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1.
Eval Rev ; : 193841X241279706, 2024 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-39229774

RESUMO

The frequency and richness of the theories developed, tested, and used by researchers in an academic discipline exemplify several pertinent factors, namely, the growth, the maturity, the independence, the legitimacy, and the influence of the discipline. Although organizations have been working on projects for centuries, Project Management (PM) is a considerably new academic discipline with emerging research themes, models, methodologies, frameworks, and paradigms. These PM concepts are anchored on or reinforced by new or existing theories. This exploratory study aims to add to the existing PM body of knowledge by investigating the prevalence of theory use in PM research. A systematic content analysis of 9200 PM research articles published from 2000 to 2019 (20 years) in the leading PM journals identified 248 unique theories. These results reveal that the PM discipline is increasingly embracing the use of theories with game theory, fuzzy theory, agency theory, contingency theory, and stakeholder theory emerging as the most dominant theories in the reviewed research articles. Also, although PM is developing its theories, the results revealed that PM researchers continue to heavily use theories borrowed from other academic disciplines such as psychology, sociology, mathematics, and economics.

2.
Soins ; 69(888): 56-58, 2024 Sep.
Artigo em Francês | MEDLINE | ID: mdl-39218523

RESUMO

In 2021, the first advanced practice nurses (APNs) specializing in psychiatry and mental health will have entered the vast field of practice of this discipline. Two years on, the missions entrusted to them within the establishments that have supported the development of their new skills are as varied as ever. While their scope of action remains to be defined in some places, the fact remains that collaboration between the APN and the local health executive is already proving to be a powerful lever for the successful completion of large-scale projects aimed at the continuous improvement of care in their shared field of practice. A look back at the deployment of a quality tool to improve care safety.


Assuntos
Prática Avançada de Enfermagem , Enfermagem Psiquiátrica , Humanos , Comportamento Cooperativo , Enfermeiros Administradores/psicologia , Serviços de Saúde Mental/organização & administração
3.
Heliyon ; 10(13): e34071, 2024 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-39091944

RESUMO

The circular economy (CE) is reasoned to organize complex systems supporting sustainable resilience by distinguishing between waste materials and economic growth. This is crucial to the electronic waste (e-waste) industry of developed countries, and e-waste operation management has become their top priority because e-waste contains toxic materials and valuable sources of elements. In the UK, although London Metropolitan city boasts an ambitious sustainable resilience target underlying the context of CE, practical implementation has yet to be feasible, with few investigations detailing if and how the existing target implications enable industrial and social-ecological sectors to continue their performance functionalities in the face of undesired disruptions. In this paper, a dynamic Bayesian Network (dynamic BN) approach is developed to address a range of potential risks. The existing London e-waste operation management is considered as an application of study for sustainable resilience development. Through the utilization of dynamic BN, a comprehensive analysis yields a Resilience Index (RI) of 0.5424, coupled with a StdDev of 0.01350. These metrics offer a profound insight into the intricate workings of a sustainable system and its capacity to swiftly rebound from unexpected shocks and disturbances. This newfound understanding equips policymakers with the knowledge needed to navigate the complexities of sustainable e-waste management effectively. The implications drawn from these in-depth analyses furnish policymakers with invaluable information, enabling them to make judicious decisions that advance the cause of sustainable e-waste management. The findings underscore that the absorptive capacity of a sustainable and resilient e-waste operation management system stands as the foremost defense mechanism against unforeseen challenges. Furthermore, it becomes evident that two pivotal factors, namely "diversifying the supply chain" and "enhancing supply chain transparency," play pivotal roles in augmenting the sustainability and resilience of e-waste operation management within the context of London's ambitious sustainability targets. These factors are instrumental in steering the trajectory of e-waste management towards a more sustainable and resilient future, aligning with London's aspirations for a greener and more eco-conscious future.

4.
Front Psychol ; 15: 1417604, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39149700

RESUMO

Drawing from social learning theory, this study aims to explore the mediating effects of team learning orientation and team agility on the relationship between servant leadership and project success in the context of construction projects. Based on data collected from 306 construction project members in China, the findings reveal that servant leadership exerts a positive influence on project success. Additionally, servant leadership significantly enhances both team learning orientation and team agility, which in turn contribute to project success. Furthermore, the results demonstrate the serial and parallel mediating roles of team learning orientation and team agility between servant leadership and project success. Theoretical and practical implications were also provided based on the findings.

