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Davis A, Knudsen HK, Walker DM, Chassler D, Lunze K, Westgate PM, Oga E, Rodriguez S, Tan S, Holloway J, Walsh SL, Oser CB, Lefebvre RC, Fanucchi LC, Glasgow L, McAlearney AS, Surratt HL, Konstan MW, Huang TTK, LeBaron P, Nakayima J, Stein MD, Rudorf M, Nouvong M, Kinnard EN, El-Bassel N, Tilley J, Macoubray A, Savitzky C, Farmer A, Beers D, Salsberry P, Huerta TR. Effects of the Communities that Heal (CTH) intervention on perceived opioid-related community stigma in the HEALing Communities Study: results of a multi-site, community-level, cluster-randomized trial. Lancet Reg Health Am 2024; 32:100710. [PMID: 38510790 PMCID: PMC10950860 DOI: 10.1016/j.lana.2024.100710] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/11/2024] [Accepted: 02/20/2024] [Indexed: 03/22/2024]
Abstract
Background Community stigma against people with opioid use disorder (OUD) and intervention stigma (e.g., toward naloxone) exacerbate the opioid overdose crisis. We examined the effects of the Communities that HEAL (CTH) intervention on perceived opioid-related community stigma by stakeholders in the HEALing Communities Study (HCS). Methods We collected three surveys from community coalition members in 66 communities across four states participating in HCS. Communities were randomized into Intervention (Wave 1) or Wait-list Control (Wave 2) arms. We conducted multilevel linear mixed models to compare changes in primary outcomes of community stigma toward people treated for OUD, naloxone, and medication for opioid use disorder (MOUD) by arm from time 1 (before the start of the intervention) to time 3 (end of the intervention period in the Intervention arm). Findings Intervention stakeholders reported a larger decrease in perceived community stigma toward people treated for OUD (adjusted mean change (AMC) -3.20 [95% C.I. -4.43, -1.98]) and toward MOUD (AMC -0.33 [95% C.I. -0.56, -0.09]) than stakeholders in Wait-list Control communities (AMC -0.18 [95% C.I. -1.38, 1.02], p = 0.0007 and AMC 0.11 [95% C.I. -0.09, 0.31], p = 0.0066). The relationship between intervention status and change in stigma toward MOUD was moderated by rural-urban status (urban AMC -0.59 [95% CI, -0.87, -0.32], rural AMC not sig.) and state. The difference in stigma toward naloxone between Intervention and Wait-list Control stakeholders was not statistically significant (p = 0.18). Interpretation The CTH intervention decreased stakeholder perceptions of community stigma toward people treated for OUD and stigma toward MOUD. Implementing the CTH intervention in other communities could decrease OUD stigma across diverse settings nationally. Funding US National Institute on Drug Abuse.
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Affiliation(s)
- Alissa Davis
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA
| | - Hannah K. Knudsen
- Department of Behavioral Science and Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Lexington, KY, 40508, USA
| | - Daniel M. Walker
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking College of Medicine, The Ohio State University, 700 Ackerman Rd., Suite 4000, Columbus, OH, 43202, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, 700 Ackerman Rd., Suite 5000, Columbus, OH, 43202, USA
| | - Deborah Chassler
- Boston University School of Social Work, 264-270 Bay State Road, Boston, MA, 02215, USA
| | - Karsten Lunze
- Boston University Chobanian & Avedisian School of Medicine/Boston Medical Center, Department of Medicine, 801 Massachusetts Ave., Boston, MA, 02118, USA
| | - Philip M. Westgate
- Department of Biostatistics, College of Public Health, University of Kentucky, 760 Press Avenue, Lexington, KY, 40536, USA
| | - Emmanuel Oga
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Sandra Rodriguez
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA
| | - Sylvia Tan
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - JaNae Holloway
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Sharon L. Walsh
- Department of Behavioral Science and Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Lexington, KY, 40508, USA
| | - Carrie B. Oser
- Department of Sociology, Center on Drug and Alcohol Research, Center for Health Equity Transformation, University of Kentucky, 1531 Patterson Office Tower, Lexington, KY, 40506, USA
| | - R. Craig Lefebvre
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Laura C. Fanucchi
- Department of Medicine, Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY, 40508, USA
| | - LaShawn Glasgow
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Ann Scheck McAlearney
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking College of Medicine, The Ohio State University, 700 Ackerman Rd., Suite 4000, Columbus, OH, 43202, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, 700 Ackerman Rd., Suite 5000, Columbus, OH, 43202, USA
| | - Hilary L. Surratt
- Department of Behavioral Science and Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Lexington, KY, 40508, USA
| | - Michael W. Konstan
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Terry T.-K. Huang
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, Graduate School of Public Health & Health Policy, City University of New York, 55 W. 125 Street, Room 803, New York, NY, 10027, USA
| | - Patricia LeBaron
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Julie Nakayima
- Department of Behavioral Science and Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Lexington, KY, 40508, USA
| | - Michael D. Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
| | - Maria Rudorf
- Boston Medical Center, Section of General Internal Medicine, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Monica Nouvong
- Boston Medical Center, Section of General Internal Medicine, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Elizabeth N. Kinnard
- Boston Medical Center, Section of General Internal Medicine, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Nabila El-Bassel
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA
| | - Jess Tilley
- New England Drug Users Union, 36 Bedford Terrace, Suite 2, Northampton, MA, 01060, USA
| | - Aaron Macoubray
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Caroline Savitzky
- Boston Medical Center, Section of Infectious Diseases, 801 Massachusetts Ave., Boston, MA, 02118, USA
| | - Amy Farmer
- The Ohio State University College of Medicine, HEALing Communities Research, 530 W. Spring St., Suite 275, Columbus, OH, 43215, USA
| | - Donna Beers
- Boston Medical Center, Section of General Internal Medicine, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Pamela Salsberry
- The Ohio State University College of Public Health, 1841 Neil Ave., Columbus, OH, 43210, USA
| | - Timothy R. Huerta
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking College of Medicine, The Ohio State University, 700 Ackerman Rd., Suite 4000, Columbus, OH, 43202, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, 700 Ackerman Rd., Suite 5000, Columbus, OH, 43202, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, 1585 Neil Ave, Columbus, OH, 43210, USA
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Walker DM, Hefner JL, MacEwan SR, Di Tosto G, Sova LN, Gaughan AA, Huerta TR, McAlearney AS. Differences by Race in Outcomes of an In-Person Training Intervention on Use of an Inpatient Portal: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2024; 7:e245091. [PMID: 38573634 DOI: 10.1001/jamanetworkopen.2024.5091] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Importance Differences in patient use of health information technologies by race can adversely impact equitable access to health care services. While this digital divide is well documented, there is limited evidence of how health care systems have used interventions to narrow the gap. Objective To compare differences in the effectiveness of patient training and portal functionality interventions implemented to increase portal use among racial groups. Design, Setting, and Participants This secondary analysis used data from a randomized clinical trial conducted from December 15, 2016, to August 31, 2019. Data were from a single health care system and included 6 noncancer hospitals. Participants were patients who were at least 18 years of age, identified English as their preferred language, were not involuntarily confined or detained, and agreed to be provided a tablet to access the inpatient portal during their stay. Data were analyzed from September 1, 2022, to October 31, 2023. Interventions A 2 × 2 factorial design was used to compare the inpatient portal training intervention (touch, in-person [high] vs built-in video tutorial [low]) and the portal functionality intervention (technology, full functionality [full] vs a limited subset of functions [lite]). Main Outcomes and Measures Primary outcomes were inpatient portal use, measured by frequency and comprehensiveness of use, and use of specific portal functions. A logistic regression model was used to test the association of the estimators with the comprehensiveness use measure. Outcomes are reported as incidence rate ratios (IRRs) for the frequency outcomes or odds ratios (ORs) for the comprehensiveness outcomes with corresponding 95% CIs. Results Of 2892 participants, 550 (19.0%) were Black individuals, 2221 (76.8%) were White individuals, and 121 (4.2%) were categorized as other race (including African, American Indian or Alaska Native, Asian or Asian American, multiple races or ethnicities, and unknown race or ethnicity). Black participants had a significantly lower frequency (IRR, 0.80 [95% CI, 0.72-0.89]) of inpatient portal use compared with White participants. Interaction effects were not observed between technology, touch, and race. Among participants who received the full technology intervention, Black participants had lower odds of being comprehensive users (OR, 0.76 [95% CI, 0.62-0.91), but interaction effects were not observed between touch and race. Conclusions and Relevance In this study, providing in-person training or robust portal functionality did not narrow the divide between Black participants and White participants with respect to their inpatient portal use. Health systems looking to narrow the digital divide may need to consider intentional interventions that address underlying issues contributing to this inequity. Trial Registration ClinicalTrials.gov Identifier: NCT02943109.
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Affiliation(s)
- Daniel M Walker
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus
| | - Jennifer L Hefner
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus
| | - Sarah R MacEwan
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus
| | - Gennaro Di Tosto
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus
| | - Lindsey N Sova
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus
| | - Alice A Gaughan
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus
| | - Timothy R Huerta
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus
| | - Ann Scheck McAlearney
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus
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Davis A, Stringer KL, Drainoni ML, Oser CB, Knudsen HK, Aldrich A, Surratt HL, Walker DM, Gilbert L, Downey DL, Gardner SD, Tan S, Lines LM, Vandergrift N, Mack N, Holloway J, Lunze K, McAlearney AS, Huerta TR, Goddard-Eckrich DA, El-Bassel N. Community-level determinants of stakeholder perceptions of community stigma toward people with opioid use disorders, harm reduction services and treatment in the HEALing Communities Study. Int J Drug Policy 2023; 122:104241. [PMID: 37890391 PMCID: PMC10841835 DOI: 10.1016/j.drugpo.2023.104241] [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: 07/17/2023] [Revised: 09/16/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Community stigma toward people with opioid use disorder (OUD) can impede access to harm reduction services and treatment with medications for opioid use disorder (MOUD). Such community OUD stigma is partially rooted in community-level social and economic conditions, yet there remains a paucity of large-scale quantitative data examining community-level factors associated with OUD stigma. We examined whether rurality, social inequity, and racialized segregation across communities from four states in the HEALing Communities Study (HCS) were associated with 1) greater perceived community stigma toward people treated for OUD, 2) greater perceived intervention stigma toward MOUD, and 3) greater perceived intervention stigma toward naloxone by community stakeholders in the HCS. METHODS From November 2019-January 2020, a cross-sectional survey about community OUD stigma was administered to 801 members of opioid overdose prevention coalitions across 66 communities in four states prior to the start of HCS intervention activities. Bivariate analyses assessed pairwise associations between community rural/urban status and each of the three stigma variables, using linear mixed effect modeling to account for response clustering within communities, state, and respondent sociodemographic characteristics. We conducted similar bivariate analyses to assess pairwise associations between racialized segregation and social inequity. RESULTS On average, the perceived community OUD stigma scale score of stakeholders from rural communities was 4% higher (β=1.57, SE=0.7, p≤0.05), stigma toward MOUD was 6% higher (β=0.28, SE=0.1, p≤0.05), and stigma toward naloxone was 10% higher (β=0.46, SE=0.1, p≤0.01) than among stakeholders from urban communities. No significant differences in the three stigma variables were found among communities based on racialized segregation or social inequity. CONCLUSION Perceived community stigma toward people treated for OUD, MOUD, and naloxone was higher among stakeholders in rural communities than in urban communities. Findings suggest that interventions and policies to reduce community-level stigma, particularly in rural areas, are warranted.
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Affiliation(s)
- Alissa Davis
- Columbia University School of Social Work, New York, NY, United States.
| | - Kristi Lynn Stringer
- Department of Health and Human Performance, Community and Public Health, Middle Tennessee State University, Murfreesboro, TN, United States
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedesian School of Medicine/Boston Medical Center, Boston, MA, United States; Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, United States
| | - Carrie B Oser
- Department of Sociology, Center on Drug & Alcohol Research, Center for Health Equity Transformation, University of Kentucky, Lexington, KY, United States
| | - Hannah K Knudsen
- Department of Behavioral Science, Center on Drug & Alcohol Research, University of Kentucky, Lexington, KY, United States
| | - Alison Aldrich
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Hilary L Surratt
- Department of Behavioral Science, Center on Drug & Alcohol Research, University of Kentucky, Lexington, KY, United States
| | - Daniel M Walker
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Louisa Gilbert
- Columbia University School of Social Work, New York, NY, United States
| | - Dget L Downey
- Columbia University School of Social Work, New York, NY, United States
| | - Sam D Gardner
- Columbia University School of Social Work, New York, NY, United States
| | - Sylvia Tan
- RTI International, Research Triangle Park, NC, United States
| | - Lisa M Lines
- RTI International, Research Triangle Park, NC, United States
| | | | - Nicole Mack
- RTI International, Research Triangle Park, NC, United States
| | - JaNae Holloway
- RTI International, Research Triangle Park, NC, United States
| | - Karsten Lunze
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedesian School of Medicine/Boston Medical Center, Boston, MA, United States
| | - Ann Scheck McAlearney
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Timothy R Huerta
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | | | - Nabila El-Bassel
- Columbia University School of Social Work, New York, NY, United States
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Gregory ME, Sova LN, Huerta TR, McAlearney AS. Implications for Electronic Surveys in Inpatient Settings Based on Patient Survey Response Patterns: Cross-Sectional Study. J Med Internet Res 2023; 25:e48236. [PMID: 37910163 PMCID: PMC10652193 DOI: 10.2196/48236] [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: 04/16/2023] [Revised: 08/24/2023] [Accepted: 08/31/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Surveys of hospitalized patients are important for research and learning about unobservable medical issues (eg, mental health, quality of life, and symptoms), but there has been little work examining survey data quality in this population whose capacity to respond to survey items may differ from the general population. OBJECTIVE The aim of this study is to determine what factors drive response rates, survey drop-offs, and missing data in surveys of hospitalized patients. METHODS Cross-sectional surveys were distributed on an inpatient tablet to patients in a large, midwestern US hospital. Three versions were tested: 1 with 174 items and 2 with 111 items; one 111-item version had missing item reminders that prompted participants when they did not answer items. Response rate, drop-off rate (abandoning survey before completion), and item missingness (skipping items) were examined to investigate data quality. Chi-square tests, Kaplan-Meyer survival curves, and distribution charts were used to compare data quality among survey versions. Response duration was computed for each version. RESULTS Overall, 2981 patients responded. Response rate did not differ between the 174- and 111-item versions (81.7% vs 83%, P=.53). Drop-off was significantly reduced when the survey was shortened (65.7% vs 20.2% of participants dropped off, P<.001). Approximately one-quarter of participants dropped off by item 120, with over half dropping off by item 158. The percentage of participants with missing data decreased substantially when missing item reminders were added (77.2% vs 31.7% of participants, P<.001). The mean percentage of items with missing data was reduced in the shorter survey (40.7% vs 20.3% of items missing); with missing item reminders, the percentage of items with missing data was further reduced (20.3% vs 11.7% of items missing). Across versions, for the median participant, each item added 24.6 seconds to a survey's duration. CONCLUSIONS Hospitalized patients may have a higher tolerance for longer surveys than the general population, but surveys given to hospitalized patients should have a maximum of 120 items to ensure high rates of completion. Missing item prompts should be used to reduce missing data. Future research should examine generalizability to nonhospitalized individuals.
