@Article{info:doi/10.2196/63681,
author="Senathirajah, Yalini
and Kaufman, R. David
and Cato, Kenrick
and Daniel, Pia
and Roblin, Patricia
and Kushniruk, Andre
and Borycki, M. Elizabeth
and Feld, Emanuel
and Debi, Poli",
title="The Impact of the Burden of COVID-19 Regulatory Reporting in a Small Independent Hospital and a Large Network Hospital: Comparative Mixed Methods Study",
journal="Online J Public Health Inform",
year="2025",
month="Mar",
day="26",
volume="17",
pages="e63681",
keywords="regulatory reporting",
keywords="human factors",
keywords="reporting burden",
keywords="emergency response",
keywords="COVID-19",
keywords="hospital resilience",
keywords="pandemic response",
abstract="Background: During the COVID-19 pandemic in 2020, hospitals encountered numerous challenges that compounded their difficulties. Some of these challenges directly impacted patient care, such as the need to expand capacities, adjust services, and use new knowledge to save lives in an ever-evolving situation. In addition, hospitals faced regulatory challenges. Objective: This paper presents the findings of a qualitative study that aimed to compare the effects of reporting requirements on a small independent hospital and a large network hospital during the COVID-19 pandemic. Methods: We used both quantitative and qualitative analyses and conducted 51 interviews, which were thematically analyzed. We quantified the changes in regulatory reporting requirements during the first 14 months of the pandemic. Results: Reporting requirements placed a substantial time burden on key clinical personnel at the small independent hospital, consequently reducing the time available for patient care. Conversely, the large network hospital had dedicated nonclinical staff responsible for reporting duties, and their robust health information system facilitated this work. Conclusions: The discrepancy in health IT capabilities suggests that there may be significant institutional inequities affecting smaller hospitals' ability to respond to a pandemic and adequately support public health efforts. Electronic certification guidelines are essential to addressing the substantial equity issues. We discuss in detail the health care policy implications of these findings. ",
doi="10.2196/63681",
url="https://ojphi.jmir.org/2025/1/e63681",
url="http://www.ncbi.nlm.nih.gov/pubmed/40137048"
}


@Article{info:doi/10.2196/72032,
author="Hooten, Michael W.
and Erickson, J. Darin
and Chawarski, Marek
and Scholz, A. Natalie
and Waljee, F. Jennifer
and Brummett, M. Chad
and Jeffery, M. Molly",
title="Unintended Prolonged Opioid Use: Protocol for a Case-Controlled Trial",
journal="JMIR Res Protoc",
year="2025",
month="Mar",
day="24",
volume="14",
pages="e72032",
keywords="opioid use",
keywords="case-control",
keywords="unintended opioid use",
keywords="prolonged opioid use",
keywords="prospective",
abstract="Background: Misuse of prescription opioids remains a public health problem. Appropriate short-term use of these medications in opioid-naive patients is indicated in selected settings but can result in unintended prolonged opioid use (UPOU), defined as the continuation of opioid therapy beyond the period by which acute pain would have been expected to resolve. Clinical strategies aimed at preventing UPOU are lacking due to the absence of information about how this poorly understood clinical phenomenon actually develops. Objective: In this research project, 3 Clinical and Translational Science Awards (CTSA) programs (Mayo Clinic, University of Michigan, and Yale University) leveraged the conceptual framework for UPOU to investigate how patient characteristics, practice environment characteristics, and opioid prescriber characteristics facilitate or impede UPOU. All data management and analyses were conducted at a fourth CTSA program (University of Minnesota). This work was accomplished by pursuing 3 specific aims. Methods: In aim 1, opioid-naive adults receiving an initial opioid prescription were recruited for study participation. Opioid prescriptions were identified longitudinally, and patterns of use were categorized as short-term, episodic, or long-term use using established criteria. Using a prospective case-control design, patients progressing to UPOU were matched 1:1 with patients who did not develop UPOU, and differences in patient characteristics were assessed. In aim 2, clinicians who prescribed opioids to patients in aim 1 were identified and recruited for prospective assessments. Institutional and individual practice environments were assessed using a validated self-report survey. In aim 3, structural equation modeling was used to evaluate data collected in aims 1 and 2, and identified interactions were further evaluated in a large national administrative claims database. Results: Patient recruitment began on August 1, 2019. However, due to the COVID-19 pandemic, patient recruitment was slowed and intermittently interrupted over the ensuing 3-year period. As a result of regional variations in the impact of the COVID-19 pandemic on research activities, the majority of patient and clinician recruitment occurred at the Mayo Clinic site. Conclusions: Following complete data analyses, it is anticipated that electronic health record systems will be leveraged to help clinicians identify at risk patients and to develop direct-to-patient educational materials to raise awareness of the risk factors for developing UPOU. Trial Registration: ClinicalTrials.gov NCT04024397; https://clinicaltrials.gov/study/NCT04024397 International Registered Report Identifier (IRRID): DERR1-10.2196/72032 ",
doi="10.2196/72032",
url="https://www.researchprotocols.org/2025/1/e72032",
url="http://www.ncbi.nlm.nih.gov/pubmed/39992690"
}


@Article{info:doi/10.2196/58227,
author="Ivanitskaya, V. Lana
and Erzikova, Elina",
title="Visualizing YouTube Commenters' Conceptions of the US Health Care System: Semantic Network Analysis Method for Evidence-Based Policy Making",
journal="JMIR Infodemiology",
year="2025",
month="Feb",
day="11",
volume="5",
pages="e58227",
keywords="social media",
keywords="semantic network",
keywords="health system",
keywords="health policy",
keywords="ideology",
keywords="VOSviewer",
keywords="health care reform",
keywords="health services",
keywords="health care workforce",
keywords="health insurance",
abstract="Background: The challenge of extracting meaningful patterns from the overwhelming noise of social media to guide decision-makers remains largely unresolved. Objective: This study aimed to evaluate the application of a semantic network method for creating an interactive visualization of social media discourse surrounding the US health care system. Methods: Building upon bibliometric approaches to conducting health studies, we repurposed the VOSviewer software program to analyze 179,193 YouTube comments about the US health care system. Using the overlay-enhanced semantic network method, we mapped the contents and structure of the commentary evoked by 53 YouTube videos uploaded in 2014 to 2023 by right-wing, left-wing, and centrist media outlets. The videos included newscasts, full-length documentaries, political satire, and stand-up comedy. We analyzed term co-occurrence network clusters, contextualized with custom-built information layers called overlays, and performed tests of the semantic network's robustness, representativeness, structural relevance, semantic accuracy, and usefulness for decision support. We examined how the comments mentioning 4 health system design concepts---universal health care, Medicare for All, single payer, and socialized medicine---were distributed across the network terms. Results: Grounded in the textual data, the macrolevel network representation unveiled complex discussions about illness and wellness; health services; ideology and society; the politics of health care agendas and reforms, market regulation, and health insurance; the health care workforce; dental care; and wait times. We observed thematic alignment between the network terms, extracted from YouTube comments, and the videos that elicited these comments. Discussions about illness and wellness persisted across time, as well as international comparisons of costs of ambulances, specialist care, prescriptions, and appointment wait times. The international comparisons were linked to commentaries with a higher concentration of British-spelled words, underscoring the global nature of the US health care discussion, which attracted domestic and global YouTube commenters. Shortages of nurses, nurse burnout, and their contributing factors (eg, shift work, nurse-to-patient staffing ratios, and corporate greed) were covered in comments with many likes. Comments about universal health care had much higher use of ideological terms than comments about single-payer health systems. Conclusions: YouTube users addressed issues of societal and policy relevance: social determinants of health, concerns for populations considered vulnerable, health equity, racism, health care quality, and access to essential health services. Versatile and applicable to health policy studies, the method presented and evaluated in our study supports evidence-based decision-making and contextualized understanding of diverse viewpoints. Interactive visualizations can help to uncover large-scale patterns and guide strategic use of analytical resources to perform qualitative research. ",
doi="10.2196/58227",
url="https://infodemiology.jmir.org/2025/1/e58227",
url="http://www.ncbi.nlm.nih.gov/pubmed/39932770"
}


@Article{info:doi/10.2196/65548,
author="He, Jinyu
and Li, Yanjun
and Zeng, Huatang
and Sun, Haoran
and Wu, Liqun
and Zhu, Zhenzhen
and Zhang, Ning
and Liang, Wannian",
title="Health Equity of Hypertension Management Between Local Residents and Internal Migrants in Shenzhen, China: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2025",
month="Feb",
day="10",
volume="11",
pages="e65548",
keywords="health equity",
keywords="hypertension management",
keywords="immigrant population",
keywords="hypertension",
keywords="China",
keywords="global health",
keywords="public health",
keywords="health disparities",
keywords="medical record",
keywords="community health care",
keywords="native population",
keywords="immigrant",
keywords="socioeconomic",
keywords="disease burden",
keywords="well-being",
keywords="chronic disease",
keywords="community health center",
abstract="Background: With hypertension emerging as a global public health concern, taking measures to alleviate its burden is urgently needed. The hypertension management program (HMP) in China is a standardized policy to help people with hypertension to improve their health levels and reduce health inequalities. However, studies focusing on details regarding participation in this program remain scarce. Objective: This study aims to investigate the participation rates in HMPs in China and examine the health disparities in hypertension management between local residents and internal migrants in Shenzhen. Methods: This study used the medical record of Shenzhen, Guangdong, China. We included adults with new-onset diagnosis of hypertension after 2017 and focused on patients who have a record in the community health center. We described the basic characteristics of people diagnosed with hypertension, including age, gender, marital status, occupation, education level, and health insurance type. Enrolled rate, follow-up rate, and adherence rate were used to measure the engagement with this program at the city, district, and community levels. Results: Of the 1,160,214 hypertensive patients, 29.70\% (344,526/1,160,214) were local residents, while 70.3\% (815,688/1,160,214) were internal migrants. In addition, 55.36\% (642,250/1,160,214) were enrolled in the HMP. Of those, 57.52\% (369,439/642,25) were followed up. In addition, 62.59\% (231,217/369,439) of followed up individuals were adherents. Internal migrants demonstrated a significantly higher participation in the HMP, especially for the enrolled rate (local residents: 156,085/344,526, 45.30\% vs internal migrants: 486,165/815,688, 59.60\%) and adherence rate (local residents: 44,044/84,635, 52.04\% vs internal migrants: 187,173/284,804, 65.72\%). Apart from that, local, single, and younger individuals had lower rates compared to their counterparts. There also existed within-district and within-community variation among enrolled, follow-up, and adherence rates. Conclusions: Based on our research, individuals with different demographic and socioeconomic characteristics and in different regions had different enrolled, follow-up, and adherence rates. Internal migrants in Shenzhen showed a significantly higher participation in the HMP. Given these findings, there exists the potential to enhance the outreach and engagement of local, single, and younger populations through targeted promotional strategies. ",
doi="10.2196/65548",
url="https://publichealth.jmir.org/2025/1/e65548"
}


@Article{info:doi/10.2196/52351,
author="Mashilo, Johannah Nkoleleng
and Oladimeji, Elizabeth Kelechi
and Gumede, Siphamandla
and Lalla-Edward, Tresha Samanta",
title="Access to Health Care and Use of Health Care Services Among Males in Africa: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="31",
volume="14",
pages="e52351",
keywords="health-seeking behavior",
keywords="health care",
keywords="access",
keywords="uptake",
keywords="services",
keywords="men",
keywords="boys",
keywords="scoping review",
keywords="Africa",
keywords="male",
keywords="health care services",
keywords="accessibility",
keywords="use",
keywords="noncommunicable disease",
keywords="depression",
keywords="substance abuse",
keywords="overdose",
keywords="physical disability",
keywords="stress",
keywords="older men",
keywords="men's health",
keywords="well-being",
keywords="health literacy",
keywords="perception",
keywords="systematic reviews",
keywords="meta-analysis",
keywords="electronic database",
keywords="EHR",
keywords="electronic health record",
keywords="narrative synthesis",
abstract="Background: There is a scarcity of data on males' health-seeking behavior, as well as their access to and use of health care services, in Africa. According to some studies, men are less likely than women to seek medical help for issues such as communicable and noncommunicable diseases, depression, substance abuse, physical disabilities, and stressful life events. The study of males' health-seeking behaviors is important, because it allows us to learn about male health, how masculinity encourages underuse of health care services, how this affects males' overall health and well-being, and how cultural values and backgrounds may impact older men's health-seeking behaviors. Objective: The objective of this review is to assess evidence on how males access and use health care services and their health knowledge, attitudes, and perceptions to identify gaps for targeted, context-specific strategies to improve males' health and outcomes, particularly in Africa. Methods: The scoping review process will be guided by the methodology frameworks of the Joanna Briggs Institute and Arksey and O'Malley and will follow the Preferred Reporting Items for Systematic reviews and Meta-analysis Protocols Extension for Scoping Reviews guidelines. The following electronic databases will be systematically searched for evidence published between January 2010 and 2023: PubMed, Scopus, Web of Science, African Journals Online, and Google Scholar. Two reviewers will independently screen full texts and chart the data; a third reviewer will be engaged in the event of disagreement between the 2 independent reviewers. The results of this scoping review will be summarized quantitatively through numerical counts and qualitatively through a narrative synthesis. Results: The electronic database search was conducted between March and April 2023 and redone in April 2024 to include the most recent articles. A total of 114,737 articles were retrieved and 4258 removed as duplicates. After title screening, 337 results remained, and after abstract selection, 140 results remained. As of December 2024, the scoping review was in the full-text screening phase. We plan to complete data extraction, synthesis, and writing of the entire manuscript of the review in January 2025, and then submit it to a journal for peer review and publication in February 2025. Conclusions: The scoping review results will advance the current knowledge about health-seeking behavior and access to and uptake of health care services among African males. To our knowledge, this scoping review is the first on this topic, and it will identify vital information on the barriers to and facilitators of African males' health care access and uptake. It will also provide information on successful health care programs for males that may be tailored and adopted across different African contexts. Trial Registration: OSF Registries https://osf.io/xz6sr International Registered Report Identifier (IRRID): DERR1-10.2196/52351 ",
doi="10.2196/52351",
url="https://www.researchprotocols.org/2025/1/e52351"
}


@Article{info:doi/10.2196/62670,
author="Heaney-Huls, Krysta
and Shams, Rida
and Nwefo, Ruth
and Kane, Rachel
and Gordon, Janna
and Laffan, M. Alison
and Stare, Scott
and Dullabh, Prashila",
title="Electronic Health Record Data Collection Practices to Advance Standardization and Interoperability of Patient Preferences for Interpretation Services: Qualitative Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="31",
volume="27",
pages="e62670",
keywords="health information exchange",
keywords="interoperability",
keywords="electronic health records",
keywords="interpreter",
keywords="limited English proficiency",
keywords="communication barriers",
abstract="Background: Poor health outcomes are well documented among patients with a non-English language preference (NELP). The use of interpreters can improve the quality of care for patients with NELP. Despite a growing and unmet need for interpretation services in the US health care system, rates of interpreter use in the care setting are consistently low. Standardized collection and exchange of patient interpretation needs can improve access to appropriate language assistance services. Objective: This study aims to examine current practices for collecting, documenting, and exchanging information on a patient's self-reported preference for an interpreter in the electronic health record (EHR) and the implementation maturity and adoption level of available data standards. The paper identifies standards implementation; data collection workflows; use cases for collecting, documenting, and exchanging information on a patient's self-reported preference for an interpreter; challenges to data collection and use; and opportunities to advance standardization of the interpreter needed data element to facilitate patient-centered care. Methods: We conducted a narrative review to describe the availability of terminology standards to facilitate health care organization documentation of a patient's self-reported preference for an interpreter in the EHR. Key informant discussions with EHR developers, health systems, clinicians, a practice-based research organization, a national standards collaborative, a professional health care association, and Federal agency representatives filled in gaps from the narrative review. Results: The findings indicate that health care organizations value standardized collection and exchange of patient language assistance service needs and preferences. Informants identified three use cases for collecting, documenting, and exchanging information on a patient's self-reported preference for an interpreter, which are (1) person-centered care, (2) transitions of care, and (3) health care administration. The discussions revealed that EHR developers provide a data field for documenting interpreter needed data, which are routinely collected across health care organizations through commonly used data collection workflows. However, this data element is not mapped to standard terminologies, such as Logical Observation Identifiers Names and Codes (LOINC) or Systematized Medical Nomenclature for Medicine--Clinical Terminology (SNOMED-CT), consequently limiting the opportunities to electronically share these data between health systems and community-based organizations. The narrative review and key informant discussions identified three potential challenges to using information on a patient's self-reported preference for an interpreter for person-centered care and quality improvement, which are (1) lack of adoption of available data standards, (2) limited electronic exchange, and (3) patient mistrust. Conclusions: Collecting and documenting patient's self-reported interpreter preferences can improve the quality of services provided, patient care experiences, and equitable health care delivery without invoking a significant burden on the health care system. Although there is routine collection and documentation of patient interpretation needs, the lack of standardization limits the exchange of this information among health care and community-based organizations. ",
doi="10.2196/62670",
url="https://www.jmir.org/2025/1/e62670",
url="http://www.ncbi.nlm.nih.gov/pubmed/39888652"
}


@Article{info:doi/10.2196/64257,
author="Alharbi, A. Abdullah
and Aljerian, A. Nawfal
and Binhotan, S. Meshary
and Alghamdi, A. Hani
and Alsultan, K. Ali
and Arafat, S. Mohammed
and Aldhabib, Abdulrahman
and Alaska, A. Yasser
and Alwahbi, B. Eid
and Muaddi, A. Mohammed
and Alqassim, Y. Ahmad
and Horner, D. Ronnie",
title="Digital Surveillance of Mental Health Care Services in Saudi Arabia: Cross-Sectional Study of National e-Referral System Data",
journal="JMIR Public Health Surveill",
year="2025",
month="Jan",
day="24",
volume="11",
pages="e64257",
keywords="digital health",
keywords="mental health",
keywords="health policy",
keywords="epidemiology",
keywords="Saudi Arabia",
keywords="SMARC",
keywords="health care transformation",
keywords="e-referral",
keywords="Saudi Medical Appointments and Referrals Centre",
abstract="Background: Mental illness affects an estimated 25\% of the global population, with treatment gaps persisting worldwide. The COVID-19 pandemic has exacerbated these challenges, leading to a significant increase in mental health issues globally. In Saudi Arabia, the lifetime prevalence of mental disorders is estimated at 34.2\%, yet 86.1\% of those with a 12-month mental disorder report no service use. To address these challenges, digital health solutions, particularly electronic referral (e-referral) systems, have emerged as powerful tools to improve care coordination and access. Saudi Arabia has pioneered the nationwide Saudi Medical Appointments and Referrals Centre (SMARC), a centralized e-referral system using artificial intelligence and predictive analytics. Objectives: This study aims to analyze Saudi Arabia's novel nationwide e-referral system for mental health services, using SMARC platform data to examine referral patterns, and service accessibility. This study also aims to demonstrate how digital health technology can inform and improve mental health care delivery and policy making. Methods: This retrospective, cross-sectional study used secondary data from SMARC on 10,033 psychiatric e-referrals in Saudi Arabia during 2020?2021. Referrals were assessed by patient sociodemographic variables, geographic data, and e-referral characteristics including date, type, bed type, and reason for e-referral. Descriptive statistical analyses identified referral patterns, while regression modeling determined predictors of external referrals to other regions. Results: Analysis of 10,033 psychiatric e-referrals revealed that 58.99\% (n=5918) were for patients aged 18?44 years, 63.93\% (n=6414) were for men, and 87.10\% (n=8739) were for Saudi nationals. The Western Business Unit generated 45.17\% (n=4532) of all e-referral requests. Emergency cases were the most common type of referral overall, followed by routine inpatient and routine outpatient department referrals. However, in the Northern Business Unit, routine inpatient referrals were most frequent. Two-thirds of requests were for ward beds, while critical beds were rarely requested. ``Unavailable subspecialty'' was the primary reason for referrals across all regions. The utilization of the mental health e-referral system varied across regions, with the Northern Border and Albaha regions showing the highest rates, while Madinah, Eastern, and Riyadh regions demonstrated lower use. Temporal analysis showed almost similar monthly patterns in 2020 and 2021. There was an overall increase in referrals in 2021 compared with 2020. Conclusions: This pioneering study of mental health e-referrals in Saudi Arabia demonstrates how digital health transformation, particularly through an e-referral system, has significantly enhanced access to mental health services nationwide in Saudi Arabia. The success of this digital initiative demonstrates how digital health solutions can transform health care access, particularly in mental health services, offering a valuable model for other health care systems. ",
doi="10.2196/64257",
url="https://publichealth.jmir.org/2025/1/e64257"
}


@Article{info:doi/10.2196/58944,
author="Cantarutti, Anna
and Boracchini, Riccardo
and Bell{\`u}, Roberto
and Ronco, Raffaella
and Rea, Federico
and Locatelli, Anna
and Zanini, Rinaldo
and Corrao, Giovanni",
title="Assessing the Impact of Distance Traveled and Birth Volumes of Hospital Maternity Units on Newborn Outcomes: Population-Based Cohort Study",
journal="JMIR Public Health Surveill",
year="2025",
month="Jan",
day="21",
volume="11",
pages="e58944",
keywords="maternity level",
keywords="road travel distance",
keywords="delivery",
keywords="regionalization",
keywords="neonatal outcome",
keywords="childbirth",
keywords="newborn",
keywords="cohort",
keywords="birth",
keywords="population-based",
keywords="maternal",
keywords="maternal outcomes",
keywords="neonatal",
keywords="European",
keywords="health system",
keywords="health care system",
keywords="perinatal care",
keywords="antenatal",
keywords="mortality",
keywords="neonatal mortality",
keywords="perinatal",
abstract="Background: The centralization of childbirth and newborn care in large maternity units has become increasingly prevalent in Europe. While this trend offers potential benefits such as specialized care and improved outcomes, it can also lead to longer travel and waiting times, especially for women in rural areas. Objective: This study aimed to evaluate the association between hospital maternity unit (HMU) volumes, road travel distance (RTD) to the hospital, and other neonatal outcomes. Methods: We conducted a population-based cohort study including all live births in hospitals without intensive care units between 2016 and 2019 in the Lombardy region, Italy. Given the hierarchical structure of our data (births nested within hospitals), we employed log-binomial regression models with random intercepts to estimate relative risks and 95\% CIs for evaluating the association between HMU volumes (?1500 births/year) and RTD (<5 km) with the risk of being transferred and/or death after birth (primary outcome). Secondary outcomes included a low Apgar score at 5 minutes and low adherence to antenatal care (ANC). We controlled for several potential confounders including adherence to the ANC pathway for the primary and low Apgar outcomes. To explore the influence of HMU volumes on the primary outcome, we identified the fractional polynomial model that best described this relationship. Results: Of 65,083 live births, 71\% (n=45,955) occurred in low-volume hospitals (<1000 births/year), 21\% (n=13,560) involved long-distance travel (>15 km), 1\% (n=735) were transferred and/or died after birth, 0.5\% (n=305) had a low Apgar score at 5 minutes, and 64\% (n=41,317) completely adhered to ANC. The risk of transfer and/or death increased as HMU volume decreased, ranging from 1\% for hospitals with 1000?1500 births/year to a 3.6-fold high risk for hospitals with <500 births/year (compared to high-volume hospitals). Travel distance did not affect the primary outcome. Neither HMU volume nor RTD were associated with low Apgar scores. Conversely, the risk of complete adherence to ANC decreased with lower HMU volumes but increased with shorter RTD. Additionally, high-volume hospitals demonstrated a decreasing trend in the frequency of the primary outcome, with transfer and/or death rates ranging from 2\% to 0.5\% and flattening to 0.5\% in hospitals, with activity volume ?1000 mean births/year. Conclusions: Our findings showed an excess risk of neonatal transfer and/or death for live births in HMUs with low activity volumes without an intensive care unit. In contrast, RTD primarily affected adherence to ANC. Moreover, data suggest that 1000 births/year could be an optimal cutoff for maternity hospitals to ensure an appropriate standard of care at delivery. ",
doi="10.2196/58944",
url="https://publichealth.jmir.org/2025/1/e58944"
}


@Article{info:doi/10.2196/65124,
author="Srithanaviboonchai, Kriengkrai
and Yingyong, Thitipong
and Tasaneeyapan, Theerawit
and Suparak, Supaporn
and Jantaramanee, Supiya
and Roudreo, Benjawan
and Tanpradech, Suvimon
and Chuayen, Jarun
and Kanphukiew, Apiratee
and Naiwatanakul, Thananda
and Aungkulanon, Suchunya
and Martin, Michael
and Yang, Chunfu
and Parekh, Bharat
and Northbrook, Chen Sanny",
title="Establishment, Implementation, Initial Outcomes, and Lessons Learned from Recent HIV Infection Surveillance Using a Rapid Test for Recent Infection Among Persons Newly Diagnosed With HIV in Thailand: Implementation Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Dec",
day="26",
volume="10",
pages="e65124",
keywords="rapid test",
keywords="surveillance",
keywords="HIV",
keywords="AIDS",
keywords="diagnosis",
keywords="Thailand",
keywords="men who have sex with men",
keywords="RITA",
keywords="human immunodeficiency virus",
keywords="acquired immune deficiency syndrome",
keywords="transgender",
keywords="recent infection testing algorithm",
abstract="Background: A recent infection testing algorithm (RITA) incorporating case surveillance (CS) with the rapid test for recent HIV infection (RTRI) was integrated into HIV testing services in Thailand as a small-scale pilot project in October 2020. Objective: We aimed to describe the lessons learned and initial outcomes obtained after the establishment of the nationwide recent HIV infection surveillance project from April through August 2022. Methods: We conducted desk reviews, developed a surveillance protocol and manual, selected sites, trained staff, implemented surveillance, and analyzed outcomes. Remnant blood specimens of consenting newly diagnosed individuals were tested using the Asant{\'e} HIV-1 Rapid Recency Assay. The duration of HIV infection was classified as RTRI-recent or RTRI-long-term. Individuals testing RTRI-recent with CD4 counts <200 cells/mm3 or those having opportunistic infections were classified as RITA-CS-long-term. Individuals testing RTRI-recent with CD4 counts >200 cells/mm3, no opportunistic infections, and not on antiretroviral treatment were classified as RITA-CS-recent. Results: Two hundred and one hospitals in 14 high-burden HIV provinces participated in the surveillance. Of these, 69 reported ?1 HIV diagnosis during the surveillance period. Of 1053 newly diagnosed cases, 64 (6.1\%) were classified as RITA-CS-recent. On multivariate analysis, self-reporting as transgender women (adjusted odds ratio [AOR] 7.41, 95\% CI 1.59?34.53) and men who have sex with men (AOR 2.59, 95\% CI 1.02?6.56) compared to heterosexual men, and students compared to office workers or employers (AOR 3.76, 95\% CI 1.25?11.35) were associated with RITA-CS-recent infection. The proper selection of surveillance sites, utilizing existing surveillance tools and systems, and conducting frequent follow-up and supervision visits were the most commonly cited lessons learned to inform the next surveillance phase. Conclusions: Recent HIV infection surveillance can provide an understanding of current epidemiologic trends to inform HIV prevention interventions to interrupt ongoing or recent HIV transmission. The key success factors of the HIV recent infection surveillance in Thailand include a thorough review of the existing HIV testing service delivery system, a streamlined workflow, strong laboratory and health services, and regular communication between sites and the Provincial Health Offices. ",
doi="10.2196/65124",
url="https://publichealth.jmir.org/2024/1/e65124"
}


@Article{info:doi/10.2196/56091,
author="Takashi, Naoki
and Fujisawa, Misaki
and Ohtera, Shosuke",
title="Associations Between Successful Home Discharge and Posthospitalization Care Planning: Cross-Sectional Ecological Study",
journal="JMIR Form Res",
year="2024",
month="Dec",
day="12",
volume="8",
pages="e56091",
keywords="health services research",
keywords="health policy",
keywords="quality of care",
keywords="access to care",
keywords="outcome assessment",
keywords="public health",
keywords="health service",
keywords="accessible",
keywords="accessibility",
keywords="care coordination",
keywords="health outcome",
keywords="surveillance",
keywords="regional disparities",
keywords="nonstandardized care",
keywords="nonstandardization",
keywords="hospital discharge",
keywords="hospital care",
keywords="analysis",
keywords="Japan",
keywords="older adults",
abstract="Background: Effective discharge planning is crucial for successful care transitions, reducing hospital length of stay and readmission rates. Japan offers a financial incentive to enhance the coordination of posthospitalization care planning for patients with complex needs. However, the national impact of this incentive remains unclear. Objective: This study aimed to (1) assess the association between the number of claims submitted for discharge planning, as an indicator of the provision of posthospitalization care planning, and key health care outcomes, including discharges to home, 30-day readmissions, length of stay, and medical expenditures at the prefectural level in Japan, and (2) to describe regional differences in the provision of posthospitalization care planning and explore associated factors. Methods: This ecological study used prefectural-level data from fiscal year 2020. Claims submitted for discharge planning were used as indicators that posthospitalization care planning was provided. Supply-adjusted standardized claim ratios (SCRs) were calculated using data from the Seventh National Database of Health Insurance Claims, to evaluate and compare the number of claims across 47 prefectures in Japan, accounting for differences in population structure. Key outcomes included discharges to home, 30-day readmissions, length of stay, and medical expenditures. Multivariate negative binomial regression models assessed associations between SCRs and outcomes, adjusting for socioeconomic covariates. In addition, regional differences in the provision of posthospitalization care planning and associated factors were analyzed using the Mann-Whitney U test. Prefectures were divided into 3 groups (low, medium, and high) based on tertiles of each factor, and supply-adjusted SCRs were compared across these groups. Results: The ratio of the minimum to maximum supply-adjusted SCR was 10.63, highlighting significant regional variation. Higher supply-adjusted SCRs, indicating more frequent provision of posthospitalization care planning, were associated with an increase of 9.68 (95\% CI 0.98-18.47) discharges to home per 1000 patients for each SD increase in supply-adjusted SCR. Several factors contributed to regional differences in the supply-adjusted SCR for posthospitalization care planning. A higher supply-adjusted SCR was significantly associated with a greater number of nurses per 100 hospital beds (median SCR in low, medium, and high groups: 0.055, 0.101, and 0.103, respectively); greater number of care manager offices per 100 km2 of habitable area (0.088, 0.082, and 0.116); higher proportion of hospitals providing electronic medical information to patients (0.083, 0.095, and 0.11); lower proportion of older adults living alone (0.116; 0.092; 0.071); and higher average per capita income (0.078, 0.102, and 0.102). Conclusions: The provision of posthospitalization care planning is associated with an increased likelihood of discharge to home, underscoring its importance in care transitions. However, significant regional disparities in care coordination exist. Addressing these disparities is crucial for equitable health care outcomes. Further research is needed to clarify causal mechanisms. ",
doi="10.2196/56091",
url="https://formative.jmir.org/2024/1/e56091"
}


@Article{info:doi/10.2196/52715,
author="H{\"a}rk{\"o}nen, Henna
and Myllykangas, Kirsi
and K{\"a}rpp{\"a}, Mikko
and Rasmus, Maaria Kirsi
and Gomes, Francis Julius
and Immonen, Milla
and Hyv{\"a}m{\"a}ki, Piia
and Jansson, Miia",
title="Perspectives of Clients and Health Care Professionals on the Opportunities for Digital Health Interventions in Cerebrovascular Disease Care: Qualitative Descriptive Study",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="2",
volume="26",
pages="e52715",
keywords="cerebrovascular disease",
keywords="stroke",
keywords="digitalization",
keywords="interventions",
keywords="health care professional",
keywords="client",
keywords="patient",
keywords="mHealth",
keywords="mobile health",
keywords="application",
keywords="digital health",
keywords="smartphones",
keywords="health system",
keywords="qualitative",
keywords="descriptive study",
keywords="brain",
keywords="blood vessel disease",
keywords="cerebrovascular disorder",
keywords="Finland",
keywords="interviews",
keywords="efficiency",
keywords="information",
keywords="quality",
keywords="accountability",
keywords="neurology",
keywords="neuroscience",
keywords="brain injury",
keywords="mobile phone",
abstract="Background: Cerebrovascular diseases (CVDs) are a major and potentially increasing burden to public health. Digital health interventions (DHIs) could support access to and provision of high-quality health care (eg, outcomes, safety, and satisfaction), but the design and development of digital solutions and technologies lack the assessment of user needs. Research is needed to identify opportunities to address health system challenges and improve CVD care with primary users of services as the key informants of everyday requirements. Objective: This study aims to identify opportunities for DHIs from clients' and health care professionals' perspectives to address health system challenges and improve CVD care. Methods: This study used a qualitative, descriptive approach. Semistructured, in-person interviews were conducted with 22 clients and 26 health care professionals in a single tertiary-level hospital in Finland between August 2021 and March 2022. The data were analyzed using a deductive and inductive content analysis. Results: Identified opportunities for DHIs in CVD care were organized according to clients, health care professionals, and data services and classified into 14 main categories and 27 generic categories, with 126 subcategories of requirements. DHIs for clients could support the long-term management of health and life changes brought on by CVD. They could provide access to personal health data and offer health information, support, and communication possibilities for clients and their caregivers. Health care professionals would benefit from access to relevant patient data, along with systems and tools that support competence and decision-making. Intersectoral and professional collaboration could be promoted with digital platforms and care pathways. DHIs for data services could enhance care planning and coordination with novel predictive data and interoperable systems for data exchange. Conclusions: The combined study of client and health care professional perspectives identified several opportunities and requirements for DHIs that related to the information, availability, quality, acceptability, utilization, efficiency, and accountability challenges of health systems. These findings provide valuable social insights into digital transformation and the emerging design, development, and use of user-centered technologies and applications to address challenges and improve CVD care and health care. ",
doi="10.2196/52715",
url="https://www.jmir.org/2024/1/e52715",
url="http://www.ncbi.nlm.nih.gov/pubmed/39622027"
}


@Article{info:doi/10.2196/60222,
author="Nabelsi, V{\'e}ronique
and Plouffe, V{\'e}ronique",
title="Enhancing Care Coordination in Oncology and Nononcology Thoracic Surgery Care Pathways Through a Digital Health Solution: Mixed Methods Study",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="26",
volume="8",
pages="e60222",
keywords="digital health solution",
keywords="care coordination",
keywords="optimization",
keywords="health care providers",
keywords="oncology",
keywords="nononcology",
keywords="thoracic surgery",
keywords="pathways",
keywords="continuity of care",
keywords="interfacility",
keywords="Quebec",
abstract="Background: Health-system fragmentation in Quebec significantly impacts care coordination, leading to interruptions in patients' care pathways and adverse effects on their health. Coordinating interfacility service corridors is complex and requires collaboration between multiple health care providers (HCPs) and care settings. Effective care coordination is essential to ensure optimal patient management at transition points. Objective: This study aims to improve oncology and nononcology thoracic surgery care pathways by enhancing care coordination during interfacility transfers through a digital health solution. Methods: A multicenter implementation study was conducted across 2 health regions and 2 health care facilities in Quebec. We conducted 27 semistructured interviews with HCPs and managers to better understand the care pathways. Participatory design workshops were held with future users and key stakeholders at an early stage of the technology's design to validate the prototype's functionalities and workflows. A web survey was sent to all end users (N=13) to assess their experience with the platform. Results: All participants (100\%) either ``agreed'' or ``strongly agreed'' that the platform provided significant benefits. It enhanced interestablishment coordination (4/13, 31\% agreed and 9/13, 69\% strongly agreed) and continuity of care and services (8/13, 62\% agreed and 5/13, 38\% strongly agreed), and it contributed to better management and patient intake (10/13, 77\% agreed and 3/13, 23\% strongly agreed) and process fluidity (3/13, 77\% agreed and 3/13, 23\% strongly agreed). Surgeons from the McGill University Health Centre confirmed that the platform facilitated and secured information transmission (2/5, 40\% agreed and 3/5, 60\% strongly agreed) and kept track of oncology patient referrals, follow-up needs, and cases where surgery is unnecessary (2/5, 40\% agreed and 3/5, 60\% strongly agreed). Nursing staff from the Centre int{\'e}gr{\'e} de sant{\'e} et de services sociaux de l'Outaouais and McGill University Health Centre reported high satisfaction with the platform's support during preoperative visit, surgery, and discharge processes. All participants perceived the platform as intuitive and easy to use. Additionally, participants valued its efficiency in providing rapid access to patient data, which reduces task time and ensures document security, thereby improving care coordination across facilities. The project's success has convinced the HCPs and senior management at both health care facilities to pursue long-term use of the Akinox digital health platform. Conclusions: This pilot project represents a significant advancement in thoracic surgery care pathways and the coordination of interfacility health care service corridors. The project provides care pathways that are adaptable to other surgical specialties. It also paves the way for improving care in cancer and other health care networks while highlighting the key role of nurse navigators in patient care management. The project underscores the value of strategic leadership and stakeholders' collaboration to improve care coordination and operational efficiency by demonstrating technology's essential role in patient care pathways. ",
doi="10.2196/60222",
url="https://formative.jmir.org/2024/1/e60222"
}


@Article{info:doi/10.2196/52552,
author="McCaffrey, Graham
and Wilson, Erin
and Zimmer, V. Lela
and Singh, Anurag
and Jonatansdottir, Steinunn
and Zimmer, Peter
and Snadden, David
and Graham, D. Ian
and MacLeod, Martha",
title="Effects of Virtual Care on Patient and Provider Experience of the Clinical Encounter: Qualitative Hermeneutic Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="26",
volume="26",
pages="e52552",
keywords="virtual medicine",
keywords="telehealth",
keywords="professional-patient relations",
keywords="hermeneutics",
keywords="kidney",
keywords="health care facility",
keywords="British Columbia",
keywords="Canada",
keywords="qualitative research",
keywords="eHealth",
keywords="health informatics",
keywords="physician",
keywords="COVID-19",
keywords="pandemic",
keywords="patient experience",
abstract="Background: Virtual health care has transformed health care delivery, with its use dramatically increasing since the COVID-19 pandemic. While it has been quickly adopted for its convenience and efficiency, there has been a relative lack of in-depth exploration of its human impact, specifically how both patients and providers experience clinical encounters. Objective: This analysis aims to identify and explore themes of change in how patients and providers in a geographically dispersed renal service described their experiences with virtual care, including those changes that occurred during the COVID-19 pandemic. Methods: Hermeneutics is an interpretive research methodology that treats human experience as inherently interpretive, generating meaning through interactions with others in specific, historically conditioned, social contexts. A total of 17 patients and 10 providers from various disciplines were interviewed by phone as part of a study on health care implementation in the context of a kidney care service in northern British Columbia, Canada. The interview data were analyzed using a hermeneutic approach, which emphasizes careful attention to reported experiences in relation to the relationships and contexts of care. Results: During analysis, the interdisciplinary team identified themes related to changes in the clinical encounter and how virtual care influenced perceptions of care among both providers and patients. We organized these themes into 2 categories: the structure and content of the encounter. The structure category included the convenience for patients, who no longer had to travel long distances for appointments, as well as changes in care networks. For example, communication between specialist services and local primary care providers became more crucial for ensuring continuity of care. The content category included issues related to trust-building and assessment. Providers expressed concerns about the difficulty in assessing and understanding their patients' physical and social well-being beyond laboratory results. Conclusions: Patients in the study appreciated the convenience of not needing to travel for appointments, while still having the option for in-person contact with local providers or specialists if their condition changed. Providers were more concerned about the loss of visual cues and sensory data for assessments, as well as the reduced opportunity to build relationships through conversation with patients. Providers also described changes in the locus of control and boundaries, as patients could join phone encounters from anywhere, bypassing traditional privacy and confidentiality boundaries. The study offers a nuanced view of the effects of virtual care on clinical encounters in one setting, seen through the experiences of both patients and providers. ",
doi="10.2196/52552",
url="https://www.jmir.org/2024/1/e52552"
}


@Article{info:doi/10.2196/63561,
author="Correia, Fa{\c{c}}anha Rafaela Bezerra
and Mourad, Prudlik Rafaela
and Dantas, Costa Janmilli da
and Silva, da Richardson Augusto Rosendo",
title="Barriers and Facilitators Affecting Access to Health Care for People With Syphilis: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2024",
month="Nov",
day="15",
volume="13",
pages="e63561",
keywords="syphilis",
keywords="acquired syphilis",
keywords="congenital syphilis",
keywords="gestational syphilis",
keywords="Treponema pallidum",
keywords="health services accessibility",
keywords="access to health services",
keywords="scoping review",
abstract="Background: Syphilis is a systemic, preventable, and curable infection caused by the bacterium Treponema pallidum. Despite being treatable, syphilis continues to have a high incidence, with a resurgence observed even in countries with strong health surveillance systems. This highlights the need to understand the various strategies used globally to improve access to care for individuals with syphilis. Objective: This scoping review aims to identify and map the barriers and facilitators affecting access to health care for people with syphilis. Methods: This scoping review will follow the methodology outlined by the Joanna Briggs Institute. The search will be conducted across several databases, including PubMed/MEDLINE, Scopus, Embase, LILACS (Virtual Health Library), and CINAHL (EBSCO). In addition, sources of unpublished studies or gray literature will be explored. Studies focusing on access to health care for individuals with syphilis will be included, regardless of geographic location, country, or language. Two independent reviewers will assess the results, and data will be extracted using a tool specifically developed for this review. The extracted quantitative data will be presented in tables and analyzed using descending hierarchical classification, represented by a class dendrogram. Barriers and facilitators will be categorized into dimensions of access. Results: Database searching began in October 2024. Full-text screening and review are expected to be completed in December 2024. Data extraction and analysis are expected to be completed by February 2025, and the final report will be completed in March 2025. Conclusions: The findings of this scoping review, guided by this protocol, will elucidate the main barriers and facilitators that affect access to syphilis treatment. This study may contribute to the practices of health professionals, managers, and the academic community, and provide relevant information for the population. Trial Registration: Open Science Framework Registries osf.io/kpsab; https://osf.io/kpsab International Registered Report Identifier (IRRID): PRR1-10.2196/63561 ",
doi="10.2196/63561",
url="https://www.researchprotocols.org/2024/1/e63561"
}


@Article{info:doi/10.2196/59800,
author="Johnson, K. Amy
and Devlin, A. Samantha
and Pyra, Maria
and Etshokin, Eriika
and Ducheny, Kelly
and Friedman, E. Eleanor
and Hirschhorn, R. Lisa
and Haider, Sadia
and Ridgway, P. Jessica",
title="Mapping Implementation Strategies to Address Barriers to Pre-Exposure Prophylaxis Use Among Women Through POWER Up (Pre-Exposure Prophylaxis Optimization Among Women to Enhance Retention and Uptake): Content Analysis",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="15",
volume="8",
pages="e59800",
keywords="pre-exposure prophylaxis",
keywords="PrEP",
keywords="Consolidated Framework for Implementation Research",
keywords="CFIR",
keywords="Expert Recommendations for Implementing Change",
keywords="ERIC",
keywords="implementation science",
keywords="HIV prevention",
keywords="AIDS",
keywords="United States",
keywords="Black women",
keywords="women's health",
abstract="Background: Black cisgender women (hereafter referred to as ``women'') experience one of the highest incidences of HIV among all populations in the United States. Pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention option, but uptake among women is low. Despite tailored strategies for certain populations, including men who have sex with men and transgender women, Black women are frequently overlooked in HIV prevention efforts. Strategies to increase PrEP awareness and use among Black women are needed at multiple levels (ie, community, system or clinic, provider, and individual or patient). Objective: This study aimed to identify barriers and facilitators to PrEP uptake and persistence among Black cisgender women and to map implementation strategies to identified barriers using the CFIR (Consolidated Framework for Implementation Research)-ERIC (Expert Recommendations for Implementing Change) Implementation Strategy Matching Tool. Methods: We conducted a secondary analysis of previous qualitative studies completed by a multidisciplinary team of HIV physicians, implementation scientists, and epidemiologists. Studies involved focus groups and interviews with medical providers and women at a federally qualified health center in Chicago, Illinois. Implementation science frameworks such as the CFIR were used to investigate determinants of PrEP use among Black women. In this secondary analysis, data from 45 total transcripts were analyzed. We identified barriers and facilitators to PrEP uptake and persistence among cisgender women across each CFIR domain. The CFIR-ERIC Implementation Strategy Matching Tool was used to map appropriate implementation strategies to address barriers and increase PrEP uptake among Black women. Results: Barriers to PrEP uptake were identified across the CFIR domains. Barriers included being unaware that PrEP was available (characteristics of individuals), worrying about side effects and impacts on fertility and pregnancy (intervention characteristics), and being unsure about how to pay for PrEP (outer setting). Providers identified lack of training (characteristics of individuals), need for additional clinical support for PrEP protocols (inner setting), and need for practicing discussions about PrEP with women (intervention characteristics). ERIC mapping resulted in 5 distinct implementation strategies to address barriers and improve PrEP uptake: patient education, provider training, PrEP navigation, clinical champions, and electronic medical record optimization. Conclusions: Evidence-based implementation strategies that address individual, provider, and clinic factors are needed to engage women in the PrEP care continuum. Tailoring implementation strategies to address identified barriers increases the probability of successfully improving PrEP uptake. Our results provide an overview of a comprehensive, multilevel implementation strategy (ie, ``POWER Up'') to improve PrEP uptake among women. International Registered Report Identifier (IRRID): RR2-10.1371/journal.pone.0285858 ",
doi="10.2196/59800",
url="https://formative.jmir.org/2024/1/e59800"
}


@Article{info:doi/10.2196/57609,
author="Liu, Yayuan
and Jin, Haofeng
and Yu, Zhuoyuan
and Tong, Yu",
title="Impact of Internet Hospital Consultations on Outpatient Visits and Expenses: Quasi-Experimental Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="11",
volume="26",
pages="e57609",
keywords="internet hospital",
keywords="online consultation",
keywords="telehealth",
keywords="outpatient visits",
keywords="outpatient expenses",
keywords="urban-rural healthcare disparity",
abstract="Background: Internet hospital consultations are emerging in China as a new channel for patients to access health care services. Unlike third-party health care platforms such as Haodf, Teladoc Health, and MDLive, internet hospitals seamlessly integrate patients' offline medical records with online consultations, offering a cohesive online and offline health care experience. However, its impact on outpatient visits remains ambiguous. While it may encourage outpatient visits due to better continuity of care, it could also reduce face-to-face visits because of the convenience of online consultations. Given that patients in China have the autonomy to freely choose their health care providers, it is critical for hospitals to understand the effect of this telehealth technology on outpatient visits. Objective: This study aimed to analyze the impact of patients' adoption of internet hospital consultations on their outpatient frequency and expenses, and whether these impacts vary between urban and rural patients. Methods: The data used in this study were collected from a public tertiary hospital situated in a southeastern county of China, covering internet hospital consultations from January 2021 to October 2022, and offline outpatient records from January 2020 to October 2022. The dataset also includes patient demographic information. To estimate the causal effect, we used a quasi-experimental design, combining the difference-in-differences (DiD) analysis with the propensity score matching (PSM). After performing PSM, 2065 pairs of patients (4130 patients) were obtained for data analysis. Results: Our findings highlight 3 key results. First, patients' adoption of internet hospital consultations increases their frequency of outpatient visits by 2.4\% per month (P<.001), and the associated expenses by 15.5\% per month (P<.001). Second, such positive effects are more pronounced for patients residing in rural areas. Specifically, for every 1\% increase in the distance between patients' residences and the county government (an urban center), the positive effect on monthly outpatient visits increases by 0.3\% (P=.06), and the positive effect on monthly outpatient expenses increases by 2.4\% (P=.03). Third, our post hoc analysis shows that rural patients living in areas with higher local health care quality experience a mitigated positive effect of internet hospital consultations, compared with those in areas with lower health care quality. Conclusions: This study extends the research scope of telehealth technologies by investigating internet hospitals, which are characterized by the integration of online and offline services. Our findings suggest that patients' adoption of internet hospital consultations is associated with an increase in both the frequency and expenses of outpatient visits. In addition, these effects vary based on patients' urban-rural status and local health care quality. These insights offer valuable guidance for policy makers and health care providers in promoting and optimizing the development and operation of internet hospitals. ",
doi="10.2196/57609",
url="https://www.jmir.org/2024/1/e57609"
}


@Article{info:doi/10.2196/55160,
author="France, Sonja
and Dettori, Amy
and Ekici, Seda
and McKinley, Lilian
and Patel, Sana
and Jewell, Teresa
and Crocker, E. Mary",
title="Community Health Worker Videoconferencing Interventions for Disease Management and Health Promotion: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2024",
month="Nov",
day="7",
volume="13",
pages="e55160",
keywords="community health worker",
keywords="lay health worker",
keywords="telehealth",
keywords="videoconferencing",
keywords="intervention",
keywords="digital divide",
keywords="disease management",
keywords="health promotion",
abstract="Background: Public health interventions delivered by community health workers (CHWs) have been proven effective in improving health outcomes across multiple fields, particularly in populations that are underserved by traditional health care systems. To date, little research is available about how CHW-led interventions could be successfully delivered virtually, despite many other health care services being offered via telehealth. Objective: This paper details a scoping review protocol that aims to assess the existing literature on CHW-led interventions using videoconferencing technology. Methods: The scoping review protocol was developed using the Joanna Briggs Institute's guidelines on conduct of scoping reviews. Included papers will describe a direct intervention to manage disease or improve health, delivered by CHWs via videoconferencing. Multiple literature databases and gray literature will be searched. Abstracts and then full texts will be reviewed to determine inclusion by 2 independent reviewers; conflicts at each stage will be resolved by a third reviewer. A data extraction tool will be used by reviewers to independently chart data from included studies; results will be reviewed for accuracy by a second reviewer. Included papers will be analyzed to identify the breadth of the available evidence, including barriers, facilitators, effectiveness, and best practices described in the literature. Data will be summarized in a narrative review. Results: This study commenced in April 2022, and the study protocol was finalized in November 2022. A preliminary search of the published literature (excluding gray literature) in July 2024 revealed 276 reports after removal of duplicates. The formal literature search will commence in August 2024, with results available by December 2024. We intend to publish results in the academic literature as well as creating a report accessible to nonacademic and community audiences. Conclusions: This review will illuminate the breadth of the evidence available on CHW videoconferencing interventions, with specific focus on strategies for implementation success and equity of access. and will be of great value to organizations that offer CHW services. International Registered Report Identifier (IRRID): DERR1-10.2196/55160 ",
doi="10.2196/55160",
url="https://www.researchprotocols.org/2024/1/e55160"
}


@Article{info:doi/10.2196/57611,
author="Fischer, Lena
and Scheibler, F{\"u}l{\"o}p
and Schaefer, Corinna
and Karge, Torsten
and Langer, Thomas
and Schewe, Vincent Leon
and Florez, D. Ivan
and Hutchinson, Andrew
and Li, Sheyu
and Maes-Carballo, Marta
and Munn, Zachary
and Perestelo-Perez, Lilisbeth
and Puljak, Livia
and Stiggelbout, Anne
and Pieper, Dawid",
title="Fostering Shared Decision-Making Between Patients and Health Care Professionals in Clinical Practice Guidelines: Protocol for a Project to Develop and Test a Tool for Guideline Developers",
journal="JMIR Res Protoc",
year="2024",
month="Nov",
day="4",
volume="13",
pages="e57611",
keywords="shared decision-making",
keywords="practice guidelines as topic",
keywords="decision support techniques",
keywords="support",
keywords="decision-making",
keywords="decisions",
keywords="tool",
keywords="testing tool",
keywords="protocol",
keywords="medical decision-making",
keywords="patient decision aid",
keywords="decision aid",
keywords="tool development",
abstract="Background: Clinical practice guidelines (CPGs) are designed to assist health care professionals in medical decision-making, but they often lack effective integration of shared decision-making (SDM) principles to reflect patient values and preferences, particularly in the context of preference-sensitive CPG recommendations. To address this shortcoming and foster SDM through CPGs, the integration of patient decision aids (PDAs) into CPGs has been proposed as an important strategy. However, methods for systematically identifying and prioritizing CPG recommendations relevant to SDM and related decision support tools are currently lacking. Objective: The aim of the project is to develop (1) a tool for systematically identifying and prioritizing CPG recommendations for which SDM is considered particularly relevant and (2) a platform for PDAs to support practical SDM implementation. Methods: The project consists of 6 work packages (WPs). It is embedded in the German health care context but has an international focus. In WP 1, we will conduct a scoping review in bibliographic databases and gray literature sources to identify methods used to foster SDM via PDAs in the context of CPGs. In WP 2, we will conduct semistructured interviews with CPG experts to better understand the concepts of preference sensitivity and identify strategies for fostering SDM through CPGs. WP 3, a modified Delphi study including surveys and focus groups with SDM experts, aims to define and operationalize preference sensitivity. Based on the results of the Delphi study, we will develop a methodology for prioritizing key questions in CPGs. In WP 4, the tool will be developed. A list of relevant items to identify CPG recommendations for which SDM is most relevant will be created, tested, and iteratively refined, accompanied by the development of a user manual. In WP 5, a platform for creating and digitizing German-language PDAs will be developed to support the practical application of SDM during clinical encounters. WP 6 will conclude the project by testing the tool with newly developed and revised CPGs. Results: The Brandenburg Medical School Ethics Committee approved the project (165122023-ANF). An international multidisciplinary advisory board is involved to guide the tool development on CPGs and SDM. Patient partners are involved throughout the project, considering the essential role of the patient perspective in SDM. As of February 20, 2024, we are currently assessing literature references to determine eligibility for inclusion in the scoping review (WP 1). We expect the project to be completed by December 31, 2026. Conclusions: The tool will enable CPG developers to systematically incorporate aspects of SDM into CPG development, thereby providing guideline-based support for the patient-practitioner interaction. Together, the tool for CPGs and the platform for PDAs will create a systematic link between CPGs, SDM, and PDAs, which may facilitate SDM in clinical practice. International Registered Report Identifier (IRRID): DERR1-10.2196/57611 ",
doi="10.2196/57611",
url="https://www.researchprotocols.org/2024/1/e57611",
url="http://www.ncbi.nlm.nih.gov/pubmed/39495553"
}


@Article{info:doi/10.2196/57285,
author="Abejew, Agalu Asrat
and Wubetu, Yismaw Gizachew
and Fenta, Gedif Teferi",
title="Antibiotic Prescribing Behavior of Physicians in Outpatient Departments in Hospitals in Northwest Ethiopia: Structural Equation Modeling Approach",
journal="Interact J Med Res",
year="2024",
month="Oct",
day="23",
volume="13",
pages="e57285",
keywords="antibiotic prescribing behavior",
keywords="Ethiopia",
keywords="outpatient departments",
keywords="physicians",
keywords="SEM",
keywords="TPB",
abstract="Background: Antibiotic resistance, fueled by irrational prescribing, is a global threat associated with health, social, and economic consequences. Understanding antibiotic prescribing behavior and associated factors is important to promote good prescribing practice. Objective: This study aimed to determine the factors affecting antibiotic prescribing behaviors of physicians based on the theory of planned behavior in hospitals in northwest Ethiopia in 2022. Methods: A cross-sectional study was conducted from September 2022 to October 2022. A total of 185 health professionals were included, and a self-administered questionnaire was used to collect data. A structural equation model based on the modified theory of planned behavior was used to determine factors affecting antibiotic prescribing behavior. The percentages of physicians' estimated prescriptions for patients with upper respiratory tract infections (URTIs) and during weekly outpatient visits were used to predict antibiotic prescribing behavior and finally linked with behavioral constructs. A P value <.05 was considered significant. Results: Physicians estimated that they prescribed antibiotics for 54.8\% (9896/18,049) of weekly outpatient encounters, and 178 (96.2\%) of the 185 physicians estimated they prescribed antibiotics for patients who presented with symptoms of a URTI. Physicians aged ?30 years were less likely to prescribe antibiotics (48/100, 48\%) for patients who presented with a URTI than physicians older than 30 years (51/100, 51\%; P=.004), and general practitioners were less likely to prescribe antibiotics (47/100, 47\%) for patients who presented with a URTI than residents (51/100, 51\%; P=.03). Similarly, during outpatient visits, physicians ?30 years old were less likely to prescribe antibiotics (54/100, 54\%) than physicians older than 30 years (57/100, 57\%; P<.001), male physicians were less likely to prescribe antibiotics (53/100, 53\%) than female physicians (64/100, 64\%; P=.03), and general practitioners were less likely to prescribe antibiotics (53/100, 53\%) than residents (57/100, 57\%; P=.02). Physicians with good knowledge were less affected by perceived social pressure (mean 4.4, SD 0.6) than those with poor knowledge (mean 4.0, SD 0.9; P<.001) and felt it was easy to make rational decisions (mean 4.1, SD 1.1) compared with those with poor knowledge (mean 3.8, SD 1; P<.001). However, intentions to reduce and prescribe antibiotics were not affected by attitudes, subjective norms, or perceived behavioral control, and perceived antibiotic prescribing behavior was not related to intentions to reduce or prescribe antibiotics. Conclusions: Antibiotic prescribing behavior was not under the volitional control of physicians. This calls for a systematic approach to change antibiotic prescribing practices in hospital. ",
doi="10.2196/57285",
url="https://www.i-jmr.org/2024/1/e57285",
url="http://www.ncbi.nlm.nih.gov/pubmed/39441643"
}


@Article{info:doi/10.2196/53828,
author="Zhu, Jiayue Nina
and Weldegiorgis, Misghina
and Carter, Emma
and Brown, Colin
and Holmes, Alison
and Aylin, Paul",
title="Economic Burden of Community-Acquired Antibiotic-Resistant Urinary Tract Infections: Systematic Review and Meta-Analysis",
journal="JMIR Public Health Surveill",
year="2024",
month="Oct",
day="9",
volume="10",
pages="e53828",
keywords="cost-effectiveness",
keywords="urinary tract infection",
keywords="antibiotic resistance",
keywords="mortality",
keywords="hospital length of stay",
abstract="Background: Antibiotic resistance (ABR) poses a major burden to global health and economic systems. ABR in community-acquired urinary tract infections (CA-UTIs) has become increasingly prevalent. Accurate estimates of ABR's clinical and economic burden are needed to support medical resource prioritization and cost-effectiveness evaluations of urinary tract infection (UTI) interventions. Objective: This study aims to systematically synthesize the evidence on the economic costs associated with ABR in CA-UTIs, using published studies comparing the costs of antibiotic-susceptible and antibiotic-resistant cases. Methods: We searched the PubMed, Ovid MEDLINE and Embase, Cochrane Review Library, and Scopus databases. Studies published in English from January 1, 2008, to January 31, 2023, reporting the economic costs of ABR in CA-UTI of any microbe were included. Independent screening of titles/abstracts and full texts was performed based on prespecified criteria. A quality assessment was performed using the Integrated Quality Criteria for Review of Multiple Study Designs (ICROMS) tool. Data in UTI diagnosis criteria, patient characteristics, perspectives, resource costs, and patient and health economic outcomes, including mortality, hospital length of stay (LOS), and costs, were extracted and analyzed. Monetary costs were converted into 2023 US dollars. Results: This review included 15 studies with a total of 57,251 CA-UTI cases. All studies were from high- or upper-middle-income countries. A total of 14 (93\%) studies took a health system perspective, 13 (87\%) focused on hospitalized patients, and 14 (93\%) reported UTI pathogens. Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa are the most prevalent organisms. A total of 12 (80\%) studies reported mortality, of which, 7 reported increased mortality in the ABR group. Random effects meta-analyses estimated an odds ratio of 1.50 (95\% CI 1.29-1.74) in the ABR CA-UTI cases. All 13 hospital-based studies reported LOS, of which, 11 reported significantly higher LOS in the ABR group. The meta-analysis of the reported median LOS estimated a pooled excess LOS ranging from 1.50 days (95\% CI 0.71-4.00) to 2.00 days (95\% CI 0.85-3.15). The meta-analysis of the reported mean LOS estimated a pooled excess LOS of 2.45 days (95\% CI 0.51?4.39). A total of 8 (53\%) studies reported costs in monetary terms---none discounted the costs. All 8 studies reported higher medical costs spent treating patients with ABR CA-UTI in hospitals. The highest excess cost was observed in UTIs caused by carbapenem-resistant Enterobacterales. No meta-analysis was performed for monetary costs due to heterogeneity. Conclusions: ABR was attributed to increased mortality, hospital LOS, and economic costs among patients with CA-UTI. The findings of this review highlighted the scarcity of research in this area, particularly in patient morbidity and chronic sequelae and costs incurred in community health care. Future research calls for a cost-of-illness analysis of infections, standardizing therapy-pathogen combination comparators, medical resources, productivity loss, intangible costs to be captured, and data from community sectors and low-resource settings and countries. ",
doi="10.2196/53828",
url="https://publichealth.jmir.org/2024/1/e53828"
}


@Article{info:doi/10.2196/60099,
author="Garc{\'i}a-Sangen{\'i}s, Ana
and Modena, Daniela
and Jensen, Nygaard Jette
and Chalkidou, Athina
and Antsupova, S. Valeria
and Marloth, Tina
and Theut, Marie Anna
and Gonz{\'a}lez L{\'o}pez-Valc{\'a}rcel, Beatriz
and Raynal, Fabiana
and Vallejo-Torres, Laura
and Lykkegaard, Jesper
and Hansen, Plejdrup Malene
and S{\o}ndergaard, Jens
and Olsen, Kanstrup Jonas
and Munck, Anders
and Balint, Andr{\'a}s
and Benko, Ria
and Petek, Davorina
and Sodja, Nina
and Kowalczyk, Anna
and Godycki-Cwirko, Maciej
and Glasov{\'a}, Helena
and Glasa, Jozef
and Radzeviciene Jurgute, Ruta
and Jaruseviciene, Lina
and Lionis, Christos
and Anastasaki, Marilena
and Angelaki, Agapi
and Petelos, Elena
and Alvarez, Laura
and Ricart, Marta
and Briones, Sergi
and Ruppe, Georg
and Monf{\`a}, Ramon
and Bjerrum, Anders
and Llor, Carl",
title="Improving Antibiotic Use in Nursing Homes by Infection Prevention and Control and Antibiotic Stewardship (IMAGINE): Protocol for a Before-and-After Intervention and Implementation Study",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="16",
volume="13",
pages="e60099",
keywords="antimicrobial stewardship",
keywords="medical audit",
keywords="hygiene",
keywords="antibacterial agents",
keywords="quality improvement",
keywords="nursing homes",
keywords="health personnel",
keywords="drug resistance, microbial",
keywords="frail elderly",
abstract="Background: Despite the extensive use of antibiotics and the growing challenge of antimicrobial resistance, there has been a lack of substantial initiatives aimed at diminishing the prevalence of infections in nursing homes and enhancing the detection of urinary tract infections (UTIs). Objective: This study aims to systematize and enhance efforts to prevent health care--associated infections, mainly UTIs and reduce antibiotic inappropriateness by implementing a multifaceted intervention targeting health care professionals in nursing homes. Methods: A before-and-after intervention study carried out in a minimum of 10 nursing homes in each of the 8 European participating countries (Denmark, Greece, Hungary, Lithuania, Poland, Slovakia, Slovenia, and Spain). A team of 4 professionals consisting of nurses, doctors, health care assistants, or health care helpers are actively involved in each nursing home. Over the initial 3-month period, professionals in each nursing home are registering information on UTIs as well as infection and prevention control measures by means of the Audit Project Odense method. The audit will be repeated after implementing a multifaceted intervention. The intervention will consist of feedback and discussion of the results from the first registration, training on the implementation of infection and prevention control techniques provided by experts, appropriateness of the diagnostic approach and antibiotic prescribing for UTIs, and provision of information materials on infection control and antimicrobial stewardship targeted to staff, residents, and relatives. We will compare the pre- and postintervention audit results using chi-square test for prescription appropriateness and Student t test for implemented hygiene elements. Results: A total of 109 nursing homes have participated in the pilot study and the first registration audit. The results of the first audit registration are expected to be published in autumn of 2024. The final results will be published by the end of 2025. Conclusions: This is a European Union--funded project aimed at contributing to the battle against antimicrobial resistance through improvement of the quality of management of common infections based on evidence-based interventions tailored to the nursing home setting and a diverse range of professionals. We expect the intervention to result in a significant increase in the number of hygiene activities implemented by health care providers and residents. Additionally, we anticipate a marked reduction in the number of inappropriately managed UTIs, as well as a substantial decrease in the overall incidence of infections following the intervention. International Registered Report Identifier (IRRID): DERR1-10.2196/60099 ",
doi="10.2196/60099",
url="https://www.researchprotocols.org/2024/1/e60099",
url="http://www.ncbi.nlm.nih.gov/pubmed/39284176"
}


@Article{info:doi/10.2196/56398,
author="Dziadzko, Mikhail
and Belhassen, Manon
and Van Ganse, Eric
and Heritier, Fabrice
and Berard, Marjorie
and Marant-Micallef, Claire
and Aubrun, Frederic",
title="Health Care Resource Use and Total Mortality After Hospital Admission for Severe COVID-19 Infections During the Initial Pandemic Wave in France: Descriptive Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Sep",
day="11",
volume="10",
pages="e56398",
keywords="claims data",
keywords="COVID-19 infection",
keywords="France",
keywords="health care resource utilizationuse",
keywords="hospitalization",
keywords="mortality",
keywords="Post-Acute COVID-19 Syndrome",
keywords="PACS",
keywords="analysis",
keywords="COVID-19",
keywords="health care",
keywords="infection",
keywords="infections",
keywords="pandemic",
keywords="descriptive study",
keywords="resource use",
keywords="outpatient care",
keywords="retrospective",
keywords="cohort study",
keywords="women",
keywords="female",
keywords="females",
keywords="population-based",
abstract="Background: Little is known about post--hospital health care resource use (HRU) of patients admitted for severe COVID-19, specifically for the care of patients with postacute COVID-19 syndrome (PACS). Objective: A list of HRU domains and items potentially related to PACS was defined, and potential PACS-related HRU (PPRH) was compared between the pre-- and post--COVID-19 periods, to identify new outpatient care likely related to PACS. Methods: A retrospective cohort study was conducted with the French National Health System claims data (SNDS). All patients hospitalized for COVID-19 between February 1, 2020, and June 30, 2020 were described and investigated for 6 months, using discharge date as index date. Patients who died during index stay or within 30 days after discharge were excluded. PPRH was assessed over the 5 months from day 31 after index date to end of follow-up, that is, for the post--COVID-19 period. For each patient, a pre--COVID-19 period was defined that covered the same calendar time in 2019, and pre--COVID-19 PPRH was assessed. Post- or pre- ratios (PP ratios) of the percentage of users were computed with their 95\% CIs, and PP ratios>1.2 were considered as ``major HRU change.'' Results: The final study population included 68,822 patients (median age 64.8 years, 47\% women, median follow-up duration 179.3 days). Altogether, 23\% of the patients admitted due to severe COVID-19 died during the hospital stay or within the 6 months following discharge. A total of 8 HRU domains were selected to study PPRH: medical visits, technical procedures, dispensed medications, biological analyses, oxygen therapy, rehabilitation, rehospitalizations, and nurse visits. PPRs showed novel outpatient care in all domains and in most items, without specificity, with the highest ratios observed for the care of thoracic conditions. Conclusions: Patients hospitalized for severe COVID-19 during the initial pandemic wave had high morbi-mortality. The analysis of HRU domains and items most likely to be related to PACS showed that new care was commonly initiated after discharge but with no specificity, potentially suggesting that any impact of PACS was part of the overall high HRU of this population after hospital discharge. These purely descriptive results need to be completed with methods for controlling for confusion bias through subgroup analyses. Trial Registration: ClinicalTrials.gov NCT05073328; https://clinicaltrials.gov/ct2/show/NCT05073328 ",
doi="10.2196/56398",
url="https://publichealth.jmir.org/2024/1/e56398"
}


@Article{info:doi/10.2196/57384,
author="Aggarwal, Sumit
and Simmy, Simmy
and Mahajan, Nupur
and Nigam, Kuldeep",
title="Challenges Experienced by Health Care Workers During Service Delivery in the Geographically Challenging Terrains of North-East India: Study Involving a Thematic Analysis",
journal="JMIR Form Res",
year="2024",
month="Sep",
day="10",
volume="8",
pages="e57384",
keywords="challenges",
keywords="thematic analysis",
keywords="infrastructure",
keywords="communication",
keywords="supply distribution",
keywords="resilience",
keywords="adaptability",
keywords="vaccination awareness",
keywords="innovative solutions",
abstract="Background: The public health landscape in North-East India is marked by the foundational principle of equitable health care provision, a critical endeavor considering the region's intricate geography and proximity to international borders. Health care workers grapple with challenges, such as treacherous routes, limited infrastructure, and diverse cultural nuances, when delivering essential medical services. Despite improvements since the National Rural Health Mission in 2005, challenges persist, prompting a study to identify health care workers' challenges and alternative strategies in Manipur and Nagaland. Objective: This study aims to document the challenges experienced by health care workers during service delivery in the geographically challenging terrains of North-East India. Methods: This study is part of the i-DRONE (Indian Council of Medical Research's Drone Response and Outreach for North East) project, which aims to assess the feasibility of drone-mediated vaccine and medical delivery. This study addresses the secondary objective of the i-DRONE project. In-depth interviews of 29 health care workers were conducted using semistructured questionnaires in 5 districts (Mokokchung and Tuensang in Nagaland, and Imphal West, Bishnupur, and Churachandpur in Manipur). Nineteen health facilities, including primary health care centers, community health centers, and district hospitals, were selected. The study considered all levels of health care professionals who were in active employment for the past 6 months without a significant vacation and those who were engaged in ground-level implementation, policy, and maintenance activities. Data were recorded, transcribed, and translated, and subsequently, codes, themes, and subthemes were developed using NVivo 14 (QSR International) for thematic analysis. Results: Five themes were generated from the data: (1) general challenges (challenges due to being an international borderline district, human resource constraints, logistical challenges for medical supply, infrastructural issues, and transportation challenges); (2) challenges during the COVID-19 pandemic (increased workload, lack of diagnostic centers, mental health challenges and family issues, routine health care facilities affected, stigma and fear of infection, and vaccine hesitancy and misinformation); (3) perception and awareness regarding COVID-19 vaccination; (4) alternative actions or strategies adopted by health care workers to address the challenges; and (5) suggestions provided by health care workers. Health care workers demonstrated adaptability by overcoming these challenges and provided suggestions for addressing these challenges in the future. Conclusions: Health care workers in Manipur and Nagaland have shown remarkable resilience in the face of numerous challenges exacerbated by the pandemic. Despite infrastructural limitations, communication barriers, and inadequate medical supply distribution in remote areas, they have demonstrated adaptability through innovative solutions like efficient data management, vaccination awareness campaigns, and leveraging technology for improved care delivery. The findings are pertinent for not only health care practitioners and policymakers but also the broader scientific and public health communities. However, the findings may have limited generalizability beyond Manipur and Nagaland. ",
doi="10.2196/57384",
url="https://formative.jmir.org/2024/1/e57384",
url="http://www.ncbi.nlm.nih.gov/pubmed/39255009"
}


@Article{info:doi/10.2196/59690,
author="Dougherty, Kylie
and Gebremariam, Abebe
and Biza, Heran
and Belew, Mulusew
and Benda, Natalie
and Tesfaye, Yihenew
and Cranmer, John
and Bakken, Suzanne",
title="Obstetric Emergency Supply Chain Dynamics and Information Flow Among Obstetric Emergency Supply Chain Employees: Key Informant Interview Study",
journal="JMIR Form Res",
year="2024",
month="Sep",
day="5",
volume="8",
pages="e59690",
keywords="basic emergency obstetric care needs",
keywords="BEmOC",
keywords="supply chain",
keywords="Ethiopia",
keywords="Sociotechnical Model",
abstract="Background: For the past several decades, the Ethiopian Ministry of Health has worked to decrease the maternal mortality ratio (MMR)---the number of pregnant women dying per 100,000 live births. However, with the most recently reported MMR of 267, Ethiopia still ranks high in the MMR globally and needs additional interventions to lower the MMR to achieve the sustainable development goal of 70. One factor contributing to the current MMR is the frequent stockouts of critical medications and supplies needed to treat obstetric emergencies. Objective: This study describes the obstetric emergency supply chain (OESC) dynamics and information flow in Amhara, Ethiopia, as a crucial first step in closing stockouts and gaps in supply availability. Methods: Applying qualitative descriptive methodology, the research team performed 17 semistructured interviews with employees of the OESC at the federal, regional, and facility level to describe and gain an understanding of the system in the region, communication flow, and current barriers and facilitators to consistent emergency supply availability. The team performed inductive and deductive analysis and used the ``Sociotechnical Model for Studying Health Information Technology in Complex Adaptive Healthcare Systems'' to guide the deductive portion. Results: The interviews identified several locations within the OESC where barriers could be addressed to improve overall facility-level readiness, such as gaps in communication about supply needs and availability in health care facilities and regional supply hubs and a lack of data transparency at the facility level. Ordering supplies through the integrated pharmaceutical logistics system was a well-established process and a frequently noted strength. Furthermore, having inventory data in one place was a benefit to pharmacists and supply managers who would need to use the data to determine their historic consumption. The greatest concern related to the workflow and communication of the OESC was an inability to accurately forecast future supply needs. This is a critical issue because inaccurate forecasting can lead to undersupplying and stockouts or oversupplying and waste of medication due to expiration. Conclusions: As a result of these interviews, we gained a nuanced understanding of the information needs for various levels of the health system to maintain a consistent supply of obstetric emergency resources and ultimately increase maternal survival. This study's findings will inform future work to create customized strategies that increase supply availability in facilities and the region overall, specifically the development of electronic dashboards to increase data availability at the regional and facility levels. Without comprehensive and timely data about the OESC, facilities will continue to remain in the dark about their true readiness to manage basic obstetric emergencies, and the central Ethiopian Pharmaceutical Supply Service and regional hubs will not have the necessary information to provide essential emergency supplies prospectively before stockouts and maternal deaths occur. ",
doi="10.2196/59690",
url="https://formative.jmir.org/2024/1/e59690",
url="http://www.ncbi.nlm.nih.gov/pubmed/39235860"
}


@Article{info:doi/10.2196/53580,
author="Valdivieso-Martinez, Bernardo
and Lopez-Sanchez, Victoria
and Sauri, Inma
and Diaz, Javier
and Calderon, Miguel Jose
and Gas-Lopez, Eugenia Maria
and Lidon, Laura
and Philibert, Juliette
and Lopez-Hontangas, Luis Jose
and Navarro, David
and Cuenca, Llanos
and Forner, Jose Maria
and Redon, Josep",
title="Impact of Long SARS-CoV-2 Omicron Infection on the Health Care Burden: Comparative Case-Control Study Between Omicron and Pre-Omicron Waves",
journal="JMIR Public Health Surveill",
year="2024",
month="Sep",
day="3",
volume="10",
pages="e53580",
keywords="Omicron",
keywords="long COVID",
keywords="post--COVID-19",
keywords="diagnostics",
keywords="primary care",
keywords="specialist",
keywords="emergency department",
keywords="hospitalization",
abstract="Background: Following the initial acute phase of COVID-19, health care resource use has escalated among individuals with SARS-CoV-2 infection. Objective: This study aimed to compare new diagnoses of long COVID and the demand for health services in the general population after the Omicron wave with those observed during the pre-Omicron waves, using similar assessment protocols for both periods and to analyze the influence of vaccination. Methods: This matched retrospective case-control study included patients of both sexes diagnosed with acute SARS-CoV-2 infection using reverse transcription polymerase chain reaction or antigen tests in the hospital microbiology laboratory during the pandemic period regardless of whether the patients were hospitalized. We included patients of all ages from 2 health care departments that cover 604,000 subjects. The population was stratified into 2 groups, youths (<18 years) and adults (?18 years). Patients were followed-up for 6 months after SARS-CoV-2 infection. Previous vaccination, new diagnoses, and the use of health care resources were recorded. Patients were compared with controls selected using a prospective score matched for age, sex, and the Charlson index. Results: A total of 41,577 patients with a history of prior COVID-19 infection were included, alongside an equivalent number of controls. This cohort encompassed 33,249 (80\%) adults aged ?18 years and 8328 (20\%) youths aged <18 years. Our analysis identified 40 new diagnoses during the observation period. The incidence rate per 100 patients over a 6-month period was 27.2 for vaccinated and 25.1 for unvaccinated adults (P=.09), while among youths, the corresponding rates were 25.7 for vaccinated and 36.7 for unvaccinated individuals (P<.001). Overall, the incidence of new diagnoses was notably higher in patients compared to matched controls. Additionally, vaccinated patients exhibited a reduced incidence of new diagnoses, particularly among women (P<.001) and younger patients (P<.001) irrespective of the number of vaccine doses administered and the duration since the last dose. Furthermore, an increase in the use of health care resources was observed in both adult and youth groups, albeit with lower figures noted in vaccinated individuals. In the comparative analysis between the pre-Omicron and Omicron waves, the incidence of new diagnoses was higher in the former; however, distinct patterns of diagnosis were evident. Specifically, depressed mood (P=.03), anosmia (P=.003), hair loss (P<.001), dyspnea (<0.001), chest pain (P=.04), dysmenorrhea (P<.001), myalgia (P=.011), weakness (P<.001), and tachycardia (P=.015) were more common in the pre-Omicron period. Similarly, health care resource use, encompassing primary care, specialist, and emergency services, was more pronounced in the pre-Omicron wave. Conclusions: The rise in new diagnoses following SARS-CoV-2 infection warrants attention due to its potential implications for health systems, which may necessitate the allocation of supplementary resources. The absence of vaccination protection presents a challenge to the health care system. ",
doi="10.2196/53580",
url="https://publichealth.jmir.org/2024/1/e53580",
url="http://www.ncbi.nlm.nih.gov/pubmed/39226091"
}


@Article{info:doi/10.2196/55411,
author="Piris-Borregas, Salvador
and Bell{\'o}n-Vaquerizo, Beatriz
and Velasco-Echebur{\'u}a, Leticia
and Ni{\~n}o-D{\'i}az, Lidia
and S{\'a}nchez-Aparicio, Susana
and L{\'o}pez-Maestro, Mar{\'i}a
and Pall{\'a}s-Alonso, Rosa Carmen",
title="Parental Autonomy in the Care of Premature Newborns and the Experience of a Neonatal Team: Observational Prospective Study",
journal="JMIR Pediatr Parent",
year="2024",
month="Aug",
day="30",
volume="7",
pages="e55411",
keywords="family-centered care",
keywords="neonatal intensive care unit",
keywords="kangaroo mother care",
keywords="mother",
keywords="mothers",
keywords="parent",
keywords="parents",
keywords="parental",
keywords="ICU",
keywords="intensive care",
keywords="training",
keywords="education",
keywords="educational",
keywords="premature",
keywords="pediatric",
keywords="pediatrics",
keywords="paediatric",
keywords="paediatrics",
keywords="infant",
keywords="infants",
keywords="infancy",
keywords="baby",
keywords="babies",
keywords="neonate",
keywords="neonates",
keywords="neonatal",
keywords="newborn",
keywords="newborns",
keywords="intensive care unit",
abstract="Background: The European Foundation for the Care of Newborn Infants (EFCNI) has promoted the importance of parental involvement in the care of children. Objective: The study aimed to examine how the time required by parents to achieve autonomy in the care of their very low--birth weight newborn infants was modified during the implementation of a training program. Methods: This was an observational prospective study in the context of a quality improvement initiative. The Cu{\'i}dame (meaning ``Take Care of Me'' in English) program was aimed at achieving parental autonomy. It was implemented over 2 periods: period 1, from September 1, 2020, to June 15, 2021; and period 2, from July 15, 2021, to May 31, 2022. The days required by parents to achieve autonomy in several areas of care were collected from the electronic health system. Results: A total of 54 and 43 families with newborn infants were recruited in periods 1 and 2, respectively. Less time was required to acheive autonomy in period 2 for participation in clinical rounds (median 10.5, IQR 5?20 vs 7, IQR 4?10.5 d; P<.001), feeding (median 53.5, IQR 34?68 vs 44.5, IQR 37?62 d; P=.049), and observation of neurobehavior (median 18, IQR 9?33 vs 11, IQR 7?16 d; P=.049). More time was required to achieve autonomy for kangaroo mother care (median 14, IQR 7?23 vs 21, IQR 10?31 d; P=.02), diaper change (median 9.5, IQR 4?20 vs 14.5, IQR 9?32 d; P=.04), and infection prevention (median 1, IQR 1?2 vs 6, IQR 3?12; P<.001). Conclusions: Parents required less time to achieve autonomy for participation in clinical rounds, feeding, and observation of neurobehavior during the implementation of the training program. Nevertheless, they required more time to achieve autonomy for kangaroo mother care, diaper change, and infection prevention. ",
doi="10.2196/55411",
url="https://pediatrics.jmir.org/2024/1/e55411"
}


@Article{info:doi/10.2196/57615,
author="Lighterness, Anthony
and Adcock, Michael
and Scanlon, Abigail Lauren
and Price, Gareth",
title="Data Quality--Driven Improvement in Health Care: Systematic Literature Review",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="22",
volume="26",
pages="e57615",
keywords="real-world data",
keywords="data quality",
keywords="quality improvement",
keywords="systematic literature review",
keywords="PRISMA",
abstract="Background: The promise of real-world evidence and the learning health care system primarily depends on access to high-quality data. Despite widespread awareness of the prevalence and potential impacts of poor data quality (DQ), best practices for its assessment and improvement are unknown. Objective: This review aims to investigate how existing research studies define, assess, and improve the quality of structured real-world health care data. Methods: A systematic literature search of studies in the English language was implemented in the Embase and PubMed databases to select studies that specifically aimed to measure and improve the quality of structured real-world data within any clinical setting. The time frame for the analysis was from January 1945 to June 2023. We standardized DQ concepts according to the Data Management Association (DAMA) DQ framework to enable comparison between studies. After screening and filtering by 2 independent authors, we identified 39 relevant articles reporting DQ improvement initiatives. Results: The studies were characterized by considerable heterogeneity in settings and approaches to DQ assessment and improvement. Affiliated institutions were from 18 different countries and 18 different health domains. DQ assessment methods were largely manual and targeted completeness and 1 other DQ dimension. Use of DQ frameworks was limited to the Weiskopf and Weng (3/6, 50\%) or Kahn harmonized model (3/6, 50\%). Use of standardized methodologies to design and implement quality improvement was lacking, but mainly included plan-do-study-act (PDSA) or define-measure-analyze-improve-control (DMAIC) cycles. Most studies reported DQ improvements using multiple interventions, which included either DQ reporting and personalized feedback (24/39, 61\%), IT-related solutions (21/39, 54\%), training (17/39, 44\%), improvements in workflows (5/39, 13\%), or data cleaning (3/39, 8\%). Most studies reported improvements in DQ through a combination of these interventions. Statistical methods were used to determine significance of treatment effect (22/39, 56\% times), but only 1 study implemented a randomized controlled study design. Variability in study designs, approaches to delivering interventions, and reporting DQ changes hindered a robust meta-analysis of treatment effects. Conclusions: There is an urgent need for standardized guidelines in DQ improvement research to enable comparison and effective synthesis of lessons learned. Frameworks such as PDSA learning cycles and the DAMA DQ framework can facilitate this unmet need. In addition, DQ improvement studies can also benefit from prioritizing root cause analysis of DQ issues to ensure the most appropriate intervention is implemented, thereby ensuring long-term, sustainable improvement. Despite the rise in DQ improvement studies in the last decade, significant heterogeneity in methodologies and reporting remains a challenge. Adopting standardized frameworks for DQ assessment, analysis, and improvement can enhance the effectiveness, comparability, and generalizability of DQ improvement initiatives. ",
doi="10.2196/57615",
url="https://www.jmir.org/2024/1/e57615"
}


@Article{info:doi/10.2196/58296,
author="Knudsen, Anne-Maj
and Dalg{\aa}rd Dunvald, Ann-Cathrine
and Hangaard, Stine
and Hejlesen, Ole
and Kronborg, Thomas",
title="The Effectiveness of Collaborative Care Interventions for the Management of Patients With Multimorbidity: Protocol for a Systematic Review, Meta-Analysis, and Meta-Regression Analysis",
journal="JMIR Res Protoc",
year="2024",
month="Aug",
day="8",
volume="13",
pages="e58296",
keywords="multimorbidity",
keywords="comorbidity",
keywords="multiple chronic conditions",
keywords="patient care team",
keywords="multidisciplinary teams",
keywords="collaborative care",
keywords="quality of life",
keywords="systematic review",
keywords="meta-analysis",
abstract="Background: Collaborative care interventions have been proposed as a promising strategy to support patients with multimorbidity. Despite this, the effectiveness of collaborative care interventions requires further evaluation. Existing systematic reviews describing the effectiveness of collaborative care interventions in multimorbidity management tend to focus on specific interventions, patient subgroups, and settings. This necessitates a comprehensive review that will provide an overview of the effectiveness of collaborative care interventions for adult patients with multimorbidity. Objective: This systematic review aims to systematically assess the effectiveness of collaborative care interventions in comparison to usual care concerning health-related quality of life (HRQoL), mental health, and mortality among adult patients with multimorbidity. Methods: Randomized controlled trials evaluating collaborative care interventions designed for adult patients (18 years and older) with multimorbidity compared with usual care will be considered for inclusion in this review. HRQoL will be the primary outcome. Mortality and mental health outcomes such as rating scales for anxiety and depression will serve as secondary outcomes. The systematic search will be conducted in the CENTRAL, PubMed, CINAHL, and Embase databases. Additional reference and citation searches will be performed in Google Scholar, Web of Science, and Scopus. Data extraction will be comprehensive and include information about participant characteristics, study design, intervention details, and main outcomes. Included studies will be assessed for limitations according to the Cochrane Risk of Bias tool. Meta-analysis will be conducted to estimate the pooled effect size. Meta-regression or subgroup analysis will be undertaken to explore if certain factors can explain the variation in effect between studies, if feasible. The certainty of evidence will be evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Results: The preliminary literature search was performed on February 16, 2024, and yielded 5255 unique records. A follow-up search will be performed across all databases before submission. The findings will be presented in forest plots, a summary of findings table, and in narrative format. This systematic review is expected to be completed by late 2024. Conclusions: This review will provide an overview of pooled estimates of treatment effects across HRQoL, mental health, and mortality from randomized controlled trials evaluating collaborative care interventions for adults with multimorbidity. Furthermore, the intention is to clarify the participant, intervention, or study characteristics that may influence the effect of the interventions. This review is expected to provide valuable insights for researchers, clinicians, and other decision-makers about the effectiveness of collaborative care interventions targeting adult patients with multimorbidity. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42024512554; https://www.crd.york.ac.uk/PROSPERO/display\_record.php?RecordID=512554 International Registered Report Identifier (IRRID): DERR1-10.2196/58296 ",
doi="10.2196/58296",
url="https://www.researchprotocols.org/2024/1/e58296"
}


@Article{info:doi/10.2196/52180,
author="Wiertz, Svenja
and Boldt, Joachim",
title="Ethical, Legal, and Practical Concerns Surrounding the Implemention of New Forms of Consent for Health Data Research: Qualitative Interview Study",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="7",
volume="26",
pages="e52180",
keywords="health data",
keywords="health research",
keywords="informed consent",
keywords="broad consent",
keywords="tiered consent",
keywords="consent management",
keywords="digital infrastructure",
keywords="data safety",
keywords="GDPR",
abstract="Background: In Europe, within the scope of the General Data Protection Regulation, more and more digital infrastructures are created to allow for large-scale access to patients' health data and their use for research. When the research is performed on the basis of patient consent, traditional study-specific consent appears too cumbersome for many researchers. Alternative models of consent are currently being discussed and introduced in different contexts. Objective: This study explores stakeholder perspectives on ethical, legal, and practical concerns regarding models of consent for health data research at German university medical centers. Methods: Semistructured focus group interviews were conducted with medical researchers at German university medical centers, health IT specialists, data protection officers, and patient representatives. The interviews were analyzed using a software-supported structuring qualitative content analysis. Results: Stakeholders regarded broad consent to be only marginally less laborious to implement and manage than tiered consent. Patient representatives favored specific consent, with tiered consent as a possible alternative. All stakeholders lamented that information material was difficult to understand. Oral information and videos were mentioned as a means of improvement. Patient representatives doubted that researchers had a sufficient degree of data security expertise to act as sole information providers. They were afraid of undue pressure if obtaining health data research consent were part of medical appointments. IT specialists and other stakeholders regarded the withdrawal of consent to be a major challenge and called for digital consent management solutions. On the one hand, the transfer of health data to non-European countries and for-profit organizations is seen as a necessity for research. On the other hand, there are data security concerns with regard to these actors. Research without consent is legally possible under certain conditions but deemed problematic by all stakeholder groups, albeit for differing reasons and to different degrees. Conclusions: More efforts should be made to determine which options of choice should be included in health data research consent. Digital tools could improve patient information and facilitate consent management. A unified and strict regulation for research without consent is required at the national and European Union level. Obtaining consent for health data research should be independent of medical appointments, and additional personnel should be trained in data security to provide information on health data research. ",
doi="10.2196/52180",
url="https://www.jmir.org/2024/1/e52180"
}


@Article{info:doi/10.2196/56237,
author="Amadi, David
and Kiwuwa-Muyingo, Sylvia
and Bhattacharjee, Tathagata
and Taylor, Amelia
and Kiragga, Agnes
and Ochola, Michael
and Kanjala, Chifundo
and Gregory, Arofan
and Tomlin, Keith
and Todd, Jim
and Greenfield, Jay",
title="Making Metadata Machine-Readable as the First Step to Providing Findable, Accessible, Interoperable, and Reusable Population Health Data: Framework Development and Implementation Study",
journal="Online J Public Health Inform",
year="2024",
month="Aug",
day="1",
volume="16",
pages="e56237",
keywords="FAIR data principles",
keywords="metadata",
keywords="machine-readable metadata",
keywords="DDI",
keywords="Data Documentation Initiative",
keywords="standardization",
keywords="JSON-LD",
keywords="JavaScript Object Notation for Linked Data",
keywords="OMOP CDM",
keywords="Observational Medical Outcomes Partnership Common Data Model",
keywords="data science",
keywords="data models",
abstract="Background: Metadata describe and provide context for other data, playing a pivotal role in enabling findability, accessibility, interoperability, and reusability (FAIR) data principles. By providing comprehensive and machine-readable descriptions of digital resources, metadata empower both machines and human users to seamlessly discover, access, integrate, and reuse data or content across diverse platforms and applications. However, the limited accessibility and machine-interpretability of existing metadata for population health data hinder effective data discovery and reuse. Objective: To address these challenges, we propose a comprehensive framework using standardized formats, vocabularies, and protocols to render population health data machine-readable, significantly enhancing their FAIRness and enabling seamless discovery, access, and integration across diverse platforms and research applications. Methods: The framework implements a 3-stage approach. The first stage is Data Documentation Initiative (DDI) integration, which involves leveraging the DDI Codebook metadata and documentation of detailed information for data and associated assets, while ensuring transparency and comprehensiveness. The second stage is Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) standardization. In this stage, the data are harmonized and standardized into the OMOP CDM, facilitating unified analysis across heterogeneous data sets. The third stage involves the integration of Schema.org and JavaScript Object Notation for Linked Data (JSON-LD), in which machine-readable metadata are generated using Schema.org entities and embedded within the data using JSON-LD, boosting discoverability and comprehension for both machines and human users. We demonstrated the implementation of these 3 stages using the Integrated Disease Surveillance and Response (IDSR) data from Malawi and Kenya. Results: The implementation of our framework significantly enhanced the FAIRness of population health data, resulting in improved discoverability through seamless integration with platforms such as Google Dataset Search. The adoption of standardized formats and protocols streamlined data accessibility and integration across various research environments, fostering collaboration and knowledge sharing. Additionally, the use of machine-interpretable metadata empowered researchers to efficiently reuse data for targeted analyses and insights, thereby maximizing the overall value of population health resources. The JSON-LD codes are accessible via a GitHub repository and the HTML code integrated with JSON-LD is available on the Implementation Network for Sharing Population Information from Research Entities website. Conclusions: The adoption of machine-readable metadata standards is essential for ensuring the FAIRness of population health data. By embracing these standards, organizations can enhance diverse resource visibility, accessibility, and utility, leading to a broader impact, particularly in low- and middle-income countries. Machine-readable metadata can accelerate research, improve health care decision-making, and ultimately promote better health outcomes for populations worldwide. ",
doi="10.2196/56237",
url="https://ojphi.jmir.org/2024/1/e56237",
url="http://www.ncbi.nlm.nih.gov/pubmed/39088253"
}


@Article{info:doi/10.2196/51672,
author="Sehgal, R. Neil K.
and Rader, Benjamin
and Brownstein, S. John",
title="Examining the Role of Physician Characteristics in Web-Based Verified Primary Care Physician Reviews: Observational Study",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="29",
volume="26",
pages="e51672",
keywords="patient review websites",
keywords="patient online review",
keywords="telemedicine",
keywords="internet",
keywords="online review",
keywords="online reviews",
keywords="rating",
keywords="physician review",
keywords="physician reviews",
keywords="doctor review",
keywords="doctor reviews",
abstract="Background: Doctor review websites have become increasingly popular as a source of information for patients looking to select a primary care provider. Zocdoc is one such platform that allows patients to not only rate and review their experiences with doctors but also directly schedule appointments. This study examines how several physician characteristics including gender, age, race, languages spoken in a physician's office, education, and facial attractiveness impact the average numerical rating of primary care doctors on Zocdoc. Objective: The aim of this study was to investigate the association between physician characteristics and patient satisfaction ratings on Zocdoc. Methods: A data set of 1455 primary care doctor profiles across 30 cities was scraped from Zocdoc. The profiles contained information on the physician's gender, education, and languages spoken in their office. Age, facial attractiveness, and race were imputed from profile pictures using commercial facial analysis software. Each doctor profile listed an average overall satisfaction rating, bedside manner rating, and wait time rating from verified patients. Descriptive statistics, the Wilcoxon rank sum test, and multivariate logistic regression were used to analyze the data. Results: The average overall rating on Zocdoc was highly positive, with older age, lower facial attractiveness, foreign degrees, allopathic degrees, and speaking more languages negatively associated with the average rating. However, the effect sizes of these factors were relatively small. For example, graduates of Latin American medical schools had a mean overall rating of 4.63 compared to a 4.77 rating for US graduates (P<.001), a difference roughly equivalent to a 2.8\% decrease in appointments. On multivariate analysis, being Asian and having a doctor of osteopathic medicine degree were positively associated with higher overall ratings, while attending a South Asian medical school and speaking more European and Middle Eastern languages in the office were negatively associated with higher overall ratings. Conclusions: Overall, the findings suggest that age, facial attractiveness, education, and multilingualism do have some impact on web-based doctor reviews, but the numerical effect is small. Notably, bias may play out in many forms. For example, a physician's appearance or accent may impact a patient's trust, confidence, or satisfaction with their physician, which could in turn influence their take-up of preventative services and lead to either better or worse health outcomes. The study highlights the need for further research in how physician characteristics influence patient ratings of care. ",
doi="10.2196/51672",
url="https://www.jmir.org/2024/1/e51672"
}


@Article{info:doi/10.2196/43894,
author="Sides, Teresa
and Kbaier, Dhouha",
title="Investigating How the Use of Technology Can Reduce Missed Appointments: Quantitative Case Study at a General Practitioner Surgery",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="29",
volume="26",
pages="e43894",
keywords="National Health Service",
keywords="primary care",
keywords="SMS text messaging",
keywords="SMS reminders",
keywords="missed appointments",
keywords="quantitative research",
keywords="Kruskal-Wallis test",
keywords="Mann-Whitney test",
abstract="Background: SMS texting systems have been considered a potential solution to reduce missed appointments in primary care. Existing research in this area focuses on qualitative studies investigating the attitudes of SMS text users and receivers. Objective: This study aimed to examine appointment data from an independent general practitioner (GP) surgery in Wrexham, United Kingdom, with approximately 15,000 patients, to determine the impact of text messaging systems on reducing missed appointments. The objective of this study was to investigate whether the use of text messages can effectively reduce missed appointments. Methods: To collect data for the study, SQL reports were run on EMIS Web, the United Kingdom's most widely used clinical system. The data spanned 10 years, from September 1, 2010, to March 31, 2020. Data accuracy was verified by cross-referencing with appointment diary records. Mann-Whitney and Kruskal-Wallis tests, chosen for their suitability in comparing groups in nonparametric settings, were conducted in Microsoft Excel due to its accessibility. Results: Statistical analyses were conducted to compare data before and after implementation of the text messaging system. The results revealed a significant 42.8\% reduction in missed appointments (before: 5848; after: 3343; P<.001). Further analysis of demographic characteristics revealed interesting trends, with no significant difference in missed appointments between genders, and variations observed across different age groups. The median number of missed appointments was not significantly different between genders (women: 1.55, IQR 1.11-2.16; men: 1.61, IQR 1.08-2.12; P=.73). Despite the prevalence of mobile phone use among young adults aged 20-25 years, the highest rates of missed appointments (848/7256, 11.7\%) were noted in this group, whereas the lowest rates were noted in the 75-80 years age group (377/7256; 5.2\%; P<.001). Analysis by age and gender indicated inconsistencies: women aged 20-25 years (571/4216) and men aged 35-40 years (306/3040) had the highest rates of missed appointments, whereas women aged 70-75 years (177/4216) and men aged 75-80 years (129/3040) had the lowest rates (P<.001 for both). Conclusions: This study demonstrates that SMS text messaging in primary care can significantly reduce missed appointments. Implementing technology such as SMS text messaging systems enables patients to cancel appointments on time, leading to improved efficiency in primary care settings. ",
doi="10.2196/43894",
url="https://www.jmir.org/2024/1/e43894",
url="http://www.ncbi.nlm.nih.gov/pubmed/39073855"
}


@Article{info:doi/10.2196/51272,
author="Ge, Xiaochen
and Chappell, Paul
and Ledger, Jean
and Bakhai, Minal
and Clarke, M. Geraldine",
title="The Use of Online Consultation Systems and Patient Experience of Primary Care: Cross-Sectional Analysis Using the General Practice Patient Survey",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="26",
volume="26",
pages="e51272",
keywords="general practice",
keywords="online consultation",
keywords="patient experience",
keywords="modern general practice",
keywords="sociodemographic health inequalities",
keywords="General Practice Patient Survey",
keywords="cross-sectional study",
abstract="Background: NHS England encourages the use of online consultation (OC) systems alongside traditional access methods for patients to contact their general practice online and for practices to manage workflow. Access is a key driver of patients' primary care experience. The use of online technology and patient experience vary by sociodemographic characteristics. Objective: This study aims to assess the association between OC system use and patient experience of primary care in English general practice and how that varies by OC system model and practice sociodemographic characteristics (rurality, deprivation, age, and ethnicity). Methods: We categorized practices as ``low-use'' or ``high-use'' according to the volume of patient-initiated contacts made via the OC system. We considered practices using one of 2 OC systems with distinct designs and implementation models---shorter ``free text'' input with an embedded single workflow OC system (FT practices) and longer ``mixed text'' input with variation in implemented workflow OC system (MT practices). We used 2022 General Practice Patient Survey data to capture 4 dimensions of patient experience---overall experience, experience of making an appointment, continuity of care, and use of self-care before making an appointment. We used logistic regression at the practice level to explore the association between OC system use and patient experience, including interaction terms to assess sociodemographic variation. Results: We included 287,194 responses from 2423 MT and 170 FT practices. The proportions of patients reporting positive experiences at MT and FT practices were similar or better than practices nationally, except at high-use MT practices. At high-use MT practices, patients were 19.8\% (odds ratio [OR] 0.802, 95\% CI 0.782-0.823) less likely to report a good overall experience; 24.5\% (OR 0.755, 95\% CI 0.738-0.773) less likely to report a good experience of making an appointment; and 18.9\% (OR 0.811, 95\% CI 0.792-0.83) less likely to see their preferred general practitioner; but 27.8\% (OR 1.278, 95\% CI 1.249-1.308) more likely to use self-care, compared with low-use MT practices. Opposite trends were seen at FT practices. Sociodemographic inequalities in patient experience were generally lower at high-use than low-use practices; for example, gaps in overall experience between practices with the most and fewest White patients decreased by 2.7 percentage points at MT practices and 6.4 percentage points at FT practices. Trends suggested greater improvements in experience for traditionally underserved groups---patients from urban and deprived areas, younger patients, and non-White patients. Conclusions: An OC system with shorter free text input and an integrated single workflow can enhance patient experience and reduce sociodemographic inequalities. Variation in patient experience between practices with different sociodemographic characteristics and OC systems underscores the importance of tailored design and implementation. Generalizing results across different OC systems is difficult due to variations in how they are integrated into practice workflows and communicated to patients. ",
doi="10.2196/51272",
url="https://www.jmir.org/2024/1/e51272"
}


