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PubMedDate not supplied

Overcoming barriers to adopting and implementing computerized physician order entry systems in U.S. hospitals.

Few U.S. hospitals have implemented computerized physician order entry (CPOE) in spite of its effectiveness at preventing serious medication errors. We interviewed senior management at twenty-six hospitals to identify ways to overcome barriers to adopting and implementing CPOE. Within the hospital, strong leadership and high-quality technology were critical. Hospitals that placed a high priority on patient safety could more easily justify the cost of CPOE. Outside the hospital, financial incentives and public pressures encouraged CPOE adoption. Dissemination of data standards would accelerate the maturation of vendors and lower CPOE costs. These findings highlight several policy levers to speed the adoption of this important patient safety technology.

Attitude of Health Personnel↗
PubMedDate not supplied

Medicare's next voyage: encouraging physicians to adopt health information technology.

Although there is growing consensus that health information technology (HIT) will be critical to improving health care quality and reducing costs, physicians' investments in technology remain limited. As the largest single U.S. purchaser of health care services, Medicare has the power to promote physician adoption of HIT. The Centers for Medicare and Medicaid Services should clarify its technology objectives, engage the physician community, shape the development of standards and technology certification criteria, and adopt concrete payment systems to promote adoption of meaningful technology that furthers the interests of Medicare beneficiaries.

Diffusion of Innovation↗
PubMed2005

Adoption and perception of electronic clinical communications in Scotland.

OBJECTIVES: To determine the uptake of multiple eHealth facilities enabled by the NHS Scotland Electronic Clinical Communications Implementation Programme (ECCI) and to ascertain primary and secondary care users' perceptions. DESIGN: Prospective monthly measurement of 37 indicators of roll-out and adoption. Retrospective questionnaire survey of users. SETTING: Scottish health board regions. Quantitative implementation indicators were gathered in primary and secondary care across all 16 regions. Questionnaire data were obtained from recorded users in five representative regions (112 general practices, 92 secondary care units). OUTCOME MEASURES: Change in uptake levels of ECCI facilities over a 15-month period. Users' perceptions of benefits, facilitators and barriers. RESULTS: All health boards participated in the monthly data set collection. The response rate to the survey was 62% in primary care and 37% in secondary care. Across Scotland as a whole, the process of implementation was gradual. While there were marked gains in the availability of ECCI facilities over the observation period, rates of adoption lagged behind and varied across alternative facilities. Electronic results were widely used, with most laboratories offering them and around half of general practices receiving them. More modest rates of adoption were observed for e-discharge letters, e-referrals, e-clinic letters and clinical e-mail. E-booking was used very little. Among engaged users responding to the survey, electronic access to test results was the most frequently utilised facility and electronic outpatient booking the least. Perceived benefits of ECCI facilities included convenience, ease of use, time-saving and provision of an audit trail. Perceived barriers included the need to duplicate data entry where new systems were not universally implemented, technological difficulties, time, training and resources. CONCLUSIONS: Significant progress was observed in the implementation of ECCI facilities across Scotland. Users reported that these improved communication and were beneficial, but system reliability, incompatibility and duplication of data hindered more widespread uptake. Data were collected at a transitional phase of the programme. Whilst, among users of ECCI facilities, perceptions of the programme and its potential benefits were generally positive, its full impact will not become evident until the new electronic tools are implemented nationally and have been more fully integrated into normal work routines.

Attitude to Computers↗
PubMed2006

Adoption of electronic health records in primary care pediatric practices.

