Search PubMed⌕ Search

Biomedical subjects

Suzanne Bakken

Publications and source records attributed to Suzanne Bakken.

At least 73 records · Page 4Linked to original sources
PubMed2002

Economic evidence for evidence-based practice.

PURPOSE: To explicate (a) the types of economic analyses available to nurses, (b) the measurement of costs in different types of economic evaluations, (c) recommendations for standardization, and (d) the assessment of economic evaluations for evidence-based practice. METHODS: Five types of economic analyses are reviewed. Recommendations for standardization of cost-effectiveness analyses are included as well as a worksheet for use in critiquing economic evaluations for validity and applicability to clinical settings. FINDINGS: Limited knowledge and a lack of consistent approaches to economic analyses are evident in the nursing and health care literature. However, nurses have not contributed to the conduct of rigorous economic evaluations or research to the extent found in other health care disciplines. CONCLUSIONS: Basing nursing practice on the best available evidence is now the expected standard of care. Applying economic evidence to practice requires understanding the methods used to conduct economic evaluations and to analyze the rigor of such evaluations.

Cost-Benefit Analysis↗
PubMed2002

Information model and terminology model issues related to goals.

Goal statements are a significant component of structures that support the process of health care delivery such as practice guidelines, standards of care, critical pathways, disease management plans, patient education plans, and nursing care plans. Although these structures are increasingly computer-based, there has been little attention to the formal representation of goal statements. This is a necessary prerequisite for enabling semantic interoperability. Existing and evolving information model and terminology model standards offer some approaches that may be applicable to goal statements, however, a number of issues require resolution

Goals↗
PubMed2002

Theoretical, empirical and practical approaches to resolving the unmet information needs of clinical information system users.

We hypothesize that when clinicians review clinical data in an electronic medical record, the information needs that arise are predictable, based on a number of situational factors. Because our theory does not say, exactly, what those needs are, we are using an empirical approach (observation) to detecting and categorizing them. For each need, we can construct an "infobutton" that links the clinical data to an on-line information resource. We have constructed an Infobutton Manager to match the data being reviewed by clinicians with context-appropriate infobuttons. This paper describes how the theory, observations, and practical solutions can come together to improve clinician decision making by resolving information needs.

Decision Making, Computer-Assisted↗
PubMedDate not supplied

Mining complex clinical data for patient safety research: a framework for event discovery.

Successfully addressing patient safety requires detecting medical events effectively. Given the volume of patients seen at medical centers, detecting events automatically from data that are already available electronically would greatly facilitate patient safety work. We have created a framework for electronic detection. Key steps include: selecting target events, assessing what information is available electronically, transforming raw data such as narrative notes into a coded format, querying the transformed data, verifying the accuracy of event detection, characterizing the events using systems and cognitive approaches, and using what is learned to improve detection.

Database Management Systems↗
PubMedDate not supplied

Representing nursing assessments in clinical information systems using the logical observation identifiers, names, and codes database.

In recent years, the Logical Observation Identifiers, Names, and Codes (LOINC) Database has been expanded to include assessment items of relevance to nursing and in 2002 met the criteria for "recognition" by the American Nurses Association. Assessment measures in LOINC include those related to vital signs, obstetric measurements, clinical assessment scales, assessments from standardized nursing terminologies, and research instruments. In order for LOINC to be of greater use in implementing information systems that support nursing practice, additional content is needed. Moreover, those implementing systems for nursing practice must be aware of the manner in which LOINC codes for assessments can be appropriately linked with other aspects of the nursing process such as diagnoses and interventions. Such linkages are necessary to document nursing contributions to healthcare outcomes within the context of a multidisciplinary care environment and to facilitate building of nursing knowledge from clinical practice. The purposes of this paper are to provide an overview of the LOINC database, to describe examples of assessments of relevance to nursing contained in LOINC, and to illustrate linkages of LOINC assessments with other nursing concepts.