@Article{info:doi/10.2196/57541,
author="Subramani, Yamini
and Querney, Jill
and Singh, Priyanka
and Zhang, Yifan
and Fochesato, Lee-Anne
and Fatima, Nida
and Wood, Natasha
and Nagappa, Mahesh",
title="Preoperative Anesthesia Virtual Video Consultations in a Preadmission Clinic: Quality Improvement Study",
journal="JMIR Perioper Med",
year="2024",
month="Jul",
day="25",
volume="7",
pages="e57541",
keywords="preoperative evaluation",
keywords="preadmission clinic",
keywords="telemedicine",
keywords="remote",
keywords="virtual care",
keywords="remote consultation",
keywords="video consultation",
keywords="telehealth",
keywords="online health",
keywords="digital health",
keywords="perioperative medicine",
keywords="preoperative",
keywords="eMedicine",
keywords="surgery",
keywords="consultation",
keywords="safety",
keywords="assessment",
keywords="workflow",
keywords="implementation",
keywords="integration",
keywords="hospital",
abstract="Background: The preadmission clinic (PAC) is crucial in perioperative care, offering evaluations, education, and patient optimization before surgical procedures. During the COVID-19 pandemic, the PAC adapted by implementing telephone visits due to a lack of infrastructure for video consultations. While the pandemic significantly increased the use of virtual care, including video appointments as an alternative to in-person consultations, our PAC had not used video consultations for preoperative assessments. Objective: This study aimed to develop, implement, and integrate preoperative video consultations into the PAC workflow. Methods: A prospective quality improvement project was undertaken using the Plan-Do-Study-Act (PDSA) methodology. The project focused on developing, implementing, and integrating virtual video consultations at London Health Sciences Centre and St. Joseph Health Care (London, Ontario, Canada) in the PAC. Data were systematically collected to monitor the number of patients undergoing video consultations, address patient flow concerns, and increase the percentage of video consultations. Communication between the PAC, surgeon offices, and patients was analyzed for continuous improvement. Technological challenges were addressed, and procedures were streamlined to facilitate video calls on appointment days. Results: The PAC team, which includes professionals from medicine, anesthesia, nursing, pharmacy, occupational therapy, and physiotherapy, offers preoperative evaluation and education to surgical patients, conducting approximately 8000 consultations annually across 3 hospital locations. Following the initial PDSA cycles, the interventions consistently improved the video consultation utilization rate to 17\%, indicating positive progress. With the onset of PDSA cycle 3, there was a notable surge to a 29\% utilization rate in the early phase. This upward trend continued, culminating in a 38\% utilization rate of virtual video consultations in the later stages of the cycle. This heightened level was consistently maintained throughout 2023, highlighting the sustained success of our interventions. Conclusions: The quality improvement process significantly enhanced the institution's preoperative video consultation workflow. By understanding the complexities within the PAC, strategic interventions were made to integrate video consultations without compromising efficiency, morale, or safety. This project highlights the potential for transformative improvements in health care delivery through the thoughtful integration of virtual care technologies. ",
doi="10.2196/57541",
url="https://periop.jmir.org/2024/1/e57541"
}


@Article{info:doi/10.2196/57005,
author="Rosenau, Lorenz
and Behrend, Paul
and Wiedekopf, Joshua
and Gruendner, Julian
and Ingenerf, Josef",
title="Uncovering Harmonization Potential in Health Care Data Through Iterative Refinement of Fast Healthcare Interoperability Resources Profiles Based on Retrospective Discrepancy Analysis: Case Study",
journal="JMIR Med Inform",
year="2024",
month="Jul",
day="23",
volume="12",
pages="e57005",
keywords="Health Level 7 Fast Healthcare Interoperability Resources",
keywords="HL7 FHIR",
keywords="FHIR profiles",
keywords="interoperability",
keywords="data harmonization",
keywords="discrepancy analysis",
keywords="data quality",
keywords="cross-institutional data exchange",
keywords="Medical Informatics Initiative",
keywords="federated data access challenges",
abstract="Background: Cross-institutional interoperability between health care providers remains a recurring challenge worldwide. The German Medical Informatics Initiative, a collaboration of 37 university hospitals in Germany, aims to enable interoperability between partner sites by defining Fast Healthcare Interoperability Resources (FHIR) profiles for the cross-institutional exchange of health care data, the Core Data Set (CDS). The current CDS and its extension modules define elements representing patients' health care records. All university hospitals in Germany have made significant progress in providing routine data in a standardized format based on the CDS. In addition, the central research platform for health, the German Portal for Medical Research Data feasibility tool, allows medical researchers to query the available CDS data items across many participating hospitals. Objective: In this study, we aimed to evaluate a novel approach of combining the current top-down generated FHIR profiles with the bottom-up generated knowledge gained by the analysis of respective instance data. This allowed us to derive options for iteratively refining FHIR profiles using the information obtained from a discrepancy analysis. Methods: We developed an FHIR validation pipeline and opted to derive more restrictive profiles from the original CDS profiles. This decision was driven by the need to align more closely with the specific assumptions and requirements of the central feasibility platform's search ontology. While the original CDS profiles offer a generic framework adaptable for a broad spectrum of medical informatics use cases, they lack the specificity to model the nuanced criteria essential for medical researchers. A key example of this is the necessity to represent specific laboratory codings and values interdependencies accurately. The validation results allow us to identify discrepancies between the instance data at the clinical sites and the profiles specified by the feasibility platform and addressed in the future. Results: A total of 20 university hospitals participated in this study. Historical factors, lack of harmonization, a wide range of source systems, and case sensitivity of coding are some of the causes for the discrepancies identified. While in our case study, Conditions, Procedures, and Medications have a high degree of uniformity in the coding of instance data due to legislative requirements for billing in Germany, we found that laboratory values pose a significant data harmonization challenge due to their interdependency between coding and value. Conclusions: While the CDS achieves interoperability, different challenges for federated data access arise, requiring more specificity in the profiles to make assumptions on the instance data. We further argue that further harmonization of the instance data can significantly lower required retrospective harmonization efforts. We recognize that discrepancies cannot be resolved solely at the clinical site; therefore, our findings have a wide range of implications and will require action on multiple levels and by various stakeholders. ",
doi="10.2196/57005",
url="https://medinform.jmir.org/2024/1/e57005"
}


@Article{info:doi/10.2196/52020,
author="Hu, Zhiyuan
and Qin, Xiaoping
and Chen, Kaiyan
and Huang, Yu-Ni
and Wang, Szewei Richard
and Tung, Tao-Hsin
and Chuang, Yen-Ching
and Wang, Bing-Long",
title="Chinese Health Insurance in the Digital Era: Bibliometric Study",
journal="Interact J Med Res",
year="2024",
month="Jul",
day="23",
volume="13",
pages="e52020",
keywords="telemedicine",
keywords="health insurance",
keywords="internet plus healthcare",
keywords="bibliometric",
keywords="VOSviewer",
abstract="Background: China has entered the era of digital health care after years of reforms in the health care system. The use of digital technologies in healthcare services is rapidly increasing, indicating the onset of a new period. The reform of health insurance has also entered a new phase. Objective: This study aims to investigate the evolution of health care insurance within the context of telemedicine and Internet Plus Healthcare (IPHC) during the digital health care era by using scientometric methods to analyze publication patterns, influential keywords, and research hot spots. It seeks to understand how health care insurance has adapted to the growing integration of IPHC and telemedicine in health care services and the implications for policy and practice. Methods: A total of 411 high-quality studies were curated from the China National Knowledge Infrastructure (CNKI) database in the Chinese language, scientometric analysis was conducted, and VOSviewer software was used to conduct a visualized analysis of keywords and hot spots in the literature. Results: The number of articles in this field has increased notably from 2000 to 2022 and has increased annually based on a curve of y=0.332exp (0.4002x) with R2=0.6788. In total, 62 institutions and 811 authors have published research articles in the Chinese language in this field. This study included 290 keywords and formulated a total of 5 hot-topic clusters of ``telemedicine,'' ``IPHC,'' ``internet hospital,'' ``health insurance payments,'' and ``health insurance system.'' Conclusions: Studies on the application of digital technologies in health care insurance has evolved from foundational studies to a broader scope. The emergence of internet hospitals has showcased the potential for integrating IPHC services into insurance payment systems. However, this development also highlights the necessity for enhanced interregional coordination mechanisms. The reform of health insurance payment is contingent upon ongoing advancements in digital technology and increased investment in electronic medical records and primary health care services. Future efforts should focus on integrating technology with administrative systems, advancing mobile health care solutions, and ensuring interoperability among various payment systems to improve efficiency and standardize health care services. ",
doi="10.2196/52020",
url="https://www.i-jmr.org/2024/1/e52020"
}


@Article{info:doi/10.2196/56312,
author="Meltzer, Ellen
and Wilshusen, Laurie
and Abdulwadood, Isra
and Yee, Claire
and Sherman, Amy
and Strader, Kelli
and Thomley, Barbara
and Millstine, Denise
and Tilburt, Jon
and Fields, Heather
and Bergstrom, Larry
and Patchett, David
and Camoriano, John
and Bauer, Brent",
title="Telemedicine and Patient Experience Ratings at an Academic Integrative Medicine Practice: Retrospective Examination",
journal="JMIR Form Res",
year="2024",
month="Jul",
day="22",
volume="8",
pages="e56312",
keywords="telemedicine",
keywords="TELE",
keywords="patient experience",
keywords="communication skills",
keywords="integrative medicine",
keywords="face-to-face",
keywords="F2F",
keywords="encounters",
abstract="Background: The use of telemedicine (TELE) increased exponentially during the COVID-19 pandemic. While patient experience with TELE has been studied in other medical disciplines, its impact and applicability to integrative medicine practices remain unknown. Objective: The aim of this study is to assess the impact of visit modality, TELE versus face-to-face (F2F) encounters, on patient experience at an integrative medicine practice at a single academic medical center. Given the significant role of the patient-physician relationship, therapeutic presence, and touch in integrative medicine, we hypothesized that TELE would result in reduced patient experience compared to traditional F2F encounters. Methods: A retrospective examination of Press Ganey surveys at an academic, consultative, and integrative medicine practice was conducted. Anonymous surveys completed by patients, older than 18 years of age, who had TELE or F2F appointments from April 1, 2020, to March 31, 2023, were included. At our medical center, patients commonly travel in from out of state for complex care. We examined percentage ``top box'' scores (ie, the percentage of respondents who selected the most positive response category on the survey, ``very good''), across a variety of experience metrics. ANOVA and chi-square analyses were completed, with a significance threshold of P<.05. Results: Over the 36 months, a total of 1066 surveys were completed and returned (TELE: n=333; F2F: n=733). Overall, 73\% (n=778) of respondents were female with an average age of 57.6 (SD 13.84) years. Most patients were English-speaking (n=728, 99.3\%), White (n=1059, 92.7\%), and not Hispanic or Latino (n=985, 92.4\%). There was significantly higher satisfaction with access to care for TELE visits compared to F2F visits. There were no differences in satisfaction with the care provider or in overall experience. When examining the specific aspects of using technology during TELE visits, there were no differences in audio quality, visual quality, or ease of talking to the care provider based on sex. There was, however, a difference in video quality based on age, where those 80 years and older rated significantly lower video quality compared to all other age groups. Conclusions: Top-level patient experience can be attained with TELE integrative medicine visits. Additional studies, particularly those correlating positive experience findings with specific behaviors used during TELE visits, would further our understanding of the integrative medicine patient experience. In the meantime, efforts should be made to ensure a policy that promotes the ongoing provision of TELE in integrative medicine. ",
doi="10.2196/56312",
url="https://formative.jmir.org/2024/1/e56312",
url="http://www.ncbi.nlm.nih.gov/pubmed/39037767"
}


@Article{info:doi/10.2196/50483,
author="Tarride, Jean-Eric
and Hall, N. Justin
and Mondoux, Shawn
and Dainty, N. Katie
and McCarron, Joy
and Paterson, Michael J.
and Plumptre, Lesley
and Borgundvaag, Emily
and Ovens, Howard
and McLeod, L. Shelley",
title="Cost Evaluation of the Ontario Virtual Urgent Care Pilot Program: Population-Based, Matched Cohort Study",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="15",
volume="26",
pages="e50483",
keywords="virtual urgent care",
keywords="health care expenditures",
keywords="Canada",
keywords="virtual care",
keywords="economic evaluation",
keywords="pilot program",
keywords="pilot",
keywords="Ontario",
keywords="urgent care",
keywords="care",
keywords="emergency department",
keywords="users",
keywords="patient",
keywords="patients",
keywords="resources",
keywords="resource allocation",
keywords="policy decision",
keywords="decision-making",
keywords="policy",
abstract="Background: In 2020, the Ministry of Health (MoH) in Ontario, Canada, introduced a virtual urgent care (VUC) pilot program to provide alternative access to urgent care services and reduce the need for in-person emergency department (ED) visits for patients with low acuity health concerns. Objective: This study aims to compare the 30-day costs associated with VUC and in-person ED encounters from an MoH perspective. Methods: Using administrative data from Ontario (the most populous province of Canada), a population-based, matched cohort study of Ontarians who used VUC services from December 2020 to September 2021 was conducted. As it was expected that VUC and in-person ED users would be different, two cohorts of VUC users were defined: (1) those who were promptly referred to an ED by a VUC provider and subsequently presented to an ED within 72 hours (these patients were matched to in-person ED users with any discharge disposition) and (2) those seen by a VUC provider with no referral to an in-person ED (these patients were matched to patients who presented in-person to the ED and were discharged home by the ED physician). Bootstrap techniques were used to compare the 30-day mean costs of VUC (operational costs to set up the VUC program plus health care expenditures) versus in-person ED care (health care expenditures) from an MoH perspective. All costs are expressed in Canadian dollars (a currency exchange rate of CAD \$1=US \$0.76 is applicable). Results: We matched 2129 patients who presented to an ED within 72 hours of VUC referral and 14,179 patients seen by a VUC provider without a referral to an ED. Our matched populations represented 99\% (2129/2150) of eligible VUC patients referred to the ED by their VUC provider and 98\% (14,179/14,498) of eligible VUC patients not referred to the ED by their VUC provider. Compared to matched in-person ED patients, 30-day costs per patient were significantly higher for the cohort of VUC patients who presented to an ED within 72 hours of VUC referral (\$2805 vs \$2299; difference of \$506, 95\% CI \$139-\$885) and significantly lower for the VUC cohort of patients who did not require ED referral (\$907 vs \$1270; difference of \$362, 95\% CI 284-\$446). Overall, the absolute 30-day costs associated with the 2 VUC cohorts were \$18.9 million (ie, \$6.0 million + \$12.9 million) versus \$22.9 million (\$4.9 million + \$18.0 million) for the 2 in-person ED cohorts. Conclusions: This costing evaluation supports the use of VUC as most complaints were addressed without referral to ED. Future research should evaluate targeted applications of VUC (eg, VUC models led by nurse practitioners or physician assistants with support from ED physicians) to inform future resource allocation and policy decisions. ",
doi="10.2196/50483",
url="https://www.jmir.org/2024/1/e50483",
url="http://www.ncbi.nlm.nih.gov/pubmed/39008348"
}


@Article{info:doi/10.2196/54309,
author="Zhang, Zhuo
and Xue, Dongmei
and Bian, Ying",
title="Association Between Socioeconomic Inequalities in Pain and All-Cause Mortality in the China Health and Retirement Longitudinal Study: Longitudinal Cohort Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Jul",
day="12",
volume="10",
pages="e54309",
keywords="pain",
keywords="equality",
keywords="all-cause mortality",
keywords="concentration index",
keywords="decomposition",
abstract="Background: Few studies focus on the equality of pain, and the relationship between pain and death is inconclusive. Investigating the distribution of pain and potential mortality risks is crucial for ameliorating painful conditions and devising targeted intervention measures. Objective: Our study aimed to investigate the association between inequalities in pain and all-cause mortality in China. Methods: Longitudinal cohort data from waves 1 and 2 of the China Health and Retirement Longitudinal Study (2011-2013) were used in this study. Pain was self-reported at baseline, and death information was obtained from the 2013 follow-up survey. The concentration index and its decomposition were used to explain the inequality of pain, and the association between pain and death was analyzed with a Cox proportional risk model. Results: A total of 16,747 participants were included, with an average age of 59.57 (SD 9.82) years. The prevalence of pain was 32.54\% (8196/16,747). Among participants with pain, the main pain type was moderate pain (1973/5426, 36.36\%), and the common pain locations were the waist (3232/16,747, 19.3\%), legs (2476/16,747, 14.78\%) and head (2250/16,747, 13.44\%). We found that the prevalence of pain was concentrated in participants with low economic status (concentration index --0.066, 95\% CI --0.078 to --0.054). Educational level (36.49\%), location (36.87\%), and economic status (25.05\%) contributed significantly to the inequality of pain. In addition, Cox regression showed that pain was associated with an increased risk of all-cause mortality (hazard ratio 1.30, 95\% CI 1.06-1.61). Conclusions: The prevalence of pain in Chinese adults is concentrated among participants with low economic status, and pain increases the risk of all-cause death. Our results highlight the importance of socioeconomic factors in reducing deaths due to pain inequalities by implementing targeted interventions. ",
doi="10.2196/54309",
url="https://publichealth.jmir.org/2024/1/e54309",
url="http://www.ncbi.nlm.nih.gov/pubmed/38872381"
}


@Article{info:doi/10.2196/56881,
author="Stimpson, P. Jim
and Park, Sungchul
and Wilson, A. Fernando
and Ortega, N. Alexander",
title="Variations in Unmet Health Care Needs by Perceptions of Social Media Health Mis- and Disinformation, Frequency of Social Media Use, Medical Trust, and Medical Care Discrimination: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Jul",
day="11",
volume="10",
pages="e56881",
keywords="United States",
keywords="cross-sectional study",
keywords="trust",
keywords="consumer health information",
keywords="misinformation",
keywords="disinformation",
keywords="perceived discrimination",
keywords="social media",
keywords="unmet need",
keywords="unmet needs",
keywords="health care",
keywords="discrimination",
keywords="racism",
keywords="adult",
keywords="adults",
keywords="medical care",
keywords="frequency",
keywords="multivariable regression",
keywords="user",
keywords="users",
keywords="cross-sectional",
keywords="survey",
keywords="surveys",
keywords="questionnaire",
keywords="questionnaires",
keywords="HINTS",
keywords="Health Information National Trends Survey",
abstract="Background: Unmet need for health care is defined as choosing to postpone or completely avoid necessary medical treatment despite having a need for it, which can worsen current conditions or contribute to new health problems. The emerging infodemic can be a barrier that prevents people from accessing quality health information, contributing to lower levels of seeking medical care when needed. Objective: We evaluated the association between perceptions of health mis- and disinformation on social media and unmet need for health care. In addition, we evaluated mechanisms for this relationship, including frequency of social media use, medical trust, and medical care discrimination. Methods: Data from 3964 active adult social media users responding to the 2022 Health Information National Trends Survey 6 (HINTS 6), a nationally representative survey, were analyzed. The outcome was unmet need for medical care, defined as delaying or not getting the necessary medical care. The predictor variables were perception of social media health mis- and disinformation, frequency of social media use, level of trust in the health care system, and perceived racial and ethnic discrimination when receiving health care. Results: Multivariable logistic regression models indicated that perception of substantial social media health mis- and disinformation (odds ratio [OR] 1.40, 95\% CI 1.07?1.82), daily use of social media (OR 1.34, 95\% CI 1.01?1.79), low medical trust (OR 1.46, 95\% CI 1.06?2.01), and perceived discrimination (OR 2.24, 95\% CI 1.44?3.50) were significantly associated with a higher likelihood of unmet need for medical care. Unmet need among adults who did not use social media daily and who did not perceive substantial mis- and disinformation (24\%; 95\% CI 19\%?30\%) was lower compared to daily social media users who perceived substantial mis- and disinformation (38\%; 95\% CI 32\%?43\%). Adults who perceived substantial mis- and disinformation and had low trust in health care had the highest probability of reporting unmet need (43\%; 95\% CI 38\%?49\%) compared to the other three groups. Adults who perceived substantial mis- and disinformation and experienced medical care discrimination had a statistically significant higher probability of reporting unmet need (51\%; 95\% CI 40\%?62\%) compared to adults who did not experience medical care discrimination and did not perceive substantial mis- and disinformation (29\%; 95\% CI 26\%?32\%). Conclusions: Unmet need for medical care was higher among individuals who perceived a substantial degree of social media mis- and disinformation, especially among those who used social media daily, did not trust the health care system, and experienced racial or ethnic discrimination when receiving health care. To counter the negative effects of social media mis- and disinformation on unmet need for health care, public health messaging must focus on daily social media users as well as improving trust and reducing structural racism in the health care system. ",
doi="10.2196/56881",
url="https://publichealth.jmir.org/2024/1/e56881"
}


@Article{info:doi/10.2196/48156,
author="Kale, U. Aditya
and Dattani, Riya
and Tabansi, Ashley
and Hogg, Jeffry Henry David
and Pearson, Russell
and Glocker, Ben
and Golder, Su
and Waring, Justin
and Liu, Xiaoxuan
and Moore, J. David
and Denniston, K. Alastair",
title="AI as a Medical Device Adverse Event Reporting in Regulatory Databases: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2024",
month="Jul",
day="11",
volume="13",
pages="e48156",
keywords="adverse event",
keywords="artificial intelligence",
keywords="regulatory science",
keywords="regulatory database",
keywords="safety issue",
keywords="feedback",
keywords="health care product",
keywords="artificial intelligence health technology",
keywords="reporting system",
keywords="safety",
keywords="medical devices",
keywords="safety monitoring",
keywords="risks",
keywords="descriptive analysis",
abstract="Background: The reporting of adverse events (AEs) relating to medical devices is a long-standing area of concern, with suboptimal reporting due to a range of factors including a failure to recognize the association of AEs with medical devices, lack of knowledge of how to report AEs, and a general culture of nonreporting. The introduction of artificial intelligence as a medical device (AIaMD) requires a robust safety monitoring environment that recognizes both generic risks of a medical device and some of the increasingly recognized risks of AIaMD (such as algorithmic bias). There is an urgent need to understand the limitations of current AE reporting systems and explore potential mechanisms for how AEs could be detected, attributed, and reported with a view to improving the early detection of safety signals. Objective: The systematic review outlined in this protocol aims to yield insights into the frequency and severity of AEs while characterizing the events using existing regulatory guidance. Methods: Publicly accessible AE databases will be searched to identify AE reports for AIaMD. Scoping searches have identified 3 regulatory territories for which public access to AE reports is provided: the United States, the United Kingdom, and Australia. AEs will be included for analysis if an artificial intelligence (AI) medical device is involved. Software as a medical device without AI is not within the scope of this review. Data extraction will be conducted using a data extraction tool designed for this review and will be done independently by AUK and a second reviewer. Descriptive analysis will be conducted to identify the types of AEs being reported, and their frequency, for different types of AIaMD. AEs will be analyzed and characterized according to existing regulatory guidance. Results: Scoping searches are being conducted with screening to begin in April 2024. Data extraction and synthesis will commence in May 2024, with planned completion by August 2024. The review will highlight the types of AEs being reported for different types of AI medical devices and where the gaps are. It is anticipated that there will be particularly low rates of reporting for indirect harms associated with AIaMD. Conclusions: To our knowledge, this will be the first systematic review of 3 different regulatory sources reporting AEs associated with AIaMD. The review will focus on real-world evidence, which brings certain limitations, compounded by the opacity of regulatory databases generally. The review will outline the characteristics and frequency of AEs reported for AIaMD and help regulators and policy makers to continue developing robust safety monitoring processes. International Registered Report Identifier (IRRID): PRR1-10.2196/48156 ",
doi="10.2196/48156",
url="https://www.researchprotocols.org/2024/1/e48156",
url="http://www.ncbi.nlm.nih.gov/pubmed/38990628"
}


@Article{info:doi/10.2196/56196,
author="Mercadal-Orfila, Gabriel
and Herrera-P{\'e}rez, Salvador
and Piqu{\'e}, N{\'u}ria
and Mateu-Amengual, Francesc
and Ventayol-Bosch, Pedro
and Maestre-Fullana, Antonia Mar{\'i}a
and Serrano-L{\'o}pez de las Hazas, Ignacio Joaqu{\'i}n
and Fern{\'a}ndez-Cort{\'e}s, Francisco
and Barcel{\'o}-Sans{\'o}, Francesc
and Rios, Santiago",
title="Implementing Systematic Patient-Reported Measures for Chronic Conditions Through the Naveta Value-Based Telemedicine Initiative: Observational Retrospective Multicenter Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jun",
day="28",
volume="12",
pages="e56196",
keywords="chronic conditions",
keywords="eHealth",
keywords="value-based care",
keywords="patient-reported outcome measures",
keywords="patient-reported experience measures",
keywords="questionnaires",
keywords="response rate",
keywords="telemedicine platform",
abstract="Background: Patient-reported outcome and experience measures can play a critical role in providing patient-centered and value-based health care to a growing population of patients who are chronically ill. Value-based telemedicine platforms such as the Naveta initiative may facilitate the effective integration of these tools into health care systems. Objective: This study aims to evaluate the response rate to electronic patient-reported outcome measures (ePROMs) and electronic patient-reported experience measures (ePREMs) among patients participating in the Naveta telemedicine initiative and its correlations with sociodemographic and clinical characteristics, as well as the evolution of the response rates over time. Methods: Between January 1, 2021, and June 30, 2023, a total of 53,364 ePREMs and ePROMs for 20 chronic conditions were administered through the Naveta-Phemium platform. Descriptive statistics were used to summarize continuous and categorical variables. Differences in response rates within each sociodemographic variable were analyzed using logistic regression models, with significance assessed via chi-square and post hoc Tukey tests. Two-way ANOVA was used to examine the interaction between time interval and disease type on response rate evolution. Results: A total of 3372 patients with severe chronic diseases from 64 public hospitals in Spain participated in the Naveta health questionnaire project. The overall response rate to ePROMs and ePREMs during the first 2.5 years of the Naveta initiative was 46.12\% (24,704/53,364), with a baseline rate of 53.33\% (7198/13,496). Several sociodemographic factors correlated with lower response rates, including male gender, older age, lower education level, frequent alcohol use, being a student, and not being physically active. There were also significant variations in response rates among different types of chronic conditions (P<.001), with the highest rates being for respiratory (433/606, 71.5\%), oncologic (200/319, 62.7\%), digestive (2247/3601, 62.4\%), and rheumatic diseases (7506/12,982, 57.82\%) and the lowest being for HIV infection (7473/22,695, 32.93\%). During the first 6 months of follow-up, the response rates decreased in all disease types, except in the case of the group of patients with oncologic disease, among whom the response rate increased up to 100\% (6/6). Subsequently, the overall response rate approached baseline levels. Conclusions: Recognizing the influence of sociodemographic factors on response rates is critical to identifying barriers to participation in telemonitoring programs and ensuring inclusiveness in patient-centered health care practices. The observed decline in response rates at follow-up may be due to survey fatigue, highlighting the need for strategies to mitigate this effect. In addition, the variation in response rates across chronic conditions emphasizes the importance of tailoring telemonitoring approaches to specific patient populations. ",
doi="10.2196/56196",
url="https://mhealth.jmir.org/2024/1/e56196",
url="http://www.ncbi.nlm.nih.gov/pubmed/38545697"
}


@Article{info:doi/10.2196/51573,
author="Maheta, Bhagvat
and Shehabat, Mouhamad
and Khalil, Ramy
and Wen, Jimmy
and Karabala, Muhammad
and Manhas, Priya
and Niu, Ashley
and Goswami, Caroline
and Frezza, Eldo",
title="The Effectiveness of Patient Education on Laparoscopic Surgery Postoperative Outcomes to Determine Whether Direct Coaching Is the Best Approach: Systematic Review of Randomized Controlled Trials",
journal="JMIR Perioper Med",
year="2024",
month="Jun",
day="27",
volume="7",
pages="e51573",
keywords="patient",
keywords="education",
keywords="surgeries",
keywords="laparoscopic",
keywords="postoperative",
keywords="outcomes",
keywords="systematic review",
abstract="Background: As of 2022, patient adherence to postoperative guidelines can reduce the risk of complications by up to 52.4\% following laparoscopic abdominal surgery. With the availability of various preoperative education interventions (POEIs), understanding which POEI results in improvement in patient outcomes across the procedures is imperative. Objective: This study aims to determine which POEI could be the most effective on patient outcomes by systematically reviewing all the POEIs reported in the literature. Methods: In total, 4753 articles investigating various POEIs (eg, videos, presentations, mobile apps, and one-on-one education or coaching) were collected from the PubMed, Embase, and Scopus databases. Inclusion criteria were adult patients undergoing abdominal laparoscopic surgery, randomized controlled trials, and studies that provided postoperative outcomes. Exclusion criteria included studies not published in English and with no outcomes reported. Title and abstract and full-text articles with POEI randomized controlled studies were screened based on the above criteria through a blinded, dual review using Covidence (Veritas Health Innovation). Study quality was assessed through the Cochrane Risk of Bias tool. The included articles were analyzed for educational content, intervention timing, intervention type, and postoperative outcomes appropriate for a particular surgery. Results: Only 17 studies matched our criteria, with 1831 patients undergoing laparoscopic cholecystectomy, bariatric surgery (gastric bypass and gastric sleeve), and colectomy. In total, 15 studies reported a statistically significant improvement in at least 1 patient postoperative outcome. None of these studies were found to have an overall high risk of bias according to Cochrane standards. In total, 41\% (7/17) of the included studies using direct individual education improved outcomes in almost all surgery types, while educational videos had the greatest statistically significant impact for anxiety, nausea, and pain postoperatively (P<.01). Direct group education demonstrated significant improvement in weight, BMI, exercise, and depressive symptoms in 33\% (2/6) of the laparoscopic gastric bypass studies. Conclusions: Direct education (individual or group based) positively impacts postoperative laparoscopic surgery outcomes. Trial Registration: PROSPERO CRD42023438698; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=438698 ",
doi="10.2196/51573",
url="https://periop.jmir.org/2024/1/e51573"
}


@Article{info:doi/10.2196/45840,
author="Yang, Meng
and He, Zonglin
and Zhang, Yin
and Liu, Taoran
and Ming, Wai-kit",
title="Pandemic Fatigue and Preferences for COVID-19 Public Health and Social Measures in China: Nationwide Discrete Choice Experiment",
journal="JMIR Public Health Surveill",
year="2024",
month="Jun",
day="27",
volume="10",
pages="e45840",
keywords="pandemic fatigue",
keywords="preference",
keywords="public health and social measures",
keywords="discrete choice experiment",
keywords="COVID-19",
abstract="Background: Information on the public's preferences for current public health and social measures (PHSMs) and people's mental health under PHSMs is insufficient. Objective: This study aimed to quantify the public's preferences for varied PHSMs and measure the level of pandemic fatigue in the COVID-19 normalization stage in China. Methods: A nationwide cross-sectional study with a discrete choice experiment and psychometric scales was conducted to assess public preferences for and attitudes toward PHSMs, using the quota sampling method. The COVID-19 Pandemic Fatigue Scale (CPFS) was used to screen fatigue levels among respondents. The multinomial logit model, latent class model, and Mann-Whitney test were used for statistical analysis. We also conducted subgroup analysis based on sex, age, monthly income, mental health status, and pandemic fatigue status. Results: A total of 689 respondents across China completed the survey. The discrete choice experiment revealed that respondents attached the greatest importance to the risk of COVID-19 infection within 3 months (45.53\%), followed by loss of income within 3 months (30.69\%). Vulnerable populations (low-income populations and elderly people) were more sensitive to the risk of infection, while younger respondents were more sensitive to income loss and preferred nonsuspension of social places and transportation. Migrants and those with pandemic fatigue had less acceptance of the mandatory booster vaccination and suspension of transportation. Additionally, a higher pandemic fatigue level was observed in female respondents, younger respondents, migrants, and relatively lower-income respondents (CPFS correlation with age: r=--0.274, P<.001; correlation with monthly income: r=--0.25, P<.001). Mandatory booster COVID-19 vaccination was also not preferred by respondents with a higher level of pandemic fatigue, while universal COVID-19 booster vaccination was preferred by respondents with a lower level of pandemic fatigue. Conclusions: Pandemic fatigue is widely prevalent in respondents across China, and respondents desired the resumption of normal social life while being confronted with the fear of COVID-19 infection in the normalization stage of COVID-19 in China. During future pandemics, the mental burden and adherence of residents should be considered for the proper implementation of PHSMs. ",
doi="10.2196/45840",
url="https://publichealth.jmir.org/2024/1/e45840",
url="http://www.ncbi.nlm.nih.gov/pubmed/38935420"
}


@Article{info:doi/10.2196/55228,
author="Wallman, Andy
and Sv{\"a}rdsudd, Kurt
and Bobits, Kent
and Wallman, Thorne",
title="Antibiotic Prescribing by Digital Health Care Providers as Compared to Traditional Primary Health Care Providers: Cohort Study Using Register Data",
journal="J Med Internet Res",
year="2024",
month="Jun",
day="26",
volume="26",
pages="e55228",
keywords="telehealth prescribing",
keywords="physical-primary health care",
keywords="internet-primary health care",
keywords="antibiotics",
keywords="prescription",
keywords="infectious disease",
keywords="antibiotic",
keywords="prescriptions",
keywords="prescribing",
keywords="telehealth",
keywords="health care",
keywords="traditional",
keywords="digital",
keywords="telemedicine",
keywords="virtual care",
keywords="Swedish",
keywords="Sweden",
keywords="primary care",
keywords="quality of care",
keywords="online setting",
keywords="ePrescription",
keywords="ePrescriptions",
keywords="ePrescribing",
keywords="eHealth",
keywords="compare",
keywords="comparison",
keywords="online consultation",
keywords="digital care",
keywords="patient record",
keywords="patient records",
keywords="mobile phone",
abstract="Background: ?``Direct-to-consumer (DTC) telemedicine'' is increasing worldwide and changing the map of primary health care (PHC). Virtual care has increased in the last decade and with the ongoing COVID-19 pandemic, patients' use of online care has increased even further. In Sweden, online consultations are a part of government-supported health care today, and there are several digital care providers on the Swedish market, which makes it possible to get in touch with a doctor within a few minutes. The fast expansion of this market has raised questions about the quality of primary care provided only in an online setting without any physical appointments. Antibiotic prescribing is a common treatment in PHC. Objective: ?This study aimed to compare antibiotic prescribing between digital PHC providers (internet-PHC) and traditional physical PHC providers (physical-PHC) and to determine whether prescriptions for specific diagnoses differed between internet-PHC and physical-PHC appointments, adjusted for the effects of attained age at the time of appointment, gender, and time relative to the COVID-19 pandemic. Methods: ?Antibiotic prescribing data based on Anatomical Therapeutic Chemical (ATC) codes were obtained for Region S{\"o}rmland residents from January 2020 until March 2021 from the Regional Administrative Office. In total, 160,238 appointments for 68,332 S{\"o}rmland residents were included (124,398 physical-PHC and 35,840 internet-PHC appointments). Prescriptions issued by internet-PHC or physical-PHC physicians were considered. Information on the appointment date, staff category serving the patient, ICD-10 (International Statistical Classification of Diseases, Tenth Revision) diagnosis codes, ATC codes of prescribed medicines, and patient-attained age and gender were used. Results: ?A total of 160,238 health care appointments were registered, of which 18,433 led to an infection diagnosis. There were large differences in gender and attained age distributions among physical-PHC and internet-PHC appointments. Physical-PHC appointments peaked among patients aged 60-80 years while internet-PHC appointments peaked at 20-30 years of age for both genders. Antibiotics with the ATC codes J01A-J01X were prescribed in 9.3\% (11,609/124,398) of physical-PHC appointments as compared with 6.1\% (2201/35,840) of internet-PHC appointments. In addition, 61.3\% (6412/10,454) of physical-PHC infection appointments resulted in antibiotic prescriptions, as compared with only 25.8\% (2057/7979) of internet-PHC appointments. Analyses of the prescribed antibiotics showed that internet-PHC followed regional recommendations for all diagnoses. Physical-PHC also followed the recommendations but used a wider spectrum of antibiotics. The odds ratio of receiving an antibiotic prescription (after adjustments for attained age at the time of appointment, patient gender, and whether the prescription was issued before or during the COVID-19 pandemic) during an internet-PHC appointment was 0.23-0.39 as compared with a physical-PHC appointment. Conclusions: ?Internet-PHC appointments resulted in a significantly lower number of antibiotics prescriptions than physical-PHC appointments, adjusted for the large differences in the characteristics of patients who consult internet-PHC and physical-PHC. Internet-PHC prescribers showed appropriate prescribing according to guidelines. ",
doi="10.2196/55228",
url="https://www.jmir.org/2024/1/e55228"
}


@Article{info:doi/10.2196/54074,
author="Gomes, Cunha Mateus
and Castro, Robert
and Silva Serra, Willian
and Sagica de Vasconcelos, Jhak
and Parente, Andressa
and Botelho, Pinheiro Eli{\~a}
and Ferreira, Glenda
and Sousa, Fabianne",
title="Demographic Profile, Health, and Associated Factors of Family Caregivers and Functionality of Hospitalized Older Adults: Cross-Sectional, Exploratory, and Descriptive Study",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="21",
volume="8",
pages="e54074",
keywords="family caregiver",
keywords="older adult",
keywords="hospitalization",
keywords="functionality",
keywords="caregiver",
keywords="health",
abstract="Background: The longevity of the world population can contribute to an increase in hospitalizations and, consequently, to the emergence of functional limitations, resulting in the need for family caregivers. Hospitalized older adults may become dependent and require more care, increasing the burden on family caregivers. Thus, the nursing team in the hospital environment faces a new situation: an increase in the number of older adults occupying hospital beds and the presence of their family caregivers. Objective: We aimed to analyze the association between the demographic variables of interest and the self-rated health of family caregivers and to describe the functionality of older adults hospitalized in a university hospital in the Amazonian context. Methods: This cross-sectional, quantitative, exploratory, and descriptive study was carried out through individual interviews with 98 interviewees, divided into 49 family caregivers and 49 older adults hospitalized in the surgical clinic sector of a university hospital in Brazil between February and March 2023. Demographic data and health conditions were collected from family caregivers, and to describe the functionality of hospitalized older adults, the Barthel Index was applied. Descriptive (frequency and percentage) and inferential analyses were used, and the student t test was applied. The significance level of 5\% was adopted. Results: Among the 49 family caregivers, the majority were women (n=40, 81.6\%) with an average age of 46.9 (SD 13.3) years. Most were single (n=28, 57.1\%) and had completed an average level of education (n=26, 53.1\%). Additionally, 25 (51\%) caregivers were caring for their parents. Regarding health conditions, respondents self-assessed their health as good (25/49, 51\%; P=.01), and they considered that their health status was not affected by the provision of care (36/49, 73.5\%; P=.01). There was a significant association between demographic variables (ie, gender, age, and education) and self-assessment of family caregivers (P=.01, P=.01, and P=.04, respectively). Of the 49 older adults hospitalized, the majority (n=31, 63.2\%) were men, with a mean age of 69.2 (SD 7.12) years. Regarding the assessment of functionality, most older adults were classified as having mild dependence on care (n=23, 46.9\%), specifically in the age group between 60 and 69 years (21/49, 67.8\%). Conclusions: The data revealed that female gender, age, and education of family caregivers contributed favorably to the provision of care to hospitalized older adults with a lower degree of functional dependence. It is important to emphasize that during the older adult's hospitalization, the family caregiver should not be seen as a delegation of responsibilities or as a complement of human resources to assist in their recovery. Health professionals need to implement assertive interventions so that the family caregiver functions as a therapeutic resource. ",
doi="10.2196/54074",
url="https://formative.jmir.org/2024/1/e54074"
}


@Article{info:doi/10.2196/55000,
author="Casella Jean-Baptiste, Meredith
and Vital Julmiste, Monide Thamar
and Ball, Ellen",
title="Health Information System Strengthening During Antenatal Care in Haiti: Continuous Quality Improvement Study",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="14",
volume="8",
pages="e55000",
keywords="maternal health",
keywords="health informatics",
keywords="quality improvement",
keywords="Plan-Do-Study-Act",
keywords="PDSA",
keywords="maternal",
keywords="neonatal",
keywords="data collection",
keywords="prenatal",
keywords="outpatient",
keywords="electronic data",
keywords="nursing",
keywords="nursing staff",
keywords="nursing leadership",
abstract="Background: Journey to 9 Plus (J9) is an integrated reproductive, maternal, neonatal, and child health approach to care that has at its core the goal of decreasing the rate of maternal and neonatal morbidity and mortality in rural Haiti. For the maximum effectiveness of this program, it is necessary that the data system be of the highest quality. OpenMRS, an electronic medical record (EMR) system, has been in place since 2013 throughout a tertiary referral hospital, the H{\^o}pital Universitaire de Mirebalais, in Haiti and has been expanded for J9 data collection and reporting. The J9 program monthly reports showed that staff had limited time and capacity to perform double charting, which contributed to incomplete and inconsistent reports. Initial evaluation of the quality of EMR data entry showed that only 18\% (58/325) of the J9 antenatal visits were being documented electronically at the start of this quality improvement project. Objective: This study aimed to improve the electronic documentation of outpatient antenatal care from 18\% (58/325) to 85\% in the EMR by J9 staff from November 2020 to September 2021. The experiences that this quality improvement project team encountered could help others improve electronic data collection as well as the transition from paper to electronic documentation within a burgeoning health care system. Methods: A continuous quality improvement strategy was undertaken as the best approach to improve the EMR data collection at H{\^o}pital Universitaire de Mirebalais. The team used several continuous quality improvement tools to conduct this project: (1) a root cause analysis using Ishikawa and Pareto diagrams, (2) baseline evaluation measurements, and (3) Plan-Do-Study-Act improvement cycles to document incremental changes and the results of each change. Results: At the beginning of the quality improvement project in November 2020, the baseline data entry for antenatal visits was 18\% (58/325). Ten months of improvement strategies resulted in an average of 89\% (272/304) of antenatal visits documented in the EMR at point of care every month. Conclusions: The experiences that this quality improvement project team encountered can contribute to the transition from paper to electronic documentation within burgeoning health care systems. Essential to success was having a strong and dedicated nursing leadership to transition from paper to electronic data and motivated nursing staff to perform data collection to improve the quality of data and thus, the reports on patient outcomes. Engaging the nursing team closely in the design and implementation of EMR and quality improvement processes ensures long-term success while centering nurses as key change agents in patient care systems. ",
doi="10.2196/55000",
url="https://formative.jmir.org/2024/1/e55000",
url="http://www.ncbi.nlm.nih.gov/pubmed/38875702"
}


@Article{info:doi/10.2196/57341,
author="Tyagi, Pranjal
and Bouldin, D. Erin
and Hathaway, A. Wendy
and D'Arcy, Derek
and Nasr, Zacharia Samer
and Intrator, Orna
and Dang, Stuti",
title="Preimplementation Evaluation of a Self-Directed Care Program in a Veterans Health Administration Regional Network: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2024",
month="Jun",
day="14",
volume="13",
pages="e57341",
keywords="long-term institutional care",
keywords="self-directed care",
keywords="veteran directed care",
keywords="veteran",
keywords="veterans",
keywords="institutional care",
keywords="long term care",
keywords="mixed-methods",
keywords="caregivers",
keywords="caregiver",
keywords="United States",
keywords="nursing home",
keywords="homecare",
keywords="community-based",
keywords="home-based",
keywords="unmet",
keywords="pre-implementation",
keywords="barriers",
keywords="barrier",
keywords="facilitators",
keywords="facilitator",
keywords="quantitative data",
abstract="Background: The Veteran-Directed Care (VDC) program serves to assist veterans at risk of long-term institutional care to remain at home by providing funding to hire veteran-selected caregivers. VDC is operated through partnerships between Department of Veterans Affairs (VA) Medical Centers (VAMCs) and third-party Aging and Disability Network Agency providers. Objective: We aim to identify facilitators, barriers, and adaptations in VDC implementation across 7 VAMCs in 1 region: Veterans Integrated Service Network (VISN) 8, which covers Florida, South Georgia, Puerto Rico, and the US Virgin Islands. We also attempted to understand leadership and stakeholder perspectives on VDC programs' reach and implementation and identify veterans served by VISN 8's VDC programs and describe their home- and community-based service use. Finally, we want to compare veterans served by VDC programs in VISN 8 to the veterans served in VDC programs across the VA. This information is intended to be used to identify strategies and propose recommendations to guide VDC program expansion in VISN 8. Methods: The mixed methods study design encompasses electronically delivered surveys, semistructured interviews, and administrative data. It is guided by the Consolidated Framework for Implementation Research (CFIR version 2.0). Participants included the staff of VAMCs and partnering aging and disability network agencies across VISN 8, leadership at these VAMCs and VISN 8, veterans enrolled in VDC, and veterans who declined VDC enrollment and their caregivers. We interviewed selected VAMC site leaders in social work, Geriatrics and Extended Care, and the Caregiver Support Program. Each interviewee will be asked to complete a preinterview survey that includes information about their personal characteristics, experiences with the VDC program, and perceptions of program aspects according to the CFIR (version 2.0) framework. Participants will complete a semistructured interview that covers constructs relevant to the respondent and facilitators, barriers, and adaptations in VDC implementation at their site. Results: We will calculate descriptive statistics including means, SDs, and percentages for survey responses. Facilitators, barriers, number of patients enrolled, and staffing will also be presented. Interviews will be analyzed using rapid qualitative techniques guided by CFIR domains and constructs. Findings from VISN 8 will be collated to identify strategies for VDC expansion. We will use administrative data to describe veterans served by the programs in VISN 8. Conclusions: The VA has prioritized VDC rollout nationwide and this study will inform these expansion efforts. The findings from this study will provide information about the experiences of the staff, leadership, veterans, and caregivers in the VDC program and identify program facilitators and barriers. These results may be used to improve program delivery, facilitate growth within VISN 8, and inform new program establishment at other sites nationwide as the VDC program expands. International Registered Report Identifier (IRRID): DERR1-10.2196/57341 ",
doi="10.2196/57341",
url="https://www.researchprotocols.org/2024/1/e57341",
url="http://www.ncbi.nlm.nih.gov/pubmed/38875003"
}


@Article{info:doi/10.2196/56493,
author="Philpot, M. Lindsey
and Ramar, Priya
and Roellinger, L. Daniel
and Njeru, W. Jane
and Ebbert, O. Jon",
title="Individual-Level Digital Determinants of Health and Technology Acceptance of Patient Portals: Cross-Sectional Assessment",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="10",
volume="8",
pages="e56493",
keywords="electronic health records",
keywords="digital determinants of health",
keywords="patient portals",
keywords="eHealth",
keywords="digital health",
keywords="technology acceptance model",
keywords="digital health literacy",
keywords="digital inclusion",
keywords="mobile phone",
abstract="Background: Digital determinants of health (DDoH), including access to technological tools and digital health literacy, function independently as barriers to health. Assessment for DDoH is not routine within most health care systems, although addressing DDoH could help mitigate differential health outcomes and the digital divide. Objective: This study aims to assess the role of individual-level DDoH factors on patient enrollment in and use of the patient portal. Methods: We developed a multimodal, cross-sectional survey and deployed it to 11,424 individuals based on their preferred mode and language documented within the electronic medical record. Based on the Technology Acceptance Model, enrollment in and intent to use the patient portal were the outcomes of interest. Perceived usefulness and ease of use were assessed to determine construct validity, and exploratory investigations included individual-level DDoH, including internet and device access, availability of technological support, medical complexity, individual relationship with the health care system, and digital health literacy. Counts (n) and proportions (\%) were used to describe response categories, and adjusted and unadjusted odds ratios are reported. Results: This study included 1850 respondents (11,424 invited, 16.2\% response rate), who were mostly female (1048/1850, 56.6\%) and White (1240/1850, 67\%), with an average age of 63 years. In the validation of the Technology Acceptance Model, measures of perceived ease of use (ie, using the patient portal will require a lot of mental effort; the patient portal will be very easy to use) and perceived usefulness (ie, the usefulness of the patient portal to send and receive messages with providers, schedule appointments, and refill medications) were positively associated with both enrollment in and intent to use the patient portal. Within adjusted models, perceived ease of use and perceived usefulness constructs, in addition to constructs of digital health literacy, knowing what health resources are available on the internet (adjusted odds ratio [aOR] 3.5, 95\% CI 1.8-6.6), portal ease of use (aOR 2.8, 95\% CI 1.6-5), and portal usefulness (aOR 2.4, 95\% CI 1.4-4.2) were significantly associated with patient portal enrollment. Other factors associated with patient portal enrollment and intent to use included being comfortable reading and speaking English, reported use of the internet to surf the web or to send or receive emails, home internet access, and access to technology devices (computer, tablet, smartphone, etc). Conclusions: Assessing for and addressing individual-level DDoH, including digital health literacy, access to digital tools and technologies, and support of the relational aspects between patients, social support systems, and health care providers, could help mitigate disparities in health. By focusing efforts to assess for and address individual-level DDoH, an opportunity exists to improve digitally driven health care delivery outcomes like access and structural outcomes like bias built within algorithms created with incomplete representation across communities. ",
doi="10.2196/56493",
url="https://formative.jmir.org/2024/1/e56493",
url="http://www.ncbi.nlm.nih.gov/pubmed/38695754"
}


@Article{info:doi/10.2196/53976,
author="Kabukye, K. Johnblack
and Namagembe, Rosemary
and Nakku, Juliet
and Kiberu, Vincent
and Sj{\"o}linder, Marie
and Nilsson, Susanne
and Wamala-Larsson, Caroline",
title="Implementing a Hospital Call Center Service for Mental Health in Uganda: User-Centered Design Approach",
journal="JMIR Hum Factors",
year="2024",
month="Jun",
day="6",
volume="11",
pages="e53976",
keywords="mHealth",
keywords="mobile health",
keywords="digital health",
keywords="digital solution",
keywords="digital solutions",
keywords="digital intervention",
keywords="digital interventions",
keywords="mental health",
keywords="awareness",
keywords="Uganda",
keywords="Africa",
keywords="African",
keywords="user centred",
keywords="user centered",
keywords="design",
keywords="qualitative",
keywords="focus group",
keywords="focus groups",
keywords="call centre",
keywords="call centres",
keywords="call center",
keywords="call centers",
keywords="mental",
keywords="experience",
keywords="experiences",
keywords="attitude",
keywords="attitudes",
keywords="opinion",
keywords="perception",
keywords="perceptions",
keywords="perspective",
keywords="perspectives",
keywords="cocreated",
keywords="cocreation",
keywords="service",
keywords="services",
keywords="mobile phone",
abstract="Background: Mental health conditions are a significant public health problem globally, responsible for >8 million deaths per year. In addition, they lead to lost productivity, exacerbate physical illness, and are associated with stigma and human rights violations. Uganda, like many low- and middle-income countries, faces a massive treatment gap for mental health conditions, and numerous sociocultural challenges exacerbate the burden of mental health conditions. Objective: This study aims to describe the development and formative evaluation of a digital health intervention for improving access to mental health care in Uganda. Methods: This qualitative study used user-centered design and design science research principles. Stakeholders, including patients, caregivers, mental health care providers, and implementation experts (N=65), participated in focus group discussions in which we explored participants' experience of mental illness and mental health care, experience with digital interventions, and opinions about a proposed digital mental health service. Data were analyzed using the Consolidated Framework for Implementation Research to derive requirements for the digital solution, which was iteratively cocreated with users and piloted. Results: Several challenges were identified, including a severe shortage of mental health facilities, unmet mental health information needs, heavy burden of caregiving, financial challenges, stigma, and negative beliefs related to mental health. Participants' enthusiasm about digital solutions as a feasible, acceptable, and convenient method for accessing mental health services was also revealed, along with recommendations to make the service user-friendly, affordable, and available 24{\texttimes}7 and to ensure anonymity. A hospital call center service was developed to provide mental health information and advice in 2 languages through interactive voice response and live calls with health care professionals and peer support workers (recovering patients). In the 4 months after launch, 456 calls, from 236 unique numbers, were made to the system, of which 99 (21.7\%) calls went to voicemails (out-of-office hours). Of the remaining 357 calls, 80 (22.4\%) calls stopped at the interactive voice response, 231 (64.7\%) calls were answered by call agents, and 22 (6.2\%) calls were not answered. User feedback was positive, with callers appreciating the inclusion of peer support workers who share their recovery journeys. However, some participant recommendations (eg, adding video call options) or individualized needs (eg, prescriptions) could not be accommodated due to resource limitations or technical feasibility. Conclusions: This study demonstrates a systematic and theory-driven approach to developing contextually appropriate digital solutions for improving mental health care in Uganda and similar contexts. The positive reception of the implemented service underscores its potential impact. Future research should address the identified limitations and evaluate clinical outcomes of long-term adoption. ",
doi="10.2196/53976",
url="https://humanfactors.jmir.org/2024/1/e53976",
url="http://www.ncbi.nlm.nih.gov/pubmed/38843515"
}


@Article{info:doi/10.2196/50376,
author="Turnbull, Joanne
and Prichard, Jane
and MacLellan, Jennifer
and Pope, Catherine",
title="eHealth Literacy and the Use of NHS 111 Online Urgent Care Service in England: Cross-Sectional Survey",
journal="J Med Internet Res",
year="2024",
month="Jun",
day="4",
volume="26",
pages="e50376",
keywords="urgent care",
keywords="digital health",
keywords="access to health care",
keywords="eHealth",
keywords="health care system",
keywords="COVID-19",
keywords="urgent",
keywords="emergency",
keywords="health literacy",
keywords="eHealth literacy",
keywords="digital literacy",
keywords="access",
keywords="cross-sectional",
abstract="Background: Many health care systems have used digital technologies to support care delivery, a trend amplified by the COVID-19 pandemic. ``Digital first'' may exacerbate health inequalities due to variations in eHealth literacy. The relationship between eHealth literacy and web-based urgent care service use is unknown. Objective: This study aims to measure the association between eHealth literacy and the use of NHS (National Health Service) 111 online urgent care service. Methods: A cross-sectional sequential convenience sample survey was conducted with 2754 adults (October 2020-July 2021) from primary, urgent, or emergency care; third sector organizations; and the NHS 111 online website. The survey included the eHealth Literacy Questionnaire (eHLQ), questions about use, preferences for using NHS 111 online, and sociodemographic characteristics. Results: Across almost all dimensions of the eHLQ, NHS 111 online users had higher mean digital literacy scores than nonusers (P<.001). Four eHLQ dimensions were significant predictors of use, and the most highly significant dimensions were eHLQ1 (using technology to process health information) and eHLQ3 (ability to actively engage with digital services), with odds ratios (ORs) of 1.86 (95\% CI 1.46-2.38) and 1.51 (95\% CI 1.22-1.88), respectively. Respondents reporting a long-term health condition had lower eHLQ scores. People younger than 25 years (OR 3.24, 95\% CI 1.87-5.62) and those with formal qualifications (OR 0.74, 95\% CI 0.55-0.99) were more likely to use NHS 111 online. Users and nonusers were likely to use NHS 111 online for a range of symptoms, including chest pain symptoms (n=1743, 70.4\%) or for illness in children (n=1117, 79\%). The users of NHS 111 online were more likely to have also used other health services, particularly the 111 telephone service ($\chi$12=138.57; P<.001). Conclusions: These differences in eHealth literacy scores amplify perennial concerns about digital exclusion and access to care for those impacted by intersecting forms of disadvantage, including long-term illness. Although many appear willing to use NHS 111 online for a range of health scenarios, indicating broad acceptability, not all are able or likely to do this. Despite a policy ambition for NHS 111 online to substitute for other services, it appears to be used alongside other urgent care services and thus may not reduce demand. ",
doi="10.2196/50376",
url="https://www.jmir.org/2024/1/e50376",
url="http://www.ncbi.nlm.nih.gov/pubmed/38833297"
}


@Article{info:doi/10.2196/55714,
author="Weirauch, Vera
and Soehnchen, Clarissa
and Burmann, Anja
and Meister, Sven",
title="Methods, Indicators, and End-User Involvement in the Evaluation of Digital Health Interventions for the Public: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="May",
day="31",
volume="26",
pages="e55714",
keywords="digital health",
keywords="digital health intervention",
keywords="public end user",
keywords="evaluation methods",
keywords="evaluation criteria",
keywords="end-user involvement",
keywords="scoping review",
abstract="Background: Digital health interventions (DHIs) have the potential to enable public end users, such as citizens and patients, to manage and improve their health. Although the number of available DHIs is increasing, examples of successfully established DHIs in public health systems are limited. To counteract the nonuse of DHIs, they should be comprehensively evaluated while integrating end users. Unfortunately, there is a wide variability and heterogeneity according to the approaches of evaluation, which creates a methodological challenge. Objective: This scoping review aims to provide an overview of the current established processes for evaluating DHIs, including methods, indicators, and end-user involvement. The review is not limited to a specific medical field or type of DHI but offers a holistic overview. Methods: This scoping review was conducted following the JBI methodology for scoping reviews based on the framework by Arksey \& O'Malley and complies with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Three scientific databases (PubMed, Scopus, and Science Direct) were searched in April 2023. English and German studies between 2008 and 2023 were considered when evaluating DHIs that explicitly address public end users. The process of study selection was carried out by several researchers to avoid reviewer bias. Results: The search strategy identified 9618 publications, of which 160 were included. Among these included articles, 200 evaluations were derived and analyzed. The results showed that there is neither a consensus on the methods to evaluate DHIs nor a commonly agreed definition or usage of the evaluated indicators, which results in a broad variety of evaluation practices. This aligns with observations of the existing literature. It was found that there is a lack of references to existing frameworks for the evaluation of DHIs. The majority of the included studies referred to user-centered approaches and involved end users in the evaluation process. As assistance for people developing and evaluating DHIs and as a basis for thinking about appropriate ways to evaluate DHIs, a results matrix was created where the findings were combined per DHI cluster. Additionally, general recommendations for the evaluators of DHIs were formulated. Conclusions: The findings of this scoping review offer a holistic overview of the variety and heterogeneity according to the approaches of evaluation of DHIs for public end users. Evaluators of these DHIs should be encouraged to reference established frameworks or measurements for justification. This would ease the transferability of the results among similar evaluation studies within the digital health sector, thereby enhancing the coherence and comparability of research in this area. ",
doi="10.2196/55714",
url="https://www.jmir.org/2024/1/e55714",
url="http://www.ncbi.nlm.nih.gov/pubmed/38819891"
}


@Article{info:doi/10.2196/50622,
author="Meng, Yingying
and Yu, Ran
and Bai, Huixin
and Han, Junqiang",
title="Evidence From the China Family Panel Studies Survey on the Effect of Integrating the Basic Medical Insurance System for Urban and Rural Residents on the Health Equity of Residents: Difference-in-Differences Analysis",
journal="JMIR Public Health Surveill",
year="2024",
month="May",
day="30",
volume="10",
pages="e50622",
keywords="medical insurance system integration",
keywords="Urban and Rural Resident Basic Medical Insurance",
keywords="URRBMI",
keywords="urban and rural residents",
keywords="health equity",
keywords="China",
keywords="difference-in-differences",
keywords="DID",
keywords="staggered DID",
abstract="Background: The fragmentation of the medical insurance system is a major challenge to achieving health equity. In response to this problem, the Chinese government is pushing to establish the unified Urban and Rural Resident Basic Medical Insurance (URRBMI) system by integrating the New Rural Cooperative Medical Scheme and the Urban Resident Basic Medical Insurance. By the end of 2020, URRBMI had been implemented almost entirely across China. Has URRBMI integration promoted health equity for urban and rural residents? Objective: This study aims to examine the effect of URRBMI integration on the health level of residents and whether the integration can contribute to reducing health disparities and promoting health equity. Methods: We used the staggered difference-in-differences method based on the China Family Panel Studies survey from 2014 to 2018. Our study had a nationally representative sample of 27,408 individuals from 98 cities. We chose self-rated health as the measurement of health status. In order to more accurately discern whether the sample was covered by URRBMI, we obtained the exact integration time of URRBMI according to the official documents issued by local governments. Finally, we grouped the sample by urban and rural areas, regions, and household income to examine the impact of the integration on health equity. Results: We found that overall, the URRBMI integration has improved the health level of Chinese residents (B=0.066, 95\% CI 0.014-0.123; P=.01). In terms of health equity, the results showed that first, the integration has improved the health level of rural residents (B=0.070, 95\% CI 0.012-0.128; P=.02), residents in western China (B=0.159, 95\% CI 0.064-0.255; P<.001), and lower-middle-income groups (B=0.113, 95\% CI 0.004-0.222, P=.04), so the integration has played a certain role in narrowing the health gap between urban and rural areas, different regions, and different income levels. Through further mechanism analysis, we found that the URRBMI integration reduced health inequity in China by facilitating access to higher-rated hospitals and increasing reimbursement rates for medical expenses. However, the integration did not improve the health of the central region and low-income groups, and the lack of access to health care for low-income groups was not effectively reduced. Conclusions: The role of URRBMI integration in promoting health equity among urban and rural residents was significant (P=.02), but in different regions and income groups, it was limited. Focusing on the rational allocation of medical resources between regions and increasing the policy tilt toward low-income groups could help improve the equity of health insurance integration. ",
doi="10.2196/50622",
url="https://publichealth.jmir.org/2024/1/e50622",
url="http://www.ncbi.nlm.nih.gov/pubmed/38815256"
}


@Article{info:doi/10.2196/46551,
author="Wei, Xia
and Yu, Shubin
and Li, (Victor) Changxu",
title="Influence of Physical Attractiveness and Gender on Patient Preferences in Digital Doctor Consultations: Experimental Study",
journal="J Med Internet Res",
year="2024",
month="May",
day="30",
volume="26",
pages="e46551",
keywords="digital doctor consultations",
keywords="health care providers",
keywords="gender stereotype",
keywords="physical attractiveness",
keywords="qualification information",
keywords="experimental",
keywords="telemedicine",
keywords="digital consultation",
keywords="disease severity",
keywords="sex",
keywords="gender",
keywords="gender stereotypes",
keywords="digital health",
abstract="Background: The rise of digital health services, particularly digital doctor consultations, has created a new paradigm in health care choice. While patients traditionally rely on digital reviews or referrals to select health care providers, the digital context often lacks such information, leading to reliance on visual cues such as profile pictures. Previous research has explored the impact of physical attractiveness in general service settings but is scant in the context of digital health care. Objective: This study aims to fill the research gap by investigating how a health care provider's physical attractiveness influences patient preferences in a digital consultation setting. We also examine the moderating effects of disease severity and the availability of information on health care providers' qualifications. The study uses signal theory and the sexual attribution bias framework to understand these dynamics. Methods: Three experimental studies were conducted to examine the influence of health care providers' physical attractiveness and gender on patient preferences in digital consultations. Study 1 (n=282) used a 2{\texttimes}2 between-subjects factorial design, manipulating doctor attractiveness and gender. Study 2 (n=158) focused on women doctors and manipulated disease severity and participant gender. Study 3 (n=150) replicated study 2 but added information about the providers' abilities. Results: This research found that patients tend to choose attractive doctors of the opposite gender but are less likely to choose attractive doctors of the same gender. In addition, our studies revealed that such an effect is more prominent when the disease severity is high. Furthermore, the influence of gender stereotypes is mitigated in both the high and low disease severity conditions when service providers' qualification information is present. Conclusions: This research contributes to the literature on medical information systems research and sheds light on what information should be displayed on digital doctor consultation platforms. To counteract stereotype-based attractiveness biases, health care platforms should consider providing comprehensive qualification information alongside profile pictures. ",
doi="10.2196/46551",
url="https://www.jmir.org/2024/1/e46551",
url="http://www.ncbi.nlm.nih.gov/pubmed/38814690"
}


@Article{info:doi/10.2196/54334,
author="Huang, Ching-Yuan
and Lee, Po-Chun
and Chen, Long-Hui",
title="Exploring Consumers' Negative Electronic Word-of-Mouth of 5 Military Hospitals in Taiwan Through SERVQUAL and Flower of Services: Web Scraping Analysis",
journal="JMIR Form Res",
year="2024",
month="May",
day="29",
volume="8",
pages="e54334",
keywords="electronic word-of-mouth",
keywords="eWOM",
keywords="service quality",
keywords="SERVQUAL scale",
keywords="Flower of Services",
keywords="health care service quality",
keywords="military hospitals",
abstract="Background: In recent years, with the widespread use of the internet, the influence of electronic word-of-mouth (eWOM) has been increasingly recognized, particularly the significance of negative eWOM, which has surpassed positive eWOM in importance. Such reviews play a pivotal role in research related to service industry management, particularly in intangible service sectors such as hospitals, where they have become a reference point for improving service quality. Objective: This study comprehensively collected negative eWOM from 5 military hospitals in Taiwan that were at or above the level of regional teaching hospitals. It aimed to investigate service quality issues before and after the pandemic. The findings provide important references for formulating strategies to improve service quality. Methods: In this study, we used web scraping techniques to gather 1259 valid negative eWOM, covering the period from the inception of the first review to December 31, 2022. These reviews were categorized using content analysis based on the modified Parasuraman, Zeithaml, and Berry service quality (PZB SERVQUAL) scale and Flower of Services. Statistical data analysis was conducted to investigate the performance of service quality. Results: The annual count of negative reviews for each hospital has exhibited a consistent upward trajectory over the years, with a more pronounced increase following the onset of the pandemic. In the analysis, among the 5 dimensions of PZB SERVQUAL framework, the ``Assurance'' dimension yielded the least favorable results, registering a negative review rate as high as 58.3\%. Closely trailing, the ``Responsiveness'' dimension recorded a negative review rate of 34.2\%. When evaluating the service process, the subitem ``In Service: Diagnosis/Examination/Medical/Hospitalization'' exhibited the least satisfactory performance, with a negative review rate of 46.2\%. This was followed by the subitem ``In Service: Pre-diagnosis Waiting,'' which had a negative review rate of 20.2\%. To evaluate the average scores of negative reviews before and during the onset of the COVID-19 pandemic, independent sample t tests (2-tailed) were used. The analysis revealed statistically significant differences (P<.001). Furthermore, an ANOVA was conducted to investigate whether the length of the negative reviews impacted their ratings, which also showed significant differences (P=.01). Conclusions: Before and during the pandemic, there were significant differences in evaluating hospital services, and a higher word count in negative reviews indicated greater dissatisfaction with the service. Therefore, it is recommended that hospitals establish more comprehensive service quality management mechanisms, carefully respond to negative reviews, and categorize significant service deficiencies as critical events to prevent a decrease in overall service quality. Furthermore, during the service process, customers are particularly concerned about the attitude and responsiveness of health care personnel in the treatment process. Therefore, hospitals should enhance training and management in this area. ",
doi="10.2196/54334",
url="https://formative.jmir.org/2024/1/e54334",
url="http://www.ncbi.nlm.nih.gov/pubmed/38809602"
}


@Article{info:doi/10.2196/49916,
author="Fernandes, Sara
and Brousse, Yann
and Zendjidjian, Xavier
and Cano, Delphine
and Riedberger, J{\'e}r{\'e}mie
and Llorca, Pierre-Michel
and Samalin, Ludovic
and Dassa, Daniel
and Trichard, Christian
and Laprevote, Vincent
and Sauvaget, Anne
and Abbar, Mocrane
and Misdrahi, David
and Berna, Fabrice
and Lancon, Christophe
and Coulon, Nathalie
and El-Hage, Wissam
and Rozier, Pierre-Emmanuel
and Benoit, Michel
and Giordana, Bruno
and Caqueo-Ur{\'i}zar, Alejandra
and Yon, Keon Dong
and Tran, Bach
and Auquier, Pascal
and Fond, Guillaume
and Boyer, Laurent",
title="Psychometric Assessment of an Item Bank for Adaptive Testing on Patient-Reported Experience of Care Environment for Severe Mental Illness: Validation Study",
journal="JMIR Ment Health",
year="2024",
month="May",
day="16",
volume="11",
pages="e49916",
keywords="psychiatry",
keywords="public mental health",
keywords="schizophrenia",
keywords="major depressive disorders",
keywords="bipolar disorders",
keywords="patient-reported experience measures",
keywords="quality of care",
keywords="health services research",
keywords="computerized adaptive testing",
keywords="real-world data",
abstract="Background: The care environment significantly influences the experiences of patients with severe mental illness and the quality of their care. While a welcoming and stimulating environment enhances patient satisfaction and health outcomes, psychiatric facilities often prioritize staff workflow over patient needs. Addressing these challenges is crucial to improving patient experiences and outcomes in mental health care. Objective: This study is part of the Patient-Reported Experience Measure for Improving Quality of Care in Mental Health (PREMIUM) project and aims to establish an item bank (PREMIUM-CE) and to develop computerized adaptive tests (CATs) to measure the experience of the care environment of adult patients with schizophrenia, bipolar disorder, or major depressive disorder. Methods: We performed psychometric analyses including assessments of item response theory (IRT) model assumptions, IRT model fit, differential item functioning (DIF), item bank validity, and CAT simulations. Results: In this multicenter cross-sectional study, 498 patients were recruited from outpatient and inpatient settings. The final PREMIUM-CE 13-item bank was sufficiently unidimensional (root mean square error of approximation=0.082, 95\% CI 0.067-0.097; comparative fit index=0.974; Tucker-Lewis index=0.968) and showed an adequate fit to the IRT model (infit mean square statistic ranging between 0.7 and 1.0). DIF analysis revealed no item biases according to gender, health care settings, diagnosis, or mode of study participation. PREMIUM-CE scores correlated strongly with satisfaction measures (r=0.69-0.78; P<.001) and weakly with quality-of-life measures (r=0.11-0.21; P<.001). CAT simulations showed a strong correlation (r=0.98) between CAT scores and those of the full item bank, and around 79.5\% (396/498) of the participants obtained a reliable score with the administration of an average of 7 items. Conclusions: The PREMIUM-CE item bank and its CAT version have shown excellent psychometric properties, making them reliable measures for evaluating the patient experience of the care environment among adults with severe mental illness in both outpatient and inpatient settings. These measures are a valuable addition to the existing landscape of patient experience assessment, capturing what truly matters to patients and enhancing the understanding of their care experiences. Trial Registration: ClinicalTrials.gov NCT02491866; https://clinicaltrials.gov/study/NCT02491866 ",
doi="10.2196/49916",
url="https://mental.jmir.org/2024/1/e49916",
url="http://www.ncbi.nlm.nih.gov/pubmed/38753416"
}


@Article{info:doi/10.2196/47280,
author="Nassehi, Damoun
and Gripsrud, Haga Birgitta
and Ramvi, Ellen",
title="Theoretical Perspectives Underpinning Research on the Physician-Patient Relationship in a Digital Health Practice: Scoping Review",
journal="Interact J Med Res",
year="2024",
month="May",
day="15",
volume="13",
pages="e47280",
keywords="digital health",
keywords="mobile health",
keywords="telemedicine",
keywords="physician-patient relations",
keywords="relational ethics",
keywords="primary care",
keywords="patient-provider",
keywords="physician-patient",
keywords="telehealth",
keywords="relationship",
keywords="eHealth",
keywords="scoping review",
keywords="review method",
keywords="mobile phone",
abstract="Background: The advent of digital health technologies has transformed the landscape of health care, influencing the dynamics of the physician-patient relationship. Although these technologies offer potential benefits, they also introduce challenges and complexities that require ethical consideration. Objective: This scoping review aims to investigate the effects of digital health technologies, such as digital messaging, telemedicine, and electronic health records, on the physician-patient relationship. To understand the complex consequences of these tools within health care, it contrasts the findings of studies that use various theoretical frameworks and concepts with studies grounded in relational ethics. Methods: Using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we conducted a scoping review. Data were retrieved through keyword searches on MEDLINE/PubMed, Embase, IEEE Xplore, and Cochrane. We screened 427 original peer-reviewed research papers published in English-language journals between 2010 and 2021. A total of 73 papers were assessed for eligibility, and 10 of these were included in the review. The data were summarized through a narrative synthesis of the findings. Results: Digital health technologies enhance communication, improve health care delivery efficiency, and empower patients, leading to shifts in power dynamics in the physician-patient relationship. They also potentially reinforce inequities in health care access due to variations in technology literacy among patients and lead to decreases in patient satisfaction due to the impersonal nature of digital interactions. Studies applying a relational ethics framework have revealed the nuanced impacts of digital health technologies on the physician-patient relationship, highlighting shifts toward more collaborative and reciprocal care. These studies have also explored transitions from traditional hierarchical relationships to mutual engagement, capturing the complexities of power dynamics and vulnerabilities. Other theoretical frameworks, such as patient-centered care, and concepts, such as patient empowerment, were also valuable for understanding these interactions in the context of digital health. Conclusions: The shift from hierarchical to collaborative models in the physician-patient relationship not only underscores the empowering potential of digital tools but also presents new challenges and reinforces existing ones. Along with applications for various theoretical frameworks and concepts, this review highlights the unique comprehensiveness of a relational ethics perspective, which could provide a more nuanced understanding of trust, empathy, and power dynamics in the context of digital health. The adoption of relational ethics in empirical research may offer richer insights into the real-life complexities of the physician-patient relationship, as mediated by digital technologies. ",
doi="10.2196/47280",
url="https://www.i-jmr.org/2024/1/e47280",
url="http://www.ncbi.nlm.nih.gov/pubmed/38748465"
}


@Article{info:doi/10.2196/53898,
author="Zhou, Yaxu
and Zhou, Ying
and Xu, Di
and Min, Jie
and Du, Yu
and Duan, Qi
and Bao, Wen
and Sun, Yingying
and Xi, Huiqin
and Wang, Chunming
and Bischof, Evelyne",
title="Practice Standards in International Medical Departments of Public Academic Hospitals in China: Cross-Sectional Study",
journal="JMIR Form Res",
year="2024",
month="May",
day="13",
volume="8",
pages="e53898",
keywords="patients",
keywords="international medical service",
keywords="demand",
keywords="satisfaction",
keywords="strategy",
keywords="health care optimization",
keywords="smart hospital",
abstract="Background: Improving health care in cities with a diverse, international population is crucial for ensuring health equity, particularly for foreigners facing challenges due to cultural and language barriers. This situation is especially relevant in China, a major destination for expatriates and travelers, where optimizing health care services and incorporating international standards in the public sector are vital. Achieving this involves understanding the operational details, cultural and linguistic nuances, and advancing medical digitalization. A strategic approach focusing on cultural competence and awareness of health care systems is essential for effectively navigating health care for foreigners and expatriates in China. Objective: The aim of this study was to perform an in-depth analysis of the subjective and objective experiences of local and international patients in public hospitals in China to provide a basis for enhancing the medical experience of all patients. Methods: A structured questionnaire was provided to patients at an international outpatient service of a top-tier university hospital in China. Qualitative analysis of the survey responses was performed to methodically categorize and analyze medical treatment, focusing on patient demand and satisfaction across four main category elements (``high demand, high satisfaction''; ``high demand, low satisfaction''; ``low demand, high satisfaction''; and ``low demand, low satisfaction''), enabling a detailed cross-sectional analysis to identify areas for improvement. Results: Elements falling under ``high demand, high satisfaction'' for both Chinese and international patients were primarily in the realms of medical quality and treatment processes. In contrast, elements identified as ``high demand, low satisfaction'' were significantly different between the two patient groups. Conclusions: The findings highlight the importance of systematic, objective research in advancing the quality of international health care services within China's leading academic medical centers. Key to this improvement is rigorous quality control involving both patients and providers. This study highlights the necessity of certifying such centers and emphasizes the role of digital platforms in disseminating information about medical services. This strategy is expected to cater to diverse patient needs, enhancing the overall patient experience. Furthermore, by developing comprehensive diagnosis and treatment services and highlighting the superior quality and costs associated with international health care, these efforts aim to foster a sense of belonging among international patients and increase the attractiveness of China's medical services for this demographic. ",
doi="10.2196/53898",
url="https://formative.jmir.org/2024/1/e53898",
url="http://www.ncbi.nlm.nih.gov/pubmed/38739428"
}


@Article{info:doi/10.2196/46029,
author="Law, Graham
and Cooper, Rhiannon
and Pirrie, Melissa
and Ferron, Richard
and McLeod, Brent
and Spaight, Robert
and Siriwardena, Niroshan A.
and Agarwal, Gina
and ",
title="Ambulance Services Attendance for Mental Health and Overdose Before and During COVID-19 in Canada and the United Kingdom: Interrupted Time Series Study",
journal="JMIR Public Health Surveill",
year="2024",
month="May",
day="10",
volume="10",
pages="e46029",
keywords="COVID-19",
keywords="mental health",
keywords="overdose",
keywords="emergency medical services",
keywords="administrative data",
keywords="Canada",
keywords="the United Kingdom",
keywords="ambulance",
keywords="sex",
keywords="age",
keywords="lockdown",
keywords="pandemic planning",
keywords="emergency service",
abstract="Background: The COVID-19 pandemic impacted mental health and health care systems worldwide. Objective: This study examined the COVID-19 pandemic's impact on ambulance attendances for mental health and overdose, comparing similar regions in the United Kingdom and Canada that implemented different public health measures. Methods: An interrupted time series study of ambulance attendances was conducted for mental health and overdose in the United Kingdom (East Midlands region) and Canada (Hamilton and Niagara regions). Data were obtained from 182,497 ambulance attendance records for the study period of December 29, 2019, to August 1, 2020. Negative binomial regressions modeled the count of attendances per week per 100,000 population in the weeks leading up to the lockdown, the week the lockdown was initiated, and the weeks following the lockdown. Stratified analyses were conducted by sex and age. Results: Ambulance attendances for mental health and overdose had very small week-over-week increases prior to lockdown (United Kingdom: incidence rate ratio [IRR] 1.002, 95\% CI 1.002-1.003 for mental health). However, substantial changes were observed at the time of lockdown; while there was a statistically significant drop in the rate of overdose attendances in the study regions of both countries (United Kingdom: IRR 0.573, 95\% CI 0.518-0.635 and Canada: IRR 0.743, 95\% CI 0.602-0.917), the rate of mental health attendances increased in the UK region only (United Kingdom: IRR 1.125, 95\% CI 1.031-1.227 and Canada: IRR 0.922, 95\% CI 0.794-1.071). Different trends were observed based on sex and age categories within and between study regions. Conclusions: The observed changes in ambulance attendances for mental health and overdose at the time of lockdown differed between the UK and Canada study regions. These results may inform future pandemic planning and further research on the public health measures that may explain observed regional differences. ",
doi="10.2196/46029",
url="https://publichealth.jmir.org/2024/1/e46029",
url="http://www.ncbi.nlm.nih.gov/pubmed/38728683"
}


@Article{info:doi/10.2196/54128,
author="Roberts, Lynae R.
and Cherry, D. Katelin
and Mohan, P. Desh
and Statler, Tiffany
and Kirkendall, Eric
and Moses, Adam
and McCraw, Jennifer
and Brown III, E. Andrew
and Fofanova, Y. Tatiana
and Gabbard, Jennifer",
title="A Personalized and Interactive Web-Based Advance Care Planning Intervention for Older Adults (Koda Health): Pilot Feasibility Study",
journal="JMIR Aging",
year="2024",
month="May",
day="6",
volume="7",
pages="e54128",
keywords="advance care planning",
keywords="ACP",
keywords="digital health tools",
keywords="system usability",
keywords="gerontology",
keywords="geriatric",
keywords="geriatrics",
keywords="older adult",
keywords="older adults",
keywords="elder",
keywords="elderly",
keywords="older person",
keywords="older people",
keywords="ageing",
keywords="aging",
keywords="adoption",
keywords="acceptance",
keywords="usability",
keywords="digital health",
keywords="platform",
keywords="website",
keywords="websites",
abstract="Background: Advance care planning (ACP) is a process that involves patients expressing their personal goals, values, and future medical care preferences. Digital applications may help facilitate this process, though their use in older adults has not been adequately studied. Objective: This pilot study aimed to evaluate the reach, adoption, and usability of Koda Health, a web-based patient-facing ACP platform, among older adults. Methods: Older adults (aged 50 years and older) who had an active Epic MyChart account at an academic health care system in North Carolina were recruited to participate. A total of 2850 electronic invitations were sent through MyChart accounts with an embedded hyperlink to the Koda platform. Participants who agreed to participate were asked to complete pre- and posttest surveys before and after navigating through the Koda Health platform. Primary outcomes were reach, adoption, and System Usability Scale (SUS) scores. Exploratory outcomes included ACP knowledge and readiness. Results: A total of 161 participants enrolled in the study and created an account on the platform (age: mean 63, SD 9.3 years), with 80\% (129/161) of these participants going on to complete all steps of the intervention, thereby generating an advance directive. Participants reported minimal difficulty in using the Koda platform, with an overall SUS score of 76.2. Additionally, knowledge of ACP (eg, mean increase from 3.2 to 4.2 on 5-point scale; P<.001) and readiness (eg, mean increase from 2.6 to 3.2 on readiness to discuss ACP with health care provider; P<.001) significantly increased from before to after the intervention. Conclusions: This study demonstrated that the Koda Health platform is feasible, had above-average usability, and improved ACP documentation of preferences in older adults. Our findings indicate that web-based health tools like Koda may help older individuals learn about and feel more comfortable with ACP while potentially facilitating greater engagement in care planning. ",
doi="10.2196/54128",
url="https://aging.jmir.org/2024/1/e54128"
}


@Article{info:doi/10.2196/49769,
author="Iqbal, Mujtaba Fahad
and Aggarwal, Ravi
and Joshi, Meera
and King, Dominic
and Martin, Guy
and Khan, Sadia
and Wright, Mike
and Ashrafian, Hutan
and Darzi, Ara",
title="Barriers to and Facilitators of Key Stakeholders Influencing Successful Digital Implementation of Remote Monitoring Solutions: Mixed Methods Analysis",
journal="JMIR Hum Factors",
year="2024",
month="May",
day="6",
volume="11",
pages="e49769",
keywords="implementation science",
keywords="health plan implementation",
keywords="mobile health",
keywords="health care industry",
keywords="stakeholder",
keywords="COVID-19",
keywords="remote monitoring",
keywords="digital tools",
keywords="digital health",
keywords="pandemic",
keywords="virtual wards",
keywords="virtual ward",
keywords="health care delivery",
keywords="telemedicine",
keywords="telehealth",
keywords="wearables",
keywords="wearable",
keywords="technology",
keywords="United Kingdom",
keywords="UK",
keywords="digital services",
abstract="Background: Implementation of remote monitoring solutions and digital alerting tools in health care has historically been challenging, despite the impetus provided by the COVID-19 pandemic. To date, a health systems--based approach to systematically describe barriers and facilitators across multiple domains has not been undertaken. Objective: We aimed to undertake a comprehensive mixed methods analysis of barriers and facilitators for successful implementation of remote monitoring and digital alerting tools in complex health organizations. Methods: A mixed methods approach using a modified Technology Acceptance Model questionnaire and semistructured interviews mapped to the validated fit among humans, organizations, and technology (HOT-fit) framework was undertaken. Likert frequency responses and deductive thematic analyses were performed. Results: A total of 11 participants responded to the questionnaire and 18 participants to the interviews. Key barriers and facilitators could be mapped onto 6 dimensions, which incorporated aspects of digitization: system use (human), user satisfaction (human), environment (organization), structure (organization), information and service quality (technology), and system quality (technology). Conclusions: The recommendations proposed can enhance the potential for future remote sensing solutions to be more successfully integrated in health care practice, resulting in more successful use of ``virtual wards.'' Trial Registration: ClinicalTrials.gov NCT05321004; https://www.clinicaltrials.gov/study/NCT05321004 ",
doi="10.2196/49769",
url="https://humanfactors.jmir.org/2024/1/e49769",
url="http://www.ncbi.nlm.nih.gov/pubmed/37338929"
}


@Article{info:doi/10.2196/49129,
author="Kim, Hoon Seung
and Kim, Hyunkyu
and Jeong, Hoon Sung
and Park, Eun-Cheol",
title="Association of the Type of Public Pension With Mental Health Among South Korean Older Adults: Longitudinal Observational Study",
journal="JMIR Public Health Surveill",
year="2024",
month="May",
day="2",
volume="10",
pages="e49129",
keywords="depression",
keywords="retirement",
keywords="contributory public pension",
keywords="low-income household",
keywords="public health",
keywords="mental health",
keywords="data",
keywords="big data",
keywords="longitudinal data",
keywords="low income",
abstract="Background: As income and health are closely related, retirement is considered undesirable for health. Many studies have shown the association between pension and health, but no research has considered the association between contribution-based public pensions or their types and health. Objective: This study investigates the association between the type of contributory public pension and depressive symptoms among older adults. Methods: We analyzed the data of 4541 older adults who participated in the South Korea Welfare Panel Study (2014-2020). Depressive symptoms were measured using the 11-item Center for Epidemiologic Studies Depression scale. Public pensions in South Korea are classified into specific corporate pensions and national pensions. For subgroup analyses, pensioners were categorized according to the amount of pension received and the proportion of public pension over gross income. Analyses using generalized estimating equations were conducted for longitudinal data. Results: Individuals receiving public pension, regardless of the pension type, demonstrated significantly decreased depressive symptoms (national pension: $\beta$=--.734; P<.001; specific corporate pension: $\beta$=--.775; P=.02). For both pension types, the higher the amount of benefits, the lower were the depression scores. However, this association was absent for those who received the smaller amount among the specific corporate pensioners. In low-income households, the decrease in the depressive symptoms based on the amount of public pension benefits was greater (fourth quartile of national pension: $\beta$=--1.472; P<.001; second and third quartiles of specific corporate pension: $\beta$=--3.646; P<.001). Conclusions: Our study shows that contributory public pension is significantly associated with lower depressive symptoms, and this association is prominent in low-income households. Thus, contributory public pensions may be good income sources for improving the mental health of older adults after retirement. ",
doi="10.2196/49129",
url="https://publichealth.jmir.org/2024/1/e49129",
url="http://www.ncbi.nlm.nih.gov/pubmed/38696246"
}


@Article{info:doi/10.2196/53311,
author="Saunders, L. Catherine",
title="Using Routine Data to Improve Lesbian, Gay, Bisexual, and Transgender Health",
journal="Interact J Med Res",
year="2024",
month="May",
day="1",
volume="13",
pages="e53311",
keywords="lesbian",
keywords="gay",
keywords="bisexual",
keywords="trans",
keywords="LGBTQ+",
keywords="routine data",
keywords="England",
keywords="United Kingdom",
keywords="health",
keywords="viewpoint",
keywords="sexual orientation",
keywords="health services",
keywords="infrastructure data",
keywords="policy",
keywords="gender",
keywords="health outcome",
keywords="epidemiology",
keywords="risk prediction",
keywords="risk",
doi="10.2196/53311",
url="https://www.i-jmr.org/2024/1/e53311",
url="http://www.ncbi.nlm.nih.gov/pubmed/38691398"
}


@Article{info:doi/10.2196/51279,
author="Kim, Jiyeong
and Cai, Ran Zhuo
and Chen, L. Michael
and Onyeka, Sonia
and Ko, M. Justin
and Linos, Eleni",
title="Telehealth Utilization and Associations in the United States During the Third Year of the COVID-19 Pandemic: Population-Based Survey Study in 2022",
journal="JMIR Public Health Surveill",
year="2024",
month="Apr",
day="26",
volume="10",
pages="e51279",
keywords="telehealth",
keywords="telemedicine",
keywords="digital health",
keywords="e-health",
keywords="e-medicine",
keywords="utilization",
keywords="population-based study",
keywords="clinical practice",
keywords="healthcare delivery",
keywords="sociodemographic factor",
keywords="COVID-19",
keywords="pandemic",
abstract="Background: The COVID-19 pandemic rapidly changed the landscape of clinical practice in the United States; telehealth became an essential mode of health care delivery, yet many components of telehealth use remain unknown years after the disease's emergence. Objective: We aim to comprehensively assess telehealth use and its associated factors in the United States. Methods: This cross-sectional study used a nationally representative survey (Health Information National Trends Survey) administered to US adults (?18 years) from March 2022 through November 2022. To assess telehealth adoption, perceptions of telehealth, satisfaction with telehealth, and the telehealth care purpose, we conducted weighted descriptive analyses. To identify the subpopulations with low adoption of telehealth, we developed a weighted multivariable logistic regression model. Results: Among a total of 6252 survey participants, 39.3\% (2517/6252) reported telehealth use in the past 12 months (video: 1110/6252, 17.8\%; audio: 876/6252, 11.6\%). The most prominent reason for not using telehealth was due to telehealth providers failing to offer this option (2200/3529, 63\%). The most common reason for respondents not using offered telehealth services was a preference for in-person care (527/578, 84.4\%). Primary motivations to use telehealth were providers' recommendations (1716/2517, 72.7\%) and convenience (1516/2517, 65.6\%), mainly for acute minor illness (600/2397, 29.7\%) and chronic condition management (583/2397, 21.4\%), yet care purposes differed by age, race/ethnicity, and income. The satisfaction rate was predominately high, with no technical problems (1829/2517, 80.5\%), comparable care quality to that of in-person care (1779/2517, 75\%), and no privacy concerns (1958/2517, 83.7\%). Younger individuals (odd ratios [ORs] 1.48-2.23; 18-64 years vs ?75 years), women (OR 1.33, 95\% CI 1.09-1.61), Hispanic individuals (OR 1.37, 95\% CI 1.05-1.80; vs non-Hispanic White), those with more education (OR 1.72, 95\% CI 1.03-2.87; at least a college graduate vs less than high school), unemployed individuals (OR 1.25, 95\% CI 1.02-1.54), insured individuals (OR 1.83, 95\% CI 1.25-2.69), or those with poor general health status (OR 1.66, 95\% CI 1.30-2.13) had higher odds of using telehealth. Conclusions: To our best knowledge, this is among the first studies to examine patient factors around telehealth use, including motivations to use, perceptions of, satisfaction with, and care purpose of telehealth, as well as sociodemographic factors associated with telehealth adoption using a nationally representative survey. The wide array of descriptive findings and identified associations will help providers and health systems understand the factors that drive patients toward or away from telehealth visits as the technology becomes more routinely available across the United States, providing future directions for telehealth use and telehealth research. ",
doi="10.2196/51279",
url="https://publichealth.jmir.org/2024/1/e51279",
url="http://www.ncbi.nlm.nih.gov/pubmed/38669075"
}


@Article{info:doi/10.2196/52646,
author="Liu, Xiaoxiao
and Guo, Huijing
and Wang, Le
and Hu, Mingye
and Wei, Yichan
and Liu, Fei
and Wang, Xifu",
title="Effect of Prosocial Behaviors on e-Consultations in a Web-Based Health Care Community: Panel Data Analysis",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="25",
volume="26",
pages="e52646",
keywords="prosocial behaviors",
keywords="proactive behaviors",
keywords="reactive behaviors",
keywords="reputations",
keywords="e-consultation volume",
keywords="live streaming",
abstract="Background: Patients using web-based health care communities for e-consultation services have the option to choose their service providers from an extensive digital market. To stand out in this crowded field, doctors in web-based health care communities often engage in prosocial behaviors, such as proactive and reactive actions, to attract more users. However, the effect of these behaviors on the volume of e-consultations remains unclear and warrants further exploration. Objective: This study investigates the impact of various prosocial behaviors on doctors' e-consultation volume in web-based health care communities and the moderating effects of doctors' digital and offline reputations. Methods: A panel data set containing information on 2880 doctors over a 22-month period was obtained from one of the largest web-based health care communities in China. Data analysis was conducted using a 2-way fixed effects model with robust clustered SEs. A series of robustness checks were also performed, including alternative measurements of independent variables and estimation methods. Results: Results indicated that both types of doctors' prosocial behaviors, namely, proactive and reactive actions, positively impacted their e-consultation volume. In terms of the moderating effects of external reputation, doctors' offline professional titles were found to negatively moderate the relationship between their proactive behaviors and their e-consultation volume. However, these titles did not significantly affect the relationship between doctors' reactive behaviors and their e-consultation volume (P=.45). Additionally, doctors' digital recommendations from patients negatively moderated both the relationship between doctors' proactive behaviors and e-consultation volume and the relationship between doctors' reactive behaviors and e-consultation volume. Conclusions: Drawing upon functional motives theory and social exchange theory, this study categorizes doctors' prosocial behaviors into proactive and reactive actions. It provides empirical evidence that prosocial behaviors can lead to an increase in e-consultation volume. This study also illuminates the moderating roles doctors' digital and offline reputations play in the relationships between prosocial behaviors and e-consultation volume. ",
doi="10.2196/52646",
url="https://www.jmir.org/2024/1/e52646",
url="http://www.ncbi.nlm.nih.gov/pubmed/38663006"
}


@Article{info:doi/10.2196/49815,
author="Hasan, Zahid Md
and Rabbani, Golam Md
and Akter, Orin
and Mehdi, Golam Gazi
and Ahmed, Wahid Mohammad
and Ahmed, Sayem
and Chowdhury, Elahi Mahbub",
title="Patient Satisfaction With the Health Care Services of a Government-Financed Health Protection Scheme in Bangladesh: Cross-Sectional Study",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="24",
volume="8",
pages="e49815",
keywords="Shasthyo Surokhsha Karmasuchi",
keywords="health care services",
keywords="health care utilization",
keywords="satisfaction",
keywords="below poverty line",
keywords="Bangladesh",
keywords="patient satisfaction",
keywords="physician behavior",
abstract="Background: Since 2016, the government of Bangladesh has been piloting a health protection scheme known as Shasthyo Surokhsha Karmasuchi (SSK), which specifically targets households living below the poverty line. This noncontributory scheme provides enrolled households access to inpatient health care services for 78 disease groups. Understanding patients' experiences with health care utilization from the pilot SSK scheme is important for enhancing the quality of health care service delivery during the national-level scale-up of the scheme. Objective: We aimed to evaluate patient satisfaction with the health care services provided under the pilot health protection scheme in Bangladesh. Methods: A cross-sectional survey was conducted with the users of the SSK scheme from August to November 2019. Patients who had spent a minimum of 2 nights at health care facilities were selected for face-to-face exit interviews. During these interviews, we collected information on patients' socioeconomic characteristics, care-seeking experiences, and level of satisfaction with various aspects of health care service delivery. To measure satisfaction, we employed a 5-point Likert scale (very satisfied, 5; satisfied, 4; neither satisfied nor dissatisfied, 3; dissatisfied, 2; very dissatisfied, 1). Descriptive statistics, statistical inferential tests (t-test and 1-way ANOVA), and linear regression analyses were performed. Results: We found that 55.1\% (241/438) of users were either very satisfied or satisfied with the health care services of the SSK scheme. The most satisfactory indicators were related to privacy maintained during diagnostic tests (mean 3.91, SD 0.64), physicians' behaviors (mean 3.86, SD 0.77), services provided at the registration booth (mean 3.86, SD 0.62), confidentiality maintained regarding diseases (mean 3.78, SD 0.72), and nurses' behaviors (mean 3.60, SD 0.83). Poor satisfaction was identified in the interaction of patients with providers about illness-related information (mean 2.14, SD 1.40), availability of drinking water (mean 1.46, SD 0.76), cleanliness of toilets (mean 2.85, SD 1.04), and cleanliness of the waiting room (mean 2.92, SD 1.09). Patient satisfaction significantly decreased by 0.20 points for registration times of 16-30 minutes and by 0.32 points for registration times of >30 minutes compared with registration times of ?15 minutes. Similarly, patient satisfaction significantly decreased with an increase in the waiting time to obtain services. However, the satisfaction of users significantly increased if they received a complete course of medicines and all prescribed diagnostic services. Conclusions: More than half of the users were satisfied with the services provided under the SSK scheme. However, there is scope for improving user satisfaction. To improve the satisfaction level, the SSK scheme implementation authorities should pay attention to reducing the registration time and waiting time to obtain services and improving the availability of drugs and prescribed diagnostic services. The authorities should also ensure the supply of drinking water and enhance the cleanliness of the facility. ",
doi="10.2196/49815",
url="https://formative.jmir.org/2024/1/e49815",
url="http://www.ncbi.nlm.nih.gov/pubmed/38656783"
}


@Article{info:doi/10.2196/55860,
author="Aggarwal, Monica
and Hutchison, G. Brian
and Kokorelias, M. Kristina
and Ramsden, R. Vivian
and Ivers, M. Noah
and Pinto, Andrew
and Uphsur, G. Ross E.
and Wong, T. Sabrina
and Pimlott, Nick
and Slade, Steve",
title="The Conceptualization and Measurement of Research Impact in Primary Health Care: Protocol for a Rapid Scoping Review",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="23",
volume="13",
pages="e55860",
keywords="research impact",
keywords="primary health care",
keywords="measurement",
keywords="definition",
keywords="concept",
keywords="development",
keywords="implementation",
keywords="health policy",
keywords="policy",
keywords="health service",
keywords="rapid review",
keywords="review",
keywords="research",
keywords="policies",
keywords="societal",
keywords="productivity",
keywords="literature database",
abstract="Background: The generation of research evidence and knowledge in primary health care (PHC) is crucial for informing the development and implementation of interventions and innovations and driving health policy, health service improvements, and potential societal changes. PHC research has broad effects on patients, practices, services, population health, community, and policy formulation. The in-depth exploration of the definition and measures of research impact within PHC is essential for broadening our understanding of research impact in the discipline and how it compares to other health services research. Objective: The objectives of the study are (1) to understand the conceptualizations and measures of research impact within the realm of PHC and (2) to identify methodological frameworks for evaluation and research impact and the benefits and challenges of using these approaches. The forthcoming review seeks to guide future research endeavors and enhance methodologies used in assessing research impact within PHC. Methods: The protocol outlines the rapid review and environmental scan approach that will be used to explore research impact in PHC and will be guided by established frameworks such as the Canadian Academy of Health Sciences Impact Framework and the Canadian Health Services and Policy Research Alliance. The rapid review follows scoping review guidelines (PRISMA-ScR; Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews). The environmental scan will be done by consulting with professional organizations, academic institutions, information science, and PHC experts. The search strategy will involve multiple databases, citation and forward citation searching, and manual searches of gray literature databases, think tank websites, and relevant catalogs. We will include gray and scientific literature focusing explicitly on research impact in PHC from high-income countries using the World Bank classification. Publications published in English from 1978 will be considered. The collected papers will undergo a 2-stage independent review process based on predetermined inclusion criteria. The research team will extract data from selected studies based on the research questions and the CRISP (Consensus Reporting Items for Studies in Primary Care) protocol statement. The team will discuss the extracted data, enabling the identification and categorization of key themes regarding research impact conceptualization and measurement in PHC. The narrative synthesis will evolve iteratively based on the identified literature. Results: The results of this study are expected at the end of 2024. Conclusions: The forthcoming review will explore the conceptualization and measurement of research impact in PHC. The synthesis will offer crucial insights that will guide subsequent research, emphasizing the need for a standardized approach that incorporates diverse perspectives to comprehensively gauge the true impact of PHC research. Furthermore, trends and gaps in current methodologies will set the stage for future studies aimed at enhancing our understanding and measurement of research impact in PHC. International Registered Report Identifier (IRRID): PRR1-10.2196/55860 ",
doi="10.2196/55860",
url="https://www.researchprotocols.org/2024/1/e55860",
url="http://www.ncbi.nlm.nih.gov/pubmed/38652900"
}