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Affiliation(s)
- Megan E Gregory
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Lindsey N Sova
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Timothy R Huerta
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, United States
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Ann Scheck McAlearney
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, United States
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
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Paskett ED, Kruse-Diehr AJ, Oliveri JM, Vanderpool RC, Gray DM, Pennell ML, Huang B, Young GS, Fickle D, Cromo M, Katz ML, Reiter PL, Rogers M, Gross DA, Fairchild V, Xu W, Carman A, Walunis JM, McAlearney AS, Huerta TR, Rahurkar S, Biederman E, Dignan M. Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) in Appalachia: protocol for a group randomized, delayed intervention trial. Transl Behav Med 2023; 13:748-756. [PMID: 37202831 PMCID: PMC10538475 DOI: 10.1093/tbm/ibad017] [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] [Indexed: 05/20/2023] Open
Abstract
Appalachian regions of Kentucky and Ohio are hotspots for colorectal cancer (CRC) mortality in the USA. Screening reduces CRC incidence and mortality; however, screening uptake is needed, especially in these underserved geographic areas. Implementation science offers strategies to address this challenge. The aim of the current study was to conduct multi-site, transdisciplinary research to evaluate and improve CRC screening processes using implementation science strategies. The study consists of two phases (Planning and Implementation). In the Planning Phase, a multilevel assessment of 12 health centers (HC) (one HC from each of the 12 Appalachian counties) was conducted by interviewing key informants, creating community profiles, identifying HC and community champions, and performing HC data inventories. Two designated pilot HCs chose CRC evidence-based interventions to adapt and implement at each level (i.e., patient, provider, HC, and community) with evaluation relative to two matched control HCs. During the Implementation Phase, study staff will repeat the rollout process in HC and community settings in a randomized, staggered fashion in the remaining eight counties/HCs. Evaluation will include analyses of electronic health record data and provider and county surveys. Rural HCs have been reluctant to participate in research because of concerns about capacity; however, this project should demonstrate that research does not need to be burdensome and can adapt to local needs and HC abilities. If effective, this approach could be disseminated to HC and community partners throughout Appalachia to encourage the uptake of effective interventions to reduce the burden of CRC.
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Affiliation(s)
- Electra D Paskett
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Medicine, Department of Internal Medicine, Columbus, OH, USA
| | - Aaron J Kruse-Diehr
- University of Kentucky College of Medicine, Department of Family and Community Medicine, Lexington, KY, USA
- University of Kentucky Markey Cancer Center, Cancer Prevention and Control Research Program, Lexington, KY, USA
| | - Jill M Oliveri
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Robin C Vanderpool
- University of Kentucky College of Public Health, Department of Health, Behavior and Society, Lexington, KY, USA
| | - Darrell M Gray
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Medicine, Department of Internal Medicine, Columbus, OH, USA
| | - Michael L Pennell
- The Ohio State University College of Public Health, Division of Biostatistics, Columbus, OH, USA
| | - Bin Huang
- University of Kentucky Markey Cancer Center, Division of Biostatistics, Biostatistics and Bioinformatics Shared Resource Facility, Lexington, KY, USA
| | | | - Darla Fickle
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Mark Cromo
- University of Kentucky College of Medicine, Department of Internal Medicine, Lexington, KY, USA
| | - Mira L Katz
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Division of Health Behavior and Health Promotion, Columbus, OH, USA
| | - Paul L Reiter
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Division of Health Behavior and Health Promotion, Columbus, OH, USA
| | - Melinda Rogers
- University of Kentucky Markey Cancer Center, Community Impact Office, Lexington, KY, USA
| | - David A Gross
- Northeast Kentucky Area Health Education Center, Morehead, KY, USA
| | - Vickie Fairchild
- Northeast Kentucky Area Health Education Center, Morehead, KY, USA
| | - Wendy Xu
- The Ohio State University College of Public Health, Division of Health Services Management and Policy, Columbus, OH, USA
| | - Angela Carman
- University of Kentucky Markey Cancer Center, Cancer Prevention and Control Research Program, Lexington, KY, USA
| | - Jean M Walunis
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Ann Scheck McAlearney
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Division of Health Services Management and Policy, Columbus, OH, USA
- The Ohio State University College of Medicine, Department of Family and Community Medicine, Columbus, OH, USA
| | - Timothy R Huerta
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Division of Health Services Management and Policy, Columbus, OH, USA
- The Ohio State University College of Medicine, Department of Family and Community Medicine, Columbus, OH, USA
| | | | - Erika Biederman
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Mark Dignan
- University of Kentucky College of Medicine, Department of Internal Medicine, Lexington, KY, USA
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6
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Venkatesh KK, Joseph JJ, Swoboda C, Strouse R, Hoseus J, Baker C, Summerfield T, Bartholomew A, Buccilla L, Pan X, Sieck C, McAlearney AS, Huerta TR, Fareed N. Multicomponent provider-patient intervention to improve glycaemic control in Medicaid-insured pregnant individuals with type 2 diabetes: clinical trial protocol for the ACHIEVE study. BMJ Open 2023; 13:e074657. [PMID: 37164461 PMCID: PMC10173964 DOI: 10.1136/bmjopen-2023-074657] [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] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION Type 2 diabetes (T2D) is one of the most frequent comorbid medical conditions in pregnancy. Glycaemic control decreases the risk of adverse pregnancy outcomes for the pregnant individual and infant. Achieving glycaemic control can be challenging for Medicaid-insured pregnant individuals who experience a high burden of unmet social needs. Multifaceted provider-patient-based approaches are needed to improve glycaemic control in this high-risk pregnant population. Mobile health (mHealth) applications (app), provider dashboards, continuous glucose monitoring (CGM) and addressing social needs have been independently associated with improved glycaemic control in non-pregnant individuals living with diabetes. The combined effect of these interventions on glycaemic control among pregnant individuals with T2D remains to be evaluated. METHODS AND ANALYSIS In a two-arm randomised controlled trial, we will examine the combined effects of a multicomponent provider-patient intervention, including a patient mHealth app, provider dashboard, CGM, a community health worker to address non-medical health-related social needs and team-based care versus the current standard of diabetes and prenatal care. We will recruit 124 Medicaid-insured pregnant individuals living with T2D, who are ≤20 weeks of gestation with poor glycaemic control measured as a haemoglobin A1c ≥ 6.5% assessed within 12 weeks of trial randomisation or within 12 weeks of enrolling in prenatal care from an integrated diabetes and prenatal care programme at a tertiary care academic health system located in the Midwestern USA. We will measure how many individuals achieve the primary outcome of glycaemic control measured as an A1c<6.5% by the time of delivery, and secondarily, adverse pregnancy outcomes; patient-reported outcomes (eg, health and technology engagement, literacy and comprehension; provider-patient communication; diabetes self-efficacy; distress, knowledge and beliefs; social needs referrals and utilisation; medication adherence) and CGM measures of glycaemic control (in the intervention group). ETHICS AND DISSEMINATION The Institutional Review Board at The Ohio State University approved this study (IRB: 2022H0399; date: 3 June 2023). We plan to submit manuscripts describing the user-designed methods and will submit the results of the trial for publication in peer-reviewed journals and presentations at international scientific meetings. TRIAL REGISTRATION NUMBER NCT05662462.
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Affiliation(s)
- Kartik K Venkatesh
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Joshua J Joseph
- Deparment of Medicine, Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University, Columbus, Ohio, USA
| | - Christine Swoboda
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, The Ohio State University, Columbus, Ohio, USA
| | - Robert Strouse
- Department of Research Information Technology, The Ohio State University, Columbus, Ohio, USA
| | | | | | - Taryn Summerfield
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Anna Bartholomew
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Lisa Buccilla
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - X Pan
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
| | - Cynthia Sieck
- Department of Pediatrics, Wright State University, Dayton, Ohio, USA
| | - Ann Scheck McAlearney
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, The Ohio State University, Columbus, Ohio, USA
- Department of Family and Community Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Timothy R Huerta
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
| | - Naleef Fareed
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
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7
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McAlearney AS, Walker DM, Sieck CJ, Fareed N, MacEwan SR, Hefner JL, Di Tosto G, Gaughan A, Sova LN, Rush LJ, Moffatt-Bruce S, Rizer MK, Huerta TR. Effect of In-Person vs Video Training and Access to All Functions vs a Limited Subset of Functions on Portal Use Among Inpatients: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2231321. [PMID: 36098967 PMCID: PMC9471980 DOI: 10.1001/jamanetworkopen.2022.31321] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/22/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Inpatient portals provide patients with clinical data and information about their care and have the potential to influence patient engagement and experience. Although significant resources have been devoted to implementing these portals, evaluation of their effects has been limited. Objective To assess the effects of patient training and portal functionality on use of an inpatient portal and on patient satisfaction and involvement with care. Design, Setting, and Participants This randomized clinical trial was conducted from December 15, 2016, to August 31, 2019, at 6 noncancer hospitals that were part of a single health care system. Patients who were at least 18 years of age, identified English as their preferred language, were not involuntarily confined or detained, and agreed to be provided a tablet to access the inpatient portal during their stay were eligible for participation. Data were analyzed from May 1, 2019, to March 15, 2021. Interventions A 2 × 2 factorial intervention design was used to compare 2 levels of a training intervention (touch intervention, consisting of in-person training vs built-in video tutorial) and 2 levels of portal function availability (tech intervention) within an inpatient portal (all functions operational vs a limited subset of functions). Main Outcomes and Measures The primary outcomes were inpatient portal use, measured by frequency and comprehensiveness of use, and patients' satisfaction and involvement with their care. Results Of 2892 participants, 1641 were women (56.7%) with a median age of 47.0 (95% CI, 46.0-48.0) years. Most patients were White (2221 [76.8%]). The median Charlson Comorbidity Index was 1 (95% CI, 1-1) and the median length of stay was 6 (95% CI, 6-7) days. Notably, the in-person training intervention was found to significantly increase inpatient portal use (incidence rate ratio, 1.34 [95% CI, 1.25-1.44]) compared with the video tutorial. Patients who received in-person training had significantly higher odds of being comprehensive portal users than those who received the video tutorial (odds ratio, 20.75 [95% CI, 16.49-26.10]). Among patients who received the full-tech intervention, those who also received the in-person intervention used the portal more frequently (incidence rate ratio, 1.36 [95% CI, 1.25-1.48]) and more comprehensively (odds ratio, 22.52; [95% CI, 17.13-29.62]) than those who received the video tutorial. Patients who received in-person training had higher odds (OR, 2.01 [95% CI, 1.16-3.50]) of reporting being satisfied in the 6-month postdischarge survey. Similarly, patients who received the full-tech intervention had higher odds (OR, 2.06 [95%CI, 1.42-2.99]) of reporting being satisfied in the 6-month postdischarge survey. Conclusions and Relevance Providing in-person training or robust portal functionality increased inpatient engagement with the portal during the hospital stay. The effects of the training intervention suggest that providing personalized training to support use of this health information technology can be a powerful approach to increase patient engagement via portals. Trial Registration ClinicalTrials.gov Identifier: NCT02943109.
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Affiliation(s)
- Ann Scheck McAlearney
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Daniel M. Walker
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Cynthia J. Sieck
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
- Dayton Children’s Hospital Center for Health Equity, Dayton, Ohio
| | - Naleef Fareed
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus
| | - Sarah R. MacEwan
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus
| | - Jennifer L. Hefner
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus
| | - Gennaro Di Tosto
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Alice Gaughan
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Lindsey N. Sova
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Laura J. Rush
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | | | - Milisa K. Rizer
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
| | - Timothy R. Huerta
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus
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8
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Di Tosto G, Walker DM, Sieck CJ, Wallace L, MacEwan SR, Gregory ME, Scarborough S, Huerta TR, McAlearney AS. Examining the Relationship between Health Literacy, Health Numeracy, and Patient Portal Use. Appl Clin Inform 2022; 13:692-699. [PMID: 35793698 DOI: 10.1055/s-0042-1751239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
OBJECTIVES The objective of this study is to investigate the relationships between health literacy and numeracy (HLN) and patient portal use, measured in inpatient and outpatient settings. METHODS Using data collected as part of a pragmatic randomized controlled trial conducted across the inpatient population of a U.S.-based academic medical center, the present study evaluated the relationships between patients' perceptions of health literacy and their skills, interpreting medical information with metrics of engagement with patient portals. RESULTS Self-reported levels of HLN for patients in the study sample (n = 654) were not significantly associated with inpatient portal use as measured by frequency of use or the number of different inpatient portal functions used. Use of the outpatient version of the portal over the course of 6 months following hospital discharge was also not associated with HLN. A subsequent assessment of patients after 6 months of portal use postdischarge (response rate 40%) did not reveal any differences with respect to portal use and health numeracy; however, a significant increase in self-reported levels of health literacy was found at this point. CONCLUSION While previous studies have suggested that low HLN might represent a barrier to inpatient portal adoption and might limit engagement with outpatient portals, we did not find these associations to hold. Our findings, however, suggest that the inpatient setting may be effective in facilitating technology acceptance. Specifically, the introduction of an inpatient portal made available on hospital-provided tablets may have practical implications and contribute to increased adoption of patient-facing health information technology tools.
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Affiliation(s)
- Gennaro Di Tosto
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Daniel M Walker
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Cynthia J Sieck
- Center for Health Equity, Dayton Children's Hospital, Dayton, Ohio, United States
| | - Lorraine Wallace
- Department of Biomedical Education and Anatomy, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Sarah R MacEwan
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Megan E Gregory
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Seth Scarborough
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Timothy R Huerta
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Ann Scheck McAlearney
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
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9
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Vest JR, Adler-Milstein J, Gottlieb LM, Bian J, Campion TR, Cohen GR, Donnelly N, Harper J, Huerta TR, Kansky JP, Kharrazi H, Khurshid A, Kooreman HE, McDonnell C, Overhage JM, Pantell MS, Parisi W, Shenkman EA, Tierney WM, Wiehe S, Harle CA. Assessment of structured data elements for social risk factors. Am J Manag Care 2022; 28:e14-e23. [PMID: 35049262 DOI: 10.37765/ajmc.2022.88816] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Computable social risk factor phenotypes derived from routinely collected structured electronic health record (EHR) or health information exchange (HIE) data may represent a feasible and robust approach to measuring social factors. This study convened an expert panel to identify and assess the quality of individual EHR and HIE structured data elements that could be used as components in future computable social risk factor phenotypes. STUDY DESIGN Technical expert panel. METHODS A 2-round Delphi technique included 17 experts with an in-depth knowledge of available EHR and/or HIE data. The first-round identification sessions followed a nominal group approach to generate candidate data elements that may relate to socioeconomics, cultural context, social relationships, and community context. In the second-round survey, panelists rated each data element according to overall data quality and likelihood of systematic differences in quality across populations (ie, bias). RESULTS Panelists identified a total of 89 structured data elements. About half of the data elements (n = 45) were related to socioeconomic characteristics. The panelists identified a diverse set of data elements. Elements used in reimbursement-related processes were generally rated as higher quality. Panelists noted that several data elements may be subject to implicit bias or reflect biased systems of care, which may limit their utility in measuring social factors. CONCLUSIONS Routinely collected structured data within EHR and HIE systems may reflect patient social risk factors. Identifying and assessing available data elements serves as a foundational step toward developing future computable social factor phenotypes.
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Affiliation(s)
- Joshua R Vest
- Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN 46202.
