Robert G Brooks

Virginia Commonwealth University, Richmond, VA, United States

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Publications (86)204.93 Total impact

  • Health 01/2014; 06(15):1994-2003. DOI:10.4236/health.2014.615234 · 0.51 Impact Factor
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    ABSTRACT: We studied characteristics of all, occasional, and frequent emergency department (ED) visits due to ambulatory care-sensitive conditions (ACSCs). We used a cross-sectional, split-sample design with multivariate logistic regressions using encounter-level, all-payer ED data from all Florida hospitals for the year of 2005. We evaluated associations of key patient characteristics, characteristics of ED utilization, and availability of primary care physicians in the area, with ED visits for ACSCs. We concluded that factors associated with ED use for ACSCs were similar for occasional and frequent ED users. Therefore, universal strategies for reduction of ED overutilization by increasing access to, timeliness, and quality of primary care for all patients likely to experience ACSCs should be used.
    The Journal of ambulatory care management 04/2012; 35(2):149-58. DOI:10.1097/JAC.0b013e318244d222
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    ABSTRACT: The purpose of this study was to examine potential associations among ambulatory surgery centers' (ASCs) organizational strategy, structure, and quality performance. The authors obtained several large-scale, all-payer claims data sets for the 1997 to 2004 period. The authors operationalized quality performance as unplanned hospitalizations at 30 days after outpatient arthroscopy and colonoscopy procedures. The authors draw on related organizational theory, behavior, and health services research literatures to develop their conceptual framework and hypotheses and fitted fixed and random effects Poisson regression models with the count of unplanned hospitalizations. Consistent with the key hypotheses formulated, the findings suggest that higher levels of specialization and the volume of procedures may be associated with a decrease in unplanned hospitalizations at ASCs.
    Medical Care Research and Review 04/2011; 68(2):202-25. DOI:10.1177/1077558710378523 · 2.57 Impact Factor
  • Nir Menachemi, Charles T Prickett, Robert G Brooks
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    ABSTRACT: Improved communication from physician- patient emailing is an important element of patient centeredness. Physician-patient email use has been low; and previous data from Florida suggest that physicians who email with patients rarely implement best-practice guidelines designed to protect physicians and patients. Our objective was to examine whether email use with patients has changed over time (2005-2008) by using two surveys of Florida physicians, and to determine whether physicians have more readily embraced the best-practice guidelines in 2008 versus 2005. Lastly, we explored the 2008 factors associated with email use with patients and determined whether these factors changed relative to 2005. Our pooled time-series design used results from a 2005 survey (targeting 14,921 physicians) and a separate 2008 survey (targeting 7003 different physicians). In both years, physicians practicing in the outpatient setting were targeted with proportionally identical sampling strategies. Combined data from questions focusing on email use were analyzed using chi-square analysis, Fisher exact test, and logistic regression. A combined 6260 responses were available for analyses, representing a participation rate of 28.2% (4203/14,921) in 2005 and 29.4% (2057/7003) in 2008. Relative to 2005, respondents in 2008 were more likely to indicate that they personally used email with patients (690/4148, 16.6% vs 408/2001, 20.4%, c(2) (1) = 13.0, P < .001). However, physicians who reported frequently using email with patients did not change from 2005 to 2008 (2.9% vs 59/2001, 2.9%). Interest among physicians in future email use with patients was lower in 2008 (58.4% vs 52.8%, c(2) (2) = 16.6, P < .001). Adherence to email best practices remained low in 2008. When comparing 2005 and 2008 adherences with each of the individual guidelines, rates decreased over time in each category and were significantly lower for 4 of the 13 guidelines. Physician characteristics in 2008 that predicted email use with patients were different from 2005. Specifically, in multivariate analysis female physicians (OR 1.48, 95% CI 1.12-1.95), specialist physicians (OR 1.43, 95% CI 1.12-1.84), and those in a multispecialty practice (OR 1.76, 95% CI 1.30-2.37) were more likely than their counterparts to email with patients. Additionally, self-reported computer competency levels (on a 5-point Likert scale) among physicians predicted email use at every level of response. Email use between physicians and patients has changed little between 2005 and 2008. However, future physician interest in using email with patients has decreased. More troubling is the decrease in adherence to best practices designed to protect physicians and patients when using email. Policy makers wanting to harness the potential benefits of physician-patient email should devise plans to encourage adherence to best practices. These plans should also educate physicians on the existence of best practices and methods to incorporate these guidelines into routine workflows.
