Review: Comparison of Consultation-Liaison Services in the United States and Japan

The paper reviewed here is  ’A Comparison of Psychiatric Consultation-Liaison Services Between Hospitals in the United States and Japan’ by Kishi and colleagues and freely available here. As the title suggest, the researchers make a comparison of consultation-liaison services in Japan and the Unites States and in the abstract there are a number of conclusions drawn. They begin with an introduction to their study. The researchers briefly describe some of their expectations of a comparison between the services in the two countries in this section.

The researchers describe their method in the next section. The researchers selected hospitals in Minnesota, USA and Kanagawa, Japan for the study. They write that cultural differences between the two countries might be reflected by the patterns of referrals to liaison services. They also state that the period of study was related to a change in the reimbursement fees for consultations although I wasn’t sure of the temporal relationship between the study period and this change. The catchment area of the Minnesota hospital was 3 million and in the Kanagawa hospital was 1 million. The researchers describe the data that was recorded during the study period. The researchers justify their use of an adjusted Length of Stay (LOS) figure which incorporates the timing of the consultation.

In the results section, there was significantly more men in the Minnesota sample (p=0.040), significantly more of the subjects were married in the Kanagawa sample – indeed almost twice as many proportionally (p<0.001) and significantly more employed in the latter sample (p=0.001). Surgical referrals seemed to be proportionally much higher in the Kanagawa sample than the Minnesota sample while the reverse was true for intensive care referrals although chi-squared and p-values weren’t displayed in the table for these figures. Interestingly almost twice as many referrals (proportionally) in the Minnesota sample had a past psychiatric history and this was highly significant (p<0.001). ‘Chemical dependency’ was the most common cause of referral in the Minnesota sample and ‘evaluation’ in the Kanagawa sample and both were significantly different from their counterpart values (i.e. in the other cities). Delirium was the most common diagnosis in the Kanagawa sample and depression in the Minnesota sample and again both proportions were significantly higher than those in the counterpart populations.

In the discussion, the authors suggest that cultural factors might not play a role in the differences in prevalence of depression between East Asian countries and western countries (however an interesting study is reviewed here). They then suggest that in Japanese culture there is a focus on the collective rather than the individual and that this may influence interactions with mental health services. They also comment on referrals from physicians to psychiatrists for ‘psychosocial issues’ which was a frequent finding in referrals. In their discussion the authors note a number of limitations to the study including the lack of controls which would be helpful in better understanding the cultural differences. Additionally they note that the selected hospitals may not be representative of other teaching hospitals in the respective countries.

As this was a comparison of retrospective data and they were interested in characteristics, the absence of primary outcome measures meant that in effect this was an exploratory analysis and adjustments may help to clarify which are the most interesting findings. The findings with regards to referrers and diagnoses would be areas that would be interesting to follow-up using a different paradigm e.g. case-controlled registry-based studies.

 

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Review: The Alignment of Information Systems with Organisational Objectives and Strategies in Health Care

The article reviewed here is ‘The Alignment of Information Systems with Organisational Objectives and Strategies in Health Care’ by Bush and colleagues. In the conclusion in the abstract the researchers ‘confirm’ that alignment of IT is an important area in healthcare organisations and that

‘Finally, it contributes by suggesting future study of alignment’s predictors and effects in health care organi(s)ations‘

In the introduction, the researchers distinguish between strategic alignment of information systems and short term developments which are responses to new technology and use in other services amongst other reasons. They identify clear research questions such as the process by which healthcare services choose their information systems as well as barriers and incentives for managerial uptake of IT. They then cite evidence which supports their central argument for the importance of alignment of strategy and IT and examples of failure of IT systems when there is no clear alignment.

The researchers then describe the methodology for their study. They have identified ‘20 healthcare organi(s)ations in a mid-western US city’. There weren’t explicitly stated inclusion criteria for the selected organisations and the researchers note that they chose a heterogenous group of organisations to represent variation in healthcare services. A structured interview was used but I thought the methodology for analysis of subject’s responses was not clear. The researchers identified people within the services who procured the IT systems and approached them to participate in the study.

The organisations chosen included a mental health service, acute and chronic care (presumably general medical) settings and outpatient clinics. The data on employee numbers and information system details are included also. There are a large number of sections in the results section corresponding to the components of the interview. They identified a number of strategies within the organisations that were objectives for alignment with IT systems and these included patient safety, growth, technology focus and staff development. They then describe the results for methods that managers used to choose IT systems. These methods included formal evaluation, return on investment analysis and ‘board of directors approval’. They then described the interview results relating to factors which supported uptake of IT systems. The key actions for managers which contributed to uptake seemed to be site visits. With regards to organisational characteristics facilitating uptake subjects most commonly thought this to be the involvement of senior management. Managerial actions which perceived to hinder uptake included involving ’stakeholders too little’, ineffective communication and the decision making process itself. The hindering characteristics of the organisation included a ‘lack of management support’, ‘lack of resources’ and ‘resistance to change’ amongst others. The researchers then propose a system for alignment which involves identifying the organisational strategy, envisioning the information system through to implementation.

The study produced some interesting results although I would have been interested to learn more about the methodology for the analysis of results. The results here are higher level and subsequent research can move in various directions from the use of a different sample set with other specificied qualitative methodologies through to the use of quantitative methodologies including large surveys and cost-benefit analyses of information technology uptake when services have been stratified according to the results of the study.

References

Bush M, Lederer A L, Li X, Palmisano J and Rao S. The Alignment of information systems with organisational objectives and strategies in health care. International Journal of Medical Informatics. 78. 446-456. 2009.

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