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The relationship between healthcare organizational accreditation and their leaders’ professional certification in healthcare management is of specific interest to institutions of higher education and individuals in the healthcare management field. Since academic program accreditation is one piece of evidence of high-quality education, and since professional certification is an attestation to the knowledge, skills, and abilities of those who are certified, we expect alumni who graduated from accredited programs and obtained professional certification to have a positive impact on the organizations that they lead, compared with alumni who did not graduate from accredited programs and who did not obtain professional certification. The authors’ analysis examined the impact of hiring graduates from higher education programs that held external accreditation from the Commission on Accreditation of Healthcare Management Education (CAHME). Graduates’ affiliation with the American College of Healthcare Executives (ACHE) professional healthcare leadership organization was also assessed as an independent variable. Study outcomes focused on these graduates’ respective healthcare organization’s performance measures (cost, quality, and access) to assess the researchers’ inquiry into the perceived value of a CAHME-accredited graduate degree in healthcare administration and a professional ACHE affiliation. The results from this study found no effect of CAHME accreditation or ACHE affiliation on healthcare organization performance outcomes. The study findings support the need for future research surrounding healthcare administration professional graduate degree program characteristics and leader development affiliations, as perceived by various industry stakeholders.
Matthew Brooks; Brad Beauvais; Clemens Kruse; Lawrence Fulton; Michael Mileski; Zo Ramamonjiarivelo; Ramalingam Shanmugam; Cristian Lieneck. Accreditation and Certification: Do They Improve Hospital Financial and Quality Performance? Healthcare 2021, 9, 887 .
AMA StyleMatthew Brooks, Brad Beauvais, Clemens Kruse, Lawrence Fulton, Michael Mileski, Zo Ramamonjiarivelo, Ramalingam Shanmugam, Cristian Lieneck. Accreditation and Certification: Do They Improve Hospital Financial and Quality Performance? Healthcare. 2021; 9 (7):887.
Chicago/Turabian StyleMatthew Brooks; Brad Beauvais; Clemens Kruse; Lawrence Fulton; Michael Mileski; Zo Ramamonjiarivelo; Ramalingam Shanmugam; Cristian Lieneck. 2021. "Accreditation and Certification: Do They Improve Hospital Financial and Quality Performance?" Healthcare 9, no. 7: 887.
BACKGROUND The virulent and unpredictable nature of COVID-19 forced rapid adoption of telemedicine around the world. What were the effects of this rapid adoption? Are barriers the same today after the rapid adoption compared to pre-pandemic conditions? OBJECTIVE The objective of this systematic literature review were to examine research literature published during the pandemic to identify facilitators, barriers, and associated medical outcomes as a result of adopting telemedicine to determine if shifts have occurred in the industry. METHODS Conducting the review in accordance with the Kruse Protocol and reporting the results in accordance with PRISMA, we analyzed 46 research articles from five continents published during the pandemic in four research databases: PubMed (MEDLINE), CINAHL, Science Direct, and Web of Science. RESULTS Reviewers identified 25 facilitator themes and observations, 12 barrier themes and observations, 14 results (compared to the control group) themes and observations. Twenty-two percent reported strongly satisfied or satisfied (zero reported a decline in satisfaction), 27% reported an improvement in administrative or efficiency results (as compared with the control group), 14% reported no statistically significant results from the control group, and 40% and 10% reported an improvement in, or no statistically significant difference in medical outcomes using the telemedicine modality over the control group, respectively. CONCLUSIONS The pandemic forced rapid adoption of telemedicine, which also forced practices to adopt the modality regardless of the challenges previous research have identified. Several barriers still exist for health policy makers to address, but healthcare administrators can feel confident in the modality as the evidence shows it is safe, effective, and widely accepted.
Clemens Kruse; Katharine Heinemann. Facilitators and Barriers to the Adoption of Telemedicine During COVID-19 (Preprint). 2021, 1 .
AMA StyleClemens Kruse, Katharine Heinemann. Facilitators and Barriers to the Adoption of Telemedicine During COVID-19 (Preprint). . 2021; ():1.
Chicago/Turabian StyleClemens Kruse; Katharine Heinemann. 2021. "Facilitators and Barriers to the Adoption of Telemedicine During COVID-19 (Preprint)." , no. : 1.
The impact of organizational accreditation and professional certification and the evidence-based measurable impact of those for both academic programs and affiliates is one of specific interest to universities and individuals in the healthcare management field [1]. The authors’ analysis examined the impact of hiring graduates from higher education programs that held external accreditation from the Commission on Accreditation of Healthcare Management Education (CAHME). Graduates’ affiliation with the American College of Healthcare Executives (ACHE) professional healthcare leadership organization was also assessed as an independent variable. Study outcomes focused on these graduates’ respective healthcare organization’s performance measures (cost, quality, and access) to assess the researchers’ inquiry into the perceived value of a CAHME-accredited graduate degree in healthcare administration and a professional ACHE affiliation [2]. The results from this study found no effect of CAHME accreditation or ACHE affiliation on healthcare organization performance outcomes. The study findings support the need for future research surrounding healthcare administration professional graduate degree program characteristics and leader development affiliations, as perceived by various industry stakeholders.
Matthew Brooks; Brad M Beauvais; Clemens Scott Kruse; Lawrence Fulton; Michael Mileski; Zo Ramamonjiarivelo; Ramalingam Shanmugam; Cristian Lieneck. Accreditation and Certification: Do they Improve Hospital Financial and Quality Performance? 2021, 1 .
AMA StyleMatthew Brooks, Brad M Beauvais, Clemens Scott Kruse, Lawrence Fulton, Michael Mileski, Zo Ramamonjiarivelo, Ramalingam Shanmugam, Cristian Lieneck. Accreditation and Certification: Do they Improve Hospital Financial and Quality Performance? . 2021; ():1.
