%0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e66978 %T Primary Tumors of the Brain and Central Nervous System in Adults and Children in Sub-Saharan Africa: Protocol for a Scoping Review %A Al-Fikri,Alhasan Ahmed Badeea %A Alhammadi,Mesk %A Arum,Chiedozie %A Kaur,Mahima %A Del Biondo,Kayla %A Bani,Ibrahim %A Mudenda,Victor %A Vermund,Sten H %+ College of Medicine, Ajman University, University Street, Al jerf 1 - Ajman, Ajman, PO Box 346, United Arab Emirates, 971 566707022, alhasanfikri@gmail.com %K tumor %K cancer %K brain %K central nervous system %K Africa %K adults %K children %K scoping review %K PRISMA %D 2025 %7 24.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: In Sub-Saharan Africa (SSA), clinical and research investments for oncology screening, diagnosis, and therapy are exceedingly modest, compared to those in higher-income regions. Diseases that are difficult to prevent or treat, such as primary brain and central nervous system (CNS) tumors, are especially challenging in low-resource settings. Objective: In order to review and synthesize existing evidence to identify research and service gaps, we will conduct a scoping review to assess epidemiological data, clinical series, and health outcomes associated with brain and CNS tumors in SSA. Methods: This scoping review is guided by the Scoping Review Chapter of the JBI (Joanna Briggs Institute) Manual for Evidence Synthesis. We will search the following databases: Ovid MEDLINE, Embase, Cochrane Library, Scopus, references from salient publications, and the gray literature, the latter focused on the International Agency for Research on Cancer (IARC) and other major global health organizations. We will review titles and abstracts of potentially eligible studies and then full texts by 2 independent reviewers. We will include data from both primary and CNS cancers in persons of all ages. Data will be abstracted independently using piloted data extraction forms, and we will present results according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols) guidelines. Results: A total of 2857 articles were identified through our search strategy. After title and abstract screening, which was completed on February 23, 2025, by 2 independent reviewers, 222 studies met the eligibility criteria, while 2203 were excluded. Full-text screening began on March 3, 2025, and will be followed by data abstraction and analysis from April 15, 2025, until the end of May 2025. The study is expected to be completed by July 2025. Conclusions: SSA faces substantial challenges in the diagnosis and treatment of CNS tumors due to health care infrastructure limitations, insufficient reporting, and diagnostic supply shortages. The high fatality rates are attributed to underdiagnosis and misdiagnosis as infectious diseases, despite low incidence rates (IRs). The inadequate neurosurgery facilities and pathology resources further complicate the treatment and prognosis. A scoping review will investigate the true burden of underdiagnosis and gaps in outcomes in children and adults in SSA. Trial Registration: OSF Registries osf.io/57zvc; https://osf.io/57zvc International Registered Report Identifier (IRRID): PRR1-10.2196/66978 %M 40273436 %R 10.2196/66978 %U https://www.researchprotocols.org/2025/1/e66978 %U https://doi.org/10.2196/66978 %U http://www.ncbi.nlm.nih.gov/pubmed/40273436 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63933 %T Efficacy And Safety of Acupoint Catgut Embedding for Perennial Allergic Rhinitis: Protocol for a Randomized Clinical Trial %A Cai,Zijie %A Meng,ChunXue %A Wang,Fei %A Tang,ChunZhi %A Zhang,Jing %A Zhang,Qian %A Guo,Bin %+ Ningxia Medical University, Yinchuan City, Ningxia Hui Autonomous Region, 750004, China, 86 18435158810, Guo12200055@163.com %K acupoint thread embedding %K catgut embedding %K allergic rhinitis %K loratadine %D 2025 %7 21.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Allergic rhinitis (AR) is a noninfectious chronic inflammatory disease of the nasal mucosa characterized mainly by itching, sneezing, nasal congestion, and rhinorrhea. It is mediated by immunoglobulin E (IgE). AR is one of the most common allergic diseases globally, affecting 10% to 20% of the population worldwide, with some regions even reaching rates as high as 50%, posing a global health issue. The prevalence of AR has been increasing since the 1960s, with a significant increase in recent years. At present, modern medicine—including desensitization therapy, the use of antiallergic drugs, antihistamines, hormones, and other treatments—can improve symptoms or regulate the immune system. However, both short- and long-term efficacy remain limited, as symptoms often recur after treatment cessation, and long-term drug use is associated with toxicity and side effects. Objective: Acupoint catgut embedding (ACE) therapy is widely used to treat AR in China. ACE therapy has been reported to be effective in managing the symptoms of AR, but the evidence faces methodological limitations. Therefore, we designed a parallel-arm, randomized controlled, multicentered, placebo-controlled, and single-blinded trial to evaluate the efficacy and safety of ACE therapy for AR. Methods: This study will be a parallel-group, patient-blind, placebo-controlled randomized controlled trial conducted in the Third Affiliated Hospital of Sun Yat-sen University, Ningxia Chinese Medicine Research Center, and the Affiliated Hospital of Shanxi University of Traditional Chinese Medicine. The trial consists of a 4-week treatment period, along with a 3-month follow-up. After providing written informed consent, eligible participants will be randomized at a ratio of 1: 1 into one of 2 groups: the ACE group receiving treatment and the sham ACE group. Both groups will receive conventional loratadine treatment. Results: The funding began in January 2022. The study was initiated on February 1, 2025, and will end in February 2026. Patient recruitment has already started, and the study results will be released in March 2026. Conclusions: We expect that this research will provide important insights into the efficacy of ACE treatment for AR and generate robust data for the foundation of future research in this field. Trial Registration: Chinese Clinical Trial Registry ChiCTR2500095634; https://www.chictr.org.cn/historyversionpubEN.html?regno=ChiCTR2500095634 International Registered Report Identifier (IRRID): PRR1-10.2196/63933 %M 40258268 %R 10.2196/63933 %U https://www.researchprotocols.org/2025/1/e63933 %U https://doi.org/10.2196/63933 %U http://www.ncbi.nlm.nih.gov/pubmed/40258268 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e55348 %T Subtyping Service Receipt in Personality Disorder Services in South London: Observational Validation Study Using Latent Profile Analysis %A Steadman,Jack %A Saunders,Rob %A Freestone,Mark %A Stewart,Robert %+ Unit for Psychological Medicine, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, United Kingdom, 44 7404042057, jack.steadman1@nhs.net %K latent profile analysis %K latent variable mixture modeling %K service use %K personality disorder %K applied health research %K electronic health records %D 2025 %7 15.4.2025 %9 Original Paper %J Interact J Med Res %G English %X Background: Personality disorders (PDs) are typically associated with higher mental health service use; however, individual patterns of engagement among patients with complex needs are poorly understood. Objective: The study aimed to identify subgroups of individuals based on patterns of service receipt in secondary mental health services and examine how routinely collected information is associated with these subgroups. Methods: A sample of 3941 patients diagnosed with a personality disorder and receiving care from secondary services in South London was identified using health care records covering an 11-year period from 2007 to 2018. Basic demographic information, service use, and treatment data were included in the analysis. Service use measures included the number of contacts with clinical teams and instances of did-not-attend. Results: Using a large sample of 3941 patients with a diagnosis of PD, latent profile analysis identified 2 subgroups characterized by low and high service receipt, denoted as profile 1 (n=2879, 73.05%) and profile 2 (n=1062, 26.95%), respectively. A 2-profile solution (P<.01) was preferred over a 3-profile solution, which was nonsignificant. In unconditional (t3941,3939=19.53; P<.001; B=7.27; 95% CI 6.54-8) and conditional (t3941,3937=−3.31; P<.001; B=−74.94; 95% CI −119.34 to −30.56) models, cluster membership was significantly related to receipt of nursing contacts, over and above other team contacts. Conclusions: These results suggest that routinely collected data may be used to classify likely engagement subtypes among patients with complex needs. The algorithm identified factors associated with service use and has the potential to inform clinical decision-making to improve treatment for individuals with complex needs. %M 40233345 %R 10.2196/55348 %U https://www.i-jmr.org/2025/1/e55348 %U https://doi.org/10.2196/55348 %U http://www.ncbi.nlm.nih.gov/pubmed/40233345 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e69829 %T Methadone Patient Access to Collaborative Treatment: Protocol for a Pilot and a Randomized Controlled Trial to Establish Feasibility of Adoption and Impact on Methadone Treatment Delivery and Patient Outcomes %A Meyerson,Beth E %A Davis,Alissa %A Crosby,Richard A %A Linde-Krieger,Linnea B %A Brady,Benjamin R %A Carter,Gregory A %A Mahoney,Arlene N %A Frank,David %A Rothers,Janet %A Coffee,Zhanette %A Deuble,Elana %A Ebert,Jonathon %A Jablonsky,Mary F %A Juarez,Marlena %A Lee,Barbara %A Lorenz,Heather M %A Pava,Michael D %A Tinsely,Kristen %A Yousaf,Sana %+ Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, 655 N Alvernon Way, Tucson, AZ, 85711, United States, 1 520 626 0275, bmeyerson@arizona.edu %K methadone %K implementation %K patient-centered treatment %K opioid use disorder %K posttraumatic stress symptoms %K vicarious trauma %D 2025 %7 15.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Access to methadone treatment can reduce opioid overdose death by up to 60%, but US patient outcomes are suboptimal. Federally allowed methadone treatment accommodations during the COVID-19 public health emergency were not widely adopted. It is likely that staff-level characteristics such as trauma symptoms influence the adoption of treatment innovation. Objective: Methadone Patient Access to Collaborative Treatment (MPACT) is a 2-phased project (pilot and field trial) to develop and test a staff-level, multimodal intervention to increase staff adoption of low-barrier, patient-centered methadone treatment practices and ultimately improve treatment retention and patient outcomes. Methods: A pilot and national trial will measure implementation feasibility, acceptability, and effects of the MPACT intervention on treatment practice change, clinic culture, patient retention, and patient posttraumatic stress symptoms (PTSS). The pilot will be a single-arm 5.5-month pilot study of MPACT conducted in 2 Arizona methadone treatment clinics (rural and urban) among 100 patients and 22 staff. The national trial will be a 20-month cluster randomized trial conducted among 30 clinics, 600 patients (20 per clinic), and 480 staff (18 per clinic). Data will be gathered by staff and patient surveys and patient chart review. The primary study outcome is increased patient methadone treatment retention measured as (1) time to first treatment interruption from study enrollment; (2) active in treatment at enrollment, day 30, 60, 90, and 120; and (3) continuous days in treatment during the study period. Secondary study outcomes include reductions in vicarious trauma and PTSS among enrolled opioid treatment program staff and PTSS among enrolled patients. Results: The pilot study was funded by the National Institute on Drug Abuse (award R61DA059889, funded September 2023), and the field trial will be funded under the associated R33 mechanism in September 2025. The pilot study was completed in March 2025. The randomized controlled trial will begin in December 2025. Both the pilot and trial have been approved by the University of Arizona Human Subjects Protection Program and have been registered with the clinical trials network. Conclusions: The MPACT study will provide a foundation for an evidence-based, staff-level intervention aimed at improving patient retention in methadone treatment. Future studies should examine the individual components of MPACT to determine their differential contributions to the primary outcome of patient methadone treatment retention and to secondary outcomes of staff and patient reduction in stress symptoms. Trial Registration: ClinicalTrials.gov NCT06513728; https://clinicaltrials.gov/study/NCT06513728 and ClinicalTrials.gov NCT06556602; https://clinicaltrials.gov/study/NCT06556602 International Registered Report Identifier (IRRID): DERR1-10.2196/69829 %M 40105313 %R 10.2196/69829 %U https://www.researchprotocols.org/2025/1/e69829 %U https://doi.org/10.2196/69829 %U http://www.ncbi.nlm.nih.gov/pubmed/40105313 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e66579 %T Feasibility of a Progesterone-Modified Natural Protocol for Frozen Embryo Transfer: Protocol for a Pilot Cohort Study %A Churchill,Alexandra %A Georgiou,Ektoras %A Abruzzo,Veronica %A Polyakov,Alex %A Teh,Wan Tinn %+ Reproductive Services Unit, The Royal Women's Hospital, 20 Flemington Rd, Parkville, Melbourne, VIC 3050, Australia, 61 (03) 8345 2000, Wan.Teh@thewomens.org.au %K frozen embryo transfer %K fertility care %K reproductive health %K infertility %K progesterone-modified natural cycle protocol %K in vitro fertilization %D 2025 %7 11.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: With the existence of various frozen embryo transfer (FET) methods currently used in the field of assisted reproductive technologies, the debate surrounding which of these is superior remains. All FET protocols aim to prime the endometrium and time embryo transfer during the window of implantation. Current methods include the true natural cycle FET (tNFET), modified natural cycle FET, artificial cycle FET, and ovulation induction. Each of these harbors, distinct advantages and disadvantages, namely, surrounding the timing of transfer and flexibility conferred through this process. More recently, a newer approach has been used whereby the need to monitor or trigger ovulation is circumvented, with luteal phase support commenced once a certain follicle diameter and endometrial thickness criteria are met but before ovulation. However, the research into this protocol has certain important limitations that our study seeks to address. Objective: This study aims to assess the feasibility of a progesterone-modified natural cycle protocol for FET. The primary outcome will be the presence of a corpus luteum on ultrasound scans on the day of embryo transfer. The secondary outcomes will include the number of clinic visits required per patient undergoing the protocol, biochemical pregnancy rate, and clinical pregnancy rate. Methods: We will conduct a prospective cohort study, recruiting 20 women undertaking FET at the Public Fertility Care of The Royal Women’s Hospital in Melbourne, Australia. These women will be matched to a control group who have undergone the tNFET protocol within the preceding 12 months of the study start date. Results: This project received ethics approval on July 17, 2024, with commencement of the study in September 2024, aiming for a duration of completion of 9 months. The completion of the follow-up and submission of the study for publication are anticipated for September 2025. Conclusions: After this preliminary study, the aim would be to progress to a noninferiority randomized controlled trial to compare the progesterone-modified natural cycle protocol for FET to the tNFET. International Registered Report Identifier (IRRID): PRR1-10.2196/66579 %M 40215104 %R 10.2196/66579 %U https://www.researchprotocols.org/2025/1/e66579 %U https://doi.org/10.2196/66579 %U http://www.ncbi.nlm.nih.gov/pubmed/40215104 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e66338 %T Examining Quality of Work Life in Atlantic Canadian Long-Term Care Homes: Protocol for a Cross-Sectional Survey Study %A Keefe,Janice M %A McCloskey,Rose %A Hodgins,Marilyn J %A McArthur,Caitlin %A MacKenzie,Adrian %A Weeks,Lori E %A Estabrooks,Carole A %+ Department of Family Studies and Gerontology, Mount Saint Vincent University, 166 Bedford Highway, McCain 201F, Halifax, NS, B3M 2J6, Canada, 1 9024576466, janice.keefe@msvu.ca %K residential long-term care %K care staff %K Atlantic Canada %K quality of work life %K work environment %K health and well-being %D 2025 %7 31.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The Canadian long-term care (LTC) workforce cares for increasingly complex residents. With greater care needs come greater demands. Despite this, LTC staffing and resources are largely unchanged and underresearched over the last decade. The Atlantic provinces are home to the oldest population in Canada, indicating a high need for LTC. The health and well-being of the LTC workforce are critical components of care quality, yet only in Western Canada are such data routinely and systematically collected. Translating Research in Elder Care is a 2-decade research program studying the LTC work environment and has found strong links between the working conditions of LTC staff and resident outcomes. We draw upon their success to generate the evidence needed to understand, support, and manage the LTC workforce in Canada’s four Atlantic provinces. Objective: This study aims (1) to assess the quality of work life among staff in LTC homes in Atlantic Canada; (2) to examine the effects of the work environment on the quality of work life; and (3) to build capacity for research in the LTC sector in Atlantic Canada among knowledge users, researchers, and trainees. The objective of this paper is to describe the approach needed to examine the quality of work life and health of care staff in LTC homes. Methods: Stratified random sampling will be used to recruit homes in Atlantic Canada. The sampling frame was designed to recruit 25% of the LTC homes in each of the 4 provinces with proportional representation by size; ownership model; and, if applicable, region or language. Key outcome variables include measures of mental health and well-being, quality of work life, intention to leave, workplace context, and missed or rushed care. Primary data will be obtained through structured interviews with care aides and web-based surveys from registered nurses, licensed practical nurses, managers, and allied health providers. Eligible participants were from an LTC home with at least 25 residents, 90% of whom were aged 65 years or older, and had worked in the home for at least 3 months. Multivariate analyses include regression analysis for explaining predictors of quality of work-life outcomes and multilevel modeling for more complex relationships of staff outcomes by provinces and LTC home characteristics. Results: Data collection and cleaning are complete as of October 2024 (N=2305). Care aides (n=1338), nurses (n=724), allied health providers (n=154), and managers (n=89) from 53 homes make up the sample. Data analysis is ongoing. Initially, individual reports will present descriptive data for each participating LTC home. Concurrent analysis is planned for publication in peer-reviewed journals. Conclusions: This peer-reviewed research protocol lays the foundation for a comprehensive analysis of the effects of the work environment on the quality of work life of LTC staff in Atlantic Canada. International Registered Report Identifier (IRRID): DERR1-10.2196/66338 %M 40163846 %R 10.2196/66338 %U https://www.researchprotocols.org/2025/1/e66338 %U https://doi.org/10.2196/66338 %U http://www.ncbi.nlm.nih.gov/pubmed/40163846 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e54651 %T Policy Spotlight Effects on Critical Time-Sensitive Diseases: Nationwide Retrospective Cohort Study on Taiwan’s Hospital Emergency Capability Categorization Policy %A Lin,Chih-Yuan %A Liu,Chih-Ching %A Huang,Yu-Tung %A Lee,Yue-Chune %+ Institute of Health and Welfare, College of Medicine, Yangming Campus, National Yang Ming Chiao Tung University, Taipei, Taiwan, No.155, Sec.2, Linong Street, Taipei City, 112, Taiwan, 886 225916681 ext 1526, DAS73@tpech.gov.tw %K categorization of hospital emergency capability %K quality %K time-sensitive diseases %K emergency care %K difference-in-differences %D 2025 %7 25.3.2025 %9 Original Paper %J Interact J Med Res %G English %X Background: Taiwan’s categorization of hospital emergency capability (CHEC) policy is designed to regionalize and dispatch critical patients. The policy was designed in 2009 to improve the quality of emergency care for critical time-sensitive diseases (CTSDs). The CHEC policy primarily uses time-based quality surveillance indicators. Objective: We aimed to investigate the impact of Taiwan’s CHEC policy on CTSDs. Methods: Using Taiwan’s 2005 Longitudinal Health Insurance Database, this nationwide retrospective cohort study examined the CHEC policy’s impact from 2005 to 2011. Propensity score matching and difference-in-differences analysis within a generalized estimating equation framework were used to compare pre- and postimplementation periods. The study focused on acute ischemic stroke (AIS), ST-segment elevation myocardial infarction (STEMI), septic shock, and major trauma. AIS and STEMI cases, monitored with time-based indicators, were evaluated for adherence to diagnostic and treatment guidelines as process quality measures. Mortality and medical use served as outcome indicators. Major trauma, with evolving guidelines and no time-based monitoring, acted as a control to test for policy spotlight effects. Results: In our cohort of 9923 patients, refined through 1:1 propensity score matching, 5566 (56.09%) were male and were mostly older adults. Our analysis revealed that the CHEC policy effectively improved system efficiency and patient outcomes, resulting in significant reductions in medical orders (–7.29 items, 95% CI –10.09 to –4.48; P<.001), short-term mortality rates (–0.09%, 95% CI –0.17% to –0.02%; P=.01) and long-term mortality rates (–0.09%, 95% CI –0.15% to –0.04%; P=.001), and total medical expenses (–5328.35 points per case, 95% CI –10,387.10 to –269.60; P=.04), despite a modest increase in diagnostic fees (376.37 points, 95% CI 92.42-660.33; P=.01). The CHEC policy led to notable increases in diagnostic fees, major treatments, and medical orders for AIS and STEMI cases. For AIS cases, significant increases were observed in major treatments (β=0.77; 95% CI 0.21-1.33; P=.007) and medical orders (β=15.20; 95% CI 5.28-25.11; P=.003) compared to major trauma. In STEMI cases, diagnostic fees significantly increased (β=1983.75; 95% CI 84.28-3883.21; P=.04), while upward transfer rates significantly decreased (β=–0.59; 95% CI –1.18 to –0.001; P=.049). There were also trends toward increased major treatments (β=0.30; 95% CI –0.03 to 0.62, P=.07), medical orders (β=11.92; 95% CI –0.90 to 24.73; P=.07), and medical expenses (β=24,275.54; 95% CI –640.71 to 4,991,991.78; P=.06), although these were not statistically significant. In contrast, no significant changes were identified in process or outcome quality indicators for septic shock. These findings suggest policy spotlight effects, reflecting a greater emphasis on diseases directly prioritized under the CHEC policy. Conclusions: The CHEC policy demonstrated the dual benefits of reducing costs and improving patient outcomes. We observed unintended consequences of policy spotlight effects, which led to a disproportionate improvement in guideline adherence and process quality for CTSDs with time-based surveillance indicators. %M 40132185 %R 10.2196/54651 %U https://www.i-jmr.org/2025/1/e54651 %U https://doi.org/10.2196/54651 %U http://www.ncbi.nlm.nih.gov/pubmed/40132185 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e60728 %T Optimizing the Pharmacotherapy of Vascular Surgery Patients at Hospital Admission and Discharge (PHAROS): Protocol for a Quasi-Experimental Clinical Uncontrolled Trial %A Porubcova,Slavka %A Lajtmanova,Kristina %A Szmicsekova,Kristina %A Slezakova,Veronika %A Tomka,Jan %A Tesar,Tomas %+ Department of Organisation and Management of Pharmacy, Faculty of Pharmacy, Comenius University, Odbojarov 10, Bratislava, 832 32, Slovakia, 421 2 9016 9348, tesar@fpharm.uniba.sk %K pharmacotherapy %K hospital pharmacy %K vascular surgery %K patient safety %K risk reduction %K pharmacist-proposed interventions %D 2025 %7 19.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patient safety is essential in pharmacotherapy, especially in surgical contexts, due to the elevated risk of drug-related complications. Vascular surgery patients are particularly susceptible because of their complex medication needs and underlying health conditions. Improved safety monitoring and targeted pharmaceutical care in collaboration with physicians are crucial to minimize these risks and enhance patient outcomes. Objective: This protocol evaluates whether structured pharmaceutical care interventions—including medication reconciliation, medication review, and patient education—can reduce the prevalence of drug-related problems at hospital admission and discharge in vascular surgery patients. Methods: This prospective, uncontrolled study was conducted over 1 year in the Vascular Surgery Department at the National Institute of Cardiovascular Diseases in Bratislava, Slovakia. The study included adult patients with carotid artery disease or lower extremity artery disease who were on 3 or more medications, with an estimated sample size of approximately 100 patients. The primary intervention involved 3 key changes in practice: medication reconciliation at both admission and discharge, where hospital pharmacists review and verify medication lists; medication review to identify and address drug-related problems; and patient education at discharge. Pharmacist-proposed interventions were documented and communicated to the physician for treatment adjustments. The primary outcome is the change in drug-related problem prevalence from hospital admission to discharge. Secondary outcomes include the acceptance rate of pharmacist recommendations and patient understanding of pharmacotherapy. Data collection involved documenting the number, type, and frequency of drug-related problems; the anatomical therapeutic chemical classification of medications associated with drug-related problems; and patients’ social, demographic, and clinical characteristics, with a focus on factors related to drug-related problems, comorbidities, and medication use. Data analysis will use the paired Wilcoxon signed-rank test to compare the prevalence of drug-related problems and medication counts between admission and discharge. Continuous variables will be presented as means (SDs), while categorical variables will be reported as counts and percentages. Patient understanding of pharmacotherapy will be evaluated using a 3-point scale, classifying understanding as good (2-3 points per medication), modest (1-2 points), or poor (0-1 point). Results: Recruitment began in September 2021 and concluded in August 2022. Data collection occurred continuously during hospital stays, capturing demographics, comorbidities, pharmacotherapy, and drug-related problems at admission and discharge. Important milestones included the initial data review, which began in August 2023 to assess recruitment and data quality, including an early evaluation of drug-related problems. The primary analysis was completed in January 2024, focusing on the reduction in drug-related problems, intervention acceptance, and patient understanding. The final report was to be prepared by June 2024, disseminating the findings on pharmacist-led intervention impacts. Conclusions: This study should demonstrate that pharmacist-led interventions in collaboration with physicians can reduce pharmacotherapy risks and optimize medicine management for patient safety. Trial Registration: ClinicalTrials.gov NCT04930302; https://clinicaltrials.gov/study/NCT04930302 International Registered Report Identifier (IRRID): RR1-10.2196/60728 %M 40106812 %R 10.2196/60728 %U https://www.researchprotocols.org/2025/1/e60728 %U https://doi.org/10.2196/60728 %U http://www.ncbi.nlm.nih.gov/pubmed/40106812 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60019 %T Application of Internet Hospitals in the Disease Management of Patients With Ulcerative Colitis: Retrospective Study %A Yu,Tianzhi %A Li,Wanyu %A Liu,Yingchun %A Jin,Chunjie %A Wang,Zimin %A Cao,Hailong %+ Department of Gastroenterology, National Key Clinical Specialty, Tianjin Medical University General Hospital, 154 Anshan Road in Heping District, Tianjin, 300052, China, 86 +86 022 6036155, caohailong@tmu.edu.cn %K inflammatory bowel disease %K ulcerative colitis %K intelligent diagnosis and treatment service %K internet hospital %K chronic disease management %D 2025 %7 18.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Ulcerative colitis (UC) is a chronic disease characterized by frequent relapses, requiring long-term management and consuming substantial medical and social resources. Effective management of UC remains challenging due to the need for sustainable remission strategies, continuity of care, and access to medical services. Intelligent diagnosis refers to the use of artificial intelligence–driven algorithms to analyze patient-reported symptoms, generate diagnostic probabilities, and provide treatment recommendations through interactive tools. This approach could potentially function as a method for UC management. Objective: This study aimed to analyze the diagnosis and treatment data of UC from both physical hospitals and internet hospitals, highlighting the potential benefits of the intelligent diagnosis and treatment service model offered by internet hospitals. Methods: We collected data on the visits of patients with UC to the Department of Gastroenterology at Tianjin Medical University General Hospital. A total of 852 patients with UC were included between July 1, 2020, and June 31, 2023. Statistical methods, including chi-square tests for categorical variables, t tests for continuous variables, and rank-sum tests for visit numbers, were used to evaluate the medical preferences and expenses of patients with UC. Results: We found that internet hospitals and physical hospitals presented different medical service models due to the different distribution of medical needs and patient groups. Patients who chose internet hospitals focused on disease consultation and prescription medication (3295/3528, 93.40%). Patients’ medical preferences gradually shifted to web-based services provided by internet hospitals. Over time, 58.57% (270/461) of patients chose either web-based services or a combination of web-based and offline services for UC diagnosis and treatment. The number of visits in the combination of web-based and offline service modes was the highest (mean 13.83, SD 11.07), and younger patients were inclined to visit internet hospitals (49.66%>34.71%). In addition, compared with physical hospitals, there was no difference in testing fees and examination fees for patients with UC in internet hospitals, but medicine fees were lower. Conclusions: The intelligent diagnosis and treatment model provided by internet hospitals demonstrates the potential benefits in managing UC, including feasibility, accessibility, convenience, and economics. %M 40101745 %R 10.2196/60019 %U https://www.jmir.org/2025/1/e60019 %U https://doi.org/10.2196/60019 %U http://www.ncbi.nlm.nih.gov/pubmed/40101745 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e69477 %T Development and Impact of a Community-Delivered, Multisectoral Lifestyle Management Service for People Living With Type 2 Diabetes (Logan Healthy Living): Protocol for a Pragmatic, Single-Arm Intervention Study %A Gomersall,Sjaan R %A Giguere,Denis Y %A Cotugno,Jacqueline %A Munro,Joanna %A Westbrook,Wallis J %A Littlewood,Robyn %A Cairney,John %A Winkler,Elisabeth AH %A van der Vliet,Phillip M %A Goode,Ana D %A Alsop,Tahlia %A Healy,Genevieve Nissa %+ Health and Wellbeing Centre for Research Innovation, School of Human Movement and Nutrition Sciences, The University of Queensland, Blair Drive, St Lucia, 4067, Australia, 61 413412822, s.gomersall1@uq.edu.au %K type 2 diabetes %K lifestyle management %K allied health %K evaluation %K protocol %D 2025 %7 10.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Type 2 diabetes is the fastest-growing chronic condition in Australia, with higher prevalence in disadvantaged groups. Logan Healthy Living by UQ Health Care is a proof-of-concept, interprofessional allied health clinic focused on supporting people with and at risk of type 2 diabetes in Logan, a region in South East Queensland, Australia, with high levels of health inequity. Logan Healthy Living is supported by the Queensland Government through Health and Wellbeing Queensland and a broader multisectoral alliance including primary health care; tertiary hospital and health services; and government, community, and university sectors. Objective: This paper describes the establishment of Logan Healthy Living and outlines the evaluation protocol for the service’s type 2 diabetes lifestyle management program. Methods: The context and setting of Logan Healthy Living are presented, and the process for establishing the multisectoral partnerships, development and governance of the service, and the facility are described. The lifestyle management program is an 8-week, group-based program that includes 1 hour of education and 1 hour of supervised, individually tailored exercise each week. The theoretical underpinnings and the program are described in detail. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework will guide evaluation of the program and inform key questions regarding the number and characteristics of the clients (reach); diabetes-related distress, health behaviors (physical activity and diet), quality of life, self-management self-efficacy, loneliness, community involvement, anthropometric measures, hemoglobin A1c levels, physical function, and health care use (effectiveness); referral pathways (adoption); fidelity, appropriateness, acceptability, and costs (implementation); and long-term effectiveness (maintenance). Data will be drawn from a purposefully embedded minimum dataset and data registry, with the process for designing and embedding data collection into practice (via surveys, in-person measures, and client management software) described in detail. Results: Ethics approval has been obtained for the data registry. Logan Healthy Living is a 4-year proof of concept that concludes on December 31, 2024, with findings expected to be reported starting in 2025. Conclusions: While multisectoral responses are needed for complex community health challenges, the processes for achieving these are rarely documented, and the description of the development of Logan Healthy Living has the potential to inform future partnerships. The findings of the evaluation will provide important new knowledge on the impact of a community-delivered type 2 diabetes program on individuals, the community, and the health system in an area of high health inequity. International Registered Report Identifier (IRRID): DERR1-10.2196/69477 %M 40063948 %R 10.2196/69477 %U https://www.researchprotocols.org/2025/1/e69477 %U https://doi.org/10.2196/69477 %U http://www.ncbi.nlm.nih.gov/pubmed/40063948 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65092 %T Correlation Between the Online Visiting Time and Frequency Increase in Telemedicine Services Offered by Health Care Providers Before, During, and After the COVID-19 Pandemic in China: Cross-Sectional Study %A Wang,Weiyi %A Chu,Yuntian %A Cui,Fangfang %A Shi,Xiaobing %A Zhang,Xu %A Sun,Dongxu %A Shi,Jinming %A Zhao,Jie %+ , National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, 3 Jianshe East Rd, Erqi District, Zhengzhou, 450001, China, 86 15093316769, zhaojie@zzu.edu.cn %K telemedicine %K post–COVID-19 %K provider’s perspective %K length of online visit %K COVID-19 %K pandemic %K China %K prevention %K questionnaire %K survey %K healthcare provider %D 2025 %7 26.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: China has changed its COVID-19 prevention and control status since 2023. However, what role telemedicine will play post–COVID-19 is still uncertain. Objective: We aimed to determine the frequency change in health care providers offering telemedicine services before, during, and after COVID-19, as well as the correlation between the frequency change and telemedicine visit time. Methods: The Telemedicine Informationization Professional Committee of China (TIPC) carried out a nationwide questionnaire survey. We adopted data from part of the questionnaires that answered questions regarding the frequency of offering telemedicine services before, during, and after the COVID-19 explosion. Chi-square tests were applied to compare general differences in the between-group telemedicine frequency. Regression models were performed to analyze correlations between the frequency change and the time spent in online versus in-person visits. Results: Questionnaires from 428 providers were included. As reported, 39 (9.11%) providers often and 159 (37.15%) always offered telemedicine services before COVID-19 exploded. The component ratio increased to 12.38% (n=53) of providers often and 45.79% (n=196) always offering telemedicine during COVID-19 explosion and 12.62% (n=54) often and 50% (n=214) always offering telemedicine after pandemic control was relaxed. The increase in frequency shown as a difference between the before and during groups (χ2=17.21, P.002) and between the before and after groups (χ2=30.17, P<.001) was significant, while it was insignificant between the during and after groups (χ2=2.89, P.57). Senior professional titles (odds ratio [OR] 4.38, 95% CI 1.72-11.6) and longer (OR 3.87, 95% CI 1.95-7.89) and shorter (OR 2.04, 95% CI 1.11-3.87) online visits were correlated with the increase in frequency during versus before COVID-19. In addition, senior professional titles (OR 3.47, 95% CI 1.46-8.49), longer (OR 3.14, 95% CI 1.64-6.11) and shorter (OR=2.27, 95% CI 1.31-4.07) online visits, and using third-party telemedicine platforms (OR 0.51, 95% CI 0.29-0.86) were correlated with the increase in frequency after versus before COVID-19. No factor was significantly correlated with the frequency change after versus during COVID-19. In stratified analysis, longer online visits were correlated with both during versus before (OR 3.84, 95% CI 1.73-8.83) and after versus before (OR 3.40, 95% CI 1.61-7.34) groups for providers using hospital-run platforms, while shorter online visits were correlated with both during versus before (OR 8.16, 95% CI 1.39-68.3) and after versus before (OR 5.70, 95% CI 1.22-33.6) groups for providers using third-party platforms. Conclusions: The frequency of telemedicine has increased since the COVID-19 pandemic exploded and is correlated with the time spent in online versus in-person visits. The correlation is different for providers using hospital-run and third party platforms. On a hospital-run platform, providers with longer online visits have a higher frequency of offering telemedicine, while on a third-party platform, providers with shorter online visits are more likely to offer telemedicine. %M 40009835 %R 10.2196/65092 %U https://www.jmir.org/2025/1/e65092 %U https://doi.org/10.2196/65092 %U http://www.ncbi.nlm.nih.gov/pubmed/40009835 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e65548 %T Health Equity of Hypertension Management Between Local Residents and Internal Migrants in Shenzhen, China: Cross-Sectional Study %A He,Jinyu %A Li,Yanjun %A Zeng,Huatang %A Sun,Haoran %A Wu,Liqun %A Zhu,Zhenzhen %A Zhang,Ning %A Liang,Wannian %K health equity %K hypertension management %K immigrant population %K hypertension %K China %K global health %K public health %K health disparities %K medical record %K community health care %K native population %K immigrant %K socioeconomic %K disease burden %K well-being %K chronic disease %K community health center %D 2025 %7 10.2.2025 %9 %J JMIR Public Health Surveill %G English %X Background: With hypertension emerging as a global public health concern, taking measures to alleviate its burden is urgently needed. The hypertension management program (HMP) in China is a standardized policy to help people with hypertension to improve their health levels and reduce health inequalities. However, studies focusing on details regarding participation in this program remain scarce. Objective: This study aims to investigate the participation rates in HMPs in China and examine the health disparities in hypertension management between local residents and internal migrants in Shenzhen. Methods: This study used the medical record of Shenzhen, Guangdong, China. We included adults with new-onset diagnosis of hypertension after 2017 and focused on patients who have a record in the community health center. We described the basic characteristics of people diagnosed with hypertension, including age, gender, marital status, occupation, education level, and health insurance type. Enrolled rate, follow-up rate, and adherence rate were used to measure the engagement with this program at the city, district, and community levels. Results: Of the 1,160,214 hypertensive patients, 29.70% (344,526/1,160,214) were local residents, while 70.3% (815,688/1,160,214) were internal migrants. In addition, 55.36% (642,250/1,160,214) were enrolled in the HMP. Of those, 57.52% (369,439/642,25) were followed up. In addition, 62.59% (231,217/369,439) of followed up individuals were adherents. Internal migrants demonstrated a significantly higher participation in the HMP, especially for the enrolled rate (local residents: 156,085/344,526, 45.30% vs internal migrants: 486,165/815,688, 59.60%) and adherence rate (local residents: 44,044/84,635, 52.04% vs internal migrants: 187,173/284,804, 65.72%). Apart from that, local, single, and younger individuals had lower rates compared to their counterparts. There also existed within-district and within-community variation among enrolled, follow-up, and adherence rates. Conclusions: Based on our research, individuals with different demographic and socioeconomic characteristics and in different regions had different enrolled, follow-up, and adherence rates. Internal migrants in Shenzhen showed a significantly higher participation in the HMP. Given these findings, there exists the potential to enhance the outreach and engagement of local, single, and younger populations through targeted promotional strategies. %R 10.2196/65548 %U https://publichealth.jmir.org/2025/1/e65548 %U https://doi.org/10.2196/65548 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e55929 %T Revisits, Readmission, and Mortality From Emergency Department Admissions for Older Adults With Vague Presentations: Longitudinal Observational Study %A Alvarez Avendano,Sebastian Alejandro %A Cochran,Amy %A Odeh Couvertier,Valerie %A Patterson,Brian %A Shah,Manish %A Zayas-Caban,Gabriel %K gerontology %K geriatric %K older adults %K elderly %K older people %K aging %K emergency department %K emergency room %K ED %K disposition decision %K disposition %K discharge %K admission %K revisit %K readmission %K observational study %K health %K hospital %D 2025 %7 6.2.2025 %9 %J JMIR Aging %G English %X Background: Older adults (65 years and older) often present to the emergency department (ED) with an unclear need for hospitalization, leading to potentially harmful and costly care. This underscores the importance of measuring the trade-off between admission and discharge for these patients in terms of patient outcomes. Objective: This study aimed to measure the relationship between disposition decisions and 3-day, 9-day, and 30-day revisits, readmission, and mortality, using causal inference methods that adjust for potential measured and unmeasured confounding. Methods: A longitudinal observational study (n=3591) was conducted using electronic health records from a large tertiary teaching hospital with an ED between January 1, 2014 and September 27, 2018. The sample consisted of older adult patients with 1 of 6 presentations with significant variability in admission: falls, weakness, syncope, urinary tract infection, pneumonia, and cellulitis. The exposure under consideration was the ED disposition decision (admission to the hospital or discharge). Nine outcome variables were considered: ED revisits, hospital readmission, and mortality within 3, 9, and 30 days of being discharged from either the hospital for admitted patients or the ED for discharged patients. Results: Admission was estimated to significantly decrease the risk of an ED revisit after discharge (30-day window: −6.4%, 95% CI −7.8 to −5.0), while significantly increasing the risk of hospital readmission (30-day window: 5.8%, 95% CI 5.0 to 6.5) and mortality (30-day window: 1.0%, 95% CI 0.4 to 1.6). Admission was found to be especially adverse for patients with weakness and pneumonia, and relatively less adverse for older adult patients with falls and syncope. Conclusions: Admission may not be the safe option for older adults with gray area presentations, and while revisits and readmissions are commonly used to evaluate the quality of care in the ED, their divergence suggests that caution should be used when interpreting either in isolation. %R 10.2196/55929 %U https://aging.jmir.org/2025/1/e55929 %U https://doi.org/10.2196/55929 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 6 %N %P e57597 %T Determinants of Periodic Health Examination Uptake: Insights From a Jordanian Cross-Sectional Study %A Tayoun,Abdul Aziz %K periodic health examination %K PHE %K preventive health services %K routine health checkups %K Jordan %K cross-sectional study %D 2025 %7 5.2.2025 %9 %J JMIRx Med %G English %X Background: Routine periodic health examinations (PHEs) for adults who are asymptomatic are included in clinical preventive services. They aim to prevent morbidity and mortality by identifying modifiable risk factors and early signs of treatable diseases. PHEs are a standard procedure in primary health care worldwide, including in Jordan. The country is undergoing an epidemiological transition toward noncommunicable diseases, which are the leading causes of morbidity and mortality. The prevalence of smoking is among the highest in the world, with escalating rates of obesity and physical inactivity. Notably, hypertension and diabetes are the most prevalent diseases. Objective: This study aims to determine the extent to which individuals in Jordan participate in PHEs and to evaluate the various factors related to sociodemographics, health, knowledge, and behavior that influence this participation. Methods: This study used a cross-sectional design and includes 362 participants 18 years or older residing in Jordan. A convenience sampling method was used, and data were collected through a hybrid web-based and face-to-face questionnaire. The analysis involved the application of logistic regression through SPSS to investigate the relationship between various influencing factors and the uptake of PHEs. Results: Our study indicated that only 98 of the 362 (27.1%, 95% CI 22.8%-31.9%) participants underwent PHEs within the last 2 years. Noteworthy predictors of PHE uptake among Jordanians included recent visits to a primary health care facility within the previous year (adjusted odds ratio [AOR] 4.32, 95% CI 2.40‐7.76; P<.001), monthly income (P=.02; individuals with a monthly income of 1500‐2000 JD displayed more than five times the odds of undertaking PHEs than those with a monthly income <500 JD; AOR 5.74, 95% CI 1.32‐24.90; P=.02; those with a monthly income of more than 2000 JD exhibited even higher odds; AOR 9.81, 95% CI 1.73‐55.55; P=.02; a currency exchange rate of 1 JD=US $1.43 is applicable), and knowledge levels regarding PHEs and preventive health measures (AOR 1.23, 95% CI 1.03‐1.47; P=.007). These variables emerged as the strongest predictors in our analysis, shedding light on key factors influencing PHE uptake in the population. Contrary to other research, our study did not find any statistically significant association between gender (P=.33), smoking status (P=.76), marital status (P=.52), health status self-evaluation (P=.18), seasonal influenza vaccination (P=.07), combined health behavior factors (P=.34), and BMI (P=.76) and PHE uptake. Conclusions: PHE uptake is notably low in Jordan. Critical determinants of this uptake include recent visits to a primary health care facility within the previous year, monthly income, and knowledge levels regarding PHEs and preventive health services. To enhance PHE uptake, there is a critical need to integrate PHEs with primary health care services, increase awareness about PHEs, and offer free preventive services, particularly for those at high risk. %R 10.2196/57597 %U https://xmed.jmir.org/2025/1/e57597 %U https://doi.org/10.2196/57597 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e53306 %T Reconstructing Risk Dimensions in Telemedicine: Investigating Technology Adoption and Barriers During the COVID-19 Pandemic in Taiwan %A Wu,Tzu-Chi %A Ho,Chien-Ta %+ Department of Emergency Medicine, Show Chwan Memorial Hospital, 542, Sec 1, Zhongshan Rd., Changhua, 500009, Taiwan, 886 958352193, j10062008@hotmail.com %K telemedicine %K perceived risk %K technology acceptance model %K risk %K performance risk %D 2025 %7 3.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has shifted health care toward virtual and online models, impacting both users and providers. Numerous user concerns and perceived risks related to telemedicine are continually evolving and adjusting in response to the pandemic. In many countries, there has been a substantial increase in the use of virtual health care visits, which offers a unique opportunity for researchers to explore these user concerns. Objective: This study aimed to first reconstruct the risk dimensions associated with telemedicine, then identify the risk factors affecting users’ adoption, and finally propose effective solutions to mitigate these concerns. By integrating the newly constructed perceived risk with the technology acceptance model (TAM), we scrutinized various dimensions of perceived risk and their influence on users’ perceptions of ease of use, perceived usefulness, and use intention (UI). Methods: Our target population consists of adults aged ≥18 years who have used or may use telemedicine services, recruited through an anonymous, voluntary, open, web-based survey. We collected responses and used part of them to reconstruct risk dimensions using exploratory factor analysis. Subsequently, we analyzed the intricate relationship between perceived risk, the TAM, and the acceptance of telemedicine using structural equation modeling with another part of the responses. Results: A total of 1600 valid responses were collected. Eight distinct risk dimensions were reconstructed, revealing a substantial negative impact of performance risk on UI. The psychological and social risk was the strongest barrier to the ease of using telemedicine. Time risk, provider risk, and privacy risk were not statistically significant to the TAM. The resulting model elucidates a remarkable 66% variance in UI for telemedicine services. Conclusions: This study substantially advances the field of telemedicine research by reconstructing and redefining 8 risk dimensions and confirming the statistical significance of 5 perceived risks on the adoption of telemedicine services. These insights are poised to facilitate the promotion and enhancement of telemedicine services in the health care sector. %M 39899842 %R 10.2196/53306 %U https://www.jmir.org/2025/1/e53306 %U https://doi.org/10.2196/53306 %U http://www.ncbi.nlm.nih.gov/pubmed/39899842 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67929 %T Metrics for Evaluating Telemedicine in Randomized Controlled Trials: Scoping Review %A Sugawara,Yuka %A Hirakawa,Yosuke %A Iwagami,Masao %A Inokuchi,Ryota %A Wakimizu,Rie %A Nangaku,Masaomi %+ Division of Nephrology and Endocrinology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, 81 3 3815 5411, mnangaku@m.u-tokyo.ac.jp %K patient experience %K patient-reported outcome %K quality of life %K quality-adjusted life year %K telehealth %K eHealth %K mobile phone %K metrics %K telemedicine %K systematic review %K scoping review %K review %K telecommunications %K database %K health care %K patient-centeredness %K patient satisfaction %K patient outcome %K clinical parameter %K cost-effectiveness %K evaluation metrics %K mHealth %K mobile health %D 2025 %7 31.1.2025 %9 Review %J J Med Internet Res %G English %X Background: Telemedicine involves medical, diagnostic, and treatment-related services using telecommunication technology. Not only does telemedicine contribute to improved patient quality of life and satisfaction by reducing travel time and allowing patients to be seen in their usual environment, but it also has the potential to improve disease management by making it easier for patients to see a doctor. Recently, owing to IT developments, research on telemedicine has been increasing; however, its usefulness and limitations in randomized controlled trials remain unclear because of the multifaceted effects of telemedicine. Furthermore, the specific metrics that can be used as cross-disciplinary indicators when comparing telemedicine and face-to-face care also remain undefined. Objective: This review aimed to provide an overview of the general and cross-disciplinarity metrics used to compare telemedicine with in-person care in randomized controlled trials. In addition, we identified previously unevaluated indicators and suggested those that should be prioritized in future clinical trials. Methods: MEDLINE and Embase databases were searched for publications that met the inclusion criteria according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews). Original, English-language articles on randomized controlled trials comparing some forms of telemedicine with face-to-face care from January 2019 to March 2024 were included, and the basic information and general metrics used in these studies were summarized. Results: Of the 2275 articles initially identified, 79 were included in the final analysis. The commonly used metrics that can be used across medical specialties were divided into the following 3 categories: (1) patient-centeredness (67/79, 85%), including patient satisfaction, workload, and quality of life; (2) patient outcomes (57/79, 72%), including general clinical parameters such as death, admission, and adverse events; and (3) cost-effectiveness (40/79, 51%), including cost assessment and quality-adjusted life year. Notably, only 25 (32%) of 79 studies evaluated all the 3 categories. Other metrics, such as staff convenience, system usability, and environmental impact, were extracted as indicators in different directions from the three categories above, although few previous reports have evaluated them (staff convenience: 8/79, 10%; system usability: 3/79, 4%; and environmental impact: 2/79, 3%). Conclusions: A significant variation was observed in the metrics used across previous studies. Notably, general indicators should be used to enhance the understandability of the results for people in other areas, even if disease-specific indicators are used. In addition, indicators should be established to include all three commonly used categories of measures to ensure a comprehensive evaluation: patient-centeredness, patient outcomes, and cost-effectiveness. Staff convenience, system usability, and environmental impact are important indicators that should be used in future trials. Moreover, standardization of the evaluation metrics is desired for future clinical trials and studies. Trial Registration: Open Science Forum Registries YH5S7; https://doi.org/10.17605/OSF.IO/YH5S7 %M 39889298 %R 10.2196/67929 %U https://www.jmir.org/2025/1/e67929 %U https://doi.org/10.2196/67929 %U http://www.ncbi.nlm.nih.gov/pubmed/39889298 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 17 %N %P e60263 %T Assessing Physician and Patient Agreement on Whether Patient Outcomes Captured in Clinical Progress Notes Reflect Treatment Success: Cross-Sectional Study %A Floyd,Sarah B %A Sutton,Jordyn C %A Okon,Marvin %A McCarthy,Mary %A Fisher,Liza %A Judkins,Benjamin %A Reynolds,Zachary Cole %A Kennedy,Ann Blair %+ Department of Public Health Sciences, Clemson University, 516 Edwards Hall, Clemson, SC, 29634, United States, 1 864 656 6946, sbf@clemson.edu %K patient outcomes %K proximal humerus fracture %K patient involvement %K orthopaedic medicine %K clinical progress notes %D 2025 %7 23.1.2025 %9 Original Paper %J J Particip Med %G English %X Background: It remains unclear if there is agreement between physicians and patients on the definition of treatment success following orthopedic treatment. Clinical progress notes are generated during each health care encounter and include information on current disease symptoms, rehabilitation progress, and treatment outcomes. Objective: This study aims to assess if physicians and patients agree on whether patient outcomes captured in clinical progress notes reflect a successful treatment outcome following orthopedic care. Methods: We performed a cross-sectional analysis of a subset of clinical notes for patients presenting to a Level-1 Trauma Center and Regional Health System for follow-up for an acute proximal humerus fracture (PHF). This study was part of a larger study of 1000 patients with PHF receiving initial treatment between 2019 and 2021. From the full dataset of 1000 physician-labeled notes, a stratified random sample of 25 notes from each outcome label group was identified for this study. A group of 2 patients then reviewed the sample of 100 clinical notes and labeled each note as reflecting treatment success or failure. Cohen κ statistics were used to assess the degree of agreement between physicians and patients on clinical note content. Results: The average age of the patients in the sample was 67 (SD 13) years and 82% of the notes came from female patients. Patients were primarily White (91%) and had Medicare insurance coverage (65%). The note sample came from fracture-related encounters ranging from the second to the tenth encounter after the index PHF visit. There were no significant differences in patient or visit characteristics across concordant and discordant notes labeled by physicians and patients. Among agreement levels ranging from poor to perfect agreement, physician and patient evaluators exhibited only a fair level of agreement in what they deemed as treatment success based on a Cohen κ of 0.32 (95% CI 0.10-0.55; P=.01). Furthermore, interpatient and interphysician agreement also demonstrated relatively low levels of agreement. Conclusions: The findings suggest that physicians and patients demonstrated low levels of agreement when assessing whether a patient’s clinical note reflected a successful outcome following treatment for a PHF. As low levels of agreement were also observed within physician and patient groups, it is clear the definition of success varied highly across both physicians and patients. Further research is needed to elucidate physician and patient perceptions of treatment success. As outcome measurement and demonstrating the value of orthopedic treatment remain important priorities, it is important to better define and reach a consensus on what treatment success means in orthopedic medicine. %R 10.2196/60263 %U https://jopm.jmir.org/2025/1/e60263 %U https://doi.org/10.2196/60263 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e50635 %T Gamified Web-Delivered Attentional Bias Modification Training for Adults With Chronic Pain: Randomized, Double-Blind, Placebo-Controlled Trial %A Vermeir,Julie F %A White,Melanie J %A Johnson,Daniel %A Crombez,Geert %A Van Ryckeghem,Dimitri M L %+ School of Psychology and Counselling, Faculty of Health, Queensland University of Technology (QUT), 170 Victoria Park Road., Brisbane, 4059, Australia, 61 731384714, julie.vermeir@hdr.qut.edu.au %K chronic pain %K cognition %K attentional bias %K gamification %K motivation %K randomized controlled trial %K web-based intervention %K pain management %K digital intervention %K digital health %D 2025 %7 16.1.2025 %9 Original Paper %J JMIR Serious Games %G English %X Background: Attentional bias to pain-related information has been implicated in pain chronicity. To date, research investigating attentional bias modification training (ABMT) procedures in people with chronic pain has found variable success, perhaps because training paradigms are typically repetitive and monotonous, which could negatively affect engagement and adherence. Increasing engagement through the gamification (ie, the use of game elements) of ABMT may provide the opportunity to overcome some of these barriers. However, ABMT studies applied to the chronic pain field have not yet incorporated gamification elements. Objective: This study aimed to investigate the effects of a gamified web-delivered ABMT intervention in a sample of adults with chronic pain via a randomized, double-blind, placebo-controlled trial. Methods: A final sample of 129 adults with chronic musculoskeletal pain, recruited from clinical (hospital outpatient waiting list) and nonclinical (wider community) settings, were included in this randomized, double-blind, placebo-controlled, 3-arm trial. Participants were randomly assigned to complete 6 web-based sessions of nongamified standard ABMT (n=43), gamified ABMT (n=41), or a control condition (nongamified sham ABMT; n=45) over a period of 3 weeks. Active ABMT conditions trained attention away from pain-related words. The gamified task included a combination of 5 game elements. Participant outcomes were assessed before training, during training, immediately after training, and at 1-month follow-up. Primary outcomes included self-reported and behavioral engagement, pain intensity, and pain interference. Secondary outcomes included anxiety, depression, cognitive biases, and perceived improvement. Results: Results of the linear mixed model analyses suggest that across all conditions, there was an overall small to medium decline in self-reported task-related engagement between sessions 1 and 2 (P<.001; Cohen d=0.257; 95% CI 0.13-0.39), sessions 1 and 3 (P<.001; Cohen d=0.368; 95% CI 0.23-0.50), sessions 1 and 4 (P<.001; Cohen d=0.473; 95% CI 0.34-0.61), sessions 1 and 5 (P<.001; Cohen d=0.488; 95% CI 0.35-0.63), and sessions 1 and 6 (P<.001; Cohen d=0.596; 95% CI 0.46-0.73). There was also an overall small decrease in depressive symptoms from baseline to posttraining assessment (P=.007; Cohen d=0.180; 95% CI 0.05-0.31) and in pain intensity (P=.008; Cohen d=0.180; 95% CI 0.05-0.31) and pain interference (P<.001; Cohen d=0.237; 95% CI 0.10-0.37) from baseline to follow-up assessment. However, no differential effects were observed over time between the 3 conditions on measures of engagement, pain intensity, pain interference, attentional bias, anxiety, depression, interpretation bias, or perceived improvement (all P values>.05). Conclusions: These findings suggest that gamification, in this context, was not effective at enhancing engagement, and they do not support the widespread clinical use of web-delivered ABMT in treating individuals with chronic musculoskeletal pain. The implications of these findings are discussed, and future directions for research are suggested. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000803998; https://anzctr.org.au/ACTRN12620000803998.aspx International Registered Report Identifier (IRRID): RR2-10.2196/32359 %M 39819575 %R 10.2196/50635 %U https://games.jmir.org/2025/1/e50635 %U https://doi.org/10.2196/50635 %U http://www.ncbi.nlm.nih.gov/pubmed/39819575 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55158 %T Patients’ Use of e-Consultations as an Alternative to Other General Practitioner Services: Cross-Sectional Survey Study %A Kristiansen,Eli %A Atherton,Helen %A Austad,Bjarne %A Bergmo,Trine Strand %A Norberg,Børge Lønnebakke %A Salisbury,Chris %A Zanaboni,Paolo %+ Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Hansine Hansens veg 18, Tromsø, 9019, Norway, 47 97162311, eli.kristiansen@ehealthresearch.no %K e-consultation %K remote consultation %K telehealth %K primary care %K general practitioner %K patient experience %K cross-sectional %K digital health %K survey %D 2025 %7 8.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: e-Consultations, defined as asynchronous text-based messaging, have transformed how patients interact with their general practitioner (GP). While e-consultations can improve patient access to GP care, concerns about increased workload for GPs are raised. Objective: This study aimed to address three research questions: (1) For what purpose and with what expectations do patients initiate e-consultations? (2) If e-consultations had not been available, what alternative actions would the patient have taken? and (3) How are the alternative actions associated with patient and e-consultation characteristics? Methods: A cross-sectional study was conducted through a web-based survey on Helsenorge. Helsenorge is the national citizen portal for digital health services in Norway, including e-consultations with the GP. All users who sent e-consultations through Helsenorge were invited to participate between January and February 2023. The survey addressed questions on users’ expectations and experience with e-consultations. The association between patient and e-consultation characteristics and alternative actions to e-consultations were analyzed using multinomial logistic regression. Results: Overall, 13,011 users answered the survey. The most common reason for initiating an e-consultation was requesting a sick certificate (4940/13,011, 38%). Overall, 68.7% (8802/13,011) of respondents expected an answer within 24 hours, and 17.7% (2310/13,011) anticipated that the GP would ask them to attend a physical examination. If e-consultations had not been available, 45.5% (5917/13,011) of respondents would have booked a GP appointment, and 44.9% (5846/13,011) would have called the front desk. Users who expected a quicker response (odds ratio [OR] 1.64, 95% CI 1.46-1.85) and were less concerned about their health issues (OR 1.29, 95% CI 1.18-1.40) were more likely to call the front desk. Only 2.5% (323/13,011) of respondents would have contacted out-of-hours services. Users with longer travel time to the GP office (OR 6.08, 95% CI 3.46-10.66) and with a new health problem (OR 2.71, 95% CI 2.09-3.51) were more likely to choose this option. In addition, 4.7% (609/13,011) of the users would not have sought help if e-consultations had not been available. Younger patients (OR 2.16, 95% CI 1.38-3.37) and those with a longer travel time to the GP office (OR 2.19, 95% CI 1.27-3.80) or a new health issue (OR 1.74, 95% CI 1.43-2.12) had higher odds for not seeking help. Conclusions: e-Consultations were often the patients’ first choice of access route, and users expected a fast response. e-Consultations were mostly perceived as an alternative to GP appointments or calling the front desk. Patients with lower availability to the GP office had higher odds of using e-consultations as an alternative to out-of-hours service or waiting and not seeking GP care. Guidance for patient use should be developed to ensure appropriate and safe use. Further research should assess the effect of e-consultations on health outcomes and efficiency. %M 39778196 %R 10.2196/55158 %U https://www.jmir.org/2025/1/e55158 %U https://doi.org/10.2196/55158 %U http://www.ncbi.nlm.nih.gov/pubmed/39778196 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e65197 %T Evaluation of a Global Initiative for Asthma Education and Implementation Program to Improve Asthma Care Quality (CARE4ALL): Protocol for a Multicenter, Single-Arm Study %A Huang,Kewu %A Wang,Wenjun %A Wang,Ying %A Li,Yanming %A Feng,Xiaokai %A Shen,Huahao %A Wang,Chen %+ Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China, 86 1085231167, kewuhuang@126.com %K asthma %K management %K quality improvement program %K Global Initiative for Asthma %K GINA %K guidelines %K implementation %K health care %K delivery %D 2025 %7 8.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Poor symptom control and exacerbations of asthma diminish quality of life and pose a significant burden to patients and society. Implementing evidence-based management as recommended by the Global Initiative for Asthma (GINA), especially introducing inhaled corticosteroid–containing treatments, has the potential to vastly reduce exacerbations and the high burden of asthma in China. However, domestic implementation of the GINA recommendations has been unsatisfactory, especially in lower-level hospitals; thus, an enhancement to the awareness of and adherence to the GINA recommendations among Chinese physicians is needed to improve patient outcomes. Objective: This study aims to bridge the gap between the GINA recommendations and the current clinical practice in China by demonstrating the benefits of an asthma quality improvement program (QIP). Methods: A single-arm study will be conducted at around 30 hospitals across China to assess the impact of a specially designed asthma QIP. Approximately 1500 patients with asthma aged ≥14 years will be enrolled in participating hospitals and followed up for 48 weeks. The QIP—targeted at all pulmonologists and specialist nurses—will include an initial comprehensive training (including a pretraining questionnaire and posttraining quizzes) provided by a dedicated, qualified training team based on the GINA 2021 recommendations, followed by regular reinforcement learnings (integrated into the regular department lectures delivered by department directors), with multiple offline and online approaches (eg, an online patient management platform) provided as supportive tools. During this study, GINA implementation performance will be continuously monitored to inform necessary adjustments at the hospital level. The primary end point is change from baseline in the proportion of participants with an inhaled corticosteroid–based maintenance or reliever treatment at week 48. Secondary end points and exploratory end points include changes in clinical practice and patient outcomes such as treatment patterns, asthma control, and hospitalization rates due to exacerbations. Results: This study has been completed, with 1500 patients enrolled and 1271 patients completing the study. The last visit of the last patient was on September 3, 2024, and the database lock was on September 28, 2024. Final analysis of data has started in October 2024. Conclusions: The Change Asthma Clinical Practice through GINA Education and Implementation for All Patients With Asthma (CARE4ALL) study will hopefully help improve asthma management and patient outcomes in China by bridging the gap between evidence-based GINA recommendations and the current clinical practice. Trial Registration: ClinicalTrials.gov NCT05440097; https://clinicaltrials.gov/study/NCT05440097 International Registered Report Identifier (IRRID): DERR1-10.2196/65197 %M 39778197 %R 10.2196/65197 %U https://www.researchprotocols.org/2025/1/e65197 %U https://doi.org/10.2196/65197 %U http://www.ncbi.nlm.nih.gov/pubmed/39778197 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e55035 %T Student and Physician Views of How the Dobbs Decision Affects Training and Practice Location Preferences: Cross-Sectional Questionnaire Study %A Levy,Morgan S %A Bernstein,Simone A %A McNeilly,Sarah M %A Liberty,Abigail %A Fishbach,Shira %A Jain,Shikha %A Gold,Jessica A %A Arora,Vineet M %+ Department of Radiation Oncology, University of Kentucky College of Medicine, 800 Rose Street, Lexington, KY, 40536, United States, 1 9733092423, morgan.levy4@gmail.com %K abortion %K physician workforce %K social media %K reproductive health %K medical education %K abortion access %K education %K survey study %K students %K training %K patient care %K care %K medical students %K human rights %K autonomy %D 2025 %7 7.1.2025 %9 Original Paper %J Interact J Med Res %G English %X Background: By allowing for abortion bans and restrictions to take effect in the majority of US states, the 2022 Dobbs v Jackson Women’s Health Organization decision portends to have lasting impacts on patient care and the physician workforce. Notably, it is already beginning to impact practice location preferences of US health care workers, evidenced by declining application rates to residency programs in abortion-restrictive states since 2022. Yet, there remains a gap in the literature regarding why this trend exists. Objective: This study aims to describe what factors are driving the practice location preferences of medical students and physicians after the Dobbs decision. Methods: This study analyzes qualitative data from a web-based, cross-sectional study. In August 2022, a nonprobabilistic sample of physicians and medical students were surveyed on social media about the impact of overturning Roe v Wade on practice location preferences, which included the free-text question “Please share your thoughts about the overturning of Roe v Wade and how it will affect your decision about your (residency/job or fellowship) programs.” A total of 3 independent team members completed an inductive thematic analysis of 524 free responses, resolving differences by discussion. Results: Approximately 1 in 4 survey respondents also completed the free-response item (524/2063, 25.4%); a total of 219 were medical students, 129 were residents and fellows, and 176 were practicing physicians. Of them, approximately half (261/524, 50.5%) resided in states where abortion bans were in place or anticipated. Those who answered the free-response item were relatively more likely to hail from states with restrictive abortion bans (P<.001) compared to those who did not, with other demographic characteristics being largely similar between the groups. Inductive thematic analysis yielded 2 broad thematic categories: patient-related and workforce-related factors influencing practice decision preferences. The 3 most common themes overall were respondent concerns regarding their patient’s access to care (249/524, 47.5%), their desire not to practice or train in a state with abortion restrictions regardless of current residence (249/524, 47.5%), and their personal belief that abortion bans are human rights and/or body autonomy violation (197/524, 37.6%). Some respondents stated that the Dobbs decision would not impact their choice of practice location (41/524, 7.8%), and some supported it (35/594, 6.7%). Conclusions: This study shows that abortion restrictions are having an impact on the practice location preferences of the physician workforce due to both patient care and personal factors. It is important that state policy makers and others who are considering abortion restrictions also consider how to address these concerns of physicians and medical students, to avoid worsening geographic maldistribution of physicians and worsening access to care from physicians for their citizens. %M 39773422 %R 10.2196/55035 %U https://www.i-jmr.org/2025/1/e55035 %U https://doi.org/10.2196/55035 %U http://www.ncbi.nlm.nih.gov/pubmed/39773422 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e60136 %T Disparities in the Prevalence of Urinary Diseases Among Prisoners in Taiwan: Population-Based Cross-Sectional Study %A Wang,Yen-Chun %A Jiesisibieke,Zhu Liduzi %A Yang,Yu-Pei %A Wang,Bing-Long %A Hsiung,Ming-Chon %A Tung,Tao-Hsin %K prisoners %K Taiwan %K health care %K urinary disease %K urinary tract infection %K prison health %D 2024 %7 24.12.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Prisoner health is a major global concern, with prisoners often facing limited access to health care and enduring chronic diseases, infectious diseases, and poor mental health due to unsafe prison environments, unhygienic living conditions, and inadequate medical resources. In Taiwan, prison health is increasingly an issue, particularly concerning urinary diseases such as urinary tract infections. Limited access to health care and unsanitary conditions exacerbate these problems. Urinary disease epidemiology varies by sex and age, yet studies in Asia are scarce, and comprehensive data on urinary diseases in Taiwanese prisons remain limited. Objective: This study aimed to investigate the prevalence of urinary diseases among Taiwanese prisoners and explore the differences in disease prevalence between men and women, as well as across different age groups. Methods: This study used data on prisoners from the National Health Insurance Research Database covering the period from January 1 to December 31, 2013. Prisoners covered by National Health Insurance who were diagnosed with urinary diseases, identified by ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) codes 580‐599 based on their medical records, and had more than one medical visit to ambulatory care or inpatient services were included. Sex- and age-stratified analyses were conducted to determine the differences in the prevalence of urinary diseases. Results: We examined 83,048 prisoners, including 2998 with urinary diseases. The overall prevalence of urinary system diseases among prisoners was 3.61% (n=2998; n=574, 6.64% in men and n=2424, 3.26% in women). The prevalence rate in men was significantly lower than that in women (prevalence ratio: 0.46, P<.001). In age-stratified analysis, the prevalence rate among prisoners aged >40 years was 4.5% (n=1815), compared to 2.77% (n=1183) in prisoners aged ≤40 years. Prisoners aged >40 years had a higher prevalence (prevalence ratio: 1.69, P<.001). Other disorders of the urethra and urinary tract (ICD-9-CM: 599), including urinary tract infection, urinary obstruction, and hematuria, were the most prevalent diseases of the urethra and urinary tract across age and sex groups. Women and older prisoners had a higher prevalence of most urinary tract diseases. There were no significant sex-specific differences in adjusted prevalence ratios for acute glomerulonephritis, nephrotic syndrome, kidney infections, urethritis (nonsexually transmitted), or urethral syndrome. However, based on the age-specific adjusted prevalence ratio analysis, cystitis was more prevalent among younger prisoners (prevalence ratio: 0.69, P=.004). Conclusions: Urinary system infections and inflammation are common in prisons. Our findings advocate for policy reforms aimed at improving health care accessibility in prisons, with a particular focus on the needs of high-risk groups such as women and older prisoners. Further research linking claims data with prisoner information is crucial to providing more comprehensive medical services and achieving health equity. %R 10.2196/60136 %U https://publichealth.jmir.org/2024/1/e60136 %U https://doi.org/10.2196/60136 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55982 %T Insights and Trends in Open Note Access: Retrospective Observational Study %A Badwal,Randeep Singh %A Cavo,Paul %A Panesar,Mandip %+ Erie County Medical Center, 462 Grider Street, Buffalo, NY, 14215, United States, 1 716 898 1417, MPanesar@ecmc.edu %K open note trends %K open notes %K open note access %K open note use, open note sex %K open note specialty %K clinical note views %K patient portal %K patients %K trends %K hospitals %K engagement %K retrospective observational study %K outpatient %K assessment %K older patients %K adults %K pandemic %K COVID-19 %D 2024 %7 17.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: As of 2021, at least 4 out of every 5 hospitals offered patients access to clinical notes via a web-based patient portal, a number that is expected to grow because of the 21st Century Cures Act. There is limited data on how open note use may have evolved over time or which types of clinical interactions were viewed most in the outpatient setting. Objective: This study aims to analyze trends in outpatient open note access over time; characterize usage in terms of age, sex, and clinical interaction type; and assess the method of access to help uncover areas of improvement in patient engagement and identify further areas of research. Methods: A retrospective observational study was conducted at Erie County Medical Center from November 1, 2021, to December 31, 2022, to coincide with the time that open notes went live. Outpatient note access and account logs were downloaded from the portal and combined into a single dataset consisting of 18,384 note accesses by 4615 users, with column headings of the patient index, sex, age, note title that was accessed, clinical interaction type, time stamp of note creation, time stamp of access, and method of access (web vs mobile). A separate table was created with sex data for all 35,273 portal accounts. Microsoft Excel and Microsoft Power Query were used to combine and analyze the data. Results: During the study period, 4615 portal users viewed 12,150 documents for a total of 18,384 times, averaging 2.6 notes per patient viewed 4 times. Only 13.1% (4615/35,273) of all portal inpatient and outpatient registrants viewed their outpatient notes. There was a female predominance in those who viewed notes (2926/4615, 63.4%; P<.001), while 56.8% (20,047/35,273) of all portal registrants were female. Users in their 30s and 50s accessed more notes than other age groups. The ratio of mobile-to-web access of notes tended to decrease as a function of increasing age, which was not observed in those aged ≥90 years. Notes regarding COVID-19 assessments were the most accessed among all clinical interactions (4725/12,150, 38.9%). Overall, the number of users accessing notes reached a maximum of 1968 before declining to 1027 by the end of the study period. Conclusions: Open note access was largely dominated by COVID-19 assessments, and the number of users viewing their notes has declined over time as the pandemic subsided. Furthermore, female patients and those aged in their 30s as well as 50s viewed more notes than other groups. Finally, the percentage of notes viewed via a mobile device tended to decrease as a function of increasing age, showing that web-based access of open notes is an important modality for older patients. %M 39689311 %R 10.2196/55982 %U https://www.jmir.org/2024/1/e55982 %U https://doi.org/10.2196/55982 %U http://www.ncbi.nlm.nih.gov/pubmed/39689311 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e59368 %T Dermatology in Student-Run Clinics in the United States: Scoping Review %A Kamat,Samir %A Agarwal,Aneesh %A Lavin,Leore %A Verma,Hannah %A Martin,Lily %A Lipoff,Jules B %K dermatology %K dermatologist %K dermatological %K volunteerism %K underserved population %K medical education %K student-run clinic %K scoping review %K review %K PRISMA %D 2024 %7 13.12.2024 %9 %J JMIR Dermatol %G English %X Background: Student-run clinics (SRCs) for dermatology hold potential to significantly advance skin-related health equity, and a comprehensive analysis of these clinics may inform strategies for optimizing program effectiveness. Objective: We aimed to perform a scoping review of the literature about dermatology SRCs across the United States. Methods: We conducted systematic literature searches of Ovid MEDLINE, Ovid Embase, and Scopus on March 1, 2023, and June 19, 2024. No date, language, or paper-type restrictions were included in the search strategy. A total of 229 references were uploaded to Covidence for screening by 2 independent reviewers (SK and LL), and 23 full-text documents were assessed for eligibility. After an additional 8 documents were identified through a gray literature search, a total of 31 studies were included in the final analysis. Inclusion criteria were as follows: (1) studies set in an SRC, which was operationally led by medical students and could render condition-relevant treatments to patients, with dermatology care; (2) published in English; (3) within the United States; (4) included characterization of any of the following: logistics, care, patients, or design; and (5) included all study or document types, including gray literature that was not peer reviewed (eg, conference abstracts, preprints, and letters to the editor). Exclusion criteria were (1) papers not published in English and (2) those with duplicated data or that were limited in scope or not generalizable. Data were extracted qualitatively using Microsoft Excel to categorize the studies by several domains, including clinic location, demographics, services offered, and barriers to care. Results: There are at least 19 dermatology SRCs across the United States. The most common conditions encountered included atopic dermatitis; acne; fungal infections; benign nevi; psoriasis; and neoplasms, such as basal cell carcinoma, squamous cell carcinoma, and melanoma. Key facilitators for the clinics included faculty oversight, attending physician participation for biopsy histopathology, and dedicated program coordinators. Major barriers included lack of follow-up, medication nonadherence, and patient no-shows. Conclusions: Dermatology SRCs serve a diverse patient population, many of whom are underrepresented in traditional dermatology settings. This scoping review provides insights to help build stronger program foundations that better address community dermatologic health needs. %R 10.2196/59368 %U https://derma.jmir.org/2024/1/e59368 %U https://doi.org/10.2196/59368 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e54240 %T Close-Up on Ambulance Service Estimation in Indonesia: Monte Carlo Simulation Study %A Brice,Syaribah N %A Boutilier,Justin J %A Palmer,Geraint %A Harper,Paul R %A Knight,Vincent %A Tuson,Mark %A Gartner,Daniel %+ School of Mathematics, Cardiff University, Senghennydd Road, Cardiff, CF24 4AG, United Kingdom, 44 (0)29 2087 4811, BriceSN@cardiff.ac.uk %K emergency medical services %K ambulance services %K hospital emergency services %K Southeast Asian countries %K low-and-middle-income countries %K EMS %K survey %D 2024 %7 13.12.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Emergency medical services have a pivotal role in giving timely and appropriate responses to emergency events caused by medical, natural, or human-caused disasters. To provide adequate resources for the emergency services, such as ambulances, it is necessary to understand the demand for such services. In Indonesia, estimates of demand for emergency services cannot be obtained easily due to a lack of published literature or official reports concerning the matter. Objective: This study aimed to ascertain an estimate of the annual volume of hospital emergency visits and the corresponding demand for ambulance services in the city of Jakarta. Methods: In this study, we addressed the problem of emergency services demand estimation when aggregated detailed data are not available or are not part of the routine data collection. We used survey data together with the local Office of National Statistics reports and sample data from hospital emergency departments to establish parameter estimation. This involved estimating 4 parameters: the population of each area per period (day and night), the annual per capita hospital emergency visits, the probability of an emergency taking place in each period, and the rate of ambulance need per area. Monte Carlo simulation and naïve methods were used to generate an estimation for the mean ambulance needs per area in Jakarta. Results: The results estimated that the total annual ambulance need in Jakarta is between 83,000 and 241,000. Assuming the rate of ambulance usage in Jakarta at 9.3%, we estimated the total annual hospital emergency visits in Jakarta at around 0.9-2.6 million. The study also found that the estimation from using the simulation method was smaller than the average (naïve) methods (P<.001). Conclusions: The results provide an estimation of the annual emergency services needed for the city of Jakarta. In the absence of aggregated routinely collected data on emergency medical service usage in Jakarta, our results provide insights into whether the current emergency services, such as ambulances, have been adequately provided. %M 39671572 %R 10.2196/54240 %U https://www.i-jmr.org/2024/1/e54240 %U https://doi.org/10.2196/54240 %U http://www.ncbi.nlm.nih.gov/pubmed/39671572 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56091 %T Associations Between Successful Home Discharge and Posthospitalization Care Planning: Cross-Sectional Ecological Study %A Takashi,Naoki %A Fujisawa,Misaki %A Ohtera,Shosuke %+ Department of Health Economics, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, 7-430, Morioka-Cho, Aichi, 474-8511, Japan, 81 562 46 2311, takashi@ncgg.go.jp %K health services research %K health policy %K quality of care %K access to care %K outcome assessment %K public health %K health service %K accessible %K accessibility %K care coordination %K health outcome %K surveillance %K regional disparities %K nonstandardized care %K nonstandardization %K hospital discharge %K hospital care %K analysis %K Japan %K older adults %D 2024 %7 12.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Effective discharge planning is crucial for successful care transitions, reducing hospital length of stay and readmission rates. Japan offers a financial incentive to enhance the coordination of posthospitalization care planning for patients with complex needs. However, the national impact of this incentive remains unclear. Objective: This study aimed to (1) assess the association between the number of claims submitted for discharge planning, as an indicator of the provision of posthospitalization care planning, and key health care outcomes, including discharges to home, 30-day readmissions, length of stay, and medical expenditures at the prefectural level in Japan, and (2) to describe regional differences in the provision of posthospitalization care planning and explore associated factors. Methods: This ecological study used prefectural-level data from fiscal year 2020. Claims submitted for discharge planning were used as indicators that posthospitalization care planning was provided. Supply-adjusted standardized claim ratios (SCRs) were calculated using data from the Seventh National Database of Health Insurance Claims, to evaluate and compare the number of claims across 47 prefectures in Japan, accounting for differences in population structure. Key outcomes included discharges to home, 30-day readmissions, length of stay, and medical expenditures. Multivariate negative binomial regression models assessed associations between SCRs and outcomes, adjusting for socioeconomic covariates. In addition, regional differences in the provision of posthospitalization care planning and associated factors were analyzed using the Mann-Whitney U test. Prefectures were divided into 3 groups (low, medium, and high) based on tertiles of each factor, and supply-adjusted SCRs were compared across these groups. Results: The ratio of the minimum to maximum supply-adjusted SCR was 10.63, highlighting significant regional variation. Higher supply-adjusted SCRs, indicating more frequent provision of posthospitalization care planning, were associated with an increase of 9.68 (95% CI 0.98-18.47) discharges to home per 1000 patients for each SD increase in supply-adjusted SCR. Several factors contributed to regional differences in the supply-adjusted SCR for posthospitalization care planning. A higher supply-adjusted SCR was significantly associated with a greater number of nurses per 100 hospital beds (median SCR in low, medium, and high groups: 0.055, 0.101, and 0.103, respectively); greater number of care manager offices per 100 km2 of habitable area (0.088, 0.082, and 0.116); higher proportion of hospitals providing electronic medical information to patients (0.083, 0.095, and 0.11); lower proportion of older adults living alone (0.116; 0.092; 0.071); and higher average per capita income (0.078, 0.102, and 0.102). Conclusions: The provision of posthospitalization care planning is associated with an increased likelihood of discharge to home, underscoring its importance in care transitions. However, significant regional disparities in care coordination exist. Addressing these disparities is crucial for equitable health care outcomes. Further research is needed to clarify causal mechanisms. %R 10.2196/56091 %U https://formative.jmir.org/2024/1/e56091 %U https://doi.org/10.2196/56091 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e64439 %T Public Awareness and Use of Price Transparency: Report From a National Survey %A Pathak,Yuvraj %A Muhlestein,David %+ West Health Institute, 10350 N Torrey Pines Rd, La Jolla, CA, 92037, United States, 1 8585357000, ypathak@westhealth.org %K price transparency %K consumer choice %K survey %K questionnaire %K finance %K cost %K economics %K price %K pricing %K consumer %K transparent %K Medicare %K Medicaid %K insurance %D 2024 %7 12.12.2024 %9 Research Letter %J Interact J Med Res %G English %X %M 39666968 %R 10.2196/64439 %U https://www.i-jmr.org/2024/1/e64439 %U https://doi.org/10.2196/64439 %U http://www.ncbi.nlm.nih.gov/pubmed/39666968 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e57960 %T Results of a Digital Multimodal Motivational and Educational Program as Follow-Up Care for Former Cardiac Rehabilitation Patients: Randomized Controlled Trial %A Bretschneider,Maxi Pia %A Mayer-Berger,Wolfgang %A Weine,Jens %A Roth,Lena %A Schwarz,Peter E H %A Petermann,Franz %K mHealth %K apps %K digital technology %K digital interventions %K coronary heart disease %K lifestyle intervention %K cardiac rehabilitation %K quality of life %K cardiac care %D 2024 %7 11.12.2024 %9 %J JMIR Cardio %G English %X Background: Digital interventions are promising additions for both usual care and rehabilitation. Evidence and studies for the latter, however, are still rare. Objective: The aim of the study was to examine the app/web-based patient education program called “mebix” (previously called “Vision 2 – Gesundes Herz”) regarding its effectiveness in relation to the parameters of disease-specific quality of life (HeartQoL), cardiovascular risk profile (Cardiovascular Risk Management [CARRISMA]), and prognostic estimation of early retirement (Screening instrument work and occupation [SIBAR]) in 190 participants from a cardiological rehabilitation clinic. Methods: To evaluate mebix, 354 patients from the Roderbirken Clinic of the German Pension Insurance Rhineland (Germany) with a coronary heart diesase were recruited and randomized either to the intervention group (using mebix postrehabiliation for up to 12 months) or the control group (receiving standard care). The data collection took place at the end of inpatient rehabilitation (t0), as well as 6 months (t1) and 12 months (t2) after the end of rehabilitation. Analyses of variance are used to assess the overall significance of difference in outcome parameters between groups and over time. Results: The primary endpoint of disease-related quality of life shows a significant improvement of 7.35 points over the course of the intervention that is also more pronounced in the intervention group. Similarly, the 10-year risk of cardiovascular death and myocardial infarction showed significant improvements in the cardiovascular risk profile over time and between groups, indicating better results in the intervention group (ie, a reduction of −1.59 and −5.03, respectively). Positive effects on secondary outcomes like body weight, blood pressure, and number of smokers only showed time effects, indicating no difference between the groups. In addition, the SIBAR was significantly lower/better at the end of the observation period than at the beginning of the observation for both groups. Conclusions: Overall, the digital training program represents an effective follow-up offer after rehabilitation that could be incorporated into standard care to further improve disease-related quality of life and cardiovascular risk profiles. Trial Registration: German Clinical Trials Register DRKS00007569; https://drks.de/search/en/trial/DRKS00007569 %R 10.2196/57960 %U https://cardio.jmir.org/2024/1/e57960 %U https://doi.org/10.2196/57960 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60817 %T Improving Oral Health in Prisons (PriOH): Protocol for a Randomized Controlled Trial %A Bryne,Emilie %A Bergum,Kathrine Høyvik %A Gjedrem,William Gilje %+ Oral Health Centre of Expertise Rogaland, Postbox 130 Sentrum, Stavanger, 4001, Norway, 47  51 50 68 46 , emilie.bryne@throg.no %K intervention %K motivational interviewing %K oral care %K marginalized groups %K correctional services %K implementation %K oral hygiene %K oral health %K randomized controlled trial %K RCT %K prison %K dental care %K pilot study %K people living in prison %D 2024 %7 11.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: People living in prisons often experience poor oral health, which could be attributed to their limited access to (dental) care, financial constraints, and a general lack of awareness and prioritization toward their oral hygiene. A pilot study involving motivational interviewing (MI) has shown promising results for improving the oral health outcomes of people living in prisons. Objective: The protocol for this study aims to assess the efficacy of integrated MI and oral hygiene packages in improving oral health among people living in prisons, compared to controls without added MI. Methods: This oral health in prisons study is a multicenter, randomized, double-blinded controlled trial that recruited inmates from 4 prisons in Rogaland County. The trial aimed to recruit 320 participants before randomly allocating them to either a control or intervention group. The intervention group received MI, consisting of a 30-minute session encouraging inmates to discuss their current and desired oral health behaviors and attitudes, highlighting discrepancies to motivate change. Assessments were conducted at 4 and 12 weeks after initiation. The primary outcome measurement is the mucosal-plaque scores to assess oral health behaviors, attitudes, and oral hygiene. Secondary outcome measurements are oral hygiene routines, sugary food and drink intake, oral health perception, and oral health-related questions. Results: Data collection started in November 2021 and ended in June 2023. A total of 327 participants were recruited, of which 126 received the intervention. Conclusions: Integrating MI in oral health programs at prisons can significantly improve the oral health of incarcerated individuals. Should the results from this study demonstrate efficacy, it could be valuable insight for policy makers, oral health practitioners, and correctional services in addressing the needs of a traditionally underserved group before being scaled up to enhance dental care practices in prisons. Trial Registration: ClinicalTrials.gov NCT05695443; https://clinicaltrials.gov/study/NCT05695443 International Registered Report Identifier (IRRID): DERR1-10.2196/60817 %M 39661440 %R 10.2196/60817 %U https://www.researchprotocols.org/2024/1/e60817 %U https://doi.org/10.2196/60817 %U http://www.ncbi.nlm.nih.gov/pubmed/39661440 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59621 %T Incentivizing Rural Work Preferences Among Specialist Physicians: Protocol for a Discrete Choice Experiment %A Joshi,Anushree %A Panchamia,Jallavi %A Pandya,Apurvakumar %+ Department of Health Policy, Management and Behavioral Science, Indian Institute of Public Health Gandhinagar, NH 147, Palaj Village, Opp. Air Force Headquarter, Gandhinagar, Gujarat, 382042, India, 91 9166052350, ajoshi@iiphg.org %K discrete choice experiment %K specialist physicians %K community health centers %K rural retention %K policy interventions %D 2024 %7 9.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Retaining specialist physicians in rural parts of India poses a fundamental challenge, which affects the health care system’s functionality and provision of standard health care services. There has been an acute shortfall of specialist physicians in the fields of medicine, pediatrics, obstetrics and gynecology, and surgery at rural community health centers. This necessitates urgent policy focus to address the shortages and design effective rural retention strategies. In this study, which uses a discrete choice experiment (DCE), individuals choose from multiple-choice preferences that resemble hypothetical job descriptions. Objective: DCEs are a quantitative approach to assessing several aspects of job selection. This study aims to develop a detailed plan of a DCE method used to determine specialist physicians’ job choices. This protocol outlines the DCE method, which uses an exploratory sequential mixed methods research design to understand specialist physicians’ preferences and design reward packages that would effectively motivate them to work in underserved regions. Methods: The qualitative phase of the study involved identifying job attributes and their corresponding levels for the DCE. We followed a meticulous process, which included reviewing relevant literature, performing qualitative pilot work, conducting in-depth individual interviews, and consulting with medical and health experts. The quantitative phase involved generating a D-efficient orthogonal fractional factorial design using Ngene software to create choice scenarios using the identified job factors and their corresponding levels. The generated choice scenarios were blocked into 6 versions in 6 blocks. The DCE was undertaken among final-year postgraduate medical residents and specialist physicians from several health care facilities in Rajasthan. Various statistical models will be applied to explore the response variability and quantify the trade-offs that participants are willing to make for nonmonetary features as a substitute for adjustments in the monetary attribute. Results: After the ethics committee’s approval of the study, the qualitative data collection phase occurred from September to December 2021, while the quantitative phase took place from May to August 2022. Six attributes and 14 levels were identified and established through qualitative surveys. The experimental design resulted in 36 choice situations, which were grouped into 6 blocks. The preliminary investigation demonstrated that the instrument was valid and reliable. Statistical data analysis has been initiated, and the principal findings are expected to be disseminated in January 2025. Conclusions: The protocol provides a systematic framework to assess specialist physicians’ preferences regarding working in rural health care centers. This research has the potential to substantially influence the future of rural health care by laying the foundation for understanding specialist physicians’ choices, which will help design future incentive schemes, policy interventions, and research. International Registered Report Identifier (IRRID): DERR1-10.2196/59621 %M 39652867 %R 10.2196/59621 %U https://www.researchprotocols.org/2024/1/e59621 %U https://doi.org/10.2196/59621 %U http://www.ncbi.nlm.nih.gov/pubmed/39652867 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60805 %T Development and Validation of a Novel Tool to Measure Medication Adherence for Noncommunicable Diseases in India: Protocol for an Exploratory Sequential Mixed Methods Multicentric Study %A Thomas,Joe %A Jose,Maria %A Rajmohan,Priyanka %A Fathima,Farah Naaz %A Moosan,Hisham %A Jose,Nisha K %A Anish,Thekkumkara Surendran %A Bairwa,Mohan %A Goswami Mahanta,Tulika %A Apte,Aditi %A Cherian,Jerin Jose %A Kuttichira,Praveenlal %A Varma P,Ravi Prasad %+ Department of Community Medicine, Jubilee Mission Medical College and Research Institute, East fort, Thrissur, 680005, India, 91 8593841000, cmicmrsrum@gmail.com %K medication adherence %K noncommunicable diseases %K self-report %K psychometric properties %K validation %K reproducibility of results %D 2024 %7 3.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In high-income countries, only 50% of patients treated for chronic diseases adhere to the prescribed treatment. This issue is even more pronounced in resource-limited countries. Medication adherence scales are simple, low-cost approaches to identify nonadherence in clinical practice. In India, nonadherence to medication varies from 18.7% to 74%, assessed using scales validated in the Western population, as there is no validated medication adherence tool contextualized to the Indian setting. The phrasing of questions in scales validated elsewhere and its interpretations may vary when applied in Indian patients unless accounting for the unique cultural, social, and economic factors influencing medication adherence in India. This could result in inaccurate reports of adherence behavior. Objective: This study aims to develop and validate a novel medication adherence tool for select noncommunicable diseases (diabetes mellitus, hypertension, chronic obstructive pulmonary disease, bronchial asthma, and coronary artery disease) in the Indian population. Methods: An exploratory sequential mixed methods design will be used, beginning with a qualitative phase where the construct of the scale is defined and preliminary items are generated through a scoping review, focus group discussions, and in-depth interviews. This will be followed by the tool’s development phase, including an expert panel review and item revision. Finally, a quantitative phase in 4 zones in India (North, South, East, and West) will be conducted to confirm and validate the newly developed scale. Results: In the first phase, we will frame the construct definition and develop an inventory of potential items for the proposed medication adherence tool. In the second phase, item-level and scale-level content validity indices, along with content validity ratio, will be estimated. In the third phase, we will conduct an item reduction analysis and determine the scoring matrix and item weightage after expert review. We will assess the tool's psychometric properties, plot the receiver operating characteristic (ROC) curve to set an adherence cut-off score, and compute the construct validity and test-retest reliability from the quantitative survey. Conclusions: A medication adherence tool for noncommunicable diseases, developed after ensuring it is ethnically, culturally, and linguistically appropriate incorporating stakeholder perspectives and validated in community settings, would offer a real-world perspective of adherence. The tool will have 2 versions for clinical practice and research, aiding policy makers in adopting tailored adherence policies. International Registered Report Identifier (IRRID): PRR1-10.2196/60805 %M 39625743 %R 10.2196/60805 %U https://www.researchprotocols.org/2024/1/e60805 %U https://doi.org/10.2196/60805 %U http://www.ncbi.nlm.nih.gov/pubmed/39625743 %0 Journal Article %@ 2817-092X %I JMIR Publications %V 3 %N %P e57661 %T Investigation of Study Procedures to Estimate Sensitivity and Reliability of a Virtual Physical Assessment Developed for Workplace Concussions: Method-Comparison Feasibility Study %A Barnes,Keely %A Sveistrup,Heidi %A Bayley,Mark %A Egan,Mary %A Bilodeau,Martin %A Rathbone,Michel %A Taljaard,Monica %A Karimijashni,Motahareh %A Marshall,Shawn %K brain injury %K virtual %K assessment %K remote %K evaluation %K concussion %K adult %K clinician review %K in-person %K comparison %K sensitivity %K reliability %K acceptability survey %K feasibility study %K psychometric properties %K vestibular/ocular motor screening %K VOMS %K workplace %K clinician %K hospital %K rehabilitation center %K brain %K neurology %K neuroscience %K neurotechnology %K technology %K digital intervention %K digital health %K psychometrics %K physical assessment %K clinical assessment %K workplace safety %K mobile phone %D 2024 %7 27.11.2024 %9 %J JMIR Neurotech %G English %X Background: Remote approaches to workplace concussion assessment have demonstrated value to end users. The feasibility of administering physical concussion assessment measures in a remote context has been minimally explored, and there is limited information on important psychometric properties of physical assessment measures used in remote contexts. Objective: The objectives of this feasibility study were to determine recruitment capability for a future larger-scale study aimed at determining sensitivity and reliability of the remote assessment, time required to complete study assessments, and acceptability of remote assessment to people with brain injuries and clinicians; document preliminary results of the sensitivity of the remote assessment when compared to the in-person assessment; and estimate the preliminary interrater and intrarater reliability of the remote assessments to inform procedures of a future larger-scale study that is adequately powered to reliably estimate these parameters of interest. Methods: People living with acquired brain injury attended 2 assessments (1 in-person and 1 remote) in a randomized order. The measures administered in these assessments included the finger-to-nose test; balance testing; and the Vestibular/Ocular Motor Screening (VOMS) tool, including documentation of change in symptoms and distance for near point convergence, saccades, cervical spine range of motion, and evaluation of effort. Both assessments occurred at the Ottawa Hospital Rehabilitation Center. After the assessments, a clinician different from the person who completed the original assessments then viewed and documented findings independently on the recordings of the remote assessment. The same second clinician viewed the recording again approximately 1 month following the initial observation. Results: The rate of recruitment was 61% (20/33) of people approached, with a total of 20 patient-participants included in the feasibility study. A total of 3 clinicians participated as assessors. The length of time required to complete the in-person and remote assessment procedures averaged 9 and 13 minutes, respectively. The majority of clinicians and patient-participants agreed or strongly agreed that they were confident in the findings on both in-person and remote assessments. Feedback obtained revolved around technology (eg, screen size), lighting, and fatigue of participants in the second assessment. Preliminary estimates of sensitivity of the remote assessment ranged from poor (finger-to-nose testing: 0.0) to excellent (near point convergence: 1.0). Preliminary estimates of reliability of the remote assessment ranged from poor (balance testing, saccades, and range of motion: κ=0.38‐0.49) to excellent (VOMS change in symptoms: κ=1.0). Conclusions: The results of this feasibility study indicate that our study procedures are feasible and acceptable to participants. Certain measures show promising psychometric properties (reliability and sensitivity); however, wide CIs due to the small sample size limit the ability to draw definitive conclusions. A planned follow-up study will expand on this work and include a sufficiently large sample to estimate these important properties with acceptable precision. International Registered Report Identifier (IRRID): RR2-10.2196/57663 %R 10.2196/57661 %U https://neuro.jmir.org/2024/1/e57661 %U https://doi.org/10.2196/57661 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59749 %T Respiratory Strength Training Versus Respiratory Relaxation Training in the Rehabilitation of Physical Impairment, Function, and Return to Participation After Stroke: Protocol for a Randomized Controlled Trial %A Rose,Dorian K %A Brunetti,Gina %A Cavka,Kathryn %A Hoisington,J Brooke %A Snyder,Hannah %A Xue,Wei %A Smith,Barbara K %+ Department of Physical Therapy, University of Florida, College of PHHP; HSC; PO. Box 100154, Gainesville, FL, 32610-0154, United States, 1 352 273 8307, dkrose@phhp.ufl.edu %K stroke %K rehabilitation %K exercise %K clinical trial %K respiration %K wellness %K community based %D 2024 %7 27.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Persistent disability in chronic stroke survivors is often attributed to arm or leg weakness; however, respiratory muscle weakness also impedes poststroke rehabilitation, reduces quality of life, and increases the risk of health complications. Respiratory complications are common after stroke and place patients at risk for both prolonged functional disability and mortality. In addition, stroke survivors face ongoing cardiovascular disease that places them at risk for recurrent stroke. Objective: The study aims to compare the effects of 2 respiratory training programs, paired with individualized flexibility, strengthening, and cardiovascular exercise programs, on physiologic, activity, and societal participation outcomes in chronic stroke survivors. Methods: This study will be a randomized controlled trial. Participants are 80 community-dwelling adults with chronic stroke. In conjunction with a 24-session (3 times/week for 8 weeks), American Heart Association–informed, whole-body exercise program, participants will be randomized to receive either respiratory strength training or respiratory relaxation training. Study intervention will be directed by a physical therapist and take place in a community fitness center. Outcome assessments will occur in a clinical research center. The primary outcome measure is maximal respiratory pressure. Secondary outcome measures include airway clearance, walking endurance, spatial-temporal gait characteristics, community walking, functional strength and fatigue, depression, and societal participation measures. Longer-term societal participation is a complex domain that may be influenced by other factors beyond physical function. Participants’ health status will be monitored for 1 year following the intervention for falls, respiratory illness, and hospitalizations. Additional subanalyses will evaluate the effect of smoke exposure on short- and long-term outcomes. Outcome assessors are blinded to group assignments. Respiratory relaxation training is an active comparator, but no pure control group is included. Results: This study was funded in March 2020 with enrollment commencing in November 2020. Completion of enrollment is projected for May 2025 with a study projected end date of April 2026. Published results are anticipated in Fall 2026. Conclusions: Results from this study will improve our understanding of the additive benefits of respiratory exercises on short- and long-term physiologic, functional, and societal gains for these individuals. These data will be instructive to meet a current unmet rehabilitative need to promote patient-centered care and contribute to decreasing morbidity and mortality in chronic stroke survivors. Trial Registration: ClinicalTrials.gov: NCT05819333; https://clinicaltrials.gov/study/NCT05819333 International Registered Report Identifier (IRRID): DERR1-10.2196/59749 %M 39602207 %R 10.2196/59749 %U https://www.researchprotocols.org/2024/1/e59749 %U https://doi.org/10.2196/59749 %U http://www.ncbi.nlm.nih.gov/pubmed/39602207 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60222 %T Enhancing Care Coordination in Oncology and Nononcology Thoracic Surgery Care Pathways Through a Digital Health Solution: Mixed Methods Study %A Nabelsi,Véronique %A Plouffe,Véronique %+ Département des sciences administratives, Université du Québec en Outaouais, C.P. 1240, Succ. Hull, Gatineau, QC, J8X 3X7, Canada, 1 8195953900 ext 1915, veronique.nabelsi@uqo.ca %K digital health solution %K care coordination %K optimization %K health care providers %K oncology %K nononcology %K thoracic surgery %K pathways %K continuity of care %K interfacility %K Quebec %D 2024 %7 26.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Health-system fragmentation in Quebec significantly impacts care coordination, leading to interruptions in patients’ care pathways and adverse effects on their health. Coordinating interfacility service corridors is complex and requires collaboration between multiple health care providers (HCPs) and care settings. Effective care coordination is essential to ensure optimal patient management at transition points. Objective: This study aims to improve oncology and nononcology thoracic surgery care pathways by enhancing care coordination during interfacility transfers through a digital health solution. Methods: A multicenter implementation study was conducted across 2 health regions and 2 health care facilities in Quebec. We conducted 27 semistructured interviews with HCPs and managers to better understand the care pathways. Participatory design workshops were held with future users and key stakeholders at an early stage of the technology’s design to validate the prototype’s functionalities and workflows. A web survey was sent to all end users (N=13) to assess their experience with the platform. Results: All participants (100%) either “agreed” or “strongly agreed” that the platform provided significant benefits. It enhanced interestablishment coordination (4/13, 31% agreed and 9/13, 69% strongly agreed) and continuity of care and services (8/13, 62% agreed and 5/13, 38% strongly agreed), and it contributed to better management and patient intake (10/13, 77% agreed and 3/13, 23% strongly agreed) and process fluidity (3/13, 77% agreed and 3/13, 23% strongly agreed). Surgeons from the McGill University Health Centre confirmed that the platform facilitated and secured information transmission (2/5, 40% agreed and 3/5, 60% strongly agreed) and kept track of oncology patient referrals, follow-up needs, and cases where surgery is unnecessary (2/5, 40% agreed and 3/5, 60% strongly agreed). Nursing staff from the Centre intégré de santé et de services sociaux de l’Outaouais and McGill University Health Centre reported high satisfaction with the platform’s support during preoperative visit, surgery, and discharge processes. All participants perceived the platform as intuitive and easy to use. Additionally, participants valued its efficiency in providing rapid access to patient data, which reduces task time and ensures document security, thereby improving care coordination across facilities. The project’s success has convinced the HCPs and senior management at both health care facilities to pursue long-term use of the Akinox digital health platform. Conclusions: This pilot project represents a significant advancement in thoracic surgery care pathways and the coordination of interfacility health care service corridors. The project provides care pathways that are adaptable to other surgical specialties. It also paves the way for improving care in cancer and other health care networks while highlighting the key role of nurse navigators in patient care management. The project underscores the value of strategic leadership and stakeholders’ collaboration to improve care coordination and operational efficiency by demonstrating technology’s essential role in patient care pathways. %M 39591606 %R 10.2196/60222 %U https://formative.jmir.org/2024/1/e60222 %U https://doi.org/10.2196/60222 %U http://www.ncbi.nlm.nih.gov/pubmed/39591606 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e58613 %T Homestay Hosting Dynamics and Refugee Well-Being: Scoping Review %A Al-Hamad,Areej %A Yasin,Yasin Mohammad %A Metersky,Kateryna %A Guruge,Sepali %A Jung,Grace %A Mahsud,Khadija %+ Toronto Metropolitan University, DCC544-288 Church Street, Toronto, ON, M5B 1Z5, Canada, 1 416 979 5044 ext 554727, areej.hamad@torontomu.ca %K homestay %K host-guest relationship %K hospitality %K hosting %K well-being %K homestay accommodation %K host-refugee relation %K refugee %K scoping review %K review %D 2024 %7 25.11.2024 %9 Review %J Interact J Med Res %G English %X Background: Homestay accommodations aim to support a smoother transition for refugees; yet, the intricate nature of relationships between refugees and their hosting families can make this process complex, which, in turn, can affect their health and well-being. It is crucial to grasp the experiences of both refugees and their host families in order to foster effective settlement, integration, and well-being. Objective: The purpose of this scoping review is to explore the dynamics of homestay or hosting with a focus on understanding the experiences of both refugees and their hosting families to identify gaps in the literature and propose directions for future research. Methods: We used the Joanna Briggs Institute methodology and followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist to guide this scoping review. Searches were conducted in MEDLINE via EBSCO, Scopus via OVID, CINAHL, SOCIndex, Web of Science Core Collection, ProQuest Dissertations and Theses, the SciELO Citation Index, and APA PsycInfo. Literature written in English and published from 2011 to 2024 that focused on homestay hosting contexts for refugees was included. Results: The results of this review illuminate the multifaceted and dynamic nature of homestay hosting for refugees. The findings include motivations and barriers for homestay hosting, factors influencing host-refugee relations, and psychological and social outcomes of homestay hosting. Conclusions: The results of this scoping review demonstrated the need for tailored support for refugees to improve homestay programs for the benefit of both refugees and host families and highlighted the need of more inclusive, supportive, and effective strategies for the hosting, resettlement, and integration of refugees. International Registered Report Identifier (IRRID): RR2-10.2196/56242 %M 39586073 %R 10.2196/58613 %U https://www.i-jmr.org/2024/1/e58613 %U https://doi.org/10.2196/58613 %U http://www.ncbi.nlm.nih.gov/pubmed/39586073 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e63376 %T Community Versus Facility-Based Services to Improve the Screening of Active Hepatitis C Virus Infection in Cambodia: The ANRS 12384 CAM-C Cluster Randomized Controlled Trial—Protocol for a Mixed Methods Study %A Mosnier,Emilie %A Ségéral,Olivier %A Neth,Sansothy %A Sagaon-Teyssier,Luis %A Khuon,Dyna %A Phoeung,Chan Leakhena %A Mam,Sovatha %A Chhay,Chhingsrean %A Heang,Kimeang %A Duclos-Vallée,Jean Charles %A Saphonn,Vonthanak %+ Aix Marseille Université, Institut national de la santé et de la recherche médicale (INSERM), Institut de recherche pour le développementIRD, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale (SESSTIM) Aix Marseille Univ,, Aix Marseille Institute of Public Health (ISSPAM), Faculté de Médecine 27 Bd Jean Moulin, Marseille, 13385, France, 33 491324600, emilie.mosnier@gmail.com %K hepatitis C virus %K HCV %K community-based intervention %K cluster randomized controlled trial %K Cambodia %K cost-effectiveness analysis %K qualitative analysis %D 2024 %7 20.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In Cambodia, hepatitis C constitutes a significant public health challenge, particularly among older adults (>45 years) for whom prevalence is estimated to be 5%. To facilitate the elimination of hepatitis C among the general population, enhancing access to screening and treatment is imperative. In this regard, the evaluation of community-based screening programs emerges as a crucial step toward improving health care accessibility. Objective: This study aims to assess the comparative efficacy of a community-based versus a facility-based approach in enhancing the uptake of hepatitis C antibody testing among the general population older than 40 years of age in Cambodia. Methods: The CAM-C (Community Versus Facility-Based Services to Improve the Screening of Active Hepatitis C Virus Infection in Cambodia) study uses a cluster-randomized controlled trial design across two Cambodian provinces to compare community-based and facility-based hepatitis testing interventions. Sampling involves a multistage cluster approach, targeting individuals older than 40 years of age due to their higher prevalence and risk of chronic hepatitis complications. This study incorporates a qualitative analysis of acceptability and a cost-effectiveness comparison. Interventions include facility-based testing with subsequent referral and community-based testing with direct in-home assessments. Follow-up for positive cases involves comprehensive management and potential direct-acting antiviral treatment. This study aims to identify a significant increase in testing uptake, requiring the screening of 6000 individuals older than 40 years of age, facilitated by a structured sampling and intervention approach to minimize contamination risks. Results: The final protocol including the quantitative, qualitative, and cost-effectiveness part of the study was registered and was approved in 2019 by the National Ethical Cambodian for Health Research. Inclusions were completed by mid-2024, with analyses starting in May 2024. Conclusions: Using a mixed methods approach that combines a robust methodology (cluster-randomized controlled trial) with a cost-effectiveness analysis and qualitative research, such a study should provide invaluable information to guide the Ministry of Health in its hepatitis C virus screening strategy and move toward elimination. Trial Registration: ClinicalTrials.gov NCT03992313; https://clinicaltrials.gov/study/NCT03992313 International Registered Report Identifier (IRRID): DERR1-10.2196/63376 %M 39566053 %R 10.2196/63376 %U https://www.researchprotocols.org/2024/1/e63376 %U https://doi.org/10.2196/63376 %U http://www.ncbi.nlm.nih.gov/pubmed/39566053 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e58277 %T Rank Ordered Design Attributes for Health Care Dashboards Including Artificial Intelligence: Usability Study %A Malkani,Melina %A Madan,Eesha %A Malkani,Dillon %A Madan,Arav %A Singh,Neel %A Bamji,Tara %A Sabharwal,Harman %+ Bullis School, 10601 Falls Road, Potomac, MD, 20854, United States, 1 301 828 8315, melinamalkani@gmail.com %K data visualization %K dashboards %K public health %K population health %K informed decisions %K consumer decision-making %K health data %K usability %D 2024 %7 20.11.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: On average, people in the United States visit a doctor 4 times a year, and many of them have chronic illnesses. Because of the increased use of technology, people frequently rely on the internet to access health information and statistics. People use health care information to make better-educated decisions for themselves and others. Health care dashboards should provide pertinent and easily understood data, such as information on timely cancer screenings, so the public can make better-informed decisions. In order to enhance health outcomes, effective dashboards should provide precise data in an accessible and easily digestible manner. Objective: This study identifies the top 15 attributes of a health care dashboard. The objective of this research is to enhance health care dashboards to benefit the public by making better health care information available for more informed decisions by the public and to improve population-level health care outcomes. Methods: The authors conducted a survey of health care dashboards with 218 individuals identifying the best practices to consider when creating a public health care dashboard. The data collection was conducted from June 2023 to August 2023. The analyses performed were descriptive statistics, frequencies, and a comparison to a prior study. Results: From May 2023 to June 2023, we collected 3259 responses in multiple different states around the United States from 218 people aged 18 years or older. The features ranking in descending order of importance are as follows: (1) easy navigation, (2) historical data, (3) simplicity of design, (4) high usability, (5) use of clear descriptions, (6) consistency of data, (7) use of diverse chart types, (8) compliance with the Americans with Disabilities Act, (9) incorporated user feedback, (10) mobile compatibility, (11) comparison data with other entities, (12) storytelling, (13) predictive analytics with artificial intelligence, (14) adjustable thresholds, and (15) charts with tabulated data. Conclusions: Future studies can extend the research to other types of dashboards such as bioinformatics, financial, and managerial dashboards as well as confirm these top 15 best practices for medical dashboards with further evidentiary support. The medical informatics community may benefit from standardization to improve efficiency and effectiveness as dashboards can communicate vital information to patients worldwide on critically prominent issues. Furthermore, health care professionals should use these best practices to help increase population health care outcomes by informing health care consumers to make better decisions with better data. %M 39566038 %R 10.2196/58277 %U https://ojphi.jmir.org/2024/1/e58277 %U https://doi.org/10.2196/58277 %U http://www.ncbi.nlm.nih.gov/pubmed/39566038 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e64248 %T Patient Profile and Cost Savings of Long-Term Care in a Spanish Hospital: Retrospective Observational Study %A Mira,José Joaquín %A García-Torres,Daniel %A Bonell-Guerrero,María del Mar %A Cáceres-Sevilla,Ana Isabel %A Ramirez-Sanz,Martina %A Martínez-Lleo,Rosa %A Carratalá,Concepción %+ Health Psychology Department, Universidad Miguel Hernández, Universidad Avenue, Elche, 03202, Spain, 34 966658984, jose.mira@umh.es %K chronicity %K length of stay %K hospital %K chronic %K long-term care %K demographics %K gerontology %K Hospitals for Acute and Chronic Long-Term Extended Stay %K HACLES %K healthcare economics %K cost savings %D 2024 %7 19.11.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Long-term care hospitals have been considered an efficient response to the health care needs of an increasingly aging population. These centers are expected to contribute to better hospital bed management and more personalized care for patients needing continuous care. The evaluation of their outcomes is necessary after a sufficient period to assess their impact. Hospitals for Acute and Chronic Long-Term Extended Stay (HACLES) emerged in Spain in the late 20th century as a response to the aging population and the increase in chronic diseases. Objective: This study aimed to analyze the profile of patients treated in a HACLES, particularly analyzing gender differences, and evaluate the cost savings associated with using these centers. Methods: A retrospective study was conducted based on data from patients 65 years old or older admitted to a HACLES between 2022 and 2023. Gender, age, household cohabitation data, diagnosis and comorbidity, daily medication intake, and degree of dependency were obtained to describe the profile of patients who attended the HACLES. Data coded in SIA-Abucasis (version 37.00.03; Consellería Sanitat, Generalitat Valenciana; a digital medical record system used in the Valencian region) were reviewed, and descriptive statistics and comparison tests were used. The direct cost savings of HACLES admissions were calculated by comparing the daily cost of a general hospital bed with that of a HACLES bed. Results: Data from 123 patients with a mean age of 77 years were analyzed. Most (n=81, 65.9%) had a cohabiting family member as their primary caregiver. Palliative care was the most frequent reason for admission (n=75, 61%). The mortality rate (odds ratio [OR] 61.8, 95% CI 53.2-70.5) was similar between men and women (OR 54.1, 95% CI 47.8-71.5 vs OR 59.7, 95% CI 42.2-66.0; P=.23). The cognitive assessment, using the Pfeiffer scale, improved at discharge (mean 3.2, SD 3.2 vs mean 2.5, SD 3.1; P=.003). The length of stay was significantly larger for patients who returned home compared with patients discharged to other facilities (mean 89.8, SD 58.2 versus mean 33.1, SD 43.1 days; P<.001). The direct cost savings were estimated at US $42,614,846 per 1000 admissions. Conclusions: Patients typically treated in HACLES are older, with a high level of cognitive impairment and physical dependency, and a significant proportion are in palliative care, highlighting the importance of adapting care to the individual needs of the admitted patients. The HACLES model contributes to the sustainability of the public health system. %M 39561362 %R 10.2196/64248 %U https://www.i-jmr.org/2024/1/e64248 %U https://doi.org/10.2196/64248 %U http://www.ncbi.nlm.nih.gov/pubmed/39561362 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56522 %T Factors Influencing Outcome After Shoulder Arthroplasty (FINOSA Study): Protocol of a Prospective Longitudinal Study With Randomized Group Allocation %A Claes,Anke %A De Mesel,Annelien %A Struyf,Thomas %A Verborgt,Olivier %A Struyf,Filip %+ Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Universiteitsplein, 1, Wilrijk, 2610, Belgium, 32 32652783, filip.struyf@uantwerpen.be %K shoulder arthroplasty %K influencing factors %K rehabilitation %K arthroplasty %K shoulder %K FINOSA-study %K evidence based %K post-operative rehabilitation %K rehabilitation protocols %K shoulder pain %K clinical outcomes %K geriatrics %K longitudinal study %K shoulder dysfunction %D 2024 %7 18.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is an increasing need for evidence-based postoperative rehabilitation strategies to optimize patient outcome. Knowledge of potential prognostic factors could steer the development of rehabilitation protocols and could result in better treatment outcomes and higher patient satisfaction. Objective: This study aimed to investigate which potential prognostic factors predict baseline shoulder pain and function and its evolution in the first 2 years following surgery, in patients with total shoulder arthroplasty. The secondary objective is to investigate which potential prognostic factors predict baseline quality of life and its evolution in the first two years following surgery. Methods: To reach the aims of this project, a prospective longitudinal study, running from January 2020 to March 2025, will be carried out with a follow-up of 48 months. Patients will be randomized based on sling wear. We will study factors such as shoulder function, patient expectations, psychosocial factors, lifestyle factors, sling wear, soft tissue integrity, and physiotherapy treatment. Test moments will take place preoperatively, at 6 weeks, 12 weeks, 6 months, 12 months, and 24 months. Descriptive statistics will be used to describe the patient population characteristics. Based on literature review, expert opinion, and univariate analyses, potential prognostic factors will be chosen as covariates. A mixed regression model for repeated measures will be used to assess both the evolution of the Shoulder Pain and Disability Index within persons from baseline over time and the differences in evolution between participants. Correlation analyses will be used to investigate associations between the other outcome measures such as the Constant and Murley Score, shoulder range of motion, shoulder muscle strength, and proprioception, and the primary outcome measure, the Shoulder Pain and Disability Index score. Potential prognostic factors not included in the model will be presented in a descriptive manner. Results: Data collection started in January 2020. In April 2023 the sample size was reached. Data collection will end in April 2025. Analyses will follow when data collection is completed. Conclusions: Knowledge of potential prognostic factors will have implications toward better rehabilitation strategies of patients after total shoulder arthroplasty. Trial Registration: ClinicalTrials.gov NCT04258267; https://clinicaltrials.gov/study/NCT04258267 International Registered Report Identifier (IRRID): DERR1-10.2196/56522 %M 39556824 %R 10.2196/56522 %U https://www.researchprotocols.org/2024/1/e56522 %U https://doi.org/10.2196/56522 %U http://www.ncbi.nlm.nih.gov/pubmed/39556824 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59800 %T Mapping Implementation Strategies to Address Barriers to Pre-Exposure Prophylaxis Use Among Women Through POWER Up (Pre-Exposure Prophylaxis Optimization Among Women to Enhance Retention and Uptake): Content Analysis %A Johnson,Amy K %A Devlin,Samantha A %A Pyra,Maria %A Etshokin,Eriika %A Ducheny,Kelly %A Friedman,Eleanor E %A Hirschhorn,Lisa R %A Haider,Sadia %A Ridgway,Jessica P %+ Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5837 S Maryland Ave, Rm L-038, Chicago, IL, 60637, United States, 1 773 702 9016, sdevlin1@bsd.uchicago.edu %K pre-exposure prophylaxis %K PrEP %K Consolidated Framework for Implementation Research %K CFIR %K Expert Recommendations for Implementing Change %K ERIC %K implementation science %K HIV prevention %K AIDS %K United States %K Black women %K women’s health %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Black cisgender women (hereafter referred to as “women”) experience one of the highest incidences of HIV among all populations in the United States. Pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention option, but uptake among women is low. Despite tailored strategies for certain populations, including men who have sex with men and transgender women, Black women are frequently overlooked in HIV prevention efforts. Strategies to increase PrEP awareness and use among Black women are needed at multiple levels (ie, community, system or clinic, provider, and individual or patient). Objective: This study aimed to identify barriers and facilitators to PrEP uptake and persistence among Black cisgender women and to map implementation strategies to identified barriers using the CFIR (Consolidated Framework for Implementation Research)-ERIC (Expert Recommendations for Implementing Change) Implementation Strategy Matching Tool. Methods: We conducted a secondary analysis of previous qualitative studies completed by a multidisciplinary team of HIV physicians, implementation scientists, and epidemiologists. Studies involved focus groups and interviews with medical providers and women at a federally qualified health center in Chicago, Illinois. Implementation science frameworks such as the CFIR were used to investigate determinants of PrEP use among Black women. In this secondary analysis, data from 45 total transcripts were analyzed. We identified barriers and facilitators to PrEP uptake and persistence among cisgender women across each CFIR domain. The CFIR-ERIC Implementation Strategy Matching Tool was used to map appropriate implementation strategies to address barriers and increase PrEP uptake among Black women. Results: Barriers to PrEP uptake were identified across the CFIR domains. Barriers included being unaware that PrEP was available (characteristics of individuals), worrying about side effects and impacts on fertility and pregnancy (intervention characteristics), and being unsure about how to pay for PrEP (outer setting). Providers identified lack of training (characteristics of individuals), need for additional clinical support for PrEP protocols (inner setting), and need for practicing discussions about PrEP with women (intervention characteristics). ERIC mapping resulted in 5 distinct implementation strategies to address barriers and improve PrEP uptake: patient education, provider training, PrEP navigation, clinical champions, and electronic medical record optimization. Conclusions: Evidence-based implementation strategies that address individual, provider, and clinic factors are needed to engage women in the PrEP care continuum. Tailoring implementation strategies to address identified barriers increases the probability of successfully improving PrEP uptake. Our results provide an overview of a comprehensive, multilevel implementation strategy (ie, “POWER Up”) to improve PrEP uptake among women. International Registered Report Identifier (IRRID): RR2-10.1371/journal.pone.0285858 %M 39546769 %R 10.2196/59800 %U https://formative.jmir.org/2024/1/e59800 %U https://doi.org/10.2196/59800 %U http://www.ncbi.nlm.nih.gov/pubmed/39546769 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56320 %T Differences in Use of a Patient Portal Across Sociodemographic Groups: Observational Study of the NHS App in England %A KC,Sukriti %A Papoutsi,Chrysanthi %A Reidy,Claire %A Gudgin,Bernard %A Powell,John %A Majeed,Azeem %A Greaves,Felix %A Laverty,Anthony A %+ Imperial College London, School of Public Health, South Kensington, London, SW7 2BX, United Kingdom, 44 2075945312, a.laverty@imperial.ac.uk %K digital health %K patient portals %K technological health divide %K eHealth %K inequality %K observational %K ecological %K England %K app %K patient portal %K disparities %K deprivation %K demographics %K long-term health care %K negative binomial regression model %K intervention %K patient support %K general practice %K digital technology %K patient %K youth %K %D 2024 %7 13.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The adoption of patient portals, such as the National Health Service (NHS) App in England, may improve patient engagement in health care. However, concerns remain regarding differences across sociodemographic groups in the uptake and use of various patient portal features, which have not been fully explored. Understanding the use of various functions across diverse populations is essential to ensure any benefits are equally distributed across the population. Objective: This study aims to explore differences in the use of NHS App features across age, sex, deprivation, ethnicity, long-term health care needs, and general practice (GP) size categories. Methods: We used weekly NHS App use data from the NHS App dashboard for 6386 GPs in England from March 2020 to June 2022. Negative binomial regression models explored variations in weekly rates of NHS App features used (registrations, log-ins, prescriptions ordered, medical record views, and appointments booked). Outcomes were measured as weekly rates per 1000 GP-registered patients, and we conducted separate models for each outcome. Regression models included all covariates mentioned above and produced incident rate ratios, which we present here as relative percentages for ease of interpretation. GP-level covariate data on sociodemographic variables were used as categorical variables in 5 groups for deprivation (Q1=least deprived practices and Q5=most deprived practices) and 4 groups for all other variables (Q1=least deprived practices and Q4=most deprived practices). Results: We found variations in the use of different features overall and across sociodemographic categories. Fully adjusted regression models found lower use of features overall in more deprived practices (eg, Q5 vs Q1: registrations=–34%, log-ins=–34.9%, appointments booked=–39.7%, medical record views=–32.3%, and prescriptions ordered=–9.9%; P<.001). Practices with greater proportions of male patients also had lower levels of NHS App use (eg, Q4 vs Q1: registration=–7.1%, log-in=–10.4%, and appointments booked=–36.4%; P<.001). Larger practices had an overall higher use of some NHS App features (eg, Q4 vs Q1: registration=3.2%, log-ins=11.7%, appointments booked=73.4%, medical record views=23.9%, and prescriptions ordered=20.7%; P<.001), as well as those with greater proportions of White patients (eg, Q4 vs Q1: registration=1.9%, log-ins=9.1%, appointments booked=14.1%, medical record views=28.7%, and prescriptions ordered=130.4%; P<.001). Use patterns varied for practices with greater proportions of patients with long-term health care needs (eg, Q4 vs Q1: registrations=–3.6%, appointments booked=–20%, and medical record views=6%; P≤.001). Conclusions: This study highlights that the use of the NHS App features varied across sociodemographic groups. In particular, it is used less by people living in more deprived areas. Tailored interventions and patient support are required to ensure that any benefits from the NHS App are spread equally throughout the population. %M 39536310 %R 10.2196/56320 %U https://www.jmir.org/2024/1/e56320 %U https://doi.org/10.2196/56320 %U http://www.ncbi.nlm.nih.gov/pubmed/39536310 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e64575 %T Transitional Care Support for Medicaid-Insured Patients With Serious Mental Illness: Protocol for a Type I Hybrid Effectiveness-Implementation Stepped-Wedge Cluster Randomized Controlled Trial %A Brooks Carthon,J Margo %A Brom,Heather %A Amenyedor,Kelvin Eyram %A Harhay,Michael O %A Grantham-Murillo,Marsha %A Nikpour,Jacqueline %A Lasater,Karen B %A Golinelli,Daniela %A Cacchione,Pamela Z %A Bettencourt,Amanda P %+ Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA, 19104, United States, 1 215 498 8050, jmbrooks@nursing.upenn.edu %K serious mental illness %K health care disparities %K Medicaid %K evidence-based practice %K implementation science %K socioeconomic disparities in health %D 2024 %7 12.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: People diagnosed with a co-occurring serious mental illness (SMI; ie, major depressive disorder, bipolar disorder, or schizophrenia) but hospitalized for a nonpsychiatric condition experience higher rates of readmissions and other adverse outcomes, in part due to poorly coordinated care transitions. Current hospital-to-home transitional care programs lack a focus on the integrated social, medical, and mental health needs of these patients. The Thrive clinical pathway provides transitional care support for patients insured by Medicaid with multiple chronic conditions by focusing on posthospitalization medical concerns and the social determinants of health. This study seeks to evaluate an adapted version of Thrive that also meets the needs of patients with co-occurring SMI discharged from a nonpsychiatric hospitalization. Objective: This study aimed to (1) engage staff and community advisors in participatory implementation processes to adapt the Thrive clinical pathway for all Medicaid-insured patients, including those with SMI; (2) examine utilization outcomes (ie, Thrive referral, readmission, emergency department [ED], primary, and specialty care visits) for Medicaid-insured individuals with and without SMI who receive Thrive compared with usual care; and (3) evaluate the acceptability, appropriateness, feasibility, and cost-benefit of an adapted Thrive clinical pathway that is tailored for Medicaid-insured patients with co-occurring SMI. Methods: This study will use a prospective, type I hybrid effectiveness-implementation, stepped-wedge, cluster randomized controlled trial design. We will randomize the initiation of Thrive referrals at the unit level. Data collection will occur over 24 months. Inclusion criteria for Thrive referral include individuals who (1) are Medicaid insured, dually enrolled in Medicaid and Medicare, or Medicaid eligible; (2) reside in Philadelphia; (3) are admitted for a medical diagnosis for over 24 hours at the study hospital; (4) are planned for discharge to home; (5) agree to receive home care services; and (6) are aged ≥18 years. Primary analyses will use a mixed-effects negative binomial regression model to evaluate readmission and ED utilization, comparing those with and without SMI who receive Thrive to those with and without SMI who receive usual care. Using a convergent parallel mixed methods design, analyses will be conducted simultaneously for the survey and interview data of patients, clinicians, and health care system leaders. The cost of Thrive will be calculated from budget monitoring data for the research budget, the cost of staff time, and average Medicaid facility fee payments. Results: This research project was funded in October 2023. Data collection will occur from April 2024 through December 2025. Results are anticipated to be published in 2025-2027. Conclusions: We anticipate that patients with and without co-occurring SMI will benefit from the adapted Thrive clinical pathway. We also anticipate the adapted version of Thrive to be deemed feasible, acceptable, and appropriate by patients, clinicians, and health system leaders. Trial Registration: ClinicalTrials.gov NCT06203509; https://clinicaltrials.gov/ct2/show/NCT06203509 International Registered Report Identifier (IRRID): DERR1-10.2196/64575 %M 39531274 %R 10.2196/64575 %U https://www.researchprotocols.org/2024/1/e64575 %U https://doi.org/10.2196/64575 %U http://www.ncbi.nlm.nih.gov/pubmed/39531274 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58780 %T Bystander Response and Out-of-Hospital Cardiac Arrest Outcomes (Bro. Study) in 3 Gulf Countries: Protocol for a Prospective, Observational, International Collaboration Study %A Farooq,Munawar %A Al Jufaili,Mahmood %A Hanjra,Faisal K %A Ahmad,Shabbir %A Dababneh,Emad Hanna %A Al Nahhas,Omar %A Bashir,Khalid %+ Department of Internal Medicine, Emergency Medicine Section, College of Medicine and Health Sciences, United Arab Emirates University, CMHS Tawam Street, Al Ain, 176666, United Arab Emirates, 971 507791906, drjam_munawar@yahoo.com %K out-of-hospital cardiac arrest %K cardiac arrest outcomes %K bystander response %K cardiopulmonary resuscitation %K CPR %K automated external defibrillator %K AED %K survival to discharge %K emergency medical services %K prehospital care %K Utstein style %D 2024 %7 12.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: : Globally, there is significant variation in the out-of-hospital cardiac arrest (OHCA) survival rate. Early links in the chain of survival, including bystander cardiopulmonary resuscitation (CPR) and the use of an automated external defibrillator at the scene, are known to be of crucial importance, with strong evidence of increased survival rate with good neurological outcomes. The data from the Middle East are limited and report variable rates of bystander CPR and survival. It is crucial to get prospective, reliable data on bystander response in these regions to help plan interventions to improve bystander response and outcomes. Objective: This international collaborative study aims to describe the characteristics, including bystander interventions and outcomes, of OHCAs brought to hospitals enrolled in the study from Abu Dhabi, United Arab Emirates; Doha, Qatar; and Muscat, Oman. It also aims to describe the strength of the association between bystander response and OHCA outcomes, including the return of spontaneous circulation, survival to hospital admission, survival to discharge, and good neurological outcome at discharge in the local context of low bystander CPR rates. Methods: This multicenter, prospective, noninterventional observational study (Bro. Study) will be conducted at the emergency departments of 4 participating tertiary care hospitals in 3 countries. The data will be collected prospectively according to the Utstein style (a set of internationally accepted guidelines for uniform reporting of cardiac arrests) on demographic variables (age, sex, nationality, country, participating center, and comorbidities), peri–cardiac arrest variables (location, witnessed or not, bystander CPR, use of automated external defibrillator, time of emergency medical services arrival, initial rhythm, number of shocks, and time of prehospital CPR), and outcome variables (return of spontaneous circulation, survival to discharge, and neurological outcome at discharge and 3 months). Univariate and multivariate analysis with logistic regression models will be used to measure the strength of the association of bystander interventions with outcomes using SPSS (version 22). Results: Data collection began in November 2023 and will continue for 2 years, with publication expected by early 2026. Conclusions: Bystander response to an OHCA is critical to a favorable outcome. The reliable, baseline bystander CPR data will be a cornerstone in the team’s next planned projects, which are to qualitatively identify the barriers to bystander CPR, conduct a scoping review of community interventions in the Gulf and other Asian countries, and design and implement strategies to help improve the bystander CPR rate in the community. International Registered Report Identifier (IRRID): DERR1-10.2196/58780 %M 39531256 %R 10.2196/58780 %U https://www.researchprotocols.org/2024/1/e58780 %U https://doi.org/10.2196/58780 %U http://www.ncbi.nlm.nih.gov/pubmed/39531256 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57609 %T Impact of Internet Hospital Consultations on Outpatient Visits and Expenses: Quasi-Experimental Study %A Liu,Yayuan %A Jin,Haofeng %A Yu,Zhuoyuan %A Tong,Yu %+ School of Management, Zhejiang University, Hangzhou, 310058, China, 86 57188206827, tong_yu@zju.edu.cn %K internet hospital %K online consultation %K telehealth %K outpatient visits %K outpatient expenses %K urban-rural healthcare disparity %D 2024 %7 11.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet hospital consultations are emerging in China as a new channel for patients to access health care services. Unlike third-party health care platforms such as Haodf, Teladoc Health, and MDLive, internet hospitals seamlessly integrate patients’ offline medical records with online consultations, offering a cohesive online and offline health care experience. However, its impact on outpatient visits remains ambiguous. While it may encourage outpatient visits due to better continuity of care, it could also reduce face-to-face visits because of the convenience of online consultations. Given that patients in China have the autonomy to freely choose their health care providers, it is critical for hospitals to understand the effect of this telehealth technology on outpatient visits. Objective: This study aimed to analyze the impact of patients’ adoption of internet hospital consultations on their outpatient frequency and expenses, and whether these impacts vary between urban and rural patients. Methods: The data used in this study were collected from a public tertiary hospital situated in a southeastern county of China, covering internet hospital consultations from January 2021 to October 2022, and offline outpatient records from January 2020 to October 2022. The dataset also includes patient demographic information. To estimate the causal effect, we used a quasi-experimental design, combining the difference-in-differences (DiD) analysis with the propensity score matching (PSM). After performing PSM, 2065 pairs of patients (4130 patients) were obtained for data analysis. Results: Our findings highlight 3 key results. First, patients’ adoption of internet hospital consultations increases their frequency of outpatient visits by 2.4% per month (P<.001), and the associated expenses by 15.5% per month (P<.001). Second, such positive effects are more pronounced for patients residing in rural areas. Specifically, for every 1% increase in the distance between patients’ residences and the county government (an urban center), the positive effect on monthly outpatient visits increases by 0.3% (P=.06), and the positive effect on monthly outpatient expenses increases by 2.4% (P=.03). Third, our post hoc analysis shows that rural patients living in areas with higher local health care quality experience a mitigated positive effect of internet hospital consultations, compared with those in areas with lower health care quality. Conclusions: This study extends the research scope of telehealth technologies by investigating internet hospitals, which are characterized by the integration of online and offline services. Our findings suggest that patients’ adoption of internet hospital consultations is associated with an increase in both the frequency and expenses of outpatient visits. In addition, these effects vary based on patients’ urban-rural status and local health care quality. These insights offer valuable guidance for policy makers and health care providers in promoting and optimizing the development and operation of internet hospitals. %M 39527807 %R 10.2196/57609 %U https://www.jmir.org/2024/1/e57609 %U https://doi.org/10.2196/57609 %U http://www.ncbi.nlm.nih.gov/pubmed/39527807 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55140 %T Service Quality and Patient Satisfaction of Internet Hospitals in China: Cross-Sectional Evaluation With the Service Quality Questionnaire %A Han,Tao %A Wei,Qinpeng %A Wang,Ruike %A Cai,Yijin %A Zhu,Hongyi %A Chen,Jiani %A Zhang,Zhiruo %A Li,Sisi %+ School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 Chongqing South Road, Shanghai, 200025, China, 86 02163846590 ext 776145, lisi8318@gmail.com %K service quality %K SERVQUAL %K Service Quality Questionnaire %K internet hospital %K e-hospital %K digital medical care %K health care professionals %K Chinese digital health care %D 2024 %7 8.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet hospitals, which refer to service platforms that integrate consultation, prescription, payment, and drug delivery based on hospital entities, have been developing at a rapid pace in China since 2014. However, assessments regarding their service quality and patient satisfaction have not been well developed. There is an urgent need to comprehensively evaluate and improve the service quality of internet hospitals. Objective: This study aims to investigate the current status of patients’ use of internet hospitals, as well as familiarity and willingness to use internet hospitals, to evaluate patients’ expected and perceived service qualities of internet hospitals using the Chinese version of the Service Quality Questionnaire (SERVQUAL-C) with a national representative sample, and to explore the association between service quality of internet hospitals and patients’ overall satisfaction toward associated medical platforms. Methods: This cross-sectional survey was conducted through face-to-face or digital interviews from June to September 2022. A total of 1481 outpatient participants (635 men and 846 women; mean age 33.22, SD 13.22). Participants reported their use of internet hospitals, and then rated their expectations and perceptions of service quality toward internet hospitals via the SERVQUAL-C, along with their demographic information. Results: Among the surveyed participants, 51.2% (n=758) of participants had used internet hospital service or services. Use varied across age, education level, and annual income. Although the majority of them (n=826, 55.8%) did not know internet hospital services well, 68.1% (n=1009) of participants expressed the willingness to adopt this service. Service quality evaluation revealed that the perceived service quality did not match with the expectation, especially the responsiveness dimension. Important-performance analysis results further alerted that reliable diagnosis, prompt response, clear feedback pathway, and active feedback handling were typically the services awaiting substantial improvement. More importantly, multiple linear regressions revealed that familiarity and willingness to use internet hospital services were significant predictors of satisfaction, above and over tangibles, reliability, and empathy service perspectives, and demographic characteristics such as gender, age, education level, and annual income. Conclusions: In the future, internet hospitals should focus more on how to narrow the gaps between the expected and perceived service quality. Promotion of internet hospitals should also be facilitated to increase patients’ familiarity with and willingness to use these services. %M 39514849 %R 10.2196/55140 %U https://www.jmir.org/2024/1/e55140 %U https://doi.org/10.2196/55140 %U http://www.ncbi.nlm.nih.gov/pubmed/39514849 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55870 %T Efficacy of Electroacupuncture in the Treatment of Mild to Moderate Female Stress Urinary Incontinence: Protocol for a Systematic Review and Network Meta-Analysis %A Shi,JiaNi %A Li,Peiqi %A Wu,Yifan %A Li,Jiawei %A Zhang,Yuchen %A Xiao,Bin %+ School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai, 201203, China, 86 17321311968, xiaobin@shutcm.edu.cn %K stress urinary incontinence %K electroacupuncture %K drugs %K pelvic floor muscle training %K systematic review %K network meta-analysis %D 2024 %7 4.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Stress urinary incontinence (SUI), the most common form of urinary incontinence, is a condition that affects many women. It is characterized by involuntary urine leakage during activities that increase abdominal pressure, such as sneezing, coughing, or physical exertion, according to the International Continence Society. SUI affects patients’ quality of life and causes depression and emotional disorders, which negatively influences physical and mental health. The participants in the studies in this review comprised women with mild to moderate SUI, because there are more female patients than male patients, and most patients with severe SUI are treated surgically. Moreover, after retrieval, there were no systematic reviews or network meta-analyses (NMAs) of conservative treatments, such as electroacupuncture (EA), in women with mild to moderate SUI. Objective: This study aims to investigate the efficacy of electroacupuncture among women with mild to moderate SUI using an NMA. Methods: Randomized clinical trials related to conservative treatments for SUI will be searched in 5 English and 3 Chinese literature databases: EMBASE, PubMed, Cochrane, Web of Science, ClinicalTrials.gov, Chinese National Knowledge Infrastructure (CNKI), WanFang, and the Chinese BioMedical Literature Database. The search period for these 8 electronic databases will be from 2002 to 2022. The PROSPERO database and the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) database will also be searched. Two reviewers will independently complete the research selection. After screening the studies, 2 other researchers will extract the data, and the quality of the included studies will be evaluated according to the quality standards specified in the Cochrane Collaboration Tool (version 2). The primary outcomes will be the change in urine leakage determined by a 1-hour pad test and International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) scores at baseline and at the conclusion of the follow-up. The secondary outcomes will be 72-hour incontinence episodes, residual bladder volume, effective rate, urodynamic indexes, and other reported measurements. Stata (version 14.0; StataCorp) and Review Manager (RevMan version 5.3; Cochrane) will be implemented for data synthesis and meta-analysis. Results: The results are not yet accessible because this is a protocol for a systematic review and meta-analysis. The protocol was registered on INPLASY on February 22, 2023. By April 6, 2023, we had completed the literature search of the 8 databases and completed the selection and data extraction of the articles. Conclusions: The results of this systematic review will demonstrate the efficacy of EA among women with mild to moderate SUI. The results will provide evidence for clinicians and guideline makers to choose suitable treatments for SUI. Trial Registration: International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) 202320098; https://inplasy.com/inplasy-2023-2-0098/ International Registered Report Identifier (IRRID): DERR1-10.2196/55870 %M 39496309 %R 10.2196/55870 %U https://www.researchprotocols.org/2024/1/e55870 %U https://doi.org/10.2196/55870 %U http://www.ncbi.nlm.nih.gov/pubmed/39496309 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60025 %T Advancing the United Nations Sustainable Development Goals Through Digital Health Research: 25 Years of Contributions From the Journal of Medical Internet Research %A Raman,Raghu %A Singhania,Monica %A Nedungadi,Prema %+ Amrita School of Business, Amrita School of Computing, Amrita Vishwa Vidyapeetham, Amritapuri, Kerala, 690525, India, 91 9895028779, raghu@amrita.edu %K sustainable development goal %K topic modeling %K public health %K surveillance %K gender equality %K non-communicable disease %K social media %K COVID-19 %K SARS-CoV-2 %K coronavirus %K machine learning %K artificial intelligence %K AI %K digital health %D 2024 %7 4.11.2024 %9 Research Letter %J J Med Internet Res %G English %X %M 39496147 %R 10.2196/60025 %U https://www.jmir.org/2024/1/e60025 %U https://doi.org/10.2196/60025 %U http://www.ncbi.nlm.nih.gov/pubmed/39496147 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e58711 %T Association Between Self-Reported Protective Behavior and Heat-Associated Health Complaints Among Patients With Chronic Diseases in Primary Care: Results of the CLIMATE Pilot Cohort Study %A Jordan,Arne %A Nothacker,Julia %A Paucke,Valentina %A Hager,Klaus Heinz %A Hueber,Susann %A Karimzadeh,Arian %A Kötter,Thomas %A Löffler,Christin %A Müller,Beate Sigrid %A Tajdar,Daniel %A Lühmann,Dagmar %A Scherer,Martin %A Schäfer,Ingmar %+ Institute and Outpatients Clinic of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany, 49 40 7410 52760, in.schaefer@uke.de %K climate change %K online survey %K open internet data %K climate %K environment %K rising temperature %K heatexposure %K chronic disease management %K epidemiology %D 2024 %7 4.11.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As a result of climate change, exposure to high temperatures is becoming more common, even in countries with temperate climates. For patients with chronic diseases, heat poses significant health risks. Empowering patients is a crucial element in protecting the population from the adverse effects of heat. In this context, self-reports of protective behavior are often used to gain a mutual understanding of patients’ issues. However, the extent to which self-reported behavior is associated with health complaints remains unclear. Objective: This study aims to describe the association between light to moderate heat and health complaints in everyday life, and to analyze whether self-reported protective behavior and related psychosocial factors are linked to these complaints. Methods: We conducted a pilot cohort study using internet climate data merged with an online survey of patients with chronic diseases recruited through general practitioner practices. Patients were eligible if they were 18 years or older and had at least one chronic disease. The heat was modeled using temperature and humidity data. Health complaints were assessed through up to 7 follow-up evaluations on the hottest day of each week during the observation period. Data were analyzed using 3 nested models with mixed effects multivariable linear regression, adjusting for random effects at the climate measuring station and participant levels. Model 1 included heat exposure, sociodemographic data, and chronic diseases. Model 2 added protective behavior and health literacy, while model 3 incorporated self-efficacy and somatosensory amplification (ie, the tendency to catastrophize normal bodily sensations such as insect bites). Results: Of the 291 eligible patients, 61 (21.0%) participated in the study, providing 294 observations. On average, participants were 61 (SD 14) years old, and 31 (51%) were men. The most prevalent conditions were cardiovascular diseases (n=23, 38%) and diabetes mellitus (n=20, 33%). The most commonly reported symptoms were tiredness/fatigue (232/294 observations, 78.9%) and shortness of breath (142/294 observations, 48.3%). Compared with temperatures of 27°C or lower, a heat index between over 27°C and 32°C (β=1.02, 95% CI 0.08-1.96, P=.03) and over 32°C (β=1.35, 95% CI 0.35-2.35, P=.008) were associated with a higher symptom burden. Lower health literacy (β=–0.25, 95% CI –0.49 to –0.01, P=.04) and better self-reported protective behavior (β=0.65, 95% CI 0.29-1.00, P<.001) were also linked to increased symptom burden but lost statistical significance in model 3. Instead, lower self-efficacy (β=–0.39, 95% CI –0.54 to –0.23, P<.001) and higher somatosensory amplification (β=0.18, 95% CI 0.07-0.28, P=.001) were associated with a higher symptom burden. Conclusions: Compared with colder weather, light and moderate heat were associated with more severe health complaints. Symptom burden was lower in participants with higher self-efficacy and less somatosensory amplification. Self-reported protective behavior was not linked to a lower symptom burden. Instead, we found that patients who tended to catastrophize normal bodily sensations reported both better protective behavior and a higher symptom burden simultaneously. Trial Registration: ClinicalTrials.gov NCT05961163; https://clinicaltrials.gov/ct2/show/NCT05961163 %M 39496153 %R 10.2196/58711 %U https://publichealth.jmir.org/2024/1/e58711 %U https://doi.org/10.2196/58711 %U http://www.ncbi.nlm.nih.gov/pubmed/39496153 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54565 %T User Views on Online Sexual Health Symptom Checker Tool: Qualitative Research %A King,Alicia Jean %A Bilardi,Jade Elissa %A Towns,Janet Mary %A Maddaford,Kate %A Fairley,Christopher Kincaid %A Chow,Eric P F %A Phillips,Tiffany Renee %+ School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 580 Swanston Street, Carlton, Melbourne, 3053, Australia, 61 93416266, aking@mshc.org.au %K sexual health %K sexually transmitted diseases %K risk assessment %K risk factors %K smartphone apps %K help-seeking behavior %K health literacy %K information seeking behavior %D 2024 %7 4.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Delayed diagnosis and treatment of sexually transmitted infections (STIs) contributes to poorer health outcomes and onward transmission to sexual partners. Access to best-practice sexual health care may be limited by barriers such as cost, distance to care providers, sexual stigma, and trust in health care providers. Online assessments of risk offer a novel means of supporting access to evidence-based sexual health information, testing, and treatment by providing more individualized sexual health information based on user inputs. Objective: This developmental evaluation aims to find potential users’ views and experiences in relation to an online assessment of risk, called iSpySTI (Melbourne Sexual Health Center), including the likely impacts of use. Methods: Individuals presenting with urogenital symptoms to a specialist sexual health clinic were given the opportunity to trial a web-based, Bayesian-powered tool that provides a list of 2 to 4 potential causes of their symptoms based on inputs of known STI risk factors and symptoms. Those who tried the tool were invited to participate in a once-off, semistructured research interview. Descriptive, action, and emotion coding informed the comparative analysis of individual cases. Results: Findings from interviews with 14 people who had used the iSpySTI tool support the superiority of the online assessment of STI risk compared to existing sources of sexual health information (eg, internet search engines) in providing trusted and probabilistic information to users. Additionally, potential users reported benefits to their emotional well-being in the intervening period between noticing symptoms and being able to access care. Differences in current and imagined urgency of health care seeking and emotional impacts were found based on clinical diagnosis (eg, non-STI, curable and incurable but treatable STIs) and whether participants were born in Australia or elsewhere. Conclusions: Online assessments of risk provide users experiencing urogenital symptoms with more individualized and evidence-based health information that can improve their health care–seeking and provide reassurance in the period before they can access care. %R 10.2196/54565 %U https://formative.jmir.org/2024/1/e54565 %U https://doi.org/10.2196/54565 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57611 %T Fostering Shared Decision-Making Between Patients and Health Care Professionals in Clinical Practice Guidelines: Protocol for a Project to Develop and Test a Tool for Guideline Developers %A Fischer,Lena %A Scheibler,Fülöp %A Schaefer,Corinna %A Karge,Torsten %A Langer,Thomas %A Schewe,Leon Vincent %A Florez,Ivan D %A Hutchinson,Andrew %A Li,Sheyu %A Maes-Carballo,Marta %A Munn,Zachary %A Perestelo-Perez,Lilisbeth %A Puljak,Livia %A Stiggelbout,Anne %A Pieper,Dawid %+ Institute for Health Services and Health System Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), Seebad 83, Rüdersdorf, 15562, Germany, 49 33638 83987, Lena.Fischer@mhb-fontane.de %K shared decision-making %K practice guidelines as topic %K decision support techniques %K support %K decision-making %K decisions %K tool %K testing tool %K protocol %K medical decision-making %K patient decision aid %K decision aid %K tool development %D 2024 %7 4.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Clinical practice guidelines (CPGs) are designed to assist health care professionals in medical decision-making, but they often lack effective integration of shared decision-making (SDM) principles to reflect patient values and preferences, particularly in the context of preference-sensitive CPG recommendations. To address this shortcoming and foster SDM through CPGs, the integration of patient decision aids (PDAs) into CPGs has been proposed as an important strategy. However, methods for systematically identifying and prioritizing CPG recommendations relevant to SDM and related decision support tools are currently lacking. Objective: The aim of the project is to develop (1) a tool for systematically identifying and prioritizing CPG recommendations for which SDM is considered particularly relevant and (2) a platform for PDAs to support practical SDM implementation. Methods: The project consists of 6 work packages (WPs). It is embedded in the German health care context but has an international focus. In WP 1, we will conduct a scoping review in bibliographic databases and gray literature sources to identify methods used to foster SDM via PDAs in the context of CPGs. In WP 2, we will conduct semistructured interviews with CPG experts to better understand the concepts of preference sensitivity and identify strategies for fostering SDM through CPGs. WP 3, a modified Delphi study including surveys and focus groups with SDM experts, aims to define and operationalize preference sensitivity. Based on the results of the Delphi study, we will develop a methodology for prioritizing key questions in CPGs. In WP 4, the tool will be developed. A list of relevant items to identify CPG recommendations for which SDM is most relevant will be created, tested, and iteratively refined, accompanied by the development of a user manual. In WP 5, a platform for creating and digitizing German-language PDAs will be developed to support the practical application of SDM during clinical encounters. WP 6 will conclude the project by testing the tool with newly developed and revised CPGs. Results: The Brandenburg Medical School Ethics Committee approved the project (165122023-ANF). An international multidisciplinary advisory board is involved to guide the tool development on CPGs and SDM. Patient partners are involved throughout the project, considering the essential role of the patient perspective in SDM. As of February 20, 2024, we are currently assessing literature references to determine eligibility for inclusion in the scoping review (WP 1). We expect the project to be completed by December 31, 2026. Conclusions: The tool will enable CPG developers to systematically incorporate aspects of SDM into CPG development, thereby providing guideline-based support for the patient-practitioner interaction. Together, the tool for CPGs and the platform for PDAs will create a systematic link between CPGs, SDM, and PDAs, which may facilitate SDM in clinical practice. International Registered Report Identifier (IRRID): DERR1-10.2196/57611 %M 39495553 %R 10.2196/57611 %U https://www.researchprotocols.org/2024/1/e57611 %U https://doi.org/10.2196/57611 %U http://www.ncbi.nlm.nih.gov/pubmed/39495553 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58340 %T Effectiveness of Self-Management Programs Among Athletes With Patellofemoral Pain Syndrome: Protocol for a Systematic Review %A Masoudi,Ameen %A Chemane,Nomzamo %A Useh,Ushotanefe %A Bello,Bashir %A Magida,Nontembiso %+ Physiotherapy Department, University of KwaZulu-Natal, E Block Westville Campus, Durban, 3629, South Africa, 27 312608147, aa.masoudi22@gmail.com %K patellofemoral pain syndrome %K athletes %K self-management %K chronic pain %K pain management %K systematic review %D 2024 %7 1.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patellofemoral pain syndrome is a highly prevalent overuse knee injury in athletic populations associated with pain and functional limitations, exacerbated by activities such as running, pivoting, cycling, and jumping. Self-management programs empowering athletes to take an active role in controlling their symptoms for chronic musculoskeletal conditions such as patellofemoral pain syndrome have grown in popularity. However, the efficacy of self-management programs specifically for athletes with patellofemoral pain syndrome is unclear due to limited and heterogeneous evidence. Objective: The systematic review study will evaluate the effectiveness of self-management programs on pain and function, in athletes with patellofemoral pain syndrome. Methods: PubMed/MEDLINE, Cochrane Library, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO databases will be systematically searched using terms related to “patellofemoral pain syndrome,” “self-management,” and “athletes.” Interventional studies that are randomized and nonrandomized controlled trials will be included, comparing self-management programs to other treatments or control conditions among athletes with patellofemoral pain syndrome. Four reviewers will independently screen studies, extract data using the COVIDENCE software, and assess the quality of the study and evidence using the Pedro scale of risk of bias tool and GRADE approach, respectively. If feasible, a meta-analysis will be performed using the RevMan (version 5.4; the Cochrane Collaboration). Results: The systematic review is currently in the search phase, with the authors refining search strings for the selected databases. The final search strings are expected to be ready by March 2024, and the review is projected to be completed by July 2024. Conclusions: This systematic review protocol outlines a rigorous methodology for evaluating the effectiveness of self-management programs among athletes with patellofemoral pain syndrome. The findings will inform clinical practice and guide the development of tailored interventions to optimize outcomes for athletes with patellofemoral pain syndrome. Trial Registration: PROSPERO CRD42023492746; https://tinyurl.com/c5jze9ca International Registered Report Identifier (IRRID): PRR1-10.2196/58340 %M 39485375 %R 10.2196/58340 %U https://www.researchprotocols.org/2024/1/e58340 %U https://doi.org/10.2196/58340 %U http://www.ncbi.nlm.nih.gov/pubmed/39485375 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57040 %T How Do Scholars Conceptualize and Conduct Health and Digital Health Literacy Research? Survey of Federally Funded Scholars %A Sakhuja,Mayank %A Yelton,Brooks %A Kavarana,Simone %A Schaurer,Lauren %A Rumthao,Jancham Rachel %A Noblet,Samuel %A Arent,Michelle A %A Macauda,Mark M %A Donelle,Lorie %A Friedman,Daniela B %+ UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 323A Rosenau Hall, Chapel Hill, NC, 27599-7295, United States, 1 8034468063, msakhuja@unc.edu %K health literacy %K digital health literacy %K eHealth literacy %K social determinants of health %K SDoH %K research scholarship %K health care %K public health research %K digital health tools %K community health %D 2024 %7 31.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The concept of health literacy (HL) is constantly evolving, and social determinants of health (SDoH) have been receiving considerable attention in public health scholarship. Since a 1-size-fits-all approach for HL fails to account for multiple contextual factors and as a result poses challenges in improving literacy levels, there is a need to develop a deeper understanding of the current state of HL and digital health literacy (DHL) research. Objective: This study examined scholars’ conceptualization and scope of work focused on HL and DHL. Methods: Using a search string, investigators (N=2042) focusing on HL, DHL, or both were identified from the grantee websites of the National Institutes of Health RePORTER (RePORT Expenditures and Results) and the Canadian Institutes of Health Research. The investigators were emailed a survey via Qualtrics. Survey questions examined the focus of work; whether the investigators studied HL/DHL in combination with other SDoH; the frameworks, definitions, and approaches used; and research settings. We analyzed survey data using SPSS Statistics version 28 and descriptive analysis, including frequencies and percentages, was conducted. Chi-square tests were performed to explore the association between the focus of work, settings, and age groups included in the investigators’ research. Results: A total of 193 (9.5%) of 2042 investigators responded to the online survey. Most investigators (76/153, 49.7%) were from public health, 83/193 (43%) reported their research focused on HL alone, 46/193 (23.8%) mentioned DHL, and 64/193 (33.2%) mentioned both. The majority (133/153, 86.9%) studied HL/DHL in combination with other SDoH, 106/135 (78.5%) conducted HL/DHL work in a community setting, and 100/156 (64.1%) reported not using any specific definition to guide their work. Digital tools (89/135, 65.9%), plain-language materials (82/135, 60.7%), and visual guides (56/135, 41.5%) were the top 3 approaches used. Most worked with adults (131/139, 94.2%) and all races and ethnicities (47/121, 38.8%). Conclusions: HL and DHL research largely considered SDoH. Multiple HL tools and approaches were used that support the examination and improvement of literacy and communication surrounding health care issues. %M 39481097 %R 10.2196/57040 %U https://www.jmir.org/2024/1/e57040 %U https://doi.org/10.2196/57040 %U http://www.ncbi.nlm.nih.gov/pubmed/39481097 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e62878 %T Parent-Led Applied Behavior Analysis to Impact Clinical Outcomes for Individuals on the Autism Spectrum: Retrospective Chart Review %A Garikipati,Anurag %A Ciobanu,Madalina %A Singh,Navan Preet %A Barnes,Gina %A Dinenno,Frank A %A Geisel,Jennifer %A Mao,Qingqing %A Das,Ritankar %K applied behavior analysis %K autism spectrum disorder %K parent training %K patient outcomes %K skill acquisition %K pediatrics %D 2024 %7 30.10.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Autism spectrum disorder (ASD) can have traits that impact multiple domains of functioning and quality of life, which can persevere throughout life. To mitigate the impact of ASD on the long-term trajectory of an individual’s life, it is imperative to seek early and adequate treatment via scientifically validated approaches, of which applied behavior analysis (ABA) is the gold standard. ABA treatment must be delivered via a behavior technician with oversight from a board-certified behavior analyst. However, shortages in certified ABA therapists create treatment access barriers for individuals on the autism spectrum. Increased ASD prevalence demands innovations for treatment delivery. Parent-led treatment models for neurodevelopmental conditions are effective yet underutilized and may be used to fill this care gap. Objective: This study reports findings from a retrospective chart review of clinical outcomes for children that received parent-led ABA treatment and intends to examine the sustained impact that modifications to ABA delivery have had on a subset of patients of Montera, Inc. dba Forta (“Forta”), as measured by progress toward skill acquisition within multiple focus areas (FAs). Methods: Parents received ≥40 hours of training in ABA prior to initiating treatment, and patients were prescribed focused (<25 hours/week) or comprehensive (>25‐40 hours/week) treatment plans. Retrospective data were evaluated over ≥90 days for 30 patients. The clinical outcomes of patients were additionally assessed by age (2-5 years, 6-12 years, 13‐22 years) and utilization of prescribed treatment. Treatment encompassed skill acquisition goals; to facilitate data collection consistency, successful attempts were logged within a software application built in-house. Results: Improved goal achievement success between weeks 1‐20 was observed for older age, all utilization, and both treatment plan type cohorts. Success rates increased over time for most FAs, with the exception of executive functioning in the youngest cohort and comprehensive plan cohort. Goal achievement experienced peaks and declines from week to week, as expected for ABA treatment; however, overall trends indicated increased skill acquisition success rates. Of 40 unique combinations of analysis cohorts and FAs, 20 showed statistically significant positive linear relationships (P<.05). Statistically significant positive linear relationships were observed in the high utilization cohort (communication with P=.04, social skills with P=.02); in the fair and full utilization cohorts (overall success with P=.03 for the fair utilization cohort and P=.001 for the full utilization cohort, and success in emotional regulation with P<.001 for the fair utilization cohort and P<.001 for the full utilization cohort); and in the comprehensive treatment cohort (communication with P=.001, emotional regulation with P=.045). Conclusions: Parent-led ABA can lead to goal achievement and improved clinical outcomes and may be a viable solution to overcome treatment access barriers that delay initiation or continuation of care. %R 10.2196/62878 %U https://pediatrics.jmir.org/2024/1/e62878 %U https://doi.org/10.2196/62878 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46983 %T Characterization of Telecare Conversations on Lifestyle Management and Their Relation to Health Care Utilization for Patients with Heart Failure: Mixed Methods Study %A Erdt,Mojisola %A Yusof,Sakinah Binte %A Chai,Liquan %A Md Salleh,Siti Umairah %A Liu,Zhengyuan %A Sarim,Halimah Binte %A Lim,Geok Choo %A Lim,Hazel %A Suhaimi,Nur Farah Ain %A Yulong,Lin %A Guo,Yang %A Ng,Angela %A Ong,Sharon %A Choo,Bryan Peide %A Lee,Sheldon %A Weiliang,Huang %A Oh,Hong Choon %A Wolters,Maria Klara %A Chen,Nancy F %A Krishnaswamy,Pavitra %+ Institute for Infocomm Research (I²R), Agency for Science, Technology and Research (A*STAR), 1 Fusionopolis Way, #21-01, Connexis South Tower, Singapore, 138632, Singapore, 65 6408 2450, pavitrak@i2r.a-star.edu.sg %K telehealth %K telecare %K heart failure %K chronic disease %K self-management %K lifestyle management %K behavior %K health care utilization %K conversation %K dialogue %K medical informatics %D 2024 %7 30.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Telehealth interventions where providers offer support and coaching to patients with chronic conditions such as heart failure (HF) and type 2 diabetes mellitus (T2DM) are effective in improving health outcomes. However, the understanding of the content and structure of these interactions and how they relate to health care utilization remains incomplete. Objective: This study aimed to characterize the content and structure of telecare conversations on lifestyle management for patients with HF and investigate how these conversations relate to health care utilization. Methods: We leveraged real-world data from 50 patients with HF enrolled in a postdischarge telehealth program, with the primary intervention comprising a series of telephone calls from nurse telecarers over a 12-month period. For the full cohort, we transcribed 729 English-language calls and annotated conversation topics. For a subcohort (25 patients with both HF and T2DM), we annotated lifestyle management content with fine-grained dialogue acts describing typical conversational structures. For each patient, we identified calls with unusually high ratios of utterances on lifestyle management as lifestyle-focused calls. We further extracted structured data for inpatient admissions from 6 months before to 6 months after the intervention period. First, to understand conversational structures and content of lifestyle-focused calls, we compared the number of utterances, dialogue acts, and symptom attributes in lifestyle-focused calls to those in calls containing but not focused on lifestyle management. Second, to understand the perspectives of nurse telecarers on these calls, we conducted an expert evaluation where 2 nurse telecarers judged levels of concern and follow-up actions for lifestyle-focused and other calls (not focused on lifestyle management content). Finally, we assessed how the number of lifestyle-focused calls relates to the number of admissions, and to the average length of stay per admission. Results: In comparative analyses, lifestyle-focused calls had significantly fewer utterances (P=.01) and more dialogue acts (Padj=.005) than calls containing but not focused on lifestyle management. Lifestyle-focused calls did not contain deeper discussions on clinical symptoms. These findings indicate that lifestyle-focused calls entail short, intense discussions with greater emphasis on understanding patient experience and coaching than on clinical content. In the expert evaluation, nurse telecarers identified 24.2% (29/120) of calls assessed as concerning enough for follow-up. For these 29 calls, nurse telecarers were more attuned to concerns about symptoms and vitals (19/29, 65.5%) than lifestyle management concerns (4/29, 13.8%). The number of lifestyle-focused calls a patient had was modestly (but not significantly) associated with a lower average length of stay for inpatient admissions (Spearman ρ=-0.30; Padj=.06), but not with the number of admissions (Spearman ρ=-0.03; Padj=.84). Conclusions: Our approach and findings offer novel perspectives on the content, structure, and clinical associations of telehealth conversations on lifestyle management for patients with HF. Hence, our study could inform ways to enhance telehealth programs for self-care management in chronic conditions. %M 39476370 %R 10.2196/46983 %U https://www.jmir.org/2024/1/e46983 %U https://doi.org/10.2196/46983 %U http://www.ncbi.nlm.nih.gov/pubmed/39476370 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53594 %T Provision of Digital Primary Health Care Services: Overview of Reviews %A Fava,Virgínia Maria Dalfior %A Lapão,Luís Velez %+ Centro de Estudos Estratégicos Antonio Ivo de Carvalho, Fundação Oswaldo Cruz (Fiocruz), Ministério da Saúde, Av. Brasil, 4036, 10º andar, sala 1001, Manguinhos, Rio de Janeiro, 21040-361, Brazil, 55 21 3882 9133, virginiafava@gmail.com %K primary health care %K digital health %K implementation %K health service quality %K patients’ clinical conditions %K digital skills %K mobile phone %D 2024 %7 29.10.2024 %9 Review %J J Med Internet Res %G English %X Background: Digital health is a growing field, and many digital interventions have been implemented on a large scale since the COVID-19 pandemic, mainly in primary health care (PHC). The development of digital health interventions and their application in PHC are encouraged by the World Health Organization. The increased number of published scientific papers on this topic has resulted in an overwhelming amount of information, but there is no overview of reviews to summarize this evidence. Objective: This study aims to provide policy makers, health managers, and researchers with a summary of evidence on digital interventions used in PHC. Methods: This overview of reviews searched the Web of Science and MEDLINE databases for systematic and scoping reviews on assessments of digital technologies implemented in PHC published from January 2007 to March 2023. Only reviews that addressed digital interventions whose targets were real patients or health care providers (HCPs) were included. Results: A total of 236 records were identified from the search strategy, of which 42 (17.8%) full-text papers were selected for analysis, and 18 (7.6%) reviews met the eligibility criteria. In total, 61% (11/18) of the reviews focused their analysis on specific digital health interventions (client-to-provider telemedicine, provider-to-provider telemedicine, health worker decision support systems, systems for tracking patients’ health status, client participation and self-care platforms, and provision of education and training to health workers), and 39% (7/18) of the reviews focused on specific topics related to PHC (preventive care, chronic disease management, behavioral health disorders, the COVID-19 pandemic, multicomponent PHC interventions, and care coordination). Most studies in the included reviews agreed on barriers to implementation, such as software and apps developed without involving end users, the lack of training of HCPs and patients in digital technology use, and the lack of reimbursement and billing strategies for remote consultations. However, they showed several mixed results related to health service quality and patients’ clinical conditions and behavior changes. Conclusions: Research in digital health applied to PHC is still concentrated in high-income countries, mainly in North America and Europe. The mixed results related to health service quality and patients’ clinical conditions or behavior changes may have been caused by deficiencies in the process of implementing digital interventions. It is necessary to examine the entire impact pathway and the causal relationship among implementation, health service quality, and clinical condition outcomes to support the spread of digital health in PHC settings. %M 39471374 %R 10.2196/53594 %U https://www.jmir.org/2024/1/e53594 %U https://doi.org/10.2196/53594 %U http://www.ncbi.nlm.nih.gov/pubmed/39471374 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e65354 %T Exploring the Importance of Race and Gender Concordance Between Patients and Physical Therapists in Digital Rehabilitation for Musculoskeletal Conditions: Observational, Longitudinal Study %A Areias,Anabela C %A Janela,Dora %A Molinos,Maria %A Bento,Virgílio %A Moreira,Carolina %A Yanamadala,Vijay %A Cohen,Steven P %A Correia,Fernando Dias %A Costa,Fabíola %+ Sword Health, Inc, 13937 Sprague Lane, Ste 100, Draper, UT, 84020, United States, 1 385 308 8034, f.costa@swordhealth.com %K musculoskeletal pain %K physical therapy %K telerehabilitation %K eHealth %K racial/ethnic concordance %K patient–provider concordance %K physical therapy %K digital rehabilitation %K musculoskeletal conditions %D 2024 %7 29.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Race/ethnicity and gender concordance between patients and providers is a potential strategy to improve health care interventions. In digital health, where human interactions occur both synchronously and asynchronously, the effect of concordance between patients and providers is unknown. Objective: This study aimed to evaluate the impact of race/ethnicity or gender concordance between patients and physical therapists (PTs) in engagement and the clinical outcomes following a digital care program (DCP) in patients with musculoskeletal (MSK) conditions. Methods: This secondary analysis of 2 prospective longitudinal studies (originally focused on assessing the acceptance, engagement, and clinical outcomes after a remote DCP) examined the impact of both race/ethnicity concordance and gender concordance between patients and PTs on outcomes for a digital intervention for MSK conditions. Outcomes included engagement (measured by the completion rate and communication, assessed by text interactions), satisfaction, and clinical outcomes (response rate, ie, percentage of patients achieving at least a minimal clinically important change in pain, measured by the Numerical Pain Rating Scale [NPRS]; anxiety, measured by the Generalized Anxiety Disorder 7-item scale [GAD-7]; depression, measured by the Patient Health Questionnaire 9-item [PHQ-9]; and daily activity impairment, measured by the Work Productivity and Activity Impairment [WPAI] questionnaire). Results: Of 71,201 patients, 63.9% (n=45,507) were matched with their PT in terms of race/ethnicity, while 61.2% (n=43,560) were matched for gender. Concordant dyads showed a higher completion rate among White (adjusted odds ratio [aOR] 1.11, 95% CI 1.05-1.19, P<.001) and Hispanic (aOR 1.27, 95% CI 1.08-1.54, P=.009) groups, as well as women (aOR 1.10, 95% CI 1.06-1.18, P<.001), when compared to discordant dyads. High and similar levels of interaction between patients and PTs were observed across race/ethnicity and gender dyads, except for Asian concordant dyads (adjusted β coefficient 5.32, 95% CI 3.28-7.36, P<.001). Concordance did not affect satisfaction, with high values (>8.52, 95% CI 8.27-8.77) reported across all dyads. Response rates for pain, anxiety, and daily activity impairment were unaffected by race/ethnicity concordance. An exception was observed for depression, with White patients reporting a higher response rate when matched with PTs from other races/ethnicities (aOR 1.20, 95% CI 1.02-1.39, P=.02). In terms of gender, men had a slightly higher pain response rate in discordant dyads (aOR 1.08, 95% CI 1.01-1.15, P=.03) and a higher depression response rate in concordant dyads (aOR 1.23, 95% CI 1.05-1.47, P=.01). Conclusions: Race/ethnicity and gender concordance between patients and PTs does not translate into higher satisfaction or improvement for most clinical outcomes, aside from a positive effect on treatment completion. These results highlight the importance of other PT characteristics, in addition to race/ethnicity or gender concordance, suggesting the potential benefit of experience, languages spoken, and cultural safety training as ways to optimize care. Trial Registration: ClinicalTrials.gov NCT04092946, NCT05417685; https://clinicaltrials.gov/study/NCT05417685, https://clinicaltrials.gov/study/NCT04092946 %M 39470695 %R 10.2196/65354 %U https://www.jmir.org/2024/1/e65354 %U https://doi.org/10.2196/65354 %U http://www.ncbi.nlm.nih.gov/pubmed/39470695 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e49975 %T Portuguese Version of the Oral Frailty Index-8: Instrument Validation Study %A Corrêa,Laura %A Júdice,André %A Scoz,Robson %A Machado,Vanessa %A Mendes,José João %A Proença,Luís %A Botelho,João %A Ferreira,Luciano %+ Egas Moniz School of Health and Science, Campus Universitário, Quinta da Granja, Monte de Caparica, Almada, 2829-511, Portugal, 351 969848394, jbotelho@egasmoniz.edu.pt %K oral frailty %K oral health %K functional disability %K frailty %K aging %K dentistry %K confirmatory factor analysis %K psychometric validity %K questionnaire development %D 2024 %7 28.10.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: The concept of oral frailty has gained scientific and clinical relevance in recent years, and early detection can facilitate timely intervention to manage its progression. The Oral Frailty Index-8 (OFI-8) was developed to assess community-dwelling older adults at risk for oral frailty. Objective: This study aims to investigate the psychometric validity of the OFI-8 in the Portuguese population, named the Portuguese version of the OFI-8 (OFI-8-PT), which may serve as a reference for future studies related to longevity and oral function. Methods: This study included 2 main phases, involving patients aged 60 years or older, Portuguese speakers, and those who consented to participate in the study. First, the researchers translated and cross-culturally adapted the original questionnaire to make it suitable for native Portuguese speakers. The translated tool was then assessed for psychometric validation, which consisted of test-retest reliability, internal consistency, construct validity, and sex invariance measurement. Results: A total of 159 older adults participated in the baseline survey, with almost equal numbers of male (n=79, 49.7%) and female participants (n=80, 50.3%). The OFI-8-PT demonstrated good reliability (Cronbach α=0.95) and construct validity (goodness-of-fit index=0.96; comparative fit index=0.85; and root mean square error of approximation=0.05, 90% CI 0.00-0.09). The study found sex invariance, indicating that the OFI-8-PT is equally valid for male and female participants, and the tested-retest reliability of the OFI-8-PT was good, indicating consistent results over time. Conclusions: The OFI-8-PT showed psychometric validity and good reliability to be used in the Portuguese population. %M 39466299 %R 10.2196/49975 %U https://www.i-jmr.org/2024/1/e49975 %U https://doi.org/10.2196/49975 %U http://www.ncbi.nlm.nih.gov/pubmed/39466299 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59894 %T Over-the-Counter Hearing Aids Versus Traditional Hearing Aids in Patients With Mild-to-Moderate Hearing Loss: Protocol for a Noninferiority Randomized Controlled Trial %A Kim,Ga-Young %A Jo,Mini %A Cho,Young Sang %A Moon,Il Joon %+ Department of Otorhinolaryngology - Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, 81, Irwon-ro, Seoul, 06342, Republic of Korea, 82 3410 3579, moonij@skku.edu %K hearing aids %K over-the-counter hearing aids %K correction of hearing impairment %K randomized controlled trial %K evidence-based medicine %K hearing loss %K aging %K hearing sensitivity %K mobile phone %D 2024 %7 25.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: With the aging of society, the prevalence of hearing loss (HL) is increasing. Currently, approximately 5% of the global population has HL, and this number is projected to reach 7 million by 2050. Although hearing aids (HAs) are the primary treatment for HL, their use is limited by barriers such as high costs and social stigma. To address these limitations, over-the-counter (OTC) HAs have been introduced, but their effectiveness and drawbacks require further investigation. Objective: This study aims to conduct a noninferiority randomized controlled trial comparing OTC HAs with traditional HAs to assess the clinical effectiveness of OTC HAs. Methods: We designed a noninferiority randomized controlled trial comparing OTC HAs and traditional HAs in adults with mild-to-moderate HL. A total of 64 participants (32 per group) will be recruited. Randomization will be performed using block randomization (block sizes of 2 or 4) with an equal allocation ratio. The study will include 2 types of HAs: an OTC HA (Jabra Enhance Pro) and a traditional HA (LiNX Quattro LE561-DRW) by GN ReSound A/S. OTC HAs will be self-fitted using a smartphone app, while traditional HAs will be fitted by a licensed audiologist using the National Acoustics Laboratories–Non-Linear Prescription, second generation. Assessments, including functional gain, real-ear measurement, speech audiometry, and questionnaires, will be conducted at 6-month intervals over the course of 3 visits. Statistical analysis will compare the 2 outcomes, focusing on functional gain, to determine noninferiority. Results: This study is scheduled to begin in August 2024 and has not yet recruited any participants. The study will be conducted over 2 years, from August 2024 to July 2026. Each participant will have 2 follow-up visits at 6-month intervals, making the total follow-up period 1 year. Conclusions: Since 2022, the introduction of OTC HAs has revolutionized access to these devices. Researchers, clinicians, and the general public are keen to evaluate the clinical effectiveness of OTC HAs, as more individuals will likely use them for HL. This increased usage will provide valuable real-world data to understand the benefits and limitations of OTC HAs. Monitoring the outcomes and user feedback will provide insights into their effectiveness and impact on hearing rehabilitation. International Registered Report Identifier (IRRID): PRR1-10.2196/59894 %M 39454188 %R 10.2196/59894 %U https://www.researchprotocols.org/2024/1/e59894 %U https://doi.org/10.2196/59894 %U http://www.ncbi.nlm.nih.gov/pubmed/39454188 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e57285 %T Antibiotic Prescribing Behavior of Physicians in Outpatient Departments in Hospitals in Northwest Ethiopia: Structural Equation Modeling Approach %A Abejew,Asrat Agalu %A Wubetu,Gizachew Yismaw %A Fenta,Teferi Gedif %+ Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Zambia Street, Tikur Anbessa Specialized Hospital Compound, Addis Ababa, 2QC2+23Q, Ethiopia, 251 0917156682, asruphar@gmail.com %K antibiotic prescribing behavior %K Ethiopia %K outpatient departments %K physicians %K SEM %K TPB %D 2024 %7 23.10.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Antibiotic resistance, fueled by irrational prescribing, is a global threat associated with health, social, and economic consequences. Understanding antibiotic prescribing behavior and associated factors is important to promote good prescribing practice. Objective: This study aimed to determine the factors affecting antibiotic prescribing behaviors of physicians based on the theory of planned behavior in hospitals in northwest Ethiopia in 2022. Methods: A cross-sectional study was conducted from September 2022 to October 2022. A total of 185 health professionals were included, and a self-administered questionnaire was used to collect data. A structural equation model based on the modified theory of planned behavior was used to determine factors affecting antibiotic prescribing behavior. The percentages of physicians’ estimated prescriptions for patients with upper respiratory tract infections (URTIs) and during weekly outpatient visits were used to predict antibiotic prescribing behavior and finally linked with behavioral constructs. A P value <.05 was considered significant. Results: Physicians estimated that they prescribed antibiotics for 54.8% (9896/18,049) of weekly outpatient encounters, and 178 (96.2%) of the 185 physicians estimated they prescribed antibiotics for patients who presented with symptoms of a URTI. Physicians aged ≤30 years were less likely to prescribe antibiotics (48/100, 48%) for patients who presented with a URTI than physicians older than 30 years (51/100, 51%; P=.004), and general practitioners were less likely to prescribe antibiotics (47/100, 47%) for patients who presented with a URTI than residents (51/100, 51%; P=.03). Similarly, during outpatient visits, physicians ≤30 years old were less likely to prescribe antibiotics (54/100, 54%) than physicians older than 30 years (57/100, 57%; P<.001), male physicians were less likely to prescribe antibiotics (53/100, 53%) than female physicians (64/100, 64%; P=.03), and general practitioners were less likely to prescribe antibiotics (53/100, 53%) than residents (57/100, 57%; P=.02). Physicians with good knowledge were less affected by perceived social pressure (mean 4.4, SD 0.6) than those with poor knowledge (mean 4.0, SD 0.9; P<.001) and felt it was easy to make rational decisions (mean 4.1, SD 1.1) compared with those with poor knowledge (mean 3.8, SD 1; P<.001). However, intentions to reduce and prescribe antibiotics were not affected by attitudes, subjective norms, or perceived behavioral control, and perceived antibiotic prescribing behavior was not related to intentions to reduce or prescribe antibiotics. Conclusions: Antibiotic prescribing behavior was not under the volitional control of physicians. This calls for a systematic approach to change antibiotic prescribing practices in hospital. %M 39441643 %R 10.2196/57285 %U https://www.i-jmr.org/2024/1/e57285 %U https://doi.org/10.2196/57285 %U http://www.ncbi.nlm.nih.gov/pubmed/39441643 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 9 %N %P e58137 %T Comparing Insulin Against Glucagon-Like Peptide-1 Receptor Agonists, Dipeptidyl Peptidase-4 Inhibitors, and Sodium-Glucose Cotransporter 2 Inhibitors on 5-Year Incident Heart Failure Risk for Patients With Type 2 Diabetes Mellitus: Real-World Evidence Study Using Insurance Claims %A Wang,Xuan %A Plantinga,Anna M %A Xiong,Xin %A Cromer,Sara J %A Bonzel,Clara-Lea %A Panickan,Vidul %A Duan,Rui %A Hou,Jue %A Cai,Tianxi %K type 2 diabetes mellitus %K diabetes %K diabetes complications %K heart failure %K antidiabetic drug %K diabetes pharmacotherapy %K insulin %K GLP-1 RA %K DPP-4I %K SGLT2I %K real-world data %K insurance data %K claims data %K glucagon-like peptide-1 receptor agonist %K dipeptidyl peptidase-4 inhibitor %K sodium-glucose cotransporter 2 inhibitor %D 2024 %7 22.10.2024 %9 %J JMIR Diabetes %G English %X Background: Type 2 diabetes mellitus (T2DM) is a common health issue, with heart failure (HF) being a common and lethal long-term complication. Although insulin is widely used for the treatment of T2DM, evidence regarding the efficacy of insulin compared to noninsulin therapies on incident HF risk is missing among randomized controlled trials. Real-world evidence on insulin’s effect on long-term HF risk may supplement existing guidelines on the management of T2DM. Objective: This study aimed to compare insulin therapy against other medications on HF risk among patients with T2DM using real-world data extracted from insurance claims. Methods: A retrospective, observational study was conducted based on insurance claims data from a single health care network. The study period was from January 1, 2016, to August 11, 2021. The cohort was defined as patients having a T2DM diagnosis code. The inclusion criteria were patients who had at least 1 record of a glycated hemoglobin laboratory test result; full insurance for at least 1 year (either commercial or Medicare Part D); and received glucose-lowering therapy belonging to 1 of the following groups: insulin, glucagon-like peptide 1 receptor agonists (GLP-1 RAs), dipeptidyl peptidase-4 inhibitors (DPP-4Is), or sodium-glucose cotransporter-2 inhibitors (SGLT2Is). The main outcome was the 5-year incident HF rate. Baseline covariates, including demographic characteristics, comorbidities, and laboratory test results, were adjusted to correct for confounding. Results: After adjusting for a broad list of confounders, patients receiving insulin were found to be associated with an 11.8% (95% CI 11.0%‐12.7%), 12.0% (95% CI 11.5%‐12.4%), and 15.1% (95% CI 14.3%‐16.0%) higher 5-year HF rate compared to those using GLP-1 RAs, DPP-4Is, and SGLT2Is, respectively. Subgroup analysis showed that insulin’s effect of a higher HF rate was significant in the subgroup with high HF risk but not significant in the subgroup with low HF risk. Conclusions: This study generated real-world evidence on the association of insulin therapy with a higher 5-year HF rate compared to GLP-1 RAs, DPP-4Is, and SGLT2Is based on insurance claims data. These findings also demonstrated the value of real-world data for comparative effectiveness studies to complement established guidelines. On the other hand, the study shares the common limitations of observational studies. Even though high-dimensional confounders are adjusted, remaining confounding may exist and induce bias in the analysis. %R 10.2196/58137 %U https://diabetes.jmir.org/2024/1/e58137 %U https://doi.org/10.2196/58137 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e58136 %T Participant Motivators and Expectations in the MEL-SELF Randomized Clinical Trial of Patient-Led Surveillance for Recurrent Melanoma: Content Analysis of Survey Responses %A Ackermann,Deonna %A Hersch,Jolyn %A Jordan,Dana %A Clinton-Gray,Emily %A Bracken,Karen %A Janda,Monika %A Turner,Robin %A Bell,Katy %+ School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown NSW, Sydney, 2050, Australia, 61 418219923, deonna.ackermann@sydney.edu.au %K teledermatology %K melanoma %K randomized controlled trial %K trial recruitment and retention %K studies within a trial %K SWATs %K dermatology %K cancer %K early detection %K dermatology clinical trials %K clinical trials %K mobile phone %D 2024 %7 17.10.2024 %9 Original Paper %J JMIR Dermatol %G English %X Background: Limited data exist on the motivations and expectations of participants when enrolling in dermatology clinical trials, including melanoma early detection trials. Understanding participant motivators for research engagement has been identified as a prioritized area for trial methodology research. Objective: The study aimed to determine motivators of participation and expectations from trial involvement among patients enrolled in the MEL-SELF randomized clinical trial of patient-led surveillance for new or recurrent melanoma. Methods: The MEL-SELF trial is recruiting patients previously treated for localized melanoma, who own a smartphone, have a partner to assist with skin self-examination (SSE), and attend routinely scheduled follow-up at specialist and primary care skin clinics in Australia. We evaluated responses from the first 100 randomized participants to 2 open-ended questions about their motivations and expectations for participating in the trial, administered through the internet-based baseline questionnaire. A total of 3 coders independently coded the free-text responses and resolved discrepancies through consensus. Qualitative content analysis by an iterative process was used to group responses into themes. Responses from potential participants who were not randomized and the 404 participants randomized subsequently into the trial, were also checked for new themes. Coding and analysis were conducted in Microsoft Excel. Results: Out of the 100 survey participants, 98 (98%) answered at least 1 of the 2 questions. Overall, responses across the motivation and expectation items indicated 3 broad themes: community benefit, perceived personal benefit, and trusting relationship with their health care provider. The most common motivators for participation were related to community benefit. These included progressing medical research, benefitting future melanoma patients who may have similar experiences, and broader altruistic sentiments such as “helping others” or “giving back.” The most common expectations from the trial related to personal benefit. These included perceived improved outcomes such as earlier diagnosis and treatment, access to additional care, and increased self-empowerment to take actions themselves that benefit their health. Patients expressed a desire to gain health-related knowledge and skills and were interested in the potential advantages of teledermatology. There were no new themes in responses from those who were not randomized or were randomized subsequent to the first 100. Conclusions: We report a tailorable, patient-focused approach to identify drivers of research engagement in clinical research. Clinical trials offer an opportunity to collate a substantial evidence base on determinants of research participation and to identify context-specific factors. Results from the MEL-SELF trial emphasized notable altruism, self-empowerment, and perceived advantages of teledermatology as specific motivators. These findings informed consent processes, recruitment, retention, response to trial tasks, and intervention adherence for the MEL-SELF host trial. