Robert G Brooks

Virginia Commonwealth University, Richmond, VA, United States

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Publications (86)227.66 Total impact

  • Karen W. Geletko · Robert G. Brooks · Andrew Hunt · Leslie M. Beitsch ·

    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
  • 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 05/2011; 56(3):183-97; discussion 197-8. · 0.73 Impact Factor
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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 · 2.62 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 · 3.43 Impact Factor
  • David W Au · Nir Menachemi · Anantachai Panjamapirom · Robert G Brooks ·
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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 · 1.40 Impact Factor
  • 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 · 1.40 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 · 1.08 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
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    ABSTRACT: To assess the current status of quality improvement (QI) within local health departments (LHDs) and examine the characteristics associated with such QI efforts. A QI module was administered to a representative sample of 545 LHDs along with the core instrument in the 2008 NACCHO Profile survey of all LHDs nationally. Using the Profile survey data set, a quantitative approach was employed to determine the current status of QI within LHDs. Statistical analysis was performed to identify characteristics of LHDs associated with QI. The response rate to the QI module was 82 percent. Of the 448 LHDs that responded to the QI Module, 55 percent reported conducting formal QI efforts during the previous 2 years. Forty-four percent of these LHDs used a specific framework for QI, 56 percent used at least one of four commonly employed QI tools or techniques, and customer focus and satisfaction was the most frequently reported area (76%) of QI efforts. LHDs with large size of jurisdiction population and those with centralized governance were more likely to have engaged in quality or performance improvement, have managers who received formal QI training, and have provided QI training to staff. The 2008 NACCHO Profile QI module furnishes an excellent baseline for measuring progress of health department QI activities as accreditation and other related activities intensify. A clear definition of QI in public health that is understood by practitioners will greatly increase our ability to measure the adoption of QI by LHDs. Further research is necessary to identify and explore some of the predictors and possible barriers to increasing the application of QI by LHDs.
    Journal of public health management and practice: JPHMP 01/2010; 16(1):49-54. DOI:10.1097/PHH.0b013e3181bedd0c · 1.47 Impact Factor
  • 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 · 4.57 Impact Factor
  • Nir Menachemi · Thomas Powers · David W Au · Robert G Brooks ·
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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 · 1.40 Impact Factor
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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
  • Dennis Tsilimingras · Marlene R Miller · Robert G Brooks ·

