The nature and accuracy of Instagram posts concerning marketed orthodontic products: A cross-sectional analysis

OBJECTIVES

To scrutinize claims contained within Instagram posts related to six popular marketed orthodontic products.

MATERIALS AND METHODS

Three hundred publicly available Instagram posts were identified using the following Instagram hashtags: #carrieremotion, #damonbraces, #invisalign, #acceledent, #propelorthodontics, and #myobrace. Pilot coding was undertaken on a subset of claims (n = 50) and a coding guide was developed. The associated claims were categorized under 24 recognized themes and their accuracy assessed on a five-point scale.

RESULTS

Of 1730 posts screened, 300 were included for analysis. The majority of posts were based on photographs (n = 244, 81.3%) with the remainder (n = 56, 18.7%) including videos. Half of the posts involved a picture of the product in isolation (n = 150, 50%), with clinical cases presented in a minority (n = 99, 33%). Overall, 472 claims were included with treatment duration being the most frequent theme (n = 125, 26.5%). In terms of accuracy, most of the claims were judged to be "false" (n = 283, 60%) with less than 2% considered "objectively true."

CONCLUSIONS

Most of the claims relating to six popular marketed orthodontic products concerned treatment duration. The vast majority of these claims were not supported by evidence and were judged to be false. Efforts should be made to promote the provision of accurate orthodontic information and to verify marketing claims on social media platforms.

Marketing cosmetic surgery - a qualitative analysis

BACKGROUND

Marketing cosmetic surgery is an under-researched topic in a Norwegian context, even though problematic aspects of such marketing have been pointed out in several contexts. This study draws attention to how providers of cosmetic surgery market their services, whom they target and how they do so.

MATERIAL AND METHOD

Critical discourse analysis was used as a framework for a qualitative study of the marketing activity of 36 private clinics. The data material was collected from the Internet and newspapers, and consists of text, still photos and video clips.

RESULTS AND INTERPRETATION

The article identifies the following marketing strategies: The providers refer to customers as patients, normalise cosmetic surgery, draw attention to physical flaws, play on femininity and sensuality, define natural appearance, promise a better self-image and quality of life, and offer package solutions and financing schemes. The underlying messages and patterns that emerge from the identified strategies are interpreted within theories on body and gender, nature and culture.

Branding Dynamics for the Esthetic Dentist: Building Your Brand to Build Your Practice

The objective of this article is to introduce the concept of branding to dentists interested in implementing elective esthetic treatment into their practice. For many, this will serve as an introduction to begin; for others, it can provide a road map for revising and reinforcing a branding program already in place.

Management and Marketing in Health Institutions

In the last decades radical changes in the health care market have happened. Customers continuously require a higher level of quality of service and they become more careful and demanding in the decision process, market intelligence is continuously growing, competition and quality of services are dramatically increasing, as well as the external influences of various lobbyists in many parts of the world. Also, it is important to mention the fact that there are many initiatives for change in many branches of health care delivery, as well as many innovative models for providing health services that change the traditional role of healthcare institutions. In these conditions in order to be competitive on the global market and to create satisfied and loyal consumers of health services, health institutions need to introduce a marketing management concept which is completely in accordance with actual trends on the global market as well as needs and demands of services consumers.

Mapping the Patient's Journey in Healthcare through Process Mining

Nowadays, assessing and improving customer experience has become a priority, and has emerged as a key differentiator for business and organizations worldwide. A customer journey (CJ) is a strategic tool, a map of the steps customers follow when engaging with a company or organization to obtain a product or service. The increase of the need to obtain knowledge about customers' perceptions and feelings when interacting with participants, touchpoints, and channels through different stages of the customer life cycle. This study aims to describe the application of process mining techniques in healthcare as a tool to asses customer journeys. The appropriateness of the approach presented is illustrated through a case study of a key healthcare process. Results depict how a healthcare process can be mapped through the CJ components, and its analysis can serve to understand and improve the patient's experience.