Computational Biology↗
PubMedDate not supplied

Formal nursing terminology systems: a means to an end.

In response to the need to support diverse and complex information requirements, nursing has developed a number of different terminology systems. The two main kinds of systems that have emerged are enumerative systems and combinatorial systems, although some systems have characteristics of both approaches. Differences in the structure and content of terminology systems, while useful at a local level, prevent effective wider communication, information sharing, integration of record systems, and comparison of nursing elements of healthcare information at a more global level. Formal nursing terminology systems present an alternative approach. This paper describes a number of recent initiatives and explains how these emerging approaches may help to augment existing nursing terminology systems and overcome their limitations through mediation. The development of formal nursing terminology systems is not an end in itself and there remains a great deal of work to be done before success can be claimed. This paper presents an overview of the key issues outstanding and provides recommendations for a way forward.

Information Systems↗
PubMedDate not supplied

Developing, implementing, and evaluating decision support systems for shared decision making in patient care: a conceptual model and case illustration.

The importance of including patient preferences in decisions regarding their care has received increased emphasis over recent years. Medical informatics can play an important role in improving patient-centered care by developing decision support systems to support the inclusion of patient preferences in clinical decision making. However, development of such systems is a complex task that requires the integration of knowledge from four major research areas: (1) the clinical domain, for understanding of the decision problem, (2) decision science and research on shared decision making, to provide the theoretical underpinnings and techniques for eliciting patient preferences; (3) medical informatics, to provide the technology and algorithms for the collection, processing, structure, presentation and integration of patient preferences into patient care; and (4) organizational knowledge, to adapt the decision support system to the practices and work flows of clinicians and the organizational and professional context of the clinical practice settings. This paper describes a conceptual model comprising eight key components that are important to be considered in the development, implementation, and evaluation of decision support systems for shared decision making in patient care. The example of CHOICE, a decision support system to assist nurses in eliciting and integrating rehabilitation patients' preferences for functional performance in patient care is used to illustrate the eight components.

Choice Behavior↗
PubMedDate not supplied

Breast cancer knowledge assessment in female Chinese immigrants in New York.

The purpose of this study was to examine the relationships between acculturation level and perceptions of health access, Chinese health beliefs, Chinese health practices, and knowledge of breast cancer risk. This descriptive, correlational cross-sectional study used a survey approach. The sample included 135 Chinese women from the New York City metropolitan area. Data were analyzed using correlational techniques and polytomous regression. There were no significant relationships between acculturation and health access, Chinese health beliefs, Chinese health practices, and breast cancer risk knowledge. Only "years of education," "marital status," and "household income" significantly predicted breast cancer risk knowledge level. The data indicate that women with a better knowledge of breast cancer risk are twice as likely to have higher income and have more education. The most knowledgeable women are less likely to be married and less likely to have partners compared to least knowledgeable group. Providers need to promote health knowledge and provide information about as well as access to preventive health practices to the immigrant population, given that acculturation to the new dominant society is inevitable.

Acculturation↗
PubMedDate not supplied

Clinical practice guideline adherence before and after implementation of the HEARTFELT (HEART Failure Effectiveness & Leadership Team) intervention.

