Theses and Dissertations
This collection includes both ASU Theses and Dissertations, submitted by graduate students, and the Barrett, Honors College theses submitted by undergraduate students.
Displaying 1 - 3 of 3
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- All Subjects: Health Sciences
- Creators: Doebbeling, Bradley
Description
Background: Exercise is Medicine (EIM) is a health promotion strategy for addressing physical inactivity in healthcare. However, it is unknown how to successfully implement the processes.
Purpose: The purpose of this study was to understand how implementing EIM influenced provider behaviors in a university-based healthcare system, using a process evaluation.
Methods: A multiple baseline, time series design was used. Providers were allocated to three groups. Group 1 (n=11) was exposed to an electronic medical record (EMR) systems change, EIM-related resources, and EIM training session. Group 2 (n=5) received the EMR change and resources but no training. Group 3 (n=6) was only exposed to the systems change. The study was conducted across three phases. Outcomes included asking about patient physical activity (PA) as a vital sign (PAVS), prescribing PA (ExRx), and providing PA resources or referrals. Patient surveys and EMR data were examined. Time series analysis, chi-square, and logistic regression were used.
Results: Patient survey data revealed the systems change increased patient reports of being asked about PA, χ2(4) = 95.47, p < .001 for all groups. There was a significant effect of training and resource dissemination on patients receiving PA advice, χ2(4) = 36.25, p < .001. Patients receiving PA advice was greater during phase 2 (OR = 4.7, 95% CI = 2.0-11.0) and phase 3 (OR = 2.9, 95% CI = 1.2-7.4). Increases were also observed in EMR data for PAVS, χ2(2) = 29.27, p <. 001 during implementation for all groups. Increases in PA advice χ2(2) = 140.90, p < .001 occurred among trained providers only. No statistically significant change was observed for ExRx, PA resources or PA referrals. However, visual analysis showed an upwards trend among trained providers.
Conclusions: An EMR systems change is effective for increasing the collection of the PAVS. Training and resources may influence provider behavior but training alone increased provider documentation. The low levels of documented outcomes for PA advice, ExRx, resources, or referrals may be due to the limitations of the EMR system. This approach was effective for examining the EIM Solution and scaled-up, longer trials may yield more robust results.
Purpose: The purpose of this study was to understand how implementing EIM influenced provider behaviors in a university-based healthcare system, using a process evaluation.
Methods: A multiple baseline, time series design was used. Providers were allocated to three groups. Group 1 (n=11) was exposed to an electronic medical record (EMR) systems change, EIM-related resources, and EIM training session. Group 2 (n=5) received the EMR change and resources but no training. Group 3 (n=6) was only exposed to the systems change. The study was conducted across three phases. Outcomes included asking about patient physical activity (PA) as a vital sign (PAVS), prescribing PA (ExRx), and providing PA resources or referrals. Patient surveys and EMR data were examined. Time series analysis, chi-square, and logistic regression were used.
Results: Patient survey data revealed the systems change increased patient reports of being asked about PA, χ2(4) = 95.47, p < .001 for all groups. There was a significant effect of training and resource dissemination on patients receiving PA advice, χ2(4) = 36.25, p < .001. Patients receiving PA advice was greater during phase 2 (OR = 4.7, 95% CI = 2.0-11.0) and phase 3 (OR = 2.9, 95% CI = 1.2-7.4). Increases were also observed in EMR data for PAVS, χ2(2) = 29.27, p <. 001 during implementation for all groups. Increases in PA advice χ2(2) = 140.90, p < .001 occurred among trained providers only. No statistically significant change was observed for ExRx, PA resources or PA referrals. However, visual analysis showed an upwards trend among trained providers.
Conclusions: An EMR systems change is effective for increasing the collection of the PAVS. Training and resources may influence provider behavior but training alone increased provider documentation. The low levels of documented outcomes for PA advice, ExRx, resources, or referrals may be due to the limitations of the EMR system. This approach was effective for examining the EIM Solution and scaled-up, longer trials may yield more robust results.
