1
|
Jagoda T, Rathnayake S, Dharmaratne S. Information needs and mHealth applications for carers of people with dementia in managing behavioural and psychological symptoms of care recipients: an integrative review protocol. BMJ Open 2022; 12:e060414. [PMID: 35768110 PMCID: PMC9244663 DOI: 10.1136/bmjopen-2021-060414] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION This integrative review aims to synthesise, appraise and analyse the evidence on informal carers' information needs, features and functions of available mHealth applications, and informal carers' usability and engagement with mHealth applications for managing behavioural and psychological symptoms of dementia (BPSD). METHODS AND ANALYSIS This integrative review will include quantitative, qualitative and mixed-methods studies and follow the 'Preferred Reporting for Systematic Reviews and Meta-Analyses 2020' guidelines. Peer-reviewed articles published in English from 2000 to 2021 will be included from Cochrane Library, CINHAL, Embase, MEDLINE, ProQuest and PsycINFO. Five broader concept categories will be included: 'dementia', 'behavioural and psychological symptoms', 'informal carers', '(information need' OR 'mHealth application)'. In title and abstract review, first, the researchers will independently screen 10% of sources for consensus, and one reviewer will screen the rest. In full-text review, two reviewers will conduct the screening process and assess the relevancy of the full-text articles using a two-point scale (high-low) and the methodological quality of included articles using the Mixed Methods Appraisal Tool. Narrative synthesis will be employed to synthesise themes. The findings may identify the need for planning interventions for carers of people with dementia concerning the management of BPSD. ETHICS AND DISSEMINATION Ethics approval not required. This review will be published in a peer-review journal and be presented at national and international conferences. PROSPERO REGISTRATION NUMBER CRD42021238540.
Collapse
Affiliation(s)
- Thilanka Jagoda
- Department of Nursing and Midwifery, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Sarath Rathnayake
- Department of Nursing, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | | |
Collapse
|
2
|
Does Internet Use Affect Medical Decisions among Older Adults in China? Evidence from CHARLS. Healthcare (Basel) 2021; 10:healthcare10010060. [PMID: 35052224 PMCID: PMC8775657 DOI: 10.3390/healthcare10010060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 11/29/2022] Open
Abstract
Background: The rapid growth of the elderly population poses a huge challenge for people to access medical services. The key to get rid of the dilemma is for patients to go firstly to primary medical institutions. Existing studies have identified numerous factors that can affect patients’ health institution choice. However, we currently know little about the role of Internet use in the patients’ medical decisions. The objective of this study is to explore health-seeking behavior and institution choice under the background of the Internet era from the perspective of older adults, and to analyze whether the Internet could guide patients to the appropriate medical institution so as to accomplish hierarchical treatment. Methods: The dataset comprises 9416 people aged 45 or above from the China Health and Retirement Longitudinal Survey (CHARLS), which, through multistage cluster sampling, was conducted in 2011, 2013, and 2015. Logistic regression, PSM, and FE model are used to estimate the influence of Internet use on the health care decision-making behavior. Results: Internet use has a significant positive impact on the self-treatment of common diseases (β = 0.05, p < 0.05). In terms of medical institution choices, those who use Internet are more inclined to choose top-level hospitals than community health service institutions to treat common diseases (β = 0.06, p < 0.01). Conclusions: The Internet has lowered the obstacles to learning about common ailments, resulting in a substitution impact of self-treatment for hospital care. However, Internet use may aggravate older adults’ perception of the risk of disease, which exacerbates the tendency of going to higher-level medical institutions for medical treatment. The finding of the study is useful for further rational planning and utilization of the Internet in order to guide patients to appropriate medical institution, which helps to improve the efficiency of the overall medical and health services.
