Papers by Karl Rethemeyer
BMC Public Health, Feb 4, 2022
Background: Death from cardiovascular disease (CVD) has been a longstanding public health challen... more Background: Death from cardiovascular disease (CVD) has been a longstanding public health challenge in the US, whereas death from opioid use is a recent, growing public health crisis. While population-level approaches to reducing CVD risk are known to be effective in preventing CVD deaths, more targeted approaches in high-risk communities are known to work better for reducing risk of opioid overdose. For communities to plan effectively in addressing both public health challenges, they need information on significant community-level (vs individual-level) predictors of death from CVD or opioid use. This study addresses this need by examining the relationship between 1) county-level social determinants of health (SDoH) and CVD deaths and 2) county-level SDoH and opioid-use deaths in the US, over a ten-year period (2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018). Methods: A single national county-level ten-year 'SDoH Database' is analyzed, to address study objectives. Fixedeffects panel-data regression analysis, including county, year, and state-by-year fixed effects, is used to examine the relationship between 1) SDoH and CVD death-rate and 2) SDoH and opioid-use death-rate. Eighteen independent (SDoH) variables are included, spanning three contexts: socio-economic (e.g., race/ethnicity, income); healthcare (e.g., system-characteristics); and physical-infrastructure (e.g., housing). Results: After adjusting for county, year, and state-by-year fixed effects, the significant county-level positive SDoH predictors for CVD death rate were, median age and percentage of civilian population in armed forces. The only significant negative predictor was percentage of population reporting White race. On the other hand, the four significant negative predictors of opioid use death rate were median age, median household income, percent of population reporting Hispanic ethnicity and percentage of civilian population consisting of veterans. Notably, a dollar increase in median household income, was estimated to decrease sample mean opioid death rate by 0.0015% based on coefficient value, and by 20.05% based on effect size. The study provides several practice and policy implications for addressing SDoH barriers at the county level, including population-based approaches to reduce CVD mortality risk among people in military service, and
Proceedings - Academy of Management, Jul 1, 2012
Rangachari P, Rissing P, Wagner P, et al. A baseline study of communication networks related to e... more Rangachari P, Rissing P, Wagner P, et al. A baseline study of communication networks related to evidence-based infection prevention practices in an intensive care unit.
Journal of hospital management and health policy, Sep 1, 2019
Similar to issues faced in health systems across USA, AU Health, based in Augusta, Georgia, faced... more Similar to issues faced in health systems across USA, AU Health, based in Augusta, Georgia, faced a scenario of low physician engagement in, and limited-use of its Electronic Health Record (EHR) Medication Reconciliation (MedRec) technology, which translated to high rates of medication discrepancies and low accuracy of the patient's active medication list, during transitions of care. In fall 2016, a two-year grant was secured from the U.S. Agency for Healthcare Research and Quality (AHRQ), to pilot a Social Knowledge Networking (SKN) system pertaining to "EHR-MedRec," to enable AU Health to progress from "limited use" of EHR MedRec technology, to "meaningful use." The rationale behind an SKN system, is that it could provide a platform for inter-professional knowledge exchange on practice issues related to EHR MedRec, across diverse provider subgroups and care settings, to highlight adverse consequences of gaps in practice for patient safety, and emphasize the value of adhering to best-practices in EHR MedRec. This, in turn, is expected to increase provider engagement in addressing issues related to EHR MedRec, and promote inter-professional learning of best-practices, to create a foundation for practice change or improvement (e.g., Meaningful Use of EHR MedRec technology).
