Clinical simulation is proposed as an effective method for proactively evaluating new health technologies before implementation. It involves simulating real clinical workflows and tasks using a technology in a realistic environment. This allows for identification of potential patient safety issues and effects on clinical work practices. A case study demonstrates how clinical simulation was used to evaluate a new clinical information system for physicians to digitally sign laboratory results before implementation. The simulation identified issues that could impact patient safety or workflow that could be addressed prior to real world use. Clinical simulation provides a safe, controlled method for comprehensive pre-implementation assessment of new health technologies.
Understanding Physicians' Adoption of Health Cloudscsandit
Recently proposed health applications are able to enforce essential advancements in the
healthcare sector. The design of these innovative solutions is often enabled through the cloud
computing model. With regards to this technology, high concerns about information security
and privacy are common in practice. These concerns with respect to sensitive medical
information could be a hurdle to successful adoption and consumption of cloud-based health
services, despite high expectations and interest in these services. This research attempts to
understand behavioural intentions of healthcare professionals to adopt health clouds in their
clinical practice. Based on different established theories on IT adoption and further related
theoretical insights, we develop a research model and a corresponding instrument to test the
proposed research model using the partial least squares (PLS) approach. We suppose that
healthcare professionals’ adoption intentions with regards to health clouds will be formed by
their outweighing two conflicting beliefs which are performance expectancy and medical
information security and privacy concerns associated with the usage of health clouds. We
further suppose that security and privacy concerns can be explained through perceived risks.
Recently proposed health applications are able to enforce essential advancements in the
healthcare sector. The design of these innovative solutions is often enabled through the cloud
computing model. With regards to this technology, high concerns about information security
and privacy are common in practice. These concerns with respect to sensitive medical
information could be a hurdle to successful adoption and consumption of cloud-based health
services, despite high expectations and interest in these services. This research attempts to
understand behavioural intentions of healthcare professionals to adopt health clouds in their
clinical practice. Based on different established theories on IT adoption and further related
theoretical insights, we develop a research model and a corresponding instrument to test the
proposed research model using the partial least squares (PLS) approach. We suppose that
healthcare professionals’ adoption intentions with regards to health clouds will be formed by
their outweighing two conflicting beliefs which are performance expectancy and medical
information security and privacy concerns associated with the usage of health clouds. We
further suppose that security and privacy concerns can be explained through perceived risks.
Designing medical devices that meet the needs of patients, healthcare providers, and the broader healthcare system requires a thorough understanding of human factors and usability principles. In this presentation, we'll explore the application of these principles to medical device design.
IntroductionHealthcare Information Systems are defined as Comp.docxvrickens
Introduction:
Healthcare Information Systems are defined as “Computerized systems designed to facilitate the management and operation of all technical (biomedical) and administrative data for the entire healthcare system, for a number of its functional units, for a single healthcare institution, or even for an institutional department or unit” [9]. The employment of computers in the healthcare sector can be traced back to the 1960s. During the early 1970s, the first attempts to adopt HIS were made [10]. However, in the past, HIS initiatives were limited to the automation of business processes related to (a) administration and (b) healthcare tools and techniques related to various medical procedures as: diagnostic, therapeutic and surgical. During the 80s, innovative patterns in database designs and applications related to HIS, concluded to developments in planning and administration of the healthcare data. In parallel, HIS also introduced low cost financial systems for hospitals under 200 beds in size [11]. It should be noted that the early computerized systems were limited in big hospitals and government projects (military).
As the IT industry flourish the HIS technology was populated with various network applications. The ‘net period with the internet, intranet and extranet affected the communication of data in hospitals especially in the 1990's. In the middle of the same decade the interface engine emerged as a product to support the integration of applications, as best-of-breed applications became harder to manage [12]. New experience and knowledge in applications such as Internet-based telemedicine, personal health records, asynchronous healthcare communication systems, m-health and picture archiving communication systems (PACS) have been applied in the healthcare sector [13]. The growth of the aforementioned applications has lead to the development of healthcare services that have been characterized as complex, redundant and transcriptive [14].
In shedding some light on the underlined services that exist in healthcare organizations, we reviewed the normative on HIS classification. Based on the services that HIS support, Mantzana [7] categorized them into: (a) clinical, (b) non-clinical, (c) pharmaceutical and (d) laboratory. The authors adopt this classification and extend it, by proposing that the patient record category should be added, as it refers to medical records that can be maintained by the citizen or the health professional. This category can be further broken down into (a) Electronic Patient Records Systems (EPR), which are detailed records of encounters between patients and their healthcare providers and (b) Electronic Personal Health Records (ePHR) that are citizen self-maintained health and healthcare records
Extensive and serious quality problems exist in health care delivery processes, resulting in tremendous harms and losses to stakeholders. An increasing concern for improving health care quality has been expressed fro ...
Understanding Physicians' Adoption of Health Cloudscsandit
Recently proposed health applications are able to enforce essential advancements in the
healthcare sector. The design of these innovative solutions is often enabled through the cloud
computing model. With regards to this technology, high concerns about information security
and privacy are common in practice. These concerns with respect to sensitive medical
information could be a hurdle to successful adoption and consumption of cloud-based health
services, despite high expectations and interest in these services. This research attempts to
understand behavioural intentions of healthcare professionals to adopt health clouds in their
clinical practice. Based on different established theories on IT adoption and further related
theoretical insights, we develop a research model and a corresponding instrument to test the
proposed research model using the partial least squares (PLS) approach. We suppose that
healthcare professionals’ adoption intentions with regards to health clouds will be formed by
their outweighing two conflicting beliefs which are performance expectancy and medical
information security and privacy concerns associated with the usage of health clouds. We
further suppose that security and privacy concerns can be explained through perceived risks.
Recently proposed health applications are able to enforce essential advancements in the
healthcare sector. The design of these innovative solutions is often enabled through the cloud
computing model. With regards to this technology, high concerns about information security
and privacy are common in practice. These concerns with respect to sensitive medical
information could be a hurdle to successful adoption and consumption of cloud-based health
services, despite high expectations and interest in these services. This research attempts to
understand behavioural intentions of healthcare professionals to adopt health clouds in their
clinical practice. Based on different established theories on IT adoption and further related
theoretical insights, we develop a research model and a corresponding instrument to test the
proposed research model using the partial least squares (PLS) approach. We suppose that
healthcare professionals’ adoption intentions with regards to health clouds will be formed by
their outweighing two conflicting beliefs which are performance expectancy and medical
information security and privacy concerns associated with the usage of health clouds. We
further suppose that security and privacy concerns can be explained through perceived risks.
Designing medical devices that meet the needs of patients, healthcare providers, and the broader healthcare system requires a thorough understanding of human factors and usability principles. In this presentation, we'll explore the application of these principles to medical device design.
IntroductionHealthcare Information Systems are defined as Comp.docxvrickens
Introduction:
Healthcare Information Systems are defined as “Computerized systems designed to facilitate the management and operation of all technical (biomedical) and administrative data for the entire healthcare system, for a number of its functional units, for a single healthcare institution, or even for an institutional department or unit” [9]. The employment of computers in the healthcare sector can be traced back to the 1960s. During the early 1970s, the first attempts to adopt HIS were made [10]. However, in the past, HIS initiatives were limited to the automation of business processes related to (a) administration and (b) healthcare tools and techniques related to various medical procedures as: diagnostic, therapeutic and surgical. During the 80s, innovative patterns in database designs and applications related to HIS, concluded to developments in planning and administration of the healthcare data. In parallel, HIS also introduced low cost financial systems for hospitals under 200 beds in size [11]. It should be noted that the early computerized systems were limited in big hospitals and government projects (military).
As the IT industry flourish the HIS technology was populated with various network applications. The ‘net period with the internet, intranet and extranet affected the communication of data in hospitals especially in the 1990's. In the middle of the same decade the interface engine emerged as a product to support the integration of applications, as best-of-breed applications became harder to manage [12]. New experience and knowledge in applications such as Internet-based telemedicine, personal health records, asynchronous healthcare communication systems, m-health and picture archiving communication systems (PACS) have been applied in the healthcare sector [13]. The growth of the aforementioned applications has lead to the development of healthcare services that have been characterized as complex, redundant and transcriptive [14].
In shedding some light on the underlined services that exist in healthcare organizations, we reviewed the normative on HIS classification. Based on the services that HIS support, Mantzana [7] categorized them into: (a) clinical, (b) non-clinical, (c) pharmaceutical and (d) laboratory. The authors adopt this classification and extend it, by proposing that the patient record category should be added, as it refers to medical records that can be maintained by the citizen or the health professional. This category can be further broken down into (a) Electronic Patient Records Systems (EPR), which are detailed records of encounters between patients and their healthcare providers and (b) Electronic Personal Health Records (ePHR) that are citizen self-maintained health and healthcare records
Extensive and serious quality problems exist in health care delivery processes, resulting in tremendous harms and losses to stakeholders. An increasing concern for improving health care quality has been expressed fro ...
The Impact of Using the Information Technology on the Quality of Health Servi...inventionjournals
International Journal of Business and Management Invention (IJBMI) is an international journal intended for professionals and researchers in all fields of Business and Management. IJBMI publishes research articles and reviews within the whole field Business and Management, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
NATIONAL CULTURAL DIMENSIONS AND ELECTRONIC CLINICAL RECORDS ACCEPTANCE: AN E...IJMIT JOURNAL
The purpose of the present paper is to describe the development of a measurement scale, to assess the impact of the national cultural factors on the electronic clinical records acceptance in the Ibn Sina Hospital Center(CHUIS)in Morocco. The methodology assumed is based on the Churchill paradigm
(1979).Thus, our contribution focuses on the exploratory phase, where the items have been analysed using principal components analysis (PCA) and internal consistency with Cronbach’s Alpha (α). The results show a satisfactory factorial structure and excellent reliability of all the items.
IMPACT OF ARTIFICIAL INTELLIGENCE ON THE AUTOMATION OF DIGITAL HEALTH SYSTEMijseajournal
Automating digital systems in healthcare plays a significant role in transforming the quality-of-care
services delivered to patients across the board. This role is anticipated to be accomplished by the
development and implementation of artificial intelligence in healthcare which has the potential to impact
the provision of healthcare services. This paper sought to investigate the impact of adopting and
implementing artificial intelligence on the automation of digital health systems within the different levels of
healthcare. The general objective of the research study was to investigate the impact of artificial
intelligence in the automation of digital health systems. The specific goals were to understand the concept
of artificial intelligence and how it automates digital strategies, to determine the AI systems that have been
developed and implemented in the healthcare systems, to establish the factors that influence the adoption
of AI in healthcare, and to find out the outcomes of implementing AI in digital health systems. The research
employed the descriptive research design. The study population included healthcare workers,
policymakers, IT specialists, and management teams in the healthcare sector in the State of Kentucky. The
sampling technique for the study was the purposive sampling technique. The study collected data using
semi-structured interviews administered through Google Teams and Zoom. Data analysis was analyzed
using the computer-assisted software for analyzing qualitative data, NVivo. The findings were that AI as a
technological concept has the potential to impact the automation of digital health systems and is key to
automating health services such as the diagnosis and treatment of illnesses and management of claims and
payments. The study recommended that policy supports the application of artificial intelligence in
healthcare, thus enabling the automation of several healthcare services and thus improving the delivery of
care.
Analysis of the User Acceptance for Implementing ISO/IEC 27001:2005 in Turkis...IJMIT JOURNAL
This study aims to develop a model for the user acceptance for implementing the information security standard (i.e. ISO 27001) in Turkish public organizations. The results of the surveys performed in Turkey reveal that the legislation on information security public which organizations have to obey is significantly related with the user acceptance during ISO 27001 implementation process. The fundamental components of our user acceptance model are perceived usefulness, attitude towards use, social norms, and performance expectancy.
NATIONAL CULTURAL DIMENSIONS AND ELECTRONIC CLINICAL RECORDS ACCEPTANCE: AN E...IJMIT JOURNAL
The propose of the present paper is to describe the development of a measurement scale to assess the impact of the national cultural factors on the electronic clinical records acceptance in the Hospital Center Ibn Sina in Morocco.The methodology assumed is based on the Churchill paradigm (1979).Thus, our contribution focuses on the exploratory phase, which the items have been analyzed by the principal components' method and aninternal consistency method using the Cronbach’s Alpha (α). The results show a satisfactory factorial structure and excellent reliability of all the items, except some which are eliminated.
MHEALTH APPLICATIONS DEVELOPED BY THE MINISTRY OF HEALTH FOR PUBLIC USERS INK...hiij
mHealth applications have shown promise in supporting the delivery of health services in peoples’ daily
life. Recently, the Ministry of Health in the Kingdom of Saudi Arabia (MOH) has launched several mHealth
applications to develop work mechanisms. Our study aimed to identify and understand the design of
mHealth apps by classifying their persuasive features using the Persuasive Systems Design (PSD) model
and expert evaluation method. This paper presents the distinct persuasive features applied in recent
applications launched by MOH for public users called “Sehha & Mawid” Apps. The results revealed the
extensive use of persuasive features; particularly features related to credibility support, dialogue support
and primary task support respectively. The implementation and design of social support features were
found to be poor; this could be due to the nature of the apps or lack of knowledge from the developers’
perspectives. The findings suggest some features that may improve the persuasion for the evaluated apps.
Making India to a global healthcare hub, it is not only about bringing new technology but also we have to take care of the
existing technology. The healthcare hub is the leading factor for current economic growth of India. Human Factor Engineering
(HFE) plays a vital role in this field. In medical or healthcare, the field is named as Medical Human Factor Engineering (MHFE).
This paper discusses on how MHFE responsible for strengthen the Technology Management of Hospital, Hazards from device
failure and use related, Human Factors consideration in medical device use and case study on (Infusion Pumps) errors committed by
users in each clinical area. Now the challenging issue for HFE is to design a proper workspace to avoid human errors and the four
workspace design principles of Sanders & McCormick (1993) is also discussed. This paper deals with the Computer-aided-design
(CAD) systems and a failure mode and effects analysis (FMEA) technique with Simple Organizational Structure of HFE in designing the workspace.
Technology Acceptance Model for Mobile Health SystemsIOSR Journals
Abstract: The purpose of this paper is to explore the factors that influence health-related consumer’s
acceptance to use the mobile technology as a tool for receiving healthcare services. Based on technology
acceptance model (TAM), this paper provides a better understanding of antecedent of key acceptance constructs
(e.g. intention to use, perceived usefulness, perceived ease of use). The proposed research model and hypotheses
validated and tested with data collected from 302 Egyptians and Yemenis patients, health professionals, and
general health users. The results are analyzed using a number of statistical techniques including partial least
squares. The key findings obtaining from the results of the three surveyed stakeholders reveal that: (1) ninety
percent are indented to use mobile health services. (2) While intention to use has greatly influenced by
perceived usefulness, the impact of perceived ease of use varies. (3) Perceived value, perceived ease of use and
portability factors are significantly affect perceived usefulness. (4) Self-efficacy and technology anxiety have a
great impact on perceived ease of use. (5) The impact of the rest of the suggested factors ranged from medium,
low, and insignificant. The research made an in-depth exploration and examination of the factors that influence
user’s intention to use mobile health services focusing on technological, cultural, organizational, political, and
social aspects whereas most of the previous studies considered only one or two aspects together. The proposed
model can be applied to assess mobile health user’s acceptance, thereby help mobile health developers and
providers to develop better mobile health applications that meet the needs of the potential users.
Keywords: Intention to use, Mobile health, portability, Resistance to change, Technology anxiety, Technology
acceptance model
UI/UX integrated holistic monitoring of PAUD using the TCSD methodjournalBEEI
User interface (UI)/user experience (UX) is one part of the stages in the development of the system to produce interactive and attractive web-based application layouts so that it is easy to understand and use by users. In this research, a case study was conducted on early childhood in PAUD Kuntum Mekar. The design of the UI/UX model for holistic integrative PAUD monitoring becomes one of the solutions to help parents and teachers. The method used to design UI/UX is the task centered system design (TCSD) approach starting from the stages; 1) identification scope of use, 2) user centered requirement analysis, 3) design and scenario, and 4) walkthrough evaluate, the method used for system testing is user satisfaction, and heuristic usability. The purpose of this study is the UI/UX design with TCSD can provide valid data needs of each actor based on the assignment and design of the story board of the developed system. The results of this research are UI/UX model design for integrative holistic PAUD monitoring application.