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10
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McAlearney AS, Sieck CJ, Gregory M, Di Tosto G, MacEwan SR, DePuccio MJ, Lee JA, Huerta TR, Walker DM. Examining Patients' Capacity to Use Patient Portals: Insights for Telehealth. Med Care 2021; 59:1067-1074. [PMID: 34593709 PMCID: PMC8595621 DOI: 10.1097/mlr.0000000000001639] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The increase in telehealth in response to the coronavirus disease 2019 pandemic highlights the need to understand patients' capacity to utilize this care modality. Patient portals are a tool whose use requires similar resources and skills as those required for telehealth. Patients' capacity to use patient portals may therefore provide insight regarding patients' readiness and capacity to use telehealth. OBJECTIVE The aim of this study was to examine factors related to patients' capacity to use a patient portal and test the impact of these factors on patients' portal use. RESEARCH DESIGN AND SUBJECTS Using data from a large-scale pragmatic randomized controlled trial of patient portal use, 1081 hospitalized patients responded to survey items that were then mapped onto the 4 dimensions of the Engagement Capacity Framework: self-efficacy, resources, willingness, and capabilities. MEASURES The outcome variable was frequency of outpatient portal use. We evaluated associations between Engagement Capacity Framework dimensions and patient portal use, using regression analyses. RESULTS Patients with fewer resources, fewer capabilities, lower willingness, and lower overall capacity to use patient portals used the portal less; in contrast, those with lower perceived self-efficacy used the portal more. CONCLUSIONS Our findings highlight differences in patients' capacity to use patient portals, which provide an initial understanding of factors that may influence the use of telehealth and offer important guidance in efforts to support patients' telehealth use. Offering patients training tailored to the use of telehealth tools may be particularly beneficial.
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Affiliation(s)
- Ann Scheck McAlearney
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Cynthia J. Sieck
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Megan Gregory
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Gennaro Di Tosto
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Sarah R. MacEwan
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Matthew J. DePuccio
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jennifer A. Lee
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Timothy R. Huerta
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Daniel M. Walker
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
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11
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Knudsen HK, Drainoni ML, Gilbert L, Huerta TR, Oser CB, Aldrich AM, Campbell AN, Crable EL, Garner BR, Glasgow LM, Goddard-Eckrich D, Marks KR, McAlearney AS, Oga EA, Scalise AL, Walker DM. Corrigendum to "Model and approach for assessing implementation context and fidelity in the HEALing Communities Study" [Drug Alcohol Depend. 217 (2020) 108330]. Drug Alcohol Depend 2021; 224:108742. [PMID: 33984669 PMCID: PMC8445314 DOI: 10.1016/j.drugalcdep.2021.108742] [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] [Indexed: 11/28/2022]
Affiliation(s)
- Hannah K. Knudsen
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY, 40508, USA,Corresponding author at: University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY, 40508, USA
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases and Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, USA; Department of Health Law, Policy and Management, Boston University School of Public Health, 801 Massachusetts Avenue, Room 2014, Boston, MA, 02118, USA.
| | - Louisa Gilbert
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
| | - Timothy R. Huerta
- College of Medicine, The Ohio State University, 460 Medical Center Drive, Suite 530, Columbus, OH, 43210, USA
| | - Carrie B. Oser
- Department of Sociology and Center on Drug and Alcohol Research, University of Kentucky, 1531 Patterson Office Tower, Lexington, KY, 40506, USA
| | - Alison M. Aldrich
- CATALYST, the Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 460 Medical Center Drive, Suite 530, Columbus, OH, 43210, USA
| | - Aimee N.C. Campbell
- Columbia University Irving Medical Center, Department of Psychiatry and New York State Psychiatric Institute, 1051 Riverside Drive, Box 120, New York, NY, 10032, USA
| | - Erika L. Crable
- Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, Department of Health Law, Policy and Management, Boston University School of Public Health, 801 Massachusetts Avenue, Room 2030, Boston, MA, 02118, USA
| | - Bryan R. Garner
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - LaShawn M. Glasgow
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - Dawn Goddard-Eckrich
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
| | - Katherine R. Marks
- Department of Behavioral Science, University of Kentucky, 1100 Veterans Drive, Medical Behavioral Science Building Room 108, Lexington, KY, 40536, USA
| | - Ann Scheck McAlearney
- Department of Family and Community Medicine and CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 460 Medical Center Drive, Suite 530, Columbus, OH, 43210, USA.
| | - Emmanuel A. Oga
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - Ariel L. Scalise
- Department of Infectious Disease, Boston Medical Center, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Daniel M. Walker
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, 460 Medical Center Drive, Suite 520, Columbus, OH, 43210, USA
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12
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Kruse-Diehr AJ, Oliveri JM, Vanderpool RC, Katz ML, Reiter PL, Gray DM, Pennell ML, Young GS, Huang B, Fickle D, Cromo M, Rogers M, Gross D, Gibson A, Jellison J, Sarap MD, Bivens TA, McGuire TD, McAlearney AS, Huerta TR, Rahurkar S, Paskett ED, Dignan M. Development of a multilevel intervention to increase colorectal cancer screening in Appalachia. Implement Sci Commun 2021; 2:51. [PMID: 34011410 PMCID: PMC8136225 DOI: 10.1186/s43058-021-00151-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/17/2020] [Accepted: 04/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) screening rates are lower in Appalachian regions of the United States than in non-Appalachian regions. Given the availability of various screening modalities, there is critical need for culturally relevant interventions addressing multiple socioecological levels to reduce the regional CRC burden. In this report, we describe the development and baseline findings from year 1 of "Accelerating Colorectal Cancer Screening through Implementation Science (ACCSIS) in Appalachia," a 5-year, National Cancer Institute Cancer MoonshotSM-funded multilevel intervention (MLI) project to increase screening in Appalachian Kentucky and Ohio primary care clinics. METHODS Project development was theory-driven and included the establishment of both an external Scientific Advisory Board and a Community Advisory Board to provide guidance in conducting formative activities in two Appalachian counties: one in Kentucky and one in Ohio. Activities included identifying and describing the study communities and primary care clinics, selecting appropriate evidence-based interventions (EBIs), and conducting a pilot test of MLI strategies addressing patient, provider, clinic, and community needs. RESULTS Key informant interviews identified multiple barriers to CRC screening, including fear of screening, test results, and financial concerns (patient level); lack of time and competing priorities (provider level); lack of reminder or tracking systems and staff burden (clinic level); and cultural issues, societal norms, and transportation (community level). With this information, investigators then offered clinics a menu of EBIs and strategies to address barriers at each level. Clinics selected individually tailored MLIs, including improvement of patient education materials, provision of provider education (resulting in increased knowledge, p = .003), enhancement of electronic health record (EHR) systems and development of clinic screening protocols, and implementation of community CRC awareness events, all of which promoted stool-based screening (i.e., FIT or FIT-DNA). Variability among clinics, including differences in EHR systems, was the most salient barrier to EBI implementation, particularly in terms of tracking follow-up of positive screening results, whereas the development of clinic-wide screening protocols was found to promote fidelity to EBI components. CONCLUSIONS Lessons learned from year 1 included increased recognition of variability among the clinics and how they function, appreciation for clinic staff and provider workload, and development of strategies to utilize EHR systems. These findings necessitated a modification of study design for subsequent years. TRIAL REGISTRATION Trial NCT04427527 is registered at https://clinicaltrials.gov and was registered on June 11, 2020.
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Affiliation(s)
- Aaron J Kruse-Diehr
- University of Kentucky College of Public Health, Lexington, KY, USA.
- University of Kentucky Markey Cancer Center, Lexington, KY, USA.
| | - Jill M Oliveri
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | | | - Mira L Katz
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Columbus, OH, USA
| | - Paul L Reiter
- The Ohio State University College of Public Health, Columbus, OH, USA
| | - Darrell M Gray
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Michael L Pennell
- The Ohio State University College of Public Health, Columbus, OH, USA
| | - Gregory S Young
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Bin Huang
- University of Kentucky Markey Cancer Center, Lexington, KY, USA
| | - Darla Fickle
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Mark Cromo
- University of Kentucky Markey Cancer Center, Lexington, KY, USA
| | - Melinda Rogers
- University of Kentucky Markey Cancer Center, Lexington, KY, USA
| | - David Gross
- Northeast Kentucky Area Health Education Center, Morehead, KY, USA
| | - Ashley Gibson
- Northeast Kentucky Area Health Education Center, Morehead, KY, USA
| | | | | | - Tonia A Bivens
- Lewis County Primary Care Center, Inc. dba PrimaryPlus, Vanceburg, KY, USA
| | - Tracy D McGuire
- Lewis County Primary Care Center, Inc. dba PrimaryPlus, Vanceburg, KY, USA
| | - Ann Scheck McAlearney
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Timothy R Huerta
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Saurabh Rahurkar
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Electra D Paskett
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Mark Dignan
- University of Kentucky Markey Cancer Center, Lexington, KY, USA
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Fareed N, Jonnalagadda P, MacEwan SR, Di Tosto G, Scarborough S, Huerta TR, McAlearney AS. Differential Effects of Outpatient Portal User Status on Inpatient Portal Use: Observational Study. J Med Internet Res 2021; 23:e23866. [PMID: 33929328 PMCID: PMC8122294 DOI: 10.2196/23866] [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: 08/26/2020] [Revised: 11/23/2020] [Accepted: 03/16/2021] [Indexed: 11/15/2022] Open
Abstract
Background The decision to use patient portals can be influenced by multiple factors, including individuals’ perceptions of the tool, which are based on both their personal skills and experiences. Prior experience with one type of portal may make individuals more comfortable with using newer portal technologies. Experienced outpatient portal users in particular may have confidence in their ability to use inpatient portals that have similar functionality. In practice, the use of both outpatient and inpatient portal technologies can provide patients with continuity of access to their health information across care settings, but the influence of one type of portal use on the use of other portals has not been studied. Objective This study aims to understand how patients’ use of an inpatient portal is influenced by outpatient portal use. Methods This study included patients from an academic medical center who were provided access to an inpatient portal during their hospital stays between 2016 and 2018 (N=1571). We analyzed inpatient portal log files to investigate how inpatient portal use varied by using 3 categories of outpatient portal users: prior users, new users, and nonusers. Results Compared with prior users (695/1571, 44.24%) of an outpatient portal, new users (214/1571, 13.62%) had higher use of a select set of inpatient portal functions (messaging function: incidence rate ratio [IRR] 1.33, 95% CI 1.06-1.67; function that provides access to the outpatient portal through the inpatient portal: IRR 1.34, 95% CI 1.13-1.58). Nonusers (662/1571, 42.14%), compared with prior users, had lower overall inpatient portal use (all active functions: IRR 0.68, 95% CI 0.60-0.78) and lower use of specific functions, which included the function to review vitals and laboratory results (IRR 0.51, 95% CI 0.36-0.73) and the function to access the outpatient portal (IRR 0.53, 95% CI 0.45-0.62). In comparison with prior users, nonusers also had lower odds of being comprehensive users (defined as using 8 or more unique portal functions; odds ratio [OR] 0.57, 95% CI 0.45-0.73) or composite users (defined as comprehensive users who initiated a 75th or greater percentile of portal sessions) of the inpatient portal (OR 0.42, 95% CI 0.29-0.60). Conclusions Patients’ use of an inpatient portal during their hospital stay appeared to be influenced by a combination of factors, including prior outpatient portal use. For new users, hospitalization itself, a major event that can motivate behavioral changes, may have influenced portal use. In contrast, nonusers might have lower self-efficacy in their ability to use technology to manage their health, contributing to their lower portal use. Understanding the relationship between the use of outpatient and inpatient portals can help direct targeted implementation strategies that encourage individuals to use these tools to better manage their health across care settings.
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Affiliation(s)
- Naleef Fareed
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Pallavi Jonnalagadda
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Sarah R MacEwan
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Gennaro Di Tosto
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Seth Scarborough
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Timothy R Huerta
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Ann Scheck McAlearney
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
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Walsh SL, El-Bassel N, Jackson RD, Samet JH, Aggarwal M, Aldridge AP, Baker T, Barbosa C, Barocas JA, Battaglia TA, Beers D, Bernson D, Bowers-Sword R, Bridden C, Brown JL, Bush HM, Bush JL, Button A, Campbell AN, Cerda M, Cheng DM, Chhatwal J, Clarke T, Conway KP, Crable EL, Czajkowski A, David JL, Drainoni ML, Fanucchi LC, Feaster DJ, Fernandez S, Freedman D, Freisthler B, Gilbert L, Glasgow LM, Goddard-Eckrich D, Gutnick D, Harlow K, Helme DW, Huang T, Huerta TR, Hunt T, Hyder A, Kerner R, Keyes K, Knott CE, Knudsen HK, Konstan M, Larochelle MR, Craig Lefebvre R, Levin F, Lewis N, Linas BP, Lofwall MR, Lounsbury D, Lyons MS, Mann S, Marks KR, McAlearney A, McCollister KE, McCrimmon T, Miles J, Miller CC, Nash D, Nunes E, Oga EA, Oser CB, Plouck T, Rapkin B, Freeman PR, Rodriguez S, Root E, Rosen-Metsch L, Sabounchi N, Saitz R, Salsberry P, Savitsky C, Schackman BR, Seiber EE, Slater MD, Slavova S, Speer D, Martinez LS, Stambaugh LF, Staton M, Stein MD, Stevens-Watkins DJ, Surratt HL, Talbert JC, Thompson KL, Toussant K, Vandergrift NA, Villani J, Walker DM, Walley AY, Walters ST, Westgate PM, Winhusen T, Wu E, Young AM, Young G, Zarkin GA, Chandler RK. The HEALing (Helping to End Addiction Long-term SM) Communities Study: Protocol for a cluster randomized trial at the community level to reduce opioid overdose deaths through implementation of an integrated set of evidence-based practices. Drug Alcohol Depend 2020; 217:108335. [PMID: 33248391 PMCID: PMC7568493 DOI: 10.1016/j.drugalcdep.2020.108335] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Opioid overdose deaths remain high in the U.S. Despite having effective interventions to prevent overdose deaths, there are numerous barriers that impede their adoption. The primary aim of the HEALing Communities Study (HCS) is to determine the impact of an intervention consisting of community-engaged, data-driven selection, and implementation of an integrated set of evidence-based practices (EBPs) on reducing opioid overdose deaths. METHODS The HCS is a four year multi-site, parallel-group, cluster randomized wait-list controlled trial. Communities (n = 67) in Kentucky, Massachusetts, New York and Ohio are randomized to active intervention (Wave 1), which starts the intervention in Year 1 or the wait-list control (Wave 2), which starts the intervention in Year 3. The HCS will test a conceptually driven framework to assist communities in selecting and adopting EBPs with three components: 1) a community engagement strategy with local coalitions to guide and implement the intervention; 2) a compendium of EBPs coupled with technical assistance; and 3) a series of communication campaigns to increase awareness and demand for EBPs and reduce stigma. An implementation science framework guides the intervention and allows for examination of the multilevel contexts that promote or impede adoption and expansion of EBPs. The primary outcome, number of opioid overdose deaths, will be compared between Wave 1 and Wave 2 communities during Year 2 of the intervention for Wave 1. Numerous secondary outcomes will be examined. DISCUSSION The HCS is the largest community-based implementation study in the field of addiction with an ambitious goal of significantly reducing fatal opioid overdoses.