Journal of healthcare leadership, Mar 1, 2019
Background: Similar to issues faced in health systems across the USA, AU Health faced a scenario ... more Background: Similar to issues faced in health systems across the USA, AU Health faced a scenario of low physician engagement in and limited use of its Electronic Health Record (EHR) Medication Reconciliation (MedRec) technology, which translated to high rates of medication discrepancies and low accuracy of the patient's active medication list, during transitions of care. In fall 2016, a 2-year research grant was secured to pilot a Social Knowledge Networking (SKN) system on "EHR MedRec" to enable AU Health to progress from "limited use" of EHR MedRec technology to "meaningful use." Purpose: The aims of this study were to 1) examine dynamics of interprofessional knowledge exchange and learning related to EHR MedRec on the SKN system and 2) explore associations between "SKN Use" and "Meaningful Use (MU) of EHR MedRec," with the latter being assessed in terms of adherence to best practices in EHR MedRec. Methods: Over a 1-year period, 50 SKN Users (practitioners from inpatient and outpatient medicine settings), participated in discussing issues related to EHR MedRec, moderated by five SKN Moderators (senior administrators). Qualitative analysis was used to understand dynamics of interprofessional knowledge exchange and descriptive analysis was used to examine trends in two measures of MU of EHR MedRec, identified for the study. Results: Interprofessional knowledge exchanges related to EHR MedRec on the SKN system, progressed from "problem statements" to "problem-solving statements" to "IT system education" to "best-practice assertions" to "culture change assertions" to "collective learning (aha) moments" to lay a foundation for practice change. These interprofessional learning dynamics were associated with distinct improvement trends in both measures of MU of EHR MedRec technology. Conclusion: Results suggest that an SKN system could be a valuable tool in enabling MU of EHR MedRec technology. The study helps identify strategies for the creation of "learning health systems," to enable successful change implementation in healthcare organizations.
A Health System's Pilot Experience with Using Mobile Social Knowledge Networking (SKN) Technology to Enable Meaningful Use of EHR Medication Reconciliation Technology
AMIA ... Annual Symposium proceedings. AMIA Symposium, 2019
In fall 2016, a two-year grant was secured from AHRQ, to pilot a mobile Social Knowledge Networki... more In fall 2016, a two-year grant was secured from AHRQ, to pilot a mobile Social Knowledge Networking (SKN) system on Electronic Health Record (EHR) Medication Reconciliation (MedRec), to enable Augusta University (AU) Health System, to progress from "limited-use" of EHR-MedRec technology, to "meaningful-use." The rationale is that an SKN system would enable knowledge exchange on practice issues related to EHR-MedRec, across diverse provider subgroups and settings-of-care, which, in turn, is expected to increase provider engagement, promote inter-professional learning of best-practices, and provide a foundation for practice change (e.g., Meaningful Use of EHR-MedRec technology). Over a one-year period, 50 SKN Users (physicians, nurses, and pharmacists from outpatient-and-inpatient-medicine services), participated in discussing issues-related-to-EHR-MedRec, moderated by 5 SKN Moderators (senior administrators). This paper describes the health system's experience...
A Mixed-Method Study of Practitioners' Perspectives on Issues Related to EHR Medication Reconciliation at a Health System
Quality management in health care, Apr 1, 2019
Background: In an effort to reduce medication discrepancies during transitions of care and improv... more Background: In an effort to reduce medication discrepancies during transitions of care and improve accuracy of the patient's medication list, AU Health conducted a study to identify a comprehensive set of issues related to electronic health record (EHR) medication reconciliation (MedRec) from the perspective of practitioners directly involved in the EHR MedRec process. Methods: An exploratory mixed-method design was used. The 2-round study included 15 individual interviews, followed by a survey of 200 practitioners (ie, physicians, nurses, and pharmacists) based in the outpatient and inpatient medicine service at AU Health. Results: Thematic analysis of interview data identified 55 issue items related to EHR MedRec under 9 issue categories. The survey sought practitioners' importance rating of all issue items identified from interviews. A total of 127 (63%) survey responses were received. Factor analysis served to validate the following 6 of the 9 issue categories, all of which were rated “important” or higher (on average), by over 70% of all respondents: (1) care coordination (CCI); (2) patient education (PEI); (3) ownership and accountability (OAI); (4) processes-of-care (PCI); (5) IT-related (ITRI); and (6) workforce training (WTI). Significance testing of importance rating by professional affiliation revealed no statistically significant differences for CCI and PEI, and some statistically significant differences for OAI, PCI, ITRI, and WTI. Conclusion: There were 2 key gleanings from the issues related to EHR MedRec unearthed by this study: (1) there was an absence of shared understanding among practitioners, of the value of EHR MedRec in promoting patient safety, which contributed to workarounds, and suboptimal use of the EHR MedRec system; and (2) there was a sociotechnical dimension to many of the issues, creating an added layer of complexity. These gleanings, in turn, provide insights into best practices for managing both (1) clinical transitions of care in the EHR MedRec process and (2) sociotechnical challenges encountered in EHR MedRec implementation.
