Showing papers in "Medical Care Research and Review in 2009"
TL;DR: One of the first empirical studies of the association of help-seeking behavior with both perceived public stigma and people’s own stigmatizing attitudes (personal stigma) is conducted, finding that perceived stigma was considerably higher than personal stigma.
Abstract: Mental illness stigma has been identified by national policy makers as an important barrier to help seeking for mental health. Using a random sample of 5,555 students from a diverse set of 13 unive...
943 citations
TL;DR: Immigrants and their children were less likely to have health insurance and a regular source of care and had lower use than the U.S. born and the foreign born or non-English speakers were less satisfied and reported lower ratings and more discrimination.
Abstract: Inadequate access and poor quality care for immigrants could have serious consequences for their health and that of the overall U.S. population. The authors conducted a systematic search for post-1996, population-based studies of immigrants and health care. Of the 1,559 articles identified, 67 met study criteria of which 77% examined access, 27% quality, and 6% cost. Noncitizens and their children were less likely to have health insurance and a regular source of care and had lower use than the U.S. born. The foreign born or non-English speakers were less satisfied and reported lower ratings and more discrimination. Immigrants incurred lower costs than the U.S. born, except emergency department expenditures for immigrant children. Policy solutions are needed to improve health care for immigrants and their children. Research is needed to elucidate immigrants' nonfinancial barriers, receipt of specific processes of care, cost of care, and health care experiences in nontraditional U.S. destinations.
326 citations
TL;DR: Investigators using EMR data should aim for consistent terminology, focus on adequately describing their methods, and consider appropriate statistical methods to control for confounding and treatment-selection bias, according to experts.
Abstract: This review assessed the use of electronic medical record (EMR) systems in outcomes research. We systematically searched PubMed to identify articles published from January 2000 to January 2007 involving EMR use for outpatient-based outcomes research in the United States. EMR-based outcomes research studies (n = 126) have increased sixfold since 2000. Although chronic conditions were most common, EMRs were also used to study less common diseases, highlighting the EMRs' flexibility to examine large cohorts as well as identify patients with rare diseases. Traditional multi-variate modeling techniques were the most commonly used technique to address confounding and potential selection bias. Data validation was a component in a quarter of studies, and many evaluated the EMR's ability to achieve similar results previously achieved using other data sources. Investigators using EMR data should aim for consistent terminology, focus on adequately describing their methods, and consider appropriate statistical methods to control for confounding and treatment-selection bias.
185 citations
TL;DR: Evidence suggests that consumers tend to choose better performing health plans and providers and are responsive to initiatives that provide quality information, and directions for future work are suggested, including better assessment of the dynamic issues related to information release and how the response to information varies across different groups of patients.
Abstract: This article reviews the literature relating quality to consumer choice of health plan or health care provider. Evidence suggests that consumers tend to choose better performing health plans and providers and are responsive to initiatives that provide quality information. The response to quality and quality information differs significantly among consumers and across population subgroups. As such the effect of quality information on choice is apparent in only a relatively small, though perhaps consequential, number of consumers. Despite the wealth of findings on the topic to date, the authors suggest directions for future work, including better assessment of the dynamic issues related to information release, as well as a better understanding of how the response to information varies across different groups of patients.
177 citations
TL;DR: A systematic review of community-level characteristics such as social capital found a lack of congruence in how social capital was measured and interpreted and a general inconsistency in findings, which made it difficult to draw firm conclusions about the effects of social capital on health care access.
Abstract: There is a growing interest in community-level characteristics such as social capital and its relationship to health care access. To assess the rigor with which this construct has been empirically applied in research on health care access, a systematic review was conducted. A total of 2,396 abstracts were reviewed, and 21 met the criteria of examining some measure of social capital and its effects on health care access. The review found a lack of congruence in how social capital was measured and interpreted and a general inconsistency in findings, which made it difficult to draw firm conclusions about the effects of social capital on health care access. Insights from the social network literature can help improve the conceptual and measurement problems. Future work should distinguish among bonding, bridging, and linking social capital and their sources and benefits, and examine whether three dimensions of social capital actually exist: cognitive, behavioral, and structural.
