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The aim of this study is to investigate patients' initial acceptance and ongoing use of a simple but typical type of consumer e-health service - an e-appointment scheduling (EAS) system - in order to identify facilitators and barriers for patients' adoption of e-health services in primary healthcare. In-depth, semi-structured interviews were conducted to gather patients' background information, their awareness of the system, their feedbacks on the characteristics of the system, and their reasons for use or not use the system. A total of 125 patients aged between 17 and 74 were interviewed. Study results show that 89% of the interviewed patients had shown reluctance to adopt this online service. The identified barriers for acceptance include many patients' lack of access to the internet, lack of awareness of the service, low computer skills and incompatibility of the online appointment service with many patients' habits of face-to-face or phone-call based medical appointment making. Health service providers need to consider the general public's acceptance for online services before implementing consumer e-health systems.

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BACKGROUND: Consider a case that has been ongoing for longer than the scheduled duration. The anesthesiologist estimates that there is 1 hour remaining. Forty-five minutes later the case has not yet finished, and closure has not yet started. We showed previously that the mean (expected) time remaining is approximately 1 hour, not 15 minutes. The relationship is a direct mathematical consequence of the log-normal probability distributions of operating room (OR) case durations. We test the hypothesis that, with an accurate probabilistic model, until closure begins the estimated mean time remaining would be the mean time from the start of closure to OR exit. METHODS: Among the 311,940 OR cases in a 7-year time series from 1 hospital, there were 3962 cases for which (1) there had been previously at least 30 cases of the same combination of scheduled procedure(s), surgeon, and type of anesthetic and (2) the actual OR time exceeded the 0.9 quantile of case duration before the case started. A Bayesian statistical method was used to calculate the mean (expected) minutes remaining in the case at the 0.9 quantile. The estimate was compared with the actual minutes from the time of the start of closure until the patient exited the OR. RESULTS: The mean ± standard error of the pairwise difference was 0.2 ± 0.4 minutes. The Bayesian estimate for the 0.9 quantile was exceeded by 10.2% ± 0.01% of cases (i.e., very close to the desired 10.0% rate). CONCLUSIONS: If a case is taking longer than the expected (scheduled) duration, closure has not yet started, and someone in the OR is asked how much time the case likely has remaining, the value recorded on a clipboard for viewing later should be the estimated time remaining (e.g., "1 hour") not an end time (e.g., "5:15 pm"). Electronic whiteboard displays should not show that the estimated time remaining in the case is less than the mean time from start of closure to OR exit. Similarly, if closure has started, the expected time remaining that is displayed should not be longer than the mean time from closure to OR exit. Finally, our results match previous reports that, before a case starts, statistical methods can reliably be used to assist in decisions involving the longest amount of time that cases may take (e.g., conflict checking for resources, filling holes in the OR schedule, and preventing holes in the schedule).

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Recently, some researchers have argued that high state rates of Centers for Medicare and Medicaid Services (CMS) Online Survey, Certification and Reporting (OSCAR) nursing facility deficiencies indicate stringent enforcement, leaving the impression of better-quality care soon to follow; others maintain that the rank ordering of states' quality of nursing facility care remains fairly constant, resting on deep-seated state characteristics that change slowly, so that short-term improvement in poor-quality care is unlikely. The authors examine change in the process and outcome quality of states' Medicare nursing facility long-term care programs across 1999 to 2005, using linear and two-stage least squares regression. They find that (1) nationally, process quality generally falls across this period while outcome quality generally increases; (2) neither a prominent enforcement stringency index nor state culture, a relatively stable state characteristic, exerts much influence on state process and outcome quality scores over time, but (3) the relative costs and benefits for CMS compliance appear to contribute to explaining change in states' quality of resident outcomes over time; and (4) states' process quality is much less stable than outcome quality, and outcome indices distinct from OSCAR deficiency data provide more reliable and possibly more valid measures of care quality.