Orthopaedic support with 3D printing in children : marketing effect or solution of the future?

In pediatric orthopaedics, the immobilization of a limb is traditionally done by a cast. The emergence of 3D technologies allows us to produce restraints specific to the anatomical characteristics of the patient. This paper aims to determine the feasibility of the process of developing these restraints. Descriptive study of the creation process involving 19 patients aged 2 to 14 years for whom a restraint was placed between April 2018 and November 2018. This was mainly post-traumatic pathology (12) and children having a clubfoot (7). This type of restraint has the following characteristics : use of recyclable material ; lightness ; ventilation ; visibility of the underlying skin tissue and its hydro-compatibility. The major limitations remaining are production time and printing errors. The emergence of 3D printing, allows us to extend its application to the medical world. When the therapeutic effectiveness of a restraint is achieved, quality of life becomes the main selection criterion. Based on observations already made in the past, we were able to develop a model that combines the advantages of the different approaches. New 3D printing technologies allow the creation of restraint devices with many advantages and customized adaptation possibilities.

Proton therapy delivery: what is needed in the next ten years?

Proton radiation therapy has been used clinically since 1952, and major advancements in the last 10 years have helped establish protons as a major clinical modality in the cancer-fighting arsenal. Technologies will always evolve, but enough major breakthroughs have been accomplished over the past 10 years to allow for a major revolution in proton therapy. This paper summarizes the major technology advancements with respect to beam delivery that are now ready for mass implementation in the proton therapy space and encourages vendors to bring these to market to benefit the cancer population worldwide. We state why these technologies are essential and ready for implementation, and we discuss how future systems should be designed to accommodate their required features.

What Role Does Patient Gratitude Play in the Relationship Between Relationship Quality and Patient Loyalty?

The environment in health care organizations is becoming increasingly competitive. Therefore, to improve patient return rates, health care organizations need to examine how to enhance the physician-patient relationship. In particular, the role of patient gratitude on the physician-patient relationship in health care organizations is still ambiguous. The specific role of patient gratitude in the medical service industry needs to be identified. Therefore, this study aimed to investigate physician-patient interactions with reference to relationship marketing and to further understand the relationships among relationship quality, patient gratitude, and patient loyalty. The potential effects of patient gratitude on the physician-patient relationship were examined by testing mediation effect. The results demonstrated that patient gratitude had a notable effect on the association between relationship quality and patient loyalty. To improve the physician-patient relationship in the medical service industry, health care managements should not ignore the 3 relationship quality tactics perceived by patients, specially the role of the potential effect of patient gratitude on relational building.

Potential Procedural Efficiencies and Challenges of Combining Multiple Type II Variations into a Single EU-RMP

The process for amending a European Union Risk Management Plan (EU-RMP) with new information requires the submission of a formal variation procedure, of which there are four distinct categories: Type IA, Type IB, Type II, and 'Extension of a marketing authorisation' (or simply 'extension'). A Type II variation, in accordance with the above-referenced European Commission regulation, is defined as 'a variation that is not an extension of the marketing authorisation (line extension) and that may have a significant impact on the quality, safety or efficacy of a medicinal product'. Additional detail regarding which type of variation should be submitted in specific circumstances is provided in the accompanying guideline. Common working practice for submission strategies when managing multiple Type II variations has been to either submit each in sequence or submit several parallel procedures each with its own corresponding EU-RMP. Submitting in sequence results in a prolonged, end-to-end process with each procedure resulting in a new, iterative version of the EU-RMP. Alternatively, submitting multiple parallel variations with their own corresponding EU-RMPs can result in very complicated procedural wrap-up activities and very short-lived approved versions. In this article, we describe an approach to the management of multiple Type II variations, which is now in line with the recently revised European Medicines Agency (EMA) frequently asked questions (FAQ) guidance on how to manage grouped Type II variation applications, whereby four parallel Type II variation procedures were successfully initiated simultaneously with a single EU-RMP.