170 citations
TL;DR: The evidence suggests that nonphysician clinicians working as substitutes or supplements for physicians in defined areas of care can maintain and often improve the quality of care and outcomes for patients.
Abstract: Health care is changing rapidly. Unacceptable variations in service access and quality of health care and pressures to contain costs have led to the redefinition of professional roles. The roles of nonphysician clinicians (nurses, physician assistants, and pharmacists) have been extended to the medical domain. It is expected that such revision of roles will improve health care effectiveness and efficiency. The evidence suggests that nonphysician clinicians working as substitutes or supplements for physicians in defined areas of care can maintain and often improve the quality of care and outcomes for patients. The effect on health care costs is mixed, with savings dependent on the context of care and specific nature of role revision. The evidence base underpinning these conclusions is strongest for nurses with a marked paucity of research into pharmacists and physician assistants. More robust evaluative studies into role revision are needed, particularly with regard to economic impacts, before definitive conclusions can be drawn.
159 citations
TL;DR: The IAT results indicate that these health care preprofessionals exhibit implicit race and skin tone biases: preferences for Whites versus Blacks and light skin versus dark skin.
Abstract: The Institute of Medicine report, Unequal Treatment, asserts that conscious and unconscious bias of providers may affect treatments delivered and contribute to health disparities. The primary study objective is to measure, compare, and contrast objective and subjective cognitive processes among pharmacy, nursing, and medical students to discern potential implications for health disparities. Data were collected using a cultural competency questionnaire and two implicit association tests (IATs). Race and skin tone IATs measure unconscious bias. Cultural competency scores were significantly higher for non-Hispanic Blacks and Hispanics in medicine and pharmacy compared with non-Hispanic Whites. Multiracial nursing students also had significantly higher cultural competency scores than non-Hispanic Whites. The IAT results indicate that these health care preprofessionals exhibit implicit race and skin tone biases: preferences for Whites versus Blacks and light skin versus dark skin. Cultural competency curricula and disparities research will be advanced by understanding the factors contributing to cultural competence and bias.
121 citations
TL;DR: Higher levels of safety climate were significantly associated with higher levels of group and entrepreneurial cultures, while lower levels ofsafety climate were associated withhigher levels of hierarchical culture.
Abstract: Improving safety climate could enhance patient safety, yet little evidence exists regarding the relationship between hospital characteristics and safety climate. This study assessed the relationship between hospitals' organizational culture and safety climate in Veterans Health Administration (VA) hospitals nationally. Data were collected from a sample of employees in a stratified random sample of 30 VA hospitals over a 6-month period (response rate = 50%; n = 4,625). The Patient Safety Climate in Healthcare Organizations (PSCHO) and the Zammuto and Krakower surveys were used to measure safety climate and organizational culture, respectively. Higher levels of safety climate were significantly associated with higher levels of group and entrepreneurial cultures, while lower levels of safety climate were associated with higher levels of hierarchical culture. Hospitals could use these results to design specific interventions aimed at improving safety climate.
116 citations
TL;DR: In this article, the authors reviewed the research literature published between 1990 and February 2008 and concluded that enhancement of the clinical expertise is a potentially effective component of improving the impact of patient care teams.
Abstract: Health care is increasingly provided by teams of health professionals rather than by individual doctors. For decision makers, it is imperative to identify the critical elements for effective teams to transform health care workplaces into effective team-based environments. The authors reviewed the research literature published between 1990 and February 2008. The available research indicated that teams with enhanced clinical expertise improved professional performance and had mixed effects on patient outcomes. Teams with improved coordination had some positive effects on patient outcomes and limited effects on costs and resource utilization. The combination of enhanced expertise and coordination only showed some limited effect on patient outcomes. The authors conclude that enhancement of the clinical expertise is a potentially effective component of improving the impact of patient care teams. The added value of coordination functions remained unclear. Overall, current studies provide little insight into the underlying mechanisms of teamwork.
