SummaryNext, the article discusses the need to incorporate the use of surveys, questionnaires, or rating instruments for the collection of end-user feedback during and after the implementation process. A description of the types of rating instruments that will facilitate the assessment of user satisfaction is provided. Initial results from physician feedback during the implementation of our prototype are discussed. Research indicates that computerized decision support systems (CDSSs) can improve clinical performance and patient outcomes, and yet CDSSs are not in widespread use. Physician guidelines, in general, face barriers in implementation. Guidelines in a computerized format can overcome some of the barriers to conventional text-form guidelines; however, computerized programs have novel aspects that have to be considered, aspects such as technical problems/support and user interface issues that can act as barriers. Though the literature points out that human, organizational, and technical issues can act as barriers in the implementation of CDSSs, studies clearly indicate that there are methods that can overcome these barriers and improve CDSS acceptance and use. These methods come from lessons learned from a variety of CDSS implementation ventures. Notably, most of the methods that improve acceptance and use of a CDSS require feedback and involvement of end-users. Measuring and addressing physician or user attitudes toward the computerized support system has been shown to be important in the successful implementation of a CDSS. This article discusses: 1) the barriers of implementation of guidelines in general and of CDSSs; 2) the importance of the physician’s role in development, implementation, and adherence; 3) methods that can improve CDSS acceptance and use; and 4) the types of tools needed to obtain end-user feedback.

A broad-based community partnership program can significantly reduce ED utilization and related costs among the uninsured.

"critical consciousness," people in a community can be empowered to take control of their lives and contribute to transforming and improving the community's health (Barnes & Fairbanks, 1997). Attempts to increase community involvement in health system services and activities have resulted in innovative case management programs such as the use of CHWs (Lemak, Johnson, & Goodrick, 2004). Community individuals can receive continuum of care and improved overall quality of care in the delivery of primary care and preventive services with CHWs acting as liaisons (Witmer, Seifer, Finocchio, Leslie, & O'Neil, 1995). Novel interventions reveal the value of training local community members to work with health professionals to achieve improved health outcomes (Department of Health and Human Services [DHHS], 1994). Those who have traditionally lacked health care access benefit from the connections that CHWs (also known as lay health promoters [LHPs]), and, in Spanish, promotoras de salud) can provide (Witmer et al., 1995). CHW programs are based on "natural helping," and build on a community's existing social network and social relationships (Israel, 1985). Natural helping strategies can successfully develop networks or incorporate existent networks into interventions designed to improve community and individual health (Eng & Young, 1992). Recent trends in health care support a greater reliance on lay helping (Service & Salber, 1979), which can reduce differences between professionals' intentions and clients' expectations (Eng, Hatch, & Callan, 1985), Community health workers (CHWs) work with health professionals to improve health outcomes by facilitating community-based health education and increase access and continuity to health services within a community. Uninsured, low-income participants of a communitybased program, Project Access Dallas, participated in focus group sessions for determining participants' perceptions of CHW effectiveness and participants' abilities to independently manage their health needs. Of the 95 adults invited, 24 (25.3%) attended. Participants reported that CHWs are an invaluable asset in learning how to navigate the health care system, obtaining appointments and being better able to care for themselves with CHW emotional/psychological support. Results suggest that CHWs in a case management model improved patient comprehension of health issues, patient navigation through a health care system, and patients' abilities to independently manage health issues. Implementation of CHWs within a case management model appears to be an effective mechanism for providing health services to underserved populations.

Computers, personal digital assistants (PDA), and the Internet are widely used as resources in medical education and clinical care. Educators who intend to incorporate these resources effectively into residency education programmes can benefit from understanding how residents currently use these tools, their skills, and their preferences. The researchers sent questionnaires to 306 US family medicine residency programmes for all of their residents to complete. Respondents were 1177 residents from 125 (41%) programmes. Access to a computer was reported by 95% of respondents. Of these, 97% of desktop and 89% of laptop computers could access the Internet. Residents accessed various educational and clinical resources. Half felt they had 'intermediate' skills at Web searches, 23% had 'some skills,' and 27% were 'quite skilled.' Those under 30 years of age reported higher skill levels. Those who experienced a Web-based curriculum in medical school reported higher search skills and greater success in finding clinical information. Respondents preferred to use technology to supplement the didactic sessions offered in resident teaching conferences. Favourable conditions exist in family medicine residency programmes to implement a blend of traditional and technology-based learning experiences. These conditions include residents' experience, skills, and preferences.

The UT Southwestern Virtual Wound Care Clinic provides care to disabled institutional residents in an urban setting. The program offers flexible financial mechanisms for residents of the facility to access specialty care. Telemedicine improves quality-of-life and reduces costs by minimizing patient transportation. The exchange of clinical knowledge benefits both parties.