Exploring Factors Associated With the Work Hours of Attending Physicians Working in Hospitals.

BACKGROUND: Long work hours for physicians not only harm the health of physicians, but also endanger patient safety. Compared with resident physicians, attending physicians-especially hospital-employed attending physicians-assume more responsibilities but has not gotten enough attention. The purpose of this study was to explore whether a hospital's geographic location and emergency care responsibility might influence the number of hours worked. METHODS: The respondents of 2365 attending physicians from 152 hospitals in the 2018 survey of Taiwan physician work hours were used as the data source. The total work hour per week and its components, the regular scheduled shift and three types of on-call shifts, were used as outcome variables. Hospital geographic location and emergency care responsibility were the independent variables. The multilevel random effect model was employed to examine the study objective after adjusting for clinical specialty, hospital teaching status, and ownership. RESULTS: The average number of total working hours was 69.09 hours per week; the regular scheduled shift was account for 75% of total work hours. The results showed the total work hours were only varied by the level of hospital's emergency care responsibility. However, the results also demonstrated the hours of duty shifts were varied by hospital's geographic location and emergency care responsibility. The results of the multilevel random effect model revealed that the hospital's emergency care responsibility was the factor consistently associated with attending physician's work hour, no matter the total work hours or its composition. CONCLUSION: In this study, we explored how a hospital's location and its level of emergency care responsibility were associated with physicians' work hours for each type of shift. Our findings offer an opportunity to review the rationality of physician workforce allocation, and financial incentives and administrative measures could be the next steps for balancing the work hours of attending physicians.

Self-Service System for the Family Members of ICU Patients: A Pilot Study.

Family members of intensive care unit patients are often experience high anxiety and require more information about the patients. However, most Taiwanese healthcare institutions currently face manpower shortages due to the COVID-19 pandemic. Therefore, the task of providing additional services to meet family members' needs and relieve their stress was deferred by some healthcare institutions. The self-service system, known to be effective and efficient in other industries, was recommended for use in the healthcare industry. This study aims to explore an intensive care unit self-service system (ICU-SSS) designed for the family members of ICU patients. This study investigates the feasibility of the system by following a mixed method approach, including qualitative interviews and a quantitative survey. Firstly, interviews with five family members and five ICU staff members of a case hospital were conducted to identify the need to develop an ICU-SSS for the family member. Secondly, a survey was completed by 30 family members to evaluate the system. The interview results reveal nine categories of family members' needs and the survey results show that the ICU family members assigned acceptable scores to all the ICU-SSS functions, except the importance of "Logistical information". Based on these findings, the scientific and practical implications are discussed.

Effects of Erythropoietin Payment Policy on Cardiovascular Outcomes of Peritoneal Dialysis Patients: Observational Study.

BACKGROUND: The change in the reimbursement policy of erythropoietin administration to patients receiving peritoneal dialysis by the Taiwan National Health Insurance (NHI) system provided a natural experimental venue to examine whether cardiovascular risk differs when maintaining the hematocrit (Hct) level below or above 30%. OBJECTIVE: The aim of this study was to analyze the impact of loosening the erythropoietin payment criteria for peritoneal dialysis patients on their cardiovascular outcomes. METHODS: Two cohorts of incident peritoneal dialysis patients were identified according to the time before and after relaxation of the NHI's erythropoietin payment criteria, designated cohort 1 (n=1759) and cohort 2 (n=2981), respectively. The cohorts were matched according to propensity scores (1754 patients in each cohort) and then followed up for cardiovascular events, which were analyzed with Cox regressions. RESULTS: For the composite cardiovascular endpoint, patients in cohort 2 had a significantly lower risk than those in cohort 1. However, subgroup analysis showed that this risk reduction was observed only in patients with diabetes. CONCLUSIONS: After loosening erythropoietin payment criteria, reduced cardiovascular risks were observed, particularly for patients with diabetes. These results indicate that it is crucial to maintain an Hct level above 30% to reduce the cardiovascular risk in patients with diabetes undergoing peritoneal dialysis.

The Impact of a Social Networking Service-Enhanced Smart Care Model on Stage 5 Chronic Kidney Disease: Quasi-Experimental Study.