109 citations
TL;DR: It is found that racial disparities in the use of formal long-term care have decreased over time and market-based incentives policies should explicitly incorporate the goal of mitigating the potential unintended consequence of increased disparities.
Abstract: A growing body of evidence documents pervasive racial, ethnic, and class disparities in long-term care in the United States. At the same time, major quality improvement initiatives are being implemented that rely on market-based incentives, many of which may have the unintended consequence of exacerbating disparities. We review existing evidence on disparities in the use and quality of long-term care services, analyze current market-based policy initiatives in terms of their potential to ameliorate or exacerbate these disparities, and suggest policies and policy modifications that may help decrease disparities. We find that racial disparities in the use of formal long-term care have decreased over time. Disparities in quality of care are more consistently documented and appear to be related to racial and socioeconomic segregation of long-term care facilities as opposed to within-provider discrimination. Market-based incentives policies should explicitly incorporate the goal of mitigating the potential unintended consequence of increased disparities.
96 citations
TL;DR: Estimates based on the independent effect of race/ethnicity were the most conservative accounting of disparities and disparity trends, underlining the importance of the role of SES mediation in the study of trends in disparities.
Abstract: Monitoring disparities over time is complicated by the varying disparity definitions applied in the literature. This study used data from the 1996-2005 Medical Expenditure Panel Survey (MEPS) to compare trends in disparities by three definitions of racial/ethnic disparities and to assess the influence of changes in socioeconomic status (SES) among racial/ethnic minorities on disparity trends. This study prefers the Institute of Medicine's (IOM) definition, which adjusts for health status but allows for mediation of racial/ethnic disparities through SES factors. Black-White disparities in having an office-based or outpatient visit and medical expenditure were roughly constant and Hispanic-White disparities increased for office-based or outpatient visits and for medical expenditure between 1996-1997 and 2004-2005. Estimates based on the independent effect of race/ethnicity were the most conservative accounting of disparities and disparity trends, underlining the importance of the role of SES mediation in the study of trends in disparities.
TL;DR: The article reviews the major approaches used to stimulate consumer engagement in health and health care and explores the concept of activation as a possible organizing construct for informing strategies to increase consumer involvement in health.
Abstract: Current policy directions place high expectations on consumers, pressing them to adopt new roles and behaviors. The price of failing to meet these expectations will be high for the individual, for the care delivery system, and for the society as a whole. Yet there is limited support in place to help consumers meet these expectations. The article reviews the major approaches used to stimulate consumer engagement in health and health care. The concept of activation is explored as a possible organizing construct for informing strategies to increase consumer involvement in health. Illustrative data are presented that show how activation levels are associated with engaging in specific health behaviors. The strategy of measuring activation and calibrating both the type and the amount of support for consumers is discussed as a way to improve current approaches. Tailoring activation to the individual, group, and community level is also explored.
TL;DR: Results of the review indicate that most QI effectiveness research is conducted in hospital settings, is focused on multiple QI interventions, and utilizes process measures as outcomes.
Abstract: This article presents a systematic review of the research methods used to study quality improvement (QI) effectiveness in health care organizations. The review relied on existing literature as well as emergent themes to identify types of QI programs (e.g., data/feedback, information technology, staff education) and quality outcomes (e.g., mortality, morbidity, unnecessary variation). Studies were separated into four categories according to the type of organization in which the QI program was introduced: (a) hospital, (b) nursing home, (c) physician group, and (d) other health care organization. Results of the review indicate that most QI effectiveness research is conducted in hospital settings, is focused on multiple QI interventions, and utilizes process measures as outcomes. The review also yielded substantial variation with respect to the study designs used to examine QI effectiveness. The article concludes with a critique of these designs and suggestions for ways future research could address these shortcomings.