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Knudsen HK, Drainoni ML, Gilbert L, Huerta TR, Oser CB, Aldrich AM, Campbell AN, Crable EL, Garner BR, Glasgow LM, Goddard-Eckrich D, Marks KR, McAlearney AS, Oga EA, Scalise AL, Walker DM. Model and approach for assessing implementation context and fidelity in the HEALing Communities Study. Drug Alcohol Depend 2020; 217:108330. [PMID: 33086156 PMCID: PMC7531282 DOI: 10.1016/j.drugalcdep.2020.108330] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 08/13/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND In response to the U.S. opioid epidemic, the HEALing (Helping to End Addiction Long-termSM) Communities Study (HCS) is a multisite, wait-listed, community-level cluster-randomized trial that aims to test the novel Communities That HEAL (CTH) intervention, in 67 communities. CTH will expand an integrated set of evidence-based practices (EBPs) across health care, behavioral health, justice, and other community-based settings to reduce opioid overdose deaths. We present the rationale for and adaptation of the RE-AIM/PRISM framework and methodological approach used to capture the CTH implementation context and to evaluate implementation fidelity. METHODS HCS measures key domains of the internal and external CTH implementation context with repeated annual surveys and qualitative interviews with community coalition members and key stakeholders. Core constructs of fidelity include dosage, adherence, quality, and program differentiation-the adaptation of the CTH intervention to fit each community's needs. Fidelity measures include a monthly CTH checklist, collation of artifacts produced during CTH activities, coalition and workgroup attendance, and coalition meeting minutes. Training and technical assistance delivered by the research sites to the communities are tracked monthly. DISCUSSION To help attenuate the nation's opioid epidemic, the adoption of EBPs must be increased in communities. The HCS represents one of the largest and most complex implementation research experiments yet conducted. Our systematic examination of implementation context and fidelity will significantly advance understanding of how to best evaluate community-level implementation of EBPs and assess relations among implementation context, fidelity, and intervention impact.
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Affiliation(s)
- Hannah K. Knudsen
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY, 40508, USA,Corresponding author at: University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY, 40508, USA
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases and Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, Department of Health Law, Policy and Management, Boston University School of Public Health, 801 Massachusetts Avenue, Room 2014, Boston, MA, 02118, USA.
| | - Louisa Gilbert
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
| | - Timothy R. Huerta
- College of Medicine, The Ohio State University, 460 Medical Center Drive, Suite 530, Columbus, OH, 43210, USA
| | - Carrie B. Oser
- Department of Sociology and Center on Drug and Alcohol Research, University of Kentucky, 1531 Patterson Office Tower, Lexington, KY, 40506, USA
| | - Alison M. Aldrich
- CATALYST, the Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 460 Medical Center Drive, Suite 530, Columbus, OH, 43210, USA
| | - Aimee N.C. Campbell
- Columbia University Irving Medical Center, Department of Psychiatry and New York State Psychiatric Institute, 1051 Riverside Drive, Box 120, New York, NY, 10032, USA
| | - Erika L. Crable
- Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, Department of Health Law, Policy and Management, Boston University School of Public Health, 801 Massachusetts Avenue, Room 2030, Boston, MA, 02118, USA
| | - Bryan R. Garner
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - LaShawn M. Glasgow
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - Dawn Goddard-Eckrich
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
| | - Katherine R. Marks
- Department of Behavioral Science, University of Kentucky, 1100 Veterans Drive, Medical Behavioral Science Building Room 108, Lexington, KY, 40536, USA
| | - Ann Scheck McAlearney
- Department of Family and Community Medicine and CATALYST, the Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 460 Medical Center Drive, Suite 530, Columbus, OH, 43210, USA.
| | - Emmanuel A. Oga
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - Ariel L. Scalise
- Department of Infectious Disease, Boston Medical Center, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Daniel M. Walker
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, 460 Medical Center Drive, Suite 520, Columbus, OH, 43210, USA
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16
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Wu E, Villani J, Davis A, Fareed N, Harris DR, Huerta TR, LaRochelle MR, Miller CC, Oga EA. Community dashboards to support data-informed decision-making in the HEALing communities study. Drug Alcohol Depend 2020; 217:108331. [PMID: 33070058 PMCID: PMC7528750 DOI: 10.1016/j.drugalcdep.2020.108331] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/18/2020] [Accepted: 09/24/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND With opioid misuse, opioid use disorder (OUD), and opioid overdose deaths persisting at epidemic levels in the U.S., the largest implementation study in addiction research-the HEALing Communities Study (HCS)-is evaluating the impact of the Communities That Heal (CTH) intervention on reducing opioid overdose deaths in 67 disproportionately affected communities from four states (i.e., "sites"). Community-tailored dashboards are central to the CTH intervention's mandate to implement a community-engaged and data-driven process. These dashboards support a participating community's decision-making for selection and monitoring of evidence-based practices to reduce opioid overdose deaths. METHODS/DESIGN A community-tailored dashboard is a web-based set of interactive data visualizations of community-specific metrics. Metrics include opioid overdose deaths and other OUD-related measures, as well as drivers of change of these outcomes in a community. Each community-tailored dashboard is a product of a co-creation process between HCS researchers and stakeholders from each community. The four research sites used a varied set of technical approaches and solutions to support the scientific design and CTH intervention implementation. Ongoing evaluation of the dashboards involves quantitative and qualitative data on key aspects posited to shape dashboard use combined with website analytics. DISCUSSION The HCS presents an opportunity to advance how community-tailored dashboards can foster community-driven solutions to address the opioid epidemic. Lessons learned can be applied to inform interventions for public health concerns and issues that have disproportionate impact across communities and populations (e.g., racial/ethnic and sexual/gender minorities and other marginalized individuals). TRIAL REGISTRATION ClinicalTrials.gov (NCT04111939).
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Affiliation(s)
- Elwin Wu
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
| | - Jennifer Villani
- National Institute on Drug Abuse, 3WFN RM 08A45 MSC 6025, 301 North Stonestreet Avenue, Rockville, MD, 20892, USA
| | - Alissa Davis
- Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA
| | - Naleef Fareed
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, 460 Medical Center Drive, Columbus, OH, 43210, USA; Department of Biomedical Informatics, College of Medicine, The Ohio State University, 1585 Neil Avenue, Columbus, OH, 43210, USA
| | - Daniel R Harris
- Institute for Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Kentucky, Lexington, KY, 40506, USA; Center for Clinical and Translational Sciences, University of Kentucky, Lexington, KY, 40506, USA
| | - Timothy R Huerta
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, 460 Medical Center Drive, Columbus, OH, 43210, USA; Department of Biomedical Informatics, College of Medicine, The Ohio State University, 1585 Neil Avenue, Columbus, OH, 43210, USA
| | - Marc R LaRochelle
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA, 02218, USA
| | - Cortney C Miller
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Emmanuel A Oga
- RTI International, 6110 Executive Boulevard, Rockville, MD, 20852, USA
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Fareed N, Swoboda CM, Jonnalagadda P, Walker DM, Huerta TR. Differences Between Races in Health Information Seeking and Trust Over Time: Evidence From a Cross-Sectional, Pooled Analyses of HINTS Data. Am J Health Promot 2020; 35:84-92. [PMID: 32588638 DOI: 10.1177/0890117120934609] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Assessed racial disparities in health information-seeking behavior and trust of information sources from 2007 to 2017. DESIGN Pooled cross-sectional survey data. SETTING Health Information National Trends Survey (HINTS). PARTICIPATION Data included 6 iterations of HINTS (pooled: N = 19 496; 2007: n = 3593; 2011: n = 3959; 2013: n = 3185; Food and Drug Administration [FDA] 2015: n = 3738; 2017: n = 3285; and FDA 2017: n = 1736). MEASURES Outcome variables were health information seeking, high confidence, and high trust of health information from several sources. Independent variable was race group, controlling for other sociodemographic and socioeconomic variables. ANALYSIS Weighted descriptive and multivariate logistic regression for the pooled sample assessed associations by race. Fully interacted models with race-survey year interactions compared differences in outcomes between years. RESULTS Black respondents, relative to white, had greater odds of having high confidence in their ability to attain health information, trust of health information from newspapers and magazines, radio, internet, television, government, charitable organizations, and religious organizations. Hispanic respondents, relative to white, had lower odds of seeking health information and trusting health information from doctors. They had higher odds of trusting health information from the radio, the internet, television, charitable organizations, and religious organizations. CONCLUSION Disparities between races in trust of information sources remained across time. Understanding optimal information media, their reach, and credibility among racial groups could enable more targeted approaches to developing interventions. Our analytical approach minimized limitations present in the HINTS.
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Affiliation(s)
- Naleef Fareed
- CATALYST-The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, Institute for Behavioral Medicine Research, 2647The Ohio State University, Columbus, OH, USA.,Department of Biomedical Informatics, College of Medicine, Institute for Behavioral Medicine Research, 2647The Ohio State University, Columbus, OH, USA
| | - Christine M Swoboda
- CATALYST-The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, Institute for Behavioral Medicine Research, 2647The Ohio State University, Columbus, OH, USA
| | - Pallavi Jonnalagadda
- CATALYST-The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, Institute for Behavioral Medicine Research, 2647The Ohio State University, Columbus, OH, USA
| | - Daniel M Walker
- CATALYST-The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, Institute for Behavioral Medicine Research, 2647The Ohio State University, Columbus, OH, USA.,Department of Biomedical Informatics, College of Medicine, Institute for Behavioral Medicine Research, 2647The Ohio State University, Columbus, OH, USA.,Department of Family Medicine, College of Medicine, Institute for Behavioral Medicine Research, 2647The Ohio State University, Columbus, OH, USA
| | - Timothy R Huerta
- CATALYST-The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, Institute for Behavioral Medicine Research, 2647The Ohio State University, Columbus, OH, USA.,Department of Biomedical Informatics, College of Medicine, Institute for Behavioral Medicine Research, 2647The Ohio State University, Columbus, OH, USA.,Department of Family Medicine, College of Medicine, Institute for Behavioral Medicine Research, 2647The Ohio State University, Columbus, OH, USA
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McAlearney AS, Hefner JL, MacEwan SR, Gaughan A, DePuccio M, Walker DM, Hogan CT, Fareed N, Sieck CJ, Huerta TR. Care Team Perspectives About an Inpatient Portal: Benefits and Challenges of Patients' Portal Use During Hospitalization. Med Care Res Rev 2020; 78:537-547. [PMID: 32552351 DOI: 10.1177/1077558720925296] [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] [Indexed: 11/15/2022]
Abstract
While current research about inpatient portals has focused largely on the patient perspective, it is also critical to consider the care team point of view, as support from these individuals is essential to successful portal implementation and use. We held brief in-person interviews with 433 care team members across a six-hospital health system to explore opinions about patients' use of an inpatient portal as perceived by care team members. Using the Inpatient Portal Evaluation Framework, we characterized benefits and challenges of portal use that care team members reported affected patients, themselves, and the collaborative work of these care teams with their patients. Interviewees noted inpatient portals can improve patient care and experience and also indicated room for improvement in portal use for hospitalized patients. Further understanding of the care team perspective is critical to inform approaches to inpatient portal implementation that best benefit both patients and providers.
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Di Tosto G, McAlearney AS, Fareed N, Huerta TR. Metrics for Outpatient Portal Use Based on Log File Analysis: Algorithm Development. J Med Internet Res 2020; 22:e16849. [PMID: 32530435 PMCID: PMC7320309 DOI: 10.2196/16849] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/16/2019] [Accepted: 02/07/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Web-based outpatient portals help patients engage in the management of their health by allowing them to access their medical information, schedule appointments, track their medications, and communicate with their physicians and care team members. Initial studies have shown that portal adoption positively affects health outcomes; however, early studies typically relied on survey data. Using data from health portal applications, we conducted systematic assessments of patients' use of an outpatient portal to examine how patients engage with the tool. OBJECTIVE This study aimed to document the functionality of an outpatient portal in the context of outpatient care by mining portal usage data and to provide insights into how patients use this tool. METHODS Using audit log files from the outpatient portal associated with the electronic health record system implemented at a large multihospital academic medical center, we investigated the behavioral traces of a study population of 2607 patients who used the portal between July 2015 and February 2019. Patient portal use was defined as having an active account and having accessed any portal function more than once during the study time frame. RESULTS Through our analysis of audit log file data of the number and type of user interactions, we developed a taxonomy of functions and actions and computed analytic metrics, including frequency and comprehensiveness of use. We additionally documented the computational steps required to diagnose artifactual data and arrive at valid usage metrics. Of the 2607 patients in our sample, 2511 were active users of the patients portal where the median number of sessions was 94 (IQR 207). Function use was comprehensive at the patient level, while each session was instead limited to the use of one specific function. Only 17.45% (78,787/451,762) of the sessions were linked to activities involving more than one portal function. CONCLUSIONS In discussing the full methodological choices made in our analysis, we hope to promote the replicability of our study at other institutions and contribute to the establishment of best practices that can facilitate the adoption of behavioral metrics that enable the measurement of patient engagement based on the outpatient portal use.
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Affiliation(s)
- Gennaro Di Tosto
- CATALYST: Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Ann Scheck McAlearney
- CATALYST: Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Naleef Fareed
- CATALYST: Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Timothy R Huerta
- CATALYST: Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, United States
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Swoboda CM, Walker DM, Huerta TR. Likelihood of Smoking Among Cancer Survivors: An Updated Health Information National Trends Survey Analysis. Nicotine Tob Res 2020; 21:1636-1643. [PMID: 30843035 DOI: 10.1093/ntr/ntz007] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/14/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Cancer survivors are at high risk for cancer reoccurrence, highlighting the importance of managing behavioral risk factors for cancer. Despite this risk, many cancer survivors continue to smoke cigarettes. This article describes the relationship between smoking behavior and demographic and clinical factors in cancer survivors. METHODS Multinomial logistic regression of cross-sectional data from the Health Information National Trends Survey was conducted using combined data from years 2003, 2005, 2007, 2011, 2012, 2013, and 2014. Independent variables included age, cancer history, race, education level, marital status, insurance status, and data year; the dependent variable was smoking status (current vs. former or never). RESULTS Cancer survivors were less likely to be current smokers but more likely to be former smokers than those with no history of cancer. Cancer survivors that currently smoked were more likely to have lower education levels, be divorced, separated, or single, or not have health insurance. Older cancer survivors, Hispanic, and non-Hispanic black survivors were less likely to smoke. Among cancer subgroups, prostate cancer survivors had the lowest rate (8.8%) of current smoking from 2011 to 2014, and cervical cancer survivors had the highest rate (31.1%). CONCLUSIONS Although those with no history of cancer had higher rates of current smoking, many subgroups of cancer survivors continued to smoke at higher rates than average cancer survivors. Cancer survivors that were younger, had lower education levels, were any marital status other than married or widowed, were uninsured, or survived cervical cancer were more likely to be smokers than other survivors. IMPLICATIONS It is important to understand which types of cancer survivors are at high risk of continued smoking to better inform tobacco dependence treatment interventions among those at high risk of cancer reoccurrence. Our findings suggest targeted tobacco dependence treatment efforts among cancer survivors should focus on survivors of cervical cancer and survivors that are young, unmarried, uninsured, or have lower education levels.
