Biomedical subjects

T Timpka

Publications and source records attributed to T Timpka.

At least 55 records · Page 3Linked to original sources

PubMed1998

The economic implications of users willingness to increase knowledge capital in health informatics.

OBJECTIVE: To develop an economic model of health care professionals demand for knowledge capital in health informatics. DESIGN: Case study with application of the Contingent Valuation Method to develop a small-scale model. SETTING: Specialized clinic at a university Hospital in Sweden. RESULTS: The model displays the economic rationale behind an individual's choice to spend leisure time for obtaining knowledge in health informatics. This decision reduces the total leisure time, but does not increase salary. Instead, it may increase the personal well being by higher satisfaction gained from using information systems and by being recognized as a computer expert. CONCLUSIONS: Individuals have preferences over all uses of time and for activities they can choose to engage in Support of health care staff's investment in health informatics knowledge capital may benefit both the individuals and indirectly the health care organization.

Attitude of Health Personnel↗

PubMed1998

Heuristic walkthrough evaluation of a prototype computer network service for occupational therapists.

AIM: To identify utility and design criteria for a computer network service for occupational therapists. DESIGN: Heuristic walkthrough evaluation. The evaluators explored a prototype and then commented upon the design in plenary sessions. SUBJECTS: One group of information system design experts and one of occupational therapists. RESULTS: The central utility criteria were the possibility to organize dynamic work groups for development of the occupational therapy profession and access to databases on assistive technologies. The main system design criteria identified were navigation, structure, tools, and content. CONCLUSION: A computer network service can support the development of the therapy professions. Generic issues exist which need to be considered in the detailed design. The heuristic walkthrough method is useful for identifying these.

Computer Communication Networks↗

PubMed1998

Risk perception during information system development in non-profit health care organizations.

The perception of risk exposure among design team members during the early phases of information system development projects can provide valuable strategic information for clinical organizations. To develop a typology of perceived risks during information system development projects in health care, interviews were performed with key team members from a specialist clinic, primary health care, and an informatics research group, during the requirements specification. Phenomenological data analysis and secondary integration of the results in available theories were performed. System objectives, the user requirements definition procedure, the communication pattern between design team members and project management were found to be perceived as the main risk areas. In the secondary analysis, the technical factors, identified as preventing a maximization of the use of the resources, were lack of informatics knowledge among economic decision makers and differences between customers and suppliers regarding their views on the nature of system design. During the implementation of a given strategy, decision makers may consider the requests of their own sponsors in the first place and maximize the use of the project resources in the second place. Informatics knowledge plays a key role in risk perception during the development of an information system in health care. Political considerations by team members are important to take into regard, since these may influence technical and economic decisions.

Humans↗

PubMed1997

Long-term economic effects of team-based clinical case management of patients with chronic minor disease and long-term absence from working life.

OBJECTIVES: To examine the socio-economic effects of team-based clinical case management of patients with chronic minor disease bound for early retirement. DESIGN: Marginal analysis of programme costs and benefits to society compared with no-programme baseline of costs occurring in society due to productivity loss. Prospective patient data collection on admission, discharge, and at one year and five years after discharge to determine programme effectiveness. SETTING: Out-patient clinic at the department of social medicine in tertiary care hospital. SUBJECTS: 239 patients with minor disease and long-term vocational absence consecutively admitted to the study. At the one-year evaluation, 17 patients had been readmitted to the team, 7 could not be found, 6 declined the interview and 2 were deceased. At the five-year evaluation of 49 patients who were active after one year, one was deceased and 10 were unable to be found. MAIN OUTCOME MEASURES: Vocational activity. Programme costs. Benefits to society measured by decrease in indirect costs. RESULTS: The one-year vocational rehabilitation rate from the program was 20.5% and the five-year rehabilitation rate was 11.3%. The total discounted cost for case management of the 239 patients was 7.3 MSEK (600,000 Pounds). The decrease in the indirect costs to society from the 28 patients found active after five years was 35.1 MSEK (2,500,000 Pounds). The net present value of the programme at the 1991 price level was 27.5 MSEK (2,365,000 Pounds). CONCLUSIONS: Tertiary care level team-based clinical case management for vocational rehabilitation of patients with chronic minor disease has a positive cost-benefit ratio. A cross-boundary awareness at a health policy level is needed of the societal costs involved for this group of patients who fall between the traditional services in health care and social work.

Absenteeism↗

PubMed1997

Study of situation-dependent clinical cognition: a meta-analysis and preliminary method.

