The use of information in online healthcare provider choice

In order to evaluate and facilitate the provision of health information online, we must first understand how it is perceived by those who use it. Two important considerations in research on patients’ information use in online healthcare provider choice are the need for a conceptual framework for studying information types and methods for studying information use. Therefore, our first contribution lies in using Donabedian's structure-process-outcome model of healthcare quality to identify specific patterns of preference and information use in online healthcare provider choice, and differences in information use between two healthcare provider types. Our second contribution lies in identifying differences in results between data collection methods (importance rating/selection, concurrent self-report of online information use and retrospective information use) in relation to choice tasks. In a mixed-methods design, provider type (primary and secondary care) was systematically varied during participants’ use of the infomediary NHS Choices. Participants preferred process topics over structure topics, in contrast with the results of concurrent and retrospective self-report. We conclude that the differences in results between the types of data collection method reflect underlying differences in choice task. Future research should address the use of novel infomediary user-interfaces, and infomediaries in relation to the use of other information sources and (e-)health literacy

Global and Episodic Bundling: An Overview and Considerations for Medicaid

Examines implementation issues for two payment strategies under which a group of providers receives a single payment per patient for a predefined time period for a predefined set of services and which involve risk adjustment and quality measurement

Communication Strategies to Address Vaccine Hesitancy in Healthcare Settings and on Social Media

Abstract Vaccine hesitancy is now recognized as a threat to global health. Its causes are complex, and it is defined by a resistance to or questioning of immunization. It is important to address vaccine hesitancy directly before people who are hesitant become vaccine refusers or anti-vaccine. Fortunately, with evidence-based information delivered with a compassionate communication style many of those who are hesitant to vaccinate can be persuaded to ultimately vaccinate. This paper aims to explain successful communication strategies used to address vaccine hesitancy in healthcare settings and on social media. Vaccine hesitant parents frequently list their child’s healthcare provider as a trusted source of information on vaccine issues. Research has shown that using presumptive language for vaccine introduction, followed by a compassionate and direct response to any concerns is an effective form of communication with vaccine hesitant parents. This paper teaches the C.A.S.E. Model as a way to formulate that communication. Although many people trust their providers, we cannot ignore the influence of the Internet, specifically social media, as a source of vaccine information for patients and parents. Although there is much pro-vaccine messaging on the Internet, the anti-vaccine messaging is frequently simpler, more emotionally appealing, and easily sharable. Since vaccine hesitant people tend to be silent observers of the vaccine debate online, it is important for pro-vaccine sources to communicate effectively in this arena. We describe our experience and lessons learned with this form of communication through the pro-immunization parent advocacy group, Immunize Texas

Impact of public release of performance data on the behaviour of healthcare consumers and providers.

BACKGROUND: It is becoming increasingly common to publish information about the quality and performance of healthcare organisations and individual professionals. However, we do not know how this information is used, or the extent to which such reporting leads to quality improvement by changing the behaviour of healthcare consumers, providers, and purchasers. OBJECTIVES: To estimate the effects of public release of performance data, from any source, on changing the healthcare utilisation behaviour of healthcare consumers, providers (professionals and organisations), and purchasers of care. In addition, we sought to estimate the effects on healthcare provider performance, patient outcomes, and staff morale. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and two trials registers on 26 June 2017. We checked reference lists of all included studies to identify additional studies. SELECTION CRITERIA: We searched for randomised or non-randomised trials, interrupted time series, and controlled before-after studies of the effects of publicly releasing data regarding any aspect of the performance of healthcare organisations or professionals. Each study had to report at least one main outcome related to selecting or changing care. DATA COLLECTION AND ANALYSIS: Two review authors independently screened studies for eligibility and extracted data. For each study, we extracted data about the target groups (healthcare consumers, healthcare providers, and healthcare purchasers), performance data, main outcomes (choice of healthcare provider, and improvement by means of changes in care), and other outcomes (awareness, attitude, knowledge of performance data, and costs). Given the substantial degree of clinical and methodological heterogeneity between the studies, we presented the findings for each policy in a structured format, but did not undertake a meta-analysis. MAIN RESULTS: We included 12 studies that analysed data from more than 7570 providers (e.g. professionals and organisations), and a further 3,333,386 clinical encounters (e.g. patient referrals, prescriptions). We included four cluster-randomised trials, one cluster-non-randomised trial, six interrupted time series studies, and one controlled before-after study. Eight studies were undertaken in the USA, and one each in Canada, Korea, China, and The Netherlands. Four studies examined the effect of public release of performance data on consumer healthcare choices, and four on improving quality.There was low-certainty evidence that public release of performance data may make little or no difference to long-term healthcare utilisation by healthcare consumers (3 studies; 18,294 insurance plan beneficiaries), or providers (4 studies; 3,000,000 births, and 67 healthcare providers), or to provider performance (1 study; 82 providers). However, there was also low-certainty evidence to suggest that public release of performance data may slightly improve some patient outcomes (5 studies, 315,092 hospitalisations, and 7502 providers). There was low-certainty evidence from a single study to suggest that public release of performance data may have differential effects on disadvantaged populations. There was no evidence about effects on healthcare utilisation decisions by purchasers, or adverse effects. AUTHORS\u27 CONCLUSIONS: The existing evidence base is inadequate to directly inform policy and practice. Further studies should consider whether public release of performance data can improve patient outcomes, as well as healthcare processes

