As an exciting information technology-based innovation, telemedicine has potential to enhance physicians' patient care and management, improve healthcare organizations' operations and performance, and cause a paradigmatic shift in health care toward a progressively emerging digital practice. Previous research has concentrated on technology developments and clinical applications and therefore offers limited discussion of technology management. Managing telemedicine technology in healthcare organizations is so complex and dynamic that it has been an important factor in the failure of many early telemedicine attempts. This dissertation research directly addressed organizational management of telemedicine technology. To deal with complexity and dynamism, the research took a multi-phase approach, using a research framework built upon a well-established theoretical foundation. Case study was used in the exploratory phase to provide detailed understanding of the underlying technology implementation process and to generate specific research questions or models for the subsequent descriptive/explanatory phase. Systematic linkage of these investigations was safeguarded by desired methodological triangulation. Findings from the case study and substantiating interviews identified technology acceptance, adoption and evaluation as problematic areas in organizational technology management. Findings of a survey study administered to most physicians practicing in public tertiary hospitals in Hong Kong suggested that perceived usefulness and ease of use, self-efficacy, and subjective norms were important to their accepting telemedicine technology. Similarly, a survey conducted with hospital executive officers, chiefs of service and center directors of all Hong Kong public healthcare establishments indicated that service needs, attitudes of medical staff, and the technology's benefits, risks and compatibility were essential to organizational technology adoption. In addition, results of an evaluative experimental study showed that the clinical decision- making of physicians can be improved through use of appropriate telemedicine technology. The combined findings suggested that these separate technology management issues were closely interrelated rather than isolated. Effects of a technology on physicians' patient care and management practice have important impacts on their technology acceptance, which, in turn, needs to be considered by their affiliating organization when making an adoption decision.

This research investigated the question of whether automatic or system-generated information classification methods can help humans better manage information. A series of four experiments were conducted; they investigated the usability (i.e., usefulness) of two automatic approaches to information classification, the concept space approach and a Kohonen-based SOM approach in the context of information retrieval. The concept space approach was evaluated in three different domains: Electronic Brainstorming (EBS) sessions, the Internet, and medical literature (the CancerLit collection). The Kohonen-based SOM approach was evaluated in the Internet and medical literature (CancerLit) domains only. In each case, the approach under investigation was compared with existing systems in order to demonstrate performance viability. The basic premise that information management, in particular information retrieval, can be successfully supported by system-based information classification techniques and that humans would find such techniques viable and useful was supported by the experiments. The concept space approach was more successful than the Kohonen-based SOM approach. After modifications to the algorithms based on user feedback from the EBS experiments had been made, users found the concept space approach results to be comparable (in the Internet study) or superior (in the CancerLit study) to existing information classification systems. The key future enhancement will be incorporation of better ways to identify document descriptors through syntactic and semantic front-end processing. The Kohonen-based SOM approach was considered difficult to use in all but one specialized case (the dynamic SOM created as part of the CancerLit prototype). This can probably be attributed to the fact that its associative organization does not match with the standard mental models (hierarchical and alphabetic) for information classification.

This paper investigates the multiskilled health practitioner (i.e., imaging specialist) how they are trained for what they do and the way their traditional role as a generalist in radiologic technology has been impacted by advancing technologies. This dissertation consists of multiple case studies, which is primarily qualitative and exploratory in nature. It does not test a hypothesis in a strict sense and is grounded in analytical categories and theories derived from the literature on technology, work, occupations, and organizations. The data analysis section consists of four sections: perceptions of the MSHPs' work, the impact of technology (i.e., incentive structures, wages, issues of autonomy/authority, task difficulty/responsibility and patterns of interaction), the enskilling/deskilling findings for all MSHPs in general and each hospital subgroup, and the MSHPs perceptions about the effectiveness of their formal education programs. With regards to a cultural examination of the workplace, the most significant sociological perspective identified were in the patterns of interaction. Specifically, three primary stylistic differences are noted. In relation to the effects of technology, an institutionalized practice of the incentive structure and the homogeneity of three broad skills were noted among our cohort. Additionally, three contextual factors that condition social action and thereby affect a technology's tendency to enskill or deskill are revealed. In light of the attributes and deficiencies noted by the interviewees regarding their formal educational programs and skills required for their new roles, the researcher provides five recommendations for strengthening technology transfer programs in which to better prepare the MSHP.

The EQ-5D is a brief, multi-attribute, preference-based health status measure. This dissertation describes the development of a statistical model for estimating U.S. population-based preference weights for the EQ-5D health states. A multistage probability sample was selected from the adult U.S. population. Using the time trade-off (TTO) method, each respondent valued 13 of the 243 health states described by the EQ-5D. The valuations were linearly transformed to lie on the interval [-1, 1]. Numerous model specifications were investigated, and a modified split-sample approach was used to evaluate the predictive accuracy of the models. All statistical analyses took into account the clustering and disproportionate selection probabilities inherent in our sampling design. The best model proved to be one based on a conceptual notion of the effect of movements away from perfect health. This model, which we have named D1, included ordinal terms to capture the effect of departures from perfect health as well as interaction effects due to increasing health problems. Relative to other models tested, a random effects specification of the D1 model provided a good fit for the observed TTO data. This model yielded an overall R² of 0.38, a mean absolute error of 0.02, and a correlation between mean observed and predicted valuations of 0.99. We also examined differences in health state valuations among the three major racial/ethnic groups in the U.S., i.e., Hispanics, non-Hispanic blacks, and others. In general, non-Hispanic blacks valued health states more highly than Hispanics or non-Hispanic non-blacks. Non-Hispanic blacks appeared to perceive extreme health problems to be associated with less disutility than did members of the other racial/ethnic groups. Differences in valuations did not appear to be related to differences between groups in education, income, or self-reported chronic conditions. The D1 model predicts the values for observed health states with a high degree of accuracy. This model's predictions provide a set of EQ-5D preference weights specifically developed for use in the U.S. population. Within the U.S. population, there exist differences among the major racial/ethnic groups in the perceived desirability of the EQ-5D health states. These differences cannot be readily explained by socioeconomic disparities.