ContributorsBirchfield, Natasha R (Author) / Der Ananian, Cheryl (Thesis advisor) / Krasnow, Aaron (Committee member) / Doebbeling, Bradley (Committee member) / Adams, Marc (Committee member) / Swan, Pamela (Committee member) / Arizona State University (Publisher)
Created2019
Description
Perioperative care has a direct and crucial impact on patient safety and patient outcomes, as well as the financial viability of the healthcare facility. The time pressure and workload of caring patients facing surgery are heavier than caring inpatients of other departments. This workload raises requirements for PreOp nurses, the primary PreOp caregiver, to complete information gathering, screening, and verification tasks accurately and efficiently. EHRs (Electronic Health Record System) have evolved continuously with increasing features to meet newly raised needs and expectations. Many healthcare institutions have undergone EHR conversion since the introduction of first-generation EHRs. Thus, the need for a systematic evaluation of changed information system workflow following conversion is becoming more and more manifest. There are a growing number of methods for analyzing health information technology use. However, few studies provide and apply a standard method to understand the impact of EHR transition and inspire opportunities for improvement.
This dissertation focuses on PreOp nurse’s EHR use in PreOp settings. The goals of this dissertation are to: (a) introduce a systematic framework to evaluate EHR-mediated workflow and the impact of the EHR transition; (b) understand the impact of different EHR systems on PreOp nurse’s workflow and preoperative care efficiency; (c) transform the evaluation results into practical user-centered EHR designs. This research draws on computational ethnography, cognitive engineering process and user-centered design concepts to build a practical approach for EHR transition-related workflow evaluation and optimization.
Observational data were collected before and after a large-scale EHR conversion throughout Mayo Clinic’s different regional health systems. For a structured computational evaluation framework, the time-efficiency of PreOp nurses’ work were compared quantitatively by means of coding and segmenting nurses’ tasks. Interview data provided contextual information, reflecting practical challenges and opportunities before and after the EHR transition.
The total case time, the time spent on EHR, and the task fragmentation were improved after converting to the new EHR system. A trend of standardization of information-related workflow and EHR transition was observed. Notably, the approach helped to identify current new system challenges and pointed out potential optimization solutions.
ContributorsZheng, Lu (Author) / Doebbeling, Bradley (Thesis advisor) / Kaufman, David (Committee member) / Wang, Dongwen (Committee member) / Patel, Vimla (Committee member) / Chiou, Erin (Committee member) / Arizona State University (Publisher)
Created2021
Description
Usability problems associated with electronic health records can adversely impact clinical workflow, leading to inefficiencies, error, and even clinician burnout. The work presented in this dissertation is concerned with understanding and improving clinical workflow. Towards that end, it is necessary to model physical and cognitive aspects of task performance in clinical settings. Task completion can be significantly impacted by the navigational efficiency of the electronic health record (EHR) interface. Workflow modeling of the EHR-mediated workflow could help identify, diagnose and eliminate problems to reduce navigational complexity. The research goal is to introduce and validate a new biomedical informatics methodological workflow analysis framework that combines expert-based and user-based techniques to guide effective EHR design and reduce navigational complexity. These techniques are combined into a modified walkthrough that aligns user goals and subgoals with estimated task completion time and characterization of cognitive demands. A two-phased validation of the framework is utilized. The first is applied to single EHR-mediated workflow tasks, medication reconciliation (MedRec), and medication administration records (MAR) to refine individual aspects of the framework. The second phase applied the framework to a pre/post EHR implementation comparative analysis of multiple workflows tasks. This validation provides evidence of the framework's applicability and feasibility across several sites, systems, and settings. Analysis of the steps executed within the interfaces involved to complete the medication administration and medication reconciliation and patient order management tasks have provided a basis for characterizing the complexities in EHR navigation. An implication of the work presented here is that small tractable changes in interface design may substantially improve EHR navigation, overall usability, and workflow. The navigational complexity framework enables scrutinizing the impact of different EHR interfaces on task performance and usability barriers across different sites, systems, and settings.
ContributorsDuncan, Benjamin (Author) / Grando, Adela (Thesis advisor) / Doebbeling, Bradley (Thesis advisor) / Kaufman, David (Committee member) / Greenes, Robert (Committee member) / Arizona State University (Publisher)
Created2021