Who sees the chaplain? Characteristics and correlates of behavioral health care-seeking in the military.

Chaplains have a critical role in the military organization and health care. Using the 2015 Health-Related Behavior Survey, we compared Service Members' (SM) use of chaplaincy services to their use of other behavioral health (BH) services: 26.2% used any BH service and 8.0% met with a chaplain/clergyperson for BH. Among the 36.5% of SM who self-identified needing counseling, percentages of SMs receiving counseling were lower among those perceiving stigma associated with BH services (51.0%) than those not perceiving stigma (66.7%). Of SM who sought counseling: many used multiple counseling sources (48.0%), with the most common sources being a BH professional (71.6%), a medical doctor (37.5%), and a chaplain or clergyperson (30.2%). SM who met with a chaplain or clergyperson had more severe histories of abuse, were more likely to have a mental health diagnosis, and had fewer positive health behaviors than SM who sought other sources of counseling.

Patient Portal Use Among Older Adults: What Is Really Happening Nationwide?

Patient portals (PPs), secure websites that allow patients to access their electronic health records and other health tools, can benefit older adults managing chronic conditions. However, studies have shown a lack of PP use in older adults. Little is known about the way they use PPs in community settings and specific challenges they encounter. The aim of this study was to examine the current state of PP use in older adults, employing baseline data (quantitative and qualitative) from an ongoing nationwide online trial. The dataset includes 272 older adults (mean age, 70.0 years [50-92]) with chronic conditions. Findings showed that the majority of participants (71.3%) were using one or more PPs, but in limited ways. Their comments revealed practical difficulties with managing PPs, perceived benefits, and suggestions for improvement. Further studies with different older adult groups (e.g., clinic patients) will help develop and disseminate more usable PPs for these individuals.

The Effects of an Online Theory-Based Bone Health Program for Older Adults.

An estimated 10 million Americans age 50 and older have osteoporosis, and many experience associated fractures. Although several interventions have been shown to be effective in preventing osteoporosis, their impact on bone health among older adults was limited. The aim of this study was, therefore, to examine the effects of a theory-based online bone health program (Bone Power program) for a large number of older adults. The 8-week program included learning modules, discussion boards, and other resources. Participants ( N = 866; M age = 62.5 years) were recruited online and randomized into a Bone Power or control group. At the end of the intervention, the Bone Power group showed significantly greater improvement over the control group in osteoporosis knowledge, self-efficacy/outcome expectations for calcium intake and exercise, and calcium intake and exercise behaviors. This study's findings suggest that online health programs can be effective in improving older adults' knowledge, beliefs, and health behaviors.

Osteoporosis Preventive Practice Between Veteran and Nonveteran Older Adults: Findings From Patient-Reported Data.

BACKGROUND: Veterans are prone to bone-related illnesses due to multiple risk factors such as prior injuries. The aim of this study was to compare trends in osteoporosis preventive practices between veteran and nonveteran older adults. METHODS: This was a secondary data analysis using selected baseline data and discussion postings from an online bone health trial including participants (N = 866) recruited from My HealtheVet (MHV) and SeniorNet (SN). Data were analyzed using descriptive statistics, parametric statistics, and content analysis. FINDINGS: Overall, MHV participants were younger and included more men than SN participants. However, they reported higher rates of bone health issues, spent less time exercising, took fewer calcium and vitamin D supplements, and were less likely to discuss bone health with their care providers. More MHV participants discussed pain and disability as barriers to bone health behaviors and fear of deteriorating health as motivators. In addition, more MHV participants found that participating in the original study was helpful for changing health behaviors. CONCLUSION: Overall, the findings suggest a disparity in bone health between veterans and nonveterans and a significant potential for using eHealth programs for veterans.

Dissemination of a theory-based online bone health program: Two intervention approaches.

With the increasing nationwide emphasis on eHealth, there has been a rapid growth in the use of the Internet to deliver health promotion interventions. Although there has been a great deal of research in this field, little information is available regarding the methodologies to develop and implement effective online interventions. This article describes two social cognitive theory-based online health behavior interventions used in a large-scale dissemination study (N = 866), their implementation processes, and the lessons learned during the implementation processes. The two interventions were a short-term (8-week) intensive online Bone Power program and a longer term (12-month) Bone Power Plus program, including the Bone Power program followed by a 10-month online booster intervention (biweekly eHealth newsletters). This study used a small-group approach (32 intervention groups), and to effectively manage those groups, an eLearning management program was used as an upper layer of the Web intervention. Both interventions were implemented successfully with high retention rates (80.7% at 18 months). The theory-based approaches and the online infrastructure used in this study showed a promising potential as an effective platform for online behavior studies. Further replication studies with different samples and settings are needed to validate the utility of this intervention structure.

Medical devices transition to information systems: lessons learned.

