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• Decentralization of health services and autonomy for hospital managers are important changes. • Hospital planning benefits include improvements in communication and resource management. • Lack of involvement of employees and inappropriate assessment impaired implementation of plans. • Technological, epidemiological and political factors affected management strategies. • Further hospital development will require appropriate resources, planning and management. To evaluate post-Soviet aspects of hospital management in Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan, considering indicators of health care and information on planning processes and factors that affect strategy in their hospitals. Data on indicators of health care were obtained from government agencies, the WHO and the World Bank. A survey of hospital managers in each of the countries was undertaken to obtain opinions on matters influencing the operation of their organizations. There was some increase in health expenditure for three countries and a recent decline for Kyrgyzstan. All countries had levels of out of pocket expenditure that were higher than recommended by WHO. Hospital bed occupancy was relatively constant. Average length of stay was higher than in European health systems. Managers in all countries reported greater motivation of staff in their work as a planning benefit. Difficulties with the implementation of plans were greater for Kyrgyzstan than the other countries. Inappropriate assessment during planning seemed important for two countries and changes in environment during implementation for two others. Issues with health policy and regulation, new health technologies, and changes in health behaviour and morbidity were considered significant by managers from all countries. The health care indicator data and survey findings may reflect differences between the countries in the rate of reorganization of hospital sectors, available resources and political circumstances. They point to areas in need of attention for future hospital planning and challenges for managers in maintaining essential health services. [ABSTRACT FROM AUTHOR]

Abstract Objective To evaluate the influence of a health technology assessment (HTA) on pediatric cochlear implantation (CI) in Kazakhstan and to provide a further perspective on the use of the technology in that country. Ideally, children should be implanted as young as possible, have adequate rehabilitation, and be integrated into the regular school system. Methods Administrative data for 2013–2016 relevant to pediatric CI in Kazakhstan were obtained from the Ministry of Health and from a survey of authorities in the 16 regions of the country. The data were compared with those for 2007–2012 used in preparation of the HTA report. Results Funding continued to be available only for unilateral CI, a clinical protocol for the procedure was finalized and availability of equipment for audiological screening had improved considerably. In Kazakhstan the proportion of children over 5 years old at implantation had decreased by 65%, while that for children less than 2 years old had increased from 12 to 35%. Rehabilitation of children post-implantation was limited by the small numbers of suitable specialists. There was an increase in numbers of children enrolled in schools for those with moderate or profound hearing impairment. The number of children educated in standard schools remains low. Conclusion The HTA made a useful contribution to the development of cochlear implantation services in Kazakhstan. The shortage of specialists for provision of rehabilitation and the limited placement of implanted children in general schools are matters for government decision - makers to consider. [ABSTRACT FROM AUTHOR]

Summary: At the request of Canadian health ministries, we reviewed recommendations in guidelines prepared by professional bodies on the referral of individuals to sleep laboratories. Searching electronic databases and the Internet, we found 37 guidelines that covered 18 applications of sleep laboratory investigation including obstructive sleep apnea, other respiratory disorders, obstructive sleep apnea and other conditions in children, sudden infant death syndrome, treatment for snoring, insomnia, depression with insomnia, narcolepsy, restless legs syndrome/periodic limb movement disorder, parasomnias and circadian rhythm disorders. We identified recommendations on referral of patients for sleep studies and assessed the quality and relevance of evidence cited in support of these. Of 81 recommendations, 46 were supported by evidence from primary investigations. Only six cases cited evidence from well-conducted, prospective controlled studies. Evidence was highly relevant in 18 cases, of some relevance in 22 and of little or no relevance in six. No evidence was provided in support of 31 recommendations, and in four cases the guideline had identified an absence of available evidence. Although the publications from professional bodies that were reviewed contain much detailed information, evidence supporting many recommendations is limited. There is a need for further, good quality, studies of many sleep laboratory applications. [Copyright &y& Elsevier]

