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Benda N, Woode S, Niño de Rivera S, Kalish RB, Riley LE, Hermann A, Masterson Creber R, Costa Pimentel E, Ancker JS. Understanding Symptom Self-Monitoring Needs Among Postpartum Black Patients: Qualitative Interview Study. J Med Internet Res 2024; 26:e47484. [PMID: 38669066 DOI: 10.2196/47484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 02/20/2024] [Accepted: 03/08/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Pregnancy-related death is on the rise in the United States, and there are significant disparities in outcomes for Black patients. Most solutions that address pregnancy-related death are hospital based, which rely on patients recognizing symptoms and seeking care from a health system, an area where many Black patients have reported experiencing bias. There is a need for patient-centered solutions that support and encourage postpartum people to seek care for severe symptoms. OBJECTIVE We aimed to determine the design needs for a mobile health (mHealth) patient-reported outcomes and decision-support system to assist Black patients in assessing when to seek medical care for severe postpartum symptoms. These findings may also support different perinatal populations and minoritized groups in other clinical settings. METHODS We conducted semistructured interviews with 36 participants-15 (42%) obstetric health professionals, 10 (28%) mental health professionals, and 11 (31%) postpartum Black patients. The interview questions included the following: current practices for symptom monitoring, barriers to and facilitators of effective monitoring, and design requirements for an mHealth system that supports monitoring for severe symptoms. Interviews were audio recorded and transcribed. We analyzed transcripts using directed content analysis and the constant comparative process. We adopted a thematic analysis approach, eliciting themes deductively using conceptual frameworks from health behavior and human information processing, while also allowing new themes to inductively arise from the data. Our team involved multiple coders to promote reliability through a consensus process. RESULTS Our findings revealed considerations related to relevant symptom inputs for postpartum support, the drivers that may affect symptom processing, and the design needs for symptom self-monitoring and patient decision-support interventions. First, participants viewed both somatic and psychological symptom inputs as important to capture. Second, self-perception; previous experience; sociocultural, financial, environmental, and health systems-level factors were all perceived to impact how patients processed, made decisions about, and acted upon their symptoms. Third, participants provided recommendations for system design that involved allowing for user control and freedom. They also stressed the importance of careful wording of decision-support messages, such that messages that recommend them to seek care convey urgency but do not provoke anxiety. Alternatively, messages that recommend they may not need care should make the patient feel heard and reassured. CONCLUSIONS Future solutions for postpartum symptom monitoring should include both somatic and psychological symptoms, which may require combining existing measures to elicit symptoms in a nuanced manner. Solutions should allow for varied, safe interactions to suit individual needs. While mHealth or other apps may not be able to address all the social or financial needs of a person, they may at least provide information, so that patients can easily access other supportive resources.
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Affiliation(s)
- Natalie Benda
- School of Nursing, Columbia University, New York, NY, United States
| | - Sydney Woode
- Department of Radiology, Early Lung and Cardiac Action Program, The Mount Sinai Health System, New York, NY, United States
| | | | - Robin B Kalish
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, United States
| | - Laura E Riley
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, United States
| | - Alison Hermann
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, United States
| | | | - Eric Costa Pimentel
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
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Flory J, Ancker JS, Kim SYH, Kuperman G, Vickers A. Decision architecture randomisation: extremely efficient clinical trials that preserve clinician and patient choice? BMJ Evid Based Med 2024; 29:71-74. [PMID: 37479243 DOI: 10.1136/bmjebm-2023-112386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 07/23/2023]
Affiliation(s)
- James Flory
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | | - Gilad Kuperman
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andrew Vickers
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Ancker JS, Benda NC, Zikmund-Fisher BJ. Do you want to promote recall, perceptions, or behavior? The best data visualization depends on the communication goal. J Am Med Inform Assoc 2024; 31:525-530. [PMID: 37468448 PMCID: PMC10797268 DOI: 10.1093/jamia/ocad137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/27/2023] [Accepted: 07/08/2023] [Indexed: 07/21/2023] Open
Abstract
Data visualizations can be effective and inclusive means for helping people understand health-related data. Yet numerous high-quality studies comparing data visualizations have yielded relatively little practical design guidance because of a lack of clarity about what communicators want their audience to accomplish. When conducting rigorous evaluations of communication (eg, applying the ISO 9186 method), describing the process simply as evaluating "comprehension" or "interpretation" of visualizations fails to do justice to the true range of outcomes being studied. We present newly developed taxonomies of outcome measures and tasks that are guiding a large-scale systematic review of the health numbers communication literature. Using these taxonomies allows a designer to determine whether a specific data presentation format or feature supports or inhibits the desired audience cognitions, feelings, or behaviors. We argue that taking a granular, outcomes-based approach to designing and evaluating information visualization research is essential to deriving practical, actionable knowledge from it.
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Affiliation(s)
- Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natalie C Benda
- School of Nursing, Columbia University, New York, New York, USA
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Wang CP, Mkuu R, Andreadis K, Muellers KA, Ancker JS, Horowitz C, Kaushal R, Lin JJ. Examining and Addressing Telemedicine Disparities Through the Lens of the Social Determinants of Health: A Qualitative Study of Patient and Provider During the COVID-19 Pandemic. AMIA Annu Symp Proc 2024; 2023:1287-1296. [PMID: 38222380 PMCID: PMC10785927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Accelerated use of telemedicine during the COVID-19 pandemic enabled uninterrupted healthcare delivery while unmasking care disparities for several vulnerable communities. The social determinants of health (SDOH) serve as a critical model for understanding how the circumstances in which people are born, work, and live impact health outcomes. We performed semi-structured interviews to understand patients and providers' experiences with telemedicine encounters during the COVID-19 pandemic. Through a deductive approach, we applied the SDOH to determine telemedicine's role and impact within this framework. Overall, patient and provider interviews supported the use of existing SDOH domains to describe disparities in Internet access and telemedicine use, rather than reframing technology as a sixth SDOH. In order to mitigate the digital divide, we identify and propose solutions that address SDOH-related barriers that shape the use of health information technologies.
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Affiliation(s)
| | | | - Katerina Andreadis
- NYU Grossman School of Medicine, New York City, NY
- Weill Cornell Medicine, New York City, NY
| | - Kimberly A Muellers
- Icahn School of Medicine at Mount Sinai, New York City, NY
- Pace University, New York City, NY
| | | | - Carol Horowitz
- Icahn School of Medicine at Mount Sinai, New York City, NY
| | | | - Jenny J Lin
- Icahn School of Medicine at Mount Sinai, New York City, NY
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Suresh U, Ancker JS, Zikmund-Fisher BJ, Benda NC. Designing Support to help Health Communication Professionals Convey Numbers Clearly to the Public - A Needs Assessment and Formative Usability Evaluation. AMIA Annu Symp Proc 2024; 2023:1277-1286. [PMID: 38222428 PMCID: PMC10785911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Communicating health-related probabilities to patients and the public presents challenges, although multiple studies have demonstrated that we can promote comprehension and appropriate application of numbers by matching presentation formats (e.g., percentage, bar charts, icon arrays) to communication goal (e.g., improving recall, decreasing worry, taking action). We used this literature to create goal-driven, evidence-based guidance to support health communicators in conveying probabilities. We then conducted semi-structured interviews with 39 health communicators to understand: communicators' goals for expressing probabilities, formats they choose to convey probabilities, and perceptions of prototypes of our "communicating numbers clearly" guidance. We found that communicators struggled to articulate granular goals for their communication, impeding their ability to select appropriate guidance. Future work should consider how best to support health communicators in selecting granular, differentiable goals to support broadly comprehensible information design.
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Affiliation(s)
- Uday Suresh
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, Department of Internal Medicine, and the Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
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Yu J, Andreadis K, Schpero WL, Abedian S, Kaushal R, Ancker JS. Patient Experiences with and Preferences for Telemedicine Relative to In-Person Care During the COVID-19 Pandemic. Telemed J E Health 2024; 30:67-76. [PMID: 37219992 DOI: 10.1089/tmj.2022.0311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Introduction: Although telemedicine emerged during the COVID-19 pandemic as a critical mode of health care delivery, there may be differences in the perceived ease of patient-clinician communication and quality of care for telemedicine versus in-person visits, as well as variation in perceptions across patient subgroups. We examined patients' experiences with and preferences for telemedicine relative to in-person care, based on their most recent visit. Methods: We conducted a survey of 2,668 adults in a large academic health care system in November 2021. The survey captured patients' reasons for their most recent visit, perceptions on patient-clinician communication and quality of care, and attitudes toward telemedicine versus in-person care. Results: Among respondents, 552 (21%) had a telemedicine visit. Patients with telemedicine and in-person visits had similar agreement on ease of patient-clinician communication and perceived quality of the visit on average. However, for individuals 65 years of age or older, men, and those not needing urgent care, telemedicine was associated with worse perceptions of patient-clinician communication (65 years of age or older: adjusted odds ratio [aOR], 0.51; 95% confidence interval [CI], 0.31-0.85; men: aOR, 0.50; 95% CI, 0.31-0.81; urgent care: aOR 0.67; 95% CI, 0.49-0.91) and lower perceived quality (65 years of age or older, aOR 0.51; 95% CI, 0.30-0.86; men: 0.51; 95% CI, 0.32-0.83; urgent care: aOR 0.68; 95% CI, 0.49-0.93). Conclusion: Patient-perceived quality of care and patient-clinician communication were similar for telemedicine and in-person visits overall. However, among men, older adults, and those not seeking urgent care, patients using telemedicine had lower perceptions of patient-clinician communication and quality.
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Affiliation(s)
- Jiani Yu
- Department of Population Health Sciences and Weill Cornell Medical College, New York, New York, USA
| | - Katerina Andreadis
- Department of Population Health Sciences and Weill Cornell Medical College, New York, New York, USA
| | - William L Schpero
- Department of Population Health Sciences and Weill Cornell Medical College, New York, New York, USA
| | - Sajjad Abedian
- Information Technologies and Services Department, Weill Cornell Medical College, New York, New York, USA
| | - Rainu Kaushal
- Department of Population Health Sciences and Weill Cornell Medical College, New York, New York, USA
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Cho LD, Rabinowitz G, Goytia C, Andreadis K, Huang HH, Benda NC, Lin JJ, Horowitz C, Kaushal R, Ancker JS, Poeran J. Development of a novel instrument to characterize telemedicine programs in primary care. BMC Health Serv Res 2023; 23:1274. [PMID: 37978511 PMCID: PMC10657014 DOI: 10.1186/s12913-023-10130-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/08/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Given the rapid deployment of telemedicine at the onset of the COVID - 19 pandemic, updated assessment methods are needed to study and characterize telemedicine programs. We developed a novel semi - structured survey instrument to systematically describe the characteristics and implementation processes of telemedicine programs in primary care. METHODS In the context of a larger study aiming to describe telemedicine programs in primary care, a survey was developed in 3 iterative steps: 1) literature review to obtain a list of telemedicine features, facilitators, and barriers; 2) application of three evaluation frameworks; and 3) stakeholder engagement through a 2-stage feedback process. During survey refinement, items were tested against the evaluation frameworks while ensuring it could be completed within 20-25 min. Data reduction techniques were applied to explore opportunity for condensed variables/items. RESULTS Sixty initially identified telemedicine features were reduced to 32 items / questions after stakeholder feedback. Per the life cycle framework, respondents are asked to report a month in which their telemedicine program reached a steady state, i.e., "maturation". Subsequent questions on telemedicine features are then stratified by telemedicine services offered at the pandemic onset and the reported point of maturation. Several open - ended questions allow for additional telemedicine experiences to be captured. Data reduction techniques revealed no indication for data reduction. CONCLUSION This 32-item semi-structured survey standardizes the description of primary care telemedicine programs in terms of features as well as maturation process. This tool will facilitate evaluation of and comparisons between telemedicine programs across the United States, particularly those that were deployed at the pandemic onset.