@Article{info:doi/10.2196/50092,
author="Benjamins, Janine
and de Vet, Emely
and de Mortier, A. Chloe
and Haveman-Nies, Annemien",
title="The Effect of Using a Client-Accessible Health Record on Perceived Quality of Care: Interview Study Among Parents and Adolescents",
journal="J Particip Med",
year="2024",
month="Apr",
day="23",
volume="16",
pages="e50092",
keywords="electronic health record",
keywords="EHR",
keywords="personal health record",
keywords="child health services",
keywords="child health",
keywords="child welfare",
keywords="adolescent health services",
keywords="pediatrics",
keywords="parent",
keywords="care quality",
keywords="perceived quality of care",
keywords="patient experience",
keywords="client perception",
keywords="quality of care",
keywords="adolescent",
keywords="patient portal",
keywords="client portal",
keywords="qualitative study",
abstract="Background: Patient-accessible electronic health records (PAEHRs) are assumed to enhance the quality of care, expressed in terms of safety, effectiveness, timeliness, person centeredness, efficiency, and equity. However, research on the impact of PAEHRs on the perceived quality of care among parents, children, and adolescents is largely lacking. In the Netherlands, a PAEHR (Iuvenelis) was developed for preventive child health care and youth care. Parents and adolescents had access to its full content, could manage appointments, ask questions, and comment on written reports. Objective: This study aims to assess whether and how using this PAEHR contributes to perceived quality of care from a client's perspective. Methods: We chose a qualitative design with a phenomenological approach to explore how parents and adolescents perceived the impact of using a PAEHR on quality of care. In-depth interviews that simultaneously included 1 to 3 people were conducted in 2021. In total, 20 participants were included in the study, representing parents and adolescents, both sexes, different educational levels, different native countries, and all participating municipalities. Within this group, 7 of 13 (54\%) parents had not previously been informed about the existence of a client portal. Their expectations of using the client portal, in relation to quality of care, were discussed after a demonstration of the portal. Results: Parents and adolescents perceived that using Iuvenelis contributed to the quality of care because they felt better informed and more involved in the care process than before the introduction of Iuvenelis. Moreover, they experienced more control over their health data, faster and simpler access to their health information, and found it easier to manage appointments or ask questions at their convenience. Parents from a migratory background, among whom 6 of 7 (86\%) had not previously been informed about the portal, expected that portal access would enhance their understanding of and control over their care processes. The parents expressed concerns about equity because parents from a migratory background might have less access to the service. Nevertheless, portal usability was regarded as high. Furthermore, both parents and adolescents saw room for improvement in the broader interdisciplinary use of Iuvenelis and the quality of reporting. Conclusions: Using Iuvenelis can contribute to the client-experienced quality of care, more specifically to perceived person centeredness, timeliness, safety, efficiency, and integration of care. However, some quality aspects, such as equity, still need addressing. In general, client information about the portal needs to be improved, specifically focusing on people in vulnerable circumstances, such as those from migratory backgrounds. In addition, to maximize the potential benefit of using Iuvenelis, stimulating a person-centered attitude among professionals is important. Considering the small number of adolescent participants (n=7), adding quantitative data from a structured survey could strengthen the available evidence. ",
doi="10.2196/50092",
url="https://jopm.jmir.org/2024/1/e50092",
url="http://www.ncbi.nlm.nih.gov/pubmed/38652532"
}


@Article{info:doi/10.2196/53362,
author="?erne, Tina
and Turk, Eva
and Mirosevic, Spela
and Rotar Pavli{\v c}, Danica",
title="Needs and Experiences With Health Care Providers of Adult Rare Disease Patients and Caregivers of People With Rare Diseases: Protocol for a Qualitative Study",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="22",
volume="13",
pages="e53362",
keywords="rare diseases",
keywords="patients",
keywords="caregivers",
keywords="needs",
keywords="barriers",
keywords="access to health care",
abstract="Background: Rare diseases in Europe are defined as diseases with a prevalence of less than 5 per 10,000 people. Despite their individual rarity, the total number of rare diseases is considerable. Rare diseases are often chronic and complex, affecting physical, mental, and neurological health. People with rare diseases face challenges such as delayed diagnosis, limited medical support, and financial burden. Caregivers, usually family members, bear significant physical and emotional burdens. Understanding the experiences of patients with rare disease and their caregivers is critical to effective care, but this is still underresearched. Better support and understanding of the challenges faced by both patients and caregivers is clearly needed. Our study will explore the experiences and needs of people with rare diseases and caregivers of people with rare diseases in relation to accessing health services. Objective: This study aims to explore the experiences of patients with rare disease and their caregivers with Slovenian health care providers and to create a theoretical model of needs and experiences. Methods: This is a qualitative thematic analysis study, using the codebook approach. The study will conduct semi--open-ended interviews to understand the experiences and needs of people with rare diseases and caregivers of people with rare diseases in relation to accessing health services. The interview questions will be based on an extensive literature review. Data from the interviews will be analyzed using thematic analysis to identify patterns and build a thematic map. Data will be analyzed by at least 2 coders. To ensure reliability, respondent validation will be conducted and negative cases investigated. Any discrepancies will be resolved by consulting the entire research team until a consensus is reached. Results: This study was not specifically funded. However, author T? is supported by grant number P3-0339 from the Slovenian Agency for Research and Innovation. This study was approved by the Medical Ethics Committee of the Republic of Slovenia (0120-47/2022/3), and recruitment is expected to begin in May 2024, with data analysis results anticipated by the end of 2025. Conclusions: This study will fill an important research gap in Slovenia by exploring the needs and experiences of people living with rare diseases and their caregivers. The results will contribute to the broader field of rare diseases and add knowledge that can inform future research processes and intervention strategies. It also aims to identify neglected areas that have a significant impact on the lives of people with rare diseases. This study is important not only because it addresses the immediate needs of the Slovenian rare disease community, but also because it contributes to a discussion on patient-centered care, health policy design, and the inclusion of psychosocial components in health care. International Registered Report Identifier (IRRID): PRR1-10.2196/53362 ",
doi="10.2196/53362",
url="https://www.researchprotocols.org/2024/1/e53362",
url="http://www.ncbi.nlm.nih.gov/pubmed/38648088"
}


@Article{info:doi/10.2196/51859,
author="Allcock, Alan Jake
and Zhuang, Mengdie
and Li, Shuyang
and Zhao, Xin",
title="Landscape of Digital Technologies Used in the National Health Service in England: Content Analysis",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="19",
volume="8",
pages="e51859",
keywords="digital health",
keywords="healthcare service",
keywords="regional difference",
keywords="National Health Service",
keywords="NHS",
keywords="digital technology",
keywords="health equity",
abstract="Background: In England, digital technologies are exploited to transform the way health and social care is provided and encompass a wide range of hardware devices and software that are used in all aspects of health care. However, little is known about the extent to which health care providers differ in digital health technology capabilities and how this relates to geographical and regional differences in health care capacities and resources. Objective: This paper aims to identify the set of digital technologies that have been deployed by the National Health Services clinical commissioning groups (NHS CCGs) in England. In doing this, we respond to calls to shed light on the internal dynamics and variation in the form of digital capability in England in terms of health service regional differences and health diversity, equity, and inclusion. Methods: We collected 135 annual reports that belong to 106 NHS CCGs in England, comprising more than 18,000 pages in total, released from 2020 to 2021. Using this data set, we identified 2163 pages related to digital technologies and labeled them using content analysis. We follow the construct taxonomy used by digital options theory, a theory from the management information systems field analyzing organizational resource investment choices, in classifying observed technologies according to digital themes---inherent design patterns that we identified and explained. We then used a hierarchical clustering method to extract groups of NHS CCGs that implement similar technology themes. Results: We found 31 technologies from the reports and grouped them into 9 digital themes. The 9 themes were further assigned to 1 of the 3 constructs of digital options theory, the identification of patients' requirements (we identified information portals [76/106], digital health engagement [67/106], and digital inclusion support [45/106]), the development of new work patterns (we identified telehealth [87/106], telemedicine [35/106], and care home technologies [40/106]), the realization of improvements in efficiency and public accessibility (we identified online booking [26/106], online triage [104/106], and digital mental health services [74/106]). The 3 clusters of CCGs are identified based on the 8 themes (Hopkins=0.9914, silhouette=0.186), namely (1) digitally disengaged, (2) digitally engaged, and (3) digital torchbearer. Conclusions: Our findings show prominent digital themes within each construct group, namely information portals, telehealth, and online triage, covering people's fundamental health information needs. Almost half of CCGs fell into the digitally disengaged group, and all London CCGs (5/106) belonged to this group. We propose that practitioners should offer specialized assistance to regions with limited digital engagement, emphasizing digital health literacy, inclusion support, and ongoing evaluation, rather than concentrating solely on technical advancements. ",
doi="10.2196/51859",
url="https://formative.jmir.org/2024/1/e51859",
url="http://www.ncbi.nlm.nih.gov/pubmed/38639996"
}


@Article{info:doi/10.2196/56346,
author="Jabin, Rahman Md Shafiqur
and Samuriwo, Ray
and Chilaka, Marcus
and Yaroson, Vann Emilia",
title="Effectiveness and Experiences of Quality Improvement Interventions in Older Adult Care: Protocol for a Mixed Methods Systematic Review",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="18",
volume="13",
pages="e56346",
keywords="patient safety",
keywords="acceptability",
keywords="accessibility",
keywords="appropriateness",
keywords="timeliness",
keywords="equitability",
keywords="social care",
abstract="Background: Quality improvement (QI) interventions are designed to resolve the recurring challenges of care for older individuals, such as working conditions for staff, roles of older individuals in their own care and their families, and relevant stakeholders. Therefore, there is a need to map the impacts of QI interventions in older adult care settings and further improve health and social care systems associated with older adults. Objective: This review aims to compile and synthesize the best available evidence regarding the effectiveness of policy and practice QI interventions in older adult care. The secondary aim is to understand the care of older individuals and QI intervention-related experiences and perspectives of stakeholders, care providers, older individuals, and their families. Methods: The mixed methods review will follow the standard methodology used by Joanna Briggs Institute. The published studies will be searched through CINAHL, MEDLINE, PsycINFO, ASSIA, and Web of Science, and the unpublished studies through Mednar, Trove, OCLC WorldCat, and Dissertations and Theses. This review included both qualitative and quantitative analyses of patients undergoing older adult care and any health and care professionals involved in the care delivery for older adults; a broad range of QI interventions, including assistive technologies, effects of training and education, improved reporting, safety programs, and medical devices; the experiences and perspectives of staff and patients; the context of older adult care setting; and a broad range of outcomes, including patient safety. The standard procedure for reporting, that is, PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, will be followed. Results: A result-based convergent synthesis design will be used in which both quantitative and qualitative studies will be analyzed separately, and the results of both syntheses will be then integrated during a final (convergent) synthesis. The integration will compare the findings of quantitative and qualitative evidence using tables in light of the results of both syntheses. Conclusions: This comprehensive review is expected to reflect on the insights into some QI interventions and their impact, outline some common challenges of quality for older adult care, and benefit both the practical usefulness of care service activities and the society at large. International Registered Report Identifier (IRRID): PRR1-10.2196/56346 ",
doi="10.2196/56346",
url="https://www.researchprotocols.org/2024/1/e56346",
url="http://www.ncbi.nlm.nih.gov/pubmed/38635311"
}


@Article{info:doi/10.2196/51211,
author="Wanberg, J. Lindsey
and Pearson, R. David",
title="Evaluating the Disease-Related Experiences of TikTok Users With Lupus Erythematosus: Qualitative and Content Analysis",
journal="JMIR Infodemiology",
year="2024",
month="Apr",
day="17",
volume="4",
pages="e51211",
keywords="lupus",
keywords="TikTok",
keywords="autoimmune disease",
keywords="qualitative research",
keywords="quality of life",
abstract="Background: Lupus erythematosus (LE) is an autoimmune condition that is associated with significant detriments to quality of life and daily functioning. TikTok, a popular social networking platform for sharing short videos, provides a unique opportunity to understand experiences with LE within a nonclinical sample, a population that is understudied in LE research. This is the first qualitative study that explores LE experiences using the TikTok platform. Objective: This study aims to evaluate the disease-related experiences of TikTok users with LE using qualitative and content analysis. Methods: TikTok videos were included if the hashtags included \#lupus, were downloadable, were in English, and involved the personal experience of an individual with LE. A codebook was developed using a standardized inductive approach of iterative coding until saturation was reached. NVivo (Lumivero), a qualitative analysis software platform, was used to code videos and perform content analysis. Inductive thematic analysis was used to derive themes from the data. Results: A total of 153 TikTok videos met the inclusion criteria. The most common codes were experiences with symptoms (106/153, 69.3\%), mucocutaneous symptoms (61/153, 39.9\%), and experiences with treatment (59/153, 38.6\%). Experiences with symptoms and mucocutaneous symptoms had the greatest cumulative views (25,381,074 and 14,879,109 views, respectively). Five thematic conclusions were derived from the data: (1) mucocutaneous symptoms had profound effects on the mental health and body image of TikTok users with LE; (2) TikTok users' negative experiences with health care workers were often derived from diagnostic delays and perceptions of ``medical gaslighting''; (3) TikTok users tended to portray pharmacologic and nonpharmacologic interventions, such as diet and naturopathic remedies, positively, whereas pharmacologic treatments were portrayed negatively or referred to as ``chemotherapy''; (4) LE symptoms, particularly musculoskeletal symptoms and fatigue, interfered with users' daily functioning; and (5) although TikTok users frequently had strong support systems, feelings of isolation were often attributed to battling an ``invisible illness.'' Conclusions: This study demonstrates that social media can provide important, clinically relevant information for health practitioners caring for patients with chronic conditions such as LE. As mucocutaneous symptoms were the predominant drivers of distress in our sample, the treatment of hair loss and rash is vital in this population. However, pharmacologic therapies were often depicted negatively, reinforcing the significance of discussions on the safety and effectiveness of these treatments. In addition, while TikTok users demonstrated robust support systems, feelings of having an ``invisible illness'' and ``medical gaslighting'' dominated negative interactions with others. This underscores the importance of providing validation in clinical interactions. ",
doi="10.2196/51211",
url="https://infodemiology.jmir.org/2024/1/e51211",
url="http://www.ncbi.nlm.nih.gov/pubmed/38631030"
}


@Article{info:doi/10.2196/54406,
author="Goel, Akash
and Kapoor, Bhavya
and Chan, Hillary
and Ladha, Karim
and Katz, Joel
and Clarke, Hance
and Pazmino-Canizares, Janneth
and Thomas, Zaaria
and Philip, Kaylyssa
and Mattina, Gabriella
and Ritvo, Paul",
title="Psychotherapy for Ketamine's Enhanced Durability in Chronic Neuropathic Pain: Protocol for a Pilot Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="17",
volume="13",
pages="e54406",
keywords="3-arm parallel group",
keywords="cognitive behavior therapy",
keywords="ketamine hydrochloride",
keywords="pain intensity",
keywords="pain interference",
keywords="psychotherapy",
keywords="randomized controlled trial",
abstract="Background: Chronic pain affects approximately 8 million Canadians ({\textasciitilde}20\%), impacting their physical and mental health while burdening the health care system with costs of upwards of US \$60 billion a year. Indeed, patients are often trialed on numerous medications over several years without reductions to their symptoms. Therefore, there is an urgent need to identify new therapies for chronic pain to improve patients' quality of life, increase the availability of treatment options, and reduce the burden on the health care system. Objective: The primary objective of this study is to examine the feasibility of a parallel 3-arm pilot randomized controlled trial whereby patients are randomized to either intravenous ketamine alone, cognitive behavioral therapy (CBT) and mindfulness meditation (MM) training (CBT/MM), or the combination of intravenous ketamine and CBT/MM. The secondary outcome is to assess the durability and efficacy of combination intravenous ketamine and CBT/MM for treatment of chronic pain as compared to CBT/MM or intravenous ketamine alone (assessed at week 20 of the study). Methods: This is a single-center, 16-week, 3-arm pilot study that will take place at the Chronic Pain Clinic at St. Michael's Hospital, Toronto, Ontario, which receives 1000 referrals per year. Patients will be enrolled in the study for a total of 20 weeks. Participants who are allocated CBT/MM therapy will receive remote weekly psychotherapy from week 1 to week 16, inclusive of health coaching administered through the NexJ Health Inc (NexJ Health) platform. Patients who are allocated ketamine-infusion therapy will receive monthly ketamine infusion treatments on weeks 2, 7, and 12. Patients who are allocated ketamine+CBT/MM will receive weekly psychotherapy from weeks 1 to 16, inclusive, as well as ketamine infusion treatments on weeks 2, 7, and 12. We will be assessing recruitment rates, consent rates, withdrawal rates, adherence, missing data, and adverse events as pilot outcome measures. Secondary clinical outcomes include changes relative to baseline in pain intensity and pain interference. Results: As of November 1, 2023, the recruitment process has not been initiated. Given the recruitment, consent, and intervention target of 30 participants for this feasibility study, with each patient undergoing monitoring and treatments for a course of 20 weeks, we expect to complete the study by December 2025. Conclusions: This study assesses the feasibility of conducting a 3-arm randomized controlled trial to examine the effects of ketamine administration with the concurrent use of CBT/MM in a population with chronic neuropathic pain. The results of this pilot randomized controlled trial will inform the development of a larger-scale randomized controlled trial. Future studies will be aimed at including a sufficiently powered sample that will inform decisions about optimal treatment calibration and treatment effect duration. Trial Registration: ClinicalTrials.gov NCT05639322; https://classic.clinicaltrials.gov/ct2/show/NCT05639322 International Registered Report Identifier (IRRID): PRR1-10.2196/54406 ",
doi="10.2196/54406",
url="https://www.researchprotocols.org/2024/1/e54406",
url="http://www.ncbi.nlm.nih.gov/pubmed/38630524"
}


@Article{info:doi/10.2196/53078,
author="Castro, Aimee
and Lalonde-LeBlond, Gabrielle
and Freitas, Zelda
and Arnaert, Antonia
and Bitzas, Vasiliki
and Kildea, John
and Moffatt, Karyn
and Phillips, Devon
and Wiseblatt, Lorne
and Hall, Audrey-Jane
and Despr{\'e}s, V{\'e}ronique
and Tsimicalis, Argerie",
title="In-Home Respite Care Services Available to Families With Palliative Care Needs in Quebec: Novel Digital Environmental Scan",
journal="JMIR Nursing",
year="2024",
month="Apr",
day="16",
volume="7",
pages="e53078",
keywords="respite care",
keywords="palliative care",
keywords="caregiving",
keywords="environmental scan",
keywords="digital methodology",
keywords="accessibility",
abstract="Background: Caregiving dyads in palliative care are confronted with complex care needs. Respite care services can be highly beneficial in alleviating the caregiving burden, supporting survivorship and dying at home. Yet, respite care services are difficult to locate and access in the province of Quebec, Canada, particularly when navigating ubiquitous sources of online health information of varying quality. Objective: This project aimed to (1) compile a list of at-home palliative respite care services in Quebec, Canada; (2) describe key accessibility features for each respite care service; (3) identify accessibility gaps and opportunities; and (4) describe a novel method for conducting environmental scans using internet search engines, internet-based community health databases, and member checking. Methods: A novel environmental scan methodology using 2 internet-based targeted databases and 1 internet search engine was conducted. Results were screened and data were extracted, descriptively analyzed, and geographically schematized. Results: A total of 401 services were screened, and 52 at-home respite care services specific to palliative populations were identified, compiled, and analyzed. These respite care services were characterized by various types of assistance, providers, fees, and serviced geographical regions. Accessibility was explored through the lens of service amenability, availability, eligibility, and compatibility. The data revealed important barriers to accessing respite care services, such as a lack of readily available information on service characteristics, limited availability, and a time-consuming, technical search process for potential respite care users and clinicians to identify appropriate services. Conclusions: Both methodological and contextual knowledge have been gained through this environmental scan. Few methodologies for conducting internet-based environmental scans have been clearly articulated, so we applied several learnings from other scans and devised a methodology for conducting an environmental scan using the mixed methods of internet search engines, internet-based community health databases, and member checking. We have carefully reported our methods, so that others conducting community health environmental scans may replicate our process. Furthermore, through this scan, we identified assorted respite care services and pinpointed needs in the provision of these services. The findings highlighted that more easily accessible and centralized information about respite care services is needed in Quebec. The data will enable the creation of a user-friendly tool to share with community support services across Quebec and ultimately help alleviate the added burden caregivers and clinicians face when looking for respite care services in fragmented and complex digital spaces. ",
doi="10.2196/53078",
url="https://nursing.jmir.org/2024/1/e53078",
url="http://www.ncbi.nlm.nih.gov/pubmed/38625735"
}


@Article{info:doi/10.2196/55285,
author="Beverly, A. Elizabeth
and Koopman-Gonzalez, Sarah
and Wright, Jackson
and Dungan, Kathleen
and Pallerla, Harini
and Gubitosi-Klug, Rose
and Baughman, Kristin
and Konstan, W. Michael
and Bolen, D. Shari",
title="Assessing Priorities in a Statewide Cardiovascular and Diabetes Health Collaborative Based on the Results of a Needs Assessment: Cross-Sectional Survey Study",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="12",
volume="8",
pages="e55285",
keywords="health collaborative",
keywords="cardiovascular disease",
keywords="type 2 diabetes",
keywords="needs assessment",
abstract="Background: The Ohio Cardiovascular and Diabetes Health Collaborative (Cardi-OH) unites general and subspecialty medical staff at the 7 medical schools in Ohio with community and public health partnerships to improve cardiovascular and diabetes health outcomes and eliminate disparities in Ohio's Medicaid population. Although statewide collaboratives exist to address health improvements, few deploy needs assessments to inform their work. Objective: Cardi-OH conducts an annual needs assessment to identify high-priority clinical topics, screening practices, policy changes for home monitoring devices and referrals, and preferences for the dissemination and implementation of evidence-based best practices. The results of the statewide needs assessment could also be used by others interested in disseminating best practices to primary care teams. Methods: A cross-sectional survey was distributed electronically via REDCap (Research Electronic Data Capture; Vanderbilt University) to both Cardi-OH grant-funded and non--grant-funded members (ie, people who have engaged with Cardi-OH but are not funded by the grant). Results: In total, 88\% (103/117) of Cardi-OH grant-funded members and 8.14\% (98/1204) of non--grant-funded members completed the needs assessment survey. Of these, 51.5\% (53/103) of Cardi-OH grant-funded members and 47\% (46/98) of non--grant-funded members provided direct clinical care. The top cardiovascular medicine and diabetes clinical topics for Cardi-OH grant-funded members (clinical and nonclinical) were lifestyle prescriptions (50/103, 48.5\%), atypical diabetes (38/103, 36.9\%), COVID-19 and cardiovascular disease (CVD; 38/103, 36.9\%), and mental health and CVD (38/103, 36.9\%). For non--grant-funded members, the top topics were lifestyle prescriptions (53/98, 54\%), mental health and CVD (39/98, 40\%), alcohol and CVD (27/98, 28\%), and cardiovascular complications (27/98, 28\%). Regarding social determinants of health, Cardi-OH grant-funded members prioritized 3 topics: weight bias and stigma (44/103, 42.7\%), family-focused interventions (40/103, 38.8\%), and adverse childhood events (37/103, 35.9\%). Non--grant-funded members' choices were family-focused interventions (51/98, 52\%), implicit bias (43/98, 44\%), and adverse childhood events (39/98, 40\%). Assessment of other risk factors for CVD and diabetes across grant- and non--grant-funded members revealed screening for social determinants of health in approximately 50\% of patients in each practice, whereas some frequency of depression and substance abuse screening occurred in 80\% to 90\% of the patients. Access to best practice home monitoring devices was challenging, with 30\% (16/53) and 41\% (19/46) of clinical grant-funded and non--grant-funded members reporting challenges in obtaining home blood pressure monitoring devices and 68\% (36/53) and 43\% (20/46) reporting challenges with continuous glucose monitors. Conclusions: Cardi-OH grant- and non--grant-funded members shared the following high-priority topics: lifestyle prescriptions, CVD and mental health, family-focused interventions, alcohol and CVD, and adverse childhood experiences. Identifying high-priority educational topics and preferred delivery modalities for evidence-based materials is essential for ensuring that the dissemination of resources is practical and useful for providers. ",
doi="10.2196/55285",
url="https://formative.jmir.org/2024/1/e55285",
url="http://www.ncbi.nlm.nih.gov/pubmed/38607661"
}


@Article{info:doi/10.2196/45959,
author="Kosyluk, Kristin
and Baeder, Tanner
and Greene, Yeona Karah
and Tran, T. Jennifer
and Bolton, Cassidy
and Loecher, Nele
and DiEva, Daniel
and Galea, T. Jerome",
title="Mental Distress, Label Avoidance, and Use of a Mental Health Chatbot: Results From a US Survey",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="12",
volume="8",
pages="e45959",
keywords="chatbots",
keywords="conversational agents",
keywords="mental health",
keywords="resources",
keywords="screening",
keywords="resource referral",
keywords="stigma",
keywords="label avoidance",
keywords="survey",
keywords="training",
keywords="behavioral",
keywords="COVID-19",
keywords="pilot test",
keywords="design",
keywords="users",
keywords="psychological distress",
keywords="symptoms",
abstract="Background: For almost two decades, researchers and clinicians have argued that certain aspects of mental health treatment can be removed from clinicians' responsibilities and allocated to technology, preserving valuable clinician time and alleviating the burden on the behavioral health care system. The service delivery tasks that could arguably be allocated to technology without negatively impacting patient outcomes include screening, triage, and referral. Objective: We pilot-tested a chatbot for mental health screening and referral to understand the relationship between potential users' demographics and chatbot use; the completion rate of mental health screening when delivered by a chatbot; and the acceptability of a prototype chatbot designed for mental health screening and referral. This chatbot not only screened participants for psychological distress but also referred them to appropriate resources that matched their level of distress and preferences. The goal of this study was to determine whether a mental health screening and referral chatbot would be feasible and acceptable to users. Methods: We conducted an internet-based survey among a sample of US-based adults. Our survey collected demographic data along with a battery of measures assessing behavioral health and symptoms, stigma (label avoidance and perceived stigma), attitudes toward treatment-seeking, readiness for change, and technology readiness and acceptance. Participants were then offered to engage with our chatbot. Those who engaged with the chatbot completed a mental health screening, received a distress score based on this screening, were referred to resources appropriate for their current level of distress, and were asked to rate the acceptability of the chatbot. Results: We found that mental health screening using a chatbot was feasible, with 168 (75.7\%) of our 222 participants completing mental health screening within the chatbot sessions. Various demographic characteristics were associated with a willingness to use the chatbot. The participants who used the chatbot found it to be acceptable. Logistic regression produced a significant model with perceived usefulness and symptoms as significant positive predictors of chatbot use for the overall sample, and label avoidance as the only significant predictor of chatbot use for those currently experiencing distress. Conclusions: Label avoidance, the desire to avoid mental health services to avoid the stigmatized label of mental illness, is a significant negative predictor of care seeking. Therefore, our finding regarding label avoidance and chatbot use has significant public health implications in terms of facilitating access to mental health resources. Those who are high on label avoidance are not likely to seek care in a community mental health clinic, yet they are likely willing to engage with a mental health chatbot, participate in mental health screening, and receive mental health resources within the chatbot session. Chatbot technology may prove to be a way to engage those in care who have previously avoided treatment due to stigma. ",
doi="10.2196/45959",
url="https://formative.jmir.org/2024/1/e45959",
url="http://www.ncbi.nlm.nih.gov/pubmed/38607665"
}


@Article{info:doi/10.2196/50410,
author="Choy, Ada Melinda
and O'Brien, Kathleen
and Barnes, Katelyn
and Sturgiss, Ann Elizabeth
and Rieger, Elizabeth
and Douglas, Kirsty",
title="Evaluating the Digital Health Experience for Patients in Primary Care: Mixed Methods Study",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="11",
volume="26",
pages="e50410",
keywords="digital health",
keywords="eHealth",
keywords="primary care",
keywords="general practice",
keywords="digital divide",
keywords="health inequities",
keywords="health inequality",
keywords="disparities",
keywords="digital cost",
keywords="financial cost",
keywords="health technology",
keywords="mixed methods",
keywords="barriers",
keywords="barrier",
abstract="Background: The digital health divide for socioeconomic disadvantage describes a pattern in which patients considered socioeconomically disadvantaged, who are already marginalized through reduced access to face-to-face health care, are additionally hindered through less access to patient-initiated digital health. A comprehensive understanding of how patients with socioeconomic disadvantage access and experience digital health is essential for improving the digital health divide. Primary care patients, especially those with chronic disease, have experience of the stages of initial help seeking and self-management of their health, which renders them a key demographic for research on patient-initiated digital health access. Objective: This study aims to provide comprehensive primary mixed methods data on the patient experience of barriers to digital health access, with a focus on the digital health divide. Methods: We applied an exploratory mixed methods design to ensure that our survey was primarily shaped by the experiences of our interviewees. First, we qualitatively explored the experience of digital health for 19 patients with socioeconomic disadvantage and chronic disease and second, we quantitatively measured some of these findings by designing and administering a survey to 487 Australian general practice patients from 24 general practices. Results: In our qualitative first phase, the key barriers found to accessing digital health included (1) strong patient preference for human-based health services; (2) low trust in digital health services; (3) high financial costs of necessary tools, maintenance, and repairs; (4) poor publicly available internet access options; (5) reduced capacity to engage due to increased life pressures; and (6) low self-efficacy and confidence in using digital health. In our quantitative second phase, 31\% (151/487) of the survey participants were found to have never used a form of digital health, while 10.7\% (52/487) were low- to medium-frequency users and 48.5\% (236/487) were high-frequency users. High-frequency users were more likely to be interested in digital health and had higher self-efficacy. Low-frequency users were more likely to report difficulty affording the financial costs needed for digital access. Conclusions: While general digital interest, financial cost, and digital health literacy and empowerment are clear factors in digital health access in a broad primary care population, the digital health divide is also facilitated in part by a stepped series of complex and cumulative barriers. Genuinely improving digital health access for 1 cohort or even 1 person requires a series of multiple different interventions tailored to specific sequential barriers. Within primary care, patient-centered care that continues to recognize the complex individual needs of, and barriers facing, each patient should be part of addressing the digital health divide. ",
doi="10.2196/50410",
url="https://www.jmir.org/2024/1/e50410",
url="http://www.ncbi.nlm.nih.gov/pubmed/38602768"
}


@Article{info:doi/10.2196/47278,
author="Gybel Jensen, Christian
and Gybel Jensen, Frederik
and Loft, Ingerslev Mia",
title="Patients' Experiences With Digitalization in the Health Care System: Qualitative Interview Study",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="11",
volume="26",
pages="e47278",
keywords="digitalization",
keywords="digital health",
keywords="eHealth",
keywords="digital health literacy",
keywords="digital practices",
keywords="patient experiences",
keywords="digital health services",
keywords="inequity in health",
keywords="qualitative research",
keywords="interview",
keywords="implementation",
keywords="tool",
keywords="neurology",
keywords="digital tool",
keywords="communication",
keywords="mobile phone",
abstract="Background: The digitalization of public and health sectors worldwide is fundamentally changing health systems. With the implementation of digital health services in health institutions, a focus on digital health literacy and the use of digital health services have become more evident. In Denmark, public institutions use digital tools for different purposes, aiming to create a universal public digital sector for everyone. However, this digitalization risks reducing equity in health and further marginalizing citizens who are disadvantaged. Therefore, more knowledge is needed regarding patients' digital practices and experiences with digital health services. Objective: This study aims to examine digital practices and experiences with public digital health services and digital tools from the perspective of patients in the neurology field and address the following research questions: (1) How do patients use digital services and digital tools? (2) How do they experience them? Methods: We used a qualitative design with a hermeneutic approach. We conducted 31 semistructured interviews with patients who were hospitalized or formerly hospitalized at the department of neurology in a hospital in Denmark. The interviews were audio recorded and subsequently transcribed. The text from each transcribed interview was analyzed using manifest content analysis. Results: The analysis provided insights into 4 different categories regarding digital practices and experiences of using digital tools and services in health care systems: social resources as a digital lifeline, possessing the necessary capabilities, big feelings as facilitators or barriers, and life without digital tools. Our findings show that digital tools were experienced differently, and specific conditions were important for the possibility of engaging in digital practices, including having access to social resources; possessing physical, cognitive, and communicative capabilities; and feeling motivated, secure, and comfortable. These prerequisites were necessary for participants to have positive experiences using digital tools in the health care system. Those who did not have these prerequisites experienced challenges and, in some cases, felt left out. Conclusions: Experiences with digital practices and digital health services are complex and multifaceted. Engagement in digital practices for the examined population requires access to continuous assistance from their social network. If patients do not meet requirements, digital health services can be experienced as exclusionary and a source of concern. Physical, cognitive, and communicative difficulties might make it impossible to use digital tools or create more challenges. To ensure that digitalization does not create inequities in health, it is necessary for developers and institutions to be aware of the differences in digital health literacy, focus on simplifying communication with patients and next of kin, and find flexible solutions for citizens who are disadvantaged. ",
doi="10.2196/47278",
url="https://www.jmir.org/2024/1/e47278",
url="http://www.ncbi.nlm.nih.gov/pubmed/38602748"
}


@Article{info:doi/10.2196/54008,
author="Palakshappa, A. Jessica
and Hale, R. Erica
and Brown, D. Joshua
and Kittel, A. Carol
and Dressler, Emily
and Rosenthal, E. Gary
and Cutrona, L. Sarah
and Foley, L. Kristie
and Haines, R. Emily
and Houston II, K. Thomas",
title="Longitudinal Monitoring of Clinician-Patient Video Visits During the Peak of the COVID-19 Pandemic: Adoption and Sustained Challenges in an Integrated Health Care Delivery System",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="8",
volume="26",
pages="e54008",
keywords="telehealth",
keywords="telemedicine",
keywords="e-health",
keywords="eHealth",
keywords="video visits",
keywords="video",
keywords="ICT",
keywords="information and communication technology",
keywords="survey",
keywords="surveys",
keywords="adoption",
keywords="usability",
keywords="experience",
keywords="experiences",
keywords="attitude",
keywords="attitudes",
keywords="opinion",
keywords="perception",
keywords="perceptions",
keywords="perspective",
keywords="perspectives",
keywords="COVID-19",
abstract="Background: Numerous prior opinion papers, administrative electronic health record data studies, and cross-sectional surveys of telehealth during the pandemic have been published, but none have combined assessments of video visit success monitoring with longitudinal assessments of perceived challenges to the rapid adoption of video visits during the pandemic. Objective: This study aims to quantify (1) the use of video visits (compared with in-person and telephone visits) over time during the pandemic, (2) video visit successful connection rates, and (3) changes in perceived video visit challenges. Methods: A web-based survey was developed for the dual purpose of monitoring and improving video visit implementation in our health care system during the COVID-19 pandemic. The survey included questions regarding rates of in-person, telephone, and video visits for clinician-patient encounters; the rate of successful connection for video visits; and perceived challenges to video visits (eg, software, hardware, bandwidth, and technology literacy). The survey was distributed via email to physicians, advanced practice professionals, and clinicians in May 2020. The survey was repeated in March 2021. Differences between the 2020 and 2021 responses were adjusted for within-respondent correlation across surveys and tested using generalized estimating equations. Results: A total of 1126 surveys were completed (511 surveys in 2020 and 615 surveys in 2021). In 2020, only 21.7\% (73/336) of clinicians reported no difficulty connecting with patients during video visits and 28.6\% (93/325) of clinicians reported no difficulty in 2021. The distribution of the percentage of successfully connected video visits (``Over the past two weeks of scheduled visits, what percentage did you successfully connect with patients by video?'') was not significantly different between 2020 and 2021 (P=.74). Challenges in conducting video visits persisted over time. Poor connectivity was the most common challenge reported by clinicians. This response increased over time, with 30.5\% (156/511) selecting it as a challenge in 2020 and 37.1\% (228/615) in 2021 (P=.01). Patients not having access to their electronic health record portals was also a commonly reported challenge (109/511, 21.3\% in 2020 and 137/615, 22.3\% in 2021, P=.73). Conclusions: During the pandemic, our health care delivery system rapidly adopted synchronous patient-clinician communication using video visits. As experience with video visits increased, the reported failure rate did not significantly decline, and clinicians continued to report challenges related to general network connectivity and patient access to technology. ",
doi="10.2196/54008",
url="https://www.jmir.org/2024/1/e54008",
url="http://www.ncbi.nlm.nih.gov/pubmed/38587889"
}


@Article{info:doi/10.2196/54330,
author="Bruce, R. Courtenay
and Klahn, Steve
and Randle, Lindsay
and Li, Xin
and Sayali, Kelkar
and Johnson, Barbara
and Gomez, Melissa
and Howard, Meagan
and Schwartz, Roberta
and Sasangohar, Farzan",
title="Impacts of an Acute Care Telenursing Program on Discharge, Patient Experience, and Nursing Experience: Retrospective Cohort Comparison Study",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="4",
volume="26",
pages="e54330",
keywords="telenursing",
keywords="telemedicine",
keywords="patient discharge",
keywords="health personnel",
keywords="surveys and questionnaires",
keywords="patient outcome assessment",
abstract="Background: Despite widespread growth of televisits and telemedicine, it is unclear how telenursing could be applied to augment nurse labor and support nursing. Objective: This study evaluated a large-scale acute care telenurse (ACTN) program to support web-based admission and discharge processes for hospitalized patients. Methods: A retrospective, observational cohort comparison was performed in a large academic hospital system (approximately 2100 beds) in Houston, Texas, comparing patients in our pilot units for the ACTN program (telenursing cohort) between June 15, 2022, and December 31, 2022, with patients who did not participate (nontelenursing cohort) in the same units and timeframe. We used a case mix index analysis to confirm comparable patient cases between groups. The outcomes investigated were patient experience, measured using the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHCPS) survey; nursing experience, measured by a web-based questionnaire with quantitative multiple-choice and qualitative open-ended questions; time of discharge during the day (from electronic health record data); and duration of discharge education processes. Results: Case mix index analysis found no significant case differences between cohorts (P=.75). For the first 4 units that rolled out in phase 1, all units experienced improvement in at least 4 and up to 7 HCAHCPS domains. Scores for ``communication with doctors'' and ``would recommend hospital'' were improved significantly (P=.03 and P=.04, respectively) in 1 unit in phase 1. The impact of telenursing in phases 2 and 3 was mixed. However, ``communication with doctors'' was significantly improved in 2 units (P=.049 and P=.002), and the overall rating of the hospital and the ''would recommend hospital'' scores were significantly improved in 1 unit (P=.02 and P=04, respectively). Of 289 nurses who were invited to participate in the survey, 106 completed the nursing experience survey (response rate 106/289, 36.7\%). Of the 106 nurses, 101 (95.3\%) indicated that the ACTN program was very helpful or somewhat helpful to them as bedside nurses. The only noticeable difference between the telenursing and nontelenursing cohorts for the time of day discharge was a shift in the volume of patients discharged before 2 PM compared to those discharged after 2 PM at a hospital-wide level. The ACTN admissions averaged 12 minutes and 6 seconds (SD 7 min and 29 s), and the discharges averaged 14 minutes and 51 seconds (SD 8 min and 10 s). The average duration for ACTN calls was 13 minutes and 17 seconds (SD 7 min and 52 s). Traditional cohort standard practice (nontelenursing cohort) of a bedside nurse engaging in discharge and admission processes was 45 minutes, consistent with our preimplementation time study. Conclusions: This study shows that ACTN programs are feasible and associated with improved outcomes for patient and nursing experience and reducing time allocated to admission and discharge education. ",
doi="10.2196/54330",
url="https://www.jmir.org/2024/1/e54330",
url="http://www.ncbi.nlm.nih.gov/pubmed/38573753"
}


@Article{info:doi/10.2196/54168,
author="McLaren, E. Jaye
and Hoang-Gia, Dat
and Dorisca, Eugenia
and Hartz, Stephanie
and Dang, Stuti
and Moo, Lauren",
title="Development and Evaluation of a Clinician-Vetted Dementia Caregiver Resources Website: Mixed Methods Approach",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="4",
volume="8",
pages="e54168",
keywords="Alzheimer disease",
keywords="caregiver education",
keywords="dementia",
keywords="interdisciplinary",
keywords="older adults",
keywords="virtual resources",
keywords="website development",
abstract="Background: About 11 million Americans are caregivers for the 6.7 million Americans currently living with dementia. They provide over 18 billion hours of unpaid care per year, yet most have no formal dementia education or support. It is extremely difficult for clinicians to keep up with the demand for caregiver education, especially as dementia is neurodegenerative in nature, requiring different information at different stages of the disease process. In this digital age, caregivers often seek dementia information on the internet, but clinicians lack a single, reliable compendium of expert-approved digital resources to provide to dementia caregivers. Objective: Our aim was to create a dementia caregiver resources website to serve as a hub for user-friendly, high-quality, and expert-reviewed dementia educational resources that clinicians can easily supply to family caregivers of people with dementia. Methods: An interdisciplinary website development team (representing dementia experts from occupational therapy, nursing, social work, geriatrics, and neurology) went through 6 iterative steps of website development to ensure resource selection quality and eligibility rigor. Steps included (1) resource collection, (2) creation of eligibility criteria, (3) resource organization by topic, (4) additional content identification, (5) finalize resource selection, and (6) website testing and launch. Website visits were tracked, and a 20-item survey about website usability and utility was sent to Veterans Affairs tele-geriatrics interdisciplinary specialty care groups. Results: Following website development, the dementia caregiver resource website was launched in February 2022. Over the first 9 months, the site averaged 1100 visits per month. The 3 subcategories with the highest number of visits were ``general dementia information,'' ``activities of daily living,'' and ``self-care and support.'' Most (44/45, 98\%) respondents agreed or strongly agreed that the website was easy to navigate, and all respondents agreed or strongly agreed that the resources were useful. Conclusions: The iterative process of creating the dementia caregiver resources website included continuous identification, categorization, and prioritization of resources, followed by clinician feedback on website usability, accessibility, and suggestions for improvement. The website received thousands of visits and positive clinician reviews in its first 9 months. Results demonstrate that an expert-vetted, nationally, and remotely available resource website allows for easy access to dementia education for clinicians to provide for their patients and caregivers. This process of website development can serve as a model for other clinical subspecialty groups seeking to create a comprehensive educational resource for populations who lack easy access to specialty care. ",
doi="10.2196/54168",
url="https://formative.jmir.org/2024/1/e54168",
url="http://www.ncbi.nlm.nih.gov/pubmed/38573761"
}


@Article{info:doi/10.2196/51338,
author="Bhyat, Fatima
and Makkink, Andrew
and Henrico, Karien",
title="Holistic Person-Centered Care in Radiotherapy: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="3",
volume="13",
pages="e51338",
keywords="cancer patient",
keywords="cancer",
keywords="cancer care",
keywords="holistic care",
keywords="person-centered care",
keywords="person-centered",
keywords="radiologist",
keywords="radiology",
keywords="radiotherapist",
keywords="radiotherapy",
keywords="scoping review",
abstract="Background: Several types of health care professionals are responsible for the care of patients with cancer throughout their engagement with the health care system. One such type is the radiotherapist. The radiotherapist not only administers treatment but is also directly involved with the patient during treatment. Despite this direct contact with the patient, the narrative tends to focus more on technical tasks than the actual patient. This task-focused interaction is often due to the highly sophisticated equipment and complex radiotherapy treatment processes involved. This often results in not meeting the psychosocial needs of the patient, and patients have acknowledged noncompliance and delayed treatment as a result. Objective: The scoping review aims to explore, chart, and map the available literature on holistic person-centered care in radiotherapy and to identify and present key concepts, definitions, methodologies, knowledge gaps, and evidence related to holistic person-centered care in radiotherapy. Methods: This protocol was developed using previously described methodological frameworks for scoping studies. The review will include both peer-reviewed and gray literature regarding holistic, person-centered care in radiotherapy. A comprehensive search strategy has been developed for MEDLINE (Ovid), which will be translated into the other included databases: Scopus, CINAHL (EBSCO), MEDLINE (PubMed), Embase (Elsevier), Cochrane Library, and the Directory of Open Access Journals. Gray literature searching will include Google (Google Books and Google Scholar), ProQuest, the WorldWideScience website, the OpenGrey website, and various university dissertation and thesis repositories. The title and abstract screening, full-text review, and relevant data extraction will be performed independently by all 3 reviewers using the Covidence (Veritas Health Innovation) software, which will also be used to guide the resolution of conflicts. Sources selected will be imported into ATLAS.ti (ATLAS.ti Scientific Software Development GmbH) for analysis, which will consist of content analysis, narrative analysis, and descriptive synthesis. Results will be presented using narrative, diagrammatic, and tabular formats. Results: The review is expected to identify research gaps that will inform current and future holistic, person-centered care in radiotherapy. The review commenced in November 2023, and the formal literature search was completed by the end of February 2024. Final results are expected to be published in a peer-reviewed journal by 2025. Conclusions: The findings of this review are expected to provide a wide variety of strategies aimed at providing holistic, person-centered care in radiotherapy, as well as to identify some gaps in the literature. These findings will be used to inform future studies aimed at designing, developing, evaluating, and implementing strategies toward improved holistic, person-centered care in radiotherapy. International Registered Report Identifier (IRRID): DERR1-10.2196/51338 ",
doi="10.2196/51338",
url="https://www.researchprotocols.org/2024/1/e51338",
url="http://www.ncbi.nlm.nih.gov/pubmed/38569177"
}


@Article{info:doi/10.2196/47422,
author="Ko, Yousang
and Park, Seuk Jae
and Min, Jinsoo
and Kim, Woo Hyung
and Koo, Hyeon-Kyoung
and Oh, Youn Jee
and Jeong, Yun-Jeong
and Lee, Eunhye
and Yang, Bumhee
and Kim, Sang Ju
and Lee, Sung-Soon
and Kwon, Yunhyung
and Yang, Jiyeon
and Han, yeon Ji
and Jang, Jin You
and Kim, Jinseob",
title="Timely Pulmonary Tuberculosis Diagnosis Based on the Epidemiological Disease Spectrum: Population-Based Prospective Cohort Study in the Republic of Korea",
journal="JMIR Public Health Surveill",
year="2024",
month="Apr",
day="1",
volume="10",
pages="e47422",
keywords="pulmonary tuberculosis",
keywords="disease spectrum",
keywords="timely diagnosis",
keywords="patient delay",
keywords="health care delay",
keywords="risk factor",
keywords="epidemiological disease",
keywords="tuberculosis",
keywords="treatment",
keywords="TB",
keywords="PTB disease spectrum",
keywords="mortality",
keywords="early diagnosis",
abstract="Background: Timely pulmonary tuberculosis (PTB) diagnosis is a global health priority for interrupting transmission and optimizing treatment outcomes. The traditional dichotomous time-divided approach for addressing time delays in diagnosis has limited clinical application because the time delay significantly varies depending on each community in question. Objective: We aimed to reevaluate the diagnosis time delay based on the PTB disease spectrum using a novel scoring system that was applied at the national level in the Republic of Korea. Methods: The Pulmonary Tuberculosis Spectrum Score (PTBSS) was developed based on previously published proposals related to the disease spectrum, and its validity was assessed by examining both all-cause and PTB-related mortality. In our analysis, we integrated the PTBSS into the Korea Tuberculosis Cohort Registry. We evaluated various time delays, including patient, health care, and overall delays, and their system-associated variables in line with each PTBSS. Furthermore, we reclassified the scores into distinct categories of mild (PTBSS=0-1), moderate (PBTBSS=2-3), and severe (PBTBSS=4-6) using a multivariate regression approach. Results: Among the 14,031 Korean patients with active PTB whose data were analyzed from 2018 to 2020, 37\% (n=5191), 38\% (n=5328), and 25\% (n=3512) were classified as having a mild, moderate, and severe disease status, respectively, according to the PTBSS. This classification can therefore reflect the disease spectrum of PTB by considering the correlation of the score with mortality. The time delay patterns differed according to the PTBSS. In health care delays according to the PTBSS, greater PTB disease progression was associated with a shorter diagnosis period, since the condition is microbiologically easy to diagnose. However, with respect to patient delays, the change in elapsed time showed a U-shaped pattern as PTB progressed. This means that a remarkable patient delay in the real-world setting might occur at both apical ends of the spectrum (ie, in both mild and severe cases of PTB). Independent risk factors for a severe PTB pattern were age (adjusted odds ratio 1.014) and male sex (adjusted odds ratio 1.422), whereas no significant risk factor was found for mild PTB. Conclusions: Timely PTB diagnosis should be accomplished. This can be improved with use of the PTBSS, a simple and intuitive scoring system, which can be more helpful in clinical and public health applications compared to the traditional dichotomous time-only approach. ",
doi="10.2196/47422",
url="https://publichealth.jmir.org/2024/1/e47422",
url="http://www.ncbi.nlm.nih.gov/pubmed/38557939"
}


@Article{info:doi/10.2196/50532,
author="Haque, Ghazal
and Asif, Fozia
and Ahmed, Ali Fasih
and Ayub, Farwa
and Syed, Hassan Sabih ul
and Pradhan, Akber Nousheen
and Hameed, Malika
and Siddiqui, Ullah Muhammad Muneeb
and Mahmood, Shafaq
and Zaidi, Tahani
and Siddiqi, Sameen
and Latif, Asad",
title="Assessment of Patient Safety in a Low-Resource Health Care System: Proposal for a Multimethod Study",
journal="JMIR Res Protoc",
year="2024",
month="Mar",
day="27",
volume="13",
pages="e50532",
keywords="patient safety",
keywords="health systems",
keywords="quality assessment",
keywords="safety culture",
keywords="assessment",
keywords="healthcare delivery",
keywords="health system",
keywords="hospital",
keywords="low-middle-income countries",
keywords="research methodology",
abstract="Background: The high prevalence of adverse events (AEs) globally in health care delivery has led to the establishment of many guidelines to enhance patient safety. However, patient safety is a relatively nascent concept in low- and middle-income countries (LMICs) where health systems are already overburdened and underresourced. This is why it is imperative to study the nuances of patient safety from a local perspective to advocate for the judicious use of scarce public health resources. Objective: This study aims to assess the status of patient safety in a health care system within a low-resource setting, using a multipronged, multimethod approach of standardized methodologies adapted to the local setting. Methods: We propose purposive sampling to include a representative mix of public and private, rural and urban, and tertiary and secondary care hospitals, preferably those ascribed to the same hospital quality standards. Six different approaches will be considered at these hospitals including (1) focus group discussions on the status quo of patient safety, (2) Hospital Survey on Patient Safety Culture, (3) Hospital Consumer Assessment of Healthcare Providers and Systems, (4) estimation of incidence of AEs identified by patients, (5) estimation of incidence of AEs via medical record review, and (6) assessment against the World Health Organization's Patient Safety Friendly Hospital Framework via thorough reviews of existing hospital protocols and in-person surveys of the facility. Results: The abovementioned studies collectively are expected to yield significant quantifiable information on patient safety conditions in a wide range of hospitals operating within LMICs. Conclusions: A multidimensional approach is imperative to holistically assess the patient safety situation, especially in LMICs. Our low-budget, non--resource-intensive research proposal can serve as a benchmark to conduct similar studies in other health care settings within LMICs. International Registered Report Identifier (IRRID): PRR1-10.2196/50532 ",
doi="10.2196/50532",
url="https://www.researchprotocols.org/2024/1/e50532",
url="http://www.ncbi.nlm.nih.gov/pubmed/38536223"
}


@Article{info:doi/10.2196/54211,
author="Brooks Carthon, Margo J.
and Brom, Heather
and Grantham-Murrillo, Marsha
and Sliwinski, Kathy
and Mason, Aleigha
and Roeser, Mindi
and Miles, Donna
and Garcia, Dianne
and Bennett, Jovan
and Harhay, O. Michael
and Flores, Emilia
and Amenyedor, Kelvin
and Clark, Rebecca",
title="Equity-Centered Postdischarge Support for Medicaid-Insured People: Protocol for a Type 1 Hybrid Effectiveness-Implementation Stepped Wedge Cluster Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Mar",
day="26",
volume="13",
pages="e54211",
keywords="health care disparities",
keywords="evidence-based practice",
keywords="Medicaid",
keywords="transitional care",
keywords="implementation science",
keywords="socioeconomic disparities in health",
abstract="Background: Disparities in posthospitalization outcomes for people with chronic medical conditions and insured by Medicaid are well documented, yet interventions that mitigate them are lacking. Prevailing transitional care interventions narrowly target people aged 65 years and older, with specific disease processes, or limitedly focus on individual-level behavioral change such as self-care or symptom management, thus failing to adequately provide a holistic approach to ensure an optimal posthospital care continuum. This study evaluates the implementation of THRIVE---an evidence-based, equity-focused clinical pathway that supports Medicaid-insured individuals with multiple chronic conditions transitioning from hospital to home by focusing on the social determinants of health and systemic and structural barriers in health care delivery. THRIVE services include coordinating care, standardizing interdisciplinary communication, and addressing unmet clinical and social needs following hospital discharge. Objective: The study's objectives are to (1) examine referral patterns, 30-day readmission, and emergency department use for participants who receive THRIVE support services compared to those receiving usual care and (2) evaluate the implementation of the THRIVE clinical pathway, including fidelity, feasibility, appropriateness, and acceptability. Methods: We will perform a sequential randomized rollout of THRIVE to case managers at the study hospital in 3 steps (4 in the first group, 4 in the second, and 5 in the third), and data collection will occur over 18 months. Inclusion criteria for THRIVE participation include (1) being Medicaid insured, dually enrolled in Medicaid and Medicare, or Medicaid eligible; (2) residing in Philadelphia; (3) having experienced a hospitalization at the study hospital for more than 24 hours with a planned discharge to home; (4) agreeing to home care at partner home care settings; and (5) being aged 18 years or older. Qualitative data will include interviews with clinicians involved in THRIVE, and quantitative data on health service use (ie, 30-day readmission, emergency department use, and primary and specialty care) will be derived from the electronic health record. Results: This project was funded in January 2023 and approved by the institutional review board on March 10, 2023. Data collection will occur from March 2023 to July 2024. Results are expected to be published in 2025. Conclusions: The THRIVE clinical pathway aims to reduce disparities and improve postdischarge care transitions for Medicaid-insured patients through a system-level intervention that is acceptable for THRIVE participants, clinicians, and their teams in hospitals and home care settings. By using our equity-focused case management services and leveraging the power of the electronic medical record, THRIVE creates efficiencies by identifying high-need patients, improving communication across acute and community-based sectors, and driving evidence-based care coordination. This study will add important findings about how the infusion of equity-focused principles in the design and evaluation of evidence-based interventions contributes to both implementation and effectiveness outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/54211 Trial Registration: ClinicalTrials.gov NCT05714605; https://clinicaltrials.gov/ct2/show/NCT05714605 ",
doi="10.2196/54211",
url="https://www.researchprotocols.org/2024/1/e54211",
url="http://www.ncbi.nlm.nih.gov/pubmed/38530349"
}


@Article{info:doi/10.2196/55332,
author="Fronteira, Ines
and Pacheco, Matilde
and Schaltz-Buchholzer, Frederik
and Ferrinho, Paulo",
title="Nonspecific Effects of the Bacillus Calmette-Gu{\'e}rin Vaccine in Portuguese Children Under 5 Years of Age: Protocol for a Population-Based Historical Birth Cohort Study",
journal="JMIR Res Protoc",
year="2024",
month="Mar",
day="14",
volume="13",
pages="e55332",
keywords="BCG",
keywords="Bacillus Calmette-Gu{\'e}rin vaccine",
keywords="policy",
keywords="Portugal",
keywords="nonspecific effects",
keywords="vaccines",
keywords="heterologous immunity",
abstract="Background: The Bacillus Calmette-Gu{\'e}rin vaccine (BCG) against tuberculosis (TB) shows beneficial nonspecific effects, which are likely related to innate immune training. Until 2016, a single BCG dose was administered to all newborns in Portugal. In July 2016, a clinical guideline established that only children under 6 years belonging to high-risk groups should receive BCG. This might have prevented nonvaccinated children from developing trained immunological responses as effectively as BCG-vaccinated children. Objective: This study aims to investigate if there is variation in TB-related and all-cause mortality, and severe, moderate, or mild morbidity in children under 5 years of age, and whether such variation might be explained by the BCG vaccination policy change in 2016. Methods: This population-based historical birth cohort study includes children under 5 years of age born in Portugal between July 1, 2010, and June 30, 2021. Newborns with low birth weight, premature status, or known or suspected HIV infection are excluded. The follow-up period is until the completion of 5 years of age or the end of follow-up (June 30, 2021). The study will use secondary data from the National Health Service user registry, death certificate database, vaccination registry, communicable diseases surveillance system, TB surveillance system, diagnosis-related group information system for hospital admissions and emergency department visits, and primary health care information system. The data will be linked. Primary outcomes include person-time incidence rates of death (all causes and TB), TB diagnosis, and all causes and some specific causes of severe, moderate, or mild morbidity, and the incidence rate ratio of nonvaccinated to BCG-vaccinated children. We will compare the probability of surviving the first and fifth years of life or of not having severe, moderate, or mild morbidity during the follow-up period according to exposure (BCG vaccinated or nonvaccinated, number of doses, and time from birth until the first dose), using the log-rank test for assessing differences in survival rates between exposed and nonexposed children and hazard ratios for quantifying the differences. Moreover, we will perform a proportional hazards regression analysis. Results: Ethics approval has been obtained. In March 2022, database owners were contacted to present the project and discuss the request for data. A unique identifier will be used. In July 2023, a process of redefinition of the variables per database was initiated. Data were received in October and November 2023. In November 2023, further work was conducted. By April 2024, we expect to start analyzing the full data set. Conclusions: The results will contribute to the accumulating body of knowledge and might have relevance to guide global BCG vaccination policy. Data linkage can contribute to a swifter mechanism to use available health data to conduct population-based studies and inform policy decision-making. Trial Registration: ClinicalTrials.gov NCT05471167; https://clinicaltrials.gov/study/NCT05471167 International Registered Report Identifier (IRRID): DERR1-10.2196/55332 ",
doi="10.2196/55332",
url="https://www.researchprotocols.org/2024/1/e55332",
url="http://www.ncbi.nlm.nih.gov/pubmed/38328938"
}


@Article{info:doi/10.2196/45987,
author="Eager, Sharon
and Killaspy, Helen
and C, Joanna
and Mezey, Gillian
and McPherson, Peter
and Downey, Megan
and Thompson, Georgina
and Lloyd-Evans, Brynmor",
title="A Web-Based Tool to Assess Social Inclusion and Support Care Planning in Mental Health Supported Accommodation: Development and Preliminary Test Study",
journal="Interact J Med Res",
year="2024",
month="Mar",
day="13",
volume="13",
pages="e45987",
keywords="social inclusion",
keywords="supported accommodation",
keywords="mental health",
keywords="digital health",
keywords="care planning",
abstract="Background: Individuals with severe mental illness living in supported accommodation are often socially excluded. Social inclusion is an important aspect of recovery-based practice and quality of life. The Social Inclusion Questionnaire User Experience (SInQUE) is a measure of social inclusion that has been validated for use with people with mental health problems. Previous research has suggested that the SInQUE could also help support care planning focused on enabling social inclusion in routine mental health practice. Objective: This study aims to develop a web-based version of the SInQUE for use in mental health supported accommodation services, examine its acceptability and perceived usefulness as a tool to support care planning with service users, determine the extent of uptake of the tool in supported accommodation settings, and develop a program theory and logic model for the online SInQUE. Methods: This study involved a laboratory-testing stage to assess the acceptability of the SInQUE tool through ``think-aloud'' testing with 6 supported accommodation staff members and a field-testing stage to assess the acceptability, utility, and use of the SInQUE tool over a 5-month period. An implementation strategy was used in 1 London borough to encourage the use of the SInQUE. Qualitative interviews with 12 service users and 12 staff members who used the tool were conducted and analyzed using thematic analysis. The use of the SInQUE was compared with that in 2 other local authority areas, 1 urban and 1 rural, where the tool was made available for use but no implementation strategy was used. Results: Overall, 17 staff members used the SInQUE with 28 different service users during the implementation period (approximately 10\% of all service users living in supported accommodation in the study area). The staff and service users interviewed felt that the SInQUE was collaborative, comprehensive, user-friendly, and relevant. Although some staff were concerned that particular questions might be too personal, service users did not echo this view. Participants generally felt that the SInQUE could help identify individuals' priorities regarding different aspects of social inclusion by prompting in-depth conversations and tailoring specific support to address service users' inclusion goals. Some interviewees also suggested that the tool could highlight areas of unmet or unmeetable needs across the borough that could feed into service planning. The SInQUE was not used in the comparison areas that had no implementation strategy. Conclusions: The online SInQUE is an acceptable and potentially useful tool that can be recommended to assess and support care planning to enable social inclusion of people living in mental health supported accommodation services. Despite this, uptake rates were modest during the study period. A concerted implementation strategy is key to embedding its use in usual care, including proactive endorsement by senior leaders and service managers. ",
doi="10.2196/45987",
url="https://www.i-jmr.org/2024/1/e45987",
url="http://www.ncbi.nlm.nih.gov/pubmed/38477978"
}


@Article{info:doi/10.2196/48292,
author="Kirby, Pippa
and Lai, Helen
and Horrocks, Sophie
and Harrison, Matthew
and Wilson, Danielle
and Daniels, Sarah
and Calvo, A. Rafael
and Sharp, J. David
and Alexander, M. Caroline",
title="Patient and Public Involvement in Technology-Related Dementia Research: Scoping Review",
journal="JMIR Aging",
year="2024",
month="Mar",
day="4",
volume="7",
pages="e48292",
keywords="dementia",
keywords="technology",
keywords="patient and public involvement and engagement",
keywords="co-design",
keywords="coproduction",
abstract="Background: Technology-related research on people with dementia and their carers often aims to enable people to remain living at home for longer and prevent unnecessary hospital admissions. To develop person-centered, effective, and ethical research, patient and public involvement (PPI) is necessary, although it may be perceived as more difficult with this cohort. With recent and rapid expansions in health and care--related technology, this review explored how and with what impact collaborations between researchers and stakeholders such as people with dementia and their carers have taken place. Objective: This review aims to describe approaches to PPI used to date in technology-related dementia research, along with the barriers and facilitators and impact of PPI in this area. Methods: A scoping review of literature related to dementia, technology, and PPI was conducted using MEDLINE, PsycINFO, Embase, and CINAHL. Papers were screened for inclusion by 2 authors. Data were then extracted using a predesigned data extraction table by the same 2 authors. A third author supported the resolution of any conflicts at each stage. Barriers to and facilitators of undertaking PPI were then examined and themed. Results: The search yielded 1694 papers, with 31 (1.83\%) being analyzed after screening. Most (21/31, 68\%) did not make clear distinctions between activities undertaken as PPI and those undertaken by research participants, and as such, their involvement did not fit easily into the National Institute for Health and Care Research definition of PPI. Most of this mixed involvement focused on reviewing or evaluating technology prototypes. A range of approaches were described, most typically using focus groups or co-design workshops. In total, 29\% (9/31) described involvement at multiple stages throughout the research cycle, sometimes with evidence of sharing decision-making power. Some (23/31, 74\%) commented on barriers to or facilitators of effective PPI. The challenges identified often regarded issues of working with people with significant cognitive impairments and pressures on time and resources. Where reported, the impact of PPI was largely reported as positive, including the experiences for patient and public partners, the impact on research quality, and the learning experience it provided for researchers. Only 4 (13\%) papers used formal methods for evaluating impact. Conclusions: Researchers often involve people with dementia and other stakeholders in technology research. At present, involvement is often limited in scope despite aspirations for high levels of involvement and partnership working. Involving people with dementia, their carers, and other stakeholders can have a positive impact on research, patient and public partners, and researchers. Wider reporting of methods and facilitative strategies along with more formalized methods for recording and reporting on meaningful impact would be helpful so that all those involved---researchers, patients, and other stakeholders---can learn how we can best conduct research together. ",
doi="10.2196/48292",
url="https://aging.jmir.org/2024/1/e48292",
url="http://www.ncbi.nlm.nih.gov/pubmed/38437014"
}


@Article{info:doi/10.2196/52590,
author="Guzelj, Domen
and Grubelnik, An?e
and Greif, Nina
and Povalej Br?an, Petra
and Fluher, Jure
and Kalamar, ?iga
and Markota, Andrej",
title="The Effect of Body Temperature Changes on the Course of Treatment in Patients With Pneumonia and Sepsis: Results of an Observational Study",
journal="Interact J Med Res",
year="2024",
month="Mar",
day="1",
volume="13",
pages="e52590",
keywords="fever",
keywords="targeted temperature management",
keywords="pneumonia",
keywords="sepsis",
keywords="intensive care unit",
abstract="Background: Traditionally, patients who are critically ill with infection and fever have been treated with antipyretics or even physically cooled. Presumed benefits of the reduction of body temperature are mostly based on decreased metabolic demands. However, it has been shown that decreasing body temperature in patients who are critically ill is not associated with improvement in treatment outcomes. Additionally, there is some data to support the use of temperature modulation (therapeutic hyperthermia) as an adjuvant treatment strategy in patients with infection. Objective: This study aims to determine the effect of body temperature on the course of intensive care unit (ICU) treatment of patients who are mechanically ventilated with pneumonia, sepsis, and positive tracheal aspirates on admission. Methods: We performed a single-center retrospective study. Core body temperature was measured in all patients. We analyzed associations between average temperatures in the first 48 hours after admission to ICU and ICU treatment parameters. Additionally, patients were divided into three groups: patients with negative tracheal aspirates 1 week after ICU admission (P-N group), patients with a different pathogen in tracheal aspirates 1 week after ICU admission (P-HAP group), and patients with a persisting pathogen in tracheal aspirates 1 week after ICU admission (P-P group). Differences in body temperature and interventions aimed at temperature modulation were determined. Results: We observed a significantly higher average temperature in the first 48 hours after admission to ICU in patients who survived to hospital discharge compared to nonsurvivors (mean 37.2 {\textdegree}C, SD 1 {\textdegree}C vs mean 36.9 {\textdegree}C, SD 1.6 {\textdegree}C; P=.04). We observed no associations between average temperatures in the first 48 hours after ICU admission and days of mechanical ventilation in the first 7 days of treatment ($\rho$=--0.090; P=.30), the average maximum daily requirement for noradrenaline in the first 7 days of treatment ($\rho$=--0.029; P=.80), average maximum FiO2 in the first 7 days of ICU treatment ($\rho$=0.040; P=.70), and requirement for renal replacement therapy in the first 7 days of ICU treatment (mean 37.3 {\textdegree}C, SD 1.4 {\textdegree}C vs mean 37.0 {\textdegree}C, SD 1.3 {\textdegree}C; P=.23). In an additional analysis, we observed a significantly greater use of paracetamol in the P-N group (mean 1.0, SD 1.1 g vs mean 0.4, SD 0.7 g vs mean 0.4, SD 0.8 g; P=.009), a trend toward greater use of active cooling in the first 24 hours after ICU admission in the P-N group (n=11, 44\% vs n=14, 33.3\% vs n=16, 32\%; P=.57), and no other significant differences in parameters of ICU treatment between patient groups. Conclusions: We observed better survival in patients who developed higher body temperatures in the first 48 hours after admission to the ICU; however, we observed no changes in other treatment parameters. Similarly, we observed greater use of paracetamol in patients with negative tracheal aspirates 1 week after ICU admission. Our results support the strategy of temperature tolerance in patients who are intubated with pneumonia and sepsis. ",
doi="10.2196/52590",
url="https://www.i-jmr.org/2024/1/e52590",
url="http://www.ncbi.nlm.nih.gov/pubmed/38427413"
}


@Article{info:doi/10.2196/48989,
author="Chen, Chih-Wei
and Walter, Paul
and Wei, Cheng-Chung James",
title="Using ChatGPT-Like Solutions to Bridge the Communication Gap Between Patients With Rheumatoid Arthritis and Health Care Professionals",
journal="JMIR Med Educ",
year="2024",
month="Feb",
day="27",
volume="10",
pages="e48989",
keywords="rheumatoid arthritis",
keywords="ChatGPT",
keywords="artificial intelligence",
keywords="communication gap",
keywords="privacy",
keywords="data management",
doi="10.2196/48989",
url="https://mededu.jmir.org/2024/1/e48989",
url="http://www.ncbi.nlm.nih.gov/pubmed/38412022"
}


@Article{info:doi/10.2196/48685,
author="K{\"o}nig, Lars
and Kuhlmey, Adelheid
and Suhr, Ralf",
title="Digital Health Literacy of the Population in Germany and Its Association With Physical Health, Mental Health, Life Satisfaction, and Health Behaviors: Nationally Representative Survey Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Feb",
day="21",
volume="10",
pages="e48685",
keywords="digital health",
keywords="digital health literacy",
keywords="eHealth",
keywords="eHealth literacy",
keywords="health behaviors",
keywords="health literacy",
keywords="life satisfaction",
keywords="mental health",
keywords="physical health",
keywords="representative survey",
abstract="Background: Digital health literacy, also known as eHealth literacy, describes the ability to seek, find, understand, and apply health information from the internet to address health problems. The World Health Organization calls for actions to improve digital health literacy. To develop target group--specific digital health literacy interventions, it is necessary to know the digital health literacy of the general population and relevant subgroups. Objective: This study aims to representatively assess the digital health literacy of the population in Germany and relevant subgroups. The results are meant to facilitate the development of target group--specific digital health literacy interventions. Additionally, this study further explores the associations between digital health literacy and physical health, mental health, life satisfaction, and diverse health behaviors. Methods: Study participants were drawn from a representative panel of the German-speaking population with internet access. To further increase the representativeness of the sample, survey weights were calculated using an iterative proportional fitting procedure. Participants answered a series of questionnaires regarding their digital health literacy, physical health, mental health, life satisfaction, and diverse health behaviors. Two-sided independent sample t tests were conducted to determine the significant differences between societal subgroups. Pearson correlation coefficients were calculated to explore the correlates of digital health literacy. Results: Digital health literacy is unevenly distributed within German society. The results of this study suggest that people with a low level of formal education and people with a low social status would benefit from digital health literacy interventions that address their competencies in the domains of information seeking and information appraisal. Furthermore, the results suggest that older people would likely benefit from digital health literacy interventions that address their competencies in the domains of information seeking and also information appraisal. Regarding sex, this study suggests that men might benefit from digital health literacy interventions that specifically address their competencies in the domain of information seeking. Furthermore, digital health literacy is weakly positively correlated with physical health, mental health, life satisfaction, exercise routines, fruit consumption, and vegetable consumption. Conclusions: Overall, the results of this study demonstrate that digital health literacy is associated with diverse health outcomes and behaviors. Furthermore, the results provide a starting point for the development of target group--specific digital health literacy interventions. ",
doi="10.2196/48685",
url="https://publichealth.jmir.org/2024/1/e48685",
url="http://www.ncbi.nlm.nih.gov/pubmed/38381497"
}


@Article{info:doi/10.2196/46740,
author="Acharya, Amish
and Black, Claire Ruth
and Smithies, Alisdair
and Darzi, Ara",
title="Evaluating the Impact of the National Health Service Digital Academy on Participants' Perceptions of Their Identity as Leaders of Digital Health Change: Mixed Methods Study",
journal="JMIR Med Educ",
year="2024",
month="Feb",
day="21",
volume="10",
pages="e46740",
keywords="digital leadership",
keywords="professional identity",
keywords="dissertation of practice",
abstract="Background: The key to the digital leveling-up strategy of the National Health Service is the development of a digitally proficient leadership. The National Health Service Digital Academy (NHSDA) Digital Health Leadership program was designed to support emerging digital leaders to acquire the necessary skills to facilitate transformation. This study examined the influence of the program on professional identity formation as a means of creating a more proficient digital health leadership. Objective: This study aims to examine the impact of the NHSDA program on participants' perceptions of themselves as digital health leaders. Methods: We recruited 41 participants from 2 cohorts of the 2-year NHSDA program in this mixed methods study, all of whom had completed it >6 months before the study. The participants were initially invited to complete a web-based scoping questionnaire. This involved both quantitative and qualitative responses to prompts. Frequencies of responses were aggregated, while free-text comments from the questionnaire were analyzed inductively. The content of the 30 highest-scoring dissertations was also reviewed by 2 independent authors. A total of 14 semistructured interviews were then conducted with a subset of the cohort. These focused on individuals' perceptions of digital leadership and the influence of the course on the attainment of skills. In total, 3 in-depth focus groups were then conducted with participants to examine shared perceptions of professional identity as digital health leaders. The transcripts from the interviews and focus groups were aligned with a previously published examination of leadership as a framework. Results: Of the 41 participants, 42\% (17/41) were in clinical roles, 34\% (14/41) were in program delivery or management roles, 20\% (8/41) were in data science roles, and 5\% (2/41) were in ``other'' roles. Interviews and focus groups highlighted that the course influenced 8 domains of professional identity: commitment to the profession, critical thinking, goal orientation, mentoring, perception of the profession, socialization, reflection, and self-efficacy. The dissertation of the practice model, in which candidates undertake digital projects within their organizations supported by faculty, largely impacted metacognitive skill acquisition and goal orientation. However, the program also affected participants' values and direction within the wider digital health community. According to the questionnaire, after graduation, 59\% (24/41) of the participants changed roles in search of more prominence within digital leadership, with 46\% (11/24) reporting that the course was a strong determinant of this change. Conclusions: A digital leadership course aimed at providing attendees with the necessary attributes to guide transformation can have a significant impact on professional identity formation. This can create a sense of belonging to a wider health leadership structure and facilitate the attainment of organizational and national digital targets. This effect is diminished by a lack of locoregional support for professional development. ",
doi="10.2196/46740",
url="https://mededu.jmir.org/2024/1/e46740",
url="http://www.ncbi.nlm.nih.gov/pubmed/38381477"
}


@Article{info:doi/10.2196/51980,
author="Sharma, Yashoda
and Saha, Anindita
and Goldsack, C. Jennifer",
title="Defining the Dimensions of Diversity to Promote Inclusion in the Digital Era of Health Care: A Lexicon",
journal="JMIR Public Health Surveill",
year="2024",
month="Feb",
day="9",
volume="10",
pages="e51980",
keywords="digital medicine",
keywords="inclusion",
keywords="digital health technology/product",
keywords="digital health",
keywords="digital technology",
keywords="health care system",
keywords="innovation",
keywords="equity",
keywords="quality",
keywords="disparity",
keywords="digital era",
keywords="digital access",
keywords="digital literacy",
doi="10.2196/51980",
url="https://publichealth.jmir.org/2024/1/e51980",
url="http://www.ncbi.nlm.nih.gov/pubmed/38335013"
}


@Article{info:doi/10.2196/51851,
author="Abd Kadir, Aziah Nor
and Azzeri, Amirah
and Jaafar, Hafiz
and Mohd Noor, Iqbal Mohd
and Kefeli, Zurina",
title="The Impact of the Ecosystem on Health Literacy Among Rural Communities in Protected Areas: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2024",
month="Jan",
day="29",
volume="13",
pages="e51851",
keywords="ecosystem",
keywords="health literacy",
keywords="protected areas",
keywords="Net-Map",
keywords="quality of life",
keywords="rural communities",
keywords="protocol",
abstract="Background: Protected areas are crucial for the maintenance of human health and well-being. They aim to preserve biodiversity and natural resources to secure various ecosystem services that are beneficial to human health. Their ecological characteristics can influence local health literacy. Typically, communities surrounding protected areas have limited economic opportunities due to restriction policies to protect the ecosystem, resulting in socioeconomic disparities. The local community faces obstacles in gaining access to health care facilities and health information due to these limitations. It is difficult for them to locate, comprehend, and apply information and services to make better health-related decisions for themselves and others. Objective: This study protocol examines the impact of the ecosystem on health literacy among rural communities in protected areas. Methods: This study comprises 5 phases. In phase 1, we conduct a systematic review to identify the issue of health literacy in protected areas. In phase 2, we will collect data from stakeholders in a protected area of Pahang National Park and analyze the results using Net-Map analysis. In phase 3, we will conduct a survey among the adult community in Pahang National Park related to health literacy, socioeconomic status, health expenditure, and quality of life. In phase 4, informed by the results of the survey, we will determine suitable intervention programs to improve health literacy through a focus group discussion. Finally, in phase 5, we will conduct a costing analysis to analyze which intervention program is the most cost-effective. Results: This study was funded by Universiti Sains Islam Malaysia (USIM) and strategic research partnership grants, and enrollment is ongoing. The first results are expected to be submitted for publication in 2024. Conclusions: This is one of the first studies to explore health literacy among rural communities in protected areas and will provide the first insights into the overall level of health literacy in the protected community, potential determinants, and a suitable intervention program with expected cost analysis. The results can be used to promote health literacy in other protected areas and populations. Trial Registration: International Standard Randomized Controlled Trial Number Registry ISRCTN40626062; http://tinyurl.com/4kjxuwk5 International Registered Report Identifier (IRRID): PRR1-10.2196/51851 ",
doi="10.2196/51851",
url="https://www.researchprotocols.org/2024/1/e51851",
url="http://www.ncbi.nlm.nih.gov/pubmed/38285500"
}


@Article{info:doi/10.2196/42462,
author="Thomson, Patrick
and Stoler, Justin
and Byford, Michelle
and Bradley, J. David",
title="The Impact of Rapid Handpump Repairs on Diarrhea Morbidity in Children: Cross-Sectional Study in Kwale County, Kenya",
journal="JMIR Public Health Surveill",
year="2024",
month="Jan",
day="16",
volume="10",
pages="e42462",
keywords="water",
keywords="Kenya",
keywords="WASH",
keywords="water, sanitation, and hygiene",
keywords="maintenance",
keywords="diarrhea",
keywords="diarrhoea",
keywords="SDG 6",
keywords="service provision",
keywords="handpump",
keywords="child health",
abstract="Background: Handpumps are used by millions of people as their main source of water. Although handpumps represent only a basic form of water provision, there have been continuous efforts to improve the performance of these systems as they are likely to remain in use for many years to come. The introduction of a professional maintenance service in southern Kenya has shown an order of magnitude improvement in operational performance over community-based management, with 90\% of handpump faults repaired within 3 days of being reported. One driver behind these efforts is the assumption that a more reliable water supply will lead to a reduction in water-related disease. However, it is not clear if operational improvements lead to health gains. Despite limited empirical evidence, some modeling studies suggest that even short periods of drinking contaminated water can lead to disproportionate negative health impacts. Objective: The aim of this study was to assess whether the improvements in operational performance from the rapid professional maintenance of rural handpumps lead to improved household health outcomes. Methods: From a sample of households using handpumps as their primary water source in Kwale County, Kenya, we measured the 2-week prevalence of World Health Organization--defined diarrhea in children, reported by the adult respondent for each household. We compared the rates before and after a period during which the households' handpumps were being professionally maintained. We then conducted a cross-sectional analysis, fitting logistic regression models with reported diarrhea as the dependent variable and speed of repair as the independent exposure of interest, adjusting for household socioeconomic characteristics; dwelling construction; and Water, Sanitation, and Hygiene (WASH)-related factors. We fitted an additional model to examine select interactions between covariates. Results: Reported diarrhea in children was lower in households whose pumps had been repaired within 24 hours (adjusted odds ratio 0.35, 95\% CI 0.24-0.51). This effect was robust to the inclusion of multiple categories of covariates. No reduction was seen in households whose pump repairs took more than 24 hours. Analysis of interaction terms showed that certain interventions associated with improved WASH outcomes were only associated with reductions in diarrhea in conjunction with socioeconomic improvements. Conclusions: Only pump repairs consistently made within 24 hours of failure led to a reduction in diarrhea in the children of families using handpumps. While the efficacy of reduction in diarrhea is substantial, the operational challenges of guaranteeing same-day repairs limits the effectiveness of even best-in-class pump maintenance. Maintenance regimes that cannot bring handpump downtimes close to zero will struggle to generate health benefits. Other factors that reduce diarrhea prevalence have limited effect in isolation, suggesting that WASH interventions will be more effective when undertaken as part of more holistic poverty-reduction efforts. ",
doi="10.2196/42462",
url="https://publichealth.jmir.org/2024/1/e42462",
url="http://www.ncbi.nlm.nih.gov/pubmed/38227359"
}


@Article{info:doi/10.2196/50379,
author="Galvez-Hernandez, Pablo
and Gonzalez-Viana, Angelina
and Gonzalez-de Paz, Luis
and Shankardass, Ketan
and Muntaner, Carles",
title="Generating Contextual Variables From Web-Based Data for Health Research: Tutorial on Web Scraping, Text Mining, and Spatial Overlay Analysis",
journal="JMIR Public Health Surveill",
year="2024",
month="Jan",
day="8",
volume="10",
pages="e50379",
keywords="web scraping",
keywords="text mining",
keywords="spatial overlay analysis",
keywords="program evaluation",
keywords="social environment",
keywords="contextual variables",
keywords="health assets",
keywords="social connection",
keywords="multilevel analysis",
keywords="health services research",
abstract="Background: Contextual variables that capture the characteristics of delimited geographic or jurisdictional areas are vital for health and social research. However, obtaining data sets with contextual-level data can be challenging in the absence of monitoring systems or public census data. Objective: We describe and implement an 8-step method that combines web scraping, text mining, and spatial overlay analysis (WeTMS) to transform extensive text data from government websites into analyzable data sets containing contextual data for jurisdictional areas. Methods: This tutorial describes the method and provides resources for its application by health and social researchers. We used this method to create data sets of health assets aimed at enhancing older adults' social connections (eg, activities and resources such as walking groups and senior clubs) across the 374 health jurisdictions in Catalonia from 2015 to 2022. These assets are registered on a web-based government platform by local stakeholders from various health and nonhealth organizations as part of a national public health program. Steps 1 to 3 involved defining the variables of interest, identifying data sources, and using Python to extract information from 50,000 websites linked to the platform. Steps 4 to 6 comprised preprocessing the scraped text, defining new variables to classify health assets based on social connection constructs, analyzing word frequencies in titles and descriptions of the assets, creating topic-specific dictionaries, implementing a rule-based classifier in R, and verifying the results. Steps 7 and 8 integrate the spatial overlay analysis to determine the geographic location of each asset. We conducted a descriptive analysis of the data sets to report the characteristics of the assets identified and the patterns of asset registrations across areas. Results: We identified and extracted data from 17,305 websites describing health assets. The titles and descriptions of the activities and resources contained 12,560 and 7301 unique words, respectively. After applying our classifier and spatial analysis algorithm, we generated 2 data sets containing 9546 health assets (5022 activities and 4524 resources) with the potential to enhance social connections among older adults. Stakeholders from 318 health jurisdictions registered identified assets on the platform between July 2015 and December 2022. The agreement rate between the classification algorithm and verified data sets ranged from 62.02\% to 99.47\% across variables. Leisure and skill development activities were the most prevalent (1844/5022, 36.72\%). Leisure and cultural associations, such as social clubs for older adults, were the most common resources (878/4524, 19.41\%). Health asset registration varied across areas, ranging between 0 and 263 activities and 0 and 265 resources. Conclusions: The sequential use of WeTMS offers a robust method for generating data sets containing contextual-level variables from internet text data. This study can guide health and social researchers in efficiently generating ready-to-analyze data sets containing contextual variables. ",
doi="10.2196/50379",
url="https://publichealth.jmir.org/2024/1/e50379",
url="http://www.ncbi.nlm.nih.gov/pubmed/38190245"
}


@Article{info:doi/10.2196/52938,
author="Jinah, Norehan
and Abdullah Sharin, Ili
and Bakit, Pangie
and Adnan, Khirman Izzuan
and Lee, Yun Kun",
title="Overview of Retention Strategies for Medical Doctors in Low- and Middle-Income Countries and Their Effectiveness: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2024",
month="Jan",
day="8",
volume="13",
pages="e52938",
keywords="health care workforce",
keywords="retention strategies",
keywords="medical doctors",
keywords="low-income and middle-income countries",
keywords="scoping review",
abstract="Background: The global shortage and maldistribution of health care workers, especially medical doctors, pose a significant threat to achieving the United Nations' sustainable development goal 3 of ensuring well-being and healthy lives for all. Low- and middle-income countries (LMICs) are disproportionately affected by this crisis, with a high rate of brain drain from rural to urban areas, as well as to high-income countries. Various retention strategies have been implemented in different settings and organizations. However, their effectiveness remains underexplored, particularly in LMICs. Objective: We aim to review the available retention strategies for medical doctors in LMICs and to determine the effectiveness of the various strategies. This review aims to compile relevant research findings on this issue to generate a thorough summary of all the retention strategies practiced in LMICs and, more importantly, to provide the current state of evidence of the effectiveness of these strategies in retaining medical doctors in countries with limited resources and high disease burden. Methods: The structured framework given by Arksey and O'Malley will serve as the basis for conducting this scoping review. A comprehensive search strategy will be conducted across 4 electronic databases (PubMed, EBSCOHost, Scopus, and ScienceDirect). A systematic approach following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines will be executed to search, screen, review, and extract data from studies that meet predefined inclusion criteria. Data encompassing bibliographical information, study location, retention strategies, influencing factors, and outcomes (effectiveness) will be obtained from the selected studies using standardized data extraction. Endnote and Microsoft Excel will be used for reference management and removal of duplicate studies. A narrative synthesis will be performed after categorizing and analyzing all the extracted data to identify recurrent themes. Results: This ongoing review will generate a comprehensive compilation of retention strategies implemented in LMICs to prevent brain drain among medical doctors. Data extraction is currently in progress, and completion is expected by early 2024. Themes regarding the types of strategies, influencing factors, and outcomes will be synthesized. The findings will highlight effective retention strategies, gaps, and challenges in implementation for the benefits of future research. By identifying common barriers and facilitators, this review will provide insights into enhancing the policies and initiatives for doctor retention in LMICs. Conclusions: This scoping review explores the retention strategies practiced in LMICs and attempts to identify effective strategies from existing research. By evaluating the barriers and challenges that influence the effectiveness of these strategies, policymakers and health care leaders can strive to obtain balanced and optimal health human resources in their respective organizations and countries. Trial Registration: Malaysian National Medical Research Register (NMRR) ID-23-01994-OGW; https://nmrr.gov.my/research-directory/ac4f5b88-8619-4b2b-b6c7-9abcef65fdcd International Registered Report Identifier (IRRID): DERR1-10.2196/52938 ",
doi="10.2196/52938",
url="https://www.researchprotocols.org/2024/1/e52938",
url="http://www.ncbi.nlm.nih.gov/pubmed/38190235"
}


@Article{info:doi/10.2196/50654,
author="Anderson, Elizabeth
and Goins, Turner R.
and Haozous, A. Emily
and Schweinhart, April",
title="Testing a Culturally Tailored Advance Care Planning Intervention (MY WAY) for an American Indian Tribe: Protocol for a Quasi-Experimental Waitlist Control Design",
journal="JMIR Res Protoc",
year="2023",
month="Dec",
day="29",
volume="12",
pages="e50654",
keywords="American Indian or Alaskan Native",
keywords="advance care planning",
keywords="end-of-life care",
abstract="Background: American Indian and Alaska Native peoples experience poor end-of-life care, including more hospitalizations and lower use of hospice and do-not-resuscitate orders. Although advance care planning (ACP) can improve end-of-life care, ACP rates are disproportionately low in American Indians and Alaska Natives. Objective: We culturally tailored and delivered an existing evidence-based ACP program for an American Indian tribal community. Here, we present the protocol for assessing the intervention's feasibility and efficacy. Methods: We measured feasibility via participant recruitment, participants' evaluation (acceptability, appropriateness, comprehension, and satisfaction), and intervention fidelity. Recruitment was measured with participant screening, eligibility, enrollment, and retention. Participant's evaluation of the intervention was measured with surveys. Fidelity was measured with direct observation and the Make Your Wishes About You (MY WAY) Fidelity Checklist Tool. To assess the intervention's efficacy, we used a quasi-experimental waitlist control design with 2 cohorts who were surveyed each on three separate occasions. The intervention's efficacy was assessed by the following: ACP barriers and facilitators as well as ACP self-efficacy, readiness, and completion. Results: A total of 166 participants were screened for eligibility; 11 were deemed ineligible, and 155 participants were enrolled in the study. Of those enrolled, 113 completed the intervention and will be included in subsequent analyses. We finalized data collection in January 2023, and analyses are underway. Study enrollment was successful, and we expect that participants will report high levels of acceptability, appropriateness, comprehension, and satisfaction with the intervention. We expect that the intervention was implemented with fidelity and will demonstrate decreases in ACP barriers and increases in ACP facilitators, self-efficacy, readiness, and completion. Conclusions: Enrolling over twice as many participants as we had hoped suggests that members of this tribal community are willing to engage in end-of-life ACP. We were able to implement a waitlist study design to show that a culturally tailored ACP program for a tribal community is feasible. Trial Registration: ClinicalTrials.gov NCT05304117; https://clinicaltrials.gov/study/NCT05304117 International Registered Report Identifier (IRRID): DERR1-10.2196/50654 ",
doi="10.2196/50654",
url="https://www.researchprotocols.org/2023/1/e50654",
url="http://www.ncbi.nlm.nih.gov/pubmed/38157237"
}


@Article{info:doi/10.2196/49349,
author="Young, Karen
and Xiong, Ting
and Lee, Rachel
and Banerjee, Tina Ananya
and Leslie, Myles
and Ko, Yu Wellam
and Guo, Jia Julia Yu
and Pham, Quynh",
title="Honoring the Care Experiences of Chinese Canadian Survivors of Prostate Cancer to Cultivate Cultural Safety and Relationality in Digital Health: Exploratory-Descriptive Qualitative Study",
journal="J Med Internet Res",
year="2023",
month="Dec",
day="28",
volume="25",
pages="e49349",
keywords="digital health",
keywords="virtual care",
keywords="digital therapeutics",
keywords="prostate cancer",
keywords="cancer survivorship",
keywords="social determinants of health",
keywords="structural determinants of health",
keywords="supportive care",
keywords="cultural adaptation",
keywords="Chinese Canadians",
abstract="Background: Prostate cancer (PCa) is the most commonly diagnosed nonskin cancer for Canadian men and has one of the highest 5-year survival rates, straining systems to provide care. Virtual care can be one way to relieve this strain, but survivors' care needs and technology use are influenced by intersecting social and cultural structures. Cultural adaptation has been posited as an effective method to tailor existing interventions to better serve racialized communities, including Chinese men. However, cultural adaptations may inadvertently draw attention away from addressing structural inequities. Objective: This study used qualitative methods to (1) explore the perceptions and experiences of Chinese Canadian PCa survivors with follow-up and virtual care, and (2) identify implications for the cultural adaptation of a PCa follow-up care app, the Ned (no evidence of disease) Clinic. Methods: An axiology of relational accountability and a relational paradigm underpinned our phenomenologically informed exploratory-descriptive qualitative study design. A community-based participatory approach was used, informed by cultural safety and user-centered design principles, to invite Chinese Canadian PCa survivors and their caregivers to share their stories. Data were inductively analyzed to explore their unmet needs, common experiences, and levels of digital literacy. Results: Unmet needs and technology preferences were similar to broader trends within the wider community of PCa survivors. However, participants indicated that they felt uncomfortable, unable to, or ignored when expressing their needs. Responses spoke to a sense of isolation and reflected a reliance on culturally informed coping mechanisms, such as ``eating bitterness,'' and familial assistance to overcome systemic barriers and gaps in care. Moreover, virtual care was viewed as ``better than nothing;'' it did not change a perceived lack of focus on improving quality of life or care continuity in survivorship care. Systemic changes were identified as likely to be more effective in improving care delivery and well-being rather than the cultural adaptation of Ned for Chinese Canadians. Participants' desires for care reflected accessibility issues that were not culturally specific to Chinese Canadians. Conclusions: Chinese Canadian survivors are seeking to strengthen their connections in a health care system that provides privacy and accessibility, protects relationality, and promotes transparency, accountability, and responsibility. Designing ``trickle-up'' adaptations that address structural inequities and emphasize accessibility, relationality, and privacy may be more effective and efficient at improving care than creating cultural adaptations of interventions. ",
doi="10.2196/49349",
url="https://www.jmir.org/2023/1/e49349",
url="http://www.ncbi.nlm.nih.gov/pubmed/38153784"
}


@Article{info:doi/10.2196/46714,
author="Muschol, Jennifer
and Heinrich, Martin
and Heiss, Christian
and Hernandez, Mauricio Alher
and Knapp, Gero
and Repp, Holger
and Schneider, Henning
and Thormann, Ulrich
and Uhlar, Johanna
and Unzeitig, Kai
and Gissel, Christian",
title="Digitization of Follow-Up Care in Orthopedic and Trauma Surgery With Video Consultations: Health Economic Evaluation Study From a Health Provider's Perspective",
journal="J Med Internet Res",
year="2023",
month="Dec",
day="25",
volume="25",
pages="e46714",
keywords="digital health",
keywords="economic evaluation",
keywords="health economics",
keywords="orthopedic",
keywords="personnel costs",
keywords="productivity gains",
keywords="telemedicine",
keywords="trauma surgery",
keywords="utility",
keywords="video consultations",
abstract="Background: Recommendations for health care digitization as issued with the Riyadh Declaration led to an uptake in telemedicine to cope with the COVID-19 pandemic. Evaluations based on clinical data are needed to support stakeholders' decision-making on the long-term implementation of digital health. Objective: This health economic evaluation aims to provide the first German analysis of the suitability of video consultations in the follow-up care of patients in orthopedic and trauma surgery, investigate the financial impact on hospital operations and personnel costs, and provide a basis for decisions on digitizing outpatient care. Methods: We conducted a randomized controlled trial that evaluated video consultations versus face-to-face consultations in the follow-up care of patients in orthopedic and trauma surgery at a German university hospital. We recruited 60 patients who had previously been treated conservatively or surgically for various knee or shoulder injuries. A digital health app and a browser-based software were used to conduct video consultations. The suitability of telemedicine was assessed using the Telemedicine Satisfaction Questionnaire and the EQ-5D-5L questionnaire. Economic analyses included average time spent by physician per consultation, associated personnel costs and capacities for additional treatable patients, and the break-even point for video consultation software fees. Results: After 4 withdrawals in each arm, data from a total of 52 patients (telemedicine group: n=26; control group: n=26) were used for our analyses. In the telemedicine group, 77\% (20/26) of all patients agreed that telemedicine provided for their health care needs, and 69\% (18/26) found telemedicine an acceptable way to receive health care services. In addition, no significant difference was found in the change of patient utility between groups after 3 months (mean 0.02, SD 0.06 vs mean 0.07, SD 0.17; P=.35). Treatment duration was significantly shorter in the intervention group (mean 8.23, SD 4.45 minutes vs mean 10.92, SD 5.58 minutes; P=.02). The use of telemedicine saved 25\% ({\texteuro}2.14 [US \$2.35]/{\texteuro}8.67 [US \$9.53]) in personnel costs and increased the number of treatable patients by 172 annually, assuming 2 hours of video consultations per week. Sensitivity analysis for scaling up video consultations to 10\% of the hospital's outpatient cases resulted in personnel cost savings of {\texteuro}73,056 (US \$ 80,275.39) for a senior physician. A total of 23 video consultations per month were required to recoup the software fees of telemedicine through reduced personnel costs (break-even point ranging from 12-38 in the sensitivity analysis). Conclusions: Our study supports stakeholders' decision-making on the long-term implementation of digital health by demonstrating that video consultations in the follow-up care of patients in orthopedic and trauma surgery result in cost savings and productivity gains for clinics with no negative impact on patient utility. Trial Registration: German Clinical Trials Register DRKS00023445; https://drks.de/search/en/trial/DRKS00023445 ",
doi="10.2196/46714",
url="https://www.jmir.org/2023/1/e46714",
url="http://www.ncbi.nlm.nih.gov/pubmed/38145481"
}


@Article{info:doi/10.2196/46490,
author="Doreswamy, Nandini
and Horstmanshof, Louise",
title="Attributes That Influence Human Decision-Making in Complex Health Services: Scoping Review",
journal="JMIR Hum Factors",
year="2023",
month="Dec",
day="20",
volume="10",
pages="e46490",
keywords="human attributes",
keywords="human decision-making",
keywords="rationality",
keywords="rational decision-making",
keywords="health policy",
keywords="health regulation",
keywords="health services",
keywords="",
abstract="Background: Humans currently dominate decision-making in both clinical health services and complex health services such as health policy and health regulation. Many assumptions inherent in health service models today are underpinned by Ramsey's Expected Utility Theory, a prominent theory in the field of economics that is rooted in rationality. Rational, evidence-based metrics currently dominate the culture of decision-making in health policy and regulation. However, as the COVID-19 pandemic has shown, rational metrics alone may not suffice in making better policy and regulatory decisions. There are ethical and moral considerations and other complex factors that cannot be reduced to evidence-based rationality alone. Therefore, this scoping review was undertaken to identify and map the attributes that influence human decision-making in complex health services. Objective: The objective is to identify and map the attributes that influence human decision-making in complex health services that have been reported in the peer-reviewed literature. Methods: This scoping review was designed to answer the following research question: what attributes have been reported in the literature that influence human decision-making in complex health services? A clear, reproducible methodology is provided. It is reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) standards and a recognized framework. As the topic of interest merited broad review to scope and understand literature from a holistic viewpoint, a scoping review of literature was appropriate here. Inclusion and exclusion criteria were developed, and a database search undertaken within 4 search systems---ProQuest, Scopus, PubMed, and Web of Science. Results: The results span 46 years, from 1976 to 2022. A total of 167 papers were identified. After removing duplicates, 81 papers remained. Of these, 77 papers were excluded based on the inclusion and exclusion criteria. The remaining 4 papers were found to be relevant. Citation tracking was undertaken, identifying 4 more relevant papers. Thus, a total of 8 papers were included. These papers were reviewed in detail to identify the human attributes mentioned and count the frequency of mentions. A thematic analysis was conducted to identify the themes. Conclusions: The results highlight key themes that underline the complex and nuanced nature of human decision-making. The results suggest that rationality is entrenched and may influence the lexicon of our thinking about decision-making. The results also highlight the counter narrative of decision-making underpinned by uniquely human attributes. This may have ramifications for decision-making in complex health services today. The review itself takes a rational approach, and the methods used were suited to this. International Registered Report Identifier (IRRID): RR2-10.2196/42353 ",
doi="10.2196/46490",
url="https://humanfactors.jmir.org/2023/1/e46490",
url="http://www.ncbi.nlm.nih.gov/pubmed/38117553"
}


@Article{info:doi/10.2196/48981,
author="Ramjee, Serena
and Mohamedthani, Hanen
and Patel, Umeshkumar Aditya
and Goiriz, Rebeca
and Harwood, A. Catherine
and Osborne, H. Richard
and Cheng, Christina
and Hasan, Zeeshaan-ul",
title="The Effect of Remote Digital Services on Health Care Inequalities Among People Under Long-Term Dermatology Follow-Up: Cross-Sectional Questionnaire Study",
journal="JMIR Dermatol",
year="2023",
month="Dec",
day="8",
volume="6",
pages="e48981",
keywords="dermatology",
keywords="health literacy",
keywords="digital health literacy",
keywords="digital literacy",
keywords="skin",
keywords="chronic",
keywords="cluster analysis",
keywords="innovation",
keywords="eHealth literacy",
keywords="dermatologists",
keywords="telehealth",
keywords="dermatologist",
keywords="telemedicine",
keywords="remote care",
keywords="service",
keywords="services",
keywords="quality improvement",
abstract="Background: Given the expansion of remote digital dermatology services from the National Health Service, particularly during the COVID-19 pandemic, there is a need for methods that identify patients at risk of digital exclusion to guide equitable representation in service co-design processes and tailor remote services to the needs of their patient population. Objective: This quality improvement project aims to inform the redesign of remote services to optimally support the ongoing needs of patients with chronic skin diseases, ensuring that the services are tailored to patients' digital health literacy requirements. Methods: We profiled the digital health literacy of 123 people with chronic skin conditions who require long-term surveillance in 2 specialist clinics (London, United Kingdom) using the Multidimensional Readiness and Enablement Index for Health Technology (READHY) questionnaire alongside the Optimizing Health Literacy and Access (Ophelia) process for hierarchical cluster analysis. Results: The cluster analysis of READHY dimensions in responding participants (n=116) revealed 7 groups with distinct digital and health literacy characteristics. High READHY scores in groups 1 (n=22, 19\%) and 2 (n=20, 17.2\%) represent those who are confident with managing their health and using technology, whereas the lower-scoring groups, 6 (n=4, 3.4\%) and 7 (n=12, 10.3\%), depended on traditional services. Groups 3 (n=27, 23.3\%), 4 (n=23, 19.8\%), and 5 (n=8, 6.9\%) had varying digital skills, access, and engagement, highlighting a population that may benefit from a co-designed dermatology service. Conclusions: By identifying patient groups with distinguishable patterns of digital access and health literacy, our method demonstrates that 63.8\% (n=74) of people attending specialist clinics in our center require support in order to optimize remote follow-up or need an alternative approach. Future efforts should streamline the READHY question profile to improve its practicality and use focus groups to elicit strategies for engaging patients with digital services. ",
doi="10.2196/48981",
url="https://derma.jmir.org/2023/1/e48981",
url="http://www.ncbi.nlm.nih.gov/pubmed/38064259"
}


