External validation of the unified model of information systems continuance (UMISC): An international comparison.

CONTEXT: The Unified Model of Information Systems Continuance (UMISC) is a metamodel for the evaluation of clinical information systems (CISs) that integrates constructs from five models that have previously been published in the literature. UMISC was developed at the Georges Pompidou University Hospital (HEGP) in Paris and was partially validated at the Saint Joseph Hospital Group (HPSJ), another acute care institution using the same CIS as HEGP. OBJECTIVE: The aim of this replication study was twofold: (1) to perform an external validation of UMISC in two different hospitals and country contexts: the Italian Hospital of Buenos Aires (HIBA) in Argentina and the Hospital Sirio Libanes in Sao Paulo, Brazil (HSL); (2) to compare, using the same evaluation model, the determinants of satisfaction, use, and continuance intention observed at HIBA and HSL with those previously observed at HEGP and HPSJ. METHODS: The UMISC evaluation questionnaires were translated from their original languages (English and French) to Brazilian Portuguese and Spanish following the translation/back-translation method. These questionnaires were then applied at each target site. The 21 UMISC-associated hypotheses were tested using structural equation modeling (SEM). RESULTS: A total of 3020 users, 1079 at HIBA and 1941 at the HSL, were included in the analysis. The respondents included 1406 medical staff and 1001 nursing staff. The average profession-adjusted use, overall satisfaction and continuance intention were significantly higher at HIBA than at HSL in the medical and nursing groups. In SEM analysis, UMISC explained 23% and 11% of the CIS use dimension, 72% and 85% of health professionals' satisfaction, and 41% and 60% of continuance intention at HIBA and HSL, respectively. Twenty of the 21 UMISC-related hypotheses were validated in at least one of the four evaluation sites, and 16 were validated in two or more sites. CONCLUSION: The UMISC evaluation metamodel appears to be a robust comparison and explanatory model of satisfaction, use and continuance intention for CISs in late post adoption situations.

Results of a venous thromboembolism prophylaxis program for hospitalized patients.

INTRODUCTION: Venous thromboembolism (VTE) is the leading cause of preventable death in hospitalized patients. However, existing prophylaxis guidelines are rarely followed. OBJECTIVE: The aim of the study was to present and discuss implementation strategies and the results of a VTE prophylaxis program for medical and surgical patients admitted to a large general hospital. PATIENTS AND METHODS: This prospective observational study was conducted to describe the strategy used to implement a VTE prophylaxis program in hospitalized medical and surgical patients and to analyze the results in terms of the risk assessment rate within the first 24 hours after admission, adequacy of the prophylaxis prescription, and prevalence of VTE in the discharge records before and after program implementation. We used the Mantel-Haenszel chi-square test for the linear trend of the data analysis and set the significance level to P<0.05. RESULTS: With the support of an institutional VTE prophylaxis committee, a multiple-strategy approach was used in the implementation of the protocol, which included continuing education, complete data recording using computerized systems, and continuous auditing of and feedback to the medical staff and multidisciplinary teams. Approximately 90% of patients were evaluated within the first 24 hours after admission, and no significant difference in this percentage was observed among the years analyzed. A progressive increase in adherence to protocol recommendations, from 63.8% in 2010 to 75.0% in 2014 (P<0.001), was noted. The prevalence of symptomatic VTE in the discharge records of patients decreased from 2.03% in 2009 to 1.69% in 2014 (P=0.033). CONCLUSION: The implementation of a VTE prophylaxis program targeting adult patients admitted to a large hospital employing a multiple-strategy approach achieved high rates of risk assessment within 24 hours of admission, improved the adherence to prophylaxis recommendations in high-risk patients, and reduced the rate of VTE events in the discharge records.

Performance evaluation of hospitals that provide care in the public health system, Brazil.

OBJECTIVE To analyze if size, administrative level, legal status, type of unit and educational activity influence the hospital network performance in providing services to the Brazilian Unified Health System. METHODS This cross-sectional study evaluated data from the Hospital Information System and the Cadastro Nacional de Estabelecimentos de Saúde (National Registry of Health Facilities), 2012, in Sao Paulo, Southeastern Brazil. We calculated performance indicators, such as: the ratio of hospital employees per bed; mean amount paid for admission; bed occupancy rate; average length of stay; bed turnover index and hospital mortality rate. Data were expressed as mean and standard deviation. The groups were compared using analysis of variance (ANOVA) and Bonferroni correction. RESULTS The hospital occupancy rate in small hospitals was lower than in medium, big and special-sized hospitals. Higher hospital occupancy rate and bed turnover index were observed in hospitals that include education in their activities. The hospital mortality rate was lower in specialized hospitals compared to general ones, despite their higher proportion of highly complex admissions. We found no differences between hospitals in the direct and indirect administration for most of the indicators analyzed. CONCLUSIONS The study indicated the importance of the scale effect on efficiency, and larger hospitals had a higher performance. Hospitals that include education in their activities had a higher operating performance, albeit with associated importance of using human resources and highly complex structures. Specialized hospitals had a significantly lower rate of mortality than general hospitals, indicating the positive effect of the volume of procedures and technology used on clinical outcomes. The analysis related to the administrative level and legal status did not show any significant performance differences between the categories of public hospitals.