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Affiliation(s)
- Logan D Cho
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA
| | - Grace Rabinowitz
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA
| | - Crispin Goytia
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue Box 1077, New York, NY, 10029, USA
| | - Katerina Andreadis
- Department of Population Health Sciences, Weill Cornell Medical College, 402 E. 67Th Street, New York, NY, 10065, USA
| | - Hsin-Hui Huang
- Institute for Healthcare Delivery Science, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue Box 1077, New York, NY, 10029, USA
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue Box 1077, New York, NY, 10029, USA
| | - Natalie C Benda
- Department of Population Health Sciences, Weill Cornell Medical College, 402 E. 67Th Street, New York, NY, 10065, USA
| | - Jenny J Lin
- Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, 17 E. 102nd Street Box 1087, New York, NY, 10029, USA
| | - Carol Horowitz
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue Box 1077, New York, NY, 10029, USA
| | - Rainu Kaushal
- Department of Population Health Sciences, Weill Cornell Medical College, 402 E. 67Th Street, New York, NY, 10065, USA
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Ave., Rm 14122, Nashville, TN, USA
| | - Jashvant Poeran
- Institute for Healthcare Delivery Science, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue Box 1077, New York, NY, 10029, USA.
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue Box 1077, New York, NY, 10029, USA.
- Department of Medicine, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue Box 1077, New York, NY, 10029, USA.
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Salwei ME, Ancker JS, Weinger MB. The decision aid is the easy part: workflow challenges of shared decision making in cancer care. J Natl Cancer Inst 2023; 115:1271-1277. [PMID: 37421403 DOI: 10.1093/jnci/djad133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/07/2023] [Accepted: 06/27/2023] [Indexed: 07/10/2023] Open
Abstract
Delivering high-quality, patient-centered cancer care remains a challenge. Both the National Academy of Medicine and the American Society of Clinical Oncology recommend shared decision making to improve patient-centered care, but widespread adoption of shared decision making into clinical care has been limited. Shared decision making is a process in which a patient and the patient's health-care professional weigh the risks and benefits of different options and come to a joint decision on the best course of action for that patient on the basis of their values, preferences, and goals for care. Patients who engage in shared decision making report higher quality of care, whereas patients who are less involved in these decisions have statistically significantly higher decisional regret and are less satisfied. Decision aids can improve shared decision making-for example, by eliciting patient values and preferences that can then be shared with clinicians and by providing patients with information that may influence their decisions. However, integrating decision aids into the workflows of routine care is challenging. In this commentary, we explore 3 workflow-related barriers to shared decision making: the who, when, and how of decision aid implementation in clinical practice. We introduce readers to human factors engineering and demonstrate its potential value to decision aid design through a case study of breast cancer surgical treatment decision making. By better employing the methods and principles of human factors engineering, we can improve decision aid integration, shared decision making, and ultimately patient-centered cancer outcomes.
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Affiliation(s)
- Megan E Salwei
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew B Weinger
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
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Raffa BJ, Muellers KA, Andreadis K, Ancker JS, Flower KB, Horowitz CR, Kaushal R, Lin JJ. A Qualitative Study on Using Telemedicine for Precepting and Teaching in the Academic Setting. Acad Med 2023; 98:1204-1210. [PMID: 37279450 DOI: 10.1097/acm.0000000000005291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To examine the impact of telemedicine use on precepting and teaching among preceptors and patients during the COVID-19 pandemic. METHOD The authors conducted a secondary analysis of a qualitative study focusing on providers' and patients' experiences with and attitudes toward telemedicine at 4 academic health centers. Teaching and precepting were emergent codes from the data and organized into themes. Themes were mapped to domains from the 2009 Consolidated Framework for Implementation Research (CFIR), a framework that assists with effective implementation and consists of 5 domains: intervention characteristics, outer settings, inner settings, characteristics of individuals, and process. RESULTS In total, 86 interviews were conducted with 65 patients and 21 providers. Nine providers and 3 patients recounted descriptions related to teaching and precepting with telemedicine. Eight themes were identified, mapping across all 5 CFIR domains, with the majority of themes (n = 6) within the domains of characteristics of individuals, processes, and intervention characteristics. Providers and patients described how a lack of prepandemic telemedicine experience and inadequate processes in place to precept and teach with telemedicine affected the learning environment and perceived quality of care. They also discussed how telemedicine exacerbated existing difficulties in maintaining resident continuity. Providers described ways communication changed with telemedicine use during the pandemic, including having to wear masks while in the same room as the trainee and sitting closely to remain within range of the camera, as well as the benefit of observing trainees with the attending's camera off. Providers expressed a lack of protected structure and time for teaching and supervising with telemedicine, and a general view that telemedicine is here to stay. CONCLUSIONS Efforts should focus on increasing knowledge of telemedicine skills and improving processes to implement telemedicine in the teaching setting in order to best integrate it into undergraduate and graduate medical education.
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Affiliation(s)
- Brittany J Raffa
- B.J. Raffa is clinical instructor and NRSA Primary Care Research Fellow, Department of Pediatrics, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kimberly A Muellers
- K.A. Muellers is a clinical research coordinator, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, and a PhD student, Department of Psychology, Pace University, New York, New York
| | - Katerina Andreadis
- K. Andreadis is a PhD student, Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Jessica S Ancker
- J.S. Ancker is professor and vice chair for educational affairs, Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kori B Flower
- K.B. Flower is professor and division chief, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Carol R Horowitz
- C.R. Horowitz is founding director, Institute for Health Equity Research, and professor, Division of General Internal Medicine and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rainu Kaushal
- R. Kaushal is senior associate dean of clinical research, Nanette Laitman Distinguished Professor, and chair, Department of Population Health Sciences, Weill Cornell Medicine, and physician-in-chief, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jenny J Lin
- J.J. Lin is professor, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Steitz BD, Padi-Adjirackor NA, Griffith KN, Reese TJ, Rosenbloom ST, Ancker JS. Impact of notification policy on patient-before-clinician review of immediately released test results. J Am Med Inform Assoc 2023; 30:1707-1710. [PMID: 37403329 PMCID: PMC10531100 DOI: 10.1093/jamia/ocad126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023] Open
Abstract
The 21st Century Cures Act mandates immediate availability of test results upon request. The Cures Act does not require that patients be informed of results, but many organizations send notifications when results become available. Our medical center implemented 2 sequential policies: immediate notifications for all results, and notifications only to patients who opt in. We used over 2 years of data from Vanderbilt University Medical Center to measure the effect of these policies on rates of patient-before-clinician result review and patient-initiated messaging using interrupted time series analysis. When releasing test results with immediate notification, the proportion of patient-before-clinician review increased 4-fold and the proportion of patients who sent messages rose 3%. After transition to opt-in notifications, patient-before-clinician review decreased 2.4% and patient-initiated messaging decreased 0.4%. Replacing automated notifications with an opt-in policy provides patients flexibility to indicate their preferences but may not substantially alleviate clinicians' messaging workload.
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Affiliation(s)
- Bryan D Steitz
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Kevin N Griffith
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Thomas J Reese
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - S Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Reynolds TL, Cobb JG, Steitz BD, Ancker JS, Rosenbloom ST. The State-of-the-Art of Patient Portals: Adapting to External Factors, Addressing Barriers, and Innovating. Appl Clin Inform 2023; 14:654-669. [PMID: 37611795 PMCID: PMC10446914 DOI: 10.1055/s-0043-1770901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/26/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Recent external factors-the 21st Century Cures Act and the coronavirus disease 2019 (COVID-19) pandemic-have stimulated major changes in the patient portal landscape. The objective of this state-of-the-art review is to describe recent developments in the patient portal literature and to identify recommendations and future directions for the design, implementation, and evaluation of portals. METHODS To focus this review on salient contemporary issues, we elected to center it on four topics: (1) 21st Century Cures Act's impact on patient portals (e.g., Open Notes); (2) COVID-19's pandemic impact on portals; (3) proxy access to portals; and (4) disparities in portal adoption and use. We conducted targeted PubMed searches to identify recent empirical studies addressing these topics, used a two-part screening process to determine relevance, and conducted thematic analyses. RESULTS Our search identified 174 unique papers, 74 were relevant empirical studies and included in this review. Among these papers, we identified 10 themes within our four a priori topics, including preparing for and understanding the consequences of increased patient access to their electronic health information (Cures Act); developing, deploying, and evaluating new virtual care processes (COVID-19); understanding current barriers to formal proxy use (proxy access); and addressing disparities in portal adoption and use (disparities). CONCLUSION Our results suggest that the recent trends toward understanding the implications of immediate access to most test results, exploring ways to close gaps in portal adoption and use among different sub-populations, and finding ways to leverage portals to improve health and health care are the next steps in the maturation of patient portals and are key areas that require more research. It is important that health care organizations share their innovative portal efforts, so that successful measures can be tested in other contexts, and progress can continue.
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Affiliation(s)
- Tera L. Reynolds
- Department of Information Systems, University of Maryland, Baltimore County, Baltimore, Maryland, United States
| | - Jared Guthrie Cobb
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Bryan D. Steitz
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Jessica S. Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - S. Trent Rosenbloom
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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12
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McCready TM, Stabile C, Vickers A, Ancker JS, Pusic A, Temple LK, Simon BA, Carter J. A Remote Symptom Monitoring Tool As Part of Ambulatory Cancer Surgery Recovery: A Qualitative Analysis of Patient Experience. JCO Oncol Pract 2023; 19:595-601. [PMID: 37235840 PMCID: PMC10424896 DOI: 10.1200/op.23.00017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/06/2023] [Accepted: 04/12/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE Patients recovering from ambulatory cancer surgery at home may find it difficult to determine whether their postoperative symptoms are normal or potentially serious. We developed the Recovery Tracker to help patients navigate such issues. The Recovery Tracker is a 10-day, web-based electronic survey that monitors symptoms daily and provides feedback as to whether reported symptoms are expected or require follow-up. We sought to examine patient perceptions using this tool. METHODS Semistructured interviews were conducted from August 2017 to September 2019 with a convenience sample of patients from a larger randomized controlled trial of the Recovery Tracker. Patients undergoing surgery at an ambulatory cancer center dedicated to the surgical treatment of breast, gynecologic, urologic, head, and neck cancers and benign tumors were included. Thematic analysis was applied to derive key themes and codes via NVivo qualitative analysis software. Recruitment was conducted iteratively until thematic saturation. RESULTS Forty-three patients were interviewed. Interview responses were organized into five main themes: (1) The Recovery Tracker led to more seamless communication with the care team; (2) symptoms not expected or not listed on the Recovery Tracker caused stress; (3) the Recovery Tracker was perceived as an extension of care, prompting reflection about symptoms and recovery; (4) Enhanced Feedback provided reassurance and helped set expectations; and (5) the Recovery Tracker was easy to use. CONCLUSION The patient experience of electronic symptom monitoring and feedback is congruent with the aims of such monitoring and feedback. Further qualitative research is required in more diverse populations.