The impact of pharmaceutical marketing on market access, treatment coverage, pricing, and social welfare

Pharmaceutical spending in the United States, Canada, and the EU is growing. Public payers cover a large portion of these costs and have responded by instituting various pricing and access policies to limit their expenditure. One challenge that public payers face is additional demand induced by a manufacturer's marketing effort. We use a game theoretic approach to study the impact of pharmaceutical marketing on six practical pricing and access policies: negotiated pricing, open pricing, controlled pricing, a listing process, a risk-sharing arrangement, and a value-based pricing with risk-sharing arrangement. We find that all non-value-based policies result in either restricted access or suboptimal treatment coverage. We find that marketing is the highest in the first-best setting where all decisions are made by a social planner. We also find that the value-based pricing with risk-sharing arrangement is preferred by the manufacturer and from a societal perspective whereas no policy is universally preferred by a health care payer. A value-based pricing with risk-sharing arrangement always results in zero net monetary benefit for a health care payer. Therefore, considering non-value-based arrangements, we find that a negotiated pricing policy, a controlled pricing policy, or a risk-sharing arrangement may be socially preferred.

Searching for a Better Online Reputation

What people see on the internet can bring in - or drive away - patients. But most physicians are not trained in either communications or digital technology, and so have little understanding of the financial impact of search engines, social media, and review sites.

Nurses' Perspectives on the Impact of Marketing Mix Elements (7Ps) on Patients' Tendency to Kind of Hospital

BACKGROUND

Marketing mix (7Ps) is a critical concept in healthcare management and health marketing. Hence, this study was conducted to investigating the role of 7Ps on patients' disposition to the kind of hospital from nurses' perspectives.

METHODS

A cross-sectional study design was used in 2015. The study was conducted in one state in Iran (Mazandaran). The statistical population included nurses (n=235) in public and private hospitals were selected randomly through the list. Data were collected by questionnaire and were analyzed using SPSS software (version 22).

RESULTS

The results showed that 38.6 percent of nurses were males and the others (61.4 percent) were females. Their mean age was 31.0±7.1 years, and the majority of them belonged to the 30-40 age group. The mean work experience of them was 11.42±6.5 years. The findings showed that there were significant differences between nurses' perspectives in public and private hospitals about the effect of 7Ps elements on patients' tendency to the public and private hospitals (p<0.05).

CONCLUSIONS

According to the results, the officials of public hospitals should take more attention to the elements like product, place, promotion, people, physical assets and process management more than the past because these elements cause that the patients are disposed to the private hospitals while the government make more investment in public hospitals.

Building Your Practice: Hot Topics

Why do some patients chose one orthopaedist for their care, and yet others find themselves in the lobbies of competitors? On the surface, it might look as if some competitors are spending more money and exerting more time marketing their practice to referral sources. In some cases, that might be true, but in most cases, there are so many variables in play that drive volume, reimbursement, and a competitive position. Understanding several topics focused on building, growing, and managing a thriving orthopaedic practice provides a broader perspective of strategy and execution versus what most orthopaedists might imagine when it comes to marketing.

Consumer-driven and commercialised practice in dentistry: an ethical and professional problem?

The rise and persistence of a commercial model of healthcare and the potential shift towards the commodification of dental services, provided to consumers, should provoke thought about the nature and purpose of dentistry and whether this paradigm is cause for concern. Within this article, whether dentistry is a commodity and the legitimacy of dentistry as a business is explored and assessed. Dentistry is perceived to be a commodity, dependent upon the context of how services are to be provided and the interpretation of the patient-professional relationship. Commercially-focused practices threaten the fiduciary nature of the interaction between consumer and provider. The solution to managing commercial elements within dentistry is not through rejection of the new paradigm of the consumer of dental services, but in the rejection of competitive practices, coercive advertising and the erosion of professional values and duty. Consumerism may bring empowerment to those accessing dental services. However, if the patient-practitioner relationship is reduced to a mere transaction in the name of enhanced consumer participation, this empowerment is but a myth.