5.
J Dr Nurs Pract ; 17(2): 77-85, 2024 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-39103190

RESUMO

Background: National nurse shortages, ongoing nurse faculty retirements, and a dearth of clinical sites make it challenging to prepare advanced practice registered nurses (APRNs) who are ready to transition into independent provider roles, especially in acute care settings. One of the most effective ways to address these experiential learning challenges is for academic institutions and healthcare systems to form collaborative academic-practice partnerships. However, many partnerships between schools of nursing and healthcare institutions have found numerous challenges, including time to devote to the partnership, funding of ideas, competing initiatives and needs, and sustainability. Objective: The University of Maryland School of Nursing (UMSON) set out to expand the traditional academic-clinical partnership approach with a new collaborative model. Methods: Rather than both parties coming to the table with their own goals, the partnership focused on intentional relationship building, transparency, measurable outcomes, and sustainability. This model, further called the Sustainable Academic-Clinical Alliance (SACA), assures that both sides of the partnership benefit. The SACA model was used to create an academic-practice partnership with the University of Maryland Upper Chesapeake Health System in order to increase APRN clinical practice sites and readiness of APRN students to provide care across the continuum in the state of Maryland. Results: Since July 2016, the SACA model has enabled over 40 clinical providers in over 20 different clinical areas to offer 329 different clinical and nonclinical experiences to APRN students from UMSON. At the end of the 5-year alliance, 150 unique UMSON APRN students completed 257 different clinical rotations. Conclusion: The SACA model effectively promotes the development and achievement of sustainable academic-practice partnerships by focusing on (a) intentional relationship building, (b) transparency in goal setting and alliance maintenance, (c) development of outcome measures, and (d) sustainability. Implications for Nursing: The components of the SACA model made sustainability more achievable, which has eluded previous academic-clinical partnerships. This model can serve as a blueprint for other academic and healthcare institutions to establish sustainable academic-practice partnerships.


Assuntos
Comportamento Cooperativo , Humanos , Maryland , Prática Avançada de Enfermagem/organização & administração , Prática Avançada de Enfermagem/educação , Feminino , Masculino , Adulto , Escolas de Enfermagem/organização & administração
6.
Heliyon ; 10(14): e33570, 2024 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-39100476

RESUMO

Recent financial crises have highlighted the utmost importance of implementing risk management practices, as exemplified by the profound repercussions of the COVID-19 pandemic. Moreover, we witnessed the rise of various initiatives within the medical sector, specifically in the fields of biomedicine, hospitals, and pharmaceuticals, across Africa, with a notable emphasis on Morocco. The government in Morocco has implemented measures to foster investment and encourage participation from companies and stakeholders. Taking into account an indeterminate and volatile future, it becomes imperative for organizations to establish robust risk management strategies to navigate successfully through these uncertainties. This research paper concentrates on the convergence of complexity, project categorization, and risks. We propose a novel approach to the implementation of the Risk Management Process, utilizing the Enterprise Risk Management framework. By establishing Risk Management rules within the context of a "complex" project, we observed enhanced performance and improved risk management through the holistic consideration of interdependencies rather than treating them as separate entities. Additionally, to substantiate this interdependency, we conducted a comparative analysis of the project's risk and complexity between 2020 and 2022.

7.
Heliyon ; 10(15): e35419, 2024 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-39170569

RESUMO

This research aims to identify the factors that influence the organizational competence (OC) of hospitals in effectively managing projects. It follows a quantitative approach, analyzing data collected from three Portuguese hospitals (51 respondents) using R software. An organizational competence score (OCS) was calculated based on standardized values across five different competence areas. The results indicate significant associations between the competence areas and project categories, organizational alignment, governance, management, people's competence, and resources. Furthermore, the study explores the relationships between the competence areas and quantitative variables such as the number of project team members and former experience in projects. The OCS is also examined regarding project categories, region, experience in projects, and number of project members. The findings provide insights into the features that impact the OC of hospitals in PM, highlight the importance of organizational alignment, effective governance, competent management, skilled personnel, and adequate resources in enhancing PM capabilities. However, the wide confidence interval for the Odds Ratio indicates a high degree of uncertainty in the effect size estimates, suggesting the need for larger sample sizes and more robust models in future research to obtain more precise estimates.

