The Technology Acceptance Model has been widely applied and has been quite successful at explaining the behavioral intention to use technology in many organizations. One of the most significant variables in the Technology Acceptance Model is perceived ease of use. The Technology Acceptance Model purports that perceived ease of use contributes to the behavioral intention to use technology. Additionally, the model purports that perceived ease of use is an antecedent of perceived usefulness. In the adoption and use of technology by physicians, previous studies show that the Technology Acceptance Model predictions have been incorrect. Specifically, the aforementioned perceived ease of use prediction is not repeatedly supported in health care environments. In order to further investigate and ultimately explain this abnormality in the Technology Acceptance Model's predictive ability in the health care industry, a positivist case study using various coding techniques was conducted to investigate physicians' behavioral intention to use a Personal Digital Assistant in their work environment. The Physicians' Technology Acceptance Model is a major result of this case study. The Physicians' Technology Acceptance Model, which is based on the Extended Technology Acceptance Model (Venkatesh et al. 2000), is absent of the perceived ease of use construct and includes two additional constructs: perceived substitution, which is defined as, "the degree to which an individual perceives that alternate sources are available to deliver the same information or assistance as the technology in question" and facilitating conditions (Venkatesh et al. 2003) , which is defined as, "the degree to which an individual believes that an organizational and technical infrastructure exists to support use of the system" (p. 453). This organizational case study rigorously follows a positivist approach ("natural-science model" of social-science research (Lee 1989b)).

Bakgrund: Att vara illamående påverkar människan negativt och den som upplever illamående känner ofta samtidigt ett lidande. Ett av sjuksköterskans grundläggande arbeten är att lindra lidande och främja hälsa. För att på bästa sätt kunna lindra lidande behöver ambulanssjuksköterskan behärska både sina vårdvetenskapliga och medicinska kunskaper. Illamående inom ambulanssjukvården är ett relativt outforskat område som förtjänar ett större fokus. Syfte: Studiens syfte var att kartlägga förekomsten av illamående hos patienter inom ambulanssjukvården samt om faktorer som kön, ålder, vårdtid i ambulans och mottagande klinik relaterat till sjukdomstillstånd utgör skillnader i förekomsten av illamående. Metod: Undersökningen genomfördes som en retrospektiv journalgranskning med en kvantitativ ansats där 362 journaler granskades. Även demografisk data och farmakologisk behandling med antiemetika registrerades. Resultatet analyserades och hypotesprövningar genomfördes med chitvåtest. Resultat: Studien visade att 17,1% av patienterna var illamående, 17,4% var inte illamående och dokumentation om illamående saknades i 65,5% av journalerna. Patienter som led av kirurgiska tillstånd upplevde mer illamående jämfört med patienter med ortopediska eller medicinska tillstånd, p = 0,0303. En tendens till mer illamående hos kvinnor än män kunde tydas, liksom hos yngre jämfört med äldre. Det fanns även en trend till att illamåendet ökade vid längre vårdtider i ambulansen. Totalt 40,3% av patienterna som upplevde illamående behandlades med antiemetika. Slutsats: Studien visade att både dokumentation om illamående i ambulansjournaler och behandling av illamående var otillräcklig. Det fanns ett samband mellan mottagande klinik och frekvensen av illamående, där patienter med kirurgiska tillstånd upplevde mest illamående. Vidare forskning om avsaknad av dokumentation av illamående och vilka faktorer som påverkar förekomsten av illamående skulle kunna leda till en utveckling av behandlingsriktlinjer och beslutstöd inom ambulanssjukvården. / Background: Nausea is an unpleasant sensation that can cause considerable suffering. One important task for nurses is to relieve suffering and promote wellbeing. In order to relieve suffering paramedics need to be proficient in both medical and caring skills.  Nausea amongst patients within the ambulance service is a relatively sparsely researched field that deserves a greater focus. Aim: To examine the prevalence of nausea amongst patients within the ambulance service and whether the prevalence is affected by factors such as gender, age, time in the ambulance or clinic. Method: In this study 362 ambulance journals from a Southern region in Sweden were examined retrospectively for documentation of nausea. Demographic data and treatment with antiemetics were also recorded. Statistical analysis of significance levels was performed using the Chi-squared test. Results: In 17.1% of cases the patient suffered from nausea and in 17.4% there was documentation that the patient was not nauseous, while there was a lack of documentation in 65.5% of the journals. A significantly larger proportion of patients with surgical conditions suffered from nausea than those with medical or orthopaedic conditions (p = 0.0303). The prevalence of nausea was slightly greater for women than men and for patients under age 60 than over age 60 and there was a trend towards more nausea the longer the time in the ambulance was. Only 40.3% of those who reported nausea were given antiemetics Conclusions: The study showed that both documentation and treatment of nausea were inadequate. There was a connection between which hospital clinic the patients were handed over to and the frequency of nausea, with surgical patients showing the most nausea. Further studies are needed to investigate the lack of documentation of nausea within the ambulance service and factors influencing the prevalence of nausea. This could lead to a predictive instrument to help paramedics detect nausea and better protocols for treating and helping to alleviate nausea.

