To examine (1) what people say is important to them in choosing a health plan; (2) the effect, if any, that giving health plan information has on what people say is important to them; and (3) the effect of preference elicitation methods on what people say is important.A random sample of 201 Wisconsin state employees who participated in a health plan choice experiment during the 1995 open enrollment period.We designed a computer system to guide subjects through the review of information about health plan options. The system began by eliciting the stated preferences of the subjects before they viewed the information, at time 0. Subjects were given an opportunity to revise their preference structures first after viewing summary information about four health plans (time 1) and then after viewing more extensive, detailed information about the same options (time 2). At time 2, these individuals were also asked to rate the relative importance of a predefined list of health plan features presented to them.Data were collected on the number of attributes listed at each point in time and the importance weightings assigned to each attribute. In addition, each item on the attribute list was content analyzed.The provision of information changes the preference structures of individuals. Costs (price) and coverage dominated the attributes cited both before and after looking at health plan information. When presented with information on costs, quality, and how plans work, many of these relatively well educated consumers revised their preference structures; yet coverage and costs remained the primary cited attributes.Although efforts to provide health plan information should continue, decisions on the information to provide and on making it available are not enough. Individuals need help in understanding, processing, and using the information to construct their preferences and make better decisions.
Technology acceptance is an important predictor of end user technology usage. Perceptions of technology characteristics relating to usability and technical performance are particularly important to understanding user acceptance. This paper reports on the implementation of Smart intravenous infusion pumps at a tertiary care hospital. Nurse user perceptions of the technology usability (five dimensions), technical performance, and acceptance were measured one month after implementation. Overall, 42% of nurses responded positively towards accepting the pump. For 21 of 23 usability characteristics and performance questions, nurses were more likely to report neutral perceptions than positive or negative perceptions. The highest positive perceptions were for ease of learning to operate the pump and reliability of the pump. Six characteristics predicted end-user acceptance. Perceptions that the IV pump enhanced job effectiveness, made the job easier, increased safety of care, and functioned as expected predicted higher acceptance, while perceptions that alarm messages were frustrating and the pump interface was rigid predicted lower acceptance. Therefore, a new finding provided in this study is that highlighting improved patient safety when hospitals implement Smart intravenous infusion pumps may improve user acceptance of the pump.
Care managers play an important role in coordinating care for chronically ill patients. They encounter various barriers related to the use of multiple health information technologies (IT) to access and process patient-related information and coordinate patient care. Using combined interviews and observations with 14 care managers in outpatient physician practices and hospitals, we identified different levels of strategies used by care managers in dealing with health IT-related barriers. These include individual (e.g., using a different system to find necessary information), team (e.g., getting help from other care managers) and organizational (e.g., reporting problems to their supervisor) strategies.
We present a case study of a care coordination program, proven effective in containing costs and improving quality at a large regional health system and its implementation at an independent community hospital participating in a federally-funded regional health IT-mediated care coordination project. We propose that, had tenets of community ergonomics been followed, the implementation and acceptance of the care coordination program would have been smoother and more expeditious.
Guidelines from the Infectious Diseases Society of America/The American Thoracic Society (IDSA/ATS) provide recommendations for diagnosis and treatment of ventilator-associated pneumonia (VAP). However, the mere presence of guidelines is rarely sufficient to promote widespread adoption and uptake. Using the Systems Engineering Initiative for Patient Safety (SEIPS) model framework, we undertook a study to understand barriers and facilitators to the adoption of the IDSA/ATS guidelines. We conducted surveys and focus group discussions of different health care providers involved in the management of VAP. The setting was medical-surgical ICUs at a tertiary academic hospital and a large multispecialty rural hospital in Wisconsin, USA. Overall, we found that 55 % of participants indicated that they were aware of the IDSA/ATS guideline. The top ranked barriers to VAP management included: 1) having multiple physician groups managing VAP, 2) variation in VAP management by differing ICU services, 3) physicians and level of training, and 4) renal failure complicating doses of antibiotics. Facilitators to VAP management included presence of multidisciplinary rounds that include nurses, pharmacist and respiratory therapists, and awareness of the IDSA/ATS guideline. This awareness was associated with receiving effective training on management of VAP, keeping up to date on nosocomial infection literature, and belief that performing a bronchoscopy to diagnose VAP would help with expeditious diagnosis of VAP. Findings from our study complement existing studies by identifying perceptions of the many different types of healthcare workers in ICU settings. These findings have implications for antibiotic stewardship teams, clinicians, and organizational leaders.