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000176864. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379527& %M 39418647 %R 10.2196/58136 %U https://derma.jmir.org/2024/1/e58136 %U https://doi.org/10.2196/58136 %U http://www.ncbi.nlm.nih.gov/pubmed/39418647 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e59915 %T Multidisciplinary Home-Based Rehabilitation Program for Individuals With Disabilities: Longitudinal Observational Study %A Barría,Patricio %A Andrade,Asterio %A Gomez-Vargas,Daniel %A Yelincic,Alejandro %A Roberti,Flavio %A Bahamonde,Eduardo %A Aguilar,Rolando %A Cordova,Bessie %+ Institute of Automatics, National University of San Juan, Av. Libertador Gral. San Martín 1102, San Juan, 5400, Argentina, 54 542644213303, dgomez@inaut.unsj.edu.ar %K rehabilitation %K home-based therapy %K physical therapy %K psychological therapy %K home physiotherapy %K disabilities %K occupational therapy %K personalized care %K patient care %K motor disorder %K mood disorder %K motor function %D 2024 %7 16.10.2024 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Disability affects a significant portion of the global population nowadays, necessitating innovative approaches to access rehabilitation processes. Home-based rehabilitation has emerged as a beneficial approach, offering comfort and context-specific therapy. Objective: This study aims to evaluate the impact of a multidisciplinary home-based rehabilitation program for individuals with moderate neuromusculoskeletal disabilities in terms of motor function and mood. Methods: A total of 270 participants with median age of 66 (IQR 20-98) years were recruited from the National Disability Registry of Chile. The intervention involved a multidisciplinary team composed of 49 health care professionals providing personalized treatment plans over 4 months (32 sessions for physical therapy, 8 sessions for occupational therapy, 4 sessions for nutrition, 8 sessions for psychology, and 4 sessions for nursing and podiatry). This program also included 2 medical evaluations (at the beginning and the end) to monitor clinical progress in terms of motor function and mental health, using the Berg Balance Scale and Beck Depression Inventory, respectively. Results: The home-based rehabilitation program showed significant improvements (P<.001) in motor function and balance with a reduction in fall risk. Specifically, the Berg Balance Scale score decreased close to 15% after the home-based rehabilitation program for all enrolled participants. On the other hand, depression levels showed no significant changes (P=.27), with percentages of variation less than 8% between the 2 assessed conditions. In this sense, participants remained with the same mild depression level (14 of 63) concerning the Beck Depression Inventory score. Conclusions: This study concludes that personalized home-based rehabilitation programs are effective in enhancing motor function and balance, particularly in individuals with neurological conditions. On the other hand, the findings in terms of mood advocate for further exploration of psychological support within such programs to enhance overall patient well-being. Trial Registration: ClinicalTrials.gov NCT06537791; https://clinicaltrials.gov/study/NCT06537791 %M 39412860 %R 10.2196/59915 %U https://rehab.jmir.org/2024/1/e59915 %U https://doi.org/10.2196/59915 %U http://www.ncbi.nlm.nih.gov/pubmed/39412860 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 16 %N %P e58096 %T Understanding the Values, Qualities, and Preferences of Patients in Their Relationships With Obstetrics and Gynecology Providers: Cross-Sectional Survey With a Mixed Methods Approach %A Kennedy,Ann Blair %A Harb,Anna Tarasidis %A Schockling,Chloe %A Ray,Lauren Jackson %A Palomo,Jennifer %A Russ-Sellers,Rebecca %+ Department of Biomedical Sciences, School of Medicine Greenville, University of South Carolina, 701 Grove Road, Health Science Administration Building, Greenville, SC, 29605, United States, 1 18647662028, kenneda5@greenvillemed.sc.edu %K communication %K obstetrics %K gynecology %K trust %K barriers to care %K patient-provider relationships %D 2024 %7 16.10.2024 %9 Original Paper %J J Particip Med %G English %X Background: The patient-provider relationship in obstetrics and gynecology (OBGYN) is uniquely complex due to the sensitive nature of examinations and topics. Patients often prefer health care providers who share similar racial, ethnic, gender, or linguistic backgrounds, particularly in sensitive health care situations, to improve communication and comfort, though historically, specific gender preferences for OBGYNs have not been evident. Objective: This study aims to describe the values, qualities, and preferences of patients in their relationships with OBGYN providers. Methods: This cross-sectional survey, conducted from October 2019 to December 2019, involved 1039 US OBGYN patients and used a mixed methods approach, integrating quantitative responses and qualitative insights from open-ended questions. Recruitment was facilitated through targeted social media campaigns, and the survey aimed to capture detailed patient preferences and barriers to care by assessing responses on provider traits, patient experiences, and demographic factors. The study’s rigorous data collection and analysis were designed to fill gaps identified in previous research on patient-provider relationships in OBGYN care. Results: The findings underscore the paramount importance of trust and comfort, with listening skills identified as crucial. A notable finding is the marked preference for same-gender providers, observed in 80.7% (545/675) of participants. Primary barriers to seeking care reported included daily commitments, highlighting the need for accessible and flexible care options. Conclusions: The study highlights a significant shift from previous scientific findings in patient preferences toward gender concordance and trust in OBGYN settings, diverging from previous research. These results emphasize the need for patient-centered care and tailored communication strategies to enhance patient experiences and outcomes. Future research should focus on diverse populations to broaden the findings’ applicability and explore the impact of recent shifts in health care policies. %M 39412870 %R 10.2196/58096 %U https://jopm.jmir.org/2024/1/e58096 %U https://doi.org/10.2196/58096 %U http://www.ncbi.nlm.nih.gov/pubmed/39412870 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58022 %T Methodology for Measuring Intraoperative Blood Loss: Protocol for a Scoping Review %A Dennin,Lätitia %A Kleeff,Jörg %A Klose,Johannes %A Ronellenfitsch,Ulrich %A Rebelo,Artur %+ Department of Visceral, Vascular and Endocrine Surgery, University Hospital of Halle (Saale), Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, Halle (Saale), 06120, Germany, 49 345 557 2314, laetitia.dennin@gmail.com %K intraoperative blood loss %K estimation of blood loss %K intraoperative monitoring %K surgery %K surgical care %K postoperative care %K quality improvement %D 2024 %7 16.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: At present, there is no standardized method for measuring intraoperative blood loss. Rather, the current data on existing methods is very broad and opaque. In many cases, blood loss during surgery is estimated visually by the surgeon. However, it is known that this type of method is very prone to error. Therefore, better standardized methods are needed. Objective: This study aims to conduct a scoping review to present the currently available methods for measuring intraoperative blood loss. This should help to capture the current status and map and summarize the available evidence for measuring blood loss to identify any gaps. Methods: We will use a state-of-the-art methodological framework. The databases PubMed (MEDLINE) and Cochrane Library will be searched using a search strategy based on the PICO (Population, Intervention, Comparator, and Outcome) scheme. The search period will be limited to January 01, 2012, to December 31, 2023, and our search will be restricted to clinical trials or clinical studies, randomized controlled trials, and observational studies (in line with PubMed definition of study types). Only publications in English and German will be considered. The intention is to identify clinical studies that define “blood loss” as a target criterion or as a primary or secondary end point. EndNote (version 20.6; Clarivate) will be used for the screening process. The data will be collected and analyzed using Microsoft Excel (version 16.77.1). Results: The included studies will be listed in a database, and the following basic data will be extracted: title, year of publication, country, language, study type, surgical specialty, and type of procedure. The number of participants will be listed and the distribution of the participants will be documented in terms of gender and age. The following results are extracted: the type of measurement method used to measure blood loss in this study and whether the parameter “blood loss” was recorded as a primary or secondary outcome. Conclusions: Currently, there is no comparable review, resulting in ambiguous data regarding the prevailing measurement methods for intraoperative blood loss. The aim of this study is to provide a comprehensive overview—from methods of measurement to various formulae for calculating blood loss—and to establish a status quo. This could then serve as a foundation for further studies. International Registered Report Identifier (IRRID): DERR1-10.2196/58022 %M 39412859 %R 10.2196/58022 %U https://www.researchprotocols.org/2024/1/e58022 %U https://doi.org/10.2196/58022 %U http://www.ncbi.nlm.nih.gov/pubmed/39412859 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60081 %T Primary Care Informatics: Vitalizing the Bedrock of Health Care %A You,Jacqueline Guan-Ting %A Leung,Tiffany I %A Pandita,Deepti %A Sakumoto,Matthew %+ Department of Medicine, University of California San Francisco, 533 Parnassus Avenue, U127, San Francisco, CA, 94143, United States, 1 4154761000, matthew.sakumoto@ucsf.edu %K health care delivery %K primary care %K primary health care %K primary prevention %K quality of health care %K holistic care %K holistic medicine %K people-centric care %K person-centric care %K medical informatics applications %K primary care informatics %K medical informatics %K health informatics %K information science %K data science %D 2024 %7 15.10.2024 %9 Viewpoint %J J Med Internet Res %G English %X Primary care informatics (PCI) professionals address workflow and technology solutions in a wide spectrum of health, ranging from optimizing the experience of the individual patient in the clinic room to supporting the health of populations and augmenting the work of frontline primary care clinical teams. PCI overlaps uniquely with 2 disciplines with an impact on societal health—primary care and health informatics. Primary care is a gateway to health care access and aims to synthesize and coordinate numerous, complex elements of patients’ health and medical care in a holistic manner. However, over the past 25 years, primary care has become a specialty in crisis: in a post–COVID-19 world, workforce shortages, clinician burnout, and continuing challenges in health care access all contribute to difficulties in sustaining primary care. Informatics professionals are poised to change this trajectory. In this viewpoint, we aim to inform readers of the discipline of PCI and its importance in the design, support, and maintenance of essential primary care services. Although this work focuses on primary care in the United States, which includes general internal medicine, family medicine, and pediatrics (and depending on definition, includes specialties such as obstetrics and gynecology), many of the principles outlined can also be applied to comparable health care services and settings in other countries. We highlight (1) common global challenges in primary care, (2) recent trends in the evolution of PCI (personalized medicine, population health, social drivers of health, and team-based care), and (3) opportunities to move forward PCI with current and emerging technologies using the 4Cs of primary care framework. In summary, PCI offers important contributions to health care and the informatics field, and there are many opportunities for informatics professionals to enhance the primary care experience for patients, families, and their care teams. %M 39405512 %R 10.2196/60081 %U https://www.jmir.org/2024/1/e60081 %U https://doi.org/10.2196/60081 %U http://www.ncbi.nlm.nih.gov/pubmed/39405512 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e63951 %T Effectiveness of a Person-Centered Interdisciplinary Rehabilitation Treatment of Post–COVID-19 Condition: Protocol for a Single-Case Experimental Design Study %A Wiertz,Carolina M H %A van Meulenbroek,Thijs %A Lamper,Cynthia %A Hemmen,Bea %A Sep,Simone %A Huijnen,Ivan %A Goossens,Marielle E J B %A Burgers,Jako %A Verbunt,Jeanine %+ Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, PO Box 616, Maastricht, 6200 MD, Netherlands, 31 433882160, cmh.wiertz@maastrichtuniversity.nl %K rehabilitation medicine %K postacute COVID-19 syndrome %K quality of life %K long COVID %K COVID-19 %K multidisciplinary care %K interdisciplinary care %D 2024 %7 11.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patients with post–COVID-19 condition (PCC) experience a wide range of complaints (physical, cognitive, and mental), sometimes with high levels of disability in daily activities. Evidence of effective interdisciplinary rehabilitation treatment is lacking. A person-centered, biopsychosocial, interdisciplinary rehabilitation program, adapted to expert opinions and the patient’s needs, was therefore developed. Objective: This study aims to present a study protocol for a clinical trial to evaluate the effect of a new, person-centered, interdisciplinary rehabilitation treatment for PCC. It is aimed at improving participation in society and health-related quality of life in patients with PCC who perceive a high level of disability in daily activities or participation. Methods: A total of 20 Dutch adults, aged 18 years or older, with high levels of disability in daily activities and participation in society will be included in this replicated and randomized single-case experimental design study, from October 2023 onward. The replicated and randomized single-case experimental design consists of 3 phases. The baseline phase is the observational period, in which no specific treatment will be given. In the intervention phase, patients will receive the new outpatient treatment 3 times a week for 12 weeks, followed by a 12-week follow-up phase. During the intervention phase, the treatment will be personalized according to the patient’s physical, mental, and cognitive symptoms and goals. The treatment team can consist of a rehabilitation physician, physiotherapist, occupational therapist, speech therapist, and psychologist. The primary outcomes of the study are daily diaries, which consist of 8 questions selected from validated questionnaires (Utrecht Scale for Evaluation of Rehabilitation-Participation, EQ-5D-5L, and the Hospital Anxiety and Depression Scale). The other primary outcome measurements are participation in society (Utrecht Scale for Evaluation of Rehabilitation-Participation) and health-related quality of life (EQ-5D-5L). The secondary outcomes are physical tests and validated questionnaires aimed at physical, mental, and cognitive complaints. Effect evaluation based on daily assessments will include visual analysis, calculation of effect sizes (Nonoverlap of All Pairs), randomization tests, and multilevel analysis. In addition, other analyses will be based on ANOVA or a 2-tailed Student t test. Results: Data collection for this study started in October 2023 and is planned to be completed in July 2024. The results will be published in peer-reviewed journals and presented at international conferences. Conclusions: This is the first study investigating the effect of an interdisciplinary rehabilitation treatment with a person-centered, biopsychosocial approach in patients with PCC. Our findings will help to improve the treatment and support of patients with PCC. Trial Registration: German Clinical Trials Register DRKS00032636; https://drks.de/search/en/trial/DRKS00032636 International Registered Report Identifier (IRRID): DERR1-10.2196/63951 %M 39393059 %R 10.2196/63951 %U https://www.researchprotocols.org/2024/1/e63951 %U https://doi.org/10.2196/63951 %U http://www.ncbi.nlm.nih.gov/pubmed/39393059 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e52287 %T Health Locus of Control and Medical Behavioral Interventions: Systematic Review and Recommendations %A Mozafari,Sogol %A Yang,Alan %A Talaei-Khoei,Jason %+ Department of Information Systems, College of Business, University of Nevada, Reno, 1664 North Virginia Street, Reno, NV, 89557, United States, 1 7757846428, alany@unr.edu %K medical behavioral interventions %K health locus of control %K internal control %K external control %K patient behavior %K synthesis %K review methods %K literature review %K narrative review %K behavior change %D 2024 %7 10.10.2024 %9 Review %J Interact J Med Res %G English %X Background: Health locus of control (HLOC) is a theory that describes how individuals perceive different forces that influence their lives. The concept of a locus of control can affect an individual’s likelihood to commit to behaviors related to their health. This study explores the literature on the relationships between HLOC and medical behavioral interventions. Objective: This study aims to better understand how HLOC constructs can potentially affect patient responses to health behavioral interventions and to propose a series of guidelines for individuals interested in designing medical behavioral interventions related to HLOC. Methods: We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology and performed an analysis of 50 papers related to the topic of HLOC and medical behavioral interventions. Inclusion criteria were studies that had a behavioral intervention involving patients and contained a metric of at least 1 of the constructs related to HLOC. The initial screening and search were conducted by 2 researchers (AY and SM) separately. The results were then combined and compared. Results: Our findings explore the influence of different levels of HLOC along with the importance of both patient- and health-related context when assessing the relationships between HLOC constructs and the likelihood of health behavior change. The findings show that different constructs related to HLOC can act as reliable predictors for patient responses to medical behavioral interventions. Patients who score higher on internal HLOC measures are more likely to exhibit behaviors that are consistent with positive health outcomes. Patients who score higher on chance HLOC are more likely to exhibit behaviors that may lead to adverse health outcomes. These conclusions are supported by most of the 50 studies surveyed. Conclusions: We propose guidelines for individuals designing medical behavioral interventions so that they can make use of these relationships linked to HLOC. The three guidelines suggested are as follows: (1) in most situations, improving internal HLOC will improve health outcomes for patients; (2) patients with high external HLOC should be further studied to determine the source of the external HLOC; and (3) patients with a high chance HLOC are less likely to follow preventative behaviors or be responsive to interventions. Limitations of the study are that the primary search and analysis were conducted by 2 principal researchers (AY and SM). Interpretation and development of the guidelines are subject to individual interpretation of results and may not be applicable to all contexts. %M 39388686 %R 10.2196/52287 %U https://www.i-jmr.org/2024/1/e52287 %U https://doi.org/10.2196/52287 %U http://www.ncbi.nlm.nih.gov/pubmed/39388686 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e63106 %T Assessing a Couples-Based, Digital HIV Serostatus-Neutral Intervention (Para Ti, Para Mí, Para Nosotros) for Adult Cisgender Sexual Minority Male Couples in Lima, Peru: Protocol for a 6-Month Pilot Randomized Controlled Trial %A Mitchell,Jason W %A Bursac,Zoran %A Diaz,David %A Reyes Diaz,Edward Michael %A Silva-Santisteban,Alfonso %A Konda,Kelika A %+ Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, AHC-5, #417, 11200 SW 8th St, Miami, FL, 33199, United States, 1 (305) 348 7789, jamitche@fiu.edu %K digital health intervention %K HIV prevention care %K sexually transmitted infection %K cisgender, sexual minority male couples %K randomized controlled trial %K Peru %K mobile phone %D 2024 %7 10.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: HIV disproportionately affects sexual minority men (SMM; eg, gay, bisexual, and other men who have sex with men) in Lima, Peru; epidemiological data estimate that 32% to 39% of new HIV infections occur among adult cisgender SMM within primary partnerships (ie, male couples). Most HIV prevention-care research in Lima, Peru, has focused on SMM as individuals and not couples. To help address this critical gap in prevention care, we developed Para Ti, Para Mí, Para Nosotros (P3): a couples-based, digital HIV serostatus-neutral intervention (DHI) for adult cisgender SMM couples in Lima, Peru. The P3 DHI is designed to facilitate couples with skill-building, communication, decision-making, and working together to form and adhere to a detailed prevention care plan that aligns with their explicit sexual agreement. The P3 DHI is theoretically informed, self-guided, directed, sequential, and fully automated. Objective: This pilot randomized controlled trial (RCT) aims to examine the preliminary effects of P3 on couples’ formation and adherence to a detailed prevention care plan containing evidence-based strategies that also aligns with their explicit sexual agreement over time. In addition, the feasibility of enrollment and retention and couples’ acceptability of P3 will be assessed. Methods: The research implements a prospective, 6-month pilot RCT with a 3-month delayed control condition. After baseline, 60 enrolled SMM couples will be randomized to 1 of 2 conditions. Couples randomized to the unmatched, delayed control condition will receive access to the P3 DHI to use during the last 3 months of the trial after the 3-month assessment. Couples randomized to the immediate intervention condition will immediately receive access to the P3 DHI for 6 months. Study assessments will occur at baseline and months 3 and 6. Descriptive, comparative, qualitative, and longitudinal analyses using generalized linear mixed-effect, multilevel, and actor-partner interdependence models will be conducted to address the specific aims. Results: The 6-month pilot RCT is ongoing. Recruitment, enrollment, and data collection began in January 2023 and ended in April 2024. A total of 74 adult cisgender SMM couples met all inclusion criteria, provided consent, and were enrolled in the pilot RCT. Retention was 92% (68/74) at month 6. Data are currently being analyzed to address the 3 specific aims regarding feasibility, acceptability, and preliminary efficacy. Conclusions: Findings from this research will reveal whether couples deemed the P3 DHI to be acceptable. Findings will also highlight the preliminary efficacy of the P3 DHI on couples managing their vulnerability to HIV and other sexually transmitted infections (STIs) over time via alignment of their prevention-care plan and sexual agreement. Trial findings will help shape the future direction of the P3 DHI while addressing the existing gap in prevention and care services for couples in the local context. Trial Registration: ClinicalTrials.gov NCT05873855; https://clinicaltrials.gov/study/NCT05873855 International Registered Report Identifier (IRRID): DERR1-10.2196/63106 %M 39388228 %R 10.2196/63106 %U https://www.researchprotocols.org/2024/1/e63106 %U https://doi.org/10.2196/63106 %U http://www.ncbi.nlm.nih.gov/pubmed/39388228 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57784 %T Multifaceted Intervention to Improve Graft Outcome Disparities in African American Kidney Transplants (MITIGAAT Study): Protocol for a Randomized Controlled Trial %A Overstreet,Morgan %A Culpepper,Hannah %A DeHoff,Deanna %A Gebregziabher,Mulugeta %A Posadas Salas,Maria Aurora %A Su,Zemin %A Chandler,Jessica %A Bartlett,Felicia %A Dunton,Paige %A Carcella,Taylor %A Taber,David %+ Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC, 29425-8900, United States, 1 18437928896, overstrm@musc.edu %K kidney transplant %K mobile health %K medication adherence %K mHealth %K nephrology %K transplant surgery %K postoperative monitoring %K telemedicine %K eHealth %D 2024 %7 10.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The outcome disparities for African American recipients of kidney transplant is a public health issue that has plagued the field of transplant since its inception. Based on national data, African American recipients have nearly twice the risk of graft loss at 5 years after transplant, when compared with White recipients. Evidence demonstrates that medication nonadherence and high tacrolimus variability substantially impact graft outcomes and racial disparities, most notably late (>2 years) after the transplant. Nonadherence is a leading cause of graft loss. Prospective multicenter data demonstrate that one-third of all graft loss are directly attributed to nonadherence. We have spent 10 years of focused research to develop a comprehensive model explaining the predominant risk factors leading to disparities in African American kidney recipients. However, there are still gaps in patient-level data that hinder the deeper understanding of the disparities. Lack of data from the patient often lead to provider biases, which will be addressed with this intervention. Culturally competent, pharmacist-led interventions in medication therapy management will also address therapeutic inertia. Pharmacist interventions will mitigate medication access barriers as well (cost and insurance denials). Thus, this multidimensional intervention addresses patient, provider, and structural factors that drive racial disparities in African American kidney recipients. Objective: This prospective, randomized controlled trial aimed to determine the impact of multimodal health services intervention on health outcomes disparities in African American recipients of kidney transplant. The aims of this study are to improve adherence and control of late clinical issues, which are predominant factors for racial disparities in kidney recipients, through a technology-enabled, telehealth-delivered, 4-level intervention. Methods: The Multifaceted Intervention to Improve Graft Outcome Disparities in African American Kidney Transplants (MITIGAAT) study is a 24-month, 2-arm, single-center (Medical University of South Carolina), 1:1 randomized controlled trial involving 190 participants (95 in each arm), measuring the impact on adherence and control of late clinical issues for racial disparities in kidney recipients, through a technology-enabled, telehealth-delivered, 4-level intervention. The key clinical issues for this study include tacrolimus variability, blood pressure, and glucose control (in those with diabetes mellitus). We will also assess the impact of the intervention on health care use (hospitalizations and emergency department visits) and conduct a cost-benefit analysis. Finally, we will assess the impact of the intervention on acute rejection and graft survival rates as compared with a large contemporary national cohort. Results: This study was funded in July 2023. Enrolled began in April 2024 and is expected to be complete in 2026. All patients will complete the study by the end of 2028. Conclusions: In this protocol, we describe the study design, methods, aims, and outcome measures that will be used in the ongoing MITIGAAT clinical trials. Trial Registration: ClinicalTrials.gov NCT06023615; https://www.clinicaltrials.gov/study/NCT06023615 International Registered Report Identifier (IRRID): PRR1-10.2196/57784 %M 39388231 %R 10.2196/57784 %U https://www.researchprotocols.org/2024/1/e57784 %U https://doi.org/10.2196/57784 %U http://www.ncbi.nlm.nih.gov/pubmed/39388231 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e44397 %T Predictive Value of Physiological Values and Symptom Scores for Exacerbations in Bronchiectasis and Chronic Obstructive Pulmonary Disease With Frequent Exacerbations: Longitudinal Observational Cohort Study %A Jones,Thomas Llewelyn %A Roberts,Claire %A Elliott,Scott %A Glaysher,Sharon %A Green,Ben %A Shute,Janis K %A Chauhan,Anoop J %+ Department of Respiratory Medicine, Portsmouth Hospitals University NHS Trust, Southwick Hill Rd, Portsmouth, PO6 3LY, United Kingdom, 44 02392286000, thomas.jones@porthosp.nhs.uk %K COPD %K chronic obstructive pulmonary disease %K bronchiectasis %K predictive models %K airway disease %K symptom score %D 2024 %7 8.10.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: COPD (chronic obstructive pulmonary disease) and bronchiectasis are common, and exacerbations contribute to their morbidity and mortality. Predictive factors for the frequency of future exacerbations include previous exacerbation frequency and airway colonization. Earlier treatment of exacerbations is likely to reduce severity. Objective: This study tested the hypothesis that, in a population with bronchiectasis, COPD, or both who have frequent exacerbations and airway colonization, changes in symptom scores or physiological variables within 10 days prior to an exacerbation would allow the prediction of the event. Methods: We performed a 6-month, longitudinal, observational, cohort study among 30 participants with bronchiectasis, COPD, or both; at least 2 exacerbations per year; and colonization with Pseudomonas aeruginosa or Haemophilus influenzae. Daily symptom and physiological data were collected, comprising pulse rate, blood pressure, oxygen saturation, peak flow rate, step count, weight, and temperature. Exacerbations (defined as the onset of new antibiotic use for respiratory symptoms) were collected, and predictive values for abnormal values in the 10 days prior to an exacerbation were calculated. Results: A total of 30 participants were recruited, collecting a total of 39,534 physiological and 25,334 symptom data points across 5358 participant-days; these included 78 exacerbations across 27 participants, with the remaining 3 participants not having exacerbations within the 6-month observation period. Peak flow rate, oxygen saturation, and weight were significantly different at the point of exacerbation (all P<.001), but no significant trends around exacerbation were noted and no clinically beneficial predictive value was found in the overall or individually adjusted model. Symptom scores tended to worsen for 10 days on either side of an exacerbation but were of insufficient magnitude for prediction, with area under the receiver operating characteristic curve values of ranging from 0.4 to 0.6. Conclusions: Within this small cohort with bronchiectasis, COPD, or both and airway colonization, physiological and symptom variables did not show sufficient predictive value for exacerbations to be of clinical utility. The self-management education provided as standard of care may be superior to either of these approaches, but benefit in another or larger cohort cannot be excluded. International Registered Report Identifier (IRRID): RR2-10.2196/resprot.6636 %M 39378078 %R 10.2196/44397 %U https://www.i-jmr.org/2024/1/e44397 %U https://doi.org/10.2196/44397 %U http://www.ncbi.nlm.nih.gov/pubmed/39378078 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57888 %T Acupuncture as Adjuvant Therapy for Glaucoma: Protocol for a Randomized Controlled Trial %A Liao,Yi-Fang %A Lee,Yu-Chen %A Lin,Hui-Ju %A Shao,Yi-Ching %+ Department of Ophthalmology, Eye Center, China Medical University Hospital, No. 2, Yude Road, North District, No. 91, Xueshi Road, North District, Taichung, 404327, Taiwan, 886 937511948, baba6467@yahoo.com.tw %K acupuncture %K open-angle glaucoma %K optical coherence tomography %K intraocular pressure %K glaucoma %K adjuvant therapy %K optic neuropathy %K disease progression %K ophthalmic disorders %K optic %K conventional treatment %K efficacy %K adjunctive therapy %D 2024 %7 8.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Glaucoma is a chronic progressive optic neuropathy that necessitates lifelong treatment to reduce the decline of the optic nerve. Due to the extended and continuous treatments required for patients, complementary therapies are often considered alongside conventional treatments to enhance the effectiveness of the treatment. Acupuncture has demonstrated the potential to lower intraocular pressure in previous clinical trials, making it a promising glaucoma intervention. Objective: The primary objective of this study is to conduct a single-center randomized control trial involving patients with glaucoma. Acupuncture will be evaluated as an adjunctive therapy. The trial aims to explore its effectiveness for glaucoma. Methods: In this single-center randomized controlled trial, participants (N=50) with primary open-angle glaucoma will be randomly assigned to the treatment group, receiving ophthalmic acupuncture with “De Qi” sensation, or the control group, receiving minimum acupuncture stimulation on nonophthalmic acupoints. The intervention will consist of weekly acupuncture treatments for a total of 6 sessions. Participants will be assessed at 8 time points, which are baseline, during the intervention (6 times), and at a 3-month follow-up. The primary outcome measure is a change in the intraocular pressure before and after each acupuncture treatment. Secondary outcomes will include measurements of heart rate and blood pressure before and after acupuncture, best-corrected visual acuity, visual field, optical coherence tomography, optical coherence tomography angiography, the Glaucoma Symptom Scale, and the Glaucoma Quality of Life-15 questionnaire. Results: Recruitment of participants for the trial commenced on June 28, 2023. A total of 10 participants have been enrolled to test the feasibility of the experiment. We anticipate that the preliminary data from this trial will be completed by December 2025. Conclusions: This trial uses rigorous methodology and comprehensive outcome measurements to assess the clinical efficacy of acupuncture as an adjunctive therapy for glaucoma, providing valuable insights for future clinical treatment guidelines. Trial Registration: ClinicalTrials.gov NCT05753137; https://clinicaltrials.gov/study/NCT05753137 International Registered Report Identifier (IRRID): DERR1-10.2196/57888 %M 39378079 %R 10.2196/57888 %U https://www.researchprotocols.org/2024/1/e57888 %U https://doi.org/10.2196/57888 %U http://www.ncbi.nlm.nih.gov/pubmed/39378079 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54991 %T Health Care Usage During the COVID-19 Pandemic and the Adoption of Telemedicine: Retrospective Study of Chronic Disease Cohorts %A Bjarnadóttir,Margrét Vilborg %A Anderson,David %A Anderson,Kelley M %A Aljwfi,Omar %A Peluso,Alina %A Ghannoum,Adam %A Balba,Gayle %A Shara,Nawar %+ Decisions, Operations and Information Technology, University of Maryland, College Park, 4353 Van Munching Hall, College Park, MD, 20742, United States, 1 301 405 2061, mbjarnad@umd.edu %K telehealth utilization %K health care utilization %K demographic differences %K cohort study %K telehealth %K COVID-19 %K telehealth adaption %D 2024 %7 3.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic accelerated telehealth adoption across disease cohorts of patients. For many patients, routine medical care was no longer an option, and others chose not to visit medical offices in order to minimize COVID-19 exposure. In this study, we take a comprehensive multidisease approach in studying the impact of the COVID-19 pandemic on health care usage and the adoption of telemedicine through the first 12 months of the COVID-19 pandemic. Objective: We studied the impact of the COVID-19 pandemic on in-person health care usage and telehealth adoption across chronic diseases to understand differences in telehealth adoption across disease cohorts and patient demographics (such as the Social Vulnerability Index [SVI]). Methods: We conducted a retrospective cohort study of 6 different disease cohorts (anxiety: n=67,578; depression: n=45,570; diabetes: n=81,885; kidney failure: n=29,284; heart failure: n=21,152; and cancer: n=35,460). We used summary statistics to characterize changes in usage and regression analysis to study how patient characteristics relate to in-person health care and telehealth adoption and usage during the first 12 months of the pandemic. Results: We observed a reduction in in-person health care usage across disease cohorts (ranging from 10% to 24%). For most diseases we study, telehealth appointments offset the reduction in in-person visits. Furthermore, for anxiety and depression, the increase in telehealth usage exceeds the reduction in in-person visits (by up to 5%). We observed that younger patients and men have higher telehealth usage after accounting for other covariates. Patients from higher SVI areas are less likely to use telehealth; however, if they do, they have a higher number of telehealth visits, after accounting for other covariates. Conclusions: The COVID-19 pandemic affected health care usage across diseases, and the role of telehealth in replacing in-person visits varies by disease cohort. Understanding these differences can inform current practices and provides opportunities to further guide modalities of in-person and telehealth visits. Critically, further study is needed to understand barriers to telehealth service usage for patients in higher SVI areas. A better understanding of the role of social determinants of health may lead to more support for patients and help individual health care providers improve access to care for patients with chronic conditions. %M 39361360 %R 10.2196/54991 %U https://www.jmir.org/2024/1/e54991 %U https://doi.org/10.2196/54991 %U http://www.ncbi.nlm.nih.gov/pubmed/39361360 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58890 %T Factors Influencing Primary Care Access for Common Mental Health Conditions Among Adults in West Africa: Protocol for a Scoping Review %A Adjei-Banuah,Nhyira Yaw %A Ayiku,Roberta Naa Barkey %A Reichenberger,Veronika %A Sasu,David %A Mirzoev,Tolib %A Murphy,Adrianna %A Ohene,Sammy %A Antwi,Edward %A Agyepong,Irene Akua %+ Ghana College of Physicians and Surgeons, 54 Independence Ave, Ridge, Accra, Ghana, 233 267771007, nhyirahene@gmail.com %K scoping review %K mental health %K noncommunicable disease %K primary care %K access %K barriers %K enablers %D 2024 %7 2.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mental health conditions are expressed in various ways in different people, and access to health care for these conditions is affected by individual factors, health care provider factors, and contextual factors. These factors may be enablers or barriers to accessing primary care for mental health conditions. Studies have reported a gap in treatment for mental health conditions in many countries in West Africa due to barriers along the access pathway. However, to the best of our knowledge, there is yet to be a review of the factors influencing access to primary care for common mental health conditions among adults in West Africa. Objective: Our scoping review will explore the factors influencing access to primary care for common mental health conditions among adults aged 18 years and older in West Africa from 2002 to 2024. Methods: Our review will follow the approach to scoping reviews developed by Arksey and O’Malley in 2005. This approach has five stages: (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies; (4) charting the data; and (5) collating, summarizing, and reporting the results. We will search electronic databases (PubMed, Embase, PsycINFO, Cairn.info, and Google Scholar), source gray literature from relevant websites (the World Health Organization and country-specific websites), and manually explore reference lists of relevant studies to identify eligible records. Pairs of independent authors (NYA-B, RNBA, VR, or DS) will screen the titles, abstracts, and full texts of studies based on predefined eligibility criteria. We will use a data extraction tool adopted from the JBI Manual for Evidence Synthesis to chart the data. Deductive, thematic analysis will be used to categorize factors influencing access to mental health care under predetermined themes. New themes derived from the literature will also be charted. Results: Database searches were conducted between February 1, 2024, and February 12, 2024. As of July 2024, the review report is being drafted, and it will be disseminated through publication in a peer-reviewed journal. Conclusions: The results of the review will inform decision-making on policies, programs, and their implementation in West Africa to improve primary care access for mental health care. International Registered Report Identifier (IRRID): DERR1-10.2196/58890 %M 39357048 %R 10.2196/58890 %U https://www.researchprotocols.org/2024/1/e58890 %U https://doi.org/10.2196/58890 %U http://www.ncbi.nlm.nih.gov/pubmed/39357048 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55883 %T Efficacy of WeChat-Based Digital Intervention Versus Metformin in Women With Polycystic Ovary Syndrome: Randomized Controlled Trial %A Dilimulati,Diliqingna %A Shao,Xiaowen %A Wang,Lihua %A Cai,Meili %A Zhang,Yuqin %A Lu,Jiayi %A Wang,Yao %A Liu,Hongying %A Kuang,Ming %A Chen,Haibing %A Zhang,Manna %A Qu,Shen %+ Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China, 86 13774448495, mannazhang@126.com %K polycystic ovary syndrome %K insulin resistance %K digital intervention %K metformin %K women’s health %D 2024 %7 2.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The first-line treatment for polycystic ovary syndrome (PCOS) is lifestyle modification. However, it is currently unknown whether digital medicine can assist patients with PCOS in maintaining a healthy lifestyle while alleviating PCOS symptoms. Objective: This study aims to evaluate the efficacy of WeChat-based digital intervention versus metformin treatment in women with PCOS and insulin resistance. Methods: A total of 80 women with PCOS and insulin resistance were recruited from an endocrinology clinic and randomly assigned to receive either a WeChat-based digital intervention (n=40, 50%) or metformin (n=40, 50%) for 12 weeks. The WeChat-based digital intervention consisted of 3 modules; a coach assisted the patients in using the intervention. The primary outcome was the change in a homeostatic model assessment for insulin resistance. At baseline and after the 12-week intervention, anthropometric parameters, menstruation frequency, sex hormone levels, metabolic factors, and body fat distribution were measured in the clinic. Furthermore, self-assessed web-based questionnaires on diet, exercise, sleep, anxiety, and depression were obtained. Results: A total of 72 participants completed the follow-up (for a 90% follow-up rate), including 35 of 40 (88%) participants from the digital intervention group and 37 of 40 (93%) participants from the metformin group. The homeostatic model assessment for insulin resistance in the digital intervention group was significantly improved after 12 weeks of treatment with a mean change of –0.93 (95% CI –1.64 to –0.23), but no statistical difference was observed between the groups (least squares mean difference –0.20; 95% CI –0.98 to 0.58; P=.62). Both digital intervention and metformin treatment significantly improved menstruation frequency (digital intervention: P<.001; metformin: P<.001) and reduced body weight (digital intervention: P<.001; metformin: P<.001) and total fat mass (digital intervention: P<.001; metformin: P<.001). Furthermore, the digital intervention had a significant advantage over metformin in improving waist circumference (least squares mean difference –1.84; 95% CI –3.44 to –0.24; P=.03), waist-to-hip ratio (least squares mean difference –0.02; 95% CI –0.03 to 0.00; P=.03), total fat mass (least squares mean difference –1.59; 95% CI –2.88 to –0.30; P=.02), and dehydroepiandrosterone sulfate (least squares mean difference –69.73; 95% CI –129.70 to –9.75; P=.02). In terms of safety, the main adverse events were sensations of hunger in the digital intervention group (2/40, 5%) and gastrointestinal adverse events in the metformin group (12/40, 30%). Conclusions: Our data suggest that digital intervention is an effective treatment option for patients with PCOS, with an efficacy comparable to that of metformin, and that it can also alleviate the negative effects of medications and make it easier and more efficient to adhere to lifestyle treatments. WeChat-based digital interventions have the potential to provide a new path for the improvement and health of women with PCOS in China. Trial Registration: ClinicalTrials.gov NCT05386706; https://clinicaltrials.gov/study/NCT05386706 %M 39357046 %R 10.2196/55883 %U https://www.jmir.org/2024/1/e55883 %U https://doi.org/10.2196/55883 %U http://www.ncbi.nlm.nih.gov/pubmed/39357046 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e64092 %T Retention in HIV Primary Care Using a Web-Based Patient Engagement Platform: Multistate Case-Control Study %A Sukhija-Cohen,Adam Carl %A Patani,Henna %A Blasingame,Michael Foxworth %A Vu,Kathy Linh %A Bastani,Ramin %+ Sutter Health, Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, United States, 1 (650) 330 5963, adam.sukhija-cohen@sutterhealth.org %K HIV %K primary health care %K retention in care %K digital technology %K appointments and schedules %D 2024 %7 2.10.2024 %9 Short Paper %J J Med Internet Res %G English %X Background: Digital interventions to improve retention in HIV care are critical to ensure viral suppression and prevent further transmission. AIDS Healthcare Foundation Healthcare Centers are centers across the United States that provide primary HIV care. Traditionally, the Healthcare Centers conduct phone calls with patients to schedule and confirm appointments, as well as share laboratory results. In 2017, Healthvana piloted a digital platform at AIDS Healthcare Foundation Healthcare Centers to send patients SMS text message appointment reminders and allow patients to review their upcoming appointment and view their laboratory results in the web-based patient portal. Objective: A national implementation in 15 US states and Washington, DC, of this digital intervention pilot by Healthvana aims to determine whether SMS appointment reminders and web-based patient portal logins improved retention in care compared to traditional methods. Methods: A retrospective analysis of 40,028 patients living with HIV was conducted at the 61 AIDS Healthcare Foundation Healthcare Centers between January 2, 2017, and May 22, 2018. Patients were invited to enroll in Healthvana’s digital intervention pilot, allowing for a natural, organization-wide case-control study. Separate binary logistic regression models evaluated the relationship between receiving SMS appointment reminders and completing scheduled appointments, as well as the relationship between logging into the web-based patient portal and completing scheduled appointments. Four scheduled consecutive appointments for each patient were included in the analysis to account for 1 full year of data per patient. Results: Patients who received the SMS appointment reminder were 1.7 times more likely to complete appointment 1 compared to patients who did not receive the SMS appointment reminder (P<.001). In addition, patients who received the SMS appointment reminder were 1.6 times more likely to complete appointment 2 (P<.001), 1.7 times more likely to complete appointment 3 (P<.001), and 1.8 times more likely to complete appointment 4 (P<.001) compared to patients who did not receive the SMS appointment reminder. Patients who logged in to the web-based patient portal prior to their scheduled appointment were 7.4 times more likely to complete appointment 1 compared to patients who did not log in (P<.001). In addition, patients who logged in to the web-based patient portal prior to their scheduled appointment were 3.6 times more likely to complete appointment 2 (P<.001), 3.2 times more likely to complete appointment 3 (P<.001), and 2.8 times more likely to complete appointment 4 (P<.001) compared to patients who did not log in. Conclusions: HIV primary care appointment completion was higher when patients engaged with Healthvana’s digital platform. Digital technology interventions to ensure patients complete their scheduled HIV care appointments are imperative to curb the HIV epidemic. %M 39357049 %R 10.2196/64092 %U https://www.jmir.org/2024/1/e64092 %U https://doi.org/10.2196/64092 %U http://www.ncbi.nlm.nih.gov/pubmed/39357049 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56632 %T Design of a Health Education Program to Manage Chronic Neck Pain: Protocol for a Development Study %A Pérez-Muñoz,Milagros %A Rodríguez-Costa,Isabel %A Lebrijo-Pérez,Gerard %A Pecos-Martín,Daniel %A Gallego-Izquierdo,Tomás %A Pérez-Martín,Yolanda %+ Physical Therapy Department, University of Alcalá, Av. de León, 3A, Alcalá de Henares, 28805, Spain, 34 918852586, isabelrodriguezcosta@gmail.com %K neck pain %K chronic pain %K physiotherapy %K health education %K emotional expression %K biopsychosocial model %D 2024 %7 1.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic neck pain (CNP) needs attention to its physical, cognitive, and social dimensions. Objective: We aimed to design a health education program (HEP) with a biopsychosocial approach for patients with CNP. Methods: A literature search on CNP, health education, and biopsychosocial models was carried out. Seven physiotherapists with expertise in HEPs and chronic pain participated in three teams that evaluated the literature and prepared a synthesis document in relation to the three target topics. Experts compiled the information obtained and prepared a proposal for an HEP with a biopsychosocial approach aimed at patients with CNP. This proposal was tested in the physiotherapy units of primary care health centers belonging to the East Assistance Directorate of Madrid, and suggestions were included in the final program. Results: The HEP for CNP with a biopsychosocial approach consists of 5 educational sessions lasting between 90 and 120 minutes, carried out every other day. Cognitive, emotional, and physical dimensions were addressed in all sessions, with particular attention to the psychosocial factors associated with people who have CNP. Conclusions: The proposed HEP with a biopsychosocial approach emphasizes emotional management, especially stress, without neglecting the importance of physical and recreational exercises for the individual’s return to social activities. The objective of this program was to achieve a clinically relevant reduction in perceived pain intensity and functional disability as well as an improvement in quality of life in the short and medium term. Trial Registration: ClinicalTrials.gov NCT02703506; https://clinicaltrials.gov/study/NCT02703506 International Registered Report Identifier (IRRID): DERR1-10.2196/56632 %M 39353191 %R 10.2196/56632 %U https://www.researchprotocols.org/2024/1/e56632 %U https://doi.org/10.2196/56632 %U http://www.ncbi.nlm.nih.gov/pubmed/39353191 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e56048 %T Exploring Racial Disparities in Awareness and Perceptions of Oncology Clinical Trials: Cross-Sectional Analysis of Baseline Data From the mychoice Study %A Hoadley,Ariel %A Fleisher,Linda %A Kenny,Cassidy %A Kelly,Patrick JA %A Ma,Xinrui %A Wu,Jingwei %A Guerra,Carmen %A Leader,Amy E %A Alhajji,Mohammed %A D’Avanzo,Paul %A Landau,Zoe %A Bass,Sarah Bauerle %+ Department of Social and Behavioral Sciences, Temple University College of Public Health, 9th Fl, 1301 Cecil B Moore Ave, Philadelphia, PA, 19122, United States, 1 215 204 0377, ariel.hoadley@temple.edu %K oncology clinical trial %K cancer %K decision-making %K racial disparity %K medical mistrust %D 2024 %7 30.9.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Black/African American adults are underrepresented in oncology clinical trials in the United States, despite efforts at narrowing this disparity. Objective: This study aims to explore differences in how Black/African American oncology patients perceive clinical trials to improve support for the clinical trial participation decision-making process. Methods: As part of a larger randomized controlled trial, a total of 244 adult oncology patients receiving active treatment or follow-up care completed a cross-sectional baseline survey on sociodemographic characteristics, clinical trial knowledge, health literacy, perceptions of cancer clinical trials, patient activation, patient advocacy, health care self-efficacy, decisional conflict, and clinical trial intentions. Self-reported race was dichotomized into Black/African American and non–Black/African American. As appropriate, 2-tailed t tests and chi-square tests of independence were used to examine differences between groups. Results: Black/African American participants had lower clinical trial knowledge (P=.006), lower health literacy (P<.001), and more medical mistrust (all P values <.05) than non–Black/African American participants. While intentions to participate in a clinical trial, if offered, did not vary between Black/African American and non–Black/African American participants, Black/African American participants indicated lower awareness of clinical trials, fewer benefits of clinical trials, and more uncertainty around clinical trial decision-making (all P values <.05). There were no differences for other variables. Conclusions: Despite no significant differences in intent to participate in a clinical trial if offered and high overall trust in individual health care providers among both groups, beliefs persist about barriers to and benefits of clinical trial participation among Black/African American patients. Findings highlight specific ways that education and resources about clinical trials could be tailored to better suit the informational and decision-making needs and preferences of Black/African American oncology patients. %M 39348891 %R 10.2196/56048 %U https://cancer.jmir.org/2024/1/e56048 %U https://doi.org/10.2196/56048 %U http://www.ncbi.nlm.nih.gov/pubmed/39348891 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56049 %T Integrating Social Determinants of Health in Machine Learning–Driven Decision Support for Diabetes Case Management: Protocol for a Sequential Mixed Methods Study %A Lee,Seung-Yup %A Hayes,Leslie W %A Ozaydin,Bunyamin %A Howard,Steven %A Garretson,Alison M %A Bradley,Heather M %A Land,Andrew M %A DeLaney,Erin W %A Pritchett,Amy O %A Furr,Amanda L %A Allgood,Ashleigh %A Wyatt,Matthew C %A Hall,Allyson G %A Banaszak-Holl,Jane C %+ School of Health Professions, University of Alabama at Birmingham, 1716 9th Ave S, Birmingham, AL, 35233, United States, 1 205 934 4315, slee9@uab.edu %K diabetes %K case management %K case manager %K social work %K case mix %K social determinants of health %K clinical decision support %K decision support %K predictive analytics %K disparities %K health disparities %K data warehouse %K tertiary care %K health care system %K chronic disease management %D 2024 %7 25.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The use of both clinical factors and social determinants of health (SDoH) in referral decision-making for case management may improve optimal use of resources and reduce outcome disparities among patients with diabetes. Objective: This study proposes the development of a data-driven decision-support system incorporating interactions between clinical factors and SDoH into an algorithm for prioritizing who receives case management services. The paper presents a design for prediction validation and preimplementation assessment that uses a mixed methods approach to guide the implementation of the system. Methods: Our study setting is a large, tertiary care academic medical center in the Deep South of the United States, where SDoH contribute to disparities in diabetes-specific hospitalizations and emergency department (ED) visits. This project will develop an interpretable artificial intelligence model for a population with diabetes using SDoH and clinical data to identify which posthospitalization cases have a higher likelihood of subsequent ED use. The electronic health record data collected for the study include demographics, SDoH, comorbidities, hospitalization-related factors, laboratory test results, and medication use to predict posthospitalization ED visits. Subsequently, a mixed methods approach will be used to validate prediction outcomes and develop an implementation strategy from insights into patient outcomes from case managers, clinicians, and quality and patient safety experts. Results: As of December 2023, we had abstracted data on 174,871 inpatient encounters between January 2018 and September 2023, involving 89,355 unique inpatients meeting inclusion criteria. Both clinical and SDoH data items were included for these patient encounters. In total, 85% of the inpatient visits (N=148,640) will be used for training (learning from the data) and the remaining 26,231 inpatient visits will be used for mixed-methods validation (testing). Conclusions: By integrating a critical suite of SDoH with clinical data related to diabetes, the proposed data-driven risk stratification model can enable individualized risk estimation and inform health professionals (eg, case managers) about the risk of patients’ upcoming ED use. The prediction outcome could potentially automate case management referrals, helping to better prioritize services. By taking a mixed methods approach, we aim to align the model with the hospital’s specific quality and patient safety considerations for the quality of patient care and the optimization of case management resource allocation. International Registered Report Identifier (IRRID): DERR1-10.2196/56049 %M 39321449 %R 10.2196/56049 %U https://www.researchprotocols.org/2024/1/e56049 %U https://doi.org/10.2196/56049 %U http://www.ncbi.nlm.nih.gov/pubmed/39321449 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55546 %T Evaluating the National Rollout of a Type 2 Diabetes Self-Management Intervention: Qualitative Interview Study With Local National Health Service Leads Responsible for Implementation %A Brunton,Lisa %A Cotterill,Sarah %A Wilson,Paul %+ Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Suite 3, 6th Floor Williamson Building, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 161 275 7603, lisa.brunton@manchester.ac.uk %K type 2 diabetes %K structured education %K self-management %K digital interventions %K implementation %K qualitative methods %K evaluation %D 2024 %7 25.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Approximately 4.5 million people live with type 2 diabetes mellitus (T2DM) in the United Kingdom. Evidence shows that structured education programs can improve glycemic control and reduce the risk of complications from T2DM, but they have low attendance rates. To widen access to T2DM structured education, National Health Service England commissioned a national rollout of Healthy Living, a digital self-management program. Objective: The objectives were to understand the barriers and enablers to adopting, implementing, and integrating Healthy Living into existing T2DM care pathways across England. Methods: We undertook a cross-sectional, qualitative telephone semistructured interview study to address the objectives. In total, 17 local National Health Service leads responsible for implementing Healthy Living across their locality were recruited. We conducted 16 one-time interviews across 16 case sites (1 of the interviews was conducted with 2 local leads from the same case site). Interview data were analyzed using thematic analysis. Results: Three overarching themes were generated: (1) implementation activities, (2) where Healthy Living fits within existing pathways, and (3) contextual factors affecting implementation. Of the 16 sites, 14 (88%) were implementing Healthy Living; the barrier to not implementing it in 2 case sites was not wanting Healthy Living to compete with their current education provision for T2DM. We identified 6 categories of implementation activities across sites: communication strategies to raise awareness of Healthy Living, developing bespoke local resources to support general practices with referrals, providing financial reimbursement or incentives to general practices, promoting Healthy Living via public events, monitoring implementation across their footprint, and widening access across high-need groups. However, outside early engagement sites, most implementation activities were “light touch,” consisting mainly of one-way communications to raise awareness. Local leads were generally positive about Healthy Living as an additional part of their T2DM structured education programs, but some felt it was more suited to specific patient groups. Barriers to undertaking more prolonged, targeted implementation campaigns included implementation not being mandated, sites not receiving data on uptake across their footprint, and confusion in understanding where Healthy Living fit within existing care pathways. Conclusions: A passive process of disseminating information about Healthy Living to general practices rather than an active process of implementation occurred across most sites sampled. This study identified that there is a need for clearer communications regarding the type of patients that may benefit from the Healthy Living program, including when it should be offered and whether it should be offered instead of or in addition to other education programs. No sites other than early engagement sites received data to monitor uptake across their footprint. Understanding variability in uptake across practices may have enabled sites to plan targeted referral campaigns in practices that were not using the service. %M 39321457 %R 10.2196/55546 %U https://www.jmir.org/2024/1/e55546 %U https://doi.org/10.2196/55546 %U http://www.ncbi.nlm.nih.gov/pubmed/39321457 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53224 %T The Development of a Digital Patient Navigation Tool to Increase Colorectal Cancer Screening Among Federally Qualified Health Center Patients: Acceptability and Usability Testing %A Savage,Leah C %A Soto-Cossio,Luz Estefhany %A Minardi,Francesca %A Beyrouty,Matthew %A Schoonover,Julie %A Musella,Jay %A Frazier,Michaela %A Villagra,Cristina N %A Sly,Jamilia R %A Erblich,Joel %A Itzkowitz,Steven H %A Jandorf,Lina H %A Calman,Neil S %A Atreja,Ashish %A Miller,Sarah J %+ Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Box 1077, 1 Gustave L Levy Place, New York, NY, 10029, United States, 1 2128247783, sarah.miller@mssm.edu %K digital navigation %K digital health %K Federally Qualified Health Center %K colorectal cancer %K cancer screening %K mobile phone %D 2024 %7 25.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Federally Qualified Health Centers (FQHCs) are an essential place for historically underserved patients to access health care, including screening for colorectal cancer (CRC), one of the leading causes of cancer death in the United States. Novel interventions aimed at increasing CRC screening completion rates at FQHCs are crucial. Objective: This study conducts user testing of a digital patient navigation tool, called eNav, designed to support FQHC patients in preparing for, requesting, and completing CRC screening tests. Methods: We recruited English- and Spanish-speaking patients (N=20) at an FQHC in New York City to user-test the eNav website (2 user tests; n=10 participants per user test). In each user test, participants engaged in a “think aloud” exercise and a qualitative interview to summarize and review their feedback. They also completed a baseline questionnaire gathering data about demographics, technology and internet use, medical history, and health literacy, and completed surveys to assess the website’s acceptability and usability. Based on participant feedback from the first user test, we modified the eNav website for a second round of testing. Then, feedback from the second user test was used to modify and finalize the eNav website. Results: Survey results supported the overall usability and acceptability of the website. The average System Usability Scale score for our first user test was 75.25; for the second, it was 75.28. The average Acceptability E-scale score for our first user test was 28.3; for the second, it was 29.2. These scores meet suggested benchmarks for usability and acceptability. During qualitative think-aloud exercises, in both user tests, many participants favorably perceived the website as motivating, interesting, informative, and user-friendly. Respondents also gave suggestions on how to improve the website’s content, usability, accessibility, and appeal. We found that some participants did not have the digital devices or internet access needed to interact with the eNav website at home. Conclusions: Based on participant feedback on the eNav website and reported limitations to digital access across both user tests, we made modifications to the content and design of the website. We also designed alternative methods of engagement with eNav to increase the tool’s usability, accessibility, and impact for patients with diverse needs, including those with limited access to devices or the internet at home. Next, we will test the eNav intervention in a randomized controlled trial to evaluate the efficacy of the eNav website for improving CRC screening uptake among patients treated at FQHCs. %M 39321451 %R 10.2196/53224 %U https://formative.jmir.org/2024/1/e53224 %U https://doi.org/10.2196/53224 %U http://www.ncbi.nlm.nih.gov/pubmed/39321451 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59917 %T Multicomponent Intervention to Improve Acute Myocardial Infarction Care in Tanzania: Protocol for a Pilot Implementation Trial %A Hertz,Julian T %A Sakita,Francis M %A Rahim,Faraan O %A Mmbaga,Blandina T %A Shayo,Frida %A Kaboigora,Vivian %A Mtui,Julius %A Bloomfield,Gerald S %A Bosworth,Hayden B %A Bettger,Janet P %A Thielman,Nathan M %+ Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, United States, 1 919 684 8111, julian.hertz@duke.edu %K myocardial infarction %K Tanzania %K sub-Saharan Africa %K implementation science %K quality improvement %D 2024 %7 24.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although the incidence of acute myocardial infarction (AMI) is rising in sub-Saharan Africa, the uptake of evidence-based care for the diagnosis and treatment of AMI is limited throughout the region. In Tanzania, studies have revealed common misdiagnosis of AMI, infrequent administration of aspirin, and high short-term mortality rates following AMI. Objective: This study aims to evaluate the implementation and efficacy outcomes of an intervention, the Multicomponent Intervention to Improve Acute Myocardial Infarction Care (MIMIC), which was developed to improve the delivery of evidence-based AMI care in Tanzania. Methods: This single-arm pilot trial will be conducted in the emergency department (ED) at a referral hospital in northern Tanzania. The MIMIC intervention will be implemented by the ED staff for 1 year. Approximately 400 adults presenting to the ED with possible AMI symptoms will be enrolled, and research assistants will observe their care. Thirty days later, a follow-up survey will be administered to assess mortality and medication use. The primary outcome will be the acceptability of the MIMIC intervention, which will be measured by the Acceptability of Intervention Measurement (AIM) instrument. Acceptability will further be assessed via in-depth interviews with key stakeholders. Secondary implementation outcomes will include feasibility and fidelity. Secondary efficacy outcomes will include the following: the proportion of participants who receive electrocardiogram and cardiac biomarker testing, the proportion of participants with AMI who receive aspirin, 30-day mortality among participants with AMI, and the proportion of participants with AMI taking aspirin 30 days following enrollment. Results: Implementation of MIMIC began on September 1, 2023. Enrollment is expected to be completed by September 1, 2024, and the first results are expected to be published by December 31, 2024. Conclusions: This study will be the first to evaluate an intervention for improving AMI care in sub-Saharan Africa. If MIMIC is found to be acceptable, the findings from this study will inform a future cluster-randomized trial to assess effectiveness and scalability. Trial Registration: ClinicalTrials.gov NCT04563546; https://clinicaltrials.gov/study/NCT04563546 International Registered Report Identifier (IRRID): DERR1-10.2196/59917 %M 39316783 %R 10.2196/59917 %U https://www.researchprotocols.org/2024/1/e59917 %U https://doi.org/10.2196/59917 %U http://www.ncbi.nlm.nih.gov/pubmed/39316783 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e58162 %T Talk Time Differences Between Interregional and Intraregional Calls to a Crisis Helpline: Statistical Analysis %A Turkington,Robin %A Potts,Courtney %A Mulvenna,Maurice %A Bond,Raymond %A O'Neill,Siobhán %A Ennis,Edel %A Hardcastle,Katie %A Scowcroft,Elizabeth %A Moore,Ciaran %A Hamra,Louise %K crisis helplines %K call duration %K mental health %K suicide %K suicidal %K suicide prevention %K population-based %K help-seeking behavior %K Samaritans %K UK %K telephony %K telephone %K telephones %K one-way analysis %K call %K calls %K talk time %K support %K talk time differences %D 2024 %7 19.9.2024 %9 %J JMIR Ment Health %G English %X Background: National suicide prevention strategies are general population-based approaches to prevent suicide by promoting help-seeking behaviors and implementing interventions. Crisis helplines are one of the suicide prevention resources available for public use, where individuals experiencing a crisis can talk to a trained volunteer. Samaritans UK operates on a national scale, with a number of branches located within each of the United Kingdom’s 4 countries or regions. Objectives: The aim of this study was to identify any differences in call duration across the helpline service in order to determine whether service varied interregionally and intraregionally and to determine the impact of calls answered in the same region as the caller, compared with calls answered in a different region on the duration of calls made from landlines to Samaritans UK. Methods: Calls may be routed by Samaritans, wherein the telephony system sends the call to the next available volunteer, irrespective of location; therefore, individuals may be routed to a branch within the same region as the caller’s current region (intraregional calls) or routed to a branch that is in a different region from that of the caller’s current region (interregional calls). The origin of calls by region was identified using the landline prefix of the anonymized caller identifier, along with the region of the destination branch (as branch details are recorded in the call details record). First, a Levene’s test of homogeneity of variance was carried out for each condition, that is, England calls and Scotland calls. Thereafter, for each condition, a one-way ANOVA or one-way analysis of means was carried out to evaluate any significant differences in call duration. Results: ANOVA results showed that there are significant differences in call durations between intraregional calls and interregional calls (P<.001). Across all conditions within this study, callers stayed on the phone for a shorter period of time when routed to a branch that is within the same region as the call origin than if they were put through to a branch within a different region than the call origin. Conclusions: Statistical analyses showed that there were significant differences between interregional and intraregional calls. On average, callers to crisis helplines stayed on the phone for a shorter period of time if they were routed to a branch within the same region in which the call originated than if they were routed to a branch in a different region of origin. The findings from this study have practical applications, which may allow crisis helplines to manage their resources more effectively and improve caller satisfaction with the service. %R 10.2196/58162 %U https://mental.jmir.org/2024/1/e58162 %U https://doi.org/10.2196/58162 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59836 %T Rethinking Health Systems Responsiveness in Low- and Middle-Income Countries: Validation Study %A Iqbal,Meesha %A Cazaban,Cecilia Ganduglia %A Morgan,Robert %A Bauer,Cici %A Siddiqi,Sameen %+ School of Public Health, the University of Texas Health Science Center at Houston, 1200 Pressler St, Houston, TX, 77030, United States, 1 2088215705, meesha_jazz@hotmail.com %K health system %K healthcare system %K health care %K responsiveness %K Pakistan %K Low-and middle-income countries %D 2024 %7 18.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health systems responsiveness (HSR) is the ability of systems to respond to legitimate non-health expectations of the population. The concept of HSR by the World Health Organization (WHO) includes respect for dignity, individual autonomy, confidentiality, prompt attention to care, availability of basic amenities, choice of provider, access to social support networks, and clarity of communication. The WHO tool is applied globally to assess HSR in low, middle, and high-income countries. Objective: We have revised the conceptual framework of HSR following a rigorous systematic review and made it specific for low- and middle-income countries (L&MICs). This study is designed to (1) run the Delphi technique to validate the upgraded conceptual framework of HSR, (2) modify and upgrade the WHO measurement tool for assessing HSR in the context of L&MICs, and (3) determine the validity of the upgraded HSR measurement tool by pilot testing it in Pakistan. Methods: The Delphi technique will be run by inviting global public health experts to provide suggestions on the domains and subdomains of HSR specific to L&MICs. Cronbach ɑ will be calculated to determine internal consistency among the participants. The upgraded HSR conceptual framework will serve as a beacon to modify the measurement tool by the research team, which will be reviewed by subject experts for refinement. The modified tool will be pilot-tested by administering it to 1128 participants from primary, secondary, and tertiary care hospitals in Rawalpindi district, Pakistan. Additionally, an “observation checklist” of HSR domains and subdomains will be completed to objectively measure the state of HSR across health care facilities. HSR assessment will be further strengthened by incorporating the perspective of hospital managers, service providers, and policy makers (ie, the supply side) as well as community leaders and representatives (ie, the demand side) through qualitative interviews. Results: The study was started in January 2024 and will continue until February 2025. A multidimensional approach will yield significant quantifiable information on HSR from the demand and supply sides of L&MICs. Conclusions: This study will provide a conceptual understanding of HSR and a corresponding measurement tool specific to L&MICs. It will contribute to global public health literature and provide a snapshot of HSR in Rawalpindi district, Pakistan, with concrete action points for policy makers. International Registered Report Identifier (IRRID): DERR1-10.2196/59836 %M 39293061 %R 10.2196/59836 %U https://www.researchprotocols.org/2024/1/e59836 %U https://doi.org/10.2196/59836 %U http://www.ncbi.nlm.nih.gov/pubmed/39293061 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60277 %T Peer Intervention to Link Overdose Survivors to Treatment (PILOT): Protocol for a Multisite, Randomized Controlled Trial Conducted Within the National Institute on Drug Abuse Clinical Trials Network %A Papa,Carrie %A McClure,Erin A %A McCauley,Jenna %A Haynes,Louise %A Matheson,Timothy %A Jones,Richard %A Jennings,Lindsey %A Lawdahl,Tricia %A Ward,Ralph %A Brady,Kathleen %A Barth,Kelly Stephenson %+ Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States, 1 843 876 1507, papa@musc.edu %K opioids %K overdose %K nonfatal overdose involving opioids %K peer support specialist %K harm reduction %K emergency department %D 2024 %7 17.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The increase in opioid-related overdoses has caused a decrease in average life expectancy, highlighting the need for effective interventions to reduce overdose risk and prevent subsequent overdoses. Peer support specialists (PSSs) offer an appealing strategy to engage overdose survivors and reduce overdose risk, but randomized controlled trials are needed to formalize peer-led interventions and evaluate their effectiveness. Objective: This National Institute on Drug Abuse Clinical Trials Network (CTN) study is a multisite, prospective, pilot randomized (1:1) controlled trial (CTN protocol 0107) that aims to evaluate the effectiveness of an emergency department (ED)–initiated, peer-delivered intervention tailored for opioid overdose survivors (Peer Intervention to Link Overdose survivors to Treatment [PILOT]), compared with treatment as usual (TAU). Methods: This study evaluates the effectiveness of the 6-month, PSS-led PILOT intervention compared with TAU on the primary outcome of reducing overdose risk behavior 6 months after enrollment. Adults (aged ≥18 years; N=150) with a recent opioid-related overdose were identified and approached in the ED. Participants were screened and enrolled, either in the ED or within 7 days of ED discharge at research offices or in the community and then asked to complete study visits at months 1, 3, 6 (end of intervention), and 7 (follow-up). Participants were enrolled at 3 study sites in the United States: Greenville, South Carolina; Youngstown, Ohio; and Everett, Washington. Participants randomized to the PILOT intervention received a 6-month, PSS-led intervention tailored to each participant’s goals to reduce their overdose risk behavior (eg, overdose harm reduction, housing, medical, and substance use treatment or recovery goals). Participants randomized to TAU received standard-of-care overdose materials, education, and services provided through the participating EDs. This paper describes the study protocol and procedures, explains the design and inclusion and exclusion decisions, and provides details of the peer-led PILOT intervention and supervision of PILOT PSSs. Results: Study enrollment opened in December 2021 and was closed in July 2023. A total of 150 participants across 3 sites were enrolled in the study, meeting the proposed sample size for the trial. Primary and secondary analyses are underway and expected to be published in early 2025. Conclusions: There is an urgent need to better understand the characteristics of overdose survivors presenting to the ED and for rigorous trials evaluating the effectiveness of PSS-led interventions on engaging overdose survivors and reducing overdose risk. Results from this pilot randomized controlled trial will provide a description of the characteristics of overdose survivors presenting to the ED; outline the implementation of PSS services research in ED settings, including PSS implementation of PSS supervision and activity tracking; and inform ED-initiated PSS-led overdose risk reduction interventions and future research to better understand the implementation and efficacy of these interventions. Trial Registration: ClinicalTrials.gov NCT05123027; https://clinicaltrials.gov/study/NCT05123027 International Registered Report Identifier (IRRID): DERR1-10.2196/60277 %M 39288373 %R 10.2196/60277 %U https://www.researchprotocols.org/2024/1/e60277 %U https://doi.org/10.2196/60277 %U http://www.ncbi.nlm.nih.gov/pubmed/39288373 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57820 %T Improving the Care of Severe, Open Fractures and Postoperative Infections of the Lower Extremities: Protocol for an Interdisciplinary Treatment Approach %A Rosslenbroich,Steffen %A Laumann,Marion %A Hasebrook,Joachim %A Rodde,Sibyll %A Grosser,John %A Greiner,Wolfgang %A Hirsch,Tobias %A Windrich,Stefan %A Raschke,Michael J %+ ZEB Business School, Steinbeis University, Breitscheidstr 51, Madgeburg, 39114, Germany, 49 15152647546, jhasebrook@zeb-bs.de %K open fracture %K open soft tissue damage %K telemedicine %K plastic surgery %K infectiology %K limb function %K health-related quality of life %K workload %K work engagement %K health economic evaluation %D 2024 %7 16.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patients with open fractures often experience complications during their injury. The treatments incur high costs. Interdisciplinary cooperation between different medical disciplines may improve treatment outcomes. Such cooperation has not yet been envisaged in the German health care system. Objective: The aim of the study is to improve the treatment of fractures with open soft tissue damage or postoperative complications in terms of duration and sustainability in a region in northwest Germany. Largely standardized diagnostics and therapy are intended to optimize processes in hospitals. In addition, a reduction in the duration of treatment and treatment costs is to be achieved. Methods: Using a digital platform, physicians from 31 hospitals present patient cases to an interdisciplinary group of experts from the fields of plastic surgery, infectiology, hygiene, and others. The group of experts from the environment of the University Hospital Münster promptly makes a joint treatment recommendation for the individual case. The plan is to examine 3300 patients with open fractures or surgical complications. As consortium partners, there are also 3 statutory health insurance companies. The extent to which the therapy recommendations are effective and contribute to cost reduction in the health care system will be empirically investigated in a stepped-wedge cluster-randomized design. In addition, medical and nonmedical professional groups involved in the project will be asked about their work in the project (in total, 248 clinic employees). The primary outcome is the complication rate of open fractures or the occurrence of postoperative complications. As secondary outcomes, the number of antibiotics administered, limb function, and quality of life will be assessed. The health economic evaluation refers to the costs of health services and absenteeism. For the work-related evaluation, workload, work engagement, work-related resources, readiness for technology, and ergonomic aspects of the new telemedical technology will be collected. In addition, clinic employees will give their assessments of the success of the project in a structured telephone interview based on scaled and open-ended questions. Results: The project started in June 2022; data collection started in April 2023. As of mid-June 2024, data from 425 patients had been included. In total, 146 members of staff had taken part in the questionnaire survey and 15 had taken part in the interviews. Conclusions: Standardized treatment pathways in the standard care of patients with open fractures and postoperative infections will be established to reduce complications, improve chances of recovery, and reduce costs. Unnecessary and redundant treatment steps will be avoided through standardized diagnostics and therapy. The interdisciplinary treatment perspective allows for a more individualized therapy. In the medium term, outpatient or inpatient treatment centers specialized in the patient group could be set up where the new diagnostic and therapeutic pathways could be competently applied. Trial Registration: German Clinical Trials Register DRKS00031308; https://drks.de/search/de/trial/DRKS00031308 International Registered Report Identifier (IRRID): DERR1-10.2196/57820 %R 10.2196/57820 %U https://www.researchprotocols.org/2024/1/e57820 %U https://doi.org/10.2196/57820 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e64373 %T Transgender-Specific Differentiated HIV Service Delivery Models in the South African Public Primary Health Care System (Jabula Uzibone): Protocol for an Implementation Study %A Poteat,Tonia %A Bothma,Rutendo %A Maposa,Innocent %A Hendrickson,Cheryl %A Meyer-Rath,Gesine %A Hill,Naomi %A Pettifor,Audrey %A Imrie,John %+ Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, United States, 1 919 684 9303, tonia.poteat@duke.edu %K HIV prevention %K HIV care %K pre-exposure prophylaxis %K antiretroviral therapy %K gender affirmation %K transgender health %D 2024 %7 13.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Almost 60% of transgender people in South Africa are living with HIV. Ending the HIV epidemic will require that transgender people successfully access HIV prevention and treatment. However, transgender people often avoid health services due to facility-based stigma and lack of availability of gender-affirming care. Transgender-specific differentiated service delivery (TG-DSD) may improve engagement and facilitate progress toward HIV elimination. Wits RHI, a renowned South African research institute, established 4 TG-DSD demonstration sites in 2019, with funding from the US Agency for International Development. These sites offer unique opportunities to evaluate the implementation of TG-DSD and test their effectiveness. Objective: The Jabula Uzibone study seeks to assess the implementation, effectiveness, and cost of TG-DSD for viral suppression and prevention-effective adherence. Methods: The Jabula Uzibone study collects baseline and 12-month observation checklists at 8 sites and 6 (12.5%) key informant interviews per site at 4 TG-DSD and 4 standard sites (n=48). We seek to enroll ≥600 transgender clients, 50% at TG-DSD and 50% at standard sites: 67% clients with HIV and 33% clients without HIV per site type. Participants complete interviewer-administered surveys quarterly, and blood is drawn at baseline and 12 months for HIV RNA levels among participants with HIV and tenofovir levels among participants on pre-exposure prophylaxis. A subset of 30 participants per site type will complete in-depth interviews at baseline and 12 months: 15 participants will be living with HIV and 15 participants will be HIV negative. Qualitative analyses will explore aspects of implementation; regression models will compare viral suppression and prevention-effective adherence by site type. Structural equation modeling will test for mediation by stigma and gender affirmation. Microcosting approaches will estimate the cost per service user served and per service user successfully treated at TG-DSD sites relative to standard sites, as well as the budget needed for a broader implementation of TG-DSD. Results: Funded by the US National Institutes of Mental Health in April 2022, the study was approved by the Human Research Ethics Committee at University of Witwatersrand in June 2022 and the Duke University Health System Institutional Review Board in June 2023. Enrollment began in January 2024. As of July 31, 2024, a total of 593 transgender participants have been enrolled: 348 are living with HIV and 245 are HIV negative. We anticipate baseline enrollment will be complete by August 31, 2024, and the final study visit will take place no later than August 2025. Conclusions: Jabula Uzibone will provide data to inform HIV policies and practices in South Africa and generate the first evidence for implementation of TG-DSD in sub-Saharan Africa. Study findings may inform the use of TG-DSD strategies to increase care engagement and advance global progress toward HIV elimination goals. International Registered Report Identifier (IRRID): DERR1-10.2196/64373 %M 39269745 %R 10.2196/64373 %U https://www.researchprotocols.org/2024/1/e64373 %U https://doi.org/10.2196/64373 %U http://www.ncbi.nlm.nih.gov/pubmed/39269745 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e62667 %T Effect of Semaglutide on Physical Function, Body Composition, and Biomarkers of Aging in Older Adults With Overweight and Insulin Resistance: Protocol for an Open-Labeled Randomized Controlled Trial %A Cortes,Tiffany M %A Vasquez,Libia %A Serra,Monica C %A Robbins,Ronna %A Stepanenko,Allison %A Brown,Kevin %A Barrus,Hannah %A Campos,Annalisa %A Espinoza,Sara E %A Musi,Nicolas %+ Division of Endocrinology, Department of Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, United States, 1 210 949 9759, cortest@uthscsa.edu %K glucagon-like peptide %K lean body mass %K physical function %K biomarkers of aging %K semaglutide %D 2024 %7 13.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older adults with type 2 diabetes mellitus (T2DM) or prediabetes are at increased risk of adverse changes in body composition, physical function, and aging-related biomarkers compared to those with normal glucose tolerance. Semaglutide is a glucagon-like peptide 1 receptor agonist that has been approved for T2DM and chronic weight management. Although semaglutide is effective for weight loss and T2DM management, its effects on lean body mass, physical function, and biomarkers of aging are understudied in older adults. Objective: This study aims to compare the effects of lifestyle counseling with and that without semaglutide on body composition, physical function, and biomarkers of aging in older adults. Methods: This is an open-label randomized controlled trial. A total of 20 adults (aged 65 years and older) with elevated BMI (27-40 kg/m2) and prediabetes or well-controlled T2DM (hemoglobin A1c 5.7%-7.5%) are recruited, stratified by sex, and randomized 1:1 to one of 2 groups (semaglutide plus lifestyle counseling vs lifestyle counseling alone) and followed up for 5 months. Those in the semaglutide group are titrated to 1 mg weekly, as tolerated, for 12 weeks. Lifestyle counseling is given by registered dietitians and based on the Diabetes Prevention Program Lifestyle Change Program. Our primary outcomes include changes in lean mass, physical function, and biomarkers of aging. Body composition is measured by dual-energy x-ray absorptiometry and includes total fat mass and lean mass. Physical function is measured by 6-minute walk distance, grip strength, and short physical performance battery. Biomarkers of aging are measured in blood, skeletal muscle, and abdominal adipose tissue to include C-reactive protein, interleukin-6, tumor necrosis factors α, and β galactosidase staining. Results: The study was funded in December 2021 with a projected data collection period from spring 2023 through summer 2024. Conclusions: Despite the elevated risk of adverse changes in body composition, physical function, and biomarkers of aging among older adults with glucose intolerance and elevated adiposity, the benefits and risks of commonly prescribed antihyperglycemic or weight loss medications such as semaglutide are understudied. This study aims to fill this knowledge gap to inform clinicians about the potential for additional clinically meaningful, nonglycemic effects of semaglutide. Trial Registration: ClinicalTrials.gov NCT05786521; https://clinicaltrials.gov/study/NCT05786521 International Registered Report Identifier (IRRID): DERR1-10.2196/62667 %M 39269759 %R 10.2196/62667 %U https://www.researchprotocols.org/2024/1/e62667 %U https://doi.org/10.2196/62667 %U http://www.ncbi.nlm.nih.gov/pubmed/39269759 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57343 %T Community Health Workers as Mental Health Paraprofessionals: Protocol for a Mixed-Methods Pilot Feasibility Study %A Moyce,Sally %A Crawford,Cassidy %+ College of Health and Human Development, Montana State University, PO Box 173560, Bozeman, MT, 59717, United States, 1 970 846 8424, cassacrawford8@gmail.com %K behavioral activation %K community health workers %K implementation science %K Latino %K mental health provider shortage area %K pilot study %K evidence-based treatments %D 2024 %7 12.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Community health workers (CHWs) are effective in delivering behavioral activation (BA), especially in low-resource settings. In an area with a lack of Spanish-speaking mental health counselors, such as southwest Montana, CHWs can provide needed care. Objective: The goal of this pilot study protocol is to test the feasibility, acceptability, and preliminary efficacy of a model of care that engages CHWs as providers of BA. Methods: We will train 2 CHWs in BA methodology. We will enroll 20 participants who screen positive for depression in a 12-week telephone intervention for BA. Preliminary efficacy will be tested in pre- and postscores of the Beck Depression Inventory and semistructured interviews. Feasibility and acceptability will be measured through participant retention and treatment adherence. The Therapeutic Alliance with Clinician Scale will be used to measure the strength of the therapeutic relationship. Descriptive statistics will measure alliances and repeated measures ANOVA will measure trends and changes in depression scores. Results: Enrollment began in October 2023. A total of 12 participants completed at least 10 BA sessions and all study measures by the time the study concluded in May 2024. In August 2024, data analysis occurred with an anticipated manuscript to be submitted for publication in October 2024. Conclusions: Results from this study will inform future studies into the implementation of an evidence-based mental health intervention in a limited resource setting for Latino people with limited English proficiency. International Registered Report Identifier (IRRID): DERR1-10.2196/57343 %M 39264699 %R 10.2196/57343 %U https://www.researchprotocols.org/2024/1/e57343 %U https://doi.org/10.2196/57343 %U http://www.ncbi.nlm.nih.gov/pubmed/39264699 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54323 %T Capitalizing on Community Groups to Improve Women’s Resilience to Maternal and Child Health Challenges: Protocol for a Human-Centered Design Study in Tanzania %A Isangula,Kahabi Ganka %A Usiri,Aminieli Itaeli %A Pallangyo,Eunice Siaity %+ School of Nursing and Midwifery, Aga Khan University, Salama House, 344 Urambo Street, P.O.Box 125, Dar Es Salaam, 255, United Republic of Tanzania, 255 754030726, kahabi.isangula@aku.edu %K maternal and child health %K maternal and child deaths %K human-centered design %K income generating associations %K sub-Saharan Africa %K Tanzania %K community groups %K community %K capitalizing %K resilience %K maternal deaths %K neonatal deaths %K mortality %K co-design %D 2024 %7 10.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Maternal and neonatal deaths remain a major public health issue worldwide. Income Generation Associations (IGAs) could form a critical entry point to addressing poverty-related contributors. However, there have been limited practical interventions to leverage the power of IGAs in addressing the challenges associated with maternal care and childcare. Objective: This study aims to co-design an intervention package with women in IGAs to improve their readiness and resilience to address maternal and child health (MCH) challenges using a human-centered design approach. Methods: The study will use a qualitative descriptive design with purposefully selected women in IGAs and key MCH stakeholders in the Shinyanga and Arusha Regions of Tanzania. A 4-step adaptation of the human-centered design process will be used involving (1) mapping of IGAs and exploring their activities, level of women’s engagement, and MCH challenges faced; (2) co-designing of the intervention package to address identified MCH challenges or needs considering the perceived acceptability, feasibility, and sustainability; (3) validation of the emerging intervention package through gathering insights of women in IGAs who did not take part in initial steps; and (4) refinement of the intervention package with MCH stakeholders based on the validation findings. Results: The participants, procedures, and findings of each co-design step will be presented. More specifically, MCH challenges facing women in IGAs, a list of potential solutions proposed, and the emerging prototype will be presented. As of August 2024, we have completed the co-design of the intervention package and are preparing validation. The findings from the validation of the emerging prototype with a new group of women in IGAs and its refinement through multistakeholder engagement will be presented. A final co-designed intervention package with the potential to improve women’s resilience and readiness to handle MCH challenges will be generated. Conclusions: The emerging intervention package will be discussed given relevant literature on the topic. We believe that subsequent testing and refinement of the package could form the basis for scaling up to broader settings and that the package could then be promoted as one of the key strategies in addressing MCH challenges facing women in low- and middle-income countries. International Registered Report Identifier (IRRID): DERR1-10.2196/54323 %M 39255483 %R 10.2196/54323 %U https://www.researchprotocols.org/2024/1/e54323 %U https://doi.org/10.2196/54323 %U http://www.ncbi.nlm.nih.gov/pubmed/39255483 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59428 %T Using Systems Engineering and Implementation Science to Design an Implementation Package for Preoperative Comprehensive Geriatric Assessment Among Older Adults Having Major Abdominal Surgery: Protocol for a 3-Phase Study %A Berian,Julia R %A Schwarze,Margaret L %A Werner,Nicole E %A Mahoney,Jane E %A Shah,Manish N %+ Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI, 53792, United States, 1 6082634224, berian@wisc.edu %K systems engineering %K participatory design %K user-centered design %K implementation science %K surgery %K aging research %K randomized controlled trial %D 2024 %7 9.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older Americans, a growing segment of the population, have an increasing need for surgical services, and they experience a disproportionate burden of postoperative complications compared to their younger counterparts. A preoperative comprehensive geriatric assessment (pCGA) is recommended to reduce risk and improve surgical care delivery for this population, which has been identified as vulnerable. The pCGA optimizes multiple chronic conditions and factors commonly overlooked in routine preoperative planning, including physical function, polypharmacy, nutrition, cognition, mental health, and social and environmental support. The pCGA has been shown to decrease postoperative morbidity, mortality, and length of stay in a variety of surgical specialties. Although national guidelines recommend the use of the pCGA, a paucity of strategic guidance for implementation limits its uptake to a few academic medical centers. By applying implementation science and human factors engineering methods, this study will provide the necessary evidence to optimize the implementation of the pCGA in a variety of health care settings. Objective: The purpose of this paper is to describe the study protocol to design an adaptable, user-centered pCGA implementation package for use among older adults before major abdominal surgery. Methods: This protocol uses systems engineering methods to develop, tailor, and pilot-test a user-centered pCGA implementation package, which can be adapted to community-based hospitals in preparation for a multisite implementation trial. The protocol is based upon the National Institutes of Health Stage Model for Behavioral Intervention Development and aligns with the goal to develop behavioral interventions with an eye to real-world implementation. In phase 1, we will use observation and interviews to map the pCGA process and identify system-based barriers and facilitators to its use among older adults undergoing major abdominal surgery. In phase 2, we will apply user-centered design methods, engaging health care providers, patients, and caregivers to co-design a pCGA implementation package. This package will be applicable to a diverse population of older patients undergoing major abdominal surgery at a large academic hospital and an affiliate community site. In phase 3, we will pilot-test and refine the pCGA implementation package in preparation for a future randomized controlled implementation-effectiveness trial. We anticipate that this study will take approximately 60 months (April 2023-March 2028). Results: This study protocol will generate (1) a detailed process map of the pCGA; (2) an adaptable, user-centered pCGA implementation package ready for feasibility testing in a pilot trial; and (3) preliminary pilot data on the implementation and effectiveness of the package. We anticipate that these data will serve as the basis for future multisite hybrid implementation-effectiveness clinical trials of the pCGA in older adults undergoing major abdominal surgery. Conclusions: The expected results of this study will contribute to improving perioperative care processes for older adults before major abdominal surgery. International Registered Report Identifier (IRRID): DERR1-10.2196/59428 %M 39250779 %R 10.2196/59428 %U https://www.researchprotocols.org/2024/1/e59428 %U https://doi.org/10.2196/59428 %U http://www.ncbi.nlm.nih.gov/pubmed/39250779 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e58456 %T Impact of an Electronic Health Record–Based Interruptive Alert Among Patients With Headaches Seen in Primary Care: Cluster Randomized Controlled Trial %A Pradhan,Apoorva %A Wright,Eric A %A Hayduk,Vanessa A %A Berhane,Juliana %A Sponenberg,Mallory %A Webster,Leeann %A Anderson,Hannah %A Park,Siyeon %A Graham,Jove %A Friedenberg,Scott %K headache management %K migraine management %K electronic health record–based alerts %K primary care %K clinician decision support tools %K electronic health record %K EHR %D 2024 %7 29.8.2024 %9 %J JMIR Med Inform %G English %X Background: Headaches, including migraines, are one of the most common causes of disability and account for nearly 20%‐30% of referrals from primary care to neurology. In primary care, electronic health record–based alerts offer a mechanism to influence health care provider behaviors, manage neurology referrals, and optimize headache care. Objective: This project aimed to evaluate the impact of an electronic alert implemented in primary care on patients’ overall headache management. Methods: We conducted a stratified cluster-randomized study across 38 primary care clinic sites between December 2021 to December 2022 at a large integrated health care delivery system in the United States. Clinics were stratified into 6 blocks based on region and patient-to–health care provider ratios and then 1:1 randomized within each block into either the control or intervention. Health care providers practicing at intervention clinics received an interruptive alert in the electronic health record. The primary end point was a change in headache burden, measured using the Headache Impact Test 6 scale, from baseline to 6 months. Secondary outcomes included changes in headache frequency and intensity, access to care, and resource use. We analyzed the difference-in-differences between the arms at follow-up at the individual patient level. Results: We enrolled 203 adult patients with a confirmed headache diagnosis. At baseline, the average Headache Impact Test 6 scores in each arm were not significantly different (intervention: mean 63, SD 6.9; control: mean 61.8, SD 6.6; P=.21). We observed a significant reduction in the headache burden only in the intervention arm at follow-up (3.5 points; P=.009). The reduction in the headache burden was not statistically different between groups (difference-in-differences estimate –1.89, 95% CI –5 to 1.31; P=.25). Similarly, secondary outcomes were not significantly different between groups. Only 11.32% (303/2677) of alerts were acted upon. Conclusions: The use of an interruptive electronic alert did not significantly improve headache outcomes. Low use of alerts by health care providers prompts future alterations of the alert and exploration of alternative approaches. Trial Registration: ClinicalTrials.gov NCT05067725; https://clinicaltrials.gov/study/NCT05067725 %R 10.2196/58456 %U https://medinform.jmir.org/2024/1/e58456 %U https://doi.org/10.2196/58456 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e63463 %T Stimulation Therapy to Induce Mothers: Protocol for a Multicenter Randomized Controlled Trial %A Tortal,Danna %A Shabanova,Veronika %A Taylor,Sarah %A Xu,Xiao %A McAdow,Molly %A Stetson,Bethany %A McCollum,Sarah %A Sanchez,Ester %A Adjakple,Amie %A Leventhal,Jessica %A Son,Moeun %+ Weill Medical College of Cornell University, 413 East 69th Street, Suite 16-086, New York, NY, 10021, United States, 1 212 746 2106, mos7003@med.cornell.edu %K nipple stimulation %K nipple stimulation therapy %K breast pump %K labor induction %K oxytocin %K lactation %D 2024 %7 29.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: More than 1 million women have their labor induced in the United States each year, and synthetic oxytocin infusion is the most common method used. However, compared to spontaneous labor, medical induction is resource intensive, has increased obstetric risks, and is associated with less successful breastfeeding. In contrast to the endogenous oxytocin hormone, which is released in a pulsatile fashion in the brain, synthetic oxytocin is continuously infused intravenously, resulting in important limitations related to efficacy, safety, and cost. Akin to spontaneous labor contractions, infant suckling of the breast nipple is known to stimulate the pulsatile release of endogenous oxytocin from the posterior pituitary gland. Nipple stimulation therapy via an electric breast pump similarly stimulates endogenous oxytocin release and may be a favorable inpatient method for patients undergoing labor induction. Objective: This study aims to examine whether inpatient nipple stimulation therapy is an efficacious labor induction method that increases the likelihood of spontaneous vaginal delivery and sustained breastfeeding and determine whether it is a cost-effective approach. Methods: This is a multicenter, pragmatic, open-label, parallel-group randomized controlled trial of nulliparous patients with singleton gestations ≥36 weeks undergoing labor induction. This trial compares inpatient nipple stimulation therapy via an electric breast pump versus immediate synthetic oxytocin infusion without nipple stimulation. This trial including 988 nulliparas will provide adequate statistical power to detect clinically meaningful differences in delivery mode and breast milk as the sole source of nutrition for newborns at hospital discharge or 72 hours after birth. Results: The project received pilot funding in 2021 and full funding in 2023. Enrollment for this study began in November 2021 at a single site, and as of May 2024, recruitment is underway at 3 study sites. It is anticipated that enrollment will be completed by late 2026. Conclusions: Successful completion of this trial will provide rigorous data to determine whether inpatient nipple stimulation therapy with an electric breast pump can improve the way we induce labor and positively impact breastfeeding success and early infant nutrition through lactation. Trial Registration: ClinicalTrials.gov NCT05079841; https://clinicaltrials.gov/study/NCT05079841 International Registered Report Identifier (IRRID): DERR1-10.2196/63463 %M 39207839 %R 10.2196/63463 %U https://www.researchprotocols.org/2024/1/e63463 %U https://doi.org/10.2196/63463 %U http://www.ncbi.nlm.nih.gov/pubmed/39207839 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59918 %T Implementation and Impact of Intimate Partner Violence Screening Expansion in the Veterans Health Administration: Protocol for a Mixed Methods Evaluation %A Portnoy,Galina A %A Relyea,Mark R %A Dichter,Melissa E %A Iverson,Katherine M %A Presseau,Candice %A Brandt,Cynthia A %A Skanderson,Melissa %A Bruce,LeAnn E %A Martino,Steve %+ VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, United States, 1 2039325711, galina.portnoy@va.gov %K screening %K intimate partner violence %K implementation %K evaluation %K national rollout %K health care %K quality improvement %K veterans %D 2024 %7 28.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Intimate partner violence (IPV) is a significant public health problem with far-reaching consequences. The health care system plays an integral role in the detection of and response to IPV. Historically, the majority of IPV screening initiatives have targeted women of reproductive age, with little known about men’s IPV screening experiences or the impact of screening on men’s health care. The Veterans Health Administration (VHA) has called for an expansion of IPV screening, providing a unique opportunity for a large-scale evaluation of IPV screening and response across all patient populations. Objective: In this protocol paper, we describe the recently funded Partnered Evaluation of Relationship Health Innovations and Services through Mixed Methods (PRISM) initiative, aiming to evaluate the implementation and impact of the VHA’s IPV screening and response expansion, with a particular focus on identifying potential gender differences. Methods: The PRISM Initiative is guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) and Consolidated Framework for Implementation Research (CFIR 2.0) frameworks. We will use mixed methods data from 139 VHA facilities to evaluate the IPV screening expansion, including electronic health record data and qualitative interviews with patients, clinicians, and national IPV program leadership. Quantitative data will be analyzed using a longitudinal observational design with repeated measurement periods at baseline (T0), year 1 (T1), and year 2 (T2). Qualitative interviews will focus on identifying multilevel factors, including potential implementation barriers and facilitators critical to IPV screening and response expansion, and examining the impact of screening on patients and clinicians. Results: The PRISM initiative was funded in October 2023. We have developed the qualitative interview guides, obtained institutional review board approval, extracted quantitative data for baseline analyses, and began recruitment for qualitative interviews. Reports of progress and results will be made available to evaluation partners and funders through quarterly and end-of-year reports. All data collection and analyses across time points are expected to be completed in June 2026. Conclusions: Findings from this mixed methods evaluation will provide a comprehensive understanding of IPV screening expansion at the VHA, including the implementation and impact of screening and the scope of IPV detected in the VHA patient population. Moreover, data generated by this initiative have critical policy and clinical practice implications in a national health care system. International Registered Report Identifier (IRRID): PRR1-10.2196/59918 %M 39194059 %R 10.2196/59918 %U https://www.researchprotocols.org/2024/1/e59918 %U https://doi.org/10.2196/59918 %U http://www.ncbi.nlm.nih.gov/pubmed/39194059 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56042 %T Creating a Modified Version of the Cambridge Multimorbidity Score to Predict Mortality in People Older Than 16 Years: Model Development and Validation %A Kar,Debasish %A Taylor,Kathryn S %A Joy,Mark %A Venkatesan,Sudhir %A Meeraus,Wilhelmine %A Taylor,Sylvia %A Anand,Sneha N %A Ferreira,Filipa %A Jamie,Gavin %A Fan,Xuejuan %A de Lusignan,Simon %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom, 44 1865617855, kathryn.taylor@phc.ox.ac.uk %K pandemics %K COVID-19 %K multimorbidity %K prevalence %K predictive model %K discrimination %K calibration %K systematized nomenclature of medicine %K computerized medical records %K systems %D 2024 %7 26.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: No single multimorbidity measure is validated for use in NHS (National Health Service) England’s General Practice Extraction Service Data for Pandemic Planning and Research (GDPPR), the nationwide primary care data set created for COVID-19 pandemic research. The Cambridge Multimorbidity Score (CMMS) is a validated tool for predicting mortality risk, with 37 conditions defined by Read Codes. The GDPPR uses the more internationally used Systematized Nomenclature of Medicine clinical terms (SNOMED CT). We previously developed a modified version of the CMMS using SNOMED CT, but the number of terms for the GDPPR data set is limited making it impossible to use this version. Objective: We aimed to develop and validate a modified version of CMMS using the clinical terms available for the GDPPR. Methods: We used pseudonymized data from the Oxford-Royal College of General Practitioners Research and Surveillance Centre (RSC), which has an extensive SNOMED CT list. From the 37 conditions in the original CMMS model, we selected conditions either with (1) high prevalence ratio (≥85%), calculated as the prevalence in the RSC data set but using the GDPPR set of SNOMED CT codes, divided by the prevalence included in the RSC SNOMED CT codes or (2) conditions with lower prevalence ratios but with high predictive value. The resulting set of conditions was included in Cox proportional hazard models to determine the 1-year mortality risk in a development data set (n=500,000) and construct a new CMMS model, following the methods for the original CMMS study, with variable reduction and parsimony, achieved by backward elimination and the Akaike information stopping criterion. Model validation involved obtaining 1-year mortality estimates for a synchronous data set (n=250,000) and 1-year and 5-year mortality estimates for an asynchronous data set (n=250,000). We compared the performance with that of the original CMMS and the modified CMMS that we previously developed using RSC data. Results: The initial model contained 22 conditions and our final model included 17 conditions. The conditions overlapped with those of the modified CMMS using the more extensive SNOMED CT list. For 1-year mortality, discrimination was high in both the derivation and validation data sets (Harrell C=0.92) and 5-year mortality was slightly lower (Harrell C=0.90). Calibration was reasonable following an adjustment for overfitting. The performance was similar to that of both the original and previous modified CMMS models. Conclusions: The new modified version of the CMMS can be used on the GDPPR, a nationwide primary care data set of 54 million people, to enable adjustment for multimorbidity in predicting mortality in people in real-world vaccine effectiveness, pandemic planning, and other research studies. It requires 17 variables to produce a comparable performance with our previous modification of CMMS to enable it to be used in routine data using SNOMED CT. %M 39186368 %R 10.2196/56042 %U https://www.jmir.org/2024/1/e56042 %U https://doi.org/10.2196/56042 %U http://www.ncbi.nlm.nih.gov/pubmed/39186368 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56197 %T Exploring New Models for Implementing Sustainable Integrated Health Access for People in Vulnerable Positions: Protocol for a Mixed Methods Multiple Case Study %A Mejsner,Sofie Buch %A Aslaug,Jane %A Bech,Mickael %A Burau,Viola %A Mark,Dorte %A Vixø,Kathrine %A Westergaard,Caroline Louise %A Fehsenfeld,Michael %+ Department of Public Health, Aarhus University, Bartholins alle 2, Aarhus, 8000, Denmark, 45 8715 0000, sbm@ph.au.dk %K health care organization %K social inequality in health %K vulnerable people %K integrated health access %K healthcare access %K accessibility %K healthcare %K Europe %K social inequalities %K health inequalities %K mental illness %K inequality %K Denmark %D 2024 %7 23.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health care is a strongly universal right across European welfare states; however, social inequalities in health persist. This literature argues that health care organization is an important but overlooked determinant of social inequalities in health, as health systems buffer or amplify structural and individual health determinants. The Client-Centered Coordination Platform (3CP) model offers integrated health access to people with severe mental illness, through core groups of professionals from across health and social services. Objective: This study focuses on vulnerable people with severe mental health problems and aims to analyze how the model can give people with severe mental illness more integrated access to health and social care. This can form a stepping-stone for the upscaling of the 3CP model. Methods: We conduct a 5-year multiple case study of 3 municipalities in Denmark, where 3CP is being implemented. In a 1-year pilot study, we expect to gather quantitative registry data from the municipalities and the Central Denmark Region to explore the characteristics of people included in 3CP. We will also collect qualitative data, including 21 hours of observations; 36 interviews with users, professionals, and managers; and 3 focus groups across the 3 municipalities. In a subsequent, 4-year qualitative study, we aim to conduct 120 hours of observations, 120 interviews, and 24 focus groups. In parallel with the qualitative study, we will facilitate a cocreation process to develop tools for sustaining integrated health access. Results: As of January 2024, we have completed the individual interviews with users of 3CP and professionals and the focus groups. Individual interviews of managers will be conducted during the 1st quarter of 2024. The quantitative data are being collected. Conclusions: Inequality is one of the greatest challenges that European societies face. Understanding new and innovative approaches to integrated care may provide valuable solutions to the challenges posed. Especially understanding and designing health and social care systems that meet the needs and abilities of those users requiring them most, is vitally important to tackle inequality. International Registered Report Identifier (IRRID): DERR1-10.2196/56197 %M 39178409 %R 10.2196/56197 %U https://www.researchprotocols.org/2024/1/e56197 %U https://doi.org/10.2196/56197 %U http://www.ncbi.nlm.nih.gov/pubmed/39178409 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e43173 %T Impact of the COVID-19 Pandemic on Influenza Hospital Admissions and Deaths in Wales: Descriptive National Time Series Analysis %A Alsallakh,Mohammad %A Adeloye,Davies %A Vasileiou,Eleftheria %A Sivakumaran,Shanya %A Akbari,Ashley %A Lyons,Ronan A %A Robertson,Chris %A Rudan,Igor %A Davies,Gwyneth A %A Sheikh,Aziz %K influenza %K hospitalization %K mortality %K COVID-19 pandemic %K nonpharmaceutical interventions %K Wales %K COVID-19 %K community health %K hospital admission %K endemic virus %K public health surveillance %D 2024 %7 21.8.2024 %9 %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic and the ensuing implementation of control measures caused widespread societal disruption. These disruptions may also have affected community transmission and seasonal circulation patterns of endemic respiratory viruses. Objective: We aimed to investigate the impact of COVID-19–related disruption on influenza-related emergency hospital admissions and deaths in Wales in the first 2 years of the pandemic. Methods: A descriptive analysis of influenza activity was conducted using anonymized pathology, hospitalization, and mortality data from the Secure Anonymised Information Linkage Databank in Wales. The annual incidence of emergency hospitalizations and deaths with influenza-specific diagnosis codes between January 1, 2015, and December 31, 2021, was estimated. Case definitions of emergency hospitalization and death required laboratory confirmation with a polymerase chain reaction test. Trends of admissions and deaths were analyzed monthly and yearly. We conducted 2 sensitivity analyses by extending case definitions to include acute respiratory illnesses with a positive influenza test and by limiting admissions to those with influenza as the primary diagnosis. We also examined yearly influenza testing trends to understand changes in testing behavior during the pandemic. Results: We studied a population of 3,235,883 Welsh residents in 2020 with a median age of 42.5 (IQR 22.9–61.0) years. Influenza testing in Wales increased notably in the last 2 months of 2020, and particularly in 2021 to 39,720 per 100,000 people, compared to the prepandemic levels (1343 in 2019). The percentage of influenza admissions matched to an influenza polymerase chain reaction test increased from 74.8% (1890/2526) in 2019 to 85.2% (98/115) in 2021. However, admissions with a positive test per 100,000 population decreased from 17.0 in 2019 to 2.7 and 0.6 in 2020 and 2021, respectively. Similarly, deaths due to influenza with a positive influenza test per 100,000 population decreased from 0.4 in 2019 to 0.0 in 2020 and 2021. Sensitivity analyses showed similar patterns of decreasing influenza admissions and deaths in the first 2 years of the COVID-19 pandemic. Conclusions: Nonpharmaceutical interventions to control COVID-19 were associated with a substantial reduction in the transmission of the influenza virus, with associated substantial reductions in hospital cases and deaths observed. Beyond the pandemic context, consideration should be given to the role of nonpharmaceutical community-driven interventions to reduce the burden of influenza. %R 10.2196/43173 %U https://publichealth.jmir.org/2024/1/e43173 %U https://doi.org/10.2196/43173 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56514 %T Comparison of Two Symptom Checkers (Ada and Symptoma) in the Emergency Department: Randomized, Crossover, Head-to-Head, Double-Blinded Study %A Knitza,Johannes %A Hasanaj,Ragip %A Beyer,Jonathan %A Ganzer,Franziska %A Slagman,Anna %A Bolanaki,Myrto %A Napierala,Hendrik %A Schmieding,Malte L %A Al-Zaher,Nizam %A Orlemann,Till %A Muehlensiepen,Felix %A Greenfield,Julia %A Vuillerme,Nicolas %A Kuhn,Sebastian %A Schett,Georg %A Achenbach,Stephan %A Dechant,Katharina %+ Institute for Digital Medicine, University Hospital Giessen, Philipps University, Baldingerstrasse, Marburg, 35043, Germany, 49 642158 ext 62589, johannes.knitza@uni-marburg.de %K symptom checker %K triage %K emergency %K eHealth %K diagnostic accuracy %K apps, health service research %K decision support system %D 2024 %7 20.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Emergency departments (EDs) are frequently overcrowded and increasingly used by nonurgent patients. Symptom checkers (SCs) offer on-demand access to disease suggestions and recommended actions, potentially improving overall patient flow. Contrary to the increasing use of SCs, there is a lack of supporting evidence based on direct patient use. Objective: This study aimed to compare the diagnostic accuracy, safety, usability, and acceptance of 2 SCs, Ada and Symptoma. Methods: A randomized, crossover, head-to-head, double-blinded study including consecutive adult patients presenting to the ED at University Hospital Erlangen. Patients completed both SCs, Ada and Symptoma. The primary outcome was the diagnostic accuracy of SCs. In total, 6 blinded independent expert raters classified diagnostic concordance of SC suggestions with the final discharge diagnosis as (1) identical, (2) plausible, or (3) diagnostically different. SC suggestions per patient were additionally classified as safe or potentially life-threatening, and the concordance of Ada’s and physician-based triage category was assessed. Secondary outcomes were SC usability (5-point Likert-scale: 1=very easy to use to 5=very difficult to use) and SC acceptance net promoter score (NPS). Results: A total of 450 patients completed the study between April and November 2021. The most common chief complaint was chest pain (160/437, 37%). The identical diagnosis was ranked first (or within the top 5 diagnoses) by Ada and Symptoma in 14% (59/437; 27%, 117/437) and 4% (16/437; 13%, 55/437) of patients, respectively. An identical or plausible diagnosis was ranked first (or within the top 5 diagnoses) by Ada and Symptoma in 58% (253/437; 75%, 329/437) and 38% (164/437; 64%, 281/437) of patients, respectively. Ada and Symptoma did not suggest potentially life-threatening diagnoses in 13% (56/437) and 14% (61/437) of patients, respectively. Ada correctly triaged, undertriaged, and overtriaged 34% (149/437), 13% (58/437), and 53% (230/437) of patients, respectively. A total of 88% (385/437) and 78% (342/437) of participants rated Ada and Symptoma as very easy or easy to use, respectively. Ada’s NPS was –34 (55% [239/437] detractors; 21% [93/437] promoters) and Symptoma’s NPS was –47 (63% [275/437] detractors and 16% [70/437]) promoters. Conclusions: Ada demonstrated a higher diagnostic accuracy than Symptoma, and substantially more patients would recommend Ada and assessed Ada as easy to use. The high number of unrecognized potentially life-threatening diagnoses by both SCs and inappropriate triage advice by Ada was alarming. Overall, the trustworthiness of SC recommendations appears questionable. SC authorization should necessitate rigorous clinical evaluation studies to prevent misdiagnoses, fatal triage advice, and misuse of scarce medical resources. Trial Registration: German Register of Clinical Trials DRKS00024830; https://drks.de/search/en/trial/DRKS00024830 %M 39163594 %R 10.2196/56514 %U https://www.jmir.org/2024/1/e56514 %U https://doi.org/10.2196/56514 %U http://www.ncbi.nlm.nih.gov/pubmed/39163594 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59266 %T Rationale, Design, and Intervention Development of a Mobile Health–Led Primary Care Program for Management of Type 2 Diabetes in Rural Thailand: Protocol for a SMARThealth Diabetes Study %A Chanpitakkul,Methee %A Praveen,Devarsetty %A John,Renu %A Ghosh,Arpita %A Lekagul,Salyaveth %A Kaewhiran,Malulee %A Tungsanga,Kriang %A Jha,Vivekanand %+ The George Institute for Global Health, #401, 4th Floor, Shangrila Plaza, Plot No.14, Road No. 2, Banjara Hills, Hyderabad, 500034, India, 91 9959777623, dpraveen@georgeinstitute.org.in %K health workforce %K primary health care %K diabetes %K digital technology %K Thailand %K capacity building. %D 2024 %7 16.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Noncommunicable diseases (NCDs), particularly diabetes and chronic kidney diseases, pose a significant health burden in Thailand, especially among socioeconomically disadvantaged populations. The existing primary health care system faces challenges in providing optimal care for NCDs due to inadequate primary care workforce. The SMARThealth program offers a technology-based solution to enhance NCD management through task-sharing among nonphysician health care workers. Objective: This study aims to adapt and implement the SMARThealth Diabetes program in rural Thailand to improve diabetes management. The main objectives are to (1) adapt, validate, and integrate the SMARThealth Diabetes program for improving the management of type 2 diabetes mellitus at the primary health care level; and (2) to determine the feasibility and acceptability of the SMARThealth Diabetes program in rural communities of Thailand. Methods: A pragmatic, type 2 hybrid effectiveness or implementation, parallel-group cluster randomized controlled trial of 12 months duration and involving 51 subdistrict health offices in rural communities of Kamphaeng Phet province, Thailand, will be conducted. The intervention arm will receive the SMARThealth Diabetes program, including workforce restructuring, clinical decision support system, and continuous performance monitoring, while the control arm will continue with usual practice. Data will be collected using the SMARThealth platform and will be stored on a server in Thailand. The primary outcome measure will be the change in mean hemoglobin A1c (HbA1c) measured at randomization and 12 months from randomization between the intervention and control clusters. Secondary outcomes will include the difference in change in albuminuria status, estimated glomerular filtration rate, systolic blood pressure, and low-density lipoprotein cholesterol level. The analysis for change in HbA1c between baseline and end of study will be performed using linear mixed models. Any imbalances between the 2 arms will be addressed by sensitivity analyses. Additionally, a mixed methods process evaluation will be conducted to assess the implementation process, that will include in-depth interviews and focus group discussions, in addition to the quantitative data collected during the implementation process. The qualitative data will be thematically analyzed to explore factors that promote or inhibit the implementation and maintenance of the program. Results: The data collection commenced in November 2022, and the results will be ready for publication by the first quarter of 2025. Effectiveness of the intervention package will be assessed by change in mean HbA1c measures, and detailed feasibility, barriers, and enablers for the implementation of the intervention will be documented through a detailed process evaluation. Conclusions: The study protocol outlines a novel approach to enhancing diabetes management in rural Thailand through digital technology–based interventions that will facilitate task-sharing among health care workers. This can help inform future strategies for improving NCD care in low-resource settings globally. Trial Registration: Thai Clinical Trials Registry TCTR20200322006; https://www.thaiclinicaltrials.org/show/TCTR20200322006 International Registered Report Identifier (IRRID): DERR1-10.2196/59266 %M 39150766 %R 10.2196/59266 %U https://www.researchprotocols.org/2024/1/e59266 %U https://doi.org/10.2196/59266 %U http://www.ncbi.nlm.nih.gov/pubmed/39150766 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57692 %T Efficacy and Implementation Planning Across the Veterans Affairs Polytrauma System of Care: Protocol for the REACH Intervention for Caregivers of Veterans and Service Members With Traumatic Brain Injury %A Perrin,Paul B %A Haun,Jolie N %A Klyce,Daniel W %A Melillo,Christine %A Nakase-Richardson,Risa %A Seel,Ronald T %A Martindale-Adams,Jennifer %A Nichols,Linda O %A Perera,Robert A %A Xia,Bridget %A Hahm,Bridget %A Zuber,Jeffrey %+ School of Data Science, University of Virginia, 102 Cresap Road, #101, Charlottesville, VA, 22903, United States, 1 (434) 982 2600, perrin@virginia.edu %K traumatic brain injury %K telehealth %K caregiver %K methodology %K veterans %K service members %D 2024 %7 15.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The responsibility of care for Veterans and Service Members (V/SMs) with traumatic brain injury (TBI) often defaults to informal family caregivers. Caregiving demands considerable knowledge, skill, and support to facilitate the health and well-being of V/SMs and themselves. Persistent and common TBI caregiver issues include strain, depression, and anxiety. While evidence-based, brief interventions have been developed and implemented for family caregivers in Veteran neurodegenerative populations, few interventions have been developed, adapted, or tested to support the unique needs of caregivers of V/SMs with TBI. Objective: This study will adapt and test an evidence-based, personalized, 6-session telehealth caregiver intervention, “Resources for Enhancing All Caregivers’ Health” (REACH), to meet the unique needs of caregivers of V/SMs with TBI. If successful, a community-based participatory research team will develop an implementation plan to roll out REACH TBI across the national Veterans Affairs Polytrauma System of Care. Methods: This mixed methods, crossover waitlist control clinical trial will use a Type 1 Hybrid Effectiveness-Implementation approach to adapt and then test the effects of REACH TBI on key TBI caregiver outcomes. Results: This study was funded by the Department of Defense in September 2023. Participant enrollment and data collection will begin in 2024. Conclusions: If effective, REACH TBI will be the first evidence-based intervention for caregivers of V/SMs with TBI that can be scaled to implement across the Veterans Affairs Polytrauma System of Care and fill a notable gap in clinical services. International Registered Report Identifier (IRRID): PRR1-10.2196/57692 %M 39145996 %R 10.2196/57692 %U https://www.researchprotocols.org/2024/1/e57692 %U https://doi.org/10.2196/57692 %U http://www.ncbi.nlm.nih.gov/pubmed/39145996 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e50047 %T Requirements for and Barriers to Rehabilitation Services for Children With Disabilities in Middle- and High-Income Countries: Scoping Review %A Xie,Yijun %A Wu,Jing %A Li,Yao %A Liu,Hui %A Peng,Yanyan %A Zhou,Ping %A Sun,Yizhou %A Kang,Luyan %A Jiang,Chenghua %A Wu,Hengjing %+ Clinical Center for Intelligent Rehabilitation Research, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, No.2209 Guangxing Road, Songjiang District, Shanghai, 201619, China, 86 15821525700, whjdata@126.com %K children with disabilities %K barriers %K health services %K middle- and high-income countries %K child %K low income %K middle income %K disability %K children %K disabilities %K income %K barrier %K rehabilitation %K suitability %K availability %K affordability %K support system %K support %K awareness %K policy %D 2024 %7 7.8.2024 %9 Review %J Interact J Med Res %G English %X Background: The rehabilitation of children with disabilities has received considerable attention from the United Nations. However, the state of rehabilitation services for children with disabilities worldwide remains far from optimistic, even in economically affluent middle- and high-income countries. Objective: This scoping review aimed to identify the rehabilitation needs of children with disabilities and their barriers to rehabilitation services in middle- and high-income countries. Methods: A systematic search was conducted using MEDLINE and Web of Science for papers published from January 2013 to December 2023. Studies were included if they were peer-reviewed, full-text articles related to children with disabilities, reporting on their access to rehabilitation services, and conducted in countries classified by the World Bank 2023 as middle- and high-income economies. Exclusion criteria included duplicates, unavailable full texts, and studies without distinct outcomes. A total of 27 studies were selected following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, focusing on children, their families, or service providers. Results: The suitability, availability, and affordability of rehabilitation services were identified as the major needs and barriers for children with disabilities in middle- and high-income countries. This included communication barriers, a need for more personnel and facilities, and the stagnation and inadequacy of economic subsidies. Conclusions: Middle- and high-income countries have relatively well-established rehabilitation infrastructure and support systems. They are nevertheless insufficient for meeting the needs of children with disabilities. More attention should be paid to these issues to improve the well-being of children with disabilities. The data provided by this review can help raise awareness of rehabilitation needs and barriers at the policy level. %M 39110502 %R 10.2196/50047 %U https://www.i-jmr.org/2024/1/e50047 %U https://doi.org/10.2196/50047 %U http://www.ncbi.nlm.nih.gov/pubmed/39110502 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51317 %T Identifying Medicine Shortages With the Twitter Social Network: Retrospective Observational Study %A Postma,Doerine J %A Heijkoop,Magali L A %A De Smet,Peter A G M %A Notenboom,Kim %A Leufkens,Hubert G M %A Mantel-Teeuwisse,Aukje K %+ Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, Utrecht, 3584 CG, Netherlands, 31 302537324, a.k.mantel@uu.nl %K medicine shortages %K signal detection %K social media %K Twitter social network %K drug shortage %K Twitter %D 2024 %7 6.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Early identification is critical for mitigating the impact of medicine shortages on patients. The internet, specifically social media, is an emerging source of health data. Objective: This study aimed to explore whether a routine analysis of data from the Twitter social network can detect signals of a medicine shortage and serve as an early warning system and, if so, for which medicines or patient groups. Methods: Medicine shortages between January 31 and December 1, 2019, were collected from the Dutch pharmacists’ society’s national catalog Royal Dutch Pharmacists Association (KNMP) Farmanco. Posts on these shortages were collected by searching for the name, the active pharmaceutical ingredient, or the first word of the brand name of the medicines in shortage. Posts were then selected based on relevant keywords that potentially indicated a shortage and the percentage of shortages with at least 1 post was calculated. The first posts per shortage were analyzed for their timing (median number of days, including the IQR) versus the national catalog, also stratified by disease and medicine characteristics. The content of the first post per shortage was analyzed descriptively for its reporting stakeholder and the nature of the post. Results: Of the 341 medicine shortages, 102 (29.9%) were mentioned on Twitter. Of these 102 shortages, 18 (5.3% of the total) were mentioned prior to or simultaneous to publication by KNMP Farmanco. Only 4 (1.2%) of these were mentioned on Twitter more than 14 days before. On average, posts were published with a median delay of 37 (IQR 7-81) days to publication by KNMP Farmanco. Shortages mentioned on Twitter affected a greater number of patients and lasted longer than those that were not mentioned. We could not conclusively relate either the presence or absence on Twitter to a disease area or route of administration of the medicine in shortage. The first posts on the 102 shortages were mainly published by patients (n=51, 50.0%) and health care professionals (n=46, 45.1%). We identified 8 categories of nature of content. Sharing personal experience (n=44, 43.1%) was the most common category. Conclusions: The Twitter social network is not a suitable early warning system for medicine shortages. Twitter primarily echoes already-known information rather than spreads new information. However, Twitter or potentially any other social media platform provides the opportunity for future qualitative research in the increasingly important field of medicine shortages that investigates how a larger population of patients is affected by shortages. %M 39106483 %R 10.2196/51317 %U https://www.jmir.org/2024/1/e51317 %U https://doi.org/10.2196/51317 %U http://www.ncbi.nlm.nih.gov/pubmed/39106483 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50749 %T Virtual Clinic Telehealth Abortion Services in the United States One Year After Dobbs: Landscape Review %A Koenig,Leah R %A Ko,Jennifer %A Upadhyay,Ushma D %+ Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, United States, 1 415 353 4626, ushma.upadhyay@ucsf.edu %K medication abortion %K telehealth %K virtual clinics %K abortion %K access %K policy %K health equity %D 2024 %7 5.8.2024 %9 Short Paper %J J Med Internet Res %G English %X Background: Telehealth abortion has taken on a vital role in maintaining abortion access since the Dobbs v. Jackson Women’s Health Organization Supreme Court decision. However, little remains known about the landscape of new telehealth-only virtual clinic abortion providers that have expanded since telehealth abortion first became widely available in the United States in 2021. Objective: This study aimed to (1) document the landscape of telehealth-only virtual clinic abortion care in the United States, (2) describe changes in the presence of virtual clinic abortion services between September 2022, following the Dobbs decision, and June 2023, and (3) identify structural factors that may perpetuate inequities in access to virtual clinic abortion care. Methods: We conducted a repeated cross-sectional study by reviewing web search results and abortion directories to identify virtual abortion clinics in September 2022 and June 2023 and described changes in the presence of virtual clinics between these 2 periods. In June 2023, we also described each virtual clinic’s policies, including states served, costs, patient age limits, insurance acceptance, financial assistance available, and gestational limits. Results: We documented 11 virtual clinics providing telehealth abortion care in 26 states and Washington DC in September 2022. By June 2023, 20 virtual clinics were providing services in 27 states and Washington DC. Most (n=16) offered care to minors, 8 provided care until 10 weeks of pregnancy, and median costs were US $259. In addition, 2 accepted private insurance and 1 accepted Medicaid, within a limited number of states. Most (n=16) had some form of financial assistance available. Conclusions: Virtual clinic abortion providers have proliferated since the Dobbs decision. We documented inequities in the availability of telehealth abortion care from virtual clinics, including age restrictions that exclude minors, gestational limits for care, and limited insurance and Medicaid acceptance. Notably, virtual clinic abortion care was not permitted in 11 states where in-person abortion is available. %M 39102679 %R 10.2196/50749 %U https://www.jmir.org/2024/1/e50749 %U https://doi.org/10.2196/50749 %U http://www.ncbi.nlm.nih.gov/pubmed/39102679 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60009 %T Correlates of Mild Behavioral Impairment in Older Adults: Protocol for a Scoping Review %A Yoon,Seolah %A Jeong,Innhee %A Kim,Jennifer Ivy %A Hong,Dahye %A Kang,Bada %+ Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea, 82 02 2228 3283, bdkang@yuhs.ac %K mild behavioral impairment %K older adults %K mild cognitive impairment %K subjective cognitive decline %K behavioral symptoms %K scoping review %K protocol %K elderly %K behavioral impairment %K cognitive %K cognitive decline %K scoping review protocol %K older adult %K neuropsychological %K impairment %K behavioral %K behavior %D 2024 %7 29.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Understanding mild behavioral impairment, a relatively recent notion in neuropsychological studies, provides significant insights into early behavioral indicators of cognitive decline and predicts the onset of dementia in older adults. Although the importance of understanding mild behavioral impairment is acknowledged, comprehensive reviews of its correlates with older adults are limited. Objective: This scoping review aims to identify the impact of mild behavioral impairment on health outcomes in older adults and the factors associated with mild behavioral impairment. Methods: The review will adhere to the Joanna Briggs Institute’s methodological principles for scoping reviews. We will include studies focusing mainly on mild behavioral impairment in older adults, with the literature on this topic being limited to the period from 2003 to the present. Other clinical diagnoses, such as cognitive impairment, Parkinson disease, and multiple sclerosis, will not be included. We will use databases including PubMed (MEDLINE), CINAHL, Web of Science, Embase, PsycINFO, Cochrane, and Scopus for relevant articles published in English. Both gray literature and peer-reviewed articles will be considered during screening. Three independent reviewers will extract data using a predefined data extraction tool. Extracted data will be presented using tables, figures, and a narrative summary aligned with review questions, accompanied by an analysis of study characteristics and categorization of mild behavioral impairment correlates. Results: The results will be presented as a descriptive summary, structured according to the associated factors related to mild behavioral impairment, and the health outcomes. Additionally, the data on study characteristics will be presented in tabular format. An exploratory search was conducted in July 2023 to establish a comprehensive search strategy, and iterative refinements to the scoping review protocol and formalization of methods were completed. A follow-up search is planned for May 2024, with the aim of submitting the findings for publication in peer-reviewed journals. Conclusions: To our knowledge, this would be the first study to map the literature on the health-related factors and outcomes of mild behavioral impairment. The findings will support the development of interventions to prevent the occurrence of mild behavioral impairment and mitigate the negative outcomes of mild behavioral impairment. International Registered Report Identifier (IRRID): DERR1-10.2196/60009 %M 39074360 %R 10.2196/60009 %U https://www.researchprotocols.org/2024/1/e60009 %U https://doi.org/10.2196/60009 %U http://www.ncbi.nlm.nih.gov/pubmed/39074360 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51672 %T Examining the Role of Physician Characteristics in Web-Based Verified Primary Care Physician Reviews: Observational Study %A Sehgal,Neil K R %A Rader,Benjamin %A Brownstein,John S %+ Department of Computer and Information Science, University of Pennsylvania, 3330 Walnut St, Philadelphia, PA, 19104, United States, 1 215 898 9672, neilsehgal99@gmail.com %K patient review websites %K patient online review %K telemedicine %K internet %K online review %K online reviews %K rating %K physician review %K physician reviews %K doctor review %K doctor reviews %D 2024 %7 29.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Doctor review websites have become increasingly popular as a source of information for patients looking to select a primary care provider. Zocdoc is one such platform that allows patients to not only rate and review their experiences with doctors but also directly schedule appointments. This study examines how several physician characteristics including gender, age, race, languages spoken in a physician’s office, education, and facial attractiveness impact the average numerical rating of primary care doctors on Zocdoc. Objective: The aim of this study was to investigate the association between physician characteristics and patient satisfaction ratings on Zocdoc. Methods: A data set of 1455 primary care doctor profiles across 30 cities was scraped from Zocdoc. The profiles contained information on the physician’s gender, education, and languages spoken in their office. Age, facial attractiveness, and race were imputed from profile pictures using commercial facial analysis software. Each doctor profile listed an average overall satisfaction rating, bedside manner rating, and wait time rating from verified patients. Descriptive statistics, the Wilcoxon rank sum test, and multivariate logistic regression were used to analyze the data. Results: The average overall rating on Zocdoc was highly positive, with older age, lower facial attractiveness, foreign degrees, allopathic degrees, and speaking more languages negatively associated with the average rating. However, the effect sizes of these factors were relatively small. For example, graduates of Latin American medical schools had a mean overall rating of 4.63 compared to a 4.77 rating for US graduates (P<.001), a difference roughly equivalent to a 2.8% decrease in appointments. On multivariate analysis, being Asian and having a doctor of osteopathic medicine degree were positively associated with higher overall ratings, while attending a South Asian medical school and speaking more European and Middle Eastern languages in the office were negatively associated with higher overall ratings. Conclusions: Overall, the findings suggest that age, facial attractiveness, education, and multilingualism do have some impact on web-based doctor reviews, but the numerical effect is small. Notably, bias may play out in many forms. For example, a physician's appearance or accent may impact a patient's trust, confidence, or satisfaction with their physician, which could in turn influence their take-up of preventative services and lead to either better or worse health outcomes. The study highlights the need for further research in how physician characteristics influence patient ratings of care. %M 39074363 %R 10.2196/51672 %U https://www.jmir.org/2024/1/e51672 %U https://doi.org/10.2196/51672 %U http://www.ncbi.nlm.nih.gov/pubmed/39074363 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45780 %T Cerebral Microbleeds in Different Brain Regions and Their Associations With the Digital Clock-Drawing Test: Secondary Analysis of the Framingham Heart Study %A Akhter-Khan,Samia C %A Tao,Qiushan %A Ang,Ting Fang Alvin %A Karjadi,Cody %A Itchapurapu,Indira Swetha %A Libon,David J %A Alosco,Michael %A Mez,Jesse %A Qiu,Wei Qiao %A Au,Rhoda %+ Framingham Heart Study, Boston University School of Medicine, 72 East Concord Street, R-623D, Boston, MA, 02118, United States, 1 6176384336, wqiu67@bu.edu %K cerebral microbleeds %K CMB %K digital clock-drawing test %K DCT %K Alzheimer disease %K dementia %K early screening %K Boston Process Approach %K cerebral microbleed %K neuroimaging %K cerebrovascular diseases %K aging %K MRI %K magnetic resonance imaging %K clock-drawing test %K cognitive function %D 2024 %7 29.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Cerebral microbleeds (CMB) increase the risk for Alzheimer disease. Current neuroimaging methods that are used to detect CMB are costly and not always accessible. Objective: This study aimed to explore whether the digital clock-drawing test (DCT) may provide a behavioral indicator of CMB. Methods: In this study, we analyzed data from participants in the Framingham Heart Study offspring cohort who underwent both brain magnetic resonance imaging scans (Siemens 1.5T, Siemens Healthcare Private Limited; T2*-GRE weighted sequences) for CMB diagnosis and the DCT as a predictor. Additionally, paper-based clock-drawing tests were also collected during the DCT. Individuals with a history of dementia or stroke were excluded. Robust multivariable linear regression models were used to examine the association between DCT facet scores with CMB prevalence, adjusting for relevant covariates. Receiver operating characteristic (ROC) curve analyses were used to evaluate DCT facet scores as predictors of CMB prevalence. Sensitivity analyses were conducted by further including participants with stroke and dementia. Results: The study sample consisted of 1020 (n=585, 57.35% female) individuals aged 45 years and older (mean 72, SD 7.9 years). Among them, 64 (6.27%) participants exhibited CMB, comprising 46 with lobar-only, 11 with deep-only, and 7 with mixed (lobar+deep) CMB. Individuals with CMB tended to be older and had a higher prevalence of mild cognitive impairment and higher white matter hyperintensities compared to those without CMB (P<.05). While CMB were not associated with the paper-based clock-drawing test, participants with CMB had a lower overall DCT score (CMB: mean 68, SD 23 vs non-CMB: mean 76, SD 20; P=.009) in the univariate comparison. In the robust multiple regression model adjusted for covariates, deep CMB were significantly associated with lower scores on the drawing efficiency (β=–0.65, 95% CI –1.15 to –0.15; P=.01) and simple motor (β=–0.86, 95% CI –1.43 to –0.30; P=.003) domains of the command DCT. In the ROC curve analysis, DCT facets discriminated between no CMB and the CMB subtypes. The area under the ROC curve was 0.76 (95% CI 0.69-0.83) for lobar CMB, 0.88 (95% CI 0.78-0.98) for deep CMB, and 0.98 (95% CI 0.96-1.00) for mixed CMB, where the area under the ROC curve value nearing 1 indicated an accurate model. Conclusions: The study indicates a significant association between CMB, especially deep and mixed types, and reduced performance in drawing efficiency and motor skills as assessed by the DCT. This highlights the potential of the DCT for early detection of CMB and their subtypes, providing a reliable alternative for cognitive assessment and making it a valuable tool for primary care screening before neuroimaging referral. %M 39073857 %R 10.2196/45780 %U https://www.jmir.org/2024/1/e45780 %U https://doi.org/10.2196/45780 %U http://www.ncbi.nlm.nih.gov/pubmed/39073857 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e52020 %T Chinese Health Insurance in the Digital Era: Bibliometric Study %A Hu,Zhiyuan %A Qin,Xiaoping %A Chen,Kaiyan %A Huang,Yu-Ni %A Wang,Richard Szewei %A Tung,Tao-Hsin %A Chuang,Yen-Ching %A Wang,Bing-Long %+ School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, 11th Floor,Block C,Mingyang International Center, No. 46 Xizongbu Hutong, Dongcheng District, Beijing, 100730, China, 86 15021345074, wangbinglong@sph.pumc.edu.cn %K telemedicine %K health insurance %K internet plus healthcare %K bibliometric %K VOSviewer %D 2024 %7 23.7.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: China has entered the era of digital health care after years of reforms in the health care system. The use of digital technologies in healthcare services is rapidly increasing, indicating the onset of a new period. The reform of health insurance has also entered a new phase. Objective: This study aims to investigate the evolution of health care insurance within the context of telemedicine and Internet Plus Healthcare (IPHC) during the digital health care era by using scientometric methods to analyze publication patterns, influential keywords, and research hot spots. It seeks to understand how health care insurance has adapted to the growing integration of IPHC and telemedicine in health care services and the implications for policy and practice. Methods: A total of 411 high-quality studies were curated from the China National Knowledge Infrastructure (CNKI) database in the Chinese language, scientometric analysis was conducted, and VOSviewer software was used to conduct a visualized analysis of keywords and hot spots in the literature. Results: The number of articles in this field has increased notably from 2000 to 2022 and has increased annually based on a curve of y=0.332exp (0.4002x) with R2=0.6788. In total, 62 institutions and 811 authors have published research articles in the Chinese language in this field. This study included 290 keywords and formulated a total of 5 hot-topic clusters of “telemedicine,” “IPHC,” “internet hospital,” “health insurance payments,” and “health insurance system.” Conclusions: Studies on the application of digital technologies in health care insurance has evolved from foundational studies to a broader scope. The emergence of internet hospitals has showcased the potential for integrating IPHC services into insurance payment systems. However, this development also highlights the necessity for enhanced interregional coordination mechanisms. The reform of health insurance payment is contingent upon ongoing advancements in digital technology and increased investment in electronic medical records and primary health care services. Future efforts should focus on integrating technology with administrative systems, advancing mobile health care solutions, and ensuring interoperability among various payment systems to improve efficiency and standardize health care services. %M 39042449 %R 10.2196/52020 %U https://www.i-jmr.org/2024/1/e52020 %U https://doi.org/10.2196/52020 %U http://www.ncbi.nlm.nih.gov/pubmed/39042449 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 7 %N %P e52278 %T Factors Influencing Neuromuscular Blockade Reversal Choice in the United States Before and During the COVID-19 Pandemic: Retrospective Longitudinal Analysis %A Turzhitsky,Vladimir %A Bash,Lori D %A Urman,Richard D %A Kattan,Michael %A Hofer,Ira %+ Merck & Co, Inc, 126 E Lincoln Avenue, Rahway, NJ, 07065, United States, 1 781206642, vladimir.turzhitsky@merck.com %K neuromuscular blockade %K sugammadex %K neostigmine %K rocuronium, vecuronium, intubation, counterfactual %K anesthesia %K anesthetic %K anesthesiologist %K anesthesiologists %K surgery %K surgical %K preference %K preferences %K retrospective %K utilization %K pattern %K patterns %K trend %K trends %K national %K healthcare database %K healthcare databases %K COVID-19 %K time-trend analysis %K neuromuscular %K longitudinal analysis %K longitudinal %K neuromuscular blockade agent %K clinical %K surgical procedure %K inpatient %K inpatient surgery %K retrospective analysis %K USA %K United States %D 2024 %7 22.7.2024 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Neuromuscular blockade (NMB) agents are a critical component of balanced anesthesia. NMB reversal methods can include spontaneous reversal, sugammadex, or neostigmine and the choice of reversal strategy can depend on various factors. Unanticipated changes to clinical practice emerged due to the COVID-19 pandemic, and a better understanding of how NMB reversal trends were affected by the pandemic may help provide insight into how providers view the tradeoffs in the choice of NMB reversal agents. Objective: We aim to analyze NMB reversal agent use patterns for US adult inpatient surgeries before and after the COVID-19 outbreak to determine whether pandemic-related practice changes affected use trends. Methods: A retrospective longitudinal analysis of a large all-payer national electronic US health care database (PINC AI Healthcare Database) was conducted to identify the use patterns of NMB reversal during early, middle, and late COVID-19 (EC, MC, and LC, respectively) time periods. Factors associated with NMB reversal choices in inpatient surgeries were assessed before and after the COVID-19 pandemic reached the United States. Multivariate logistic regression assessed the impact of the pandemic on NMB reversal, accounting for patient, clinical, procedural, and site characteristics. A counterfactual framework was used to understand if patient characteristics affected how COVID-19–era patients would have been treated before the pandemic. Results: More than 3.2 million inpatients experiencing over 3.6 million surgical procedures across 931 sites that met all inclusion criteria were identified between March 1, 2017, and December 31, 2021. NMB reversal trends showed a steady increase in reversal with sugammadex over time, with the trend from January 2018 onwards being linear with time (R2>0.99). Multivariate analysis showed that the post–COVID-19 time periods had a small but statistically significant effect on the trend, as measured by the interaction terms of the COVID-19 time periods and the time trend in NMB reversal. A slight increase in the likelihood of sugammadex reversal was observed during EC relative to the pre–COVID-19 trend (odds ratio [OR] 1.008, 95% CI 1.003-1.014; P=.003), followed by negation of that increase during MC (OR 0.992, 95% CI 0.987-0.997; P<.001), and no significant interaction identified during LC (OR 1.001, 95% CI 0.996-1.005; P=.81). Conversely, active reversal (using either sugammadex or neostigmine) did not show a significant association relative to spontaneous reversal, or a change in trend, during EC or MC (P>.05), though a slight decrease in the active reversal trend was observed during LC (OR 0.987, 95% CI 0.983-0.992; P<.001). Conclusions: We observed a steady increase in NMB active reversal overall, and specifically with sugammadex compared to neostigmine, during periods before and after the COVID-19 outbreak. Small, transitory alterations in the NMB reversal trends were observed during the height of the COVID-19 pandemic, though these alterations were independent of the underlying NMB reversal time trends. %M 39038283 %R 10.2196/52278 %U https://periop.jmir.org/2024/1/e52278 %U https://doi.org/10.2196/52278 %U http://www.ncbi.nlm.nih.gov/pubmed/39038283 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 9 %N %P e58832 %T Exploring the Impact of Device Sourcing on Real-World Adherence and Cost Implications of Continuous Glucose Monitoring in Patients With Diabetes: Retrospective Claims Analysis %A Allaire,Jason C %A Dennis,Consuela %A Masturzo,Arti %A Wittlin,Steven %+ CCS Medical, 3030 LBJ Fwy, Suite 1525, Clearwater, FL, 75234, United States, 1 5132527683, Arti.Masturzo@ccsmed.com %K diabetes %K diabetic %K adherence %K medical costs %K continuous glucose monitor %K propensity score matching %K CGM %K glucose %K cost %K costs %K claim %K claims %K insurance %K economic %K economics %K finance %K financial %D 2024 %7 22.7.2024 %9 Original Paper %J JMIR Diabetes %G English %X Background: Insurance benefit design influences whether individuals with diabetes who require a continuous glucose monitor (CGM) to provide real-time feedback on their blood glucose levels can obtain the CGM device from either a pharmacy or a durable medical equipment supplier. The impact of the acquisition channel on device adherence and health care costs has not been systematically evaluated. Objective: This study aims to compare the adherence rates for patients new to CGM therapy and the costs of care for individuals who obtained CGM devices from a pharmacy versus acquisition through a durable medical equipment supplier using retrospective claims analysis. Methods: Using the Mariner commercial claims database, individuals aged >18 years with documented diabetes and an initial CGM claim during the first quarter of 2021 (2021 Q1, index date) were identified. Patients had to maintain uninterrupted enrollment for a duration of 15 months but file no CGM claim during the 6 months preceding the index date. We used direct matching to establish comparable pharmacy and durable medical equipment cohorts. Outcomes included quarterly adherence, reinitiation, and costs for the period from 2021 Q1 to the third quarter of 2022 (2022 Q3). Between-cohort differences in adherence rates and reinitiation rates were analyzed using z tests, and cost differences were analyzed using 2-tailed t tests. Results: Direct matching was used to establish comparable pharmacy and durable medical equipment cohorts. A total of 2356 patients were identified, with 1178 in the pharmacy cohort and 1178 in the durable medical equipment cohorts. Although adherence declined over time in both cohorts, the durable medical equipment cohort exhibited significantly superior adherence compared to the pharmacy cohort at 6 months (pharmacy n=615, 52% and durable medical equipment n=761, 65%; P<.001), 9 months (pharmacy n=579, 49% and durable medical equipment cohorts n=714, 61%; P<.001), and 12 months (pharmacy 48% and durable medical equipment n=714, 59%; P<.001). Mean annual total medical costs for adherent patients in the pharmacy cohort were 53% higher than the durable medical equipment cohort (pharmacy US $10,635 and durable medical equipment US $6967; P<.001). In nonadherent patients, the durable medical equipment cohort exhibited a significantly higher rate of therapy reinitiation during the period compared to the pharmacy cohort (pharmacy 61/613, 10% and durable medical equipment 108/485, 22%; P<.001). Conclusions: The results from this real-world claims analysis demonstrate that, in a matched set, individuals who received their CGM through a durable medical equipment supplier were more adherent to their device. For individuals who experienced a lapse in therapy, those whose supplies were provided through the durable medical equipment channel were more likely to resume use after an interruption than those who received their supplies from a pharmacy. In the matched cohort analysis, those who received their CGM equipment through a durable medical equipment supplier demonstrated a lower total cost of care. %M 38804821 %R 10.2196/58832 %U https://diabetes.jmir.org/2024/1/e58832 %U https://doi.org/10.2196/58832 %U http://www.ncbi.nlm.nih.gov/pubmed/38804821 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e57290 %T Prevalence, Mortality, and Access to Care for Chronic Kidney Disease in Medicaid-Enrolled Adults With Sickle Cell Disease in California: Retrospective Cohort Study %A Valle,Jhaqueline %A Lebensburger,Jeffrey D %A Garimella,Pranav S %A Gopal,Srila %+ Tracking California, Public Health Institute, 555 12th Street, Oakland, CA, 94607, United States, 1 4085942436, jhaqueline.valle@trackingcalifornia.org %K sickle cell disease %K chronic kidney disease %K prevalence %K mortality %K access to care %K Medicaid %K California %K United States %K retrospective %K cohort study %K investigate %K emergency department %K hospitalization %K specialized care %K adult %K adults %K hematologist %K hematologists %K nephrologist %K nephrologists %K t-test %D 2024 %7 15.7.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Chronic kidney disease (CKD) is a significant complication in patients with sickle cell disease (SCD), leading to increased mortality. Objective: This study aims to investigate the burden of CKD in Medicaid-enrolled adults with SCD in California, examine differences in disease burden between male and female individuals, and assess mortality rates and access to specialized care. Methods: This retrospective cohort study used the California Sickle Cell Data Collection program to identify and monitor individuals with SCD. Medicaid claims, vital records, emergency department, and hospitalization data from 2011 to 2020 were analyzed. CKD prevalence was assessed based on ICD (International Classification of Diseases) codes, and mortality rates were calculated. Access to specialized care was examined through outpatient encounter rates with hematologists and nephrologists. Results: Among the 2345 adults with SCD, 24.4% (n=572) met the case definition for CKD. The SCD-CKD group was older at the beginning of this study (average age 44, SD 14 vs 34, SD 12.6 years) than the group without CKD. CKD prevalence increased with age, revealing significant disparities by sex. While the youngest (18-29 years) and oldest (>65 years) groups showed similar CKD prevalences between sexes (female: 12/111, 10.8% and male: 12/101, 11.9%; female: 74/147, 50.3% and male: 34/66, 51.5%, respectively), male individuals in the aged 30-59 years bracket exhibited significantly higher rates than female individuals (30-39 years: 49/294, 16.7%, P=.01; 40-49 years: 52/182, 28.6%, P=.02; and 50-59 years: 76/157,48.4%, P<.001). During this study, of the 2345 adults, 435 (18.5%) deaths occurred, predominantly within the SCD-CKD cohort (226/435, 39.5%). The median age at death was 53 (IQR 61-44) years for the SCD-CKD group compared to 43 (IQR 33-56) years for the SCD group, with male individuals in the SCD-CKD group showing significantly higher mortality rates (111/242, 45.9%; P=.009) than female individuals (115/330, 34.9%). Access to specialist care was notably limited: approximately half (281/572, 49.1%) of the SCD-CKD cohort had no hematologist visits, and 61.9% (354/572) did not see a nephrologist during this study’s period. Conclusions: This study provides robust estimates of CKD prevalence and mortality among Medicaid-enrolled adults with SCD in California. The findings highlight the need for improved access to specialized care for this population and increased awareness of the high mortality risk and progression associated with CKD. %M 39008353 %R 10.2196/57290 %U https://publichealth.jmir.org/2024/1/e57290 %U https://doi.org/10.2196/57290 %U http://www.ncbi.nlm.nih.gov/pubmed/39008353 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e41749 %T Census-Dependent Mortality of Ventilated Patients With COVID-19 in Israel: Noninterventional Observational Cohort Study %A Mendlovic,Joseph %A Mimouni,Francis B %+ Shaare Zedek Medical Center, Affiliated with the Hadassah-Hebrew University School of Medicine, PO Box 12000, Shmuel (Hans) Beyth St 12, Jerusalem, 91120, Israel, 972 6777111 ext 1, sefimen@gmail.com %K COVID-19 %K mortality %K ventilation %K intensive care %K pandemic %K contagious %K disease %K mortality %K database %K data %K patient %K mortality %K medical %K resources %K validation %K public policy %K policy %K pandemic %K health policy %K global health policy %D 2024 %7 9.7.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: The COVID-19 pandemic led to several surges in the mass hospitalization rate. Extreme increases in hospital admissions without adequate medical resources may increase mortality. No study has addressed the impact of daily census of ventilated patients on mortality in the context of the pandemic in a nationwide setting. Objective: This study aimed to determine whether daily census of ventilated patients affected COVID-19 mortality rates nationwide in Israel. Methods: We conducted a cohort study using nationwide, public-domain, population-based COVID-19 data of hospitalized patients from an Israeli database from March 11, 2020, until February 11, 2021. We included all COVID-19 hospital admissions, classified as mild to severe per the Centers for Diseases Control and Prevention classification irrespective of whether they were mechanically ventilated. Outcome measures were daily death rates and death rates expressed as a percentage of ventilated patients. Results: During the study period (338 days from March 11, 2020, to February 11, 2021), 715,743 patients contracted and were clinically confirmed as having COVID-19. Among them, 5577 (0.78%) patients died. In total, 3398 patients were ventilated because of severe COVID-19. Daily mortality correlated with daily census of ventilated patients (R2=0.828, P<.001). The daily percent mortality of ventilated patients also correlated with the daily census of ventilated patients (R2=0.365, P<.001)—backward multiple regression analysis demonstrated that this positive correlation was still highly significant even when correcting for the average age or gender of ventilated patients (R2=0.4328, P<.001) or for the surge in their number. Overall, 40% of the variation in mortality was explained by variations in the daily census of ventilated patients. ANOVA revealed that at less than 50 ventilated patients per day, the daily mortality of ventilated patients was slightly above 5%, and it nearly doubled (10%) with 50-149 patients; moreover, in all categories of ≥200 patients ventilated per day, it more than tripled at ≥15% (P<.001). Conclusions: Daily mortality rates per ventilated patient increased with an increase in the number of ventilated patients, suggesting the saturation of medical resources. Policy makers should be aware that expanding medical services without adequate resources may increase mortality. Governments should perform similar analyses to provide indicators of system saturation, although further validation of these results might be needed to use this indicator to drive public policy. %M 38981116 %R 10.2196/41749 %U https://www.i-jmr.org/2024/1/e41749 %U https://doi.org/10.2196/41749 %U http://www.ncbi.nlm.nih.gov/pubmed/38981116 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59121 %T Characterizing Mental Health Status and Service Utilization in Chinese Americans With Type 2 Diabetes in New York City: Cross-Sectional Study %A Shi,Yun %A Wu,Bei %A Islam,Nadia %A Sevick,Mary Ann %A Shallcross,Amanda J %A Levy,Natalie %A Tamura,Kosuke %A Bao,Han %A Lieu,Ricki %A Xu,Xinyi %A Jiang,Yulin %A Hu,Lu %+ Center for Healthful Behavior Change, New York University Grossman School of Medicine, New York University Langone Health, 180 Madison Ave, 7th floor, New York, NY, 10016, United States, 1 6465013438, lu.hu@nyulangone.org %K mental health %K diabetes distress %K depression %K anxiety %K service utilization %K psychological distress %K type 2 diabetes %K diabetes %K United States %K mental health burden %K Chinese American %K cross-sectional %K telephone survey %K stress %K depressive symptoms %K mental health care %K mental health screening %D 2024 %7 2.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Emerging evidence indicates that individuals with type 2 diabetes (T2D) are more prone to mental health issues than the general population; however, there is a significant lack of data concerning the mental health burden in Chinese Americans with T2D. Objective: The aim of this study was to explore the comorbid mental health status, health-seeking behaviors, and mental service utilization among Chinese Americans with T2D. Methods: A cross-sectional telephone survey was performed among 74 Chinese Americans with T2D in New York City. We used standardized questionnaires to assess mental health status and to gather data on mental health–seeking behaviors and service utilization. Descriptive statistics were applied for data analysis. Results: A total of 74 Chinese Americans with T2D completed the survey. Most participants (mean age 56, SD 10 years) identified as female (42/74, 57%), were born outside the United States (73/74, 99%), and had limited English proficiency (71/74, 96%). Despite nearly half of the participants (34/74, 46%) reporting at least one mental health concern (elevated stress, depressive symptoms, and/or anxiety), only 3% (2/74) were currently using mental health services. Common reasons for not seeking care included no perceived need, lack of information about Chinese-speaking providers, cost, and time constraints. The cultural and language competence of the provider was ranked as the top factor related to seeking mental health care. Conclusions: Chinese Americans with T2D experience relatively high comorbid mental health concerns yet have low service utilization. Clinicians may consider team-based care to incorporate mental health screening and identify strategies to provide culturally and linguistically concordant mental health services to engage Chinese Americans with T2D. %M 38954806 %R 10.2196/59121 %U https://formative.jmir.org/2024/1/e59121 %U https://doi.org/10.2196/59121 %U http://www.ncbi.nlm.nih.gov/pubmed/38954806 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e51381 %T Erlotinib or Gefitinib for Treating Advanced Epidermal Growth Factor Receptor Mutation–Positive Lung Cancer in Aotearoa New Zealand: Protocol for a National Whole-of-Patient-Population Retrospective Cohort Study and Results of a Validation Substudy %A Aye,Phyu Sin %A Barnes,Joanne %A Laking,George %A Cameron,Laird %A Anderson,Malcolm %A Luey,Brendan %A Delany,Stephen %A Harris,Dean %A McLaren,Blair %A Brenman,Elliott %A Wong,Jayden %A Lawrenson,Ross %A Arendse,Michael %A Tin Tin,Sandar %A Elwood,Mark %A Hope,Philip %A McKeage,Mark James %+ Department of Pharmacology and Clinical Pharmacology, University of Auckland, 85 Park Road, Auckland, 1025, New Zealand, 64 21 859 588, m.mckeage@auckland.ac.nz %K epidermal growth factor receptor %K erlotinib %K gefitinib %K lung cancer %K retrospective cohort %K study protocol %K validation %D 2024 %7 2.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Starting in 2010, the epidermal growth factor receptor (EGFR) kinase inhibitors erlotinib and gefitinib were introduced into routine use in Aotearoa New Zealand (NZ) for treating advanced lung cancer, but their impact in this setting is unknown. Objective: The study described in this protocol aims to understand the effectiveness and safety of these new personalized lung cancer treatments and the contributions made by concomitant medicines and other factors to adverse outcomes in the general NZ patient population. A substudy aimed to validate national electronic health databases as the data source and the methods for determining patient eligibility and identifying outcomes and variables. Methods: This study will include all NZ patients with advanced EGFR mutation–positive lung cancer who were first dispensed erlotinib or gefitinib before October 1, 2020, and followed until death or for at least 1 year. Routinely collected health administrative and clinical data will be collated from national electronic cancer registration, hospital discharge, mortality registration, and pharmaceutical dispensing databases by deterministic data linkage using National Health Index numbers. The primary effectiveness and safety outcomes will be time to treatment discontinuation and serious adverse events, respectively. The primary variable will be high-risk concomitant medicines use with erlotinib or gefitinib. For the validation substudy (n=100), data from clinical records were compared to those from national electronic health databases and analyzed by agreement analysis for categorical data and by paired 2-tailed t tests for numerical data. Results: In the validation substudy, national electronic health databases and clinical records agreed in determining patient eligibility and for identifying serious adverse events, high-risk concomitant medicines use, and other categorical data with overall agreement and κ statistic of >90% and >0.8000, respectively; for example, for the determination of patient eligibility, the comparison of proxy and standard eligibility criteria applied to national electronic health databases and clinical records, respectively, showed overall agreement and κ statistic of 96% and 0.8936, respectively. Dates for estimating time to treatment discontinuation and other numerical variables and outcomes showed small differences, mostly with nonsignificant P values and 95% CIs overlapping with zero difference; for example, for the dates of the first dispensing of erlotinib or gefitinib, national electronic health databases and clinical records differed on average by approximately 4 days with a nonsignificant P value of .33 and 95% CIs overlapping with zero difference. As of May 2024, the main study is ongoing. Conclusions: A protocol is presented for a national whole-of-patient-population retrospective cohort study designed to describe the safety and effectiveness of erlotinib and gefitinib during their first decade of routine use in NZ for treating EGFR mutation–positive lung cancer. The validation substudy demonstrated the feasibility and validity of using national electronic health databases and the methods for determining patient eligibility and identifying the study outcomes and variables proposed in the study protocol. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12615000998549; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368928 International Registered Report Identifier (IRRID): DERR1-10.2196/51381 %M 38954434 %R 10.2196/51381 %U https://www.researchprotocols.org/2024/1/e51381 %U https://doi.org/10.2196/51381 %U http://www.ncbi.nlm.nih.gov/pubmed/38954434 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e44906 %T Intramural Health Care Through Video Consultations and the Need for Referrals and Hospital Admissions: Retrospective Quantitative Subanalysis of an Evaluation Study %A Schmalstieg-Bahr,Katharina %A Colombo,Miriam Giovanna %A Koch,Roland %A Szecsenyi,Joachim %A Völker,Friedrich %A Blozik,Eva Elisabeth %A Scherer,Martin %+ Department of General Practice and Primary Care, University Medical Center Eppendorf, Martinistrasse 52, Bldg. W37, 5th Fl, Hamburg, 20246, Germany, 49 40 7410 52400, k.schmalstieg-bahr@uke.de %K intramural health care %K prison %K telemedicine %K primary care %K family medicine %K referral %K hospital admission %K admission rate %K intramural %K penal %K video consult %K e-consult %K remote care %K virtual care %K health care delivery %K service delivery %K health care system %D 2024 %7 28.6.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: In comparison to the general population, prison inmates are at a higher risk for drug abuse and psychiatric, as well as infectious, diseases. Although intramural health care has to be equivalent to extramural services, prison inmates have less access to primary and secondary care. Furthermore, not every prison is constantly staffed with a physician. Since transportation to the nearest extramural medical facility is often resource-intensive, video consultations may offer cost-effective health care for prison inmates. Objective: This study aims to quantify the need for referrals to secondary care services and hospital admissions when video consultations with family physicians and psychiatrists are offered in prison. Methods: In 5 German prisons, a mixed methods evaluation study was conducted to assess feasibility, acceptance, and reasons for conducting video consultations with family physicians and psychiatrists. This analysis uses quantitative data from these consultations (June 2018 to February 2019) in addition to data from a sixth prison added in January 2019 focusing on referral and admission rates, as well as reasons for encounters. Results: At the initiation of the project, 2499 prisoners were detained in the 6 prisons. A total of 435 video consultations were conducted by 12 physicians (3 female and 7 male family physicians, and 2 male psychiatrists during the study period). The majority were scheduled consultations (341/435, 78%). In 68% (n=294) of all encounters, the patient was asked to consult a physician again if symptoms persisted or got worse. In 26% (n=115), a follow-up appointment with either the video consultant or prison physician was scheduled. A referral to other specialties, most often psychiatry, was necessary in 4% (n=17) of the cases. Only in 2% (n=8) of the consultations, a hospital admission was needed. Usually, hospital admissions were the result of unscheduled consultations, and the videoconferencing system was the method of communication in 88% (n=7) of these cases, while 12% (n=1) were carried out over the phone. Reasons for admissions were severe abdominal pain, hypotension, unstable angina or suspected myocardial infarction, or a suspected schizophrenic episode. Conclusions: Most scheduled and unscheduled consultations did not require subsequent patient transport to external health care providers. Using telemedicine services allowed a prompt patient-physician encounter with the possibility to refer patients to other specialties or to admit them to a hospital if necessary. %M 38941595 %R 10.2196/44906 %U https://www.i-jmr.org/2024/1/e44906 %U https://doi.org/10.2196/44906 %U http://www.ncbi.nlm.nih.gov/pubmed/38941595 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56123 %T Effects of a Patient Portal Intervention to Address Diabetes Care Gaps: Protocol for a Pragmatic Randomized Controlled Trial %A Hackstadt,Amber J %A Elasy,Tom A %A Gangaputra,Sapna %A Harper,Kryseana J %A Mayberry,Lindsay S %A Nelson,Lyndsay A %A Peterson,Neeraja B %A Rosenbloom,S Trent %A Yu,Zhihong %A Martinez,William %+ Division of General Internal Medicine, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 450, Nashville, TN, 37203, United States, 1 615 322 5000, william.martinez@vumc.org %K patient portals %K self-management %K self-efficacy %K diabetes mellitus %K health literacy %K attitudes %D 2024 %7 28.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite the potential to significantly reduce complications, many patients do not consistently receive diabetes preventive care. Our research team recently applied user-centered design sprint methodology to develop a patient portal intervention empowering patients to address selected diabetes care gaps (eg, no diabetes eye examination in last 12 months). Objective: This study aims to evaluate the effect of our novel diabetes care gap intervention on completion of selected evidence-based diabetes preventive care services and secondary outcomes. Methods: We are conducting a pragmatic randomized controlled trial of the effect of the intervention on diabetes care gaps. Adult patients with diabetes mellitus (DM) are recruited from primary care clinics affiliated with Vanderbilt University Medical Center. Participants are eligible if they have type 1 or 2 DM, can read in English, are aged 18-75 years, have a current patient portal account, and have reliable access to a mobile device with internet access. We exclude patients with medical conditions that prevent them from using a mobile device, severe difficulty seeing, pregnant women or women who plan to become pregnant during the study period, and patients on dialysis. Participants will be randomly assigned to the intervention or usual care. The primary outcome measure will be the number of diabetes care gaps among 4 DM preventive care services (diabetes eye examination, pneumococcal vaccination, hemoglobin A1c, and urine microalbumin) at 12 months after randomization. Secondary outcomes will include diabetes self-efficacy, confidence managing diabetes in general, understanding of diabetes preventive care, diabetes distress, patient portal satisfaction, and patient-initiated orders at baseline, 3 months, 6 months, and 12 months after randomization. An ordinal logistic regression model will be used to quantify the effect of the intervention on the number of diabetes care gaps at the 12-month follow-up. For dichotomous secondary outcomes, a logistic regression model will be used with random effects for the clinic and provider variables as needed. For continuous secondary outcomes, a regression model will be used. Results: This study is ongoing. Recruitment was closed in February 2022; a total of 433 patients were randomized. Of those randomized, most (n=288, 66.5%) were non-Hispanic White, 33.5% (n=145) were racial or ethnic minorities, 33.9% (n=147) were aged 65 years or older, and 30.7% (n=133) indicated limited health literacy. Conclusions: The study directly tests the hypothesis that a patient portal intervention—alerting patients about selected diabetes care gaps, fostering understanding of their significance, and allowing patients to initiate care—will reduce diabetes care gaps compared with usual care. The insights gained from this study may have broad implications for developing future interventions to address various care gaps, such as gaps in cancer screening, and contribute to the development of effective, scalable, and sustainable approaches to engage patients in chronic disease management and prevention. Trial Registration: ClinicalTrials.gov NCT04894903; https://classic.clinicaltrials.gov/ct2/show/NCT04894903 International Registered Report Identifier (IRRID): DERR1-10.2196/56123 %M 38941148 %R 10.2196/56123 %U https://www.researchprotocols.org/2024/1/e56123 %U https://doi.org/10.2196/56123 %U http://www.ncbi.nlm.nih.gov/pubmed/38941148 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 7 %N %P e51573 %T The Effectiveness of Patient Education on Laparoscopic Surgery Postoperative Outcomes to Determine Whether Direct Coaching Is the Best Approach: Systematic Review of Randomized Controlled Trials %A Maheta,Bhagvat %A Shehabat,Mouhamad %A Khalil,Ramy %A Wen,Jimmy %A Karabala,Muhammad %A Manhas,Priya %A Niu,Ashley %A Goswami,Caroline %A Frezza,Eldo %+ California Northstate University College of Medicine, 9700 W Taron Dr, Elk Grove, CA, 95757, United States, 1 (916) 378 3491, eldo.frezza@cnsuedu.onmicrosoft.com %K patient %K education %K surgeries %K laparoscopic %K postoperative %K outcomes %K systematic review %D 2024 %7 27.6.2024 %9 Review %J JMIR Perioper Med %G English %X Background: As of 2022, patient adherence to postoperative guidelines can reduce the risk of complications by up to 52.4% following laparoscopic abdominal surgery. With the availability of various preoperative education interventions (POEIs), understanding which POEI results in improvement in patient outcomes across the procedures is imperative. Objective: This study aims to determine which POEI could be the most effective on patient outcomes by systematically reviewing all the POEIs reported in the literature. Methods: In total, 4753 articles investigating various POEIs (eg, videos, presentations, mobile apps, and one-on-one education or coaching) were collected from the PubMed, Embase, and Scopus databases. Inclusion criteria were adult patients undergoing abdominal laparoscopic surgery, randomized controlled trials, and studies that provided postoperative outcomes. Exclusion criteria included studies not published in English and with no outcomes reported. Title and abstract and full-text articles with POEI randomized controlled studies were screened based on the above criteria through a blinded, dual review using Covidence (Veritas Health Innovation). Study quality was assessed through the Cochrane Risk of Bias tool. The included articles were analyzed for educational content, intervention timing, intervention type, and postoperative outcomes appropriate for a particular surgery. Results: Only 17 studies matched our criteria, with 1831 patients undergoing laparoscopic cholecystectomy, bariatric surgery (gastric bypass and gastric sleeve), and colectomy. In total, 15 studies reported a statistically significant improvement in at least 1 patient postoperative outcome. None of these studies were found to have an overall high risk of bias according to Cochrane standards. In total, 41% (7/17) of the included studies using direct individual education improved outcomes in almost all surgery types, while educational videos had the greatest statistically significant impact for anxiety, nausea, and pain postoperatively (P<.01). Direct group education demonstrated significant improvement in weight, BMI, exercise, and depressive symptoms in 33% (2/6) of the laparoscopic gastric bypass studies. Conclusions: Direct education (individual or group based) positively impacts postoperative laparoscopic surgery outcomes. Trial Registration: PROSPERO CRD42023438698; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=438698 %M 38935953 %R 10.2196/51573 %U https://periop.jmir.org/2024/1/e51573 %U https://doi.org/10.2196/51573 %U http://www.ncbi.nlm.nih.gov/pubmed/38935953 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e55418 %T Geographic Disparities in Access to Assisted Reproductive Technology Centers in China: Spatial-Statistical Study %A Zhou,Qingqing %A Zeng,Huatang %A Wu,Liqun %A Diao,Kaichuan %A He,Rongxin %A Zhu,Bin %+ School of Public Health and Emergency Management, Southern University of Science and Technology, No 1088 Xueyuan Avenue, Nanshan District, Shenzhen, 518055, China, 86 0755 8801 5610, zhub6@sustech.edu.cn %K assisted reproductive technology %K spatial accessibility %K travel time %K travel cost %K China %D 2024 %7 12.6.2024 %9 Research Letter %J JMIR Public Health Surveill %G English %X A study on infertility in China found that while 543 health care institutions are approved for assisted reproductive technology (ART), only 10.1% offer all ART services, with a significant skew toward the eastern regions, highlighting the accessibility challenges faced by rural and remote populations; this study recommends government measures including travel subsidies and education initiatives to improve ART access for economically disadvantaged individuals. %M 38865169 %R 10.2196/55418 %U https://publichealth.jmir.org/2024/1/e55418 %U https://doi.org/10.2196/55418 %U http://www.ncbi.nlm.nih.gov/pubmed/38865169 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e53354 %T Real-World Survival Comparisons Between Radiotherapy and Surgery for Metachronous Second Primary Lung Cancer and Predictions of Lung Cancer–Specific Outcomes Using Machine Learning: Population-Based Study %A Zheng,Yue %A Zhao,Ailin %A Yang,Yuqi %A Wang,Laduona %A Hu,Yifei %A Luo,Ren %A Wu,Yijun %+ Division of Thoracic Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Guoxue Lane 37, Chengdu, 610041, China, 86 17888841669, wuyj01029@wchscu.cn %K metachronous second primary lung cancer %K radiotherapy %K surgical resection %K propensity score matching analysis %K machine learning %D 2024 %7 12.6.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Metachronous second primary lung cancer (MSPLC) is not that rare but is seldom studied. Objective: We aim to compare real-world survival outcomes between different surgery strategies and radiotherapy for MSPLC. Methods: This retrospective study analyzed data collected from patients with MSPLC between 1988 and 2012 in the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) analyses and machine learning were performed to compare variables between patients with MSPLC. Survival curves were plotted using the Kaplan-Meier method and were compared using log-rank tests. Results: A total of 2451 MSPLC patients were categorized into the following treatment groups: 864 (35.3%) received radiotherapy, 759 (31%) underwent surgery, 89 (3.6%) had surgery plus radiotherapy, and 739 (30.2%) had neither treatment. After PSM, 470 pairs each for radiotherapy and surgery were generated. The surgery group had significantly better survival than the radiotherapy group (P<.001) and the untreated group (563 pairs; P<.001). Further analysis revealed that both wedge resection (85 pairs; P=.004) and lobectomy (71 pairs; P=.002) outperformed radiotherapy in overall survival for MSPLC patients. Machine learning models (extreme gradient boosting, random forest classifier, adaptive boosting) demonstrated high predictive performance based on area under the curve (AUC) values. Least absolute shrinkage and selection operator (LASSO) regression analysis identified 9 significant variables impacting cancer-specific survival, emphasizing surgery’s consistent influence across 1 year to 10 years. These variables encompassed age at diagnosis, sex, year of diagnosis, radiotherapy of initial primary lung cancer (IPLC), primary site, histology, surgery, chemotherapy, and radiotherapy of MPSLC. Competing risk analysis highlighted lower mortality for female MPSLC patients (hazard ratio [HR]=0.79, 95% CI 0.71-0.87) and recent IPLC diagnoses (HR=0.79, 95% CI 0.73-0.85), while radiotherapy for IPLC increased mortality (HR=1.31, 95% CI 1.16-1.50). Surgery alone had the lowest cancer-specific mortality (HR=0.83, 95% CI 0.81-0.85), with sublevel resection having the lowest mortality rate among the surgical approaches (HR=0.26, 95% CI 0.21-0.31). The findings provide valuable insights into the factors that influence cumulative cancer-specific mortality. Conclusions: Surgical resections such as wedge resection and lobectomy confer better survival than radiation therapy for MSPLC, but radiation can be a valid alternative for the treatment of MSPLC. %M 38865182 %R 10.2196/53354 %U https://cancer.jmir.org/2024/1/e53354 %U https://doi.org/10.2196/53354 %U http://www.ncbi.nlm.nih.gov/pubmed/38865182 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48464 %T Effect of a Structured Multilevel Telehealth Service on Hospital Admissions and Mortality During COVID-19 in a Resource-Limited Region in Brazil: Retrospective Cohort Study %A Oliveira,Clara Rodrigues Alves %A Pires,Magda Carvalho %A Meira,Karina Cardoso %A de Jesus,Jordana Cristina %A Borges,Isabela Nascimento %A Paixão,Maria Cristina %A Mendes,Mayara Santos %A Ribeiro,Leonardo Bonisson %A Marcolino,Milena Soriano %A Alkmim,Maria Beatriz Moreira %A Ribeiro,Antonio Luiz Pinho %+ Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, 110 Avenida Professor Alfredo Balena, Room 107, Ala Sul Santa Efigênia, Belo Horizonte, 30130-100, Brazil, 55 3134099669, claralves@gmail.com %K COVID-19 %K telehealth %K health care %K clinical outcomes %K hospital admission %K mortality %K adoption %K effectiveness %K digital health tool %K flu %K teleconsultation %K digital health %K digital literacy %K telemonitoring %D 2024 %7 10.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic represented a great stimulus for the adoption of telehealth and many initiatives in this field have emerged worldwide. However, despite this massive growth, data addressing the effectiveness of telehealth with respect to clinical outcomes remain scarce.  Objective: The aim of this study was to evaluate the impact of the adoption of a structured multilevel telehealth service on hospital admissions during the acute illness course and the mortality of adult patients with flu syndrome in the context of the COVID-19 pandemic. Methods: A retrospective cohort study was performed in two Brazilian cities where a public COVID-19 telehealth service (TeleCOVID-MG) was deployed. TeleCOVID-MG was a structured multilevel telehealth service, including (1) first response and risk stratification through a chatbot software or phone call center, (2) teleconsultations with nurses and medical doctors, and (3) a telemonitoring system. For this analysis, we included data of adult patients registered in the Flu Syndrome notification databases who were diagnosed with flu syndrome between June 1, 2020, and May 31, 2021. The exposed group comprised patients with flu syndrome who used TeleCOVID-MG at least once during the illness course and the control group comprised patients who did not use this telehealth service during the respiratory illness course. Sociodemographic characteristics, comorbidities, and clinical outcomes data were extracted from the Brazilian official databases for flu syndrome, Severe Acute Respiratory Syndrome (due to any respiratory virus), and mortality. Models for the clinical outcomes were estimated by logistic regression. Results: The final study population comprised 82,182 adult patients with a valid registry in the Flu Syndrome notification system. When compared to patients who did not use the service (n=67,689, 82.4%), patients supported by TeleCOVID-MG (n=14,493, 17.6%) had a lower chance of hospitalization during the acute respiratory illness course, even after adjusting for sociodemographic characteristics and underlying medical conditions (odds ratio [OR] 0.82, 95% CI 0.71-0.94; P=.005). No difference in mortality was observed between groups (OR 0.99, 95% CI 0.86-1.12; P=.83). Conclusions: A telehealth service applied on a large scale in a limited-resource region to tackle COVID-19 was related to reduced hospitalizations without increasing the mortality rate. Quality health care using inexpensive and readily available telehealth and digital health tools may be delivered in areas with limited resources and should be considered as a potential and valuable health care strategy. The success of a telehealth initiative relies on a partnership between the involved stakeholders to define the roles and responsibilities; set an alignment between the different modalities and levels of health care; and address the usual drawbacks related to the implementation process, such as infrastructure and accessibility issues. %M 38857068 %R 10.2196/48464 %U https://www.jmir.org/2024/1/e48464 %U https://doi.org/10.2196/48464 %U http://www.ncbi.nlm.nih.gov/pubmed/38857068 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50376 %T eHealth Literacy and the Use of NHS 111 Online Urgent Care Service in England: Cross-Sectional Survey %A Turnbull,Joanne %A Prichard,Jane %A MacLellan,Jennifer %A Pope,Catherine %+ School of Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, United Kingdom, 44 2380597940, j.c.turnbull@soton.ac.uk %K urgent care %K digital health %K access to health care %K eHealth %K health care system %K COVID-19 %K urgent %K emergency %K health literacy %K eHealth literacy %K digital literacy %K access %K cross-sectional %D 2024 %7 4.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Many health care systems have used digital technologies to support care delivery, a trend amplified by the COVID-19 pandemic. “Digital first” may exacerbate health inequalities due to variations in eHealth literacy. The relationship between eHealth literacy and web-based urgent care service use is unknown. Objective: This study aims to measure the association between eHealth literacy and the use of NHS (National Health Service) 111 online urgent care service. Methods: A cross-sectional sequential convenience sample survey was conducted with 2754 adults (October 2020-July 2021) from primary, urgent, or emergency care; third sector organizations; and the NHS 111 online website. The survey included the eHealth Literacy Questionnaire (eHLQ), questions about use, preferences for using NHS 111 online, and sociodemographic characteristics. Results: Across almost all dimensions of the eHLQ, NHS 111 online users had higher mean digital literacy scores than nonusers (P<.001). Four eHLQ dimensions were significant predictors of use, and the most highly significant dimensions were eHLQ1 (using technology to process health information) and eHLQ3 (ability to actively engage with digital services), with odds ratios (ORs) of 1.86 (95% CI 1.46-2.38) and 1.51 (95% CI 1.22-1.88), respectively. Respondents reporting a long-term health condition had lower eHLQ scores. People younger than 25 years (OR 3.24, 95% CI 1.87-5.62) and those with formal qualifications (OR 0.74, 95% CI 0.55-0.99) were more likely to use NHS 111 online. Users and nonusers were likely to use NHS 111 online for a range of symptoms, including chest pain symptoms (n=1743, 70.4%) or for illness in children (n=1117, 79%). The users of NHS 111 online were more likely to have also used other health services, particularly the 111 telephone service (χ12=138.57; P<.001). Conclusions: These differences in eHealth literacy scores amplify perennial concerns about digital exclusion and access to care for those impacted by intersecting forms of disadvantage, including long-term illness. Although many appear willing to use NHS 111 online for a range of health scenarios, indicating broad acceptability, not all are able or likely to do this. Despite a policy ambition for NHS 111 online to substitute for other services, it appears to be used alongside other urgent care services and thus may not reduce demand. %M 38833297 %R 10.2196/50376 %U https://www.jmir.org/2024/1/e50376 %U https://doi.org/10.2196/50376 %U http://www.ncbi.nlm.nih.gov/pubmed/38833297 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e50622 %T Evidence From the China Family Panel Studies Survey on the Effect of Integrating the Basic Medical Insurance System for Urban and Rural Residents on the Health Equity of Residents: Difference-in-Differences Analysis %A Meng,Yingying %A Yu,Ran %A Bai,Huixin %A Han,Junqiang %+ School of Public Management, South-Central Minzu University, 182 Minzu Avenue, Hongshan District, Wuhan, 430074, China, 86 35 5409 4333, Junqianghan@scuec.edu.cn %K medical insurance system integration %K Urban and Rural Resident Basic Medical Insurance %K URRBMI %K urban and rural residents %K health equity %K China %K difference-in-differences %K DID %K staggered DID %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The fragmentation of the medical insurance system is a major challenge to achieving health equity. In response to this problem, the Chinese government is pushing to establish the unified Urban and Rural Resident Basic Medical Insurance (URRBMI) system by integrating the New Rural Cooperative Medical Scheme and the Urban Resident Basic Medical Insurance. By the end of 2020, URRBMI had been implemented almost entirely across China. Has URRBMI integration promoted health equity for urban and rural residents? Objective: This study aims to examine the effect of URRBMI integration on the health level of residents and whether the integration can contribute to reducing health disparities and promoting health equity. Methods: We used the staggered difference-in-differences method based on the China Family Panel Studies survey from 2014 to 2018. Our study had a nationally representative sample of 27,408 individuals from 98 cities. We chose self-rated health as the measurement of health status. In order to more accurately discern whether the sample was covered by URRBMI, we obtained the exact integration time of URRBMI according to the official documents issued by local governments. Finally, we grouped the sample by urban and rural areas, regions, and household income to examine the impact of the integration on health equity. Results: We found that overall, the URRBMI integration has improved the health level of Chinese residents (B=0.066, 95% CI 0.014-0.123; P=.01). In terms of health equity, the results showed that first, the integration has improved the health level of rural residents (B=0.070, 95% CI 0.012-0.128; P=.02), residents in western China (B=0.159, 95% CI 0.064-0.255; P<.001), and lower-middle-income groups (B=0.113, 95% CI 0.004-0.222, P=.04), so the integration has played a certain role in narrowing the health gap between urban and rural areas, different regions, and different income levels. Through further mechanism analysis, we found that the URRBMI integration reduced health inequity in China by facilitating access to higher-rated hospitals and increasing reimbursement rates for medical expenses. However, the integration did not improve the health of the central region and low-income groups, and the lack of access to health care for low-income groups was not effectively reduced. Conclusions: The role of URRBMI integration in promoting health equity among urban and rural residents was significant (P=.02), but in different regions and income groups, it was limited. Focusing on the rational allocation of medical resources between regions and increasing the policy tilt toward low-income groups could help improve the equity of health insurance integration. %M 38815256 %R 10.2196/50622 %U https://publichealth.jmir.org/2024/1/e50622 %U https://doi.org/10.2196/50622 %U http://www.ncbi.nlm.nih.gov/pubmed/38815256 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46551 %T Influence of Physical Attractiveness and Gender on Patient Preferences in Digital Doctor Consultations: Experimental Study %A Wei,Xia %A Yu,Shubin %A Li,Changxu (Victor) %+ Department of Communication and Culture, BI Norwegian Business School, Nydalsveien 37, Oslo, 0484, Norway, 47 41228055, shubin.yu@bi.no %K digital doctor consultations %K health care providers %K gender stereotype %K physical attractiveness %K qualification information %K experimental %K telemedicine %K digital consultation %K disease severity %K sex %K gender %K gender stereotypes %K digital health %D 2024 %7 30.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The rise of digital health services, particularly digital doctor consultations, has created a new paradigm in health care choice. While patients traditionally rely on digital reviews or referrals to select health care providers, the digital context often lacks such information, leading to reliance on visual cues such as profile pictures. Previous research has explored the impact of physical attractiveness in general service settings but is scant in the context of digital health care. Objective: This study aims to fill the research gap by investigating how a health care provider’s physical attractiveness influences patient preferences in a digital consultation setting. We also examine the moderating effects of disease severity and the availability of information on health care providers’ qualifications. The study uses signal theory and the sexual attribution bias framework to understand these dynamics. Methods: Three experimental studies were conducted to examine the influence of health care providers’ physical attractiveness and gender on patient preferences in digital consultations. Study 1 (n=282) used a 2×2 between-subjects factorial design, manipulating doctor attractiveness and gender. Study 2 (n=158) focused on women doctors and manipulated disease severity and participant gender. Study 3 (n=150) replicated study 2 but added information about the providers’ abilities. Results: This research found that patients tend to choose attractive doctors of the opposite gender but are less likely to choose attractive doctors of the same gender. In addition, our studies revealed that such an effect is more prominent when the disease severity is high. Furthermore, the influence of gender stereotypes is mitigated in both the high and low disease severity conditions when service providers’ qualification information is present. Conclusions: This research contributes to the literature on medical information systems research and sheds light on what information should be displayed on digital doctor consultation platforms. To counteract stereotype-based attractiveness biases, health care platforms should consider providing comprehensive qualification information alongside profile pictures. %M 38814690 %R 10.2196/46551 %U https://www.jmir.org/2024/1/e46551 %U https://doi.org/10.2196/46551 %U http://www.ncbi.nlm.nih.gov/pubmed/38814690 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52921 %T Successful Electronic Consultation Service Initiative in Quebec, Canada With Primary Care Physicians’ and Specialists’ Experiences on Acceptance and Use of Technological Innovation: Cross-Sectional Exploratory Study %A Nabelsi,Véronique %A Lévesque-Chouinard,Annabelle %+ Department of Administrative Sciences, Université du Québec en Outaouais, C.P. 1240, Succ. Hull, Gatineau, QC, J8X 3X7, Canada, 1 819 595 3900 ext 1915, veronique.nabelsi@uqo.ca %K eConsult %K electronic consultation %K digital health solutions %K primary care providers %K specialists %K United Theory of Acceptance and Use of Technology %K UTAUT %K Task-Technology Fit %K TTF %K technology acceptance %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic consultation (eConsult) is an eHealth service that allows primary care providers (PCPs) to electronically consult specialists regarding their patients’ medical issues. Many studies have demonstrated that eConsult services improve timely access to specialist care; prevent unnecessary referrals; improve PCPs’, specialists’, and patients’ satisfaction; and therefore have a large impact on costs. However, no studies have evaluated PCPs’ and specialists’ acceptance of eConsult services in Quebec, Canada, and worldwide. Objective: This exploratory study aims to identify factors affecting eConsult service acceptance by PCPs and specialists in urban and rural primary care clinics across 3 regions in the province of Quebec, Canada, by integrating the Unified Theory of Acceptance and Use of Technology and Task-Technology Fit (TTF) models and user satisfaction. This research was designed to broaden and assist in scaling up this effective eHealth service innovation across the province. Methods: A cross-sectional web-based survey was sent to all PCPs (n=263) and specialists (n=62) who used the eConsult Quebec Service between July 2017 and May 2021. We proposed a unified model integrating the Unified Theory of Acceptance and Use of Technology model and TTF model and user satisfaction by endorsing 11 hypotheses. The partial least squares was used to investigate factors influencing the acceptance of the eConsult Quebec Service. Results: Of the 325 end users, 136 (41.8%) users responded (PCPs: 101/263, 38.4%; specialists: 35/62, 57%). The results of the analysis with partial least squares method indicate that 9 of our 11 hypotheses are supported. The direct relationships uniting the various constructs of the model highlighted the importance of several key constructs and predominant correlations. The results suggest that satisfaction is the key driver behind the use of the eConsult Quebec Service. Performance expectancy (P<.001) and effort expectancy (P=.03) can have a positive impact on behavioral intention (BI), and BI (P<.001) can impact adoption. TTF has an influence on performance expectancy (P<.001), adoption (P=.02), and satisfaction (P<.001). However, the results show that there is no direct effect between social influence (P=.38) and BI or between facilitating conditions (P=.17) and adoption. Conclusions: This study provides a better understanding of the factors influencing PCPs’ and specialists’ intention to adopt the eConsult Quebec Service. Furthermore, this study tests a research model and a technology that have never been explored in Quebec until now. On the basis of the results, the service is a good fit to meet the users’ need to improve access to specialized medical advice. Therefore, the results of our study have made a valuable contribution to the implementation of the service by policy makers in order to maximize acceptance, use, adoption, and success across the province of Quebec. Moreover, after 4 successful years, the eConsult Quebec pilot project is now the Conseil Numérique digital consultation service. %M 38814689 %R 10.2196/52921 %U https://formative.jmir.org/2024/1/e52921 %U https://doi.org/10.2196/52921 %U http://www.ncbi.nlm.nih.gov/pubmed/38814689 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50857 %T Where Do I Go When My Doctor’s Office Is Closed? The Availability of Out-of-Hours Care Information on Primary Care Practitioners’ Websites %A Legg,David %A Napierala,Hendrik %A Holzinger,Felix %A Slagman,Anna %+ Health Services Research in Emergency and Acute Medicine, Charité - Universitätsmedizin, Charitéplatz 1, Berlin, 10117, Germany, 49 30 450 553 037, david.legg@charite.de %K out of hours %K primary care %K telephone triage %K websites %K care information %D 2024 %7 29.5.2024 %9 Research Letter %J JMIR Form Res %G English %X %M 38809600 %R 10.2196/50857 %U https://formative.jmir.org/2024/1/e50857 %U https://doi.org/10.2196/50857 %U http://www.ncbi.nlm.nih.gov/pubmed/38809600 %0 Journal Article %@ 2369-3762 %I %V 10 %N %P e53810 %T Time for Medicine and Public Health to Leave Platform X %A Timpka,Toomas %K internet %K social media %K medical informatics %K knowledge translation %K digital technology %K clinical decision support %K health services research %K public health %K digital health %K perspective %K medicine %D 2024 %7 24.5.2024 %9 %J JMIR Med Educ %G English %X For more than 50 years, digital technologies have been employed for the creation and distribution of knowledge in health services. In the last decade, digital social media have been developed for applications in clinical decision support and population health monitoring. Recently, these technologies have also been used for knowledge translation, such as in the process where research findings created in academic settings are established as evidence and distributed for use in clinical practice, policy making, and health self-management. To date, it has been common for medical and public health institutions to have social media accounts for the dissemination of novel research findings and to facilitate conversations about these findings. However, recent events such as the transformation of the microblog Twitter to platform X have brought to light the need for the social media industry to exploit user data to generate revenue. In this viewpoint, it is argued that a redirection of social media use is required in the translation of knowledge to action in the fields of medicine and public health. A new kind of social internet is currently forming, known as the “fediverse,” which denotes an ensemble of open social media that can communicate with each other while remaining independent platforms. In several countries, government institutions, universities, and newspapers use open social media to distribute information and enable discussions. These organizations control their own channels while being able to communicate with other platforms through open standards. Examples of medical knowledge translation via such open social media platforms, where users are less exposed to disinformation than in general platforms, are also beginning to appear. The current status of the social media industry calls for a broad discussion about the use of social technologies by health institutions involving researchers and health service practitioners, academic leaders, scientific publishers, social technology providers, policy makers, and the public. This debate should not primarily take place on social media platforms but rather at universities, in scientific journals, at public seminars, and other venues, allowing for the transparent and undisturbed communication and formation of opinions. %R 10.2196/53810 %U https://mededu.jmir.org/2024/1/e53810 %U https://doi.org/10.2196/53810 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50205 %T Findings From a National Survey of Older US Adults on Patient Willingness to Use Telehealth Services: Cross-Sectional Survey %A Odebunmi,Olufeyisayo O %A Hughes,Tamera D %A Waters,Austin R %A Urick,Benjamin Y %A Herron,Caroline %A Wangen,Mary %A Rohweder,Catherine %A Ferrari,Renée M %A Marciniak,Macary W %A Wheeler,Stephanie B %A Brenner,Alison T %A Shah,Parth D %+ Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Avenue, PO Box 19024, Seattle, WA, 98109, United States, 1 2066676120, pshah@fredhutch.org %K community pharmacy %K telehealth %K telemedicine %K telepharmacy %K pharmacy service quality %K patient willingness %K willingness %K cross-sectional %K national survey %K telehealth cost %D 2024 %7 23.