Ohio Appalachian women's perceptions of the cost of cervical cancer screening

BACKGROUND: Despite evidence of the importance of cervical cancer screening, screening rates in the United States remain below national prevention goals. Women in the Appalachia Ohio region have higher cervical cancer incidence and mortality rates along with lower cancer screening rates. This study explored the expectations of Appalachian Ohio women with regard to Papanicolaou (Pap) test cost and perceptions of cost as a barrier to screening. METHODS: Face-to-face interviews were conducted with 571 women who were part of a multilevel, observational community-based research program in Appalachia Ohio. Eligible women were identified through 14 participating health clinics and asked questions regarding Pap test cost and perceptions of cost as a barrier to screening. Estimates of medical costs were compared with actual costs reported by clinics. RESULTS: When asked about how much a Pap test would cost, 80% of the women reported they did not know. Among women who reportedly believed they knew the cost, 40% overestimated test cost. Women who noted cost as a barrier were twice as likely to not receive a test within screening guidelines as those who did not perceive a cost barrier. Furthermore, uninsured women were more than 8.5 times as likely to note cost as a barrier than women with private insurance. CONCLUSIONS: Although underserved women in need of cancer screening commonly report cost as a barrier, the findings of the current study suggest that women may have a very limited and often inaccurate understanding concerning Pap test cost. Providing women with this information may help reduce the impact of this barrier to screening. Cancer 2010. © 2010 American Cancer Society.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78231/1/25491_ftp.pd

Improving the patient experience through patient portals: Insights from experienced portal users

Background: Patient portals have become part of the ecosystem of care as both patients and providers use them for a range of activities both individually and collaboratively. As patients and providers gain greater experience using portals, their use and needs related to portals may evolve. Objective: This study aimed to learn from experienced patient portal users to improve our understanding of their perspectives on portal use for collaboration and engagement as well as explore how using a portal influenced their experiences with primary care providers. Methods: Qualitative study involving 29 semi-structured interviews with family medicine patients from a large Academic Medical Center (AMC). Interviewees were patients with chronic conditions who had been identified by their providers as experienced portal users. Interview transcripts were analyzed using rigorous qualitative methods. Results: Common themes emerged around both logistical and psychological benefits of portal use. Logistical benefits included increased efficiency, improved ability to track their health information, and better documentation of communications and information during and between office visits. Psychological benefits were a greater sense of collaboration in care, increased trust in providers, and enhanced engagement in health care activities. Conclusion: Experienced portal users discussed ways in which patient portals improved both their ability to manage their care and their relationships with providers. Frequent users described a sense of collaboration with their providers and greater trust in the relationship. These findings suggest that portal use may be a mechanism through which patients can increase patient engagement and improve the patient experience

Why do they do that?: Looking beyond typical reasons for non-urgent ED use among Medicaid patients

Barriers to accessing primary care, including lack of transportation and inadequate appointment times, are common reasons for non-urgent emergency department (ED) use yet even when these barriers are addressed, the problem persists. This study explored non-urgent ED use by Medicaid enrollees through interviews with patients and providers and sought to identify themes beyond the commonly mentioned logistical and access issues. Qualitative interviews with 23 Medicaid enrollees and 31 PCP and ED providers utilizing a semi-structured interview guide focused on reasons for seeking care in the ED and issues associated with PCP appointments. We identified overlap as well as surprising differences in themes identified by providers and by patients. Providers identified cultural and educational issues including that many Medicaid patients had grown up using the ED as their main source of care and lacked awareness of other sources healthcare. Patients did not mention educational and cultural factors directly, but discussed a concern that their condition was too serious for the PCP, or that the ED provided more comprehensive services. Both patients and providers raised neglected concepts, particularly those related to understanding primary care compared to emergency care. These results highlight the importance of addressing multiple paths toward more appropriate ED use, including barriers beyond logistical and access-related concerns. Considering the patient’s perception of the situation, as well as identifying opportunities to improve patients’ understanding of where to seek care may help to create interventions with broader impact than those that address access and logistical barriers alone

Why providers participate in clinical trials: Considering the National Cancer Institute's Community Clinical Oncology Program

The translation of research evidence into practice is facilitated by clinical trials such as those sponsored by the National Cancer Institute’s Community Clinical Oncology Program (CCOP) that help disseminate cancer care innovations to community-based physicians and provider organizations. However, CCOP participation involves unsubsidized costs and organizational challenges that raise concerns about sustained provider participation in clinical trials

Increasing Capacity for Evaluation of Community-Based Organizations: Lessons from the Ohio Equity Institute

Background: Community-based organizations (CBOs) play an important role delivering disease prevention and health promotion activities to address community health needs and improve the health of individuals living in their communities. While CBOs play this important role, evaluation of the services they deliver is hampered by limited infrastructure to systematically collect data from these organizations. To address this gap, we report on a case study of the development of the Ohio Equity Institute (OEI) Data Portal. The OEI is a statewide initiative that supports 65 CBOs across Ohio to deliver 3 evidence-based interventions (ie, CenteringPregnancy, Community Health Workers, and Home Visiting) to address infant mortality in underserved populations. Methods: Employing principles of community-engaged stakeholder research and user-centered design, we conducted Plan-Do-Study-Act cycles, including semistructured interviews with 43 key informants, to improve the development, implementation, and use of the OEI Data Portal. Results: This process identified both technical and implementation challenges, and offered opportunities to make improvements to the data collection system itself as well as to the integration of this system with CBO workflows. These improvements yielded significant gains in terms of the quantity and quality of data submission, ultimately contributing to ongoing outcome evaluation efforts. Conclusion: Our findings provide important insight into the challenges experienced by CBOs when participating in a statewide CBO data evaluation infrastructure development and implementation. As Ohio and other states push to expand collaborations between CBOs and health care organizations, leaders should leverage existing data collection to facilitate a more comprehensive and effective process