STUDY PROTOCOL Open AccessSafety Assurance Factors for Ele.docxhanneloremccaffery
STUDY PROTOCOL Open Access
Safety Assurance Factors for Electronic Health
Record Resilience (SAFER): study protocol
Hardeep Singh1*, Joan S Ash2 and Dean F Sittig3
Abstract
Background: Implementation and use of electronic health records (EHRs) could lead to potential improvements in
quality of care. However, the use of EHRs also introduces unique and often unexpected patient safety risks.
Proactive assessment of risks and vulnerabilities can help address potential EHR-related safety hazards before harm
occurs; however, current risk assessment methods are underdeveloped. The overall objective of this project is to
develop and validate proactive assessment tools to ensure that EHR-enabled clinical work systems are safe and
effective.
Methods/Design: This work is conceptually grounded in an 8-dimension model of safe and effective health
information technology use. Our first aim is to develop self-assessment guides that can be used by health care
institutions to evaluate certain high-risk components of their EHR-enabled clinical work systems. We will solicit input
from subject matter experts and relevant stakeholders to develop guides focused on 9 specific risk areas and will
subsequently pilot test the guides with individuals representative of likely users. The second aim will be to examine
the utility of the self-assessment guides by beta testing the guides at selected facilities and conducting on-site
evaluations. Our multidisciplinary team will use a variety of methods to assess the content validity and perceived
usefulness of the guides, including interviews, naturalistic observations, and document analysis. The anticipated
output of this work will be a series of self-administered EHR safety assessment guides with clear, actionable,
checklist-type items.
Discussion: Proactive assessment of patient safety risks increases the resiliency of health care organizations to
unanticipated hazards of EHR use. The resulting products and lessons learned from the development of the
assessment guides are expected to be helpful to organizations that are beginning the EHR selection and
implementation process as well as those that have already implemented EHRs. Findings from our project, currently
underway, will inform future efforts to validate and implement tools that can be used by health care organizations
to improve the safety of EHR-enabled clinical work systems.
Keywords: Electronic health records, Health information technology, Patient safety, Risk assessment, Resilience
Background
Several countries have made recent multi-billion dollar
investments in electronic health record (EHR) infra-
structure to transform their health care delivery systems.
However, implementation of EHR-related initiatives has
encountered greater than expected challenges [1-4].
Although successful transformations have occurred in a
few pioneering healthcare organizations across the globe,
[5,6] the vast majority of organizations are still in the
process of implementing.
A comprehensive study on disease risk predictions in machine learning IJECEIAES
Over recent years, multiple disease risk prediction models have been developed. These models use various patient characteristics to estimate the probability of outcomes over a certain period of time and hold the potential to improve decision making and individualize care. Discovering hidden patterns and interactions from medical databases with growing evaluation of the disease prediction model has become crucial. It needs many trials in traditional clinical findings that could complicate disease prediction. A Comprehensive study on different strategies used to predict disease is conferred in this paper. Applying these techniques to healthcare data, has improvement of risk prediction models to find out the patients who would get benefit from disease management programs to reduce hospital readmission and healthcare cost, but the results of these endeavors have been shifted.
Application Evaluation Project Part 1 Evaluation Plan FocusTec.docxalfredai53p
Application: Evaluation Project Part 1: Evaluation Plan Focus
Technology increases human effectiveness. Using a lever, you can move an object several times your size. In an airplane, you can move exponentially faster than on foot. Using the Internet, you can access information much more quickly than at a library. What possibilities like this exist in the nursing field? What health information technologies can amplify your impact as a nurse far more than ever before? In this Evaluation Project, you will have the opportunity to answer these questions.
Because of the great differences between HIT systems and different goals of an evaluation, there is no one-size-fits-all evaluation plan. Different technologies require different evaluation methods. Consequently, in this part of your Evaluation Project, you will conduct research on how system implementations similar to the one you select have been previously evaluated. After exploring similar system implementations, you will select one research goal and viewpoint to use in the evaluation.
Read the following three scenarios, and select the one that is of most interest to you:
Scenario 1:
Your hospital is implementing a new unified acute and ambulatory Electronic Health Record (EHR) system through which patient care documentation will occur. Interdisciplinary assessment forms (including nursing), clinical decision support, and medical notes will be documented in this system. The implementation of the system is anticipated to improve the hospital’s performance in a multitude of areas. In particular, it is hoped that the use of the EHR system will reduce the rate of patient safety events, improve the quality of care, deter sentinel events, reduce patient readmissions, and impact spending. The implementation of the EHR system is also intended to fulfill the “Meaningful Use” requirements stipulated in the Health Information Technology for Economic and Clinical Health (HITECH) Act. As the hospital’s lead nurse informaticist, you have been tasked with planning the evaluation of the EHR implementation.
Scenario 2:
As the lead nurse informaticist in your hospital, you have been given the task of planning an evaluation for a soon-to-be launched computerized provider order entry (CPOE) system. The CPOE system is designed to replace conventional methods of placing medication, laboratory, admission, referral, and radiology orders. CPOE systems enable health care providers to electronically specify orders, rather than rely on paper prescriptions, telephone calls, and faxes. The intended goal of a CPOE system is to improve safety by ensuring that orders are easily comprehensible through the use of evidence-based order sets. In addition, the CPOE system has the potential for improving workflow by avoiding duplicate orders and reducing the steps between those who place medical orders and their recipients.
Scenario 3:
You are the lead nurse informaticist in a large urban hospital that has recently implemented a new .
Advances in information and communication technologies have led to the emergence of Internet of Things
(IoT). In the modern health care environment, the usage of IoT technologies brings convenience to physicians and
patients since they are applied to various medical areas (such as real-time monitoring, patient information and healthcare
management). The body sensor network (BSN) technology is one of the core technologies of IoT developments in
healthcare system, where a patient can be monitored using a collection of tiny-powered and lightweight wireless sensor
nodes
CompetencyAnalyze how human resource standards and practices.docxbartholomeocoombs
Competency
Analyze how human resource standards and practices within the healthcare field support organizational mission, visions, and values.
Scenario
Wynn Regional Medical Center (WRMC) is the premier hospital in your area. The hospital has been in your city for over 100 years. Over the past decade, the hospital has been losing money for various reasons, though primarily due to uncompensated care. You were recently hired as the Vice President for Human Resources at WRMC, and part of your responsibilities include presenting historical information to participants of the new employee orientation.
Instructions
Create a PowerPoint presentation detailing the changing nature of the healthcare workforce. The presentation should contain speaker notes for each slide or voiceover narration. The presentation should address the following topics and questions:
Historical information on the changing healthcare workforce
How have legislation and policies changed in the past decade?
How have patient demographics changed in the past decade (baby boomers, generation X, millennials, ethnicities)?
How have patient centric approaches changed in the past decade (use of the Internet and social media to gather health information)?
Challenges associated with the changing healthcare workforce
What are some of the challenges associated with the policy and legislative changes?
What are some challenges associated with demographic changes?
What are some of the challenges associated with patients “researching” their own health instead of going to the doctor?
Current state of healthcare
What have been some of the improvements to the healthcare system over the last decade?
Resources
This
link
has information for creating a PowerPoint presentation.
Here is a
link
to information about adding speaker notes.
Here is a
link
to information about creating a voiceover narration using Screencast-O-Matic.
GRADING RUBRICS:
1.Clear and thorough explanation of the history of the changing healthcare workforce. Includes comprehensive descriptions with multiple supporting examples for each of the SUB-BULLET POINTS.
2. Clear and thorough discussion of the challenges associated with the changing healthcare workforce. Includes comprehensive descriptions with multiple supporting examples for each of the SUB-BULLET POINTS.
3. Comprehensive analysis of the current state of healthcare.
Includes a clear and thorough assessment of improvements to the healthcare system over the last decade and supports assertions with multiple supporting examples.
.
CompetencyAnalyze financial statements to assess performance.docxbartholomeocoombs
Competency
Analyze financial statements to assess performance and to ensure organizational improvement and long-term viability
.
Scenario
In an ongoing effort to explore the feasibility of expanding services into rural areas of the state, leadership at Memorial Hospital has determined that conducting a review of its financial condition will be essential to ensuring the organization’s ability to successfully achieve its expansion goals.
Instructions
The CFO has provided you with a copy of the organization’s
financial statements
. This information will be critical in evaluating the organization’s financial capacity to support the proposed expansion of services into the rural areas of the state.
You are asked to review these financial statements (which include the Income Statement, Statement of Cash Flows, and the Balance Sheet) and prepare an executive summary outlining the financial strength of the organization and evidence to support the expansion. Your executive summary should include the following:
An overview of the issue.
A review of critical financial ratios (Liquidity, Solvency, Profitability, and Efficiency) based on financial statements.
Inferences of forecasts, estimates, interpretations, and conclusions based on the key ratios.
Provide a recommendation based on ration analysis.
Resources
This
link
has information for creating an executive summary.
Grading Rubric:
1.
Comprehensive identification of summary of the issue. Includes multiple examples or supporting details.
2. Clear and thorough review of critical financial ratios--Liquidity, Solvency, Profitability, and Efficiency--based on financial statements. Includes multiple examples or supporting details per topic.
3. Clear and thorough inferences of forecasts, estimates, interpretations, and conclusions based on the key ratios. Includes multiple examples or supporting details per topic.
4. Comprehensive recommendation, based on ration analysis. Includes multiple examples or supporting details.
.
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The purpose of the present paper is to describe the development of a measurement scale, to assess the impact of the national cultural factors on the electronic clinical records acceptance in the Ibn Sina Hospital Center(CHUIS)in Morocco. The methodology assumed is based on the Churchill paradigm
(1979).Thus, our contribution focuses on the exploratory phase, where the items have been analysed using principal components analysis (PCA) and internal consistency with Cronbach’s Alpha (α). The results show a satisfactory factorial structure and excellent reliability of all the items.
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services delivered to patients across the board. This role is anticipated to be accomplished by the
development and implementation of artificial intelligence in healthcare which has the potential to impact
the provision of healthcare services. This paper sought to investigate the impact of adopting and
implementing artificial intelligence on the automation of digital health systems within the different levels of
healthcare. The general objective of the research study was to investigate the impact of artificial
intelligence in the automation of digital health systems. The specific goals were to understand the concept
of artificial intelligence and how it automates digital strategies, to determine the AI systems that have been
developed and implemented in the healthcare systems, to establish the factors that influence the adoption
of AI in healthcare, and to find out the outcomes of implementing AI in digital health systems. The research
employed the descriptive research design. The study population included healthcare workers,
policymakers, IT specialists, and management teams in the healthcare sector in the State of Kentucky. The
sampling technique for the study was the purposive sampling technique. The study collected data using
semi-structured interviews administered through Google Teams and Zoom. Data analysis was analyzed
using the computer-assisted software for analyzing qualitative data, NVivo. The findings were that AI as a
technological concept has the potential to impact the automation of digital health systems and is key to
automating health services such as the diagnosis and treatment of illnesses and management of claims and
payments. The study recommended that policy supports the application of artificial intelligence in
healthcare, thus enabling the automation of several healthcare services and thus improving the delivery of
care.
Analysis of the User Acceptance for Implementing ISO/IEC 27001:2005 in Turkis...IJMIT JOURNAL
This study aims to develop a model for the user acceptance for implementing the information security standard (i.e. ISO 27001) in Turkish public organizations. The results of the surveys performed in Turkey reveal that the legislation on information security public which organizations have to obey is significantly related with the user acceptance during ISO 27001 implementation process. The fundamental components of our user acceptance model are perceived usefulness, attitude towards use, social norms, and performance expectancy.
NATIONAL CULTURAL DIMENSIONS AND ELECTRONIC CLINICAL RECORDS ACCEPTANCE: AN E...IJMIT JOURNAL
The propose of the present paper is to describe the development of a measurement scale to assess the impact of the national cultural factors on the electronic clinical records acceptance in the Hospital Center Ibn Sina in Morocco.The methodology assumed is based on the Churchill paradigm (1979).Thus, our contribution focuses on the exploratory phase, which the items have been analyzed by the principal components' method and aninternal consistency method using the Cronbach’s Alpha (α). The results show a satisfactory factorial structure and excellent reliability of all the items, except some which are eliminated.
MHEALTH APPLICATIONS DEVELOPED BY THE MINISTRY OF HEALTH FOR PUBLIC USERS INK...hiij
mHealth applications have shown promise in supporting the delivery of health services in peoples’ daily
life. Recently, the Ministry of Health in the Kingdom of Saudi Arabia (MOH) has launched several mHealth
applications to develop work mechanisms. Our study aimed to identify and understand the design of
mHealth apps by classifying their persuasive features using the Persuasive Systems Design (PSD) model
and expert evaluation method. This paper presents the distinct persuasive features applied in recent
applications launched by MOH for public users called “Sehha & Mawid” Apps. The results revealed the
extensive use of persuasive features; particularly features related to credibility support, dialogue support
and primary task support respectively. The implementation and design of social support features were
found to be poor; this could be due to the nature of the apps or lack of knowledge from the developers’
perspectives. The findings suggest some features that may improve the persuasion for the evaluated apps.
Making India to a global healthcare hub, it is not only about bringing new technology but also we have to take care of the
existing technology. The healthcare hub is the leading factor for current economic growth of India. Human Factor Engineering
(HFE) plays a vital role in this field. In medical or healthcare, the field is named as Medical Human Factor Engineering (MHFE).
This paper discusses on how MHFE responsible for strengthen the Technology Management of Hospital, Hazards from device
failure and use related, Human Factors consideration in medical device use and case study on (Infusion Pumps) errors committed by
users in each clinical area. Now the challenging issue for HFE is to design a proper workspace to avoid human errors and the four
workspace design principles of Sanders & McCormick (1993) is also discussed. This paper deals with the Computer-aided-design
(CAD) systems and a failure mode and effects analysis (FMEA) technique with Simple Organizational Structure of HFE in designing the workspace.
Technology Acceptance Model for Mobile Health SystemsIOSR Journals
Abstract: The purpose of this paper is to explore the factors that influence health-related consumer’s
acceptance to use the mobile technology as a tool for receiving healthcare services. Based on technology
acceptance model (TAM), this paper provides a better understanding of antecedent of key acceptance constructs
(e.g. intention to use, perceived usefulness, perceived ease of use). The proposed research model and hypotheses
validated and tested with data collected from 302 Egyptians and Yemenis patients, health professionals, and
general health users. The results are analyzed using a number of statistical techniques including partial least
squares. The key findings obtaining from the results of the three surveyed stakeholders reveal that: (1) ninety
percent are indented to use mobile health services. (2) While intention to use has greatly influenced by
perceived usefulness, the impact of perceived ease of use varies. (3) Perceived value, perceived ease of use and
portability factors are significantly affect perceived usefulness. (4) Self-efficacy and technology anxiety have a
great impact on perceived ease of use. (5) The impact of the rest of the suggested factors ranged from medium,
low, and insignificant. The research made an in-depth exploration and examination of the factors that influence
user’s intention to use mobile health services focusing on technological, cultural, organizational, political, and
social aspects whereas most of the previous studies considered only one or two aspects together. The proposed
model can be applied to assess mobile health user’s acceptance, thereby help mobile health developers and
providers to develop better mobile health applications that meet the needs of the potential users.