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Telehealth (telemedicine and telepharmacy) services increase access to patient services and ensure continuity of care. However, few studies have assessed factors that influence patients’ willingness to use telehealth services, and we sought to investigate this. Objective: This study aims to examine respondents’ (aged between 45 and 75 years) willingness to use telehealth services (telepharmacy and telemedicine) and the correlates of the willingness to use telehealth services. Methods: We administered a cross-sectional national survey of 1045 noninstitutionalized US adults aged between 45 and 75 years in March and April 2021. Multiple logistic regression analyses were used to identify demographic and health service use correlates of self-reported willingness to use telehealth services. Results: Overall willingness to use telemedicine was high (674/1045, 64.5%). Adults aged 55 years and older were less willing to use telemedicine (aged between 55 and 64 years: odds ratio [OR] 0.61, 95% CI 0.42-0.86; aged 65 years or older: OR 0.33, 95% CI 0.22-0.49) than those younger than 55 years. Those with a regular provider (OR 1.01, 95% CI 1-1.02) and long travel times (OR 1.75, 95% CI 1.03-2.98) were more willing to use telemedicine compared to those without a regular provider and had shorter travel times, respectively. Willingness to use telemedicine services increased from 64.5% (674/1045) to 83% (867/1045) if the service was low-cost or insurance-covered, was with their existing health care provider, or was easy-to-use. Overall willingness to use telepharmacy was 76.7% (801/1045). Adults aged older than 55 years were less willing to use telepharmacy (aged between 55 and 64 years: OR 0.57, 95% CI 0.38-0.86; aged 65 years or older: OR 0.24, 95% CI 0.15-0.37) than those younger than 55 years. Those who rated pharmacy service quality higher were more willing to use telepharmacy (OR 1.06, 95% CI 1.03-1.09) than those who did not. Conclusions: Respondents were generally willing to use telehealth (telemedicine and telepharmacy) services, but the likelihood of their being willing to use telehealth decreased as they were older. For those initially unwilling (aged 55 years or older) to use telemedicine services, inexpensive or insurance-covered services were acceptable. %M 38780994 %R 10.2196/50205 %U https://www.jmir.org/2024/1/e50205 %U https://doi.org/10.2196/50205 %U http://www.ncbi.nlm.nih.gov/pubmed/38780994 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e53894 %T Data-Driven Exploration of National Health Service Talking Therapies Care Pathways Using Process Mining: Retrospective Cohort Study %A Yardley,Elizabeth %A Davis,Alice %A Eldridge,Chris %A Vasilakis,Christos %+ School of Management, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom, 44 01249 701100, egmy20@bath.ac.uk %K electronic health record %K EHR %K electronic health records %K EHRs %K health record %K data science %K secondary data analysis %K mental health services %K mental health %K health information system %K HIS %K information system %K information systems %K process mining %K flow %K flows %K path %K pathway %K pathways %K delivery %K visualization %D 2024 %7 21.5.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: The National Health Service (NHS) Talking Therapies program treats people with common mental health problems in England according to “stepped care,” in which lower-intensity interventions are offered in the first instance, where clinically appropriate. Limited resources and pressure to achieve service standards mean that program providers are exploring all opportunities to evaluate and improve the flow of patients through their service. Existing research has found variation in clinical performance and stepped care implementation across sites and has identified associations between service delivery and patient outcomes. Process mining offers a data-driven approach to analyzing and evaluating health care processes and systems, enabling comparison of presumed models of service delivery and their actual implementation in practice. The value and utility of applying process mining to NHS Talking Therapies data for the analysis of care pathways have not been studied. Objective: A better understanding of systems of service delivery will support improvements and planned program expansion. Therefore, this study aims to demonstrate the value and utility of applying process mining to NHS Talking Therapies care pathways using electronic health records. Methods: Routine collection of a wide variety of data regarding activity and patient outcomes underpins the Talking Therapies program. In our study, anonymized individual patient referral records from two sites over a 2-year period were analyzed using process mining to visualize the care pathway process by mapping the care pathway and identifying common pathway routes. Results: Process mining enabled the identification and visualization of patient flows directly from routinely collected data. These visualizations illustrated waiting periods and identified potential bottlenecks, such as the wait for higher-intensity cognitive behavioral therapy (CBT) at site 1. Furthermore, we observed that patients discharged from treatment waiting lists appeared to experience longer wait durations than those who started treatment. Process mining allowed analysis of treatment pathways, showing that patients commonly experienced treatment routes that involved either low- or high-intensity interventions alone. Of the most common routes, >5 times as many patients experienced direct access to high-intensity treatment rather than stepped care. Overall, 3.32% (site 1: 1507/45,401) and 4.19% (site 2: 527/12,590) of all patients experienced stepped care. Conclusions: Our findings demonstrate how process mining can be applied to Talking Therapies care pathways to evaluate pathway performance, explore relationships among performance issues, and highlight systemic issues, such as stepped care being relatively uncommon within a stepped care system. Integration of process mining capability into routine monitoring will enable NHS Talking Therapies service stakeholders to explore such issues from a process perspective. These insights will provide value to services by identifying areas for service improvement, providing evidence for capacity planning decisions, and facilitating better quality analysis into how health systems can affect patient outcomes. %M 38771630 %R 10.2196/53894 %U https://mental.jmir.org/2024/1/e53894 %U https://doi.org/10.2196/53894 %U http://www.ncbi.nlm.nih.gov/pubmed/38771630 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53327 %T Person-Generated Health Data in Women’s Health: Scoping Review %A Karim,Jalisa Lynn %A Wan,Rachel %A Tabet,Rhea S %A Chiu,Derek S %A Talhouk,Aline %+ Department of Obstetrics and Gynaecology, University of British Columbia, 593 - 828 West 10th Ave, Vancouver, BC, V5Z 1M9, Canada, 1 604 875 3111, a.talhouk@ubc.ca %K digital health %K women’s health %K mobile health %K health app %K wearables %K femtech %K self-tracking %K personalized health %K person-generated health data %K patient-generated health data %K scoping review %K mobile phone %D 2024 %7 16.5.2024 %9 Review %J J Med Internet Res %G English %X Background: The increased pervasiveness of digital health technology is producing large amounts of person-generated health data (PGHD). These data can empower people to monitor their health to promote prevention and management of disease. Women make up one of the largest groups of consumers of digital self-tracking technology. Objective: In this scoping review, we aimed to (1) identify the different areas of women’s health monitored using PGHD from connected health devices, (2) explore personal metrics collected through these technologies, and (3) synthesize facilitators of and barriers to women’s adoption and use of connected health devices. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews, we searched 5 databases for articles published between January 1, 2015, and February 29, 2020. Papers were included if they targeted women or female individuals and incorporated digital health tools that collected PGHD outside a clinical setting. Results: We included a total of 406 papers in this review. Articles on the use of PGHD for women steadily increased from 2015 to 2020. The health areas that the articles focused on spanned several topics, with pregnancy and the postpartum period being the most prevalent followed by cancer. Types of digital health used to collect PGHD included mobile apps, wearables, websites, the Internet of Things or smart devices, 2-way messaging, interactive voice response, and implantable devices. A thematic analysis of 41.4% (168/406) of the papers revealed 6 themes regarding facilitators of and barriers to women’s use of digital health technology for collecting PGHD: (1) accessibility and connectivity, (2) design and functionality, (3) accuracy and credibility, (4) audience and adoption, (5) impact on community and health service, and (6) impact on health and behavior. Conclusions: Leading up to the COVID-19 pandemic, the adoption of digital health tools to address women’s health concerns was on a steady rise. The prominence of tools related to pregnancy and the postpartum period reflects the strong focus on reproductive health in women’s health research and highlights opportunities for digital technology development in other women’s health topics. Digital health technology was most acceptable when it was relevant to the target audience, was seen as user-friendly, and considered women’s personalization preferences while also ensuring accuracy of measurements and credibility of information. The integration of digital technologies into clinical care will continue to evolve, and factors such as liability and health care provider workload need to be considered. While acknowledging the diversity of individual needs, the use of PGHD can positively impact the self-care management of numerous women’s health journeys. The COVID-19 pandemic has ushered in increased adoption and acceptance of digital health technology. This study could serve as a baseline comparison for how this field has evolved as a result. International Registered Report Identifier (IRRID): RR2-10.2196/26110 %M 38754098 %R 10.2196/53327 %U https://www.jmir.org/2024/1/e53327 %U https://doi.org/10.2196/53327 %U http://www.ncbi.nlm.nih.gov/pubmed/38754098 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51728 %T Quality Improvement Intervention Using Social Prescribing at Discharge in a University Hospital in France: Quasi-Experimental Study %A Cailhol,Johann %A Bihan,Hélène %A Bourovali-Zade,Chloé %A Boloko,Annie %A Duclos,Catherine %+ Laboratoire Educations et Promotion de la Santé, University Sorbonne Paris Nord, 74 rue marcel cachin, Bobigny, 93007, France, 33 148955426, johann.cailhol@aphp.fr %K social prescription %K discharge coordination %K language barriers %K readmission rates %K ethnic matching %K trust %K personalized care %K discharge %K social determinant %K social need %K tool %K quality of care %K readmission %K quality improvement %D 2024 %7 13.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Social prescription is seen as a public health intervention tool with the potential to mitigate social determinants of health. On one side, social prescription is not yet well developed in France, where social workers usually attend to social needs, and historically, there is a deep divide between the health and social sectors. On the other side, discharge coordination is gaining attention in France as a critical tool to improve the quality of care, assessed indirectly using unplanned rehospitalization rates. Objective: This study aims to combine social prescription and discharge coordination to assess the need for social prescription and its effect on unplanned rehospitalization rates. Methods: We conducted a quasi-experimental study in two departments of medicine in a French university hospital in a disadvantaged suburb of Paris over 2 years (October 2019-October 2021). A discharge coordinator screened patients for social prescribing needs and provided services on the spot or referred the patient to the appropriate service when needed. The primary outcome was the description of the services delivered by the discharge coordinator and of its process, as well as the characteristics of the patients in terms of social needs. The secondary outcome was the comparison of unplanned rehospitalization rates after data chaining. Results: A total of 223 patients were included in the intervention arm, with recruitment being disrupted by the COVID-19 pandemic. More than two-thirds of patients (n=154, 69.1%) needed help understanding discharge information. Slightly less than half of the patients (n=98, 43.9%) seen by the discharge coordinator needed social prescribing, encompassing language, housing, health literacy, and financial issues. The social prescribing covered a large range of services, categorized into finding a general practitioner or private sector nurse, including language-matching; referral to a social worker; referral to nongovernmental organization or group activities; support for transportation issues; support for health-related administrative procedures; and support for additional appointments with nonmedical clinicians. All supports were delivered in a highly personalized way. Ethnic data collection was not legally permitted, but for 81% (n=182) of the patients, French was not the mother tongue. After data chaining, rehospitalization rates were compared between 203 patients who received the intervention (n=5, 3.1%) versus 2095 patients who did not (n=51, 2.6%), and there was no statistical difference. Conclusions: First, our study revealed the breadth of patient’s unmet social needs in our university hospital, which caters to an area where the immigrant population is high. The study also revealed the complexity of the discharge coordinator’s work, who provided highly personalized support and managed to gain trust. Hospital discharge could be used in France as an opportunity in disadvantaged settings. Eventually, indicators other than the rehospitalization rate should be devised to evaluate the effect of social prescribing and discharge coordination. %M 38739912 %R 10.2196/51728 %U https://formative.jmir.org/2024/1/e51728 %U https://doi.org/10.2196/51728 %U http://www.ncbi.nlm.nih.gov/pubmed/38739912 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e46029 %T Ambulance Services Attendance for Mental Health and Overdose Before and During COVID-19 in Canada and the United Kingdom: Interrupted Time Series Study %A Law,Graham %A Cooper,Rhiannon %A Pirrie,Melissa %A Ferron,Richard %A McLeod,Brent %A Spaight,Robert %A Siriwardena,A Niroshan %A Agarwal,Gina %A , %+ Department of Family Medicine, McMaster University, 100 Main Street West, Hamilton, ON, , Canada, 1 905 525 9140, gina.agarwal@gmail.com %K COVID-19 %K mental health %K overdose %K emergency medical services %K administrative data %K Canada %K the United Kingdom %K ambulance %K sex %K age %K lockdown %K pandemic planning %K emergency service %D 2024 %7 10.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic impacted mental health and health care systems worldwide. Objective: This study examined the COVID-19 pandemic’s impact on ambulance attendances for mental health and overdose, comparing similar regions in the United Kingdom and Canada that implemented different public health measures. Methods: An interrupted time series study of ambulance attendances was conducted for mental health and overdose in the United Kingdom (East Midlands region) and Canada (Hamilton and Niagara regions). Data were obtained from 182,497 ambulance attendance records for the study period of December 29, 2019, to August 1, 2020. Negative binomial regressions modeled the count of attendances per week per 100,000 population in the weeks leading up to the lockdown, the week the lockdown was initiated, and the weeks following the lockdown. Stratified analyses were conducted by sex and age. Results: Ambulance attendances for mental health and overdose had very small week-over-week increases prior to lockdown (United Kingdom: incidence rate ratio [IRR] 1.002, 95% CI 1.002-1.003 for mental health). However, substantial changes were observed at the time of lockdown; while there was a statistically significant drop in the rate of overdose attendances in the study regions of both countries (United Kingdom: IRR 0.573, 95% CI 0.518-0.635 and Canada: IRR 0.743, 95% CI 0.602-0.917), the rate of mental health attendances increased in the UK region only (United Kingdom: IRR 1.125, 95% CI 1.031-1.227 and Canada: IRR 0.922, 95% CI 0.794-1.071). Different trends were observed based on sex and age categories within and between study regions. Conclusions: The observed changes in ambulance attendances for mental health and overdose at the time of lockdown differed between the UK and Canada study regions. These results may inform future pandemic planning and further research on the public health measures that may explain observed regional differences. %M 38728683 %R 10.2196/46029 %U https://publichealth.jmir.org/2024/1/e46029 %U https://doi.org/10.2196/46029 %U http://www.ncbi.nlm.nih.gov/pubmed/38728683 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52124 %T Prevalence and Disparities in Telehealth Use Among US Adults Following the COVID-19 Pandemic: National Cross-Sectional Survey %A Spaulding,Erin M %A Fang,Michael %A Commodore-Mensah,Yvonne %A Himmelfarb,Cheryl R %A Martin,Seth S %A Coresh,Josef %+ Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21205, United States, 1 4109554766, espauld2@jhu.edu %K telehealth %K telemedicine %K delivery of health care %K health care disparities %K COVID-19 %D 2024 %7 10.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Telemedicine expanded during the COVID-19 pandemic, though use differed by age, sex, race or ethnicity, educational attainment, income, and location. It is unclear if high telehealth use or inequities persisted late into the pandemic. Objective: This study aims to evaluate the prevalence of, inequities in, and primary reasons for telehealth visits a year after telemedicine expansion. Methods: We used cross-sectional data from the 2022 Health Information National Trends Survey (HINTS 6), the first cycle with data on telemedicine. In total, 4830 English- and Spanish-speaking US adults (aged ≥18 years) were included in this study. The primary outcomes were telehealth visit attendance in the 12 months before March 7, 2022, to November 8, 2022, and the primary reason for the most recent telehealth visit. We evaluated sociodemographic and clinical predictors of telehealth visit attendance and the primary reason for the most recent telehealth visit through Poisson regression. Analyses were weighted according to HINTS 6 standards. Results: We included 4830 participants (mean age 48.3, SD 17.5 years; 50.28% women; 65.21% White). Among US adults, 38.78% reported having a telehealth visit in the previous year. Telehealth visit attendance rates were similar across age, race or ethnicity, income, and urban versus rural location. However, individuals with a telehealth visit were less likely to live in the Midwest (adjusted prevalence ratio [aPR] 0.65, 95% CI 0.54-0.77), and more likely to be women (aPR 1.21, 95% CI 1.06-1.38), college graduates or postgraduates (aPR 1.24, 95% CI 1.05-1.46), covered by health insurance (aPR 1.56, 95% CI 1.08-2.26), and married or cohabitating (aPR 1.17, 95% CI 1.03-1.32), adjusting for sociodemographic characteristics, frequency of health care visits, and comorbidities. Among participants with a telehealth visit in the past year, the primary reasons for their most recent visit were minor or acute illness (32.15%), chronic disease management (21%), mental health or substance abuse (16.94%), and an annual exam (16.22%). Older adults were more likely to report that the primary reason for their most recent telehealth visit was for chronic disease management (aPR 2.08, 95% CI 1.33-3.23), but less likely to report that it was for a mental health or substance abuse issue (aPR 0.19, 95% CI 0.10-0.35), adjusting for sociodemographic characteristics and frequency of health care visits. Conclusions: Among US adults, telehealth visit attendance was high more than a year after telemedicine expansion and did not differ by age, race or ethnicity, income, or urban versus rural location. Telehealth could continue to be leveraged following COVID-19 to improve access to care and health equity. %M 38728070 %R 10.2196/52124 %U https://www.jmir.org/2024/1/e52124 %U https://doi.org/10.2196/52124 %U http://www.ncbi.nlm.nih.gov/pubmed/38728070 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e49769 %T Barriers to and Facilitators of Key Stakeholders Influencing Successful Digital Implementation of Remote Monitoring Solutions: Mixed Methods Analysis %A Iqbal,Fahad Mujtaba %A Aggarwal,Ravi %A Joshi,Meera %A King,Dominic %A Martin,Guy %A Khan,Sadia %A Wright,Mike %A Ashrafian,Hutan %A Darzi,Ara %+ Division of Surgery, Imperial College London, 10th Floor QEQM Building, Praed Street, London, W2 1NY, United Kingdom, 44 020 3312 6666, fahad.iqbal@doctors.org.uk %K implementation science %K health plan implementation %K mobile health %K health care industry %K stakeholder %K COVID-19 %K remote monitoring %K digital tools %K digital health %K pandemic %K virtual wards %K virtual ward %K health care delivery %K telemedicine %K telehealth %K wearables %K wearable %K technology %K United Kingdom %K UK %K digital services %D 2024 %7 6.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Implementation of remote monitoring solutions and digital alerting tools in health care has historically been challenging, despite the impetus provided by the COVID-19 pandemic. To date, a health systems–based approach to systematically describe barriers and facilitators across multiple domains has not been undertaken. Objective: We aimed to undertake a comprehensive mixed methods analysis of barriers and facilitators for successful implementation of remote monitoring and digital alerting tools in complex health organizations. Methods: A mixed methods approach using a modified Technology Acceptance Model questionnaire and semistructured interviews mapped to the validated fit among humans, organizations, and technology (HOT-fit) framework was undertaken. Likert frequency responses and deductive thematic analyses were performed. Results: A total of 11 participants responded to the questionnaire and 18 participants to the interviews. Key barriers and facilitators could be mapped onto 6 dimensions, which incorporated aspects of digitization: system use (human), user satisfaction (human), environment (organization), structure (organization), information and service quality (technology), and system quality (technology). Conclusions: The recommendations proposed can enhance the potential for future remote sensing solutions to be more successfully integrated in health care practice, resulting in more successful use of “virtual wards.” Trial Registration: ClinicalTrials.gov NCT05321004; https://www.clinicaltrials.gov/study/NCT05321004 %M 37338929 %R 10.2196/49769 %U https://humanfactors.jmir.org/2024/1/e49769 %U https://doi.org/10.2196/49769 %U http://www.ncbi.nlm.nih.gov/pubmed/37338929 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 16 %N %P e49262 %T Investigating Patient Satisfaction Through Web-Based Reviews of Norwegian Dentists: Quantitative Study Using the Meaning Extraction Method %A Larsen,Maria %A Holde,Gro Eirin %A Johnsen,Jan-Are Kolset %+ Department of Clinical Dentistry, Faculty of Health Sciences, UiT The Arctic University of Norway, Hansine Hansens veg 86, Tromsø, 9019, Norway, 47 77 64 67 51, jan.a.johnsen@uit.no %K internet use %K Linguistic Inquiry and Word Count %K LIWC %K patient satisfaction %K patient preference %K challenging encounters %K preventive dentistry %K population surveillance %D 2024 %7 3.5.2024 %9 Original Paper %J J Particip Med %G English %X Background: Challenging encounters in health care professions, including in dentistry, are relatively common. Challenging encounters can be defined as stressful or emotional situations involving patients that could impact both treatment outcomes and patients’ experiences. Through written web-based reviews, patients can share their experiences with health care providers, and these posts can be a useful source for investigating patient satisfaction and their experiences of challenging encounters. Objective: This study aims to identify dominant themes from patient-written, web-based reviews of dentists and investigate how these themes are related to patient satisfaction with dental treatment. Methods: The study data consisted of 11,764 reviews written by dental patients, which included 1- to 5-star ratings on overall satisfaction and free-text comments. The free-text comments were analyzed using Linguistic Inquiry and Word Count software, and the meaning extraction method was used to group words into thematic categories. These themes were used as variables in a multilevel logistic regression analysis to predict patient satisfaction. Results: Eight themes emerged from the analyses, of which 6 (75%)—explanation (odds ratio [OR] 2.56, 95% CI 2.16-3.04; P<.001), assurance (OR 3.61, 95% CI 2.57-5.06; P<.001), performance assessment (OR 2.17, 95% CI 1.84-2.55; P<.001), professional advice (OR 1.81, 95% CI 1.55-2.13; P<.001), facilities (OR 1.78, 95% CI 1.08-2.91; P=.02), and recommendation (OR 1.31, 95% CI 1.12-1.53; P<.001)—increased the odds of high patient satisfaction. The remaining themes (2/8, 25%)—consequences of treatment need (OR 0.24, 95% CI 0.20-0.29; P<.001) and patient-centered care (OR 0.62, 95% CI 0.52-0.74; P<.001)—reduced the odds of high patient satisfaction. Conclusions: The meaning extraction method is an interesting approach to explore patients’ written accounts of encounters with dental health professionals. The experiences described by patients provide insight into key elements related to patient satisfaction that can be used in the education of dental health professionals and to improve the provision of dental health services. %M 38700933 %R 10.2196/49262 %U https://jopm.jmir.org/2024/1/e49262 %U https://doi.org/10.2196/49262 %U http://www.ncbi.nlm.nih.gov/pubmed/38700933 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e53311 %T Using Routine Data to Improve Lesbian, Gay, Bisexual, and Transgender Health %A Saunders,Catherine L %+ Department of Psychiatry, University of Cambridge, Herchel Smith Building, Forvie Site, Robinson Way, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, United Kingdom, 44 1223337106, cs834@medschl.cam.ac.uk %K lesbian %K gay %K bisexual %K trans %K LGBTQ+ %K routine data %K England %K United Kingdom %K health %K viewpoint %K sexual orientation %K health services %K infrastructure data %K policy %K gender %K health outcome %K epidemiology %K risk prediction %K risk %D 2024 %7 1.5.2024 %9 Viewpoint %J Interact J Med Res %G English %X The collection of sexual orientation in routine data, generated either from contacts with health services or in infrastructure data resources designed and collected for policy and research, has improved substantially in the United Kingdom in the last decade. Inclusive measures of gender and transgender status are now also beginning to be collected. This viewpoint considers current data collections, and their strengths and limitations, including accessing data, sample size, measures of sexual orientation and gender, measures of health outcomes, and longitudinal follow-up. The available data are considered within both sociopolitical and biomedical models of health for individuals who are lesbian, gay, bisexual, transgender, queer, or of other identities including nonbinary (LGBTQ+). Although most individual data sets have some methodological limitations, when put together, there is now a real depth of routine data for LGBTQ+ health research. This paper aims to provide a framework for how these data can be used to improve health and health care outcomes. Four practical analysis approaches are introduced—descriptive epidemiology, risk prediction, intervention development, and impact evaluation—and are discussed as frameworks for translating data into research with the potential to improve health. %M 38691398 %R 10.2196/53311 %U https://www.i-jmr.org/2024/1/e53311 %U https://doi.org/10.2196/53311 %U http://www.ncbi.nlm.nih.gov/pubmed/38691398 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54706 %T Physician Versus Large Language Model Chatbot Responses to Web-Based Questions From Autistic Patients in Chinese: Cross-Sectional Comparative Analysis %A He,Wenjie %A Zhang,Wenyan %A Jin,Ya %A Zhou,Qiang %A Zhang,Huadan %A Xia,Qing %+ Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, Tuanpo New Town West, Jinghai District, Tianjin, 301617, China, 86 13820689541, xiaqingcho@163.com %K artificial intelligence %K chatbot %K ChatGPT %K ERNIE Bot %K autism %D 2024 %7 30.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: There is a dearth of feasibility assessments regarding using large language models (LLMs) for responding to inquiries from autistic patients within a Chinese-language context. Despite Chinese being one of the most widely spoken languages globally, the predominant research focus on applying these models in the medical field has been on English-speaking populations. Objective: This study aims to assess the effectiveness of LLM chatbots, specifically ChatGPT-4 (OpenAI) and ERNIE Bot (version 2.2.3; Baidu, Inc), one of the most advanced LLMs in China, in addressing inquiries from autistic individuals in a Chinese setting. Methods: For this study, we gathered data from DXY—a widely acknowledged, web-based, medical consultation platform in China with a user base of over 100 million individuals. A total of 100 patient consultation samples were rigorously selected from January 2018 to August 2023, amounting to 239 questions extracted from publicly available autism-related documents on the platform. To maintain objectivity, both the original questions and responses were anonymized and randomized. An evaluation team of 3 chief physicians assessed the responses across 4 dimensions: relevance, accuracy, usefulness, and empathy. The team completed 717 evaluations. The team initially identified the best response and then used a Likert scale with 5 response categories to gauge the responses, each representing a distinct level of quality. Finally, we compared the responses collected from different sources. Results: Among the 717 evaluations conducted, 46.86% (95% CI 43.21%-50.51%) of assessors displayed varying preferences for responses from physicians, with 34.87% (95% CI 31.38%-38.36%) of assessors favoring ChatGPT and 18.27% (95% CI 15.44%-21.10%) of assessors favoring ERNIE Bot. The average relevance scores for physicians, ChatGPT, and ERNIE Bot were 3.75 (95% CI 3.69-3.82), 3.69 (95% CI 3.63-3.74), and 3.41 (95% CI 3.35-3.46), respectively. Physicians (3.66, 95% CI 3.60-3.73) and ChatGPT (3.73, 95% CI 3.69-3.77) demonstrated higher accuracy ratings compared to ERNIE Bot (3.52, 95% CI 3.47-3.57). In terms of usefulness scores, physicians (3.54, 95% CI 3.47-3.62) received higher ratings than ChatGPT (3.40, 95% CI 3.34-3.47) and ERNIE Bot (3.05, 95% CI 2.99-3.12). Finally, concerning the empathy dimension, ChatGPT (3.64, 95% CI 3.57-3.71) outperformed physicians (3.13, 95% CI 3.04-3.21) and ERNIE Bot (3.11, 95% CI 3.04-3.18). Conclusions: In this cross-sectional study, physicians’ responses exhibited superiority in the present Chinese-language context. Nonetheless, LLMs can provide valuable medical guidance to autistic patients and may even surpass physicians in demonstrating empathy. However, it is crucial to acknowledge that further optimization and research are imperative prerequisites before the effective integration of LLMs in clinical settings across diverse linguistic environments can be realized. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300074655; https://www.chictr.org.cn/bin/project/edit?pid=199432 %M 38687566 %R 10.2196/54706 %U https://www.jmir.org/2024/1/e54706 %U https://doi.org/10.2196/54706 %U http://www.ncbi.nlm.nih.gov/pubmed/38687566 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e51279 %T Telehealth Utilization and Associations in the United States During the Third Year of the COVID-19 Pandemic: Population-Based Survey Study in 2022 %A Kim,Jiyeong %A Cai,Zhuo Ran %A Chen,Michael L %A Onyeka,Sonia %A Ko,Justin M %A Linos,Eleni %+ Stanford Center for Digital Health, School of Medicine, Stanford University, 3180 Porter Dr, Stanford, CA, 94305, United States, 1 6507245017, jykim3@stanford.edu %K telehealth %K telemedicine %K digital health %K e-health %K e-medicine %K utilization %K population-based study %K clinical practice %K healthcare delivery %K sociodemographic factor %K COVID-19 %K pandemic %D 2024 %7 26.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic rapidly changed the landscape of clinical practice in the United States; telehealth became an essential mode of health care delivery, yet many components of telehealth use remain unknown years after the disease’s emergence. Objective: We aim to comprehensively assess telehealth use and its associated factors in the United States. Methods: This cross-sectional study used a nationally representative survey (Health Information National Trends Survey) administered to US adults (≥18 years) from March 2022 through November 2022. To assess telehealth adoption, perceptions of telehealth, satisfaction with telehealth, and the telehealth care purpose, we conducted weighted descriptive analyses. To identify the subpopulations with low adoption of telehealth, we developed a weighted multivariable logistic regression model. Results: Among a total of 6252 survey participants, 39.3% (2517/6252) reported telehealth use in the past 12 months (video: 1110/6252, 17.8%; audio: 876/6252, 11.6%). The most prominent reason for not using telehealth was due to telehealth providers failing to offer this option (2200/3529, 63%). The most common reason for respondents not using offered telehealth services was a preference for in-person care (527/578, 84.4%). Primary motivations to use telehealth were providers’ recommendations (1716/2517, 72.7%) and convenience (1516/2517, 65.6%), mainly for acute minor illness (600/2397, 29.7%) and chronic condition management (583/2397, 21.4%), yet care purposes differed by age, race/ethnicity, and income. The satisfaction rate was predominately high, with no technical problems (1829/2517, 80.5%), comparable care quality to that of in-person care (1779/2517, 75%), and no privacy concerns (1958/2517, 83.7%). Younger individuals (odd ratios [ORs] 1.48-2.23; 18-64 years vs ≥75 years), women (OR 1.33, 95% CI 1.09-1.61), Hispanic individuals (OR 1.37, 95% CI 1.05-1.80; vs non-Hispanic White), those with more education (OR 1.72, 95% CI 1.03-2.87; at least a college graduate vs less than high school), unemployed individuals (OR 1.25, 95% CI 1.02-1.54), insured individuals (OR 1.83, 95% CI 1.25-2.69), or those with poor general health status (OR 1.66, 95% CI 1.30-2.13) had higher odds of using telehealth. Conclusions: To our best knowledge, this is among the first studies to examine patient factors around telehealth use, including motivations to use, perceptions of, satisfaction with, and care purpose of telehealth, as well as sociodemographic factors associated with telehealth adoption using a nationally representative survey. The wide array of descriptive findings and identified associations will help providers and health systems understand the factors that drive patients toward or away from telehealth visits as the technology becomes more routinely available across the United States, providing future directions for telehealth use and telehealth research. %M 38669075 %R 10.2196/51279 %U https://publichealth.jmir.org/2024/1/e51279 %U https://doi.org/10.2196/51279 %U http://www.ncbi.nlm.nih.gov/pubmed/38669075 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54326 %T Exploring the Prevalence of Tinnitus and Ear-Related Symptoms in China After the COVID-19 Pandemic: Online Cross-Sectional Survey %A Wang,Di %A Li,Peifan %A Huang,Xiaoling %A Liu,Yixuan %A Mao,Shihang %A Yin,Haoning %A Wang,Na %A Luo,Yan %A Sun,Shan %+ Research Service Office, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China, 86 18917786102, shansun@fudan.edu.cn %K COVID-19 pandemic %K tinnitus %K ear-related symptoms %K online survey %K prevalence %K ear-related %K China %K cross-sectional %K complex %K heterogeneous %K symptom %K symptoms %K Chinese %K population %K investigate %K health care %K exploratory %K teen %K teens %K teenager %K teenagers %K older adult %K older adults %K elder %K elderly %K older person %K older people %K COVID-19 %K regression analysis %D 2024 %7 24.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Tinnitus is a complex and heterogeneous disease that has been identified as a common manifestation of COVID-19. To gain a comprehensive understanding of tinnitus symptoms in individuals following COVID-19 infection, we conducted an online survey called the China Ear Nose and Throat Symptom Survey in the COVID-19 Pandemic (CENTSS) among the Chinese population. Objective: Our objective was to investigate tinnitus and ear-related symptoms after COVID-19 infection in the Chinese population, with the aim of providing a solid empirical foundation for improved health care. The findings from CENTSS can contribute to the development of enhanced management strategies for tinnitus in the context of long COVID. By gaining a better understanding of the factors contributing to tinnitus in individuals with COVID-19, health care providers can tailor interventions to address the specific needs of affected patients. Furthermore, this study serves as a basis for research on the long-term consequences of COVID-19 infection and its associated tinnitus symptoms. Methods: A quantitative, online, cross-sectional survey study design was used to explore the impact of the COVID-19 pandemic on experiences with tinnitus in China. Data were collected through an online questionnaire designed to identify the presence of tinnitus and its impacts. Descriptive statistics were used to analyze individuals' demographic characteristics, COVID-19 infection–related ear symptoms, and the cognitive and emotional implications of tinnitus. Univariable and multivariable logistic regression analyses were used to model the cross-sectional baseline associations between demographic characteristics, noise exposure, educational level, health and lifestyle factors, and the occurrence of tinnitus. Results: Between December 19, 2022, and February 1, 2023, we obtained responses from 1262 Chinese participants representing 24 regions, with an average age of 37 years. Among them, 540 patients (42.8%) reported experiencing ear-related symptoms after COVID-19 infection. Only 114 (9%) of these patients sought medical attention specifically for their ear symptoms, while 426 (33.8%) did not seek hospital care. Tinnitus emerged as the most prevalent and impactful symptom among all ear-related symptoms experienced after COVID-19 infection. Of the respondents, female participants (688/888, 77.78%), younger individuals (<30 years), individuals with lower education levels, participants residing in western China, and those with a history of otolaryngology diseases were more likely to develop tinnitus following COVID-19 infection. Conclusions: In summary, tinnitus was identified as the most common ear-related symptom during COVID-19 infection. Individuals experiencing tinnitus after COVID-19 infection were found to have poorer cognitive and emotional well-being. Different ear-related symptoms in patients post–COVID-19 infection may suggest viral invasion of various parts of the ear. It is therefore crucial to monitor and manage hearing-related changes resulting from COVID-19 as clinical services resume. %R 10.2196/54326 %U https://formative.jmir.org/2024/1/e54326 %U https://doi.org/10.2196/54326 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e49861 %T Real-World Registry on the Pharmacotherapy of Multiple Myeloma and Associated Renal and Pulmonary Impairments in the Greater Gulf Region: Protocol for a Retrospective Real-World Data Study %A Nourallah,Abdulnaser %A Alshehri,Abdulrahman %A Alhejazi,Ayman %A Usman,Binyam %A ElGohary,Ghada %A Malhan,Hafiz %A Motabi,Ibraheem %A Al Farsi,Khalil %A Alshuaibi,Mohammed %A Siddiqui,Mustaqeem %A Ghonema,Rasha %A Taha,Ruba Yasin %A Abouzeid,Tarek %A Ahmed,Wesam %A Diab,Mohanad %A Alhuraiji,Ahmad %A Rabea,Magdy %A Chouikrat,Mohamed Zahir %+ Medical Affairs Department, Sanofi, One JLT building 3rd Floor, Jumeirah Lake Towers, Dubai, 500001, United Arab Emirates, 971 (0) 50 527 1412, Zahir.Chouikrat@sanofi.com %K Greater Gulf region %K multiple myeloma %K pulmonary dysfunction %K renal impairment %K RRMM %K Real-world data %D 2024 %7 24.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Multiple myeloma (MM) is the second-most common cancer among hematological malignancies. Patients with active disease may experience several comorbidities, including renal insufficiency and asthma, which may lead to treatment failure. The treatment of relapsed or refractory MM (RRMM) has been associated with multiple factors, causing a decline in progression-free survival as well as overall survival with subsequent lines of therapy. Data about the characteristics of this group of patients in the Greater Gulf region are lacking. Objective: The primary objective of this study is to describe the disease characteristics and various treatment approaches or regimens used in the management of patients with RRMM in the Greater Gulf region. Methods: We will conduct a regional, retrospective study collecting real-world and epidemiological data on patients with MM in countries of the Greater Gulf region. Medical records will be used to obtain the required data. Around 150 to 170 patients’ records are planned to be retrospectively reviewed over 6 months without any cross-sectional or prospective intervention. Cases will be collected from Saudi Arabia, the United Arab Emirates, Kuwait, Oman, and Qatar. Descriptive as well as analytical statistics will be performed on the extracted data. The calculated sample size will allow us to estimate the percentages of RRMM cases with acceptable precision while complying with the challenges in light of data scarcity. We will obtain a comprehensive description of the demographic profile of patients with MM; treatment outcomes; the proportion of patients with MM with renal impairment and asthma, chronic obstructive pulmonary disease, or both at the time of diagnosis and any subsequent point; and data related to treatment lines, regimens, and MM-associated morbidities. Results: Patient medical records were reviewed between June 2022 and January 2023 for eligibility and data extraction. A total of 148 patients were eligible for study inclusion, of whom 64.2% (n=95) were male and 35.8% (n=53) were female. The study is currently in its final stages of data analysis. The final manuscript is expected to be published in 2024. Conclusions: Although MM is a predominant hematological disease, data on its prevalence and patients’ characteristics in the Greater Gulf region are scarce. Therefore, this study will give us real-world insights into disease characteristics and various management approaches of patients with MM in the Greater Gulf region. International Registered Report Identifier (IRRID): DERR1-10.2196/49861 %M 38657230 %R 10.2196/49861 %U https://www.researchprotocols.org/2024/1/e49861 %U https://doi.org/10.2196/49861 %U http://www.ncbi.nlm.nih.gov/pubmed/38657230 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49815 %T Patient Satisfaction With the Health Care Services of a Government-Financed Health Protection Scheme in Bangladesh: Cross-Sectional Study %A Hasan,Md Zahid %A Rabbani,Md Golam %A Akter,Orin %A Mehdi,Gazi Golam %A Ahmed,Mohammad Wahid %A Ahmed,Sayem %A Chowdhury,Mahbub Elahi %+ Health Systems and Population Studies Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh, 880 01673163613, md.zahid@icddrb.org %K Shasthyo Surokhsha Karmasuchi %K health care services %K health care utilization %K satisfaction %K below poverty line %K Bangladesh %K patient satisfaction %K physician behavior %D 2024 %7 24.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Since 2016, the government of Bangladesh has been piloting a health protection scheme known as Shasthyo Surokhsha Karmasuchi (SSK), which specifically targets households living below the poverty line. This noncontributory scheme provides enrolled households access to inpatient health care services for 78 disease groups. Understanding patients’ experiences with health care utilization from the pilot SSK scheme is important for enhancing the quality of health care service delivery during the national-level scale-up of the scheme. Objective: We aimed to evaluate patient satisfaction with the health care services provided under the pilot health protection scheme in Bangladesh. Methods: A cross-sectional survey was conducted with the users of the SSK scheme from August to November 2019. Patients who had spent a minimum of 2 nights at health care facilities were selected for face-to-face exit interviews. During these interviews, we collected information on patients’ socioeconomic characteristics, care-seeking experiences, and level of satisfaction with various aspects of health care service delivery. To measure satisfaction, we employed a 5-point Likert scale (very satisfied, 5; satisfied, 4; neither satisfied nor dissatisfied, 3; dissatisfied, 2; very dissatisfied, 1). Descriptive statistics, statistical inferential tests (t-test and 1-way ANOVA), and linear regression analyses were performed. Results: We found that 55.1% (241/438) of users were either very satisfied or satisfied with the health care services of the SSK scheme. The most satisfactory indicators were related to privacy maintained during diagnostic tests (mean 3.91, SD 0.64), physicians’ behaviors (mean 3.86, SD 0.77), services provided at the registration booth (mean 3.86, SD 0.62), confidentiality maintained regarding diseases (mean 3.78, SD 0.72), and nurses’ behaviors (mean 3.60, SD 0.83). Poor satisfaction was identified in the interaction of patients with providers about illness-related information (mean 2.14, SD 1.40), availability of drinking water (mean 1.46, SD 0.76), cleanliness of toilets (mean 2.85, SD 1.04), and cleanliness of the waiting room (mean 2.92, SD 1.09). Patient satisfaction significantly decreased by 0.20 points for registration times of 16-30 minutes and by 0.32 points for registration times of >30 minutes compared with registration times of ≤15 minutes. Similarly, patient satisfaction significantly decreased with an increase in the waiting time to obtain services. However, the satisfaction of users significantly increased if they received a complete course of medicines and all prescribed diagnostic services. Conclusions: More than half of the users were satisfied with the services provided under the SSK scheme. However, there is scope for improving user satisfaction. To improve the satisfaction level, the SSK scheme implementation authorities should pay attention to reducing the registration time and waiting time to obtain services and improving the availability of drugs and prescribed diagnostic services. The authorities should also ensure the supply of drinking water and enhance the cleanliness of the facility. %M 38656783 %R 10.2196/49815 %U https://formative.jmir.org/2024/1/e49815 %U https://doi.org/10.2196/49815 %U http://www.ncbi.nlm.nih.gov/pubmed/38656783 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55860 %T The Conceptualization and Measurement of Research Impact in Primary Health Care: Protocol for a Rapid Scoping Review %A Aggarwal,Monica %A Hutchison,Brian G %A Kokorelias,Kristina M %A Ramsden,Vivian R %A Ivers,Noah M %A Pinto,Andrew %A Uphsur,Ross E G %A Wong,Sabrina T %A Pimlott,Nick %A Slade,Steve %+ Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada, 1 6473815534, monica.aggarwal@utoronto.ca %K research impact %K primary health care %K measurement %K definition %K concept %K development %K implementation %K health policy %K policy %K health service %K rapid review %K review %K research %K policies %K societal %K productivity %K literature database %D 2024 %7 23.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The generation of research evidence and knowledge in primary health care (PHC) is crucial for informing the development and implementation of interventions and innovations and driving health policy, health service improvements, and potential societal changes. PHC research has broad effects on patients, practices, services, population health, community, and policy formulation. The in-depth exploration of the definition and measures of research impact within PHC is essential for broadening our understanding of research impact in the discipline and how it compares to other health services research. Objective: The objectives of the study are (1) to understand the conceptualizations and measures of research impact within the realm of PHC and (2) to identify methodological frameworks for evaluation and research impact and the benefits and challenges of using these approaches. The forthcoming review seeks to guide future research endeavors and enhance methodologies used in assessing research impact within PHC. Methods: The protocol outlines the rapid review and environmental scan approach that will be used to explore research impact in PHC and will be guided by established frameworks such as the Canadian Academy of Health Sciences Impact Framework and the Canadian Health Services and Policy Research Alliance. The rapid review follows scoping review guidelines (PRISMA-ScR; Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews). The environmental scan will be done by consulting with professional organizations, academic institutions, information science, and PHC experts. The search strategy will involve multiple databases, citation and forward citation searching, and manual searches of gray literature databases, think tank websites, and relevant catalogs. We will include gray and scientific literature focusing explicitly on research impact in PHC from high-income countries using the World Bank classification. Publications published in English from 1978 will be considered. The collected papers will undergo a 2-stage independent review process based on predetermined inclusion criteria. The research team will extract data from selected studies based on the research questions and the CRISP (Consensus Reporting Items for Studies in Primary Care) protocol statement. The team will discuss the extracted data, enabling the identification and categorization of key themes regarding research impact conceptualization and measurement in PHC. The narrative synthesis will evolve iteratively based on the identified literature. Results: The results of this study are expected at the end of 2024. Conclusions: The forthcoming review will explore the conceptualization and measurement of research impact in PHC. The synthesis will offer crucial insights that will guide subsequent research, emphasizing the need for a standardized approach that incorporates diverse perspectives to comprehensively gauge the true impact of PHC research. Furthermore, trends and gaps in current methodologies will set the stage for future studies aimed at enhancing our understanding and measurement of research impact in PHC. International Registered Report Identifier (IRRID): PRR1-10.2196/55860 %M 38652900 %R 10.2196/55860 %U https://www.researchprotocols.org/2024/1/e55860 %U https://doi.org/10.2196/55860 %U http://www.ncbi.nlm.nih.gov/pubmed/38652900 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55829 %T Toward Telemonitoring in Immune-Mediated Inflammatory Diseases: Protocol for a Mixed Attention Model Study %A Novella-Navarro,Marta %A Iniesta-Chamorro,Jose M %A Benavent,Diego %A Bachiller-Corral,Javier %A Calvo-Aranda,Enrique %A Borrell,Helena %A Berbel-Arcobé,Laura %A Navarro-Compan,Victoria %A Michelena,Xabier %A Lojo-Oliveira,Leticia %A Arroyo-Palomo,Jaime %A Diaz-Almiron,Mariana %A García García,Verónica %A Monjo-Henry,Irene %A Gómez González,Claudia María %A Gomez,Enrique J %A Balsa,Alejandro %A Plasencia-Rodríguez,Chamaida %+ Rheumatology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, Madrid, 28046, Spain, 34 9172777108, mnovellanavarro@gmail.com %K digital health %K mHealth, telemonitoring, rheumatic musculoskeletal diseases %K digital resources, mixed attention model %K rheumatic disease %K musculoskeletal diseases %K chronic diseases %K pain %K inflammation %K antirheumatic drugs %K telemonitoring %K rheumatology %K hybrid care model %K care model %K MAM %K implementation %K clinical outcome %D 2024 %7 22.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Rheumatic and musculoskeletal diseases (RMDs) are chronic diseases that may alternate between asymptomatic periods and flares. These conditions require complex treatments and close monitoring by rheumatologists to mitigate their effects and improve the patient’s quality of life. Often, delays in outpatient consultations or the patient’s difficulties in keeping appointments make such close follow-up challenging. For this reason, it is very important to have open communication between patients and health professionals. In this context, implementing telemonitoring in the field of rheumatology has great potential, as it can facilitate the close monitoring of patients with RMDs. The use of these tools helps patients self-manage certain aspects of their disease. This could result in fewer visits to emergency departments and consultations, as well as enable better therapeutic compliance and identification of issues that would otherwise go unnoticed. Objective: The main objective of this study is to evaluate the implementation of a hybrid care model called the mixed attention model (MAM) in clinical practice and determine whether its implementation improves clinical outcomes compared to conventional follow-up. Methods: This is a multicenter prospective observational study involving 360 patients with rheumatoid arthritis (RA) and spondylarthritis (SpA) from 5 Spanish hospitals. The patients will be followed up by the MAM protocol, which is a care model that incorporates a digital tool consisting of a mobile app that patients can use at home and professionals can review asynchronously to detect incidents and follow patients' clinical evolution between face-to-face visits. Another group of patients, whose follow-up will be conducted in accordance with a traditional face-to-face care model, will be assessed as the control group. Sociodemographic characteristics, treatments, laboratory parameters, assessment of tender and swollen joints, visual analog scale for pain, and electronic patient-reported outcome (ePRO) reports will be collected for all participants. In the MAM group, these items will be self-assessed via both the mobile app and during face-to-face visits with the rheumatologist, who will do the same for patients included in the traditional care model. The patients will be able to report any incidence related to their disease or treatment through the mobile app. Results: Participant recruitment began in March 2024 and will continue until December 2024. The follow-up period will be extended by 12 months for all patients. Data collection and analysis are scheduled for completion in December 2025. Conclusions: This paper aims to provide a detailed description of the development and implementation of a digital solution, specifically an MAM. The goal is to achieve significant economic and psychosocial impact within our health care system by enhancing control over RMDs. Trial Registration: ClinicalTrials.gov NCT06273306; https://clinicaltrials.gov/ct2/show/NCT06273306 International Registered Report Identifier (IRRID): PRR1-10.2196/55829 %M 38501508 %R 10.2196/55829 %U https://www.researchprotocols.org/2024/1/e55829 %U https://doi.org/10.2196/55829 %U http://www.ncbi.nlm.nih.gov/pubmed/38501508 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51859 %T Landscape of Digital Technologies Used in the National Health Service in England: Content Analysis %A Allcock,Jake Alan %A Zhuang,Mengdie %A Li,Shuyang %A Zhao,Xin %+ Information School, University of Sheffield, The Wave, 2 Whitham Road, Sheffield, S10 2AH, United Kingdom, 44 114 222 6339, m.zhuang@sheffield.ac.uk %K digital health %K healthcare service %K regional difference %K National Health Service %K NHS %K digital technology %K health equity %D 2024 %7 19.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In England, digital technologies are exploited to transform the way health and social care is provided and encompass a wide range of hardware devices and software that are used in all aspects of health care. However, little is known about the extent to which health care providers differ in digital health technology capabilities and how this relates to geographical and regional differences in health care capacities and resources. Objective: This paper aims to identify the set of digital technologies that have been deployed by the National Health Services clinical commissioning groups (NHS CCGs) in England. In doing this, we respond to calls to shed light on the internal dynamics and variation in the form of digital capability in England in terms of health service regional differences and health diversity, equity, and inclusion. Methods: We collected 135 annual reports that belong to 106 NHS CCGs in England, comprising more than 18,000 pages in total, released from 2020 to 2021. Using this data set, we identified 2163 pages related to digital technologies and labeled them using content analysis. We follow the construct taxonomy used by digital options theory, a theory from the management information systems field analyzing organizational resource investment choices, in classifying observed technologies according to digital themes—inherent design patterns that we identified and explained. We then used a hierarchical clustering method to extract groups of NHS CCGs that implement similar technology themes. Results: We found 31 technologies from the reports and grouped them into 9 digital themes. The 9 themes were further assigned to 1 of the 3 constructs of digital options theory, the identification of patients’ requirements (we identified information portals [76/106], digital health engagement [67/106], and digital inclusion support [45/106]), the development of new work patterns (we identified telehealth [87/106], telemedicine [35/106], and care home technologies [40/106]), the realization of improvements in efficiency and public accessibility (we identified online booking [26/106], online triage [104/106], and digital mental health services [74/106]). The 3 clusters of CCGs are identified based on the 8 themes (Hopkins=0.9914, silhouette=0.186), namely (1) digitally disengaged, (2) digitally engaged, and (3) digital torchbearer. Conclusions: Our findings show prominent digital themes within each construct group, namely information portals, telehealth, and online triage, covering people’s fundamental health information needs. Almost half of CCGs fell into the digitally disengaged group, and all London CCGs (5/106) belonged to this group. We propose that practitioners should offer specialized assistance to regions with limited digital engagement, emphasizing digital health literacy, inclusion support, and ongoing evaluation, rather than concentrating solely on technical advancements. %M 38639996 %R 10.2196/51859 %U https://formative.jmir.org/2024/1/e51859 %U https://doi.org/10.2196/51859 %U http://www.ncbi.nlm.nih.gov/pubmed/38639996 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52106 %T Effectiveness of Sensitization Campaigns in Reducing Leprosy-Related Stigma in Rural Togo: Protocol for a Mixed Methods Cluster Randomized Controlled Trial %A Jockers,Dominik %A Bakoubayi,Akila Wimima %A Bärnighausen,Kate %A Bando,P'tanam P'kontème %A Pechar,Stefanie %A Maina,Teresia Wamuyu %A Wachinger,Jonas %A Vetter,Mark %A Djakpa,Yawovi %A Saka,Bayaki %A Gnossike,Piham %A Schröder,Nora Maike %A Liu,Shuyan %A Gadah,Denis Agbenyigan Yawovi %A Kasang,Christa %A Bärnighausen,Till %+ Heidelberg Insititute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, INF 130.3, Heidelberg, 69120, Germany, 49 6221560, dominik.jockers@uni-heidelberg.de %K audio %K community health worker %K information campaign %K knowledge, attitude, and practices %K language %K leprosy-related stigma %K qualitative and quantitative research %K stigma intervention %K Togo %K West Africa %D 2024 %7 18.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In the global strategy to eliminate leprosy, there remains a need for early case detection to successfully interrupt transmissions. Poor knowledge about leprosy and leprosy-related stigma are key drivers of delayed diagnosis and treatment. Sensitization campaigns to inform and increase awareness among the general population are an integral part of many national neglected tropical disease programs. Despite their importance, the effectiveness of such campaigns has not been rigorously studied in the West African context. A multilingual rural setting with low health literacy in this region presents challenges to the potential impact of sensitization campaigns. Objective: The primary objective of this study is to assess the causal effect of common practice community sensitization campaigns on leprosy-related knowledge and stigma at the community level and among community health volunteers. Additionally, we will test the potential of novel educational audio tools in the 15 most prominent local languages to overcome literacy and language barriers and amplify sensitization campaigns. Methods: We will conduct a cluster randomized controlled trial using a sequential mixed methods approach in 60 rural communities across all regions of Togo, West Africa. The study features 2 intervention arms and 1 control arm, with intervention and control assignments made at the community level through randomization. Communities in intervention arm 1 will receive a sensitization campaign in line with the current Togolese national neglected tropical disease program. Communities in intervention arm 2 will receive the same sensitization campaign along with educational audio tools distributed to community households. The control arm will receive no intervention before data collection. Quantitative outcome measures on knowledge and stigma will be collected from a random sample of 1200 individuals. Knowledge will be assessed using the 9-item standardized Knowledge, Attitudes, and Practices Questionnaire. Stigma will be measured using the 7-item Social Distance Scale and the 15-item Explanatory Model Interview Catalogue Community Stigma Scale. We will estimate intention-to-treat effects at the individual level, comparing the outcomes of the intervention and control arms. In an accompanying qualitative component, we will conduct in-depth interviews with community members, community health volunteers, and health care workers in both treatment arms and the control arm to explore intervention and stigma-related experiences. Results: This paper describes and discusses the protocol for a mixed methods cluster randomized controlled trial. Data collection is planned to be completed in June 2024, with ongoing data analysis. The first results are expected to be submitted for publication by the end of 2024. Conclusions: This trial will be among the first to test the causal effectiveness of community-based sensitization campaigns and audio tools to increase knowledge and reduce leprosy-related stigma. As such, the results will inform health policy makers, decision-makers, and public health practitioners designing sensitization campaigns in rural multilingual settings. Trial Registration: German Clinical Trials Register DRKS00029355; https://drks.de/search/en/trial/DRKS00029355 International Registered Report Identifier (IRRID): DERR1-10.2196/52106 %M 38635983 %R 10.2196/52106 %U https://www.researchprotocols.org/2024/1/e52106 %U https://doi.org/10.2196/52106 %U http://www.ncbi.nlm.nih.gov/pubmed/38635983 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47125 %T Evaluating Algorithmic Bias in 30-Day Hospital Readmission Models: Retrospective Analysis %A Wang,H Echo %A Weiner,Jonathan P %A Saria,Suchi %A Kharrazi,Hadi %+ Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Hampton House, Baltimore, MD, United States, 1 443 287 8264, kharrazi@jhu.edu %K algorithmic bias %K model bias %K predictive models %K model fairness %K health disparity %K hospital readmission %K retrospective analysis %D 2024 %7 18.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The adoption of predictive algorithms in health care comes with the potential for algorithmic bias, which could exacerbate existing disparities. Fairness metrics have been proposed to measure algorithmic bias, but their application to real-world tasks is limited. Objective: This study aims to evaluate the algorithmic bias associated with the application of common 30-day hospital readmission models and assess the usefulness and interpretability of selected fairness metrics. Methods: We used 10.6 million adult inpatient discharges from Maryland and Florida from 2016 to 2019 in this retrospective study. Models predicting 30-day hospital readmissions were evaluated: LACE Index, modified HOSPITAL score, and modified Centers for Medicare & Medicaid Services (CMS) readmission measure, which were applied as-is (using existing coefficients) and retrained (recalibrated with 50% of the data). Predictive performances and bias measures were evaluated for all, between Black and White populations, and between low- and other-income groups. Bias measures included the parity of false negative rate (FNR), false positive rate (FPR), 0-1 loss, and generalized entropy index. Racial bias represented by FNR and FPR differences was stratified to explore shifts in algorithmic bias in different populations. Results: The retrained CMS model demonstrated the best predictive performance (area under the curve: 0.74 in Maryland and 0.68-0.70 in Florida), and the modified HOSPITAL score demonstrated the best calibration (Brier score: 0.16-0.19 in Maryland and 0.19-0.21 in Florida). Calibration was better in White (compared to Black) populations and other-income (compared to low-income) groups, and the area under the curve was higher or similar in the Black (compared to White) populations. The retrained CMS and modified HOSPITAL score had the lowest racial and income bias in Maryland. In Florida, both of these models overall had the lowest income bias and the modified HOSPITAL score showed the lowest racial bias. In both states, the White and higher-income populations showed a higher FNR, while the Black and low-income populations resulted in a higher FPR and a higher 0-1 loss. When stratified by hospital and population composition, these models demonstrated heterogeneous algorithmic bias in different contexts and populations. Conclusions: Caution must be taken when interpreting fairness measures’ face value. A higher FNR or FPR could potentially reflect missed opportunities or wasted resources, but these measures could also reflect health care use patterns and gaps in care. Simply relying on the statistical notions of bias could obscure or underplay the causes of health disparity. The imperfect health data, analytic frameworks, and the underlying health systems must be carefully considered. Fairness measures can serve as a useful routine assessment to detect disparate model performances but are insufficient to inform mechanisms or policy changes. However, such an assessment is an important first step toward data-driven improvement to address existing health disparities. %M 38422347 %R 10.2196/47125 %U https://www.jmir.org/2024/1/e47125 %U https://doi.org/10.2196/47125 %U http://www.ncbi.nlm.nih.gov/pubmed/38422347 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56346 %T Effectiveness and Experiences of Quality Improvement Interventions in Older Adult Care: Protocol for a Mixed Methods Systematic Review %A Jabin,Md Shafiqur Rahman %A Samuriwo,Ray %A Chilaka,Marcus %A Yaroson,Emilia Vann %+ Department of Medicine and Optometry, Linnaeus University, Linnéuniversitetet Box 451, Växjö, 351 06, Sweden, 44 07915673612, mjabin@bradford.ac.uk %K patient safety %K acceptability %K accessibility %K appropriateness %K timeliness %K equitability %K social care %D 2024 %7 18.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Quality improvement (QI) interventions are designed to resolve the recurring challenges of care for older individuals, such as working conditions for staff, roles of older individuals in their own care and their families, and relevant stakeholders. Therefore, there is a need to map the impacts of QI interventions in older adult care settings and further improve health and social care systems associated with older adults. Objective: This review aims to compile and synthesize the best available evidence regarding the effectiveness of policy and practice QI interventions in older adult care. The secondary aim is to understand the care of older individuals and QI intervention-related experiences and perspectives of stakeholders, care providers, older individuals, and their families. Methods: The mixed methods review will follow the standard methodology used by Joanna Briggs Institute. The published studies will be searched through CINAHL, MEDLINE, PsycINFO, ASSIA, and Web of Science, and the unpublished studies through Mednar, Trove, OCLC WorldCat, and Dissertations and Theses. This review included both qualitative and quantitative analyses of patients undergoing older adult care and any health and care professionals involved in the care delivery for older adults; a broad range of QI interventions, including assistive technologies, effects of training and education, improved reporting, safety programs, and medical devices; the experiences and perspectives of staff and patients; the context of older adult care setting; and a broad range of outcomes, including patient safety. The standard procedure for reporting, that is, PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, will be followed. Results: A result-based convergent synthesis design will be used in which both quantitative and qualitative studies will be analyzed separately, and the results of both syntheses will be then integrated during a final (convergent) synthesis. The integration will compare the findings of quantitative and qualitative evidence using tables in light of the results of both syntheses. Conclusions: This comprehensive review is expected to reflect on the insights into some QI interventions and their impact, outline some common challenges of quality for older adult care, and benefit both the practical usefulness of care service activities and the society at large. International Registered Report Identifier (IRRID): PRR1-10.2196/56346 %M 38635311 %R 10.2196/56346 %U https://www.researchprotocols.org/2024/1/e56346 %U https://doi.org/10.2196/56346 %U http://www.ncbi.nlm.nih.gov/pubmed/38635311 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55601 %T Effectiveness and Cost-Effectiveness of Survivorship Care for Survivors of Hodgkin Lymphoma (INSIGHT Study): Protocol for a Multicenter Retrospective Cohort Study With a Quasi-Experimental Design %A Lammers,Eline M J %A Zijlstra,Josée M %A Retèl,Valesca P %A Aleman,Berthe M P %A van Leeuwen,Flora E %A Nijdam,Annelies %A , %+ Department of Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX Amsterdam, Netherlands, 31 20 5126132, a.nijdam@nki.nl %K research design %K Hodgkin lymphoma %K late effects of cancer treatment %K survivorship care %K screening %K cost-effectiveness analysis %D 2024 %7 18.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Hodgkin lymphoma (HL) occurs at young ages, with the highest incidence between 20 and 40 years. While cure rates have improved to 80%-90% over the past decades, survivors of HL are at substantial risk of late treatment–related complications, such as cardiovascular diseases, breast cancer, severe infections, and hypothyroidism. To reduce morbidity and mortality from late treatment effects, the Dutch Better care after lymphoma, Evaluation of long-term Treatment Effects and screening Recommendations (BETER) consortium developed a survivorship care program for 5-year survivors of HL that includes risk-based screening for and treatment of (risk factors for) late adverse events. Even though several cancer survivorship care programs have been established worldwide, there is a lack of knowledge about their effectiveness in clinical practice. Objective: The Improving Nationwide Survivorship care Infrastructure and Guidelines after Hodgkin lymphoma Treatment (INSIGHT) study evaluates whether Dutch BETER survivorship care for survivors of HL decreases survivors’ burden of disease from late adverse events after HL treatment and associated health care costs and improves their quality of life. Methods: The INSIGHT study is a multicenter retrospective cohort study with a quasi-experimental design and prospective follow-up, embedded in the national BETER survivorship care infrastructure. The first BETER clinics started in 2013-2016 and several other centers started or will start BETER clinics in 2019-2024. This allows us to compare survivors who did and those who did not receive BETER survivorship care in the last decade. Survivors in the intervention group are matched to controls (n=450 per group) based on sex, age at diagnosis (±5 years), age in 2013 (±5 years), and treatment characteristics. The primary outcome is the burden of disease in disability-adjusted life years from cardiovascular disease, breast cancer, severe infections, and hypothyroidism. In a cost-effectiveness analysis, we will assess the cost of BETER survivorship care per averted or gained disability-adjusted life year and quality-adjusted life year. Secondary outcomes are BETER clinic attendance, adherence to screening guidelines, and knowledge and distress about late effects among survivors of HL. Study data are collected from a survivor survey, a general practitioner survey, medical records, and through linkages with national disease registries. Results: The study was funded in November 2020 and approved by the institutional review board of the Netherlands Cancer Institute in July 2021. We expect to finalize recruitment by October 2024, data collection by early 2025, and data analysis by May 2025. Conclusions: INSIGHT is the first evaluation of a comprehensive survivorship program using real-world data; it will result in new information on the (cost-)effectiveness of survivorship care in survivors of HL in clinical practice. The results of this study will be used to improve the BETER program where necessary and contribute to more effective evidence-based long-term survivorship care for lymphoma survivors. International Registered Report Identifier (IRRID): PRR1-10.2196/55601 %M 38635308 %R 10.2196/55601 %U https://www.researchprotocols.org/2024/1/e55601 %U https://doi.org/10.2196/55601 %U http://www.ncbi.nlm.nih.gov/pubmed/38635308 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54838 %T Global Trends of Medical Misadventures Using International Classification of Diseases, Tenth Revision Cluster Y62-Y69 Comparing Pre–, Intra–, and Post–COVID-19 Pandemic Phases: Protocol for a Retrospective Analysis Using the TriNetX Platform %A Caruso,Rosario %A Di Muzio,Marco %A Di Simone,Emanuele %A Dionisi,Sara %A Magon,Arianna %A Conte,Gianluca %A Stievano,Alessandro %A Girani,Emanuele %A Boveri,Sara %A Menicanti,Lorenzo %A Dolansky,Mary A %+ Health Professions Research and Development Unit, IRCCS Policlinico San Donato, via morandi 30, San Donato Milanese, 20097, Italy, 39 025277 ext 4940, rosario.caruso@grupposandonato.it %K COVID-19 %K curve-fitting analyses %K health care quality %K health care safety %K International Classification of Diseases, Tenth Revision %K ICD-10 %K incidence rates %K safety %K TriNetX %D 2024 %7 17.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has sharpened the focus on health care safety and quality, underscoring the importance of using standardized metrics such as the International Classification of Diseases, Tenth Revision (ICD-10). In this regard, the ICD-10 cluster Y62-Y69 serves as a proxy assessment of safety and quality in health care systems, allowing researchers to evaluate medical misadventures. Thus far, extensive research and reports support the need for more attention to safety and quality in health care. The study aims to leverage the pandemic’s unique challenges to explore health care safety and quality trends during prepandemic, intrapandemic, and postpandemic phases, using the ICD-10 cluster Y62-Y69 as a key tool for their evaluation. Objective: This research aims to perform a comprehensive retrospective analysis of incidence rates associated with ICD-10 cluster Y62-Y69, capturing both linear and nonlinear trends across prepandemic, intrapandemic, and postpandemic phases over an 8-year span. Therefore, it seeks to understand how these trends inform health care safety and quality improvements, policy, and future research. Methods: This study uses the extensive data available through the TriNetX platform, using an observational, retrospective design and applying curve-fitting analyses and quadratic models to comprehend the relationships between incidence rates over an 8-year span (from 2015 to 2023). These techniques will enable the identification of nuanced trends in the data, facilitating a deeper understanding of the impacts of the COVID-19 pandemic on medical misadventures. The anticipated results aim to outline complex patterns in health care safety and quality during the COVID-19 pandemic, using global real-world data for robust and generalizable conclusions. This study will explore significant shifts in health care practices and outcomes, with a special focus on geographical variations and key clinical conditions in cardiovascular and oncological care, ensuring a comprehensive analysis of the pandemic’s impact across different regions and medical fields. Results: This study is currently in the data collection phase, with funding secured in November 2023 through the Ricerca Corrente scheme of the Italian Ministry of Health. Data collection via the TriNetX platform is anticipated to be completed in May 2024, covering an 8-year period from January 2015 to December 2023. This dataset spans pre-pandemic, intra-pandemic, and early post-pandemic phases, enabling a comprehensive analysis of trends in medical misadventures using the ICD-10 cluster Y62-Y69. The final analytics are anticipated to be completed by June 2024. The study's findings aim to provide actionable insights for enhancing healthcare safety and quality, reflecting on the pandemic's transformative impact on global healthcare systems. Conclusions: This study is anticipated to contribute significantly to health care safety and quality literature. It will provide actionable insights for health care professionals, policy makers, and researchers. It will highlight critical areas for intervention and funding to enhance health care safety and quality globally by examining the incidence rates of medical misadventures before, during, and after the pandemic. In addition, the use of global real-world data enhances the study’s strength by providing a practical view of health care safety and quality, paving the way for initiatives that are informed by data and tailored to specific contexts worldwide. This approach ensures the findings are applicable and actionable across different health care settings, contributing significantly to the global understanding and improvement of health care safety and quality. International Registered Report Identifier (IRRID): PRR1-10.2196/54838 %M 38630516 %R 10.2196/54838 %U https://www.researchprotocols.org/2024/1/e54838 %U https://doi.org/10.2196/54838 %U http://www.ncbi.nlm.nih.gov/pubmed/38630516 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54406 %T Psychotherapy for Ketamine’s Enhanced Durability in Chronic Neuropathic Pain: Protocol for a Pilot Randomized Controlled Trial %A Goel,Akash %A Kapoor,Bhavya %A Chan,Hillary %A Ladha,Karim %A Katz,Joel %A Clarke,Hance %A Pazmino-Canizares,Janneth %A Thomas,Zaaria %A Philip,Kaylyssa %A Mattina,Gabriella %A Ritvo,Paul %+ Department of Anesthesia and Pain Medicine, St Michael’s Hospital, 30 Bond Street, 65-501 Donnelly South, Toronto, ON, M5B1W8, Canada, 1 4168645071, akash.goel@unityhealth.to %K 3-arm parallel group %K cognitive behavior therapy %K ketamine hydrochloride %K pain intensity %K pain interference %K psychotherapy %K randomized controlled trial %D 2024 %7 17.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic pain affects approximately 8 million Canadians (~20%), impacting their physical and mental health while burdening the health care system with costs of upwards of US $60 billion a year. Indeed, patients are often trialed on numerous medications over several years without reductions to their symptoms. Therefore, there is an urgent need to identify new therapies for chronic pain to improve patients’ quality of life, increase the availability of treatment options, and reduce the burden on the health care system. Objective: The primary objective of this study is to examine the feasibility of a parallel 3-arm pilot randomized controlled trial whereby patients are randomized to either intravenous ketamine alone, cognitive behavioral therapy (CBT) and mindfulness meditation (MM) training (CBT/MM), or the combination of intravenous ketamine and CBT/MM. The secondary outcome is to assess the durability and efficacy of combination intravenous ketamine and CBT/MM for treatment of chronic pain as compared to CBT/MM or intravenous ketamine alone (assessed at week 20 of the study). Methods: This is a single-center, 16-week, 3-arm pilot study that will take place at the Chronic Pain Clinic at St. Michael’s Hospital, Toronto, Ontario, which receives 1000 referrals per year. Patients will be enrolled in the study for a total of 20 weeks. Participants who are allocated CBT/MM therapy will receive remote weekly psychotherapy from week 1 to week 16, inclusive of health coaching administered through the NexJ Health Inc (NexJ Health) platform. Patients who are allocated ketamine-infusion therapy will receive monthly ketamine infusion treatments on weeks 2, 7, and 12. Patients who are allocated ketamine+CBT/MM will receive weekly psychotherapy from weeks 1 to 16, inclusive, as well as ketamine infusion treatments on weeks 2, 7, and 12. We will be assessing recruitment rates, consent rates, withdrawal rates, adherence, missing data, and adverse events as pilot outcome measures. Secondary clinical outcomes include changes relative to baseline in pain intensity and pain interference. Results: As of November 1, 2023, the recruitment process has not been initiated. Given the recruitment, consent, and intervention target of 30 participants for this feasibility study, with each patient undergoing monitoring and treatments for a course of 20 weeks, we expect to complete the study by December 2025. Conclusions: This study assesses the feasibility of conducting a 3-arm randomized controlled trial to examine the effects of ketamine administration with the concurrent use of CBT/MM in a population with chronic neuropathic pain. The results of this pilot randomized controlled trial will inform the development of a larger-scale randomized controlled trial. Future studies will be aimed at including a sufficiently powered sample that will inform decisions about optimal treatment calibration and treatment effect duration. Trial Registration: ClinicalTrials.gov NCT05639322; https://classic.clinicaltrials.gov/ct2/show/NCT05639322 International Registered Report Identifier (IRRID): PRR1-10.2196/54406 %M 38630524 %R 10.2196/54406 %U https://www.researchprotocols.org/2024/1/e54406 %U https://doi.org/10.2196/54406 %U http://www.ncbi.nlm.nih.gov/pubmed/38630524 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48767 %T Recruitment Strategies in the Integration of Mobile Health Into Sickle Cell Disease Care to Increase Hydroxyurea Utilization Study (meSH): Multicenter Survey Study %A Nwosu,Chinonyelum %A Khan,Hamda %A Masese,Rita %A Nocek,Judith M %A Gollan,Siera %A Varughese,Taniya %A Bourne,Sarah %A Clesca,Cindy %A Jacobs,Sara R %A Baumann,Ana %A Klesges,Lisa M %A Shah,Nirmish %A Hankins,Jane S %A Smeltzer,Matthew P %+ The University of Memphis, 222 Robison Hall, Memphis, TN, 38152, United States, 1 901 678 3702, msmltzer@memphis.edu %K sickle cell %K recruitment %K eHealth %K multicenter %K utilization %K strategy %K hydroxyurea %K mobile health %K mhealth %K intervention %D 2024 %7 16.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Hydroxyurea is an evidence-based disease-modifying therapy for sickle cell disease (SCD) but is underutilized. The Integration of Mobile Health into Sickle Cell Disease Care to Increase Hydroxyurea Utilization (meSH) multicenter study leveraged mHealth to deliver targeted interventions to patients and providers. SCD studies often underenroll; and recruitment strategies in the SCD population are not widely studied. Unanticipated events can negatively impact enrollment, making it important to study strategies that ensure adequate study accrual. Objective: The goal of this study was to evaluate enrollment barriers and the impact of modified recruitment strategies among patients and providers in the meSH study in response to a global emergency. Methods: Recruitment was anticipated to last 2 months for providers and 6 months for patients. The recruitment strategies used with patients and providers, new recruitment strategies, and recruitment rates were captured and compared. To document recruitment adaptations and their reasons, study staff responsible for recruitment completed an open-ended 9-item questionnaire eliciting challenges to recruitment and strategies used. Themes were extrapolated using thematic content analysis. Results: Total enrollment across the 7 sites included 89 providers and 293 patients. The study acceptance rate was 85.5% (382/447) for both patients and providers. The reasons patients declined participation were most frequently a lack of time and interest in research, while providers mostly declined because of self-perceived high levels of SCD expertise, believing they did not need the intervention. Initially, recruitment involved an in-person invitation to participate during clinic visits (patients), staff meetings (providers), or within the office (providers). We identified several important recruitment challenges, including (1) lack of interest in research, (2) lack of human resources, (3) unavailable physical space for recruitment activities, and (4) lack of documentation to verify eligibility. Adaptive strategies were crucial to alleviate enrollment disruptions due to the COVID-19 pandemic. These included remote approaching and consenting (eg, telehealth, email, and telephone) for patients and providers. Additionally, for patients, recruitment was enriched by simplification of enrollment procedures (eg, directly approaching patients without a referral from the provider) and a multitouch method (ie, warm introductions with flyers, texts, and patient portal messages). We found that patient recruitment rates were similar between in-person and adapted (virtual with multitouch) approaches (167/200, 83.5% and 126/143, 88.1%, respectively; P=.23). However, for providers, recruitment was significantly higher for in-person vs remote recruitment (48/50, 96% and 41/54, 76%, respectively, P<.001). Conclusions: We found that timely adaptation in recruitment strategies secured high recruitment rates using an assortment of enriched remote recruitment strategies. Flexibility in approach and reducing the burden of enrollment procedures for participants aided enrollment. It is important to continue identifying effective recruitment strategies in studies involving patients with SCD and their providers and the impact and navigation of recruitment challenges. Trial Registration: ClinicalTrials.Gov NCT03380351; https://clinicaltrials.gov/study/NCT03380351 International Registered Report Identifier (IRRID): RR2-10.2196/16319 %M 38625729 %R 10.2196/48767 %U https://formative.jmir.org/2024/1/e48767 %U https://doi.org/10.2196/48767 %U http://www.ncbi.nlm.nih.gov/pubmed/38625729 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54002 %T The Use of Medical Services for Low-Acuity Emergency Cases in Germany: Protocol for a Multicenter Observational Pilot Study %A Nau,Lara Maria %A Laux,Gunter %A Altiner,Attila %A Szecsenyi,Joachim %A Leutgeb,Rüdiger %+ Department of General Practice and Health Services Research, University of Heidelberg, Im Neuenheimer Feld 130, Heidelberg, 69120, Germany, 49 622156310446, ruediger.leutgeb@med.uni-heidelberg.de %K emergency medical service %K EMS %K ambulance misuse %K low-acuity calls %K emergency department %K paramedics %K rescue operations %D 2024 %7 10.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The increasing number of requests for help for acutely ill patients and their management is a major problem in the health systems of many countries, but especially in Germany. Rescue coordination centers and ambulances in Germany are increasingly overloaded. As a result, rides as a part of rescue operations have been increasing in length for years, yet a relevant proportion of these operations represent low-acuity calls (LACs). The basic objective of this pilot study is the quantitative analysis of the potential misuse of requests to the rescue control center. Indications for alternative treatment options and how to handle these treatment options in nonacute, non–life-threatening health conditions, such as minor injuries or minor infectious diseases, will be assessed. The identification of these LACs is vital in order to prevent health care resources in emergency medical care becoming inadequate. Objective: The overarching goal of this study is to determine the percentage of unnecessary rescue missions on site and subsequently to obtain an impression of the paramedics’ assessment of alternative treatment options or alternative methods of rescue transportation. Methods: This will be an exploratory, noninterventional, cross-sectional study with a quantitative approach. The study is multicentric, with 21 ambulances in 12 different locations. The data for this study were collected via a questionnaire, newly developed for this study, for rescue personnel. Additionally, secondary data from the responsible control center will be linked and processed in an initial descriptive analysis. This descriptive analysis will form the basis for a subsequent variance analysis. Results: Data collection started as projected on September 18, 2023, and was ongoing until end of November 2023. We expect the documentation of several thousand rescue operations. We expect the following study results: (1) many unnecessary rescue operations, (2) immediate on-site assessment of correct care and treatment, and (3) patients’ reasons for calling a rescue coordination center. Conclusions: To our knowledge, this is the first observational study in which acute rescue operations are recorded on site. The focus of this study is on the trained paramedics’ assessment of whether rescue operations are necessary or not. Additionally, alternative treatments, such as out-of-hours care service or primary care service, are shown for each individual case. The study also intends to cover the question of which factors are relevant and statistically significantly connected to the misuse of ambulances. Trial Registration: German Register for Clinical Studies (Deutsches Register für Klinische Studien) DRKS00032510; https://drks.de/search/en/trial/DRKS00032510 International Registered Report Identifier (IRRID): DERR1-10.2196/54002 %M 38598281 %R 10.2196/54002 %U https://www.researchprotocols.org/2024/1/e54002 %U https://doi.org/10.2196/54002 %U http://www.ncbi.nlm.nih.gov/pubmed/38598281 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52616 %T Assessing and Improving the Care of Patients With Heart Failure in Ghana: Protocol for a Prospective Observational Study and the Ghana Heart Initiative-Heart Failure Registry %A Awindaogo,Felix %A Acheamfour-Akowuah,Emmanuel %A Doku,Alfred %A Kokuro,Collins %A Agyekum,Francis %A Owusu,Isaac Kofi %+ Department of Medicine and Therapeutics, University of Ghana Medical School, University of Ghana, 22nd Guggisberg Avenue, Korle-Bu, PO Box GP 4236, Accra, Ghana, 233 244273573, dokukavin@gmail.com %K clinical %K cross-sectional %K epidemiology %K Ghana %K heart failure %K heart %K management %K medium-term %K monitoring %K mortality %K outcome %K patient data %K prevention %K protocol %K teaching %K treatment %D 2024 %7 8.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Heart failure (HF) is a leading cause of morbidity and mortality globally, with a high disease burden. The prevalence of HF in Ghana is increasing rapidly, but epidemiological profiles, treatment patterns, and survival data are scarce. The national capacity to diagnose and manage HF appropriately is also limited. To address the growing epidemic of HF, it is crucial to recognize the epidemiological characteristics and medium-term outcomes of HF in Ghana and improve the capability to identify and manage HF promptly and effectively at all levels of care. Objective: This study aims to determine the epidemiological characteristics and medium-term HF outcomes in Ghana. Methods: We conducted a prospective, multicenter, multilevel cross-sectional observational study of patients with HF from January to December 2023. Approximately 5000 patients presenting with HF to 9 hospitals, including teaching, regional, and municipal hospitals, will be recruited and evaluated according to a standardized protocol, including the use of an echocardiogram and an N-terminal pro-brain natriuretic peptide (NT-proBNP) test. Guideline-directed medical treatment of HF will be initiated for 6 months, and the medium-term outcomes of interventions, including rehospitalization and mortality, will be assessed. Patient data will be collated into a HF registry for continuous assessment and monitoring. Results: This intervention will generate the necessary information on the etiology of HF, clinical presentations, the diagnostic yield of various tools, and management outcomes. In addition, it will build the necessary capacity and support for HF management in Ghana. As of July 30, 2023, the training and onboarding of all 9 centers had been completed. Preliminary analyses will be conducted by the end of the second quarter of 2024, and results are expected to be publicly available by the middle of 2024. Conclusions: This study will provide the necessary data on HF, which will inform decisions on the prevention and management of HF and form the basis for future research. Trial Registration: ISRCTN Registry (United Kingdom) ISRCTN18216214; https:www.isrctn.com/ISRCTN18216214 International Registered Report Identifier (IRRID): DERR1-10.2196/52616 %M 38588528 %R 10.2196/52616 %U https://www.researchprotocols.org/2024/1/e52616 %U https://doi.org/10.2196/52616 %U http://www.ncbi.nlm.nih.gov/pubmed/38588528 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54330 %T Impacts of an Acute Care Telenursing Program on Discharge, Patient Experience, and Nursing Experience: Retrospective Cohort Comparison Study %A Bruce,Courtenay R %A Klahn,Steve %A Randle,Lindsay %A Li,Xin %A Sayali,Kelkar %A Johnson,Barbara %A Gomez,Melissa %A Howard,Meagan %A Schwartz,Roberta %A Sasangohar,Farzan %+ Houston Methodist, 8100 Greenbriar Drive, Houston, TX, 77030, United States, 1 281 620 9040, crbruce@houstonmethodist.org %K telenursing %K telemedicine %K patient discharge %K health personnel %K surveys and questionnaires %K patient outcome assessment %D 2024 %7 4.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite widespread growth of televisits and telemedicine, it is unclear how telenursing could be applied to augment nurse labor and support nursing. Objective: This study evaluated a large-scale acute care telenurse (ACTN) program to support web-based admission and discharge processes for hospitalized patients. Methods: A retrospective, observational cohort comparison was performed in a large academic hospital system (approximately 2100 beds) in Houston, Texas, comparing patients in our pilot units for the ACTN program (telenursing cohort) between June 15, 2022, and December 31, 2022, with patients who did not participate (nontelenursing cohort) in the same units and timeframe. We used a case mix index analysis to confirm comparable patient cases between groups. The outcomes investigated were patient experience, measured using the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHCPS) survey; nursing experience, measured by a web-based questionnaire with quantitative multiple-choice and qualitative open-ended questions; time of discharge during the day (from electronic health record data); and duration of discharge education processes. Results: Case mix index analysis found no significant case differences between cohorts (P=.75). For the first 4 units that rolled out in phase 1, all units experienced improvement in at least 4 and up to 7 HCAHCPS domains. Scores for “communication with doctors” and “would recommend hospital” were improved significantly (P=.03 and P=.04, respectively) in 1 unit in phase 1. The impact of telenursing in phases 2 and 3 was mixed. However, “communication with doctors” was significantly improved in 2 units (P=.049 and P=.002), and the overall rating of the hospital and the ”would recommend hospital” scores were significantly improved in 1 unit (P=.02 and P=04, respectively). Of 289 nurses who were invited to participate in the survey, 106 completed the nursing experience survey (response rate 106/289, 36.7%). Of the 106 nurses, 101 (95.3%) indicated that the ACTN program was very helpful or somewhat helpful to them as bedside nurses. The only noticeable difference between the telenursing and nontelenursing cohorts for the time of day discharge was a shift in the volume of patients discharged before 2 PM compared to those discharged after 2 PM at a hospital-wide level. The ACTN admissions averaged 12 minutes and 6 seconds (SD 7 min and 29 s), and the discharges averaged 14 minutes and 51 seconds (SD 8 min and 10 s). The average duration for ACTN calls was 13 minutes and 17 seconds (SD 7 min and 52 s). Traditional cohort standard practice (nontelenursing cohort) of a bedside nurse engaging in discharge and admission processes was 45 minutes, consistent with our preimplementation time study. Conclusions: This study shows that ACTN programs are feasible and associated with improved outcomes for patient and nursing experience and reducing time allocated to admission and discharge education. %M 38573753 %R 10.2196/54330 %U https://www.jmir.org/2024/1/e54330 %U https://doi.org/10.2196/54330 %U http://www.ncbi.nlm.nih.gov/pubmed/38573753 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54168 %T Development and Evaluation of a Clinician-Vetted Dementia Caregiver Resources Website: Mixed Methods Approach %A McLaren,Jaye E %A Hoang-Gia,Dat %A Dorisca,Eugenia %A Hartz,Stephanie %A Dang,Stuti %A Moo,Lauren %+ New England Geriatric Research Education and Clinical Center, Veterans Affairs Bedford Health Care System, 200 Springs Rd, Bedford, MA, 01730, United States, 1 781 687 2000, Jaye.McLaren@va.gov %K Alzheimer disease %K caregiver education %K dementia %K interdisciplinary %K older adults %K virtual resources %K website development %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: About 11 million Americans are caregivers for the 6.7 million Americans currently living with dementia. They provide over 18 billion hours of unpaid care per year, yet most have no formal dementia education or support. It is extremely difficult for clinicians to keep up with the demand for caregiver education, especially as dementia is neurodegenerative in nature, requiring different information at different stages of the disease process. In this digital age, caregivers often seek dementia information on the internet, but clinicians lack a single, reliable compendium of expert-approved digital resources to provide to dementia caregivers. Objective: Our aim was to create a dementia caregiver resources website to serve as a hub for user-friendly, high-quality, and expert-reviewed dementia educational resources that clinicians can easily supply to family caregivers of people with dementia. Methods: An interdisciplinary website development team (representing dementia experts from occupational therapy, nursing, social work, geriatrics, and neurology) went through 6 iterative steps of website development to ensure resource selection quality and eligibility rigor. Steps included (1) resource collection, (2) creation of eligibility criteria, (3) resource organization by topic, (4) additional content identification, (5) finalize resource selection, and (6) website testing and launch. Website visits were tracked, and a 20-item survey about website usability and utility was sent to Veterans Affairs tele-geriatrics interdisciplinary specialty care groups. Results: Following website development, the dementia caregiver resource website was launched in February 2022. Over the first 9 months, the site averaged 1100 visits per month. The 3 subcategories with the highest number of visits were “general dementia information,” “activities of daily living,” and “self-care and support.” Most (44/45, 98%) respondents agreed or strongly agreed that the website was easy to navigate, and all respondents agreed or strongly agreed that the resources were useful. Conclusions: The iterative process of creating the dementia caregiver resources website included continuous identification, categorization, and prioritization of resources, followed by clinician feedback on website usability, accessibility, and suggestions for improvement. The website received thousands of visits and positive clinician reviews in its first 9 months. Results demonstrate that an expert-vetted, nationally, and remotely available resource website allows for easy access to dementia education for clinicians to provide for their patients and caregivers. This process of website development can serve as a model for other clinical subspecialty groups seeking to create a comprehensive educational resource for populations who lack easy access to specialty care. %M 38573761 %R 10.2196/54168 %U https://formative.jmir.org/2024/1/e54168 %U https://doi.org/10.2196/54168 %U http://www.ncbi.nlm.nih.gov/pubmed/38573761 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e51338 %T Holistic Person-Centered Care in Radiotherapy: Protocol for a Scoping Review %A Bhyat,Fatima %A Makkink,Andrew %A Henrico,Karien %+ Department of Emergency Medical Care, University of Johannesburg, John Orr Building, Cnr Siemert and Beit Street, Johannesburg, 2091, South Africa, 27 11 5596236, amakkink@uj.ac.za %K cancer patient %K cancer %K cancer care %K holistic care %K person-centered care %K person-centered %K radiologist %K radiology %K radiotherapist %K radiotherapy %K scoping review %K holistic care %D 2024 %7 3.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Several types of health care professionals are responsible for the care of patients with cancer throughout their engagement with the health care system. One such type is the radiotherapist. The radiotherapist not only administers treatment but is also directly involved with the patient during treatment. Despite this direct contact with the patient, the narrative tends to focus more on technical tasks than the actual patient. This task-focused interaction is often due to the highly sophisticated equipment and complex radiotherapy treatment processes involved. This often results in not meeting the psychosocial needs of the patient, and patients have acknowledged noncompliance and delayed treatment as a result. Objective: The scoping review aims to explore, chart, and map the available literature on holistic person-centered care in radiotherapy and to identify and present key concepts, definitions, methodologies, knowledge gaps, and evidence related to holistic person-centered care in radiotherapy. Methods: This protocol was developed using previously described methodological frameworks for scoping studies. The review will include both peer-reviewed and gray literature regarding holistic, person-centered care in radiotherapy. A comprehensive search strategy has been developed for MEDLINE (Ovid), which will be translated into the other included databases: Scopus, CINAHL (EBSCO), MEDLINE (PubMed), Embase (Elsevier), Cochrane Library, and the Directory of Open Access Journals. Gray literature searching will include Google (Google Books and Google Scholar), ProQuest, the WorldWideScience website, the OpenGrey website, and various university dissertation and thesis repositories. The title and abstract screening, full-text review, and relevant data extraction will be performed independently by all 3 reviewers using the Covidence (Veritas Health Innovation) software, which will also be used to guide the resolution of conflicts. Sources selected will be imported into ATLAS.ti (ATLAS.ti Scientific Software Development GmbH) for analysis, which will consist of content analysis, narrative analysis, and descriptive synthesis. Results will be presented using narrative, diagrammatic, and tabular formats. Results: The review is expected to identify research gaps that will inform current and future holistic, person-centered care in radiotherapy. The review commenced in November 2023, and the formal literature search was completed by the end of February 2024. Final results are expected to be published in a peer-reviewed journal by 2025. Conclusions: The findings of this review are expected to provide a wide variety of strategies aimed at providing holistic, person-centered care in radiotherapy, as well as to identify some gaps in the literature. These findings will be used to inform future studies aimed at designing, developing, evaluating, and implementing strategies toward improved holistic, person-centered care in radiotherapy. International Registered Report Identifier (IRRID): DERR1-10.2196/51338 %M 38569177 %R 10.2196/51338 %U https://www.researchprotocols.org/2024/1/e51338 %U https://doi.org/10.2196/51338 %U http://www.ncbi.nlm.nih.gov/pubmed/38569177 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54352 %T Heat and Acupuncture to Manage Osteoarthritis of the Knee (HARMOKnee): Protocol for an Effectiveness-Implementation Hybrid Randomized Controlled Trial %A Tan,Bryan Yijia %A Tan,Chun Yue %A Tan,Tong Leng %A Yang,Su-Yin %A Chew,Gillian Long Szu %A Tan,Siang Ing %A Chua,Yu Chun %A Yan,Yew Wai %A Soh,Derrick Bing Quan %A Goh,Tong Hwee %A Ng,Pu Jue %A Ng,Yee Teck %A Kuan,Swee Boey %A Teo,Bo Siang %A Kong,Keng He %A Pereira,Michelle Jessica %A Ng,Hui Ping %+ Department of Orthopaedic Surgery, Woodlands Health, National Healthcare Group, 17 Woodlands Dr 17, Singapore, 737628, Singapore, 65 90057277, bryan_tan@wh.com.sg %K knee osteoarthritis %K acupuncture %K heat therapy %K effectiveness-implementation hybrid study %K randomized controlled trial %K RCT %D 2024 %7 3.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Knee osteoarthritis (KOA) is one of most prevalent and fastest-growing causes of pain, impaired mobility, and poor quality of life in the rapidly aging population worldwide. There is a lack of high-quality evidence on the efficacy of traditional Chinese medicine (TCM), particularly acupuncture, and a lack of KOA practice guidelines that are tailored to unique population demographics and tropical climates. Objective: Our HARMOKnee (Heat and Acupuncture to Manage Osteoarthritis of the Knee) trial aims to address these gaps by evaluating the short- and medium-term clinical and cost-effectiveness of acupuncture with heat therapy in addition to standard care, compared to standard care alone. Through a robust process and economic evaluation, we aim to inform evidence-based practice for patients with KOA to facilitate the large-scale implementation of a comprehensive and holistic model of care that harmonizes elements of Western medicine and TCM. We hypothesize that acupuncture with heat therapy as an adjunct to standard care is clinically more effective than standard care alone. Methods: A multicenter, pragmatic, parallel-arm, single-blinded, effectiveness-implementation hybrid randomized controlled trial will be conducted. We intend to recruit 100 patients with KOA randomized to either the control arm (standard care only) or intervention arm (acupuncture with heat therapy, in addition to standard care). The inclusion criteria are being a community ambulator and having primary KOA, excluding patients with secondary arthritis or previous knee replacements. The primary outcome measure is the Knee Osteoarthritis Outcome Score at 6 weeks. Secondary outcome measures include psychological, physical, quality of life, satisfaction, and global outcome measures at 6, 12, and 26 weeks. A mixed method approach through an embedded process evaluation will facilitate large-scale implementation. An economic evaluation will be performed to assess financial sustainability. Results: Patient enrollment has been ongoing since August 2022. The recruitment process is anticipated to conclude by July 2024, and the findings will be analyzed and publicized as they are obtained. As of November 6, 2023, our patient enrollment stands at 65 individuals. Conclusions: The findings of our HARMOKnee study will contribute substantial evidence to the current body of literature regarding the effectiveness of acupuncture treatment for KOA. Additionally, we aim to facilitate the creation of standardized national guidelines for evidence-based practice that are specifically tailored to our unique population demographics. Furthermore, we seek to promote the adoption and integration of acupuncture and heat therapy into existing treatment models. Trial Registration: ClinicalTrials.gov NCT05507619; https://clinicaltrials.gov/study/NCT05507619 International Registered Report Identifier (IRRID): DERR1-10.2196/54352 %M 38568718 %R 10.2196/54352 %U https://www.researchprotocols.org/2024/1/e54352 %U https://doi.org/10.2196/54352 %U http://www.ncbi.nlm.nih.gov/pubmed/38568718 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e48135 %T Using Project Extension for Community Healthcare Outcomes to Enhance Substance Use Disorder Care in Primary Care: Mixed Methods Study %A Koester,MacKenzie %A Motz,Rosemary %A Porto,Ariel %A Reyes Nieves,Nikita %A Ashley,Karen %+ Weitzman Institute, Moses Weitzman Health System, 1575 I Street Northwest, Suite 300, Washington, DC, 20005, United States, 1 8603476971, koestem@mwhs1.com %K continuing medical education %K telementoring %K substance use disorder treatment %K substance use disorder %K SUD %K primary care %K Extension for Community Healthcare Outcomes %K Project ECHO %D 2024 %7 1.4.2024 %9 Original Paper %J JMIR Med Educ %G English %X Background: Substance use and overdose deaths make up a substantial portion of injury-related deaths in the United States, with the state of Ohio leading the nation in rates of diagnosed substance use disorder (SUD). Ohio’s growing epidemic has indicated a need to improve SUD care in a primary care setting through the engagement of multidisciplinary providers and the use of a comprehensive approach to care. Objective: The purpose of this study was to assess the ability of the Weitzman Extension for Community Healthcare Outcomes (ECHO): Comprehensive Substance Use Disorder Care program to both address and meet 7 series learning objectives and address substances by analyzing (1) the frequency of exposure to the learning objective topics and substance types during case discussions and (2) participants’ change in knowledge, self-efficacy, attitudes, and skills related to the treatment of SUDs pre- to postseries. The 7 series learning objective themes included harm reduction, team-based care, behavioral techniques, medication-assisted treatment, trauma-informed care, co-occurring conditions, and social determinants of health. Methods: We used a mixed methods approach using a conceptual content analysis based on series learning objectives and substances and a 2-tailed paired-samples t test of participants’ self-reported learner outcomes. The content analysis gauged the frequency and dose of learning objective themes and illicit and nonillicit substances mentioned in participant case presentations and discussions, and the paired-samples t test compared participants’ knowledge, self-efficacy, attitudes, and skills associated with learning objectives and medication management of substances from pre- to postseries. Results: The results of the content analysis indicated that 3 learning objective themes—team-based care, harm reduction, and social determinants of health—resulted in the highest frequencies and dose, appearing in 100% (n=22) of case presentations and discussions. Alcohol had the highest frequency and dose among the illicit and nonillicit substances, appearing in 81% (n=18) of case presentations and discussions. The results of the paired-samples t test indicated statistically significant increases in knowledge domain statements related to polysubstance use (P=.02), understanding the approach other disciplines use in SUD care (P=.02), and medication management strategies for nicotine (P=.03) and opioid use disorder (P=.003). Statistically significant increases were observed for 2 self-efficacy domain statements regarding medication management for nicotine (P=.002) and alcohol use disorder (P=.02). Further, 1 statistically significant increase in the skill domain was observed regarding using the stages of change theory in interventions (P=.03). Conclusions: These findings indicate that the ECHO program’s content aligned with its stated learning objectives; met its learning objectives for the 3 themes where significant improvements were measured; and met its intent to address multiple substances in case presentations and discussions. These results demonstrate that Project ECHO is a potential tool to educate multidisciplinary providers in a comprehensive approach to SUD care. %M 38557477 %R 10.2196/48135 %U https://mededu.jmir.org/2024/1/e48135 %U https://doi.org/10.2196/48135 %U http://www.ncbi.nlm.nih.gov/pubmed/38557477 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47523 %T Telehealth Care Through Internet Hospitals in China: Qualitative Interview Study of Physicians’ Views on Access, Expectations, and Communication %A Zhong,Yuqiong %A Hahne,Jessica %A Wang,Xiaomin %A Wang,Xuxi %A Wu,Ying %A Zhang,Xin %A Liu,Xing %+ Office of International Cooperation and Exchanges, Xiangya Hospital, Central South University, No 87 Xiangya Road, Kaifu District, Changsha, 410008, China, 86 18229765509, xingliu0706@csu.edu.cn %K China %K internet hospital %K health care access %K telehealth %K doctor-patient relationship %K mobile phone %D 2024 %7 29.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet hospitals in China are an emerging medical service model similar to other telehealth models used worldwide. Internet hospitals are currently in a stage of rapid development, giving rise to a series of new opportunities and challenges for patient care. Little research has examined the views of chronic disease physicians regarding internet hospitals in China. Objective: We aimed to explore the experience and views of chronic disease physicians at 3 tertiary hospitals in Changsha, China, regarding opportunities and challenges in internet hospital care. Methods: We conducted semistructured qualitative interviews with physicians (n=26) who had experience working in internet hospitals affiliated with chronic disease departments in 3 tertiary hospitals in Changsha, Hunan province, south central China. Interviews were transcribed verbatim and analyzed by content analysis using NVivo software (version 11; Lumivero). Results: Physicians emphasized that internet hospitals expand opportunities to conduct follow-up care and health education for patients with chronic illnesses. However, physicians described disparities in access for particular groups of patients, such as patients who are older, patients with lower education levels, patients with limited internet or technology access, and rural patients. Physicians also perceived a gap between patients’ expectations and the reality of limitations regarding both physicians’ availability and the scope of services offered by internet hospitals, which raised challenges for doctor-patient boundaries and trust. Physicians noted challenges in doctor-patient communication related to comprehension and informed consent in internet hospital care. Conclusions: This study explored the experience and views of physicians in 3 tertiary hospitals in Changsha, China, regarding access to care, patients’ expectations versus the reality of services, and doctor-patient communication in internet hospital care. Findings from this study highlight the need for physician training in telehealth communication skills, legislation regulating informed consent in telehealth care, public education clarifying the scope of internet hospital services, and design of internet hospitals that is informed by the needs of patient groups with barriers to access, such as older adults. %M 38551618 %R 10.2196/47523 %U https://www.jmir.org/2024/1/e47523 %U https://doi.org/10.2196/47523 %U http://www.ncbi.nlm.nih.gov/pubmed/38551618 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50036 %T Factors Explaining the Use of Web-Based Consultations With Physicians by Young and Middle-Aged Individuals in China: Qualitative Comparative Analysis %A Zhang,Chunyu %A Hu,Ning %A Li,Rui %A Zhu,Aiping %A Yu,Zhongguang %+ Respiratory Centre, China-Japan Friendship Hospital, Yinghua Road 2#, Beijing, 100013, China, 86 84206468, yzg081892@163.com %K web-based consultation %K Andersen Behavioral Model %K qualitative comparative analysis %K perceived convenience %K complementary role %K user's confidence %K China %D 2024 %7 29.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: It was only upon the occurrence of the COVID-19 pandemic that the demand for web-based consultations with physicians grew at unprecedented rates. To meet the demand, the service environment developed rapidly during the pandemic. Objective: This study aimed to identify the current status of the use of web-based consultations with physicians among young and middle-aged Chinese individuals and explore users’ perspectives on key factors that influence its use in terms of optimizing benefits and compensating for disadvantages. Methods: We conducted semistructured interviews with 65 individuals (aged 18 to 60 years) across China between September and October 2022. The interviewees were selected through snowball sampling. They described their experiences of using web-based physician consultations and the reasons for using or not using the service. Based on the Andersen Behavioral Model, a qualitative comparative analysis was used to analyze the factors associated with the use of web-based physician consultations and explore the combinations of these factors. Results: In all, 31 (48%) of the 65 interviewees used web-based consultation services. The singular necessary condition analysis revealed that the complementary role of the service and perceived convenience are necessary conditions for the use of web-based consultation services, and user’s confidence in the service was a sufficient condition. Based on the Andersen Behavioral Model, the configuration analysis uncovered 2 interpretation models: an enabling-oriented model and a need-oriented model. The basic combination of the enabling-oriented model included income and perceived convenience. The basic combination of the need-oriented model included complementary role and user’s confidence. Conclusions: Among the factors associated with the use of web-based consultations, perceived convenience, complementary role, and user’s confidence were essential factors. Clear instructions on the conduct of the service, cost regulations, provider qualifications guarantee, privacy and safety supervision, the consultations’ application in chronic disease management settings, and subsequent visits can promote the positive development of web-based consultations. %M 38551645 %R 10.2196/50036 %U https://formative.jmir.org/2024/1/e50036 %U https://doi.org/10.2196/50036 %U http://www.ncbi.nlm.nih.gov/pubmed/38551645 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e47914 %T A Mobile App (Concerto) to Empower Hospitalized Patients in a Swiss University Hospital: Development, Design, and Implementation Report %A Dietrich,Damien %A Bornet dit Vorgeat,Helena %A Perrin Franck,Caroline %A Ligier,Quentin %+ Geneva Hub for Global Digital Health, Faculty of Medicine, University of Geneva, Campus Biotech, 9 Chemin des Mines, Geneva, 1202, Switzerland, 41 227714730, damien.dietrich@gmail.com %K patient empowerment %K mobile apps %K digital health %K mobile health %K implementation science %K health care system %K hospital information system %K health promotion %D 2024 %7 28.3.2024 %9 Implementation Report %J JMIR Med Inform %G English %X Background: Patient empowerment can be associated with better health outcomes, especially in the management of chronic diseases. Digital health has the potential to promote patient empowerment. Objective: Concerto is a mobile app designed to promote patient empowerment in an in-patient setting. This implementation report focuses on the lessons learned during its implementation. Methods: The app was conceptualized and prototyped during a hackathon. Concerto uses hospital information system (HIS) data to offer the following key functionalities: a care schedule, targeted medical information, practical information, information about the on-duty care team, and a medical round preparation module. Funding was obtained following a feasibility study, and the app was developed and implemented in four pilot divisions of a Swiss University Hospital using institution-owned tablets. Implementation (Results): The project lasted for 2 years with effective implementation in the four pilot divisions and was maintained within budget. The induced workload on caregivers impaired project sustainability and warranted a change in our implementation strategy. The presence of a killer function would have facilitated the deployment. Furthermore, our experience is in line with the well-accepted need for both high-quality user training and a suitable selection of superusers. Finally, by presenting HIS data directly to the patient, Concerto highlighted the data that are not fit for purpose and triggered data curation and standardization initiatives. Conclusions: This implementation report presents a real-world example of designing, developing, and implementing a patient-empowering mobile app in a university hospital in-patient setting with a particular focus on the lessons learned. One limitation of the study is the lack of definition of a “key success” indicator. %M 38546728 %R 10.2196/47914 %U https://medinform.jmir.org/2024/1/e47914 %U https://doi.org/10.2196/47914 %U http://www.ncbi.nlm.nih.gov/pubmed/38546728 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46412 %T Evaluation of Telehealth Services that are Clinically Appropriate for Reimbursement in the US Medicaid Population: Mixed Methods Study %A Saravanakumar,Sanjeev %A Ostrovsky,Andrey %+ GW School of Medicine & Health Sciences, 2300 I St NW, Washington, DC, 20052, United States, 1 6307303002, sanjeev@gwu.edu %K mobile phone %K telehealth %K Medicaid reimbursement %K health equity %K Center for Medicare & Medicaid Services %K telemedicine %K reimbursement %K digital health %K Medicaid %K Public Health Emergency %K access %K equity %K health insurance %K coverage %K reimburse %K equitable %K health policy %K telehealth expansion %D 2024 %7 28.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: When the US Department of Health and Human Services instituted a State of Public Health Emergency (PHE) during the COVID-19 pandemic, many telehealth flexibilities were fast-tracked to allow state Medicaid agencies to reimburse new specialty services, sites of care, and mediums such as FaceTime to communicate with patients.. This resulted in expanded access to care for financially vulnerable Medicaid patients, as evidenced by an uptick in telehealth use. Research has mostly focused on telehealth reimbursement for limited use cases such as rural primary care, without broader consideration for how telehealth can be appropriately mainstreamed and maintained. Objective: This study sought to (1) evaluate the continuation of flexible telehealth reimbursement broadly, beyond the COVID-19 pandemic; (2) analyze the clinical effectiveness of the new telehealth services; and (3) offer code-by-code reimbursement guidance to state Medicaid leaders. Methods: We surveyed 10 state Medicaid medical directors (MMDs) who are responsible for the scientific and clinical appropriateness of Medicaid policies in their respective states. Participants were asked to complete an internet-based survey with a list of medical billing codes, grouped by service type, and asked if they believed they should be reimbursed by Medicaid on a permanent basis. Additional questions covered more detailed recommendations, such as reimbursing video with audio versus audio-only, guardrails for certain specialty services, and motivations behind responses. Results: The MMDs felt that the majority of services should be reimbursed via some modality of telehealth after the PHE, with the most support for video combined with audio compared to audio-only. There were exceptions on both ends of the spectrum, where services such as pulmonary diagnostics were not recommended to be reimbursed in any form and services such as psychotherapy for mental health had the most support for audio-only. The vast majority of MMDs were supportive of reimbursement for remote monitoring services, but some preferred to have some reimbursement guardrails. We found that 90% (n=9) of MMDs were supportive of reimbursement for telehealth interprofessional services, while half (n=5) of the respondents felt that there should be continued guardrails for reimbursement. Motivations for continuing reimbursement flexibility were largely attributed to improving access to care, improving outcomes, and improving equity among the Medicaid patient population. Conclusions: There is a strong clinical endorsement to continue the telehealth flexibility enabled by the PHE, primarily for video combined with audio telehealth, with caution against audio-only telehealth in situations where hands-on intervention is necessary for diagnosis or treatment. There is also support for reimbursing remote monitoring services and telehealth interprofessional services, albeit with guardrails. These results are primarily from a perspective of improving access, outcomes, and equity; other state-specific factors such as fiscal impact and technical implementation may need to be taken into account when considering reimbursement decisions on telehealth. %M 38546706 %R 10.2196/46412 %U https://www.jmir.org/2024/1/e46412 %U https://doi.org/10.2196/46412 %U http://www.ncbi.nlm.nih.gov/pubmed/38546706 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e49130 %T Digital Health Interventions in Older Adult Populations Living With Chronic Disease in High-Income Countries: Protocol for a Scoping Review %A Ashraf,Mir Nabila %A Gallant,Natasha L %A Bradley,Cara %+ Department of Psychology and Centre on Aging and Health, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada, 1 306 585 4219, Natasha.Gallant@uregina.ca %K chronic disease %K high-income countries %K digital health %K interventions %K older adults %K quality of life %D 2024 %7 28.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Globally, around 80% percent of adults aged 65 years or older are living with at least 1 chronic disease, and 68% percent have 2 or more chronic diseases. Older adults living with chronic diseases require greater health care services, but these health care services are not always easily accessible. Furthermore, the COVID-19 pandemic has resulted in unprecedented changes in the provision of health care services for older adults. During the COVID-19 pandemic, digital health interventions for chronic disease management were developed out of necessity, but the evidence regarding these and developed interventions is lacking. Objective: In this scoping review, we aim to identify available digital health interventions such as emails, text messages, voice messages, telephone calls, video calls, mobile apps, and web-based platforms for chronic disease management for older adults in high-income countries. Methods: We will follow the Arksey and O’Malley framework to conduct the scoping review. Our full search strategy was developed following a preliminary search on MEDLINE. We will include studies where older adults are at least 65 years of age, living with at least 1 chronic disease (eg, cancer, cardiovascular disease, chronic obstructive pulmonary disease, and diabetes), and residing in high-income countries. Digital health interventions will be broadly defined to include emails, text messages, voice messages, telephone calls, video calls, mobile apps, and web-based platforms. Results: This scoping review is currently ongoing. As of March 2023, our full search strategy has resulted in a total of 9901 records. We completed the screening of titles and abstracts and obtained 442 abstracts for full-text review. We are aiming to complete our full-text review in October 2024, data extraction in November 2024, and data synthesis in December 2024. Conclusions: This scoping review will generate evidence that will contribute to the further development of digital health interventions for future chronic disease management among older adults in high-income countries. More evidence-based research is needed to better understand the feasibility and limitations associated with the use of digital health interventions for this population. These evidence-based findings can then be disseminated to decision-makers and policy makers in other high-income countries. International Registered Report Identifier (IRRID): DERR1-10.2196/49130 %M 38546710 %R 10.2196/49130 %U https://www.researchprotocols.org/2024/1/e49130 %U https://doi.org/10.2196/49130 %U http://www.ncbi.nlm.nih.gov/pubmed/38546710 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49058 %T Outpatient Video Visits During the COVID-19 Pandemic: Cross-Sectional Survey Study of Patients’ Experiences and Characteristics %A van den Bosch,Stefanie C %A van Dalen,Demi %A Meinders,Marjan %A van Goor,Harry %A Bergé,Stefaan %A Stommel,Martijn %A van Dulmen,Sandra %+ Department of Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, 6525 GA, Netherlands, 31 243611111, demi.vandalen@radboudumc.nl %K telemedicine %K video visit %K remote consultation %K eHealth %K patient-centered care %K COVID-19 %K mobile phone %D 2024 %7 27.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: During the first lockdown of the COVID-19 pandemic, an exponential increase in video consultations replacing in-person outpatient visits was observed in hospitals. Insight into patients’ experiences with this type of consultation is helpful for a broad, sustainable, and patient-centered implementation of video consultation. Objective: This study aims to examine patients’ experiences with video consultation during the COVID-19 pandemic and identify discriminative patient and consultation characteristics to determine when video consultation is most feasible. Methods: A cross-sectional survey study was conducted. Patients aged ≥18 years and scheduled for a video consultation at the outpatient clinic of a Dutch university medical center from August 2020 to December 2020 for all medical specialties were eligible. Patients’ experiences were explored through a study-specific survey using descriptive quantitative statistics. Open-ended questions were qualitatively analyzed and thematically categorized into appreciated aspects and aspects for improvement. Discriminative patient and consultation characteristics were identified using 3 distinctive survey items. Characteristics of patients who scored and those who did not score all 3 items positively were analyzed using binary logistic regression. Results: A total of 1054 patients were included in the analysis. Most patients (964/1054, 91.46%) were satisfied with their video consultation, with a mean overall grade of 8.6 (SD 1.3) of 10. In the qualitative analyses, 70.02% (738/1054) of the patients cited aspects they appreciated and 44.97% (474/1054) mentioned aspects for improvement during their consultation. Patients with better self-rated health reported a positive evaluation significantly more often (P=.001), which also held true for other medical specialties (vs surgical and nonsurgical specialties; P<.001). Conclusions: Video consultation was perceived as highly satisfactory by patients during the COVID-19 pandemic, with the best experience reported by healthy participants and those undergoing their first consultation. Appreciated aspects are mainly at the individual professional level, organizational level, and innovation level itself. The aspects that were mentioned for improvement can be changed for the better. %M 38536236 %R 10.2196/49058 %U https://www.jmir.org/2024/1/e49058 %U https://doi.org/10.2196/49058 %U http://www.ncbi.nlm.nih.gov/pubmed/38536236 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56892 %T Patient Education and Decision Support for Long-Acting Injectable HIV Antiretroviral Therapy: Protocol for Tool Development and Pilot Testing with Ryan White HIV/AIDS Program Medical Case Management Programs in New York %A Irvine,Mary Kathryn %A Zimba,Rebecca %A Avoundjian,Tigran %A Peterson,Meghan %A Emmert,Connor %A Kulkarni,Sarah G %A Philbin,Morgan M %A Kelvin,Elizabeth A %A Nash,Denis %+ Bureau of Hepatitis, HIV and Sexually Transmitted Infections (BHHS), New York City Department of Health and Mental Hygiene, 42-09 28th St., New York, NY, 11101, United States, 1 347 396 7712, maryk.irvine@gmail.com %K HIV %K implementation science %K long-acting injectables %K LAI %K patient decision aid %K medical case management %K MCM %K antiretroviral therapy %K ART %D 2024 %7 27.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Long-acting injectable (LAI) HIV antiretroviral therapy (ART) presents a major opportunity to facilitate and sustain HIV viral suppression, thus improving health and survival among people living with HIV and reducing the risk of onward transmission. However, realizing the public health potential of LAI ART requires reaching patients who face barriers to daily oral ART adherence and thus can clinically benefit from alternative treatment modalities. Ryan White HIV/AIDS Program Part A medical case management (MCM) programs provide an array of services to address barriers to HIV care and treatment among economically and socially marginalized people living with HIV. These programs have demonstrated effectiveness in improving engagement along the continuum of care, but findings of limited program impact on durable viral suppression highlight the need to further innovate and hone strategies to support long-term ART adherence. Objective: This study aims to adapt and expand Ryan White MCM service strategies to integrate LAI ART regimen options, with the larger goal of improving health outcomes in the populations that could most benefit from alternatives to daily oral ART regimens. Methods: In 3 phases of work involving patient and provider participants, this study uses role-specific focus groups to elicit perceptions of LAI versus daily oral ART; discrete choice experiment (DCE) surveys to quantify preferences for different ART delivery options and related supports; and a nonrandomized trial to assess the implementation and utility of newly developed tools at 6 partnering Ryan White HIV/AIDS Program Part A MCM programs based in urban, suburban, and semirural areas of New York. Findings from the focus groups and DCEs, as well as feedback from advisory board meetings, informed the design and selection of the tools: a patient-facing, 2-page fact sheet, including frequently asked questions and a side-by-side comparison of LAI with daily oral ART; a patient-facing informational video available on YouTube (Google Inc); and a patient-provider decision aid. Implementation outcomes, measured through provider interviews, surveys, and service reporting, will guide further specification of strategies to integrate LAI ART options into MCM program workflows. Results: The study was funded in late April 2021 and received approval from the institutional review board in May 2021 under protocol 20-096. Focus groups were conducted in late 2021 (n=21), DCEs ran from June 2022 to January 2023 (n=378), and tools for piloting were developed by May 2023. The trial (May 2023 through January 2024) has enrolled >200 patients. Conclusions: This study is designed to provide evidence regarding the acceptability, feasibility, appropriateness, and utility of a package of patient-oriented tools for comparing and deciding between LAI ART and daily oral ART options. Study strengths include formative work to guide tool development, a mixed methods approach, and the testing of tools in real-world safety-net service settings. Trial Registration: Clinicaltrials.gov NCT05833542; https://clinicaltrials.gov/study/NCT05833542 International Registered Report Identifier (IRRID): DERR1-10.2196/56892 %M 38536227 %R 10.2196/56892 %U https://www.researchprotocols.org/2024/1/e56892 %U https://doi.org/10.2196/56892 %U http://www.ncbi.nlm.nih.gov/pubmed/38536227 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e50532 %T Assessment of Patient Safety in a Low-Resource Health Care System: Proposal for a Multimethod Study %A Haque,Ghazal %A Asif,Fozia %A Ahmed,Fasih Ali %A Ayub,Farwa %A Syed,Sabih ul Hassan %A Pradhan,Nousheen Akber %A Hameed,Malika %A Siddiqui,Muhammad Muneeb Ullah %A Mahmood,Shafaq %A Zaidi,Tahani %A Siddiqi,Sameen %A Latif,Asad %+ Department of Anesthesiology, Aga Khan University Medical College, Stadium Road, Karachi, 74800, Pakistan, 92 2134864639, asad.latif@aku.edu %K patient safety %K health systems %K quality assessment %K safety culture %K assessment %K healthcare delivery %K health system %K hospital %K low-middle-income countries %K research methodology %D 2024 %7 27.3.2024 %9 Proposal %J JMIR Res Protoc %G English %X Background: The high prevalence of adverse events (AEs) globally in health care delivery has led to the establishment of many guidelines to enhance patient safety. However, patient safety is a relatively nascent concept in low- and middle-income countries (LMICs) where health systems are already overburdened and underresourced. This is why it is imperative to study the nuances of patient safety from a local perspective to advocate for the judicious use of scarce public health resources. Objective: This study aims to assess the status of patient safety in a health care system within a low-resource setting, using a multipronged, multimethod approach of standardized methodologies adapted to the local setting. Methods: We propose purposive sampling to include a representative mix of public and private, rural and urban, and tertiary and secondary care hospitals, preferably those ascribed to the same hospital quality standards. Six different approaches will be considered at these hospitals including (1) focus group discussions on the status quo of patient safety, (2) Hospital Survey on Patient Safety Culture, (3) Hospital Consumer Assessment of Healthcare Providers and Systems, (4) estimation of incidence of AEs identified by patients, (5) estimation of incidence of AEs via medical record review, and (6) assessment against the World Health Organization’s Patient Safety Friendly Hospital Framework via thorough reviews of existing hospital protocols and in-person surveys of the facility. Results: The abovementioned studies collectively are expected to yield significant quantifiable information on patient safety conditions in a wide range of hospitals operating within LMICs. Conclusions: A multidimensional approach is imperative to holistically assess the patient safety situation, especially in LMICs. Our low-budget, non–resource-intensive research proposal can serve as a benchmark to conduct similar studies in other health care settings within LMICs. International Registered Report Identifier (IRRID): PRR1-10.2196/50532 %M 38536223 %R 10.2196/50532 %U https://www.researchprotocols.org/2024/1/e50532 %U https://doi.org/10.2196/50532 %U http://www.ncbi.nlm.nih.gov/pubmed/38536223 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55351 %T Wait Times for Scheduling Appointments for Prevention of Macrovascular and Microvascular Complications of Diabetes: Cross-Sectional Descriptive Study %A Basch,Corey H %A Hillyer,Grace C %A Basch,Charles E %+ Department of Public Health, William Paterson University, University Hall, Wayne, NJ, 07470, United States, 1 973 720 2603, baschc@wpunj.edu %K appointment scheduling %K cardiologists %K chronic disease %K cross-sectional study %K diabetes %K endocrinologists %K healthcare utilization %K lifestyle modification %K management plan %K metabolic control %K online booking %K ophthalmologists %K prevention %K quality of life %K scheduling appointments %K scheduling %K specialist %K timeliness %K United States %K wait time %K well-being %D 2024 %7 26.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Diabetes is a chronic disease that requires lifelong management and care, affecting around 422 million people worldwide and roughly 37 million in the United States. Patients newly diagnosed with diabetes must work with health care providers to formulate a management plan, including lifestyle modifications and regular office visits, to improve metabolic control, prevent or delay complications, optimize quality of life, and promote well-being. Objective: Our aim is to investigate one component of system-wide access to timely health care for people with diabetes in New York City (NYC), namely the length of time for someone with newly diagnosed diabetes to obtain an appointment with 3 diabetes care specialists: a cardiologist, an endocrinologist, and an ophthalmologist, respectively. Methods: We contacted the offices of 3 different kinds of specialists: cardiologists, endocrinologists, and ophthalmologists, by telephone, for this descriptive cross-sectional study, to determine the number of days required to schedule an appointment for a new patient with diabetes. The sampling frame included all specialists affiliated with any private or public hospital in NYC. The number of days to obtain an appointment with each specialist was documented, along with “time on hold” when attempting to schedule an appointment and the presence of online booking capabilities. Results: Of the 1639 unique physicians affiliated with (private and public) hospitals in the 3 subspecialties, 1032 (cardiologists, endocrinologists, and ophthalmologists) were in active practice and did not require a referral. The mean wait time for scheduling an appointment was 36 (SD 36.4; IQR 12-51.5) days for cardiologists; 82 (SD 47; IQR 56-101) days for endocrinologists; and 50.4 (SD 56; IQR 10-72) days for ophthalmologists. The median wait time was 27 days for cardiologists, 72 days for endocrinologists, and 30 days for ophthalmologists. The mean time on hold while attempting to schedule an appointment with these specialists was 2.6 (SD 5.5) minutes for cardiologists, 5.4 (SD 4.3) minutes for endocrinologists, and 3.2 (SD 4.8) minutes for ophthalmologists, respectively. Over 46% (158/341) of cardiologists enabled patients to schedule an appointment on the web, and over 55% (128/228) of endocrinologists enabled patients to schedule an appointment on the web. In contrast, only approximately 25% (117/463) of ophthalmologists offered web-based appointment scheduling options. Conclusions: The results indicate considerable variation in wait times between and within the 3 specialties examined for a new patient in NYC. Given the paucity of research on wait times for newly diagnosed people with diabetes to obtain an appointment with different specialists, this study provides preliminary estimates that can serve as an initial reference. Additional research is needed to document the extent to which wait times are associated with complications and the demographic and socio-economic characteristics of people served by different providers. %M 38530352 %R 10.2196/55351 %U https://www.jmir.org/2024/1/e55351 %U https://doi.org/10.2196/55351 %U http://www.ncbi.nlm.nih.gov/pubmed/38530352 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54211 %T Equity-Centered Postdischarge Support for Medicaid-Insured People: Protocol for a Type 1 Hybrid Effectiveness-Implementation Stepped Wedge Cluster Randomized Controlled Trial %A Brooks Carthon,J Margo %A Brom,Heather %A Grantham-Murrillo,Marsha %A Sliwinski,Kathy %A Mason,Aleigha %A Roeser,Mindi %A Miles,Donna %A Garcia,Dianne %A Bennett,Jovan %A Harhay,Michael O %A Flores,Emilia %A Amenyedor,Kelvin %A Clark,Rebecca %+ University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA, 19104, United States, 1 215 498 8050, jmbrooks@nursing.upenn.edu %K health care disparities %K evidence-based practice %K Medicaid %K transitional care %K implementation science %K socioeconomic disparities in health %D 2024 %7 26.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Disparities in posthospitalization outcomes for people with chronic medical conditions and insured by Medicaid are well documented, yet interventions that mitigate them are lacking. Prevailing transitional care interventions narrowly target people aged 65 years and older, with specific disease processes, or limitedly focus on individual-level behavioral change such as self-care or symptom management, thus failing to adequately provide a holistic approach to ensure an optimal posthospital care continuum. This study evaluates the implementation of THRIVE—an evidence-based, equity-focused clinical pathway that supports Medicaid-insured individuals with multiple chronic conditions transitioning from hospital to home by focusing on the social determinants of health and systemic and structural barriers in health care delivery. THRIVE services include coordinating care, standardizing interdisciplinary communication, and addressing unmet clinical and social needs following hospital discharge. Objective: The study’s objectives are to (1) examine referral patterns, 30-day readmission, and emergency department use for participants who receive THRIVE support services compared to those receiving usual care and (2) evaluate the implementation of the THRIVE clinical pathway, including fidelity, feasibility, appropriateness, and acceptability. Methods: We will perform a sequential randomized rollout of THRIVE to case managers at the study hospital in 3 steps (4 in the first group, 4 in the second, and 5 in the third), and data collection will occur over 18 months. Inclusion criteria for THRIVE participation include (1) being Medicaid insured, dually enrolled in Medicaid and Medicare, or Medicaid eligible; (2) residing in Philadelphia; (3) having experienced a hospitalization at the study hospital for more than 24 hours with a planned discharge to home; (4) agreeing to home care at partner home care settings; and (5) being aged 18 years or older. Qualitative data will include interviews with clinicians involved in THRIVE, and quantitative data on health service use (ie, 30-day readmission, emergency department use, and primary and specialty care) will be derived from the electronic health record. Results: This project was funded in January 2023 and approved by the institutional review board on March 10, 2023. Data collection will occur from March 2023 to July 2024. Results are expected to be published in 2025. Conclusions: The THRIVE clinical pathway aims to reduce disparities and improve postdischarge care transitions for Medicaid-insured patients through a system-level intervention that is acceptable for THRIVE participants, clinicians, and their teams in hospitals and home care settings. By using our equity-focused case management services and leveraging the power of the electronic medical record, THRIVE creates efficiencies by identifying high-need patients, improving communication across acute and community-based sectors, and driving evidence-based care coordination. This study will add important findings about how the infusion of equity-focused principles in the design and evaluation of evidence-based interventions contributes to both implementation and effectiveness outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/54211 Trial Registration: ClinicalTrials.gov NCT05714605; https://clinicaltrials.gov/ct2/show/NCT05714605 %M 38530349 %R 10.2196/54211 %U https://www.researchprotocols.org/2024/1/e54211 %U https://doi.org/10.2196/54211 %U http://www.ncbi.nlm.nih.gov/pubmed/38530349 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54440 %T Telehealth-Delivered Program and Accompanying Patients to Enhance the Clinical Condition of Patients Throughout a Liver Transplant: Protocol for a Mixed Methods Study %A Pomey,Marie-Pascale %A Le Roux,Enora %A Nadon,Nathalie %A Perron,Jessie %A Barry,Angèle %A Bémeur,Chantal %A Poder,Thomas G %A Duford,Fernand %A Laviolette,Louise %A Tétrault-Lassonde,Johanne %A Vialaron,Cécile %A Escalona,Manuel J %A Normandin,Louise %A Huard,Geneviève %A Girardin,Catherine %A Rose,Christopher %A Malas,Kathy %A Ouellet,Denis %A Vincent,Catherine %+ Carrefour de l’Innovation, Centre de recherche du Centre hospitalier de l'Université de Montréal, 850, rue Saint-Denis (bureau S01.124), Montréal, QC, H2X 0A9, Canada, 1 514 890 8000 ext 14302, marie-pascale.pomey@umontreal.ca %K liver transplantation %K accompanying patients %K connected objects %K health care model %K digital platform %D 2024 %7 22.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Liver transplantation (LT) is indicated in patients with severe acute or chronic liver failure for which no other therapy is available. With the increasing number of LTs in recent years, liver centers worldwide must manage their patients according to their clinical situation and the expected waiting time for transplantation. The LT clinic at the Centre hospitalier de l’Université de Montréal (CHUM) is developing a new health care model across the entire continuum of pre-, peri-, and posttransplant care that features patient monitoring by an interdisciplinary team, including an accompanying patient; a digital platform to host a clinical plan; a learning program; and data collection from connected objects. Objective: This study aims to (1) evaluate the outcomes following the implementation of a patient platform with connected devices and an accompanying patient, (2) identify implementation barriers and facilitators, (3) describe service outcomes in terms of health outcomes and the rates and nature of contact with the accompanying patient, (4) describe patient outcomes, and (5) assess the intervention’s cost-effectiveness. Methods: Six types of participants will be included in the study: (1) patients who received transplants and reached 1 year after transplantation before September 2023 (historical cohort or control group), (2) patients who will receive an LT between December 2023 and November 2024 (prospective cohort/intervention group), (3) relatives of those patients, (4) accompanying patients who have received an LT and are interested in supporting patients who will receive an LT, (5) health care professionals, and (6) decision makers. To describe the study sample and collect data to achieve all the objectives, a series of validated questionnaires, accompanying patient logbooks, transcripts of interviews and focus groups, and clinical indicators will be collected throughout the study. Results: In total, 5 (steering, education, clinical-technological, nurse prescription, and accompanying patient) working committees have been established for the study. Recruitment of patients is expected to start in November 2023. All questionnaires and technological platforms have been prepared, and the clinicians, stakeholders, and accompanying patient personnel have been recruited. Conclusions: The implementation of this model in the trajectory of LT recipients at the CHUM may allow for better monitoring and health of patients undergoing transplantation, ultimately reducing the average length of hospital stay and promoting better use of medical resources. In the event of positive results, this model could be transposed to all transplant units at the CHUM and across Quebec (potentially affecting 888 patients per year) but could also be applied more widely to the monitoring of patients with other chronic diseases. The lessons learned from this project will be shared with decision makers and will serve as a model for other initiatives involving accompanying patients, connected objects, or digital platforms. International Registered Report Identifier (IRRID): PRR1-10.2196/54440 %M 38517464 %R 10.2196/54440 %U https://www.researchprotocols.org/2024/1/e54440 %U https://doi.org/10.2196/54440 %U http://www.ncbi.nlm.nih.gov/pubmed/38517464 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56242 %T Homestay Hosting Dynamics and Refugee Well-Being: Protocol for a Scoping Review %A Al-Hamad,Areej %A Yasin,Yasin M %A Metersky,Kateryna %A Guruge,Sepali %A Mahsud,Khadija %+ Toronto Metropolitan University, DCC544- 288 Church St., Toronto, ON, M5B 1Z5, Canada, 1 416 979 5044 ext 554727, areej.hamad@torontomu.ca %K cohabitation %K homestay %K hospitality %K host family %K host-guest relationship %K refugee %K well-being %D 2024 %7 19.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The process of refugee resettlement and integration into new communities is a complex and multifaceted challenge, not only for the refugees themselves but also for the host families involved in homestay housing arrangements. While these homestay arrangements are designed to facilitate smoother transitions and enhance the well-being of refugees, the nuanced dynamics of these interactions and their overall impact on both refugees and their host families remain underexplored. Understanding the experiences of refugees and their host families is vital for effective refugee settlement, integration, and well-being. However, the intricacies of homestay refugee hosting, their interactions with host families, and the impact on their well-being are still unclear and ambiguous. Objective: The aim of this scoping review is to examine the breadth of literature on the experiences of refugees living in homestay arrangements with their host families. This review seeks to understand how these dynamics influence refugee well-being, including their integration, social connections, and mental health. Additionally, this scoping review aims to synthesize existing literature on homestay hosting dynamics, focusing on the experiences of refugees and their host families, to identify gaps in knowledge and suggest areas for future research. Methods: This scoping review follows Joanna Briggs Institute methodology and will search databases such as CINAHL, SOCIndex, MEDLINE through EBSCO; APA PsycInfo, Scopus through OVID; and Web of Science Core Collection, ProQuest Dissertations, and Theses, and SciELO Citation Index, focusing on literature from 2011 onward, in English, in relation to refugee groups in different host countries, including all types of literature. Literature will be screened by 2 independent reviewers, with disagreements resolved by consensus or a third reviewer. A custom data extraction tool will be created by the research team. Results: The results will be organized in tables or diagrams, accompanied by a narrative overview, emphasizing the main synthesized findings related to the dynamics of homestay hosting with host families and refugee well-being. No critical appraisal will be conducted. This scoping review is expected to identify research gaps that will inform the development of homestay refugee hosting models, policies, and practices. It will also offer insights into best practices and policy recommendations to improve homestay hosting programs, ultimately contributing to more effective refugee settlement and integration strategies. Conclusions: Understanding the intricate dynamics of homestay hosting arrangements is crucial for developing policies and programs that support the well-being of refugees and the families that host them. This scoping review will shed light on the current knowledge landscape, identify research gaps, and suggest ways to enhance the homestay hosting experience for all parties involved. Through this work, we aim to contribute to the development of more inclusive, supportive, and effective approaches to refugee hosting, resettlement, and integration. International Registered Report Identifier (IRRID): DERR1-10.2196/56242 %M 38502182 %R 10.2196/56242 %U https://www.researchprotocols.org/2024/1/e56242 %U https://doi.org/10.2196/56242 %U http://www.ncbi.nlm.nih.gov/pubmed/38502182 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55332 %T Nonspecific Effects of the Bacillus Calmette-Guérin Vaccine in Portuguese Children Under 5 Years of Age: Protocol for a Population-Based Historical Birth Cohort Study %A Fronteira,Ines %A Pacheco,Matilde %A Schaltz-Buchholzer,Frederik %A Ferrinho,Paulo %+ NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, NOVA University, Avenida Padre Cruz, Lisbon, 1600-560, Portugal, 351 919745584, ines.fronteira@ensp.unl.pt %K BCG %K Bacillus Calmette-Guérin vaccine %K policy %K Portugal %K nonspecific effects %K vaccines %K heterologous immunity %D 2024 %7 14.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The Bacillus Calmette-Guérin vaccine (BCG) against tuberculosis (TB) shows beneficial nonspecific effects, which are likely related to innate immune training. Until 2016, a single BCG dose was administered to all newborns in Portugal. In July 2016, a clinical guideline established that only children under 6 years belonging to high-risk groups should receive BCG. This might have prevented nonvaccinated children from developing trained immunological responses as effectively as BCG-vaccinated children. Objective: This study aims to investigate if there is variation in TB-related and all-cause mortality, and severe, moderate, or mild morbidity in children under 5 years of age, and whether such variation might be explained by the BCG vaccination policy change in 2016. Methods: This population-based historical birth cohort study includes children under 5 years of age born in Portugal between July 1, 2010, and June 30, 2021. Newborns with low birth weight, premature status, or known or suspected HIV infection are excluded. The follow-up period is until the completion of 5 years of age or the end of follow-up (June 30, 2021). The study will use secondary data from the National Health Service user registry, death certificate database, vaccination registry, communicable diseases surveillance system, TB surveillance system, diagnosis-related group information system for hospital admissions and emergency department visits, and primary health care information system. The data will be linked. Primary outcomes include person-time incidence rates of death (all causes and TB), TB diagnosis, and all causes and some specific causes of severe, moderate, or mild morbidity, and the incidence rate ratio of nonvaccinated to BCG-vaccinated children. We will compare the probability of surviving the first and fifth years of life or of not having severe, moderate, or mild morbidity during the follow-up period according to exposure (BCG vaccinated or nonvaccinated, number of doses, and time from birth until the first dose), using the log-rank test for assessing differences in survival rates between exposed and nonexposed children and hazard ratios for quantifying the differences. Moreover, we will perform a proportional hazards regression analysis. Results: Ethics approval has been obtained. In March 2022, database owners were contacted to present the project and discuss the request for data. A unique identifier will be used. In July 2023, a process of redefinition of the variables per database was initiated. Data were received in October and November 2023. In November 2023, further work was conducted. By April 2024, we expect to start analyzing the full data set. Conclusions: The results will contribute to the accumulating body of knowledge and might have relevance to guide global BCG vaccination policy. Data linkage can contribute to a swifter mechanism to use available health data to conduct population-based studies and inform policy decision-making. Trial Registration: ClinicalTrials.gov NCT05471167; https://clinicaltrials.gov/study/NCT05471167 International Registered Report Identifier (IRRID): DERR1-10.2196/55332 %M 38328938 %R 10.2196/55332 %U https://www.researchprotocols.org/2024/1/e55332 %U https://doi.org/10.2196/55332 %U http://www.ncbi.nlm.nih.gov/pubmed/38328938 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 9 %N %P e53835 %T Outcomes of an Asynchronous Care Model for Chronic Conditions in a Diverse Population: 12-Month Retrospective Chart Review Study %A Hofner,Michael %A Hurnaus,Patrick %A DiStefano,Dan %A Philip,Shaji %A Kim,Sarah %A Shaw,Julie %A Waring,Avantika Chander %+ 9amHealth, 914 N Coast Highway 101, Suite A, Encinitas, CA, 92024, United States, 1 (202) 932 9958, avantika.waring@9am.health %K asynchronous %K blood pressure %K cardiology %K chronic disease %K cohort %K diabetes mellitus therapy %K diabetes %K diabetics %K eHealth %K e-health %K HbA1c %K health disparities %K heart %K hemoglobin A1c %K hypertension therapy %K hypertension %K hypertensive %K remote care %K retrospective %K telehealth %K telemedicine %K virtual care %D 2024 %7 13.3.2024 %9 Original Paper %J JMIR Diabetes %G English %X Background: Diabetes and hypertension are some of the most prevalent and costly chronic conditions in the United States. However, outcomes continue to lag behind targets, creating further risk of long-term complications, morbidity, and mortality for people living with these conditions. Furthermore, racial and ethnic disparities in glycemic and hypertension control persist. Flexible telehealth programs leveraging asynchronous care allow for increased provider access and more convenient follow-up, ultimately improving critical health outcomes across demographic groups. Objective: We aim to evaluate the 12-month clinical outcomes of participants in the 9amHealth web-based clinic for diabetes and hypertension. We hypothesized that participation in the 9amHealth program would be associated with significant improvements in glycemic and blood pressure (BP) control across a diverse group of individuals. Methods: We enrolled 95 patients in a completely web-based care clinic for diabetes and hypertension who received nutrition counseling, health coaching, and asynchronous physician consultations for medication prescribing. Patients received standard or cellular-connected glucose meters and BP cuffs in order to share data. Laboratory tests were completed either with at-home phlebotomy draws or a self-administered test kit. Patients’ first and last hemoglobin A1c (HbA1c) and BP results over the 12-month period were compared, and analyses were repeated across race and ethnicity groups. Results: Among all 95 patients, the average HbA1c decreased by –1.0 (from 8.2% to 7.2%; P<.001) over 12 months of program participation. In those with a baseline HbA1c >8%, the average HbA1c decreased by –2.1 (from 10.2% to 8.1%; P<.001), and in those with a baseline HbA1c >9%, the average HbA1c decreased by –2.8 (from 11% to 8.2%; P<.001). Among participants who identified as a race or ethnicity other than White, the HbA1c decreased by –1.2 (from 8.6% to 7.4%, P=.001). Further examination of subgroups confirmed HbA1c lowering within each race or ethnicity group. In the overall population, the average systolic BP decreased by 17.7 mm Hg (P=.006) and the average diastolic BP decreased by 14.3 mm Hg (P=.002). Among participants self-identifying as a race or ethnicity other than White, the results similarly showed a decrease in BP (average reduction in systolic BP of 10 mm Hg and in diastolic BP of 9 mm Hg). Conclusions: A fully web-based model leveraging all-asynchronous physician review and prescribing, combined with synchronous and asynchronous coaching and nutrition support, was associated with clinically meaningful improvement in HbA1c and BP control over a 12-month period among a diverse group of individuals. Further studies should prospectively evaluate the effectiveness of such models among larger populations, assess the longer-term sustainability of these outcomes, and explore financial models to make these types of programs broadly accessible. %M 38363585 %R 10.2196/53835 %U https://diabetes.jmir.org/2024/1/e53835 %U https://doi.org/10.2196/53835 %U http://www.ncbi.nlm.nih.gov/pubmed/38363585 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46713 %T Effect of Negative Online Reviews and Physician Responses on Health Consumers’ Choice: Experimental Study %A Han,Xi %A Lin,Yongxi %A Han,Wenting %A Liao,Ke %A Mei,Kefu %+ School of Management Science and Engineering, Shandong University of Finance and Economics, 7366 Erhuan East Road, Yifu Building 5th FL., Jinan, 250014, China, 86 15951933930, hwt_2023@126.com %K negative review %K proportion %K claim type %K attribution theory %K physician-rating websites %K consumer %K physician response %D 2024 %7 12.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has highlighted the importance of online medical services. Although some researchers have investigated how numerical ratings affect consumer choice, limited studies have focused on the effect of negative reviews that most concern physicians. Objective: This study aimed to investigate how negative review features, including proportion (low/high), claim type (evaluative/factual), and physician response (absence/presence), influence consumers’ physician evaluation process under conditions in which a physician’s overall rating is high. Methods: Using a 2×2×2 between-subject decision-controlled experiment, this study examined participants’ judgment on physicians with different textual reviews. Collected data were analyzed using the t test and partial least squares–structural equation modeling. Results: Negative reviews decreased consumers’ physician selection intention. The negative review proportion (β=–0.371, P<.001) and claim type (β=–0.343, P<.001) had a greater effect on consumers’ physician selection intention compared to the physician response (β=0.194, P<.001). A high negative review proportion, factual negative reviews, and the absence of a physician response significantly reduced consumers’ physician selection intention compared to their counterparts. Consumers’ locus attributions on the negative reviews affected their evaluation process. Physician attribution mediated the effects of review proportion (β=–0.150, P<.001), review claim type (β=–0.068, P=.01), and physician response (β=0.167, P<.001) on consumer choice. Reviewer attribution also mediated the effects of review proportion (β=–0.071, P<.001), review claim type (β=–0.025, P=.01), and physician response (β=0.096, P<.001) on consumer choice. The moderating effects of the physician response on the relationship between review proportion and physician attribution (β=–0.185, P<.001), review proportion and reviewer attribution (β=–0.110, P<.001), claim type and physician attribution (β=–0.123, P=.003), and claim type and reviewer attribution (β=–0.074, P=.04) were all significant. Conclusions: Negative review features and the physician response significantly influence consumer choice through the causal attribution to physicians and reviewers. Physician attribution has a greater effect on consumers’ physician selection intention than reviewer attribution does. The presence of a physician response decreases the influence of negative reviews through direct and moderating effects. We propose some practical implications for physicians, health care providers, and online medical service platforms. %M 38470465 %R 10.2196/46713 %U https://www.jmir.org/2024/1/e46713 %U https://doi.org/10.2196/46713 %U http://www.ncbi.nlm.nih.gov/pubmed/38470465 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e52296 %T Improvements in Neoplasm Classification in the International Classification of Diseases, Eleventh Revision: Systematic Comparative Study With the Chinese Clinical Modification of the International Classification of Diseases, Tenth Revision %A Xu,Yicong %A Zhou,Jingya %A Li,Hongxia %A Cai,Dong %A Zhu,Huanbing %A Pan,Shengdong %+ Department of Medical Administration, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China, 86 1 366 666 9123, psd618@zju.edu.cn %K Chinese Clinical Modification of the International Classification of Diseases, Tenth Revision %K ICD-10 %K ICD-10-CCM %K ICD-11 %K improvement %K International Classification of Diseases, Eleventh Revision %K International Classification of Diseases, Tenth Revision %K International Classification of Diseases %K neoplasm %K transition %D 2024 %7 8.3.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: The International Classification of Diseases, Eleventh Revision (ICD-11) improved neoplasm classification. Objective: We aimed to study the alterations in the ICD-11 compared to the Chinese Clinical Modification of the International Classification of Diseases, Tenth Revision (ICD-10-CCM) for neoplasm classification and to provide evidence supporting the transition to the ICD-11. Methods: We downloaded public data files from the World Health Organization and the National Health Commission of the People’s Republic of China. The ICD-10-CCM neoplasm codes were manually recoded with the ICD-11 coding tool, and an ICD-10-CCM/ICD-11 mapping table was generated. The existing files and the ICD-10-CCM/ICD-11 mapping table were used to compare the coding, classification, and expression features of neoplasms between the ICD-10-CCM and ICD-11. Results: The ICD-11 coding structure for neoplasms has dramatically changed. It provides advantages in coding granularity, coding capacity, and expression flexibility. In total, 27.4% (207/755) of ICD-10 codes and 38% (1359/3576) of ICD-10-CCM codes underwent grouping changes, which was a significantly different change (χ21=30.3; P<.001). Notably, 67.8% (2424/3576) of ICD-10-CCM codes could be fully represented by ICD-11 codes. Another 7% (252/3576) could be fully described by uniform resource identifiers. The ICD-11 had a significant difference in expression ability among the 4 ICD-10-CCM groups (χ23=93.7; P<.001), as well as a considerable difference between the changed and unchanged groups (χ21=74.7; P<.001). Expression ability negatively correlated with grouping changes (r=–.144; P<.001). In the ICD-10-CCM/ICD-11 mapping table, 60.5% (2164/3576) of codes were postcoordinated. The top 3 postcoordinated results were specific anatomy (1907/3576, 53.3%), histopathology (201/3576, 5.6%), and alternative severity 2 (70/3576, 2%). The expression ability of postcoordination was not fully reflected. Conclusions: The ICD-11 includes many improvements in neoplasm classification, especially the new coding system, improved expression ability, and good semantic interoperability. The transition to the ICD-11 will inevitably bring challenges for clinicians, coders, policy makers and IT technicians, and many preparations will be necessary. %M 38457228 %R 10.2196/52296 %U https://www.i-jmr.org/2024/1/e52296 %U https://doi.org/10.2196/52296 %U http://www.ncbi.nlm.nih.gov/pubmed/38457228 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e52590 %T The Effect of Body Temperature Changes on the Course of Treatment in Patients With Pneumonia and Sepsis: Results of an Observational Study %A Guzelj,Domen %A Grubelnik,Anže %A Greif,Nina %A Povalej Bržan,Petra %A Fluher,Jure %A Kalamar,Žiga %A Markota,Andrej %+ Medical Intensive Care Unit, University Medical Centre Maribor, Ljubljanska ulica 5, Maribor, 2000, Slovenia, 386 23212008, andrej.markota@ukc-mb.si %K fever %K targeted temperature management %K pneumonia %K sepsis %K intensive care unit %D 2024 %7 1.3.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Traditionally, patients who are critically ill with infection and fever have been treated with antipyretics or even physically cooled. Presumed benefits of the reduction of body temperature are mostly based on decreased metabolic demands. However, it has been shown that decreasing body temperature in patients who are critically ill is not associated with improvement in treatment outcomes. Additionally, there is some data to support the use of temperature modulation (therapeutic hyperthermia) as an adjuvant treatment strategy in patients with infection. Objective: This study aims to determine the effect of body temperature on the course of intensive care unit (ICU) treatment of patients who are mechanically ventilated with pneumonia, sepsis, and positive tracheal aspirates on admission. Methods: We performed a single-center retrospective study. Core body temperature was measured in all patients. We analyzed associations between average temperatures in the first 48 hours after admission to ICU and ICU treatment parameters. Additionally, patients were divided into three groups: patients with negative tracheal aspirates 1 week after ICU admission (P-N group), patients with a different pathogen in tracheal aspirates 1 week after ICU admission (P-HAP group), and patients with a persisting pathogen in tracheal aspirates 1 week after ICU admission (P-P group). Differences in body temperature and interventions aimed at temperature modulation were determined. Results: We observed a significantly higher average temperature in the first 48 hours after admission to ICU in patients who survived to hospital discharge compared to nonsurvivors (mean 37.2 °C, SD 1 °C vs mean 36.9 °C, SD 1.6 °C; P=.04). We observed no associations between average temperatures in the first 48 hours after ICU admission and days of mechanical ventilation in the first 7 days of treatment (ρ=–0.090; P=.30), the average maximum daily requirement for noradrenaline in the first 7 days of treatment (ρ=–0.029; P=.80), average maximum FiO2 in the first 7 days of ICU treatment (ρ=0.040; P=.70), and requirement for renal replacement therapy in the first 7 days of ICU treatment (mean 37.3 °C, SD 1.4 °C vs mean 37.0 °C, SD 1.3 °C; P=.23). In an additional analysis, we observed a significantly greater use of paracetamol in the P-N group (mean 1.0, SD 1.1 g vs mean 0.4, SD 0.7 g vs mean 0.4, SD 0.8 g; P=.009), a trend toward greater use of active cooling in the first 24 hours after ICU admission in the P-N group (n=11, 44% vs n=14, 33.3% vs n=16, 32%; P=.57), and no other significant differences in parameters of ICU treatment between patient groups. Conclusions: We observed better survival in patients who developed higher body temperatures in the first 48 hours after admission to the ICU; however, we observed no changes in other treatment parameters. Similarly, we observed greater use of paracetamol in patients with negative tracheal aspirates 1 week after ICU admission. Our results support the strategy of temperature tolerance in patients who are intubated with pneumonia and sepsis. %M 38427413 %R 10.2196/52590 %U https://www.i-jmr.org/2024/1/e52590 %U https://doi.org/10.2196/52590 %U http://www.ncbi.nlm.nih.gov/pubmed/38427413 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e48989 %T Using ChatGPT-Like Solutions to Bridge the Communication Gap Between Patients With Rheumatoid Arthritis and Health Care Professionals %A Chen,Chih-Wei %A Walter,Paul %A Wei,James Cheng-Chung %+ National Applied Research Laboratories, 3F, No 106, Sector 2, Heping East Road, Taipei, 106214, Taiwan, 886 975303092, chihwei.chen@udm.global %K rheumatoid arthritis %K ChatGPT %K artificial intelligence %K communication gap %K privacy %K data management %D 2024 %7 27.2.2024 %9 Viewpoint %J JMIR Med Educ %G English %X The communication gap between patients and health care professionals has led to increased disputes and resource waste in the medical domain. The development of artificial intelligence and other technologies brings new possibilities to solve this problem. This viewpoint paper proposes a new relationship between patients and health care professionals—“shared decision-making”—allowing both sides to obtain a deeper understanding of the disease and reach a consensus during diagnosis and treatment. Then, this paper discusses the important impact of ChatGPT-like solutions in treating rheumatoid arthritis using methotrexate from clinical and patient perspectives. For clinical professionals, ChatGPT-like solutions could provide support in disease diagnosis, treatment, and clinical trials, but attention should be paid to privacy, confidentiality, and regulatory norms. For patients, ChatGPT-like solutions allow easy access to massive amounts of information; however, the information should be carefully managed to ensure safe and effective care. To ensure the effective application of ChatGPT-like solutions in improving the relationship between patients and health care professionals, it is essential to establish a comprehensive database and provide legal, ethical, and other support. Above all, ChatGPT-like solutions could benefit patients and health care professionals if they ensure evidence-based solutions and data protection and collaborate with regulatory authorities and regulatory evolution. %M 38412022 %R 10.2196/48989 %U https://mededu.jmir.org/2024/1/e48989 %U https://doi.org/10.2196/48989 %U http://www.ncbi.nlm.nih.gov/pubmed/38412022 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e47817 %T Behavioral Insights from Vaccine Adoption in Nigeria: Cross-Sectional Survey Findings %A Agha,Sohail %A Nsofor,Ifeanyi %A Bernard,Drew %A Francis,Sarah %A Rao,Nandan %+ Behavior Design Lab, Stanford University, 581 Capistrano Way, Stanford, CA, 94305, United States, 1 1 206 351 9346, sohailagha@gmail.com %K behavioral insights %K COVID-19 %K Nigeria %K surveys %K vaccination %D 2024 %7 26.2.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: To generate behavioral insights for the development of effective vaccination interventions, we need approaches that combine rapid and inexpensive survey data collection with instruments based on easy-to-use behavior models. This study demonstrates how an inexpensive digital survey helped identify the drivers of COVID-19 vaccination in Nigeria. Objective: This study aims to illustrate how behavioral insights can be generated through inexpensive digital surveys. Methods: We designed and conducted a cross-sectional survey with multistage sampling. Data were collected from Nigerians (aged ≥18 years) from 120 strata based on age, sex, state, and urban or rural location. Respondents were recruited via advertisements on Meta platforms (Facebook and Instagram) using the Virtual Lab open-source tool. We used a Meta Messenger chatbot for data collection; participants were compensated with 400 naira (US $0.87 cents). Data collection took 2 weeks. In total, 957 respondents completed the survey, at an advertising cost of US $1.55 per respondent. An 18-item instrument measuring core motivators, ability barriers, sociodemographic characteristics, and respondents’ vaccination status was pretested before data collection. We ran separate logistic regression models to examine the relationships between vaccine uptake and core motivators, ability barriers, and sociodemographic variables. A final model that predicted vaccine uptake included all 3 sets of variables. Results: About 56% (n=540) of respondents reported that they had received at least 1 COVID-19 vaccination. Three core motivators were positively associated with vaccine uptake: the belief that the COVID-19 vaccine promised a better life (adjusted odds ratio [aOR] 3.51, 95% CI 2.23-5.52), the belief that the vaccine would allow respondents to do more things they enjoyed (aOR 1.97, 95% CI 1.33-2.93), and respondents’ perception that their friends and family members accepted their decision to get vaccinated (aOR 1.62, 95% CI 1.06-2.48). Two ability barriers were negatively associated with vaccine uptake: cost- or income-related concerns lowered the odds of being vaccinated (aOR 0.35, 95% CI 0.24-0.50) and the lack of availability of vaccines at places respondents routinely visited also lowered their odds of being vaccinated (aOR 0.29, 95% CI 0.21-0.40). After adjusting for other variables, the perceived fear of getting COVID-19 and the hardship associated with the disease were no longer associated with vaccine uptake. Conclusions: These findings suggest that hope is more important for Nigerians than fear when it comes to vaccine adoption, enjoying life is more important than worrying about getting the disease, and approval from friends and family is more powerful than their disapproval. These findings suggest that emphasizing the benefits of leading a fuller life after being vaccinated is more likely to succeed than increasing Nigerians’ fear of COVID-19. This study identifies a very different set of factors associated with COVID-19 vaccine adoption than previous Nigerian studies. %M 38407956 %R 10.2196/47817 %U https://www.i-jmr.org/2024/1/e47817 %U https://doi.org/10.2196/47817 %U http://www.ncbi.nlm.nih.gov/pubmed/38407956 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e44062 %T The Use of ICD-9-CM Coding to Identify COVID-19 Diagnoses and Determine Risk Factors for 30-Day Death Rate in Hospitalized Patients in Italy: Retrospective Study %A Giordani,Barbara %A Burgio,Alessandra %A Grippo,Francesco %A Barone,Alessandra %A Eugeni,Erica %A Baglio,Giovanni %+ Research, National Outcomes Evaluation Programme (PNE) and International Relations Unit, Italian National Agency for Regional Healthcare Services, Via Piemonte 60, Rome, 00187, Italy, 39 06 42749713, giordani@agenas.it %K COVID-19 %K ICD-9-CM coding %K hospitalizations %K SARS-CoV-2 %K coronavirus %K risk factor %K Italy %K death rate %K monitoring %K hospital records %K coding %K algorithm %D 2024 %7 23.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In Italy, it has been difficult to accurately quantify hospital admissions of patients with a COVID-19 diagnosis using the Hospital Information System (HIS), mainly due to the heterogeneity of codes used in the hospital discharge records during different waves of the COVID-19 pandemic. Objective: The objective of this study was to define a specific combination of codes to identify the COVID-19 hospitalizations within the HIS and to investigate the risk factors associated with mortality due to COVID-19 among patients admitted to Italian hospitals in 2020. Methods: A retrospective study was conducted using the hospital discharge records, provided by more than 1300 public and private Italian hospitals. Inpatient hospitalizations were detected by implementing an algorithm based on specific International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code combinations. Hospitalizations were analyzed by different clinical presentations associated with COVID-19 diagnoses. In addition, 2 multivariable Cox regression models were performed among patients hospitalized “due to COVID-19” from January 1 to December 31, 2020, to investigate potential risk factors associated with 30-day death and the temporal changes over the course of the pandemic; in particular, the 30-day death rates during the first and the second waves were analyzed across 3 main geographical areas (North, Center, and South and Islands) and by discharge wards (ordinary and intensive care). Results: We identified a total of 325,810 hospitalizations with COVID-19–related diagnosis codes. Among these, 73.4% (n=239,114) were classified as “due to COVID-19,” 14.5% (n=47,416) as “SARS-CoV-2 positive, but not due to COVID-19,” and 12.1% (n=39,280) as “suspected COVID-19” hospitalizations. The cohort of patients hospitalized “due to COVID-19” included 205,048 patients, with a median age of 72 years and a higher prevalence of male patients (n=124,181, 60.6%). The overall 30-day death rate among hospitalized patients due to COVID-19 was 9.9 per 1000 person-days. Mortality was lower for women (hazard ratio [HR]=0.83; P<.001) and for patients coming from high migration pressure countries, especially Northern Africans (HR=0.65; P<.001) and Central and Eastern Europeans (HR=0.66; P<.001), compared to patients coming from Italy and high-income countries. In the southern regions and the Islands, mortality was higher compared to the northern regions (HR=1.17; P<.001), especially during the second wave of COVID-19 among patients with a transfer to intensive care units (HR=2.52; P<.001). Conclusions: To our knowledge, the algorithm is the first attempt to define, at a national level, selection criteria for identifying COVID-19 hospitalizations within the HIS. The implemented algorithm will be used to monitor the pandemic over time, and the patients selected in 2020 will be followed up in the next years to assess the long-term effects of COVID-19. %M 38393763 %R 10.2196/44062 %U https://publichealth.jmir.org/2024/1/e44062 %U https://doi.org/10.2196/44062 %U http://www.ncbi.nlm.nih.gov/pubmed/38393763 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54707 %T Supporting Life Adjustment in Patients With Lung Cancer Through a Comprehensive Care Program: Protocol for a Controlled Before-and-After Trial %A Jung,Wonyoung %A Ahn,Alice %A Lee,Genehee %A Kong,Sunga %A Kang,Danbee %A Lee,Dongok %A Kim,Tae Eun %A Shim,Young Mog %A Kim,Hong Kwan %A Cho,Jongho %A Cho,Juhee %A Shin,Dong Wook %+ Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea, 82 2 3410 5252, dwshin.md@gmail.com %K comprehensive care %K early intervention %K adjustment to cancer %K return to work %K lung cancer %K unmet needs %K lung %K lungs %K pulmonary %K respiratory %K cancer %K oncology %K prehabilitation %K survivor %K survivors %K survivorship %K education %K educational %D 2024 %7 13.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Lung cancer diagnosis affects an individual’s quality of life as well as physical and emotional functioning. Information on survivorship care tends to be introduced at the end of treatment, but early intervention may affect posttreatment adjustment. However, to the best of our knowledge, no study has explored the effect of early information intervention on the return to work, family, and societal roles of lung cancer survivors. Objective: We report the study protocol of a comprehensive care prehabilitation intervention designed to facilitate lung cancer survivors’ psychological adjustment after treatment. Methods: A comprehensive care program was developed based on a literature review and a qualitative study of patients with lung cancer and health professionals. The Lung Cancer Comprehensive Care Program consists of educational videos and follow-up visits by a family medicine physician. To prevent contamination, the control group received routine education, whereas the intervention group received routine care and intervention. Both groups completed questionnaires before surgery (T0) and at 1-month (T1), 6-month (T2), and 1-year (T3) follow-up visits after surgery. The primary outcome was survivors’ psychological adjustment to cancer 6 months after pulmonary resection. Results: The historical control group (n=441) was recruited from September 8, 2021, to April 20, 2022, and the intervention group (n=350) was recruited from April 22, 2022, to October 17, 2022. All statistical analyses will be performed upon completion of the study. Conclusions: This study examined the effectiveness of an intervention that provided general and tailored informational support to lung cancer survivors, ranging from before to the end of treatment. Trial Registration: ClinicalTrials.gov NCT05078918; https://clinicaltrials.gov/ct2/show/NCT05078918 International Registered Report Identifier (IRRID): DERR1-10.2196/54707 %M 38349712 %R 10.2196/54707 %U https://www.researchprotocols.org/2024/1/e54707 %U https://doi.org/10.2196/54707 %U http://www.ncbi.nlm.nih.gov/pubmed/38349712 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52917 %T Let’s Agree to Disagree on Operative Versus Nonoperative Treatment for Distal Radius Fractures in Older People: Protocol for a Prospective International Multicenter Cohort Study %A van Veelen,Nicole Maria %A van de Wall,Bryan J M %A Hoepelman,Ruben J %A IJpma,Frank F A %A Link,Björn-Christian %A Babst,Reto %A Groenwold,Rolf H H %A van der Velde,Detlef %A Diwersi,Nadine %A van Heijl,Mark %A Houwert,R Marijn %A Beeres,Frank J P %+ Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Spitalstrasse, Luzern, 6000, Switzerland, 41 412054770, nicole.vanveelen@luks.ch %K distal radius fracture %K older patients %K natural experiment %K study protocol %K observational study %D 2024 %7 13.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Distal radius fractures are the most frequently encountered fractures in Western societies, typically affecting patients aged 50 years and older. Although this is a common injury, the best treatment for these fractures in older patients is still under debate. Objective: This prospective study aims to compare the outcome of operatively and nonoperatively treated distal radius fractures in the older population. Only patients with distal radius fractures for which equipoise regarding the optimal treatment exists will be included. Methods: This prospective international multicenter observational cohort study will be designed as a natural experiment. Natural experiments are observational studies in which treatment allocation is determined by factors outside the control of the investigators but also (largely) independent of patient characteristics. Patients aged 65 years and older with an acute distal radius fracture will be considered for inclusion. Treatment allocation (operative vs nonoperative) will be based on the local preferences of the treating hospital either in Switzerland or the Netherlands. Hence, the process governing treatment allocation resembles that of randomization. Patients will be identified after treatment has been initiated. Based on the radiographs and baseline information of the patient, an expert panel of 6 certified trauma surgeons from 2 regions will provide their treatment recommendation. Only patients for whom the experts disagree on treatment recommendations will ultimately be included in the study (ie, for whom there is a clinical equipoise). For these patients, both operative and nonoperative treatment of distal radius fractures are viable, and treatment choice is predominantly determined by personal or local preference. The primary outcome will be the Patient-Rated Wrist Evaluation score at 12 weeks. Secondary outcomes will include the Physical Activity Score for the Elderly, the EQ questionnaire, pain, the living situation, range of motion, complications, and radiological outcomes. By including outcomes such as living situation and the Physical Activity Score for the Elderly, which are not relevant for younger cohorts, valuable information to tailor treatment to the needs of the older population can be gained. According to the sample size collection, which was based on the minimal important clinical difference of the Patient-Rated Wrist Evaluation, 92 patients will have to be included, with at least 46 patients in each treatment group. Results: Enrollment began in July 2023 and is expected to continue until summer 2024. The final follow-up will be 2 years after the last patient is included. Conclusions: Although many trials on this topic have previously been published, there remains an ongoing debate regarding the optimal treatment for distal radius fractures in older patients. This observational study, which will use a fairly new methodological study design, will provide further information on treatment outcomes for older patients with distal radius fractures for which to date equipoise exists regarding the optimal treatment. International Registered Report Identifier (IRRID): DERR1-10.2196/52917 %M 38349719 %R 10.2196/52917 %U https://www.researchprotocols.org/2024/1/e52917 %U https://doi.org/10.2196/52917 %U http://www.ncbi.nlm.nih.gov/pubmed/38349719 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e51683 %T Identification of Anterior Large Vessel Occlusion Stroke During the Emergency Call: Protocol for a Controlled, Nonrandomized Trial %A Wimmesberger,Nicole %A Rau,Diana %A Schuchardt,Florian %A Meier,Simone %A Herrmann,Matthias L %A Bergmann,Ulrike %A Farin-Glattacker,Erik %A Brich,Jochen %+ Section Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Street 49, Freiburg im Breisgau, 79106, Germany, 49 0761270 ext 74450, nicole.wimmesberger@uniklinik-freiburg.de %K large vessel occlusion %K emergency medical dispatch %K lay first responder %K emergency call %K thrombectomy %K stroke %K thrombolysis %K triage %K anterior large vessel occlusion %K endovascular thrombectomy %K intravenous thrombolysis %K modified ranking scale %D 2024 %7 13.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Endovascular thrombectomy (ET), combined with intravenous thrombolysis if possible, is an effective treatment option for patients with stroke who have confirmed anterior large vessel occlusion (aLVO). However, ET is mainly limited to comprehensive stroke centers (CSCs), resulting in a lack of ET capacity in remote, sparsely populated areas. Most stroke networks use the “Drip and Ship” or “Mothership” strategy, resulting in either delayed ET or intravenous thrombolysis, respectively. Objective: This study protocol introduces the Leitstellen-Basierte Erkennung von Schlaganfall-Patienten für eine Thrombektomie und daraufhin abgestimmte Optimierung der Rettungskette (LESTOR) strategy, developed to optimize the preclinical part of the stroke chain of survival to improve the clinical outcome of patients with suspected aLVO stroke. This involves refining the dispatch strategy for identifying patients with acute aLVO stroke using a phone-based aLVO query. This includes dispatching emergency physicians and emergency medical services (EMS) to urban emergency sites, as well as dispatching helicopter EMS to remote areas. If a highly suspected aLVO is identified after a standardized aLVO score evaluation during a structured examination at the emergency scene, prompt transport to a CSC should be prioritized. Methods: The LESTOR study is a controlled, nonrandomized study implementing the LESTOR strategy, with a stepped-wedge, cluster trial design in 6 districts in southwest Germany. In an interprofessional, iterative approach, an aLVO query or dispatch protocol intended for use by dispatchers, followed by a coordinated aLVO examination score for use by EMS, is being developed, evaluated, and pretested in a simulation study. After the training of all participating health care professionals with the corresponding final aLVO query, the LESTOR strategy is being implemented stepwise. Patients otherwise receive usual stroke care in both the control and intervention groups. The primary outcome is the modified Rankin Scale at 90 days in patients with stroke receiving endovascular treatment. We will use a generalized linear mixed model for data analysis. This study is accompanied by a cost-effectiveness analysis and a qualitative process evaluation. Results: This paper describes and discusses the protocol for this controlled, nonrandomized LESTOR study. Enrollment was completed in June 2023. Data analysis is ongoing and the first results are expected to be submitted for publication in 2024. The project started in April 2020 and will end in February 2024. Conclusions: We expect that the intervention will improve the clinical outcome of patients with aLVO stroke, especially outside the catchment areas of CSCs. The results of the accompanying process evaluation and the cost-effectiveness analysis will provide further insights into the implementation process and allow for a better interpretation of the results. Trial Registration: German Clinical Trials Register DRKS00022152; https://drks.de/search/de/trial/DRKS00022152 International Registered Report Identifier (IRRID): DERR1-10.2196/51683 %M 38349728 %R 10.2196/51683 %U https://www.researchprotocols.org/2024/1/e51683 %U https://doi.org/10.2196/51683 %U http://www.ncbi.nlm.nih.gov/pubmed/38349728 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e51851 %T The Impact of the Ecosystem on Health Literacy Among Rural Communities in Protected Areas: Protocol for a Mixed Methods Study %A Abd Kadir,Nor Aziah %A Azzeri,Amirah %A Jaafar,Hafiz %A Mohd Noor,Mohd Iqbal %A Kefeli,Zurina %+ Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Bandar Baru Nilai, Negeri Sembilan, 71800, Malaysia, 60 132088543, amirah.azzeri@usim.edu.my %K ecosystem %K health literacy %K protected areas %K Net-Map %K quality of life %K rural communities %K protocol %D 2024 %7 29.1.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Protected areas are crucial for the maintenance of human health and well-being. They aim to preserve biodiversity and natural resources to secure various ecosystem services that are beneficial to human health. Their ecological characteristics can influence local health literacy. Typically, communities surrounding protected areas have limited economic opportunities due to restriction policies to protect the ecosystem, resulting in socioeconomic disparities. The local community faces obstacles in gaining access to health care facilities and health information due to these limitations. It is difficult for them to locate, comprehend, and apply information and services to make better health-related decisions for themselves and others. Objective: This study protocol examines the impact of the ecosystem on health literacy among rural communities in protected areas. Methods: This study comprises 5 phases. In phase 1, we conduct a systematic review to identify the issue of health literacy in protected areas. In phase 2, we will collect data from stakeholders in a protected area of Pahang National Park and analyze the results using Net-Map analysis. In phase 3, we will conduct a survey among the adult community in Pahang National Park related to health literacy, socioeconomic status, health expenditure, and quality of life. In phase 4, informed by the results of the survey, we will determine suitable intervention programs to improve health literacy through a focus group discussion. Finally, in phase 5, we will conduct a costing analysis to analyze which intervention program is the most cost-effective. Results: This study was funded by Universiti Sains Islam Malaysia (USIM) and strategic research partnership grants, and enrollment is ongoing. The first results are expected to be submitted for publication in 2024. Conclusions: This is one of the first studies to explore health literacy among rural communities in protected areas and will provide the first insights into the overall level of health literacy in the protected community, potential determinants, and a suitable intervention program with expected cost analysis. The results can be used to promote health literacy in other protected areas and populations. Trial Registration: International Standard Randomized Controlled Trial Number Registry ISRCTN40626062; http://tinyurl.com/4kjxuwk5 International Registered Report Identifier (IRRID): PRR1-10.2196/51851 %M 38285500 %R 10.2196/51851 %U https://www.researchprotocols.org/2024/1/e51851 %U https://doi.org/10.2196/51851 %U http://www.ncbi.nlm.nih.gov/pubmed/38285500 %0 Journal Article %@ 2373-6658 %I JMIR Publications %V 8 %N %P e49493 %T Toward Sustaining Web-Based Senior Center Programming Accessibility With and for Older Adult Immigrants: Community-Based Participatory Research Cross-Sectional Study %A Nguyen-Truong,Connie Kim Yen %A Wuestney,Katherine %A Leung,Holden %A Chiu,Chenya %A Park,Maria %A Chac,Christina %A Fritz,Roschelle Lynette %+ Nursing and Systems Science Department, College of Nursing in Vancouver, Washington State University, 14204 NE Salmon Creek Ave, Vancouver, WA, 98686-9600, United States, 1 3605469395, c.nguyen-truong@wsu.edu %K Asian American %K Chinese %K Korean %K Vietnamese %K community-based participatory research %K CBPR %K COVID-19 %K health equity %K immigrants %K older adults %K psychosocial %K technology access %K telehealth use %K web-based senior center %K mobile phone %D 2024 %7 26.1.2024 %9 Original Paper %J Asian Pac Isl Nurs J %G English %X Background: During the COVID-19 pandemic, many community-based organizations serving Asian Americans pivoted to provide web-based care and social services. Asian American community leaders in the United States Pacific Northwest, including Asian Health & Service Center expressed that there are older immigrant adults who experienced backlash from discrimination, fear, and anxiety owing in part to anti-Asian hate and isolation, including from infection precautions. Pivoting supported staying safe from COVID-19 transmission and anti-Asian hate crimes. Objective: This study aims to examine the readiness of diverse groups of older Asian American immigrant adults (Chinese, Koreans, and Vietnamese) to use a web-based senior center, including technology access and telehealth use, and to identify the psychosocial health impacts that a web-based senior center could be positioned to meet. Methods: A community-based participatory research approach was used to conduct a cross-sectional survey study in an Asian-based health and service center in 2022. We selected surveys from the National Institutes of Health–supported PhenX Toolkit. Analyses were performed using R software. Results: There was an 88.2% (216/245) response rate. Overall, 39.8% (86/216) of participants were Chinese, 25% (54/216) were Korean, and 24.5% (53/216) were Vietnamese. There were significant group differences in mobile data plans (P=.0005). Most had an unlimited mobile data plan (38/86, 44% Chinese; 39/54, 72% Koreans; 25/53, 47% Vietnamese). Significant group differences existed regarding whether they started using a new electronic device to communicate with friends or family after the COVID-19 outbreak (P=.0005); most were Korean participants (31/54, 57%). For written text and audio or video apps, most Chinese participants used WeChat (65/85, 76%; 57/84, 68%, respectively), most Koreans used KakaoTalk (49/54, 91%; 49/54, 91%, respectively), and most Vietnamese used Facebook Messenger for written text (32/50, 64%) and Apple Face Time (33/50, 66%) or Facebook Messenger (31/50, 62%) for audio or video. Significant group differences existed regarding whether to try telehealth (P=.0005); most Vietnamese expressed that they would never consider it (41/53, 77%). Significant group differences existed regarding how well they were able to concentrate (χ22=44.7; P<.0001); Chinese participants reported a greater inability (median 5, IQR 4-6). With regard to difficulties in life experiences (χ22=51; P<.0001), the median was 6 (IQR 5-7) for the Vietnamese group. Significant group differences existed in having had a family/household member’s salary, hours, and contracts reduced (P=.0005) and having had a family/household member or friend fallen physically ill (P=.0005)—most Vietnamese (15/53, 28%) and Korean participants (10/53, 19%). Conclusions: To build an efficacious, web-based senior center with web-based care and social service options, more older adults need access to the internet and education about using technology-enabled communication devices. Addressing the unique psychosocial impacts of the COVID-19 pandemic on each group could improve health equity. The strength of the participating older adults was observed and honored. %M 38277216 %R 10.2196/49493 %U https://apinj.jmir.org/2024/1/e49493 %U https://doi.org/10.2196/49493 %U http://www.ncbi.nlm.nih.gov/pubmed/38277216 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e49261 %T Quality of Life in Children With Achondroplasia Undergoing Paired Limb Lengthening With an External Fixator and Modified Distraction Control: Observational Nonrandomized Study %A Trofimchuk,Vitaliy %A Dossanov,Bolatbek %A Lozovoy,Vassiliy %A Khmyzov,Sergey %A Dossanova,Assem %A Angelov,Aleksandr %A Pashenko,Andrey %A Zhukenov,Olzhas %+ Department of Pediatrician Surgery, Non-Profit Joint Stock Company Astana Medical University, Beibitshilik St 49/A, Astana, 010000, Kazakhstan, 7 701 473 6786, vatrofi86@gmail.com %K achondroplasia %K external fixator %K quality of life %K transosseous osteosynthesis %K paired limb lengthening %K bone growth disorder %K dwarfism %K limb lengthening %K circular multiaxial system %K hereditary disease %K limb reconstruction %K children %K youth %K pediatric %K bone disorder %K orthopedics %K rehabilitation %K bone %K growth %K disorder %K genetic %D 2024 %7 24.1.2024 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Transosseous distraction osteosynthesis is prioritized in orthopedic care for children with achondroplasia. However, difficulties encountered during treatment and rehabilitation directly impact patients’ quality of life. Using rod external fixators within a semicircular frame for osteosynthesis is less traumatic compared to spoke circular devices. Their straightforward assembly and mounting on the limb segment can help significantly reduce treatment duration, thereby improving children’s quality of life during treatment and rehabilitation. Objective: This study aimed to conduct a comparative analysis of the quality of life (measured by postoperative pain syndrome, physical activity, and emotional state) among children with achondroplasia undergoing paired limb lengthening using either an external fixator with modified distraction control or a circular multiaxial system developed by the authors. Methods: This was an observational, prospective, nonrandomized, and longitudinal study with historical control. The study group consisted of 14 patients ranging from 5 to 15 (mean 7.6, SD 2.3) years old with a genetically confirmed diagnosis of achondroplasia. All patients underwent paired limb lengthening with a rod external fixator and a modified distraction control developed by the authors. A total of 28 limb segments, among them 4 (14%) humeri, 8 (29%) femurs, and 16 (57%) tibias, were lengthened in 1 round. Unpublished data from the previous study served as the control group, comprising 9 patients (18 limb segments) of the same age group (mean age at surgery 8.6, SD 2.3 years), who underwent limb lengthening surgery using a circular multiaxial system—2 (11%) humeri, 6 (33%) femurs, and 10 (56%) tibias. The Wong-Baker Faces Rating Scale was used to measure pain symptoms, while the Russified Pediatric Quality of Life (PedsQL) v4.0 questionnaire assessed quality of life. Results: During the latent phase (7 to 10 days after surgery), a more pronounced decrease in the indicators of physical activity and emotional state on the PedsQL v4.0 questionnaire was noted in the control group (mean 52.4, SD 4.8 versus mean 52.8, SD 5.5 points according to children’s responses and their parents’ responses, respectively) compared to the experimental group (mean 59.5, SD 6.8 points and mean 61.33, SD 6.5 points according to the children’s responses and their parents’ responses, respectively). The differences between the groups were statistically significant (P<.05 for children's responses and P<.01 for parents’ responses). Importantly, 6 months after surgery, these quality-of-life indicators, as reported by children in the experimental group, averaged 70.25 (SS 4.8) points. Similarly, their parents reported a mean of 70.54 (SD 4.2) points. In the control group, the corresponding values were 69.64 (SD 5.6) and 69.35 (SD 6.2), respectively. There was no statistically significant difference between the groups. Conclusions: The external fixator with modified distraction control developed by the authors provides a higher standard of living compared with the circular multiaxial system during the latency phase. %M 38265860 %R 10.2196/49261 %U https://rehab.jmir.org/2024/1/e49261 %U https://doi.org/10.2196/49261 %U http://www.ncbi.nlm.nih.gov/pubmed/38265860 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53130 %T Participatory Development and Assessment of Audio-Delivered Interventions and Written Material and Their Impact on the Perception, Knowledge, and Attitudes Toward Leprosy in Nigeria: Protocol for a Cluster Randomized Controlled Trial %A Murphy-Okpala,Ngozi %A Dahiru,Tahir %A van ’t Noordende,Anna T %A Gunesch,Carolin %A Chukwu,Joseph %A Nwafor,Charles %A Abdullahi,Suleiman Hudu %A Anyaike,Chukwuma %A Okereke,Ugochinyere Angelic %A Meka,Anthony %A Eze,Chinwe %A Ezeakile,Okechukwu %A Ekeke,Ngozi %+ RedAid Nigeria, 56 Nza Street, Independence Layout, Enugu, 23401, Nigeria, 234 706 749 0052, ngozi.murphyokpala@redaid-nigeria.org %K audio health education %K community perception of leprosy %K health education %K leprosy %K Nigeria %K persons affected by leprosy %D 2024 %7 24.1.