    Joint Commission journal on quality and patient safety / Joint Commission Resources 12/2009; 35(12):620-1.
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    Dennis Tsilimingras · Kenneth Brummel-Smith · Robert G Brooks ·
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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 · 1.49 Impact Factor
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    ABSTRACT: To assess the current deployment of quality improvement (QI) approaches within local health departments (LHDs) and gain a better understanding of the depth and intensity of QI activities. A mixed quantitative and qualitative approach was employed to determine the current status of QI utilization within LHDs. All respondents from the 2005 NACCHO Profile QI module questionnaire who indicated that their LHD was involved in some kind of QI activity received a follow-up Web-based survey in 2007. A smaller convenience sample of 30 LHDs representing all groups of respondents was selected for the follow-up interview to validate and expound upon survey data. Survey response rate was 62 percent (181/292). Eighty-one percent of LHDs reported QI programmatic activities, with 39 percent occurring agency-wide. Seventy-four percent of health departments had staff trained in QI methods. External funding sources for QI were infrequent (28%). LHDs that were serving large jurisdictions and LHDs that were subunits of state health agencies (centralized states) were more likely to engage in most QI activities. However, interview responses did not consistently corroborate survey results and noted a need for shared definitions. Multiple factors, including funders and accreditation, may be driving the increase of QI for public health. Additional research to confirm and validate these findings is necessary. A common QI vocabulary is also recommended.
    Journal of public health management and practice: JPHMP 11/2009; 15(6):494-502. DOI:10.1097/PHH.0b013e3181aab5ca · 1.47 Impact Factor
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    Nir Menachemi · Michael Matthews · Eric W Ford · Neset Hikmet · Robert G Brooks ·
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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
  • Nir Menachemi · Thomas L Powers · Robert G Brooks ·
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    ABSTRACT: Despite the growing use of information technology (IT) in medical practices, little is known about the relationship between IT and physician satisfaction. The objective of this study was to examine the relationship between physician IT adoption (of various applications) and overall practice satisfaction, as well as satisfaction with the level of computerization at the practice. Data from a Florida survey examining physicians' use of IT and satisfaction were analyzed. Odds ratios (ORs), adjusted for physician demographics and practice characteristics, were computed utilizing logistic regressions to study the independent relationship of electronic health record (EHR) usage, PDA usage, use of e-mail with patients, and the use of disease management software with satisfaction. In addition, we examined the relationship between satisfaction with IT and overall satisfaction with the current medical practice. In multivariate analysis, EHR users were 5 times more likely to be satisfied with the level of computerization in their practice (OR = 4.93, 95% CI = 3.68-6.61) and 1.8 times more likely to be satisfied with their overall medical practice (OR = 1.77, 95% CI = 1.35-2.32). PDA use was also associated with an increase in satisfaction with the level of computerization (OR = 1.23, 95% CI = 1.02-1.47) and with the overall medical practice (OR = 1.30, 95% CI = 1.07-1.57). E-mail use with patients was negatively related to satisfaction with the level of computerization in the practice (OR = 0.69, 95% CI = 0.54-0.90). Last, physicians who were satisfied with IT were 4 times more likely to be satisfied with the current state of their medical practice (OR = 3.97, 95% CI = 3.29-4.81). Physician users of IT applications, especially EHRs, are generally satisfied with these technologies. Potential adopters and/or policy makers interested in influencing IT adoption should consider the positive impact that computer automation can have on medical practice.
    Health care management review 10/2009; 34(4):364-71. DOI:10.1097/HMR.0b013e3181a90d53 · 1.30 Impact Factor
  • Robert G Brooks · Leslie M Beitsch · Phil Street · Askar Chukmaitov ·
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    ABSTRACT: The purpose of this study was to assess the alignment of state and local health department financing with the 10 essential public health service (10EPHS) categories and National Public Health Performance Standards (NPHPS). To determine this, we collected primary data from the Florida Department of Health (FDOH) for fiscal year 2005-2006 and compared it with secondary data collected in the same year through NPHPS survey instruments. A structured interview technique was used to collect primary budget data from each program office at the FDOH and assign each program budget to 10EPHS categories. Local county health department (CHD) expenditures were assessed through an interview with the director and budget chief of one small, medium, and large CHD, and results were then extrapolated for other local CHDs. It was possible for almost 98 percent of the FDOH budget to be allocated into the 10EPHS categories. A majority of resources (68.7%) were used for individual healthcare services, category 7b (assuring provision of services) and category 7a (linking people to needed services). No direct correlation was found between the level of funding by 10EPHS category and the performance standards scores at state or local levels. Public health continues to utilize a majority of its available resources for individual healthcare services, despite increasing requests for improved population-based programs.
    Journal of public health management and practice: JPHMP 07/2009; 15(4):299-306. DOI:10.1097/PHH.0b013e3181a02074 · 1.47 Impact Factor

Publication Stats

2k Citations
227.66 Total Impact Points


  • 2012
    • Virginia Commonwealth University
      • Department of Healthcare Policy and Research
      Richmond, VA, United States
  • 2010-2011
    • University of South Florida
      Tampa, Florida, United States
  • 2002-2011
    • Florida State University
      • • Center on Patient Safety
      • • Department of Family Medicine & Rural Health
      • • College of Medicine
      Tallahassee, Florida, United States
  • 2008-2009
    • University of Alabama at Birmingham
      • Department of Health Care Organization and Policy
      Birmingham, AL, United States
  • 2006
    • Tallahassee Memorial HealthCare
      Tallahassee, Florida, United States
  • 2000-2001
    • Florida Department of Health
      Tallahassee, Florida, United States