Revised IRB

This isn't formatted exactly as it appears in a Word document, however, I wanted to provide the revised copy within my blog. Please keep in mind that this is a memo attached to a prior approved IRB.

Here's the link to my original blog: http://issuu.com/ddbwaco/docs/burleson_irb_501064?mode=embed&documentId=090130033154-d9c

MEMORANDUM

DATE: January 24, 2009

TO: Texas Tech University’s IRB Committee
FROM: Debra Burleson, Ph.D. student; Dr. Amy Koerber, PI
SUBJECT: Amendment to IRB # 501064

My original IRB request in the fall of 2007 was titled “Study of Communication Practices and Expectations of Hospitalists.” I have attached this IRB request to this memo. Dr. Amy Koerber was my PI for the original IRB and will continue as my PI in this study. I will be interviewing hospitalists from the Waco area. Hospitalists are medical doctors, usually internists, who only treat patients during their stay in the hospital.

I am continuing my prior study by gathering information about documentation practices. Methods from ethnography will be used for this study. The focus of this research is the hospitalists’ documentation practices of patient records during the patient’s hospital stay. These records are very important as they are used by the patient’s primary care physician and other specialists after discharge as well as by hospitalists for inpatient care.

Research has shown two significant areas that are of concern to the medical profession: fragmentation of care and patient safety, specifically regarding electronic medical records. As Lee Hock states in his 2008 article, “The increasing complexity of healthcare is accelerating the rate of specialisation in medicine, which in turn aggravates the fragmentation of care in hospitals.” Moore notes that of the outpatients workups recommended by hospitalists, only 45.6% of the cases had written documentation for the primary care physicians.All interviews will either be videotaped or audiotaped so that the researcher can transcribe and analyze their procedures but also use a “think out loud” protocol to capture their thought processes as they write. Videotaping is preferred, and the only exception would be if videotaping is not possible due to location of the interview. In that case, the interview would be audiotaped. “Think out loud” protocols record the process as well as results. This protocol allows the participant to think through—audibly—word choices which allows the researcher to document the process.Questions used for this study on attached.

Script of Face-to-Face Interview with the Hospitalist:
The following is a sample of questions I will ask each person I interview. As this is a qualitative study, additional questions may be asked as the interview progresses.

Thank you for meeting with me and participating in this study.

This study is focusing on the documentation practices as you write patient summaries that will be communicated to primary care physicians and other specialists. Questions will not be asked that require you to critique the hospital, nurses, or your administrators. My questions are for information in understanding the processes you use, the wording you choose, and the information you write about the patient. Just a reminder that I’m audio/video taping today’s interview to make sure that my notes are accurate.

If, however, at any time you wish to stop the interview or wish to skip a question, that is perfectly fine. I appreciate your willingness to meet with me.

Questions

Are you writing summary papers for discharge or updating the patient’s chart?

What is the process you follow when updating the patient’s information? In other words, do you record information throughout the day, make notes throughout the day and summary at the end of your shift?

What previous experiences have you had as a physician before becoming a hospitalist? [if the hospitalist has been a primary care physician, then I will ask the following]

What challenges do you face when recording patient information?

Do you find that you record patient information differently than you would if you were the patient’s primary care physician? In other words, if you were continuing care after discharge, would you choose the same words and/or including the same information?

The remaining questions will flow from the information that the hospitalists provides as well as information audibly shared through the “think out loud” protocol process.

Additional References

Hock, Lee Kheng (2008). The hospitalist movement—a complex adaptive response to fragmentation of care in hospitals [Electronic Version]. Annals Academy of Medicine, 37(2), 145-150.
Jancin, Bruce (2007). Hospitalists win points for inpatient efficiency [Electronic version]. Internal Medicine News, 40(12), 42.
Lindenauer, Peter K., Rothberg, Michael B., Pekow, Penelope S., Kenwood, Christopher, Benjamin, Evan M., & Auerbach, Andrew D. (2007). Outcomes of care by hospitalists, general internists, and family physicians [Electronic version]. The New England Journal of Medicine, 357(25): 2589-2600.
Moore, Carlton, McGinn, Thomas, & Halm, Ethan (2007). Tying up loose ends [Electronic Version]. Archives of Internal Medicine, 167(12), 1305-1311.
Schnipper, J., Gandhi, T., Wald, J., Grant, R., Poon, E., Volk, L., et al. (2008, June). Design and implementation of a web-based patient portal linked to an electronic health record designed to improve medication safety: the Patient Gateway medications module. Informatics in Primary Care, 16(2), 147-155.
Walraven, Carl van, Stih, Ratilka, & Laupacis, Andreas (2002). Dissemination of discharge summaries [Electronic Version]. Canadian Family Physician, 49, 737-742

IRB Proposal in Progress.....

I am amending an earlier IRB from a previous project. As part of that project, I interviewed 2 hospitalists, 1 hospitalist practitioner, 1 primary care physician, an administrator, and an ER Nurse Manager at one hospital. Questions covered either their role as a hospitalist or how they interact with the hospitalist program. The focus of the study was on communication practices for this new field which has only been in existence since 1996.

This is the beginning of my memo which will be an attachment to my original IRB. Mrs. Donna Peters, in the Tech IRB office, suggested this as the best step to take. I'm still working on the questions but have the overall plan in mind. Dr. Amy Koerber was my PI and will continue as my PI with the amended IRB.

The focus of this study will be on documentation practices of hospitalists. Hopefully this will include looking over documents they produce as a mini-ethnography, observe them creating the documents and then conduct a "think out loud" protocol as they explain the words they selected in their documents. I'd record (probably video this time instead of just audio), transcribe and analyze.

Let me know your thoughts - below is the first draft of my memo. As stated before, I'm still working on the questions, so they are not included!

DATE: January 18, 2009

TO: Texas Tech’s IRB Committee

FROM: Debra Burleson, Ph.D. student; Dr. Amy Koerber, PI

SUBJECT: Amendment to IRB # 501064


My original IRB request in the fall of 2007 was titled “Study of Communication Practices and Expectations of Hospitalists.” Dr. Amy Koerber is my PI. I am continuing this study by adding interviews with hospitalists who were not interviewed in my prior study. I will focus on their documentation practices as they record patient information to be used by hospital personnel during the patient’s hospital stay but also used by the patient’s primary care physician and other specialists.

If time permits, I would like to interview the two hospitalists and a hospitalist practitioner interviewed in my prior study and focus on the same research as mentioned above.

All interviews will be videotaped so that the researcher can transcribe and analyze their procedures but also to use a “think out loud” protocol to capture their thought processes as they write.

I have attached the questions I will ask the hospitalists.

Possible Research Project for Field Methods

My research interest is communication practices with hospitalists. I'm very new to ethnography; very new to field methods. I hope my comments help you or at least give you a sense of community with fellow novice researchers!

I am new to the TCR Ph.D. program recently transferred from the MATC program. I've been taking courses in the program for two years. I'm still learning and hopefully always will be!

I am a full-time lecturer in the Management Information Systems department at Baylor University's Hankamer School of Business. I teach an Intro to Information Systems course and Integrated Business Writing. This is my 5th year at Baylor. I'm a graduate of Baylor. I obtained my M.Ed. in Instructional Technology from Texas Tech in 2004. I have a husband of 29 1/2 years, two sons--24 and 21, one daughter--16, and two dogs.

I am often humbled as in the case of our first session when I had marked my calendar for Monday nights and subsequently missed our first session.