Keywords: Intention to use, Mobile health, portability, Resistance to change, Technology anxiety, Technology
acceptance model
UI/UX integrated holistic monitoring of PAUD using the TCSD methodjournalBEEI
User interface (UI)/user experience (UX) is one part of the stages in the development of the system to produce interactive and attractive web-based application layouts so that it is easy to understand and use by users. In this research, a case study was conducted on early childhood in PAUD Kuntum Mekar. The design of the UI/UX model for holistic integrative PAUD monitoring becomes one of the solutions to help parents and teachers. The method used to design UI/UX is the task centered system design (TCSD) approach starting from the stages; 1) identification scope of use, 2) user centered requirement analysis, 3) design and scenario, and 4) walkthrough evaluate, the method used for system testing is user satisfaction, and heuristic usability. The purpose of this study is the UI/UX design with TCSD can provide valid data needs of each actor based on the assignment and design of the story board of the developed system. The results of this research are UI/UX model design for integrative holistic PAUD monitoring application.
STUDY PROTOCOL Open AccessSafety Assurance Factors for Ele.docxhanneloremccaffery
STUDY PROTOCOL Open Access
Safety Assurance Factors for Electronic Health
Record Resilience (SAFER): study protocol
Hardeep Singh1*, Joan S Ash2 and Dean F Sittig3
Abstract
Background: Implementation and use of electronic health records (EHRs) could lead to potential improvements in
quality of care. However, the use of EHRs also introduces unique and often unexpected patient safety risks.
Proactive assessment of risks and vulnerabilities can help address potential EHR-related safety hazards before harm
occurs; however, current risk assessment methods are underdeveloped. The overall objective of this project is to
develop and validate proactive assessment tools to ensure that EHR-enabled clinical work systems are safe and
effective.
Methods/Design: This work is conceptually grounded in an 8-dimension model of safe and effective health
information technology use. Our first aim is to develop self-assessment guides that can be used by health care
institutions to evaluate certain high-risk components of their EHR-enabled clinical work systems. We will solicit input
from subject matter experts and relevant stakeholders to develop guides focused on 9 specific risk areas and will
subsequently pilot test the guides with individuals representative of likely users. The second aim will be to examine
the utility of the self-assessment guides by beta testing the guides at selected facilities and conducting on-site
evaluations. Our multidisciplinary team will use a variety of methods to assess the content validity and perceived
usefulness of the guides, including interviews, naturalistic observations, and document analysis. The anticipated
output of this work will be a series of self-administered EHR safety assessment guides with clear, actionable,
checklist-type items.
Discussion: Proactive assessment of patient safety risks increases the resiliency of health care organizations to
unanticipated hazards of EHR use. The resulting products and lessons learned from the development of the
assessment guides are expected to be helpful to organizations that are beginning the EHR selection and
implementation process as well as those that have already implemented EHRs. Findings from our project, currently
underway, will inform future efforts to validate and implement tools that can be used by health care organizations
to improve the safety of EHR-enabled clinical work systems.
Keywords: Electronic health records, Health information technology, Patient safety, Risk assessment, Resilience
Background
Several countries have made recent multi-billion dollar
investments in electronic health record (EHR) infra-
structure to transform their health care delivery systems.
However, implementation of EHR-related initiatives has
encountered greater than expected challenges [1-4].
Although successful transformations have occurred in a
few pioneering healthcare organizations across the globe,
[5,6] the vast majority of organizations are still in the
process of implementing.
A comprehensive study on disease risk predictions in machine learning IJECEIAES
Over recent years, multiple disease risk prediction models have been developed. These models use various patient characteristics to estimate the probability of outcomes over a certain period of time and hold the potential to improve decision making and individualize care. Discovering hidden patterns and interactions from medical databases with growing evaluation of the disease prediction model has become crucial. It needs many trials in traditional clinical findings that could complicate disease prediction. A Comprehensive study on different strategies used to predict disease is conferred in this paper. Applying these techniques to healthcare data, has improvement of risk prediction models to find out the patients who would get benefit from disease management programs to reduce hospital readmission and healthcare cost, but the results of these endeavors have been shifted.
Application Evaluation Project Part 1 Evaluation Plan FocusTec.docxalfredai53p
Application: Evaluation Project Part 1: Evaluation Plan Focus
Technology increases human effectiveness. Using a lever, you can move an object several times your size. In an airplane, you can move exponentially faster than on foot. Using the Internet, you can access information much more quickly than at a library. What possibilities like this exist in the nursing field? What health information technologies can amplify your impact as a nurse far more than ever before? In this Evaluation Project, you will have the opportunity to answer these questions.
Because of the great differences between HIT systems and different goals of an evaluation, there is no one-size-fits-all evaluation plan. Different technologies require different evaluation methods. Consequently, in this part of your Evaluation Project, you will conduct research on how system implementations similar to the one you select have been previously evaluated. After exploring similar system implementations, you will select one research goal and viewpoint to use in the evaluation.
Read the following three scenarios, and select the one that is of most interest to you:
Scenario 1:
Your hospital is implementing a new unified acute and ambulatory Electronic Health Record (EHR) system through which patient care documentation will occur. Interdisciplinary assessment forms (including nursing), clinical decision support, and medical notes will be documented in this system. The implementation of the system is anticipated to improve the hospital’s performance in a multitude of areas. In particular, it is hoped that the use of the EHR system will reduce the rate of patient safety events, improve the quality of care, deter sentinel events, reduce patient readmissions, and impact spending. The implementation of the EHR system is also intended to fulfill the “Meaningful Use” requirements stipulated in the Health Information Technology for Economic and Clinical Health (HITECH) Act. As the hospital’s lead nurse informaticist, you have been tasked with planning the evaluation of the EHR implementation.
Scenario 2:
As the lead nurse informaticist in your hospital, you have been given the task of planning an evaluation for a soon-to-be launched computerized provider order entry (CPOE) system. The CPOE system is designed to replace conventional methods of placing medication, laboratory, admission, referral, and radiology orders. CPOE systems enable health care providers to electronically specify orders, rather than rely on paper prescriptions, telephone calls, and faxes. The intended goal of a CPOE system is to improve safety by ensuring that orders are easily comprehensible through the use of evidence-based order sets. In addition, the CPOE system has the potential for improving workflow by avoiding duplicate orders and reducing the steps between those who place medical orders and their recipients.
Scenario 3:
You are the lead nurse informaticist in a large urban hospital that has recently implemented a new .
Advances in information and communication technologies have led to the emergence of Internet of Things
(IoT). In the modern health care environment, the usage of IoT technologies brings convenience to physicians and
patients since they are applied to various medical areas (such as real-time monitoring, patient information and healthcare
management). The body sensor network (BSN) technology is one of the core technologies of IoT developments in
healthcare system, where a patient can be monitored using a collection of tiny-powered and lightweight wireless sensor
nodes
CompetencyAnalyze how human resource standards and practices.docxbartholomeocoombs
Competency
Analyze how human resource standards and practices within the healthcare field support organizational mission, visions, and values.
Scenario
Wynn Regional Medical Center (WRMC) is the premier hospital in your area. The hospital has been in your city for over 100 years. Over the past decade, the hospital has been losing money for various reasons, though primarily due to uncompensated care. You were recently hired as the Vice President for Human Resources at WRMC, and part of your responsibilities include presenting historical information to participants of the new employee orientation.
Instructions
Create a PowerPoint presentation detailing the changing nature of the healthcare workforce. The presentation should contain speaker notes for each slide or voiceover narration. The presentation should address the following topics and questions:
Historical information on the changing healthcare workforce
How have legislation and policies changed in the past decade?
How have patient demographics changed in the past decade (baby boomers, generation X, millennials, ethnicities)?
How have patient centric approaches changed in the past decade (use of the Internet and social media to gather health information)?
Challenges associated with the changing healthcare workforce
What are some of the challenges associated with the policy and legislative changes?
What are some challenges associated with demographic changes?
What are some of the challenges associated with patients “researching” their own health instead of going to the doctor?
Current state of healthcare
What have been some of the improvements to the healthcare system over the last decade?
Resources
This
link
has information for creating a PowerPoint presentation.
Here is a
link
to information about adding speaker notes.
Here is a
link
to information about creating a voiceover narration using Screencast-O-Matic.
GRADING RUBRICS:
1.Clear and thorough explanation of the history of the changing healthcare workforce. Includes comprehensive descriptions with multiple supporting examples for each of the SUB-BULLET POINTS.
2. Clear and thorough discussion of the challenges associated with the changing healthcare workforce. Includes comprehensive descriptions with multiple supporting examples for each of the SUB-BULLET POINTS.
3. Comprehensive analysis of the current state of healthcare.
Includes a clear and thorough assessment of improvements to the healthcare system over the last decade and supports assertions with multiple supporting examples.
.
CompetencyAnalyze financial statements to assess performance.docxbartholomeocoombs
Competency
Analyze financial statements to assess performance and to ensure organizational improvement and long-term viability
.
Scenario
In an ongoing effort to explore the feasibility of expanding services into rural areas of the state, leadership at Memorial Hospital has determined that conducting a review of its financial condition will be essential to ensuring the organization’s ability to successfully achieve its expansion goals.
Instructions
The CFO has provided you with a copy of the organization’s
financial statements
. This information will be critical in evaluating the organization’s financial capacity to support the proposed expansion of services into the rural areas of the state.
You are asked to review these financial statements (which include the Income Statement, Statement of Cash Flows, and the Balance Sheet) and prepare an executive summary outlining the financial strength of the organization and evidence to support the expansion. Your executive summary should include the following:
An overview of the issue.
A review of critical financial ratios (Liquidity, Solvency, Profitability, and Efficiency) based on financial statements.
Inferences of forecasts, estimates, interpretations, and conclusions based on the key ratios.
Provide a recommendation based on ration analysis.
Resources
This
link
has information for creating an executive summary.
Grading Rubric:
1.
Comprehensive identification of summary of the issue. Includes multiple examples or supporting details.
2. Clear and thorough review of critical financial ratios--Liquidity, Solvency, Profitability, and Efficiency--based on financial statements. Includes multiple examples or supporting details per topic.
3. Clear and thorough inferences of forecasts, estimates, interpretations, and conclusions based on the key ratios. Includes multiple examples or supporting details per topic.
4. Comprehensive recommendation, based on ration analysis. Includes multiple examples or supporting details.
.
CompetencyAnalyze ethical and legal dilemmas that healthcare.docxbartholomeocoombs
Competency
Analyze ethical and legal dilemmas that healthcare workers may encounter in the medical field.
Instructions
You have recently been promoted to Health Services Manager at Three Mountains Regional Hospital, a small hospital located in a mid-size city in the Midwest. Three Mountains is a general medical and surgical facility with 400 beds. Last year there were approximately 62,000 emergency visits and 15,000 admissions. More than 6,000 outpatient and 10,000 inpatient surgeries were performed.
An important aspect of the provider/patient relationship pertains to open communication and trust. Patients want to know that their doctors and the support staff associated with their care understand their wishes and will abide by them. Ideally, these conversations happen well before an emergency or procedure takes place; however, often times this information is missing from a patient's file. As part of Three Mountains' initiative to build trust with their patients, an increased emphasis has been placed on obtaining living wills from the patient as part of the intake process to ensure that the healthcare team has written directives of the patient's wishes in case of incapacitation. You will be creating a living will for a patient and provide educational information as to why the patient should fill it out during the admission process before a procedure.
Introduction:
Explain the definition of a living will and its key components. This section will provide an educational overview of the document for the patient.
Living Will Template:
Create a living will that can serve as a template to the patients. This should cover the basic treatment issues such as resuscitation, feeding tubes, ventilation, organ and tissue donations, etc. Provide instructions in the template that can be easily altered, depending on each patient's wishes.
Summary:
In this section, you will discuss the importance of this document and encourage patients to complete it. Address how this document ensures that a patient's wishes are known and followed by the healthcare team.
NOTE
- APA formatting and proper grammar, punctuation, and form required. APA help is available
here.
.
CompetencyAnalyze ethical and legal dilemmas that healthcare wor.docxbartholomeocoombs
Competency
Analyze ethical and legal dilemmas that healthcare workers may encounter in the medical field.
Instructions
You have recently been promoted to Health Services Manager at Three Mountains Regional Hospital, a small hospital located in a mid-size city in the Midwest. Three Mountains is a general medical and surgical facility with 400 beds. Last year there were approximately 62,000 emergency visits and 15,000 admissions. More than 6,000 outpatient and 10,000 inpatient surgeries were performed.
An important aspect of the provider/patient relationship pertains to open communication and trust. Patients want to know that their doctors and the support staff associated with their care understand their wishes and will abide by them. Ideally, these conversations happen well before an emergency or procedure takes place; however, often times this information is missing from a patient's file. As part of Three Mountains' initiative to build trust with their patients, an increased emphasis has been placed on obtaining living wills from the patient as part of the intake process to ensure that the healthcare team has written directives of the patient's wishes in case of incapacitation. You will be creating a living will for a patient and provide educational information as to why the patient should fill it out during the admission process before a procedure.
Introduction:
Explain the definition of a living will and its key components. This section will provide an educational overview of the document for the patient.
Living Will Template:
Create a living will that can serve as a template to the patients. This should cover the basic treatment issues such as resuscitation, feeding tubes, ventilation, organ and tissue donations, etc. Provide instructions in the template that can be easily altered, depending on each patient's wishes.
Summary:
In this section, you will discuss the importance of this document and encourage patients to complete it. Address how this document ensures that a patient's wishes are known and followed by the healthcare team.
NOTE
- APA formatting and proper grammar, punctuation, and form required.
.
CompetencyAnalyze collaboration tools to support organizatio.docxbartholomeocoombs
Competency
Analyze collaboration tools to support organizational goals.
Scenario
You are a new manager at Elliot Building Supplies International who has seen huge success in managing your global team remotely. This success has been shown in the team outcomes/production and employee satisfaction and engagement. Senior leadership has taken notice of your success and has asked you to create a presentation to share with your peers, who also manage remotely, that explains the best collaboration tools for remote teams. Also, you will explain the best way to manage effectively and create a motivating and satisfying work environment that supports collaboration.
Instructions
You will need to include the following in your PowerPoint presentation.
Presentation welcome/introduction slide.
Collaboration tools that you have used to be successful.
This should include at least 4 different types of tools.
Each type should be explained in detail, along with the benefits it provides.
Critical skills to successfully manage remote employees.
Closing slide to share final thoughts and ideas.
.
Competency Checklist and Professional Development Resources .docxbartholomeocoombs
Competency Checklist and Professional Development Resources
An important and yet often overlooked function of leadership in an early childhood program is the ability to positively influence the people in the program. For this group assignment, consider the characteristics of a leader who can support and lead teachers in reflective teaching. This type of self-reflection is the first step to understanding how a supervisor supports teachers to accomplish their goals through mentoring. For this assignment, your group will need to address the following two components:
Part 1
: Consider the following question as your group completes the competency checklist below: What might be evidence that a teacher leader possesses the competence to also be a mentor? You are encouraged to evenly divide the competencies among your group, so that each member contributes to providing brief examples of interactions while highlighting the characteristic(s) that demonstrates each competency. While this portion can be completed independently, you should then collaborate to ensure that each group member provides feedback before submitting the full collaborative document.
Competency Checklist
Competency
Describe an example of a teacher-leader with children (when acting as a teacher)
Describe an example of a teacher-leader with adults (when acting as a supervisor)
Listens well, does not interrupt, and respects the pace of the other person
Is able to wait for others to discover solutions, form own ideas, and reflect
Asks questions that encourage details
Is aware of and comfortable with his or her feelings and the emotions of others
Is responsive to others
Guides, nurtures, supports, and empathizes
Integrates emotion and intellect
Fosters reflection or wondering by others
Is aware of how others’ reactions affect a process of dialogue and reflection, including sensitivity to bias and cultural context
Is willing to have consistent and predictable meeting times and places
Is flexible and available
Is able to form trusting relationships
Part 2:
Professional Development Resources Document
–Early childhood programs have numerous curriculum options which may contribute to a need to support teachers and staff in a curriculum context they are not familiar with. Therefore, as we prepare to support protégés, we can refer to the National Association of the Education of Young Children core standards for professional development, to promote the use of best practices. These six core standards, briefly describe what early childhood professionals should know and be able to do. After reading each of the
NAEYC Standards for Early Childhood Professional Preparation Programs (Links to an external site.)