• Electronic health records (EHR) support health centre programs for HIV/AIDS. • Differences in documentation between EHR and paper records increase workload. • There are challenges to consistently operating and managing the EHR system. • The EHR system cannot communicate with other health or government facilities. • EHR use should be integrated with all health structures and processes. To investigate barriers to the effective use of electronic health records (EHR) to improve health outcomes for HIV/AIDS care treatment in health centres in rural areas of Botswana. In a qualitative study interviews were held with 57 staff members at 32 health centres in rural and remote areas of the country. Closed and open-ended questions were used to gain insights into the implementation and use of the EHR system. Transcripts were analysed and evaluated using thematic coding and structured around themes through NVivo 11 data analysis software. Themes covered were: changes in nursing practice; EHR system support; non-use of EHR; lack of leadership commitment to EHR use; and risks of using EHR. A large majority of staff were confident users of the EHR, despite limited training. Many nursing staff reported changes in administrative duties as documentation with EHR was different from that used in paper-based records and reports to management. Lack of appropriate support led to challenges in consistent operation and management of the EHR system. There were risks of data corruption through equipment failures and security vulnerabilities. The EHR system could not communicate with outside healthcare providers or facilities, leading to loss of patient follow up and delays in obtaining results of laboratory tests. Progress has been made with a national EHR system to support HIV management in Botswana within small local facilities. However, nurses' perspectives indicate limitations in staff training, insufficient support for health centres, and lost communication between facilities. Such barriers led to continued delays in treatment and fragmentation of health records. These areas should be addressed in further development. [ABSTRACT FROM AUTHOR]

Presents a paper which examines the routine use of cost-effectiveness analysis in decisions by the Australian Pharmaceutical Benefits Advisory Committee with reference to drug and health technologies. Limitation of available material in the public domain; Information on the status of population and health; Evaluation of pharmaceuticals.

Purposes: This study aimed to compare between electronic medication administration records and paper-based records in the nursing time spent on various activities in a medication round and the medication administration processes followed by nurses in an Australian residential aged care home. It also aimed to identify the benefits and unintended adverse consequences of using the electronic medication administration records.Methods: Time-motion observation, taking of field notes, informal conversation and document review were used to collect data in two units of a residential aged care home. Each unit had one nurse administer medication. Seven nurses were observed over 12 morning shifts. Unit 1 used electronic medication administration records and Unit 2 used paper-based records.Results: No significant difference between the two units was found in the nursing time spent on various activities in a medication round, including documentation, verbal communication, medication administration, infection control and transit. Comparison of the medication administration processes between the electronic and paper-based medication administration records identified a procedural problem which violated the organization's documentation requirement. This problem was documenting before providing medication to a resident when using the paper-based records. It was not observed with the electronic medication administration records. Benefits of introducing the electronic medication administration records included improving nurses' compliance with documentation requirements, freedom from the error of signing twice, reducing the possibility of forgetting to medicate a resident, facilitating nurses to record the time of medication administration to a resident and increasing documentation space. Unintended adverse consequences of introducing the electronic medication administration records included inadequate information about residents, late addition of a new resident's medication profile in the records and nurses' forgetting to medicate a resident due to power outage of the portable device.Conclusions: The electronic medication administration records may not change nursing time spent on various activities in a medication round or substantially alter the medication administration processes, but can generate both benefits and unintended adverse consequences. Future research may investigate whether and how the adverse consequences can be prevented. [ABSTRACT FROM AUTHOR]

Introduction The nursing care plan plays an essential role in supporting care provision in Australian aged care. The implementation of electronic systems in aged care homes was anticipated to improve documentation quality. Standardized nursing terminologies, developed to improve communication and advance the nursing profession, are not required in aged care practice. The language used by nurses in the nursing care plan and the effect of the electronic system on documentation quality in residential aged care need to be investigated. Purpose To describe documentation practice for the nursing care plan in Australian residential aged care homes and to compare the quantity and quality of documentation in paper-based and electronic nursing care plans. Methods A nursing documentation audit was conducted in seven residential aged care homes in Australia. One hundred and eleven paper-based and 194 electronic nursing care plans, conveniently selected, were reviewed. The quantity of documentation in a care plan was determined by the number of phrases describing a resident problem and the number of goals and interventions. The quality of documentation was measured using 16 relevant questions in an instrument developed for the study. Results There was a tendency to omit ‘nursing problem’ or ‘nursing diagnosis’ in the nursing process by changing these terms (used in the paper-based care plan) to ‘observation’ in the electronic version. The electronic nursing care plan documented more signs and symptoms of resident problems and evaluation of care than the paper-based format (48.30 vs. 47.34 out of 60, P < 0.01), but had a lower total mean quality score. The electronic care plan contained fewer problem or diagnosis statements, contributing factors and resident outcomes than the paper-based system ( P < 0.01). Both types of nursing care plan were weak in documenting measurable and concrete resident outcomes. Conclusions The overall quality of documentation content for the nursing process was no better in the electronic system than in the paper-based system. Omission of the nursing problem or diagnosis from the nursing process may reflect a range of factors behind the practice that need to be understood. Further work is also needed on qualitative aspects of the nurse care plan, nurses’ attitudes towards standardized terminologies and the effect of different documentation practice on care quality and resident outcomes. [ABSTRACT FROM AUTHOR]