The relationship between pharmacy benefit managers (PBMs) and the cost of therapies in the US pharmaceutical market: A policy primer for clinicians

Pharmaceutical benefit managers (PBMs) are playing an increasingly important role in establishing access to pharmaceutical products for patients. PBMs set retail prices for pharmaceutical products, negotiate "rebates" from manufacturers based on total sales volume of products, and achieve several types of postsale price concessions and payments from pharmacies. All of these activities describe a complex flow of funds that has not been transparent to clinicians or to patients. In this article, we describe these terms and processes to better understand how pharmaceutical products are financed in the United States. In 2016, US pharmaceutical manufacturers reported gross pharmaceutical sales of $462 billion and net pharmaceutical sales of $318 billion. The difference between gross and net sales is largely due to the different "payments" from manufacturers to PBMs and other intermediaries in the marketplace. We examine the flow of funds through the US pharmaceutical distribution system over time using data from the annual reports of 13 major pharmaceutical manufacturers for the period 2011-2016. Overall, we find that net revenues for our sample of firms grew by an average of 2.7% annually between 2011 and 2016, whereas rebates and other payments increased by 15% annually over the same period. Our examination of the pharmaceutical market reveals the enormous scale of payments from pharmaceutical manufacturers to intermediaries. We observed that these payments have been growing disproportionally to manufacturer net income over the past 5 years. We also found a lack of transparency regarding the flow of funds through intermediaries. This entire marketplace is now the subject of intense public debate.

Effect of an Educational Intervention on Knowledge and Perception Regarding Rational Medicine Use and Self-medication

BACKGROUND

Rational use of medicines is important for safe and cost-effective pharmacotherapy. However, nearly half of the medicines available in the market may be used irrationally. The present study assessed the perceptions and knowledge about rational medicine use and responsible self-medication among participants before and after an educational intervention at KIST Medical College, Lalitpur.

METHODS

An educational module was conducted among healthcare professionals, media personnel and female community health volunteers. The questionnaire was administered before and immediately after the module. The areas addressed were rational medicine use, ethical prescribing, rational drug use situation in Nepal, pharmaceutical promotion, rational self-medication, safe use of antibiotics, and drug use problems in Nepal.

RESULTS

Among healthcare professionals, the rational drug use situation in Nepal and the total score significantly increased post-intervention (p<0.05). Among media personnel the mean scores increased significantly in pharmaceutical promotion and drug use problems in Nepal areas but there was a significant decrease in safe use of antibiotics. The pre-intervention pharmaceutical promotion score was significantly higher among healthcare professionals compared to media personnel while the rational self-medication scores were highest among female community health volunteers, safe use of antibiotics scores were highest among the media personnel. Post-intervention the mean pharmaceutical promotion scores was highest among healthcare professionals, rational self-medication scores among female community health volunteers, safe use of antibiotics, drug use problems in Nepal and total scores were highest among the media personnel.

CONCLUSIONS

There were differences in the mean pre-intervention scores among different subgroups. A single session may not be enough to bring about significant changes in knowledge and perception. The retention of knowledge could be measured in future studies.

Study on the Influence of Government Intervention on the Occupational Health and Safety (OHS) Services of Small- and Medium-Sized Enterprises (SMEs)

The OHS services of SMEs are still in their start-up stage in China. As such, there is an absence of mature market norms, which in turn makes it difficult to guarantee the quality of OHS services. The government, as the "night watchman" of the market, is supposed to not only involve itself in the regulation of OHS service quality, but also introduce and implement proper regulatory strategies. This paper employs a computational experiment approach to construct an experimental platform based on multiagent interactions. By simulating the OHS service transaction activities of SMEs, this paper takes the perspective of dynamic evolution. From this perspective, we probe into the optimal regulatory strategy covering the positive influence of government punishment, policy supports, and service quality ratings of the OHS services of SMEs. These strategies should be built on the foundation of proper punishment standard and intensity, proper support standard and intensity, and quality rating information disclosure.