@Article{info:doi/10.2196/41974,
author="Tacey, Alexander
and Behne, Jack
and Patten, K. Rhiannon
and Ngo, Truc Minh
and Thomas, Rees
and Ancilleri, Jessica
and Bone, Chelsea
and Paredes Castro, Angela
and McCarthy, Helen
and Harkin, Katherine
and Gilmartin-Thomas, FM Julia
and Takla, Amir
and Downie, Calum
and Mulcahy, Jane
and Ball, Michelle
and Sharples, Jenny
and Dash, Sarah
and Lawton, Amy
and Wright, Breanna
and Sleeth, Peter
and Kostecki, Tina
and Sonn, Christopher
and McKenna, J. Michael
and Apostolopoulos, Vasso
and Lane, Rebecca
and Said, M. Catherine
and De Gori, Mary
and McAinch, Andrew
and Tran, Phong
and Levinger, Itamar
and Parker, Alexandra
and Woessner, N. Mary
and Pascoe, Michaela",
title="Development of a Digital Health Intervention to Support Patients on a Waitlist for Orthopedic Specialist Care: Co-Design Study",
journal="JMIR Form Res",
year="2023",
month="Dec",
day="8",
volume="7",
pages="e41974",
keywords="osteoarthritis",
keywords="web intervention",
keywords="eHealth",
keywords="orthopedic waitlist",
keywords="human-centered design",
keywords="self-management",
keywords="knee pain",
keywords="hip pain",
keywords="mobile phone",
abstract="Background: The demand for orthopedic specialist consultations for patients with osteoarthritis in public hospitals is high and continues to grow. Lengthy waiting times are increasingly affecting patients from low socioeconomic and culturally and linguistically diverse backgrounds who are more likely to rely on public health care. Objective: This study aimed to co-design a digital health intervention for patients with OA who are waiting for an orthopedic specialist consultation at a public health service, which is located in local government areas (LGAs) of identified social and economic disadvantage. Methods: The stakeholders involved in the co-design process included the research team; end users (patients); clinicians; academic experts; senior hospital staff; and a research, design, and development agency. The iterative co-design process comprised several key phases, including the collation and refinement of evidence-based information by the research team, with assistance from academic experts. Structured interviews with 16 clinicians (female: n=10, 63\%; male: n=6, 38\%) and 11 end users (age: mean 64.3, SD 7.2 y; female: n=7, 64\%; male: n=4, 36\%) of 1-hour duration were completed to understand the requirements for the intervention. Weekly workshops were held with key stakeholders throughout development. A different cohort of 15 end users (age: mean 61.5, SD 9.7 y; female: n=12, 80\%; male: n=3, 20\%) examined the feasibility of the study during a 2-week testing period. The System Usability Scale was used as the primary measure of intervention feasibility. Results: Overall, 7 content modules were developed and refined over several iterations. Key themes highlighted in the clinician and end user interviews were the diverse characteristics of patients, the hierarchical structure with which patients view health practitioners, the importance of delivering information in multiple formats (written, audio, and visual), and access to patient-centered information as early as possible in the health care journey. All content was translated into Vietnamese, the most widely spoken language following English in the local government areas included in this study. Patients with hip and knee osteoarthritis from culturally and linguistically diverse backgrounds tested the feasibility of the intervention. A mean System Usability Scale score of 82.7 (SD 16) was recorded for the intervention, placing its usability in the excellent category. Conclusions: Through the co-design process, we developed an evidence-based, holistic, and patient-centered digital health intervention. The intervention was specifically designed to be used by patients from diverse backgrounds, including those with low health, digital, and written literacy levels. The effectiveness of the intervention in improving the physical and mental health of patients will be determined by a high-quality randomized controlled trial. ",
doi="10.2196/41974",
url="https://formative.jmir.org/2023/1/e41974",
url="http://www.ncbi.nlm.nih.gov/pubmed/38064257"
}


@Article{info:doi/10.2196/49237,
author="Zhou, Siyu
and Gromala, Diane
and Wang, Leyu",
title="Ethical Challenges of Virtual Reality Technology Interventions for the Vulnerabilities of Patients With Chronic Pain: Exploration of Technician Responsibility",
journal="J Med Internet Res",
year="2023",
month="Dec",
day="4",
volume="25",
pages="e49237",
keywords="patients with chronic pain",
keywords="vulnerability",
keywords="virtual reality interventions",
keywords="ethics",
keywords="responsibility",
keywords="technical developers",
doi="10.2196/49237",
url="https://www.jmir.org/2023/1/e49237",
url="http://www.ncbi.nlm.nih.gov/pubmed/38048153"
}


@Article{info:doi/10.2196/33147,
author="Reston, Elizabeth Riley
and Caskey, J. Fergus
and Hole, Barnaby
and Udayaraj, Udaya
and Weinman, John",
title="CareKnowDo---A Multichannel Digital and Telephone Support Program for People With Chronic Kidney Disease: Feasibility Randomized Controlled Trial",
journal="JMIR Form Res",
year="2023",
month="Nov",
day="23",
volume="7",
pages="e33147",
keywords="kidney disease",
keywords="chronic",
keywords="blood pressure",
keywords="randomized controlled trial",
keywords="telemedicine",
keywords="mobile health",
keywords="mHealth",
keywords="self-management",
keywords="guideline adherence",
keywords="medication adherence",
keywords="illness beliefs",
keywords="medication beliefs",
keywords="health psychology",
keywords="preventative medicine",
keywords="qualitative research",
abstract="Background: Chronic kidney disease (CKD) is a common, progressive condition. Lifestyle changes and antihypertensive medication can slow the progression to end-stage kidney disease, which requires renal replacement therapy. However, adherence to these recommendations is often low. Objective: The aim of CareKnowDo was to assess the feasibility of rolling out a digital self-management support and adherence program integrated with a patient-facing electronic health record, Patient View (PV). Methods: A 2-arm, parallel, individual-level pragmatic feasibility pilot randomized controlled trial was conducted at 2 National Health Service (NHS) sites in the United Kingdom. A total of 61 patients with CKD were randomized 1:1 into 2 groups and provided with either a new, tailored digital and telephone support program (CareKnowDo: 31/61, 51\%) integrated with PV or standard care (PV alone: 30/61, 49\%). Quantitative measures included clinical and psychosocial measures. The primary outcomes were feasibility based: recruitment rate, dropout, and the exploration of associations. Results: Of the 1392 patients screened in local kidney clinics, 269 (19.32\%) met the basic inclusion criteria; the first 22.7\% (61/269) who met the eligibility criteria were recruited to participate in the study. Of the 69 patients, 23 (38\%) patients completed the final 6-month follow-up web-based survey. Reasons for the attrition were explored. A higher belief in the ability of the treatment to control CKD was associated with lower blood pressure at baseline (r=0.52; P=.005), and a higher perceived understanding of CKD at baseline was associated with lower blood pressure at follow-up (r=0.66; P<.001). Beliefs about medicines at baseline were associated with blood pressure at baseline but not at follow-up. This was true for both concerns about medicines (r=0.58; P=.001) and perceived necessity of medicines (r=0.42; P=.03). Conclusions: A tailored digital and nurse call--based program to enhance support for patients with CKD was piloted in 2 NHS sites and found to be feasible and acceptable. However, to maximize the effectiveness of the intervention (and of future trials), consideration should be given to the target audience most likely to benefit, as well as how to help them access the program as quickly and easily as possible. Trial Registration: NHS Health Research Authority, IRAS ID 184206; https://www.hra.nhs.uk/planning-and-improving -research/application-summaries/research-summaries/careknowdo-pilot-version-1/ ",
doi="10.2196/33147",
url="https://formative.jmir.org/2023/1/e33147",
url="http://www.ncbi.nlm.nih.gov/pubmed/37995117"
}


@Article{info:doi/10.2196/45200,
author="Vuohijoki, Anni
and Huusko, Mira
and Ristolainen, Leena
and Hakasaari, Pipsa
and Kautiainen, Hannu
and Leppilahti, Juhana
and Kivivuori, Sanna-Maria
and Hurri, Heikki",
title="The Effects of Quality Assurance System Implementation on Work Well-Being and Patient Safety: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2023",
month="Nov",
day="23",
volume="12",
pages="e45200",
keywords="Joint Commission International",
keywords="health and safety",
keywords="JCI",
keywords="human resource management",
keywords="organizational development",
keywords="quality in health care",
abstract="Background: Systematic monitoring of work atmosphere and patient safety incidents is a necessary part of a quality assurance system, particularly an accredited system like the Joint Commission International (JCI). How the implementation of quality assurance systems affects well-being at work and patient safety is unclear. Evidence shows that accreditation improves workplace atmosphere and well-being. Thus, the assumption that an increase in employees' well-being at work improves patient safety is reasonable. Objective: This study aims to describe the protocol for monitoring the effects of implementing the quality assurance system of JCI at Orton Orthopedic Hospital on employees' well-being (primary outcome) and patient safety (secondary outcome). Methods: Quantitative (questionnaires and register data) and qualitative (semistructured interviews) methods will be used. In addition, quantitative data will be collected from register data. Both quantitative and register data will be analyzed. Register data analysis will be performed using generalized linear models with an appropriate distribution and link function. The study timeline covers the time before, during, and after the start of the accreditation process. The collected data will be used to compare job satisfaction, as a part of the well-being questionnaire, and the development of patient safety during the accreditation process. Results: The results of the quality assurance system implementation illuminate its possible effects on the patient's safety and job satisfaction. The repeatability and internal consistency reliability of the well-being questionnaire will be reported. Data collection will begin in May, 2024. It will be followed by data analysis and the results are expected to be published by 2025. Conclusions: The planned study will contribute to the evaluation of the effects of JCI accreditation in terms of well-being at work and patient safety. International Registered Report Identifier (IRRID): PRR1-10.2196/45200 ",
doi="10.2196/45200",
url="https://www.researchprotocols.org/2023/1/e45200",
url="http://www.ncbi.nlm.nih.gov/pubmed/37995119"
}


@Article{info:doi/10.2196/45624,
author="Padhye, Rashmi
and Sahasrabudhe, D. Shruti
and Orme, W. Mark
and Pina, Ilaria
and Dhamdhere, Dipali
and Borade, Suryakant
and Bhakare, Meenakshi
and Ahmed, Zahira
and Barton, Andy
and Modi, Mahavir
and Malcolm, Dominic
and Salvi, Sundeep
and Singh, J. Sally",
title="Perspectives of Patients With Chronic Respiratory Diseases and Medical Professionals on Pulmonary Rehabilitation in Pune, India: Qualitative Analysis",
journal="JMIR Form Res",
year="2023",
month="Nov",
day="7",
volume="7",
pages="e45624",
keywords="COPD",
keywords="chronic obstructive pulmonary disease",
keywords="asthma",
keywords="patients' suffering",
keywords="self-management",
keywords="digital mode of PR",
keywords="integrating yoga with PR",
keywords="thematic qualitative analysis",
keywords="knowledge about PR",
keywords="barriers to PR",
keywords="chronic respiratory diseases",
keywords="CRD",
keywords="India",
keywords="pulmonary rehabilitation",
keywords="medical professional",
keywords="treatment",
keywords="inhaler",
abstract="Background: Chronic respiratory diseases (CRDs) contribute significantly to morbidity and mortality worldwide and in India. Access to nonpharmacological options, such as pulmonary rehabilitation (PR), are, however, limited. Given the difference between need and availability, exploring PR, specifically remotely delivered PR, in a resource-poor setting, will help inform future work. Objective: This study explored the perceptions, experiences, needs, and challenges of patients with CRDs and the potential of and the need for PR from the perspective of patients as well as medical professionals involved in the referral (doctors) and delivery (physiotherapists) of PR. Methods: In-depth qualitative semistructured interviews were conducted among 20 individuals diagnosed with CRDs and 9 medical professionals. An inductive thematic analysis approach was used as we sought to identify the meanings shared both within and across the 2 participant groups. Results: The 20 patients considered lifestyle choices (smoking and drinking), a lack of physical activity, mental stress, and heredity as the triggering factors for their CRDs. All of them equated the disease with breathlessness and a lack of physical strength, consulting multiple doctors about their physical symptoms. The most commonly cited treatment choice was an inhaler. Most of them believed that yoga and exercise are good self-management strategies, and some were performing yoga postures and breathing exercises, as advised by friends or family members or learned from a televised program or YouTube videos. None of them identified with the term ``pulmonary rehabilitation,'' but many were aware of the exercise component and its benefits. Despite being naive to smartphone technology or having difficulty in reading, most of them were enthusiastic about enrolling in an application-based remotely delivered digital PR program. The 9 medical professionals were, however, reluctant to depend on a PR program delivered entirely online. They recommended that patients with CRDs be supported by their family to use technology, with some time spent with a medical professional during the program. Conclusions: Patients with CRDs in India currently manage their disease with nonguided strategies but are eager to improve and would benefit from a guided PR program to feel better. A home-based PR program, with delivery facilitated by digital solutions, would be welcomed by patients and health care professionals involved in their care, as it would reduce the need for travel, specialist equipment, and setup. However, low digital literacy, low resource availability, and a lack of expertise are of concern to health care professionals. For India, including yoga could be a way of making PR ``culturally congruent'' and more successful. The digital PR intervention should be flexible to individual patient needs and should be complemented with physical sessions and a feedback mechanism for both practitioners as well as patients for better uptake and adherence. ",
doi="10.2196/45624",
url="https://formative.jmir.org/2023/1/e45624",
url="http://www.ncbi.nlm.nih.gov/pubmed/37934558"
}


@Article{info:doi/10.2196/44299,
author="Nazarov, Anthony
and Fikretoglu, Deniz
and Liu, Aihua
and Born, Jennifer
and Michaud, Kathy
and Hendriks, Tonya
and B{\'e}langer, AH St{\'e}phanie
and Do, T. Minh
and Lam, Quan
and Brooks, Brenda
and King, Kristen
and Sudom, Kerry
and Jetly, Rakesh
and Garber, Bryan
and Thompson, Megan",
title="Moral Distress, Mental Health, and Risk and Resilience Factors Among Military Personnel Deployed to Long-Term Care Facilities During the COVID-19 Pandemic: Research Protocol and Participation Metrics",
journal="JMIR Res Protoc",
year="2023",
month="Nov",
day="6",
volume="12",
pages="e44299",
keywords="mental health",
keywords="military",
keywords="Canadian Armed Forces",
keywords="operational organization",
keywords="logistics support",
keywords="health care",
keywords="moral distress",
keywords="moral injury",
keywords="deployment",
keywords="risk factors",
keywords="COVID-19",
keywords="quarantine",
keywords="readiness",
keywords="well-being",
keywords="resilience",
keywords="long-term care facility",
keywords="centre de soins de longue dur{\'e}e",
keywords="survey",
keywords="older adult",
keywords="qualitative interviews",
keywords="quantitative",
abstract="Background: The earliest days of the COVID-19 pandemic in Canada were marked by a significant surge in COVID-19 cases and COVID-19--related deaths among residents of long-term care facilities (LTCFs). As part of Canada's response to the COVID-19 pandemic, Canadian Armed Forces (CAF) personnel were mobilized for an initial emergency domestic deployment to the hardest-hit LTCFs (Operation LASER LTCF) to support the remaining civilian staff in ensuring the continued delivery of care to residents. Akin to what was observed following past CAF international humanitarian missions, there was an expected increased risk of exposure to multiple stressors that may be psychologically traumatic and potentially morally injurious in nature (ie, related to core values, eg, witnessing human suffering). Emerging data from health care workers exposed to the unprecedented medical challenges and dilemmas of the early pandemic stages also indicated that such experiences were associated with increased risk of adverse mental health outcomes. Objective: This study aims to identify and quantify the individual-, group-, and organizational-level risk and resilience factors associated with moral distress, moral injury, and traditional mental health and well-being outcomes of Operation LASER LTCF CAF personnel. This paper aimed to document the methodology, implementation procedures, and participation metrics. Methods: A multimethod research initiative was conducted consisting of 2 primary data collection studies (a quantitative survey and qualitative interviews). The quantitative arm was a complete enumeration survey with web-based, self-report questionnaires administered at 3 time points (3, 6, and 12 mo after deployment). The qualitative arm consisted of individual, web-based interviews with a focus on understanding the nuanced lived experiences of individuals participating in the Operation LASER LTCF deployment. Results: CAF personnel deployed to Operation LASER LTCF (N=2595) were invited to participate in the study. Data collection is now complete. Overall, of the 2595 deployed personnel, 1088 (41.93\%), 582 (22.43\%), and 497 (19.15\%) responded to the survey at time point 1 (3 mo), time point 2 (6 mo), and time point 3 (12 mo) after deployment, respectively. The target sample size for the qualitative interviews was set at approximately 50 considering resourcing and data saturation. Interest in participating in qualitative interviews surpassed expectations, with >200 individuals expressing interest; this allowed for purposive sampling across key characteristics, including gender, rank, Operation LASER LTCF role, and province. In total, 53 interviews were conducted. Conclusions: The data generated through this research have the potential to inform and promote better understanding of the well-being and mental health of Operation LASER LTCF personnel over time; identify general and Operation LASER LTCF--specific risk and protective factors; provide necessary support to the military personnel who served in this mission; and inform preparation and interventions for future missions, especially those more domestic and humanitarian in nature. International Registered Report Identifier (IRRID): DERR1-10.2196/44299 ",
doi="10.2196/44299",
url="https://www.researchprotocols.org/2023/1/e44299",
url="http://www.ncbi.nlm.nih.gov/pubmed/37676877"
}


@Article{info:doi/10.2196/46227,
author="Schwalbe, Daria
and Sodemann, Morten
and Iachina, Maria
and N{\o}rg{\aa}rd, Mertz Bente
and Chodkiewicz, H{\o}y Nina
and Ammentorp, Jette",
title="Causes of Patient Nonattendance at Medical Appointments: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2023",
month="Nov",
day="3",
volume="12",
pages="e46227",
keywords="missed appointments",
keywords="nonattendance",
keywords="hospital appointments",
keywords="Danish health care",
keywords="prevention strategies",
keywords="positive deviance",
keywords="quality of treatment",
keywords="mixed methods",
abstract="Background: Approximately one-third of patient appointments in Danish health care result in failures, leading to patient risk and sizable resource waste. Existing interventions to alleviate no-shows often target the patients. The underlying reason behind these interventions is a view that attendance or nonattendance is solely the patient's problem. However, these interventions often prove to be ineffective and can perpetuate social biases and health inequalities, leaving behind patients who are more vulnerable or disadvantaged (in terms of social, economical, and linguistic factors, etc). A more holistic understanding of no-shows is needed to optimize processes, reduce waste, and support patients who are vulnerable. Objective: This study aims to gain a deep and more comprehensive understanding of the causes, mechanisms, and recurring patterns and elements contributing to nonattendance at Danish hospitals in the Region of Southern Denmark. It emphasizes the patient perspective and analyzes the relational and organizational processes surrounding no-shows in health care. In addition, the study aims to identify effective communicative strategies and organizational processes that can support the development and implementation of successful interventions. Methods: The study uses mixed quantitative-qualitative methods, encompassing 4 analytical projects focusing on nonattendance patterns, patient knowledge and behavior, the management of hospital appointments, and in situ communication. To address the complexity of no-shows in health care, the study incorporates various data sources. The quantitative data sources include the electronic patient records, Danish central registries, Danish National Patient Registry, and Register of Medicinal Product Statistics. Baseline characteristics of patients at different levels are compared using chi-square tests and Kruskal-Wallis tests. The qualitative studies involve observational data, individual semistructured interviews with patients and practitioners, and video recordings of patient consultations. Results: This paper presents the protocol of the study, which was funded by the Novo Nordisk Foundation in July 2022. Recruitment started in February 2023. It is anticipated that the quantitative data analysis will be completed by the end of September 2023, with the qualitative investigation starting in October 2023. The first study findings are anticipated to be available by the end of 2024. Conclusions: The existing studies of nonattendance in Danish health care are inadequate in addressing relational and organizational factors leading to hospital no-shows. Interventions have had limited effect, highlighting the Danish health care system's failure to accommodate patients who are vulnerable. Effective interventions require a qualitative approach and robust ethnographic data to supplement the description and categorization of no-shows at hospitals. Obtaining comprehensive knowledge about the causes of missed patient appointments will yield practical benefits, enhancing the safety, coherence, and quality of treatment in health care. International Registered Report Identifier (IRRID): PRR1-10.2196/46227 ",
doi="10.2196/46227",
url="https://www.researchprotocols.org/2023/1/e46227",
url="http://www.ncbi.nlm.nih.gov/pubmed/37723870"
}


@Article{info:doi/10.2196/48558,
author="Hedges, Joanne
and Hermes Soares, Gustavo
and Cadet-James, Yvonne
and Dodd, Zell
and Cooney, Sinon
and Newman, James
and Mittinty, Murthy
and Kularatna, Sanjeewa
and Larkins, Priscilla
and Zwolak, Roman
and Roberts, Rachel
and Jamieson, Lisa",
title="A Silver Fluoride Intervention to Improve Oral Health Trajectories of Young Indigenous Australians: Protocol for a Cluster Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Nov",
day="2",
volume="12",
pages="e48558",
keywords="clinical trial",
keywords="community",
keywords="dental caries",
keywords="Indigenous Australian",
keywords="intervention",
keywords="silver fluoride intervention",
abstract="Background: Indigenous Australian children and adolescents experience profound levels of preventable dental disease. The application of silver fluoride (AgF) to active dental caries is a noninvasive alternative to traditional dental treatment approaches. There is particular utility among Indigenous children and young people with dental fear, who may not have access to timely or culturally safe dental service provisions. Objective: The aims of this study are to: (1) assess levels of active dental caries among Indigenous children and young people in 6 Australian states and territories; (2) determine if an AgF intervention reduces levels of active disease over 12-24 months; (3) measure the impact of improved oral health on social and emotional well-being (SEWB) and oral health-related quality of life; and (4) calculate the cost-effectiveness of implementing such an initiative. Methods: The study will use a 2-arm, parallel cluster randomized controlled trial design. Approximately 1140 Indigenous children and youth aged between 2 and 18 years will be recruited. Each state or territory will have 2 clusters. The intervention group will receive the AgF intervention at the start of the study, with the delayed intervention group receiving the AgF intervention 12 months after study commencement. The primary outcome will be the arrest of active carious lesions, with arrested caries defined as nonpenetration by a dental probe. Secondary outcomes will include SEWB, oral health-related quality of life, and dental anxiety, with covariates including dental behaviors (brushing and dental visits). Effectiveness measures for the economic evaluation will include the number of children and young people managed in primary oral health care without the need for specialist referral, changes in SEWB, the numbers and types of treatments provided, and caries increments. Results: Participant recruitment will commence in May 2023. The first results are expected to be submitted for publication 1 year after a 24-month follow-up. Conclusions: Our findings have the potential to change the way in which active dental disease among Indigenous children and young people can be managed through the inclusion of specifically tailored AgF applications to improve dental health and SEWB delivered by Indigenous health care workers. Desired impacts include cost savings on expensive dental treatments; improved SEWB, nutrition, social, and learning outcomes; and improved quality of life for both children and young people and their caregivers and the broader Indigenous community. The AgF application could be easily implemented into the training program of Indigenous health workers and yield critical information in the management armamentarium of health and well-being recommendations for Australia's First Peoples. International Registered Report Identifier (IRRID): PRR1-10.2196/48558 ",
doi="10.2196/48558",
url="https://www.researchprotocols.org/2023/1/e48558",
url="http://www.ncbi.nlm.nih.gov/pubmed/37917128"
}


@Article{info:doi/10.2196/50147,
author="Xu, Huan Richard
and Ng, M. Shamay S.
and Luo, Nan
and Dong, Dong
and Zhang, Shuyang",
title="Measurement of Health-Related Quality of Life in Individuals With Rare Diseases in China: Nation-Wide Online Survey",
journal="JMIR Public Health Surveill",
year="2023",
month="Oct",
day="31",
volume="9",
pages="e50147",
keywords="EQ-5D-5L",
keywords="rare disease",
keywords="normative profile",
keywords="utility score",
keywords="caregiver",
abstract="Background: Rare diseases (RDs) affect millions of people worldwide, and these diseases can severely impact the health-related quality of life (HRQoL) of those affected. Despite this, there is a lack of research measuring HRQoL using the EQ-5D-5L, which is one of the most widely used generic preference-based instruments to measure HRQoL in populations living with RDs. Objective: This study aimed to measure HRQoL using the EQ-5D-5L in a large number of patients with various types of RDs in China, and to examine the relationship between respondents' socioeconomic characteristics and preference-based health utility scores. Methods: The data used in this study were obtained from a web-based survey conducted in China. The survey aimed to explore and understand the health and socioeconomic status of patients with RDs in China. We recruited registered and eligible members, including patients or their primary caregivers, from 33 RD patient associations to complete the questionnaires via their internal social networks. HRQoL was measured using the EQ-5D-5L utility score, which was calculated based on an established Chinese value set. Utility scores have been presented based on demographics and disease-related information. Univariate linear regression analysis was used to assess the differences in the EQ-5D-5L utility scores between subgroups. Results: A total of 12,502 respondents completed the questionnaire and provided valid responses, including 6919 self-completed respondents and 5583 proxy-completed respondents. Data from 10,102 participants over the age of 12 years were elicited for analysis. Among patients with RDs, 65.3\% (6599/10,102), 47.5\% (4799/10,102), 47.0\% (4746/10,102), 24.8\% (2506/10,102), and 18.4\% (1855/10,102) reported no problems for ``self-care,'' ``usual activities,'' ``mobility,'' ``pain/discomfort,'' and ``anxiety/depression,'' respectively. A full health state was reported by 6.0\% (413/6902) and 9.2\% (295/3200) of self- and proxy-completed patients, respectively. Among self-completed patients, 69.9\% (4826/6902) and 50.4\% (3478/6902) reported no problems for ``self-care'' and ``usual activities,'' respectively, whereas only 17.7\% (1223/6902) reported problems for ``anxiety/depression.'' Proxy-completed respondents showed a higher proportion of reporting extreme problems than self-completed respondents in all 5 dimensions. The mean utility scores reported by self- and proxy-completed respondents were 0.691 and 0.590, respectively. Different types of caregivers reported different utility scores, and among them, proxy-completed (mother) respondents reported the highest mean utility score. Conclusions: The establishment of a normative profile for RD patients can facilitate patients' adaptation and assess the effectiveness of interventions to improve the HRQoL and well-being of this population. Differences between self- and proxy-completed HRQoL assessed by the EQ-5D-5L have been identified in this study. This finding highlights the importance of incorporating perspectives from both patients and their proxies in clinical practice. Further development of the patient cohort is necessary to assess long-term changes in HRQoL in the RD population. ",
doi="10.2196/50147",
url="https://publichealth.jmir.org/2023/1/e50147",
url="http://www.ncbi.nlm.nih.gov/pubmed/37906229"
}


@Article{info:doi/10.2196/48150,
author="Luo, Zilin
and Dong, Xuesi
and Wang, Chenran
and Cao, Wei
and Zheng, Yadi
and Wu, Zheng
and Xu, Yongjie
and Zhao, Liang
and Wang, Fei
and Li, Jibin
and Ren, Jiansong
and Shi, Jufang
and Chen, Wanqing
and Li, Ni",
title="Association Between Socioeconomic Status and Adherence to Fecal Occult Blood Tests in Colorectal Cancer Screening Programs: Systematic Review and Meta-Analysis of Observational Studies",
journal="JMIR Public Health Surveill",
year="2023",
month="Oct",
day="31",
volume="9",
pages="e48150",
keywords="adherence",
keywords="colorectal cancer",
keywords="fecal occult blood test",
keywords="screening",
keywords="socioeconomic status",
abstract="Background: Screening adherence is important in reducing colorectal cancer (CRC) incidence and mortality. Disparity in CRC screening adherence was observed in populations of different socioeconomic status (SES), but the direction and strength of the association remained unclear. Objective: We aimed to systematically review all the observational studies that have analyzed the association between SES and adherence to organized CRC screening based on fecal occult blood tests. Methods: We systematically reviewed the studies in PubMed, Embase, and Web of Science and reference lists of relevant reviews from the inception of the database up until June 7, 2023. Individual SES, neighborhood SES, and small-area SES were included, while any SES aggregated by geographic areas larger than neighbors were excluded. Studies assessing SES with any index or score combining indicators of income, education, deprivation, poverty, occupation, employment, marital status, cohabitation, and others were included. A random effect model meta-analysis was carried out for pooled odds ratios (ORs) and relative risks for adherence related to SES. Results: Overall, 10 studies, with a total of 3,542,379 participants and an overall adherence rate of 64.9\%, were included. Compared with low SES, high SES was associated with higher adherence (unadjusted OR 1.73, 95\% CI 1.42-2.10; adjusted OR 1.53, 95\% CI 1.28-1.82). In the subgroup of nonindividual-level SES, the adjusted association was significant (OR 1.57, 95\% CI 1.26-1.95). However, the adjusted association was insignificant in the subgroup of individual-level SES (OR 1.46, 95\% CI 0.98-2.17). As for subgroups of the year of print, not only was the unadjusted association significantly stronger in the subgroup of early studies (OR 1.97, 95\% CI 1.59-2.44) than in the subgroup of late studies (OR 1.43, 95\% CI 1.31-1.56), but also the adjusted one was significantly stronger in the early group (OR 1.86, 95\% CI 1.43-2.42) than in the late group (OR 1.26, 95\% CI 1.14-1.39), which was consistent and robust. Despite being statistically insignificant, the strength of the association seemed lower in studies that did not adjust for race and ethnicity (OR 1.31, 95\% CI 1.21-1.43) than the overall estimate (OR 1.53, 95\% CI 1.28-1.82). Conclusions: The higher-SES population had higher adherence to fecal occult blood test--based organized CRC screening. Neighborhood SES, or small-area SES, was more competent than individual SES to be used to assess the association between SES and adherence. The disparity in adherence between the high SES and the low SES narrowed along with the development of interventions and the improvement of organized programs. Race and ethnicity were probably important confounding factors for the association. ",
doi="10.2196/48150",
url="https://publichealth.jmir.org/2023/1/e48150",
url="http://www.ncbi.nlm.nih.gov/pubmed/37906212"
}


@Article{info:doi/10.2196/48855,
author="Crocker, Kaitlyn
and Gnatt, Inge
and Haywood, Darren
and Bhat, Ravi
and Butterfield, Ingrid
and Raveendran Nair Lalitha, Anoop
and Bishop, Ruby
and Castle, J. David
and Jenkins, M. Zoe",
title="Investigating Attraction and Retention of Staff Within Public Mental Health Services in Victoria, Australia: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2023",
month="Oct",
day="31",
volume="12",
pages="e48855",
keywords="mental health personnel",
keywords="career choice",
keywords="recruitment",
keywords="retention, turnover intention",
keywords="public mental health",
keywords="mental health",
keywords="workforce",
keywords="challenges",
keywords="attraction",
keywords="retention of staff",
keywords="staff retention",
keywords="human resources",
keywords="human resourcing",
keywords="HR",
keywords="hire",
keywords="hiring",
keywords="new hire",
keywords="onboarding",
keywords="orientation",
abstract="Background: A large proportion of Australians are affected by mental illness each year, and treatment gaps are well known. To meet current and future demands and enable access to treatment that is safe, effective, and acceptable, a robust and sustainable mental health workforce is required. Factors reported to attract people to work within the mental health sector include aspiring to help others, having an interest in mental health and human behavior, the desire to make a difference and do something worthwhile, personal lived experience, recognition, and value of discipline-specific roles. However, despite the various reasons people enter the public mental health workforce, recruitment and retention continue to be ongoing challenges. To date, there has been limited investigation into understanding which factors are most relevant to the current Victorian workforce. Furthermore, a comparison to health care workers outside of mental health is also needed to better understand the specific needs of staff within the mental health sector. Objective: This study aims to explore factors related to attraction, recruitment, and retention of the public mental health workforce in Victoria, Australia. Methods: The study is a multisite, mixed methods cross-sectional study to be conducted at 4 public hospital services within Victoria, Australia: 2 in metropolitan and 2 in regional or rural locations. Current, previous, and nonmental health workers will be asked to complete a 20-25--minute web-based survey, which is developed based on previous research and offered participation in an optional 30-60--minute semistructured interview to examine personal experiences and perceptions. Both aspects of the project will examine factors related to attraction, recruitment, and retention in the public mental health workforce. Differences between groups (ie, current, past, and nonmental health workers), as well as location, discipline, and health setting will be examined. Regression analyses will be performed to determine the factors most strongly associated with retention (ie, job satisfaction) and turnover intention. Qualitative data will be transcribed verbatim and thematically analyzed to identify common themes. Results: As of May 2023, we enrolled 539 participants in the web-based survey and 27 participants in the qualitative interview. Conclusions: This project seeks to build on current knowledge from within Australia and internationally to understand role and service/system-related issues of attraction, recruitment, and retention specifically within Victoria, Australia. Seeking up-to-date information from across the health workforce may provide factors specific to mental health by illuminating any differences between mental health workers and health care workers outside of mental health. Furthermore, exploring motivators across health care disciplines and locations to enter, stay in, or leave a role in public mental health settings will provide valuable information to support how the sector plans and develops strategies that are fit for purpose. International Registered Report Identifier (IRRID): DERR1-10.2196/48855 ",
doi="10.2196/48855",
url="https://www.researchprotocols.org/2023/1/e48855",
url="http://www.ncbi.nlm.nih.gov/pubmed/37906222"
}


@Article{info:doi/10.2196/51861,
author="Meza-Torres, Bernardo
and Forbes, Anna
and Elson, William
and Kar, Debasish
and Jamie, Gavin
and Hinton, William
and Fan, Xuejuan
and Byford, Rachel
and Feher, Michael
and Whyte, Martin
and Joy, Mark
and de Lusignan, Simon",
title="Hepatitis A Vaccination Coverage Among People With Chronic Liver Disease in England (HEALD): Protocol for a Retrospective Cohort Study",
journal="JMIR Res Protoc",
year="2023",
month="Oct",
day="24",
volume="12",
pages="e51861",
keywords="chronic liver disease",
keywords="computerized",
keywords="data accuracy",
keywords="data extract",
keywords="ethnicity",
keywords="fatty liver disease",
keywords="general practitioner",
keywords="hepatitis A vaccination",
keywords="hepatitis",
keywords="liver disease",
keywords="medical record systems",
keywords="primary care",
keywords="routine data sets",
keywords="Systematized Nomenclature of Medicine",
keywords="vaccination monitoring and surveillance",
keywords="vaccination",
abstract="Background: Hepatitis A outbreaks in the United Kingdom are uncommon. Most people develop mild to moderate symptoms that resolve, without sequelae, within months. However, in high-risk groups, including those with underlying chronic liver disease (CLD), hepatitis A infection can be severe, with a higher risk of mortality and morbidity. The Health Security Agency and the National Institute of Health and Care Excellence recommend preexposure hepatitis A vaccination given in 2 doses to people with CLD, regardless of its cause. There are currently no published reports of vaccination coverage for people with CLD in England or internationally. Objective: This study aims to describe hepatitis A vaccination coverage in adults with CLD in a UK primary care setting and compare liver disease etiology, sociodemographic characteristics, and comorbidities in people who are and are not exposed to the hepatitis A vaccine. Methods: We will conduct a retrospective cohort study with data from the Primary Care Sentinel Cohort of the Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub database, which is nationally representative of the English population. We will include people aged 18 years and older who have been registered in general practices in the Research and Surveillance Centre network and have a record of CLD between January 1, 2012, and December 31, 2022, including those with alcohol-related liver disease, chronic hepatitis B, chronic hepatitis C, nonalcohol fatty liver disease, Wilson disease, hemochromatosis, and autoimmune hepatitis. We will carefully curate variables using the Systematized Nomenclature of Medicine Clinical Terms. We will report the sociodemographic characteristics of those who are vaccinated. These include age, gender, ethnicity, population density, region, socioeconomic status (measured using the index of multiple deprivation), obesity, alcohol consumption, and smoking. Hepatitis A vaccination coverage for 1 and 2 doses will be calculated using an estimate of the CLD population as the denominator. We will analyze the baseline characteristics using descriptive statistics, including measures of dispersion. Pairwise comparisons of case-mix characteristics, comorbidities, and complications will be reported according to vaccination status. A multistate survival model will be fitted to estimate the transition probabilities among four states: (1) diagnosed with CLD, (2) first dose of hepatitis A vaccination, (3) second dose of hepatitis A vaccination, and (4) death. This will identify any potential disparities in how people with CLD get vaccinated. Results: The Research and Surveillance Centre population comprises over 8 million people. The reported incidence of CLD is 20.7 cases per 100,000. International estimates of hepatitis A vaccine coverage vary between 10\% and 50\% in this group. Conclusions: This study will describe the uptake of the hepatitis A vaccine in people with CLD and report any disparities or differences in the characteristics of the vaccinated population. International Registered Report Identifier (IRRID): PRR1-10.2196/51861 ",
doi="10.2196/51861",
url="https://www.researchprotocols.org/2023/1/e51861",
url="http://www.ncbi.nlm.nih.gov/pubmed/37874614"
}


@Article{info:doi/10.2196/45564,
author="Wang, Xijie
and Dong, Bin
and Huang, Feifei
and Zhang, Ji
and He, Rongxin
and Du, Shufa
and Zhang, Jiguo
and Ma, Jun
and Wang, Huijun
and Zhang, Bing
and Liang, Wannian",
title="Temporal Trends in Cardiovascular Health Status Among Chinese School-Aged Children From 1989 to 2018: Multiwave Cross-Sectional Analysis",
journal="JMIR Public Health Surveill",
year="2023",
month="Oct",
day="23",
volume="9",
pages="e45564",
keywords="cardiovascular health",
keywords="school-aged children",
keywords="temporal change",
keywords="China Health and Nutrition Survey",
abstract="Background: Despite the release of updated metrics for Life's Essential 8 (LE8), key indicators for assessing cardiovascular health (CVH) status, there is currently no report on their distribution among Chinese children. Objective: This study aimed to assess the nationwide distribution of CVH in Chinese school-aged children using LE8 scores and analyze temporal changes in these scores over time. Methods: Participants aged 7 to 19 years from 11 waves (between 1989 and 2018) of the China Health and Nutrition Survey were included in this study. LE8 components were grouped into 2 domains of health behaviors (diet, physical activity, nicotine exposure, sleep) and health factors (BMI, blood lipids, blood glucose, blood pressure). Scores of overall CVH and each LE8 metric were calculated individually. Temporal changes were assessed with joint point regression models by rural and urban living residence. The causal relationships between health behaviors and health factors that changed the most over time were built with cross-lagged panel models. Results: A total of 21,921 participants, 52.6\% (n=11,537) of whom were male, who had data for at least 4 CVH components were included in the analysis. The mean age was 13 (SD 3.6) years. The overall CVH score remained stable in most regions, with the lowest found in Shandong from East China, which had a mean between 67 (SD 10.9) and 67.2 (SD 12.4). In contrast, the highest score was found in Guizhou from Southwest China, with a mean between 71.4 (SD 10.8) and 74.3 (SD 10.3). In rural areas, the diet score decreased significantly from 1997 onward with a speed of 0.18 (95\% CI: 0.15-0.21; P<.001) per year, and the BMI score decreased significantly from 2005 onward with a speed of 0.56 (95\% CI 0.44-0.68; P<.001) per year. In urban areas, the diet score decreased from 1994 onward with a speed of 0.03 (95\% CI: 0.001-0.07; P=.04) per year, and the BMI score decreased from 2002 onward with a speed of 0.63 (95\% CI 0.47-0.79; P<.001) per year. The sleep score dropped constantly in both urban and rural areas, with a speed of 0.69 (95\% CI 0.58-0.80; P<.001) and 0.69 (95\% CI: 0.52-0.86; P<.001) per year, respectively. A decline in the diet score led to a decline in the BMI score with a coefficient of 0.190 (95\% CI 0.030-0.351; P=.02), while a decline in the BMI score led to a decline in sleep health with a coefficient of 0.089 (95\% CI 0.010-0.168; P=.03). Conclusions: Chinese school-aged children and adolescents were generally of moderate CVH status, but mutual influences existed between CVH metrics. Dietary interventions should be prioritized for promoting overall CVH in the future. ",
doi="10.2196/45564",
url="https://publichealth.jmir.org/2023/1/e45564",
url="http://www.ncbi.nlm.nih.gov/pubmed/37870895"
}


@Article{info:doi/10.2196/44702,
author="Sapari, Hadita
and Selamat, Ikhsan Mohamad
and Isa, Rodi Mohamad
and Ismail, Rohaida
and Wan Mahiyuddin, Rozita Wan",
title="The Impact of Heat Waves on Health Care Services in Low- or Middle-Income Countries: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2023",
month="Oct",
day="16",
volume="12",
pages="e44702",
keywords="heat wave",
keywords="burden",
keywords="health care service",
keywords="morbidity",
keywords="low- or middle-income countries",
keywords="LMICs",
keywords="mortality",
abstract="Background: Heat waves significantly impact ecosystems and human health, especially that of vulnerable populations, and are associated with increased morbidity and mortality. Besides being directly related to climate-sensitive health outcomes, heat waves have indirectly increased the burden on our health care systems. Although the existing literature examines the impact of heat waves and morbidity, past research has mostly been conducted in high-income countries (HICs), and studies on the impact of heat waves on morbidity in low- or middle-income countries (LMICs) are still scarce. Objective: This paper presents the protocol for a systematic review that aims to provide evidence of the impact of heat waves on health care services in LMICs. Methods: We will identify peer-reviewed studies from 3 online databases, including the Web of Science, PubMed, and SCOPUS, published from January 2002 to April 2023, using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Quality assessment will be conducted using the Navigation Guide checklist. Key search terms include heatwaves, extreme heat, hospitalization, outpatient visit, burden, health services, and morbidity. Results: This systematic review will provide insight into the impact of heat waves on health care services in LMICs, especially on emergency department visits, ambulance call-outs, hospital admissions, outpatient department visits, in-hospital mortality, and health care operational costs. Conclusions: The results of this review are anticipated to help policymakers and key stakeholders obtain a better understanding of the impact of heat waves on health care services and prioritize investments to mitigate the effects of heat waves in LMICs. This entails creating a comprehensive heat wave plan and ensuring that adequate infrastructure, capacity, and human resources are allocated in the health care sector. These measures will undoubtedly contribute to the development of resilience in health care systems and hence protect the health and well-being of individuals and communities. Trial Registration: PROSPERO CRD42022365471; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=365471 International Registered Report Identifier (IRRID): DERR1-10.2196/44702 ",
doi="10.2196/44702",
url="https://www.researchprotocols.org/2023/1/e44702",
url="http://www.ncbi.nlm.nih.gov/pubmed/37843898"
}


@Article{info:doi/10.2196/49731,
author="Hinneburg, Jana
and Zacher, Sandro
and Berger-H{\"o}ger, Birte
and Berger-Th{\"u}rmel, Karin
and Kratzer, Vanessa
and Steckelberg, Anke
and L{\"u}hnen, Julia
and ",
title="Enhancing Transsectoral Interdisciplinary Patient-Centered Care for Patients With Rare Cancers: Protocol for a Mixed Methods Process Evaluation",
journal="JMIR Res Protoc",
year="2023",
month="Oct",
day="12",
volume="12",
pages="e49731",
keywords="process evaluation",
keywords="study protocol",
keywords="logic model",
keywords="complex intervention",
keywords="coordination of care",
keywords="rare cancer",
keywords="mobile phone",
abstract="Background: Rare cancers account for approximately 24\% of all new cancers. The category of rare tumor diseases includes almost 200 different entities. In particular, the treatment of patients with extensive care needs requires cooperation between service providers, both between sectors (outpatient and inpatient) and within sectors (eg, between different medical disciplines). The treatment pathway is associated with a high need for coordination and information sharing between providers. When crossing sectoral boundaries in the German health care system, interface problems between the outpatient and inpatient sectors can lead to gaps in care delivery. The multicomponent program Trans-sectoral Personalised Care Concept for Patients with Rare Cancers aims to optimize transsectoral cooperation and coordination of care to enhance patient involvement and the medical care coordination of patients with rare cancers. Objective: This process evaluation will contribute to answering questions about intervention fidelity and the implementation of transsectoral communication, identifying and describing the intended and nonintended effects of the intervention, and exploring the barriers to and facilitators of the implementation. Methods: We will include patients who participate in the intervention phase; all persons and staff involved in the development and implementation of the intervention (Onco Coach, psychologists, physicians on the contact platform, IT staff, and staff of the Bavarian Association of Statutory Health Insurance Physicians); physicians from the Ludwig-Maximilians-University Hospital Munich and the hospital of the Technical University Munich who are involved in the treatment of patients during the course of the project; and participating office--based hematologists and oncologists. Data collection will be conducted at the beginning, during, and at the end of the intervention using mixed methods. Data will be collected from questionnaires, document analyses, semistructured interviews, and structured observations and will cover different aspects of process evaluation. These include examining the context to explore existing patterns, changes in patterns, attitudes, and interactions; analyzing the implementation of intervention elements; and exploring the complex causal pathways and mediators of the intervention. Qualitative data will be analyzed using thematic analysis. The data will then be combined using between-methods triangulation. Results: This project received funding on March 1, 2022. The intervention phase and recruitment for the process evaluation began on March 1, 2023, and the recruitment is expected to end on September 30, 2025. At the time of protocol submission in June 2023, a total of 8 doctors from hematology and oncology practices were enrolled. Data collection began on March 14, 2023. Conclusions: The Trans-sectoral Personalised Care Concept for Patients with Rare Cancers project is a complex intervention that is to be implemented in an equally complex health care context. The process evaluation will help understand the influence of contextual factors and assess the mechanisms of change. Trial Registration: ISRCTN registry ISRCTN16441179; https://doi.org/10.1186/ISRCTN16441179 International Registered Report Identifier (IRRID): DERR1-10.2196/49731 ",
doi="10.2196/49731",
url="https://www.researchprotocols.org/2023/1/e49731",
url="http://www.ncbi.nlm.nih.gov/pubmed/37824180"
}


@Article{info:doi/10.2196/48097,
author="Layer, Erica
and Slim, Salim
and Mussa, Issa
and Al-Mafazy, Abdul-Wahid
and Besana, R. Giulia V.
and Msellem, Mwinyi
and Fulcher, Isabel
and Hornung, Heiko
and Lampariello, Riccardo",
title="The Journey of Zanzibar's Digitally Enabled Community Health Program to National Scale: Implementation Report",
journal="JMIR Med Inform",
year="2023",
month="Oct",
day="9",
volume="11",
pages="e48097",
keywords="Zanzibar",
keywords="digital health",
keywords="community health",
keywords="health systems strengthening",
keywords="maternal health",
keywords="child health",
keywords="data for decision-making",
keywords="implementation science",
keywords="health systems",
keywords="healthcare infrastructure",
keywords="health care",
keywords="implementation report",
abstract="Background: While high-quality primary health care services can meet 80\%-90\% of health needs over a person's lifetime, this potential is severely hindered in many low-resource countries by a constrained health care system. There is a growing consensus that effectively designed, resourced, and managed community health worker programs are a critical component of a well-functioning primary health system, and digital technology is recognized as an important enabler of health systems transformation. Objective: In this implementation report, we describe the design and rollout of Zanzibar's national, digitally enabled community health program--Jamii ni Afya. Methods: Since 2010, D-tree International has partnered with the Ministry of Health Zanzibar to pilot and generate evidence for a digitally enabled community health program, which was formally adopted and scaled nationally by the government in 2018. Community health workers use a mobile app that guides service delivery and data collection for home-based health services, resulting in comprehensive service delivery, access to real-time data, efficient management of resources, and continuous quality improvement. Results: The Zanzibar government has documented increases in the delivery of health facilities among pregnant women and reductions in stunting among children younger than 5 years since the community health program has scaled. Key success factors included starting with the health challenge and local context rather than the technology, usage of data for decision-making, and extensive collaboration with local and global partners and funders. Lessons learned include the significant time it takes to scale and institutionalize a digital health systems innovation due to the time to generate evidence, change opinions, and build capacity. Conclusions: Jamii ni Afya represents one of the world's first examples of a nationally scaled digitally enabled community health program. This implementation report outlines key successes and lessons learned, which may have applicability to other governments and partners working to sustainably strengthen primary health systems. ",
doi="10.2196/48097",
url="https://medinform.jmir.org/2023/1/e48097",
url="http://www.ncbi.nlm.nih.gov/pubmed/37812488"
}


@Article{info:doi/10.2196/47288,
author="MacPherson, Megan",
title="Immigrant, Refugee, and Indigenous Canadians' Experiences With Virtual Health Care Services: Rapid Review",
journal="JMIR Hum Factors",
year="2023",
month="Oct",
day="9",
volume="10",
pages="e47288",
keywords="delivery of health care",
keywords="emigrants and immigrants",
keywords="health disparate",
keywords="indigenous Canadians",
keywords="minority and vulnerable populations",
keywords="refugees",
keywords="telemedicine",
abstract="Background: The remote, dispersed, and multicultural population of Canada presents unique challenges for health care services. Currently, virtual care solutions are being offered as an innovative solution to improve access to care. Objective: Given the inequities in health care access faced by immigrant, refugee, and Indigenous Canadians, this review aimed to summarize information obtained from original research regarding these people's experiences with virtual care services in Canada. Methods: We conducted a rapid review following published recommendations. MEDLINE and CINAHL were searched for studies relating to virtual care and Canadian immigrants, refugees, or Indigenous peoples. Peer-reviewed articles of any type were included so long as they included information on the experiences of virtual care service delivery in Canada among the abovementioned groups. Results: This review demonstrates an extreme paucity of evidence examining the experiences of immigrant, refugee, and Indigenous groups with virtual care in Canada. Of the 694 publications screened, 8 were included in this review. A total of 2 studies focused on immigrants and refugees in Canada, with the remaining studies focusing on Indigenous communities. Results demonstrate that virtual care is generally accepted within these communities; however, cultural appropriateness or safety and inequitable access to wireless services in certain communities were among the most cited barriers. Conclusions: Little evidence exists outlining immigrants', refugees', and Indigenous peoples' perspectives on the landscape of virtual care in Canada. The development of virtual care programming should take into consideration the barriers, facilitators, and recommendations outlined in this review to improve equitable access. Further, developers should consult with local community members to ensure the appropriateness of services for immigrant, refugee, and Indigenous communities in Canada. ",
doi="10.2196/47288",
url="https://humanfactors.jmir.org/2023/1/e47288",
url="http://www.ncbi.nlm.nih.gov/pubmed/37812489"
}


@Article{info:doi/10.2196/51235,
author="Polusny, A. Melissa
and Marquardt, A. Craig
and Hubbling, Michelle
and Campbell, Hagel Emily
and Arbisi, A. Paul
and Davenport, D. Nicholas
and Lim, O. Kelvin
and Lissek, Shmuel
and Schaefer, D. Jonathan
and Sponheim, R. Scott
and Masten, S. Ann
and Noorbaloochi, Siamak",
title="Adaptation in Young Military Recruits: Protocol for the Advancing Research on Mechanisms of Resilience (ARMOR) Prospective Longitudinal Study",
journal="JMIR Res Protoc",
year="2023",
month="Oct",
day="4",
volume="12",
pages="e51235",
keywords="study protocol",
keywords="military personnel",
keywords="longitudinal studies",
keywords="resilience",
keywords="adaptive behavior",
keywords="stress",
keywords="adversity",
keywords="mechanisms",
keywords="protective factors",
abstract="Background: Military services provide a unique opportunity for studying resilience, a dynamic process of successful adaptation (ie, doing well in terms of functioning and symptoms) in response to significant adversity. Despite the tremendous interest in positive adaptation among military service members, little is known about the processes underlying their resilience. Understanding the neurobiological, cognitive, and social mechanisms underlying adaptive functioning following military stressor exposure is essential for enhancing the resilience of military service members. Objective: The primary objective of the Advancing Research on Mechanisms of Resilience (ARMOR) longitudinal study is to characterize the trajectories of positive adaptation among young military recruits in response to basic combat training (BCT), a well-defined, uniform, and 10-week period of intense stress (aim 1), and identify promotive and protective processes contributing to individual variations in resilience (aim 2). The secondary objective is to investigate the pathways by which neurobehavioral markers of self-regulation assessed using electroencephalography and magnetic resonance imaging contribute to adaptive trajectories (aim 3). Methods: ARMOR is an ongoing, prospective longitudinal cohort study of young military recruits who recently joined the National Guard but have not yet shipped out for BCT. Participants (N=1201) are assessed at 5 time points over the initial >2 years of military service beginning before BCT (baseline) and followed up at 2 weeks and 6, 12, and 18 months after BCT. Participants complete web-based questionnaires assessing vulnerability and protective factors, mental health, and socioemotional functioning at each time point and a battery of neurocognitive tests at time 0. A subset of participants also complete structured diagnostic interviews and additional self-report measures and perform neurobehavioral tasks before and after BCT during electroencephalography sessions and before BCT only during magnetic resonance imaging sessions. Results: This UG3/UH3 project was initially funded in August 2017, with the UG3 pilot work completed at the end of 2018. The UH3 phase of the project was funded in March 2019. Study enrollment for the UH3 phase began on April 14, 2019, and ended on October 16, 2021. A total of 1201 participants are enrolled in the study. Follow-up data collection for the UH3 phase is ongoing and projected to continue through February 2024. We will disseminate the findings through conferences, webinars, open access publications, and communications with participants and stakeholders. Conclusions: The ARMOR study provides a rich data set to identify the predictors and mechanisms of resilient and nonresilient outcomes in the context of military stressors, which are intended to empirically inform the development of prevention and intervention strategies to enhance the resilience of military trainees and potentially other young people facing significant life challenges. International Registered Report Identifier (IRRID): DERR1-10.2196/51235 ",
doi="10.2196/51235",
url="https://www.researchprotocols.org/2023/1/e51235",
url="http://www.ncbi.nlm.nih.gov/pubmed/37792432"
}


@Article{info:doi/10.2196/47556,
author="Xu, Huan Richard
and Chan, Hin Ho
and Shi, Lushaobo
and Li, Ting
and Wang, Dong",
title="Moderating Effect of eHealth Literacy on the Associations of Coronaphobia With Loneliness, Irritability, Depression, and Stigma in Chinese Young Adults: Bayesian Structural Equation Model Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Sep",
day="29",
volume="9",
pages="e47556",
keywords="coronaphobia",
keywords="eHealth literacy",
keywords="Bayesian statistics",
keywords="structural equation modeling",
keywords="mediating effect",
keywords="mental health",
abstract="Background: The COVID-19 pandemic has led to an increase in known risk factors for mental health problems. Although medical information available through the internet and smartphones has greatly expanded, people's ability to seek, eschew, and use reliable web-based medical information and services to promote their mental health remains unknown. Objective: This study aims to explore the associations between coronaphobia and 4 frequently reported mental health problems, loneliness, irritability, depression, and stigma, during the COVID-19 pandemic and to assess the moderating effects of eHealth literacy (eHL) on the adjustment of these relationships in Chinese young adults. Methods: The data used in this study were collected from a web-based survey of the general Chinese population, aged between 18 and 30 years, conducted in China between December 2022 and January 2023. A nonprobability snowball sampling method was used for data collection. A Bayesian structural equation model (BSEM) using parameter expansion was used to estimate the moderating effect of eHL on the relationship between coronaphobia and psychological problems. The posterior mean and 95\% highest density intervals (HDIs) were estimated. Results: A total of 4119 participants completed the questionnaire and provided valid responses. Among them, 64.4\% (n=2653) were female and 58.7\% (n=2417) were rural residents. All measures showed statistically significant but minor-to-moderate associations (correlation coefficients ranged from ?0.04 to 0.65). Significant heterogeneity was observed between rural and urban residents at the eHL level, and coronaphobia was observed. The BSEM results demonstrated that eHL was a significant moderator in reducing the negative effects of coronaphobia on loneliness (posterior mean ?0.0016, 95\% HDI ?0.0022 to ?0.0011), depression (posterior mean ?0.006, 95\% HDI ?0.0079 to ?0.004), stigma (posterior mean ?0.0052, 95\% HDI ?0.0068 to ?0.0036), and irritability (posterior mean ?0.0037, 95\% HDI ?0.0052 to ?0.0022). The moderating effects of eHL varied across the rural and urban subsamples. Conclusions: Using BSEM, this study demonstrated that improving eHL can significantly mitigate the negative effects of coronaphobia on 4 COVID-19--related mental health problems in Chinese young adults. Future eHL initiatives should target rural communities to ensure equal access to information and resources that can help protect their mental health during the pandemic. ",
doi="10.2196/47556",
url="https://publichealth.jmir.org/2023/1/e47556",
url="http://www.ncbi.nlm.nih.gov/pubmed/37773621"
}


@Article{info:doi/10.2196/42450,
author="Mundra, Anuj
and Kalantri, Ashwini
and Jakasania, Arjunkumar
and Sathe, Harshal
and Raut, Abhishek
and Maliye, Chetna
and Bahulekar, Pramod
and Dawale, Ajay
and Paradkar, J. Rameshwar
and Siriah, Sakshi
and Kumar, Satish
and Gupta, S. Subodh
and Garg, Bishan",
title="Vitalizing Community for Health Promotion Against Modifiable Risk Factors of Noncommunicable Diseases (V-CaN) in Rural Central India: Protocol for a Hybrid Type II Implementation Effectiveness Trial",
journal="JMIR Res Protoc",
year="2023",
month="Sep",
day="29",
volume="12",
pages="e42450",
keywords="noncommunicable diseases",
keywords="action research",
keywords="implementation research",
keywords="community-based participatory research",
keywords="salutogenesis",
keywords="primary prevention",
abstract="Background: Low- and middle-income countries are facing the emerging burden of chronic noncommunicable diseases (NCDs). Apart from loss of human lives and premature deaths, NCDs result in huge costs for treatment to individuals and the health system. Although NCDs develop in later life, the risk factors begin at an early age. The key to the control of the global epidemic of NCDs is primary prevention based on comprehensive community-based programs. Objective: This study aims to develop, implement, and evaluate the effect of a participatory health promotion initiative utilizing the existing mechanisms of Village Health Nutrition and Sanitation Committees (VHNSCs), women's self-help groups (SHGs), and schools on modifiable risk factors for NCDs among young people aged 10-30 years. Methods: The proposed type II hybrid effectiveness implementation cluster randomized field trial will be conducted in the catchment area of 4 primary health centers (PHCs) in Wardha district, India, comprising 100 villages with a population of 144,000. Each PHC will be randomly allocated to one of the 3 intervention arms or the control arm. The 3-intervention arm PHCs will utilize a unique strategy with either VHNSC or SHG members or school students as change agents for health action against common modifiable NCD risk factors. This study will be implemented in 3 phases from January 2022 to December 2024. First, the preparatory phase for baseline assessments includes anthropometry, behavioral and biochemical risk factors for NCDs, and participatory development of the health promotion intervention modules. Second, the implementation phase will focus on capacity building of the change agents and implementation of the participatory health promotion initiative. The implementation will include organization of community-based events, 6-monthly participatory assessment of change, and preparation of a sustainability and exit plan toward the end of this phase. Third, the evaluation phase will consist of studying the effectiveness of each intervention strategy in the reduction of risk factor prevalence at the population level. Results: We will assess 12,000 (3000 in each arm) randomly selected individuals for behavioral risk factors and 1600 (400 in each arm) individuals for biochemical risk factors during baseline as well as endline assessments. Difference in differences, ANOVA or multivariate analysis of covariance, and regression analysis will be performed to assess the effectiveness of the interventions. Qualitative methods such as focus group discussions and stories of change will be documented and analyzed using thematic framework analysis. The implementation outcomes will be reported using the PRISM (Practical Robust Implementation and Sustainability Model) RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. The results are expected to be published by mid-2025. Conclusions: This study will show the magnitude of risk factors for NCDs, its determinants, feasibility, effectiveness of community-based interventions, and health promotion models for NCD prevention. Trial Registration: Clinical Trials Registration India CTRI/2020/10/028700; https://ctri.nic.in/Clinicaltrials/showallp.php?mid1=47597\&EncHid=\&userName=V-CaN International Registered Report Identifier (IRRID): DERR1-10.2196/42450 ",
doi="10.2196/42450",
url="https://www.researchprotocols.org/2023/1/e42450",
url="http://www.ncbi.nlm.nih.gov/pubmed/37773622"
}


@Article{info:doi/10.2196/40783,
author="Khan, A. Mohammed
and Thompson, W. William
and Osinubi, Ademola
and Meyer 3rd, A. William
and Kaufman, W. Harvey
and Armstrong, A. Paige
and Foster, A. Monique
and Nelson, P. Noele
and Wester, Carolyn",
title="Testing for Hepatitis C During Pregnancy Among Persons With Medicaid and Commercial Insurance: Cohort Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Sep",
day="27",
volume="9",
pages="e40783",
keywords="hepatitis C",
keywords="testing",
keywords="pregnancy",
keywords="pregnant",
keywords="trend",
keywords="insurance",
keywords="insured",
keywords="HCV",
keywords="hepatitis",
keywords="Medicaid",
keywords="health coverage",
keywords="maternal",
keywords="fetus",
keywords="birth",
keywords="natal",
keywords="maternity",
keywords="liver",
keywords="communicable disease",
keywords="viral infection",
abstract="Background: The reported incidence of acute hepatitis C virus (HCV) infection is increasing among persons of childbearing age in the United States. Infants born to pregnant persons with HCV infection are at risk for perinatal HCV acquisition. In 2020, the United States Preventive Services Task Force and Centers for Disease Control and Prevention recommended that all pregnant persons be screened during each pregnancy for hepatitis C. However, there are limited data on trends in hepatitis C testing during pregnancy. Objective: We estimated hepatitis C testing rates in a large cohort of patients with Medicaid and commercial insurance who gave birth during 2015-2019 and described demographic and risk-based factors associated with testing. Methods: Medicaid and commercial insurance claims for patients aged 15-44 years and who gave birth between 2015 and 2019 were included. Birth claims were identified using procedure and diagnosis codes for vaginal or cesarean delivery. Hepatitis C testing was defined as an insurance claim during the 42 weeks before delivery. Testing rates were calculated among patients who delivered and among the subset of patients who were continuously enrolled for 42 weeks before delivery. We also compared the timing of testing relative to delivery among patients with commercial or Medicaid insurance. Multivariable logistic regression was used to identify factors associated with testing. Results: Among 1,142,770 Medicaid patients and 1,207,132 commercially insured patients, 175,223 (15.3\%) and 221,436 (18.3\%) were tested for hepatitis C during pregnancy, respectively. Testing rates were 89,730 (21.8\%) and 187,819 (21.9\%) among continuously enrolled Medicaid and commercially insured patients, respectively. Rates increased from 2015 through 2019 among Medicaid (from 20,758/108,332, 19.2\% to 13,971/52,330, 26.8\%) and commercially insured patients (from 38,308/211,555, 18.1\% to 39,152/139,972, 28\%), respectively. Among Medicaid patients, non-Hispanic Black (odds ratio 0.73, 95\% CI 0.71-0.74) and Hispanic (odds ratio 0.53, 95\% CI 0.51-0.56) race or ethnicity were associated with lower odds of testing. Opioid use disorder, HIV infection, and high-risk pregnancy were associated with higher odds of testing in both Medicaid and commercially insured patients. Conclusions: Hepatitis C testing during pregnancy increased from 2015 through 2019 among patients with Medicaid and commercial insurance, although tremendous opportunity for improvement remains. Interventions to increase testing among pregnant persons are needed. ",
doi="10.2196/40783",
url="https://publichealth.jmir.org/2023/1/e40783",
url="http://www.ncbi.nlm.nih.gov/pubmed/37756048"
}


@Article{info:doi/10.2196/46473,
author="Forman-Hoffman, L. Valerie
and Pirner, C. Maddison
and Flom, Megan
and Kirvin-Quamme, Andrew
and Durden, Emily
and Kissinger, A. Jennifer
and Robinson, Athena",
title="Engagement, Satisfaction, and Mental Health Outcomes Across Different Residential Subgroup Users of a Digital Mental Health Relational Agent: Exploratory Single-Arm Study",
journal="JMIR Form Res",
year="2023",
month="Sep",
day="27",
volume="7",
pages="e46473",
keywords="adoption",
keywords="anxiety",
keywords="chatbot",
keywords="cognitive behavioral therapy",
keywords="conversational agent",
keywords="CBT",
keywords="depression",
keywords="digital health",
keywords="medically underserved area",
keywords="mental health",
keywords="mhealth",
keywords="mobile app",
keywords="mobile health",
keywords="mobile phone",
keywords="mood",
keywords="psychotherapy",
keywords="relational agent",
keywords="rural",
keywords="satisfaction",
keywords="smartphone app",
keywords="smartphone",
keywords="underserved",
keywords="usage",
keywords="vulnerable",
abstract="Background: Mental illness is a pervasive worldwide public health issue. Residentially vulnerable populations, such as those living in rural medically underserved areas (MUAs) or mental health provider shortage areas (MHPSAs), face unique access barriers to mental health care. Despite the growth of digital mental health interventions using relational agent technology, little is known about their use patterns, efficacy, and favorability among residentially vulnerable populations. Objective: This study aimed to explore differences in app use, therapeutic alliance, mental health outcomes, and satisfaction across residential subgroups (metropolitan, nonmetropolitan, or rural), MUAs (yes or no), and MHPSAs (yes or no) among users of a smartphone-based, digital mental health intervention, Woebot LIFE (WB-LIFE). WB-LIFE was designed to help users better understand and manage their moods and features a relational agent, Woebot, that converses through text-based messages. Methods: We used an exploratory study that examined data from 255 adults enrolled in an 8-week, single-arm trial of WB-LIFE. Analyses compared levels of app use and therapeutic alliance total scores as well as subscales (goal, task, and bond), mental health outcomes (depressive and anxiety symptoms, stress, resilience, and burnout), and program satisfaction across residential subgroups. Results: Few study participants resided in nonmetropolitan (25/255, 10\%) or rural (3/255, 1\%) areas, precluding estimates across this variable. Despite a largely metropolitan sample, nearly 39\% (99/255) resided in an MUA and 55\% (141/255) in an MHPSA. There were no significant differences in app use or satisfaction by MUA or MHPSA status. There also were no differences in depressive symptoms, anxiety, stress, resilience, or burnout, with the exception of MUA participants having higher baseline depressive symptoms among those starting in the moderate range or higher (Patient Health Questionnaire-8 item scale?10) than non-MUA participants (mean 16.50 vs 14.41, respectively; P=.01). Although working alliance scores did not differ by MHPSA status, those who resided in an MUA had higher goal (2-tailed t203.47=2.21; P=.03), and bond (t203.47=1.94; P=.05) scores at day 3 (t192.98=2.15; P=.03), and higher goal scores at week 8 (t186.19=2.28; P=.02) as compared with those not living in an MUA. Conclusions: Despite the study not recruiting many participants from rural or nonmetropolitan populations, sizable proportions resided in an MUA or an MHPSA. Analyses revealed few differences in app use, therapeutic alliance, mental health outcomes (including baseline levels), or satisfaction across MUA or MHPSA status over the 8-week study. Findings suggest that vulnerable residential populations may benefit from using digital agent--guided cognitive behavioral therapy. Trial Registration: ClinicalTrials.gov NCT05672745; https://clinicaltrials.gov/study/NCT05672745 ",
doi="10.2196/46473",
url="https://formative.jmir.org/2023/1/e46473",
url="http://www.ncbi.nlm.nih.gov/pubmed/37756047"
}


@Article{info:doi/10.2196/50085,
author="Belhassen, Manon
and Nolin, Maeva
and Jacoud, Flore
and Marant Micallef, Claire
and Van Ganse, Eric",
title="Trajectories of Controller Therapy Use Before and After Asthma-Related Hospitalization in Children and Adults: Population-Based Retrospective Cohort Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Sep",
day="26",
volume="9",
pages="e50085",
keywords="asthma",
keywords="hospitalization",
keywords="inhaled corticosteroids",
keywords="trajectories",
keywords="quality of care",
keywords="clustering",
abstract="Background: Inappropriate use of inhaled corticosteroids (ICSs) for asthma impairs control and may cause exacerbation, including asthma-related hospitalization (ARH). In prospective studies, ICS use peaked around ARH, but information on routine care use is limited. Since ARH is a major outcome, controller therapy use in routine care before and after ARH should be documented. Objective: This study aimed to distinguish ICS use typologies (trajectories) before and after ARH, and assess their relationships with sociodemographic, disease, and health care characteristics. Methods: A retrospective cohort study was performed using a 1\% random sample of the French claims database. All patients hospitalized for asthma between January 01, 2013, and December 31, 2015, were classified as either children (aged 1-10 years) or teens/adults (aged ?11 years). Health care resource use was assessed between 24 and 12 months before ARH. ICS use was computed with the Continuous Measures of Medication Acquisition-7 (CMA7) for the 4 quarters before and after ARH. Initially, the overall impact of hospitalization on the CMA7 value was studied using a segmented regression analysis in both children and teens/adults. Then, group-based trajectory modeling differentiated the groups with similar ICS use. We tested different models having 2 to 5 distinct trajectory groups before selecting the most appropriate trajectory form. We finally selected the model with the lowest Bayesian Information Criterion, the highest proportion of patients in each group, and the maximum estimated probability of assignment to a specific group. Results: Overall, 863 patients were included in the final study cohort, of which 447 (51.8\%) were children and 416 (48.2\%) were teens/adults. In children, the average CMA7 value was 12.6\% at the start of the observation period, and there was no significant quarter-to-quarter change in the value (P=.14) before hospitalization. Immediately after hospitalization, the average CMA7 value rose by 34.9\% (P=.001), before a significant decrease (P=.01) of 7.0\% per quarter. In teens/adults, the average CMA7 value was 31.0\% at the start, and there was no significant quarter-to-quarter change in the value (P=.08) before hospitalization. Immediately after hospitalization, the average CMA7 value rose by 26.9\% (P=.002), before a significant decrease (P=.01) of 7.0\% per quarter. We identified 3 and 5 trajectories before ARH in children and adults, respectively, and 5 after ARH for both groups. Trajectories were related to sociodemographic characteristics (particularly, markers of social deprivation) and to potentially inappropriate health care, such as medical management and choice of therapy. Conclusions: Although ARH had an overall positive impact on ICS use trajectories, the effect was often transient, and patient behaviors were heterogeneous. Along with overall trends, distinct trajectories were identified, which were related to specific patients and health care characteristics. Our data reinforce the evidence that inappropriate use of ICS paves the way for ARH. ",
doi="10.2196/50085",
url="https://publichealth.jmir.org/2023/1/e50085",
url="http://www.ncbi.nlm.nih.gov/pubmed/37751244"
}


@Article{info:doi/10.2196/48400,
author="Carrier, Annie
and Bolduc, Fran{\c{c}}ois
and Delli-Colli, Nathalie
and Makela, Finn
and Hudon, Anne
and Caty, Marie-Eve
and Duhoux, Arnaud
and Beaudoin, Micha{\"e}l",
title="Fear of Reprisal and Change Agency in the Public Health and Social Service System: Protocol for a Sequential Mixed Methods Study",
journal="JMIR Res Protoc",
year="2023",
month="Sep",
day="21",
volume="12",
pages="e48400",
keywords="change agency",
keywords="fear",
keywords="professional practice",
keywords="retaliation",
keywords="social justice",
abstract="Background: ?Since they are key witnesses to the systemic difficulties and social inequities experienced by vulnerable patients, health and social service (HSS) professionals and clinical managers must act as change agents. Using their expertise to achieve greater social justice, change agents employ a wide range of actions that span a continuum from the clinical (microsystem) to the societal (macrosystem) sphere and involve actors inside and outside the HSS system. Typically, however, clinical professionals and managers act in a circumscribed manner, that is, within the clinical sphere and with patients and colleagues. Among the hypotheses explaining this reduced scope of action is the fear of reprisal. Little is known about the prevalence of this fear and its complex dynamics. Objective: ?The overall aim is to gain a better understanding of the complex dynamic process leading to clinical professionals' and managers' fear of reprisal in their change agent actions and senior administrators' and managers' determination of wrongdoing. The objectives are (1) to estimate the prevalence of fear of reprisal among clinical professionals and managers; (2) to identify the factors involved in (a) the emergence of this fear among clinical professionals and managers, and (b) the determination of wrongdoing by senior administrators and managers; (3) to describe the process of emergence of (a) the fear of reprisal among clinical professionals and managers, and (b) the determination of wrongdoing by senior administrators and managers; and (4) to document the legal and ethical issues associated with the factors identified (objective 2) and the processes described (objective 3). Methods: ?Based on the Exit, Voice, Loyalty, Neglect model, a 3-part sequential mixed methods design will include (1) a web-based survey (objective 1), (2) a qualitative grounded theory design (objectives 2 and 3), and (3) legal and ethical analysis (objective 4). Survey: 77,794 clinical professionals or clinical managers working in the Qu{\'e}bec public HSS system will be contacted via email. Data will be analyzed using descriptive statistics. Grounded theory design: for each of the 3 types of participants (clinical professionals, clinical managers, and senior administrators and managers), a theoretical sample of 15 to 30 people will be selected via various strategies. Data will be independently analyzed using constant comparison process. Legal and ethical analysis: situations described by participants will be analyzed using, respectively, applicable legislation and jurisprudence and 2 ethical models. Results: ?This ongoing study began in June 2022 and is scheduled for completion by March 2027. Conclusions: ?Instead of acting, fear of reprisal could induce clinical professionals to tolerate situations that run counter to their social justice values. To ensure they use their capacities for serving a population that is or could become vulnerable, it is important to know the prevalence of the fear of reprisal and gain a better understanding of its complex dynamics. International Registered Report Identifier (IRRID): PRR1-10.2196/48400 ",
doi="10.2196/48400",
url="https://www.researchprotocols.org/2023/1/e48400",
url="http://www.ncbi.nlm.nih.gov/pubmed/37733408"
}


@Article{info:doi/10.2196/49968,
author="Zhang, Yanting
and Rumgay, Harriet
and Li, Mengmeng
and Cao, Sumei
and Chen, Wanqing",
title="Nasopharyngeal Cancer Incidence and Mortality in 185 Countries in 2020 and the Projected Burden in 2040: Population-Based Global Epidemiological Profiling",
journal="JMIR Public Health Surveill",
year="2023",
month="Sep",
day="20",
volume="9",
pages="e49968",
keywords="nasopharyngeal cancer",
keywords="incidence",
keywords="mortality",
keywords="epidemiology",
keywords="worldwide",
abstract="Background: Nasopharyngeal cancer (NPC) is one of the most common head and neck cancers. Objective: This study describes the global epidemiological profiles of NPC incidence and mortality in 185 countries in 2020 and the projected burden in 2040. Methods: The estimated numbers of NPC cases and deaths were retrieved from the GLOBOCAN 2020 data set. Age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs) were calculated using the world standard. The future number of NPC cases and deaths by 2040 were estimated based on global demographic projections. Results: Globally, approximately 133,354 cases and 80,008 deaths from NPC were estimated in 2020 corresponding to ASIRs and ASMRs of 1.5 and 0.9 per 100,000 person-years, respectively. The largest numbers of both global cases and deaths from NPC occurred in Eastern Asia (65,866/133,354, 49.39\% and 36,453/80,008, 45.56\%, respectively), in which China contributed most to this burden (62,444/133,354, 46.82\% and 34,810/80,008, 43.50\%, respectively). The ASIRs and ASMRs in men were approximately 3-fold higher than those in women. Incidence rates varied across world regions, with the highest ASIRs for both men and women detected in South-Eastern Asia (7.7 and 2.5 per 100,000 person-years, respectively) and Eastern Asia (3.9 and 1.5 per 100,000 person-years, respectively). The highest ASMRs for both men and women were found in South-Eastern Asia (5.4 and 1.5 per 100,000 person-years, respectively). By 2040, the annual number of cases and deaths will increase to 179,476 (46,122/133,354, a 34.58\% increase from the year 2020) and 113,851 (33,843/80,008, a 42.29\% increase), respectively. Conclusions: Disparities in NPC incidence and mortality persist worldwide. Our study highlights the urgent need to develop and accelerate NPC control initiatives to tackle the NPC burden in certain regions and countries (eg, South-Eastern Asia, China). ",
doi="10.2196/49968",
url="https://publichealth.jmir.org/2023/1/e49968",
url="http://www.ncbi.nlm.nih.gov/pubmed/37728964"
}


@Article{info:doi/10.2196/46690,
author="Gaetz, Stephen
and Bonakdar, Ahmad
and Ecker, John
and MacDonald, Cora
and Ilyniak, Sophia
and Ward, Ashley
and Kimura, Lauren
and Vijayaratnam, Aranie
and Banchani, Emmanuel",
title="Evaluating the Effectiveness of the Housing First for Youth Intervention for Youth Experiencing Homelessness in Canada: Protocol for a Multisite, Mixed Methods Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Sep",
day="19",
volume="12",
pages="e46690",
keywords="youth homelessness",
keywords="Housing First for Youth",
keywords="Canada",
keywords="randomized controlled trial",
keywords="RCT",
keywords="Making the Shift",
abstract="Background: Emerging evidence at the international level suggests that the Housing First approach could improve the housing stability of young people experiencing homelessness. However, there is a dearth of literature in Canada on whether the Housing First intervention for young people experiencing homelessness can improve outcomes including housing stability, health and well-being, and access to complementary supports. Adapted from the original Housing First model, Housing First for Youth (HF4Y) was developed in Canada as a rights-based approach tailored specifically for young people aged 16 to 24 years who are experiencing or are at risk of homelessness. Objective: The Making the Shift Youth Homelessness Social Innovation Lab is testing the effectiveness of the HF4Y intervention in Canada. The objective of this study is to determine whether the HF4Y model results in better participant-level outcomes than treatment-as-usual services for young people experiencing homelessness in 2 urban settings: Ottawa and Toronto, Ontario. Primary outcomes include housing stability, health and well-being, and complementary supports, and secondary outcomes include employment and educational attainment and social inclusion. Methods: The HF4Y study used a multisite, mixed methods, randomized controlled trial research approach for data collection and analysis. Eligible participants included young people aged 16 to 24 years who were experiencing homelessness or housing precarity. The participants were randomly assigned to either the treatment-as-usual group or the housing first intervention group. Survey and interview data in Ottawa and Toronto, Ontario are being collected at multiple time points (3-6 months) over 4 years to capture a range of outcomes. Analytic strategies for quantitative data will include mixed-effects modeling for repeated measures and logistic models. A thematic analysis will be used to analyze qualitative data based on participants' narratives and life journeys through homelessness. Furthermore, program fidelity evaluations are conducted within each HF4Y program. These evaluations assess how well the intervention aligns with the HF4Y model and identify any areas that may require adjustments or additional support. Results: The HF4Y study has received human participant research ethics approval from the Office of Research Ethics at York University. Recruitment was conducted between February 2018 and March 2020. Data collection is expected to be completed at both sites by March 2024. A preliminary analysis of the quantitative and qualitative data collected between baseline and 24 months is underway. Conclusions: This pilot randomized controlled trial is the first to test the effectiveness of the HF4Y intervention in Canada. The findings of this study will enhance our understanding of how to effectively deliver and scale up the HF4Y intervention, with the aim of continually improving the HF4Y model to promote better outcomes for youth. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) ISRCTN10505930; https://www.isrctn.com/ISRCTN10505930 International Registered Report Identifier (IRRID): DERR1-10.2196/46690 ",
doi="10.2196/46690",
url="https://www.researchprotocols.org/2023/1/e46690",
url="http://www.ncbi.nlm.nih.gov/pubmed/37725430"
}


@Article{info:doi/10.2196/47047,
author="Ward, M. Marcia
and Ullrich, Fred
and Bhagianadh, Divya
and Nelson, Eve-Lynn
and Marcin, P. James
and Carter, D. Knute
and Law, Beth Kari
and McCord, Carly
and Neufeld, Jonathan
and Merchant, S. Kimberly A.",
title="Telehealth and In-Person Behavioral Health Services in Rural Communities Before and During the COVID-19 Pandemic: Multisite Prospective Cohort Study",
journal="JMIR Ment Health",
year="2023",
month="Sep",
day="18",
volume="10",
pages="e47047",
keywords="anxiety",
keywords="behavior",
keywords="behavioral health",
keywords="COVID-19",
keywords="depression",
keywords="digital health",
keywords="eHealth",
keywords="mental health",
keywords="mHealth",
keywords="pandemic",
keywords="rural health services",
keywords="rural",
keywords="telehealth",
keywords="telemedicine",
abstract="Background: The COVID-19 pandemic triggered widespread adjustments across the US health care system. Telehealth use showed a substantial increase in mental health conditions and services due to acute public health emergency (PHE) behavioral health needs on top of long-standing gaps in access to behavioral health services. How health systems that were already providing behavioral telehealth services adjusted services and staffing during this period has not been well documented, particularly in rural areas with chronic shortages of behavioral health providers and services. Objective: This study investigates patient and treatment characteristic changes from before the COVID-19 PHE to during the PHE within both telehealth and in-person behavioral health services provided in 95 rural communities across the United States. Methods: We used a nonrandomized, prospective, multisite research design involving 2 active treatment groups. The telehealth cohort included all patients who initiated telehealth treatment regimens during the data collection period. A comparison group included a cohort of patients who initiated in-person treatment regimen. Patient enrollment occurred on a rolling basis, and data collection was extended for 3 months after treatment initiation for each patient. Chi-square tests compared changes from pre-PHE to PHE time periods within telehealth and in-person treatment cohorts. The dependent measures included patient diagnosis, clinicians providing treatment services, and type of treatment services provided at each encounter. The 4780 patients in the telehealth cohort and the 6457 patients in the in-person cohort had an average of 3.5 encounters during the 3-month follow-up period. Results: The encounters involving anxiety, dissociative, and stress-related disorders in the telehealth cohort increased from 30\% (698/2352) in the pre-PHE period to 35\% (4632/12,853) in the PHE period (P<.001), and encounters involving substance use disorders in the in-person cohort increased from 11\% (468/4249) in the pre-PHE period to 18\% (3048/17,047) in the PHE period (P<.001). The encounters involving treatment service codes for alcohol, drug, and medication-assisted therapy in the telehealth cohort increased from 1\% (22/2352) in the pre-PHE period to 11\% (1470/13,387) in the PHE period (P<.001); likewise, encounters for this type of service in the in-person cohort increased from 0\% (0/4249) in the pre-PHE period to 16\% (2687/17,047) in the PHE period (P<.001). From the pre-PHE to the PHE period, encounters involving 60-minute psychotherapy in the telehealth cohort increased from 8\% (190/2352) to 14\% (1802/13,387; P<.001), while encounters involving group therapy in the in-person cohort decreased from 12\% (502/4249) to 4\% (739/17,047; P<.001). Conclusions: The COVID-19 pandemic challenged health service providers, and they adjusted the way both telehealth and in-person behavioral therapy services were delivered. Looking forward, future research is needed to explicate the interaction of patient, provider, setting, and intervention factors that influenced the patterns observed as a result of the COVID-19 pandemic. ",
doi="10.2196/47047",
url="https://mental.jmir.org/2023/1/e47047",
url="http://www.ncbi.nlm.nih.gov/pubmed/37721793"
}


@Article{info:doi/10.2196/47284,
author="Bostr{\o}m, Katrine
and B{\o}r{\o}sund, Elin
and Eide, Hilde
and Varsi, Cecilie
and Kristjansdottir, Birna {\'O}l{\"o}f
and Schreurs, G. Karlein M.
and Waxenberg, B. Lori
and Weiss, E. Karen
and Morrison, J. Eleshia
and Stavenes St{\o}le, Hanne
and Cvancarova Sm{\aa}stuen, Milada
and Stubhaug, Audun
and Solberg Nes, Lise",
title="Short-Term Findings From Testing EPIO, a Digital Self-Management Program for People Living With Chronic Pain: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="25",
volume="25",
pages="e47284",
keywords="chronic pain",
keywords="self-management",
keywords="digital health",
keywords="efficacy",
keywords="cognitive behavioral therapy",
keywords="acceptance and commitment therapy",
abstract="Background: Chronic pain conditions involve numerous physical and psychological challenges, and while psychosocial self-management interventions can be of benefit for people living with chronic pain, such in-person treatment is not always accessible. Digital self-management approaches could improve this disparity, potentially bolstering outreach and providing easy, relatively low-cost access to pain self-management interventions. Objective: This randomized controlled trial aimed to evaluate the short-term efficacy of EPIO (ie, inspired by the Greek goddess for the soothing of pain, Epione), a digital self-management intervention, for people living with chronic pain. Methods: Patients (N=266) were randomly assigned to either the EPIO intervention (n=132) or a care-as-usual control group (n=134). Outcome measures included pain interference (Brief Pain Inventory; primary outcome measure), anxiety and depression (Hospital Anxiety and Depression Scale), self-regulatory fatigue (Self-Regulatory Fatigue 18 scale), health-related quality of life (SF-36 Short Form Health Survey), pain catastrophizing (Pain Catastrophizing Scale), and pain acceptance (Chronic Pain Acceptance Questionnaire). Linear regression models used change scores as the dependent variables. Results: The participants were primarily female (210/259, 81.1\%), with a median age of 49 (range 22-78) years and a variety of pain conditions. Analyses (n=229) after 3 months revealed no statistically significant changes for the primary outcome of pain interference (P=.84), but significant reductions in the secondary outcomes of depression (mean difference ?0.90; P=.03) and self-regulatory fatigue (mean difference ?2.76; P=.008) in favor of the intervention group. No other statistically significant changes were observed at 3 months (all P>.05). Participants described EPIO as useful (ie, totally agree or agree; 95/109, 87.2\%) and easy to use (101/109, 92.7\%), with easily understandable exercises (106/109, 97.2\%). Conclusions: Evidence-informed, user-centered digital pain self-management interventions such as EPIO may have the potential to effectively support self-management and improve psychological functioning in the form of reduced symptoms of depression and improved capacity to regulate thoughts, feelings, and behavior for people living with chronic pain. Trial Registration: ClinicalTrials.gov NCT03705104; https://clinicaltrials.gov/ct2/show/NCT03705104 ",
doi="10.2196/47284",
url="https://www.jmir.org/2023/1/e47284",
url="http://www.ncbi.nlm.nih.gov/pubmed/37624622"
}


@Article{info:doi/10.2196/46148,
author="Neumann, Ariana
and K{\"o}nig, Hans-Helmut
and Bokermann, Josephine
and Hajek, Andr{\'e}",
title="Determinants of Patient Use and Satisfaction With Synchronous Telemental Health Services During the COVID-19 Pandemic: Systematic Review",
journal="JMIR Ment Health",
year="2023",
month="Aug",
day="18",
volume="10",
pages="e46148",
keywords="telemedicine",
keywords="digital health",
keywords="teletherapy",
keywords="mental health",
keywords="use",
keywords="satisfaction",
abstract="Background: Several recent studies examined patient use and satisfaction with synchronous telemental health services in response to the widespread implementation during the COVID-19 pandemic. However, a systematic review of recent literature on the determinants of these outcomes is missing. Objective: The aim of this systematic review was to give an extensive overview of the literature on and highlight the influential determinants of patient use and satisfaction with synchronous telemental health services during the COVID-19 pandemic. Methods: This review satisfied the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was registered in PROSPERO. Peer-reviewed, quantitative studies that observed the determinants of patient use or satisfaction with synchronous telemental health services during the COVID-19 pandemic were included. PubMed, PsycInfo, and Web of Science database searches were conducted in August 2022 for English and German language studies published from 2020 onward. Key steps were performed by 2 reviewers. Determinants were synthesized into major categories informed by the dimensions of the widely used and established Unified Theory of Acceptance and Use of Technology. Results: Of the 20 included studies, 10 studies examined determinants of patient use, 7 examined determinants of patient satisfaction, and 3 observed both outcomes. The quality of the studies was mainly good or fair. There was substantial heterogeneity in the study designs, methods, and findings. Sociodemographic characteristics and health-related determinants were mostly considered. Some of the major dimensions of the Unified Theory of Acceptance and Use of Technology were neglected in recent studies. Although most findings were mixed or nonsignificant, some indications for potential relationships were found (eg, for sex, age, and symptom severity). Conclusions: The findings revealed potential target groups (eg, female and young patients with mild symptoms) for future postpandemic telemental health interventions. However, they also identified patient groups that were harder to reach (eg, older patients with severe symptoms); efforts may be beneficial to address such groups. Future quantitative and qualitative research is needed to secure and expand on recent findings, which could help improve services. Trial Registration: PROSPERO CRD42022351576; https://tinyurl.com/yr6zrva5 ",
doi="10.2196/46148",
url="https://mental.jmir.org/2023/1/e46148",
url="http://www.ncbi.nlm.nih.gov/pubmed/37594785"
}


@Article{info:doi/10.2196/46953,
author="Wang, Jiamin
and Zhen, Xuemei
and Coyte, C. Peter
and Shao, Di
and Zhao, Ni
and Chang, Lele
and Feng, Yujia
and Sun, Xiaojie",
title="Association Between Online Health Information--Seeking Behaviors by Caregivers and Delays in Pediatric Cancer: Mixed Methods Study in China",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="16",
volume="25",
pages="e46953",
keywords="online health information--seeking behaviors",
keywords="patient delay",
keywords="diagnostic delay",
keywords="treatment delay",
keywords="mixed methods study",
abstract="Background: Pediatric cancer patients in China often present at an advanced stage of disease resulting in lower survival and poorer health outcomes. One factor hypothesized to contribute to delays in pediatric cancer has been the online health information--seeking (OHIS) behaviors by caregivers. Objective: This study aims to examine the association between OHIS behaviors by caregivers and delays for Chinese pediatric cancer patients using a mixed methods approach. Methods: This study used a mixed methods approach, specifically a sequential explanatory design. OHIS behavior by the caregiver was defined as the way caregivers access information relevant to their children's health via the Internet. Delays in pediatric cancer were defined as any one of the following 3 types of delay: patient delay, diagnosis delay, or treatment delay. The quantitative analysis methods included descriptive analyses, Student t tests, Pearson chi-square test, and binary logistic regression analysis, all performed using Stata. The qualitative analysis methods included conceptual content analysis and the Colaizzi method. Results: A total of 303 pediatric cancer patient-caregiver dyads was included in the quantitative survey, and 29 caregivers completed the qualitative interview. Quantitative analysis results revealed that nearly one-half (151/303, 49.8\%) of patients experienced delays in pediatric cancer, and the primary type of delay was diagnosis delay (113/303, 37.3\%), followed by patient delay (50/303, 16.5\%) and treatment delay (24/303, 7.9\%). In this study, 232 of the 303 (76.6\%) caregiver participants demonstrated OHIS behaviors. When those engaged in OHIS behaviors were compared with their counterparts, the likelihood of patient delay more than doubled (odds ratio=2.21; 95\% CI 1.03-4.75). Qualitative analysis results showed that caregivers' OHIS behaviors impacted the cancer care pathway by influencing caregivers' symptom appraisal before the first medical contact and caregivers' acceptance of health care providers' diagnostic and treatment decisions. Conclusions: Our ?ndings suggest that OHIS among Chinese pediatric caregivers may be a risk factor for increasing the likelihood of patient delay. Our government and society should make a concerted effort to regulate online health information and improve its quality. Specialized freemium consultations provided by health care providers via online health informatic platforms are needed to shorten the time for caregivers' cancer symptom appraisal before the first medical contact. ",
doi="10.2196/46953",
url="https://www.jmir.org/2023/1/e46953",
url="http://www.ncbi.nlm.nih.gov/pubmed/37585244"
}


@Article{info:doi/10.2196/38965,
author="Campos-Castillo, Celeste",
title="Impact of Beliefs About Local Physician Supply and Self-Rated Health on Willingness to See a Nurse Practitioner During the COVID-19 Pandemic: Web-Based Survey and Experiment",
journal="JMIR Form Res",
year="2023",
month="Aug",
day="16",
volume="7",
pages="e38965",
keywords="primary care shortage",
keywords="workforce",
keywords="health care seeking",
keywords="public opinion",
keywords="consumers",
keywords="online studies",
keywords="COVID-19",
keywords="pandemic",
keywords="primary care",
keywords="nurse practitioners",
keywords="nurse",
keywords="healthcare",
keywords="resources",
keywords="advocacy",
abstract="Background: The COVID-19 pandemic overburdened primary care clinicians. For nurse practitioners (NPs) to alleviate the burden, the public must be willing to see an NP over a physician. Those with poor health tended to continue seeking care during the pandemic, suggesting that they may be willing to see an NP. Objective: The aim of this study is to evaluate the public's willingness to see an NP for primary care and how this may be associated with their beliefs about the local supply of physicians and self-rated health. Two studies were conducted: (1) a survey to identify correlations and (2) an experiment to assess how willingness is dependent on information about the local supply of physicians. Methods: The survey and experiment were conducted digitally in April and December 2020, respectively. Participants were US adults recruited from Amazon's Mechanical Turk platform. The key independent variables were self-rated health, which was a dichotomized 5-point scale (excellent, very good, good vs fair, and poor), and beliefs about local physician supply. The survey measured beliefs about local physician supply, while the experiment manipulated beliefs by altering information the participants read about the local supply of physicians. Willingness to see an NP was assessed in 2 ways. First as an overall preference over a physician and the second as a preference given 2 clinically significant scenarios in which participants imagined they were experiencing either coughing or a headache (presentation order randomized). Multiple regressions and ANOVAs were used to assess how beliefs about the local physician supply and self-rated health were associated with overall willingness to see an NP. Bivariate probits simultaneously estimated willingness to see an NP in the 2 clinically significant scenarios. Results: The survey showed that concerns about physician supply were associated with lower willingness to see an NP among respondents with comparatively better health but a greater willingness among respondents with comparatively worse health. The experiment suggests that only the latter is causal. For the 2 clinically significant scenarios, these patterns appeared for the coughing scenario in the survey and the headache scenario in the experiment. Conclusions: US adults with comparatively worse self-rated health become more willing to see an NP for primary care when they hear information that raises their concerns about the local physician supply. The differences between the survey and experiment results may be useful for interpreting findings from future studies. Findings may aid in managing finite health care resources during public health crises and crafting successful messaging by NP advocacy groups. Efforts to address nursing shortages will also be needed. ",
doi="10.2196/38965",
url="https://formative.jmir.org/2023/1/e38965",
url="http://www.ncbi.nlm.nih.gov/pubmed/37347928"
}


@Article{info:doi/10.2196/46056,
author="Fischer, Ann-Kathrin
and M{\"u}hlbacher, C. Axel",
title="Patient and Public Acceptance of Digital Technologies in Health Care: Protocol for a Discrete Choice Experiment",
journal="JMIR Res Protoc",
year="2023",
month="Aug",
day="10",
volume="12",
pages="e46056",
keywords="health preference research",
keywords="stated preference survey",
keywords="discrete choice experiment",
keywords="study protocol",
keywords="digital transformation",
keywords="digital technologies",
keywords="digital interventions",
keywords="health care",
keywords="rehabilitation",
keywords="stroke",
keywords="mobile phone",
abstract="Background: Strokes pose a particular challenge to the health care system. Although stroke-related mortality has declined in recent decades, the absolute number of new strokes (incidence), stroke deaths, and survivors of stroke has increased. With the increasing need of neurorehabilitation and the decreasing number of professionals, innovations are needed to ensure adequate care. Digital technologies are increasingly used to meet patients' unfilled needs during their patient journey. Patients must adhere to unfamiliar digital technologies to engage in health interventions. Therefore, the acceptance of the benefits and burdens of digital technologies in health interventions is a key factor in implementing these innovations. Objective: This study aims to describe the development of a discrete choice experiment (DCE) to weigh criteria that impact patient and public acceptance. Secondary study objectives are a benefit-burden assessment (estimation of the maximum acceptable burden of technical features and therapy-related characteristics for the patient or individual, eg, no human contact), overall comparison (assessment of the relative importance of attributes for comparing digital technologies), and adherence (identification of key attributes that influence patient adherence). The exploratory objectives include heterogeneity assessment and subgroup analysis. The methodological aims are to investigate the use of DCE. Methods: To obtain information on the criteria impacting acceptance, a DCE will be conducted including 7 attributes based on formative qualitative research. Patients with stroke (experimental group) and the general population (control group) are surveyed. The final instrument includes 6 best-best choice tasks in partial design. The experimental design is a fractional-factorial efficient Bayesian design (D-error). A conditional logit regression model and mixed logistic regression models will be used for analysis. To consider the heterogeneity of subgroups, a latent class analysis and an analysis of heteroscedasticity will be performed. Results: The literature review, qualitative preliminary study, survey development, and pretesting were completed. Data collection and analysis will be completed in the last quarter of 2023. Conclusions: Our results will inform decision makers about patients' and publics' acceptance of digital technologies used in innovative interventions. The patient preference information will improve decisions regarding the development, adoption, and pricing of innovative interventions. The behavioral changes in the choice of digital intervention alternatives are observable and can therefore be statistically analyzed. They can be translated into preferences, which define the value. This study will investigate the influences on the acceptance of digital interventions and thus support decisions and future research. International Registered Report Identifier (IRRID): DERR1-10.2196/46056 ",
doi="10.2196/46056",
url="https://www.researchprotocols.org/2023/1/e46056",
url="http://www.ncbi.nlm.nih.gov/pubmed/37561559"
}


@Article{info:doi/10.2196/45602,
author="Zhang, Jinghui
and Peng, Sha
and Hou, Jianmei
and Ma, Guiyuan
and Liu, Yanhui
and Fan, Yuhua
and Luo, Lingxia
and Shi, Zhengkun",
title="Nurses' Willingness and Demand for Internet+Home Care Services and the Associated Factors in Municipal Hospitals in China: Cross-Sectional Survey",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="4",
volume="25",
pages="e45602",
keywords="Internet+home care services",
keywords="willingness",
keywords="demand",
keywords="clinical nurses",
keywords="municipal hospitals",
abstract="Background: Developing Internet+home care (IHC) services is a promising way to address the problems related to population aging, which is an important global issue. However, IHC services are in their infancy in China. Limited studies have investigated the willingness and demand of nurses in municipal hospitals to provide IHC services. Objective: This study aims to investigate the willingness and demand of nurses in municipal hospitals in China to provide IHC services and analyze the factors to promote IHC development in China. Methods: This cross-sectional study used multistage sampling to recruit 9405 nurses from 10 hospitals in 5 regions of China. A self-designed questionnaire with good reliability and validity was used to measure nurses' willingness and demand for providing IHC services. Data analysis used the chi-square test, Welch t test, binary logistic regression analysis, and multiple linear regression analysis. Results: Nurses were highly willing to provide IHC services and preferred service distances of <5 km and times from 8 AM to 6 PM. An individual share >60\% was the expected service pay sharing. Job title, educational level, monthly income, and marital status were associated with nurses' willingness to provide IHC services in binary logistic regression analysis. Supervising nurses were 1.177 times more likely to express a willingness to provide IHC services than senior nurses. Nurses with a bachelor's degree had a 1.167 times higher likelihood of expressing willingness to provide IHC services than those with a junior college education or lower. Married nurses were 1.075 times more likely to express a willingness than unmarried nurses. A monthly income >{\textyen}10,000 increased the likelihood of nurses' willingness to provide IHC services, by 1.187 times, compared with an income <{\textyen}5000. Nurses' total mean demand score for IHC services was 17.38 (SD 3.67), with the highest demand being privacy protection. Multiple linear regression analysis showed that job title, monthly income, and educational level were associated with nurses' demand for IHC services. Supervising nurses (B=1.058, P<.001) and co-chief nurses or those with higher positions (B=2.574, P<.001) reported higher demand scores than senior nurses. Monthly incomes of {\textyen}5000 to {\textyen}10,000 (B=0.894, P<.001) and >{\textyen}10,000 (B=1.335, P<.001), as well as a bachelor's degree (B=0.484, P=.002) and at least a master's degree (B=1.224, P=.02), were associated with higher demand scores compared with a monthly income <{\textyen}5000 and junior college education or lower, respectively. Conclusions: Nurses in municipal hospitals showed a high willingness and demand to provide IHC services, with differences in willingness and demand by demographic characteristics. Accordingly, government and hospitals should regulate the service period, service distance, and other characteristics according to nurses' willingness and demand and establish relevant laws and regulations to ensure the steady and orderly development of IHC services. ",
doi="10.2196/45602",
url="https://www.jmir.org/2023/1/e45602",
url="http://www.ncbi.nlm.nih.gov/pubmed/37540546"
}


