Information in crisis : health & technology-related information behaviors of parents in emergency departments

This research examined the information behavior of parents (including legal guardians) during an emergent health situation with a child. Although many studies examine health-related information behaviors, very few explore health consumers' information practices during moments of health crisis. This study explored parents' information needs, source use, and source preferences during a visit to the emergency department. An online questionnaire was administered using iPads given to 897 parents with children at one of 32 participating general emergency departments (ED) across Canada. Before taking their child to the ED, only 38.8% (n=348) of parents looked for information; those who did search looked most frequently for information about specific symptoms or severity of illness. Prior to visiting the ED the sources most frequently accessed were the internet and direct contact with healthcare professionals. At the emergency department, parents' information needs centred on immediate concerns, including explanations of their child's illness, treatments, and care instructions. Household income, education level, and parents' age were factors that affected information seeking in emergent health situations. Overwhelmingly, speaking to a healthcare professional in person is the typical and preferred way to obtain health information when facing a health crisis involving a child. The results have implications for how and when healthcare information is shared; the findings add to the limited research on parents' information behavior, particularly their roles as information proxies for their children

The Empirical Foundations of Telemedicine Interventions in Primary Care

Introduction: This article presents the scientific evidence for the merits of telemedicine interventions in primary care. Although there is no uniform and consistent definition of primary care, most agree that it occupies a central role in the healthcare system as first contact for patients seeking care, as well as gatekeeper and coordinator of care. It enables and supports patient-centered care, the medical home, managed care, accountable care, and population health. Increasing concerns about sustainability and the anticipated shortages of primary care physicians have sparked interest in exploring the potential of telemedicine in addressing many of the challenges facing primary care in the United States and the world. Materials and Methods: The findings are based on a systematic review of scientific studies published from 2005 through 2015. The initial search yielded 2,308 articles, with 86 meeting the inclusion criteria. Evidence is organized and evaluated according to feasibility/acceptance, intermediate outcomes, health outcomes, and cost. Results: The majority of studies support the feasibility/acceptance of telemedicine for use in primary care, although it varies significantly by demographic variables, such as gender, age, and socioeconomic status, and telemedicine has often been found more acceptable by patients than healthcare providers. Outcomes data are limited but overall suggest that telemedicine interventions are generally at least as effective as traditional care. Cost analyses vary, but telemedicine in primary care is increasingly demonstrated to be cost-effective. Conclusions: Telemedicine has significant potential to address many of the challenges facing primary care in today's healthcare environment. Challenges still remain in validating its impact on clinical outcomes with scientific rigor, as well as in standardizing methods to assess cost, but patient and provider acceptance is increasingly making telemedicine a viable and integral component of primary care around the world.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140293/1/tmj.2016.0045.pd

Washington University Record, March 15, 2002

https://digitalcommons.wustl.edu/record/1926/thumbnail.jp

Telehealthcare for asthma

BACKGROUND: Healthcare systems internationally need to consider new models of care to cater for the increasing numbers of people with asthma. Telehealthcare interventions are increasingly being seen by policymakers as a potential means of delivering asthma care. We defined telehealthcare as being healthcare delivered from a distance, facilitated electronically and involving the exchange of information through the personalised interaction between a healthcare professional using their skills and judgement and the patient providing information. OBJECTIVES: To assess the effectiveness of telehealthcare interventions in people with asthma. SEARCH METHODS: We searched in the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO; this was supplemented by handsearching of respiratory journals. We also searched registers of ongoing and unpublished trials. SELECTION CRITERIA: We selected completed randomised controlled trials of telehealthcare initiatives aiming to improve asthma care. DATA COLLECTION AND ANALYSIS: Two review authors independently appraised studies for inclusion and extracted data and performed meta‐analyses. We analysed dichotomous variables to produce an odds ratio (OR) and continuous variables to produce a mean difference. MAIN RESULTS: We included 21 trials in this review. The 21 included studies investigated a range of technologies aiming to support the provision of care from a distance. These included: telephone (n = 9); video‐conferencing (n = 2); Internet (n = 2); other networked communications (n = 6); text Short Messaging Service (n = 1); or a combination of text and Internet (n = 1). Meta‐analysis showed that these interventions did not result in clinically important improvements in asthma quality of life (minimum clinically important difference = 0.5): mean difference in Juniper's Asthma Quality of Life Questionnaire (AQLQ) 0.08 (95% CI 0.01 to 0.16). Telehealthcare for asthma resulted in a non‐significant increase in the odds of emergency department visits over a 12‐month period: OR 1.16 (95% CI 0.52 to 2.58). There was, however, a significant reduction in hospitalisations over a 12‐month period: OR 0.21 (95% CI 0.07 to 0.61), the effect being most marked in people with more severe asthma managed predominantly in secondary care settings. AUTHORS' CONCLUSIONS: Telehealthcare interventions are unlikely to result in clinically relevant improvements in health outcomes in those with relatively mild asthma, but they may have a role in those with more severe disease who are at high risk of hospital admission. Further trials evaluating the effectiveness and cost‐effectiveness of a range of telehealthcare interventions are needed