The use of technology in primary care settings is not a new concept; the benefits of implementing electronic medical records are stated throughout the literature related to gains in productivity, patient safety, and adherence to clinical guidelines. Yet, despite these benefits, the adoption of electronic medical records in primary care settings, in Canada remains low. This thesis research, a descriptive case study, is an in-depth look at the process of electronic medical record implementation for a family practice group in an attempt to understand the process, technology, and the challenges associated with such as transition. This research uses two well-known models as its framework: the Delone and McLean IS Success Model and John Kotter’s Eight Stages of Organizational Change. The use of the two models together is unique; their use together provides a broader look at the aspects of implementation including the environment in which it is being conducted.

Sammanfattning Syftet med föreliggande arbete var att studera förekomsten av felaktiga läkemedelsordinationer på en pediatrisk avdelning. Metoden bestod i journalgranskning av läkemedelsordinationer av inskrivna patienter (n = 94) under två månader, 2012. Journalgranskningen utfördes i journaldatabasen Cosmic och omfattade 543 läkemedelsordinationer vilka granskades utifrån flertalet variabler. Resultatet visade att 174 av 543 (32 %) ordinationslistor var felaktiga. Läkemedelsnamn samt hänvisning till speciallista var angivet i samtliga ordinationer. Läkemedelsform var angivet i majoriteten av läkemedelsordinationerna. Styrka var ej angivet i 1 %, dos var ej angivet i 2 %, administrationssätt var felaktigt angivet i 6 % och var ej angivet i 9 %, administrationstidpunkt var ej angivet i 2 %. Maxdos för vid behovsläkemedel var ej angivet i 35 % och spädningsschema eller hänvisning till spädningsschema var ej angivet i 10 % av läkemedelsordinationerna. Slutsatsen visar att de vanligaste felaktigheterna bestod i administrationssätt, maxdos för vid behovsläkemedel samt spädningsschema eller hänvisning till spädningsschema. Alla felaktigheter i läkemedelsordinationen har påverkan på arbetssituationen för sjuksköterskan i såväl handhavandet av läkemedel, tidsåtgång samt resurser inom vården, vilket äventyrar patientsäkerheten. / Abstract The aim of the study was to investigate the incidence of drug prescription errors at a pediatric ward facility. The method used consisted of medical record review of drug prescription errors of enrolled patients (n = 94) for two months during 2012. Medical record review was performed and included 543 drug prescriptions, which were evaluated. The results showed that 174 of 543 (32 %) of prescription lists were incorrect, based on information given with the medication. The study found that drug name and reference to the specialist were always provided. However, errors included: dosage form not specified in 0.4%, strength was not specified in 1.1%, dose was not specified in 1.6%, route of administration was incorrectly stated in 5.9% and was not specified in 8.8%, administration time was not specified in 1.7%. Maximum dose for range order was not specified in 34.9% and dilution scheme or reference to dilution scheme was not specified in 9.6%. The conclusion of the study was that the most common prescription errors consisted of route of administration, the maximum dose if necessary drugs and dilution scheme or reference to dilution scheme. Prescription errors have effects in the workplace for nurses in the administration of drugs, which threatens patient safety.

