Electronic health record (EHR) systems were designed to enhance clinical decision-making, yet the way data is organized and displayed can create significant cognitive demands for physicians. This study examines how EHR data usability (data quality, data completeness, and data-driven use) and system usability jointly shape physicians’ cognitive load. Using survey responses from 564 physicians across 32 specialties, we tested a mediated model with covariance-based structural equation modeling. Reliability and validity were assessed through standard psychometric criteria. Findings show that stronger data usability increases germane cognitive load, promoting deeper engagement with clinically meaningful information. In contrast, higher system usability reduces extraneous cognitive load by aligning interface design with clinical workflow and minimizing navigation-related effort. Information overload partially mediated these effects, suggesting that better data usability helps physicians better filter irrelevant data and stay focused on diagnostically relevant cues. Overall, the results highlight two levers for improving cognitive performance: enhancing system usability lowers unnecessary cognitive effort and documentation-related errors, while improving data usability supports reasoning-intensive diagnostic work. Optimizing both fosters balanced cognitive load and more sustainable, error-resilient clinical decision-making.

Objectives: Through the lens of self-determination theory, this quantitative study investigates how patient-provider collaboration through perceived shared decision -making (SDM) and autonomy support impact type 2 diabetes (T2D) outcomes. Methods: We sampled 474 individuals over 18 years old who self -identified as having T2D. Completed and valid responses were received from 378 participants from two separate groups in an online survey. Data was analyzed using the IBM Statistical Package for Social Sciences (SPSS), AMOS package, version 28, and Mplus, version 8.8. Results: Patient -provider collaboration through autonomy support improved treatment satisfaction (beta = .16, p < .05) and self -management adherence (beta = .43, p < .001). While collaboration through SDM improved treatment satisfaction (beta = .25, p < .01), it worsened SM adherence (beta = -.31, p < .001). The negative impact of SDM on self -management adherence was mitigated by our moderator, coping ability. However, coping ability minimally impacted treatment satisfaction and SM adherence when autonomous support was provided. Conclusions: Autonomy support increases treatment satisfaction and self -management adherence. SDM enhances treatment satisfaction but may adversely affect self -management adherence. The study also suggests that coping ability can mitigate the negative effect of SDM on self -management adherence, although its influence is limited when autonomy support is provided by the provider. Practical Implications: For providers, SDM and autonomy support permits shared power over treatment decisions while fostering independence over self -management tasks. Providers should evaluate patients' coping ability and adapt their approach to care based on the patient's coping capacity.

Background COVID-19 disrupted healthcare routines and prompted rapid telemedicine implementation. We investigated the drivers of visit modality selection (telemedicine versus in-person) in primary care clinics at an academic medical centre.Methods We used electronic medical record data from March 2020 to May 2022 from 13 primary care clinics (N = 21,031 new, N = 207,292 return visits), with 55% overall telemedicine use. Hierarchical logistic regression and cross-validation methods were used to estimate the variation in visit modality explained by the patient, clinician and visit factors as measured by the mean-test area under the curve (AUC).Results There was significant variation in telemedicine use across clinicians (ranging from 0-100%) for the same visit diagnosis. The strongest predictors of telemedicine were the clinician seen for new visits (mean AUC of 0.79) and the primary visit diagnosis for return visits (0.77). Models based on all patient characteristics combined accounted for relatively little variation in modality selection, 0.54 for new and 0.58 for return visits, respectively. Amongst patient characteristics, males, patients over 65 years, Asians and patient's with non-English language preferences used less telemedicine; however, those using interpreter services used significantly more telemedicine.Conclusion Clinician seen and primary visit diagnoses were the best predictors of visit modality. The distinction between new and return visits and the minimal impact of patient characteristics on visit modality highlights the complexity of clinical care and warrants research approaches that go beyond linear models to uncover the emergent causal effects of specific technology features mediated by tasks, people and organisations.

The persistent difficulty of defining the mechanisms of interprofessional learning that can lead to collaborative behavior poses a challenge to evidence-based curricular design. To begin the process of building a framework for curricular development we used an inductive approach to better understand the lived experience of students engaged in an interprofessional activity. Utilizing methods from grounded theory, we analyzed reflective essays from an interprofessional classroom-based workshop for early learners at Case Western Reserve University. Students from four professional schools (medicine, nursing, social work, and dentistry) participated in facilitator guided small groups for an interactive, case-based, tabletop simulation workshop. Written reflections (N = 245) were collected, and a coding scheme was iteratively developed through constant comparison analysis in the review of a random subsample of essays (n = 19), and saturation was achieved in the second subset (n = 15). Second-order themes and four aggregate dimensions arose from the data. Aggregate dimensions were integrated into a proposed framework for the interprofessional learning process, including factors identified as necessary for the learning to occur. In this report, we describe the development of this preliminary framework, examine its components, and demonstrate potential utility in relation to established theory and research.