Racial disparities in clinically significant prostate cancer treatment: The potential health information technology offers

Copyright © 2018 American Society of Clinical Oncology. All rights reserved. Black men are more likely to die as a result of prostate cancer than white men, despite effective treatments that improve survival for clinically significant prostate cancer. We undertook this study to identify gaps in prostate cancer care quality, racial disparities in care, and underlying reasons for poorer quality care. Methods We identified all black men and random age-matched white men with Gleason scores $ 7 diagnosed between 2006 and 2013 at two urban hospitals to determine rates of treatment underuse. Underuse was defined as not receiving primary surgery, cryotherapy, or radiotherapy. We then interviewed treating physicians about the reasons for underuse. Results Of 359 black and 282 white men, only 25 (4%) experienced treatment underuse, and 23 (92%) of these were black. Most (78%) cases of underuse were due to system failures, where treatment was recommended but not received; 38% of these men continued receiving care at the hospitals. All men with treatment underuse due to system failures were black. Conclusion Treatment rates of prostate cancer are high. Yet, racial disparities in rates and causes of underuse remain. Only black men experienced system failures, a type of underuse amenable to health information technology-based solutions. Institutions are missing opportunities to use their health information technology capabilities to reduce disparities in cancer care

Smartphone and medical related App use among medical students and junior doctors in the United Kingdom (UK): a regional survey

Background: Smartphone usage has spread to many settings including that of healthcare with numerous potential and realised benefits. The ability to download custom-built software applications (apps) has created a new wealth of clinical resources available to healthcare staff, providing evidence-based decisional tools to reduce medical errors. Previous literature has examined how smartphones can be utilised by both medical student and doctor populations, to enhance educational and workplace activities, with the potential to improve overall patient care. However, this literature has not examined smartphone acceptance and patterns of medical app usage within the student and junior doctor populations. Methods: An online survey of medical student and foundation level junior doctor cohorts was undertaken within one United Kingdom healthcare region. Participants were asked whether they owned a Smartphone and if they used apps on their Smartphones to support their education and practice activities. Frequency of use and type of app used was also investigated. Open response questions explored participants’ views on apps that were desired or recommended and the characteristics of apps that were useful. Results: 257 medical students and 131 junior doctors responded, equating to a response rate of 15.0% and 21.8% respectively. 79.0% (n=203/257) of medical students and 74.8% (n=98/131) of junior doctors owned a smartphone, with 56.6% (n=115/203) of students and 68.4% (n=67/98) of doctors owning an iPhone. The majority of students and doctors owned 1–5 medical related applications, with very few owning more than 10, and iPhone owners significantly more likely to own apps (Chi sq, p<0.001). Both populations showed similar trends of app usage of several times a day. Over 24hours apps were used for between 1–30 minutes for students and 1–20 minutes for doctors, students used disease diagnosis/management and drug reference apps, with doctors favouring clinical score/calculator apps. Conclusions: This study found a high level of smartphone ownership and usage among medical students and junior doctors. Both groups endorse the development of more apps to support their education and clinical practice

Personal digital assistants: Essential tools for preparing dietetics professionals to use new generation information technology

Rapid integration of information technology into health care systems has included the use of highly portable systems-in particular, personal digital assistants (PDAs). With their large built-in memories, fast processors, wireless connectivity, multimedia capacity, and large library of applications, PDAs have been widely adopted by physicians and nurses for patient tracking, disease management, medical references and drug information, enhancing a quality of health care. Many health-related PDA applications are available to both dietetics professionals and clients. Dietetics professionals can effectively use PDAs for client tracking and support, accessing to hospital database or information, and providing better self-monitoring tools to clients. Internship programs for dietetics professionals should include training in the use of PDAs and their dietetics applications, so that new practitioners can stay abreast of this rapidly evolving technology. Several considerations to keep in mind in selecting a PDA and its applications are discussed

The business case for provider participation in clinical trials research: An application to the National Cancer Institute’s community clinical oncology program

Provider-based research networks (PBRNs) make clinical trials available in community-based practice settings, where most people receive their care, but provider participation requires both financial and in-kind contributions

Impact of electronic health record implementation on patient flow metrics in a pediatric emergency department

Implementing electronic health records (EHR) in healthcare settings incurs challenges, none more important than maintaining efficiency and safety during rollout. This report quantifies the impact of offloading low-acuity visits to an alternative care site from the emergency department (ED) during EHR implementation. In addition, the report evaluated the effect of EHR implementation on overall patient length of stay (LOS), time to medical provider, and provider productivity during implementation of the EHR. Overall LOS and time to doctor increased during EHR implementation. On average, admitted patients' LOS was 6–20% longer. For discharged patients, LOS was 12–22% longer. Attempts to reduce patient volumes by diverting patients to another clinic were not effective in minimizing delays in care during this EHR implementation. Delays in ED throughput during EHR implementation are real and significant despite additional providers in the ED, and in this setting resolved by 3 months post-implementation