Chicago/Turabian StyleMatthew Brooks; Brad M Beauvais; Clemens Scott Kruse; Lawrence Fulton; Michael Mileski; Zo Ramamonjiarivelo; Ramalingam Shanmugam; Cristian Lieneck. 2021. "Accreditation and Certification: Do they Improve Hospital Financial and Quality Performance?" , no. : 1.
Background: Approximately 6.5 to 6.9 million individuals in the United States have heart failure, and the disease costs approximately $43.6 billion in 2020. This research provides geographical incidence and cost models of this disease in the U.S. and explanatory models to account for hospitals’ number of heart failure DRGs using technical, workload, financial, geographical, and time-related variables. Methods: The number of diagnoses is forecast using regression (constrained and unconstrained) and ensemble (random forests, extra trees regressor, gradient boosting, and bagging) techniques at the hospital unit of analysis. Descriptive maps of heart failure diagnostic-related groups (DRGs) depict areas of high incidence. State- and county-level spatial and non-spatial regression models of heart failure admission rates are performed. Expenditure forecasts are estimated. Results: The incidence of heart failure has increased over time with the highest intensities in the East and center of the country; however, several Northern states have seen large increases since 2016. The best predictive model for the number of diagnoses (hospital unit of analysis) was an extremely randomized tree ensemble (predictive R2 = 0.86). The important variables in this model included workload metrics and hospital type. State-level spatial lag models using first-order Queen criteria were best at estimating heart failure admission rates (R2 = 0.816). At the county level, OLS was preferred over any GIS model based on Moran’s I and resultant R2; however, none of the traditional models performed well (R2 = 0.169 for the OLS). Gradient-boosted tree models predicted 36% of the total sum of squares; the most important factors were facility workload, mean cash on hand of the hospitals in the county, and mean equity of those hospitals. Online interactive maps at the state and county levels are provided. Conclusions. Heart failure and associated expenditures are increasing. Costs of DRGs in the study increased $61 billion from 2016 through 2018. The increase in the more expensive DRG 291 outpaced others with an associated increase of $92 billion. With the increase in demand and steady-state supply of cardiologists, the costs are likely to balloon over the next decade. Models such as the ones presented here are needed to inform healthcare leaders.
Clemens Kruse; Bradley Beauvais; Matthew Brooks; Michael Mileski; Lawrence Fulton. Models for Heart Failure Admissions and Admission Rates, 2016 through 2018. Healthcare 2020, 9, 22 .
AMA StyleClemens Kruse, Bradley Beauvais, Matthew Brooks, Michael Mileski, Lawrence Fulton. Models for Heart Failure Admissions and Admission Rates, 2016 through 2018. Healthcare. 2020; 9 (1):22.
Chicago/Turabian StyleClemens Kruse; Bradley Beauvais; Matthew Brooks; Michael Mileski; Lawrence Fulton. 2020. "Models for Heart Failure Admissions and Admission Rates, 2016 through 2018." Healthcare 9, no. 1: 22.
Telemedicine diagnoses and treats patients remotely via telecommunications technology all over the world. Telemedicine becomes more prevalent as providers recognize the benefits, patients receive increased access and payers see the reduction in cost of care. Telemedicine studies have shown success in limiting geographical constraints, time spent, and costs incurred by patients with positive health outcomes across medical specialties. The aim of this review is to evaluate the implications of telemedicine and health policies. An assessment of the literature in four databases was made on content germane to health policy implications of telemedicine. From the results of the search, 48 publications were kept for analysis. The fifteen facilitators mentioned most often were increased access, increased convenience, improved population health, care enabled through mobile technology, self-efficacy, increased patient-to-provider communication, cost advantages, efficacy of modality, increased health outcomes, reaches developing countries, increased quality, a positive previous experience, and a secure means of care. The twelve barriers mentioned most often were the increased cost to providers, patient privacy, technical literacy, state licensing, data security, socioeconomics, limited reimbursements, issues of interoperability, patient safety, less personal means of care, misaligned incentives, and ethical concerns. Telemedicine has the potential for growth and adoption, however, there are several implications and barriers of health policy surrounding telemedicine that make it difficult to adopt. Policies will likely encourage and incentivize its spread and use. Future research should focus on standardization of telemedicine and new policies and incentives that encourage its use.
Clemens Scott Kruse; Kelly Williams; John Bohls; Waleed Shamsi. Telemedicine and health policy: A systematic review. Health Policy and Technology 2020, 10, 209 -229.
AMA StyleClemens Scott Kruse, Kelly Williams, John Bohls, Waleed Shamsi. Telemedicine and health policy: A systematic review. Health Policy and Technology. 2020; 10 (1):209-229.
Chicago/Turabian StyleClemens Scott Kruse; Kelly Williams; John Bohls; Waleed Shamsi. 2020. "Telemedicine and health policy: A systematic review." Health Policy and Technology 10, no. 1: 209-229.
Electronic health records (EHRs) are a central feature of care delivery in acute care hospitals; however, the financial and quality outcomes associated with system performance remain unclear. In this study, we aimed to evaluate the association between the top 3 EHR vendors and measures of hospital financial and quality performance. This study evaluated 2667 hospitals with Cerner, Epic, or Meditech as their primary EHR and considered their performance with regard to net income, Hospital Value–Based Purchasing Total Performance Score (TPS), and the unweighted subdomains of efficiency and cost reduction; clinical care; patient- and caregiver-centered experience; and patient safety. We hypothesized that there would be a difference among the 3 vendors for each measure. None of the EHR systems were associated with a statistically significant financial relationship in our study. Epic was positively associated with TPS outcomes (R2=23.6%; β=.0159, SE 0.0079; P=.04) and higher patient perceptions of quality (R2=29.3%; β=.0292, SE 0.0099; P=.003) but was negatively associated with patient safety quality scores (R2=24.3%; β=−.0221, SE 0.0102; P=.03). Cerner and Epic were positively associated with improved efficiency (R2=31.9%; Cerner: β=.0330, SE 0.0135, P=.01; Epic: β=.0465, SE 0.0133, P<.001). Finally, all 3 vendors were associated with positive performance in the clinical care domain (Epic: β=.0388, SE 0.0122, P=.002; Cerner: β=.0283, SE 0.0124, P=.02; Meditech: β=.0273, SE 0.0123, P=.03) but with low explanatory power (R2=4.2%). The results of this study provide evidence of a difference in clinical outcome performance among the top 3 EHR vendors and may serve as supportive evidence for health care leaders to target future capital investments to improve health care delivery.