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Affiliation(s)
- Christine M Swoboda
- Department of Family Medicine, Ohio State University College of Medicine, Columbus, OH
| | - Daniel M Walker
- Department of Family Medicine, Ohio State University College of Medicine, Columbus, OH
| | - Timothy R Huerta
- Department of Family Medicine, Ohio State University College of Medicine, Columbus, OH.,Department of Biomedical Informatics, Ohio State University College of Medicine, Columbus, OH
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Swoboda CM, Fareed N, Walker DM, Huerta TR. The effect of cancer treatment summaries on patient-centered communication and quality of care for cancer survivors: A pooled cross-sectional HINTS analysis. Patient Educ Couns 2020; 103:301-308. [PMID: 31477514 DOI: 10.1016/j.pec.2019.08.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/21/2019] [Accepted: 08/25/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Provision of cancer treatment summaries to patients is recommended to improve patient-centered communication (PCC). The objective of this study is to assess relationships between cancer treatment summary receipt, PCC, and quality of care (QOC). METHODS Linear and logistic regression of cross-sectional data from the Health Information National Trends Survey (HINTS) was conducted using data from years 2012, 2014, and 2017. The independent variable was receipt of treatment summary; the dependent variables were overall PCC score, six domains of PCC, and QOC. RESULTS In the pooled sample, 36.9% of patients with cancer treatment history reported receiving a treatment summary. There was a significant positive association between overall PCC score and treatment summary receipt, and higher odds of high scores for the PCC domains "responding to emotions" and "managing uncertainty." We did not observe significant associations between treatment summary receipt and other PCC domains or QOC. CONCLUSION Providing patients cancer treatment summaries may improve PCC, but fewer than half of patients reported receiving one of these summaries. PRACTICE IMPLICATIONS Providing cancer treatment summaries is important, however, providing them without engaging in additional communication may be insufficient to improve all patient-centered care domains or quality of care.
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Affiliation(s)
- Christine M Swoboda
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, USA.
| | - Naleef Fareed
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, USA; Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Daniel M Walker
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, USA; Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA; Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Timothy R Huerta
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, USA; Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA; Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
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McAlearney AS, Walker DM, Gaughan A, Moffatt-Bruce S, Huerta TR. Helping Patients Be Better Patients: A Qualitative Study of Perceptions About Inpatient Portal Use. Telemed J E Health 2020; 26:1184-1187. [PMID: 31990635 DOI: 10.1089/tmj.2019.0198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Indexed: 11/12/2022] Open
Abstract
Introduction: As more hospitals introduce inpatient portals, it is increasingly important to understand their impact on patient experience and the care process. We conducted this study to learn from patients and care team members about their experience with an inpatient portal. Methods: We interviewed 120 patients and 433 care team members across a seven-hospital academic medical center that offers an inpatient portal to hospitalized patients. Interviewees were asked about their use of the inpatient portal and its impact on patient experience. Recorded interviews were transcribed and rigorously analyzed using both inductive and deductive methods. Results: We found that the inpatient portal was perceived to help patients be "better patients" by improving their ability to be informed about their health and by enabling them to be more involved in the care process. Care team members suggested portal use could be improved by addressing challenges with tablet administration, use of the patient education feature, and the functionality of the scheduling feature. Conclusions: Across interviewees, we found that inpatient portals were perceived to improve the hospital experience and increase empowerment for patients by offering information about care in a manner that allowed patients to join their care teams as active, participating members.
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Affiliation(s)
- Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Daniel M Walker
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Alice Gaughan
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Susan Moffatt-Bruce
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Surgery, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Timothy R Huerta
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
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Walker DM, DePuccio MJ, Huerta TR, McAlearney AS. Designing Quality Improvement Collaboratives for Dissemination: Lessons from a Multiple Case Study of the Implementation of Obstetric Emergency Safety Bundles. Jt Comm J Qual Patient Saf 2019; 46:136-145. [PMID: 31839423 DOI: 10.1016/j.jcjq.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/23/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Quality improvement collaboratives (QICs) can help to disseminate evidence-based practices, but there is limited guidance from the perspectives of QIC organizers and participants of best practices to support practice change. To address this gap, this study aimed to identify key structures and processes of QICs that support dissemination and implementation of quality improvement projects. METHODS Semistructured one-on-one and group interviews were conducted from December 2017 to May 2018 with project administrators (n = 28) at three QICs that had been funded to develop and disseminate obstetric emergency safety bundles in more than 300 hospitals across five states. For further study, the project leads (n = 25) at six hospitals nominated by each QIC were interviewed. A multiple case study design was used to evaluate the dissemination strategies of each of the three QICs. For the QIC interviews, questions asked about dissemination approach, and for the hospital interviews, questions asked about implementation facilitators and barriers. All interviews were transcribed, coded, and analyzed using both deductive and inductive methods. RESULTS A key element supporting the dissemination strategy of each QIC was leveraging existing partnerships and relationships and promoting a shared vision with participating hospitals. A robust data infrastructure to support the project was identified as a critical element to support dissemination, yet was a challenge for the QICs. CONCLUSION These findings highlight specific elements of a dissemination approach that QICs can deploy to support their dissemination efforts. In particular, building data infrastructure may be a useful strategy to support ongoing quality improvement projects.
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Fareed N, Walker D, Sieck CJ, Taylor R, Scarborough S, Huerta TR, McAlearney AS. Inpatient portal clusters: identifying user groups based on portal features. J Am Med Inform Assoc 2019; 26:28-36. [PMID: 30476122 DOI: 10.1093/jamia/ocy147] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 10/18/2018] [Indexed: 01/17/2023] Open
Abstract
Objective Conduct a cluster analysis of inpatient portal (IPP) users from an academic medical center to improve understanding of who uses these portals and how. Methods We used 18 months of data from audit log files, which recorded IPP user actions, of 2815 patient admissions. A hierarchical clustering algorithm was executed to group patient admissions on the basis of proportion of use for each of 10 IPP features. Post-hoc analyses were conducted to further understand IPP use. Results Five cluster solutions were developed for the study sample. Our taxonomy included users with high levels of accessing features that were linked to reviewing schedules, results, tutorials, and ordering food. Patients tended to stay within their clusters over multiple admissions, and the clusters had differences based on patient and clinical characteristics. Discussion Distinct groups of users exist among IPP users, suggesting that training on IPP use to enhance patient engagement could be tailored to patients. More exploration is also needed to understand why certain features were not used across all clusters. Conclusions It is important to understand the specifics about how patients use IPPs to help them better engage with their healthcare. Our taxonomy enabled characterization of 5 groups of IPP users who demonstrated distinct preferences. These results may inform targeted improvements to IPP tools, could provide insights to improve patient training around portal use, and may help care team members effectively engage patients in the use of IPPs. We also discuss the implications of our findings for future research.
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Affiliation(s)
- Naleef Fareed
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Daniel Walker
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Cynthia J Sieck
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Robert Taylor
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Seth Scarborough
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Timothy R Huerta
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Ann Scheck McAlearney
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA
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Hefner JL, Fareed N, Walker DM, Huerta TR, McAlearney AS. Central line infections in United States hospitals: An exploration of variation in central line device days and infection rates across hospitals that serve highly complex patient populations. Am J Infect Control 2019; 47:1032-1034. [PMID: 30638670 DOI: 10.1016/j.ajic.2018.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/02/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
Our descriptive analyses show a wide distribution in rates of central line device days and central line-associated bloodstream infections for a given standardized infection ratio-the measure linked to federal payment penalties-among 215 US hospitals serving highly complex patient populations. We established that the standardized infection ratio masks hospital-level variation in device use and associated patient safety.
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Walker DM, Hefner JL, Fareed N, Huerta TR, McAlearney AS. Exploring the Digital Divide: Age and Race Disparities in Use of an Inpatient Portal. Telemed J E Health 2019; 26:603-613. [PMID: 31313977 DOI: 10.1089/tmj.2019.0065] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background: Age and race disparities in the use of new technologies-the digital divide-may be limiting the potential of patient-facing health information technology to improve health and health care. Objective: To investigate whether disparities exist in the use of patient portals designed specifically for the inpatient environment. Methods: Patients admitted to the six hospitals affiliated with a large, Midwestern academic medical center from July 2017 to July 2018 were provided with access to a tablet equipped with an inpatient portal and recruited to participate in the study (n = 842). Demographic characteristics of study enrollees were obtained from patients' electronic health records and surveys given to patients during their hospital stay. Log files from the inpatient portal were used to create a global measure of use and calculate use rates for specific portal features. Results: We found both age and race disparities in use of the inpatient portal. Patients aged 60-69 (45.3% difference, p < 0.001) and those over age 70 (36.7% difference, p = 0.04) used the inpatient portal less than patients aged 18-29. In addition, African American patients used the portal less than White patients (40.4% difference, p = 0.004). Discussion: These findings suggest that the availability of the technology alone may be insufficient to overcome barriers to use and that additional intervention may be needed to close the digital divide. Conclusions: We identified lower use of the inpatient portal among African American and older patients, relative to White and younger patients, respectively.
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Affiliation(s)
- Daniel M Walker
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jennifer L Hefner
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Naleef Fareed
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Timothy R Huerta
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA
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McAlearney AS, Sieck CJ, Gaughan A, Fareed N, Volney J, Huerta TR. Patients' Perceptions of Portal Use Across Care Settings: Qualitative Study. J Med Internet Res 2019; 21:e13126. [PMID: 31172960 PMCID: PMC6592494 DOI: 10.2196/13126] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 12/13/2018] [Revised: 03/01/2019] [Accepted: 03/24/2019] [Indexed: 01/22/2023] Open
Abstract
Background Patient portals are a promising instrument to improve patient-centered care, as they provide patients information and tools that can help them better manage their health. The implementation of portals in both the inpatient and outpatient setting gives health care providers an opportunity to support patients both during hospitalization and after discharge. Thus, there is a need to better understand how inpatient and outpatient portals are used across care contexts. Objective This study aimed to examine patients’ perceptions of using inpatient and outpatient portals across the care settings, including how they used the portals and the benefits and concerns associated with portal use. Methods This study was conducted in a large Midwestern academic medical center consisting of seven hospitals. We interviewed 120 patients who had used an inpatient portal during their hospitalization, at 15 days and 6 months postdischarge, to determine their perspectives of portal use in both hospital and outpatient settings. Interview transcripts were analyzed inductively and deductively by using team coding processes consistent with a grounded theory approach. Results Interviews focused on three main areas of portal use: experience with the portal features, perceived benefits, and concerns. Responses at 15 days (n=60) and 6 months (n=60) postdischarge were consistent with respect to perceptions about portal use. Patients identified viewing their health information, managing their schedule, and communicating with providers as notable activities. Convenience, access to information, and better engagement in care were indicated as benefits. Concerns were related to technology issues and privacy/security risks. Conclusions Implementation of inpatient portals as a complement to outpatient portals is increasing and can enable patients to better manage aspects of their care. Although care processes vary substantively across settings, the benefits of convenience, improved access to information, and better engagement in care provide opportunities for portal use across care settings to support patient-centered care.
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Affiliation(s)
- Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States.,CATALYST (Center for the Advancement of Team Science, Analytics, and Systems Thinking), College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Cynthia J Sieck
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States.,CATALYST (Center for the Advancement of Team Science, Analytics, and Systems Thinking), College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Alice Gaughan
- CATALYST (Center for the Advancement of Team Science, Analytics, and Systems Thinking), College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Naleef Fareed
- CATALYST (Center for the Advancement of Team Science, Analytics, and Systems Thinking), College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Jaclyn Volney
- CATALYST (Center for the Advancement of Team Science, Analytics, and Systems Thinking), College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Timothy R Huerta
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States.,CATALYST (Center for the Advancement of Team Science, Analytics, and Systems Thinking), College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, United States
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McAlearney AS, Menser T, Sieck CJ, Sova LN, Huerta TR. Opportunities for Community Health Worker Training to Improve Access to Health Care for Medicaid Enrollees. Popul Health Manag 2019; 23:38-46. [PMID: 31140931 DOI: 10.1089/pop.2018.0117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Limited access to care can negatively affect population health, which is particularly concerning for individuals of lower socioeconomic status. Shortages of US health care providers in areas that predominantly serve Medicaid enrollees contribute to a lack of access. The Ohio Medicaid Technical Assistance and Policy Program Healthcare Access Initiative was designed as a workforce development initiative to train and deploy community health workers (CHWs). The authors conducted 55 key informant interviews with preceptors, CHWs, and administrators across 5 sites with the specific aim of improving understanding of common barriers to and benefits of CHW program implementation across different CHW programs in Ohio. CHW programs reportedly act as a bridge between the patient and providers, and program benefits were reported for participants, organizations, and patients. This study found that CHW programs enabled training of health professionals that can empower participants while allowing them to also give back to their communities. Organizations employing CHWs reported being able to extend clinic services, increase utilization of community resources, and improve patient compliance through the efforts of CHWs; program impacts also led to increased patient support, patient education, and overall better care. To better integrate CHWs into health care organizations, organizations should focus on clearly defining the CHW role and ensuring adequate infrastructure to support CHW efforts.
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Affiliation(s)
- Ann Scheck McAlearney
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio.,Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Terri Menser
- Center for Outcomes Research, Houston Methodist, Houston, Texas
| | - Cynthia J Sieck
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio.,Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Lindsey N Sova
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Timothy R Huerta
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio.,Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio
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McAlearney AS, Gaughan A, MacEwan SR, Fareed N, Huerta TR. Improving Acceptance of Inpatient Portals: Patients' and Care Team Members' Perspectives. Telemed J E Health 2019; 26:310-326. [PMID: 31081723 DOI: 10.1089/tmj.2019.0026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Inpatient portals are gaining interest as a means to increase patient-centered care during hospitalization. However, acceptance of a new technology such as the inpatient portal relies on perceptions of both its usefulness and ease of use. These factors have not been studied in the context of inpatient portal implementation. Methods: We interviewed patients (n = 123) and care team members (n = 447) about their experiences using an inpatient portal that had been implemented across a large, academic medical center. Interviews lasted 5-15 min, were audio-recorded, transcribed verbatim, and then analyzed using a combination of deductive and inductive methods. Results: Collectively, interviewees reported that the inpatient portal was a useful tool as it improved patients' access to information, enhanced communication, facilitated education, and appeared to promote patients' sense of control while in the hospital. Most interviewees also found the technology easy to use. However, there were concerns that the portal was not easy to use for those less experienced with technology. Interviewees identified the need to emphasize the value of the technology to both patients and care team members and the need to provide additional training to support portal use, as ways to promote acceptance of the tool. Discussion and Conclusions: Inpatient portals can improve patient-centered care, but such improvements require acceptance of the tool by both patients and care team members. Our findings about the usefulness and ease of use of an inpatient portal can inform future efforts to improve the implementation and acceptance of this new technology.