@Article{info:doi/10.2196/47637,
author="Sakumoto, Matthew",
title="Virtual First Emergency Medicine Visits: The Future of Convenient and Efficient Emergency Care",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="3",
volume="25",
pages="e47637",
keywords="telehealth",
keywords="virtual care",
keywords="emergency medicine",
keywords="telemedicine",
keywords="emergency department",
keywords="acute care facilities",
keywords="virtual visit",
keywords="COVID-19",
keywords="virtual",
keywords="utilization",
keywords="medicine",
keywords="acute illness",
keywords="illness",
keywords="injury",
keywords="patient",
keywords="infection",
keywords="care",
keywords="physician",
doi="10.2196/47637",
url="https://www.jmir.org/2023/1/e47637",
url="http://www.ncbi.nlm.nih.gov/pubmed/36976827"
}


@Article{info:doi/10.2196/42840,
author="Potter, Jennifer
and Watson Gans, Dana
and Gardner, Alison
and O'Neill, James
and Watkins, Christopher
and Husain, Iltifat",
title="Using Virtual Emergency Medicine Clinicians as a Health System Entry Point (Virtual First): Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="3",
volume="25",
pages="e42840",
keywords="telehealth",
keywords="virtual care",
keywords="emergency medicine",
keywords="telemedicine",
keywords="emergency department",
keywords="acute care facilities",
keywords="virtual visit",
keywords="COVID-19",
keywords="virtual",
keywords="utilization",
keywords="medicine",
keywords="acute illness",
keywords="illness",
keywords="injury",
keywords="patient",
keywords="efficacy",
keywords="infection",
keywords="care",
keywords="physician",
abstract="Background: The COVID-19 pandemic accelerated the use and acceptance of telemedicine. Simultaneously, emergency departments (EDs) have experienced increased ED boarding. With this acceptance of telemedicine and the weighty increase in patient boarding, we proposed the innovative Virtual First (VF) program to leverage emergency medicine clinicians' (EMCs) ability to triage patients. VF seeks to reduce unnecessary ED visits by connecting patients with EMCs prior to seeking in-person care rather than using traditional ED referral systems. Objective: The goal of this study is to investigate how patients' access to EMCs from home via the establishment of VF changed how patients sought care for acute care needs. Methods: VF is a synchronous virtual video visit at a tertiary care academic hospital. VF was staffed by EMCs and enabled full management of patient complaints or, if necessary, referral to the appropriate level of care. Patients self-selected this service as an alternative to seeking in-person care at a primary care provider, urgent care center, or ED. A postvisit convenience sample survey was collected through a phone SMS text message or email to VF users. This is a cross-sectional survey study. The primary outcome measure is based on responses to the question ``How would you have sought care if a VF visit was not available to you?'' Secondary outcome measures describe valued aspects and criticisms. Results were analyzed using descriptive statistics. Results: There were 3097 patients seen via VF from July 2021 through May 2022. A total of 176 (5.7\%) patients completed the survey. Of these, 87 (49.4\%) would have sought care at urgent care centers if VF had not been available. There were 28 (15.9\%) patients, 26 (14.8\%) patients, and 1 (0.6\%) patient that would have sought care at primary care providers, EDs, or other locations, respectively. Interestingly, 34 (19.3\%) patients would not have sought care. The most valued aspect of VF was receiving care in the comfort of the home (n=137, 77.8\%). For suggested improvements, 58 (33\%) patients most commonly included ``Nothing'' as free text. Conclusions: VF has the potential to restructure how patients seek medical care by connecting EMCs with patients prior to ED arrival. Without the option of VF, 64.2\% (113/177) of patients would have sought care at an acute care facility. VF's innovative employment of EMCs allows for acute care needs to be treated virtually if feasible. If not, EMCs understand the local resources to better direct patients to the appropriate site. This has the potential to substantially decrease patient costs because patients are given the appropriate destination for in-person care, reducing the likelihood of the need for transfer and multiple ED visits. ",
doi="10.2196/42840",
url="https://www.jmir.org/2023/1/e42840",
url="http://www.ncbi.nlm.nih.gov/pubmed/37276547"
}


@Article{info:doi/10.2196/41032,
author="Groeneveld, M. Sjors W.
and den Ouden, M. Marjolein E.
and van Gemert-Pijnen, C. J. E. W.
and Verdaasdonk, M. Rudolph
and van Os-Medendorp, Harmieke",
title="Underestimated Factors Regarding the Use of Technology in Daily Practice of Long-Term Care: Qualitative Study Among Health Care Professionals",
journal="JMIR Nursing",
year="2023",
month="Jul",
day="26",
volume="6",
pages="e41032",
keywords="health technology",
keywords="eHealth",
keywords="digital health",
keywords="nurse",
keywords="nurse assistant",
keywords="health care professionals",
keywords="implementation",
keywords="adoption",
keywords="acceptance",
keywords="competencies",
abstract="Background: Increasing life expectancy is resulting in a growing demand for long-term care; however, there is a shortage of qualified health care professionals (HCPs) to deliver it. If used optimally, technology can provide a solution to this challenge. HCPs play an important role in the use of technology in long-term care. However, technology influences several core aspects of the work that HCPs do, and it is therefore important to have a good understanding of their viewpoint regarding the use of technology in daily practice of long-term care. Objective: The aim of this study was to identify the factors that HCPs consider as relevant for using technology in daily practice of long-term care. Methods: In this qualitative study, 11 focus groups were organized with 73 HCPs. The focus group discussions were guided by an innovative game, which was specifically developed for this study. The content of the game was categorized into 4 categories: health care technology and me; health care technology, the patient, and me; health care technology, the organization, and me; and facilitating conditions. The perspectives of HCPs about working with technology were discussed based on this game. The focus groups were recorded and transcribed, followed by an inductive thematic analysis using ATLAS.ti 9x (ATLAS.ti Scientific Software Development GmbH). Results: Overall, 2 main domain summaries were developed from the data: technology should improve the quality of care and acceptance and use of technology in care. The first factor indicates the need for tailored and personalized care and balance between human contact and technology. The second factor addresses several aspects regarding working with technology such as trusting technology, learning to work with technology, and collaboration with colleagues. Conclusions: HCPs are motivated to use technology in daily practice of long-term care when it adds value to the quality of care and there is sufficient trust, expertise, and collaboration with colleagues. Their perspectives need to be considered as they play a crucial part in the successful use of technology, transcending their role as an actor in implementation. On the basis of the findings from this study, we recommend focusing on developing technology for situations where both efficiency and quality of care can be improved; redefining the roles of HCPs and the impact of technology hereon; involving HCPs in the design process of technology to enable them to link it to their daily practice; and creating ambassadors in care teams who are enthusiastic about working with technology and can support and train their colleagues. ",
doi="10.2196/41032",
url="https://nursing.jmir.org/2023/1/e41032",
url="http://www.ncbi.nlm.nih.gov/pubmed/37494092"
}


@Article{info:doi/10.2196/49131,
author="Howard, Michelle
and Aubrey-Bassler, Kris
and Drummond, Neil
and Lussier, Marie-Th{\'e}r{\`e}se
and Queenan, A. John
and Vanstone, Meredith
and Nicholson, Kathryn
and Ramdyal, Amanda
and Lawson, Jennifer
and Hafid, Shuaib
and Freeman, Karla
and Clark, Rebecca
and Mangin, Dee",
title="Effects of the COVID-19 Pandemic on Primary Health Care for Chronic Conditions in Canada: Protocol for a Retrospective Pre-Post Study Using National Practice-Based Research Network Data",
journal="JMIR Res Protoc",
year="2023",
month="Jul",
day="21",
volume="12",
pages="e49131",
keywords="COVID-19",
keywords="chronic disease",
keywords="primary health care",
keywords="electronic health record",
keywords="health services research",
keywords="retrospective studies",
abstract="Background: Since the COVID-19 pandemic began, there have been concerns that interruptions to the health care system may have led to changes in primary care, especially for care of chronic conditions such as diabetes and heart failure. Such changes may have longer term implications for population health. Objective: This study aims to describe the impacts of the COVID-19 pandemic on indicators of primary care access, comprehensiveness, and appropriateness among adult patients, as well as on specific indictors of chronic conditions. Additionally, this study aims to determine whether any identified changes were associated with patient sociodemographic characteristics and multimorbidity. Methods: This is a retrospective, single-arm, pre-post study using Canadian Primary Care Sentinel Surveillance Network (CPCSSN) data. CPCSSN is a research network supported by a primary care electronic medical record database, comprising over 1500 physicians and nearly 2 million patients. We are examining changes in care (eg, frequency of contacts, laboratory tests and investigations, referrals, medications prescribed, etc) among adults. We will also examine indicators specific to evidence-based recommendations for care in patients with diabetes and those with heart failure. We will compare rates of outcomes during key periods of the pandemic between March 13, 2020, and December 31, 2022, with equal time periods before the pandemic. Differences will be examined among specific subgroups of adults, including by decade of age, number of comorbidities, and socioeconomic status. Regression models appropriate to outcome distributions will be used to estimate changes, adjusting for potential confounders. This analysis is part of a mixed-methods study with a qualitative component investigating how patients with diabetes with or without concurrent heart failure perceived the impact of the pandemic on access to primary care and health care--related decisions. This study was approved by the Hamilton Integrated Research Ethics Board (14782-C). Results: The start date of this study was October 5, 2022, and the prospective end date is January 31, 2024. As of May 2023, the study cohort (n=875,934) is defined, data cleaning is complete, and exploratory analyses have begun. Extended analyses using 2022 data are planned once the new data becomes available. We will disseminate results through peer-reviewed publications and academic conference, as well as creating evidence briefs, infographics, and a video for policy maker and patient audiences. Conclusions: This study will investigate whether the COVID-19 pandemic has resulted in changes in the provision of primary care in Canada and whether these potential changes have led to gaps in care. This study will also identify patient-level characteristics associated with changes in care patterns across the COVID-19 pandemic. Indicators specific to chronic conditions, namely diabetes and heart failure, will also be explored to determine whether there were changes in care of these conditions. Trial Registration: ClinicalTrials.gov NCT05813652; https://clinicaltrials.gov/ct2/show/NCT05813652 International Registered Report Identifier (IRRID): RR1-10.2196/49131 ",
doi="10.2196/49131",
url="https://www.researchprotocols.org/2023/1/e49131",
url="http://www.ncbi.nlm.nih.gov/pubmed/37477967"
}


@Article{info:doi/10.2196/42898,
author="Liu, Ruyue
and Li, Qiuxia
and Li, Yifan
and Wei, Wenjian
and Ma, Siqi
and Wang, Jialin
and Zhang, Nan",
title="Public Preference Heterogeneity and Predicted Uptake Rate of Upper Gastrointestinal Cancer Screening Programs in Rural China: Discrete Choice Experiments and Latent Class Analysis",
journal="JMIR Public Health Surveill",
year="2023",
month="Jul",
day="10",
volume="9",
pages="e42898",
keywords="upper gastrointestinal cancer",
keywords="screening programs",
keywords="discrete choice experiment",
keywords="latent class logit model",
keywords="public preference heterogeneity",
keywords="uptake rate",
abstract="Background: Rapid increases in the morbidity and mortality of patients with upper gastrointestinal cancer (UGC) in high-incidence countries in Asia have raised public health concerns. Screening can effectively reduce the incidence and mortality of patients with UGC, but the low population uptake rate seriously affects the screening effect. Objective: We aimed to determine the characteristics that influence residents' preference heterogeneity for a UGC-screening program and the extent to which these characteristics predict residents' uptake rates. Methods: A discrete choice experiment was conducted in 1000 residents aged 40-69 years who were randomly selected from 3 counties (Feicheng, Linqu, and Dongchangfu) in Shandong Province, China. Each respondent was repeatedly asked to choose from 9 discrete choice questions of 2 hypothetical screening programs comprising 5 attributes: screening interval, screening technique, regular follow-up for precancerous lesions, mortality reduction, and out-of-pocket costs. The latent class logit model was used to estimate residents' preference heterogeneity for each attribute level, their willingness to pay, and the expected uptake rates. Results: Of the 1000 residents invited, 926 (92.6\%) were included in the final analyses. The mean age was 57.32 (SD 7.22) years. The best model contained 4 classes of respondents (Akaike information criterion=7140.989, Bayesian information criterion=7485.373) defined by different preferences for the 5 attributes. In the 4-class model, out of 926 residents, 88 (9.5\%) were assigned to class 1, named as the negative latent type; 216 (3.3\%) were assigned to class 2, named as the positive integrated type; 434 (46.9\%) were assigned to class 3, named as the positive comfortable type; and 188 (20.3\%) were assigned to class 4, named as the neutral quality type. For these 4 latent classes, ``out-of-pocket cost'' is the most preferred attribute in negative latent type and positive integrated type residents (45.04\% vs 66.04\% importance weights), whereas ``screening technique'' is the most preferred factor in positive comfortable type residents (62.56\% importance weight) and ``screening interval'' is the most valued attribute in neutral quality type residents (47.05\% importance weight). Besides, residents in different classes had common preference for painless endoscopy, and their willingness to pay were CNY {\textyen}385.369 (US \$59.747), CNY {\textyen}93.44 (US \$14.486), CNY {\textyen}1946.48 (US \$301.810), and CNY {\textyen}3566.60 (US \$552.961), respectively. Residents' participation rate could increase by more than 89\% (except for the 60.98\% in class 2) if the optimal UGC screening option with free, follow-up for precancerous lesions, 45\% mortality reduction, screening every year, and painless endoscopy was implemented. Conclusions: Public preference heterogeneity for UGC screening does exist. Most residents have a positive attitude toward UGC screening, but their preferences vary in selected attributes and levels, except for painless endoscopy. Policy makers should consider these heterogeneities to formulate UGC-screening programs that incorporate the public's needs and preferences to improve participation rates. ",
doi="10.2196/42898",
url="https://publichealth.jmir.org/2023/1/e42898",
url="http://www.ncbi.nlm.nih.gov/pubmed/37428530"
}


@Article{info:doi/10.2196/43813,
author="Weber, Franziska
and Kloek, Corelien
and Arntz, Angela
and Gr{\"u}neberg, Christian
and Veenhof, Cindy",
title="Blended Care in Patients With Knee and Hip Osteoarthritis in Physical Therapy: Delphi Study on Needs and Preconditions",
journal="JMIR Rehabil Assist Technol",
year="2023",
month="Jul",
day="7",
volume="10",
pages="e43813",
keywords="telerehabilitation",
keywords="osteoarthritis",
keywords="physical therapy",
keywords="knee",
keywords="hip",
keywords="blended",
keywords="preconditions",
keywords="Delphi",
keywords="focus group",
keywords="user need",
abstract="Background: Osteoarthritis is a major public health concern. Despite existing evidence-based treatment options, the health care situation remains unsatisfactory. Digital care options, especially when combined with in-person sessions, seem to be promising. Objective: The aim of this study was to investigate the needs, preconditions, barriers, and facilitators of blended physical therapy for osteoarthritis. Methods: This Delphi study consisted of interviews, an online questionnaire, and focus groups. Participants were physical therapists, patients with hip and/or knee osteoarthritis with or without experience in digital care, and stakeholders of the health care system. In the first phase, interviews were conducted with patients and physical therapists. The interview guide was based on the Consolidated Framework For Implementation Research. The interviews focused on experiences with digital and blended care. Furthermore, needs, facilitators, and barriers were discussed. In the second phase, an online questionnaire and focus groups served the process to confirm the needs and collect preconditions. The online questionnaire contained statements drawn by the results of the interviews. Patients and physical therapists were invited to complete the questionnaire and participate in one of the three focus groups including (1) patients; (2) physical therapists; and (3) a patient, a physical therapist, and stakeholders from the health care system. The focus groups were used to determine concordance with the results of the interviews and the online questionnaire. Results: Nine physical therapists, seven patients, and six stakeholders confirmed that an increase of acceptance of the digital care part by physical therapists and patients is crucial. One of the most frequently mentioned facilitators was conducting regular in-person sessions. Physical therapists and patients concluded that blended physical therapy must be tailored to the patients' needs. Participants of the last focus group stated that the reimbursement of blended physical therapy needs to be clarified. Conclusions: Most importantly, it is necessary to strengthen the acceptance of patients and physical therapists toward digital care. Overall, for development and usage purposes, it is crucial to take the needs and preconditions into account. Trial Registration: German Clinical Trials Register DRKS00023386; https://drks.de/search/en/trial/DRKS00023386 ",
doi="10.2196/43813",
url="https://rehab.jmir.org/2023/1/e43813",
url="http://www.ncbi.nlm.nih.gov/pubmed/37418301"
}


@Article{info:doi/10.2196/41113,
author="Fatoye, Francis
and Gebrye, Tadesse
and Mbada, Chidozie
and Useh, Ushotanefe",
title="Economic Evaluations of Digital Health Interventions for the Management of Musculoskeletal Disorders: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2023",
month="Jul",
day="6",
volume="25",
pages="e41113",
keywords="musculoskeletal disorders",
keywords="digital health interventions",
keywords="cost-effectiveness",
keywords="systematic review",
keywords="digital health",
keywords="intervention",
keywords="management",
keywords="musculoskeletal",
keywords="muscles",
keywords="joints",
keywords="nerves",
keywords="blood",
keywords="pain",
keywords="knee",
keywords="hip",
abstract="Background: Musculoskeletal disorders (MSDs) are widespread in many countries and their huge burden on the society has necessitated innovative approaches such as digital health interventions. However, no study has evaluated the findings of cost-effectiveness of these interventions. Objective: This study aims to synthesize the cost-effectiveness of digital health interventions for people with MSDs. Methods: Electronic databases including MEDLINE, AMED, CIHAHL, PsycINFO, Scopus, Web of Science, and Centre for Review and Dissemination were searched for cost-effectiveness of digital health published between inception and June 2022 following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. References of all retrieved articles were checked for relevant studies. Quality appraisal of the included studies was performed using the Quality of Health Economic Studies (QHES) instrument. Results were presented using a narrative synthesis and random effects meta-analysis. Results: A total of 10 studies from 6 countries met the inclusion criteria. Using the QHES instrument, we found that the mean score of the overall quality of the included studies was 82.5. Included studies were on nonspecific chronic low back pain (n=4), chronic pain (n=2), knee and hip osteoarthritis (n=3), and fibromyalgia (n=1). The economic perspectives adopted in the included studies were societal (n=4), societal and health care (n=3), and health care (n=3). Of the 10 included studies, 5 (50\%) used quality-adjusted life-years as the outcome measures. Except 1 study, all the included studies reported that digital health interventions were cost-effective compared with the control group. In a random effects meta-analysis (n=2), the pooled disability and quality-adjusted life-years were --0.176 (95\% CI --0.317 to --0.035; P=.01) and 3.855 (95\% CI 2.023 to 5.687; P<.001), respectively. The meta-analysis (n=2) for the costs was in favor of the digital health intervention compared with control: US \$417.52 (95\% CI --522.01 to --313.03). Conclusions: Studies indicate that digital health interventions are cost-effective for people with MSDs. Our findings suggest that digital health intervention could help improve access to treatment for patients with MSDs and as a result improve their health outcomes. Clinicians and policy makers should consider the use of these interventions for patients with MSDs. Trial Registration: PROSPERO CRD42021253221; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=253221 ",
doi="10.2196/41113",
url="https://www.jmir.org/2023/1/e41113",
url="http://www.ncbi.nlm.nih.gov/pubmed/37410542"
}


@Article{info:doi/10.2196/42283,
author="Darwich, S. Adam
and Bostr{\"o}m, Anne-Marie
and Guidetti, Susanne
and Raghothama, Jayanth
and Meijer, Sebastiaan",
title="Investigating the Connections Between Delivery of Care, Reablement, Workload, and Organizational Factors in Home Care Services: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2023",
month="Jun",
day="30",
volume="10",
pages="e42283",
keywords="aging",
keywords="intervention",
keywords="health policy",
keywords="health services administration and management",
keywords="health care intervention",
keywords="home care",
keywords="home support",
keywords="in-home assistance",
keywords="personal care",
keywords="policy",
keywords="reablement",
keywords="rehabilitation",
keywords="rehabilitation medicine",
keywords="social support",
keywords="stress",
keywords="support",
keywords="systems thinking",
keywords="user",
abstract="Background: Home care is facing increasing demand due to an aging population. Several challenges have been identified in the provision of home care, such as the need for support and tailoring support to individual needs. Goal-oriented interventions, such as reablement, may provide a solution to some of these challenges. The reablement approach targets adaptation to disease and relearning of everyday life skills and has been found to improve health-related quality of life while reducing service use. Objective: The objective of this study is to characterize home care system variables (elements) and their relationships (connections) relevant to home care staff workload, home care user needs and satisfaction, and the reablement approach. This is to examine the effects of improvement and interventions, such as the person-centered reablement approach, on the delivery of home care services, workload, work-related stress, home care user experience, and other organizational factors. The main focus was on Swedish home care and tax-funded universal welfare systems. Methods: The study used a mixed methods approach where a causal loop diagram was developed grounded in participatory methods with academic health care science research experts in nursing, occupational therapy, aging, and the reablement approach. The approach was supplemented with theoretical models and the scientific literature. The developed model was verified by the same group of experts and empirical evidence. Finally, the model was analyzed qualitatively and through simulation methods. Results: The final causal loop diagram included elements and connections across the categories: stress, home care staff, home care user, organization, social support network of the home care user, and societal level. The model was able to qualitatively describe observed intervention outcomes from the literature. The analysis suggested elements to target for improvement and the potential impact of relevant studied interventions. For example, the elements ``workload'' and ``distress'' were important determinants of home care staff health, provision, and quality of care. Conclusions: The developed model may be of value for informing hypothesis formulation, study design, and discourse within the context of improvement in home care. Further work will include a broader group of stakeholders to reduce the risk of bias. Translation into a quantitative model will be explored. ",
doi="10.2196/42283",
url="https://humanfactors.jmir.org/2023/1/e42283",
url="http://www.ncbi.nlm.nih.gov/pubmed/37389904"
}


@Article{info:doi/10.2196/43776,
author="Salazar, Alejandro
and Moreno-Pulido, Soledad
and Prego-Meleiro, Pablo
and Henares-Montiel, Jes{\'u}s
and Pulido, Jos{\'e}
and Donat, Marta
and Sotres-Fernandez, Gabriel
and Sordo, Luis",
title="Correlation Between Opioid Drug Prescription and Opioid-Related Mortality in Spain as a Surveillance Tool: Ecological Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Jun",
day="28",
volume="9",
pages="e43776",
keywords="opioid",
keywords="overdose",
keywords="drug overdose",
keywords="opioid-related deaths",
keywords="mortality",
keywords="tramadol",
keywords="fentanyl",
keywords="substance use",
keywords="substance misuse",
keywords="substance abuse",
keywords="ecological study",
keywords="death",
abstract="Background: Opioid drug prescription (ODP) and opioid-related mortality (ORM) have increased in Spain. However, their relationship is complex, as ORM is registered without considering the type of opioid (legal or illegal). Objective: This ecological study aimed to examine the correlation between ODP and ORM in Spain and discuss their usefulness as a surveillance tool. Methods: This was an ecological descriptive study using retrospective annual data (2000-2019) from the Spanish general population. Data were collected from people of all ages. Information on ODP was obtained from the Spanish Medicines Agency in daily doses per 1000 inhabitants per day (DHD) for total ODP, total ODP excluding those with better safety protocols (codeine and tramadol), and each opioid drug separately. Rates of ORM (per 1,000,000 inhabitants) were calculated based on deaths registered (International Classification of Diseases, 10th Revision codes) as opioid poisoning by the National Statistics Institute, derived from the drug data recorded by medical examiners in death certificates. Opioid-related deaths were considered to be those that indicated opioid consumption (accidental, infringed, or self-inflicted) as the main cause of death: death due to accidental poisoning (X40-X44), intentional self-inflicted poisoning (X60-X64), drug-induced aggression (X85), and poisoning of undetermined intention (Y10-Y14). A descriptive analysis was carried out, and correlations between the annual rates of ORM and DHD of the prescribed opioid drugs globally, excluding medications of the least potential risk of overdose and lowest treatment tier, were analyzed using Pearson linear correlation coefficient. Their temporal evolution was analyzed using cross-correlations with 24 lags and the cross-correlation function. The analyses were carried out using Stata and StatGraphics Centurion 19. Results: The rate of ORM (2000-2019) ranged between 14 and 23 deaths per 1,000,000 inhabitants, with a minimum in 2006 and an increasing trend starting in 2010. The ODP ranged between 1.51 to 19.94 DHD. The rates of ORM were directly correlated with the DHD of total ODP (r=0.597; P=.006), total ODP without codeine and tramadol (r=0.934; P<.001), and every prescribed opioid except buprenorphine (P=.47). In the time analysis, correlations between DHD and ORM were observed in the same year, although not statistically significant (all P?.05). Conclusions: There is a correlation between greater availability of prescribed opioid drugs and an increase in opioid-related deaths. The correlation between ODP and ORM may be a useful tool in monitoring legal opiates and possible disturbances in the illegal market. The role of tramadol (an easily prescribed opioid) is important in this correlation, as is that of fentanyl (the strongest opioid). Measures stronger than recommendations need to be taken to reduce off-label prescribing. This study shows that not only is opioid use directly related to the prescribing of opioid drugs above what is desirable but also an increase in deaths. ",
doi="10.2196/43776",
url="https://publichealth.jmir.org/2023/1/e43776",
url="http://www.ncbi.nlm.nih.gov/pubmed/37379061"
}


@Article{info:doi/10.2196/46842,
author="Abdulai, Abdul-Fatawu
and Naghdali, Hasti
and Tekie Ghirmay, Eden
and Adam, Fuseini
and Bawafaa, Eunice",
title="Trauma-Informed Care in Digital Health Technologies: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2023",
month="Jun",
day="23",
volume="12",
pages="e46842",
keywords="clinical intervention",
keywords="digital health technologies",
keywords="digital health",
keywords="psychological trauma",
keywords="stress",
keywords="trauma",
keywords="trauma-informed care",
abstract="Background: The use of digital health technologies is becoming increasingly common across the globe as they offer immense potential to enhance health care delivery by promoting accessibility, flexibility, and personalized care, connecting patients to health care professionals, and offering more efficient services and treatments to remote residents. At the same time, there is an increasing recognition of how digital health can inadvertently foment psychological trauma. This phenomenon has led to the adoption of trauma-informed care in designing and deploying digital health technologies. However, how trauma-informed care is defined and characterized, and the various trauma-informed care strategies used in designing and deploying digital health technologies remain unexplored. Objective: This scoping review aims to explore and synthesize the literature on how trauma-informed care is defined and characterized in digital health and the various trauma-informed care principles, strategies, or recommendations used in designing and deploying digital health. Methods: This review will draw on the Joanna Briggs Institute's updated methodological guidance for scoping reviews. A search will be conducted on CINAHL, PubMed, Embase, Compendex Engineering Village, Web of Science, Scopus, and PsycINFO. This review will consider published research studies and unpublished work (gray literature). Studies will be included if they applied trauma-informed care in designing or deploying digital health for patients across all geographical locations or provide trauma-informed recommendations on how web developers should develop digital health. Studies will be limited to publications within the past 10 years and studies in all languages will be considered. Two independent reviewers will screen the titles and abstracts, and then perform a full-text review. Data will be extracted into a data extraction tool developed for this study. Results: The scoping review was undergoing a full search as of April 2023. The main results will synthesize the peer-reviewed and gray literature on adopting trauma-informed care practices in digital health research and development. The study is expected to be completed by December 2023 and the results are expected to be published in a peer-reviewed journal. Conclusions: This review is expected to provide the knowledge base on the adoption of trauma-informed care in designing and deploying digital health. This knowledge can lead to more engaging, and likely, more effective digital health interventions that have less potential for harm. A synthesis of the various trauma-informed care strategies in digital health will also provide a trauma-informed language by enabling researchers and digital health developers to consider trauma as a critical factor in each stage of the design process. International Registered Report Identifier (IRRID): DERR1-10.2196/46842 ",
doi="10.2196/46842",
url="https://www.researchprotocols.org/2023/1/e46842",
url="http://www.ncbi.nlm.nih.gov/pubmed/37351935"
}


@Article{info:doi/10.2196/41902,
author="Te, Vannarath
and Chhim, Srean
and Buffel, Veerle
and Van Damme, Wim
and van Olmen, Josefien
and Ir, Por
and Wouters, Edwin",
title="Evaluation of Diabetes Care Performance in Cambodia Through the Cascade-of-Care Framework: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Jun",
day="22",
volume="9",
pages="e41902",
keywords="diabetes",
keywords="cascade of care",
keywords="implementation research",
keywords="population-based survey",
keywords="care continuum",
keywords="mobile phone",
abstract="Background: Cambodia has seen an increase in the prevalence of type 2 diabetes (T2D) over the last 10 years. Three main care initiatives for T2D are being scaled up in the public health care system across the country: hospital-based care, health center--based care, and community-based care. To date, no empirical study has systematically assessed the performance of these care initiatives across the T2D care continuum in Cambodia. Objective: This study aimed to assess the performance of the 3 care initiatives---individually or in coexistence---and determine the factors associated with the failure to diagnose T2D in Cambodia. Methods: We used a cascade-of-care framework to assess the T2D care continuum. The cascades were generated using primary data from a cross-sectional population-based survey conducted in 2020 with 5072 individuals aged ?40 years. The survey was conducted in 5 operational districts (ODs) selected based on the availability of the care initiatives. Multiple logistic regression analysis was used to identify the factors associated with the failure to diagnose T2D. The significance level of P<.05 was used as a cutoff point. Results: Of the 5072 individuals, 560 (11.04\%) met the definition of a T2D diagnosis (fasting blood glucose level ?126 mg/dL and glycated hemoglobin level ?6.5\%). Using the 560 individuals as the fixed denominator, the cascade displayed substantial drops at the testing and control stages. Only 63\% (353/560) of the participants had ever tested their blood glucose level in the last 3 years, and only 10.7\% (60/560) achieved blood glucose level control with the cutoff point of glycated hemoglobin level <8\%. The OD hosting the coexistence of care displayed the worst cascade across all bars, whereas the OD with hospital-based care had the best cascade among the 5 ODs. Being aged 40 to 49 years, male, and in the poorest category of the wealth quintile were factors associated with the undiagnosed status. Conclusions: The unmet needs for T2D care in Cambodia were large, particularly in the testing and control stages, indicating the need to substantially improve early detection and management of T2D in the country. Rapid scale-up of T2D care components at public health facilities to increase the chances of the population with T2D of being tested, diagnosed, retained in care, and treated, as well as of achieving blood glucose level control, is vital in the health system. Specific population groups susceptible to being undiagnosed should be especially targeted for screening through active community outreach activities. Future research should incorporate digital health interventions to evaluate the effectiveness of the T2D care initiatives longitudinally with more diverse population groups from various settings based on routine data vital for integrated care. Trial Registration: International Standard Randomized Controlled Trials Number (ISRCTN) ISRCTN41932064; https://www.isrctn.com/ISRCTN41932064 International Registered Report Identifier (IRRID): RR2-10.2196/36747 ",
doi="10.2196/41902",
url="https://publichealth.jmir.org/2023/1/e41902",
url="http://www.ncbi.nlm.nih.gov/pubmed/37347529"
}


@Article{info:doi/10.2196/45626,
author="Norgren, Therese
and Richardson, X. Matt
and Wamala-Andersson, Sarah",
title="Obstacles to Evidence-Based Procurement, Implementation, and Evaluation of Health and Welfare Technologies in Swedish Municipalities: Mixed Methods Study",
journal="JMIR Form Res",
year="2023",
month="Jun",
day="15",
volume="7",
pages="e45626",
keywords="evaluation",
keywords="evidence",
keywords="health and welfare technology",
keywords="implementation",
keywords="mixed methods",
keywords="municipalities",
keywords="procurement",
keywords="social care",
keywords="effectiveness",
keywords="Sweden",
keywords="support",
keywords="design",
keywords="survey",
keywords="interview",
keywords="welfare",
keywords="technology",
abstract="Background: Health and welfare technologies (HWTs) are interventions that aim at maintaining or promoting health, well-being, quality of life, and increasing efficiency in the service delivery system of welfare, social, and health care services, while improving the working conditions of the staff. Health and social care must be evidence-based according to national policy, but there are indications that evidence for HWT effectiveness is lacking in related Swedish municipal work processes. Objective: This study aimed to investigate whether the evidence is used when Swedish municipalities procure, implement, and evaluate HWT, and if so, the kinds of evidence and the manner of their use. The study also aimed to identify if municipalities currently receive adequate support in using evidence for HWT, and if not, what support is desired. Methods: An explanatory sequential mixed methods design was used with quantitative surveys and subsequent semistructured interviews with officials in 5 nationally designated ``model'' municipalities regarding HWT implementation and use. Results: In the past 12 months, 4 of 5 municipalities had required some form of evidence during procurement processes, but the frequency of this varied and often consisted of references from other municipalities instead of other objective sources. Formulating requirements or requests for evidence during procurement was viewed as difficult, and gathered evidence was often only assessed by procurement administration personnel. In total, 2 of 5 municipalities used an established process for the implementation of HWT, and 3 of 5 had a plan for structured follow-up, but the use and dissemination of evidence within these were varying and often weakly integrated. Standardized processes for follow-up and evaluation across municipalities did not exist, and those processes used by individual municipalities were described as inadequate and difficult to follow. Most municipalities desired support for using evidence when procuring, establishing evaluation frameworks for, and following up effectiveness of HWT, while all municipalities suggested tools or methods for this kind of support. Conclusions: Structured use of evidence in procurement, implementation, and evaluation of HWT is inconsistent among municipalities, and internal and external dissemination of evidence for effectiveness is rare. This may establish a legacy of ineffective HWT in municipal settings. The results suggest that existing national agency guidance is not sufficient to meet current needs. New, more effective types of support to increase the use of evidence in critical phases of municipal procurement and implementation of HWT are recommended. ",
doi="10.2196/45626",
url="https://formative.jmir.org/2023/1/e45626",
url="http://www.ncbi.nlm.nih.gov/pubmed/37318831"
}


@Article{info:doi/10.2196/42254,
author="Gallagher, Kevin
and Bhatt, Nikita
and Clement, Keiran
and Zimmermann, Eleanor
and Khadhouri, Sinan
and MacLennan, Steven
and Kulkarni, Meghana
and Gaba, Fortis
and Anbarasan, Thineskrishna
and Asif, Aqua
and Light, Alexander
and Ng, Alexander
and Chan, Vinson
and Nathan, Arjun
and Cooper, David
and Aucott, Lorna
and Marcq, Gautier
and Teoh, Yuen-Chun Jeremy
and Hensley, Patrick
and Duncan, Eilidh
and Goulao, Beatriz
and O'Brien, Tim
and Nielsen, Matthew
and Mariappan, Paramananthan
and Kasivisvanathan, Veeru",
title="Audit, Feedback, and Education to Improve Quality and Outcomes in Transurethral Resection and Single-Instillation Intravesical Chemotherapy for Nonmuscle Invasive Bladder Cancer Treatment: Protocol for a Multicenter International Observational Study With an Embedded Cluster Randomized Trial",
journal="JMIR Res Protoc",
year="2023",
month="Jun",
day="15",
volume="12",
pages="e42254",
keywords="TURBT",
keywords="bladder cancer",
keywords="quality improvement",
keywords="performance feedback",
keywords="transurethral resection",
keywords="urology",
keywords="oncology",
keywords="recurrence",
keywords="surgery",
keywords="surgical",
keywords="quality indicator",
keywords="performance",
keywords="feedback",
keywords="evaluation",
abstract="Background: Nonmuscle invasive bladder cancer (NMIBC) accounts for 75\% of bladder cancers. It is common and costly. Cost and detriment to patient outcomes and quality of life are driven by high recurrence rates and the need for regular invasive surveillance and repeat treatments. There is evidence that the quality of the initial surgical procedure (transurethral resection of bladder tumor [TURBT]) and administration of postoperative bladder chemotherapy significantly reduce cancer recurrence rates and improve outcomes (cancer progression and mortality). There is surgeon-reported evidence that TURBT practice varies significantly across surgeons and sites. There is limited evidence from clinical trials of intravesical chemotherapy that NMIBC recurrence rate varies significantly between sites and that this cannot be accounted for by differences in patient, tumor, or adjuvant treatment factors, suggesting that how the surgery is performed may be a reason for the variation. Objective: This study primarily aims to determine if feedback on and education about surgical quality indicators can improve performance and secondarily if this can reduce cancer recurrence rates. Planned secondary analyses aim to determine what surgeon, operative, perioperative, institutional, and patient factors are associated with better achievement of TURBT quality indicators and NMIBC recurrence rates. Methods: This is an observational, international, multicenter study with an embedded cluster randomized trial of audit, feedback, and education. Sites will be included if they perform TURBT for NMIBC. The study has four phases: (1) site registration and usual practice survey; (2) retrospective audit; (3) randomization to audit, feedback, and education intervention or to no intervention; and (4) prospective audit. Local and national ethical and institutional approvals or exemptions will be obtained at each participating site. Results: The study has 4 coprimary outcomes, which are 4 evidence-based TURBT quality indicators: a surgical performance factor (detrusor muscle resection); an adjuvant treatment factor (intravesical chemotherapy administration); and 2 documentation factors (resection completeness and tumor features). A key secondary outcome is the early cancer recurrence rate. The intervention is a web-based surgical performance feedback dashboard with educational and practical resources for TURBT quality improvement. It will include anonymous site and surgeon-level peer comparison, a performance summary, and targets. The coprimary outcomes will be analyzed at the site level while recurrence rate will be analyzed at the patient level. The study was funded in October 2020 and began data collection in April 2021. As of January 2023, there were 220 hospitals participating and over 15,000 patient records. Projected data collection end date is June 30, 2023. Conclusions: This study aims to use a distributed collaborative model to deliver a site-level web-based performance feedback intervention to improve the quality of endoscopic bladder cancer surgery. The study is funded and projects to complete data collection in June 2023. Trial Registration: ClinicalTrials.org NCT05154084; https://clinicaltrials.gov/ct2/show/NCT05154084 International Registered Report Identifier (IRRID): DERR1-10.2196/42254 ",
doi="10.2196/42254",
url="https://www.researchprotocols.org/2023/1/e42254",
url="http://www.ncbi.nlm.nih.gov/pubmed/37318875"
}


@Article{info:doi/10.2196/38696,
author="O'Callaghan, Erin
and Belanger, Heather
and Lucero, Steven
and Boston, Shannon
and Winsberg, Mirene",
title="Consumer Expectations and Attitudes About Psychotherapy: Survey Study",
journal="JMIR Form Res",
year="2023",
month="Jun",
day="8",
volume="7",
pages="e38696",
keywords="internet",
keywords="survey",
keywords="psychotherapy",
keywords="telehealth, psychiatry, mental health",
abstract="Background: Although mental illness is common among adults in the United States, access to, and public perception of, mental health care continue to present as key barriers to care. Objective: Given the importance of attitudes toward, and perceptions of, mental health treatment in the successful access to mental health care and treatment of mental health issues, the primary goal of this survey study was to further investigate consumer perspectives of psychotherapy among adults in the United States; specifically, adding to the literature by investigating perceptions of both the general public and patients receiving telehealth. More specifically, the aims were to better understand openness to, and satisfaction with, therapy; perceptions, preferences, and expectations around therapy; and perceptions of psychotropic medication. Methods: An electronic survey was administered to current and former patients (those receiving psychotherapy) of Brightside, a nationwide telehealth company, as well as to the general public; both were convenience samples. Using the same survey questions, Brightside surveyed its own members (using Qualtrics; Qualtrics International Inc) and the general population (using SurveyMonkey's Audience tool; Momentive). This survey included questions about basic participant demographics, as well as questions about current mental health treatment, perceptions about therapy, and therapists' qualities. Results: A total of 714 people completed the survey. The data were fairly evenly split between those collected from Brightside patients (368/714, 51.5\%) and those collected from the general public (346/714, 48.5\%). Combining both samples, overall participation was 67.1\% (479/714) women; 73.1\% (522/714) White, 7.3\% (52/714) Asian, 6.7\% (48/714) African American, and 7.4\% (53/714) Hispanic or Latinx; largely aged 25 to 34 years (255/714, 35.7\%) or 35 to 44 years (187/714, 26.2\%); from either the Mid-Atlantic (131/714, 18.3\%) or South Atlantic (129/714, 18.1\%) regions of the country; and most (402/714, 56.3\%) earning annual salaries of US \$30,000 to US \$100,000. There were generally favorable perceptions of both psychotherapy and psychiatric medication. Selecting a therapist as well as cost and insurance are the common factors in therapy that are important to patients. The most commonly held perception of psychotherapy duration was indefinite (250/714, 35\%). Very few (58/714, 8.1\%) thought that therapy typically lasts 1 to 3 months. Most of the participants (414/714, 58\%) thought that evidence-based practice was important. Conclusions: Public education is needed to increase awareness of the typical duration and cost of psychotherapy. There seem to be generally favorable perceptions of both psychotherapy and psychotropic medication. Selecting a therapist as well as cost and insurance are the common factors in therapy that are important to patients. Practitioners and those marketing their services might consider using their marketing campaigns to counter some of the more common falsely held beliefs. ",
doi="10.2196/38696",
url="https://formative.jmir.org/2023/1/e38696",
url="http://www.ncbi.nlm.nih.gov/pubmed/37289494"
}


@Article{info:doi/10.2196/40000,
author="Ju, Hsiao-Hui
and Momin, Rashmi
and Cron, Stanley
and Jularbal, Jed
and Alford, Jeffery
and Johnson, Constance",
title="A Nurse-Led Telehealth Program for Diabetes Foot Care: Feasibility and Usability Study",
journal="JMIR Nursing",
year="2023",
month="Jun",
day="6",
volume="6",
pages="e40000",
keywords="diabetes mellitus, type 2",
keywords="telehealth",
keywords="telemedicine",
keywords="foot care education",
keywords="self-management",
keywords="self-care",
keywords="preventive health services",
keywords="patient education",
keywords="diabetes complications",
keywords="diabetic foot",
abstract="Background: Diabetes mellitus can lead to severe and debilitating foot complications, such as infections, ulcerations, and amputations. Despite substantial progress in diabetes care, foot disease remains a major challenge in managing this chronic condition that causes serious health complications worldwide. Objective: The primary aim of this study was to examine the feasibility and usability of a telehealth program focused on preventive diabetes foot care. A secondary aim was to descriptively measure self-reported changes in diabetes knowledge, self-care, and foot care behaviors before and after participating in the program. Methods: The study used a single-arm, pre-post design in 2 large family medical practice clinics in Texas. Participants met individually with the nurse practitioner once a month for 3 months using synchronous telehealth videoconferencing. Each participant received diabetes foot education guided by the Integrated Theory of Health Behavior Change. Feasibility was measured with rates of enrollment and program and assessment completion. Usability was measured with the Telehealth Usability Questionnaire. Diabetes knowledge, self-care, and foot care behaviors were measured with validated survey instruments at baseline, 1.5 months, and 3 months. Results: Of 50 eligible individuals, 39 (78\%) enrolled; 34 of 39 (87\%) completed the first videoconference and 29 of 39 (74\%) completed the second and third videoconferences. Of the 39 who consented, 37 (95\%) completed the baseline assessment; 50\% (17/34) of those who attended the first videoconference completed the assessment at 1.5 months, and 100\% (29/29) of those who attended the subsequent videoconferences completed the final assessment. Overall, participants reported a positive attitude toward the use of telehealth, with a mean Telehealth Usability Questionnaire score of 6.24 (SD 0.98) on a 7-point scale. Diabetes knowledge increased by a mean of 15.82 (SD 16.69) points of 100 (P<.001) from baseline to 3 months. The values for the Summary of Diabetes Self-Care Activities measure demonstrated better self-care, with participants performing foot care on average 1.74 (SD 2.04) more days per week (P<.001), adhering to healthy eating habits on average 1.57 (SD 2.12) more days per week (P<.001), and being physically active on average 1.24 (SD 2.21) more days per week (P=.005). Participants also reported an improvement in the frequency of foot self-examinations and general foot care behaviors. The mean scores for foot care increased by a mean of 7.65 (SD 7.04) points (scale of 7 to 35) from baseline to 3 months postintervention (P<.001). Conclusions: This study demonstrates that a nurse-led telehealth educational program centered on diabetes foot care is feasible, acceptable, and has the potential to improve diabetes knowledge and self-care, which are precursors to preventing debilitating foot complications. ",
doi="10.2196/40000",
url="https://nursing.jmir.org/2023/1/e40000",
url="http://www.ncbi.nlm.nih.gov/pubmed/37279046"
}


@Article{info:doi/10.2196/46721,
author="Zhou, Weijiao
and Cho, Youmin
and Shang, Shaomei
and Jiang, Yun",
title="Use of Digital Health Technology Among Older Adults With Cancer in the United States: Findings From a National Longitudinal Cohort Study (2015-2021)",
journal="J Med Internet Res",
year="2023",
month="May",
day="31",
volume="25",
pages="e46721",
keywords="digital health",
keywords="technology",
keywords="older adults",
keywords="cancer",
keywords="survivorship",
keywords="cancer survivor",
keywords="older cancer survivors",
keywords="digital health technology",
abstract="Background: Despite the benefits of digital health technology use, older adults with cancer (ie, aged 65 years) have reported challenges to technology adoption. However, there has been a lack of a good understanding of their digital health technology use patterns and the associated influential factors in the past few years. Objective: This study aimed to examine the trends in and factors associated with digital health technology use among older adults with cancer. Methods: The National Health and Aging Trends Study (NHATS) data set is a national longitudinal cohort study with annual survey waves of Medicare beneficiaries 65 years and older. Participants were community-dwelling older adults who self-reported previous or current cancer diagnoses in each round. The study sample size of each round ranged from 1996 (2015) to 1131 (2021). Digital health technology use was defined as using the internet or online in the last month to order or refill prescriptions, contact medical providers, handle Medicare or other insurance matters, or get information about their health conditions. The association of sociodemographics, clinical factors (self-rated health, chronic conditions, difficulties in activities of daily living, dementia, anxiety, and depression), and physical function (Short Physical Performance Battery and grip strength) with digital health technology use was examined using design-based logistic regression. All statistical analyses accounted for the complex sample design. Results: The prevalence of any digital health technology use increased from 36\% in 2015 to 45\% in 2019. In 2020-2021, which was amid the COVID-19 pandemic, it ranged from 51\% to 52\%. In terms of each digital health technology use behavior, in 2015, overall, 28\% of older cancer survivors used digital health technology to obtain health information, followed by contacting clinicians (19\%), filling prescriptions (14\%), and handling insurance (11\%). Greater use of digital health technology was associated with younger age, being White, having a college or higher education, having a higher income, having more comorbidities, nondementia, and having a higher gait speed. Conclusions: Digital health technology use in older adults with cancer has gradually increased, particularly during the COVID-19 pandemic. However, socioeconomic and racial disparities have remained in older cancer survivors. Additionally, older adults with cancer may have some unique features associated with digital health technology use; for example, their use of digital health may be increased by their comorbidities (ie, health care needs) and reduced by their frailty. ",
doi="10.2196/46721",
url="https://www.jmir.org/2023/1/e46721",
url="http://www.ncbi.nlm.nih.gov/pubmed/37256672"
}


@Article{info:doi/10.2196/46595,
author="Nygren, M. Jens
and Lundgren, Lina
and B{\"a}ckstr{\"o}m, Ingela
and Svedberg, Petra",
title="Strengthening Digital Transformation and Innovation in the Health Care System: Protocol for the Design and Implementation of a Multidisciplinary National Health Innovation Research School",
journal="JMIR Res Protoc",
year="2023",
month="May",
day="31",
volume="12",
pages="e46595",
keywords="digital health technology",
keywords="doctoral education",
keywords="health",
keywords="health care",
keywords="health innovation",
keywords="implementation",
keywords="improvement",
keywords="innovation",
keywords="research school",
abstract="Background: Digital health technologies have the potential to transform health care services to be more cost-effective, coordinated, and accessible on equal terms for entire populations. In the future, people will be assisted by such technologies to monitor their health status, take preventive measures, and have more control of their health situation. An increase in digital supplementation or substitution of physical care visits can potentially add value to patients and care providers by increasing accessibility, safety, and quality of care. However, health care organizations struggle with the challenges of developing and implementing digital health technologies and services in practice. As a response to this, we have developed a national multidisciplinary research school to increase competence and capacity for research on the development, implementation, and dissemination of digital health technology solutions. The overall aim of the research school is to increase national competence and capacity for the development, implementation, and dissemination of digital health technology to increase the preparedness to support and facilitate the ongoing digital transformation in the health care system. Objective: The purpose of this paper is to outline the protocol for the development and implementation of a national multidisciplinary doctoral education program of health innovation supporting digital transformation in the health care system. Methods: A national multidisciplinary research school for health innovation was planned in collaboration between 7 Swedish universities and their partners from industry and the public sector. The research school will run over 6 years, of which 5 years are dedicated for the doctoral education program and 1 year for the project start-up and closing. In this paper, we outline the methodological approach of the research school; the combining of knowledge and expertise of the universities that are important to run the research school; the jointly formulated research-oriented and societally relevant research focus, goals, and objectives for the research school; the established and developed relationships with partners from industry and the public sector for joint research training projects; the forms of collaboration in the research school; and the format of the doctoral education process. Results: The research school was funded in December 2021 and started in March 2022. The research school starts with an initiation period from March 2022 to December 2022 where the infrastructure and the action plans to run the school are set up. The PhD projects start in January 2023, and these projects will be completed in 5 years. Additional activities within the research program are doctoral courses, networking activities, and dissemination of results. Conclusions: The network of several partners from industry, public sector, and academia enables the research school to pose research questions that can contribute to solving relevant societal problems related to the development, evaluation, implementation, and dissemination of methods and processes assisted by digital technologies. Ultimately, this will promote innovation to improve health outcomes, quality of care, and prioritizations of resources. International Registered Report Identifier (IRRID): PRR1-10.2196/46595 ",
doi="10.2196/46595",
url="https://www.researchprotocols.org/2023/1/e46595",
url="http://www.ncbi.nlm.nih.gov/pubmed/37256654"
}


@Article{info:doi/10.2196/46371,
author="Lee, Hocheol
and Koh, Baek Sang
and Jo, Sug Heui
and Lee, Ho Tae
and Nam, Kweun Hae
and Zhao, Bo
and Lim, Subeen
and Lim, Aeh Joo
and Lee, Hee Ho
and Hwang, Seong Yu
and Kim, Hyun Dong",
title="Evaluating the Effectiveness of Rural Digital Social Prescribing in Korea: Protocol for a Cohort Study",
journal="JMIR Res Protoc",
year="2023",
month="May",
day="24",
volume="12",
pages="e46371",
keywords="digital health",
keywords="digital social prescribing",
keywords="elderly health",
keywords="community health",
keywords="digital health intervention",
abstract="Background: The UK National Health Service (NHS) has introduced a digital social prescribing (DSP) system to improve the mental health of the aging population. In Korea, an ongoing pilot social prescribing project has been implemented for older individuals in rural areas since 2019. Objective: This research aims to develop a DSP program and to evaluate the effectiveness of the digital platform in rural areas of Korea. Methods: This study was designed as a prospective cohort method for the development and effectiveness evaluation of rural DSP in Korea. The study divided participants into four groups. Group 1 will continuously implement the existing social prescribing program, group 2 implemented the existing social prescribing program but was switched to DSP in 2023, group 3 newly started the DSP, and the remaining group is the control. The research area of this study is Gangwon Province in Korea. The study is being conducted in Wonju, Chuncheon, and Gangneung. This study will use indicators to measure depression, anxiety, loneliness, cognitive function, and digital literacy. In the future, the interventions will implement the digital platform and the Music Story Telling program. This study will evaluate the effectiveness of DSP using difference-in-differences regression and cost-benefit analysis. Results: This study was approved for funding from the National Research Foundation of Korea funded by the Ministry of Education in October 2022. The results of the data analysis are expected to be available in September 2023. Conclusions: The platform will be spread to rural areas in Korea and will serve as the foundation for effectively managing the feelings of solitude and depression among older individuals. This study will provide vital evidence for disseminating DSP in Asian countries such as Japan, China, Singapore, and Taiwan as well as for studying DSP in Korea. International Registered Report Identifier (IRRID): PRR1-10.2196/46371 ",
doi="10.2196/46371",
url="https://www.researchprotocols.org/2023/1/e46371",
url="http://www.ncbi.nlm.nih.gov/pubmed/37223972"
}


@Article{info:doi/10.2196/43381,
author="Chen, Ying
and Pan, Mingming
and He, Yaling
and Dong, Xiaokang
and Hu, Ze
and Hou, Jian
and Bao, Yining
and Yang, Jing
and Yuchi, Yinghao
and Li, Ruiying
and Zhu, Linghui
and Kang, Ning
and Liao, Wei
and Li, Shuoyi
and Wang, Chongjian
and Zhang, Lei",
title="Disease Burden and the Accumulation of Multimorbidity of Noncommunicable Diseases in a Rural Population in Henan, China: Cross-sectional Study",
journal="JMIR Public Health Surveill",
year="2023",
month="May",
day="22",
volume="9",
pages="e43381",
keywords="multimorbidity",
keywords="prevalence",
keywords="associating factors",
keywords="noncommunicable disease accumulation",
keywords="NCD accumulation",
keywords="public health",
abstract="Background: Multimorbidity causes substantial disease and economic burdens on individuals and the health care system. Objective: This study aimed to explore the disease burden of multimorbidity and the potential correlations among chronic noncommunicable diseases (NCDs) in a rural population in Henan, China. Methods: A cross-sectional analysis was performed using the baseline survey of the Henan Rural Cohort Study. Multimorbidity was defined as the simultaneous occurrence of at least two NCDs in a participant. This study examined the multimorbidity pattern of 6 NCDs, including hypertension, dyslipidemia, type 2 diabetes mellitus, coronary heart disease, stroke, and hyperuricemia. Results: From July 2015 to September 2017, a total of 38,807 participants (aged 18-79 years; 15,354 men and 23,453 women) were included in this study. The overall population prevalence of multimorbidity was 28.1\% (10,899/38,807), and the multimorbidity of hypertension and dyslipidemia was the most common (8.1\%, 3153/38,807). Aging, higher BMI, and unfavorable lifestyles were significantly associated with a higher risk of multimorbidity (multinomial logistic regression, all P<.05). The analysis of the mean age at diagnosis suggested a cascade of interrelated NCDs and their accumulation over time. Compared with participants without 2 conditional NCDs, participants with 1 conditional NCD would have higher odds of another NCD (1.2-2.5; all P<.05), and those with 2 conditional NCDs would elevate the odds of the third NCD to 1.4-3.5 (binary logistic regression, all P<.05). Conclusions: Our findings indicate a plausible tendency for the coexistence and accumulation of NCDs in a rural population in Henan, China. Early prevention of multimorbidity is essential to reduce the NCD burden in the rural population. ",
doi="10.2196/43381",
url="https://publichealth.jmir.org/2023/1/e43381",
url="http://www.ncbi.nlm.nih.gov/pubmed/37213192"
}


@Article{info:doi/10.2196/46673,
author="Olesen, Linnet Mette
and Rossen, Sine
and J{\o}rgensen, Rikke
and Langballe Udbj{\o}rg, Line
and Hansson, Helena",
title="Usefulness of a Digitally Assisted Person-Centered Care Intervention: Qualitative Study of Patients' and Nurses' Experiences in a Long-term Perspective",
journal="JMIR Nursing",
year="2023",
month="May",
day="18",
volume="6",
pages="e46673",
keywords="digital technology",
keywords="digital nursing",
keywords="digitally assisted guided self-determination",
keywords="empowerment",
keywords="self-management",
keywords="person-centered care",
keywords="qualitative",
keywords="service design",
keywords="patient care",
keywords="nurse",
keywords="quality of life",
keywords="interview",
keywords="web-based questionnaire",
keywords="functionality",
keywords="support",
keywords="training",
keywords="implementation",
keywords="self-determination",
keywords="autonomy",
keywords="agency",
keywords="person centered",
keywords="patient centered",
keywords="client focus",
keywords="gynecology",
keywords="oncology",
keywords="health knowledge",
keywords="health care professional",
keywords="health care provider",
keywords="HCP",
keywords="mobile phone",
abstract="Background: Person-centered care responsive to individual preferences, needs, and values is recognized as an important aspect of high-quality health care, and patient empowerment is increasingly viewed as a central core value of person-centered care. Web-based interventions aimed at empowerment report a beneficial effect on patient empowerment and physical activity; however, there is limited information available on barriers, facilitators, and user experiences. A recent review of the effect of digital self-management support tools suggests a beneficial effect on the quality of life in patients with cancer. On the basis of an overall philosophy of empowerment, guided self-determination is a person-centered intervention that uses preparatory reflection sheets to help achieve focused communication between patients and nurses. The intervention was adapted into a digital version called digitally assisted guided self-determination (DA-GSD) hosted by the Sundhed DK website that can be delivered face-to-face, via video, or by the combination of the 2 methods. Objective: We aimed to investigate the experiences of nurses, nurse managers, and patients of using DA-GSD in 2 oncology departments and 1 gynecology department over a 5-year implementation period from 2018 to 2022. Methods: This qualitative study was inspired by action research comprising the responses of 17 patients to an open-ended question on their experience of specific aspects of DA-GSD in a web questionnaire, 14 qualitative semistructured interviews with nurses and patients who initially completed the web questionnaire, and transcripts of meetings held between the researchers and nurses during the implementation of the intervention. The thematic analysis of all data was done using NVivo (QSR International). Results: The analysis generated 2 main themes and 7 subthemes that reflect conflicting perspectives and greater acceptability of the intervention among the nurses over time owing to better familiarity with the increasingly mature technology. The first theme was the different experiences and perspectives of nurses and patients concerning barriers to using DA-GSD and comprised 4 subthemes: conflicting perspectives on the ability of patients to engage with DA-GSD and how to provide it, conflicting perspectives on DA-GSD as a threat to the nurse-patient relationship, functionality of DA-GSD and available technical equipment, and data security. The other theme was what influenced the increased acceptability of DA-GSD among the nurses over time and comprised 3 subthemes: a re-evaluation of the nurse-patient relationship; improved functionality of DA-GSD; and supervision, experience, patient feedback, and a global pandemic. Conclusions: The nurses experienced more barriers to DA-GSD than the patients did. Acceptance of the intervention increased over time among the nurses in keeping with the intervention's improved functionality, additional guidance, and positive experiences, combined with patients finding it useful. Our findings emphasize the importance of supporting and training nurses if new technologies are to be implemented successfully. ",
doi="10.2196/46673",
url="https://nursing.jmir.org/2023/1/e46673",
url="http://www.ncbi.nlm.nih.gov/pubmed/37200076"
}


@Article{info:doi/10.2196/45718,
author="Zhao, Xin
and Stadnick, A. Nicole
and Ceballos-Corro, Eduardo
and Castro Jr, Jorge
and Mallard-Swanson, Kera
and Palomares, J. Kristina
and Eikey, Elizabeth
and Schneider, Margaret
and Zheng, Kai
and Mukamel, B. Dana
and Schueller, M. Stephen
and Sorkin, H. Dara",
title="Facilitators of and Barriers to Integrating Digital Mental Health Into County Mental Health Services: Qualitative Interview Analyses",
journal="JMIR Form Res",
year="2023",
month="May",
day="16",
volume="7",
pages="e45718",
keywords="digital mental health",
keywords="mobile health",
keywords="mHealth",
keywords="implementation readiness",
keywords="implementation science",
keywords="qualitative analyses",
keywords="mobile phone",
abstract="Background: Digital mental health interventions (DMHIs) represent a promising solution to address the growing unmet mental health needs and increase access to care. Integrating DMHIs into clinical and community settings is challenging and complex. Frameworks that explore a wide range of factors, such as the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, can be useful for examining multilevel factors related to DMHI implementation efforts. Objective: This paper aimed to identify the barriers to, facilitators of, and best practice recommendations for implementing DMHIs across similar organizational settings, according to the EPIS domains of inner context, outer context, innovation factors, and bridging factors. Methods: This study stems from a large state-funded project in which 6 county behavioral health departments in California explored the use of DMHIs as part of county mental health services. Our team conducted interviews with clinical staff, peer support specialists, county leaders, project leaders, and clinic leaders using a semistructured interview guide. The development of the semistructured interview guide was informed by expert input regarding relevant inner context, outer context, innovation factors, and bridging factors in the exploration, preparation, and implementation phases of the EPIS framework. We followed a recursive 6-step process to conduct qualitative analyses using inductive and deductive components guided by the EPIS framework. Results: On the basis of 69 interviews, we identified 3 main themes that aligned with the EPIS framework: readiness of individuals, readiness of innovations, and readiness of organizations and systems. Individual-level readiness referred to the extent to which clients had the necessary technological tools (eg, smartphones) and knowledge (digital literacy) to support the DMHI. Innovation-level readiness pertained to the accessibility, usefulness, safety, and fit of the DMHI. Organization- and system-level readiness concerned the extent to which providers and leadership collectively held positive views about DMHIs as well as the extent to which infrastructure (eg, staffing and payment model) was appropriate. Conclusions: The successful implementation of DMHIs requires readiness at the individual, innovation, and organization and system levels. To improve individual-level readiness, we recommend equitable device distribution and digital literacy training. To improve innovation readiness, we recommend making DMHIs easier to use and introduce, clinically useful, and safe and adapting them to fit into the existing client needs and clinical workflow. To improve organization- and system-level readiness, we recommend supporting providers and local behavioral health departments with adequate technology and training and exploring potential system transformations (eg, integrated care model). Conceptualizing DMHIs as services allows the consideration of both the innovation characteristics of DMHIs (eg, efficacy, safety, and clinical usefulness) and the ecosystem around DMHIs, such as individual and organizational characteristics (inner context), purveyors and intermediaries (bridging factor), client characteristics (outer context), as well as the fit between the innovation and implementation settings (innovation factor). ",
doi="10.2196/45718",
url="https://formative.jmir.org/2023/1/e45718",
url="http://www.ncbi.nlm.nih.gov/pubmed/37191975"
}


@Article{info:doi/10.2196/43604,
author="Williams, Cynthia
and Shang, Di",
title="Telehealth Usage Among Low-Income Racial and Ethnic Minority Populations During the COVID-19 Pandemic: Retrospective Observational Study",
journal="J Med Internet Res",
year="2023",
month="May",
day="12",
volume="25",
pages="e43604",
keywords="COVID-19",
keywords="telehealth",
keywords="health equity",
keywords="minority health",
keywords="low income",
keywords="healthcare access",
keywords="pandemic",
keywords="USA",
keywords="United States",
keywords="healthcare system",
keywords="health care",
keywords="risk",
keywords="minority",
keywords="database",
keywords="utilization",
keywords="education",
abstract="Background: Despite considerable efforts to encourage telehealth use during the COVID-19 pandemic, we witnessed a potential widening of health inequities that may continue to plague the US health care system unless we mitigate modifiable risk factors. Objective: This study aimed to examine the hypothesis that there are systemic differences in telehealth usage among people who live at or below 200\% of the federal poverty level. Factors that we consider are age, gender, race, ethnicity, education, employment status, household size, and income. Methods: A retrospective observational study was performed using the COVID-19 Research Database to analyze factors contributing to telehealth inequities. The study period ranged from March 2020 to April 2021. The Office Ally database provided US claims data from 100 million unique patients and 3.4 billion claims. The Analytics IQ PeopleCore Consumer database is nationally representative of 242.5 million US adults aged 19 years and older. We analyzed medical claims to investigate the influence of demographic and socioeconomic factors on telehealth usage among the low-income racial and ethnic minority populations. We conducted a multiple logistic regression analysis to determine the odds of patients in diverse groups using telehealth during the study period. Results: Among 2,850,831 unique patients, nearly 60\% of them were female, 75\% of them had a high school education or less, 49\% of them were unemployed, and 62\% of them identified as non-Hispanic White. Our results suggest that 9.84\% of the patients had ?1 telehealth claims during the study period. Asian (odds ratio [OR] 1.569, 95\% CI 1.528-1.611, P<.001) and Hispanic (OR 1.612, 95\% CI 1.596-1.628, P<.001) patients were more likely to use telehealth than non-Hispanic White and -Black patients. Patients who were employed full-time were 15\% (OR 1.148, 95\% CI 1.133-1.164, P<.001) more likely to use telehealth than unemployed patients. Patients who identified as male were 12\% (OR 0.875, 95\% CI 0.867-0.883, P<.001) less likely to use telehealth than those who identified as female. Patients with high school education or less were 5\% (OR 0.953, 95\% CI 0.944-0.962, P<.001) less likely to use telehealth than those with a bachelor's degree or higher. Patients in the 18-44--year age group were 32\% (OR 1.324, 95\% CI 1.304-1.345, P<.001) more likely to use telehealth than those in the ?65-year age group. Conclusions: Factors that impact telehealth usage include age, gender, race, education, employment status, and income. While low-income racial and ethnic minority communities are at greater risk for health inequities among this group, Hispanic communities are more likely to use telehealth, and non-Hispanic Black patients continue to demonstrate telehealth inequity. Gender, age, and household income contribute to health inequities across gradients of poverty. Strategies to improve health use should consider characteristics of subgroups, as people do not experience poverty equally. ",
doi="10.2196/43604",
url="https://www.jmir.org/2023/1/e43604",
url="http://www.ncbi.nlm.nih.gov/pubmed/37171848"
}


@Article{info:doi/10.2196/41487,
author="Mamuye, Adane
and Nigatu, Mesfin Araya
and Chanyalew, Asressie Moges
and Amor, Ben Lamia
and Loukil, Sihem
and Moyo, Chris
and Quarshie, Samuel
and Antypas, Konstantinos
and Tilahun, Binyam",
title="Facilitators and Barriers to the Sustainability of eHealth Solutions in Low- and Middle-Income Countries: Descriptive Exploratory Study",
journal="JMIR Form Res",
year="2023",
month="May",
day="12",
volume="7",
pages="e41487",
keywords="attributes",
keywords="Africa",
keywords="eHealth",
keywords="low- and middle-income countries",
keywords="sustainability",
abstract="Background: Despite the widely anticipated benefits of eHealth technologies in enhancing health care service delivery, the sustainable usage of eHealth in transitional countries remains low. There is limited evidence supporting the low sustainable adoption of eHealth in low- and middle-income countries. Objective: The aim of this study was to explore the facilitators and barriers to the sustainable use of eHealth solutions in low- and middle-income nations. Methods: A qualitative descriptive exploratory study was conducted in 4 African nations from September to December 2021. A semistructured interview guide was used to collect the data. Data were audio-recorded and transcribed from the local to the English language verbatim, and the audio data were transcribed. On the basis of the information gathered, we assigned codes to the data, searched for conceptual patterns, and created emerging themes. Data were analyzed thematically using OpenCode software. Results: A total of 49 key informant interviews (10 from Tunisia, 15 from Ethiopia, 13 from Ghana, and 11 from Malawi) were conducted. About 40.8\% (20/49) of the study participants were between the ages of 26 and 35 years; 73.5\% (36/49) of them were male participants; and 71.4\% (35/49) of them had a master's degree or higher in their educational background. Additionally, the study participants' work experience ranged from 2 to 35 years. Based on the data we gathered, we identified 5 themes: organizational, technology and technological infrastructure, human factors, economy or funding, and policy and regulations. Conclusions: This study explores potential facilitators and barriers to long-term eHealth solution implementation. Addressing barriers early in the implementation process can aid in the development of eHealth solutions that will better fulfill the demands of end users. Therefore, focusing on potential challenges would enhance the sustainability of eHealth solutions in low- and middle-income countries. ",
doi="10.2196/41487",
url="https://formative.jmir.org/2023/1/e41487",
url="http://www.ncbi.nlm.nih.gov/pubmed/37171865"
}


@Article{info:doi/10.2196/45248,
author="Brannigan, M. Jamie F.
and Mowforth, D. Oliver
and Rogers, Matthew
and Wood, Helen
and Karimi, Zahabiya
and Kotter, N. Mark R.
and Davies, M. Benjamin",
title="Osteopathy in the Early Diagnosis and Management of Degenerative Cervical Myelopathy: National Survey",
journal="JMIR Form Res",
year="2023",
month="May",
day="9",
volume="7",
pages="e45248",
keywords="cervical cord",
keywords="myelopathy",
keywords="spondylosis",
keywords="stenosis",
keywords="disc herniation",
keywords="ossification posterior longitudinal ligament",
keywords="degeneration",
keywords="disability",
keywords="diagnosis",
keywords="degenerative cervical myelopathy",
keywords="spine",
keywords="osteopathy",
keywords="neurodegenerative condition",
keywords="surgical decompression",
keywords="neurodegeneration",
keywords="survey",
abstract="Background: Degenerative cervical myelopathy (DCM) is a common and disabling neurodegenerative condition. Surgical decompression is the only evidence-based treatment to halt disease progression; however, diagnosis and access to timely treatment are often delayed, which contribute to significant disability and dependence. Supporting early diagnosis and access to timely treatment is a critical priority. Exploring these challenges, Myelopathy.org has observed that people with DCM may seek osteopathy care for their symptoms, both before and after diagnosis. Objective: This study aimed to describe the current interaction between osteopaths and people with DCM and understand how this may be targeted to enhance the DCM diagnostic pathway. Methods: Registered osteopaths in the United Kingdom completed a web-based survey hosted by the Institute of Osteopathy, as part of their institute's 2021 census. Responses were collected from February to May 2021. Demographic information about the respondents was captured, including age, gender, and ethnicity. Professional information captured included the year of qualification; region of practice; type of practice; and number of undiagnosed, operated diagnosed, and unoperated diagnosed DCM cases encountered per year. The completion of the survey was voluntary; however, a prize draw incentive was offered to participants. Results: The demographics were heterogenous for the 547 practitioners who completed the survey. There was representation from a wide range of demographic groups, including the level of experience, gender, age, and the region of United Kingdom. At least 68.9\% (377/547) of osteopaths reported encounters with DCM each year. Osteopaths most frequently encountered patients with undiagnosed DCM, with a mean of 3 patient encounters per year. This compares to 2 encounters per year with patients with diagnosed DCM. The level of practitioner experience was positively correlated with the detection of undiagnosed DCM (P<.005). The influence of practitioner experience was corroborated by a subgroup analysis looking at the relationship between practitioner age on the detection of undiagnosed DCM. Osteopaths older than 54 years encountered an average of 4.2 cases per year, whereas those younger than 35 years detected 2.9 cases per year. Osteopaths in private clinics reported encounters with a greater mean number (4.4) of undiagnosed DCM cases per year than osteopaths in other clinic types (3.0). Conclusions: Osteopaths reported that they frequently consult people with DCM, including those suspected to have undiagnosed or presurgical DCM. Given this concentrated presentation of early DCM and a workforce professionally trained to examine musculoskeletal disease, osteopaths could have an important role in accelerating access to timely treatment. We included a decision support tool and specialist referral template as a tool to support onward care. ",
doi="10.2196/45248",
url="https://formative.jmir.org/2023/1/e45248",
url="http://www.ncbi.nlm.nih.gov/pubmed/37159244"
}


@Article{info:doi/10.2196/44825,
author="Osborne-Grinter, Maia
and Bianca, Chiamaka Offorbuike
and Sanghera, Jasleen
and Kaliaperumal, Chandrasekaran",
title="Fertility Preservation Techniques in Neuro-Oncology Patients: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2023",
month="May",
day="8",
volume="12",
pages="e44825",
keywords="fertility",
keywords="reproduction",
keywords="central nervous system",
keywords="CNS cancer",
keywords="neuro-oncology",
keywords="cancer",
keywords="awareness",
keywords="electronic database",
keywords="tool",
keywords="fertility preservation",
keywords="patient",
keywords="treatment",
keywords="reproductive",
keywords="oncology",
keywords="infertility",
keywords="in vitro fertilization",
keywords="artificial insemination",
keywords="human reproduction",
keywords="gynecology",
keywords="gynecologist",
keywords="assisted reproductive technology",
keywords="gestational surrogacy",
keywords="surrogate",
keywords="fertility tourism",
keywords="test tube baby",
keywords="intracytoplasmic sperm injection",
abstract="Background: Advancements in cancer treatments have successfully improved central nervous system (CNS) cancer survivorship and overall quality of life. As a result, the awareness of the importance of fertility preservation techniques is increasing. Currently, a range of established techniques, such as oocyte cryopreservation and sperm cryopreservation, are available. However, oncologists may be hesitant to refer patients to a reproductive specialist. Objective: The primary aim of the proposed systematic review is to assess the best evidence for fertility preservation techniques used in patients with CNS cancers. It also aims to evaluate outcomes related to their success and complications. Methods: This protocol was produced in adherence with the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols). Electronic databases will be systematically searched to identify studies that meet our eligibility criteria. Studies will be included if they report at least one type of fertility preserving or sparing technique in male patients of any age and female patients aged <35 years. Animal studies, non-English studies, editorials, and guidelines will be excluded from the review. From the included studies, data will be extracted and synthesized by using a narrative approach and summarized in tables. The primary outcome will be the number of patients successfully undergoing a fertility preservation technique. The secondary outcomes will include the number of retrieved oocytes, the number of oocytes or embryos vitrified for cryopreservation, clinical pregnancy, and live birth. The quality of the included studies will be assessed by using the National Heart, Lung, and Blood Institute risk-of-bias tool for any type of study. Results: The systematic review is expected to be completed by the end of 2023, and results will be published in a peer-reviewed journal and on PROSPERO. Conclusions: The proposed systematic review will summarize the fertility preservation techniques available for patients with CNS cancers. Given the improvement in cancer survivorship, it is becoming increasingly important to educate patients about fertility preservation techniques. There are likely to be several limitations to this systematic review. Current literature is likely to be of low quality due to insufficient numbers, and there may be difficulty in accessing data sets. However, it is our hope that the results from the systematic review provide an evidence base to help inform the referral of patients with CNS cancers for fertility preservation treatments. Trial Registration: PROSPERO CRD42022352810; https://tinyurl.com/69xd9add International Registered Report Identifier (IRRID): PRR1-10.2196/44825 ",
doi="10.2196/44825",
url="https://www.researchprotocols.org/2023/1/e44825",
url="http://www.ncbi.nlm.nih.gov/pubmed/37155238"
}


@Article{info:doi/10.2196/42186,
author="Heidel, Alexandra
and Hagist, Christian
and Spinler, Stefan
and Schoeneberger, Michael",
title="Removing Dust From the German Health Care System by Introducing Health Apps Into Standard Care: Semistructured Interview Study",
journal="JMIR Hum Factors",
year="2023",
month="May",
day="4",
volume="10",
pages="e42186",
keywords="health apps",
keywords="DVG",
keywords="Digitale Versorgung Gesetz",
keywords="Digital Healthcare Act",
keywords="mobile health",
keywords="mHealth",
keywords="German statutory health care system",
keywords="interview study",
abstract="Background: In 2019, Germany launched the Digital Healthcare Act. The reform enables physicians to prescribe health apps as treatments to their statutory-insured patients. Objective: We aimed to determine the extent to which the integration of health apps into standard care could be considered beneficial and which aspects of the regulation could still be improved. Methods: We conducted a semistructured interview study with 23 stakeholders in Germany and analyzed them thematically. We used descriptive coding for the first-order codes and pattern coding for the second-order codes. Results: We created 79 first-order codes and 9 second-order codes following the interview study. Most stakeholders argued that the option of prescribing health apps could improve treatment quality. Conclusions: The inclusion of health apps into German standard care could improve the quality of treatment by expanding treatment portfolios. The educational elements of the apps might additionally lead to more patient emancipation through a better understanding of personal conditions. Location and time flexibility are the biggest advantages of the new technologies, but they also raise the most significant concerns for stakeholders because app use requires personal initiative and self-motivation. Overall, stakeholders agree that the Digital Healthcare Act has the potential to remove dust from the German health care system. ",
doi="10.2196/42186",
url="https://humanfactors.jmir.org/2023/1/e42186",
url="http://www.ncbi.nlm.nih.gov/pubmed/37140980"
}


@Article{info:doi/10.2196/39904,
author="Park, Minah
and Yun, Choa
and Joo, Hong Jae
and Kang, Hyun Soo
and Jeong, Hoon Sung
and Nam, Chung-Mo
and Park, Eun-Cheol
and Han, Yoondae
and Jang, In Sung",
title="Regional Differences in Medical Costs of Chronic Kidney Disease in the South Korean Population: Marginalized Two-Part Model",
journal="JMIR Public Health Surveill",
year="2023",
month="Mar",
day="30",
volume="9",
pages="e39904",
keywords="chronic kidney disease",
keywords="cost analysis",
keywords="medical expenses",
keywords="medically vulnerable regions",
keywords="kidney",
keywords="public health",
keywords="cost",
keywords="economic",
keywords="chronic disease",
keywords="insurance",
keywords="regional",
keywords="longitudinal model",
abstract="Background: There are regional gaps in the access to medical services for patients with chronic kidney disease (CKD), and it is necessary to reduce those gaps, including the gaps involving medical costs. Objective: This study aimed to analyze regional differences in the medical costs associated with CKD in the South Korean population. Methods: This longitudinal cohort study included participants randomly sampled from the National Health Insurance Service-National Sample Cohort of South Korea. To select those who were newly diagnosed with CKD, we excluded those who were diagnosed in 2002-2003 and 2018-2019. A total of 5903 patients with CKD were finally included. We used a marginalized two-part longitudinal model to assess total medical costs. Results: Our cohort included 4775 (59.9\%) men and 3191 (40.1\%) women. Of these, 971 (12.2\%) and 6995 (87.8\%) lived in medically vulnerable and nonvulnerable regions, respectively. The postdiagnosis costs showed a significant difference between the regions (estimate: --0.0152, 95\% confidence limit: --0.0171 to --0.0133). The difference in medical expenses between the vulnerable and nonvulnerable regions showed an increase each year after the diagnosis. Conclusions: Patients with CKD living in medically vulnerable regions are likely to have higher postdiagnostic medical expenses compared to those living in regions that are not medically vulnerable. Efforts to improve early diagnosis of CKD are needed. Relevant policies should be drafted to decrease the medical costs of patients with CKD disease living in medically deprived areas. ",
doi="10.2196/39904",
url="https://publichealth.jmir.org/2023/1/e39904",
url="http://www.ncbi.nlm.nih.gov/pubmed/36995749"
}


@Article{info:doi/10.2196/39568,
author="Li, Ping
and Cao, Xueying
and Liu, Weicen
and Zhao, Delong
and Pan, Sai
and Sun, Xuefeng
and Cai, Guangyan
and Zhou, Jianhui
and Chen, Xiangmei",
title="Peritoneal Dialysis Care in Mainland China: Nationwide Survey",
journal="JMIR Public Health Surveill",
year="2023",
month="Mar",
day="14",
volume="9",
pages="e39568",
keywords="renal replacement therapy",
keywords="peritoneal dialysis",
keywords="medical quality",
keywords="tertiary hospital",
keywords="secondary hospital",
keywords="China",
abstract="Background: Peritoneal dialysis (PD) care in mainland China has been progressing in the past 10 years. Objective: To complement information from the dialysis registry, a large-scale nationwide survey was conducted to investigate the current infrastructure and management of PD care at hospitals of different tiers. Methods: A web-based multiple-choice questionnaire was distributed through the National Center for Nephrology Medical Quality Management and Control to PD centers of secondary and tertiary hospitals in October 2020. The 2-part survey collected the information of PD centers and the clinical management of patients on PD. A total of 788 effective surveys from 746 hospitals were voluntarily returned, and data were extracted and analyzed. Results: The effective survey data covered 101,537 patients on PD, with 95\% (96,460/101,537) in the tertiary hospitals. The median number of patients per PD center was 60 (IQR 21-152); this number was 32 (IQR 8-65) and 70 (IQR 27-192) for secondary and tertiary hospitals, respectively. There was a discrepancy in the availability of designated physical areas for different functions of PD care between the secondary and tertiary hospitals. The proportion of tertiary hospitals with PD training (P=.01), storage (P=.09), and procedure area (P<.001) was higher compared to secondary hospitals. PD catheter placement was performed in 96\% (608/631) of the PD centers in tertiary hospitals, which was significantly higher compared to 86\% (99/115) in secondary hospitals (P<.001). Automated PD was available in 55\% (347/631) of the tertiary hospitals, which was significantly higher than that in secondary hospitals (37/115, 32\%) according to the survey (P<.001). The most commonly performed PD module was continuous ambulatory peritoneal dialysis (772/788, 98\%), followed by intermittent peritoneal dialysis (543/788, 69\%). The overall reported nocturnal intermittent peritoneal dialysis was 31\% (244/788); it was 28\% (220/788) for continuous cycling peritoneal dialysis and 15\% (118/788) for tidal peritoneal dialysis. Comparisons between the secondary and tertiary hospitals revealed no significant differences in prophylactic antibiotic use for PD catheter placement and therapeutic use for peritonitis. The first peritoneal equilibrium test was conducted in 58\% (454/788) of patients at 4-6 weeks after initiation of PD, and 91\% (718/788) reported at least one peritoneal equilibrium test per year. Overall, 79\% (570/722) and 65\% (469/722) of PD centers performed assessment for dialysis adequacy and residual kidney function, respectively; and 87\% (685/788) of patients on PD were followed every 1 to 3 months for laboratory and auxiliary examinations. Conclusions: This national survey reflects the current status and disparities of PD center management in mainland China. The study results suggest that the PD care needs to be more conveniently accessible in secondary hospitals, and quality management and staff training in secondary hospitals are still in high demand. ",
doi="10.2196/39568",
url="https://publichealth.jmir.org/2023/1/e39568",
url="http://www.ncbi.nlm.nih.gov/pubmed/36917165"
}


@Article{info:doi/10.2196/37671,
author="Bian, Dongsheng
and Xiao, Yuyin
and Song, Keyu
and Dong, Minye
and Li, Li
and Millar, Ross
and Shi, Chenshu
and Li, Guohong",
title="Determinants Influencing the Adoption of Internet Health Care Technology Among Chinese Health Care Professionals: Extension of the Value-Based Adoption Model With Burnout Theory",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="10",
volume="25",
pages="e37671",
keywords="internet health care technology",
keywords="value-based adoption model",
keywords="employee burnout",
keywords="China",
keywords="health care",
keywords="health care workers",
keywords="internet",
keywords="technology",
keywords="cross-sectional study",
keywords="burnout",
keywords="internet hospitals",
abstract="Background: The global COVID-19 pandemic has been widely regarded as a catalyst for adopting internet health care technology (IHT) in China. IHT consists of new health care technologies that are shaping health services and medical consultations. Health care professionals play a substantial role in the adoption of any IHT, but the consequences of doing so can often be challenging, particularly when employee burnout is prevalent. Few studies have explored whether employee burnout influences the adoption intention of IHT in health care professionals. Objective: This study aims to explain the determinants influencing the adoption of IHT from the perspective of health care professionals. To do so, the study extends the value-based adoption model (VAM) with consideration for employee burnout as a determining factor. Methods: A cross-sectional web-based survey using a sample of 12,031 health care professionals selected through multistage cluster sampling from 3 provinces in mainland China was conducted. The hypotheses of our research model were developed based on the VAM and employee burnout theory. Structural equation modeling was then used to test the research hypotheses. Results: The results indicate that perceived usefulness, perceived enjoyment, and perceived complexity positively correlate with perceived value ($\beta$=.131, P=.01; $\beta$=.638, P<.001; $\beta$=.198, P<.001, respectively). Perceived value had a positive direct effect on adoption intention ($\beta$=.725, P<.001), perceived risk negatively correlated with perceived value ($\beta$=?.083, P<.001), and perceived value negatively correlated with employee burnout ($\beta$=?.308, P<.001). In addition, employee burnout was negatively related to adoption intention ($\beta$=?.170, P<.001) and mediated the relationship between perceived value and adoption intention ($\beta$=.052, P<.001). Conclusions: Perceived value, perceived enjoyment, and employee burnout were the most important determinants of IHT adoption intention by health care professionals. In addition, while employee burnout was negatively related to adoption intention, perceived value inhibited employee burnout. Therefore, this study finds that it is necessary to develop strategies to improve the perceived value and reduce employee burnout, which will benefit the promotion of the adoption intention of IHT in health care professionals. This study supports the use of the VAM and employee burnout in explaining health care professionals' adoption intention regarding IHT. ",
doi="10.2196/37671",
url="https://www.jmir.org/2023/1/e37671",
url="http://www.ncbi.nlm.nih.gov/pubmed/36897630"
}


@Article{info:doi/10.2196/42350,
author="Miser, S. James
and Shia, Ben-Chang
and Kao, Yi-Wei
and Liu, Yen-Lin
and Chen, Shih-Yen
and Ho, Wan-Ling",
title="The Health Care Utilization and Medical Costs in Long-Term Follow-Up of Children Diagnosed With Leukemia, Solid Tumor, or Brain Tumor: Population-Based Study Using the National Health Insurance Claims Data",
journal="JMIR Public Health Surveill",
year="2023",
month="Mar",
day="2",
volume="9",
pages="e42350",
keywords="brain tumor",
keywords="cancer survivor",
keywords="children",
keywords="cost of care",
keywords="health care",
keywords="health resource",
keywords="leukemia",
keywords="long-term follow-up",
keywords="population-based study",
keywords="solid tumor",
abstract="Background: Childhood cancer survivors are at a high risk of medical consequences of their disease and treatment. There is growing information about the long-term health issues of childhood cancer survivors; however, there are very few studies describing the health care utilization and costs for this unique population. Understanding their utilization of health care services and costs will provide the basis for developing strategies to better serve these individuals and potentially reduce the cost. Objective: This study aims to determine the utilization of health services and costs for long-term survivors of childhood cancer in Taiwan. Methods: This is a nationwide, population-based, retrospective case-control study. We analyzed the claims data of the National Health Insurance that covers 99\% of the Taiwanese population of 25.68 million. A total of 33,105 children had survived for at least 5 years after the first appearance of a diagnostic code of cancer or a benign brain tumor before the age of 18 years from 2000 to 2010 with follow-up to 2015. An age- and gender-matched control group of 64,754 individuals with no cancer was randomly selected for comparison. Utilization was compared between the cancer and no cancer groups by $\chi$2 test. The annual medical expense was compared by the Mann-Whitney U test and Kruskal-Wallis rank-sum test. Results: At a median follow-up of 7 years, childhood cancer survivors utilized a significantly higher proportion of medical center, regional hospital, inpatient, and emergency services in contrast to no cancer individuals: 57.92\% (19,174/33,105) versus 44.51\% (28,825/64,754), 90.66\% (30,014/33,105) versus 85.70\% (55,493/64,754), 27.19\% (9000/33,105) versus 20.31\% (13,152/64,754), and 65.26\% (21,604/33,105) versus 59.36\% (38,441/64,754), respectively (all P<.001). The annual total expense (median, interquartile range) of childhood cancer survivors was significantly higher than that of the comparison group (US \$285.56, US \$161.78-US \$535.80 per year vs US \$203.90, US \$118.98-US \$347.55 per year; P<.001). Survivors with female gender, diagnosis before the age of 3 years, and diagnosis of brain cancer or a benign brain tumor had significantly higher annual outpatient expenses (all P<.001). Moreover, the analysis of outpatient medication costs showed that hormonal and neurological medications comprised the 2 largest costs in brain cancer and benign brain tumor survivors. Conclusions: Survivors of childhood cancer and a benign brain tumor had higher utilization of advanced health resources and higher costs of care. The design of the initial treatment plan minimizing long-term consequences, early intervention strategies, and survivorship programs have the potential to mitigate costs of late effects due to childhood cancer and its treatment. ",
doi="10.2196/42350",
url="https://publichealth.jmir.org/2023/1/e42350",
url="http://www.ncbi.nlm.nih.gov/pubmed/36862495"
}


@Article{info:doi/10.2196/40912,
author="Muehlensiepen, Felix
and Petit, Pascal
and Knitza, Johannes
and Welcker, Martin
and Vuillerme, Nicolas",
title="Factors Associated With Telemedicine Use Among Patients With Rheumatic and Musculoskeletal Disease: Secondary Analysis of Data From a German Nationwide Survey",
journal="J Med Internet Res",
year="2023",
month="Jan",
day="27",
volume="25",
pages="e40912",
keywords="telemedicine",
keywords="rheumatology",
keywords="primary care",
keywords="secondary analysis",
keywords="health services research",
abstract="Background: Previous studies have demonstrated telemedicine (TM) to be an effective tool to complement rheumatology care and address workforce shortage. With the outbreak of the COVID-19 pandemic, TM experienced a massive upswing. A previous study revealed that physicians' willingness to use TM and actual use of TM are closely connected to their knowledge of TM. However, it remains unclear which factors are associated with patients' motivation to use TM. Objective: This study aims to identify the factors that determine patients' willingness to try TM (TM try) and their wish that their rheumatologists offer TM services (TM wish). Methods: We conducted a secondary analysis of data from a German nationwide cross-sectional survey among patients with rheumatic and musculoskeletal disease (RMD). Bayesian univariate and multivariate logistic regression analyses were applied to the data to determine which factors were associated with TM try and TM wish. The predictor variables (covariates) studied individually included sociodemographic factors (eg, age and sex) and health characteristics (eg, disease type and health status). All the variables positively or negatively associated with TM try or TM wish in the univariate analyses were then considered for the Bayesian model averaging analysis after a selection based on the variance inflation factor (?2.5). All the analyses were stratified by sex. Results: Of the total 102 variables, 59 (57.8\%) and 45 (44.1\%) variables were found to be positively or negatively associated (region of practical equivalence ?5\%) with TM try and TM wish, respectively. A total of 16 and 8 determinant factors were identified for TM try and TM wish, respectively. Wishing that TM services were offered by rheumatologists, having internet access at home, residing 5 to 10 km away from the general practitioner's office, owning an electronic device, and being aged 40 to 60 years were among the factors positively associated with TM try and TM wish. By contrast, not yet being diagnosed with an RMD, having no prior knowledge of TM, having a bad health status, living in a rural area, not documenting one's health status, not owning an electronic device, and being aged 60 to 80 years were negatively associated with TM try and TM wish. Conclusions: Our results suggest that health status, knowledge, age, and access to technical equipment and infrastructure influence the motivation of patients with RMD to use telehealth services. In particular, older patients with RMD living in rural areas, who could likely benefit from using TM, are currently not motivated to use TM and seem to need additional TM support. ",
doi="10.2196/40912",
url="https://www.jmir.org/2023/1/e40912",
url="http://www.ncbi.nlm.nih.gov/pubmed/36705950"
}


@Article{info:doi/10.2196/37569,
author="Pollmanns, Johannes
and Gro{\ss}garten, Karlheinz
and Wolff, K. Julia
and Nolting, Hans-Dieter
and Graf, Clarissa
and Bergmann, Frank
and Nelles, Gereon",
title="A Stepped Health Services Intervention to Improve Care for Mental and Neurological Diseases: Protocol for a Prospective Cohort Trial",
journal="JMIR Res Protoc",
year="2023",
month="Jan",
day="17",
volume="12",
pages="e37569",
keywords="mental health",
keywords="neurology",
keywords="quality of care",
keywords="organization of health services",
keywords="primary care",
keywords="mental disorder",
keywords="intervention",
keywords="neurological disease",
keywords="healthcare system",
keywords="accessibility",
keywords="therapy",
abstract="Background: Mental and neurological disorders cause a large proportion of morbidity burden and require adequate health care structures. However, deficits in the German health care system like long waiting times for access to specialized care and a lack of coordination between health care providers lead to suboptimal quality of care and elevated health care costs. Objective: To overcome these deficits, we implement and evaluate a unique stepped and coordinated model of care (the Neurologisch-psychiatrische und psychotherapeutische Versorgung [NPPV] program) for patients with mental and neurological diseases. Methods: Patients included in the program receive an appropriate treatment according to medical needs in a multiprofessional network of ambulatory health care providers. The therapy is coordinated by a managing physician and complemented by additional therapy modules, such as group therapy, internet-based cognitive behavioral therapy, and a case management. Statutory health insurance (SHI) routine data and data from a longitudinal patient survey will be used to compare the program with regular care and evaluate SHI expenditures and patient-related outcomes. A health care provider survey will evaluate the quality of structure and processes and provider satisfaction. Finally, an analysis of ambulatory claims data and drug prescription data will be used to evaluate if health care providers follow a needs-led approach in therapy. Ethics approval for this trial was obtained from the ethics committee of the chamber of physicians in North Rhine (September 13, 2017, reference No. 2017287). Results: Patient enrollment of NPPV ended in September 2021. Data analysis has been completed in 2022. The results of this study will be disseminated through scientific publications, academic conferences, and a publicly available report to the German Federal Joint Committee, which is expected to be available in the first half of 2023. Conclusions: The NPPV program is the first intervention to implement a stepped model of care for both mental and neurological diseases in Germany. The analysis of several data sources and a large sample size (more than 14,000 patients) enable a comprehensive evaluation of the NPPV program. Trial Registration: German Clinical Trials Register DRKS00022754; https://tinyurl.com/3mx9pz5z. International Registered Report Identifier (IRRID): DERR1-10.2196/37569 ",
doi="10.2196/37569",
url="https://www.researchprotocols.org/2023/1/e37569",
url="http://www.ncbi.nlm.nih.gov/pubmed/36649065"
}


@Article{info:doi/10.2196/42332,
author="Roberts, C. Scott
and Havill, L. Nancy
and Flores, M. Rosa
and Hendrix II, Anthony Curtis
and Williams, J. Maximillian
and Feinn, S. Richard
and Choi, J. Steven
and Martinello, A. Richard
and Marks, M. Asher
and Murray, S. Thomas",
title="Disinfection of Virtual Reality Devices in Health Care Settings: In Vitro Assessment and Survey Study",
journal="J Med Internet Res",
year="2022",
month="Dec",
day="1",
volume="24",
number="12",
pages="e42332",
keywords="disinfection",
keywords="healthcare-acquired infection",
keywords="healthcare worker",
keywords="virtual reality",
keywords="disinfect",
keywords="occupational health",
keywords="occupational safety",
keywords="infection control",
keywords="infection spread",
abstract="Background: Virtual reality (VR) devices are increasingly used in health care settings. The use among patients has the potential to unintentionally transmit pathogens between patients and hospital staff. No standard operating procedure for disinfection exists to ensure safe use between patients. Objective: This study aims to determine the efficacy of disinfectants on VR devices in order to ensure safe use in health care settings. Methods: Three types of bacteria were inoculated onto porous and nonporous surfaces of 2 VR devices: the Meta Oculus Quest and Meta Oculus Quest 2. Disinfection was performed using either isopropyl alcohol or alcohol-free quaternary ammonium wipes. A quantitative culture was used to assess the adequacy of disinfection. A survey was separately sent out to VR device technicians at other pediatric health care institutes to compare the methods of disinfection and how they were established. Results: Both products achieved adequate disinfection of the treated surfaces; however, a greater log-kill was achieved on nonporous surfaces than on the porous surfaces. Alcohol performed better than quaternary ammonium on porous surfaces. The survey respondents reported a wide variability in disinfection processes with only 1 person reporting an established standard operating procedure. Conclusions: Disinfection can be achieved through the use of either isopropyl alcohol or quaternary ammonium products. Porous surfaces showed lesser log-kill rates than the nonporous surfaces, indicating that the use of an added barrier may be of benefit and should be a point of future research. Given the variability in the disinfection process across health care systems, a standard operating procedure is proposed. ",
doi="10.2196/42332",
url="https://www.jmir.org/2022/12/e42332",
url="http://www.ncbi.nlm.nih.gov/pubmed/36269222"
}


@Article{info:doi/10.2196/40304,
author="Muehlensiepen, Felix
and Petit, Pascal
and Knitza, Johannes
and Welcker, Martin
and Vuillerme, Nicolas",
title="Factors Associated With Telemedicine Use Among German General Practitioners and Rheumatologists: Secondary Analysis of Data From a Nationwide Survey",
journal="J Med Internet Res",
year="2022",
month="Nov",
day="30",
volume="24",
number="11",
pages="e40304",
keywords="telemedicine",
keywords="rheumatology",
keywords="primary care",
keywords="secondary analysis",
keywords="health services research",
abstract="Background: Previous studies have demonstrated telemedicine (TM) to be an effective tool to complement rheumatology care and address workforce shortage. With the outbreak of the SARS-CoV-2 pandemic, TM experienced a massive upswing. However, in rheumatology care, the use of TM stagnated again shortly thereafter. Consequently, the factors associated with physicians' willingness to use TM (TM willingness) and actual use of TM (TM use) need to be thoroughly investigated. Objective: This study aimed to identify the factors that determine TM use and TM willingness among German general practitioners and rheumatologists. Methods: We conducted a secondary analysis of data from a German nationwide cross-sectional survey with general practitioners and rheumatologists. Bayesian univariate and multivariate logistic regression analyses were applied to the data to determine which factors were associated with TM use and TM willingness. The predictor variables (covariates) that were studied individually included sociodemographic factors (eg, age and sex), work characteristics (eg, practice location and medical specialty), and self-assessed knowledge of TM. All the variables positively and negatively associated with TM use and TM willingness in the univariate analysis were then considered for Bayesian model averaging analysis after a selection based on the variance inflation factor (?2.5). All analyses were stratified by sex. Results: Univariate analysis revealed that out of 83 variables, 36 (43\%) and 34 (41\%) variables were positively or negatively associated (region of practical equivalence?5\%) with TM use and TM willingness, respectively. The Bayesian model averaging analysis allowed us to identify 13 and 17 factors of TM use and TM willingness, respectively. Among these factors, being female, having very poor knowledge of TM, treating <500 patients per quarter, and not being willing to use TM were negatively associated with TM use, whereas having good knowledge of TM and treating >1000 patients per quarter were positively associated with TM use. In addition, being aged 51 to 60 years, thinking that TM is not important for current and future work, and not currently using TM were negatively associated with TM willingness, whereas owning a smart device and working in an urban area were positively associated with TM willingness. Conclusions: The results point to the close connection between health care professionals' knowledge of TM and actual TM use. These results lend support to the integration of digital competencies into medical education as well as hands-on training for health care professionals. Incentive programs for physicians aged >50 years and practicing in rural areas could further encourage TM willingness. ",
doi="10.2196/40304",
url="https://www.jmir.org/2022/11/e40304",
url="http://www.ncbi.nlm.nih.gov/pubmed/36449333"
}


@Article{info:doi/10.2196/40124,
author="von Wedel, Philip
and Hagist, Christian
and Liebe, Jan-David
and Esdar, Moritz
and H{\"u}bner, Ursula
and Pross, Christoph",
title="Effects of Hospital Digitization on Clinical Outcomes and Patient Satisfaction: Nationwide Multiple Regression Analysis Across German Hospitals",
journal="J Med Internet Res",
year="2022",
month="Nov",
day="10",
volume="24",
number="11",
pages="e40124",
keywords="health care information technology",
keywords="electronic health records",
keywords="hospital digitization",
keywords="quality of care",
keywords="clinical outcomes",
keywords="patient satisfaction",
keywords="user-perceived value",
abstract="Background: The adoption of health information technology (HIT) by health care providers is commonly believed to improve the quality of care. Policy makers in the United States and Germany follow this logic and deploy nationwide HIT adoption programs to fund hospital investments in digital technologies. However, scientific evidence for the beneficial effects of HIT on care quality at a national level remains mostly US based, is focused on electronic health records (EHRs), and rarely accounts for the quality of digitization from a hospital user perspective. Objective: This study aimed to examine the effects of digitization on clinical outcomes and patient experience in German hospitals. Hence, this study adds to the small stream of literature in this field outside the United States. It goes beyond assessing the effects of mere HIT adoption and also considers user-perceived HIT value. In addition, the impact of a variety of technologies beyond EHRs was examined. Methods: Multiple linear regression models were estimated using emergency care outcomes, elective care outcomes, and patient satisfaction as dependent variables. The adoption and user-perceived value of HIT represented key independent variables, and case volume, hospital size, ownership status, and teaching status were included as controls. Care outcomes were captured via risk-adjusted, observed-to-expected outcome ratios for patients who had stroke, myocardial infarction, or hip replacement. The German Patient Experience Questionnaire of Weisse Liste provided information on patient satisfaction. Information on the adoption and user-perceived value of 10 subdomains of HIT and EHRs was derived from the German 2020 Healthcare IT Report. Results: Statistical analysis was based on an overall sample of 383 German hospitals. The analyzed data set suggested no significant effect of HIT or EHR adoption on clinical outcomes or patient satisfaction. However, a higher user-perceived value or quality of the installed tools did improve outcomes. Emergency care outcomes benefited from user-friendly overall digitization ($\beta$=?.032; P=.04), which was especially driven by the user-friendliness of admission HIT ($\beta$=?.023; P=.07). Elective care outcomes were positively impacted by user-friendly EHR installations ($\beta$=?.138; P=.008). Similarly, the results suggested user-friendly, overall digitization to have a moderate positive effect on patient satisfaction ($\beta$=?.009; P=.01). Conclusions: The results of this study suggest that hospital digitization is not an end in itself. Policy makers and hospitals are well advised to not only focus on the mere adoption of digital technologies but also continuously work toward digitization that is perceived as valuable by physicians and nurses who rely on it every day. Furthermore, hospital digitization strategies should consider that the assumed benefits of single technologies are not realized across all care domains. ",
doi="10.2196/40124",
url="https://www.jmir.org/2022/11/e40124",
url="http://www.ncbi.nlm.nih.gov/pubmed/36355423"
}