BACKGROUND: Stage 5 chronic kidney disease (CKD) presents a high risk for dialysis initiation and for complications such as uremic encephalopathy, uremic symptoms, gastrointestinal bleeding, and infection. One of the most common barriers to health care for patients with stage 5 CKD is poor continuity of care due to unresolved communication gaps. OBJECTIVE: Our aim was to establish a powerful care model that includes the use of a social networking service (SNS) to improve care quality for patients with CKD and safely delay dialysis initiation. METHODS: We used a retrospective cohort of CKD patients aged 20-85 years who received care between 2007 and 2017 to evaluate the efficacy of incorporating an SNS into the health care system. In 2014, author F-JY, a nephrologist at the National Taiwan University Hospital Yunlin Branch, started to use an SNS app to connect with stage 5 CKD patients and their families. In cases of emergency, patients and families could quickly report any condition to F-JY. Using this app, F-JY helped facilitate productive interactions between these patients and the health care system. The intention was to safely delay the initiation of dialysis therapy. We divided patients into four groups: group 1 (G1) included patients at the study hospital during the 2007-2014 period who had contact only with nephrologists other than F-JY; group 2 (G2) included patients who visited F-JY during the 2007-2014 period before he began using the SNS app; group 3 (G3) included patients who visited nephrologists other than F-JY during the 2014-2017 period and had no interactions using the SNS; and group 4 (G4) included patients who visited F-JY during the 2014-2017 period and interacted with him using the SNS app. RESULTS: We recruited 209 patients with stage 5 CKD who had been enrolled in the study hospital's CKD program between 2007 and 2017. Each of the four groups initiated dialysis at different times. Before adjusting for baseline estimated glomerular filtration rate (eGFR), the G4 patients had a longer time to dialysis (mean 761.7 days, SD 616.2 days) than the other groups (G1: mean 403.6 days, SD 409.4 days, P=.011 for G4 vs G1; G2: 394.8 days, SD 318.8 days, P=.04; G3: 369.1 days, SD 330.8 days, P=.049). After adjusting for baseline eGFR, G4 had a longer duration for each eGFR drop (mean 84.8 days, SD 65.1 days) than the other groups (G1: mean 43.5 days, SD 45.4 days, P=.005; G2: mean 42.5 days, SD 26.5 days, P=.03; G3: mean 3.8.7 days, SD 33.5 days, P=.002). CONCLUSIONS: The use of an SNS app between patients with stage 5 CKD and their physicians can reduce the communication gap between them and create benefits such as prolonging time-to-dialysis initiation. The role of SNSs and associated care models should be further investigated in a larger population.

Positive Impacts of Electronic hand-off systems designs on Nurses' communication effectiveness.

AIM: Different designs of electronic hand-off systems might have different levels of effectiveness; this study validated the effectiveness of systems with an Identify, Situation, Background, Assessment and Recommendation (ISBAR) design to one without such a design. BACKGROUND: Adverse consequences in hospital commonly occur when there are breakdowns in the transmission of information between team members. To ensure information accuracy and consistency, some Taiwan hospitals implemented electronic hand-off systems. However, the effectiveness of such systems was not investigated. METHODS: A quasi-experiment was conducted to the nurses of two Taiwan case hospitals, one with ISBAR and the other with non-ISBAR design systems and 200 questionnaires were used to collect data. RESULTS: The respondent rate was 72%. Using system with ISBAR design, nurses can enhance their communication effectiveness and further increase their individual benefits at hand-off. Using a non-ISBAR hand-off system, communication effectiveness depends solely on the nurses' individual cognitive and expressive ability. CONCLUSION: System with ISBAR design can ensure effective information transmission among nurses for care continuity and prevention of adverse events. IMPLICATIONS FOR NURSING MANAGEMENT: Ensuring the design of electronic systems is adequate, nursing managers can save nurses' time and effort while using the system to perform their regular work effectively and gain competitive advantage.

Effects of perceived autonomy support and basic need satisfaction on quality of life in hemodialysis patients.

PURPOSE: Despite a growing understanding of health-related quality of life (HRQOL) and its determinants in hemodialysis (HD) patients, little is known about the effects and interrelationships concerning the perception of autonomy support and basic need satisfaction of HD patients on their HRQOL. Based on self-determination theory (SDT), this study examines whether HD patients' perceived autonomy support from health care practitioners (physicians and nurses) relates to the satisfaction of HD patients' basic needs and in turn influences their HRQOL. METHODS: A questionnaire was administered to 250 Taiwanese HD patients recruited from multiclinical centers and regional hospitals in northern Taiwan. Structural equation modeling (SEM) analysis was conducted to examine the causal relationships between patient perceptions of autonomy support and HRQOL through basic need satisfaction. RESULTS: The empirical results of SEM indicated that the HD patients' perceived autonomy support increased the satisfaction of their basic needs (autonomy, competency, and relatedness), as expected. The higher degree of basic need satisfaction led to higher HRQOL, as measured by physical and mental component scores. CONCLUSION: Autonomy support from physicians and nurses contributes to improving HD patients' HRQOL through basic need satisfaction. This indicates that staff caring for patients with severe chronic diseases should offer considerable support for patient autonomy.