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Affiliation(s)
- Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.,CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Alice Gaughan
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Sarah R MacEwan
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Naleef Fareed
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Timothy R Huerta
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.,CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio
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Paskett ED, Young GS, Bernardo BM, Washington C, DeGraffinreid C, Fisher JL, Huerta TR. Correlates of Rural, Appalachian, and Community Identity in the CITIES Cohort. J Rural Health 2019; 35:167-175. [PMID: 30830989 DOI: 10.1111/jrh.12347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To determine correlates of rural, Appalachian, and community identity among a cohort of participants in the Community Initiative Towards Improving Equity and Health Status (CITIES) project. METHODS Mixed linear and logistic regression effects models were utilized to determine correlates of 3 outcomes: 1) community identity, 2) rural identity, and 3) Appalachian identity among participants in the Ohio CITIES project. FINDINGS Distinct demographic characteristics were found to be associated with each of the outcomes. For community identity, while no differences were found for rural or urban participants, those who were single or never married (P < .0001) as well as those who graduated from college (P = .0005) reported significantly lower community identity scores than married individuals with less than a college education. Those who resided in an Appalachian county reported higher community identity scores (P = .0009) than non-Appalachian residents. For rural identity, those who did not identify as Christian (P = .018) as well as those who identified as Democrat (P = .027) reported significantly lower rural identity scores than others. Lastly, for Appalachian identity, county-level percentage of families in poverty (P = .06), as well as gender (P = .05), were associated with self-reported Appalachian identity, but these effects were only marginally significant. CONCLUSIONS Although community, rural, and Appalachian identity may be viewed as similar due to their measure of attachment to a place, results from this study suggest that there are distinct individual and area-level correlates associated with community, rural, and Appalachian identity.
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Affiliation(s)
- Electra D Paskett
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio.,Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Gregory S Young
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Brittany M Bernardo
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Chasity Washington
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | | | - James L Fisher
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Timothy R Huerta
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio.,Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio
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Paskett ED, Young GS, Bernardo BM, Washington C, DeGraffinreid CR, Fisher JL, Huerta TR. The CITIES Project: Understanding the Health of Underrepresented Populations in Ohio. Cancer Epidemiol Biomarkers Prev 2018; 28:442-454. [PMID: 30377208 DOI: 10.1158/1055-9965.epi-18-0793] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/06/2018] [Accepted: 10/23/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Ohio, the catchment area of The Ohio State University Comprehensive Cancer Center (OSUCCC), includes diverse populations with different cancer profiles. As part of the National Cancer Institute (NCI)-funded initiative to conduct population health assessments in cancer center catchment areas, the OSUCCC surveyed residents, focusing on factors contributing to cancer disparities in Ohio populations. METHODS Two sampling strategies were used: (i) probability sampling of mailing lists and (ii) convenience sampling at community events, coupled with phone/in-person/web surveys. Survey items were chosen along multilevel framework constructs, used in concert with other funded NCI-Designated Cancer Centers. Multivariable logistic regression models investigated predictors associated with health behaviors, cancer beliefs, knowledge, and screening. RESULTS The sample of 1,005 respondents were white (46.6%), African American (24.7%), Hispanic (13.7%), Somali (7.6%), and Asian (7.5%). A total of 216 respondents were Appalachian. Variations in cancer attitudes, knowledge, and behaviors were noted by racial/ethnic and geographic group. Multivariable models identified individuals with less financial security as less likely to exercise or be within guidelines for screening, but more likely to smoke and have a poor diet. At the community-level, measures of poverty were highest in Appalachia, whereas children in female-headed households were greater in urban minority areas. CONCLUSIONS This population health assessment reinforced the diversity of the OSUCCC catchment area. These populations are ripe for implementation science strategies, focusing in communities and clinics that serve vulnerable populations. IMPACT Understanding attitudes, knowledge, and behaviors of this population can assist tailoring outreach and research strategies to lessen the cancer burden.
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Affiliation(s)
- Electra D Paskett
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio. .,Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio.,Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Gregory S Young
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Brittany M Bernardo
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Chasity Washington
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | | | - James L Fisher
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Timothy R Huerta
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio.,Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio
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Sieck CJ, Walker DM, Hefner JL, Volney J, Huerta TR, McAlearney AS. Understanding Secure Messaging in the Inpatient Environment: A New Avenue for Communication and Patient Engagement. Appl Clin Inform 2018; 9:860-868. [PMID: 30517969 PMCID: PMC6281442 DOI: 10.1055/s-0038-1675814] [Citation(s) in RCA: 6] [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: 06/19/2018] [Accepted: 10/05/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Patient portals, and the secure messaging feature in particular, have been studied in the outpatient setting, but research in the inpatient setting is relatively less mature. OBJECTIVE To understand the topics discussed in secure messaging in the inpatient environment, we analyzed and categorized messages sent within an inpatient portal. MATERIALS AND METHODS This observational study examined the content of all secure messages sent from December 2013 to June 2017 within an inpatient portal at a large Midwestern academic medical center (AMC). We analyzed a total of 2,598 messages, categorizing them by sender (patient, family, or care team member), type, and topic, and conducted a descriptive analysis of categories and an examination of code co-occurrence. RESULTS Patients were the most frequent message senders (63%); family members sent the fewest messages (10%). We identified five types of messages: Alert/Request; Thanks; Response; Question; and Other (typo/test message). Patient messages included Alerts/Requests (38%), Questions (31%), Statements of Thanks (24%), Response (1.2%), and Other (5%). We also identified 14 nonmutually exclusive message topics: Medication; Procedure/Treatment Plan; Schedule; Pain; Results; Diet; Discharge; Non-Medication Questions; Provider Requests; Symptoms; Custodial; Technical Issues; Potential Error; and Contact Information. Patient message topics most commonly discussed Symptoms (18%), Procedure/Treatment Plan (14%), or Pain (12%). CONCLUSION Our analysis of secure message content suggests certain message types and topics such as Alerts/Requests and Questions about symptoms and treatment plans are particularly important to patients. These findings demonstrate that both patients and family members utilize the secure messaging function to engage in the care process by posing questions, making requests, and alerting staff to problems. As this technology is implemented in additional facilities, future work should examine how use of secure messaging may be influenced by factors including patients' demographics, reasons for hospitalization, and length of stay.
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Affiliation(s)
- Cynthia J. Sieck
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Daniel M. Walker
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Jennifer L. Hefner
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Jaclyn Volney
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Timothy R. Huerta
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, United States
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, United States
| | - Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, United States
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, United States
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Swoboda CM, Benedict JA, Hade E, McAlearney AS, Huerta TR. Effectiveness of an infant mortality prevention home-visiting program on high-risk births in Ohio. Public Health Nurs 2018; 35:551-557. [PMID: 30264408 DOI: 10.1111/phn.12544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 05/10/2018] [Revised: 07/13/2018] [Accepted: 08/09/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The Ohio Infant Mortality Reduction Initiative (OIMRI) is a home-visiting program that aims to reduce infant mortality among infants of high-risk black women. This study examined birth outcomes among OIMRI participants and compared program participants to matched non-OIMRI women. DESIGN Program data were linked to birth records, death records, and Medicaid claims data. Propensity score matching was used to match program participants with like women in Ohio. SAMPLE The sample consisted of 2,837 black mothers from 14 counties in Ohio. MEASUREMENTS Infant mortality, causes of death, and birth weight were examined. RESULTS There were 25 deaths among 2,837 OIMRI participants from 2010 to 2015, for an infant mortality rate of 8.8 deaths per 1,000 live births (95% CI 5.4-12.2). Among those women who participated in OIMRI, three fewer deaths per 1,000 births within the first year of life were estimated compared to those not in OIMRI; however, this was not statistically significant. CONCLUSIONS The number of infant deaths among women enrolled in the OIMRI program was not significantly different from those who did not participate in OIMRI. Programs like OIMRI cannot singlehandedly address the infant mortality disparity but may help prevent some infant mortality risks.
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Affiliation(s)
| | - Jason A Benedict
- Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | - Erinn Hade
- Department of Biomedical Informatics & Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | | | - Timothy R Huerta
- Departments of Family Medicine & Biomedical Informatics, The Ohio State University, Columbus, Ohio
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Swoboda CM, Van Hulle JM, McAlearney AS, Huerta TR. Odds of talking to healthcare providers as the initial source of healthcare information: updated cross-sectional results from the Health Information National Trends Survey (HINTS). BMC Fam Pract 2018; 19:146. [PMID: 30157770 PMCID: PMC6116497 DOI: 10.1186/s12875-018-0805-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 06/26/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND People use a variety of means to find health information, including searching the Internet, seeking print sources, and talking to healthcare providers, family members, and friends. Doctors are considered the most trusted source of health information, but people may be underutilizing them in favor of searching the Internet. METHODS A multinomial logistic regression of cross-sectional data from Cycle 4 of the Health Information National Trends Survey (HINTS) was conducted. Independent variables included gender, age, rurality, cancer history, general health, income, race, education level, insurance status, veteran status, Internet use, and data year; the dependent variable was the first chosen source of health information. RESULTS The most frequent initial source of health information was the Internet, and the second most frequent was healthcare providers. There were significant differences in odds of using healthcare providers as the first source of health information. Those likely to use doctors as their initial source of health information were older adults, black adults, adults with health insurance, those who do not use the Internet, and adults who do not have a college degree. CONCLUSIONS People who use healthcare providers as the first source of health information may have better access to health care and be those less likely to use the Internet. Doctors may have to provide more information to those who do not use the internet and spend time verifying information for those who do use health information from the internet.
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Affiliation(s)
- Christine M Swoboda
- Department of Family Medicine, The Ohio State University, Room 502, 460 Medical Center Drive, Columbus, OH, 43210, USA
| | - Joseph M Van Hulle
- Department of Family Medicine, The Ohio State University, Room 502, 460 Medical Center Drive, Columbus, OH, 43210, USA
| | - Ann Scheck McAlearney
- Department of Family Medicine, The Ohio State University, Room 530, 460 Medical Center Drive, Columbus, OH, 43210, USA
| | - Timothy R Huerta
- Departments of Family Medicine and Biomedical Informatics, The Ohio State University, Room 532, 460 Medical Center Drive, Columbus, OH, 43210, USA.
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Kharrazi H, Gonzalez CP, Lowe KB, Huerta TR, Ford EW. Forecasting the Maturation of Electronic Health Record Functions Among US Hospitals: Retrospective Analysis and Predictive Model. J Med Internet Res 2018; 20:e10458. [PMID: 30087090 PMCID: PMC6104443 DOI: 10.2196/10458] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/01/2018] [Accepted: 06/16/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Meaningful Use (MU) program has promoted electronic health record adoption among US hospitals. Studies have shown that electronic health record adoption has been slower than desired in certain types of hospitals; but generally, the overall adoption rate has increased among hospitals. However, these studies have neither evaluated the adoption of advanced functionalities of electronic health records (beyond MU) nor forecasted electronic health record maturation over an extended period in a holistic fashion. Additional research is needed to prospectively assess US hospitals' electronic health record technology adoption and advancement patterns. OBJECTIVE This study forecasts the maturation of electronic health record functionality adoption among US hospitals through 2035. METHODS The Healthcare Information and Management Systems Society (HIMSS) Analytics' Electronic Medical Record Adoption Model (EMRAM) dataset was used to track historic uptakes of various electronic health record functionalities considered critical to improving health care quality and efficiency in hospitals. The Bass model was used to predict the technological diffusion rates for repeated electronic health record adoptions where upgrades undergo rapid technological improvements. The forecast used EMRAM data from 2006 to 2014 to estimate adoption levels to the year 2035. RESULTS In 2014, over 5400 hospitals completed HIMSS' annual EMRAM survey (86%+ of total US hospitals). In 2006, the majority of the US hospitals were in EMRAM Stages 0, 1, and 2. By 2014, most hospitals had achieved Stages 3, 4, and 5. The overall technology diffusion model (ie, the Bass model) reached an adjusted R-squared of .91. The final forecast depicted differing trends for each of the EMRAM stages. In 2006, the first year of observation, peaks of Stages 0 and 1 were shown as electronic health record adoption predates HIMSS' EMRAM. By 2007, Stage 2 reached its peak. Stage 3 reached its full height by 2011, while Stage 4 peaked by 2014. The first three stages created a graph that exhibits the expected "S-curve" for technology diffusion, with inflection point being the peak diffusion rate. This forecast indicates that Stage 5 should peak by 2019 and Stage 6 by 2026. Although this forecast extends to the year 2035, no peak was readily observed for Stage 7. Overall, most hospitals will achieve Stages 5, 6, or 7 of EMRAM by 2020; however, a considerable number of hospitals will not achieve Stage 7 by 2035. CONCLUSIONS We forecasted the adoption of electronic health record capabilities from a paper-based environment (Stage 0) to an environment where only electronic information is used to document and direct care delivery (Stage 7). According to our forecasts, the majority of hospitals will not reach Stage 7 until 2035, absent major policy changes or leaps in technological capabilities. These results indicate that US hospitals are decades away from fully implementing sophisticated decision support applications and interoperability functionalities in electronic health records as defined by EMRAM's Stage 7.
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Affiliation(s)
- Hadi Kharrazi
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Claudia P Gonzalez
- Strategic Management Program, Foster School of Business, University of Washington, Seattle, WA, United States
| | - Kevin B Lowe
- The University of Sydney Business School, Sydney, Australia
| | - Timothy R Huerta
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Eric W Ford
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama Birmingham, Birmingham, AL, United States
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Apathy NC, Menser T, Keeran LM, Ford EW, Harle CA, Huerta TR. Trends and Gaps in Awareness of Direct-to-Consumer Genetic Tests From 2007 to 2014. Am J Prev Med 2018; 54:806-813. [PMID: 29656919 DOI: 10.1016/j.amepre.2018.02.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 01/30/2018] [Accepted: 02/19/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Direct-to-consumer genetic tests for inherited disease risks have gained recent approvals from the Food and Drug Administration, and interest in these tests has continued to grow. Broad use of these tests coupled with planning and discussion with health providers regarding genetic risks and potential protective behavior changes have been proposed as preventive tools to reduce health disparities and improve equity in health outcomes. However, awareness of direct-to-consumer genetic testing has historically demonstrated differences by education, income, and race; these disparities could jeopardize potential benefits by limiting access and use. METHODS The national survey data from the Health Information National Trends Survey was analyzed to understand how overall awareness of direct-to-consumer genetic testing and disparities in awareness across sociodemographic groups have changed since 2007. RESULTS The findings showed persistent disparities, as well as a widening gap in awareness between Hispanics and non-Hispanic whites (OR2007 =1.52, OR2014 =0.58, pchange =0.0056), despite overall increases in awareness over time. CONCLUSIONS Given these findings, policies regulating direct-to-consumer genetic tests should prioritize equitable distribution of benefits by including provisions that counteract prevailing disparities in awareness.
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Affiliation(s)
- Nate C Apathy
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Terri Menser
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - Lindsay M Keeran
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, Ohio
| | - Eric W Ford
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christopher A Harle
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana; Regenstrief Institute, Indianapolis, Indiana
| | - Timothy R Huerta
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, Ohio; Department of Biomedical Informatics, Ohio State University, Columbus, Ohio.
