TY - JOUR AU - Garg, Suneela AU - Basu, Saurav AU - Rustagi, Ruchir AU - Borle, Amod PY - 2020 DA - 2020/6/1 TI - Primary Health Care Facility Preparedness for Outpatient Service Provision During the COVID-19 Pandemic in India: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e19927 VL - 6 IS - 2 KW - primary health care KW - COVID-19 KW - pandemic KW - health systems KW - India AB - 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. UR - http://publichealth.jmir.org/2020/2/e19927/ UR - https://doi.org/10.2196/19927 UR - http://www.ncbi.nlm.nih.gov/pubmed/32452819 DO - 10.2196/19927 ID - info:doi/10.2196/19927 ER - TY - JOUR AU - Yang, Xin AU - Parton, Jason AU - Lewis, Dwight AU - Yang, Ning AU - Hudnall, Matthew PY - 2020 DA - 2020/1/29 TI - Effect of Patient-Physician Relationship on Withholding Information Behavior: Analysis of Health Information National Trends Survey (2011-2018) Data JO - J Med Internet Res SP - e16713 VL - 22 IS - 1 KW - withholding information behavior KW - patient-physician relationship KW - electronic medical records KW - privacy AB - 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. UR - http://www.jmir.org/2020/1/e16713/ UR - https://doi.org/10.2196/16713 UR - http://www.ncbi.nlm.nih.gov/pubmed/32012083 DO - 10.2196/16713 ID - info:doi/10.2196/16713 ER - TY - JOUR AU - Ssendikaddiwa, Joseph AU - Lavergne, Ruth PY - 2019 DA - 2019/11/18 TI - 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 JO - JMIR Public Health Surveill SP - e13130 VL - 5 IS - 4 KW - internet KW - ambulatory care facilities KW - emergency departments KW - primary health care KW - health services accessibility AB - 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. UR - http://publichealth.jmir.org/2019/4/e13130/ UR - https://doi.org/10.2196/13130 UR - http://www.ncbi.nlm.nih.gov/pubmed/31738175 DO - 10.2196/13130 ID - info:doi/10.2196/13130 ER - TY - JOUR AU - Fulton, Lawrence AU - Kruse, Clemens Scott PY - 2019 DA - 2019/10/29 TI - Hospital-Based Back Surgery: Geospatial-Temporal, Explanatory, and Predictive Models JO - J Med Internet Res SP - e14609 VL - 21 IS - 10 KW - back surgery KW - neurosurgeon KW - elastic net KW - lasso KW - ridge KW - random forest KW - geospatial mapping KW - health economics KW - obesity KW - practice variation AB - 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. UR - http://www.jmir.org/2019/10/e14609/ UR - https://doi.org/10.2196/14609 UR - http://www.ncbi.nlm.nih.gov/pubmed/31663856 DO - 10.2196/14609 ID - info:doi/10.2196/14609 ER - TY - JOUR AU - Hansen, Arne AU - Herrmann, Maximilian AU - Ehlers, Jan P AU - Mondritzki, Thomas AU - Hensel, Kai Oliver AU - Truebel, Hubert AU - Boehme, Philip PY - 2019 DA - 2019/10/28 TI - Perception of the Progressing Digitization and Transformation of the German Health Care System Among Experts and the Public: Mixed Methods Study JO - JMIR Public Health Surveill SP - e14689 VL - 5 IS - 4 KW - digitization KW - health care sector KW - transformation KW - mixed method KW - delivery of health care KW - diffusion of innovation KW - reform AB - 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. UR - http://publichealth.jmir.org/2019/4/e14689/ UR - https://doi.org/10.2196/14689 UR - http://www.ncbi.nlm.nih.gov/pubmed/31661082 DO - 10.2196/14689 ID - info:doi/10.2196/14689 ER - TY - JOUR AU - Neves, Ana Luísa AU - Poovendran, Dilkushi AU - Freise, Lisa AU - Ghafur, Saira AU - Flott, Kelsey AU - Darzi, Ara AU - Mayer, Erik K PY - 2019 DA - 2019/9/26 TI - Health Care Professionals’ Perspectives on the Secondary Use of Health Records to Improve Quality and Safety of Care in England: Qualitative Study JO - J Med Internet Res SP - e14135 VL - 21 IS - 9 KW - electronic health records KW - information technology KW - health policy KW - safety culture AB - 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. UR - https://www.jmir.org/2019/9/e14135 UR - https://doi.org/10.2196/14135 UR - http://www.ncbi.nlm.nih.gov/pubmed/31573898 DO - 10.2196/14135 ID - info:doi/10.2196/14135 ER - TY - JOUR AU - Chiang, Austin Lee AU - Galler Rabinowitz, Loren AU - Kumar, Akhil AU - Chan, Walter Wai-Yip PY - 2019 DA - 2019/09/06 TI - Association Between Institutional Social Media Involvement and Gastroenterology Divisional Rankings: Cohort Study JO - J Med Internet Res SP - e13345 VL - 21 IS - 9 KW - social media KW - Twitter KW - hospital ranking AB - 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 (β=.00004; P<.001) and reputation score (β=–.00002; P=.03) in 2014. Academic affiliation also independently predicted USNWR division ranking (β=5.3; P=.04) and reputation score (β=–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. UR - http://www.jmir.org/2019/9/e13345/ UR - https://doi.org/10.2196/13345 UR - http://www.ncbi.nlm.nih.gov/pubmed/31493321 DO - 10.2196/13345 ID - info:doi/10.2196/13345 ER - TY - JOUR AU - Houze-Cerfon, Charles-Henri AU - Vaissié, Christine AU - Gout, Laurent AU - Bastiani, Bruno AU - Charpentier, Sandrine AU - Lauque, Dominique PY - 2019 DA - 2019/08/08 TI - Development and Evaluation of a Virtual Research Environment to Improve Quality of Care in Overcrowded Emergency Departments: Observational Study JO - JMIR Serious Games SP - e13993 VL - 7 IS - 3 KW - virtual reality KW - interprofessional relations KW - emergency medicine AB - 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. UR - http://games.jmir.org/2019/3/e13993/ UR - https://doi.org/10.2196/13993 UR - http://www.ncbi.nlm.nih.gov/pubmed/31397292 DO - 10.2196/13993 ID - info:doi/10.2196/13993 ER - TY - JOUR AU - Liu, Jing AU - Hou, Shengchao AU - Evans, Richard AU - Xia, Chenxi AU - Xia, Weidong AU - Ma, Jingdong PY - 2019 DA - 2019/08/07 TI - What Do Patients Complain About Online: A Systematic Review and Taxonomy Framework Based on Patient Centeredness JO - J Med Internet Res SP - e14634 VL - 21 IS - 8 KW - patient-centered care KW - delivery of health care KW - systematic review KW - taxonomy AB - 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. UR - https://www.jmir.org/2019/8/e14634/ UR - https://doi.org/10.2196/14634 UR - http://www.ncbi.nlm.nih.gov/pubmed/31392961 DO - 10.2196/14634 ID - info:doi/10.2196/14634 ER - TY - JOUR AU - Senft, Nicole AU - Everson, Jordan PY - 2018 DA - 2018/12/05 TI - eHealth Engagement as a Response to Negative Healthcare Experiences: Cross-Sectional Survey Analysis JO - J Med Internet Res SP - e11034 VL - 20 IS - 12 KW - care coordination KW - eHealth KW - health disparities KW - patient-centered care AB - 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. UR - https://www.jmir.org/2018/12/e11034/ UR - https://doi.org/10.2196/11034 UR - http://www.ncbi.nlm.nih.gov/pubmed/30518513 DO - 10.2196/11034 ID - info:doi/10.2196/11034 ER - TY - JOUR AU - Feldman, Sue S AU - Buchalter, Scott AU - Hayes, Leslie W PY - 2018 DA - 2018/06/04 TI - Health Information Technology in Healthcare Quality and Patient Safety: Literature Review JO - JMIR Med Inform SP - e10264 VL - 6 IS - 2 KW - Health Information Technology KW - Healthcare Quality KW - Patient Safety AB - 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. UR - http://medinform.jmir.org/2018/2/e10264/ UR - https://doi.org/10.2196/10264 DO - 10.2196/10264 ID - info:doi/10.2196/10264 ER - TY - JOUR AU - Khairat, Saif Sherif AU - Dukkipati, Aniesha AU - Lauria, Heather Alico AU - Bice, Thomas AU - Travers, Debbie AU - Carson, Shannon S PY - 2018 DA - 2018/05/31 TI - The Impact of Visualization Dashboards on Quality of Care and Clinician Satisfaction: Integrative Literature Review JO - JMIR Hum Factors SP - e22 VL - 5 IS - 2 KW - intensive care unit KW - visualization, Dashboard KW - cognitive load KW - information overload KW - usability KW - user interface design KW - health information technology KW - electronic health record AB - 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. UR - http://humanfactors.jmir.org/2018/2/e22/ UR - https://doi.org/10.2196/humanfactors.9328 DO - 10.2196/humanfactors.9328 ID - info:doi/10.2196/humanfactors.9328 ER - TY - JOUR AU - Daskivich, Timothy AU - Luu, Michael AU - Noah, Benjamin AU - Fuller, Garth AU - Anger, Jennifer AU - Spiegel, Brennan PY - 2018 DA - 2018/05/09 TI - Differences in Online Consumer Ratings of Health Care Providers Across Medical, Surgical, and Allied Health Specialties: Observational Study of 212,933 Providers JO - J Med Internet Res SP - e176 VL - 20 IS - 5 KW - online ratings KW - consumer ratings KW - patient satisfaction KW - digital health KW - telemedicine AB - 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. UR - http://www.jmir.org/2018/5/e176/ UR - https://doi.org/10.2196/jmir.9160 UR - http://www.ncbi.nlm.nih.gov/pubmed/29743150 DO - 10.2196/jmir.9160 ID - info:doi/10.2196/jmir.9160 ER - TY - JOUR AU - Nilsson, Ulrica AU - Dahlberg, Karuna AU - Jaensson, Maria PY - 2017 DA - 2017/12/3 TI - The Swedish Web Version