BACKGROUND: Electronic health records may improve care delivery. Although professional organizations and federal agencies encourage widespread adoption, no national data are available regarding the penetration of electronic health records into primary care pediatric practices. METHODS: We used a national mail survey of 1000 randomly selected primary care pediatricians conducted from August to November 2005. RESULTS: The response rate was 58%. Overall, 21.3% of respondents had an electronic health record in their practice. The likelihood of having an electronic health record increased with practice size. Those in a practice network were more likely to have an electronic health record than those in other settings. Smaller and independent practices were less likely to be considering implementing an electronic health record. Although most electronic health records include some pediatric-specific functionality such as the ability to record immunizations, many do not offer decision support; only approximately one third included immunization prompts or alerts for abnormal laboratory results. Cost was a barrier for nearly all of those without an electronic health record; half of the respondents questioned whether electronic health records lead to improvement in quality of care, and many could not identify an electronic health record that would meet their practice requirements. CONCLUSIONS: Electronic health records are concentrated in larger and networked pediatric practices. Smaller and independent pediatric practices, the most common types of practice, are unlikely to adopt electronic health records until the cost of implementing and maintaining the systems decreases, developing standards for interoperability are adopted, and electronic health records are widely perceived to improve quality of care by practicing general pediatricians. The lack of decision support in current electronic health records may limit the ability of these tools to improve care delivery.

Attitude of Health Personnel↗
PubMed2007

Will pediatricians adopt the new rotavirus vaccine?

OBJECTIVES: Our objective was to determine the following among US pediatricians: (1) perceptions regarding burden of rotavirus disease and need for a vaccine; (2) intentions for recommending a newly licensed rotavirus vaccine; (3) perceived barriers to implementation; and (4) factors associated with plans for vaccine adoption. PATIENTS AND METHODS: A network of 431 pediatricians was recruited from a random sample of American Academy of Pediatrics' members. The network was designed to be representative of the American Academy of Pediatrics with respect to region of the country, practice type, and practice setting. During January and February 2006, physicians were surveyed by Internet or mail. The survey contained a paragraph summarizing results of the new rotavirus vaccine trial. Respondents were asked about intentions to use the vaccine and anticipated barriers. RESULTS: The survey response rate was 71%. Of the respondents, 52% strongly agreed and 37% somewhat agreed with the need for a rotavirus vaccine. If recommended for routine use, 50% would strongly recommend and 34% would recommend but not strongly; 52% would begin to use within 6 months and 27% from 6 months to 1 year. The top 3 "definite" barriers to implementation included concerns about uniform coverage of vaccine by insurers, lack of adequate reimbursement, and parental reluctance because of withdrawal of previous rotavirus vaccine. In multivariate analysis, factors associated with very likely adoption of the vaccine included perception of a high burden of rotavirus disease and a high level of confidence in prelicensure studies of vaccine safety. The presence of physician concerns about safety of the new vaccine and the perception of parental concerns about vaccine safety in general were negatively associated with adoption. CONCLUSIONS: The majority of pediatricians reported willingness to implement the new rotavirus vaccine, most within 6 months. Major barriers to optimal implementation included provider concerns about reimbursement issues and parental acceptance of the vaccine.

Attitude of Health Personnel↗
PubMed1988

Eradication of syngeneic tumor (Meth A fibrosarcoma) from mice by adoptive immunotherapy of immunized spleen cells induced by Corynebacterium parvum-pyridine extract residue.

Eradication of immunologically-syngeneic tumors was achieved by adoptive chemotherapy using effector cells induced by Corynebacterium parvum-Pyridine Extract Residue (CP-PER). A mixture of 2 X 10(6) Meth A cells and 0.1 mg CP-PER was subcutaneously inoculated into the back of donor BALB/c mice, with the result that their spleen cells showed an antitumor effect 10 to 13 days after the inoculation. These cells were used as immune cells. Recipient mice were inoculated with 1 X 10(6) Meth A cells, and 2 days later were administered cyclophosphamide. On the following day, 1 X 10(8) immune cells were adoptively transferred into the recipient mice. As a result, the tumor began to regress 7 to 12 days after the adoptive transfer. An immuno-histochemical study of the donors' spleens and the recipients' regressing tumors revealed that the ratio of L3T4+ T cells to Lyt-2+ T cells in the donors' spleens was increased and that the infiltrating cells in the recipients' tumors were mainly composed of L3T4+ T cells. This confirmed that the transfer of L3T4+ T cells led to the infiltration of L3T4+ T cells into the recipients' tumors, causing their eradication.