8.
Stud Health Technol Inform ; 315: 622-623, 2024 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-39049352

RESUMO

The issue of lacking standardized organizational guidance is examined in the context of providing patient-centered care to meet the needs of an aging population. Standardization across an integrated organization is increasingly recognized as a social justice concern in the pursuit of equitable and timely healthcare delivery, particularly as the healthcare industry grapples with a severe nursing shortage in the United States. A master project plan methodology (MPPM) was tested to effectively develop an electronic Age-Friendly 4Ms documentation tool using the system development lifecycle (SDLC) framework. The MPPM successfully guided the design and national implementation, achieving an 84% installation rate across 124 facilities within one of America's largest integrated healthcare systems.


Assuntos
Documentação , Registros Eletrônicos de Saúde , Humanos , Estados Unidos , Assistência Centrada no Paciente , Idoso
9.
Network ; : 1-21, 2024 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-39034534

RESUMO

Effective project planning and management in the global software development landscape relies on addressing major issues like cost estimation and effort allocation. Timely estimation of software development is a critical focus in software engineering research. With the industry increasingly relying on diverse teams worldwide, accurate estimation becomes vital. Software size serves as a common measure for costs and schedules, but advanced estimation methods consider various variables, such as project purpose, personnel expertise, time and efficiency constraints, and technology requirements. Estimating software costs involve significant financial and strategic commitments, making it crucial to address complexity and versatility related to cost drivers. To achieve enhanced accuracy and convergence, we employ the cuckoo algorithm in our proposed NFDLNN (Neuro Fuzzy Logic and Deep Learning Neural Networks) model. Through extensive validation with industrial project data, using Function Point Analysis as the algorithmic models, our NFA model demonstrates high accuracy in software cost approximation, outperforming existing methods insights of MRE of 3.33, BRE of 0.13, and PI of 74.48. Our research contributes to improved project planning and decision-making processes in global software development endeavours.

10.
MethodsX ; 13: 102795, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-39007029

RESUMO

The primary objective of transdisciplinary research (TDR) is to contribute to the solution of complex 'real-world' problems by integrating heterogeneous knowledge and achieving societal effects. However, establishing a continuous impact orientation during TDR processes remains a challenge, as the necessary tools are not yet sufficiently available. We developed and tested a half-day workshop format for strengthening the impact-oriented project management and research activities of seven TDR projects. Our findings indicate that the reflective impact workshops supported participants in pursuing societal effects systematically. Applying the methodological approach also fosters TDR process qualities such as knowledge integration. Conducted at different project stages, the results can serve as a basis for monitoring and adapting the project design. The reflective approach•includes scientific and non-scientific TDR project team members,•draws on Theory of Change as a conceptual framework and motivates participants to reflect on plausible impact pathways and make implicit assumptions about interlinkages between different forms of societal effects explicit, and•provides results which enable project partners to adjust their project design for greater societal effectiveness.

11.
Australas Emerg Care ; 2024 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-38997909

RESUMO

BACKGROUND: This collaborative study by The Australasian College of Paramedicine's Clinical Practice Guidelines (CPG) Working Group aimed to examine CPG development practices in Australian and New Zealand ambulance services. METHODS: Employing a qualitative descriptive design, the research utilised thematic analysis to extract insights from interviews with eleven experts actively involved in CPG development. The study embraced a nominalist and constructivist approach, recognising the intricate connection between individual experiences and the realities of CPG development in the paramedic field. RESULTS: Key findings revealed significant heterogeneity in CPG development practices, emphasising a lack of formal training and a substantial reliance on existing guidelines. The study highlighted challenges in project management flexibility, limited research capacity, and inconsistencies in external consultations and resource utilisation. CONCLUSION: The study recommends adopting project management frameworks, investing in training, and utilising evidence evaluation methodologies like GRADE. It emphasises the need for multidisciplinary teams and formal expertise in evidence synthesis, advocating for targeted training programs. Funding challenges highlight the importance of dedicated budgets and collaborative efforts for resource allocation. Knowledge translation and implementation issues underscore the significance of training programs for evidence evaluation and knowledge translation in overcoming these challenges.

