Research method ch15 selected research papers

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Research method ch15 selected research papers

  1. 1. Research Methods in Health Chapter 15. Selected Research Papers - Purpose, Framework, Results - Young Moon Chae, Ph.D. Graduate School of Public Health Yonsei University, Korea ymchae@yuhs.ac
  2. 2. Table of Contents • Online psychological service for health professional --------------------------- 3 • Evaluation of CDSS for Drug Prescription Based on Success Measures --12 • Implementing Health Management Information Systems: Measuring Success in Korea’s Health Centers ------------------------------------------------- 20 • Risk Factors for Cervical Cancer among Korean Women from the Korean Cancer Prevention Study -------------------------------------------------------------- 30 • Evaluation of Mobile Phone-based Diet Game for Weight Control ---------- 51 • Management Issues in Health Information Systems ---------------------------- 58 • Competency-based Learning for Distance Education in System Analysis and Design ---------------------------------------------- ---------------------------------- 62 2
  3. 3. Burnout, job stress and job satisfaction: A study among doctors and nurses of Ulaanbaatar, Mongolia 3 Ariunsanaa B, Sugarmaa M, Khuderchuluun N, Saranchuluun O, Chae YM
  4. 4. Introduction • Background – Mongolia is considered to be one of the countries with a sufficient supply of health professionals in terms of proportion to the size of the population, especially in urban areas. – However, the problem of dense population in urban areas and internal migration has deteriorated the quality, accessibility, and load of healthcare services. – In this situation, it is claimed that the stress and depression driven by over workload of health professionals has somewhat negativel y influenced their attitude towards work and job satisfaction. – Other factors, such as the number of the patients, duration of medical checkups, procedures, consultations, and other additional functions, like serving patients with special needs, can lead to significant job stress. • Significance – There was no study dealing with job stress and job satisfaction for health professionals in Mongolia 4
  5. 5. Research Objectives • General – To study job stress, burnout and some depressive symptoms of medical doctors and nurses of tertiary health care settings of Ulaanbaatar • Specific Objectives – To determine the prevalence of job stress and burnout among medical doctors and nurses, – To determine the prevalence of job dissatisfaction and some depressive symptoms of medical doctors and nurses – To analyze the association between job stress, burnout and depressive symptoms 5
  6. 6. Methods • Study design – Study design is cross sectional and pre-experimental as it is social science research. • Sampling – In this study 400 of medical doctors and nurses will be included. – Stratified sampling by using hospital size as strata 6
  7. 7. Research Framework Burn out Job stress Job satisfaction Age Sex Education Job characteristics Multiple regression Chi square or t-test Correlation or Chi square test 7
  8. 8. Analytic Methods • All variables are ordinal scale (5 points) • Simple regression vs correlation (direction) • Correlation vs Chi-square test • T-test vs Chi-square test • T-test vs paired t-test • Parametric test vs non-parametric test • Multiple regression vs logistic regression 8
  9. 9. Relation between burnout and job characteristics 9
  10. 10. Comparison of job characteristics between doctors and nurses 10
  11. 11. Regression on burnout 11
  12. 12. ANCOVA 12 Table 9. Result of ANCOVA for job stress components (ERI model) and for burnout dimensions Male MD (n=31) Female MD (n=1 28) Female nurses (n =199) P-valueª Total (n=362) Mean SD Mean SD Mean SD Mean SD Extrinsic effort † 12.03 3.88 13.49 3.79 11.72 3.69 0.000 12.38 3.82 Reward† 47.75 5.75 45.44 5.86 47.35 5.92 0.006 46.70 5.94 Effort-reward ratio† 0.58 0.29 0.68 0.28 0.57 0.27 0.002 0.61 0.28 Overcommitment † 13.60 3.97 13.64 3.47 14.96 3.42 0.002 14.36 3.54 Personal burnout 39.33 17.99 45.35 16.10 44.92 16.61 0.158 44.61 16.57 Work related burnout 40.36 18.43 46.82 18.28 43.24 17.78 0.059 44.28 18.08 Client related burnout †‡ 25.86 19.23 36.31 19.89 30.33 19.72 0.004 32.14 19.97 Job satisfaction†‡ 74.83 14.36 66.67 12.44 70.21 14.88 0.006 69.29 14.15 † Difference between Female MD and Female Nurses (Multiple Comparisons, Tukey HSD) ‡ Difference between Male MD and Female Nurses (Multiple Comparisons, Tukey HSD)
