Models + Frameworks Measurement Efficacy Efficiency Effectiveness Burden of disease Causation Determinants Implementation Measurement Efficacy Efficiency Effectiveness After P Tugwell, 1985

Selye’s Stress Model

Defining Dimensions of Quality of Life and Health-Related Quality of Life Health Canada-Quality of Life Mayo Clinic- Health-Related Quality of Life

Professional Expertise Model

Models + Frameworks Measurement Efficacy Efficiency Effectiveness Burden of disease Causation Determinants Implementation Measurement Efficacy Efficiency Effectiveness After P Tugwell, 1985

Generic Predictive Model

International Classification of Determinants of Functional Outcomes ICF Model Application to COPD

Theory of Planned Behavior Ajzen, 1985, 1991, 2001

CIHR: Causal Map for Identifying Determinants and Policy Priorities for Obesity in Canada

Public Health Model of Determinants of Diarrheal Disease

Models + Frameworks Measurement Efficacy Efficiency Effectiveness Burden of disease Causation Determinants Implementation Measurement Efficacy Efficiency Effectiveness After P Tugwell, 1985

The Precede-Proceed Model of Health Program Planning & Evaluation Green, Lawrence: Health Program Planning: An Educational and Ecological Approach, New York: McGraw-Hill, 2005. Heath Education, Media, Advocacy Predisposing Lifestyle Quality of Life Health Reinforcing Policy, Regulation, Resources. Organization Environment Enabling

Patho-physiological Models Alternate Therapy Targets for Multi-Drug Resistance in TB

Models + Frameworks Measurement Efficacy Efficiency Effectiveness Burden of disease Causation Determinants Implementation Measurement Efficacy Efficiency Effectiveness After P Tugwell, 1985

Ottawa Model of Research Use Assess + Monitor + Evaluate Innovation Potential Adopters Interventions Adoption Outcomes When the barriers related to the practice environment, potential adopters and innovation have been addressed, strategies are designed to disseminate the new practice for use. Practice Environment University of Ottawa/ CIHR 16

Ottawa Model of Research Use Assess + Monitor + Evaluate barriers & supports interventions outcomes & degree of use Innovation (CPG, tools) Potential Adopters Interventions Adoption Outcomes When the barriers related to the practice environment, potential adopters and innovation have been addressed, strategies are designed to disseminate the new practice for use. Practice Environment University of Ottawa/ CIHR 16

Ottawa Model of Research Use Assess + Monitor + Evaluate barriers & supports interventions outcomes & degree of use Innovation Implementation Interventions barrier management transfer follow-up Potential Adopters Outcomes Adoption When the barriers related to the practice environment, potential adopters and innovation have been addressed, strategies are designed to disseminate the new practice for use. Practice Environment University of Ottawa/ CIHR 16

Ottawa Model of Research Use Assess + Monitor + Evaluate barriers & supports interventions outcomes & degree of use Innovation (guideline) development process innovation attributes Potential Adopters awareness attitudes knowledge/skill concerns current practice Interventions barrier management transfer follow-up Adoption intention use sustained use Outcomes patient practitioner system When the barriers related to the practice environment, potential adopters and innovation have been addressed, strategies are designed to disseminate the new practice for use. Practice Environment structural culture/social patients economic University of Ottawa/ CIHR 16

Ottawa Model of Research Use Assess + Monitor + Evaluate barriers & supports interventions outcomes & degree of use Innovation development process innovation attributes Potential Adopters awareness attitudes knowledge/skill concerns current practice Outcomes patient practitioner system Interventions barrier management transfer follow-up Adoption intention use sustained use When the barriers related to the practice environment, potential adopters and innovation have been addressed, strategies are designed to disseminate the new practice for use. Practice Environment structural culture/social patients economic University of Ottawa/ CIHR 16

Micro-Theories of Adoption Technology Acceptance Model 2 ½% Innovators 34% Early majority 34% Late majority 16% Laggards These physicians could be considered to be early adopters of technology. Research demonstrates that the success of technology diffusion depends on the experience of this group. Also market evidence in NA of substantial rejection rate in e-rx systems, with no real evaluation Within this group, the ability to predict the rate of utilization will be associated with the likelihood of success, the speed of the diffusion, and the magnitude of the benefit for improving safety and qualitiy. Although efficiency and integration issues have been proposed as reasons for failure to utilize e-rx systems, there is sufficient variation in utilization rates to warrant further investigation. Equally important is the fact that drivers of physician behaviour in the current system (including remuneration schemes, access to physicians, lack of integration of care, lack of practice evaluation/measurement of quality and safety). The question remains then, what predicts physicians utilization of e-rx. 13 ½% Early adaptors Time to adoption of innovations

Predicting the Adoption of Electronic-Prescribing e-RX Utilization Practice Characteristics Continuity of Care Practice Volume Practice Size Medication Use Gender Age Computer Experience Information Acquisition Style Perceived Value of Technology Perceived Ease Of Use Perceived Usefulness Social Influence Behavioural Intention Adapted from Venkatesh, Morris, Davis, Davis (2003) User Acceptance of Information Technology: Toward a Unified View, MIS Quarterly, 27 (3), p.447 Explains 4% of Utilization (p-value 0.29) Explains 15% of Utilization (p-value 0.07) Explains 40% of Utilization (p-value 0.001) Explains 86% of Behavioural Intention (p-value <0.001) Facilitating Conditions: Physician Characteristics Explains 23% of Utilization (p-value 0.32) Adjusted R2=8.4% Adjusted R2=82.1% Adjusted R2=3.6% Adjusted R2=29.6% Adjusted R2=0.9%