    Journal of Medical Internet Research 02/2011; 13(1):e23. DOI:10.2196/jmir.1578 · 4.67 Impact Factor
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    ABSTRACT: Limited studies have examined electronic prescribing (e-prescribing) adoption in physician office practices. Specifically, none have explored the influence of payer mix on e-prescribing adoption among physicians. This study examines the impact of practice composition of Medicare, Medicaid, and private insurance on e-prescribing adoption among physicians. Logistic regression was used to analyze data collected from a large-scale information technology-related survey of Florida physicians. After controlling for practice and physician characteristics, physicians with the highest (odds ratio = 1.67, 95% confidence interval = 1.01-2.78) and above-average (odds ratio [OR] = 1.83, 95% confidence interval = 1.04-3.22) volume of Medicare patients were significantly more likely to e-prescribe as compared with those in the low-volume category. No differences in adoption were found across all Medicaid and private insurance practice composition categories. Our findings support the notion that direct incentives, such as those in the Medicare Modernization Act of 2003, may influence physician adoption of e-prescribing.
    Health care management review 01/2011; 36(1):95-101. DOI:10.1097/HMR.0b013e3181dc8246 · 1.30 Impact Factor
  • Nir Menachemi, Darrell Burke, Robert G Brooks
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    ABSTRACT: Information technology (IT) that positively affects both quality of care and patient safety currently exists but is not used widely. This study identifies organizational and external factors associated with the adoption of patient safety-related IT (PSIT) in acute care hospitals in Florida. Factors found to be positively correlated with PSIT use included physicians' active involvement in clinical IT planning, the placement of strategic importance on IT by the organization, CIO involvement in patient safety planning, and the perception of an adequate selection of products from vendors. Other factors and implications are discussed as well.
    Journal for Healthcare Quality 01/2011; 26(6):39-44. DOI:10.1111/j.1945-1474.2004.tb00535.x
  • Darrell Burke, Nir Menachemi, Robert G Brooks
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    ABSTRACT: This article examines the degree to which healthcare information technology (HIT) supporting the Institute of Medicine's (IOM) six care aims is utilized in the hospital setting and explores organizational factors associated with HIT use. Guided by the IOM's Crossing the quality chasm report and associated literature, 27 applications and/or capabilities are classified according to one or more of the six care aims. A structured survey of Florida hospitals identified the use of HIT. Results suggest that, on average, hospitals have not yet embraced HIT to support the IOM's care aims and that associated organizational factors vary according to care aim.
    Journal for Healthcare Quality 01/2011; 27(1):24-32, 39. DOI:10.1111/j.1945-1474.2005.tb00542.x
  • Nir Menachemi, Thomas L Powers, Robert G Brooks
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    ABSTRACT: This article identifies practice- and physician-related characteristics associated with the increased use of EHRs by physicians in outpatient practices. Two Florida surveys conducted in 2005 and 2008 on physician use of EHRs were examined to determine the practice and physician characteristics associated with increased EHR use over time. Based on multivariate analysis, several variables were found to influence increased EHR adoption. Practice variables included participation in a single-specialty practice and percentage of Medicare patients in the practice, but not percentage of Medicaid patients in the practice. Physician characteristics included younger physician age, but not specialty nor years practicing in the community. Factors associated with EHR adoption at any given point in time did not necessarily predict longitudinal increases in EHR adoption. These results are important for physicians to consider in their potential adoption of EHRs and should also be considered by policymakers interested in promoting increased use of EHRs by physicians.
