Building a clinical ladder for ambulatory care

Finding innovative rewards for nursing service will be integral in meeting the challenges of future shortages of nursing staff. A clinical ladder is one tool worth exploring and perfecting to address those challenges. Exploration of a case study demonstrates a method for developing a clinical ladder. Steps and pitfalls in developing a clinical path are illustrated. Future uses, benefits, and opportunities for clinical ladders are suggested.     

Patient intensity in an ambulatory oncology research center: a step forward for the field of ambulatory care

Nursing leaders in ambulatory care need to objectively quantify patient intensity to balance patient care needs and nursing resources. In this three-part series the current literature on acuity/intensity tools will be reviewed, and the development of an Ambulatory Intensity System (AIS) to objectively quantify the nursing care will be described.     

Health care reform: current updates and future initiatives for ambulatory care nursing

While the signing of the Patient Protection and Affordable Care Act was a historical event marking the beginning of health care reform in the United States, it signaled the start of a golden age for ambulatory care nursing. Ambulatory care RNs are well-positioned to fully participate in health care reform initiatives. RNs are well-positioned to lead, facilitate, and/or participate in all patient care medical homes' and accountable care organizations' quality and safety initiatives through enhanced use of major ambulatory care RN role dimensions such as advocacy, telehealth, patient education, care coordination and transitional care, and community outreach. RNs are also well-positioned to provide patient-centered care, coordinate care, and manage transitions across ambulatory care settings. For the golden age of ambulatory care nursing to become a reality, initiatives surrounding competencies, education modules, and leadership must be addressed immediately.     

Implementing clinical IT in critical care: keys to success

Ensuring the success of a clinical information system in critical care requires careful selection of the right system to address the unique needs in this area. In addition, the methodology used for implementation must include key stakeholders, ensure nursing and physician leadership, understand and improve clinical processes, and provide ongoing training and support. These guidelines can be applied to the implementation of any clinical information system. They provide the opportunity to demonstrate value and benefits from CIS in critical care and beyond.     

Linking nursing workload and performance indicators in ambulatory care

More and more ambulatory care organizations are using nursing report cards to monitor and evaluate the quality and effectiveness of nursing care in the ambulatory setting. Nurse staffing levels is usually one of the items included in a nursing report card and the one most scrutinized by ambulatory care administrators. One strategy employed by the nursing leadership at the South Texas Veterans Healthcare System to justify nurse staffing levels is linking administrative staffing monitors with nurse-sensitive outcomes via workload and performance indicators. Through this approach, nurse leaders are able to justify nurse staffing level changes, needed technology changes, process improvements, and/or workflow needs to administrators with positive results and support.     

Health IT adoption,productivity and quality in primary care

Within the last decade, there has been a growing push towards the use of electronic medical records and health information technology (IT) within primary care physician practices. Despite financial subsidies, smaller practices remain reluctant to adopt these information systems. Using a nationally representative survey of physicians, this study explores the relationship between physician, practice and area attributes and the adoption of health IT systems. Controlling for these attributes, the analysis subsequently studies the relationship between health IT, physician productivity and perceived quality of care. It finds that smaller practices and physicians with lower incomes are less likely to adopt health IT systems and that adoption varies with the type of medical conditions the practice typically treats. With regards to productivity, health IT adopters are more likely to see fewer patients and spend a larger amount of time on each visit with marginal increases in time on administrative tasks and no differences in perceived ability to deliver quality health care.     

IT for green and green IT: A proposed typology of eco-innovation

This article is in support of the development of an ecological economic framework. It discusses, from an interdisciplinary perspective, the increasing use of green IT and their applications (IT for green). IT and sustainable development have had a concomitant rise and reach. The future world emerging from their respective interpretations enables, in both cases, a shift from today's questionable industrial capitalism towards post-industrial capitalism. This paper addresses the following questions: What is known about green IT and IT for green? Are smart solutions (buildings, energy grids, transport) always beneficial to an ecological economy? And, if so, in what ways? In the first part of this article, we analyse the economic, social and environmental impact of IT and argue for the need for green applications of green IT in order to achieve sustainable outcomes. The second part focuses on the managerial dimension of eco-innovation theory and presents one of the distinctive features of green applications of green IT: the collective organisation of innovation. A typology of eco-innovation aimed at reconciling IT development and green growth is then proposed explicitly addressing four kinds of changes towards sustainable development: technological, social, institutional and organisational innovation.     

Nurse entrepreneurship: opportunities in acute care hospitals

"Heartcheck," a new hospital-based program initiated by a nurse clinician, focuses on patient needs. Factors related to the program's success are evaluated from an entrepreneurial perspective.     