, focus on the first four standards:
STANDARD 1.
PROMOTING CHILD DEVELOPMENT AND LEARNING
STANDARD 2.
BUILDING FAMILY AND COMMUNITY RELATIONSHIPS
STANDARD 3.
OBSERVING, DOCUMENTING, AND ASSESSING TO SUPPORT YOUNG CHILDREN AND FAMILIES
STANDARD 4.
US.
Competency 6 Enagage with Communities and Organizations (3 hrs) (1 .docxbartholomeocoombs
Competency 6: Enagage with Communities and Organizations (3 hrs) (1 to 2 Pages)
Behavior: use empathy, reflection, and interpersonal skills to effectively engage diverse clients and constituencies.
For this assignment, you are to explore how your community is addressing the needs of its citizens during the CoVID 19 situation. Explore how you can consult and connect with community leaders and organizations to be a part of solutions in your community. Provide a detailed account of your exploration of community needs, as well as how you participated at the community level to address the needs of your community.
.
Competency 2 Examine the organizational behavior within busines.docxbartholomeocoombs
Competency 2: Examine the organizational behavior within business systems
Provide the name of the corporation you will be using as the basis for this project.
Provide the organization’s purpose or mission statement.
Describe the organization's industry.
Provide the name and position of the person interviewed during this portion of the assignment (indicate as much pertinent information (e.g., length of service with company, previous roles in the company, educational background, etc.).
Provide the list of interview questions you asked the manager/executive.
Indicate which two - three of the following concepts from this competency that you intend to evaluate the organization/team on and describe the company’s/team’s current situation with each topic you’ve selected:
Motivational theories
Psychological contract
Job design
Use of evaluation, feedback and rewards
Misbehavior
Individual or organizational stress
Provide citations in APA format for any references
.
CompetenciesEvaluate the challenges and benefits of employ.docxbartholomeocoombs
Competencies
Evaluate the challenges and benefits of employing a diverse workforce.
Design a plan for conducting business and managing employees in a global society.
Critique the actions of organizations as they integrate diverse perspectives into their cultures.
Evaluate the role of identity, diverse segments, and cultural backgrounds within organizations.
Attribute different cultural perspectives to current social-cultural dimensions.
Analyze the importance of managing a diverse workforce.
Scenario Information
Your company has been nominated for a national diversity award associated with your efforts and dedication to diversity initiatives in the workplace and their impact on the organization and community. You have been asked to summarize your efforts for the year in a slide presentation for the diversity committee who selects the winner. Be sure to include details of the changes you made in your organization and the impact the changes made.
Instructions
As part of your nomination, you have been asked to create a slide presentation including a voice recording for your entry (Voice Recording not needed). Remember your audience when giving your presentation and include the following slides:
Title slide
Highlighting the importance of workplace diversity
Discussing the points that were included in your diversity plan
Describing how culture and inclusion impact your organization
Providing examples of how diverse workgroups work together in the workplace
Gives examples of strategies used to incorporate Hofstede's cultural dimensions in a global workforce
Provides best practices for managers associated with managing a diverse, global workforce
Conclusion slide that includes a summary of why you should win this award
Any additional, relevant information
References
.
CompetenciesDescribe the supply chain management principle.docxbartholomeocoombs
Competencies
Describe the supply chain management principles through the flow of information, materials, services, and resources.
Analyze the external and internal drivers that influence supply chain principles.
Evaluate supply chain management operational best practices.
Compare the nature of logistics operations and services in both international and domestic contexts.
Apply strategic supply chain management to logistics systems.
Analyze different software systems and technology strategies used in supply chain management.
Scenario
You have just been promoted to Senior Analyst at Mitchell Consulting, a firm that specializes in providing managerial expertise in supply chain management. After completing many assignments under the supervision of a Senior Analyst, your role now allows you to make selections for clients. You are assigned a new client, Scent
Solution
s. Your new manager, Partner Ronda Anderson, has directed you to work on this case and provide analysis and options to resolve the problems directly to the client.
Scent
.
CompetenciesABCDF1.1 Create oral, written, or visual .docxbartholomeocoombs
Competencies
A
B
C
D
F
1.1: Create oral, written, or visual communications appropriate to the audience, purpose, and context.
4 points
Key Criteria: Tailors communication to purpose, context, and target audience. Clearly articulates the thesis and purpose, and supports the thesis and purpose with authentic and appropriate evidence. Provides smooth transitions and leaves no awkward gaps from point to point. Shows coherent progress from the introduction to the conclusion with no unnecessary sections.
3 points
Key Criteria: Tailors communication to purpose, context, and target audience. Articulates the thesis and purpose, and supports the thesis and purpose with authentic and appropriate evidence. Generally provides smooth transitions and leaves few awkward gaps from point to point. Shows identifiable progress from the introduction to the conclusion with no unnecessary sections.
2 points
Key Criteria: Considers the purpose, context, and target audience. Articulates the thesis and purpose, and shows some evidence supporting both. Some transitions are not smooth, and there are occasional gaps or awkward connections from point to point. There is a sense of progress from the introduction through the conclusion, but the organization may not be completely clear.
1 point
Key Criteria: Does not tailor communication well in terms of purpose, context, and target audience. Provides a weak thesis, unclear purpose, and little or no evidence to support points. Transitions may be rough or nonexistent, and there are significant gaps or connections between points that leave sections incomprehensible. Progress from the introduction through the conclusion is difficult to decipher, and there may be some material that is unrelated to thesis and purpose.
0 points
Key Criteria: Does not tailor communication in terms of purpose, context, and target audience. Lacks a good thesis and has little or no evidence to support a thesis. Transitions are rough or nonexistent, and there are few discernable connections from point to point. There is no identifiable progress from the introduction through the conclusion, and/or there is substantial material that is unrelated to thesis and purpose.
1.2: Communicate using appropriate writing conventions, including spelling, grammar, mechanics, word choice, and format.
4 points
Uses a format that is highly appropriate to the writing task and carefully tailors the style and tone to the specific audience. Aligns both the writing style and grammar usage to standards appropriate to the task.
3 points
Uses a format that is appropriate to the writing task and tailors the style and tone to the specific audience. Aligns both the writing style and grammar usage to standards appropriate to the task.
2 points
Generally has a clear purpose, but there may be a gap between the format used and the writing task. Fails to fully align the style and tone to the audience, or fails to fully define the audience for the writing task. Has some style or grammar.
COMPETENCIES734.3.4 Healthcare Utilization and Finance.docxbartholomeocoombs
COMPETENCIES
734.3.4
:
Healthcare Utilization and Finance
The graduate analyzes financial implications related to healthcare delivery, reimbursement, access, and national initiatives.
INTRODUCTION
It is essential that nurses understand the issues related to healthcare financing, including local, state, and national healthcare policies and initiatives that affect healthcare delivery. As a patient advocate, the professional nurse is in a position to work with patients and families to access available resources to meet their healthcare needs.
REQUIREMENTS
Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide.
You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.
A. Compare the U.S. healthcare system with the healthcare system of Great Britain, Japan, Germany, or Switzerland, by doing the following:
1. Identify
one
country from the following list whose healthcare system you will compare to the U.S. healthcare system: Great Britain, Japan, Germany, or Switzerland.
2. Compare access between the
two
healthcare systems for children, people who are unemployed, and people who are retired.
a. Discuss coverage for medications in the two healthcare systems.
b. Determine the requirements to get a referral to see a specialist in the two healthcare systems.
c. Discuss coverage for preexisting conditions in the two healthcare systems.
3. Explain
two
financial implications for patients with regard to the healthcare delivery differences between the two countries (i.e.; how are the patients financially impacted).
B. Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.
C. Demonstrate professional communication in the content and presentation of your submission.
File Restrictions
File name may contain only letters, numbers, spaces, and these symbols: ! - _ . * ' ( )
File size limit: 200 MB
File types allowed: doc, docx, rtf, xls, xlsx, ppt, pptx, odt, pdf, txt, qt, mov, mpg, avi, mp3, wav, mp4, wma, flv, asf, mpeg, wmv, m4v, svg, tif, tiff, jpeg, jpg, gif, png, zip, rar, tar, 7z
RUBRIC
A1:COUNTRY TO COMPARE
NOT EVIDENT
A country for comparison is not identified.
APPROACHING COMPETENCE
The identified country for comparison is not from the given list.
COMPETENT
The identified country for comparison is from the given list.
A2:ACCESS
NOT EVIDENT
A comparison of healthcare system access is not provided.
APPROACHING COMPETENCE
The comparison does not acc.
Competencies and KnowledgeWhat competencies were you able to dev.docxbartholomeocoombs
Competencies and Knowledge
What competencies were you able to develop in researching and writing the course Comprehensive Project? How did you leverage knowledge gained in the assignments (Units 1–4) in completing the Comprehensive Project? How will these competencies and knowledge support your career advancement in management
.
Competencies and KnowledgeThis assignment has 2 parts.docxbartholomeocoombs
Competencies and Knowledge
This assignment has 2 parts:
What competencies were you able to develop in researching and writing the course Comprehensive Project? How did you leverage knowledge gained in the intellipath assignments (Units 1- 4) in completing the Comprehensive Project? How will these competencies and knowledge support your career advancement in management?
Discuss the similarities and differences between shareholder wealth maximization and stakeholder wealth maximization.
.
Competencies and KnowledgeThis assignment has 2 partsWhat.docxbartholomeocoombs
Competencies and Knowledge
This assignment has 2 parts:
What competencies were you able to develop in researching and writing the course Comprehensive Project? How did you leverage knowledge gained in the intellipath assignments (Units 1- 4) in completing the Comprehensive Project? How will these competencies and knowledge support your career advancement in management?
Discuss the similarities and differences between shareholder wealth maximization and stakeholder wealth maximization.
.
Competences, Learning Theories and MOOCsRecent Developments.docxbartholomeocoombs
Competences, Learning Theories and MOOCs:
Recent Developments in Lifelong Learning
Karl Steffens
Introduction
We think of our societies as ‘knowledge societies’ in which lifelong learning is
becoming increasingly important. Lifelong learning refers to the idea that people
not only learn in schools and universities, but also in non-formal and informal
ways during their lifespan.The concepts of lifelong learning and lifelong education
began to enter the discourse on educational policies in the late 1960s (Tuijnman
& Boström, 2002). However, these are related, but distinct concepts. As Lee (2014,
p. 472) notes ‘the terminological change (from lifelong education, continuing
education and adult education, to lifelong learning) reflects a conceptual departure
from the idea of organised educational provision to that of a more individualised
pursuit of learning’.
One of the first important documents on lifelong learning was the report of the
International Commission on the Development of Education to UNESCO in
1972, titled ‘Learning to be. The world of education today and tomorrow’. In his
introductory letter to the Director-General of UNESCO, the chairman of the
Commission, Edgar Faure, stated that the work of the Commission was based on
four assumptions (see Elfert pp. and Carneiro pp. in this issue). The first was
related to the idea that there was an international community which was united by
common aspirations and the second was the belief in democracy and in education
as its keystones. The third was ‘that the aim of development is the complete
fulfilment of man, in all the richness of his personality, the complexity of his forms
of expression and his various commitments — as individual, member of a family
and of a community, citizen and producer, inventor of techniques and creative
dreamer’. The last assumption was that ‘only an over-all, lifelong education can
produce the kind of complete man, the need for whom is increasing with the
continually more stringent constraints tearing the individual asunder’ (Faure,
1972, p. vi).
Following the Faure Report, the UNESCO Institute for Education, which
was founded in Germany in 1951, started to focus on lifelong learning and
subsequently became the UNESCO Institute for Lifelong Learning (UIL, http://
uil.unesco.org/home/). It was under its leadership that a formal model of lifelong
education was developed and published in the book ‘Towards a System of Life-
long Education’ (Cropley, 1980). The concept of lifelong learning also became
manifest in the ‘Education for All’ (EFA) agenda that was launched at the World
Conference on Education for All which took place in Jomtien (Thailand) in
1990 (Inter-Agency Commission, 1990). Ten years later, at the World Education
Forum in Dakar (Senegal) in 2000, the Dakar Framework for Action was
designed ‘to enable all individuals to realize their right to learn and to fulfil their
responsibility to contribute to the development of their society’ (UNESCO,
2000, p..
Compensation & Benefits Class 700 words with referencesA stra.docxbartholomeocoombs
Compensation & Benefits Class 700 words with references
A strategic purpose for a well-blended compensation program, one that includes various types of direct compensation, is gaining employee commitment and productivity. One of the most effective tactics for this strategy is designing a process for linking individual achievement to organizational goals.
Prepare a report to senior leaders addressing the following:
·
Explain the concept of tying performance to organizational goals.
·
Describe the different types of individual and group-level performance measurements.
·
What are the advantages and disadvantages of individual versus group-level performance recognition?
·
Discuss the options an organization has to link individual or group monetary rewards to organizational success.
·
Develop recommendations for how to implement, monitor, and evaluate such a program.
.
Compensation, Benefits, Reward & Recognition Plan for V..docxbartholomeocoombs
Compensation, Benefits, Reward & Recognition Plan for V.P. Operations
Learning Team B
HRM 595
December 19, 2017
Rosalie M. Lopez
Running head: COMPENSATION, BENEFITS, REWARD & RECOGNITION PLAN
1
COMPENSATION, BENEFITS, REWARD & RECOGNITION PLAN
2
Compensation, Benefits, Reward & Recognition Plan for V.P. Operations
Introduction
Base Salary Range
For the position of VP of Operations, the National Average Salary is $122,624. In San Francisco, the average is higher and placed at $155,946. This amount is 16% higher than the National Average (Payscale, 2016). The reason for this increase is because of experience and geography. These are the two prime factors that impact the pay scale. Another major factor is the employer. Most employers base their decision to hire an individual on the experience they bring with them. Of course, with more experience, higher pay is required. With our company cutting cost a less experienced individual would be the best fit for the position.
Standard Employee Benefit
In many cases, your employee benefits could be the turning point for a prospective employee. This benefit is a vital portion of any employee packet. These valuable benefits are used as a blanket of security in the case of any sickness, injury, unemployment, old age, or death (Gomez-Mejia, Balkin & Cardy, 2015, p. 362). There is a significant difference between incentives and benefits: benefits are financial and nonfinancial compensations that are indirect to the employee. To have a competitive strategy Blossoms Up! must align their profits with the compensation package that has been already put in place. This action will help provide flexibility to the amount and the benefits available (Gomez-Mejia et al., 2015).
There are also some benefits that most companies are legally obligated to provide. Three benefits are required regardless of the number of employees that the company has. These interests involve social security, workers compensation, and unemployment insurance (Gomez-Mejia et al., 2015). Other laws must be adhered to when dealing with a certain number of individuals. When a company has 50 or more employee they must have the Family and Medical Leave Act in place and since its induction in 2015 the Affordable Care Act for Health Insurance for companies with 20 or more employees. For the health insurance to be considered standard medical, vision and dental plans must be made available to the business. These programs that must be regarded as being under the Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO) (Gomez-Mejia et al., 2015).
There are some voluntary benefits that we can include. We are already looking into adding a pension package using the Defined Contribution Plan as well as the 401(K) plan (Gomez-Mejia et al., 2015). Life insurance is another excellent benefit that could be added to the package as well as short-term and long-term disability insurance. Adding Vacation and PTO, and Holiday pay is .
Compete the following tablesTheoryKey figuresKey concepts o.docxbartholomeocoombs
Compete the following tables:
Theory
Key figures
Key concepts of personality formation
Explanation of the disordered personality
Scientific credibility
Comprehensiveness
Applicability
Attachment
Complete the following...200-300 words..
Is Freud's theory a viable theory for this century?
Provide reasons for
your
view.
