Health Digital Inclusion and Patient-centered Care Readiness in the USA

Patient-centered care is a relatively new form of healthcare that empowers people when they receive services, but patients must get ready for the active roles they are going to play in order to participate. Based on a literature review, this study conceptualizes that patient-centered care readiness has two basic capabilities: (1) health information access and (2) coordination and communication. The development of these capabilities, leading to the ultimate objective of patient choice and empowerment, depends on the status of health digital inclusion. To maximize the benefits of patient-centered care and reduce the risk of health disparity, it is necessary to assess the patient-centered care readiness of a population, especially to find out who is at a disadvantage. Using the 2009 U.S. National Health Interview Survey data, this study conducts logistic regression and classification tree analyses to predict the two capabilities with eleven physiological, population, socioeconomic, and healthcare-related variables. The results suggest that there is an uneven development of patient-centered care readiness in the country, especially for those who are socially and economically disadvantaged, such as minority people and senior citizens. The findings provide researchers and practitioners the insights on how to cross the gap and prepare the whole nation for the transition

Design of Integral Reminder for Collaborative Appointment Management

Reminder systems have great potential to enhance healthcare outcome, but there is a big space for improvement to facilitate the collaborative appointment management with accessible mobile communication technology. This study proposes a design of integral reminder systems that automates the process of appointment rescheduling for patients and physicians in addition to confirmation and cancellation. Based on the premises of patient-centered care of media synchronicity theory, design principles are proposed to cater to the different requirements of healthcare providers and patient users on appointment management. The design provides useful guidelines for building integral reminder systems that enhance medical compliance

Evaluating the Impact of Broadband Access and Internet Use in a Small Underserved Rural Community

Having adequate access to the internet at home enhances quality-of-life for households and facilitates economic and social opportunities. Despite increased investment in response to the COVID-19 pandemic, millions of households in the rural United States still lack adequate access to high-speed internet. In this study, we evaluate a wireless broadband network deployed in Turney, a small, underserved rural community in northwest Missouri. In addition to collecting survey data before and after this internet intervention, we collected pre-treatment and post-treatment survey data from comparison communities to serve as a control group. Due to technical constraints, some of Turney\u27s interested participants could not connect to the network, creating an additional comparison group. These comparisons suggest two primary findings, (1) changes in using the internet for employment, education, and health could not be directly attributed to the internet intervention, and (2) the internet intervention was associated with benefits stemming from the ability to use multiple devices at once. This study has implications for the design of future broadband evaluation studies, particularly those examining underserved rather than unserved communities. Recommendations for identifying appropriate outcome variables, executing recruitment strategies, and selecting the timing of surveys are made

Evaluating the Impact of Broadband Access and Internet Use in a Small Underserved Rural Community

Having adequate access to the internet at home enhances quality-of-life for households and facilitates economic and social opportunities. Despite increased investment in response to the COVID-19 pandemic, millions of households in the rural United States still lack adequate access to high-speed internet. In this study, we evaluate a wireless broadband network deployed in Turney, a small, underserved rural community in northwest Missouri. In addition to collecting survey data before and after this internet intervention, we collected pre-treatment and post-treatment survey data from comparison communities to serve as a control group. Due to technical constraints, some of Turney\u27s interested participants could not connect to the network, creating an additional comparison group. These comparisons suggest two primary findings, (1) changes in using the internet for employment, education, and health could not be directly attributed to the internet intervention, and (2) the internet intervention was associated with benefits stemming from the ability to use multiple devices at once. This study has implications for the design of future broadband evaluation studies, particularly those examining underserved rather than unserved communities. Recommendations for identifying appropriate outcome variables, executing recruitment strategies, and selecting the timing of surveys are made

Trends in U.S. Consumers’ Use of E-Health Services: Fine-Grained Results from a Longitudinal, Demographic Survey

Although growth in U.S. consumers’ overall use of e-health is strong, it is being driven by only a portion of the e-health services that are offered through online health portals. Fine-grained, longitudinal analysis of three representative e-health services shows that, while online communication with medical personnel has grown consistently between 2003 and 2012, the purchase of health supplies online plateaued by 2007, and participation in online support groups has been flat since 2003. Socio-economic factors of income and education level continue to have an impact on consumers’ use of e-health; however, differences based on age, sex, and race/ethnicity are trending lower during this period. The findings caution against the common practice of studying e-health adoption principally at the level of online health portals, which can mask substantial variation in adoption trends among the underlying e-health services, and suggest that it is important to update trend studies on a regular basis to maintain currency

Evaluating barriers to and impacts of rural broadband access

The lack of adequate broadband infrastructure persists in many rural communities. Beyond funding, additional barriers persist, such as digital literacy and community-level self-efficacy. As a result, the first contribution articulates barriers at the organizational level. This work proposes a framework based on the Theory of Planned Behavior to highlight stakeholder dynamics that have constrained Regional Planning Commissions from advancing broadband infrastructure in rural areas. One approach to address these barriers is to provide stakeholders with analytical tools to evaluate the benefits and costs of various broadband options for their community since there is not a one-size-fits-all solution. To this end, there are three contributions that provide guidance for evaluating improved broadband access. The first solution proposes a benefit-cost analysis at the county-level where changes in tax revenue are used to monetize the impact of rural broadband for a hypothetical Midwest county. The second solution demonstrates a method for evaluating the benefit of broadband in terms of social impact on education, employment, and healthcare in a small under-served community in northwest Missouri. Pre- and post-survey data were used to conduct comparisons between the targeted community, which received faster internet, and control communities. The third solution describes a socio-technical reference architecture to support the development of community-driven wireless broadband projects. By providing analytical tools for evaluating the impact of broadband solutions for rural communities, this research increases the capability of local communities to identify and advocate for broadband solutions that fit their needs --Abstract, page iv

Mobile appointment reminders in patient-centered care: Design and evaluation

Reminder systems have great potential to enhance healthcare outcome if it can facilitate collaborative appointment management with accessible mobile communication technology in patient-centered care. Yet, Current appointment reminder systems are effective but not optimal (McLean, et al. 2016). Following the design science process delineated by Peffers et al. (2007) and other requirements, this study proposes a design of reciprocal reminder system that automates the process of appointment rescheduling for healthcare providers and patients in addition to confirmation and cancellation. Based on the premises of media synchronicity theory, media naturalness theory and stakeholder theory as kernel theories, this study develops a design theory that covers platform design, communication design and service design. Design principles of new mobile appointment reminders are proposed to cater to the different requirements of provider and patient users. Situation adaptivity and privacy sensitivity are identified as the major design features that need to strike a balance between different user requirements. An experiment investigates how the variation in design may influence user behavior, and the findings suggest that situation adaptivity and privacy sensitivity have positive effects on users’ system experiences in terms of performance expectancy, effort expectancy and subjective consonance. Further survey results on the final design confirm that the reciprocal reminder system adaptive to patient situations and sensitive to privacy concerns has the expected effects on user behavior

Patient-centered Coordination in Healthcare Service Networks - Measuring and Improving Inter-organizational Information Flow

This thesis investigates the idea of a coordination service that improves the information flow between independent stakeholders along the patient care pathway. Based on identified requirements regarding process, ICT-structure, and legal constraints, a stroke-specific coordination service was developed, validated, implemented, and evaluated. A randomized controlled trial showed improved patients\u27 HRQoL and competences, positive cost-benefit ratio, and acceptance by the involved stakeholders