Medical devices designed to network can share data with a Clinical Information System (CIS), making that data available within clinician workflow. Some lessons learned by transitioning anesthesia reporting and monitoring devices (ARMDs) on a local area network (LAN) to integration of anesthesia documentation within a CIS include the following categories: access, contracting, deployment, implementation, planning, security, support, training and workflow integration. Areas identified for improvement include: Vendor requirements for access reconciled with the organizations' security policies and procedures. Include clauses supporting transition from stand-alone devices to information integrated into clinical workflow in the medical device procurement contract. Resolve deployment and implementation barriers that make the process less efficient and more costly. Include effective field communication and creative alternatives in planning. Build training on the baseline knowledge of trainees. Include effective help desk processes and metrics. Have a process for determining where problems originate when systems share information.

Embracing a health services research perspective on personal health records: lessons learned from the VA My HealtheVet system.

BACKGROUND: Personal health records (PHRs) are designed to help people manage information about their health. Over the past decade, there has been a proliferation of PHRs, but research regarding their effects on clinical, behavioral, and financial outcomes remains limited. The potential for PHRs to facilitate patient-centered care and health system transformation underscores the importance of embracing a broader perspective on PHR research. OBJECTIVE: Drawing from the experiences of VA staff to evaluate the My HealtheVet (MHV) PHR, this article advocates for a health services research perspective on the study of PHR systems. METHODS: We describe an organizing framework and research agenda, and offer insights that have emerged from our ongoing efforts regarding the design of PHR-related studies, the need to address PHR data ownership and consent, and the promotion of effective PHR research collaborations. CONCLUSION: These lessons are applicable to other PHR systems and the conduct of PHR research across different organizational contexts.

Challenges of electronic medical record extracts for a personal health record.

The goal of providing electronic medical record (EMR) extracts is to facilitate patient participation in their healthcare and enhance patient-provider collaboration. There are many challenges in selecting a subset of the information available in an electronic medical record (EMR) for export to a Web-based personal health record (PHR). Critical success factors include perspectives in decision-making about what information to extract and assumptions about how extracted information will be used. Existing hard copy release of electronic medical record information provides a starting point. Guiding principles for the extract selection process include extracting information with meaning for the patient, user-friendly presentation of that information, and identifying how the patient will learn more about the information presented. Since a patient may choose to share their extract, a context is necessary in order for a healthcare team member to make sense of the extracted information. Part of the extract selection process is identifying patient education, clinical adoption, and evaluation strategies. Models and frameworks to guide evaluation are essential for success.

Home telehealth electronic health information lessons learned.

Interoperability issues are critical for home telehealth applications, electronic health records, electronic medical records, and personal health records. Issues of interoperability affect clinical decision-making and clinician information synthesis. The ability to exchange data collected in the home with an electronic medical record has been positively related to improvements in process outcomes for chronic illness. However, to realize this benefit, risk must be minimized. Evaluation of interoperability challenges and their potential solutions supports data-driven risk management decisions.

Personal health record evaluation: my HealtheVet and RE-AIM.

Evaluation of the U.S. Veterans Health Administration personal health record, My HealtheVet, applies the measures of RE-AIM (reach, effectiveness / efficacy, adoption, implementation, and maintenance) to three areas: program evaluation, program management, and research. The initial three metrics developed address release of information baseline and trends, registrations, and visits (usage). Evaluation of My HealtheVet using the RE-AIM model and extending resources through collaborative partnerships with researchers and external organizations allows broadly applicable measures.

Nursing informatics, outcomes, and quality improvement.

Nursing informatics actively supports nursing by providing standard language systems, databases, decision support, readily accessible research results, and technology assessments. Through normalized datasets spanning an entire enterprise or other large demographic, nursing informatics tools support improvement of healthcare by answering questions about patient outcomes and quality improvement on an enterprise scale, and by providing documentation for business process definition, business process engineering, and strategic planning. Nursing informatics tools provide a way for advanced practice nurses to examine their practice and the effect of their actions on patient outcomes. Analysis of patient outcomes may lead to initiatives for quality improvement. Supported by nursing informatics tools, successful advance practice nurses leverage their quality improvement initiatives against the enterprise strategic plan to gain leadership support and resources.

Why don't physicians use their personal digital assistants?

As the Personal Digital Assistant (PDA) user population continues to expand, there is a need to design more useful devices and applications to facilitate the utilization of PDAs. We conducted a structured interview study to examine PDA usage and non-usage patterns among physicians. The purpose of this descriptive study was to identify the barriers that impede physicians in their PDA use. A data collection tool was developed to record: 1) how physicians use their PDAs, 2) functions and applications used, 3) functions and applications not used, 4) reasons and examples of why physicians don't use PDAs for those functions, and 5) the recall of specific incidents of PDA usage using Critical Incident Technique (CIT). Interview data were transcribed and analyzed. Study findings and how those barriers can be addressed are discussed.