of the Quality of Recovery Scale Adapted for Use in a Mobile App: Prospective Psychometric Evaluation Study JO - JMIR Mhealth Uhealth SP - e188 VL - 5 IS - 12 KW - psychometric evaluation KW - postoperative recovery KW - Web version KW - evaluation studies KW - mobile application KW - Quality of Recovery scale AB - 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. UR - http://mhealth.jmir.org/2017/12/e188/ UR - https://doi.org/10.2196/mhealth.9061 UR - http://www.ncbi.nlm.nih.gov/pubmed/29229590 DO - 10.2196/mhealth.9061 ID - info:doi/10.2196/mhealth.9061 ER - TY - JOUR AU - Miron-Shatz, Talya AU - Becker, Stefan AU - Zaromb, Franklin AU - Mertens, Alexander AU - Tsafrir, Avi PY - 2017 DA - 2017/11/02 TI - “A Phenomenal Person and Doctor”: Thank You Letters to Medical Care Providers JO - Interact J Med Res SP - e22 VL - 6 IS - 2 KW - quality of health care KW - doctor-patient relationship KW - content analysis KW - decision making KW - doctor-patient communication KW - clinical encounter KW - patient satisfaction KW - online reviews KW - patient-centered care AB - 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 (χ21, 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 (χ21, 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. UR - http://www.i-jmr.org/2017/2/e22/ UR - https://doi.org/10.2196/ijmr.7107 UR - http://www.ncbi.nlm.nih.gov/pubmed/29097353 DO - 10.2196/ijmr.7107 ID - info:doi/10.2196/ijmr.7107 ER - TY - JOUR AU - McLennan, Stuart AU - Strech, Daniel AU - Reimann, Swantje PY - 2017 DA - 2017/08/25 TI - Developments in the Frequency of Ratings and Evaluation Tendencies: A Review of German Physician Rating Websites JO - J Med Internet Res SP - e299 VL - 19 IS - 8 KW - physician rating websites KW - patient satisfaction AB - 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 Medführer) 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 (Medführer) to 1.2 (Jameda and Topmedic). (5) Only Jameda (position 317) and Medführer (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. UR - http://www.jmir.org/2017/8/e299/ UR - https://doi.org/10.2196/jmir.6599 UR - http://www.ncbi.nlm.nih.gov/pubmed/28842391 DO - 10.2196/jmir.6599 ID - info:doi/10.2196/jmir.6599 ER - TY - JOUR AU - Tran, Nam N AU - Lee, Joon PY - 2017 DA - 2017/07/12 TI - Online Reviews as Health Data: Examining the Association Between Availability of Health Care Services and Patient Star Ratings Exemplified by the Yelp Academic Dataset JO - JMIR Public Health Surveill SP - e43 VL - 3 IS - 3 KW - Yelp KW - health care access KW - health care availability KW - patient satisfaction KW - patient rating KW - patient experience KW - open hour KW - clinic hour KW - online reviews AB - 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. UR - http://publichealth.jmir.org/2017/3/e43/ UR - https://doi.org/10.2196/publichealth.7001 UR - http://www.ncbi.nlm.nih.gov/pubmed/28701293 DO - 10.2196/publichealth.7001 ID - info:doi/10.2196/publichealth.7001 ER - TY - JOUR AU - Davis, Matthew A AU - Zheng, Kai AU - Liu, Yang AU - Levy, Helen PY - 2017 DA - 2017/05/26 TI - Public Response to Obamacare on Twitter JO - J Med Internet Res SP - e167 VL - 19 IS - 5 KW - Patient Protection and Affordable Care Act KW - health care reform KW - social media KW - data collection AB - 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. UR - http://www.jmir.org/2017/5/e167/ UR - https://doi.org/10.2196/jmir.6946 UR - http://www.ncbi.nlm.nih.gov/pubmed/28550002 DO - 10.2196/jmir.6946 ID - info:doi/10.2196/jmir.6946 ER - TY - JOUR AU - Hung, Man AU - Zhang, Weiping AU - Chen, Wei AU - Bounsanga, Jerry AU - Cheng, Christine AU - Franklin, Jeremy D AU - Crum, Anthony B AU - Voss, Maren W AU - Hon, Shirley D PY - 2015 DA - 2015/09/23 TI - Patient-Reported Outcomes and Total Health Care Expenditure in Prediction of Patient Satisfaction: Results From a National Study JO - JMIR Public Health Surveill SP - e13 VL - 1 IS - 2 KW - health care quality KW - value KW - expenditure KW - cost KW - medical outcomes KW - patient satisfaction KW - Medical Expenditure Panel Survey KW - patient-reported outcomes KW - Affordable Care Act KW - big data analytics AB - 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. UR - http://publichealth.jmir.org/2015/2/e13/ UR - https://doi.org/10.2196/publichealth.4360 UR - http://www.ncbi.nlm.nih.gov/pubmed/27227131 DO - 10.2196/publichealth.4360 ID - info:doi/10.2196/publichealth.4360 ER -