The art of long-term thinking: A bridge between sustainability science and politics

Policy makers are dependent upon scientific knowledge. However, scientific results cannot be applied straightforwardly in practical decision making. We deploy Kant's term “power of judgment” – the human capacity to apply general insights to specific, contingent situations – to show that this problem is systematic rather than coincidental: decision making requires the power of judgment to make use of scientific knowledge. Power of judgment, in turns, can be supported by heuristics. Against this background, we focus on sustainability politics and outline a heuristic for framing and analyzing sustainability problems. Because time is a key factor in relation to sustainability we distinguish three distinct concepts of time and argue that the economic concepts of “stocks” and “institutions” can be used to foster power of judgment with respect to these time concepts. Based on these concepts, the heuristic serves to bridge the gap between scientific knowledge and practical decision making in sustainability politics.     

Thinking outside the exam room: accessing community resources for patients in ambulatory care settings

Patients and families receiving care in the ambulatory care setting have increasingly complex needs, requiring nurses to employ a large variety of resources. Parents of pediatric patients have identified services available through community resources as a high priority, although medical personnel do not tend to appreciate the value of these services. Learning about the services offered by community agencies requires some investment of nursing time, but may result in improved effectiveness of nursing care across an institution or network of ambulatory care nurses.     

IT能力与企业创新绩效关系研究——双元学习的调节作用

近年来IT能力对企业创新绩效的影响愈发受到关注,然而,关于双元学习对两者关系作用的研究较少。基于组织学习理论,构建理论模型,探讨IT基础能力和IT体系惯例对企业创新绩效的影响,以及双元学习的调节效应。对313家企业问卷调查的分析表明：IT基础能力和IT体系惯例两种IT能力均能促进企业创新绩效提升。调节作用结果显示：探索式学习、利用式学习均能加强IT能力对企业创新绩效的促进作用。     

企业信息技术匹配动态调整模式的多案例研究

不断变化的内外部环境使得企业需要不断调整才能实现信息技术与业务的动态匹配。应用案例研究方法,分析3家企业信息技术匹配的动态调整模式和匹配程度变化,并通过内外部环境分析确定信息技术匹配动态调整模式的影响因素。研究发现：①企业信息技术匹配动态调整存在理想轨迹、矛盾决策、过量改革及飘忽立场等4种基本模式;②动态调整后,企业信息技术匹配程度可能发生变化,这取决于调整前的信息技术匹配程度及其调整模式;③市场竞争激烈、国家政策支持、客户需求变化、企业认识变化、管理模式创新等因素影响企业选择信息技术匹配动态调整模式。基于3家中国企业的多案例分析结果,可为我国企业实现信息技术与业务动态匹配提供参考。     

Determinants of specialist physician ambulatory visits: a neurology example

Background: Economic theory argues that specialization in medicine improves efficiency. Current literature suggests that access to and utilization of specialist care vary widely based on many determinants. Thus, understanding the determinants of specialist physician ambulatory care utilization is integral to healthcare policy.

Objectives: The objective is to investigate the individual and community determinants of specialist ambulatory care utilization—specifically neurologists. The aim was to find predictors of specialist utilization and to identify the particular determinants that can be modified by regulatory or legislative action.

Methods: A large claims database, Truven Health Analytics? Marketscan data, was used from 2007–2010 as the sample. These data are supplemented with data from the American Academy of Neurology (for geographic distribution of neurologists) and the US Census American FactFinder (for community demographic factors). Multivariate regression analysis was run to test the hypotheses. Several robustness tests of our models were included.

Results: Most importantly, neurologists per capita has a meaningful impact on utilization. Additionally, the difference in neurologist usage by neurological condition is an important factor. It was also found that union status, age, comorbidities, and diagnosis are significant individual level determinants, and that the percentage of Hispanic residents and median income are significant community level determinants.

Conclusions: There are two predictors believed to be the most important. The first is the unique neurologists per 1,000 capita variable, which shows a small increase in the number of neurologists would be correlated with a small increase in the probability of seeing a neurologist. We suggest that this is within policymakers’ control, and policymakers should consider this action in the face of the predicted shortage. The second is what appears to be possible sorting by neurologists of patients based on diagnosis – the large difference in the fraction of patients seeing a neurologist by disease.     

Expanded role of nursing in ambulatory managed care. Part I: Literature, role development, and justification

New expanded roles in nursing are developing in response to the health system switch from private, episodic care of individuals to health maintenance organizations (HMO's) focusing on disease prevention and promotion of health for populations of persons with chronic illness. This evaluation project explored the role of the nurse clinician in population and case management at a large HMO in the Northwest United States. In Part I of this two-part series, a literature review, is presented on chronic illness, ambulatory nursing, expanded role nursing, and nursing in HMOs. The development of the expanded role nurse clinician at the managed care organization is also described. Results could be used by HMOs to attract and retain nurses, improve care processes, and decrease costs in ambulatory care.