Competence-based human resource management to improve managerial competence of first-line nurse managers: A scale development.

AIM: This study aimed to develop and psychometrically test a competence-based human resource management scale to improve managerial competence of first-line nurse managers in public hospitals. BACKGROUND: To ensure the high competence of the first-line nurse managers, the competence-based human resource management should be evaluated using the best-fit instrument. However, no instrument has been identified in the hospital setting. METHODS: This methodological study consists of three main steps: (1) generating scale items based on literature review and expert interviews, (2) pilot testing of face and content validity and (3) evaluating psychometric properties with 300 first-line nurse managers from 16 public hospitals in Indonesia selected using a multistage sampling. Data were collected from May to December 2017. Principal component analysis and Cronbach's α were used for construct validity and internal consistency reliability. RESULTS: The final scale consists of 30 items in five dimensions, which explained 65.48% of the total variance. The dimensions include 'training and evaluation, career planning and development, rewards scheme, recruitment and selection, and appraisal system'. Cronbach's α for the scale was .89, with a range of .85 to .88. CONCLUSION: The competence-based human resource management scale is reliable and valid to use in public hospital settings.

A Key to Transforming a Nursing Curriculum: Integrating a Continuous Improvement Simulation Expansion Strategy.

INTRODUCTION: Changes in nursing, health care, and education warrant continued pedagogical innovations. Faculty are challenged to develop many innovative strategies in the clinical and simulation laboratory setting. Intentional simulation-based learning experiences are one method to prepare new graduates for nursing practice. METHODS: One college integrated intentional simulation-based learning experiences as an improvement strategy in a newly transformed undergraduate nursing curriculum, from mapping through evaluation and revision. Simulation-based learning experiences that were intentionally mapped, organized, and interactive enhanced the teaching and learning needs of students and faculty. CONCLUSION: The positive outcomes from this curricular transformation serve as a platform for continuous improvement for future approaches to nursing education. This affirmed that the key to transforming a nursing curriculum encompasses intentional mapping, evaluation, and revision.

Managerial Competence of First-Line Nurse Managers in Public Hospitals in Indonesia.

PURPOSE: Working as a first-line nurse manager requires high managerial competence as an essential component in the delivery of health care. Therefore, factors that influence managerial competence warrant examination. The aim of this study was to identify factors associated with managerial competence of the first-line nurse managers using the best-fit model of human resource management framework. METHODS: A cross-sectional study was conducted. A total of 247 first-line nurse managers from 18 public hospitals in Indonesia participated. Data on managerial competence and its related factors were collected via validated questionnaires. RESULTS: The five factors of managerial competence were identified - performance appraisal (ß = 0.476, p < 0.001), career advancement (ß = 0.425, p < 0.001), recruitment and selection (ß = 0.354, p < 0.001), larger hospitals (ß = 0.165, p = 0.001), and management training attendance (ß = 0.109, p = 0.029), which collectively explained 44.9% of the variance in managerial competence. CONCLUSION: Human resource management factors, hospital types, and training attendance have significant roles to improve managerial competence of the first-line nurse managers. Nurse managers should provide routine performance appraisal, career advancement, and transparent recruitment and selection as well as to improve the attendance of management training and learn from larger hospitals for leadership and development of the first-line nurse managers.

Fall Prevention Decision Making of Acute Care Registered Nurses.

OBJECTIVE: The aim of this study was to examine acute care registered nurses' (RNs') fall prevention decision-making. BACKGROUND: The RN decision-making process related to fall prevention needs to be investigated to ensure that hospital policies align with nursing workflow and support nursing judgment. METHODS: Qualitative semistructured interviews based on the Critical Decision Method were conducted with RNs about their planning and decision making during their last 12-hour shift worked. RESULTS: Data saturation was achieved with 12 RNs. Nine themes emerged related to the RN decision-making process and included hospital-level (eg, fear of discipline), unit-level (eg, value of bed alarm technology), and nurse-level (eg, professional judgment) factors that could influence fall prevention. CONCLUSIONS: Nursing administrators should consider a multilevel approach to fall prevention policies that includes promoting a practice environment that embraces self-reporting adverse events without fear of shame or being reprimanded, evaluating unit-level practice and technology acceptance and usability, and supporting autonomous nursing practice.

Perceived Managerial Competence of First-Line Nurse Managers: A Comparative Analysis Among Public Hospitals.

