What is the best model for managing health care surge for COVID patients?

The 2019 coronavirus disease (COVID-19) is projected to infect a substantial proportion of Hoosiers. Experts are forecasting the number of individuals who will become infected over time and the subset of those that will require hospitalization. Given the COVID-19 experience in other countries, many of those hospitalized will require intensive care services including mechanical ventilation. Demand for all U.S. hospital services is projected, by many computer models, to outpace supply. In preparation for this surge, the current brief report explores issues associated with approaches that could facilitate the expansion of acute care and intensive care capacity within Indiana

Environmental market factors associated with electronic health record adoption among cancer hospitals

Background: Although recent literature has explored the relationship between various environmental market characteristics and the adoption of electronic health records (EHRs) among general, acute care hospitals, no such research currently exists for specialty hospitals, including those providing cancer care. Purpose: The aim of the study was to examine the relationship between market characteristics and the adoption of EHRs among Commission on Cancer (CoC)-accredited hospitals. Methods/Approach: Secondary data on EHR adoption combined with hospital and environmental market characteristics were analyzed using logistic regression. Using the resource dependence theory, we examined how measures of munificence, complexity, and dynamism are related to the adoption of EHRs among CoC-accredited hospitals and, separately, hospitals not CoC-accredited. Findings: In a sample of 2,670 hospitals, 141 (0.05%) were academic-based CoC-accredited hospitals and 562 (21%) were community-based CoC-accredited hospitals. Measures of munificence such as cancer incidence rates (OR = 0.99, CI [0.99, 1.00], p = .020) and percentage population aged 65+ (OR = 0.99, CI [0.99, 1.00], p = .001) were negatively associated with basic EHR adoption, whereas urban location was positively associated with comprehensive EHR adoption (OR = 3.07, CI [0.89, 10.61], p = .076) for community-based CoC-accredited hospitals. Measures of complexity such as hospitals in areas with less competition were less likely to adopt a basic EHR (OR = 0.33, CI [0.19, 0.96], p = .005), whereas Medicare Managed Care penetration was positively associated with comprehensive EHR adoption (OR = 1.02, CI [1.00, 1.05], p = .070) among community-based CoC-accredited hospitals. Lastly, dynamism, measured as population change, was negatively associated with the adoption of comprehensive EHRs (OR = 0.99, CI [0.99, 1.00], p = .070) among academic-based CoC-accredited hospitals. Practice implications: A greater understanding of the environment’s relationship to health information technology adoption in cancer hospitals will help stakeholders in these institutions make informed strategic decisions about information technology investments guided by their facilities’ respective environmental factors. The results of this study may also be useful to hospital chief information officers and chief executive officers seeking to either improve their quality of care or achieve and maintain accreditation in providing cancer care

A population ecology perspective on the functioning and future of health information organizations

Background: Increasingly, health care providers need to exchange information to meet policy expectations and business needs. A variety of health information organizations (HIOs) provide services to facilitate health information exchange (HIE). However, the future of these organizations is unclear. Purpose: The aim of this study was to explore the environmental context, potential futures, and survivability of community HIOs, enterprise HIEs, and electronic health record vendor-mediated exchange using the population ecology theory. Approach: Qualitative interviews with 33 key informants representing each type of HIE organization were analyzed using template analysis. Results: Community HIOs, enterprise HIEs, and electronic health record vendors exhibited a high degree of competition for resources, especially in the area of exchange infrastructure services. Competition resulted in closures in some areas. In response to environmental pressures, each organizational type was endeavoring to differentiate its services and unique use case, as well as pursing symbiotic relationships or attempting resource partitioning. Conclusion: HIOs compete for similar resources and are reacting to environmental pressures to better position themselves for continued survival and success. Our ecological research perspective helps move the discourse away from situation of a single exchange organization type toward a view of the broader dynamics and relationships of all organizations involved in facilitating HIE activities

Barriers to ambulatory EHR: who are 'imminent adopters' and how do they differ from other physicians?