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Tarver WL, Menser T, Hesse BW, Johnson TJ, Beckjord E, Ford EW, Huerta TR. Growth Dynamics of Patient-Provider Internet Communication: Trend Analysis Using the Health Information National Trends Survey (2003 to 2013). J Med Internet Res 2018; 20:e109. [PMID: 29599107 PMCID: PMC5897625 DOI: 10.2196/jmir.7851] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [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: 04/24/2017] [Revised: 10/03/2017] [Accepted: 11/16/2017] [Indexed: 11/16/2022] Open
Abstract
Background Communication is key in chronic disease management, and the internet has altered the manner in which patients and providers can exchange information. Adoption of secure messaging differs among patients due to the digital divide that keeps some populations from having effective access to online resources. Objective This study aimed to examine the current state of online patient-provider communication, exploring trends over time in the use of online patient-provider communication tools. Methods A 3-part analytic process was used to study the following: (1) reanalysis, (2) close replication across years, and (3) trend analysis extension. During the reanalysis stage, the publicly available Health Information National Trends Survey (HINTS) 1 and 2 data were used with the goal of identifying the precise analytic methodology used in a prior study, published in 2007. The original analysis was extended to add 3 additional data years (ie, 2008, 2011, and 2013) using the original analytical approach with the purpose of identifying trends over time. Multivariate logistic regression was used to analyze pooled data across all years, with year as an added predictor, in addition to a model for each individual data year. Results The odds of internet users to communicate online with health care providers was significantly and increasingly higher year-over-year, starting in 2003 (2005: odds ratio [OR] 1.31, 95% CI 1.03-1.68; 2008: OR 2.14, 95% CI 1.76-2.59; 2011: OR 2.92, 95% CI 2.33-3.66; and 2013: OR 5.77; 95% CI 4.62-7.20). Statistically significant socio-economic factors found to be associated with internet users communicating online with providers included age, having health insurance, having a history of cancer, and living in an urban area of residence. Conclusions The proportion of internet users communicating online with their health care providers has significantly increased since 2003. Although these trends are encouraging, access challenges still exist for some groups, potentially giving rise to a new set of health disparities related to communication.
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Affiliation(s)
- Will L Tarver
- Health Services Research and Development Service Center for Health Information and Communication, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Terri Menser
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States
| | - Bradford W Hesse
- Health Communication and Informatics Research Branch, National Cancer Institute, Bethesda, MD, United States
| | - Tyler J Johnson
- Department of Family Medicine, The Ohio State University, Columbus, OH, United States
| | - Ellen Beckjord
- Population Health Program Design and Engagement Optimization, UPMC Health Plan, Pittsburgh, PA, United States
| | - Eric W Ford
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Timothy R Huerta
- Department of Family Medicine, The Ohio State University, Columbus, OH, United States
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Walker DM, Sieck CJ, Menser T, Huerta TR, Scheck McAlearney A. Information technology to support patient engagement: where do we stand and where can we go? J Am Med Inform Assoc 2018; 24:1088-1094. [PMID: 28460042 DOI: 10.1093/jamia/ocx043] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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: 02/15/2017] [Accepted: 03/31/2017] [Indexed: 01/13/2023] Open
Abstract
Objective Given the strong push to empower patients and make them partners in their health care, we evaluated the current capability of hospitals to offer health information technology that facilitates patient engagement (PE). Materials and Methods Using an ontology mapping approach, items from the American Hospital Association Information Technology Supplement were mapped to defined levels and categories within the PE Framework. Points were assigned for each health information technology function based upon the level of engagement it encompassed to create a PE-information technology (PE-IT) score. Scores were divided into tertiles, and hospital characteristics were compared across tertiles. An ordered logit model was used to estimate the effect of characteristics on the adjusted odds of being in the highest tertile of PE-IT scores. Results Thirty-six functions were mapped to specific levels and categories of the PE Framework, and adoption of each item ranged from 23.5 to 96.7%. Hospital characteristics associated with being in the highest tertile of PE-IT scores included medium and large bed size (relative to small), nonprofit (relative to government nonfederal), teaching hospital, system member, Midwest and South regions, and urban location. Discussion Hospital adoption of PE-oriented technology remains varied, suggesting that hospitals are considering how technology can create partnerships with patients. However, PE functionalities that facilitate higher levels of engagement are lacking, suggesting room for improvement. Conclusion While hospitals have reached modest levels of adoption of PE technologies, consistent monitoring of this capacity can identify opportunities to use technology to facilitate engagement.
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Affiliation(s)
- Daniel M Walker
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, OH, USA
| | - Cynthia J Sieck
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, OH, USA
| | - Terri Menser
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, OH, USA
| | - Timothy R Huerta
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, OH, USA.,Department of Bioinformatics, College of Medicine, Ohio State University
| | - Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, OH, USA
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Bae J, Ford EW, Kharrazi HHK, Huerta TR. Electronic medical record reminders and smoking cessation activities in primary care. Addict Behav 2018; 77:203-209. [PMID: 29065376 DOI: 10.1016/j.addbeh.2017.10.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 12/17/2016] [Revised: 09/28/2017] [Accepted: 10/06/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this paper is to assess electronic medical record (EMR) automatic reminder use in relation to smoking cessation activities among primary-care providers. BACKGROUND Primary-care physicians are in the frontline of efforts to promote smoking cessation. Moreover, doctors' prescribing privileges give them additional tools to help patients successfully quit smoking. New EMR functions can provide automated reminders for physicians to counsel smokers and provide prescriptions to support quit attempts. SAMPLE AND METHODS Logit regression is used to analyze the 2012 National Ambulatory Medical Care Survey (NAMCS). Variables related to the EMR's clinical reminder capability, patient's smoking status, the provision of cessation counseling and the prescribing of drugs that support quitting are analyzed. RESULTS For primary care visit documents, smoking status was recorded 77.7% of the time. Smoking cessation counseling was ordered/provided 16.4% of the time in physicians' offices using electronic reminders routinely compared to 9.1% in those lacking the functionality. Smoking cessation medication was ordered/prescribed for 3.7% of current smokers when reminders were routinely used versus 2.1% when no reminder was used. All the differences were statistically significant. CONCLUSIONS The presence of an EMR equipped with automated clinical reminders is a valuable resource in efforts to promote smoking cessation. Insurers, regulators, and organizations promulgating clinical guidelines should include the use of EMR technology as part of their programs.
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Affiliation(s)
- Jaeyong Bae
- School of Nursing and Health Studies, Northern Illinois University, Wirtz Hall 257, Dekalb, IL 60115, United States.
| | - Eric W Ford
- Health Care Organization and Policy, University of Alabama Birmingham, 1665 University Blvd., Birmingham, AL 35294, United States.
| | - Hadi H K Kharrazi
- Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House 606, Baltimore, MD 21205, United States.
| | - Timothy R Huerta
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, 265 Northwood and High Building, Columbus, OH 43201, United States.
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Hefner JL, Huerta TR, McAlearney AS, Barash B, Latimer T, Moffatt-Bruce SD. Navigating a ship with a broken compass: evaluating standard algorithms to measure patient safety. J Am Med Inform Assoc 2017; 24:310-315. [PMID: 27578751 DOI: 10.1093/jamia/ocw126] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/24/2016] [Indexed: 11/12/2022] Open
Abstract
Objective Agency for Healthcare Research and Quality (AHRQ) software applies standardized algorithms to hospital administrative data to identify patient safety indicators (PSIs). The objective of this study was to assess the validity of PSI flags and report reasons for invalid flagging. Material and Methods At a 6-hospital academic medical center, a retrospective analysis was conducted of all PSIs flagged in fiscal year 2014. A multidisciplinary PSI Quality Team reviewed each flagged PSI based on quarterly reports. The positive predictive value (PPV, the percent of clinically validated cases) was calculated for 12 PSI categories. The documentation for each reversed case was reviewed to determine the reasons for PSI reversal. Results Of 657 PSI flags, 185 were reversed. Seven PSI categories had a PPV below 75%. Four broad categories of reasons for reversal were AHRQ algorithm limitations (38%), coding misinterpretations (45%), present upon admission (10%), and documentation insufficiency (7%). AHRQ algorithm limitations included 2 subcategories: an "incident" was inherent to the procedure, or highly likely (eg, vascular tumor bleed), or an "incident" was nonsignificant, easily controlled, and/or no intervention was needed. Discussion These findings support previous research highlighting administrative data problems. Additionally, AHRQ algorithm limitations was an emergent category not considered in previous research. Herein we present potential solutions to address these issues. Conclusions If, despite poor validity, US policy continues to rely on PSIs for incentive and penalty programs, improvements are needed in the quality of administrative data and the standardized PSI algorithms. These solutions require national motivation, research attention, and dissemination support.
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Affiliation(s)
- Jennifer L Hefner
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Timothy R Huerta
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Barbara Barash
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Tina Latimer
- Quality and Operations, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Susan D Moffatt-Bruce
- Quality and Operations, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Hefner JL, Sieck CJ, Walker DM, Huerta TR, McAlearney AS. System-Wide Inpatient Portal
Implementation: Survey of Health Care Team Perceptions. JMIR Med Inform 2017; 5:e31. [PMID: 28912115 PMCID: PMC5620453 DOI: 10.2196/medinform.7707] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 07/23/2017] [Accepted: 08/21/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Inpatient portals, a new type of patient portal tailored specifically to the hospital setting, can allow patients to access up-to-date health information and exchange secure communications with their care team. As such, inpatient portals present an opportunity for patients to increase engagement in their care during a time of acute crisis that emphasizes focus on a patient's health. While there is a large body of research on patient portals in the outpatient setting, questions are being raised specifically about inpatient portals, such as how they will be incorporated into the flow of patient care in hectic, stressed, team-based hospital settings. OBJECTIVE Our aim is to improve understanding about hospital care team members' perceptions of the value of an interactive patient portal for admitted patients, as well as to ascertain staff orientation toward this new technology. METHODS Throughout the course of 2016, an inpatient portal, MyChart Bedside (MCB) was implemented across a five-hospital health system. The portal is a tablet-based app that includes a daily schedule, lab/test results, secure messaging with the care team, a place to take notes, and access to educational materials. Within a month of initial rollout, hospital care team members completed a 5-minute, anonymous online survey to assess attitudes and perceptions about MCB use and staff training for the new technology. RESULTS Throughout the health system, 686 staff members completed the survey: 193 physicians (23.6%), 439 nurses (53.7%), and 186 support staff (22.7%). Questions about the importance of MCB, self-efficacy in using MCB with patients, and feelings about sufficient training and resources showed that an average of 40-60% of respondents in each group reported a positive orientation toward the MCB technology and training received. This positive orientation was highest among support staff, lower among nurses, and lowest for physicians (all differences by staff role were statistically significant at P<.001). Additionally, 62.0% of respondents reported "not enough" training. CONCLUSIONS Despite the robust training effort, similar to that used in previous health information technology implementations at this health system, hospital care team members reported only a moderately positive orientation toward MCB and its potential, and the majority wanted more training. We propose that due to the unique elements of the inpatient portal-interactive features used by patients and providers requiring explanation and collaboration-traditional training approaches may be insufficient. Introduction of the inpatient portal as a new collaborative tool may thus require new methods of training to support enhanced engagement between patients and their care team.
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Affiliation(s)
- Jennifer L Hefner
- Department of Family Medicine, The College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Cynthia J Sieck
- Department of Family Medicine, The College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Daniel M Walker
- Department of Family Medicine, The College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Timothy R Huerta
- Department of Family Medicine, The College of Medicine, The Ohio State University, Columbus, OH, United States
- Department of Biomedical Informatics, The College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Ann Scheck McAlearney
- Department of Family Medicine, The College of Medicine, The Ohio State University, Columbus, OH, United States
- Division of Health Services Management and Policy, The College of Public Health, The Ohio State University, Columbus, OH, United States
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Yen PY, McAlearney AS, Sieck CJ, Hefner JL, Huerta TR. Health Information Technology (HIT) Adaptation: Refocusing on the Journey to Successful HIT Implementation. JMIR Med Inform 2017; 5:e28. [PMID: 28882812 PMCID: PMC5608986 DOI: 10.2196/medinform.7476] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 08/04/2017] [Accepted: 08/04/2017] [Indexed: 11/26/2022] Open
Abstract
In past years, policies and regulations required hospitals to implement advanced capabilities of certified electronic health records (EHRs) in order to receive financial incentives. This has led to accelerated implementation of health information technologies (HIT) in health care settings. However, measures commonly used to evaluate the success of HIT implementation, such as HIT adoption, technology acceptance, and clinical quality, fail to account for complex sociotechnical variability across contexts and the different trajectories within organizations because of different implementation plans and timelines. We propose a new focus, HIT adaptation, to illuminate factors that facilitate or hinder the connection between use of the EHR and improved quality of care as well as to explore the trajectory of changes in the HIT implementation journey as it is impacted by frequent system upgrades and optimizations. Future research should develop instruments to evaluate the progress of HIT adaptation in both its longitudinal design and its focus on adaptation progress rather than on one cross-sectional outcome, allowing for more generalizability and knowledge transfer.
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Affiliation(s)
- Po-Yin Yen
- Washington University in St Louis, Institute for Informatics, St Louis, MO, United States.,Goldfarb School of Nursing, BJC Healthcare, St Louis, MO, United States
| | - Ann Scheck McAlearney
- The Ohio State University, Department of Family Medicine, Columbus, OH, United States
| | - Cynthia J Sieck
- The Ohio State University, Department of Family Medicine, Columbus, OH, United States
| | - Jennifer L Hefner
- The Ohio State University, Department of Family Medicine, Columbus, OH, United States
| | - Timothy R Huerta
- The Ohio State University, Department of Family Medicine, Columbus, OH, United States
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McAlearney AS, Hefner JL, Sieck CJ, Walker DM, Aldrich AM, Sova LN, Gaughan AA, Slevin CM, Hebert C, Hade E, Buck J, Grove M, Huerta TR. Searching for management approaches to reduce HAI transmission (SMART): a study protocol. Implement Sci 2017; 12:82. [PMID: 28659159 PMCID: PMC5490089 DOI: 10.1186/s13012-017-0610-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 06/14/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Healthcare-associated infections (HAIs) impact patients' lives through prolonged hospitalization, morbidity, and death, resulting in significant costs to both health systems and society. Central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) are two of the most preventable HAIs. As a result, these HAIs have been the focus of significant efforts to identify evidence-based clinical strategies to reduce infection rates. The Comprehensive Unit-based Safety Program (CUSP) provides a formal model for translating CLABSI-reduction evidence into practice. Yet, a national demonstration project found organizations experienced variable levels of success using CUSP to reduce CLABSIs. In addition, in Fiscal year 2019, Medicare will expand use of CLABSI and CAUTI metrics beyond ICUs to the entire hospital for reimbursement purposes. As a result, hospitals need guidance about how to successfully translate HAI-reduction efforts such as CUSP to non-ICU settings (clinical practice), and how to shape context (management practice)-including culture and management strategies-to proactively support clinical teams. METHODS Using a mixed-methods approach to evaluate the contribution of management factors to successful HAI-reduction efforts, our study aims to: (1) Develop valid and reliable measures of structural management practices associated with the recommended CLABSI Management Strategies for use as a survey (HAI Management Practice Guideline Survey) to support HAI-reduction efforts in both medical/surgical units and ICUs; (2) Develop, validate, and then deploy the HAI Management Practice Guideline Survey, first across Ohio hospitals, then nationwide, to determine the positive predictive value of the measurement instrument as it relates to CLABSI- and CAUTI-prevention; and (3) Integrate findings into a Management Practices Toolkit for HAI reduction that includes an organization-specific data dashboard for monitoring progress and an implementation program for toolkit use, and disseminate that Toolkit nationwide. DISCUSSION Providing hospitals with the tools they need to successfully measure management structures that support clinical care provides a powerful approach that can be leveraged to reduce the incidence of HAIs experienced by patients. This study is critical to providing the information necessary to successfully "make health care safer" by providing guidance on how contextual factors within a healthcare setting can improve patient safety across hospitals.