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In Nigeria, similar to many leprosy-endemic countries, leprosy is highly stigmatized. High levels of stigma among community members as well as internalized stigma among persons affected by leprosy often result in negative psychosocial consequences for those affected. To break this vicious cycle, it is important to conduct context-specific behavioral change activities. Although written material has been successful in improving knowledge and perception, it is not suitable for populations with low educational levels. Audio-delivered interventions are likely to be more suitable for people who are illiterate. This study proposes to assess the impact of an audio-delivered intervention on the perception (knowledge, attitudes, and beliefs) of community members with regard to leprosy in Nigeria. Objective: This study aims to assess the impact of audio-delivered and written health education on the perception of leprosy. Specific objectives are to (1) investigate the perception (local beliefs, knowledge, and attitudes) of community members toward leprosy and persons affected by leprosy; (2) investigate whether there is a difference in impact on perception between participants who have received audio-delivered health education and those who have received written health education, with specific reference to gender differences and differences between rural and urban areas; and (3) assess the impact of the participatory development of the audio-delivered and written interventions on empowerment and internalized stigma of persons affected by leprosy who developed the interventions. Additionally, we will translate and cross-culturally validate 4 study instruments measuring outcomes in 2 major Nigerian languages. Methods: We will use a mixed methods, cross-sectional study design for the intervention development and a 3-arm cluster randomized controlled trial for its implementation and evaluation, comprising (1) baseline assessments of knowledge, attitudes, perceptions, and fears of community members, to develop the audio-delivered content and written material, and the self-esteem and internalized stigma of persons affected by leprosy; and (2) participatory development of the audio-delivered content and written material by persons affected by leprosy and the pilot and implementation of the interventions. This will be done among different groups (selected using cluster randomization) that will be compared (control group, audio-intervention group, and written material group) to evaluate the intervention and the impact of developing the intervention on the persons affected. Results: This study was funded in June 2022, and community member participant recruitment started in January 2023. Baseline data collection was completed by May 2023 (n=811). Participatory cocreation of the audio and written health education content began in July 2023, and the materials are currently under development. Study results are expected in September 2024. Conclusions: Study findings will contribute to developing evidence-based, context-specific behavioral change interventions, which are critical to addressing stigma in many leprosy-endemic communities where leprosy is highly stigmatized, and contribute toward global triple zero leprosy efforts. Trial Registration: Pan African Clinical Trial Registry PACTR202205543939385; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=23667 International Registered Report Identifier (IRRID): DERR1-10.2196/53130 %M 38265859 %R 10.2196/53130 %U https://www.researchprotocols.org/2024/1/e53130 %U https://doi.org/10.2196/53130 %U http://www.ncbi.nlm.nih.gov/pubmed/38265859 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e51820 %T Fatigue and Mental Illness Symptoms in Long COVID: Protocol for a Prospective Cohort Multicenter Observational Study %A Pires,Ligia %A Reis,Cláudia %A Mesquita Facão,Ana Rita %A Moniri,Armin %A Marreiros,Ana %A Drummond,Marta %A Berger-Estilita,Joana %+ Institute of Anaesthesiology and Intensive Care, Salem Spital, Hirslanden Medical Group, Schänzlistrasse 39, Bern, 3013, Switzerland, 41 788438161, joanamberger@gmail.com %K SARS-CoV-2 %K coronavirus %K COVID %K long COVID %K fatigue %K tired %K tiredness %K anxiety %K depression %K PTSD %K stress %K quality of life %K mental health %K post-COVID-condition %K neuropsychological %K neuropsychology %K psychological %K long COVID-19 %K COVID-19 %K myalgia %K correlation %K impairment %D 2024 %7 19.1.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The aftermath of the COVID-19 pandemic continues to affect millions worldwide, resulting in persisting postvirus complaints and impacting peoples’ quality of life. Long COVID, characterized by lingering symptoms like fatigue and mental illness, can extend beyond a few months, necessitating further research to understand its implications. Objective: This study aims to quantify the degree of physical and psychological fatigue in patients following COVID-19 infection and examine its correlation with mental health disorders. Methods: Using a consecutive nonrandom sampling technique, we will conduct a prospective cohort multicenter observational study in 5 Portuguese hospitals. Symptomatic adult patients with previous COVID-19 attending follow-up consultations will be enrolled. We will include patients who had mild, moderate, and severe acute disease. We will assess clinical outcomes related to COVID-19, including the type of respiratory support such as high-flow nasal cannula, noninvasive ventilation, and invasive mechanical ventilation. The exclusion criteria will include previous severe psychiatric disorders confirmed by a psychiatrist; refusal or inability to respond to the questionnaire; concomitant neurological disorder; persistent fatigue symptoms during the 6 months before infection; and the need for invasive mechanical ventilation during COVID-19 infection due to a high prevalence of postintensive care syndrome. Our primary outcome is the prevalence of fatigue in patients with post–COVID-19 depression and/or anxiety, as measured by the Chalder Fatigue Scale (CFQ-11) and the Hospital Anxiety and Depression Scale (HADS). The secondary outcomes will include an assessment of health-related quality of life via the EQ-5D questionnaire and an exploration of the prevalence of symptoms of posttraumatic stress disorder (PTSD) using the 14-item Posttraumatic Stress Scale (PTSS-14). We will also examine the association between mental health symptoms and the severity of acute COVID-19. The post–COVID-19 data will be collected at least 6 months after the positive test and no longer than 9 months during the clinical appointment. Results: We expect our multicenter study on patients post COVID-19 to reveal a significant link between mental illness symptoms and both physical and psychological fatigue. Patients with heightened depression and anxiety may report increased levels of fatigue. Additionally, we expect to find persistent PTSD symptoms in a subset of participants, indicating the enduring psychological impact of the virus. Conclusions: This study may underscore the need for integrated care addressing physical and mental health in patients post COVID-19. The observed connections emphasize the importance of considering mental well-being for long-term health outcomes. Despite study limitations, our findings contribute valuable insights for future treatment strategies and highlight the necessity for comprehensive mental health support in post–COVID-19 care. This research provides valuable insights into the mental health implications of COVID-19 and its impact on post–COVID-19 fatigue and the overall well-being of affected individuals. Trial Registration: ClinicalTrials.gov NCT05323318; https://clinicaltrials.gov/study/NCT05323318 International Registered Report Identifier (IRRID): DERR1-10.2196/51820 %M 38241071 %R 10.2196/51820 %U https://www.researchprotocols.org/2024/1/e51820 %U https://doi.org/10.2196/51820 %U http://www.ncbi.nlm.nih.gov/pubmed/38241071 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e45302 %T Characteristics, Opportunities, and Challenges of Osteopathy Based on the Perceptions of Osteopaths in Austria: Qualitative Interview Study %A Manschel,Jonas %A Porthun,Jan %A Winkler,Ulrike %A Beuckels,Jean Marie A T %A Martin,David %+ Norwegian University of Science and Technology, Campus Gjøvik, Teknologivn 22, Gjøvik, 2815, Norway, 47 95007916, jan.porthun@ntnu.no %K osteopathy %K osteopath %K osteopaths %K osteopathic profession %K health care system %K Austria %D 2024 %7 17.1.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: There are no uniform regulations for the osteopathic profession in Europe. It is subject to country-specific regulations defining who shall be allowed to practice osteopathy and which qualification shall be required. In recent years, legal regulations have been established in several European countries for the profession of osteopathy; however, these are also still pending for Austria. Currently, physiotherapists and physicians with osteopathic training are practicing osteopathy in Austria. Objective: This study aims to examine the characteristics, challenges, and opportunities of osteopaths in Austria. Methods: Guideline-based interviews with osteopaths (N=10) were conducted. The different research questions were examined using a qualitative content analysis. Results: The study provided a differentiated insight into the professional situation of osteopaths in Austria. The most important result was that all interviewees unanimously supported a legal regulation of their profession. However, owing to their different professional self-image—on the one hand, individuals working on a structural basis, and, on the other hand, individuals working on a cranial or biodynamic basis—they were able to imagine a uniform professional regulation only to a limited extent. Additional topics for the interviewed osteopaths in Austria were the quality assurance of training and the urgent need for scientific research. Furthermore, the study also dealt with the influence of the COVID-19 pandemic on daily practice and on education and training in osteopathy. Conclusions: This study is a pioneering study with regard to systematic basic research on osteopathy in Austria. The obtained results and the newly acquired research questions not only have the potential to serve as a basis for further studies but also provide insight into the working and professional situation of osteopaths in Austria for universities, schools, professional associations, politics, and—last but not least—all interested parties. International Registered Report Identifier (IRRID): RR2-10.2196/15399 %M 38231542 %R 10.2196/45302 %U https://humanfactors.jmir.org/2024/1/e45302 %U https://doi.org/10.2196/45302 %U http://www.ncbi.nlm.nih.gov/pubmed/38231542 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e50403 %T Hyaluronidase for Dermal Filler Complications: Review of Applications and Dosage Recommendations %A Kroumpouzos,George %A Treacy,Patrick %+ GK Dermatology, PC, 541 Main St, Suite 320, South Weymouth, MA, 02190, United States, 1 7818121078, gk@gkderm.com %K hyaluronidase %K hyaluronic acid %K filler %K complications %K nodule %K vascular occlusion %K therapy %K treatment %K application %K dosage %K management %K skin %K data %K inflammatory nodule %K inflammatory %K injection %D 2024 %7 17.1.2024 %9 Review %J JMIR Dermatol %G English %X Background: Hyaluronidase (Hyal) can reverse complications of hyaluronic acid (HA) fillers, which has contributed substantially to the popularity of such procedures. Still, there are differing opinions regarding Hyal treatment, including dosage recommendations in filler complication management. Objective: We aimed to address unanswered questions regarding Hyal treatment for HA filler complications, including timing and dosage, skin pretesting, properties of various Hyals and interactions with HA gels, and pitfalls of the treatment. Methods: PubMed and Google Scholar databases were searched from inception for articles on Hyal therapy for filler complications. Articles were evaluated regarding their contribution to the field. The extensive literature review includes international leaders’ suggestions and expert panels’ recommendations. Results: There are limited controlled data but increasing clinical experience with Hyal treatment. The currently used Hyals provide good results and have an acceptable safety profile. Nonemergent complications such as the Tyndall effect, noninflamed nodules, and allergic or hypersensitivity reactions should be treated with low or moderate Hyal doses. Hyal should be considered with prior or simultaneous oral antibiotic treatment in managing inflammatory nodules. Hyal may be tried for granulomas that have not responded to intralesional steroids. Emergent complications such as vascular occlusion and blindness require immediate, high-dose Hyal treatment. Regarding blindness, the injection technique, retrobulbar versus supraorbital, remains controversial. Ultrasound guidance can increase the efficacy of the above interventions. Conclusions: Hyal is essential in aesthetic practice because it can safely treat most HA filler complications. Immediate Hyal treatment is required for emergent complications. Aesthetic practitioners should be versed in using Hyal and effective dosage protocols. %M 38231537 %R 10.2196/50403 %U https://derma.jmir.org/2024/1/e50403 %U https://doi.org/10.2196/50403 %U http://www.ncbi.nlm.nih.gov/pubmed/38231537 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e42462 %T The Impact of Rapid Handpump Repairs on Diarrhea Morbidity in Children: Cross-Sectional Study in Kwale County, Kenya %A Thomson,Patrick %A Stoler,Justin %A Byford,Michelle %A Bradley,David J %+ Department of Engineering Science, University of Oxford, Old Road Campus Building, Headington, Oxford, OX3 7DQ, United Kingdom, 44 1865 617675, patrick.thomson@ouce.ox.ac.uk %K water %K Kenya %K WASH %K water, sanitation, and hygiene %K maintenance %K diarrhea %K diarrhoea %K SDG 6 %K service provision %K handpump %K child health %D 2024 %7 16.1.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Handpumps are used by millions of people as their main source of water. Although handpumps represent only a basic form of water provision, there have been continuous efforts to improve the performance of these systems as they are likely to remain in use for many years to come. The introduction of a professional maintenance service in southern Kenya has shown an order of magnitude improvement in operational performance over community-based management, with 90% of handpump faults repaired within 3 days of being reported. One driver behind these efforts is the assumption that a more reliable water supply will lead to a reduction in water-related disease. However, it is not clear if operational improvements lead to health gains. Despite limited empirical evidence, some modeling studies suggest that even short periods of drinking contaminated water can lead to disproportionate negative health impacts. Objective: The aim of this study was to assess whether the improvements in operational performance from the rapid professional maintenance of rural handpumps lead to improved household health outcomes. Methods: From a sample of households using handpumps as their primary water source in Kwale County, Kenya, we measured the 2-week prevalence of World Health Organization–defined diarrhea in children, reported by the adult respondent for each household. We compared the rates before and after a period during which the households’ handpumps were being professionally maintained. We then conducted a cross-sectional analysis, fitting logistic regression models with reported diarrhea as the dependent variable and speed of repair as the independent exposure of interest, adjusting for household socioeconomic characteristics; dwelling construction; and Water, Sanitation, and Hygiene (WASH)-related factors. We fitted an additional model to examine select interactions between covariates. Results: Reported diarrhea in children was lower in households whose pumps had been repaired within 24 hours (adjusted odds ratio 0.35, 95% CI 0.24-0.51). This effect was robust to the inclusion of multiple categories of covariates. No reduction was seen in households whose pump repairs took more than 24 hours. Analysis of interaction terms showed that certain interventions associated with improved WASH outcomes were only associated with reductions in diarrhea in conjunction with socioeconomic improvements. Conclusions: Only pump repairs consistently made within 24 hours of failure led to a reduction in diarrhea in the children of families using handpumps. While the efficacy of reduction in diarrhea is substantial, the operational challenges of guaranteeing same-day repairs limits the effectiveness of even best-in-class pump maintenance. Maintenance regimes that cannot bring handpump downtimes close to zero will struggle to generate health benefits. Other factors that reduce diarrhea prevalence have limited effect in isolation, suggesting that WASH interventions will be more effective when undertaken as part of more holistic poverty-reduction efforts. %M 38227359 %R 10.2196/42462 %U https://publichealth.jmir.org/2024/1/e42462 %U https://doi.org/10.2196/42462 %U http://www.ncbi.nlm.nih.gov/pubmed/38227359 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e50921 %T Trends in the Ophthalmic Workforce and Eye Care Infrastructure in South India: Cross-Sectional Questionnaire Study %A Pallerla,Srinivasa R %A Pallerla,Madhurima R %A Krishnaiah,Sannapaneni %+ Andhra Pradesh Right to Sight Society, Plot No 12 BN Reddy Colony Road, No 14 Banjara Hills, Hyderabad, 500034, India, 91 9849078882, srinivasar107@hotmail.com %K trends %K human resources %K infrastructure %K eye care %K South India %D 2024 %7 9.1.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: This study is part of broad-based research to determine the impact of blindness control activities in general and with special reference to the Andhra Pradesh Right to Sight Society (APRTSS) activities in the southern Indian states of Andhra Pradesh and Telangana. As part of the global “VISION 2020: The Right to Sight” initiative, the APRTSS was established in the undivided state of Andhra Pradesh in 2002. Since then, the APRTSS has been actively implementing the strategies of VISION 2020 to reduce visual impairment and blindness in the state. Objective: The availability and distribution of the eye care workforce are essential to reach the goals of VISION 2020: The Right to Sight, the global initiative to eliminate avoidable blindness. This study assessed the trends in the availability and distribution of eye health professionals and eye care infrastructure in 2 southern Indian states: Andhra Pradesh and Telangana. Methods: This cross-sectional study used a pretested questionnaire to gather data for the year from 2012 to 2013. Data for 2002 to 2003 were collected from available historical records. The questionnaires were pretested in a pilot study conducted before the main survey. Pretested questionnaires were administered to all eye care professionals—ophthalmologists (n=1712) and midlevel ophthalmic personnel (MLOP; n=1250)—eye care facilities with ≥10 inpatient beds or performing ≥100 cataract surgeries per annum (n=640), local nongovernmental eye care organizations (n=182), and international eye care organizations (n=10). Data were collected for 2 different time periods: the baseline year of 2002 to 2003 and the target year of 2012 to 2013. Data analysis was conducted using SPSS version 19.0. Results: The response rates were 81.1% (519/640) for eye care facilities, 96.1% (1645/1712) for ophthalmologists, and 67.6% (845/1250) for MLOP. From 2002-2003 to 2012-2013, there has been an increase in eye care facilities, from 234 to 519 (121.8%); ophthalmologists, from 935 to 1712 (83.1%); and MLOP, from 767 to 1250 (63%). The ophthalmologist:population ratio improved from 1:88,260 in 2002-2003 to 1:51,468 in 2012-2013. The MLOP:population ratio improved from 1:168,283 in 2002-2003 to 1:138,117 in 2012-2013 but still falls short of the ideal number. Conclusions: Both southern Indian states are able to meet the requirements for ophthalmologists and eyecare infrastructure as per the goals of VISION 2020. However, the number of MLOP falls short of the ideal ratio for the population. This study has some limitations. For example, most of the data collected through questionnaires were based on self-report, which might introduce bias due to memory recall or over or under-reporting of certain information. However, this was addressed by cross-checking the collected data with information from supplementary sources. %M 38261522 %R 10.2196/50921 %U https://ojphi.jmir.org/2024/1/e50921 %U https://doi.org/10.2196/50921 %U http://www.ncbi.nlm.nih.gov/pubmed/38261522 %0 Journal Article %@ 2373-6658 %I JMIR Publications %V 8 %N %P e50703 %T Exploring Nursing Research Culture in Clinical Practice: Qualitative Ethnographic Study %A Hwang,Hyeyoung %A De Gagne,Jennie C %A Yoo,Leeho %A Lee,Miji %A Jo,Hye Kyung %A Kim,Ju-eun %+ College of Nursing, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, Republic of Korea, 82 10 7259 9699, jueun.kimmm@gmail.com %K clinical nursing research %K ethnography %K evidence-based nursing %K nursing research %K qualitative research %D 2024 %7 9.1.2024 %9 Original Paper %J Asian Pac Isl Nurs J %G English %X Background: Cultivating a positive research culture is considered the key to facilitating the utilization of research findings. In the realm of clinical nursing research, nurses conducting research may find the utilization of findings challenging due to the lack of a positive research culture. Objective: This study aims to identify and describe the sociocultural context of nursing research in a clinical setting at a Korean tertiary hospital. Methods: We included participant observation and ethnographic interviews with 6 registered nurses working in a medical-surgical unit in a Korean tertiary hospital who had experience conducting nursing research in clinical settings in this qualitative ethnographic study. The study was conducted from April 2022 to May 2022. Data analysis was conducted using Spradley’s ethnographic approach, which includes domain analysis, taxonomic analysis, componential analysis, and theme analysis, and occurred concurrently with data collection. Results: The overarching theme identified for nursing research culture in clinical practice was the development of a driving force for growth within the clinical environment. This theme encompasses (1) balancing positive and negative influences in the research process, (2) fostering transformational change for both nurses and patients, and (3) promoting complementary communication among nurses. Conclusions: Clinical research plays a vital role in nursing practice that requires a balance of supportive elements, such as patient-driven research questions and hospital research support, with practical challenges such as shift work and high work intensity. This study found that a positive clinical nursing research culture can serve as a unifying bridge, connecting researchers, patients, who serve as both the origin and ultimate beneficiaries of research, and hospitals that facilitate research endeavors. Future research should explore whether the themes derived from this study fully reflect a clinical nursing research culture comprising patients, nurses, and the hospital environment and determine what requirements are needed to establish such a nursing research culture. %M 38194262 %R 10.2196/50703 %U https://apinj.jmir.org/2024/1/e50703 %U https://doi.org/10.2196/50703 %U http://www.ncbi.nlm.nih.gov/pubmed/38194262 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e50379 %T Generating Contextual Variables From Web-Based Data for Health Research: Tutorial on Web Scraping, Text Mining, and Spatial Overlay Analysis %A Galvez-Hernandez,Pablo %A Gonzalez-Viana,Angelina %A Gonzalez-de Paz,Luis %A Shankardass,Ketan %A Muntaner,Carles %+ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 4th Fl., 155 College St, Toronto, ON, M5T 3M6, Canada, 1 6475752195, pau.galvez@utoronto.ca %K web scraping %K text mining %K spatial overlay analysis %K program evaluation %K social environment %K contextual variables %K health assets %K social connection %K multilevel analysis %K health services research %D 2024 %7 8.1.2024 %9 Tutorial %J JMIR Public Health Surveill %G English %X Background: Contextual variables that capture the characteristics of delimited geographic or jurisdictional areas are vital for health and social research. However, obtaining data sets with contextual-level data can be challenging in the absence of monitoring systems or public census data. Objective: We describe and implement an 8-step method that combines web scraping, text mining, and spatial overlay analysis (WeTMS) to transform extensive text data from government websites into analyzable data sets containing contextual data for jurisdictional areas. Methods: This tutorial describes the method and provides resources for its application by health and social researchers. We used this method to create data sets of health assets aimed at enhancing older adults’ social connections (eg, activities and resources such as walking groups and senior clubs) across the 374 health jurisdictions in Catalonia from 2015 to 2022. These assets are registered on a web-based government platform by local stakeholders from various health and nonhealth organizations as part of a national public health program. Steps 1 to 3 involved defining the variables of interest, identifying data sources, and using Python to extract information from 50,000 websites linked to the platform. Steps 4 to 6 comprised preprocessing the scraped text, defining new variables to classify health assets based on social connection constructs, analyzing word frequencies in titles and descriptions of the assets, creating topic-specific dictionaries, implementing a rule-based classifier in R, and verifying the results. Steps 7 and 8 integrate the spatial overlay analysis to determine the geographic location of each asset. We conducted a descriptive analysis of the data sets to report the characteristics of the assets identified and the patterns of asset registrations across areas. Results: We identified and extracted data from 17,305 websites describing health assets. The titles and descriptions of the activities and resources contained 12,560 and 7301 unique words, respectively. After applying our classifier and spatial analysis algorithm, we generated 2 data sets containing 9546 health assets (5022 activities and 4524 resources) with the potential to enhance social connections among older adults. Stakeholders from 318 health jurisdictions registered identified assets on the platform between July 2015 and December 2022. The agreement rate between the classification algorithm and verified data sets ranged from 62.02% to 99.47% across variables. Leisure and skill development activities were the most prevalent (1844/5022, 36.72%). Leisure and cultural associations, such as social clubs for older adults, were the most common resources (878/4524, 19.41%). Health asset registration varied across areas, ranging between 0 and 263 activities and 0 and 265 resources. Conclusions: The sequential use of WeTMS offers a robust method for generating data sets containing contextual-level variables from internet text data. This study can guide health and social researchers in efficiently generating ready-to-analyze data sets containing contextual variables. %M 38190245 %R 10.2196/50379 %U https://publichealth.jmir.org/2024/1/e50379 %U https://doi.org/10.2196/50379 %U http://www.ncbi.nlm.nih.gov/pubmed/38190245 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52938 %T Overview of Retention Strategies for Medical Doctors in Low- and Middle-Income Countries and Their Effectiveness: Protocol for a Scoping Review %A Jinah,Norehan %A Abdullah Sharin,Ili %A Bakit,Pangie %A Adnan,Izzuan Khirman %A Lee,Kun Yun %+ Centre of Leadership & Professional Development, Institute for Health Management, National Institutes of Health Malaysia, Blok B1, Kompleks NIH, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, Shah Alam, 40170, Malaysia, 60 33627400 ext 8306, norehan.j@moh.gov.my %K health care workforce %K retention strategies %K medical doctors %K low-income and middle-income countries %K scoping review %D 2024 %7 8.1.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The global shortage and maldistribution of health care workers, especially medical doctors, pose a significant threat to achieving the United Nations’ sustainable development goal 3 of ensuring well-being and healthy lives for all. Low- and middle-income countries (LMICs) are disproportionately affected by this crisis, with a high rate of brain drain from rural to urban areas, as well as to high-income countries. Various retention strategies have been implemented in different settings and organizations. However, their effectiveness remains underexplored, particularly in LMICs. Objective: We aim to review the available retention strategies for medical doctors in LMICs and to determine the effectiveness of the various strategies. This review aims to compile relevant research findings on this issue to generate a thorough summary of all the retention strategies practiced in LMICs and, more importantly, to provide the current state of evidence of the effectiveness of these strategies in retaining medical doctors in countries with limited resources and high disease burden. Methods: The structured framework given by Arksey and O'Malley will serve as the basis for conducting this scoping review. A comprehensive search strategy will be conducted across 4 electronic databases (PubMed, EBSCOHost, Scopus, and ScienceDirect). A systematic approach following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines will be executed to search, screen, review, and extract data from studies that meet predefined inclusion criteria. Data encompassing bibliographical information, study location, retention strategies, influencing factors, and outcomes (effectiveness) will be obtained from the selected studies using standardized data extraction. Endnote and Microsoft Excel will be used for reference management and removal of duplicate studies. A narrative synthesis will be performed after categorizing and analyzing all the extracted data to identify recurrent themes. Results: This ongoing review will generate a comprehensive compilation of retention strategies implemented in LMICs to prevent brain drain among medical doctors. Data extraction is currently in progress, and completion is expected by early 2024. Themes regarding the types of strategies, influencing factors, and outcomes will be synthesized. The findings will highlight effective retention strategies, gaps, and challenges in implementation for the benefits of future research. By identifying common barriers and facilitators, this review will provide insights into enhancing the policies and initiatives for doctor retention in LMICs. Conclusions: This scoping review explores the retention strategies practiced in LMICs and attempts to identify effective strategies from existing research. By evaluating the barriers and challenges that influence the effectiveness of these strategies, policymakers and health care leaders can strive to obtain balanced and optimal health human resources in their respective organizations and countries. Trial Registration: Malaysian National Medical Research Register (NMRR) ID-23-01994-OGW; https://nmrr.gov.my/research-directory/ac4f5b88-8619-4b2b-b6c7-9abcef65fdcd International Registered Report Identifier (IRRID): DERR1-10.2196/52938 %M 38190235 %R 10.2196/52938 %U https://www.researchprotocols.org/2024/1/e52938 %U https://doi.org/10.2196/52938 %U http://www.ncbi.nlm.nih.gov/pubmed/38190235 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e52711 %T Challenges for Medical Students in Applying Ethical Principles to Allocate Life-Saving Medical Devices During the COVID-19 Pandemic: Content Analysis %A Hsieh,Hsing-yen %A Lin,Chyi-her %A Huang,Ruyi %A Lin,Guan-chun %A Lin,Jhen-Yu %A Aldana,Clydie %+ School of Medicine for International Students, College of Medicine, I-Shou University, 8 Yida Rd, Yanchao District, Kaohsiung, 82445, Taiwan, 886 7 615 0011 ext 2547, ruyi@mail.harvard.edu %K virtual patient %K virtual patients %K medical resources distribution %K medical ethical education %K COVID-19 pandemic %K ethics %K medical student %K medical students %K medical ethics %K decision-making %K ethical dilemna %K simulation %K reasoning %K decision support %K medical guideline %K medical guidelines %K medical devices %K medical device %K life-saving %K thematic analysis %K virtual platform %D 2024 %7 5.1.2024 %9 Original Paper %J JMIR Med Educ %G English %X Background: The emergence of the COVID-19 pandemic has posed a significant ethical dilemma in the allocation of scarce, life-saving medical equipment to critically ill patients. It remains uncertain whether medical students are equipped to navigate this complex ethical process. Objective: This study aimed to assess the ability and confidence of medical students to apply principles of medical ethics in allocating critical medical devices through the scenario of virtual patients. Methods: The study recruited third- and fourth-year medical students during clinical rotation. We facilitated interactions between medical students and virtual patients experiencing respiratory failure due to COVID-19 infection. We assessed the students’ ability to ethically allocate life-saving resources. Subsequently, we analyzed their written reports using thematic analysis to identify the ethical principles guiding their decision-making. Results: We enrolled a cohort of 67 out of 71 medical students with a mean age of 34 (SD 4.7) years, 60% (n=40) of whom were female students. The principle of justice was cited by 73% (n=49) of students while analyzing this scenario. A majority of them expressed hesitancy in determining which patient should receive life-saving resources, with 46% (n=31) citing the principle of nonmaleficence, 31% (n=21) advocating for a first-come-first-served approach, and 25% (n=17) emphasizing respect for patient autonomy as key influencers in their decisions. Notably, medical students exhibited a lack of confidence in making ethical decisions concerning the distribution of medical resources. A minority, comprising 12% (n=8), proposed the exploration of legal alternatives, while 4% (n=3) suggested medical guidelines and collective decision-making as potential substitutes for individual ethical choices to alleviate the stress associated with personal decision-making. Conclusions: This study highlights the importance of improving ethical reasoning under time constraints using virtual platforms. More than 70% of medical students identified justice as the predominant principle in allocating limited medical resources to critically ill patients. However, they exhibited a lack of confidence in making ethical determinations and leaned toward principles such as nonmaleficence, patient autonomy, adherence to legal and medical standards, and collective decision-making to mitigate the pressure associated with such decisions. %M 38050366 %R 10.2196/52711 %U https://mededu.jmir.org/2024/1/e52711 %U https://doi.org/10.2196/52711 %U http://www.ncbi.nlm.nih.gov/pubmed/38050366 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e50654 %T Testing a Culturally Tailored Advance Care Planning Intervention (MY WAY) for an American Indian Tribe: Protocol for a Quasi-Experimental Waitlist Control Design %A Anderson,Elizabeth %A Goins,R Turner %A Haozous,Emily A %A Schweinhart,April %+ Pacific Institute for Research and Evaluation, 101 Conner Drive, Suite 200, Chapel Hill, NC, 27514, United States, 1 919 265 2635, eanderson@pire.org %K American Indian or Alaskan Native %K advance care planning %K end-of-life care %D 2023 %7 29.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: American Indian and Alaska Native peoples experience poor end-of-life care, including more hospitalizations and lower use of hospice and do-not-resuscitate orders. Although advance care planning (ACP) can improve end-of-life care, ACP rates are disproportionately low in American Indians and Alaska Natives. Objective: We culturally tailored and delivered an existing evidence-based ACP program for an American Indian tribal community. Here, we present the protocol for assessing the intervention’s feasibility and efficacy. Methods: We measured feasibility via participant recruitment, participants’ evaluation (acceptability, appropriateness, comprehension, and satisfaction), and intervention fidelity. Recruitment was measured with participant screening, eligibility, enrollment, and retention. Participant’s evaluation of the intervention was measured with surveys. Fidelity was measured with direct observation and the Make Your Wishes About You (MY WAY) Fidelity Checklist Tool. To assess the intervention’s efficacy, we used a quasi-experimental waitlist control design with 2 cohorts who were surveyed each on three separate occasions. The intervention’s efficacy was assessed by the following: ACP barriers and facilitators as well as ACP self-efficacy, readiness, and completion. Results: A total of 166 participants were screened for eligibility; 11 were deemed ineligible, and 155 participants were enrolled in the study. Of those enrolled, 113 completed the intervention and will be included in subsequent analyses. We finalized data collection in January 2023, and analyses are underway. Study enrollment was successful, and we expect that participants will report high levels of acceptability, appropriateness, comprehension, and satisfaction with the intervention. We expect that the intervention was implemented with fidelity and will demonstrate decreases in ACP barriers and increases in ACP facilitators, self-efficacy, readiness, and completion. Conclusions: Enrolling over twice as many participants as we had hoped suggests that members of this tribal community are willing to engage in end-of-life ACP. We were able to implement a waitlist study design to show that a culturally tailored ACP program for a tribal community is feasible. Trial Registration: ClinicalTrials.gov NCT05304117; https://clinicaltrials.gov/study/NCT05304117 International Registered Report Identifier (IRRID): DERR1-10.2196/50654 %M 38157237 %R 10.2196/50654 %U https://www.researchprotocols.org/2023/1/e50654 %U https://doi.org/10.2196/50654 %U http://www.ncbi.nlm.nih.gov/pubmed/38157237 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46714 %T Digitization of Follow-Up Care in Orthopedic and Trauma Surgery With Video Consultations: Health Economic Evaluation Study From a Health Provider’s Perspective %A Muschol,Jennifer %A Heinrich,Martin %A Heiss,Christian %A Hernandez,Alher Mauricio %A Knapp,Gero %A Repp,Holger %A Schneider,Henning %A Thormann,Ulrich %A Uhlar,Johanna %A Unzeitig,Kai %A Gissel,Christian %+ Department of Health Economics, Justus Liebig University, Klinikstrasse 29, Giessen, 35392, Germany, 49 641 99 48550, cg@phec.de %K digital health %K economic evaluation %K health economics %K orthopedic %K personnel costs %K productivity gains %K telemedicine %K trauma surgery %K utility %K video consultations %D 2023 %7 25.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Recommendations for health care digitization as issued with the Riyadh Declaration led to an uptake in telemedicine to cope with the COVID-19 pandemic. Evaluations based on clinical data are needed to support stakeholders’ decision-making on the long-term implementation of digital health. Objective: This health economic evaluation aims to provide the first German analysis of the suitability of video consultations in the follow-up care of patients in orthopedic and trauma surgery, investigate the financial impact on hospital operations and personnel costs, and provide a basis for decisions on digitizing outpatient care. Methods: We conducted a randomized controlled trial that evaluated video consultations versus face-to-face consultations in the follow-up care of patients in orthopedic and trauma surgery at a German university hospital. We recruited 60 patients who had previously been treated conservatively or surgically for various knee or shoulder injuries. A digital health app and a browser-based software were used to conduct video consultations. The suitability of telemedicine was assessed using the Telemedicine Satisfaction Questionnaire and the EQ-5D-5L questionnaire. Economic analyses included average time spent by physician per consultation, associated personnel costs and capacities for additional treatable patients, and the break-even point for video consultation software fees. Results: After 4 withdrawals in each arm, data from a total of 52 patients (telemedicine group: n=26; control group: n=26) were used for our analyses. In the telemedicine group, 77% (20/26) of all patients agreed that telemedicine provided for their health care needs, and 69% (18/26) found telemedicine an acceptable way to receive health care services. In addition, no significant difference was found in the change of patient utility between groups after 3 months (mean 0.02, SD 0.06 vs mean 0.07, SD 0.17; P=.35). Treatment duration was significantly shorter in the intervention group (mean 8.23, SD 4.45 minutes vs mean 10.92, SD 5.58 minutes; P=.02). The use of telemedicine saved 25% (€2.14 [US $2.35]/€8.67 [US $9.53]) in personnel costs and increased the number of treatable patients by 172 annually, assuming 2 hours of video consultations per week. Sensitivity analysis for scaling up video consultations to 10% of the hospital’s outpatient cases resulted in personnel cost savings of €73,056 (US $ 80,275.39) for a senior physician. A total of 23 video consultations per month were required to recoup the software fees of telemedicine through reduced personnel costs (break-even point ranging from 12-38 in the sensitivity analysis). Conclusions: Our study supports stakeholders’ decision-making on the long-term implementation of digital health by demonstrating that video consultations in the follow-up care of patients in orthopedic and trauma surgery result in cost savings and productivity gains for clinics with no negative impact on patient utility. Trial Registration: German Clinical Trials Register DRKS00023445; https://drks.de/search/en/trial/DRKS00023445 %M 38145481 %R 10.2196/46714 %U https://www.jmir.org/2023/1/e46714 %U https://doi.org/10.2196/46714 %U http://www.ncbi.nlm.nih.gov/pubmed/38145481 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e46490 %T Attributes That Influence Human Decision-Making in Complex Health Services: Scoping Review %A Doreswamy,Nandini %A Horstmanshof,Louise %+ National Coalition of Independent Scholars, Suite 465, 48 Dickson Place, Dickson, ACT, Canberra, 2602, Australia, 61 424890997, ndoreswamy@outlook.com %K human attributes %K human decision-making %K rationality %K rational decision-making %K health policy %K health regulation %K health services %K %D 2023 %7 20.12.2023 %9 Review %J JMIR Hum Factors %G English %X Background: Humans currently dominate decision-making in both clinical health services and complex health services such as health policy and health regulation. Many assumptions inherent in health service models today are underpinned by Ramsey’s Expected Utility Theory, a prominent theory in the field of economics that is rooted in rationality. Rational, evidence-based metrics currently dominate the culture of decision-making in health policy and regulation. However, as the COVID-19 pandemic has shown, rational metrics alone may not suffice in making better policy and regulatory decisions. There are ethical and moral considerations and other complex factors that cannot be reduced to evidence-based rationality alone. Therefore, this scoping review was undertaken to identify and map the attributes that influence human decision-making in complex health services. Objective: The objective is to identify and map the attributes that influence human decision-making in complex health services that have been reported in the peer-reviewed literature. Methods: This scoping review was designed to answer the following research question: what attributes have been reported in the literature that influence human decision-making in complex health services? A clear, reproducible methodology is provided. It is reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) standards and a recognized framework. As the topic of interest merited broad review to scope and understand literature from a holistic viewpoint, a scoping review of literature was appropriate here. Inclusion and exclusion criteria were developed, and a database search undertaken within 4 search systems—ProQuest, Scopus, PubMed, and Web of Science. Results: The results span 46 years, from 1976 to 2022. A total of 167 papers were identified. After removing duplicates, 81 papers remained. Of these, 77 papers were excluded based on the inclusion and exclusion criteria. The remaining 4 papers were found to be relevant. Citation tracking was undertaken, identifying 4 more relevant papers. Thus, a total of 8 papers were included. These papers were reviewed in detail to identify the human attributes mentioned and count the frequency of mentions. A thematic analysis was conducted to identify the themes. Conclusions: The results highlight key themes that underline the complex and nuanced nature of human decision-making. The results suggest that rationality is entrenched and may influence the lexicon of our thinking about decision-making. The results also highlight the counter narrative of decision-making underpinned by uniquely human attributes. This may have ramifications for decision-making in complex health services today. The review itself takes a rational approach, and the methods used were suited to this. International Registered Report Identifier (IRRID): RR2-10.2196/42353 %M 38117553 %R 10.2196/46490 %U https://humanfactors.jmir.org/2023/1/e46490 %U https://doi.org/10.2196/46490 %U http://www.ncbi.nlm.nih.gov/pubmed/38117553 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42798 %T Implementation of a Triage Protocol Outside the Hospital Setting for Timely Referral During the COVID-19 Second Wave in Chennai, India %A John,Alby %A M,Jagadeesan %A Rubeshkumar,Polani %A Ganeshkumar,Parasuraman %A Masanam Sriramulu,Hemalatha %A Narnaware,Manish %A Singh Bedi,Gagandeep %A Kaur,Prabhdeep %+ Indian Council of Medical Research-National Institute of Epidemiology, R-127, Second Main Road, Tamil Nadu Housing Board, Ayapakkam, Chennai, 600 077, India, 91 44261336233, kprabhdeep@gmail.com %K COVID-19 %K triage %K low- and middle-income countries %K LMIC %K India %K pulse oximeter %K implementation %K health care system %K self-management %K patient care %K community health %K low income %K health disparity %K low-resource setting %D 2023 %7 18.12.2023 %9 Viewpoint %J JMIR Form Res %G English %X India experienced a surge in COVID-19 cases during the second wave in the period of April-June 2021. A rapid rise in cases posed challenges to triaging patients in hospital settings. Chennai, the fourth largest metropolitan city in India with an 8 million population, reported 7564 COVID-19 cases on May 12, 2021, nearly 3 times higher than the number of cases in the peak of COVID-19 in 2020. A sudden surge of cases overwhelmed the health system. We had established standalone triage centers outside the hospitals in the first wave, which catered to up to 2500 patients per day. In addition, we implemented a home-based triage protocol from May 26, 2021, to evaluate patients with COVID-19 who were aged ≤45 years without comorbidities. Among the 27,816 reported cases between May 26 and June 24, 2021, a total of 16,022 (57.6%) were aged ≤45 years without comorbidities. The field teams triaged 15,334 (55.1%), and 10,917 (39.2%) patients were evaluated at triage centers. Among 27,816 cases, 19,219 (69.1%) were advised to self-isolate at home, 3290 (11.8%) were admitted to COVID-19 care centers, and 1714 (6.2%) were admitted to hospitals. Only 3513 (12.7%) patients opted for the facility of their choice. We implemented a scalable triage strategy covering nearly 90% of the patients in a large metropolitan city during the COVID-19 surge. The process enabled early referral of high-risk patients and ensured evidence-informed treatment. We believe that the out-of-hospital triage strategy can be rapidly implemented in low-resource settings. %M 37235721 %R 10.2196/42798 %U https://formative.jmir.org/2023/1/e42798 %U https://doi.org/10.2196/42798 %U http://www.ncbi.nlm.nih.gov/pubmed/37235721 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e44606 %T Evaluating the Effectiveness of School Closure in COVID-19–Related Syndromes From Community-Based Syndromic Surveillance: Longitudinal Observational Study %A Chung,Ping-Chen %A Chen,Kevin J %A Chang,Hui-Mei %A Chan,Ta-Chien %+ Research Center for Humanities and Social Sciences, Academia Sinica, 128 Academia Road, Section 2, Taipei City, 115, Taiwan, 886 227898160, tachien@sinica.edu.tw %K school closure %K COVID-19 %K syndromic surveillance %K outpatient %K mobility %D 2023 %7 15.12.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: During the COVID-19 pandemic, a school closure policy was adopted to prevent cluster transmission in schools and subsequent household transmission. However, the effectiveness of school closure is not consistent in studies conducted in different countries. Objective: This study aimed to explore the association between school closure and the daily standardized incidence of COVID-19–related syndromes in an outpatient syndromic surveillance system. Methods: We calculated the incidence of COVID-19–related syndromes derived from a community-based syndromic surveillance system between the first week of January and the second or fourth weeks after school closure in 2021 and 2022 in Taipei City, Taiwan. The effect of school closure on the standardized incidence of COVID-19–related syndromes was evaluated by interrupted time series analysis using an autoregressive integrated moving average with a distributed lag function. The exogenous variables were changes in human mobility measured by Google COVID-19 community mobility reports. Furthermore, the models quantified the influence of different age groups and the hierarchy of medical facilities, such as clinics or community hospitals. Results: School closure was only negatively and significantly associated with the overall standardized incidence of COVID-19–related syndromes in 2021 for 2 weeks after the intervention (coefficient −1.24, 95% CI −2.40 to −0.08). However, in different age groups, school closure had a significantly negative association with the standardized incidence among people aged 13-18 years and ≥65 years for 2 weeks after the intervention in clinics in 2021. In community hospitals, school closure was significantly positively associated with the standardized incidence among people aged 19-24 years in 2021. In 2022, 2 weeks after the intervention, school closure had a significantly negative association with the standardized incidence among people aged 0-6, 7-12, and 19-24 years in community hospitals and aged >45 years in clinics. Furthermore, the standardized incidence was positively associated with movement change toward grocery and pharmacy stores in all age groups in 2022. In addition, movement changes toward residences were significantly positively associated with the standardized incidence among all age groups. Conclusions: Overall, school closure effectively suppresses COVID-19–related syndromes in students owing to the reduction of physical contact. In addition, school closure has a spillover effect on elderly people who stay at home. %M 38100192 %R 10.2196/44606 %U https://www.i-jmr.org/2023/1/e44606 %U https://doi.org/10.2196/44606 %U http://www.ncbi.nlm.nih.gov/pubmed/38100192 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e53063 %T Analgesic Effect of Intraoperative Intravenous S(+)-Ketamine During Total Knee Arthroplasty Surgery: Study Protocol for a Randomized Controlled Clinical Trial %A Deng,Shiyuan %A Chen,Lina %A Song,Xiao %A Guo,Liang %A Zhao,Fei %A Liu,Jing %A Dong,Ling %+ Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University, 16766 Jingshi Road, Shandong Province, Jinan, 250014, China, 86 15169155151, mjx1222@163.com %K analgesic %K S(+)-ketamine %K total knee arthroplasty surgery %K older patients, multimodal pain management %D 2023 %7 8.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Total knee arthroplasty (TKA) is currently the main treatment for end-stage knee disease. The number of cases of TKA in China increased from 53,880 in 2011 to 374,833 in 2019, representing a 5.9-fold increase. Moderate to severe pain often occurs after TKA, which seriously affects postoperative rehabilitation, patient satisfaction, and overall outcome. Multimodal analgesia is considered the ideal solution. Adequate postoperative analgesia can not only reduce pain, opioid consumption, and, consequently, opioid-related adverse events, but can also reduce the length of hospital stay and costs and improve rehabilitation and patient satisfaction. Objective: Effective multimodal pain management in the early postoperative period is essential for anesthesiologists. Additional studies have demonstrated that a low-dose intravenous infusion of ketamine can be administered as an adjuvant drug to alleviate acute postoperative pain. Therefore, we aim to appraise the efficacy and safety of intraoperative intravenous injection of S(+)-ketamine to relieve acute pain after TKA in older patients. Methods: This is a protocol for a randomized, placebo-controlled trial. A total of 144 participants aged 65 years and older undergoing TKA will be randomly allocated into the S(+)-ketamine and placebo groups in a 1:1 ratio. S(+)-ketamine or the placebo will be intravenously administered at 0.3 mg/kg/h during the operation by anesthesiologists. Blinded evaluation by trained investigators will be completed at 2 hours, 24 hours, and 48 hours after surgery. The primary outcome measure will be the numeric rating scale score at rest and movement at 24 hours after surgery. The secondary outcomes will include the numeric rating scale scores at rest and movement at 2 hours and 48 hours after surgery, the number of patients who require additional analgesics during the first 48 hours after operation, the total consumption of opioids or nonsteroid anti-inflammatory drugs during the first 48 hours after operation, and adverse events at 2, 24, and 48 hours after operation. Results: The protocol was registered at Clinical Trials.gov on February 26, 2022. It was performed in accordance with the approved guidelines and regulations of the participating institutions. Recruitment began in April 2022. Data collection is expected to conclude in September 2024. Study completion is expected in December 2024. Conclusions: A randomized, controlled, clinical study was designed to observe the analgesic effect of intraoperative intravenous administration of a lower dose of S(+)-ketamine (0.3 mg/kg/h) in older patients after TKA surgery. The protocol will appraise the efficacy and safety of intraoperative intravenous injection of S(+)-ketamine to relieve acute pain after TKA in older patients who may benefit from the administration of S(+)-ketamine. Trial Registration: ClinicalTrials.gov NCT05289050; https://clinicaltrials.gov/ct2/show/NCT05289050 International Registered Report Identifier (IRRID): DERR1-10.2196/53063 %M 38064260 %R 10.2196/53063 %U https://www.researchprotocols.org/2023/1/e53063 %U https://doi.org/10.2196/53063 %U http://www.ncbi.nlm.nih.gov/pubmed/38064260 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e47349 %T Changing Trends in the Global Burden of Cataract Over the Past 30 Years: Retrospective Data Analysis of the Global Burden of Disease Study 2019 %A Jiang,Bo %A Wu,Tianhong %A Liu,Weiming %A Liu,Gaoqin %A Lu,Peirong %+ Department of Ophthalmology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, China, 86 51265215191, lupeirong@suda.edu.cn %K burden %K cataract %K disability-adjusted life-years %K human development index %K prediction %K risk factor %D 2023 %7 5.12.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Cataracts now account for the largest proportion of the global burden of blindness and vision loss. Understanding the changing trends in the global burden of cataracts over the past 30 years and the next 15 years is of clear significance for the prevention and control of cataracts in key populations. As far as we know, research on the future burden of cataracts is lacking. Objective: This study aims to assess the global burden of cataracts over the past 30 years by using age-period-cohort modeling and to estimate trends in the next 15 years. Methods: Data were obtained from the Global Burden of Disease Study 2019, the United Nations Development Programme, and the WHO (World Health Organization) Global Health Observatory data repository. The assessment of trends and disparities in the number and rate of disability-adjusted life years (DALYs) for cataracts from 1990 to 2019 was conducted. The association between the age-standardized DALY rate (ASDR) and the socio-demographic index (SDI), human development index (HDI), national levels of particulate matter <2.5 μm in diameter (PM2.5), and ambient ultraviolet radiation (UVR) was determined using linear regression analysis. Additionally, we used the Nordpred (Harald Fekjær and Bjørn Møller) age-period-cohort model to predict the cataract burden from 2020 to 2034. Results: Globally, the number of DALYs due to cataract increased from 3,492,604 (95% uncertainty interval [UI] 2,481,846-4,719,629) in 1990 to 6,676,281 (95% UI 4,761,210-9,006,193) in 2019. The ASDRs due to cataract decreased from 93.17 (95% UI 66.14-125.32) in 1990 to 82.94 (95% UI 59.06-111.75) in 2019, with an average annual percentage change of –0.37 (95% CI –0.44 to –0.3; P<.001). Age, female sex, air pollution, smoking, high fasting plasma glucose levels, and a high body mass index were risk factors for the burden of cataracts. SDI and HDI were negatively correlated with ASDRs of cataracts, while PM2.5 and UVR were positively associated with them. Higher DALY rates were also associated with lower SDI (R2=0.1939; P<.001), lower HDI (R2=0.2828; P<.001), national PM2.5 concentration (R2=0.1874; P<.001), and ambient UVR levels (R2=0.2354; P<.001). The prediction model suggested that the number of DALYs due to cataract will continue to rise globally, while the cataract DALY rate will continue to decrease. Conclusions: While the ASDR of cataracts has decreased, there has been a notable increase in the number of DALYs over the past 30 years. Projections suggest that the global burden of cataracts will continue to rise over the next 15 years. To address this challenge, appropriate prevention and treatment policies must be implemented. %M 38051579 %R 10.2196/47349 %U https://publichealth.jmir.org/2023/1/e47349 %U https://doi.org/10.2196/47349 %U http://www.ncbi.nlm.nih.gov/pubmed/38051579 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e51480 %T FORWARD Study of GORE VIABAHN Balloon-Expandable Endoprostheses and Bare Metal Stents in the United States, European Union, United Kingdom, Australia, and New Zealand When Placed to Treat Complex Iliac Occlusive Disease: Protocol for a Randomized Superiority Trial %A Kirkwood,Melissa L %A Armstrong,Ehrin J %A Ansari,Mohammad M %A Holden,Andrew %A Reijnen,Michel M P J %A Steinbauer,Markus %A Crannell,Zachary %A Novoa,Hector %A Phillips,Austin %A Schneider,Darren B %+ Division of Vascular and Endovascular Surgery, The University of Texas Southwestern Medical Center, 5959 Harry Hines Blvd, POB I, Ste. 620, Dallas, TX, 75390-3157, United States, 1 214 645 2040, Melissa.Kirkwood@UTSouthwestern.edu %K iliac artery occlusive disease %K VIABAHN VBX balloon expandable endoprosthesis %K covered stent %K stent graft %K stent %K randomized control trial %K FORWARD %K endoprosthesis %K atherosclerosis %K endovascular %K stenting %K occlusion %K RCT %K iliac occlusion %D 2023 %7 4.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The recommendations for the use of and selection of covered stent grafts in patients with aortoiliac occlusive disease are limited. Objective: The GORE VBX FORWARD clinical study aims to demonstrate the superiority of the GORE VIABAHN VBX Balloon Expandable Endoprosthesis (VBX device) for primary patency when compared to bare metal stenting (BMS) for the treatment of complex iliac artery occlusive disease. Methods: A prospective, multicenter, randomized control study in the United States, European Union, United Kingdom, Australia, and New Zealand will enroll patients with symptomatic, complex iliac artery occlusive disease. In this study, iliac artery occlusive disease is defined as a unilateral or bilateral disease with single or multiple lesions (with >50% stenosis or chronic total occlusion) each between 4 and 11 cm in length. In an attempt to more closely match real-world practices, patients with minor tissue loss (Rutherford class 5) and patients requiring hemodialysis will be included. Baseline aortoiliac angiography will be performed to assess target lesion characteristics and determine final patient eligibility. Once the patient is confirmed and guidewires are in place across the target lesions, the patient will be randomized in a 1:1 format to treatment with either the VBX device or a BMS. The BMS can be balloon- or self-expanding and must be approved for the iliac artery occlusive disease indication. Patients, the independent core laboratory reviewers, and Clinical Events Committee members will be blinded from the assigned treatment. Dual antithrombotic medical therapy is required through a minimum of 3 months post procedure. The primary end point is 12‑month primary patency and will be adjudicated by an independent imaging core laboratory and Clinical Events Committee. Key secondary end points will be tested for superiority and include technical, acute procedural, and clinical success; changes in Ankle-brachial index; patient quality of life; primary patency; freedom from restenosis; primary-assisted patency; secondary patency; freedom from target lesion revascularizations; cumulative reintervention rate; amputation-free survival; survival; and change in Rutherford category. Study follow-up will continue through 5 years. Results: Outcomes will be reported following study completion. Enrollment is anticipated to start in October 2023. Conclusions: The results of this study will provide definitive, level 1 clinical evidence to clinicians on the optimal choice of stent device to use for the treatment of complex iliac artery occlusive disease. The FORWARD study is powered for superiority and includes only complex, unilateral, or bilateral lesions involving the common or external iliac arteries. This study is a multidisciplinary endeavor involving vascular surgery, interventional cardiology, and interventional radiology across multiple countries with a blinded core laboratory review of end points in hopes that the outcomes will be widely accepted and incorporated into practice guidelines for optimal treatment of patients with complex iliac artery occlusive disease. Trial Registration: ClinicalTrials.gov NCT05811364; https://clinicaltrials.gov/study/NCT05811364 International Registered Report Identifier (IRRID): PRR1-10.2196/51480 %M 38048145 %R 10.2196/51480 %U https://www.researchprotocols.org/2023/1/e51480 %U https://doi.org/10.2196/51480 %U http://www.ncbi.nlm.nih.gov/pubmed/38048145 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49578 %T Facility-Based Audit System With Integrated Community Engagement to Improve Maternal and Perinatal Health Outcomes in Rural Pakistan: Protocol for a Mixed Methods Implementation Study %A Memon,Zahid %A Ahmed,Wardah %A Muhammad,Shah %A Soofi,Sajid %A Chohan,Shanti %A Rizvi,Arjumand %A Barach,Paul %A Bhutta,Zulfiqar A %+ The Aga Khan University, National Stadium Road, The Aga Khan University., Karachi, 74800, Pakistan, 92 21 34869826, zulfiqar.bhutta@aku.edu %K audit system %K perinatal outcome %K neonatal mortality %K stillbirth %K maternal %K mortality %K implementation research %K death audit %D 2023 %7 30.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Maternal and newborn mortality in Pakistan remains as a major public health challenge. Pakistan faces significant infrastructure challenges and inadequate access to quality health care, exacerbated by sociocultural factors. Facility-based audit systems coupled with community engagement are key elements in achieving improved health system performance. We describe an implementation approach adapted from the World Health Organization audit cycle in real-world settings, with a plan to scale-up through mixed methods evaluation plan. Objective: This study aims to implement a locally acceptable and relevant audit system and evaluate its feasibility within the rural health system of Pakistan for scale-up. Methods: The implementation of the audit system comprises six phases: (1) identify facility and community leadership through consultative meetings with government district health offices, (2) establish the audit committee under the supervision of district health officer, (3) initiate audit with ongoing community engagement, (4) train the audit committee members, (5) launch the World Health Organization audit cycle (monthly meetings), and (6) quarterly review and refresher training. Data from all deliveries, live births, maternal deaths, maternal near misses, stillbirths, and neonatal deaths will be identified and recorded from four sources: (1) secondary-level care rural health facilities, (2) lady health workers’ registers, (3) community representatives, and (4) project routine survey team. Concurrent quantitative and qualitative data will be drawn from case assessments, process analysis, and recommendations as components of iterative improvement cycles during the project. Outcomes will be the geographic distribution of mortality to measure the reach, proportion of facilities initiated to implement an audit system for measuring the adoption, proportion of audit committees with community representation, and proportion of audit committee members’ sharing feedback regularly to measure acceptability and feasibility. In addition, outcomes of effectiveness will be measured based on data recording and reporting trends, identified modifiable factors for mortality and morbidity as underpinned by the Three Delays framework. Qualitative data will be analyzed based on perceived facilitators, barriers, and lessons learned for policy implications. Results will be summarized in frequencies and percentages and triangulated by the project team. Data will be analyzed using Stata (version 16; StataCorp) and NVivo (Lumivero) software. Results: The study will be implemented for 20 months, followed by an additional 4-month period for follow-up. Initial results will be presented to the district health office and the District Health Program Management Team Meeting in the districts. Conclusions: This study will generate evidence about the feasibility and potential scale-up of a facility-based mortality audit system with integrated community engagement in rural Pakistan. Audit committees will complete the feedback loop linking health care providers, community representatives, and district health officials (policy makers). This implementation approach will serve decision makers in improving maternal and perinatal health outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/49578 %M 38032708 %R 10.2196/49578 %U https://www.researchprotocols.org/2023/1/e49578 %U https://doi.org/10.2196/49578 %U http://www.ncbi.nlm.nih.gov/pubmed/38032708 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49412 %T The Primary Prevention of Poststroke Epilepsy in Patients With Middle Cerebral Artery Infarct: Protocol for a Randomized Controlled Trial %A Chen,Yu-Shiue %A Sung,Pi-Shan %A Lai,Ming-Chi %A Huang,Chin-Wei %+ Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138, Sheng-Li Rd, North District, Tainan, 704302, Taiwan, 886 62353535 ext 5485, huangcw@mail.ncku.edu.tw %K poststroke epilepsy %K middle cerebral artery infarct %K seizure %K randomized control trial %K epilepsy %K stroke %K stroke survivor %K prognosis %K mortality %K drug therapy %K development %K seizure severity %K efficacy %K heart attack %K angina %K cardiovascular %K cardiology %K cardiologist %D 2023 %7 24.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Poststroke epilepsy poses a significant clinical challenge for individuals recovering from strokes, leading to a less favorable long-term outlook and increased mortality rates. Existing studies have primarily concentrated on administering antiseizure or anticonvulsant treatments only after the onset of late-onset seizures, without intervening during the epileptogenesis phase following a stroke. Objective: This research protocol is designed to conduct a randomized controlled trial to assess whether the early, preventive introduction of low-dose antiepileptic drug therapy (levetiracetam [LEV] or perampanel [PER]) in patients who have experienced middle cerebral artery (MCA) infarction can reduce the risk of developing poststroke epilepsy (primary prevention). Methods: Participants with MCA infarction, either with or without reperfusion treatments, will be recruited and promptly receive preventive intervention within 72 hours of the stroke occurrence. These participants will be randomly assigned to receive either PER (4 mg per day), LEV (1000 mg per day), or a placebo that matches the active drugs. This treatment will continue for 12 weeks after allocation. Brain magnetic resonance imaging will be used to confirm the presence of MCA territory infarction, and an electroencephalography will be used to ensure the absence of epileptiform discharges or electrographic seizures at the time of the stroke. All participants will undergo follow-up assessments for 72 weeks after allocation. Results: The primary outcome under evaluation will be the incidence of poststroke epilepsy in the 3 groups following the 18-month study period. Secondary outcomes will encompass the time to the occurrence of the first seizure, the severity of seizures, any treatment-related adverse events, and the modified Rankin scale score at 3 and 18 months. Exploratory outcomes will involve comparing the effectiveness and safety of PER and LEV. Conclusions: We anticipate that the intervention groups will experience a lower incidence and reduced severity of poststroke epilepsy compared to the control group after 18 months. We aim to establish evidence supporting the potential preventive effects of LEV and PER on poststroke seizures and epilepsy in patients with MCA infarction, as well as to explore the antiepileptogenic potential of both LEV and PER in patients with major ischemic strokes. Trial Registration: ClinicalTrials.gov NCT04858841; https://clinicaltrials.gov/study/NCT04858841 International Registered Report Identifier (IRRID): DERR1-10.2196/49412 %M 37999939 %R 10.2196/49412 %U https://www.researchprotocols.org/2023/1/e49412 %U https://doi.org/10.2196/49412 %U http://www.ncbi.nlm.nih.gov/pubmed/37999939 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e33147 %T CareKnowDo—A Multichannel Digital and Telephone Support Program for People With Chronic Kidney Disease: Feasibility Randomized Controlled Trial %A Reston,Riley Elizabeth %A Caskey,Fergus J %A Hole,Barnaby %A Udayaraj,Udaya %A Weinman,John %+ Atlantis Health, 1st Floor, Building 3, 566 Chiswick High Road, London, W4 5YA, United Kingdom, 44 7727735151, riley.reston@atlantishealth.com %K kidney disease %K chronic %K blood pressure %K randomized controlled trial %K telemedicine %K mobile health %K mHealth %K self-management %K guideline adherence %K medication adherence %K illness beliefs %K medication beliefs %K health psychology %K preventative medicine %K qualitative research %D 2023 %7 23.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic kidney disease (CKD) is a common, progressive condition. Lifestyle changes and antihypertensive medication can slow the progression to end-stage kidney disease, which requires renal replacement therapy. However, adherence to these recommendations is often low. Objective: The aim of CareKnowDo was to assess the feasibility of rolling out a digital self-management support and adherence program integrated with a patient-facing electronic health record, Patient View (PV). Methods: A 2-arm, parallel, individual-level pragmatic feasibility pilot randomized controlled trial was conducted at 2 National Health Service (NHS) sites in the United Kingdom. A total of 61 patients with CKD were randomized 1:1 into 2 groups and provided with either a new, tailored digital and telephone support program (CareKnowDo: 31/61, 51%) integrated with PV or standard care (PV alone: 30/61, 49%). Quantitative measures included clinical and psychosocial measures. The primary outcomes were feasibility based: recruitment rate, dropout, and the exploration of associations. Results: Of the 1392 patients screened in local kidney clinics, 269 (19.32%) met the basic inclusion criteria; the first 22.7% (61/269) who met the eligibility criteria were recruited to participate in the study. Of the 69 patients, 23 (38%) patients completed the final 6-month follow-up web-based survey. Reasons for the attrition were explored. A higher belief in the ability of the treatment to control CKD was associated with lower blood pressure at baseline (r=0.52; P=.005), and a higher perceived understanding of CKD at baseline was associated with lower blood pressure at follow-up (r=0.66; P<.001). Beliefs about medicines at baseline were associated with blood pressure at baseline but not at follow-up. This was true for both concerns about medicines (r=0.58; P=.001) and perceived necessity of medicines (r=0.42; P=.03). Conclusions: A tailored digital and nurse call–based program to enhance support for patients with CKD was piloted in 2 NHS sites and found to be feasible and acceptable. However, to maximize the effectiveness of the intervention (and of future trials), consideration should be given to the target audience most likely to benefit, as well as how to help them access the program as quickly and easily as possible. Trial Registration: NHS Health Research Authority, IRAS ID 184206; https://www.hra.nhs.uk/planning-and-improving -research/application-summaries/research-summaries/careknowdo-pilot-version-1/ %M 37995117 %R 10.2196/33147 %U https://formative.jmir.org/2023/1/e33147 %U https://doi.org/10.2196/33147 %U http://www.ncbi.nlm.nih.gov/pubmed/37995117 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45200 %T The Effects of Quality Assurance System Implementation on Work Well-Being and Patient Safety: Protocol for a Mixed Methods Study %A Vuohijoki,Anni %A Huusko,Mira %A Ristolainen,Leena %A Hakasaari,Pipsa %A Kautiainen,Hannu %A Leppilahti,Juhana %A Kivivuori,Sanna-Maria %A Hurri,Heikki %+ Faculty of Medicine, University of Oulu, PO BOX 8000, Oulu, 90014, Finland, 358 401446503, anni@terveysmyrsky.com %K Joint Commission International %K health and safety %K JCI %K human resource management %K organizational development %K quality in health care %D 2023 %7 23.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Systematic monitoring of work atmosphere and patient safety incidents is a necessary part of a quality assurance system, particularly an accredited system like the Joint Commission International (JCI). How the implementation of quality assurance systems affects well-being at work and patient safety is unclear. Evidence shows that accreditation improves workplace atmosphere and well-being. Thus, the assumption that an increase in employees’ well-being at work improves patient safety is reasonable. Objective: This study aims to describe the protocol for monitoring the effects of implementing the quality assurance system of JCI at Orton Orthopedic Hospital on employees’ well-being (primary outcome) and patient safety (secondary outcome). Methods: Quantitative (questionnaires and register data) and qualitative (semistructured interviews) methods will be used. In addition, quantitative data will be collected from register data. Both quantitative and register data will be analyzed. Register data analysis will be performed using generalized linear models with an appropriate distribution and link function. The study timeline covers the time before, during, and after the start of the accreditation process. The collected data will be used to compare job satisfaction, as a part of the well-being questionnaire, and the development of patient safety during the accreditation process. Results: The results of the quality assurance system implementation illuminate its possible effects on the patient’s safety and job satisfaction. The repeatability and internal consistency reliability of the well-being questionnaire will be reported. Data collection will begin in May, 2024. It will be followed by data analysis and the results are expected to be published by 2025. Conclusions: The planned study will contribute to the evaluation of the effects of JCI accreditation in terms of well-being at work and patient safety. International Registered Report Identifier (IRRID): PRR1-10.2196/45200 %M 37995119 %R 10.2196/45200 %U https://www.researchprotocols.org/2023/1/e45200 %U https://doi.org/10.2196/45200 %U http://www.ncbi.nlm.nih.gov/pubmed/37995119 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e52489 %T Built Environments to Support Rehabilitation for People With Stroke From the Hospital to the Home (B-Sure): Protocol for a Mixed Method Participatory Co-Design Study %A Kylén,Maya %A Sturge,Jodi %A Lipson-Smith,Ruby %A Schmidt,Steven M %A Pessah-Rasmussen,Hélène %A Svensson,Tony %A de Vries,Laila %A Bernhardt,Julie %A Elf,Marie %+ School of Health and Welfare, Dalarna University, Högskolegatan 2, Falun, 79188, Sweden, 46 701917856, mel@du.se %K stroke rehabilitation %K built environment %K person-centered %K participation %K self-efficacy %K meaningful activities %K accessibility %K participatory co-design %K good quality and local care %D 2023 %7 9.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: A global trend is to move rehabilitation closer to people's neighborhoods and homes. Still, little attention has been given to how the built environment outside the hospital setting might impact rehabilitation and recovery for stroke survivors. Objective: The overarching objective of this project is to develop conceptual models of built environments that support stroke rehabilitation and recovery outside the hospital setting. Specifically, the project will explore factors and characteristics of the built environment that support people with stroke and their families and identify innovative built environments that can be designed for local health care. The project will examine facilitators and obstacles for implementing built environmental solutions and evaluate the potential benefits, feasibility, and acceptability. Methods: The project uses a mixed methods design approach with 3 phases. In phase 1, factors and characteristics of the built environment for rehabilitation will be identified. Based on the results from phase 1, phase 2 will involve co-designing prototypes of environments to support the rehabilitation process for people with stroke. Finally, the prototypes will be evaluated in phase 3. Qualitative and quantitative methods will include a literature review, a concept mapping (CM) study, stakeholder interviews, prototype development, and testing. The project will use multidimensional scaling, hierarchical cluster analysis, descriptive statistics for quantitative data, and content analysis for qualitative data. Location analysis will rely on the location-allocation model for network problems, and the rule-based analysis will be based on geographic information systems data. Results: As of the submission of this protocol, ethical approval for the CM study and the interview study has been obtained. Data collection is planned to start in September 2023 and the workshops later in the same year. The scoping review is ongoing from January 2023. The CM study is ongoing and will be finalized in the spring of 2024. We expect to finish the data analysis in the second half of 2024. The project is a 3-year project and will continue until December 2025. Conclusions: We aim to determine how new environments could better support a person’s control over their day, environment, goals, and ultimately control over their recovery and rehabilitation activities. This “taking charge” approach would have the greatest chance of transferring the care closer to the patient's home. By co-designing with multiple stakeholders, we aim to create solutions with the potential for rapid implementation. The project’s outcomes may target other people with frail health after a hospital stay or older persons in Sweden and anywhere else. The impact and social benefits include collaboration between important stakeholders to explore how new environments can support the transition to local health care, co-design, and test of new conceptual models of environments that can promote health and well-being for people post stroke. International Registered Report Identifier (IRRID): DERR1-10.2196/52489 %M 37943590 %R 10.2196/52489 %U https://www.researchprotocols.org/2023/1/e52489 %U https://doi.org/10.2196/52489 %U http://www.ncbi.nlm.nih.gov/pubmed/37943590 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48521 %T Clinical Prediction Models for Hospital-Induced Delirium Using Structured and Unstructured Electronic Health Record Data: Protocol for a Development and Validation Study %A Ser,Sarah E %A Shear,Kristen %A Snigurska,Urszula A %A Prosperi,Mattia %A Wu,Yonghui %A Magoc,Tanja %A Bjarnadottir,Ragnhildur I %A Lucero,Robert J %+ Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, United States, 1 3522735468, sser@ufl.edu %K big data %K machine learning %K data science %K hospital-acquired condition %K hospital induced %K hospital acquired %K predict %K predictive %K prediction %K model %K models %K natural language processing %K risk factors %K delirium %K risk %K unstructured %K structured %K free text %K clinical text %K text data %D 2023 %7 9.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Hospital-induced delirium is one of the most common and costly iatrogenic conditions, and its incidence is predicted to increase as the population of the United States ages. An academic and clinical interdisciplinary systems approach is needed to reduce the frequency and impact of hospital-induced delirium. Objective: The long-term goal of our research is to enhance the safety of hospitalized older adults by reducing iatrogenic conditions through an effective learning health system. In this study, we will develop models for predicting hospital-induced delirium. In order to accomplish this objective, we will create a computable phenotype for our outcome (hospital-induced delirium), design an expert-based traditional logistic regression model, leverage machine learning techniques to generate a model using structured data, and use machine learning and natural language processing to produce an integrated model with components from both structured data and text data. Methods: This study will explore text-based data, such as nursing notes, to improve the predictive capability of prognostic models for hospital-induced delirium. By using supervised and unsupervised text mining in addition to structured data, we will examine multiple types of information in electronic health record data to predict medical-surgical patient risk of developing delirium. Development and validation will be compliant to the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) statement. Results: Work on this project will take place through March 2024. For this study, we will use data from approximately 332,230 encounters that occurred between January 2012 to May 2021. Findings from this project will be disseminated at scientific conferences and in peer-reviewed journals. Conclusions: Success in this study will yield a durable, high-performing research-data infrastructure that will process, extract, and analyze clinical text data in near real time. This model has the potential to be integrated into the electronic health record and provide point-of-care decision support to prevent harm and improve quality of care. International Registered Report Identifier (IRRID): DERR1-10.2196/48521 %M 37943599 %R 10.2196/48521 %U https://www.researchprotocols.org/2023/1/e48521 %U https://doi.org/10.2196/48521 %U http://www.ncbi.nlm.nih.gov/pubmed/37943599 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e50740 %T Perceptions of and Preferences for Telemedicine Use Since the Early Stages of the COVID-19 Pandemic: Cross-Sectional Survey of Patients and Physicians %A Mazouri-Karker,Sanae %A Lüchinger,Robin %A Braillard,Olivia %A Bajwa,Nadia %A Achab,Sophia %A Hudelson,Patricia %A Dominicé Dao,Melissa %A Junod Perron,Noelle %+ E-health and Telemedicine Division, Geneva University Hospitals, street Gabrielle Perret Gentil 6, Geneva, 1205, Switzerland, 41 22 379 59 40, dr.mazouri@cmtb.ch %K acceptability %K acceptance %K adoption %K attitude %K cross sectional %K e-consultation %K eHealth %K opinion %K patient %K perception %K perspective %K physician %K questionnaire %K remote consultation %K survey %K telehealth %K telemedicine %K usage %K video consultation %D 2023 %7 7.11.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: While the use of telemedicine (TLM) increased worldwide during the early phases of the COVID-19 pandemic, little is known about the use and acceptance of TLM post the COVID-19 pandemic. Objective: This study aims to evaluate patients’ and physicians’ self-reported use, preferences, and acceptability of different types of TLM after the initial phases of the COVID-19 pandemic. Methods: We conducted a cross-sectional survey among patients and physicians in Geneva, Switzerland, between September 2021 and January 2022. Patients in waiting rooms of both private and public medical centers and emergency services were invited to answer a web-based questionnaire. Physicians working in private and public settings were invited by email to answer a similar questionnaire. The questionnaires assessed participants’ sociodemographics and digital literacy; self-reported use of TLM; as well as preferences and acceptability of TLM for different clinical situations. Results: A total of 567 patients (309/567, 55% women) and 448 physicians (230/448, 51% women and 225/448, 50% in private practice) responded to the questionnaire. Patients (263/567, 46.5%) and physicians (247/448, 55.2%) generally preferred the phone over other TLM formats and considered it to be acceptable for most medical situations. Email (417/567, 73.6% and 308/448, 68.8%) was acceptable for communicating exam results, and medical certificates (327/567, 67.7% and 297/448, 66.2%) and video (302/567, 53.2% and 288/448, 64.3%) was considered acceptable for psychological support by patients and physicians, respectively. Older age was associated with lower acceptability of video for both patients and physicians (odds ratio [OR] 0.03, 95% CI 0.00-0.33 and OR 0.23, 95% CI 0.08-0.66) while previous use of video was positively associated with video acceptability (OR 3.16, 95% CI 1.84-5.43 and OR 3.34, 95% CI 2.91-5.54). Psychiatrists and hospital physicians were more likely to consider video to be acceptable (OR 10.79, 95% CI 3.96-29.30 and OR 3.97, 95% CI 2.23-7.60). Conclusions: Despite the development of video, the acceptability of video remains lower than that of the phone for most health issues or patient requests. There is a need to better define for which patients and in which medical situations video can become safe and efficient. %M 37934574 %R 10.2196/50740 %U https://humanfactors.jmir.org/2023/1/e50740 %U https://doi.org/10.2196/50740 %U http://www.ncbi.nlm.nih.gov/pubmed/37934574 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45624 %T Perspectives of Patients With Chronic Respiratory Diseases and Medical Professionals on Pulmonary Rehabilitation in Pune, India: Qualitative Analysis %A Padhye,Rashmi %A Sahasrabudhe,Shruti D %A Orme,Mark W %A Pina,Ilaria %A Dhamdhere,Dipali %A Borade,Suryakant %A Bhakare,Meenakshi %A Ahmed,Zahira %A Barton,Andy %A Modi,Mahavir %A Malcolm,Dominic %A Salvi,Sundeep %A Singh,Sally J %+ Clinical Research Department, Symbiosis Medical College for Women, Symbiosis University Hospitals and Research Centre, Symbiosis (Deemed University), Mulshi Road, Lavale, Pune, 412115, India, 91 020 61930000 ext 3514, rashmi.deshpande.gr@siu.edu.in %K COPD %K chronic obstructive pulmonary disease %K asthma %K patients’ suffering %K self-management %K digital mode of PR %K integrating yoga with PR %K thematic qualitative analysis %K knowledge about PR %K barriers to PR %K chronic respiratory diseases %K CRD %K India %K pulmonary rehabilitation %K medical professional %K treatment %K inhaler %D 2023 %7 7.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic respiratory diseases (CRDs) contribute significantly to morbidity and mortality worldwide and in India. Access to nonpharmacological options, such as pulmonary rehabilitation (PR), are, however, limited. Given the difference between need and availability, exploring PR, specifically remotely delivered PR, in a resource-poor setting, will help inform future work. Objective: This study explored the perceptions, experiences, needs, and challenges of patients with CRDs and the potential of and the need for PR from the perspective of patients as well as medical professionals involved in the referral (doctors) and delivery (physiotherapists) of PR. Methods: In-depth qualitative semistructured interviews were conducted among 20 individuals diagnosed with CRDs and 9 medical professionals. An inductive thematic analysis approach was used as we sought to identify the meanings shared both within and across the 2 participant groups. Results: The 20 patients considered lifestyle choices (smoking and drinking), a lack of physical activity, mental stress, and heredity as the triggering factors for their CRDs. All of them equated the disease with breathlessness and a lack of physical strength, consulting multiple doctors about their physical symptoms. The most commonly cited treatment choice was an inhaler. Most of them believed that yoga and exercise are good self-management strategies, and some were performing yoga postures and breathing exercises, as advised by friends or family members or learned from a televised program or YouTube videos. None of them identified with the term “pulmonary rehabilitation,” but many were aware of the exercise component and its benefits. Despite being naive to smartphone technology or having difficulty in reading, most of them were enthusiastic about enrolling in an application-based remotely delivered digital PR program. The 9 medical professionals were, however, reluctant to depend on a PR program delivered entirely online. They recommended that patients with CRDs be supported by their family to use technology, with some time spent with a medical professional during the program. Conclusions: Patients with CRDs in India currently manage their disease with nonguided strategies but are eager to improve and would benefit from a guided PR program to feel better. A home-based PR program, with delivery facilitated by digital solutions, would be welcomed by patients and health care professionals involved in their care, as it would reduce the need for travel, specialist equipment, and setup. However, low digital literacy, low resource availability, and a lack of expertise are of concern to health care professionals. For India, including yoga could be a way of making PR “culturally congruent” and more successful. The digital PR intervention should be flexible to individual patient needs and should be complemented with physical sessions and a feedback mechanism for both practitioners as well as patients for better uptake and adherence. %M 37934558 %R 10.2196/45624 %U https://formative.jmir.org/2023/1/e45624 %U https://doi.org/10.2196/45624 %U http://www.ncbi.nlm.nih.gov/pubmed/37934558 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46961 %T Development of an Information Guideline for Kidney Transplant Recipients in a Clinical Trial: Protocol for a Modified Delphi Method %A Faraldo-Cabana,Araceli %A Sánchez-Fructuoso,Ana %A Pérez-Flores,Isabel %A Beneit-Montesinos,Juan Vicente %A Muñoz-Jiménez,Daniel %A Peix Jiménez,Belén %A Asensio Arredondo,Sara %A Nuño Santana,Enriqueta Isabel %A Santana Valeros,María José %A Hidalgo González,Virginia %A González García,Fernando %A Ortuño-Soriano,Ismael %+ Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria San Carlos, Avda. Complutense, s/n, Madrid, 28040, Spain, 34 913941346, iortunos@ucm.es %K compliance %K Delphi method %K guideline %K kidney transplantation %K patient adherence %K patients %D 2023 %7 6.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Renal transplantation is the treatment of choice for most cases of end-stage renal disease. Recipients need to lead a healthy lifestyle to minimize the potential side effects of immunosuppressive drugs and improve transplant outcomes. There is not much evidence about the best way to increase adherence to healthy lifestyles in kidney transplant recipients, so one of the objectives set by the nursing team is to train people to acquire the necessary skills and tools to be able to take care of themselves. In this sense, the consensual development of appropriate materials may be useful and of interest. Objective: The aim of this study was to develop an information guide for adults with kidney transplants to be assessed in a subsequent clinical trial as an intervention to increase adherence to healthy habits. Methods: We used a 3-step, methodological, sequential approach: (1) training from a group of experts and item consensus; (2) review of the medical literature available; and (3) use of the Delphi technique with on-site meetings. A total of 5 nurses from the Community of Madrid Kidney Transplantation Unit in Spain were asked to participate. The patients’ lifestyle factors that, according to the medical literature available and experts’ opinions, have the greatest impact on the survival of the transplanted organ and the recipients themselves were all described. Results: After using the modified Delphi method to reach a consensus on the items to be included and the information needed in each, an information guide for adult kidney transplant patients was developed. This guide facilitates the structuring of health care, information, and recommendations necessary for effective self-care for each person. The result is considered to be an easy-to-understand tool, useful for transplant doctors and nurses, in simple language, with information based on the latest scientific-medical evidence published to date, aspects of which will be evaluated in a clinical trial designed for this purpose. Conclusions: Currently, this guide is the main intervention variable of a clinical trial (registered on ClinicalTrials.gov; NCT05715580) aimed at improving compliance with healthy habits in kidney transplant recipients in the Community of Madrid, Spain. The method used in its development has been useful and agile, and the result is a guide that can be easily updated periodically following the same procedure. International Registered Report Identifier (IRRID): DERR1-10.2196/46961 %M 37930773 %R 10.2196/46961 %U https://www.researchprotocols.org/2023/1/e46961 %U https://doi.org/10.2196/46961 %U http://www.ncbi.nlm.nih.gov/pubmed/37930773 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44299 %T Moral Distress, Mental Health, and Risk and Resilience Factors Among Military Personnel Deployed to Long-Term Care Facilities During the COVID-19 Pandemic: Research Protocol and Participation Metrics %A Nazarov,Anthony %A Fikretoglu,Deniz %A Liu,Aihua %A Born,Jennifer %A Michaud,Kathy %A Hendriks,Tonya %A Bélanger,Stéphanie AH %A Do,Minh T %A Lam,Quan %A Brooks,Brenda %A King,Kristen %A Sudom,Kerry %A Jetly,Rakesh %A Garber,Bryan %A Thompson,Megan %+ MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, 550 Wellington Road, London, ON, N6C 0A7, Canada, 1 6474044924, anthony.nazarov@proton.me %K mental health %K military %K Canadian Armed Forces %K operational organization %K logistics support %K health care %K moral distress %K moral injury %K deployment %K risk factors %K COVID-19 %K quarantine %K readiness %K well-being %K resilience %K long-term care facility %K centre de soins de longue durée %K survey %K older adult %K qualitative interviews %K quantitative %D 2023 %7 6.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The earliest days of the COVID-19 pandemic in Canada were marked by a significant surge in COVID-19 cases and COVID-19–related deaths among residents of long-term care facilities (LTCFs). As part of Canada’s response to the COVID-19 pandemic, Canadian Armed Forces (CAF) personnel were mobilized for an initial emergency domestic deployment to the hardest-hit LTCFs (Operation LASER LTCF) to support the remaining civilian staff in ensuring the continued delivery of care to residents. Akin to what was observed following past CAF international humanitarian missions, there was an expected increased risk of exposure to multiple stressors that may be psychologically traumatic and potentially morally injurious in nature (ie, related to core values, eg, witnessing human suffering). Emerging data from health care workers exposed to the unprecedented medical challenges and dilemmas of the early pandemic stages also indicated that such experiences were associated with increased risk of adverse mental health outcomes. Objective: This study aims to identify and quantify the individual-, group-, and organizational-level risk and resilience factors associated with moral distress, moral injury, and traditional mental health and well-being outcomes of Operation LASER LTCF CAF personnel. This paper aimed to document the methodology, implementation procedures, and participation metrics. Methods: A multimethod research initiative was conducted consisting of 2 primary data collection studies (a quantitative survey and qualitative interviews). The quantitative arm was a complete enumeration survey with web-based, self-report questionnaires administered at 3 time points (3, 6, and 12 mo after deployment). The qualitative arm consisted of individual, web-based interviews with a focus on understanding the nuanced lived experiences of individuals participating in the Operation LASER LTCF deployment. Results: CAF personnel deployed to Operation LASER LTCF (N=2595) were invited to participate in the study. Data collection is now complete. Overall, of the 2595 deployed personnel, 1088 (41.93%), 582 (22.43%), and 497 (19.15%) responded to the survey at time point 1 (3 mo), time point 2 (6 mo), and time point 3 (12 mo) after deployment, respectively. The target sample size for the qualitative interviews was set at approximately 50 considering resourcing and data saturation. Interest in participating in qualitative interviews surpassed expectations, with >200 individuals expressing interest; this allowed for purposive sampling across key characteristics, including gender, rank, Operation LASER LTCF role, and province. In total, 53 interviews were conducted. Conclusions: The data generated through this research have the potential to inform and promote better understanding of the well-being and mental health of Operation LASER LTCF personnel over time; identify general and Operation LASER LTCF–specific risk and protective factors; provide necessary support to the military personnel who served in this mission; and inform preparation and interventions for future missions, especially those more domestic and humanitarian in nature. International Registered Report Identifier (IRRID): DERR1-10.2196/44299 %M 37676877 %R 10.2196/44299 %U https://www.researchprotocols.org/2023/1/e44299 %U https://doi.org/10.2196/44299 %U http://www.ncbi.nlm.nih.gov/pubmed/37676877 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46227 %T Causes of Patient Nonattendance at Medical Appointments: Protocol for a Mixed Methods Study %A Schwalbe,Daria %A Sodemann,Morten %A Iachina,Maria %A Nørgård,Bente Mertz %A Chodkiewicz,Nina Høy %A Ammentorp,Jette %+ Centre for Patient Communication (CFPK), Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Kløvervænget 12B, 116, Odense, 5000, Denmark, 45 26826039, dschwalbe@sdu.dk %K missed appointments %K nonattendance %K hospital appointments %K Danish health care %K prevention strategies %K positive deviance %K quality of treatment %K mixed methods %D 2023 %7 3.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Approximately one-third of patient appointments in Danish health care result in failures, leading to patient risk and sizable resource waste. Existing interventions to alleviate no-shows often target the patients. The underlying reason behind these interventions is a view that attendance or nonattendance is solely the patient’s problem. However, these interventions often prove to be ineffective and can perpetuate social biases and health inequalities, leaving behind patients who are more vulnerable or disadvantaged (in terms of social, economical, and linguistic factors, etc). A more holistic understanding of no-shows is needed to optimize processes, reduce waste, and support patients who are vulnerable. Objective: This study aims to gain a deep and more comprehensive understanding of the causes, mechanisms, and recurring patterns and elements contributing to nonattendance at Danish hospitals in the Region of Southern Denmark. It emphasizes the patient perspective and analyzes the relational and organizational processes surrounding no-shows in health care. In addition, the study aims to identify effective communicative strategies and organizational processes that can support the development and implementation of successful interventions. Methods: The study uses mixed quantitative-qualitative methods, encompassing 4 analytical projects focusing on nonattendance patterns, patient knowledge and behavior, the management of hospital appointments, and in situ communication. To address the complexity of no-shows in health care, the study incorporates various data sources. The quantitative data sources include the electronic patient records, Danish central registries, Danish National Patient Registry, and Register of Medicinal Product Statistics. Baseline characteristics of patients at different levels are compared using chi-square tests and Kruskal-Wallis tests. The qualitative studies involve observational data, individual semistructured interviews with patients and practitioners, and video recordings of patient consultations. Results: This paper presents the protocol of the study, which was funded by the Novo Nordisk Foundation in July 2022. Recruitment started in February 2023. It is anticipated that the quantitative data analysis will be completed by the end of September 2023, with the qualitative investigation starting in October 2023. The first study findings are anticipated to be available by the end of 2024. Conclusions: The existing studies of nonattendance in Danish health care are inadequate in addressing relational and organizational factors leading to hospital no-shows. Interventions have had limited effect, highlighting the Danish health care system’s failure to accommodate patients who are vulnerable. Effective interventions require a qualitative approach and robust ethnographic data to supplement the description and categorization of no-shows at hospitals. Obtaining comprehensive knowledge about the causes of missed patient appointments will yield practical benefits, enhancing the safety, coherence, and quality of treatment in health care. International Registered Report Identifier (IRRID): PRR1-10.2196/46227 %M 37723870 %R 10.2196/46227 %U https://www.researchprotocols.org/2023/1/e46227 %U https://doi.org/10.2196/46227 %U http://www.ncbi.nlm.nih.gov/pubmed/37723870 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48558 %T A Silver Fluoride Intervention to Improve Oral Health Trajectories of Young Indigenous Australians: Protocol for a Cluster Randomized Controlled Trial %A Hedges,Joanne %A Hermes Soares,Gustavo %A Cadet-James,Yvonne %A Dodd,Zell %A Cooney,Sinon %A Newman,James %A Mittinty,Murthy %A Kularatna,Sanjeewa %A Larkins,Priscilla %A Zwolak,Roman %A Roberts,Rachel %A Jamieson,Lisa %+ Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Level 4, Rundle Mall Plaza, 50 Rundle Mall, Adelaide, 5005, Australia, 61 883034611, lisa.jamieson@adelaide.edu.au %K clinical trial %K community %K dental caries %K Indigenous Australian %K intervention %K silver fluoride intervention %D 2023 %7 2.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Indigenous Australian children and adolescents experience profound levels of preventable dental disease. The application of silver fluoride (AgF) to active dental caries is a noninvasive alternative to traditional dental treatment approaches. There is particular utility among Indigenous children and young people with dental fear, who may not have access to timely or culturally safe dental service provisions. Objective: The aims of this study are to: (1) assess levels of active dental caries among Indigenous children and young people in 6 Australian states and territories; (2) determine if an AgF intervention reduces levels of active disease over 12-24 months; (3) measure the impact of improved oral health on social and emotional well-being (SEWB) and oral health-related quality of life; and (4) calculate the cost-effectiveness of implementing such an initiative. Methods: The study will use a 2-arm, parallel cluster randomized controlled trial design. Approximately 1140 Indigenous children and youth aged between 2 and 18 years will be recruited. Each state or territory will have 2 clusters. The intervention group will receive the AgF intervention at the start of the study, with the delayed intervention group receiving the AgF intervention 12 months after study commencement. The primary outcome will be the arrest of active carious lesions, with arrested caries defined as nonpenetration by a dental probe. Secondary outcomes will include SEWB, oral health-related quality of life, and dental anxiety, with covariates including dental behaviors (brushing and dental visits). Effectiveness measures for the economic evaluation will include the number of children and young people managed in primary oral health care without the need for specialist referral, changes in SEWB, the numbers and types of treatments provided, and caries increments. Results: Participant recruitment will commence in May 2023. The first results are expected to be submitted for publication 1 year after a 24-month follow-up. Conclusions: Our findings have the potential to change the way in which active dental disease among Indigenous children and young people can be managed through the inclusion of specifically tailored AgF applications to improve dental health and SEWB delivered by Indigenous health care workers. Desired impacts include cost savings on expensive dental treatments; improved SEWB, nutrition, social, and learning outcomes; and improved quality of life for both children and young people and their caregivers and the broader Indigenous community. The AgF application could be easily implemented into the training program of Indigenous health workers and yield critical information in the management armamentarium of health and well-being recommendations for Australia’s First Peoples. International Registered Report Identifier (IRRID): PRR1-10.2196/48558 %M 37917128 %R 10.2196/48558 %U https://www.researchprotocols.org/2023/1/e48558 %U https://doi.org/10.2196/48558 %U http://www.ncbi.nlm.nih.gov/pubmed/37917128 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49605 %T Characteristics and Admission Preferences of Pediatric Emergency Patients and Their Waiting Time Prediction Using Electronic Medical Record Data: Retrospective Comparative Analysis %A Guo,Lin Lin %A Guo,Lin Ying %A Li,Jiao %A Gu,Yao Wen %A Wang,Jia Yang %A Cui,Ying %A Qian,Qing %A Chen,Ting %A Jiang,Rui %A Zheng,Si %+ Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, 3 Yabao Rd, Chaoyang District, Beijing, 100020, China, 86 010 52328745, zheng.si@imicams.ac.cn %K pediatric emergency department %K characteristics %K admission preferences %K waiting time %K machine learning %K electronic medical record %D 2023 %7 1.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The growing number of patients visiting pediatric emergency departments could have a detrimental impact on the care provided to children who are triaged as needing urgent attention. Therefore, it has become essential to continuously monitor and analyze the admissions and waiting times of pediatric emergency patients. Despite the significant challenge posed by the shortage of pediatric medical resources in China’s health care system, there have been few large-scale studies conducted to analyze visits to the pediatric emergency room. Objective: This study seeks to examine the characteristics and admission patterns of patients in the pediatric emergency department using electronic medical record (EMR) data. Additionally, it aims to develop and assess machine learning models for predicting waiting times for pediatric emergency department visits. Methods: This retrospective analysis involved patients who were admitted to the emergency department of Children’s Hospital Capital Institute of Pediatrics from January 1, 2021, to December 31, 2021. Clinical data from these admissions were extracted from the electronic medical records, encompassing various variables of interest such as patient demographics, clinical diagnoses, and time stamps of clinical visits. These indicators were collected and compared. Furthermore, we developed and evaluated several computational models for predicting waiting times. Results: In total, 183,024 eligible admissions from 127,368 pediatric patients were included. During the 12-month study period, pediatric emergency department visits were most frequent among children aged less than 5 years, accounting for 71.26% (130,423/183,024) of the total visits. Additionally, there was a higher proportion of male patients (104,147/183,024, 56.90%) compared with female patients (78,877/183,024, 43.10%). Fever (50,715/183,024, 27.71%), respiratory infection (43,269/183,024, 23.64%), celialgia (9560/183,024, 5.22%), and emesis (6898/183,024, 3.77%) were the leading causes of pediatric emergency room visits. The average daily number of admissions was 501.44, and 18.76% (34,339/183,204) of pediatric emergency department visits resulted in discharge without a prescription or further tests. The median waiting time from registration to seeing a doctor was 27.53 minutes. Prolonged waiting times were observed from April to July, coinciding with an increased number of arrivals, primarily for respiratory diseases. In terms of waiting time prediction, machine learning models, specifically random forest, LightGBM, and XGBoost, outperformed regression methods. On average, these models reduced the root-mean-square error by approximately 17.73% (8.951/50.481) and increased the R2 by approximately 29.33% (0.154/0.525). The SHAP method analysis highlighted that the features “wait.green” and “department” had the most significant influence on waiting times. Conclusions: This study offers a contemporary exploration of pediatric emergency room visits, revealing significant variations in admission rates across different periods and uncovering certain admission patterns. The machine learning models, particularly ensemble methods, delivered more dependable waiting time predictions. Patient volume awaiting consultation or treatment and the triage status emerged as crucial factors contributing to prolonged waiting times. Therefore, strategies such as patient diversion to alleviate congestion in emergency departments and optimizing triage systems to reduce average waiting times remain effective approaches to enhance the quality of pediatric health care services in China. %M 37910168 %R 10.2196/49605 %U https://www.jmir.org/2023/1/e49605 %U https://doi.org/10.2196/49605 %U http://www.ncbi.nlm.nih.gov/pubmed/37910168 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48236 %T Implications for Electronic Surveys in Inpatient Settings Based on Patient Survey Response Patterns: Cross-Sectional Study %A Gregory,Megan E %A Sova,Lindsey N %A Huerta,Timothy R %A McAlearney,Ann Scheck %+ The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, 700 Ackerman Rd, Suite 4000, Columbus, OH, 43202, United States, 1 614 293 8973, Ann.McAlearney@osumc.edu %K surveys %K patient satisfaction %K patient experience %K patient surveys %K electronic survey %K cross-sectional study %K quality of life %K mental health %K symptoms %K data quality %K hospitalization %D 2023 %7 1.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background:  Surveys of hospitalized patients are important for research and learning about unobservable medical issues (eg, mental health, quality of life, and symptoms), but there has been little work examining survey data quality in this population whose capacity to respond to survey items may differ from the general population. Objective:  The aim of this study is to determine what factors drive response rates, survey drop-offs, and missing data in surveys of hospitalized patients. Methods:  Cross-sectional surveys were distributed on an inpatient tablet to patients in a large, midwestern US hospital. Three versions were tested: 1 with 174 items and 2 with 111 items; one 111-item version had missing item reminders that prompted participants when they did not answer items. Response rate, drop-off rate (abandoning survey before completion), and item missingness (skipping items) were examined to investigate data quality. Chi-square tests, Kaplan-Meyer survival curves, and distribution charts were used to compare data quality among survey versions. Response duration was computed for each version. Results: Overall, 2981 patients responded. Response rate did not differ between the 174- and 111-item versions (81.7% vs 83%, P=.53). Drop-off was significantly reduced when the survey was shortened (65.7% vs 20.2% of participants dropped off, P<.001). Approximately one-quarter of participants dropped off by item 120, with over half dropping off by item 158. The percentage of participants with missing data decreased substantially when missing item reminders were added (77.2% vs 31.7% of participants, P<.001). The mean percentage of items with missing data was reduced in the shorter survey (40.7% vs 20.3% of items missing); with missing item reminders, the percentage of items with missing data was further reduced (20.3% vs 11.7% of items missing). Across versions, for the median participant, each item added 24.6 seconds to a survey’s duration. Conclusions:  Hospitalized patients may have a higher tolerance for longer surveys than the general population, but surveys given to hospitalized patients should have a maximum of 120 items to ensure high rates of completion. Missing item prompts should be used to reduce missing data. Future research should examine generalizability to nonhospitalized individuals. %M 37910163 %R 10.2196/48236 %U https://www.jmir.org/2023/1/e48236 %U https://doi.org/10.2196/48236 %U http://www.ncbi.nlm.nih.gov/pubmed/37910163 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48855 %T Investigating Attraction and Retention of Staff Within Public Mental Health Services in Victoria, Australia: Protocol for a Mixed Methods Study %A Crocker,Kaitlyn %A Gnatt,Inge %A Haywood,Darren %A Bhat,Ravi %A Butterfield,Ingrid %A Raveendran Nair Lalitha,Anoop %A Bishop,Ruby %A Castle,David J %A Jenkins,Zoe M %+ Department of Mental Health, St Vincent's Hospital Melbourne, 46 Nicholson St, Fitzroy, 3065, Australia, 61 0477077114, kaitlyn.crocker@svha.org.au %K mental health personnel %K career choice %K recruitment %K retention, turnover intention %K public mental health %K mental health %K workforce %K challenges %K attraction %K retention of staff %K staff retention %K human resources %K human resourcing %K HR %K hire %K hiring %K new hire %K onboarding %K orientation %K workforce %D 2023 %7 31.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: A large proportion of Australians are affected by mental illness each year, and treatment gaps are well known. To meet current and future demands and enable access to treatment that is safe, effective, and acceptable, a robust and sustainable mental health workforce is required. Factors reported to attract people to work within the mental health sector include aspiring to help others, having an interest in mental health and human behavior, the desire to make a difference and do something worthwhile, personal lived experience, recognition, and value of discipline-specific roles. However, despite the various reasons people enter the public mental health workforce, recruitment and retention continue to be ongoing challenges. To date, there has been limited investigation into understanding which factors are most relevant to the current Victorian workforce. Furthermore, a comparison to health care workers outside of mental health is also needed to better understand the specific needs of staff within the mental health sector. Objective: This study aims to explore factors related to attraction, recruitment, and retention of the public mental health workforce in Victoria, Australia. Methods: The study is a multisite, mixed methods cross-sectional study to be conducted at 4 public hospital services within Victoria, Australia: 2 in metropolitan and 2 in regional or rural locations. Current, previous, and nonmental health workers will be asked to complete a 20-25–minute web-based survey, which is developed based on previous research and offered participation in an optional 30-60–minute semistructured interview to examine personal experiences and perceptions. Both aspects of the project will examine factors related to attraction, recruitment, and retention in the public mental health workforce. Differences between groups (ie, current, past, and nonmental health workers), as well as location, discipline, and health setting will be examined. Regression analyses will be performed to determine the factors most strongly associated with retention (ie, job satisfaction) and turnover intention. Qualitative data will be transcribed verbatim and thematically analyzed to identify common themes. Results: As of May 2023, we enrolled 539 participants in the web-based survey and 27 participants in the qualitative interview. Conclusions: This project seeks to build on current knowledge from within Australia and internationally to understand role and service/system-related issues of attraction, recruitment, and retention specifically within Victoria, Australia. Seeking up-to-date information from across the health workforce may provide factors specific to mental health by illuminating any differences between mental health workers and health care workers outside of mental health. Furthermore, exploring motivators across health care disciplines and locations to enter, stay in, or leave a role in public mental health settings will provide valuable information to support how the sector plans and develops strategies that are fit for purpose. International Registered Report Identifier (IRRID): DERR1-10.2196/48855 %M 37906222 %R 10.2196/48855 %U https://www.researchprotocols.org/2023/1/e48855 %U https://doi.org/10.2196/48855 %U http://www.ncbi.nlm.nih.gov/pubmed/37906222 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47379 %T Human Papillomavirus (HPV) Infections Among Participants Undergoing Chlamydia trachomatis Testing in Reunion Island (RUN-SurV-HPV Study): Protocol for a Prevalence Study %A Gandelin,Maxence %A Tran,Phuong Lien %A Chirpaz,Emmanuel %A Jaffar-Bandjee,Marie-Christine %A Traversier,Nicolas %A Machalek,Dorothy %A Bertolotti,Antoine %+ Service des Maladies Infectieuses, Dermatologie, Centre Hospitalier Universitaire La Réunion, Avenue du Président Mitterrand, BP 350, Saint-Pierre, 97448, Réunion, 262 02 623591 91, antoine_bertolotti@yahoo.fr %K human papillomavirus %K HPV %K Reunion Island %K epidemiological study %K vaccination %K vaccine %K sexual health %K sexual transmission %K sexually transmitted infection %K STI %K epidemiological %K epidemiology %K cross-sectional %K genotyping %D 2023 %7 31.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Infection by human papillomavirus (HPV) induces various cancers, mainly cervical cancer but also anal and pharyngeal cancers. Reunion Island is a French department in the Indian Ocean. Due to the history of its settlement, the island’s population has a wide variety of origins, and the population’s sociodemographic characteristics differ from those of the French mainland. These characteristics make the island’s population an original French population in its own right, particularly in terms of health. Cervical cancer incidence and mortality in Reunion Island are 10.4 per 100,000 and 4.4 per 100,000, respectively, both of which are much higher than those in mainland France. There is also a disparity in the prevalence of different HPV types, with types 33 and 52 being overrepresented and type 18 being underrepresented. However, vaccination and screening coverage in Reunion Island is low. It is important to understand the burden of infection and its risk factors in members of the young Reunionese population at risk of HPV infection to promote and evaluate the implementation of future vaccination and screening programs on a larger scale. Objective: The RUN-SurV-HPV study will have the following four objectives: (1) to describe the prevalence of HPV genotypes in a population at risk of sexually transmitted infections in Reunion Island; (2) to describe the prevalence of HPV genotypes by anatomical site, gender, and sexuality; (3) to describe the correlates and risk factors for HPV detection; and (4) to examine HPV genotypes between different anatomical sites. Methods: Cross-sectional analyses of 1200 routine vaginal, anal, pharyngeal, and urinary samples collected between October 2020 to December 2022 from female and male patients aged 16 to 30 years undergoing Chlamydia trachomatis testing at a sexually transmitted infection (STI) testing center at Reunion Island will be performed. The population included 333 women who all had vaginal and pharyngeal swabs, with 80 of them also having had an anal swab. There are 167 men who have sex with men who have had anal and pharyngeal swabs, and 120 men who have sex with women who have had a urine swab only. Results will be correlated with sociodemographic and clinical data collected routinely during the consultations. HPV detection and genotyping will be performed using the Anyplex II HPV28 detection assay (Seegene). Results: The first polymerase chain reactions should begin in November 2023. The first results should be submitted for publication in 2024. Conclusions: The study will determine HPV prevalence by age, sex, male sexual preference, human immunodeficiency virus status, and STI co-infection. Collecting data from young patients not usually routinely screened for HPV infection will be a simple and reproducible way of better understanding local specificities, encouraging vaccination campaigns in the short-term, and evaluating their effectiveness in the future. International Registered Report Identifier (IRRID): DERR1-10.2196/47379 %M 37906221 %R 10.2196/47379 %U https://www.researchprotocols.org/2023/1/e47379 %U https://doi.org/10.2196/47379 %U http://www.ncbi.nlm.nih.gov/pubmed/37906221 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e51861 %T Hepatitis A Vaccination Coverage Among People With Chronic Liver Disease in England (HEALD): Protocol for a Retrospective Cohort Study %A Meza-Torres,Bernardo %A Forbes,Anna %A Elson,William %A Kar,Debasish %A Jamie,Gavin %A Hinton,William %A Fan,Xuejuan %A Byford,Rachel %A Feher,Michael %A Whyte,Martin %A Joy,Mark %A de Lusignan,Simon %+ Clinical Informatics and Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House, Walton Well Rd, Oxford, OX2 6ED, United Kingdom, 44 01865617855, bernardo.meza-torres@phc.ox.ac.uk %K chronic liver disease %K computerized %K data accuracy %K data extract %K ethnicity %K fatty liver disease %K general practitioner %K hepatitis A vaccination %K hepatitis %K liver disease %K medical record systems %K primary care %K routine data sets %K Systematized Nomenclature of Medicine %K vaccination monitoring and surveillance %K vaccination %D 2023 %7 24.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Hepatitis A outbreaks in the United Kingdom are uncommon. Most people develop mild to moderate symptoms that resolve, without sequelae, within months. However, in high-risk groups, including those with underlying chronic liver disease (CLD), hepatitis A infection can be severe, with a higher risk of mortality and morbidity. The Health Security Agency and the National Institute of Health and Care Excellence recommend preexposure hepatitis A vaccination given in 2 doses to people with CLD, regardless of its cause. There are currently no published reports of vaccination coverage for people with CLD in England or internationally. Objective: This study aims to describe hepatitis A vaccination coverage in adults with CLD in a UK primary care setting and compare liver disease etiology, sociodemographic characteristics, and comorbidities in people who are and are not exposed to the hepatitis A vaccine. Methods: We will conduct a retrospective cohort study with data from the Primary Care Sentinel Cohort of the Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub database, which is nationally representative of the English population. We will include people aged 18 years and older who have been registered in general practices in the Research and Surveillance Centre network and have a record of CLD between January 1, 2012, and December 31, 2022, including those with alcohol-related liver disease, chronic hepatitis B, chronic hepatitis C, nonalcohol fatty liver disease, Wilson disease, hemochromatosis, and autoimmune hepatitis. We will carefully curate variables using the Systematized Nomenclature of Medicine Clinical Terms. We will report the sociodemographic characteristics of those who are vaccinated. These include age, gender, ethnicity, population density, region, socioeconomic status (measured using the index of multiple deprivation), obesity, alcohol consumption, and smoking. Hepatitis A vaccination coverage for 1 and 2 doses will be calculated using an estimate of the CLD population as the denominator. We will analyze the baseline characteristics using descriptive statistics, including measures of dispersion. Pairwise comparisons of case-mix characteristics, comorbidities, and complications will be reported according to vaccination status. A multistate survival model will be fitted to estimate the transition probabilities among four states: (1) diagnosed with CLD, (2) first dose of hepatitis A vaccination, (3) second dose of hepatitis A vaccination, and (4) death. This will identify any potential disparities in how people with CLD get vaccinated. Results: The Research and Surveillance Centre population comprises over 8 million people. The reported incidence of CLD is 20.7 cases per 100,000. International estimates of hepatitis A vaccine coverage vary between 10% and 50% in this group. Conclusions: This study will describe the uptake of the hepatitis A vaccine in people with CLD and report any disparities or differences in the characteristics of the vaccinated population. International Registered Report Identifier (IRRID): PRR1-10.2196/51861 %M 37874614 %R 10.2196/51861 %U https://www.researchprotocols.org/2023/1/e51861 %U https://doi.org/10.2196/51861 %U http://www.ncbi.nlm.nih.gov/pubmed/37874614 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42788 %T Predicting the Risk of Total Hip Replacement by Using A Deep Learning Algorithm on Plain Pelvic Radiographs: Diagnostic Study %A Chen,Chih-Chi %A Wu,Cheng-Ta %A Chen,Carl P C %A Chung,Chia-Ying %A Chen,Shann-Ching %A Lee,Mel S %A Cheng,Chi-Tung %A Liao,Chien-Hung %+ Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Trauma Center, 5, Fuxin Street, Kweishiang District, Taoyuan City, Taoyuan, 333, Taiwan, 886 3 3281200 ext 3651, atong89130@gmail.com %K osteoarthritis %K orthopedic procedure %K artificial intelligence %K AI %K deep learning %K machine learning %K orthopedic %K pelvic %K radiograph %K predict %K hip replacement %K surgery %K convolutional neural network %K CNN %K algorithm %K surgical %K medical image %K medical imaging %D 2023 %7 20.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Total hip replacement (THR) is considered the gold standard of treatment for refractory degenerative hip disorders. Identifying patients who should receive THR in the short term is important. Some conservative treatments, such as intra-articular injection administered a few months before THR, may result in higher odds of arthroplasty infection. Delayed THR after functional deterioration may result in poorer outcomes and longer waiting times for those who have been flagged as needing THR. Deep learning (DL) in medical imaging applications has recently obtained significant breakthroughs. However, the use of DL in practical wayfinding, such as short-term THR prediction, is still lacking. Objective: In this study, we will propose a DL-based assistant system for patients with pelvic radiographs to identify the need for THR within 3 months. Methods: We developed a convolutional neural network–based DL algorithm to analyze pelvic radiographs, predict the hip region of interest (ROI), and determine whether or not THR is required. The data set was collected from August 2008 to December 2017. The images included 3013 surgical hip ROIs that had undergone THR and 1630 nonsurgical hip ROIs. The images were split, using split-sample validation, into training (n=3903, 80%), validation (n=476, 10%), and testing (n=475, 10%) sets to evaluate the algorithm performance. Results: The algorithm, called SurgHipNet, yielded an area under the receiver operating characteristic curve of 0.994 (95% CI 0.990-0.998). The accuracy, sensitivity, specificity, and F1-score of the model were 0.977, 0.920, 0932, and 0.944, respectively. Conclusions: The proposed approach has demonstrated that SurgHipNet shows the ability and potential to provide efficient support in clinical decision-making; it can assist physicians in promptly determining the optimal timing for THR. %M 37862084 %R 10.2196/42788 %U https://formative.jmir.org/2023/1/e42788 %U https://doi.org/10.2196/42788 %U http://www.ncbi.nlm.nih.gov/pubmed/37862084 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45701 %T The Efficacy and Feasibility of an Interoceptive Exposure Technique for Preventing the Transition From Subacute to Chronic Back Pain by Altering the Emotional Response to Pain: Protocol for a Pilot Randomized Controlled Trial %A Orenius,Tage Ingemar %A Ristolainen,Leena %A Silén,Esko %A Hurri,Heikki %+ Orton Orthopaedic Hospital, Tenholantie 10, Helsinki, 00280, Finland, 358 50 5223780 ext 9, tage.orenius@orton.fi %K biomarkers %K functional connectivity %K interoceptive exposure %K low back pain %K prevention %K subacute %D 2023 %7 19.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Psychological factors such as stress, anxiety, mood, emotions, cognitive functioning, and pain behavior are relevant to the onset of pain and its continuation in the transition to chronic conditions. Subacute low back pain (LBP), a precursor to chronic LBP, is particularly poorly understood, and its relationships with psychological factors are understudied. Objective: We will conduct a study aiming to prevent the chronicity of subacute LBP by altering the emotional response to pain using an interoceptive exposure technique (IET). Considering the recent increase in knowledge about psychological risk factors, as well as recent findings in cognitive neuroscience regarding emotional and cognitive background factors in the LBP chronicity process, efforts should be made to discover effective preventive methods. Methods: We present a novel method aiming to prevent the transition from subacute to chronic back pain by altering the emotional response to pain using an IET. In this pilot randomized controlled trial, participants who are at a higher risk of LBP chronification due to the presence of a biomarker (ie, functional connectivity between the medial prefrontal cortex and nucleus accumbens) will be randomly assigned to the IET intervention group or control group A (treatment as usual). Participants who do not present with the biomarker will be assigned to control group B (treatment as usual) to assess how well this biomarker predicts the chronification of subacute LBP in this study population. Questionnaires measuring the pain experience and psychological distress will be used before the intervention, after the intervention (at 3 months), and at the 12-month follow-up. Results: This research project will combine 2 novel methods: a biomarker as the inclusion criterion and an IET as the intervention. The comparative study design enables evaluation of the efficacy of the IET, as well as replication of the biomarker’s validity as a possible clinical screening method. Conclusions: If found to be useful, the IET would offer a cost-effective and reasonable way to develop treatment for acute and subacute back pain conditions. Potential benefits include increased pain management and quality of life for the individual patient with the addition of a potentially useful functional pain management method at the societal level. Trial Registration: ClinicalTrials.gov NCT05450263; https://clinicaltrials.gov/ct2/show/NCT05450263 International Registered Report Identifier (IRRID): PRR1-10.2196/45701 %M 37856182 %R 10.2196/45701 %U https://www.researchprotocols.org/2023/1/e45701 %U https://doi.org/10.2196/45701 %U http://www.ncbi.nlm.nih.gov/pubmed/37856182 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43038 %T Characteristics Associated With Telemonitoring Use Among Patients With Chronic Heart Failure: Retrospective Cohort Study %A Auener,Stefan L %A van Dulmen,Simone A %A Atsma,Femke %A van der Galiën,Onno %A Bellersen,Louise %A van Kimmenade,Roland %A Westert,Gert P %A Jeurissen,Patrick P T %+ IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Kapittelweg 54, Nijmegen, 6500HB, Netherlands, 31 243616359, stefan.auener@radboudumc.nl %K heart failure %K telemonitoring %K remote monitoring %K eHealth %K chronic heart failure %K heart %K disease %K patient %K self-management %K prevention %K utilization %K Netherlands %K hospital %K treatment %D 2023 %7 18.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic heart failure (HF) is a chronic disease affecting more than 64 million people worldwide, with an increasing prevalence and a high burden on individual patients and society. Telemonitoring may be able to mitigate some of this burden by increasing self-management and preventing use of the health care system. However, it is unknown to what degree telemonitoring has been adopted by hospitals and if the use of telemonitoring is associated with certain patient characteristics. Insight into the dissemination of this technology among hospitals and patients may inform strategies for further adoption. Objective: We aimed to explore the use of telemonitoring among hospitals in the Netherlands and to identify patient characteristics associated with the use of telemonitoring for HF. Methods: We performed a retrospective cohort study based on routinely collected health care claim data in the Netherlands. Descriptive analyses were used to gain insight in the adoption of telemonitoring for HF among hospitals in 2019. We used logistic multiple regression analyses to explore the associations between patient characteristics and telemonitoring use. Results: Less than half (31/84, 37%) of all included hospitals had claims for telemonitoring, and 20% (17/84) of hospitals had more than 10 patients with telemonitoring claims. Within these 17 hospitals, a total of 7040 patients were treated for HF in 2019, of whom 5.8% (409/7040) incurred a telemonitoring claim. Odds ratios (ORs) for using telemonitoring were higher for male patients (adjusted OR 1.90, 95% CI 1.50-2.41) and patients with previous hospital treatment for HF (adjusted OR 1.76, 95% CI 1.39-2.24). ORs were lower for higher age categories and were lowest for the highest age category, that is, patients older than 80 years (OR 0.30, 95% CI 0.21-0.44) compared to the reference age category (18-59 years). Socioeconomic status, degree of multimorbidity, and excessive polypharmacy were not associated with the use of telemonitoring. Conclusions: The use of reimbursed telemonitoring for HF was limited up to 2019, and our results suggest that large variation exists among hospitals. A lack of adoption is therefore not only due to a lack of diffusion among hospitals but also due to a lack of scaling up within hospitals that already deploy telemonitoring. Future studies should therefore focus on both kinds of adoption and how to facilitate these processes. Older patients, female patients, and patients with no previous hospital treatment for HF were less likely to use telemonitoring for HF. This shows that some patient groups are not served as much by telemonitoring as other patient groups. The underlying mechanism of the reported associations should be identified in order to gain a deeper understanding of telemonitoring use among different patient groups. %M 37851505 %R 10.2196/43038 %U https://www.jmir.org/2023/1/e43038 %U https://doi.org/10.2196/43038 %U http://www.ncbi.nlm.nih.gov/pubmed/37851505 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46765 %T Prehabilitation in an Integrative Medicine Day Clinic for Patients Undergoing Neoadjuvant Treatment: Single-Center Feasibility Pilot Study %A Raff,Christian %A Dörr-Harim,Colette %A Otto,Stephanie %A Thiele,Johanna %A Mihaljevic,Andre %A Kramer,Klaus %+ Department of General and Visceral Surgery, Working Group of Integrative Medicine, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm, 89081, Germany, 49 73150053538, christian.raff@uniklinik-ulm.de %K supportive care %K prehabilitation %K neoadjuvant treatment %K integrative medicine %K multimodal prehabilitation %K cancer %K oncology %K surgery %K preoperative %K feasibility %K integrative %K naturopathy %K naturopathic %K diet %K nutrition %D 2023 %7 18.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patients with cancer receiving neoadjuvant treatment prior to surgery are in a very stressful situation. Chemotherapy and radiation therapy put a strain on the quality of life and the pending surgery poses a relevant burden for many patients. Preparation of these patients for the intervention in terms of prehabilitation has great potential to reduce the burden of postoperative complications and may improve the clinical outcome. A prehabilitation approach also yields the possibility to address unmet patients’ needs and to help them modify their lifestyle in a maintainable way. Therefore, a multimodal approach is mandatory during this critical period. Objective: The aim of this study is to assess the feasibility of prehabilitation in an integrative medicine day clinic (PRIME-DC) prior to cancer surgery at a major university clinic. PRIME-DC is considered feasible if 80% of enrolled patients are willing and able to complete at least 6 out of the 8 weekly meetings, each lasting 6.5 hours, at such a clinic. Secondary end points aim to evaluate this multimodal program. Methods: The PRIME-DC intervention combines mind-body medicine, exercise therapy, nutrition therapy, naturopathic counseling, and the application of a yarrow liver compress. Adult patients with cancer, with a primary tumor in the abdomen (including intraperitoneal cancer, stomach cancer, and extraperitoneal cancers such as pancreatic, bladder, rectal, esophageal, endometrial, ovarian, and cervical cancer) or the breast requiring a neoadjuvant oncological treatment setting are eligible to participate. The addressed cancer entities imply either an extensive surgical intervention with an expected need for prehabilitation (eg, abdominal surgery) or a neoadjuvant treatment of several months with a high burden of treatment-associated side effects (breast cancer). Adherence to the day clinic program is the primary end point being defined as presence during the day clinic session. Secondary end points are physical assessment and quality of life, together with a structured assessment of neoadjuvant treatment-associated side effects. Furthermore, to collect qualitative data voluntary participants of the day clinic will be interviewed in a semistructured way after completion of the day clinic program on each component of the study (mind-body intervention, exercise, nutrition, naturopathic counseling, and a yarrow liver compress). Results: The procedures used in this study adhere to the tenets of the Declaration of Helsinki. As of February 2023, we enrolled 23 patients; the dominant cancer entity is breast cancer (18 enrolled patients). Conclusions: The presented protocol combines prehabilitation, lifestyle modification, naturopathic counseling, dietary assistance, and naturopathic treatment in an innovative and integrative way. Trial Registration: Deutsches Register Klinischer Studien German Clinical Trials Register DRKS00028126; https://drks.de/search/de/trial/DRKS00028126 International Registered Report Identifier (IRRID): DERR1-10.2196/46765 %M 37851493 %R 10.2196/46765 %U https://www.researchprotocols.org/2023/1/e46765 %U https://doi.org/10.2196/46765 %U http://www.ncbi.nlm.nih.gov/pubmed/37851493 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46190 %T Effectiveness of Facebook Groups and Pages on Participant Recruitment Into a Randomized Controlled Trial During the COVID-19 Pandemic: Descriptive Study %A Wong,Kirstie H T W %A Lau,Wallis C Y %A Man,Kenneth K C %A Bilbow,Andrea %A Ip,Patrick %A Wei,Li %+ Research Department of Practice and Policy, University College London, Mezzanine Floor, BMA House, Tavistock Square, London, WC1H 9JP, United Kingdom, 44 20 3987 2846, l.wei@ucl.ac.uk %K 1-2-3 Magic, ADHD %K attention deficit/hyperactivity disorder %K behavioral parenting training %K BPT %K clinical trial %K COVID-19 %K Facebook group %K Facebook page %K Facebook %K pediatric %K randomized controlled trial %K recruitment %K social media %K youth %K Zoom %D 2023 %7 17.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: In response to the unprecedented challenges posed by the COVID-19 pandemic, conventional recruitment approaches were halted, causing the suspension of numerous clinical trials. Previously, Facebook (Meta Platforms, Inc) has emerged as a promising tool for augmenting participant recruitment. While previous research has explored the use of Facebook for surveys and qualitative studies, its potential for recruiting participants into randomized controlled trials (RCTs) remains underexplored. Objective: This study aimed to comprehensively examine the effectiveness of using Facebook groups and pages to facilitate participant recruitment during the COVID-19 pandemic for an RCT on the effectiveness of a remote parenting program, 1-2-3 Magic, in families who have children with attention-deficit/hyperactivity disorder (ADHD) in the United Kingdom. Methods: We disseminated 5 Facebook posts with an attached digital flyer across 4 prominent ADHD UK support groups and pages run by the National Attention Deficit Disorder Information and Support Services, reaching an audience of around 16,000 individuals over 2 months (January 7 to March 4, 2022). Eligibility criteria mandated participants to be parents or caregivers of a child with diagnosed ADHD aged 12 years or younger, be residing in the United Kingdom, have access to stable internet, and have a device with the Zoom (Zoom Video Communications) app. Participants were required to have never attended 1-2-3 Magic training previously. Prospective participants expressed their interest through Microsoft Forms (Microsoft Corporation). The trial aimed to recruit 84 parents. It is important to note that the term “parent” or “caregiver” in the RCT and in this study within a trial refers to anybody who has legal responsibility for the child. Results: Overall, 478 individuals registered their interest through Microsoft Forms within the stipulated 2-month window. After the eligibility check, 135 participants were contacted for a baseline meeting through Zoom. The first 84 participants who attended a baseline meeting and returned a completed consent form were enrolled. Subsequently, another 16 participants were added, resulting in a final sample of 100 participants. This recruitment strategy incurred negligible expenses and demanded minimal human resources. The approach yielded favorable outcomes by efficiently attracting eligible participants in a condensed time frame, transcending geographical barriers throughout the United Kingdom, which would have been tedious to achieve through traditional recruitment methods. Conclusions: Our experience demonstrated that digital flyers posted in the targeted Facebook groups were a cost-effective and quick method for recruiting for an RCT, which opened during the COVID-19 pandemic when lockdown restrictions were in place in the United Kingdom. Trialists should consider this low-cost recruitment intervention for trials going forward, and in the case of a global pandemic, this novel recruitment method enabled the trial to continue where many have failed. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 15281572; https://www.isrctn.com/ISRCTN15281572 %M 37847536 %R 10.2196/46190 %U https://www.jmir.org/2023/1/e46190 %U https://doi.org/10.2196/46190 %U http://www.ncbi.nlm.nih.gov/pubmed/37847536 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44702 %T The Impact of Heat Waves on Health Care Services in Low- or Middle-Income Countries: Protocol for a Systematic Review %A Sapari,Hadita %A Selamat,Mohamad Ikhsan %A Isa,Mohamad Rodi %A Ismail,Rohaida %A Wan Mahiyuddin,Wan Rozita %+ Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi Mara, Jalan Hospital, Selangor, 47000, Malaysia, 60 199565077, mohamadikhsan@uitm.edu.my %K heat wave %K burden %K health care service %K morbidity %K low- or middle-income countries %K LMICs %K mortality %D 2023 %7 16.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Heat waves significantly impact ecosystems and human health, especially that of vulnerable populations, and are associated with increased morbidity and mortality. Besides being directly related to climate-sensitive health outcomes, heat waves have indirectly increased the burden on our health care systems. Although the existing literature examines the impact of heat waves and morbidity, past research has mostly been conducted in high-income countries (HICs), and studies on the impact of heat waves on morbidity in low- or middle-income countries (LMICs) are still scarce. Objective: This paper presents the protocol for a systematic review that aims to provide evidence of the impact of heat waves on health care services in LMICs. Methods: We will identify peer-reviewed studies from 3 online databases, including the Web of Science, PubMed, and SCOPUS, published from January 2002 to April 2023, using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Quality assessment will be conducted using the Navigation Guide checklist. Key search terms include heatwaves, extreme heat, hospitalization, outpatient visit, burden, health services, and morbidity. Results: This systematic review will provide insight into the impact of heat waves on health care services in LMICs, especially on emergency department visits, ambulance call-outs, hospital admissions, outpatient department visits, in-hospital mortality, and health care operational costs. Conclusions: The results of this review are anticipated to help policymakers and key stakeholders obtain a better understanding of the impact of heat waves on health care services and prioritize investments to mitigate the effects of heat waves in LMICs. This entails creating a comprehensive heat wave plan and ensuring that adequate infrastructure, capacity, and human resources are allocated in the health care sector. These measures will undoubtedly contribute to the development of resilience in health care systems and hence protect the health and well-being of individuals and communities. Trial Registration: PROSPERO CRD42022365471; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=365471 International Registered Report Identifier (IRRID): DERR1-10.2196/44702 %M 37843898 %R 10.2196/44702 %U https://www.researchprotocols.org/2023/1/e44702 %U https://doi.org/10.2196/44702 %U http://www.ncbi.nlm.nih.gov/pubmed/37843898 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49731 %T Enhancing Transsectoral Interdisciplinary Patient-Centered Care for Patients With Rare Cancers: Protocol for a Mixed Methods Process Evaluation %A Hinneburg,Jana %A Zacher,Sandro %A Berger-Höger,Birte %A Berger-Thürmel,Karin %A Kratzer,Vanessa %A Steckelberg,Anke %A Lühnen,Julia %A , %+ Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str 8, Halle (Saale), 06112, Germany, 49 345 557 1220, sandro.zacher@medizin.uni-halle.de %K process evaluation %K study protocol %K logic model %K complex intervention %K coordination of care %K rare cancer %K mobile phone %D 2023 %7 12.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Rare cancers account for approximately 24% of all new cancers. The category of rare tumor diseases includes almost 200 different entities. In particular, the treatment of patients with extensive care needs requires cooperation between service providers, both between sectors (outpatient and inpatient) and within sectors (eg, between different medical disciplines). The treatment pathway is associated with a high need for coordination and information sharing between providers. When crossing sectoral boundaries in the German health care system, interface problems between the outpatient and inpatient sectors can lead to gaps in care delivery. The multicomponent program Trans-sectoral Personalised Care Concept for Patients with Rare Cancers aims to optimize transsectoral cooperation and coordination of care to enhance patient involvement and the medical care coordination of patients with rare cancers. Objective: This process evaluation will contribute to answering questions about intervention fidelity and the implementation of transsectoral communication, identifying and describing the intended and nonintended effects of the intervention, and exploring the barriers to and facilitators of the implementation. Methods: We will include patients who participate in the intervention phase; all persons and staff involved in the development and implementation of the intervention (Onco Coach, psychologists, physicians on the contact platform, IT staff, and staff of the Bavarian Association of Statutory Health Insurance Physicians); physicians from the Ludwig-Maximilians-University Hospital Munich and the hospital of the Technical University Munich who are involved in the treatment of patients during the course of the project; and participating office–based hematologists and oncologists. Data collection will be conducted at the beginning, during, and at the end of the intervention using mixed methods. Data will be collected from questionnaires, document analyses, semistructured interviews, and structured observations and will cover different aspects of process evaluation. These include examining the context to explore existing patterns, changes in patterns, attitudes, and interactions; analyzing the implementation of intervention elements; and exploring the complex causal pathways and mediators of the intervention. Qualitative data will be analyzed using thematic analysis. The data will then be combined using between-methods triangulation. Results: This project received funding on March 1, 2022. The intervention phase and recruitment for the process evaluation began on March 1, 2023, and the recruitment is expected to end on September 30, 2025. At the time of protocol submission in June 2023, a total of 8 doctors from hematology and oncology practices were enrolled. Data collection began on March 14, 2023. Conclusions: The Trans-sectoral Personalised Care Concept for Patients with Rare Cancers project is a complex intervention that is to be implemented in an equally complex health care context. The process evaluation will help understand the influence of contextual factors and assess the mechanisms of change. Trial Registration: ISRCTN registry ISRCTN16441179; https://doi.org/10.1186/ISRCTN16441179 International Registered Report Identifier (IRRID): DERR1-10.2196/49731 %M 37824180 %R 10.2196/49731 %U https://www.researchprotocols.org/2023/1/e49731 %U https://doi.org/10.2196/49731 %U http://www.ncbi.nlm.nih.gov/pubmed/37824180 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e51783 %T A Hospital-Wide Open-Label Cluster Crossover Pragmatic Comparative Effectiveness Randomized Trial Comparing Normal Saline to Ringer’s Lactate: Protocol and Statistical Analysis Plan of The FLUID Trial %A Shaw,Julia F %A Ouyang,Yongdong %A Fergusson,Dean A %A McArdle,Tracy %A Martin,Claudio %A Cook,Deborah %A Graham,Ian D %A Hawken,Steven %A McCartney,Colin J L %A Menon,Kusum %A Saginur,Raphael %A Seely,Andrew %A Stiell,Ian %A Fox-Robichaud,Alison %A English,Shane %A Marshall,John %A Thavorn,Kednapa %A Taljaard,Monica %A McIntyre,Lauralyn A %A , %+ Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8M2, Canada, 1 613 737 8899 ext 73231, lmcintyre@ohri.ca %K statistical analysis plan %K fluid therapy %K normal saline %K Ringer’s lactate %K cluster randomized trial %K pragmatic %K comparative effectiveness %D 2023 %7 6.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Normal saline (NS) and Ringer’s lactate (RL) are the most common crystalloids given to hospitalized patients. Despite concern about possible harm associated with NS (eg, hyperchloremic metabolic acidosis, impaired kidney function, and death), few large multicenter randomized trials focused on critically ill patients have compared these fluids. Uncertainty exists about the effects of these fluids on clinically important outcomes across all hospitalized patients. Objective: The FLUID trial is a pragmatic, multicenter, 2×2 cluster crossover comparative effectiveness randomized trial that aims to evaluate the effectiveness of a hospital-wide policy that stocks either NS or RL as the main crystalloid fluid in 16 hospitals across Ontario, Canada. Methods: All hospitalized adult and pediatric patients (anticipated sample size 144,000 patients) with an incident admission to the hospital over the course of each study period will be included. Either NS or RL will be preferentially stocked throughout the hospital for 12 weeks before crossing to the alternate fluid for the subsequent 12 weeks. The primary outcome is a composite of death and hospital readmission within 90 days of hospitalization. Secondary outcomes include death, hospital readmission, dialysis, reoperation, postoperative reintubation, length of hospital stay, emergency department visits, and discharge to a facility other than home. All outcomes will be obtained from health administrative data, eliminating the need for individual case reports. The primary analysis will use cluster-level summaries to estimate cluster-average treatment effects. Results: The statistical analysis plan has been prepared “a priori” in advance of receipt of the trial data set from ICES and any analyses. Conclusions: We describe the protocol and statistical analysis plan for the evaluation of primary and secondary outcomes for the FLUID trial. Trial Registration: ClinicalTrials.gov NCT04512950; https://classic.clinicaltrials.gov/ct2/show/NCT04512950 International Registered Report Identifier (IRRID): DERR1-10.2196/51783 %M 37801356 %R 10.2196/51783 %U https://www.researchprotocols.org/2023/1/e51783 %U https://doi.org/10.2196/51783 %U http://www.ncbi.nlm.nih.gov/pubmed/37801356 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e48220 %T Evaluating Staff Attitudes, Intentions, and Behaviors Related to Cyber Security in Large Australian Health Care Environments: Mixed Methods Study %A Dart,Martin %A Ahmed,Mohiuddin %+ School of Science, Edith Cowan University, Building 23, 270 Joondalup Drive, Joondalup, 6027, Australia, 61 8 6304 0000, m.dart@ecu.edu.au %K computer security %K cyber security %K surveys %K governance %K mixed methods %K Australia %K delivery of health care %D 2023 %7 4.10.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Previous studies have identified that the effective management of cyber security in large health care environments is likely to be significantly impacted by human and social factors, as well as by technical controls. However, there have been limited attempts to confirm this by using measured and integrated studies to identify specific user motivations and behaviors that can be managed to achieve improved outcomes. Objective: This study aims to document and analyze survey and interview data from a diverse range of health care staff members, to determine the primary motivations and behaviors that influence their acceptance and application of cyber security messaging and controls. By identifying these issues, recommendations can be made to positively influence future cyber security governance in health care. Methods: An explanatory sequential mixed methods approach was undertaken to analyze quantitative data from a web-based staff survey (N=103), with a concurrent qualitative investigation applied to data gathered via in-depth staff interviews (N=9). Data from both stages of this methodology were mapped to descriptive variables based on a modified version of the Technology Acceptance Model (TAM; TAM2). After normalization, the quantitative data were verified and analyzed using descriptive statistics, distribution and linearity measures, and a bivariate correlation of the TAM variables to identify the Pearson coefficient (r) and significance (P) values. Finally, after confirming Cronbach α, the determinant score for multicollinearity, and the Kaiser-Meyer-Olkin measure, and applying the Bartlett test of sphericity (χ2), an exploratory factor analysis (EFA) was conducted to identify the primary factors with an eigenvalue (λ) >1.0. Comments captured during the qualitative interviews were coded using NVivo software (QSR International) to create an emic-to-etic understanding, which was subsequently integrated with the quantitative results to produce verified conclusions. Results: Using the explanatory sequential methodology, this study showed that the perceived usefulness of security controls emerged as the most significant factor influencing staff beliefs and behaviors. This variable represented 24% of all the variances measured in the EFA and was also the most common category identified across all coded interviews (281/692, 40.6%). The word frequency analysis showed that systems, patients, and people represented the top 3 recurring themes reported by the interviewees. Conclusions: To improve cyber security governance in large health care environments, efforts should be focused on demonstrating how confidentiality, integrity, availability, policies, and cloud or vendor-based controls (the main contributors of usefulness measured by the EFA) can directly improve outcomes for systems, staff, and patients. Further consideration also needs to be given to how clinicians should share data and collaborate on patient care, with tools and processes provided to support and manage data sharing securely and to achieve a consistent baseline of secure and normalized behaviors. %M 37792450 %R 10.2196/48220 %U https://humanfactors.jmir.org/2023/1/e48220 %U https://doi.org/10.2196/48220 %U http://www.ncbi.nlm.nih.gov/pubmed/37792450 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e51235 %T Adaptation in Young Military Recruits: Protocol for the Advancing Research on Mechanisms of Resilience (ARMOR) Prospective Longitudinal Study %A Polusny,Melissa A %A Marquardt,Craig A %A Hubbling,Michelle %A Campbell,Emily Hagel %A Arbisi,Paul A %A Davenport,Nicholas D %A Lim,Kelvin O %A Lissek,Shmuel %A Schaefer,Jonathan D %A Sponheim,Scott R %A Masten,Ann S %A Noorbaloochi,Siamak %+ Minneapolis Veterans Affairs Health Care System, 1 Veterans Drive, Minneapolis, MN, 55417, United States, 1 612 467 3965, melissa.polusny@va.gov %K study protocol %K military personnel %K longitudinal studies %K resilience %K adaptive behavior %K stress %K adversity %K mechanisms %K protective factors %D 2023 %7 4.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Military services provide a unique opportunity for studying resilience, a dynamic process of successful adaptation (ie, doing well in terms of functioning and symptoms) in response to significant adversity. Despite the tremendous interest in positive adaptation among military service members, little is known about the processes underlying their resilience. Understanding the neurobiological, cognitive, and social mechanisms underlying adaptive functioning following military stressor exposure is essential for enhancing the resilience of military service members. Objective: The primary objective of the Advancing Research on Mechanisms of Resilience (ARMOR) longitudinal study is to characterize the trajectories of positive adaptation among young military recruits in response to basic combat training (BCT), a well-defined, uniform, and 10-week period of intense stress (aim 1), and identify promotive and protective processes contributing to individual variations in resilience (aim 2). The secondary objective is to investigate the pathways by which neurobehavioral markers of self-regulation assessed using electroencephalography and magnetic resonance imaging contribute to adaptive trajectories (aim 3). Methods: ARMOR is an ongoing, prospective longitudinal cohort study of young military recruits who recently joined the National Guard but have not yet shipped out for BCT. Participants (N=1201) are assessed at 5 time points over the initial >2 years of military service beginning before BCT (baseline) and followed up at 2 weeks and 6, 12, and 18 months after BCT. Participants complete web-based questionnaires assessing vulnerability and protective factors, mental health, and socioemotional functioning at each time point and a battery of neurocognitive tests at time 0. A subset of participants also complete structured diagnostic interviews and additional self-report measures and perform neurobehavioral tasks before and after BCT during electroencephalography sessions and before BCT only during magnetic resonance imaging sessions. Results: This UG3/UH3 project was initially funded in August 2017, with the UG3 pilot work completed at the end of 2018. The UH3 phase of the project was funded in March 2019. Study enrollment for the UH3 phase began on April 14, 2019, and ended on October 16, 2021. A total of 1201 participants are enrolled in the study. Follow-up data collection for the UH3 phase is ongoing and projected to continue through February 2024. We will disseminate the findings through conferences, webinars, open access publications, and communications with participants and stakeholders. Conclusions: The ARMOR study provides a rich data set to identify the predictors and mechanisms of resilient and nonresilient outcomes in the context of military stressors, which are intended to empirically inform the development of prevention and intervention strategies to enhance the resilience of military trainees and potentially other young people facing significant life challenges. International Registered Report Identifier (IRRID): DERR1-10.2196/51235 %M 37792432 %R 10.2196/51235 %U https://www.researchprotocols.org/2023/1/e51235 %U https://doi.org/10.2196/51235 %U http://www.ncbi.nlm.nih.gov/pubmed/37792432 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e42450 %T Vitalizing Community for Health Promotion Against Modifiable Risk Factors of Noncommunicable Diseases (V-CaN) in Rural Central India: Protocol for a Hybrid Type II Implementation Effectiveness Trial %A Mundra,Anuj %A Kalantri,Ashwini %A Jakasania,Arjunkumar %A Sathe,Harshal %A Raut,Abhishek %A Maliye,Chetna %A Bahulekar,Pramod %A Dawale,Ajay %A Paradkar,Rameshwar J %A Siriah,Sakshi %A Kumar,Satish %A Gupta,Subodh S %A Garg,Bishan %+ Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Kasturba Health Society, Old hospital building, 1st Floor, Bapu kuti road, Sevagram, Wardha, 442102, India, 91 9422518347, abhishekvraut@gmail.com %K noncommunicable diseases %K action research %K implementation research %K community-based participatory research %K salutogenesis %K primary prevention %D 2023 %7 29.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Low- and middle-income countries are facing the emerging burden of chronic noncommunicable diseases (NCDs). Apart from loss of human lives and premature deaths, NCDs result in huge costs for treatment to individuals and the health system. Although NCDs develop in later life, the risk factors begin at an early age. The key to the control of the global epidemic of NCDs is primary prevention based on comprehensive community-based programs. Objective: This study aims to develop, implement, and evaluate the effect of a participatory health promotion initiative utilizing the existing mechanisms of Village Health Nutrition and Sanitation Committees (VHNSCs), women’s self-help groups (SHGs), and schools on modifiable risk factors for NCDs among young people aged 10-30 years. Methods: The proposed type II hybrid effectiveness implementation cluster randomized field trial will be conducted in the catchment area of 4 primary health centers (PHCs) in Wardha district, India, comprising 100 villages with a population of 144,000. Each PHC will be randomly allocated to one of the 3 intervention arms or the control arm. The 3-intervention arm PHCs will utilize a unique strategy with either VHNSC or SHG members or school students as change agents for health action against common modifiable NCD risk factors. This study will be implemented in 3 phases from January 2022 to December 2024. First, the preparatory phase for baseline assessments includes anthropometry, behavioral and biochemical risk factors for NCDs, and participatory development of the health promotion intervention modules. Second, the implementation phase will focus on capacity building of the change agents and implementation of the participatory health promotion initiative. The implementation will include organization of community-based events, 6-monthly participatory assessment of change, and preparation of a sustainability and exit plan toward the end of this phase. Third, the evaluation phase will consist of studying the effectiveness of each intervention strategy in the reduction of risk factor prevalence at the population level. Results: We will assess 12,000 (3000 in each arm) randomly selected individuals for behavioral risk factors and 1600 (400 in each arm) individuals for biochemical risk factors during baseline as well as endline assessments. Difference in differences, ANOVA or multivariate analysis of covariance, and regression analysis will be performed to assess the effectiveness of the interventions. Qualitative methods such as focus group discussions and stories of change will be documented and analyzed using thematic framework analysis. The implementation outcomes will be reported using the PRISM (Practical Robust Implementation and Sustainability Model) RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. The results are expected to be published by mid-2025. Conclusions: This study will show the magnitude of risk factors for NCDs, its determinants, feasibility, effectiveness of community-based interventions, and health promotion models for NCD prevention. Trial Registration: Clinical Trials Registration India CTRI/2020/10/028700; https://ctri.nic.in/Clinicaltrials/showallp.php?mid1=47597&EncHid=&userName=V-CaN International Registered Report Identifier (IRRID): DERR1-10.2196/42450 %M 37773622 %R 10.2196/42450 %U https://www.researchprotocols.org/2023/1/e42450 %U https://doi.org/10.2196/42450 %U http://www.ncbi.nlm.nih.gov/pubmed/37773622 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47548 %T Health Care Provider Stigma Toward Patients With Substance Use Disorders: Protocol for a Nationally Representative Survey %A Parish,Carrigan Leigh %A Feaster,Daniel J %A Pollack,Harold A %A Horigian,Viviana E %A Wang,Xiaoming %A Jacobs,Petra %A Pereyra,Margaret R %A Drymon,Christina %A Allen,Elizabeth %A Gooden,Lauren K %A del Rio,Carlos %A Metsch,Lisa R %+ Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, Miami Research Center, 1120 NW 14th St, Miami, FL, 33136, United States, 1 9546469499, cp2695@columbia.edu %K substance use disorders %K provider stigma %K cross-sectional survey study %K provider attitudes %K survey methodology %D 2023 %7 26.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The US overdose epidemic is an escalating public health emergency, accounting for over 100,000 deaths annually. Despite the availability of medications for opioid use disorders, provider-level barriers, such as negative attitudes, exacerbate the treatment gap in clinical care settings. Assessing the prevalence and intensity of provider stigma, defined as the negative perceptions and behaviors that providers embody and enact toward patients with substance use disorders, across providers with different specialties, is critical to expanding the delivery of substance use treatment. Objective: To thoroughly understand provider stigma toward patients with substance use disorders, we conducted a nationwide survey of emergency medicine and primary care physicians and dentists using a questionnaire designed to reveal how widely and intensely provider attitudes and stigma can impact these providers’ clinical practices in caring for their patients. The survey also queried providers’ stigma and clinical practices toward other chronic conditions, which can then be compared with their stigma and practices related to substance use disorders. Methods: Our cross-sectional survey was mailed to a nationally representative sample of primary care physicians, emergency medicine physicians, and dentists (N=3011), obtained by American Medical Association and American Dental Association licensees based on specified selection criteria. We oversampled nonmetropolitan practice areas, given the potential differences in provider stigma and available resources in these regions compared with metropolitan areas. Data collection followed a recommended series of contacts with participants per the Dillman Total Design Method, with mixed-modality options offered (email, mail, fax, and phone). A gradually increasing compensation scale (maximum US$250) was implemented to recruit chronic nonresponders and assess the association between requiring higher incentives to participate and providers stigma. The primary outcome, provider stigma, was measured using the Medical Condition Regard Scale, which inquired about participants’ views on substance use and other chronic conditions. Additional survey measures included familiarity and social engagement with people with substance use disorders; clinical practices (screening, treating, and referring for a range of chronic conditions); subjective norms and social desirability; knowledge and prior education; and descriptions of their patient populations. Results: Data collection was facilitated through collaboration with the National Opinion Research Center between October 2020 and October 2022. The overall Council of American Survey Research Organizations completion rate was 53.62% (1240/2312.7; physicians overall: 855/1681.9, 50.83% [primary care physicians: 506/1081.3, 46.79%; emergency medicine physicians: 349/599.8, 58.2%]; dentists: 385/627.1, 61.4%). The ineligibility rate among those screened is applied to those not screened, causing denominators to include fractional numbers. Conclusions: Using systematically quantified data on the prevalence and intensity of provider stigma toward substance use disorders in health care, we can provide evidence-based improvement strategies and policies to inform the development and implementation of stigma-reduction interventions for providers to address their perceptions and treatment of substance use. International Registered Report Identifier (IRRID): DERR1-10.2196/47548 %M 37751236 %R 10.2196/47548 %U https://www.researchprotocols.org/2023/1/e47548 %U https://doi.org/10.2196/47548 %U http://www.ncbi.nlm.nih.gov/pubmed/37751236 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e38521 %T Epidemiological Modeling of the Impact of Public Health Policies on Hepatitis C: Protocol for a Gamification Tool Targeting Microelimination %A Baptista-Leite,Ricardo %A Lopes,Henrique %A Vandewalle,Björn %A Félix,Jorge %A Franco,Diogo %A Clemens,Timo %A Brand,Helmut %+ NOVA Center for Global Health - Information Management School, Universidade Nova de Lisboa, Campus de Campolide, Lisbon, 1070-312 Lisboa, Portugal, 351 919276865, r.guerreirobaptistaleite@maastrichtuniversity.nl %K hepatitis C %K modeling %K public health policies %K patient advocacy %K mobile phone %D 2023 %7 25.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Hepatitis C is a disease with a strong social component, as its main transmission route is via blood, making it associated with lifestyle. Therefore, it is suitable to be worked on from the perspective of public health policy, which still has a lot of room to explore and improve, contrary to diagnoses and treatments, which are already very refined and effective. Objective: An interactive gamified policy tool, designated as Let’s End HepC (LEHC), was created to understand the impact of policies related to hepatitis C on the disease’s epidemiology on a yearly basis until 2030. Methods: To this end, an innovative epidemiological model was developed, integrating Markov chains to model the natural history of the disease and adaptive conjoint analysis to reflect the degree of application of each of the 24 public health policies included in the model. This double imputation model makes it possible to assess a set of indicators such as liver transplant, incidence, and deaths year by year until 2030 in different risk groups. Populations at a higher risk were integrated into the model to understand the specific epidemiological dynamics within the total population of each country and within segments that comprise people who have received blood products, prisoners, people who inject drugs, people infected through vertical transmission, and the remaining population. Results: The model has already been applied to a group of countries, and studies in 5 of these countries have already been concluded, showing results very close to those obtained through other forms of evaluation. Conclusions: The LEHC model allows the simulation of different degrees of implementation of each policy and thus the verification of its epidemiological impact on each studied population. The gamification feature allows assessing the adequate fulfillment of the World Health Organization goals for the elimination of hepatitis C by 2030. LEHC supports health decision makers and people who practice patient advocacy in making decisions based on science, and because LEHC is democratically shared, it ends up contributing to the increase of citizenship in health. International Registered Report Identifier (IRRID): RR1-10.2196/38521 %M 37747764 %R 10.2196/38521 %U https://www.researchprotocols.org/2023/1/e38521 %U https://doi.org/10.2196/38521 %U http://www.ncbi.nlm.nih.gov/pubmed/37747764 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50486 %T Global Implications From the Rise and Recession of Telehealth in Aotearoa New Zealand Mental Health Services During the COVID-19 Pandemic: Mixed Methods Study %A Werkmeister,Benjamin %A Haase,Anne M %A Fleming,Theresa %A Officer,Tara N %+ School of Health, Te Herenga Waka - Victoria University of Wellington, Kelburn Parade, Kelburn, PO Box 600, Wellington, 6140, New Zealand, 64 44636575, benjamin.werkmeister@vuw.ac.nz %K telehealth %K mental health services %K Aotearoa New Zealand %K mixed methods research %K clinician %K COVID-19 %D 2023 %7 22.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic accelerated the adoption of telehealth services for remote mental health care provision. Although studies indicate that telehealth can enhance the efficiency of service delivery and might be favored or even preferred by certain clients, its use varied after the pandemic. Once the pandemic-related restrictions eased, some regions curtailed their telehealth offerings, whereas others sustained them. Understanding the factors that influenced these decisions can offer valuable insights for evidence-based decision-making concerning the future of telehealth in mental health services. Objective: This study explored the factors associated with the uptake of and retreat from telehealth across a multiregional outpatient mental health service in Aotearoa New Zealand. We aimed to contribute to the understanding of the factors influencing clinicians’ use of telehealth services to inform policy and practice. Methods: Applying an interpretive description methodology, this sequential mixed methods study involved semistructured interviews with 33 mental health clinicians, followed by a time-series analysis of population-level quantitative data on clinician appointment activities before and throughout the COVID-19 pandemic. The interviews were thematically analyzed, and select themes were reframed for quantitative testing. The time-series analysis was conducted using administrative data to explore the extent to which these data supported the themes. In total, 4,117,035 observations were analyzed between September 2, 2019, and August 1, 2022. The findings were then synthesized through the rereview of qualitative themes. Results: The rise and recession of telehealth in the study regions were related to 3 overarching themes: clinician preparedness and role suitability, population determinants, and service capability. Participants spoke about the importance of familiarity and training but noted differences between specialist roles. Quantitative data further suggested differences based on the form of telehealth services offered (eg, audiovisual or telephone). In addition, differences were noted based on age, gender, and ethnicity; however, clinicians recognized that effective telehealth use enabled clinicians’ flexibility and client choice. In turn, clinicians spoke about system factors such as telehealth usability and digital exclusion that underpinned the daily functionality of telehealth. Conclusions: For telehealth services to thrive when they are not required by circumstances such as pandemic, investment is needed in telehealth training for clinicians, digital infrastructure, and resources for mental health teams. The strength of this study lies in its use of population-level data and consideration of a telehealth service operating across a range of teams. In turn, these findings reflect the voice of a variety of mental health clinicians, including teams operating from within specific cultural perspectives. %M 37738075 %R 10.2196/50486 %U https://formative.jmir.org/2023/1/e50486 %U https://doi.org/10.2196/50486 %U http://www.ncbi.nlm.nih.gov/pubmed/37738075 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48400 %T Fear of Reprisal and Change Agency in the Public Health and Social Service System: Protocol for a Sequential Mixed Methods Study %A Carrier,Annie %A Bolduc,François %A Delli-Colli,Nathalie %A Makela,Finn %A Hudon,Anne %A Caty,Marie-Eve %A Duhoux,Arnaud %A Beaudoin,Michaël %+ School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada, 1 8198218000 ext 72917, Annie.Carrier@USherbrooke.ca %K change agency %K fear %K professional practice %K retaliation %K social justice %D 2023 %7 21.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background:  Since they are key witnesses to the systemic difficulties and social inequities experienced by vulnerable patients, health and social service (HSS) professionals and clinical managers must act as change agents. Using their expertise to achieve greater social justice, change agents employ a wide range of actions that span a continuum from the clinical (microsystem) to the societal (macrosystem) sphere and involve actors inside and outside the HSS system. Typically, however, clinical professionals and managers act in a circumscribed manner, that is, within the clinical sphere and with patients and colleagues. Among the hypotheses explaining this reduced scope of action is the fear of reprisal. Little is known about the prevalence of this fear and its complex dynamics. Objective:  The overall aim is to gain a better understanding of the complex dynamic process leading to clinical professionals’ and managers’ fear of reprisal in their change agent actions and senior administrators’ and managers’ determination of wrongdoing. The objectives are (1) to estimate the prevalence of fear of reprisal among clinical professionals and managers; (2) to identify the factors involved in (a) the emergence of this fear among clinical professionals and managers, and (b) the determination of wrongdoing by senior administrators and managers; (3) to describe the process of emergence of (a) the fear of reprisal among clinical professionals and managers, and (b) the determination of wrongdoing by senior administrators and managers; and (4) to document the legal and ethical issues associated with the factors identified (objective 2) and the processes described (objective 3). Methods:  Based on the Exit, Voice, Loyalty, Neglect model, a 3-part sequential mixed methods design will include (1) a web-based survey (objective 1), (2) a qualitative grounded theory design (objectives 2 and 3), and (3) legal and ethical analysis (objective 4). Survey: 77,794 clinical professionals or clinical managers working in the Québec public HSS system will be contacted via email. Data will be analyzed using descriptive statistics. Grounded theory design: for each of the 3 types of participants (clinical professionals, clinical managers, and senior administrators and managers), a theoretical sample of 15 to 30 people will be selected via various strategies. Data will be independently analyzed using constant comparison process. Legal and ethical analysis: situations described by participants will be analyzed using, respectively, applicable legislation and jurisprudence and 2 ethical models. Results:  This ongoing study began in June 2022 and is scheduled for completion by March 2027. Conclusions:  Instead of acting, fear of reprisal could induce clinical professionals to tolerate situations that run counter to their social justice values. To ensure they use their capacities for serving a population that is or could become vulnerable, it is important to know the prevalence of the fear of reprisal and gain a better understanding of its complex dynamics. International Registered Report Identifier (IRRID): PRR1-10.2196/48400 %M 37733408 %R 10.2196/48400 %U https://www.researchprotocols.org/2023/1/e48400 %U https://doi.org/10.2196/48400 %U http://www.ncbi.nlm.nih.gov/pubmed/37733408 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43376 %T Refocusing of Attention on Positive Events Using Monitoring-Based Feedback and Microinterventions for Patients With Chronic Musculoskeletal Pain in the PerPAIN Randomized Controlled Trial: Protocol for a Microrandomized Trial %A Ader,Leonie %A Schick,Anita %A Löffler,Martin %A Löffler,Annette %A Beiner,Eva %A Eich,Wolfgang %A Vock,Stephanie %A Sirazitdinov,Andrei %A Malone,Christopher %A Hesser,Jürgen %A Hopp,Michael %A Ruckes,Christian %A Flor,Herta %A Tesarz,Jonas %A Reininghaus,Ulrich %+ Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, Mannheim, 68159, Germany, 49 62117031930, Ulrich.Reininghaus@zi-mannheim.de %K experience sampling method %K ESM %K ecological momentary intervention %K EMI %K microrandomized trial %K mobile health %K mHealth %K positive intervention %K complex intervention %K mobile phone %D 2023 %7 20.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic musculoskeletal pain (CMSP) affects between 13% and 47% of the population, with a global growth rate of 20.3% within the last 15 years, suggesting that there is a high need for effective treatments. Pain diaries have long been a common tool in nonpharmacological pain treatment for monitoring and providing feedback on patients’ symptoms in daily life. More recently, positive refocusing techniques have come to be used, promoting pain-free episodes and positive outcomes rather than focusing on managing the pain. Objective: This study aims to evaluate the feasibility (ie, acceptability, intervention adherence, and fidelity) and initial signals of efficacy of the PerPAIN app, an ecological momentary intervention for patients with CMSP. The app comprises digitalized monitoring using the experience sampling method (ESM) and feedback. In addition, the patients receive 3 microinterventions targeted at refocusing of attention on positive events. Methods: In a microrandomized trial, we will recruit 35 patients with CMSP who will be offered the app for 12 weeks. Participants will be prompted to fill out 4 ESM monitoring questionnaires a day assessing information on their current context and the proximal outcome variables: absence of pain, positive mood, and subjective activity. Participants will be randomized daily and weekly to receive no feedback, verbal feedback, or visual feedback on proximal outcomes assessed by the ESM. In addition, the app will encourage participants to complete 3 microinterventions based on positive psychology and cognitive behavioral therapy techniques. These microinterventions are prompts to report joyful moments and everyday successes or to plan pleasant activities. After familiarizing themselves with each microintervention individually, participants will be randomized daily to receive 1 of the 3 exercises or none. We will assess whether the 2 feedback types and the 3 microinterventions increase proximal outcomes at the following time point. The microrandomized trial is part of the PerPAIN randomized controlled trial (German Clinical Trials Register DRKS00022792) investigating a personalized treatment approach to enhance treatment outcomes in CMSP. Results: Approval was granted by the Ethics Committee II of the University of Heidelberg on August 4, 2020. Recruitment for the microrandomized trial began in May 2021 and is ongoing at the time of submission. By October 10, 2022, a total of 24 participants had been enrolled in the microrandomized trial. Conclusions: This trial will provide evidence on the feasibility of the PerPAIN app and the initial signals of efficacy of the different intervention components. In the next step, the intervention would need to be further refined and investigated in a definitive trial. This ecological momentary intervention presents a potential method for offering low-level accessible treatment to a wide range of people, which could have substantial implications for public health by reducing disease burden of chronic pain in the population. International Registered Report Identifier (IRRID): DERR1-10.2196/43376 %M 37728983 %R 10.2196/43376 %U https://www.researchprotocols.org/2023/1/e43376 %U https://doi.org/10.2196/43376 %U http://www.ncbi.nlm.nih.gov/pubmed/37728983 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46690 %T Evaluating the Effectiveness of the Housing First for Youth Intervention for Youth Experiencing Homelessness in Canada: Protocol for a Multisite, Mixed Methods Randomized Controlled Trial %A Gaetz,Stephen %A Bonakdar,Ahmad %A Ecker,John %A MacDonald,Cora %A Ilyniak,Sophia %A Ward,Ashley %A Kimura,Lauren %A Vijayaratnam,Aranie %A Banchani,Emmanuel %+ The Canadian Observatory on Homelessness, York University, 6th Floor Kaneff Tower, 4700 Keele St., Toronto, ON, M3J 1P3, Canada, 1 416 736 2100 ext 30208, bonakdar@yorku.ca %K youth homelessness %K Housing First for Youth %K Canada %K randomized controlled trial %K RCT %K Making the Shift %D 2023 %7 19.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Emerging evidence at the international level suggests that the Housing First approach could improve the housing stability of young people experiencing homelessness. However, there is a dearth of literature in Canada on whether the Housing First intervention for young people experiencing homelessness can improve outcomes including housing stability, health and well-being, and access to complementary supports. Adapted from the original Housing First model, Housing First for Youth (HF4Y) was developed in Canada as a rights-based approach tailored specifically for young people aged 16 to 24 years who are experiencing or are at risk of homelessness. Objective: The Making the Shift Youth Homelessness Social Innovation Lab is testing the effectiveness of the HF4Y intervention in Canada. The objective of this study is to determine whether the HF4Y model results in better participant-level outcomes than treatment-as-usual services for young people experiencing homelessness in 2 urban settings: Ottawa and Toronto, Ontario. Primary outcomes include housing stability, health and well-being, and complementary supports, and secondary outcomes include employment and educational attainment and social inclusion. Methods: The HF4Y study used a multisite, mixed methods, randomized controlled trial research approach for data collection and analysis. Eligible participants included young people aged 16 to 24 years who were experiencing homelessness or housing precarity. The participants were randomly assigned to either the treatment-as-usual group or the housing first intervention group. Survey and interview data in Ottawa and Toronto, Ontario are being collected at multiple time points (3-6 months) over 4 years to capture a range of outcomes. Analytic strategies for quantitative data will include mixed-effects modeling for repeated measures and logistic models. A thematic analysis will be used to analyze qualitative data based on participants’ narratives and life journeys through homelessness. Furthermore, program fidelity evaluations are conducted within each HF4Y program. These evaluations assess how well the intervention aligns with the HF4Y model and identify any areas that may require adjustments or additional support. Results: The HF4Y study has received human participant research ethics approval from the Office of Research Ethics at York University. Recruitment was conducted between February 2018 and March 2020. Data collection is expected to be completed at both sites by March 2024. A preliminary analysis of the quantitative and qualitative data collected between baseline and 24 months is underway. Conclusions: This pilot randomized controlled trial is the first to test the effectiveness of the HF4Y intervention in Canada. The findings of this study will enhance our understanding of how to effectively deliver and scale up the HF4Y intervention, with the aim of continually improving the HF4Y model to promote better outcomes for youth. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) ISRCTN10505930; https://www.isrctn.com/ISRCTN10505930 International Registered Report Identifier (IRRID): DERR1-10.2196/46690 %M 37725430 %R 10.2196/46690 %U https://www.researchprotocols.org/2023/1/e46690 %U https://doi.org/10.2196/46690 %U http://www.ncbi.nlm.nih.gov/pubmed/37725430 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e51643 %T A Model for Empowering Rural Solutions for Cervical Cancer Prevention (He Tapu Te Whare Tangata): Protocol for a Cluster Randomized Crossover Trial %A Lawton,Beverley %A MacDonald,Evelyn Jane %A Storey,Francesca %A Stanton,Jo-Ann %A Adcock,Anna %A Gibson,Melanie %A Parag,Varsha %A Sparkes,Ngaire Kereru %A Kaimoana,Bobby %A King,Frances %A Terry,Marion %A Watson,Huti %A Bennett,Matthew %A Lambert,Charles Seymour %A Geller,Stacie %A Paasi,Isitokia %A Hibma,Merilyn %A Sykes,Peter %A Hawkes,David %A Saville,Marion %+ National Women's Health Research Centre, Faculty of Health, Victoria University of Wellington, 14 Kelburn Parade, Kelburn, Wellington, 6041, New Zealand, 64 21845381, e.jane.macdonald@vuw.ac.nz %K uterine cervical neoplasms %K cervical intraepithelial neoplasia %K early detection of cancer %K papillomavirus infections %K New Zealand %K self-testing %K primary health care %K Indigenous people %K Māori %K point-of-care systems %K colposcopy %K health equity %D 2023 %7 14.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Māori are the Indigenous people of Aotearoa (New Zealand). Despite global acceptance that cervical cancer is almost entirely preventable through vaccination and screening, wāhine Māori (Māori women) are more likely to have cervical cancer and 2.5 times more likely to die from it than non-Māori women. Rural Māori residents diagnosed with cervical cancer have worse outcomes than urban residents. Living in rural Aotearoa means experiencing barriers to appropriate and timely health care, resulting from distance, the lack of community resourcing, and low prioritization of rural needs by the health system and government. These barriers are compounded by the current screening processes and referral pathways that create delays at each step. Screening for high-risk human papillomavirus (hrHPV) and point-of-care (POC) testing are scientific advances used globally to prevent cervical cancer. Objective: This study aims to compare acceptability, feasibility, timeliness, referral to, and attendance for colposcopy following hrHPV detection between a community-controlled pathway and standard care. Methods: This is a cluster randomized crossover trial, with 2 primary care practices (study sites) as clusters. Each site was randomized to implement either pathway 1 or 2, with crossover occurring at 15 months. Pathway 1 (community-controlled pathway) comprises HPV self-testing, 1-hour POC results, face-to-face information, support, and immediate referral to colposcopy for women with a positive test result. Pathway 2 (standard care) comprises HPV self-testing, laboratory analysis, usual results giving, information, support, and standard referral pathways for women with a positive test result. The primary outcome is the proportion of women with hrHPV-positive results having a colposcopy within 20 working days of the HPV test (national performance indicator). Qualitative research will analyze successes and challenges of both pathways from the perspectives of governance groups, clinical staff, women, and their family. This information will directly inform the new National Cervical Screening Program. Results: In the first 15-month period, 743 eligible HPV self-tests were performed: 370 in pathway 1 with POC testing and 373 in pathway 2 with laboratory testing. The positivity rate for hrHPV was 7.3% (54/743). Data collection for the second period, qualitative interviews, and analyses are ongoing. Conclusions: This Māori-centered study combines quantitative and qualitative research to compare 2 clinical pathways from detection of hrHPV to colposcopy. This protocol draws on rural community practices strengths, successfully engaging Māori from a whānau ora (family wellness) approach including kanohi ki te kanohi (face-to-face), kaiāwhina (nonclinical community health workers), and multiple venues for interventions. It will inform the theory and practice of rural models of the use of innovative technology, addressing Māori cervical cancer inequities and facilitating Māori wellness. The findings are anticipated to be applicable to other Indigenous and rural people in high-income countries. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621000553875; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621000553875 International Registered Report Identifier (IRRID): DERR1-10.2196/51643 %M 37707939 %R 10.2196/51643 %U https://www.researchprotocols.org/2023/1/e51643 %U https://doi.org/10.2196/51643 %U http://www.ncbi.nlm.nih.gov/pubmed/37707939 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48321 %T Factors Influencing Surgical Decision-Making in the Posterior Laminectomy With Fixation for Degenerative Cervical Myelopathy (POLYFIX-DCM) Trial: Survey Study %A Yordanov,Stefan %A Yang,Xiaoyu %A Mowforth,Oliver %A K Demetriades,Andreas %A Ivanov,Marcel %A Vergara,Pierluigi %A Gardner,Adrian %A Pereira,Erlick %A Bateman,Antony %A Alamri,Alexander %A Francis,Jibin %A Trivedi,Rikin %A Kotter,Mark %A Davies,Benjamin %A Budu,Alexandru %A , %+ Academic Neurosurgery Unit, Department of Clinical Neurosurgery, Cambridge University, Hills Rd, Cambridge, CB2 0QQ, United Kingdom, 44 7874649949, yordanov.stefan@yahoo.com %K cervical myelopathy %K spondylosis %K spondylotic stenosis %K disc herniation %K ossification posterior longitudinal ligament %K degeneration %K disability %K recovery %K questionnaire %K decision-making %K surgeons %K myelopathy %K stress %K spinal cord %K surgeons %K surgery %K decompression %K laminectomy %D 2023 %7 12.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Degenerative cervical myelopathy (DCM) is estimated to affect 2% of the adult population. DCM occurs when degenerative processes cause compression and injure the spinal cord. Surgery to remove the stress caused by the compression of the spinal cord is the mainstay of treatment, with a range of techniques in use. Although various factors are described to inform the selection of these techniques, there needs to be more consensus and limited comparative evidence. Objective: The main objective of this survey was to explore the variation of practice and decision-making, with a focus on laminectomy versus laminectomy and fusion in posterior surgery of the cervical spine. We present the results of a survey conducted among the principal investigators (PIs) of the National Institute for Health and Care Research (NIHR) randomized controlled trial on posterior laminectomy with fixation for degenerative cervical myelopathy (POLYFIX-DCM). Methods: A series of 7 cases were shared with 24 PIs using SurveyMonkey. Each case consisted of a midsagittal T2-weighted magnetic resonance imaging and lateral cervical x-rays in flexion and extension. Surgeons were asked if their preferred approach was anterior or posterior. If posterior, they were asked whether they preferred to instrument and whether they had the equipoise to randomize in the NIHR POLYFIX-DCM trial. Variability in decision-making was then explored using factors reported to inform decision-making, such as alignment, location of compression, number of levels operated, presence of mobile spondylolisthesis, and patient age. Results: The majority of PIs (16/30, 53%) completed the survey. Overall, PIs favored a posterior approach (12/16, 75%) with instrumentation (75/112, average 66%) and would randomize (67/112, average 62%) most cases. Factors reported to inform decision-making poorly explained variability in responses in both univariate testing and with a multivariate model (R2=0.1). Only surgeon experience of more than 5 years and orthopedic specialty training background were significant predictors, both associated with an anterior approach (odds ratio [OR] 1.255; P=.02 and OR 1.344; P=.007, respectively) and fusion for posterior procedures (OR 0.628; P<.001 and OR 1.344; P<.001, respectively). Surgeon experience also significantly affected the openness to randomize, with those with more than 5 years of experience less likely to randomize (OR –0.68; P<.001). Conclusions: In this representative sample of spine surgeons participating in the POLYFIX-DCM trial as investigators, there is no consensus on surgical strategy, including the role of instrumented fusion following posterior decompression. Overall, this study supports the view that there appears to be a clinical equipoise, and conceptually, a randomized controlled trial appears feasible, which sets the scene for the NIHR POLYFIX-DCM trial. %M 37698903 %R 10.2196/48321 %U https://formative.jmir.org/2023/1/e48321 %U https://doi.org/10.2196/48321 %U http://www.ncbi.nlm.nih.gov/pubmed/37698903 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49593 %T Integrated Real-World Study Databases in 3 Diverse Asian Health Care Systems in Taiwan, India, and Thailand: Scoping Review %A Shau,Wen-Yi %A Setia,Sajita %A Chen,Ying-Jan %A Ho,Tsu-yun %A Prakash Shinde,Salil %A Santoso,Handoko %A Furtner,Daniel %+ Executive Office, Transform Medical Communications Limited, 184 Glasgow Street, Wanganui, 4500, New Zealand, 64 0276175433, sajita.setia@transform-medcomms.com %K Asia %K health care databases %K real-world data %K real-world evidence %K scoping review %D 2023 %7 11.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of real-world data (RWD) warehouses for research in Asia is on the rise, but current trends remain largely unexplored. Given the varied economic and health care landscapes in different Asian countries, understanding these trends can offer valuable insights. Objective: We sought to discern the contemporary landscape of linked RWD warehouses and explore their trends and patterns in 3 Asian countries with contrasting economies and health care systems: Taiwan, India, and Thailand. Methods: Using a systematic scoping review methodology, we conducted an exhaustive literature search on PubMed with filters for the English language and the past 5 years. The search combined Medical Subject Heading terms and specific keywords. Studies were screened against strict eligibility criteria to identify eligible studies using RWD databases from more than one health care facility in at least 1 of the 3 target countries. Results: Our search yielded 2277 studies, of which 833 (36.6%) met our criteria. Overall, single-country studies (SCS) dominated at 89.4% (n=745), with cross-country collaboration studies (CCCS) being at 10.6% (n=88). However, the country-wise breakdown showed that of all the SCS, 623 (83.6%) were from Taiwan, 81 (10.9%) from India, and 41 (5.5%) from Thailand. Among the total studies conducted in each country, India at 39.1% (n=133) and Thailand at 43.1% (n=72) had a significantly higher percentage of CCCS compared to Taiwan at 7.6% (n=51). Over a 5-year span from 2017 to 2022, India and Thailand experienced an annual increase in RWD studies by approximately 18.2% and 13.8%, respectively, while Taiwan’s contributions remained consistent. Comparative effectiveness research (CER) was predominant in Taiwan (n=410, or 65.8% of SCS) but less common in India (n=12, or 14.8% of SCS) and Thailand (n=11, or 26.8% of SCS). CER percentages in CCCS were similar across the 3 countries, ranging from 19.2% (n=10) to 29% (n=9). The type of RWD source also varied significantly across countries, with India demonstrating a high reliance on electronic medical records or electronic health records at 55.6% (n=45) of SCS and Taiwan showing an increasing trend in their use over the period. Registries were used in 26 (83.9%) CCCS and 31 (75.6%) SCS from Thailand but in <50% of SCS from Taiwan and India. Health insurance/administrative claims data were used in most of the SCS from Taiwan (n=458, 73.5%). There was a consistent predominant focus on cardiology/metabolic disorders in all studies, with a noticeable increase in oncology and infectious disease research from 2017 to 2022. Conclusions: This review provides a comprehensive understanding of the evolving landscape of RWD research in Taiwan, India, and Thailand. The observed differences and trends emphasize the unique economic, clinical, and research settings in each country, advocating for tailored strategies for leveraging RWD for future health care research and decision-making. International Registered Report Identifier (IRRID): RR2-10.2196/43741 %M 37615085 %R 10.2196/49593 %U https://www.jmir.org/2023/1/e49593 %U https://doi.org/10.2196/49593 %U http://www.ncbi.nlm.nih.gov/pubmed/37615085 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44759 %T The Current Status of the Use of Internet Hospitals for Outpatients With Pain: Retrospective Study %A Sang,Ling %A Song,Li %+ Department of Pain Management, West China Hospital, Sichuan University, No 37 Guoxue Xiang, Wuhou District, Chengdu, 610041, China, 86 18980601501, song_li76@163.com %K internet hospital %K internet + %K pain management %K online visit %K outpatient %K pain %D 2023 %7 11.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The national “Internet +” policies and the emergence of internet hospitals have created a new direction for the management of pain outside of the hospital. Nevertheless, there are no consolidated studies conducted by pain physicians on the current state of internet hospital–based online medical services used by patients with pain outside of a hospital setting. Objective: In this retrospective study, we aimed to examine the status of the use of internet hospitals by patients who experience pain. Moreover, we identified the factors that influenced patients' decisions to make an online visit through the internet hospital. Methods: Detailed information was collected online and offline from outpatients with pain at the information technology center of West China Hospital of Sichuan University from February 2020 to April 2022. Binary logistic regression analysis was conducted to identify the determinants that influenced patients' decisions to make an online visit to the internet hospital. Results: Over a 2-year period, 85,266 pain-related clinic visits were recorded. Ultimately, 39,260 patients were enrolled for the analysis, with 12.9% (5088/39,260) having online visits. Both online and offline clinics had a greater number of visits by women than men. The average age of patients attending the online clinic was 46.85 (SD 16.56) years, whereas the average age of patients attending the offline clinic was 51.48 (SD 16.12) years. The majority of online clinic visitors (3059/5088, 60.1%) were employed, and one of the most common occupations was farming (721/5088, 14.2%). In addition, 51.8% (2635/5088) of patients who participated in the online clinics lived outside the hospital vicinity. Young (odds ratio [OR] 1.35, 95% CI 1.01-1.81; P=.045) and middle-aged (OR 1.98, 95% CI 1.81-2.16; P<.001) patients, employed patients (OR 1.11, 95% CI 1.04-1.18; P=.002), nonlocal patients (OR 1.57, 95% CI 1.48-1.67; P<.001), and the ordinary staff (OR 1.19, 95%CI 1.01-1.39; P=.03) were more likely to have the intention to choose online visits through the internet hospitals. Conclusions: Internet hospitals are flourishing as a more efficient and promising method of pain management and follow-up for patients with pain outside the hospital. People with pain who are young, working, and not in the vicinity of hospitals are more likely to visit internet hospitals. %M 37695652 %R 10.2196/44759 %U https://www.jmir.org/2023/1/e44759 %U https://doi.org/10.2196/44759 %U http://www.ncbi.nlm.nih.gov/pubmed/37695652 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40560 %T Segmenting Patients With Diabetes With the Navigator Service in Primary Care and a Description of the Self-Acting Patient Group: Cross-Sectional Study %A Riihimies,Riikka %A Kosunen,Elise %A Koskela,Tuomas H %+ Faculty of Medicine and Health Technology, Tampere University, Arvo Building, Arvo Ylpön katu 34, Tampere, 33520, Finland, 358 505262556, riikka.riihimies@tuni.fi %K patient segmentation %K Navigator %K self-acting patient %K diabetes %K primary care %K self-management %K skills %K care %K nurse %K medication %K quality of life %K well-being %K digital %K patient %D 2023 %7 8.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The aim of patient segmentation is to recognize patients with similar health care needs. The Finnish patient segmentation service Navigator segregates patients into 4 groups, including a self-acting group, who presumably manages their everyday life and coordinates their health care. Digital services could support their self-care. Knowledge on self-acting patients’ characteristics is lacking. Objective: The study aims are to describe how Navigator assigns patients with diabetes to the 4 groups at nurses’ appointments at a health center, the self-acting patient group’s characteristics compared with other patient groups, and the concordance between the nurse’s evaluation of the patient’s group and the actual group assigned by Navigator (criterion validity). Methods: Patients with diabetes ≥18 years old visiting primary care were invited to participate in this cross-sectional study. Patients with disability preventing informed consent for participation were excluded. Nurses estimated the patients’ upcoming group results before the appointment. We describe the concordance (%) between the evaluation and actual groups. Nurses used Navigator patients with diabetes (n=304) at their annual follow-up visits. The self-acting patients’ diabetes care values (glycated hemoglobin [HbA1c], urine albumin to creatinine ratio, low-density lipoprotein cholesterol, blood pressure, BMI), chronic conditions, medication, smoking status, self-rated health, disability (World Health Organization Disability Assessment Schedule [WHODAS] 2.0), health-related quality of life (EQ-5D-5L), and well-being (Well-being Questionnaire [WBQ-12]) and the patients’ responses to Navigator’s question concerning their digital skills as outcome variables were compared with those of the other patients. We used descriptive statistics for the patients’ distribution into the 4 groups and demographic data. We used the Mann-Whitney U test with nonnormally distributed variables, independent samples t test with normally distributed variables, and Pearson chi-square tests with categorized variables to compare the groups. Results: Most patients (259/304, 85.2%) were in the self-acting group. Hypertension, hyperlipidemia, and joint ailments were the most prevalent comorbidities among all patients. Self-acting patients had less ischemic cardiac disease (P=.001), depression or anxiety (P=.03), asthma or chronic obstructive pulmonary disease (P<.001), long-term pain (P<.001), and related medication. Self-acting patients had better self-rated health (P<.001), functional ability (P<.001), health-related quality of life (P<.001), and general well-being (P<.001). All patients considered their skills at using electronic services to be good. Conclusions: The patients in the self-acting group had several comorbidities. However, their functional ability was not yet diminished compared with patients in the other groups. Therefore, to prevent diabetic complications and disabilities, support for patients’ self-management should be emphasized in their integrated care services. Digital services could be involved in the care of patients willing to use them. The study was performed in 1 health center, the participants were volunteers, and most patients were assigned to self-acting patient group. These facts limit the generalizability of our results. International Registered Report Identifier (IRRID): RR2-10.2196/20570 %M 37682585 %R 10.2196/40560 %U https://www.jmir.org/2023/1/e40560 %U https://doi.org/10.2196/40560 %U http://www.ncbi.nlm.nih.gov/pubmed/37682585 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46526 %T Supervised Home-Based Exercise Prehabilitation in Unfit Patients Scheduled for Pancreatic Surgery: Protocol for a Multicenter Feasibility Study %A Hildebrand,Nicole D %A Wijma,Allard G %A Bongers,Bart C %A Rensen,Sander S %A den Dulk,Marcel %A Klaase,Joost M %A Olde Damink,Steven W M %+ Department of Surgery, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, 6229 HX, Netherlands, 31 (0)43 3875492, nicole.hildebrand@mumc.nl %K preoperative care %K prehabilitation %K preoperative training %K high-intensity interval training %K pancreatic resection %K cardiorespiratory fitness %D 2023 %7 7.