Absolute quantification of microRNAs in green tea (Camellia sinensis) by stem-loop quantitative real-time PCR.

BACKGROUND: There are some studies to show that food-derived plant microRNAs (miRNAs) may be detected in mammals. The research evidence has provoked a considerable debate whether plant-derived miRNAs exert the same regulatory functions as endogenous animal miRNAs. To test the hypothesis, methods of highly sensitive absolute quantification miRNAs have been developed. However, absolute miRNA quantification of green tea has not yet been reported. This study is the first to build an absolute quantification method to detect miRNAs level in green tea using stem-loop quantitative real-time PCR (qRT-PCR). RESULTS: Two miRNAs, csn-miR164 (a conserved miRNA) and csn-miRn329 (a tea-specific miRNA), were selected as examples for the detection and absolute quantification of miRNAs in green tea samples using stem-loop qRT-PCR. The content of csn-miR164 was significantly higher in the Yuexi Cuilan (YX) samples than in the Shucheng Orchid (SC) samples. The content of csn-miRn329 was found to be high at the start of processing in leaf tissues in both the withering and soaking experiments, after which it gradually decreased with time. CONCLUSION: To the best of our knowledge, this is the first report to absolutely quantify the miRNAs present in green tea. This method will help to further investigate the possibility that tea-derived miRNAs may play an important role on defending against various diseases in humans. © 2016 Society of Chemical Industry.

Application of an importance-performance analysis approach to evaluate an acupuncture treatment information system.

Acupuncture treatment has become increasingly popular worldwide, but it is not without risk to the patient. Most physicians in Taiwan have adopted a computerized physician order entry system for traditional Chinese medicine. Use of such a system can prevent some adverse events related to a paper-based system but increases other unexpected risks. This study is the first to introduce a patient safety-based acupuncture treatment information system that integrates advanced healthcare devices to reduce the risks associated with acupuncture treatment using a computerized physician order entry system for traditional Chinese medicine. The acupuncture treatment information system considerably improved patient safety and increased clinicians' workflow efficiency. The importance-performance analysis indicated that improvement in the vital sign measurement function was of the highest priority. In conclusion, acupuncture treatment--the demand for which is increasing--can be performed more safely using an acupuncture treatment information system.

The association of clinical guideline adherence and pay-for-performance among patients with diabetes.

BACKGROUND: Diabetes mellitus management is one of the most challenging health care issues in Taiwan. To improve guideline adherence and the quality of diabetes care, the diabetes mellitus pay-for-performance (DM-P4P) program was introduced in 2001. This study examined the effects of the DM-P4P program on guideline adherence among patients with diabetes. METHODS: This cross-sectional study used National Health Insurance (NHI) claim data to assess guideline adherence among three groups of patients with diabetes: patients enrolled in the DM-P4P program, patients not enrolled but treated by DM-P4P-participating physicians, and patients treated by non-P4P physicians. Guideline adherence measures included hemoglobin A1c, blood glucose, lipid, serum creatinine, alanine transaminase, urinalysis, and eye examinations. Multiple logistic regression with generalized estimated equation approach were used to assess the effect of the DM-P4P program while controlling for patient and physician characteristics. RESULTS: A total of 520,804 patients were included in the analysis. Patients enrolled in the DM-P4P program were more likely to receive all of the guideline-recommended tests/examinations than patients treated by non-P4P physicians. Patients who were not enrolled in the program but who were treated by DM-P4P-participating physicians were more likely to receive three of the seven recommended tests/examinations than were those treated by non-P4P physicians. CONCLUSION: When physicians participated in the P4P program, this increased the likelihood that patients would receive guideline-recommended tests or examinations. Increasing the DM-P4P participation rates for physicians and patients are important and worthwhile objectives that can assist in the effort to more effectively manage diabetes in the general population.

