2 research outputs found
CHARACTERIZING, ASSESSING AND IMPROVING HEALTHCARE REFERRAL COMMUNICATION
Similar to other health care processes, referrals are susceptible to breakdowns. These breakdowns in the referral process can lead to poor continuity of care, slow diagnostic processes, delays and repetition of tests, patient and provider dissatisfaction, and can lead to a loss of confidence in providers. These facts and the necessity for a deeper understanding of referrals in healthcare served as the motivation to conduct a comprehensive study of referrals.
The research began with the real problem and need to understand referral communication as a mean to improve patient care. Despite previous efforts to explain referrals and the dynamics and interrelations of the variables that influence referrals there is not a common, contemporary, and accepted definition of what a referral is in the health care context. The research agenda was guided by the need to explore referrals as an abstract concept by: 1) developing a conceptual definition of referrals, and 2) developing a model of referrals, to finally propose a 3) comprehensive research framework.
This dissertation has resulted in a standard conceptual definition of referrals and a model of referrals. In addition a mixed-method framework to evaluate referrals was proposed, and finally a data driven model was developed to predict whether a referral would be approved or denied by a specialty service. The three manuscripts included in this dissertation present the basis for studying and assessing referrals using a common framework that should allow an easier comparative research agenda to improve referrals taking into account the context where referrals occur
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Online Health Information Seeking Behaviors of Hispanics in New York City
Hispanics are the fastest-growing minority group in the United States, but they are the most underserved population in terms of access to online health information. The specific aims of this descriptive, correlational study were to examine factors associated with online health information seeking behaviors of Hispanics and to examine the association between online health information seeking behaviors and health behaviors. The study sample (n=4,070) was recruited from five zip codes in the Washington Heights/Inwood community of New York City for the Washington Heights Inwood Informatics Infrastructure for Comparative Effectiveness Research project. Survey data were collected via interview by bilingual community health workers in three settings: a community center affiliated with Columbia University, households and other community settings, and New York-Presbyterian Ambulatory Care Network clinics. Data were analyzed using logistic and linear regressions. In regards to survey respondents' situational, sociodemographic, and literacy factors (health literacy, computer literacy) associated with their online health information seeking behaviors and those of their household members, the study found that that worse health status (OR=0.42, p<0.001), lack of hypertension (OR=0.60, p<0.01), a high level of education (OR=3.04, p<0.001), and computer literacy (OR=3.78, p < 0.001) were positively associated with respondents online health information seeking behaviors. Health literacy was only positively associated (OR=2.13, p<0.001) in a subsample of respondents (n=2,680) in which it was measured by one item related to understanding written health information. Respondents' factors significantly associated with online health information seeking by household members were: female gender (OR=1.60, p<0.01), younger age (OR=0.75, p<0.01), married (OR=1.36, p<0.01), higher education (OR=1.80, p<0.001), higher computer literacy (OR=2.24, p<0.001), in worse health status (OR=0.592, p<0.001), and presence of serious health problems (OR=1.83, p<0.01). Controlling for factors found to be significant in Aim 1, respondents' online health information seeking behaviors were hypothesized to be positively associated with fruit consumption, vegetable consumption, physical activity, and hypertension medication adherence and negatively associated with alcohol consumption. Hypotheses related to fruit consumption (p<0.05), vegetable consumption (p<0.05), and physical activity (p<0.01) were supported. This study contributes to the understanding of Hispanics' online health information seeking behaviors and provides the foundation for informatics and public health interventions