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Morbidity rates in pancreatic surgery are high, and frail patients with low aerobic capacity are especially at risk of complications and require prophylactic interventions. Previous studies of small patient cohorts receiving intra-abdominal surgery have shown that an exercise prehabilitation program increases aerobic capacity, leading to better treatment outcomes. Objective: In this study, we aim to assess the feasibility of a home-based exercise prehabilitation program in unfit patients scheduled for pancreatic surgery on a larger scale. Methods: In this multicenter study, adult patients scheduled for elective pancreatic surgery with a preoperative oxygen uptake (VO2) at the ventilatory anaerobic threshold ≤13 mL/kg/min or a VO2 at peak exercise ≤18 mL/kg/min will be recruited. A total of 30 patients will be included in the 4-week, home-based, partly supervised exercise prehabilitation program. The program comprises 25-minute high-intensity interval training on an advanced cycle ergometer 3 times a week. Training intensity will be based on steep ramp test performance (ie, a short-term maximal exercise test on a cycle ergometer), aiming to improve aerobic capacity. Twice a week, patients will perform functional task exercises to improve muscle function and functional mobility. A steep ramp test will be repeated weekly, and training intensity will be adjusted accordingly. Next to assessing the feasibility (participation rate, reasons for nonparticipation, adherence, dropout rate, reasons for dropout, adverse events, and patient and therapist appreciation) of this program, individual patients’ responses to prehabilitation on aerobic capacity, functional mobility, body composition, quality of life, and immune system factors will be evaluated. Results: Recruitment for this study began in January 2022 and is expected to be completed in the summer of 2023. Conclusions: Results of this study will provide important clinical and scientific knowledge on the feasibility of a partly supervised home-based exercise prehabilitation program in a vulnerable patient population. This might ease the path to implementing prehabilitation programs in unfit patients undergoing complex abdominal surgery, such as pancreatic surgery. Trial Registration: ClinicalTrials.gov NCT05496777; https://classic.clinicaltrials.gov/ct2/show/NCT05496777 International Registered Report Identifier (IRRID): DERR1-10.2196/46526 %M 37676715 %R 10.2196/46526 %U https://www.researchprotocols.org/2023/1/e46526 %U https://doi.org/10.2196/46526 %U http://www.ncbi.nlm.nih.gov/pubmed/37676715 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46701 %T Flexible and Innovative Connectivity Solution to Support National Decentralized Infectious Diseases Point-of-Care Testing Programs in Primary Health Services: Descriptive Evaluation Study %A Saha,Amit %A Andrewartha,Kelly %A Badman,Steven G %A Tangey,Annie %A Smith,Kirsty S %A Sandler,Sergio %A Ramsay,Stuart %A Braund,Wilton %A Manoj-Margison,Stuart %A Matthews,Susan %A Shephard,Mark D S %A Guy,Rebecca %A Causer,Louise %+ Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia, 61 2 9385 9254, asaha@kirby.unsw.edu.au %K infectious disease %K diagnostics %K POC testing %K point-of-care %K connectivity %K digital health %K disease surveillance %K GeneXpert %D 2023 %7 1.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Molecular point-of-care (POC) testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) has been available in regional and remote primary health services in Australia as part of a decentralized POC testing program since 2016 and for SARS-CoV-2 from 2020. As there was no suitable existing connectivity infrastructure to capture and deliver POC test results to a range of end users, a new system needed to be established. Objective: The aim of the study is to design, implement, and optimize a connectivity system to meet clinical management, analytical quality management, and public health surveillance needs. Methods: We used commercially available e-messaging technology coupled with adapted proprietary software to integrate a decentralized molecular POC testing platform (GeneXpert) in primary health services and interface with end-user databases. This connectivity infrastructure was designed to overcome key barriers to the implementation, integration, and monitoring of these large multijurisdictional infectious disease POC testing networks. Test result messages were tailored to meet end-user needs. Using centrally captured deidentified data, we evaluated the time to receipt of test results and completeness of accompanying demographic data. Results: From January 2016 to April 2020, we operationalized the system at 31 health services across 4 jurisdictions and integrated with 5 different patient management systems to support the real-time delivery of 29,356 CT/NG and TV test results to designated recipients (patient management system and local clinical and central program databases). In 2019, 12,105 CT/NG and TV results were delivered, and the median time to receipt of results was 3.2 (IQR 2.2-4.6) hours, inclusive of test runtime. From May 2020 to August 2022, we optimized the system to support rapid scale-up of SARS-CoV-2 testing (105 services; 6 jurisdictions; 71,823 tests) and additional sexually transmissible infection testing (16,232 tests), including the electronic disease-specific notifications to jurisdictional health departments and alerts for connectivity disruption and positive results. In 2022, 19,355 results were delivered with an overall median transmission time of 2.3 (IQR 1.4-3.1) hours, 2.2 (IQR 1.2-2.3) hours for SARS-CoV-2 (n=16,066), 3.0 (IQR 2.0-4.0) hours for CT/NG (n=1843), and 2.6 (IQR 1.5-3.8) hours for TV (n=1446). Demographic data (age, sex, and ethnicity) were completed for 99.5% of test results in 2022. Conclusions: This innovative connectivity system designed to meet end-user needs has proven to be sustainable, flexible, and scalable. It represents the first such system in Australia established independent of traditional pathology providers to support POC testing in geographically dispersed remote primary health services. The system has been optimized to deliver real-time test results and has proven critical for clinical, public health, and quality management. The system has significantly supported equitable access to rapid diagnostics for infectious diseases across Australia, and its design is suitable for onboarding other POC tests and testing platforms in the future. %M 37656506 %R 10.2196/46701 %U https://www.jmir.org/2023/1/e46701 %U https://doi.org/10.2196/46701 %U http://www.ncbi.nlm.nih.gov/pubmed/37656506 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48616 %T Deferring Postoperative Follow‑Up Visits up to 4 Weeks After Uneventful Cataract Surgery in a Tertiary Level Eye Hospital: Protocol for a Prospective, Quantitative, Experimental Control Study %A Parajuli,Sanket %A Dhakhwa,Parami %A Adhikary,Rabindra %+ Reiyukai Eiko Masunaga Eye Hospital, Budol, Banepa, Kavrepalanchowk, 45210, Nepal, 977 9827430614, sanketparajuli@gmail.com %K cataract surgery %K operational research %K SICS %K small-incision cataract surgery %K postoperative visits %K cataract %K follow-up visit %K postoperative care %K surgery %D 2023 %7 31.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Routine examination after cataract surgery, including a refraction test 4 to 6 weeks after surgery, is mandatory in most hospitals. In recent years, there has been growing interest in exploring alternative approaches to postoperative follow-up in cataract surgery patients due to the increasing number of cataract surgeries being performed, the limited availability of health care resources, and the need to optimize the use of health care services. Objective: We aim to compare postoperative visual outcomes after a day 0 examination in patients with 2 follow‑ups, one on day 7 and other on day 30, and patients with a single ophthalmic follow‑up between days 25 to 30. Methods: A prospective, quantitative, experimental control study will be carried out in Reiyukai Eiko Masunaga Eye Hospital, located in Banepa, Kavrepalanchok, Nepal. All patients undergoing cataract surgery meeting the inclusion and exclusion criteria irrespective of the type of surgery (small-incision cataract surgery or phacoemulsification) will be included in the study. The patients will be randomly assigned to 1 of 2 groups. Patients in group 1 will be examined on day 1, day 7, and day 30, whereas patients in group 2 will be examined on day 1 and once between days 25 to 30. The minimum clinically important difference (MCID) in our study will be set according to the improvement in the Snellen visual acuity chart. Results: The study is expected to be completed within 6 to 8 months from the start of the project. Data analysis and report writing will be carried out in a 2-month period. Best-corrected visual acuity will be compared between the 2 groups to determine if the MCID is achieved. The cost-effectiveness of the new approach will also be analyzed. Conclusions: We aim to conclude that we can safely defer the 1-week postoperative follow-up visit in patients undergoing uncomplicated cataract surgery and that, moreover, we can reduce the patient load at the hospital and decrease patient expenses by decreasing the frequency of hospital visits. International Registered Report Identifier (IRRID): PRR1-10.2196/48616 %M 37651180 %R 10.2196/48616 %U https://www.researchprotocols.org/2023/1/e48616 %U https://doi.org/10.2196/48616 %U http://www.ncbi.nlm.nih.gov/pubmed/37651180 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e46322 %T Web-Based Application Based on Human-in-the-Loop Deep Learning for Deidentifying Free-Text Data in Electronic Medical Records: Development and Usability Study %A Liu,Leibo %A Perez-Concha,Oscar %A Nguyen,Anthony %A Bennett,Vicki %A Blake,Victoria %A Gallego,Blanca %A Jorm,Louisa %+ Centre for Big Data Research in Health, University of New South Wales, Level 2, AGSM Building, G27, Botany St, Sydney, 2052, Australia, 61 290657847, z5250377@ad.unsw.edu.au %K web-based system %K deidentification %K electronic medical records %K deep learning %K narrative free text %K human in the loop %K free text %K unstructured data %K electronic health records %K machine learning %D 2023 %7 25.8.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: The narrative free-text data in electronic medical records (EMRs) contain valuable clinical information for analysis and research to inform better patient care. However, the release of free text for secondary use is hindered by concerns surrounding personally identifiable information (PII), as protecting individuals' privacy is paramount. Therefore, it is necessary to deidentify free text to remove PII. Manual deidentification is a time-consuming and labor-intensive process. Numerous automated deidentification approaches and systems have been attempted to overcome this challenge over the past decade. Objective: We sought to develop an accurate, web-based system deidentifying free text (DEFT), which can be readily and easily adopted in real-world settings for deidentification of free text in EMRs. The system has several key features including a simple and task-focused web user interface, customized PII types, use of a state-of-the-art deep learning model for tagging PII from free text, preannotation by an interactive learning loop, rapid manual annotation with autosave, support for project management and team collaboration, user access control, and central data storage. Methods: DEFT comprises frontend and backend modules and communicates with central data storage through a filesystem path access. The frontend web user interface provides end users with a user-friendly workspace for managing and annotating free text. The backend module processes the requests from the frontend and performs relevant persistence operations. DEFT manages the deidentification workflow as a project, which can contain one or more data sets. Customized PII types and user access control can also be configured. The deep learning model is based on a Bidirectional Long Short-Term Memory-Conditional Random Field (BiLSTM-CRF) with RoBERTa as the word embedding layer. The interactive learning loop is further integrated into DEFT to speed up the deidentification process and increase its performance over time. Results: DEFT has many advantages over existing deidentification systems in terms of its support for project management, user access control, data management, and an interactive learning process. Experimental results from DEFT on the 2014 i2b2 data set obtained the highest performance compared to 5 benchmark models in terms of microaverage strict entity–level recall and F1-scores of 0.9563 and 0.9627, respectively. In a real-world use case of deidentifying clinical notes, extracted from 1 referral hospital in Sydney, New South Wales, Australia, DEFT achieved a high microaverage strict entity–level F1-score of 0.9507 on a corpus of 600 annotated clinical notes. Moreover, the manual annotation process with preannotation demonstrated a 43% increase in work efficiency compared to the process without preannotation. Conclusions: DEFT is designed for health domain researchers and data custodians to easily deidentify free text in EMRs. DEFT supports an interactive learning loop and end users with minimal technical knowledge can perform the deidentification work with only a shallow learning curve. %M 37624624 %R 10.2196/46322 %U https://www.i-jmr.org/2023/1/e46322 %U https://doi.org/10.2196/46322 %U http://www.ncbi.nlm.nih.gov/pubmed/37624624 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39089 %T Online Physician-Patient Interaction and Patient Satisfaction: Empirical Study of the Internet Hospital Service %A Wu,Doris Chenguang %A Zhao,Xianduo %A Wu,Ji %+ School of Business, Sun Yat-Sen University, No. 135, Xingang Xi Road, Guangzhou, 510275, China, 86 02084112443, wuji3@mail.sysu.edu.cn %K internet hospital %K online health service %K online physician-patient interaction %K patient satisfaction %K COVID-19 %D 2023 %7 24.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: In China, a form of online health service called the internet hospital became a prominent means of patient care when face-to-face visits were not possible during the COVID-19 pandemic to minimize transmission of the SARS-CoV-2 virus. Patients’ internet hospital experiences largely depend on online physician-patient interaction. Yet, little is known about how physicians can improve patient satisfaction by using specific communication strategies online. Objective: This study aimed to identify specific communication strategies to help physicians deliver better quality internet hospital services. We also outline recommendations for hospitals to operate internet hospital platforms more effectively. Methods: A longitudinal data set was collected from an internet hospital platform operated by a top hospital in China. By extracting communication patterns from approximately 20,000 records of online health care services and by controlling the features of service requests, we tested the impacts of response load, more detailed style, and emotional comfort on patient satisfaction. We further explored the effects of these communication patterns in different service contexts. Results: Physicians with a low response load, a more detailed style, and expressions of emotional comfort received more positive patient feedback. Response load did not affect patient satisfaction with free online health service, whereas a more detailed style and emotional comfort enhanced satisfaction with free service. Response load significantly reduced patient satisfaction with paid online health service, while a more detailed style had no effect. Compared with free service, emotional comfort more strongly promoted patient satisfaction with paid service. Conclusions: The communication strategies identified can help physicians provide patients with a better internet hospital experience. These strategies require hospitals to schedule each physician’s online service period more appropriately. In addition, tailoring the strategies to service situations can facilitate more targeted and effective internet hospital service for patients. %M 37616031 %R 10.2196/39089 %U https://www.jmir.org/2023/1/e39089 %U https://doi.org/10.2196/39089 %U http://www.ncbi.nlm.nih.gov/pubmed/37616031 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 6 %N %P e45150 %T The Use of Social Media by Clinical Nurse Specialists at a Tertiary Hospital: Mixed Methods Study %A AL-Rumhi,Alya %A AL-Rasbi,Samira %A Momani,Aaliyah M %+ Nursing Department, Clinical Nurse Specialist, Sultan Qaboos University Hospital, Muscat, A`Seeb, 121, Oman, 968 24144258, alrumhi@squ.edu.om %K social media %K clinical nurse specialist %K cross-sectional %K tertiary hospital %K Oman %K health education tool %D 2023 %7 24.8.2023 %9 Original Paper %J JMIR Nursing %G English %X Background: Recently, many health care professionals, who use social media to communicate with patients and colleagues, share information about medical research and promote public health campaigns. Objective: This study aimed to examine the motives, barriers, and implementation of social media use among clinical nurse specialists in Oman. Methods: A mixed methods study was conducted among 47 clinical nurse specialists at Sultan Qaboos University Hospital between November and December 2020. Qualitative data were collected using an open-ended questionnaire and analyzed using thematic analysis, and quantitative data were collected with a questionnaire and analyzed using SPSS (version 21.0; IBM Corp). Results: Of the 47 clinical nurse specialists surveyed, 43 (91.5%) responded. All respondents reported using social media applications, with WhatsApp being the most commonly used platform. Most respondents (n=18, 41.9%) spent 1-2 hours per day on social media. The main motives for using social media were increasing knowledge, communication, reaching patients easily, and reducing the number of hospital visits. The main barriers to social media use were privacy concerns, time constraints, and a lack of awareness of legal guidelines for social media use in the workplace. All participants requested clear rules and regulations regarding the use of social media among health care providers in the future. Conclusions: Social media has the option to be a powerful institutional communication and health education tool for clinical nurse specialists in Oman. However, several obstacles must be addressed, including privacy concerns and the need for clear guidelines on social media use in the workplace. Our findings suggest that health care institutions and clinical nurse specialists must work together to overcome these impediments and leverage the benefits of social media for health care.Bottom of Form %M 37616026 %R 10.2196/45150 %U https://nursing.jmir.org/2023/1/e45150 %U https://doi.org/10.2196/45150 %U http://www.ncbi.nlm.nih.gov/pubmed/37616026 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47519 %T Improving the Quality of Postpartum Care in Ghana: Protocol for a Parallel Randomized Controlled Trial %A Adams,Yenupini Joyce %A Agbenyo,John Stephen %+ Eck Institute for Global Health, University of Notre Dame, 915 Flanner Hall, Notre Dame, IN, 46556, United States, 1 5746313224, yadams@nd.edu %K postpartum care %K postnatal care %K maternal mortality %K Ghana %K randomized controlled trial %K protocol %D 2023 %7 22.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although the postpartum period poses substantial risks and can result in significant maternal morbidity and mortality, postpartum care of the mother receives much less attention in transitional countries. Objective: We describe the protocol for a randomized controlled trial to implement and evaluate a postpartum care delivery model titled Focused-PPC (Focused Postpartum Care). Methods: Focused-PPC is an integrated group postpartum care model that meets the clinical care, education, and support needs of mothers up to 1 year after birth. The Focused-PPC intervention is a parallel randomized controlled trial with a total of 192 postpartum women at 4 health centers in Tamale, Ghana. Participants will be randomized into 1 of 2 trial arms at a 1:1 allocation ratio: (1) the control arm, which receives the standard postnatal care currently delivered in health facilities, or (2) the intervention arm, which receives the Focused-PPC model of care. Women enrolled in the intervention arm will receive postpartum clinical assessments and education for the first 6 weeks and will continue to receive education, measures of vital signs, and peer support for 12 months post partum during child welfare visits. Led by trained midwives, each postpartum group in the intervention arm will meet at 1-2 weeks, 6 weeks, and monthly thereafter for up to 1 year post partum, following the Ghana Health Service postnatal care schedule. Results: The Focused-PPC guide, data collection tools, and audiovisual education materials were successfully developed and translated into the local language. We have enrolled and conducted baseline surveys for 192 women (sample size met) in the Focused-PPC trial who have been randomized into intervention and control arms. We have established a total of 12 Focused-PPC groups in the intervention arm, 3 groups from each site, all of which have sessions underway. Conclusions: Focused-PPC has the potential to change the postpartum care delivery model in Ghana and other countries in sub-Saharan Africa and beyond. Trial Registration: ClinicalTrials.gov NCT05280951; https://clinicaltrials.gov/study/NCT05280951 International Registered Report Identifier (IRRID): DERR1-10.2196/47519 %M 37606965 %R 10.2196/47519 %U https://www.researchprotocols.org/2023/1/e47519 %U https://doi.org/10.2196/47519 %U http://www.ncbi.nlm.nih.gov/pubmed/37606965 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45374 %T Association of Generation and Group Size With the Usage of a Mobile Health App in Thailand: Secondary Analysis of the ThaiSook Cohort Study %A Inchusri,Tharoj %A Surangsrirat,Decho %A Kwanmuang,Papichaya %A Poomivanichakij,Prapasiri %A Apiwatgaroon,Ponnapat %A Ongprakobkul,Surathep %A Kongchu,Apissara %A Klinpikul,Anda %A Taneeheng,Ammarin %A Pruphetkaew,Nannapat %A Thongseiratch,Therdpong %A Ngamchaliew,Pitchayanont %A Vichitkunakorn,Polathep %+ Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Songkhla, 90110, Thailand, 66 7451330, polathep.v@psu.ac.th %K application %K cohort %K generation group size %K health care personnel %K logging function %K mobile health technology %K Thailand %D 2023 %7 17.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: In Thailand, The National Science and Technology Development Agency developed ThaiSook, a behavior-tracking app, to promote healthy lifestyles. The Faculty of Medicine, Prince of Songkla University (MED PSU)×ThaiSook Healthier Challenge encouraged employees to use the app over a 28-day period (from July 11 to August 7, 2022). Until recently, no previous studies have examined the association of generations and group sizes with mobile health (mHealth) app use. Understanding these relationships can inform the design of effective mHealth interventions and facilitate targeted interventions. Objective: This study aimed to (1) compare the overall app usage and logging function across different generations and group sizes and (2) describe the demographic characteristics of the participants of the MED PSU×ThaiSook Healthier Challenge. Methods: We conducted a secondary data analysis of the data from the ThaiSook prospective cohort study. Data were collected through the app and comprised demographic characteristics (ie, age, sex, weight, height, and group size) and behaviors (ie, water consumption, fruit and vegetable consumption, sleep hours, and exercise). The outcomes consisted of users who used the app for at least 80% of the participation period (≥23 days). Bivariate tests (Pearson chi-square test for categorical variables and Mann-Whitney U and Kruskal-Wallis tests for continuous variables) were conducted over sex, generations, initial BMI, and group size. Finally, multiple logistic regression models were used to examine the relationship between the independent variables used by the ThaiSook app and consistent users who had used the app for at least 80% of the participation period. Results: Of the 827 participants, most were female (734/827, 88.8%), belonged to a medium-sized group of 6-10 members (479/827, 57.9%), and belonged to generation Y (377/761, 49.5%). Multivariate analysis revealed that the overall app usage was 2.09 times higher in women than in men (adjusted odds ratio [AOR] 2.09, 95% CI 1.27-3.44). The older generations used all logging functions more frequently than did generation Y (baby boomers AOR 2.54, 95% CI 1.31-4.92; generation X AOR 1.96, 95% CI 1.42-2.72). The use of all logging functions was higher among participants belonging to larger groups than among those belonging to smaller groups (large groups AOR 2.85, 95% CI 1.58-5.16; medium groups AOR 2.06, 95% CI 1.47-2.88). Water logging was most used (806/827, 97.5% participants), followed by food, sleep, and workout logging. Conclusions: The MED PSU×ThaiSook Healthier Challenge participants were mostly females from generation Y and medium-sized groups. Water logging was most frequently used, followed by fruit and vegetable logging. The results indicate that generation and group size were significantly associated with consistent and daily usage (P<.05). Older generations and larger groups engaged with the app more consistently than younger generations and smaller groups and individuals. %M 37590057 %R 10.2196/45374 %U https://www.jmir.org/2023/1/e45374 %U https://doi.org/10.2196/45374 %U http://www.ncbi.nlm.nih.gov/pubmed/37590057 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e45504 %T Use of Wearable Devices for Peak Oxygen Consumption Measurement in Clinical Cardiology: Case Report and Literature Review %A Bayshtok,Gabriella %A Tiosano,Shmuel %A Furer,Ariel %+ Leviev Heart Center, Sheba Medical Center, Derech Sheba 2, Ramat Gan, Israel, 972 52 927 7372, furera@gmail.com %K cardiac fitness %K cardiac patient %K cardiorespiratory fitness %K CRF %K clinical cardiology %K oxygen consumption %K peak VO2 %K smartwatch %K wearable device %D 2023 %7 15.8.2023 %9 Case Report %J Interact J Med Res %G English %X Background: Oxygen consumption is an important index to evaluate in cardiac patients, particularly those with heart failure, and is measured in the setting of advanced cardiopulmonary exercise testing. However, technological advances now allow for the estimation of this parameter in many consumer and medical-grade wearable devices, making it available for the medical provider at the initial evaluation of patients. We report a case of an apparently healthy male aged 40 years who presented for evaluation due to an Apple Watch (Apple Inc) notification of low cardiac fitness. This alert triggered a thorough workup, revealing a diagnosis of familial nonischemic cardiomyopathy with severely reduced left ventricular systolic function. While the use of wearable devices for the measurement of oxygen consumption and related parameters is promising, further studies are needed for validation. Objective: The aim of this report is to investigate the potential utility of wearable devices as a screening and risk stratification tool for cardiac fitness for the general population and those with increased cardiovascular risk, particularly through the measurement of peak oxygen consumption (VO2). We discuss the possible advantages of measuring oxygen consumption using wearables and propose its integration into routine patient evaluation and follow-up processes. With the current evidence and limitations, we encourage researchers and clinicians to explore bringing wearable devices into clinical practice. Methods: The case was identified at Sheba Medical Center, and the patient’s cardiac fitness was monitored through an Apple Watch Series 6. The patient underwent a comprehensive cardiac workup following his presentation. Subsequently, we searched the literature for articles relating to the clinical utility of peak VO2 monitoring and available wearable devices. Results: The Apple Watch data provided by the patient demonstrated reduced peak VO2, a surrogate index for cardiac fitness, which improved after treatment initiation. A cardiological workup confirmed familial nonischemic cardiomyopathy with severely reduced left ventricular systolic function. A review of the literature revealed the potential clinical benefit of peak VO2 monitoring in both cardiac and noncardiac scenarios. Additionally, several devices on the market were identified that could allow for accurate oxygen consumption measurement; however, future studies and approval by the Food and Drug Administration (FDA) are still necessary. Conclusions: This case report highlights the potential utility of peak VO2 measurements by wearable devices for early identification and screening of cardiac fitness for the general population and those at increased risk of cardiovascular disease. The integration of wearable devices into routine patient evaluation may allow for earlier presentation in the diagnostic workflow. Cardiac fitness can be serially measured using the wearable device, allowing for close monitoring of functional capacity parameters. Devices need to be used with caution, and further studies are warranted. %M 37581915 %R 10.2196/45504 %U https://www.i-jmr.org/2023/1/e45504 %U https://doi.org/10.2196/45504 %U http://www.ncbi.nlm.nih.gov/pubmed/37581915 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46252 %T Validation of a Geriatric Bedside Swallowing Screen (GEBS): Protocol of a Prospective Cohort Study %A Javorszky,Susanne Maria %A Reiter,Raphael %A Iglseder,Bernhard %+ Institute for Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, Salzburg, 5020, Austria, 43 662 2420 80365, susanne_maria.javorszky@fh-campuswien.ac.at %K dysphagia %K geriatrics %K swallowing disorder %K assessment %K screening %K cohort study %K multimorbidity %K hospital setting %D 2023 %7 11.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Demographic changes will raise the need for specialized care of older patients. Oropharyngeal dysphagia has recently been declared a geriatric syndrome reflecting its multifactorial background. Alongside multimorbidity, sarcopenia, frailty, and disability, swallowing disorders increase with advancing age, with prevalence rates reported to be as high as 44% in acute geriatric hospital settings and 80% in long-term care facilities. Hence, systematic screening of older patients to diagnose dysphagia and initiate treatment is of paramount importance to prevent bolus death, aspiration pneumonia, and malnutrition and improve quality of life. Several screening tools have been evaluated in emergency and stroke units. However, no published dysphagia screening tool has been validated in the hospitalized, older adult population using a gold standard in dysphagia diagnostics as a reference test. The validation of the proposed test is a first step. Objective: The Geriatric Bedside Swallowing Screen (GEBS) study aims to validate a new screening tool developed specifically for older inpatients against an instrumental swallowing evaluation, the flexible endoscopic evaluation of swallowing (FEES), which is considered a gold standard. Primary outcomes to be evaluated are sensitivity and specificity for the GEBS in the detection of dysphagia in a mixed older adult population. The presence of dysphagia will be defined by an instrumental swallowing evaluation (FEES), analyzed by the standardized penetration-aspiration scale. Methods: To validate the GEBS, a prospective cohort study will be carried out. Two institutions, an acute geriatric department and a long-term care facility, will aim to recruit a total of 100 patients aged ≥75 years. After giving their informed consent, patients will undergo the full screening protocol described in the GEBS as well as an evaluation of swallowing function using the FEES. Investigators will be blinded to the results of the respective other testing. The analysis of pseudonymized data sets will be done by a third investigator. Outcomes to be considered are sensitivity, specificity, diagnostic odds ratio, positive and negative likelihood quotient, and the reliability of the proposed dysphagia screening tool using the κ coefficient. Results: Recruitment started in October 2022 and will end in April 2024. Data publication is planned for early 2025. Conclusions: If proven to be a valid screening tool for the early detection of dysphagia, further studies including different older adult populations as well as studies to determine the impact of systematic dysphagia screening on parameters, such as rates of aspiration pneumonia or nutritional status, should be planned. Effective screening of dysphagia will lead to earlier detection of patients with impaired swallowing. Those who fail the screening will be referred to speech language pathology for further diagnosis, thus optimizing care while streamlining personnel resources. Trial Registration: ISCRTN Registry ISRCTN11581931; https://www.isrctn.com/ISRCTN11581931 International Registered Report Identifier (IRRID): DERR1-10.2196/46252 %M 37566452 %R 10.2196/46252 %U https://www.researchprotocols.org/2023/1/e46252 %U https://doi.org/10.2196/46252 %U http://www.ncbi.nlm.nih.gov/pubmed/37566452 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e11623 %T Examining Feasibility, Acceptability, and Preliminary Outcomes of a Culturally Adapted Evidence-Based Postpartum Depression Preventive Intervention for Women in Doha, Qatar: Protocol for a Randomized Controlled Trial %A Ahmed,Sawssan R %A Watt,Felice %A Mahfoud,Ziyad Riyad %A Korayem,Mona %A Buhmaid,Sara %A Alberry,Medhat %A Ibrahim,Ibrahim Mamoun %A Tandon,S Darius %+ Department of Psychology, California State University-Fullerton, 800 N. State College Blvd., Fullerton, CA, 92832, United States, 1 657 278 2173, saahmed@fullerton.edu %K postpartum depression %K intervention %K prevention %K cultural adaptation %K Arabic %D 2023 %7 11.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Postpartum depression and anxiety are the 2 most common perinatal mental health disorders, with prevalence rates higher among women living in the Middle East than in most Western countries. The negative outcomes associated with postpartum depression and anxiety are profound and include less responsive parenting and compromised infant and young child development. Although interventions exist to prevent postpartum depression and anxiety, to date, there have been no studies that have attempted to prevent postpartum depression or anxiety among Arabic-speaking women in the Middle East, including Qatar. Objective: The purpose of this study is to conduct a randomized controlled trial (RCT) of an evidence-based postpartum depression preventive intervention—Mothers and Babies (MB)—culturally adapted for use with Arabic-speaking women in Doha, Qatar. MB is guided by a cognitive behavioral therapy framework that focuses on increasing pleasant activities, promoting healthy thought patterns, and increasing the type and frequency of personal contacts. MB is tailored to specific needs and issues related to pregnancy and the postpartum period. Methods: A multidisciplinary and multiethnic investigator team adapted MB to promote cultural and contextual fit for Arabic-speaking women. Intervention concepts were reviewed to ensure core content would be understood by Arabic-speaking women in Qatar. Subsequently, images, activities, and examples in the intervention manuals were adapted, as needed, to make the content more relevant to Arab culture. To deliver the adapted intervention, 30 Arabic-speaking individuals with mental health backgrounds were trained. The adapted intervention was subsequently pilot-tested with 10 pregnant women receiving prenatal care at Sidra Hospital in Doha. We are now conducting an RCT to examine the effectiveness of the adapted intervention. We plan to enroll 210 pregnant individuals who are Arabic-speaking, with 1:1 randomization to the MB intervention or usual prenatal care. Among the enrolled participants, a stratified subsample of 40 pregnant women with diabetes is being recruited. Data collection will take place at baseline and a 6-month follow-up. The primary outcomes are depressive and anxiety symptoms and perceived stress. Diabetes self-care is the exploratory outcome for the subsample of individuals with diabetes. Intervention implementation will be assessed via client and provider surveys during and after intervention delivery. Power and sample size were calculated using a 2-sided 5% effort rate and assumed analyses on the individual level, accounting for attrition of 20%. Results: The cultural adaptation and pilot study of the adapted MB intervention are completed. A total of 157 women have been enrolled in the RCT as of March 31, 2023. Conclusions: This study is highly innovative, as it is the first study to our knowledge to examine the effectiveness of an evidence-based postpartum depression preventive intervention in the Middle East. Limitations include a single follow-up time point and a small subsample of individuals with diabetes. Trial Registration: ClinicalTrials.gov NCT04442529; https://www.clinicaltrials.gov/study/NCT04442529 International Registered Report Identifier (IRRID): DERR1-10.2196/11623 %M 37566449 %R 10.2196/11623 %U https://www.researchprotocols.org/2023/1/e11623 %U https://doi.org/10.2196/11623 %U http://www.ncbi.nlm.nih.gov/pubmed/37566449 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46794 %T Developing a Core Outcome Set for Assessing Clinical Safety Outcomes of Prostate Cancer in Clinical Trials of Traditional Chinese Medicine: Protocol for a Mixed Methods Study %A Tian,Huichuan %A Zhang,Yao %A Ren,Jiajun %A Wang,Chaoran %A Mou,Ruiyu %A Li,Xiaojiang %A Jia,Yingjie %+ The First Affiliated Hospital of Tianjin University of Chinese Medicine, No.88 Yuquan Road, Nankai District, Tianjin, 300193, China, 86 18162042779, jiayingjie1616@sina.com %K core outcome set %K safety outcomes %K prostate cancer %K traditional Chinese medicine %K clinical trial %K study protocol %K quality of life %K efficacy %K clinical safety outcome %K men %D 2023 %7 7.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Among the common malignant tumors in men worldwide, the incidence of prostate cancer ranks second to lung cancer. This disease will bring an economic burden to patients and their families and can reduce the quality of life of patients. Researchers have conducted numerous clinical trials on the efficacy and safety of different interventions in the treatment of prostate cancer with traditional Chinese medicine (TCM) combined with standard treatment regimens. However, the currently published clinical trials exhibit inconsistent and irregular reporting of outcome measures. Objective: The objective of this paper is to emphasize the need for a core outcome set (COS) to facilitate future prostate cancer research, aiming to improve the quality of trials and generate high-quality evidence. Methods: This mixed methods project has three phases, as follows: (1) a scoping review of the literature to identify outcomes that have been reported in clinical trials and systematic reviews of interventions involving TCM for the treatment of prostate cancer as well as a qualitative component using interviews to obtain the views of patients with prostate cancer, their families, and their caregivers who have a history of TCM treatment; (2) a Delphi survey among stakeholders to prioritize the core outcomes—Participants will include traditional Chinese and Western medicine clinicians in prostate cancer–related directions, nurses, and methodology experts who will participate in 2 rounds of the Delphi method expert consultation to score each outcome in the list of outcome indicators; and (3) a face-to-face consensus meeting to discuss and agree on the final COS for the application of TCM in the treatment of prostate cancer. Results: The protocol has been registered in PROSPERO (CRD42022356184) before the start of the review process, and we will initiate the review on August 1, 2023; results should be expected by September 1, 2023. The Delphi survey among stakeholders is expected to start in October 2023. Conclusions: The development of a core outcome set for assessing clinical safety outcomes of prostate cancer in clinical trials of TCM will provide a significant first step to assist Chinese doctors, researchers, and policy makers. Trial Registration: PROSPERO CRD42022356184; https://tinyurl.com/ysakz74r International Registered Report Identifier (IRRID): PRR1-10.2196/46794 %M 37549007 %R 10.2196/46794 %U https://www.researchprotocols.org/2023/1/e46794 %U https://doi.org/10.2196/46794 %U http://www.ncbi.nlm.nih.gov/pubmed/37549007 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e42500 %T Left Head Rotation as an Alternative to Difficult Tracheal Intubation: Randomized Open Label Clinical Trial %A Chan,Danya P %A Jularbal III,George Carlos Rosendo M %A Mapili,Ismael Julius R %+ Department of Anesthesiology, Baguio General Hospital and Medical Center, Governor Pack Road, Baguio City, 2600, Philippines, 63 9958515061, danyachan@yahoo.com %K tracheal %K endotracheal %K intubation %K airway management %K sniffing position %K LeHeR %D 2023 %7 4.8.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Tracheal intubation is a life-saving intervention, and optimizing the patient’s head and neck position for the best glottic view is a crucial step that accelerates the procedure. The left head rotation maneuver has been recently described as an innovative alternative to the traditional sniffing position used for tracheal intubation with marked improvement in glottic visualization. Objective: This study compared the glottic view and intubating conditions in the sniffing position versus left head rotation during direct laryngoscopy. Methods: This randomized, open-label clinical trial enrolled 52 adult patients admitted to Baguio General Hospital and Medical Center from September 2020 to January 2021 for an elective surgical procedure requiring tracheal intubation under general anesthesia. Intubation was done using a 45° left head rotation in the experimental group (n=26), while the control group (n=26) was intubated using the conventional sniffing position. Glottic visualization and intubation difficulty with the two procedures were assessed using the Cormack-Lehane grade and Intubation Difficulty Scale, respectively. Successful intubation is measured by observing a capnographic waveform in the end-tidal CO2 monitor after placement of the endotracheal tube. Results: There was no statistically significant difference in the Cormack-Lehane grade, with 85% (n=44) of patients classified under grades 1 (n=11 and n=15) and 2 (n=11 and n=7) in the left head rotation and sniffing position groups, respectively. In addition, there were no statistically significant differences in the Intubation Difficulty Scale scores of patients intubated with left head rotation or sniffing position; 30.7% (n=8) of patients in both groups were easily intubated, while 53.8% (n=14) in left head rotation and 57.6% (n=15) in sniffing position groups were intubated with slight difficulty. Similarly, there were no significant differences between the 2 techniques in any of the 7 parameters of the Intubation Difficulty Scale, although numerically fewer patients required the application of additional lifting force (n=7, 26.9% vs n=11, 42.3%) or laryngeal pressure (n=3, 11.5% vs n=7, 26.9%) when intubated with left head rotation. The intubation success rate with left head rotation was 92.3% versus 100% in the sniffing position, but this difference was not statistically significant. Conclusions: Left head rotation produces comparable laryngeal exposure and intubation ease to the conventional sniffing position. Therefore, left head rotation may be an alternative for patients who cannot be intubated in the sniffing position, especially in hospitals where advanced techniques such as video laryngoscopes and flexible bronchoscopes are unavailable, as is the case in this study. However, since our sample size was small, studies with a larger study population are warranted to establish the generalizability of our findings. In addition, we observed inadequate familiarity among anesthesiologists with the left head rotation technique, and the intubation success rate may improve as practitioners attain greater technical familiarization. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN)ISRCTN23442026; https://www.isrctn.com/ISRCTN23442026 %M 37335071 %R 10.2196/42500 %U https://www.i-jmr.org/2023/1/e42500 %U https://doi.org/10.2196/42500 %U http://www.ncbi.nlm.nih.gov/pubmed/37335071 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47637 %T Virtual First Emergency Medicine Visits: The Future of Convenient and Efficient Emergency Care %A Sakumoto,Matthew %+ University of California, San Francisco, 533 Parnassus Ave, U127, San Francisco, CA, 94143, United States, 1 4154761000, matthew.sakumoto@ucsf.edu %K telehealth %K virtual care %K emergency medicine %K telemedicine %K emergency department %K acute care facilities %K virtual visit %K COVID-19 %K virtual %K utilization %K medicine %K acute illness %K illness %K injury %K patient %K infection %K care %K physician %D 2023 %7 3.8.2023 %9 Commentary %J J Med Internet Res %G English %X The COVID-19 pandemic has led to increased patient volumes, staff shortages, and limited resources in emergency departments, resulting in the rapid acceleration of telemedicine in emergency medicine. The virtual first (VF) program connects patients with emergency medicine clinicians via synchronous virtual video visits, reducing unnecessary emergency department visits and diverting patients to appropriate care settings. VF video visits can improve patient outcomes by providing early intervention for acute care needs and can enhance patient satisfaction by providing convenient, accessible, and personalized care. However, challenges include the lack of physical examination, clinician telehealth training and competencies, and the requirement for a robust telemedicine infrastructure. Additionally, digital health equity is important to ensure equitable access to care. Despite these challenges, the potential benefits of VF video visits in emergency medicine are substantial, and this study is a strong step in building the evidence base for these advancements. %M 36976827 %R 10.2196/47637 %U https://www.jmir.org/2023/1/e47637 %U https://doi.org/10.2196/47637 %U http://www.ncbi.nlm.nih.gov/pubmed/36976827 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42840 %T Using Virtual Emergency Medicine Clinicians as a Health System Entry Point (Virtual First): Cross-Sectional Survey Study %A Potter,Jennifer %A Watson Gans,Dana %A Gardner,Alison %A O'Neill,James %A Watkins,Christopher %A Husain,Iltifat %+ Department of Emergency Medicine, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, United States, 1 9204504469, j.k.potter@wakehealth.edu %K telehealth %K virtual care %K emergency medicine %K telemedicine %K emergency department %K acute care facilities %K virtual visit %K COVID-19 %K virtual %K utilization %K medicine %K acute illness %K illness %K injury %K patient %K efficacy %K infection %K care %K physician %D 2023 %7 3.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic accelerated the use and acceptance of telemedicine. Simultaneously, emergency departments (EDs) have experienced increased ED boarding. With this acceptance of telemedicine and the weighty increase in patient boarding, we proposed the innovative Virtual First (VF) program to leverage emergency medicine clinicians’ (EMCs) ability to triage patients. VF seeks to reduce unnecessary ED visits by connecting patients with EMCs prior to seeking in-person care rather than using traditional ED referral systems. Objective: The goal of this study is to investigate how patients’ access to EMCs from home via the establishment of VF changed how patients sought care for acute care needs. Methods: VF is a synchronous virtual video visit at a tertiary care academic hospital. VF was staffed by EMCs and enabled full management of patient complaints or, if necessary, referral to the appropriate level of care. Patients self-selected this service as an alternative to seeking in-person care at a primary care provider, urgent care center, or ED. A postvisit convenience sample survey was collected through a phone SMS text message or email to VF users. This is a cross-sectional survey study. The primary outcome measure is based on responses to the question “How would you have sought care if a VF visit was not available to you?” Secondary outcome measures describe valued aspects and criticisms. Results were analyzed using descriptive statistics. Results: There were 3097 patients seen via VF from July 2021 through May 2022. A total of 176 (5.7%) patients completed the survey. Of these, 87 (49.4%) would have sought care at urgent care centers if VF had not been available. There were 28 (15.9%) patients, 26 (14.8%) patients, and 1 (0.6%) patient that would have sought care at primary care providers, EDs, or other locations, respectively. Interestingly, 34 (19.3%) patients would not have sought care. The most valued aspect of VF was receiving care in the comfort of the home (n=137, 77.8%). For suggested improvements, 58 (33%) patients most commonly included “Nothing” as free text. Conclusions: VF has the potential to restructure how patients seek medical care by connecting EMCs with patients prior to ED arrival. Without the option of VF, 64.2% (113/177) of patients would have sought care at an acute care facility. VF’s innovative employment of EMCs allows for acute care needs to be treated virtually if feasible. If not, EMCs understand the local resources to better direct patients to the appropriate site. This has the potential to substantially decrease patient costs because patients are given the appropriate destination for in-person care, reducing the likelihood of the need for transfer and multiple ED visits. %M 37276547 %R 10.2196/42840 %U https://www.jmir.org/2023/1/e42840 %U https://doi.org/10.2196/42840 %U http://www.ncbi.nlm.nih.gov/pubmed/37276547 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48799 %T An mHealth Intervention to Improve Guardians’ Adherence to Children’s Follow-Up Care for Acute Lymphoblastic Leukemia in Tanzania (GuardiansCan Project): Protocol for a Development and Feasibility Study %A Chiwanga,Faraja S %A Woodford,Joanne %A Masika,Golden M %A Richards,David A %A Savi,Victor %A von Essen,Louise %+ Department of Women's and Children's health, Healthcare Sciences and e-Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, 751 05, Sweden, 46 070 425 07 14, louise-von.essen@kbh.uu.se %K childhood cancer %K eHealth %K feasibility %K guardians %K intervention development %K low- and middle-income countries %K Tanzania %K mHealth %K mobile health %K public contribution %K public involvement %K mHealth intervention %K leukemia %K psychological distress %D 2023 %7 2.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cancer is a leading cause of death during childhood and in low- and middle-income countries survival rates can be as low as 20%. A leading reason for low childhood cancer survival rates in low- and middle-income countries such as Tanzania is treatment abandonment. Contributing factors include poor communication between health care providers and children’s guardians, insufficient cancer knowledge, and psychological distress. Objective: Our aim is to respond to Tanzanian guardians’ poor adherence to children’s follow-up care after treatment for acute lymphoblastic leukemia with the help of mobile health (mHealth) technology. Our goal is to increase guardians’ adherence to children’s medications and follow-up visits and to decrease their psychological distress. Methods: Following the Medical Research Council framework for developing and evaluating complex interventions, we will undertake the GuardiansCan project in an iterative phased approach to develop an mHealth intervention for subsequent testing. Public contribution activities will be implemented throughout via the establishment of a Guardians Advisory Board consisting of guardians of children with acute lymphoblastic leukemia. We will examine the acceptability, feasibility, and perceived impact of Guardians Advisory Board activities via an impact log and semistructured interviews (study I). In phase 1 (intervention development) we will explore guardians’ needs and preferences for the provision of follow-up care reminders, information, and emotional support using focus group discussions and photovoice (study II). We will then co-design the mHealth intervention with guardians, health care professionals, and technology experts using participatory action research (study III). In phase 2 (feasibility), we will examine clinical, methodological, and procedural uncertainties associated with the intervention and study procedures to prepare for the design and conduct of a future definitive randomized controlled trial using a single-arm pre-post mixed methods feasibility study (study IV). Results: Data collection for the GuardiansCan project is anticipated to take 3 years. We plan to commence study I by recruiting Guardians Advisory Board members in the autumn of 2023. Conclusions: By systematically following the intervention development and feasibility phases of the Medical Research Council Framework, and working alongside an advisory board of guardians, we intend to develop an acceptable, culturally appropriate, feasible, and relevant mHealth intervention with the potential to increase guardians’ adherence to children’s follow-up care after treatment of acute lymphoblastic leukemia, leading to a positive impact on children’s health and chances to survive, and reducing distress for guardians. International Registered Report Identifier (IRRID): PRR1-10.2196/48799 %M 37403706 %R 10.2196/48799 %U https://www.researchprotocols.org/2023/1/e48799 %U https://doi.org/10.2196/48799 %U http://www.ncbi.nlm.nih.gov/pubmed/37403706 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44399 %T An Assessment of Patient Portal Messaging Use by Patients With Multiple Chronic Conditions Living in Rural Communities: Retrospective Analysis %A Chivela,Fernando L %A Burch,Ashley E %A Asagbra,Oghale %+ Department of Health Services and Information Management, East Carolina University, 4340N Health Sciences Building, 2150 West 5th Street, Greenville, NC, 27834, United States, 1 2527441205, burchas15@ecu.edu %K patient portal %K multimorbidity %K chronic disease %K patient messaging %K rural %K mobile phone %D 2023 %7 1.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient portals can facilitate the delivery of health care services and support self-management for patients with multiple chronic conditions. Despite their benefits, the evidence of patient portal use among patients with multimorbidity in rural communities is limited. Objective: This study aimed to explore the factors associated with portal messaging use by rural patients. Methods: We assessed patient portal use among patients with ≥1 chronic diagnoses who sent or received messages via the Epic MyChart (Epic Systems Corporation) portal between January 1, 2015, and November 9, 2021. Patient portal use was defined as sending or receiving a message through the portal during the study period. We fit a zero-inflated negative binomial model to predict portal use based on the patient’s number of chronic conditions, sex, race, age, marital status, and insurance type. County-level characteristics, based on the patient’s home address, were also included in the model to assess the influence of community factors on portal use. County-level factors included educational attainment, smartphone ownership, median income, and primary care provider density. Results: A total of 65,178 patients (n=38,587, 59.2% female and n=21,454, 32.92% Black) were included in the final data set, of which 38,380 (58.88%) sent at least 1 message via the portal during the 7-year study period. As the number of chronic diagnoses increased, so did portal messaging use; however, this relationship was driven primarily by younger patients. Patients with 2 chronic conditions were 1.57 times more likely to send messages via the portal than those with 1 chronic condition (P<.001). In comparison, patients with ≥7 chronic conditions were approximately 11 times more likely to send messages than patients with 1 chronic condition (P<.001). A robustness check confirmed the interaction effect of age and the number of diagnoses on portal messaging. In the model including only patients aged <65 years, there was a significant effect of increased portal messaging corresponding to the number of chronic conditions (P<.001). Conversely, this relationship was not significant for the model consisting of older patients. Other significant factors associated with increased portal use include being female; White; married; having private insurance; and living in an area with a higher average level of educational attainment, greater medical provider density, and a lower median income. Conclusions: Patients’ use of the portal to send messages to providers was incrementally related to their number of diagnoses. As the number of chronic diagnoses increased, so did portal messaging use. Patients of all ages, particularly those living in rural areas, could benefit from the convenience and cost-effectiveness of portal communication. Health care systems and providers are encouraged to increase the use of patient portals by implementing educational interventions to promote the advantages of portal communication, particularly among patients with multimorbidity. %M 37526967 %R 10.2196/44399 %U https://www.jmir.org/2023/1/e44399 %U https://doi.org/10.2196/44399 %U http://www.ncbi.nlm.nih.gov/pubmed/37526967 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45713 %T Building the Business Case for an Inclusive Approach to Digital Health Measurement With a Web App (Market Opportunity Calculator): Instrument Development Study %A Tang,Mitchell %A Sharma,Yashoda %A Goldsack,Jennifer C %A Stern,Ariel Dora %+ Digital Medicine Society, 90 Canal Street, 4th Floor, Boston, MA, 02114, United States, 1 7652343463, yashoda@dimesociety.org %K inclusion %K digital health %K digital product development %K health equity %K public health %K Digital Health Measurement Collaborative Community %K DATAcc %D 2023 %7 26.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of digital health measurement tools has grown substantially in recent years. However, there are concerns that the promised benefits from these products will not be shared equitably. Underserved populations, such as those with lower education and income, racial and ethnic minorities, and those with disabilities, may find such tools poorly suited for their needs. Because underserved populations shoulder a disproportionate share of the US disease burden, they also represent a substantial share of digital health companies’ target markets. Incorporating inclusive principles into the product development process can help ensure that the resulting tools are broadly accessible and effective. In this context, inclusivity not only maximizes societal benefit but also leads to greater commercial success. Objective: A critical element in fostering inclusive product development is building the business case for why it is worthwhile. The Digital Health Measurement Collaborative Community (DATAcc) Market Opportunity Calculator was developed as an open-access resource to enable digital health measurement product developers to build a business case for incorporating inclusive practices into their research and development processes. Methods: The DATAcc Market Opportunity Calculator combines data on population demographics and disease prevalence and health status from the US Census Bureau and the US Centers for Disease Control and Prevention (CDC). Together, these data are used to calculate the share of US adults with specific conditions (eg, diabetes) falling into various population segments along key “inclusion vectors” (eg, race and ethnicity). Results: A free and open resource, the DATAcc Market Opportunity Calculator can be accessed from the DATAcc website. Users first select the target health condition addressed by their product, and then an inclusion vector to segment the patient population. The calculator displays each segment as a share of the overall US adult population and its share specifically among adults with the target condition, quantifying the importance of underserved patient segments to the target market. The calculator also estimates the value of improvements to product inclusivity by modeling the downstream impact on the accessible market size. For example, simplifying prompts on a hypertension-focused product to make it more accessible for adults with lower educational attainment is shown by the calculator to increase the target market by 2 million people and the total addressable market opportunity by US $200 million. Conclusions: Digital health measurement is still in its infancy. Now is the time to establish a precedent for inclusive product development to maximize societal benefit and build sustainable commercial returns. The Market Opportunity Calculator can help build the business case for “why”—showing how inclusivity can translate to financial opportunity. Once the decision has been made to pursue inclusive design, other components of the broader DATAcc toolkit for inclusive product development can support the “how.” %M 37494108 %R 10.2196/45713 %U https://formative.jmir.org/2023/1/e45713 %U https://doi.org/10.2196/45713 %U http://www.ncbi.nlm.nih.gov/pubmed/37494108 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46542 %T Creation of a Laboratory for Statistics and Analysis of Dependence and Chronic Conditions: Protocol for the Bages Territorial Specialization and Competitiveness Project (PECT BAGESS) %A Pujolar-Díaz,Georgina %A Vidal-Alaball,Josep %A Forcada,Anna %A Descals-Singla,Elisabet %A Basora,Josep %A , %+ Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Carrer Pica d'Estats 13-15, Sant Fruitós de Bages, 08272, Spain, 34 93 693 00 40, jvidal.cc.ics@gencat.cat %K chronic disease %K multiple chronic conditions %K primary health care %K diffusion of innovation %K health data %K data sharing %D 2023 %7 26.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: With the increasing prevalence of chronic diseases, partly due to the increase in life expectancy and the aging of the population, the complexity of the approach faced by the structures, dynamics, and actors that are part of the current care and attention systems is evident. The territory of Bages (Catalonia, Spain) presents characteristics of a highly complex ecosystem where there is a need to develop new, more dynamic structures for the various actors in the health and social systems, aimed at incorporating new actors in the technological and business field that would allow innovation in the management of this context. Within the framework of the Bages Territorial Specialization and Competitiveness Project (PECT BAGESS), the aim is to address these challenges through various entities that will develop 7 interrelated operations. Of these, the operation of the IDIAP Jordi Gol-Catalan Health Institute focuses on the creation of a Laboratory for Statistics and Analysis of Dependence and Chronic Conditions in the Bages region, in the form of a database that will collect the most relevant information from the different environments that affect the management of chronic conditions and dependence: health, social, economic, and environment. Objective: This study aims to create a laboratory for statistical, dependence, and chronic condition analysis in the Bages region, to determine the chronic conditions and conditions that generate dependence in the Bages area, in order to propose products and services that respond to the needs of people in these situations. Methods: PECT BAGESS originated from the Shared Agenda initiative, which was established in the Bages region with the goal of enhancing the quality of life and fostering social inclusion for individuals with chronic diseases. This study presents part of this broader project, consisting of the creation of a database. Data from chronic conditions and dependence service providers will be combined, using a unique identifier for the different sources of information. A thorough legal analysis was conducted to establish a secure data sharing mechanism among the entities participating in the project. Results: The laboratory will be a key piece in the structure generated in the environment of the PECT BAGESS, which will allow relevant information to be passed on from the different sectors involved to respond to the needs of people with chronic conditions and dependence, as well as to generate opportunities for products and services. Conclusions: The emerging organizational dynamics and structures are expected to demonstrate a health and social management model that may have a remarkable impact on these sectors. Products and services developed may be very useful for generating synergies and facilitating the living conditions of people who can benefit from all these services. However, secure data sharing circuits must be considered. International Registered Report Identifier (IRRID): PRR1-10.2196/46542 %M 37494102 %R 10.2196/46542 %U https://www.researchprotocols.org/2023/1/e46542 %U https://doi.org/10.2196/46542 %U http://www.ncbi.nlm.nih.gov/pubmed/37494102 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e43384 %T Electronic Phenotype for Advanced Chronic Kidney Disease in a Veteran Health Care System Clinical Database: Systems-Based Strategy for Model Development and Evaluation %A Chamarthi,Gajapathiraju %A Orozco,Tatiana %A Shell,Popy %A Fu,Devin %A Hale-Gallardo,Jennifer %A Jia,Huanguang %A Shukla,Ashutosh M %+ Advanced Chronic Kidney Disease and Home Dialysis Program, North Florida/South Georgia Veteran Healthcare System, 1600 Archer Road, Gainesville, FL, 32610, United States, 1 352 273 8821, Ashutosh.Shukla@medicine.ufl.edu %K advanced chronic kidney disease %K EHR phenotype %K Veteran Health System %K CKD cohort %K kidney disease %K chronic %K clinical %K database %K data %K diagnosis %K risk %K disease %D 2023 %7 24.7.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Identifying advanced (stages 4 and 5) chronic kidney disease (CKD) cohorts in clinical databases is complicated and often unreliable. Accurately identifying these patients can allow targeting this population for their specialized clinical and research needs. Objective: This study was conducted as a system-based strategy to identify all prevalent Veterans with advanced CKD for subsequent enrollment in a clinical trial. We aimed to examine the prevalence and accuracy of conventionally used diagnosis codes and estimated glomerular filtration rate (eGFR)-based phenotypes for advanced CKD in an electronic health record (EHR) database. We sought to develop a pragmatic EHR phenotype capable of improving the real-time identification of advanced CKD cohorts in a regional Veterans health care system. Methods: Using the Veterans Affairs Informatics and Computing Infrastructure services, we extracted the source cohort of Veterans with advanced CKD based on a combination of the latest eGFR value ≤30 ml·min–1·1.73 m–2 or existing International Classification of Diseases (ICD)-10 diagnosis codes for advanced CKD (N18.4 and N18.5) in the last 12 months. We estimated the prevalence of advanced CKD using various prior published EHR phenotypes (ie, advanced CKD diagnosis codes, using the latest single eGFR <30 ml·min–1·1.73 m–2, utilizing two eGFR values) and our operational EHR phenotypes of a high-, intermediate-, and low-risk advanced CKD cohort. We evaluated the accuracy of these phenotypes by examining the likelihood of a sustained reduction of eGFR <30 ml·min–1·1.73 m–2 over a 6-month follow-up period. Results: Of the 133,756 active Veteran enrollees at North Florida/South Georgia Veterans Health System (NF/SG VHS), we identified a source cohort of 1759 Veterans with advanced nondialysis CKD. Among these, 1102 (62.9%) Veterans had diagnosis codes for advanced CKD; 1391(79.1%) had the index eGFR <30 ml·min–1·1.73 m–2; and 928 (52.7%), 480 (27.2%), and 315 (17.9%) Veterans had high-, intermediate-, and low-risk advanced CKD, respectively. The prevalence of advanced CKD among Veterans at NF/SG VHS varied between 1% and 1.5% depending on the EHR phenotype. At the 6-month follow-up, the probability of Veterans remaining in the advanced CKD stage was 65.3% in the group defined by the ICD-10 codes and 90% in the groups defined by eGFR values. Based on our phenotype, 94.2% of high-risk, 71% of intermediate-risk, and 16.1% of low-risk groups remained in the advanced CKD category. Conclusions: While the prevalence of advanced CKD has limited variation between different EHR phenotypes, the accuracy can be improved by utilizing two eGFR values in a stratified manner. We report the development of a pragmatic EHR-based model to identify advanced CKD within a regional Veterans health care system in real time with a tiered approach that allows targeting the needs of the groups at risk of progression to end-stage kidney disease. %M 37486757 %R 10.2196/43384 %U https://www.i-jmr.org/2023/1/e43384 %U https://doi.org/10.2196/43384 %U http://www.ncbi.nlm.nih.gov/pubmed/37486757 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49679 %T The Senior Companion Program Plus for African American Caregivers of Persons With Alzheimer Disease and Related Dementias: Protocol for a Randomized Controlled Trial %A Fields,Noelle L %A Xu,Ling %A Williams,Ishan C %A Gaugler,Joseph E %A Cipher,Daisha J %+ School of Social Work, University of Texas at Arlington, 501 W Mitchell, Arlington, TX, 76010, United States, 1 817 272 7390, noellefields@uta.edu %K Alzheimer disease %K dementia %K lay provider %K senior companion %K volunteer %K intervention %K culturally informed %K African American %K family caregivers %D 2023 %7 24.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alzheimer disease and related dementias (ADRD) pose significant challenges as chronic health conditions in the United States. Additionally, there are notable disparities in the diagnosis and prevalence of ADRD among diverse populations. Specifically, African American populations have a higher risk of developing late-onset ADRD than White people, and missed diagnoses of ADRD are more common among older African American populations than older White populations. These disparities also impact African American ADRD family caregivers. Objective: The overall goal of this project is to develop a culturally informed, lay provider psychoeducational intervention named Senior Companion Program Plus (SCP Plus), which is specifically designed for African American ADRD caregivers and is potentially accessible, affordable, and sustainable. Methods: In the proposed explanatory sequential mixed methods study, a randomized controlled trial will be used that includes 114 African American family caregivers of a relative with ADRD who will participate in the 3-month SCP Plus program. Results: The study was funded on September 15, 2018, by the National Institutes of Health (1R15AG058182-01A1). Data collection began on May 16, 2019, but due to COVID-19 restrictions, ended 12 months into the planned 27-month recruitment period on March 31, 2023. The study was completed in June 30, 2023, and currently the results are being analyzed. Conclusions: The SCP Plus offers promise as an intervention that utilizes an existing platform for the delivery of a lay provider intervention and offers a novel approach for addressing gaps in accessible, community-based support for caregivers of people with ADRD. Trial Registration: ClinicalTrials.gov NCT03602391; https://classic.clinicaltrials.gov/ct2/show/NCT03602391 International Registered Report Identifier (IRRID): RR1-10.2196/49679 %M 37486759 %R 10.2196/49679 %U https://www.researchprotocols.org/2023/1/e49679 %U https://doi.org/10.2196/49679 %U http://www.ncbi.nlm.nih.gov/pubmed/37486759 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47916 %T Personalized Integrated Care Promoting Quality of Life for Older People: Protocol for a Multicenter Randomized Controlled Trial %A Judica,Elda %A Tropea,Peppino %A Bouça-Machado,Raquel %A Marín,Mayca %A Calarota,Elisa %A Cozma,Liviu %A Badea,Raluca %A Ahmed,Mona %A Brach,Michael %A Ferreira,Joaquim J %A Corbo,Massimo %+ Department of Neurorehabilitation Sciences, Casa di Cura Igea, via Dezza, 48, Milan, 20144, Italy, 39 02 4859 3124, p.tropea@casadicuraigea.it %K Parkinson disease %K dementia %K neurodegenerative %K chronic diseases %K health care technologies %K integrated care %D 2023 %7 24.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alzheimer disease (AD) and Parkinson disease (PD) are the 2 most common neurodegenerative diseases affecting millions of people worldwide. The Personalized Integrated Care Promoting Quality of Life for Older People (PC4L) project proposes an integrated, scalable, and interactive care ecosystem that can be easily adapted to the needs of several neurodegenerative and chronic diseases, care institutions, and end user requirements. Objective: The study protocol developed within the framework of the PC4L project aims to iteratively test the integrated platform and its modules, and focuses primarily on assessing the impact of the proposed solution (ie, the PC4L platform) on patients’ quality of life, as well as its usability and feasibility on a large-scale sample size in 3 different scenarios (home, neurorehabilitation, and day care centers). Methods: A prospective multicenter clinical study is conducted in 5 European countries (Germany, Italy, Portugal, Romania, and Spain) at 6 different pilot centers, for 3 months, in patients with PD, Parkinsonism, AD, and other dementias (ODs). Patients were randomized in a ratio of 1:1 to the intervention group (use of the PC4L system) or the control group (no intervention). The PC4L system consists mainly of a wristband for monitoring parameters such as steps and levels of physical activity, and the PC4L app, which includes different engaging functionalities. Both groups are assessed through baseline and end-of-study clinical evaluations, including assessment of quality of life through the EQ-5D-3L scale. Results: The study protocol is part of a project approved and funded by the European Commission Horizon 2020 (grant agreement number 875221). The ethics committees of all involved centers reviewed and approved the study protocol. The study began with the recruitment phase in September 2022, and enrollment ended in February 2023. Recruitment is now closed (April 2023). The results of this study are expected to be published in summer 2023. A total of 558 patients, 279 per study group, were recruited. The results will allow to clarify the impact of PC4L on quality of life, will assess the empowerment of patients and the medical resources use, as well as the usability of the final version of the PC4L system. It will also provide information on the support of the system as a tool to facilitate the decision-making process. Conclusions: The PC4L project intends to test a technology-based, integrated, scalable, and interactive care platform on patients with neurodegenerative diseases and proposes a good coordinated care model between all involved actors. Future developments of the PC4L solution may involve caregivers and socio-health professionals in the decision-making process in order to facilitate efficient communication between all stakeholders and ensure reliable and protected access to data within Europe. Trial Registration: ClinicalTrials.gov NCT05538455; https://clinicaltrials.gov/study/NCT05538455 International Registered Report Identifier (IRRID): DERR1-10.2196/47916 %M 37486732 %R 10.2196/47916 %U https://www.researchprotocols.org/2023/1/e47916 %U https://doi.org/10.2196/47916 %U http://www.ncbi.nlm.nih.gov/pubmed/37486732 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42483 %T The Digital Divide in Brazil and Barriers to Telehealth and Equal Digital Health Care: Analysis of Internet Access Using Publicly Available Data %A Nakayama,Luis Filipe %A Binotti,William Warr %A Link Woite,Naira %A Fernandes,Chrystinne Oliveira %A Alfonso,Pia Gabrielle %A Celi,Leo Anthony %A Regatieri,Caio Vinicius %+ Laboratory for Computational Physiology, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA, 02139, United States, 1 617 253 781, luisnaka@mit.edu %K digital divide %K digital health %K health equity %K internet access %K medical care %D 2023 %7 21.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has increased the use of digital solutions in medical care, especially for patients in remote areas and those requiring regular medical care. However, internet access is essential for the implementation of digital health care. The digital divide is the unequal distribution of access to digital technology, and the first level digital divide encompasses structural barriers. Brazil, a country with economic inequality and uneven population distribution, faces challenges in achieving internet access for all. Objective: This study aims to provide a comprehensive overview of the first-level digital divide in Brazil, estimate the relationship between variables, and identify the challenges and opportunities for digital health care implementation. Methods: Data were retrieved from the Brazilian Institute of Geography and Statistics National Continuous House survey database, including demographic, health, and internet-related variables. Statistical analysis included 2-tailed t tests, chi-square, and multivariate logistic regression to assess associations between variables. Results: Our analysis included 279,382 interviews throughout Brazil. The sample included more houses from the northeast (n=99,553) and fewer houses from the central west (n=30,804). A total of 223,386 (80.13%) of the interviewed population used the internet, with urban areas having higher internet access (187,671/212,109, 88.48%) than rural areas (35,715/67,077, 53.24%). Among the internet users, those interviewed who lived in urban houses, were women, were younger, and had higher income had a statistically higher prevalence (P<.001). Cell phones were the most common device used to access the internet (141,874/143,836, 98.63%). Reasons for not using the internet included lack of interest, knowledge, availability, and cost, with regional variations. The prevalence of internet access also varied among races, with 84,747 of 98,968 (85.63%) White respondents having access, compared to 22,234 of 28,272 (78.64%) Black respondents, 113,518 of 148,191 (76.6%) multiracial respondents, and 2887 of 3755 (76.88%) other respondents. In the southeast, central west, and south regions, the numbers of people with internet access were 49,790 of 56,298 (88.44%), 27,209 of 30,782 (88.39%), and 27,035 of 31,226 (86.58%), respectively, and in the north and northeast, 45,038 of 61,404 (73.35%) and 74,314 of 99,476 (74.7%). The income of internet users was twice the income of internet nonusers. Among those with diabetes-related limitations in daily activities, 945 of 2377 (39.75%) did not have internet access, and among those with daily activity restrictions, 1381 of 3644 (37.89%) did not have access. In a multivariate logistic regression analysis, women (odds ratio [OR] 1.147, 95% CI 0.118-0.156; P<.001), urban households (OR 6.743, 95% CI 1.888-1.929; P<.001), and those earning more than the minimum wage (OR 2.087, 95% CI 0.716-0.756; P<.01) had a positive association with internet access. Conclusions: Brazil’s diverse regions have different demographic distributions, house characteristics, and internet access levels, requiring targeted measures to address the first-level digital divide in rural areas and reduce inequalities in digital health solutions. Older people, poor, and rural populations face the greatest challenges in the first level digital divide in Brazil, highlighting the need to tackle the digital divide in order to promote equitable access to digital health care. %M 37477958 %R 10.2196/42483 %U https://www.jmir.org/2023/1/e42483 %U https://doi.org/10.2196/42483 %U http://www.ncbi.nlm.nih.gov/pubmed/37477958 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49131 %T Effects of the COVID-19 Pandemic on Primary Health Care for Chronic Conditions in Canada: Protocol for a Retrospective Pre-Post Study Using National Practice-Based Research Network Data %A Howard,Michelle %A Aubrey-Bassler,Kris %A Drummond,Neil %A Lussier,Marie-Thérèse %A Queenan,John A %A Vanstone,Meredith %A Nicholson,Kathryn %A Ramdyal,Amanda %A Lawson,Jennifer %A Hafid,Shuaib %A Freeman,Karla %A Clark,Rebecca %A Mangin,Dee %+ Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 5th Floor, 100 Main St. W, Hamilton, ON, L8P 1H6, Canada, 1 905 525 9140 ext 28502, mhoward@mcmaster.ca %K COVID-19 %K chronic disease %K primary health care %K electronic health record %K health services research %K retrospective studies %D 2023 %7 21.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Since the COVID-19 pandemic began, there have been concerns that interruptions to the health care system may have led to changes in primary care, especially for care of chronic conditions such as diabetes and heart failure. Such changes may have longer term implications for population health. Objective: This study aims to describe the impacts of the COVID-19 pandemic on indicators of primary care access, comprehensiveness, and appropriateness among adult patients, as well as on specific indictors of chronic conditions. Additionally, this study aims to determine whether any identified changes were associated with patient sociodemographic characteristics and multimorbidity. Methods: This is a retrospective, single-arm, pre-post study using Canadian Primary Care Sentinel Surveillance Network (CPCSSN) data. CPCSSN is a research network supported by a primary care electronic medical record database, comprising over 1500 physicians and nearly 2 million patients. We are examining changes in care (eg, frequency of contacts, laboratory tests and investigations, referrals, medications prescribed, etc) among adults. We will also examine indicators specific to evidence-based recommendations for care in patients with diabetes and those with heart failure. We will compare rates of outcomes during key periods of the pandemic between March 13, 2020, and December 31, 2022, with equal time periods before the pandemic. Differences will be examined among specific subgroups of adults, including by decade of age, number of comorbidities, and socioeconomic status. Regression models appropriate to outcome distributions will be used to estimate changes, adjusting for potential confounders. This analysis is part of a mixed-methods study with a qualitative component investigating how patients with diabetes with or without concurrent heart failure perceived the impact of the pandemic on access to primary care and health care–related decisions. This study was approved by the Hamilton Integrated Research Ethics Board (14782-C). Results: The start date of this study was October 5, 2022, and the prospective end date is January 31, 2024. As of May 2023, the study cohort (n=875,934) is defined, data cleaning is complete, and exploratory analyses have begun. Extended analyses using 2022 data are planned once the new data becomes available. We will disseminate results through peer-reviewed publications and academic conference, as well as creating evidence briefs, infographics, and a video for policy maker and patient audiences. Conclusions: This study will investigate whether the COVID-19 pandemic has resulted in changes in the provision of primary care in Canada and whether these potential changes have led to gaps in care. This study will also identify patient-level characteristics associated with changes in care patterns across the COVID-19 pandemic. Indicators specific to chronic conditions, namely diabetes and heart failure, will also be explored to determine whether there were changes in care of these conditions. Trial Registration: ClinicalTrials.gov NCT05813652; https://clinicaltrials.gov/ct2/show/NCT05813652 International Registered Report Identifier (IRRID): RR1-10.2196/49131 %M 37477967 %R 10.2196/49131 %U https://www.researchprotocols.org/2023/1/e49131 %U https://doi.org/10.2196/49131 %U http://www.ncbi.nlm.nih.gov/pubmed/37477967 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46710 %T A “Bundle of Care” to Improve Anticoagulation Control in Patients Receiving Warfarin in Uganda and South Africa: Protocol for an Implementation Study %A Jorgensen,Andrea L %A Orrell,Catherine %A Waitt,Catriona %A Toh,Cheng-Hock %A Sekaggya-Wiltshire,Christine %A Hughes,Dyfrig A %A Allen,Elizabeth %A Okello,Emmy %A Tatz,Gayle %A Culeddu,Giovanna %A Asiimwe,Innocent G %A Semakula,Jerome Roy %A Mouton,Johannes P %A Cohen,Karen %A Blockman,Marc %A Lamorde,Mohammed %A Pirmohamed,Munir %+ Infectious Diseases Institute, Makerere University College of Health Sciences, PO Box 22418, Kampala, 256, Uganda, 256 312307000, cwaitt@liverpool.ac.uk %K drug monitoring %K international normalized ratio %K Sub-Saharan Africa %K warfarin bundle %K warfarin %K anticoagulation control %D 2023 %7 19.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The quality of warfarin anticoagulation among Sub-Saharan African patients is suboptimal. This is due to several factors, including a lack of standardized dosing algorithms, difficulty in providing timely international normalized ratio (INR) results, a lack of patient feedback on their experiences with treatment, a lack of education on adherence, and inadequate knowledge and training of health care workers. Low quality of warfarin anticoagulation, expressed as time in therapeutic range (TTR), is associated with higher adverse event rates, including bleeding and thrombosis, and ultimately, increased morbidity and mortality. Processes and interventions that improve this situation are urgently needed. Objective: This study aims to evaluate the implementation of the “warfarin bundle,” a package of interventions to improve the quality of anticoagulation and thereby clinical outcomes. The primary outcome for this study is TTR over the initial 3 months of warfarin therapy. Methods: Patients aged 18 years or older who are newly initiated on warfarin for venous thromboembolism, atrial fibrillation, or valvular heart disease will be enrolled and followed up for 3 months at clinics in Cape Town, South Africa, and Kampala, Uganda, where the warfarin bundle is implemented. A retrospective review of the clinical records of patients on warfarin treatment before implementation (controls) will be used for comparison. This study uses a mixed methods approach of the implementation of patient- and process-centered activities to improve the quality of anticoagulation. Patient-centered activities include the use of clinical dosing algorithms, adherence support, and root cause analysis, whereas process-centered activities include point-of-care INR testing, staff training, and patient education and training. We will assess the impact of these interventions by comparing the TTR and safety outcomes across the 2 groups, as well as the cost-effectiveness and acceptability of the package. Results: We started recruitment in June 2021 and stopped in August 2022, having recruited 167 participants. We obtained ethics approval from the University of Cape Town Faculty of Health Sciences Human Research Ethics Committee, the Provincial Health Research Committees in South Africa, the Joint Clinical Research Centre Institutional Review Board, Kampala, and the University of Liverpool Research Ethics Committee. As of February 2023, data cleaning and formal analysis are underway. We expect to publish the full results by December 2023. Conclusions: We anticipate that the “bundle of care,” which includes a clinical algorithm to guide individualized dosing of warfarin, will improve INR control and TTR of patients in Uganda and South Africa. We will use these findings to design a larger, multisite clinical trial across several Sub-Saharan African countries. International Registered Report Identifier (IRRID): DERR1-10.2196/46710 %M 37467034 %R 10.2196/46710 %U https://www.researchprotocols.org/2023/1/e46710 %U https://doi.org/10.2196/46710 %U http://www.ncbi.nlm.nih.gov/pubmed/37467034 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41836 %T Perceptions of Global Health Engagements in Relation to the COVID-19 Pandemic Among Health Care Workers and Administrators in Western Kenya: Protocol for a Multistage Qualitative Study %A Amick,Erick %A Naanyu,Violet %A Bucher,Sherri %A Henry,Beverly W %+ Susan and Richard Kiphart Center for Global Health and Social Development, Crown Family School of Social Work, Policy, and Practice, University of Chicago, 969 E 60th st, Chicago, IL, 60637, United States, 1 773 702 0795, eamick@uchicago.edu %K global health %K global health engagements %K GHEs %K health care workers %K local perspectives %K low- and middle-income countries %K LMICs %D 2023 %7 19.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: There has been significant interest in global health in low- and middle-income countries (LMICs) among individuals living in high-income countries (HICs) over the past 30 years. Much of the literature on global health engagements (GHEs) has been presented from the perspective of individuals from high-income countries. Local stakeholders such as health care workers and health care administrators represent critical constituencies for global health activities, yet their perspectives are underrepresented in the literature. The purpose of this study is to examine the experiences of local health care workers and administrators with GHEs in Kenya. We will explore the perceived role GHEs play in preparing the health system to address a public health crisis, as well as their role in pandemic recovery and its aftermath. Objective: The aims of this study are to (1) examine how Kenyan health care workers and administrators interpret experiences with GHEs as having advantaged or hindered them and the local health system to provide care during an acute public health crisis and (2) to explore recommendations to reimagine GHEs in a postpandemic Kenya. Methods: This study will be conducted at a large teaching and referral hospital in western Kenya with a long history of hosting GHEs in support of its tripartite mission of providing care, training, and research. This qualitative study will be conducted in 3 phases. In phase 1, in-depth interviews will be conducted to capture participants’ lived experience in relation to their unique understandings of the pandemic, GHEs, and the local health system. In phase 2, group discussions using nominal group techniques will be conducted to determine potential priority areas to reimagine future GHEs. In phase 3, in-depth interviews will be conducted to explore these priority areas in greater detail to explore recommendations for potential strategies, policies, and other actions that might be used to achieve the priorities determined to be of highest importance. Results: The study activities commenced in late summer 2022, with findings to be published in 2023. It is anticipated that the findings from this study will provide insight into the role GHEs play in a local health system in Kenya and provide critical stakeholder and partner input from persons hitherto ignored in the design, implementation, and management of GHEs. Conclusions: This qualitative study will examine the perspectives of GHEs in relation to the COVID-19 pandemic among Kenyan health care workers and health care administrators in western Kenya using a multistage protocol. Using a combination of in-depth interviews and nominal group techniques, this study aims to shed light on the roles global health activities are perceived to play in preparing health care professionals and the health system to address an acute public health crisis. International Registered Report Identifier (IRRID): PRR1-10.2196/41836 %M 37315197 %R 10.2196/41836 %U https://www.researchprotocols.org/2023/1/e41836 %U https://doi.org/10.2196/41836 %U http://www.ncbi.nlm.nih.gov/pubmed/37315197 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41431 %T Assessing Interventions on Crowdsourcing Platforms to Nudge Patients for Engagement Behaviors in Primary Care Settings: Randomized Controlled Trial %A Chen,Kay-Yut %A Lang,Yan %A Zhou,Yuan %A Kosmari,Ludmila %A Daniel,Kathryn %A Gurses,Ayse %A Xiao,Yan %+ Department of Business, State University of New York at Oneonta, 108 Ravine Pkwy, Oneonta, NY, 13820, United States, 1 607 436 3251, yan.lang@oneonta.edu %K Amazon Mechanical Turk %K behavioral interventions %K crowdsourcing %K medication safety %K Mturk %K patient engagement %K primary care %D 2023 %7 13.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Engaging patients in health behaviors is critical for better outcomes, yet many patient partnership behaviors are not widely adopted. Behavioral economics–based interventions offer potential solutions, but it is challenging to assess the time and cost needed for different options. Crowdsourcing platforms can efficiently and rapidly assess the efficacy of such interventions, but it is unclear if web-based participants respond to simulated incentives in the same way as they would to actual incentives. Objective: The goals of this study were (1) to assess the feasibility of using crowdsourced surveys to evaluate behavioral economics interventions for patient partnerships by examining whether web-based participants responded to simulated incentives in the same way they would have responded to actual incentives, and (2) to assess the impact of 2 behavioral economics–based intervention designs, psychological rewards and loss of framing, on simulated medication reconciliation behaviors in a simulated primary care setting. Methods: We conducted a randomized controlled trial using a between-subject design on a crowdsourcing platform (Amazon Mechanical Turk) to evaluate the effectiveness of behavioral interventions designed to improve medication adherence in primary care visits. The study included a control group that represented the participants’ baseline behavior and 3 simulated interventions, namely monetary compensation, a status effect as a psychological reward, and a loss frame as a modification of the status effect. Participants’ willingness to bring medicines to a primary care visit was measured on a 5-point Likert scale. A reverse-coding question was included to ensure response intentionality. Results: A total of 569 study participants were recruited. There were 132 in the baseline group, 187 in the monetary compensation group, 149 in the psychological reward group, and 101 in the loss frame group. All 3 nudge interventions increased participants’ willingness to bring medicines significantly when compared to the baseline scenario. The monetary compensation intervention caused an increase of 17.51% (P<.001), psychological rewards on status increased willingness by 11.85% (P<.001), and a loss frame on psychological rewards increased willingness by 24.35% (P<.001). Responses to the reverse-coding question were consistent with the willingness questions. Conclusions: In primary care, bringing medications to office visits is a frequently advocated patient partnership behavior that is nonetheless not widely adopted. Crowdsourcing platforms such as Amazon Mechanical Turk support efforts to efficiently and rapidly reach large groups of individuals to assess the efficacy of behavioral interventions. We found that crowdsourced survey-based experiments with simulated incentives can produce valid simulated behavioral responses. The use of psychological status design, particularly with a loss framing approach, can effectively enhance patient engagement in primary care. These results support the use of crowdsourcing platforms to augment and complement traditional approaches to learning about behavioral economics for patient engagement. %M 37440308 %R 10.2196/41431 %U https://www.jmir.org/2023/1/e41431 %U https://doi.org/10.2196/41431 %U http://www.ncbi.nlm.nih.gov/pubmed/37440308 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e42283 %T Investigating the Connections Between Delivery of Care, Reablement, Workload, and Organizational Factors in Home Care Services: Mixed Methods Study %A Darwich,Adam S %A Boström,Anne-Marie %A Guidetti,Susanne %A Raghothama,Jayanth %A Meijer,Sebastiaan %+ Division of Health Informatics and Logistics, Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Hälsovägen 11C, Huddinge, Stockholm, 141 57, Sweden, 46 8 790 48 05, darwich@kth.se %K aging %K intervention %K health policy %K health services administration and management %K health care intervention %K home care %K home support %K in-home assistance %K personal care %K policy %K reablement %K rehabilitation %K rehabilitation medicine %K social support %K stress %K support %K systems thinking %K user %D 2023 %7 30.6.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Home care is facing increasing demand due to an aging population. Several challenges have been identified in the provision of home care, such as the need for support and tailoring support to individual needs. Goal-oriented interventions, such as reablement, may provide a solution to some of these challenges. The reablement approach targets adaptation to disease and relearning of everyday life skills and has been found to improve health-related quality of life while reducing service use. Objective: The objective of this study is to characterize home care system variables (elements) and their relationships (connections) relevant to home care staff workload, home care user needs and satisfaction, and the reablement approach. This is to examine the effects of improvement and interventions, such as the person-centered reablement approach, on the delivery of home care services, workload, work-related stress, home care user experience, and other organizational factors. The main focus was on Swedish home care and tax-funded universal welfare systems. Methods: The study used a mixed methods approach where a causal loop diagram was developed grounded in participatory methods with academic health care science research experts in nursing, occupational therapy, aging, and the reablement approach. The approach was supplemented with theoretical models and the scientific literature. The developed model was verified by the same group of experts and empirical evidence. Finally, the model was analyzed qualitatively and through simulation methods. Results: The final causal loop diagram included elements and connections across the categories: stress, home care staff, home care user, organization, social support network of the home care user, and societal level. The model was able to qualitatively describe observed intervention outcomes from the literature. The analysis suggested elements to target for improvement and the potential impact of relevant studied interventions. For example, the elements “workload” and “distress” were important determinants of home care staff health, provision, and quality of care. Conclusions: The developed model may be of value for informing hypothesis formulation, study design, and discourse within the context of improvement in home care. Further work will include a broader group of stakeholders to reduce the risk of bias. Translation into a quantitative model will be explored. %M 37389904 %R 10.2196/42283 %U https://humanfactors.jmir.org/2023/1/e42283 %U https://doi.org/10.2196/42283 %U http://www.ncbi.nlm.nih.gov/pubmed/37389904 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 10 %N %P e41186 %T Models of Telehealth Service Delivery in Adults With Spinal Cord Injuries: Scoping Review %A Mirbaha,Shaghayegh %A Morgan,Ashley %A Tang,Ada %A Smith-Turchyn,Jenna %A Richardson,Julie %+ School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada, 1 9055259140, jrichard@mcmaster.ca %K community-dwelling adults with spinal cord injury %K models of telehealth services %K remotely delivery of health care %K SCI %K scoping review %K spinal cord injury %K telehealth %K telemedicine %K telerehabilitation %K web-based care %D 2023 %7 29.6.2023 %9 Review %J JMIR Rehabil Assist Technol %G English %X Background: In Canada, approximately 86,000 people live with spinal cord injury (SCI), and there are an estimated 3675 new cases of traumatic or nontraumatic etiology per year. Most people with SCI will experience secondary health complications, such as urinary and bowel issues, pain syndrome, pressure ulcers, and psychological disorders, resulting in severe chronic multimorbidity. Moreover, people with SCI may face barriers in accessing health care services, such as primary care physicians’ expert knowledge regarding secondary complications related to SCI. Telehealth, defined as the delivery of information and health-related services through telecommunication technologies, may help address some of the barriers, and indeed, the present global COVID-19 pandemic has emphasized the importance of integration of telehealth in health care systems. As a result of this crisis, health care providers have increased the usage of telehealth services, providing health services to individuals in need of community-based supportive care. However, the evidence on models of telehealth service delivery for adults with SCI has not been previously synthesized. Objective: The purpose of this scoping review was to identify, describe, and compare models of telehealth services for community-dwelling adults with SCI. Methods: This scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Studies published between 1990 and December 31, 2022, were identified by searching the Ovid MEDLINE, Ovid Embase, Ovid PsycINFO, Web of Science, and CINAHL databases. Papers with specified inclusion criteria were screened by 2 investigators. Included articles focused on identifying, implementing, or evaluating telehealth interventions, including primary health care services and self-management services delivered in the community and home-based settings. One investigator performed a full-text review of each article, and data extraction included (1) study characteristics; (2) participant characteristics; (3) key characteristics of the interventions, programs, and services; and (4) outcome measures and results. Results: A total of 61 articles reported telehealth services used for preventing, managing, or treating the most common secondary complications and consequences of SCI, including chronic pain, low physical activity, pressure ulcers, and psychosocial dysfunction. Where evidence exists, improvements in community participation, physical activity, and reduction in chronic pain, pressure ulcers, etc, following SCI were demonstrated. Conclusions: Telehealth may offer an efficient and effective option for health service delivery for community-dwelling individuals with SCI, ensuring continuity of rehabilitation, follow-up after hospital discharge, and early detection, management, or treatment of potential secondary complications following SCI. We recommend that the stakeholders involved with patients with SCI consider the uptake of hybridized (blend of web-based and in-person) health care delivery models to optimize the care continuum and self-management of SCI-related care. The findings of this scoping review may be used to inform policy makers, health care professionals, and stakeholders engaged in establishing web-based clinics for individuals with SCI. %M 37384377 %R 10.2196/41186 %U https://rehab.jmir.org/2023/1/e41186 %U https://doi.org/10.2196/41186 %U http://www.ncbi.nlm.nih.gov/pubmed/37384377 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e46075 %T Development of a Pilot Introductory Advanced Cardiovascular Resuscitation Course for Senior Medical Students in Switzerland: Student-Driven Implementation Study %A Herren,Tara %A Fivaz,Loris %A Dufeil,Eva %A Golay,Eric %A Braun,Ely %A Straub,Emilie %A Nidegger,Philippe %A Grosgurin,Olivier %A Gartner,Birgit Andrea %A Suppan,Mélanie %A Suppan,Laurent %+ Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, Geneva, 1211, Switzerland, 41 223723311, laurent.suppan@hcuge.ch %K advanced cardiovascular life support %K undergraduate medical education %K cardiopulmonary resuscitation %K CPR %K medical education %K resuscitation %K web-based questionnaire %K collaborative design %K implementation %K medical course %K curriculum %K student %K life support %K training %K cardiac arrest %K medical student %D 2023 %7 27.6.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Cardiac arrest is the most time-critical emergency medical students and junior physicians may face in their personal or professional life. However, many studies have shown that most of them lack the necessary knowledge and skills to efficiently perform resuscitation. This could be related to the fact that advanced cardiovascular resuscitation courses are not always part of the undergraduate medical curriculum. Objective: The aim of this study was to describe the development, pilot implementation, and assessment of an advanced cardiovascular resuscitation course designed to enable senior medical students to manage the initial resuscitation phase in case of cardiac arrest. Methods: An introductory advanced cardiovascular resuscitation course was developed on the initiative of fifth-year medical students, in collaboration with the prehospital emergency medical service team of the Geneva University Hospitals. The 60 slots available to the 157 members of the fifth-year promotion of the University of Geneva Faculty of Medicine were filled in less than 8 hours. This unexpected success prompted the creation of a first questionnaire, which was sent to all fifth-year students to determine the overall proportion of students interested in attending an advanced cardiovascular resuscitation course. This questionnaire was also used to assess basic life support education and experience among course participants. A postcourse questionnaire was used to gather feedback regarding the course and to assess student confidence regarding the resuscitation skills they had been taught. Results: Out of 157 fifth-year medical students, 73 (46%) completed the first questionnaire. Most thought that the current curriculum did not provide them with enough knowledge and skills regarding resuscitation and 85% (62/73) wished to attend an introductory advanced cardiovascular resuscitation course. All the participants who would have wanted to follow the full Advanced Cardiovascular Life Support course before graduating were set back by its cost (10/10, 100%). Of the 60 students who had registered for the training sessions, 56 (93%) actually attended. The postcourse questionnaire was completed by 42 (87%) students (out of 48 who had registered on the platform). They unanimously answered that an advanced cardiovascular resuscitation course should be part of the standard curriculum. Conclusions: This study demonstrates the interest of senior medical students in an advanced cardiovascular resuscitation course and their willingness to see such a course integrated as a part of their regular curriculum. %M 37231610 %R 10.2196/46075 %U https://www.i-jmr.org/2023/1/e46075 %U https://doi.org/10.2196/46075 %U http://www.ncbi.nlm.nih.gov/pubmed/37231610 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46014 %T Application of Artificial Intelligence in Geriatric Care: Bibliometric Analysis %A Wang,Jingjing %A Liang,Yiqing %A Cao,Songmei %A Cai,Peixuan %A Fan,Yimeng %+ Department of Nursing, The Affiliated Hospital of Jiangsu University, No 438 North Jiefang Road, Jingkou District, Jiangsu Province, Zhenjiang, 212000, China, 86 13815159881, caosongmei75@126.com %K artificial intelligence %K older adults %K geriatric care %K bibliometric analysis %D 2023 %7 23.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Artificial intelligence (AI) can improve the health and well-being of older adults and has the potential to assist and improve nursing care. In recent years, research in this area has been increasing. Therefore, it is necessary to understand the status of development and main research hotspots and identify the main contributors and their relationships in the application of AI in geriatric care via bibliometric analysis. Objective: Using bibliometric analysis, this study aims to examine the current research hotspots and collaborative networks in the application of AI in geriatric care over the past 23 years. Methods: The Web of Science Core Collection database was used as a source. All publications from inception to August 2022 were downloaded. The external characteristics of the publications were summarized through HistCite and the Web of Science. Keywords and collaborative networks were analyzed using VOSviewers and Citespace. Results: We obtained a total of 230 publications. The works originated in 499 institutions in 39 countries, were published in 124 journals, and were written by 1216 authors. Publications increased sharply from 2014 to 2022, accounting for 90.87% (209/230) of all publications. The United States and the International Journal of Social Robotics had the highest number of publications on this topic. The 1216 authors were divided into 5 main clusters. Among the 230 publications, 4 clusters were modeled, including Alzheimer disease, aged care, acceptance, and the surveillance and treatment of diseases. Machine learning, deep learning, and rehabilitation had also become recent research hotspots. Conclusions: Research on the application of AI in geriatric care has developed rapidly. The development of research and cooperation among countries/regions and institutions are limited. In the future, strengthening the cooperation and communication between different countries/regions and institutions may further drive this field’s development. This study provides researchers with the information necessary to understand the current state, collaborative networks, and main research hotspots of the field. In addition, our results suggest a series of recommendations for future research. %M 37351923 %R 10.2196/46014 %U https://www.jmir.org/2023/1/e46014 %U https://doi.org/10.2196/46014 %U http://www.ncbi.nlm.nih.gov/pubmed/37351923 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46842 %T Trauma-Informed Care in Digital Health Technologies: Protocol for a Scoping Review %A Abdulai,Abdul-Fatawu %A Naghdali,Hasti %A Tekie Ghirmay,Eden %A Adam,Fuseini %A Bawafaa,Eunice %+ School of Nursing, Faculty of Applied Sciences, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada, 1 6048227214, fatawu.abdulai@ubc.ca %K clinical intervention %K digital health technologies %K digital health %K psychological trauma %K stress %K trauma %K trauma-informed care %D 2023 %7 23.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The use of digital health technologies is becoming increasingly common across the globe as they offer immense potential to enhance health care delivery by promoting accessibility, flexibility, and personalized care, connecting patients to health care professionals, and offering more efficient services and treatments to remote residents. At the same time, there is an increasing recognition of how digital health can inadvertently foment psychological trauma. This phenomenon has led to the adoption of trauma-informed care in designing and deploying digital health technologies. However, how trauma-informed care is defined and characterized, and the various trauma-informed care strategies used in designing and deploying digital health technologies remain unexplored. Objective: This scoping review aims to explore and synthesize the literature on how trauma-informed care is defined and characterized in digital health and the various trauma-informed care principles, strategies, or recommendations used in designing and deploying digital health. Methods: This review will draw on the Joanna Briggs Institute’s updated methodological guidance for scoping reviews. A search will be conducted on CINAHL, PubMed, Embase, Compendex Engineering Village, Web of Science, Scopus, and PsycINFO. This review will consider published research studies and unpublished work (gray literature). Studies will be included if they applied trauma-informed care in designing or deploying digital health for patients across all geographical locations or provide trauma-informed recommendations on how web developers should develop digital health. Studies will be limited to publications within the past 10 years and studies in all languages will be considered. Two independent reviewers will screen the titles and abstracts, and then perform a full-text review. Data will be extracted into a data extraction tool developed for this study. Results: The scoping review was undergoing a full search as of April 2023. The main results will synthesize the peer-reviewed and gray literature on adopting trauma-informed care practices in digital health research and development. The study is expected to be completed by December 2023 and the results are expected to be published in a peer-reviewed journal. Conclusions: This review is expected to provide the knowledge base on the adoption of trauma-informed care in designing and deploying digital health. This knowledge can lead to more engaging, and likely, more effective digital health interventions that have less potential for harm. A synthesis of the various trauma-informed care strategies in digital health will also provide a trauma-informed language by enabling researchers and digital health developers to consider trauma as a critical factor in each stage of the design process. International Registered Report Identifier (IRRID): DERR1-10.2196/46842 %M 37351935 %R 10.2196/46842 %U https://www.researchprotocols.org/2023/1/e46842 %U https://doi.org/10.2196/46842 %U http://www.ncbi.nlm.nih.gov/pubmed/37351935 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42775 %T Diagnostic Concordance of Telemedicine as Compared With Face-to-Face Care in Primary Health Care Clinics in Rural India: Randomized Crossover Trial %A Verma,Neha %A Buch,Bimal %A Taralekar,Radha %A Acharya,Soumyadipta %+ Intelehealth, 3400 N Charles Street, Suite 208, Baltimore, MD, 21218, United States, 1 4108707146, nverma39@gmail.com %K telemedicine %K telehealth %K eHealth %K opensource %K digital assistant %K diagnostic concordance %K COVID-19 %K primary care %K rural health %K teleconsultation %K patient care %D 2023 %7 23.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: With the COVID-19 pandemic, there was an increase and scaling up of provider-to-provider telemedicine programs that connect frontline health providers such as nurses and community health workers at primary care clinics with remote doctors at tertiary facilities to facilitate consultations for rural patients. Considering this new trend of increasing use of telemedicine, this study was conducted to generate evidence for patients, health providers, and policymakers to compare if provider-to-provider telemedicine-based care is equivalent to in-person care and is safe and acceptable in terms of diagnostic and treatment standards. Objective: This study aims to compare the diagnosis and treatment decisions from teleconsultations to those of in-person care in teleclinics in rural Gujarat. Methods: We conducted a diagnostic concordance study using a randomized crossover study design with 104 patients at 10 telemedicine primary care clinics. Patients reporting to 10 telemedicine primary care clinics were randomly assigned to first receive an in-person doctor consultation (59/104, 56.7%) or to first receive a health worker–assisted telemedicine consultation (45/104, 43.3%). The 2 groups were then switched, with the first group undergoing a telemedicine consultation following the in-person consultation and the second group receiving an in-person consultation after the teleconsultation. The in-person doctor and remote doctor were blinded to the diagnosis and management plan of the other. The diagnosis and treatment plan of in-person doctors was considered the gold standard. Results: We enrolled 104 patients reporting a range of primary health care issues into the study. We observed 74% (77/104) diagnostic concordance and 79.8% (83/104) concordance in the treatment plan between the in-person and remote doctors. No significant association was found between the diagnostic and treatment concordance and the order of the consultation (P=.65 and P=.81, respectively), the frontline health worker–doctor pair (both P=.93), the gender of the patient (both P>.99), or the mode of teleconsultation (synchronous vs asynchronous; P=.32 and P=.29, respectively), as evaluated using Fisher exact tests. A significant association was seen between the diagnostic and treatment concordance and the type of case (P=.004 and P=.03, respectively). The highest diagnostic concordance was seen in the management of hypertension (20/21, 95% concordance; Cohen kappa=0.93) and diabetes (14/15, 93% concordance; Cohen kappa=0.89). The lowest values were seen in cardiology (1/3, 33%) and patients presenting with nonspecific symptoms (3/10, 30%). The use of a digital assistant to facilitate the consultation resulted in increased adherence to evidence-based care protocols. Conclusions: The findings reflect that telemedicine can be a safe and acceptable alternative mode of care especially in remote rural settings when in-person care is not accessible. Telemedicine has advantages. for the potential gains for improved health care–seeking behavior for patients, reduced costs for the patient, and improved health system efficiency by reducing overcrowding at tertiary health facilities. %M 37130015 %R 10.2196/42775 %U https://formative.jmir.org/2023/1/e42775 %U https://doi.org/10.2196/42775 %U http://www.ncbi.nlm.nih.gov/pubmed/37130015 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43788 %T Design and Implementation of a Digitally Enabled Care Pathway to Improve Management of Depression in a Large Health Care System: Protocol for the Implementation of a Patient Care Platform %A Khatib,Rasha %A McCue,Maggie %A Blair,Chris %A Roy,Anit %A Franco,John %A Fehnert,Ben %A King,James %A Sarkey,Sara %A Chrones,Lambros %A Martin,Michael %A Kabir,Christopher %A Kemp,David E %+ Takeda Pharmaceuticals U.S.A., Inc., 95 Hayden Ave, Lexington, MA, 02421, United States, 1 781 482 0426, chris.blair@takeda.com %K mental health %K depression %K depressive %K major depressive disorder %K depression management %K primary care %K patient engagement %K measurement-based care %K shared decision-making %K user-centered design %K mobile app %K digital platform %K mobile phone %K mobile health %K adherence %D 2023 %7 23.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Major depressive disorder (MDD) is a serious public health concern worldwide. A treatment approach that incorporates measurement-based care (MBC) and shared decision-making between patients with MDD and their providers may foster patient engagement and improve clinical outcomes. While digital tools such as mobile apps show promise for expanding health interventions, these apps are rarely integrated into clinical practice. Objective: The primary objective of this ongoing study is to determine whether implementation of a digital tool—the Pathway Platform—in primary care improves adherence to MBC practices; here, we present the study methods. Methods: This large-scale, real-world implementation study is based on a pilot study of an earlier iteration of a mobile app (the Pathway app) that confirmed the feasibility of using the app in patients with MDD and showed a positive trend in patient engagement in the app arm. In addition, a user-centered design approach that included qualitative assessments from patients and providers was used to improve understanding of the patient journey and care team workflows. User feedback highlighted the need for enhanced features, education modules, and real-time data sharing via integration with the electronic health record. The current iteration of the Platform includes the newest version of the Pathway app, education modules for both patients and providers, and real-time patient-level data sharing with the electronic health record. The study takes place in primary care sites within the Advocate Aurora Health system in Illinois and includes adult patients with MDD who were recently prescribed monotherapy antidepressant medication (defined as a new start, medication switch, or dose change in the past 3 months). Clinical performance and selected patient outcomes will be compared before and after the implementation of the Platform. Results: Patient recruitment was completed in July 2022, with initial results expected in mid-2023. Conclusions: This study will provide useful insights into real-world integration of a digital platform within a large health system. The methods presented here highlight the unique user-centric development of the Pathway Platform, which has resulted in an enhanced digital tool with the potential to foster MBC and shared decision-making, improve patient-provider communication, and ultimately lead to optimized treatment outcomes for patients with MDD. Trial Registration: ClinicalTrials.gov NCT04891224; https://clinicaltrials.gov/ct2/show/NCT04891224 International Registered Report Identifier (IRRID): DERR1-10.2196/43788 %M 37351941 %R 10.2196/43788 %U https://www.researchprotocols.org/2023/1/e43788 %U https://doi.org/10.2196/43788 %U http://www.ncbi.nlm.nih.gov/pubmed/37351941 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46741 %T Recovery of Breakthrough Asthma Attacks Treated With Oral Steroids While on Monoclonal Antibody Therapy: Protocol for a Prospective Observational Study (BOOST) %A Howell,Imran %A Mahdi,Mahdi %A Bafadhel,Mona %A Hinks,Timothy S C %A Ramakrishnan,Sanjay %A Melhorn,James %A Jabeen,Maisha %A Pavord,Ian D %+ Nuffield Department of Medicine, University of Oxford, Level 7 E/F, Rm 7400, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom, 44 01865 221753, imran.howell@ndm.ox.ac.uk %K asthma %K monoclonal antibodies %K steroids %K monoclonal antibody %K oral steroid %K asthma attack %K quality of life %K adult %K inflammatory response %K prednisolone treatment %K treatment %D 2023 %7 23.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Asthma attacks are a common and important problem. Someone experiences an asthma attack in the United Kingdom every 10 seconds. Asthma attacks cause coughing, wheezing, breathlessness, and chest tightness and are highly stressful for patients. They result in reduced quality of life, with days lost from work or school. Asthma attacks are treated with oral corticosteroids (OCSs), but these have many short- and long-term side effects. Asthma monoclonal antibodies (mAbs) have revolutionized the treatment of severe asthma by reducing asthma attacks and OCS burden by over 50%, but some people still experience attacks while on mAbs. The MEX study showed that residual asthma attacks are broadly eosinophilic (high fractional exhaled nitric oxide [FeNO]) or noneosinophilic (low FeNO), but it did not measure response to OCS treatment. There is an evidence gap in understanding the clinical and inflammatory responses that occur when using OCSs to treat residual asthma attacks in patients taking asthma mAbs. Objective: The primary objective is to compare the clinical recovery between high-FeNO and low-FeNO attacks after acute treatment with oral prednisolone among people established on long-term asthma mAb treatment. The exploratory objective is to compare the inflammatory response to acute treatment with oral prednisolone between high-FeNO and low-FeNO attacks. Methods: BOOST (Breakthrough Asthma Attacks Treated With Oral Steroids) is a single-center, prospective observational study of 60 adults established on long-term asthma mAb treatment who receive acute treatment with oral prednisolone (usual care) for an asthma attack. The primary outcome will be the proportion of treatment failure (the need to start oral prednisolone or antibiotics or an unscheduled health care visit for asthma, following an attack) at day 28. The secondary outcomes will be the change in forced expiratory volume in 1 second and the change in visual analogue scale symptom score between the stable state, attack, day 7, and day 28 visits. The exploratory outcomes include the changes in sputum, nasal, and blood inflammometry between the stable state, attack, day 7, and day 28 visits. Results: The last asthma attack visit is anticipated to occur in December 2023. Data analysis and publication will take place in 2024. Conclusions: We will test the hypothesis that there is a difference in the rate of recovery of clinical and inflammatory measures between high-FeNO and low-FeNO asthma attacks that occur in patients on mAb therapy. The study data will help power a future randomized placebo-controlled trial of prednisolone treatment for nonsevere attacks in patients treated with asthma mAbs and will provide important information on whether corticosteroid treatment should be FeNO-directed. International Registered Report Identifier (IRRID): DERR1-10.2196/46741 %M 37351918 %R 10.2196/46741 %U https://www.researchprotocols.org/2023/1/e46741 %U https://doi.org/10.2196/46741 %U http://www.ncbi.nlm.nih.gov/pubmed/37351918 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45557 %T The Impact of Counseling on the Dignity of Older People: Protocol for a Mixed Methods Study %A Hung,Ho Yeow %A Azman,Azlinda %A Jamir Singh,Paramjit Singh %+ School of Social Sciences, Universiti Sains Malaysia, Malaysia,, Gelugor St, Penang, 11800, Malaysia, 60 96548150, hoyeowhung123@gmail.com %K counseling %K dignity %K elderly %K emotional management %K psychological %K Singapore %D 2023 %7 23.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Psychological counseling is perceived as a treatment that could significantly improve older individuals’ psychological and behavioral functioning. There is a dearth of information on the impact of psychological counseling on preserving dignity and facilitating good aging among older people in Singapore. Objective: The objectives of this study are as follows: (1) to assess advance care planning among older people and their perception of life and health, end of life, and end-of-life care; (2) to explore older people’s accessibility and receptiveness toward counseling; (3) elucidate older people’s perspectives on counseling and its impact on emotional management and decision-making; (4) to assess older people’s competencies in emotional management; and (5) to propose an intervention model for enhancing older people’s well-being and dignity through psychological counseling in Singapore. Methods: A mixed method study design involving quantitative and qualitative methods will be used. Older individuals receiving some form of preventive, primary, or long-term care in the community through voluntary welfare organizations from the senior activity centers located in eastern Singapore participated in the qualitative phase. Six older individuals from each senior activity center have been enrolled for the interview phase to explore 6 components: the Advanced Care Planning (ACP) booklet, Trait Meta Mood Scale (TMMS), accessibility and receptiveness toward counseling, and emotional management and decision-making. The ACP, an instrument designed to assess advanced care planning among older individuals, and the TMMS, an instrument developed to measure meta-mood experience and emotional management, were used in the quantitative phase among 100 participants. The data will be analyzed thematically using NVivo version 12, whereas descriptive statistics and a 2-tailed, 1-sample t test will be conducted in SPSS (version 25; IBM Corp) for empirical data analyses. Results: The qualitative phase, which involves a semistructured interview, has been completed among 20 older individuals aged 66-86 years. Thematic analysis of the data is still ongoing. Meanwhile, the quantitative phase commenced on March 22, 2022, with 100 participants providing signed informed consent to participate in the study. The study is expected to be completed by March 2023. Conclusions: The mixed methods study will document the current awareness of ACP, accessibility and receptiveness toward counseling, and the potential use of psychological counseling in enhancing well-being and dignity among older people in Singapore. The research findings will benefit policy makers in their decision-making when attempting to mitigate the potential barriers to seeking counseling assistance among older people. International Registered Report Identifier (IRRID): DERR1-10.2196/45557 %M 37272062 %R 10.2196/45557 %U https://www.researchprotocols.org/2023/1/e45557 %U https://doi.org/10.2196/45557 %U http://www.ncbi.nlm.nih.gov/pubmed/37272062 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e42254 %T Audit, Feedback, and Education to Improve Quality and Outcomes in Transurethral Resection and Single-Instillation Intravesical Chemotherapy for Nonmuscle Invasive Bladder Cancer Treatment: Protocol for a Multicenter International Observational Study With an Embedded Cluster Randomized Trial %A Gallagher,Kevin %A Bhatt,Nikita %A Clement,Keiran %A Zimmermann,Eleanor %A Khadhouri,Sinan %A MacLennan,Steven %A Kulkarni,Meghana %A Gaba,Fortis %A Anbarasan,Thineskrishna %A Asif,Aqua %A Light,Alexander %A Ng,Alexander %A Chan,Vinson %A Nathan,Arjun %A Cooper,David %A Aucott,Lorna %A Marcq,Gautier %A Teoh,Jeremy Yuen-Chun %A Hensley,Patrick %A Duncan,Eilidh %A Goulao,Beatriz %A O'Brien,Tim %A Nielsen,Matthew %A Mariappan,Paramananthan %A Kasivisvanathan,Veeru %+ Department of Urology, Western General Hospital Edinburgh, Urology Registrar's Office, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, United Kingdom, 44 131 537 1000, kevin.gallagher@ucl.ac.uk %K TURBT %K bladder cancer %K quality improvement %K performance feedback %K transurethral resection %K urology %K oncology %K recurrence %K surgery %K surgical %K quality indicator %K performance %K feedback %K evaluation %D 2023 %7 15.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Nonmuscle invasive bladder cancer (NMIBC) accounts for 75% of bladder cancers. It is common and costly. Cost and detriment to patient outcomes and quality of life are driven by high recurrence rates and the need for regular invasive surveillance and repeat treatments. There is evidence that the quality of the initial surgical procedure (transurethral resection of bladder tumor [TURBT]) and administration of postoperative bladder chemotherapy significantly reduce cancer recurrence rates and improve outcomes (cancer progression and mortality). There is surgeon-reported evidence that TURBT practice varies significantly across surgeons and sites. There is limited evidence from clinical trials of intravesical chemotherapy that NMIBC recurrence rate varies significantly between sites and that this cannot be accounted for by differences in patient, tumor, or adjuvant treatment factors, suggesting that how the surgery is performed may be a reason for the variation. Objective: This study primarily aims to determine if feedback on and education about surgical quality indicators can improve performance and secondarily if this can reduce cancer recurrence rates. Planned secondary analyses aim to determine what surgeon, operative, perioperative, institutional, and patient factors are associated with better achievement of TURBT quality indicators and NMIBC recurrence rates. Methods: This is an observational, international, multicenter study with an embedded cluster randomized trial of audit, feedback, and education. Sites will be included if they perform TURBT for NMIBC. The study has four phases: (1) site registration and usual practice survey; (2) retrospective audit; (3) randomization to audit, feedback, and education intervention or to no intervention; and (4) prospective audit. Local and national ethical and institutional approvals or exemptions will be obtained at each participating site. Results: The study has 4 coprimary outcomes, which are 4 evidence-based TURBT quality indicators: a surgical performance factor (detrusor muscle resection); an adjuvant treatment factor (intravesical chemotherapy administration); and 2 documentation factors (resection completeness and tumor features). A key secondary outcome is the early cancer recurrence rate. The intervention is a web-based surgical performance feedback dashboard with educational and practical resources for TURBT quality improvement. It will include anonymous site and surgeon-level peer comparison, a performance summary, and targets. The coprimary outcomes will be analyzed at the site level while recurrence rate will be analyzed at the patient level. The study was funded in October 2020 and began data collection in April 2021. As of January 2023, there were 220 hospitals participating and over 15,000 patient records. Projected data collection end date is June 30, 2023. Conclusions: This study aims to use a distributed collaborative model to deliver a site-level web-based performance feedback intervention to improve the quality of endoscopic bladder cancer surgery. The study is funded and projects to complete data collection in June 2023. Trial Registration: ClinicalTrials.org NCT05154084; https://clinicaltrials.gov/ct2/show/NCT05154084 International Registered Report Identifier (IRRID): DERR1-10.2196/42254 %M 37318875 %R 10.2196/42254 %U https://www.researchprotocols.org/2023/1/e42254 %U https://doi.org/10.2196/42254 %U http://www.ncbi.nlm.nih.gov/pubmed/37318875 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46486 %T Assessing the Feasibility of Economic Approaches to Prevent Substance Abuse Among Adolescents: Protocol for a Mixed Methods Study %A Brathwaite,Rachel %A Mutumba,Massy %A Nanteza,Jacqueline %A Filiatreau,Lindsey M %A Migadde,Herbert %A Namatovu,Phionah %A Nabisere,Betina %A Mugisha,James %A Mwebembezi,Abel %A Ssewamala,Fred M %+ Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St Louis, MO, 63130, United States, 1 3149351775, rachel.brathwaite@wustl.edu %K adolescents living with HIV %K alcohol %K Sub-Saharan Africa %K substance use %K Uganda %D 2023 %7 14.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescent alcohol and drug use (ADU) is a significant public health challenge. Uganda, one of the poorest countries in Sub-Saharan Africa (SSA), has the second-highest rate of per capita alcohol consumption in SSA, and over one-third of Ugandan adolescents have used alcohol in their lifetime (over 50% of them engage in heavy episodic drinking). These estimates further increase in fishing villages, a key HIV-vulnerable population, where ADU is normative. However, few studies have assessed ADU among adolescents and youths living with HIV despite their increased risk for ADU and its impact on engagement in HIV care. Moreover, data on risk and resilience factors for ADU are scarce as only few studies evaluating ADU interventions in SSA have reported positive outcomes. The majority have been implemented in school settings, potentially excluding adolescents in fishing communities with high school dropout rates, and none have targeted risk factors including poverty and mental health, which are rampant among adolescents and youths living with HIV and their families, undermine their coping skills and resources, and have been associated with increased risk for ADU among them. Objective: We propose a mixed methods study with a sample of 200 adolescents and youths living with HIV (aged 18-24 years) seen at 6 HIV clinics in southwestern Uganda’s fishing communities to (1) examine the prevalence and consequences of ADU and identify the multilevel risk and resilience factors associated with ADU among them and (2) explore the feasibility and short-term effects of an economic empowerment intervention on ADU among them. Methods: This study comprises four components: (1) focus group discussions (FGDs) with adolescents and youths living with HIV (n=20) and in-depth qualitative interviews with health providers (n=10) from 2 randomly selected clinics; (2) a cross-sectional survey with 200 adolescents and youths living with HIV; (3) a randomized controlled trial with a subgroup of adolescents and youths living with HIV (n=100); and (4) 2 postintervention FGD with adolescents and youths living with HIV (n=10 per group). Results: Participant recruitment for the first qualitative phase has completed. As of May 4, 2023, ten health providers from 6 clinics have been recruited, provided written consent to participate, and participated in in-depth qualitative interviews. Two FGDs was conducted with 20 adolescents and youths living with HIV from 2 clinics. Data transcription, translation, and analysis of qualitative data has commenced. The cross-sectional survey will commence shortly after and dissemination of the main study findings is targeted for 2024. Conclusions: Our findings will advance our understanding of ADU among adolescents and youths living with HIV and inform the design of future interventions to address ADU among them. Trial Registration: ClinicalTrials.gov NCT05597865; https://clinicaltrials.gov/ct2/show/NCT05597865 International Registered Report Identifier (IRRID): PRR1-10.2196/46486 %M 37314844 %R 10.2196/46486 %U https://www.researchprotocols.org/2023/1/e46486 %U https://doi.org/10.2196/46486 %U http://www.ncbi.nlm.nih.gov/pubmed/37314844 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46307 %T A Comprehensive Self-Management Intervention for Inflammatory Bowel Disease (CSM-IBD): Protocol for a Pilot Randomized Controlled Trial %A Kamp,Kendra %A Clark-Snustad,Kindra %A Yoo,Linda %A Winders,Samantha %A Cain,Kevin %A Levy,Rona L %A Dey,Neelendu %A Lee,Scott %A Keefer,Laurie %A Heitkemper,Margaret %+ Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Box 357266, Seattle, WA, 98195, United States, 1 206 221 4617, kamp@uw.edu %K inflammatory bowel disease %K self-management %K symptom management %K pilot %K intervention %K randomized controlled trial %D 2023 %7 7.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite pharmacological treatment, individuals with inflammatory bowel disease (IBD) experience a variety of symptoms, including abdominal pain, fatigue, anxiety, and depression. Few nonmedical self-management interventions are available for people with IBD. A validated comprehensive self-management (CSM) intervention is effective for patients with irritable bowel syndrome who can have symptoms similar to those of individuals with IBD. We created a modified CSM intervention tailored to individuals with IBD (CSM-IBD). The CSM-IBD is an 8-session program delivered over 8-12 weeks with check-ins with a registered nurse. Objective: The primary objective of this pilot study is to determine the feasibility and acceptability of study procedures and the CSM-IBD intervention and to evaluate preliminary efficacy on quality of life and daily symptoms for a future randomized controlled trial. Additionally, we will examine the association of socioecological, clinical, and biological factors with symptoms at baseline and response to intervention. Methods: We are conducting a pilot randomized controlled trial of the CSM-IBD intervention. Participants aged 18-75 years who are experiencing at least 2 symptoms are eligible for inclusion. We plan to enroll 54 participants who will be randomized (2:1) into the CSM-IBD program or usual care. Patients in the CSM-IBD program will have 8 intervention sessions. Primary study outcomes include the feasibility of recruitment, randomization, and data or sample collection, as well as the acceptability of study procedures and interventions. Preliminary efficacy outcome variables include quality of life and symptoms. Outcomes data will be assessed at baseline, immediately post intervention, and 3 months post intervention. Participants in the usual care group will have access to the intervention after study participation. Results: This project is funded by the National Institutes of Nursing Research and reviewed by the University of Washington’s institutional review board. Recruitment began in February 2023. As of April 2023, we have enrolled 4 participants. We expect the study to be completed by March 2025. Conclusions: This pilot study will evaluate the feasibility and efficacy of a self-management intervention (a web-based program with weekly check-ins with a registered nurse) that aims to improve symptom management in individuals with IBD. In the long term, we aim to validate a self-management intervention to improve patient quality of life, reduce direct and indirect costs related to IBD, and be culturally appropriate and accessible, particularly in rural and underserved communities. Trial Registration: ClinicalTrials.gov NCT05651542; https://clinicaltrials.gov/ct2/show/NCT05651542 International Registered Report Identifier (IRRID): PRR1-10.2196/46307 %M 37285195 %R 10.2196/46307 %U https://www.researchprotocols.org/2023/1/e46307 %U https://doi.org/10.2196/46307 %U http://www.ncbi.nlm.nih.gov/pubmed/37285195 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46144 %T Effectiveness of Silver Diamine Fluoride for Early Childhood Caries Among Children Aged 24 to 72 Months: Protocol for a Randomized Controlled Trial %A Basheer N,Amitha %A Jodalli,Praveen S %A Nayak,Namratha %A K S,Aparna %A Badekkila,Avinash R %+ Department of Public Health Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Light House Hill Road, Manipal, 5756104, India, 91 9886244093, praveen.jodalli@manipal.edu %K silver diamine fluoride %K children %K caries %K childhood %K dental %K dentist %K oral health %K child %K pediatric %K RCT %K randomized %K fluoride %K prevention %D 2023 %7 7.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Dental caries is a serious public health issue globally. It is one of the most prevalent chronic disease in children worldwide. An important public health concern is the existence of one or more decayed, missing, or filled tooth surfaces in any primary teeth of preschool children. Early childhood caries (ECC) can be halted with the use of silver diamine fluoride (SDF) solution. Previous research has indicated that it may have a preventive impact in the treatment of ECC. It is well known that 38% silver diamine fluoride (SDF) is helpful at preventing dental caries. On the other hand, there is not enough evidence on SDF’s ability to prevent caries in primary teeth. To date, no well-planned clinical study has been carried out to investigate SDF’s impact on caries protection. Objective: The study’s objective is to evaluate and compare the efficacy of 12%, 30%, and 38% silver diamine fluoride in preventing ECC in children aged 24 to 72 months in Mangaluru Taluk. Methods: This is a single-center, randomized, active-controlled, parallel-group pragmatic trial. Children attending preschool in Mangalore Taluk aged 24 to 72 months will be included in the study. There will be three study groups: group 1 will receive 12% SDF semiannually; group 2 will receive 30% SDF semiannually; and group 3 will receive 38% SDF semiannually. After 6 and 12 months, the principal examiner will conduct a clinical examination of the teeth with a visual and tactile assessment. The effectiveness of the various concentrations of SDF will be determined after 12 months. Results: The research was funded in September 2020, and data collection started in September 2022. As of February 2023, 150 participants have enrolled in the study. The project is still underway, and it is expected to be completed in December 2023. Conclusions: Uncertainty surrounds the efficacy of 38% SDF in preventing ECC. Consensus-Based Clinical Case Reporting (CARE) guidelines recommending the use of SDF for ECC prevention will be modified if the findings are as expected. Additionally, since the findings will be broadly disseminated, more nations will implement the use of SDF, easing the burden of ECC on the entire world. Future research on the treatment and prevention of ECC will benefit from the study results. If SDF is successful in preventing caries in a classroom or community context, it will mark an important turning point for preventive dentistry. Trial Registration: Clinical Trial Registry of India CTRI/2020/02/023420; https://tinyurl.com/3ju2apab International Registered Report Identifier (IRRID): PRR1-10.2196/46144 %M 37285186 %R 10.2196/46144 %U https://www.researchprotocols.org/2023/1/e46144 %U https://doi.org/10.2196/46144 %U http://www.ncbi.nlm.nih.gov/pubmed/37285186 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47659 %T The Effects of Online Access to General Practice Medical Records Perceived by Patients: Longitudinal Survey Study %A Thielmann,Rosa R L C %A Hoving,Ciska %A Cals,Jochen W L %A Crutzen,Rik %+ School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Debyeplein 1, Maastricht, 6226 HA, Netherlands, 31 38 82423, r.thielmann@maastrichtuniversity.nl %K electronic health records %K personal health records %K medical records %K patient access to records %K patient portals %K patient participation %K informed decision-making %K patient empowerment %D 2023 %7 2.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient online access to medical records is assumed to facilitate patient empowerment and advance patient-centered health care. However, to date, the actual effects of online access to medical records perceived by patients and other outcomes are insufficiently empirically tested. Objective: This study aimed to investigate the effects of online access to medical records on patient empowerment, informed decision-making, and the patient-provider relationship perceived by patients. Methods: A nationwide, 2-wave, longitudinal survey study was conducted among Dutch adults (N=2402). Linear regression analyses were performed. In model 1, the perceived effects of online access to medical records (measured at T1 [first measurement; July 2021]) on 16 outcomes (measured at T2 [second measurement; January 2022]), which were associated with the use of online access to general practice medical records in previous research, were investigated. Model 2 included sociodemographic factors and patient characteristics as confounders. Results: Users indicated more strongly than nonusers that online access to medical records would increase their participation in health care, improve the relationship with their general practitioner, and support informed decision-making. These results were robust when adjusted for the influence of confounders. Effect sizes were very small, with unstandardized regression coefficients (B) ranging between −0.39 and 0.28. Higher digital and health literacy were associated with higher ratings of almost all effects. Conclusions: Online access to medical records has the potential to empower patients and foster informed decision-making among patients. The effects in this study were small but might grow over time. Other factors, such as the attitude of general practitioners toward online access to medical records, might moderate these effects. The results indicate that the potential benefits of online access to medical records might be unevenly distributed. We suggest future exploration of the conditions under which online access to medical records can improve health care system functioning and efficiency without increasing health inequality. %M 37266981 %R 10.2196/47659 %U https://www.jmir.org/2023/1/e47659 %U https://doi.org/10.2196/47659 %U http://www.ncbi.nlm.nih.gov/pubmed/37266981 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e38176 %T A Video-Observed Treatment Strategy to Improve Adherence to Treatment Among Persons Who Inject Drugs Infected With Hepatitis C Virus: Qualitative Study of Stakeholder Perceptions and Experiences %A Karasz,Alison %A Merchant,Krupa %A Arnsten,Julia %A Feinberg,Judith %A Kim,Arthur Y %A Lum,Paula J %A McKee,Melissa Diane %A Mehta,Shruti H %A Meissner,Paul %A Norton,Brianna L %A Page,Kimberly %A Pericot-Valverde,Irene %A Singh,Reena %A Stein,Ellen %A Taylor,Lynn E %A Tsui,Judith I %A Wagner,Katherine %A Litwin,Alain %+ University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, United States, 1 508 856 8989, alison.karasz@umassmed.edu %K mHealth %K video-observed therapy %K directly observed treatment %K hepatitis C virus %K persons who inject drugs %K antiviral %K adherence %K HCV %K opioid treatment %K mobile health %K adherence behavior %K behavior intervention %K telemedicine %K digital health %K perception %K therapy %K treatment %D 2023 %7 2.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Direct-acting antiviral medications have the potential to eliminate the hepatitis C virus (HCV) epidemic among people who inject drugs; yet, suboptimal adherence remains a barrier. Directly observed treatment (DOT), an effective strategy for optimizing adherence, has been frequently implemented in opioid treatment programs but less commonly in community health settings due to the heavy burden of daily visits. An alternative is video-observed therapy (VOT), which uses mobile health technology to monitor adherence. VOT has not been widely studied among people who inject drugs with HCV. Objective: This qualitative study, part of a larger implementation evaluation, investigates stakeholder perceptions and experiences with VOT in Project HERO (Hepatitis C Real Outcomes), a multisite pragmatic trial testing treatment delivery models for people who inject drugs with HCV. Our goal was to understand the potential barriers and facilitators to the implementation of the VOT technology. Methods: Qualitative interviews were conducted with 27 Project HERO study staff and 7 patients. Interviews focused on perceptions and experiences with the VOT app and barriers and facilitators to implementation. Team meeting minutes over the first 2 years of the project were transcribed. A coding system was developed and applied to the data. We summarized thematic data and compared participant perceptions to generate a close understanding of the data. Results: Frequent barriers to VOT included mechanical failure, stolen or lost phones, and a steep learning curve for participants and study staff. In sites with older and less technically skilled participants, staff found it difficult to implement the VOT app. Research staff found that the routine monitoring of app use led to closer engagement with participants. This was both a benefit and a potential threat to the validity of this pragmatic trial. Patient participants reported mixed experiences. Conclusions: VOT may be a useful alternative to DOT for some patients, but it may not be feasible for all. Significant staff involvement may be required. %M 37266986 %R 10.2196/38176 %U https://www.jmir.org/2023/1/e38176 %U https://doi.org/10.2196/38176 %U http://www.ncbi.nlm.nih.gov/pubmed/37266986 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46339 %T The Electronic Surviving Cancer Competently Intervention Program—a Psychosocial Digital Health Intervention for English- and Spanish-Speaking Parents of Children With Cancer: Protocol for Randomized Controlled Trial %A Canter,Kimberly S %A Ritterband,Lee %A Freyer,David R %A Askins,Martha A %A Bava,Laura %A Loucas,Caitlyn %A Arasteh,Kamyar %A You,Wen %A Kazak,Anne E %+ Center for Healthcare Delivery Science, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, United States, 1 8455988924, kimberly.canter@nemours.org %K pediatric cancer %K digital health %K parents %K caregivers %K psychosocial intervention %K family systems %K cultural and linguistic adaptation %D 2023 %7 2.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The psychosocial needs and risks of children with cancer and their families are well-documented including increased risk of parental distress, posttraumatic stress, and anxiety. There is a critical need to provide evidence-based psychosocial care to parents and caregivers of children with cancer. Digital health interventions are important to address many barriers to in-person intervention delivery but are not widely used in pediatric psychosocial cancer care. The COVID-19 pandemic has reinforced the need for flexible, acceptable, and accessible psychosocial digital health interventions. The Electronic Surviving Cancer Competently Intervention Program (eSCCIP) is an innovative digital health intervention for parents and caregivers of children with cancer, delivered through a combination of self-guided web-based content and supplemented by 3 telehealth follow-up sessions with a trained telehealth guide. A Spanish language adaptation of eSCCIP, El Programa Electronico de Intervencion para Superar Cancer Competentemente (eSCCIP-SP), has been developed. The self-guided web-based cores of eSCCIP/eSCCIP-SP are a mix of didactic video content, multifamily video discussion groups featuring parents of children with cancer, and hands-on web-based activities. Objective: The objective of this study is to test eSCCIP/eSCCIP-SP in a multisite randomized controlled trial, compared to an internet-based education control condition consisting of information specifically focused on concerns relevant to parents and caregivers of children with cancer. Methods: Using a randomized controlled clinical trial design, 350 eligible parents and caregivers of children with cancer will be randomly assigned to the intervention (eSCCIP/eSCCIP-SP) or an education control condition. Data will be collected at 3 time points: preintervention (prior to randomization), immediately post intervention (after 6 weeks), and at a 3-month follow-up (from baseline). Participants randomized to either condition will receive study material (eSCCIP/eSCCIP-SP intervention or education control website) in English or Spanish, based on the primary language spoken in the home and participant preference. Results: The primary study end point is a reduction in acute distress from baseline to postintervention, with secondary end points focused on reductions in symptoms of posttraumatic stress and anxiety, and improvements in coping self-efficacy and cognitive coping. An additional exploratory aim will be focused on implementation strategies and potential costs and cost-savings of eSCCIP/eSCCIP-SP, laying the groundwork for future trials focused on dissemination and implementation, stepped-care models, and intervention refinement. Conclusions: This trial will provide necessary data to evaluate the efficacy of eSCCIP/eSCCIP-SP. This intervention has the potential to be an easily scalable and highly impactful psychosocial treatment option for parents and caregivers of children with cancer. Trial Registration: ClinicalTrials.gov NCT05294302; https://clinicaltrials.gov/ct2/show/NCT05294302 International Registered Report Identifier (IRRID): PRR1-10.2196/46339 %M 37267038 %R 10.2196/46339 %U https://www.researchprotocols.org/2023/1/e46339 %U https://doi.org/10.2196/46339 %U http://www.ncbi.nlm.nih.gov/pubmed/37267038 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e38828 %T Barriers and Facilitators to Implementing a Digital Adherence Technology for Tuberculosis Treatment Supervision in Uganda: Qualitative Study %A Leddy,Anna %A Ggita,Joseph %A Berger,Christopher A %A Kityamuwesi,Alex %A Sanyu,Agnes Nakate %A Tinka,Lynn Kunihira %A Crowder,Rebecca %A Turyahabwe,Stavia %A Katamba,Achilles %A Cattamanchi,Adithya %+ Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, 550 16th St 3rd floor, San Francisco, CA, 94158, United States, 1 5102385100, Adithya.Cattamanchi@ucsf.edu %K digital adherence technology %K gender norms %K tuberculosis %K adherence %K sub-Saharan Africa %D 2023 %7 30.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Ensuring the completion of treatment for tuberculosis (TB) remains a key challenge in many high-burden countries. 99DOTS is a low-cost digital adherence technology that has emerged as a promising tool for monitoring and supporting TB treatment completion. Objective: We aimed to understand the feasibility and acceptability of 99DOTS, a mobile phone–based TB treatment support method, and characterize barriers and facilitators to its implementation during a pragmatic trial in Uganda. Methods: Between April 1 and August 31, 2021, we conducted in-depth interviews with people with TB and key informant interviews with health workers and district and regional TB officers involved in the implementation of 99DOTS at 18 health facilities in Uganda. Semistructured interview guides were informed by the capability, opportunity, motivation, and behavior (COM-B) model and explored perceptions of, and experiences with, 99DOTS, including barriers and facilitators to its use. Qualitative analysis was conducted using the framework approach. Results: Interviews were conducted with 30 people with TB, 12 health workers, and 7 TB officers. All people with TB, health workers, and TB officers noted that 99DOTS supported and encouraged people with TB to take their anti-TB medication, facilitated treatment monitoring, and improved relationships between people with TB and health workers. Participants also liked that the platform was free, easy to use, and improved TB treatment outcomes. Barriers to 99DOTS implementation for some people with TB were related to limited literacy, including technology literacy; limited access to electricity to charge their mobile phone to make dosing confirmation calls; and poor network connection. Gender differences in 99DOTS uptake also emerged. Specifically, women with TB were described to be more concerned that 99DOTS use would expose them to TB stigma and to be more likely to have mobile phone–access issues than men with TB. By contrast, men with TB not only had access to mobile phones but also received substantial support from their female partners to take their anti-TB medication and make 99DOTS dosing confirmation calls. Finally, although women with TB were described to face more barriers to 99DOTS use than men with TB, the women’s narratives centered on the ways the platform facilitated and improved their adherence, whereas the men’s narratives did not. Conclusions: Overall, 99DOTS seems to be a feasible and acceptable strategy to support anti-TB medication adherence in Uganda. However, access to mobile phones, inability to charge mobile phones, and concerns about stigma should be considered and addressed as part of programmatic implementation to maximize uptake among all people with TB, particularly women and those with fewer financial resources. %M 37252774 %R 10.2196/38828 %U https://www.jmir.org/2023/1/e38828 %U https://doi.org/10.2196/38828 %U http://www.ncbi.nlm.nih.gov/pubmed/37252774 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e39022 %T Prevalence of Antibiotic-Resistant Pathogenic Bacteria and Level of Antibiotic Residues in Hospital Effluents in Selangor, Malaysia: Protocol for a Cross-sectional Study %A Bakon,Sophia Karen %A Mohamad,Zuraifah Asrah %A Jamilan,Mohd Azerulazree %A Hashim,Hazimah %A Kuman,Mohamed Yazid %A Shaharudin,Rafiza %A Ahmad,Norazah %A Muhamad,Nor Asiah %+ Environmental Health Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Persiaran Setia Murni, Setia Alam, Shah Alam, 40170, Malaysia, 60 +60333627774, sophia.karen@moh.gov.my %K ESKAPE %K antimicrobial resistance %K hospital effluent %K antibiotics %K health care %K antibiotic resistance %K antimicrobial %K hospital setting %K antibiotic residues %K wastewater %D 2023 %7 29.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Antimicrobial resistance (AMR) has emerged as a major global public health challenge due to the overuse and misuse of antibiotics for humans and animals. Hospitals are among the major users of antibiotics, thereby having a large contribution to AMR. Objective: The aim of this study is to determine the prevalence of antibiotic-resistant pathogenic bacteria and the level of antibiotic residues in the hospital effluents in Selangor, Malaysia. Methods: A cross-sectional study will be performed in the state of Selangor, Malaysia. Tertiary hospitals will be identified based on the inclusion and exclusion criteria. The methods are divided into three phases: sample collection, microbiological analysis, and chemical analysis. Microbiological analyses will include the isolation of bacteria from hospital effluents by culturing on selective media. Antibiotic sensitivity testing will be performed on the isolated bacteria against ceftriaxone, ciprofloxacin, meropenem, vancomycin, colistin, and piperacillin/tazobactam. The identification of bacteria will be confirmed using 16S RNA polymerase chain reaction (PCR) and multiplex PCR will be performed to detect resistance genes (ermB, mecA, blaNDM-L, blaCTX-M, blaOXA-48, blaSHV, VanA, VanB, VanC1, mcr-1, mcr-2, mcr-3, Intl1, Intl2, and qnrA). Finally, the level of antibiotic residues will be measured using ultrahigh-performance liquid chromatography. Results: The expected outcomes will be the prevalence of antibiotic-resistant Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter (ESKAPE) bacterial species from the hospital effluents, the occurrence of antibiotic resistance genes (ARGs) from the isolated ESKAPE bacteria, and the level of antibiotic residues that may be detected from the effluent. Sampling has been conducted in three hospitals. Data analysis from one hospital showed that as of July 2022, 80% (8/10) of E. faecium isolates were resistant to vancomycin and 10% (1/10) were resistant to ciprofloxacin. Further analysis will be conducted to determine if the isolates harbor any ARGs and effluent samples are being analyzed to detect antibiotic residues. Sampling activities will be resumed after being suspended due to the COVID-19 pandemic and are scheduled to end by December 2022. Conclusions: This study will provide the first baseline information to elucidate the current status of AMR of highly pathogenic bacteria present in hospital effluents in Malaysia. International Registered Report Identifier (IRRID): DERR1-10.2196/39022 %M 37247207 %R 10.2196/39022 %U https://www.researchprotocols.org/2023/1/e39022 %U https://doi.org/10.2196/39022 %U http://www.ncbi.nlm.nih.gov/pubmed/37247207 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44330 %T Text Analysis of Trends in Health Equity and Disparities From the Internal Revenue Service Tax Documentation Submitted by US Nonprofit Hospitals Between 2010 and 2019: Exploratory Study %A Hadley,Emily %A Marcial,Laura Haak %A Quattrone,Wes %A Bobashev,Georgiy %+ RTI International, 3040 East Cornwallis Road, Durham, NC, 27514, United States, 1 919 541 6000, ehadley@rti.org %K text mining %K natural language processing %K health care disparities %K hospital administration %D 2023 %7 24.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Many US hospitals are classified as nonprofits and receive tax-exempt status partially in exchange for providing benefits to the community. Proof of compliance is collected with the Schedule H form submitted as part of the annual Internal Revenue Service Form 990 (F990H), including a free-response text section that is known for being ambiguous and difficult to audit. This research is among the first to use natural language processing approaches to evaluate this text section with a focus on health equity and disparities. Objective: This study aims to determine the extent to which the free-response text in F990H reveals how nonprofit hospitals address health equity and disparities, including alignment with public priorities. Methods: We used free-response text submitted by hospital reporting entities in Part V and VI of the Internal Revenue Service Form 990 Schedule H between 2010 and 2019. We identified 29 main themes connected to health equity and disparities, and 152 related key phrases. We tallied occurrences of these phrases through term frequency analysis, calculated the Moran I statistic to assess geographic variation in 2018, analyzed Google Trends use for the same terms during the same period, and used semantic search with Sentence-BERT in Python to understand contextual use. Results: We found increased use from 2010 to 2019 across all the 29 phrase themes related to health equity and disparities. More than 90% of hospital reporting entities used terms in 2018 and 2019 related to affordability (2018: 2117/2131, 99.34%; 2019: 1620/1627, 99.57%), government organizations (2018: 2053/2131, 96.33%; 2019: 1577/1627, 96.93%), mental health (2018: 1937/2131, 90.9%; 2019: 1517/1627, 93.24%), and data collection (2018: 1947/2131, 91.37%; 2019: 1502/1627, 92.32%). The themes with the largest relative increase were LGBTQ (lesbian, gay, bisexual, transgender, and queer; 1676%; 2010: 12/2328, 0.51%; 2019: 149/1627, 9.16%) and social determinants of health (958%; 2010: 68/2328, 2.92%; 2019: 503/1627, 30.92%). Terms related to homelessness varied geographically from 2010 to 2018, and terms related to equity, health IT, immigration, LGBTQ, oral health, rural, social determinants of health, and substance use showed statistically significant (P<.05) geographic variation in 2018. The largest percentage point increase was for terms related to substance use (2010: 403/2328, 17.31%; 2019: 1149/1627, 70.62%). However, use in themes such as LGBTQ, disability, oral health, and race and ethnicity ranked lower than public interest in these topics, and some increased mentions of themes were to explicitly say that no action was taken. Conclusions: Hospital reporting entities demonstrate an increasing awareness of health equity and disparities in community benefit tax documentation, but these do not necessarily correspond with general population interests or additional action. We propose further investigation of alignment with community health needs assessments and make suggestions for improvements to F990H reporting requirements. %M 37223985 %R 10.2196/44330 %U https://www.jmir.org/2023/1/e44330 %U https://doi.org/10.2196/44330 %U http://www.ncbi.nlm.nih.gov/pubmed/37223985 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48109 %T Comprehensive Acute Kidney Injury Survivor Care: Protocol for the Randomized Acute Kidney Injury in Care Transitions Pilot Trial %A May,Heather P %A Griffin,Joan M %A Herges,Joseph R %A Kashani,Kianoush B %A Kattah,Andrea G %A Mara,Kristin C %A McCoy,Rozalina G %A Rule,Andrew D %A Tinaglia,Angeliki G %A Barreto,Erin F %+ Mayo Clinic, 200 1st Ave SW, Rochester, MN, 55905, United States, 1 5072555866, barreto.erin@mayo.edu %K acute kidney injury %K acute renal failure %K care transitions %K chronic kidney disease %K nephrologists %K randomized controlled trials %D 2023 %7 22.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Innovative care models are needed to address gaps in kidney care follow-up among acute kidney injury (AKI) survivors. We developed the multidisciplinary AKI in Care Transitions (ACT) program, which embeds post-AKI care in patients’ primary care clinic. Objective: The objective of this randomized pilot trial is to test the feasibility and acceptability of the ACT program and study protocol, including recruitment and retention, procedures, and outcome measures. Methods: The study will be conducted at Mayo Clinic in Rochester, Minnesota, a tertiary care center with a local primary care practice. Individuals who are included have stage 3 AKI during their hospitalization, do not require dialysis at discharge, have a local primary care provider, and are discharged to their home. Patients unable or unwilling to provide informed consent and recipients of any transplant within 100 days of enrollment are excluded. Consented patients are randomized to receive the intervention (ie, ACT program) or usual care. The ACT program intervention includes predischarge kidney health education from nurses and coordinated postdischarge laboratory monitoring (serum creatinine and urine protein assessment) and follow-up with a primary care provider and pharmacist within 14 days. The usual care group receives no specific study-related intervention, and any aspects of AKI care are at the direction of the treating team. This study will examine the feasibility of the ACT program, including recruitment, randomization and retention in a trial setting, and intervention fidelity. The feasibility and acceptability of participating in the ACT program will also be examined in qualitative interviews with patients and staff and through surveys. Qualitative interviews will be deductively and inductively coded and themes compared across data types. Observations of clinical encounters will be examined for discussion and care plans related to kidney health. Descriptive analyses will summarize quantitative measures of the feasibility and acceptability of ACT. Participants’ knowledge about kidney health, quality of life, and process outcomes (eg, type and timing of laboratory assessments) will be described for both groups. Clinical outcomes (eg, unplanned rehospitalization) up to 12 months will be compared with Cox proportional hazards models. Results: This study received funding from the Agency for Health Care Research and Quality on April 21, 2021, and was approved by the Institutional Review Board on December 14, 2021. As of March 14, 2023, seventeen participants each have been enrolled in the intervention and usual care groups. Conclusions: Feasible and generalizable AKI survivor care delivery models are needed to improve care processes and health outcomes. This pilot trial will test the ACT program, which uses a multidisciplinary model focused on primary care to address this gap. Trial Registration: ClinicalTrials.gov NCT05184894; https://www.clinicaltrials.gov/ct2/show/NCT05184894 International Registered Report Identifier (IRRID): DERR1-10.2196/48109 %M 37213187 %R 10.2196/48109 %U https://www.researchprotocols.org/2023/1/e48109 %U https://doi.org/10.2196/48109 %U http://www.ncbi.nlm.nih.gov/pubmed/37213187 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e38167 %T Mapping the Evidence for Opioid-Mediated Changes in Malignancy and Chemotherapeutic Efficacy: Protocol for a Scoping Review %A Constance,Jonathan E %A McFarland,Mary M %A Casucci,Tallie %A Deininger,Michael W %A Enioutina,Elena Y %A Job,Kathleen %A Lemons,Richard S %A Lim,Carol S %A Ward,Robert M %A Yellepeddi,Venkata %A Watt,Kevin M %+ Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, United States, 1 8017128088, jonathan.constance@utah.edu %K opioid %K opioid receptor %K drug %K cocaine %K crack %K prescription opioid %K opium %K war on drug %K cancer %K chemotherapy %K drug-drug interaction %K malignancy %K treatment %K oncology %K tumor %K survival %K antineoplastic %K cancer cell %K scoping %K chemotherapeutic %K librarian %K library science %K antineoplast %K cancer cell survival %K cancer cell growth %K addict %K addiction %D 2023 %7 22.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Numerous reports contend opioids can augment or inhibit malignancy. At present, there is no consensus on the risk or benefit posed by opioids on malignancy or chemotherapeutic activity. Distinguishing the consequences of opioid use from pain and its management is challenging. Additionally, opioid concentration data is often lacking in clinical studies. A scoping review approach inclusive of preclinical and clinical data will improve our understanding of the risk-benefit relationship concerning commonly prescribed opioids and cancer and cancer treatment. Objective: The aim of the study is to map diverse studies spanning from preclinical to clinical regarding opioids with malignancy and its treatment. Methods: This scoping review will use the Arksey six stages framework to (1) identify the research question; (2) identify relevant studies; (3) select studies meeting criteria; (4) extract and chart data; (5) collate, summarize, and report results; and (6) conduct expert consultation. An initial pilot study was undertaken to (1) parameterize the extent and scale of existing data for an evidence review, (2) identify key factors to be extracted in systematic charting efforts, and (3) assess opioid concentration as a variable for its relevance to the central hypothesis. Six databases will be searched with no filters: MEDLINE, Embase, CINAHL Complete, Cochrane Library, Biological Sciences Collection, and International Pharmaceutical Abstracts. Trial registries will include ClinicalTrials.gov, Cochrane CENTRAL, International Standard Randomised Controlled Trial Number Registry, European Union Clinical Trials Register, and World Health Organization International Clinical Trials Registry. Eligibility criteria will include preclinical and clinical study data on opioids effects on tumor growth or survival, or alteration on the antineoplastic activity of chemotherapeutics. We will chart data on (1) opioid concentration from human subjects with cancer, yielding a “physiologic range” to better interpret available preclinical data; (2) patterns of opioid exposure with disease and treatment-related patient outcomes; and (3) the influence of opioids on cancer cell survival, as well as opioid-related changes to cancer cell susceptibility for chemotherapeutics. Results: This scoping review will present results in narrative forms as well as with the use of tables and diagrams. Initiated in February 2021 at the University of Utah, this protocol is anticipated to generate a scoping review by August 2023. The results of the scoping review will be disseminated through scientific conference proceedings and presentations, stakeholder meetings, and by publication in a peer-reviewed journal. Conclusions: The findings of this scoping review will provide a comprehensive description of the consequences of prescription opioids on malignancy and its treatment. By incorporating preclinical and clinical data, this scoping review will invite novel comparisons across study types that could inform new basic, translational, and clinical studies regarding risks and benefits of opioid use among patients with cancer. International Registered Report Identifier (IRRID): PRR1-10.2196/38167 %M 37213193 %R 10.2196/38167 %U https://www.researchprotocols.org/2023/1/e38167 %U https://doi.org/10.2196/38167 %U http://www.ncbi.nlm.nih.gov/pubmed/37213193 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43604 %T Telehealth Usage Among Low-Income Racial and Ethnic Minority Populations During the COVID-19 Pandemic: Retrospective Observational Study %A Williams,Cynthia %A Shang,Di %+ School of Global Health Management and Informatics, University of Central Florida, 528 W Livingston St, Suite 401, Orlando, FL, 32801, United States, 1 4078230948, cynthia.williams@ucf.edu %K COVID-19 %K telehealth %K health equity %K minority health %K low income %K healthcare access %K pandemic %K USA %K United States %K healthcare system %K health care %K risk %K minority %K database %K utilization %K education %D 2023 %7 12.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite considerable efforts to encourage telehealth use during the COVID-19 pandemic, we witnessed a potential widening of health inequities that may continue to plague the US health care system unless we mitigate modifiable risk factors. Objective: This study aimed to examine the hypothesis that there are systemic differences in telehealth usage among people who live at or below 200% of the federal poverty level. Factors that we consider are age, gender, race, ethnicity, education, employment status, household size, and income. Methods: A retrospective observational study was performed using the COVID-19 Research Database to analyze factors contributing to telehealth inequities. The study period ranged from March 2020 to April 2021. The Office Ally database provided US claims data from 100 million unique patients and 3.4 billion claims. The Analytics IQ PeopleCore Consumer database is nationally representative of 242.5 million US adults aged 19 years and older. We analyzed medical claims to investigate the influence of demographic and socioeconomic factors on telehealth usage among the low-income racial and ethnic minority populations. We conducted a multiple logistic regression analysis to determine the odds of patients in diverse groups using telehealth during the study period. Results: Among 2,850,831 unique patients, nearly 60% of them were female, 75% of them had a high school education or less, 49% of them were unemployed, and 62% of them identified as non-Hispanic White. Our results suggest that 9.84% of the patients had ≥1 telehealth claims during the study period. Asian (odds ratio [OR] 1.569, 95% CI 1.528-1.611, P<.001) and Hispanic (OR 1.612, 95% CI 1.596-1.628, P<.001) patients were more likely to use telehealth than non-Hispanic White and -Black patients. Patients who were employed full-time were 15% (OR 1.148, 95% CI 1.133-1.164, P<.001) more likely to use telehealth than unemployed patients. Patients who identified as male were 12% (OR 0.875, 95% CI 0.867-0.883, P<.001) less likely to use telehealth than those who identified as female. Patients with high school education or less were 5% (OR 0.953, 95% CI 0.944-0.962, P<.001) less likely to use telehealth than those with a bachelor’s degree or higher. Patients in the 18-44–year age group were 32% (OR 1.324, 95% CI 1.304-1.345, P<.001) more likely to use telehealth than those in the ≥65-year age group. Conclusions: Factors that impact telehealth usage include age, gender, race, education, employment status, and income. While low-income racial and ethnic minority communities are at greater risk for health inequities among this group, Hispanic communities are more likely to use telehealth, and non-Hispanic Black patients continue to demonstrate telehealth inequity. Gender, age, and household income contribute to health inequities across gradients of poverty. Strategies to improve health use should consider characteristics of subgroups, as people do not experience poverty equally. %M 37171848 %R 10.2196/43604 %U https://www.jmir.org/2023/1/e43604 %U https://doi.org/10.2196/43604 %U http://www.ncbi.nlm.nih.gov/pubmed/37171848 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43329 %T Determining the Impact of the COVID-19 Pandemic on Availability, Use, and Readiness of Family Planning and Contraceptive Services at Selected Primary Health Care Facilities in Africa and Asia: Protocol for a Mixed Methods Study %A Kabra,Rita %A Joshi,Beena %A Elisaria,Ester %A Akande,Tanimola Makanjuola %A Allagh,Komal Preet %A Olumide,Adesola %A Tandon,Deepti %A Prusty,Ranjan Kumar %A Ramesh,Mary %A Shamba,Donat %A Kiarie,James %+ UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia-20, Geneva, 1211, Switzerland, 41 796036224, kabrar@who.int %K contraception %K family planning %K stock-out %K COVID-19 %K facility assessment %D 2023 %7 10.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic and the associated social restrictions may have disrupted the provision of essential services, including family planning (FP) and contraceptive services. This protocol is adapted from a generic study protocol titled “Health systems analysis and evaluations of the barriers to availability and readiness of sexual and reproductive health services in COVID-19 affected areas,” conducted by the World Health Organization (WHO) Department of Reproductive Health and Research. Objective: This study aims to assess the availability and use of FP and contraceptive services in primary health facilities during and after the COVID-19 pandemic; assess the risk perceptions of COVID-19 stigma, barriers to access, and quality of services from clients’ and providers’ perspectives in the COVID-19–affected areas; and assess the postpandemic recovery of the facilities in the provision of FP and contraceptive services. Methods: In-depth interviews will be conducted with clients—women in the reproductive age group and their male partners who visit the selected health facilities for FP and contraceptive services—and health providers (the most knowledgeable person on FP and contraceptive service provision) at the selected health facilities. Focus group discussions will be conducted with clients at the selected health facilities and in the community. The in-depth interviews and focus group discussions will help to understand clients’ and health service providers’ perspectives of FP and contraceptive service availability and readiness in COVID-19–affected areas. A cross-sectional health facility assessment will be conducted in all the selected health facilities to determine the health facility infrastructure’s ability and readiness to provide FP and contraceptive services and to capture the trends in FP and contraceptive services available during the COVID-19 pandemic. Scientific approval for this study is obtained from the WHO Research Project Review Panel, and the WHO Ethics Review Committee has given ethical approval in the 3 countries. Results: Using a standardized research protocol will ensure that the results from this study can be compared across regions and countries. The study was funded in March 2021. It received ethics approval from the WHO Ethics Review Committee in February 2022. We completed data collection in September 2022. We plan to complete the data analysis by March 2023. We plan to publish the study results by Summer 2023. Conclusions: The findings from this study will provide a better understanding of the impact of the COVID-19 pandemic on FP and contraceptive services at the facility level, which will help policy makers and health managers develop and strengthen FP policies and services in health facilities to be more responsive to community needs. International Registered Report Identifier (IRRID): DERR1-10.2196/43329 %M 36927830 %R 10.2196/43329 %U https://www.researchprotocols.org/2023/1/e43329 %U https://doi.org/10.2196/43329 %U http://www.ncbi.nlm.nih.gov/pubmed/36927830 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45248 %T Osteopathy in the Early Diagnosis and Management of Degenerative Cervical Myelopathy: National Survey %A Brannigan,Jamie F M %A Mowforth,Oliver D %A Rogers,Matthew %A Wood,Helen %A Karimi,Zahabiya %A Kotter,Mark R N %A Davies,Benjamin M %+ Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrookes' Hospital, Cambridge, CB2 0QQ, United Kingdom, 44 7825545404, jb2172@cam.ac.uk %K cervical cord %K myelopathy %K spondylosis %K stenosis %K disc herniation %K ossification posterior longitudinal ligament %K degeneration %K disability %K diagnosis %K degenerative cervical myelopathy %K spine %K osteopathy %K neurodegenerative condition %K surgical decompression %K neurodegeneration %K survey %D 2023 %7 9.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Degenerative cervical myelopathy (DCM) is a common and disabling neurodegenerative condition. Surgical decompression is the only evidence-based treatment to halt disease progression; however, diagnosis and access to timely treatment are often delayed, which contribute to significant disability and dependence. Supporting early diagnosis and access to timely treatment is a critical priority. Exploring these challenges, Myelopathy.org has observed that people with DCM may seek osteopathy care for their symptoms, both before and after diagnosis. Objective: This study aimed to describe the current interaction between osteopaths and people with DCM and understand how this may be targeted to enhance the DCM diagnostic pathway. Methods: Registered osteopaths in the United Kingdom completed a web-based survey hosted by the Institute of Osteopathy, as part of their institute’s 2021 census. Responses were collected from February to May 2021. Demographic information about the respondents was captured, including age, gender, and ethnicity. Professional information captured included the year of qualification; region of practice; type of practice; and number of undiagnosed, operated diagnosed, and unoperated diagnosed DCM cases encountered per year. The completion of the survey was voluntary; however, a prize draw incentive was offered to participants. Results: The demographics were heterogenous for the 547 practitioners who completed the survey. There was representation from a wide range of demographic groups, including the level of experience, gender, age, and the region of United Kingdom. At least 68.9% (377/547) of osteopaths reported encounters with DCM each year. Osteopaths most frequently encountered patients with undiagnosed DCM, with a mean of 3 patient encounters per year. This compares to 2 encounters per year with patients with diagnosed DCM. The level of practitioner experience was positively correlated with the detection of undiagnosed DCM (P<.005). The influence of practitioner experience was corroborated by a subgroup analysis looking at the relationship between practitioner age on the detection of undiagnosed DCM. Osteopaths older than 54 years encountered an average of 4.2 cases per year, whereas those younger than 35 years detected 2.9 cases per year. Osteopaths in private clinics reported encounters with a greater mean number (4.4) of undiagnosed DCM cases per year than osteopaths in other clinic types (3.0). Conclusions: Osteopaths reported that they frequently consult people with DCM, including those suspected to have undiagnosed or presurgical DCM. Given this concentrated presentation of early DCM and a workforce professionally trained to examine musculoskeletal disease, osteopaths could have an important role in accelerating access to timely treatment. We included a decision support tool and specialist referral template as a tool to support onward care. %M 37159244 %R 10.2196/45248 %U https://formative.jmir.org/2023/1/e45248 %U https://doi.org/10.2196/45248 %U http://www.ncbi.nlm.nih.gov/pubmed/37159244 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e41353 %T Bringing the Pediatric Endocrine Spanish Speaking Community Together: First Virtual Pediatric Endocrine Meeting in Low- and Middle-Income Countries in Central and South America %A Bogarin,Roberto %A Elizondo,Luis %A Kalaitzoglou,Evangelia %A Popovic,Jadranka %A Rogol,Alan %A Richmond,Erick %A Chanoine,Jean-Pierre %A Lopez-Pedrosa,Jose M %A Ruiz Salazar,Francis %A Vuguin,Patricia %+ Columbia University, 3959 Broadway, New York, NY, 10032, United States, 1 212 305 8999, pv2267@cumc.columbia.edu %K continuing medical education %K continuing education %K medical education %K professional development %K pediatric %K child %K endocrinology %K endocrine %K pediatric endocrinology %K diabetes %K low- and middle-income countries %K Latin America %K Spanish %K virtual %K resources %K digital %D 2023 %7 8.5.2023 %9 Viewpoint %J Interact J Med Res %G English %X Background: Pediatric endocrinology is a specialty that is struggling worldwide to maintain adequately trained professionals. Pediatric endocrine care in Central America and Caribbean countries is often performed by pediatricians or adult endocrinologists due to the limited number of pediatric endocrinologists. These health care providers are seldom members of endocrine societies and frequently lack formal training in the field. Objective: In this study, we describe the scope of a virtual conference in pediatric endocrinology and diabetes targeted to low- and middle-income countries to provide equal opportunities for access to medical education for health care professionals. Methods: The virtual conference was sponsored by the Pediatric Endocrine Society (North America), Asociación Costarricense de Endocrinología (previously, Asociación Nacional Pro Estudio de la Diabetes, Endocrinología y Metabolismo), and Asociacion Centroamericana y del Caribe de Endocrinologia Pediátrica. The conference was free to participants and comprised 23 sessions that were either synchronous with ability for real-time interactive sessions or asynchronous sessions, where content was available online to access at their convenience. Topics included idiopathic short stature, polycystic ovarian syndrome, diabetes mellitus, telemedicine, Turner syndrome, congenital adrenal hyperplasia, obesity, central precocious puberty, and subclinical hypothyroidism. The participants were asked to evaluate the conference after its completion with a questionnaire. Results: A total of 8 speakers from Spain, Canada, Costa Rica, and the United States delivered the virtual event to 668 health care professionals from Guatemala, Venezuela, Dominican Republic, Costa Rica, Ecuador, Peru, Uruguay, Mexico, Honduras, Argentina, the United States, Bolivia, Chile, Panama, El Salvador, Nicaragua, Paraguay, Belize, Spain, and Colombia. Name, profession, and country were fully disclosed by 410 (61.4%) of the 668 health care professionals. The profession or level of training of participants were as follows: pediatric endocrinologists (n=129, 19.3%), pediatricians (n=116, 17.4%), general practitioners (n=77, 11.5%), adult endocrinologists (n=34, 5.1%), medical students (n=23, 3.4%), residents in various specialties (n=14, 2.1%), and others (n=17, 2.6%). A total of 23 sessions were offered, most of which were bilingual (Spanish and English). Feedback from the evaluation questionnaire indicated that the content of the conference was very relevant to the participants’ professional practice. Additionally, the participants reported that they were very satisfied with the organization, the web-based platform, and the sessions of the conference. Conclusions: Lack of accessibility to the latest and cutting-edge medical education in pediatric endocrinology and diabetes for medical professionals from low- and middle-income countries can be overcome with a virtual conference. Online availability, low cost, and easy-to-use technology were well received from the participants, who were overall very satisfied by the quality and the relevance of the sessions to their professional practice. %M 37155229 %R 10.2196/41353 %U https://www.i-jmr.org/2023/1/e41353 %U https://doi.org/10.2196/41353 %U http://www.ncbi.nlm.nih.gov/pubmed/37155229 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44823 %T The Role of Virtual Consulting in Developing Environmentally Sustainable Health Care: Systematic Literature Review %A Pickard Strange,Martha %A Booth,Amy %A Akiki,Melissa %A Wieringa,Sietse %A Shaw,Sara E %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom, 44 1865 617873, sara.shaw@phc.ox.ac.uk %K virtual consulting %K environmental sustainability %K systematic review %K carbon footprinting %K net zero %K mobile phone %D 2023 %7 3.5.2023 %9 Review %J J Med Internet Res %G English %X Background: Health systems globally need to rapidly set and achieve targets for reaching net zero carbon emissions. Virtual consulting (including video- and telephone-based consulting) is regarded as one means by which this might be achieved, largely through reduced patient travel. Little is currently known about the ways in which forms of virtual consulting might contribute to the net zero agenda or how countries may develop and implement programs at scale that can support increased environmental sustainability. Objective: In this paper, we asked, What is the impact of virtual consulting on environmental sustainability in health care? and What can we learn from current evaluations that can inform future reductions in carbon emissions? Methods: We conducted a systematic review of published literature according to PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines. We searched the MEDLINE, PubMed, and Scopus databases using key terms relating to “carbon footprint,” “environmental impact,” “telemedicine,” and “remote consulting,” using citation tracking to identify additional articles. The articles were screened, and full texts that met the inclusion criteria were obtained. Data on the approach to carbon footprinting reported reductions in emissions, and the opportunities and challenges associated with the environmental sustainability of virtual consultations were extracted into a spreadsheet, analyzed thematically, and theorized using the Planning and Evaluating Remote Consultation Services framework to consider the various interacting influences, including environmental sustainability, that shape the adoption of virtual consulting services. Results: A total of 1672 papers were identified. After removing duplicates and screening for eligibility, 23 papers that focused on a range of virtual consulting equipment and platforms across different clinical conditions and services were included. The focus on the environmental sustainability potential of virtual consulting was unanimously reported through carbon savings achieved by a reduction in travel related to face-to-face appointments. The shortlisted papers used a range of methods and assumptions to determine carbon savings, reporting these using different units and across varied sample sizes. This limited the potential for comparison. Despite methodological inconsistencies, all papers concluded that virtual consulting significantly reduced carbon emissions. However, there was limited consideration of wider factors (eg, patient suitability, clinical indication, and organizational infrastructure) influencing the adoption, use, and spread of virtual consultations and the carbon footprint of the entire clinical pathway in which the virtual consultation was provided (eg, risk of missed diagnoses from virtual consultations that result in the need for subsequent in-person consultations or admissions). Conclusions: There is overwhelming evidence that virtual consulting can reduce health care carbon emissions, largely through reducing travel related to in-person appointments. However, the current evidence fails to look at system factors associated with implementing virtual health care delivery and wider research into carbon emissions across the entire clinical pathway. %M 37133914 %R 10.2196/44823 %U https://www.jmir.org/2023/1/e44823 %U https://doi.org/10.2196/44823 %U http://www.ncbi.nlm.nih.gov/pubmed/37133914 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46123 %T Telemedicine Use by Age in Louisiana Medicaid During COVID-19: Claims-Based Longitudinal Analysis %A Park,Sooyeol %A Walker,Brigham %A Anderson,Andrew %A Shao,Yixue %A Callison,Kevin %+ Department of Health Policy and Management, Tulane University, 1440 Canal Street, New Orleans, LA, 70112, United States, 1 6149891764, kcallison@tulane.edu %K telemedicine %K age %K disparities %K COVID-19 %K availability %K health care services %K infection %K age %K pandemic %K usage %K users %K reliance %K digital literacy %K internet %K trends %D 2023 %7 26.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Limited availability of in-person health care services and fear of contracting COVID-19 during the pandemic promoted an increased reliance on telemedicine. However, long-standing inequities in telemedicine due to unequal levels of digital literacy and internet connectivity among different age groups raise concerns about whether the uptake of telemedicine has exacerbated or alleviated those inequities. Objective: The aim of this study is to examine changes in telemedicine and in-person health service use during the COVID-19 pandemic across age groups for Medicaid beneficiaries in the state of Louisiana. Methods: Interrupted time series models were used on Louisiana Medicaid claims data to estimate trends in total, in-person, and telemedicine monthly office visit claims per 1000 Medicaid beneficiaries between January 2018 and December 2020. Changes in care pattern trends and levels were estimated around the infection peaks (April 2020 and July 2020) and for an end-of-year infection leveling off period (December 2020). Four mutually exclusive age categories (0 to 17, 18 to 34, 35 to 49, and 50 to 64 years) were used to compare the differences. Results: Prior to the COVID-19 pandemic, telemedicine services accounted for less than 1% of total office visit claim volume across the age groups. Each age group followed similar patterns of sharp increases in April 2020, downward trends until sharp increases again in July 2020, followed by flat trends thereafter until December 2020. These sharp increases were most pronounced for older patients, with those aged 50 to 64 years seeing increases of 184.09 telemedicine claims per 1000 Medicaid beneficiaries in April 2020 (95% CI 172.19 to 195.99) and 120.81 in July 2020 (95% CI 101.32 to 140.31) compared with those aged 18 to 34 years, seeing increases of 84.47 (95% CI 78.64 to 90.31) and 57.00 (95% CI 48.21 to 65.79), respectively. This resulted in overall changes from baseline to December 2020 levels of 123.65 (95% CI 112.79 to 134.51) for those aged 50 to 64 years compared with 59.07 (95% CI 53.89 to 64.24) for those aged 18 to 34 years. Conclusions: Older Medicaid beneficiaries in Louisiana had higher rates of telemedicine claim volume during the COVID-19 pandemic compared with younger beneficiaries. %M 37099371 %R 10.2196/46123 %U https://www.jmir.org/2023/1/e46123 %U https://doi.org/10.2196/46123 %U http://www.ncbi.nlm.nih.gov/pubmed/37099371 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46187 %T Enhancing the Cardiovascular Safety of Hemodialysis Care Using Multimodal Provider Education and Patient Activation Interventions: Protocol for a Cluster Randomized Controlled Trial %A Veinot,Tiffany Christine %A Gillespie,Brenda %A Argentina,Marissa %A Bragg-Gresham,Jennifer %A Chatoth,Dinesh %A Collins Damron,Kelli %A Heung,Michael %A Krein,Sarah %A Wingard,Rebecca %A Zheng,Kai %A Saran,Rajiv %+ School of Information, University of Michigan, 4314 North Quad, 105 S State Street, Ann Arbor, MI, 48109-1285, United States, 1 734 615 8281, tveinot@umich.edu %K hemodialysis care %K patient peer mentoring %K telehealth %K digital checklist %K team training %K cluster randomized controlled trial %K pragmatic trial %D 2023 %7 20.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: End-stage kidney disease (ESKD) is treated with dialysis or kidney transplantation, with most patients with ESKD receiving in-center hemodialysis treatment. This life-saving treatment can result in cardiovascular and hemodynamic instability, with the most common form being low blood pressure during the dialysis treatment (intradialytic hypotension [IDH]). IDH is a complication of hemodialysis that can involve symptoms such as fatigue, nausea, cramping, and loss of consciousness. IDH increases risks of cardiovascular disease and ultimately hospitalizations and mortality. Provider-level and patient-level decisions influence the occurrence of IDH; thus, IDH may be preventable in routine hemodialysis care. Objective: This study aims to evaluate the independent and comparative effectiveness of 2 interventions—one directed at hemodialysis providers and another for patients—in reducing the rate of IDH at hemodialysis facilities. In addition, the study will assess the effects of interventions on secondary patient-centered clinical outcomes and examine factors associated with a successful implementation of the interventions. Methods: This study is a pragmatic, cluster randomized trial to be conducted in 20 hemodialysis facilities in the United States. Hemodialysis facilities will be randomized using a 2 × 2 factorial design, such that 5 sites will receive a multimodal provider education intervention, 5 sites will receive a patient activation intervention, 5 sites will receive both interventions, and 5 sites will receive none of the 2 interventions. The multimodal provider education intervention involved theory-informed team training and the use of a digital, tablet-based checklist to heighten attention to patient clinical factors associated with increased IDH risk. The patient activation intervention involves tablet-based, theory-informed patient education and peer mentoring. Patient outcomes will be monitored during a 12-week baseline period, followed by a 24-week intervention period and a 12-week postintervention follow-up period. The primary outcome of the study is the proportion of treatments with IDH, which will be aggregated at the facility level. Secondary outcomes include patient symptoms, fluid adherence, hemodialysis adherence, quality of life, hospitalizations, and mortality. Results: This study is funded by the Patient-Centered Outcomes Research Institute and approved by the University of Michigan Medical School’s institutional review board. The study began enrolling patients in January 2023. Initial feasibility data will be available in May 2023. Data collection will conclude in November 2024. Conclusions: The effects of provider and patient education on reducing the proportion of sessions with IDH and improving other patient-centered clinical outcomes will be evaluated, and the findings will be used to inform further improvements in patient care. Improving the stability of hemodialysis sessions is a critical concern for clinicians and patients with ESKD; the interventions targeted to providers and patients are predicted to lead to improvements in patient health and quality of life. Trial Registration: ClinicalTrials.gov NCT03171545; https://clinicaltrials.gov/ct2/show/NCT03171545 International Registered Report Identifier (IRRID): PRR1-10.2196/46187 %M 37079365 %R 10.2196/46187 %U https://www.researchprotocols.org/2023/1/e46187 %U https://doi.org/10.2196/46187 %U http://www.ncbi.nlm.nih.gov/pubmed/37079365 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46657 %T Using User-Centered Design to Facilitate Adherence to Annual Lung Cancer Screening: Protocol for a Mixed Methods Study for Intervention Development %A Hirsch,Erin A %A Studts,Jamie L %+ Division of Medical Oncology, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, 13001 E. 17th Place, Mail Stop B189, Aurora, CO, 80045, United States, 1 303 724 1658, Erin.Hirsch@cuanschutz.edu %K health information processing %K intervention design %K lung cancer %K lung cancer screening %K LCS %K mixed methods %K photovoice %K user-centered design %D 2023 %7 14.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Lung cancer is the leading cause of cancer-related death in the United States, with the majority of lung cancer occurrence diagnosed after the disease has already metastasized. Lung cancer screening (LCS) with low-dose computed tomography can diagnose early-stage disease, especially when eligible individuals participate in screening on a yearly basis. Unfortunately, annual adherence has emerged as a challenge for academic and community screening programs, endangering the individual and population health benefits of LCS. Reminder messages have effectively increased adherence rates in breast, colorectal, and cervical cancer screenings but have not been tested with LCS participants who experience unique barriers to screening associated with the stigma of smoking and social determinants of health. Objective: This research aims to use a theory-informed, multiphase, and mixed methods approach with LCS experts and participants to develop a set of clear and engaging reminder messages to support LCS annual adherence. Methods: In aim 1, survey data informed by the Cognitive-Social Health Information Processing model will be collected to assess how LCS participants process health information aimed at health protective behavior to develop content for reminder messages and pinpoint options for message targeting and tailoring. Aim 2 focuses on identifying themes for message imagery through a modified photovoice activity that asks participants to identify 3 images that represent LCS and then participate in an interview about the selection, likes, and dislikes of each photo. A pool of candidate messages for multiple delivery platforms will be developed in aim 3, using results from aim 1 for message content and aim 2 for imagery selection. The refinement of message content and imagery combinations will be completed through iterative feedback from LCS experts and participants. Results: Data collection began in July 2022 and will be completed by May 2023. The final reminder message candidates are expected to be completed by June 2023. Conclusions: This project proposes a novel approach to facilitate adherence to annual LCS through the development of reminder messages that embrace content and imagery representative of the target population directly in the design process. Developing effective strategies to increase LCS adherence is instrumental in achieving optimal LCS outcomes at individual and population health levels. International Registered Report Identifier (IRRID): DERR1-10.2196/46657 %M 37058339 %R 10.2196/46657 %U https://www.researchprotocols.org/2023/1/e46657 %U https://doi.org/10.2196/46657 %U http://www.ncbi.nlm.nih.gov/pubmed/37058339 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46335 %T Management of Pain and Cachexia in Pancreatic Cancer: Protocol for Two Systematic Reviews, Network Meta-Analysis, Surveys, and Focus Groups %A Roberts,Danielle Amanda %A Watson,Eila %A Macdonald,Christopher %A Khan,Yarunnessa %A Prideaux,Sarah %A Puthiyakunnel Saji,Alwin %A Postaleniec,Emilia %A Selvakumar,Jashan %A Haghighat Ghahfarokhi,Mahta %A Davidson,Brian %A Gurusamy,Kurinchi %+ Division of Surgery and Interventional Science, Hampstead Campus, University College London, 9th Floor, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, United Kingdom, 44 2076792000, danielle.roberts@ucl.ac.uk %K cachexia %K pain relief %K palliative care %K pancreatic cancer %K quality of life %K systematic review %D 2023 %7 4.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background:  Approximately 75% of people with pancreatic cancer experience pain, and >50% of them have cachexia (weakness and wasting of the body). However, there is considerable uncertainty regarding the management of these distressing symptoms. Objective:  Our primary objectives are to compare the relative benefits and harms of different interventions for pain in people with unresectable pancreatic cancer and for prevention and treatment of cachexia due to pancreatic cancer, through systematic reviews and network meta-analysis. Our secondary objectives are to develop an evidence-based clinical care pathway to manage pain and prevent and treat cachexia in people with pancreatic cancer through surveys and focus groups involving patients, carers, and health care professionals. Methods:  We will perform 2 systematic reviews of the literature related to pain and cachexia in people with pancreatic cancer using searches from Cochrane Library, MEDLINE, Embase, Science Citation Index, and trial registries. Two researchers will independently screen for eligibility and identify randomized controlled trials (no language or publication status restriction), comparing interventions for pain or cachexia based on full-texts for articles shortlisted during screening. We will assess risk of bias in the trials using the Cochrane risk of bias tool (version 2.0) and obtain data related to baseline prognostic characteristics, potential effect modifiers and outcome data related to overall survival, health-related quality of life, treatment-related complications, and resource utilisation. We aim to conduct network meta-analysis on outcomes with multiple treatment comparisons where possible, otherwise, meta-analysis with direct comparisons, or narrative synthesis. We will perform various subgroup and sensitivity analyses. Using information obtained from both systematic reviews, we will conduct 2 surveys: one directed to patients or carers to assess acceptability of interventions, and the other to health care professionals to assess feasibility of delivery in the National Health Service. Four mixed focus groups will be conducted to evaluate findings and foster consensus in the development of the care pathway. Results:  Funding was awarded from April 2022 (NIHR202727). Both systematic review protocols were prospectively registered on PROSPERO in May 2022. Formal searches began thereafter. Approval by the University College London Research Ethics Committee (23563/001) was received in December 2022. Data collection began in January 2023; data analysis will begin in May 2023 (completion expected by October 2023). Conclusions:  This study will comprehensively encompass major interventions for management of pain in people with unresectable pancreatic cancer, and prevention and treatment of cachexia in people with pancreatic cancer. Key stakeholders will facilitate the development of an evidence-based care pathway, ensuring both acceptability and feasibility. The project ends in April 2024 and published results are expected within 12 months of completion. We aim to present the findings through patient group websites, conferences, and publications, irrespective of the findings, in a peer-reviewed journal. International Registered Report Identifier (IRRID): DERR1-10.2196/46335 %M 37014692 %R 10.2196/46335 %U https://www.researchprotocols.org/2023/1/e46335 %U https://doi.org/10.2196/46335 %U http://www.ncbi.nlm.nih.gov/pubmed/37014692 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e39904 %T Regional Differences in Medical Costs of Chronic Kidney Disease in the South Korean Population: Marginalized Two-Part Model %A Park,Minah %A Yun,Choa %A Joo,Jae Hong %A Kang,Soo Hyun %A Jeong,Sung Hoon %A Nam,Chung-Mo %A Park,Eun-Cheol %A Han,Yoondae %A Jang,Sung In %+ Department of Preventive Medicine, College of Medicine, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 1863, jangsi@yuhs.ac %K chronic kidney disease %K cost analysis %K medical expenses %K medically vulnerable regions %K kidney %K public health %K cost %K economic %K chronic disease %K insurance %K regional %K longitudinal model %D 2023 %7 30.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: There are regional gaps in the access to medical services for patients with chronic kidney disease (CKD), and it is necessary to reduce those gaps, including the gaps involving medical costs. Objective: This study aimed to analyze regional differences in the medical costs associated with CKD in the South Korean population. Methods: This longitudinal cohort study included participants randomly sampled from the National Health Insurance Service-National Sample Cohort of South Korea. To select those who were newly diagnosed with CKD, we excluded those who were diagnosed in 2002-2003 and 2018-2019. A total of 5903 patients with CKD were finally included. We used a marginalized two-part longitudinal model to assess total medical costs. Results: Our cohort included 4775 (59.9%) men and 3191 (40.1%) women. Of these, 971 (12.2%) and 6995 (87.8%) lived in medically vulnerable and nonvulnerable regions, respectively. The postdiagnosis costs showed a significant difference between the regions (estimate: –0.0152, 95% confidence limit: –0.0171 to –0.0133). The difference in medical expenses between the vulnerable and nonvulnerable regions showed an increase each year after the diagnosis. Conclusions: Patients with CKD living in medically vulnerable regions are likely to have higher postdiagnostic medical expenses compared to those living in regions that are not medically vulnerable. Efforts to improve early diagnosis of CKD are needed. Relevant policies should be drafted to decrease the medical costs of patients with CKD disease living in medically deprived areas. %M 36995749 %R 10.2196/39904 %U https://publichealth.jmir.org/2023/1/e39904 %U https://doi.org/10.2196/39904 %U http://www.ncbi.nlm.nih.gov/pubmed/36995749 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45211 %T Perceptions About Augmented Reality in Remote Medical Care: Interview Study of Emergency Telemedicine Providers %A Dinh,Alana %A Tseng,Emily %A Yin,Andrew Lukas %A Estrin,Deborah %A Greenwald,Peter %A Fortenko,Alexander %+ Medical College, Weill Cornell Medicine, 1300 York Avenue, New York, NY, 10021, United States, 1 212 746 1067, ald4006@med.cornell.edu %K augmented reality %K telemedicine %K telehealth %K emergency medicine %K education %K mobile phone %D 2023 %7 28.