Understanding adoption of a personal health record in rural health care clinics: revealing barriers and facilitators of adoption including attributions about potential patient portal users and self-reported characteristics of early adopting users.

Personal health records (PHRs) are important for improving patient care. An important prerequisite to realize benefits of PHR use is patient recruitment. To understand clinic barriers to adoption, we used Rogers' Diffusion of Innovations theory to frame an examination of clinic staff perceptions of a new PHR and perceptions of likely patient portal users.

Psychometric assessment of the patient activation measure short form (PAM-13) in rural settings.

Purpose: The patient activation measure short form (PAM-13) assesses patients' self-reported health management skills, knowledge, confidence, and motivation. We used item response theory to evaluate the psychometric properties of the PAM-13 utilized in rural settings.

Methods: A Rasch partial credit model analysis was conducted on the PAM-13 instrument using a sample of 812 rural patients recruited by providers and our research staff.

Provider detailing: an intervention to decrease prescription opioid deaths in Utah.

Background: Utah undertook a multipronged effort to reverse an epidemic of deaths among patients taking prescription opioids. This article describes the provider detailing portion of the effort.

Methods: Presentations highlighting six recommended prescribing practices were developed and presented to health care workers.

Improved clinical outcomes with utilization of a community-acquired pneumonia guideline.

Background: We previously reported decreased mortality following implementation of a community-acquired pneumonia guideline derived from specialty society recommendations. However, patients with respiratory failure and sepsis from pneumonia were not included, adjustment for comorbidities was limited, and no guideline compliance data were available. We also questioned whether decreased mortality continued after 1997.

Use of a personal digital assistant for managing antibiotic prescribing for outpatient respiratory tract infections in rural communities.

Objective: To assess the acceptability and usage of a standalone personal digital assistant (PDA)-based clinical decision-support system (CDSS) for the diagnosis and management of acute respiratory tract infections (RTIs) in the outpatient setting.

Design: Observational study performed as part of a larger randomized trial in six rural communities in Utah and Idaho from January 2002 to March 2004. Ninety-nine primary care providers received a PDA-based CDSS for use at the point-of-care, and were asked to use the tool with at least 200 patients with suspected RTIs.

Experience with a clinical decision support system in community pharmacies to recommend narrow-spectrum antimicrobials, nonantimicrobial prescriptions, and OTC products to decrease broad-spectrum antimicrobial use.

Background: Overuse of antibiotics increases the incidence of bacterial resistance and contributes avoidable costs to the health care system.

Objective: To determine the feasibility of a protocol-driven community pharmacy intervention that was designed to decrease broad-spectrum antimicrobial (BSA) use in patients with upper respiratory tract infections.

Methods: The intervention involved pharmacists who conducted guided interviews regarding patient symptoms in a cohort of patients with BSA prescription visiting 2 rural community pharmacies during peak respiratory illness season.

Clinical decision support and appropriateness of antimicrobial prescribing: a randomized trial.

Context: The impact of clinical decision support systems (CDSS) on antimicrobial prescribing in ambulatory settings has not previously been evaluated.

Objective: To measure the added value of CDSS when coupled with a community intervention to reduce inappropriate prescribing of antimicrobial drugs for acute respiratory tract infections.

Design, Participants And Setting: Cluster randomized trial that included 407,460 inhabitants and 334 primary care clinicians in 12 rural communities in Utah and Idaho (6 with 1 shared characteristic and 6 with another), and a third group of 6 communities that served as nonstudy controls.

A multifaceted intervention to improve antimicrobial prescribing for upper respiratory tract infections in a small rural community.

Background: Antibiotic prescribing for upper respiratory tract infections (URTIs) is widespread, is often inappropriate, and may contribute to antibiotic resistance among community-acquired pathogens, such as Streptococcus pneumoniae.

Methods: A multifaceted intervention involving health care professionals and patients was introduced to a small rural Utah community and included the repetitive use of printed diagnostic and treatment algorithms by professionals. Data on the quantity and class of antibiotic prescribing, which were collected from multiple sources, were measured for the intervention period (from January through June) in 2001 and compared with data for the baseline period during the same months in 2000.

Local guidelines for community-acquired pneumonia: development, implementation, and outcome studies.

Published outcome studies mostly report a positive effect of successfully implemented pneumonia guidelines. Confirmatory studies are needed that use randomized, parallel groups with precisely defined treatments, however. Further research also is needed to develop methodology for more easily providing guideline logic to clinicians at the point of care.

Improving health care systems performance: a human factors approach.

Under contract from the Centers for Medicare & Medicaid Services (CMS), Medicare Quality Improvement Organizations (QIOs) promote improvement in health care system performance. With the QIO contract cycle that began in the fall of 1999, CMS adopted a broad national improvement agenda emphasizing 24 quality measures from 6 clinical topic areas. The Utah QIO developed a human factors and organizational safety management-based intervention strategy for the inpatient clinical topic areas, borrowing approaches and principles previously applied in hospital-based medication systems safety improvement efforts.