Properties of Healthcare Teaming Networks as a Function of Network Construction Algorithms

Network models of healthcare systems can be used to examine how providers collaborate, communicate, refer patients to each other. Most healthcare service network models have been constructed from patient claims data, using billing claims to link patients with providers. The data sets can be quite large, making standard methods for network construction computationally challenging and thus requiring the use of alternate construction algorithms. While these alternate methods have seen increasing use in generating healthcare networks, there is little to no literature comparing the differences in the structural properties of the generated networks. To address this issue, we compared the properties of healthcare networks constructed using different algorithms and the 2013 Medicare Part B outpatient claims data. Three different algorithms were compared: binning, sliding frame, and trace-route. Unipartite networks linking either providers or healthcare organizations by shared patients were built using each method. We found that each algorithm produced networks with substantially different topological properties. Provider networks adhered to a power law, and organization networks to a power law with exponential cutoff. Censoring networks to exclude edges with less than 11 shared patients, a common de-identification practice for healthcare network data, markedly reduced edge numbers and greatly altered measures of vertex prominence such as the betweenness centrality. We identified patterns in the distance patients travel between network providers, and most strikingly between providers in the Northeast United States and Florida. We conclude that the choice of network construction algorithm is critical for healthcare network analysis, and discuss the implications for selecting the algorithm best suited to the type of analysis to be performed.Comment: With links to comprehensive, high resolution figures and networks via figshare.co

Critical factors affecting consumer acceptance of online health communication: an application of service quality models

The paper examines critical factors affecting consumer behavioral intentions in accepting online health communication through social networking sites. Unlike recent research under this topic, the paper assimilates some components of service quality dimensions and consumer behavior theories. The paper employs factor analysis and structural equation modelling analysis with latent variables to identify critical factors from the survey data collected from Korean consumers. The results of the study identifies three major constructs: consumer needs for health information, the perceived value of tangible attributes of health information providers, and the perceived value of intangible attributes of health information providers. The results show that consumer needs for health information and the tangible and intangible attributes of health information providers should be considered as important antecedents of accepting online health communication through social networking sites. The findings suggest that the success of online health communication via social networking sites largely depends on the tangible and intangible attributes of health information providers