.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Clinical Simulation as an Evaluation Method in Health Inf.docx
1. Clinical Simulation as an Evaluation Method
in Health Informatics
Sanne JENSEN
a,1
a
The Capital Region of Denmark, Copenhagen, Denmark
Abstract. Safe work processes and information systems are vital
in health care.
Methods for design of health IT focusing on patient safety are
one of many
initiatives trying to prevent adverse events. Possible patient
safety hazards need to
be investigated before health IT is integrated with local clinical
work practice
including other technology and organizational structure.
Clinical simulation is
ideal for proactive evaluation of new technology for clinical
work practice.
Clinical simulations involve real end-users as they simulate the
use of technology
2. in realistic environments performing realistic tasks. Clinical
simulation study
assesses effects on clinical workflow and enables identification
and evaluation of
patient safety hazards before implementation at a hospital.
Clinical simulation also
offers an opportunity to create a space in which healthcare
professionals working
in different locations or sectors can meet and exchange
knowledge about work
practices and requirement needs. This contribution will discuss
benefits and
challenges of using clinical simulation, and will describe how
clinical simulation
fits into classical usability studies, how patient safety may
benefit by use of
clinical simulation, and it will describe the different steps of
how to conduct
clinical simulation. Furthermore a case study is presented.
Keywords. Ergonomics, eHealth, qualitative evaluation, clinical
simulation, risk,
safety.
1. Introduction
Implementation of health IT in relation to improvement of
3. patient safety and
optimization of work flow is a paradox [1]. Even though health
IT is intended and
anticipated to have a positive impact on quality and efficiency
of health care [2], the
application of new technology in healthcare may also increase
patient safety hazards [3,
4]. Studies show that adverse events are indeed often related to
the use of technology
[5-7].
Design of health IT focusing on protecting patient safety is one
of many initiatives
trying to prevent adverse events [8, 9].
2
Patient safety does not entirely rely on
technology but is highly influenced by the interaction between
users and technology in
a specific context [10], and sociotechnical issues and human
factors are related to many
unintended consequences and patient safety hazards [7, 8, 11].
Possible patient safety
hazards such as design of the IT system itself; embedding of IT
system into local work
5. complexity of organizations,
work practices and physical environments within the healthcare
sector impacts design,
evaluation and implementation of information systems [12, 13].
Healthcare
environments are profoundly collaborative and rely on
coordination between various
health professionals [14]. They are characterized by delegated
decision-making,
multiple viewpoints and inconsistent and evolving knowledge
bases [15]. Multiple
groups with potentially divergent values and objectives work
together and face many
contingencies which cannot be fully anticipated [16, 17]. These
matters challenge
design and evaluation of health IT.
Clinical simulation tries to address this challenge. Compared
with other methods,
e.g. heuristic inspection and low fidelity usability evaluation
3
, clinical simulation takes
the clinical context into account. In contrast, for example,
heuristic inspection focuses
on the user interface, and low fidelity usability testing focuses
6. on technology and on
the specific tasks of individual users. By including the clinical
context, clinical
simulation is ideal for proactive evaluation of new technology
for clinical work practice
[18, 19]. Clinical simulations involve real end-users as they
simulate the use of
technology in realistic environments performing realistic tasks
[20]. Clinical simulation
studies the effects on clinical workflow [21] and enables
identification and evaluation
of patient safety hazards before implementation at a hospital or
other clinical setting
[22]. Clinical simulation also offers an opportunity to create a
space in which
healthcare professionals working in different locations or
sectors can meet and
exchange knowledge about work practices and requirement
needs [23, 24].
Hospital organizations and work practice are extremely complex
with many
different healthcare groups and many interactions and
correlations [25] involved, and
many acute situations are encountered during daily work
7. practice in hospital settings
[26]. This complexity affects the technology that is
implemented at hospitals [27] and
confronts the methodology used for design and evaluation of
healthcare information
systems. Failure to comprehend the nature and range of end-
users has been highlighted
as a key issue in many systems’ failing to become accepted by
healthcare professionals
[28]. Furthermore, an understanding of the context in which the
systems will be used
must take into account not only tasks and settings [29], but also
the range, competences
and cognitive capacities of an increasing variety of potential
end-users [30]. The risk of
endangering patient security calls for careful evaluation before
implementing new
technology in real life settings [31].
Usability relates to how a product can be used to achieve
specified goals with
effectiveness, efficiency and satisfaction in a specified context
of use.
3
Usability
8. focuses on use of technology in a specific context [32]. Context
may be defined as
“users, tasks, equipment (hardware, software and materials),
and the physical and
social environment in which a product is used” [32]. It does
however raise several
questions, e.g. ‘who are the users?’, ‘what are their tasks?’ and
‘with whom, where and
under what conditions are they performing these task?’. The
healthcare sector poses
challenges due to the larger potential numbers and classes of
users, e.g. nurses,
physicians and pharmacists [28]. Furthermore, the definition
does not take multiple
3
See also: R. Marcilly et al., From usability engineering to
evidence-based usability in health IT, in: E.
Ammenwerth, M. Rigby (eds.), Evidence-Based Health
Informatics, Stud Health Technol Inform 222, IOS
Press, Amsterdam, 2016.
S. Jensen / Clinical Simulation as an Evaluation Method in
Health Informatics 153
9. users and their professional interaction into account, and nor
does it take parts of or a
whole organization into account.
According to Hertzum [33] many views may be put on usability,
dividing it into
six images; 1) universal usability: usability in a system for
everybody to use, 2)
situational usability: quality-in-use of a system in a specified
situation with its users,
tasks, and wider context of use, 3) perceived usability: usability
concerns the user’s
subjective experience of a system based on her or his
interaction with it, 4) hedonic
usability: usability is about joy of use rather than ease of use,
task accomplishment, and
freedom of discomfort, 5) organizational usability: usability
implies groups of people
collaborating in an organizational setting, and 6) cultural
usability: usability takes on
different meaning depending on the users different background.
Hertzum claims that all
images should be taken into account when evaluating usability.
Another aspect when designing and evaluating information
systems is user
10. involvement. User-centred design focuses on incorporating the
user’s perspective into
the development process in order to attain a usable IT system
[34].
4
The key principles
of user-centred design are 1) active involvement of users and
clear understanding of
user and task requirements; 2) an appropriate allocation of
function between user and
system; 3) iteration of design solutions; and 4) multi-
disciplinary design teams. The
human-centred design cycle [32] shown in Figure 1 describes
five essential processes
which should be undertaken in order to incorporate usability
requirements into the
software development process.
Figure 1: The human-centred design cycle.
The process is iterative with the cycle being repeated until the
particular usability
objectives have been obtained. Studies show that effective
involvement of users may
leads to 1) improved quality of the system arising from more
accurate user
11. requirements; 2) avoidance of costly system features that users
do not want or cannot
4
See also: A. Kushniruk et al., Participatory design and health
IT evaluation, in: E. Ammenwerth, M.
Rigby (eds.), Evidence-Based Health Informatics, Stud Health
Technol Inform 222, IOS Press, Amsterdam,
2016.
S. Jensen / Clinical Simulation as an Evaluation Method in
Health Informatics154
use; 3) improved levels of acceptance of the system; 4) greater
understanding of the
system by the user resulting in more effective use; and 5)
increased participation in
decision-making in the organization [35, 36].
2. Clinical simulation
Clinical simulation supports involvement of context as well as
end-users in pre-
implementation design and evaluation of health IT. Clinical
simulations involve real
end-users as they simulate the use of technology in realistic
12. environments performing
realistic tasks [20]. As shown in Figure 2, clinical simulation
can be used in different
evaluation activities at various phases of the development life
cycle from evaluation of
work practice and user requirements, evaluation of the initial
specification and early
design solution so as to seek to eliminate patient risks created
or perpetuated, through
to application assessment in work practice and assessment of
training programs.
Patient safety issues may be explored in all phases of the
lifecycle by observing
and analysing medical errors and work flow in a simulated
situation close to a real life
environment [22]. In the first phases of the lifecycle of health
IT, simulation may be
used for specification and evaluation of user requirements [19],
as well as for obtaining
knowledge and evaluate work practice [37]. This may involves
observation of
clinicians applying information technology under simulated
conditions
Figure 2. Simulation evaluations in information system life
13. cycle.
Likewise in the design phase simulation is well suited as a
method for user
involvement in connection with evaluation of the design.
Simulation studies can be
designed to gain practical experience in evaluation of new
technology without
introducing any kind of ethical issues and without putting
patients at risk [20]. In this
way it is possible to test prototypical software in realistic
scenarios and environments.
Simulations can be performed in laboratories as well as in situ
in a ward, an operating
theatre or an outpatient clinic [20]. Simulation studies aim to
evaluate design proposals
for a new technology and combine elements of the laboratory
test and the field study
[22].
Particular aspects of implementation can be visualized by
simulation e.g. user
interaction in work practice, the need for training, and the
impact of decision support
[22]. Unintended consequences of new systems such as changes
in work processes and
14. patient outcome
5
may also be detected and can provide constructive and valuable
5
See also: F. Magrabi et al., Health IT for patient safety and
improving the safety of health IT, in: E.
Ammenwerth, M. Rigby (eds.), Evidence-Based Health
Informatics, Stud Health Technol Inform 222, IOS
Press, Amsterdam, 2016.
S. Jensen / Clinical Simulation as an Evaluation Method in
Health Informatics 155
information for organizational decision makers [18]. Clinical
simulation can also be
used as common ground for discussion and negotiation and as
an organizational
learnings space, where knowledge of other parts of an
organization can be acquired
[37].
The realism and acceptance of the simulation depend on the
degree of fidelity in
the simulation set-up. Dahl and colleagues [38] have developed
a simulation
15. acceptance model
with four fidelity dimensions: 1) environment – physical
elements,
such as rooms, beds and patient; 2) equipment – elements, such
as mock-ups and
electronic devices; 3) functionality – such as system
functionalities and interactive
devices; and 4) tasks – clinical task such as administration of
drugs and ward rounds.
These fidelity dimensions affect the perceived realism and
thereby acceptance of the
simulation made by the involved clinicians and should be
considered carefully
according to the purpose of the simulation.
Clinical simulations are performed in three phases; 1)
introduction, 2) simulation,
and 3) evaluation. Prior to the simulation, the participants are
introduced to the
information system and to the simulation. Simulation facilities
are a dedicated facility
with two rooms linked by a one-way mirror. During the
simulation, a simulation
facilitator is located in the simulation room. The facilitator
16. assists the simulation and
supports the participating clinician. An instructor located in the
observation room
instructs the patient and the simulation facilitator. A one-way
mirror separates the two
rooms. The simulation is observed by health informatics experts
and sometimes by key
stakeholders, such as colleagues from hospitals, clinical
managers, quality managers
and vendors [37]. The observers are located in the observation
room.
An example of how simulation facilities may look like is
presented in Figure 3.
The simulation room is established as a bed room for two
patients with bedside tables
and a portable for the healthcare professional. An observation
room with portables and
chairs is located in the right corner. A one-way mirror is
separating the two rooms.
Figure 3. Overview of the physical simulation set-up.
Simulation of handover from hospital to community care by
messaging
17. technologies can also be carried out in a simulation laboratory.
In such situations
another simulation room may replicate a nursing office at the
community care. In
situations where it is not possible to replicate the location of the
simulation in a
laboratory, simulation in situ may be used. This could be
scenarios where large x-ray
scanners or other large equipment is involved.
S. Jensen / Clinical Simulation as an Evaluation Method in
Health Informatics156
The simulating clinicians are asked to “think aloud” so that the
observers can
acquire a deeper understanding of the human task-behaviour.
Depending on the
purpose of the clinical simulation, the clinicians are sometimes
also able to observe
their colleagues, when not participating in the simulation
themselves [39]. The different
roles and their locations are described in Table 1.
Table 1. Overview and description of different roles and their
locations during clinical simulation.
18. Roles Description Location
Instructor Overall responsible for the simulation. Instructs
simulation facilitator and patient(s) during simulation by
use of intercom equipment and facilitates debriefing.
Observation room
Simulation
facilitator
Briefs clinicians prior to simulation and provides support
during simulation. Receives instructions from and assists
instructor during simulation.
Simulation room
Observers Observes and makes notes during simulation; e.g.
usability, support of work practice, patient safety
Observation room
Clinicians Simulates scenario. Thinks aloud during simulation.
Participates as interviewee in interview
Simulation room
Actor Acts as e.g. patient, colleague during simulation and
19. receives instructions from instructor.
Simulation room
After the simulation, the proposed information system is
evaluated. Participants
are asked to complete questionnaires and participate in a de-
briefing interview.
Additional to interview guides, observations made by the
observers during the
simulations are used as background for the interviews [24]. It
must be clarified in
advance to whom the results are to be presented and how the
results and
recommendations should be implemented. The same goes for the
respective mandates
of the participating clinicians as well as the observers.
3. Case Study: Simulation study of a clinical information
system
The aim of the case study was to investigate how a newly-
acquired standard clinical
information system for doctors to sign for laboratory results
might support clinical
practice, and to identify potential patient safety hazards prior to
its implementation [40].
The aim of the information system was to obtain an IT
20. supported work flow for
physicians receiving and signing laboratory test results in order
to improve patient
safety. In addition to implementation aspects such as training
and information, the
purpose was also to evaluate future work practice, the relation
between technology and
existing work processes, and the extent to which clinical
simulation may be applied as
a proactive method to identify and evaluate potential patient
safety hazards prior to
implementation.
The existing workflow was paper based; i.e. prints were made
from digital systems
and were signed by a doctor in order to document that the
specific test result had been
reviewed by a doctor. The laboratory tests were handled by
various information
systems. Some test results were on paper and others were
electronic. The background
for the local work flows was based on interpretations of a
national guideline for
handling laboratory test results. This national guideline was
developed as part of a
21. quality assurance initiative to increase patient safety. As a rule,
the physicians signed to
confirm that they have seen a laboratory test result. The
physicians also signed to
S. Jensen / Clinical Simulation as an Evaluation Method in
Health Informatics 157
confirm that they have handled the test results. The essential
challenges about the paper
based workflow were 1) lack of overview about whether a result
has arrived; 2)
uncertainty about whether a test result has been seen by a
physician; and 3) lack of
documentation about which physician has seen a test result.
The objective of purchasing the new information system was to
increase quality in
work practice and minimize the risk to patient safety by
implementing a new standard
information system. The information system collects laboratory
test results and
supports electronically documentation of acknowledging the
results. The study was
expected to be moderate and manageable because the
22. information system was a
standard off-the-shelf product and the intended work flow was
supposed to be narrow
and well-defined. The information system was to be
implemented at two pilot
departments. Both departments included patient wards and
outpatient clinics. Prior to
implementation, the existing work practice was analysed and
future generic work flows
defined. The functionality of the information system and
collaborative future work
practice were evaluated by means of clinical simulation. The
aim of the simulation
study was to assess how the information system supported
clinical practice and to
identify potential patient safety hazards prior to its
implementation.
Initial field studies were carried out at the two pilot
departments covering both
patient wards and outpatient clinics in order to gain insight into
existing work practice
concerning receipt, handover and acknowledgement of
laboratory test results. Two
workshops were then held with physicians, nurses and medical
23. secretaries from the
pilot departments, health informaticians and experts from the
regional quality unit. At
the first workshop, future work practice and the information
system were analysed and
required changes were identified. At the second workshop,
future work practice was
determined, focusing on improved efficiency, quality,
continuity and communication.
Existing routines were contested and organizational changes
were initiated ahead of
implementation to create acceptance and a readiness to change
among future end-users.
An analysis of work practice conducted prior to the clinical
simulation revealed
that there were significant differences between the hospitals,
between the patient wards,
and the outpatient clinics – and indeed also between the
individual healthcare
professionals. Furthermore, the design of future work practice
presented a number of
challenges and it was not possible to design a generic work flow
to cover both patient
ward and outpatient clinic. This was to some extent due to
24. differences between local
work flows but also due to the fact that the information system
functionality did not
provide adequate support for work practice.