Collapse
|
3
|
Eichberg DG, Epstein RH, Dexter F, Di L, Vadhan JD, Luther E, Komotar RJ. Building a Brain Tumor Practice: Objective Analysis of Referral Patterns and Implications for the Growth of a Subspecialty Surgical Program. Cureus 2020; 12:e10416. [PMID: 33062532 PMCID: PMC7550243 DOI: 10.7759/cureus.10416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Introduction Growth of surgical caseload among specialties with a large contribution margin is an important financial objective for hospitals. In this study, we examined the diversity of referral patterns to a neurosurgeon over an eight-year interval and examined practice attributes related to surgical growth. Methods The electronic records of all patients undergoing an intracranial surgical procedure between August 2011 and August 2019 by an academic neurosurgeon were reviewed retrospectively. The Herfindahl-Hirschman index (HHI) was used to assess the distribution of referrals among community physicians who referred such patients; a value of HHI <0.15 indicates diversity. The yearly HHI trend was evaluated using meta-regression. Results The neurosurgeon's brain surgery caseload progressively increased on an annual basis from 1.4 to 12.5 cases per week between 2012 and 2018. Among the 1540 cases referred by 1775 different physicians, 78% were from three counties in southeast Florida and 8.1% from two counties in southwest Florida. The HHI declined between 2013 and 2018 by 0.023 per year (0.0046 standard error [SE], p = 0.0073) with the estimated value 0.0063 (0.0014 SE) < 0.15 in 2018 (p < 0.0001). The findings indicate that the base of referring physicians was highly diverse and that growth in caseload was accompanied by significantly less concentration of referrals. Conclusion Surgical growth in the neurosurgeon's practice resulted from a small number of referrals from many physicians, not from many referrals from a small number of physicians. Few physicians referred a sufficient number of patients to warrant attribution of the referral itself to personal knowledge of their patients' eventual outcomes. Rather, factors promoting timely access to patient care appear to have been the driving force for growth.
Collapse
Affiliation(s)
- Daniel G Eichberg
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Richard H Epstein
- Anesthesiology, University of Miami Miller School of Medicine, Miami, USA
| | | | - Long Di
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Jason D Vadhan
- Neurological Surgery, College of Osteopathic Medicine, Nova Southeastern University, Miami, USA
| | - Evan Luther
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Ricardo J Komotar
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| |
Collapse
|
4
|
Ma Q, Sun D, Cui F, Zhai Y, Zhao J, He X, Shi J, Gao J, Li M, Zhang W. Impact of the Internet on Medical Decisions of Chinese Adults: Longitudinal Data Analysis. J Med Internet Res 2020; 22:e18481. [PMID: 32880581 PMCID: PMC7499166 DOI: 10.2196/18481] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 08/04/2020] [Accepted: 08/10/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The internet has caused the explosive growth of medical information and has greatly improved the availability of medical knowledge. This makes the internet one of the main ways for residents to obtain medical information and knowledge before seeking medical treatment. However, little has been researched on how the internet affects medical decisions. OBJECTIVE The purpose of this study was to explore the associations between internet behaviors and medical decisions among Chinese adults aged 18 or over, including whether to go to the hospital and which level of medical institution to choose. METHODS With the adult residents (≥18 years old) in 12 regions including urban and rural areas taken as the research objects, the differences in medical choices of adults with various characteristics were analyzed, and generalized linear mixed models were adopted to analyze the longitudinal data of the China Health Nutrition Survey from 2006 to 2015. RESULTS Adult groups with different ages, genders, education levels, regions, places of residence, severities of illness and injury, years of suffering from hypertension, and history of chronic diseases showed diverse medical decisions, and the differences were statistically significant (P<.05). After controlling for these potential confounding factors and taking self-care as the reference, the probability of Chinese adults who participated in online browsing activities selecting hospital care was 0.82 (95% CI 0.69-0.98; P=.03) times that of residents who did not participate in online browsing activities. In terms of medical institution choices, adults who participated in online browsing activities were 1.86 (95% CI 1.35-2.58; P<.001) times more likely to opt for municipal medical treatment than primary care. However, the effect of online browsing on the selection probability of county-level hospitals was not significant compared with primary hospitals (P=.59). Robust analysis verified that accessing the internet had a similar effect on Chinese adults' medical decisions. CONCLUSIONS Chinese adults who use the internet are a little less likely to go to the hospital than self-care. The internet has broken down the barriers to obtain knowledge of common diseases and thus has a slight substitution effect of self-care on hospital care. Internet use may increase the probability of adults going to municipal hospitals. The rising tendency of visiting high-level medical institutions may be consequently exacerbated due to knowledge monopoly of severe and complicated diseases that is difficult to eliminate, and the increase in inconsistent and incomplete medical information online will blur the residents' cognitive boundary of common diseases and severe diseases. Exploring the substantive impact of the internet on medical decision making is of great significance for further rational planning and utilization of the internet, in order to guide patients to appropriate medical institution.