Animals↗
PubMed1981

Adoption of innovations from applied behavioral research: "Does anybody care?".

Applied behavioral researchers develop useful innovative technologies experimentally, and yet few of these technologies enjoy widespread adoption by our society. This paper analyzes several instances in which government agencies adopted behavioral technology, identifies 10 manipulable variables that could increase the rate of adoption of such technological innovations, and relates them to the field of knowledge diffusion. Unifying theory and experimental analysis are lacking in that field, yet an implicit technology may exist.

Journal Article↗
PubMed1995

Accelerated beta-cell destruction in adoptively transferred autoimmune diabetes correlates with an increased expression of the genes coding for TNF-alpha and granzyme A in the intra-islet infiltrates.

Autoimmune destruction of beta-cells in nonobese diabetic (NOD) mice is greatly accelerated by adoptive cotransfer of syngeneic CD4+ and CD8+ T-cells from diabetic animals into newborn NOD mice. We followed, by in situ hybridization, the appearance of mRNA of the tumor necrosis factor (TNF)-alpha gene and, as a marker for activated cytotoxic T-cells, of the serine protease granzyme A gene in the cellular infiltrates generated by cell transfer at birth. Cells expressing the genes for granzyme A or TNF-alpha were seen in considerable numbers already on day 14, after adoptive transfer. These numbers gradually increased in the intra-islet infiltrates from day 14 through day 30 after adoptive transfer. Compared with our previous findings in NOD mice developing spontaneous insulin-dependent diabetes mellitus (IDDM) (Held W, MacDonald HR, Weissman IL, Hess MW, Mueller C: Genes encoding tumor necrosis factor alpha and granzyme A are expressed during development of autoimmune diabetes. Proc Natl Acad Sci USA 87:2239-2243, 1990), frequencies of cells with TNF-alpha and granzyme A mRNA were 2- and 12-fold higher, respectively, in transferred IDDM (trIDDM). TNF-alpha mRNA positive cells were predominantly found in the CD4+ T-cell subset of the pancreas-infiltrating cells, whereas granzyme A mRNA positive cells were mainly observed in the CD4- T-cell subset. The effects of the observed enhanced TNF expression upon the pathogenesis of trIDDM are as yet unknown.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2006

Failure of transplanted bone marrow cells to adopt a pancreatic beta-cell fate.

Recent studies in normal mice have suggested that transplanted bone marrow cells can transdifferentiate into pancreatic beta-cells at relatively high efficiency. Herein, adopting the same and alternative approaches to deliver and fate map-transplanted bone marrow cells in the pancreas of normal as well as diabetic mice, we further investigated the potential of bone marrow transplantation as an alternative approach for beta-cell replacement. In contrast to previous studies, transplanted bone marrow cells expressing green fluorescence protein (GFP) under the control of the mouse insulin promoter failed to express GFP in the pancreas of normal as well as diabetic mice. Although bone marrow cells expressing GFP under the ubiquitously expressed beta-actin promoter efficiently engrafted the pancreas of normal and hyperglycemic mice, virtually all expressed CD45 and Mac-1/Gr-1, demonstrating that they adopt a hematopoietic rather than beta-cell fate, a finding further substantiated by the complete absence of GFP(+) cells expressing insulin and the beta-cell transcription factors pancreatic duodenal homeobox factor-1 and homeodomain protein. Thus, transplanted bone marrow cells demonstrated little, if any, capacity to adopt a beta-cell fate.

Animals↗
PubMedDate not supplied

Predicting the adoption and maintenance of exercise participation using self-efficacy and previous exercise participation rates.