    Journal of healthcare management / American College of Healthcare Executives 01/2011; 56(3):183-97; discussion 197-8. · 0.73 Impact Factor
  • Valerie A Yeager, Nir Menachemi, Robert G Brooks
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    ABSTRACT: The purpose of this study is to examine Electronic Health Record (EHR) adoption among Florida doctors who treat the elderly. This analysis contributes to the EHR adoption literature by determining if doctors who disproportionately treat the elderly differ from their counterparts with respect to the utilization of an important quality-enhancing health information technology application. This study is based on a primary survey of a large, statewide sample of doctors practising in outpatient settings in Florida. Logistic regression analysis was used to determine whether doctors who treat a high volume of elderly (HVE) patients were different with respect to EHR adoption. Our analyses included responses from 1724 doctors. In multivariate analyses controlling for doctor age, training, computer sophistication, practice size and practice setting, HVE doctors were significantly less likely to adopt EHR. Specifically, compared with their counterparts, HVE doctors were observed to be 26.7% less likely to be utilizing an EHR system (OR=0.733, 95% CI 0.547-0.982). We also found that doctor age is negatively related to EHR adoption, and practice size and doctor computer savvy-ness is positively associated. Despite the fact that EHR adoption has improved in recent years, doctors in Florida who serve the elderly are less likely to adopt EHRs. As long as HVE doctors are adopting EHR systems at slower rates, the elderly patients treated by these doctors will be at a disadvantage with respect to potential benefits offered by this technology.
    Journal of Evaluation in Clinical Practice 12/2010; 16(6):1103-7. DOI:10.1111/j.1365-2753.2009.01277.x · 1.58 Impact Factor
  • Askar Chukmaitov, Anqi Tang, Robert G. Brooks
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    ABSTRACT: We compared financial performance of freestanding ambulatory surgery centres (ASCs) and hospital-based outpatient departments (HOPDs). Patient-level ambulatory surgery data (1997-2004) for the state of Florida were assembled and analysed. We used a pooled, cross-sectional design. We applied multiple regression models to study pricing differences for freestanding ASCs and HOPDs. Substantial charge differences exist for patients undergoing the most common outpatient procedures, and that these differentials are in favour of freestanding ASCs over HOPDs in the majority of studied procedures. These differences in charges are large enough to presume that they may translate into similar difference in actual costs. Although previous research does not show a clear 'winner' (neither ASCs nor HOPDs) in terms of quality outcomes, healthcare policymakers, payers, and patients may be led to look more carefully at charge and cost data in their contracting processes, or choosing a certain provider of outpatient services.
    International Journal of Public Policy 09/2010; 6(3):204-218. DOI:10.1504/IJPP.2010.035125
  • Dennis Tsilimingras, Robert G Brooks
    Journal of the American Geriatrics Society 01/2010; 58(1):190-1. DOI:10.1111/j.1532-5415.2009.02661.x · 4.22 Impact Factor
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    ABSTRACT: Electronic health records (EHRs) have experienced slow adoption rates but play an important role in improving ambulatory quality of care. Sustained use of EHRs is closely related to physician satisfaction, however little research exists on this issue. We focused on physician EHR users to determine factors that are related to satisfaction with the level of computerization in their office practice. After controlling for various factors, physicians with more robust EHRs, and those who adopted their system two or more years ago, were more likely to be satisfied. Lastly, several individual EHR functionalities were independently related to improved satisfaction.
    Journal for Healthcare Quality 01/2010; 32(1):35-41. DOI:10.1111/j.1945-1474.2009.00062.x
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    ABSTRACT: This paper examines the empirical consistency of the Diagnosis Cost Groups/Hierarchical Condition Categories (DCG/HCC) risk-adjustment method for comparing 7-day mortality between hospital-based outpatient departments (HOPDs) and freestanding ambulatory surgery centers (ASCs). We used patient level data for the three most common outpatient procedures provided during the 1997-2004 period in Florida. We estimated base-line logistic regression models without any diagnosis-based risk adjustment and compared them to logistic regression models with the DCG/HCC risk-adjustment, and to conditional logit models with a matched cohort risk-adjustment approach. We also evaluated models that adjusted for primary diagnoses only, and then for all available diagnoses, to assess how the frequently absent secondary diagnoses fields in ambulatory surgical data affect risk-adjustment. We found that risk-adjustment using both diagnosis-based methods resulted in similar 7-day mortality estimates for HOPD patients in comparison with ASC patients in two out of three procedures. We conclude that the DCG/HCC risk-adjustment method is relatively consistent and stable, and recommend this risk-adjustment method for health policy research and practice with ambulatory surgery data. We also recommend using risk-adjustment with all available diagnoses.
