The change in the availability and dissemination of health-related information has outpaced graduate educational programs in community health. The move toward risk-based reimbursement systems for health care services mandates that graduates of masters programs in community health nursing and health services administration be skilled in accessing and analyzing multiple databases from a variety of sources.
To increase skills in information use, analysis, and teamwork, an interdisciplinary course in community assessment incorporating the use of electronic systems was incorporated into course work for both master of science in nursing (MSN) and master of health services administration (MHSA) candidates. Students were required to access health data using hospital discharge databases, the World Wide Web (WWW), and other regional health and environmental databases. In addition they used email for communication between groups, presentation software for their community presentations, and statistical software. This article presents the rationale for the teaching methodology, a critique of the process, and evidence regarding perceived changes in MSN and MHSA students' ability to use the various computer-based tools.
There is a paucity of articles related to electronically-based teaching methods in the nursing education literature. Graveley and Fullerton (1998) described electronicbased strategies for a graduate course in nursing administration. The electronic systems used in the course included email, a spreadsheet program, and a computerassisted instruction package for financial concepts. The authors reported that students felt the approach was worthwhile; however, the authors omitted the quantitative support for this conclusion. They also did not include any reference to student perception of their skill level prior to or after the class. Among health services administration students, a statistically significant improvement in general attitude toward the use of personal computers occurred after students participated in a structured class that explained the use of computer software (Agho, 1995). Austin and Malee (1990) suggested that field projects using information systems skills were an essential part of curriculum training related to information systems for health services administration students.
In another article, Russell, Miller, and Czerwinska (1994) discussed the use of a computer-assisted instruction (CAI) program for an undergraduate community health nursing course. The authors included the results of the student evaluation of the program and reported that more than three-fourths of the students (N=106) chose the CAI and lecture as the preferred learning format over lecture alone.
Several authors have commented on the role of data analysis and information synthesis for professionals who are seeking to manage and improve community health status. Bushy (1997) suggested that a data driven community health assessment is an essential activity for providers working with consumers in a collaborative model to plan community health interventions and implement an overall community health improvement plan.
Proenca (1998) emphasized the need for systematic community health status assessment as an essential part of hospital and multiorganizational community cooperation. Community-oriented approach to care enables health services organizations to balance accountability to community stakeholders with accountability to payers and patients. Proenca also emphasized the ability to assess and prioritize community health problems as an essential skill for managers.
Bazzoli et al. (1997) identified several communities where private/public partnerships have occurred to rationalize the allocation of health care and human services resources in the community based on an information-driven approach. The importance of using a multidisciplinary team to improve community-based health systems was shown through a recent effort at Mercy Health Services to better integrate clinical care and develop a system that is ready to manage care for population groups (Porter, Van Cleave, Milobowski, Conlon, & Mambourg, 1996).
Regional, national, and global health organizations provide extensive epidemiological data on the WWW. These sources of information provide ready access to the latest figures on disease trends in a variety of populations. These databases provide opportunities for comparisons between populations. Besides teaching students how to analyze population-based health data, educators must also teach students in the health care field how to access these databases and enter them into computer software programs designed to facilitate analysis and interpretation.
The MSN and MHSA students involved in this class were responsible for conducting a community health assessment project that required completion of three levels of analysis. The MSN and MHSA students worked in interdisciplinary teams to complete the assessment. To begin the process students were provided with an initial list of Internet sites in Netscape® bookmark file format.
To complete the first level of analysis, the students collected data on the sociodemographic and health related characteristics of an urban neighborhood as well as the inpatient discharges from that neighborhood in comparison with other areas. Based on these findings the students selected a priority health condition relevant to the neighborhood. The second level of analysis required the students selected to complete an in-depth epidemiological assessment for this chosen priority condition. Finally, based on the findings from the first two levels of analysis and a literature review on community-based interventions, the students made programmatic recommendations aimed at improving the community's ability to provide effective prevention strategies relevant to the selected health priority.
The steps taken by students to complete the required analysis for this project included:
(1) The students developed an overview of the sociodemographics of the neighborhood using information from the United States Census Internet site. Specifically this sociodemographic profile for the neighborhood included family and economic structure and level of education of residents in comparison with the county.
(2) Description of the neighborhood structure was accomplished by developing a list of existing organizations and their leadership. The major organizations and environmental features were plotted on a computer generated map of the neighborhood obtained from the Internet site.
(3) Identification of reasons for hospital discharge was accomplished using a database from the local hospital council with personal identifiers removed. This included the determination of approximate discharge rates per 1,000 population for the 10 most frequent inpatient discharge categories during a 3-year period.