12.
Trials ; 25(1): 487, 2024 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-39020430

RESUMO

BACKGROUND: Pulmonary rehabilitation (PR) is accepted as standard care for individuals with COPD. We conducted an international, multi-centred randomized controlled trial (RCT) to determine if adding balance training to PR would reduce the incidence of falls in people with COPD. While there have been many trials investigating the effectiveness of PR, few have involved international collaboration. Successful execution of rehabilitation trials requires a significant investment of time, staffing, and resources. With the recent completion of the Balance Training for Fall Reduction in COPD RCT, we report on the design, implementation, and execution of our trial using project management phases. We also highlight our lessons learned for consideration in future multi-centre rehabilitation trials. METHODS: This was a retrospective review of the planning, preparation, timelines, and personnel training involved in the execution of this study using four of the five project management phases described by Farrell et al. in 2010: (1) initiation, (2) planning, (3) execution, and (4) monitoring and controlling. We report descriptive statistics as percentages and counts and summarize our lessons learned. RESULTS: Ten outpatient PR programs in three continents participated. Thirty-one personnel worked on the trial across all sites. Enrolment began in January 2017 and was suspended in March 2020 due to the COVID-19 pandemic. Approximately 1275 patients were screened, 455 (36%) were eligible, 258 (57%) consented, 243 (53%) participated, and 130 (61%) completed the 12-month follow-up assessment. Lessons learned through our experience included (1) ensuring awareness of funder policies and considering the impact on collaborating sites; (2) preparing for the possibility of human resource and program disruptions; (3) anticipating site dropout and having a contingency plan in place; (4) planning and monitoring process measure data before, during, and after trial initiation; (5) ensuring frequent and consistent communication with and between collaborating sites; (6) maximizing features of database platform to ensure data set completeness and controlled data access; and (7) identifying strategies for increasing patient engagement in a high-demand study. CONCLUSIONS: We identify seven lessons learned through our experience conducting an international, multicentre rehabilitation-based RCT. These lessons can provide guidance to other trialists conducting studies with similar logistics and may assist with future trial planning and implementation.


Assuntos
Acidentes por Quedas , Equilíbrio Postural , Doença Pulmonar Obstrutiva Crônica , Humanos , Doença Pulmonar Obstrutiva Crônica/reabilitação , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Acidentes por Quedas/prevenção & controle , Estudos Retrospectivos , Incidência , Resultado do Tratamento , Estudos Multicêntricos como Assunto , Projetos de Pesquisa , Ensaios Clínicos Controlados Aleatórios como Assunto , Terapia por Exercício/métodos , Fatores de Tempo
13.
Heliyon ; 10(11): e31886, 2024 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-38841493

RESUMO

The construction industry wields significant influence in the economies of various countries. However, compared to sectors like manufacturing and aeronautics, it has lagged in terms of digitalization of processes and project management advancement. This study aims to explore how the integration of Lean principles, Building Information Modeling (BIM), and Project Lifecycle Management methodologies within an information system can enhance decision-making in construction project management as a complex environment. A comprehensive literature review was conducted to establish a conceptual framework and gather necessary information for designing an information system. The design was based on the viable systems model and the soft systems methodology, from a systemic perspective that encourages the synergistic interaction of these methodologies. The resulting abstract model would facilitate a comprehensive understanding of the interconnectedness of these methodologies, emphasizing collaborative work environments for efficient information management. This approach aims to replace the current isolated application of each of those methodologies and promises improved project management performance.

14.
Acta Psychol (Amst) ; 247: 104305, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38735247

RESUMO

Globalization and competition drive rapid adoption of new technologies, leading to a rise in complex projects. Project managers need to know how to lead teams through the planning and execution phases of a project while keeping in line with the organization's objectives. In order to successfully manage complex projects, emotional intelligence is an essential leadership quality. Therefore, the present research aimed to investigate the impact of project manager's emotional intelligence (PMEI) on megaprojects China-Pakistan Economic Corridor (CPEC) success through mediating roles of human-related agile challenges Inventory (HRACI) and project success factors (PSF), and project management as a moderator. The study employed convenience and purposive sampling methods to collect data from 533 project managers working on CPEC projects. The Smart PLS 4 software was utilized to evaluate the hypotheses. The results of this study indicated that the direct effect of a PMEI is not significant on CPEC. However, through mediating variables, HRACI exhibited a negative and significant association, while PSF positively and significantly mediate the relationship among PMEI and CPEC. Furthermore, project management as a moderator has a significant and positive effect on PMEI and PSF, however, insignificant between PMEI and CPEC, and negatively significant among PMEI and HRACI. The findings of this study are of great significance for project managers and project leaders. They will need to acquire the skills to prevent issues from arising, particularly when conflicts emerge, in order to ensure the success of megaproject. Therefore, current study recommend that PMEI appears to have a vital role in social interactions, promoting emotions of trust, efficient communication, and cooperation with other project teams in high-stress work environments like CPEC. Lastly, theoretical and practical contributions are discussed, as well as research constraints and future research directions.


