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Biomedical subjects

Bryan J Weiner

Publications and source records attributed to Bryan J Weiner.

17 recordsLinked to original sources
PubMed2006

Recruiting participants to cancer prevention clinical trials: lessons from successful community oncology networks.

PURPOSE/OBJECTIVES: To describe the organizational designs and task environments of community oncology networks with high accrual rates to cancer prevention clinical trials. DESIGN: Replicated case study design; structural contingency theory. SETTING: Local Community Clinical Oncology Programs (CCOPs) funded by the National Cancer Institute to test preventive and therapeutic interventions in community settings. SAMPLE: Primary sample: oncology professionals affiliated with four CCOPs ranking among the top 10 in earned cancer control accrual credits in fiscal years 1999-2003. Secondary sample: oncology professionals affiliated with three CCOPs ranking among the top 10 three to four times during the study period. A total of 63 people participated in the interviews. METHODS: Primary sample: on-site interviews with CCOP investigators, clinical research staff, and nononcology physicians. Secondary sample: telephone interviews with each CCOP's nurse administrator and at least one prevention research nurse. MAIN RESEARCH VARIABLES: Staffing patterns, organizational processes, recruitment strategies, and environmental characteristics. FINDINGS: All of the CCOPs employed dedicated prevention research staff. Recruitment through media publicity, mass mailings, or group information sessions worked best when prevention trials had flexible eligibility requirements and evaluated interventions with few health risks. Prevention trials evaluating agents with known toxicities in high-risk populations required more targeted recruitment through cancer screening programs, physician referral networks, and one-on-one discussions with protocol candidates. CONCLUSIONS: High-performing CCOPs configured their structures, processes, and recruitment strategies to fit with accrual goals. They also benefited from stable and supportive task environments. IMPLICATIONS FOR NURSING: Nurse-coordinated research networks have great potential to generate new knowledge about cancer prevention that can reduce cancer incidence and mortality significantly.

Clinical Trials as Topic↗
PubMed2006

Adapting clinical trials networks to promote cancer prevention and control research.

BACKGROUND: Since 1987, cancer centers and clinical cooperative groups serving as 'research bases' for the National Cancer Institute's (NCI) Community Clinical Oncology Program (CCOP) have been required to design and conduct cancer prevention and control (CP/C) clinical trials in addition to therapeutic trials. The study describes the structural and strategic adaptations that CCOP research bases have made to incorporate CP/C research into their scientific agendas and operations. METHODS: Approaches to CP/C research in four cooperative groups with different scientific agendas were investigated: the Eastern Cooperative Oncology Group, the National Surgical Adjuvant Breast and Bowel Project, the North Central Cancer Treatment Group, and the Southwest Oncology Group. Sixty-five individual interviews with group leaders and investigators were conducted. Data were coded and thematically analyzed from transcribed interviews, observations of scientific sessions, and secondary documents. RESULTS: The cooperative groups have tailored CP/C research programs to fit the interests, skills, and practice settings of their investigators without making significant adaptations in administrative and statistical infrastructures. Ongoing challenges include finding ways to broaden the pool of investigators designing CP/C protocols, involve more nononcologists in protocol design, and secure more stable and adequate funding for CP/C research. CONCLUSION: The cooperative groups' experiences with CP/C research suggest that, with adequate resource investments, existing clinical research networks can expand into new areas of scientific investigation.

Biomedical Research↗
PubMed2006

The effect of physician permission versus notification on research recruitment through cancer registries (United States).

OBJECTIVE: To determine how physicians responded when investigators inquired about contacting patients identified through a central cancer registry, and to examine participation rates under physician permission versus notification approaches. METHODS: We analyzed existing data from seven observational epidemiologic studies conducted in North Carolina between 1993 and 2004, capitalizing on a 'natural experiment' that arose when the state registry changed from a policy requiring investigators to obtain physician permission to one requiring only physician notification. RESULTS: When a notification approach was used, physicians approved researcher contact with a higher proportion of patients, and a higher proportion of physicians approved contact with or provided eligibility information about all patients requested, compared with a permission approach. Among physicians who were contacted under both approaches, the proportion of patients for whom they approved contact or provided information was significantly higher when they were notified. Physician notification was also associated with higher patient contact and overall response rates. Patient cooperation rates did not differ between the two approaches, suggesting that patients did not respond negatively to the fact that their physician was not explicitly asked to provide permission. CONCLUSION: Notification is likely an efficient way of involving patients' physicians, providing opportunity for physician input but avoiding the burdens associated with requiring their permission.

Clinical Trials as Topic↗
PubMed2006

The effects of managed care and competition on community-based clinical research.