Addressing Patients' Social Needs: An Emerging Business Case for Provider Investment

Despite growing evidence documenting the impact of social factors on health, providers have rarely addressed patients' social needs in clinical settings. But today, changes in the health care landscape are catapulting social determinants of health from an academic topic to an on-the-ground reality for providers, with public and private payers holding providers accountable for patients' health and health care costs and linking payments to outcomes. These new models are creating economic incentives for providers to incorporate social interventions into their approach to care. Investing in these interventions can enhance patient satisfaction and loyalty, as well as satisfaction and productivity among providers. A variety of tools for addressing patients' social needs are available to providers looking to leverage these opportunities. With the confluence of sound economics and good policy, investing in interventions that address patients' social as well as clinical needs is starting to make good business sense

A Comparison of the Effects of a Web-Based Education Program about the ICU Environment and a Standard Education Program on Anxiety, Depression, and Acute Stress Experienced Among Family Members of ICU Patients

Family members of ICU patients may experience anxiety, depression, and acute stress disorder symptoms. A need identified by the multi-society task for critical care research was to study the usefulness of interventions to quantify and treat anxiety, depression, and stress symptoms experienced by family members of ICU patients (Deutschman et al., 2012). This task force encouraged investigating using technology to address this need. (Deutschman et al.). The purpose of this prospective, quasi-experimental nonequivalent control group (pretest/posttest) design study was to compare the effect of standard ICU education and a web-based education program about the ICU environment on the level of anxiety, depression, and acute stress disorder symptoms among family members of ICU patients. Participants (n = 127) included 63 enrolled in standard ICU education and 64 in web-based education. This study found family members of ICU patients experienced anxiety, depression, and acute stress disorder symptoms, reinforcing findings of previous studies. This study was unable to conclude if a web-based education program could reduce anxiety F(1, 49) = .60, p = .444 , partial η2 = .01, observed power = .12.; depression F(1, 49) = 1.39, p = .244 , partial η2 = .03, observed power = .21; or acute stress disorder symptoms ASDS F(1, 48) = .65, p = .425 , partial η2 = .01, observed power = .12 IES-R F(1, 48) = .00, p = .988 , partial η2 = .00, observed power = .05 experienced by family members of ICU patients. This study reinforced that family members with lower education levels experienced statistically significantly increased levels of stress compared to family members of ICU patients with higher education levels Λ = .84, F (12, 317.78) = 1.86, p = .039, partial η2 = .06, observed power = .84. Family members of ICU patients who had a prior experience within the past two years were found more likely to experience anxiety, depression, and acute stress symptoms than family members who had not had an ICU experience within the past two years Λ = .92, F [4,122] = 2.70, p = .034, partial η2 = .08, observed power = .74

University of South Alabama College of Medicine Annual Report for 2020-2021

The 2020-21 annual report for the University of South Alabama College of Medicine catalogues the accomplishments of our faculty, staff and students relating to teaching, research, other scholarship and community service. Despite the COVID-19 pandemic continuing its prevalence, the accomplishments are significant.https://jagworks.southalabama.edu/com_report/1005/thumbnail.jp