TL;DR: In this paper, the authors investigated differences in health care access and utilization across Latino adults (>18 years), with U.S. Latino adults of Mexican ancestry demonstrating the worst patterns of accessing and utilization.
Abstract: This study hypothesizes that differences in health care access and utilization exist across Latino adults (>18 years), with U.S. Latino adults of Mexican ancestry demonstrating the worst patterns of access and utilization. The analyses use the National Health Interview Survey (NHIS) data from 1999 to 2007 (N = 33,908). The authors first estimate the disparities in health care access and utilization among different categories of Latinos. They also implement Blinder-Oaxaca techniques to decompose disparities into observed and unobserved components, comparing Latinos of Mexican ancestry with non-Mexican Latinos. Latinos of Mexican ancestry consistently demonstrate lower health care access and utilization patterns than non-Mexican Latinos. Health insurance and region of residence were the most important factors that explained observable differences. In contrast, language and citizenship status were relatively unimportant. Although a significant share of these disparities may be explained by observed characteristics, disparities because of unobserved heterogeneity among the different Latino cohorts are also considerable.
TL;DR: The findings suggest that disparities in health care utilization may differ across communities and that residential segregation may be a confounding factor.
Abstract: We compared race disparities in health services use in a national sample of adults from the 2002 Medical Expenditure Panel Survey and data from the Exploring Health Disparities in Integrated Communities Project, a 2003 survey of adult residents from a low-income integrated urban community in Maryland. In the Medical Expenditure Panel Survey data, African Americans were less likely to have a health care visit compared with Whites. However, in the Exploring Health Disparities in Integrated Communities Project, the integrated community, African Americans were more likely to have a health care visit than Whites. The race disparities in the incidence rate of health care use among persons who had at least one visit were similar in both samples. Our findings suggest that disparities in health care utilization may differ across communities and that residential segregation may be a confounding factor.
TL;DR: Attendance at NCI cancer centers is associated with a significant survival benefit for the four major cancers among Medicare beneficiaries and was evident across all levels of comorbidities.
Abstract: Some evidence links cancer outcomes to place of service, but the influence of NCI (National Cancer Institute) cancer centers on outcomes has not been established. We compared mortality for NCI cancer center attendees versus nonattendees. This retrospective cohort study included individuals with incident cancers of the lung, breast, colon/rectum, or prostate from 1998 to 2002 (N = 211,084) from SEER (Surveillance, Epidemiology, and End Results)—Medicare linked data, with claims through 2003. We examined the relation of NCI cancer center attendance with 1- and 3-year all-cause and cancer-specific mortality using multilevel logistic regression models. NCI cancer center attendance was associated with a significant reduction in the odds of 1- and 3-year all-cause and cancer-specific mortality. The mortality risk reduction associated with NCI cancer center attendance was most apparent in late-stage cancers and was evident across all levels of comorbidities. Attendance at NCI cancer centers is associated with a ...
TL;DR: The collected evidence on risk reduction concerns a variety of interventions to reduce medication errors, fall incidents, diagnostic errors, and adverse events in general, and it was difficult to draw generic lessons from this body of research.
Abstract: The aim of this systematic review was (a) to synthesize the evidence on the effectiveness of detection, mitigation, and actions to reduce risks in hospitals and (b) to identify and describe components of interventions responsible for effectiveness. Thirteen literature databases were explored using a structured search and data extraction strategy. All included studies dealing with incident reporting described positive effects. Evidence regarding the effectiveness and efficiency of safety analysis is scarce. No studies on mitigation were included. The collected evidence on risk reduction concerns a variety of interventions to reduce medication errors, fall incidents, diagnostic errors, and adverse events in general. Most studies reported positive effects; however, interventions were often multifaceted, and it was difficult to disentangle their impact. This made it difficult to draw generic lessons from this body of research. More rigorous evaluations are needed, in particular, of continuous learning and safety analysis techniques.