Knowing the perceptions of first-line nurse managers (FLNMs) regarding their managerial competence is an important step to resolve disparities between their perceived competence and the competencies required for them to effectively function in their roles. Yet, evidence examining managerial competence of FLNMs among public hospitals in Indonesia is sparse. To fill this gap, we conducted a cross-sectional study aimed to identify managerial competence of FLNMs according to hospital type and ownership. This study was conducted from January to May 2018 and included a convenience sample of 233 FLNMs selected from 13 public hospitals. We used the Indonesian-First-Line Nurse Managers Managerial Competence Scale (I-FLNMMCS) to measure managerial competence. Descriptive statistics, Kruskal-Wallis, and Dunn's Pairwise were used for data analysis. Findings showed a significant difference in managerial competence according to the hospital type (p < .05). The FLNMs with a Diploma III, those relatively older, in their position for 7 or more years, and with managerial training in Type A hospitals (larger hospitals) had the highest managerial competence. The FLNMs with a bachelor's degree, those relatively younger, with less training, and those in their position for 3 to 4 years in Type B and C hospitals (smaller hospitals) had less managerial competence. A significant difference was also found in managerial competence according to hospital ownership (p <.05). Public hospitals owned by the Ministry of Health of Indonesia had the highest competence among the others. This study is useful for guiding future policy work for human resource development in public hospitals.

Comparison of managerial competence of Indonesian first-line nurse managers: a two-generational analysis.

BACKGROUND: Much research provides evidence that four age groups or generations of nurse managers exist, and it is assumed that they work and act differently according to each generation's characteristics and attitudes, which may influence their managerial competence. AIMS: To compare first-line nurse managers' managerial competence according to generational analysis across public hospitals in Indonesia. METHODS: This study employed a cross-sectional survey in 18 public hospitals in Indonesia with 254 first-line nurse managers selected using simple random sampling. The Indonesian First-Line Nurse Managers Managerial Competence Scale (IFLNMMCS) was used to measure managerial competence. Data were analysed using descriptive analyses using means, standard deviations and independent t-test. RESULTS: There was no significant difference in the total score of managerial competence of Generation X and Millennial first-line nurse managers (p = 0.077). Of five dimensions of managerial competence, only applying quality care improvement (p = 0.028) and financial management (p = 0.013) were significantly different, while leadership (p = 0.142), facilitating spiritual nursing care (p = 0.353), self-management (p = 0.130), staffing and professional development (p = 0.068) and utilizing informatics (p = 0.304) were not significantly different. CONCLUSION: This study serves as a foundation for better human resource management, education and professional development for first-line nurse managers among public hospitals in Indonesia.

EMBRACE: Developing an Inclusive Leadership Program With and for Undergraduate Nursing Students.

In order to meet the needs of an increasingly diverse patient population, nursing schools around the United States have been trying to recruit future nurses from a variety of racial/ethnic backgrounds, with limited success. To date, the literature does not describe how to develop culturally appropriate engagement models that can successfully transform minority nursing students into nurse researchers and leaders. Thus, the purpose of this article is to describe a promising research and leadership program for underrepresented undergraduate students entitled, "EMBRACE - Engaging Multiple-communities of BSN students in Research and Academic Curricular Experiences". More specifically, this article will: 1) describe the steps one College of Nursing has taken toward developing the EMBRACE program; 2) describe the theoretical framework developed for the program; and 3) present the initial challenges and positive outcomes of the program. The theoretical framework of the program is based on principles of excellence for diversity and inclusion as well as student and faculty engagement. The EMBRACE framework includes components of education, faculty contributions, social connections and emotional intelligence. The EMBRACE program consists of group mentoring with peers, one-on-one mentoring with faculty and graduate students, and working on a hands-on project relating to research or leadership.

Development and Psychometric Properties of Managerial Competence Scale for First-Line Nurse Managers in Indonesia.

This study aimed to develop and psychometrically test the managerial competence scale for first-line nurse managers (FLNMs) in Indonesia. The scale was based on items derived from an integrative review and interviews with experts. A total of 300 FLNMs from 16 public hospitals were randomly selected for this test of psychometric properties. A principal component analysis generated seven dimensions with 43 items as a final scale, with overall Cronbach's α of .95 while the dimensions' Cronbach's α ranged from .71 to .90. The findings demonstrate that the scale is valid and reliable as a vehicle for assessment of managerial competence of FLNMs.

Evidence-based tobacco treatment utilization among dual users of cigarettes and E-cigarettes.