Clinical simulation was conducted after the two workshops. The
purpose of the
clinical simulation was to evaluate patient safety issues and
future work practice using
the new information system before its implementation. Six
healthcare professionals
from the two pilot departments (two physicians, three nurses
and one medical
secretary) participated in the simulations. Clinical managers
from the pilot sites,
implementation experts and health informatics experts were
observing the simulations.
Figure 4 shows the simulation room seen from the observation
room through a one way
mirror. The simulation set-up is an outpatient clinic where a
physician is preparing for
a meeting with a patient.
A total of 11 scenarios were performed during the simulation;
six scenarios from
25. patient wards and five scenarios from outpatient clinics. All
scenarios were related to
signing and handling laboratory test results. Some of these were
frequently performed
work flows, e.g. ward rounds and visits to the outpatient clinic,
while others were
critical work flows; e.g. urgent test results, sorting test results
and handover of
S. Jensen / Clinical Simulation as an Evaluation Method in
Health Informatics158
responsibility. The simulation set-up was very realistic. The
computers used were
identical with those used at the hospitals and the system was
fully developed and
operational. The scenarios were composed in participation with
clinicians from the
pilot sites and based on realistic patient cases. The simulation
room was designed as
either a ward bedroom or clinical office. The role of patient was
enacted by a
healthcare professional.
One of the purposes of using clinical simulation in relation to
implementation was
26. to investigate how the information system supported clinical
practice and to determine
whether the information system should be implemented at the
hospitals. Therefore
there was a need for high fidelity in the case study.
Figure 4. Simulation room seen from observation room.
The clinical simulation identified many uncertainties
concerning work flow,
handling of responsibility, and other organizational and
technical challenges. High
fidelity functionalities, such as integration to other information
systems, revealed
patient safety issues; e.g. notes related to a test result were not
shown in relation to the
test result in the new information system. The physician could
only find the notes in the
lab system. Apart from many negative findings, there were also
positive findings,
including improved overview of laboratory test results and no
paper test results were
left lying around, at the risk of disappearing.
27. We did not have any patient safety experts attending as
observers during the
simulation. Instead the simulation evaluation report was
subsequently shown to the
patient safety experts. Having patient safety experts observe the
simulation would have
improved the outcome considerably. Several organizational and
technological issues,
which were regarded as inconveniences by others, were detected
as patient safety risks
by the patient safety experts. These experts have great
experience of what can go
wrong and are able to focus on these matters during the
simulation. They observe the
interaction between the user and the interface of the technology
but just as much the
interaction with the technology in the clinical context. Inclusion
of clinical context is
one of the most powerful elements in clinical simulation. By
allowing clinicians to use
new technology in the way it is supposed to be used, patient
safety issues become
visible. Clinical simulation enables visualization of technology
in connection with
28. clinical context without endangering patients [22]. Therefore
the choice of observers is
very important. Each expert focuses on his or her own field. For
this reason, observers
must be chosen carefully and bearing in mind the purpose of the
simulation.
S. Jensen / Clinical Simulation as an Evaluation Method in
Health Informatics 159
As a result of the simulation additional new requirements of the
information
system were determined, e.g. new functionality for sorting the
list of laboratory results
according to date and time of the results. It was decided to
initiate a pilot
implementation despite the fact that the information system did
not fully support the
work flows. Some of the organizational challenges were solved
and it was agreed that
the remaining challenges regarding future work practice should
be subject to scrutiny
during the pilot implementation.
The challenges not solved prior to the pilot implementation
were the transferability
29. of work practice between patient wards and outpatient clinics,
confidentiality of some
test results, risk of several users handling the same test result
simultaneously, missing
interaction between prescription of test and signing of test
results, no possibility of
undoing signing of test results, comments do not stand out
distinctly and integration
between information system and paper-based test results from
private laboratories. The
issues were observed and evaluated after the system was
implemented.
4. Discussion
The clinical simulation focused on formative evaluation and
primarily was used as a
learning process. Formative evaluation studies can facilitate
system adoption and
utilization [41] and aim to improve a system during its
development or implementation,
while summative evaluation focuses on evaluation of a system
that is already up and
running [42]. Formative evaluation may identify potential
problems, such as patient
30. safety issues, during the development phase and thus provide
opportunities to improve
a system as it develops.
In the simulation study, the results of the formative evaluation
regarding patient
safety issues and work practice for handling laboratory test
results were presented and
discussed at meetings with the various stakeholders, i.e. the
patient safety unit, the
quality unit and the implementation departments. Precautions
were taken in relation to
patient safety matters and work practice. Many of these
precautions were subsequently
implemented, regardless of the implementation of information
system.
Unintended incidents often occur in the interaction between
humans, technology
and work practice [4, 10]. Clinical simulations allow
visualization of the correlation
between human, technology and organization. More
conventional usability evaluations
tend to visualize the interaction between the user and the
technology but do not include
work practice context [20, 43]. By including all three aspects
31. (humans, technology and
organization), patient safety challenges were revealed as well as
organizational and
technical challenges. New work practice in itself may also lead
to unintended incidents.
This was also revealed during the clinical simulation.
To expose cognitive and socio-technical issues, all fidelity
dimensions described
by Dahl and colleagues [23] need to be high on all four
dimensions. The overall
simulation configuration affects how the realism of the
simulation experience is
perceived [38]. Cognitive aspects of work practice relate to the
clinical context and
therefore depend on the degree of environment and task realism,
whereas equipment
fidelity and functional fidelity relate to cognitive aspects of the
technical context.
Socio-technical aspects and patient safety matters lie in the
intersection between user,
organization and technology [40]. High fidelity simulations are
time-consuming [44]
though and the purpose of simulation studies and the need for
fidelity should therefore
32. be planned carefully.
S. Jensen / Clinical Simulation as an Evaluation Method in
Health Informatics160
Traditional information systems are often designed around an
idealized model of
the tasks and workflow, and failures in information systems are
often blamed on human,
social and cultural “barriers” to technology adoption [10]. The
case study revealed
differences between such an idealized model of the task that
needed to be accomplished
and the way in which clinicians were actually working. Some of
the differences were
due to local interpretations of the regional guidelines and one of
the conclusions
reached was that the regional quality unit should develop a
regional standard for
signing off test results. Another issue lay in the fact that the
information system was a
standard system which did not provide adequate opportunities to
configure the system
to match the local setting. If work practice differs from
33. department to department, local
configuration is a requirement. A regional standard was
introduced to resolve this issue.
Clinical simulation did not reveal all challenges related to the
information system.
The outcome of clinical simulations depends on the quality of
the scenarios and patient
cases they cover. In the case study, the scenarios during the
simulations did not include
unusual results or pre-ambulatory test results, but only became
clear during a
subsequently pilot implementation. Clinical simulation involves
an inherent risk of
giving an idealized picture compared to real life as it is very
resource demanding to
simulate the complexity of real life situations at a hospital.
These matters are important
to take into account when planning and designing the
simulation.
Another aspect is the purpose of the evaluation and the relation
between existing
and future work practice. What is to be evaluated - future or
existing work practice?
And do the end-users comprehend and approve the new work
34. practice? Furthermore, if
the existing work practice in a department does not follow the
existing guidelines, this
may influence the simulation of the interaction between future
work practice, end-users
and technology as well as subsequent implementation.
Several muddled work flows became clear during the simulation
and observers
focusing on work flows agreed that a further work flow analysis
was needed. This
resulted in revision of the future work practice. Many of the
issues found during the
simulation were addressed before the pilot implementation, and
those that were not
solved were observed again during the pilot implementation. As
such clinical
simulation cannot replace a pilot implementation, but should
rather be regarded as a
valuable supplement.
Patient safety issues are difficult to assess due to the fact that
many patient safety
challenges lie in the details and are triggered by adverse events
and disturbances [24].
35. The results of the case study showed that clinical simulation
took the clinical context
into account, while other methods, e.g. heuristic inspection,
focus on the user interface.
Low fidelity usability testing focuses on technology and
specific tasks for single users.
Some patient safety risks may therefore be difficult to pinpoint
using these methods.
Clinical simulation provides a comprehensive view on the
information system taking
into account the correlation between IT, work practice and
adverse events, and is
therefore a very suitable method for assessing patient safety
issues.
The resources invested in preparing and performing simulation
studies may be
exhaustive, depending on the required degree of fidelity. It is
essential that the
resources invested in creating a realistic setting match the
purposes of the simulation
and the simulation set-up [43, 44]. However, the resources
saved and iatrogenic effects
avoided by using clinical simulation for analysis and evaluation
purposes are difficult
36. to quantity as it is difficult to put a price on the value of
patients’ lives. Still, clinical
simulation is a beneficial evaluation method, as it takes place in
a controlled
environment where there is no risk of injuring real patients [20,
40].
S. Jensen / Clinical Simulation as an Evaluation Method in
Health Informatics 161
As described clinical simulation can be used to analyse, design
and evaluate user
requirements and work practice and serve as common ground to
help to achieve a
shared understanding between various communities of practice.
The primary benefits
of using clinical simulation are 1) involvement of users and
clinical context, 2)
controlled environments for experiments and formative
evaluations of user satisfaction,
usefulness and patient safety, 3) environments for addressing
and visualizing cross-
sectorial and cross-functional topics, and 4) organizational
learning space and common
ground for gaining shared understanding.
37. The main concerns and challenges of using clinical simulation
are that clinical
simulation does not reflect the social-technical issues over time
and does not cover all
possible work practice situations and issues. The purpose and
choice of scenarios
determines to a great extent the outcome, and the purpose and
design of clinical
simulation must therefore be considered very carefully.
Recommended further readings
1. Kushniruk A, Nohr C, Jensen S, Borycki EM, From Usability
Testing to Clinical
Simulations: Bringing Context into the Design and Evaluation
of Usable and Safe
Health Information Technologies, Yearb Med Inform 8 (2013),
78-85.
2. Jensen S, Kushniruk A, Boundary objects in clinical
simulation and design of
eHealth, Health Informatics Journal Oct 9,
2014:1460458214551846.
3. Jensen S, Kushniruk AW, Nøhr C, Clinical simulation: A
method for development
and evaluation of clinical information systems, Journal of
38. Biomedical Informatics
54 (2015), 65-76.
4. Ammenwerth E, Hackl WO, Binzer K, Christoffersen TE,
Jensen S, Lawton K,
Skjoet P, Nohr C, Simulation Studies for the evaluation of
health information
technologies: experiences and results, HIM J 41(2012), 14-21.
5. Jensen S, Clinical Simulation: For what and how can it be
used in design and
evaluation of health IT, Techno-Anthropology in Health
Informatics:
Methodologies for Improving Human-Technology Relations,
Studies in Health
Technology and Informatcs 215 (2015), pp. 217-28.
Food for thought
1. What might be the pros and cons of clinical simulation seen
from an end-user
perspective and how may it differ from a management and
policy perspective?
2. Clinical simulation refers to simulation in a clinical set-up.
How may simulation fit
into other high-risk areas such as pharmacies and ambulances?
3. As healthcare technology moves into patients’ homes,
simulation could also be
39. used in private settings. How would a simulation design differ
when conducting
simulations in patients home?
4. How may clinical simulation be used in other clinical fields,
such as biomedical
engineering?
S. Jensen / Clinical Simulation as an Evaluation Method in
Health Informatics162
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S. Jensen / Clinical Simulation as an Evaluation Method in
Health Informatics164
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Title:
Assessment report for proposed researched projects
Paper type
Research Paper
Language style
English (U.S.)
Deadline
16th April 2019 @ 08:31:45 P.M. (LONDON TIME)
Paper format
APA
Course level
Undergraduate
Subject Area
Nursing
# pages
8 ( or 2200 words Minimum)
Spacing
Double Spacing
Cost
$ 40.00
# sources
4
Paper Details
A hospital marketing director at a very large hospital in an
urban setting has several research projects to undertake this
quarter. The hospital is continuing to expand its offerings in the
metropolitan area and ensure a strong relationship with the top
47. physicians in the community.
The 3 current projects that he is currently researching include
the following:
1) The hospital urology department wants to establish a sexual
dysfunction clinic. The department head wants to get an
estimate of the number of men ages 35-60 in the community
suffering from some form of sexual dysfunction.
2) A primary care medical group is trying to determine whether
patients are being greeted and serviced appropriately by the
billing and admitting departments.
3) A managed care organization (MCO) is trying to determine
what concerns physicians have in agreeing to become part of its
panel of physicians who will treat their enrollees.
You are assigned the following task:
Develop a report analyzing how each of these 3 projects would
be communicated to each market segment and how each will
help the hospital improve its relationship with the public.
Because of the nature of the report, it must include a critique of
current literature (scholarly references) to support a position on
each.
DO NOT PLAGIARIZE, WRITE WELL, GOOD GRAMMAR IS
A PLUS, REFERENCE WELL.
ORIGINAL PAPER
Comparison of a Self-Directed and Therapist-Assisted
Telehealth
Parent-Mediated Intervention for Children with ASD: A Pilot
RCT
48. Brooke Ingersoll1 • Allison L. Wainer1,2 • Natalie I. Berger1 •
Katherine E. Pickard1 •
Nicole Bonter1
Published online: 27 February 2016
� Springer Science+Business Media New York 2016
Abstract This pilot RCT compared the effect of a self-
directed and therapist-assisted telehealth-based parent-
mediated intervention for young children with ASD.
Families were randomly assigned to a self-directed or
therapist-assisted program. Parents in both groups
improved their intervention fidelity, self-efficacy, stress,
and positive perceptions of their child; however, the ther-
apist-assisted group had greater gains in parent fidelity and
positive perceptions of child. Children in both groups
improved on language measures, with a trend towards
greater gains during a parent–child interaction for the
therapist-assisted group. Only the children in the therapist-
assisted group improved in social skills. Both models show
promise for delivering parent-mediated intervention; how-
49. ever, therapist assistance provided an added benefit for
some outcomes. A full-scale comparative efficacy trial is
warranted.
Keywords Autism � Parent training � Telehealth
Introduction
Autism spectrum disorder (ASD) is characterized by per-
vasive deficits in social communication and the presence of
restricted and repetitive behaviors (American Psychiatric
Association 2013). Individuals with ASD often require
intensive and comprehensive intervention across the life
span (National Research Council 2001). There has been a
dramatic increase in the number of individuals with this
diagnosis over the last two decades (Fombonne 2009)
without a corresponding growth in the availability of evi-
dence-based intervention services, which has contributed to
high levels of unmet service needs for individuals with
ASD and their families (Bitterman et al. 2008; Kogan et al.
2008). Thus, systematic research examining strategies for
50. increasing access to evidence-based ASD services is a high
priority.
Parent-mediated intervention (PMI) programs are one
potentially cost-effective strategy to increase access to
evidence-based ASD intervention. Teaching parents to
provide intervention themselves can increase the number of
intervention hours a child receives and has been shown to
result in improvements in child social-communication
skills (e.g., Kasari et al. 2015; Wetherby et al. 2014) and
parent well-being (Keen et al. 2010). Yet, formal PMI
programs are rare in community-based settings for young
children with ASD (Thomas et al. 2007a, b). Barriers
include a shortage of trained professionals, lengthy wait-
lists, limited financial resources and transportation, lack of
child care, geographic isolation, and time limitations (Sy-
mon 2005). Thus, it is essential to consider the adaptation
of evidence-based PMI to non-traditional service delivery
models.
