Search

Background: This study explored the characteristics of colorectal cancer (CRC) patients who accessed Internet-based health information as part of their symptom appraisal process prior to consulting a health care provider. Method: Newly diagnosed CRC patients who experienced symptoms prior to diagnosis were interviewed. Brief COPE was used to measure patient coping. Logistic and linear regressions were used to assess Internet use and appraisal delay. Results: Twenty-five percent of the sample (61/242) consulted the Internet prior to visiting a health care provider. Internet use was associated with having private health insurance (odds ratio [OR] = 2.55; 95% confidence interval [CI] = 1.20-5.43) and experiencing elimination symptoms (OR = 1.43; 95% CI = 1.14-1.80) and was marginally associated with age (OR = 0.96; 95% CI = 0.93-0.99). Internet use was not related to delayed medical care seeking. Conclusion: Internet use did not influence decisions to seek medical care. The Internet provided a preliminary information resource for individuals who experienced embarrassing CRC symptoms, had private health insurance, and were younger. (Contains 2 tables.)

Context and Purpose: With heightened attention to medical errors and patient safety, we surveyed Utah and Missouri hospitals to assess the "state of the art" in patient safety systems and identify changes over time. This study examines differences between urban and rural hospitals. Methods: Survey of all acute care hospitals in Utah and Missouri at 2 points in time (2002 and 2004). Factor analysis was used to develop 7 latent variables to summarize the data, comparing rural and urban hospitals at each point in time and on change between the 2 survey times. Findings: On 3 of the 7 latent variables, there was a statistically significant difference between rural and urban hospitals at the first survey, with rural hospitals indicating lower levels of implementation. The differences remained present on 2 of those latent variables at the second survey. In both cases, 1 of those variables was computerized physician order entry (CPOE) systems. Rural hospitals reported more improvement in systems implementation between the 2 survey times, with the difference statistically significant on 1 of the 7 latent variables; the greatest improvement was in implementation of "root cause analysis." Conclusions: Adoption of patient safety systems overall is low. Although rates of adoption among rural versus urban hospitals appear lower, most differences are not statistically significant; the gap between rural and urban hospitals relative to quality measures is narrowing. Change in rural and urban hospitals is in the right direction, with the rate of change higher in rural hospitals for many systems.

Context and Purpose: Medical schools located in states with sizable rural areas are concerned about preparing physicians for practice in these areas; this is of particular concern for medical schools that are part of a state-owned university with a responsibility to educate physicians for rural areas. Because individuals from rural areas are most likely to return to practice medicine in rural areas at the conclusion of their training, it is important to recruit these individuals to medical schools to educate them for rural practice. Methods: This study examines 7 years of admission data for students who applied and were accepted to the University of Missouri-Columbia School of Medicine, which has as a specific mandate to prepare physicians for rural practice. Findings: The study indicates that rural applicants are more likely to be admitted to the medical school, and based on admissions criteria they are at least as academically qualified as nonrural applicants. Conclusions: The study demonstrates that a medical school can maintain competitive admission criteria while at the same time accepting those students more likely to enter rural practice. This is valuable information that medical schools with a similar mission to prepare physicians for rural practice might consider in their admissions decision-making process.

The status of hospital patient safety since the release of the Institute of Medicine (IOM) reports is assessed and the changes over time in 2 states that collaborated on a patient safety funded by the Agency for Healthcare Research and Quality is identified. The status of hospital patient safety systems is revealed not to be close to meeting IOM recommendations and that patient's safety system progress is slow and is a cause for great concern.

Many hospitals may change or add services following the publication of a consumer report. Consumer reports are essentially report cards that rate hospitals and physicians and were created to help consumers choose health care wisely. In Missouri, consumer reports are mandated annually by law. The 1993 report was sent to all Missouri hospitals that provided obstetrical services. One-third to half of the 82 hospitals that responded to a subsequent survey said they had added services that they did not offer prior to the consumer report. Almost half rated the report as helpful and 38% believed it would help consumers., Context.--Consumer reports in health care are a relatively recent phenomenon. Primarily designed to assist consumers in making more informed decisions about their personal health care, they appear to have an important by-product--they led to positive changes in the behavior of clinicians and health care delivery organizations. While there has been much speculation on their impact on health care consumer behavior, consumer reports offer an effective strategy in improving the quality of patient care. Objective.--To examine the impact of an obstetrics consumer report developed and issued by the Missouri Department of Health on hospital behavior. Design and Setting.--A retrospective study of hospital behavior using both primary survey and secondary clinical data. Participants.--Consumer reports were issued in 1993 to all Missouri hospitals providing obstetrical services (n=90). A survey was conducted a year later, and the results were analyzed with other available data to determine the effect of the report. Two hospitals discontinued obstetrical services by the time of the survey; of the remaining 88 hospitals, 82 (93%) responded to the survey. Main Outcome Measures.--The following outcomes were examined: (1) number and percentage of hospitals that previously did not have services at the time report was issued, but had, or planned to have, services after a guide was published; (2) the percentage of obstetrical policies that were changed, planned to change, or are under discussion for change (car seat program, obstetrical follow-up services, formal transfer agreement, nurse educator for breast-feeding, and availability of tubal ligations); and (3) clinical outcomes, including satisfaction, appropriateness of charges, and the rates of cesarean delivery, high-risk infant transfer, ultrasound, vaginal birth after cesarean, very low birth weight, and newborn death. Results.--Within 1 year of the report, approximately 50% of hospitals that did not have car seat programs, formal transfer agreements, or nurse educators for breast-feeding prior to the report either instituted or planned to institute these services. Hospitals in competitive markets that did not offer one of these services at the time of the report were more likely to institute a service and/or were about twice as likely to consider improving several indicators. Clinical outcome indicators all improved in the expected direction. Conclusion.--Public release of consumer reports may be useful not only in assisting consumers to make informed health care choices, but also in facilitating improvement in the quality of hospital services offered and care provided. Changes occur especially in competitive markets.