BACKGROUND: The National Institutes of Health is developing practice-based clinical research networks (PBRNs) to expedite the pace of scientific discovery and improve care quality. Anecdotal evidence suggests managed care penetration and provider competition negatively affect PBRN clinical research. OBJECTIVE: The objective of this study is to examine the effects of environmental factors on clinical research performance in the National Cancer Institute's Community Clinical Oncology Program (CCOP). RESEARCH DESIGN: This study examined 49 CCOPs in 34 states using longitudinal (1991-2001) generalized least-squares regression including fixed effects, using secondary data from the National Cancer Institute, Group Health Association of America, InterStudy, American Hospital Association, Area Resource Files, and the Current Population Survey. MEASURES: Performance was measured as CCOP-level accrual in treatment trials, cancer prevention and control (CP/C) trials, and all trials combined. HMO penetration served as a proxy for managed care penetration. Competition measures included both hospital competition and physician competition. RESULTS: Managed care penetration was positively associated with accrual in areas of low to moderate penetration and negative in the areas of high penetration. Compared with areas with 5% penetration, areas with 15% penetration had 21% more treatment accrual and 66% more CP/C accrual. Compared with areas with 40% penetration, areas with 50% penetration had 11% lower treatment accrual and 3% lower CP/C accrual. CP/C accrual was more positively affected than treatment accrual. Greater hospital competition was associated with a decline in trial enrollment. CONCLUSIONS: The healthcare environment appears to have a significant effect on accrual into community-based cancer treatment and CP/C clinical trials. Findings for treatment and CP/C accrual suggest each type of accrual is distinct and requires different strategies and administrative methods.

Clinical Trials as Topic↗
PubMed2006

Quality improvement implementation and hospital performance on quality indicators.

OBJECTIVE: To examine the association between the scope of quality improvement (QI) implementation in hospitals and hospital performance on selected indicators of clinical quality. DATA SOURCES: Secondary data from 1997 mailed survey of hospital QI practices, Medicare Inpatient Database, American Hospital Association's Annual Survey of Hospitals, the Bureau of Health Professions' Area Resource File, and two proprietary data sets compiled by Solucient Inc. containing data on managed care penetration and hospital financial performance. STUDY DESIGN: Cross-sectional study of 1,784 community hospitals to assess relationship between QI implementation approach and six hospital-level quality indicators. DATA COLLECTION/ABSTRACTION METHODS: Two-stage instrumental variables estimation in which predicted values (instruments) of four QI scope variables and control (exogenous) variables used to estimate hospital-level quality indicators. PRINCIPAL FINDINGS: Involvement by multiple hospital units in QI effort is associated with worse values on hospital-level quality indicators. Percentage of hospital staff and percentage of senior managers participating in formally organized QI teams are associated with better values on quality indicators. Percentage of physicians participating in QI teams is not associated with better values on the hospital-level quality indicators studied. CONCLUSIONS: Results supported the proposition that the scope of QI implementation in hospitals is significantly associated with hospital-level quality indicators. However, the direction of the association varied across different measures of QI implementation scope.

Cross-Sectional Studies↗
PubMed2006

The effects of governing board configuration on profound organizational change in hospitals.

This study extends the literature on governing boards and organizational change by examining how governing board configurations have influenced profound organizational change in U.S. hospitals, and the conditions under which such change occurs. Hospitals governed by boards that more closely resembled a corporate governance model were more likely to experience positive changes such as diversification and merger and less likely to undergo negative changes such as closure. Organizational performance influenced change, but largely independent of governance configurations. Only in the case of closure did we find that governance configuration operated jointly with organizational performance.

Data Collection↗
PubMed2006

Quality improvement implementation and hospital performance on patient safety indicators.

This study examines the association between scope of Quality Improvement (QI) implementation in hospitals and hospital performance on patient safety indicators. Secondary data sources included a 1997 survey of hospital QI practices, Medicare Inpatient Database, American Hospital Association's Annual Survey of Hospitals, the Bureau of Health Professions' Area Resource File, and two proprietary data sets. Using a sample of 1,784 community hospitals, the study employed two-stage instrumental variables estimation in which predicted values of four QI scope variables and control variables were used to estimate four patient safety indicators. Involvement by multiple hospital units in the QI effort is associated with worse values on all four patient safety indicators. Percentages of hospital staff and of senior managers participating in QI teams exhibited no statistically significant association with any patient safety indicator. Percentage of physicians participating in QI teams is associated with better values on two patient safety indicators.

Health Care Surveys↗
PubMed2006

The role of organizational infrastructure in implementation of hospitals' quality improvement.