Bradley Beauvais; Clemens Kruse; Lawrence Fulton; Ramalingam Shanmugam; Zo Ramamonjiarivelo; Matthew Brooks. Electronic Health Record Vendors: An Evaluation of the Association with Hospital Financial and Quality Performance (Preprint). Journal of Medical Internet Research 2020, 23, e23961 .
AMA StyleBradley Beauvais, Clemens Kruse, Lawrence Fulton, Ramalingam Shanmugam, Zo Ramamonjiarivelo, Matthew Brooks. Electronic Health Record Vendors: An Evaluation of the Association with Hospital Financial and Quality Performance (Preprint). Journal of Medical Internet Research. 2020; 23 (4):e23961.
Chicago/Turabian StyleBradley Beauvais; Clemens Kruse; Lawrence Fulton; Ramalingam Shanmugam; Zo Ramamonjiarivelo; Matthew Brooks. 2020. "Electronic Health Record Vendors: An Evaluation of the Association with Hospital Financial and Quality Performance (Preprint)." Journal of Medical Internet Research 23, no. 4: e23961.
BACKGROUND Electronic health records are a central feature of care delivery in the acute care hospital, but financial and quality outcomes associated with system performance remain unclear. OBJECTIVE This study evaluates the association between the top three electronic health record vendors and measures of hospital financial and quality performance. METHODS This study evaluates 2,667 hospitals with Cerner, Epic, or Meditech as their primary EHR and considers performance on net income, Hospital Value Based Purchasing (HVBP) Total Performance Score (TPS) and the unweighted sub-domains: Efficiency and Cost Reduction, Clinical Care, Patient and Caregiver-Centered Experience, and Patient Safety. We hypothesize there is a difference among the three vendors on each measure. RESULTS None of the EHR systems was associated with a statistically significant financial relationship in our study. Epic was positively associated with Total Performance Score outcomes (R2 = 23.6%; β:.0159, S.E.:.0079, P = .043) and higher patient perceptions of quality (R2 = 29.3%; β:.0292, S.E.:.0099, P =.003) but negatively associated with patient safety quality scores (R2 = 24.3%; β: -.0221, S.E.:.0102, P =.029). Cerner and Epic were positively associated with improved efficiency (R2 = 31.9%; Cerner: β:.0330, S.E.:.0135, P =.014; Epic: β:.0465, S.E.:.0133, P < .001). Lastly, all three vendors were associated with positive performance in the Clinical Care domain ( Epic: β:.0388, S.E.:.0122, P =.002; Cerner: β:.0283, S.E.:.0124, P =.022; Meditech: β:.0273, S.E.:.0123, P =.026) but with low explanatory power (R2 = 4.2%). CONCLUSIONS The results of this study provide evidence of a difference in clinical outcome performance among the top three EHR vendors and may serve as supportive evidence for healthcare leaders to target future capital investments to improve healthcare delivery.
Bradley Beauvais; Clemens Scott Kruse; Lawrence Fulton; Ramalingam Shanmugam; Zo Ramamonjiarivelo; Matthew Brooks. Electronic Health Record Vendors: An Evaluation of the Association with Hospital Financial and Quality Performance (Preprint). 2020, 1 .
AMA StyleBradley Beauvais, Clemens Scott Kruse, Lawrence Fulton, Ramalingam Shanmugam, Zo Ramamonjiarivelo, Matthew Brooks. Electronic Health Record Vendors: An Evaluation of the Association with Hospital Financial and Quality Performance (Preprint). . 2020; ():1.
Chicago/Turabian StyleBradley Beauvais; Clemens Scott Kruse; Lawrence Fulton; Ramalingam Shanmugam; Zo Ramamonjiarivelo; Matthew Brooks. 2020. "Electronic Health Record Vendors: An Evaluation of the Association with Hospital Financial and Quality Performance (Preprint)." , no. : 1.
Doctor shopping is the practice of visiting multiple physicians to obtain multiple prescriptions. Health information technology (HIT) allows healthcare providers and patients to leverage records or shared information to improve effective care. Our research objective was to determine how HIT is being leveraged to control for doctor shopping. We analyzed articles that covered a 10-year time period from four databases and reported using preferred reporting items for systematic reviews and meta-analysis (PRISMA). We compared intervention, study design, and bias, in addition to showing intervention interactions with facilitators, barriers, and medical outcomes. From 42 articles published from six countries, we identified seven interventions, five facilitator themes with two individual observations, three barrier themes with six individual observations, and two medical outcome themes with four individual observations. Multiple HIT mechanisms exist to control for doctor shopping. Some are associated with a decrease in overdose mortality, but access is not universal or compulsory, and data sharing is sporadic. Because shoppers travel hundreds of miles in pursuit of prescription drugs, data sharing should be an imperative. Research supports leveraging HIT to control doctor shopping, yet without robust data sharing agreements, the efforts of the system are limited to the efforts of the entity with the least number of barriers to their goal. Shoppers will seek out and exploit that organization that does not require participation or checking of prescription drug monitoring programs (PDMP), and the research shows that they will drive great distances to exploit this weakest link.