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Affiliation(s)
- Taylor M. McCready
- Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, NY
- Current Address: Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Cara Stabile
- Department of Surgery, Gynecology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jessica S. Ancker
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN
| | - Andrea Pusic
- Department of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard University, Boston, MA
| | - Larissa K.F. Temple
- Department of Surgery, Colorectal Surgery Division, University of Rochester Medical Center, Rochester, NY
| | - Brett A. Simon
- Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY
| | - Jeanne Carter
- Department of Surgery, Gynecology Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Psychiatry, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Psychology, Weill Cornell Medical College, New York, NY
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13
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Hersh WR, Hoyt RE, Chamberlin S, Ancker JS, Gupta A, Borlawsky-Payne TB. Beyond mathematics, statistics, and programming: data science, machine learning, and artificial intelligence competencies and curricula for clinicians, informaticians, science journalists, and researchers. Health Syst (Basingstoke) 2023; 12:255-263. [PMID: 37860593 PMCID: PMC10583607 DOI: 10.1080/20476965.2023.2237745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/09/2023] [Indexed: 10/21/2023] Open
Abstract
Data science, machine learning and artificial intelligence applications impact clinicians, informaticians, science journalists, and researchers. Most biomedical data science training focuses on learning a programming language in addition to higher mathematics and advanced statistics. This approach is appropriate for graduate students but greatly reduces the number of individuals in healthcare who can be involved in data science. To serve these four stakeholder audiences, we describe several curricular strategies focusing on solving real problems of interest to these audiences. Relevant competencies for these audiences include using intuitive programming tools that facilitate data exploration with minimal programming background, creating data models, evaluating results of data analyses, and assessing data science research reports, among others. Offering the curricula described here more broadly could broaden the stakeholder groups knowledgeable about and engaged in data science.
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Affiliation(s)
- William R. Hersh
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Robert E. Hoyt
- Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Steven Chamberlin
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Jessica S. Ancker
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA
| | - Aditi Gupta
- Institute for Informatics, Washington University, St. Louis, MO, USA
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14
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Kern LM, Aucapina JE, Jacobson A, Kelly T, Ringel JB, Shen MJ, Ancker JS, Rodriguez NV. Building research capacity in primary care practices that serve predominantly racial and ethnic minority populations. Am J Manag Care 2023; 29:280-282. [PMID: 37341974 DOI: 10.37765/ajmc.2023.89368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Primary care research represents only 1% of all federally funded projects. However, innovation in primary care is central to advancing health care delivery. Indeed, leaders in health care innovation recently called for primary care payment reform proposals to be tested in accountable care organizations (ACOs) consisting of independent practices (ie, practices not owned by hospitals). Yet these same practices may have less experience with the kind of systematic innovation that leads to generalizable insights, because what little funding is available for primary care research is mostly awarded to large academic medical centers. In this commentary, we report on lessons learned over 2 years (2020-2022) from conducting primary care research through a novel alliance of an ACO consisting of independent practices, a health plan, and several academic researchers, with the support of a private foundation. This collaboration is also notable because it was specifically assembled to address racial and ethnic inequities in the midst of the COVID-19 pandemic.
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Affiliation(s)
- Lisa M Kern
- Weill Cornell Medicine, 420 E 70th St, Box 331, New York, NY 10021.
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15
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Rabinowitz G, Cho LD, Benda NC, Goytia C, Andreadis K, Lin JJ, Horowitz C, Kaushal R, Ancker JS, Poeran J. The Telemedicine Experience in Primary Care Practices in the United States: Insights From Practice Leaders. Ann Fam Med 2023; 21:207-212. [PMID: 37217324 PMCID: PMC10202513 DOI: 10.1370/afm.2967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/22/2022] [Accepted: 12/01/2022] [Indexed: 05/24/2023] Open
Abstract
PURPOSE The need to rapidly implement telemedicine in primary care during the coronavirus disease 2019 (COVID-19) pandemic was addressed differently by various practices. Using qualitative data from semistructured interviews with primary care practice leaders, we aimed to report commonly shared experiences and unique perspectives regarding telemedicine implementation and evolution/maturation since March 2020. METHODS We administered a semistructured, 25-minute, virtual interview with 25 primary care practice leaders from 2 health systems in 2 states (New York and Florida) included in PCORnet, the Patient-Centered Outcomes Research Institute clinical research network. Questions were guided by 3 frameworks (health information technology evaluation, access to care, and health information technology life cycle) and involved practice leaders' perspectives on the process of telemedicine implementation in their practice, with a specific focus on the process of maturation and facilitators/barriers. Two researchers conducted inductive coding of qualitative data open-ended questions to identify common themes. Transcripts were electronically generated by virtual platform software. RESULTS Twenty-five interviews were administered for practice leaders representing 87 primary care practices in 2 states. We identified the following 4 major themes: (1) the ease of telemedicine adoption depended on both patients' and clinicians' prior experience using virtual health platforms, (2) regulation of telemedicine varied across states and differentially affected the rollout processes, (3) visit triage rules were unclear, and (4) there were positive and negative effects of telemedicine on clinicians and patients. CONCLUSIONS Practice leaders identified several challenges to telemedicine implementation and highlighted 2 areas, including telemedicine visit triage guidelines and telemedicine-specific staffing and scheduling protocols, for improvement.
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Affiliation(s)
- Grace Rabinowitz
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Logan D Cho
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Natalie C Benda
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Crispin Goytia
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Katerina Andreadis
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Jenny J Lin
- Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Carol Horowitz
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rainu Kaushal
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jashvant Poeran
- Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Institute for Healthcare Delivery Science, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, New York
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16
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Andreadis K, Muellers K, Ancker JS, Horowitz C, Kaushal R, Lin JJ. Telemedicine Impact on the Patient-Provider Relationship in Primary Care During the COVID-19 Pandemic. Med Care 2023; 61:S83-S88. [PMID: 36893423 PMCID: PMC9994565 DOI: 10.1097/mlr.0000000000001808] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND The COVID-19 pandemic has necessitated a rapid uptake of telemedicine in primary care requiring both patients and providers to learn how to navigate care remotely. This change can impact the patient-provider relationship that often defines care, especially in primary care. OBJECTIVE This study aims to provide insight into the experiences of patients and providers with telemedicine during the pandemic, and the impact it had on their relationship. RESEARCH DESIGN A qualitative study using thematic analysis of semistructured interviews. SUBJECTS Primary care providers (n=21) and adult patients (n=65) with chronic disease across primary care practices in 3 National Patient-centered Clinical Research Network sites in New York City, North Carolina, and Florida. MEASURES Experiences with telemedicine during the COVID-19 pandemic in primary care. Codes related to the patient-provider relationship were analyzed for this study. RESULTS A recurrent theme was the challenge telemedicine posed on rapport building and alliance. Patients felt that telemedicine affected provider's attentiveness in varying ways, whereas providers appreciated that telemedicine provided unique insight into patients' lives and living situations. Finally, both patients and providers described communication challenges. CONCLUSIONS Telemedicine has altered structure and process aspects of primary health care such as the physical spaces of encounters, creating a new setting to which both patients and providers must adjust. It is important to recognize the opportunities and limits that this new technology has to help providers maintain the type of one-on-one attention that patients expect and that contributes to relationship building.
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Affiliation(s)
- Katerina Andreadis
- Department of Population Health Sciences, Weill Cornell Medicine
- New York University Grossman School of Medicine, New York, NY
| | - Kimberly Muellers
- Pace University, New York, NY
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Rainu Kaushal
- Department of Population Health Sciences, Weill Cornell Medicine
| | - Jenny J. Lin
- Icahn School of Medicine at Mount Sinai, New York, NY
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17
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Khairat S, Chourasia P, Muellers KA, Andreadis K, Lin JJ, Ancker JS. Patient and Provider Recommendations for Improved Telemedicine User Experience in Primary Care: A Multi-Center Qualitative Study. Telemed Rep 2023; 4:21-29. [PMID: 36950478 PMCID: PMC10027343 DOI: 10.1089/tmr.2023.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE The purpose of this study was to explore telemedicine use and obtain actionable recommendations to improve telemedicine user experience from a diverse group of patients and providers. METHODS We interviewed adult patients and primary care providers (PCPs) across three National Patient-Centered Clinical Research Network (PCORnet) sites in New York City, North Carolina, and Florida. Both patients and providers could participate via phone or videoconferencing; patients could complete the interview in English or Spanish. Spanish interviews were conducted by a member of the research team who spoke Spanish fluently. Interviews were audio-recorded, transcribed verbatim, and when necessary, professionally translated. RESULTS We interviewed 21 PCPs and 65 patients between March and October 2021. We found that patients' and providers' perspectives on ways to improve the telemedicine experience focused on three recommendation themes: (1) expectations of care provided via telemedicine, (2) innovations to support usability, and (3) alleviation of physician burden. Key recommendations were related to expectations regarding (1) care provided, for example, adding educational content for the patients, and clarity about long-term payment models; (2) support innovation to improve telemedicine usability, for example, providing patients with remote monitoring devices, integrating in-home testing and nursing evaluation; (3) and reduce physician burden, for example, virtual rooming, reimbursement of time spent outside of the telemedicine encounter. DISCUSSION Primary care patients and providers see merit in telemedicine. However, both groups recommended novel ways to improve the quality of care and user experience. Findings from this article suggest that policymakers would be best served by addressing current gaps in patient digital literacy by creating technical support strategies, and gaps in telemedicine reimbursement to present an equitable form of payment.
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Affiliation(s)
- Saif Khairat
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- School of Nursing, University of North Carolina at Chapel Hill, North Carolina, USA
- Sheps G. Cecil Center for Health Services Research, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Prabal Chourasia
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kimberly A. Muellers
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Psychology, Pace University, New York, New York, USA
| | - Katerina Andreadis
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Jenny J. Lin
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jessica S. Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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18
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Yu J, Yun H, Unruh MA, O'Donnell EM, Katz PR, Ancker JS, Jung HY. Perspectives of Physicians with Experience in Nursing Home Care on Telehealth Use During the COVID-19 Public Health Emergency. J Gen Intern Med 2023; 38:1722-1728. [PMID: 36913142 PMCID: PMC10010241 DOI: 10.1007/s11606-023-08087-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/07/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Despite expanded access to telehealth services for Medicare beneficiaries in nursing homes (NHs) during the COVID-19 public health emergency, information on physicians' perspectives on the feasibility and challenges of telehealth provision for NH residents is lacking. OBJECTIVE To examine physicians' perspectives on the appropriateness and challenges of providing telehealth in NHs. PARTICIPANTS Medical directors or attending physicians in NHs. APPROACH We conducted 35 semistructured interviews with members of the American Medical Directors Association from January 18 through January 29, 2021. Outcomes of the thematic analysis reflected perspectives of physicians experienced in NH care on telehealth use. MAIN MEASURES The extent to which participants used telehealth in NHs, the perceived value of telehealth for NH residents, and barriers to telehealth provision. KEY RESULTS Participants included 7 (20.0%) internists, 8 (22.9%) family physicians, and 18 (51.4%) geriatricians. Five common themes emerged: (1) direct care is needed to adequately care for residents in NHs; (2) telehealth may allow physicians to reach NH residents more flexibly during offsite hours and other scenarios when physicians cannot easily reach patients; (3) NH staff and other organizational resources are critical to the success of telehealth, but staff time is a major barrier to telehealth provision; (4) appropriateness of telehealth in NHs may be limited to certain resident populations and/or services; (5) conflicting views about whether telehealth use will be sustained over time in NHs. Subthemes included the role of resident-physician relationships in facilitating telehealth and the appropriateness of telehealth for residents with cognitive impairment. CONCLUSIONS Participants had mixed views on the effectiveness of telehealth in NHs. Staff resources to facilitate telehealth and the limitations of telehealth for NH residents were the most raised issues. These findings suggest that physicians in NHs may not view telehealth as a suitable substitute for most in-person services.