An integrated method was constructed for the study of in situ clinical reasoning. A meta-analysis of existing theories and an exploratory case study were performed. Twelve physicians at the department of otorhinolaryngology, and three physicians and three biomedical technologists at the clinical microbiological laboratory of an 800-bed university hospital were involved in the evaluation of the method. The meta-analysis identified situations where practitioners face assignments for which they follow no routine strategy as suitable starting points for the development of the method, in which organizational processes are presented as workflow graphs. Using the critical incident technique, problem situations in the processes are identified, and stimulated recall interviews are employed to construct a model of the situation-dependent logic used in decision-making. The case study showed that the first levels of the method could easily be used by physicians without training in organizational development or cognitive psychology. It is concluded that the method can be a means for case construction in problem-oriented learning programs that have an empirical background. It can also be used in the development of clinical organization, where training is combined with the establishment of critical paths and computer support.

Algorithms↗

PubMed1996

Development of community nursing: analysis of the central services and practice dilemmas.

As examples of nurse practitioners in primary care, Swedish district nurses have been shown, in several studies, to respond well to the general pressure to achieve higher productivity in health care. Yet they have less frequently been involved in studies of the detailed content of the service they provide. To maintain total service quality, change should not be brought about only for the sake of efficacy. This study is divided into an analysis of the basic service provided in district nursing by identifying a typical interaction with a patient; and an analysis of the daily dilemmas district nurses experience, their consequences, and possible measures for change. For the consultation study, data were collected from 40 videorecordings of office-hour consultations by a rural district nurse. Regarding the dilemma situations, a critical incident questionnaire was returned by 153 district nurses in a Swedish country. The analyses showed that the district nurse practises in an area between self-care on the one hand, and the intersection of the different specialties in health care, on the other. Both the consultation study and the study of dilemmas in practice showed that the district nurse has to approach the health care organisation from a viewpoint close to that of the patient, which implies that she can, and has to, maintain an overview of the patient's total interaction with social institutions. This focal localisation of the shared care and co-ordination aspects constitutes a critical target for change and development efforts. The conclusions are that, first, the role of the district nurse/nurse practitioner as co-ordinator and advocate in patient-centred care could be considered in central health services policies and planning. Second, the content of the district nurses' daily work could be taken into account in the implementation of quality programs. These measures together can lead to an integration between today's theoretical nursing models and the dynamically changing structures of health care organisations.

Adult↗

PubMed1996

Ten years of experiences from a participatory community-based injury prevention program in Motala, Sweden.

Exploratory studies in the Scandinavian countries have suggested that the national cost of unintentional injuries is equal to 4% of the Gross National Product (GNP). One way for Swedish society to handle this situation has been through community-based injury prevention programs. This study used action research methods to supplement the understanding of the community development for injury prevention. The aim of this paper is to present the participative model used in one of the first of these programs, the Motala Injury Prevention Program, and lessons learned from the first 10 years of its operation. The program 'succeeded' in 1993, when Motala Municipality formed a regular Safety Board chaired by the Municipal Commissioner. These are five main messages from the initial phases of the program: a community-based injury prevention program has to be regarded as a long-term project; preferably over more than a 10 year period, economic calculations are important in the community analysis phase of the program, inter-linkage between community organizations is essential in the design phase, the hand-over from the initial program developers to practitioners is critical in the implementation phase, it is important to maintain a high-quality data collection routine even after the conclusion of the community analysis phase of the program. These observations have a potential to be valid at least for Northern Europe, which, by comparison with other parts of the world is a relatively homogenous area with regard to external causes of injuries. Regarding other communities, there are known differences in injury rates and community organization.

Adolescent↗

PubMed1996

Division of labour in clinical microbiology. Co-operation and fragmentation.

The aim of this study was to describe clinical microbiological practices in a hospital setting. A grounded theory was developed from qualitative data in two steps: initial participant observation to describe the clinical work-flow, and a main case study based in depth interviews and analyses of work practices using a video-based stimulated recall technique. Six physicians, 2 senior medical laboratory technologists and one head nurse were interviewed in depth based on their organizational positions. Stimulated recall interviews were conducted with 11 nurses, 6 secretaries, 6 medical laboratory technologists, and 3 physicians. An informal clinical microbiological 'workgroup' was found to co-operate around two physical objects: the microbiological sample and the laboratory request form. Work organization was divided into planning, based on science and legislations, and performance based on tradition and local supervision. None of the practitioners had a total overview of an analysis cycle, all being occupied with a discrete part of planning, practical work and information management. The conclusion of the study is that fragmentation in the division of labour may be a critical hindrance to development in clinical microbiology. If a common strategy is not shared between specialties and professions, even minor changes in routines by individual practitioners may influence patient outcome.

Cooperative Behavior↗

PubMed1996

Injuries during leisure physical activity in a Swedish municipality.