Marketing Self-management Education: Lessons on Messaging and Framing

Objective Self-management education (SME) refers to educational interventions that help individuals with chronic diseases maintain or improve their quality of life. To help increase SME participation, the US Centers for Disease Control and Prevention conducted audience research to assess feasibility of a campaign to market SME as a chronic disease management strategy and increase future receptivity to specific SME programs. Methods Twenty focus groups were conducted in 3 rounds across 8 cities with men and women ages 45-75 with a variety of, or multiple, chronic conditions. Data were analyzed to identify cross-cutting themes and assess differences by sex, race/ethnicity, and location. Results Findings revealed that although people with chronic disease are not aware of SME, it is feasible to deliver motivating messages about SME, and content need not be condition- or intervention-specific. Concepts viewed most positively by focus groups incorporated positive tone, empowering language, specific references to health, relatable images, and a website for more information. Conclusion This qualitative work suggests SME marketing strategies will be most effective by providing background information, framing messages positively, using clear relatable language, and making it easy for potential participants to find a program.

Health Care Sharing Ministries: What Are the Risks to Consumers and Insurance Markets?

ISSUE

Health care sharing ministries (HCSMs) are a form of health coverage in which members--who typically share a religious belief--make monthly payments to cover expenses of other members. HCSMs do not have to comply with the consumer protections of the Affordable Care Act and may provide value for some individuals, but pose risks for others. Although HCSMs are not insurance and do not guarantee payment of claims, their features closely mimic traditional insurance products, possibly confusing consumers. Because they are largely unregulated and provide limited benefits, HCSMs may be disproportionately attractive to healthy individuals, causing the broader insurance market to become smaller, sicker, and more expensive.

GOAL

To understand state regulator perspectives on regulation of HCSMs and the impact of these arrangements on consumers and markets.

METHODS

Analysis of state laws governing HCSMs in all states; interviews with officials in 13 states; and review of the membership requirements and benefits of five HCSMs.

FINDINGS AND CONCLUSIONS

State regulators voiced concerns regarding the potential risks of HCSMs to consumers and their individual markets. However, in the absence of reliable data describing HCSM enrollment, regulators cannot adequately assess harm. Though limited resources and political constraints have made oversight difficult, all states, regardless of their regulatory approach to HCSMs, should obtain data to better understand the role of HCSMs in their markets.

A Doctor's Name as a Brand: A Nationwide Survey on Registered Clinic Names in Taiwan

In countries where the private clinics of physicians can be freely named, registering a clinic with a physician’s name is one way to make patients familiar with the physician. No previous study had investigated how clinics make use of this method of personal branding. Therefore, the current study analyzed 10,847 private physician Western medicine clinics in Taiwan. Of those clinics, 31.0% (n = 3363) were named with a physician’s full name, 8.9% (n = 960) with a surname, and 8.1% (n = 884) with a given name. The proportion of clinics registered with a physician’s name was lower in rural areas (37.3%) than in urban (48.5%) and suburban areas (49.2%), respectively. Among clinics with only one kind of specialist, a physician’s name was used most frequently in clinics of obstetrics and gynecology (64.9%), otorhinolaryngology (64.1%), and dermatology (63.4%). In Taiwan, fewer than half of clinics used a physician’s name as a brand. The sociocultural or strategic factors and real benefits of doing so could be further studied in the future for a better understanding of healthcare services management.

Pharma Opportunities and Risks Multiply as Regulatory Reform Remakes APAC: Expanded Accelerated Pathways Challenge Developer Value Story, Evidence Collection, and Market Access Strategies

Sweeping reforms in the largest markets of the Asia-Pacific region are transforming the regulatory and commercial landscape for foreign pharmaceutical companies. Japan, South Korea, and China are leading the charge, establishing mechanisms and infrastructure that both reflect and help drive international regulatory convergence and accelerate delivery of needed, innovative products to patients. In this rapidly evolving regulatory and commercial environment, drug developers can benefit from reforms and proliferating accelerated pathway (AP) frameworks, but only with regulatory and evidence-generation strategies tailored to the region. Otherwise, they will confront significant pricing and reimbursement headwinds. Although APAC economies are at different stages of development, they share a common imperative: to balance pharmaceutical innovation with affordability. Despite the complexity of meeting these sometimes conflicting demands, companies that focus on demonstrating and delivering value for money, and that price new treatments reasonably and sustainably, can succeed both for their shareholders and the region's patient population.