Quality improvement (QI) is an organized approach to planning and implementing continuous improvement in performance. Although QI holds promise for improving quality of care and patient safety, hospitals that adopt QI often struggle with its implementation. This article examines the role of organizational infrastructure in implementation of quality improvement practices and structures in hospitals. The authors focus specifically on four elements of hospital support and infrastructure for QI-integrated data systems, financial support for QI, clinical integration, and information system capability. These macrolevel factors provide consistent, ongoing support for the QI efforts of clinical teams engaging in direct patient care, thus promoting institutionalization of QI. Results from the multivariate analysis of 1997 survey data on 2350 hospitals provide strong support for the hypotheses. Results signal that organizations intent upon improving quality must attend to the context in which QI efforts are practiced, and that such efforts are unlikely to be effective unless appropriate support systems are in place to ensure full implementation.

Data Collection↗
PubMed2005

The effects of leadership and governance processes on member participation in community health coalitions.

This study examines the effects of coalition leadership and governance on member participation in voluntary community health coalitions. Path modeling was used to explore how leadership and governance processes in coalitions affect existing member costs, benefits, and levels of participation. It was hypothesized that the effects of coalition decision making and leadership variables would be indirect by working through their effects on participants' perceived influence over coalition decision making and on overall consensus around the coalition vision. Results of the analysis indicate that open and collaborative decision making and empowering leadership do have indirect, positive effects on the level of participation by way of vision consensus and participation benefits. Participation costs, however, show no significant direct effect on the level of participation. Perceived personal influence appears to be primarily an outcome of participation rather than an antecedent.

Community Health Planning↗
PubMed2004

Communities and hospitals: social capital, community accountability, and service provision in U.S. community hospitals.

OBJECTIVES: The study related community social capital to the level of community accountability and provision of community-oriented services in U.S. community hospitals. STUDY SETTING: The sample included 1,383 community hospitals that participated in the 1997 American Hospital Association's (AHA) Hospital Annual and Governance Surveys. DATA SOURCES: (1) The 1997 AHA Annual Hospital Survey, (2) the 1997 AHA Hospital Governance Survey, (3) the DDB Needham Market Facts Survey, (4) the 1996 County Election Data File, and (5) the 1998 Area Resource File. RESEARCH DESIGN: The study used a mix of longitudinal and cross-sectional data. KEY FINDINGS: We identified two distinct indicators of social capital-community participation and voting participation. Community accountability in hospitals was unrelated to either indicator. Hospitals' provision of community-oriented health services was negatively associated with community participation but unrelated with voting participation. The interaction between voting participation and community representation on hospital governance was positively associated with community accountability and provision of community-oriented health services. CONCLUSION: Neither community participation nor voting participation was sufficient to influence hospital behavior. The positive finding associated with the interaction between voting participation and community representation on hospital governance underscored the importance of an active political culture in influencing hospital behavior, without which the installation of community representatives on hospital governance might be more symbolic than actually serving the health concerns of community residents.

Catchment Area, Health↗
PubMed2003

Sustainability of collaborative capacity in community health partnerships.

Sustainability is a key requirement for partnership success and a major challenge for such organizations. Despite the critical importance of sustainability to the success of community health partnerships and the many threats to sustainability, there is little evidence that would provide partnerships with clear guidance on long-term viability. This article attempts to (1) develop a conceptual model of sustainability in community health partnerships and (2) identify potential determinants of sustainability using comparative qualitative data from four partnerships from the Community Care Network (CCN) Demonstration Program. Based on a grounded theory examination of qualitative data from the CCN evaluation, the authors hypothesize that there are five primary attributes/ activities of partnerships leading to consequential value and eventually to sustainability of collaborative capacity. They include outcomes-based advocacy, vision-focus balance, systems orientation, infrastructure development, and community linkages. The context in which the partnership operates provides the conditions for determining the appropriateness and relative impact of each of the factors related to creating consequential value in the partnership.

Community Networks↗
PubMed2002

Management and governance processes in community health coalitions: a procedural justice perspective.

Community-based coalitions are a popular strategy for promoting community health despite the fact that coalitions often fail to achieve measurable results. Using a procedural justice framework, this study seeks to advance knowledge about the relationship between coalition governance and management processes and indicators of coalition functioning. Member survey data from 25 coalitions participating in the Community Care Network Demonstration Program were analyzed using two-stage least squares regression. Results show that personal influence in decision making. decision process clarity, and collaborative conflict resolution were significantly associated with procedural fairness perceptions. Procedural fairness perceptions, in turn, were positively associated with member satisfaction with coalition decisions, but not personal engagement in the coalition or organizational integration of coalition goals and activities. Personal influence in decision making and collaborative conflict resolution also exhibited direct relationships with all three indicators of coalition functioning examined in the study.

Community Health Planning↗
PubMedDate not supplied

How do integrated delivery systems adopt and implement clinical information systems?

We examined how five integrated delivery systems make decisions about and implement clinical information systems. Using case study methods, we identified general themes and explored how organizational context factors and information technology characteristics affect adoption and implementation processes.

Administrative Personnel↗