51. Telehealth, or the provision of health services and
information over the Internet and related technologies, has
the potential to replace or augment traditional service
models to increase access to evidence-based intervention
(Baggett et al. 2010; United States Department of Educa-
tion, Office of Planning, Evaluation, and Policy Develop-
ment 2010). Telehealth programs can reduce costs and
increase provider system coverage relative to traditional in-
& Brooke Ingersoll
[email protected]
1
Department of Psychology, Michigan State University, 316
Physics Rd., East Lansing, MI 48824, USA
2
Present Address: Rush University Medical Center, Chicago,
IL, USA
123
J Autism Dev Disord (2016) 46:2275–2284
DOI 10.1007/s10803-016-2755-z
http://crossmark.crossref.org/dialog/?doi=10.1007/s10803-016-
52. 2755-z&domain=pdf
http://crossmark.crossref.org/dialog/?doi=10.1007/s10803-016-
2755-z&domain=pdf
person service delivery models (Gros et al. 2013). Such
programs have improved care for patients with chronic
diseases (Wootton 2012), and increased access to evidence-
based health promotion, psychological, and parenting
interventions (e.g., Andersson and Cuijpers 2009; Krebs
et al. 2010; Nieuwboer et al. 2013). Patients report high
levels of satisfaction with care received via telehealth
(Gustke et al. 2000) and efficacy studies have found
moderate to large effects of telehealth interventions on
participant knowledge and behavior change (Andersson
and Cuijpers; Krebs et al.; Nieuwboer et al. 2013). Further,
several meta-analyses have found that cognitive behavioral
therapy (CBT) delivered via telehealth is as effective as
traditional therapy (Andrews et al. 2010).
Telehealth interventions can be either self-directed (i.e.,
participant independently engages with the interactive
53. program) or therapist-assisted (i.e., participant receives
additional guidance from a professional as part of the
program). Self-directed programs have greater dissemina-
tion potential as they do not require a trained professional
and can typically be administered at a reduced cost.
However, therapist-assisted CBT telehealth programs typ-
ically lead to better patient outcomes than self-directed
programs (Andersson and Cuijpers 2009; Spek et al. 2007).
This finding may be particularly relevant for telehealth
PMIs, as research suggests that parent coaching is impor-
tant for increasing parents’ fidelity of implementation
(Kaminski et al. 2008).
Empirical evaluations of telehealth PMI programs for
children with ASD are limited. Several uncontrolled stud-
ies have demonstrated the feasibility, acceptability, and
initial effectiveness (i.e., gains in parent knowledge) of
self-directed telehealth PMI programs (Hamad et al. 2010;
Jang et al. 2012; Kobak et al. 2011). A small RCT (n = 27)
54. found that parents who received a DVD-based self-directed
program made greater gains in their use of pivotal response
treatment (PRT) strategies, provided more language
opportunities, and were rated as displaying greater parent
confidence during a 10-min parent–child observation in the
home than parents in a no-treatment control group (Nefdt
et al. 2009). In addition, their children demonstrated
greater gains in their rate of functional verbal utterances
during the parent–child interaction. A single-case design
study (n = 3) demonstrated that parents improved their use
of reciprocal imitation training (RIT) strategies after
completing a web-based self-directed program (Wainer and
Ingersoll 2013), and their children increased their rate of
imitative toy play during parent–child interactions.
Importantly, parents in both studies indicated that coaching
from a professional would have been beneficial.
Several single-case design studies have examined the
efficacy of therapist-assisted telehealth PMI programs for
55. children with ASD. Across two studies, Vismara and
colleagues examined the ability of a DVD-based (n = 8) or
web-based tutorial (n = 9) in conjunction with weekly
coaching sessions via video-conferencing to teach parents
to use the Early Start Denver Model (ESDM) (Vismara
et al. 2012, 2013). Parents in both studies increased their
use of the ESDM intervention strategies and positively
altered their engagement styles during parent–child inter-
actions in response to the program. Furthermore, their
children demonstrated gains in functional verbal utterances
and imitative play actions. To evaluate the relative con-
tributions of self-directed instruction and therapist assis-
tance on parent learning, Wainer and Ingersoll (2015)
conducted a second study (n = 5) that measured parents’
use of RIT at baseline, after a self-directed web-based
tutorial, and then again after receiving coaching via video-
conferencing. Similar to their previous study (Wainer and
Ingersoll 2013), all parents improved their use of RIT
56. strategies during parent–child interactions in response to
the self-directed program, but roughly a third showed
additional benefit from remote coaching. In addition, most
children demonstrated gains in imitative play with the
onset of treatment; however, child gains were most robust
when parents received coaching.
These preliminary findings suggest telehealth PMI pro-
grams are acceptable to parents of children with ASD, and
can improve parent knowledge and intervention use and
child social communication skills. To date, no studies have
conducted a head-to-head comparison of self-directed and
therapist-assisted telehealth PMI. Data thus far suggest
therapist assistance may be necessary for some, but not all
parents to implement interventions with fidelity. A better
understanding of the contributions of self-directed
instruction and therapist assistance will make it possible to
develop more cost-effective delivery models in which
services are offered at different levels of intensity,
57. depending on family needs (i.e., stepped-care) (Phaneuf
and McIntyre 2011; Steever 2011). Pilot studies enhance
the likelihood of success of randomized controlled trials
(RCT) (e.g., Campbell et al. 2007). Thus, the goal of this
pilot study was to compare the effect of self-directed and
therapist-assisted delivery models of ImPACT Online, a
telehealth PMI program that targets social communication
using a naturalistic, developmental-behavioral intervention
(NDBI) (Schreibman et al. 2015), on key parent and child
outcomes in preparation for a fully powered RCT.
Method
Participants
Twenty-eight families of a child with ASD between the
ages of 19 and 73 months participated. Participants were
2276 J Autism Dev Disord (2016) 46:2275–2284
123
recruited from agencies serving children with ASD. All
58. children met criteria for Autistic Disorder or PDD-NOS
based on DSM-IV criteria (American Psychiatric Associ-
ation 2000) and the ADOS-G or ADOS-2 (Lord et al.
2000). Parents had to be proficient in English, although
other languages could be spoken in the home. One family
who was assigned to the therapist-assisted group had to
suspend treatment after 2 months due to significant health
problems. After a 7-month break, the family finished the
program; however, the time between their pre- and post-
treatment assessments (14 months) was not comparable to
the other participants’. Thus, their data were not included
in the analyses. All parents gave informed consent under
the oversight of Michigan State University’s IRB.
Design and Procedure
Families were administered standardized assessments at
pre-treatment in the lab and family home. Children were
matched within 3 months on expressive language age on
the Mullen Scales of Early Learning (MSEL; Mullen 1995)
59. and randomly assigned to the self-directed (n = 13) or
therapist-assisted group (n = 14) using a coin flip.
Assessments were re-administered at post-treatment and
3-month follow-up in the family home. See Table 1 for
participant flow through the study.
Eligibility and Sample Characteristics Measures
Parents provided information on family and child demo-
graphics at pre-treatment. They also provided information
on hours per week of all non-study treatments at pre- and
post-treatment. Children were administered the ADOS-G
or ADOS-2 to determine study eligibility and the MSEL as
a measure of developmental functioning. See Table 2 for
participant demographic information.
Parent Outcomes Measures
Parent Intervention Fidelity
Parents were videotaped during a parent–child interaction
(PCI) in the family home at pre-treatment, post-treatment,
and 3-month follow-up. They were asked to: (1) play with
60. Table 1 Participant flow
through the study Assessed for eligibility (n=29)
Excluded (n=1)
Not meeting inclusion criteria (n=1)
Declined to participate (n=0)
Other reasons (n=0)
Analysed (n=13)
Excluded from analysis (n=0)
Lost to follow-up (n=0)
Discontinued intervention (did not have time;
family crisis; began intensive program) (n=4)
Allocated to self-directed group (n=13)
Received allocated intervention (n=13)
Did not receive allocated intervention (n=0)
Lost to follow-up (n=0)
Discontinued intervention (n=0)
Allocated to therapist-assisted group (n=15)
Received allocated intervention (n=15)
Did not receive allocated intervention (n=0)
Analysed (n=14)
Excluded from analysis (family took 14
months to complete due to crisis) (n=1)
Allocation
Analysis
61. Follow-Up
Randomized (n=28)
Enrollment
J Autism Dev Disord (2016) 46:2275–2284 2277
123
their child for 10 min; and (2) have a snack with their
child. Parent behavior was scored for correct use of the
intervention using the Project ImPACT fidelity checklist
(Ingersoll and Dvortcsak 2010). Fidelity ratings for the
play and snack routines were averaged to form an overall
fidelity rating for each time point. Reliability was calcu-
lated for 20 % of the observations using intra-class corre-
lation (ICC = .96, p .001).
Parent Sense of Competence Scale (PSOC)
Parents completed the PSOC (Gibaud-Wallston and Wan-
dersmann 1978) at pre- and post-treatment as a measure of
parent self-efficacy. Parents rated items from 1 (‘‘Strongly
62. agree’’) to 6 (‘‘Strongly disagree’’) with higher scores
indicative of higher parenting self-efficacy. Missing item
level data (5 %) were imputed by using the participant’s
average for the scale. Cronbach’s alpha was .85.
Family Impact Questionnaire (FIQ)
Parents completed the FIQ (Donenberg and Baker 1993) at
pre- and post-treatment as a measure of the impact of their
child on their family life. Parents endorse items on a
4-point scale, with higher scores indicating greater impact.
The average of the negative and social impact subscales
was used as a measure of parenting stress, and the positive
impact subscale was used as the measure of positive per-
ceptions of the child. Missing item level data (5 %) were
imputed by using the participant’s average for the scale.
Cronbach’s alphas ranged from .86 to .92 for the parenting
stress items and from .81 to .86 for the positive impact
subscale.
Child Outcome Measures
Language Targets
63. The children’s use of language targets was scored during
the PCI at pre, post, and follow-up. Language that was at or
above the child’s targeted language level and used appro-
priately was scored using frequency counts and converted
to rate per minute. Language targets were determined at
intake based on the child’s spontaneous language during
standardized and observational assessments using Tager-
Flusberg et al. (2009) framework for defining spoken lan-
guage benchmarks for children with ASD. Language acts
were scored if they were at or above the child’s current
expressive language phase, which included word approxi-
mations for children at the preverbal communication stage,
single words for children at the first words stage, phrase
speech for children at the word combinations stage, and
grammatically correct sentences for children at the sen-
tences stage. Both prompted and spontaneous use of lan-
guage targets was scored. Data from the play and snack
routines were averaged to form an overall rate of language
64. targets for each time point. Reliability was calculated for
25 % of the observations (ICC = .98, p .001).
Table 2 Participant demographic information
Group Test statistic p value
Self-directed (n = 13) Therapist-assisted (n = 14)
Parent characteristics
Gender (% female) 92 % 100 % 1.12
a
.29
Education (% less than college degree) 54 % 36 % .90
a
.34
Marital status (% not married) 8 % 29 % 1.95
a
.16
Employment status (% not employed) 46 % 29 % .65
a
.42
Residence in underserved area 77 % 64 % .52
a
65. .47
Child characteristics
Gender (% female) 39 % 21 % .94
a
.33
Race/ethnicity (% minority) 8 % 36 % 3.06
a
.08
Chronological age (Mos.) 46.08 (13.18) 41.57 (12.24) -.71
b
.48
Nonverbal mental age (Mos.) 25.42 (13.92) 24.29 (9.38) -.25
b
.80
Verbal mental age (Mos.) 19.15 (9.63) 21.64 (10.74) .63
b
.53
Outside intervention (Hrs/wk)
c
13.62 (10.96) 12.38 (9.70) -.31
b
.76
66. a
Chi-square
b
t test
c
Average of hours received at pre- and post-treatment
2278 J Autism Dev Disord (2016) 46:2275–2284
123
MacArthur-Bates Communicative Development Inventory
(MCDI)
Parents completed the MCDI at pre and post as a measure
of their child’s expressive vocabulary (Fenson et al. 2006).
The total number of words reported as ‘‘understands and
says’’ (Words and Gestures Form) or ‘‘words produced’’
(Word and Sentences Form) was used. Test–retest relia-
bility of the MCDI is .95 (Fenson et al. 1994). The MCDI
was missing at pre-treatment for one participant.
Vineland Adaptive Behavior Scales, Second Edition
67. (VABS-II)
Parents were interviewed on the VABS-II at pre and post
(Sparrow et al. 2005). The VABS-II is a standardized
parent interview that assesses child adaptive functioning in
four domains: Communication, Socialization, Daily Living
Skills, and Motor Skills. Each domain yields a standard
score with a mean of 100 and a standard deviation of 15.
Test–retest reliability estimates range from .88 to .92 for
the domain scores. Given the focus of ImPACT Online
(social communication development), we expected
improvement in standard scores on the Social and Com-
munication domains indicating accelerated development.
As a comparison, we examined changes on the Daily
Living and Motor Skills domains, with no expectation for
improvement. The VABS was missing at post-treatment for
one participant.
Group Assignment
Self-Directed Group
68. The self-directed group received access to the secure,
password-protected, ImPACT Online website for
6 months. The content was adapted from Project ImPACT
(Ingersoll and Dvortcsak 2010), a NDBI-based PMI for
young children with ASD targeting social communication
development. The website contained 12, self-directed les-
sons; each took approximately 75 min to complete. Parents
were encouraged to complete one lesson per week and to
practice the intervention with their child between each
lesson. Parents were able to contact project staff for
assistance with technology-related problems, but received
no staff support in learning the intervention. See Table 3
for description of the ImPACT Online program
components.
Therapist-Assisted Group
The therapist-assisted group was given access to the
ImPACT Online website for 6 months and was encouraged
to work through the program at the same pace as the self-
69. directed group. These parents also received 2, 30 min
coaching sessions per week (24 total) from a trained ther-
apist via video-conferencing. The first coaching session of
each week was used to clarify the lesson content and help
parents apply the information to their child. The second
Table 3 ImPACT online program components
Primary lesson components
Slideshow Users watch narrated slideshow with embedded video
examples of techniques
Manual Users read the manual which provides a written
description of lesson that corresponds to slideshow
Self-check Users answer comprehension check questions based
on content of slideshow. The program provides automated
positive
and corrective feedback
Exercises Users observe brief video clips and must indicate
whether technique is implemented correctly or incorrectly. The
program provides automated positive and corrective feedback
Homework Users complete a homework plan that outlines
techniques and activities in which to practice. These responses
are
available to the coach for the therapist-assisted group
70. Reflection Users complete reflection questions based on their
practice. These responses are available to the coach for the
therapist-
assisted group
Supplemental components
Video library Users can observe longer videos of adults using
the intervention techniques together with children at different
language
levels
Forum Users can share information with other participants and
post content-related questions and receive feedback from
project
staff
Resources Users can access paper copies of all forms, additional
information on the evidence-base for this intervention, and links
to
relevant websites
Tip of the week
Emails
Users receive weekly ‘‘Tip of the Week’’ emails that provide
tips for implementing the intervention techniques along
with a link to the program
71. J Autism Dev Disord (2016) 46:2275–2284 2279
123
session of the week was used to provide parents with live
feedback on their intervention use with their child.
Coaching was provided by masters’ level therapists trained
to fidelity. Coaches used a fidelity checklist to rate their
fidelity to the coaching procedure at the end of each ses-
sion. Average self-assessed fidelity across sessions was
99.6 %. A random sample of 10 % of coaching sessions
were scored by independent raters for reliability using
exact agreement. Reliability for coaching fidelity was
97.8 %.
Results
Analytic Strategy
We used an Intention-to-Treat model (ITT) which requires
that all randomly assigned participants be compared on
outcomes regardless of adherence to treatment, reasons for
72. withdrawal, or missing responses (Moher et al. 2001).
Accordingly, we included all participants in the data
analysis, followed up participants who discontinued treat-
ment, and imputed missing data. Four parents, all in the
self-directed group, did not complete the program, which
represented a significant group difference in rate of pro-
gram completion, v2 (n = 27) = 5.06, p = .03. We
obtained post-treatment data for these families on all
measures, with the exception of the VABS-II and PCI for
one family. The MCDI was missing for one child in the
therapist-assisted group at pre-treatment. We used partici-
pants’ data from the opposite point of treatment for the
missing data point. We collected follow-up 3-month PCI
data from the 23 parents who completed the program. For
these data, we conducted a completer analysis only.