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Augmented reality (AR) and virtual reality (VR) have increasingly appeared in the medical literature in the past decade, with AR recently being studied for its potential role in remote health care delivery and communication. Recent literature describes AR’s implementation in real-time telemedicine contexts across multiple specialties and settings, with remote emergency services in particular using AR to enhance disaster support and simulation education. Despite the introduction of AR in the medical literature and its potential to shape the future of remote medical services, studies have yet to investigate the perspectives of telemedicine providers regarding this novel technology. Objective: This study aimed to understand the applications and challenges of AR in telemedicine anticipated by emergency medicine providers with a range of experiences in using telemedicine and AR or VR technology. Methods: Across 10 academic medical institutions, 21 emergency medicine providers with variable exposures to telemedicine and AR or VR technology were recruited for semistructured interviews via snowball sampling. The interview questions focused on various potential uses of AR, anticipated obstacles that prevent its implementation in the telemedicine area, and how providers and patients might respond to its introduction. We included video demonstrations of a prototype using AR during the interviews to elicit more informed and complete insights regarding AR’s potential in remote health care. Interviews were transcribed and analyzed via thematic coding. Results: Our study identified 2 major areas of use for AR in telemedicine. First, AR is perceived to facilitate information gathering by enhancing observational tasks such as visual examination and granting simultaneous access to data and remote experts. Second, AR is anticipated to supplement distance learning of both minor and major procedures and nonprocedural skills such as cue recognition and empathy for patients and trainees. AR may also supplement long-distance education programs and thereby support less specialized medical facilities. However, the addition of AR may exacerbate the preexisting financial, structural, and literacy barriers to telemedicine. Providers seek value demonstrated by extensive research on the clinical outcome, satisfaction, and financial benefits of AR. They also seek institutional support and early training before adopting novel tools such as AR. Although an overall mixed reception is anticipated, consumer adoption and awareness are key components in AR’s adoption. Conclusions: AR has the potential to enhance the ability to gather observational and medical information, which would serve a diverse set of applications in remote health care delivery and education. However, AR faces obstacles similar to those faced by the current telemedicine technology, such as lack of access, infrastructure, and familiarity. This paper discusses the potential areas of investigation that would inform future studies and approaches to implementing AR in telemedicine. %M 36976628 %R 10.2196/45211 %U https://formative.jmir.org/2023/1/e45211 %U https://doi.org/10.2196/45211 %U http://www.ncbi.nlm.nih.gov/pubmed/36976628 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44711 %T The Use of Digital Health Services Among Patients and Citizens Living at Home: Scoping Review %A Rosenlund,Milla %A Kinnunen,Ulla-Mari %A Saranto,Kaija %+ Department of Health and Social Management, University of Eastern Finland, PO Box 1627, Kuopio, FIN-70211, Finland, 358 407436486, milla.rosenlund@uef.fi %K health technology %K telemedicine %K digital %K health services %K patient care %K home %K review %D 2023 %7 27.3.2023 %9 Review %J J Med Internet Res %G English %X Background: The development of digital health services reflects not only the technical development of services but also a change in attitude and the way of thinking. It has become a cornerstone for engaging and activating patients and citizens in health management while living at home. Digital health services are also aimed at enhancing the efficiency and quality of services, while simultaneously providing services more cost-effectively. In 2020, the COVID-19 pandemic accelerated worldwide the development and use of digital services in response to requirements for social distancing and other regulations. Objective: The aim of this review is to identify and summarize how digital health services are being used among patients and citizens while living at home. Methods: The Joanna Briggs Institute (JBI) methodology for scoping reviews was used as guidance. A search conducted in 3 databases (CINAHL, PubMed, Scopus) resulted in 419 papers. The reporting was conducted by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review (PRISMA-ScR), and the analysis of the included papers was performed using a framework consisting of 5 clusters describing the use of digital health services. After screening and excluding papers that did not match the inclusion criteria, 88 (21%) papers from 2010 to 2022 were included in the final analysis. Results: Results indicated that digital health services are used in different situations and among different kinds of populations. In most studies, digital health services were used in the form of video visits or consultations. The telephone was also used regularly for consultations. Other services, such as remote monitoring and transmitting of recorded information and the use the of internet or portals for searching information, were observed as well. Alerts, emergency systems, and reminders were observed to offer possibilities of use, for example, among older people. The digital health services also showed to have potential for use in patient education. Conclusions: The development of digital services reflects a shift toward the provision of care regardless of time and place. It also reflects a shift toward emphasis on patient-centered care, meaning activating and engaging patients in their own care as they use digital services for various health-related purposes. Despite the development of digital services, many challenges (eg, adequate infrastructure) still prevail worldwide. %M 36972122 %R 10.2196/44711 %U https://www.jmir.org/2023/1/e44711 %U https://doi.org/10.2196/44711 %U http://www.ncbi.nlm.nih.gov/pubmed/36972122 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e39967 %T Optimizing the Quality of Clinical Data in an Australian Aged Care and Disability Service to Improve Care Delivery and Clinical Outcomes: Protocol for an Agile Lean Six Sigma Study %A Troeung,Lakkhina %A Tshering,Gap %A Walton,Rebecca %A Martini,Angelita %A Roberts,Martin %+ Brightwater Research Centre, Brightwater Care Group, 2A Walter Road West, Inglewood, 6052, Australia, 61 0892022800, lakkhina.troeung@brightwatergroup.com %K aged care %K disability %K information technology %K data %K quality %K health services %D 2023 %7 27.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: In Australia, aged care and disability service providers are legally required to maintain comprehensive and accurate clinical documentation to meet regulatory and funding requirements and support safe and high-quality care provision. However, evidence suggests that poor-quality clinical data and documentation are widespread across the sector and can substantially affect clinical decision-making and care delivery and increase business costs. Objective: In the Optimizing the Quality of Clinical Data in an Australian Aged Care and Disability Service to Improve Care Delivery and Clinical Outcomes (OPTIMISE) study, we aim to use an Agile Lean Six Sigma framework to identify opportunities for the optimization of clinical documentation processes and clinical information systems, implement and test optimization solutions, and evaluate postoptimization outcomes in a large postacute community-based health service providing aged care and disability services in Western Australia. Methods: A 3-stage prospective optimization study will be conducted. Stage 1 (baseline [T0]) will measure existing clinical data quality, identify root causes of data quality issues across services, and generate optimization solutions. Stage 2 (optimization) will implement and test changes to clinical documentation processes and information systems using incremental Agile sprints. Stage 3 (evaluation) will evaluate changes in primary and secondary outcomes from T0 to 12 months after optimization. The primary outcome is the data quality measured in terms of defects per unit, defects per million opportunities, and Sigma level. The secondary outcomes are care delivery (direct care time), clinical incidents, business outcomes (cost of quality and workforce productivity), and user satisfaction. Case studies will be analyzed to understand the impact of optimization on clinical outcomes and business processes. Results: As of June 1, 2022, stage 1 commenced with T0 data quality audits conducted to measure current data quality. T0 data quality audits will be followed by user consultations to identify root causes of data quality issues. Optimization solutions will be developed by May 2023 to inform optimization (stage 2) and evaluation (stage 3). Results are expected to be published in June 2023. Conclusions: The study findings will be of interest to individuals and organizations in the health care sector seeking novel solutions to improve the quality of clinical data, support high-quality care delivery, and reduce business costs. International Registered Report Identifier (IRRID): DERR1-10.2196/39967 %M 36622197 %R 10.2196/39967 %U https://www.researchprotocols.org/2023/1/e39967 %U https://doi.org/10.2196/39967 %U http://www.ncbi.nlm.nih.gov/pubmed/36622197 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e45898 %T Prediction of Male Coronary Artery Bypass Grafting Outcomes Using Body Surface Area Weighted Left Ventricular End-diastolic Diameter: Multicenter Retrospective Cohort Study %A Zhu,Zhihui %A Li,Yuehuan %A Zhang,Fan %A Steiger,Stefanie %A Guo,Cheng %A Liu,Nan %A Lu,Jiakai %A Fan,Guangpu %A Wu,Wenbo %A Wu,Mingying %A Wang,Huaibin %A Xu,Dong %A Chen,Yu %A Zhu,Junming %A Meng,Xu %A Hou,Xiaotong %A Anders,Hans-Joachim %A Ye,Jian %A Zheng,Zhe %A Li,Chenyu %A Zhang,Haibo %+ Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China, 86 13370103561, zhanghb2318@163.com %K body surface area %K BSA %K left ventricular end-diastolic diameter %K LVEDD %K coronary artery bypass grafting %K CABG %K outcomes %D 2023 %7 23.3.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: The presence of a high left ventricular end-diastolic diameter (LVEDD) has been linked to a less favorable outcome in patients undergoing coronary artery bypass grafting (CABG) procedures. However, by taking into consideration the reference of left ventricular size and volume measurements relative to the patient's body surface area (BSA), it has been suggested that the accuracy of the predicting outcomes may be improved. Objective: We propose that BSA weighted LVEDD (bLVEDD) is a more accurate predictor of outcomes in patients undergoing CABG compared to simply using LVEDD alone. Methods: This study was a comprehensive retrospective cohort study that was conducted across multiple medical centers. The inclusion criteria for this study were patients who were admitted for treatment between October 2016 and May 2021. Only elective surgery patients were included in the study, while those undergoing emergency surgery were not considered. All participants in the study received standard care, and their clinical data were collected through the institutional registry in accordance with the guidelines set forth by the Society of Thoracic Surgeons National Adult Cardiac Database. bLVEDD was defined as LVEDD divided by BSA. The primary outcome was in-hospital all-cause mortality (30 days), and the secondary outcomes were postoperative severe adverse events, including use of extracorporeal membrane oxygenation, multiorgan failure, use of intra-aortic balloon pump, postoperative stroke, and postoperative myocardial infarction. Results: In total, 9474 patients from 5 centers under the Chinese Cardiac Surgery Registry were eligible for analysis. We found that a high LVEDD was a negative factor for male patients’ mortality (odds ratio 1.44, P<.001) and secondary outcomes. For female patients, LVEDD was associated with secondary outcomes but did not reach statistical differences for morality. bLVEDD showed a strong association with postsurgery mortality (odds ratio 2.70, P<.001), and secondary outcomes changed in parallel with bLVEDD in male patients. However, bLVEDD did not reach statistical differences when fitting either mortality or severer outcomes in female patients. In male patients, the categorical bLVEDD showed high power to predict mortality (area under the curve [AUC] 0.71, P<.001) while BSA (AUC 0.62) and LVEDD (AUC 0.64) both contributed to the risk of mortality but were not as significant as bLVEDD (P<.001). Conclusions: bLVEDD is an important predictor for male mortality in CABG, removing the bias of BSA and showing a strong capability to accurately predict mortality outcomes. Trial Registration: ClinicalTrials.gov NCT02400125; https://clinicaltrials.gov/ct2/show/NCT02400125 %M 36951893 %R 10.2196/45898 %U https://www.i-jmr.org/2023/1/e45898 %U https://doi.org/10.2196/45898 %U http://www.ncbi.nlm.nih.gov/pubmed/36951893 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43759 %T Effects of COVID-19 Acute Respiratory Distress Syndrome Intensive Care Unit Survivor Telemedicine Clinic on Patient Readmission, Pain Perception, and Self-Assessed Health Scores: Randomized, Prospective, Single-Center, Exploratory Study %A Balakrishnan,Bathmapriya %A Hamrick,Lucas %A Alam,Ariful %A Thompson,Jesse %+ Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, West Virginia University, 64 Medical Center Drive, PO Box 9166, Morgantown, WV, 26505, United States, 1 937 304 8855, p.bala1286@gmail.com %K acute respiratory distress syndrome %K aftercare %K COVID-19 pneumonia %K critical care %K survivor %K telemedicine %D 2023 %7 22.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Post-intensive care syndrome (PICS) affects up to 50% of intensive care unit (ICU) survivors, leading to long-term neurocognitive, psychosocial, and physical impairments. Approximately 80% of COVID-19 pneumonia ICU patients are at elevated risk for developing acute respiratory distress syndrome (ARDS). Survivors of COVID-19 ARDS are at high risk of unanticipated health care utilization postdischarge. This patient group commonly has increased readmission rates, long-term decreased mobility, and poorer outcomes. Most multidisciplinary post-ICU clinics for ICU survivors are in large urban academic medical centers providing in-person consultation. Data are lacking on the feasibility of providing telemedicine post-ICU care for COVID-19 ARDS survivors. Objective: We explored the feasibility of instituting a COVID-19 ARDS ICU survivor telemedicine clinic and examined its effect on health care utilization post-hospital discharge. Methods: This randomized, unblinded, single-center, parallel-group, exploratory study was conducted at a rural, academic medical center. Study group (SG) participants underwent a telemedicine visit within 14 days of discharge, during which a 6-minute walk test (6MWT), EuroQoL 5-Dimension (EQ-5D) questionnaire, and vital signs logs were reviewed by an intensivist. Additional appointments were arranged as needed based on the outcome of this review and tests. The control group (CG) underwent a telemedicine visit within 6 weeks of discharge and completed the EQ-5D questionnaire; additional care was provided as needed based on findings in this telemedicine visit. Results: Both SG (n=20) and CG (n=20) participants had similar baseline characteristics and dropout rate (10%). Among SG participants, 72% (13/18) agreed to pulmonary clinic follow-up, compared with 50% (9/18) of CG participants (P=.31). Unanticipated visits to the emergency department occurred for 11% (2/18) of the SG compared with 6% (1/18) of the CG (>.99). The rate of pain or discomfort was 67% (12/18) in the SG compared with 61% (11/18) in the CG (P=.72). The anxiety or depression rate was 72% (13/18) in the SG versus 61% (11/18; P=.59) in the CG. Participants’ mean self-assessed health rating scores were 73.9 (SD 16.1) in the SG compared with 70.6 (SD 20.9) in the CG (P=.59). Both primary care physicians (PCPs) and participants in the SG perceived the telemedicine clinic as a favorable model for postdischarge critical illness follow-up in an open-ended questionnaire regarding care. Conclusions: This exploratory study found no statistically significant results in reducing health care utilization postdischarge and health-related quality of life. However, PCPs and patients perceived telemedicine as a feasible and favorable model for postdischarge care among COVID-19 ICU survivors to facilitate expedited subspecialty assessment, decrease unanticipated postdischarge health care utilization, and reduce PICS. Further investigation is warranted to determine the feasibility of incorporating telemedicine-based post-hospitalization follow-up for all medical ICU survivors that may show improvement in health care utilization in a larger population. %M 36877802 %R 10.2196/43759 %U https://formative.jmir.org/2023/1/e43759 %U https://doi.org/10.2196/43759 %U http://www.ncbi.nlm.nih.gov/pubmed/36877802 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44219 %T Strengthening Addiction Care Continuum Through Community Consortium in Vietnam: Protocol for a Cluster-Randomized Controlled Trial %A Li,Li %A Nguyen,Tuan Anh %A Liang,Li-Jung %A Lin,Chunqing %A Pham,Thang Hong %A Nguyen,Ha Thi Thanh %A Kha,Steven %+ University of California, Los Angeles, 10920 Wilshire Blvd, Suite 350, Los Angeles, CA, 90024, United States, 1 3107942446, lililili@ucla.edu %K addiction service %K community consortium %K drug addiction %K health care worker %K health %K family %K Vietnam %D 2023 %7 22.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: A chronic condition, drug addiction, requires long-term multipronged health care and treatment services. Community-based approaches can offer the advantages of managing integrated care along the care continuum and improving clinical outcomes. However, scant rigorous research focuses on sustainable, community-based care and service delivery. Objective: This protocol describes a study aiming to develop and test an intervention that features the alliance of community health workers and family members to provide integrated support and individualized services and treatment for people who use drugs (PWUD) in community settings. Methods: Based on the National Institute on Drug Abuse’s Seek-Test-Treat-Retain (STTR) framework, an intervention that provides training to community health workers will be developed and piloted before an intervention trial. Trained community health workers will conduct home visits and provide support for PWUD and their families. The intervention trial will be conducted in 3 regions in Vietnam, with 60 communities (named communes). These communes will be randomized to either an intervention or control condition. Intervention outcomes will be evaluated at baseline and at 3, 6, 9, and 12 months. The primary outcome measure is PWUD’s STTR fulfillment, consisting of multiple individual fulfillment indicators across 5 domains: Seek, Test, Treat, Retain, and Health. The secondary outcomes of interest are the community health workers’ service provision and family members’ support. The primary analysis will follow an intention-to-treat approach. Generalized mixed-effects regression models will be used to compare changes in the outcome measures from baseline between intervention and control conditions. Results: During the first year of the project, we conducted formative studies, including in-depth interviews and focus groups, to identify service barriers and intervention strategies. The intervention and assessment pilots are scheduled in 2023 before commencing the trial. Reports based on the baseline data will be distributed in early 2024. The intervention outcome results will be available within 6 months of the final data collection date, that is, the main study findings are expected to be available in early 2026. Conclusions: This study will inform the establishment of community health workers and family members alliance, a locally available infrastructure, to support addiction services and care for PWUD. The methodology, findings, and lessons learned are expected to shed light on the addiction service continuum’s implementation and demonstrate a community-based addiction service delivery model that can be transferable to other countries. Trial Registration: ClinicalTrials.gov NCT05315492; https://clinicaltrials.gov/ct2/show/NCT05315492 International Registered Report Identifier (IRRID): DERR1-10.2196/44219 %M 36947125 %R 10.2196/44219 %U https://www.researchprotocols.org/2023/1/e44219 %U https://doi.org/10.2196/44219 %U http://www.ncbi.nlm.nih.gov/pubmed/36947125 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40956 %T Association Between Internet Use and Physical Health, Mental Health, and Subjective Health in Middle-aged and Older Adults: Nationally Representative Cross-sectional Survey in China %A Wen,Wen %A Zhang,Yaru %A Shi,Wenjie %A Li,Jiajia %+ School of Public Health, Shandong University, No.44, West Culture Road, Jinan, 250012, China, 86 88382269 ext 612, lijiajia@sdu.edu.cn %K internet use %K health status %K middle-aged and older adults %K China %D 2023 %7 21.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet use is an important means of accessing health-related information. Identifying the associations between internet use and health outcomes could provide insight into strategies for improving public health among middle-aged and older adults (45 years and up). Objective: This study aimed to examine the relationship between internet use and health outcomes in middle-aged and older adults. Methods: Data were obtained from the 2018 China Health and Retirement Longitudinal Study. Physical, mental, and subjective health were assessed using the Activities of Daily Living (ADL) Scale, the 10-item Center for Epidemiologic Studies Depression Scale, and the 3-level Self-Rated Health Scale, respectively. The chi-square test and rank sum test were used to explore whether internet use was associated with health status. A multivariate logistic regression model was used to determine this association further after controlling for the confounding factors. Results: Overall, 13% (1752/13,474) of the participants used the internet. Regression analyses revealed that the prevalence of depression (odds ratio [OR] 0.59, 95% CI 0.52-0.68; P<.001), negative self-rated health (OR 0.68, 95% CI 0.61-0.76; P<.001), and difficulty with ADL (OR 0.48, 95% CI 0.39-0.60; P<.001) in the participating middle-aged and older adult was lower in those using the internet than nonusers. After controlling for confounding factors, internet use was found to be negatively associated with difficulty with ADL (urban: OR 0.44, 95% CI 0.32-0.61; P<.001 vs rural: OR 0.55, 95% CI 0.41-0.75; P<.001), depression (urban: OR 0.69, 95% CI 0.57-0.84; P<.001 vs rural: OR 0.52, 95% CI: 0.43-0.63; P<.001), and self-rated health status (urban: OR 0.70, 95% CI 0.61-0.81; P<.001 vs rural: OR 0.67, 95% CI 0.57-0.78; P<.001) among middle-aged and older adults in both urban and rural areas. Conclusions: Internet use had a positive effect on the physical and mental health of middle-aged and older adults who participated in this study. However, the internet usage rate remains low among older Chinese people. Therefore, the internet penetration rate should be a priority. %M 36943368 %R 10.2196/40956 %U https://www.jmir.org/2023/1/e40956 %U https://doi.org/10.2196/40956 %U http://www.ncbi.nlm.nih.gov/pubmed/36943368 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44832 %T Evaluation and Management of Dyspnea in Hypermobile Ehlers-Danlos Syndrome and Generalized Hypermobility Spectrum Disorder: Protocol for a Pilot and Feasibility Randomized Controlled Trial %A Rozenberg,Dmitry %A Al Kaabi,Noor %A Camacho Perez,Encarna %A Nourouzpour,Sahar %A Lopez-Hernandez,Laura %A McGillis,Laura %A Goligher,Ewan %A Reid,W Darlene %A Chow,Chung-Wai %A Ryan,Clodagh M %A Kumbhare,Dinesh %A Huszti,Ella %A Champagne,Kateri %A Raj,Satish %A Mak,Susanna %A Santa Mina,Daniel %A Clarke,Hance %A Mittal,Nimish %+ Respirology and Lung Transplantation, Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, ON, M4G 2C4, Canada, 1 416 340 4800 ext 7358, dmitry.rozenberg@uhn.ca %K Ehlers-Danlos Syndrome %K generalized hypermobility spectrum disorders %K inspiratory muscle training %K rehabilitation %K exercise %K mobile phone %D 2023 %7 20.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Dyspnea is a prevalent symptom in individuals with hypermobile Ehlers-Danlos Syndrome (hEDS) and generalized hypermobility spectrum disorder (G-HSD), yet its contributors have not been identified. One known contributor to dyspnea is respiratory muscle weakness. The feasibility and effectiveness of inspiratory muscle training (IMT) in combination with standard-of-care rehabilitation (aerobic, resistance, neuromuscular stabilization, and balance and proprioception exercises) in improving respiratory muscle strength and patient-reported outcomes in patients with hEDS or G-HSD have not been evaluated. Objective: This study aims to evaluate dyspnea, respiratory muscle strength, and patient-reported outcome measures (PROMs) in hEDS or G-HSD compared with healthy controls and to assess the feasibility of a randomized controlled trial of IMT and standard-of-care rehabilitation for improving respiratory muscle strength, exercise capacity, and PROMs compared with standard-of-care rehabilitation in hEDS and G-HSD. Methods: The study will include 34 participants with hEDS or G-HSD and 17 healthy, age- and sex-matched controls to compare respiratory muscle structure and function and PROMs. After baseline assessments, participants with hEDS or G-HSD will be randomized into the intervention group and provided IMT combined with Ehlers-Danlos Syndrome standard-of-care rehabilitation or into the usual care group, and provided only standard-of-care rehabilitation for 8 weeks. The intervention group will be prescribed IMT in their home environment using the POWERbreathe K5 IMT device (POWERbreathe International Ltd). IMT will comprise 2 daily sessions of 30 breaths for 5 days per week, with IMT progressing from 20% to 60% of the baseline maximal inspiratory pressure (MIP) over an 8-week period. Feasibility will be assessed through rates of recruitment, attrition, adherence, adverse events, and participant satisfaction. The primary pilot outcome is MIP change over an 8-week period in hEDS or G-HSD. Secondary outcomes will include the evaluation of dyspnea using Medical Research Council Scale and 18-point qualitative dyspnea descriptors; diaphragmatic thickening fraction using ultrasound; respiratory muscle endurance; pulmonary function; prefrontal cortical activity using functional near-infrared spectroscopy; aerobic capacity during cardiopulmonary exercise testing; quality of life using Short Form-36; and scores from the Depression, Anxiety, and Stress scale-21. These measures will also be performed once in healthy controls to compare normative values. Multivariable regression will be used to assess the contributors to dyspnea. Paired 2-tailed t tests will be used to assess the changes in MIP and secondary measures after 8 weeks of IMT. Results: Study recruitment began in August 2021 and, with several disruptions owing to COVID-19, is expected to be completed by December 2023. Conclusions: This study will provide a better understanding of the factors associated with dyspnea and the feasibility and effectiveness of IMT combined with standard-of-care rehabilitation. IMT may be a novel therapeutic strategy for improving respiratory muscle function and patient-reported outcomes in individuals with hEDS or G-HSD. Trial Registration: ClinicalTrials.gov NCT04972565; https://clinicaltrials.gov/ct2/show/NCT04972565 International Registered Report Identifier (IRRID): DERR1-10.2196/44832 %M 36939815 %R 10.2196/44832 %U https://www.researchprotocols.org/2023/1/e44832 %U https://doi.org/10.2196/44832 %U http://www.ncbi.nlm.nih.gov/pubmed/36939815 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38932 %T Web-Based Public Ratings of General Practitioners in Norway: Validation Study %A Bjertnæs,Øyvind %A Iversen,Hilde Hestad %A Norman,Rebecka %A Valderas,Jose M %+ Norwegian Institute of Public Health, Sandakerveien 24c, Bygg D, Oslo, 0473, Norway, 47 91176045, oyvindandresen.bjertnaes@fhi.no %K web-based rating %K questionnaire %K psychometric %K patient-reported experiences and satisfaction %K survey %K health care %K practitioner %K doctor rating %K physician rating %K patient provider %K patient experience %K patient satisfaction %D 2023 %7 17.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Understanding the complex relationships among multiple strategies for gathering users’ perspectives in the evaluation of the performance of services is crucial for the interpretation of user-reported measures. Objective: The main objectives were to (1) evaluate the psychometric performance of an 11-item web-based questionnaire of ratings of general practitioners (GPs) currently used in Norway (Legelisten.no) and (2) assess the association between web-based and survey-based patient experience indicators. Methods: We included all published ratings on GPs and practices on Legelisten.no in the period of May 5, 2012, to December 15, 2021 (N=76,521). The questionnaire consists of 1 mandatory item and 10 voluntary items with 5 response categories (1 to 5 stars), alongside an open-ended review question and background variables. Questionnaire dimensionality and internal consistency were assessed with Cronbach α, exploratory factor, and item response theory analyses, and a priori hypotheses were developed for assessing construct validity (chi-square analysis). We calculated Spearman correlations between web-based ratings and reference patient experience indicators based on survey data using the patient experiences with the GP questionnaire (n=5623 respondents for a random sample of 50 GPs). Results: Web-based raters were predominantly women (n=32,074, 64.0%), in the age range of 20-50 years (n=35,113, 74.6%), and reporting 5 or fewer consultations with the GP each year (n=28,798, 64.5%). Ratings were missing for 18.9% (n=14,500) to 27.4% (n=20,960) of nonmandatory items. A total of 4 of 11 rating items showed a U-shaped distribution, with >60% reporting 5 stars. Factor analysis and internal consistency testing identified 2 rating scales: “GP” (5 items; α=.98) and “practice” (6 items; α=.85). Some associations were not consistent with a priori hypotheses and allowed only partial confirmation of the construct validity of ratings. Item response theory analysis results were adequate for the “practice” scale but not for the “GP” scale, with items with inflated discrimination (>5) distributed over a narrow interval of the scale. The correlations between the web-based ratings GP scale and GP reference indicators ranged from 0.34 (P=.021) to 0.44 (P=.002), while the correlation between the web-based ratings practice scale and reference indicators ranged from 0.17 (not significant) to 0.49 (P<.001). The strongest correlations between web-based and survey scores were found for items measuring practice-related experiences: phone availability (ρ=0.51), waiting time in the office (ρ=0.62), other staff (ρ=0.54-0.58; P<.001). Conclusions: The practice scale of the web-based ratings has adequate psychometric performance, while the GP suffers from important limitations. The associations with survey-based patient experience indicators were accordingly mostly weak to modest. Our study underlines the importance of interpreting web-based ratings with caution and the need to further develop rating sites. %M 36930207 %R 10.2196/38932 %U https://formative.jmir.org/2023/1/e38932 %U https://doi.org/10.2196/38932 %U http://www.ncbi.nlm.nih.gov/pubmed/36930207 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45064 %T The Influence of a Wearable-Based Reward Program on Health Care Costs: Retrospective, Propensity Score–Matched Cohort Study %A Zaleski,Amanda %A Sigler,Brittany %A Leggitt,Alan %A Choudhary,Shruti %A Berns,Ryan %A Rhee,Kyu %A Schwarzwald,Heidi %+ Clinical Evidence Development, Aetna Medical Affairs, CVS Health, 151 Farmington Avenue, Hartford, CT, 06156, United States, 1 8024898816, zaleskia@aetna.com %K digital health intervention %K mobile app %K wellness %K physical activity %K wearable %K cost-effectiveness %K mobile health app %K health plan %K medical cost %K health care cost %D 2023 %7 14.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health (mHealth) technology holds great promise as an easily accessible and effective solution to improve population health at scale. Despite the abundance of mHealth offerings, only a minority are grounded in evidence-based practice, whereas even fewer have line of sight into population-level health care spending, limiting the clinical utility of such tools. Objective: This study aimed to explore the influence of a health plan–sponsored, wearable-based, and reward-driven digital health intervention (DHI) on health care spending over 1 year. The DHI was delivered through a smartphone-based mHealth app available only to members of a large commercial health plan and leveraged a combination of behavioral economics, user-generated sensor data from the connected wearable device, and claims history to create personalized, evidence-based recommendations for each user. Methods: This study deployed a propensity score–matched, 2-group, and pre-post observational design. Adults (≥18 years of age) enrolled in a large, national commercial health plan and self-enlisted in the DHI for ≥7 months were allocated to the intervention group (n=56,816). Members who were eligible for the DHI but did not enlist were propensity score–matched to the comparison group (n=56,816). Average (and relative change from baseline) medical and pharmacy spending per user per month was computed for each member of the intervention and comparison groups during the pre- (ie, 12 months) and postenlistment (ie, 7-12 months) periods using claims data. Results: Baseline characteristics and medical spending were similar between groups (P=.89). On average, the total included sample population (N=113,632) consisted of young to middle-age (mean age 38.81 years), mostly White (n=55,562, 48.90%), male (n=46,731, 41.12%) and female (n=66,482, 58.51%) participants. Compared to a propensity score–matched cohort, DHI users demonstrated approximately US $10 per user per month lower average medical spending (P=.02) with a concomitant increase in preventive care activities and decrease in nonemergent emergency department admissions. These savings translated to approximately US $6.8 million in avoidable health care costs over the course of 1 year. Conclusions: This employer-sponsored, digital health engagement program has a high likelihood for return on investment within 1 year owing to clinically meaningful changes in health-seeking behaviors and downstream medical cost savings. Future research should aim to elucidate health behavior–related mechanisms in support of these findings and continue to explore novel strategies to ensure equitable access of DHIs to underserved populations that stand to benefit the most. %M 36917152 %R 10.2196/45064 %U https://www.jmir.org/2023/1/e45064 %U https://doi.org/10.2196/45064 %U http://www.ncbi.nlm.nih.gov/pubmed/36917152 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e39568 %T Peritoneal Dialysis Care in Mainland China: Nationwide Survey %A Li,Ping %A Cao,Xueying %A Liu,Weicen %A Zhao,Delong %A Pan,Sai %A Sun,Xuefeng %A Cai,Guangyan %A Zhou,Jianhui %A Chen,Xiangmei %+ Department of Nephrology, First Medical Center of Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China, 86 66935462, xmchen301@126.com %K renal replacement therapy %K peritoneal dialysis %K medical quality %K tertiary hospital %K secondary hospital %K China %D 2023 %7 14.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Peritoneal dialysis (PD) care in mainland China has been progressing in the past 10 years. Objective: To complement information from the dialysis registry, a large-scale nationwide survey was conducted to investigate the current infrastructure and management of PD care at hospitals of different tiers. Methods: A web-based multiple-choice questionnaire was distributed through the National Center for Nephrology Medical Quality Management and Control to PD centers of secondary and tertiary hospitals in October 2020. The 2-part survey collected the information of PD centers and the clinical management of patients on PD. A total of 788 effective surveys from 746 hospitals were voluntarily returned, and data were extracted and analyzed. Results: The effective survey data covered 101,537 patients on PD, with 95% (96,460/101,537) in the tertiary hospitals. The median number of patients per PD center was 60 (IQR 21-152); this number was 32 (IQR 8-65) and 70 (IQR 27-192) for secondary and tertiary hospitals, respectively. There was a discrepancy in the availability of designated physical areas for different functions of PD care between the secondary and tertiary hospitals. The proportion of tertiary hospitals with PD training (P=.01), storage (P=.09), and procedure area (P<.001) was higher compared to secondary hospitals. PD catheter placement was performed in 96% (608/631) of the PD centers in tertiary hospitals, which was significantly higher compared to 86% (99/115) in secondary hospitals (P<.001). Automated PD was available in 55% (347/631) of the tertiary hospitals, which was significantly higher than that in secondary hospitals (37/115, 32%) according to the survey (P<.001). The most commonly performed PD module was continuous ambulatory peritoneal dialysis (772/788, 98%), followed by intermittent peritoneal dialysis (543/788, 69%). The overall reported nocturnal intermittent peritoneal dialysis was 31% (244/788); it was 28% (220/788) for continuous cycling peritoneal dialysis and 15% (118/788) for tidal peritoneal dialysis. Comparisons between the secondary and tertiary hospitals revealed no significant differences in prophylactic antibiotic use for PD catheter placement and therapeutic use for peritonitis. The first peritoneal equilibrium test was conducted in 58% (454/788) of patients at 4-6 weeks after initiation of PD, and 91% (718/788) reported at least one peritoneal equilibrium test per year. Overall, 79% (570/722) and 65% (469/722) of PD centers performed assessment for dialysis adequacy and residual kidney function, respectively; and 87% (685/788) of patients on PD were followed every 1 to 3 months for laboratory and auxiliary examinations. Conclusions: This national survey reflects the current status and disparities of PD center management in mainland China. The study results suggest that the PD care needs to be more conveniently accessible in secondary hospitals, and quality management and staff training in secondary hospitals are still in high demand. %M 36917165 %R 10.2196/39568 %U https://publichealth.jmir.org/2023/1/e39568 %U https://doi.org/10.2196/39568 %U http://www.ncbi.nlm.nih.gov/pubmed/36917165 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44172 %T Health System–Level Barriers to Living Donor Kidney Transplantation: Protocol for a Comparative Case Study Analysis %A Horton,Anna %A Loban,Katya %A Nugus,Peter %A Fortin,Marie-Chantal %A Gunaratnam,Lakshman %A Knoll,Greg %A Mucsi,Istvan %A Chaudhury,Prosanto %A Landsberg,David %A Paquet,Michel %A Cantarovich,Marcelo %A Sandal,Shaifali %+ Research Institute of the McGill University Health Centre, 1001 Boul Decarie d05-7160, Montreal, QC, H4A 3J1, Canada, 1 5149341934, shaifali.sandal@mcgill.ca %K transplantation %K living donor kidney transplantation %K health systems %K barriers %K resource based theory %K complex adaptive systems %D 2023 %7 7.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Living donor kidney transplantation (LDKT) is the best treatment option for patients with kidney failure and offers significant medical and economic advantages for both patients and health systems. Despite this, rates of LDKT in Canada have stagnated and vary significantly across Canadian provinces, the reasons for which are not well understood. Our prior work has suggested that system-level factors may be contributing to these differences. Identifying these factors can help inform system-level interventions to increase LDKT. Objective: Our objective is to generate a systemic interpretation of LDKT delivery across provincial health systems with variable performance. We aim to identify the attributes and processes that facilitate the delivery of LDKT to patients, and those that create barriers and compare these across systems with variable performance. These objectives are contextualized within our broader goal of increasing rates of LDKT in Canada, particularly in lower-performing provinces. Methods: This research takes the form of a qualitative comparative case study analysis of 3 provincial health systems in Canada that have high, moderate, and low rates of LDKT performance (the percentage of LDKT to all kidney transplantations performed). Our approach is underpinned by an understanding of health systems as complex adaptive systems that are multilevel and interconnected, and involve nonlinear interactions between people and organizations, operating within a loosely bounded network. Data collection will comprise semistructured interviews, document reviews, and focus groups. Individual case studies will be conducted and analyzed using inductive thematic analysis. Following this, our comparative analysis will operationalize resource-based theory to compare case study data and generate explanations for our research question. Results: This project was funded from 2020 to 2023. Individual case studies were carried out between November 2020 and August 2022. The comparative case analysis will begin in December 2022 and is expected to conclude in April 2023. Submission of the publication is projected for June 2023. Conclusions: By investigating health systems as complex adaptive systems and making comparisons across provinces, this study will identify how health systems can improve the delivery of LDKT to patients with kidney failure. Our resource-based theory framework will provide a granular analysis of the attributes and processes that facilitate or create barriers to LDKT delivery across multiple organizations and levels of practice. Our findings will have practice and policy implications and help inform transferrable competencies and system-level interventions conducive to increasing LDKT. International Registered Report Identifier (IRRID): DERR1-10.2196/44172 %M 36881454 %R 10.2196/44172 %U https://www.researchprotocols.org/2023/1/e44172 %U https://doi.org/10.2196/44172 %U http://www.ncbi.nlm.nih.gov/pubmed/36881454 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42021 %T Attitudes and Experiences of Clinicians After Mandated Implementation of Open Notes by the 21st Century Cures Act: Survey Study %A Leonard,Sophia M %A Zackula,Rosalee %A Wilcher,Jonathan %+ Kansas City Campus, The University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS, 66160, United States, 1 3167599185, sleonard7@kumc.edu %K 21st Century Cures Act %K Final Rule %K shared notes %K open notes %K OpenNotes %K health policy %K clinician opinion %K mobile phone %D 2023 %7 28.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: On December 13, 2016, the US Congress enacted the 21st Century Cures Act (hereafter the Cures Act), which contained the Final Rule mandate that took effect on April 5, 2021. Since then, health systems have been required to provide patients digital access to their eHealth information “without delay” and without charge. Objective: This study aimed to assess clinicians’ initial experiences with, and attitudes toward, sharing visit notes with patients after being mandated to do so by the Cures Act and to determine clinician preferences regarding instant record release. Methods: This cross-sectional survey study was conducted between June 10, 2021, and August 15, 2021, at the University of Kansas Health System, a large academic medical center in Kansas City, Kansas, United States. Participants included clinicians currently employed by the health system, including resident and attending physicians, physician assistants, nurse practitioners, and critical care and emergency medicine registered nurses. Results: A total of 1574 attending physicians, physician assistants, and nurse practitioners, as well as 506 critical care and emergency medicine nurses, were sent invitations; 538 (34.18%) and 72 (14.2%), respectively, responded. Of 609 resident physicians, 4 (response rate not applicable because it was unknown how many residents viewed the website while the link was available) responded. The majority of respondents were attending physicians (402/614, 65.5%) and within the department of internal medicine (160/614, 26.1%). Most agreed that sharing visit notes was a good idea (355/613, 57.9%) and that it is important to speak with the patients before they accessed their records (431/613, 70.3%). Those who agreed that sharing visit notes is a good idea tended to view the practice as a useful tool for engaging patients (“Agree”: 139/355, 39.2%; “Somewhat agree”: 161/355, 45.4%; P<.001) and experience no change in the clinical value of their notes for other clinicians (326/355, 91.8%; P<.001). Those who disagreed (or were neutral) tended not to encourage patients to read their notes (235/258, 91.1%; P<.001) and were more likely to experience a change in their charting practice (168/257, 65.4%; P<.001) and increased time charting (99/258, 38.4%; P<.001). Conclusions: The findings of this study may be generalizable to institutions similar to the University of Kansas Health System, and the clinician testimonies gathered in this study may provide valuable insight into the initial opinions and experiences of clinicians at these institutions. In addition, these clinician experiences collected early in the transition period may be used to guide future health policy implementation and to understand how best to prepare clinicians for these changes in practice. %M 36853747 %R 10.2196/42021 %U https://www.jmir.org/2023/1/e42021 %U https://doi.org/10.2196/42021 %U http://www.ncbi.nlm.nih.gov/pubmed/36853747 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40634 %T User Testing of the Veteran Delegation Tool: Qualitative Inquiry %A Haun,Jolie N %A Melillo,Christine %A Schneider,Tali %A Merzier,Marie M %A Klanchar,S Angelina %A Fowler,Christopher A %A Benzinger,Rachel C %+ James A Haley Veterans Hospital, 8900 Grand Oak Circle, Tampa, FL, 33637, United States, 1 813 558 3938, christine.melillo@va.gov %K electronic health portal %K human-centered design %K delegate %K electronic resources %K delegation %K care partner %K veteran %K Veteran Delegation Tool %K Veterans Health Administration %D 2023 %7 23.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Informal caregivers, or care partners, provide critical support to care recipients when managing health care. Veterans Health Administration (VHA) priorities identify care partners as vital in supporting veterans’ care management. The Veteran Delegation Tool (VDT) is VHA’s Health Insurance Portability and Accountability Act–compliant solution for care partners to comanage veterans’ care through VHA’s electronic health portal. Human-centered design approaches in VDT development are needed to inform enhancements aimed at promoting uptake and sustained use. Objective: The objective of this prospective descriptive quality improvement project was to use a human-centered design approach to examine VDT use perceptions and practical experiences. Methods: This project was conducted using a 4-phase approach: frame, discover, design, and deliver. The frame phase designed the protocol and prepared the VDT system for testing. This paper reports on the discover phase, which used semistructured and follow-up interviews and user testing to examine VDT’s benefits, facilitators, and barriers. The discover phase data informed the design and deliver phases, which are underway. Results: Veterans (24/54, 44%), care partners (21/54, 39%), and individuals who represented dual roles (9/54, 17%)—namely veteran care partner (4/54, 7%), veteran clinical provider (2/54, 4%), and care partner provider (3/54, 6%)—participated in semistructured interviews in the discover phase. A subsample of these participants (3/54, 6%) participated in the follow-up interviews and user testing. Analysis of the semistructured interviews indicated convergence on the respondents’ perceptions of VDT’s benefits, facilitators, and barriers and recommendations for improving VDT. The perceived benefits were authorized access, comanagement of care needs on the web, communication with the clinical team, access to resources, and ease of burden. Perceived barriers were nonrecognition of the benefits of VDT, technical literacy access issues, increased stress in or burden on care partners, and personal health information security. Participant experiences across 4 VDT activity domains were upgrade to My HealtheVet Premium account, registration, sign-in, and use. User testing demonstrated users’ challenges to register, navigate, and use VDT. Findings informed VDT development enhancements and recommendations. Conclusions: Care partners need Health Insurance Portability and Accountability Act–compliant access to electronic health portals to assist with care management. VDT is VHA’s solution, allowing communication among delegates, veterans, and clinical care teams. Users value VDT’s potential use and benefits, while access and navigation improvements to ensure uptake and sustained use are needed. Future efforts need to iteratively evaluate the human-centered phases, design and deliver, of VDT to target audiences. Continued efforts to understand and respond to care partners’ needs are warranted. %M 36821364 %R 10.2196/40634 %U https://www.jmir.org/2023/1/e40634 %U https://doi.org/10.2196/40634 %U http://www.ncbi.nlm.nih.gov/pubmed/36821364 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e38568 %T Distance in Distant Care: Qualitative Content Analysis of Providers’ Experiences in Tele–Mental Care %A Åhs,Jill W %A Ranheim,Albertine %A Mattelin,Erica %A Eriksson,Henrik %A Mazaheri,Monir %+ Department of Health Sciences, Swedish Red Cross University, PO Box 1059, Huddinge, 141 21, Sweden, 46 0858751600, jill.w.ahs@gmail.com %K telehealth %K telemedicine %K patient care %K mental health %K care delivery %K communication technology %K patient-provider %K provider %K provider experience %K health care professional %K experience %K content analysis %K qualitative %D 2023 %7 17.2.2023 %9 Research Letter %J J Med Internet Res %G English %X %M 36800225 %R 10.2196/38568 %U https://www.jmir.org/2023/1/e38568 %U https://doi.org/10.2196/38568 %U http://www.ncbi.nlm.nih.gov/pubmed/36800225 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e43602 %T Canadian Pediatric Intensive Care Adaptations for Critically Ill Adults During the COVID-19 Pandemic: Survey Study %A Parchomchuk,Evan %A Holt,Tanya %A Hansen,Gregory %+ Jim Pattison Children's Hospital, Pediatric Intensive Care Unit, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada, 1 306 844 1068, gregory.hansen@usask.ca %K Canada %K COVID-19 pandemic %K delivery of health care %K pediatrics %K population health %K health care %K intensive care %K patient care %D 2023 %7 10.2.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The COVID-19 pandemic overwhelmed Canadian hospitals with adult admissions. A large number of adult patients required critical care therapies, placing significant strain on hospital resources. In order to decompress adult intensive care units, pediatric intensive care units (PICUs) introduced adapted models of traditional care to lessen these burdens. Objective: We aimed to evaluate how PICUs across Canada adapted care for the high volumes of critically ill adults. Methods: A survey containing 40 questions was sent to the medical directors of 14 Canadian PICUs where English was the primary clinical language. The survey was designed to gain perspective on the various adaptations that PICUs instituted during the COVID-19 pandemic. Results: Of the 13 PICUs that returned survey responses (response rate: 13/14, 93%), 10 (77%) participated in at least one adaptation to support the influx of admitted adults with COVID-19. The key challenges included disorganization, loss of autonomy, and compromised patient care. The significant advantages of these adaptations included a sense of learning and comradery. Conclusions: Our study highlighted an unpreparedness in critical care surge capacity. During the COVID-19 pandemic, adaptations rapidly emerged in Canada that involved PICUs with adult care. In the future, preplanned adaptations for optimizing robust critical care services should be developed based on what has been learned from the COVID-19 pandemic. %M 36724349 %R 10.2196/43602 %U https://pediatrics.jmir.org/2023/1/e43602 %U https://doi.org/10.2196/43602 %U http://www.ncbi.nlm.nih.gov/pubmed/36724349 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42892 %T Parent-Reported Use of Pediatric Primary Care Telemedicine: Survey Study %A Ray,Kristin N %A Wittman,Samuel R %A Burns,Sarah %A Doan,Tran T %A Schweiberger,Kelsey A %A Yabes,Jonathan G %A Hanmer,Janel %A Krishnamurti,Tamar %+ Department of Pediatrics, University of Pittsburgh, 3414 Fifth Avenue, Pittsburgh, PA, 15213, United States, 1 4126927518, knr16@pitt.edu %K telehealth %K telemedicine %K pediatrics %K primary care %D 2023 %7 9.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Telemedicine delivered from primary care practices became widely available for children during the COVID-19 pandemic. Objective: Focusing on children with a usual source of care, we aimed to examine factors associated with use of primary care telemedicine. Methods: In February 2022, we surveyed parents of children aged ≤17 years on the AmeriSpeak panel, a probability-based panel of representative US households, about their children’s telemedicine use. We first compared sociodemographic factors among respondents who did and did not report a usual source of care for their children. Among those reporting a usual source of care, we used Rao-Scott F tests to examine factors associated with parent-reported use versus nonuse of primary care telemedicine for their children. Results: Of 1206 respondents, 1054 reported a usual source of care for their children. Of these respondents, 301 of 1054 (weighted percentage 28%) reported primary care telemedicine visits for their children. Factors associated with primary care telemedicine use versus nonuse included having a child with a chronic medical condition (87/301, weighted percentage 27% vs 113/753, 15%, respectively; P=.002), metropolitan residence (262/301, weighted percentage 88% vs 598/753, 78%, respectively; P=.004), greater internet connectivity concerns (60/301, weighted percentage 24% vs 116/753, 16%, respectively; P=.05), and greater health literacy (285/301, weighted percentage 96% vs 693/753, 91%, respectively; P=.005). Conclusions: In a national sample of respondents with a usual source of care for their children, approximately one-quarter reported use of primary care telemedicine for their children as of 2022. Equitable access to primary care telemedicine may be enhanced by promoting access to primary care, sustaining payment for primary care telemedicine, addressing barriers in nonmetropolitan practices, and designing for lower health-literacy populations. %M 36757763 %R 10.2196/42892 %U https://www.jmir.org/2023/1/e42892 %U https://doi.org/10.2196/42892 %U http://www.ncbi.nlm.nih.gov/pubmed/36757763 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43798 %T The Factors Associated With Telehealth Use and Avoidance During the COVID-19 Pandemic: Longitudinal Survey %A Farrer,Louise M %A Batterham,Philip J %A Gulliver,Amelia %A Morse,Alyssa %A Calear,Alison L %A McCallum,Sonia %A Banfield,Michelle %A Shou,Yiyun %A Newman,Eryn %A Dawel,Amy %+ Centre for Mental Health Research, The Australian National University, Bld 63, Eggleston Rd, Canberra, 2601, Australia, 61 2 6125 8859, louise.farrer@anu.edu.au %K telehealth %K access %K inequity %K health care %K COVID-19 %K telemedicine %K health care service %K longitudinal survey %K health care system %K technology acceptance %K health care delivery %K Australian population %D 2023 %7 8.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Social distancing requirements due to the COVID-19 pandemic saw a rapid increase in the delivery of telehealth consultations as an alternative to face-to-face health care services. Objective: The aims of this study were to assess the use and acceptability of telehealth during the early stages of the pandemic and identify factors associated with telehealth avoidance during this period. Methods: Data were obtained from waves 4 and 7 of a longitudinal survey designed to assess the impact of the COVID-19 pandemic on the health and behavior of a representative sample of Australian adults. Participants reported on their use or avoidance of telehealth during the assessment period, as well as the mode of telehealth used and acceptability. Results: Approximately 30% of participants reported using telehealth during the assessment periods, with the most common telehealth modality being the telephone. Acceptance of telehealth was generally high and was higher among those who used telehealth compared with those who did not. Approximately 18% of participants reported avoiding health care due to telehealth. Across assessment waves, avoidance was associated with younger age, speaking a language other than or in addition to English, having a current medical diagnosis, and lower levels of telehealth acceptability. Conclusions: While most participants in this study were accepting of telehealth services, there remain barriers to use, especially among those from particular sociodemographic groups. At a population level, avoidance of health services in nearly one in five adults may have considerable long-term impacts on morbidity and potentially mortality. Targeted efforts to promote engagement with telehealth services are critical if these adverse outcomes are to be avoided, particularly during periods when access to face-to-face services may be limited. %M 36649254 %R 10.2196/43798 %U https://www.jmir.org/2023/1/e43798 %U https://doi.org/10.2196/43798 %U http://www.ncbi.nlm.nih.gov/pubmed/36649254 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37596 %T Helping Patients With Chronic Conditions Overcome Challenges of High-Deductible Health Plans: Mixed Methods Study %A Hu,Tiffany Yung-Shin %A Ali,Iman %A Heisler,Michele %A Levy,Helen %A Fagerlin,Angela %A Kullgren,Jeffrey T %+ University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, United States, 1 203 824 4785, tyshu@umich.edu %K high-deductible health plan %K HDHP %K chronic conditions %K cost-conscious strategies %K consumer behaviors %K health care costs %K out-of-pocket spending %K OOP %K behavioral intervention %K mobile phone %D 2023 %7 31.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: A growing number of Americans are enrolled in high-deductible health plans (HDHPs). Enrollees in HDHPs, particularly those with chronic conditions, face high out-of-pocket costs and often delay or forgo needed care owing to cost. These challenges could be mitigated by the use of cost-conscious strategies when seeking health care, such as discussing costs with providers, saving for medical expenses, and using web-based tools to compare prices, but few HDHP enrollees engage in such cost-conscious strategies. A novel behavioral intervention could enable HDHP enrollees with chronic conditions to adopt these strategies, but it is unknown which intervention features would be most valued and used by this patient population. Objective: This study aimed to assess preferences among HDHP enrollees with chronic conditions for a novel behavioral intervention that supports the use of cost-conscious strategies when planning for and seeking health care. Methods: In an exploratory sequential mixed methods study among HDHP enrollees with chronic conditions, we conducted 20 semistructured telephone interviews and then surveyed 432 participants using a national internet survey panel. Participants were adult HDHP enrollees with diabetes, hypertension, coronary artery disease, chronic obstructive pulmonary disease, or asthma. The interviews and survey assessed participants’ health care experiences when using HDHPs and their preferences for the content, modality, and frequency of use of a novel intervention that would support their use of cost-conscious strategies when seeking health care. Results: Approximately half (11/20, 55%) of the interview participants reported barriers to using cost-conscious strategies. These included not knowing where to find information and worrying that the use of cost-conscious strategies would be very time consuming. Most (18/20, 90%) interviewees who had discussed costs with providers, saved for medical expenses, or used web-based price comparison tools found these strategies to be helpful for managing their health care costs. Most (17/20, 85%) interviewees expressed interest in an intervention delivered through a website or phone app that would help them compare prices for services at different locations. Survey participants were most interested in learning to compare prices and quality, followed by discussing costs with their providers and putting aside money for care, through a website-based or email-based intervention that they would use a few times a year. Conclusions: Regular use of cost-conscious strategies could mitigate financial barriers faced by HDHP enrollees with chronic conditions. Interventions to encourage the use of cost-conscious strategies should be delivered through a web-based modality and focus on helping these patients in navigating their HDHPs to better manage their out-of-pocket spending. %M 36719718 %R 10.2196/37596 %U https://formative.jmir.org/2023/1/e37596 %U https://doi.org/10.2196/37596 %U http://www.ncbi.nlm.nih.gov/pubmed/36719718 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40912 %T Factors Associated With Telemedicine Use Among Patients With Rheumatic and Musculoskeletal Disease: Secondary Analysis of Data From a German Nationwide Survey %A Muehlensiepen,Felix %A Petit,Pascal %A Knitza,Johannes %A Welcker,Martin %A Vuillerme,Nicolas %+ Center for Health Services Research, Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf bei Berlin, 15562, Germany, 49 15119126024, Felix.Muehlensiepen@mhb-fontane.de %K telemedicine %K rheumatology %K primary care %K secondary analysis %K health services research %D 2023 %7 27.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous studies have demonstrated telemedicine (TM) to be an effective tool to complement rheumatology care and address workforce shortage. With the outbreak of the COVID-19 pandemic, TM experienced a massive upswing. A previous study revealed that physicians’ willingness to use TM and actual use of TM are closely connected to their knowledge of TM. However, it remains unclear which factors are associated with patients’ motivation to use TM. Objective: This study aims to identify the factors that determine patients’ willingness to try TM (TM try) and their wish that their rheumatologists offer TM services (TM wish). Methods: We conducted a secondary analysis of data from a German nationwide cross-sectional survey among patients with rheumatic and musculoskeletal disease (RMD). Bayesian univariate and multivariate logistic regression analyses were applied to the data to determine which factors were associated with TM try and TM wish. The predictor variables (covariates) studied individually included sociodemographic factors (eg, age and sex) and health characteristics (eg, disease type and health status). All the variables positively or negatively associated with TM try or TM wish in the univariate analyses were then considered for the Bayesian model averaging analysis after a selection based on the variance inflation factor (≤2.5). All the analyses were stratified by sex. Results: Of the total 102 variables, 59 (57.8%) and 45 (44.1%) variables were found to be positively or negatively associated (region of practical equivalence ≤5%) with TM try and TM wish, respectively. A total of 16 and 8 determinant factors were identified for TM try and TM wish, respectively. Wishing that TM services were offered by rheumatologists, having internet access at home, residing 5 to 10 km away from the general practitioner’s office, owning an electronic device, and being aged 40 to 60 years were among the factors positively associated with TM try and TM wish. By contrast, not yet being diagnosed with an RMD, having no prior knowledge of TM, having a bad health status, living in a rural area, not documenting one’s health status, not owning an electronic device, and being aged 60 to 80 years were negatively associated with TM try and TM wish. Conclusions: Our results suggest that health status, knowledge, age, and access to technical equipment and infrastructure influence the motivation of patients with RMD to use telehealth services. In particular, older patients with RMD living in rural areas, who could likely benefit from using TM, are currently not motivated to use TM and seem to need additional TM support. %M 36705950 %R 10.2196/40912 %U https://www.jmir.org/2023/1/e40912 %U https://doi.org/10.2196/40912 %U http://www.ncbi.nlm.nih.gov/pubmed/36705950 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43167 %T The Effect of Mobile Payment on Payment Waiting Time for Outpatients With Medical Insurance: Historically Controlled Study %A Xie,Wanhua %A Cao,Xiaojun %+ Outpatient Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No 9 Jinsui Road, Tianhe District, Guangzhou, 510623, China, 86 13725370379, xiewanhua1@126.com %K smartphone %K mobile payment for health insurance %K waiting time %K outpatient service %K patient satisfaction %K medical insurance %K mobile payment %K mobile app %D 2023 %7 26.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Waiting for a long time to make payments in outpatient wards and long queues of insured patients at the checkout window are common in many hospitals across China. To alleviate the problem of long queues for payment, many hospitals in China have established various mobile apps that those without health insurance can use. However, medically insured outpatients are still required to pay manually at the checkout window. Therefore, it is urgent to use information technology to innovate and optimize the outpatient service process, implement mobile payment for medically insured outpatients, and shorten the waiting time for outpatients, especially in the context of the COVID-19 epidemic. Furthermore, smartphone-based mobile payment for outpatients with health insurance could be superior to on-site cashier billing. Objective: This study aimed to investigate the impact of smartphone-based mobile payment in relation to different aspects, such as waiting time, satisfaction with patients’ waiting time, payment experience, the proportion of those dissatisfied with payment, total outpatient satisfaction, and outpatient volume, and compare mobile payment with on-site payment. Methods: This was a historically controlled study. This study analyzed the outpatients’ waiting time to make a medical insurance payment, their satisfaction with the waiting time and payment experience, the proportion of those dissatisfied with payment, and the outpatient volume of patients at Guangzhou Women and Children’s Medical Center 1 year before and after the implementation of mobile payment for medical insurance in January 2021. An independent sample 2-tailed t test was used to compare waiting time, satisfaction with waiting time, and overall satisfaction. Paired sample 2-tailed t test was used to compare monthly outpatient visits. The chi-square test was used to compare the percentages of patients dissatisfied with payment. Results: After the implementation of mobile payment for medical insurance outpatients, the patients’ payment waiting time was significantly shortened (mean 45.28, SD 10.35 min vs mean 1.02, SD 0.25 min; t9014=53.396; P<.001), and satisfaction with waiting time and payment experience were significantly improved (mean 82.08, SD 3.17 vs mean 90.36, SD 3.45; t9014=–118.65; P<.001). Dissatisfaction with payment significantly decreased (10.27%, SD 2.18% vs 1.19% vs SD 0.30%; P<.001). The total satisfaction of outpatients significantly improved (mean 86.91, SD 3.23 vs mean 89.98, SD 3.31; t9014=–44.57; P<.001), and the outpatient volume increased (248,105.58, SD 89,280.76 vs 303,194.75, SD 53,773.12; t11=2.414; P=.03). Furthermore, payment efficiency improved, and the number of the on-site cashiers substantially decreased. Conclusions: Mobile payment for health insurance significantly shortened patients’ payment waiting time; improved patient satisfaction on waiting time and payment experience and overall satisfaction; reduced the proportion of patients who were dissatisfied with payment and the cashier at the hospital; and increased monthly outpatient volume. This approach was effective and thus worthy of promoting. %M 36696970 %R 10.2196/43167 %U https://formative.jmir.org/2023/1/e43167 %U https://doi.org/10.2196/43167 %U http://www.ncbi.nlm.nih.gov/pubmed/36696970 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42151 %T The Usability of Homelab, a Digital Self-service at a Dutch General Practice, for Diagnostic Tests: Pilot Study With a Questionnaire %A Schnoor,Kyma %A Versluis,Anke %A Chavannes,Niels H %A Talboom-Kamp,Esther P W A %+ Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZA, Netherlands, 31 71526 8433, k.schnoor@lumc.nl %K eHealth %K diagnostic testing %K general practitioner %K general practice %K GP %K referral %K online testing %K diagnostic %K laboratory test %K usability %K digital health %K health care service %K service delivery %D 2023 %7 26.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: eHealth potentially can make health care more accessible and efficient and help reduce the workload in primary health care. Homelab is an eHealth tool implemented in a general practice environment, and it offers relatively simple laboratory diagnostic tests without the referral of the general practitioner. After logging in this eHealth tool, patients select and order a diagnostic test based on their symptoms. The test results are presented online to the general practitioner and the patient. Objective: This study aims to evaluate the use, usability, and user characteristics of Homelab. Further, it aims to evaluate whether Homelab replaces an appointment with the general practitioner. Methods: Homelab has been implemented since May 2021 as a pilot in a Dutch general practice. The number of requests and the ordered diagnostic packages are monitored. After using Homelab, patients are invited to complete a short questionnaire. The questionnaire contains demographic questions and assesses usability using the System Usability Scale (10 items). In addition, questions about requesting an appointment with the general practitioner without Homelab are included. All data were anonymous. Results: The questionnaire was filled by 74 individual patients. The mean age of the patients was 40.33 (SD 12.11) years, and half of them were females (39/74, 53%). The majority of the patients were highly educated (56/74, 76%) and employed (53/74, 72%). Approximately 81% (60/74) of the patients reported that they would use Homelab again in the future and 66% (49/74) reported that they would have gone to the general practitioner if they had not used Homelab. The usability of Homelab was perceived higher by the younger age group (mean 73.96, SD 14.74) than by the older age group (mean 61.59, SD 14.37). In total, 106 test packages were ordered over 1 year, and the most requested diagnostic package was “Am I still healthy? I want to do my annual health checkup.” Homelab was used the most during the months of the COVID-19 lockdown. Conclusions: The use of Homelab, a digital self-service for ordering diagnostic tests, was monitored in this study, and its usability was perceived as above average. Our findings showed that patients are willing to use Homelab in the future and they would use it most of the time as a replacement for regular consultations. Homelab offers opportunities for more accessible and efficient health care for both the patient and the general practitioner. %M 36701183 %R 10.2196/42151 %U https://formative.jmir.org/2023/1/e42151 %U https://doi.org/10.2196/42151 %U http://www.ncbi.nlm.nih.gov/pubmed/36701183 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39034 %T User Experience Regarding Digital Primary Health Care in Santarém, Amazon: Evaluation of Patient Satisfaction and Doctor’s Feedback %A Bin,Kaio Jia %A Santana Alves,Patrícia Gabriela %A Costa,Raquel %A Eiras,Paula Cruz %A Nader de Araujo,Luciano %A Pereira,Antonio José Rodrigues %A Carvalho,Carlos %A Malik,Ana Maria %+ Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, R. Dr. Ovídio Pires de Campos, 225 - 3º andar, São Paulo, 05403-110, Brazil, 55 1126616208, kaiobin@gmail.com %K telemedicine %K primary health care %K user’s experience %K Amazon %K digital health %K pilot %K patient %K pilot model %K pandemic %K medical care %K assist %K urban %K community %K Brazil %K technology %K consultation %K physician %K survey %D 2023 %7 11.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: With the arrival of the pandemic, telemedicine has been widely used to provide medical care and can be used to assist patients in regions far from urban centers that are difficult to access, such as riverside communities in the Brazilian Amazon region. A telemedicine project connecting São Paulo, a mega-metropolis, to Paysandú, a riverside district in the Amazon, was built to serve the local population where access to the nearest medical care is 6 hours away by speedboat. Objective: This study aims to assess the feedback from patients and doctors regarding the use of telemedicine in outpatient care at Paysandú, a riverside district in the Amazon. Methods: This is a single-center study following the guidelines “Evaluating digital health products” from Public Health England, with local adaptations for the project and the Brazilian reality, that was conducted between São Paulo and Santarém in Brazil. A survey was carried out with patients who were treated by a doctor in the city of São Paulo, about 2500 km from the local basic health unit, between September 27 to December 15, 2021. At the end of each teleconsultation, the attending physician answered an administrative survey form, and the patient answered a satisfaction survey. Results: A total of 111 patients completed the satisfaction survey from a total of 220 consultations carried out during the period (95% CI margin error 0.22%). According to the survey, more than 95% of patients were satisfied with the service, 87.4% (n=97) had previous experience with videoconferencing, and 76.6% (n=85) reported that their demand was fully solved. Additionally, according to the hired doctor’s feedback, the average duration of the consultations was between 15 and 20 minutes. Of the 220 teleconsultations performed, 90.9% (n=200) of the demands were solved with support from the local health team, and 99.1% (n=218) of the appointments had a problem with audio or video. Conclusions: This teleconsultation project between São Paulo and Paysandú showed that it is possible to offer medical care from more developed locations to communities far from urban centers, as is the case with Paysandú District. Beyond the feasibility of the infrastructure, acceptance and satisfaction among patients were high. This health care supply model has proven to be functional and should be expanded nationally or perhaps internationally to regions lacking medical assistance. Escalation of the project does not seem too difficult once infrastructure issues are solved. %M 36630164 %R 10.2196/39034 %U https://formative.jmir.org/2023/1/e39034 %U https://doi.org/10.2196/39034 %U http://www.ncbi.nlm.nih.gov/pubmed/36630164 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41812 %T FLASH Radiotherapy for the Treatment of Symptomatic Bone Metastases (FAST-01): Protocol for the First Prospective Feasibility Study %A Daugherty,Emily C %A Mascia,Anthony %A Zhang,Yong %A Lee,Eunsin %A Xiao,Zhiyan %A Sertorio,Mathieu %A Woo,Jennifer %A McCann,Claire %A Russell,Kenneth %A Levine,Lisa %A Sharma,Ricky %A Khuntia,Deepak %A Bradley,Jeffrey %A Simone II,Charles B %A Perentesis,John %A Breneman,John %+ Department of Radiation Oncology, University of Cincinnati, 234 Goodman Avenue ML0757, Cincinnati, OH, 45219, United States, 1 513 584 5327, brenemjc@ucmail.uc.edu %K bone metastases %K FLASH %K proton therapy %K external beam radiotherapy %K palliative radiotherapy %K extremities %K pain relief %K ultra-high dose rate %K radiation therapy %K cancer treatment %K toxicity %K oncology %K radiotherapy %D 2023 %7 5.1.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: In preclinical studies, FLASH therapy, in which radiation delivered at ultrahigh dose rates of ≥40 Gy per second, has been shown to cause less injury to normal tissues than radiotherapy delivered at conventional dose rates. This paper describes the protocol for the first-in-human clinical investigation of proton FLASH therapy. Objective: FAST-01 is a prospective, single-center trial designed to assess the workflow feasibility, toxicity, and efficacy of FLASH therapy for the treatment of painful bone metastases in the extremities. Methods: Following informed consent, 10 subjects aged ≥18 years with up to 3 painful bone metastases in the extremities (excluding the feet, hands, and wrists) will be enrolled. A treatment field selected from a predefined library of plans with fixed field sizes (from 7.5 cm × 7.5 cm up to 7.5 cm × 20 cm) will be used for treatment. Subjects will receive 8 Gy of radiation in a single fraction—a well-established palliative regimen evaluated in prior investigations using conventional dose rate photon radiotherapy. A FLASH-enabled Varian ProBeam proton therapy unit will be used to deliver treatment to the target volume at a dose rate of ≥40 Gy per second, using the plateau (transmission) portion of the proton beam. After treatment, subjects will be assessed for pain response as well as any adverse effects of FLASH radiation. The primary end points include assessing the workflow feasibility and toxicity of FLASH treatment. The secondary end point is pain response at the treated site(s), as measured by patient-reported pain scores, the use of pain medication, and any flare in bone pain after treatment. The results will be compared to those reported historically for conventional dose rate photon radiotherapy, using the same radiation dose and fractionation. Results: FAST-01 opened to enrollment on November 3, 2020. Initial results are expected to be published in 2022. Conclusions: The results of this investigation will contribute to further developing and optimizing the FLASH-enabled ProBeam proton therapy system workflow. The pain response and toxicity data acquired in our study will provide a greater understanding of FLASH treatment effects on tumor responses and normal tissue toxicities, and they will inform future FLASH trial designs. Trial Registration: : ClinicalTrials.gov NCT04592887; http://clinicaltrials.gov/ct2/show/NCT04592887 International Registered Report Identifier (IRRID): DERR1-10.2196/41812 %M 36206189 %R 10.2196/41812 %U https://www.researchprotocols.org/2023/1/e41812 %U https://doi.org/10.2196/41812 %U http://www.ncbi.nlm.nih.gov/pubmed/36206189 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e40771 %T Factors Influencing Adoption and Use of Telemedicine Services in Rural Areas of China: Mixed Methods Study %A Du,Yumeng %A Zhou,Qiru %A Cheng,Weibin %A Zhang,Zhang %A Hoelzer,Samantha %A Liang,Yizhi %A Xue,Hao %A Ma,Xiaochen %A Sylvia,Sean %A Tian,Junzhang %A Tang,Weiming %+ Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, No.466 Xingangzhong Road, Haizhu District, Guangzhou, 510317, China, 86 15920567132, weiming_tang@med.unc.edu %K telemedicine %K telehealth %K rural residents %K mixed methods %K China %K mobile phone %D 2022 %7 23.12.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The shortage of medical resources in rural China reflects the health inequity in resource-limited settings, whereas telemedicine could provide opportunities to fill this gap. However, evidence of patient acceptance of telemedicine services from low- and middle-income countries is still lacking. Objective: We aimed to understand the profile of patient end-user telemedicine use and identify factors influencing telemedicine service use in rural China. Methods: Our study followed a mixed methods approach, with a quantitative cross-sectional survey followed by in-depth semistructured interviews to describe telemedicine use and its associated factors among rural residents in Guangdong Province, China. In the quantitative analysis, explanatory variables included environmental and context factors, household-level factors, individual sociodemographic factors, access to digital health care, and health needs and demand factors. We conducted univariate and multivariate analyses using Firth logistic regression to examine the correlations of telemedicine uptake. A thematic approach was used, guided by the Social Cognitive Theory for the qualitative analysis. Results: A total of 2101 households were recruited for the quantitative survey. With a mean age of 61.4 (SD 14.41) years, >70% (1364/2101, 72.94%) of the household respondents were male. Less than 1% (14/2101, 0.67%) of the respondents reported experience of using telemedicine. The quantitative results supported that villagers living with family members who had a fever in the past 2 weeks (adjusted odds ratio 6.96, 95% CI 2.20-21.98; P=.001) or having smartphones or computers (adjusted odds ratio 3.71, 95% CI 0.64-21.32; P=.14) had marginally higher telemedicine uptake, whereas the qualitative results endorse these findings. The results of qualitative interviews (n=27) also supplemented the potential barriers to telemedicine use from the lack of knowledge, trust, demand, low self-efficacy, and sufficient physical and social support. Conclusions: This study found extremely low use of telemedicine in rural China and identified potential factors affecting telemedicine uptake. The main barriers to telemedicine adoption among rural residents were found, including lack of knowledge, trust, demand as well as low self-efficacy, and insufficient physical and social support. Our study also suggests strategies to facilitate telemedicine engagement in low-resource settings: improving digital literacy and self-efficacy, building trust, and strengthening telemedicine infrastructure support. %M 36563026 %R 10.2196/40771 %U https://publichealth.jmir.org/2022/12/e40771 %U https://doi.org/10.2196/40771 %U http://www.ncbi.nlm.nih.gov/pubmed/36563026 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 12 %P e42484 %T Experiences of Health Care Access Challenges for Back Pain Care Across the Rural-Urban Continuum in Canada: Protocol for Cross-sectional Research %A Crockett,Katie %A Lovo,Stacey %A Irvine,Alison %A Trask,Catherine %A Oosman,Sarah %A McKinney,Veronica %A McDonald,Terrence %A Sari,Nazmi %A Carnegie,Bertha %A Custer,Marie %A McIntosh,Stacey %A Bath,Brenna %+ School of Rehabilitation Science, University of Saskatchewan, 104 Clinic Place, Health Sciences E-Wing, Saskatoon, SK, S7N 2Z4, Canada, 1 3069666573, katie.crockett@usask.ca %K low back pain %K rural health %K rehabilitation %K health services %D 2022 %7 19.12.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Back pain is common and costly, with negative impacts on both individuals and the health care system. Rural, remote, and Indigenous populations are at greater risk of experiencing back pain compared to urban and non-Indigenous populations. Potential barriers to health care access among Canadians with chronic back pain (CBP) have been identified; however, no study has used lived experiences of people with CBP to drive the selection, analysis, and interpretation of variables most meaningful to patients. Objective: The aims of this study are to (1) engage with rural, remote, and urban Indigenous and non-Indigenous patients, health care providers, and health system decision makers to explore lived experiences among people with CBP in Saskatchewan, Canada; (2) cocreate meaningful indicators of CBP care access and effectiveness; and (3) identify program and policy recommendations to overcome access barriers to CBP care. Methods: In phase 1, one-on-one interviews with 30 people with current or past CBP and 10 health care providers residing or practicing in rural, remote, or urban Saskatchewan communities will be conducted. We will recruit Indigenous (n=10) and non-Indigenous (n=20) rural, remote, and urban people. In phase 2, findings from the interviews will inform development of a population-based telephone survey focused on access to health care barriers and facilitators among rural, remote, and urban people; this survey will be administered to 383 residents with CBP across Saskatchewan. In phase 3, phase 1 and 2 findings will be presented to provincial and national policy makers; health system decision makers; health care providers; rural, remote, and urban people with CBP and their communities; and other knowledge users at an interactive end-of-project knowledge translation event. A World Café method will facilitate interactive dialogue designed to catalyze future patient-oriented research and pathways to improve access to CBP care. Patient engagement will be conducted, wherein people with lived experience of CBP, including Indigenous and non-Indigenous people from rural, remote, and urban communities (ie, patient partners), are equal members of the research team. Patient partners are engaged throughout the research process, providing unique knowledge to ensure more comprehensive collection of data while shaping culturally appropriate messages and methods of sharing findings to knowledge users. Results: Participant recruitment began in January 2021. Phase 1 interviews occurred between January 2021 and September 2022. Phase 2 phone survey was administered in May 2022. Final results are anticipated in late 2022. Conclusions: This study will privilege patient experiences to better understand current health care use and potential access challenges and facilitators among rural, remote, and urban people with CBP in Saskatchewan. We aim to inform the development of comprehensive measures that will be sensitive to geographical location and relevant to culturally diverse people with CBP, ultimately leading to enhanced access to more patient-centered care for CBP. International Registered Report Identifier (IRRID): DERR1-10.2196/42484 %M 36534454 %R 10.2196/42484 %U https://www.researchprotocols.org/2022/12/e42484 %U https://doi.org/10.2196/42484 %U http://www.ncbi.nlm.nih.gov/pubmed/36534454 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e41520 %T Frailty, Comorbidity, and Associations With In-Hospital Mortality in Older COVID-19 Patients: Exploratory Study of Administrative Data %A Heyl,Johannes %A Hardy,Flavien %A Tucker,Katie %A Hopper,Adrian %A Marchã,Maria J M %A Navaratnam,Annakan V %A Briggs,Tim W R %A Yates,Jeremy %A Day,Jamie %A Wheeler,Andrew %A Eve-Jones,Sue %A Gray,William K %+ Department of Physics and Astronomy, University College London, Gower St, London, WC1E 6BT, United Kingdom, 44 020 7679 7155, johannes.heyl.19@ucl.ac.uk %K COVID-19 %K coronavirus %K SARS-CoV-2 %K frailty %K comorbidity %K mortality %K death %K hospitalization %K hospital admission %K hospitalisation %K patient %K age %K sex %K ethnicity %K disease %K hospital %K cancer %K heart %K heart failure %K weight loss %K weight %K renal disease %K support %K geriatric %K older adult %K elder %K descriptive statistics %K machine learning %K model %D 2022 %7 12.12.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: Older adults have worse outcomes following hospitalization with COVID-19, but within this group there is substantial variation. Although frailty and comorbidity are key determinants of mortality, it is less clear which specific manifestations of frailty and comorbidity are associated with the worst outcomes. Objective: We aimed to identify the key comorbidities and domains of frailty that were associated with in-hospital mortality in older patients with COVID-19 using models developed for machine learning algorithms. Methods: This was a retrospective study that used the Hospital Episode Statistics administrative data set from March 1, 2020, to February 28, 2021, for hospitalized patients in England aged 65 years or older. The data set was split into separate training (70%), test (15%), and validation (15%) data sets during model development. Global frailty was assessed using the Hospital Frailty Risk Score (HFRS) and specific domains of frailty were identified using the Global Frailty Scale (GFS). Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Additional features employed in the random forest algorithms included age, sex, deprivation, ethnicity, discharge month and year, geographical region, hospital trust, disease severity, and International Statistical Classification of Disease, 10th Edition codes recorded during the admission. Features were selected, preprocessed, and input into a series of random forest classification algorithms developed to identify factors strongly associated with in-hospital mortality. Two models were developed; the first model included the demographic, hospital-related, and disease-related items described above, as well as individual GFS domains and CCI items. The second model was similar to the first but replaced the GFS domains and CCI items with the HFRS as a global measure of frailty. Model performance was assessed using the area under the receiver operating characteristic (AUROC) curve and measures of model accuracy. Results: In total, 215,831 patients were included. The model using the individual GFS domains and CCI items had an AUROC curve for in-hospital mortality of 90% and a predictive accuracy of 83%. The model using the HFRS had similar performance (AUROC curve 90%, predictive accuracy 82%). The most important frailty items in the GFS were dementia/delirium, falls/fractures, and pressure ulcers/weight loss. The most important comorbidity items in the CCI were cancer, heart failure, and renal disease. Conclusions: The physical manifestations of frailty and comorbidity, particularly a history of cognitive impairment and falls, may be useful in identification of patients who need additional support during hospitalization with COVID-19. %M 36423306 %R 10.2196/41520 %U https://www.i-jmr.org/2022/2/e41520 %U https://doi.org/10.2196/41520 %U http://www.ncbi.nlm.nih.gov/pubmed/36423306 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e40209 %T Experiences of Health Care Professionals Working Extra Weekends to Reduce COVID-19–Related Surgical Backlog: Cross-sectional Study %A Matava,Clyde %A So,Jeannette P %A Hossain,Alomgir %A Kelley,Simon %+ Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada, 1 416 813 7445, clyde.matava@sickkids.ca %K staff %K wait-list %K surgery %K health care delivery %K patient safety %K quality improvement %K patient satisfaction %K COVID-19 %K practice redesign %K burnout %K preoperative %K pediatric %K perioperative %K surgery %K surgical staff %K surgeon %K healthcare %K health care %K staff perception %K workforce %K stress %K work %K occupational health %K occupational safety %K perception %K workload %K nurse %K nursing %K anesthesiologist %K health care provider %K health care professional %K cross-sectional %K online survey %D 2022 %7 6.12.2022 %9 Original Paper %J JMIR Perioper Med %G English %X Background: During the quiescent periods of the COVID-19 pandemic in 2020, we implemented a weekend-scheduled pediatric surgery program to reduce COVID-19–related backlogs. Over 100 staff members from anesthesiologists to nurses, surgeons, and administrative and supporting personnel signed up to work extra weekends as part of a novel weekend elective pediatric surgery program to reduce COVID-19–related backlog: Operating Room Ramp-Up After COVID-19 Lockdown Ends-Extra Lists (ORRACLE-Xtra). Objective: In this study, we sought to evaluate staff perceptions and their level of satisfaction and experiences with working extra scheduled weekend elective surgical cases at the end of the 3-month pilot phase of ORRACLE-Xtra and identify key factors for participation. Methods: Following the pilot of ORRACLE-Xtra, all perioperative staff who worked at least 1 weekend list were invited to complete an online survey that was developed and tested prior to distribution. The survey collected information on the impact of working weekends on well-being, overall satisfaction, and likelihood of and preferences for working future weekend lists. Logistic regression was used to estimate the association of well-being with satisfaction and willingness to work future weekend lists. Results: A total of 82 out of 118 eligible staff responded to the survey for a response rate of 69%. Staff worked a median of 2 weekend lists (IQR 1-9). Of 82 staff members, 65 (79%) were satisfied or very satisfied with working the extra weekend elective lists, with surgeons and surgical trainees reporting the highest levels of satisfaction. Most respondents (72/82, 88%) would continue working weekend lists. A sense of accomplishment was associated with satisfaction with working on the weekend (odds ratio [OR] 19.97, 95% CI 1.79-222.63; P=.02) and willingness to participate in future weekend lists (OR 17.74, 95% CI 1.50-200.70; P=.02). Many (56/82, 68%) were willing to work weekend lists that included longer, more complex cases, which was associated with a sense of community (OR 0.12, 95% CI 0.02-0.63; P=.01). Conclusions: Staff participating in the first 3 months of the ORRACLE-Xtra program reported satisfaction with working weekends and a willingness to continue with the program, including doing longer, more complex cases. Institutions planning on implementing COVID-19 surgical backlog work may benefit from gathering key information from their staff. %M 36423322 %R 10.2196/40209 %U https://periop.jmir.org/2022/1/e40209 %U https://doi.org/10.2196/40209 %U http://www.ncbi.nlm.nih.gov/pubmed/36423322 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e40124 %T Effects of Hospital Digitization on Clinical Outcomes and Patient Satisfaction: Nationwide Multiple Regression Analysis Across German Hospitals %A von Wedel,Philip %A Hagist,Christian %A Liebe,Jan-David %A Esdar,Moritz %A Hübner,Ursula %A Pross,Christoph %+ Chair of Economic and Social Policy, WHU - Otto Beisheim School of Management, Burgplatz 2, Vallendar, 56179, Germany, 49 02616509 ext 255, philip.wedel@whu.edu %K health care information technology %K electronic health records %K hospital digitization %K quality of care %K clinical outcomes %K patient satisfaction %K user-perceived value %D 2022 %7 10.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The adoption of health information technology (HIT) by health care providers is commonly believed to improve the quality of care. Policy makers in the United States and Germany follow this logic and deploy nationwide HIT adoption programs to fund hospital investments in digital technologies. However, scientific evidence for the beneficial effects of HIT on care quality at a national level remains mostly US based, is focused on electronic health records (EHRs), and rarely accounts for the quality of digitization from a hospital user perspective. Objective: This study aimed to examine the effects of digitization on clinical outcomes and patient experience in German hospitals. Hence, this study adds to the small stream of literature in this field outside the United States. It goes beyond assessing the effects of mere HIT adoption and also considers user-perceived HIT value. In addition, the impact of a variety of technologies beyond EHRs was examined. Methods: Multiple linear regression models were estimated using emergency care outcomes, elective care outcomes, and patient satisfaction as dependent variables. The adoption and user-perceived value of HIT represented key independent variables, and case volume, hospital size, ownership status, and teaching status were included as controls. Care outcomes were captured via risk-adjusted, observed-to-expected outcome ratios for patients who had stroke, myocardial infarction, or hip replacement. The German Patient Experience Questionnaire of Weisse Liste provided information on patient satisfaction. Information on the adoption and user-perceived value of 10 subdomains of HIT and EHRs was derived from the German 2020 Healthcare IT Report. Results: Statistical analysis was based on an overall sample of 383 German hospitals. The analyzed data set suggested no significant effect of HIT or EHR adoption on clinical outcomes or patient satisfaction. However, a higher user-perceived value or quality of the installed tools did improve outcomes. Emergency care outcomes benefited from user-friendly overall digitization (β=−.032; P=.04), which was especially driven by the user-friendliness of admission HIT (β=−.023; P=.07). Elective care outcomes were positively impacted by user-friendly EHR installations (β=−.138; P=.008). Similarly, the results suggested user-friendly, overall digitization to have a moderate positive effect on patient satisfaction (β=−.009; P=.01). Conclusions: The results of this study suggest that hospital digitization is not an end in itself. Policy makers and hospitals are well advised to not only focus on the mere adoption of digital technologies but also continuously work toward digitization that is perceived as valuable by physicians and nurses who rely on it every day. Furthermore, hospital digitization strategies should consider that the assumed benefits of single technologies are not realized across all care domains. %M 36355423 %R 10.2196/40124 %U https://www.jmir.org/2022/11/e40124 %U https://doi.org/10.2196/40124 %U http://www.ncbi.nlm.nih.gov/pubmed/36355423 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e39728 %T Virtual Care and Electronic Patient Communication During COVID-19: Cross-sectional Study of Inequities Across a Canadian Tertiary Cancer Center %A Safavi,Amir H %A Lovas,Mike %A Liu,Zhihui Amy %A Melwani,Sheena %A Truong,Tran %A Devonish,Shayla %A Abdelmutti,Nazek %A Sayani,Ambreen %A Rodin,Danielle %A Berlin,Alejandro %+ Radiation Medicine Program, Princess Margaret Cancer Centre, 700 University Ave, 7th Floor - RMP, Toronto, ON, M5G 2M9, Canada, 1 4169462983, alejandro.berlin@rmp.uhn.ca %K digital health %K telehealth %K telemedicine %K eHealth %K oncology %K cancer care %K virtual care %K health inequities %K health inequality %K digital divide %K COVID-19 %K electronic mail %K cross sectional %K engagement %K satisfaction %K patient reported %K experience %D 2022 %7 4.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Virtual care (VC) visits (telephone or video) and email-based patient communication have been rapidly adopted to facilitate cancer care during the COVID-19 pandemic. Inequities in access and patient experience may arise as these digital health tools become prevalent. Objective: We aimed to characterize inequities in access and patient-reported experience following adoption of digital health tools at a tertiary cancer center during the COVID-19 pandemic. Methods: We designed a cross-sectional study of outpatients with visits from September to December 2020. Patient characteristics and responses to an email-based patient-experience survey were collated. Inequities in access were assessed across three pairs of comparison groups: (1) patients with VC and in-person visits, (2) patients with and without documented email addresses, and (3) responders and nonresponders to the survey. Inequities in patient-reported experience were assessed among survey responders. Demographics were mapped to area-level averages from national census data. Socioeconomic status was mapped to area-level dimensions of the Canadian Index of Multiple Deprivation. Covariate balance between comparison groups was assessed using standardized mean differences (SMDs), with SMD≥0.2 indicating differences between groups. Associations between patient experience satisfaction scores and covariates were assessed using multivariable analyses, with P<.05 indicating statistical significance. Results: Among the 42,194 patients who had outpatient visits, 62.65% (n=26,435) had at least one VC visit and 31.15% (n=13,144) were emailable. Access to VC and email was similar across demographic and socioeconomic indices (SMD<0.2). Among emailable patients, 21.84% (2870/13,144) responded to the survey. Survey responsiveness was similar across indices, aside from a small difference by age (SMD=0.24). Among responders, 24.4% received VC and were similar to in-person responders across indices (SMD<0.2). VC and in-person responders had similar satisfaction levels with all care domains surveyed (all P>.05). Regardless of visit type, patients had variable satisfaction with care domains across demographic and socioeconomic indices. Patients with higher ethnocultural composition scores were less satisfied with the cultural appropriateness of their care (odds ratio [OR] 0.70, 95% CI 0.57-0.86). Patients with higher situational vulnerability scores were less satisfied with discussion of physical symptoms (OR 0.67, 95% CI 0.48-0.93). Patients with higher residential instability scores were less satisfied with discussion of both physical (OR 0.81, 95% CI 0.68-0.97) and emotional (OR 0.86, 95% CI 0.77-0.96) symptoms, and also with the duration of their visit (OR 0.85, 95% CI 0.74-0.98; P=.02). Male patients were more satisfied with how their health care provider had listened to them (OR 1.64, 95% CI 1.11-2.44; P=.01). Conclusions: Adoption of VC and email can equitably maintain access and patient-reported experience in cancer care across demographics and socioeconomic indices. Existing health inequities among structurally marginalized patients must continue to be addressed to improve their care experience. %M 36331536 %R 10.2196/39728 %U https://www.jmir.org/2022/11/e39728 %U https://doi.org/10.2196/39728 %U http://www.ncbi.nlm.nih.gov/pubmed/36331536 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e39366 %T How Face Masks Affect the Use of Echolocation by Individuals With Visual Impairments During COVID-19: International Cross-sectional Online Survey %A Kreidy,Chantal %A Martiniello,Natalina %A Nemargut,Joseph Paul %A Wittich,Walter %+ School of Optometry, University of Montreal, 3744, rue Jean-Brillant Bureau 260-7, Montréal, QC, H3T 1P1, Canada, 1 514 343 7962, chantal.kreidy@umontreal.ca %K visual impairment %K echolocation %K COVID-19 %K orientation and mobility %K vision rehabilitation %K online survey %K rehabilitation %K face mask %K visual disability %K vision disorder %K quality of life %K health intervention %D 2022 %7 25.10.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: Although a critical safety measure, preliminary studies have suggested that the use of a face mask may pose a problem for some users with disabilities. To date, little is known about how the wearing of a traditional face mask may pose a barrier to individuals with visual impairments who draw on auditory cues and echolocation techniques during independent travel. Objective: The goal of this study was to document the difficulties, if any, encountered during orientation and mobility due to the use of a face mask during the COVID-19 pandemic and the strategies used to address these barriers. Methods: In total, 135 individuals aged 18 years and older who self-identified as being blind, being deafblind, or having low vision and who could communicate in either English or French completed an anonymous cross-sectional online survey between March 29 and August 23, 2021. Results: In total, 135 respondents (n=52, 38.5%, men; n=83, 61.5%, women) between the ages of 18 and 79 (mean 48.22, SD 14.48) years participated. Overall, 78 (57.7%) self-identified as blind and 57 (42.3%) as having low vision. In addition, 13 (9.6%) identified as having a combined vision and hearing loss and 3 (2.2%) as deafblind. The most common face coverings used were cloth (n=119, 88.1%) and surgical masks (n=74, 54.8%). Among the barriers raised, participants highlighted that face masks made it more difficult to locate people (n=86, 63.7%), communicate with others (n=101, 74.8%), and locate landmarks (n=82, 60.7%). Although the percentage of those who used a white cane before the pandemic did not substantially change, 6 (14.6%) of the 41 participants who were guide dog users prior to the pandemic reported no longer working with a guide dog at the time of the survey. Moreover, although guide dog users reported the highest level of confidence with independent travel before the pandemic, they indicated the lowest level of confidence a year after the pandemic began. Conclusions: These results suggest that participants were less able to draw on nonvisual cues during independent travel and social interactions due to the use of a facemask, contributing to a reduction in perceived self-confidence and independence. Findings inform the development of evidence-based recommendations to address identified barriers. %M 36223434 %R 10.2196/39366 %U https://www.i-jmr.org/2022/2/e39366 %U https://doi.org/10.2196/39366 %U http://www.ncbi.nlm.nih.gov/pubmed/36223434 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e37436 %T Understanding How the Design and Implementation of Online Consultations Affect Primary Care Quality: Systematic Review of Evidence With Recommendations for Designers, Providers, and Researchers %A Darley,Sarah %A Coulson,Tessa %A Peek,Niels %A Moschogianis,Susan %A van der Veer,Sabine N %A Wong,David C %A Brown,Benjamin C %+ Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 7919103175, Benjamin.brown@manchester.ac.uk %K general practice %K systematic review %K remote consultation %K OC %K triage %K primary health care %K care provider %K health care professional %K workforce %K telemedicine %K COVID-19 %K pandemic %K primary care %K health outcome %K patient care %D 2022 %7 24.10.2022 %9 Review %J J Med Internet Res %G English %X Background: Online consultations (OCs) allow patients to contact their care providers on the web. Worldwide, OCs have been rolled out in primary care rapidly owing to policy initiatives and COVID-19. There is a lack of evidence regarding how OC design and implementation influence care quality. Objective: We aimed to synthesize research on the impacts of OCs on primary care quality, and how these are influenced by system design and implementation. Methods: We searched databases from January 2010 to February 2022. We included quantitative and qualitative studies of real-world OC use in primary care. Quantitative data were transformed into qualitative themes. We used thematic synthesis informed by the Institute of Medicine domains of health care quality, and framework analysis informed by the nonadoption, abandonment, scale-up, spread, and sustainability framework. Strength of evidence was judged using the GRADE-CERQual approach. Results: We synthesized 63 studies from 9 countries covering 31 OC systems, 14 (22%) of which used artificial intelligence; 41% (26/63) of studies were published from 2020 onward, and 17% (11/63) were published after the COVID-19 pandemic. There was no quantitative evidence for negative impacts of OCs on patient safety, and qualitative studies suggested varied perceptions of their safety. Some participants believed OCs improved safety, particularly when patients could describe their queries using free text. Staff workload decreased when sufficient resources were allocated to implement OCs and patients used them for simple problems or could describe their queries using free text. Staff workload increased when OCs were not integrated with other software or organizational workflows and patients used them for complex queries. OC systems that required patients to describe their queries using multiple-choice questionnaires increased workload for patients and staff. Health costs decreased when patients used OCs for simple queries and increased when patients used them for complex queries. Patients using OCs were more likely to be female, younger, and native speakers, with higher socioeconomic status. OCs increased primary care access for patients with mental health conditions, verbal communication difficulties, and barriers to attending in-person appointments. Access also increased by providing a timely response to patients’ queries. Patient satisfaction increased when using OCs owing to better primary care access, although it decreased when using multiple-choice questionnaire formats. Conclusions: This is the first theoretically informed synthesis of research on OCs in primary care and includes studies conducted during the COVID-19 pandemic. It contributes new knowledge that, in addition to having positive impacts on care quality such as increased access, OCs also have negative impacts such as increased workload. Negative impacts can be mitigated through appropriate OC system design (eg, free text format), incorporation of advanced technologies (eg, artificial intelligence), and integration into technical infrastructure (eg, software) and organizational workflows (eg, timely responses). Trial Registration: PROSPERO CRD42020191802; https://tinyurl.com/2p84ezjy %M 36279172 %R 10.2196/37436 %U https://www.jmir.org/2022/10/e37436 %U https://doi.org/10.2196/37436 %U http://www.ncbi.nlm.nih.gov/pubmed/36279172 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e33769 %T Readiness for Telemedical Services in Patients With Cardiovascular Diseases: Cross-sectional Study %A Kalańska-Łukasik,Barbara %A Gładyś,Aleksandra %A Jadczyk,Tomasz %A Gruz-Kwapisz,Monika %A Wojakowski,Wojciech %A Kowalska,Malgorzata %+ Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziołowa 47, Katowice, 40-635, Poland, 1 32 359 86 90, b.kalanska.lukasik@gmail.com %K telemedicine %K readiness %K patient-cardiologist contact %K telehealth %K acceptance %D 2022 %7 18.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Telemedicine solutions, especially in the face of epidemiological emergencies such as the COVID-19 pandemic, played an important role in the remote communication between patients and medical providers. However, the implementation of modern technologies should rely on patients’ readiness toward new services to enable effective cooperation with the physician. Thus, successful application of patient-centric telehealth services requires an in-depth analysis of users’ expectations. Objective: This study aimed to evaluate factors determining readiness for using telehealth solutions among patients with cardiovascular diseases. Methods: We conducted a cross-sectional study based on an investigator-designed, validated questionnaire that included 19 items (demographics, health status, medical history, previous health care experience, expected telehealth functionalities, and preferred remote communication methods). Multivariate logistic regression was applied to assess the relationship between readiness and their determinants. Results: Of the 249 respondents, 83.9% (n=209) consented to the use of telemedicine to contact a cardiologist. The nonacceptance of using telemedicine was 2 times more frequent in rural dwellers (odds ratio [OR] 2.411, 95% CI 1.003-5.796) and patients without access to the internet (OR 2.432, 95% CI 1.022-5.786). In comparison to participants living in rural areas, city dwellers demonstrated a higher willingness to use telemedicine, including following solutions: issuing e-prescriptions (19/31, 61.3% vs 141/177, 79.7%; P=.02); alarming at the deterioration of health (18/31, 58.1% vs 135/177, 76.3%; P=.03); and arranging or canceling medical visits (16/31, 51.6% vs 126/176, 71.6%; P=.03). Contact by mobile phone was preferred by younger patients (OR 2.256, 95% CI 1.058-4.814), whereas older patients and individuals who had no previous difficulties in accessing physicians preferred landline phone communication. Conclusions: During a nonpandemic state, 83.9% of patients with cardiovascular diseases declared readiness to use telemedicine solutions. %M 36256834 %R 10.2196/33769 %U https://formative.jmir.org/2022/10/e33769 %U https://doi.org/10.2196/33769 %U http://www.ncbi.nlm.nih.gov/pubmed/36256834 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e38661 %T Evidence for Telemedicine’s Ongoing Transformation of Health Care Delivery Since the Onset of COVID-19: Retrospective Observational Study %A Mandal,Soumik %A Wiesenfeld,Batia M %A Mann,Devin %A Lawrence,Katharine %A Chunara,Rumi %A Testa,Paul %A Nov,Oded %+ Department of Population Health, New York University Grossman School of Medicine, New York University, 180 Madison Ave, New York, NY, 10016, United States, 1 6465013442, mandal.soumik@gmail.com %K digital health %K telemedicine %K urgent care %K COVID-19 %K health care delivery %D 2022 %7 14.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The surge of telemedicine use during the early stages of the COVID-19 pandemic has been well documented. However, scarce evidence considers the use of telemedicine in the subsequent period. Objective: This study aims to evaluate use patterns of video-based telemedicine visits for ambulatory care and urgent care provision over the course of recurring pandemic waves in 1 large health system in New York City (NYC) and what this means for health care delivery. Methods: Retrospective electronic health record (EHR) data of patients from January 1, 2020, to February 28, 2022, were used to longitudinally track and analyze telemedicine and in-person visit volumes across ambulatory care specialties and urgent care, as well as compare them to a prepandemic baseline (June-November 2019). Diagnosis codes to differentiate suspected COVID-19 visits from non–COVID-19 visits, as well as evaluating COVID-19–based telemedicine use over time, were compared to the total number of COVID-19–positive cases in the same geographic region (city level). The time series data were segmented based on change-point analysis, and variances in visit trends were compared between the segments. Results: The emergence of COVID-19 prompted an early increase in the number of telemedicine visits across the urgent care and ambulatory care settings. This use continued throughout the pandemic at a much higher level than the prepandemic baseline for both COVID-19 and non–COVID-19 suspected visits, despite the fluctuation in COVID-19 cases throughout the pandemic and the resumption of in-person clinical services. The use of telemedicine-based urgent care services for COVID-19 suspected visits showed more variance in response to each pandemic wave, but telemedicine visits for ambulatory care have remained relatively steady after the initial crisis period. During the Omicron wave, the use of all visit types, including in-person activities, decreased. Patients between 25 and 34 years of age were the largest users of telemedicine-based urgent care. Patient satisfaction with telemedicine-based urgent care remained high despite the rapid scaling of services to meet increased demand. Conclusions: The trend of the increased use of telemedicine as a means of health care delivery relative to the pre–COVID-19 baseline has been maintained throughout the later pandemic periods despite fluctuating COVID-19 cases and the resumption of in-person care delivery. Overall satisfaction with telemedicine-based care is also high. The trends in telemedicine use suggest that telemedicine-based health care delivery has become a mainstream and sustained supplement to in-person-based ambulatory care, particularly for younger patients, for both urgent and nonurgent care needs. These findings have implications for the health care delivery system, including practice leaders, insurers, and policymakers. Further investigation is needed to evaluate telemedicine adoption by key demographics, identify ongoing barriers to adoption, and explore the impacts of sustained use of telemedicine on health care outcomes and experience. %M 36103553 %R 10.2196/38661 %U https://formative.jmir.org/2022/10/e38661 %U https://doi.org/10.2196/38661 %U http://www.ncbi.nlm.nih.gov/pubmed/36103553 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e29927 %T Business Process Model and Notation and openEHR Task Planning for Clinical Pathway Standards in Infections: Critical Analysis %A Iglesias,Natalia %A Juarez,Jose M %A Campos,Manuel %+ Instituto de Investigación de Tecnologías de la Información y las Comunicaciones Orientadas, University of Murcia, Faculty of Computer Science, Campus Espinardo, University of Murcia, Murcia, 30100, Spain, 34 868887864, natalia.iglesias@um.es %K openEHR task planning %K business process model and notation %K BPMN %K clinical pathways %K catheter-related bloodstream infection %K CR-BSI %K clinical guidelines %D 2022 %7 15.9.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Clinical pathways (CPs) are usually expressed by means of workflow formalisms, providing health care personnel with an easy-to-understand, high-level conceptual model of medical steps in specific patient conditions, thereby improving overall health care process quality in clinical practice. From a standardized perspective, the business process model and notation (BPMN), a widely spread general-purpose process formalism, has been used for conceptual modeling in clinical domains, mainly because of its easy-to-use graphical notation, facilitating the common understanding and communication of the parties involved in health care. However, BPMN is not particularly oriented toward the peculiarities of complex clinical processes such as infection diagnosis and treatment, in which time plays a critical role, which is why much of the BPMN clinical-oriented research has revolved around how to extend the standard to address these special needs. The shift from an agnostic, general-purpose BPMN notation to a natively clinical-oriented notation such as openEHR Task Planning (TP) could constitute a major step toward clinical process improvement, enhancing the representation of CPs for infection treatment and other complex scenarios. Objective: Our work aimed to analyze the suitability of a clinical-oriented formalism (TP) to successfully represent typical process patterns in infection treatment, identifying domain-specific improvements to the standard that could help enhance its modeling capabilities, thereby promoting the widespread adoption of CPs to improve medical practice and overall health care quality. Methods: Our methodology consisted of 4 major steps: identification of key features of infection CPs through literature review, clinical guideline analysis, and BPMN extensions; analysis of the presence of key features in TP; modeling of relevant process patterns of catheter-related bloodstream infection as a case study; and analysis and proposal of extensions in view of the results. Results: We were able to easily represent the same logic applied in the extended BPMN-based process models in our case study using out-of-the-box standard TP primitives. However, we identified possible improvements to the current version of TP to allow for simpler conceptual models of infection CPs and possibly of other complex clinical scenarios. Conclusions: Our study showed that the clinical-oriented TP specification is able to successfully represent the most complex catheter-related bloodstream infection process patterns depicted in our case study and identified possible extensions that can help increase its adequacy for modeling infection CPs and possibly other complex clinical conditions. %M 36107480 %R 10.2196/29927 %U https://www.jmir.org/2022/9/e29927 %U https://doi.org/10.2196/29927 %U http://www.ncbi.nlm.nih.gov/pubmed/36107480 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e39230 %T The Characteristics of Student SARS-CoV-2 Cases on an Urban University Campus: Observational Study %A Landry,Megan %A Vyas,Amita %A Nagaraj,Nitasha %A Sardon Jr,Gary A %A Bornstein,Sydney %A Latif,Hannah %A Kucherlapaty,Padmini %A McDonnell,Karen %A Castel,Amanda %A Goldman,Lynn %+ Office of the Dean, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW, 7th Floor, Washington, DC, 20052, United States, 1 202 994 0883, mmlandry@gwu.edu %K COVID-19 %K SARS-CoV-2 %K college %K university %K students %K young adult %K youth %K communicable disease %K prevention %K school health %K outbreak prevention %K contact tracing %K pandemic %D 2022 %7 13.9.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: Academic institutions are central hubs for young adults, laden with academic and social interactions and communal living arrangements, heightening the risk of transmission of many communicable diseases, including COVID-19. Shortly after the start of the fall 2020 academic year, institutions of higher learning were identified as hot spots for rises in COVID-19 incidence among young adults. Objective: This study aims to identify the characteristics of student SARS-CoV-2 cases, identify the extent to which the student population adhered to preventative strategies, and examine behaviors that would put them at higher risk of contracting or spreading COVID-19. Methods: This observational study comprises 1175 university students at The George Washington University in Washington, DC, with a confirmed COVID-19 diagnosis between August 3, 2020, and November 30, 2021. Case investigation and contact tracing tools were developed by the Campus COVID-19 Support Team and captured in REDCap (Research Electronic Data Capture). Trained case investigators were notified of a case and attempted to contact all cases within 24 hours of the case receiving their lab result. Associations between case characteristics and number of contacts were examined using Wilcoxon rank sum tests. Knowledge of exposure, behaviors since exposure, student residence status, and fraternity and sorority life affiliation were examined using chi-square tests. Results: Positive student cases reported a median of 3 close contacts, and 84.6% (993/1175) reported at least one symptom with a median of 4 COVID-19 symptoms. Congestion (628/1175, 53.4%), cough (530/1175, 45.1%), and headache (484/1175, 41.2%) were the most frequently reported symptoms. Moreover, 36% (415/1160) reported that they did not know how they were exposed to the virus. Among those aware of contact with a COVID-19 confirmed case, 55.1% (109/198) reported the contact was a close friend or family member, and 25.3% (50/198) reported that it was someone with whom they lived. Athlete (vs nonathlete; P<.001), on-campus (vs off-campus; P<.001), and undergraduate (vs graduate; P=.01) students all reported a significantly higher number of contacts. Students living on campus were more likely to report attending campus events in the 2 days prior to symptom onset or positive test result (P=.004). Students with fraternity or sorority affiliation were more likely to report attending campus events in the 2 days prior to symptom onset or positive test result (P<.001). Conclusions: COVID-19 cases have not yet stabilized to a predictable state, but this study provides case characteristics and insights for how academic institutions might prepare to mitigate outbreaks on their campuses as the world plans for the transition from pandemic to endemic COVID-19. %M 36037255 %R 10.2196/39230 %U https://www.i-jmr.org/2022/2/e39230 %U https://doi.org/10.2196/39230 %U http://www.ncbi.nlm.nih.gov/pubmed/36037255 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 9 %P e34488 %T Use of a Semiautomatic Text Message System to Improve Satisfaction With Wait Time in the Adult Emergency Department: Cross-sectional Survey Study %A Ehrler,Frederic %A Rochat,Jessica %A Siebert,Johan N %A Guessous,Idris %A Lovis,Christian %A Spechbach,Hervé %+ Division of Medical Information Sciences, University Hospitals of Geneva, Gabrielle Perret Gentil 4, Geneva, 1205, Switzerland, 41 79 553 16 03, frederic.ehrler@hcuge.ch %K emergency %K patient satisfaction %K service-oriented health care %K quality of care %K health service %K emergency department %D 2022 %7 6.9.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Many factors influence patient satisfaction during an emergency department (ED) visit, but the perception of wait time plays a central role. A long wait time in the waiting room increases the risk of hospital-acquired infection, as well as the risk of a patient leaving before being seen by a physician, particularly those with a lower level of urgency who may have to wait for a longer time. Objective: We aimed to improve the perception of wait time through the implementation of a semiautomatic SMS text message system that allows patients to wait outside the hospital and facilitates the recall of patients closer to the scheduled time of meeting with the physician. Methods: We performed a cross-sectional survey to evaluate the system using a tailored questionnaire to assess the patient perspective and the Unified Theory of Acceptance and Use of Technology questionnaire for the caregiver perspective. We also monitored the frequency of system use with logs. Results: A total of 110 usable responses were collected (100 patients and 10 caregivers). Findings revealed that 97 of 100 (97%) patients were satisfied, with most patients waiting outside the ED but inside the hospital. The caregiver evaluation showed that it was very easy to use, but the adoption of the system was more problematic because of the perceived additional workload associated with its use. Conclusions: Although not suitable for all patients, our system allows those who have a low-severity condition to wait outside the waiting room and to be recalled according to the dedicated time defined in the Swiss Emergency Triage Scale. It not only has the potential to reduce the risk of hospital-acquired infection but also can enhance the patient experience; additionally, it was perceived as a real improvement. Further automation of the system needs to be explored to reduce caregiver workload and increase its use. %M 36066921 %R 10.2196/34488 %U https://medinform.jmir.org/2022/9/e34488 %U https://doi.org/10.2196/34488 %U http://www.ncbi.nlm.nih.gov/pubmed/36066921 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e39778 %T Ranolazine Versus Allopurinol for Eligible Symptomatic Patients With a History of Angioplasty: Comparative Efficacy Study %A Rahmani,Reza %A Moradi Farsani,Ehsan %A Bahrami,Sima %+ Tehran University of Medical Sciences, Imam Khomeini Hospital, Tehran, 1419733141, Iran, 98 2172858684, simabahrami1368@gmail.com %K ranolazine %K allopurinol %K recurrent angina %K exercise tolerance %D 2022 %7 17.8.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: Recurrent angina, which is defined as a return of chest pain or chest discomfort, occurs in many patients undergoing coronary interventions. Objective: This study aims to compare the antianginal efficacy of ranolazine versus allopurinol for eligible symptomatic patients with a history of angioplasty. Methods: A total of 62 eligible symptomatic patients with a history of angioplasty were randomly allocated into two groups. For group A, 300 mg of allopurinol was administered twice daily, while for group B, 1000 mg of ranolazine daily was prescribed for a duration of 4 weeks. An initial screening visit was done for all participants where patients’ medical history was recorded and a physical examination was given; electrocardiography, blood pressure, and heart rate measurements were done as well. The patients were also given a blood and exercise test. At the end of the medication period, participants were revisited, and the tests were done again. All the required data were collected via a researcher-made form, and data analysis was conducted using SPSS. The study was approved by a formal ethics committee. Results: The mean age of participants in the two groups (A and B) was 57.36 (SD 8.36) and 60.27 (SD 9.17) years, respectively. Among the 62 patients, 34 (59%) were men, while 28 (41%) were women. Creatinine, fasting blood sugar, C-reactive protein, N-terminal prohormone of brain natriuretic protein, uric acid, white blood cell, and hemoglobin levels of participants were not significantly different between groups (P>.05). Both allopurinol and ranolazine increased the total exercise time and decreased the ST depression of the patients. Additionally, they both improved the chest pain severity and Duke Treadmill Score of patients. At the same time, ranolazine had a statistically greater effect on ST depression reduction (mean 2.64, SD 0.74 vs mean 1.57, SD 0.49), while allopurinol showed better efficacy in reducing chest pain severity (mean 1.86, SD 0.37 vs mean 0.59, SD 0.21) and the Duke Treadmill Score (mean –14.77, SD 3.65 vs mean –6.88, SD 1.93). Conclusions: Based on the results, the antianginal efficacy of allopurinol and ranolazine was approved but with different effects on ST depression, chest pain severity, and the Duke Treadmill Score. Therefore, the precise differences in their effects need to be explored further. %M 35976197 %R 10.2196/39778 %U https://www.i-jmr.org/2022/2/e39778 %U https://doi.org/10.2196/39778 %U http://www.ncbi.nlm.nih.gov/pubmed/35976197 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 3 %P e34263 %T Waiting Time and Patient Satisfaction in a Subspecialty Eye Hospital Using a Mobile Data Collection Kit: Pre-Post Quality Improvement Intervention %A Mbwogge,Mathew %A Astbury,Nicholas %A Nkumbe,Henry Ebong %A Bunce,Catey %A Bascaran,Covadonga %+ International Center for Eye Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 07424409211, m.mbwoge@gmail.com %K waiting time %K waiting list %K patient satisfaction %K quality improvement %K clinical audit %K ophthalmology %K patient-centered care %D 2022 %7 9.8.2022 %9 Original Paper %J JMIRx Med %G English %X Background: Waiting time can considerably increase the cost to both the clinic and the patient and be a major predictor of the satisfaction of eye care users. Efficient management of waiting time remains as a challenge in hospitals. Waiting time management will become even more crucial in the postpandemic era. A key consideration when improving waiting time is the involvement of eye care users. This study aimed at improving patient waiting time and satisfaction through the use of Plan-Do-Study-Act (PDSA) quality improvement cycles. Objective: The objectives of this study were to determine the waiting time and patient satisfaction, measure the association between waiting time and patient satisfaction, and determine the effectiveness of the PDSA model in improving waiting time and satisfaction. Methods: This was a pre-post quality improvement study among patients aged 19 to 80 years, who are consulting with the Magrabi International Council of Ophthalmology Cameroon Eye Institute. We used PDSA cycles to conduct improvement audits of waiting time and satisfaction over 6 weeks. A data collection app known as Open Data Kit (Get ODK Inc) was used for real-time tracking of waiting, service, and idling times at each service point. Participants were also asked whether they were satisfied with the waiting time at the point of exit. Data from 51% (25/49) preintervention participants and 49% (24/49) postintervention participants were analyzed using Stata 14 at .05 significance level. An unpaired 2-tailed t test was used to assess the statistical significance of the observed differences in times before and after the intervention. Logistic regression was used to examine the association between satisfaction and waiting time. Results: In total, 49 participants were recruited with mean age of 49 (SD 15.7) years. The preintervention mean waiting, service, and idling times were 450 (SD 96.6), 112 (SD 47), and 338 (SD 98.1) minutes, respectively. There was no significant association between patient waiting time and satisfaction (odds ratio 1, 95% CI 0.99-1; P=.37; χ23=0.4). The use of PDSA led to 15% (66 minutes/450 minutes) improvement in waiting time (t47=2; P=.05) and nonsignificant increase in patient satisfaction from 32% (8/25) to 33% (8/24; z=0.1; P=.92). Conclusions: Use of PDSA led to a borderline statistically significant reduction of 66 minutes in waiting time over 6 weeks and an insignificant improvement in satisfaction, suggesting that quality improvement efforts at the clinic have to be made over a considerable period to be able to produce significant changes. The study provides a good basis for standardizing the cycle (consultation) time at the clinic. We recommend shortening the patient pathway and implementing other measures including a phasic appointment system, automated patient time monitoring, robust ticketing, patient pathway supervision, standard triaging, task shifting, physician consultation planning, patient education, and additional registration staff. %M 37725529 %R 10.2196/34263 %U https://med.jmirx.org/2022/3/e34263 %U https://doi.org/10.2196/34263 %U http://www.ncbi.nlm.nih.gov/pubmed/37725529 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e40181 %T Self-management Interventions for People With Parkinson Disease: Scoping Review %A Milne-Ives,Madison %A Carroll,Camille %A Meinert,Edward %+ Centre for Health Technology, University of Plymouth, 6 Kirkby Place, Room 2, Plymouth, PL4 6DN, United Kingdom, 44 01752600600, edward.meinert@plymouth.ac.uk %K Parkinson disease %K self-management %K self-care %K home nursing %K self-efficacy %K quality of life %K signs and symptoms %K health behaviour %D 2022 %7 5.8.2022 %9 Review %J J Med Internet Res %G English %X Background: Parkinson disease can impose substantial distress and costs on patients, their families and caregivers, and health care systems. To address these burdens for families and health care systems, there is a need to better support patient self-management. To achieve this, an overview of the current state of the literature on self-management is needed to identify what is being done, how well it is working, and what might be missing. Objective: The aim of this scoping review was to provide an overview of the current body of research on self-management interventions for people with Parkinson disease and identify any knowledge gaps. Methods: The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) and Population, Intervention, Comparator, Outcome, and Study type frameworks were used to structure the methodology of the review. Due to time and resource constraints, 1 reviewer systematically searched 4 databases (PubMed, Ovid, Scopus, and Web of Science) for the evaluations of self-management interventions for Parkinson disease published in English. The references were screened using the EndNote X9 citation management software, titles and abstracts were manually reviewed, and studies were selected for inclusion based on the eligibility criteria. Data were extracted into a pre-established form and synthesized in a descriptive analysis. Results: There was variation among the studies on study design, sample size, intervention type, and outcomes measured. The randomized controlled trials had the strongest evidence of effectiveness: 5 out of 8 randomized controlled trials found a significant difference between groups favoring the intervention on their primary outcome, and the remaining 3 had significant effects on at least some of the secondary outcomes. The 2 interventions included in the review that targeted mental health outcomes both found significant changes over time, and the 3 algorithms evaluated performed well. The remaining studies examined patient perceptions, acceptability, and cost-effectiveness and found generally positive results. Conclusions: This scoping review identified a wide variety of interventions designed to support various aspects of self-management for people with Parkinson disease. The studies all generally reported positive results, and although the strength of the evidence varied, it suggests that self-management interventions are promising for improving the care and outcomes of people with Parkinson disease. However, the research tended to focus on the motor aspects of Parkinson disease, with few nonmotor or holistic interventions, and there was a lack of evaluation of cost-effectiveness. This research will be important to providing self-management interventions that meet the varied and diverse needs of people with Parkinson disease and determining which interventions are worth promoting for widespread adoption. %M 35930315 %R 10.2196/40181 %U https://www.jmir.org/2022/8/e40181 %U https://doi.org/10.2196/40181 %U http://www.ncbi.nlm.nih.gov/pubmed/35930315 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e34514 %T Consumer Perspectives on the Use of Artificial Intelligence Technology and Automation in Crisis Support Services: Mixed Methods Study %A Ma,Jennifer S %A O’Riordan,Megan %A Mazzer,Kelly %A Batterham,Philip J %A Bradford,Sally %A Kõlves,Kairi %A Titov,Nickolai %A Klein,Britt %A Rickwood,Debra J %+ Discipline of Psychology, Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT, 2617, Australia, 61 (0)2 6201 2701, Debra.Rickwood@canberra.edu.au %K consumer %K community %K help-seeker %K perspective %K technology %K artificial intelligence %K crisis %K support %K acceptability %D 2022 %7 5.8.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Emerging technologies, such as artificial intelligence (AI), have the potential to enhance service responsiveness and quality, improve reach to underserved groups, and help address the lack of workforce capacity in health and mental health care. However, little research has been conducted on the acceptability of AI, particularly in mental health and crisis support, and how this may inform the development of responsible and responsive innovation in the area. Objective: This study aims to explore the level of support for the use of technology and automation, such as AI, in Lifeline’s crisis support services in Australia; the likelihood of service use if technology and automation were implemented; the impact of demographic characteristics on the level of support and likelihood of service use; and reasons for not using Lifeline’s crisis support services if technology and automation were implemented in the future. Methods: A mixed methods study involving a computer-assisted telephone interview and a web-based survey was undertaken from 2019 to 2020 to explore expectations and anticipated outcomes of Lifeline’s crisis support services in a nationally representative community sample (n=1300) and a Lifeline help-seeker sample (n=553). Participants were aged between 18 and 93 years. Quantitative descriptive analysis, binary logistic regression models, and qualitative thematic analysis were conducted to address the research objectives. Results: One-third of the community and help-seeker participants did not support the collection of information about service users through technology and automation (ie, via AI), and approximately half of the participants reported that they would be less likely to use the service if automation was introduced. Significant demographic differences were observed between the community and help-seeker samples. Of the demographics, only older age predicted being less likely to endorse technology and automation to tailor Lifeline’s crisis support service and use such services (odds ratio 1.48-1.66, 99% CI 1.03-2.38; P<.001 to P=.005). The most common reason for reluctance, reported by both samples, was that respondents wanted to speak to a real person, assuming that human counselors would be replaced by automated robots or machine services. Conclusions: Although Lifeline plans to always have a real person providing crisis support, help-seekers automatically fear this will not be the case if new technology and automation such as AI are introduced. Consequently, incorporating innovative use of technology to improve help-seeker outcomes in such services will require careful messaging and assurance that the human connection will continue. %M 35930334 %R 10.2196/34514 %U https://humanfactors.jmir.org/2022/3/e34514 %U https://doi.org/10.2196/34514 %U http://www.ncbi.nlm.nih.gov/pubmed/35930334 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e38874 %T The Variations in Care and Real-world Outcomes in Individuals With Rectal Cancer: Protocol for the Ontario Rectal Cancer Cohort %A Patel,Sunil %A McClintock,Chad %A Booth,Christopher %A Merchant,Shaila %A Heneghan,Carl %A Bankhead,Clare %+ Department of Surgery, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada, 1 613 549 6666 ext 7995, sunil.patel@kingstonhsc.ca %K rectal cancer %K survival %K adherence to care %K regional variability %D 2022 %7 5.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Individuals with rectal cancer require a number of pretreatment investigations, often require multidisciplinary treatment, and require ongoing follow-ups after treatment is completed. Due to the complexity of treatments, large variations in practice patterns and outcomes have been identified. At present, few comprehensive, population-level data sets are available for assessing interventions and outcomes in this group. Objective: Our study aims to create a comprehensive database of individuals with rectal cancer who have been treated in a single-payer, universal health care system. This database will provide an excellent resource that investigators can use to study variations in the delivery of care to and real-world outcomes of this population. Methods: The Ontario Rectal Cancer Cohort database will include comprehensive details about the management and outcomes of individuals with rectal cancer who have been diagnosed in Ontario, Canada (population: 14.6 million), between 2010 and 2019. Linked administrative data sets will be used to construct this comprehensive database. Individual and care provider characteristics, investigations, treatments, follow-ups, and outcomes will be derived and linked. Surgical pathology details, including the stage of disease, histopathology characteristics, and the quality of surgical excision, will be included. Ethics approval for this study was obtained through the Queen’s University Health Sciences and Affiliated Teaching Hospitals Research Ethics Board. Results: Approximately 20,000 individuals who meet the inclusion criteria for this study have been identified. Data analysis is ongoing, with an expected completion date of March 2023. This study was funded through the Canadian Institute of Health Research Operating Grant. Conclusions: The Ontario Rectal Cancer Cohort will include a comprehensive data set of individuals with rectal cancer who received care within a single-payer, universal health care system. This cohort will be used to determine factors associated with regional variability and adherence to recommended care, and it will allow for an assessment of a number of understudied areas within the delivery of rectal cancer treatment. International Registered Report Identifier (IRRID): RR1-10.2196/38874 %M 35930352 %R 10.2196/38874 %U https://www.researchprotocols.org/2022/8/e38874 %U https://doi.org/10.2196/38874 %U http://www.ncbi.nlm.nih.gov/pubmed/35930352 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e36756 %T Trends in the Prevalence of Chronic Medication Use Among Children in Israel Between 2010 and 2019: Protocol for a Retrospective Cohort Study %A Sadaka,Yair %A Horwitz,Dana %A Wolff,Leor %A Sela,Tomer %A Meyerovitch,Joseph %A Peleg,Assaf %A Bachmat,Eitan %A Benis,Arriel %+ Neuro-Developmental Research Centre, Beer Sheva Mental Health Centre, Ministry of Health, Hatzadik Meyerushalim 2, Beer Sheva, 8461144, Israel, 972 587800404, yair.sadaka@moh.healh.gov.il %K psychotropic drugs %K central nervous system stimulants %K mental health %K medication therapy management %K drug prescriptions %K attention deficit hyperactivity disorder %K ADHD, Israel %K children %K data mining %K machine learning %K electronic medical records %K pediatrics %K chronic disease %K epidemiology %D 2022 %7 5.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Prescription of psychostimulants has significantly increased in most countries worldwide for both preschool and school-aged children. Understanding the trends of chronic medication use among children in different age groups and from different sociodemographic backgrounds is essential. It is essential to distinguish between selected therapy areas to help decision-makers evaluate not only the relevant expected medication costs but also the specific services related to these areas. Objective: This study will analyze differences in trends regarding medications considered psychobehavioral treatments and medications considered nonpsychobehavioral treatments and will identify risk factors and predictors for chronic medication use among children. Methods: This is a retrospective study. Data will be extracted from the Clalit Health Services data warehouse. For each year between 2010 and 2019, there are approximately 1,500,000 children aged 0-18 years. All medication classes will be identified using the Anatomical Therapeutic Chemical code. A time-trend analysis will be performed to investigate if there is a significant difference between the trends of children’s psychobehavioral and nonpsychobehavioral medication prescriptions. A logistic regression combined with machine learning models will be developed to identify variables that may increase the risk for specific chronic medication types and identify children likely to get such treatment. Results: The project was funded in 2019. Data analysis is currently underway, and the results are expected to be submitted for publication in 2022. Understanding trends regarding medications considered psychobehavioral treatments and medications considered nonpsychobehavioral treatments will support the identification of risk factors and predictors for chronic medication use among children. Conclusions: Analyzing the response of the patient (and their parents or caregivers) population over time will hopefully help improve policies for prescriptions and follow-up of chronic treatments in children. International Registered Report Identifier (IRRID): DERR1-10.2196/36756 %M 35775233 %R 10.2196/36756 %U https://www.researchprotocols.org/2022/8/e36756 %U https://doi.org/10.2196/36756 %U http://www.ncbi.nlm.nih.gov/pubmed/35775233 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e24595 %T Design and Rationale of the National Tunisian Registry of Percutaneous Coronary Intervention: Protocol for a Prospective Multicenter Observational Study %A Hammami,Rania %A Boudiche,Selim %A Rami,Tlili %A Ben Halima,Nejeh %A Jamel,Ahmed %A Rekik,Bassem %A Gribaa,Rym %A Imtinene,Ben Mrad %A Charfeddine,Salma %A Ellouze,Tarek %A Bahloul,Amine %A Hédi,Ben Slima %A Langar,Jamel %A Ben Ahmed,Habib %A Ibn Elhadj,Zied %A Hmam,Mohamed %A Ben Abdessalem,Mohamed Aymen %A Maaoui,Sabri %A Fennira,Sana %A Lobna,Laroussi %A Hassine,Majed %A Ouanes,Sami %A Mohamed Faouzi,Drissi %A Mallek,Souad %A Mahdhaoui,Abdallah %A Meriem,Dghim %A Jomaa,Walid %A Zayed,Sofien %A Kateb,Tawfik %A Bouchahda,Nidhal %A Azaiez,Fares %A Ben Salem,Helmi %A Marouen,Morched %A Noamen,Aymen %A Abdesselem,Salem %A Hichem,Denguir %A Ibn Hadj Amor,Hassen %A Abdeljelil,Farhati %A Amara,Amine %A Bejar,Karim %A Khaldoun,Ben Hamda %A Hamza,Chiheb %A Ben Jamaa,Mohsen %A Fourati,Sami %A Elleuch,Faycal %A Grati,Zeineb %A Chtourou,Slim %A Marouene,Sami %A Sahnoun,Mohamed %A Hadrich,Morched %A Mohamed Abdelkader,Maalej %A Bouraoui,Hatem %A Kamoun,Kamel %A Hadrich,Moufid %A Ben Chedli,Tarek %A Drissa,Mohamed Akrem %A Charfeddine,Hanene %A Saadaoui,Nizar %A Achraf,Gargouri %A Ahmed,Siala %A Ayari,Mokdad %A Nabil,Marsit %A Mnif,Sabeur %A Sahnoun,Maher %A Kammoun,Helmi %A Ben Jemaa,Khaled %A Mostari,Gharbi %A Hamrouni,Nebil %A Yamen,Maazoun %A Ellouz,Yassine %A Smiri,Zahreddine %A Hdiji,Amine %A Bassem,Jerbi %A Ayadi,Wacef %A Zouari,Amir %A Abbassi,Chedly %A Fatma,Boujelben Masmoudi %A Battikh,Kais %A Kharrat,Elyes %A Gtif,Imen %A Sami,Milouchi %A Bezdah,Leila %A Kachboura,Salem %A Maatouk,Mohamed Faouzi %A Kraiem,Sondes %A Jeridi,Gouider %A Neffati,Elyes %A Kammoun,Samir %A Ben Ameur,Youssef %A Fehri,Wafa %A Gamra,Habib %A Zakhama,Lilia %A Addad,Faouzi %A Mohamed Sami,Mourali %A Abid,Leila %+ Department of Cardiology, Hédi Chaker Hospital, Faculty of Medicine of Sfax, University of Sfax, 3029 Al Ain Road, Sfax, 3029, Tunisia, 216 24056985, raniahammami@yahoo.fr %K percutaneous coronary intervention %K 1-year outcome %K Tunisia %K national %K multicentric %K registry %K percutaneous %K coronary %K artery disease %D 2022 %7 5.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Coronary artery diseases remain the leading cause of death in the world. The management of this condition has improved remarkably in the recent years owing to the development of new technical tools and multicentric registries. Objective: The aim of this study is to investigate the in-hospital and 1-year clinical outcomes of patients treated with percutaneous coronary intervention (PCI) in Tunisia. Methods: We will conduct a prospective multicentric observational study with patients older than 18 years who underwent PCI between January 31, 2020 and June 30, 2020. The primary end point is the occurrence of a major adverse cardiovascular event, defined as cardiovascular death, myocardial infarction, cerebrovascular accident, or target vessel revascularization with either repeat PCI or coronary artery bypass grafting (CABG). The secondary end points are procedural success rate, stent thrombosis, and the rate of redo PCI/CABG for in-stent restenosis. Results: In this study, the demographic profile and the general risk profile of Tunisian patients who underwent PCI and their end points will be analyzed. The complexity level of the procedures and the left main occlusion, bifurcation occlusion, and chronic total occlusion PCI will be analyzed, and immediate as well as long-term results will be determined. The National Tunisian Registry of PCI (NATURE-PCI) will be the first national multicentric registry of angioplasty in Africa. For this study, the institutional ethical committee approval was obtained (0223/2020). This trial consists of 97 cardiologists and 2498 patients who have undergone PCI with a 1-year follow-up period. Twenty-eight catheterization laboratories from both public (15 laboratories) and private (13 laboratories) sectors will enroll patients after receiving informed consent. Of the 2498 patients, 1897 (75.9%) are managed in the public sector and 601 (24.1%) are managed in the private sector. The COVID-19 pandemic started in Tunisia in March 2020; 719 patients (31.9%) were included before the COVID-19 pandemic and 1779 (60.1%) during the pandemic. The inclusion of patients has been finished, and we expect to publish the results by the end of 2022. Conclusions: This study would add data and provide a valuable opportunity for real-world clinical epidemiology and practice in the field of interventional cardiology in Tunisia with insights into the uptake of PCI in this limited-income region. Trial Registration: Clinicaltrials.gov NCT04219761; https://clinicaltrials.gov/ct2/show/NCT04219761 International Registered Report Identifier (IRRID): RR1-10.2196/24595 %M 35930353 %R 10.2196/24595 %U https://www.researchprotocols.org/2022/8/e24595 %U https://doi.org/10.2196/24595 %U http://www.ncbi.nlm.nih.gov/pubmed/35930353 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 14 %N 1 %P e35798 %T Moving to Personalized Medicine Requires Personalized Health Plans %A Powell,Adam %A Dolan,Paul %+ Payer+Provider Syndicate, 20 Oakland Ave, Newton, MA, 02466, United States, 1 617 939 9168, powell@payerprovider.com %K quality-adjusted life years %K health insurance %K personalized outcomes %K patient preferences %K cost-effectiveness %K managed care %D 2022 %7 4.8.2022 %9 Viewpoint %J J Particip Med %G English %X When individuals, families, and employers select health plans in the United States, they are typically only shown the financial structure of the plans and their provider networks. This variation in financial structure can lead patients to have health plans aligned with their financial needs, but not with their underlying nonfinancial preferences. Compounding the challenge is the fact that managed care organizations have historically used a combination of population-level budget impact models, cost-effectiveness analyses, medical necessity criteria, and current medical consensus to make coverage decisions. This approach to creating and presenting health plan options does not consider heterogeneity in patient and family preferences and values, as it treats populations as uniform. Similarly, it does not consider that there are some situations in which patients are price-insensitive. We seek to highlight the challenges posed by presenting health plans to patients in strictly financial terms, and to call for more consideration of nonfinancial patient preferences in the health plan design and selection process. %M 35925669 %R 10.2196/35798 %U https://jopm.jmir.org/2022/1/e35798 %U https://doi.org/10.2196/35798 %U http://www.ncbi.nlm.nih.gov/pubmed/35925669 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 2 %P e36442 %T The Association Between Telemedicine Use and Changes in Health Care Usage and Outcomes in Patients With Congestive Heart Failure: Retrospective Cohort Study %A Chu,Cherry %A Stamenova,Vess %A Fang,Jiming %A Shakeri,Ahmad %A Tadrous,Mina %A Bhatia,R Sacha %+ Ontario Health, 500-505 University Ave, Toronto, ON, M5G 2L3, Canada, 1 877 280 8538, sacha.bhatia@ontariohealth.ca %K telemedicine %K telehealth %K eHealth %K digital health %K population %K outcomes %K health service %K health system %K utilization %K congestive heart failure %K cardiology %K health outcome %K clinical outcome %K patient outcome %K heart %K cardiac %K cardiology %K ambulatory %K COVID-19 %D 2022 %7 4.8.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: Telemedicine use has become widespread owing to the COVID-19 pandemic, but its impact on patient outcomes remains unclear. Objective: We sought to investigate the effect of telemedicine use on changes in health care usage and clinical outcomes in patients diagnosed with congestive heart failure (CHF). Methods: We conducted a population-based retrospective cohort study using administrative data in Ontario, Canada. Patients were included if they had at least one ambulatory visit between March 14 and September 30, 2020, and a heart failure diagnosis any time prior to March 14, 2020. Telemedicine users were propensity score–matched with unexposed users based on several baseline characteristics. Monthly use of various health care services was compared between the 2 groups during 12 months before to 3 months after their index in-person or telemedicine ambulatory visit after March 14, 2020, using generalized estimating equations. Results: A total of 11,131 pairs of telemedicine and unexposed patients were identified after matching (49% male; mean age 78.9, SD 12.0 years). All patients showed significant reductions in health service usage from pre- to postindex visit. There was a greater decline across time in the unexposed group than in the telemedicine group for CHF admissions (ratio of slopes for high- vs low-frequency users 1.02, 95% CI 1.02-1.03), cardiovascular admissions (1.03, 95% CI 1.02-1.04), any-cause admissions (1.03, 95% CI 1.02-1.04), any-cause ED visits (1.03, 95% CI 1.03-1.04), visits with any cardiologist (1.01, 95% CI 1.01-1.02), laboratory tests (1.02, 95% CI 1.02-1.03), diagnostic tests (1.04, 95% CI 1.03-1.05), and new prescriptions (1.02, 95% CI 1.01-1.03). However, the decline in primary care visit rates was steeper among telemedicine patients than among unexposed patients (ratio of slopes 0.99, 95% CI 0.99-1.00). Conclusions: Overall health care usage over time appeared higher among telemedicine users than among low-frequency users or nonusers, suggesting that telemedicine was used by patients with the greatest need or that it allowed patients to have better access or continuity of care among those who received it. %M 35881831 %R 10.2196/36442 %U https://cardio.jmir.org/2022/2/e36442 %U https://doi.org/10.2196/36442 %U http://www.ncbi.nlm.nih.gov/pubmed/35881831 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e39277 %T Optimization of a Quality Improvement Tool for Cancer Diagnosis in Primary Care: Qualitative Study %A Chima,Sophie %A Martinez-Gutierrez,Javiera %A Hunter,Barbara %A Manski-Nankervis,Jo-Anne %A Emery,Jon %+ Centre for Cancer Research, Victorian Comprehensive Cancer Centre, University of Melbourne, 305 Grattan St, Parkville, Melbourne, 3010, Australia, 61 410 798 352, s.chima@unimelb.edu.au %K cancer %K primary health care %K diagnosis %K quality improvement %K clinical decision support tool %K general practice %K pilot %K feasibility %K Clinical Performance Feedback Intervention Theory %D 2022 %7 4.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The most common route to a diagnosis of cancer is through primary care. Delays in diagnosing cancer occur when an opportunity to make a timely diagnosis is missed and is evidenced by patients visiting the general practitioner (GP) on multiple occasions before referral to a specialist. Tools that minimize prolonged diagnostic intervals and reduce missed opportunities to investigate patients for cancer are therefore a priority. Objective: This study aims to explore the usefulness and feasibility of a novel quality improvement (QI) tool in which algorithms flag abnormal test results that may be indicative of undiagnosed cancer. This study allows for the optimization of the cancer recommendations before testing the efficacy in a randomized controlled trial. Methods: GPs, practice nurses, practice managers, and consumers were recruited to participate in individual interviews or focus groups. Participants were purposively sampled as part of a pilot and feasibility study, in which primary care practices were receiving recommendations relating to the follow-up of abnormal test results for prostate-specific antigen, thrombocytosis, and iron-deficiency anemia. The Clinical Performance Feedback Intervention Theory (CP-FIT) was applied to the analysis using a thematic approach. Results: A total of 17 interviews and 3 focus groups (n=18) were completed. Participant themes were mapped to CP-FIT across the constructs of context, recipient, and feedback variables. The key facilitators to use were alignment with workflow, recognized need, the perceived importance of the clinical topic, and the GPs’ perception that the recommendations were within their control. Barriers to use included competing priorities, usability and complexity of the recommendations, and knowledge of the clinical topic. There was consistency between consumer and practitioner perspectives, reporting language concerns associated with the word cancer, the need for more patient-facing resources, and time constraints of the consultation to address patients’ worries. Conclusions: There was a recognized need for the QI tool to support the diagnosis of cancer in primary care, but barriers were identified that hindered the usability and actionability of the recommendations in practice. In response, the tool has been refined and is currently being evaluated as part of a randomized controlled trial. Successful and effective implementation of this QI tool could support the detection of patients at risk of undiagnosed cancer in primary care and assist in preventing unnecessary delays. %M 35925656 %R 10.2196/39277 %U https://formative.jmir.org/2022/8/e39277 %U https://doi.org/10.2196/39277 %U http://www.ncbi.nlm.nih.gov/pubmed/35925656 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 8 %P e32347 %T Mental Health Presentations Across Health Care Settings During the First 9 Months of the COVID-19 Pandemic in England: Retrospective Observational Study %A Smith,Gillian E %A Harcourt,Sally E %A Hoang,Uy %A Lemanska,Agnieszka %A Elliot,Alex J %A Morbey,Roger A %A Hughes,Helen E %A Lake,Iain %A Edeghere,Obaghe %A Oliver,Isabel %A Sherlock,Julian %A Amlôt,Richard %A de Lusignan,Simon %+ Real-time Syndromic Surveillance Team, Field Service, UK Health Security Agency, 2nd Floor 23 Stephenson Street, Birmingham, B2 4BH, United Kingdom, 44 77407 40944, alex.elliot@ukhsa.gov.uk %K pandemic %K public health %K syndromic surveillance %K mental health %K anxiety %K sleep problems %K COVID-19 %K health care %K health surveillance %K health care service %D 2022 %7 3.8.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has resulted in an unprecedented impact on the day-to-day lives of people, with several features potentially adversely affecting mental health. There is growing evidence of the size of the impact of COVID-19 on mental health, but much of this is from ongoing population surveys using validated mental health scores. Objective: This study investigated the impact of the pandemic and control measures on mental health conditions presenting to a spectrum of national health care services monitored using real-time syndromic surveillance in England. Methods: We conducted a retrospective observational descriptive study of mental health presentations (those calling the national medical helpline, National Health Service [NHS] 111; consulting general practitioners [GPs] in and out-of-hours; calling ambulance services; and attending emergency departments) from January 1, 2019, to September 30, 2020. Estimates for the impact of lockdown measures were provided using an interrupted time series analysis. Results: Mental health presentations showed a marked decrease during the early stages of the pandemic. Postlockdown, attendances for mental health conditions reached higher than prepandemic levels across most systems—a rise of 10% compared to that expected for NHS 111 and 21% for GP out-of-hours service—while the number of consultations to GP in-hours service was 13% lower compared to the same time previous year. Increases were observed in calls to NHS 111 for sleep problems. Conclusions: These analyses showed marked changes in the health care attendances and prescribing for common mental health conditions across a spectrum of health care provision, with some of these changes persisting. The reasons for such changes are likely to be complex and multifactorial. The impact of the pandemic on mental health may not be fully understood for some time, and therefore, these syndromic indicators should continue to be monitored. %M 35486809 %R 10.2196/32347 %U https://publichealth.jmir.org/2022/8/e32347 %U https://doi.org/10.2196/32347 %U http://www.ncbi.nlm.nih.gov/pubmed/35486809 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e38792 %T Teledermatology to Facilitate Patient Care Transitions From Inpatient to Outpatient Dermatology: Mixed Methods Evaluation %A Kling,Samantha M R %A Saliba-Gustafsson,Erika A %A Winget,Marcy %A Aleshin,Maria A %A Garvert,Donn W %A Amano,Alexis %A Brown-Johnson,Cati G %A Kwong,Bernice Y %A Calugar,Ana %A El-Banna,Ghida %A Shaw,Jonathan G %A Asch,Steven M %A Ko,Justin M %+ Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, 3180 Porter Dr, MC 5702, Palo Alto, CA, 94304, United States, 1 650 723 1146, skling@stanford.edu %K teledermatology %K telemedicine %K telehealth %K video visits %K care transitions %K care coordination %K discharge planning %K follow-up %K inpatient %K outpatient %K mixed methods %K dermatology %K mobile phone %K smartphone %D 2022 %7 3.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Both clinicians and patients have increasingly turned to telemedicine to improve care access, even in physical examination–dependent specialties such as dermatology. However, little is known about whether teledermatology supports effective and timely transitions from inpatient to outpatient care, which is a common care coordination gap. Objective: Using mixed methods, this study sought to retrospectively evaluate how teledermatology affected clinic capacity, scheduling efficiency, and timeliness of follow-up care for patients transitioning from inpatient to outpatient dermatology care. Methods: Patient-level encounter scheduling data were used to compare the number and proportion of patients who were scheduled and received in-clinic or video dermatology follow-ups within 14 and 90 days after discharge across 3 phases: June to September 2019 (before teledermatology), June to September 2020 (early teledermatology), and February to May 2021 (sustained teledermatology). The time from discharge to scheduling and completion of patient follow-up visits for each care modality was also compared. Dermatology clinicians and schedulers were also interviewed between April and May 2021 to assess their perceptions of teledermatology for postdischarge patients. Results: More patients completed follow-up within 90 days after discharge during early (n=101) and sustained (n=100) teledermatology use than at baseline (n=74). Thus, the clinic’s capacity to provide follow-up to patients transitioning from inpatient increased from baseline by 36% in the early (101 from 74) and sustained (100 from 74) teledermatology periods. During early teledermatology use, 61.4% (62/101) of the follow-ups were conducted via video. This decreased significantly to 47% (47/100) in the following year, when COVID-19–related restrictions started to lift (P=.04), indicating more targeted but still substantial use. The proportion of patients who were followed up within the recommended 14 days after discharge did not differ significantly between video and in-clinic visits during the early (33/62, 53% vs 15/39, 38%; P=.15) or sustained (26/53, 60% vs 28/47, 49%; P=.29) teledermatology periods. Interviewees agreed that teledermatology would continue to be offered. Most considered postdischarge follow-up patients to be ideal candidates for teledermatology as they had undergone a recent in-person assessment and might have difficulty attending in-clinic visits because of competing health priorities. Some reported patients needing technological support. Ultimately, most agreed that the choice of follow-up care modality should be the patient’s own. Conclusions: Teledermatology could be an important tool for maintaining accessible, flexible, and convenient care for recently discharged patients needing follow-up care. Teledermatology increased clinic capacity, even during the pandemic, although the timeliness of care transitions did not improve. Ultimately, the care modality should be determined through communication with patients to incorporate their and their caregivers’ preferences. %M 35921146 %R 10.2196/38792 %U https://www.jmir.org/2022/8/e38792 %U https://doi.org/10.2196/38792 %U http://www.ncbi.nlm.nih.gov/pubmed/35921146 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e38424 %T Evaluation of a Digital Self-management Platform for Patients With Chronic Illness in Primary Care: Qualitative Study of Stakeholders’ Perspectives %A van de Vijver,Steven %A Hummel,Deirdre %A van Dijk,Annericht Hester %A Cox,Jan %A van Dijk,Oscar %A Van den Broek,Nicoline %A Metting,Esther %+ Amsterdam Health & Technology Institute, Amsterdam University Medical Center, Paasheuvelweg 25, Amsterdam, 1105 BP, Netherlands, 31 6 19053595, s.vandevijver@ahti.nl %K primary care %K chronic disease %K telemonitoring %K digital health %K self-management %K patient-centered care %K chronic care %K chronic care management %K illness %K healthcare %K healthcare professional %K user %K patient %K platform %K tool %K communication %K empowerment %K online %D 2022 %7 3.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Population aging and multimorbidity has led to increasing chronic care needs associated with new challenges in managing growing costs, rising health care professional workloads, and the adoption of rigorous guidelines. These issues could all benefit from greater digitalization and a more patient-centered approach to chronic care, a situation brought to the fore by the COVID-19 pandemic. Little is known about real-life use in primary care. Objective: This study aimed to explore the views, thoughts, usability, and experiences concerning a recently introduced digital self-care platform for chronic conditions in 3 Dutch primary care practices. Methods: We conducted an explorative study combining questionnaires and interviews among patients and general practitioners from 3 general practices that used the digital platform. Questionnaires were sent to patients in each practice to seek the views and experiences of both patient nonusers (n=20) and patient users (n=58) of the platform, together with standardized questionnaires about illness perception and quality of life. In addition, patients (n=15) and general practitioners (n=4) who used the platform took part in semistructured interviews. We transcribed interviews verbatim and performed qualitative content analysis using a deductive approach. The results of the questionnaires were analyzed with descriptive analysis. Results: Among patients who had not actively used the platform but had received an explanation, only 35% (7/20) would recommend its use due to concerns over communication and handling. However, this percentage increased to 76.3% (45/59) among the people who actively used the platform. Interviews with patients and general practitioners who used the platform uncovered several key benefits, including reduced time requirements, reduced workload, improved care quality, and improved accessibility due to the greater patient-centeredness and use of different communication tools. In addition, the self-management tool led to greater patient autonomy and empowerment. Although users considered the platform feasible, usable, and easy to use, some technical issues remained and some patients expressed concerns about the reduction in human contact and feedback. Conclusions: The overall experience and usability of the platform was good. Support for the online self-management platform for chronic care increased when patients actively used the tool and could experience or identify important advantages. However, patients still noted several areas for improvement that need to be tackled in future iterations. To ensure benefit in the wider population, we must also evaluate this platform in cohorts with lower digital and health literacy. %M 35921145 %R 10.2196/38424 %U https://formative.jmir.org/2022/8/e38424 %U https://doi.org/10.2196/38424 %U http://www.ncbi.nlm.nih.gov/pubmed/35921145 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e38263 %T COVID-box Experiences of Patients and Health Care Professionals (COVID-box Project): Single-Center, Retrospective, Observational Study %A Dirikgil,Ebru %A Brons,Kim %A Duindam,Michael %A Groeneveld,Geert H %A Geelhoed,J J Miranda %A Heringhaus,Christian %A van der Boog,Paul J M %A Rabelink,Ton J %A Bos,Willem Jan W %A Chavannes,Niels H %A Atsma,Douwe E %A Teng,Y K Onno %+ Department of Nephrology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, Netherlands, 31 071 52621, y.k.o.teng@lumc.nl %K COVID-19 %K digital health %K eHealth %K telemedicine %K telemonitoring %K hospital admission %K health care professional %K thematic analysis %K user satisfaction %K usability %K home monitoring %K health care system %D 2022 %7 28.7.2022 %9 Short Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, several home monitoring programs have described the success of reducing hospital admissions, but only a few studies have investigated the experiences of patients and health care professionals. Objective: The objective of our study was to determine patients’ and health care professionals’ experiences and satisfaction with employing the COVID-box. Methods: In this single-center, retrospective, observational study, patients and health care professionals were asked to anonymously fill out multiple-choice questionnaires with questions on a 5-point or 10-point Likert scale. The themes addressed by patients were the sense of reassurance and safety, experiences with teleconsultations, their appreciation for staying at home, and the instructions for using the COVID-box. The themes addressed by health care professionals who treated patients with the COVID-box were the characteristics of the COVID-box, the technical support service and general satisfaction, and their expectations and support for this telemonitoring concept. Scores were interpreted as insufficient (≤2 or ≤5, respectively), sufficient (3 or 6-7, respectively), or good (≥4 or ≥8, respectively) on a 5-point or 10-point Likert scale. Results: A total of 117 patients and 25 health care professionals filled out the questionnaires. The median score was 4 (IQR 4-5) for the sense of safety, the appreciation for staying at home, and experiences with teleconsultations, with good scores from 76.5% (88/115), 86% (56/65), and 83.6% (92/110) of the patients, respectively. Further, 74.4% (87/117) of the patients scored the home monitoring program with a score of ≥8. Health care professionals scored the COVID-box with a minimum median score of 7 (IQR 7-10) on a 10-point scale for all domains (ie, the characteristics of the COVID-box and the technical support service and general satisfaction). For the sense of safety, user-friendliness, and additional value of the COVID-box, the median scores were 8 (IQR 8-10), 8 (IQR 7-9), and 10 (IQR 8-10), respectively, with good scores from 86% (19/22), 75% (15/20), and 96% (24/25) of the health care professionals, respectively. All health care professionals (25/25, 100%) gave a score of ≥8 for supporting this home monitoring concept, with a median score of 10 (IQR 10-10). Conclusions: The positive experiences and satisfaction of involved users are key factors for the successful implementation of a novel eHealth solution. In our study, patients, as well as health care professionals, were highly satisfied with the use of the home monitoring program—the COVID-box project. Remote home monitoring may be an effective approach in cases of increased demand for hospital care and high pressure on health care systems. %M 35816688 %R 10.2196/38263 %U https://formative.jmir.org/2022/7/e38263 %U https://doi.org/10.2196/38263 %U http://www.ncbi.nlm.nih.gov/pubmed/35816688 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 7 %P e31289 %T Experiences and Challenges of Implementing Universal Health Coverage With China’s National Basic Public Health Service Program: Literature Review, Regression Analysis, and Insider Interviews %A Fang,Guixia %A Yang,Diling %A Wang,Li %A Wang,Zhihao %A Liang,Yuanyuan %A Yang,Jinxia %+ School of Health Service Management, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China, 86 15345699071, yangjinxiaamu@163.com %K universal health coverage %K basic public health service %K China %K experience %K challenge %D 2022 %7 22.7.2022 %9 Review %J JMIR Public Health Surveill %G English %X Background: Public health service is an important component and pathway to achieve universal health coverage (UHC), a major direction goal of many countries. China’s National Basic Public Health Service Program (the Program) is highly consistent with this direction. Objective: The aim of this study was to analyze the key experience and challenges of the Program so as to present China’s approach to UHC, help other countries understand and learn from China’s experience, and promote UHC across the world. Methods: A literature review was performed across five main electronic databases and other sources. Some data were obtained from the Department of Primary Health, National Health Commission, China. Data obtained included the financing share of the national/provincial/prefectural government among the total investment of the program in 32 provinces in 2016, their respective per capita funding levels, and some indicators related to program implementation from 2009 to 2016. The Joinpoint regression model was adopted to test the time trend of changes in program implementation indicators. Face-to-face individual interviews and group discussions were conducted with 48 key insiders. Results: The program provided full life cycle service to the whole population with an equitable and affordable financing system, enhanced the capability and quality of the health workforce, and facilitated integration of the public health service delivery system. Meanwhile, there were also some shortcomings, including lack of selection and an exit mechanism of service items, inadequate system integration, shortage of qualified professionals, limited role played by actors outside the health sector, and a large gap between the subsidy standard and the actual service cost. The Joinpoint regression analysis demonstrated that 13 indicators related to program implementation showed a significant upward trend (P<.05) from 2009 to 2016, with average annual percent change values above 10% for 6 indicators and below 6% for 7 indicators. Three indicators (coverage of health records, electronic health records, and health management among the elderly) rose rapidly with annual percent change values above 30% between 2009 and 2011, but rose slowly or remained stable between 2011 and 2016. In 2016, the subsidy standard per capita in the eastern, central, and western regions was equivalent to US $7.43, $7.15, and $6.57, respectively, of which the national-level subsidy accounted for 25.50%, 60.57%, and 79.52%, respectively. Conclusions: The Program has made a significant contribution to China’s efforts in achieving UHC. The Program focuses on a key population and provides full life cycle services for the whole population. The financing system completely supported by the government makes the services more equitable and affordable. However, there are a few challenges to implementing the Program in China, especially to increase the public investment, optimize service items, enhance quality of the services, and evaluate the health outcomes. %M 35867386 %R 10.2196/31289 %U https://publichealth.jmir.org/2022/7/e31289 %U https://doi.org/10.2196/31289 %U http://www.ncbi.nlm.nih.gov/pubmed/35867386 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e38602 %T Pandemic-Triggered Adoption of Telehealth in Underserved Communities: Descriptive Study of Pre- and Postshutdown Trends %A Xu,Pei %A Hudnall,Matthew %A Zhao,Sidi %A Raja,Uzma %A Parton,Jason %A Lewis,Dwight %+ Department of Information Systems, Statistics, and Management Science, University of Alabama, 500 Colonial Drive, Tuscaloosa, AL, 35487, United States, 1 205 348 0856, matthew.hudnall@ua.edu %K telehealth services %K telemedicine %K COVID-19 %K rural communities %K mental health %K Medicaid %K health service %K telehealth %K health care service %K health care facility %K undeserved community %K undeserved population %K health claim %K technology adoption %K health insurance %D 2022 %7 15.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The adoption of telehealth services has been a challenge in rural communities. The reasons for the slow adoption of such technology-driven services have been attributed to social norms, health care policies, and a lack of infrastructure to support the delivery of services. However, the COVID-19 pandemic–related shutdown of in-person health care services resulted in the usage of telehealth services as a necessity rather than a choice. The pandemic also fast-tracked some needed legislation to allow medical cost reimbursement for remote examination and health care services. As services return to normalcy, it is important to examine whether the usage of telehealth services during the period of a shutdown has changed any of the trends in the acceptance of telehealth as a reliable alternative to traditional in-person health care services. Objective: Our aim was to explore whether the temporary shift to telehealth services has changed the attitudes toward the usage of technology-enabled health services in rural communities. Methods: We examined the Medicaid reimbursement data for the state of Alabama from March 2019 through June 2021. Selecting the telehealth service codes, we explored the adoption rates in 3 phases of the COVID-19 shutdown: prepandemic, pandemic before the rollout of mass vaccination, and pandemic after the rollout of mass vaccination. Results: The trend in telemedicine claims had an opposite pattern to that in nontelemedicine claims across the 3 periods. The distribution of various characteristics of patients who used telemedicine (age group, gender, race, level of rurality, and service provider type) was different across the 3 periods. Claims related to behavior and mental health had the highest rates of telemedicine usage after the onset of the pandemic. The rate of telemedicine usage remained at a high level after the rollout of mass vaccination. Conclusions: The current trends indicate that adoption of telehealth services is likely to increase postpandemic and that the consumers (patients), service providers, health care establishments, insurance companies, and state and local policies have changed their attitudes toward telehealth. An increase in the use of telehealth could help local and federal governments address the shortage of health care facilities and service providers in underserved communities, and patients can get the much-needed care in a timely and effective manner. %M 35786564 %R 10.2196/38602 %U https://www.jmir.org/2022/7/e38602 %U https://doi.org/10.2196/38602 %U http://www.ncbi.nlm.nih.gov/pubmed/35786564 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e36569 %T Assessing Progress Toward the Vision of a Comprehensive, Shared Electronic Care Plan: Scoping Review %A Norton,Jenna M %A Ip,Alex %A Ruggiano,Nicole %A Abidogun,Tolulope %A Camara,Djibril Souleymane %A Fu,Helen %A Hose,Bat-Zion %A Miran,Saadia %A Hsiao,Chun-Ju %A Wang,Jing %A Bierman,Arlene S %+ Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 6707 Democracy Blvd, 6th Floor, Bethesda, MD, 20817, United States, 1 301 928 5509, jenna.norton@nih.gov %K electronic care plan %K care planning %K care plan %K care coordination %K multiple conditions %K multiple chronic conditions %K chronic disease %K chronic condition %K electronic care %K digital health %K electronic tools %K e-care %K healthcare data %K eHealth %D 2022 %7 10.6.2022 %9 Review %J J Med Internet Res %G English %X Background: Care plans are central to effective care delivery for people with multiple chronic conditions. But existing care plans—which typically are difficult to share across care settings and care team members—poorly serve people with multiple chronic conditions, who often receive care from numerous clinicians in multiple care settings. Comprehensive, shared electronic care (e-care) plans are dynamic electronic tools that facilitate care coordination and address the totality of health and social needs across care contexts. They have emerged as a potential way to improve care for individuals with multiple chronic conditions. Objective: To review the landscape of e-care plans and care plan–related initiatives that could allow the creation of a comprehensive, shared e-care plan and inform a joint initiative by the National Institutes of Health and the Agency for Healthcare Research and Quality to develop e-care planning tools for people with multiple chronic conditions. Methods: We conducted a scoping review, searching literature from 2015 to June 2020 using Scopus, Clinical Key, and PubMed; we also searched the gray literature. To identify initiatives potentially missing from this search, we interviewed expert informants. Relevant data were then identified and extracted in a structured format for data synthesis and analysis using an expanded typology of care plans adapted to our study context. The extracted data included (1) the perspective of the initiatives; (2) their scope, (3) network, and (4) context; (5) their use of open syntax standards; and (6) their use of open semantic standards. Results: We identified 7 projects for e-care plans and 3 projects for health care data standards. Each project provided critical infrastructure that could be leveraged to promote the vision of a comprehensive, shared e-care plan. All the e-care plan projects supported both broad goals and specific behaviors; 1 project supported a network of professionals across clinical, community, and home-based networks; 4 projects included social determinants of health. Most projects specified an open syntax standard, but only 3 specified open semantic standards. Conclusions: A comprehensive, shared, interoperable e-care plan has the potential to greatly improve the coordination of care for individuals with multiple chronic conditions across multiple care settings. The need for such a plan is heightened in the wake of the ongoing COVID-19 pandemic. While none of the existing care plan projects meet all the criteria for an optimal e-care plan, they all provide critical infrastructure that can be leveraged as we advance toward the vision of a comprehensive, shared e-care plan. However, critical gaps must be addressed in order to achieve this vision. %M 35687382 %R 10.2196/36569 %U https://www.jmir.org/2022/6/e36569 %U https://doi.org/10.2196/36569 %U http://www.ncbi.nlm.nih.gov/pubmed/35687382 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e37574 %T Outpatient Care Among Users and Nonusers of Direct-to-Patient Telehealth: Observational Study %A Cuellar,Alison %A Pomeroy,J Mary Louise %A Burla,Sriteja %A Jena,Anupam B %+ Department of Health Administration and Policy, George Mason University, MS 1J3, 4400 University Dr, Fairfax, VA, 22030, United States, 1 703 993 5048, aevanscu@gmu.edu %K telemedicine %K insurance %K policy %K telehealth %K user %K primary care %K outpatient %K claims %K in-person %K virtual %K insurer %K coverage %D 2022 %7 6.6.2022 %9 Short Paper %J J Med Internet Res %G English %X Background: Expansion of telehealth insurance coverage is hampered by concerns that such coverage may encourage excessive use and spending. Objective: The aim of this paper is to examine whether users of telehealth services rely more on other forms of outpatient care than nonusers, and to estimate the differences in payment rates. Methods: We examined claims data from a large national insurer in 2017. We limited our analysis to patients with visits for 3 common diagnoses (N=660,546). We calculated the total number of visits per patient, overall, and by setting, and adjusted for patient- and county-level factors. Results: After multivariable adjustment, telehealth-visit users, compared to nonusers, had 0.44 fewer visits to primary care, 0.11 fewer visits to emergency departments, and 0.17 fewer visits to retail and urgent care. All estimates are statistically significant at P<.001. Average payment rates for telehealth visits were lower than all other settings. Conclusions: These findings suggest that telehealth visits may substitute rather than add to in-person care for some types of care. Our study suggests that telehealth visits may offer an efficient and less costly alternative. %M 35666556 %R 10.2196/37574 %U https://www.jmir.org/2022/6/e37574 %U https://doi.org/10.2196/37574 %U http://www.ncbi.nlm.nih.gov/pubmed/35666556 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35380 %T Digital Health Opportunities to Improve Primary Health Care in the Context of COVID-19: Scoping Review %A Silva,Cícera Renata Diniz Vieira %A Lopes,Rayssa Horácio %A de Goes Bay Jr,Osvaldo %A Martiniano,Claudia Santos %A Fuentealba-Torres,Miguel %A Arcêncio,Ricardo Alexandre %A Lapão,Luís Velez %A Dias,Sonia %A Uchoa,Severina Alice da Costa %+ Faculty of Health Sciences, Federal University of Rio Grande do Norte, 601 General Gustavo Cordeiro de Faria Street, Natal, 59012-570, Brazil, 55 84 3221 0862, renatadiniz_enf@yahoo.com.br %K digital health %K telehealth %K telemedicine %K primary health care %K quality of care %K COVID-19 %K pandemic %K science database %K gray literature %D 2022 %7 31.5.2022 %9 Review %J JMIR Hum Factors %G English %X Background: The COVID-19 pandemic brought social, economic, and health impacts, requiring fast adaptation of health systems. Although information and communication technologies were essential for achieving this objective, the extent to which health systems incorporated this technology is unknown. Objective: The aim of this study was to map the use of digital health strategies in primary health care worldwide and their impact on quality of care during the COVID-19 pandemic. Methods: We performed a scoping review based on the Joanna Briggs Institute manual and guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Extension for Scoping Reviews. A systematic and comprehensive three-step search was performed in June and July 2021 in multidisciplinary health science databases and the gray literature. Data extraction and eligibility were performed by two authors independently and interpreted using thematic analysis. Results: A total of 44 studies were included and six thematic groups were identified: characterization and geographic distribution of studies; nomenclatures of digital strategies adopted; types of information and communication technologies; characteristics of digital strategies in primary health care; impacts on quality of care; and benefits, limitations, and challenges of digital strategies in primary health care. The impacts on organization of quality of care were investigated by the majority of studies, demonstrating the strengthening of (1) continuity of care; (2) economic, social, geographical, time, and cultural accessibility; (3) coordination of care; (4) access; (5) integrality of care; (6) optimization of appointment time; (7) and efficiency. Negative impacts were also observed in the same dimensions, such as reduced access to services and increased inequity and unequal use of services offered, digital exclusion of part of the population, lack of planning for defining the role of professionals, disarticulation of actions with real needs of the population, fragile articulation between remote and face-to-face modalities, and unpreparedness of professionals to meet demands using digital technologies. Conclusions: The results showed the positive and negative impacts of remote strategies on quality of care in primary care and the inability to take advantage of the potential of technologies. This may demonstrate differences in the organization of fast and urgent implementation of digital strategies in primary health care worldwide. Primary health care must strengthen its response capacity, expand the use of information and communication technologies, and manage challenges using scientific evidence since digital health is important and must be integrated into public service. %M 35319466 %R 10.2196/35380 %U https://humanfactors.jmir.org/2022/2/e35380 %U https://doi.org/10.2196/35380 %U http://www.ncbi.nlm.nih.gov/pubmed/35319466 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e36799 %T Self-efficacy and Use of Digital Health Care and Social Welfare Services Among Incarcerated People: Cross-sectional Survey Study %A Rantanen,Teemu %A Järveläinen,Eeva %A Leppälahti,Teppo %+ Laurea University of Applied Sciences, Ratatie 22, Vantaa, 01300, Finland, 358 408306149, teemu.rantanen@laurea.fi %K digital inclusion %K digital exclusion %K digital divide %K digitalization in prisons %K incarcerated people %D 2022 %7 31.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The digitization of health care and social welfare services creates many opportunities for the rehabilitation of incarcerated people and their preparation for release from prison. A range of digital platforms and technology solutions have been developed that offer multiple opportunities to handle private matters either by video conference, email, or some other digital format during imprisonment. However, incarcerated people have limited access to digital health care and social welfare services, and face challenges related to shortcomings in their digital skills and self-efficacy. Objective: This article assessed the significance of incarcerated people’s self-efficacy in terms of their sense of control over the use of digital health care and social welfare services. Methods: A cross-sectional study was conducted using a questionnaire. Research data were collected from 11 prisons in different parts of Finland, and a total of 225 incarcerated people responded to the survey. Statistical analyses were conducted using the Pearson product-moment correlation coefficient, 2-tailed t test, linear regression analysis, and Hayes bootstrapping method. Results: The results showed the significance of both general and internet-specific self-efficacy, which appear to be more important for the use of digital health care and social welfare services than factors related to a person’s socioeconomic background or sentence. Age was negatively correlated with perceived control over the use of digital health care and social welfare services. Furthermore, the study emphasized the importance of support from family and friends, as well as prison employees. Conclusions: The digitalization of prisons offers many opportunities, but special consideration should be given to how the digitization of health care and social welfare services responds to the needs of incarcerated people in terms of their integration into society and the prevention of recidivism. During imprisonment, attention should be paid to strengthening the digital skills of incarcerated people, with support provided by prison employees. In addition to providing guidance on the use of individual digital services, the study recommends strengthening the general digital skills of incarcerated people, as well as developing their life management skills. %M 35639446 %R 10.2196/36799 %U https://www.jmir.org/2022/5/e36799 %U https://doi.org/10.2196/36799 %U http://www.ncbi.nlm.nih.gov/pubmed/35639446 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 2 %P e33025 %T Satisfaction With Health Care Services at the Pediatric Specialist Clinic of the National Referral Center in Malaysia: Cross-sectional Study of Caregivers’ Perspectives %A M Selvarajah,Thinakaran %A Yamamoto,Eiko %A Saw,Yu Mon %A Kariya,Tetsuyoshi %A Hamajima,Nobuyuki %+ Hospital Putrajaya, Ministry of Health, Pejabat Pentadbiran, Aras LG, Jalan P9, Presint 7, Putrajaya, 62250, Malaysia, 60 122094360, thinakaranmd@yahoo.com %K pediatrics %K caregivers %K health care services %K public hospital %K Malaysia %K public-private-partnership %K children %D 2022 %7 25.5.2022 %9 Original Paper %J JMIRx Med %G English %X Background: The concept of customer satisfaction is gaining hold in all corporate sectors worldwide, and a satisfaction survey is used as a tool to discover service problems and as a chance for customers to rate their experience with health care services. A high degree of patient satisfaction with the services given has been found in numerous studies conducted in Malaysian public health care facilities. However, there is limited information available on caregiver satisfaction with pediatric clinics run by the Ministry of Health (MoH) of Malaysia. Objective: This was the first research performed at a public hospital’s pediatric clinic, which was the first hospital to adopt the public-private-partnership model under the MoH, with the aim of discovering the prevalence and factors affecting the satisfaction of caregivers at the national referral center. Methods: Cross-sectional research using the standard self-administered SERVQUAL questionnaire was conducted among caregivers accompanying their children to the clinic. The questionnaire consists of 16 paired statements to evaluate their expectations and experiences with the clinic services. Results: A total of 459 caregivers were involved in this study with a majority aged between 30 and 39 years (n=254, 55.4%). Caregivers from the Indian community (adjusted odds ratio [AOR] 2.91, 95% CI 1.37-6.18) and lower income groups (AOR 2.94, 95% CI 1.87-4.64), and those with lower educational backgrounds (AOR 3.58, 95% CI 1.19-10.72) were more likely to be satisfied with the quality of pediatric clinic services. Housewives/househusbands (AOR 0.48, 95% CI 0.25-0.90), on the other hand, appeared less likely to be satisfied with the services provided during their visit to the clinic. Looking at overall patient satisfaction, 50.5% (n=232) of caregivers demonstrated satisfaction with the quality of services, compared to 49.5% (n=227) of dissatisfied respondents. Conclusions: This paper suggests that, although most caregivers are satisfied with the services, greater emphasis must be placed on delivering reliable service in response to the MoH’s mission to provide quality and integrated people-centered health services in Malaysia. %M 37725531 %R 10.2196/33025 %U https://med.jmirx.org/2022/2/e33025 %U https://doi.org/10.2196/33025 %U http://www.ncbi.nlm.nih.gov/pubmed/37725531 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e33380 %T Use of Robots in Critical Care: Systematic Review %A Teng,Rachel %A Ding,Yichen %A See,Kay Choong %+ Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore, 65 6772 3737, yichending@u.nus.edu %K COVID-19 %K intensive care %K high dependency %K telepresence %K intubation %D 2022 %7 16.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The recent focus on the critical setting, especially with the COVID-19 pandemic, has highlighted the need for minimizing contact-based care and increasing robotic use. Robotics is a rising field in the context of health care, and we sought to evaluate the use of robots in critical care settings. Objective: Although robotic presence is prevalent in the surgical setting, its role in critical care has not been well established. We aimed to examine the uses and limitations of robots for patients who are critically ill. Methods: This systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. MEDLINE, Embase, IEEE Xplore, and ACM Library were searched from their inception to December 23, 2021. Included studies involved patients requiring critical care, both in intensive care units or high-dependency units, or settings that required critical care procedures (eg, intubation and cardiopulmonary resuscitation). Randomized trials and observational studies were included. Results: A total of 33 studies were included. The greatest application of robots in the intensive care unit was in the field of telepresence, whereby robots proved advantageous in providing a reduced response time, earlier intervention, and lower mortality rates. Challenges of telepresence included regulatory and financial barriers. In therapy and stroke rehabilitation, robots achieved superior clinical outcomes safely. Robotic use in patient evaluation and assessment was mainly through ultrasound evaluation, obtaining satisfactory to superior results with the added benefits of remote assessment, time savings, and increased efficiency. Robots in drug dispensing and delivery increased efficiency and generated cost savings. All the robots had technological limitations and hidden costs. Conclusions: Overall, our results show that robotic use in critical care settings is a beneficial, effective, and well-received intervention that delivers significant benefits to patients, staff, and hospitals. Looking ahead, it is necessary to form strong ethical and legislative frameworks and overcome various regulatory and financial barriers. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021234162; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=234162 %M 35576567 %R 10.2196/33380 %U https://www.jmir.org/2022/5/e33380 %U https://doi.org/10.2196/33380 %U http://www.ncbi.nlm.nih.gov/pubmed/35576567 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34021 %T eRegTime—Time Spent on Health Information Management in Primary Health Care Clinics Using a Digital Health Registry Versus Paper-Based Documentation: Cluster-Randomized Controlled Trial %A Venkateswaran,Mahima %A Nazzal,Zaher %A Ghanem,Buthaina %A Khraiwesh,Reham %A Abbas,Eatimad %A Abu Khader,Khadija %A Awwad,Tamara %A Hijaz,Taghreed %A Isbeih,Mervett %A Mørkrid,Kjersti %A Rose,Christopher James %A Frøen,J Frederik %+ Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213, Oslo, Norway, 47 21 07 70 00, frederik.froen@fhi.no %K time-motion study %K clinical workflow %K digital health intervention %K eRegistry %K antenatal care %K cluster-randomized controlled trial %K digital health %K child health registry %K eRegistry %K primary care %K health information %K primary care %D 2022 %7 13.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health interventions have been shown to improve data quality and health services in low- and middle-income countries (LMICs). Nonetheless, in LMICs, systematic assessments of time saved with the use of digital tools are rare. We ran a set of cluster-randomized controlled trials as part of the implementation of a digital maternal and child health registry (eRegistry) in the West Bank, Palestine. Objective: In the eRegTime study, we compared time spent on health information management in clinics that use the eRegistry versus the existing paper-based documentation system. Methods: Intervention (eRegistry) and control (paper documentation) arms were defined by a stratified random subsample of primary health care clinics from the concurrent eRegQual trial. We used time-motion methodology to collect data on antenatal care service provision. Four observers used handheld tablets to record time-use data during one working day per clinic. We estimated relative time spent on health information management for booking and follow-up visits and on client care using mixed-effects linear regression. Results: In total, 22 of the 24 included clinics (12 intervention, 10 control) contributed data; no antenatal care visits occurred in the other two clinics during the study period. A total of 123 and 118 consultations of new pregnancy registrations and follow-up antenatal care visits were observed in the intervention and control groups, respectively. Average time spent on health information management for follow-up antenatal care visits in eRegistry clinics was 5.72 minutes versus 8.10 minutes in control clinics (adjusted relative time 0.69, 95% CI 0.60-0.79; P<.001), and 15.26 minutes versus 18.91 minutes (adjusted relative time 0.96, 95% CI 0.61-1.50; P=.85) for booking visits. The average time spent on documentation, a subcategory of health information management, was 5.50 minutes in eRegistry clinics versus 8.48 minutes in control clinics (adjusted relative time 0.68, 95% CI 0.56-0.83; P<.001). While the average time spent on client care was 5.01 minutes in eRegistry clinics versus 4.91 minutes in control clinics, some uncertainty remains, and the CI was consistent with eRegistry clinics using less, the same, or more time on client care compared to those that use paper (adjusted relative time 0.85, 95% CI 0.64-1.13; P=.27). Conclusions: The eRegistry captures digital data at point of care during client consultations and generates automated routine reports based on the clinical data entered. Markedly less time (plausibly a saving of at least 18%) was spent on health information management in eRegistry clinics compared to those that use paper-based documentation. This is likely explained by the fact that the eRegistry requires lesser repetitive documentation work than paper-based systems. Adoption of eRegistry-like systems in comparable settings may save valuable and scarce health care resources. Trial Registration: ISRCTN registry ISRCTN18008445; https://doi.org/10.1186/ISRCTN18008445 International Registered Report Identifier (IRRID): RR2-10.2196/13653 %M 35559792 %R 10.2196/34021 %U https://formative.jmir.org/2022/5/e34021 %U https://doi.org/10.2196/34021 %U http://www.ncbi.nlm.nih.gov/pubmed/35559792 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e36448 %T The Impact of Health Care Funding on Interprofessional Collaboration and Integrated Service Delivery in Primary and Allied Care: Protocol for a Scoping Review %A Archer,Jessica %A Robinson,Luke %A Brown,Ted %+ Department of Occupational Therapy, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Level 4, Building G, 47-49 McMahon's Road, Frankston, 3199, Australia, 61 399044462, jessica.archer@monash.edu %K allied health %K healthcare funding %K interprofessional collaboration %K integrated healthcare %K primary health %K primary care %D 2022 %7 13.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Improving funding models and implementing policies that facilitate greater interprofessional collaboration and integration at the primary and allied health level could improve the ongoing quality and safety and future sustainability of the wider health care system by reducing inefficiencies and inequalities. Defining these key health care funding–related models, policies, and concepts, identifying research gaps, and systematically mapping the associated literature will inform future research on this topic. Objective: The aim of this scoping review is to provide a descriptive overview of contemporary health care funding models and the key policies involved in the delivery of primary and allied health care. Further, it will investigate the impact these models and policies have on interprofessional collaboration and integrated service delivery at the primary and allied health care levels. Methods: A search of published and grey literature will be conducted using the following databases: the Allied and Complementary Medicine Database, CINAHL, Embase, Emcare, MEDLINE, PsycINFO, Scopus, Open Access Theses and Dissertations, and Web of Science. The search will be limited to resources available in the English language and published since 2011. Following the search, an independent screening of titles and abstracts will be undertaken by 2 independent reviewers, with a third reviewer available to resolve any potential disagreements. Full-text resources will then be assessed against the inclusion criteria following the same process. Extracted data will be presented using a convergent narrative approach, accompanied by tables and figures. Results: Electronic database searches have retrieved 8013 articles. The results of this scoping review are expected in May 2022. Conclusions: The findings from this review will be used to inform future research projects investigating the role of primary health care funding, interprofessional collaboration, and service integration in improving health care access, efficiency, effectiveness, and sustainability. International Registered Report Identifier (IRRID): DERR1-10.2196/36448 %M 35559853 %R 10.2196/36448 %U https://www.researchprotocols.org/2022/5/e36448 %U https://doi.org/10.2196/36448 %U http://www.ncbi.nlm.nih.gov/pubmed/35559853 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e36673 %T Long COVID Optimal Health Program (LC-OHP) to Enhance Psychological and Physical Health: Protocol for a Feasibility Randomized Controlled Trial %A Al-Jabr,Hiyam %A Windle,Karen %A Thompson,David R %A Jenkins,Zoe M %A Castle,David J %A Ski,Chantal F %+ Integrated Care Academy, University of Suffolk, Waterfront Building, 19 Neptune Quay, Ipswich, IP4 1QJ, United Kingdom, 44 01473 338845, h.al-jabr@uos.ac.uk %K long COVID %K COVID-19 %K optimal health program %K telemedicine %K integrated care %K telehealth %K patient care %K health intervention %K mental health %K physical health %K psychological health %K pandemic %K patient support %D 2022 %7 12.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Long COVID is a collection of symptoms that develop during or following a confirmed or suspected case of COVID-19, which continue for more than 12 weeks. Despite the negative impact of long COVID on people’s lives and functioning, there is no validated treatment or even rehabilitation guidance. What has been recommended thus far is the adoption of holistic management approaches. The Optimal Health Program (OHP) is a brief 5-session, plus booster, psychosocial program designed to support mental and physical well-being that has been used effectively for a range of chronic conditions. Objective: This study examines the feasibility and acceptability of employing an especially customized version of OHP (long COVID OHP [LC-OHP]) to improve psychological and physical health of people with long COVID. Methods: This is a feasibility randomized controlled trial that will be running from November 2021 to February 2023. Eligible participants aged 18 years or older who are experiencing symptoms of long COVID will be identified through their secondary practitioners with recruitment to be undertaken by the research team. A total of 60 participants will be randomized into a control (usual care) or an intervention (LC-OHP) group. Outcomes will be feasibility and acceptability of the program (primary); and efficacy of the LC-OHP in improving anxiety, depression, fatigue, self-efficacy, and quality of life (secondary). Up to 20 participants will be interviewed at the end of the trial to explore their experience with the program. Quantitative data will be analyzed using SPSS, and differences between groups will be compared using inferential tests where appropriate. Qualitative data will be transcribed and thematically analyzed to identify common emerging themes. Results: This is an ongoing study, which began in November 2021. Conclusions: Long COVID has a significant impact on an individual’s mental and physical functioning. The LC-OHP has a potential to provide people living with long COVID with additional support and to improve self-efficacy. The findings of this study would identify the feasibility of delivering this program to this population and will provide an indication for the program’s effectiveness. Trial Registration: ISRCTN Registry ISRCTN38746119; https://www.isrctn.com/ISRCTN38746119 International Registered Report Identifier (IRRID): DERR1-10.2196/36673 %M 35468586 %R 10.2196/36673 %U https://www.researchprotocols.org/2022/5/e36673 %U https://doi.org/10.2196/36673 %U http://www.ncbi.nlm.nih.gov/pubmed/35468586 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e37092 %T Using Artificial Intelligence to Revolutionise the Patient Care Pathway in Hip and Knee Arthroplasty (ARCHERY): Protocol for the Development of a Clinical Prediction Model %A Farrow,Luke %A Ashcroft,George Patrick %A Zhong,Mingjun %A Anderson,Lesley %+ Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, United Kingdom, 44 01224552908, luke.farrow@abdn.ac.uk %K orthopedics %K prediction modelling %K machine learning %K artificial intelligence %K imaging %K hip %K knee %K arthroplasty %K health care %K patient care %K arthritis %D 2022 %7 11.