@Article{info:doi/10.2196/31055,
author="Mendlovic, Joseph
and Mimouni, B. Francis
and Arad, Iris
and Heiman, Eyal",
title="Trends in Health Quality--Related Publications Over the Past Three Decades: Systematic Review",
journal="Interact J Med Res",
year="2022",
month="Oct",
day="4",
volume="11",
number="2",
pages="e31055",
keywords="health quality",
keywords="publication",
keywords="medline",
keywords="quality assessmnet",
keywords="healthcare quality",
abstract="Background: Quality assessment in health care is a process of planned activities with the ultimate goal of achieving a continuous improvement of medical care through the evaluation of structure, process, and outcome measures. Physicians and health care specialists involved with quality issues are faced with an enormous and nearly always increasing amount of literature to read and integrate. Nevertheless, the novelty and quality of these articles (in terms of evidence-based medicine) has not been systematically assessed and described. Objective: The objective of this study was to test the hypothesis that the number of high-evidence journal articles (according to the pyramid of evidence), such as randomized control trials, systematic reviews, and ultimately, practice guidelines, increases over time, relative to lower-evidence journal articles, such as editorials, reviews, and letters to the editors. Methods: We used PubMed database to retrieve relevant articles published during the 31-year period between January 1, 1989, and December 31, 2021. The search was conducted in April 2022. We used the keywords ``quality care,'' ``quality management,'' ``quality indicators,'' and ``quality improvement'' and limited the search fields to title and abstract in order to limit our search results to articles nearly exclusively related to health care quality. Results: During this 31-year evaluation period, there was a significant cubic increase in the total number of publications, reviews, clinical trials (peaking in 2017, with a sharp decline until 2021), controlled trials (peaking in 2016, with a sharp drop until 2021), randomized controlled trials (peaking in 2017, with a sharp drop until 2021), systematic reviews (nearly nonexistent in the 1980s through 1990s to a peak of 222 in 2021), and meta-analyses (from nearly none in the 1980s through 1990s to a peak of approximately 40 per year in 2020). There was a linear increase in practice guidelines from none during 1989-1991 to approximately 25 per year during 2019-2021, including a cubic increase in editorials, peaking in 2021 at 125 per year, and in letters to the editor, peaking at 50-78 per year in the last 4 years (ie, 2018-2021). Conclusions: Over the past 31 years, the field of quality in health care has seen a significant yearly increase of published original studies with a relative stagnation since 2015. We suggest that contributors to this dynamic field of research should focus on producing more evidence-based publications and guidelines. ",
doi="10.2196/31055",
url="https://www.i-jmr.org/2022/2/e31055",
url="http://www.ncbi.nlm.nih.gov/pubmed/36194464"
}


@Article{info:doi/10.2196/38746,
author="Ekman, Bj{\"o}rn
and Thulesius, Hans
and Wilkens, Jens
and Arvidsson, Eva",
title="Digitalization of Health Care: Findings From Key Informant Interviews in Sweden on Technical, Regulatory, and Patient Safety Aspects",
journal="J Med Internet Res",
year="2022",
month="Sep",
day="1",
volume="24",
number="9",
pages="e38746",
keywords="digitalization",
keywords="regulation",
keywords="patient safety",
keywords="quality of care",
keywords="interview",
keywords="Sweden",
keywords="health care",
keywords="digital health",
keywords="decision-making",
keywords="digital care",
doi="10.2196/38746",
url="https://www.jmir.org/2022/9/e38746",
url="http://www.ncbi.nlm.nih.gov/pubmed/36048503"
}


@Article{info:doi/10.2196/36756,
author="Sadaka, Yair
and Horwitz, Dana
and Wolff, Leor
and Sela, Tomer
and Meyerovitch, Joseph
and Peleg, Assaf
and Bachmat, Eitan
and Benis, Arriel",
title="Trends in the Prevalence of Chronic Medication Use Among Children in Israel Between 2010 and 2019: Protocol for a Retrospective Cohort Study",
journal="JMIR Res Protoc",
year="2022",
month="Aug",
day="5",
volume="11",
number="8",
pages="e36756",
keywords="psychotropic drugs",
keywords="central nervous system stimulants",
keywords="mental health",
keywords="medication therapy management",
keywords="drug prescriptions",
keywords="attention deficit hyperactivity disorder",
keywords="ADHD, Israel",
keywords="children",
keywords="data mining",
keywords="machine learning",
keywords="electronic medical records",
keywords="pediatrics",
keywords="chronic disease",
keywords="epidemiology",
abstract="Background: Prescription of psychostimulants has significantly increased in most countries worldwide for both preschool and school-aged children. Understanding the trends of chronic medication use among children in different age groups and from different sociodemographic backgrounds is essential. It is essential to distinguish between selected therapy areas to help decision-makers evaluate not only the relevant expected medication costs but also the specific services related to these areas. Objective: This study will analyze differences in trends regarding medications considered psychobehavioral treatments and medications considered nonpsychobehavioral treatments and will identify risk factors and predictors for chronic medication use among children. Methods: This is a retrospective study. Data will be extracted from the Clalit Health Services data warehouse. For each year between 2010 and 2019, there are approximately 1,500,000 children aged 0-18 years. All medication classes will be identi?ed using the Anatomical Therapeutic Chemical code. A time-trend analysis will be performed to investigate if there is a significant difference between the trends of children's psychobehavioral and nonpsychobehavioral medication prescriptions. A logistic regression combined with machine learning models will be developed to identify variables that may increase the risk for specific chronic medication types and identify children likely to get such treatment. Results: The project was funded in 2019. Data analysis is currently underway, and the results are expected to be submitted for publication in 2022. Understanding trends regarding medications considered psychobehavioral treatments and medications considered nonpsychobehavioral treatments will support the identification of risk factors and predictors for chronic medication use among children. Conclusions: Analyzing the response of the patient (and their parents or caregivers) population over time will hopefully help improve policies for prescriptions and follow-up of chronic treatments in children. International Registered Report Identifier (IRRID): DERR1-10.2196/36756 ",
doi="10.2196/36756",
url="https://www.researchprotocols.org/2022/8/e36756",
url="http://www.ncbi.nlm.nih.gov/pubmed/35775233"
}


@Article{info:doi/10.2196/39277,
author="Chima, Sophie
and Martinez-Gutierrez, Javiera
and Hunter, Barbara
and Manski-Nankervis, Jo-Anne
and Emery, Jon",
title="Optimization of a Quality Improvement Tool for Cancer Diagnosis in Primary Care: Qualitative Study",
journal="JMIR Form Res",
year="2022",
month="Aug",
day="4",
volume="6",
number="8",
pages="e39277",
keywords="cancer",
keywords="primary health care",
keywords="diagnosis",
keywords="quality improvement",
keywords="clinical decision support tool",
keywords="general practice",
keywords="pilot",
keywords="feasibility",
keywords="Clinical Performance Feedback Intervention Theory",
abstract="Background: The most common route to a diagnosis of cancer is through primary care. Delays in diagnosing cancer occur when an opportunity to make a timely diagnosis is missed and is evidenced by patients visiting the general practitioner (GP) on multiple occasions before referral to a specialist. Tools that minimize prolonged diagnostic intervals and reduce missed opportunities to investigate patients for cancer are therefore a priority. Objective: This study aims to explore the usefulness and feasibility of a novel quality improvement (QI) tool in which algorithms flag abnormal test results that may be indicative of undiagnosed cancer. This study allows for the optimization of the cancer recommendations before testing the efficacy in a randomized controlled trial. Methods: GPs, practice nurses, practice managers, and consumers were recruited to participate in individual interviews or focus groups. Participants were purposively sampled as part of a pilot and feasibility study, in which primary care practices were receiving recommendations relating to the follow-up of abnormal test results for prostate-specific antigen, thrombocytosis, and iron-deficiency anemia. The Clinical Performance Feedback Intervention Theory (CP-FIT) was applied to the analysis using a thematic approach. Results: A total of 17 interviews and 3 focus groups (n=18) were completed. Participant themes were mapped to CP-FIT across the constructs of context, recipient, and feedback variables. The key facilitators to use were alignment with workflow, recognized need, the perceived importance of the clinical topic, and the GPs' perception that the recommendations were within their control. Barriers to use included competing priorities, usability and complexity of the recommendations, and knowledge of the clinical topic. There was consistency between consumer and practitioner perspectives, reporting language concerns associated with the word cancer, the need for more patient-facing resources, and time constraints of the consultation to address patients' worries. Conclusions: There was a recognized need for the QI tool to support the diagnosis of cancer in primary care, but barriers were identified that hindered the usability and actionability of the recommendations in practice. In response, the tool has been refined and is currently being evaluated as part of a randomized controlled trial. Successful and effective implementation of this QI tool could support the detection of patients at risk of undiagnosed cancer in primary care and assist in preventing unnecessary delays. ",
doi="10.2196/39277",
url="https://formative.jmir.org/2022/8/e39277",
url="http://www.ncbi.nlm.nih.gov/pubmed/35925656"
}


@Article{info:doi/10.2196/32347,
author="Smith, E. Gillian
and Harcourt, E. Sally
and Hoang, Uy
and Lemanska, Agnieszka
and Elliot, J. Alex
and Morbey, A. Roger
and Hughes, E. Helen
and Lake, Iain
and Edeghere, Obaghe
and Oliver, Isabel
and Sherlock, Julian
and Aml{\^o}t, Richard
and de Lusignan, Simon",
title="Mental Health Presentations Across Health Care Settings During the First 9 Months of the COVID-19 Pandemic in England: Retrospective Observational Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Aug",
day="3",
volume="8",
number="8",
pages="e32347",
keywords="pandemic",
keywords="public health",
keywords="syndromic surveillance",
keywords="mental health",
keywords="anxiety",
keywords="sleep problems",
keywords="COVID-19",
keywords="health care",
keywords="health surveillance",
keywords="health care service",
abstract="Background: The COVID-19 pandemic has resulted in an unprecedented impact on the day-to-day lives of people, with several features potentially adversely affecting mental health. There is growing evidence of the size of the impact of COVID-19 on mental health, but much of this is from ongoing population surveys using validated mental health scores. Objective: This study investigated the impact of the pandemic and control measures on mental health conditions presenting to a spectrum of national health care services monitored using real-time syndromic surveillance in England. Methods: We conducted a retrospective observational descriptive study of mental health presentations (those calling the national medical helpline, National Health Service [NHS] 111; consulting general practitioners [GPs] in and out-of-hours; calling ambulance services; and attending emergency departments) from January 1, 2019, to September 30, 2020. Estimates for the impact of lockdown measures were provided using an interrupted time series analysis. Results: Mental health presentations showed a marked decrease during the early stages of the pandemic. Postlockdown, attendances for mental health conditions reached higher than prepandemic levels across most systems---a rise of 10\% compared to that expected for NHS 111 and 21\% for GP out-of-hours service---while the number of consultations to GP in-hours service was 13\% lower compared to the same time previous year. Increases were observed in calls to NHS 111 for sleep problems. Conclusions: These analyses showed marked changes in the health care attendances and prescribing for common mental health conditions across a spectrum of health care provision, with some of these changes persisting. The reasons for such changes are likely to be complex and multifactorial. The impact of the pandemic on mental health may not be fully understood for some time, and therefore, these syndromic indicators should continue to be monitored. ",
doi="10.2196/32347",
url="https://publichealth.jmir.org/2022/8/e32347",
url="http://www.ncbi.nlm.nih.gov/pubmed/35486809"
}


@Article{info:doi/10.2196/38424,
author="van de Vijver, Steven
and Hummel, Deirdre
and van Dijk, Hester Annericht
and Cox, Jan
and van Dijk, Oscar
and Van den Broek, Nicoline
and Metting, Esther",
title="Evaluation of a Digital Self-management Platform for Patients With Chronic Illness in Primary Care: Qualitative Study of Stakeholders' Perspectives",
journal="JMIR Form Res",
year="2022",
month="Aug",
day="3",
volume="6",
number="8",
pages="e38424",
keywords="primary care",
keywords="chronic disease",
keywords="telemonitoring",
keywords="digital health",
keywords="self-management",
keywords="patient-centered care",
keywords="chronic care",
keywords="chronic care management",
keywords="illness",
keywords="healthcare",
keywords="healthcare professional",
keywords="user",
keywords="patient",
keywords="platform",
keywords="tool",
keywords="communication",
keywords="empowerment",
keywords="online",
abstract="Background: Population aging and multimorbidity has led to increasing chronic care needs associated with new challenges in managing growing costs, rising health care professional workloads, and the adoption of rigorous guidelines. These issues could all benefit from greater digitalization and a more patient-centered approach to chronic care, a situation brought to the fore by the COVID-19 pandemic. Little is known about real-life use in primary care. Objective: This study aimed to explore the views, thoughts, usability, and experiences concerning a recently introduced digital self-care platform for chronic conditions in 3 Dutch primary care practices. Methods: We conducted an explorative study combining questionnaires and interviews among patients and general practitioners from 3 general practices that used the digital platform. Questionnaires were sent to patients in each practice to seek the views and experiences of both patient nonusers (n=20) and patient users (n=58) of the platform, together with standardized questionnaires about illness perception and quality of life. In addition, patients (n=15) and general practitioners (n=4) who used the platform took part in semistructured interviews. We transcribed interviews verbatim and performed qualitative content analysis using a deductive approach. The results of the questionnaires were analyzed with descriptive analysis. Results: Among patients who had not actively used the platform but had received an explanation, only 35\% (7/20) would recommend its use due to concerns over communication and handling. However, this percentage increased to 76.3\% (45/59) among the people who actively used the platform. Interviews with patients and general practitioners who used the platform uncovered several key benefits, including reduced time requirements, reduced workload, improved care quality, and improved accessibility due to the greater patient-centeredness and use of different communication tools. In addition, the self-management tool led to greater patient autonomy and empowerment. Although users considered the platform feasible, usable, and easy to use, some technical issues remained and some patients expressed concerns about the reduction in human contact and feedback. Conclusions: The overall experience and usability of the platform was good. Support for the online self-management platform for chronic care increased when patients actively used the tool and could experience or identify important advantages. However, patients still noted several areas for improvement that need to be tackled in future iterations. To ensure benefit in the wider population, we must also evaluate this platform in cohorts with lower digital and health literacy. ",
doi="10.2196/38424",
url="https://formative.jmir.org/2022/8/e38424",
url="http://www.ncbi.nlm.nih.gov/pubmed/35921145"
}


@Article{info:doi/10.2196/31289,
author="Fang, Guixia
and Yang, Diling
and Wang, Li
and Wang, Zhihao
and Liang, Yuanyuan
and Yang, Jinxia",
title="Experiences and Challenges of Implementing Universal Health Coverage With China's National Basic Public Health Service Program: Literature Review, Regression Analysis, and Insider Interviews",
journal="JMIR Public Health Surveill",
year="2022",
month="Jul",
day="22",
volume="8",
number="7",
pages="e31289",
keywords="universal health coverage",
keywords="basic public health service",
keywords="China",
keywords="experience",
keywords="challenge",
abstract="Background: Public health service is an important component and pathway to achieve universal health coverage (UHC), a major direction goal of many countries. China's National Basic Public Health Service Program (the Program) is highly consistent with this direction. Objective: The aim of this study was to analyze the key experience and challenges of the Program so as to present China's approach to UHC, help other countries understand and learn from China's experience, and promote UHC across the world. Methods: A literature review was performed across five main electronic databases and other sources. Some data were obtained from the Department of Primary Health, National Health Commission, China. Data obtained included the financing share of the national/provincial/prefectural government among the total investment of the program in 32 provinces in 2016, their respective per capita funding levels, and some indicators related to program implementation from 2009 to 2016. The Joinpoint regression model was adopted to test the time trend of changes in program implementation indicators. Face-to-face individual interviews and group discussions were conducted with 48 key insiders. Results: The program provided full life cycle service to the whole population with an equitable and affordable financing system, enhanced the capability and quality of the health workforce, and facilitated integration of the public health service delivery system. Meanwhile, there were also some shortcomings, including lack of selection and an exit mechanism of service items, inadequate system integration, shortage of qualified professionals, limited role played by actors outside the health sector, and a large gap between the subsidy standard and the actual service cost. The Joinpoint regression analysis demonstrated that 13 indicators related to program implementation showed a significant upward trend (P<.05) from 2009 to 2016, with average annual percent change values above 10\% for 6 indicators and below 6\% for 7 indicators. Three indicators (coverage of health records, electronic health records, and health management among the elderly) rose rapidly with annual percent change values above 30\% between 2009 and 2011, but rose slowly or remained stable between 2011 and 2016. In 2016, the subsidy standard per capita in the eastern, central, and western regions was equivalent to US \$7.43, \$7.15, and \$6.57, respectively, of which the national-level subsidy accounted for 25.50\%, 60.57\%, and 79.52\%, respectively. Conclusions: The Program has made a significant contribution to China's efforts in achieving UHC. The Program focuses on a key population and provides full life cycle services for the whole population. The financing system completely supported by the government makes the services more equitable and affordable. However, there are a few challenges to implementing the Program in China, especially to increase the public investment, optimize service items, enhance quality of the services, and evaluate the health outcomes. ",
doi="10.2196/31289",
url="https://publichealth.jmir.org/2022/7/e31289",
url="http://www.ncbi.nlm.nih.gov/pubmed/35867386"
}


@Article{info:doi/10.2196/28510,
author="Chukwu, Emeka
and Garg, Lalit
and Obande-Ogbuinya, Nkiruka
and Chattu, Kumar Vijay",
title="Standardizing Primary Health Care Referral Data Sets in Nigeria: Practitioners' Survey, Form Reviews, and Profiling of Fast Healthcare Interoperability Resources (FHIR)",
journal="JMIR Form Res",
year="2022",
month="Jul",
day="7",
volume="6",
number="7",
pages="e28510",
keywords="FHIR",
keywords="COVID-19",
keywords="digital health",
keywords="eHealth",
keywords="mHealth",
keywords="BlockMom",
keywords="Nigeria",
keywords="primary health care",
keywords="health information",
keywords="health information exchange",
keywords="interoperability",
abstract="Background: Referral linkages are crucial for efficient functioning of primary health care (PHC) systems. Fast Healthcare Interoperability Resource (FHIR) is an open global standard that facilitates structuring of health information for coordinated exchange among stakeholders. Objective: The objective of this study is to design FHIR profiles and present methodology and the profiled FHIR resource for Maternal and Child Health referral use cases in Ebonyi state, Nigeria---a typical low- and middle-income country (LMIC) setting. Methods: Practicing doctors, midwives, and nurses were purposefully sampled and surveyed. Different referral forms were reviewed. The union of data sets from surveys and forms was aggregated and mapped to base patient FHIR resource elements, and extensions were created for data sets not in the core FHIR specification. This study also introduced FHIR and its relation to the World Health Organization's (WHO's) International Classification of Diseases. Results: We found many different data elements from the referral forms and survey responses even in urban settings. The resulting FHIR standard profile is published on GitHub for adaptation or adoption as necessary to aid alignment with WHO recommendations. Understanding data sets used in health care and clinical practice for information sharing is crucial in properly standardizing information sharing, particularly during the management of COVID-19 and other infectious diseases. Development organizations and governments can use this methodology and profile to fast-track FHIR standards adoption for paper and electronic information sharing at PHC systems in LMICs. Conclusions: We presented our methodology for profiling the referral resource crucial for the standardized exchange of new and expectant moms' information. Using data from frontline providers and mapping to the FHIR profile helped contextualize the standardized profile. ",
doi="10.2196/28510",
url="https://formative.jmir.org/2022/7/e28510",
url="http://www.ncbi.nlm.nih.gov/pubmed/35797096"
}


@Article{info:doi/10.2196/38361,
author="Rivas, Carol
and Anand, Kusha
and Wu, Fang-Wei Alison
and Goff, Louise
and Dobson, Ruth
and Eccles, Jessica
and Ball, Elizabeth
and Kumar, Sarabajaya
and Camaradou, Jenny
and Redclift, Victoria
and Nasim, Bilal
and Aksoy, Ozan",
title="Lessons From the COVID-19 Pandemic to Improve the Health, Social Care, and Well-being of Minoritized Ethnic Groups With Chronic Conditions or Impairments: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2022",
month="Jul",
day="1",
volume="11",
number="7",
pages="e38361",
keywords="racism",
keywords="minoritized ethnic group",
keywords="disabled",
keywords="social care",
keywords="intersectional",
keywords="pandemic",
keywords="social networks",
keywords="public health",
keywords="migrant",
keywords="COVID-19",
abstract="Background: The COVID-19 pandemic has inequitably impacted the experiences of people living with ill health/impairments or from minoritized ethnic groups across all areas of life. Given possible parallels in inequities for disabled people and people from minoritized ethnic backgrounds, their existence before the pandemic and increase since, and the discriminations that each group faces, our interest is in understanding the interplay between being disabled AND being from a minoritized ethnic group. Objective: The overarching aim of the Coronavirus Chronic Conditions and Disabilities Awareness (CICADA) project, building on this understanding, is to improve pandemic and longer-term support networks, and access to and experiences of care, services, and resources for these underserved groups, both during the pandemic and longer term, thereby reducing inequities and enhancing social, health, and well-being outcomes. Methods: This mixed methods study involves three ``sweeps'' of a new UK survey; secondary analyses of existing cohort and panel surveys; a rapid scoping review; a more granular review; and qualitative insights from over 200 semistructured interviews, including social network/map/photo elicitation methods and two subsequent sets of remote participatory research workshops. Separate stakeholder cocreation meetings, running throughout the study, will develop analyses and outputs. Our longitudinal study design enables the exploration of significant relationships between variables in the survey data collected and to the assessment of changes in variables over time, including consideration of varying pandemic contexts. The qualitative data will provide more granular detail. We will take a strengths and assets--based approach, underpinned by the social model of disability and by intersectional considerations to challenge discrimination. Our exploration of the social determinants of health and well-being is framed by the social ecological model. Results: The CICADA project was funded by the Health and Social Care Delivery Research (HSDR) Programme of the United Kingdom (UK) National Institute for Health and Care Research (NIHR) in March 2021 and began in May 2021. Further work within the project (84 interviews) was commissioned in March 2022, a substudy focusing on mental health, specifically in Northeast England, Greater Manchester, and the Northwest Coast of the United Kingdom. Data collection began in August 2021, with the last participants due to be recruited in September 2022. As of January 2022, 5792 survey respondents and 227 interviewees had provided data. From April 2022, the time of article submission, we will recruit participants for the substudy and wave 2 of the surveys and qualitative work. We expect results to be published by winter 2022. Conclusions: In studying the experiences of disabled people with impairments and those living with chronic conditions who come from certain minoritized ethnic groups, we are aiming for transformative research to improve their health and well-being. International Registered Report Identifier (IRRID): DERR1-10.2196/38361 ",
doi="10.2196/38361",
url="https://www.researchprotocols.org/2022/7/e38361",
url="http://www.ncbi.nlm.nih.gov/pubmed/35609311"
}


@Article{info:doi/10.2196/37966,
author="Hendriks, Erik
and Koelen, Maria
and Verkooijen, Kirsten
and Hassink, Jan
and Vaandrager, Lenneke",
title="The Health Impact of Social Community Enterprises in Vulnerable Neighborhoods: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2022",
month="Jun",
day="22",
volume="11",
number="6",
pages="e37966",
keywords="social community enterprise",
keywords="health",
keywords="well-being",
keywords="public health",
keywords="social determinants of health",
keywords="health inequalities",
keywords="assets-based approach",
keywords="conceptual modeling",
abstract="Background: This 4-year research project focuses on 6 social community enterprises (SCEs) that operate in 5 neighborhoods in a Dutch city. Residents of these neighborhoods face problems such as poor average levels of physical and mental health, high unemployment rates, and weak social cohesion. SCEs offer residents social, cultural, and work-related activities and are therefore believed to help these persons develop themselves and strengthen the social ties in the community. Because of a lack of empirical evidence; however, it is unclear whether and how SCEs benefit the health and well-being of participants. Objective: This paper outlines a protocol for an evaluation study on the impact of SCEs, aiming to determine (1) to what extent SCEs affect health and well-being of participating residents, (2) what underlying processes and mechanisms can explain such impact, and (3) what assets are available to SCEs and how they can successfully mobilize these assets. Methods: A mixed methods multiple-case study design including repeated measurements will be conducted. Six SCEs form the cases. An integrated model of SCE health intervention will be used as the theoretical basis. First, the impact of SCEs is measured on the individual and community level, using questionnaires and in-depth interviews conducted with participants. Second, the research focuses on the underlying processes and mechanisms and the organizational and sociopolitical factors that influence the success or failure of these enterprises in affecting the health and well-being of residents. At this organizational level, in-depth interviews are completed with SCE initiators and stakeholders, such as municipal district managers. Finally, structurally documented observations are made on the organizational and sociopolitical context of the SCEs. Results: This research project received funding from the Netherlands Organization for Health Research and Development in 2018. Data collection takes place from 2018 until 2022. Data analysis starts after the last round of data collection in 2022 and finalizes in 2024. Expected results will be published in 2023 and 2024. Conclusions: Despite the societal relevance of SCEs, little empirical research has been performed on their functioning and impact. This research applies a variety of methods and includes the perspectives of multiple stakeholders aiming to generate new empirical evidence. The results will enable us to describe how SCE activities influence intermediate and long-term health outcomes and how the organizational and sociopolitical context of SCEs may shape opportunities or barriers for health promotion. As the number of these initiatives in the Netherlands is increasing rapidly, this research can benefit many SCEs attempting to become more effective and increase their impact. The findings of this research will be shared directly with relevant stakeholders through local and national meetings and annual reports and disseminated among other researchers through scientific publications. International Registered Report Identifier (IRRID): DERR1-10.2196/37966 ",
doi="10.2196/37966",
url="https://www.researchprotocols.org/2022/6/e37966",
url="http://www.ncbi.nlm.nih.gov/pubmed/35731574"
}


@Article{info:doi/10.2196/37334,
author="Chen, Yun Julie
and Chao, David
and Wong, Yeung-shan Samuel
and Tse, Emily Tsui Yee
and Wan, Fai Eric Yuk
and Tsang, Yan Joyce Pui
and Leung, Wa Maria Kwan
and Ko, Welchie
and Li, Yim-chu
and Chen, Catherine
and Luk, Wan
and Dao, Man-Chi
and Wong, Michelle
and Leung, Mun Wing
and Lam, Kuen Cindy Lo",
title="Morbidity Patterns in Primary Care in Hong Kong: Protocol for a Practice-Based Morbidity Survey",
journal="JMIR Res Protoc",
year="2022",
month="Jun",
day="22",
volume="11",
number="6",
pages="e37334",
keywords="morbidity survey",
keywords="primary care",
keywords="general practice",
keywords="family medicine",
abstract="Background: Up-to-date and accurate information about the health problems encountered by primary care doctors is essential to understanding the morbidity pattern of the community to better inform health care policy and practice. Morbidity surveys of doctors allow documentation of actual consultations, reflecting the patient's reason for seeking care as well as the doctor's diagnostic interpretation of the illness and management approach. Such surveys are particularly critical in the absence of a centralized primary care electronic medical record database. Objective: With the changing sociodemographic profile of the population and implementation of health care initiatives in the past 10 years, the aim of this study is to determine the morbidity and management patterns in Hong Kong primary care during a pandemic and compare the results with the last survey conducted in 2007-2008. Methods: This will be a prospective, practice-based survey of Hong Kong primary care doctors. Participants will be recruited by convenience and targeted sampling from both public and private sectors. Participating doctors will record the health problems and corresponding management activities for consecutive patient encounters during one designated week in each season of the year. Coding of health problems will follow the International Classification of Primary Care, Second Edition. Descriptive statistics will be used to calculate the prevalence of health problems and diseases as well as the rates of management activities (referral, investigation, prescription, preventive care). Nonlinear mixed effects models will assess the differences between the private and public sectors as well as factors associated with morbidity and management patterns in primary care. Results: The data collection will last from March 1, 2021, to August 31, 2022. As of April 2022, 176 doctor-weeks of data have been collected. Conclusions: The results will provide information about the health of the community and inform the planning and allocation of health care resources. Trial Registration: ClinicalTrials.gov NCT04736992; https://clinicaltrials.gov/ct2/show/NCT04736992 International Registered Report Identifier (IRRID): DERR1-10.2196/37334 ",
doi="10.2196/37334",
url="https://www.researchprotocols.org/2022/6/e37334",
url="http://www.ncbi.nlm.nih.gov/pubmed/35731566"
}


@Article{info:doi/10.2196/36569,
author="Norton, M. Jenna
and Ip, Alex
and Ruggiano, Nicole
and Abidogun, Tolulope
and Camara, Souleymane Djibril
and Fu, Helen
and Hose, Bat-Zion
and Miran, Saadia
and Hsiao, Chun-Ju
and Wang, Jing
and Bierman, S. Arlene",
title="Assessing Progress Toward the Vision of a Comprehensive, Shared Electronic Care Plan: Scoping Review",
journal="J Med Internet Res",
year="2022",
month="Jun",
day="10",
volume="24",
number="6",
pages="e36569",
keywords="electronic care plan",
keywords="care planning",
keywords="care plan",
keywords="care coordination",
keywords="multiple conditions",
keywords="multiple chronic conditions",
keywords="chronic disease",
keywords="chronic condition",
keywords="electronic care",
keywords="digital health",
keywords="electronic tools",
keywords="e-care",
keywords="healthcare data",
keywords="eHealth",
abstract="Background: Care plans are central to effective care delivery for people with multiple chronic conditions. But existing care plans---which typically are difficult to share across care settings and care team members---poorly serve people with multiple chronic conditions, who often receive care from numerous clinicians in multiple care settings. Comprehensive, shared electronic care (e-care) plans are dynamic electronic tools that facilitate care coordination and address the totality of health and social needs across care contexts. They have emerged as a potential way to improve care for individuals with multiple chronic conditions. Objective: To review the landscape of e-care plans and care plan--related initiatives that could allow the creation of a comprehensive, shared e-care plan and inform a joint initiative by the National Institutes of Health and the Agency for Healthcare Research and Quality to develop e-care planning tools for people with multiple chronic conditions. Methods: We conducted a scoping review, searching literature from 2015 to June 2020 using Scopus, Clinical Key, and PubMed; we also searched the gray literature. To identify initiatives potentially missing from this search, we interviewed expert informants. Relevant data were then identified and extracted in a structured format for data synthesis and analysis using an expanded typology of care plans adapted to our study context. The extracted data included (1) the perspective of the initiatives; (2) their scope, (3) network, and (4) context; (5) their use of open syntax standards; and (6) their use of open semantic standards. Results: We identified 7 projects for e-care plans and 3 projects for health care data standards. Each project provided critical infrastructure that could be leveraged to promote the vision of a comprehensive, shared e-care plan. All the e-care plan projects supported both broad goals and specific behaviors; 1 project supported a network of professionals across clinical, community, and home-based networks; 4 projects included social determinants of health. Most projects specified an open syntax standard, but only 3 specified open semantic standards. Conclusions: A comprehensive, shared, interoperable e-care plan has the potential to greatly improve the coordination of care for individuals with multiple chronic conditions across multiple care settings. The need for such a plan is heightened in the wake of the ongoing COVID-19 pandemic. While none of the existing care plan projects meet all the criteria for an optimal e-care plan, they all provide critical infrastructure that can be leveraged as we advance toward the vision of a comprehensive, shared e-care plan. However, critical gaps must be addressed in order to achieve this vision. ",
doi="10.2196/36569",
url="https://www.jmir.org/2022/6/e36569",
url="http://www.ncbi.nlm.nih.gov/pubmed/35687382"
}


@Article{info:doi/10.2196/35380,
author="Silva, Vieira C{\'i}cera Renata Diniz
and Lopes, Hor{\'a}cio Rayssa
and de Goes Bay Jr, Osvaldo
and Martiniano, Santos Claudia
and Fuentealba-Torres, Miguel
and Arc{\^e}ncio, Alexandre Ricardo
and Lap{\~a}o, Velez Lu{\'i}s
and Dias, Sonia
and Uchoa, Costa Severina Alice da",
title="Digital Health Opportunities to Improve Primary Health Care in the Context of COVID-19: Scoping Review",
journal="JMIR Hum Factors",
year="2022",
month="May",
day="31",
volume="9",
number="2",
pages="e35380",
keywords="digital health",
keywords="telehealth",
keywords="telemedicine",
keywords="primary health care",
keywords="quality of care",
keywords="COVID-19",
keywords="pandemic",
keywords="science database",
keywords="gray literature",
abstract="Background: The COVID-19 pandemic brought social, economic, and health impacts, requiring fast adaptation of health systems. Although information and communication technologies were essential for achieving this objective, the extent to which health systems incorporated this technology is unknown. Objective: The aim of this study was to map the use of digital health strategies in primary health care worldwide and their impact on quality of care during the COVID-19 pandemic. Methods: We performed a scoping review based on the Joanna Briggs Institute manual and guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Extension for Scoping Reviews. A systematic and comprehensive three-step search was performed in June and July 2021 in multidisciplinary health science databases and the gray literature. Data extraction and eligibility were performed by two authors independently and interpreted using thematic analysis. Results: A total of 44 studies were included and six thematic groups were identified: characterization and geographic distribution of studies; nomenclatures of digital strategies adopted; types of information and communication technologies; characteristics of digital strategies in primary health care; impacts on quality of care; and benefits, limitations, and challenges of digital strategies in primary health care. The impacts on organization of quality of care were investigated by the majority of studies, demonstrating the strengthening of (1) continuity of care; (2) economic, social, geographical, time, and cultural accessibility; (3) coordination of care; (4) access; (5) integrality of care; (6) optimization of appointment time; (7) and efficiency. Negative impacts were also observed in the same dimensions, such as reduced access to services and increased inequity and unequal use of services offered, digital exclusion of part of the population, lack of planning for defining the role of professionals, disarticulation of actions with real needs of the population, fragile articulation between remote and face-to-face modalities, and unpreparedness of professionals to meet demands using digital technologies. Conclusions: The results showed the positive and negative impacts of remote strategies on quality of care in primary care and the inability to take advantage of the potential of technologies. This may demonstrate differences in the organization of fast and urgent implementation of digital strategies in primary health care worldwide. Primary health care must strengthen its response capacity, expand the use of information and communication technologies, and manage challenges using scientific evidence since digital health is important and must be integrated into public service. ",
doi="10.2196/35380",
url="https://humanfactors.jmir.org/2022/2/e35380",
url="http://www.ncbi.nlm.nih.gov/pubmed/35319466"
}


@Article{info:doi/10.2196/36673,
author="Al-Jabr, Hiyam
and Windle, Karen
and Thompson, R. David
and Jenkins, M. Zoe
and Castle, J. David
and Ski, F. Chantal",
title="Long COVID Optimal Health Program (LC-OHP) to Enhance Psychological and Physical Health: Protocol for a Feasibility Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="May",
day="12",
volume="11",
number="5",
pages="e36673",
keywords="long COVID",
keywords="COVID-19",
keywords="optimal health program",
keywords="telemedicine",
keywords="integrated care",
keywords="telehealth",
keywords="patient care",
keywords="health intervention",
keywords="mental health",
keywords="physical health",
keywords="psychological health",
keywords="pandemic",
keywords="patient support",
abstract="Background: Long COVID is a collection of symptoms that develop during or following a confirmed or suspected case of COVID-19, which continue for more than 12 weeks. Despite the negative impact of long COVID on people's lives and functioning, there is no validated treatment or even rehabilitation guidance. What has been recommended thus far is the adoption of holistic management approaches. The Optimal Health Program (OHP) is a brief 5-session, plus booster, psychosocial program designed to support mental and physical well-being that has been used effectively for a range of chronic conditions. Objective: This study examines the feasibility and acceptability of employing an especially customized version of OHP (long COVID OHP [LC-OHP]) to improve psychological and physical health of people with long COVID. Methods: This is a feasibility randomized controlled trial that will be running from November 2021 to February 2023. Eligible participants aged 18 years or older who are experiencing symptoms of long COVID will be identified through their secondary practitioners with recruitment to be undertaken by the research team. A total of 60 participants will be randomized into a control (usual care) or an intervention (LC-OHP) group. Outcomes will be feasibility and acceptability of the program (primary); and efficacy of the LC-OHP in improving anxiety, depression, fatigue, self-efficacy, and quality of life (secondary). Up to 20 participants will be interviewed at the end of the trial to explore their experience with the program. Quantitative data will be analyzed using SPSS, and differences between groups will be compared using inferential tests where appropriate. Qualitative data will be transcribed and thematically analyzed to identify common emerging themes. Results: This is an ongoing study, which began in November 2021. Conclusions: Long COVID has a significant impact on an individual's mental and physical functioning. The LC-OHP has a potential to provide people living with long COVID with additional support and to improve self-efficacy. The findings of this study would identify the feasibility of delivering this program to this population and will provide an indication for the program's effectiveness. Trial Registration: ISRCTN Registry ISRCTN38746119; https://www.isrctn.com/ISRCTN38746119 International Registered Report Identifier (IRRID): DERR1-10.2196/36673 ",
doi="10.2196/36673",
url="https://www.researchprotocols.org/2022/5/e36673",
url="http://www.ncbi.nlm.nih.gov/pubmed/35468586"
}


@Article{info:doi/10.2196/30496,
author="Friedman, Diane
and Grimaldi, Lamiae
and Cariou, Alain
and Aegerter, Philippe
and Gaudry, St{\'e}phane
and Ben Salah, Abdel
and Oueslati, Haikel
and Megarbane, Bruno
and Meunier-Beillard, Nicolas
and Quenot, Jean-Pierre
and Schwebel, Carole
and Jacob, Laurent
and Robin Lagandr{\'e}, S{\'e}glo{\`e}ne
and Kalfon, Pierre
and Sonneville, Romain
and Siami, Shidasp
and Mazeraud, Aurelien
and Sharshar, Tarek",
title="Impact of a Postintensive Care Unit Multidisciplinary Follow-up on the Quality of Life (SUIVI-REA): Protocol for a Multicenter Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="May",
day="9",
volume="11",
number="5",
pages="e30496",
keywords="critical illness",
keywords="Post-ICU syndrome",
keywords="Mortality",
keywords="cognitive impairments",
keywords="cognition",
keywords="quality of life",
keywords="patients",
keywords="intensive care",
keywords="post-traumatic",
keywords="post intensive care",
abstract="Background: Critically ill patients are at risk of developing a postintensive care syndrome (PICS), which is characterized by physical, psychological, and cognitive impairments and which dramatically impacts the patient's quality of life (QoL). No intervention has been shown to improve QoL. We hypothesized that a medical, psychological, and social follow-up would improve QoL by mitigating the PICS. Objective: This multicenter, randomized controlled trial (SUIVI-REA) aims to compare a multidisciplinary follow-up with a standard postintensive care unit (ICU) follow-up. Methods: Patients were randomized to the control or intervention arm. In the intervention arm, multidisciplinary follow-up involved medical, psychological, and social evaluation at ICU discharge and at 3, 6, and 12 months thereafter. In the placebo group, patients were seen only at 12 months by the multidisciplinary team. Baseline characteristics at ICU discharge were collected for all patients. The primary outcome was QoL at 1 year, assessed using the Euro Quality of Life-5 dimensions (EQ5D). Secondary outcomes were mortality, cognitive, psychological, and functional status; social and professional reintegration; and the rate of rehospitalization and outpatient consultations at 1 year. Results: The study was funded by the Ministry of Health in June 2010. It was approved by the Ethics Committee on July 8, 2011. The first and last patient were randomized on December 20, 2012, and September 1, 2017, respectively. A total of 546 patients were enrolled across 11 ICUs. At present, data management is ongoing, and all parties involved in the trial remain blinded. Conclusions: The SUVI-REA multicenter randomized controlled trial aims to assess whether a post-ICU multidisciplinary follow-up improves QoL at 1 year. Trial Registration: Clinicaltrials.gov NCT01796509; https://clinicaltrials.gov/ct2/show/NCT01796509 International Registered Report Identifier (IRRID): DERR1-10.2196/30496 ",
doi="10.2196/30496",
url="https://www.researchprotocols.org/2022/5/e30496",
url="http://www.ncbi.nlm.nih.gov/pubmed/35532996"
}


@Article{info:doi/10.2196/31720,
author="Milne-Ives, Madison
and Shankar, Rohit
and Goodley, Dan
and Lamb, Kirsten
and Laugharne, Richard
and Harding, Tracey
and Meinert, Edward",
title="Humanizing Health and Social Care Support for People With Intellectual and Developmental Disabilities: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2022",
month="May",
day="4",
volume="11",
number="5",
pages="e31720",
keywords="developmental disabilities",
keywords="intellectual disability",
keywords="delivery of health care",
keywords="patient care management",
keywords="social work",
keywords="social support",
keywords="patient-centered care",
keywords="empathy",
keywords="respect",
keywords="social care",
abstract="Background: Health care is shifting toward a more person-centered model; however, people with intellectual and developmental disabilities can still experience difficulties in accessing equitable health care. Given these difficulties, it is important to consider how humanizing principles, such as empathy and respect, can be best incorporated into health and social care practices for people with intellectual and developmental disabilities to ensure that they are receiving equitable treatment and support. Objective: The purpose of our scoping review is to provide an overview of the current research landscape and knowledge gaps regarding the development and implementation of interventions based on humanizing principles that aim to improve health and social care practices for people with intellectual and developmental disabilities. Methods: The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and PICOS (Population, Intervention, Comparator, Outcome, and Study) frameworks will be used to structure the review. A total of 6 databases (PubMed, MEDLINE, Embase, CINAHL, PsycINFO, and Web of Science) will be searched for English articles published in the previous 10 years that describe or evaluate health and social care practice interventions underpinned by the humanizing principles of empathy, compassion, dignity, and respect. Two reviewers will screen and select references based on the eligibility criteria and extract the data into a predetermined form. A descriptive analysis will be conducted to summarize the results and provide an overview of interventions in the following three main care areas: health care, social care, and informal social support. Results: The results will be included in the scoping review, which is expected to begin in October 2022 and be completed and submitted for publication by January 2023. Conclusions: Our scoping review will summarize the state of the field of interventions that are using humanizing principles to improve health and social care for adults with intellectual and developmental disabilities. International Registered Report Identifier (IRRID): PRR1-10.2196/31720 ",
doi="10.2196/31720",
url="https://www.researchprotocols.org/2022/5/e31720",
url="http://www.ncbi.nlm.nih.gov/pubmed/35507388"
}


@Article{info:doi/10.2196/36753,
author="Garcia, K. Franshelis
and Verkooijen, T. Kirsten
and Veen, J. Esther
and Mulder, C. Bob
and Koelen, A. Maria
and Hazebroek, J. Eric",
title="Stigma Toward Bariatric Surgery in the Netherlands, France, and the United Kingdom: Protocol for a Cross-cultural Mixed Methods Study",
journal="JMIR Res Protoc",
year="2022",
month="Apr",
day="28",
volume="11",
number="4",
pages="e36753",
keywords="bariatric surgery",
keywords="obesity surgery",
keywords="weight loss surgery",
keywords="stigma",
keywords="cross-cultural study",
keywords="France",
keywords="the Netherlands",
keywords="the United Kingdom",
abstract="Background: Bariatric surgery is an effective procedure for the treatment of obesity. Despite this, only 0.1\% to 2\% of eligible individuals undergo surgery worldwide. The stigma surrounding surgery might be a reason for this. Thus far, no research has systematically studied the nature and implications of bariatric surgery stigma. The limited studies on bariatric surgery stigma are often conducted from the perspective of the public or health care professions and either use small and nonrepresentative samples or fail to capture the full essence and implications of the stigma altogether, including attitudes toward patients and perpetrators of the stigma. In addition, studies from patients' perspectives are limited and tend to address bariatric surgery stigma superficially or implicitly. Finally, the extent to which cultural factors shape and facilitate this stigma and the experiences of patients have not yet been researched. Objective: This study aimed to explore the perceptions, experiences, and consequences of bariatric surgery stigma from the perspective of the public, health care professionals, and patients before and after bariatric surgery. Furthermore, although the concept of stigma is universal, every society has specific cultural norms and values that define acceptable attributes and behaviors for its members. Therefore, this study also aimed to explore the extent to which cultural factors influence bariatric surgery stigma by comparing the Netherlands, France, and the United Kingdom. Methods: This paper describes the protocol for a multiphase mixed methods research design. In the first part, we will conduct a scoping review to determine the current knowledge on bariatric surgery stigma and identify knowledge gaps. In the second part, semistructured interviews among patients before and after bariatric surgery will be conducted to explore their experiences and consequences of bariatric surgery stigma. In the third part, surveys will be conducted among both the public and health care professionals to determine the prevalence, nature, and impact of bariatric surgery stigma. Surveys and interviews will be conducted in the Netherlands, France, and the United Kingdom. Finally, data integration will be conducted at the interpretation and reporting levels. Results: The study began in September 2020 and will continue through September 2025. With the results of the review, we will create an overview of the current knowledge regarding bariatric surgery stigma from patients' perspectives. Qualitative data will provide insights into patients' experiences with bariatric surgery stigma. Quantitative data will provide information related to the prevalence and nature of bariatric surgery stigma from the perspective of the public and health care professionals. Both qualitative and quantitative data will be compared for each country. Conclusions: The findings from this study will lead to new insights that can be used to develop strategies to reduce bariatric surgery stigma and improve access, use, and outcomes of bariatric surgery. International Registered Report Identifier (IRRID): PRR1-10.2196/36753 ",
doi="10.2196/36753",
url="https://www.researchprotocols.org/2022/4/e36753",
url="http://www.ncbi.nlm.nih.gov/pubmed/35482364"
}


@Article{info:doi/10.2196/35243,
author="Ronellenfitsch, Ulrich
and Mathis, Nika
and Friedrichs, Juliane
and Kleeff, J{\"o}rg",
title="Lymph Node Yield in Gastrointestinal Cancer Surgery With or Without Prior Neoadjuvant Therapy: Protocol for a Systematic Review and Meta-analysis",
journal="JMIR Res Protoc",
year="2022",
month="Apr",
day="28",
volume="11",
number="4",
pages="e35243",
keywords="lymph node yield",
keywords="lymph node harvest",
keywords="neoadjuvant therapy",
keywords="neoadjuvant chemotherapy",
keywords="neoadjuvant radiotherapy",
keywords="surgery",
keywords="resection",
keywords="gastrointestinal cancer",
keywords="chemotherapy",
keywords="cancer",
abstract="Background: Lymph node yield is the number of lymph nodes retrieved during oncological resection and histopathologically identified in the resection specimen. It is an important surrogate parameter for assessing the oncological radicality of the resection of gastrointestinal carcinomas, as well as a prognostic factor in these diseases. It remains unclear if and to what extent neoadjuvant chemotherapy, radiotherapy, or chemoradiotherapy, which have become established treatments for carcinoma of the esophagus, stomach, and rectum and are increasingly used in pancreatic carcinoma, affect the lymph node yield. Objective: This systematic review with meta-analysis is conducted with the aim of summarizing the available evidence regarding the lymph node yield, an oncological surrogate marker, in patients with gastrointestinal carcinomas undergoing surgery after neoadjuvant therapy compared to those undergoing surgery without neoadjuvant therapy. Methods: Randomized and nonrandomized studies comparing oncological resection of esophageal, stomach, pancreatic, and rectal carcinoma with and without prior neoadjuvant therapy are eligible for inclusion regardless of study design. Publications will be identified with a defined search strategy in 2 electronic databases: PubMed and Cochrane Library. The primary endpoint of the analysis is the number of lymph nodes identified in the resected specimen. Secondary endpoints include the number of harvested metastatic lymph nodes, operation time, postoperative complications, pathological TNM staging, and overall and recurrence-free survival time. Using suitable statistical methods, the endpoints between patients with and without neoadjuvant therapy, as well as in defined subgroups (neoadjuvant chemotherapy, radiotherapy, or chemoradiotherapy; and patients with esophageal, gastric, pancreatic, or rectal cancer), will be compared. Results: The literature search and data collection started in October 2021. Results are expected to be published in mid-2022. Conclusions: This meta-analysis will provide the most up-to-date and complete summary of the evidence on an association between neoadjuvant therapy and lymph node yield in gastrointestinal cancer surgery. The underlying hypothesis is that neoadjuvant therapy decreases the number and size of lymph nodes through lymphocyte depletion and radiation-induced fibrosis, thus leading to a lower possible lymph node yield. The findings of the meta-analysis will show if this hypothesis is supported by evidence. Trial Registration: PROSPERO CRD218459; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42021218459 International Registered Report Identifier (IRRID): DERR1-10.2196/35243 ",
doi="10.2196/35243",
url="https://www.researchprotocols.org/2022/4/e35243",
url="http://www.ncbi.nlm.nih.gov/pubmed/35482374"
}


@Article{info:doi/10.2196/34544,
author="Elgersma, Hess Ingeborg
and Fretheim, Atle
and Indseth, Thor
and Munch, Thorolvsen Anita
and Johannessen, B{\o}e Live
and Hansen, Engh Christine",
title="The Evaluation of a Social Media Campaign to Increase COVID-19 Testing in Migrant Groups: Cluster Randomized Trial",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="24",
volume="24",
number="3",
pages="e34544",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="social media",
keywords="campaign",
keywords="cluster randomized trial",
keywords="nonpharmaceutical interventions",
keywords="migrant",
keywords="intervention",
keywords="testing",
keywords="strategy",
keywords="public health",
keywords="Facebook",
keywords="communication",
abstract="Background: A low test positivity rate is key to keeping the COVID-19 pandemic under control. Throughout the pandemic, several migrant groups in Norway have seen higher rates of confirmed COVID-19 and related hospitalizations, while test positivity has remained high in the same groups. The Norwegian government has used several platforms for communication, and targeted social media advertisements have in particular been an important part of the communication strategy to reach these groups. Objective: In this study, we aimed to investigate whether such a targeted Facebook campaign increased the rate of COVID-19 tests performed in certain migrant groups. Methods: We randomly assigned 386 Norwegian municipalities and city districts to intervention or control groups. Individuals born in Eritrea, Iraq, Pakistan, Poland, Russia, Somalia, Syria, and Turkey residing in intervention areas were targeted with a social media campaign aiming at increasing the COVID-19 test rate. The campaign message was in a simple language and conveyed in the users' main language or in English. Results: During the 2-week follow-up period, the predicted probability of having a COVID-19 test taken was 4.82\% (95\% CI 4.47\%-5.18\%) in the control group, and 5.58\% (95\% CI 5.20\%-5.99\%) in the intervention group (P=.004). Conclusions: Our targeted social media intervention led to a modest increase in test rates among certain migrant groups in Norway. Trial Registration: ClinicalTrials.gov NCT04866589; https://clinicaltrials.gov/ct2/show/NCT04866589 ",
doi="10.2196/34544",
url="https://www.jmir.org/2022/3/e34544",
url="http://www.ncbi.nlm.nih.gov/pubmed/35285811"
}


@Article{info:doi/10.2196/25906,
author="Lahtio, Heli
and Rintala, Aki
and Immonen, Jaakko
and Sj{\"o}gren, Tuulikki",
title="The Effectiveness of Physical Activity-Promoting Web- and Mobile-Based Distance Weight Loss Interventions on Body Composition in Rehabilitation Settings: Systematic Review, Meta-analysis, and Meta-Regression Analysis",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="24",
volume="24",
number="3",
pages="e25906",
keywords="technology",
keywords="weight loss",
keywords="rehabilitation",
keywords="overweight",
keywords="obesity",
keywords="body mass index",
keywords="waist circumference",
keywords="body fat percentage",
keywords="mobile phone",
abstract="Background: Overweight and obesity are major problems worldwide, and they lead to an increased risk for several diseases. The use of technology in the treatment of obesity is promising, but in the existing literature, there is considerable uncertainty regarding its efficacy. In this review, we included web- and mobile-based weight loss interventions that were implemented remotely in rehabilitation settings. Objective: The aim of this systematic review is to study the effectiveness of physical activity-promoting web- and mobile-based distance weight loss interventions in rehabilitation settings on body composition in comparison with control groups that did not use technology. Methods: Studies were searched from 9 databases. The inclusion criteria were as follows: population: age 18-65 years; intervention: physical activity-promoting web- and mobile-based distance weight loss interventions; comparison: control groups without the use of technology; outcome: changes in BMI, waist circumference, or body fat percentage; study design: randomized controlled trial. The quality of the studies was assessed by 2 researchers. Meta-analysis was performed, and we also conducted a meta-regression analysis to evaluate the factors associated with the changes in body composition outcomes if statistical heterogeneity was observed. Results: The meta-analysis included 30 studies. The mean quality of the studies was 7 of 13 (SD 1.9; range 3-10). A statistically significant difference was observed in BMI (mean difference [MD] 0.83, 95\% CI 0.51-1.15 kg/m2; P<.001), waist circumference (MD 2.45, 95\% CI 1.83-3.07 cm; P<.001), and body fat percentage (MD 1.07\%, 95\% CI 0.74\%-1.41\%; P<.001) in favor of the weight loss groups using web- or mobile-based interventions. Meta-regression analyses found an association between personal feedback and BMI (P=.04), but other factors did not play a role in explaining statistical heterogeneity. Conclusions: Web- and mobile-based distance weight loss interventions significantly reduced BMI, waist circumference, and body fat percentage. Future studies should focus on the comparability of the intervention content. Future studies are needed to better understand weight loss and identify which components are essential in achieving it. Trial Registration: PROSPERO CRD42016035831; https://tinyurl.com/7c93tvd4 ",
doi="10.2196/25906",
url="https://www.jmir.org/2022/3/e25906",
url="http://www.ncbi.nlm.nih.gov/pubmed/35323126"
}


@Article{info:doi/10.2196/30454,
author="Mariathas, H. Hensley
and Hurley, Oliver
and Anaraki, Rahimipour Nahid
and Young, Christina
and Patey, Christopher
and Norman, Paul
and Aubrey-Bassler, Kris
and Wang, Peter Peizhong
and Gadag, Veeresh
and Nguyen, V. Hai
and Etchegary, Holly
and McCrate, Farah
and Knight, C. John
and Asghari, Shabnam",
title="A Quality Improvement Emergency Department Surge Management Platform (SurgeCon): Protocol for a Stepped Wedge Cluster Randomized Trial",
journal="JMIR Res Protoc",
year="2022",
month="Mar",
day="24",
volume="11",
number="3",
pages="e30454",
keywords="SurgeCon",
keywords="emergency department",
keywords="stepped wedge design",
keywords="cluster randomized trials",
keywords="wait time",
abstract="Background: Despite many efforts, long wait times and overcrowding in emergency departments (EDs) have remained a significant health service issue in Canada. For several years, Canada has had one of the longest wait times among the Organisation for Economic Co-operation and Development countries. From a patient's perspective, this challenge has been described as ``patients wait in pain or discomfort for hours before being seen at EDs.'' To overcome the challenge of increased wait times, we developed an innovative ED management platform called SurgeCon that was designed based on continuous quality improvement principles to maintain patient flow and mitigate the impact of patient surge on ED efficiency. The SurgeCon quality improvement intervention includes a protocol-driven software platform, restructures ED organization and workflow, and aims to establish a more patient-centric environment. We piloted SurgeCon at an ED in Carbonear, Newfoundland and Labrador, and found that there was a 32\% reduction in ED wait times. Objective: The primary objective of this trial is to determine the effects of SurgeCon on ED performance by assessing its impact on length of stay, the time to a physician's initial assessment, and the number of patients leaving the ED without being seen by a physician. The secondary objectives of this study are to evaluate SurgeCon's effects on patient satisfaction and patient-reported experiences with ED wait times and its ability to create better-value care by reducing the per-patient cost of delivering ED services. Methods: The implementation of the intervention will be assessed using a comparative effectiveness-implementation hybrid design. This type of hybrid design is known to shorten the amount of time associated with transitioning interventions from being the focus of research to being used for practice and health care services. All EDs with 24/7 on-site physician support (category A hospitals) will be enrolled in a 31-month, pragmatic, stepped wedge cluster randomized trial. All clusters (hospitals) will start with a baseline period of usual care and will be randomized to determine the order and timing of transitioning to intervention care until all hospitals are using the intervention to manage and operationalize their EDs. Results: Data collection for this study is continuing. As of February 2022, a total of 570 randomly selected patients have participated in telephone interviews concerning patient-reported experiences and patient satisfaction with ED wait times. The first of the 4 EDs was randomly selected, and it is currently using SurgeCon's eHealth platform and applying efficiency principles that have been learned through training since September 2021. The second randomly selected site will begin intervention implementation in winter 2022. Conclusions: By assessing the impact of SurgeCon on ED services, we hope to be able to improve wait times and create better-value ED care in this health care context. Trial Registration: ClinicalTrials.gov NCT04789902; https://clinicaltrials.gov/ct2/show/NCT04789902 International Registered Report Identifier (IRRID): DERR1-10.2196/30454 ",
doi="10.2196/30454",
url="https://www.researchprotocols.org/2022/3/e30454",
url="http://www.ncbi.nlm.nih.gov/pubmed/35323121"
}


@Article{info:doi/10.2196/29513,
author="Paralkar, Anmol Tapasvini
and Lay, Phoebe
and Stubbs, Sawyer
and Ahmed, Hadi Syed
and Ghani, Minha
and Osier, Nico",
title="Occurrence Patterns of Traumatic Brain Injury Within the Emergency Department and Internal Screening Process Efficacy During the COVID-19 Pandemic: Retrospective Analysis",
journal="Interact J Med Res",
year="2022",
month="Mar",
day="23",
volume="11",
number="1",
pages="e29513",
keywords="COVID-19",
keywords="coronavirus",
keywords="pandemic",
keywords="clinical recruitment",
keywords="traumatic brain injury",
keywords="children",
keywords="participant-focused",
keywords="recruitment",
keywords="enrollment",
keywords="digital screening",
keywords="brain",
keywords="EHR",
keywords="electronic health record",
keywords="database",
abstract="Background: Traumatic brain injury (TBI) is one of the leading causes of death in pediatric patients. Continued recruitment of pediatric TBI participants into a biobank amidst the COVID-19 pandemic not only necessitates adaptive changes to traditional recruitment methods but also requires an evaluation of emergency department (ED) utilization by TBI-presenting patients. Objective: The primary objective of this exploratory retrospective study was to evaluate pediatric TBI-related ED utilization during the pandemic. The secondary objective was to appraise the efficacy of the research team's internal screening processes. Methods: Potential participants (ie, individuals who met all inclusion criteria and would be approached by a consenter) were screened from an ED's electronic health record system. Data regarding their visit were recorded in a Health Insurance Portability and Accountability Act--compliant manner, which were cleaned through Google Sheets. Cleaned data were then coded as either a screening variable or a hospital utilization variable to examine the effects of the pandemic on internal operations and hospital utilization patterns. The variables were compared between select months during the pandemic in 2020 to analogous months in 2019 in the R programming language via the two-sample Student t test and the Mann-Whitney-Wilcoxon rank-sum test. Results: The sample (N=2321) consisted of 1245 entries from 2019 and 1076 entries from 2020. A significantly greater proportion of potential participants (P<.001) were identified in 2020 (222/633, 35.1\%) than in 2019 (195/908, 21.4\%). A significantly greater proportion of potential participants (P<.001) had a visit reason indicative of a TBI in 2020 (181/222, 81.5\%) than in 2019 (103/195, 52.8\%). A significantly greater proportion of these injuries (P=.02) occurred inside (39/181, 21.5\%) in 2020 than in 2019 (11/103, 10.7\%). No significant difference was found across the mechanism of injury categories reported for potential participants between 2019 and 2020. Potential participants were significantly older (P=.006) in 2019 (mean 8.93 years) than in 2020 (mean 7.31 years). Screeners spent significantly longer (P=.03) to identify potential participants in March 2020 (55 minutes) than in March 2019 (32 minutes), but spent significantly less time (P=.01) to do so in July 2020 (22 minutes) than in July 2019 (42 minutes). Screening coverage was significantly lower (P<.001) in March 2020 (241.8 hours) than in March 2019 (346.5 hours). Screening coverage was significantly greater (P<.001) in April 2020 (611.5 hours) and July 2020 (513.5 hours) than in April 2019 (470.5 hours) and July 2019 (404.3 hours), respectively. Conclusions: There was a significant increase in the rate of incoming TBI cases to the ED during the COVID-19 pandemic, warranting continued enrollment with added safety measures. Additionally, refinement of internal processes improved the accuracy of data collection. As demonstrated in this study, researchers can leverage ongoing data collection to facilitate process improvements and evaluate the impact of unexpected global events on their research. ",
doi="10.2196/29513",
url="https://www.i-jmr.org/2022/1/e29513",
url="http://www.ncbi.nlm.nih.gov/pubmed/35225820"
}


@Article{info:doi/10.2196/23844,
author="Lim, Sahnah
and Islam, S. Nadia",
title="Small Practices, Big (QI) Dreams: Customizing Quality Improvement (QI) Efforts for Under-Resourced Primary Care Practices to Improve Diabetes Disparities",
journal="JMIR Diabetes",
year="2022",
month="Mar",
day="18",
volume="7",
number="1",
pages="e23844",
keywords="electronic health record",
keywords="quality improvement",
keywords="health equity",
keywords="clinical practice guidelines",
keywords="diabetes",
abstract="International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3711-y ",
doi="10.2196/23844",
url="https://diabetes.jmir.org/2022/1/e23844",
url="http://www.ncbi.nlm.nih.gov/pubmed/35302500"
}


@Article{info:doi/10.2196/25275,
author="Dong, Wei
and Lei, Xiangxi
and Liu, Yongmei",
title="The Mediating Role of Patients' Trust Between Web-Based Health Information Seeking and Patients' Uncertainty in China: Cross-sectional Web-Based Survey",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="11",
volume="24",
number="3",
pages="e25275",
keywords="patient trust",
keywords="online health information quality",
keywords="online word-of-mouth",
keywords="patient uncertainty",
keywords="principal-agent theory",
keywords="physician-patient relationship",
abstract="Background: In the physician-patient relationship, patients' uncertainty about diseases and the lack of trust in physicians not only hinder patients' rehabilitation but also disrupt the harmony in this relationship. With the development of the web-based health industry, patients can easily access web-based information about health care and physicians, thus reducing patients' uncertainty to some extent. However, it is not clear how patients' web-based health information--seeking behaviors reduce their uncertainty. Objective: On the basis of the principal-agent theory and the perspective of uncertainty reduction, this study aims to investigate the mechanism of how web-based disease-related information and web-based physician-related information reduce patients' uncertainty. Methods: A web-based survey involving 337 participants was conducted. In this study, we constructed a structural equation model and used SmartPLS (version 3.3.3; SmartPLS GmbH) software to test the reliability and validity of the measurement model. The path coefficients of the structural model were also calculated to test our hypotheses. Results: By classifying patients' uncertainties into those concerning diseases and those concerning physicians, this study identified the different roles of the two types of patients' uncertainty and revealed that web-based disease-related information quality and web-based physician-related information can act as uncertainty mitigators. The quality of disease-related information reduces patients' perceived information scarcity about the disease ($\beta$=?.588; P<.001), and the higher the information scarcity perceived by patients, the higher their uncertainty toward the disease ($\beta$=.111; P=.02). As for physician-related information, web-based word-of-mouth information about physicians reduces patients' perceived information scarcity about the physician ($\beta$=?.511; P<.001), mitigates patients' fears about physician opportunism ($\beta$=?.268; P<.001), and facilitates patients' trust ($\beta$=.318; P<.001). These factors further influence patients' uncertainty about the physician. In addition, from the test of mediating effect, patients' trust in the physician fully mediates the relationship between their perceived information scarcity about the physician's medical service and their uncertainty about the physician. Patients' trust also partially mediates the relationship between their fear of the physician's opportunism and their uncertainty about the physician. As for the two different types of uncertainty, patients' uncertainty about the physician also increases their uncertainty about the diseases ($\beta$=.587; P<.001). Conclusions: This study affirms the role of disease-related web-based information quality and physician-related web-based word-of-mouth information in reducing patients' uncertainties. With regard to the traits of principal-agent relationships, this study describes the influence mechanism based on patients' perceived information scarcity, fears of physicians' opportunism, and patients' trust. Moreover, information about physicians is effective in reducing patients' uncertainties, but only if the information enhances patients' trust in their physicians. This research generates new insights into understanding the impact of web-based health information on patients' uncertainties. ",
doi="10.2196/25275",
url="https://www.jmir.org/2022/3/e25275",
url="http://www.ncbi.nlm.nih.gov/pubmed/35275074"
}


@Article{info:doi/10.2196/34098,
author="Marx, Gernot
and Greiner, Wolfgang
and Juhra, Christian
and Elkenkamp, Svenja
and Gensorowsky, Daniel
and Lemmen, Sebastian
and Englbrecht, Jan
and Dohmen, Sandra
and Gottschalk, Antje
and Haverkamp, Miriam
and Hempen, Annette
and Fl{\"u}gel-Bleienheuft, Christian
and Bause, Daniela
and Schulze-Steinen, Henna
and Rademacher, Susanne
and Kistermann, Jennifer
and Hoch, Stefan
and Beckmann, Hans-Juergen
and Lanckohr, Christian
and Lowitsch, Volker
and Peine, Arne
and Juzek-Kuepper, Fabian
and Benstoem, Carina
and Sperling, Kathrin
and Deisz, Robert",
title="An Innovative Telemedical Network to Improve Infectious Disease Management in Critically Ill Patients and Outpatients (TELnet@NRW): Stepped-Wedge Cluster Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="2",
volume="24",
number="3",
pages="e34098",
keywords="telemedicine",
keywords="infectious disease medicine",
keywords="sepsis",
keywords="evidence-based medicine",
keywords="eHealth",
abstract="Background: Evidence-based infectious disease and intensive care management is more relevant than ever. Medical expertise in the two disciplines is often geographically limited to university institutions. In addition, the interconnection between inpatient and outpatient care is often insufficient (eg, no shared electronic health record and no digital transfer of patient findings). Objective: This study aims to establish and evaluate a telemedical inpatient-outpatient network based on expert teleconsultations to increase treatment quality in intensive care medicine and infectious diseases. Methods: We performed a multicenter, stepped-wedge cluster randomized trial (February 2017 to January 2020) to establish a telemedicine inpatient-outpatient network among university hospitals, hospitals, and outpatient physicians in North Rhine-Westphalia, Germany. Patients aged ?18 years in the intensive care unit or consulting with a physician in the outpatient setting were eligible. We provided expert knowledge from intensivists and infectious disease specialists through advanced training courses and expert teleconsultations with 24/7/365 availability on demand respectively once per week to enhance treatment quality. The primary outcome was adherence to the 10 Choosing Wisely recommendations for infectious disease management. Guideline adherence was analyzed using binary logistic regression models. Results: Overall, 159,424 patients (10,585 inpatients and 148,839 outpatients) from 17 hospitals and 103 outpatient physicians were included. There was a significant increase in guideline adherence in the management of Staphylococcus aureus infections (odds ratio [OR] 4.00, 95\% CI 1.83-9.20; P<.001) and in sepsis management in critically ill patients (OR 6.82, 95\% CI 1.27-56.61; P=.04). There was a statistically nonsignificant decrease in sepsis-related mortality from 29\% (19/66) in the control group to 23.8\% (50/210) in the intervention group. Furthermore, the extension of treatment with prophylactic antibiotics after surgery was significantly less likely (OR 9.37, 95\% CI 1.52-111.47; P=.04). Patients treated by outpatient physicians, who were regularly participating in expert teleconsultations, were also more likely to be treated according to guideline recommendations regarding antibiotic therapy for uncomplicated upper respiratory tract infections (OR 1.34, 95\% CI 1.16-1.56; P<.001) and asymptomatic bacteriuria (OR 9.31, 95\% CI 3.79-25.94; P<.001). For the other recommendations, we found no significant effects, or we had too few observations to generate models. The key limitations of our study include selection effects due to the applied on-site triage of patients as well as the limited possibilities to control for secular effects. Conclusions: Telemedicine facilitates a direct round-the-clock interaction over broad distances between intensivists or infectious disease experts and physicians who care for patients in hospitals without ready access to these experts. Expert teleconsultations increase guideline adherence and treatment quality in infectious disease and intensive care management, creating added value for critically ill patients. Trial Registration: ClinicalTrials.gov NCT03137589; https://clinicaltrials.gov/ct2/show/NCT03137589 ",
doi="10.2196/34098",
url="https://www.jmir.org/2022/3/e34098",
url="http://www.ncbi.nlm.nih.gov/pubmed/35103604"
}


@Article{info:doi/10.2196/27534,
author="Chishtie, Jawad
and Bielska, Anna Iwona
and Barrera, Aldo
and Marchand, Jean-Sebastien
and Imran, Muhammad
and Tirmizi, Ali Syed Farhan
and Turcotte, A. Luke
and Munce, Sarah
and Shepherd, John
and Senthinathan, Arrani
and Cepoiu-Martin, Monica
and Irvine, Michael
and Babineau, Jessica
and Abudiab, Sally
and Bjelica, Marko
and Collins, Christopher
and Craven, Catharine B.
and Guilcher, Sara
and Jeji, Tara
and Naraei, Parisa
and Jaglal, Susan",
title="Interactive Visualization Applications in Population Health and Health Services Research: Systematic Scoping Review",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="18",
volume="24",
number="2",
pages="e27534",
keywords="interactive visualization",
keywords="data visualization",
keywords="secondary health care data",
keywords="public health informatics",
keywords="population health",
keywords="health services research",
abstract="Background: Simple visualizations in health research data, such as scatter plots, heat maps, and bar charts, typically present relationships between 2 variables. Interactive visualization methods allow for multiple related facets such as numerous risk factors to be studied simultaneously, leading to data insights through exploring trends and patterns from complex big health care data. The technique presents a powerful tool that can be used in combination with statistical analysis for knowledge discovery, hypothesis generation and testing, and decision support. Objective: The primary objective of this scoping review is to describe and summarize the evidence of interactive visualization applications, methods, and tools being used in population health and health services research (HSR) and their subdomains in the last 15 years, from January 1, 2005, to March 30, 2019. Our secondary objective is to describe the use cases, metrics, frameworks used, settings, target audience, goals, and co-design of applications. Methods: We adapted standard scoping review guidelines with a peer-reviewed search strategy: 2 independent researchers at each stage of screening and abstraction, with a third independent researcher to arbitrate conflicts and validate findings. A comprehensive abstraction platform was built to capture the data from diverse bodies of literature, primarily from the computer science and health care sectors. After screening 11,310 articles, we present findings from 56 applications from interrelated areas of population health and HSR, as well as their subdomains such as epidemiologic surveillance, health resource planning, access, and use and costs among diverse clinical and demographic populations. Results: In this companion review to our earlier systematic synthesis of the literature on visual analytics applications, we present findings in 6 major themes of interactive visualization applications developed for 8 major problem categories. We found a wide application of interactive visualization methods, the major ones being epidemiologic surveillance for infectious disease, resource planning, health service monitoring and quality, and studying medication use patterns. The data sources included mostly secondary administrative and electronic medical record data. In addition, at least two-thirds of the applications involved participatory co-design approaches while introducing a distinct category, embedded research, within co-design initiatives. These applications were in response to an identified need for data-driven insights into knowledge generation and decision support. We further discuss the opportunities stemming from the use of interactive visualization methods in studying global health; inequities, including social determinants of health; and other related areas. We also allude to the challenges in the uptake of these methods. Conclusions: Visualization in health has strong historical roots, with an upward trend in the use of these methods in population health and HSR. Such applications are being fast used by academic and health care agencies for knowledge discovery, hypotheses generation, and decision support. International Registered Report Identifier (IRRID): RR2-10.2196/14019 ",
doi="10.2196/27534",
url="https://www.jmir.org/2022/2/e27534",
url="http://www.ncbi.nlm.nih.gov/pubmed/35179499"
}


@Article{info:doi/10.2196/30804,
author="Nigusie, Adane
and Endehabtu, F. Berhanu
and Angaw, Abebaw Dessie
and Teklu, Alemayehu
and Mekonnen, Abebaw Zeleke
and Feletto, Marta
and Assan, Abraham
and Samuel, Assegid
and Sheikh, Kabir
and Tilahun, Binyam",
title="Status of Compassionate, Respectful, and Caring Health Service Delivery: Scoping Review",
journal="JMIR Hum Factors",
year="2022",
month="Feb",
day="7",
volume="9",
number="1",
pages="e30804",
keywords="compassionate",
keywords="respectful",
keywords="caring",
keywords="CRC",
keywords="health care delivery",
abstract="Background: A compassionate, respectful, and caring (CRC) health professional is very important for human-centered care, serving clients ethically and with respect, adhering to the professional oath, and serving as a model for young professionals. As countries try to achieve universal health coverage (UHC), quality delivery of health services is crucial. CRC health care is an initiative around the need to provide quality care services to clients and patients. However, there is an evidence gap on the status of CRC health care service delivery. Objective: This scoping review aimed to map global evidence on the status of CRC health service delivery practice. Methods: An exhaustive literature review and Delphi technique were used to answer the 2 research questions: ``What is the current status of CRC health care practices among health workers?'' and ``Is it possible for health professionals, health managers, administrators, and policy makers to incorporate it into their activity while designing strategies that could improve the humanistic and holistic approach to health care provision?'' The studies were searched from the year 2014 to September 2020 using electronic databases such as MEDLINE (PubMed), Cochrane Library, Web of Science, Hinari, and the World Health Organization (WHO) library. Additionally, grey literature such as Google, Google Scholar, and WorldWideScience were scrutinized. Studies that applied any study design and data collection and analysis methods related to CRC care were included. Two authors extracted the data and compared the results. Discrepancies were resolved by discussion, or the third reviewer made the decision. Findings from the existing literature were presented using thematic analysis. Results: A total of 1193 potentially relevant studies were generated from the initial search, and 20 studies were included in the final review. From this review, we identified 5 thematic areas: the status of CRC implementation, facilitators for CRC health care service delivery, barriers to CRC health care delivery, disrespectful and abusive care encountered by patients, and perspectives on CRC. The findings of this review indicated that improving the mechanisms for monitoring health facilities, improving accountability, and becoming aware of the consequences of maltreatment within facilities are critical steps to improving health care delivery practices. Conclusions: This scoping review identified that there is limited CRC service provision. Lack of training, patient flow volume, and bed shortages were found to be the main contributors of CRC health care delivery. Therefore, the health care system should consider the components of CRC in health care delivery during in-service training, pre-service training, monitoring and evaluation, community engagement, workload division, and performance appraisal. ",
doi="10.2196/30804",
url="https://humanfactors.jmir.org/2022/1/e30804",
url="http://www.ncbi.nlm.nih.gov/pubmed/35129450"
}


@Article{info:doi/10.2196/29837,
author="Gillam, Juliet
and Davies, Nathan
and Aworinde, Jesutofunmi
and Yorganci, Emel
and Anderson, E. Janet
and Evans, Catherine",
title="Implementation of eHealth to Support Assessment and Decision-making for Residents With Dementia in Long-term Care: Systematic Review",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="3",
volume="24",
number="2",
pages="e29837",
keywords="telemedicine",
keywords="implementation science",
keywords="dementia",
keywords="long-term care",
keywords="systematic review",
abstract="Background: As dementia progresses, symptoms and concerns increase, causing considerable distress for the person and their caregiver. The integration of care between care homes and health care services is vital to meet increasing care needs and maintain quality of life. However, care home access to high-quality health care is inequitable. eHealth can facilitate this by supporting remote specialist input on care processes, such as clinical assessment and decision-making, and streamlining care on site. How to best implement eHealth in the care home setting is unclear. Objective: The aim of this review was to identify the key factors that influence the implementation of eHealth for people living with dementia in long-term care. Methods: A systematic search of Embase, PsycINFO, MEDLINE, and CINAHL was conducted to identify studies published between 2000 and 2020. Studies were eligible if they focused on eHealth interventions to improve treatment and care assessment or decision-making for residents with dementia in care homes. Data were thematically analyzed and deductively mapped onto the 6 constructs of the adapted Consolidated Framework for Implementation Research (CFIR). The results are presented as a narrative synthesis. Results: A total of 29 studies were included, focusing on a variety of eHealth interventions, including remote video consultations and clinical decision support tools. Key factors that influenced eHealth implementation were identified across all 6 constructs of the CFIR. Most concerned the inner setting construct on requirements for implementation in the care home, such as providing a conducive learning climate, engaged leadership, and sufficient training and resources. A total of 4 novel subconstructs were identified to inform the implementation requirements to meet resident needs and engage end users. Conclusions: Implementing eHealth in care homes for people with dementia is multifactorial and complex, involving interaction between residents, staff, and organizations. It requires an emphasis on the needs of residents and the engagement of end users in the implementation process. A novel conceptual model of the key factors was developed and translated into 18 practical recommendations on the implementation of eHealth in long-term care to guide implementers or innovators in care homes. Successful implementation of eHealth is required to maximize uptake and drive improvements in integrated health and social care. ",
doi="10.2196/29837",
url="https://www.jmir.org/2022/2/e29837",
url="http://www.ncbi.nlm.nih.gov/pubmed/35113029"
}


@Article{info:doi/10.2196/31184,
author="Griauzde, H. Dina
and Ling, Grace
and Wray, Daniel
and DeJonckheere, Melissa
and Mizokami Stout, Kara
and Saslow, R. Laura
and Fenske, Jill
and Serlin, David
and Stonebraker, Spring
and Nisha, Tabassum
and Barry, Colton
and Pop-Busui, Rodica
and Sen, Ananda
and Richardson, R. Caroline",
title="Continuous Glucose Monitoring With Low-Carbohydrate Nutritional Coaching to Improve Type 2 Diabetes Control: Randomized Quality Improvement Program",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="2",
volume="24",
number="2",
pages="e31184",
keywords="type 2 diabetes mellitus",
keywords="continuous glucose monitoring",
keywords="low-carbohydrate counseling",
abstract="Background: Type 2 diabetes mellitus (T2DM) is a leading cause of morbidity and mortality globally, with adverse health consequences largely related to hyperglycemia. Despite clinical practice guideline recommendations, effective pharmacotherapy, and interventions to support patients and providers, up to 60\% of patients diagnosed with T2DM are estimated to have hemoglobin A1c (HbA1c) levels above the recommended targets owing to multilevel barriers hindering optimal glycemic control. Objective: The aim of this study is to compare changes in HbA1c levels among patients with suboptimally controlled T2DM who were offered the opportunity to use an intermittently viewed continuous glucose monitor and receive personalized low-carbohydrate nutrition counseling (<100 g/day) versus those who received usual care (UC). Methods: This was a 12-month, pragmatic, randomized quality improvement program. All adult patients with T2DM who received primary care at a university-affiliated primary care clinic (N=1584) were randomized to either the UC or the enhanced care (EC) group. Within each program arm, we identified individuals with HbA1c >7.5\% (58 mmol/mol) who were medically eligible for tighter glycemic control, and we defined these subgroups as UC--high risk (UC-HR) or EC-HR. UC-HR participants (n=197) received routine primary care. EC-HR participants (n=185) were invited to use an intermittently viewed continuous glucose monitor and receive low-carbohydrate nutrition counseling. The primary outcome was mean change in HbA1c levels from baseline to 12 months using an intention-to-treat difference-in-differences analysis comparing EC-HR with UC-HR groups. We conducted follow-up semistructured interviews to understand EC-HR participant experiences with the intervention. Results: HbA1c decreased by 0.41\% (4.5 mmol/mol; P=.04) more from baseline to 12 months among participants in the EC-HR group than among those in UC-HR; however, only 61 (32.9\%) of 185 EC-HR participants engaged in the program. Among the EC-HR participants who wore continuous glucose monitors (61/185, 32.9\%), HbA1c was 1.1\% lower at 12 months compared with baseline (P<.001). Interviews revealed themes related to EC-HR participants' program engagement and continuous glucose monitor use. Conclusions: Among patients with suboptimally controlled T2DM, a combined approach that includes continuous glucose monitoring and low-carbohydrate nutrition counseling can improve glycemic control compared with the standard of care. ",
doi="10.2196/31184",
url="https://www.jmir.org/2022/2/e31184",
url="http://www.ncbi.nlm.nih.gov/pubmed/35107429"
}


@Article{info:doi/10.2196/31528,
author="Renner, Simon
and Marty, Tom
and Khadhar, Micka{\"i}l
and Foulqui{\'e}, Pierre
and Voillot, Pam{\'e}la
and Mebarki, Adel
and Montagni, Ilaria
and Texier, Nathalie
and Sch{\"u}ck, St{\'e}phane",
title="A New Method to Extract Health-Related Quality of Life Data From Social Media Testimonies: Algorithm Development and Validation",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="28",
volume="24",
number="1",
pages="e31528",
keywords="health-related quality of life",
keywords="social media use",
keywords="measures",
keywords="real world",
keywords="natural language processing",
keywords="social media",
keywords="NLP",
keywords="infoveillance",
keywords="quality of life",
keywords="digital health",
keywords="social listening",
abstract="Background: Monitoring social media has been shown to be a useful means to capture patients' opinions and feelings about medical issues, ranging from diseases to treatments. Health-related quality of life (HRQoL) is a useful indicator of overall patients' health, which can be captured online. Objective: This study aimed to describe a social media listening algorithm able to detect the impact of diseases or treatments on specific dimensions of HRQoL based on posts written by patients in social media and forums. Methods: Using a web crawler, 19 forums in France were harvested, and messages related to patients' experience with disease or treatment were specifically collected. The SF-36 (Short Form Health Survey) and EQ-5D (Euro Quality of Life 5 Dimensions) HRQoL surveys were mixed and adapted for a tailored social media listening system. This was carried out to better capture the variety of expression on social media, resulting in 5 dimensions of the HRQoL, which are physical, psychological, activity-based, social, and financial. Models were trained using cross-validation and hyperparameter optimization. Oversampling was used to increase the infrequent dimension: after annotation, SMOTE (synthetic minority oversampling technique) was used to balance the proportions of the dimensions among messages. Results: The training set was composed of 1399 messages, randomly taken from a batch of 20,000 health-related messages coming from forums. The algorithm was able to detect a general impact on HRQoL (sensitivity of 0.83 and specificity of 0.74), a physical impact (0.67 and 0.76), a psychic impact (0.82 and 0.60), an activity-related impact (0.73 and 0.78), a relational impact (0.73 and 0.70), and a financial impact (0.79 and 0.74). Conclusions: The development of an innovative method to extract health data from social media as real time assessment of patients' HRQoL is useful to a patient-centered medical care. As a source of real-world data, social media provide a complementary point of view to understand patients' concerns and unmet needs, as well as shedding light on how diseases and treatments can be a burden in their daily lives. ",
doi="10.2196/31528",
url="https://www.jmir.org/2022/1/e31528",
url="http://www.ncbi.nlm.nih.gov/pubmed/35089152"
}


@Article{info:doi/10.2196/31754,
author="Ware, Patrick
and Shah, Amika
and Ross, Joan Heather
and Logan, Gordon Alexander
and Segal, Phillip
and Cafazzo, Antony Joseph
and Szacun-Shimizu, Katarzyna
and Resnick, Myles
and Vattaparambil, Tessy
and Seto, Emily",
title="Challenges of Telemonitoring Programs for Complex Chronic Conditions: Randomized Controlled Trial With an Embedded Qualitative Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="26",
volume="24",
number="1",
pages="e31754",
keywords="telemonitoring",
keywords="telemedicine",
keywords="heart failure",
keywords="diabetes",
keywords="hypertension",
keywords="tertiary health care",
keywords="multiple chronic conditions",
keywords="mobile phone",
abstract="Background: Despite the growing prevalence of people with complex conditions and evidence of the positive impact of telemonitoring for single conditions, little research exists on telemonitoring for this population. Objective: This randomized controlled trial and embedded qualitative study aims to evaluate the impact on and experiences of patients and health care providers (HCPs) using a telemonitoring system with decision support to manage patients with complex conditions, including those with multiple chronic conditions, compared with the standard of care. Methods: A pragmatic, unblinded, 6-month randomized controlled trial sought to recruit 146 patients with ?1 diagnosis of heart failure (HF), uncontrolled hypertension (HT), and insulin-requiring diabetes mellitus (DM) from outpatient specialty settings in Toronto, Ontario, Canada. Participants were randomized into the control and telemonitoring groups, with the latter being instructed to take readings relevant to their conditions. The telemonitoring system contained an algorithm that generated decision support in the form of actionable self-care directives to patients and alerts to HCPs. The primary outcome was health status (36-Item Short Form Health Survey questionnaire). Secondary outcomes included anxiety and depression, self-efficacy in chronic disease management, and self-reported health service use. HF-related quality of life and self-care measures were also collected from patients followed for HF. Within- and between-group change scores were analyzed for statistical significance (P<.05). A convenience sample of HCPs and patients in the intervention group was interviewed about their experiences. Results: A total of 96 patients were recruited and randomized. Recruitment was terminated early because of implementation challenges and the onset of the COVID-19 pandemic. No significant within- and between-group differences were found for the main primary and secondary outcomes. However, a within-group analysis of patients with HF found improvements in self-care maintenance (P=.04) and physical quality of life (P=.046). Opinions expressed by the 5 HCPs and 13 patients who were interviewed differed based on the monitored conditions. Although patients with HF reported benefitting from actionable self-care guidance and meaningful interactions with their HCPs, patient and HCP users of the DM and HT modules did not think telemonitoring improved the clinical management of those conditions to the same degree. These differing experiences were largely attributed to the siloed nature of specialty care and the design of the decision support, whereby fluctuations in the status of HT and DM typically required less urgent interventions compared with patients with HF. Conclusions: We recommend that future research conceive telemonitoring as a program and that self-management and clinical decision support are necessary but not sufficient components of such programs for patients with complex conditions and lower acuity. We conclude that telemonitoring for patients with complex conditions or within multidisciplinary care settings may be best operationalized through nurse-led models of care. Trial Registration: ClinicalTrials.gov NCT03127852; https://clinicaltrials.gov/ct2/show/NCT03127852 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.8367 ",
doi="10.2196/31754",
url="https://www.jmir.org/2022/1/e31754",
url="http://www.ncbi.nlm.nih.gov/pubmed/35080502"
}


@Article{info:doi/10.2196/31123,
author="Hopper, Wade
and Fox, Justin
and Dimucci-Ward, JuliSu",
title="Assessment of Glycemic Control at St. Luke's Free Medical Clinic: Retrospective Chart Review",
journal="Interact J Med Res",
year="2022",
month="Jan",
day="24",
volume="11",
number="1",
pages="e31123",
keywords="free clinic",
keywords="glycemic control",
keywords="underserved",
keywords="uninsured",
keywords="diabetes",
keywords="health care delivery",
keywords="treatment program",
abstract="Background: A free clinic is a health care delivery model that provides primary care and pharmaceutical services exclusively to uninsured patients. With a multidisciplinary volunteer clinical staff, which includes physicians, social workers, dieticians, and osteopathic medical students, St. Luke's Free Medical Clinic (SLFMC) cares for over 1700 patients annually in Spartanburg, South Carolina. Objective: This study aims to measure the change, over time, in patient hemoglobin A1c measurements at the SLFMC to quantify the success of the clinic's diabetes treatment program. Methods: A prospective-retrospective chart review of patients (n=140) enrolled at the SLFMC between January 1, 2018, and January 1, 2021, was performed. Patients were stratified as having controlled (hemoglobin A1c<7.0, n=53) or uncontrolled (hemoglobin A1c?7.0, n=87) diabetes relative to a therapeutic hemoglobin A1c target of 7.0, which is recommended by the American Diabetes Association. For both controlled and uncontrolled groups, baseline hemoglobin A1c values were compared to subsequent readings using a Wilcoxon matched-pairs signed rank test. Results from the SLFMC population were compared to the published literature on hemoglobin A1c from other free clinics. Results: Patients with uncontrolled diabetes experienced significant reductions in median hemoglobin A1c at both 6 months (P=.006) and 1 year (P=.002) from baseline. Patients with controlled diabetes showed no significant changes. Black and Hispanic patients with uncontrolled diabetes experienced a 1.0\% mean improvement in hemoglobin A1c over the study window. The SLFMC's wholly uninsured patient population showed a population rate of controlled diabetes (42\%), which was similar to recent nationwide averages for adults with diabetes (51\% to 56\%), as reported by the National Health and Nutrition Examination Survey. The clinic's Hispanic population (n=47) showed the greatest average improvement in hemoglobin A1c of any ethnic group from baseline. Additionally, 61\% of the SLFMC's Black population (n=33) achieved a hemoglobin A1c of <7.0 by the end of the study window, which surpassed the nationwide averages for glycemic control. Conclusions: We present free clinic hemoglobin A1c outcomes obtained through a retrospective chart review. Uninsured patients treated for diabetes at the SLFMC show a reduction in hemoglobin A1c, which is comparable to nationwide standards, although average hemoglobin A1c levels in this study were higher than nationwide averages. Black and Hispanic patients with uncontrolled diabetes showed a mean 1\% improvement in hemoglobin A1c levels. These results represent some of the first in the literature emerging from a free clinic that is not affiliated with a major medical school. ",
doi="10.2196/31123",
url="https://www.i-jmr.org/2022/1/e31123",
url="http://www.ncbi.nlm.nih.gov/pubmed/35072636"
}


@Article{info:doi/10.2196/22957,
author="Chen, Ying-Hsien
and Hung, Chi-Sheng
and Huang, Ching-Chang
and Lee, Jen-Kuang
and Yu, Jiun-Yu
and Ho, Yi-Lwun",
title="The Impact of Synchronous Telehealth Services With a Digital Platform on Day-by-Day Home Blood Pressure Variability in Patients with Cardiovascular Diseases: Retrospective Cohort Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="10",
volume="24",
number="1",
pages="e22957",
keywords="blood pressure",
keywords="variability",
keywords="telehealth",
keywords="hypertension",
keywords="cardiovascular disease",
keywords="chronic disease",
keywords="heart",
keywords="digital platform",
keywords="cohort",
keywords="management",
keywords="intervention",
abstract="Background: Hypertension is associated with a large global disease burden with variable control rates across different regions and races. Telehealth has recently emerged as a health care strategy for managing chronic diseases, but there are few reports regarding the effects of synchronous telehealth services on home blood pressure (BP) control and variability. Objective: The objective of this study is to investigate the effect of synchronous telehealth services with a digital platform on home BP. Methods: This retrospective study was conducted by the Taiwan ELEctroHEALTH study group at the Telehealth Center of the National Taiwan University Hospital. We analyzed home BP data taken from 2888 patients with cardiovascular disease (CVD) enrolled in our telehealth program between 2009 to 2017. Of the 2888 patients with CVD, 348 (12.05\%) patients who received home BP surveillance for ?56 days were selected for BP analysis. Patients were stratified into three groups: (1) poorly controlled hypertension, (2) well-controlled hypertension, and (3) nonhypertension. The mean, SD, coefficient of variation (CV), and average real variability were calculated. Results: Telehealth interventions significantly and steadily reduced systolic blood pressure (SBP) in the poorly controlled hypertension group from 144.8.2{\textpm}9.2 to 133.7{\textpm}10.2 mmHg after 2 months (P<.001). BP variability reduced in all patients: SBP-SD decreased from 7.8{\textpm}3.4 to 7.3{\textpm}3.4 after 2 months (P=.004), and SBP-CV decreased from 6.3{\textpm}2.5 to 5.9{\textpm}2.6 after 2 months (P=.004). Event-free survival (admission) analysis stratified by SBP-SD showed longer time to first hospitalization for Q1 patients compared with Q4 patients (P=.02, odds ratio 2.15, 95\% CI 1.18-3.89). Conclusions: Synchronous telehealth intervention may improve home BP control and decrease day-by-day home BP variability in patients with CVD. ",
doi="10.2196/22957",
url="https://www.jmir.org/2022/1/e22957",
url="http://www.ncbi.nlm.nih.gov/pubmed/35006089"
}


@Article{info:doi/10.2196/26299,
author="Braekman, Elise
and Demarest, Stefaan
and Charafeddine, Rana
and Drieskens, Sabine
and Berete, Finaba
and Gisle, Lydia
and Van der Heyden, Johan
and Van Hal, Guido",
title="Unit Response and Costs in Web Versus Face-To-Face Data Collection: Comparison of Two Cross-sectional Health Surveys",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="7",
volume="24",
number="1",
pages="e26299",
keywords="health interview surveys",
keywords="data collection mode",
keywords="face-to-face",
keywords="web",
keywords="unit response",
keywords="response rate",
keywords="nonresponse",
keywords="data collection costs",
keywords="web data",
keywords="health surveys",
keywords="internet penetration",
keywords="web survey",
keywords="costs",
abstract="Background: Potential is seen in web data collection for population health surveys due to its combined cost-effectiveness, implementation ease, and increased internet penetration. Nonetheless, web modes may lead to lower and more selective unit response than traditional modes, and this may increase bias in the measured indicators. Objective: This research assesses the unit response and costs of a web study versus face-to-face (F2F) study. Methods: Alongside the Belgian Health Interview Survey by F2F edition 2018 (BHISF2F; net sample used: 3316), a web survey (Belgian Health Interview Survey by Web [BHISWEB]; net sample used: 1010) was organized. Sociodemographic data on invited individuals was obtained from the national register and census linkages. Unit response rates considering the different sampling probabilities of both surveys were calculated. Logistic regression analyses examined the association between mode system and sociodemographic characteristics for unit nonresponse. The costs per completed web questionnaire were compared with the costs for a completed F2F questionnaire. Results: The unit response rate is lower in BHISWEB (18.0\%) versus BHISF2F (43.1\%). A lower response rate was observed for the web survey among all sociodemographic groups, but the difference was higher among people aged 65 years and older (15.4\% vs 45.1\%), lower educated people (10.9\% vs 38.0\%), people with a non-Belgian European nationality (11.4\% vs 40.7\%), people with a non-European nationality (7.2\% vs 38.0\%), people living alone (12.6\% vs 40.5\%), and people living in the Brussels-Capital (12.2\% vs 41.8\%) region. The sociodemographic characteristics associated with nonresponse are not the same in the 2 studies. Having another European (OR 1.60, 95\% CI 1.20-2.13) or non-European nationality (OR 2.57, 95\% CI 1.79-3.70) compared to a Belgian nationality and living in the Brussels-Capital (OR 1.72, 95\% CI 1.41-2.10) or Walloon (OR 1.47, 95\% CI 1.15-1.87) regions compared to the Flemish region are associated with a higher nonresponse only in the BHISWEB study. In BHISF2F, younger people (OR 1.31, 95\% CI 1.11-1.54) are more likely to be nonrespondents than older people, and this was not the case in BHISWEB. In both studies, lower educated people have a higher probability of being nonrespondent, but this effect is more pronounced in BHISWEB (low vs high education level: Web, OR 2.71, 95\% CI 2.21-3.39 and F2F OR 1.70, 95\% CI 1.48-1.95). The BHISWEB study had a considerable advantage; the cost per completed questionnaire was almost 3 times lower ({\texteuro}41 [US \$48]) compared with F2F data collection ({\texteuro}111 [US \$131]). Conclusions: The F2F unit response rate was generally higher, yet for certain groups the difference between web and F2F was more limited. Web data collection has a considerable cost advantage. It is therefore worth experimenting with adaptive mixed-mode designs to optimize financial resources without increasing selection bias (eg, only inviting sociodemographic groups who are keener to participate online for web surveys while continuing to focus on increasing F2F response rates for other groups). ",
doi="10.2196/26299",
url="https://www.jmir.org/2022/1/e26299",
url="http://www.ncbi.nlm.nih.gov/pubmed/34994701"
}


@Article{info:doi/10.2196/24126,
author="Restar, Arjee
and Surace, Anthony
and Adia, Alexander
and Goedel, William
and Ogunbajo, Adedotun
and Jin, Harry
and Edeza, Alberto
and Hernandez, Laufred
and Cu-Uvin, Susan
and Operario, Don",
title="Characterizing Awareness of Pre-Exposure Prophylaxis for HIV Prevention in Manila and Cebu, Philippines: Web-Based Survey of Filipino Cisgender Men Who Have Sex With Men",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="7",
volume="24",
number="1",
pages="e24126",
keywords="HIV prevention",
keywords="PrEP",
keywords="men who have sex with men",
keywords="the Philippines",
abstract="Background: The Philippines is experiencing an HIV crisis and is considering implementing pre-exposure prophylaxis (PrEP) as a national public health strategy for HIV prevention for cisgender men who have sex with men (cis-MSM). However, critical information on the awareness of PrEP among cis-MSM is needed to roll out this public health initiative. Objective: This study aims to assess PrEP awareness and related correlates (ie, sociodemographic variables, social factors, and health care access and use) among Filipino cis-MSM. Methods: We conducted a web-based survey with Filipino cis-MSM (n=179) residing in the cities of Manila and Cebu, Philippines. Multivariable analysis procedures were performed to examine the factors associated with PrEP awareness. Results: Our sample demonstrated high awareness (134/179, 74.9\%) and interest (159/179, 88.8\%) in taking PrEP. The adjusted model showed that greater odds of PrEP awareness were associated with having a college education or higher versus a high school education or lower (adjusted odds ratio [aOR] 7.30, 95\% CI 1.01-52.47), earning between PHP 10,000 (US \$198.6) and PHP 20,000 (US \$397.2) versus <PHP 10,000 (US \$198.60; aOR 9.32, 95\% CI 1.41-6.22), having had a prior HIV test (aOR 6.06, 95\% CI 1.20-13.55), having high HIV knowledge (aOR 3.50, 95\% CI 1.11-10.98), and having friends who discussed PrEP (aOR 11.17, 95\% CI 2.73-14.5). Conclusions: Our findings demonstrate that Filipino cis-MSM are aware of and interested in taking PrEP, but there is currently an unmet need for such biomedical HIV prevention technologies among this population. Incorporating PrEP education into routine HIV screening and leveraging cis-MSM social networks may be useful in optimizing potential PrEP implementation in the Philippines. ",
doi="10.2196/24126",
url="https://www.jmir.org/2022/1/e24126",
url="http://www.ncbi.nlm.nih.gov/pubmed/34994705"
}


@Article{info:doi/10.2196/26613,
author="Hannan, Jafrul Md
and Parveen, Kohinoor Mosammat
and Hoque, Mozammel Md
and Chowdhury, Kabir Tanvir
and Hasan, Samiul Md
and Nandy, Alak",
title="Management of Acute Appendicitis in Children During COVID-19 and Perspectives of Pediatric Surgeons From South Asia: Survey Study",
journal="JMIR Perioper Med",
year="2021",
month="Dec",
day="21",
volume="4",
number="2",
pages="e26613",
keywords="COVID-19",
keywords="gastrointestinal",
keywords="pediatric",
keywords="global surgery",
abstract="Background: Nonoperative treatment (NOT) of pediatric appendicitis as opposed to surgery elicits great debate and is potentially influenced by physician preferences. Owing to the effects of the COVID-19 pandemic on health care, the practice of NOT has generally increased by necessity and may, in a post--COVID-19 world, change surgeons' perceptions of NOT. Objective: The aim of this study was to determine whether the use of NOT has increased in South Asia and whether these levels of practice would be sustained after the pandemic subsides. Methods: A survey was conducted among pediatric surgeons regarding their position, institute, and country; the number of appendicitis cases they managed; and their mode of treatment between identical time periods in 2019 and 2020 (April 1 to August 31). The survey also directly posed the question as to whether they would continue with the COVID-19--imposed level of NOT after the effect of the pandemic diminishes. Results: A total of 134 responses were collected out of 200 (67.0\%). A significant increase in the practice of NOT was observed for the entire cohort, although no effect was observed when grouped by country or institute. When grouped by position, senior physicians increased the practice of NOT the most, while junior physicians reported the least change. The data suggest that only professors would be inclined to maintain the COVID-19--level of NOT practice after the pandemic. Conclusions: Increased practice of NOT during the COVID-19 pandemic was observed in South Asia, particularly by senior surgeons. Only professors appeared inclined to consider maintaining this increased level of practice in the post--COVID-19 world. ",
doi="10.2196/26613",
url="https://periop.jmir.org/2021/2/e26613",
url="http://www.ncbi.nlm.nih.gov/pubmed/34818209"
}