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Affiliation(s)
- Jiani Yu
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, USA.
| | - Hyunkyung Yun
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, USA
| | - Mark A Unruh
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, USA
| | - Eloise M O'Donnell
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, USA
| | - Paul R Katz
- Department of Geriatrics, Florida State University College of Medicine, Tallahassee, USA
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, USA
| | - Hye-Young Jung
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, USA
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19
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Muellers KA, Andreadis K, Ancker JS, Horowitz CR, Kaushal R, Lin JJ. Provider and Patient Experiences of Delays in Primary Care During the Early COVID-19 Pandemic. J Healthc Qual 2023; 45:169-176. [PMID: 37010342 DOI: 10.1097/jhq.0000000000000380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
BACKGROUND The necessary suspension of nonacute services by healthcare systems early in the COVID-19 pandemic was predicted to cause delays in routine care in the United States, with potentially serious consequences for chronic disease management. However, limited work has examined provider or patient perspectives about care delays and their implications for care quality in future healthcare emergencies. OBJECTIVE This study explores primary care provider (PCP) and patient experiences with healthcare delays during the COVID-19 pandemic. METHODS PCPs and patients were recruited from four large healthcare systems in three states. Participants underwent semistructured interviews asking about their experiences with primary care and telemedicine. Data were analyzed using interpretive description. RESULTS Twenty-one PCPs and 65 patients participated in interviews. Four main topics were identified: (1) types of care delayed, (2) causes for delays, (3) miscommunication contributing to delays, and (4) patient solutions to unmet care needs. CONCLUSIONS Both patients and providers reported delays in preventive and routine care early in the pandemic, driven by healthcare system changes and patient concerns about infection risk. Primary care practices should develop plans for care continuity and consider new strategies for assessing care quality for effective chronic disease management in future healthcare system disruptions.
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20
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Armstrong M, Benda NC, Seier K, Rogers C, Ancker JS, Stetson PD, Peng Y, Diamond LC. Improving Cancer Care Communication: Identifying Sociodemographic Differences in Patient Portal Secure Messages Not Authored by the Patient. Appl Clin Inform 2023; 14:296-299. [PMID: 36657471 PMCID: PMC10115514 DOI: 10.1055/a-2015-8679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/16/2023] [Indexed: 01/21/2023] Open
Affiliation(s)
- Misha Armstrong
- Department of Surgery, New York Presbyterian-Weill Cornell Medicine, New York, New York
| | - Natalie C. Benda
- Department of Population Health Science, Weill Cornell Medicine, New York, New York
| | - Kenneth Seier
- Department of Epidemiology- Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christopher Rogers
- Department of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jessica S. Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Peter D. Stetson
- Department of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yifan Peng
- Department of Population Health Science, Weill Cornell Medicine, New York, New York
| | - Lisa C. Diamond
- Department of Population Health Science, Weill Cornell Medicine, New York, New York
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Hospital Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York
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21
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Lin JJ, Horowitz CR, Ancker JS. An Urgent Need for Guidelines for Telemedicine Use. J Gen Intern Med 2023; 38:1061-1062. [PMID: 36333548 PMCID: PMC9638176 DOI: 10.1007/s11606-022-07905-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Jenny J Lin
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Carol R Horowitz
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
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22
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Kern LM, Aucapina JE, Jacobson A, Shen MJ, Ancker JS, Ringel JB, Kelly T, Rodriguez NV. COVID-19 Vaccine Hesitancy in a Predominantly Minority Population and Trust in Primary Care Physicians as a Potential Solution. J Ambul Care Manage 2023; 46:63-68. [PMID: 36305803 PMCID: PMC10144426 DOI: 10.1097/jac.0000000000000443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | | | | | | | - Tim Kelly
- AdvantageCare Physicians, New York, NY
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23
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Quach WT, Le CH, Clark MG, McArthur E, Ancker JS, Gadd CS, Johnson KB. Engaging the next generation of physician-informaticians through early exposure to the field: successes and challenges associated with starting a novel clinical informatics interest group. J Am Med Inform Assoc 2022; 30:202-205. [PMID: 36228129 PMCID: PMC9748539 DOI: 10.1093/jamia/ocac189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/23/2022] [Accepted: 10/03/2022] [Indexed: 12/15/2022] Open
Abstract
Clinical informatics remains underappreciated among medical students in part due to a lack of integration into undergraduate medical education (UME). New developments in the study and practice of medicine are traditionally introduced via formal integration into undergraduate medical curricula. While this path has certain advantages, curricular changes are slow and may fail to showcase the breadth of clinical informatics activities. Less formal and more flexible approaches can circumvent these drawbacks. Interest groups (IGs), which are organized through the Association of American Medical College Careers in Medicine (CiM) program, exemplify the informal approach. CiM IGs are student-led groups that provide exposure to different specialty options, acting as an adjunct to the traditional medical curriculum. While the primary purpose of these groups is to assist students applying to residency programs, we took a novel approach of using an IG to increase student exposure to an area of medicine that had not yet been formally integrated at our institution. IGs provide unique advantages to formal integration into a curriculum as they can be more easily setup and can quickly respond to student interests. Furthermore, IGs can act synergistically with UME, acting as proving grounds for ideas that can lead to new courses. We believe that the lessons and takeaways from our experience can act as a guide for those interested in starting similar organizations at their own schools.
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Affiliation(s)
- William T Quach
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Chi H Le
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Michael G Clark
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Evonne McArthur
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Cynthia S Gadd
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin B Johnson
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Computer and Information Science, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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24
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Valdez RS, Ancker JS, Veinot TC. Provocations for Reimagining Informatics Approaches to Health Equity. Yearb Med Inform 2022; 31:15-19. [PMID: 36463864 PMCID: PMC9719775 DOI: 10.1055/s-0042-1742514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
As the informatics community commits to the goal of advancing health equity, it is essential that we openly critique our current approaches and reimagine the ways in which we design, implement, evaluate, and advocate for policies related to informatics interventions. In this paper, we present five provocations as a starting point for building more conscientious informatics practice in service of this goal: 1) Health informatics interventions can create an "illusion of impactful action" without significant material benefits for marginalized patients, families, and communities; 2) Health informatics interventions target the wrong stakeholders, the wrong processes, and the wrong technologies to achieve equity; 3) Informaticians must conceptualize health literacy and other factors shaping patients' experiences as a system-level rather than individual-level characteristic; 4) Informatics interventions wrongly assume that interacting contextual factors can be meaningfully captured by over-simplified structured variables; and 5) Informatics interventions often specify the wrong system boundaries and solution space. We further assert that drastic shifts in our current practices will allow us to honor our claims of valuing patient-centered approaches, especially for marginalized communities.
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Affiliation(s)
- Rupa S. Valdez
- Department of Public Health Sciences, Department of Engineering Systems and Environment, University of Virginia, Charlottesville, Virginia, USA,Correspondence to: Rupa S. Valdez, PhD Department of Public Health Sciences, University of VirginiaP.O. Box 800717, Hospital West Complex, Charlottesville, VA 22908USA
| | - Jessica S. Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tiffany C. Veinot
- School of Information and Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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Ancker JS, Benda NC, Sharma MM, Johnson SB, Weiner S, Zikmund-Fisher BJ. Taxonomies for synthesizing the evidence on communicating numbers in health: Goals, format, and structure. Risk Anal 2022; 42:2656-2670. [PMID: 35007354 PMCID: PMC10241486 DOI: 10.1111/risa.13875] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Many people, especially those with low numeracy, are known to have difficulty interpreting and applying quantitative information to health decisions. These difficulties have resulted in a rich body of research about better ways to communicate numbers. Synthesizing this body of research into evidence-based guidance, however, is complicated by inconsistencies in research terminology and researcher goals. In this article, we introduce three taxonomies intended to systematize terminology in the literature, derived from an ongoing systematic literature review. The first taxonomy provides a systematic nomenclature for the outcome measures assessed in the studies, including perceptions, decisions, and actions. The second taxonomy is a nomenclature for the data formats assessed, including numbers (and different formats for numbers) and graphics. The third taxonomy describes the quantitative concepts being conveyed, from the simplest (a single value at a single point in time) to more complex ones (including a risk-benefit trade-off and a trend over time). Finally, we demonstrate how these three taxonomies can be used to resolve ambiguities and apparent contradictions in the literature.
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Affiliation(s)
- Jessica S Ancker
- Vanderbilt University Medical Center, Department of Biomedical Informatics, Nashville, TN
| | - Natalie C Benda
- Weill Cornell Medicine, Department of Population Health Sciences, New York, NY
| | - Mohit M Sharma
- Weill Cornell Medicine, Department of Population Health Sciences, New York, NY
| | - Stephen B Johnson
- New York University Langone Health, Department of Population Health, New York, NY
| | - Stephanie Weiner
- Weill Cornell Medicine, Department of Population Health Sciences, New York, NY
| | - Brian J Zikmund-Fisher
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, Ann Arbor, MI
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Reading Turchioe M, Mangal S, Ancker JS, Gwyn J, Varosy P, Slotwiner D. "Replace uncertainty with information": Shared decision-making and decision quality surrounding catheter ablation for atrial fibrillation. Eur J Cardiovasc Nurs 2022; 22:430-440. [PMID: 36031860 PMCID: PMC10111971 DOI: 10.1093/eurjcn/zvac078] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 11/12/2022]
Abstract
AIMS As a first step in developing a decision aid to support shared decision-making (SDM) for patients with atrial fibrillation (AF) to evaluate treatment options for rhythm and symptom control, we aimed to measure decision quality and describe decision-making processes among patients and clinicians involved in decision-making around catheter ablation for AF. METHODS AND RESULTS We conducted a cross-sectional, mixed-methods study guided by a SDM model outlining decision antecedents, processes, and outcomes. Patients and clinicians completed semi-structured interviews about decision-making around ablation, feelings of decision conflict and regret, and preferences for the content, delivery, and format of a hypothetical decision aid for ablation. Patients also completed surveys about AF symptoms and aspects of decision quality. Fifteen patients (mean age 71.1 ± 8.6 years; 27% female) and five clinicians were recruited. For most patients, decisional conflict and regret were low, but they also reported low levels of information and agency in the decision-making process. Most clinicians report routinely providing patients with information and encouraging engagement during consultations. Patients reported preferences for an interactive, web-based decision aid that clearly presents evidence regarding outcomes using data, visualizations, videos, and personalized risk assessments, and is available in multiple languages. CONCLUSION Disconnects between clinician efforts to provide information and bolster agency and patient experiences of decision-making suggest decision aids may be needed to improve decision quality in practice. Reported experiences with current decision-making practices and preferences for decision aid content, format, and delivery can support the user-centered design and development of a decision aid.
