The hospitals and their healthcare providers need to optimize simultaneously three outcomes: healthcare costs, healthcare options offered to customers, and information utilization efficiency. The adoption of electronic healthcare record (EHR) technologies is a potential managerial mechanism for balancing these outcomes. EHR offers patient management and decision support capabilities that can ameliorate health delivery outcomes for patients, doctors, and hospitals through better-informed business and care decisions. The analysis of data collected in an EHR system may lower costs and improve health care delivery (or both). In sum, it could be argued that EHR is a source of competitive advantage. Despite this prima facie appeal, many hospitals remain reluctant to adopt and implement EHR due to lack of insights into return on investment, unavailability of tested systems and data entry obstacles. To address this gap between the potential of EHR system and lack of its adoption, the purpose of this research is to investigate the role of EHR as a resource of competitive advantage for hospital. Essay 1, titled "Implementation and Adoption of EHR: A Conceptual Model based on Resource Advantage Theory", describes the antecedents and consequences of EHR adoption and implementation. Essay 2, titled "Exploring the Relationship Between Electronic Healthcare Record Adoption and Quality of Care", delves deeper into the operational performance of a hospital. This essay focuses on the impact of EHR on different aspects of patient care and thereby on the financial performance of the hospital. Essay 3, titled "The Effect of Resources on a Hospital's Financial Performance: The Moderating Role of Electronic Health Records Implementation and Adoption", is an empirical inquiry into the key factors that may influence hospitals' financial performance. These include organizational factors (such as, number of nurses and beds) and environmental factors (such as, location and received donations). Further, this essay explores the interaction effects between EHR and these factors. In summary, this research provides a conceptualization and an empirical investigation of EHR adoption and implementation and its impact on hospitals' operational and financial performance, an area receiving widespread attention from health care organizations, patient rights activists, public policy makers and the media. Future research can take two paths. First, further research should address questions related to the integration of EHR with other production and inventory management systems, and the prospective benefits attained from system integration. Second research is needed to investigate how parallel information transfer across multiple stakeholders may concurrently preserve Health Insurance Portability and Accountability Act, reduce health care delivery costs and optimize service quality.

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Introduction: Adverse childhood experiences (ACEs) have been considered a significant risk factor for poorer adult outcomes. Considering the studies linking ACEs to chronic diseases in adulthood as well as the increasing prevalence for these chronic conditions, exposure to childhood traumas represents a significant economic burden in the United States which has not been explored. This study provides the first examination of the attributable burden and costs of conditions associated with exposure to ACEs in Tennessee (TN) and Virginia (VA) during 2017. Methods: This is a cross-sectional study of individuals aged 18+ having exposure to ACEs using Behavioral Risk Factor Surveillance System (BRFSS) data for TN and VA in 2017. Eight chronic diseases (asthma, obesity, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), depression, cardiovascular disease, and arthritis ) and two risk factors (smoking and drinking ) associated with ACEs were analyzed. Pearson's chi-square tests analyzed the association between individuals exposed to ACEs and the risk factors with the chronic diseases. The population attributable risk (PAR) were estimated for the ACEs related diseases and risk factors. These estimates were combined with published estimates of health care expenses and Disability Adjusted-Life-Years (DALYs). Results: Among those who had experienced at least 1 ACE in TN, 10% had COPD, 17% had diabetes, 36% had obesity, and 30% had depression. Individuals who had experienced at least 1 ACE in VA had higher percentages for COPD, obesity and depression diseases compared to those who had no ACE (p< .0001). ACEs exposure resulted in a burden of about 115,00 years and 125,000 years in terms of DALYs in TN and VA respectively. The total health spending associated with ACEs based on PARs was about $650 million ($158.15 per adult) and $942 million ($305.02 per adult) in TN and VA respectively. Depression accounted for the largest combined sum of health care spending (TN - $448,105,983, VA – $633,225,398). With DALYs valued at $235,855 in 2017 dollars, the monetized cost of DALYs attributable to ACEs was over $27 billion, $6615 per exposed adult Tennessean. The monetized loss due to DALYs represents over $30 billion (in 2017 dollars) , $9,737 per exposed adult in Virginia. Conclusions: This study emphasizes the need to reduce ACEs which can be utilized to inform interventions to reduce the impact of ACEs in Tennessee and Virginia. Medical conditions attributable to childhood traumas can result in increased utilization of hospital services, psychiatric care, as well as care related to chronic conditions, which includes increased primary and specialty care utilization as well as the cost of medications. While medical expenses represent a significant burden, reduced quality of life resulting from ACE attributable conditions also represents a burden in disability adjusted life years (DALYs) and premature morbidity. As resources are limited and the burden of ACEs shown here is very high, there is the need for a wide range of prevention and treatment strategies to mitigate these effects.