TL;DR: The review suggests that the components of in-home visiting associated with favorable disability outcomes include multiple home visits, geriatric training and experience, health provider collaboration, multidimensional assessment, and theory use.
Abstract: Despite there being a considerable number of meta-analyses and reviews synthesizing the nurse in-home visiting literature, there have been no reviews examining nurse in-home visiting for patients who are already disabled. This article presents a literature review and synthesis of 10 trials targeted on older adults with disability. The review is organized into structure and process components related to the outcome variable disability based on the classic Donabedian model. The review suggests that the components of in-home visiting associated with favorable disability outcomes include multiple home visits, geriatric training and experience, health provider collaboration, multidimensional assessment, and theory use. In contrast, lack of process measures, physician collaboration, training, and specific intervention components targeting disability are associated with ineffective interventions. This review helps provide insight into variables that influence disability outcomes as well as the development of best-practice models of in-home visiting to older adults with existing disability.
TL;DR: More attention to measurement and policy-level interventions will be required to increase the use of proven tools and to achieve significant improvements in the quality of treatment decisions.
Abstract: There is considerable evidence, across different clinical contexts, that treatment decisions are characterized by poor communication, significant knowledge gaps, and a lack of attention to patients' preferences for different health states. Over the past two decades, patient decision aids have been shown to be an effective means to improve the quality of decisions. More recently, the Internet has increased expectations about the impact of information and decision aids on the involvement of patients in decisions. However, there are several challenges to effective dissemination and implementation of decision support interventions, through the Internet or other media. The authors recommend specific policy and research initiatives to facilitate the local and system-level changes necessary to support patients more effectively in making treatment choices. More attention to measurement and policy-level interventions will be required to increase the use of proven tools and to achieve significant improvements in the quality of treatment decisions.
TL;DR: The implementation of prior authorization protocols by each plan was associated with declines in use of advanced imaging procedures, especially during the first year of the program, suggesting that RBM prior authorization initiatives may be a viable approach for addressing concerns about appropriate use ofAdvanced imaging.
Abstract: Since the late 1990s, the use of advanced diagnostic imaging modalities has increased by double-digit rates, outpacing the rate of increase of medical spending overall. In an attempt to assure the appropriate use of advanced imaging procedures, private insurers are increasingly contracting with radiology benefit management programs (RBMs) to reduce overall use and expenditures for radiology services. This article describes the services offered by RBMs and then presents trends in utilization of advanced imaging procedures from three health plans that adopted RBM prior authorization protocols. The implementation of prior authorization protocols by each plan was associated with declines in use of advanced imaging procedures, especially during the first year of the program. Although more rigorous empirical analysis is required in order to draw definitive conclusions, these trends suggest that RBM prior authorization initiatives may be a viable approach for addressing concerns about appropriate use of advanced imaging.
TL;DR: Patients reported higher satisfaction with certain aspects of access to care, providers reported improvements in the quality of service given to patients, and enrollment in Group Health stayed aligned with statewide trends in health care coverage in the 2 years following the redesign.
Abstract: The Institute of Medicine suggests redesigning health care to ensure safe, effective, timely, efficient, equitable, and patient-centered care. The concept of patient-centered access supports these goals. Group Health, a mixed-model health care system, attempted to improve patients’ access to care through the following changes: (a) offering a patient Web site with patient access to patient—physician secure e-mail, electronic medical records, and health promotion information; (b) offering advanced access to primary physicians; (c) redesigning primary care services to enhance care efficiency; (d) offering direct access to physician specialists; and (e) aligning primary physician compensation through incentives for patient satisfaction, productivity, and secure messaging with patients. In the 2 years following the redesign, patients reported higher satisfaction with certain aspects of access to care, providers reported improvements in the quality of service given to patients, and enrollment in Group Health st...