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Affiliation(s)
| | - Sabrina Mangal
- Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medicine; New York, NY
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center; Nashville, TN
| | - Jaslynn Gwyn
- Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medicine; New York, NY
| | - Paul Varosy
- University of Colorado Anschutz Medical Campus, Aurora, CO
| | - David Slotwiner
- Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medicine; New York, NY.,NewYork Presbyterian Hospital-Queens; New York, NY
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Stabile C, McCready T, Ancker JS, Pusic A, Temple LKF, Vickers A, Simon B, Ashby C, Carter J. A qualitative analysis of caregiver burden during the recovery process in ambulatory cancer surgery. Support Care Cancer 2022; 30:5713-5721. [PMID: 35318529 PMCID: PMC10107336 DOI: 10.1007/s00520-022-06991-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 03/15/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Cancer impacts caregivers as well as patients. Ambulatory oncology surgeries requiring a short hospital stay place additional responsibility on informal caregivers as they help patients navigate their post-operative recovery at home, and determine if symptoms are expected or emergent. Our objective was to explore the experience of informal caregivers during patients' ambulatory cancer surgery and then recovery at home with remote monitoring of symptoms via web-based patient-reported outcomes questionnaire ("Recovery Tracker"). METHODS Semi-structured interviews were conducted with caregivers from a larger sample participating in a randomized trial of the Recovery Tracker. Thematic analysis was applied to derive key themes and codes via NVivo qualitative analysis software (QSR International Inc.). Recruitment was conducted iteratively to ensure a heterogenous sample and thematic saturation. RESULTS Twenty-three semi-structured interviews were conducted. Four main themes emerged: (1) Predictability reduced stress among caregivers; (2) Unexpected events caused stress for caregivers; (3) The importance of a caregiver being present during the recovery process; and (4) Caregiver involvement in remote monitoring of symptoms was minimal. CONCLUSION Caregivers report not being overly burdened by the ambulatory surgery process, but they are very sensitive to any deviations from what they expected to happen. Further research and clinical practice on caregivers in the ambulatory setting should focus on how to set expectations and avoid unexpected events.
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Affiliation(s)
- Cara Stabile
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Taylor McCready
- Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA
| | - Andrea Pusic
- Department of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Larissa K F Temple
- Colorectal Surgery Division, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brett Simon
- Department of Anesthesia and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Anesthesiology, Weill Medical College of Cornell University, New York, NY, USA
| | - Christina Ashby
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeanne Carter
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA. .,Department of Psychiatry, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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28
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Sharko M, Sharma MM, Benda NC, Chan M, Wilsterman E, Liu LG, Demetres M, Delgado D, Ancker JS. Strategies to optimize comprehension of numerical medication instructions: A systematic review and concept map. Patient Educ Couns 2022; 105:1888-1903. [PMID: 35123834 PMCID: PMC9203902 DOI: 10.1016/j.pec.2022.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 12/13/2021] [Accepted: 01/25/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To develop evidence-based recommendations for improving comprehension of quantitative medication instructions. METHODS This review included a literature search from inception to November 2021. Studies were included for the following: 1) original research; 2) compared multiple formats for presenting quantitative medication information on dose, frequency, and/or time; 3) included patients/lay-people; 4) assessed comprehension-related outcomes quantitatively. To classify the studies, we developed a concept map. We weighed 3 factors (risk of bias in individual studies, consistency of findings among studies, and homogeneity of the interventions tested) to generate 3 levels of recommendations. RESULTS Twenty-one studies were included. Level 1 recommendations are: 1) use visualizations of medication doses for liquid medications, and 2) express instructions in time-periods rather than times per day. Level 2 recommendations include: validate icons, use panels or tables with explanatory text, use visualizations for non-English speaking populations and for those with low health literacy and limited English proficiency. CONCLUSIONS Visualized liquid medication doses and time period-based administration instructions improve comprehension of numerical medication instructions. Use of visualizations for those with limited health literacy and English proficiency could result in improved outcomes. PRACTICE IMPLICATIONS Practitioners should use visualizations for liquid medication instructions and time period-based instructions to improve outcomes.
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Affiliation(s)
- Marianne Sharko
- Dept. of Population Health Sciences, Division of Health Informatics, Weill Cornell Medical College, New York, NY, USA; Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA.
| | - Mohit M Sharma
- Dept. of Population Health Sciences, Division of Health Informatics, Weill Cornell Medical College, New York, NY, USA
| | - Natalie C Benda
- Dept. of Population Health Sciences, Division of Health Informatics, Weill Cornell Medical College, New York, NY, USA
| | - Melissa Chan
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| | - Eric Wilsterman
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| | - Lisa Grossman Liu
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | | | - Diana Delgado
- Weill Cornell Medicine Samuel J Wood Library, New York, NY, USA
| | - Jessica S Ancker
- Dept. of Population Health Sciences, Division of Health Informatics, Weill Cornell Medical College, New York, NY, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
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Abstract
OBJECTIVES Health care providers managing the complex health needs of adolescents must comply with state laws governing adolescent consent and right to privacy. However, these laws vary. Our objectives were to summarize consent and privacy laws state-by-state and assess the implications of variation for compliance with the 21st Century Cures Act and with evidence-based guidance on adolescent care. METHODS We summarized state laws and regulations on minor consent for the following: health services, substance abuse treatment, prenatal care, mental health care, contraceptive management, immunizations, sexually transmitted infection management, human immunodeficiency viruses testing and treatment, dental care, and sexual assault evaluation. We compared state laws and regulations with American Academy of Pediatrics' evidence-based guidelines to assess consistencies in guidance. RESULTS We observed notable state-by-state variability in laws governing consent for adolescent patients. No states had identical policies for all services studied. For example, although all states had provisions for consent to management of sexually transmitted infections, there were variable specifications in the age and type of minor, whether this includes human immunodeficiency viruses, and whether confidentiality is protected. Providing confidential care to the adolescent patient has been set as a priority by medical societies; however, guidelines are limited by the need to comply with state laws and regulations. CONCLUSIONS State laws on consent and privacy for adolescents are highly variable, and many do not reflect pediatric professional standards of care. This inconsistency is a barrier to operationalizing a consistent and equitable experience providing evidence-based medical care and ensuring adolescent privacy protection.
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Affiliation(s)
- Marianne Sharko
- Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | - Rachael Jameson
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lisa Krams
- American Academy of Pediatrics, Itasca, Illinois
| | - Emily C Webber
- Riley Hospital for Children, Indianapolis, Indiana.,Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana
| | - S Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
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30
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Liu Y, Hao H, Sharma MM, Harris Y, Scofi J, Trepp R, Farmer B, Ancker JS, Zhang Y. Clinician Acceptance of Order Sets for Pain Management: A Survey in Two Urban Hospitals. Appl Clin Inform 2022; 13:447-455. [PMID: 35477148 PMCID: PMC9045963 DOI: 10.1055/s-0042-1745828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Order sets are a clinical decision support (CDS) tool in computerized provider order entry systems. Order set use has been associated with improved quality of care. Particularly related to opioids and pain management, order sets have been shown to standardize and reduce the prescription of opioids. However, clinician-level barriers often limit the uptake of this CDS modality. OBJECTIVE To identify the barriers to order sets adoption, we surveyed clinicians on their training, knowledge, and perceptions related to order sets for pain management. METHODS We distributed a cross-sectional survey between October 2020 and April 2021 to clinicians eligible to place orders at two campuses of a major academic medical center. Survey questions were adapted from the widely used framework of Unified Theory of Acceptance and Use of Technology. We hypothesize that performance expectancy (PE) and facilitating conditions (FC) are associated with order set use. Survey responses were analyzed using logistic regression. RESULTS The intention to use order sets for pain management was associated with PE to existing order sets, social influence (SI) by leadership and peers, and FC for electronic health record (EHR) training and function integration. Intention to use did not significantly differ by gender or clinician role. Moderate differences were observed in the perception of the effort of, and FC for, order set use across gender and roles of clinicians, particularly emergency medicine and internal medicine departments. CONCLUSION This study attempts to identify barriers to the adoption of order sets for pain management and suggests future directions in designing and implementing CDS systems that can improve order sets adoption by clinicians. Study findings imply the importance of order set effectiveness, peer influence, and EHR integration in determining the acceptability of the order sets.
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Affiliation(s)
- Yifan Liu
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States
| | - Haijing Hao
- Department of Computer Information Systems, Bentley University, Waltham, Massachusetts, United States
| | - Mohit M Sharma
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States
| | - Yonaka Harris
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States
| | - Jean Scofi
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, United States
| | - Richard Trepp
- Department of Emergency Medicine, Columbia University, New York, New York, United States
| | - Brenna Farmer
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, United States
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, New York, New York, United States
| | - Yiye Zhang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States.,Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, United States
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31
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Turchioe MR, Ancker JS, Volodarskiy A, Vapnik J, Sunkaraneni S, Slotwiner D. Experiences of care delays and telehealth use during the COVID-19 pandemic among socioeconomically diverse cardiovascular patients and clinicians in an urban hospital. AMIA Annu Symp Proc 2022; 2022:1091-1100. [PMID: 37128386 PMCID: PMC10148370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
An understanding of care delays and telehealth experiences during the pandemic among vulnerable patients, such as those with cardiac disease, is needed to inform future telehealth policy. We conducted a cross-sectional survey study with socioeconomically diverse cardiac patients (n=28) and clinicians (n=26). Most patients (89%) preferred to receive some or all of their care in-person during the pandemic and endorsed the lack of in-person visits as the top facilitator to telehealth use. Significantly more clinicians perceived high ease of use of video visits compared to patients (82% vs. 44%). Significantly more patients perceived high ease of learning to use (69% vs. 18%) and using (69% vs. 27%) remote monitoring compared to clinicians. Results suggest that patients are more open to receiving in-person care during the pandemic than clinicians recognize and may need greater support surrounding video visits when in-person care is not feasible or safe.