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Affiliation(s)
- Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH 43201 USA
| | - Jennifer L. Hefner
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
| | - Cynthia J. Sieck
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
| | - Daniel M. Walker
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
| | - Alison M. Aldrich
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
| | - Lindsey N. Sova
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
| | - Alice A. Gaughan
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
| | - Caitlin M. Slevin
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
| | - Courtney Hebert
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH 43201 USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, 310-E Lincoln Tower, 1800 Cannon Drive, Columbus, OH 43201 USA
- Division of Infectious Disease, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH USA
| | - Erinn Hade
- Center for Biostatistics, College of Medicine, The Ohio State University, 320G Lincoln Tower, 1800 Cannon Drive, Columbus, OH 43201 USA
| | - Jacalyn Buck
- The Ohio State University Wexner Medical Center, 134 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
- Administrator of Health System Nursing Quality, Research, Education and Evidence- Based Practice, The Ohio State University Wexner Medical Center, Office 2021, 600 Ackerman Road, Columbus, OH 43202 USA
| | - Michele Grove
- The Ohio State University Wexner Medical Center, 134 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
| | - Timothy R. Huerta
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, 310-E Lincoln Tower, 1800 Cannon Drive, Columbus, OH 43201 USA
- Division of Infectious Disease, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH USA
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Huerta TR, Walker DM, Ford EW. Cancer Center Website Rankings in the USA: Expanding Benchmarks and Standards for Effective Public Outreach and Education. J Cancer Educ 2017; 32:364-373. [PMID: 26472325 DOI: 10.1007/s13187-015-0931-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The 68 National Cancer Institute (NCI)-designated comprehensive and cancer centers have been tasked with leading the campaign in the fight against cancer, as well as providing education and outreach to the public. Therefore, it is important for these organizations to have an effective online presence to disseminate information and engage patients. The purpose of this study was to assess both the functionality and usability of cancer centers' websites. The 68 center web domains were evaluated using two separate but complementary approaches. First, a webcrawler was used to score each website on five dimensions: accessibility, content, marketing, technology, and usability. Rankings on each dimension and an average ranking were calculated for all 68 centers. Second, a three-reader system was used to determine a list of all functionalities present on the websites. Both webcrawler scores and functionality prevalence were compared across center type. No differences were observed in webcrawler scores between comprehensive and cancer centers. Mean scores on all dimensions ranged between 5.47 and 7.09. For the functionality assessment, 64 unique functions were determined and categorized into 12 domains, with the average center possessing less than 50 % of the functions. This census assessment of NCI centers' websites suggests the need for improvement to capitalize on new dissemination platforms available online. Progress in development of this technology can help achieve the goals of public education and outreach to a broad audience. This paper presents performance guidelines evaluated against best-demonstrated practice to facilitate social media use improvement.
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Affiliation(s)
- Timothy R Huerta
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, 265 Northwood and High Building, Columbus, OH, 43201, USA.
| | - Daniel M Walker
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, 265 Northwood and High Building, Columbus, OH, 43201, USA
| | - Eric W Ford
- Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House 533, Baltimore, MD, 21205, USA
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Huerta TR, Walker DM, Mullen D, Johnson TJ, Ford EW. Trends in E-Cigarette Awareness and Perceived Harmfulness in the U.S. Am J Prev Med 2017; 52:339-346. [PMID: 27890516 DOI: 10.1016/j.amepre.2016.10.017] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 09/16/2016] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Electronic cigarettes (e-cigarettes) are gaining in popularity as an alternative to regular cigarettes, as they are viewed as potentially less harmful. However, it remains unclear how awareness about e-cigarettes is permeating through the general U.S. POPULATION This study seeks to extend previous research and examine trends in e-cigarette awareness and perceived harmfulness, and their association with smoking-cessation efforts. METHODS Data from three cycles (2012, 2013, and 2014) of the Health Information National Trends Survey were combined into a single data set. Controlling for survey year, multivariate logit models were used to determine the association between demographic characteristics and e-cigarette awareness, perceived harmfulness, quit attempts, and quit intentions. Data were analyzed in 2015. RESULTS Awareness of e-cigarettes increased from 77.1% in 2012 to 94.3% in 2014. Controlling for demographic characteristics, e-cigarette awareness significantly increased in both 2013 and 2014, relative to 2012. Perception that e-cigarettes were less harmful than regular cigarettes declined from 50.7% in 2012 to 43.1% in 2014. Among smokers, no relationship was observed between e-cigarette awareness and past-year quit attempts or quit intentions, but those that viewed e-cigarettes as less harmful were less likely to have a past-year quit attempt. CONCLUSIONS These analyses reveal a continued increase in overall public awareness of e-cigarettes and shifting harm perceptions relative to regular cigarettes. New regulatory oversight by the U.S. Food and Drug Administration may have major effects on both dimensions, which are worth continued monitoring.
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Affiliation(s)
- Timothy R Huerta
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.
| | - Daniel M Walker
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Deborah Mullen
- International Diabetes Center, HealthPartners Institute, Minneapolis, Minnesota
| | - Tyler J Johnson
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Eric W Ford
- Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Walker DM, Johnson T, Ford EW, Huerta TR. Trust Me, I'm a Doctor: Examining Changes in How Privacy Concerns Affect Patient Withholding Behavior. J Med Internet Res 2017; 19:e2. [PMID: 28052843 PMCID: PMC5244032 DOI: 10.2196/jmir.6296] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 06/30/2016] [Revised: 09/21/2016] [Accepted: 11/30/2016] [Indexed: 11/13/2022] Open
Abstract
Background As electronic health records (EHRs) become ubiquitous in the health care industry, privacy breaches are increasing and being made public. These breaches may make consumers wary of the technology, undermining its potential to improve care coordination and research. Objective Given the developing concerns around privacy of personal health information stored in digital format, it is important for providers to understand how views on privacy and security may be associated with patient disclosure of health information. This study aimed to understand how privacy concerns may be shifting patient behavior. Methods Using a pooled cross-section of data from the 2011 and 2014 cycles of the Health Information and National Trends Survey (HINTS), we tested whether privacy and security concerns, as well as quality perceptions, are associated with the likelihood of withholding personal health information from a provider. A fully interacted multivariate model was used to compare associations between the 2 years, and interaction terms were used to evaluate trends in the factors that are associated with withholding behavior. Results No difference was found regarding the effect of privacy and security concerns on withholding behavior between 2011 and 2014. Similarly, whereas perceived high quality of care was found to reduce the likelihood of withholding information from a provider in both 2011 (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.56-0.94) and 2014 (OR 0.61, 95% CI 0.48-0.76), no difference was observed between years. Conclusions These findings suggest that consumers’ beliefs about EHR privacy and security, the relationship between technology use and quality, and intentions to share information with their health care provider have not changed. These findings are counter to the ongoing discussions about the implications of security failures in other domains. Our results suggest that providers could ameliorate privacy and security by focusing on the care quality benefits EHRs provide.
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Affiliation(s)
- Daniel M Walker
- Department of Family Medicine, The Ohio State University, College of Medicine, Columbus, OH, United States
| | - Tyler Johnson
- Department of Family Medicine, The Ohio State University, College of Medicine, Columbus, OH, United States
| | - Eric W Ford
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Timothy R Huerta
- Department of Family Medicine, The Ohio State University, College of Medicine, Columbus, OH, United States
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Rizer MK, Sieck C, Lehman JS, Hefner JL, Huerta TR, McAlearney AS. Working with an Electronic Medical Record in Ambulatory Care: A Study of Patient Perceptions of Intrusiveness. Perspect Health Inf Manag 2017; 14:1g. [PMID: 28566996 PMCID: PMC5430115] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess patient perceptions of electronic medical record (EMR) intrusiveness during ambulatory visits to clinics associated with a large academic medical center. METHOD We conducted a survey of patients seen at any of 98 academic medical center clinics. The survey assessed demographics, visit satisfaction, computer use, and perceived intrusiveness of the computer. RESULTS Of 7,058 patients, slightly more than 80 percent reported that the physician had used the computer while in the room, but only 24 percent were shown results in the EMR. Most patients were very satisfied or satisfied with their visit and did not find the computer intrusive (83 percent). Younger respondents, those shown results, and those who reported that the physician used the computer were more likely to perceive the computer as intrusive. Qualitative comments suggest different perceptions related to computer intrusiveness than to EMR use more generally. DISCUSSION Patients were generally accepting of EMRs and therefore use of computers in the exam room. However, subgroups of patients may require greater study to better understand patient perceptions related to EMR use and intrusiveness. CONCLUSION Results suggest the need for greater focus on how physicians use computers in the exam room in a manner that facilitates maintaining good rapport with patients.
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Affiliation(s)
- Milisa K Rizer
- Departments of Family Medicine and Biomedical Informatics in the College of Medicine of The Ohio State University and chief medical information officer of the Ohio State University Wexner Medical Center in Columbus, OH
| | - Cynthia Sieck
- Department of Family Medicine in the College of Medicine of The Ohio State University in Columbus, OH
| | - Jennifer S Lehman
- Department of Family Medicine in the College of Medicine of The Ohio State University in Columbus, OH
| | - Jennifer L Hefner
- Department of Family Medicine in the College of Medicine of The Ohio State University in Columbus, OH
| | - Timothy R Huerta
- Departments of Family Medicine and Biomedical Informatics in the College of Medicine of The Ohio State University in Columbus, OH
| | - Ann Scheck McAlearney
- Department of Family Medicine in the College of Medicine of The Ohio State University and research director for the Central Ohio Practice-Based Research Network in Columbus, OH
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McAlearney AS, Sieck CJ, Hefner JL, Aldrich AM, Walker DM, Rizer MK, Moffatt-Bruce SD, Huerta TR. High Touch and High Tech (HT2) Proposal: Transforming Patient Engagement Throughout the Continuum of Care by Engaging Patients with Portal Technology at the Bedside. JMIR Res Protoc 2016; 5:e221. [PMID: 27899338 PMCID: PMC5172441 DOI: 10.2196/resprot.6355] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/20/2016] [Accepted: 09/22/2016] [Indexed: 01/04/2023] Open
Abstract
Background For patients with complex care needs, engagement in disease management activities is critical. Chronic illnesses touch almost every person in the United States. The costs are real, personal, and pervasive. In response, patients often seek tools to help them manage their health. Patient portals, personal health records tethered to an electronic health record, show promise as tools that patients value and that can improve health. Although patient portals currently focus on the outpatient experience, the Ohio State University Wexner Medical Center (OSUWMC) has deployed a portal designed specifically for the inpatient experience that is connected to the ambulatory patient portal available after discharge. While this inpatient technology is in active use at only one other hospital in the United States, health care facilities are currently investing in infrastructure necessary to support large-scale deployment. Times of acute crisis such as hospitalization may increase a patient’s focus on his/her health. During this time, patients may be more engaged with their care and especially interested in using tools to manage their health after discharge. Evidence shows that enhanced patient self-management can lead to better control of chronic illness. Patient portals may serve as a mechanism to facilitate increased engagement. Objective The specific aims of our study are (1) to investigate the independent effects of providing both High Tech and High Touch interventions on patient-reported outcomes at discharge, including patients’ self-efficacy for managing chronic conditions and satisfaction with care; and (2) to conduct a mixed-methods analysis to determine how providing patients with access to MyChart Bedside (MCB, High Tech) and training/education on patient portals, and MyChart Ambulatory (MCA, High Touch) will influence engagement with the patient portal and relate to longer-term outcomes. Methods Our proposed 4-year study uses a mixed-methods research (MMR) approach to evaluate a randomized controlled trial studying the effectiveness of a High Tech intervention (MCB, the inpatient portal), and an accompanying High Touch intervention (training patients to use the portal to manage their care and conditions) in a sample of hospitalized patients with two or more chronic conditions. This study measures how access to a patient portal tailored to the inpatient stay can improve patient experience and increase patient engagement by (1) improving patients’ perceptions of the process of care while in the hospital; (2) increasing patients’ self-efficacy for managing chronic conditions; and (3) facilitating continued use of a patient portal for care management after discharge. In addition, we aim to enhance patients’ use of the portal available to outpatients (MCA) once they are discharged. Results This study has been funded by the Agency for Healthcare Research and Quality (AHRQ). Research is ongoing and expected to conclude in August 2019. Conclusions Providing patients real-time access to health information can be a positive force for change in the way care is provided. Meaningful use policies require minimum demonstrated use of patient portal technology, most often in the ambulatory setting. However, as the technology matures to bridge the care transition, there is a greater need to understand how patient portals transform care delivery. By working in concert with patients to address and extend current technologies, our study aims to advance efforts to increase patients’ engagement in their care and develop a template for how other hospitals might integrate similar technologies.
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Affiliation(s)
- Ann Scheck McAlearney
- Research Division, Department of Family Medicine, The Ohio State University, Columbus, OH, United States
| | - Cynthia J Sieck
- Research Division, Department of Family Medicine, The Ohio State University, Columbus, OH, United States
| | - Jennifer L Hefner
- Research Division, Department of Family Medicine, The Ohio State University, Columbus, OH, United States
| | - Alison M Aldrich
- Research Division, Department of Family Medicine, The Ohio State University, Columbus, OH, United States
| | - Daniel M Walker
- Research Division, Department of Family Medicine, The Ohio State University, Columbus, OH, United States
| | - Milisa K Rizer
- Information Technology, Wexner Medical Center, Ohio State University, Columbus, OH, United States.,Clinical Division, Department of Family Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Susan D Moffatt-Bruce
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States.,Quality & Patient Safety, Wexner Medical Center, The Ohio State University, Columbus, OH, United States.,Department of Surgery, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Timothy R Huerta
- Research Division, Department of Family Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States
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Huerta TR, Walker DM, Johnson T, Ford EW. A Time Series Analysis of Cancer-Related Information Seeking: Hints From the Health Information National Trends Survey (HINTS) 2003-2014. J Health Commun 2016; 21:1031-1038. [PMID: 27565190 DOI: 10.1080/10810730.2016.1204381] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Recent technological changes, such as the growth of the Internet, have made cancer information widely available. However, it remains unknown whether changes in access have resulted in concomitant changes in information seeking behavior. Previous work explored the cancer information seeking behaviors of the general population using the 2003 Health Information National Trends Survey (HINTS). This article aims to reproduce, replicate, and extend that existing analysis using the original dataset and five additional iterations of HINTS (2007, 2011, 2012, 2013, 2014). This approach builds on the earlier work by quantifying the magnitude of change in information seeking behaviors. Bivariate comparison of the 2003 and 2014 data revealed very similar results; however, the multivariate model including all years of data indicated differences between the original and extended models: individuals age 65 and older were no longer less likely to seek cancer information than the 18-35 reference population, and Hispanics were also no longer less likely to be cancer information seekers. The results of our analysis indicate an overall shift in cancer information seeking behaviors and also illuminate the impact of increased Internet usage over the past decade, suggesting specific demographic groups that may benefit from cancer information seeking encouragement.
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Affiliation(s)
- Timothy R Huerta
- a Department of Family Medicine, College of Medicine , The Ohio State University , Columbus , Ohio , USA
| | - Daniel M Walker
- a Department of Family Medicine, College of Medicine , The Ohio State University , Columbus , Ohio , USA
| | - Tyler Johnson
- a Department of Family Medicine, College of Medicine , The Ohio State University , Columbus , Ohio , USA
| | - Eric W Ford
- b Health Policy and Management , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
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