Submitted by Jos? Henrique Henrique (jose.neves@ufvjm.edu.br) on 2018-03-23T17:53:05Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) carole_gusmao_almeida.pdf: 2424928 bytes, checksum: 67d863472b7a8b3959f22add291f705d (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2018-03-29T14:01:57Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) carole_gusmao_almeida.pdf: 2424928 bytes, checksum: 67d863472b7a8b3959f22add291f705d (MD5) / Made available in DSpace on 2018-03-29T14:01:57Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) carole_gusmao_almeida.pdf: 2424928 bytes, checksum: 67d863472b7a8b3959f22add291f705d (MD5) Previous issue date: 2017 / O Diabetes Mellitus (DM) ? considerado um problema de sa?de p?blica, os principais fatores de risco para seu desenvolvimento s?o sedentarismo, excesso de peso, tabagismo e alimenta??o inadequada. A necessidade no desenvolvimento de estudos com ?nfase na preven??o prim?ria, controle da incid?ncia e complica??es do DM demonstra a import?ncia deste estudo que teve como objetivo, tra?ar o perfil epidemiol?gico do paciente diab?tico usu?rio da rede p?blica no munic?pio de Diamantina- MG no decorrer do ano de 2015. Os dados foram coletados a partir de 112 prontu?rios armazenados nas ESFs deste munic?pio, onde se constatou que: aproximadamente 50% dos pacientes receberam cerca de 2 consultas ao ano (?ndice considerado baixo), a m?dia de idade destes pacientes era de 63 anos sendo prevalente o sexo feminino e predom?nio do diabetes tipo 2, cerca de 60% destes foram classificados como acima do peso. Foram consumidos em m?dia 5 medicamentos/dia por paciente; 10,7% apresentaram relatos de automedica??o, 30% dos pacientes entre 51-60 anos tiveram algum tipo de rea??o aos medicamentos. A politerapia foi o esquema terap?utico dominante, sendo a metformina associada com glibenclamida os hipoglicemiantes mais utilizados; aproximadamente 25% dos indiv?duos tiveram altera??es na dose do medicamento consumido no decorrer do estudo. Sobre as comorbidades, destacaram-se: hipertens?o, acometendo cerca de 80% dos usu?rios e problemas oftalmol?gicos abrangendo 23% dos usu?rios. Houve elevado ?ndice de pacientes com valor glic?mico alterado e defici?ncia no monitoramento atrav?s de an?lises laboratoriais. Ao todo 17 pacientes apresentaram diabetes de forma descompensada. Averiguou-se atrav?s dos dados defici?ncia na implanta??o de grupos de acompanhamentos coletivos assim como falhas nos registros por meio de prontu?rios, houve tamb?m limita??o na disponibilidade da oferta de acompanhamento atrav?s de equipe multiprofissional. Tais an?lises trouxeram como conclus?o a defici?ncia da equipe em fornecer atendimento integral aos usu?rios do SUS, com falhas na padroniza??o de atendimento e implanta??o das normas preconizadas pelos protocolos fornecidos pela Secretaria de Estado da Sa?de - Minas Gerais. Ressalta-se tamb?m a import?ncia de se registrar os procedimentos o que propiciaria a continuidade de informa??es colaborando para um atendimento ?ntegro ao paciente. / Disserta??o (Mestrado) ? Programa de P?s-gradua??o em Ci?ncias Farmac?uticas, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2017. / Diabetes mellitus (DM) is considered a public health problem, the main risk factors for its development are sedentary lifestyle, excess weight, smoking and inadequate diet. The need in the development of studies with emphasis on primary prevention, control of the incidence and complications of DM demonstrates the importance of this study that aimed to trace the epidemiological profile of the diabetic patient user of the public network in the municipality of Diamantina-MG during the year Of 2015. Data were collected from 112 records stored in the FHS of this municipality, where it was found that: approximately 50% of the patients received about 2 visits per year (index considered low), the mean age of these patients was 63 Being prevalent the female gender and predominance of type 2 diabetes, about 60% of these were classified as overweight. An average of 5 medications / day per patient were consumed; 10.7% presented reports of self-medication, 30% of patients between 51-60 years had some type of reaction to the medications. Polytherapy was the dominant therapeutic regimen, with metformin associated with glibenclamide being the most commonly used hypoglycemic agents; Approximately 25% of subjects had changes in the dose of the drug consumed during the study. On comorbidities, hypertension, affecting about 80% of users and ophthalmological problems, were observed, covering 23% of users. There was a high index of patients with altered glycemic value and deficiency in monitoring through laboratory analysis. Overall, 17 patients presented with decompensated diabetes. It was found through the data deficiency in the implantation of groups of collective follow-ups as well as failures in the registries by means of medical records, there was also limitation in the availability of the offer of accompaniment through multiprofessional team. These analyzes led to the conclusion of the team's failure to provide comprehensive care to SUS users, with failures in standardization of care and implementation of the standards recommended by the protocols provided by the State Health Department - Minas Gerais. It is also important to register the procedures, which would allow for the continuity of information, collaborating for a complete care to the patient.