Clemens Kruse; Brady Kindred; Shaneel Brar; Guillermo Gutierrez; Kaleigh Cormier. Health Information Technology and Doctor Shopping: A Systematic Review. Healthcare 2020, 8, 306 .
AMA StyleClemens Kruse, Brady Kindred, Shaneel Brar, Guillermo Gutierrez, Kaleigh Cormier. Health Information Technology and Doctor Shopping: A Systematic Review. Healthcare. 2020; 8 (3):306.
Chicago/Turabian StyleClemens Kruse; Brady Kindred; Shaneel Brar; Guillermo Gutierrez; Kaleigh Cormier. 2020. "Health Information Technology and Doctor Shopping: A Systematic Review." Healthcare 8, no. 3: 306.
Background: Assistive technologies (AT) have been used to improve the daily living conditions of people living with dementia (PWD). Research supports the positive impact of the use of AT such as decreased burden on caregivers and behavioral support for people with dementia. Four reviews in the last six years have analyzed AT and PWD, but none have incorporated the dimension of medical outcomes. Objectives: The purpose of this review is to identify the facilitators, barriers, and medical outcomes commensurate with the use of AT with PWD. Method: This review queried The Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science, Science Direct, and PubMed databases for peer-reviewed publications in the last five years for facilitators, barriers, and medical outcomes commensurate with the use of AT with PWD. The study is reported and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and the Kruse Protocol for conducting a systematic review. Results: 48 studies were analyzed. Fourteen types of AT, 17 facilitators, 17 barriers, and 16 medical outcomes were identified in the literature. The two most frequently mentioned ATs were cognitive stimulators (9/48, 19%) and social robots (5/48, 10%). The two most frequently mentioned facilitators were caregivers want AT (8/68, 12%) and enables increased independence (7/68, 10%). The top two barriers were cost (8/75, 11%) and PWD reject AT (8/75, 11%). The top medical outcomes were improved cognitive abilities (6/69, 9%), increased activities of daily living (ADLs), and increased autonomy (each at 5/69, 7%): Zero negative outcomes were reported. Conclusion: The systematic review revealed the positive relations that occur when PWD and their caregivers use AT. Although many reservations surrounding the use of AT exist, a majority of the literature shows a positive effect of its use. Research supports a strong support for AT by caregivers due to many positive medical outcomes, but also a reticence to adopt by PWD. If ATs for PWD are a way to reduce stress on caregivers, barriers of cost and complexity need to be addressed through health policy or grants.
Clemens Scott Kruse; Joanna Fohn; Gilson Umunnakwe; Krupa Patel; Saloni Patel. Evaluating the Facilitators, Barriers, and Medical Outcomes Commensurate with the Use of Assistive Technology to Support People with Dementia: A Systematic Review Literature. Healthcare 2020, 8, 278 .
AMA StyleClemens Scott Kruse, Joanna Fohn, Gilson Umunnakwe, Krupa Patel, Saloni Patel. Evaluating the Facilitators, Barriers, and Medical Outcomes Commensurate with the Use of Assistive Technology to Support People with Dementia: A Systematic Review Literature. Healthcare. 2020; 8 (3):278.
Chicago/Turabian StyleClemens Scott Kruse; Joanna Fohn; Gilson Umunnakwe; Krupa Patel; Saloni Patel. 2020. "Evaluating the Facilitators, Barriers, and Medical Outcomes Commensurate with the Use of Assistive Technology to Support People with Dementia: A Systematic Review Literature." Healthcare 8, no. 3: 278.
Background Rising telehealth capabilities and improving access to older adults can aid in improving health outcomes and quality of life indicators. Telehealth is not being used ubiquitously at present. Objective This review aimed to identify the barriers that prevent ubiquitous use of telehealth and the ways in which telehealth improves health outcomes and quality of life indicators for older adults. Methods This systematic review was conducted and reported in accordance with the Kruse protocol and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Reviewers queried the following four research databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed (MEDLINE), Web of Science, and Embase (Science Direct). Reviewers analyzed 57 articles, performed a narrative analysis to identify themes, and identified barriers and reports of health outcomes and quality of life indicators found in the literature. Results Reviewers analyzed 57 studies across the following five interventions of telehealth: eHealth, mobile health (mHealth), telemonitoring, telecare (phone), and telehealth video calls, with a Cohen κ of 0.75. Reviewers identified 14 themes for barriers. The most common of which were technical literacy (25/144 occurrences, 17%), lack of desire (19/144 occurrences, 13%), and cost (11/144 occurrences, 8%). Reviewers identified 13 medical outcomes associated with telehealth interventions. The most common of which were decrease in psychological stress (21/118 occurrences, 18%), increase in autonomy (18/118 occurrences, 15%), and increase in cognitive ability (11/118 occurrences, 9%). Some articles did not report medical outcomes (18/57, 32%) and some did not report barriers (19/57, 33%). Conclusions The literature suggests that the elimination of barriers could increase the prevalence of telehealth use by older adults. By increasing use of telehealth, proximity to care is no longer an issue for access, and thereby care can reach populations with chronic conditions and mobility restrictions. Future research should be conducted on methods for personalizing telehealth in older adults before implementation. Trial Registration PROSPERO CRD42020182162; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020182162. International Registered Report Identifier (IRRID) RR2-10.2196/15490
Clemens Kruse; Joanna Fohn; Nakia Wilson; Evangelina Nunez Patlan; Stephanie Zipp; Michael Mileski. Utilization Barriers and Medical Outcomes Commensurate With the Use of Telehealth Among Older Adults: Systematic Review. JMIR Medical Informatics 2020, 8, e20359 .