    Health Care Management Science 12/2009; 12(4):420-33. DOI:10.1007/s10729-009-9101-3 · 1.05 Impact Factor
  • Joint Commission journal on quality and patient safety / Joint Commission Resources 12/2009; 35(12):620-1.
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    ABSTRACT: The most common types of adverse events identified in the United States and Canadian studies within 3 to 4 weeks after hospital discharge were due to medications (66%Y72%), procedures (7%Y17%), therapeutic errors (16%), nosocomial infections (5%Y11%), pressure ulcers (7%), diag- nostic errors (6%), and falls (2%Y4%). 3,4 In these studies, approximately one-third of these adverse events were preventable (an adverse event injury that could have been avoided as a result of an error or a system design flaw), 3,4,7 and another third were ameliorable (an injury whose severity could have been substantially reduced if different actions or procedures had been performed or followed). 3,4 Twenty-five to thirty percent of adverse events in these studies were associated with a nonpermanent disability, 3% resulted in permanent disabilities, and 3% resulted in death. 3,4 Of the adverse events resulting in at least a nonpermanent disability, 48% were preventable, and 24% were ameliorable. 3 Also within 3 to 4 weeks after hospital discharge, 9% to 21% of patients in these studies had an additional physician visit, 5% required laboratory monitoring in addition to their physician care, 11% to 12% had an emergency department visit, and 17% to 24% had a hospital readmission. 3,4 Thus, postdischarge adverse events may lead to serious disability or even death, and most are either preventable or ameliorable. Geriatric syndromes such as falls, delirium, pressure ulcers, and underfeeding have often been viewed as preventable adverse events that may occur in the elderly during transitions of care. 21 For example, the United States study noted above reported 2 of 3 falls experienced by postdischarge patients as preventable. 3 If these geriatric syndromes are to be viewed as preventable adverse events, then their prevention will require a systems-based approach to care. 21 Geriatricians have made substantial efforts to improve systems of care for the elderly by developing innovative management programs. Examples of geriatric management programs include Acute Care for the Elderly units, 22,23 Delirium Intensive Care, 23 and Delirium and Falls teams, 24Y26
    Journal of Patient Safety 12/2009; 5(4):201-4. DOI:10.1097/PTS.0b013e3181c11f70 · 0.88 Impact Factor
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    ABSTRACT: In light of new federal policies allowing hospitals to subsidize the cost of information systems for physicians, we examine the relationship between local hospital investments in information technology (IT) and physician EMR adoption. Data from two Florida surveys were combined with secondary data from the State of Florida and the Area Resource File (ARF). Hierarchal logistic regression was used to examine the effect of hospital adoption of clinical information systems on physician adoption of EMR systems after controlling for confounders. In multivariate analysis, each additional clinical IT application adopted by a local hospital was associated with an 8% increase in the odds of EMR adoption by physicians practicing in that county. Given this existing relationship between hospital IT capabilities and physician adoption patterns, federal policies designed to encourage this more directly will positively promote the proliferation of EMR systems.
    Journal of Medical Systems 10/2009; 33(5):329-35. DOI:10.1007/s10916-008-9194-0 · 2.21 Impact Factor
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    ABSTRACT: In the absence of meaningful health reform, Florida implemented a volunteer health care program to strengthen the existing safety net. Since program implementation in 1992, over $1 billion of services have been provided to uninsured and underserved populations. Currently, over 20,000 volunteers participate statewide. Key incentives for provider participation have been an organized framework for volunteering and liability protection through state-sponsored sovereign immunity. Volunteerism, although not a solution to the health care crisis, serves as a valuable adjunct pending full-scale health care reform.