Dagens samhälle förlitar sig på och investerar enorma resurser på informationssystem. Inte minst inom hälso- och sjukvården där IT idag inte enbart används som en stödkomponent, utan är en stor del av verksamhetens kärna. Digitala patientjournalsystem återfinns inom alla sjukvårdsverksamheter, där användarna enligt lag måste journalföra information om samtliga patienter. Systemen implementeras i verksamheten till förmån för både patienter och användare som genom användning av IT-stöd effektiviserar och underlättar det dagliga arbetet. Dagens patientjournalsystem inom hälso- och sjukvården är utvecklade samt designade för flertalet decennier sedan och är ur ett användarcentrerat användbarhetsperspektiv mycket bristfälliga, vilket flertalet studier tidigare har påvisat. Syftet med denna studie är att ur ett användarcentrerat användbarhetsperspektiv undersöka uppfattad bristfällighet i det elektroniska journalsystemet AmbuLink, i relation till dess design. Detta för att skapa en generell uppfattning kring graden av användbarhet hos patientjournalsystem inom ambulanssjukvården. Resultatet av undersökningen är tänkt att agera som underlag för fortsatt utveckling och hantering av AmbuLink, samt liknande och nya patientjournalsystem. Uppsatsen presenterar en kvalitativ fallstudie där empirin har samlats in på två sätt; genom intervjuer och en dokumentgranskning. Processen är uppdelad i främst tre olika faser. Under den första fasen samlade forskningsgruppen på sig kunskap genom att läsa tidigare forskning inom ämnet och samla in ett teoretiskt fundament som sedan låg till grund för det ramverk som presenteras i uppsatsen. Ramverket var tänkt att fungera som en referenspunkt för att utvärdera användbarhet inom medicinska informationssystem. Under den andra fasen genomfördes fallstudien på ambulansens huvudkontor i Göteborg, där informanterna fick svara på frågor angående patientjournalsystemet AmbuLink, som de brukar i dagligt arbete. Under den tredje fasen analyserades den insamlade empirin, samt utbildningsmaterial för systemet som tillhandahölls av verksamheten. Resultatet som presenteras i studien bidrar till en ökad förståelse av de användbarhetsbrister som idag återfinns inom standardiserade patientjournalsystem. Det framtagna ramverket går att återanvända vid fortsatta undersökningar och fallstudier inom ämnet, både i Sverige och internationellt. / Today’s society relies on and invests enormous resources on information systems. Not least in healthcare where IT today is not only used as an aid component, but is a major part of the core business. Digital patient record systems are currently seen in all types of healthcare industries, where users are required to log all patient journals according to the law. The systems are implemented in the business for both patients and users who, through the use of IT support, streamline and facilitate daily work in healthcare. Today´s patient journal systems in the healthcare business has been developed and designed decades ago and many of them are today highly deficient from a user-centric usability perspective, as the majority of previous studies have shown. The purpose of this study is to investigate perceived shortcomings in the electronical journal system AmbuLink, in relation to its design, from a user-centered utility perspective. This to create a general perception of the degree of utility of patient record systems in the field of ambulance care. The result of the survey is intended to act as basis for continued development and management of AmbuLink, as well as similar and new patient record systems. This essay presents a qualitative case study where the empiricism has been collected in two ways; through interviews and a documentary review. The process is divided into three main phases. During the first phase, the research group gathered knowledge by reading previous research within the subject and collecting a theoretical foundation that then served as the basis for the framework presented in the paper. The framework intends to serve as a reference point for evaluating usability in electronical medical information systems. During the second phase, a case study was conducted at the ambulance headquarters in Gothenburg, where the informants were able to answer questions regarding the AmbuLink patient record system, which they use in their daily work. During the third phase, the collected empiricism was analyzed, as well as educational material for the system provided by the business. The results presented in the study contribute to an increased understanding of the usability shortcomings found today in standard patient record systems. The framed framework can be reused in further studies and case studies in the subject, both in Sweden and internationally.