AMA StyleClemens Kruse, Joanna Fohn, Nakia Wilson, Evangelina Nunez Patlan, Stephanie Zipp, Michael Mileski. Utilization Barriers and Medical Outcomes Commensurate With the Use of Telehealth Among Older Adults: Systematic Review. JMIR Medical Informatics. 2020; 8 (8):e20359.
Chicago/Turabian StyleClemens Kruse; Joanna Fohn; Nakia Wilson; Evangelina Nunez Patlan; Stephanie Zipp; Michael Mileski. 2020. "Utilization Barriers and Medical Outcomes Commensurate With the Use of Telehealth Among Older Adults: Systematic Review." JMIR Medical Informatics 8, no. 8: e20359.
Background Computerized decision support systems (CDSSs) are software programs that support the decision making of practitioners and other staff. Other reviews have analyzed the relationship between CDSSs, practitioner performance, and patient outcomes. These reviews reported positive practitioner performance in over half the articles analyzed, but very little information was found for patient outcomes. Objective The purpose of this review was to analyze the relationship between CDSSs, practitioner performance, and patient medical outcomes. PubMed, CINAHL, Embase, Web of Science, and Cochrane databases were queried. Methods Articles were chosen based on year published (last 10 years), high quality, peer-reviewed sources, and discussion of the relationship between the use of CDSS as an intervention and links to practitioner performance or patient outcomes. Reviewers used an Excel spreadsheet (Microsoft Corporation) to collect information on the relationship between CDSSs and practitioner performance or patient outcomes. Reviewers also collected observations of participants, intervention, comparison with control group, outcomes, and study design (PICOS) along with those showing implicit bias. Articles were analyzed by multiple reviewers following the Kruse protocol for systematic reviews. Data were organized into multiple tables for analysis and reporting. Results Themes were identified for both practitioner performance (n=38) and medical outcomes (n=36). A total of 66% (25/38) of articles had occurrences of positive practitioner performance, 13% (5/38) found no difference in practitioner performance, and 21% (8/38) did not report or discuss practitioner performance. Zero articles reported negative practitioner performance. A total of 61% (22/36) of articles had occurrences of positive patient medical outcomes, 8% (3/36) found no statistically significant difference in medical outcomes between intervention and control groups, and 31% (11/36) did not report or discuss medical outcomes. Zero articles found negative patient medical outcomes attributed to using CDSSs. Conclusions Results of this review are commensurate with previous reviews with similar objectives, but unlike these reviews we found a high level of reporting of positive effects on patient medical outcomes.
Clemens Scott Kruse; Nolan Ehrbar. Effects of Computerized Decision Support Systems on Practitioner Performance and Patient Outcomes: Systematic Review. JMIR Medical Informatics 2020, 8, e17283 .
AMA StyleClemens Scott Kruse, Nolan Ehrbar. Effects of Computerized Decision Support Systems on Practitioner Performance and Patient Outcomes: Systematic Review. JMIR Medical Informatics. 2020; 8 (8):e17283.
Chicago/Turabian StyleClemens Scott Kruse; Nolan Ehrbar. 2020. "Effects of Computerized Decision Support Systems on Practitioner Performance and Patient Outcomes: Systematic Review." JMIR Medical Informatics 8, no. 8: e17283.
The obesity epidemic in the United States has been well documented and serves as the basis for a number of health interventions across the nation. However, those who have served in the U.S. military (Veteran population) suffer from obesity in higher numbers and have an overall disproportionate poorer health status when compared to the health of the older non-Veteran population in the U.S. which may further compound their overall health risk. This study examined both the commonalities and the differences in obesity rates and the associated co-morbidities among the U.S. Veteran population, utilizing data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS). These data are considered by the Centers for Disease Control and Prevention (CDC) to be the nation’s best source for health-related survey data, and the 2018 version includes 437,467 observations. Study findings show not only a significantly higher risk of obesity in the U.S. Veteran population, but also a significantly higher level (higher odds ratio) of the associated co-morbidities when compared to non-Veterans, including coronary heart disease (CHD) or angina (odds ratio (OR) = 2.63); stroke (OR = 1.86); skin cancer (OR = 2.18); other cancers (OR = 1.73); chronic obstructive pulmonary disease (COPD) (OR = 1.52), emphysema, or chronic bronchitis; arthritis (OR = 1.52), rheumatoid arthritis, gout, lupus, or fibromyalgia; depressive disorders (OR = 0.84), and diabetes (OR = 1.61) at the 0.95 confidence interval level.
Jose A. Betancourt; Paula Stigler Granados; Gerardo J. Pacheco; Ramalingam Shanmugam; C. Scott Kruse; Lawrence V. Fulton. Obesity and Morbidity Risk in the U.S. Veteran. Healthcare 2020, 8, 191 .
AMA StyleJose A. Betancourt, Paula Stigler Granados, Gerardo J. Pacheco, Ramalingam Shanmugam, C. Scott Kruse, Lawrence V. Fulton. Obesity and Morbidity Risk in the U.S. Veteran. Healthcare. 2020; 8 (3):191.
Chicago/Turabian StyleJose A. Betancourt; Paula Stigler Granados; Gerardo J. Pacheco; Ramalingam Shanmugam; C. Scott Kruse; Lawrence V. Fulton. 2020. "Obesity and Morbidity Risk in the U.S. Veteran." Healthcare 8, no. 3: 191.