The objective of this study was to provide an epidemiologic basis for planning community programmes preventing injuries during leisure physical activity, especially participation in sports. A total population survey of unintentional injuries was carried out in an area with a population of over 41,000. All sports injuries (n = 933) occurring within a 12-month period and requiring medical care were noted, giving a ratio of 22.5 per 1000 inhabitants. The majority of the injuries occurred in soccer (38.9%), followed by injuries in basketball/volleyball/handball (10.9%), and bandy/hockey (9.2%). The results correspond to previous studies in southern Scandinavia. In northern communities, the proportion of injuries in winter sports has been shown to be higher. Identification of these similarities and differences between the studies makes it possible to use the findings together in the design of general community-based sports injury prevention programmes suited to northern European conditions.

Accidental Falls↗

PubMed1996

Talking at work--professional advice-seeking at primary health care centres.

OBJECTIVES: To describe professional advice- and information-seeking at primary health care (PHC) centres. DESIGN: Prospective cross-sectional data collection using semi-structured interviews. Statistical analysis of association between team-based and centralized organization, profession and pattern of advice-seeking. SETTING: 4 urban PHC centres in Ostergötland County, Sweden. PARTICIPANTS: 199 PHC centre staff members (25 doctors, 70 nurses, 49 nurses' aides, 12 medical laboratory technologists, 24 secretaries, 19 physiotherapists). Nine (4%) staff members did not participate in the study (4 doctors, 3 nurses, 1 nurses' aide, and 1 secretary). MAIN OUTCOME MEASURES: Number of staff using an advice source. RESULTS: For organizational advice, PHC centre managers were consulted at the centrally organized PHC centres, while staff at centres using team organization more often consulted outside sources. Having no one to ask for advice on patient communication was more common in the centralized organization. Regarding medical advice, only nurses' aides differed by consulting their own profession rather than doctors. For patient communication problems, the professions shared an intra-professional advice pattern. CONCLUSIONS: The PHC centre staff maintain parallel overlapping networks of professional advice-seeking. The observed networks can also be seen to answer simultaneous demands from patients, the local health care administration, social services and professional authorities. Straightforward ways to develop the professional communication at PHC centres would be to visualize these multiple dependencies and to support their optimal function in the organization.

Communication↗

PubMed1996

Implementation of computer-based patient records in primary care: the societal health economic effects.

OBJECTIVE: Exploration of the societal health economic effects occurring during the first year after implementation of Computerised Patient Records (CPRs) at Primary Health Care (PHC) centres. DESIGN: Comparative case studies of practice processes and their consequences one year after CPR implementation, using the constant comparison method. Application of transaction-cost analyses at a societal level on the results. SETTING: Two urban PHC centres under a managed care contract in Ostergötland county, Sweden. MAIN OUTCOME MEASURES: Central implementation issues. First-year societal direct normal costs, direct unexpected costs, and indirect costs. Societal benefits. RESULTS: The total societal effect of the CPR implementation was a cost of nearly 250,000 SEK (USD 37,000) per GP team. About 20% of the effect consisted of direct unexpected costs, accured from the reduction of practitioners' leisure time. The main issues in the implementation process were medical informatics knowledge and computer skills, adaptation of the human-computer interaction design to practice routines, and information access through the CPR. CONCLUSIONS: The societal costs exceed the benefits during the first year after CPR implementation at the observed PHC centres. Early investments in requirements engineering and staff training may increase the efficiency. Exploitation of the CPR for disease prevention and clinical quality improvement is necessary to defend the investment in societal terms. The exact calculation of societal costs requires further analysis of the affected groups' willingness to pay.

Computer Literacy↗

PubMed1995

The pragmatics of clinical hypermedia: experiences from 5 years of participatory design in the MEDEA project.

To explore a medical hypermedia design process where requirements engineering and participatory design are used in a naturalistic setting, 5 years of participatory action research (PAR) have been performed in the development of a hypermedia system to be used in primary care practice. In PAR, the participating organizations cooperate with the researchers in deciding and later evaluating organizational actions, and the results are concluded cooperatively. A new type of system emerged from the study, in that the resulting design has its focus on the management of large volumes of hypermedia material, the traceability of authority in the documents, and teamwork support. Regarding the participatory design process, it was found to be essential to deal with social and organizational issues in the design group and its surroundings--and not to cover these over. For instance, an agreement was reached with the managers responsible for health care in the county where the design process took place, whereby the design activity was also given priority at the highest local administrative level. Since health care is a practice organization, there is a potential market for similar systems if only ways of organizing design and marketing the products of participatory design are further developed. Modified versions of structured product specification methods could be a valuable complement. The conclusion of the study is that the development and spread of hypermedia systems in health care may require considerable changes in current design routines and organizations.

