Dissertation/Thesis Abstract

Factors affecting acceptance of an electronic continuity of care record for case management of persons living with HIV in New York City
by Schnall, Rebecca Berger, Ph.D., Columbia University, 2009, 208; 3393603
Abstract (Summary)

Information access, coordination of care, and continuity of care are precursors of successful outcomes for persons living with HIV (PLWH). Use of health information technology (HIT) can play a critical role in supporting chronic care management for PLWH, by providing access to health information and facilitating care coordination and continuity. Given the need for consolidating PLWH health information, a single electronic record, such as a Continuity of Care Record (CCR), provides the opportunity to improve quality of care and health outcomes. The goals of the overall study were to analyze the factors related to implementing a CCR, the SelectHealth Continuity of Care Document (SH-CCD) and to explore the information needs related to SH-CCD use from the perspective of case management of PLWH. Study participants were case managers who provide care to PLWH within the context of an HIV Medicaid managed care organization (SelectHealth) in four boroughs of New York City. Three distinct, but related studies were conducted.

In the qualitative focus group study, predisposing, enabling, and reinforcing factors related to acceptance of the CCR were examined from the perspective of case managers (N=37). Major themes by factor included: predisposing (client characteristics, confidentiality, and system functionality), enabling (user training and computer access), reinforcing (work efficiency, continuity of care, information quality, and communication). The findings of the cognitive walkthrough evaluation with four case managers suggested that the SH-CCD had usability problems that should be addressed before system implementation.

The findings from the information needs survey (N=94) revealed that case managers' experienced information needs while caring for PLWH and that the most frequently identified needs related to patient education (33.3%), patient data (23.4%), and referral resources (22.0%) accounting for 78.7% of all (N = 222) needs. This study also operationalized the constructs of the Technology Acceptance Model to determine case managers' acceptance of a prototype CCR with context-specific links. Overall, case managers found the prototype to be easy to use and useful and perceived few barriers to use. In a linear regression model, agency type and Internet use had a significant overall effect (p < .05) on Barriers to Use, but the R2</super> was small (0.72). Likewise, gender, ethnicity and Internet use had a significant overall effect (p < .05) on Behavioral Intention, but explained only a small proportion of the variance (R2 = .148). Barriers to Use, Perceived Ease of Use, and Perceived Usefulness explained 43.6% (p <.001) of the variance in Behavioral Intention to use a CCR with context-specific links. A CCR has the potential to promote information sharing focused on care coordination and transform the way that PLWH receive healthcare services.

Indexing (document details)
Advisor: Bakken, Suzanne
Commitee:
School: Columbia University
School Location: United States -- New York
Source: DAI-B 71/02, Dissertation Abstracts International
Source Type: DISSERTATION
Subjects: Nursing, Public health, Bioinformatics
Keywords: Case management, Continuity of care, Electronic records, HIV, New York City, Technology acceptance
Publication Number: 3393603
ISBN: 9781109604788
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