BACKGROUND Rising telehealth capabilities and improving access to older adults can aid in improving health outcomes and quality of life indicators. Telehealth is not being used ubiquitously at present. OBJECTIVE This review aimed to identify the barriers that prevent ubiquitous use of telehealth and the ways in which telehealth improves health outcomes and quality of life indicators for older adults. METHODS This systematic review was conducted and reported in accordance with the Kruse protocol and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Reviewers queried the following four research databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed (MEDLINE), Web of Science, and Embase (Science Direct). Reviewers analyzed 57 articles, performed a narrative analysis to identify themes, and identified barriers and reports of health outcomes and quality of life indicators found in the literature. RESULTS Reviewers analyzed 57 studies across the following five interventions of telehealth: eHealth, mobile health (mHealth), telemonitoring, telecare (phone), and telehealth video calls, with a Cohen κ of 0.75. Reviewers identified 14 themes for barriers. The most common of which were technical literacy (25/144 occurrences, 17%), lack of desire (19/144 occurrences, 13%), and cost (11/144 occurrences, 8%). Reviewers identified 13 medical outcomes associated with telehealth interventions. The most common of which were decrease in psychological stress (21/118 occurrences, 18%), increase in autonomy (18/118 occurrences, 15%), and increase in cognitive ability (11/118 occurrences, 9%). Some articles did not report medical outcomes (18/57, 32%) and some did not report barriers (19/57, 33%). CONCLUSIONS The literature suggests that the elimination of barriers could increase the prevalence of telehealth use by older adults. By increasing use of telehealth, proximity to care is no longer an issue for access, and thereby care can reach populations with chronic conditions and mobility restrictions. Future research should be conducted on methods for personalizing telehealth in older adults before implementation. CLINICALTRIAL PROSPERO CRD42020182162; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020182162. INTERNATIONAL REGISTERED REPORT RR2-10.2196/15490
Clemens Kruse; Joanna Fohn; Nakia Wilson; Evangelina Nunez Patlan; Stephanie Zipp; Michael Mileski. Utilization Barriers and Medical Outcomes Commensurate With the Use of Telehealth Among Older Adults: Systematic Review (Preprint). 2020, 1 .
AMA StyleClemens Kruse, Joanna Fohn, Nakia Wilson, Evangelina Nunez Patlan, Stephanie Zipp, Michael Mileski. Utilization Barriers and Medical Outcomes Commensurate With the Use of Telehealth Among Older Adults: Systematic Review (Preprint). . 2020; ():1.
Chicago/Turabian StyleClemens Kruse; Joanna Fohn; Nakia Wilson; Evangelina Nunez Patlan; Stephanie Zipp; Michael Mileski. 2020. "Utilization Barriers and Medical Outcomes Commensurate With the Use of Telehealth Among Older Adults: Systematic Review (Preprint)." , no. : 1.
Intelligent use of rural residential land and sustainable construction is inexorably linked to cost; however, options exist that are eco-friendly and have a positive return on investment. In 2011, a research residence was built to evaluate various land-use and sustainable components. This Texas house has subsequently been used for both residential and research purposes. The purpose of this case study was to evaluate break-even construction considerations, to assess environmental impacts, and to evaluate qualitatively efficacy of sustainable options incorporated in the research residence. Some of the specific components discussed are home site placement (directional positioning); materiel acquisition (transportation); wood product minimization; rainwater harvesting; wastewater management; grid-tied solar array power; electric car charging via a solar array; geothermal heating and cooling; insulation selection; windows, fixtures, and appliance selection; and on-demand electric water heaters for guest areas. This study seeks to identify the impact of proper land use and sustainable techniques on the environment and return-on-investment in rural areas. Break-even and 15-year Net Present Value (NPV) analysis at 3% and 5% cost of capital were used to evaluate traditional construction, partially sustainable construction, and fully sustainable construction options for the case study house, which was built sustainably. The additional cost of sustainable construction is estimated at $54,329. At 3%, the analysis suggests a 15-year NPV of $334,355 (traditional) versus $250,339 million (sustainable) for a difference of $84K. At 5% cost of capital, that difference falls to $63K. The total estimated annual difference in carbon emissions is 4.326 million g/CO2e for this research residence. The results indicate that good choices for quick return-on-investment in rural construction would be the use of engineered lumber, Icynene foam, and Energy Star windows and doors. Medium-term options include photovoltaic systems (PVS) capable of powering the home and an electric car. Sustainable construction options should positively affect the environment and the pocketbook. Regulations and code should require adoption of short-range, break-even sustainable solutions in residential construction.
Lawrence Fulton; Bradley Beauvais; Matthew Brooks; Scott Kruse; Kimberly Lee. Sustainable Residential Building Considerations for Rural Areas: A Case Study. Land 2020, 9, 152 .
AMA StyleLawrence Fulton, Bradley Beauvais, Matthew Brooks, Scott Kruse, Kimberly Lee. Sustainable Residential Building Considerations for Rural Areas: A Case Study. Land. 2020; 9 (5):152.
Chicago/Turabian StyleLawrence Fulton; Bradley Beauvais; Matthew Brooks; Scott Kruse; Kimberly Lee. 2020. "Sustainable Residential Building Considerations for Rural Areas: A Case Study." Land 9, no. 5: 152.
A major consideration for consumers and the residential construction industry is the cost–benefit and break-even of various sustainable construction options. This research provides a publicly available simulation that allows users to compare baseline construction options versus sustainable options and evaluates both break-even costs as well as environmental effects. This R Shiny Monte Carlo simulation uses common pseudo-random number streams for replicability and includes options for solar, rainwater harvesting, wells, Icynene foam, engineered lumber, Energy Star windows and doors, low flow fixtures, aerobic/non-aerobic/city waste treatment, electric versus gasoline vehicles, and many other options. This is the first simulation to quantify multiple sustainable construction options, associated break-even points, and environmental considerations for public use. Using user default parameters, coupled with a 100% solar solution for a baseline 3000 square foot/279 square meter house with 2 occupants results in a break-even of 9 years. Results show that many of the sustainable options are both green for the environment and green for the pocketbook.