OBJECTIVES: To investigate the relationships among self-efficacy, changes in self-efficacy, past exercise participation, future exercise adherence, and exercise program format. METHODS: Two-year randomized trial involving subjects (n = 63) participating in an aerobic exercise program. Subjects were randomly assigned to one of three exercise conditions: higher-intensity home-based exercise, higher-intensity class-based exercise, or lower-intensity home-based exercise. RESULTS: Results indicated that baseline self-efficacy and exercise format had significant (p < .02), independent effects on adherence during the adoption and early maintenance phases of exercise behavior. In contrast, in predicting long-term exercise program maintenance, a significant (p < .05) self-efficacy x exercise format interaction indicated that self-efficacy predicted adherence only in the supervised home-based exercise conditions. Results also suggest that baseline self-efficacy, independent of the effect of past adherence, significantly (p < .03) predicted exercise adherence during the adoption phase, but not early maintenance phase, of exercise behavior. Finally, adherence change during the adoption phase of exercise behavior significantly (p < .04) predicted Year-one levels of self-efficacy even after adjusting for the effect of baseline self-efficacy. CONCLUSIONS: These results suggest that exercise program format as well as an individual's initial cognitive and behavioral experiences in an exercise program play significant roles in determining exercise adherence.

Exercise↗
PubMedDate not supplied

Construct validity of the stages of change of exercise adoption for different intensities of physical activity in four samples of differing age groups.

PURPOSE: To examine whether the stages of change of exercise adoption appropriately address strenuous, moderate, and mild intensities of physical activity. DESIGN AND SETTING: Secondary analysis of four data sets investigating transtheoretical model (TTM) constructs for exercise adoption. SUBJECTS: Four samples of differing age groups (adolescents, n = 400; college students, n = 240; adults, n = 346; seniors, n = 504). MEASURES: Stage of change algorithm for exercise adoption and self-reported physical activity. RESULTS: Multivariate analysis of variance (MANOVA) results showed that stages of change were distinguished by strenuous and moderate but not mild exercise in the adolescent, college student, and adult sample. In the senior sample, stage differences were found in the frequency of exercising (equivalent for moderate to strenuous exercise) and the frequency of walking (equivalent for mild exercise). Bivariate correlation coefficients as well as sensitivity, specificity, and related quality indices decreased respectively from strenuous to moderate to mild exercise and from exercising to walking. CONCLUSIONS: Results provide additional support for the construct validity of the stages of change for strenuous and moderate intensities of physical activity. Development of a new stage assessment instrument for mild intensities of physical activity is recommended. Limitations include use of a different validation measure of exercise behavior in the senior sample.

Adolescent↗
PubMed1993

Organizational and administrative factors influencing the adoption of consortia programs by rural hospitals.

This study was designed to assess the effects of various hospital and environmental characteristics on the involvement of rural hospitals in forming and governing consortia and adopting consortia programs. The study focused on the 127 hospitals that are members of the nine rural consortia developed by grants from the Robert Wood Johnson Foundation during 1989 under its Hospital-Based Rural Hospital Consortia Program. Hospital involvement in the formation and governance of the consortia was found to be far less than expected for these grass-roots organizations. Only 38 percent of the administrators said that their hospitals were involved in developing the consortia, and 44 percent said that they played a role in determining the program menu. Governing board and medical staff involvement was even more limited. Program adoption rates were found to be related to both the types of programs offered by the consortia and the characteristics of the hospitals. In general, greater involvement of physicians and governing board members in hospital decisions was found to enhance program adoption rates, but the influence varied by type of involvement in the hospital and program content.

Chief Executive Officers, Hospital↗
PubMed1997

What is a board's liability for not adopting a compliance program?

A key element of the 1991 United States Sentencing Commission's guidelines, used in sentencing corporations and business convicted of Federal crimes, is the provision of leniency for organizations that adopt effective corporate compliance programs. Given the increased scrutiny of healthcare organizations by Federal Investigators, the incentive to adopt corporate compliance programs has never been greater. Directors or trustees of healthcare organizations should be especially interested in adopting such programs, since recent case law suggests that they may be held personally liable for damages or losses resulting from a finding of fraud and abuse at their facilities.

Financial Audit↗
PubMed1997

Adoption of a time-based competition paradigm into the health care industry.