HEART Failure Effectiveness & Leadership Team (HEARTFELT) is a multifaceted intervention designed to improve adherence with the American College of Cardiology/American Heart Association practice guidelines for heart failure (HF). The purpose of this study was to assess differences in clinician adherence with clinical practice guidelines before and after implementation of HEARTFELT. A quasi-experimental, untreated control group design with separate pretest/posttest samples was employed at a community hospital in Connecticut. The untreated historical control group included patients aged 65 years or older with HF and a nonequivalent comparison group of patients with stroke. The posttest samples included patients with the diagnosis of HF and stroke admitted after implementation of the HEARTFELT intervention. The HEARTFELT intervention included automated pathway in electronic medical record (order sets, interdisciplinary plan of care, self-management plan), access to evidence for clinicians and patients, HF self-management education tools, and ongoing discipline-specific feedback regarding adherence. Data were analyzed using parametric and nonparametric methods. The HEARTFELT intervention significantly improved clinician adherence with addressing all self-management categories in the electronic medical record (P = .000) and adherence with self-management education given to the patient in writing at discharge (P = .000). There were no significant differences in adherence with medical interventions (P = .39). While guideline adherence is associated with less practice variation and improved processes, methods of integration into practice in community hospital settings have been largely unexplored. The multifaceted HEARTFELT intervention is promising for its potential to integrate evidence at the point of care, to reduce unwarranted variation in practice, and ultimately to improve the outcomes of individuals with HF.

Aged↗
PubMedDate not supplied

Perceived nursing work environment of critical care nurses.

BACKGROUND: Different concepts and measures have been used to evaluate the work environment of nurses in hospital settings. There is increasing need for updated measurement tools that reflect the evolving nature of the work environment. OBJECTIVES: To report the psychometric properties of the Perceived Nursing Work Environment (PNWE) instrument, and to compare these results with those of other scales derived from the same background instrument: the Nursing Work Index-Revised. METHODS: The Nursing Work Index-Revised was used in a national survey of critical care nurses. Exploratory principal component analysis with orthogonal rotation was conducted. Psychometric properties were examined. Construct validity was evaluated by comparing the scores for a subsample of nurses in magnet and nonmagnet hospitals. RESULTS: Surveys obtained from 68 hospitals across the nation had a mean response rate of 41%, resulting in a sample of 2,324 participants. The PNWE, with its seven subscales and 42 items, explained 53% of the total variance of the Nursing Work Index-Revised. The subscales exhibited moderate to high reliabilities ranging from .70 to .91, except for one subscale (.56), and generally low intercorrelation. A similar version of the nurse-physician collaboration subscale was found in three of the other four scales compared. The positive scheduling climate subscale was a unique finding. Nurses employed at magnet hospitals had more positive perceived work environments than those employed at nonmagnet hospitals, and showed higher mean scores in four of the seven subscales (p < .05). CONCLUSIONS: The PNWE, a measure of the work environment as perceived by nurses, represents the latest version of the Nursing Work Index-Revised based on current practice. In this study, it exhibited sound psychometric properties. Further application and testing of the PNWE in various patient care settings is recommended.

Adult↗
PubMedDate not supplied

Applying an evaluation framework for health information system design, development, and implementation.

BACKGROUND: Dramatic advances in health information technologies necessitate a comprehensive evaluation framework covering all phases of development, from conception to routine operational use. OBJECTIVES: The purpose of this article was to illustrate the application of an informatics evaluation framework that provides a heuristic for matching the stage of system design and the level of evaluation. METHODS: An evaluation framework is illustrated in the context of five studies in different stages of system design. RESULTS: The studies discussed in this article represent the various stages of the framework. In addition, they are examples of how evaluation research studies not only contribute to the assessment of system design but also constitute distinct contributions to knowledge. DISCUSSION: The ability to engineer advanced information systems has exceeded the understanding of how to deploy them effectively in complex settings and to adapt them to a range of user populations. A systematic, continuous evaluation increases the likelihood that the conditions for success will be understood, including how to tailor a system, how to maintain the target population's use of the system, and how to innovate continually to enhance the functionality of the system and the users' experience. Without sound evaluation methodologies throughout the stages of system development, information systems have limited potential to influence healthcare processes positively.

Humans↗
PubMedDate not supplied

Testing a nurse-tailored HIV medication adherence intervention.