Lawrence Fulton; Bradley Beauvais; Matthew Brooks; Clemens Scott Kruse; Kimberly Lee. A Publicly Available Cost Simulation of Sustainable Construction Options for Residential Houses. Sustainability 2020, 12, 2873 .
AMA StyleLawrence Fulton, Bradley Beauvais, Matthew Brooks, Clemens Scott Kruse, Kimberly Lee. A Publicly Available Cost Simulation of Sustainable Construction Options for Residential Houses. Sustainability. 2020; 12 (7):2873.
Chicago/Turabian StyleLawrence Fulton; Bradley Beauvais; Matthew Brooks; Clemens Scott Kruse; Kimberly Lee. 2020. "A Publicly Available Cost Simulation of Sustainable Construction Options for Residential Houses." Sustainability 12, no. 7: 2873.
This publicly available simulation analysis compares baseline construction options versus sustainable options and evaluates both break-even costs as well as environmental effects. The simulation (https://rminator.shinyapps.io/sustain4/) provides users with comparative estimates based upon existing research on costs. This is the first simulation of its type that quantifies multiple sustainable construction options, associated break-even points, and environmental considerations for public use. Results estimate that a 100% solar solution for the baseline 3,000 square foot / 279 square meter house with 2 occupants results in a break-even of 9 years. The simulation includes options for rainwater harvesting or wells, Icynene foam, engineered lumber, Energy Star windows and doors, low flow water fixtures, aerobic / non-aerobic waste treatment or municipal services, and many other options. This is the first simulation of its type to provide publicly available sustainable construction analysis based on research, and it illustrates that sustainable construction might be both green for the environment and green for the pocketbook.
Lawrence Fulton; Bradley Beauvauis; Matthew Brooks; Scott Kruse; Kim Lee. A Publicly Available Cost Simulation of Sustainable Construction Options for Residential Houses. 2020, 1 .
AMA StyleLawrence Fulton, Bradley Beauvauis, Matthew Brooks, Scott Kruse, Kim Lee. A Publicly Available Cost Simulation of Sustainable Construction Options for Residential Houses. . 2020; ():1.
Chicago/Turabian StyleLawrence Fulton; Bradley Beauvauis; Matthew Brooks; Scott Kruse; Kim Lee. 2020. "A Publicly Available Cost Simulation of Sustainable Construction Options for Residential Houses." , no. : 1.
The question of building sustainable in a geographical locality is inexorably linked to cost. In 2011, one of the authors built a sustainable house that was (at the time) the highest certified sustainable home based on the National Association of Home Builder’s standards for sustainable construction. This Texas house has been used for residential and research purposes for the past decade. In this case study, the authors evaluate components of the construction and their effectiveness as well as unseen secondary and tertiary effects. Some of the specific components discussed are home site placement; rainwater harvesting (100% of residential requirements); aerobic septic system; grid-tied solar array power; electric car charging; geothermal heating and cooling; reclaimed wood framing; spray foam installation; selection of windows, fixtures, and appliances; on-demand electric water heaters for guest areas; generator backups; and use of local items. Electric bills and water system improvements are discussed in detail, as improvements were made as part of residential and research requirements. This case study suggests that the financial outlay is worth the extra up-front costs if residents in this geographical area and climate will occupy the residence 7 years.
Lawrence Fulton; Bradley Beauvais; Matthew Brooks; Clemens Scott Kruse; Kimberly Lee. Green for the Environment and Green for the Pocketbook: A Decade of Living Sustainably. 2020, 1 .
AMA StyleLawrence Fulton, Bradley Beauvais, Matthew Brooks, Clemens Scott Kruse, Kimberly Lee. Green for the Environment and Green for the Pocketbook: A Decade of Living Sustainably. . 2020; ():1.
Chicago/Turabian StyleLawrence Fulton; Bradley Beauvais; Matthew Brooks; Clemens Scott Kruse; Kimberly Lee. 2020. "Green for the Environment and Green for the Pocketbook: A Decade of Living Sustainably." , no. : 1.
Background More than 18 million Americans are currently suffering from alcohol use disorder (AUD): a compulsive behavior of alcohol use as a result of a chronic, relapsing brain disease. With alcohol-related injuries being one of the leading causes of preventable deaths, there is a dire need to find ways to assist those suffering from alcohol dependence. There still exists a gap in knowledge as to the potential of telemedicine in improving health outcomes for those patients suffering from AUD. Objective The purpose of this systematic review was to evaluate the measures of effectiveness, efficiency, and quality that result from the utilization of telemedicine in the management of alcohol abuse, addiction, and rehabilitation. Methods This review was conducted utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The articles used in this analysis were gathered using keywords inclusive of both telemedicine and alcohol abuse, which were then searched in the Cumulative Index to Nursing and Allied Health Literature, Cochrane, and MEDLINE (PubMed) databases. A total of 22 articles were chosen for analysis. Results The results indicated that telemedicine reduced alcohol consumption. Other common outcomes included reduced depression (4/35, 11%), increased patient satisfaction (3/35, 9%), increase in accessibility (3/35, 9%), increased quality of life (2/35, 6%), and decreased cost (1/35, 3%). Interventions included mobile health (11/22, 50%), electronic health (6/22, 27%), telephone (3/33, 14%), and 2-way video (2/22, 9%). Studies were conducted in 3 regions: the United States (13/22, 59%), the European Union (8/22, 36%), and Australia (1/22, 5%). Conclusions Telemedicine was found to be an effective tool in reducing alcohol consumption and increasing patients’ accessibility to health care services or health providers. The group of articles for analysis suggested that telemedicine may be effective in reducing health care costs and improving the patient’s quality of life. Although telemedicine shows promise as an effective way to manage alcohol-related disorders, it should be further investigated before implementation.