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Hip and knee osteoarthritis is substantially prevalent worldwide, with large numbers of older adults undergoing joint replacement (arthroplasty) every year. A backlog of elective surgery due to the COVID-19 pandemic, and an aging population, has led to substantial issues with access to timely arthroplasty surgery. A potential method to improve the efficiency of arthroplasty services is by increasing the percentage of patients who are listed for surgery from primary care referrals. The use of artificial intelligence (AI) techniques, specifically machine learning, provides a potential unexplored solution to correctly and rapidly select suitable patients for arthroplasty surgery. Objective: This study has 2 objectives: (1) develop a cohort of patients with referrals by general practitioners regarding assessment of suitability for hip or knee replacement from National Health Service (NHS) Grampian data via the Grampian Data Safe Haven and (2) determine the demographic, clinical, and imaging characteristics that influence the selection of patients to undergo hip or knee arthroplasty, and develop a tested and validated patient-specific predictive model to guide arthroplasty referral pathways. Methods: The AI to Revolutionise the Patient Care Pathway in Hip and Knee Arthroplasty (ARCHERY) project will be delivered through 2 linked work packages conducted within the Grampian Data Safe Haven and Safe Haven Artificial Intelligence Platform. The data set will include a cohort of individuals aged ≥16 years with referrals for the consideration of elective primary hip or knee replacement from January 2015 to January 2022. Linked pseudo-anonymized NHS Grampian health care data will be acquired including patient demographics, medication records, laboratory data, theatre records, text from clinical letters, and radiological images and reports. Following the creation of the data set, machine learning techniques will be used to develop pattern classification and probabilistic prediction models based on radiological images. Supplemental demographic and clinical data will be used to improve the predictive capabilities of the models. The sample size is predicted to be approximately 2000 patients—a sufficient size for satisfactory assessment of the primary outcome. Cross-validation will be used for development, testing, and internal validation. Evaluation will be performed through standard techniques, such as the C statistic (area under curve) metric, calibration characteristics (Brier score), and a confusion matrix. Results: The study was funded by the Chief Scientist Office Scotland as part of a Clinical Research Fellowship that runs from August 2021 to August 2024. Approval from the North Node Privacy Advisory Committee was confirmed on October 13, 2021. Data collection started in May 2022, with the results expected to be published in the first quarter of 2024. ISRCTN registration has been completed. Conclusions: This project provides a first step toward delivering an automated solution for arthroplasty selection using routinely collected health care data. Following appropriate external validation and clinical testing, this project could substantially improve the proportion of referred patients that are selected to undergo surgery, with a subsequent reduction in waiting time for arthroplasty appointments. Trial Registration: ISRCTN Registry ISRCTN18398037; https://www.isrctn.com/ISRCTN18398037 International Registered Report Identifier (IRRID): PRR1-10.2196/37092 %M 35544289 %R 10.2196/37092 %U https://www.researchprotocols.org/2022/5/e37092 %U https://doi.org/10.2196/37092 %U http://www.ncbi.nlm.nih.gov/pubmed/35544289 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34485 %T Assessing the Availability of Teleconsultation and the Extent of Its Use in Malaysian Public Primary Care Clinics: Cross-sectional Study %A Ng,Sock Wen %A Hwong,Wen Yea %A Husin,Masliyana %A Ab Rahman,Norazida %A Nasir,Nazrila Hairizan %A Juval,Kawselyah %A Sivasampu,Sheamini %+ Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Blok B4, Kompleks Institut Kesihatan Negara (NIH), No.1, Jalan Setia Murni U13/52, Shah Alam, 40170, Malaysia, 60 333627700 ext 8857, ngsockwen@gmail.com %K teleconsultation %K telemedicine %K video consultation %K telephone consultation %K virtual clinic %K primary care %K cross-sectional %K virtual care %K Asia %D 2022 %7 9.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The integration of teleconsultation into health care systems as a complement to existing approaches to care is growing rapidly. There is, however, limited information on the extent of its implementation across low- and middle-income countries. Objective: The aim of this study was to determine the availability and the extent of teleconsultation in Malaysian primary care clinics. Methods: A cross-sectional study of public primary care clinics in Malaysia was conducted between November 2020 and December 2020. All clinics in Malaysia that see more than 300 daily patients were recruited. A web-based, self-administered questionnaire including questions on availability of the service, whether it uses video or telephone, and the types of services it provides was distributed to the medical officer in charge of each clinic. Results: In total, 97.6% (249/255) of the clinics responded. Out of these clinics, 45.8% (114/249) provided teleconsultation. A majority of the clinics providing consultation (69/114, 60.5%) provided only telephone consultation, while 24.6% (28/114) of the clinics offered video and telephone consultation, and 14.9% (17/114) offered only video consultation. Eighty percent (92/114) of the clinics were located in urban areas. A breakdown by state showed that 17.5% (20/114) and 16.7% (19/114) of the clinics were from two larger states; other states comprised less than 10% each (range 7-9/114). For the clinics providing video consultation, funding for the service came mostly (42/45, 93%) from the Ministry of Health. Conversely, nearly 1 out of 4 (23/97) clinics that provided telephone consultation funded the service either from donations or through self-funding. Most of the clinics provided teleconsultation for diabetes and hypertension. Less than 50% of the clinics with teleconsultation used it for follow up with allied health care providers or pharmacists (video consultation, 20/45; telephone consultation, 36/97). Conclusions: Our findings show that telephone consultation is more widely used than video consultation, despite a quarter of its funding being self-subsidized or obtained through donations. Also, teleconsultation was less utilized by allied health care providers and pharmacists. Plans for the expansion of teleconsultation in Malaysian primary health care should take into consideration these findings to ensure a better and more cost-effective implementation of the service. %M 35532973 %R 10.2196/34485 %U https://formative.jmir.org/2022/5/e34485 %U https://doi.org/10.2196/34485 %U http://www.ncbi.nlm.nih.gov/pubmed/35532973 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e30496 %T Impact of a Postintensive Care Unit Multidisciplinary Follow-up on the Quality of Life (SUIVI-REA): Protocol for a Multicenter Randomized Controlled Trial %A Friedman,Diane %A Grimaldi,Lamiae %A Cariou,Alain %A Aegerter,Philippe %A Gaudry,Stéphane %A Ben Salah,Abdel %A Oueslati,Haikel %A Megarbane,Bruno %A Meunier-Beillard,Nicolas %A Quenot,Jean-Pierre %A Schwebel,Carole %A Jacob,Laurent %A Robin Lagandré,Ségloène %A Kalfon,Pierre %A Sonneville,Romain %A Siami,Shidasp %A Mazeraud,Aurelien %A Sharshar,Tarek %+ GHU-Paris Psychiatrie & Neurosciences, Sainte-Anne Hospital, Université de Paris, 1, rue Cabanis, Paris, 75014, France, 33 0145658000, tsharshar@gmail.com %K critical illness %K Post-ICU syndrome %K Mortality %K cognitive impairments %K cognition %K quality of life %K patients %K intensive care %K post-traumatic %K post intensive care %D 2022 %7 9.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Critically ill patients are at risk of developing a postintensive care syndrome (PICS), which is characterized by physical, psychological, and cognitive impairments and which dramatically impacts the patient’s quality of life (QoL). No intervention has been shown to improve QoL. We hypothesized that a medical, psychological, and social follow-up would improve QoL by mitigating the PICS. Objective: This multicenter, randomized controlled trial (SUIVI-REA) aims to compare a multidisciplinary follow-up with a standard postintensive care unit (ICU) follow-up. Methods: Patients were randomized to the control or intervention arm. In the intervention arm, multidisciplinary follow-up involved medical, psychological, and social evaluation at ICU discharge and at 3, 6, and 12 months thereafter. In the placebo group, patients were seen only at 12 months by the multidisciplinary team. Baseline characteristics at ICU discharge were collected for all patients. The primary outcome was QoL at 1 year, assessed using the Euro Quality of Life-5 dimensions (EQ5D). Secondary outcomes were mortality, cognitive, psychological, and functional status; social and professional reintegration; and the rate of rehospitalization and outpatient consultations at 1 year. Results: The study was funded by the Ministry of Health in June 2010. It was approved by the Ethics Committee on July 8, 2011. The first and last patient were randomized on December 20, 2012, and September 1, 2017, respectively. A total of 546 patients were enrolled across 11 ICUs. At present, data management is ongoing, and all parties involved in the trial remain blinded. Conclusions: The SUVI-REA multicenter randomized controlled trial aims to assess whether a post-ICU multidisciplinary follow-up improves QoL at 1 year. Trial Registration: Clinicaltrials.gov NCT01796509; https://clinicaltrials.gov/ct2/show/NCT01796509 International Registered Report Identifier (IRRID): DERR1-10.2196/30496 %M 35532996 %R 10.2196/30496 %U https://www.researchprotocols.org/2022/5/e30496 %U https://doi.org/10.2196/30496 %U http://www.ncbi.nlm.nih.gov/pubmed/35532996 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e37709 %T The Impact of Resistance Exercise on Muscle Mass in Glioblastoma in Survivors (RESIST): Protocol for a Randomized Controlled Trial %A Keats,Melanie R %A Grandy,Scott A %A Blanchard,Christopher %A Fowles,Jonathon R %A Neyedli,Heather F %A Weeks,Adrienne C %A MacNeil,Mary V %+ Division of Kinesiology, School of Health and Human Performance, Dalhousie University, PO Box 15000, 6230 South Street, Halifax, NS, B3H 4R2, Canada, 1 902 494 7173, melanie.keats@dal.ca %K glioblastoma %K myopathy %K resistance exercise %K functional fitness %K quality of life %K intervention %K randomized controlled trial %D 2022 %7 4.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Glioblastoma is the most common primary brain malignancy in adults, accounting for approximately 48% of all brain tumors. Standard treatment includes radiation and temozolomide chemotherapy. Glioblastomas are highly vascular and can cause vasogenic brain edema and mass effect, which can worsen the neurologic symptoms associated with the disease. The steroid dexamethasone (DEX) is the treatment of choice to reduce vasogenic edema and intracranial pressure associated with glioblastoma. However high-dose DEX or long-term use can result in muscle myopathy in 10%-60% of glioblastoma patients, significantly reducing functional fitness and quality of life (QOL). There is a wealth of evidence to support the use of exercise as an adjuvant therapy to improve functional ability as well as help manage treatment-related symptoms. Specifically, resistance training has been shown to increase muscle mass, strength, and functional fitness in aging adults and several cancer populations. Although studies are limited, research has shown that exercise is safe and feasible in glioblastoma populations. However, it is not clear whether resistance training can be successfully used in glioblastoma to prevent or mitigate steroid-induced muscle myopathy and associated loss of function. Objective: The primary purpose of this study is to establish whether an individualized circuit-based program will reduce steroid-induced muscle myopathy, as indicated by maintained or improved functional fitness for patients on active treatment and receiving steroids. Methods: This is a 2-armed, randomized controlled trial with repeated measures. We will recruit 38 adult (≥18 years) patients diagnosed with either primary or secondary glioblastoma who are scheduled to receive standard radiation and concurrent and adjuvant temozolomide chemotherapy postsurgical debulking and received any dose of DEX through the neurooncology clinic and the Nova Scotia Health Cancer Center. Patients will be randomly allocated to a standard of care waitlist control group or standard of care + circuit-based resistance training exercise group. The exercise group will receive a 12-week individualized, group and home-based exercise program. The control group will be advised to maintain an active lifestyle. The primary outcome, muscle myopathy (functional fitness), will be assessed using the Short Physical Performance Battery and hand grip strength. Secondary outcome measures will include body composition, cardiorespiratory fitness, physical activity, QOL, fatigue, and cognitive function. All measures will be assessed pre- and postintervention. Participant accrual, exercise adherence, and safety will be assessed throughout the study. Results: This study has been funded by the Canadian Cancer Society Atlantic Cancer Research Grant and the J.D. Irving Limited–Excellence in Cancer Research Fund (grant number 707182). The protocol was approved by the Nova Scotia Health and Acadia University’s Research Ethics Boards. Enrollment is anticipated to begin in March 2022. Conclusions: This study will inform how individualized circuit-based resistance training may improve functional independence and overall QOL of glioblastoma patients. Trial Registration: ClinicalTrails.gov NCT05116137; https://www.clinicaltrials.gov/ct2/show/NCT05116137 International Registered Report Identifier (IRRID): DERR1-10.2196/37709 %M 35507403 %R 10.2196/37709 %U https://www.researchprotocols.org/2022/5/e37709 %U https://doi.org/10.2196/37709 %U http://www.ncbi.nlm.nih.gov/pubmed/35507403 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e35706 %T An Agreement of Antigen Tests on Oral Pharyngeal Swabs or Less Invasive Testing With Reverse Transcription Polymerase Chain Reaction for Detecting SARS-CoV-2 in Adults: Protocol for a Prospective Nationwide Observational Study %A Schneider,Uffe Vest %A Knudsen,Jenny Dahl %A Koch,Anders %A Kirkby,Nikolai Søren %A Lisby,Jan Gorm %+ Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, Hvidovre, 2650, Denmark, 45 38623189, uffe.vest.schneider@regionh.dk %K SARS-CoV-2 %K COVID-19 %K point of care %K PoC %K antigen test %K anatomic sampling location %K Reverse Transcription Polymerase Chain Reaction %K RT-PCR %K rapid antigen test %K RAT %K testing %K antigen %K sampling %K PCR %K rapid %K protocol %K prospective %K observational %K agreement %K oral %K adult %K sensitivity %K specificity %K test location %K anatomy %K saliva %K swab %K nasopharyngeal %K nasal %D 2022 %7 4.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The SARS-CoV-2 pandemic has resulted in an unprecedented level of worldwide testing for epidemiologic and diagnostic purposes, and due to the extreme need for tests, the gold-standard Reverse Transcription Polymerase Chain Reaction (RT-PCR) testing capacity has been unable to meet the overall worldwide testing demand. Consequently, although the current literature has shown the sensitivity of rapid antigen tests (RATs) to be inferior to RT-PCR, RATs have been implemented on a large scale without solid data on performance. Objective: This study will compare analytical and clinical sensitivities and specificities of 50 lateral flow– or laboratory-based RATs and 3 strand invasion–based amplification (SIBA)-RT-PCR tests from 30 manufacturers to RT-PCR testing of samples obtained from the deep oropharynx. In addition, the study will compare sensitivities and specificities of the included RATs as well as RT-PCR on clinical samples obtained from the deep oropharynx, the anterior nasal cavity, saliva, the deep nasopharynx, and expired air to RT-PCR on deep oropharyngeal samples. Methods: In the prospective part of the study, 200 individuals found SARS-CoV-2 positive and 200 individuals found SARS-CoV-2 negative by routine RT-PCR testing will be retested with each RAT, applying RT-PCR as the reference method. In the retrospective part of the study, 304 deep oropharyngeal cavity swabs divided into 4 groups based on RT-PCR quantification cycle (Cq) levels will be tested with each RAT. Results: The results will be reported in several papers with different aims. The first paper will report retrospective (analytical sensitivity, overall and stratified into different Cq range groups) and prospective (clinical sensitivity) data for RATs, with RT-PCR as the reference method. The second paper will report results for RAT based on anatomical sampling location. The third paper will compare different anatomical sampling locations by RT-PCR testing. The fourth paper will focus on RATs that rely on central laboratory testing. Tests from 4 different manufacturers will be compared for analytical performance data on retrospective deep oropharyngeal swab samples. The fifth paper will report the results of 4 RATs applied both as professional use and as self-tests. The last paper will report the results from 2 breath tests in the study. A comparison of sensitivity and specificity between RATs will be conducted using the McNemar test for paired samples and the chi-squared test for unpaired samples. Comparison of the positive predictive value (PPV) and negative predictive value (NPV) between RATs will be performed by the bootstrap test, and 95% CIs for sensitivity, specificity, PPV, and NPV will be calculated as bootstrap CIs. Conclusions: The study will compare the sensitivities of a large number of RATs for SARS-CoV-2 to with those of RT-PCR and will address whether lateral flow–based RATs differ significantly from laboratory-based RATs. The anatomical test locations for both RATs and RT-PCR will also be compared. Trial Registration: ClinicalTrials.gov NCT04913116; https://clinicaltrials.gov/ct2/show/NCT04913116 International Registered Report Identifier (IRRID): DERR1-10.2196/35706 %M 35394449 %R 10.2196/35706 %U https://www.researchprotocols.org/2022/5/e35706 %U https://doi.org/10.2196/35706 %U http://www.ncbi.nlm.nih.gov/pubmed/35394449 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e31720 %T Humanizing Health and Social Care Support for People With Intellectual and Developmental Disabilities: Protocol for a Scoping Review %A Milne-Ives,Madison %A Shankar,Rohit %A Goodley,Dan %A Lamb,Kirsten %A Laugharne,Richard %A Harding,Tracey %A Meinert,Edward %+ Centre for Health Technology, University of Plymouth, 6 Kirkby Place, Room 2, Plymouth, PL4 6DN, United Kingdom, 44 01752600600, edward.meinert@plymouth.ac.uk %K developmental disabilities %K intellectual disability %K delivery of health care %K patient care management %K social work %K social support %K patient-centered care %K empathy %K respect %K social care %D 2022 %7 4.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health care is shifting toward a more person-centered model; however, people with intellectual and developmental disabilities can still experience difficulties in accessing equitable health care. Given these difficulties, it is important to consider how humanizing principles, such as empathy and respect, can be best incorporated into health and social care practices for people with intellectual and developmental disabilities to ensure that they are receiving equitable treatment and support. Objective: The purpose of our scoping review is to provide an overview of the current research landscape and knowledge gaps regarding the development and implementation of interventions based on humanizing principles that aim to improve health and social care practices for people with intellectual and developmental disabilities. Methods: The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and PICOS (Population, Intervention, Comparator, Outcome, and Study) frameworks will be used to structure the review. A total of 6 databases (PubMed, MEDLINE, Embase, CINAHL, PsycINFO, and Web of Science) will be searched for English articles published in the previous 10 years that describe or evaluate health and social care practice interventions underpinned by the humanizing principles of empathy, compassion, dignity, and respect. Two reviewers will screen and select references based on the eligibility criteria and extract the data into a predetermined form. A descriptive analysis will be conducted to summarize the results and provide an overview of interventions in the following three main care areas: health care, social care, and informal social support. Results: The results will be included in the scoping review, which is expected to begin in October 2022 and be completed and submitted for publication by January 2023. Conclusions: Our scoping review will summarize the state of the field of interventions that are using humanizing principles to improve health and social care for adults with intellectual and developmental disabilities. International Registered Report Identifier (IRRID): PRR1-10.2196/31720 %M 35507388 %R 10.2196/31720 %U https://www.researchprotocols.org/2022/5/e31720 %U https://doi.org/10.2196/31720 %U http://www.ncbi.nlm.nih.gov/pubmed/35507388 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e37255 %T Effectiveness of Hydrotherapy on Neuropathic Pain and Pain Catastrophization in Patients With Spinal Cord Injury: Protocol for a Pilot Trial Study %A Campo,Andrés Reyes %A Pacichana-Quinayáz,Sara Gabriela %A Bonilla-Escobar,Francisco Javier %A Leiva-Pemberthy,Luz Miriam %A Tovar-Sánchez,Maria Ana %A Hernández-Orobio,Olga Marina %A Arango-Hoyos,Gloria-Patricia %A Mujanovic,Adnan %+ Departamento de Medicina Física y Rehabilitación, Grupo de Investigación en Rehabilitación de la Universidad del Valle, Universidad del Valle, Hospital Universitario del Valle, Cl 5#36-08, Cali, 760001, Colombia, 57 2 6206000, fjbonillaescobar@gmail.com %K spinal cord injury %K neuropathic pain %K quality of life %K catastrophization %K hydrotherapy %K neurology %K spinal cord %K nonpharmacological %D 2022 %7 29.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Neuropathic pain (NP) is one of the most frequent spinal cord injury (SCI) complications. Pain, quality of life, and functionality are associated and can lead to pain catastrophization. Pharmacological management of patients with NP secondary to SCI is widely known and there is increasing evidence in the area. Nevertheless, nonpharmacological management is not fully elucidated since its efficacy is inconclusive. Objective: We hypothesize that (1) hydrotherapy is effective in reducing NP secondary to SCI. Additionally, our secondary hypotheses are that (2) hydrotherapy decreases the catastrophization of NP, and that (3) hydrotherapy improves life quality and minimizes the degree of disability, when compared to physical therapy. Methods: A sample of approximately 20 participants will be randomly assigned to either the intervention (hydrotherapy) or control group (standard physical therapy). Both interventions will be administered twice a week over a 9-week period (18 sessions in total). Primary outcomes are changes in neuropathic pain perception and pain catastrophization. Secondary outcomes are changes in disability and quality of life scores. They will be assessed at baseline and follow-up at 4 weeks after discharge. Validated Spanish language scales that will be used are the following: Numerical Pain Rating Scale, Pain Catastrophization, Health-related Quality of life, and the World Health Organization’s Disability Assessment Schedule 2.0. Generalized mixed linear models will be used for comparing baseline and postintervention means of each group and their differences, together with 95% CIs and P values. A P value of less than .05 will be considered significant. Results: Recruitment began in April 2019, and we recruited the last participants by December 2019, with 10 individuals assigned to hydrotherapy and 8 to physical therapy (control). Results from this study will be disseminated via scientific publication, in ClinicalTrials.gov, and in national and international conferences in the latter half of 2022. Conclusions: This trial will explore the effects of hydrotherapy on neuropathic pain, together with functionality and quality of life, in patients with SCI. Furthermore, this study aims to evaluate these therapeutic modalities, including perception variables, and mental processes, which may affect the clinical condition and rehabilitation outcomes in these patients. Hydrotherapy is likely to be a safe, efficient, and cost-effective alternative to the current standard of care for NP secondary to SCI, with comparable results between the two. Trial Registration: ClinicalTrials.gov NCT04164810; https://clinicaltrials.gov/ct2/show/NCT04164810 International Registered Report Identifier (IRRID): DERR1-10.2196/37255 %M 35486436 %R 10.2196/37255 %U https://www.researchprotocols.org/2022/4/e37255 %U https://doi.org/10.2196/37255 %U http://www.ncbi.nlm.nih.gov/pubmed/35486436 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e31003 %T Buccal Mucosal Grafts as a Novel Treatment for the Repair of Rectovaginal Fistulas: Protocol for an Upcoming Prospective Single-Surgeon Case Series %A Cahill,Caitlin %A Kruger,Natalia %A Heine,John %+ Cumming School of Medicine, University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada, 1 403 880 1775, natalia.kruger@ucalgary.ca %K surgical protocol %K colorectal surgery, rectovaginal fistulas %K fistula %K surgery %K gynecology %K grafts %K perioperative medicine %D 2022 %7 29.4.2022 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Rectovaginal fistulas (RVFs) are abnormal communications between the rectum/anus and the vagina. They are most frequently formed a result of obstetric injury and have deleterious effects on patients’ quality of life. Despite several treatment modalities, RVFs remain difficult problems to manage, and many patients fail multiple attempts at surgical repair. Buccal mucosal grafts (BMGs) may be a solution to this problem. A BMG is an oral mucosal tissue harvested from the inner cheek. There are 2 case reports that describe the successful use of BMGs in the repair of RVFs. Objective: Our objective is to validate these findings with a prospective case series while also addressing the key issues of indication, technical details, procedure safety, and short-term outcomes. Methods: A prospective single-surgeon case series will be undertaken at a university-affiliated academic tertiary care hospital in Calgary, Alberta (Canada). The estimated recruitment is between 3 and 5 patients. Patients will undergo surgical repair of their RVFs with an autologous BMG. Data on patient characteristics, fistula characteristics, and surgical variables will be collected and analyzed prospectively. The primary outcome is fistula closure. This study has been approved by the Conjoint Health Research Ethics Board at the University of Calgary (REB20-1123). Results: Two previous case reports have described the successful use of BMGs in the repair of RVFs. We have received ethics approval to attempt to validate these findings through a prospective case series. Conclusions: RVFs cause significant patient morbidity and are difficult problems to manage. Bolstered by the successful use of BMGs in urologic surgery and the previously published case reports demonstrating success in RVFs, we believe that BMGs may be a solution to RVFs. International Registered Report Identifier (IRRID): PRR1-10.2196/31003 %M 35486431 %R 10.2196/31003 %U https://www.researchprotocols.org/2022/4/e31003 %U https://doi.org/10.2196/31003 %U http://www.ncbi.nlm.nih.gov/pubmed/35486431 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e36753 %T Stigma Toward Bariatric Surgery in the Netherlands, France, and the United Kingdom: Protocol for a Cross-cultural Mixed Methods Study %A Garcia,Franshelis K %A Verkooijen,Kirsten T %A Veen,Esther J %A Mulder,Bob C %A Koelen,Maria A %A Hazebroek,Eric J %+ Health and Society, Department of Social Sciences, Wageningen University, Hollandseweg 1, Wageningen, 6706 KN, Netherlands, 31 (0) 317480292, franshelis.garcia@wur.nl %K bariatric surgery %K obesity surgery %K weight loss surgery %K stigma %K cross-cultural study %K France %K the Netherlands %K the United Kingdom %D 2022 %7 28.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Bariatric surgery is an effective procedure for the treatment of obesity. Despite this, only 0.1% to 2% of eligible individuals undergo surgery worldwide. The stigma surrounding surgery might be a reason for this. Thus far, no research has systematically studied the nature and implications of bariatric surgery stigma. The limited studies on bariatric surgery stigma are often conducted from the perspective of the public or health care professions and either use small and nonrepresentative samples or fail to capture the full essence and implications of the stigma altogether, including attitudes toward patients and perpetrators of the stigma. In addition, studies from patients’ perspectives are limited and tend to address bariatric surgery stigma superficially or implicitly. Finally, the extent to which cultural factors shape and facilitate this stigma and the experiences of patients have not yet been researched. Objective: This study aimed to explore the perceptions, experiences, and consequences of bariatric surgery stigma from the perspective of the public, health care professionals, and patients before and after bariatric surgery. Furthermore, although the concept of stigma is universal, every society has specific cultural norms and values that define acceptable attributes and behaviors for its members. Therefore, this study also aimed to explore the extent to which cultural factors influence bariatric surgery stigma by comparing the Netherlands, France, and the United Kingdom. Methods: This paper describes the protocol for a multiphase mixed methods research design. In the first part, we will conduct a scoping review to determine the current knowledge on bariatric surgery stigma and identify knowledge gaps. In the second part, semistructured interviews among patients before and after bariatric surgery will be conducted to explore their experiences and consequences of bariatric surgery stigma. In the third part, surveys will be conducted among both the public and health care professionals to determine the prevalence, nature, and impact of bariatric surgery stigma. Surveys and interviews will be conducted in the Netherlands, France, and the United Kingdom. Finally, data integration will be conducted at the interpretation and reporting levels. Results: The study began in September 2020 and will continue through September 2025. With the results of the review, we will create an overview of the current knowledge regarding bariatric surgery stigma from patients’ perspectives. Qualitative data will provide insights into patients’ experiences with bariatric surgery stigma. Quantitative data will provide information related to the prevalence and nature of bariatric surgery stigma from the perspective of the public and health care professionals. Both qualitative and quantitative data will be compared for each country. Conclusions: The findings from this study will lead to new insights that can be used to develop strategies to reduce bariatric surgery stigma and improve access, use, and outcomes of bariatric surgery. International Registered Report Identifier (IRRID): PRR1-10.2196/36753 %M 35482364 %R 10.2196/36753 %U https://www.researchprotocols.org/2022/4/e36753 %U https://doi.org/10.2196/36753 %U http://www.ncbi.nlm.nih.gov/pubmed/35482364 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e35243 %T Lymph Node Yield in Gastrointestinal Cancer Surgery With or Without Prior Neoadjuvant Therapy: Protocol for a Systematic Review and Meta-analysis %A Ronellenfitsch,Ulrich %A Mathis,Nika %A Friedrichs,Juliane %A Kleeff,Jörg %+ Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, Halle (Saale), 06120, Germany, 49 3455572327, ulrich.ronellenfitsch@uk-halle.de %K lymph node yield %K lymph node harvest %K neoadjuvant therapy %K neoadjuvant chemotherapy %K neoadjuvant radiotherapy %K surgery %K resection %K gastrointestinal cancer %K chemotherapy %K cancer %D 2022 %7 28.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Lymph node yield is the number of lymph nodes retrieved during oncological resection and histopathologically identified in the resection specimen. It is an important surrogate parameter for assessing the oncological radicality of the resection of gastrointestinal carcinomas, as well as a prognostic factor in these diseases. It remains unclear if and to what extent neoadjuvant chemotherapy, radiotherapy, or chemoradiotherapy, which have become established treatments for carcinoma of the esophagus, stomach, and rectum and are increasingly used in pancreatic carcinoma, affect the lymph node yield. Objective: This systematic review with meta-analysis is conducted with the aim of summarizing the available evidence regarding the lymph node yield, an oncological surrogate marker, in patients with gastrointestinal carcinomas undergoing surgery after neoadjuvant therapy compared to those undergoing surgery without neoadjuvant therapy. Methods: Randomized and nonrandomized studies comparing oncological resection of esophageal, stomach, pancreatic, and rectal carcinoma with and without prior neoadjuvant therapy are eligible for inclusion regardless of study design. Publications will be identified with a defined search strategy in 2 electronic databases: PubMed and Cochrane Library. The primary endpoint of the analysis is the number of lymph nodes identified in the resected specimen. Secondary endpoints include the number of harvested metastatic lymph nodes, operation time, postoperative complications, pathological TNM staging, and overall and recurrence-free survival time. Using suitable statistical methods, the endpoints between patients with and without neoadjuvant therapy, as well as in defined subgroups (neoadjuvant chemotherapy, radiotherapy, or chemoradiotherapy; and patients with esophageal, gastric, pancreatic, or rectal cancer), will be compared. Results: The literature search and data collection started in October 2021. Results are expected to be published in mid-2022. Conclusions: This meta-analysis will provide the most up-to-date and complete summary of the evidence on an association between neoadjuvant therapy and lymph node yield in gastrointestinal cancer surgery. The underlying hypothesis is that neoadjuvant therapy decreases the number and size of lymph nodes through lymphocyte depletion and radiation-induced fibrosis, thus leading to a lower possible lymph node yield. The findings of the meta-analysis will show if this hypothesis is supported by evidence. Trial Registration: PROSPERO CRD218459; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021218459 International Registered Report Identifier (IRRID): DERR1-10.2196/35243 %M 35482374 %R 10.2196/35243 %U https://www.researchprotocols.org/2022/4/e35243 %U https://doi.org/10.2196/35243 %U http://www.ncbi.nlm.nih.gov/pubmed/35482374 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e35971 %T The Effect of the COVID-19 Pandemic on Glycemic Monitoring and Other Processes of Care for Type 2 Diabetes: Protocol for a Retrospective Cohort Study %A Mathew,Mekha %A van Vlymen,Jeremy %A Meza-Torres,Bernardo %A Hinton,William %A Delanerolle,Gayathri %A Yonova,Ivelina %A Feher,Michael %A Fan,Xuejuan %A Liyanage,Harshana %A Joy,Mark %A Carinci,Fabrizio %A de Lusignan,Simon %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House, Walton Well Road, Jericho, Oxford, OX2 6ED, United Kingdom, 44 01865 617283, simon.delusignan@phc.ox.ac.uk %K cohort studies %K COVID-19 %K computerized medical record systems %K primary health care %K type 2 diabetes mellitus %K diabetes %K glycemic control %K monitoring %D 2022 %7 22.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Social distancing and other nonpharmaceutical interventions to reduce the spread of COVID-19 infection in the United Kingdom have led to substantial changes in delivering ongoing care for patients with chronic conditions, including type 2 diabetes mellitus (T2DM). Clinical guidelines for the management and prevention of complications for people with T2DM delivered in primary care services advise routine annual reviews and were developed when face-to-face consultations were the norm. The shift in consultations from face-to-face to remote consultations caused a reduction in direct clinical contact and may impact the process of care for people with T2DM. Objective: The aim of this study is to explore the impact of the COVID-19 pandemic’s first year on the monitoring of people with T2DM using routine annual reviews from a national primary care perspective in England. Methods: A retrospective cohort study of adults with T2DM will be performed using routinely collected primary care data from the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC). We will describe the change in the rate of monitoring of hemoglobin A1c (HbA1c) between the first year of the COVID-19 pandemic (2020) and the preceding year (2019). We will also report any change in the eight checks that make up the components of these reviews. The change in HbA1c monitoring rates will be determined using a multilevel logistic regression model, adjusting for patient and practice characteristics, and similarly, the change in a composite measure of the completeness of all eight checks will be modeled using ordinal regression. The models will be adjusted for the following patient-level variables: age, gender, socioeconomic status, ethnicity, COVID-19 shielding status, duration of diabetes, and comorbidities. The model will also be adjusted for the following practice-level variables: urban versus rural, practice size, Quality and Outcomes Framework achievement, the National Health Service region, and the proportion of face-to-face consultations. Ethical approval was provided by the University of Oxford Medical Sciences Interdivisional Research Ethics Committee (September 2, 2021, reference R77306/RE001). Results: The analysis of the data extract will include 3.96 million patients with T2DM across 700 practices, which is 6% of the available Oxford-RCGP RSC adult population. The preliminary results will be submitted to a conference under the domain of primary care. The resulting publication will be submitted to a peer-reviewed journal on diabetes and endocrinology. Conclusions: The COVID-19 pandemic has impacted the delivery of care, but little is known about the process of caring for people with T2DM. This study will report the impact of the COVID-19 pandemic on these processes of care. International Registered Report Identifier (IRRID): DERR1-10.2196/35971 %M 35417404 %R 10.2196/35971 %U https://www.researchprotocols.org/2022/4/e35971 %U https://doi.org/10.2196/35971 %U http://www.ncbi.nlm.nih.gov/pubmed/35417404 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 2 %P e33205 %T GoFundMe as a Medical Plan: Ecological Study of Crowdfunding Insulin Success %A Blanchette,Julia E %A Tran,MJ %A Grigorian,Ernest G %A Iacob,Eli %A Edelman,Linda S %A Oser,Tamara K %A Litchman,Michelle L %+ College of Nursing, University of Utah, 10 2000 E, Salt Lake City, UT, 84112, United States, 1 801 585 9612, Michelle.Litchman@nurs.utah.edu %K diabetes %K health care cost %K crowdfunding %K financial stress %K insulin %D 2022 %7 15.4.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: Individuals in need of medical care turn to crowdfunding websites to engage a “crowd” or group for financial support. In the last decade, access to insulin has decreased considerably for several reasons, including the rising cost of insulin, increasing popularity of high-deductible insurance plans, and increasing insurance premiums. Many people with diabetes are forced to ration or go without insulin, and they turn to crowdfunding websites to seek financial donations to purchase insulin needed to reduce health risks and mortality, and sustain quality of life.  Objective: This study aimed to explore crowdfunding campaign requests to purchase insulin in the United States. Methods: In this retrospective, quantitative, and qualitative study, we coded the text of GoFundMe online crowdfunding campaigns and viral measures (shares, hearts, and comments) from February 25 to April 15, 2019. We described campaigns (N=205) and explored the factors associated with campaign success using correlations and qualitative thematic analysis. Results: The majority of campaigns were initiated by middle-aged adults (age 26-64 years; 77/205, 37.6%), those with type 1 diabetes (94/205, 45.9%), and those needing funds owing to insurance coverage issues (125/205, 61.0%). The factors associated with campaign success included requests for ≤US $500 (P=.007) and higher viral measures (shares, P=.007; hearts, P<.001; comments, P=.002). The following 4 themes emerged from the campaign text: (1) desire for self-management and survival, (2) diabetes management untenable given insulin access, (3) aftermath of insulin unaffordability, and (4) privacy issues with crowdfunding. Campaign comments were both supportive (tangible, informational, and emotional) and unsupportive (questioned the need for the campaign and deemed crowdfunding inappropriate). Conclusions: Despite crowdfunding websites being used to support the purchase of insulin, campaigns raised only a fraction of the money requested. Therefore, GoFundMe campaigns are not a reliable solution to obtain funds for insulin in the United States. Applying quantitative and qualitative methods is adequate to analyze online crowdfunding for costs of medications such as insulin. However, it is critical for people with diabetes to use resources other than online crowdfunding to access and obtain insulin owing to low success rates. Clinicians should routinely assess difficulty accessing or affording insulin, and federal health care policies should support lowering the cost of insulin. %M 35436214 %R 10.2196/33205 %U https://diabetes.jmir.org/2022/2/e33205 %U https://doi.org/10.2196/33205 %U http://www.ncbi.nlm.nih.gov/pubmed/35436214 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 1 %P e34142 %T The Impact of Health Literacy–Sensitive Design and Heart Age in a Cardiovascular Disease Prevention Decision Aid: Randomized Controlled Trial and End-User Testing %A Bonner,Carissa %A Batcup,Carys %A Ayre,Julie %A Cvejic,Erin %A Trevena,Lyndal %A McCaffery,Kirsten %A Doust,Jenny %+ School of Public Health, Faculty of Medicine and Health, University of Sydney, Rm 128A, Edward Ford Building A27, Sydney, 2006, Australia, 61 293517125, carissa.bonner@sydney.edu.au %K decision aids %K shared decision-making %K risk communication %K heart age %K cardiovascular disease prevention %K behavior change %K health literacy %D 2022 %7 15.4.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: Shared decision-making is an essential principle for the prevention of cardiovascular disease (CVD), where asymptomatic people consider lifelong medication and lifestyle changes. Objective: This study aims to develop and evaluate the first literacy-sensitive CVD prevention decision aid (DA) developed for people with low health literacy, and investigate the impact of literacy-sensitive design and heart age. Methods: We developed a standard DA based on international standards. The standard DA was based on our existing general practitioner DA. The literacy-sensitive DA included simple language, supporting images, white space, and a lifestyle action plan. The control DA used Heart Foundation materials. A randomized trial included 859 people aged 45-74 years using a 3 (DA: standard, literacy-sensitive, control) ×2 (heart age: heart age + percentage risk, percentage risk only) factorial design, with outcomes including prevention intentions and behaviors, gist and verbatim knowledge of risk, credibility, emotional response, and decisional conflict. We iteratively improved the literacy-sensitive version based on end-user testing interviews with 20 people with varying health literacy levels. Results: Immediately after the intervention (n=859), there were no differences in any outcome among the DA groups. The heart age group was less likely to have a positive emotional response, perceived the message as less credible, and had higher gist and verbatim knowledge of heart age risk but not percentage risk. After 4 weeks (n=596), the DA group had better gist knowledge of percentage risk than the control group. The literacy-sensitive DA group had higher fruit consumption, and the standard DA group had better verbatim knowledge of percentage risk. Verbatim knowledge was higher for heart age than for percentage risk among those who received both. Conclusions: The literacy-sensitive DA resulted in increased knowledge of CVD risk and increased fruit consumption in participants with varying health literacy levels and CVD risk results. Adding heart age did not increase lifestyle change intentions or behavior but did affect psychological outcomes, consistent with previous findings. This tool will be integrated with additional resources to improve other lifestyle outcomes. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000806965; https://tinyurl.com/226yhk8a %M 35436208 %R 10.2196/34142 %U https://cardio.jmir.org/2022/1/e34142 %U https://doi.org/10.2196/34142 %U http://www.ncbi.nlm.nih.gov/pubmed/35436208 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e37200 %T Home Delivery of Water for Caries Prevention in Latinx Children (“Sediento por una Sonrisa,” Thirsty for a Smile): Protocol for a Single-Arm Feasibility Study %A Cunha-Cruz,Joana %A Ko,Linda K %A Mancl,Lloyd %A Rothen,Marilynn L %A Harter,Catherine %A Davis,Stephen %A Koday,Mark %+ Department of Clinical and Community Sciences, University of Alabama at Birmingham, 1919 7th Ave S, Birmingham, AL, 35209, United States, 1 2059965298, joanaccruz@uab.edu %K dental caries %K behavioral intervention %K environmental restructuring %K practice-based research %K sugar consumption %K feasibility %K water consumption %K nutrition %K oral health %K Latino (a) health %K dental health %K dentistry %K dental %K public health %D 2022 %7 15.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Dental caries has significant public health implications afflicting young children. In addition to low social economic status, the most prominent risk factor for early childhood caries is sugar in the diet, particularly sugar-sweetened beverages. Dental treatment for caries in young children is commonly performed under general anesthesia and a significant proportion of children require repeated treatment. Interventions to reduce sugar-sweetened beverage consumption could lead to reduced rates of retreatment for dental caries in young children. Objective: This protocol describes the rationale, design, and methods of the “Thirsty for a Smile” feasibility study. The aim of the study is to assess the feasibility, acceptability, and appropriateness of a dietary intervention promoting water consumption in lieu of sugar-sweetened beverages among young patients, mostly from Latino heritage. Methods: This protocol describes a single-arm feasibility study. Twenty-one dyads of children and their caregivers will be recruited. Children between 2 and 9 years old who recently had treatment under general anesthesia for early childhood dental caries will be eligible to participate. The intervention has two components: (1) environmental, in which bottled water is delivered to participants’ homes; and (2) behavioral, in which caregivers will receive patient-centered counseling to increase children’s water intake and reduce sugar-sweetened beverages consumption. Dental caries and anthropometric data will be collected at examination during baseline and final visits. The primary outcome is feasibility and secondary outcomes are acceptability and appropriateness of the intervention. Results: Funding has been obtained from the National Institute of Dental and Craniofacial Research and the University of Washington approved the study. The feasibility study was conducted from March to November 2019. Conclusions: This feasibility study will test the study processes prior to a two-arm randomized controlled trial to determine feasibility and acceptability of the intervention and study procedures. This study may provide useful information for other researchers attempting to test similar interventions. International Registered Report Identifier (IRRID): RR1-10.2196/37200 %M 35436235 %R 10.2196/37200 %U https://www.researchprotocols.org/2022/4/e37200 %U https://doi.org/10.2196/37200 %U http://www.ncbi.nlm.nih.gov/pubmed/35436235 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e34576 %T Casting Without Reduction Versus Closed Reduction With or Without Fixation in the Treatment of Distal Radius Fractures in Children: Protocol for a Randomized Noninferiority Trial %A Garcia-Rueda,Maria Fernanda %A Bohorquez-Penaranda,Adriana Patricia %A Gil-Laverde,Jacky Fabian Armando %A Aguilar-Sierra,Francisco Javier %A Mendoza-Pulido,Camilo %+ Department of Orthopedics, Instituto Roosevelt, Carrera 4 Este No. 17-50, Bogotá, 110321, Colombia, 57 353 40 00 ext 6252, m-garciar@javeriana.edu.co %K radius fractures %K distal radius %K pediatric %K remodeling %K surgical reduction %K cast immobilization %K outcome measure %D 2022 %7 14.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Acute treatment for distal radius fractures, the most frequent fractures in the pediatric population, represents a challenge to the orthopedic surgeon. Deciding on surgical restoration of the alignment or cast immobilization without reducing the fracture is a complex concern given the remodeling potential of bones in children. In addition, the lack of evidence-based safe boundaries of shortening and angulation, that will not jeopardize upper-extremity functionality in the future, further complicates this decision. Objective: The authors aim to measure functional outcomes, assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Physical Function v2.0 instrument. The authors hypothesize that outcomes will not be worse in children treated with cast immobilization in situ compared with those treated with closed reduction with or without percutaneous fixation. The authors also aim to compare the following as secondary outcomes: ulnar variance and fracture alignment in the sagittal and coronal planes, range of motion, pressure ulcers, pain control, radius osteotomy due to deformity, pseudoarthrosis cure, and remanipulation. Methods: This is the protocol of a randomized noninferiority trial comparing upper-extremity functionality in children aged 5 to 10 years, after sustaining a distal radius fracture, treated with either cast immobilization in situ or closed reduction with or without fixation in a single orthopedic hospital. Functional follow-up is projected at 6 months, while clinical and radiographic follow-up will occur at 2 weeks, 3 months, and 9 months. Results: Recruitment commenced in July 2021. As of January 2022, 23 children have been randomized. Authors expect an average of 5 patients to be recruited monthly; therefore, recruitment and analysis should be complete by October 2024. Conclusions: This experimental design that addresses upper-extremity functionality after cast immobilization in situ in children who have sustained a distal fracture of the radius may yield compelling information that could aid the clinician in deciding on the most suitable orthopedic treatment. Trial Registration: ClinicalTrials.gov NCT05008029; https://clinicaltrials.gov/ct2/show/NCT05008029 International Registered Report Identifier (IRRID): DERR1-10.2196/34576 %M 35436224 %R 10.2196/34576 %U https://www.researchprotocols.org/2022/4/e34576 %U https://doi.org/10.2196/34576 %U http://www.ncbi.nlm.nih.gov/pubmed/35436224 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e22124 %T The Efficacy of Health Information Technology in Supporting Health Equity for Black and Hispanic Patients With Chronic Diseases: Systematic Review %A Senteio,Charles %A Murdock,Paul Joseph %+ Department of Library and Information Science, School of Communication and Information, Rutgers University, 4 Huntington St, New Brunswick, NJ, 08901-1071, United States, 1 8489327586, charles.senteio@rutgers.edu %K chronic disease %K minority health %K technology assessment %K biomedical %K self-management %K systematic review %K mobile phone %D 2022 %7 4.4.2022 %9 Review %J J Med Internet Res %G English %X Background: Racial inequity persists for chronic disease outcomes amid the proliferation of health information technology (HIT) designed to support patients in following recommended chronic disease self-management behaviors (ie, medication behavior, physical activity, and dietary behavior and attending follow-up appointments). Numerous interventions that use consumer-oriented HIT to support self-management have been evaluated, and some of the related literature has focused on racial minorities who experience disparate chronic disease outcomes. However, little is known about the efficacy of these interventions. Objective: This study aims to conduct a systematic review of the literature that describes the efficacy of consumer-oriented HIT interventions designed to support self-management involving African American and Hispanic patients with chronic diseases. Methods: We followed an a priori protocol using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-Equity 2012 Extension guidelines for systematic reviews that focus on health equity. Themes of interest included the inclusion and exclusion criteria. We identified 7 electronic databases, created search strings, and conducted the searches. We initially screened results based on titles and abstracts and then performed full-text screening. We then resolved conflicts and extracted relevant data from the included articles. Results: In total, there were 27 included articles. The mean sample size was 640 (SD 209.5), and 52% (14/27) of the articles focused on African American participants, 15% (4/27) of the articles focused on Hispanic participants, and 33% (9/27) included both. Most articles addressed 3 of the 4 self-management behaviors: medication (17/27, 63%), physical activity (17/27, 63%), and diet (16/27, 59%). Only 15% (4/27) of the studies focused on follow-up appointment attendance. All the articles investigated HIT for use at home, whereas 7% (2/27) included use in the hospital. Conclusions: This study addresses a key gap in research that has not sufficiently examined what technology designs and capabilities may be effective for underserved populations in promoting health behavior in concordance with recommendations. %M 35377331 %R 10.2196/22124 %U https://www.jmir.org/2022/4/e22124 %U https://doi.org/10.2196/22124 %U http://www.ncbi.nlm.nih.gov/pubmed/35377331 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e32994 %T Synthesizing Dimensions of Digital Maturity in Hospitals: Systematic Review %A Duncan,Rhona %A Eden,Rebekah %A Woods,Leanna %A Wong,Ides %A Sullivan,Clair %+ School of Information Systems, Queensland University of Technology, 2 George Street, Brisbane, 4000, Australia, 61 434237975, rg.eden@qut.edu.au %K digital maturity %K digital capability %K eHealth %K digital hospitals %K capability model %K maturity model %K literature review %K electronic medical records %D 2022 %7 30.3.2022 %9 Review %J J Med Internet Res %G English %X Background: Digital health in hospital settings is viewed as a panacea for achieving the “quadruple aim” of health care, yet the outcomes have been largely inconclusive. To optimize digital health outcomes, a strategic approach is necessary, requiring digital maturity assessments. However, current approaches to assessing digital maturity have been largely insufficient, with uncertainty surrounding the dimensions to assess. Objective: The aim of this study was to identify the current dimensions used to assess the digital maturity of hospitals. Methods: A systematic literature review was conducted of peer-reviewed literature (published before December 2020) investigating maturity models used to assess the digital maturity of hospitals. A total of 29 relevant articles were retrieved, representing 27 distinct maturity models. The articles were inductively analyzed, and the maturity model dimensions were extracted and consolidated into a maturity model framework. Results: The consolidated maturity model framework consisted of 7 dimensions: strategy; information technology capability; interoperability; governance and management; patient-centered care; people, skills, and behavior; and data analytics. These 7 dimensions can be evaluated based on 24 respective indicators. Conclusions: The maturity model framework developed for this study can be used to assess digital maturity and identify areas for improvement. %M 35353050 %R 10.2196/32994 %U https://www.jmir.org/2022/3/e32994 %U https://doi.org/10.2196/32994 %U http://www.ncbi.nlm.nih.gov/pubmed/35353050 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e34090 %T Effects of Behavioral Economics–Based Messaging on Appointment Scheduling Through Patient Portals and Appointment Completion: Observational Study %A Liang,Su-Ying %A Stults,Cheryl D %A Jones,Veena G %A Huang,Qiwen %A Sutton,Jeremy %A Tennyson,Guy %A Chan,Albert S %+ Sutter Health Center for Health Systems Research, 795 El Camino Real, Ames Building, Palo Alto, CA, , United States, 1 650 691 6432, liangs2@sutterhealth.org %K access to care %K behavioral economics %K online %K web-based appointment scheduling %K health service %K behavior %K health care %D 2022 %7 30.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Behavioral economics–based techniques have been an increasingly utilized method in health care to influence behavior change by modifying language in patient communication (through choice architecture and the framing of words). Patient portals are a key tool for facilitating patient engagement in their health, and interventions deployed via patient portals have been effective in improving utilization of preventive health services. Objective: We examined the impacts of behavioral economics–based nudge health maintenance reminders on appointment scheduling through a patient portal and appointment completion for 2 preventive services: Medicare wellness visits and Pap smear. Methods: We conducted a retrospective observational study using electronic health record data from an integrated health care system in Northern California. Nudge health maintenance reminders with behavioral economics–based language were implemented for all sites in November 2017 for Medicare wellness visits and for selected sites in February 2018 for Pap smears. We analyzed 125,369 health maintenance reminders for Medicare wellness visits, and 585,358 health maintenance reminders for Pap smear sent between January 2017 and February 2020. The primary outcomes were rate of appointments scheduled through the patient portal and appointment completion rate. We compared the outcomes between those who received the new, behavioral economics–based health maintenance reminders (the nudge group) and those who received the original, standard health maintenance reminders (the control group). We used segmented regression with interrupted time series to assess the immediate and gradual effect of the nudge for Medicare wellness visits, and we used logistic regression to assess the association of nudge health maintenance reminders, adjusting for the propensity to receive a nudge health maintenance reminder, for Pap smear. Results: The rates of appointments scheduled through the patient portal were higher for nudge health maintenance reminder recipients than those for control health maintenance reminder recipients (Medicare wellness visits—nudge: 12,537/96,839, 13.0%; control: 2,769/28,530, 9.7%, P<.001; Pap smear—nudge: 8,239/287,149, 2.9%; control: 1,868/120,047, 1.6%; P<.001). Rates of appointment completion were higher for nudge health maintenance reminders for Pap smear (nudge: 67,399/287,149, 23.5% control: 20,393/120,047, 17.0%; P<.001) but were comparable for Medicare wellness visits (nudge: 49,835/96,839, 51.5% control: 14,781/28,530, 51.8%; P=.30). There was a marginally gradual effect of nudge on number of appointments scheduled through the patient portal for the overall Medicare wellness visits sample (at a monthly rate of 0.26%, P=.09), and a significant gradual effect among scheduled appointments (at a monthly rate of 0.46%, P=.04). For Pap smear, nudge health maintenance reminders were positively associated with number of appointments scheduled through the patient portal (overall sample: propensity adjusted odds ratio [OR] 1.62; 95% CI 1.50-1.74; among scheduled appointments: propensity adjusted OR 1.61, 95% CI 1.47-1.76) and with appointment completion (propensity adjusted OR 1.07; 1.04-1.10). Conclusions: Nudges, a behavioral economics–based approach to providing health maintenance reminders, increased the number of appointments scheduled through the patient portal for Medicare wellness visits and Pap smear. Our study demonstrates that a simple approach—framing and modifying language in an electronic message—can have a significant and long-term impact on patient engagement and access to care. %M 35353051 %R 10.2196/34090 %U https://humanfactors.jmir.org/2022/1/e34090 %U https://doi.org/10.2196/34090 %U http://www.ncbi.nlm.nih.gov/pubmed/35353051 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 1 %P e35490 %T The Impact of Transitioning From In-Person to Virtual Heart Transplantation Selection Committee Meetings: Observational Study %A Shan,Rongzi %A Chandra,Neha V %A Hsu,Jeffrey J %A Fraschilla,Stephanie %A Moore,Melissa %A Ardehali,Abbas %A Nsair,Ali %A Parikh,Rushi V %+ Division of Cardiology, University of California, Los Angeles, 100 Medical Plaza, Suite 630 West, Los Angeles, CA, 90095, United States, 1 (310) 825 9011, rparikh@mednet.ucla.edu %K telemedicine %K transplantation %K heart failure %K physician %K heart transplant %K virtual meeting %K interprofessional relations %K health systems %K selection committee %D 2022 %7 30.3.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: Heart transplant selection committee meetings have transitioned from in-person to remote video meetings during the COVID-19 pandemic, but how this impacts committee members and patient outcomes is unknown. Objective: The aim of this study is to determine the perceived impact of remote video transplant selection meetings on usability and patient care and to measure patient selection outcomes during the transition period from in-person to virtual meetings. Methods: A 35-item anonymous survey was developed and distributed electronically to the heart transplant selection committee. We reviewed medical records to compare the outcomes of patients presented at in-person meetings (January-March 2020) to those presented during video meetings (March-June 2020). Results: Among 83 committee members queried, 50 were regular attendees. Of the 50 regular attendees, 24 (48%) were physicians and 26 (52%) were nonphysicians, including nurses, social workers, and coordinators; 46 responses were received, 23 (50%) from physicians and 23 (50%) from nonphysicians, with 41 responses fully completed. Overall, respondents were satisfied with the videoconference format and felt that video meetings did not impact patient care and were an acceptable alternative to in-person meetings. However, 54% (22/41) preferred in-person meetings, with 71% (15/21) of nonphysicians preferring in-person meetings compared to only 35% (7/20) of physicians (P=.02). Of the 46 new patient evaluations presented, there was a statistically nonsignificant trend toward fewer patients initially declined at video meetings compared with in-person meetings (6/24, 25% compared to 10/22, 45%; P=.32). Conclusions: The transition from in-person to video heart transplant selection committee meetings was well-received and did not appear to affect committee members’ perceived ability to deliver patient care. Patient selection outcomes were similar between meeting modalities. %M 35353041 %R 10.2196/35490 %U https://cardio.jmir.org/2022/1/e35490 %U https://doi.org/10.2196/35490 %U http://www.ncbi.nlm.nih.gov/pubmed/35353041 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e33128 %T Telehealth Business Models and Their Components: Systematic Review %A Velayati,Farnia %A Ayatollahi,Haleh %A Hemmat,Morteza %A Dehghan,Reza %+ Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, No. 4 Rashid Yasemi St, Vali-Asr St, Tehran, 1996713883, Iran, 98 21 88794302, ayatollahi.h@iums.ac.ir %K telehealth %K telemedicine %K mobile health %K business model %K value %K commerce %K revenue %K market %K systematic review %K health care %D 2022 %7 29.3.2022 %9 Review %J J Med Internet Res %G English %X Background: Telehealth technology is an excellent solution to resolve the problems of health care delivery. However, this technology may fail during large-scale implementation. As a result, business models can be used to facilitate commercialization of telehealth products and services. Objective: The purpose of this study was to review different types of business models or frameworks and their components used in the telehealth industry. Methods: This was a systematic review conducted in 2020. The databases used for searching related articles included Ovid, PubMed, Scopus, Web of Science, Emerald, and ProQuest. Google Scholar was also searched. These databases and Google Scholar were searched until the end of January 2020 and duplicate references were removed. Finally, articles meeting the inclusion criteria were selected and the Critical Appraisal Skills Programme (CASP) checklist was used for appraising the strengths and limitations of each study. Data were extracted using a data extraction form, and the results were synthesized narratively. Results: Initially, 4998 articles were found and after screening, 23 were selected to be included in the study. The results showed that new telehealth business models were presented in 13 studies, and the applications of the existing business models were reported in 10 studies. These studies were related to different types of services, namely, telemonitoring (4 studies), telemedicine (3 studies), mobile health (3 studies), telerehabilitation (3 studies), telehealth (2 studies), assisted living technologies (2 studies), sensor-based systems (2 studies), and mobile teledermoscopy, teleradiology, telecardiology, and teletreatment (1 study related to each area). In most of the business models, value proposition, financial variables, and revenue streams were the main components. Conclusions: Applying business models in the commercialization of telehealth services will be useful to gain a better understanding of the required components, market challenges, and possible future changes. The results showed that different business models can be used for different telehealth technologies in various health systems and cultures. However, it is necessary to evaluate the effectiveness of these models in practice. Moreover, comparing the usefulness of these models in different domains of telehealth services will help identify the strengths and weaknesses of these models for future optimization. %M 35348471 %R 10.2196/33128 %U https://www.jmir.org/2022/3/e33128 %U https://doi.org/10.2196/33128 %U http://www.ncbi.nlm.nih.gov/pubmed/35348471 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e28724 %T Telemedicine Acceptance Among Older Adult Patients With Cancer: Scoping Review %A Pang,Ning-Qi %A Lau,Jerrald %A Fong,Si-Ying %A Wong,Celine Yu-Hui %A Tan,Ker-Kan %+ Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 8, 1E Kent Ridge Road, Singapore, 119228, Singapore, 65 67724220, surtkk@nus.edu.sg %K older adult patients %K cancer %K telemedicine %K acceptability %K satisfaction %D 2022 %7 29.3.2022 %9 Review %J J Med Internet Res %G English %X Background: Cancer is likely to remain the most prevalent noncommunicable disease in high-income countries with an older population. Interestingly, no review of attitudes toward telemedicine among older adults has been performed. This is likely to be the group most affected by both cancer and the increasing use of technology in health care. Objective: We aimed to map research on the acceptance of telemedicine among older adults who are cancer patients. Methods: We conducted a scoping review. PubMed, EMBASE, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials were systematically searched from inception to September 2020. Articles were included if the study population had a mean or median age ≥65 years, with cancer diagnoses and if the study assessed patients’ acceptance of a telemedicine intervention. Quantitative, qualitative, and mixed method studies were included. Results: Out of a total of 887 articles that were identified, 19 were included in the review. Interventions were delivered via telephone, videoconference, web portal, mobile app, wearable technology, and text messaging and included teleconsultation, monitoring and follow-up, psychosocial support and nursing care, and prompts. The most often cited facilitating factor was convenience. Other facilitators included an increase in telemedicine care accessibility, previous positive experiences of telemedicine, appropriate technical knowledge and support, decreased cost, physician recommendations, and privacy conferred by the telemedicine intervention. Barriers include a preference for conventional care along with negative perceptions of telemedicine, concerns about technical difficulties, and confidentiality concerns in the adoption of telemedicine. Conclusions: None of the studies explored the ability of tailored interventions to address facilitators and barriers of the acceptance of telemedicine in order to increase its adoption by older adults. Facilitators and barriers will likely differ across different cultural contexts and by type of telemedicine; however, this is a gap in current knowledge. In-depth studies are necessary to determine if interventions could potentially address the barriers identified in this review, to increase acceptability. %M 35348462 %R 10.2196/28724 %U https://www.jmir.org/2022/3/e28724 %U https://doi.org/10.2196/28724 %U http://www.ncbi.nlm.nih.gov/pubmed/35348462 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e35461 %T The Impact of Hypoglycemia on Productivity Loss and Utility in Patients With Type 2 Diabetes Treated With Insulin in Real-world Canadian Practice: Protocol for a Prospective Study %A Lambert-Obry,Veronique %A Lafrance,Jean-Philippe %A Savoie,Michelle %A Lachaine,Jean %+ Faculty of Pharmacy, Université de Montréal, 2940 chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada, 1 514 343 6111 ext 4873, veronique.lambert-obry@umontreal.ca %K real-world evidence %K work productivity %K health-related quality of life %K diabetes %K hypoglycemia %D 2022 %7 28.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Type 2 diabetes mellitus (T2DM) imposes a substantial burden owing to its increasing prevalence and life-threatening complications. In patients who do not achieve glycemic targets with oral antidiabetic drugs, the initiation of insulin is recommended. However, a serious concern regarding insulin is drug-induced hypoglycemia. Hypoglycemia is known to affect quality of life and the use of health care resources. However, health economics and outcomes research (HEOR) data for economic modelling are limited, particularly regarding utility values and productivity losses. Objective: This real-world prospective study aims to assess the impact of hypoglycemia on productivity and utility in insulin-treated adults with T2DM from Ontario and Quebec, Canada. Methods: This noninterventional, multicenter, 3-month prospective study will recruit patients from 4 medical clinics and 2 endocrinology or diabetes clinics. Patients will be identified using appointment lists and enrolled through consecutive sampling during routinely scheduled consultations. To be eligible, patients must be aged ≥18 years, diagnosed with T2DM, and treated with insulin. Utility and productivity will be measured using the EQ-5D-5L questionnaire and Institute for Medical Technology Assessment Productivity Cost Questionnaire, respectively. Questionnaires will be completed 4, 8, and 12 weeks after recruitment. Generalized estimating equation models will be used to investigate productivity losses and utility decrements associated with incident hypoglycemic events while controlling for individual patient characteristics. A total of 500 patients will be enrolled to ensure the precision of HEOR estimates. Results: This study is designed to fill a gap in the Canadian evidence on the impact of hypoglycemia on HEOR outcomes. More specifically, it will generate productivity and utility inputs for the economic modeling of T2DM. Conclusions: Insulin therapy is expensive, and hypoglycemia is a significant component of economic evaluation. Robust HEOR data may help health technology assessment agencies in future reimbursement decision-making. International Registered Report Identifier (IRRID): PRR1-10.2196/35461 %M 35343912 %R 10.2196/35461 %U https://www.researchprotocols.org/2022/3/e35461 %U https://doi.org/10.2196/35461 %U http://www.ncbi.nlm.nih.gov/pubmed/35343912 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 1 %P e27486 %T Constructing an Adapted Cascade of Diabetes Care Using Inpatient Admissions Data: Cross-sectional Study %A Ryan,Irene %A Herrick,Cynthia %A Ebeling,Mary F E %A Foraker,Randi %+ Institute for Public Health, Washington University, 600 S Taylor Ave, St Louis, MO, 63110-1035, United States, 1 314 747 9212, Ryan.irene3@gmail.com %K diabetes mellitus %K cascade of care %K EHR data %K health care monitoring %K inpatient care %D 2022 %7 25.3.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: The diabetes mellitus cascade of care has been constructed to evaluate diabetes care at a population level by determining the percentage of individuals diagnosed and linked to care as well as their reported glycemic control. Objective: We sought to adapt the cascade of care to an inpatient-only setting using the electronic health record (EHR) data of 81,633 patients with type 2 diabetes. Methods: In this adaptation, linkage to care was defined as prescription of diabetes medications within 3 months of discharge, and control was defined as hemoglobin A1c (HbA1c) below individual target levels, as these are the most reliably captured items in the inpatient setting. We applied the cascade model to assess differences in demographics and percent loss at each stage of the cascade; we then conducted two-sample chi-square equality of proportions tests for each demographic. Based on findings in the previous literature, we hypothesized that women, Black patients, younger patients (<45 years old), uninsured patients, and patients living in an economically deprived area called the Promise Zone would be disproportionately unlinked and uncontrolled. We also predicted that patients who received inpatient glycemic care would be more likely to reach glycemic control. Results: We found that out of 81,633 patients, 28,716 (35.2%) were linked to care via medication prescription. Women and younger patients were slightly less likely to be linked to care than their male and older counterparts, while Black patients (n=19,141, 23.4% of diagnosed population vs n=6741, 23.5% of the linked population) were as proportionately part of the linked population as White patients (n=58,291, 71.4% of diagnosed population vs n=20,402, 71.0% of the linked population). Those living in underserved communities (ie, the Promise Zone) and uninsured patients were slightly overrepresented (n=6789, 8.3% of diagnosed population vs n=2773, 9.7% of the linked population) in the linked population as compared to patients living in wealthier zip codes and those who were insured. Similar patterns were observed among those more likely to reach glycemic control via HbA1c. However, conclusions are limited by the relatively large amount of missing glycemic data. Conclusions: We conclude that inpatient EHR data do not adequately capture the care cascade as defined in the outpatient setting. In particular, missing data in this setting may preclude assessment of glycemic control. Future work should integrate inpatient and outpatient data sources to complete the picture of diabetes care. %M 35333182 %R 10.2196/27486 %U https://diabetes.jmir.org/2022/1/e27486 %U https://doi.org/10.2196/27486 %U http://www.ncbi.nlm.nih.gov/pubmed/35333182 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e34544 %T The Evaluation of a Social Media Campaign to Increase COVID-19 Testing in Migrant Groups: Cluster Randomized Trial %A Elgersma,Ingeborg Hess %A Fretheim,Atle %A Indseth,Thor %A Munch,Anita Thorolvsen %A Johannessen,Live Bøe %A Hansen,Christine Engh %+ Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Postboks 222, Skøyen, Oslo, 0213, Norway, 47 91584782, ingeborghess.elgersma@fhi.no %K COVID-19 %K SARS-CoV-2 %K social media %K campaign %K cluster randomized trial %K nonpharmaceutical interventions %K migrant %K intervention %K testing %K strategy %K public health %K Facebook %K communication %D 2022 %7 24.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: A low test positivity rate is key to keeping the COVID-19 pandemic under control. Throughout the pandemic, several migrant groups in Norway have seen higher rates of confirmed COVID-19 and related hospitalizations, while test positivity has remained high in the same groups. The Norwegian government has used several platforms for communication, and targeted social media advertisements have in particular been an important part of the communication strategy to reach these groups. Objective: In this study, we aimed to investigate whether such a targeted Facebook campaign increased the rate of COVID-19 tests performed in certain migrant groups. Methods: We randomly assigned 386 Norwegian municipalities and city districts to intervention or control groups. Individuals born in Eritrea, Iraq, Pakistan, Poland, Russia, Somalia, Syria, and Turkey residing in intervention areas were targeted with a social media campaign aiming at increasing the COVID-19 test rate. The campaign message was in a simple language and conveyed in the users’ main language or in English. Results: During the 2-week follow-up period, the predicted probability of having a COVID-19 test taken was 4.82% (95% CI 4.47%-5.18%) in the control group, and 5.58% (95% CI 5.20%-5.99%) in the intervention group (P=.004). Conclusions: Our targeted social media intervention led to a modest increase in test rates among certain migrant groups in Norway. Trial Registration: ClinicalTrials.gov NCT04866589; https://clinicaltrials.gov/ct2/show/NCT04866589 %M 35285811 %R 10.2196/34544 %U https://www.jmir.org/2022/3/e34544 %U https://doi.org/10.2196/34544 %U http://www.ncbi.nlm.nih.gov/pubmed/35285811 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e25906 %T The Effectiveness of Physical Activity-Promoting Web- and Mobile-Based Distance Weight Loss Interventions on Body Composition in Rehabilitation Settings: Systematic Review, Meta-analysis, and Meta-Regression Analysis %A Lahtio,Heli %A Rintala,Aki %A Immonen,Jaakko %A Sjögren,Tuulikki %+ Faculty of Sport and Health Sciences, The University of Jyväskylä, Keskussairaalantie 4, Jyväskylä, 40014, Finland, 358 14 260 1211, heli.lahtio@gmail.com %K technology %K weight loss %K rehabilitation %K overweight %K obesity %K body mass index %K waist circumference %K body fat percentage %K mobile phone %D 2022 %7 24.3.2022 %9 Review %J J Med Internet Res %G English %X Background: Overweight and obesity are major problems worldwide, and they lead to an increased risk for several diseases. The use of technology in the treatment of obesity is promising, but in the existing literature, there is considerable uncertainty regarding its efficacy. In this review, we included web- and mobile-based weight loss interventions that were implemented remotely in rehabilitation settings. Objective: The aim of this systematic review is to study the effectiveness of physical activity-promoting web- and mobile-based distance weight loss interventions in rehabilitation settings on body composition in comparison with control groups that did not use technology. Methods: Studies were searched from 9 databases. The inclusion criteria were as follows: population: age 18-65 years; intervention: physical activity-promoting web- and mobile-based distance weight loss interventions; comparison: control groups without the use of technology; outcome: changes in BMI, waist circumference, or body fat percentage; study design: randomized controlled trial. The quality of the studies was assessed by 2 researchers. Meta-analysis was performed, and we also conducted a meta-regression analysis to evaluate the factors associated with the changes in body composition outcomes if statistical heterogeneity was observed. Results: The meta-analysis included 30 studies. The mean quality of the studies was 7 of 13 (SD 1.9; range 3-10). A statistically significant difference was observed in BMI (mean difference [MD] 0.83, 95% CI 0.51-1.15 kg/m2; P<.001), waist circumference (MD 2.45, 95% CI 1.83-3.07 cm; P<.001), and body fat percentage (MD 1.07%, 95% CI 0.74%-1.41%; P<.001) in favor of the weight loss groups using web- or mobile-based interventions. Meta-regression analyses found an association between personal feedback and BMI (P=.04), but other factors did not play a role in explaining statistical heterogeneity. Conclusions: Web- and mobile-based distance weight loss interventions significantly reduced BMI, waist circumference, and body fat percentage. Future studies should focus on the comparability of the intervention content. Future studies are needed to better understand weight loss and identify which components are essential in achieving it. Trial Registration: PROSPERO CRD42016035831; https://tinyurl.com/7c93tvd4 %M 35323126 %R 10.2196/25906 %U https://www.jmir.org/2022/3/e25906 %U https://doi.org/10.2196/25906 %U http://www.ncbi.nlm.nih.gov/pubmed/35323126 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 1 %P e30626 %T Virtual Endocrinology Care Emphasizing Data-Driven Insights and Continuous Engagement and Its Impact on Glycemic Outcomes in Patients With Uncontrolled Diabetes: A Real-world Retrospective Case Series %A Wu,Calvin C %A Wu,Karin C %A José,Aimée S %A Novin,Niloufar %+ Steady Health, Inc, 100 Bush Street, Suite 1600, San Francisco, CA, 94104, United States, 1 4158863778, calvin@steady.health %K continuous glucose monitoring %K connected care %K digital health %K telemedicine %K type 1 diabetes %K type 2 diabetes %D 2022 %7 24.3.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: Steady Health’s novel virtual care model incorporates continuous glucose monitoring (CGM) and a multidisciplinary approach to timely person-centered diabetes care. Objective: This real-world retrospective case series explores the early glycemic outcomes of its patients with uncontrolled diabetes. Methods: All patients of Steady Health who had an initial time in range (TIR) below 70% from their first 4 weeks of available CGM data and who had completed onboarding by February 2021 were included in this analysis. We compared the change in TIR, time below range, and average blood glucose from their first 4 weeks with their latest 4 weeks of available CGM data. Hemoglobin A1c (HbA1c) values at baseline and at the end of the study were also compared. Patients completed a questionnaire assessing their satisfaction with Steady Health’s intervention. Results: A total of 53 patients (n=35, 66% with type 1 diabetes; n=44, 83% treated with insulin) were included in this analysis. This cohort had a median baseline TIR of 53.0% (IQR 40.9%, 61.7%) and saw a median change in TIR of +16.6% (IQR +6.0%, +27.9%; P<.001) over a median duration of care of 11 months, amounting to nearly 4 more hours spent between 70 to 180 mg/dL a day. Of the 27 patients who had both baseline and follow-up HbA1c results, their median baseline HbA1c was 8.6% (IQR 7.5%, 11.4%; 70 mmol/mol), while their median change in HbA1c was –1.2% (IQR –2.6%, –0.2%; P=.001). Importantly, these glycemic improvements were achieved with a median decrease in the time below range by –0.3% (IQR –1.1%, 0.0%; P<.001), regardless of whether patients were started on an automated insulin delivery system. A total of 40 (75.5%) patients improved TIR by ≥5%, and 27 (50.9%) achieved TIR≥70% by the end of the study. Glycemic improvements were greatest among patients with the lowest baseline TIR and those who collaborated most intensively with Steady Health’s clinicians. A total of 25 of these patients responded to a questionnaire assessing levels of satisfaction with their care, and all of them agreed that Steady Health had a positive impact on their diabetes management. Conclusions: Our findings suggest that patients with uncontrolled diabetes can achieve significant glycemic improvements by working with a virtual multidisciplinary care team that uses CGM to provide continuous clinical feedback and support. %M 35323114 %R 10.2196/30626 %U https://diabetes.jmir.org/2022/1/e30626 %U https://doi.org/10.2196/30626 %U http://www.ncbi.nlm.nih.gov/pubmed/35323114 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e30454 %T A Quality Improvement Emergency Department Surge Management Platform (SurgeCon): Protocol for a Stepped Wedge Cluster Randomized Trial %A Mariathas,Hensley H %A Hurley,Oliver %A Anaraki,Nahid Rahimipour %A Young,Christina %A Patey,Christopher %A Norman,Paul %A Aubrey-Bassler,Kris %A Wang,Peizhong Peter %A Gadag,Veeresh %A Nguyen,Hai V %A Etchegary,Holly %A McCrate,Farah %A Knight,John C %A Asghari,Shabnam %+ Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, NL, A1B3V6, Canada, 1 709 777 2142, shabnam.asghari@med.mun.ca %K SurgeCon %K emergency department %K stepped wedge design %K cluster randomized trials %K wait time %D 2022 %7 24.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite many efforts, long wait times and overcrowding in emergency departments (EDs) have remained a significant health service issue in Canada. For several years, Canada has had one of the longest wait times among the Organisation for Economic Co-operation and Development countries. From a patient’s perspective, this challenge has been described as “patients wait in pain or discomfort for hours before being seen at EDs.” To overcome the challenge of increased wait times, we developed an innovative ED management platform called SurgeCon that was designed based on continuous quality improvement principles to maintain patient flow and mitigate the impact of patient surge on ED efficiency. The SurgeCon quality improvement intervention includes a protocol-driven software platform, restructures ED organization and workflow, and aims to establish a more patient-centric environment. We piloted SurgeCon at an ED in Carbonear, Newfoundland and Labrador, and found that there was a 32% reduction in ED wait times. Objective: The primary objective of this trial is to determine the effects of SurgeCon on ED performance by assessing its impact on length of stay, the time to a physician’s initial assessment, and the number of patients leaving the ED without being seen by a physician. The secondary objectives of this study are to evaluate SurgeCon’s effects on patient satisfaction and patient-reported experiences with ED wait times and its ability to create better-value care by reducing the per-patient cost of delivering ED services. Methods: The implementation of the intervention will be assessed using a comparative effectiveness-implementation hybrid design. This type of hybrid design is known to shorten the amount of time associated with transitioning interventions from being the focus of research to being used for practice and health care services. All EDs with 24/7 on-site physician support (category A hospitals) will be enrolled in a 31-month, pragmatic, stepped wedge cluster randomized trial. All clusters (hospitals) will start with a baseline period of usual care and will be randomized to determine the order and timing of transitioning to intervention care until all hospitals are using the intervention to manage and operationalize their EDs. Results: Data collection for this study is continuing. As of February 2022, a total of 570 randomly selected patients have participated in telephone interviews concerning patient-reported experiences and patient satisfaction with ED wait times. The first of the 4 EDs was randomly selected, and it is currently using SurgeCon’s eHealth platform and applying efficiency principles that have been learned through training since September 2021. The second randomly selected site will begin intervention implementation in winter 2022. Conclusions: By assessing the impact of SurgeCon on ED services, we hope to be able to improve wait times and create better-value ED care in this health care context. Trial Registration: ClinicalTrials.gov NCT04789902; https://clinicaltrials.gov/ct2/show/NCT04789902 International Registered Report Identifier (IRRID): DERR1-10.2196/30454 %M 35323121 %R 10.2196/30454 %U https://www.researchprotocols.org/2022/3/e30454 %U https://doi.org/10.2196/30454 %U http://www.ncbi.nlm.nih.gov/pubmed/35323121 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e29513 %T Occurrence Patterns of Traumatic Brain Injury Within the Emergency Department and Internal Screening Process Efficacy During the COVID-19 Pandemic: Retrospective Analysis %A Paralkar,Tapasvini Anmol %A Lay,Phoebe %A Stubbs,Sawyer %A Ahmed,Syed Hadi %A Ghani,Minha %A Osier,Nico %+ School of Nursing, The University of Texas at Austin, 1710 Red River Street, Austin, TX, 78712, United States, 1 (512) 471 7913, nicoosier@utexas.edu %K COVID-19 %K coronavirus %K pandemic %K clinical recruitment %K traumatic brain injury %K children %K participant-focused %K recruitment %K enrollment %K digital screening %K brain %K EHR %K electronic health record %K database %D 2022 %7 23.3.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: Traumatic brain injury (TBI) is one of the leading causes of death in pediatric patients. Continued recruitment of pediatric TBI participants into a biobank amidst the COVID-19 pandemic not only necessitates adaptive changes to traditional recruitment methods but also requires an evaluation of emergency department (ED) utilization by TBI-presenting patients. Objective: The primary objective of this exploratory retrospective study was to evaluate pediatric TBI-related ED utilization during the pandemic. The secondary objective was to appraise the efficacy of the research team’s internal screening processes. Methods: Potential participants (ie, individuals who met all inclusion criteria and would be approached by a consenter) were screened from an ED’s electronic health record system. Data regarding their visit were recorded in a Health Insurance Portability and Accountability Act–compliant manner, which were cleaned through Google Sheets. Cleaned data were then coded as either a screening variable or a hospital utilization variable to examine the effects of the pandemic on internal operations and hospital utilization patterns. The variables were compared between select months during the pandemic in 2020 to analogous months in 2019 in the R programming language via the two-sample Student t test and the Mann-Whitney-Wilcoxon rank-sum test. Results: The sample (N=2321) consisted of 1245 entries from 2019 and 1076 entries from 2020. A significantly greater proportion of potential participants (P<.001) were identified in 2020 (222/633, 35.1%) than in 2019 (195/908, 21.4%). A significantly greater proportion of potential participants (P<.001) had a visit reason indicative of a TBI in 2020 (181/222, 81.5%) than in 2019 (103/195, 52.8%). A significantly greater proportion of these injuries (P=.02) occurred inside (39/181, 21.5%) in 2020 than in 2019 (11/103, 10.7%). No significant difference was found across the mechanism of injury categories reported for potential participants between 2019 and 2020. Potential participants were significantly older (P=.006) in 2019 (mean 8.93 years) than in 2020 (mean 7.31 years). Screeners spent significantly longer (P=.03) to identify potential participants in March 2020 (55 minutes) than in March 2019 (32 minutes), but spent significantly less time (P=.01) to do so in July 2020 (22 minutes) than in July 2019 (42 minutes). Screening coverage was significantly lower (P<.001) in March 2020 (241.8 hours) than in March 2019 (346.5 hours). Screening coverage was significantly greater (P<.001) in April 2020 (611.5 hours) and July 2020 (513.5 hours) than in April 2019 (470.5 hours) and July 2019 (404.3 hours), respectively. Conclusions: There was a significant increase in the rate of incoming TBI cases to the ED during the COVID-19 pandemic, warranting continued enrollment with added safety measures. Additionally, refinement of internal processes improved the accuracy of data collection. As demonstrated in this study, researchers can leverage ongoing data collection to facilitate process improvements and evaluate the impact of unexpected global events on their research. %M 35225820 %R 10.2196/29513 %U https://www.i-jmr.org/2022/1/e29513 %U https://doi.org/10.2196/29513 %U http://www.ncbi.nlm.nih.gov/pubmed/35225820 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e34144 %T Inequities in Health Care Services Caused by the Adoption of Digital Health Technologies: Scoping Review %A Yao,Rui %A Zhang,Wenli %A Evans,Richard %A Cao,Guang %A Rui,Tianqi %A Shen,Lining %+ School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, No 13 Hangkong Road, Wuhan, 430030, China, 86 (027)83692730, sln2008@hust.edu.cn %K health inequities %K digital health technologies %K health care services %K socially disadvantaged groups %K scoping review %K mobile phone %D 2022 %7 21.3.2022 %9 Review %J J Med Internet Res %G English %X Background: Digital health technologies (ie, the integration of digital technology and health information) aim to increase the efficiency of health care delivery; they are rapidly adapting to health care contexts to provide improved medical services for citizens. However, contrary to expectations, their rapid adoption appears to have led to health inequities, with differences in health conditions or inequality in the distribution of health care resources among different populations. Objective: This scoping review aims to identify and describe the inequities of health care services brought about by the adoption of digital health technologies. The factors influencing such inequities, as well as the corresponding countermeasures to ensure health equity among different groups of citizens, were also studied. Methods: Primary studies and literature, including articles and reviews, published in English between 1990 and 2020 were retrieved using appropriate search strategies across the following three electronic databases: Clarivate Analytics’ Web of Science, PubMed, and Scopus. Data management was performed by two authors (RY and WZ) using Thomson Endnote (Clarivate Analytics, Inc), by systematically screening and identifying eligible articles for this study. Any conflicts of opinion were resolved through discussions with the corresponding author. A qualitative descriptive synthesis was performed to determine the outcomes of this scoping review. Results: A total of 2325 studies were collected during the search process, of which 41 (1.76%) papers were identified for further analysis. The quantity of literature increased until 2016, with a peak in 2020. The United States, the United Kingdom, and Norway ranked among the top 3 countries for publication output. Health inequities caused by the adoption of digital health technologies in health care services can be reflected in the following two dimensions: the inability of citizens to obtain and adopt technology and the different disease outcomes found among citizens under technical intervention measures. The factors that influenced inequities included age, race, region, economy, and education level, together with health conditions and eHealth literacy. Finally, action can be taken to alleviate inequities in the future by government agencies and medical institutions (eg, establishing national health insurance), digital health technology providers (eg, designing high-quality tools), and health care service recipients (eg, developing skills to access digital technologies). Conclusions: The application of digital health technologies in health care services has caused inequities to some extent. However, existing research has certain limitations. The findings provide a comprehensive starting point for future research, allowing for further investigation into how digital health technologies may influence the unequal distribution of health care services. The interaction between individual subjective factors as well as social support and influencing factors should be included in future studies. Specifically, access to and availability of digital health technologies for socially disadvantaged groups should be of paramount importance. %M 35311682 %R 10.2196/34144 %U https://www.jmir.org/2022/3/e34144 %U https://doi.org/10.2196/34144 %U http://www.ncbi.nlm.nih.gov/pubmed/35311682 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e33092 %T Treatment Interruptions and Telemedicine Utilization in Serious Mental Illness: Retrospective Longitudinal Claims Analysis %A Ainslie,Marcy %A Brunette,Mary F %A Capozzoli,Michelle %+ Department of Nursing, University of New Hampshire, 4 library way, hewitt hall, Durham, NH, 03824, United States, 1 603 562 8833, marcy.ainslie@unh.edu %K telemedicine %K mental health %K serious mental illness %K retention %K mental illness %K telehealth %D 2022 %7 21.3.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Avoiding interruptions and dropout in outpatient care can prevent mental illness symptom exacerbation and costly crisis services, such as emergency room visits and inpatient psychiatric hospitalization. During the COVID-19 pandemic, to attempt to maintain care continuity, telemedicine services were increasingly utilized, despite the lack of data on efficacy in patients with serious mental illness. Patients with serious mental illness are challenging to enroll and sustain in randomized controlled trials over time due to fluctuations in disease exacerbation. However, capturing and examining utilization and efficacy data in community mental health center (CMHC) patients with serious mental illness during the pandemic is a unique opportunity to inform future clinical and policy decision-making. Objective: We aimed to identify and describe the characteristics of CMHC patients with serious mental illness who experienced treatment interruptions and who utilized telemedicine during the pandemic. Methods: We conducted a retrospective observational study of treatment interruptions and telemedicine use during the period from December 2019 to June 2020 (compared to the period from December 2018 to June 2019) in New Hampshire CMHC patients. The study population included all Medicaid beneficiaries with serious mental illness engaged in treatment 3 months prior to the declaration of a state of emergency in response to the COVID-19 pandemic. We used chi-square tests of independence and logistic regression to explore associations between treatment interruptions and variables (gender, age, rurality, and diagnosis). Telemedicine utilization was categorized as low (<25%), medium (25%-75%), or high (>75%) use. Results: A total of 16,030 patients were identified. New Hampshire CMHCs demonstrated only a 4.9% increase in treatment interruptions compared with the year prior. Patients who were male (odds ratio [OR] 1.27, 95% CI 1.17-1.38; P<.001), under the age of 18 years (ages 0-12 years: OR 1.37, 95% CI 0.62-0.86, P<.001; aged 13-17 years: OR 1.49, 95% CI 0.57-0.79, P<.001), or among milder diagnostic categories, such as anxiety disorders (OR 3.77, 95% CI 3.04-4.68; P<.001) and posttraumatic stress disorder (OR 3.69, 95% CI 2.96-4.61; P<.001), were most likely to experience treatment interruptions. Patients who were female (OR 0.89, CI 0.65-0.74), 18 to 34 years old (OR 0.74, CI 0.70-0.79), or among milder diagnostic categories, such as anxiety disorder (OR 0.69, CI 0.65-0.74) or posttraumatic stress disorder (OR 0.77, CI 0.72-0.83), and with major depressive disorder (OR 0.73, CI 0.68-0.78) were less likely to be in the low telemedicine utilization group. Conclusions: The integration of telemedicine supported care continuity for most CMHC patients; yet, retention varied by subpopulation, as did telemedicine utilization. The development of policies and clinical practice guidelines requires empirical evidence on the effectiveness and limitations of telemedicine in patients with serious mental illness. %M 35311673 %R 10.2196/33092 %U https://mental.jmir.org/2022/3/e33092 %U https://doi.org/10.2196/33092 %U http://www.ncbi.nlm.nih.gov/pubmed/35311673 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e24592 %T Pulmonary Screening Practices of Otolaryngology–Head and Neck Surgeons Across Saudi Arabia in the Posttreatment Surveillance of Squamous Cell Carcinoma: Cross-sectional Survey Study %A Alnefaie,Majed %A Alamri,Abdullah %A Saeedi,Asalh %A Althobaiti,Awwadh %A Alosaimi,Shahad %A Alqurashi,Yousuf %A Marzouki,Hani %A Merdad,Mazin %+ King Fahad Armed Forces Hospital, Medical Services of The Armed Forces, Al Kurnaysh Rd, Al Andalus, Jeddah, 23311, Saudi Arabia, 966 500900450, Majed.n.md@gmail.com %K squamous cell carcinoma of head and neck %K lung neoplasms %K radiography %K otolaryngology %K surgeons %K survey %D 2022 %7 18.3.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: With respect to patients with head and neck squamous cell carcinoma (HNSCC), posttreatment surveillance for distant disease has mostly focused on the lungs, as HNSCC distant metastasis occurs in this organ in 90% of HNSCC cases. Additionally, the incidence rate of primary tumors in the lungs is high due to the field cancerization of the entire upper aerodigestive tract. Objective: Our cross-sectional survey study aims to evaluate the current beliefs and pulmonary screening practices of otolaryngology–head and neck surgeons across Saudi Arabia with respect to the posttreatment surveillance of HNSCC. Methods: This nationwide cross-sectional survey was conducted among head and neck surgeon members of the Saudi Society of Otolaryngology from June 1 to June 30, 2020. A predesigned questionnaire was used for data collection, and a descriptive analysis was carried out. Results: This study included 22 participants and had a 78% (22/28) response rate. This study found that the majority of participants (9/22, 41%) used lung radiography for routine lung screening during posttreatment follow-ups, whereas 32% (7/22) used low-dose computed tomography (CT; 7/22, 32%). With regard to the number of years for which participants perform lung screening during follow-ups, the majority of participants (17/22, 77%) reported 5 years, and only 9% (2/22) have performed lifelong lung screening. With regard to the frequency of lung screening, 77% (17/22) of participants conduct screening annually, 18% (4/22) conduct screening half-yearly, and 5% (1/22) conduct screening biennially. With regard to beliefs about the effectiveness of screening procedures in reducing lung cancer mortality rates during follow-ups, 36% (8/22) of participants believed them to be very effective or somewhat effective, 18% (4/22) did not know, and only 9% (2/22) believed that they were not effective. Conclusions: The participants mainly used lung radiography (9/22, 41%), low-dose CT (7/22, 32%), or positron emission tomography/CT (6/22, 27%) as a routine lung screening method during the posttreatment follow-up of patients with head and neck cancer for 5 years (17/22, 77%) or 10 years (3/22, 14%), and only a small percentage of participants have performed lifelong lung screening (2/22, 9%). Lung screening was mostly conducted annually or half-yearly. Such screening was believed to be very effective or somewhat effective. %M 35302511 %R 10.2196/24592 %U https://www.i-jmr.org/2022/1/e24592 %U https://doi.org/10.2196/24592 %U http://www.ncbi.nlm.nih.gov/pubmed/35302511 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e28692 %T Statistical Methods for Item Reduction in a Representative Lifestyle Questionnaire: Pilot Questionnaire Study %A Staffini,Alessio %A Fujita,Kento %A Svensson,Akiko Kishi %A Chung,Ung-Il %A Svensson,Thomas %+ Precision Health, Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan, 81 358414737, kishi@bioeng.t.u-tokyo.ac.jp %K item reduction %K surveys and lifestyle questionnaires %K feedback measures %K questionnaire design %K variance inflation factor %K factor analysis %K mobile phone %D 2022 %7 18.3.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: Reducing the number of items in a questionnaire while maintaining relevant information is important as it is associated with advantages such as higher respondent engagement and reduced response error. However, in health care, after the original design, an a posteriori check of the included items in a questionnaire is often overlooked or considered to be of minor importance. When conducted, this is often based on a single selected method. We argue that before finalizing any lifestyle questionnaire, a posteriori validation should always be conducted using multiple approaches to ensure the robustness of the results. Objective: The objectives of this study are to compare the results of two statistical methods for item reduction (variance inflation factor [VIF] and factor analysis [FA]) in a lifestyle questionnaire constructed by combining items from different sources and analyze the different results obtained from the 2 methods and the conclusions that can be made about the original items. Methods: Data were collected from 79 participants (heterogeneous in age and sex) with a high risk of metabolic syndrome working in a financial company based in Tokyo. The lifestyle questionnaire was constructed by combining items (asked with daily, weekly, and monthly frequency) from multiple validated questionnaires and other selected questions. Item reduction was conducted using VIF and exploratory FA. Adequacy tests were used to check the data distribution and sampling adequacy. Results: Among the daily and weekly questions, both VIF and FA identified redundancies in sleep-related items. Among the monthly questions, both approaches identified redundancies in stress-related items. However, the number of items suggested for reduction often differed: VIF suggested larger reductions than FA for daily questions but fewer reductions for weekly questions. Adequacy tests always confirmed that the structural detection was adequate for the considered items. Conclusions: As expected, our analyses showed that VIF and FA produced both similar and different findings, suggesting that questionnaire designers should consider using multiple methods for item reduction. Our findings using both methods indicate that many questions, especially those related to sleep, are redundant, indicating that the considered lifestyle questionnaire can be shortened. %M 35302507 %R 10.2196/28692 %U https://www.i-jmr.org/2022/1/e28692 %U https://doi.org/10.2196/28692 %U http://www.ncbi.nlm.nih.gov/pubmed/35302507 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e35936 %T Survivorship of Patients After Long Intensive Care Stay With Exploration and Experience in a New Zealand Cohort (SPLIT ENZ): Protocol for a Mixed Methods Study %A Sutton,Lynsey %A Bell,Elliot %A Every-Palmer,Susanna %A Weatherall,Mark %A Skirrow,Paul %+ Intensive Care Unit, Level 3, Wellington Regional Hospital, Capital and Coast District Health Board, 49 Riddiford Street, Newtown, Wellington, 6021, New Zealand, 64 211211385, lynsey.sutton-smith@ccdhb.org.nz %K COVID-19 %K critical illness %K disability %K intensive care unit %K survivorship %K Post Intensive Care Syndrome %D 2022 %7 17.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Post Intensive Care Syndrome (PICS) was defined by the Society of Critical Care Medicine in 2012 with subsequent international research highlighting poor long-term outcomes; reduced quality of life; and impairments, for survivors of critical illness. To date, there has been no published research on the long-term outcomes of survivors of critical illness in New Zealand. Objective: The aim of this study is to explore long-term outcomes after critical illness in New Zealand. The primary objectives are to describe and quantify symptoms and disability, explore possible risk factors, and to identify unmet needs in survivors of critical illness. Methods: This will be a mixed methods study with 2 components. First, a prospective cohort study of approximately 100 participants with critical illness will be followed up at 1, 6, and 12 months after hospital discharge. The primary outcome will be disability assessed using the World Health Organization Disability Assessment Scale 2.0. Secondary outcomes will focus on mental health using the Hospital Anxiety and Depression Scale and the Impact of Events Scale-revised, cognitive function using the Montreal Cognitive Assessment (Montreal Cognitive Assessment–BLIND), and health-related quality of life using the European Quality of Life-Five Dimension-Five Level. The second element of the study will use qualitative grounded theory methods to explore participants experiences of recovery and highlight unmet needs. Results: This study was approved by the New Zealand Northern A Health and Disability Ethics Committee on August 16, 2021 (21/NTA/107), and has been registered with the Australian New Zealand Clinical Trials Registry on October 5, 2021. SPLIT ENZ is due to start recruitment in early 2022, aiming to enroll 125 patients over 2 years. Data collection is estimated to be completed by 2024-2025 and will be published once all data are available for reporting. Conclusions: Although international research has identified the prevalence of PICS and the extent of disability in survivors of critical illness, there is no published research in New Zealand. Research in this field is particularly pressing in the context of COVID-19, an illness that may include PICS in its sequelae. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN1262100133588; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382566&showOriginal=true&isReview=true International Registered Report Identifier (IRRID): PRR1-10.2196/35936 %M 35297773 %R 10.2196/35936 %U https://www.researchprotocols.org/2022/3/e35936 %U https://doi.org/10.2196/35936 %U http://www.ncbi.nlm.nih.gov/pubmed/35297773 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e29019 %T Barriers to and Facilitators for Acceptance of Comprehensive Clinical Decision Support System–Driven Care Maps for Patients With Thoracic Trauma: Interview Study Among Health Care Providers and Nurses %A Jones,Emma K %A Banks,Alyssa %A Melton,Genevieve B %A Porta,Carolyn M %A Tignanelli,Christopher J %+ Department of Surgery, University of Minnesota, 420 Delaware St SE, Mayo Mail Code 195, Minneapolis, MN, 55455, United States, 1 6126261968, ctignane@umn.edu %K clinical decision support systems %K rib fractures %K trauma %K Unified Theory of Acceptance and Use of Technology %K human computer interaction %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Comprehensive clinical decision support (CDS) care maps can improve the delivery of care and clinical outcomes. However, they are frequently plagued by usability problems and poor user acceptance. Objective: This study aims to characterize factors influencing successful design and use of comprehensive CDS care maps and identify themes associated with end-user acceptance of a thoracic trauma CDS care map earlier in the process than has traditionally been done. This was a planned adaptive redesign stage of a User Acceptance and System Adaptation Design development and implementation strategy for a CDS care map. This stage was based on a previously developed prototype CDS care map guided by the Unified Theory of Acceptance and Use of Technology. Methods: A total of 22 multidisciplinary end users (physicians, advanced practice providers, and nurses) were identified and recruited using snowball sampling. Qualitative interviews were conducted, audio-recorded, and transcribed verbatim. Generation of prespecified codes and the interview guide was informed by the Unified Theory of Acceptance and Use of Technology constructs and investigative team experience. Interviews were blinded and double-coded. Thematic analysis of interview scripts was conducted and yielded descriptive themes about factors influencing the construction and potential use of an acceptable CDS care map. Results: A total of eight dominant themes were identified: alert fatigue (theme 1), automation (theme 2), redundancy (theme 3), minimalistic design (theme 4), evidence based (theme 5), prevent errors (theme 6), comprehensive across the spectrum of disease (theme 7), and malleability (theme 8). Themes 1 to 4 addressed factors directly affecting end users, and themes 5 to 8 addressed factors affecting patient outcomes. More experienced providers prioritized a system that is easy to use. Nurses prioritized a system that incorporated evidence into decision support. Clinicians across specialties, roles, and ages agreed that the amount of extra work generated should be minimal and that the system should help them administer optimal care efficiently. Conclusions: End user feedback reinforces attention toward factors that improve the acceptance and use of a CDS care map for patients with thoracic trauma. Common themes focused on system complexity, the ability of the system to fit different populations and settings, and optimal care provision. Identifying these factors early in the development and implementation process may facilitate user-centered design and improve adoption. %M 35293873 %R 10.2196/29019 %U https://humanfactors.jmir.org/2022/1/e29019 %U https://doi.org/10.2196/29019 %U http://www.ncbi.nlm.nih.gov/pubmed/35293873 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e35584 %T A Canadian Weekend Elective Pediatric Surgery Program to Reduce the COVID-19–Related Backlog: Operating Room Ramp-Up After COVID-19 Lockdown Ends—Extra Lists (ORRACLE-Xtra) Implementation Study %A Matava,Clyde %A So,Jeannette %A Williams,RJ %A Kelley,Simon %A , %+ Department of Anesthesia and Pain Medicine, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada, 1 4168137445, clyde.matava@sickkids.ca %K waiting lists %K quality improvement %K patient satisfaction %K COVID-19 %K ambulatory surgery %K pandemics %K Canada %D 2022 %7 15.3.2022 %9 Original Paper %J JMIR Perioper Med %G English %X Background: The COVID-19 pandemic caused by the SARS-COV-2 virus has resulted in unprecedented challenges for the health care system. A decrease of surgical services led to substantial backlogs for time-sensitive scheduled pediatric patients. We designed and implemented a novel pilot weekend surgical quality improvement project called Operating Room Ramp-Up After COVID Lockdown Ends—Extra Lists (ORRACLE-Xtra). Objective: Our overall goals are to increase patient access to surgery (and reduce the wait list), improve operating room efficiencies, and optimize parent and staff experience. Methods: Using the DMAIC (define, measure, analyze, improve, control) framework, we implemented ORRACLE-Xtra in a tertiary care academic pediatric hospital during a quiescent period of the COVID-19 pandemic. We defined process and outcome measures based on provincial targets of out-of-window cases. Parental and staff satisfaction was tracked by surveys. Results: ORRACLE-Xtra led to 247 patients receiving surgery during the pilot period, resulting in a 5% decrease in the total number of patients on our wait list with Paediatric Canadian Access Targets for Surgery IV (147/247, 59.5%), with 38.1% (94/247) out-of-window of provincial targets. Most of the process and outcome measures were met or exceeded. Overall parental satisfaction was at 95.8% (110/121), with 79% (64/81) of staff reporting satisfaction with working weekends. Conclusions: Through the ORRACLE-Xtra pilot program, we have shown that hospitals impacted by COVID-19 can reduce the surgical backlog using innovative models of service delivery in a Canadian context. Sustained funding is critical to achieving more meaningful reductions in wait times for scheduled surgeries over the longer term and needs to be balanced with staff well-being. %M 34887242 %R 10.2196/35584 %U https://periop.jmir.org/2022/1/e35584 %U https://doi.org/10.2196/35584 %U http://www.ncbi.nlm.nih.gov/pubmed/34887242 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e33076 %T Assessing Determinants of Programmatic Performance of Community Management of Malaria, Pneumonia, and Diarrhea in Children in Africa: Protocol and Data Collection for a Mixed Methods Evaluation of Integrated Community Case Management %A Karim,Aliya %A de Savigny,Don %A Ngaima,Jean Serge %A Mäusezahl,Daniel %A Cobos Muñoz,Daniel %A Tshefu,Antoinette %+ University of Basel, Petersplatz 1, Basel, 4001, Switzerland, 41 061 207 31 11, aliya.karim@unibas.ch %K iCCM %K integrated community case management %K systems thinking %K malaria %K study design %K systems methods %K child health %K program evaluation %D 2022 %7 14.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Integrated community case management (iCCM) is a child health program designed to provide integrated community-based care for children with pneumonia, malaria, or diarrhea in hard-to-reach areas of low- and middle-income countries. The foundation of the intervention is service delivery by community health workers (CHWs) who depend on reliable provision of drugs and supplies, consistent supervision, comprehensive training, and community acceptance and participation to perform optimally. The effectiveness of the program may also depend on a number of other elements, including an enabling policy environment, financing mechanisms from the national to the local level, data transmission systems, and appropriate monitoring and evaluation. The extent to which these factors act upon each other to influence the effectiveness and viability of iCCM is both variable and challenging to assess, especially across different implementation contexts. Objective: In this paper, we describe a mixed methods systems-based study protocol to assess the programmatic components of iCCM that are associated with intervention effectiveness and report preliminary results of data collection. Methods: This protocol uses a mixed qualitative and quantitative study design based on a systems thinking approach within four iCCM programs in Malawi, Democratic Republic of the Congo, and Niger State and Abia State in Nigeria. Routine monitoring data are collected to determine intervention effectiveness, namely testing, treatment, and referral outcomes. Surveys with CHWs, supervisors, and caregivers are performed to collect quantitative data on their demographics, activities, and experiences within the program and how these relate to the areas of intervention effectiveness. Focus group discussions are conducted with these stakeholders as well as local traditional leaders to contextualize these data. Key informant interviews are undertaken with national- and district-level program stakeholders and officers knowledgeable in critical program processes. Results: We performed 3836 surveys and 45 focus group discussions of 379 participants with CHWs, supervisors, caregivers, and traditional leaders, as well as 120 key informant interviews with district- and national-level program managers, health officers, and ministry officials. Policy and program documents were additionally collected for review. Conclusions: We expect that evidence from this study will inform child health programs and practice in low- and middle-income settings as well as future policy development within the iCCM intervention. International Registered Report Identifier (IRRID): DERR1-10.2196/33076 %M 35285813 %R 10.2196/33076 %U https://www.researchprotocols.org/2022/3/e33076 %U https://doi.org/10.2196/33076 %U http://www.ncbi.nlm.nih.gov/pubmed/35285813 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e35291 %T Effects of Integrating Family Planning With Maternal, Newborn, and Child Health Services on Uptake of Voluntary Modern Contraceptive Methods in Rural Pakistan: Protocol for a Quasi-experimental Study %A Memon,Zahid Ali %A Reale,Sophie %A Ahmed,Wardah %A Spencer,Rachael %A Lashari,Talib Hussain %A Bhutta,Zulfiqar %A Soltani,Hora %+ Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan, 92 3085550859, zahid.memon@aku.edu %K family planning %K integrated health services %K contraceptive prevalence rate %K modern contraceptive prevalence rate %K modern contraceptive method %K rural Pakistan %D 2022 %7 8.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The uptake of modern contraceptive methods (MCMs) remains low, with 25% of women reporting their use in Pakistan. The overarching interventions covering service delivery platforms at facility and community levels necessitate the integration of family planning (FP) with maternal, newborn, and child health (MNCH) services. Objective: The main aim of this study is to evaluate the impact of an integrated FP-MNCH service delivery model to increase coverage of MCMs in rural Pakistan. Moreover, we aim to measure the level of effectiveness of interventions regarding the uptake of MCMs. Methods: A quasi-experimental, sequential, mixed methods study design with pre- and postevaluation will be adopted to evaluate the impact of integration of FP with MNCH services. The interventions include the following: (1) capacity strengthening of health care providers, including technical trainings; training in counseling of women who attend immunization centers, antenatal care (ANC) clinics, and postnatal care (PNC) clinics; and provision of job aids; (2) counseling of women and girls attending ANC, PNC, and pediatric clinics; (3) ensuring sustained provision of supplies and commodities; (4) community engagement, including establishing adolescent-friendly spaces; and (5) use of District Health Information System data in decision-making. Descriptive statistics will be used to estimate prevalence (ie, proportions) and frequencies of outcome indicators. A univariate difference-in-difference analytical approach will be used to estimate the effect of the interventions. In addition, a Blinder-Oaxaca decomposition analysis will be conducted to identify and quantify determinants of the modern contraceptive prevalence rate. Results: The intervention phase began in July 2021 and will run until June 2022. The impact assessment will be conducted from July to September 2022. Conclusions: This project will evaluate the impact of integrating FP with MNCH services. Furthermore, this study will identify the drivers and barriers in uptake of MCMs and will simultaneously help in modifying the interventional strategies that can be scaled up through existing service delivery platforms within the public and private sectors, according to the local sociocultural and health system context. Trial Registration: ClinicalTrials.gov NCT05045599; https://clinicaltrials.gov/ct2/show/NCT05045599 International Registered Report Identifier (IRRID): DERR1-10.2196/35291 %M 35258461 %R 10.2196/35291 %U https://www.researchprotocols.org/2022/3/e35291 %U https://doi.org/10.2196/35291 %U http://www.ncbi.nlm.nih.gov/pubmed/35258461 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e30883 %T Applications and User Perceptions of Smart Glasses in Emergency Medical Services: Semistructured Interview Study %A Zhang,Zhan %A Joy,Karen %A Harris,Richard %A Ozkaynak,Mustafa %A Adelgais,Kathleen %A Munjal,Kevin %+ School of Computer Science and Information Systems, Pace University, 163 William Street, New York, NY, 10078, United States, 1 2123461897, zzhang@pace.edu %K smart glasses %K hands-free technologies %K emergency medical services %K user studies %K mobile phone %D 2022 %7 28.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Smart glasses have been gaining momentum as a novel technology because of their advantages in enabling hands-free operation and see-what-I-see remote consultation. Researchers have primarily evaluated this technology in hospital settings; however, limited research has investigated its application in prehospital operations. Objective: The aim of this study is to understand the potential of smart glasses to support the work practices of prehospital providers, such as emergency medical services (EMS) personnel. Methods: We conducted semistructured interviews with 13 EMS providers recruited from 4 hospital-based EMS agencies in an urban area in the east coast region of the United States. The interview questions covered EMS workflow, challenges encountered, technology needs, and users’ perceptions of smart glasses in supporting daily EMS work. During the interviews, we demonstrated a system prototype to elicit more accurate and comprehensive insights regarding smart glasses. Interviews were transcribed verbatim and analyzed using the open coding technique. Results: We identified four potential application areas for smart glasses in EMS: enhancing teleconsultation between distributed prehospital and hospital providers, semiautomating patient data collection and documentation in real time, supporting decision-making and situation awareness, and augmenting quality assurance and training. Compared with the built-in touch pad, voice commands and hand gestures were indicated as the most preferred and suitable interaction mechanisms. EMS providers expressed positive attitudes toward using smart glasses during prehospital encounters. However, several potential barriers and user concerns need to be considered and addressed before implementing and deploying smart glasses in EMS practice. They are related to hardware limitations, human factors, reliability, workflow, interoperability, and privacy. Conclusions: Smart glasses can be a suitable technological means for supporting EMS work. We conclude this paper by discussing several design considerations for realizing the full potential of this hands-free technology. %M 35225816 %R 10.2196/30883 %U https://humanfactors.jmir.org/2022/1/e30883 %U https://doi.org/10.2196/30883 %U http://www.ncbi.nlm.nih.gov/pubmed/35225816 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e33812 %T Remote Electroencephalography Monitoring of Epilepsy in Adults: Protocol for a Scoping Review %A Milne-Ives,Madison %A Shankar,Rohit %A McLean,Brendan %A Duun-Henriksen,Jonas %A Blaabjerg,Lykke %A Meinert,Edward %+ Centre for Health Technology, University of Plymouth, 6 Kirkby Place, Room 2, Plymouth, PL4 6DT, United Kingdom, 44 1752600600, edward.meinert@plymouth.ac.uk %K epilepsy %K remote monitoring %K electroencephalography %K EEG %K seizures, home care services %K mental health %D 2022 %7 25.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Electroencephalography (EEG) monitoring is a key tool in diagnosing and determining treatment for people with epilepsy; however, obtaining sufficient high-quality data can be a time-consuming, costly, and inconvenient process for patients and health care providers. Remote EEG monitoring has the potential to improve patient experience, data quality, and accessibility for people with intellectual or developmental disabilities. Objective: The purpose of this scoping review is to provide an overview of the current research evidence and knowledge gaps regarding the use of remote EEG monitoring interventions for adults with epilepsy. Methods: The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and Population, Intervention, Comparator, Outcome, and Study (PICOS) frameworks will be used to structure the review. Searches will be conducted in 6 databases (PubMed, MEDLINE, Embase, CINAHL, Web of Science, and ClinicalTrials.gov) for articles published in English that evaluate at least one out-of-hospital EEG monitoring intervention or device for adults with epilepsy. A descriptive analysis will be conducted to summarize the results; key themes and gaps in the literature will be discussed. Results: Results will be included in the scoping review, which will be submitted for publication by April 2022. Conclusions: This scoping review will summarize the state of the field of remote EEG monitoring interventions for adults with epilepsy and provide an overview of the strengths, weaknesses, and gaps in the research. International Registered Report Identifier (IRRID): PRR1-10.2196/33812 %M 35212630 %R 10.2196/33812 %U https://www.researchprotocols.org/2022/2/e33812 %U https://doi.org/10.2196/33812 %U http://www.ncbi.nlm.nih.gov/pubmed/35212630 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e26405 %T The Effects of Modified Intermittent Fasting in Psoriasis (MANGO): Protocol for a Two-Arm Pilot Randomized Controlled Open Cross-over Study %A Grine,Lynda %A Hilhorst,Niels %A Michels,Nathalie %A Abbeddou,Souheila %A De Henauw,Stefaan %A Lambert,Jo %+ Dermatology Research Unit, Department of Head and Skin, Ghent University, Medical Research Building 2, Entrance 38, Corneel Heymanslaan 10, Ghent, 9000, Belgium, 32 9 332 5117, lynda.grine@ugent.be %K psoriasis %K leaky gut %K gut-skin axis %K dietary intervention %K intermittent fasting %D 2022 %7 23.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Psoriasis is a complex disease associated with multiple comorbidities, including metabolic syndrome and leaky gut syndrome. Dietary lifestyle interventions have been reported to affect the disease in terms of lesional severity. It remains unclear how diets affect these comorbidities and the general health in psoriasis patients. Modified intermittent fasting (MIF) on 2 nonconsecutive days has shown beneficial effects on metabolic parameters. A significant advantage of MIF over the currently investigated dietary changes is its feasibility. Objective: Here, we aim to study the effects of MIF on skin, gut, and metabolic health in psoriasis patients. Methods: A 2-arm pilot randomized controlled open cross-over study will be performed in 24 patients with psoriasis. Patients will be randomized 1:1 to either start with 12 weeks of MIF and go on a subsequent regular diet for another 12 weeks or start with 12 weeks of regular diet and do subsequent MIF for 12 weeks. The following parameters will be assessed: demographics, disease phenotype, medical and familial history, psoriasis severity, dermatology-specific and general quality of life, nutritional and physical habits, mental and intestinal health, intestinal and cutaneous integrity, inflammatory and metabolic markers, and satisfaction. Results: A total of 24 participants have been enrolled in the study. The final visit is foreseen for June 2021. Conclusions: The aim is to uncover the effects of MIF on psoriasis severity and gut health integrity through clinical and molecular investigation. More precisely, we want to map the evolution of the different markers, such as psoriasis severity, permeability, and inflammation, in response to MIF as compared to a regular diet,. Understanding how dietary lifestyles can affect epithelial lineages, such as the skin and gut, will greatly improve our understanding of the development of psoriasis and may offer a nonpharmacological venue for treatments. Trial Registration: ClinicalTrials.gov NCT04418791; https://clinicaltrials.gov/ct2/show/NCT04418791 International Registered Report Identifier (IRRID): DERR1-10.2196/26405 %M 35195533 %R 10.2196/26405 %U https://www.researchprotocols.org/2022/2/e26405 %U https://doi.org/10.2196/26405 %U http://www.ncbi.nlm.nih.gov/pubmed/35195533 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e27534 %T Interactive Visualization Applications in Population Health and Health Services Research: Systematic Scoping Review %A Chishtie,Jawad %A Bielska,Iwona Anna %A Barrera,Aldo %A Marchand,Jean-Sebastien %A Imran,Muhammad %A Tirmizi,Syed Farhan Ali %A Turcotte,Luke A %A Munce,Sarah %A Shepherd,John %A Senthinathan,Arrani %A Cepoiu-Martin,Monica %A Irvine,Michael %A Babineau,Jessica %A Abudiab,Sally %A Bjelica,Marko %A Collins,Christopher %A Craven,B Catharine %A Guilcher,Sara %A Jeji,Tara %A Naraei,Parisa %A Jaglal,Susan %+ Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada, 1 6479756965, jac161@gmail.com %K interactive visualization %K data visualization %K secondary health care data %K public health informatics %K population health %K health services research %D 2022 %7 18.2.2022 %9 Review %J J Med Internet Res %G English %X Background: Simple visualizations in health research data, such as scatter plots, heat maps, and bar charts, typically present relationships between 2 variables. Interactive visualization methods allow for multiple related facets such as numerous risk factors to be studied simultaneously, leading to data insights through exploring trends and patterns from complex big health care data. The technique presents a powerful tool that can be used in combination with statistical analysis for knowledge discovery, hypothesis generation and testing, and decision support. Objective: The primary objective of this scoping review is to describe and summarize the evidence of interactive visualization applications, methods, and tools being used in population health and health services research (HSR) and their subdomains in the last 15 years, from January 1, 2005, to March 30, 2019. Our secondary objective is to describe the use cases, metrics, frameworks used, settings, target audience, goals, and co-design of applications. Methods: We adapted standard scoping review guidelines with a peer-reviewed search strategy: 2 independent researchers at each stage of screening and abstraction, with a third independent researcher to arbitrate conflicts and validate findings. A comprehensive abstraction platform was built to capture the data from diverse bodies of literature, primarily from the computer science and health care sectors. After screening 11,310 articles, we present findings from 56 applications from interrelated areas of population health and HSR, as well as their subdomains such as epidemiologic surveillance, health resource planning, access, and use and costs among diverse clinical and demographic populations. Results: In this companion review to our earlier systematic synthesis of the literature on visual analytics applications, we present findings in 6 major themes of interactive visualization applications developed for 8 major problem categories. We found a wide application of interactive visualization methods, the major ones being epidemiologic surveillance for infectious disease, resource planning, health service monitoring and quality, and studying medication use patterns. The data sources included mostly secondary administrative and electronic medical record data. In addition, at least two-thirds of the applications involved participatory co-design approaches while introducing a distinct category, embedded research, within co-design initiatives. These applications were in response to an identified need for data-driven insights into knowledge generation and decision support. We further discuss the opportunities stemming from the use of interactive visualization methods in studying global health; inequities, including social determinants of health; and other related areas. We also allude to the challenges in the uptake of these methods. Conclusions: Visualization in health has strong historical roots, with an upward trend in the use of these methods in population health and HSR. Such applications are being fast used by academic and health care agencies for knowledge discovery, hypotheses generation, and decision support. International Registered Report Identifier (IRRID): RR2-10.2196/14019 %M 35179499 %R 10.2196/27534 %U https://www.jmir.org/2022/2/e27534 %U https://doi.org/10.2196/27534 %U http://www.ncbi.nlm.nih.gov/pubmed/35179499 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e30810 %T Digital and Mobile Health Technology in Collaborative Behavioral Health Care: Scoping Review %A Moon,Khatiya %A Sobolev,Michael %A Kane,John M %+ Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, Glen Oaks, NY, 11004, United States, 1 718 470 4597, KMoon2@northwell.edu %K collaborative care %K integrated care %K augmented care %K digital health %K mobile health %K behavioral health %K review %D 2022 %7 16.2.2022 %9 Review %J JMIR Ment Health %G English %X Background: The collaborative care model (CoCM) is a well-established system of behavioral health care in primary care settings. There is potential for digital and mobile technology to augment the CoCM to improve access, scalability, efficiency, and clinical outcomes. Objective: This study aims to conduct a scoping review to synthesize the evidence available on digital and mobile health technology in collaborative care settings. Methods: This review included cohort and experimental studies of digital and mobile technologies used to augment the CoCM. Studies examining primary care without collaborative care were excluded. A literature search was conducted using 4 electronic databases (MEDLINE, Embase, Web of Science, and Google Scholar). The search results were screened in 2 stages (title and abstract screening, followed by full-text review) by 2 reviewers. Results: A total of 3982 nonduplicate reports were identified, of which 20 (0.5%) were included in the analysis. Most studies used a combination of novel technologies. The range of digital and mobile health technologies used included mobile apps, websites, web-based platforms, telephone-based interactive voice recordings, and mobile sensor data. None of the identified studies used social media or wearable devices. Studies that measured patient and provider satisfaction reported positive results, although some types of interventions increased provider workload, and engagement was variable. In studies where clinical outcomes were measured (7/20, 35%), there were no differences between groups, or the differences were modest. Conclusions: The use of digital and mobile health technologies in CoCM is still limited. This study found that technology was most successful when it was integrated into the existing workflow without relying on patient or provider initiative. However, the effect of digital and mobile health on clinical outcomes in CoCM remains unclear and requires additional clinical trials. %M 35171105 %R 10.2196/30810 %U https://mental.jmir.org/2022/2/e30810 %U https://doi.org/10.2196/30810 %U http://www.ncbi.nlm.nih.gov/pubmed/35171105 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e35590 %T Integrating and Disseminating Pre-Exposure Prophylaxis (PrEP) Screening and Dispensing for Black Men Who Have Sex With Men in Atlanta, Georgia: Protocol for Community Pharmacies %A Crawford,Natalie D %A Harrington,Kristin R V %A Alohan,Daniel I %A Sullivan,Patrick S %A Holland,David P %A Klepser,Donald G %A Quamina,Alvan %A Siegler,Aaron J %A Young,Henry N %+ Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, United States, 1 404 712 9445, ndcrawford@emory.edu %K PrEP %K MSM %K HIV %K prevention %K pharmacy %K implementation %K pre-exposure prophylaxis %K men who have sex with men %K protocol %K integration %K dissemination %K prophylaxis %K screening %K race %K demographic %K sex %K sexuality %K development %K access %D 2022 %7 9.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Black men who have sex with men (BMSM) suffer from alarmingly high rates of HIV in the United States. Pre-exposure prophylaxis (PrEP) can reduce the risk of HIV infection by 99% among men who have sex with men, yet profound racial disparities in the uptake of PrEP persist. Low PrEP uptake in BMSM is driven by poor access to PrEP, including inconvenient locations of PrEP-prescribing physicians, distrust of physicians, and stigma, which limit communication about PrEP and its side effects. Previous work indicates that offering HIV prevention services in pharmacies located in low-income, underserved neighborhoods is feasible and can reduce stigma because pharmacies offer a host of less stigmatized health services (eg, vaccinations). We present a protocol for a pharmacy PrEP model that seeks to address challenges and barriers to pharmacy-based PrEP specifically for BMSM. Objective: We aim to develop a sustainable pharmacy PrEP delivery model for BMSM that can be implemented to increase PrEP access in low-income, underserved neighborhoods. Methods: This study design is a pilot intervention to test a pharmacy PrEP delivery model among pharmacy staff and BMSM. We will examine the PrEP delivery model’s feasibility, acceptability, and safety and gather early evidence of its impact and cost with respect to PrEP uptake. A mixed-methods approach will be performed, including three study phases: (1) a completed formative phase with qualitative interviews from key stakeholders; (2) a completed transitional pilot phase to assess customer eligibility and willingness to receive PrEP in pharmacies during COVID-19; and (3) a planned pilot intervention phase which will test the delivery model in 2 Atlanta pharmacies in low-income, underserved neighborhoods. Results: Data from the formative phase showed strong support of pharmacy-based PrEP delivery among BMSM, pharmacists, and pharmacy staff. Important factors were identified to facilitate the implementation of PrEP screening and dissemination in pharmacies. During the transitional pilot phase, we identified 81 individuals who would have been eligible for the pilot phase. Conclusions: Pharmacies have proven to be a feasible source for offering PrEP for White men who have sex with men but have failed to reach the most at-risk, vulnerable population (ie, BMSM). Increasing PrEP access and uptake will reduce HIV incidence and racial inequities in HIV. Translational studies are required to build further evidence and scale pharmacy-based PrEP services specifically for populations that are disconnected from HIV prevention resources. International Registered Report Identifier (IRRID): DERR1-10.2196/35590 %M 35138252 %R 10.2196/35590 %U https://www.researchprotocols.org/2022/2/e35590 %U https://doi.org/10.2196/35590 %U http://www.ncbi.nlm.nih.gov/pubmed/35138252 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e30804 %T Status of Compassionate, Respectful, and Caring Health Service Delivery: Scoping Review %A Nigusie,Adane %A Endehabtu,Berhanu F %A Angaw,Dessie Abebaw %A Teklu,Alemayehu %A Mekonnen,Zeleke Abebaw %A Feletto,Marta %A Assan,Abraham %A Samuel,Assegid %A Sheikh,Kabir %A Tilahun,Binyam %K compassionate %K respectful %K caring %K CRC %K health care delivery %D 2022 %7 7.2.2022 %9 Review %J JMIR Hum Factors %G English %X Background: A compassionate, respectful, and caring (CRC) health professional is very important for human-centered care, serving clients ethically and with respect, adhering to the professional oath, and serving as a model for young professionals. As countries try to achieve universal health coverage (UHC), quality delivery of health services is crucial. CRC health care is an initiative around the need to provide quality care services to clients and patients. However, there is an evidence gap on the status of CRC health care service delivery. Objective: This scoping review aimed to map global evidence on the status of CRC health service delivery practice. Methods: An exhaustive literature review and Delphi technique were used to answer the 2 research questions: “What is the current status of CRC health care practices among health workers?” and “Is it possible for health professionals, health managers, administrators, and policy makers to incorporate it into their activity while designing strategies that could improve the humanistic and holistic approach to health care provision?” The studies were searched from the year 2014 to September 2020 using electronic databases such as MEDLINE (PubMed), Cochrane Library, Web of Science, Hinari, and the World Health Organization (WHO) library. Additionally, grey literature such as Google, Google Scholar, and WorldWideScience were scrutinized. Studies that applied any study design and data collection and analysis methods related to CRC care were included. Two authors extracted the data and compared the results. Discrepancies were resolved by discussion, or the third reviewer made the decision. Findings from the existing literature were presented using thematic analysis. Results: A total of 1193 potentially relevant studies were generated from the initial search, and 20 studies were included in the final review. From this review, we identified 5 thematic areas: the status of CRC implementation, facilitators for CRC health care service delivery, barriers to CRC health care delivery, disrespectful and abusive care encountered by patients, and perspectives on CRC. The findings of this review indicated that improving the mechanisms for monitoring health facilities, improving accountability, and becoming aware of the consequences of maltreatment within facilities are critical steps to improving health care delivery practices. Conclusions: This scoping review identified that there is limited CRC service provision. Lack of training, patient flow volume, and bed shortages were found to be the main contributors of CRC health care delivery. Therefore, the health care system should consider the components of CRC in health care delivery during in-service training, pre-service training, monitoring and evaluation, community engagement, workload division, and performance appraisal. %M 35129450 %R 10.2196/30804 %U https://humanfactors.jmir.org/2022/1/e30804 %U https://doi.org/10.2196/30804 %U http://www.ncbi.nlm.nih.gov/pubmed/35129450 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e30351 %T Examining Diurnal Differences in Multidisciplinary Care Teams at a Pediatric Trauma Center Using Electronic Health Record Data: Social Network Analysis %A Durojaiye,Ashimiyu %A Fackler,James %A McGeorge,Nicolette %A Webster,Kristen %A Kharrazi,Hadi %A Gurses,Ayse %+ Armstrong Institute Center for Health Care Human Factors, Johns Hopkins University, 750 E. Pratt St. 15th Floor, Baltimore, MD, 21202, United States, 1 410 637 4387, agurses1@jhmi.edu %K pediatric trauma %K multidisciplinary health team %K multi-team systems %K social network analysis %K electronic health record %K process mining %K fluid teams %D 2022 %7 4.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The care of pediatric trauma patients is delivered by multidisciplinary care teams with high fluidity that may vary in composition and organization depending on the time of day. Objective: This study aims to identify and describe diurnal variations in multidisciplinary care teams taking care of pediatric trauma patients using social network analysis on electronic health record (EHR) data. Methods: Metadata of clinical activities were extracted from the EHR and processed into an event log, which was divided into 6 different event logs based on shift (day or night) and location (emergency department, pediatric intensive care unit, and floor). Social networks were constructed from each event log by creating an edge among the functional roles captured within a similar time interval during a shift. Overlapping communities were identified from the social networks. Day and night network structures for each care location were compared and validated via comparison with secondary analysis of qualitatively derived care team data, obtained through semistructured interviews; and member-checking interviews with clinicians. Results: There were 413 encounters in the 1-year study period, with 65.9% (272/413) and 34.1% (141/413) beginning during day and night shifts, respectively. A single community was identified at all locations during the day and in the pediatric intensive care unit at night, whereas multiple communities corresponding to individual specialty services were identified in the emergency department and on the floor at night. Members of the trauma service belonged to all communities, suggesting that they were responsible for care coordination. Health care professionals found the networks to be largely accurate representations of the composition of the care teams and the interactions among them. Conclusions: Social network analysis was successfully used on EHR data to identify and describe diurnal differences in the composition and organization of multidisciplinary care teams at a pediatric trauma center. %M 35119372 %R 10.2196/30351 %U https://www.jmir.org/2022/2/e30351 %U https://doi.org/10.2196/30351 %U http://www.ncbi.nlm.nih.gov/pubmed/35119372 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e31082 %T The Effects of Intravenous Iron Infusion on Preoperative Hemoglobin Concentration in Iron Deficiency Anemia: Retrospective Observational Study %A Nicholls,Guy %A Mehta,Rajan %A McVeagh,Karen %A Egan,Matthew %+ Anaesthetics and Critical Care, Southend University Hospital, Prittlewell Chase, Southend on Sea, SS0 0RY, United Kingdom, 44 7379867037, Guy.a.nicholls91@gmail.com %K anemia %K perioperative medicine %K anesthetics %K preoperative %K perioperative %K surgery %K hemoglobin %K hemoglobin concentration %K iron deficiency %K intravenous %K blood %D 2022 %7 3.2.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: An iron infusion pathway using Ferrinject (ferric carboxymaltose) was implemented at Southend University Hospital for preoperative surgical patients with iron deficiency anemia undergoing major surgery. This was based on a treatment algorithm proposed by Munting and colleagues according to the international consensus statement on perioperative management of anemia and the UK National Institute for Health and Care Excellence (NICE) guidelines. These guidelines state that intravenous iron is indicated when oral iron is poorly tolerated or ineffective, there is insufficient time to surgery, or due to a functional iron deficiency. Objective: The objective of this study was to evaluate the change in adult hemoglobin (Hb) concentration (g/L) after Ferrinject infusion at the time of surgery. Methods: Data were retrospectively collected on all surgical patients that received an iron infusion preoperatively for iron deficiency anemia from July 2019 to April 2020. Nonsurgical, obstetric, and pediatric patients, and those without a postinfusion Hb level measurement were excluded. Data collected included the Hb, ferritin, and transferrin levels pre and postinfusion; correct dose of intravenous iron received; and any adverse reactions noted. Results: Thirty-two surgical patients with iron deficiency anemia received intravenous iron between July 2019 and April 2020 prior to surgery. The average pre and post iron infusion Hb concentration across the cohort was 97 g/L and 114 g/L, respectively (18% increase; P=.001). Two (6%) patients had a posttransfusion Hb level ≥130 g/L prior to surgery after infusion. Nine patients had both a pre and postinfusion ferritin level recorded, which showed an increase from 12 ng/mL preinfusion to 94 ng/mL postinfusion (P=.02). Twenty-three (72%) patients did not receive the full dose of intravenous iron based on their Hb level and weight. Twenty-four (75%) patients received an iron infusion >2 weeks prior to surgery and the other 8 (25%) patients received the infusion <2 weeks before their surgery. There was an average increase in Hb of 22% (21 g/L, 95% CI 13-28) and 5% (5 g/L, 95% CI 1-10), respectively, across the two groups (P=.03). There were no documented adverse reactions to intravenous iron. Conclusions: Intravenous iron is an effective intervention to improve the Hb concentration in patients with iron deficiency anemia despite the majority of patients not receiving the full dose based on their baseline Hb level and weight. Increasing the interval time between infusion and surgery was associated with a greater increase in Hb, with only a minimal increase observed if given less than 2 weeks prior to surgery. %M 35113024 %R 10.2196/31082 %U https://www.i-jmr.org/2022/1/e31082 %U https://doi.org/10.2196/31082 %U http://www.ncbi.nlm.nih.gov/pubmed/35113024 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e31184 %T Continuous Glucose Monitoring With Low-Carbohydrate Nutritional Coaching to Improve Type 2 Diabetes Control: Randomized Quality Improvement Program %A Griauzde,Dina H %A Ling,Grace %A Wray,Daniel %A DeJonckheere,Melissa %A Mizokami Stout,Kara %A Saslow,Laura R %A Fenske,Jill %A Serlin,David %A Stonebraker,Spring %A Nisha,Tabassum %A Barry,Colton %A Pop-Busui,Rodica %A Sen,Ananda %A Richardson,Caroline R %+ VA Ann Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI, 48105, United States, 1 603 860 1066, dhafez@med.umich.edu %K type 2 diabetes mellitus %K continuous glucose monitoring %K low-carbohydrate counseling %D 2022 %7 2.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Type 2 diabetes mellitus (T2DM) is a leading cause of morbidity and mortality globally, with adverse health consequences largely related to hyperglycemia. Despite clinical practice guideline recommendations, effective pharmacotherapy, and interventions to support patients and providers, up to 60% of patients diagnosed with T2DM are estimated to have hemoglobin A1c (HbA1c) levels above the recommended targets owing to multilevel barriers hindering optimal glycemic control. Objective: The aim of this study is to compare changes in HbA1c levels among patients with suboptimally controlled T2DM who were offered the opportunity to use an intermittently viewed continuous glucose monitor and receive personalized low-carbohydrate nutrition counseling (<100 g/day) versus those who received usual care (UC). Methods: This was a 12-month, pragmatic, randomized quality improvement program. All adult patients with T2DM who received primary care at a university-affiliated primary care clinic (N=1584) were randomized to either the UC or the enhanced care (EC) group. Within each program arm, we identified individuals with HbA1c >7.5% (58 mmol/mol) who were medically eligible for tighter glycemic control, and we defined these subgroups as UC–high risk (UC-HR) or EC-HR. UC-HR participants (n=197) received routine primary care. EC-HR participants (n=185) were invited to use an intermittently viewed continuous glucose monitor and receive low-carbohydrate nutrition counseling. The primary outcome was mean change in HbA1c levels from baseline to 12 months using an intention-to-treat difference-in-differences analysis comparing EC-HR with UC-HR groups. We conducted follow-up semistructured interviews to understand EC-HR participant experiences with the intervention. Results: HbA1c decreased by 0.41% (4.5 mmol/mol; P=.04) more from baseline to 12 months among participants in the EC-HR group than among those in UC-HR; however, only 61 (32.9%) of 185 EC-HR participants engaged in the program. Among the EC-HR participants who wore continuous glucose monitors (61/185, 32.9%), HbA1c was 1.1% lower at 12 months compared with baseline (P<.001). Interviews revealed themes related to EC-HR participants’ program engagement and continuous glucose monitor use. Conclusions: Among patients with suboptimally controlled T2DM, a combined approach that includes continuous glucose monitoring and low-carbohydrate nutrition counseling can improve glycemic control compared with the standard of care. %M 35107429 %R 10.2196/31184 %U https://www.jmir.org/2022/2/e31184 %U https://doi.org/10.2196/31184 %U http://www.ncbi.nlm.nih.gov/pubmed/35107429 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e33034 %T Trends in Remote Health Care Consumption in Sweden: Comparison Before and During the First Wave of the COVID-19 Pandemic %A Milos Nymberg,Veronica %A Ellegård,Lina Maria %A Kjellsson,Gustav %A Wolff,Moa %A Borgström Bolmsjö,Beata %A Wallman,Thorne %A Calling,Susanna %+ Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Building 28, Floor 11, Jan Waldenströms Street 35, Malmö, 20502, Sweden, 46 767700240, veronica.milos_nymberg@med.lu.se %K remote health care %K telemedicine %K primary health care %K respiratory tract infections %K COVID-19 %D 2022 %7 2.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Remote assessment of respiratory tract infections (RTIs) has been a controversial topic during the fast development of private telemedicine providers in Swedish primary health care. The possibility to unburden the traditional care has been put against a questionable quality of care as well as risks of increased utilization and costs. The COVID-19 pandemic has contributed to a changed management of patient care to decrease viral spread, with an expected shift in contact types from in-person to remote ones. Objective: The main aim of this study was to compare health care consumption and type of contacts (in-person or remote) for RTIs before and during the COVID-19 pandemic. The second aim was to study whether the number of follow-up contacts after an index contact for RTIs changed during the study period, and whether the number of follow-up contacts differed if the index contact was in-person or remote. A third aim was to study whether the pattern of follow-up contacts differed depending on whether the index contact was with a traditional or a private telemedicine provider. Methods: The study design was an observational retrospective analysis with a description of all index contacts and follow-up contacts with physicians in primary care and emergency rooms in a Swedish region (Skåne) for RTIs including patients of all ages and comparison for the same periods in 2018, 2019, and 2020. Results: Compared with 2018 and 2019, there were fewer index contacts for RTIs per 1000 inhabitants in 2020. By contrast, the number of follow-up contacts, both per 1000 inhabitants and per index contact, was higher in 2020. The composition of both index and follow-up contacts changed as the share of remote contacts, in particular for traditional care providers, increased. Conclusions: During the COVID-19 pandemic in 2020, fewer index contacts for RTIs but more follow-up contacts were conducted, compared with 2018-2019. The share of both index and follow-up contacts that were conducted remotely increased. Further studies are needed to study the reasons behind the increase in remote contacts, and if it will last after the pandemic, and more clinical guidelines for remote assessments of RTI are warranted. %M 34846304 %R 10.2196/33034 %U https://humanfactors.jmir.org/2022/1/e33034 %U https://doi.org/10.2196/33034 %U http://www.ncbi.nlm.nih.gov/pubmed/34846304 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e35481 %T Providers’ Experience of Abortion Care: Protocol for a Scoping Review %A Dempsey,B %A Callaghan,S %A Higgins,M F %+ Perinatal Research Centre, University College Dublin, National Maternity Hospital, Holles St, Dublin, D02 NX40, Ireland, 353 1 637 3209, brendan.dempsey@ucdconnect.ie %K abortion %K termination of pregnancy %K reproductive health %K health care providers %K experience %K scoping review %D 2022 %7 2.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite being one of the most common gynecological procedures in the world, abortion care remains highly stigmatized. Internationally, providers have noted negative impacts related to their involvement in the services, and abortion care has been described as “dirty work.” Though much of the existing research focuses on the challenges of providing, many have also highlighted the positive aspects of working in abortion care. Despite the steadily increasing interest in this area over the past decade, however, no one has sought to systematically review the literature to date. Objective: The aim of this review is to systematically explore published studies on the experiences of abortion care providers to create a narrative review on the lived experience of providing abortion care, reflecting on what is already known and what areas require further exploration. Methods: This review will be conducted according to the framework outlined by Levac et al, which expanded on the popular Arksey and O’Malley framework. We will systematically search for peer-reviewed articles in 6 electronic databases: CINAHL, the Cochrane Library, EMBASE, PsycInfo, PubMed, and Web of Science. Following a pilot exercise, we devised a search strategy to identify relevant studies. In this protocol, we outline how citations will be assessed for eligibility and what information will be extracted from the included articles. We also highlight how this information will be combined in the review. Results: As of December 2021, at the time of writing, we have searched for articles in the electronic databases and identified 6624 unique citations. We intend to fully assess these citations for eligibility by the end of January 2022, chart and analyze data from the eligible citations by the end of March 2022, and submit a journal article for peer review by late spring 2022. Conclusions: The findings of this review will provide a comprehensive overview on the known experiences of providing abortion care. We also anticipate that the findings will identify aspects of care and experiences that are not reflected in the available literature. We will disseminate the results via a publication in a peer-reviewed academic journal and by presenting the findings at conferences in the areas of abortion care, obstetrics, and midwifery. As this review is a secondary analysis of published articles, ethical approval was not required. International Registered Report Identifier (IRRID): DERR1-10.2196/35481 %M 35107435 %R 10.2196/35481 %U https://www.researchprotocols.org/2022/2/e35481 %U https://doi.org/10.2196/35481 %U http://www.ncbi.nlm.nih.gov/pubmed/35107435 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 1 %P e34140 %T Mortality Outcomes in Dermatology: An Exploration of Core Outcome Sets and Cochrane Skin Systematic Reviews %A Sivesind,Torunn E %A Szeto,Mindy D %A Hassan,Shahzeb %A Tugwell,Peter %A Dellavalle,Robert P %+ Department of Dermatology, University of Colorado Anschutz Medical Campus, 1665 Aurora Ct, Aurora, CO, 80045, United States, 1 916 474 9963, torunn.sivesind@cuanschutz.edu %K mortality %K death %K systematic reviews %K outcomes %K dermatology %K Cochrane %D 2022 %7 1.2.2022 %9 Research Letter %J JMIR Dermatol %G English %X %M 37632866 %R 10.2196/34140 %U https://derma.jmir.org/2022/1/e34140 %U https://doi.org/10.2196/34140 %U http://www.ncbi.nlm.nih.gov/pubmed/37632866 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e31528 %T A New Method to Extract Health-Related Quality of Life Data From Social Media Testimonies: Algorithm Development and Validation %A Renner,Simon %A Marty,Tom %A Khadhar,Mickaïl %A Foulquié,Pierre %A Voillot,Paméla %A Mebarki,Adel %A Montagni,Ilaria %A Texier,Nathalie %A Schück,Stéphane %+ Kap Code, 4 Rue de Cléry, Paris, 75002, France, 33 9 72 60 57 63, simon.renner@kapcode.fr %K health-related quality of life %K social media use %K measures %K real world %K natural language processing %K social media %K NLP %K infoveillance %K quality of life %K digital health %K social listening %D 2022 %7 28.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Monitoring social media has been shown to be a useful means to capture patients’ opinions and feelings about medical issues, ranging from diseases to treatments. Health-related quality of life (HRQoL) is a useful indicator of overall patients’ health, which can be captured online. Objective: This study aimed to describe a social media listening algorithm able to detect the impact of diseases or treatments on specific dimensions of HRQoL based on posts written by patients in social media and forums. Methods: Using a web crawler, 19 forums in France were harvested, and messages related to patients’ experience with disease or treatment were specifically collected. The SF-36 (Short Form Health Survey) and EQ-5D (Euro Quality of Life 5 Dimensions) HRQoL surveys were mixed and adapted for a tailored social media listening system. This was carried out to better capture the variety of expression on social media, resulting in 5 dimensions of the HRQoL, which are physical, psychological, activity-based, social, and financial. Models were trained using cross-validation and hyperparameter optimization. Oversampling was used to increase the infrequent dimension: after annotation, SMOTE (synthetic minority oversampling technique) was used to balance the proportions of the dimensions among messages. Results: The training set was composed of 1399 messages, randomly taken from a batch of 20,000 health-related messages coming from forums. The algorithm was able to detect a general impact on HRQoL (sensitivity of 0.83 and specificity of 0.74), a physical impact (0.67 and 0.76), a psychic impact (0.82 and 0.60), an activity-related impact (0.73 and 0.78), a relational impact (0.73 and 0.70), and a financial impact (0.79 and 0.74). Conclusions: The development of an innovative method to extract health data from social media as real time assessment of patients’ HRQoL is useful to a patient-centered medical care. As a source of real-world data, social media provide a complementary point of view to understand patients’ concerns and unmet needs, as well as shedding light on how diseases and treatments can be a burden in their daily lives. %M 35089152 %R 10.2196/31528 %U https://www.jmir.org/2022/1/e31528 %U https://doi.org/10.2196/31528 %U http://www.ncbi.nlm.nih.gov/pubmed/35089152 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 1 %P e30204 %T Patient Satisfaction and Recommendations for Delivering a Group-Based Intensive Outpatient Program via Telemental Health During the COVID-19 Pandemic: Cross-sectional Cohort Study %A Skime,Michelle K %A Puspitasari,Ajeng J %A Gentry,Melanie T %A Heredia Jr,Dagoberto %A Sawchuk,Craig N %A Moore,Wendy R %A Taylor-Desir,Monica J %A Schak,Kathryn M %+ Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, United States, 1 507 255 0501, skime.michelle@mayo.edu %K COVID-19 %K telemental health %K teletherapy %K telepsychiatry %K telemedicine %K intensive outpatient %K patient satisfaction %D 2022 %7 28.1.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Although group-based intensive outpatient programs (IOPs) are a level of care commonly utilized by adults with serious mental illness, few studies have examined the acceptability of group-based IOPs that required rapid transition to a telemental health (TMH) format during the COVID-19 pandemic. Objective: The aim of this study was to evaluate patient satisfaction and future recommendations for a group-based IOP that was transitioned to a TMH format during the COVID-19 pandemic. Methods: A 17-item patient satisfaction questionnaire was completed by patients at discharge and covered 3 areas: IOP TMH satisfaction, future recommendations, and video technology challenges. Descriptive and content analyses were conducted for the quantitative and open-ended questions, respectively. Results: A total of 76 patients completed the program in 2020. A subset of patients (n=40, 53%) responded to the survey at program discharge. The results indicated that the patients were satisfied overall with the TMH program format; 50% (n=20) of the patients preferred the program continue offering the TMH format, and the rest preferred returning to in-person formats after the pandemic. The patients indicated the elements of the program that they found most valuable and provided recommendations for future program improvement. Conclusions: Overall, adults with serious mental illness reported high satisfaction with the group-based IOP delivered via TMH. Health care systems may want to consider offering both TMH and in-person formats regardless of the state of the pandemic. Patients’ feedback on future improvements should be considered to help ensure long-term success. %M 34878999 %R 10.2196/30204 %U https://mental.jmir.org/2022/1/e30204 %U https://doi.org/10.2196/30204 %U http://www.ncbi.nlm.nih.gov/pubmed/34878999 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e29880 %T Quantifying the Impact of COVID-19 on Telemedicine Utilization: Retrospective Observational Study %A Vogt,Emily Louise %A Welch,Brandon M %A Bunnell,Brian E %A Barrera,Janelle F %A Paige,Samantha R %A Owens,Marisa %A Coffey,Patricia %A Diazgranados,Nancy %A Goldman,David %+ Lab of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5625 Fishers Lane, Rm 3S-32: MSC 9412, Rockville, MD, 20892, United States, 1 301 443 0059, davidgoldman@mail.nih.gov %K telemedicine %K COVID-19 %K utilization %K impact %K retrospective %K observational %K trend %K telehealth %K health policy %K policy %D 2022 %7 28.1.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: While telemedicine has been expanding over the past decade, the COVID-19–related restrictions regarding in-person care have led to unprecedented levels of telemedicine utilization. To the authors’ knowledge, no studies to date have quantitatively analyzed both national and regional trends in telemedicine utilization during the pandemic, both of which have key implications for informing health policy. Objective: This study aimed to investigate how trends in telemedicine utilization changed across the course of the COVID-19 pandemic. Methods: Using data from doxy.me, the largest free telemedicine platform, and the NIH (National Institutes of Health) Clinical Center, the largest clinical research hospital in the United States, we assessed changes in total telemedicine minutes, new provider registrations, monthly sessions, and average session length from March to November 2020. We also conducted a state-level analysis of how telemedicine expansion differed by region. Results: National telemedicine utilization peaked in April 2020 at 291 million minutes and stabilized at 200 to 220 million monthly minutes from May to November 2020. Surges were strongest in New England and weakest in the South and West. Greater telemedicine expansion during the COVID-19 pandemic was geographically associated with fewer COVID-19 cases per capita. The nature of telemedicine visits also changed, as the average monthly visits per provider doubled and the average visit length decreased by 60%. Conclusions: The COVID-19 pandemic led to an abrupt and subsequently sustained uptick in telemedicine utilization. Regional and institute-level differences in telemedicine utilization should be further investigated to inform policy and procedures for sustaining meaningful telemedicine use in clinical practice. %M 34751158 %R 10.2196/29880 %U https://www.i-jmr.org/2022/1/e29880 %U https://doi.org/10.2196/29880 %U http://www.ncbi.nlm.nih.gov/pubmed/34751158 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e32764 %T Digital Health Skillsets and Digital Preparedness: Comparison of Veterans Health Administration Users and Other Veterans Nationally %A Wray,Charlie %A Tang,Janet %A Byers,Amy %A Keyhani,Salomeh %+ Section of Hospital Medicine, San Francisco Department of Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA, 94121, United States, 1 415 595 9662, charlie.wray@ucsf.edu %K digital health literacy %K Veterans Health Administration %K health care %K telemedicine %K veterans %K digital tools %K social risk factors %K digital uptake %D 2022 %7 28.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: As health care systems shift to greater use of telemedicine and digital tools, an individual’s digital health literacy has become an important skillset. The Veterans Health Administration (VA) has invested resources in providing digital health care; however, to date, no study has compared the digital health skills and preparedness of veterans receiving care in the VA to veterans receiving care outside the VA. Objective: The goal of the research was to describe digital health skills and preparedness among veterans who receive care within and outside the VA health care system and examine whether receiving care in the VA is associated with digital preparedness (reporting more than 2 digital health skills) after accounting for demographic and social risk factors. Methods: We used cross-sectional data from the 2016-2018 National Health Interview Survey to identify veterans (aged over 18 years) who obtain health care either within or outside the VA health care system. We used multivariable logistic regression models to examine the association of sociodemographic (age, sex, race, ethnicity), social risk factors (economic instability, disadvantaged neighborhood, low educational attainment, and social isolation), and health care delivery location (VA and non-VA) with digital preparedness. Results: Those who received health care within the VA health care system (n=3188) were younger (age 18-49 years: 33.3% [95% CI 30.7-36.0] vs 24.2% [95% CI 21.9-26.5], P<.01), were more often female (34.7% [95% CI 32.0-37.3] vs 6.6% [95% CI 5.5-7.6], P<.01) and identified as Black (13.1% [95% CI 11.2-15.0] vs 10.2% [95% CI 8.7-11.8], P<.01), and reported greater economic instability (8.3% [95% CI 6.9-9.8] vs 5.5% [95% CI 4.6-6.5], P<.01) and social isolation (42.6% [95% CI 40.3-44.9] vs 35.4% [95% CI 33.4-37.5], P<.01) compared to veterans who received care outside the VA (n=3393). Veterans who obtained care within the VA reported more digital health skills than those who obtained care outside the VA, endorsing greater rates of looking up health information on the internet (51.8% [95% CI 49.2-54.4] vs 45.0% [95% CI 42.6-47.3], P<.01), filling a prescription using the internet (16.2% [95% CI 14.5-18.0] vs 11.3% [95% CI 9.6-13.0], P<.01), scheduling a health care appointment on the internet (14.1% [95% CI 12.4-15.8] vs 11.6% [95% CI 10.1-13.1], P=.02), and communicating with a health care provider by email (18.0% [95% CI 16.1-19.8] vs 13.3% [95% CI 11.6-14.9], P<.01). Following adjustment for sociodemographic and social risk factors, receiving health care from the VA was the only characteristic associated with higher odds (adjusted odds ratio [aOR] 1.36, 95% CI 1.12-1.65) of being digitally prepared. Conclusions: Despite these demographic disadvantages to digital uptake, veterans who receive care in the VA reported more digital health skills and appear more digitally prepared than veterans who do not receive care within the VA, suggesting a positive, system-level influence on this cohort. %M 35089147 %R 10.2196/32764 %U https://formative.jmir.org/2022/1/e32764 %U https://doi.org/10.2196/32764 %U http://www.ncbi.nlm.nih.gov/pubmed/35089147 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e31754 %T Challenges of Telemonitoring Programs for Complex Chronic Conditions: Randomized Controlled Trial With an Embedded Qualitative Study %A Ware,Patrick %A Shah,Amika %A Ross,Heather Joan %A Logan,Alexander Gordon %A Segal,Phillip %A Cafazzo,Joseph Antony %A Szacun-Shimizu,Katarzyna %A Resnick,Myles %A Vattaparambil,Tessy %A Seto,Emily %+ Centre for Global eHealth Innovation, University Health Network, 190 Elizabeth St., Toronto, ON, M5G 2C4, Canada, 1 (416) 340 4800 ext 4765, Patrick.Ware@uhn.ca %K telemonitoring %K telemedicine %K heart failure %K diabetes %K hypertension %K tertiary health care %K multiple chronic conditions %K mobile phone %D 2022 %7 26.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the growing prevalence of people with complex conditions and evidence of the positive impact of telemonitoring for single conditions, little research exists on telemonitoring for this population. Objective: This randomized controlled trial and embedded qualitative study aims to evaluate the impact on and experiences of patients and health care providers (HCPs) using a telemonitoring system with decision support to manage patients with complex conditions, including those with multiple chronic conditions, compared with the standard of care. Methods: A pragmatic, unblinded, 6-month randomized controlled trial sought to recruit 146 patients with ≥1 diagnosis of heart failure (HF), uncontrolled hypertension (HT), and insulin-requiring diabetes mellitus (DM) from outpatient specialty settings in Toronto, Ontario, Canada. Participants were randomized into the control and telemonitoring groups, with the latter being instructed to take readings relevant to their conditions. The telemonitoring system contained an algorithm that generated decision support in the form of actionable self-care directives to patients and alerts to HCPs. The primary outcome was health status (36-Item Short Form Health Survey questionnaire). Secondary outcomes included anxiety and depression, self-efficacy in chronic disease management, and self-reported health service use. HF-related quality of life and self-care measures were also collected from patients followed for HF. Within- and between-group change scores were analyzed for statistical significance (P<.05). A convenience sample of HCPs and patients in the intervention group was interviewed about their experiences. Results: A total of 96 patients were recruited and randomized. Recruitment was terminated early because of implementation challenges and the onset of the COVID-19 pandemic. No significant within- and between-group differences were found for the main primary and secondary outcomes. However, a within-group analysis of patients with HF found improvements in self-care maintenance (P=.04) and physical quality of life (P=.046). Opinions expressed by the 5 HCPs and 13 patients who were interviewed differed based on the monitored conditions. Although patients with HF reported benefitting from actionable self-care guidance and meaningful interactions with their HCPs, patient and HCP users of the DM and HT modules did not think telemonitoring improved the clinical management of those conditions to the same degree. These differing experiences were largely attributed to the siloed nature of specialty care and the design of the decision support, whereby fluctuations in the status of HT and DM typically required less urgent interventions compared with patients with HF. Conclusions: We recommend that future research conceive telemonitoring as a program and that self-management and clinical decision support are necessary but not sufficient components of such programs for patients with complex conditions and lower acuity. We conclude that telemonitoring for patients with complex conditions or within multidisciplinary care settings may be best operationalized through nurse-led models of care. Trial Registration: ClinicalTrials.gov NCT03127852; https://clinicaltrials.gov/ct2/show/NCT03127852 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.8367 %M 35080502 %R 10.2196/31754 %U https://www.jmir.org/2022/1/e31754 %U https://doi.org/10.2196/31754 %U http://www.ncbi.nlm.nih.gov/pubmed/35080502 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e29367 %T Early Adopters of Apple Health Records at a Large Academic Medical Center: Cross-sectional Survey of Users %A Rolnick,Joshua %A Ward,Robin %A Tait,Gordon %A Patel,Neha %+ United States Department of Veterans Affairs, 3900 Woodland Avenue, Philadelphia, PA, 19104, United States, 1 6175385191, rolnick@pennmedicine.upenn.edu %K Apple Health Records %K personal health record %K electronic health record %K patient satisfaction %K early adopters %K cross-sectional survey %D 2022 %7 25.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile applications offer a new approach to personal health records, which are internet-based tools for patients to consolidate and manage their health information. The University of Pennsylvania Health System (UPHS) was one of the first health systems to participate in Apple Health Records (AHR), a prominent example of this new generation of personal health records. Objective: This study aimed to characterize early adoption of AHR among UPHS patients and understand user perspectives. Methods: An email-based survey with fixed answer, Likert scale, and open-ended questions was administered to all UPHS patients using AHR in the first 10 months of enrollment. Survey data linked to the UPHS electronic health record system were used to analyze responses. Multivariable logistic regression modeled the association of patient characteristics with user ratings. Content analysis was used to analyze open-ended questions. Results: At the time of the survey, a total of 1458 patients had used AHR at least once. Mean age of AHR users was 47.5 years, 66.3% (967/1458) were male, 70.9% (1033/1458) were white, and 80.8% (1178/1458) had private insurance. Response rate was 26.8% (391/1458); 46.3% (180/389) were very satisfied with AHR, and 67.7% (264/390) described it as very easy to use. The most commonly utilized features were lab results (324/391, 82.9%), clinical vitals (264/391, 67.5%), and medications (253/391, 64.7%). No patient characteristics were associated with reporting high satisfaction or ease of use. The most common reason for using AHR was convenience/ease of use, and 58.2% (160/275) of users reported allowing no other apps to access their health information, citing privacy as one consideration. Conclusions: Early adopters of AHR were demographically white, male, and privately insured. Convenience was an important facilitator, and users were selective in which apps they allowed to access their health information. %M 35076397 %R 10.2196/29367 %U https://www.jmir.org/2022/1/e29367 %U https://doi.org/10.2196/29367 %U http://www.ncbi.nlm.nih.gov/pubmed/35076397 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e33188 %T Predictors of Smartphone and Tablet Use Among Patients With Hypertension: Secondary Analysis of Health Information National Trends Survey Data %A Eze,Chinwe E %A West,Brady T %A Dorsch,Michael P %A Coe,Antoinette B %A Lester,Corey A %A Buis,Lorraine R %A Farris,Karen %+ College of Pharmacy, University of Michigan, 428 Church Street, Ann Arbor, MI, 48109-1065, United States, 1 7346806587, ceeze@umich.edu %K hypertension %K mHealth %K remote monitoring %K telemonitoring %K smartphones %K tablets %K text messaging %K Health Information National Trends Survey %K mobile health %K digital health %K mobile phone %D 2022 %7 24.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Uncontrolled hypertension leads to significant morbidity and mortality. The use of mobile health technology, such as smartphones, for remote blood pressure (BP) monitoring has improved BP control. An increase in BP control is more significant when patients can remotely communicate with their health care providers through technologies and receive feedback. Little is known about the predictors of remote BP monitoring among hypertensive populations. Objective: The objective of this study is to quantify the predictors of smartphone and tablet use in achieving health goals and communicating with health care providers via SMS text messaging among hypertensive patients in the United States. Methods: This study was a cross-sectional, secondary analysis of the 2017 and 2018 Health Information National Trends Survey 5, cycles 1 and 2 data. A total of 3045 respondents answered “Yes” to the question “Has a doctor or other healthcare provider ever told you that you had high blood pressure or hypertension?”, which defined the subpopulation used in this study. We applied the Health Information National Trends Survey full sample weight to calculate the population estimates and 50 replicate weights to calculate the SEs of the estimates. We used design-adjusted descriptive statistics to describe the characteristics of respondents who are hypertensive based on relevant survey items. Design-adjusted multivariable logistic regression models were fitted to estimate predictors of achieving health goals with the help of smartphone or tablet and sending or receiving an SMS text message to or from a health care provider in the last 12 months. Results: An estimated 36.9%, SE 0.9% (183,285,150/497,278,883) of the weighted adult population in the United States had hypertension. The mean age of the hypertensive population was 58.3 (SE 0.48) years. Electronic communication with the doctor or doctor’s office through email or internet (odds ratio 2.93, 95% CI 1.85-4.63; P<.001) and having a wellness app (odds ratio 1.82, 95% CI 1.16-2.86; P=.02) were significant predictors of using SMS text message communication with a health care professional, adjusting for other demographic and technology-related variables. The odds of achieving health-related goals with the help of a tablet or smartphone declined significantly with older age (P<.001) and ownership of basic cellphones (P=.04). However, they increased significantly with being a woman (P=.045) or with being married (P=.03), having a wellness app (P<.001), using devices other than smartphones or tablets to monitor health (P=.008), making health treatment decisions (P=.048), and discussing with a provider (P=.02) with the help of a tablet or smartphone. Conclusions: Intervention measures accounting for age, gender, marital status, and the patient’s technology-related health behaviors are required to increase smartphone and tablet use in self-care and SMS text message communication with health care providers. %M 35072647 %R 10.2196/33188 %U https://www.jmir.org/2022/1/e33188 %U https://doi.org/10.2196/33188 %U http://www.ncbi.nlm.nih.gov/pubmed/35072647 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e31123 %T Assessment of Glycemic Control at St. Luke’s Free Medical Clinic: Retrospective Chart Review %A Hopper,Wade %A Fox,Justin %A Dimucci-Ward,JuliSu %+ Department of Surgery, Edward Via College of Osteopathic Medicine - Carolinas, 350 Howard St, Spartanburg, SC, 29303, United States, 1 8643279800, whopper@carolinas.vcom.edu %K free clinic %K glycemic control %K underserved %K uninsured %K diabetes %K health care delivery %K treatment program %D 2022 %7 24.1.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: A free clinic is a health care delivery model that provides primary care and pharmaceutical services exclusively to uninsured patients. With a multidisciplinary volunteer clinical staff, which includes physicians, social workers, dieticians, and osteopathic medical students, St. Luke’s Free Medical Clinic (SLFMC) cares for over 1700 patients annually in Spartanburg, South Carolina. Objective: This study aims to measure the change, over time, in patient hemoglobin A1c measurements at the SLFMC to quantify the success of the clinic’s diabetes treatment program. Methods: A prospective-retrospective chart review of patients (n=140) enrolled at the SLFMC between January 1, 2018, and January 1, 2021, was performed. Patients were stratified as having controlled (hemoglobin A1c<7.0, n=53) or uncontrolled (hemoglobin A1c≥7.0, n=87) diabetes relative to a therapeutic hemoglobin A1c target of 7.0, which is recommended by the American Diabetes Association. For both controlled and uncontrolled groups, baseline hemoglobin A1c values were compared to subsequent readings using a Wilcoxon matched-pairs signed rank test. Results from the SLFMC population were compared to the published literature on hemoglobin A1c from other free clinics. Results: Patients with uncontrolled diabetes experienced significant reductions in median hemoglobin A1c at both 6 months (P=.006) and 1 year (P=.002) from baseline. Patients with controlled diabetes showed no significant changes. Black and Hispanic patients with uncontrolled diabetes experienced a 1.0% mean improvement in hemoglobin A1c over the study window. The SLFMC’s wholly uninsured patient population showed a population rate of controlled diabetes (42%), which was similar to recent nationwide averages for adults with diabetes (51% to 56%), as reported by the National Health and Nutrition Examination Survey. The clinic’s Hispanic population (n=47) showed the greatest average improvement in hemoglobin A1c of any ethnic group from baseline. Additionally, 61% of the SLFMC’s Black population (n=33) achieved a hemoglobin A1c of <7.0 by the end of the study window, which surpassed the nationwide averages for glycemic control. Conclusions: We present free clinic hemoglobin A1c outcomes obtained through a retrospective chart review. Uninsured patients treated for diabetes at the SLFMC show a reduction in hemoglobin A1c, which is comparable to nationwide standards, although average hemoglobin A1c levels in this study were higher than nationwide averages. Black and Hispanic patients with uncontrolled diabetes showed a mean 1% improvement in hemoglobin A1c levels. These results represent some of the first in the literature emerging from a free clinic that is not affiliated with a major medical school. %M 35072636 %R 10.2196/31123 %U https://www.i-jmr.org/2022/1/e31123 %U https://doi.org/10.2196/31123 %U http://www.ncbi.nlm.nih.gov/pubmed/35072636 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e31628 %T Pediatric Tele–Home Care Compared to Usual Care: Cost-Minimization Analysis %A Adroher Mas,Cristina %A Esposito Català,Candela %A Batlle Boada,Astrid %A Casadevall Llandrich,Ricard %A Millet Elizalde,Marta %A García García,Juan José %A del Castillo Rey,Manel %A García Cuyàs,Francesc %A Pons Serra,Miquel %A López Seguí,Francesc %+ Sant Joan de Déu Hospital, Catalan Ministry of Health, Passeig de Sant Joan de Déu, 2, Esplugues de Llobregat, 08950, Spain, 34 932 53 21 00 ext 73041, cristina.adroher@sjd.es %K cost analysis %K pediatric tele–home care %K home care service %K health economics %K telehealth %K economic evaluation %K telemedicine %K pediatrics %D 2022 %7 20.1.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Although home hospitalization has been a well-known and widespread practice for some time in the adult population, it has not been the same case in the pediatric setting. Simultaneously, telemedicine tools are a facilitator of the change in the health care model, which is increasingly focused on home care. In a pioneering way in Spain, the in-home hospitalization program of the Hospital Sant Joan de Déu in Barcelona allows the child to be in their home environment at the time they are being monitored and clinically followed by the professionals. Besides being the preferred option for families, previous experience suggests that pediatric home hospitalization reduces costs, primarily thanks to savings on the structural cost of the stay. Objective: The aim of this study is to compare the average cost of a discharge by tele–home care with the usual care and to analyze the main drivers of the differential costs of both care models. Methods: A cost-minimization analysis is conducted under a hospital’s perspective, based on observational data, and estimated retrospectively. A historical control group of similar patients in terms of clinical casuistry to children hospitalized at home was used for comparison. Results: A 24-hour stay at the hospital costs US $574.19, while the in-home hospitalization costs US $301.71 per day, representing a saving of almost half (48%) of the cost compared to usual care. The main saving drivers were the personnel costs (US $102.83/US $284.53, 35.5% of the total), intermediate noncare costs (US $6.09/US $284.53, 33.17%), and structural costs (US $55.16/US $284.53, 19.04%). Home hospitalization involves a total stay 27.61% longer, but at almost half the daily cost, and thus represents a saving of US $176.70 (9.01%) per 24-hour stay. Conclusions: The cost analysis conducted under a hospital perspective shows that pediatric tele–home care is 9% cheaper compared to regular hospital care. These results motivate the most widespread implementation of the service from the point of view of economic efficiency, adding to previous experiences that suggest that it is also preferable from the perspective of user satisfaction. %M 35049513 %R 10.2196/31628 %U https://pediatrics.jmir.org/2022/1/e31628 %U https://doi.org/10.2196/31628 %U http://www.ncbi.nlm.nih.gov/pubmed/35049513 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e33512 %T Regional Utilization of Preventive Services in the 55-Plus Age Group: Protocol for a Mixed Methods Study %A Hrudey,Ilona %A Minow,Annemarie %A Walter,Svenja %A March,Stefanie %A Swart,Enno %A Stallmann,Christoph %+ Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, 39120, Germany, 49 391 67 24318, ilona.hrudey@med.ovgu.de %K prevention %K utilization %K determinants %K barriers %K Germany %K cancer screening %K medical check-ups %K vaccinations %K preventive dental care %K older people %D 2022 %7 12.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: In Germany, the proportion of people with chronic diseases and multimorbidity is increasing. To counteract the emergence and worsening of age-related conditions, there is a need for preventive care structures and measures. The preventive services that are financed by statutory health insurance (SHI; eg, vaccinations, cancer screening) are only used by part of the German population. There are no current findings about the utilization of these services by older adults in the eastern German federal state of Saxony-Anhalt, which is particularly strongly affected by demographic change. Objective: The aim of this study is to investigate the actual utilization and determinants of, reasons for, and barriers to utilization of preventive services financed by the SHI in Saxony-Anhalt in the 55-plus age group. Methods: In this study, a convergent mixed methods design is used. The actual use of preventive services will be shown by means of (1) a claims data analysis looking at data on statutory outpatient medical care from both the Central Research Institute of Ambulatory Health Care in Germany (Zi) and the Association of Statutory Health Insurance Dentists in Saxony-Anhalt (KZV LSA). The determinants, attitudes, and behaviors associated with use will be analyzed through (2) a cross-sectional survey as well as (3) qualitative data from semistructured interviews with residents of Saxony-Anhalt and from focus group discussions with physicians. (4) A stock take and systematic evaluation of digitally available informational material on colorectal cancer screening, by way of example, provides an insight into the information available as well as its quality. The conceptual framework of the study is the behavioral model of health services use by Andersen et al (last modified in 2014). Results: (1) The Zi and KZV LSA are currently preparing the requested claims data. (2) The survey was carried out from April 2021 to June 2021 in 2 urban and 2 rural municipalities (encompassing a small town and surrounding area) in Saxony-Anhalt. In total, 3665 people were contacted, with a response rate of 25.84% (n=954). (3) For the semistructured interviews, 18 participants from the 4 different study regions were recruited in the same period. A total of 4 general practitioners and 3 medical specialists participated in 2 focus group discussions. (4) For the systematic evaluation of existing informational material on colorectal cancer screening, 37 different informational materials were identified on the websites of 16 health care actors. Conclusions: This study will provide current and reliable data on the use of preventive services in the 55-plus age group in Saxony-Anhalt. It will yield insights into the determinants, reasons, and barriers associated with their utilization. The results will reveal the potential for preventive measures and enable concrete recommendations for action for the target population of the study. Trial Registration: German Clinical Trials Register DRKS00024059; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024059 International Registered Report Identifier (IRRID): DERR1-10.2196/33512 %M 35019847 %R 10.2196/33512 %U https://www.researchprotocols.org/2022/1/e33512 %U https://doi.org/10.2196/33512 %U http://www.ncbi.nlm.nih.gov/pubmed/35019847 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e26299 %T Unit Response and Costs in Web Versus Face-To-Face Data Collection: Comparison of Two Cross-sectional Health Surveys %A Braekman,Elise %A Demarest,Stefaan %A Charafeddine,Rana %A Drieskens,Sabine %A Berete,Finaba %A Gisle,Lydia %A Van der Heyden,Johan %A Van Hal,Guido %+ Lifestyle and chronic diseases, Epidemiology and public health, Sciensano, Juliette Wytsmanstraat 14, Brussels, Belgium, 32 2 642 57 06, elise.braekman@sciensano.be %K health interview surveys %K data collection mode %K face-to-face %K web %K unit response %K response rate %K nonresponse %K data collection costs %K web data %K health surveys %K internet penetration %K web survey %K costs %D 2022 %7 7.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Potential is seen in web data collection for population health surveys due to its combined cost-effectiveness, implementation ease, and increased internet penetration. Nonetheless, web modes may lead to lower and more selective unit response than traditional modes, and this may increase bias in the measured indicators. Objective: This research assesses the unit response and costs of a web study versus face-to-face (F2F) study. Methods: Alongside the Belgian Health Interview Survey by F2F edition 2018 (BHISF2F; net sample used: 3316), a web survey (Belgian Health Interview Survey by Web [BHISWEB]; net sample used: 1010) was organized. Sociodemographic data on invited individuals was obtained from the national register and census linkages. Unit response rates considering the different sampling probabilities of both surveys were calculated. Logistic regression analyses examined the association between mode system and sociodemographic characteristics for unit nonresponse. The costs per completed web questionnaire were compared with the costs for a completed F2F questionnaire. Results: The unit response rate is lower in BHISWEB (18.0%) versus BHISF2F (43.1%). A lower response rate was observed for the web survey among all sociodemographic groups, but the difference was higher among people aged 65 years and older (15.4% vs 45.1%), lower educated people (10.9% vs 38.0%), people with a non-Belgian European nationality (11.4% vs 40.7%), people with a non-European nationality (7.2% vs 38.0%), people living alone (12.6% vs 40.5%), and people living in the Brussels-Capital (12.2% vs 41.8%) region. The sociodemographic characteristics associated with nonresponse are not the same in the 2 studies. Having another European (OR 1.60, 95% CI 1.20-2.13) or non-European nationality (OR 2.57, 95% CI 1.79-3.70) compared to a Belgian nationality and living in the Brussels-Capital (OR 1.72, 95% CI 1.41-2.10) or Walloon (OR 1.47, 95% CI 1.15-1.87) regions compared to the Flemish region are associated with a higher nonresponse only in the BHISWEB study. In BHISF2F, younger people (OR 1.31, 95% CI 1.11-1.54) are more likely to be nonrespondents than older people, and this was not the case in BHISWEB. In both studies, lower educated people have a higher probability of being nonrespondent, but this effect is more pronounced in BHISWEB (low vs high education level: Web, OR 2.71, 95% CI 2.21-3.39 and F2F OR 1.70, 95% CI 1.48-1.95). The BHISWEB study had a considerable advantage; the cost per completed questionnaire was almost 3 times lower (€41 [US $48]) compared with F2F data collection (€111 [US $131]). Conclusions: The F2F unit response rate was generally higher, yet for certain groups the difference between web and F2F was more limited. Web data collection has a considerable cost advantage. It is therefore worth experimenting with adaptive mixed-mode designs to optimize financial resources without increasing selection bias (eg, only inviting sociodemographic groups who are keener to participate online for web surveys while continuing to focus on increasing F2F response rates for other groups). %M 34994701 %R 10.2196/26299 %U https://www.jmir.org/2022/1/e26299 %U https://doi.org/10.2196/26299 %U http://www.ncbi.nlm.nih.gov/pubmed/34994701 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e25899 %T Use of the McIsaac Score to Predict Group A Streptococcal Pharyngitis in Outpatient Nurse Phone Triage and Electronic Visits Compared With In-Person Visits: Retrospective Observational Study %A Pecina,Jennifer L %A Nigon,Leah M %A Penza,Kristine S %A Murray,Martha A %A Kronebusch,Beckie J %A Miller,Nathaniel E %A Jensen,Teresa B %+ Department of Family Medicine, Mayo Clinic, 200 1st street SW, Rochester, MN, United States, 1 507 284 2511, pecina.jennifer@mayo.edu %K strep pharygitis %K e-visit %K electronic visit %K telemedicine %K telecare %K virtual visit %K McIssac score %K nurse phone triage %K scoring system %K sore throat %K group A streptococcus %K telehealth %K nurse %K phone %K triage %D 2021 %7 20.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The McIsaac criteria are a validated scoring system used to determine the likelihood of an acute sore throat being caused by group A streptococcus (GAS) to stratify patients who need strep testing. Objective: We aim to compare McIsaac criteria obtained during face-to-face (f2f) and non-f2f encounters. Methods: This retrospective study compared the percentage of positive GAS tests by McIsaac score for scores calculated during nurse protocol phone encounters, e-visits (electronic visits), and in person f2f clinic visits. Results: There was no difference in percentages of positive strep tests between encounter types for any of the McIsaac scores. There were significantly more phone and e-visit encounters with any missing score components compared with f2f visits. For individual score components, there were significantly fewer e-visits missing fever and cough information compared with phone encounters and f2f encounters. F2f encounters were significantly less likely to be missing descriptions of tonsils and lymphadenopathy compared with phone and e-visit encounters. McIsaac scores of 4 had positive GAS rates of 55% to 68% across encounter types. There were 4 encounters not missing any score components with a McIsaac score of 0. None of these 4 encounters had a positive GAS test. Conclusions: McIsaac scores of 4 collected during non-f2f care could be used to consider empiric treatment for GAS without testing if significant barriers to testing exist such as the COVID-19 pandemic or geographic barriers. Future studies should evaluate further whether non-f2f encounters with McIsaac scores of 0 can be safely excluded from GAS testing. %M 34932016 %R 10.2196/25899 %U https://www.jmir.org/2021/12/e25899 %U https://doi.org/10.2196/25899 %U http://www.ncbi.nlm.nih.gov/pubmed/34932016 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e33116 %T Augmenting the Referral Pathway for Retinal Services Among Patients With Diabetes Mellitus at Reiyukai Eiko Masunaga Eye Hospital, Nepal: Protocol for a Nonrandomized, Pre–Post Intervention Study %A Shrestha,Ruchi %A Singh,Prerana %A Dhakhwa,Parami %A Tetali,Shailaja %A Batchu,Tripura %A Shrestha Thapa,Pragati %+ Department of Vitreoretina, Reiyukai Eiko Masunaga Eye Hospital, Banepa-6, Kavre, Banepa, 977, Nepal, 977 9847027650, drruchishrestha@gmail.com %K diabetes mellitus %K diabetic retinopathy %K Nepal %K health education %K study protocol %D 2021 %7 17.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Diabetic retinopathy (DR) is an important public health issue in Nepal with a huge social and economic impact. Despite the availability of retinal services, people may not access them because of the lack of knowledge about DR and poor referral systems. Published studies on referral pathways in Nepal are scarce. Improving DR awareness among general physicians has the potential to address these challenges. Objective: The aim of this study is to evaluate the effect of a health education intervention on health personnel, establish a referral pathway, and assess the impact of the intervention on the attendance of patients with diabetes mellitus for retinal screening at Reiyukai Eiko Masunaga Eye Hospital in Nepal. Methods: This is a nonrandomized, pre- and postintervention study. Health education on DR will be provided to selected health personnel of the intervention hospital (Scheer Memorial) using information education and communication (IEC) materials in the form of PowerPoint presentations, posters, pamphlets, videos, and pre- and postevaluation questionnaires along with referral slip. Pre- and postevaluation will be undertaken during the study period. Data will be analyzed using MS Excel and Epi Info 7. Results: The ethical approval for this study has been obtained from the Ethical Review Board of the Nepal Health Research Council (ERB Protocol Registration Number # 582/2020P). The study is expected to be completed in 18 months from the start of the project. The baseline data collection was from June to January 2020 for a period of 8 months. The postintervention data collection was from February to September 2021 for a period of 8 months. The last 2 months are planned for data analysis and report writing. Conclusions: Health education intervention could be a low-cost solution to improve the awareness, access, and utilization of retinal health care services; this is an understudied topic in Nepal. Working closely with the stakeholders, this study will evaluate the role of health education interventions (which are already validated in other low-income settings) to strengthen referral and reduce the burden of DR in Nepal. Trial Registration: ClinicalTrials.gov NCT04829084; https://clinicaltrials.gov/ct2/show/NCT04829084 International Registered Report Identifier (IRRID): DERR1-10.2196/33116 %M 34927596 %R 10.2196/33116 %U https://www.researchprotocols.org/2021/12/e33116 %U https://doi.org/10.2196/33116 %U http://www.ncbi.nlm.nih.gov/pubmed/34927596 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e26381 %T mUzima Mobile Electronic Health Record (EHR) System: Development and Implementation at Scale %A Were,Martin Chieng %A Savai,Simon %A Mokaya,Benard %A Mbugua,Samuel %A Ribeka,Nyoman %A Cholli,Preetam %A Yeung,Ada %+ Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 750, Nashville, TN, 37203, United States, 1 615 322 9374, martin.c.were@vumc.org %K mobile health %K electronic medical records %K developing countries %K digital divide %K digital health %K global health %D 2021 %7 14.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The predominant implementation paradigm of electronic health record (EHR) systems in low- and middle-income countries (LMICs) relies on standalone system installations at facilities. This implementation approach exacerbates the digital divide, with facilities in areas with inadequate electrical and network infrastructure often left behind. Mobile health (mHealth) technologies have been implemented to extend the reach of digital health, but these systems largely add to the problem of siloed patient data, with few seamlessly interoperating with the EHR systems that are now scaled nationally in many LMICs. Robust mHealth applications that effectively extend EHR systems are needed to improve access, improve quality of care, and ameliorate the digital divide. Objective: We report on the development and scaled implementation of mUzima, an mHealth extension of the most broadly deployed EHR system in LMICs (OpenMRS). Methods: The “Guidelines for reporting of health interventions using mobile phones: mobile (mHealth) evidence reporting assessment (mERA)” checklist was employed to report on the mUzima application. The World Health Organization (WHO) Principles for Digital Development framework was used as a secondary reference framework. Details of mUzima’s architecture, core features, functionalities, and its implementation status are provided to highlight elements that can be adapted in other systems. Results: mUzima is an open-source, highly configurable Android application with robust features including offline management, deduplication, relationship management, security, cohort management, and error resolution, among many others. mUzima allows providers with lower-end Android smartphones (version 4.4 and above) who work remotely to access historical patient data, collect new data, view media, leverage decision support, conduct store-and-forward teleconsultation, and geolocate clients. The application is supported by an active community of developers and users, with feature priorities vetted by the community. mUzima has been implemented nationally in Kenya, is widely used in Rwanda, and is gaining scale in Uganda and Mozambique. It is disease-agnostic, with current use cases in HIV, cancer, chronic disease, and COVID-19 management, among other conditions. mUzima meets all WHO’s Principles of Digital Development, and its scaled implementation success has led to its recognition as a digital global public good and its listing in the WHO Digital Health Atlas. Conclusions: Greater emphasis should be placed on mHealth applications that robustly extend reach of EHR systems within resource-limited settings, as opposed to siloed mHealth applications. This is particularly important given that health information exchange infrastructure is yet to mature in many LMICs. The mUzima application demonstrates how this can be done at scale, as evidenced by its adoption across multiple countries and for numerous care domains. %M 34904952 %R 10.2196/26381 %U https://www.jmir.org/2021/12/e26381 %U https://doi.org/10.2196/26381 %U http://www.ncbi.nlm.nih.gov/pubmed/34904952 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e27886 %T Web-Based Return of Individual Patient-Reported Outcome Results Among Patients With Lymphoma: Randomized Controlled Trial %A Oerlemans,Simone %A Arts,Lindy Paulina Johanna %A Kieffer,Jacobien M %A Prins,Judith %A Hoogendoorn,Mels %A van der Poel,Marjolein %A Koster,Ad %A Lensen,Chantal %A Stevens,Wendy Bernadina Catharina %A Issa,Djamila %A Pruijt,Johannes F M %A Oosterveld,Margriet %A van der Griend,René %A Nijziel,Marten %A Tick,Lidwine %A Posthuma,Eduardus F M %A van de Poll-Franse,Lonneke V %+ Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, Netherlands, 31 088 234 60 00, s.oerlemans@iknl.nl %K lymphoma %K patient-reported outcomes %K return of individual results %K randomized controlled trial %K self-management %D 2021 %7 14.