Collapse
Affiliation(s)
- Qianqian Ma
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Dongxu Sun
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Fangfang Cui
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Yunkai Zhai
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
- School of Management Engineering, Zhengzhou University, Zhengzhou, Henan, China
| | - Jie Zhao
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Xianying He
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Jinming Shi
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Jinghong Gao
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Mingyuan Li
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Wenjie Zhang
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
| |
Collapse
|
5
|
Obtaining and Modeling Variability in Travel Times From Off-Site Satellite Clinics to Hospitals and Surgery Centers for Surgeons and Proceduralists Seeing Office Patients in the Morning and Performing a To-Follow List of Cases in the Afternoon. Anesth Analg 2020; 131:228-238. [PMID: 30998561 DOI: 10.1213/ane.0000000000004148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Hospitals achieve growth in surgical caseload primarily from the additive contribution of many surgeons with low caseloads. Such surgeons often see clinic patients in the morning then travel to a facility to do 1 or 2 scheduled afternoon cases. Uncertainty in travel time is a factor that might need to be considered when scheduling the cases of to-follow surgeons. However, this has not been studied. We evaluated variability in travel times within a city with high traffic density. METHODS We used the Google Distance Matrix application programming interface to prospectively determine driving times incorporating current traffic conditions at 5-minute intervals between 9:00 AM and 4:55 PM during the first 4 months of 2018 between 4 pairs of clinics and hospitals in the University of Miami health system. Travel time distributions were modeled using lognormal and Burr distributions and compared using the absolute and signed differences for the median and the 0.9 quantile. Differences were evaluated using 2-sided, 1-group t tests and Wilcoxon signed-rank tests. We considered 5-minute signed differences between the distributions as managerially relevant. RESULTS For the 80 studied combinations of origin-to-destination pairs (N = 4), day of week (N = 5), and the hour of departure between 10:00 AM and 1:55 PM (N = 4), the maximum difference between the median and 0.9 quantile travel time was 8.1 minutes. This contrasts with the previously published corresponding difference between the median and the 0.9 quantile of 74 minutes for case duration. Travel times were well fit by Burr and lognormal distributions (all 160 differences of medians and of 0.9 quantiles <5 minutes; P < .001). For each of the 4 origin-destination pairs, travel times at 12:00 PM were a reasonable approximation to travel times between the hours of 10:00 AM and 1:55 PM during all weekdays. CONCLUSIONS During mid-day, when surgeons likely would travel between a clinic and an operating room facility, travel time variability is small compared to case duration prediction variability. Thus, afternoon operating room scheduling should not be restricted because of concern related to unpredictable travel times by surgeons. Providing operating room managers and surgeons with estimated travel times sufficient to allow for a timely arrival on 90% of days may facilitate the scheduling of additional afternoon cases especially at ambulatory facilities with substantial underutilized time.
Collapse
|
6
|
van den Driessen Mareeuw FA, Coppus AMW, Delnoij DMJ, de Vries E. Capturing the complexity of healthcare for people with Down syndrome in quality indicators - a Delphi study involving healthcare professionals and patient organisations. BMC Health Serv Res 2020; 20:694. [PMID: 32718322 PMCID: PMC7385945 DOI: 10.1186/s12913-020-05492-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 07/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Insight into quality of healthcare for people with Down Syndrome (DS) is limited. Quality indicators (QIs) can provide this insight. This study aims to find consensus among participants regarding QIs for healthcare for people with DS. METHODS We conducted a four-round Delphi study, in which 33 healthcare professionals involved in healthcare for people with DS and two patient organisations' representatives in the Netherlands participated. Median and 75-percentiles were used to determine consensus among the answers on 5-point Likert-scales. In each round, participants received an overview of participants' answers from the previous round. RESULTS Participants agreed (consensus was achieved) that a QI-set should provide insight into available healthcare, enable healthcare improvements, and cover a large diversity of quality domains and healthcare disciplines. However, the number of QIs in the set should be limited in order to prevent registration burden. Participants were concerned that QIs would make quality information about individual healthcare professionals publicly available, which would induce judgement of healthcare professionals and harm quality, instead of improving it. CONCLUSIONS We unravelled the complexity of capturing healthcare for people with DS in a QI-set. Patients' rights to relevant information have to be carefully balanced against providers' entitlement to a safe environment in which they can learn and improve. A QI-set should be tailored to different healthcare disciplines and information systems, and measurement instruments should be suitable for collecting information from people with DS. Results from this study and two preceding studies, will form the basis for the further development of a QI-set.