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Affiliation(s)
- Meghan Reading Turchioe
- Div.of Health Informatics, Dept. of Population Health Sciences, Weill Cornell Medicine; New York, NY
| | - Jessica S Ancker
- Dept. of Biomedical Informatics, Vanderbilt University Medical Center; Nashville, TN
| | | | | | | | - David Slotwiner
- Div.of Health Informatics, Dept. of Population Health Sciences, Weill Cornell Medicine; New York, NY
- NewYork Presbyterian Hospital-Queens; New York, NY
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32
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Grando A, Ancker JS, Tao D, Howe R, Coonan C, Johns M, Chapman W. Design and evaluation of a Women in American Medical Informatics Association (AMIA) leadership program. J Am Med Inform Assoc 2021; 29:163-170. [PMID: 34679176 DOI: 10.1093/jamia/ocab232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/10/2021] [Accepted: 10/06/2021] [Indexed: 11/12/2022] Open
Abstract
The objective is to report on the design and evaluation of the inaugural Women in AMIA Leadership Program. A year-long leadership curriculum was developed. Survey responses were summarized with descriptive statistics and quotes selected. Twenty-four scholars participated in the program. There was a significant increase in perceived achievement of learning objectives after the program (P < .0001). The largest improvement was in leadership confidence and presence in work interactions (modal answer Neutral in presurvey from 21 responses rose to Agree in postsurvey from 24 responses). Most (92% of 13) scholars clarified leadership vision and goals and (83% of 18) would be Very Likely to recommend the program to others. The goals of the program-developing women's leader identity, increasing networks, and accumulating experience for future programs-were achieved. The second leadership program is on its way in the United States and Australia. This study may benefit organizations seeking to develop leadership programs for women in informatics and digital health.
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Affiliation(s)
- Adela Grando
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Donghua Tao
- Medical Center Library, Saint Louis University, St. Louis, Missouri, USA
| | | | | | - Merida Johns
- The Monarch Center for Women's Leadership Development, Huntley, Illinois, USA
| | - Wendy Chapman
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, VIC, Australia
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Benda NC, Novak LL, Reale C, Ancker JS. Trust in AI: why we should be designing for APPROPRIATE reliance. J Am Med Inform Assoc 2021; 29:207-212. [PMID: 34725693 DOI: 10.1093/jamia/ocab238] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/29/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
Use of artificial intelligence in healthcare, such as machine learning-based predictive algorithms, holds promise for advancing outcomes, but few systems are used in routine clinical practice. Trust has been cited as an important challenge to meaningful use of artificial intelligence in clinical practice. Artificial intelligence systems often involve automating cognitively challenging tasks. Therefore, previous literature on trust in automation may hold important lessons for artificial intelligence applications in healthcare. In this perspective, we argue that informatics should take lessons from literature on trust in automation such that the goal should be to foster appropriate trust in artificial intelligence based on the purpose of the tool, its process for making recommendations, and its performance in the given context. We adapt a conceptual model to support this argument and present recommendations for future work.
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Affiliation(s)
- Natalie C Benda
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Laurie L Novak
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carrie Reale
- Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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34
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Ancker JS, Benda NC, Reddy M, Unertl KM, Veinot T. Guidance for publishing qualitative research in informatics. J Am Med Inform Assoc 2021; 28:2743-2748. [PMID: 34537840 PMCID: PMC8633663 DOI: 10.1093/jamia/ocab195] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 11/25/2022] Open
Abstract
Qualitative research, the analysis of nonquantitative and nonquantifiable data through methods such as interviews and observation, is integral to the field of biomedical and health informatics. To demonstrate the integrity and quality of their qualitative research, authors should report important elements of their work. This perspective article offers guidance about reporting components of the research, including theory, the research question, sampling, data collection methods, data analysis, results, and discussion. Addressing these points in the paper assists peer reviewers and readers in assessing the rigor of the work and its contribution to the literature. Clearer and more detailed reporting will ensure that qualitative research will continue to be published in informatics, helping researchers disseminate their understanding of people, organizations, context, and sociotechnical relationships as they relate to biomedical and health data.
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Affiliation(s)
- Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natalie C Benda
- Department of Population Health Sciences, Weill Cornell Medicine, New York, USA
| | - Madhu Reddy
- Department of Informatics, University of California, Irvine, Irvine, California, USA
| | - Kim M Unertl
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tiffany Veinot
- School of Information, University of Michigan, Ann Arbor, Michigan, USA
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35
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Benda NC, Yang Z, Li H, Zhang T, Ancker JS. Lower objectively and subjectively assessed numeracy are both associated with poorer self-rated health. BMC Res Notes 2021; 14:321. [PMID: 34419167 PMCID: PMC8379725 DOI: 10.1186/s13104-021-05737-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/11/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To compare an objective with a subjective numeracy assessment for association with self-reported health status, where numeracy refers to “the degree to which individuals have the capacity to access, process, interpret, communicate, and act on numerical, quantitative, graphical, biostatistical, and probabilistic health information needed to make effective health decisions” Results We completed a secondary analysis of two population-based surveys, the Empire State Poll (n = 763) and the Program for the International Assessment of Adult Competencies (PIAAC; n = 2609). The first survey assessed numeracy with a 3-item subjective instrument. The second assessed numeracy with more than 20 math problems. Both used the same measure for self-reported health status. Lower numeracy, whether subjectively or objectively assessed, was associated with worse self-reported health, even after controlling for education and other sociodemographic confounders. The odds ratios for the association were very similar (0.91 and 0.90 respectively). A lengthy objective numeracy assessment and a brief self-report assessment had similar associations with health status. A brief self-report measure of numeracy has similar properties to a lengthy objective assessment and is likely to be more feasible to use to screen patients in practice. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05737-y.
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Affiliation(s)
- Natalie C Benda
- Department of Population Health Sciences, Weill Cornell Medicine, 425 E 61 stStreet, Suite 301, New York, NY, 10065, USA.
| | - Zihan Yang
- Department of Population Health Sciences, Weill Cornell Medicine, 425 E 61 stStreet, Suite 301, New York, NY, 10065, USA
| | - Haojia Li
- Department of Population Health Sciences, Weill Cornell Medicine, 425 E 61 stStreet, Suite 301, New York, NY, 10065, USA
| | - Tianran Zhang
- Department of Population Health Sciences, Weill Cornell Medicine, 425 E 61 stStreet, Suite 301, New York, NY, 10065, USA
| | - Jessica S Ancker
- Department of Population Health Sciences, Weill Cornell Medicine, 425 E 61 stStreet, Suite 301, New York, NY, 10065, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Ave., Rm, Nashville, TN, 14122, USA
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36
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Pusic AL, Temple LK, Carter J, Stabile CM, Assel MJ, Vickers AJ, Niehaus K, Ancker JS, McCready T, Stetson PD, Simon BA. A Randomized Controlled Trial Evaluating Electronic Outpatient Symptom Monitoring After Ambulatory Cancer Surgery. Ann Surg 2021; 274:441-448. [PMID: 34132697 DOI: 10.1097/sla.0000000000005005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We implemented routine daily electronic monitoring of patient-reported outcomes (PROs) for 10 days after discharge after ambulatory cancer surgery, with alerts to clinical staff for worrying symptoms. We sought to determine whether enhancing this monitoring by adding immediate automated normative feedback to patients regarding expected symptoms would further improve the patient experience. SUMMARY OF BACKGROUND DATA PRO monitoring reduces symptom severity in cancer patients. In ambulatory cancer surgery, it reduces potentially avoidable urgent care center (UCC) visits, defined as those UCC visits without readmission. METHODS Patients undergoing ambulatory cancer surgery (n = 2624) were randomized to receive standard PRO monitoring or enhanced feedback. The primary study outcome was UCC visits without readmission within 30 days; secondary outcomes included patient anxiety and nursing utilization. RESULTS There was no significant difference in the risk of a potentially avoidable UCC visit [1.0% higher in enhanced feedback, 95% confidence interval (CI) -0.2-3.1%; P = 0.12]. There were similarly no significant differences in UCC visits with readmission or readmission overall (P = 0.4 for both). Patients randomized to enhanced feedback demonstrated a quicker reduction in anxiety (P < 0.001) and required 14% (95% CI 8-19%; P < 0.001) and 10% (95% CI 5-16%, P < 0.001) fewer nursing calls over 10 and 30 days postoperatively. CONCLUSIONS Providing patients with feedback about symptom severity during recovery from ambulatory cancer surgery reduces anxiety and nursing workload without affecting UCC visits or readmissions. These results support wider incorporation of normative feedback in systems for routine PRO monitoring.
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Affiliation(s)
- Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Larissa K Temple
- Division of Colorectal Surgery, University of Rochester School of Medicine, Rochester, New York
| | - Jeanne Carter
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Psychiatry, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Psychiatry, Weill Cornell Medical College, New York, New York
| | - Cara M Stabile
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melissa J Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kate Niehaus
- Patient and Family Advisory Council for Quality, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee
| | - Taylor McCready
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter D Stetson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Brett A Simon
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Anesthesiology, Weill Cornell Medical College, New York, New York
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Dunn AN, Radakovich N, Ancker JS, Donskey CJ, Deshpande A. The Impact of Clinical Decision Support Alerts on Clostridioides difficile Testing: A Systematic Review. Clin Infect Dis 2021; 72:987-994. [PMID: 32060501 DOI: 10.1093/cid/ciaa152] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/12/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Several studies have investigated the utility of electronic decision support alerts in diagnostic stewardship for Clostridioides difficile infection (CDI). However, it is unclear if alerts are effective in reducing inappropriate CDI testing and/or CDI rates. The aim of this systematic review was to determine if alerts related to CDI diagnostic stewardship are effective at reducing inappropriate CDI testing volume and CDI rates among hospitalized adult patients. METHODS We searched Ovid Medline and 5 other databases for original studies evaluating the association between alerts for CDI diagnosis and CDI testing volume and/or CDI rate. Two investigators independently extracted data on study characteristics, study design, alert triggers, cointerventions, and study outcomes. RESULTS Eleven studies met criteria for inclusion. Studies varied significantly in alert triggers and in study outcomes. Six of 11 studies demonstrated a statistically significant decrease in CDI testing volume, 6 of 6 studies evaluating appropriateness of CDI testing found a significant reduction in the proportion of inappropriate testing, and 4 of 7 studies measuring CDI rate demonstrated a significant decrease in the CDI rate in the postintervention vs preintervention period. The magnitude of the increase in appropriate CDI testing varied, with some studies reporting an increase with minimal clinical significance. CONCLUSIONS The use of electronic alerts for diagnostic stewardship for C. difficile was associated with reductions in CDI testing, the proportion of inappropriate CDI testing, and rates of CDI in most studies. However, broader concerns related to alerts remain understudied, including unintended adverse consequences and alert fatigue.