Public Funding for Genomics and the Return on Investment: A Public Health Perspective

This article traces the emergence of lean principles in genomics research and connects this new way of doing science with many of the current pitfalls of precision medicine in its attempts at improving population health outcomes. Precision medicine has a history of public funding, yet the benefits in clinical settings are very slowly being realized due to a variety of factors, such as uncertainty regarding relevant treatments after identifying disease risk, lack of cost-effectiveness studies for general population-level interventions, and letting a culture of "over promise and under deliver" permeate some areas of genomics research. The article concludes with insights into the challenges and opportunities that will need careful consideration and consultation with the wider society in order to decide whether to turn off the "tap" for investment of public funds in research on genomics and other "omics." Ultimately, this article argues for a moderate course correction in how public funds are invested to truly improve the health of all of us, and not just some of us.

Influence of pharmaceutical marketing on Medicare prescriptions in the District of Columbia

Importance

Gifts from pharmaceutical companies are believed to influence prescribing behavior, but few studies have addressed the association between industry gifts to physicians and drug costs, prescription volume, or preference for generic drugs. Even less research addresses the effect of gifts on the prescribing behavior of nurse practitioners (NPs), physician assistants (PAs), and podiatrists.

Objective

To analyze the association between gifts provided by pharmaceutical companies to individual prescribers in Washington DC and the number of prescriptions, cost of prescriptions, and proportion of branded prescriptions for each prescriber.

Design

Gifts data from the District of Columbia’s (DC) AccessRx program and the federal Center for Medicare and Medicaid Services (CMS) Open Payments program were analyzed with claims data from the CMS 2013 Medicare Provider Utilization and Payment Data.

Setting

Washington DC, 2013

Participants

Physicians, nurse practitioners, physician assistants, podiatrists, and other licensed Medicare Part D prescribers who participated in Medicare Part D (a Federal prescription drug program that covers patients over age 65 or who are disabled).

Exposure(s)

Gifts to healthcare prescribers (including cash, meals, and ownership interests) from pharmaceutical companies.

Main outcomes and measures

Average number of Medicare Part D claims per prescriber, number of claims per patient, cost per claim, and proportion of branded claims.

Results

In 2013, 1,122 (39.1%) of 2,873 Medicare Part D prescribers received gifts from pharmaceutical companies totaling $3.9 million in 2013. Compared to non-gift recipients, gift recipients prescribed 2.3 more claims per patient, prescribed medications costing $50 more per claim, and prescribed 7.8% more branded drugs. In six specialties (General Internal Medicine, Family Medicine, Obstetrics/Gynecology, Urology, Ophthalmology, and Dermatology), gifts were associated with a significantly increased average cost of claims. For Internal Medicine, Family Medicine, and Ophthalmology, gifts were associated with more branded claims. Gift acceptance was associated with increased average cost per claim for PAs and NPs. Gift acceptance was also associated with higher proportion of branded claims for PAs but not NPs. Physicians who received small gifts (less than $500 annually) had more expensive claims ($114 vs. $85) and more branded claims (30.3% vs. 25.7%) than physicians who received no gifts. Those receiving large gifts (greater than $500 annually) had the highest average costs per claim ($189) and branded claims (39.9%) than other groups. All differences were statistically significant (p<0.05).

Conclusions and relevance

Gifts from pharmaceutical companies are associated with more prescriptions per patient, more costly prescriptions, and a higher proportion of branded prescriptions with variation across specialties. Gifts of any size had an effect and larger gifts elicited a larger impact on prescribing behaviors. Our study confirms and expands on previous work showing that industry gifts are associated with more expensive prescriptions and more branded prescriptions. Industry gifts influence prescribing behavior, may have adverse public health implications, and should be banned.