Objective Despite existing knowledge regarding electronic health record (EHR) barriers in the ambulatory setting, little is known, specifically, about physicians who are likely to adopt EHR imminently. The current study identifies these imminent adopters and compares their barriers to other physicians. Design and measurements Mail survey of Florida physicians (n=14 921) about barriers to EHR and adoption intentions. The survey asked respondents to classify themselves as planning to adopt an EHR system within one year (herein referred to as 'imminent adopters'), as planning to adopt an EHR systembut not within one year ('interested adopters'), and as not considering an EHR system. Chi-square analysis and logistic regression models were used to identify trends among imminent adopters and to compare barriers among respondents in each of the adoption categories above. Results A total of 4203 returned surveys represented a 28.2% response rate. Imminent adopters were significantly less likely to be in solo practice (19.6% vs. 40.0%, P<0.001) and more likely to be in an urban area (P=0.044) or in a multi-specialty practice (P=0.023). Imminent adopters were also more likely to be practising family medicine (P=0.014) or obstetrics/gyn_cology (P=0.038). When comparedwith their colleagues, imminent adopters perceived EHR barriers very differently. For example, imminent adopters were significantly less likely to consider upfront cost of hardware/software [OR=0.35 (0.30, 0.45)] or that an inadequate return on investment [OR=0.25 (0.19, 0.34)] was a major barrier to EHR. Moreover, imminent adopters differed from their colleagues with respect to numerous other productivity-related and technical-related barriers. Conclusion Policy and decision makers interested in promoting the adoption of EHR among physicians should focus on the needs and barriers of those most likely to adopt EHR. Given that imminent adopters differ considerably from their peers, current EHR incentive programmes that focus on financial barriers only might prove sub-optimal in achieving immediate widespread EHR adoption

Using Web-Based Search Data to Study the Public’s Reactions to Societal Events: The Case of the Sandy Hook Shooting

Background: Internet search is the most common activity on the World Wide Web and generates a vast amount of user-reported data regarding their information-seeking preferences and behavior. Although this data has been successfully used to examine outbreaks, health care utilization, and outcomes related to quality of care, its value in informing public health policy remains unclear. Objective: The aim of this study was to evaluate the role of Internet search query data in health policy development. To do so, we studied the public’s reaction to a major societal event in the context of the 2012 Sandy Hook School shooting incident. Methods: Query data from the Yahoo! search engine regarding firearm-related searches was analyzed to examine changes in user-selected search terms and subsequent websites visited for a period of 14 days before and after the shooting incident. Results: A total of 5,653,588 firearm-related search queries were analyzed. In the after period, queries increased for search terms related to “guns” (+50.06%), “shooting incident” (+333.71%), “ammunition” (+155.14%), and “gun-related laws” (+535.47%). The highest increase (+1054.37%) in Web traffic was seen by news websites following “shooting incident” queries whereas searches for “guns” (+61.02%) and “ammunition” (+173.15%) resulted in notable increases in visits to retail websites. Firearm-related queries generally returned to baseline levels after approximately 10 days. Conclusions: Search engine queries present a viable infodemiology metric on public reactions and subsequent behaviors to major societal events and could be used by policymakers to inform policy development. [JMIR Public Health Surveill 2017;3(1):e12

The Relationship between External Environment and Physician E-mail Communication: The Mediating Role of Health Information Technology (HIT) Availability

Background: Physician e-mail communication, with patients and other providers, is one of the cornerstones of effective care coordination but varies significantly across physicians. A physician's external environment may contribute to such variations by enabling or constraining a physician's ability to adopt innovations such as health information technology (HIT) that can be used to support e-mail communication. Purpose: The aim of the study was to examine whether the relationship of the external environment and physician e-mail communication with patients and other providers is mediated by the practice's HIT availability. Methodology: The data were obtained from the Health Tracking Physician Survey (2008) and the Area Resource File (2008). Cross-sectional multivariable subgroup path analysis was used to investigate the mediating role of HIT availability across 2,850 U.S. physicians. Findings: Solo physicians' perceptions about malpractice were associated with 0.97 lower odds (p < .05) of e-mail communication with patients and other providers, as compared to group and hospital practices, even when mediated by HIT availability. Subgroup analyses indicated that different types of practices are responsive to the different dimensions of the external environment. Specifically, solo practitioners were more responsive to the availability of resources in their environment, with per capita income associated with lower likelihood of physician e-mail communication (OR = 0.99, p < .01). In contrast, physicians working in the group practices were more responsive to the complexity of their environment, with a physician's perception of practicing in environments with higher malpractice risks associated with greater information technology availability, which in turn was associated with a greater likelihood of communicating via e-mail with patients (OR = 1.02, p < .05) and other physicians (OR = 1.03, p < .001). Practical Applications: The association between physician e-mail communication and the external environment is mediated by the practice's HIT availability. Efforts to improve physician e-mail communication and HIT adoption may need to reflect the varied perceptions of different types of practices

Using Bibliometric Big Data to Analyze Faculty Research Productivity in Health Policy and Management