Collapse
Affiliation(s)
- Francine A. van den Driessen Mareeuw
- Tranzo, Scientific Center for Care and Wellbeing, Faculty of Social and Behavioral Sciences, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
- Jeroen Bosch Hospital, PO Box 90153, 5200 ME ´s-Hertogenbosch, The Netherlands
| | - Antonia M. W. Coppus
- Department for Primary and Community Care, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
- Dichterbij, Center for the Intellectually Disabled, PO Box 9, 6590 AA Gennep, The Netherlands
| | - Diana M. J. Delnoij
- Erasmus School of Health Policy & Management, Erasmus University, PO Box, 3000, DR Rotterdam, The Netherlands
- National Health Care Institute, PO Box 320, 1110 AH Diemen, The Netherlands
| | - Esther de Vries
- Tranzo, Scientific Center for Care and Wellbeing, Faculty of Social and Behavioral Sciences, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
- Jeroen Bosch Hospital, PO Box 90153, 5200 ME ´s-Hertogenbosch, The Netherlands
| |
Collapse
|
7
|
Berger GK, Medairos R, Regala P, Jacobsohn K, Langenstroer P, See WA, Johnson SC. Factors Influencing Patient Selection of Urologists. Urology 2019; 137:19-25. [PMID: 31809771 DOI: 10.1016/j.urology.2019.08.066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/01/2019] [Accepted: 08/16/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To describe the factors affecting patients' selection of a urologist, and the utilization of the Internet and social media. MATERIALS AND METHODS All new patients presenting to a single-institution for evaluation were invited to complete an anonymous 26-item questionnaire between April 2018 and October 2018, including demographic information, use of Internet and social media resources, and relative importance of factors when selecting a urologist. Descriptive statistics were reported, and a stratified analysis was performed for age, gender, and education. RESULTS A total of 238 patients responded. More than half (53%) of patients searched their medical condition prior to presentation. When stratified by age, younger patients were 3 times as likely to utilize Internet resources (Group 1 vs Group 2; OR 3.3, 95%CI 1.5-7.2, P <.01). Few patients utilized Facebook (7%) or Twitter (1%). The 3 most important surveyed urologist selection factors included hospital reputation (4.3 ± 1.0), in-network providers (4.0 ± 1.3), and appointment availability (3.9 ± 1.0). The 3 least important included medical school attended (2.7 ± 1.3), urologist on social media (1.9 ± 1.2), and TV, radio, and/or billboard advertisements (1.7 ± 1.3). CONCLUSION This study suggests a significant proportion of patients search the Internet regarding their medical condition prior to presenting to clinic. Further, younger patients utilize this methodology significantly more than the senior population. Important factors when selecting a urologist may be driven by a hospital's reputation, in addition to scheduling convenience.
Collapse
Affiliation(s)
- Garrett K Berger
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI.
| | - Robert Medairos
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - Peter Regala
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | | | | | - William A See
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - Scott C Johnson
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
8
|
Emmert M, Kast K, Sander U. Characteristics and decision making of hospital report card consumers: Lessons from an onsite-based cross-sectional study. Health Policy 2019; 123:1061-1067. [PMID: 31383371 DOI: 10.1016/j.healthpol.2019.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/13/2019] [Accepted: 07/14/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Hospitals report cards (HRCs) have had little impact on the hospital choice of patients. Thus, health policy makers should learn more about HRC consumers to better understand how to present and target hospital-related quality information. OBJECTIVE We sought to learn more about consumers of HRCs and determine the impact of the complexity and tailoring of HRCs on the hospital choice. METHODS We used primary data drawn from an onsite-based survey, conducted in 2017 at Germany's premier portal, Weisse Liste (N = 635). We performed hierarchical multivariate logistic regression models to identify main predictors associated with hospital choices. RESULTS HRC consumers differ from the national online population and the national population in general. Eighty percent of those patients or family members, who have used a HRC before, confirmed an impact on the hospital choice. The quality of hospital choices decreased with an increasing level of complexity (p < .001); the latter was identified as a significant predictor for making good choices. However, tailoring HRCs did not have an impact on the quality of the hospital choice (p > .05). CONCLUSIONS HRCs have a significant impact on the hospital choice among report card consumers. Health policy makers might focus on decreasing the level of complexity; this, more than tailoring report cards, may help consumers make good hospital choices.
