnover intent. Methodology: Data were collected from 58 long-term care facilities in five states. We used latent class analysis to group facility characteristics into three sets of combinations: "organic," "mechanistic," and "minimalist." We used multivariate regression to test the relationship of each of these groups on DCW's job satisfaction and turnover intent. Findings: After controlling for state, organizational, and individual covariates, the organic group, which represents decentralized and less formalized structures and high levels of job training and communication, was positively related to job satisfaction and negatively related to intent to leave. On the other hand, the minimalist group, which is characterized by low levels of job-related training and communication, showed no significant differences from the mechanistic group (referent) on job satisfaction and intent to leave. Practice Implications: These findings imply that managers in long-term care facilities may want to consider adopting organic, decentralized structures and HR practices to retain DCWs. [ABSTRACT FROM AUTHOR]

The article discusses the study which found that local health departments have improved the areas which would further develop the Public Health Preparedness (PHP) infrastructure. However, some efforts are still fragmented and barriers in collaboration and bureaucratic impediments still persists. It recommends the performance metrics to quantify outcomes of the public health preparedness programs including the current capacity and the capabilities of the local health departments in Texas.

Objective: Nearly $7 billion has been invested through national cooperative funding since 2002 to strengthen state and local response capacity. Yet, very little outcome evidence exists to analyze funding effectiveness. The objective of this research is to analyze the relationship between investment (funding) and capacity (readiness) for public health preparedness (PHP). The aim of the authors is to use a management framework to evaluate capacity, and to explore the "immediacy bias" impact on investment stability., Design: This study employs a longitudinal study design, incorporating survey research of the entire population of 68 health departments in the state of Texas., Methods: The authors assessed the investment-capacity relationship through several statistical methods. The authors created a structural measure of managerial capacity through principal components analysis, factorizing 10 independent variables and augment this with a perceived readiness level reported from PHP managers. The authors then employ analysis of variance, correlation analyses, and other descriptive statistics., Results: There has been a 539 percent coefficient of variation in funding at the local level between the years 2004 and 2008, and a 63 percent reduction in total resources since the peak of funding, using paired sample data. Results suggest that investment is positively associated with readiness and managerial capacity in local health departments. The authors also find that investment was related to greater community collaboration, higher adoption of Incident Command System (ICS) structure, and more frequent operational drills and exercises., Conclusions: Greater investment is associated with higher levels of capacity and readiness. The authors conclude from this that investment should be stabilized and continued, and not be influenced by historical cognitive biases.

Students beginning a career in healthcare administration must possess an array of professional and management skills in addition to a strong fundamental understanding of the field of healthcare administration. Proficient computer skills are a prime example of an essential management tool for healthcare administrators. However, it is unclear which computer skills are absolutely necessary for healthcare administrators and the extent of congruency between the computer skills possessed by new graduates and the needs of senior healthcare professionals. Our objectives in this research are to assess which computer skills are the most important to senior healthcare executives and recent healthcare administration graduates and examine the level of agreement between the two groups. Based on a survey of senior healthcare executives and graduate healthcare administration students, we identify a comprehensive and pragmatic array of computer skills and categorize them into four groups, according to their importance, for making recent health administration graduates valuable in the healthcare administration workplace. Traditional parametric hypothesis tests are used to assess congruency between responses of senior executives and of recent healthcare administration graduates. For each skill, responses of the two groups are averaged to create an overall ranking of the computer skills. Not surprisingly, both groups agreed on the importance of computer skills for recent healthcare administration graduates. In particular, computer skills such as word processing, graphics and presentation, using operating systems, creating and editing databases, spreadsheet analysis, using imported data, e-mail, using electronic bulletin boards, and downloading information were among the highest ranked computer skills necessary for recent graduates. However, there were statistically significant differences in perceptions between senior executives and healthcare administration students as to the extent of computer skills required in areas such as word processing, graphics and presentation, spreadsheet analysis, using imported data, and working with local area networks (LANs).