@Article{info:doi/10.2196/27886,
author="Oerlemans, Simone
and Arts, Johanna Lindy Paulina
and Kieffer, M. Jacobien
and Prins, Judith
and Hoogendoorn, Mels
and van der Poel, Marjolein
and Koster, Ad
and Lensen, Chantal
and Stevens, Catharina Wendy Bernadina
and Issa, Djamila
and Pruijt, M. Johannes F.
and Oosterveld, Margriet
and van der Griend, Ren{\'e}
and Nijziel, Marten
and Tick, Lidwine
and Posthuma, M. Eduardus F.
and van de Poll-Franse, V. Lonneke",
title="Web-Based Return of Individual Patient-Reported Outcome Results Among Patients With Lymphoma: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="14",
volume="23",
number="12",
pages="e27886",
keywords="lymphoma",
keywords="patient-reported outcomes",
keywords="return of individual results",
keywords="randomized controlled trial",
keywords="self-management",
abstract="Background: There has been a cultural shift toward patient engagement in health, with a growing demand from patients to access their results. Objective: The Lymphoma Intervention (LIVE) trial is conducted to examine the impact of return of individual patient-reported outcome (PRO) results and a web-based self-management intervention on psychological distress, self-management, satisfaction with information, and health care use in a population-based setting. Methods: Return of PRO results included comparison with age- and sex-matched peers and was built into the Patient-Reported Outcomes Following Initial Treatment and Long-Term Evaluation of Survivorship registry. The self-management intervention is an adaptation of a fully automated evidence-based intervention for breast cancer survivors. Patients with lymphoma who completed the web-based questionnaire were equally randomized to care as usual, return of PRO results, and return of PRO results plus self-management intervention. Patients completed questionnaires 9 to 18 months after diagnosis (T0; n=227), 4 months (T1; n=190), 12 months (T2; n=170), and 24 months (T3; n=98). Results: Of all invited patients, 51.1\% (456/892) responded and web-based participants (n=227) were randomly assigned to care as usual (n=76), return of PRO results (n=74), or return of PRO results and access to Living with lymphoma (n=77). Return of PRO results was viewed by 76.7\% (115/150) of those with access. No statistically significant differences were observed for psychological distress, self-management, satisfaction with information provision, and health care use between patients who received PRO results and those who did not (P>.05). Use of the self-management intervention was low (2/76, 3\%), and an effect could therefore not be determined. Conclusions: Return of individual PRO results seems to meet patients' wishes but had no beneficial effects on patient outcome. No negative effects were found when individual PRO results were disclosed, and the return of individual PRO results can therefore be safely implemented in daily clinical practice. Trial Registration: Netherlands Trial Register NTR5953; https://www.trialregister.nl/trial/5790 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-017-1943-2 ",
doi="10.2196/27886",
url="https://www.jmir.org/2021/12/e27886",
url="http://www.ncbi.nlm.nih.gov/pubmed/34904948"
}


@Article{info:doi/10.2196/31047,
author="Finstad, Alexandra
and Lee, Alex
and George, Ralph
and Alhusayen, Raed",
title="Exploring Access to Surgical Interventions for Hidradenitis Suppurativa: Retrospective Population-Based Analysis",
journal="JMIR Dermatol",
year="2021",
month="Dec",
day="14",
volume="4",
number="2",
pages="e31047",
keywords="hidradenitis suppurativa",
keywords="surgery",
keywords="dermatology",
keywords="access",
keywords="epidemiology",
keywords="universal health care",
abstract="Background: Hidradenitis suppurativa (HS) is a painful inflammatory disorder that confers significant distress to patients, with surgery as an integral treatment modality. Objective: To inform improvements in care, patterns in HS surgery were assessed. Methods: A retrospective population-based analysis was performed on Ontario billing claims for HS surgery across a period of 10 years from January 1, 2008 to December 31, 2017. HS surgery was defined as the excision of inguinal, perineal, or axillary skin and sweat glands for hidradenitis. The top 5 billing specialties, including general and plastic surgery, were analyzed. The total number of procedures performed as well as the number performed per physician were investigated. Patient and physician locations were compared. Results: A total of 7195 claims for the excision of inguinal, perineal, or axillary skin and sweat glands for HS were submitted across the study period. Annual HS surgery claims showed an increasing trend across 10 years, ranging between 4.9 and 5.8 per 100,000 population. However, overall, for every additional year, the number of claims per 100,000 population only increased slightly, by 0.03 claims. The number of providers steadily decreased, ranging between 1.7 and 1.9 per 100,000, with approximately twice as many general than plastic surgeons. However, again overall, for every additional year, the number of providers per 100,000 population decreased slightly, by 0.002 physicians. The mean annual number of procedures per physician rose from 2.8 to 3.1. In rural areas, analyzed per claim, general surgeons performed the majority of surgeries (1318/2003, 65.8\%), while in urban areas, surgeries were more equally performed by general (2616/5192, 50.4\%) and plastic (2495/5192, 48.1\%) surgeons. Of HS surgery claims, 25.7\%-35.9\% were provided by a physician residing in a different area than the patient receiving care. Conclusions: No significant improvements in access to HS surgery were seen across the study period, with access potentially worsening with annual HS claims rising overall and number of providers decreasing, with patients travelling further to access surgery. System barriers across the continuum of HS diagnosis and management must be evaluated to improve access to surgical care. ",
doi="10.2196/31047",
url="https://derma.jmir.org/2021/2/e31047",
url="http://www.ncbi.nlm.nih.gov/pubmed/37632848"
}


@Article{info:doi/10.2196/25022,
author="Singh, Janmajay
and Sato, Masahiro
and Ohkuma, Tomoko",
title="On Missingness Features in Machine Learning Models for Critical Care: Observational Study",
journal="JMIR Med Inform",
year="2021",
month="Dec",
day="8",
volume="9",
number="12",
pages="e25022",
keywords="electronic health records",
keywords="informative missingness",
keywords="machine learning",
keywords="missing data",
keywords="hospital mortality",
keywords="sepsis",
abstract="Background: Missing data in electronic health records is inevitable and considered to be nonrandom. Several studies have found that features indicating missing patterns (missingness) encode useful information about a patient's health and advocate for their inclusion in clinical prediction models. But their effectiveness has not been comprehensively evaluated. Objective: The goal of the research is to study the effect of including informative missingness features in machine learning models for various clinically relevant outcomes and explore robustness of these features across patient subgroups and task settings. Methods: A total of 48,336 electronic health records from the 2012 and 2019 PhysioNet Challenges were used, and mortality, length of stay, and sepsis outcomes were chosen. The latter dataset was multicenter, allowing external validation. Gated recurrent units were used to learn sequential patterns in the data and classify or predict labels of interest. Models were evaluated on various criteria and across population subgroups evaluating discriminative ability and calibration. Results: Generally improved model performance in retrospective tasks was observed on including missingness features. Extent of improvement depended on the outcome of interest (area under the curve of the receiver operating characteristic [AUROC] improved from 1.2\% to 7.7\%) and even patient subgroup. However, missingness features did not display utility in a simulated prospective setting, being outperformed (0.9\% difference in AUROC) by the model relying only on pathological features. This was despite leading to earlier detection of disease (true positives), since including these features led to a concomitant rise in false positive detections. Conclusions: This study comprehensively evaluated effectiveness of missingness features on machine learning models. A detailed understanding of how these features affect model performance may lead to their informed use in clinical settings especially for administrative tasks like length of stay prediction where they present the greatest benefit. While missingness features, representative of health care processes, vary greatly due to intra- and interhospital factors, they may still be used in prediction models for clinically relevant outcomes. However, their use in prospective models producing frequent predictions needs to be explored further. ",
doi="10.2196/25022",
url="https://medinform.jmir.org/2021/12/e25022",
url="http://www.ncbi.nlm.nih.gov/pubmed/34889756"
}


@Article{info:doi/10.2196/28503,
author="Bailey, E. James
and Gurgol, Cathy
and Pan, Eric
and Njie, Shirilyn
and Emmett, Susan
and Gatwood, Justin
and Gauthier, Lynne
and Rosas, G. Lisa
and Kearney, M. Shannon
and Robler, Kleindienst Samantha
and Lawrence, H. Raymona
and Margolis, L. Karen
and Osunkwo, Ifeyinwa
and Wilfley, Denise
and Shah, O. Vallabh",
title="Early Patient-Centered Outcomes Research Experience With the Use of Telehealth to Address Disparities: Scoping Review",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="7",
volume="23",
number="12",
pages="e28503",
keywords="telehealth",
keywords="scoping review",
keywords="disparities",
keywords="implementation science",
abstract="Background: Health systems and providers across America are increasingly employing telehealth technologies to better serve medically underserved low-income, minority, and rural populations at the highest risk for health disparities. The Patient-Centered Outcomes Research Institute (PCORI) has invested US \$386 million in comparative effectiveness research in telehealth, yet little is known about the key early lessons garnered from this research regarding the best practices in using telehealth to address disparities. Objective: This paper describes preliminary lessons from the body of research using study findings and case studies drawn from PCORI seminal patient-centered outcomes research (PCOR) initiatives. The primary purpose was to identify common barriers and facilitators to implementing telehealth technologies in populations at risk for disparities. Methods: A systematic scoping review of telehealth studies addressing disparities was performed. It was guided by the Arksey and O'Malley Scoping Review Framework and focused on PCORI's active portfolio of telehealth studies and key PCOR identified by study investigators. We drew on this broad literature using illustrative examples from early PCOR experience and published literature to assess barriers and facilitators to implementing telehealth in populations at risk for disparities, using the active implementation framework to extract data. Major themes regarding how telehealth interventions can overcome barriers to telehealth adoption and implementation were identified through this review using an iterative Delphi process to achieve consensus among the PCORI investigators participating in the study. Results: PCORI has funded 89 comparative effectiveness studies in telehealth, of which 41 assessed the use of telehealth to improve outcomes for populations at risk for health disparities. These 41 studies employed various overlapping modalities including mobile devices (29/41, 71\%), web-based interventions (30/41, 73\%), real-time videoconferencing (15/41, 37\%), remote patient monitoring (8/41, 20\%), and store-and-forward (ie, asynchronous electronic transmission) interventions (4/41, 10\%). The studies targeted one or more of PCORI's priority populations, including racial and ethnic minorities (31/41, 41\%), people living in rural areas, and those with low income/low socioeconomic status, low health literacy, or disabilities. Major themes identified across these studies included the importance of patient-centered design, cultural tailoring of telehealth solutions, delivering telehealth through trusted intermediaries, partnering with payers to expand telehealth reimbursement, and ensuring confidential sharing of private information. Conclusions: Early PCOR evidence suggests that the most effective health system- and provider-level telehealth implementation solutions to address disparities employ patient-centered and culturally tailored telehealth solutions whose development is actively guided by the patients themselves to meet the needs of specific communities and populations. Further, this evidence shows that the best practices in telehealth implementation include delivery of telehealth through trusted intermediaries, close partnership with payers to facilitate reimbursement and sustainability, and safeguards to ensure patient-guided confidential sharing of personal health information. ",
doi="10.2196/28503",
url="https://www.jmir.org/2021/12/e28503",
url="http://www.ncbi.nlm.nih.gov/pubmed/34878986"
}


@Article{info:doi/10.2196/26185,
author="Dorsch, P. Michael
and Farris, B. Karen
and Rowell, E. Brigid
and Hummel, L. Scott
and Koelling, M. Todd",
title="The Effects of the ManageHF4Life Mobile App on Patients With Chronic Heart Failure: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Dec",
day="7",
volume="9",
number="12",
pages="e26185",
keywords="mHealth",
keywords="remote monitoring",
keywords="self-management",
keywords="self-care",
keywords="heart failure",
keywords="medical therapy",
keywords="mobile app",
abstract="Background: The successful management of heart failure (HF) involves guideline-based medical therapy as well as self-management behavior. As a result, the management of HF is moving toward a proactive real-time technological model of assisting patients with monitoring and self-management. Objective: The aim of this paper was to evaluate the efficacy of enhanced self-management via a mobile app intervention on health-related quality of life, self-management, and HF readmissions. Methods: A single-center randomized controlled trial was performed. Participants older than 45 years and admitted for acute decompensated HF or recently discharged in the past 4 weeks were included. The intervention group (``app group'') used a mobile app, and the intervention prompted daily self-monitoring and promoted self-management. The control group (``no-app group'') received usual care. The primary outcome was the change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score from baseline to 6 and 12 weeks. Secondary outcomes were the Self-Care Heart Failure Index (SCHFI) questionnaire score and recurrent HF admissions. Results: A total of 83 participants were enrolled and completed all baseline assessments. Baseline characteristics were similar between the groups except for the prevalence of ischemic HF. The app group had a reduced MLHFQ at 6 weeks (mean 37.5, SD 3.5 vs mean 48.2, SD 3.7; P=.04) but not at 12 weeks (mean 44.2, SD 4 vs mean 45.9, SD 4; P=.78), compared to the no-app group. There was no effect of the app on the SCHFI at 6 or 12 weeks. The time to first HF readmission was not statistically different between the app group and the no-app group (app group 11/42, 26\% vs no-app group 12/41, 29\%; hazard ratio 0.89, 95\% CI 0.39-2.02; P=.78) over 12 weeks. Conclusions: The adaptive mobile app intervention, which focused on promoting self-monitoring and self-management, improved the MLHFQ at 6 weeks but did not sustain its effects at 12 weeks. No effect was seen on HF self-management measured by self-report. Further research is needed to enhance engagement in the app for a longer period and to determine if the app can reduce HF readmissions in a larger study. Trial Registration: ClinicalTrials.gov NCT03149510; https://clinicaltrials.gov/ct2/show/NCT03149510 ",
doi="10.2196/26185",
url="https://mhealth.jmir.org/2021/12/e26185",
url="http://www.ncbi.nlm.nih.gov/pubmed/34878990"
}


@Article{info:doi/10.2196/29812,
author="Allam, Ahmed
and Feuerriegel, Stefan
and Rebhan, Michael
and Krauthammer, Michael",
title="Analyzing Patient Trajectories With Artificial Intelligence",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="3",
volume="23",
number="12",
pages="e29812",
keywords="patient trajectories",
keywords="longitudinal data",
keywords="digital medicine",
keywords="artificial intelligence",
keywords="machine learning",
doi="10.2196/29812",
url="https://www.jmir.org/2021/12/e29812",
url="http://www.ncbi.nlm.nih.gov/pubmed/34870606"
}


@Article{info:doi/10.2196/29071,
author="Steele Gray, Carolyn
and Chau, Edward
and Tahsin, Farah
and Harvey, Sarah
and Loganathan, Mayura
and McKinstry, Brian
and Mercer, W. Stewart
and Nie, Xin Jason
and Palen, E. Ted
and Ramsay, Tim
and Thavorn, Kednapa
and Upshur, Ross
and Wodchis, P. Walter",
title="Assessing the Implementation and Effectiveness of the Electronic Patient-Reported Outcome Tool for Older Adults With Complex Care Needs: Mixed Methods Study",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="2",
volume="23",
number="12",
pages="e29071",
keywords="older adults",
keywords="goal-oriented care",
keywords="quality of life",
keywords="self-management",
keywords="primary care",
keywords="eHealth",
keywords="pragmatic trial",
keywords="mobile phone",
abstract="Background: Goal-oriented care is being adopted to deliver person-centered primary care to older adults with multimorbidity and complex care needs. Although this model holds promise, its implementation remains a challenge. Digital health solutions may enable processes to improve adoption; however, they require evaluation to determine feasibility and impact. Objective: This study aims to evaluate the implementation and effectiveness of the electronic Patient-Reported Outcome (ePRO) mobile app and portal system, designed to enable goal-oriented care delivery in interprofessional primary care practices. The research questions driving this study are as follows: Does ePRO improve quality of life and self-management in older adults with complex needs? What mechanisms are likely driving observed outcomes? Methods: A multimethod, pragmatic randomized controlled trial using a stepped-wedge design and ethnographic case studies was conducted over a 15-month period in 6 comprehensive primary care practices across Ontario with a target enrollment of 176 patients. The 6 practices were randomized into either early (3-month control period; 12-month intervention) or late (6-month control period; 9-month intervention) groups. The primary outcome measure of interest was the Assessment of Quality of Life-4D (AQoL-4D). Data were collected at baseline and at 3 monthly intervals for the duration of the trial. Ethnographic data included observations and interviews with patients and providers at the midpoint and end of the intervention. Outcome data were analyzed using linear models conducted at the individual level, accounting for cluster effects at the practice level, and ethnographic data were analyzed using qualitative description and framework analysis methods. Results: Recruitment challenges resulted in fewer sites and participants than expected; of the 176 target, only 142 (80.6\%) patients were identified as eligible to participate because of lower-than-expected provider participation and fewer-than-expected patients willing to participate or perceived as ready to engage in goal-setting. Of the 142 patients approached, 45 (32\%) participated. Patients set a variety of goals related to self-management, mental health, social health, and overall well-being. Owing to underpowering, the impact of ePRO on quality of life could not be definitively assessed; however, the intervention group, ePRO plus usual care (mean 15.28, SD 18.60) demonstrated a nonsignificant decrease in quality of life (t24=?1.20; P=.24) when compared with usual care only (mean 21.76, SD 2.17). The ethnographic data reveal a complex implementation process in which the meaningfulness (or coherence) of the technology to individuals' lives and work acted as a key driver of adoption and tool appraisal. Conclusions: This trial experienced many unexpected and significant implementation challenges related to recruitment and engagement. Future studies could be improved through better alignment of the research methods and intervention to the complex and diverse clinical settings, dynamic goal-oriented care process, and readiness of provider and patient participants. Trial Registration: ClinicalTrials.gov NCT02917954; https://clinicaltrials.gov/ct2/show/NCT02917954 ",
doi="10.2196/29071",
url="https://www.jmir.org/2021/12/e29071",
url="http://www.ncbi.nlm.nih.gov/pubmed/34860675"
}


@Article{info:doi/10.2196/27626,
author="Al kalali, Ahmed Fadwa Salem
and Mahyoub, Essam
and Al-Hammadi, Abdulbary
and Anam, Labiba
and Khader, Yousef",
title="Evaluation of the National Tuberculosis Surveillance System in Sana'a, Yemen, 2018: Observational Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Nov",
day="30",
volume="7",
number="11",
pages="e27626",
keywords="evaluation",
keywords="surveillance system",
keywords="tuberculosis",
keywords="Yemen",
abstract="Background: Tuberculosis remains a public problem that is considered one of the top causes of morbidity and mortality worldwide. The National Tuberculosis Control Program in Yemen was established in 1970 and included in the national health policy under the leadership of the Ministry of Public Health and Population to monitor tuberculosis control. The surveillance system must be evaluated periodically to produce recommendations for improving performance and usefulness. Objective: This study aims to assess the usefulness and the performance of the tuberculosis surveillance system attributes and to identify the strengths and weaknesses of the system. Methods: A quantitative and qualitative evaluation of the national tuberculosis surveillance system was conducted using the Centers for Disease Control and Prevention's updated guidelines. The study was carried out in 10 districts in Sana'a City. A total of 28 public health facilities providing tuberculosis services for the whole population in their assigned catchment areas were purposively selected. All participants were interviewed based on their involvement with key aspects of tuberculosis surveillance activities. Results: The tuberculosis surveillance system was found to have an average performance in usefulness (57/80, 71\%), flexibility (30/40, 75\%), acceptability (174/264, 66\%), data quality (4/6, 67\%), and positive predictive value (78/107, 73\%), and poor performance in simplicity (863/1452, 59\%) and stability (15\%, 3/20). In addition, the system also had a good performance in sensitivity (78/81, 96\%). Conclusions: The tuberculosis surveillance system was found to be useful. The flexibility, positive predictive value, and data quality were average. Stability and simplicity were poor. The sensitivity was good. The main weaknesses in the tuberculosis surveillance system include a lack of governmental financial support, a paper-based system, and a lack of regular staff training. Developing an electronic system, securing governmental finances, and training the staff on tuberculosis surveillance are strongly recommended to improve the system performance. ",
doi="10.2196/27626",
url="https://publichealth.jmir.org/2021/11/e27626",
url="http://www.ncbi.nlm.nih.gov/pubmed/34851294"
}


@Article{info:doi/10.2196/30632,
author="Tsou, Christina
and Robinson, Suzanne
and Boyd, James
and Jamieson, Andrew
and Blakeman, Robert
and Yeung, Justin
and McDonnell, Josephine
and Waters, Stephanie
and Bosich, Kylie
and Hendrie, Delia",
title="Effectiveness of Telehealth in Rural and Remote Emergency Departments: Systematic Review",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="26",
volume="23",
number="11",
pages="e30632",
keywords="telehealth",
keywords="telemedicine",
keywords="clinical effectiveness",
keywords="treatment outcome",
keywords="rural population",
keywords="rural health",
keywords="remote",
abstract="Background: Emergency telehealth has been used to improve access of patients residing in rural and remote areas to specialist care in the hope of mitigating the significant health disparities that they experience. Patient disposition decisions in rural and remote emergency departments (EDs) can be complex and largely dependent on the expertise and experience available at local (receiving-end) hospitals. Although there has been some synthesis of evidence of the effectiveness of emergency telehealth in clinical practice in rural and remote EDs for nonacute presentations, there has been limited evaluation of the influence of contextual factors such as clinical area and acuity of presentation on these findings. Objective: The aims of this systematic review are to examine the outcome measures used in studying the effectiveness of telehealth in rural and remote EDs and to analyze the clinical context in which these outcome measures were used and interpreted. Methods: The search strategy used Medical Subject Headings and equivalent lists of subject descriptors to find articles covering 4 key domains: telehealth or telemedicine, EDs, effectiveness, and rural and remote. Studies were selected using the Population, Intervention, Comparator, Outcomes of Interest, and Study Design framework. This search strategy was applied to MEDLINE (Ovid), Cochrane Library, Scopus, CINAHL, ProQuest, and EconLit, as well as the Centre for Reviews and Dissemination databases (eg, National Health Service Economic Evaluation Database) for the search period from January 1, 1990, to May 23, 2020. Qualitative synthesis was performed on the outcome measures used in the included studies, in particular the clinical contexts within which they were interpreted. Results: A total of 21 full-text articles were included for qualitative analysis. Telehealth use in rural and remote EDs demonstrated effectiveness in achieving improved or equivalent clinical effectiveness, appropriate care processes, and---depending on the context---improvement in speed of care, as well as favorable service use patterns. The definition of effectiveness varied across the clinical areas and contexts of the studies, and different measures have been used to affirm the safety and clinical effectiveness of telehealth in rural and remote EDs. The acuity of patient presentation emerged as a dominant consideration in the interpretation of interlinking time-sensitive clinical effectiveness and patient disposition measures such as transfer and discharge rates, local hospital admission, length of stay, and ED length of stay. These, together with clinical area and acuity of presentation, are the outcome determination criteria that emerged from this review. Conclusions: Emergency telehealth studies typically use multiple outcome measures to determine the effectiveness of the services. The outcome determination criteria that emerged from this analysis are useful when defining the favorable direction for each outcome measure of interest. The findings of this review have implications for emergency telehealth service design and policies. Trial Registration: PROSPERO CRD42019145903; https://tinyurl.com/ndmkr8ry ",
doi="10.2196/30632",
url="https://www.jmir.org/2021/11/e30632",
url="http://www.ncbi.nlm.nih.gov/pubmed/34842537"
}


@Article{info:doi/10.2196/30399,
author="Iyamu, Ihoghosa
and Xu, T. Alice X.
and G{\'o}mez-Ram{\'i}rez, Oralia
and Ablona, Aidan
and Chang, Hsiu-Ju
and Mckee, Geoff
and Gilbert, Mark",
title="Defining Digital Public Health and the Role of Digitization, Digitalization, and Digital Transformation: Scoping Review",
journal="JMIR Public Health Surveill",
year="2021",
month="Nov",
day="26",
volume="7",
number="11",
pages="e30399",
keywords="digital public health",
keywords="digital transformation",
keywords="digitalization",
keywords="scoping review",
keywords="digitization",
keywords="definition",
keywords="mobile phone",
abstract="Background: The recent proliferation and application of digital technologies in public health has spurred interest in digital public health. However, as yet, there appears to be a lack of conceptual clarity and consensus on its definition. Objective: In this scoping review, we seek to assess formal and informal definitions of digital public health in the literature and to understand how these definitions have been conceptualized in relation to digitization, digitalization, and digital transformation. Methods: We conducted a scoping literature search in Ovid MEDLINE, Embase, Google Scholar, and 14 government and intergovernmental agency websites encompassing 6 geographic regions. Among a total of 409 full articles identified, we reviewed 11 publications that either formally defined digital public health or informally described the integration of digital technologies into public health in relation to digitization, digitalization, and digital transformation, and we conducted a thematic analysis of the identified definitions. Results: Two explicit definitions of digital public health were identified, each with divergent meanings. The first definition suggested digital public health was a reimagination of public health using new ways of working, blending established public health wisdom with new digital concepts and tools. The second definition highlighted digital public health as an asset to achieve existing public health goals. In relation to public health, digitization was used to refer to the technical process of converting analog records to digital data, digitalization referred to the integration of digital technologies into public health operations, and digital transformation was used to describe a cultural shift that pervasively integrates digital technologies and reorganizes services on the basis of the health needs of the public. Conclusions: The definition of digital public health remains contested in the literature. Public health researchers and practitioners need to clarify these conceptual definitions to harness opportunities to integrate digital technologies into public health in a way that maximizes their potential to improve public health outcomes. International Registered Report Identifier (IRRID): RR2-10.2196/preprints.27686 ",
doi="10.2196/30399",
url="https://publichealth.jmir.org/2021/11/e30399",
url="http://www.ncbi.nlm.nih.gov/pubmed/34842555"
}


@Article{info:doi/10.2196/31214,
author="Mathioudakis, Nestoras
and Aboabdo, Moeen
and Abusamaan, S. Mohammed
and Yuan, Christina
and Lewis Boyer, LaPricia
and Pilla, J. Scott
and Johnson, Erica
and Desai, Sanjay
and Knight, Amy
and Greene, Peter
and Golden, H. Sherita",
title="Stakeholder Perspectives on an Inpatient Hypoglycemia Informatics Alert: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2021",
month="Nov",
day="26",
volume="8",
number="4",
pages="e31214",
keywords="informatics alert",
keywords="clinical decision support",
keywords="hypoglycemia",
keywords="hospital",
keywords="inpatient",
abstract="Background: Iatrogenic hypoglycemia is a common occurrence among hospitalized patients and is associated with poor clinical outcomes and increased mortality. Clinical decision support systems can be used to reduce the incidence of this potentially avoidable adverse event. Objective: This study aims to determine the desired features and functionality of a real-time informatics alert to prevent iatrogenic hypoglycemia in a hospital setting. Methods: Using the Agency for Healthcare Research and Quality Five Rights of Effective Clinical Decision Support Framework, we conducted a mixed methods study using an electronic survey and focus group sessions of hospital-based providers. The goal was to elicit stakeholder input to inform the future development of a real-time informatics alert to target iatrogenic hypoglycemia. In addition to perceptions about the importance of the problem and existing barriers, we sought input regarding the content, format, channel, timing, and recipient for the alert (ie, the Five Rights). Thematic analysis of focus group sessions was conducted using deductive and inductive approaches. Results: A 21-item electronic survey was completed by 102 inpatient-based providers, followed by 2 focus group sessions (6 providers per session). Respondents universally agreed or strongly agreed that inpatient iatrogenic hypoglycemia is an important problem that can be addressed with an informatics alert. Stakeholders expressed a preference for an alert that is nonintrusive, accurate, communicated in near real time to the ordering provider, and provides actionable treatment recommendations. Several electronic medical record tools, including alert indicators in the patient header, glucose management report, and laboratory results section, were deemed acceptable formats for consideration. Concerns regarding alert fatigue were prevalent among both survey respondents and focus group participants. Conclusions: The design preferences identified in this study will provide the framework needed for an informatics team to develop a prototype alert for pilot testing and evaluation. This alert will help meet the needs of hospital-based clinicians caring for patients with diabetes who are at a high risk of treatment-related hypoglycemia. ",
doi="10.2196/31214",
url="https://humanfactors.jmir.org/2021/4/e31214",
url="http://www.ncbi.nlm.nih.gov/pubmed/34842544"
}


@Article{info:doi/10.2196/33231,
author="Cheong, Queena
and Au-yeung, Martin
and Quon, Stephanie
and Concepcion, Katsy
and Kong, Dzevela Jude",
title="Predictive Modeling of Vaccination Uptake in US Counties: A Machine Learning--Based Approach",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="25",
volume="23",
number="11",
pages="e33231",
keywords="COVID-19",
keywords="vaccine",
keywords="public health",
keywords="machine learning",
keywords="XGBoost",
keywords="SARS-CoV-2",
keywords="sociodemographic factors",
keywords="United States",
keywords="sociodemographic",
keywords="prediction",
keywords="model",
keywords="uptake",
abstract="Background: Although the COVID-19 pandemic has left an unprecedented impact worldwide, countries such as the United States have reported the most substantial incidence of COVID-19 cases worldwide. Within the United States, various sociodemographic factors have played a role in the creation of regional disparities. Regional disparities have resulted in the unequal spread of disease between US counties, underscoring the need for efficient and accurate predictive modeling strategies to inform public health officials and reduce the burden on health care systems. Furthermore, despite the widespread accessibility of COVID-19 vaccines across the United States, vaccination rates have become stagnant, necessitating predictive modeling to identify important factors impacting vaccination uptake. Objective: This study aims to determine the association between sociodemographic factors and vaccine uptake across counties in the United States. Methods: Sociodemographic data on fully vaccinated and unvaccinated individuals were sourced from several online databases such as the US Centers for Disease Control and Prevention and the US Census Bureau COVID-19 Site. Machine learning analysis was performed using XGBoost and sociodemographic data. Results: Our model predicted COVID-19 vaccination uptake across US counties with 62\% accuracy. In addition, it identified location, education, ethnicity, income, and household access to the internet as the most critical sociodemographic features in predicting vaccination uptake in US counties. Lastly, the model produced a choropleth demonstrating areas of low and high vaccination rates, which can be used by health care authorities in future pandemics to visualize and prioritize areas of low vaccination and design targeted vaccination campaigns. Conclusions: Our study reveals that sociodemographic characteristics are predictors of vaccine uptake rates across counties in the United States and, if leveraged appropriately, can assist policy makers and public health officials to understand vaccine uptake rates and craft policies to improve them. ",
doi="10.2196/33231",
url="https://www.jmir.org/2021/11/e33231",
url="http://www.ncbi.nlm.nih.gov/pubmed/34751650"
}


@Article{info:doi/10.2196/29693,
author="Shi, Xin
and Lima, Silva Simone Maria da
and Mota, Miranda Caroline Maria de
and Lu, Ying
and Stafford, S. Randall
and Pereira, Viana Corintho",
title="Prevalence of Multimorbidity of Chronic Noncommunicable Diseases in Brazil: Population-Based Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Nov",
day="25",
volume="7",
number="11",
pages="e29693",
keywords="multimorbidity",
keywords="prevalence",
keywords="health care",
keywords="public health",
keywords="Brazil",
keywords="logistic regression",
abstract="Background: Multimorbidity is the co-occurrence of two or more chronic diseases. Objective: This study, based on self-reported medical diagnosis, aims to investigate the dynamic distribution of multimorbidity across sociodemographic levels and its impacts on health-related issues over 15 years in Brazil using national data. Methods: Data were analyzed using descriptive statistics, hypothesis tests, and logistic regression. The study sample comprised 679,572 adults (18-59 years of age) and 115,699 elderly people (?60 years of age) from the two latest cross-sectional, multiple-cohort, national-based studies: the National Sample Household Survey (PNAD) of 1998, 2003, and 2008, and the Brazilian National Health Survey (PNS) of 2013. Results: Overall, the risk of multimorbidity in adults was 1.7 times higher in women (odds ratio [OR] 1.73, 95\% CI 1.67-1.79) and 1.3 times higher among people without education (OR 1.34, 95\% CI 1.28-1.41). Multiple chronic diseases considerably increased with age in Brazil, and people between 50 and 59 years old were about 12 times more likely to have multimorbidity than adults between 18 and 29 years of age (OR 11.89, 95\% CI 11.27-12.55). Seniors with multimorbidity had more than twice the likelihood of receiving health assistance in community services or clinics (OR 2.16, 95\% CI 2.02-2.31) and of being hospitalized (OR 2.37, 95\% CI 2.21-2.56). The subjective well-being of adults with multimorbidity was often worse than people without multiple chronic diseases (OR=12.85, 95\% CI: 12.07-13.68). These patterns were similar across all 4 cohorts analyzed and were relatively stable over 15 years. Conclusions: Our study shows little variation in the prevalence of the multimorbidity of chronic diseases in Brazil over time, but there are differences in the prevalence of multimorbidity across different social groups. It is hoped that the analysis of multimorbidity from the two latest Brazil national surveys will support policy making on epidemic prevention and management. ",
doi="10.2196/29693",
url="https://publichealth.jmir.org/2021/11/e29693",
url="http://www.ncbi.nlm.nih.gov/pubmed/34842558"
}


@Article{info:doi/10.2196/27880,
author="Wang, Chaofan
and Jiang, Weiwei
and Yang, Kangning
and Yu, Difeng
and Newn, Joshua
and Sarsenbayeva, Zhanna
and Goncalves, Jorge
and Kostakos, Vassilis",
title="Electronic Monitoring Systems for Hand Hygiene: Systematic Review of Technology",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="24",
volume="23",
number="11",
pages="e27880",
keywords="hand hygiene",
keywords="hand hygiene compliance",
keywords="hand hygiene quality",
keywords="electronic monitoring systems",
keywords="systematic review",
keywords="mobile phone",
abstract="Background: Hand hygiene is one of the most effective ways of preventing health care--associated infections and reducing their transmission. Owing to recent advances in sensing technologies, electronic hand hygiene monitoring systems have been integrated into the daily routines of health care workers to measure their hand hygiene compliance and quality. Objective: This review aims to summarize the latest technologies adopted in electronic hand hygiene monitoring systems and discuss the capabilities and limitations of these systems. Methods: A systematic search of PubMed, ACM Digital Library, and IEEE Xplore Digital Library was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were initially screened and assessed independently by the 2 authors, and disagreements between them were further summarized and resolved by discussion with the senior author. Results: In total, 1035 publications were retrieved by the search queries; of the 1035 papers, 89 (8.60\%) fulfilled the eligibility criteria and were retained for review. In summary, 73 studies used electronic monitoring systems to monitor hand hygiene compliance, including application-assisted direct observation (5/73, 7\%), camera-assisted observation (10/73, 14\%), sensor-assisted observation (29/73, 40\%), and real-time locating system (32/73, 44\%). A total of 21 studies evaluated hand hygiene quality, consisting of compliance with the World Health Organization 6-step hand hygiene techniques (14/21, 67\%) and surface coverage or illumination reduction of fluorescent substances (7/21, 33\%). Conclusions: Electronic hand hygiene monitoring systems face issues of accuracy, data integration, privacy and confidentiality, usability, associated costs, and infrastructure improvements. Moreover, this review found that standardized measurement tools to evaluate system performance are lacking; thus, future research is needed to establish standardized metrics to measure system performance differences among electronic hand hygiene monitoring systems. Furthermore, with sensing technologies and algorithms continually advancing, more research is needed on their implementation to improve system performance and address other hand hygiene--related issues. ",
doi="10.2196/27880",
url="https://www.jmir.org/2021/11/e27880",
url="http://www.ncbi.nlm.nih.gov/pubmed/34821565"
}


@Article{info:doi/10.2196/30042,
author="Knapp, Andreas
and Harst, Lorenz
and Hager, Stefan
and Schmitt, Jochen
and Scheibe, Madlen",
title="Use of Patient-Reported Outcome Measures and Patient-Reported Experience Measures Within Evaluation Studies of Telemedicine Applications: Systematic Review",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="17",
volume="23",
number="11",
pages="e30042",
keywords="telemedicine",
keywords="telehealth",
keywords="evaluation",
keywords="outcome",
keywords="patient-reported outcome measures",
keywords="patient-reported outcome",
keywords="patient-reported experience measures",
keywords="patient-reported experience",
keywords="measurement instrument",
keywords="questionnaire",
abstract="Background: With the rise of digital health technologies and telemedicine, the need for evidence-based evaluation is growing. Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are recommended as an essential part of the evaluation of telemedicine. For the first time, a systematic review has been conducted to investigate the use of PROMs and PREMs in the evaluation studies of telemedicine covering all application types and medical purposes. Objective: This study investigates the following research questions: in which scenarios are PROMs and PREMs collected for evaluation purposes, which PROM and PREM outcome domains have been covered and how often, which outcome measurement instruments have been used and how often, does the selection and quantity of PROMs and PREMs differ between study types and application types, and has the use of PROMs and PREMs changed over time. Methods: We conducted a systematic literature search of the MEDLINE and Embase databases and included studies published from inception until April 2, 2020. We included studies evaluating telemedicine with patients as the main users; these studies reported PROMs and PREMs within randomized controlled trials, controlled trials, noncontrolled trials, and feasibility trials in English and German. Results: Of the identified 2671 studies, 303 (11.34\%) were included; of the 303 studies, 67 (22.1\%) were feasibility studies, 70 (23.1\%) were noncontrolled trials, 20 (6.6\%) were controlled trials, and 146 (48.2\%) were randomized controlled trials. Health-related quality of life (n=310; mean 1.02, SD 1.05), emotional function (n=244; mean 0.81, SD 1.18), and adherence (n=103; mean 0.34, SD 0.53) were the most frequently assessed outcome domains. Self-developed PROMs were used in 21.4\% (65/303) of the studies, and self-developed PREMs were used in 22.3\% (68/303). PROMs (n=884) were assessed more frequently than PREMs (n=234). As the evidence level of the studies increased, the number of PROMs also increased ($\tau$=?0.45), and the number of PREMs decreased ($\tau$=0.35). Since 2000, not only has the number of studies using PROMs and PREMs increased, but the level of evidence and the number of outcome measurement instruments used have also increased, with the number of PREMs permanently remaining at a lower level. Conclusions: There have been increasingly more studies, particularly high-evidence studies, which use PROMs and PREMs to evaluate telemedicine. PROMs have been used more frequently than PREMs. With the increasing maturity stage of telemedicine applications and higher evidence level, the use of PROMs increased in line with the recommendations of evaluation guidelines. Health-related quality of life and emotional function were measured in almost all the studies. Simultaneously, health literacy as a precondition for using the application adequately, alongside proper training and guidance, has rarely been reported. Further efforts should be pursued to standardize PROM and PREM collection in evaluation studies of telemedicine. ",
doi="10.2196/30042",
url="https://www.jmir.org/2021/11/e30042",
url="http://www.ncbi.nlm.nih.gov/pubmed/34523604"
}


@Article{info:doi/10.2196/25976,
author="Yang, Shi-Ping
and Su, Hui-Luan
and Chen, Xiu-Bei
and Hua, Li
and Chen, Jian-Xian
and Hu, Min
and Lei, Jian
and Wu, San-Gang
and Zhou, Juan",
title="Long-Term Survival Among Histological Subtypes in Advanced Epithelial Ovarian Cancer: Population-Based Study Using the Surveillance, Epidemiology, and End Results Database",
journal="JMIR Public Health Surveill",
year="2021",
month="Nov",
day="17",
volume="7",
number="11",
pages="e25976",
keywords="ovarian epithelial carcinoma",
keywords="survivors",
keywords="histology",
keywords="survival rate",
keywords="survival",
keywords="ovarian",
keywords="cancer",
keywords="surveillance",
keywords="epidemiology",
keywords="women's health",
keywords="reproductive health",
keywords="Surveillance, Epidemiology, and End Results",
keywords="ovary",
keywords="oncology",
keywords="survivorship",
keywords="long-term outcome",
keywords="epithelial",
abstract="Background: Actual long-term survival rates for advanced epithelial ovarian cancer (EOC) are rarely reported. Objective: This study aimed to assess the role of histological subtypes in predicting the prognosis among long-term survivors (?5 years) of advanced EOC. Methods: We performed a retrospective analysis of data among patients with stage III-IV EOC diagnosed from 2000 to 2014 using the Surveillance, Epidemiology, and End Results cancer data of the United States. We used the chi-square test, Kaplan--Meier analysis, and multivariate Cox proportional hazards model for the analyses. Results: We included 8050 patients in this study, including 6929 (86.1\%), 743 (9.2\%), 237 (2.9\%), and 141 (1.8\%) patients with serous, endometrioid, clear cell, and mucinous tumors, respectively. With a median follow-up of 91 months, the most common cause of death was primary ovarian cancer (80.3\%), followed by other cancers (8.1\%), other causes of death (7.3\%), cardiac-related death (3.2\%), and nonmalignant pulmonary disease (3.2\%). Patients with the serous subtype were more likely to die from primary ovarian cancer, and patients with the mucinous subtype were more likely to die from other cancers and cardiac-related disease. Multivariate Cox analysis showed that patients with endometrioid (hazard ratio [HR] 0.534, P<.001), mucinous (HR 0.454, P<.001), and clear cell (HR 0.563, P<.001) subtypes showed better ovarian cancer-specific survival than those with the serous subtype. Similar results were found regarding overall survival. However, ovarian cancer--specific survival and overall survival were comparable among those with endometrioid, clear cell, and mucinous tumors. Conclusions: Ovarian cancer remains the primary cause of death in long-term ovarian cancer survivors. Moreover, the probability of death was significantly different among those with different histological subtypes. It is important for clinicians to individualize?the?surveillance?program for long-term ovarian cancer survivors. ",
doi="10.2196/25976",
url="https://publichealth.jmir.org/2021/11/e25976",
url="http://www.ncbi.nlm.nih.gov/pubmed/34787583"
}


@Article{info:doi/10.2196/31186,
author="Hammam, Nevin
and Izadi, Zara
and Li, Jing
and Evans, Michael
and Kay, Julia
and Shiboski, Stephen
and Schmajuk, Gabriela
and Yazdany, Jinoos",
title="The Relationship Between Electronic Health Record System and Performance on Quality Measures in the American College of Rheumatology's Rheumatology Informatics System for Effectiveness (RISE) Registry: Observational Study",
journal="JMIR Med Inform",
year="2021",
month="Nov",
day="12",
volume="9",
number="11",
pages="e31186",
keywords="rheumatoid arthritis",
keywords="electronic health record",
keywords="patient-reported outcomes",
keywords="quality measures",
keywords="disease activity",
keywords="quality of care",
keywords="performance reporting",
keywords="medical informatics",
keywords="clinical informatics",
abstract="Background: Routine collection of disease activity (DA) and patient-reported outcomes (PROs) in rheumatoid arthritis (RA) are nationally endorsed quality measures and critical components of a treat-to-target approach. However, little is known about the role electronic health record (EHR) systems play in facilitating performance on these measures. Objective: Using the American College Rheumatology's (ACR's) RISE registry, we analyzed the relationship between EHR system and performance on DA and functional status (FS) quality measures. Methods: We analyzed data collected in 2018 from practices enrolled in RISE. We assessed practice-level performance on quality measures that require DA and FS documentation. Multivariable linear regression and zero-inflated negative binomial models were used to examine the independent effect of EHR system on practice-level quality measure performance, adjusting for practice characteristics and patient case-mix. Results: In total, 220 included practices cared for 314,793 patients with RA. NextGen was the most commonly used EHR system (34.1\%). We found wide variation in performance on DA and FS quality measures by EHR system (median 30.1, IQR 0-74.8, and median 9.0, IQR 0-74.2), respectively). Even after adjustment, NextGen practices performed significantly better than Allscripts on the DA measure (51.4\% vs 5.0\%; P<.05) and significantly better than eClinicalWorks and eMDs on the FS measure (49.3\% vs 29.0\% and 10.9\%; P<.05). Conclusions: Performance on national RA quality measures was associated with the EHR system, even after adjusting for practice and patient characteristics. These findings suggest that future efforts to improve quality of care in RA should focus not only on provider performance reporting but also on developing and implementing rheumatology-specific standards across EHRs. ",
doi="10.2196/31186",
url="https://medinform.jmir.org/2021/11/e31186",
url="http://www.ncbi.nlm.nih.gov/pubmed/34766910"
}


@Article{info:doi/10.2196/28098,
author="Li, Xuan
and Chou, Shin-Yi
and Deily, E. Mary
and Qian, Mengcen",
title="Comparing the Impact of Online Ratings and Report Cards on Patient Choice of Cardiac Surgeon: Large Observational Study",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="28",
volume="23",
number="10",
pages="e28098",
keywords="online physician reviews",
keywords="report cards",
keywords="cardiac surgeons",
keywords="patient choice",
abstract="Background: Patients may use two information sources about a health care provider's quality: online physician reviews, which are written by patients to reflect their subjective experience, and report cards, which are based on objective health outcomes. Objective: The aim of this study was to examine the impact of online ratings on patient choice of cardiac surgeon compared to that of report cards. Methods: We obtained ratings from a leading physician review platform, Vitals; report card scores from Pennsylvania Cardiac Surgery Reports; and information about patients' choices of surgeons from inpatient records on coronary artery bypass graft (CABG) surgeries done in Pennsylvania from 2008 to 2017. We scraped all reviews posted on Vitals for surgeons who performed CABG surgeries in Pennsylvania during our study period. We linked the average overall rating and the most recent report card score at the time of a patient's surgery to the patient's record based on the surgeon's name, focusing on fee-for-service patients to avoid impacts of insurance networks on patient choices. We used random coefficient logit models with surgeon fixed effects to examine the impact of receiving a high online rating and a high report card score on patient choice of surgeon for CABG surgeries. Results: We found that a high online rating had positive and significant effects on patient utility, with limited variation in preferences across individuals, while the impact of a high report card score on patient choice was trivial and insignificant. About 70.13\% of patients considered no information on Vitals better than a low rating; the corresponding figure was 26.66\% for report card scores. The findings were robust to alternative choice set definitions and were not explained by surgeon attrition, referral effect, or admission status. Our results also show that the interaction effect of rating information and a time trend was positive and significant for online ratings, but small and insignificant for report cards. Conclusions: A patient's choice of surgeon is affected by both types of rating information; however, over the past decade, online ratings have become more influential, while the effect of report cards has remained trivial. Our findings call for information provision strategies that incorporate the advantages of both online ratings and report cards. ",
doi="10.2196/28098",
url="https://www.jmir.org/2021/10/e28098",
url="http://www.ncbi.nlm.nih.gov/pubmed/34709192"
}


@Article{info:doi/10.2196/27671,
author="van Poelgeest, Rube
and Schrijvers, Augustinus
and Boonstra, Albert
and Roes, Kit",
title="Medical Specialists' Perspectives on the Influence of Electronic Medical Record Use on the Quality of Hospital Care: Semistructured Interview Study",
journal="JMIR Hum Factors",
year="2021",
month="Oct",
day="27",
volume="8",
number="4",
pages="e27671",
keywords="electronic medical record (emr)",
keywords="hospitals",
keywords="quality",
keywords="health care",
keywords="medical specialist",
abstract="Background: Numerous publications show that electronic medical records (EMRs) may make an important contribution to increasing the quality of care. There are indications that particularly the medical specialist plays an important role in the use of EMRs in hospitals. Objective: The aim of this study was to examine how, and by which aspects, the relationship between EMR use and the quality of care in hospitals is influenced according to medical specialists. Methods: To answer this question, a qualitative study was conducted in the period of August-October 2018. Semistructured interviews of around 90 min were conducted with 11 medical specialists from 11 different Dutch hospitals. For analysis of the answers, we used a previously published taxonomy of factors that can influence the use of EMRs. Results: The professional experience of the participating medical specialists varied between 5 and 27 years. Using the previously published taxonomy, these medical specialists considered technical barriers the most significant for EMR use. The suboptimal change processes surrounding implementation were also perceived as a major barrier. A final major problem is related to the categories ``social'' (their relationships with the patients and fellow care providers), ``psychological'' (based on their personal issues, knowledge, and perceptions), and ``time'' (the time required to select, implement, and learn how to use EMR systems and subsequently enter data into the system). However, the medical specialists also identified potential technical facilitators, particularly in the assured availability of information to all health care professionals involved in the care of a patient. They see promise in using EMRs for medical decision support to improve the quality of care but consider these possibilities currently lacking. Conclusions: The 11 medical specialists shared positive experiences with EMR use when comparing it to formerly used paper records. The fact that involved health care professionals can access patient data at any time they need is considered important. However, in practice, potential quality improvement lags as long as decision support cannot be applied because of the lack of a fully coded patient record. ",
doi="10.2196/27671",
url="https://humanfactors.jmir.org/2021/4/e27671",
url="http://www.ncbi.nlm.nih.gov/pubmed/34704955"
}


@Article{info:doi/10.2196/31101,
author="Ainley, Esther
and Witwicki, Cara
and Tallett, Amy
and Graham, Chris",
title="Using Twitter Comments to Understand People's Experiences of UK Health Care During the COVID-19 Pandemic: Thematic and Sentiment Analysis",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="25",
volume="23",
number="10",
pages="e31101",
keywords="patient experience",
keywords="COVID-19",
keywords="remote health care",
keywords="phone consultation",
keywords="video consultation",
keywords="Twitter",
keywords="sentiment analysis",
keywords="social media",
keywords="digital health",
keywords="public health",
keywords="public opinion",
abstract="Background: The COVID-19 pandemic has led to changes in health service utilization patterns and a rapid rise in care being delivered remotely. However, there has been little published research examining patients' experiences of accessing remote consultations since COVID-19. Such research is important as remote methods for delivering some care may be maintained in the future. Objective: The aim of this study was to use content from Twitter to understand discourse around health and care delivery in the United Kingdom as a result of COVID-19, focusing on Twitter users' views on and attitudes toward care being delivered remotely. Methods: Tweets posted from the United Kingdom between January 2018 and October 2020 were extracted using the Twitter application programming interface. A total of 1408 tweets across three search terms were extracted into Excel; 161 tweets were removed following deduplication and 610 were identified as irrelevant to the research question. The remaining relevant tweets (N=637) were coded into categories using NVivo software, and assigned a positive, neutral, or negative sentiment. To examine views of remote care over time, the coded data were imported back into Excel so that each tweet was associated with both a theme and sentiment. Results: The volume of tweets on remote care delivery increased markedly following the COVID-19 outbreak. Five main themes were identified in the tweets: access to remote care (n=267), quality of remote care (n=130), anticipation of remote care (n=39), online booking and asynchronous communication (n=85), and publicizing changes to services or care delivery (n=160). Mixed public attitudes and experiences to the changes in service delivery were found. The proportion of positive tweets regarding access to, and quality of, remote care was higher in the immediate period following the COVID-19 outbreak (March-May 2020) when compared to the time before COVID-19 onset and the time when restrictions from the first lockdown eased (June-October 2020). Conclusions: Using Twitter data to address our research questions proved beneficial for providing rapid access to Twitter users' attitudes to remote care delivery at a time when it would have been difficult to conduct primary research due to COVID-19. This approach allowed us to examine the discourse on remote care over a relatively long period and to explore shifting attitudes of Twitter users at a time of rapid changes in care delivery. The mixed attitudes toward remote care highlight the importance for patients to have a choice over the type of consultation that best suits their needs, and to ensure that the increased use of technology for delivering care does not become a barrier for some. The finding that overall sentiment about remote care was more positive in the early stages of the pandemic but has since declined emphasizes the need for a continued examination of people's preference, particularly if remote appointments are likely to remain central to health care delivery. ",
doi="10.2196/31101",
url="https://www.jmir.org/2021/10/e31101",
url="http://www.ncbi.nlm.nih.gov/pubmed/34469327"
}


@Article{info:doi/10.2196/27261,
author="Mannering, Hannah
and Yan, Chao
and Gong, Yang
and Alrifai, Wael Mhd
and France, Daniel
and Chen, You",
title="Assessing Neonatal Intensive Care Unit Structures and Outcomes Before and During the COVID-19 Pandemic: Network Analysis Study",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="20",
volume="23",
number="10",
pages="e27261",
keywords="neonatal intensive care unit",
keywords="collaboration",
keywords="health care organization structures",
keywords="intensive care",
keywords="length of stay",
keywords="discharge dispositions",
keywords="electronic health records",
keywords="network analysis",
keywords="COVID-19",
keywords="temporal network analysis",
abstract="Background: Health care organizations (HCOs) adopt strategies (eg. physical distancing) to protect clinicians and patients in intensive care units (ICUs) during the COVID-19 pandemic. Many care activities physically performed before the COVID-19 pandemic have transitioned to virtual systems during the pandemic. These transitions can interfere with collaboration structures in the ICU, which may impact clinical outcomes. Understanding the differences can help HCOs identify challenges when transitioning physical collaboration to the virtual setting in the post--COVID-19 era. Objective: This study aims to leverage network analysis to determine the changes in neonatal ICU (NICU) collaboration structures from the pre-- to the intra--COVID-19 era. Methods: In this retrospective study, we applied network analysis to the utilization of electronic health records (EHRs) of 712 critically ill neonates (pre--COVID-19, n=386; intra--COVID-19, n=326, excluding those with COVID-19) admitted to the NICU of Vanderbilt University Medical Center between September 1, 2019, and June 30, 2020, to assess collaboration between clinicians. We characterized pre--COVID-19 as the period of September-December 2019 and intra--COVID-19 as the period of March-June 2020. These 2 groups were compared using patients' clinical characteristics, including age, sex, race, length of stay (LOS), and discharge dispositions. We leveraged the clinicians' actions committed to the patients' EHRs to measure clinician-clinician connections. We characterized a collaboration relationship (tie) between 2 clinicians as actioning EHRs of the same patient within the same day. On defining collaboration relationship, we built pre-- and intra--COVID-19 networks. We used 3 sociometric measurements, including eigenvector centrality, eccentricity, and betweenness, to quantify a clinician's leadership, collaboration difficulty, and broad skill sets in a network, respectively. We assessed the extent to which the eigenvector centrality, eccentricity, and betweenness of clinicians in the 2 networks are statistically different, using Mann-Whitney U tests (95\% CI). Results: Collaboration difficulty increased from the pre-- to intra--COVID-19 periods (median eccentricity: 3 vs 4; P<.001). Nurses had reduced leadership (median eigenvector centrality: 0.183 vs 0.087; P<.001), and neonatologists with broader skill sets cared for more patients in the NICU structure during the pandemic (median betweenness centrality: 0.0001 vs 0.005; P<.001). The pre-- and intra--COVID-19 patient groups shared similar distributions in sex ({\textasciitilde}0 difference), race (4\% difference in White, and 3\% difference in African American), LOS (interquartile range difference in 1.5 days), and discharge dispositions ({\textasciitilde}0 difference in home, 2\% difference in expired, and 2\% difference in others). There were no significant differences in the patient demographics and outcomes between the 2 groups. Conclusions: Management of NICU-admitted patients typically requires multidisciplinary care teams. Understanding collaboration structures can provide fine-grained evidence to potentially refine or optimize existing teamwork in the NICU. ",
doi="10.2196/27261",
url="https://www.jmir.org/2021/10/e27261",
url="http://www.ncbi.nlm.nih.gov/pubmed/34637393"
}


@Article{info:doi/10.2196/27499,
author="Maruster, Laura
and van der Zee, Durk-Jouke
and Buskens, Erik",
title="Identifying Frequent Health Care Users and Care Consumption Patterns: Process Mining of Emergency Medical Services Data",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="6",
volume="23",
number="10",
pages="e27499",
keywords="process mining",
keywords="frequent users",
keywords="hospital care",
keywords="emergency medical services",
keywords="regional care networks",
keywords="elderly",
keywords="Netherlands",
abstract="Background: Tracing frequent users of health care services is highly relevant to policymakers and clinicians, enabling them to avoid wasting scarce resources. Data collection on frequent users from all possible health care providers may be cumbersome due to patient privacy, competition, incompatible information systems, and the efforts involved. Objective: This study explored the use of a single key source, emergency medical services (EMS) records, to trace and reveal frequent users' health care consumption patterns. Methods: A retrospective study was performed analyzing EMS calls from the province of Drenthe in the Netherlands between 2012 and 2017. Process mining was applied to identify the structure of patient routings (ie, their consecutive visits to hospitals, nursing homes, and EMS). Routings are used to identify and quantify frequent users, recognizing frail elderly users as a focal group. The structure of these routes was analyzed at the patient and group levels, aiming to gain insight into regional coordination issues and workload distributions among health care providers. Results: Frail elderly users aged 70 years or more represented over 50\% of frequent users, making 4 or more calls per year. Over the period of observation, their annual number and the number of calls increased from 395 to 628 and 2607 to 3615, respectively. Structural analysis based on process mining revealed two categories of frail elderly users: low-complexity patients who need dialysis, radiation therapy, or hyperbaric medicine, involving a few health care providers, and high-complexity patients for whom routings appear chaotic. Conclusions: This efficient approach exploits the role of EMS as the unique regional ``ferryman,'' while the combined use of EMS data and process mining allows for the effective and efficient tracing of frequent users' utilization of health care services. The approach informs regional policymakers and clinicians by quantifying and detailing frequent user consumption patterns to support subsequent policy adaptations. ",
doi="10.2196/27499",
url="https://www.jmir.org/2021/10/e27499",
url="http://www.ncbi.nlm.nih.gov/pubmed/34612834"
}


@Article{info:doi/10.2196/30280,
author="Budhwani, Suman
and Fujioka, Keiko Jamie
and Chu, Cherry
and Baranek, Hayley
and Pus, Laura
and Wasserman, Lori
and Vigod, Simone
and Martin, Danielle
and Agarwal, Payal
and Mukerji, Geetha",
title="Delivering Mental Health Care Virtually During the COVID-19 Pandemic: Qualitative Evaluation of Provider Experiences in a Scaled Context",
journal="JMIR Form Res",
year="2021",
month="Sep",
day="21",
volume="5",
number="9",
pages="e30280",
keywords="virtual care",
keywords="mental health",
keywords="quality of care",
keywords="implementation",
keywords="COVID-19",
keywords="digital health",
keywords="pandemic",
keywords="ambulatory care",
abstract="Background: Virtual care delivery within mental health has increased rapidly during the COVID-19 pandemic. Understanding facilitators and challenges to adoption and perceptions of the quality of virtual care when delivered at scale can inform service planning postpandemic. Objective: We sought to understand consistent facilitators and persistent challenges to adoption of virtual care and perceived impact on quality of care in an initial pilot phase prior to the pandemic and then during scaled use during the pandemic in the mental health department of an ambulatory care hospital. Methods: This study took place at Women's College Hospital, an academic ambulatory hospital located in Toronto, Canada. We utilized a multimethods approach to collect quantitative data through aggregate utilization data of phone, video, and in-person visits prior to and during COVID-19 lockdown measures and through a provider experience survey administered to mental health providers (n=30). Qualitative data were collected through open-ended questions on provider experience surveys, focus groups (n=4) with mental health providers, and interviews with clinical administrative and implementation hospital staff (n=3). Results: Utilization data demonstrated slower uptake of video visits at launch and prior to COVID-19 lockdown measures in Ontario (pre-March 2020) and subsequent increased uptake of phone and video visits during COVID-19 lockdown measures (post-March 2020). Mental health providers and clinic staff highlighted barriers and facilitators to adoption of virtual care at the operational, behavioral, cultural, and system/policy levels such as required changes in workflows and scheduling, increased provider effort, provider and staff acceptance, and billing codes for physician providers. Much of the described provider experiences focused on perceived impact on quality of mental health care delivery, including perceptions on providing appropriate and patient-centered care, virtual care effectiveness, and equitable access to care for patients. Conclusions: Continued efforts to enhance suggested facilitators, reduce persistent challenges, and address provider concerns about care quality based on these findings can enable a hybrid model of patient-centered and appropriate care to emerge in the future, with options for in-person, video, and phone visits being used to meet patient and clinical needs as required. ",
doi="10.2196/30280",
url="https://formative.jmir.org/2021/9/e30280",
url="http://www.ncbi.nlm.nih.gov/pubmed/34406967"
}


@Article{info:doi/10.2196/26231,
author="Liu, Lei
and Ni, Yizhao
and Beck, F. Andrew
and Brokamp, Cole
and Ramphul, C. Ryan
and Highfield, D. Linda
and Kanjia, Karkera Megha
and Pratap, ``Nick'' J.",
title="Understanding Pediatric Surgery Cancellation: Geospatial Analysis",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="10",
volume="23",
number="9",
pages="e26231",
keywords="surgery cancellation",
keywords="socioeconomic factors",
keywords="spatial regression models",
keywords="machine learning",
abstract="Background: Day-of-surgery cancellation (DoSC) represents a substantial wastage of hospital resources and can cause significant inconvenience to patients and families. Cancellation is reported to impact between 2\% and 20\% of the 50 million procedures performed annually in American hospitals. Up to 85\% of cancellations may be amenable to the modification of patients' and families' behaviors. However, the factors underlying DoSC and the barriers experienced by families are not well understood. Objective: This study aims to conduct a geospatial analysis of patient-specific variables from electronic health records (EHRs) of Cincinnati Children's Hospital Medical Center (CCHMC) and of Texas Children's Hospital (TCH), as well as linked socioeconomic factors measured at the census tract level, to understand potential underlying contributors to disparities in DoSC rates across neighborhoods. Methods: The study population included pediatric patients who underwent scheduled surgeries at CCHMC and TCH. A 5-year data set was extracted from the CCHMC EHR, and addresses were geocoded. An equivalent set of data >5.7 years was extracted from the TCH EHR. Case-based data related to patients' health care use were aggregated at the census tract level. Community-level variables were extracted from the American Community Survey as surrogates for patients' socioeconomic and minority status as well as markers of the surrounding context. Leveraging the selected variables, we built spatial models to understand the variation in DoSC rates across census tracts. The findings were compared to those of the nonspatial regression and deep learning models. Model performance was evaluated from the root mean squared error (RMSE) using nested 10-fold cross-validation. Feature importance was evaluated by computing the increment of the RMSE when a single variable was shuffled within the data set. Results: Data collection yielded sets of 463 census tracts at CCHMC (DoSC rates 1.2\%-12.5\%) and 1024 census tracts at TCH (DoSC rates 3\%-12.2\%). For CCHMC, an L2-normalized generalized linear regression model achieved the best performance in predicting all-cause DoSC rate (RMSE 1.299\%, 95\% CI 1.21\%-1.387\%); however, its improvement over others was marginal. For TCH, an L2-normalized generalized linear regression model also performed best (RMSE 1.305\%, 95\% CI 1.257\%-1.352\%). All-cause DoSC rate at CCHMC was predicted most strongly by previous no show. As for community-level data, the proportion of African American inhabitants per census tract was consistently an important predictor. In the Texas area, the proportion of overcrowded households was salient to DoSC rate. Conclusions: Our findings suggest that geospatial analysis offers potential for use in targeting interventions for census tracts at a higher risk of cancellation. Our study also demonstrates the importance of home location, socioeconomic disadvantage, and racial minority status on the DoSC of children's surgery. The success of future efforts to reduce cancellation may benefit from taking social, economic, and cultural issues into account. ",
doi="10.2196/26231",
url="https://www.jmir.org/2021/9/e26231",
url="http://www.ncbi.nlm.nih.gov/pubmed/34505837"
}


@Article{info:doi/10.2196/25195,
author="Peters, M. Guido
and Kooij, Laura
and Lenferink, Anke
and van Harten, H. Wim
and Doggen, M. Carine J.",
title="The Effect of Telehealth on Hospital Services Use: Systematic Review and Meta-analysis",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="1",
volume="23",
number="9",
pages="e25195",
keywords="telehealth",
keywords="systematic review",
keywords="meta-analysis",
keywords="hospitalization",
keywords="health services use",
keywords="eHealth",
abstract="Background: Telehealth interventions, that is, health care provided over a distance using information and communication technology, are suggested as a solution to rising health care costs by reducing hospital service use. However, the extent to which this is possible is unclear. Objective: The aim of this study is to evaluate the effect of telehealth on the use of hospital services, that is, (duration of) hospitalizations, and to compare the effects between telehealth types and health conditions. Methods: We searched PubMed, Scopus, and the Cochrane Library from inception until April 2019. Peer-reviewed randomized controlled trials (RCTs) reporting the effect of telehealth interventions on hospital service use compared with usual care were included. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool and quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation guidelines. Results: We included 127 RCTs in the meta-analysis. Of these RCTs, 82.7\% (105/127) had a low risk of bias or some concerns overall. High-quality evidence shows that telehealth reduces the risk of all-cause or condition-related hospitalization by 18 (95\% CI 0-30) and 37 (95\% CI 20-60) per 1000 patients, respectively. We found high-quality evidence that telehealth leads to reductions in the mean all-cause and condition-related hospitalizations, with 50 and 110 fewer hospitalizations per 1000 patients, respectively. Overall, the all-cause hospital days decreased by 1.07 (95\% CI ?1.76 to ?0.39) days per patient. For hospitalized patients, the mean hospital stay for condition-related hospitalizations decreased by 0.89 (95\% CI ?1.42 to ?0.36) days. The effects were similar between telehealth types and health conditions. A trend was observed for studies with longer follow-up periods yielding larger effects. Conclusions: Small to moderate reductions in hospital service use can be achieved using telehealth. It should be noted that, despite the large number of included studies, uncertainties around the magnitude of effects remain, and not all effects are statistically significant. ",
doi="10.2196/25195",
url="https://www.jmir.org/2021/9/e25195",
url="http://www.ncbi.nlm.nih.gov/pubmed/34468324"
}


@Article{info:doi/10.2196/26887,
author="Patel, N. Kunal
and Mazurenko, Olena
and Ford, Eric",
title="Analysis of Hospital Quality Measures and Web-Based Chargemasters, 2019: Cross-sectional Study",
journal="JMIR Form Res",
year="2021",
month="Aug",
day="19",
volume="5",
number="8",
pages="e26887",
keywords="chargemaster",
keywords="standard charge",
keywords="price transparency",
keywords="health care",
keywords="diagnosis-related group",
keywords="DRG",
keywords="quality measures",
keywords="the Centers for Medicare and Medicaid Services regulation",
keywords="CMS",
abstract="Background: The federal health care price transparency regulation from 2019 is aimed at bending the health care cost curve by increasing the availability of hospital pricing information for the public. Objective: This study aims to examine the associations between publicly reported diagnosis-related group chargemaster prices on the internet and quality measures, process indicators, and patient-reported experience measures. Methods: In this cross-sectional study, we collected and analyzed a random 5.02\% (212/4221) stratified sample of US hospital prices in 2019 using descriptive statistics and multivariate analysis. Results: We found extreme price variation in shoppable services and significantly greater price variation for medical versus surgical services (P=.006). In addition, we found that quality indicators were positively associated with standard charges, such as mortality ($\beta$=.929; P<.001) and readmissions ($\beta$=.514; P<.001). Other quality indicators, such as the effectiveness of care ($\beta$=?.919; P<.001), efficient use of medical imaging ($\beta$=?.458; P=.001), and patient recommendation scores ($\beta$=?.414; P<.001), were negatively associated with standard charges. Conclusions: We found that hospital chargemasters display wide variations in prices for medical services and procedures and match variations in quality measures. Further work is required to investigate 100\% of US hospital prices posted publicly on the internet and their relationship with quality measures. ",
doi="10.2196/26887",
url="https://formative.jmir.org/2021/8/e26887",
url="http://www.ncbi.nlm.nih.gov/pubmed/34420914"
}


@Article{info:doi/10.2196/30453,
author="Khuntia, Jiban
and Ning, Xue
and Stacey, Rulon",
title="Digital Orientation of Health Systems in the Post--COVID-19 ``New Normal'' in the United States: Cross-sectional Survey",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="16",
volume="23",
number="8",
pages="e30453",
keywords="post--COVID-19",
keywords="digital orientation",
keywords="health systems",
keywords="digital transformation",
keywords="digital health",
keywords="telehealth",
keywords="telemedicine",
keywords="COVID-19",
keywords="impact",
keywords="insight",
keywords="cross-sectional",
keywords="survey",
keywords="United States",
keywords="electronic health record",
keywords="EHR",
abstract="Background: Almost all health systems have developed some form of customer-facing digital technologies and have worked to align these systems to their existing electronic health records to accommodate the surge in remote and virtual care deliveries during the COVID-19 pandemic. Others have developed analytics-driven decision-making capabilities. However, it is not clear how health systems in the United States are embracing digital technologies and there is a gap in health systems' abilities to integrate workflows with expanding technologies to spur innovation and futuristic growth. There is a lack of reliable and reported estimates of the current and futuristic digital orientations of health systems. Periodic assessments will provide imperatives to policy formulation and align efforts to yield the transformative power of emerging digital technologies. Objective: The aim of this study was to explore and examine differences in US health systems with respect to digital orientations in the post--COVID-19 ``new normal'' in 2021. Differences were assessed in four dimensions: (1) analytics-oriented digital technologies (AODT), (2) customer-oriented digital technologies (CODT), (3) growth and innovation--oriented digital technologies (GODT), and (4) futuristic and experimental digital technologies (FEDT). The former two dimensions are foundational to health systems' digital orientation, whereas the latter two will prepare for future disruptions. Methods: We surveyed a robust group of health system chief executive officers (CEOs) across the United States from February to March 2021. Among the 625 CEOs, 135 (22\%) responded to our survey. We considered the above four broad digital technology orientations, which were ratified with expert consensus. Secondary data were collected from the Agency for Healthcare Research and Quality Hospital Compendium, leading to a matched usable dataset of 124 health systems for analysis. We examined the relationship of adopting the four digital orientations to specific hospital characteristics and earlier reported factors as barriers or facilitators to technology adoption. Results: Health systems showed a lower level of CODT (mean 4.70) or GODT (mean 4.54) orientations compared with AODT (mean 5.03), and showed the lowest level of FEDT orientation (mean 4.31). The ordered logistic estimation results provided nuanced insights. Medium-sized (P<.001) health systems, major teaching health systems (P<.001), and systems with high-burden hospitals (P<.001) appear to be doing worse with respect to AODT orientations, raising some concerns. Health systems of medium (P<.001) and large (P=.02) sizes, major teaching health systems (P=.07), those with a high revenue (P=.05), and systems with high-burden hospitals (P<.001) have less CODT orientation. Health systems in the midwest (P=.05) and southern (P=.04) states are more likely to adopt GODT, whereas high-revenue (P=.004) and investor-ownership (P=.01) health systems are deterred from GODT. Health systems of a medium size, and those that are in the midwest (P<.001), south (P<.001), and west (P=.01) are more adept to FEDT, whereas medium (P<.001) and high-revenue (P<.001) health systems, and those with a high discharge rate (P=.04) or high burden (P=.003, P=.005) have subdued FEDT orientations. Conclusions: Almost all health systems have some current foundational digital technological orientations to glean intelligence or service delivery to customers, with some notable exceptions. Comparatively, fewer health systems have growth or futuristic digital orientations. The transformative power of digital technologies can only be leveraged by adopting futuristic digital technologies. Thus, the disparities across these orientations suggest that a holistic, consistent, and well-articulated direction across the United States remains elusive. Accordingly, we suggest that a policy strategy and financial incentives are necessary to spur a well-visioned and articulated digital orientation for all health systems across the United States. In the absence of such a policy to collectively leverage digital transformations, differences in care across the country will continue to be a concern. ",
doi="10.2196/30453",
url="https://www.jmir.org/2021/8/e30453",
url="http://www.ncbi.nlm.nih.gov/pubmed/34254947"
}


@Article{info:doi/10.2196/27842,
author="Aerts, Hannelore
and Kalra, Dipak
and S{\'a}ez, Carlos
and Ram{\'i}rez-Anguita, Manuel Juan
and Mayer, Miguel-Angel
and Garcia-Gomez, M. Juan
and Dur{\`a}-Hern{\'a}ndez, Marta
and Thienpont, Geert
and Coorevits, Pascal",
title="Quality of Hospital Electronic Health Record (EHR) Data Based on the International Consortium for Health Outcomes Measurement (ICHOM) in Heart Failure: Pilot Data Quality Assessment Study",
journal="JMIR Med Inform",
year="2021",
month="Aug",
day="4",
volume="9",
number="8",
pages="e27842",
keywords="data quality",
keywords="electronic health records",
keywords="heart failure",
keywords="value-based health insurance",
keywords="patient outcome assessment",
abstract="Background: There is increasing recognition that health care providers need to focus attention, and be judged against, the impact they have on the health outcomes experienced by patients. The measurement of health outcomes as a routine part of clinical documentation is probably the only scalable way of collecting outcomes evidence, since secondary data collection is expensive and error-prone. However, there is uncertainty about whether routinely collected clinical data within electronic health record (EHR) systems includes the data most relevant to measuring and comparing outcomes and if those items are collected to a good enough data quality to be relied upon for outcomes assessment, since several studies have pointed out significant issues regarding EHR data availability and quality. Objective: In this paper, we first describe a practical approach to data quality assessment of health outcomes, based on a literature review of existing frameworks for quality assessment of health data and multistakeholder consultation. Adopting this approach, we performed a pilot study on a subset of 21 International Consortium for Health Outcomes Measurement (ICHOM) outcomes data items from patients with congestive heart failure. Methods: All available registries compatible with the diagnosis of heart failure within an EHR data repository of a general hospital (142,345 visits and 12,503 patients) were extracted and mapped to the ICHOM format. We focused our pilot assessment on 5 commonly used data quality dimensions: completeness, correctness, consistency, uniqueness, and temporal stability. Results: We found high scores (>95\%) for the consistency, completeness, and uniqueness dimensions. Temporal stability analyses showed some changes over time in the reported use of medication to treat heart failure, as well as in the recording of past medical conditions. Finally, the investigation of data correctness suggested several issues concerning the characterization of missing data values. Many of these issues appear to be introduced while mapping the IMASIS-2 relational database contents to the ICHOM format, as the latter requires a level of detail that is not explicitly available in the coded data of an EHR. Conclusions: Overall, results of this pilot study revealed good data quality for the subset of heart failure outcomes collected at the Hospital del Mar. Nevertheless, some important data errors were identified that were caused by fundamentally different data collection practices in routine clinical care versus research, for which the ICHOM standard set was originally developed. To truly examine to what extent hospitals today are able to routinely collect the evidence of their success in achieving good health outcomes, future research would benefit from performing more extensive data quality assessments, including all data items from the ICHOM standards set and across multiple hospitals. ",
doi="10.2196/27842",
url="https://medinform.jmir.org/2021/8/e27842",
url="http://www.ncbi.nlm.nih.gov/pubmed/34346902"
}


@Article{info:doi/10.2196/23516,
author="Pimentel, B. Camilla
and Clark, Valerie
and Baughman, W. Amy
and Berlowitz, R. Dan
and Davila, Heather
and Mills, L. Whitney
and Mohr, C. David
and Sullivan, L. Jennifer
and Hartmann, W. Christine",
title="Health Care Providers and the Public Reporting of Nursing Home Quality in the United States Department of Veterans Affairs: Protocol for a Mixed Methods Pilot Study",
journal="JMIR Res Protoc",
year="2021",
month="Jul",
day="21",
volume="10",
number="7",
pages="e23516",
keywords="nursing homes",
keywords="public reporting",
keywords="quality",
abstract="Background: In June 2018, the United States Department of Veterans Affairs (VA) began the public reporting of its 134 Community Living Centers' (CLCs) overall quality by using a 5-star rating system based on data from the national quality measures captured in CLC Compare. Given the private sector's positive experience with report cards, this is a seminal moment for stimulating measurable quality improvements in CLCs. However, the public reporting of CLC Compare data raises substantial and immediate implications for CLCs. The report cards, for example, facilitate comparisons between CLCs and community nursing homes in which CLCs generally fare worse. This may lead to staff anxiety and potentially unintended consequences. Additionally, CLC Compare is designed to spur improvement, yet the motivating aspects of the report cards are unknown. Understanding staff attitudes and early responses is a critical first step in building the capacity for public reporting to spur quality.  Objective: We will adapt an existing community nursing home public reporting survey to reveal important leverage points and support CLCs' quality improvement efforts. Our work will be grounded in a conceptual framework of strategic orientation. We have 2 aims. First, we will qualitatively examine CLC staff reactions to CLC Compare. Second, we will adapt and expand upon an extant community nursing home survey to capture a broad range of responses and then pilot the adapted survey in CLCs. Methods: We will conduct interviews with staff at 3 CLCs (1 1-star CLC, 1 3-star CLC, and 1 5-star CLC) to identify staff actions taken in response to their CLCs' public data; staff's commitment to or difficulties with using CLC Compare; and factors that motivate staff to improve CLC quality. We will integrate these findings with our conceptual framework to adapt and expand a community nursing home survey to the current CLC environment. We will conduct cognitive interviews with staff in 1 CLC to refine survey items. We will then pilot the survey in 6 CLCs (2 1-star CLCs, 2 3-star CLCs, and 2 5-star CLCs) to assess the survey's feasibility, acceptability, and preliminary psychometric properties.  Results: We will develop a brief survey for use in a future national administration to identify system-wide responses to CLC Compare; evaluate the impact of CLC Compare on veterans' clinical outcomes and satisfaction; and develop, test, and disseminate interventions to support the meaningful use of CLC Compare for quality improvement.  Conclusions: The knowledge gained from this pilot study and from future work will help VA refine how CLC Compare is used, ensure that CLC staff understand and are motivated to use its quality data, and implement concrete actions to improve clinical quality. The products from this pilot study will also facilitate studies on the effects of public reporting in other critical VA clinical areas. International Registered Report Identifier (IRRID): DERR1-10.2196/23516 ",
doi="10.2196/23516",
url="https://www.researchprotocols.org/2021/7/e23516",
url="http://www.ncbi.nlm.nih.gov/pubmed/34287218"
}


@Article{info:doi/10.2196/27980,
author="Lantoine, Jos{\'e}phine
and Brysse, Anne
and Dideberg, Vinciane
and Claes, Kathleen
and Symoens, Sofie
and Coucke, Wim
and Benoit, Val{\'e}rie
and Rombout, Sonia
and De Rycke, Martine
and Seneca, Sara
and Van Laer, Lut
and Wuyts, Wim
and Corveleyn, Anniek
and Van Den Bogaert, Kris
and Rydlewski, Catherine
and Wilkin, Fran{\c{c}}oise
and Ravoet, Marie
and Fastr{\'e}, Elodie
and Capron, Arnaud
and Vandevelde, Monique Nathalie",
title="Frequency of Participation in External Quality Assessment Programs Focused on Rare Diseases: Belgian Guidelines for Human Genetics Centers",
journal="JMIR Med Inform",
year="2021",
month="Jul",
day="12",
volume="9",
number="7",
pages="e27980",
keywords="human genetics",
keywords="external quality assessment",
keywords="quality control",
keywords="proficiency testing",
keywords="frequency",
keywords="genetic testing",
keywords="rare diseases",
keywords="cost-effectiveness",
keywords="surveillance, public health authorities",
keywords="public health",
keywords="health informatics",
keywords="medical informatics",
keywords="genetics",
keywords="algorithm",
abstract="Background: Participation in quality controls, also called external quality assessment (EQA) schemes, is required for the ISO15189 accreditation of the Medical Centers of Human Genetics. However, directives on the minimal frequency of participation in genetic quality control schemes are lacking or too heterogeneous, with a possible impact on health care quality. Objective: The aim of this project is to develop Belgian guidelines on the frequency of participation in quality controls for genetic testing in the context of rare diseases. Methods: A group of experts analyzed 90 EQA schemes offered by accredited providers and focused on analyses used for the diagnosis of rare diseases. On that basis, the experts developed practical recommendations about the minimal frequencies of participation of the Medical Centers of Human Genetics in quality controls and how to deal with poor performances and change management. These guidelines were submitted to the Belgian Accreditation Body and then reviewed and approved by the Belgian College of Human Genetics and Rare Diseases and by the National Institute for Health and Disability Insurance. Results: The guidelines offer a decisional algorithm for the minimal frequency of participation in human genetics EQA schemes. This algorithm has been developed taking into account the scopes of the EQA schemes, the levels of experience, and the annual volumes of the Centers of Human Genetics in the performance of the tests considered. They include three key principles: (1) the recommended annual assessment of all genetic techniques and technological platforms, if possible through EQAs covering the technique, genotyping, and clinical interpretation; (2) the triennial assessment of the genotyping and interpretation of specific germline mutations and pharmacogenomics analyses; and (3) the documentation of actions undertaken in the case of poor performances and the participation to quality control the following year. The use of a Bayesian statistical model has been proposed to help the Centers of Human Genetics to determine the theoretical number of tests that should be annually performed to achieve a certain threshold of performance (eg, a maximal error rate of 1\%). Besides, the guidelines insist on the role and responsibility of the national public health authorities in the follow-up of the quality of analyses performed by the Medical Centers of Human Genetics and in demonstrating the cost-effectiveness and rationalization of participation frequency in these quality controls. Conclusions: These guidelines have been developed based on the analysis of a large panel of EQA schemes and data collected from the Belgian Medical Centers of Human Genetics. They are applicable to other countries and will facilitate and improve the quality management and financing systems of the Medical Centers of Human Genetics. ",
doi="10.2196/27980",
url="https://medinform.jmir.org/2021/7/e27980",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255700"
}


@Article{info:doi/10.2196/26391,
author="Nichol, A. Ariadne
and Batten, N. Jason
and Halley, C. Meghan
and Axelrod, K. Julia
and Sankar, L. Pamela
and Cho, K. Mildred",
title="A Typology of Existing Machine Learning--Based Predictive Analytic Tools Focused on Reducing Costs and Improving Quality in Health Care: Systematic Search and Content Analysis",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="22",
volume="23",
number="6",
pages="e26391",
keywords="machine learning",
keywords="artificial intelligence",
keywords="ethics",
keywords="regulation",
keywords="health care quality",
keywords="costs",
abstract="Background: Considerable effort has been devoted to the development of artificial intelligence, including machine learning--based predictive analytics (MLPA) for use in health care settings. The growth of MLPA could be fueled by payment reforms that hold health care organizations responsible for providing high-quality, cost-effective care. Policy analysts, ethicists, and computer scientists have identified unique ethical and regulatory challenges from the use of MLPA in health care. However, little is known about the types of MLPA health care products available on the market today or their stated goals. Objective: This study aims to better characterize available MLPA health care products, identifying and characterizing claims about products recently or currently in use in US health care settings that are marketed as tools to improve health care efficiency by improving quality of care while reducing costs. Methods: We conducted systematic database searches of relevant business news and academic research to identify MLPA products for health care efficiency meeting our inclusion and exclusion criteria. We used content analysis to generate MLPA product categories and characterize the organizations marketing the products. Results: We identified 106 products and characterized them based on publicly available information in terms of the types of predictions made and the size, type, and clinical training of the leadership of the companies marketing them. We identified 5 categories of predictions made by MLPA products based on publicly available product marketing materials: disease onset and progression, treatment, cost and utilization, admissions and readmissions, and decompensation and adverse events. Conclusions: Our findings provide a foundational reference to inform the analysis of specific ethical and regulatory challenges arising from the use of MLPA to improve health care efficiency. ",
doi="10.2196/26391",
url="https://www.jmir.org/2021/6/e26391",
url="http://www.ncbi.nlm.nih.gov/pubmed/34156338"
}


@Article{info:doi/10.2196/18488,
author="Rose, Susannah
and Hurwitz, McKee Heather
and Mercer, Beth Mary
and Hizlan, Sabahat
and Gali, Kari
and Yu, Pei-Chun
and Franke, Caroline
and Martinez, Kathryn
and Stanton, Matthew
and Faiman, Matthew
and Rasmussen, Peter
and Boissy, Adrienne",
title="Patient Experience in Virtual Visits Hinges on Technology and the Patient-Clinician Relationship: A Large Survey Study With Open-ended Questions",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="21",
volume="23",
number="6",
pages="e18488",
keywords="telehealth",
keywords="virtual visit",
keywords="patient experience",
keywords="mobile phone",
abstract="Background: Patient satisfaction with in-person medical visits includes patient-clinician engagement. However, communication, empathy, and other relationship-centered care measures in virtual visits have not been adequately investigated. Objective: This study aims to comprehensively consider patient experience, including relationship-centered care measures, to assess patient satisfaction during virtual visits. Methods: We conducted a large survey study with open-ended questions to comprehensively assess patients' experiences with virtual visits in a diverse patient population. Adults with a virtual visit between June 21, 2017, and July 12, 2017, were invited to complete a survey of 21 Likert-scale items and textboxes for comments following their visit. Factor analysis of the survey items revealed three factors: experience with technology, patient-clinician engagement, and overall satisfaction. Multivariable logistic regression was used to test the associations among the three factors and patient demographics, clinician type, and prior relationship with the clinician. Using qualitative framework analysis, we identified recurrent themes in survey comments, quantitatively coded comments, and computed descriptive statistics of the coded comments. Results: A total of 65.7\% (426/648) of the patients completed the survey; 64.1\% (273/426) of the respondents were women, and the average age was 46 (range 18-86) years. The sample was geographically diverse: 70.2\% (299/426) from Ohio, 6.8\% (29/426) from Florida, 4.2\% (18/426) from Pennsylvania, and 18.7\% (80/426) from other states. With regard to insurance coverage, 57.5\% (245/426) were undetermined, 23.7\% (101/426) had the hospital's employee health insurance, and 18.7\% (80/426) had other private insurance. Types of virtual visits and clinicians varied. Overall, 58.4\% (249/426) of patients had an on-demand visit, whereas 41.5\% (177/426) had a scheduled visit. A total of 41.8\% (178/426) of patients had a virtual visit with a family physician, 20.9\% (89/426) with an advanced practice provider, and the rest had a visit with a specialist. Most patients (393/423, 92.9\%) agreed that their virtual visit clinician was interested in them as a person, and their virtual visit made it easy to get the care they needed (383/421, 90.9\%). A total of 81.9\% (344/420) of respondents agreed or strongly agreed that their virtual visit was as good as an in-person visit by a clinician. Having a prior relationship with their virtual visit clinician was associated with less comfort and ease with virtual technology among patients (odds ratio 0.58, 95\% CI 0.35-0.98). In terms of technology, patients found the interface easy to use (392/423, 92.7\%) and felt comfortable using it (401/423, 94.8\%). Technical difficulties were associated with lower odds of overall satisfaction (odds ratio 0.46, 95\% CI 0.28-0.76). Conclusions: Patient-clinician engagement in virtual visits was comparable with in-person visits. This study supports the value and acceptance of virtual visits. Evaluations of virtual visits should include assessments of technology and patient-clinician engagement, as both are likely to influence patient satisfaction. ",
doi="10.2196/18488",
url="https://www.jmir.org/2021/6/e18488",
url="http://www.ncbi.nlm.nih.gov/pubmed/34152276"
}


@Article{info:doi/10.2196/25028,
author="Lee, Ji-Hyun
and Park, Hyeoun-Ae
and Song, Tae-Min",
title="A Determinants-of-Fertility Ontology for Detecting Future Signals of Fertility Issues From Social Media Data: Development of an Ontology",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="14",
volume="23",
number="6",
pages="e25028",
keywords="ontology",
keywords="fertility",
keywords="public policy",
keywords="South Korea",
keywords="social media",
keywords="future",
keywords="infodemiology",
keywords="infoveillance",
abstract="Background: South Korea has the lowest fertility rate in the world despite considerable governmental efforts to boost it. Increasing the fertility rate and achieving the desired outcomes of any implemented policies requires reliable data on the ongoing trends in fertility and preparations for the future based on these trends. Objective: The aims of this study were to (1) develop a determinants-of-fertility ontology with terminology for collecting and analyzing social media data; (2) determine the description logics, content coverage, and structural and representational layers of the ontology; and (3) use the ontology to detect future signals of fertility issues. Methods: An ontology was developed using the Ontology Development 101 methodology. The domain and scope of the ontology were defined by compiling a list of competency questions. The terms were collected from Korean government reports, Korea's Basic Plan for Low Fertility and Aging Society, a national survey about marriage and childbirth, and social media postings on fertility issues. The classes and their hierarchy were defined using a top-down approach based on an ecological model. The internal structure of classes was defined using the entity-attribute-value model. The description logics of the ontology were evaluated using Prot{\'e}g{\'e} (version 5.5.0), and the content coverage was evaluated by comparing concepts extracted from social media posts with the list of ontology classes. The structural and representational layers of the ontology were evaluated by experts. Social media data were collected from 183 online channels between January 1, 2011, and June 30, 2015. To detect future signals of fertility issues, 2 classes of the ontology, the socioeconomic and cultural environment, and public policy, were identified as keywords. A keyword issue map was constructed, and the defined keywords were mapped to identify future signals. R software (version 3.5.2) was used to mine for future signals. Results: A determinants-of-fertility ontology comprised 236 classes and terminology comprised 1464 synonyms of the 236 classes. Concept classes in the ontology were found to be coherently and consistently defined. The ontology included more than 90\% of the concepts that appeared in social media posts on fertility policies. Average scores for all of the criteria for structural and representations layers exceeded 4 on a 5-point scale. Violence and abuse (socioeconomic and cultural factor) and flexible working arrangement (fertility policy) were weak signals, suggesting that they could increase rapidly in the future. Conclusions: The determinants-of-fertility ontology developed in this study can be used as a framework for collecting and analyzing social media data on fertility issues and detecting future signals of fertility issues. The future signals identified in this study will be useful for policy makers who are developing policy responses to low fertility. ",
doi="10.2196/25028",
url="https://www.jmir.org/2021/6/e25028",
url="http://www.ncbi.nlm.nih.gov/pubmed/34125068"
}


@Article{info:doi/10.2196/25261,
author="Gilroy, John
and Bulkeley, Kim
and Talbot, Folau
and Gwynn, Josephine
and Gwynne, Kylie
and Henningham, Mandy
and Alcorso, Caroline
and Rambaldini, Boe
and Lincoln, Michelle",
title="Retention of the Aboriginal Health, Ageing, and Disability Workforce: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="28",
volume="10",
number="5",
pages="e25261",
keywords="Indigenous health",
keywords="disability",
keywords="ageing",
keywords="Indigenous methodologies",
keywords="Indigenous",
keywords="Australia",
keywords="Aboriginal",
abstract="Background: Despite a plethora of research into Aboriginal employment and recruitment, the extent and nature of the retention of frontline Aboriginal people in health, ageing, and disability workforces are currently unknown. In this application, frontline service delivery is defined as Aboriginal people who are paid employees in the health, ageing, and disability service sectors in roles that involve direct client, participant, or patient contact. There is a need to identify the factors that inhibit (push) and promote (pull) staff retention or departure of this workforce from the sectors. This study will provide additional insight about this topic. Objective: The objective of this project is to uncover the factors that influence the retention of frontline Aboriginal workers in the health, ageing, and disability workforces in New South Wales (NSW) who do not have university qualifications. The aim of the proposed project aims to discover the push and pull factors for the retention of the frontline Aboriginal workforce in the health, ageing, and disability sectors in NSW in relation to their role, employment, and community and design evidence-based strategies for retaining the Aboriginal frontline workforce in the health, ageing, and disability sectors in NSW. Methods: The proposed research will use a mixed methods approach, collecting both quantitative and qualitative data via surveys and interviews to capture and represent the voices and perspectives of Aboriginal people in a way that the participants chose. Results: Indigenous research methodologies are a growing field in Aboriginal health research in Australia. A key strength of this study is that it is led by Aboriginal scholars and Aboriginal controlled organizations that apply an Indigenous methodological framework throughout the research process. Conclusions: This study uses a mixed methods design. The survey and interview questions and model were developed in partnership with Aboriginal health, ageing, and disability service workers rather than relying only on research publications on the workforce, government policies, and human resources strategies. This design places a strong emphasis on generalizable findings together with an inductive approach that explores employers and workers' lived experience of the Aboriginal health workforce in NSW. Excluding workers who have graduated from university places a strong focus on the workforce who have obtained either school or Technical and Further Education or registered training organizations qualifications. Data collection was conducted during the COVID-19 pandemic, and results will include the unique experiences of Aboriginal workers and employers delivering services in an extremely challenging organizational, community, and personal context. International Registered Report Identifier (IRRID): PRR1-10.2196/25261 ",
doi="10.2196/25261",
url="https://www.researchprotocols.org/2021/5/e25261",
url="http://www.ncbi.nlm.nih.gov/pubmed/34047698"
}


@Article{info:doi/10.2196/28629,
author="Solans, Oscar
and Vidal-Alaball, Josep
and Roig Cabo, Pasqual
and Mora, N{\'u}ria
and Coma, Ermengol
and Bonet Sim{\'o}, Maria Josep
and Hermosilla P{\'e}rez, Eduardo
and Saig{\'i}-Rubi{\'o}, Francesc
and Olmos Dom{\'i}nguez, Carmen
and Piera-Jim{\'e}nez, Jordi
and Abizanda Gonz{\'a}lez, Merc{\`e}
and L{\'o}pez Segu{\'i}, Francesc",
title="Characteristics of Citizens and Their Use of Teleconsultations in Primary Care in the Catalan Public Health System Before and During the COVID-19 Pandemic: Retrospective Descriptive Cross-sectional Study",
journal="J Med Internet Res",
year="2021",
month="May",
day="27",
volume="23",
number="5",
pages="e28629",
keywords="teleconsultation",
keywords="primary care",
keywords="remote consultation",
keywords="telehealth",
keywords="COVID-19",
keywords="e-consultation",
abstract="Background: eConsulta---that is, asynchronous, two-way teleconsultation in primary care---is one of the most important telemedicine developments in the Catalan public health system, a service that has been heavily boosted by the onset of the COVID-19 pandemic. It is vital to know the characteristics of its users in order to be able to meet their needs and understand the coverage of this service in a context where there is reduced accessibility to the health system. Objective: This study aims to analyze the profile of the citizens who use the eConsulta tool and the reasons for their use, as well as to gain an understanding of the elements that characterize their decision to use it while distinguishing between those who used it before and those who have used it since the onset of the COVID-19 pandemic. Methods: A descriptive, observational study based on administrative data was performed. This study differentiates between the COVID-19 pandemic era and the period preceding it, considering the day the state of emergency was declared in Spain (ie, March 12, 2020) as the cut-off point. It also differentiates between eConsulta users who send messages and those who only receive them. Results: During the pandemic, the number of unique users of this teleconsultation service had almost tripled, with up to 33.10 visits per 1000 inhabitants per month reported in the first three months. For the two user profiles analyzed, most users since the start of the COVID-19 outbreak were predominantly female, systematically younger, more actively employed, and with less complex pathologies. Furthermore, eConsulta users received more messages proactively from the health professionals. There was also a relative decrease in the number of conversations initiated by higher-income urban users and an increase in conversations initiated by users in rural areas. Conclusions: The COVID-19 pandemic has helped to generalize the use of telemedicine as a tool to compensate, to some extent, for the decline in face-to-face visits, especially among younger citizens in Catalonia. Telemedicine has made it possible to maintain contact between citizens and the health care system in the context of maximum complexity. ",
doi="10.2196/28629",
url="https://www.jmir.org/2021/5/e28629",
url="http://www.ncbi.nlm.nih.gov/pubmed/33970867"
}


@Article{info:doi/10.2196/29298,
author="Khoury, Dalia
and Preiss, Alexander
and Geiger, Paul
and Anwar, Mohd
and Conway, Paul Kevin",
title="Increases in Naloxone Administrations by Emergency Medical Services Providers During the COVID-19 Pandemic: Retrospective Time Series Study",
journal="JMIR Public Health Surveill",
year="2021",
month="May",
day="27",
volume="7",
number="5",
pages="e29298",
keywords="opioids",
keywords="naloxone",
keywords="EMS",
keywords="emergency medical services",
keywords="COVID-19",
keywords="pandemic",
keywords="medical services",
keywords="overdose",
keywords="outcomes",
keywords="opioid crisis",
keywords="public health",
abstract="Background: The opioid crisis in the United States may be exacerbated by the COVID-19 pandemic. Increases in opioid use, emergency medical services (EMS) runs for opioid-related overdoses, and opioid overdose deaths have been reported. No study has examined changes in multiple naloxone administrations, an indicator of overdose severity, during the COVID-19 pandemic. Objective: This study examines changes in the occurrence of naloxone administrations and multiple naloxone administrations during EMS runs for opioid-related overdoses during the COVID-19 pandemic in Guilford County, North Carolina (NC). Methods: Using a period-over-period approach, we compared the occurrence of opioid-related EMS runs, naloxone administrations, and multiple naloxone administrations during the 29-week period before (September 1, 2019, to March 9, 2020) and after NC's COVID-19 state of emergency declaration (ie, the COVID-19 period of March 10 to September 30, 2020). Furthermore, historical data were used to generate a quasi-control distribution of period-over-period changes to compare the occurrence of each outcome during the COVID-19 period to each 29-week period back to January 1, 2014. Results: All outcomes increased during the COVID-19 period. Compared to the previous 29 weeks, the COVID-19 period experienced increases in the weekly mean number of opioid-related EMS runs (25.6, SD 5.6 vs 18.6, SD 6.6; P<.001), naloxone administrations (22.3, SD 6.2 vs 14.1, SD 6.0; P<.001), and multiple naloxone administrations (5.0, SD 1.9 vs 2.7, SD 1.9; P<.001), corresponding to proportional increases of 37.4\%, 57.8\%, and 84.8\%, respectively. Additionally, the increases during the COVID-19 period were greater than 91\% of all historical 29-week periods analyzed. Conclusions: The occurrence of EMS runs for opioid-related overdoses, naloxone administrations, and multiple naloxone administrations during EMS runs increased during the COVID-19 pandemic in Guilford County, NC. For a host of reasons that need to be explored, the COVID-19 pandemic appears to have exacerbated the opioid crisis. ",
doi="10.2196/29298",
url="https://publichealth.jmir.org/2021/5/e29298",
url="http://www.ncbi.nlm.nih.gov/pubmed/33999828"
}


@Article{info:doi/10.2196/25446,
author="Papautsky, Lerner Elizabeth
and Rice, R. Dylan
and Ghoneima, Hana
and McKowen, W. Anna Laura
and Anderson, Nicholas
and Wootton, R. Angie
and Veldhuis, Cindy",
title="Characterizing Health Care Delays and Interruptions in the United States During the COVID-19 Pandemic: Internet-Based, Cross-sectional Survey Study",
journal="J Med Internet Res",
year="2021",
month="May",
day="19",
volume="23",
number="5",
pages="e25446",
keywords="COVID-19",
keywords="health care delays",
keywords="internet survey",
keywords="preventive care",
keywords="delay",
keywords="interruption",
keywords="lockdown",
keywords="precaution",
keywords="prevention",
keywords="social media",
keywords="survey",
abstract="Background: The COVID-19 pandemic has broader geographic spread and potentially longer lasting effects than those of previous disasters. Necessary preventive precautions for the transmission of COVID-19 has resulted in delays for in-person health care services, especially at the outset of the pandemic. Objective: Among a US sample, we examined the rates of delays (defined as cancellations and postponements) in health care at the outset of the pandemic and characterized the reasons for such delays. Methods: As part of an internet-based survey that was distributed on social media in April 2020, we asked a US--based convenience sample of 2570 participants about delays in their health care resulting from the COVID-19 pandemic. Participant demographics and self-reported worries about general health and the COVID-19 pandemic were explored as potent determinants of health care delays. In addition to all delays, we focused on the following three main types of delays, which were the primary outcomes in this study: dental, preventive, and diagnostic care delays. For each outcome, we used bivariate statistical tests (t tests and chi-square tests) and multiple logistic regression models to determine which factors were associated with health care delays. Results: The top reported barrier to receiving health care was the fear of SARS-CoV-2 infection (126/374, 33.6\%). Almost half (1227/2570, 47.7\%) of the participants reported experiencing health care delays. Among those who experienced health care delays and further clarified the type of delay they experienced (921/1227, 75.1\%), the top three reported types of care that were affected by delays included dental (351/921, 38.1\%), preventive (269/921, 29.2\%), and diagnostic (151/921, 16.4\%) care. The logistic regression models showed that age (P<.001), gender identity (P<.001), education (P=.007), and self-reported worry about general health (P<.001) were significantly associated with experiencing health care delays. Self-reported worry about general health was negatively related to experiencing delays in dental care. However, this predictor was positively associated with delays in diagnostic testing based on the logistic regression model. Additionally, age was positively associated with delays in diagnostic testing. No factors remained significant in the multiple logistic regression for delays in preventive care, and although there was trend between race and delays (people of color experienced fewer delays than White participants), it was not significant (P=.06). Conclusions: The lessons learned from the initial surge of COVID-19 cases can inform systemic mitigation strategies for potential future disruptions. This study addresses the demand side of health care delays by exploring the determinants of such delays. More research on health care delays during the pandemic is needed, including research on their short- and long-term impacts on patient-level outcomes such as mortality, morbidity, mental health, people's quality of life, and the experience of pain. ",
doi="10.2196/25446",
url="https://www.jmir.org/2021/5/e25446",
url="http://www.ncbi.nlm.nih.gov/pubmed/33886489"
}