Background/ObjectiveThe prevalence of chronic pain and its links to the opioid epidemic have given way to widespread aims to improve pain management care and reduce opioid use, especially in rural areas. Pain Management Specialty Care Access Network-Extension for Community Health Outcomes (VA-ECHO) promotes increased pain care access to rural Veterans through knowledge sharing from specialists to primary care providers (PCPs). We explored PCP participants' experiences in VA-ECHO and pain management care. MethodsThis qualitative study is based on a descriptive secondary analysis of semi-structured interviews (n = 10) and 3 focus groups with PCPs participating in VA-ECHO from 2017-2019. A rapid matrix analysis approach was used to analyze participants' responses. ResultsVA-ECHO was an effective workforce development strategy for meeting PCPs' training needs by providing pain management knowledge and skills training (eg alternative care approaches and communicating treatment options). Having protected time to participate in VA-ECHO was a challenge for many PCPs, mitigated by leadership and administrative support. Participants who volunteer to participate had more positive experiences than those required to attend. ConclusionsVA-ECHO could be used for meeting the workforce development needs of PCPs. Respondents were satisfied with the program citing improvement in their practice and increased confidence in providing pain management care to Veterans despite some challenges to participation. These findings offer insight into using VA-ECHO to meet the VHA's workforce development to improve Veterans' access to pain management care. The ECHO model presents opportunities for workforce development in large complex healthcare systems and garnering ongoing support for this training model is necessary for promoting workforce development for PCPs.

OBJECTIVE To examine characteristics that are associated with receipt of Aid and Attendance (A&A), an enhanced pension benefit for Veterans who qualify on the basis of needing daily assistance, among Veterans who receive pensions. DATA SOURCES Secondary data analysis of 2016-2017 national VA administrative data linked with Medicare claims. STUDY DESIGN Observational study examining sociodemographic, medical, and healthcare utilization characteristics associated with receipt of A&A among Veterans receiving pension. PRINCIPAL FINDINGS In 2017, 9.7% of Veterans with pension newly received the A&A benefit. The probability of receiving A&A among black and Hispanic pensioners was 4.6 percentage points lower than for white pensioners (95%CI = -0.051, -0.042). Married Veterans receiving pension had a 4.4-percentage point higher probability of receiving A&A (95%CI = 0.039, 0.048). Most indicators of need for assistance (eg, home health utilization, dementia, stroke) were associated with significantly higher probabilities of receiving A&A, with notable exceptions: pensioners with a diagnosis of Post-Traumatic Stress Disorder (marginal effect = -0.029 95%CI = -0.037, -0.021) or enrolled in Medicaid (marginal effect = -0.053, 95%CI = -0.057, -0.050) had lower probabilities of receiving A&A. Unadjusted and adjusted rates of receiving A&A among Veterans receiving pension varied by VA medical center. CONCLUSIONS This study identified potential inequities in receipt of the A&A enhanced pension among a sample of Veterans receiving pension. Increased Veteran outreach, provider education, and VA office coordination can potentially reduce inequities in access to this benefit.

Background: New models of care delivery are necessary to meet workforce needs while delivering expert care in neurorehabilitation. Therefore, we sought to develop and assess the implementation of a new model of care for neurorehabilitation using a 5-member team of therapists (5-Team Model) for the treatment of individuals with chronic stroke, rather than a conventional single-therapist model. Methods: A mixed methods approach was employed; continuous quality improvement methods and quasi-experimental pre-test/post-test methods were used to assess the effectiveness of the new model. Six chronic stroke patients participated in an upper limb neurorehabilitation motor learning protocol 5 days/week, 5 hours/day (60 sessions; 300 hours); treatment was administered using the 5-Team Model approach to treatment. Results: Mean improvement on the Fugl Meyer (FM) was 11.5 points. All six participants demonstrated improvement on Fugl Meyer that was within or beyond the minimal clinically important difference (MCID) range of 4.25-7.25 points for chronic stroke. Results indicated that the 5-Team Model was effective in implementing care. Conclusions: The 5-Team Model for neurorehabilitation was successfully implemented, with patient hand-off every day to a different therapist; it produced clinically significant improvement on a measure of coordination (FM) which is comparable to or better than prior reports from a standard care model. This new model of care met the needs of the research team workforce for flexibility, while maintaining the level of quality of care. Successful implementation required addressing a series of hindering factors in an iterative manner and enhancing promoting factors. These elements included the context within which the change was implemented, the methods used in implementing the change, the evidence that the change was successful, and communication that the change was successful. The context requirements included existing framework and participating model members who were willing to exert the required effort for success, model champions. This high level of enthusiastic participation along with strong leadership contributed to long-term success, sustainability.