Marketing Is Not a Luxury - Marketing Is a Necessity

Physicians who work in small practices constantly face a basic marketing question: What's the best way to sell myself and my business to the community? Because few physicians studied business principles, many won't know the answer. That's why the Texas Medical Association is publishing a book titled Marketing Smart: A Guide for Medical Practices.

Current and emerging global themes in the bioethics of regenerative medicine: the tangled web of stem cell translation

Probably the most serious problem facing the field of regenerative medicine today is the challenge of effective translation and development of viable stem cell-based therapies. Particular concerns have been raised over the growing market in unproven cell therapies. In this article, I explore recent developments in the stem cell therapy landscape and argue that while the sale of unproven therapies undoubtedly poses ethical concerns, it must be understood as part of a larger problem at the interface between biomedicine, healthcare, publics, policy and the market. Addressing this will require a broader perspective incorporating the shifting relationships between different stakeholder groups, the global politics of research and innovation, and the evolving role of publics and patients with respect to science.

Collaborative Branding of Partnered Health Systems in Radiology

In an effort to expand clinical reach and achieve economies of scale, academic radiology practices are strategically expanding into the community by establishing partnerships with existing community health systems. A challenge with this model is to effectively brand the collaboration in a way that underscores the strengths of both partners. In this article, the authors look at the benefits and risks of cobranding and review cobranding strategies for implementation by academic radiology practices considering partnership-based network expansion.

Health care public reporting utilization - user clusters, web trails, and usage barriers on Germany's public reporting portal Weisse-Liste.de

BACKGROUND

Quality of care public reporting provides structural, process and outcome information to facilitate hospital choice and strengthen quality competition. Yet, evidence indicates that patients rarely use this information in their decision-making, due to limited awareness of the data and complex and conflicting information. While there is enthusiasm among policy makers for public reporting, clinicians and researchers doubt its overall impact. Almost no study has analyzed how users behave on public reporting portals, which information they seek out and when they abort their search.

METHODS

This study employs web-usage mining techniques on server log data of 17 million user actions from Germany's premier provider transparency portal Weisse-Liste.de (WL.de) between 2012 and 2015. Postal code and ICD search requests facilitate identification of geographical and treatment area usage patterns. User clustering helps to identify user types based on parameters like session length, referrer and page topic visited. First-level markov chains illustrate common click paths and premature exits.

RESULTS

In 2015, the WL.de Hospital Search portal had 2,750 daily users, with 25% mobile traffic, a bounce rate of 38% and 48% of users examining hospital quality information. From 2013 to 2015, user traffic grew at 38% annually. On average users spent 7 min on the portal, with 7.4 clicks and 54 s between clicks. Users request information for many oncologic and orthopedic conditions, for which no process or outcome quality indicators are available. Ten distinct user types, with particular usage patterns and interests, are identified. In particular, the different types of professional and non-professional users need to be addressed differently to avoid high premature exit rates at several key steps in the information search and view process. Of all users, 37% enter hospital information correctly upon entry, while 47% require support in their hospital search.

CONCLUSIONS

Several onsite and offsite improvement options are identified. Public reporting needs to be directed at the interests of its users, with more outcome quality information for oncology and orthopedics. Customized reporting can cater to the different needs and skill levels of professional and non-professional users. Search engine optimization and hospital quality advocacy can increase website traffic.

Seven Deadly Sins of a Medical Practice

The seven deadly sins, also known as the capital vices or cardinal sins, is a list of vices of Christian origin. They are hubris, greed, lust, malicious envy, gluttony, anger, and sloth. Likewise, there are deadly sins (mistakes) that have a negative impact on the medical practice. This article discusses the deadly sins of a medical practice and what each physician and each practice manager can do to combat those sins or mistakes.