Market and regulatory pressures are requiring health care organizations to find new ways to compete. This article introduces the concept of time-based competition, a strategy adopted by firms in the manufacturing sector to strengthen their competitive positions, as a new strategy for health care organizations. The Just-in-Time technique and set-up time reduction activities are used to demonstrate the adoption of this paradigm by health care organizations. A case study comparing the movement of elderly patient through the health care delivery system under traditional and time-based competition practices is used to illustrate gains from adopting the new paradigm.

Case Management↗
PubMed1984

Synergy, influence, and information in the adoption of administrative innovations.

The adoption processes of two related administrative innovations in the private sector dealing with employee health are examined. Results of multiple logistic regressions using survey data on a sample of Illinois firms suggest that these two innovations are synergistically linked, such that the adoption of one increases the likelihood of the subsequent adoption of the other.

Alcoholism↗
PubMed1999

Adoption of a pharmacist conscience clause by Professional Associations and Boards of Pharmacy in the United States.

OBJECTIVE: To determine the number of professional associations and boards of pharmacy in the United States that have adopted or are considering to adopt a conscience clause as part of their codes of ethics, rules, laws or regulations. BACKGROUND: Pharmacists are often exposed to ethical dilemmas in their day-to-day practice and their response depends on a number of factors, including the personal beliefs and values of those involved. This has lead some professional associations to address whether their members have the right to refuse to participate in procedures which are contrary to their conscience or moral convictions. The outcome of these discussions is usually the development and adoption of a conscience clause. METHODS: A one-page self-administered questionnaire was sent by Fax to the highest ranking officer of 108 pharmacy organizations in the United States. RESULTS: Thirty-five completed questionnaires were received for a 32.4% response rate. In general, it was found that there is a lack of knowledge as to what a conscience clause is. Only two state associations and one board of pharmacy responded that they have a conscience clause as part of their code of ethics or regulations. Reasons given for not having a conscience clause included lack of interest and low priority. Nevertheless, four state associations, one national association and one board of pharmacy responded that they are considering developing a pharmacist conscience clause. More professional associations than boards of pharmacy expressed interest to obtain information about conscience clauses. CONCLUSION: Although many state associations and boards of pharmacy that responded do not have a conscience clause as part of their codes of ethics, laws or regulations, this survey shows an increasing interest to learn about it. This is expected as the pharmacist assumes increasing responsibility in patient care.

Ethics, Pharmacy↗
PubMed2000

Adoptive Transfer of Herpesvirusspecific Cytotoxic T Lymphocytes in Transplant Recipients.

Profound suppression of T-cell immunity observed after transplantation may permit the emergence of life-threatening viral complications. Prevention or treatment of viral infections in immunocompromised patients through the infusion of small numbers of antigen-specific T-cell lines or clones is the most successful example of adoptive immunotherapy in humans. In fact, adoptive transfer of T cells of donor origin has been demonstrated to be able to restore protective immunity towards these infectious agents and to control established disease. This article reviews human trials of adoptive immunotherapy for herpesvirus-related complications, with the aim of defining principles and problems encountered so far to aid the design of future clinical studies.

Journal Article↗
PubMedDate not supplied

A description of the adoption of the 'Fresh start' smoking cessation program by antenatal clinic managers.

This paper reports the dissemination by the Cancer Education Research Program (CERP) of a previously tested smoking cessation program called 'Fresh start' to 23 antenatal clinics. The program was specifically designed for use by staff in antenatal clinics. The aim of the study was to investigate the factors that influenced midwifery managers' adoption of the program. Clinics were randomly assigned to groups that received the program by simple dissemination (mail-out), or intensive dissemination (a mail-out, plus personal contact with midwifery facilitators). A case history approach was used to investigate the variables which influenced a midwifery manager's decision to adopt the program. The results indicated that intensive dissemination improved program adoption and that program components were selected to fit the physical and social context within antenatal clinics. Managers believed the main barriers to the implementation of the program were: the negative reactions of clients; insufficient time available for smoking cessation interventions; lack of support from professional colleagues; inability to provide follow-up to clients; staff turnover; and poor access and storage of materials.

Attitude of Health Personnel↗