Dual users of e-cigarettes and cigarettes may represent a unique and receptive population for evidence-based tobacco dependence treatment. We measured the frequency of quit attempts during the past year, and the use of evidence-based tobacco dependence treatments (i.e., behavioral and/or pharmacological treatments), among adult smokers who are current e-cigarette users (dual users) compared with those who do not use e-cigarettes (exclusive smokers). Data were analyzed from the 2015 National Health Interview Survey. Multivariate-adjusted regression models were used to examine the correlates of tobacco treatment use among adult smokers, comparing current e-cigarette users with those who did not use e-cigarettes, stratifying by age group, and adjusting for sociodemographic characteristics. Analyses were based on 5415 adult current cigarette smokers. Compared to exclusive smokers, dual users were more likely to report a quit attempt in the past year among adults <65 years: 18-24 years (odds ratio [OR] = 2.25), 25-44 years (OR = 1.60), and 45-64 years (OR = 1.96). With the exception of adults ≥65 years, dual users reported low rates of using combination (behavioral and pharmacological) treatments that were not statistically different from exclusive smokers: 18-24 years (0.1% vs. 2.1%, respectively), 25-44 years (4.3% vs. 4.7%), and 45-64 years (3.0% vs. 8.3%). Despite higher likelihood for dual users to make a quit attempt, their use of evidence-based tobacco treatment is low, similar to exclusive smokers. Dual users of cigarettes and e-cigarettes represent a prime target for interventions to expand access and utilization of evidence-based tobacco use treatments.

Psychometric testing of the caring assessment tool: Administration (CAT-Adm©).

OBJECTIVES: The overall purpose of this study was to evaluate the validity and reliability of the Caring Assessment Tool-Administration survey. Three specific aims were to (1) evaluate construct validity of the Caring Assessment Tool-Administration survey by testing the hypothesized eight-factor structure of staff nurses' perceptions of nurse manager caring behaviors, (2) estimate the internal consistency, and (3) conduct item reduction analysis. METHODS: A 94-item Caring Assessment Tool-Administration designed to assess nurse manager caring behaviors appeared in the literature but lacked robust psychometric testing. Using a foundational theory and a cross-sectional descriptive design, the Caring Assessment Tool-Administration was evaluated for reliability and construct validity. Using convenience sampling, 1143 registered nurses were recruited from acute care hospitals in three states located in the Midwestern, Mid-Atlantic, and Southern Regions of the United States. RESULTS: Psychometric testing of the Caring Assessment Tool-Administration was conducted using confirmatory analysis to determine the dimensionality of the construct, nurse manager caring behavior. The null hypothesis was an eight-factor solution fitting the theoretical model being tested. The null hypothesis was rejected because none of the measures examined for goodness of fit indicated the model fit the data. Confirmatory factor analysis did not support the hypothesized structure; however, exploratory factor analysis supported a one-factor solution that was conceptually labeled caring behaviors. To decrease subject burden, the 94-item survey was reduced to 25 items using item reduction analysis including assessing minimum factor loadings of ≥0.60 and evaluating survey item-total correlation and alpha. The Cronbach's alpha of the new 25-item survey was 0.98. CONCLUSION: The new 25-item Caring Assessment Tool-Administration survey provides hospital administrators, nurse managers, and researchers with a sound, less burdensome instrument to collect valuable information about nurse manager caring behaviors.

A Shovel-Ready Solution to Fill the Nursing Data Gap in the Interdisciplinary Clinical Picture.

PURPOSE: To critically evaluate 2014 American Academy of Nursing (AAN) call-to-action plan for generating interoperable nursing data. DATA SOURCES: Healthcare literature. DATA SYNTHESIS: AAN's plan will not generate the nursing data needed to participate in big data science initiatives in the short term because Logical Observation Identifiers Names and Codes and Systematized Nomenclature of Medicine - Clinical Terms are not yet ripe for generating interoperable data. Well-tested viable alternatives exist. CONCLUSIONS: Authors present recommendations for revisions to AAN's plan and an evidence-based alternative to generating interoperable nursing data in the near term. These revisions can ultimately lead to the proposed terminology goals of the AAN's plan in the long term.

Refinement of a Conceptual Model for Adolescent Readiness to Engage in End-of-Life Discussions.