Collapse
Affiliation(s)
- Martin Emmert
- Friedrich-Alexander-University of Erlangen-Nuremberg, School of Business and Economics, Chair of Health Care Management, Lange Gasse 20, 90403 Nuremberg, Germany.
| | - Kristina Kast
- Friedrich-Alexander-University of Erlangen-Nuremberg, School of Business and Economics, Chair of Health Care Management, Lange Gasse 20, 90403 Nuremberg, Germany.
| | - Uwe Sander
- Department of Information and Communication, Faculty for Media, Information and Design, University of Applied Sciences and Arts, Expo Plaza 12, 30539 Hannover, Germany.
| |
Collapse
|
9
|
Wiegers TA, Hendriks M, Malanda U, de Boer D. Users' Experiences With Web-Based Health Care Information: Qualitative Study About Diabetes and Dementia Information Presented on a Governmental Website. J Med Internet Res 2019; 21:e11340. [PMID: 31287066 PMCID: PMC6643759 DOI: 10.2196/11340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 01/29/2019] [Accepted: 04/07/2019] [Indexed: 01/17/2023] Open
Abstract
Background Information on health and health care is abundant on the internet. To make informed choices, patients need reliable and easy-to-understand information about quality and availability of care providers and treatment options. However, the reliability of such Web-based information is difficult to assess. Objective This study aimed to test Web-based information about diabetes and dementia and specifically a new presentation format of care routes to see if people are able to understand and use the information. Methods Overall, 38 cognitive interviews were held; 20 people viewed the information about diabetes and 18 viewed the dementia information. Participants were asked what they would want to know about either diabetes or dementia, what choices they would want to make concerning their preferred care provider and treatment, and what information they would like to find to make these choices. They were then asked to view the relevant pages and comment on them. The interview was focused on general information about the condition, the care route, and the quality information for choosing a hospital. The interviews were transcribed verbatim and then systematically coded and ordered into themes. Results The themes that were developed for both Web pages during the analysis were information needs, findability, usability, comprehension and readability, recognizability, care route, quality information, and usefulness. Information needs were found to be very diverse and dependent on the personal situation and condition of the participant. Several participants were unable to find specific items because they were not where they expected them to be. Most participants were positive about the layout, font, and color scheme of the test pages. However, options of clicking through to another website and indications where information can be expanded and collapsed could be made clearer. Participants generally found the information easy to understand but felt a need for a more detailed explanation of the medical terms. Recognition of the information played an important role: participants assessed whether the information they found matched their experiences. The term care route meant little to most of the participants, but the layout of the care route itself was found to be clear. Not many respondents spontaneously went to the quality information, and a number of participants had difficulty understanding it. Overall, the participants thought the information on the website was useful and helpful. Conclusions The cognitive interviews gave numerous insights into how Web-based information is processed and understood. The care route offers a clear overview of the various stages as the condition progresses, but the name care route is not clear to everyone. We gained insight into differences between subgroups of people in terms of information needs, comprehension, and use of the information because the diversity within the group of participants was lower than expected.
Collapse
|
10
|
Rothenfluh F, Schulz PJ. Content, Quality, and Assessment Tools of Physician-Rating Websites in 12 Countries: Quantitative Analysis. J Med Internet Res 2018; 20:e212. [PMID: 29903704 PMCID: PMC6024097 DOI: 10.2196/jmir.9105] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/06/2018] [Accepted: 03/13/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Websites on which users can rate their physician are becoming increasingly popular, but little is known about the website quality, the information content, and the tools they offer users to assess physicians. This study assesses these aspects on physician-rating websites in German- and English-speaking countries. OBJECTIVE The objective of this study was to collect information on websites with a physician rating or review tool in 12 countries in terms of metadata, website quality (transparency, privacy and freedom of speech of physicians and patients, check mechanisms for appropriateness and accuracy of reviews, and ease of page navigation), professional information about the physician, rating scales and tools, as well as traffic rank. METHODS A systematic Web search based on a set of predefined keywords was conducted on Google, Bing, and Yahoo in August 2016. A final sample of 143 physician-rating websites was analyzed and coded for metadata, quality, information content, and the physician-rating tools. RESULTS The majority of websites were registered in the United States (40/143) or Germany (25/143). The vast majority were commercially owned (120/143, 83.9%), and 69.9% (100/143) displayed some form of physician advertisement. Overall, information content (mean 9.95/25) as well as quality were low (mean 18.67/47). Websites registered in the United Kingdom obtained the highest quality scores (mean 26.50/47), followed by Australian websites (mean 21.50/47). In terms of rating tools, physician-rating websites were most frequently asking users to score overall performance, punctuality, or wait time in practice. CONCLUSIONS This study evidences that websites that provide physician rating should improve and communicate their quality standards, especially in terms of physician and user protection, as well as transparency. In addition, given that quality standards on physician-rating websites are low overall, the development of transparent guidelines is required. Furthermore, attention should be paid to the financial goals that the majority of physician-rating websites, especially the ones that are commercially owned, pursue.