Background: Many patients discharged from the hospital do not appropriately fill their discharge medications. At Boston Medical Center, an urban safety net facility, a bedside discharge medication delivery service was pilot tested in 2012 to ensure pediatric patients with asthma left in possession of their new medications. The service was expanded to all pediatric discharges in 2013. It is unknown whether beside delivery increases the proportion of written prescriptions captured by the hospital-owned pharmacy or if the service achieves a positive return on investment. Whether such a service improves patients’ satisfaction, medication adherence, or clinical outcomes is also unknown. Methods: Two primary methodologies were used to evaluate the impact of this novel service. The first evaluated the relative risk of filling a prescription in the hospital- owned pharmacy after the expansion of delivery eligibility criteria using two years of discharge prescription information, corresponding pharmacy fill data, and a hierarchical model with generalized estimating equations (GEE) to account for non-independent events. Initial patient-level impacts of the delivery service were evaluated through a pilot randomized controlled trial to test logistics and obtain empiric estimates of study parameters. Results: Patients were 1.44 times more likely to fill a medication at the hospital- owned pharmacy providing the delivery service after the intervention (95%CI 1.3-1.59). The increased profit generated by prescriptions captured as a result of offering the delivery service is estimated to be equivalent to 8-15% of a pharmacist full-time- equivalent (FTE), whereas only 3% of an FTE was required to provide the service, indicating a positive return on investment. Pilot study data suggest families did not differ significantly with regards to perceived satisfaction or reported outcomes whether randomized to usual care or delivery. Conclusion: A service to deliver discharge medications can yield a positive return on investment, allowing an institution to offset uncompensated care. To further study the intervention, a trial with randomization at the level of the ward or institution is needed. / 2017-10-02T00:00:00Z

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Title: Helping or Hovering: Examining Social Loafing and the Free-Rider Effect in Youth’s Transition Readiness Author: Mekyala Williams, East Tennessee State University Co-author(s): Kiana Johnson, MS, PhD Department of Pediatrics Quillen College of Medicine East Tennessee State University Lindsay Ellis Lee, PhD Department of Pediatrics Quillen College of Medicine East Tennessee State University Introduction Transition readiness in youth has been hard to study because parents and providers have served as managers rather than coaches hindering the process. Social loafing is a phenomenon that explains why people are more prone to exert less effort in group settings. We decided to observe the prevalence of social loafing in youth we examined if students knew how to perform specific transition readiness skills but allowed their support systems to do the task for them. This would be measured in opposition to them performing the tasks themselves since they do have the necessary skillset. The present study aims to validate the 4 domain subscales (i.e., managing medications, keeping appointments, tracking health issues, and talking with providers) found in the revised 20-item Transition Readiness Assessment Questionnaire (TRAQ). Additionally, the study will evaluate youth reliance on familial support systems for healthcare through the lens of the social loafing phenomenon. Methods To obtain demographic information, participants were asked on the survey to report their sex, age, ethnicity, and race (i.e., White, Black or African American, Asian, Native Hawaiian/Pacific Islander, Hispanic/Latino, American Indian, or Alaska Native, or other). Once all the surveys were completed, participants were categorized into white and non-white. We surveyed 161 youth from two different schools in South Central Appalachia about their transition readiness using anchors from the TRAQ with revised response categories. The response categories were whether they know how to do the specific task or not and whether youth perform the task themselves or if someone else does the task for them. Using confirmatory factor analysis, the revised 20-item version of the TRAQ will validate with the present sample. All statistical analyses will be conducted in R. Anticipatory Results and Conclusions Preliminary results based on the 161 participants found that youth can perform these tasks but very frequently allow someone else to do them. Out of the 20 items listed on the TRAQ, the endorsement rate of social loafing response varied between 10% and 52%. Fifteen out of the 20 items had a 30% response rate for social loafing. For the transition to adulthood to be successful for youth, they have to learn to accept different roles and responsibilities without the help of anyone else. This emphasizes the importance of shifting parents and providers to a coaching role rather than a managing role. Doing so will help enhance the youths’ ability and independence as they get older. This can also be applied to healthcare settings as using a coaching approach will minimize social loafing and allow more competence in managing their health.

Introduction and Background: Burnout is a syndrome that many health professionals are experiencing. It involves a state of emotional and mental exhaustion and professional fatigue that can impact the personal lives of these individuals leading to anxiety, depression, and discontentment. The impact may go further in the healthcare setting and lead to a decrease in patient safety and diminished quality of care for patients. Purpose: The purpose of this literature review is to systematically and critically appraise current literature to examine the associations between nurse burnout rates and poor patient outcomes. Literature Review: A total of thirteen articles, one literature review, and one meta-analysis were included in this review. Databases that were used to obtain these articles included PubMed, ScienceDirect, Scopus, and CINAHL. Findings: The related factors that were associated with nurse burnout included a high-stress work environment, lack of support, emotional exhaustion, depersonalization, and inadequate staffing. In situations where the staff was experiencing high levels of burnout, there was a correlation with decreased patient and family satisfaction and an increase in adverse events such as medication errors and missed care. Conclusion: Due to the COVID-19 pandemic, articles published within the past years have consisted of data collection through questionnaires and online surveys to limit the transmission of the virus. This technique could have led to a bias gap within the literature collected considering the lack of validity questionnaires yield due to the collection of information without further explanation. Despite this limitation, the data results still exposed that the presence of burnout among health professionals is associated with worsening patient safety. High levels of burnout are related to external factors, such as high workload, long hours, and interpersonal relationships. Avoiding professional exhaustion is an important strategy for improving patient safety.

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