BACKGROUND: Adolescents living with incurable cancer require ongoing support to process grief, emotions, and information as disease progresses including treatment options (phase 1 clinical trials and/or hospice/palliative care). Little is known about how adolescents become ready for such discussions. OBJECTIVE: The purpose of this study was to explore the process of adolescent readiness for end-of-life preparedness discussions, generating a theoretical understanding for guiding clinical conversations when curative options are limited. METHODS: We explored 2 in-depth cases across time using case-study methodology. An à priori conceptual model based on current end-of-life research guided data collection and analysis. Multiple sources including in-depth adolescent interviews generated data collection on model constructs. Analysis followed a logical sequence establishing a chain of evidence linking raw data to study conclusions. Synthesis and data triangulation across cases and time led to theoretical generalizations. Initially, we proposed a linear process of readiness with 3 domains: a cognitive domain (awareness), an emotional domain (acceptance), and a behavioral domain (willingness), which preceded preparedness. RESULTS: Findings led to conceptual model refinement showing readiness is a dynamic internal process that interacts with preparedness. Current awareness context facilitates the type of preparedness discussions (cognitive or emotional). Furthermore, social constraint inhibits discussions. CONCLUSIONS: Data support theoretical understanding of the dynamism of readiness. Future research that validates adolescent conceptualization will ensure age-appropriate readiness representation. IMPLICATIONS FOR PRACTICE: Understanding the dynamic process of readiness for engaging in end-of-life preparedness provides clinician insight for guiding discussions that facilitate shared decision making and promote quality of life for adolescents and their families.

Associations between hyponatraemia, volume depletion and the risk of falls in US hospitalised patients: a case-control study.

OBJECTIVE: We aimed to determine if abnormal laboratory values which may indicate volume depletion are associated with increased odds of experiencing a hospital-acquired fall. DESIGN: Matched case-control study. SETTING: Four hospitals located in the Southeast USA. PARTICIPANTS: Data from 699 adult fallers and 1189 matched controls (non-fallers) were collected via chart review from 2005 to 2010. Controls were matched to cases by nursing unit, time of fall and length of stay. OUTCOME MEASURES: The primary exposures included serum sodium, blood urea nitrogen (BUN), creatinine, BUN/creatinine ratio and haematocrit. Conditional logistic regression with m:n matching was used to determine adjusted and unadjusted ORs. RESULTS: Serum sodium levels were strongly associated with falls. In models controlling for demographic and other fall risk factors, patients with serum sodium levels of 125 mEq/L or less were associated with increased odds of experiencing a fall as compared with those with serum sodium levels of greater than 134 mEq/L (adjusted OR (aOR)=5.08, 95% CI 1.43 to 18.08). Conversely, elevated BUN, creatinine and elevated BUN/creatinine ratios were not associated with increased odds of experiencing a fall (aOR=0.64, 95% CI 0.49 to 0.84; aOR=0.70, 95% CI 0.54 to 0.92 and aOR=0.77, 95% CI 0.58 to 1.04, respectively.) CONCLUSIONS: Laboratory indices that may indicate volume depletion appear to be unrelated to falls. However, hyponatraemia does appear to be a risk factor for falls, and those with serum sodium levels below 126 mEq/L are at especially high risk. It may be that other deficits associated with hyponatraemia, like altered mental status, are associated with risk of experiencing a hospital-acquired fall. These results indicate that abnormal laboratory values, like low sodium, can be useful for identifying hospitalised patients at risk of falling. Therefore, further investigation into abnormal laboratory values as predictors of hospital-acquired falls is warranted.

Impact of the CMS No-Pay Policy on Hospital-Acquired Fall Prevention Related Practice Patterns.

BACKGROUND AND OBJECTIVES: In October 2008, the Centers for Medicare & Medicaid Services (CMS) stopped reimbursing hospitals for costs related to patient falls. This study aimed to examine whether the CMS no-pay policy influenced four fall prevention practices: bed alarms, sitters, room changes, and physical restraints. RESEARCH DESIGN AND METHODS: Using electronic medical record data collected from four hospitals between 2005 and 2010, this secondary observational analysis examined the associations between the CMS no-pay policy and nursing interventions and medical orders related to fall prevention. Multivariable generalized linear mixed models with logit link function and accommodation for matching was used to assess the associations between the CMS no-pay policy and nursing interventions and medical orders. RESULTS: After the CMS policy change, nurses were more likely to perform one or more fall-related interventions (adjusted odds ratio (aOR): 1.667; 95% confidence interval (CI): 1.097-2.534). Of the four prevention practices, the use of bed alarms (aOR: 2.343; 95% CI: 1.409-3.897) increased significantly after the CMS policy change. DISCUSSION AND IMPLICATIONS: The CMS no-pay policy increased utilization of fall prevention strategies despite little evidence that these measures prevent falls.

