Global practice experience: A useful lens for understanding patient and staff perceptions of successful integration of health information technology in primary care

Making healthcare comprehensive and more efficient remains a complex challenge. Health Information Technology (HIT) is recognized as an important component of this transformation but few studies describe HIT adoption and it's effect on the bedside experience by physicians, staff and patients. This study applied descriptive statistics and correlation analysis to data from the Patient-Centered Medical Home National Demonstration Project (NDP) of the American Academy of Family Physicians. Thirty-six clinics were followed for 26 months by clinician/staff questionnaires and patient surveys. This study characterizes those clinics as well as staff and patient perspectives on HIT usefulness, the doctor-patient relationship, electronic medical record (EMR) implementation, and computer connections in the practice throughout the study. The Global Practice Experience factor, a composite score related to key components of primary care, was then correlated to clinician and patient perspectives. This study found wide adoption of HIT among NDP practices. Patient perspectives on HIT helpfulness on the doctor-patient showed a suggestive trend that approached statistical significance (p = 0.172). Clinicians and staff noted successful integration of EMR into clinic workflow and their perception of helpfulness to the doctor-patient relationship show a suggestive increase also approaching statistical significance (p=0.06). GPE was correlated with clinician/staff assessment of a helpful doctor-patient relationship midway through the study (R 0.460, p = 0.021) with the remaining time points nearing statistical significance. GPE was also correlated to both patient perspectives of EMR helpfulness in the doctor-patient relationship (R 0.601, p = 0.001) and computer connections (R 0.618, p = 0.0001) at the start of the study. ^

Child Welfare Workers’ Perceptions of the Influence of the Organizational Environment on Permanency Decisions for Families

The findings of this study suggest that while child welfare workers are consistently distracted by competing priorities from unexpected events, most are committed, and to understand perspectives is more inclusive and may improve retention rates. Notably, while it is recognized that permanency decisions are not made in an intellectual, legal or clinical vacuum and certain traditional aspects of the bureaucratic structure do not impact decision making, this study advances the body of knowledge on child welfare decision making. Examined in this study are child welfare case workers’ perceptions of the extent to which the organizational environment influences the permanency decisions they make to reunify or terminate parental rights of children placed out-of-home. This study includes a sample of 95 child welfare social workers employed in three public child welfare agencies in the Baltimore and Washington, DC metropolitan area. It used a cross-sectional research design, employing a survey instrument to examine bureaucratic distraction, role conflict, and supervisory adequacy as contextual factors in the organizational environment's influence on permanency outcome decisions. Implications are made for child welfare policy, practice, and research.

Family Preservation: The Parents’ Perceptions

This research documents the perspective of 100 parents who had an open case with the Department of Children and Family Service’s (DCFS) regarding their family’s well-being, reasons for referral and satisfaction with services. Two DCFS services, Family Preservation (FP) and routine Family Maintenance (FM) were examined using standardized instruments. Parents’ responses regarding reasons for involvement with the system differed from DCFS administrative data. FP parents had more children, were more likely to be monolingual Spanish speakers, and perceived greater improvement in discipline and emotional care of children and housing than FM parents. FP parents reported being satisfied with services. Implications include supporting community based culturally competent FP programs.

Social Workers' Perceptions of Family Preservation Programs

The passage of the Adoptions and Safe Families Act of 1997, with its focus on child safety and concurrent planning, has presented family preservation workers with new challenges and new opportunities. Twenty volunteers from a large comprehensive social service agency were interviewed to determine their experiences with two models of family preservation—Multisystemic Therapy (MST) and Traditional Family Preservation Service (TFPS) or practice as usual. Workers from both programs were able to articulate values consistent with family preservation as important strengths of the programs— keeping families together and empowering families for example. Information from referring agencies was described as variable and not especially useful when working with seriously troubled families, especially as it related to risk and child safety. Both groups indicated that the jargon of family preservation had permeated their agencies, and that working with other agencies was at times a challenge, though for different reasons. Finally, despite some reservations about the effectiveness of short-term treatment with families that face serious challenges, both groups of workers were generally satisfied with family preservation as an approach to practice.