A self-administered, mail questionnaire was used to assess the current state of hospital drug-use evaluation (DUE) programs within short-term, general U.S. hospitals. During February-March 1992, two mailings were sent to pharmacy directors at 491 randomly selected institutions. A net response rate of 66.6% (327/491) was achieved. The level of pharmacist participation in DUE program activities was found to be very high and to have a significant, positive correlation with the rated effectiveness of current DUE programs and the rated importance of pharmacist participation in DUE program activities. Pharmacists were members on 97.9% of responders' DUE (sub)committees, while 65.5% of pharmacist members held voting privileges. Pharmacists devoted an average of 11.27 hours per week to DUE-related tasks. Wide variation was demonstrated in rationale used to select DUE study drugs, interventions employed, use of DUE study results, and methods selected to evaluate DUE program effectiveness.

In a descriptive study, Lutzen's Moral Sensitivity Questionnaire (MSQ) was used to describe nurse case managers' perception of ethical decision making. Both community-based and hospital-based case managers responded. Research questions addressed (a) relationship between respondent's age and patient autonomy and between length of experience as case manager and benevolence; and (b) difference in conflict in ethical decision-making by level of education and difference in rules in ethical decision-making by type of setting. No significant correlations were found between the respondent age and patient autonomy nor between the respondents' length of experience as case manager and benevolence. There was a statistically significant difference in perception of conflict by educational level. Difference in rules in ethical decision making by type of setting approached statistical significance.

The purpose of this study was to determine the perceptions of residents, family members, and nursing staff regarding quality of care and the physical environment in the nursing home. Relationships among quality of care, the physical environment, and selected organizational characteristics were then described. The Quality of Care Scale (QoCS) and the Environment Description Scale (EDS) were given to a convenience sample of 100 subjects. A significant difference in perceptions of quality of care was found between the nurse assistants and residents. Significant relationships were obtained between perceptions of quality of care and the physical environment for Registered Nurses, Licensed Practical Nurses, and families. Defining quality of care and determining the significance of the physical environment from the consumer perspective may contribute to both quality of life and quality of care in the nursing home.

This research study was conducted to examine changes in cost and service utilization of nurse case managed clients. A secondary analysis was conducted using a pre-test/post-test design. Data for this analysis were collected by Papenhausen (1995) for a study to measure the effect of nurse case management intervention on client outcomes. Cost data for 53 subjects for the periods six months before and six months after nurse case management intervention was initiated were compared. Statistically significant decreases were found in the frequencies of inpatient admissions and emergency visits, as well as in inpatient length of stay and the total cost of services. This cost, including that of nurse case management service, as determined by Huggins (1996), represented a 61% decrease from the total cost before nurse case management was started.

<p> The infusion of information and communication technology (ICT) as the electronic health record (EHR) requires a significant increase in the knowledge and skills of the current Canadian health information management (HIM) workforce (Prism Economics and Analysis [Prism], 2009). However, there exists a shortfall in the capacity of the Canadian Health Information Management Association (CHIMA) to provide the required training and development to the organization&rsquo;s membership (Prism, 2009). This study is an exploratory qualitative case study to examine the reasons for the CHIMA&rsquo;s capacity shortfall and whether or not the use of a virtual community of practice (vCoP) might be effective to address the need. Three one-hour teleconference interviews were conducted with the CHIMA leadership. Data were analyzed using the work of Senge (1990a), Rogers (2003), and Wenger (1998) as a theoretical lens, which implies that leadership has a responsibility to provide a strategy and communication channels for organizational learning and development. The study findings provide implications for the CHIMA, its membership, and related educational stakeholder organizations to make firm determinations of their role in continuing professional education (CPE) for Canadian HIM professionals. The study is significant in its contribution to understanding the CPE challenges and opportunities resultant from the EHR implementation. Future research areas include (a) engagement of the CHIMA membership in the association, (b) awareness of Canadian HIM professionals of the changing profession (c) visibility of the Canadian HIM profession, and (d) the role of vCoPs in the Canadian HIM setting.</p>

<p> American Heart Association officials and other expert cardiologists recommend omega-3 (n-3) dietary supplementation for the secondary prevention of cardiovascular disease, a prevalent health problem in the United States. Physicians' lack of understanding of possible n-3 preventive health benefits results in underprescribing n-3 dietary supplements and lower n-3 dietary supplement product sales. N-3 dietary supplement marketers do not understand physician n-3 prescribing decision criteria enough to optimize high-impact communication to physicians to increase n-3 dietary supplement product use. The purpose of this phenomenological research study was to improve n-3 marketers' understanding of how physicians reach decisions to prescribe or recommend products including n-3 dietary supplements. Argyris' ladder of inference theory provided the study framework to facilitate understanding physicians' decision criteria. Rich data collected and analyzed from 20 primary care physician interviews in Kentucky, Indiana, and Tennessee revealed physicians use similar decision criteria for drugs and n-3s. Three essential influencers of physician decisions included clinical evidence, personal experience, and cost. Other influencers were opinions of peers, pharmaceutical representatives, samples, direct-to-consumer advertising, and knowledge of dietary supplements. Study outcomes may inform pharmaceutical marketers regarding presentation of clinical evidence, cost emphasis, and pharmaceutical representative skills and may facilitate competitive advantage for n-3 marketers. The social benefit of this study is improved physician understanding of n-3s may result in more accurate and appropriate prescribing to augment positive health outcomes. </p>