Provider diversity in the NHS: impact on quality and innovation

The overall objective of the research project has been to assess the impact of provider diversity on quality and innovation in the NHS. The specific research aims were to identify the differences in performance between non-profit Third Sector organisations, for-profit private enterprises, and incumbent public sector institutions within the NHS as providers of health care services, as well as the factors that affect the entry and growth of new private and Third Sector providers. The study used both qualitative and quantitative methods based on case studies of four Local Health Economies (LHEs). Qualitative methods included documentary analysis and interviews with key informants and managers of both commissioning and provider organisations. To provide a focus to the study, two tracer conditions were followed: orthopaedic surgery and home health care for frail older people. In the case of hospital inpatient care, data on patient characteristics were also collected from the HES database. The analysis of this data provided preliminary estimates of the effects of provider type on quality, controlling for client characteristics and case mix. In addition, a survey of patient experience in diverse provider organisations was analysed to compare the different dimensions of quality of provision of acute services between incumbent NHS organisations and new independent sector treatment centres. The research has shown that, in respect of inpatient hospital services, diverse providers supply health services of at least as good quality as traditional NHS providers, and that there is ample opportunity to expand their scale and scope as providers of services commissioned by the NHS. The research used patient experience survey data to investigate whether hospital ownership affects the quality of services reported by NHS patients in areas other than clinical quality. The raw survey data appear to show that private hospitals provide higher quality services than the public hospitals. However, further empirical analysis leads to a more nuanced understanding of the performance differences. Firstly, the analysis shows that each sector offers greater quality in certain specialties. Secondly, the analysis shows that differences in the quality of patients’ reported experience are mainly attributable to patient characteristics, the selection of patients into each type of hospital, and the characteristics of individual hospitals, rather than to hospital ownership as such. Controlling for such differences, NHS patients are on average likely to experience a similar quality of care in a public or privately-run hospital. Nevertheless, for specific groups of patients and for specific types of treatments, especially the more straightforward ones, the private sector provides an improved patient experience compared to the public sector. Elsewhere, the NHS continues to provide a high quality service and outperforms the private sector in a range of services and for a range of clients

WHAT NUTRITION INFORMATION ARE DIETITIANS USING WITH THEIR PATIENTS WHO HAVE TYPE 2 DIABETES?

Introduction Dietitians offer specialist evidence-based dietary advice to their patients. Dietary advice for people with type 2 diabetes (T2DM) including written nutrition information (NI) is a key component of the management plan. The aim of the project was to investigate the NI used by dietitians with people with T2DM. Methods An online ad hoc questionnaire exploring whether dietitians produced NI, whether they have had training in the production, any patient involvement in the production, other sources of NIs, factors affecting choice of NIs used and the provision of NIs to other healthcare professionals (HCPs) was developed and pre-piloted. Individual dietitians and departments with dietitians who were working with people with T2DM across England were emailed a link to an online questionnaire. Data were analysed using descriptive statistics and thematic analysis. Ethics approval was obtained from the University of Hertfordshire. Results All 93 respondents used NIs in their consultations. The main sources were a national diabetes charity and a national provider of nutrition information. The main reason given for their use was that the information met the needs of patients. Two thirds of respondents also used NIs produced by their own departments. However almost 40% reported not having any training in the production of NIs and only 10% involved patients in their development. Over 80% of respondents also supplied HCPs with information; nurses and GPs being the main recipients. Conclusions, discussion and/or practical application Dietitians are using evidence-based information and in ensuring HCPs who work with people with T2DM have access to appropriate resources. However their lack of access to training in the development of NIs and in involving patients may limit the effectiveness of resources developed by their own departments. Dietitians could benefit from training in the development of NIs and should be encouraged to involve patients in the development process.Peer reviewe

Patient Choice for Older People in English NHS Primary Care: Theory and Practice

In the English National Health Service (NHS), patients are now expected to choose the time and place of treatment and even choose the actual treatment. However, the theory on which patient choice is based and the implementation of patient choice are controversial. There is evidence to indicate that attitudes and abilities to make choices are relatively sophisticated and not as straightforward as policy developments suggest. In addition, and surprisingly, there is little research on whethermaking individual choices about care is regarded as a priority by the largest NHS patient group and the single largest group for most GPs—older people.This conceptual paper examines the theory of patient choice concerning accessing and engaging with healthcare provision and reviews existing evidence on older people and patient choice in primary care

A healthcare provider perspective in overcoming the psychological and emotional barriers of advance care planning: The need to normalize the conversation

Barriers to advance care planning in the patient population were explored. The need to normalize the conversation was identified. A more attention grabbing pamphlet was designed.https://scholarworks.uvm.edu/fmclerk/1414/thumbnail.jp