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Structure of Inter-Professional Knowledge Exchange Related to "EHR MedRec" within an SKN System
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Author: Pavani Rangachari, Augusta U.
Author: Karl Rethemeyer, U. at Albany, State U. of New York
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Similar to issues faced in health systems across U.S., AU Health faced a scenario of low physician engagement in, and limited-use of its EHR Medication Reconciliation (MedRec) technology. In fall 2016, a two-year grant was secured from AHRQ, to pilot-test a Social Knowledge Networking (SKN) system pertaining to “EHR-MedRec,” to enable AU Health to progress from “limited-use” of EHR-MedRec technology, to “meaningful-use.” A total of 50 “SKN Users” (physicians, nurses, and pharmacists from outpatient-and-inpatient-medicine services), participated in discussing issues-related-to EHR-MedRec, moderated by 5 “SKN Moderators” (senior administrators), over a one-year period. The pilot study, which was completed in fall 2018, found that inter-professional knowledge exchange on the SKN system, enabled several “collective-learning-(aha)-moments” to emerge. These learning dynamics in turn, were associated with distinct improvement trends in two measures of “Meaningful-Use-of EHR-MedRec” that emerged from the discussions. The key takeaway was that an SKN system could be a valuable tool in enabling meaningful use of EHR MedRec technology. Detailed findings related to the content and dynamics of inter-professional knowledge exchange related to EHR MedRec on the SKN system, have been described in a separate manuscript. The aim of this paper, is to describe the structure of inter-professional knowledge exchange, over the one-year SKN-pilot period. Social Network Analysis techniques, specifically, two-mode and ego-network analysis, are used to describe the structure of inter-professional knowledge exchange on the SKN system. Results revealed that 3 of the 5 SKN Moderators played a strong “collective brokerage” role in facilitating inter-professional knowledge exchange related to EHR MedRec, to enable learning and change (improvement). Together, they played complementary roles in reinforcing best-practice-assertions, providing IT system-education, and synthesizing collective-learning-moments, to enable change-champions to emerge from among SKN Users. Results provide insight into strategies for the design of effective knowledge sharing networks for learning and change in healthcare organizations.
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Paper is No Longer Available Online: Please contact the author(s).
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Trauma Certification and Hospital Referral Region Diversity: A System Approach Theory
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Author: Hanadi Hamadi, U. of North Florida
Author: Nazik Zakari, AlMaarefa U.
Author: Aurora Tafili, U. of North Florida
Author: Emma Apatu, U. of North Florida
Author: Aaron Spaulding, Mayo Clinic
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The U.S. model for trauma care has been seen as one of the most advanced systems in the world, however, there are clear racial and ethnic disparities in the trauma care service delivery that warrant further investigation. Previous inquiry has indicated that the prevalence of trauma centers (TCs) may be related to environmental factors, and differences in health utilization. However, previous inquiry has not examined the possible relationships between structural determinants that relate to the level of trauma care designations (L-I through L-IV) or verification along with social factors of the surrounding community as it relates to its population of diversity. Thus, this study is focused on examining the relationship between community diversity in a Hospital Referral Region (HRR), and U.S.-based hospitals’ attainment of trauma certification and trauma designation L-I/II. We conducted a cross-sectional analysis of data from the 2017 American Hospital Association (AHA) Annual Survey, Current Population Survey (CPS) , and the Dartmouth Atlas Hospital Referral Region datasets. Poisson regression and propensity score matching were used to analyze 303 HRRs. Our primary dependent variables were hospitals with trauma certification and hospitals with trauma L-I/II. Our primary independent variable was the diversity of an HRR operationalized by estimating an entropy index score for each county—aggregated to the HRR level—that is comprised of the proportions of the ethnic groups. We found that hospitals with trauma certification or trauma L-I/II were more likely to be in HRRs with less diverse population. Furthermore, market competition was a significant factor in reducing the availability of trauma certified centers. Our findings highlight that in the U.S. system disparities do exist in trauma care. Research is needed to determine if other factors such as resource allocation and reimbursements distribution from Medicaid Disproportionate Share Hospital have impact the availability of trauma facilities.
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Paper is No Longer Available Online: Please contact the author(s).
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Distributed Leadership Enactment in the Implementation of Inter-Organizational Networks
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Author: Jennifer Gutberg, U. of Toronto
Author: Sobia Khan, U. of Toronto, Institute of Health Policy, Management & Evaluation
Author: Reham Abdelhalim, U. of Toronto, Institute of Health Policy, Management & Evaluation
Author: Walter Wodchis, U. of Toronto, Institute of Health Policy, Management & Evaluation
Author: Agnes Grudniewicz, U. of Ottawa
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Providing care for increasingly medically and socially complex populations is a well-recognized challenge that necessitates coordinating services across multiple sectors and organizations. There is a need to re-organize how care is delivered to align with coordination efforts, in the form of inter-organizational networks. However, substantial gaps remain in our understanding of how to effectively implement these networks, and what leadership approaches will facilitate successful implementation. Drawing on distributed leadership theory, we examine how leadership is enacted in Health Links networks, a care coordination initiative in Ontario, Canada. We conducted a qualitative multiple case study of three Health Links. 30 leaders and frontline providers participated in hour-long, semi-structured interviews. We find that distributed leadership was enacted across all cases, and ranged from highly distributed models with numerous strategic partners, to less strongly distributed approaches that were primarily directed by the lead organization’s vision and leadership. In all cases, the lead organization’s influence was critical to the network’s perceived successful implementation. When effectively leveraging its role, the lead organization empowered partners to enact distributed leadership across their network. However, strong variability was seen in the capacity of each lead organization to harness their power and position, resulting in mixed experiences of implementation.
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Paper is No Longer Available Online: Please contact the author(s).
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The Role of Proximity in Explaining Patient Transfer Networks in Outpatient Healthcare
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Author: Eva Kesternich, U. of Freiburg
Author: Olaf N. Rank, U. of Freiburg
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We examine to what extent spatial and non-spatial proximity drive patient transfer networks between outpatient healthcare organizations. Previous studies have emphasized the relevance of different proximity types for explaining network formations in the hospital sector. We obtain similar results with respect to the outpatient healthcare setting. Doctors’ offices and ambulatory care centers are actors within the primary healthcare system and often the first point of contact for patients. Interdisciplinary exchange is needed to organize treatment processes. Patient transfer is defined as a routine process in care supplying and a type of interorganizational collaboration. We argue that in addition to medical factors and geographical proximity, institutional, technological and social proximity also have a positive effect on the formation of patient transfer ties. We use claims data from the Medicare program to identify a directed network within a Primary Care Service Area. Applying exponential random graph models, we find that institutional and social proximity positively affect the tendency of medical practices to form patient transfer ties, whereas geographical and technological proximity are not relevant. Our findings support policymakers and healthcare system administrators understand the underlying mechanisms of network structure in outpatient care provision and to derive beneficial information for future healthcare planning.
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Paper is No Longer Available Online: Please contact the author(s).
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