  13. 13. Evaluation of CDSS for Drug Prescription Based on Success Measures Jinwoo Park , Young Moon Chae, Young Taek Lee, Koungwon Cho, Junghee Kim, Byung Hwa Lee (Published in Journal of Korean Society of Medical Informatics. 2009; 15(3): 293-301) 13
  14. 14. Introduction • Background – Medication errors are increasing – The Clinical Decision Support System (CDSS) for drug prescriptions was developed by integrating the computerized physician order entry (CPOE) system to support doctors and pharmacists in making correct decisions on prescribing drugs in line with the prescription guidelines by the Health Insurance Review Agency (HIRA) • Significance – This is the first attempt to evaluate effectiveness of CDSS for drug prescription in Korea – Use of DeLone and McFarlan model for performance evaluation of CDSS 14
  15. 15. Objectives • The purpose of this paper is to analyze the performance of the CDSS with respect to system quality, information quality, and user satisfaction to reduce prescription error • Specific objectives are: – To identify the factors influencing CDSS performance – To analyze association between quality measures and user satisfaction 15
  16. 16. Subjects • A questionnaire was designed by structuring primary evaluation areas first and then more detailed sub-areas in each primary area. • The survey was conducted by mail or by visit for 6 weeks from April 20 to May 29, 2009, for the pharmacists from 38 hospitals using the CDSS. • Hospitals were selected by stratified random sampling • Research design is cross-sectional design • A total of 84 questionnaires were returned from 22 users (response rate of 58%). Of them, 77 were used for the analysis, excluding 7 that were found unusable for statistical analysis. 16
  17. 17. Model and Statistical Analysis • Based on the Delone and McLean framework, we evaluated the success of the CDSS by using two quality measures (system quality and information quality) as independent variables; and three performance measures (user satisfaction and organizational impact) as dependent variables for the multiple regression analysis (Figure 1). • Chi-square analysis with cross-tabulation was performed to analyze the specific associations among two quality measures and three measures of user satisfaction (information satisfaction, system satisfaction, and willingness to recommend to others). • We also analyzed the associations between two quality measures and improvements in drug safety as a performance measure of organizational impact by using Chi-square 17
  18. 18. Research Framework 18
  19. 19. The effect of the information quality measures on user Satisfaction Factors Regression coefficient Standard error t-value P-value Information accuracy 0.060 0.252 0.24 0.8116 Information timelines 0.502 0.285 1.76 0.0823 Information reliability 0.462 0.275 1.68 0.0975 Information up-to-datedness 0.252 0.265 0.95 0.3438 Decision supporting function 0.771 0.263 2.94 0.0045 19
  20. 20. The association of quality measures and information satisfaction Description Information satisfaction No In-between Yes Total Chisq p- value System Quality Ease of system use No 1(25.0) 3(75.0) 0( 0.0) 4( 5.2) 18.0 0.002 In-between 0( 0.0) 19(59.4) 13(40.6) 32(41.6) Yes 1( 2.4) 12(29.3) 28(68.3) 41(53.2) Results understanding No 1(100.0 ) 0( 0.0) 0( 0.0) 1( 1.3) 58.7 <.001 In-between 1( 3.2) 23(74.2) 7(22.6) 31(40.3) Yes 0( 0.0) 11(24.4) 34(75.6) 45(58.4) Terminology understanding No 1(33.3) 0( 0.0) 2(66.7) 3( 3.9) 32.7 <.001 In-between 1( 2.6) 27(69.2) 11(28.2) 39(50.6) Yes 0( 0.0) 7(20.0) 28(80.0) 35(45.5) 20
  21. 21. Implementing Health Management Information Systems: Measuring Success in Korea’s Health Centers Young Moon Chae, Suck Il Kim, Byung Hwa Lee, Sung Hae Choi, In Sook Kim (Published in International Journal of Health Planning and Management, 1994; 9: 341-8) 21