TL;DR: The author defines the patient navigation problem and its probable consequences and argues that research and action are needed to identify underlying organizational structures and behaviors that can make navigation easy or difficult, and assess whether and how policies, regulations, and improvement strategies can influence these structures and behavior.
Abstract: American health care is complex, fragmented, and arcane rather than being patient centered. Many patients have considerable difficulty navigating this system. As a result, care is less timely, safe, effective, and efficient. Since navigation problems are more likely for those who are sicker and less educated, they contribute to inequity. Early solutions proposed for this problem focused on the use of yet another specialized professional, the "navigator," to help individuals find their way through the system so they get the care they need. The author defines the patient navigation problem and its probable consequences and argues that research and action are needed to (a) document the problem empirically, (b) identify underlying organizational structures and behaviors that can make navigation easy or difficult, and (c) assess whether and how policies, regulations, and improvement strategies can influence these structures and behaviors.
TL;DR: Analyzing national data on hospital demographics and quality of care, the authors found little overlap among three different, commonly used approaches for classifying hospitals as safety-net providers.
Abstract: A challenge to investigating quality of care at safety-net hospitals is the absence of a standard method for identifying these hospitals. The authors identified three different, commonly used approaches for classifying hospitals as safety-net providers. Analyzing national data on hospital demographics and quality of care, they found little overlap among these three sets of hospitals. Under two definitions, safety-net providers clearly underperformed on quality compared with non-safety-net providers; under a third definition, results were mixed. How one defines safety-net providers can affect health services research outcomes and policy recommendations.
TL;DR: Assessment of cost differences of liver transplantation and clinical follow-up between the United States and other Organization for Economic Cooperation and Development countries found that health system characteristics differed between the U.S. and other OECD countries.
Abstract: Large cost variations of liver transplantation are reported. The aim of this study was to assess cost differences of liver transplantation and clinical follow-up between the United States and other Organization for Economic Cooperation and Development (OECD) countries. Eight electronic databases were searched, and 2,000 citations published after 1990 with more than 10 transplantations, and with original cost data, were identified. A total of 30 articles included 5,975 liver transplantations. Meta-analysis was used to derive a combined mean using a random-effects model to test for heterogeneity between studies. Estimated mean cost of a U.S. liver transplantation was US$163,438 (US$145,277-181,598) compared to US$103,548 (US$85,514-121,582) for other OECD countries. Patient characteristics, disease characteristics, quality of the health care provider, and methodology could not explain this cost difference. Health system characteristics differed between the U.S. and other OECD countries. Cost differences in liver transplantation between these two groups may be largely explained by health system characteristics.
TL;DR: A great majority of adults believe that the Medicare Part D program is too complicated and most favor some form of simplification, and in multivariate analyses, one of the most consistent predictors is political orientation.
Abstract: Evidence suggests that Medicare Part D plan ownership is “sticky”; beneficiaries are unlikely to change plans from year to year, even when it would be in their financial interest to do so. The comp...
TL;DR: There were no significant differences between Medicaid adults and children and the privately insured in emergency, outpatient, or inpatient hospital use, and the former had significantly lower expenditures.
Abstract: Data from the 2005 Medical Expenditure Panel Survey were used to conduct a disaggregated comparison of utilization and expenditures under Medicaid and private health insurance for low-income adults and children. After adjustment for health status and other factors, Medicaid adults and children had greater use of prescription drugs than the privately insured, but there were no significant differences in prescription expenditures. Adults on Medicaid had lower utilization of office-based medical and dental care and much lower expenditures than the privately insured. Contrary to stereotypes, there were no significant differences between Medicaid adults and children and the privately insured in emergency, outpatient, or inpatient hospital use, and the former had significantly lower expenditures.