The technological advance has been contributing to the survival of newborns considered to be at risk for infant mortality. The concept of Near Miss Neonatal, defined as a newborn who presented a severe complication at birth but survived the neonatal period, came to define further studies on those infants who overcame causes of probable early neonatal death, and to evaluate the conditions of perinatal care. Objective: To identify the birth risk conditions related to the Near Miss Neonatal criteria from the secondary database analysis through a linkage between SINASC and SIM, in the period from 2011 to 2016 in the State of Sergipe. Methodology: an analytical retrospective cohort study with analysis of secondary data in a historical series in the official databases, through the linkage between SINASC and SIM. Data were collected on live births resident in the State of Sergipe, and the sample was selected from all newborns with early Near Miss Neonatal criteria: gestational age less than 31 weeks, birth weight less than 1,500 g and APGAR at the fifth minute below 7. We selected variables present in the SINASC: sociodemographic, obstetric and newborn, categorized and analyzed within the sample. The final statistical analysis evaluated the results by determining the relative risk and their respective confidence intervals, which identified the probability of the outcome selected by the study. Results: the variables that most had relation with the risk conditions at birth with a relative risk greater than 1 were: place of birth in the capital, home birth, illiteracy or low maternal schooling, age under 20 years and over 35 years, losses fetal abortions, prenatal care with 6 or fewer visits, number of prenatal consultations not suitable for gestational age at the start of follow-up, multiple gestation, non-cephalic presentation and congenital anomaly. The variables identified as protection factors with relative risk less than 1 were: the presence of partners, pregnant women aged between 20 and 35 years, maternal schooling over 4 years, cesarean delivery and induced labor. And the variables unrelated to the outcome, with relative risk crossing the 1 value in their confidence interval, were the maternal color / race and the sex of the newborn. Conclusion: In this study it was verified that the variables found as risk factors come according to what the literature has described and, therefore, it is intended that it serve as support for other studies on the subject and contributes to the survey of evidences that can subsidize bases for the construction of programs and public policies directed to the reduction of the infant morbimortality. / O avanço tecnológico vem colaborando para a sobrevida de recém-nascidos considerados de risco para mortalidade infantil. O conceito de Near Miss Neonatal, definido como um recém-nascido que apresentou uma complicação grave ao nascer, mas sobreviveu ao período neonatal, veio para que se delimitassem mais estudos sobre essas crianças que superaram causas de provável óbito neonatal precoce, e se avaliasse as condições de assistência perinatal. Objetivo: Identificar as condições de risco ao nascer relacionadas aos critérios de Near Miss Neonatal a partir da análise secundária de banco de dados através de um linkage entre o SINASC e o SIM, no período de 2011 a 2016 no Estado de Sergipe. Metodologia: estudo analítico de coorte retrospectiva com análise de dados secundários em uma série histórica nos bancos de dados oficiais, através do linkage entre o SINASC e o SIM. Foram coletados os dados referentes aos nascidos vivos residentes no Estado de Sergipe, sendo que a amostra selecionada foi de todos recém-nascidos com os critérios de Near Miss Neonatal precoce: idade gestacional menor que 31 semanas, peso ao nascer menor que 1.500g e APGAR no quinto minuto menor que 7. Foram selecionadas variáveis presentes no SINASC: sociodemograficas, obstétricas e do recém nascido, categorizadas e analisadas dentro da amostra. A análise estatística final avaliou os resultados através da determinação do risco relativo e de seus respectivos intervalos de confiança os quais identificaram a probabilidade do desfecho selecionado pelo estudo. Resultados: as variáveis que mais tiveram relação com as condições de risco ao nascer apresentando risco relativo maior que 1 foram: local de ocorrência na capital, parto domiciliar, analfabetismo ou baixa escolaridade materna, idade menor a 20 anos e maior que 35 anos, perdas fetais/abortos prévios, pré-natal com 6 ou menos consultas, número de consultas pré-natais inadequadas à idade gestacional de início do acompanhamento, gestação múltipla, apresentação não cefálica e anomalia congênita. As variáveis identificadas como fatores de proteção com risco relativo menor que 1 foram: presença de companheiro, gestantes com idade entre 20 e 35 anos, escolaridade materna maior que 4 anos, parto cesáreo e trabalho de parto induzido. E as variáveis sem relação com o desfecho, com risco relativo perpassando o valor 1 em seu intervalo de confiança, foram a cor/raça materna e o sexo do recém-nascido. Conclusão: Neste estudo verificou-se que as variáveis encontradas como fatores de risco vêm de acordo com o que a literatura tem descrito e, assim sendo, pretende-se que o mesmo sirva de apoio a demais estudos sobre o tema e contribua para o levantamento de evidências que possam subsidiar bases para a construção de programas e políticas públicas direcionadas à diminuição da morbimortalidade infantil. / Aracaju