Application of the balanced scorecard to an academic medical center in Taiwan: the effect of warning systems on improvement of hospital performance.

BACKGROUND: The balanced scorecard (BSC) is considered to be a useful tool for management in a variety of business environments. The purpose of this article is to utilize the experimental data produced by the incorporation and implementation of the BSC in hospitals and to investigate the effects of the BSC red light tracking warning system on performance improvement. METHODS: This research was designed to be a retrospective follow-up study. The linear mixed model was applied for correcting the correlated errors. The data used in this study were secondary data collected by repeated measurements taken between 2004 and 2010 by 67 first-line medical departments of a public academic medical center in Taipei, Taiwan. The linear mixed model of analysis was applied for multilevel analysis. RESULTS: Improvements were observed with various time lags, from the subsequent month to three months after red light warning. During follow-up, the red light warning system more effectively improved controllable costs, infection rates, and the medical records completion rate. This further suggests that follow-up management promotes an enhancing and supportive effect to the red light warning. CONCLUSION: The red light follow-up management of BSC is an effective and efficient tool where improvement depends on ongoing and consistent attention in a continuing effort to better administer medical care and control costs.

[Critical factors affecting nurse use of in-hospital employee communication networks].

BACKGROUND: Level of concealment/suppression of true feelings in the course of carrying out nursing duties relates positively to risk of emotional exhaustion and burnout. Therefore, nurses need channels to release and reduce emotional stressors. PURPOSE: We surveyed nurse use of an In-Hospital Employee Communication Network (IECN) to identify its efficacy as well as factors that influence nurse IECN use. This paper also provides research suggestions to help further reduce emotional exhaustion and burnout in nurses. METHODS: We chose a region hospital as our case hospital and received Institution Review Board (IRB) approval for this study. A stratified sampling approach that reflected the ratio of staff in each department was used to distribute the questionnaires at the case hospital. RESULTS: 80 questionnaires were sent out with a response rate of 80%. All returned questionnaires were qualified as valid responses. IECN users numbered three times more than non-users. Nearly sixty percent of non-users did not use IECN due to, "lack of interest in the IECN." About half of the users have more than four years' experience with IECN. Primary motivations for using the IECN were entertainment, learning, and emotional relaxation, e.g., expressing emotions (43.8%) and emotional support (31.3%). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: IECN may be improved by enriching content to increase readability. Hospital managers should pay attention to network content and give timely feedback to improve nurse communication and effectively relieve emotional stresses to reduce risks of emotional exhaustion and burnout. Increasing opportunities for nurses to obtain new knowledge through information sharing via IECN can achieve a win-win situation for both the hospital and its employees.

Managing nursing assistants with a web-based system: an empirical investigation of the mixed-staff strategy.

Under the global shortage of Registered Nurses (RNs), some hospitals have integrated nursing assistants (NAs) into their teams to help to provide maximum quality care for acute patients, while keeping the hospital's staff-related costs down. However, the RNs may have to shoulder an increased burden of assigning and overseeing NAs. A web-based Nursing Assistants Management System (NAMS) was developed and evaluated for a case hospital in Taiwan to compare the processes of assigning and managing NAs before and after the NAMS intervention. The results showed that NAMS saved 80% of the time needed for manual operation and there were no more complains about NAs being slow in dealing with patients after the system intervention. The satisfaction levels of all NA managers and RNs were acceptable. Based on the research findings, the implication and limitations of this study were discussed.

Factors influencing computer literacy of Taiwan and South Korea nurses.

Healthcare is experiencing a major transformation in its information technology base. Hospitals are adopting information technology (IT) to reduce costs and increase competitiveness. IT applications in healthcare are trending towards electronic patient records and even health records. Therefore, practices in nursing are also affected by IT. Many researchers have studied what computer literacy a nurse should possess, but have focused less on factors that actually impact computer literacy. The purposes of this study are to examine current computer literacy levels of nurses, and to indicate what variables influence their computer literacy. Taiwan and South Korea both implemented a national health insurance system, and used state-of-the art IT to provide higher volume and better quality of services. The data were collected from two case hospitals which are located in Taiwan and South Korea, respectively. By using a structured questionnaire, a total of 203 nurses responded; 104 from Taiwan and 99 from South Korea. The results revealed that personal innovativeness in IT, computer education, and age are significant factors that affected computer literacy levels. These factors serve as reference for administrators and executives in hospitals, or nursing educators seeking the data necessary to make decisions on curriculum.