Assuntos
Inteligência Emocional , Liderança , Humanos , China , Masculino , Feminino , Paquistão , Adulto , Pessoa de Meia-Idade
15.
Artigo em Inglês | MEDLINE | ID: mdl-38807534

RESUMO

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

16.
Sci Rep ; 14(1): 9238, 2024 04 22.
Artigo em Inglês | MEDLINE | ID: mdl-38649510

RESUMO

This study begins by considering the resource-sharing characteristics of scientific research projects to address the issues of resource misalignment and conflict in scientific research project management. It comprehensively evaluates the tangible and intangible resources required during project execution and establishes a resource conflict risk index system. Subsequently, a resource conflict risk management model for scientific research projects is developed using Back Propagation (BP) neural networks. This model incorporates the Dropout regularization technique to enhance the generalization capacity of the BP neural network. Leveraging the BP neural network's non-linear fitting capabilities, it captures the intricate relationship between project resource demand and supply. Additionally, the model employs self-learning to continuously adapt to new scenarios based on historical data, enabling more precise resource conflict risk assessments. Finally, the model's performance is analyzed. The results reveal that risks in scientific research project management primarily fall into six categories: material, equipment, personnel, financial, time, and organizational factors. This study's model algorithm exhibits the highest accuracy in predicting time-related risks, achieving 97.21%, surpassing convolutional neural network algorithms. Furthermore, the Root Mean Squared Error of the model algorithm remains stable at approximately 0.03, regardless of the number of hidden layer neurons, demonstrating excellent fitting capabilities. The developed BP neural network risk prediction framework in this study, while not directly influencing resource utilization efficiency or mitigating resource conflicts, aims to offer robust data support for research project managers when making decisions on resource allocation. The framework provides valuable insights through sensitivity analysis of organizational risks and other factors, with their relative importance reaching up to 20%. Further research should focus on defining specific strategies for various risk factors to effectively enhance resource utilization efficiency and manage resource conflicts.


Assuntos
Algoritmos , Redes Neurais de Computação , Humanos , Gestão de Riscos/métodos , Medição de Risco/métodos , Pesquisa Biomédica
17.
Artigo em Inglês | MEDLINE | ID: mdl-38557858

RESUMO

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: An investigational drug services (IDS) pharmacy plays a vital role in supporting clinical trial research by ensuring the safe and efficient management of investigational products. This article describes the implementation of an electronic project management software to improve an IDS pharmacy's study protocol work. The article describes the implementation of the software and how this approach addressed specific challenges, including project oversight, process standardization, documentation, reporting, accountability, and intrateam communication. SUMMARY: We describe an electronic project management software system used to streamline and standardize the work associated with study protocols. This software provides an organized and customizable workspace to manage tasks associated with each study protocol. The software automates task creation, tracks progress, and ensures comprehensive record keeping. Additionally, the software fosters effective communication within the team and offers real-time reporting to assess team productivity and progress. We have observed improved consistency, enhanced revenue, including approximately $18,000 in additional fee capture, and increased collaboration among pharmacy team members. CONCLUSION: Implementing an electronic project management software has proven highly beneficial in the IDS pharmacy. The software has significantly improved workflow efficiency by addressing challenges in study protocol management. While initial setup and training required time and resources, the long-term benefits in project oversight, collaboration, and revenue capture justify the investment. An electronic project management software is a valuable tool in managing the complexity of study protocol activities and supports the pharmacy's crucial role in advancing clinical research.

