| This research addresses two major research topics: (1) the role of nursing informatics in improving clinical decision-making and reducing errors, and (2) acceptance and adoption of health information technology (IT) for improved patient safety and quality. The goal of this research was to determine whether preventable adverse outcomes in long-term care (LTC) settings such as nursing homes could be reduced by providing prospective computerized information to alert nursing and other staff to the resident-specific risk factors and likelihood of the problem occurring, so that preventive actions could be taken. A quasi-experimental research design was used to compare outcomes between nursing homes that had access to this information via web-based risk reports with a matched control group of nursing homes that did not have access to the risk reports.; This research in patient safety and nursing informatics is pertinent to LTC, and focuses on two very common, serious, and preventable patient safety issues---falls and pressure ulcers, which account for an estimated 75% of all nursing home litigation and often result in poor regulatory surveys.; Most nursing home staff do not have timely and ready access to their own resident assessment data called the Minimum Data Set (MDS), despite the fact that nursing homes collect and submit this data at least every quarter. Clinical support tools for nurses, especially LTC nurses, have been limited and slow to be adopted, due to many factors, such as low investment in IT and computer training, and the lack of useful, high-quality clinical decision-support applications relevant to the nursing home population.; The MDS, risk assessment data, and surveys and interviews with nursing home staff were used to determine if the MDS-based risk models predicted falls and pressure ulcers better than common risk assessment tools, and to identify factors that facilitated and inhibited use and integration of the computerized clinical decision-making tools by nursing home staff. These factors included nursing home characteristics, facilitation, and organizational climate. A framework for understanding the use of new informatics tools is presented, based on research on organizational culture, change, and adoption of evidence-based information in health care. |