A more widespread adoption of smoking bans in workplaces could encourage more smokers to quit smoking altogether. Researchers interviewed 1,469 current or former smokers who worked in hospitals in 21 states and 920 current or former smokers who worked in workplaces in the community that did not have smoking bans. In 1993, the agency that accredits hospitals required all hospitals to be smoke-free. The quit rates among hospital employees one year after the smoking ban were almost twice as high as those in the community workers. Quit rates were even higher in hospitals that had voluntarily mandated smoking bans before 1993. Hospital employees also appeared to be further along on the smoking cessation cycle. For example, 30.5% were seriously thinking of quitting, compared to 23.4% in the community. Hospital employees who continued to smoke had reduced their daily cigarette consumption by an average of one cigarette. The hospital industry is the only industry that has implemented a nationwide smoking ban., Objective--To examine the impact of workplace smoking bans on smoking behavior of employees. Participants.--A total of 1469 current or former smokers (interventon group) employed in smoke-free hospitals and 920 current or former smokers (comparison group) employed in non-smoke-free workplaces were surveyed to determine smoking behavior. Design.--This cross-sectional study is part of a larger, ongoing prospective study. The study design was quasi-experimental. We randomly selected sites consisting of a hospital and a corresponding community. Furthermore, we randomly selected subjects from hospitals and their corresponding communities. Main Outcome Measures.--Postban quit ratio and progression along the stages-of-change continuum. Methods.--The Cox proportional hazards model was used to compare the postban quit ratio between the intervention and comparison groups. The Cochran-Mantel-Haenszel analysis of variance statistic was used to compare groups on the stages-of-change variables. Results.--Beginning with the smoking ban and continuing for 5 years after implementation, statistically significant differences in the postban quit ratio were observed between employees of smoke-free hospitals who were smokers and counterparts in the community (P

An overwhelming majority of accredited U.S. hospitals appear to comply with smoking bans in a short period of time. Nearly 93% of 3,327 hospitals surveyed by the American Hospital Association complied with smoking bans in 1992, the first year after the ban went into effect. By 1993, 95.6% of these hospitals had complied with standards set by the Joint Commission on Accreditation of Healthcare Organizations. Hospitals in tobacco-growing states had higher rates of compliance than hospitals in other states, a finding that was unexpected. About 88% of psychiatric and chemical dependency hospitals complied with the ban. The lower compliance with smoking bans among these hospitals may be attributed to the higher priority placed on treating alcohol and drug addiction, while allowing tobacco use., Objective.--To examine compliance and characteristics of hospitals with tobacco control standards enacted by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Design and Setting.--On-site national survey of hospitals as part of routine JCAHO accreditation visits. Participants.--A total of 3327 US hospitals received site visits in 1992 and 1993 and were matched with American Hospital Association Annual Survey of Hospitals data. Main Outcome Measures.--Compliance or noncompliance with tobacco control standards; location in a tobacco-producing state; and organizational characteristics, including provision of psychiatric/alcohol--chemical dependency services. Results.--Two years after implementation, 95.6% of hospitals met the new JCAHO smoking ban standard; 90.9% of hospitals were in compliance with a second smoking standard requiring development and use of medical criteria for physician-ordered exceptions to the ban. Hospitals in tobacco-producing states had higher-than-average rates of compliance when compared with hospitals in other states. Hospitals providing psychiatric and/or substance abuse services had lower-than-average rates of compliance. Conclusion.--this first industry-wide smoking ban has been successful. However, hospitals should consider evaluating the use of medical exceptions to this policy. JAMA. 1995; 274:488-491

Abstract Background Evidence-based preventive services offer profound health benefits, yet Americans receive only half of indicated care. A variety of government and specialty society policy initiatives are promoting the adoption of information technologies to engage patients in their care, such as personal health records, but current systems may not utilize the technology's full potential. Methods Using a previously described model to make information technology more patient-centered, we developed an interactive preventive health record (IPHR) designed to more deeply engage patients in preventive care and health promotion. We recruited 14 primary care practices to promote the IPHR to all adult patients and sought practice and patient input in designing the IPHR to ensure its usability, salience, and generalizability. The input involved patient usability tests, practice workflow observations, learning collaboratives, and patient feedback. Use of the IPHR was measured using practice appointment and IPHR databases. Results The IPHR that emerged from this process generates tailored patient recommendations based on guidelines from the U.S. Preventive Services Task Force and other organizations. It extracts clinical data from the practices' electronic medical record and obtains health risk assessment information from patients. Clinical content is translated and explained in lay language. Recommendations review the benefits and uncertainties of services and possible actions for patients and clinicians. Embedded in recommendations are self management tools, risk calculators, decision aids, and community resources - selected to match patient's clinical circumstances. Within six months, practices had encouraged 14.4% of patients to use the IPHR (ranging from 1.5% to 28.3% across the 14 practices). Practices successfully incorporated the IPHR into workflow, using it to prepare patients for visits, augment health behavior counseling, explain test results, automatically issue patient reminders for overdue services, prompt clinicians about needed services, and formulate personalized prevention plans. Conclusions The IPHR demonstrates that a patient-centered personal health record that interfaces with the electronic medical record can give patients a high level of individualized guidance and be successfully adopted by busy primary care practices. Further study and refinement are necessary to make information systems even more patient-centered and to demonstrate their impact on care. Trial Registration Clinicaltrials.gov identifier: NCT00589173