Perceptions of Family Preservation Practitioners: A Preliminary Study

This exploratory, qualitative study examined practitioners' perceptions about family preservation practice. Findings reveal a wide range of identified strengths as well as the limitations of such a model. Interestingly, the most frequently identified strengths were value based rather than practice based in perspective whereas limitations were practice based. Keeping families together was the most common perceived strength but concern about children's safety by keeping the family intact was a frequently reported limitation. Further, lack of support and a lack of theoretical clarity were identified as considerable limitations. Implications suggest these practitioners (mostly child welfare/mental health workers) believe in the approach for the sake of keeping families together but are concerned with endangering the child in the process and recognize the need for theoretical guidance.

Family Preservation: Perceptions of Effectiveness

This qualitative study examines the attributes or perceptions of service providers and overseers as to the effectiveness of intensive family preservation services provided by a social services agency in Tucson, Arizona. The services provided are patterned after the Homebuilders' model developed in 1974 in Tacoma, Washington. Data collection was generated from interviews and focus groups with the in-home service providers, the program supervisor, and investigators and case managers with Child Protective Services (CPS). Although placement prevention rates (PPR) are the dependent variable in most studies on this form of intervention, this study seeks to understand those characteristics of the model that contribute to successful outcomes with client families. Those appear to be the short-term intervention coupled with a non-judgmental approach to client families and the clinical supervision provided by the program supervisor.

Perceptions of institutional support of community -based participatory research within prevention research centers

The Institute of Medicine (IOM) report on the future of health care states that the focus on health needs to shift to the management and prevention of chronic illnesses and that academic health centers (AHCs) should play an active role in this process through community partnerships (IOM, 2002). Grant funding from the National Institutes of Health and the creation of the Centers for Disease Control and Prevention (CDC) Prevention Research Centers (PRC) across the county represent a transition toward more proactively seeking out community partnerships to better design and disseminate health promotion programs (Green, 2001). ^ The focus of the PRCs is to conduct rigorous, community-based, prevention research, to seek outcomes applicable to public health programs and policies. The PRCs work is to create and foster partnerships among public health and community organizations, to address health promotion and disease prevention issues (CDC, 2003). ^ The W.K. Kellogg Foundation defines CBPR as "a collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community with the aim of combining knowledge and action for social change to improve community health." ^ In 1995, CDC asked the IOM to review the PRC program to examine the extent to which the program is providing the public health community with strategies to address public health problems in disease prevention and health promotion (IOM, 1997). No comprehensive evaluation n of the individual PRCs had ever been done (IOM, 1997). ^ The CDC was interested in understanding how it could better support the PRC program through improved management and oversight to influence the program's success. The CDC only represents one of the entities that influence the success of a PRC. Another key entity to consider is the support of and influence of the Schools of Public Health in which the PRCs reside. Using evaluation criteria similar to those that were developed by the IOM, this study examined how aspects of structural capacity of the Schools of Public Health in which the PRCs reside are perceived to influence PRC community-based research activities. ^

The Effect That Project Management Certification Has on Employability: Agent's Perceptions from Spain

This study analyses the effects that the project management certification has on employability. This analysis started with a participative process in which various groups of experts who are involved in the certification of people were consulted. A personal interview was carried out amongst 106 professionals —certifying bodies, training institutions, the civil service, and international organisations— and amongst professional who are certified in project management by the International Project Management Association in Spain. The results show that the certification emerges as a powerful tool for improving employability. The effects are demonstrated across two complementary aspects: internal company aspects and external aspects relating to the labour market. Finally, by compiling the different agents’ opinions, a series of measures emerge for improving the accreditation processes as an employability tool and increasing the mutual learning between public and private actors.

