BackgroundThe value of health information technology (IT) ultimately depends on end users accepting and appropriately using it for patient care. This study examined pediatric intensive care unit nurses’ perceptions, acceptance, and use of a novel health IT, the Large Customizable Interactive Monitor.MethodsAn expanded technology acceptance model was tested by applying stepwise linear regression to data from a standardized survey of 167 nurses.ResultsNurses reported low-moderate ratings of the novel IT’s ease of use and low to very low ratings of usefulness, social influence, and training. Perceived ease of use, usefulness for patient/family involvement, and usefulness for care delivery were associated with system satisfaction (R2 = 70%). Perceived usefulness for care delivery and patient/family social influence were associated with intention to use the system (R2 = 65%). Satisfaction and intention were associated with actual system use (R2 = 51%).ConclusionsThe findings have implications for research, design, implementation, and policies for nursing informatics, particularly novel nursing IT. Several changes are recommended to improve the design and implementation of the studied IT.

The introduction of generic medications attenuated the decline in adherence to AIs over three years of treatment among breast cancer survivors not receiving low-income subsidies for Medicare D coverage.

Objectives Explore the performance patterns of invasive bedside procedures at an academic medical center, evaluate whether patient characteristics predict referral, and examine procedure outcomes. Methods This was a prospective, observational, and retrospective chart review of adults admitted to a general medicine service who had a paracentesis, thoracentesis, or lumbar puncture between February 22, 2013 and February 21, 2014. Results Of a total of 399 procedures, 335 (84%) were referred to a service other than the primary team for completion. Patient characteristics did not predict referral status. Complication rates were low overall and did not differ, either by referral status or location of procedure. Model-based results showed a 41% increase in the average length of time until procedure completion for those referred to the hospital procedure service or radiology (7.9 vs 5.8 hours; P < 0.05) or done in radiology instead of at the bedside (9.0 vs 5.8 hours; P < 0.001). The average procedure cost increased 38% ($1489.70 vs $1023.30; P < 0.001) for referred procedures and 56% ($1625.77 vs $1150.98; P < 0.001) for radiology-performed procedures. Conclusions Although referral often is the easier option, our study shows its shortcomings, specifically pertaining to cost and time until completion. Procedure performance remains an important skill for residents and hospitalists to learn and use as a part of patient care.

Background Breast cancer patients exhibit survival disparities based on socioeconomic status (SES). Disparities may be attributable to access to expensive oral endocrine agents. Objectives Define recent socioeconomic disparities in breast cancer survival and determine whether these improved after implementation of the Medicare Part D program. Design Difference-in-difference natural experiment of women diagnosed and treated before or after implementation of Medicare Part D. Subjects Female Medicare beneficiaries with early stage breast cancer: 54,772 diagnosed in 2001 and 46,371 in 2007. Measures SES was based on Medicaid enrollment and zip code per capita income, all-cause mortality from Medicare, and cause of death from National Death Index. Results Among women diagnosed pre-Part D, 40.5% of poor beneficiaries had died within 5 years compared to 20.3% of high-income women (p<0.0001). Post-Part D, 33.6% of poor women and 18.4% of high-income women died by 5 years. After adjustment for potential confounders, improvement in all-cause mortality post-Part D was greater for poorer women compared to more affluent women (p=0.002). However, absolute improvement in breast cancer-specific mortality was 1.8%, 1.2%, and 0.8% (p=0.88 for difference in improvement by SES) respectively for poor, near poor, and high-income women, while analogous improvement in mortality from other causes was 5.1%, 3.8% and 0.9% (p=0.067 for difference in improvement by SES). Conclusions Large survival disparities by SES exist among breast cancer patients. The Part D program successfully ameliorated SES disparities in all-cause mortality. However, improvement was concentrated in causes of death other than breast cancer, suggesting remaining gaps in care.

Patients with chronic noncancer pain utilized more traditional and uncompensated health care resources compared with patients without chronic pain.