This paper is based on findings of a qualitative study of 27 project team members functioning as multiteam systems in financial services firms. The findings included developing a process model of communication that was evident in successful project teams, but absent in unsuccessful ones. The distinctive features of the communication practices displayed by successful project teams is that they recognized the need for and constructed a shared understanding of the organizational, technological, and economic reality they were confronting. This agreed upon sense of the key elements of the project's socio-technical context, is neither a

Introduction: As the population ages, the number of older adults with diabetes mellitus will continue to rise. The burden of diabetes on older adults is significant due to the disease itself, its complications, and its treatments. This is compounded by geriatric syndromes such as frailty and cognitive dysfunction. Consequently, health and diabetes-related quality of life (QoL) are diminished. Areas covered: This article reviews the value of assessing QoL in providing patient-centered care and the associations between QoL measures and health outcomes. The determinants of QoL particular to diabetes and the older population are reviewed, including psychosocial, physical, and cognitive burdens of diabetes and aging and the impact of hypoglycemia on QoL. Strategies are described to alleviate these burdens and improve QoL, and barriers to multidisciplinary patient-centered care are discussed. QoL measurement instruments are reviewed. Expert opinion: The goals of treating diabetes and its complications should be considered carefully along with each patient's capacity to withstand the burdens of treatment. This capacity is reduced by socioeconomic, psychological, cognitive, and physical factors reduces this capacity. Incorporating measurement of HRQoL into clinical practices is possible, but deficiencies in the systems of health-care delivery need to be addressed to facilitate their use.

For a project to be successful team members must be aligned with each other on their goal. The purpose of this study was to understand how a cross-functional project team engages in accepting a project goal as real. We framed our study using shared reality theory and a qualitative approach to analyze the video and audio recorded meetings of three cross-functional project teams over a four-month period in a mid-sized private fintech firm. We proposed that the establishment of a goal as a project teams reality requires the integration of functional and organizational identity for the project team to align. We found that when teams faced events of uncertainty related to their goal, the team that had integrated their goal as reality had reconciled identity. Teams that had not accepted their goal as reality engaged in continuous interpretations of an events meaning and challenged each other’s functional identity. Given this validation we then examined how the goal aligned with the organization’s identity in the form of their mission statement. We found that the team’s inability to create a shared goal was because the goal itself conflicted with the organization’s identity. Functional team members have an identity that is partially supported by this identity rendering the integration of the goal as reality impossible. The findings of this study contribute an important understanding about the interrelationship between organizational goals and identity alignment. It exposes the critical role goal formation plays in maintaining a coherent organizational story so that functional team members may correctly act their part. This research also extends goal theory by considering the implications of the relational context of a goal within the organizational context.

Project structures have become a dominating form to organize and accomplish work in firms today. This study focused on firms that source the functional expertise needed to support project implementations on a temporary basis from their organizational hierarchy. In this matrixed structure, individuals reside in two social worlds, that of the project team and that of their functional team. The purpose of this quantitative study was to understand the effect of social identity on cross-functional project teams’ communication and their ability to develop a shared reality with other project team members. In this study, we surveyed 212 members of cross-functional project teams in the financial services sector. We found that a strong functional identity was positively related to the ability of an individual to understand what is being communicated from another discipline. The ability to understand someone from another discipline was positively related to a successful project outcome. This study contributes to the literature on team social identity by demonstrating how it is mediated by effective communication across functional boundaries to create successful project outcomes.

Introduction:. Electronic Medical Records provide new opportunities for studying the historical condition and dynamics of individual patients and populations to enable new insights that may lead to improved care and treatment. Diabetes is a prime target for new analyses as it is a chronic condition that affects 1 in 10 of the U.S. adult population and causes substantial disability and loss of life. Methods:. We take typical physiological measures from 3 healthcare appointments of 1,711 diabetic patients and extract combined measures that capture the overall conditions of patients and the structure of the population. Further, we examined the dynamics of individual patients across appointments in this combined measure space and examined regions associated with variability in clinical measures. Results:. Our results suggest that the dynamics of standard measures may aid evaluation of the risk of adverse events, and their utility should be tested in medical trials. Conclusions:. Dynamic variability of vital signs and standard measures may reflect a loss of homeostasis, associated physiological instability, and potential for adverse events that can be estimated using the proposed method.

Much of the brand alliance literature focuses on the publicly espoused visible catalyst to alliance change, that of resource enhancement and market adaptation. This research suggests members are profoundly affected by less visible, less apparent constructs of system structure, governance, stakeholder aspiration pressures, and relationships. While the power to influence brand alliance decisions lies with executive membership, a system that lacks sufficient structure, governance, or relationships can disempower executive members, making them vulnerable to stakeholder aspiration pressure. Relationships can have an inverse effect enhancing a member’s agency to focus on their view of mission, create stability, and improve the predictability of the system.