Awareness of Evidence-Based Practices Alone Does Not Translate to Implementation
Quality management in health care, Apr 1, 2013
This article offers a scholarly review and perspective on the potential of &amp;amp;amp;amp;q... more This article offers a scholarly review and perspective on the potential of &amp;amp;amp;amp;quot;implementation research&amp;amp;amp;amp;quot; to generate incremental, context-sensitive, evidence-based management strategies for the successful implementation of evidence-based practices (EBPs) (such as the &amp;amp;amp;amp;quot;central line bundle&amp;amp;amp;amp;quot;). Many hospitals have difficulty consistently implementing EBPs at the unit level. This problem has been broadly characterized as &amp;amp;amp;amp;quot;change implementation failure&amp;amp;amp;amp;quot; in health care organizations. The popular hospital response to this challenge has been to raise clinician awareness of EBPs through mandated educational programs. However, this approach has not always succeeded in changing practice. The health services research literature has emphasized the role of several organizational variables (eg, leadership, safety culture, organizational learning, teamwork and communication, and physician/staff engagement) in successful change implementation. Correspondingly, this literature has developed broad frameworks and programs for change in health care organizations. While these broad change frameworks have been successfully applied by some facilities to change practice, they are not incrementally actionable. As such, several facilities have not leveraged broad change frameworks because of resource and/or contextual limitations; a majority of hospitals continue to resort to mandated clinician education (awareness-building) for change implementation. The recent impetus toward &amp;amp;amp;amp;quot;implementation research&amp;amp;amp;amp;quot; in health care has the potential to generate incremental, context-sensitive, evidence-based management strategies for practice change. Authors discuss specific insights from a recently completed study on central line bundle implementation in 2 intensive care units in an academic health center. The study demonstrates that awareness of EBPs alone does not translate to implementation. More importantly, the study also identifies incremental, context-sensitive, evidence-based management strategies for successful implementation of EBPs at the unit level.
Journal of healthcare leadership, Jul 1, 2019
Background: In fall 2016, a 2-year grant was secured to pilot a Social Knowledge Networking (SKN)... more Background: In fall 2016, a 2-year grant was secured to pilot a Social Knowledge Networking (SKN) system pertaining to Electronic Health Record (EHR) Medication Reconciliation (MedRec), to enable Augusta University Health System to progress from "limited use" of EHR MedRec technology, to "meaningful use" (MU). A total of 50 "SKN users" (practitioners), participated in discussing practice issues related to EHR MedRec, over a 1-year period. These discussions were moderated by five "SKN moderators" (senior administrators). The pilot study, completed in fall 2018, found that inter-professional knowledge exchanges on the SKN, enabled several collective learning ("aha") moments to emerge. These learning dynamics in turn, were associated with distinct improvement trends in two measures of MU of EHR MedRec technology, identified for the study. A key takeaway was that an SKN could be a valuable tool in enabling MU of EHR MedRec technology. Purpose: The study's key findings related to the content and dynamics of inter-professional knowledge exchange on the SKN system, and their association with trends in measures of MU of EHR MedRec technology, have been described in a separate publication. This paper seeks to describe the structure of inter-professional knowledge exchange (or the pattern of connections) related to EHR MedRec, over the 1-year SKN period. Methods: Social network analysis (SNA) techniques were used to describe the structure of inter-professional knowledge exchange on the SKN system. Results: Results revealed that three of the five SKN moderators played a strong "collective brokerage" role in facilitating inter-professional knowledge exchange related to EHR MedRec, to enable learning and practice change. Together, they played complementary roles in reinforcing best-practice assertions, providing IT system education, and synthesizing collective learning moments, to enable "champions for change" to emerge from among SKN users. Conclusion: Results provide insight into the structure of effective knowledge-sharing networks for enabling inter-professional learning and practice change in health care organizations.