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Affiliation(s)
- Aaron N Dunn
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Nathan Radakovich
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Jessica S Ancker
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
| | - Curtis J Donskey
- Geriatric Research, Education, and Clinical Center, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Abhishek Deshpande
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA.,Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA
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Sieck CJ, Sheon A, Ancker JS, Castek J, Callahan B, Siefer A. Digital inclusion as a social determinant of health. NPJ Digit Med 2021; 4:52. [PMID: 33731887 PMCID: PMC7969595 DOI: 10.1038/s41746-021-00413-8] [Citation(s) in RCA: 154] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 12/24/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Cynthia J Sieck
- Department of Family Medicine, The Ohio State University College of Medicine, Columbus, OH, USA. .,The Ohio State University Center for the Advancement of Team Science, Analytics, and Systems Thinking, Columbus, OH, USA.
| | - Amy Sheon
- Case Western Reserve University School of Medicine, Clinical and Translational Science Collaborative, Cleveland, OH, USA
| | - Jessica S Ancker
- Weill Cornell Medical College, Department of Healthcare Policy & Research, Division of Health Informatics, New York City, NY, USA
| | - Jill Castek
- College of Education, Department of Teaching, Learning, and Sociocultural Studies, University of Arizona, Tucson, AZ, USA
| | - Bill Callahan
- National Digital Inclusion Alliance, Columbus, OH, USA
| | - Angela Siefer
- National Digital Inclusion Alliance, Columbus, OH, USA
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Grossman Liu L, Ancker JS, Masterson Creber RM. Improving Patient Engagement Through Patient Decision Support. Am J Prev Med 2021; 60:438-441. [PMID: 33280958 PMCID: PMC7902347 DOI: 10.1016/j.amepre.2020.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/07/2020] [Accepted: 08/03/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Lisa Grossman Liu
- Department of Biomedical Informatics, Columbia University, New York, New York.
| | - Jessica S Ancker
- Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Ruth M Masterson Creber
- Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
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40
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Ancker JS, Gossey JT, Nosal S, Xu C, Banerjee S, Wang Y, Veras Y, Mitchell H, Bao Y. Effect of an Electronic Health Record "Nudge" on Opioid Prescribing and Electronic Health Record Keystrokes in Ambulatory Care. J Gen Intern Med 2021; 36:430-437. [PMID: 33105005 PMCID: PMC7878599 DOI: 10.1007/s11606-020-06276-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 09/28/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Multiple policy initiatives encourage more cautious prescribing of opioids in light of their risks. Electronic health record (EHR) redesign can influence prescriber choices, but some redesigns add to workload. OBJECTIVE To estimate the effect of an EHR prescribing redesign on both opioid prescribing choices and keystrokes. DESIGN Quality improvement quasi-experiment, analyzed as interrupted time series. PARTICIPANTS Adult patients of an academic multispecialty practice and a federally qualified health center (FQHC) who received new prescriptions for short-acting opioids, and their providers. INTERVENTION In the redesign, new prescriptions of short-acting opioids defaulted to the CDC-recommended minimum for opioid-naïve patients, with no alerts or hard stops, such that 9 keystrokes were required for a guideline-concordant prescription and 24 for a non-concordant prescription. MAIN MEASURES Proportion of guideline-concordant prescriptions, defined as new prescriptions with a 3-day supply or less, calculated per 2-week period. Number of mouse clicks and keystrokes needed to place prescriptions. KEY RESULTS Across the 2 sites, 22,113 patients received a new short-acting opioid prescription from 821 providers. Before the intervention, both settings showed secular trends toward smaller-quantity prescriptions. At the academic practice, the intervention was associated with an immediate increase in guideline-concordant prescriptions from an average of 12% to 31% of all prescriptions. At the FQHC, about 44% of prescriptions were concordant at the time of the intervention, which was not associated with an additional significant increase. However, total keystrokes needed to place the concordant prescriptions decreased 62.7% from 3552 in the 6 months before the intervention to 1323 in the 6 months afterwards. CONCLUSIONS Autocompleting prescription forms with guideline-recommended values was associated with a large increase in guideline concordance in an organization where baseline concordance was low, but not in an organization where it was already high. The redesign markedly reduced the number of keystrokes needed to place orders, with important implications for EHR-related stress. TRIAL REGISTRATION www.ClinicalTrials.gov protocol 1710018646.
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Affiliation(s)
- Jessica S Ancker
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
| | - J Travis Gossey
- Physician Organization Information Services, Weill Cornell Medicine, New York, NY, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Sarah Nosal
- Institute for Family Health, New York, NY, USA
| | - Chenghuiyun Xu
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Samprit Banerjee
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Yuming Wang
- Physician Organization Information Services, Weill Cornell Medicine, New York, NY, USA
| | - Yulia Veras
- Institute for Family Health, New York, NY, USA
| | - Hannah Mitchell
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
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41
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Bao Y, Li Y, Jeng PJ, Scodes J, Papp MA, Humensky JL, Wall M, Lee R, Ancker JS, Pincus HA, Smith TE, Dixon LB. Design of a Payment Decision-Support Tool for Coordinated Specialty Care for Early Psychosis. Psychiatr Serv 2021; 72:180-185. [PMID: 33267653 PMCID: PMC8317229 DOI: 10.1176/appi.ps.202000129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A strengthened evidence base and earmarked federal funding have spurred the implementation of coordinated specialty care (CSC) for people experiencing early psychosis. However, existing funding mechanisms are insufficient and unsustainable to support population-wide deployment of CSC. This article describes the design framework of an innovative payment model for CSC that includes a bundled case rate payment and an optional outcome-based payment. To assist CSC payer and provider organizations in designing payment systems tailored to local preferences and circumstances, the research team is developing a decision-support tool that allows users to define design choices and provide input. The authors document the analytical algorithms underlying the tool and discuss how it could be further developed or expanded for CSC and other behavioral health interventions that feature an interdisciplinary team of clinicians and nonclinical professionals, public education and outreach, patient centeredness, and a recovery orientation.
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Affiliation(s)
- Yuhua Bao
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Yan Li
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Philip J Jeng
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Jennifer Scodes
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Michelle A Papp
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Jennifer L Humensky
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Melanie Wall
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Rufina Lee
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Jessica S Ancker
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Harold Alan Pincus
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Thomas E Smith
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Lisa B Dixon
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
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Benda NC, Alexopoulos GS, Marino P, Sirey JA, Kiosses D, Ancker JS. The Age Limit Does Not Exist: A Pilot Usability Assessment of a SMS-Messaging and Smartwatch-Based Intervention for Older Adults with Depression. AMIA Annu Symp Proc 2021; 2020:213-222. [PMID: 33936393 PMCID: PMC8075500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Current treatments for major depressive disorder are either less effective for older adults (i.e. pharmacotherapy) or are challenging to extend to community settings (i.e. psychotherapy). To improve and extend mental health treatment for older adults, our team has expanded a previously developed streamlined talk-therapy model to incorporate a technology package that includes patient-reported outcome questions (sent via SMS) and a smartwatch. The goal of this pilot study was to assess and improve the usability, usefulness, and acceptability of the technology package. We completed a pilot feasibility and usability assessment with 15 older adults. Participants demonstrated the feasibility of use of the intervention, successfully completing 99% of their assigned tasks during the pilot. Findings were used to address usability barriers in preparation for future clinical trials. Our results highlight the importance completing usability assessment and involving older adults in the intervention design process when incorporating technology into care.
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Affiliation(s)
| | - George S Alexopoulos
- Weill Cornell Medicine, New York, NY
- Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY
| | - Patricia Marino
- Weill Cornell Medicine, New York, NY
- Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY
| | - Jo Anne Sirey
- Weill Cornell Medicine, New York, NY
- Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY
| | - Dimitris Kiosses
- Weill Cornell Medicine, New York, NY
- Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY
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Abstract
Health informatics studies the use of information technology to improve human health. As informaticists, we seek to reduce the gaps between current healthcare practices and our societal goals for better health and healthcare quality, safety, or cost. It is time to recognize health equity as one of these societal goals-a point underscored by this Journal of the American Medical Informatics Association Special Focus Issue, "Health Informatics and Health Equity: Improving our Reach and Impact." This Special Issue highlights health informatics research that focuses on marginalized and underserved groups, health disparities, and health equity. In particular, this Special Issue intentionally showcases high-quality research and professional experiences that encompass a broad range of subdisciplines, methods, marginalized populations, and approaches to disparities. Building on this variety of submissions and other recent developments, we highlight contents of the Special Issue and offer an assessment of the state of research at the intersection of health informatics and health equity.
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Affiliation(s)
- Tiffany C Veinot
- School of Information, University of Michigan, Ann Arbor, Michigan, USA.,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Jessica S Ancker
- Division of Health Informatics, Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, New York, USA
| | - Suzanne Bakken
- School of Nursing, Columbia University, New York, New York, USA.,Department of Biomedical Informatics, Columbia University, New York, New York, USA.,Data Science Institute, Columbia University, New York, New York, USA
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44
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Grossman LV, Masterson Creber RM, Benda NC, Wright D, Vawdrey DK, Ancker JS. Interventions to increase patient portal use in vulnerable populations: a systematic review. J Am Med Inform Assoc 2021; 26:855-870. [PMID: 30958532 DOI: 10.1093/jamia/ocz023] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/05/2019] [Accepted: 02/12/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND More than 100 studies document disparities in patient portal use among vulnerable populations. Developing and testing strategies to reduce disparities in use is essential to ensure portals benefit all populations. OBJECTIVE To systematically review the impact of interventions designed to: (1) increase portal use or predictors of use in vulnerable patient populations, or (2) reduce disparities in use. MATERIALS AND METHODS A librarian searched Ovid MEDLINE, EMBASE, CINAHL, and Cochrane Reviews for studies published before September 1, 2018. Two reviewers independently selected English-language research articles that evaluated any interventions designed to impact an eligible outcome. One reviewer extracted data and categorized interventions, then another assessed accuracy. Two reviewers independently assessed risk of bias. RESULTS Out of 18 included studies, 15 (83%) assessed an intervention's impact on portal use, 7 (39%) on predictors of use, and 1 (6%) on disparities in use. Most interventions studied focused on the individual (13 out of 26, 50%), as opposed to facilitating conditions, such as the tool, task, environment, or organization (SEIPS model). Twelve studies (67%) reported a statistically significant increase in portal use or predictors of use, or reduced disparities. Five studies (28%) had high or unclear risk of bias. CONCLUSION Individually focused interventions have the most evidence for increasing portal use in vulnerable populations. Interventions affecting other system elements (tool, task, environment, organization) have not been sufficiently studied to draw conclusions. Given the well-established evidence for disparities in use and the limited research on effective interventions, research should move beyond identifying disparities to systematically addressing them at multiple levels.
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Affiliation(s)
- Lisa V Grossman
- Department of Biomedical Informatics, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | | | - Natalie C Benda
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York, USA
| | - Drew Wright
- Samuel J Wood Library, Information Technologies and Services, Weill Cornell Medicine, New York, New York, USA
| | - David K Vawdrey
- Department of Biomedical Informatics, College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Value Institute, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jessica S Ancker
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York, USA
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Wiley KK, Hilts KE, Ancker JS, Unruh MA, Jung HY, Vest JR. Organizational characteristics and perceptions of clinical event notification services in healthcare settings: a study of health information exchange. JAMIA Open 2020; 3:611-618. [PMID: 33623895 PMCID: PMC7886547 DOI: 10.1093/jamiaopen/ooaa065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/04/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Event notification systems are an approach to health information exchange (HIE) that notifies end-users of patient interactions with the healthcare system through real-time automated alerts. We examined associations between organizational capabilities and perceptions of event notification system use. MATERIALS AND METHODS We surveyed representatives (n = 196) from healthcare organizations (n = 96) that subscribed to 1 of 3 Health Information Organizations' event notification services in New York City (response rate = 27%). The survey was conducted in Fall 2017 and Winter 2018. Surveys measured respondent characteristics, perceived organizational capabilities, event notification use, care coordination, and care quality. Exploratory factor analysis was used to identify relevant independent and dependent variables. We examined the relationship between organizational capabilities, care coordination, and care quality using multilevel linear regression models with random effects. RESULTS Respondents indicated that the majority of their organizations provided follow-up care for emergency department visits (66%) and hospital admissions (73%). Perceptions of care coordination were an estimated 57.5% (β = 0.575; P < 0.001) higher among respondents who reported event notifications fit within their organization's existing workflows. Perceptions of care quality were 46.5% (β = 0.465; P < 0.001) higher among respondents who indicated event notifications fit within existing workflows and 23.8% (β = 0.238; P < 0.01) higher where respondents reported having supportive policies and procedures for timely response and coordination of event notifications. DISCUSSION AND CONCLUSION Healthcare organizations with specific workflow processes and positive perceptions of fit are more likely to use event notification services to improve care coordination and care quality. In addition, event notification capacity and patient consent procedures influence how end-users perceive event notification services.