Administrative Personnel↗

PubMed1995

Situated clinical cognition.

The features characterizing study of clinical cognition in situ are formulated as: Re-cognition of context, culture, history and affect. Socializing and phenomenalistic elements are again included in the research agenda. Interest for representations: an analysis level is reserved for the symbols, rules and images relevant to define in models of clinical cognition. De-emphasis on computer modeling: investigations focus on the 'functional systems' in which computers are involved. Rootedness in classical philosophical problems: issues concerning situated clinical cognition are connected to the width of available theoretical literature. Belief in interdisciplinary studies: productive interactions between the new and traditional disciplines is anticipated, implying that new shared methods have to be developed. When scientific perspectives are broadened, a new balance has to be found between the relevance of the subject of study and methodological rigor. The situated clinical cognition framework is to allow for moving between models, theories, and perspectives, as it does not presuppose a singular model of clinical thinking.

Artificial Intelligence↗

PubMed1995

Decentralized diagnostics of beta haemolytic streptococci group A--introduction of a developmental model for microbiological consultation in primary health care.

OBJECTIVE: To define and evaluate forms for introduction of decentralized diagnosis in primary care. DESIGN: The study was divided into three phases. Intervention I. An intensive course on microbiological diagnostics in cases of tonsillitis with information about rapid EIA-based test kits for beta haemolytic streptococci group A. Intervention II. External quality assurance of the decentralized test. Evaluation. Recording of changes in work practice and attitude regarding decentralized diagnosis by means of a questionnaire. PARTICIPANTS: Thirty-three GPs and 36 laboratory technicians from 37 primary health care centres (PHC) in the county of Ostergötland, Sweden. RESULTS: Thirty-one of the responding GPs (94%) considered that the information gained from quality assurance was useful. Twenty-nine GPs (88%) reported that they had changed their clinical practice to some extent, and 26 of the responding laboratory technicians (72%) reported that they had changed method after the interventions. CONCLUSION: Uniform acceptance was not achieved, but a large number of GPs and PHC laboratory technicians did conform to a rational-empirical strategy for change in clinical practice.

Family Practice↗

PubMed1995

Participatory design of computer-supported organizational learning in health care: methods and experiences.

This paper outlines a Computer-Supported Co-operative Work (CSCW) system for primary care and presents from its participatory design process time consumption, costs, and experiences. The system integrates a hypermedia environment, a computerized patient record, and an electronicmessage system. It is developed to coordinate organizational learning in primary care from micro to macro levels by connecting strategic planning to monitoring of patient routines. Summing up design experiences, critical issues for making CSCW systems support cost-effectiveness of health care are discussed.

Community Health Centers↗

PubMed1995

Beyond computer-based clinical reminders: improvement of the total service quality by small-group based organizational learning in primary care.

In order to support continuous development of the services in a patient-centered primary care organization, a Computer-Supported Co-operative Work (CSCW) system has been developed. The system structures and supports organizational learning as a daily activity in parallel to clinical work. It is based on coordinated small-group activities in which strategic planning is integrated with monitoring and change of patient management. Implications for the future role of information systems in primary care are discussed.

Ambulatory Care Information Systems↗

PubMed1995

Inside multi-disciplinary design in medical informatics: experiences from the use of an argumentative design method.

This paper reports on a qualitative study using an argumentation-based design method (Argumentative Design) in the development of clinical software systems. The method, which requires visualization of the underlying design goals, the specific needs-for-change, and the probable consequences of the alternative design measures, caused previously implicit argument structures to be exposed and discussed. This uncovering of hidden agendas also revealed previously implicit coalitions and organizational influences on the design process. Implications for software development practices in medical informatics are discussed.

Clinical Protocols↗

PubMed1995

Computerized knowledge bases in primary health care: a curse or a blessing for health promotion, prevention and patient quality?.

This paper presents a future scenario analysis of how the introduction of computerized knowledge bases (KBs) can come to affect primary care practice. For the collection and analysis of data, a two-level video method was applied. First, four consultations where a computerized KB was used were video-recorded. A search workshop was then carried out by letting a multi-disciplinary panel comment on the video recordings. The comments were categorized with regard to content and perspective. Analyses of the comments showed a concern for a disregard of patients' health beliefs and for difficulties in portioning out the acquired medical knowledge to the patient during the consultation. Furthermore, the computerized KB was found to easily break the natural flow of the consultation and be perceived as a third party. The conclusion is that the most critical aspects for using computerized KBs in a reformed primary health care concern the integration of the systems into the consultation process. Health promotion, prevention, and patient quality are central here, and the introduction of KB technology must not lead the consultation away from these issues.

Artificial Intelligence↗