    American Journal of Public Health 06/2009; 99(7):1166-9. DOI:10.2105/AJPH.2008.145623 · 4.23 Impact Factor
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    ABSTRACT: Purpose – This paper aims to examine the role of network effects (defined as increased utility for users of a technology that occurs when adoption increases among other users) in the adoption of electronic medical records (EMR) systems. EMR systems, which have experienced slow adoption rates, promise to improve the efficiency of the healthcare system by facilitating information exchange among physicians caring for the same patients. Design/methodology/approach – Survey responses from physicians are used to test several hypotheses. The authors are interested in how market level EMR adoption was related to physician adoption intentions. The authors also test the “strong ties” notion of network effects by examining whether EMR adoption among generalists, and specialist physicians, had differing influences on adoption intentions in a given market. Findings – Support for network effects is found; each one unit increase in market-level EMR adoption is associated with a significant increase in overall physician adoption intention in that market. Secondary analyses suggest adoption of EMRs by specialists is significantly predictive of generalists' adoption intentions in a given market. However, as predicted, EMR among generalists does not influence other generalists' intentions; nor does EMR adoption by a specialists influence other specialists' intentions. Research implications – Network effects play a role in the EMR adoption among physicians. Decision-makers wanting to influence adoption should target defined market segments in an effort to build a critical mass of adoption then move to adjacent segments once network effects take hold. Originality/value – This paper applies network effects theory to help explain the suboptimal adoption rates of an important healthcare technology.
    Journal of Product &amp Brand Management 04/2009; 18(2):127-135. DOI:10.1108/10610420910949022
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    ABSTRACT: To assess the amount of local rural hospital outpatient department (HOPD) bypass for outpatient procedures. We analyzed data on colonoscopies and upper gastrointestinal endoscopies performed in the state of Florida over the period 1997-2004. Approximately, 53% of colonoscopy and 45% of upper gastrointestinal endoscopy patients bypassed their local rural hospital for treatment at either a free-standing ambulatory surgical center (ASC) or a nonlocal hospital outpatient department. Independent predictors of bypass included risk-adjusted severity of the patient's medical condition, insurance status, and race. Patients treated in ASCs were predominately healthier, white and commercially insured. Nonlocal HOPDs tend to treat a sicker cohort of patients who were publicly insured or under managed care. The results indicate that patients who bypass their local HOPD to an ASC differ from those bypassing to a nonlocal HOPD, and that patient factors influencing bypass for outpatient procedures differ from those influencing inpatient bypass. From a policy perspective, as procedures continue to migrate from the inpatient to the outpatient setting, bypassing the local rural hospital for treatment elsewhere could create conditions that negatively impact rural hospital operations.
    The Journal of Rural Health 03/2009; 25(2):174-81. DOI:10.1111/j.1748-0361.2009.00214.x · 1.77 Impact Factor
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    ABSTRACT: The purpose of this study was to examine the adoption of health information technology by children's hospitals and to document barriers and priorities as they relate to health information technology adoption. Primary data of interest were obtained through the use of a survey instrument distributed to the chief information officers of 199 children's hospitals in the United States. Data were collected on current and future use of a variety of clinical health information technology and telemedicine applications, organizational priorities, barriers to use of health information technology, and hospital and chief information officer characteristics. Among the 109 responding hospitals (55%), common clinical applications included clinical scheduling (86.2%), transcription (85.3%), and pharmacy (81.9%) and laboratory (80.7%) information. Electronic health records (48.6%), computerized order entry (40.4%), and clinical decision support systems (35.8%) were less common. The most common barriers to health information technology adoption were vendors' inability to deliver products or services to satisfaction (85.4%), lack of staffing resources (82.3%), and difficulty in achieving end-user acceptance (80.2%). The most frequent priority for hospitals was to implement technology to reduce medical errors or to promote safety (72.5%). This first national look at health information technology use by children's hospitals demonstrates the progress in health information technology adoption, current barriers, and priorities for these institutions. In addition, the findings can serve as important benchmarks for future study in this area.
    PEDIATRICS 02/2009; 123 Suppl 2:S80-4. DOI:10.1542/peds.2008-1755F · 5.30 Impact Factor

Publication Stats

1k Citations
204.93 Total Impact Points

Institutions

  • 2012
    • Virginia Commonwealth University
      • Department of Healthcare Policy and Research
      Richmond, VA, United States
  • 2008–2011
    • University of Alabama at Birmingham
      • • Department of Health Services Administration
      • • School of Public Health
      • • Department of Health Care Organization and Policy
      Birmingham, AL, United States
  • 2002–2011
    • Florida State University
      • • Center on Patient Safety
      • • Department of Family Medicine & Rural Health
      • • Department of Medical Humanities & Social Sciences
      Tallahassee, Florida, United States
  • 2006
    • Tallahassee Memorial HealthCare
      Tallahassee, Florida, United States
  • 2000–2001
    • Florida Department of Health
      Tallahassee, Florida, United States