Toward a Discourse Community for Telemedicine: A Domain Analytic View of Published Scholarship

In the past 20 years, the use of telemedicine has increased, with telemedicine programs increasingly being conducted through the Internet and ISDN technologies. The purpose of this dissertation is to examine the discourse community of telemedicine. This study examined the published literature on telemedicine as it pertains to quality of care, defined as correct diagnosis and treatment (Bynum and Irwin 2011). Content analysis and bibliometrics were conducted on the scholarly discourse, and the most prominent authors and journals were documented to paint and depict the epistemological map of the discourse community of telemedicine. A taxonomy based on grounded research of scholarly literature was developed and validated against other existing taxonomies. Telemedicine has been found to increase the quality and access of health care and decrease health care costs (Heinzelmann, Williams, Lugn and Kvedar 2005 and Wootton and Craig 1999). Patients in rural areas where there is no specialist or patients who find it difficult to get to a doctor’s office benefit from telemedicine. Little research thus far has examined scholarly journals in order to aggregate and analyze the prevalent issues in the discourse community of telemedicine. The purpose of this dissertation is to empiricallydocument the prominent topics and issues in telemedicine by examining the related published scholarly discourse of telemedicine during a snapshot in time. This study contributes to the field of telemedicine by offering a comprehensive taxonomy of the leading authors and journals in telemedicine, and informs clinicians, librarians and other stakeholders, including those who may want to implement telemedicine in their institution, about issues telemedicine

CAPTURING NURSING EFFORT IN THE EMERGENCY DEPARTMENT TO IMPROVE SOCIOECONOMIC EFFECTIVENESS

Objective: This study was undertaken to create and examine a theoretical programmatic framework designed to improve socioeconomic effectiveness in the ED. Methods: At the Johns Hopkins Hospital ED, our study utilized a case study design as its framework. We will then test the theoretical framework of our study through both literal and theoretical replication across multiple EDs to generalize the case studies to theory. That testing will employ a holistic multiple case study design, but is outside the scope of this dissertation. The conceptual framework of the case study involved a program centered on maximizing nursing clinical care effort capture as a method to achieve improvements along three socioeconomic axes that collectively drove organizational effectiveness. The study team – a multidisciplinary assembly of clinical and administrative practitioners, subject matter experts from the ED and the hospital, and key opinion leaders from among the nursing staff – proposed fourteen “programmatic activities” designed to address identified shortcomings in nursing effort capture and to maximize compensated work through enhanced billing practices. These fourteen action items, grouped under three intervention areas, composed the Facility Billing Program that was our programmatic intervention. The activities of this billing program were structured to elicit short- and intermediate-term outcomes hypothesized to produce specific long-term departmental outcomes. This hypothesis was initially tested via a pilot program to improve nursing effort capture and improve revenue generation. The long-term departmental outcomes of the billing program were grouped into eight measures hypothesized to quantify the effect of the intervention. They were then aligned under three outcome constructs. The constructs were Financial Outcomes, Human Capital Outcomes, and Social Outcomes. Each construct represented one of the aforementioned socioeconomic axes along which the ED operated and which collectively drove its organizational effectiveness. As the eight outcome measures improved, we hypothesized the three outcome constructs they represented would also advance, and collectively energize improved socioeconomic effectiveness – the strategic outcome of this performance improvement initiative. Results: In this study, we found that we were unable to demonstrate a relationship between clinical effort capture and workforce outcomes. We found that social outcomes were improved. The study reduced organizational risk by eliminating out-of-date patient charges and enhancing the level of compliance built into our patient billing structure. We found evidence suggesting a positive association between study efforts to capture clinical output and positive financial outcomes. Such was the case in both our outcome measures of interest – revenue and production efficiency. The net programmatic benefit of our effort capture project was $1,198,703 in revenue during FY13. Our program also improved the production efficiency of the nursing workforce. Controlling for observation RVUs, we observed an improvement of$0.73 (p<0.01, 95%CI: $1.26-$0.20) in the marginal product of capital between baseline and intervention timeframes