(4) Students examined neighborhood inpatient resources in comparison with the county and United States for the chosen disease categories. Specifically, students determined total patient days, average length of stay, and estimated cost of inpatient care for a particular disease. Sources of data for this analysis included local hospitalization data and national hospital discharge survey data summaries from the ACPHR Internet site.
(5) Comparison of the county with the neighborhood regarding age, ethnicity, crime, industrial development characteristics, and access to health services was completed using the United States Census Internet site and local databases.
(6) The students used national survey results and local public clinic utilization data to estimate the reasons for physician office visits in the neighborhood study area.
(7) The students determined trends in age-specific and age-adjusted mortality rates for the chosen disease categories in the United States, Ohio, and the county using the Centers for Disease Control and Prevention Wonder Internet site.
(8) Each student team prepared a narrative that described observed differences in the community health indicators as specified in the previous steps. The students developed a Power Point* presentation that presented a summary of their findings and their recommendations for community health programming.
At the end of the course each student completed a project evaluation questionnaire. The questionnaire included questions related to the impact of the project on their electronic information skills. The questionnaire included a Likert scale skill evaluation tool that included items related to each electronic skill necessary for completion of the project. In addition, students were provided with an opportunity to answer open-ended questions related to the benefits of the course.
A total of 69 students completed the evaluation questionnaire. The areas related to electronic-based skills included in the questionnaire were: using email, obtaining information on the WWW, using Microsoft Power Point 7®, using Microsoft Excel«, and using SPSS® (the computer statistical program used in the course).
A significant improvement in the students' perceived software skills occurred after completion of the multidisciplinary community assessment project. Specifically, skills in use of Microsoft Excel®, SPSS®, and Microsoft Powerpoint 7s were judged to have improved significantly during the project (P<.050). Perceived email and Netscape® skills did not change significantly. Information acquisition/assimilation skills did not change regarding ability to locate information; however, there was a drop in perceived skill in organizing a project (P<.059).
Several observations are suggested by the classroom project evaluation results. The evaluation focused on changes in students' perception of their skill in the use of electronic software and information acquisition. This evaluation allowed for observation of the usefulness of this project in helping students use the electronic information systems relevant to the completion of an indepth community assessment.
Perceived software skill improvement varied depending on the type of software. The reason for no change in basic skills regarding use of email and browser software may reflect students' higher functional skills with this software at the start of the course, as well as a possible ceiling effect. The major perceived changes in software skills were in use of analytic and presentation software. For many of the students this was their first opportunity to apply previous software training to an actual data analysis for an applied community project. The acquisition of such skills is important to students who are entering a competitive, information driven health care environment.
A surprising finding was the drop in perceived ability to organize a project. In this and past years students have found the group process for completion of the project especially challenging. Most of the students (97%) who participated in this course evaluation included at least one open-ended comment about difficulties experienced working in groups to accomplish the neighborhood community health analysis. These difficulties have consistently occurred despite faculty assistance with group process and detailed step-bystep guidelines for the project. Fundamental reasons seem related to the students' differing perceptions of the work plan implementation, varying levels of commitment, and difficulty finding times for effective group communication.
As Austin and Malee (1990) suggested, community field projects that use information systems skills enhance curricula aimed at training graduate students who will have responsibilities for management of health care delivery. Future training programs must find a balanced approach to prepare these students in both technical and group process skills. Future project evaluations must include more formal direct assessment of pre- and post-project changes in technical and group skills.
- Agho, A. (1995). In pursuit of computer literacy in health management education. The Journal of Health Administration Education, 13, 287-304.
- Austin, C, & Malee, B. (1990). Information systems education for future health systems administrators. The Journal of Health Administration Education, 8, 53-61.
- Bazzoli, G.J., Stein, R., Alexander, J.A., Conrad, D.A., Sofaer, S., & Shortell, S.M. (1997). Public-private collaboration in health and human service delivery: Evidence from community partnerships. Milbank Quarterly, 75, 533-561.
- Bushy, A. (1997). Empowering initiatives to improve a community's health status. Journal of Nursing Care Quality, 11, 32-42.
- Graveley, E., & Fullerton, J. T. (1998). Incorporating electronic-based and computer-based strategies: Graduate nursing courses in administration. Journal of Nursing Education, 37, 186-188.
- Porter, A.L., Van Cleave, B.L., Milobowski, L.A., Conlon, RF., & Mambourg, R.D. (1996). Clinical integration: An interdisciplinary approach to a system priority. Nursing Administration Quarterly, 20, 65-73.
- Proenca, E.J. (1998). Community orientation in health services: The concept and its implementation. Health Care Management Review, 23, 28-38.
- Russell, K.M., Miller, A.M., & Czerwinska, J. (1994). Epidemiology for community health nursing: An interactive computer assisted instruction program. Computers in Nursing, 12, 98-105.