Inpatient nurses' preferences and decisions with risk information visualization.

OBJECTIVE: We examined the influence of 4 different risk information formats on inpatient nurses' preferences and decisions with an acute clinical deterioration decision-support system. MATERIALS AND METHODS: We conducted a comparative usability evaluation in which participants provided responses to multiple user interface options in a simulated setting. We collected qualitative data using think aloud methods. We collected quantitative data by asking participants which action they would perform after each time point in 3 different patient scenarios. RESULTS: More participants (n = 6) preferred the probability format over relative risk ratios (n = 2), absolute differences (n = 2), and number of persons out of 100 (n = 0). Participants liked average lines, having a trend graph to supplement the risk estimate, and consistent colors between trend graphs and possible actions. Participants did not like too much text information or the presence of confidence intervals. From a decision-making perspective, use of the probability format was associated with greater concordance in actions taken by participants compared to the other 3 risk information formats. DISCUSSION: By focusing on nurses' preferences and decisions with several risk information display formats and collecting both qualitative and quantitative data, we have provided meaningful insights for the design of clinical decision-support systems containing complex quantitative information. CONCLUSION: This study adds to our knowledge of presenting risk information to nurses within clinical decision-support systems. We encourage those developing risk-based systems for inpatient nurses to consider expressing risk in a probability format and include a graph (with average line) to display the patient's recent trends.

School-Based Health Centers: A Concept Analysis.

INTRODUCTION: This concept analysis aims to provide a conceptual definition for school-based health centers (SBHCs). Despite growing evidence of SBHC growth and impact, there is a gap in the conceptual clarity of SBHCs. METHOD: A systematic review using Walker and Avant's 8-step method of concept analysis produced 369 articles, of which 17 were analyzed. PubMed, CINAHL, Embase, PsycINFO, and Cochrane Library were searched with no time limit to capture the history and development of SBHCs. Search terms included "school-based health" and "school-based health center." RESULTS: Accessible and advanced practitioners, heterogeneity, integrated care and location, and youth-friendly provide defining attributions to SBHCs. Antecedents, consequences, and empirical referents are discussed. DISCUSSION: This concept analysis highlights evidence supporting the potential impact of SBHCs as a health service model for advancing health equity. Clear criteria contribute to understanding SBHCs and serve as a basis for ongoing research and stakeholder collaboration.

Show Me The Money Saved! Cost Savings From Acute Asthma Care in the School-Based Health Center.

Chronic school absenteeism directly affects educational outcomes while reducing school funding and reimbursement. Asthma is a prevalent disease associated with chronic absenteeism. This quality improvement project demonstrated classroom seat time preserved through use of school-based health centers (SBHC). The project also highlights the educational benefits, reduced emergency department utilization, potential cost savings to hospitals, and lower overall health care costs. Visit summary data were collected and analyzed to show quality asthma care and cost savings. Of 44 acute asthma visits that returned to class, an average classroom time of 3:42 hours were saved per student during the 2017-2018 academic year, resulting in a combined total of 166:07 hours saved. A minimum potential cost savings was estimated to be $67,770 for all 44 visits. Data analysis of structural, process, and outcome measures through quality improvement tools can demonstrate cost savings of SBHC care, which advocates funding for this pediatric care model.

Taking Action on Asthma: Increasing Influenza Vaccination Rates in Pediatric Asthma Through Quality Improvement.

INTRODUCTION: Through a QI Collaborative, a school-based health center (SBHC) program was tasked with identifying ways to decrease asthma mortality and promote national asthma guidelines with evidence-based interventions. Children with asthma are at increased risk for influenza complications such as pneumonia, hospitalization, and death. Flu vaccinations reduce these morbidities. METHODS: Utilizing the Institute for Healthcare Improvement Framework, a clinical microsystems assessment and root cause analysis evaluated both enablers and barriers in improving flu vaccination rates in asthma students. Continuous quality improvement over three academic years with adaption of process efficiencies including asthma database tracking, flu vaccination rates, and asthma preventative visits was demonstrated. RESULTS: The number of students with asthma who received their flu vaccination increased from 11% to 47%. DISCUSSION: The SBHC program improved flu vaccination rates and targeted asthma preventative services. Additional successes included the adaptation of a vaccination campaign to 14 SBHCs, education on flu vaccination, and better electronic health record documentation of asthma severity.