Collapse
Affiliation(s)
- Fabia Rothenfluh
- Institute of Communication and Health, Università della Svizzera italiana, Lugano, Switzerland
| | - Peter J Schulz
- Institute of Communication and Health, Università della Svizzera italiana, Lugano, Switzerland
| |
Collapse
|
11
|
Yaraghi N, Wang W, Gao GG, Agarwal R. How Online Quality Ratings Influence Patients' Choice of Medical Providers: Controlled Experimental Survey Study. J Med Internet Res 2018; 20:e99. [PMID: 29581091 PMCID: PMC5891665 DOI: 10.2196/jmir.8986] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 11/21/2017] [Accepted: 12/10/2017] [Indexed: 11/19/2022] Open
Abstract
Background In recent years, the information environment for patients to learn about physician quality is being rapidly changed by Web-based ratings from both commercial and government efforts. However, little is known about how various types of Web-based ratings affect individuals’ choice of physicians. Objective The objective of this research was to measure the relative importance of Web-based quality ratings from governmental and commercial agencies on individuals’ choice of primary care physicians. Methods In a choice-based conjoint experiment conducted on a sample of 1000 Amazon Mechanical Turk users in October 2016, individuals were asked to choose their preferred primary care physician from pairs of physicians with different ratings in clinical and nonclinical aspects of care provided by governmental and commercial agencies. Results The relative log odds of choosing a physician increases by 1.31 (95% CI 1.26-1.37; P<.001) and 1.32 (95% CI 1.27-1.39; P<.001) units when the government clinical ratings and commercial nonclinical ratings move from 2 to 4 stars, respectively. The relative log odds of choosing a physician increases by 1.12 (95% CI 1.07-1.18; P<.001) units when the commercial clinical ratings move from 2 to 4 stars. The relative log odds of selecting a physician with 4 stars in nonclinical ratings provided by the government is 1.03 (95% CI 0.98-1.09; P<.001) units higher than a physician with 2 stars in this rating. The log odds of selecting a physician with 4 stars in nonclinical government ratings relative to a physician with 2 stars is 0.23 (95% CI 0.13-0.33; P<.001) units higher for females compared with males. Similar star increase in nonclinical commercial ratings increases the relative log odds of selecting the physician by female respondents by 0.15 (95% CI 0.04-0.26; P=.006) units. Conclusions Individuals perceive nonclinical ratings provided by commercial websites as important as clinical ratings provided by government websites when choosing a primary care physician. There are significant gender differences in how the ratings are used. More research is needed on whether patients are making the best use of different types of ratings, as well as the optimal allocation of resources in improving physician ratings from the government’s perspective.
Collapse
Affiliation(s)
- Niam Yaraghi
- Department of Operations and Information Management, University of Connecticut, Stamford, CT, United States.,Center for Technology Innovation, The Brookings Institution, Washington, DC, United States
| | - Weiguang Wang
- Department of Decision, Operations and Information Technologies, Robert H Smith School of Business, University of Maryland at College Park, College Park, MD, United States
| | - Guodong Gordon Gao
- Department of Decision, Operations and Information Technologies, Robert H Smith School of Business, University of Maryland at College Park, College Park, MD, United States
| | - Ritu Agarwal
- Department of Decision, Operations and Information Technologies, Robert H Smith School of Business, University of Maryland at College Park, College Park, MD, United States
| |
Collapse
|
12
|
Years Versus Days Between Successive Surgeries, After an Initial Outpatient Procedure, for the Median Patient Versus the Median Surgeon in the State of Iowa. Anesth Analg 2018; 126:787-793. [DOI: 10.1213/ane.0000000000002774] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|