Many states have introduced home visitation programs to improve the health of mothers and newborn infants. In South Carolina, the Postpartum/Infant Home Visit (P/IHV) program seeks to provide all Medicaid-eligible mothers and infants with at least one home visit by a nurse or other qualified health professional. In the summer 2002, the authors conducted a cost-benefit analysis of the P/IHV program using both qualitative and quantitative methods. This article describes the qualitative methods and findings from the larger study. Focus groups were held with nurses who provide P/IHV visits to gain insight into the structure and functioning of the P/IHV program, to hear firsthand the nurses' experiences with the program, and to provide guidance in developing the empiric model for measuring cost-benefit. Analysis of the focus-group data suggests that what actually occurs during a home visit is fairly standardized. Nurses indicated that they were knowledgeable about community resources and services available to the families they serve. Referral processes were identified as an important factor in determining whether a mother receives a home visit. Overall, the nurses felt that the home visit program has had a positive impact on the health and well-being of the mothers and infants served.
The majority of users of an Electronic Medical Record (EMR) at a family medicine clinic located in a small city in the western United States are currently quite dissatisfied with the system. The practice experienced a disastrous implementation of the EMR in 1994 and has not recovered. Although the level of dissatisfaction varies among the practice employees, several influential physicians are pushing to “pull the plug” and start over with a brand new system. The authors of this case studied this practice during a more comprehensive qualitative study of the impact of an EMR system on primary care. The practice’s negative experience was particularly noteworthy, because the other four practices in the larger study were satisfied with the EMR system. As with most system failures, there are multiple organizational and other factors that have contributed to the frustrations and dissatisfactions with the use of EMR within this practice.
The majority of users of an electronic medical record (EMR) at a family medicine clinic located in a small city in the western United States are currently quite dissatisfied with the system. The practice experienced a disastrous implementation of the EMR in 1994 and has not recovered. Although the level of dissatisfaction varies among the practice employees, several influential physicians are pushing to pull the plug and start over with a brand new system. The authors of this case studied this practice during a more comprehensive qualitative study of the impact of an EMR system on primary care. The practices negative experience was particularly noteworthy, because the other four practices in the larger study were satisfied with the EMR system. As with most system failures, there are multiple organizational and other factors that have contributed to the frustrations and dissatisfactions with the use of EMR within this practice.
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