  22. 22. Introduction • Background – Quality of health statistics produced at the district level is still very low so that health status of the district cannot be accurately determined. – Management data needed for planning, organizing, and evaluating health programs are not readily available for district managers. – Productivity and morale of most health workers are low because they suffer from heavy workloads of tedious paper works and simple tabulation. – Health centers and health subcenters are not responding to the changing needs of primary health services, which has been changed from family planning or MCH to chronic degenerative diseases (e.g. hypertension, diabetes) • Significances – HMIS can be regarded as management innovation within health center to meet the unrelenting challenge of providing and assuring health services to the community. – Relatively little research, however, has been done on measuring the processes of introducing a management innovation into a health center. 22
  23. 23. Purposes • To assess the extent to which a management innovation, in this case a HMIS, is perceived as successful to health center personnel • Specifically, – To examine the three key measures of successful implementation of HMIS: productivity of health center staffs, adoption process, and the satisfaction of visitors to the health center. – To compare user satisfaction between computerized center and not-computerized center 23
  24. 24. Methods • Research design – longitudinal design with control – Three surveys were conducted to measure the changes in productivity and adoption process (knowledge, persuasion, decision, implementation, and confirmation) of health workers over time during the period of 20 months. – The effects of the Health Management Information System (HMIS) on the quality of services to the visitors were also measured 7 months after the 3rd survey by comparing the quality of services between the study health center and the similar health center as a control group 24
  25. 25. Research Design 25
  26. 26. 26
  27. 27. Statistical Analysis • The changes in three adoption variables (knowledge, persuasion, and decision) were compared between the survey 1 and survey 2 (before and after the implementation of the HMIS) using Wilcoxson signed-rank test. • The changes in job processing time, which is a surrogate measure for the productivity of health center staffs, between the three surveys were compared using the Bonferroni method because there were significant differences in variances among the three groups. • Three satisfaction variables (waiting time, credibility, and convenience) of visitors between the two health centers were compared with Chi-square test, and average score of these variables were compared with t-test (1 point for the dissatisfied and 3 point for the satisfied). 27
  28. 28. 28 Bonferroni method
  29. 29. 29 Wilcoxson signed-rank test
  30. 30. 30
  31. 31. Association between Smoking, Screening, and Death Caused by Cervical Cancer in Korean Women Odongua N, Chae YM, Kim MR, Yun JE, Jee SH (Published in Yonsei Medical Journal, 2007; 48(2): 192-200)
  32. 32. Introduction Cervical Cancer: 2004 1. Worldwide – 510.000 new cases – 288.000 deaths 2. United States – 10,520 new cases – 3,900 deaths 3. Korea – … new cases – … deaths Developed countries 17.0% Developing countries 83.0% Risk Factors: •Failure to obtain regular Pap smear test •HPV infection •Cigarette smoking •Sex at an early age •Multiple sexual partners •Late menarche •Early age at first delivery •High parity
  33. 33. 13.8-17.14.0-7.5 7.6-13.71.1-3.9 17.2-36.5 Source: IARC, Globocan 2002 Global Mortality from Cervical Cancer
  34. 34. Proportion of Cancer Cases among Korean Women (1999-2001) stomach 16.4% breast 13.7% colorectal 10.4% cervix 9.8% lung 8.0% liver 7.3% thyroid 6.7% gallbladder 3.5% ovary 3.0% pancreas 2.5% others 18.7% Source: National Cancer Center, Korea
  35. 35. Objectives The purpose of this study is to explore and investigate the risk factors for cervical cancer among Korean women from KCPS. Specifically: 1. To estimate the age-adjusted standardized incidence and mortality rates of cervical cancer among Korean women aged 30 years and older. 2. To investigate the relationship between cervical cancer and reproductive factors. 3. To investigate the relationship between cervical cancer and smoking and other behavioral factors.