Differences in Circulating Endothelial Progenitor Cells among Childhood Cancer Survivors Treated with and without Radiation.

Radiation during childhood cancer treatment increases the propensity to atherosclerotic cardiovascular disease among adult survivors of childhood cancer. This is thought to be mediated through the damage to the underlying vascular endothelium. Endothelial progenitor cells (EPCs) involved in vascular endothelial repair after its damage may be affected by radiation therapy but have never been investigated in adult survivors of childhood cancer. In this pilot study, utilizing multi-parametric flowcytometry, endothelial colony forming cells (ECFCs), which are the bonafide EPCs, and circulating endothelial cells (CECs), which are not EPCs, were compared between adult survivors of childhood cancer with or without radiation exposure. In addition, their associations with blood-pressure, physical activity and diet were examined. Survivors who received radiotherapy had lower ECFCs and CECs (p<0.05) compared to those without it. Significant positive correlations included physical activity with ECFCs and diet with CECs, while blood-pressure negatively correlated with ECFCs. Further evaluation is needed to examine the effect of radiation and modifiable risk factors on ECFCs and CECs. The preliminary findings from this study suggest evidence of the role of ECFCs as biomarkers of vascular injury following treatment for childhood cancer that may help in early identification of survivors at risk for cardiovascular disease.

Hypothesis generation using network structures on community health center cancer-screening performance.

RESEARCH OBJECTIVES: Nationally sponsored cancer-care quality-improvement efforts have been deployed in community health centers to increase breast, cervical, and colorectal cancer-screening rates among vulnerable populations. Despite several immediate and short-term gains, screening rates remain below national benchmark objectives. Overall improvement has been both difficult to sustain over time in some organizational settings and/or challenging to diffuse to other settings as repeatable best practices. Reasons for this include facility-level changes, which typically occur in dynamic organizational environments that are complex, adaptive, and unpredictable. This study seeks to understand the factors that shape community health center facility-level cancer-screening performance over time. This study applies a computational-modeling approach, combining principles of health-services research, health informatics, network theory, and systems science. METHODS: To investigate the roles of knowledge acquisition, retention, and sharing within the setting of the community health center and to examine their effects on the relationship between clinical decision support capabilities and improvement in cancer-screening rate improvement, we employed Construct-TM to create simulated community health centers using previously collected point-in-time survey data. Construct-TM is a multi-agent model of network evolution. Because social, knowledge, and belief networks co-evolve, groups and organizations are treated as complex systems to capture the variability of human and organizational factors. In Construct-TM, individuals and groups interact by communicating, learning, and making decisions in a continuous cycle. Data from the survey was used to differentiate high-performing simulated community health centers from low-performing ones based on computer-based decision support usage and self-reported cancer-screening improvement. RESULTS: This virtual experiment revealed that patterns of overall network symmetry, agent cohesion, and connectedness varied by community health center performance level. Visual assessment of both the agent-to-agent knowledge sharing network and agent-to-resource knowledge use network diagrams demonstrated that community health centers labeled as high performers typically showed higher levels of collaboration and cohesiveness among agent classes, faster knowledge-absorption rates, and fewer agents that were unconnected to key knowledge resources. Conclusions and research implications: Using the point-in-time survey data outlining community health center cancer-screening practices, our computational model successfully distinguished between high and low performers. Results indicated that high-performance environments displayed distinctive network characteristics in patterns of interaction among agents, as well as in the access and utilization of key knowledge resources. Our study demonstrated how non-network-specific data obtained from a point-in-time survey can be employed to forecast community health center performance over time, thereby enhancing the sustainability of long-term strategic-improvement efforts. Our results revealed a strategic profile for community health center cancer-screening improvement via simulation over a projected 10-year period. The use of computational modeling allows additional inferential knowledge to be drawn from existing data when examining organizational performance in increasingly complex environments.

A randomised controlled trial to prevent smoking relapse among recently quit smokers enrolled in employer and health plan sponsored quitlines.