Bibliometric big data and social media tools provide new opportunities to aggregate and analyze researchers' scholarly impact. The purpose of the current paper is to describe the process and results we obtained after aggregating a list of public Google Scholar profiles representing researchers in Health Policy and Management or closely-related disciplines. We extracted publication and citation data on 191 researchers affiliated with health administration programs in the U.S. With these data, we created a publicly available listing of faculty that includes each person's name, affiliation, year of first citation, total citations, h-index, and i-10 index. The median of total citations per individual faculty member was 700, while the maximum was 46,363. The median h-index was 13, while the maximum was 91. We plan to update these statistics and add new faculty to our public listing as new Google Scholar profiles are created by faculty members in the field. This listing provides a resource for students and faculty in our discipline to easily compare productivity and publication records of faculty members in their own and other departments. Similarly, this listing provides a resource for faculty, including department chairs and deans, who desire discipline-specific context for promotion and tenure processes

Interdisciplinary Dissertation Research Among Public Health Doctoral Trainees, 2003-2015

Given the call for more interdisciplinary research in public health, the objectives of this study were to (1) examine the correlates of interdisciplinary dissertation completion and (2) identify secondary fields most common among interdisciplinary public health graduates. METHODS: We analyzed pooled cross-sectional data from 11 120 doctoral graduates in the Survey of Earned Doctorates, 2003-2015. The primary outcome was interdisciplinary dissertation completion. Covariates included primary public health field, sociodemographic characteristics, and institutional attributes. RESULTS: From 2003 to 2015, a total of 4005 of 11 120 (36.0%) doctoral graduates in public health reported interdisciplinary dissertations, with significant increases observed in recent years. Compared with general public health graduates, graduates of environmental health (odds ratio [OR] = 1.74; P < .001) and health services administration (OR = 1.38; P < .001) doctoral programs were significantly more likely to report completing interdisciplinary dissertation work, whereas graduates from biostatistics (OR = 0.51; P < .001) and epidemiology (OR = 0.76; P < .001) were less likely to do so. Completing an interdisciplinary dissertation was associated with being male, a non-US citizen, a graduate of a private institution, and a graduate of an institution with high but not the highest level of research activity. Many secondary dissertation fields reported by interdisciplinary graduates included other public health fields. CONCLUSION: Although interdisciplinary dissertation research among doctoral graduates in public health has increased in recent years, such work is bounded in certain fields of public health and certain types of graduates and institutions. Academic administrators and other stakeholders may use these results to inform greater interdisciplinary activity during doctoral training and to evaluate current and future collaborations across departments or schools

What can we learn about SARS-CoV-2 prevalence from testing and hospital data?

Measuring the prevalence of active SARS-CoV-2 infections is difficult because tests are conducted on a small and non-random segment of the population. But people admitted to the hospital for non-COVID reasons are tested at very high rates, even though they do not appear to be at elevated risk of infection. This sub-population may provide valuable evidence on prevalence in the general population. We estimate upper and lower bounds on the prevalence of the virus in the general population and the population of non-COVID hospital patients under weak assumptions on who gets tested, using Indiana data on hospital inpatient records linked to SARS-CoV-2 virological tests. The non-COVID hospital population is tested fifty times as often as the general population. By mid-June, we estimate that prevalence was between 0.01 and 4.1 percent in the general population and between 0.6 to 2.6 percent in the non-COVID hospital population. We provide and test conditions under which this non-COVID hospitalization bound is valid for the general population. The combination of clinical testing data and hospital records may contain much more information about the state of the epidemic than has been previously appreciated. The bounds we calculate for Indiana could be constructed at relatively low cost in many other states

Not only teachers: What do health administration faculty members do?

Researchers have long been interested in how university faculty allocate their time between professional tasks. This study uses multiple years of Health Administration (HA) faculty survey data to examine how work activity has changed over time, and how work activity relates to faculty rank and the type of school in which a faculty member is employed. We report on faculty time allocation to research, teaching, and administration by survey year, faculty rank, and type of school. We also examine factors related to faculty's status as a principal investigator, teaching load, and research funding. On average, HA faculty spent 43% of their time teaching, 31% doing research, 20% in administrative activities, and 5% in other activities. Full professors spent significantly less time teaching, had lighter teaching loads, and spent more time on administration than other faculty. Faculty in schools of health professions, business, and other schools spent more time in teaching and had lower research funding expectations than faculty in schools of public health and medicine. These findings may help faculty identify jobs that best align with their interests and benchmark their work against industry norms. These findings may also help administrators in HA programs set appropriate expectations for their faculty