  36. 36. Methods
  37. 37. Cohort Design for the Study Population
  38. 38. Research Framework
  39. 39. Results
  40. 40. Number of cervical cancer cases by age group (n=2,520) Incidence 405 263 145 98 34 0 318 283 121 0 226 330 235 21 41 0 200 400 600 800 1000 30-39 40-49 50-59 60-69 ≥70 Age group Numberofcases Women with abnormal result Women with normal result Unscreened women
  41. 41. Age-adjusted standard incidence rates by age group Incidence rate 13.6 12.6 10.6 7.9 1.3 13.6 12.2 9.0 7.4 1.1 0.0 9.0 7.6 4.5 0.80.0 31.1 18.1 13.6 2.5 0 10 20 30 40 30-39 40-49 50-59 60-69 ≥70 Age group Rateper100,000 All women (overall rate 45.9) Unscreened women (43.2) Women with normal result (21.9) Women with abnormal result (65.2)
  42. 42. Number of cervical cancer deaths by age group (n=209) Mortality 12 19 16 18 19 0 12 24 12 9 0 11 22 27 8 0 20 40 60 80 30-39 40-49 50-59 60-69 ≥70 Age group Numberofdeaths Women with abnormal result Women with normal result Unscreened women
  43. 43. Age-adjusted standard mortality rates by age group Mortality rate 0.4 0.7 0.9 1.0 0.5 0.4 0.9 1.0 1.4 0.6 0.0 0.3 0.6 0.4 0.4 0.0 1.5 1.2 1.6 0.5 0 0.5 1 1.5 2 30-39 40-49 50-59 60-69 ≥70 Age group Rateper100,000 All women (overall rate 3.4) Unscreened women (4.2) Women with normal result (1.8) Women with abnormal result (4.7)
  44. 44. General characteristics of study subjects
  45. 45. General characteristics of study subjects (cont’d)
  46. 46. Relative risks (RR) of cervical cancer incidence by reproductive factors among all women (n=475,398)
  47. 47. Relative risks (RR) of cervical cancer mortality by reproductive factors among all women (n=475,398)
  48. 48. Discussion
  49. 49. Incidence and mortality rate of cervical cancer among all women Cervical cancer: – Incidence rate: 45.9 per 100,000. • The highest incidence rate: women aged 30-39 years old – Mortality rate: 3.4 per 100,000 • The highest mortality rate: women aged 50 or older Pap smear test: – Women who had never been screened by Pap smears: • 1.7-fold high risk of incidence for cervical cancer • 2-fold high risk of mortality for cervical cancer
  50. 50. Discussion • The Healthy People 2010 target for cervical cancer is a reduction in mortality to 2.0 deaths per 100,000 women. • Since 1998, the rate remains near 3.0 deaths per 100,000 women. The U.S. Preventive Services Task Force strongly recommends screening for cervical cancer in women who have been sexually active and have a cervix. • Pap smear screening should be targeted for younger women. As a result, we can also reduce the overall burden of cervical cancer among Korean women. • Future studies are needed.
  51. 51. Discussion • This large prospective cohort study of Korean women showed that several reproductive factors including age at menarche, age at first delivery, menopause status and long-term estrogen exposure were independent risk factors for development of cervical cancer. • Death due to cervical cancer among Korean women was associated with high level of fasting serum glucose (FSG) (RR=1.73, 95%CI=1.03-2.92), late stage of hypertension (RR=2.00, 95%CI=1.06-3.59) and smoking.