OBJECTIVE: To test adding an interactive voice response (IVR)-supported protocol to standard quitline treatment to prevent relapse among recently quit smokers. DESIGN: Parallel randomised controlled trial with three arms: standard quitline, standard plus technology enhanced quitline with 10 risk assessments (TEQ-10), standard plus 20 TEQ assessments (TEQ-20). SETTING: Quit For Life (QFL) programme. PARTICIPANTS: 1785 QFL enrolees through 19 employers or health plans who were 24+ h quit. INTERVENTIONS: QFL is a 5-call telephone-based cessation programme including medications and web-based support. TEQ interventions included 10 or 20 IVR-delivered relapse risk assessments over 8 weeks with automated transfer to counselling for those at risk. MAIN OUTCOME MEASURES: Self-reported 7-day and 30-day abstinence assessed at 6-month and 12-month post-enrolment (response rates: 61% and 59%, respectively). Missing data were imputed. RESULTS: 1785 were randomised (standard n=592, TEQ-10 n=602, TEQ-20 n=591). Multiple imputation-derived, intent-to-treat 30-day quit rates (95% CI) at 6 months were 59.4% (53.7% to 63.8%) for standard, 62.3% (57.7% to 66.9%) for TEQ-10, 59.4% (53.7% to 65.1%) for TEQ-20 and 30-day quit rates at 12 months were 61.2% (55.6% to 66.8%) for standard, 60.6% (56.0% to 65.2%) for TEQ-10, 54.9% (49.0% to 60.9%) for TEQ-20. There were no significant differences in quit rates. 73.3% of TEQ participants were identified as at-risk by IVR assessments; on average, participants completed 0.41 IVR-transferred counselling calls. Positive risk assessments identified participants less likely (OR=0.56, 95% CI 0.42 to 0.76) to be abstinent at 6 months. CONCLUSIONS: Standard treatment was highly effective, with 61% remaining abstinent at 12 months using multiple imputation intent-to-treat (intent-to-treat missing=smoking quit rate: 38%). TEQ assessments identified quitters at risk for relapse. However, adding IVR-transferred counselling did not yield higher quit rates. Research is needed to determine if alternative designs can improve outcomes. TRIAL REGISTRATION NUMBER: NCT00888992.

Psychometric analysis of two new scales: the evidence-based practice nursing leadership and work environment scales.

BACKGROUND: Those in nursing have been charged with practicing to the full extent of their education and training by the Institute of Medicine. Therefore, evidence-based practice (EBP) has never been more important to nursing than in the current healthcare environment. Frequently the burden of EBP is the responsibility of the bedside practitioner, but has been found to be a process that requires leadership and organizational support. A key underlying component of a strong EBP environment includes effective communications and collaboration among staff and nursing leadership. AIMS: Developing measurement tools that examine the milieu and nursing leadership in which the staff nurse practices is an important component of understanding the factors that support or hinder EBP. The aim of this study is to report on the development and analysis of two new scales designed to explore leadership and organizational support for EBP. The EBP Nursing Leadership Scale (10 items) examines the staff nurses perception of support provided by the nurse manager for EBP, and the EBP Work Environment Scale (8 items) examines organizational support for EBP. METHODS: Staff nurses who worked at least .5 FTE in direct patient care, from two inner city hospitals (n = 422) completed the scales. The scales were evaluated for internal consistency reliability with the Cronbach alpha technique, content validity using a panel of experts, and construct validity by RESULTS: The content validity index computed from expert rankings was .78 to 1.0 with an average of.96. Cronbach's alpha was .96 (n = 422) for the EBP Nursing Leadership Scale and .86 (n = 422) for the EBP Work Environment Scale. Factor analysis confirmed that each scale measured a unidimensional construct (p < .000). LINKING EVIDENCE TO ACTION: The EBP Nursing Leadership Scale and the EBP Work Environment Scale are psychometrically sound instruments to examine organizational influences on EBP.

Using computational modeling to assess the impact of clinical decision support on cancer screening improvement strategies within the community health centers.

Our conceptual model demonstrates our goal to investigate the impact of clinical decision support (CDS) utilization on cancer screening improvement strategies in the community health care (CHC) setting. We employed a dual modeling technique using both statistical and computational modeling to evaluate impact. Our statistical model used the Spearman's Rho test to evaluate the strength of relationship between our proximal outcome measures (CDS utilization) against our distal outcome measure (provider self-reported cancer screening improvement). Our computational model relied on network evolution theory and made use of a tool called Construct-TM to model the use of CDS measured by the rate of organizational learning. We employed the use of previously collected survey data from community health centers Cancer Health Disparities Collaborative (HDCC). Our intent is to demonstrate the added valued gained by using a computational modeling tool in conjunction with a statistical analysis when evaluating the impact a health information technology, in the form of CDS, on health care quality process outcomes such as facility-level screening improvement. Significant simulated disparities in organizational learning over time were observed between community health centers beginning the simulation with high and low clinical decision support capability.