Since the start of the twenty-first century, the development of mobile technology has revolutioni... more Since the start of the twenty-first century, the development of mobile technology has revolutionized the primary modes of interactions between people, allowing for more timely, effective, and cost-efficient communications through computers and web-enabled "telepresence." In recent years, smartphone (e.g., iPhone, Android, Blackberry, Palm, Window Mobile, etc.) use has boomed. In 2010, twenty-eight percent of U.S. mobile phone subscribers used smartphones and forty-two percent of those who acquired a new mobile phone in the past six months chose a smartphone over a feature phone (i.e., a low-end mobile phone with less sophisticated computing capabilities than smartphone) (Nielsen Company, 2010). This change in cellphone preferences has brought into focus the concept of "perpetual contact" (Katz & Aakhus, 2002). Interpersonal interactions can be
Challenges in the Data Collection and Analysis of Big Data in the Public Sector
2015 Fall Conference: The Golden Age of Evidence-Based Policy, Nov 12, 2015
Journal of Applied Social Science, Aug 6, 2020
This paper explores the role of homophily with respect to demographic attributes on the formation... more This paper explores the role of homophily with respect to demographic attributes on the formation of friendships, focusing on the moderating effect of attribute salience and time effect. To address the research questions, we explored a data set collected from Master of Public Administration (MPA) students in four waves over a period of nearly a year. An actor-based model was employed to test various research hypotheses concerning the longitudinal evolution of a friendship network. As a result, we found that (1) salience of demographic attributes does not moderate the relationship between the attributes and friendship ties and (2) age homophily is associated with friendship formation only in the initial stage.
The past 10 years have been a period of enormous growth in efforts around father involvement, wit... more The past 10 years have been a period of enormous growth in efforts around father involvement, with local government systems attempting to meet the needs of the diverse father population. The Bay Area Fathering Indicators Data System (BAYFIDS) Project is designed to track and analyze the operation and impact of fathering programs and describe the nature of local and county policy efforts around fatherhood in the San Francisco Bay Area. This report expands in two ways on an earlier study conducted in 2000: (1) it offers through the directory an updated count of programs; and (2) it addresses directly policy changes in the nine counties as they relate to program development, implementation, expansion, and devolution. Chapter 1 of the report, the BAYFIDS directory, updates the findings regarding programs in the Bay Area as of Spring 2003. Chapter 2 summarizes data from telephone surveys with policymakers in county child support services, social services agencies, and county departments of education and with practitioners representing the "master group" from the 2000 study; the survey was to determine ways in which they have experienced change, problems, and possibilities. Chapter 3 discusses cross-cutting themes and offers conclusions. Survey findings revealed that fatherhood, male involvement, and unwanted fatherhood prevention were of relatively low priority for the social service agencies in the Bay Area. Practitioners suggested that child and family service organizations may have internalized some key ideas from the fatherhood movement and integrated them into their programs. Balanced against this picture for fathering efforts was the retrenchment found in publicly sponsored father support programs. (KB) Reproductions supplied by EDRS are the best that can be made from the original document.
Reproductions supplied by EDRS are the best that can be made from the original document.
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Papers by Karl Rethemeyer