Clemens Scott Kruse; Kimberly Lee; Jeress B Watson; Lorraine G Lobo; Ashton G Stoppelmoor; Sabrina E Oyibo. Measures of Effectiveness, Efficiency, and Quality of Telemedicine in the Management of Alcohol Abuse, Addiction, and Rehabilitation: Systematic Review. Journal of Medical Internet Research 2020, 22, e13252 .
AMA StyleClemens Scott Kruse, Kimberly Lee, Jeress B Watson, Lorraine G Lobo, Ashton G Stoppelmoor, Sabrina E Oyibo. Measures of Effectiveness, Efficiency, and Quality of Telemedicine in the Management of Alcohol Abuse, Addiction, and Rehabilitation: Systematic Review. Journal of Medical Internet Research. 2020; 22 (1):e13252.
Chicago/Turabian StyleClemens Scott Kruse; Kimberly Lee; Jeress B Watson; Lorraine G Lobo; Ashton G Stoppelmoor; Sabrina E Oyibo. 2020. "Measures of Effectiveness, Efficiency, and Quality of Telemedicine in the Management of Alcohol Abuse, Addiction, and Rehabilitation: Systematic Review." Journal of Medical Internet Research 22, no. 1: e13252.
BACKGROUND Computerized decision support systems (CDSSs) are software programs that support the decision making of practitioners and other staff. Other reviews have analyzed the relationship between CDSSs, practitioner performance, and patient outcomes. These reviews reported positive practitioner performance in over half the articles analyzed, but very little information was found for patient outcomes. OBJECTIVE The purpose of this review was to analyze the relationship between CDSSs, practitioner performance, and patient medical outcomes. PubMed, CINAHL, Embase, Web of Science, and Cochrane databases were queried. METHODS Articles were chosen based on year published (last 10 years), high quality, peer-reviewed sources, and discussion of the relationship between the use of CDSS as an intervention and links to practitioner performance or patient outcomes. Reviewers used an Excel spreadsheet (Microsoft Corporation) to collect information on the relationship between CDSSs and practitioner performance or patient outcomes. Reviewers also collected observations of participants, intervention, comparison with control group, outcomes, and study design (PICOS) along with those showing implicit bias. Articles were analyzed by multiple reviewers following the Kruse protocol for systematic reviews. Data were organized into multiple tables for analysis and reporting. RESULTS Themes were identified for both practitioner performance (n=38) and medical outcomes (n=36). A total of 66% (25/38) of articles had occurrences of positive practitioner performance, 13% (5/38) found no difference in practitioner performance, and 21% (8/38) did not report or discuss practitioner performance. Zero articles reported negative practitioner performance. A total of 61% (22/36) of articles had occurrences of positive patient medical outcomes, 8% (3/36) found no statistically significant difference in medical outcomes between intervention and control groups, and 31% (11/36) did not report or discuss medical outcomes. Zero articles found negative patient medical outcomes attributed to using CDSSs. CONCLUSIONS Results of this review are commensurate with previous reviews with similar objectives, but unlike these reviews we found a high level of reporting of positive effects on patient medical outcomes.
Clemens Scott Kruse; Nolan Ehrbar. Effects of Computerized Decision Support Systems on Practitioner Performance and Patient Outcomes: Systematic Review (Preprint). 2019, 1 .
AMA StyleClemens Scott Kruse, Nolan Ehrbar. Effects of Computerized Decision Support Systems on Practitioner Performance and Patient Outcomes: Systematic Review (Preprint). . 2019; ():1.
Chicago/Turabian StyleClemens Scott Kruse; Nolan Ehrbar. 2019. "Effects of Computerized Decision Support Systems on Practitioner Performance and Patient Outcomes: Systematic Review (Preprint)." , no. : 1.
Background Computerized decision support systems (CDSS) are software programs that support the decision making of practitioners and other staff. Other reviews have analyzed the relationship between CDSS, practitioner performance, and patient outcomes. These reviews reported positive practitioner performance in over half the articles analyzed, but very little information was found for patient outcomes. The purpose of this review was to analyze the relationship between CDSS, practitioner performance, and patient medical outcomes. PubMed, CINAHL, and Cochrane databases were queried.Methods 27 articles were chosen based on year published (last ten years), high quality source, and discussion of the relationship between the use of CDSS as an intervention and links to practitioner performance or patient outcomes. Reviewers used an Excel spreadsheet to collect information on the relationship between CDSS and practitioner performance or patient outcomes. Reviewers also collected observations of participants, intervention, comparison with control group, and outcomes (PICO) along with those showing implicit bias. Articles were analyzed by multiple reviewers following the Kruse Protocol for systematic reviews. Data were organized into multiple tables for analysis and reporting.Results Fourteen articles (52%) discussed positive practitioner performance, three articles (11%) found no difference in practitioner performance, ten articles (37%) did not discuss practitioner performance. Zero articles reported negative practitioner performance. Fifteen articles (56%) discussed positive patient medical outcomes, two articles (7%) found no statistically significant difference in medical outcomes between intervention and control groups, and ten articles (37%) did not discuss medical outcomes. Zero articles found negative patient medical outcomes.Conclusions Results of this review are commensurate with previous reviews with similar objectives, but unlike these reviews we found significant positive reporting of a positive effect on patient medical outcomes. Our findings support adoption of decision support systems.
Clemens Scott Kruse; Nolan Ehrbar. What are the Effects of Computerized Decision Support Systems on Practitioner Performance and Patient Outcomes. 2019, 1 .
AMA StyleClemens Scott Kruse, Nolan Ehrbar. What are the Effects of Computerized Decision Support Systems on Practitioner Performance and Patient Outcomes. . 2019; ():1.
Chicago/Turabian StyleClemens Scott Kruse; Nolan Ehrbar. 2019. "What are the Effects of Computerized Decision Support Systems on Practitioner Performance and Patient Outcomes." , no. : 1.