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OBJECTIVES: To assess nursing home staffing data reported in the Online Survey Certification and Reporting (OSCAR) system database for research and policy. DESIGN: Comparisons were made between OSCAR and a concurrent research survey of staffing data collected for the same facilities, using inter-rater agreement and correlation analyses. SETTING: Freestanding nursing homes from New York State (NYS) in 1997 (N = 327). MEASUREMENTS: Selected staffing variables were defined in comparable terms in both OSCAR and the NYS survey. RESULTS: The two data sources were in substantial agreement on the reported availability of a full-time physician (other than medical director) and of a physician assistant or nurse practitioner (Kappa >0.7), and they correlated well in the full-time equivalent (FTE) number of such staff (Spearman correlation >0.6). The correlation was 0.8 for FTE registered nurses (RNs), 0.7 for licensed practical nurses (LPNs), and 0.8 for certified nurse aides (CNAs). In terms of average nurse hours per patient day, separately for RNs, LPNs, CNAs, and all combined, the correlation was relatively weak (between 0.3 and 0.6). Overall staffing levels tended to be lower in OSCAR than in NYS. CONCLUSION: The OSCAR data are useful for exploring relationships between staffing and various quality of care outcomes, but may not be accurate enough on a case-specific basis, or to determine policy regarding minimal staffing levels using average nurse hours per patient day measures. More systematic and timely efforts are needed to refine the OSCAR content and survey methodology to document nursing home staffing information.

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PURPOSE: The effect on efficiency of patient care in a busy academic interventional radiology practice was studied by the analysis of procedure times both before and after the implementation of a computerized interactive daily schedule. Procedure start and end times were retrospectively collected from the department's quality assurance database for two identical 6-month periods, representing the time before and after the deployment of the software. The delay in the start of the first case, the time between cases, and the time required to complete each day's work were compared for the two periods. RESULTS: The average time of delay between cases was reduced after the implementation of the software (p < 0.025). More total cases were performed during the period of time after the implementation of the software, resulting in a greater work relative value unit production. Although the average number of cases performed per day was greater after the software was in use (p < 0.03), the average amount of time required to complete the day's work was not significantly changed (p = 0.08). There was no apparent effect on the average delay of the start of the day's first case (p = 0.34). CONCLUSION: The use of a computerized interactive daily schedule has a positive effect on departmental efficiency by allowing more cases to be performed without lengthening the workday.

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OBJECTIVES: Our objective is to make the New Deal on junior doctors' hours sufficiently precise that the definitions may be used as a basis for computer software that checks the compliance of rotas or that automatically generates compliant rotas. METHODS: We formalize the clauses of the New Deal, as relevant to 'full shifts', using the Z specification language. RESULTS: The mathematical definitions are simple and concise. CONCLUSIONS: Mathematical specification is a useful way to express constraints on rotas unambiguously.

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BACKGROUND: Many physicians are transitioning from paper to electronic formats for billing, scheduling, medical charts, communications, etc. The primary objective of this research was to identify the relationship (if any) between the software selection process and the office staff's perceptions of the software's impact on practice activities. METHODS: A telephone survey was conducted with office representatives of 407 physician practices in Oregon who had purchased information technology. The respondents, usually office managers, answered scripted questions about their selection process and their perceptions of the software after implementation. RESULTS: Multiple logistic regression revealed that software type, selection steps, and certain factors influencing the purchase were related to whether the respondents felt the software improved the scheduling and financial analysis practice activities. Specifically, practices that selected electronic medical record or practice management software, that made software comparisons, or that considered prior user testimony as important were more likely to have perceived improvements in the scheduling process than were other practices. Practices that considered value important, that did not consider compatibility important, that selected managed care software, that spent less than 10,000 dollars, or that provided learning time (most dramatic increase in odds ratio, 8.2) during implementation were more likely to perceive that the software had improved the financial analysis process than were other practices. CONCLUSION: Perhaps one of the most important predictors of improvement was providing learning time during implementation, particularly when the software involves several practice activities. Despite this importance, less than half of the practices reported performing this step.

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