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Affiliation(s)
- Kevin K Wiley
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd, Indianapolis, Indiana 46202-2872, USA
- Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Katy Ellis Hilts
- School of Nursing, Indiana University, Indianapolis, Indiana, USA
| | - Jessica S Ancker
- Division of Health Policy and Economics, Weill-Cornell Medicine, New York, New York, USA
| | - Mark A Unruh
- Division of Health Policy and Economics, Weill-Cornell Medicine, New York, New York, USA
| | - Hye-Young Jung
- Division of Health Policy and Economics, Weill-Cornell Medicine, New York, New York, USA
| | - Joshua R Vest
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd, Indianapolis, Indiana 46202-2872, USA
- Regenstrief Institute, Inc., Indianapolis, Indiana, USA
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46
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Zhang Y, Tayarani M, Al’Aref SJ, Beecy AN, Liu Y, Sholle E, RoyChoudhury A, Axsom KM, Gao HO, Pathak J, Ancker JS. Using electronic health records for population health sciences: a case study to evaluate the associations between changes in left ventricular ejection fraction and the built environment. JAMIA Open 2020; 3:386-394. [PMID: 33215073 PMCID: PMC7660965 DOI: 10.1093/jamiaopen/ooaa038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/16/2020] [Accepted: 08/20/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Electronic health record (EHR) data linked with address-based metrics using geographic information systems (GIS) are emerging data sources in population health studies. This study examined this approach through a case study on the associations between changes in ejection fraction (EF) and the built environment among heart failure (HF) patients. MATERIALS AND METHODS We identified 1287 HF patients with at least 2 left ventricular EF measurements that are minimally 1 year apart. EHR data were obtained at an academic medical center in New York for patients who visited between 2012 and 2017. Longitudinal clinical information was linked with address-based built environment metrics related to transportation, air quality, land use, and accessibility by GIS. The primary outcome is the increase in the severity of EF categories. Statistical analyses were performed using mixed-effects models, including a subgroup analysis of patients who initially had normal EF measurements. RESULTS Previously reported effects from the built environment among HF patients were identified. Increased daily nitrogen dioxide concentration was associated with the outcome while controlling for known HF risk factors including sex, comorbidities, and medication usage. In the subgroup analysis, the outcome was significantly associated with decreased distance to subway stops and increased distance to parks. CONCLUSIONS Population health studies using EHR data may drive efficient hypothesis generation and enable novel information technology-based interventions. The availability of more precise outcome measurements and home locations, and frequent collection of individual-level social determinants of health may further drive the use of EHR data in population health studies.
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Affiliation(s)
- Yiye Zhang
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York City, New York, USA
- Department of Emergency Medicine, Weill Cornell Medicine, Cornell University, New York City, New York, USA
| | - Mohammad Tayarani
- School of Civil and Environmental Engineering, Cornell University, Ithaca, New York, USA
| | - Subhi J Al’Aref
- Division of Cardiology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ashley N Beecy
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Yifan Liu
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York City, New York, USA
| | - Evan Sholle
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York City, New York, USA
| | - Arindam RoyChoudhury
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York City, New York, USA
| | - Kelly M Axsom
- Columbia University Irving Medical Center, New York, New York, USA
| | - Huaizhu Oliver Gao
- School of Civil and Environmental Engineering, Cornell University, Ithaca, New York, USA
| | - Jyotishman Pathak
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York City, New York, USA
| | - Jessica S Ancker
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York City, New York, USA
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Brandt PS, Kiefer RC, Pacheco JA, Adekkanattu P, Sholle ET, Ahmad FS, Xu J, Xu Z, Ancker JS, Wang F, Luo Y, Jiang G, Pathak J, Rasmussen LV. Toward cross-platform electronic health record-driven phenotyping using Clinical Quality Language. Learn Health Syst 2020; 4:e10233. [PMID: 33083538 PMCID: PMC7556419 DOI: 10.1002/lrh2.10233] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/31/2020] [Accepted: 06/02/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Electronic health record (EHR)-driven phenotyping is a critical first step in generating biomedical knowledge from EHR data. Despite recent progress, current phenotyping approaches are manual, time-consuming, error-prone, and platform-specific. This results in duplication of effort and highly variable results across systems and institutions, and is not scalable or portable. In this work, we investigate how the nascent Clinical Quality Language (CQL) can address these issues and enable high-throughput, cross-platform phenotyping. METHODS We selected a clinically validated heart failure (HF) phenotype definition and translated it into CQL, then developed a CQL execution engine to integrate with the Observational Health Data Sciences and Informatics (OHDSI) platform. We executed the phenotype definition at two large academic medical centers, Northwestern Medicine and Weill Cornell Medicine, and conducted results verification (n = 100) to determine precision and recall. We additionally executed the same phenotype definition against two different data platforms, OHDSI and Fast Healthcare Interoperability Resources (FHIR), using the same underlying dataset and compared the results. RESULTS CQL is expressive enough to represent the HF phenotype definition, including Boolean and aggregate operators, and temporal relationships between data elements. The language design also enabled the implementation of a custom execution engine with relative ease, and results verification at both sites revealed that precision and recall were both 100%. Cross-platform execution resulted in identical patient cohorts generated by both data platforms. CONCLUSIONS CQL supports the representation of arbitrarily complex phenotype definitions, and our execution engine implementation demonstrated cross-platform execution against two widely used clinical data platforms. The language thus has the potential to help address current limitations with portability in EHR-driven phenotyping and scale in learning health systems.
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Affiliation(s)
- Pascal S. Brandt
- Biomedical Informatics and Medical EducationUniversity of WashingtonSeattleWashingtonUSA
| | - Richard C. Kiefer
- Department of Health Sciences ResearchMayo ClinicRochesterMinnesotaUSA
| | | | - Prakash Adekkanattu
- Information Technologies and ServicesWeill Cornell MedicineNew YorkNew YorkUSA
| | - Evan T. Sholle
- Information Technologies and ServicesWeill Cornell MedicineNew YorkNew YorkUSA
| | - Faraz S. Ahmad
- Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Jie Xu
- Department of Population Health SciencesWeill Cornell MedicineNew YorkNew YorkUSA
| | - Zhenxing Xu
- Department of Population Health SciencesWeill Cornell MedicineNew YorkNew YorkUSA
| | - Jessica S. Ancker
- Department of Population Health SciencesWeill Cornell MedicineNew YorkNew YorkUSA
| | - Fei Wang
- Department of Population Health SciencesWeill Cornell MedicineNew YorkNew YorkUSA
| | - Yuan Luo
- Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Guoqian Jiang
- Department of Health Sciences ResearchMayo ClinicRochesterMinnesotaUSA
| | - Jyotishman Pathak
- Department of Population Health SciencesWeill Cornell MedicineNew YorkNew YorkUSA
| | - Luke V. Rasmussen
- Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
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Baidal JW, Wang AY, Zumwalt K, Gary D, Greenberg Y, Cormack B, Lovinsky-Desir S, Nichols K, Pasco N, Nieto A, Ancker JS, Goldsmith J, Meyer D. Social Determinants of Health and COVID-19 Among Patients in New York City. Res Sq 2020:rs.3.rs-70959. [PMID: 32995762 PMCID: PMC7523130 DOI: 10.21203/rs.3.rs-70959/v1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Covid-19 testing and disease outcomes according to demographic and neighborhood characteristics must be understood. Methods Using aggregate administrative data from a multi-site academic healthcare system in New York from March 1 - May 14, 2020, we examined patient demographic and neighborhood characteristics according to Covid-19 testing and disease outcomes. Results Among the 23,918 patients, higher proportions of those over 65 years old, male sex, Hispanic ethnicity, Medicare, or Medicaid insurance had positive tests, were hospitalized, or died than those with younger age, non-Hispanic ethnicity, or private insurance. Patients living in census tracts with more non-White individuals, Hispanic individuals, individuals in poverty, or housing crowding had higher proportions of Covid-19 positive tests, hospitalizations, and deaths than counterparts. Discussion Variation exists in Covid-19 testing and disease outcomes according to patient and neighborhood characteristics. There is a need to monitor Covid-19 testing access and disease outcomes and resolve racist policies and practices.
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Affiliation(s)
| | - Amanda Y Wang
- Columbia University Vagelos College of Physicians & Surgeons
| | | | | | | | | | | | | | - Neil Pasco
- Columbia University Irving Medical Center
| | | | | | | | - Dodi Meyer
- Columbia University Irving Medical Center
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Baidal JW, Wang AY, Zumwalt K, Gary D, Greenberg Y, Cormack B, Lovinsky-Desir S, Nichols K, Pasco N, Nieto A, Ancker JS, Goldsmith J, Meyer D. Social Determinants of Health and COVID-19 Among Patients in New York City. Res Sq 2020. [PMID: 32995762 DOI: 10.21203/rs.3.rs‐70959/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: Covid-19 testing and disease outcomes according to demographic and neighborhood characteristics must be understood. Methods: Using aggregate administrative data from a multi-site academic healthcare system in New York from March 1 â€" May 14, 2020, we examined patient demographic and neighborhood characteristics according to Covid-19 testing and disease outcomes. Results: Among the 23,918 patients, higher proportions of those over 65 years old, male sex, Hispanic ethnicity, Medicare, or Medicaid insurance had positive tests, were hospitalized, or died than those with younger age, non-Hispanic ethnicity, or private insurance. Patients living in census tracts with more non-White individuals, Hispanic individuals, individuals in poverty, or housing crowding had higher proportions of Covid-19 positive tests, hospitalizations, and deaths than counterparts. Discussion: Variation exists in Covid-19 testing and disease outcomes according to patient and neighborhood characteristics. There is a need to monitor Covid-19 testing access and disease outcomes and resolve racist policies and practices.
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Abstract
For decades, health literacy has been used to describe the ability of individuals to locate, interpret, and apply health information to their decisions. The US Department of Health and Human Services has now proposed redefining the term to emphasize the role of society in providing accessible, comprehensible information. This redefinition would reflect a welcome shift to encompass the roles of those who communicate information, not simply those who seek it. However, redefining an accepted term would have serious negative effects on the indexing of the research literature and create difficulties interpreting studies conducted under the previous definition. Therefore, we strongly caution against redefining the accepted term. Instead, we propose introducing a new term-health information fluency-defined as universal effective use of health information. The old term can continue to be used to describe the set of concerns about individual skills, but by promoting the new term, the Department of Health and Human Services can encourage research into creating accurate, accessible health information that people can easily find, understand, and use to inform their decisions.
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Affiliation(s)
- Jessica S Ancker
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA.
| | - Lisa V Grossman
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Natalie C Benda
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
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