Introduction: every year millions of children die worldwide, mainly due to preventable causes, infant mortality is a key tracer of quality of life and health services, which reveals the conditions of social, political and ethical well-being of a population. Objectives: To describe the risk factors associated with early neonatal mortality from the linkage between the information of live births registered in the SINASC in Sergipe in the period from 2011 to 2016 and the respective early neonatal deaths recorded in the SIM. Methodology: a retrospective cohort study using data from live births recorded in the SINASC, where a deterministic linkage was performed with data on early neonatal deaths recorded in the SIM. Results: in all were 205,042 live births between the period of 2011 and 2016, of these 203,334 survived and 1708 died. Regarding the variables analyzed regarding the mother, risk was found in adolescent mothers with advanced maternal age. As for the variables in gestation at delivery, there was a risk for adequate prenatal care, at preterm gestational age, at home, at vaginal delivery and without labor induction. For the variables associated with the newborn, APGAR of the 5th minute was lower than 7, birth weight less than 2500 g and for the presence of congenital anomaly. Conclusion: the main risk factors for early neonatal mortality in Sergipe were evidenced in this study; presented a risk factor for adolescent and advanced maternal age, vaginal delivery, very preterm gestational age, extreme low birth weight, Apgar score on the 5th critically low, and the presence of congenital malformation. Protective effect for brown / black race and maternal schooling. / Introdução: todos os anos milhões de crianças morrem no mundo, principalmente por causas evitáveis, a mortalidade infantil é um traçador-chave de qualidade de vida e dos serviços de saúde, que revela as condições de bem-estar social, político e ético de uma determinada população. Objetivos: Descrever os fatores de risco associados à mortalidade neonatal precoce a partir do linkage entre as informações de nascidos vivos registradas no SINASC em Sergipe, no período de 2011 a 2016 e os respectivos óbitos neonatais precoces registrados no SIM. Metodologia: estudo de coorte retrospectiva utilizando-se os dados de nascidos vivos registrados no SINASC, onde foi realizado um linkage determinístico com os dados de óbitos neonatais precoces registrados no SIM. Resultados: ao todo foram 205.042 nascidos vivos entre o período de 2011 e 2016, destes 203.334 sobreviveram e 1708 foram a óbito. Em relação as variáveis analisadas referentes a mãe, constatou-se risco nas mães adolescentes e com idade materna avançada. Quanto as variáveis na gestação em parto, apresentou risco para o pré-natal adequado, na idade gestacional pré-termo, ao parto ocorrido em domicílio, no parto vaginal e sem indução no trabalho de parto. Já para as variáveis associadas ao RN, demonstrou-se para o sexo masculino, APGAR do 5º minuto menor que 7, o peso ao nascer menor que 2500 g e para a presença de anomalia congênita. Conclusão: foram evidenciados neste estudo os principais fatores de risco para a mortalidade neonatal precoce em Sergipe; apresentou fator de risco para a idade materna adolescente e avançada, parto vaginal, idade gestacional muito pré-termo, o extremo baixo peso ao nascer, o Apgar no 5º criticamente baixo e a presença de malformação congênita. Efeito protetor para raça pardo/negra e escolaridade materna. / Aracaju

付記する学位プログラム名: デザイン学大学院連携プログラム / 京都大学 / 0048 / 新制・課程博士 / 博士(情報学) / 甲第22804号 / 情博第734号 / 新制||情||125(附属図書館) / 京都大学大学院情報学研究科社会情報学専攻 / (主査)教授 黒田 知宏, 教授 吉川 正俊, 教授 緒方 広明 / 学位規則第4条第1項該当 / Doctor of Informatics / Kyoto University / DFAM

Some hospital leaders are ineffective in implementing the electronic medical record (EMR) systems in the hospitals. The purpose of this multiple case study was to explore strategies hospital leaders use to successfully implement EMR systems. The target population consisted of hospital leaders and healthcare professionals from two hospitals who have successfully implemented EMR systems. The conceptual framework of this research study was Kotter's 8-stage process for leading change, building on the model of an effective change management method. Data were collected from 5 interviewed participants and company documents related to strategies regarding the EMR system implementation. The results of reviewing open-ended interview questions and archived documents were analyzed using codes and themes to facilitate triangulation. Three primary themes were developed from the coded data: (a) strategies hospital leaders use to implement the EMR system, (b) strategies hospital leaders use to achieve quality and best practice, and (c) strategies hospital leaders use to manage change and resistance to change. Results revealed 4 steps for successful implementation: (1) creating a vision, (2) communicating the vision, (3) establishing strong leadership, and (4) consolidating gains. Utilizing the successful strategies hospital leaders use to implement the EMR systems could produce quality patient care, efficiencies in hospital operations, and reduced organizational operation cost. The findings could effect positive social change through delivery of quality health and patient care that results in community cost benefits and healthier patient lifestyles.