Final year project: students and instructors perceptions as a competence-strengthening tool for engineering students

This work indicates the importance of the Final Year Project (FYP) in the strengthening of competences of engineering students. The study also shows which personal competences of students are reinforced most during the FYP process,including the preparation, elaboration, presentation and defence stages. In order to gather information on this subject, a survey was conducted at two different Spanish technical universities—one public and one private—and a comparative analysis was performed of the questionnaires collected. The competence model considered is that used by the Accreditation Board for Engineering and Technology (ABET), since the official title of the public university has been accredited by this model. The results indicate which personal and professional competences of students are reinforced well by undertaking the FYP. Any significant differences in response by university are explained in the study. For validation purposes, the results were contrasted with the instructor’s perspective using the triangulation methodology. Finally, the conclusions drawn will permit the design of new study plans to cope more effectively with the challenges of the FYP in the new Bologna framework.

An approach to automatic learning assessment based on the computational theory of perceptions

E-learning systems output a huge quantity of data on a learning process. However, it takes a lot of specialist human resources to manually process these data and generate an assessment report. Additionally, for formative assessment, the report should state the attainment level of the learning goals defined by the instructor. This paper describes the use of the granular linguistic model of a phenomenon (GLMP) to model the assessment of the learning process and implement the automated generation of an assessment report. GLMP is based on fuzzy logic and the computational theory of perceptions. This technique is useful for implementing complex assessment criteria using inference systems based on linguistic rules. Apart from the grade, the model also generates a detailed natural language progress report on the achieved proficiency level, based exclusively on the objective data gathered from correct and incorrect responses. This is illustrated by applying the model to the assessment of Dijkstra’s algorithm learning using a visual simulation-based graph algorithm learning environment, called GRAPHs

Leadership and project management competences in executive women: different styles from the agents' perceptions

The exercise of management and leadership are key aspects to achieve objectives, goals and relationships in the current knowledge society marked by increasingly competitive environments in which cognitive factors, creativity, knowledge and information determine the success of organizations. Both concepts have been historically associated with the male domain because of the underrepresentation of women in managerial positions. However, the increasing participation of women in the workplace has led to the development of an extensive literature on the possible existence of differences between the styles of male and female leadership, although it has not been addressed from the analysis of competences associated with each sex. Through a participatory process the abilities and skills related to women managers are analyzed and the differences in leadership styles. The results indicate that women particularly value the skills associated with human relationships, and that female leadership style tends to be transformational.

The relationship between young people's transit use and their perceptions of equity concepts in transit service provision

This study investigates the effect of price and travel mode fairness and spatial equity in transit provision on the perceived transit service quality, willingness to pay, and habitual frequency of use. Based on the theory of planned behavior, we developed a web-based questionnaire for revealed preferences data collection. The survey was administered among young people in Copenhagen and Lisbon to explore the transit perceptions and use under different economic and transit provision conditions. The survey yielded 499 questionnaires, analyzed by means of structural equation models. Results show that higher perceived fairness relates positively to higher perceived quality of transit service and higher perceived ease of paying for transit use. Higher perceived spatial equity in service provision is associated with higher perceived service quality. Higher perceived service quality relates to higher perceived ease of payment, which links to higher frequency of transit use.

Self-perceptions of decision making competence in Spanish football players

Background: It is known that competence to make decisions is a fundamental aspect of sport competition. Objective: This study has analyzed the decision profile of a sample of Spanish football players of different levels of expertise. Methods: 690 Spanish football players of national and international level completed the decision mak- ing questionnaire, which cover three dimensions ? perceived decision competence, decision anxiety and commit- ment with decision learning. MANCOVA and ANOVA analysis were carried out to analyse the differences in each dimension based on the level of expertise. Results: Results showed that perception of decision making competence increased and the anxiety decreased with the level of expertise. Conclusions: This study confirmed the usefulness of this questionnaire in the process of training for coaches and sport psychologists.

Insights, attitudes, and perceptions about asthma and its treatment : a multinational survey of patients from Europe and Canada

Acknowledgments Editorial assistance was provided by Ken Kauffman and Patricia Abramo, Adelphi Communications, New York, NY. This assistance was funded by Merck & Co., Inc.