Transformations were applied to non-normal data as
appropriate. VABS-II data remained non-normal after
multiple transformation attempts, potentially due to out-
liers. We report analyses for the VABS-II with non-normal
73. data as ANOVA is robust to this violation.
Independent t tests and Chi-square tests revealed no
statistically significant group differences on any pre-treat-
ment variables, although a marginally significant group
difference (p = .08) was observed in the percent of chil-
dren who were minorities. To determine the effect of the
intervention on parent and child outcomes, we conducted a
series of mixed-model repeated measures ANOVAs with
time (pre, post) as the within group variable and group
(self-directed, therapist-assisted) as the between group
variable. We conducted a second set of mixed-model
repeated measures ANOVAs on the follow-up PCI data
with time (pre, follow-up) and group as the within and
between group variables. Post hoc comparisons of simple
effects of significant interactions were conducted using
relevant t tests. See Table 4 for ANOVA results for out-
come variables.
Parent Outcomes
74. There was a significant main effect of time for parent
fidelity, such that parents were rated higher on their use of
the intervention at post-treatment. There was also a sig-
nificant time X group interaction, indicating the therapist-
assisted group made greater gains in fidelity than the self-
directed group. Post-hoc tests of simple effects suggested
Table 4 ANOVA results for outcome variables
Outcome measure Self-directed group Therapist-assisted group
Effects
Pre Post Pre Post Time Time X group
Mean (SD) Mean (SD) Mean (SD) Mean (SD) F (gp
2
) F (gp
2
)
Parent fidelity (PCI) 1.77 (.67) 2.52 (.78) 1.62 (.37) 3.39 (.76)
65.78** (.72) 10.76** (.30)
Parent self-efficacy (PSOC) 53.23 (13.14) 58.62 (12.12) 54.60
(14.81) 61.43 (13.27) 10.98** (.31) .15 (.006)
Parenting stress (FIQ) 1.24 (.84) 1.04 (.61) 1.02 (.46) .69 (.30)
6.53* (.21) 2.18 (.08)
76. treatment (ps .01), and at post-treatment, the therapist-
assisted group was significantly higher than the self-di-
rected group (p .01). At follow-up, there was a signifi-
cant main effect of time, F(1, 21) = 44.26, p .001,
gp
2
= .68, suggesting that the benefits of the program on
parent fidelity maintained. The time X group interaction
was not significant, F(1, 21) = 1.17, p = .29, gp
2
= .05,
suggesting that the therapist-assisted group (M = 3.00,
SD = .66) no longer showed an advantage over the self-
directed group (M = 2.57, SD = 1.21) at follow-up,
although their mean fidelity ratings remained higher.
There was a significant main effect of time on parent
self-efficacy, such that parents in both groups rated them-
selves as more efficacious at post-treatment. There was no
significant effect of group or time X group interaction.
There was a main effect of time on parenting stress, such
that parents in both groups rated themselves as less stressed
77. at post-treatment, but no significant main effect of group or
time X group interaction. Finally, there was a significant
main effect of time and time X group interaction for pos-
itive perceptions of the child. Post-hoc tests suggested that
the therapist-assisted group had significant (p = .001) and
the self-directed group had marginally significant (p = .09)
increases in their positive perceptions of their child, and the
therapist-assisted group had significantly more positive
perceptions than the self-directed group at post-treatment
(p = .03).
Child Outcomes
There was a significant main effect of time on language
targets during the PCI, indicating improvement in child
language use over time. There was also a marginally sig-
nificant time X group interaction (p = .10), suggesting that
the children in the therapist-assisted group made margin-
ally more gains in their use of language targets than the
self-directed group. Post-hoc tests indicated children in
78. both groups exhibited significant gains in their language
targets from pre- to post-treatment (ps .05), but there
were no differences between groups at post-treatment. At
follow-up, there was a significant main effect of time on
child language targets, F(1, 21) = 8.59, p = .008,
gp
2
= .29, and a marginally significant time X group
interaction, F(1, 21) = 3.38, p = .08, gp
2
= .14. Post-hoc
tests indicated language targets were higher at follow-up
(M = 1.71, SD = 1.28) than pre-treatment for the thera-
pist-assisted group (p = .003). The difference in language
targets from pre-treatment (M = 1.50, SD = 1.81) to fol-
low-up (M = 1.64, SD = 1.21) was not significant for the
self-directed group, although the trend was in the expected
direction. There were no group differences in language
targets at follow-up.
On the MCDI and VABS-II Communication domain,
there was a main effect of time, but no effect of group or
79. time X group interaction, suggesting that children in both
groups improved their language skills on these measures
from pre- to post-treatment. On the VABS-II Social
domain, there were no main effects of time or group;
however, there was a significant time X group interaction.
Post-hoc tests suggested that the children in the therapist-
assisted group exhibited significant increases in their
standard scores (p = .04), while the children in the self-
directed group did not. At post-treatment, the therapist-
assisted group had marginally higher standard scores than
the self-directed group (p = .08).
No significant main effects of time or group and no
significant time X group interactions were observed for the
VABS-II Daily Living or Motor Skills domains.
Discussion
This pilot RCT compared the effect of a self-directed and a
therapist-assisted telehealth PMI for children with ASD on
parent and child outcomes. Parents in both groups
80. improved their fidelity. This finding suggests the self-di-
rected website was sufficient for increasing parent inter-
vention use and provides additional support for the benefits
of self-directed telehealth programs for increasing parents’
skills (Nefdt et al. 2009; Wainer and Ingersoll 2013).
However, parents in the therapist-assisted group made
greater gains in their use of the intervention. Similar
findings were observed regarding parents’ perceptions of
their child; parents in the therapist-assisted group had
greater increases in their positive perceptions of their child
than the self-directed group.
These findings are consistent with research on the ben-
efits of coaching in traditional PMI (Kaminski et al. 2008),
and suggest that coaching may be important for maximiz-
ing parent gains from telehealth PMI as well. Coaching
provides parents with feedback on their intervention use
and highlights its impact on their child’s behavior. Parents
who received coaching likely thus developed a greater
81. understanding of their child’s skills and a better apprecia-
tion for the impact of their own behavior on their child’s,
potentially improving their positive perceptions of their
child. Higher rates of program completion among the
therapist-assisted group may also have contributed to
observed group differences. Indeed, these parents were
significantly more likely to complete the program (100 %)
than parents in the self-directed group (69 %). Thus,
therapist assistance may be important not only for pro-
viding parents with feedback on their use of the interven-
tion and highlighting child skills, but also for encouraging
higher levels of engagement with the program in general,
J Autism Dev Disord (2016) 46:2275–2284 2281
123
both of which may influence parent fidelity and/or positive
child perceptions. Given that program completion was
related to increases in parent fidelity (Ingersoll and Berger
82. 2015), this is a distinct possibility. Either way, there
appears to be a benefit of therapist assistance on these two
parent outcomes. Additional research that can examine
which aspects of therapist assistance are most important
would be beneficial.
Improvements were also observed for parent self-effi-
cacy and parenting stress. This finding is important as
parents of children with ASD often experience lower self-
efficacy and higher stress than other parents (Hayes and
Watson 2013), and both are related to parent well-being
(Carter 2009; Karst and Hecke 2012). Interestingly, there
were no group differences in these parent outcomes. These
findings suggest that the self-directed program may be
sufficient for increasing parent well-being. Perhaps parents
who receive instruction in strategies to help their child
experience a greater sense of empowerment or agency,
regardless of instructional format. Indeed, parent empow-
erment and agency are associated with greater self-efficacy
83. and lower parenting stress in families of children with ASD
(Kuhn and Carter 2006). Future research that can identify
those components most likely to improve parent self-effi-
cacy and parenting stress would be informative. We also
found evidence for improvement in children’s social
communication skills. Although the groups did not differ in
the degree of improvement on the two parent-reported
language measures, the children in the therapist-assisted
group made marginally greater gains in their language
targets during the PCI than the self-directed group. These
findings suggest that both the self-directed and therapist-
assisted formats may be effective for increasing child
communication skills, although there may be a small
benefit of therapist assistance, as observed within the PCI.
In contrast, only the therapist-assisted group made
improvements in their social skills on the VABS-II. Studies
examining parent-mediated social communication inter-
ventions for young children with ASD have more often
84. reported improvements in child language than social skills
(McConachie and Diggle 2007). Social skills may be less
amenable to treatment than language, and as such, therapist
assistance may be necessary to help parents improve their
child’s social development. For this study, we had only one
broad measure of social skills. Thus, it is possible that we
would have observed improvements in the self-directed
group as well, had we used a more sensitive measure or
examined specific skills. Future research that can determine
which social skills are most responsive to the intervention,
as well as the potential benefit of the self-directed program
on specific social skills is necessary.
A major limitation to this study is the small sample size
inherent in a pilot study. Our small sample and resultant
limited power may have contributed to our failure to
identify group differences in treatment response for several
of our outcome measures. For example, despite not
reaching significance, the effect sizes for the time X group
85. interactions for parenting stress (gp
2
= .08) and child lan-
guage targets (gp
2
= .10) were in the moderate range,
suggesting that with a larger sample size, these interactions
would likely have become significant. A power analysis
suggested that we would have needed a sample size of 60
to detect significant differences for effect sizes in this
range.
In addition, while we were able to establish an effect of
therapist assistance for those outcomes for which the
therapist-assisted group demonstrated greater improvement
than the self-directed group, without a no-treatment control
group, we cannot conclude that the improvements observed
in the self-directed group were a result of treatment. Sim-
ilarly, we cannot rule out maturation or placebo effects for
those outcomes for which both groups improved to the
same degree. We were, however, able to compare child
86. changes across VABS-II domains. As predicted, we found
improvements for only those domains targeted by the
program, suggesting that maturation or a placebo effect
(i.e., parent reporting bias) were unlikely solely responsible
for gains in child skills. However, additional research that
includes a web-based control is necessary to establish the
effect of both formats on parent and child functioning.
One additional limitation is that our treatment groups
differed in number of children from minority backgrounds,
with a larger number of minority children in the therapist-
assisted group (36 %) than the self-directed group (8 %). It
is not clear to what extent this might have impacted the
findings. Child minority status was not associated with rate
of parent program engagement (Ingersoll and Berger 2015)
for either group. However, it is possible that it might
impact other aspects of the treatment process. Future
research should examine the degree to which racial/ethnic
background and other demographic variables might affect
87. treatment response.
These data contribute to the growing empirical support
for the benefits of parent-mediated NDBIs on parent and
child outcomes (Schreibman et al. 2015), and provide
further support for the ability of telehealth to teach parents
to deliver these interventions (Nefdt et al. 2009; Vismara
et al. 2013; Wainer and Ingersoll 2015). These pilot data
suggest a potential role for both self-directed and therapist-
assisted programs for increasing parent access to evidence-
based interventions, and suggest the potential benefit of
supplementing telehealth interventions with therapist sup-
port. In addition, these data strongly support conducting a
fully powered comparative efficacy trial to examine
mediators and moderators of treatment. Such a study
should identify which outcomes are best targeted by each
2282 J Autism Dev Disord (2016) 46:2275–2284
123
88. format, as well as which parents and children benefit from
the different levels of care. The ultimate goal is to develop
a stepped-care model that can increase access to evidence-
based interventions, and reduce the high level of unmet
needs experienced by families of children with ASD.
Acknowledgments This project was supported by CDMRP
Grant:
#W81XWH-10-1-0586. The first author receives royalties from
the
sale of the manual that was adapted for use in the online
tutorial.
Royalities are donated to the research. We thank the families
who
participated in this study.
Author Contributions BI conceived of the study, participated in
its
design and coordination and drafted the manuscript; ALW, NIB,
and
KEP performed the measurement and participated in its design
and
coordination and helped to draft the manuscript. NB performed
the
measurement and participated in the study’s coordination. All
89. authors
read and approved the final manuscript.
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Journal of Autism & Developmental Disorders is a copyright of
Springer, 2016. All Rights
Reserved.
Comparison of a Self-Directed and Therapist-Assisted
Telehealth Parent-Mediated Intervention for Children with
ASD: A Pilot
RCTAbstractIntroductionMethodParticipantsDesign and
ProcedureEligibility and Sample Characteristics MeasuresParent
Outcomes MeasuresParent Intervention FidelityParent Sense of
Competence Scale (PSOC)Family Impact Questionnaire
102. (FIQ)Child Outcome MeasuresLanguage TargetsMacArthur-
Bates Communicative Development Inventory (MCDI)Vineland
Adaptive Behavior Scales, Second Edition (VABS-II)Group
AssignmentSelf-Directed GroupTherapist-Assisted
GroupResultsAnalytic StrategyParent OutcomesChild
OutcomesDiscussionAcknowledgmentsReferences
Psychological Services
Customizing a Clinical App to Reduce Hazardous
Drinking Among Veterans in Primary Care
Daniel M. Blonigen, Brooke Harris-Olenak, Jon Randolph
Haber, Eric Kuhn, Christine Timko, Keith
Humphreys, and Patrick L. Dulin
Online First Publication, November 8, 2018.
http://dx.doi.org/10.1037/ser0000300
CITATION
Blonigen, D. M., Harris-Olenak, B., Haber, J. R., Kuhn, E.,
Timko, C., Humphreys, K., & Dulin, P. L.
(2018, November 8). Customizing a Clinical App to Reduce
Hazardous Drinking Among Veterans
in Primary Care. Psychological Services. Advance online
publication.
http://dx.doi.org/10.1037/ser0000300
Customizing a Clinical App to Reduce Hazardous Drinking
Among
Veterans in Primary Care
Daniel M. Blonigen
Department of Veterans Affairs Palo Alto Health Care System,
103. Menlo Park, California, and Stanford University School of
Medicine
Brooke Harris-Olenak and Jon Randolph Haber
Department of Veterans Affairs Palo Alto Health Care System,
Menlo Park, California
Eric Kuhn, Christine Timko, and Keith Humphreys
Department of Veterans Affairs Palo Alto Health Care System,
Menlo Park, California, and Stanford University School of
Medicine
Patrick L. Dulin
University of Alaska–Anchorage
Within the Veterans Health Administration (VHA), 15–30% of
patients seen in primary care are identified as
hazardous drinkers, yet the vast majority of these patients
receive no intervention. Time constraints on
providers and patient-level barriers to in-person treatment
contribute to this problem. The scientific literature
provides a compelling case that mobile-based interventions can
reduce hazardous drinking and underscores
the role of peer support in behavioral change. Here, we describe
the benefits of using a clinical app–Step
Away–to treat hazardous drinking among VHA primary care
patients as well as an approach to customizing
the app to maximize its engagement and effectiveness with this
population. We highlight the value of
integrating use of Step Away with telephone support from a
trained VHA peer support specialist. This type
of integrated approach may provide the key therapeutic
components necessary to generate an effective and
easily implemented alcohol use intervention that can be made
104. available to VHA primary care patients who
screen positive for hazardous drinking but are unwilling or
unable to attend in-person treatment.
Keywords: Veterans Health Administration, primary care,
hazardous drinking, smartphone application,
peer support
Hazardous drinking is defined as a pattern of alcohol
consumption
that places an individual at risk for adverse health
consequences, even
though the individual may not meet criteria for a diagnosis of
alcohol
use disorder. Globally, hazardous drinking negatively impacts
medi-
cal treatment, increases the likelihood of chronic medical
conditions,
and increases health care utilization and costs (Whiteford et al.,
2013).
Among U.S. military veterans, alcohol is the most widely used
psy-
choactive substance and carries the greatest clinical burden on
the
Veterans Health Administration (VHA; Fuehrlein et al., 2016).
Im-
portantly, within the VHA, 15–30% of veterans who are seen in
primary care are identified as hazardous drinkers, yet the vast
majority
of these patients go untreated (Bradley et al., 2017).
Daniel M. Blonigen, Health Services Research and Development
Center for Innovation to Implementation, Department of
Veterans Af-
fairs Palo Alto Health Care System, Menlo Park, California, and