BACKGROUND: The relationship between patient adherence and treatment outcomes has been documented across chronic health conditions, but the evidence base for effective adherence interventions in human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) requires more rigorous research and reporting. OBJECTIVES: The aims of this study were to determine whether a tailored, nurse-delivered adherence intervention program--Client Adherence Profiling and Intervention Tailoring (CAP-IT)--improved adherence to HIV medications, compared with standard care, and to identify the relationship among adherence measures. METHODS: A randomized controlled trial (RCT) with repeated measures was used to test the efficacy of CAP-IT over a 6-month period. A convenience sample of 240 participants was recruited from a freestanding public HIV/AIDS clinic in Houston, TX, that provides medical, psychological, and pharmaceutical services for over 5,000 clients. Study instruments and measures included demographics; chart audit to capture CD4 count, viral load, and prescribed medications; health literacy; and five measures of adherence (AIDS Clinical Trial Group-Revised Reasons for Missing Medications, Morisky Self-Report of Medication Non-Adherence, Pill Count, Medication Event Monitoring System [MEMS] caps, and Pharmacy Refill). RESULTS: A logistic regression using generalized estimating equations method showed no significant differences over time on the five medication-adherence measures between the experimental and control groups. Little correlation was documented among the five different adherence measures, and there was minimal correlation with clinical markers. DISCUSSION: It is unclear why the tailored adherence intervention was not efficacious in improving medication adherence. The findings suggest that these measures of medication adherence did not perform as expected and that, perhaps, they are not adequate measures of adherence. Effective and efficient adherence interventions are needed to address the barriers to medication adherence in HIV/AIDS.

Adult↗
PubMedDate not supplied

Implementing a Web-based information resource at an inner-city community church: lessons learned.

The objective of this project was to develop and implement electronic access to HIV/AIDS information resources at Glide Memorial Church in San Francisco, CA. This involved developing tailored Web-based access to the relevant information for the Glide Clinic patients. In addition, the project deployed workstations in 2 clinic areas and provided support to clinic patients as they learned to access the information resources. This article describes the experience with information retrieval in a clinic setting for underserved patients, including lessons learned, effective strategies, and anecdotes of effect on patients. Required nursing informatics competencies in this particular area are also addressed.

Attitude to Health↗
PubMedDate not supplied

The role of nurses in installing telehealth technology in the home.

Home telehealth involves the use of video conferencing or remote monitoring equipment in patients' homes. The installation of hardware and training of patients has historically been performed by nurses, typically RNs. This article examines the experience of RNs as telehealth installers in the Informatics for Diabetes Education and Telemedicine (IDEATel) project, where RNs were responsible for the installation of the Home Telemedicine Units (HTUs) and for training patients in the use of the HTUs, blood pressure cuffs, and fingerstick glucose meters. Average installation and training time was 166 minutes (SD 51 min). Structured interviews with RN installers revealed that patient education and training accounted for roughly two thirds of the in-home time. Technology-related problems, especially those related to telecommunications, were the primary cause of installation difficulties. Thematic analysis of installer interviews identified eight major themes and confirmed the importance of both clinical and technical knowledge during the telehealth installation process.

Aged↗
PubMedDate not supplied

Improving the human readability of Arden Syntax medical logic modules using a concept-oriented terminology and object-oriented programming expressions.

Medical logic modules are a procedural representation for sharing task-specific knowledge for decision support systems. Based on the premise that clinicians may perceive object-oriented expressions as easier to read than procedural rules in Arden Syntax-based medical logic modules, we developed a method for improving the readability of medical logic modules. Two approaches were applied: exploiting the concept-oriented features of the Medical Entities Dictionary and building an executable Java program to replace Arden Syntax procedural expressions. The usability evaluation showed that 66% of participants successfully mapped all Arden Syntax rules to Java methods. These findings suggest that these approaches can play an essential role in the creation of human readable medical logic modules and can potentially increase the number of clinical experts who are able to participate in the creation of medical logic modules. Although our approaches are broadly applicable, we specifically discuss the relevance to concept-oriented nursing terminologies and automated processing of task-specific nursing knowledge.

Attitude of Health Personnel↗