18.
J Dr Nurs Pract ; 17(1): 54-64, 2024 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-38538109

RESUMO

Background: Developing rigorous doctor of nursing practice (DNP) projects continues to challenge faculty and doctoral students. To address project rigor, expert content validity methods have been applied to clinical projects. Students implement expert content validity processes to literature-based project components. Objectives: The objectives of this study are to describe some of the developmental phases of DNP projects during the courses of one DNP program and to explore one strategy for increasing the rigor of DNP projects, review details on expert-type content validity methods, and examine literature for projects implementing an alternate application of expert-type content validity and scoring approaches to components of DNP projects. Methods: Expert content validity methods are described for DNP projects, such as guidelines, teaching plans, support groups, and algorithms. They are used to judge components generated from initial content analysis strategies. Types of expert panelists and descriptions of scoring ranks on project components are presented to represent different expert content validity strategies. Results The steps are presented to support expert content validity processes. Conclusions: DNP projects challenge faculty and students to create systematically constructed quality improvement projects on important and interesting clinical problems. The expert context validity process is one approach of enhancing project rigor. Implications for Nursing: An outline offers steps to establish expert content validity for translational DNP projects.


Assuntos
Educação de Pós-Graduação em Enfermagem , Médicos , Estudantes de Enfermagem , Humanos , Docentes de Enfermagem , Melhoria de Qualidade
19.
Stud Conserv ; 69(1): 1-16, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38384673

RESUMO

This contribution presents the results of a technical investigation on the pigments of William Burges' Great Bookcase (1859-62), preserved at the Ashmolean Museum. It is the first thorough material investigation of a remarkable piece of Gothic Revival painted furniture, notably an artwork by Burges, whose work has so far received little attention from a technical point of view. This study was developed during the Covid-19 pandemic, which significantly affected the planned research activities since the investigation relied extensively on collaborations with institutions within and beyond the University of Oxford. The disruption caused by the lockdown and other restrictions went far beyond any prediction and led us to redefine the project's outcome and methodology 'on the fly' while maintaining its overall vision. However, thanks to the timeliness of a substantial research grant received from the Capability for Collection Fund (CapCo, Art and Humanities Research Council), we could ultimately turn this research into a unique opportunity to test the potential of recently acquired instruments, namely the Opus Apollo infrared camera and the Bruker CRONO XRF mapping spectrometer. Therefore, besides reporting on the findings, this contribution outlines the strategy adopted and assesses the new equipment's capability for the non-invasive analysis of complex polychromies.

20.
JMIR Med Inform ; 12: e52524, 2024 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-38265848

RESUMO

BACKGROUND: The Health Information Technology for Economic and Clinical Health Act of 2009 was legislated to reduce health care costs, improve quality, and increase patient safety. Providers and organizations were incentivized to exhibit meaningful use of certified electronic health record (EHR) systems in order to achieve this objective. EHR adoption is an expensive investment, given the resources and capital that are invested. Due to the cost of the investment, a return on the EHR adoption investment is expected. OBJECTIVE: This study performed a value analysis of EHRs. The objective of this study was to investigate the relationship between EHR adoption levels and financial and clinical outcomes by combining both financial and clinical outcomes into one conceptual model. METHODS: We examined the multivariate relationships between different levels of EHR adoption and financial and clinical outcomes, along with the time variant control variables, using moderation analysis with a longitudinal fixed effects model. Since it is unknown as to when hospitals begin experiencing improvements in financial outcomes, additional analysis was conducted using a 1- or 2-year lag for profit margin ratios. RESULTS: A total of 5768 hospital-year observations were analyzed over the course of 4 years. According to the results of the moderation analysis, as the readmission rate increases by 1 unit, the effect of a 1-unit increase in EHR adoption level on the operating margin decreases by 5.38%. Hospitals with higher readmission payment adjustment factors have lower penalties. CONCLUSIONS: This study fills the gap in the literature by evaluating individual relationships between EHR adoption levels and financial and clinical outcomes, in addition to evaluating the relationship between EHR adoption level and financial outcomes, with clinical outcomes as moderators. This study provided statistically significant evidence (P<.05), indicating that there is a relationship between EHR adoption level and operating margins when this relationship is moderated by readmission rates, meaning hospitals that have adopted EHRs could see a reduction in their readmission rates and an increase in operating margins. This finding could further be supported by evaluating more recent data to analyze whether hospitals increasing their level of EHR adoption would decrease readmission rates, resulting in an increase in operating margins. Hospitals would incur lower penalties as a result of improved readmission rates, which would contribute toward improved operating margins.

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