Highlights: [•] Assessment documentation practices are varying across aged care organizations. [•] EHRs produce higher amount and more comprehensive assessment data. [•] Electronic assessment forms are better signed and dated than the paper forms. [•] EHRs need to improve the completeness and timeliness of assessment documentation. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To describe the paper-based and electronic formats of resident admission forms used in several aged care facilities in Australia and to compare the extent to which resident admission information was documented in paper-based and the electronic health records. Methods: Retrospective auditing and comparison of the documentation quality of paper-based and electronic resident admission forms were conducted. A checklist of admission data was qualitatively derived from different formats of the admission forms collected. Three measures were used to assess the quality of documentation of the admission forms, including completeness rate, comprehensiveness rate and frequency of documented data element. The associations between the number of items and their completeness and comprehensiveness rates were estimated at a general level and at each information category level. Results: Various paper-based and electronic formats of admission forms were collected, reflecting varying practice among the participant facilities. The overall completeness and comprehensiveness rates of the admission forms were poor, but were higher in the electronic health records than in the paper-based records (60% versus 56% and 40% versus 29% respectively, p <0.01). There were differences in the overall completeness and comprehensiveness rates between the different formats of admission forms (p <0.01). At each information category level, varying degrees of difference in the completeness and comprehensiveness rates were found between different form formats and between the paper-based and the electronic records. A negative association between the completeness rate and the number of items in a form was found at each information category level (p <0.01), i.e., more data items designed in a form, the less likely that the items would be completely filled. However, the associations between the comprehensiveness rates and the number of items were highly positive at both overall and individual information category levels (p <0.01), suggesting more items designed in a form, more information would be captured. Conclusion: Better quality of documentation in resident admission forms was identified in the electronic documentation systems than in previous paper-based systems, but still needs to be further improved in practice. The quality of documentation of resident admission data should be further analysed in relation to its specific content. [Copyright &y& Elsevier]

Abstract: Purpose: To determine whether the introduction of an electronic nursing documentation system in a nursing home reduces the proportion of time nursing staff spend on documentation, and to use this information in evaluating the usefulness of the system in improving the work of nursing staff. Methods: An observational work sampling study was conducted in 2009 and 2010, 2months before, and 3, 6 and 12months after the introduction of an electronic nursing documentation system. An observer (ENM) used a work classification tool to record documentation activities being performed using paper and with a computer by nursing staff at particular times for periods of 5days. Results: Three hundred and eighty three (383) activities were recorded before implementation of the electronic system, 472 activities at 3months, 502 at 6months, and 338 at 12months after implementation. There was no significant difference between the proportion of time nursing staff spent on documentation 2months before and 3months after the implementation of the electronic system. Six months after implementation, the proportion of time on documentation increased significantly and after 12months, settled back to original levels that were recorded in the paper-based system. Over half of the proportion of time on documentation at 6 and 12months after implementation was spent on paper documentation tasks. Conclusion: Introduction of an electronic nursing documentation system did not reduce the proportion of time nursing staff spent on documentation. This may in part have been a result of the practice of documenting some information items on paper and others on a computer. To reduce the use of paper documentation or to achieve a paper-free documentation environment in this setting, an in-depth understanding of nursing staff''s information needs, and documentation workflow is necessary. [Copyright &y& Elsevier]

Abstract: Purpose: To date few studies have compared nursing home caregivers’ perceptions about the quality of information and benefits of nursing documentation in paper and electronic formats. With the increased interest in the use of information technology in nursing homes, it is important to obtain information on the benefits of newer approaches to nursing documentation so as to inform investment, organisational and care service decisions in the aged care sector. This study aims to investigate caregivers’ perceptions about the quality of information and benefits of nursing documentation before and after the introduction of an electronic documentation system in a nursing home. Methods: A self-administered questionnaire survey was conducted three months before, and then six, 18 and 31 months after the introduction of an electronic documentation system. Further evidence was obtained through informal discussions with caregivers. Results: Scores for questionnaire responses showed that the benefits of the electronic documentation system were perceived by the caregivers as provision of more accurate, legible and complete information, and reduction of repetition in data entry, with consequential managerial benefits. However, caregivers’ perceptions of relevance and reliability of information, and of their communication and decision-making abilities were perceived to be similar either using an electronic or a paper-based documentation system. Improvement in some perceptions about the quality of information and benefits of nursing documentation was evident in the measurement conducted six months after the introduction of the electronic system, but were not maintained 18 or 31 months later. Conclusions: The electronic documentation system was perceived to perform better than the paper-based system in some aspects, with subsequent benefits to management of aged care services. In other areas, perceptions of additional benefits from the electronic documentation system were not maintained. In a number of attributes, there were similar perceptions on the two types of systems. [Copyright &y& Elsevier]