TL;DR: The authors sought to develop an approach to measuring patient-centered quality of care using epilepsy as an exemplar and identified 10 patient-generated quality indicators, 5 of which were subsequently rated by an expert panel using a modified RAND appropriateness methodology.
Abstract: As health care systems seek to provide patient-centered care as a cornerstone of quality, how to measure this aspect of quality has become a concern. Previous development of quality indicators for treating individual chronic disease has rarely included patient perspectives on quality of care. Using epilepsy as an exemplar, the authors sought to develop an approach to measuring patient-centered quality of care. They conducted six focus groups with adults with epilepsy. Using qualitative methods, the authors initially identified 10 patient-generated quality indicators, 5 of which were subsequently rated, along with literature-based quality indicators, by an expert panel using a modified RAND appropriateness methodology. The authors discuss similarities and differences in aspects of care patients and providers value as essential for good quality. The process presented in this article may serve as a model for incorporating patient perceptions of quality into the future development of quality indicators for chronic diseases.
TL;DR: Results suggest that CEO compensation was largely unrelated to hospital financial performance, but inflation-adjusted salaries appeared to increase over time independent of hospital performance, and hospital size was positively correlated with CEO compensation.
Abstract: Growing interest in pay-for-performance and the level of chief executive officers' (CEOs') pay raises questions about the link between performance and compensation in the health sector. This study compares the compensation of nonprofit hospital CEOs in Ontario, Canada to the three longest reported and most used measures of hospital financial performance. Our sample consisted of 132 CEOs from 92 hospitals between 1999 and 2006. Unbalanced panel data were analyzed using fixed effects regression. Results suggest that CEO compensation was largely unrelated to hospital financial performance. Inflation-adjusted salaries appeared to increase over time independent of hospital performance, and hospital size was positively correlated with CEO compensation. The apparent upward trend in salary despite some declines in financial performance challenges the fundamental assumption underlying this article, that is, financial performance is likely linked to CEO compensation in Ontario. Further research is needed to understand long-term performance related to compensation incentives.
TL;DR: After adjusting for age, socioeconomic status, and community characteristics, the association between increasing comorbidities and survival remained weaker for Blacks than for Whites, and racial disparity in survival decreased with increasing number of comor bidities.
Abstract: This study investigates differences in the effects of comorbidities on survival in Medicare beneficiaries with prostate cancer. Medicare data were used to assemble a cohort of 65- to 76-year-old Black (n = 6,402) and White (n = 47,458) men with incident localized prostate cancer in 1999 who survived ≥1 year postdiagnosis. Comorbidities were more prevalent among Blacks than among Whites. For both races, greater comorbidity was associated with decreasing survival rates; however, the effect among Blacks was smaller than in Whites. After adjusting for age, socioeconomic status, and community characteristics, the association between increasing comorbidities and survival remained weaker for Blacks than for Whites, and racial disparity in survival decreased with increasing number of comorbidities. Differential effects of comorbidities on survival were also evident when examining different classes of comorbid conditions. Adjusting for treatment had little impact on these results, despite variation in the racial difference in receipt of prostatectomy with differing comorbidity levels.
TL;DR: The study suggests that as organizations encourage more time in the Super User role and develop more positive attitudes about this role, the possibility of positive employee attitudes toward CIS increases.
Abstract: The purpose of this study is to examine the manner in which Super User attitudes toward clinical information systems (CIS) are associated with employee experiences with CIS implementation. Super Users (N = 82), selected by hospital administration to assist in implementation of the new CIS, completed a survey that assessed time spent in the Super User role as well as attitudes toward the role. These data were matched with hospital employee (N = 325) survey data about attitudes toward CIS and its impact on work processes. Time spent in the role of Super User was associated with employee attitudes; Super Users' perceptions about qualifications also predicted employee attitudes, particularly about care outcomes and perceptions about implementation of the CIS. The study suggests that as organizations encourage more time in the Super User role and develop more positive attitudes about this role, the possibility of positive employee attitudes toward CIS increases.