@Article{info:doi/10.2196/23479,
author="Fadahunsi, Philip Kayode
and O'Connor, Siobhan
and Akinlua, Tosin James
and Wark, A. Petra
and Gallagher, Joseph
and Carroll, Christopher
and Car, Josip
and Majeed, Azeem
and O'Donoghue, John",
title="Information Quality Frameworks for Digital Health Technologies: Systematic Review",
journal="J Med Internet Res",
year="2021",
month="May",
day="17",
volume="23",
number="5",
pages="e23479",
keywords="digital health",
keywords="patient safety",
keywords="information quality",
abstract="Background: Digital health technologies (DHTs) generate a large volume of information used in health care for administrative, educational, research, and clinical purposes. The clinical use of digital information for diagnostic, therapeutic, and prognostic purposes has multiple patient safety problems, some of which result from poor information quality (IQ). Objective: This systematic review aims to synthesize an IQ framework that could be used to evaluate the extent to which digital health information is fit for clinical purposes. Methods: The review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We searched Embase, MEDLINE, PubMed, CINAHL, Maternity and Infant Care, PsycINFO, Global Health, ProQuest Dissertations and Theses Global, Scopus, and HMIC (the Health Management Information Consortium) from inception until October 2019. Multidimensional IQ frameworks for assessing DHTs used in the clinical context by health care professionals were included. A thematic synthesis approach was used to synthesize the Clinical Information Quality (CLIQ) framework for digital health. Results: We identified 10 existing IQ frameworks from which we developed the CLIQ framework for digital health with 13 unique dimensions: accessibility, completeness, portability, security, timeliness, accuracy, interpretability, plausibility, provenance, relevance, conformance, consistency, and maintainability, which were categorized into 3 meaningful categories: availability, informativeness, and usability. Conclusions: This systematic review highlights the importance of the IQ of DHTs and its relevance to patient safety. The CLIQ framework for digital health will be useful in evaluating and conceptualizing IQ issues associated with digital health, thus forestalling potential patient safety problems. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42018097142; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=97142 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-024722 ",
doi="10.2196/23479",
url="https://www.jmir.org/2021/5/e23479",
url="http://www.ncbi.nlm.nih.gov/pubmed/33835034"
}


@Article{info:doi/10.2196/27180,
author="Tossaint-Schoenmakers, Rosian
and Versluis, Anke
and Chavannes, Niels
and Talboom-Kamp, Esther
and Kasteleyn, Marise",
title="The Challenge of Integrating eHealth Into Health Care: Systematic Literature Review of the Donabedian Model of Structure, Process, and Outcome",
journal="J Med Internet Res",
year="2021",
month="May",
day="10",
volume="23",
number="5",
pages="e27180",
keywords="eHealth",
keywords="digital health",
keywords="blended care",
keywords="quality",
keywords="integration",
keywords="health care organization",
keywords="structure",
keywords="process",
keywords="outcome",
abstract="Background: Health care organizations are increasingly working with eHealth. However, the integration of eHealth into regular health care is challenging. It requires organizations to change the way they work and their structure and care processes to be adapted to ensure that eHealth supports the attainment of the desired outcomes. Objective: The aims of this study are to investigate whether there are identifiable indicators in the structure, process, and outcome categories that are related to the successful integration of eHealth in regular health care, as well as to investigate which indicators of structure and process are related to outcome indicators. Methods: A systematic literature review was conducted using the Donabedian Structure-Process-Outcome (SPO) framework to identify indicators that are related to the integration of eHealth into health care organizations. Data extraction sheets were designed to provide an overview of the study characteristics, eHealth characteristics, and indicators. The extracted indicators were organized into themes and subthemes of the structure, process, and outcome categories. Results: Eleven studies were included, covering a variety of study designs, diseases, and eHealth tools. All studies identified structure, process, and outcome indicators that were potentially related to the integration of eHealth. The number of indicators found in the structure, process, and outcome categories was 175, 84, and 88, respectively. The themes with the most-noted indicators and their mutual interaction were inner setting (51 indicators, 16 interactions), care receiver (40 indicators, 11 interactions), and technology (38 indicators, 12 interactions)---all within the structure category; health care actions (38 indicators, 15 interactions) within the process category; and efficiency (30 indicators, 15 interactions) within the outcome category. In-depth examination identified four most-reported indicators, namely ``deployment of human resources'' (n=11), in the inner setting theme within the structure category; ``ease of use'' (n=16) and ``technical issue'' (n=10), both in the technology theme within the structure category; and ``health logistics'' (n=26), in the efficiency theme within the outcome category. Conclusions: Three principles are important for the successful integration of eHealth into health care. First, the role of the care receiver needs to be incorporated into the organizational structure and daily care process. Second, the technology must be well attuned to the organizational structure and daily care process. Third, the deployment of human resources to the daily care processes needs to be aligned with the desired end results. Not adhering to these points could negatively affect the organization, daily process, or the end results. ",
doi="10.2196/27180",
url="https://www.jmir.org/2021/5/e27180",
url="http://www.ncbi.nlm.nih.gov/pubmed/33970123"
}


@Article{info:doi/10.2196/26616,
author="Yang, Yuan-Chi
and Al-Garadi, Ali Mohammed
and Bremer, Whitney
and Zhu, M. Jane
and Grande, David
and Sarker, Abeed",
title="Developing an Automatic System for Classifying Chatter About Health Services on Twitter: Case Study for Medicaid",
journal="J Med Internet Res",
year="2021",
month="May",
day="3",
volume="23",
number="5",
pages="e26616",
keywords="natural language processing",
keywords="machine learning",
keywords="Twitter",
keywords="infodemiology",
keywords="infoveillance",
keywords="social media",
keywords="Medicaid",
keywords="consumer feedback",
abstract="Background: The wide adoption of social media in daily life renders it a rich and effective resource for conducting near real-time assessments of consumers' perceptions of health services. However, its use in these assessments can be challenging because of the vast amount of data and the diversity of content in social media chatter. Objective: This study aims to develop and evaluate an automatic system involving natural language processing and machine learning to automatically characterize user-posted Twitter data about health services using Medicaid, the single largest source of health coverage in the United States, as an example. Methods: We collected data from Twitter in two ways: via the public streaming application programming interface using Medicaid-related keywords (Corpus 1) and by using the website's search option for tweets mentioning agency-specific handles (Corpus 2). We manually labeled a sample of tweets in 5 predetermined categories or other and artificially increased the number of training posts from specific low-frequency categories. Using the manually labeled data, we trained and evaluated several supervised learning algorithms, including support vector machine, random forest (RF), na{\"i}ve Bayes, shallow neural network (NN), k-nearest neighbor, bidirectional long short-term memory, and bidirectional encoder representations from transformers (BERT). We then applied the best-performing classifier to the collected tweets for postclassification analyses to assess the utility of our methods. Results: We manually annotated 11,379 tweets (Corpus 1: 9179; Corpus 2: 2200) and used 7930 (69.7\%) for training, 1449 (12.7\%) for validation, and 2000 (17.6\%) for testing. A classifier based on BERT obtained the highest accuracies (81.7\%, Corpus 1; 80.7\%, Corpus 2) and F1 scores on consumer feedback (0.58, Corpus 1; 0.90, Corpus 2), outperforming the second best classifiers in terms of accuracy (74.6\%, RF on Corpus 1; 69.4\%, RF on Corpus 2) and F1 score on consumer feedback (0.44, NN on Corpus 1; 0.82, RF on Corpus 2). Postclassification analyses revealed differing intercorpora distributions of tweet categories, with political (400778/628411, 63.78\%) and consumer feedback (15073/27337, 55.14\%) tweets being the most frequent for Corpus 1 and Corpus 2, respectively. Conclusions: The broad and variable content of Medicaid-related tweets necessitates automatic categorization to identify topic-relevant posts. Our proposed system presents a feasible solution for automatic categorization and can be deployed and generalized for health service programs other than Medicaid. Annotated data and methods are available for future studies. ",
doi="10.2196/26616",
url="https://www.jmir.org/2021/5/e26616",
url="http://www.ncbi.nlm.nih.gov/pubmed/33938807"
}


@Article{info:doi/10.2196/22975,
author="Yan, Qi
and Jensen, J. Katherine
and Thomas, Rose
and Field, R. Alyssa
and Jiang, Zheng
and Goei, Christian
and Davies, G. Mark",
title="Digital Footprint of Academic Vascular Surgeons in the Southern United States on Physician Rating Websites: Cross-sectional Evaluation Study",
journal="JMIR Cardio",
year="2021",
month="Feb",
day="24",
volume="5",
number="1",
pages="e22975",
keywords="internet",
keywords="patient satisfaction",
keywords="quality of care",
keywords="physician rating sites",
keywords="patient experience",
keywords="professional reviews",
keywords="social media",
abstract="Background: The internet has become a popular platform for patients to obtain information and to review the health care providers they interact with. However, little is known about the digital footprint of vascular surgeons and their interactions with patients on social media. Objective: This study aims to understand the activity of academic vascular surgeons on physician rating websites. Methods: Information on attending vascular surgeons affiliated with vascular residency or with fellowships in the Southern Association for Vascular Surgery (SAVS) was collected from public sources. A listing of websites containing physician ratings was obtained via literature reviews and Google search. Open access websites with either qualitative or quantitative evaluations of vascular surgeons were included. Closed access websites were excluded. Ranking scores from each website were converted to a standard 5-point scale for comparison. Results: A total of 6238 quantitative and 967 qualitative reviews were written for 287 physicians (236 males, 82.2\%) across 16 websites that met the inclusion criteria out of the 62 websites screened. The surgeons affiliated with the integrated vascular residency and vascular fellowship programs in SAVS had a median of 8 (IQR 7-10) profiles across 16 websites, with only 1 surgeon having no web presence in any of the websites. The median number of quantitative ratings for each physician was 17 (IQR 6-34, range 1-137) and the median number of narrative reviews was 3 (IQR 2-6, range 1-28). Vitals, WebMD, and Healthgrades were the only 3 websites where over a quarter of the physicians were rated, and those rated had more than 5 ratings on average. The median score for the quantitative reviews was 4.4 (IQR 4.0-4.9). Most narrative reviews (758/967, 78.4\%) were positive, but 20.2\% (195/967) were considered negative; only 1.4\% (14/967) were considered equivocal. No statistical difference was found in the number of quantitative reviews or in the overall average score in the physician ratings between physicians with social media profiles and those without social media profiles (departmental social media profile: median 23 vs 15, respectively, P=.22; personal social media profile: median 19 vs 14, respectively, P=.08). Conclusions: The representation of vascular surgeons on physician rating websites is varied, with the majority of the vascular surgeons represented only in half of the physician rating websites The number of quantitative and qualitative reviews for academic vascular surgeons is low. No vascular surgeon responded to any of the reviews. The activity of vascular surgeons in this area of social media is low and reflects only a small digital footprint that patients can reach and review. ",
doi="10.2196/22975",
url="https://cardio.jmir.org/2021/1/e22975",
url="http://www.ncbi.nlm.nih.gov/pubmed/33625359"
}


@Article{info:doi/10.2196/25619,
author="Berthelot, Simon
and Breton, Mylaine
and Guertin, Robert Jason
and Archambault, Michel Patrick
and Berger Pelletier, Elyse
and Blouin, Danielle
and Borgundvaag, Bjug
and Duhoux, Arnaud
and Harvey Labb{\'e}, Laurie
and Laberge, Maude
and Lachapelle, Philippe
and Lapointe-Shaw, Lauren
and Layani, G{\'e}raldine
and Lefebvre, Gabrielle
and Mallet, Myriam
and Matthews, Deborah
and McBrien, Kerry
and McLeod, Shelley
and Mercier, Eric
and Messier, Alexandre
and Moore, Lynne
and Morris, Judy
and Morris, Kathleen
and Ovens, Howard
and Pageau, Paul
and Paquette, Jean-S{\'e}bastien
and Perry, Jeffrey
and Schull, Michael
and Simon, Mathieu
and Simonyan, David
and Stelfox, Thomas Henry
and Talbot, Denis
and Vaillancourt, Samuel",
title="A Value-Based Comparison of the Management of Ambulatory Respiratory Diseases in Walk-in Clinics, Primary Care Practices, and Emergency Departments: Protocol for a Multicenter Prospective Cohort Study",
journal="JMIR Res Protoc",
year="2021",
month="Feb",
day="22",
volume="10",
number="2",
pages="e25619",
keywords="emergency department",
keywords="primary care",
keywords="walk-in clinic",
keywords="health economics",
keywords="quality of care",
keywords="patient preferences",
keywords="patient-reported outcomes",
keywords="outcome assessment, health care",
abstract="Background: In Canada, 30\%-60\% of patients presenting to emergency departments are ambulatory. This category has been labeled as a source of emergency department overuse. Acting on the presumption that primary care practices and walk-in clinics offer equivalent care at a lower cost, governments have invested massively in improving access to these alternative settings in the hope that patients would present there instead when possible, thereby reducing the load on emergency departments. Data in support of this approach remain scarce and equivocal. Objective: The aim of this study is to compare the value of care received in emergency departments, walk-in clinics, and primary care practices by ambulatory patients with upper respiratory tract infection, sinusitis, otitis media, tonsillitis, pharyngitis, bronchitis, influenza-like illness, pneumonia, acute asthma, or acute exacerbation of chronic obstructive pulmonary disease. Methods: A multicenter prospective cohort study will be performed in Ontario and Qu{\'e}bec. In phase 1, a time-driven activity-based costing method will be applied at each of the 15 study sites. This method uses time as a cost driver to allocate direct costs (eg, medication), consumable expenditures (eg, needles), overhead costs (eg, building maintenance), and physician charges to patient care. Thus, the cost of a care episode will be proportional to the time spent receiving the care. At the end of this phase, a list of care process costs will be generated and used to calculate the cost of each consultation during phase 2, in which a prospective cohort of patients will be monitored to compare the care received in each setting. Patients aged 18 years and older, ambulatory throughout the care episode, and discharged to home with one of the aforementioned targeted diagnoses will be considered. The estimated sample size is 1485 patients. The 3 types of care settings will be compared on the basis of primary outcomes in terms of the proportion of return visits to any site 3 and 7 days after the initial visit and the mean cost of care. The secondary outcomes measured will include scores on patient-reported outcome and experience measures and mean costs borne wholly by patients. We will use multilevel generalized linear models to compare the care settings and an overlap weights approach to adjust for confounding factors related to age, sex, gender, ethnicity, comorbidities, registration with a family physician, socioeconomic status, and severity of illness. Results: Phase 1 will begin in 2021 and phase 2, in 2023. The results will be available in 2025. Conclusions: The end point of our program will be for deciders, patients, and care providers to be able to determine the most appropriate care setting for the management of ambulatory emergency respiratory conditions, based on the quality and cost of care associated with each alternative. International Registered Report Identifier (IRRID): PRR1-10.2196/25619 ",
doi="10.2196/25619",
url="https://www.researchprotocols.org/2021/2/e25619",
url="http://www.ncbi.nlm.nih.gov/pubmed/33616548"
}


@Article{info:doi/10.2196/25809,
author="Yang, Xin
and Yang, Ning
and Lewis, Dwight
and Parton, Jason
and Hudnall, Matthew",
title="Patterns and Influencing Factors of eHealth Tools Adoption Among Medicaid and Non-Medicaid Populations From the Health Information National Trends Survey (HINTS) 2017-2019: Questionnaire Study",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="18",
volume="23",
number="2",
pages="e25809",
keywords="Medicaid program",
keywords="eHealth",
keywords="internet access",
keywords="digital divide",
keywords="health information technology",
abstract="Background: Evidence suggests that eHealth tools adoption is associated with better health outcomes among various populations. The patterns and factors influencing eHealth adoption among the US Medicaid population remain obscure. Objective: The objective of this study is to explore patterns of eHealth tools adoption among the Medicaid population and examine factors associated with eHealth adoption. Methods: Data from the Health Information National Trends Survey from 2017 to 2019 were used to estimate the patterns of eHealth tools adoption among Medicaid and non-Medicaid populations. The effects of Medicaid insurance status and other influencing factors were assessed with logistic regression models. Results: Compared with the non-Medicaid population, the Medicaid beneficiaries had significantly lower eHealth tools adoption rates for health information management (11.2\% to 17.5\% less) and mobile health for self-regulation (0.8\% to 9.7\% less). Conversely, the Medicaid population had significantly higher adoption rates for using social media for health information than their counterpart (8\% higher in 2018, P=.01; 10.1\% higher in 2019, P=.01). Internet access diversity, education, and cardiovascular diseases were positively associated with health information management and mobile health for self-regulation among the Medicaid population. Internet access diversity is the only factor significantly associated with social media adoption for acquisition of health information (OR 1.98, 95\% CI 1.26-3.11). Conclusions: Our results suggest digital disparities in eHealth tools adoption between the Medicaid and non-Medicaid populations. Future research should investigate behavioral correlates and develop interventions to improve eHealth adoption and use among underserved communities. ",
doi="10.2196/25809",
url="http://www.jmir.org/2021/2/e25809/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33599619"
}


@Article{info:doi/10.2196/25074,
author="Singh, Aniruddha
and Mountjoy, Natalie
and McElroy, Doug
and Mittal, Shilpi
and Al Hemyari, Bashar
and Coffey, Nicholas
and Miller, Kristen
and Gaines, Kenneth",
title="Patient Perspectives With Telehealth Visits in Cardiology During COVID-19: Online Patient Survey Study",
journal="JMIR Cardio",
year="2021",
month="Jan",
day="22",
volume="5",
number="1",
pages="e25074",
keywords="COVID-19",
keywords="telehealth",
keywords="cardiology",
keywords="internet",
keywords="broadband",
keywords="patient satisfaction",
keywords="restriction",
keywords="survey",
abstract="Background: The rise of COVID-19 and the issue of a mandatory stay-at-home order in March 2020 led to the use of a direct-to-consumer model for cardiology telehealth in Kentucky. Kentucky has poor health outcomes and limited broadband connectivity. Given these and other practice-specific constraints, the region serves as a unique context to explore the efficacy of telehealth in cardiology. Objective: This study aims to determine the limitations of telehealth accessibility, patient satisfaction with telehealth relative to in-person visits, and the perceived advantages and disadvantages to telehealth. Our intent was two-fold. First, we wanted to conduct a rapid postassessment of the mandated overhaul of the health care delivery system, focusing on a representative specialty field, and how it was affecting patients. Second, we intend to use our findings to make suggestions about the future application of a telehealth model in specialty fields such as cardiology. Methods: We constructed an online survey in Qualtrics following the Patient Assessment of Communication During Telemedicine, a patient self-report questionnaire that has been previously developed and validated. We invited all patients who had a visit scheduled during the COVID-19 telehealth-only time frame to participate. Questions included factors for declining telehealth, patient satisfaction ratings of telehealth and in-person visits, and perceived advantages and disadvantages associated with telehealth. We also used electronic medical records to collect no-show data for in-person versus telehealth visits to check for nonresponse bias. Results: A total of 224 respondents began our survey (11\% of our sample of 2019 patients). Our recruitment rate was 86\% (n=193) and our completion rate was 62\% (n=120). The no-show rate for telehealth visits (345/2019, 17\%) was nearly identical to the typical no-show rate for in-person appointments. Among the 32 respondents who declined a telehealth visit, 20 (63\%) cited not being aware of their appointment as a primary factor, and 15 (47\%) respondents cited their opinion that a telehealth appointment was not medically necessary as at least somewhat of a factor in their decision. Both in-person and telehealth were viewed favorably, but in-person was rated higher across all domains of patient satisfaction. The only significantly lower mean score for telehealth (3.7 vs 4.2, P=.007) was in the clinical competence domain. Reduced travel time, lower visit wait time, and cost savings were seen as big advantages. Poor internet connectivity was rated as at least somewhat of a factor by 33.0\% (35/106) of respondents. Conclusions: This study takes advantage of the natural experiment provided by the COVID-19 pandemic to assess the efficacy of telehealth in cardiology. Patterns of satisfaction are consistent across modalities and show that telehealth appears to be a viable alternative to in-person appointments. However, we found evidence that scheduling of telehealth visits may be problematic and needs additional attention. Additionally, we include a note of caution that patient satisfaction with telehealth may be artificially inflated during COVID-19 due to external health concerns connected with in-person visits. ",
doi="10.2196/25074",
url="http://cardio.jmir.org/2021/1/e25074/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33385234"
}


@Article{info:doi/10.2196/22135,
author="de Batlle, Jordi
and Massip, Mireia
and Vargiu, Eloisa
and Nadal, Nuria
and Fuentes, Araceli
and Ortega Bravo, Marta
and Miralles, Felip
and Barb{\'e}, Ferran
and Torres, Gerard
and ",
title="Implementing Mobile Health--Enabled Integrated Care for Complex Chronic Patients: Intervention Effectiveness and Cost-Effectiveness Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jan",
day="14",
volume="9",
number="1",
pages="e22135",
keywords="chronic disease",
keywords="cost-benefit analysis",
keywords="delivery of health care, integrated",
keywords="mHealth",
keywords="eHealth",
keywords="quality of life",
abstract="Background: Integrated care can generate health and social care efficiencies through the defragmentation of care and adoption of patient-centered preventive models. eHealth can be a key enabling technology for integrated care. Objective: The aim of this study was to assess the effectiveness and cost-effectiveness of the implementation of a mobile health (mHealth)-enabled integrated care model for complex chronic patients. Methods: As part of the CONNECARE Horizon 2020 project, a prospective, pragmatic, two-arm, parallel implementation trial was held in a rural region of Catalonia, Spain. During 3 months, elderly patients with chronic obstructive pulmonary disease or heart failure and their carers experienced the combined benefits of the CONNECARE organizational integrated care model and the eHealth platform supporting it, consisting of a patient self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care. We assessed changes in health status with the 12-Item Short-Form Survey (SF-12), unplanned visits and admissions during a 6-month follow up, and the incremental cost-effectiveness ratio (ICER). Results: A total of 48 patients were included in the integrated care arm and 28 patients receiving usual care were included in the control arm (mean age 82 years, SD 7 years; mean Charlson index 7, SD 2). Integrated care patients showed a significant increase in the SF-12 physical domain with a mean change of +3.7 (SD 8.4) (P=.004) and total SF-12 score with a mean change of +5.8 (SD 12.8) (P=.003); however, the differences in differences between groups were not statistically significant. Integrated care patients had 57\% less unplanned visits (P=.004) and 50\% less hospital admissions related to their main chronic diseases (P=.32). The integrated care program generated savings in different cost scenarios and the ICER demonstrated the cost-effectiveness of the program. Conclusions: The implementation of a patient-centered mHealth-enabled integrated care model empowering the patient, and connecting primary, hospital, and social care professionals reduced unplanned contacts with the health system and health costs, and was cost-effective. These findings support the notion of system-wide cross-organizational care pathways supported by mHealth as a successful way to implement integrated care. ",
doi="10.2196/22135",
url="https://mhealth.jmir.org/2021/1/e22135",
url="http://www.ncbi.nlm.nih.gov/pubmed/33443486"
}


@Article{info:doi/10.2196/24569,
author="Ghanbari, Khaton Mahboubeh
and Behzadifar, Masoud
and Doshmangir, Leila
and Martini, Mariano
and Bakhtiari, Ahad
and Alikhani, Mahtab
and Bragazzi, Luigi Nicola",
title="Mapping Research Trends of Universal Health Coverage From 1990 to 2019: Bibliometric Analysis",
journal="JMIR Public Health Surveill",
year="2021",
month="Jan",
day="11",
volume="7",
number="1",
pages="e24569",
keywords="bibliometrics",
keywords="scientometrics",
keywords="universal health coverage",
keywords="universal health",
keywords="health coverage",
keywords="developing countries",
keywords="low-income countries",
abstract="Background: Universal health coverage (UHC) is one of many ambitious, health-related, sustainable development goals. Sharing various experiences of achieving UHC, in terms of challenges, pitfalls, and future prospects, can help policy and decision-makers reduce the likelihood of committing errors. As such, scholarly articles and technical reports are of paramount importance in shedding light on the determinants that make it possible to achieve UHC. Objective: The purpose of this study is to conduct a comprehensive analysis of UHC-related scientific literature from 1990 to 2019. Methods: We carried out a bibliometric analysis of papers related to UHC published from January 1990 to September 2019 and indexed in Scopus via VOSviewer (version 1.6.13; CWTS). Relevant information was extracted: the number of papers published, the 20 authors with the highest number of publications in the field of UHC, the 20 journals with the highest number of publications related to UHC, the 20 most active funding sources for UHC-related research, the 20 institutes and research centers that have produced the highest number of UHC-related research papers, the 20 countries that contributed the most to the research field of UHC, the 20 most cited papers, and the latest available impact factors of journals in 2018 that included the UHC-related items under investigation. Results: In our analysis, 7224 articles were included. The publication trend was increasing, showing high interest in the scientific community. Most researchers were from the United States, the United Kingdom, and Canada, with Thailand being a notable exception. The Lancet accounted for 3.95\% of published UHC-related research. Among the top 20 funding sources, the World Health Organization (WHO), the Bill and Melinda Gates Foundation, and the National Institutes of Health (NIH) accounted for 1.41\%, 1.34\%, and 1.02\% of published UHC-related research, respectively. The highest number of citations was found for articles published in The Lancet, the American Journal of Psychiatry, and the Journal of the American Medical Association (JAMA). The top keywords were ``health insurance,'' ``insurance,'' ``healthcare policy,'' ``healthcare delivery,'' ``economics,'' ``priority,'' ``healthcare cost,'' ``organization and management,'' ``health services accessibility,'' ``reform,'' ``public health,'' and ``health policy.'' Conclusions: The findings of our study showed an increasing scholarly interest in UHC and related issues. However, most research concentrated in middle- and high-income regions and countries. Therefore, research in low-income countries should be promoted and supported, as this could enable a better understanding of the determinants of the barriers and obstacles to UHC achievement and improve global health. ",
doi="10.2196/24569",
url="http://publichealth.jmir.org/2021/1/e24569/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33427687"
}


@Article{info:doi/10.2196/20629,
author="Yu, Qiao
and Zhu, Chunpeng
and Feng, Shuyi
and Xu, Liyi
and Hu, Shurong
and Chen, Hao
and Chen, Hanwen
and Yao, Sheng
and Wang, Xiaoying
and Chen, Yan",
title="Economic Burden and Health Care Access for Patients With Inflammatory Bowel Diseases in China: Web-Based Survey Study",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="5",
volume="23",
number="1",
pages="e20629",
keywords="inflammatory bowel disease",
keywords="Crohn disease",
keywords="ulcerative colitis",
keywords="primary care provider",
keywords="emergency room",
keywords="eHealth",
keywords="gastroenterology",
keywords="proctology",
abstract="Background: The increasing incidence of inflammatory bowel disease (IBD) has imposed heavy financial burdens for Chinese patients; however, data about their financial status and access to health care are still lacking. This information is important for informing patients with IBD about disease treatment budgets and health care strategies. Objective: The aim of this study was to evaluate the economic status and medical care access of patients with IBD through the China Crohn's \& Colitis Foundation web-based platform in China. Methods: Our study was performed in 14 IBD centers in mainland China between 2018 and 2019 through WeChat. Participants were asked to complete a 64-item web-based questionnaire. Data were collected by the Wenjuanxing survey program. We mainly focused on income and insurance status, medical costs, and access to health care providers. Respondents were stratified by income and the associations of income with medical costs and emergency visit times were analyzed. Results: In this study, 3000 patients with IBD, that is, 1922 patients with Crohn disease, 973 patients with ulcerative colitis, and 105 patients with undetermined colitis were included. During the last 12 months, the mean (SD) direct and indirect costs for per patient with IBD were approximately US \$11,668.68 (\$7944.44) and US \$74.90 (\$253.60) in China. The average reimbursement ratios for most outpatient and inpatient costs were less than 50\%. However, the income of 85.5\% (2565/3000) of the patients was less than {\textyen}10,000 (US \$1445) per month. Approximately 96.5\% (2894/3000) of the patients were covered by health insurance, but only 24.7\% (741/3000) of the patients had private commercial insurance, which has higher imbursement ratios. Nearly 98.0\% (2954/3000) of the patients worried about their financial situation. Thus, 79.7\% (2392/3000) of the patients with IBD tried to save money for health care and even delayed their medical treatments. About half of the respondents (1282/3000, 42.7\%) had no primary care provider, and 52.2\% (1567/3000) of the patients had to visit the emergency room 1-4 times per year for the treatment of their IBD. Multivariate analysis revealed that lower income (P=.001) and higher transportation (P=.004) and accommodation costs (P=.001) were significantly associated with the increased number of emergency visits of the patients. Conclusions: Chinese patients with IBD have enormous financial burdens and difficulties in accessing health care, which have increased their financial anxiety and inevitably influenced their disease outcomes. Early purchase of private insurance, thereby increasing the reimbursement ratio for medical expenses, and developing the use of telemedicine would be effective strategies for saving on health care costs. ",
doi="10.2196/20629",
url="https://www.jmir.org/2021/1/e20629",
url="http://www.ncbi.nlm.nih.gov/pubmed/33399540"
}


@Article{info:doi/10.2196/17928,
author="Patel, T. Atul
and Wein, Theodore
and Bahroo, B. Laxman
and Wilczynski, Oph{\'e}lie
and Rios, D. Carl
and Murie-Fern{\'a}ndez, Manuel",
title="Perspective of an International Online Patient and Caregiver Community on the Burden of Spasticity and Impact of Botulinum Neurotoxin Therapy: Survey Study",
journal="JMIR Public Health Surveill",
year="2020",
month="Dec",
day="7",
volume="6",
number="4",
pages="e17928",
keywords="spasticity",
keywords="activities of daily living",
keywords="quality of life",
keywords="survey methodology",
abstract="Background: Patient- and caregiver-reported data are lacking on the burden of spasticity, and the impact of botulinum neurotoxin type A (BoNT-A) treatment for this condition, on patients' daily lives. As recommended in recent guidance from the US Food and Drug Administration, online patient communities can represent a platform from which to gather specific information outside of a clinical trial setting on the burden of conditions experienced by patients and caregivers and their views on treatment options in order to inform evidence-based medicine and drug development. Objective: The objective of our study is to characterize spasticity symptoms and their associated burdens on Western European and US patients and caregivers in the realms of work, daily activities, quality of life (QoL), as well as the positive and negative impacts of treatment with BoNT-A (cost, time, QoL) using Carenity, an international online community for people with chronic health conditions. Methods: We performed a noninterventional, multinational survey. Eligible participants were 18 years old or older and had, or had cared for, someone with spasticity who had been treated with BoNT-A for at least 1 year. Patients and caregivers were asked to complete an internet-based survey via Carenity; caregivers reported their own answers and answered on behalf of their patients. Questions included the burden of spasticity on the ability to work, functioning, daily-living activities, and QoL, the impact of BoNT A therapy on patients' lives, and the potential benefits of fewer injections. Results: There were 615 respondents (427 patients and 188 caregivers). The mean age of patients and caregivers was 41.7 years and 38.6 years, respectively, and the most commonly reported cause of spasticity was multiple sclerosis. Caregivers were most often the parents (76/188, 40\%) or another family member (51/188, 27\%) of their patients. Spasticity had a clear impact on patients' and caregivers' lives, including the ability to work and injection costs. For patients, spasticity caused difficulties with activities of daily living and reduced QoL indices. The median number of BoNT-A injections was 4 times per year, and 92\% (393/427) of patients reported that treatment improved their overall satisfaction with life. Regarding the BoNT-A injection burden, the greatest patient-reported challenges were the cost and availability of timely appointments. Overall, 86\% (368/427) of patients believed that a reduced injection frequency would be beneficial. Caregivers answering for their patients gave largely similar responses to those reported by patients. Conclusions: Spasticity has a negative impact on both patients' and caregivers' lives. All respondents reported that BoNT A treatment improved their lives, despite the associated challenges. Patients believed that reducing the frequency of BoNT-A injections could alleviate practical issues associated with treatment, implying that a longer-acting BoNT-A injection would be well received. ",
doi="10.2196/17928",
url="http://publichealth.jmir.org/2020/4/e17928/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33284124"
}


@Article{info:doi/10.2196/17595,
author="Sharma, Estelle Anjana
and Mann, Ziva
and Cherian, Roy
and Del Rosario, Bing Jan
and Yang, Janine
and Sarkar, Urmimala",
title="Recommendations From the Twitter Hashtag \#DoctorsAreDickheads: Qualitative Analysis",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="28",
volume="22",
number="10",
pages="e17595",
keywords="social media",
keywords="patient engagement",
keywords="Twitter messaging",
keywords="missed diagnosis",
keywords="internet",
keywords="physician patient relationship",
abstract="Background: The social media site Twitter has 145 million daily active users worldwide and has become a popular forum for users to communicate their health care concerns and experiences as patients. In the fall of 2018, a hashtag titled \#DoctorsAreDickheads emerged, with almost 40,000 posts calling attention to health care experiences. Objective: This study aims to identify common health care conditions and conceptual themes represented within the phenomenon of this viral Twitter hashtag. Methods: We analyzed a random sample of 5.67\% (500/8818) available tweets for qualitative analysis between October 15 and December 31, 2018, when the hashtag was the most active. Team coders reviewed the same 20.0\% (100/500) tweets and the remainder individually. We abstracted the user's health care role and clinical conditions from the tweet and user profile, and used phenomenological content analysis to identify prevalent conceptual themes through sequential open coding, memoing, and discussion of concepts until an agreement was reached. Results: Our final sample comprised 491 tweets and unique Twitter users. Of this sample, 50.5\% (248/491) were from patients or patient advocates, 9.6\% (47/491) from health care professionals, 4.3\% (21/491) from caregivers, 3.7\% (18/491) from academics or researchers, 1.0\% (5/491) from journalists or media, and 31.6\% (155/491) from non--health care individuals or other. The most commonly mentioned clinical conditions were chronic pain, mental health, and musculoskeletal conditions (mainly Ehlers-Danlos syndrome). We identified 3 major themes: disbelief in patients' experience and knowledge that contributes to medical errors and harm, the power inequity between patients and providers, and metacommentary on the meaning and impact of the \#DoctorsAreDickheads hashtag. Conclusions: People publicly disclose personal and often troubling health care experiences on Twitter. This adds new accountability for the patient-provider interaction, highlights how harmful communication affects diagnostic safety, and shapes the public's viewpoint of how clinicians behave. Hashtags such as this offer valuable opportunities to learn from patient experiences. Recommendations include developing best practices for providers to improve communication, supporting patients through challenging diagnoses, and promoting patient engagement. ",
doi="10.2196/17595",
url="http://www.jmir.org/2020/10/e17595/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33112246"
}


@Article{info:doi/10.2196/21057,
author="Bidmon, Sonja
and Elshiewy, Ossama
and Terlutter, Ralf
and Boztug, Yasemin",
title="Authors' Reply to: Is a Ratio Scale Assumption for Physician Ratings Justified? Comment on ``What Patients Value in Physicians: Analyzing Drivers of Patient Satisfaction Using Physician-Rating Website Data''",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="26",
volume="22",
number="10",
pages="e21057",
keywords="online physician ratings",
keywords="patient satisfaction",
keywords="multiattribute models",
keywords="health care management",
doi="10.2196/21057",
url="https://www.jmir.org/2020/10/e21057",
url="http://www.ncbi.nlm.nih.gov/pubmed/33104006"
}


@Article{info:doi/10.2196/18289,
author="Konerding, Uwe",
title="Is a Ratio Scale Assumption for Physician Ratings Justified? Comment on ``What Patients Value in Physicians: Analyzing Drivers of Patient Satisfaction Using Physician-Rating Website Data''",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="26",
volume="22",
number="10",
pages="e18289",
keywords="patient satisfaction",
keywords="modeling",
keywords="method",
keywords="scale level",
keywords="measurement theory",
doi="10.2196/18289",
url="http://www.jmir.org/2020/10/e18289/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33104009"
}


@Article{info:doi/10.2196/18200,
author="Poss-Doering, Regina
and Kuehn, Lukas
and Kamradt, Martina
and Glassen, Katharina
and Wensing, Michel",
title="Applying Digital Information Delivery to Convert Habits of Antibiotic Use in Primary Care in Germany: Mixed-Methods Study",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="7",
volume="22",
number="10",
pages="e18200",
keywords="antimicrobial resistance",
keywords="educative digital solutions",
keywords="health literacy",
keywords="diffusion of innovations",
abstract="Background: Antimicrobial resistance is an important global health issue. In Germany, the national agenda supports various interventions to convert habits of antibiotic use. In the CHANGE-3 (Converting Habits of Antibiotic Use for Respiratory Tract Infections in German Primary Care) study, digital tools were applied for information delivery: tablet computers in primary care practices, e-learning platforms for medical professionals, and a public website to promote awareness and health literacy among primary care physicians, their teams, and their patients. Objective: This study is embedded in the process evaluation of the CHANGE-3 study. The aim of this study was to evaluate the acceptance and uptake of digital devices for the delivery of health-related information to enhance awareness and change habits of antibiotic use in primary care in Germany. Methods: This study used a convergent-parallel mixed-methods design. Audio-recorded semistructured telephone interviews were conducted with physicians, nonphysician health professionals, and patients in the CHANGE-3 program. Pseudonymized verbatim transcripts were coded using thematic analysis. In-depth analysis was performed based on the inductive category of information provision via digital information tools. Identified themes were related to the main postulates of Diffusion of Innovations theory (DIT) to provide an explanatory frame. In addition, data generated through a structured survey with physicians and nonphysician health professionals in the program were analyzed descriptively and integrated with the qualitative data to explore the complementarity of the findings. Results: Findings regarding the acceptance and uptake of digital devices were related to three postulates of DIT: innovation characteristics, communication channels, and unanticipated consequences. Participants considered the provided digital educative solutions to be supportive for promoting health literacy regarding conversion of habits of antibiotic use. However, health care professionals found it challenging to integrate these solutions into existing routines in primary care and to align them with their professional values. Low technology affinity was a major barrier to the use of digital information in primary care. Patients welcomed the general idea of introducing health-related information in digital formats; however, they expressed concerns about device-related hygiene and the appropriateness of the digital tools for older patients. Conclusions: Patients and medical professionals in German primary care are reluctant to use digital devices for information and education. Using a Diffusion of Innovations approach can support assessment of existing barriers and provide information about setting-specific preconditions that are necessary for future tailoring of implementation strategies. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 15061174; http://www.isrctn.com/ISRCTN15061174. ",
doi="10.2196/18200",
url="http://www.jmir.org/2020/10/e18200/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32960773"
}


@Article{info:doi/10.2196/22146,
author="Garcia-Huidobro, Diego
and Rivera, Solange
and Valderrama Chang, Sebasti{\'a}n
and Bravo, Paula
and Capurro, Daniel",
title="System-Wide Accelerated Implementation of Telemedicine in Response to COVID-19: Mixed Methods Evaluation",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="6",
volume="22",
number="10",
pages="e22146",
keywords="telemedicine",
keywords="telehealth",
keywords="virtual medicine",
keywords="health services evaluation",
keywords="COVID-19",
abstract="Background: As the COVID-19 pandemic disrupted medical practice, telemedicine emerged as an alternative to outpatient visits. However, it is not known how patients and physicians responded to an accelerated implementation of this model of medical care. Objective: The aim of this study is to report the system-wide accelerated implementation of telemedicine, compare patient satisfaction between telemedicine and in-person visits, and report provider perceptions. Methods: This study was conducted at the UC Christus Health Network, a large private academic health network in Santiago, Chile. The satisfaction of patients receiving telemedicine care in March and April 2020 was compared to those receiving in-person care during the same period (concurrent control group) as well as in March and April 2019 (retrospective control group). Patient satisfaction with in-person care was measured using the Net Promoter Score (NPS) survey. Patient satisfaction with telemedicine was assessed with an online survey assessing similar domains. Providers rated their satisfaction and responded to open-ended questions assessing challenges, strategies used to address challenges, the diagnostic process, treatment, and the patient-provider relationship. Results: A total of 3962 patients receiving telemedicine, 1187 patients from the concurrent control group, and 1848 patients from the retrospective control group completed the surveys. Satisfaction was very high with both telemedicine and in-person services. Overall, 263 physicians from over 41 specialties responded to the survey. During telemedicine visits, most providers felt their clinical skills were challenged (61.8\%). Female providers felt more challenged than male providers (70.7\% versus 50.9\%, P=.002). Surgeons, obstetricians, and gynecologists felt their clinical skills were challenged the least, compared to providers from nonsurgical specialties (P<.001). Challenges related to the delivery modality, diagnostic process, and patient-provider relationship differed by provider specialty (P=.046, P<.001, and P=.02, respectively). Conclusions: Telemedicine implemented in response to the COVID-19 pandemic produced high patient and provider satisfaction. Specialty groups perceived the impact of this new mode of clinical practice differently. ",
doi="10.2196/22146",
url="https://www.jmir.org/2020/10/e22146",
url="http://www.ncbi.nlm.nih.gov/pubmed/32903195"
}


@Article{info:doi/10.2196/19198,
author="Serhal, Eva
and Kirvan, Anne
and Sanches, Marcos
and Crawford, Allison",
title="Client Satisfaction and Experience With Telepsychiatry: Development and Validation of a Survey Using Clinical Quality Domains",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="29",
volume="22",
number="9",
pages="e19198",
keywords="telemedicine",
keywords="psychiatry",
keywords="mental health",
keywords="patient satisfaction",
keywords="quality of health care",
abstract="Background: Telepsychiatry is an increasingly used model of mental health care that connects patients with psychiatrists at a distance via videoconference. Telepsychiatry is an effective clinical intervention that improves access to quality care in regions with limited resources or in clinical situations where in-person care is unavailable. Objective: This study aims to develop a validated survey tool to measure patient experience and satisfaction with telepsychiatry based on the quality of care domains. This study also seeks to understand which health service outcomes were most strongly correlated with overall satisfaction in the context of telepsychiatry. Methods: The survey created in this study was developed and validated with a panel of subject matter and process experts and was piloted with 274 patients who received clinical consultations through the TeleMental Health Program at the Centre for Addiction and Mental Health. Factor analysis was used to determine correlations between questions and quality of care domains and was also used to assess model fit. Results: The study provides a validated survey to measure patient satisfaction and experience with telepsychiatry across 4 domains: access and timeliness, appropriateness, effectiveness, and safety. Both safety and access and timeliness were found to be statistically significant predictors of satisfaction in our sample. Conclusions: By situating patient satisfaction and experience within this framework, the survey facilitates patient data collection and interpretation through a clinical quality lens. ",
doi="10.2196/19198",
url="http://www.jmir.org/2020/9/e19198/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32755896"
}


@Article{info:doi/10.2196/20910,
author="Zhang, Shuang
and Wang, Jying-Nan
and Chiu, Ya-Ling
and Hsu, Yuan-Teng",
title="Exploring Types of Information Sources Used When Choosing Doctors: Observational Study in an Online Health Care Community",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="16",
volume="22",
number="9",
pages="e20910",
keywords="information source",
keywords="decision making",
keywords="online reviews",
keywords="online health care community",
keywords="doctor",
keywords="health information",
abstract="Background: Patients attempt to make appropriate decisions based on their own knowledge when choosing a doctor. In this process, the first question usually faced is that of how to obtain useful and relevant information. This study investigated the types of information sources that are used widely by patients in choosing a doctor and identified ways in which the preferred sources differ in various situations. Objective: This study aims to address the following questions: (1) What is the proportion in which each of the various information sources is used? (2) How does the information source preferred by patients in choosing a doctor change when there is a difference in the difficulty of medical decision making, in the level of the hospital, or in a rural versus urban situation? (3) How do information sources used by patients differ when they choose doctors with different specialties? Methods: This study overcomes a major limitation in the use of the survey technique by employing data from the Good Doctor website, which is now China's leading online health care community, data which are objective and can be obtained relatively easily and frequently. Multinomial logistic regression models were applied to examine whether the proportion of use of these information sources changes in different situations. We then used visual analysis to explore the question of which type of information source patients prefer to use when they seek medical assistance from doctors with different specialties. Results: The 3 main information sources were online reviews (OR), family and friend recommendations (FR), and doctor recommendations (DR), with proportions of use of 32.93\% (559,345/1,698,666), 23.68\% (402,322/1,698,666), and 17.48\% (296,912/1,698,666), respectively. Difficulty in medical decision making, the hospital level, and rural-urban differences were significantly associated with patients' preferred information sources for choosing doctors. Further, the sources of information that patients prefer to use were found to vary when they looked for doctors with different medical specialties. Conclusions: Patients are less likely to use online reviews when medical decisions are more difficult or when the provider is not a tertiary hospital, the former situation leading to a greater use of online reviews and the latter to a greater use of family and friend recommendations. In addition, patients in large cities are more likely to use information from online reviews than family and friend recommendations. Among different medical specialties, for those in which personal privacy is a concern, online reviews are the most common source. For those related to children, patients are more likely to refer to family and friend recommendations, and for those related to surgery, they value doctor recommendations more highly. Our results can not only contribute to aiding government efforts to further promote the dissemination of health care information but may also help health care industry managers develop better marketing strategies. ",
doi="10.2196/20910",
url="http://www.jmir.org/2020/9/e20910/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32936080"
}


@Article{info:doi/10.2196/18147,
author="Kaleta, Michaela
and Niederkrotenthaler, Thomas
and Kautzky-Willer, Alexandra
and Klimek, Peter",
title="How Specialist Aftercare Impacts Long-Term Readmission Risks in Elderly Patients With Metabolic, Cardiac, and Chronic Obstructive Pulmonary Diseases: Cohort Study Using Administrative Data",
journal="JMIR Med Inform",
year="2020",
month="Sep",
day="16",
volume="8",
number="9",
pages="e18147",
keywords="multimorbity",
keywords="patient-sharing networks",
keywords="network analysis",
keywords="gender medicine",
keywords="chronic disease",
keywords="morbidity",
keywords="elderly",
keywords="older adults",
keywords="cohort study",
abstract="Background: The health state of elderly patients is typically characterized by multiple co-occurring diseases requiring the involvement of several types of health care providers. Objective: We aimed to quantify the benefit for multimorbid patients from seeking specialist care in terms of long-term readmission risks. Methods: From an administrative database, we identified 225,238 elderly patients with 97 different diagnosis (ICD-10 codes) from hospital stays and contact with 13 medical specialties. For each diagnosis associated with the first hospital stay, we used multiple logistic regression analysis to quantify the sex-specific and age-adjusted long-term all-cause readmission risk (hospitalizations occurring between 3 months and 3 years after the first admission) and how specialist contact impacts these risks. Results: Men have a higher readmission risk than women (mean difference over all first diagnoses 1.9\%, P<.001), but similar reduction in readmission risk after receiving specialist care. Specialist care can reduce readmission risk by almost 50\%. We found the greatest reductions in risk when the first hospital stay was associated with diagnoses corresponding to complex chronic diseases such as acute myocardial infarction (57.6\% reduction in readmission risk, SE 7.6\% for men [m]; 55.9\% reduction, SE 9.8\% for women [w]), diabetic and other retinopathies (m: 62.3\%, SE 8.0; w: 60.1\%, SE 8.4\%), chronic obstructive pulmonary disease (m: 63.9\%, SE 7.8\%; w: 58.1\%, SE 7.5\%), disorders of lipoprotein metabolism (m: 64.7\%, SE 3.7\%; w: 63.8\%, SE 4.0\%), and chronic ischemic heart diseases (m: 63.6\%, SE 3.1\%; w: 65.4\%, SE 3.0\%). Conclusions: Specialist care can greatly reduce long-term readmission risk for patients with chronic and multimorbid diseases. Further research is needed to identify the specific reasons for these findings and to understand the detected sex-specific differences. ",
doi="10.2196/18147",
url="http://medinform.jmir.org/2020/9/e18147/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32936077"
}


@Article{info:doi/10.2196/21718,
author="Balcombe, Luke
and De Leo, Diego",
title="An Integrated Blueprint for Digital Mental Health Services Amidst COVID-19",
journal="JMIR Ment Health",
year="2020",
month="Jul",
day="22",
volume="7",
number="7",
pages="e21718",
keywords="digital mental health",
keywords="mental well-being online assessments",
keywords="machine learning",
keywords="automation",
keywords="COVID-19",
keywords="well-being services",
doi="10.2196/21718",
url="https://mental.jmir.org/2020/7/e21718",
url="http://www.ncbi.nlm.nih.gov/pubmed/32668402"
}


@Article{info:doi/10.2196/15911,
author="Abdulaal, Ahmed
and Arhi, Chanpreet
and Ziprin, Paul",
title="Effect of Health Care Provider Delays on Short-Term Outcomes in Patients With Colorectal Cancer: Multicenter Population-Based Observational Study",
journal="Interact J Med Res",
year="2020",
month="Jul",
day="17",
volume="9",
number="3",
pages="e15911",
keywords="surgery",
keywords="cancer",
keywords="colorectal",
keywords="delay",
abstract="Background: The United Kingdom has lower survival figures for all types of cancers compared to many European countries despite similar national expenditures on health. This discrepancy may be linked to long diagnostic and treatment delays. Objective: The aim of this study was to determine whether delays experienced by patients with colorectal cancer (CRC) affect their survival. Methods: This observational study utilized the Somerset Cancer Register to identify patients with CRC who were diagnosed on the basis of positive histology findings. The effects of diagnostic and treatment delays and their subdivisions on outcomes were investigated using Cox proportional hazards regression. Kaplan-Meier plots were used to illustrate group differences. Results: A total of 648 patients (375 males, 57.9\% males) were included in this study. We found that neither diagnostic delay nor treatment delay had an effect on the overall survival in patients with CRC ($\chi$23=1.5, P=.68; $\chi$23=0.6, P=.90, respectively). Similarly, treatment delays did not affect the outcomes in patients with CRC ($\chi$23=5.5, P=.14). The initial Cox regression analysis showed that patients with CRC who had short diagnostic delays were less likely to die than those experiencing long delays (hazard ratio 0.165, 95\% CI 0.044-0.616; P=.007). However, this result was nonsignificant following sensitivity analysis. Conclusions: Diagnostic and treatment delays had no effect on the survival of this cohort of patients with CRC. The utility of the 2-week wait referral system is therefore questioned. Timely screening with subsequent early referral and access to diagnostics may have a more beneficial effect. ",
doi="10.2196/15911",
url="https://www.i-jmr.org/2020/3/e15911",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706666"
}


@Article{info:doi/10.2196/18527,
author="Yu, Haiyan
and Wang, Yali
and Wang, Jying-Nan
and Chiu, Ya-Ling
and Qiu, Hang
and Gao, Mingyue",
title="Causal Effect of Honorary Titles on Physicians' Service Volumes in Online Health Communities: Retrospective Study",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="9",
volume="22",
number="7",
pages="e18527",
keywords="causality",
keywords="health information systems",
keywords="organizational policy",
keywords="physician-patient relations",
keywords="remote consultation",
abstract="Background: An OHC online health community (OHC) is an interactive platform for virtual communication between patients and physicians. Patients can typically search, seek, and share their experience and rate physicians, who may be involved in giving advice.  Some OHC providers provide incentives in form of honorary titles to encourage the web-based involvement of physicians, but it is  unclear whether the award of honorary titles has an impact on their consultation volume in an OHC. Objective: This study is designed to identify the differential treatment effect of the incentive policy on the service volumes for the subgroups of treatment and control in an OHC. This study aims to answer the following questions: Does an honorary title for physicians impact their service volumes in an OHC? During the period of discontinuity, can we identify the sharp effect of the incentive award on the outcomes of physicians' service volumes? Methods: We acquired the targeted samples based on treatment, namely, physicians with an honorary title or not and outcomes measured before and after the award of the 2 subgroups. A regression discontinuity design was applied to investigate the impact of the honorary titles incentive as a treatment in an OHC. There was a sharply discontinuous effect of treatment on physicians' online health service performance. The experimental data set consisted of 346 physicians in the treatment group (with honorary titles). Applying the propensity score matching method, the same size of physicians (n=346) was matched and selected as the control group. Results: A sharp discontinuity was found at the time of the physician receiving the honorary title. The results showed that the parametric estimates of the coefficient were significantly positively (P<.001) associated with monthly home page views. The jump in the monthly volumes of home page views was much sharper than that of the monthly consultations. Conclusions: The changes in the volumes of monthly consultations and home page views reflect the differential treatment effect of honorary titles on physicians' service volumes. The effect of the incentive policy with honorary titles is objectively estimated from both the perspective of online and offline medical services in an OHC. Being named with honorary titles significantly multiplied monthly home page views, yet it did not significantly impact monthly consultations. This may be because consultation capacity is limited by the physician's schedule for consultations. ",
doi="10.2196/18527",
url="https://www.jmir.org/2020/7/e18527",
url="http://www.ncbi.nlm.nih.gov/pubmed/32673232"
}


@Article{info:doi/10.2196/19927,
author="Garg, Suneela
and Basu, Saurav
and Rustagi, Ruchir
and Borle, Amod",
title="Primary Health Care Facility Preparedness for Outpatient Service Provision During the COVID-19 Pandemic in India: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2020",
month="Jun",
day="1",
volume="6",
number="2",
pages="e19927",
keywords="primary health care",
keywords="COVID-19",
keywords="pandemic",
keywords="health systems",
keywords="India",
abstract="Background: Primary health centers (PHCs) represent the first tier of the Indian health care system, providing a range of essential outpatient services to people living in the rural, suburban, and hard-to-reach areas. Diversion of health care resources for containing the coronavirus disease (COVID-19) pandemic has significantly undermined the accessibility and availability of essential health services. Under these circumstances, the preparedness of PHCs in providing safe patient-centered care and meeting the current health needs of the population while preventing further transmission of the severe acute respiratory syndrome coronavirus 2 infection is crucial. Objective: The aim of this study was to determine the primary health care facility preparedness toward the provision of safe outpatient services during the COVID-19 pandemic in India. Methods: We conducted a cross-sectional study among supervisors and managers of primary health care facilities attached to medical colleges and institutions in India. A list of 60 faculties involved in the management and supervision of PHCs affiliated with the community medicine departments of medical colleges and institutes across India was compiled from an accessible private organization member database. We collected the data through a rapid survey from April 24 to 30, 2020, using a Google Forms online digital questionnaire that evaluated preparedness parameters based on self-assessment by the participants. The preparedness domains assessed were infrastructure availability, health worker safety, and patient care. Results: A total of 51 faculties responded to the survey. Each medical college and institution had on average a total of 2.94 (SD 1.7) PHCs under its jurisdiction. Infrastructural and infection control deficits at the PHC were reported in terms of limited physical space and queuing capacity, lack of separate entry and exit gates (n=25, 49\%), inadequate ventilation (n=29, 57\%), and negligible airborne infection control measures (n=38, 75.5\%). N95 masks were available at 26 (50.9\%) sites. Infection prevention and control measures were also suboptimal with inadequate facilities for handwashing and hand hygiene reported in 23.5\% (n=12) and 27.4\% (n=14) of sites, respectively. The operation of outpatient services, particularly related to maternal and child health, was significantly disrupted (P<.001) during the COVID-19 pandemic. Conclusions: Existing PHC facilities in India providing outpatient services are constrained in their functioning during the COVID-19 pandemic due to weak infrastructure contributing to suboptimal patient safety and infection control measures. Furthermore, there is a need for effective planning, communication, and coordination between the centralized health policy makers and health managers working at primary health care facilities to ensure overall preparedness during public health emergencies. ",
doi="10.2196/19927",
url="http://publichealth.jmir.org/2020/2/e19927/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32452819"
}


@Article{info:doi/10.2196/16713,
author="Yang, Xin
and Parton, Jason
and Lewis, Dwight
and Yang, Ning
and Hudnall, Matthew",
title="Effect of Patient-Physician Relationship on Withholding Information Behavior: Analysis of Health Information National Trends Survey (2011-2018) Data",
journal="J Med Internet Res",
year="2020",
month="Jan",
day="29",
volume="22",
number="1",
pages="e16713",
keywords="withholding information behavior",
keywords="patient-physician relationship",
keywords="electronic medical records",
keywords="privacy",
abstract="Background: Patients' withholding information from doctors can undermine medical treatment, create barriers for appropriate diagnoses, and increase systemic cost in health care systems. To date, there is limited literature detailing the association between trends of patients withholding information behavior (WIB) and the patient-physician relationship (PPR). Objective: The aim of this study was to explore the prevalence trend of WIB after 2011 and examine the effects of PPR on WIB and its time trend. Methods: A total of 5 iterations of data from the Health Information National Trends Survey (years: 2011-2018; n=11,954) were used to explore curvilinear trends of WIB among the US population. Multiple logistic regression models were used to examine curvilinear time trends of WIB, effects of PPR on WIB, and moderation effects of PPR on the WIB time trend. Results: The WIB prevalence has an increasing trend before 2014, which has the highest rate of 13.57\%, and then it decreases after 2014 to 8.65\%. The trend of WIB is curvilinear as the quadratic term in logistic regression model was statistically significant (P=.04; beta=?.022; SE=0.011; odds ratio [OR] 0.978, 95\% CI 0.957-0.999). PPR is reversely associated with WIB (P<.001; beta=?.462; SE=0.097; OR 0.630, 95\% CI 0.518-0.766) and has a significant moderation effect on time trends (P=.02; beta=?.06; SE=0.025; OR 0.941, 95\% CI 0.896-0.989). In general, poor quality of PPR not only significantly increased the WIB probability but also postponed the change of point for WIB curvilinear trend. Conclusions: Findings suggest that the time trend of WIB between 2011 and 2018 is curvilinear and moderated by the quality of the PPR. Given these results, providers may reduce WIB by improving PPR. More research is needed to confirm these findings. ",
doi="10.2196/16713",
url="http://www.jmir.org/2020/1/e16713/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32012083"
}


@Article{info:doi/10.2196/13130,
author="Ssendikaddiwa, Joseph
and Lavergne, Ruth",
title="Access to Primary Care and Internet Searches for Walk-In Clinics and Emergency Departments in Canada: Observational Study Using Google Trends and Population Health Survey Data",
journal="JMIR Public Health Surveill",
year="2019",
month="Nov",
day="18",
volume="5",
number="4",
pages="e13130",
keywords="internet",
keywords="ambulatory care facilities",
keywords="emergency departments",
keywords="primary health care",
keywords="health services accessibility",
abstract="Background: Access to primary care is a challenge for many Canadians. Models of primary care vary widely among provinces, including arrangements for same-day and after-hours access. Use of walk-in clinics and emergency departments (EDs) may also vary, but data sources that allow comparison are limited. Objective: We used Google Trends to examine the relative frequency of searches for walk-in clinics and EDs across provinces and over time in Canada. We correlated provincial relative search frequencies from Google Trends with survey responses about primary care access from the Commonwealth Fund's 2016 International Health Policy Survey of Adults in 11 Countries and the 2016 Canadian Community Health Survey. Methods: We developed search strategies to capture the range of terms used for walk-in clinics (eg, urgent care clinic and after-hours clinic) and EDs (eg, emergency room) across Canadian provinces. We used Google Trends to determine the frequencies of these terms relative to total search volume within each province from January 2011 to December 2018. We calculated correlation coefficients and 95\% CIs between provincial Google Trends relative search frequencies and survey responses. Results: Relative search frequency of walk-in clinic searches increased steadily, doubling in most provinces between 2011 and 2018. Relative frequency of walk-in clinic searches was highest in the western provinces of British Columbia, Alberta, Saskatchewan, and Manitoba. At the provincial level, higher walk-in clinic relative search frequency was strongly positively correlated with the percentage of survey respondents who reported being able to get same- or next-day appointments to see a doctor or a nurse and inversely correlated with the percentage of respondents who reported going to ED for a condition that they thought could have been treated by providers at usual place of care. Relative search frequency for walk-in clinics was also inversely correlated with the percentage of respondents who reported having a regular medical provider. ED relative search frequencies were more stable over time, and we did not observe statistically significant correlation with survey data. Conclusions: Higher relative search frequency for walk-in clinics was positively correlated with the ability to get a same- or next-day appointment and inversely correlated with ED use for conditions treatable in the patient's regular place of care and also with having a regular medical provider. Findings suggest that patient use of Web-based tools to search for more convenient or accessible care through walk-in clinics is increasing over time. Further research is needed to validate Google Trends data with administrative information on service use. ",
doi="10.2196/13130",
url="http://publichealth.jmir.org/2019/4/e13130/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31738175"
}


@Article{info:doi/10.2196/14609,
author="Fulton, Lawrence
and Kruse, Scott Clemens",
title="Hospital-Based Back Surgery: Geospatial-Temporal, Explanatory, and Predictive Models",
journal="J Med Internet Res",
year="2019",
month="Oct",
day="29",
volume="21",
number="10",
pages="e14609",
keywords="back surgery",
keywords="neurosurgeon",
keywords="elastic net",
keywords="lasso",
keywords="ridge",
keywords="random forest",
keywords="geospatial mapping",
keywords="health economics",
keywords="obesity",
keywords="practice variation",
abstract="Background: Hospital-based back surgery in the United States increased by 60\% from January 2012 to December 2017, yet the supply of neurosurgeons remained relatively constant. During this time, adult obesity grew by 5\%. Objective: This study aimed to evaluate the demand and associated costs for hospital-based back surgery by geolocation over time to evaluate provider practice variation. The study then leveraged hierarchical time series to generate tight demand forecasts on an unobserved test set. Finally, explanatory financial, technical, workload, geographical, and temporal factors as well as state-level obesity rates were investigated as predictors for the demand for hospital-based back surgery. Methods: Hospital data from January 2012 to December 2017 were used to generate geospatial-temporal maps and a video of the Current Procedural Terminology codes beginning with the digit 63 claims. Hierarchical time series modeling provided forecasts for each state, the census regions, and the nation for an unobserved test set and then again for the out-years of 2018 and 2019. Stepwise regression, lasso regression, ridge regression, elastic net, and gradient-boosted random forests were built on a training set and evaluated on a test set to evaluate variables important to explaining the demand for hospital-based back surgery. Results: Widespread, unexplained practice variation over time was seen using geographical information systems (GIS) multimedia mapping. Hierarchical time series provided accurate forecasts on a blind dataset and suggested a 6.52\% (from 497,325 procedures in 2017 to 529,777 in 2018) growth of hospital-based back surgery in 2018 (529,777 and up to 13.00\% by 2019 [from 497,325 procedures in 2017 to 563,023 procedures in 2019]). The increase in payments by 2019 are estimated to be US \$323.9 million. Extreme gradient-boosted random forests beat constrained and unconstrained regression models on a 20\% unobserved test set and suggested that obesity is one of the most important factors in explaining the increase in demand for hospital-based back surgery. Conclusions: Practice variation and obesity are factors to consider when estimating demand for hospital-based back surgery. Federal, state, and local planners should evaluate demand-side and supply-side interventions for this emerging problem. ",
doi="10.2196/14609",
url="http://www.jmir.org/2019/10/e14609/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31663856"
}


@Article{info:doi/10.2196/14689,
author="Hansen, Arne
and Herrmann, Maximilian
and Ehlers, P. Jan
and Mondritzki, Thomas
and Hensel, Oliver Kai
and Truebel, Hubert
and Boehme, Philip",
title="Perception of the Progressing Digitization and Transformation of the German Health Care System Among Experts and the Public: Mixed Methods Study",
journal="JMIR Public Health Surveill",
year="2019",
month="Oct",
day="28",
volume="5",
number="4",
pages="e14689",
keywords="digitization",
keywords="health care sector",
keywords="transformation",
keywords="mixed method",
keywords="delivery of health care",
keywords="diffusion of innovation",
keywords="reform",
abstract="Background: Health care systems worldwide are struggling to keep rising costs at bay with only modest outcome improvement among many diseases. Digitization with technologies like Artificial Intelligence or Machine Learning algorithms might address this. Although digital technologies have been successfully applied in clinical studies the effect on the overall health care system so far was limited. The regulatory ecosystem or data privacy might be responsible, but other reasons may also predominate. Objective: We analyzed how the digitization of the German health care market is currently perceived among different stakeholders and investigated reasons for its slow adaption. Methods: This was a mixed methods study split into a qualitative Part A using the conceptual approach of the Grounded Theory and a quantitative Part B using the Delphi method. For Part A we interviewed experts in the health care system and converted the results into 17 hypotheses. The Delphi method consisted of an online survey which was sent to the participants via email and was available for three months. For the assessment of the 17 hypotheses, the participants were given a six-point Likert scale. The participants were grouped into patients, physicians, and providers of services within the German health care market. Results: There was a strong alignment of opinions on the hypotheses between experts (N=21) and survey participants (N=733), with 70.5\% overall agreement on 12/17 hypotheses. Physicians demonstrated the lowest level of agreement with the expert panel at 88\% (15/17) disagreement, with the hypotheses ``H8: Digitization in the health care system will free up jobs,'' and ``H6: Digitization in the health care system will empower the patients,'' perceived to be in profound disagreement (P=.036 and P<.001, respectively). Conclusions: Despite the firm agreement among participants and experts regarding the impact of digitization on the health care system, physicians demonstrated a more negative attitude. We assume that this might be a factor contributing to the slow adoption of digitization in practice. Physicians might be struggling with changing power structures, so future measures to transform the market should involve them to a larger degree. ",
doi="10.2196/14689",
url="http://publichealth.jmir.org/2019/4/e14689/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31661082"
}


@Article{info:doi/10.2196/14135,
author="Neves, Lu{\'i}sa Ana
and Poovendran, Dilkushi
and Freise, Lisa
and Ghafur, Saira
and Flott, Kelsey
and Darzi, Ara
and Mayer, K. Erik",
title="Health Care Professionals' Perspectives on the Secondary Use of Health Records to Improve Quality and Safety of Care in England: Qualitative Study ",
journal="J Med Internet Res",
year="2019",
month="Sep",
day="26",
volume="21",
number="9",
pages="e14135",
keywords="electronic health records",
keywords="information technology",
keywords="health policy",
keywords="safety culture",
abstract="Background: Health care professionals (HCPs) are often patients' first point of contact in what concerns the communication of the purposes, benefits, and risks of sharing electronic health records (EHRs) for nondirect care purposes. Their engagement is fundamental to ensure patients' buy-in and a successful implementation of health care data sharing schemes. However, their views on this subject are seldom evaluated. Objective: This study aimed to explore HCPs' perspectives on the secondary uses of health care data in England. Specifically, we aimed to assess their knowledge on its purposes and the main concerns about data sharing processes. Methods: A total of 30 interviews were conducted between March 27, 2017, and April 7, 2017, using a Web-based interview platform and following a topic guide with open-ended questions. The participants represented a variety of geographic locations across England (London, West Midlands, East of England, North East England, and Yorkshire and the Humber), covering both primary and secondary care services. The transcripts were compiled verbatim and systematically reviewed by 2 independent reviewers using the framework analysis method to identify emerging themes. Results: HCPs were knowledgeable about the possible secondary uses of data and highlighted its importance for patient profiling and tailored care, research, quality assurance, public health, and service delivery planning purposes. Main concerns toward data sharing included data accuracy, patients' willingness to share their records, challenges on obtaining free and informed consent, data security, lack of adequacy or understanding of current policies, and potential patient exposure and exploitation. Conclusions: These results suggest a high level of HCPs' understanding about the purposes of data sharing for secondary purposes; however, some concerns still remain. A better understanding of HCPs' knowledge and concerns could inform national communication policies and improve tailoring to maximize efficiency and improve patients' buy-in. ",
doi="10.2196/14135",
url="https://www.jmir.org/2019/9/e14135",
url="http://www.ncbi.nlm.nih.gov/pubmed/31573898"
}


@Article{info:doi/10.2196/13345,
author="Chiang, Lee Austin
and Rabinowitz, Galler Loren
and Kumar, Akhil
and Chan, Wai-Yip Walter",
title="Association Between Institutional Social Media Involvement and Gastroenterology Divisional Rankings: Cohort Study",
journal="J Med Internet Res",
year="2019",
month="Sep",
day="06",
volume="21",
number="9",
pages="e13345",
keywords="social media",
keywords="Twitter",
keywords="hospital ranking",
abstract="Background: Patients often look to social media as an important tool to gather information about institutions and professionals. Since 1990, United States News and World Report (USNWR) has published annual rankings of hospitals and subspecialty divisions. It remains unknown if social media presence is associated with the USNWR gastroenterology and gastrointestinal (GI) surgery divisional rankings, or how changes in online presence over time affects division ranking. Objective: The objective of this study was to determine if social media presence is associated with USNWR gastroenterology and GI surgery divisional rankings and to ascertain how changes in online presence over time affect division rankings. Methods: Social media presence among the top 30 institutions listed in the 2014 USNWR gastroenterology and GI surgery divisional rankings were assessed using Pearson's correlation coefficients and multivariate analysis, controlling for covariates. Linear and logistic regression using data from 2014 and 2016 USNWR rankings were then used to assess the association between institutional ranking or reputation score with any potential changes in numbers of followers over time. Sensitivity analysis was performed by assessing the area under the receiver operating characteristic curve to determine the follower threshold associated with improved or maintained ranking, which was done by dichotomizing changes in followers at values between the 7000 and 12,000 follower mark. Results: Twitter follower count was an independent predictor of divisional ranking ($\beta$=.00004; P<.001) and reputation score ($\beta$=--.00002; P=.03) in 2014. Academic affiliation also independently predicted USNWR division ranking ($\beta$=5.3; P=.04) and reputation score ($\beta$=--7.3; P=.03). Between 2014 and 2016, Twitter followers remained significantly associated with improved or maintained rankings (OR 14.63; 95\% CI 1.08-197.81; P=.04). On sensitivity analysis, an 8000 person increase in Twitter followers significantly predicted improved or maintained rankings compared to other cutoffs. Conclusions: Institutional social media presence is independently associated with USNWR divisional ranking and reputation score. Improvement in social media following was also independently associated with improved or maintained divisional ranking and reputation score, with a threshold of 8000 additional followers as the best predictor of improved or stable ranking. ",
doi="10.2196/13345",
url="http://www.jmir.org/2019/9/e13345/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31493321"
}


@Article{info:doi/10.2196/13993,
author="Houze-Cerfon, Charles-Henri
and Vaissi{\'e}, Christine
and Gout, Laurent
and Bastiani, Bruno
and Charpentier, Sandrine
and Lauque, Dominique",
title="Development and Evaluation of a Virtual Research Environment to Improve Quality of Care in Overcrowded Emergency Departments: Observational Study",
journal="JMIR Serious Games",
year="2019",
month="Aug",
day="08",
volume="7",
number="3",
pages="e13993",
keywords="virtual reality",
keywords="interprofessional relations",
keywords="emergency medicine",
abstract="Background: Despite a wide range of literature on emergency department (ED) overcrowding, scientific knowledge on emergency physicians' cognitive processes coping with overcrowding is limited. Objective: This study aimed to develop and evaluate a virtual research environment that will allow us to study the effect of physicians' strategies and behaviors on quality of care in the context of ED overcrowding. Methods: A simulation-based observational study was conducted over two stages: the development of a simulation model and its evaluation. A research environment in emergency medicine combining virtual reality and simulated patients was designed and developed. Afterwards, 12 emergency physicians took part in simulation scenarios and had to manage 13 patients during a 2-hour period. The study outcome was the authenticity of the environment through realism, consistency, and mastering. The realism was the resemblance perceived by the participants between virtual and real ED. The consistency of the scenario and the participants' mastering of the environment was expected for 90\% (12/13) of the participants. Results: The virtual ED was considered realistic with no significant difference from the real world with respect to facilities and resources, except for the length of time of procedures that was perceived to be shorter. A total of 100\% (13/13) of participants deemed that patient information, decision making, and managing patient flow were similar to real clinical practice. The virtual environment was well-mastered by all participants over the course of the scenarios. Conclusions: The new simulation tool, Virtual Research Environment in Emergency Medicine, has been successfully designed and developed. It has been assessed as perfectly authentic by emergency physicians compared with real EDs and thus offers another way to study human factors, quality of care, and patient safety in the context of ED overcrowding. ",
doi="10.2196/13993",
url="http://games.jmir.org/2019/3/e13993/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31397292"
}


@Article{info:doi/10.2196/14634,
author="Liu, Jing
and Hou, Shengchao
and Evans, Richard
and Xia, Chenxi
and Xia, Weidong
and Ma, Jingdong",
title="What Do Patients Complain About Online: A Systematic Review and Taxonomy Framework Based on Patient Centeredness",
journal="J Med Internet Res",
year="2019",
month="Aug",
day="07",
volume="21",
number="8",
pages="e14634",
keywords="patient-centered care",
keywords="delivery of health care",
keywords="systematic review",
keywords="taxonomy",
abstract="Background: Complaints made online by patients about their health care experiences are becoming prevalent because of widespread worldwide internet connectivity. An a priori framework, based on patient centeredness, may be useful in identifying the types of issues patients complain about online across multiple settings. It may also assist in examining whether the determinants of patient-centered care (PCC) mirror the determinants of patient experiences. Objective: The objective of our study was to develop a taxonomy framework for patient complaints online based on patient centeredness and to examine whether the determinants of PCC mirror the determinants of patient experiences. Methods: First, the best fit framework synthesis technique was applied to develop the proposed a priori framework. Second, electronic databases, including Web of Science, Scopus, and PubMed, were searched for articles published between 2000 and June 2018. Studies were only included if they collected primary quantitative data on patients' online complaints. Third, a deductive and inductive thematic analysis approach was adopted to code the themes of recognized complaints into the framework. Results: In total, 17 studies from 5 countries were included in this study. Patient complaint online taxonomies and theme terms varied. According to our framework, patients expressed most dissatisfaction with patient-centered processes (101,586/204,363, 49.71\%), followed by prerequisites (appropriate skills and knowledge of physicians; 50,563, 24.74\%) and the care environment (48,563/204,363, 23.76\%). The least dissatisfied theme was expected outcomes (3651/204,363, 1.79\%). People expressed little dissatisfaction with expanded PCC dimensions, such as involvement of family and friends (591/204,363, 0.29\%). Variation in the concerns across different countries' patients were also observed. Conclusions: Online complaints made by patients are of major value to health care providers, regulatory bodies, and patients themselves. Our PCC framework can be applied to analyze them under a wide range of conditions, treatments, and countries. This review has shown significant heterogeneity of patients' online complaints across different countries. ",
doi="10.2196/14634",
url="https://www.jmir.org/2019/8/e14634/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31392961"
}


@Article{info:doi/10.2196/11034,
author="Senft, Nicole
and Everson, Jordan",
title="eHealth Engagement as a Response to Negative Healthcare Experiences: Cross-Sectional Survey Analysis",
journal="J Med Internet Res",
year="2018",
month="Dec",
day="05",
volume="20",
number="12",
pages="e11034",
keywords="care coordination",
keywords="eHealth",
keywords="health disparities",
keywords="patient-centered care",
abstract="Background: eHealth provides individuals with new means of accessing health information and communicating with providers through online channels. Prior evidence suggests that patients use eHealth to find information online when they receive care that is low in patient centeredness. However, it is unclear how other problems with the healthcare-delivery system motivate the use of eHealth, how these problems relate to different kinds of eHealth activities, and which populations are most likely to use eHealth when they receive low-quality care. Objective: We aimed to determine how two types of negative care experiences---low patient centeredness and care coordination problems---motivate the use of different eHealth activities, and whether more highly educated individuals, who may find these tools easier to use, are more likely to use eHealth following negative experiences than less highly educated individuals. Methods: Using nationally representative data from the 2017 Health Information National Trends Survey, we used factor analysis to group 25 different eHealth activities into categories based on the correlation between respondents' reports of their usage. Subsequently, we used multivariate negative binomial generalized linear model regressions to determine whether negative healthcare experiences predicted greater use of these resulting categories. Finally, we stratified our sample based on education level to determine whether the associations between healthcare experiences and eHealth use differed across groups. Results: The study included 2612 individuals. Factor analysis classified the eHealth activities into two categories: provider-facing (eg, facilitating communication with providers) and independent (eg, patient-driven information seeking and communication with non-providers). Negative care experiences were not associated with provider-facing eHealth activity in the overall population (care coordination: P=.16; patient centeredness: P=.57) or among more highly educated respondents (care coordination: P=.73; patient centeredness: P=.32), but respondents with lower education levels who experienced problems with care coordination used provider-facing eHealth more often (IRR=1.40, P=.07). Individuals engaged in more independent eHealth activities if they experienced problems with either care coordination (IRR=1.15 P=.01) or patient-centered communication (IRR=1.16, P=.01). Although care coordination problems predicted independent eHealth activity across education levels (higher education: IRR=1.13 P=.01; lower education: IRR=1.19, P=.07), the relationship between low perceived patient centeredness and independent activity was limited to individuals with lower education levels (IRR=1.25, P=.02). Conclusions: Individuals use a greater number of eHealth activities, especially activities that are independent of healthcare providers, when they experience problems with their healthcare. People with lower levels of education seem particularly inclined to use eHealth when they have negative healthcare experiences. To maximize the potential for eHealth to meet the needs of all patients, especially those who are traditionally underserved by the healthcare system, additional work should be performed to ensure that eHealth resources are accessible and usable to all members of the population. ",
doi="10.2196/11034",
url="https://www.jmir.org/2018/12/e11034/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30518513"
}


@Article{info:doi/10.2196/10264,
author="Feldman, S. Sue
and Buchalter, Scott
and Hayes, W. Leslie",
title="Health Information Technology in Healthcare Quality and Patient Safety: Literature Review",
journal="JMIR Med Inform",
year="2018",
month="Jun",
day="04",
volume="6",
number="2",
pages="e10264",
keywords="Health Information Technology",
keywords="Healthcare Quality",
keywords="Patient Safety",
abstract="Background: The area of healthcare quality and patient safety is starting to use health information technology to prevent reportable events, identify them before they become issues, and act on events that are thought to be unavoidable. As healthcare organizations begin to explore the use of health information technology in this realm, it is often unclear where fiscal and human efforts should be focused. Objective: The purpose of this study was to provide a foundation for understanding where to focus health information technology fiscal and human resources as well as expectations for the use of health information technology in healthcare quality and patient safety. Methods: A literature review was conducted to identify peer-reviewed publications reporting on the actual use of health information technology in healthcare quality and patient safety. Inductive thematic analysis with open coding was used to categorize a total of 41 studies. Three pre-set categories were used: prevention, identification, and action. Three additional categories were formed through coding: challenges, outcomes, and location. Results: This study identifies five main categories across seven study settings. A majority of the studies used health IT for identification and prevention of healthcare quality and patient safety issues. In this realm, alerts, clinical decision support, and customized health IT solutions were most often implemented. Implementation, interface design, and culture were most often noted as challenges. Conclusions: This study provides valuable information as organizations determine where they stand to get the most ``bang for their buck'' relative to health IT for quality and patient safety. Knowing what implementations are being effectivity used by other organizations helps with fiscal and human resource planning as well as managing expectations relative to cost, scope, and outcomes. The findings from this scan of the literature suggest that having organizational champion leaders that can shepherd implementation, impact culture, and bridge knowledge with developers would be a valuable resource allocation to consider. ",
doi="10.2196/10264",
url="http://medinform.jmir.org/2018/2/e10264/"
}


@Article{info:doi/10.2196/humanfactors.9328,
author="Khairat, Sherif Saif
and Dukkipati, Aniesha
and Lauria, Alico Heather
and Bice, Thomas
and Travers, Debbie
and Carson, S. Shannon",
title="The Impact of Visualization Dashboards on Quality of Care and Clinician Satisfaction: Integrative Literature Review",
journal="JMIR Hum Factors",
year="2018",
month="May",
day="31",
volume="5",
number="2",
pages="e22",
keywords="intensive care unit",
keywords="visualization, Dashboard",
keywords="cognitive load",
keywords="information overload",
keywords="usability",
keywords="user interface design",
keywords="health information technology",
keywords="electronic health record",
abstract="Background: Intensive Care Units (ICUs) in the United States admit more than 5.7 million people each year. The ICU level of care helps people with life-threatening illness or injuries and involves close, constant attention by a team of specially-trained health care providers. Delay between condition onset and implementation of necessary interventions can dramatically impact the prognosis of patients with life-threatening diagnoses. Evidence supports a connection between information overload and medical errors. A tool that improves display and retrieval of key clinical information has great potential to benefit patient outcomes. The purpose of this review is to synthesize research on the use of visualization dashboards in health care. Objective: The purpose of conducting this literature review is to synthesize previous research on the use of dashboards visualizing electronic health record information for health care providers. A review of the existing literature on this subject can be used to identify gaps in prior research and to inform further research efforts on this topic. Ultimately, this evidence can be used to guide the development, testing, and implementation of a new solution to optimize the visualization of clinical information, reduce clinician cognitive overload, and improve patient outcomes. Methods: Articles were included if they addressed the development, testing, implementation, or use of a visualization dashboard solution in a health care setting. An initial search was conducted of literature on dashboards only in the intensive care unit setting, but there were not many articles found that met the inclusion criteria. A secondary follow-up search was conducted to broaden the results to any health care setting. The initial and follow-up searches returned a total of 17 articles that were analyzed for this literature review. Results: Visualization dashboard solutions decrease time spent on data gathering, difficulty of data gathering process, cognitive load, time to task completion, errors, and improve situation awareness, compliance with evidence-based safety guidelines, usability, and navigation. Conclusions: Researchers can build on the findings, strengths, and limitations of the work identified in this literature review to bolster development, testing, and implementation of novel visualization dashboard solutions. Due to the relatively few studies conducted in this area, there is plenty of room for researchers to test their solutions and add significantly to the field of knowledge on this subject. ",
doi="10.2196/humanfactors.9328",
url="http://humanfactors.jmir.org/2018/2/e22/"
}


@Article{info:doi/10.2196/jmir.9160,
author="Daskivich, Timothy
and Luu, Michael
and Noah, Benjamin
and Fuller, Garth
and Anger, Jennifer
and Spiegel, Brennan",
title="Differences in Online Consumer Ratings of Health Care Providers Across Medical, Surgical, and Allied Health Specialties: Observational Study of 212,933 Providers",
journal="J Med Internet Res",
year="2018",
month="May",
day="09",
volume="20",
number="5",
pages="e176",
keywords="online ratings",
keywords="consumer ratings",
keywords="patient satisfaction",
keywords="digital health",
keywords="telemedicine",
abstract="Background: Health care consumers are increasingly using online ratings to select providers, but differences in the distribution of scores across specialties and skew of the data have the potential to mislead consumers about the interpretation of ratings. Objective: The objective of our study was to determine whether distributions of consumer ratings differ across specialties and to provide specialty-specific data to assist consumers and clinicians in interpreting ratings. Methods: We sampled 212,933 health care providers rated on the Healthgrades consumer ratings website, representing 29 medical specialties (n=128,678), 15 surgical specialties (n=72,531), and 6 allied health (nonmedical, nonnursing) professions (n=11,724) in the United States. We created boxplots depicting distributions and tested the normality of overall patient satisfaction scores. We then determined the specialty-specific percentile rank for scores across groupings of specialties and individual specialties. Results: Allied health providers had higher median overall satisfaction scores (4.5, interquartile range [IQR] 4.0-5.0) than physicians in medical specialties (4.0, IQR 3.3-4.5) and surgical specialties (4.2, IQR 3.6-4.6, P<.001). Overall satisfaction scores were highly left skewed (normal between --0.5 and 0.5) for all specialties, but skewness was greatest among allied health providers (--1.23, 95\% CI --1.280 to --1.181), followed by surgical (--0.77, 95\% CI --0.787 to --0.755) and medical specialties (--0.64, 95\% CI --0.648 to --0.628). As a result of the skewness, the percentages of overall satisfaction scores less than 4 were only 23\% for allied health, 37\% for surgical specialties, and 50\% for medical specialties. Percentile ranks for overall satisfaction scores varied across specialties; percentile ranks for scores of 2 (0.7\%, 2.9\%, 0.8\%), 3 (5.8\%, 16.6\%, 8.1\%), 4 (23.0\%, 50.3\%, 37.3\%), and 5 (63.9\%, 89.5\%, 86.8\%) differed for allied health, medical specialties, and surgical specialties, respectively. Conclusions: Online consumer ratings of health care providers are highly left skewed, fall within narrow ranges, and differ by specialty, which precludes meaningful interpretation by health care consumers. Specialty-specific percentile ranks may help consumers to more meaningfully assess online physician ratings. ",
doi="10.2196/jmir.9160",
url="http://www.jmir.org/2018/5/e176/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29743150"
}


@Article{info:doi/10.2196/mhealth.9061,
author="Nilsson, Ulrica
and Dahlberg, Karuna
and Jaensson, Maria",
title="The Swedish Web Version of the Quality of Recovery Scale Adapted for Use in a Mobile App: Prospective Psychometric Evaluation Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Dec",
day="3",
volume="5",
number="12",
pages="e188",
keywords="psychometric evaluation",
keywords="postoperative recovery",
keywords="Web version",
keywords="evaluation studies",
keywords="mobile application",
keywords="Quality of Recovery scale",
abstract="Background: The 40-item Quality of Recovery (QoR-40) questionnaire is well validated for measuring self-assessed postoperative recovery. The Swedish version of the 40-item Quality of Recovery (QoR-40) has been developed into a Web-based questionnaire, the Swedish Web version of the Quality of Recovery (SwQoR) questionnaire, adapted for use in a mobile app, Recovery Assessment by Phone Points, or RAPP. Objective: The aim of this study was to test the validity, reliability, responsiveness, and clinical acceptability and feasibility of SwQoR. Methods: We conducted a prospective psychometric evaluation study including 494 patients aged ?18 years undergoing day surgery at 4 different day-surgery departments in Sweden. SwQoR was completed daily on postoperative days 1 to 14. Results: All a priori hypotheses were confirmed, supporting convergent validity. There was excellent internal consistency (Cronbach alpha range .91-.93), split-half reliability (coefficient range .87-.93), and stability (ri=.99, 95\% CI .96-.99; P<.001). Cohen d effect size was 1.00, with a standardized response mean of 1.2 and a percentage change from baseline of 59.1\%. An exploratory factor analysis found 5 components explaining 57.8\% of the total variance. We noted a floor effect only on postoperative day 14; we found no ceiling effect. Conclusions: SwQoR is valid, has excellent reliability and high responsiveness, and is clinically feasible for the systematic follow-up of patients' postoperative recovery. ",
doi="10.2196/mhealth.9061",
url="http://mhealth.jmir.org/2017/12/e188/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29229590"
}


@Article{info:doi/10.2196/ijmr.7107,
author="Miron-Shatz, Talya
and Becker, Stefan
and Zaromb, Franklin
and Mertens, Alexander
and Tsafrir, Avi",
title="``A Phenomenal Person and Doctor'': Thank You Letters to Medical Care Providers",
journal="Interact J Med Res",
year="2017",
month="Nov",
day="02",
volume="6",
number="2",
pages="e22",
keywords="quality of health care",
keywords="doctor-patient relationship",
keywords="content analysis",
keywords="decision making",
keywords="doctor-patient communication",
keywords="clinical encounter",
keywords="patient satisfaction",
keywords="online reviews",
keywords="patient-centered care",
abstract="Background: Thank you letters to physicians and medical facilities are an untapped resource, providing an invaluable glimpse into what patients notice and appreciate in their care. Objective: The aim of this study was to analyze such thank you letters as posted on the Web by medical institutions to find what patients and families consider to be good care. In an age of patient-centered care, it is pivotal to see what metrics patients and families apply when assessing their care and whether they grasp specific versus general qualities in their care. Methods: Our exploratory inquiry covered 100 thank you letters posted on the Web by 26 medical facilities in the United States and the United Kingdom. We systematically coded and descriptively presented the aspects of care that patients and their families thanked doctors and medical facilities for. We relied on previous work outlining patient priorities and satisfaction (Anderson et al, 2007), to which we added a distinction between global and specific evaluations for each of the already existing categories with two additional categories: general praise and other, and several subcategories, such as treatment outcome, to the category of medical care. Results: In 73\% of the letters (73/100), physicians were primarily thanked for their medical treatment. In 71\% (71/100) of the letters, they were thanked for their personality and demeanor. In 52\% cases (52/100), these two aspects were mentioned together, suggesting that from the perspective of patient as well as the family member, both are deemed necessary in positive evaluation of medical care. Only 8\% (8/100) of the letters lacked reference to medical care, personality or demeanor, or communication. No statistically significant differences were observed in the number of letters that expressed gratitude for the personality or demeanor of medical care providers versus the quality of medical care ($\chi$21, N=200=0.1, not statistically significant). Letters tended to express more specific praise for personality or demeanor, such as being supportive, understanding, humane and caring (48/71, 68\%) but more general praise for medical care ($\chi$21, N=424=63.9, P<.01). The most often mentioned specific quality of medical care were treatment outcomes (30/73, 41\%), followed by technical competence (15/73, 21\%) and treatment approach (14/73, 19\%). A limitation of this inquiry is that we analyzed the letters that medical centers chose to post on the Web. These are not necessarily a representative sample of all thank you letters as are sent to health care institutions but are still indicative of what centers choose to showcase on the Web. Conclusions: Physician demeanor and quality of interaction with patients are pivotal in how laymen perceive good care, no less so than medical care per se. This inquiry can inform care providers and medical curricula, leading to an improvement in the perceived quality of care. ",
doi="10.2196/ijmr.7107",
url="http://www.i-jmr.org/2017/2/e22/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29097353"
}


@Article{info:doi/10.2196/jmir.6599,
author="McLennan, Stuart
and Strech, Daniel
and Reimann, Swantje",
title="Developments in the Frequency of Ratings and Evaluation Tendencies: A Review of German Physician Rating Websites",
journal="J Med Internet Res",
year="2017",
month="Aug",
day="25",
volume="19",
number="8",
pages="e299",
keywords="physician rating websites",
keywords="patient satisfaction",
abstract="Background: Physician rating websites (PRWs) have been developed to allow all patients to rate, comment, and discuss physicians' quality online as a source of information for others searching for a physician. At the beginning of 2010, a sample of 298 randomly selected physicians from the physician associations in Hamburg and Thuringia were searched for on 6 German PRWs to examine the frequency of ratings and evaluation tendencies. Objective: The objective of this study was to examine (1) the number of identifiable physicians on German PRWs; (2) the number of rated physicians on German PRWs; (3) the average and maximum number of ratings per physician on German PRWs; (4) the average rating on German PRWs; (5) the website visitor ranking positions of German PRWs; and (6) how these data compare with 2010 results. Methods: A random stratified sample of 298 selected physicians from the physician associations in Hamburg and Thuringia was generated. Every selected physician was searched for on the 6 PRWs (Jameda, Imedo, Docinsider, Esando, Topmedic, and Medf{\"u}hrer) used in the 2010 study and a PRW, Arztnavigator, launched by Allgemeine Ortskrankenkasse (AOK). Results: The results were as follows: (1) Between 65.1\% (194/298) on Imedo to 94.6\% (282/298) on AOK-Arztnavigator of the physicians were identified on the selected PRWs. (2) Between 16.4\% (49/298) on Esando to 83.2\% (248/298) on Jameda of the sample had been rated at least once. (3) The average number of ratings per physician ranged from 1.2 (Esando) to 7.5 (AOK-Arztnavigator). The maximum number of ratings per physician ranged from 3 (Esando) to 115 (Docinsider), indicating an increase compared with the ratings of 2 to 27 in the 2010 study sample. (4) The average converted standardized rating (1=positive, 2=neutral, and 3=negative) ranged from 1.0 (Medf{\"u}hrer) to 1.2 (Jameda and Topmedic). (5) Only Jameda (position 317) and Medf{\"u}hrer (position 9796) were placed among the top 10,000 visited websites in Germany. Conclusions: Whereas there has been an overall increase in the number of ratings when summing up ratings from all 7 analyzed German PRWs, this represents an average addition of only 4 new ratings per physician in a year. The increase has also not been even across the PRWs, and it would be advisable for the users of PRWs to utilize a number of PRWs to ascertain the rating of any given physician. Further research is needed to identify barriers for patients to rate their physicians and to assist efforts to increase the number of ratings on PRWs to consequently improve the fairness and practical importance of PRWs. ",
doi="10.2196/jmir.6599",
url="http://www.jmir.org/2017/8/e299/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28842391"
}


@Article{info:doi/10.2196/publichealth.7001,
author="Tran, N. Nam
and Lee, Joon",
title="Online Reviews as Health Data: Examining the Association Between Availability of Health Care Services and Patient Star Ratings Exemplified by the Yelp Academic Dataset",
journal="JMIR Public Health Surveill",
year="2017",
month="Jul",
day="12",
volume="3",
number="3",
pages="e43",
keywords="Yelp",
keywords="health care access",
keywords="health care availability",
keywords="patient satisfaction",
keywords="patient rating",
keywords="patient experience",
keywords="open hour",
keywords="clinic hour",
keywords="online reviews",
abstract="Background: There have been public health interventions that aim to reduce barriers to health care access by extending opening hours of health care facilities. However, the impact of opening hours from the patient's perspective is not well understood. Objective: This study aims to investigate the relationship between temporal accessibility of health care services and how patients rate the providers on Yelp, an online review website that is popular in the United States. Using crowdsourced open Internet data, such as Yelp, can help circumvent the traditional survey method. Methods: From Yelp's limited academic dataset, this study examined the pattern of visits to health care providers and performed a secondary analysis to examine the association between patient rating (measured by Yelp's rating) and temporal accessibility of health care services (measured by opening hours) using ordinal logistic regression models. Other covariates included were whether an appointment was required, the type of health care service, the region of the health care service provider, the number of reviews the health care service provider received in the past, the number of nearby competitors, the mean rating of competitors, and the standard deviation of competitors' ratings. Results: From the 2085 health care service providers identified, opening hours during certain periods, the type of health care service, and the variability of competitors' ratings showed an association with patient rating. Most of the visits to health care service providers took place between normal working hours (9 AM-5 PM) from Sunday to Thursday, and the least on Saturday. A model fitted to the entire sample showed that increasing hours during normal working hours on Monday (OR 0.926, 95\% CI 0.880-0.973, P=0.03), Saturday (OR 0.897, 95\% CI 0.860-0.935, P<0.001), Sunday (OR 0.904, 95\% CI 0.841-0.970, P=0.005), and outside normal working hours on Friday (OR 0.872, 95\% CI 0.760-0.998, P=0.048) was associated with receiving lower ratings. But increasing hours during outside normal working hours on Sunday was associated with receiving higher ratings (OR 1.400, 95\% CI 1.036-1.924, P=0.03). There were also observed differences in patient ratings among the health care services types, but not geographically or by appointment requirement. Conclusions: This study shows that public health interventions, especially those involving opening hours, could use crowdsourced open Internet data to enhance the evidence base for decision making and evaluation in the future. This study illustrates one example of how Yelp data could be used to understand patient experiences with health care services, making a case for future research for exploring online reviews as a health dataset. ",
doi="10.2196/publichealth.7001",
url="http://publichealth.jmir.org/2017/3/e43/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28701293"
}


@Article{info:doi/10.2196/jmir.6946,
author="Davis, A. Matthew
and Zheng, Kai
and Liu, Yang
and Levy, Helen",
title="Public Response to Obamacare on Twitter",
journal="J Med Internet Res",
year="2017",
month="May",
day="26",
volume="19",
number="5",
pages="e167",
keywords="Patient Protection and Affordable Care Act",
keywords="health care reform",
keywords="social media",
keywords="data collection",
abstract="Background: The Affordable Care Act (ACA), often called ``Obamacare,'' is a controversial law that has been implemented gradually since its enactment in 2010. Polls have consistently shown that public opinion of the ACA is quite negative. Objective: The aim of our study was to examine the extent to which Twitter data can be used to measure public opinion of the ACA over time. Methods: We prospectively collected a 10\% random sample of daily tweets (approximately 52 million since July 2011) using Twitter's streaming application programming interface (API) from July 10, 2011 to July 31, 2015. Using a list of key terms and ACA-specific hashtags, we identified tweets about the ACA and examined the overall volume of tweets about the ACA in relation to key ACA events. We applied standard text sentiment analysis to assign each ACA tweet a measure of positivity or negativity and compared overall sentiment from Twitter with results from the Kaiser Family Foundation health tracking poll. Results: Public opinion on Twitter (measured via sentiment analysis) was slightly more favorable than public opinion measured by the Kaiser poll (approximately 50\% vs 40\%, respectively) but trends over time in both favorable and unfavorable views were similar in both sources. The Twitter-based measures of opinion as well as the Kaiser poll changed very little over time: correlation coefficients for favorable and unfavorable public opinion were .43 and .37, respectively. However, we found substantial spikes in the volume of ACA-related tweets in response to key events in the law's implementation, such as the first open enrollment period in October 2013 and the Supreme Court decision in June 2012. Conclusions: Twitter may be useful for tracking public opinion of health care reform as it appears to be comparable with conventional polling results. Moreover, in contrast with conventional polling, the overall amount of tweets also provides a potential indication of public interest of a particular issue at any point in time. ",
doi="10.2196/jmir.6946",
url="http://www.jmir.org/2017/5/e167/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28550002"
}


@Article{info:doi/10.2196/publichealth.4360,
author="Hung, Man
and Zhang, Weiping
and Chen, Wei
and Bounsanga, Jerry
and Cheng, Christine
and Franklin, D. Jeremy
and Crum, B. Anthony
and Voss, W. Maren
and Hon, D. Shirley",
title="Patient-Reported Outcomes and Total Health Care Expenditure in Prediction of Patient Satisfaction: Results From a National Study",
journal="JMIR Public Health Surveill",
year="2015",
month="Sep",
day="23",
volume="1",
number="2",
pages="e13",
keywords="health care quality",
keywords="value",
keywords="expenditure",
keywords="cost",
keywords="medical outcomes",
keywords="patient satisfaction",
keywords="Medical Expenditure Panel Survey",
keywords="patient-reported outcomes",
keywords="Affordable Care Act",
keywords="big data analytics",
abstract="Background: Health care quality is often linked to patient satisfaction. Yet, there is a lack of national studies examining the relationship between patient satisfaction, patient-reported outcomes, and medical expenditure. Objective: The aim of this study is to examine the contribution of physical health, mental health, general health, and total health care expenditures to patient satisfaction using a longitudinal, nationally representative sample. Methods: Using data from the 2010-2011 Medical Expenditure Panel Survey, analyses were conducted to predict patient satisfaction from patient-reported outcomes and total health care expenditures. The study sample consisted of adult participants (N=10,157), with sampling weights representative of 233.26 million people in the United States. Results: The results indicated that patient-reported outcomes and total health care expenditure were associated with patient satisfaction such that higher physical and mental function, higher general health status, and higher total health care expenditure were associated with higher patient satisfaction. Conclusions: We found that patient-reported outcomes and total health care expenditure had a significant relationship with patient satisfaction. As more emphasis is placed on health care value and quality, this area of research will become increasingly needed and critical questions should be asked about what we value in health care and whether we can find a balance between patient satisfaction, outcomes, and expenditures. Future research should apply big data analytics to investigate whether there is a differential effect of patient-reported outcomes and medical expenditures on patient satisfaction across different medical specialties. ",
doi="10.2196/publichealth.4360",
url="http://publichealth.jmir.org/2015/2/e13/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27227131"
}