  52. 52. Evaluation of Mobile Phone-based Diet Game for Weight Control Wonbok Lee, Young Moon Chae, Sukil Kim,, Seung Hee Ho, Inyoung Choi (Published in Journal of Telemedicine and Telehealth, 2009; 16: 270-275) 52
  53. 53. Introduction • Background – 3rd National Health and Nutrition Survey conducted in 2005 reported that 32% of Korean adults were obese, based on the same criteria. Obesity is related to a metabolic syndrome and therefore obese people are at a greater risk of developing cardiovascular disease – web-based therapy management system with mobile phone access has been developed and distributed to obese patients to support weight management. • Significance – We developed the SmartDiet, a mobile phone-based weight control system that not only closely tracks an obese patient’s daily nutrition intake, but also has games that users can play to learn about weight control. – The SmartDiet is different from the previous dieting applications in a sense that users could download and implement personalized diet ary information onto their personal mobile phones 53
  54. 54. Objectives • This study evaluated the effectiveness of the mobile phone application SmartDiet with respect to acquiring dietary information, weight control, and user satisfaction. • Specific objectives are: – To describe demographic characteristics and lifestyle of study population – To analyze the effects of SmartDiet by comparing body composition between case and control group – To analyze user satisfaction 54
  55. 55. Research Design • Subjects – The effectiveness of the SmartDiet was evaluated based on the pretest-posttest with control design. – 19 subjects were assigned to the case or intervention group, and 17 subjects were assigned to the control group. • Statistical Analysis – Differences in demographic characteristics and lifestyle between the intervention group and the control group were analyzed by the Chi-square test. – The changes in body composition before and after the intervention for both groups were compared by the paired t test. 55
  56. 56. 56
  57. 57. 57 Paired t-test
  58. 58. 58
  59. 59. Management Issues in Health Information Systems 59 Kwak EA, Chae YM, Ho SH, Kim GK. Management issues in hospital information systems. (Published in Journal of Korea Society of Medical Informatics. 2007; 13 (1): 9-18)
  60. 60. • Purpose – This study was conducted to identify management issues in hospital information systems – Specifically, • To identify management issues in 2007 and compare them with 1999 • Classify management issues by using McFarlan’s framework • Methods – Sample survey of 50 managers from 28 hospital information centers. – Two rounds of interview surveys were conducted by using the Delphi method. 60
  61. 61. Changes in Management Issues 61 Key Issues Rank 7-year Change2007 1999 Top Management Support 1 1 0 Cooperation within IS Organization 2 4 +2 PACS 3 18 +15 Disaster Recovery 4 - NEW Improving IS Strategic Planning 5 17 +12 Standardization 6 - NEW Legalization of Electronic Medical Record (EMR) 7 6 -1 Improving Information Security & Control 8 3 -5 EMR 9 12 +3 Educating System Engineers 10 7 -3 Reference: Kwak EA, Chae YM, Ho SH, Kim GK. Management issues in hospital information systems. Journal of Korea Society of Medical Informatics. 2007; 13 (1): 9-18
  62. 62. Classification of Management Issues Based on McFarlan’s Framework 62 High Present Low Key Operational Strategic Educating System Engineers Top Management Support EMR Aligning the IS Organization within the Enterprise PACS Standardization Disaster Recovery Improving IS Strategic Planning Support High Potential Improving Information Security & Control Integrated HIS Making Effective Use of Data Resource IS/IT Strategy & Planning Building Patient Information System Infrastructure for U-Health Recruiting & Developing IS Human Resource Activation of Ubiquitous Application System Collaborative IT System Organization & Hospital Developing Laboratory Information System (LIS) Improving the Effectiveness of Software Development Low High Future
  63. 63. Competency-based Learning for Distance Education in System Analysis and Design Byung Hwa Lee, Young Moon Chae, Tomiko Hokama, Seok Kim (Published in Asia-Pacific Journal of Public Health. 2010; 22(3): 299-309) 63
  64. 64. Purposes • To assess how well SAD competencies could be taught via a CBL-based e-learning course that we developed for students registered at the ICUH. • Specifically, – To develop a CBL-based curriculum by linking various competencies to the learning goals of SAD. – To develop a CBL model for SAD based on the curriculum – To measures the competency scores of students three times (before, during, and after the class) by using a competency diary, in order to assess the students’ progress. – To identify the factors affecting learning effectiveness. 64
  65. 65. Research Framework for CBL Course Evaluation 65 Learning process Case and problem Tutor’s role Student’s role Learning effectiveness Multiple regression
  66. 66. 66
  67. 67. 67
  68. 68. 68
  69. 69. 69

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