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: There has been a cultural shift toward patient engagement in health, with a growing demand from patients to access their results. Objective: The Lymphoma Intervention (LIVE) trial is conducted to examine the impact of return of individual patient-reported outcome (PRO) results and a web-based self-management intervention on psychological distress, self-management, satisfaction with information, and health care use in a population-based setting. Methods: Return of PRO results included comparison with age- and sex-matched peers and was built into the Patient-Reported Outcomes Following Initial Treatment and Long-Term Evaluation of Survivorship registry. The self-management intervention is an adaptation of a fully automated evidence-based intervention for breast cancer survivors. Patients with lymphoma who completed the web-based questionnaire were equally randomized to care as usual, return of PRO results, and return of PRO results plus self-management intervention. Patients completed questionnaires 9 to 18 months after diagnosis (T0; n=227), 4 months (T1; n=190), 12 months (T2; n=170), and 24 months (T3; n=98). Results: Of all invited patients, 51.1% (456/892) responded and web-based participants (n=227) were randomly assigned to care as usual (n=76), return of PRO results (n=74), or return of PRO results and access to Living with lymphoma (n=77). Return of PRO results was viewed by 76.7% (115/150) of those with access. No statistically significant differences were observed for psychological distress, self-management, satisfaction with information provision, and health care use between patients who received PRO results and those who did not (P>.05). Use of the self-management intervention was low (2/76, 3%), and an effect could therefore not be determined. Conclusions: Return of individual PRO results seems to meet patients’ wishes but had no beneficial effects on patient outcome. No negative effects were found when individual PRO results were disclosed, and the return of individual PRO results can therefore be safely implemented in daily clinical practice. Trial Registration: Netherlands Trial Register NTR5953; https://www.trialregister.nl/trial/5790 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-017-1943-2 %M 34904948 %R 10.2196/27886 %U https://www.jmir.org/2021/12/e27886 %U https://doi.org/10.2196/27886 %U http://www.ncbi.nlm.nih.gov/pubmed/34904948 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 2 %P e31047 %T Exploring Access to Surgical Interventions for Hidradenitis Suppurativa: Retrospective Population-Based Analysis %A Finstad,Alexandra %A Lee,Alex %A George,Ralph %A Alhusayen,Raed %+ Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada, 1 416 480 6100 ext 7243, Raed.Alhusayen@sunnybrook.ca %K hidradenitis suppurativa %K surgery %K dermatology %K access %K epidemiology %K universal health care %D 2021 %7 14.12.2021 %9 Original Paper %J JMIR Dermatol %G English %X Background: Hidradenitis suppurativa (HS) is a painful inflammatory disorder that confers significant distress to patients, with surgery as an integral treatment modality. Objective: To inform improvements in care, patterns in HS surgery were assessed. Methods: A retrospective population-based analysis was performed on Ontario billing claims for HS surgery across a period of 10 years from January 1, 2008 to December 31, 2017. HS surgery was defined as the excision of inguinal, perineal, or axillary skin and sweat glands for hidradenitis. The top 5 billing specialties, including general and plastic surgery, were analyzed. The total number of procedures performed as well as the number performed per physician were investigated. Patient and physician locations were compared. Results: A total of 7195 claims for the excision of inguinal, perineal, or axillary skin and sweat glands for HS were submitted across the study period. Annual HS surgery claims showed an increasing trend across 10 years, ranging between 4.9 and 5.8 per 100,000 population. However, overall, for every additional year, the number of claims per 100,000 population only increased slightly, by 0.03 claims. The number of providers steadily decreased, ranging between 1.7 and 1.9 per 100,000, with approximately twice as many general than plastic surgeons. However, again overall, for every additional year, the number of providers per 100,000 population decreased slightly, by 0.002 physicians. The mean annual number of procedures per physician rose from 2.8 to 3.1. In rural areas, analyzed per claim, general surgeons performed the majority of surgeries (1318/2003, 65.8%), while in urban areas, surgeries were more equally performed by general (2616/5192, 50.4%) and plastic (2495/5192, 48.1%) surgeons. Of HS surgery claims, 25.7%-35.9% were provided by a physician residing in a different area than the patient receiving care. Conclusions: No significant improvements in access to HS surgery were seen across the study period, with access potentially worsening with annual HS claims rising overall and number of providers decreasing, with patients travelling further to access surgery. System barriers across the continuum of HS diagnosis and management must be evaluated to improve access to surgical care. %M 37632848 %R 10.2196/31047 %U https://derma.jmir.org/2021/2/e31047 %U https://doi.org/10.2196/31047 %U http://www.ncbi.nlm.nih.gov/pubmed/37632848 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e30278 %T Acceptance, Use, and Barriers of Telemedicine in Transgender Health Care in Times of SARS-CoV-2: Nationwide Cross-sectional Survey %A Hertling,Stefan %A Hertling,Doreen %A Martin,David %A Graul,Isabel %+ Department of Obstetrics and Gynaecology, University Hospital Jena, Am Klinikum 1, Jena, 07743, Germany, 49 17632251161, stefan.hertling@yahoo.de %K telemedicine %K health services research %K COVID-19 %K transgender health care %K acceptance %K usage %K barrier %K telehealth %K gender %K identity %K transgender %K cross-sectional %K survey %K Germany %K framework %K implementation %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The global incidence in the treatment of transgender people is increasing. During the COVID-19 pandemic, many consultations had to be cancelled, postponed, or converted to a virtual format. Telemedicine in the management of transgender health care could support physicians. Objective: The aim of this study was to analyze the acceptance, use, and barriers of telemedicine in transgender health care in times of SARS-CoV-2 in Germany. Methods: This prospective cross-sectional study was based on a survey of gynecological endocrinologists and transgender patients undergoing gender-affirming hormone treatment in Germany during the COVID-19 pandemic. Descriptive statistics were calculated, and regression analyses were performed to show correlations. Results: We analyzed responses of 269 transgender patients and 202 gynecological endocrinologists treating transgender patients. Most believed that telemedicine was useful. Physicians and patients rated their knowledge of telemedicine as unsatisfactory. The majority of respondents said they did not currently use telemedicine, although they would like to do so. Patients and physicians reported that their attitudes toward telemedicine had changed positively and that their use of telemedicine had increased due to COVID-19. The majority in both groups agreed on the implementation of virtual visits in the context of stable disease conditions. In the treatment phases, 74.3% (150/202) of the physicians said they would use telemedicine during follow-ups. Half of the physicians said they would choose tele-counseling as a specific approach to improving care (128/202, 63.4%). Obstacles to the introduction of telemedicine among physicians included the purchase of technical equipment (132/202, 65.3%), administration (124/202, 61.4%), and poor reimbursement (106/202, 52.5%). Conclusions: Telemedicine in transgender health care found limited use but high acceptance among doctors and patients alike. The absence of a structured framework is an obstacle for effective implementation. Training courses should be introduced to improve the limited knowledge of physicians in the use of telemedicine. More research in tele-endogynecology is needed. Future studies should include large-scale randomized controlled trials, economic analyses, and the exploration of user preferences. %M 34591783 %R 10.2196/30278 %U https://publichealth.jmir.org/2021/12/e30278 %U https://doi.org/10.2196/30278 %U http://www.ncbi.nlm.nih.gov/pubmed/34591783 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e29812 %T Analyzing Patient Trajectories With Artificial Intelligence %A Allam,Ahmed %A Feuerriegel,Stefan %A Rebhan,Michael %A Krauthammer,Michael %+ Ludwig Maximilian University of Munich, Geschwister-Scholl-Platz 1, Munich, 80539, Germany, 49 8921806790, feuerriegel@lmu.de %K patient trajectories %K longitudinal data %K digital medicine %K artificial intelligence %K machine learning %D 2021 %7 3.12.2021 %9 Viewpoint %J J Med Internet Res %G English %X In digital medicine, patient data typically record health events over time (eg, through electronic health records, wearables, or other sensing technologies) and thus form unique patient trajectories. Patient trajectories are highly predictive of the future course of diseases and therefore facilitate effective care. However, digital medicine often uses only limited patient data, consisting of health events from only a single or small number of time points while ignoring additional information encoded in patient trajectories. To analyze such rich longitudinal data, new artificial intelligence (AI) solutions are needed. In this paper, we provide an overview of the recent efforts to develop trajectory-aware AI solutions and provide suggestions for future directions. Specifically, we examine the implications for developing disease models from patient trajectories along the typical workflow in AI: problem definition, data processing, modeling, evaluation, and interpretation. We conclude with a discussion of how such AI solutions will allow the field to build robust models for personalized risk scoring, subtyping, and disease pathway discovery. %M 34870606 %R 10.2196/29812 %U https://www.jmir.org/2021/12/e29812 %U https://doi.org/10.2196/29812 %U http://www.ncbi.nlm.nih.gov/pubmed/34870606 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e30632 %T Effectiveness of Telehealth in Rural and Remote Emergency Departments: Systematic Review %A Tsou,Christina %A Robinson,Suzanne %A Boyd,James %A Jamieson,Andrew %A Blakeman,Robert %A Yeung,Justin %A McDonnell,Josephine %A Waters,Stephanie %A Bosich,Kylie %A Hendrie,Delia %+ School of Population Health, Curtin Univeristy, Kent Street, Bentley, 6102, Australia, 61 08 92669266, christina.tsou@curtin.edu.au %K telehealth %K telemedicine %K clinical effectiveness %K treatment outcome %K rural population %K rural health %K remote %D 2021 %7 26.11.2021 %9 Review %J J Med Internet Res %G English %X Background: Emergency telehealth has been used to improve access of patients residing in rural and remote areas to specialist care in the hope of mitigating the significant health disparities that they experience. Patient disposition decisions in rural and remote emergency departments (EDs) can be complex and largely dependent on the expertise and experience available at local (receiving-end) hospitals. Although there has been some synthesis of evidence of the effectiveness of emergency telehealth in clinical practice in rural and remote EDs for nonacute presentations, there has been limited evaluation of the influence of contextual factors such as clinical area and acuity of presentation on these findings. Objective: The aims of this systematic review are to examine the outcome measures used in studying the effectiveness of telehealth in rural and remote EDs and to analyze the clinical context in which these outcome measures were used and interpreted. Methods: The search strategy used Medical Subject Headings and equivalent lists of subject descriptors to find articles covering 4 key domains: telehealth or telemedicine, EDs, effectiveness, and rural and remote. Studies were selected using the Population, Intervention, Comparator, Outcomes of Interest, and Study Design framework. This search strategy was applied to MEDLINE (Ovid), Cochrane Library, Scopus, CINAHL, ProQuest, and EconLit, as well as the Centre for Reviews and Dissemination databases (eg, National Health Service Economic Evaluation Database) for the search period from January 1, 1990, to May 23, 2020. Qualitative synthesis was performed on the outcome measures used in the included studies, in particular the clinical contexts within which they were interpreted. Results: A total of 21 full-text articles were included for qualitative analysis. Telehealth use in rural and remote EDs demonstrated effectiveness in achieving improved or equivalent clinical effectiveness, appropriate care processes, and—depending on the context—improvement in speed of care, as well as favorable service use patterns. The definition of effectiveness varied across the clinical areas and contexts of the studies, and different measures have been used to affirm the safety and clinical effectiveness of telehealth in rural and remote EDs. The acuity of patient presentation emerged as a dominant consideration in the interpretation of interlinking time-sensitive clinical effectiveness and patient disposition measures such as transfer and discharge rates, local hospital admission, length of stay, and ED length of stay. These, together with clinical area and acuity of presentation, are the outcome determination criteria that emerged from this review. Conclusions: Emergency telehealth studies typically use multiple outcome measures to determine the effectiveness of the services. The outcome determination criteria that emerged from this analysis are useful when defining the favorable direction for each outcome measure of interest. The findings of this review have implications for emergency telehealth service design and policies. Trial Registration: PROSPERO CRD42019145903; https://tinyurl.com/ndmkr8ry %M 34842537 %R 10.2196/30632 %U https://www.jmir.org/2021/11/e30632 %U https://doi.org/10.2196/30632 %U http://www.ncbi.nlm.nih.gov/pubmed/34842537 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 11 %P e31442 %T Assessing the Value of Unsupervised Clustering in Predicting Persistent High Health Care Utilizers: Retrospective Analysis of Insurance Claims Data %A Ramachandran,Raghav %A McShea,Michael J %A Howson,Stephanie N %A Burkom,Howard S %A Chang,Hsien-Yen %A Weiner,Jonathan P %A Kharrazi,Hadi %+ Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins School of Public Health, , Baltimore, MD, United States, 1 4432878264, kharrazi@jhu.edu %K persistent high users %K persistent high utilizers %K latent class analysis %K comorbidity patterns %K utilization prediction %K unsupervised clustering %K population health analytics %K health care %K prediction models %K health care services %K health care costs %D 2021 %7 25.11.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: A high proportion of health care services are persistently utilized by a small subpopulation of patients. To improve clinical outcomes while reducing costs and utilization, population health management programs often provide targeted interventions to patients who may become persistent high users/utilizers (PHUs). Enhanced prediction and management of PHUs can improve health care system efficiencies and improve the overall quality of patient care. Objective: The aim of this study was to detect key classes of diseases and medications among the study population and to assess the predictive value of these classes in identifying PHUs. Methods: This study was a retrospective analysis of insurance claims data of patients from the Johns Hopkins Health Care system. We defined a PHU as a patient incurring health care costs in the top 20% of all patients’ costs for 4 consecutive 6-month periods. We used 2013 claims data to predict PHU status in 2014-2015. We applied latent class analysis (LCA), an unsupervised clustering approach, to identify patient subgroups with similar diagnostic and medication patterns to differentiate variations in health care utilization across PHUs. Logistic regression models were then built to predict PHUs in the full population and in select subpopulations. Predictors included LCA membership probabilities, demographic covariates, and health utilization covariates. Predictive powers of the regression models were assessed and compared using standard metrics. Results: We identified 164,221 patients with continuous enrollment between 2013 and 2015. The mean study population age was 19.7 years, 55.9% were women, 3.3% had ≥1 hospitalization, and 19.1% had 10+ outpatient visits in 2013. A total of 8359 (5.09%) patients were identified as PHUs in both 2014 and 2015. The LCA performed optimally when assigning patients to four probability disease/medication classes. Given the feedback provided by clinical experts, we further divided the population into four diagnostic groups for sensitivity analysis: acute upper respiratory infection (URI) (n=53,232; 4.6% PHUs), mental health (n=34,456; 12.8% PHUs), otitis media (n=24,992; 4.5% PHUs), and musculoskeletal (n=24,799; 15.5% PHUs). For the regression models predicting PHUs in the full population, the F1-score classification metric was lower using a parsimonious model that included LCA categories (F1=38.62%) compared to that of a complex risk stratification model with a full set of predictors (F1=48.20%). However, the LCA-enabled simple models were comparable to the complex model when predicting PHUs in the mental health and musculoskeletal subpopulations (F1-scores of 48.69% and 48.15%, respectively). F1-scores were lower than that of the complex model when the LCA-enabled models were limited to the otitis media and acute URI subpopulations (45.77% and 43.05%, respectively). Conclusions: Our study illustrates the value of LCA in identifying subgroups of patients with similar patterns of diagnoses and medications. Our results show that LCA-derived classes can simplify predictive models of PHUs without compromising predictive accuracy. Future studies should investigate the value of LCA-derived classes for predicting PHUs in other health care settings. %M 34592712 %R 10.2196/31442 %U https://medinform.jmir.org/2021/11/e31442 %U https://doi.org/10.2196/31442 %U http://www.ncbi.nlm.nih.gov/pubmed/34592712 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 4 %P e22325 %T Including the Reason for Use on Prescriptions Sent to Pharmacists: Scoping Review %A Mercer,Kathryn %A Carter,Caitlin %A Burns,Catherine %A Tennant,Ryan %A Guirguis,Lisa %A Grindrod,Kelly %+ Library, University of Waterloo, 200 University Avenue West, DC 1555, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4567 ext 42659, kmercer@uwaterloo.ca %K patient safety %K human factors %K patient engagement %K multidisciplinary %D 2021 %7 25.11.2021 %9 Review %J JMIR Hum Factors %G English %X Background: In North America, although pharmacists are obligated to ensure prescribed medications are appropriate, information about a patient’s reason for use is not a required component of a legal prescription. The benefits of prescribers including the reason for use on prescriptions is evident in the current literature. However, it is not standard practice to share this information with pharmacists. Objective: Our aim was to characterize the research on how including the reason for use on a prescription impacts pharmacists. Methods: We performed an interdisciplinary scoping review, searching literature in the fields of health care, informatics, and engineering. The following databases were searched between December 2018 and January 2019: PubMed, Institute of Electrical and Electronics Engineers (IEEE), Association for Computing Machinery (ACM), International Pharmaceutical Abstracts (IPA), and EMBASE. Results: A total of 3912 potentially relevant articles were identified, with 9 papers meeting the inclusion criteria. The studies used different terminology (eg, indication, reason for use) and a wide variety of study methodologies, including prospective and retrospective observational studies, randomized controlled trials, and qualitative interviews and focus groups. The results suggest that including the reason for use on a prescription can help the pharmacist catch more errors, reduce the need to contact prescribers, support patient counseling, impact communication, and improve patient safety. Reasons that may prevent prescribers from adding the reason for use information are concerns about workflow and patient privacy. Conclusions: More research is needed to understand how the reason for use information should be provided to pharmacists. In the limited literature to date, there is a consensus that the addition of this information to prescriptions benefits patient safety and enables pharmacists to be more effective. Future research should use an implementation science or theory-based approach to improve prescriber buy-in and, consequently, adoption. %M 34842545 %R 10.2196/22325 %U https://humanfactors.jmir.org/2021/4/e22325 %U https://doi.org/10.2196/22325 %U http://www.ncbi.nlm.nih.gov/pubmed/34842545 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e27261 %T Assessing Neonatal Intensive Care Unit Structures and Outcomes Before and During the COVID-19 Pandemic: Network Analysis Study %A Mannering,Hannah %A Yan,Chao %A Gong,Yang %A Alrifai,Mhd Wael %A France,Daniel %A Chen,You %+ Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Ave, Suite 1475, Nashville, TN, 37203, United States, 1 6153431939, you.chen@vanderbilt.edu %K neonatal intensive care unit %K collaboration %K health care organization structures %K intensive care %K length of stay %K discharge dispositions %K electronic health records %K network analysis %K COVID-19 %K temporal network analysis %D 2021 %7 20.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Health care organizations (HCOs) adopt strategies (eg. physical distancing) to protect clinicians and patients in intensive care units (ICUs) during the COVID-19 pandemic. Many care activities physically performed before the COVID-19 pandemic have transitioned to virtual systems during the pandemic. These transitions can interfere with collaboration structures in the ICU, which may impact clinical outcomes. Understanding the differences can help HCOs identify challenges when transitioning physical collaboration to the virtual setting in the post–COVID-19 era. Objective: This study aims to leverage network analysis to determine the changes in neonatal ICU (NICU) collaboration structures from the pre– to the intra–COVID-19 era. Methods: In this retrospective study, we applied network analysis to the utilization of electronic health records (EHRs) of 712 critically ill neonates (pre–COVID-19, n=386; intra–COVID-19, n=326, excluding those with COVID-19) admitted to the NICU of Vanderbilt University Medical Center between September 1, 2019, and June 30, 2020, to assess collaboration between clinicians. We characterized pre–COVID-19 as the period of September-December 2019 and intra–COVID-19 as the period of March-June 2020. These 2 groups were compared using patients’ clinical characteristics, including age, sex, race, length of stay (LOS), and discharge dispositions. We leveraged the clinicians’ actions committed to the patients’ EHRs to measure clinician-clinician connections. We characterized a collaboration relationship (tie) between 2 clinicians as actioning EHRs of the same patient within the same day. On defining collaboration relationship, we built pre– and intra–COVID-19 networks. We used 3 sociometric measurements, including eigenvector centrality, eccentricity, and betweenness, to quantify a clinician’s leadership, collaboration difficulty, and broad skill sets in a network, respectively. We assessed the extent to which the eigenvector centrality, eccentricity, and betweenness of clinicians in the 2 networks are statistically different, using Mann-Whitney U tests (95% CI). Results: Collaboration difficulty increased from the pre– to intra–COVID-19 periods (median eccentricity: 3 vs 4; P<.001). Nurses had reduced leadership (median eigenvector centrality: 0.183 vs 0.087; P<.001), and neonatologists with broader skill sets cared for more patients in the NICU structure during the pandemic (median betweenness centrality: 0.0001 vs 0.005; P<.001). The pre– and intra–COVID-19 patient groups shared similar distributions in sex (~0 difference), race (4% difference in White, and 3% difference in African American), LOS (interquartile range difference in 1.5 days), and discharge dispositions (~0 difference in home, 2% difference in expired, and 2% difference in others). There were no significant differences in the patient demographics and outcomes between the 2 groups. Conclusions: Management of NICU-admitted patients typically requires multidisciplinary care teams. Understanding collaboration structures can provide fine-grained evidence to potentially refine or optimize existing teamwork in the NICU. %M 34637393 %R 10.2196/27261 %U https://www.jmir.org/2021/10/e27261 %U https://doi.org/10.2196/27261 %U http://www.ncbi.nlm.nih.gov/pubmed/34637393 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e26486 %T Prediction of Readmission in Geriatric Patients From Clinical Notes: Retrospective Text Mining Study %A Goh,Kim Huat %A Wang,Le %A Yeow,Adrian Yong Kwang %A Ding,Yew Yoong %A Au,Lydia Shu Yi %A Poh,Hermione Mei Niang %A Li,Ke %A Yeow,Joannas Jie Lin %A Tan,Gamaliel Yu Heng %+ Nanyang Business School, Nanyang Technological University, S3-B2A-34, 50 Nanyang Avenue, Singapore, 639798, Singapore, 65 67904808, akhgoh@ntu.edu.sg %K geriatrics %K readmission risk %K artificial intelligence %K text mining %K psychosocial factors %D 2021 %7 19.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Prior literature suggests that psychosocial factors adversely impact health and health care utilization outcomes. However, psychosocial factors are typically not captured by the structured data in electronic medical records (EMRs) but are rather recorded as free text in different types of clinical notes. Objective: We here propose a text-mining approach to analyze EMRs to identify older adults with key psychosocial factors that predict adverse health care utilization outcomes, measured by 30-day readmission. The psychological factors were appended to the LACE (Length of stay, Acuity of the admission, Comorbidity of the patient, and Emergency department use) Index for Readmission to improve the prediction of readmission risk. Methods: We performed a retrospective analysis using EMR notes of 43,216 hospitalization encounters in a hospital from January 1, 2017 to February 28, 2019. The mean age of the cohort was 67.51 years (SD 15.87), the mean length of stay was 5.57 days (SD 10.41), and the mean intensive care unit stay was 5% (SD 22%). We employed text-mining techniques to extract psychosocial topics that are representative of these patients and tested the utility of these topics in predicting 30-day hospital readmission beyond the predictive value of the LACE Index for Readmission. Results: The added text-mined factors improved the area under the receiver operating characteristic curve of the readmission prediction by 8.46% for geriatric patients, 6.99% for the general hospital population, and 6.64% for frequent admitters. Medical social workers and case managers captured more of the psychosocial text topics than physicians. Conclusions: The results of this study demonstrate the feasibility of extracting psychosocial factors from EMR clinical notes and the value of these notes in improving readmission risk prediction. Psychosocial profiles of patients can be curated and quantified from text mining clinical notes and these profiles can be successfully applied to artificial intelligence models to improve readmission risk prediction. %M 34665149 %R 10.2196/26486 %U https://www.jmir.org/2021/10/e26486 %U https://doi.org/10.2196/26486 %U http://www.ncbi.nlm.nih.gov/pubmed/34665149 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e27499 %T Identifying Frequent Health Care Users and Care Consumption Patterns: Process Mining of Emergency Medical Services Data %A Maruster,Laura %A van der Zee,Durk-Jouke %A Buskens,Erik %+ Faculty of Economics and Business, University of Groningen, Nettelbosje 2, Groningen, 9747 AE, Netherlands, 31 50 3637316, l.maruster@rug.nl %K process mining %K frequent users %K hospital care %K emergency medical services %K regional care networks %K elderly %K Netherlands %D 2021 %7 6.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Tracing frequent users of health care services is highly relevant to policymakers and clinicians, enabling them to avoid wasting scarce resources. Data collection on frequent users from all possible health care providers may be cumbersome due to patient privacy, competition, incompatible information systems, and the efforts involved. Objective: This study explored the use of a single key source, emergency medical services (EMS) records, to trace and reveal frequent users’ health care consumption patterns. Methods: A retrospective study was performed analyzing EMS calls from the province of Drenthe in the Netherlands between 2012 and 2017. Process mining was applied to identify the structure of patient routings (ie, their consecutive visits to hospitals, nursing homes, and EMS). Routings are used to identify and quantify frequent users, recognizing frail elderly users as a focal group. The structure of these routes was analyzed at the patient and group levels, aiming to gain insight into regional coordination issues and workload distributions among health care providers. Results: Frail elderly users aged 70 years or more represented over 50% of frequent users, making 4 or more calls per year. Over the period of observation, their annual number and the number of calls increased from 395 to 628 and 2607 to 3615, respectively. Structural analysis based on process mining revealed two categories of frail elderly users: low-complexity patients who need dialysis, radiation therapy, or hyperbaric medicine, involving a few health care providers, and high-complexity patients for whom routings appear chaotic. Conclusions: This efficient approach exploits the role of EMS as the unique regional “ferryman,” while the combined use of EMS data and process mining allows for the effective and efficient tracing of frequent users’ utilization of health care services. The approach informs regional policymakers and clinicians by quantifying and detailing frequent user consumption patterns to support subsequent policy adaptations. %M 34612834 %R 10.2196/27499 %U https://www.jmir.org/2021/10/e27499 %U https://doi.org/10.2196/27499 %U http://www.ncbi.nlm.nih.gov/pubmed/34612834 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e29990 %T Trends in Health Information Technology Use Among the US Population With and Without Cardiovascular Risk Factors, 2012-2018: Evidence From the National Health Interview Survey %A Gandrakota,Nikhila %A Ali,Mohammed K %A Shah,Megha K %+ Department of Family & Preventive Medicine, Emory University School of Medicine, 4500 N Shallowford Rd, Atlanta, GA, 30338, United States, 1 4047786920, nikhila.gandrakota@emory.edu %K telemedicine %K cardiovascular risk factors %K health information technology %K telehealth %K digital health %K public health %K surveillance %D 2021 %7 30.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has required clinicians to pivot to offering services via telehealth; however, it is unclear which patients (users of care) are equipped to use digital health. This is especially pertinent for adults managing chronic diseases, such as obesity, hypertension, and diabetes, which require regular follow-up, medication management, and self-monitoring. Objective: The aim of this study is to measure the trends and assess factors affecting health information technology (HIT) use among members of the US population with and without cardiovascular risk factors. Methods: We used serial cross-sectional data from the National Health Interview Survey for the years 2012-2018 to assess trends in HIT use among adults, stratified by age and cardiovascular risk factor status. We developed multivariate logistic regression models adjusted for age, sex, race, insurance status, marital status, geographic region, and perceived health status to assess the likelihood of HIT use among patients with and without cardiovascular disease risk factors. Results: A total of 14,304 (44.6%) and 14,644 (58.7%) participants reported using HIT in 2012 and 2018, respectively. When comparing the rates of HIT use for the years 2012 and 2018, among participants without cardiovascular risk factors, the HIT use proportion increased from 51.1% to 65.8%; among those with one risk factor, it increased from 43.9% to 59%; and among those with more than one risk factor, it increased from 41.3% to 54.7%. Increasing trends in HIT use were highest among adults aged >65 years (annual percentage change [APC] 8.3%), who had more than one cardiovascular risk factor (APC 5%) and among those who did not graduate from high school (APC 8.8%). Likelihood of HIT use was significantly higher in individuals who were younger, female, and non-Hispanic White; had higher education and income; were married; and reported very good or excellent health status. In 2018, college graduates were 7.18 (95% CI 5.86-8.79), 6.25 (95% CI 5.02-7.78), or 7.80 (95% CI 5.87-10.36) times more likely to use HIT compared to adults without high school education among people with multiple cardiovascular risk factors, one cardiovascular risk factor, or no cardiovascular risk factors, respectively. Conclusions: Over 2012-2018, HIT use increased nationally, with greater use noted among younger and higher educated US adults. Targeted strategies are needed to engage wider age, racial, education, and socioeconomic groups by lowering barriers to HIT access and use. %M 34591026 %R 10.2196/29990 %U https://publichealth.jmir.org/2021/9/e29990 %U https://doi.org/10.2196/29990 %U http://www.ncbi.nlm.nih.gov/pubmed/34591026 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26744 %T The Effect of Noninvasive Telemonitoring for Chronic Heart Failure on Health Care Utilization: Systematic Review %A Auener,Stefan L %A Remers,Toine E P %A van Dulmen,Simone A %A Westert,Gert P %A Kool,Rudolf B %A Jeurissen,Patrick P T %+ IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, 6525GA, Netherlands, 31 243616359, stefan.auener@radboudumc.nl %K heart failure %K telemonitoring %K remote monitoring %K health care utilization %K eHealth %D 2021 %7 29.9.2021 %9 Review %J J Med Internet Res %G English %X Background: Chronic heart failure accounts for approximately 1%-2% of health care expenditures in most developed countries. These costs are primarily driven by hospitalizations and comorbidities. Telemonitoring has been proposed to reduce the number of hospitalizations and decrease the cost of treatment for patients with heart failure. However, the effects of telemonitoring on health care utilization remain unclear. Objective: This systematic review aims to study the effect of telemonitoring programs on health care utilization and costs in patients with chronic heart failure. We assess the effect of telemonitoring on hospitalizations, emergency department visits, length of stay, hospital days, nonemergency department visits, and health care costs. Methods: We searched PubMed, Embase, and Web of Science for randomized controlled trials and nonrandomized studies on noninvasive telemonitoring and health care utilization. We included studies published between January 2010 and August 2020. For each study, we extracted the reported data on the effect of telemonitoring on health care utilization. We used P<.05 and CIs not including 1.00 to determine whether the effect was statistically significant. Results: We included 16 randomized controlled trials and 13 nonrandomized studies. Inclusion criteria, population characteristics, and outcome measures differed among the included studies. Most studies showed no effect of telemonitoring on health care utilization. The number of hospitalizations was significantly reduced in 38% (9/24) of studies, whereas emergency department visits were reduced in 13% (1/8) of studies. An increase in nonemergency department visits (6/9, 67% of studies) was reported. Health care costs showed ambiguous results, with 3 studies reporting an increase in health care costs, 3 studies reporting a reduction, and 4 studies reporting no significant differences. Health care cost reductions were realized through a reduction in hospitalizations, whereas increases were caused by the high costs of the telemonitoring program or increased health care utilization. Conclusions: Most telemonitoring programs do not show clear effects on health care utilization measures, except for an increase in nonemergency outpatient department visits. This may be an unwarranted side effect rather than a prerequisite for effective telemonitoring. The consequences of telemonitoring on nonemergency outpatient visits should receive more attention from regulators, payers, and providers. This review further demonstrates the high clinical and methodological heterogeneity of telemonitoring programs. This should be taken into account in future meta-analyses aimed at identifying the effective components of telemonitoring programs. %M 34586072 %R 10.2196/26744 %U https://www.jmir.org/2021/9/e26744 %U https://doi.org/10.2196/26744 %U http://www.ncbi.nlm.nih.gov/pubmed/34586072 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e30162 %T Assessing the Care Modality Preferences and Predictors for Digital Mental Health Treatment Seekers in a Technology-Enabled Stepped Care Delivery System: Cross-sectional Study %A Kozlov,Elissa %A McDarby,Meghan %A Prescott,Maximo %A Altman,Myra %+ Modern Health, 450 Sansome St, 12th Floor, San Francisco, CA, 94111, United States, 1 603 306 6231, myra@joinmodernhealth.com %K stepped care %K technology %K mental health care %K patient-centered care %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Access to mental health services continues to be a systemic problem in the United States and around the world owing to a variety of barriers including the limited availability of skilled providers and lack of mental health literacy among patients. Individuals seeking mental health treatment may not be aware of the multiple modalities of digital mental health care available to address their problems (eg, self-guided and group modalities, or one-to-one care with a provider). In fact, one-to-one, in-person treatment is the dominant care model with a masters- or doctoral-level trained mental health provider, and it may or may not be the appropriate or preferred level of care for an individual. Technology-enabled mental health platforms may be one way to improve access to mental health care by offering stepped care, but more research is needed to understand the care modality preferences of digital mental health care seekers because additional modalities become increasingly validated as effective treatment options. Objective: The purpose of this study was to describe and evaluate the predictors of care modality preferences among individuals enrolled in a technology-enabled stepped mental health care platform. Methods: This exploratory, cross-sectional study used employee data from the 2021 Modern Health database, an employer-sponsored mental health benefit that uses a technology-enabled platform to optimize digital mental health care delivery. Chi-square tests and one-way analysis of variance (ANOVA) were conducted to evaluate associations among the categorical and continuous factors of interest and the preferred care modality. Bivariate logistic regression models were constructed to estimate the odds ratios (ORs) of preferring a one-on-one versus self-guided group, or no preference for digital mental health care modalities. Results: Data were analyzed for 3661 employees. The most common modality preference was one-on-one care (1613/3661, 44.06%). Approximately one-fourth of the digital mental health care seekers (881/3661, 24.06%) expressed a preference for pursuing self-guided care, and others (294/3661, 8.03%) expressed a preference for group care. The ORs indicated that individuals aged 45 years and above were significantly more likely to express a preference for self-guided care compared to individuals aged between 18 and 24 years (OR 2.47, 95% CI 1.70-3.59; P<.001). Individuals screening positive for anxiety (OR 0.73, 95% CI 0.62-0.86; P<.001) or depression (OR 0.79, 95% CI 0.66-0.95; P=.02) were more likely to prefer one-on-one care. Conclusions: Our findings elucidated that care modality preferences vary and are related to clinical severity factors and demographic variables among individuals seeking digital mental health care. %M 34343965 %R 10.2196/30162 %U https://formative.jmir.org/2021/9/e30162 %U https://doi.org/10.2196/30162 %U http://www.ncbi.nlm.nih.gov/pubmed/34343965 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e29622 %T Characterization and Identification of Variations in Types of Primary Care Visits Before and During the COVID-19 Pandemic in Catalonia: Big Data Analysis Study %A Lopez Segui,Francesc %A Hernandez Guillamet,Guillem %A Pifarré Arolas,Héctor %A Marin-Gomez,Francesc X %A Ruiz Comellas,Anna %A Ramirez Morros,Anna Maria %A Adroher Mas,Cristina %A Vidal-Alaball,Josep %+ Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Pica d'Estats 36, Sant Fruitós de Bages, Spain, 34 93 693 0040, jvidal.cc.ics@gencat.cat %K COVID-19 %K primary care %K diagnose variations %K big data %K ICD10 %K health system %K big data %K primary care %K healthcare system %D 2021 %7 14.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has turned the care model of health systems around the world upside down, causing the abrupt cancellation of face-to-face visits and redirection of the model toward telemedicine. Digital transformation boosts information systems—the more robust they are, the easier it is to monitor the health care system in a highly complex state and allow for more agile and reliable analysis. Objective: The purpose of this study was to analyze diagnoses from primary care visits and distinguish between those that had higher and lower variations, relative to the 2019 and 2020 periods (roughly before and during COVID-19), to identify clinical profiles that may have been most impaired from the least-used diagnostic codes for visits during the pandemic. Methods: We used a database from the Primary Care Services Information Technologies Information System of Catalonia. We analyzed the register of visits (n=2,824,185) and their International Classification of Diseases (ICD-10) diagnostic codes (n=3,921,974; mean 1.38 per visit), as approximations of the reasons for consultations, at 3 different grouping levels. The data were represented by a term frequency matrix and analyzed recursively in different partitions aggregated according to date. Results: The increase in non–face-to-face visits (+267%) did not counterbalance the decrease in face-to-face visits (–47%), with an overall reduction in the total number of visits of 1.36%, despite the notable increase in nursing visits (10.54%). The largest increases in 2020 were visits with diagnoses related to COVID-19 (ICD-10 codes Z20-Z29: 2.540%), along with codes related to economic and housing problems (ICD-10 codes Z55-Z65: 44.40%). Visits with most of the other diagnostic codes decreased in 2020 relative to those in 2019. The largest reductions were chronic pathologies such as arterial hypertension (ICD-10 codes I10-I16: –32.73%) or diabetes (ICD-10 codes E08-E13: –21.13%), but also obesity (E65-E68: –48.58%) and bodily injuries (ICD-10 code T14: –33.70%). Visits with mental health–related diagnostic codes decreased, but the decrease was less than the average decrease. There was a decrease in consultations—for children, adolescents, and adults—for respiratory infections (ICD-10 codes J00-J06: –40.96%). The results show large year-on-year variations (in absolute terms, an average of 12%), which is representative of the strong shock to the health system. Conclusions: The disruption in the primary care model in Catalonia has led to an explosive increase in the number of non–face-to-face visits. There has been a reduction in the number of visits for diagnoses related to chronic pathologies, respiratory infections, obesity, and bodily injuries. Instead, visits for diagnoses related to socioeconomic and housing problems have increased, which emphasizes the importance of social determinants of health in the context of this pandemic. Big data analytics with routine care data yield findings that are consistent with those derived from intuition in everyday clinical practice and can help inform decision making by health planners in order to use the next few years to focus on the least-treated diseases during the COVID-19 pandemic. %M 34313600 %R 10.2196/29622 %U https://www.jmir.org/2021/9/e29622 %U https://doi.org/10.2196/29622 %U http://www.ncbi.nlm.nih.gov/pubmed/34313600 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e31240 %T Using Telehealth to Deliver Primary Care to Adolescents During and After the COVID-19 Pandemic: National Survey Study of US Primary Care Professionals %A Gilkey,Melissa B %A Kong,Wei Yi %A Huang,Qian %A Grabert,Brigid K %A Thompson,Peyton %A Brewer,Noel T %+ Department of Health Behavior, University of North Carolina at Chapel Hill, CB 7440, Chapel Hill, NC, 27599, United States, 1 9199668650, gilkey@email.unc.edu %K adolescent health %K primary care %K telemedicine %K health communication %K health services %K telehealth %K adolescent %K young adult %K teenager %K COVID-19 %K survey %K policy %K access %D 2021 %7 10.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has led to unprecedented use of telehealth, including by primary care professionals (PCPs) who serve adolescents. Objective: To inform future practice and policies, we sought to characterize PCPs’ recent experience using adolescent telehealth as well as their support for it after the COVID-19 pandemic is over. Methods: From February to March 2021, we conducted a web-based survey of 1047 PCPs in the United States. Our national sample included physicians (747/1047, 71%), advanced practice providers (177/1047, 17%), and nurses (123/1047, 12%) who provided primary care to adolescents aged 11-17 years. Results: Most PCPs reported using telehealth for a low, moderate, or high proportion of their adolescent patients in the three months prior to the survey (424/1047, 40%, 286/1047, 27%, and 219/1047, 21%, respectively); only 11% (118/1047) reported no use. A majority of respondents agreed that adolescent telehealth increases access to care (720/1047, 69%) and enables them to provide high-quality care (560/1047, 53%). Few believed that adolescent telehealth takes too much time (142/1047, 14%) or encourages health care overuse (157/1047, 15%). Most supported giving families the option of adolescent telehealth for primary care after the pandemic is over (683/1047, 65%) and believed that health insurance plans should continue to reimburse for telehealth visits (863/1047, 82%). Approximately two-thirds (702/1047, 67%) wanted to offer adolescent telehealth visits after the pandemic, with intentions being higher among those with recent telehealth experience (P<.001). Conclusions: PCPs in our national sample reported widespread use of and predominantly positive attitudes toward adolescent telehealth. Our findings also suggest broad support among PCPs for continuing to offer adolescent telehealth after the COVID-19 pandemic ends. %M 34406974 %R 10.2196/31240 %U https://www.jmir.org/2021/9/e31240 %U https://doi.org/10.2196/31240 %U http://www.ncbi.nlm.nih.gov/pubmed/34406974 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26231 %T Understanding Pediatric Surgery Cancellation: Geospatial Analysis %A Liu,Lei %A Ni,Yizhao %A Beck,Andrew F %A Brokamp,Cole %A Ramphul,Ryan C %A Highfield,Linda D %A Kanjia,Megha Karkera %A Pratap,J “Nick” %+ Department of Anesthesia, Cincinnati Children's Hospital Medical Center, MLC 2001, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, United States, 1 513 636 4408, jnpratap@pratap.co.uk %K surgery cancellation %K socioeconomic factors %K spatial regression models %K machine learning %D 2021 %7 10.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Day-of-surgery cancellation (DoSC) represents a substantial wastage of hospital resources and can cause significant inconvenience to patients and families. Cancellation is reported to impact between 2% and 20% of the 50 million procedures performed annually in American hospitals. Up to 85% of cancellations may be amenable to the modification of patients’ and families’ behaviors. However, the factors underlying DoSC and the barriers experienced by families are not well understood. Objective: This study aims to conduct a geospatial analysis of patient-specific variables from electronic health records (EHRs) of Cincinnati Children’s Hospital Medical Center (CCHMC) and of Texas Children’s Hospital (TCH), as well as linked socioeconomic factors measured at the census tract level, to understand potential underlying contributors to disparities in DoSC rates across neighborhoods. Methods: The study population included pediatric patients who underwent scheduled surgeries at CCHMC and TCH. A 5-year data set was extracted from the CCHMC EHR, and addresses were geocoded. An equivalent set of data >5.7 years was extracted from the TCH EHR. Case-based data related to patients’ health care use were aggregated at the census tract level. Community-level variables were extracted from the American Community Survey as surrogates for patients’ socioeconomic and minority status as well as markers of the surrounding context. Leveraging the selected variables, we built spatial models to understand the variation in DoSC rates across census tracts. The findings were compared to those of the nonspatial regression and deep learning models. Model performance was evaluated from the root mean squared error (RMSE) using nested 10-fold cross-validation. Feature importance was evaluated by computing the increment of the RMSE when a single variable was shuffled within the data set. Results: Data collection yielded sets of 463 census tracts at CCHMC (DoSC rates 1.2%-12.5%) and 1024 census tracts at TCH (DoSC rates 3%-12.2%). For CCHMC, an L2-normalized generalized linear regression model achieved the best performance in predicting all-cause DoSC rate (RMSE 1.299%, 95% CI 1.21%-1.387%); however, its improvement over others was marginal. For TCH, an L2-normalized generalized linear regression model also performed best (RMSE 1.305%, 95% CI 1.257%-1.352%). All-cause DoSC rate at CCHMC was predicted most strongly by previous no show. As for community-level data, the proportion of African American inhabitants per census tract was consistently an important predictor. In the Texas area, the proportion of overcrowded households was salient to DoSC rate. Conclusions: Our findings suggest that geospatial analysis offers potential for use in targeting interventions for census tracts at a higher risk of cancellation. Our study also demonstrates the importance of home location, socioeconomic disadvantage, and racial minority status on the DoSC of children’s surgery. The success of future efforts to reduce cancellation may benefit from taking social, economic, and cultural issues into account. %M 34505837 %R 10.2196/26231 %U https://www.jmir.org/2021/9/e26231 %U https://doi.org/10.2196/26231 %U http://www.ncbi.nlm.nih.gov/pubmed/34505837 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26189 %T The Impact of Digital Patient Portals on Health Outcomes, System Efficiency, and Patient Attitudes: Updated Systematic Literature Review %A Carini,Elettra %A Villani,Leonardo %A Pezzullo,Angelo Maria %A Gentili,Andrea %A Barbara,Andrea %A Ricciardi,Walter %A Boccia,Stefania %+ Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, L go F Vito 1, Rome, 00168, Italy, 39 0630154396, angelomaria.pezzullo01@icatt.it %K digital health %K patient portal %K health outcomes %K patient satisfaction %K patient attitudes %K health service research %K health care efficiency %D 2021 %7 8.9.2021 %9 Review %J J Med Internet Res %G English %X Background: Patient portals are becoming increasingly popular worldwide even though their impact on individual health and health system efficiency is still unclear. Objective: The aim of this systematic review was to summarize evidence on the impact of patient portals on health outcomes and health care efficiency, and to examine user characteristics, attitudes, and satisfaction. Methods: We searched the PubMed and Web of Science databases for articles published from January 1, 2013, to October 31, 2019. Eligible studies were primary studies reporting on the impact of patient portal adoption in relation to health outcomes, health care efficiency, and patient attitudes and satisfaction. We excluded studies where portals were not accessible for patients and pilot studies, with the exception of articles evaluating patient attitudes. Results: Overall, 3456 records were screened, and 47 articles were included. Among them, 11 studies addressed health outcomes reporting positive results, such as better monitoring of health status, improved patient-doctor interaction, and improved quality of care. Fifteen studies evaluated the impact of digital patient portals on the utilization of health services with mixed results. Patient characteristics were described in 32 studies, and it was reported that the utilization rate usually increases with age and female gender. Finally, 30 studies described attitudes and defined the main barriers (concerns about privacy and data security, and lack of time) and facilitators (access to clinical data and laboratory results) to the use of a portal. Conclusions: Evidence regarding health outcomes is generally favorable, and patient portals have the potential to enhance the doctor-patient relationship, improve health status awareness, and increase adherence to therapy. It is still unclear whether the use of patient portals improves health service utilization and efficiency. %M 34494966 %R 10.2196/26189 %U https://www.jmir.org/2021/9/e26189 %U https://doi.org/10.2196/26189 %U http://www.ncbi.nlm.nih.gov/pubmed/34494966 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e29396 %T Using Administrative Data to Explore Potentially Aberrant Provision of Virtual Care During COVID-19: Retrospective Cohort Study of Ontario Provincial Data %A Stamenova,Vess %A Chu,Cherry %A Pang,Andrea %A Tadrous,Mina %A Bhatia,R Sacha %A Cram,Peter %+ Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 416 268 0985, vess.stamenova@wchospital.ca %K telemedicine %K virtual care %K COVID-19 %K pandemic %K virtual health %K telehealth %K ambulatory visits %K physicians %K patients %K digital health %D 2021 %7 7.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has led to a rapid increase in virtual care use across the globe. Many health care systems have responded by creating virtual care billing codes that allow physicians to see their patients over telephone or video. This rapid liberalization of billing requirements, both in Canada and other countries, has led to concerns about potential abuse, but empirical data are limited. Objective: The objectives of this study were to examine whether there were substantial changes in physicians’ ambulatory visit volumes coinciding with the liberalization of virtual care billing rules and to describe the characteristics of physicians who significantly increased their ambulatory visit volumes during this period. We also sought to describe the relationship between visit volume changes in 2020 and the volumes of virtual care use among individual physicians and across specialties. Methods: We conducted a population-based, retrospective cohort study using health administrative data from the Ontario Health Insurance Plan, which was linked to the ICES Physician Database. We identified a unique cohort of providers based on physicians’ billings and calculated the ratio of total in-person and virtual ambulatory visits over the period from January to June 2020 (virtual predominating) relative to that over the period from January to June 2019 (in-person predominating) for each physician. Based on these ratios, we then stratified physicians into four groups: low-, same-, high-, and very high–use physicians. We then calculated various demographic and practice characteristics of physicians in each group. Results: Among 28,383 eligible physicians in 2020, the mean ratio of ambulatory visits in January to June 2020:2019 was 0.99 (SD 2.53; median 0.81, IQR 0.59-1.0). Out of 28,383 physicians, only 2672 (9.4%) fell into the high-use group and only 291 (1.0%) fell into the very high–use group. High-use physicians were younger, more recent graduates, more likely female, and less likely to be international graduates. They also had, on average, lower-volume practices. There was a significant positive correlation between percent virtual care and the 2020:2019 ratio only in the group of physicians who maintained their practice (R=0.35, P<.001). There was also a significant positive correlation between the 2020:2019 ratio and the percent virtual care per specialty (R=0.59, P<.01). Conclusions: During the early stages of the pandemic, the introduction of virtual care did not lead to significant increases in visit volume. Our results provide reassuring evidence that relaxation of billing requirements early in the COVID-19 pandemic in Ontario were not associated with widespread and aberrant billing behaviors. Furthermore, the strong relationship between the ability to maintain practice volumes and the use of virtual care suggests that the introduction of virtual care allowed for continued access to care for patients. %M 34313590 %R 10.2196/29396 %U https://www.jmir.org/2021/9/e29396 %U https://doi.org/10.2196/29396 %U http://www.ncbi.nlm.nih.gov/pubmed/34313590 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e25195 %T The Effect of Telehealth on Hospital Services Use: Systematic Review and Meta-analysis %A Peters,Guido M %A Kooij,Laura %A Lenferink,Anke %A van Harten,Wim H %A Doggen,Carine J M %+ Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Drienerlolaan 5, Enschede, 7522NB, Netherlands, 31 534897475, c.j.m.doggen@utwente.nl %K telehealth %K systematic review %K meta-analysis %K hospitalization %K health services use %K eHealth %D 2021 %7 1.9.2021 %9 Review %J J Med Internet Res %G English %X Background: Telehealth interventions, that is, health care provided over a distance using information and communication technology, are suggested as a solution to rising health care costs by reducing hospital service use. However, the extent to which this is possible is unclear. Objective: The aim of this study is to evaluate the effect of telehealth on the use of hospital services, that is, (duration of) hospitalizations, and to compare the effects between telehealth types and health conditions. Methods: We searched PubMed, Scopus, and the Cochrane Library from inception until April 2019. Peer-reviewed randomized controlled trials (RCTs) reporting the effect of telehealth interventions on hospital service use compared with usual care were included. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool and quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation guidelines. Results: We included 127 RCTs in the meta-analysis. Of these RCTs, 82.7% (105/127) had a low risk of bias or some concerns overall. High-quality evidence shows that telehealth reduces the risk of all-cause or condition-related hospitalization by 18 (95% CI 0-30) and 37 (95% CI 20-60) per 1000 patients, respectively. We found high-quality evidence that telehealth leads to reductions in the mean all-cause and condition-related hospitalizations, with 50 and 110 fewer hospitalizations per 1000 patients, respectively. Overall, the all-cause hospital days decreased by 1.07 (95% CI −1.76 to −0.39) days per patient. For hospitalized patients, the mean hospital stay for condition-related hospitalizations decreased by 0.89 (95% CI −1.42 to −0.36) days. The effects were similar between telehealth types and health conditions. A trend was observed for studies with longer follow-up periods yielding larger effects. Conclusions: Small to moderate reductions in hospital service use can be achieved using telehealth. It should be noted that, despite the large number of included studies, uncertainties around the magnitude of effects remain, and not all effects are statistically significant. %M 34468324 %R 10.2196/25195 %U https://www.jmir.org/2021/9/e25195 %U https://doi.org/10.2196/25195 %U http://www.ncbi.nlm.nih.gov/pubmed/34468324 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e26887 %T Analysis of Hospital Quality Measures and Web-Based Chargemasters, 2019: Cross-sectional Study %A Patel,Kunal N %A Mazurenko,Olena %A Ford,Eric %+ Northern Illinois University, 1425 West Lincoln Highway, DeKalb, IL, 60115, United States, 1 815 753 1891, kpatel27@niu.edu %K chargemaster %K standard charge %K price transparency %K health care %K diagnosis-related group %K DRG %K quality measures %K the Centers for Medicare and Medicaid Services regulation %K CMS %D 2021 %7 19.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The federal health care price transparency regulation from 2019 is aimed at bending the health care cost curve by increasing the availability of hospital pricing information for the public. Objective: This study aims to examine the associations between publicly reported diagnosis-related group chargemaster prices on the internet and quality measures, process indicators, and patient-reported experience measures. Methods: In this cross-sectional study, we collected and analyzed a random 5.02% (212/4221) stratified sample of US hospital prices in 2019 using descriptive statistics and multivariate analysis. Results: We found extreme price variation in shoppable services and significantly greater price variation for medical versus surgical services (P=.006). In addition, we found that quality indicators were positively associated with standard charges, such as mortality (β=.929; P<.001) and readmissions (β=.514; P<.001). Other quality indicators, such as the effectiveness of care (β=−.919; P<.001), efficient use of medical imaging (β=−.458; P=.001), and patient recommendation scores (β=−.414; P<.001), were negatively associated with standard charges. Conclusions: We found that hospital chargemasters display wide variations in prices for medical services and procedures and match variations in quality measures. Further work is required to investigate 100% of US hospital prices posted publicly on the internet and their relationship with quality measures. %M 34420914 %R 10.2196/26887 %U https://formative.jmir.org/2021/8/e26887 %U https://doi.org/10.2196/26887 %U http://www.ncbi.nlm.nih.gov/pubmed/34420914 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e30453 %T Digital Orientation of Health Systems in the Post–COVID-19 “New Normal” in the United States: Cross-sectional Survey %A Khuntia,Jiban %A Ning,Xue %A Stacey,Rulon %+ CU Business School, University of Colorado Denver, 1475 Lawrence Street, Denver, CO, 80202, United States, 1 3038548024, jiban.khuntia@ucdenver.edu %K post–COVID-19 %K digital orientation %K health systems %K digital transformation %K digital health %K telehealth %K telemedicine %K COVID-19 %K impact %K insight %K cross-sectional %K survey %K United States %K electronic health record %K EHR %D 2021 %7 16.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Almost all health systems have developed some form of customer-facing digital technologies and have worked to align these systems to their existing electronic health records to accommodate the surge in remote and virtual care deliveries during the COVID-19 pandemic. Others have developed analytics-driven decision-making capabilities. However, it is not clear how health systems in the United States are embracing digital technologies and there is a gap in health systems’ abilities to integrate workflows with expanding technologies to spur innovation and futuristic growth. There is a lack of reliable and reported estimates of the current and futuristic digital orientations of health systems. Periodic assessments will provide imperatives to policy formulation and align efforts to yield the transformative power of emerging digital technologies. Objective: The aim of this study was to explore and examine differences in US health systems with respect to digital orientations in the post–COVID-19 “new normal” in 2021. Differences were assessed in four dimensions: (1) analytics-oriented digital technologies (AODT), (2) customer-oriented digital technologies (CODT), (3) growth and innovation–oriented digital technologies (GODT), and (4) futuristic and experimental digital technologies (FEDT). The former two dimensions are foundational to health systems’ digital orientation, whereas the latter two will prepare for future disruptions. Methods: We surveyed a robust group of health system chief executive officers (CEOs) across the United States from February to March 2021. Among the 625 CEOs, 135 (22%) responded to our survey. We considered the above four broad digital technology orientations, which were ratified with expert consensus. Secondary data were collected from the Agency for Healthcare Research and Quality Hospital Compendium, leading to a matched usable dataset of 124 health systems for analysis. We examined the relationship of adopting the four digital orientations to specific hospital characteristics and earlier reported factors as barriers or facilitators to technology adoption. Results: Health systems showed a lower level of CODT (mean 4.70) or GODT (mean 4.54) orientations compared with AODT (mean 5.03), and showed the lowest level of FEDT orientation (mean 4.31). The ordered logistic estimation results provided nuanced insights. Medium-sized (P<.001) health systems, major teaching health systems (P<.001), and systems with high-burden hospitals (P<.001) appear to be doing worse with respect to AODT orientations, raising some concerns. Health systems of medium (P<.001) and large (P=.02) sizes, major teaching health systems (P=.07), those with a high revenue (P=.05), and systems with high-burden hospitals (P<.001) have less CODT orientation. Health systems in the midwest (P=.05) and southern (P=.04) states are more likely to adopt GODT, whereas high-revenue (P=.004) and investor-ownership (P=.01) health systems are deterred from GODT. Health systems of a medium size, and those that are in the midwest (P<.001), south (P<.001), and west (P=.01) are more adept to FEDT, whereas medium (P<.001) and high-revenue (P<.001) health systems, and those with a high discharge rate (P=.04) or high burden (P=.003, P=.005) have subdued FEDT orientations. Conclusions: Almost all health systems have some current foundational digital technological orientations to glean intelligence or service delivery to customers, with some notable exceptions. Comparatively, fewer health systems have growth or futuristic digital orientations. The transformative power of digital technologies can only be leveraged by adopting futuristic digital technologies. Thus, the disparities across these orientations suggest that a holistic, consistent, and well-articulated direction across the United States remains elusive. Accordingly, we suggest that a policy strategy and financial incentives are necessary to spur a well-visioned and articulated digital orientation for all health systems across the United States. In the absence of such a policy to collectively leverage digital transformations, differences in care across the country will continue to be a concern. %M 34254947 %R 10.2196/30453 %U https://www.jmir.org/2021/8/e30453 %U https://doi.org/10.2196/30453 %U http://www.ncbi.nlm.nih.gov/pubmed/34254947 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e22316 %T Integrating Welfare Technology in Long-term Care Services: Nationwide Cross-sectional Survey Study %A Rostad,Hanne Marie %A Stokke,Randi %+ Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Teknologivegen 22, Gjøvik, 2815, Norway, 47 61 13 54 00, hanne.m.rostad@ntnu.no %K ambient assisted living %K cross-sectional survey %K home care services %K innovation %K long-term care %K nursing homes %K telecare %K welfare technology %K mobile phone %D 2021 %7 16.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Welfare technologies are often described as a solution to the increasing pressure on primary health care services. However, despite initiating welfare technology projects in the health care sector and different government incentives, research indicates that it is difficult to integrate welfare technology innovations in a complex and varying setting, such as long-term care. Objective: We aim to describe the types of welfare technology and the extent to which welfare technology is provided in long-term care (ie, nursing homes and home care services); examine whether the extent of welfare technology provision differs on the basis of municipal characteristics (ie, population size, centrality, the proportion of older inhabitants, and income); and identify how local governments (ie, municipalities) describe their efforts toward integrating welfare technologies in long-term care. Methods: Quantitative and qualitative data about welfare technology from a larger cross-sectional survey about the provision of long-term care services in Norwegian municipalities were combined with registry data. Representatives of 422 Norwegian municipalities were invited to participate in the survey. Frequencies were used to describe the distribution of the types and extent of welfare technologies, whereas the Fisher exact test and Kruskal-Wallis one-way analysis of variance were used to determine the association between the extent of welfare technology and municipal characteristics. Free-form text data were analyzed using thematic analysis. Results: A total of 277 municipalities were surveyed. Technology for safety was the most widespread type of welfare technology, whereas technology for social contact was the least prevalent. Two-thirds of the sample (183/277, 66.1%) in nursing home and (197/277, 71.1%) in home care services reported providing one or two different types of welfare technology. There was a statistically significant association between the extent of welfare technology and population size (in both nursing homes and home care services: P=.01), centrality (nursing homes: P=.01; home care services: P<.001), and municipal income (nursing homes: P=.02; home care services: P<.001). The extent of welfare technology was not associated with the proportion of older adults. The municipalities described being in a piloting phase and committing to future investment in welfare technology. Monetary resources were allocated, competency development among staff was initiated, and the municipalities were concerned about establishing collaborations within and between municipalities. Home care services seem to have a more person-centered approach in their efforts toward integrating welfare technologies, whereas nursing homes seem to have a more technology-centered approach. Conclusions: Many municipalities provide welfare technologies; however, their extent is limited and varies according to municipal characteristics. Municipal practices still seem dominated by piloting, and welfare technologies are not fully integrated into long-term care services. Innovation with welfare technology appears top-down and is influenced by national policy but also reflects creating a window of opportunity through the organization of municipal efforts toward integrating welfare technology through, for example, collaborations and committing personnel and financial resources. %M 34398791 %R 10.2196/22316 %U https://www.jmir.org/2021/8/e22316 %U https://doi.org/10.2196/22316 %U http://www.ncbi.nlm.nih.gov/pubmed/34398791 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e27618 %T Public Awareness and Utilization of 937-Telephone Health Services in the Kingdom of Saudi Arabia Before and During the COVID-19 Pandemic: Longitudinal Study %A Al-Rayes,Saja A %A Alumran,Arwa %A Aljabri,Duaa %A Aljaffary,Afnan %A Aldoukhi,Ethar %A Alahmedalyousif,Zainab %A Al Madani,Reem %+ Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman bin Faisal University, King Faisal Road, Dammam, Saudi Arabia, 966 1333333766, aaljaffari@iau.edu.sa %K awareness %K COVID-19 %K Kingdom of Saudi Arabia %K telehealth %K telemedicine %K utilization %D 2021 %7 30.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Telehealth plays a key role in supporting health care systems and influencing methods of health care delivery. Government laws and medical operating protocols have been largely modified to provide remote care to reduce social contact and ensure a safer patient environment. In the Kingdom of Saudi Arabia (KSA), the Ministry of Health (MOH) introduced several forms of telemedicine as alternatives to face-to-face consultations in clinical settings. Objective: This study aimed to assess the awareness and utilization of telehealth services before and during the COVID-19 outbreak in the KSA. Methods: In this longitudinal study, we compared the awareness and utilization of 937-telephone health services (ie, a toll-free telephone service to provide medical and administrative health care services at any time for the population) before and during the COVID-19 outbreak in the KSA. Using a convenience sampling technique, a validated web-based questionnaire was distributed on social media platforms (Facebook, Twitter, and WhatsApp) at 2 timepoints: before (February 2019) and during (May 2020) the COVID-19 pandemic. Results: The study sample comprised a total of 1961 participants who completed the questionnaire before (n=1303, 66%) and during (n=658, 33%) the COVID-19 pandemic. Both awareness (before=46% vs during=78%) and utilization (before=42% vs during=48%) of the 937-telephone health services increased significantly during the pandemic (P<.001). No significant association of the awareness or utilization of 937-telephone health services before and during the COVID-19 pandemic was found with respect to the participants’ age, education level, having children, or having any chronic disease. Conclusions: Our findings indicate significant increases in the awareness and utilization of 937-telephone health services during the early days of the COVID-19 pandemic, suggesting an increase in public acceptance of the service and providing evidence of an equitable telemedicine service for the population. Further studies are needed to provide a deeper understanding of the barriers and facilitators to the use of 937-telephone health services for different groups of the population. %M 34156963 %R 10.2196/27618 %U https://www.jmir.org/2021/7/e27618 %U https://doi.org/10.2196/27618 %U http://www.ncbi.nlm.nih.gov/pubmed/34156963 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 7 %P e26187 %T Tele–Mental Health for Reaching Out to Patients in a Time of Pandemic: Provider Survey and Meta-analysis of Patient Satisfaction %A Mazziotti,Raffaele %A Rutigliano,Grazia %+ Department of Pathology, University of Pisa, via Savi, 10, Pisa, 56126, Italy, 39 3496117744, grazia.rutigliano.gr@gmail.com %K telepsychiatry %K telepsychology %K e-mental health %K document clustering %K survey %K COVID-19 %K access to care %K patient satisfaction %K mental health %K tele–mental health %K review %K telemedicine %K satisfaction %K access %D 2021 %7 29.7.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic threatened to impact mental health by disrupting access to care due to physical distance measures and the unexpected pressure on public health services. Tele–mental health was rapidly implemented to deliver health care services. Objective: The aims of this study were (1) to present state-of-the-art tele–mental health research, (2) to survey mental health providers about care delivery during the pandemic, and (3) to assess patient satisfaction with tele–mental health. Methods: Document clustering was applied to map research topics within tele–mental health research. A survey was circulated among mental health providers. Patient satisfaction was investigated through a meta-analysis of studies that compared satisfaction scores between tele–mental health and face-to-face interventions for mental health disorders, retrieved from Web of Knowledge and Scopus. Hedges g was used as the effect size measure, and effect sizes were pooled using a random-effect model. Sources of heterogeneity and bias were examined. Results: Evidence on tele–mental health has been accumulating since 2000, especially regarding service implementation, depressive or anxiety disorders, posttraumatic stress disorder, and special populations. Research was concentrated in a few countries. The survey (n=174 respondents from Italy, n=120 international) confirmed that, after the onset of COVID-19 outbreak, there was a massive shift from face-to-face to tele–mental health delivery of care. However, respondents held skeptical views about tele–mental health and did not feel sufficiently trained and satisfied. Meta-analysis of 29 studies (n=2143) showed that patients would be equally satisfied with tele–mental health as they are with face-to-face interventions (Hedges g=−0.001, 95% CI −0.116 to 0.114, P=.98, Q=43.83, I2=36%, P=.03) if technology-related issues were minimized. Conclusions: Mental health services equipped with tele–mental health will be better able to cope with public health crises. Both providers and patients need to be actively engaged in digitization, to reshape their reciprocal trust around technological innovations. %M 34114956 %R 10.2196/26187 %U https://mental.jmir.org/2021/7/e26187 %U https://doi.org/10.2196/26187 %U http://www.ncbi.nlm.nih.gov/pubmed/34114956 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e23779 %T Understanding “Internet Plus Healthcare” in China: Policy Text Analysis %A Yang,Feng %A Shu,Huilin %A Zhang,Xiaoqian %+ McGill University, 3661 Peel St., Montreal, QC, H3A 1X1, Canada, 1 5149674660, xiaoqian.zhang@mail.mcgill.ca %K internet plus health care %K China %K policy analysis %K COVID-19 %K epidemic %D 2021 %7 26.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The combination of the internet and healthcare has excellent benefits and far-reaching positive effects in improving service efficiency and promoting social equity. The role of the “internet plus healthcare” (IPHC) has been recognized, especially during the COVID-19 pandemic. This new healthcare model is also familiar to people and shows a bright prospect. Objective: This article seeks to accurately understand and fully grasp the characteristics of IPHC policies that can enlighten the formulation of future policies. Methods: The content analysis method was used to analyze China’s IPHC policies collected from the Beida Fabao database and several official websites. Results: We found that the development of IPHC policy has gone through 4 stages and is currently entering a phase of rapid development. IPHC policymakers are primarily health administrative departments. In addition, policy instruments are classified into either supply, environment, or demand, and policy themes can be summarized into 4 categories: facilities, technology, service, and management. Conclusions: China’s IPHC policy has good prospects from the perspective of development trends. The health administrative departments mainly lead the development of China’s IPHC policy. It is suggested that these departments involve other stakeholders (ie, medical workers, medical industries, and technology sectors) in formulating policies. Policies prefer to use supply-based and environment-based policy instruments. The policy themes emphasize improving infrastructure construction and high-quality diagnostic and treatment services, strengthening the supporting role of information technology, and ensuring all stakeholders understand their responsibilities. %M 34309581 %R 10.2196/23779 %U https://www.jmir.org/2021/7/e23779 %U https://doi.org/10.2196/23779 %U http://www.ncbi.nlm.nih.gov/pubmed/34309581 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e24917 %T The Effect of 24/7, Digital-First, NHS Primary Care on Acute Hospital Spending: Retrospective Observational Analysis %A Winward,Sam %A Patel,Tejal %A Al-Saffar,Mazin %A Noble,Matthew %+ Babylon Health, 1 Knightsbridge Green, London, SW1X 7QA, United Kingdom, 44 0330 223 1008, sam.winward@babylonhealth.com %K primary health care %K family practice %K general practice %K cost %K cost analysis %K telemedicine %K digital technology %K digital health %K digital care %K virtual care %K hospital %K retrospective %K observational %K cohort %K finance %K economics %K health services research %D 2021 %7 22.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health has the potential to revolutionize health care by improving accessibility, patient experience, outcomes, productivity, safety, and cost efficiency. In England, the NHS (National Health Service) Long Term Plan promised the right to access digital-first primary care by March 31, 2024. However, there are few global, fully digital-first providers and limited research into their effects on cost from a health system perspective. Objective: The aim of this study was to evaluate the impact of highly accessible, digital-first primary care on acute hospital spending. Methods: A retrospective, observational analysis compared acute hospital spending on patients registered to a 24/7, digital-first model of NHS primary care with that on patients registered to all other practices in North West London Collaboration of Clinical Commissioning Groups. Acute hospital spending data per practice were obtained under a freedom of information request. Three versions of NHS techniques designed to fairly allocate funding according to need were used to standardize or “weight” the practice populations; hence, there are 3 results for each year. The weighting adjusted the populations for characteristics that impact health care spending, such as age, sex, and deprivation. The total spending was divided by the number of standardized or weighted patients to give the spending per weighted patient, which was used to compare the 2 groups in the NHS financial years (FY) 2018-2019 (FY18/19) and 2019-2020 (FY19/20). FY18/19 costs were adjusted for inflation, so they were comparable with the values of FY19/20. Results: The NHS spending on acute hospital care for 2.43 million and 2.54 million people (FY18/19 and FY19/20) across 358 practices and 49 primary care networks was £1.6 billion and £1.65 billion (a currency exchange rate of £1=US $1.38 is applicable), respectively. The spending on acute care per weighted patient for Babylon GP at Hand members was 12%, 31%, and 54% (£93, P=.047; £223, P<.001; and £389, P<.001) lower than the regional average in FY18/19 for the 3 weighting methodologies used. In FY19/20, it was 15%, 35%, and 51% (£114, P=.006; £246, P<.001; and £362, P<.001) lower. This amounted to lower costs for the Babylon GP at Hand population of £1.37, £4.40 million, and £11.6 million, respectively, in FY18/19; and £3.26 million, £9.54 million, and £18.8 million, respectively, in FY19/20. Conclusions: Patients with access to 24/7, digital-first primary care incurred significantly lower acute hospital costs. %M 34292160 %R 10.2196/24917 %U https://www.jmir.org/2021/7/e24917 %U https://doi.org/10.2196/24917 %U http://www.ncbi.nlm.nih.gov/pubmed/34292160 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e18488 %T Patient Experience in Virtual Visits Hinges on Technology and the Patient-Clinician Relationship: A Large Survey Study With Open-ended Questions %A Rose,Susannah %A Hurwitz,Heather McKee %A Mercer,Mary Beth %A Hizlan,Sabahat %A Gali,Kari %A Yu,Pei-Chun %A Franke,Caroline %A Martinez,Kathryn %A Stanton,Matthew %A Faiman,Matthew %A Rasmussen,Peter %A Boissy,Adrienne %+ Office of Patient Experience, Clinical Transformation, Cleveland Clinic, 9500 Euclid Avenue, JJ60, Cleveland, OH, 44195, United States, 1 216 444 0849, roses2@ccf.org %K telehealth %K virtual visit %K patient experience %K mobile phone %D 2021 %7 21.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient satisfaction with in-person medical visits includes patient-clinician engagement. However, communication, empathy, and other relationship-centered care measures in virtual visits have not been adequately investigated. Objective: This study aims to comprehensively consider patient experience, including relationship-centered care measures, to assess patient satisfaction during virtual visits. Methods: We conducted a large survey study with open-ended questions to comprehensively assess patients’ experiences with virtual visits in a diverse patient population. Adults with a virtual visit between June 21, 2017, and July 12, 2017, were invited to complete a survey of 21 Likert-scale items and textboxes for comments following their visit. Factor analysis of the survey items revealed three factors: experience with technology, patient-clinician engagement, and overall satisfaction. Multivariable logistic regression was used to test the associations among the three factors and patient demographics, clinician type, and prior relationship with the clinician. Using qualitative framework analysis, we identified recurrent themes in survey comments, quantitatively coded comments, and computed descriptive statistics of the coded comments. Results: A total of 65.7% (426/648) of the patients completed the survey; 64.1% (273/426) of the respondents were women, and the average age was 46 (range 18-86) years. The sample was geographically diverse: 70.2% (299/426) from Ohio, 6.8% (29/426) from Florida, 4.2% (18/426) from Pennsylvania, and 18.7% (80/426) from other states. With regard to insurance coverage, 57.5% (245/426) were undetermined, 23.7% (101/426) had the hospital’s employee health insurance, and 18.7% (80/426) had other private insurance. Types of virtual visits and clinicians varied. Overall, 58.4% (249/426) of patients had an on-demand visit, whereas 41.5% (177/426) had a scheduled visit. A total of 41.8% (178/426) of patients had a virtual visit with a family physician, 20.9% (89/426) with an advanced practice provider, and the rest had a visit with a specialist. Most patients (393/423, 92.9%) agreed that their virtual visit clinician was interested in them as a person, and their virtual visit made it easy to get the care they needed (383/421, 90.9%). A total of 81.9% (344/420) of respondents agreed or strongly agreed that their virtual visit was as good as an in-person visit by a clinician. Having a prior relationship with their virtual visit clinician was associated with less comfort and ease with virtual technology among patients (odds ratio 0.58, 95% CI 0.35-0.98). In terms of technology, patients found the interface easy to use (392/423, 92.7%) and felt comfortable using it (401/423, 94.8%). Technical difficulties were associated with lower odds of overall satisfaction (odds ratio 0.46, 95% CI 0.28-0.76). Conclusions: Patient-clinician engagement in virtual visits was comparable with in-person visits. This study supports the value and acceptance of virtual visits. Evaluations of virtual visits should include assessments of technology and patient-clinician engagement, as both are likely to influence patient satisfaction. %M 34152276 %R 10.2196/18488 %U https://www.jmir.org/2021/6/e18488 %U https://doi.org/10.2196/18488 %U http://www.ncbi.nlm.nih.gov/pubmed/34152276 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e17095 %T Rating Hospital Performance in China: Review of Publicly Available Measures and Development of a Ranking System %A Dong,Shengjie %A Millar,Ross %A Shi,Chenshu %A Dong,Minye %A Xiao,Yuyin %A Shen,Jie %A Li,Guohong %+ China Hospital Development Institute, Shanghai Jiao Tong University School of Medicine, 227 South Chong Qing Road, Shanghai, 200025, China, 86 21 63846590, guohongli@sjtu.edu.cn %K hospital ranking %K performance measurement %K health care quality %K China health care reform %D 2021 %7 17.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In China, significant emphasis and investment in health care reform since 2009 has brought with it increasing scrutiny of its public hospitals. Calls for greater accountability in the quality of hospital care have led to increasing attention toward performance measurement and the development of hospital ratings. Despite such interest, there has yet to be a comprehensive analysis of what performance information is publicly available to understand the performance of hospitals in China. Objective: This study aims to review the publicly available performance information about hospitals in China to assess options for ranking hospital performance. Methods: A review was undertaken to identify performance measures based on publicly available data. Following several rounds of expert consultation regarding the utility of these measures, we clustered the available options into three key areas: research and development, academic reputation, and quality and safety. Following the identification and clustering of the available performance measures, we set out to translate these into a practical performance ranking system to assess variation in hospital performance. Results: A new hospital ranking system termed the China Hospital Development Index (CHDI) is thus presented. Furthermore, we used CHDI for ranking well-known tertiary hospitals in China. Conclusions: Despite notable limitations, our assessment of available measures and the development of a new ranking system break new ground in understanding hospital performance in China. In doing so, CHDI has the potential to contribute to wider discussions and debates about assessing hospital performance across global health care systems. %M 34137724 %R 10.2196/17095 %U https://www.jmir.org/2021/6/e17095 %U https://doi.org/10.2196/17095 %U http://www.ncbi.nlm.nih.gov/pubmed/34137724 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e25028 %T A Determinants-of-Fertility Ontology for Detecting Future Signals of Fertility Issues From Social Media Data: Development of an Ontology %A Lee,Ji-Hyun %A Park,Hyeoun-Ae %A Song,Tae-Min %+ College of Nursing and Research Institute of Nursing Science, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 27408827, hapark@snu.ac.kr %K ontology %K fertility %K public policy %K South Korea %K social media %K future %K infodemiology %K infoveillance %D 2021 %7 14.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: South Korea has the lowest fertility rate in the world despite considerable governmental efforts to boost it. Increasing the fertility rate and achieving the desired outcomes of any implemented policies requires reliable data on the ongoing trends in fertility and preparations for the future based on these trends. Objective: The aims of this study were to (1) develop a determinants-of-fertility ontology with terminology for collecting and analyzing social media data; (2) determine the description logics, content coverage, and structural and representational layers of the ontology; and (3) use the ontology to detect future signals of fertility issues. Methods: An ontology was developed using the Ontology Development 101 methodology. The domain and scope of the ontology were defined by compiling a list of competency questions. The terms were collected from Korean government reports, Korea’s Basic Plan for Low Fertility and Aging Society, a national survey about marriage and childbirth, and social media postings on fertility issues. The classes and their hierarchy were defined using a top-down approach based on an ecological model. The internal structure of classes was defined using the entity-attribute-value model. The description logics of the ontology were evaluated using Protégé (version 5.5.0), and the content coverage was evaluated by comparing concepts extracted from social media posts with the list of ontology classes. The structural and representational layers of the ontology were evaluated by experts. Social media data were collected from 183 online channels between January 1, 2011, and June 30, 2015. To detect future signals of fertility issues, 2 classes of the ontology, the socioeconomic and cultural environment, and public policy, were identified as keywords. A keyword issue map was constructed, and the defined keywords were mapped to identify future signals. R software (version 3.5.2) was used to mine for future signals. Results: A determinants-of-fertility ontology comprised 236 classes and terminology comprised 1464 synonyms of the 236 classes. Concept classes in the ontology were found to be coherently and consistently defined. The ontology included more than 90% of the concepts that appeared in social media posts on fertility policies. Average scores for all of the criteria for structural and representations layers exceeded 4 on a 5-point scale. Violence and abuse (socioeconomic and cultural factor) and flexible working arrangement (fertility policy) were weak signals, suggesting that they could increase rapidly in the future. Conclusions: The determinants-of-fertility ontology developed in this study can be used as a framework for collecting and analyzing social media data on fertility issues and detecting future signals of fertility issues. The future signals identified in this study will be useful for policy makers who are developing policy responses to low fertility. %M 34125068 %R 10.2196/25028 %U https://www.jmir.org/2021/6/e25028 %U https://doi.org/10.2196/25028 %U http://www.ncbi.nlm.nih.gov/pubmed/34125068 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e27259 %T An Environmental Scan of Virtual “Walk-In” Clinics in Canada: Comparative Study %A Matthewman,Spencer %A Spencer,Sarah %A Lavergne,M Ruth %A McCracken,Rita K %A Hedden,Lindsay %+ Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada, 1 236 521 207, lindsay_hedden@sfu.ca %K virtual care %K primary care %K Canada %K virtual health %K patients %K physicians %D 2021 %7 11.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Canada has been slow to implement virtual care relative to other countries. However, in recent years, the availability of on-demand, “walk-in” virtual clinics has increased, with the COVID-19 pandemic contributing to the increased demand and provision of virtual care nationwide. Although virtual care facilitates access to physicians while maintaining physical distancing, there are concerns regarding the continuity and quality of care as well as equitable access. There is a paucity of research documenting the availability of virtual care in Canada, thus hampering the efforts to evaluate the impacts of its relatively rapid emergence on the broader health care system and on individual health. Objective: We conducted a national environmental scan to determine the availability and scope of virtual walk-in clinics, cataloging the services they offer and whether they are operating through public or private payment. Methods: We developed a power term and implemented a structured Google search to identify relevant clinics. From each clinic meeting our inclusion criteria, we abstracted data on the payment model, region of operation, services offered, and continuity of care. We compared clinics operating under different payment models using Fisher exact tests. Results: We identified 18 virtual walk-in clinics. Of the 18 clinics, 10 (56%) provided some services under provincial public insurance, although 44% (8/18) operated on a fully private payment model while an additional 39% (7/18) charged patients out of pocket for some services. The most common supplemental services offered included dermatology (15/18, 83%), mental health services (14/18, 78%), and sexual health (11/18, 61%). Continuity, information sharing, or communication with the consumers’ existing primary care providers were mentioned by 22% (4/18) of the clinics. Conclusions: Virtual walk-in clinics have proliferated; however, concerns about equitable access, continuity of care, and diversion of physician workforce within these models highlight the importance of supporting virtual care options within the context of longitudinal primary care. More research is needed to support quality virtual care and understand its effects on patient and provider experiences and the overall health system utilization and costs. %M 34114963 %R 10.2196/27259 %U https://www.jmir.org/2021/6/e27259 %U https://doi.org/10.2196/27259 %U http://www.ncbi.nlm.nih.gov/pubmed/34114963 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e24947 %T Association of Smartphone Ownership and Internet Use With Markers of Health Literacy and Access: Cross-sectional Survey Study of Perspectives From Project PLACE (Population Level Approaches to Cancer Elimination) %A Oshima,Sachiko M %A Tait,Sarah D %A Thomas,Samantha M %A Fayanju,Oluwadamilola M %A Ingraham,Kearston %A Barrett,Nadine J %A Hwang,E Shelley %+ Department of Surgery, Duke University School of Medicine, 465 Seeley Mudd Building, Durham, NC, 27710, United States, 1 919 684 6849, shelley.hwang@duke.edu %K telehealth %K technology %K health literacy %K access to health care %K mobile phone %D 2021 %7 9.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Telehealth is an increasingly important component of health care delivery in response to the COVID-19 pandemic. However, well-documented disparities persist in the use of digital technologies. Objective: This study aims to describe smartphone and internet use within a diverse sample, to assess the association of smartphone and internet use with markers of health literacy and health access, and to identify the mediating factors in these relationships. Methods: Surveys were distributed to a targeted sample designed to oversample historically underserved communities from April 2017 to December 2017. Multivariate logistic regression was used to estimate the association of internet and smartphone use with outcomes describing health care access and markers of health literacy for the total cohort and after stratifying by personal history of cancer. Health care access was captured using multiple variables, including the ability to obtain medical care when needed. Markers of health literacy included self-reported confidence in obtaining health information. Results: Of the 2149 participants, 1319 (61.38%) were women, 655 (30.48%) were non-Hispanic White, and 666 (30.99%) were non-Hispanic Black. The median age was 51 years (IQR 38-65). Most respondents reported using the internet (1921/2149, 89.39%) and owning a smartphone (1800/2149, 83.76%). Compared with the respondents with smartphone or internet access, those without smartphone or internet access were more likely to report that a doctor was their most recent source of health information (344/1800, 19.11% vs 116/349, 33.2% for smartphone and 380/1921, 19.78% vs 80/228, 35.1% for internet, respectively; both P<.001). Internet use was associated with having looked for information on health topics from any source (odds ratio [OR] 3.81, 95% CI 2.53-5.75) and confidence in obtaining health information when needed (OR 1.83, 95% CI 1.00-3.34) compared with noninternet users. Smartphone owners had lower odds of being unable to obtain needed medical care (OR 0.62, 95% CI 0.40-0.95) than nonsmartphone owners. Among participants with a prior history of cancer, smartphone ownership was significantly associated with higher odds of confidence in ability to obtain needed health information (OR 5.63, 95% CI 1.05-30.23) and lower odds of inability to obtain needed medical care (OR 0.17, 95% CI 0.06-0.47), although these associations were not significant among participants without a prior history of cancer. Conclusions: We describe widespread use of digital technologies in a community-based cohort, although disparities persist. In this cohort, smartphone ownership was significantly associated with ability to obtain needed medical care, suggesting that the use of smartphone technology may play a role in increasing health care access. Similarly, major illnesses such as cancer have the potential to amplify health engagement. Finally, special emphasis must be placed on reaching patient populations with limited digital access, so these patients are not further disadvantaged in the new age of telehealth. %M 34106076 %R 10.2196/24947 %U https://www.jmir.org/2021/6/e24947 %U https://doi.org/10.2196/24947 %U http://www.ncbi.nlm.nih.gov/pubmed/34106076 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e28629 %T Characteristics of Citizens and Their Use of Teleconsultations in Primary Care in the Catalan Public Health System Before and During the COVID-19 Pandemic: Retrospective Descriptive Cross-sectional Study %A Solans,Oscar %A Vidal-Alaball,Josep %A Roig Cabo,Pasqual %A Mora,Núria %A Coma,Ermengol %A Bonet Simó,Josep Maria %A Hermosilla Pérez,Eduardo %A Saigí-Rubió,Francesc %A Olmos Domínguez,Carmen %A Piera-Jiménez,Jordi %A Abizanda González,Mercè %A López Seguí,Francesc %+ Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Carrer Pica d'Estats, 36, Sant Fruitós de Bages, 08272, Spain, 34 936930040, jvidal.cc.ics@gencat.cat %K teleconsultation %K primary care %K remote consultation %K telehealth %K COVID-19 %K e-consultation %D 2021 %7 27.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: eConsulta—that is, asynchronous, two-way teleconsultation in primary care—is one of the most important telemedicine developments in the Catalan public health system, a service that has been heavily boosted by the onset of the COVID-19 pandemic. It is vital to know the characteristics of its users in order to be able to meet their needs and understand the coverage of this service in a context where there is reduced accessibility to the health system. Objective: This study aims to analyze the profile of the citizens who use the eConsulta tool and the reasons for their use, as well as to gain an understanding of the elements that characterize their decision to use it while distinguishing between those who used it before and those who have used it since the onset of the COVID-19 pandemic. Methods: A descriptive, observational study based on administrative data was performed. This study differentiates between the COVID-19 pandemic era and the period preceding it, considering the day the state of emergency was declared in Spain (ie, March 12, 2020) as the cut-off point. It also differentiates between eConsulta users who send messages and those who only receive them. Results: During the pandemic, the number of unique users of this teleconsultation service had almost tripled, with up to 33.10 visits per 1000 inhabitants per month reported in the first three months. For the two user profiles analyzed, most users since the start of the COVID-19 outbreak were predominantly female, systematically younger, more actively employed, and with less complex pathologies. Furthermore, eConsulta users received more messages proactively from the health professionals. There was also a relative decrease in the number of conversations initiated by higher-income urban users and an increase in conversations initiated by users in rural areas. Conclusions: The COVID-19 pandemic has helped to generalize the use of telemedicine as a tool to compensate, to some extent, for the decline in face-to-face visits, especially among younger citizens in Catalonia. Telemedicine has made it possible to maintain contact between citizens and the health care system in the context of maximum complexity. %M 33970867 %R 10.2196/28629 %U https://www.jmir.org/2021/5/e28629 %U https://doi.org/10.2196/28629 %U http://www.ncbi.nlm.nih.gov/pubmed/33970867 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26616 %T Developing an Automatic System for Classifying Chatter About Health Services on Twitter: Case Study for Medicaid %A Yang,Yuan-Chi %A Al-Garadi,Mohammed Ali %A Bremer,Whitney %A Zhu,Jane M %A Grande,David %A Sarker,Abeed %+ Department of Biomedical Informatics, School of Medicine, Emory University, 101 Woodruff Circle, 4th Floor East, Atlanta, GA, 30322, United States, 1 404 727 6123, yuan-chi.yang@emory.edu %K natural language processing %K machine learning %K Twitter %K infodemiology %K infoveillance %K Twitter %K social media %K Medicaid %K consumer feedback %D 2021 %7 3.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The wide adoption of social media in daily life renders it a rich and effective resource for conducting near real-time assessments of consumers’ perceptions of health services. However, its use in these assessments can be challenging because of the vast amount of data and the diversity of content in social media chatter. Objective: This study aims to develop and evaluate an automatic system involving natural language processing and machine learning to automatically characterize user-posted Twitter data about health services using Medicaid, the single largest source of health coverage in the United States, as an example. Methods: We collected data from Twitter in two ways: via the public streaming application programming interface using Medicaid-related keywords (Corpus 1) and by using the website’s search option for tweets mentioning agency-specific handles (Corpus 2). We manually labeled a sample of tweets in 5 predetermined categories or other and artificially increased the number of training posts from specific low-frequency categories. Using the manually labeled data, we trained and evaluated several supervised learning algorithms, including support vector machine, random forest (RF), naïve Bayes, shallow neural network (NN), k-nearest neighbor, bidirectional long short-term memory, and bidirectional encoder representations from transformers (BERT). We then applied the best-performing classifier to the collected tweets for postclassification analyses to assess the utility of our methods. Results: We manually annotated 11,379 tweets (Corpus 1: 9179; Corpus 2: 2200) and used 7930 (69.7%) for training, 1449 (12.7%) for validation, and 2000 (17.6%) for testing. A classifier based on BERT obtained the highest accuracies (81.7%, Corpus 1; 80.7%, Corpus 2) and F1 scores on consumer feedback (0.58, Corpus 1; 0.90, Corpus 2), outperforming the second best classifiers in terms of accuracy (74.6%, RF on Corpus 1; 69.4%, RF on Corpus 2) and F1 score on consumer feedback (0.44, NN on Corpus 1; 0.82, RF on Corpus 2). Postclassification analyses revealed differing intercorpora distributions of tweet categories, with political (400778/628411, 63.78%) and consumer feedback (15073/27337, 55.14%) tweets being the most frequent for Corpus 1 and Corpus 2, respectively. Conclusions: The broad and variable content of Medicaid-related tweets necessitates automatic categorization to identify topic-relevant posts. Our proposed system presents a feasible solution for automatic categorization and can be deployed and generalized for health service programs other than Medicaid. Annotated data and methods are available for future studies. %M 33938807 %R 10.2196/26616 %U https://www.jmir.org/2021/5/e26616 %U https://doi.org/10.2196/26616 %U http://www.ncbi.nlm.nih.gov/pubmed/33938807 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26558 %T Impact of the COVID-19 Pandemic on Health Care Utilization in a Large Integrated Health Care System: Retrospective Cohort Study %A Xu,Stanley %A Glenn,Sungching %A Sy,Lina %A Qian,Lei %A Hong,Vennis %A Ryan,Denison S %A Jacobsen,Steven %+ Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, 5th Floor, Pasadena, CA, 91101, United States, 1 6263726807, stan.xu@kp.org %K cohort %K COVID-19 %K difference-in-difference analysis %K health care utilization %K health care worker %K impact %K knowledge %K pandemic %K policy %K retrospective %K telehealth %K telemedicine %K usage %K utilization %D 2021 %7 29.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has caused an abrupt reduction in the use of in-person health care, accompanied by a corresponding surge in the use of telehealth services. However, the extent and nature of changes in health care utilization during the pandemic may differ by care setting. Knowledge of the impact of the pandemic on health care utilization is important to health care organizations and policy makers. Objective: The aims of this study are (1) to evaluate changes in in-person health care utilization and telehealth visits during the COVID-19 pandemic and (2) to assess the difference in changes in health care utilization between the pandemic year 2020 and the prepandemic year 2019. Methods: We retrospectively assembled a cohort consisting of members of a large integrated health care organization, who were enrolled between January 6 and November 2, 2019 (prepandemic year), and between January 5 and October 31, 2020 (pandemic year). The rates of visits were calculated weekly for four settings: inpatient, emergency department (ED), outpatient, and telehealth. Using Poisson models, we assessed the impact of the pandemic on health care utilization during the early days of the pandemic and conducted difference-in-deference (DID) analyses to measure the changes in health care utilization, adjusting for the trend of health care utilization in the prepandemic year. Results: In the early days of the pandemic, we observed significant reductions in inpatient, ED, and outpatient utilization (by 30.2%, 37.0%, and 80.9%, respectively). By contrast, there was a 4-fold increase in telehealth visits between weeks 8 (February 23) and 12 (March 22) in 2020. DID analyses revealed that after adjusting for prepandemic secular trends, the reductions in inpatient, ED, and outpatient visit rates in the early days of the pandemic were 1.6, 8.9, and 367.2 visits per 100 person-years (P<.001), respectively, while the increase in telehealth visits was 272.9 visits per 100 person-years (P<.001). Further analyses suggested that the increase in telehealth visits offset the reduction in outpatient visits by week 26 (June 28, 2020). Conclusions: In-person health care utilization decreased drastically during the early period of the pandemic, but there was a corresponding increase in telehealth visits during the same period. By end-June 2020, the combined outpatient and telehealth visits had recovered to prepandemic levels. %M 33882020 %R 10.2196/26558 %U https://www.jmir.org/2021/4/e26558 %U https://doi.org/10.2196/26558 %U http://www.ncbi.nlm.nih.gov/pubmed/33882020 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 2 %P e28589 %T Patient Satisfaction and Trust in Telemedicine During the COVID-19 Pandemic: Retrospective Observational Study %A Orrange,Sharon %A Patel,Arpna %A Mack,Wendy Jean %A Cassetta,Julia %+ Keck School of Medicine of USC, University of Southern California, 1975 Zonal Avenue, Los Angeles, CA, 90033, United States, 1 323 442 5100, sharon.orrange@med.usc.edu %K telemedicine %K patient satisfaction %K COVID-19 %K health services research %K health policy %K health care delivery %K physicians %K medicine %D 2021 %7 22.4.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Los Angeles County is a hub for COVID-19 cases in the United States. Academic health centers rapidly deployed and leveraged telemedicine to permit uninterrupted care of patients. Telemedicine enjoys high patient satisfaction, yet little is known about the level of satisfaction during a crisis and to what extent patient- or visit-related factors and trust play when in-person visits are eliminated. Objective: The aim of this study is to examine correlates of patients’ satisfaction with a telemedicine visit. Methods: In this retrospective observational study conducted in our single-institution, urban, academic medical center in Los Angeles, internal medicine patients aged ≥18 years who completed a telemedicine visit between March 10th and April 17th, 2020, were invited for a survey (n=1624). Measures included patient demographics, degree of interpersonal trust in patient-physician relationships (using the Trust in Physician Scale), and visit-related concerns. Statistical analysis used descriptive statistics, Spearman rank-order correlation, and linear and ordinal logistic regression. Results: Of 1624 telemedicine visits conducted during this period, 368 (22.7%) patients participated in the survey. Across the study, respondents were very satisfied (173/365, 47.4%) or satisfied (n=129, 35.3%) with their telemedicine visit. Higher physician trust was associated with higher patient satisfaction (Spearman correlation r=0.51, P<.001). Visit-related factors with statistically significant correlation with Trust in Physician score were technical issues with the telemedicine visit (r=–0.16), concerns about privacy (r=–0.19), concerns about cost (r=–0.23), satisfaction with telemedicine convenience (r=0.41), and amount of time spent (r=0.47; all P<.01). Visit-related factors associated with patients’ satisfaction included fewer technical issues (P<.001), less concern about privacy (P<.001) or cost (P=.02), and successful face-to-face video (P<.001). The only patient variable with a significant positive association was income and level of trust in physician (r=0.18, P<.001). Younger age was associated with higher satisfaction with the telemedicine visit (P=.005). Conclusions: There have been calls for redesigning primary care after the COVID-19 pandemic and for the widespread adoption of telemedicine. Patients’ satisfaction with telemedicine during the COVID-19 pandemic is high. Their satisfaction is shaped by the degree of trust in physician and visit-related factors more so than patient factors. This has widespread implications for outpatient practices and further research into visit-related factors and the patient-provider connection over telemedicine is needed. %M 33822736 %R 10.2196/28589 %U https://humanfactors.jmir.org/2021/2/e28589 %U https://doi.org/10.2196/28589 %U http://www.ncbi.nlm.nih.gov/pubmed/33822736 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25817 %T Characteristics of Online Health Care Services From China’s Largest Online Medical Platform: Cross-sectional Survey Study %A Jiang,Xuehan %A Xie,Hong %A Tang,Rui %A Du,Yanmei %A Li,Tao %A Gao,Jinsheng %A Xu,Xiuping %A Jiang,Siqi %A Zhao,Tingting %A Zhao,Wei %A Sun,Xingzhi %A Hu,Gang %A Wu,Dejun %A Xie,Guotong %+ Ping An Healthcare and Technology Company Limited, 17/F Building B, No. 166 Kaibin Road, Xuhui District, Shanghai, China, 86 18951670324, xiehong858@jk.cn %K eHealth %K internet hospital %K China %K online health care services %K mHealth %K COVID-19 %K digital health %K app %K online consultation %K user experience %D 2021 %7 15.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet hospitals in China are in great demand due to limited and unevenly distributed health care resources, lack of family doctors, increased burdens of chronic diseases, and rapid growth of the aged population. The COVID-19 epidemic catalyzed the expansion of online health care services. In recent years, internet hospitals have been rapidly developed. Ping An Good Doctor is the largest, national online medical entry point in China and is a widely used platform providing online health care services. Objective: This study aims to give a comprehensive description of the characteristics of the online consultations and inquisitions in Ping An Good Doctor. The analyses tried to answer the following questions: (1) What are the characteristics of the consultations in Ping An Good Doctor in terms of department and disease profiles? (2) Who uses the online health services most frequently? and (3) How is the user experience of the online consultations of Ping An Good Doctor? Methods: A total of 35.3 million consultations and inquisitions over the course of 1 year were analyzed with respect to the distributions of departments and diseases, user profiles, and consulting behaviors. Results: The geographical distribution of the usage of Ping An Good Doctor showed that Shandong (18.4%), Yunnan (15.6%), Shaanxi (7.2%), and Guangdong (5.5%) were the provinces that used it the most; they accounted for 46.6% of the total consultations and inquisitions. In terms of department distribution, we found that gynecology and obstetrics (19.2%), dermatology (17.0%), and pediatrics (14.4%) were the top three departments in Ping An Good Doctor. The disease distribution analysis showed that, except for nondisease-specific consultations, acute upper respiratory infection (AURI) (4.1%), pregnancy (2.8%), and dermatitis (2.4%) were the most frequently consulted diseases. In terms of user profiles, females (60.4%) from 19 to 35 years of age were most likely to seek consultations online, in general. The user behavior analyses showed that the peak times of day for online consultations occurred at 10 AM, 3 PM, and 9 PM. Regarding user experience, 93.0% of users gave full marks following their consultations. For some disease-related health problems, such as AURI, dermatitis, and eczema, the feedback scores were above average. Conclusions: The prevalence of internet hospitals, such as Ping An Good Doctor, illustrated the great demand for online health care services that can go beyond geographical limitations. Our analyses showed that nondisease-specific issues and moderate health problems were much more frequently consulted about than severe clinical conditions. This indicated that internet hospitals played the role of the family doctor, which helped to relieve the stress placed on offline hospitals and facilitated people’s lives. In addition, good user experiences, especially regarding disease-related inquisitions, suggested that online health services can help solve health problems. With support from the government and acceptance by the public, online health care services could develop at a fast pace and greatly benefit people’s daily lives. %M 33729985 %R 10.2196/25817 %U https://www.jmir.org/2021/4/e25817 %U https://doi.org/10.2196/25817 %U http://www.ncbi.nlm.nih.gov/pubmed/33729985 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 2 %P e23335 %T Utilization of Telehealth Services in Libya in Response to the COVID-19 Pandemic: Cross-sectional Analysis %A Elhadi,Muhammed %A Msherghi,Ahmed %A Elhadi,Ahmed %A Ashini,Aimen %A Alsoufi,Ahmed %A Bin Alshiteewi,Fatimah %A Elmabrouk,Amna %A Alsuyihili,Ali %A Elgherwi,Alsafa %A Elkhafeefi,Fatimah %A Abdulrazik,Sarah %A Tarek,Ahmed %+ Faculty of Medicine, University of Tripoli, Furnaj, University Road, Tripoli, 13275, Libyan Arab Jamahiriya, 218 945196407, muhammed.elhadi.uot@gmail.com %K COVID-19 %K cross-sectional study %K resource-limited countries %K SARS-CoV-2 %K telehealth %K telemedicine %K transitional countries %K usability %D 2021 %7 26.2.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Health care systems in transitional countries have witnessed unprecedented challenges related to adequate and continuous health care provision during the COVID-19 pandemic. In many countries, including Libya, institutions and organizations have begun to implement telehealth technology for the first time. This serves to establish an alternative modality for direct physician-patient interviews to reduce the risk of COVID-19 transmission. Objective: This study aimed to assess the usability of telehealth services in Libya and to provide an overview of the current COVID-19 scenario. Methods: In this cross-sectional study, an anonymous web-based survey was administered to Libyan residents between April and May 2020. Participants were contacted through text messaging, emails, and social media. The survey items yielded information on the sociodemographic characteristics, availability and accessibility of health care services, effects of the COVID-19 pandemic on health care services, mental health status, and the feasibility and application of the telehealth system. Results: We obtained 2512 valid responses, of which 1721 (68.5%) were from females. The participants were aged 28.2 (SD 7.6) years, of whom 2333 (92.9%) were aged <40 years, and 1463 (58.2%) were single. Regarding the health care services and their accessibility, 786 (31.1%) participants reported having a poor health status in general, and 492 (19.6%) reported having a confirmed diagnosis of at least one chronic disease. Furthermore, 498 (19.9%) participants reported varying degrees of difficulty in accessing health care centers, and 1558 (62.0%) could not access their medical records. Additionally, 1546 (61.6%) participants experienced problems in covering medical costs, and 1429 (56.9%) avoided seeking medical care owing to financial concerns. Regarding the feasibility of the telehealth system, approximately half of the participants reported that telehealth services were useful during the COVID-19 pandemic, and 1545 (61.5%) reported that the system was an effective means of communication and of obtaining health care services. Furthermore, 1435 (57.1%) participants felt comfortable using the telehealth system, and 1129 (44.9%) felt that they were able to express themselves effectively. Moreover, 1389 (55.3%) participants found the system easy to understand, and 1354 (53.9%) reported having excellent communication with physicians through the telehealth system. However, only 1018 (40.5%) participants reported that communication was better with the telehealth system than with traditional methods. Conclusions: Our study revealed high levels of usability and willingness to use the telemedicine system as an alternative modality to in-person consultations among the Libyan residents in this study. This system is advantageous because it helps overcome health care costs, increases access to prompt medical care and follow-up evaluation, and reduces the risk of COVID-19 transmission. However, internet connectivity and electricity issues could be a substantial barrier for many resource-limited communities, and further studies should address such obstacles. %M 33606654 %R 10.2196/23335 %U https://medinform.jmir.org/2021/2/e23335 %U https://doi.org/10.2196/23335 %U http://www.ncbi.nlm.nih.gov/pubmed/33606654 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 5 %N 1 %P e22975 %T Digital Footprint of Academic Vascular Surgeons in the Southern United States on Physician Rating Websites: Cross-sectional Evaluation Study %A Yan,Qi %A Jensen,Katherine J %A Thomas,Rose %A Field,Alyssa R %A Jiang,Zheng %A Goei,Christian %A Davies,Mark G %+ Division of Vascular Surgery, Department of Surgery, UT Health San Antonio, 7703 Floyd Curl Dr, MC7741, San Antonio, TX, 78229, United States, 1 210 567 5715, DaviesM@uthscsa.edu %K internet %K patient satisfaction %K quality of care %K physician rating sites %K patient experience %K professional reviews %K social media %D 2021 %7 24.2.2021 %9 Original Paper %J JMIR Cardio %G English %X Background: The internet has become a popular platform for patients to obtain information and to review the health care providers they interact with. However, little is known about the digital footprint of vascular surgeons and their interactions with patients on social media. Objective: This study aims to understand the activity of academic vascular surgeons on physician rating websites. Methods: Information on attending vascular surgeons affiliated with vascular residency or with fellowships in the Southern Association for Vascular Surgery (SAVS) was collected from public sources. A listing of websites containing physician ratings was obtained via literature reviews and Google search. Open access websites with either qualitative or quantitative evaluations of vascular surgeons were included. Closed access websites were excluded. Ranking scores from each website were converted to a standard 5-point scale for comparison. Results: A total of 6238 quantitative and 967 qualitative reviews were written for 287 physicians (236 males, 82.2%) across 16 websites that met the inclusion criteria out of the 62 websites screened. The surgeons affiliated with the integrated vascular residency and vascular fellowship programs in SAVS had a median of 8 (IQR 7-10) profiles across 16 websites, with only 1 surgeon having no web presence in any of the websites. The median number of quantitative ratings for each physician was 17 (IQR 6-34, range 1-137) and the median number of narrative reviews was 3 (IQR 2-6, range 1-28). Vitals, WebMD, and Healthgrades were the only 3 websites where over a quarter of the physicians were rated, and those rated had more than 5 ratings on average. The median score for the quantitative reviews was 4.4 (IQR 4.0-4.9). Most narrative reviews (758/967, 78.4%) were positive, but 20.2% (195/967) were considered negative; only 1.4% (14/967) were considered equivocal. No statistical difference was found in the number of quantitative reviews or in the overall average score in the physician ratings between physicians with social media profiles and those without social media profiles (departmental social media profile: median 23 vs 15, respectively, P=.22; personal social media profile: median 19 vs 14, respectively, P=.08). Conclusions: The representation of vascular surgeons on physician rating websites is varied, with the majority of the vascular surgeons represented only in half of the physician rating websites The number of quantitative and qualitative reviews for academic vascular surgeons is low. No vascular surgeon responded to any of the reviews. The activity of vascular surgeons in this area of social media is low and reflects only a small digital footprint that patients can reach and review. %M 33625359 %R 10.2196/22975 %U https://cardio.jmir.org/2021/1/e22975 %U https://doi.org/10.2196/22975 %U http://www.ncbi.nlm.nih.gov/pubmed/33625359 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25809 %T Patterns and Influencing Factors of eHealth Tools Adoption Among Medicaid and Non-Medicaid Populations From the Health Information National Trends Survey (HINTS) 2017-2019: Questionnaire Study %A Yang,Xin %A Yang,Ning %A Lewis,Dwight %A Parton,Jason %A Hudnall,Matthew %+ Institute of Data and Analytics, The University of Alabama, 250 Bidgood Hall, Tuscaloosa, AL, 35406, United States, 1 2053483267, xyang15@cba.ua.edu %K Medicaid program %K eHealth %K internet access %K digital divide %K health information technology %D 2021 %7 18.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Evidence suggests that eHealth tools adoption is associated with better health outcomes among various populations. The patterns and factors influencing eHealth adoption among the US Medicaid population remain obscure. Objective: The objective of this study is to explore patterns of eHealth tools adoption among the Medicaid population and examine factors associated with eHealth adoption. Methods: Data from the Health Information National Trends Survey from 2017 to 2019 were used to estimate the patterns of eHealth tools adoption among Medicaid and non-Medicaid populations. The effects of Medicaid insurance status and other influencing factors were assessed with logistic regression models. Results: Compared with the non-Medicaid population, the Medicaid beneficiaries had significantly lower eHealth tools adoption rates for health information management (11.2% to 17.5% less) and mobile health for self-regulation (0.8% to 9.7% less). Conversely, the Medicaid population had significantly higher adoption rates for using social media for health information than their counterpart (8% higher in 2018, P=.01; 10.1% higher in 2019, P=.01). Internet access diversity, education, and cardiovascular diseases were positively associated with health information management and mobile health for self-regulation among the Medicaid population. Internet access diversity is the only factor significantly associated with social media adoption for acquisition of health information (OR 1.98, 95% CI 1.26-3.11). Conclusions: Our results suggest digital disparities in eHealth tools adoption between the Medicaid and non-Medicaid populations. Future research should investigate behavioral correlates and develop interventions to improve eHealth adoption and use among underserved communities. %M 33599619 %R 10.2196/25809 %U http://www.jmir.org/2021/2/e25809/ %U https://doi.org/10.2196/25809 %U http://www.ncbi.nlm.nih.gov/pubmed/33599619 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e22135 %T Implementing Mobile Health–Enabled Integrated Care for Complex Chronic Patients: Intervention Effectiveness and Cost-Effectiveness Study %A de Batlle,Jordi %A Massip,Mireia %A Vargiu,Eloisa %A Nadal,Nuria %A Fuentes,Araceli %A Ortega Bravo,Marta %A Miralles,Felip %A Barbé,Ferran %A Torres,Gerard %A , %+ Group of Translational Research in Respiratory Medicine, Institut de Recerca Biomedica de Lleida, 80 Rovira Roure, Lleida, 25198, Spain, 34 973705372, gtorres@gss.cat %K chronic disease %K cost-benefit analysis %K delivery of health care, integrated %K mHealth %K eHealth %K quality of life %D 2021 %7 14.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Integrated care can generate health and social care efficiencies through the defragmentation of care and adoption of patient-centered preventive models. eHealth can be a key enabling technology for integrated care. Objective: The aim of this study was to assess the effectiveness and cost-effectiveness of the implementation of a mobile health (mHealth)-enabled integrated care model for complex chronic patients. Methods: As part of the CONNECARE Horizon 2020 project, a prospective, pragmatic, two-arm, parallel implementation trial was held in a rural region of Catalonia, Spain. During 3 months, elderly patients with chronic obstructive pulmonary disease or heart failure and their carers experienced the combined benefits of the CONNECARE organizational integrated care model and the eHealth platform supporting it, consisting of a patient self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care. We assessed changes in health status with the 12-Item Short-Form Survey (SF-12), unplanned visits and admissions during a 6-month follow up, and the incremental cost-effectiveness ratio (ICER). Results: A total of 48 patients were included in the integrated care arm and 28 patients receiving usual care were included in the control arm (mean age 82 years, SD 7 years; mean Charlson index 7, SD 2). Integrated care patients showed a significant increase in the SF-12 physical domain with a mean change of +3.7 (SD 8.4) (P=.004) and total SF-12 score with a mean change of +5.8 (SD 12.8) (P=.003); however, the differences in differences between groups were not statistically significant. Integrated care patients had 57% less unplanned visits (P=.004) and 50% less hospital admissions related to their main chronic diseases (P=.32). The integrated care program generated savings in different cost scenarios and the ICER demonstrated the cost-effectiveness of the program. Conclusions: The implementation of a patient-centered mHealth-enabled integrated care model empowering the patient, and connecting primary, hospital, and social care professionals reduced unplanned contacts with the health system and health costs, and was cost-effective. These findings support the notion of system-wide cross-organizational care pathways supported by mHealth as a successful way to implement integrated care. %M 33443486 %R 10.2196/22135 %U https://mhealth.jmir.org/2021/1/e22135 %U https://doi.org/10.2196/22135 %U http://www.ncbi.nlm.nih.gov/pubmed/33443486 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e25507 %T Building Health Services in a Rapidly Changing Landscape: Lessons in Adaptive Leadership and Pivots in a COVID-19 Remote Monitoring Program %A Laur,Celia Violet %A Agarwal,Payal %A Mukerji,Geetha %A Goulbourne,Elaine %A Baranek,Hayley %A Pus,Laura %A Bhatia,R Sacha %A Martin,Danielle %A Bhattacharyya,Onil %+ Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada, 1 (416) 323 6400, onil.bhattacharyya@wchospital.ca %K adaptive leadership %K pivots %K acute care %K COVID-19 %K leadership %K remote monitoring %K monitoring %K health service %K framework %D 2021 %7 13.1.2021 %9 Viewpoint %J J Med Internet Res %G English %X Adaptive leadership has become an essential skill for leaders in health systems to respond to the COVID-19 pandemic as new knowledge emerges and case counts rise, fall, and rise again. This leadership approach has been described as an iterative process of taking a wide view of the situation, interpreting the meaning of incoming data from multiple directions, and taking real-time action. This process is also common in start-ups, which attempt to create new products or services of uncertain value for consumer markets that may not yet exist. Start-ups manage uncertainty through “pivots,” which can include changes in the target group, need, features, or intended benefit of a product or service. Pivots are large changes that account for the high likelihood of getting something wrong during development, and they are distinct from the “tweaks” or small tests of change that define quality improvement methodology. This case study describes three pivots in the launch of a remote monitoring program for COVID-19. Adaptive leadership helped inform strategic decisions, with pivots providing a framework for internal and external stakeholders to articulate options for changes to address shifting needs. There is considerable uncertainty in the appropriate design and implementation of health services, and although this case example focuses on the use of adaptive leadership and pivots during a pandemic, these strategies are relevant for health care leaders at any time. %M 33417588 %R 10.2196/25507 %U http://www.jmir.org/2021/1/e25507/ %U https://doi.org/10.2196/25507 %U http://www.ncbi.nlm.nih.gov/pubmed/33417588 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e20195 %T The Role of Health Technologies in Multicomponent Primary Care Interventions: Systematic Review %A Jimenez,Geronimo %A Matchar,David %A Koh,Choon Huat Gerald %A van der Kleij,Rianne %A Chavannes,Niels H %A Car,Josip %+ Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road, Level 18, Clinical Sciences Building, Novena Campus, Singapore, 308232, 65 6904 7027, geronimo.jimenez@gmail.com %K digital health %K health system improvements %K health technologies %K primary care %K systematic review %D 2021 %7 11.1.2021 %9 Review %J J Med Internet Res %G English %X Background: Several countries around the world have implemented multicomponent interventions to enhance primary care, as a way of strengthening their health systems to cope with an aging chronically ill population and rising costs. Some of these efforts have included technology-based enhancements as one of the features to support the overall intervention, but their details and impacts have not been explored. Objective: This study aimed to identify the role of digital/health technologies within wider multifeature interventions that are aimed at enhancing primary care, and to describe their aims and stakeholders, types of technologies used, and potential impacts. Methods: A systematic review was performed following Cochrane guidelines. An electronic search, conducted on May 30, 2019, was supplemented with manual and grey literature searches in December 2019, to identify multicomponent interventions that included at least one technology-based enhancement. After title/abstract and full text screening, selected articles were assessed for quality based on their study design. A descriptive narrative synthesis was used for analysis and presentation of the results. Results: Of 37 articles, 14 (38%) described the inclusion of a technology-based innovation as part of their multicomponent interventions to enhance primary care. The most commonly identified technologies were the use of electronic health records, data monitoring technologies, and online portals with messaging platforms. The most common aim of these technologies was to improve continuity of care and comprehensiveness, which resulted in increased patient satisfaction, increased primary care visits compared to specialist visits, and the provision of more health prevention education and improved prescribing practices. Technologies seem also to increase costs and utilization for some parameters, such as increased consultation costs and increased number of drugs prescribed. Conclusions: Technologies and digital health have not played a major role within comprehensive innovation efforts aimed at enhancing primary care, reflecting that these technologies have not yet reached maturity or wider acceptance as a means for improving primary care. Stronger policy and financial support, and advocacy of key stakeholders are needed to encourage the introduction of efficient technological innovations, which are backed by evidence-based research, so that digital technologies can fulfill the promise of supporting strong sustainable primary care. %M 33427676 %R 10.2196/20195 %U http://www.jmir.org/2021/1/e20195/ %U https://doi.org/10.2196/20195 %U http://www.ncbi.nlm.nih.gov/pubmed/33427676 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e24569 %T Mapping Research Trends of Universal Health Coverage From 1990 to 2019: Bibliometric Analysis %A Ghanbari,Mahboubeh Khaton %A Behzadifar,Masoud %A Doshmangir,Leila %A Martini,Mariano %A Bakhtiari,Ahad %A Alikhani,Mahtab %A Bragazzi,Nicola Luigi %+ Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Anooshirvan Rezaei Square, Khorramabad, 6813833946, Iran, 98 9128934237, masoudbehzadifar@gmail.com %K bibliometrics %K scientometrics %K universal health coverage %K universal health %K health coverage %K developing countries %K low-income countries %D 2021 %7 11.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Universal health coverage (UHC) is one of many ambitious, health-related, sustainable development goals. Sharing various experiences of achieving UHC, in terms of challenges, pitfalls, and future prospects, can help policy and decision-makers reduce the likelihood of committing errors. As such, scholarly articles and technical reports are of paramount importance in shedding light on the determinants that make it possible to achieve UHC. Objective: The purpose of this study is to conduct a comprehensive analysis of UHC-related scientific literature from 1990 to 2019. Methods: We carried out a bibliometric analysis of papers related to UHC published from January 1990 to September 2019 and indexed in Scopus via VOSviewer (version 1.6.13; CWTS). Relevant information was extracted: the number of papers published, the 20 authors with the highest number of publications in the field of UHC, the 20 journals with the highest number of publications related to UHC, the 20 most active funding sources for UHC-related research, the 20 institutes and research centers that have produced the highest number of UHC-related research papers, the 20 countries that contributed the most to the research field of UHC, the 20 most cited papers, and the latest available impact factors of journals in 2018 that included the UHC-related items under investigation. Results: In our analysis, 7224 articles were included. The publication trend was increasing, showing high interest in the scientific community. Most researchers were from the United States, the United Kingdom, and Canada, with Thailand being a notable exception. The Lancet accounted for 3.95% of published UHC-related research. Among the top 20 funding sources, the World Health Organization (WHO), the Bill and Melinda Gates Foundation, and the National Institutes of Health (NIH) accounted for 1.41%, 1.34%, and 1.02% of published UHC-related research, respectively. The highest number of citations was found for articles published in The Lancet, the American Journal of Psychiatry, and the Journal of the American Medical Association (JAMA). The top keywords were “health insurance,” “insurance,” “healthcare policy,” “healthcare delivery,” “economics,” “priority,” “healthcare cost,” “organization and management,” “health services accessibility,” “reform,” “public health,” and “health policy.” Conclusions: The findings of our study showed an increasing scholarly interest in UHC and related issues. However, most research concentrated in middle- and high-income regions and countries. Therefore, research in low-income countries should be promoted and supported, as this could enable a better understanding of the determinants of the barriers and obstacles to UHC achievement and improve global health. %M 33427687 %R 10.2196/24569 %U http://publichealth.jmir.org/2021/1/e24569/ %U https://doi.org/10.2196/24569 %U http://www.ncbi.nlm.nih.gov/pubmed/33427687 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e20629 %T Economic Burden and Health Care Access for Patients With Inflammatory Bowel Diseases in China: Web-Based Survey Study %A Yu,Qiao %A Zhu,Chunpeng %A Feng,Shuyi %A Xu,Liyi %A Hu,Shurong %A Chen,Hao %A Chen,Hanwen %A Yao,Sheng %A Wang,Xiaoying %A Chen,Yan %+ Department of Gastroenterology, the Second Affiliated Hospital, Zhejiang University School of Medicine, No 88, Jiefang Road, Hangzhou, 310000, China, 86 13757118653, chenyan72_72@zju.edu.cn %K inflammatory bowel disease %K Crohn disease %K ulcerative colitis %K primary care provider %K emergency room %K eHealth %K gastroenterology %K proctology %D 2021 %7 5.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The increasing incidence of inflammatory bowel disease (IBD) has imposed heavy financial burdens for Chinese patients; however, data about their financial status and access to health care are still lacking. This information is important for informing patients with IBD about disease treatment budgets and health care strategies. Objective: The aim of this study was to evaluate the economic status and medical care access of patients with IBD through the China Crohn’s & Colitis Foundation web-based platform in China. Methods: Our study was performed in 14 IBD centers in mainland China between 2018 and 2019 through WeChat. Participants were asked to complete a 64-item web-based questionnaire. Data were collected by the Wenjuanxing survey program. We mainly focused on income and insurance status, medical costs, and access to health care providers. Respondents were stratified by income and the associations of income with medical costs and emergency visit times were analyzed. Results: In this study, 3000 patients with IBD, that is, 1922 patients with Crohn disease, 973 patients with ulcerative colitis, and 105 patients with undetermined colitis were included. During the last 12 months, the mean (SD) direct and indirect costs for per patient with IBD were approximately US $11,668.68 ($7944.44) and US $74.90 ($253.60) in China. The average reimbursement ratios for most outpatient and inpatient costs were less than 50%. However, the income of 85.5% (2565/3000) of the patients was less than ¥10,000 (US $1445) per month. Approximately 96.5% (2894/3000) of the patients were covered by health insurance, but only 24.7% (741/3000) of the patients had private commercial insurance, which has higher imbursement ratios. Nearly 98.0% (2954/3000) of the patients worried about their financial situation. Thus, 79.7% (2392/3000) of the patients with IBD tried to save money for health care and even delayed their medical treatments. About half of the respondents (1282/3000, 42.7%) had no primary care provider, and 52.2% (1567/3000) of the patients had to visit the emergency room 1-4 times per year for the treatment of their IBD. Multivariate analysis revealed that lower income (P=.001) and higher transportation (P=.004) and accommodation costs (P=.001) were significantly associated with the increased number of emergency visits of the patients. Conclusions: Chinese patients with IBD have enormous financial burdens and difficulties in accessing health care, which have increased their financial anxiety and inevitably influenced their disease outcomes. Early purchase of private insurance, thereby increasing the reimbursement ratio for medical expenses, and developing the use of telemedicine would be effective strategies for saving on health care costs. %M 33399540 %R 10.2196/20629 %U https://www.jmir.org/2021/1/e20629 %U https://doi.org/10.2196/20629 %U http://www.ncbi.nlm.nih.gov/pubmed/33399540 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 9 %N 4 %P e24371 %T Dental Treatments During the COVID-19 Pandemic in Three Hospitals in Jordan: Retrospective Study %A Obeidat,Lina %A Masarwa,Nader %A AlWarawreh,Amjad %A El-Naji,Waddah %+ Dental Department, Royal Medical Services of Jordan Armed Forces, 230 King Abdulla II Street, Amman, 11733, Jordan, 962 5840840, lina_obeidat@yahoo.com %K COVID-19 %K dental treatments %K Jordan %K lockdown %K pandemic %D 2020 %7 29.12.2020 %9 Original Paper %J Interact J Med Res %G English %X Background: Cases of COVID-19 first emerged in December 2019. Since then, the virus has spread rapidly worldwide, with daily increases in the numbers of infections and deaths. COVID-19 spreads via airborne transmission, which renders dental treatment a potential source of virus transmission. Dental treatments require the use of handpieces, ultrasonic devices, or air–water syringes, which generate considerable amounts of aerosols. Jordan, being one of the affected countries, instituted preventive lockdown measures on March 17, 2020. Emergency dental treatments were only allowed in dental clinics of the Royal Medical Services of Jordan Armed Forces and Ministry of Health, and were prohibited in other sectors such as private clinics and universities. Objective: The aim of this study is to investigate the dental treatments performed in three military hospitals during the 44-day lockdown period in Jordan. The investigation explores the impact of COVID-19 on the number of patients and types of performed dental treatments. Methods: Data such as number of patients, patients’ age and gender, and performed dental treatments were collected retrospectively from the hospital records and were analyzed. Results: Our results showed a 90% (17,591 to 1689) decrease in patient visits during the lockdown period compared to regular days. The total number of treatments (n=1689) during the lockdown period varied between endodontic cases (n=877, 51.9%), extraction and other surgical cases (n=374, 22.1%), restorative cases (n=142, 8.4%), orthodontic treatments (n=4, 0.2%), and other procedures (n=292, 17.3%). The differences in gender and age group among all clinics were statistically significant (P<.001 and P=.02, respectively). Conclusions: The COVID-19 pandemic had a significant effect on the number of patients seeking dental treatments. It also affected the types of treatments performed. Endodontic treatment accounted for almost 50% of patient load during the lockdown compared to approximately 20% during regular days. %M 33325372 %R 10.2196/24371 %U http://www.i-jmr.org/2020/4/e24371/ %U https://doi.org/10.2196/24371 %U http://www.ncbi.nlm.nih.gov/pubmed/33325372 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e18046 %T Capitated Telehealth Coaching Hospital Readmission Service in Australia: Pragmatic Controlled Evaluation %A Martin,Carmel %A Hinkley,Narelle %A Stockman,Keith %A Campbell,Donald %+ Monash Health Faculty of Medicine, Nursing and Health Sciences, Monash University, Monash Medicine (Level 5), 35 Rainforest Walk, Clayton, VIC 3800, Australia, 61 3 9905 5035, carmelmarymartin@gmail.com %K telehealth %K funding model %K evaluation %K health services research %K potentially preventable hospitalizations, medical informatics %D 2020 %7 1.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: MonashWatch is a telehealth public hospital outreach pilot service as a component of the Government of Victoria’s statewide redesign initiative called HealthLinks: Chronic Care. Rather than only paying for hospitalizations, projected funding is released earlier to hospitals to allow them to reduce hospitalization costs. MonashWatch introduced a web-based app, Patient Journey Record System, to assess the risk of the journeys of a cohort of patients identified as frequent admitters. Telecare guides call patients using the Patient Journey Record System to flag potential deterioration. Health coaches (nursing and allied health staff) triage risk and adapt care for individuals. Objective: The aim was a pragmatic controlled evaluation of the impact of MonashWatch on the primary outcome of bed days for acute nonsurgical admissions in the intention-to-treat group versus the usual care group. The secondary outcome was hospital admission rates. The net promoter score was used to gauge satisfaction. Methods: Patients were recruited into an intention-to-treat group, which included active telehealth and declined/lost/died groups, versus a systematically sampled (4:1) usual care group. A rolling sample of 250-300 active telehealth patients was maintained from December 23, 2016 to June 23, 2019. The outcome—mean bed days in intervention versus control—was adjusted using analysis of covariance for age, gender, admission type, and effective days active in MonashWatch. Time-series analysis tested for trends in change patterns. Results: MonashWatch recruited 1373 suitable patients who were allocated into the groups: usual care (n=293) and intention-to-treat (n=1080; active telehealth: 471/1080, 43.6%; declined: 485, 44.9%; lost to follow-up: 178 /1080, 10.7%; died: 8/1080, 0.7%). Admission frequency of intention-to-treat compared to that of the usual care group did not significantly improve (P=.05), with a small number of very frequent admitters in the intention-to-treat group. Age, MonashWatch effective days active, and treatment group independently predicted bed days. The analysis of covariance demonstrated a reduction in bed days of 1.14 (P<.001) in the intention-to-treat group compared with that in the usual care group, with 1236 bed days estimated savings. Both groups demonstrated regression-to-the-mean. The downward trend in improved bed days was significantly greater (P<.001) in the intention-to-treat group (Sen slope –406) than in the usual care group (Sen slope –104). The net promoter score was 95% in the active telehealth group compared with typical hospital scores of 77%. Conclusions: Clinically and statistically meaningful reductions in acute hospital bed days in the intention-to-treat group when compared to that of the usual care group were demonstrated (P<.001), although admission frequency was unchanged with more short stay admissions in the intention-to-treat group. Nonrandomized control selection was a limitation. Nonetheless, MonashWatch was successful in the context of the HealthLinks: Chronic Care capitation initiative and is expanding. %M 33258781 %R 10.2196/18046 %U https://www.jmir.org/2020/12/e18046 %U https://doi.org/10.2196/18046 %U http://www.ncbi.nlm.nih.gov/pubmed/33258781 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 11 %P e15776 %T Health Care Management Models for the Evolution of Hospitalization in Acute Inpatient Psychiatry Units: Comparative Quantitative Study %A Góngora Alonso,Susel %A Sainz-De-Abajo,Beatriz %A De la Torre-Díez,Isabel %A Franco-Martin,Manuel %+ Department of Signal Theory and Communications, and Telematics Engineering, University of Valladolid, Paseo de Belén, 15, Valladolid, 47011, Spain, 34 983423000 ext 3703, isator@tel.uva.es %K acute inpatient psychiatry unit %K database %K hospitalizations %K mental health %K readmission %K SPSS %D 2020 %7 30.11.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental health disorders are a problem that affects patients, their families, and the professionals who treat them. Hospital admissions play an important role in caring for people with these diseases due to their effect on quality of life and the high associated costs. In Spain, at the Healthcare Complex of Zamora, a new disease management model is being implemented, consisting of not admitting patients with mental diseases to the hospital. Instead, they are supervised in sheltered apartments or centers for patients with these types of disorders. Objective: The main goal of this research is to evaluate the evolution of hospital days of stay of patients with mental disorders in different hospitals in a region of Spain, to analyze the impact of the new hospital management model. Methods: For the development of this study, a database of patients with mental disorders was used, taking into account the acute inpatient psychiatry unit of 11 hospitals in a region of Spain. SPSS Statistics for Windows, version 23.0 (IBM Corp), was used to calculate statistical values related to hospital days of stay of patients. The data included are from the periods of 2005-2011 and 2012-2015. Results: After analyzing the results, regarding the days of stay in the different health care complexes for the period between 2005 and 2015, we observed that since 2012 at the Healthcare Complex of Zamora, the total number of days of stay were reduced by 64.69%. This trend is due to the implementation of a new hospital management model in this health complex. Conclusions: With the application of a new hospital management model at the Healthcare Complex of Zamora, the number of days of stay of patients with mental diseases as well as the associated hospital costs were considerably reduced. %M 33252351 %R 10.2196/15776 %U http://mental.jmir.org/2020/11/e15776/ %U https://doi.org/10.2196/15776 %U http://www.ncbi.nlm.nih.gov/pubmed/33252351 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e17595 %T Recommendations From the Twitter Hashtag #DoctorsAreDickheads: Qualitative Analysis %A Sharma,Anjana Estelle %A Mann,Ziva %A Cherian,Roy %A Del Rosario,Jan Bing %A Yang,Janine %A Sarkar,Urmimala %+ Department of Family & Community Medicine, University of California San Francisco, 995 Potrero Ave, Ward 83, San Francisco, CA, 94110, United States, 1 6179454776, anjana.sharma@ucsf.edu %K social media %K patient engagement %K Twitter messaging %K missed diagnosis %K internet %K physician patient relationship %D 2020 %7 28.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The social media site Twitter has 145 million daily active users worldwide and has become a popular forum for users to communicate their health care concerns and experiences as patients. In the fall of 2018, a hashtag titled #DoctorsAreDickheads emerged, with almost 40,000 posts calling attention to health care experiences. Objective: This study aims to identify common health care conditions and conceptual themes represented within the phenomenon of this viral Twitter hashtag. Methods: We analyzed a random sample of 5.67% (500/8818) available tweets for qualitative analysis between October 15 and December 31, 2018, when the hashtag was the most active. Team coders reviewed the same 20.0% (100/500) tweets and the remainder individually. We abstracted the user’s health care role and clinical conditions from the tweet and user profile, and used phenomenological content analysis to identify prevalent conceptual themes through sequential open coding, memoing, and discussion of concepts until an agreement was reached. Results: Our final sample comprised 491 tweets and unique Twitter users. Of this sample, 50.5% (248/491) were from patients or patient advocates, 9.6% (47/491) from health care professionals, 4.3% (21/491) from caregivers, 3.7% (18/491) from academics or researchers, 1.0% (5/491) from journalists or media, and 31.6% (155/491) from non–health care individuals or other. The most commonly mentioned clinical conditions were chronic pain, mental health, and musculoskeletal conditions (mainly Ehlers-Danlos syndrome). We identified 3 major themes: disbelief in patients’ experience and knowledge that contributes to medical errors and harm, the power inequity between patients and providers, and metacommentary on the meaning and impact of the #DoctorsAreDickheads hashtag. Conclusions: People publicly disclose personal and often troubling health care experiences on Twitter. This adds new accountability for the patient-provider interaction, highlights how harmful communication affects diagnostic safety, and shapes the public’s viewpoint of how clinicians behave. Hashtags such as this offer valuable opportunities to learn from patient experiences. Recommendations include developing best practices for providers to improve communication, supporting patients through challenging diagnoses, and promoting patient engagement. %M 33112246 %R 10.2196/17595 %U http://www.jmir.org/2020/10/e17595/ %U https://doi.org/10.2196/17595 %U http://www.ncbi.nlm.nih.gov/pubmed/33112246 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e18200 %T Applying Digital Information Delivery to Convert Habits of Antibiotic Use in Primary Care in Germany: Mixed-Methods Study %A Poss-Doering,Regina %A Kuehn,Lukas %A Kamradt,Martina %A Glassen,Katharina %A Wensing,Michel %+ Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 6221 56 ext 38643, regina.poss-doering@med.uni-heidelberg.de %K antimicrobial resistance %K educative digital solutions %K health literacy %K diffusion of innovations %D 2020 %7 7.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Antimicrobial resistance is an important global health issue. In Germany, the national agenda supports various interventions to convert habits of antibiotic use. In the CHANGE-3 (Converting Habits of Antibiotic Use for Respiratory Tract Infections in German Primary Care) study, digital tools were applied for information delivery: tablet computers in primary care practices, e-learning platforms for medical professionals, and a public website to promote awareness and health literacy among primary care physicians, their teams, and their patients. Objective: This study is embedded in the process evaluation of the CHANGE-3 study. The aim of this study was to evaluate the acceptance and uptake of digital devices for the delivery of health-related information to enhance awareness and change habits of antibiotic use in primary care in Germany. Methods: This study used a convergent-parallel mixed-methods design. Audio-recorded semistructured telephone interviews were conducted with physicians, nonphysician health professionals, and patients in the CHANGE-3 program. Pseudonymized verbatim transcripts were coded using thematic analysis. In-depth analysis was performed based on the inductive category of information provision via digital information tools. Identified themes were related to the main postulates of Diffusion of Innovations theory (DIT) to provide an explanatory frame. In addition, data generated through a structured survey with physicians and nonphysician health professionals in the program were analyzed descriptively and integrated with the qualitative data to explore the complementarity of the findings. Results: Findings regarding the acceptance and uptake of digital devices were related to three postulates of DIT: innovation characteristics, communication channels, and unanticipated consequences. Participants considered the provided digital educative solutions to be supportive for promoting health literacy regarding conversion of habits of antibiotic use. However, health care professionals found it challenging to integrate these solutions into existing routines in primary care and to align them with their professional values. Low technology affinity was a major barrier to the use of digital information in primary care. Patients welcomed the general idea of introducing health-related information in digital formats; however, they expressed concerns about device-related hygiene and the appropriateness of the digital tools for older patients. Conclusions: Patients and medical professionals in German primary care are reluctant to use digital devices for information and education. Using a Diffusion of Innovations approach can support assessment of existing barriers and provide information about setting-specific preconditions that are necessary for future tailoring of implementation strategies. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 15061174; http://www.isrctn.com/ISRCTN15061174. %M 32960773 %R 10.2196/18200 %U http://www.jmir.org/2020/10/e18200/ %U https://doi.org/10.2196/18200 %U http://www.ncbi.nlm.nih.gov/pubmed/32960773 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19198 %T Client Satisfaction and Experience With Telepsychiatry: Development and Validation of a Survey Using Clinical Quality Domains %A Serhal,Eva %A Kirvan,Anne %A Sanches,Marcos %A Crawford,Allison %+ Virtual Mental Health and Outreach, Centre for Addiction and Mental Health, 825-250 College St, Toronto, ON, M5T1R8, Canada, 1 4165358501 ext 30318, allison.crawford@utoronto.ca %K telemedicine %K psychiatry %K mental health %K patient satisfaction %K quality of health care %D 2020 %7 29.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Telepsychiatry is an increasingly used model of mental health care that connects patients with psychiatrists at a distance via videoconference. Telepsychiatry is an effective clinical intervention that improves access to quality care in regions with limited resources or in clinical situations where in-person care is unavailable. Objective: This study aims to develop a validated survey tool to measure patient experience and satisfaction with telepsychiatry based on the quality of care domains. This study also seeks to understand which health service outcomes were most strongly correlated with overall satisfaction in the context of telepsychiatry. Methods: The survey created in this study was developed and validated with a panel of subject matter and process experts and was piloted with 274 patients who received clinical consultations through the TeleMental Health Program at the Centre for Addiction and Mental Health. Factor analysis was used to determine correlations between questions and quality of care domains and was also used to assess model fit. Results: The study provides a validated survey to measure patient satisfaction and experience with telepsychiatry across 4 domains: access and timeliness, appropriateness, effectiveness, and safety. Both safety and access and timeliness were found to be statistically significant predictors of satisfaction in our sample. Conclusions: By situating patient satisfaction and experience within this framework, the survey facilitates patient data collection and interpretation through a clinical quality lens. %M 32755896 %R 10.2196/19198 %U http://www.jmir.org/2020/9/e19198/ %U https://doi.org/10.2196/19198 %U http://www.ncbi.nlm.nih.gov/pubmed/32755896 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 9 %N 3 %P e19776 %T Exploring the Usage Intentions of Wearable Medical Devices: A Demonstration Study %A Chang,Chiao-Chen %+ College of Management, Taipei Medical University, 11F, No 172-1, Sec 2, Keelung Rd, Da an Dist, Taipei City, 10675, Taiwan, 886 266382736 ext 1128, ariel66@tmu.edu.tw %K wearable medical device %K unified theory of acceptance and use of technology %K usage intention %K health consciousness %K trust %D 2020 %7 18.9.2020 %9 Original Paper %J Interact J Med Res %G English %X Background: In the face of an aging society, an immediate and preventive medical system urgently needs to be established, and the application of wearable devices is essential. However, the application of smart medical care in Taiwan is still not widespread, and few studies have explored the related issues of wearable medical device usage. Thus, determining the success of a wearable medical device mainly depends on the degree of user adoption and use. Objective: The purpose of this study was to examine the factors that influence the intention to use wearable medical devices. Methods: This study applied the unified theory of acceptance and use of technology (UTAUT) to build a comprehensive model that explains intentions to use wearable medical devices. Results: The research findings showed that health consciousness and trust were the strongest predictors of intentions to use wearable medical devices. Conclusions: The results reveal the magnitudes of the impacts of the variables in a well-accepted revised UTAUT model in the context of the medical industry, particularly in the setting of wearable medical devices. Several important implications for academics and industry decision-makers can be formulated from these results. %M 32945778 %R 10.2196/19776 %U http://www.i-jmr.org/2020/3/e19776/ %U https://doi.org/10.2196/19776 %U http://www.ncbi.nlm.nih.gov/pubmed/32945778 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 9 %P e18147 %T How Specialist Aftercare Impacts Long-Term Readmission Risks in Elderly Patients With Metabolic, Cardiac, and Chronic Obstructive Pulmonary Diseases: Cohort Study Using Administrative Data %A Kaleta,Michaela %A Niederkrotenthaler,Thomas %A Kautzky-Willer,Alexandra %A Klimek,Peter %+ Section for Science of Complex Systems, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, BT86, Vienna, 1090, Austria, 43 140160 ext 36255, peter.klimek@meduniwien.ac.at %K multimorbity %K patient-sharing networks %K network analysis %K gender medicine %K chronic disease %K morbidity %K elderly %K older adults %K cohort study %D 2020 %7 16.9.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: The health state of elderly patients is typically characterized by multiple co-occurring diseases requiring the involvement of several types of health care providers. Objective: We aimed to quantify the benefit for multimorbid patients from seeking specialist care in terms of long-term readmission risks. Methods: From an administrative database, we identified 225,238 elderly patients with 97 different diagnosis (ICD-10 codes) from hospital stays and contact with 13 medical specialties. For each diagnosis associated with the first hospital stay, we used multiple logistic regression analysis to quantify the sex-specific and age-adjusted long-term all-cause readmission risk (hospitalizations occurring between 3 months and 3 years after the first admission) and how specialist contact impacts these risks. Results: Men have a higher readmission risk than women (mean difference over all first diagnoses 1.9%, P<.001), but similar reduction in readmission risk after receiving specialist care. Specialist care can reduce readmission risk by almost 50%. We found the greatest reductions in risk when the first hospital stay was associated with diagnoses corresponding to complex chronic diseases such as acute myocardial infarction (57.6% reduction in readmission risk, SE 7.6% for men [m]; 55.9% reduction, SE 9.8% for women [w]), diabetic and other retinopathies (m: 62.3%, SE 8.0; w: 60.1%, SE 8.4%), chronic obstructive pulmonary disease (m: 63.9%, SE 7.8%; w: 58.1%, SE 7.5%), disorders of lipoprotein metabolism (m: 64.7%, SE 3.7%; w: 63.8%, SE 4.0%), and chronic ischemic heart diseases (m: 63.6%, SE 3.1%; w: 65.4%, SE 3.0%). Conclusions: Specialist care can greatly reduce long-term readmission risk for patients with chronic and multimorbid diseases. Further research is needed to identify the specific reasons for these findings and to understand the detected sex-specific differences. %M 32936077 %R 10.2196/18147 %U http://medinform.jmir.org/2020/9/e18147/ %U https://doi.org/10.2196/18147 %U http://www.ncbi.nlm.nih.gov/pubmed/32936077 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e21607 %T Consumer Reported Care Deferrals Due to the COVID-19 Pandemic, and the Role and Potential of Telemedicine: Cross-Sectional Analysis %A Atherly,Adam %A Van Den Broek-Altenburg,Eline %A Hart,Victoria %A Gleason,Kelsey %A Carney,Jan %+ Center for Health Services Research, Larner College of Medicine, University of Vermont, 89 Beaumont Avenue, Burlington, VT, 05404, United States, 1 8026563555, adam.atherly@med.uvm.edu %K COVID-19 %K telemedicine %K deferred care %K mental health %K alternative %K health effect %K viability %D 2020 %7 14.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic forced many health systems to proactively reduce care delivery to prepare for an expected surge in hospitalizations. There have been concerns that care deferral may have negative health effects, but it is hoped that telemedicine can provide a viable alternative. Objective: This study aimed to understand what type of health care services were being deferred during the COVID-19 pandemic lockdown, the role played by telemedicine to fill in care gaps, and changes in attitudes toward telemedicine. Methods: We conducted a cross-sectional analysis of survey responses from 1694 primary care patients in a mid-sized northeastern city. Our main outcomes were use of telemedicine and reports of care deferral during the shutdown. Results: Deferred care was widespread—48% (n=812) of respondents deferred care—but it was largely for preventive services, particularly dental and primary care, and did not cause concerns about negative health effects. In total, 30.2% (n=242) of those who delayed care were concerned about health effects, with needs centered around orthopedics and surgery. Telemedicine was viewed more positively than prior to the pandemic; it was seen as a viable option to deliver deferred care, particularly by respondents who were over 65 years of age, female, and college educated. Mental health services stood out for having high levels of deferred care. Conclusions: Temporary health system shutdowns will give rise to deferred care. However, much of the deferrals will be for preventive services. The effect of this on patient health can be moderated by prioritizing surgical and orthopedic services and delivering other services through telemedicine. Having telemedicine as an option is particularly crucial for mental health services. %M 32833661 %R 10.2196/21607 %U http://publichealth.jmir.org/2020/3/e21607/ %U https://doi.org/10.2196/21607 %U http://www.ncbi.nlm.nih.gov/pubmed/32833661 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e21691 %T Current Challenges of Digital Health Interventions in Pakistan: Mixed Methods Analysis %A Kazi,Abdul Momin %A Qazi,Saad Ahmed %A Ahsan,Nazia %A Khawaja,Sadori %A Sameen,Fareeha %A Saqib,Muhammad %A Khan Mughal,Muhammad Ayub %A Wajidali,Zabin %A Ali,Sikander %A Ahmed,Rao Moueed %A Kalimuddin,Hussain %A Rauf,Yasir %A Mahmood,Fatima %A Zafar,Saad %A Abbasi,Tufail Ahmad %A Khoumbati,Khalil-Ur-Rahmen %A Abbasi,Munir A %A Stergioulas,Lampros K %+ Department of Pediatrics and Child Health, Aga Khan University, Stadium Road​, P.O. Box 350​0, Karachi, 74800, Pakistan, 92 2134864232, momin.kazi@aku.edu %K digital health %K eHealth %K LMICs %K mHealth %K Pakistan %K SWOT %K telehealth %D 2020 %7 3.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health is well-positioned in low and middle-income countries (LMICs) to revolutionize health care due, in part, to increasing mobile phone access and internet connectivity. This paper evaluates the underlying factors that can potentially facilitate or hinder the progress of digital health in Pakistan. Objective: The objective of this study is to identify the current digital health projects and studies being carried out in Pakistan, as well as the key stakeholders involved in these initiatives. We aim to follow a mixed-methods strategy and to evaluate these projects and studies through a strengths, weaknesses, opportunities, and threats (SWOT) analysis to identify the internal and external factors that can potentially facilitate or hinder the progress of digital health in Pakistan. Methods: This study aims to evaluate digital health projects carried out in the last 5 years in Pakistan with mixed methods. The qualitative and quantitative data obtained from field surveys were categorized according to the World Health Organization’s (WHO) recommended building blocks for health systems research, and the data were analyzed using a SWOT analysis strategy. Results: Of the digital health projects carried out in the last 5 years in Pakistan, 51 are studied. Of these projects, 46% (23/51) used technology for conducting research, 30% (15/51) used technology for implementation, and 12% (6/51) used technology for app development. The health domains targeted were general health (23/51, 46%), immunization (13/51, 26%), and diagnostics (5/51, 10%). Smartphones and devices were used in 55% (28/51) of the interventions, and 59% (30/51) of projects included plans for scaling up. Artificial intelligence (AI) or machine learning (ML) was used in 31% (16/51) of projects, and 74% (38/51) of interventions were being evaluated. The barriers faced by developers during the implementation phase included the populations’ inability to use the technology or mobile phones in 21% (11/51) of projects, costs in 16% (8/51) of projects, and privacy concerns in 12% (6/51) of projects. Conclusions: We conclude that while digital health has a promising future in Pakistan, it is still in its infancy at the time of this study. However, due to the coronavirus disease 2019 (COVID-19) pandemic, there is an increase in demand for digital health and implementation of health outcomes following global social distancing protocols, especially in LMICs. Hence, there is a need for active involvement by public and private organizations to regulate, mobilize, and expand the digital health sector for the improvement of health care systems in countries. %M 32880584 %R 10.2196/21691 %U https://www.jmir.org/2020/9/e21691 %U https://doi.org/10.2196/21691 %U http://www.ncbi.nlm.nih.gov/pubmed/32880584 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 9 %N 3 %P e15911 %T Effect of Health Care Provider Delays on Short-Term Outcomes in Patients With Colorectal Cancer: Multicenter Population-Based Observational Study %A Abdulaal,Ahmed %A Arhi,Chanpreet %A Ziprin,Paul %+ Imperial College London, Department of Surgery and Cancer, St Mary's Hospital Campus, Praed Street, London, W2 1NY, United Kingdom, 44 0754513315, ahmed.abdulaal@nhs.net %K surgery %K cancer %K colorectal %K delay %D 2020 %7 17.7.2020 %9 Original Paper %J Interact J Med Res %G English %X Background: The United Kingdom has lower survival figures for all types of cancers compared to many European countries despite similar national expenditures on health. This discrepancy may be linked to long diagnostic and treatment delays. Objective: The aim of this study was to determine whether delays experienced by patients with colorectal cancer (CRC) affect their survival. Methods: This observational study utilized the Somerset Cancer Register to identify patients with CRC who were diagnosed on the basis of positive histology findings. The effects of diagnostic and treatment delays and their subdivisions on outcomes were investigated using Cox proportional hazards regression. Kaplan-Meier plots were used to illustrate group differences. Results: A total of 648 patients (375 males, 57.9% males) were included in this study. We found that neither diagnostic delay nor treatment delay had an effect on the overall survival in patients with CRC (χ23=1.5, P=.68; χ23=0.6, P=.90, respectively). Similarly, treatment delays did not affect the outcomes in patients with CRC (χ23=5.5, P=.14). The initial Cox regression analysis showed that patients with CRC who had short diagnostic delays were less likely to die than those experiencing long delays (hazard ratio 0.165, 95% CI 0.044-0.616; P=.007). However, this result was nonsignificant following sensitivity analysis. Conclusions: Diagnostic and treatment delays had no effect on the survival of this cohort of patients with CRC. The utility of the 2-week wait referral system is therefore questioned. Timely screening with subsequent early referral and access to diagnostics may have a more beneficial effect. %M 32706666 %R 10.2196/15911 %U https://www.i-jmr.org/2020/3/e15911 %U https://doi.org/10.2196/15911 %U http://www.ncbi.nlm.nih.gov/pubmed/32706666 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e14283 %T Integrating Health Technologies in Health Services for Syrian Refugees in Lebanon: Qualitative Study %A Talhouk,Reem %A Akik,Chaza %A Araujo-Soares,Vera %A Ahmad,Balsam %A Mesmar,Sandra %A Olivier,Patrick %A Balaam,Madeline %A Montague,Kyle %A Garbett,Andrew %A Ghattas,Hala %+ School of Design, Northumbria University, City Campus East 2, Newcastle upon Tyne, United Kingdom, 44 191 208 4642, reem.talhouk@northumbria.ac.uk %K Syrian refugees %K Lebanon %K health technologies %K eHealth %K mHealth %K primary health care %D 2020 %7 6.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Lebanon currently hosts around one million Syrian refugees. There has been an increasing interest in integrating eHealth and mHealth technologies into the provision of primary health care to refugees and Lebanese citizens. Objective: We aimed to gain a deeper understanding of the potential for technology integration in primary health care provision in the context of the protracted Syrian refugee crisis in Lebanon. Methods: A total of 17 face-to-face semistructured interviews were conducted with key informants (n=8) and health care providers (n=9) involved in the provision of health care to the Syrian refugee population in Lebanon. Interviews were audio recorded and directly translated and transcribed from Arabic to English. Thematic analysis was conducted. Results: Study participants indicated that varying resources, primarily time and the availability of technologies at primary health care centers, were the main challenges for integrating technologies for the provision of health care services for refugees. This challenge is compounded by refugees being viewed by participants as a mobile population thus making primary health care centers less willing to invest in refugee health technologies. Lastly, participant views regarding the health and technology literacies of refugees varied and that was considered to be a challenge that needs to be addressed for the successful integration of refugee health technologies. Conclusions: Our findings indicate that in the context of integrating technology into the provision of health care for refugees in a low or middle income country such as Lebanon, some barriers for technology integration related to the availability of resources are similar to those found elsewhere. However, we identified participant views of refugees’ health and technology literacies to be a challenge specific to the context of this refugee crisis. These challenges need to be addressed when considering refugee health technologies. This could be done by increasing the visibility of refugee capabilities and configuring refugee health technologies so that they may create spaces in which refugees are empowered within the health care system and can work toward debunking the views discovered in this study. %M 32628121 %R 10.2196/14283 %U https://www.jmir.org/2020/7/e14283 %U https://doi.org/10.2196/14283 %U http://www.ncbi.nlm.nih.gov/pubmed/32628121 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17221 %T Patients’ Perceptions of Barriers and Facilitators to the Adoption of E-Hospitals: Cross-Sectional Study in Western China %A Li,Peiyi %A Luo,Yunmei %A Yu,Xuexin %A Wen,Jin %A Mason,Elizabeth %A Li,Weimin %A Jalali,Mohammad S %+ Department of Respiratory Medicine, West China Hospital of Sichuan University, Guo Xue Xiang 37, Chengdu, 610041, China, 86 2885424666, weimi003@scu.edu.cn %K innovation adoption %K e-hospital %K internet hospital %K eHealth %K barriers %K facilitators %D 2020 %7 11.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: As an innovative approach to providing web-based health care services from physical hospitals to patients at a distance, e-hospitals (ie, extended care hospitals through the internet) have been extensively developed in China. This closed health care delivery chain was developed by combining e-hospitals with physical hospitals; treatment begins with web-based consultation and registration, and then, patients are diagnosed and treated in a physical hospital. This approach is promising in its ability to improve accessibility, efficiency, and quality of health care. However, there is limited research on end users’ acceptance of e-hospitals and the effectiveness of strategies aimed to prompt the adoption of e-hospitals in China. Objective: This study aimed to provide insights regarding the adoption of e-hospitals by investigating patients’ willingness to use e-hospitals and analyzing the barriers and facilitators to the adoption of this technology. Methods: We used a pretested self-administered questionnaire and performed a cross-sectional analysis in 1032 patients across three hierarchical hospitals in West China from June to August 2019. Patients’ sociodemographic characteristics, medical history, current disease status, proficiency with electronic devices, previous experience with web-based health services, willingness to use e-hospitals, and perceived facilitators and barriers were surveyed. Multiple significance tests were employed to examine disparities across four age groups, as well as those between patients who were willing to use e-hospitals and those who were not. Multivariate logistic regression was also performed to identify the potential predictors of willingness to use e-hospitals. Results: Overall, it was found that 65.6% (677/1032) of participants were willing to use e-hospitals. The significant predictors of willingness to use e-hospitals were employment status (P=.02), living with children (P<.001), education level (P=.046), information technology skills (P<.001), and prior experience with web-based health care services (P<.001), whereas age, income, medical insurance, and familiarity with e-hospitals were not predictors. Additionally, the prominent facilitators of e-hospitals were convenience (641/677, 94.7%) and accessibility to skilled medical experts (489/677, 72.2%). The most frequently perceived barrier varied among age groups; seniors most often reported their inability to operate technological devices as a barrier (144/166, 86.7%), whereas young participants most often reported that they avoided e-hospital services because they were accustomed to face-to-face consultation (39/52, 75%). Conclusions: We identified the variables, facilitators, and barriers that play essential roles in the adoption of e-hospitals. Based on our findings, we suggest that efforts to increase the adoption of e-hospitals should focus on making target populations accustomed to web-based health care services while maximizing ease of use and providing assistance for technological inquiries. %M 32525483 %R 10.2196/17221 %U http://www.jmir.org/2020/6/e17221/ %U https://doi.org/10.2196/17221 %U http://www.ncbi.nlm.nih.gov/pubmed/32525483 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17997 %T Internet Influence of Assisted Reproduction Technology Centers in China: Qualitative Study Based on WeChat Official Accounts %A Shao,Fang %A He,Zhiqiang %A Zhu,Zheng %A Wang,Xiang %A Zhang,Jianping %A Shan,Jinhua %A Pan,Jiajia %A Wang,Hui %+ Department of Histology and Embryology, School of Basic Medical Sciences, Nanjing Medical University, 101 Longmian Rd, Nanjing, 211166, China, 86 025 86869380, anniewang@njmu.edu.cn %K ART center %K WeChat official account %K Internet influence %D 2020 %7 10.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The prevalence of infertility in China is high, but the advent of assisted reproduction technology (ART) has greatly eased this situation. Social media, such as WeChat official accounts, have become the preferred tool for ART centers to communicate with patients, but their attention and operational status differ, and the Internet influence of WeChat official accounts is insufficient. In addition, questions about whether Internet influence is consistent with academic influence and whether the Internet can influence patients’ choice of medical treatment to a certain extent have not been explored. Objective: This study aimed to examine the operational status and Internet influence of WeChat official accounts for ART centers and to explore the degree of Internet influence on patients’ choices of medical treatment. Methods: We collected information from the WeChat official accounts for ART centers approved by the National Health Commission of the People’s Republic of China and used the technique for order of preference by similarity to ideal solution to build an Internet influence model of the ART centers and obtained a Ranking of Internet Influence on Reproductive Centers (RIIRC) for each center. Results: We found there were 451 ART centers throughout the country by the end of 2016 and 498 by the end of 2018. The number of medical institutions is quite large, but their distribution is uneven, and their level of medical technical ability is very different. Analysis of the text data of posts of WeChat official accounts showed the ART centers have insufficient awareness of network exposure and publicity, and the RIIRC of some medical institutions was inconsistent with their medical level and academic status. Conclusions: ART institutions have varying degrees of emphasis and use of WeChat official accounts in China. They fail to realize that the Internet influence of WeChat may bring them potential patient resources and that Internet influence may affect the future market structure of ART and may also potentially affect academic rankings. %M 32357124 %R 10.2196/17997 %U https://www.jmir.org/2020/6/e17997 %U https://doi.org/10.2196/17997 %U http://www.ncbi.nlm.nih.gov/pubmed/32357124 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e15875 %T Patient Uptake, Experience, and Satisfaction Using Web-Based and Face-to-Face Hearing Health Services: Process Evaluation Study %A Ratanjee-Vanmali,Husmita %A Swanepoel,De Wet %A Laplante-Lévesque,Ariane %+ Department of Speech-Language Pathology & Audiology, University of Pretoria, Lynnwood Rd & Roper Street, Pretoria, 0001, South Africa, 27 124204280, dewet.swanepoel@up.ac.za %K audiology %K hearing loss %K internet-based intervention %K patient outcome assessment %K patient satisfaction %K telemedicine %K text messaging %K eHealth %K mHealth %K social media %K patient-centered care %D 2020 %7 20.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Globally, access to hearing health care is a growing concern with 900 million people estimated to suffer from disabling hearing loss by 2050. Hearing loss is one of the most common chronic health conditions, yet access to hearing health care is limited. Incorporating Web-based (voice calling, messaging, or emailing) service delivery into current treatment pathways could improve access and allow for better scalability of services. Current electronic health studies in audiology have focused on technical feasibility, sensitivity, and specificity of diagnostic hearing testing and not on patient satisfaction, experiences, and sustainable models along the entire patient journey. Objective: This study aimed to investigate a hybrid (Web-based and face-to-face) hearing health service in terms of uptake, experience, and satisfaction in adult patients with hearing loss. Methods: A nonprofit hearing research clinic using online and face-to-face services was implemented in Durban, South Africa, using online recruitment from the clinic’s Facebook page and Google AdWords, which directed persons to an online Web-based hearing screening test. Web-based and face-to-face care pathways included assessment, treatment, and rehabilitation. To evaluate the service, an online survey comprising (1) a validated satisfaction measurement tool (Short Assessment of Patient Satisfaction), (2) a process evaluation of all the 5 steps completed, and (3) personal preferences of communication methods used vs methods preferred was conducted, which was sent to 46 patients who used clinic services. Results: Of the patients invited, 67% (31/46) completed the survey with mean age 66 years, (SD 16). Almost all patients, 92% (30/31) reported that the online screening test assisted them in seeking hearing health care. Approximately 60% (18/31) of the patients accessed the online hearing screening test from an Android device. Patients stayed in contact with the audiologist mostly through WhatsApp instant messaging (27/31, 87%), and most patients (25/31, 81%) preferred to use this method of communication. The patients continuing with hearing health care were significantly older and had significantly poorer speech recognition abilities compared with the patients who discontinued seeking hearing health care. A statistically significant positive result (P=.007) was found between age and the number of appointments per patient. Around 61% (19/31) of patients previously completed diagnostic testing at other practices, with 95% (18/19) rating the services at the hybrid clinic as better. The net promoter score was 87, indicating that patients were highly likely to recommend the hybrid clinic to friends and family. Conclusions: This study applied Web-based and face-to-face components into a hybrid clinic and measured an overall positive experience with high patient satisfaction through a process evaluation. The findings support the potential of a hybrid clinic with synchronous and asynchronous modes of communication to be a scalable hearing health care model, addressing the needs of adults with hearing loss globally. %M 32196459 %R 10.2196/15875 %U http://www.jmir.org/2020/3/e15875/ %U https://doi.org/10.2196/15875 %U http://www.ncbi.nlm.nih.gov/pubmed/32196459 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e17026 %T An Analysis of the Learning Health System in Its First Decade in Practice: Scoping Review %A Platt,Jodyn E %A Raj,Minakshi %A Wienroth,Matthias %+ Department of Health Management and Policy, University of Michigan School of Public Health, 1420 Washington Heights, Ann Arbor, MI, 48109, United States, 1 3155593112, miraj@umich.edu %K learning health system %K review %K knowledge management %K bioethics %K health information exchange %D 2020 %7 19.3.2020 %9 Review %J J Med Internet Res %G English %X Background: In the past decade, Lynn Etheredge presented a vision for the Learning Health System (LHS) as an opportunity for increasing the value of health care via rapid learning from data and immediate translation to practice and policy. An LHS is defined in the literature as a system that seeks to continuously generate and apply evidence, innovation, quality, and value in health care. Objective: This review aimed to examine themes in the literature and rhetoric on the LHS in the past decade to understand efforts to realize the LHS in practice and to identify gaps and opportunities to continue to take the LHS forward. Methods: We conducted a thematic analysis in 2018 to analyze progress and opportunities over time as compared with the initial Knowledge Gaps and Uncertainties proposed in 2007. Results: We found that the literature on the LHS has increased over the past decade, with most articles focused on theory and implementation; articles have been increasingly concerned with policy. Conclusions: There is a need for attention to understanding the ethical and social implications of the LHS and for exploring opportunities to ensure that these implications are salient in implementation, practice, and policy efforts. %M 32191214 %R 10.2196/17026 %U http://www.jmir.org/2020/3/e17026/ %U https://doi.org/10.2196/17026 %U http://www.ncbi.nlm.nih.gov/pubmed/32191214 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e17921 %T The Multiple Sclerosis Health Resource Utilization Survey (MS-HRS): Development and Validation Study %A Ness,Nils-Henning %A Haase,Rocco %A Kern,Raimar %A Schriefer,Dirk %A Ettle,Benjamin %A Cornelissen,Christian %A Akguen,Katja %A Ziemssen,Tjalf %+ University Hospital Carl Gustav Carus, Fetscherstr. 74, Dresden, 01307, Germany, 49 3514584465, tjalf.ziemssen@uniklinikum-dresden.de %K multiple sclerosis %K patient-reported outcome measures %K resource utilization %K validation %K questionnaire development %D 2020 %7 17.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Survey-based studies are frequently used to describe the economic impact of multiple sclerosis (MS). However, there is no validated health resource survey available, preventing comparison of study results and meaningful conclusions regarding the efficiency of long-term treatments. Objective: The aim of this study was to develop and validate a tablet- and paper-based MS health resource utilization survey. Methods: We developed and validated the Multiple Sclerosis Health Resource Utilization Survey (MS-HRS), consisting of 24 cost items for paper and tablet users. Data for validation came from two large German observational studies. Survey practicability was assessed according to the response rate. Reliability was described using test-retest reliability as well as Guttman lambda. Construct validity was assessed as convergent and discriminant validity via correlations with associated patient-reported outcomes and known-group analyses. Results: In total, 2207 out of 2388 (response rate: 92.4%) patients completed the survey and were included to determine psychometric properties. The test-retest reliability had an intraclass correlation coefficient of 0.828 over a course of 3 months. Convergent validity analyses showed that total costs correlated positively with increased disability (r=0.411, P<.001). For discriminant validity, correlations of total costs with the Treatment Satisfaction Questionnaire for Medication ranged from −0.006 (convenience) to −0.216 (effectiveness). The mean annual cost was €28,203 (SD €14,808) (US $39,203; SD US $20,583) with disease-modifying therapies. Conclusions: The MS-HRS is a multilingual, reliable, valid, electronically available, and easy-to-administer questionnaire providing a holistic cross-sectional and longitudinal assessment of resource utilization in patients with MS. %M 32181745 %R 10.2196/17921 %U http://www.jmir.org/2020/3/e17921/ %U https://doi.org/10.2196/17921 %U http://www.ncbi.nlm.nih.gov/pubmed/32181745 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e13120 %T The Association Between Health Information Seeking on the Internet and Physician Visits (The Seventh Tromsø Study - Part 4): Population-Based Questionnaire Study %A Yigzaw,Kassaye Yitbarek %A Wynn,Rolf %A Marco-Ruiz,Luis %A Budrionis,Andrius %A Oyeyemi,Sunday Oluwafemi %A Fagerlund,Asbjørn Johansen %A Bellika,Johan Gustav %+ Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050 Langnes, Tromsø, 9037, Norway, 47 95748049, johan.gustav.bellika@ehealthresearch.no %K eHealth %K internet %K health care service %K physician visit %K Tromsø study %K health information seeking %K Web search engine %K health app %K social media %K video search engine %D 2020 %7 5.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The internet is being widely used for seeking health information. However, there is no consensus on the association between health information seeking on the internet and the use of health care services. Objective: We examined the association between health information seeking via the internet and physician visits. In addition, we investigated the association between online health information seeking and the decisions to visit and not to visit a physician. Methods: We used the cross-sectional electronic health (eHealth) data of 18,197 participants from the seventh survey of the Tromsø Study (Tromsø 7). The participants were aged ≥40 years and living in Tromsø, Norway. We used logistic regression models to examine the association between online health information seeking and physician visits, the decision to visit a physician, and the decision not to visit a physician, with adjustment for the demographic status, socioeconomic status, and health status of the participants. Results: The use of Web search engines was associated with a physician visit. However, the association was moderated by age, and the OR decreased as age increased. The ORs for the use of Web search engines were 1.99 (95% CI 1.94-2.02) and 1.07 (95% CI 1.03-1.12) at ages 40 and 80 years, respectively. The decision to visit a physician was associated with the use of Web search engines (OR 2.95, 95% CI 2.03-4.46), video search engines (OR 1.43, 95% CI 1.21-1.70), and health apps (OR 1.26, 95% CI 1.13-1.42). The association between social media use and the decision to visit a physician was moderated by gender. Women who used social media had 1.42 (95% CI 1.31-1.55) times higher odds of deciding to visit a physician, whereas the decision to visit a physician was not different between men who used social media and those who did not use social media. Conversely, the decision not to visit a physician was associated with the use of Web search engines (OR 2.78, 95% CI 1.92-4.18), video search engines (OR 1.27, 95% CI 1.07-1.51), social media (OR 1.28, 95% CI 1.10-1.49), and health apps (OR 1.20, 95% CI 1.07-1.35). Conclusions: Health information found on the internet was positively associated with both the decision to visit a physician and the decision not to visit a physician. However, the association of health information seeking with the decision to visit a physician was slightly stronger than the association with the decision not to visit a physician. This could imply that the use of eHealth services is associated with a resultant increase in physician visits. In summary, our findings suggest that the internet serves as a supplement to health care services rather than as a replacement. %M 32134387 %R 10.2196/13120 %U https://www.jmir.org/2020/3/e13120 %U https://doi.org/10.2196/13120 %U http://www.ncbi.nlm.nih.gov/pubmed/32134387 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 12 %N 1 %P e12336 %T The Challenges of Including Patients With Aphasia in Qualitative Research for Health Service Redesign: Qualitative Interview Study %A Prior,Sarah %A Miller,Andrea %A Campbell,Steven %A Linegar,Karen %A Peterson,Gregory %+ School of Medicine, University of Tasmania, Brickport Road, Burnie, 7320, Australia, 61 417313676, sarah.prior@utas.edu.au %K stroke %K communication %K research %K qualitative %K aphasia %K participatory research %D 2020 %7 7.2.2020 %9 Original Paper %J J Participat Med %G English %X Background: Aphasia is an impairment of language, affecting the production or comprehension of speech and the ability to read or write. Aphasia is a frequent complication of stroke and is a major disability for patients and their families. The provision of services for stroke patients differs across health care providers and regions, and strategies directed at improving these services have benefited from the involvement of patients. However, patients with aphasia are often excluded from these co-design activities due to a diminished capacity to communicate verbally and a lack of health researcher experience in working with patients with aphasia. Objective: The primary aim of this paper is to identify approaches appropriate for working with patients with aphasia in an interview situation and, more generally, determine the importance of including people with aphasia in health service improvement research. The secondary aim is to describe the experiences of researchers involved in interviewing patients with aphasia. Methods: A total of 5 poststroke patients with aphasia participated in face-to-face interviews in their homes to gain insight into their in-hospital experience following their stroke. Interviews were audio-recorded, and thematic analysis was performed. The experiences of the researchers interviewing these patients were informally recorded postinterview, and themes were derived from these reflections. Results: The interview technique utilized in this study was unsuitable to gain rich, qualitative data from patients with aphasia. The experience of researchers performing these interviews suggests that preparation, emotion, and understanding were three of the main factors influencing their ability to gather useful experiential information from patients with aphasia. Patients with aphasia are valuable contributors to qualitative health services research, and researchers need to be flexible and adaptable in their methods of engagement. Conclusions: Including patients with aphasia in health service redesign research requires the use of nontraditional interview techniques. Researchers intending to engage patients with aphasia must devise appropriate strategies and methods to maximize the contributions and valuable communications of these participants. %R 10.2196/12336 %U https://jopm.jmir.org/2020/1/e12336 %U https://doi.org/10.2196/12336 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 9 %N 1 %P e14546 %T A Strategic Imperative for Promoting Hospital Branding: Analysis of Outcome Indicators %A Shieh,Gow-Jen %A Wu,Shi-Liang %A Tsai,Che-Fu %A Chang,Chi-Sen %A Chang,Tsung-Hung %A Lui,Ping-Wing %A Yao,Yuh %A Sheu,Wayne Huey-Herng %+ Department of Top Hospital Administration, Taichung Veterans General Hospital, No 1650, Section 4, Taiwan Boulevard, Taichung, , Taiwan, 886 4 2359 2525 ext 2005, whhsheu@vghtc.gov.tw %K social media %K branding %K Facebook %K Taiwan %K health services research %K marketing of health services %D 2020 %7 22.1.2020 %9 Original Paper %J Interact J Med Res %G English %X Background: Optimizing the use of social media to promote hospital branding is important in the present digital era. In Taiwan, only 51.1% of hospitals have official Facebook fan pages. The numbers of likes for these hospitals are also relatively low. Objective: Our objective was to establish a special branding team for social media operation, led by top administrators of our hospital. Here we present our strategic imperative for promoting hospital branding as well as an analysis of its effectiveness. Methods: Led by top administrators, the branding team was formed by 11 divisions to create branding strategies. From 2016 to 2018, the team implemented action plans. All information unique to the hospital was posted on Facebook, as well as on the hospital’s official website. To determine the plans’ efficiencies, we obtained reference data from Google Analytics, and we compared Facebook Insights reports for 2016 with those for 2017 and 2018. Results: One of the branding team’s main missions was to establish branding strategies and to integrate segmental branding messages. In each quarter we regularly monitored a total of 52 action plan indicators, including those for process and outcome, and discussed the results at team meetings. We selected 4 main performance outcome indicators to reflect the effectiveness of the branding efforts. Compared with 2016, the numbers of likes posted on the Facebook fan page increased by 61.2% in 2017 and 116.2% in 2018. Similarly, visits to the hospital website increased by 4.8% in 2017 and 33.1% in 2018. Most Facebook fan page and website viewers were in 2 age groups: 25 to 34 years, and 35 to 44 years. Women constituted 60.42% (14,160/23,436) of Facebook fans and 59.39% (778,992/1,311,605) of website viewers. According to the Facebook Insights reports, the number of likes and post sharing both increased in 2017 and 2018, relative to 2016. Comment messages also increased from 2016 to 2018 (P=.02 for the trend). The most common theme of posts varied over time, from media reports in 2016, to innovative services in both 2017 and 2018. Likes for innovative services posts increased from 2016 through 2018 (P=.045 for the trend). By the end of 2018, we recorded 23,436 cumulative likes for posts, the highest number among medical centers in Taiwan. Conclusions: We achieved the largest number of Facebook fans among all medical centers in Taiwan. We would like to share our experience with other hospitals that might be interested in engaging in social media for future communications and interactions with their patients. %M 32012047 %R 10.2196/14546 %U https://www.i-jmr.org/2020/1/e14546 %U https://doi.org/10.2196/14546 %U http://www.ncbi.nlm.nih.gov/pubmed/32012047 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e13130 %T Access to Primary Care and Internet Searches for Walk-In Clinics and Emergency Departments in Canada: Observational Study Using Google Trends and Population Health Survey Data %A Ssendikaddiwa,Joseph %A Lavergne,Ruth %+ Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada, 1 7787823937, joseph_ssendikaddiwa@sfu.ca %+ Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada, 1 7787823937, ruth_lavergne@sfu.ca %K internet %K ambulatory care facilities %K emergency departments %K primary health care %K health services accessibility %D 2019 %7 18.11.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Access to primary care is a challenge for many Canadians. Models of primary care vary widely among provinces, including arrangements for same-day and after-hours access. Use of walk-in clinics and emergency departments (EDs) may also vary, but data sources that allow comparison are limited. Objective: We used Google Trends to examine the relative frequency of searches for walk-in clinics and EDs across provinces and over time in Canada. We correlated provincial relative search frequencies from Google Trends with survey responses about primary care access from the Commonwealth Fund’s 2016 International Health Policy Survey of Adults in 11 Countries and the 2016 Canadian Community Health Survey. Methods: We developed search strategies to capture the range of terms used for walk-in clinics (eg, urgent care clinic and after-hours clinic) and EDs (eg, emergency room) across Canadian provinces. We used Google Trends to determine the frequencies of these terms relative to total search volume within each province from January 2011 to December 2018. We calculated correlation coefficients and 95% CIs between provincial Google Trends relative search frequencies and survey responses. Results: Relative search frequency of walk-in clinic searches increased steadily, doubling in most provinces between 2011 and 2018. Relative frequency of walk-in clinic searches was highest in the western provinces of British Columbia, Alberta, Saskatchewan, and Manitoba. At the provincial level, higher walk-in clinic relative search frequency was strongly positively correlated with the percentage of survey respondents who reported being able to get same- or next-day appointments to see a doctor or a nurse and inversely correlated with the percentage of respondents who reported going to ED for a condition that they thought could have been treated by providers at usual place of care. Relative search frequency for walk-in clinics was also inversely correlated with the percentage of respondents who reported having a regular medical provider. ED relative search frequencies were more stable over time, and we did not observe statistically significant correlation with survey data. Conclusions: Higher relative search frequency for walk-in clinics was positively correlated with the ability to get a same- or next-day appointment and inversely correlated with ED use for conditions treatable in the patient’s regular place of care and also with having a regular medical provider. Findings suggest that patient use of Web-based tools to search for more convenient or accessible care through walk-in clinics is increasing over time. Further research is needed to validate Google Trends data with administrative information on service use. %M 31738175 %R 10.2196/13130 %U http://publichealth.jmir.org/2019/4/e13130/ %U https://doi.org/10.2196/13130 %U http://www.ncbi.nlm.nih.gov/pubmed/31738175 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e14689 %T Perception of the Progressing Digitization and Transformation of the German Health Care System Among Experts and the Public: Mixed Methods Study %A Hansen,Arne %A Herrmann,Maximilian %A Ehlers,Jan P %A Mondritzki,Thomas %A Hensel,Kai Oliver %A Truebel,Hubert %A Boehme,Philip %+ Cardiovascular Research, Bayer Aktiengesellschaft, Apratherweg 18a, Wuppertal, 42113, Germany, 49 17632087847, philip.boehme@bayer.com %K digitization %K health care sector %K transformation %K mixed method %K delivery of health care %K diffusion of innovation %K reform %D 2019 %7 28.10.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Health care systems worldwide are struggling to keep rising costs at bay with only modest outcome improvement among many diseases. Digitization with technologies like Artificial Intelligence or Machine Learning algorithms might address this. Although digital technologies have been successfully applied in clinical studies the effect on the overall health care system so far was limited. The regulatory ecosystem or data privacy might be responsible, but other reasons may also predominate. Objective: We analyzed how the digitization of the German health care market is currently perceived among different stakeholders and investigated reasons for its slow adaption. Methods: This was a mixed methods study split into a qualitative Part A using the conceptual approach of the Grounded Theory and a quantitative Part B using the Delphi method. For Part A we interviewed experts in the health care system and converted the results into 17 hypotheses. The Delphi method consisted of an online survey which was sent to the participants via email and was available for three months. For the assessment of the 17 hypotheses, the participants were given a six-point Likert scale. The participants were grouped into patients, physicians, and providers of services within the German health care market. Results: There was a strong alignment of opinions on the hypotheses between experts (N=21) and survey participants (N=733), with 70.5% overall agreement on 12/17 hypotheses. Physicians demonstrated the lowest level of agreement with the expert panel at 88% (15/17) disagreement, with the hypotheses “H8: Digitization in the health care system will free up jobs,” and “H6: Digitization in the health care system will empower the patients,” perceived to be in profound disagreement (P=.036 and P<.001, respectively). Conclusions: Despite the firm agreement among participants and experts regarding the impact of digitization on the health care system, physicians demonstrated a more negative attitude. We assume that this might be a factor contributing to the slow adoption of digitization in practice. Physicians might be struggling with changing power structures, so future measures to transform the market should involve them to a larger degree. %M 31661082 %R 10.2196/14689 %U http://publichealth.jmir.org/2019/4/e14689/ %U https://doi.org/10.2196/14689 %U http://www.ncbi.nlm.nih.gov/pubmed/31661082 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 3 %P e14519 %T The Presence of Physical Symptoms in Patients With Tinnitus: International Web-Based Survey %A Michiels,Sarah %A Harrison,Stephen %A Vesala,Markku %A Schlee,Winfried %+ Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610, Belgium, 32 485840758, sarah.michiels@uantwerpen.be %K tinnitus %K self report %K surveys %D 2019 %7 30.07.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Tinnitus, or ringing in the ears, is a phantom perception of sound in the absence of overt acoustic stimulation. Many patients indicate that the perception of their tinnitus is not constant and can vary from moment to moment. This tinnitus fluctuation is one of the diagnostic criteria for somatosensory tinnitus (ST), a tinnitus subtype that is influenced by cervical spine or temporomandibular dysfunctions, although various factors have been reported to cause fluctuations in tinnitus, such as stress, anxiety, and physical activity. Objective: The aim of this study was twofold: (1) to investigate the presence of physical symptoms in a large group of participants with tinnitus and (2) to investigate if these physical symptoms are more frequently present in a subgroup of participants with ST. Methods: A Web-based survey, questioning the presence of physical symptoms in a convenience sample of participants with tinnitus, was launched on the online forum, Tinnitus Talk, managed by Tinnitus Hub. After a general analysis of the physical symptoms present in our survey population, we further analyzed the group of participants who were diagnosed by a physician (n=1262). This subgroup was divided into 2 groups, one group diagnosed with ST and another group diagnosed with other types of tinnitus. Results: In total, 6115 participants with a mean age of 54.08 years (SD 13.8) completed the survey. Physical symptoms were frequently present in our sample of participants with tinnitus: 4221 participants (69.02%) reported some form of neck pain, 429 (7.01%) were diagnosed with temporomandibular disorders, 2730 (44.64%) indicated they have bruxism, and between 858 and 1419 (14.03%-23.20%) participants were able to modulate their tinnitus by voluntary movements. ST was diagnosed in 154 out of 1262 (12.20%) participants whose tinnitus cause was diagnosed by a physician. Symptoms referring to the known diagnostic criteria were evidently more present in the ST group than in the non-ST group. Additionally, participants with ST more often indicated a negative effect of a bad night’s sleep (P=.01) and light intensity exercise (P=.01). Conclusions: Physical activity and movement (disorders) frequently affect tinnitus severity. Head-neck related symptoms are more frequently reported in the ST group, as is the ability to modulate the tinnitus by head or jaw movements. Additionally, participants with ST more often report fluctuations of their tinnitus and reaction to sleeping difficulties and low intensity exercise. %M 31364603 %R 10.2196/14519 %U http://www.i-jmr.org/2019/3/e14519/ %U https://doi.org/10.2196/14519 %U http://www.ncbi.nlm.nih.gov/pubmed/31364603 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 2 %P e12603 %T Pneumococcal Vaccination Utilization Among Hispanic Long-Term Colorectal Cancer Survivors: Cross-Sectional Assessment of Claims %A Moran,Ryan J %A Waalen,Jill %A Murphy,James %A Nalawade,Vinit %A Schiaffino,Melody %+ Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, Mail Code #0811, La Jolla, CA, 92093, United States, 1 8582258535, rjmoran@ucsd.edu %K Hispanic Americans %K cancer survivors %K medicare %K preventive medicine %K pneumococcal vaccines %D 2019 %7 13.05.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Colorectal cancer (CRC) is the second leading cancer-related cause of death in the United States. However, survivorship has been increasing. Both cancer survivors and underserved populations experience unique health-related challenges and disparities that may exist among long-term CRC survivors as it relates to routine preventive care, specifically pneumococcal (PNM) vaccination. Objective: The aim of this study was to explore the relationship between long-term CRC survival and the receipt of PNM vaccine among Hispanic Medicare recipients compared with non-Hispanic populations. Methods: This study is a cross-sectional analysis of the Surveillance, Epidemiology, and End Results (SEER)-Medicare claims data examining ethnic differences in the receipt of PNM vaccination among long-term CRC survivors. Multivariable logistic regression models considered Hispanic ethnicity while controlling for sociodemographic characteristics, comorbidity score, age, tumor stage, and SEER registry. Results: Our sample revealed 32,501 long-term CRC survivors, and 1509 identified as Hispanic (4.64%) based on an established SEER algorithm. In total, 16,252 CRC survivors, or 50.00% of our sample, received a PNM vaccination. We found that Hispanic CRC survivors had 10% decreased odds of having received a PNM vaccine compared with non-Hispanic survivors (P=.03). Conclusions: Disparities likely exist in the utilization of PNM vaccination among long-term CRC survivors. Among Medicare beneficiaries, the use of claims data regarding PNM vaccination highlights the relatively poor utilization of guideline-directed preventive care. %M 31094341 %R 10.2196/12603 %U http://publichealth.jmir.org/2019/2/e12603/ %U https://doi.org/10.2196/12603 %U http://www.ncbi.nlm.nih.gov/pubmed/31094341 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e12517 %T The Evidence Base for an Ideal Care Pathway for Frail Multimorbid Elderly: Combined Scoping and Systematic Intervention Review %A Berntsen,Gro %A Strisland,Frode %A Malm-Nicolaisen,Kristian %A Smaradottir,Berglind %A Fensli,Rune %A Røhne,Mette %+ Norwegian Center for E-health Research, University Hospital of North Norway, PB 35, 9038 Tromsø, Tromsø, 9038, Norway, 47 90518895, gro.rosvold.berntsen@ehealthresearch.no %K systematic review %K patient-centered care %K delivery of health care, integrated %K secondary prevention %K risk management %D 2019 %7 22.04.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: There is a call for bold and innovative action to transform the current care systems to meet the needs of an increasing population of frail multimorbid elderly. International health organizations propose complex transformations toward digitally supported (1) Person-centered, (2) Integrated, and (3) Proactive care (Digi-PIP care). However, uncertainty regarding both the design and effects of such care transformations remain. Previous reviews have found favorable but unstable impacts of each key element, but the maturity and synergies of the combination of elements are unexplored. Objective: This study aimed to describe how the literature on whole system complex transformations directed at frail multimorbid elderly reflects (1) operationalization of intervention, (2) maturity, (3) evaluation methodology, and (4) effect on outcomes. Methods: We performed a systematic health service and electronic health literature review of care transformations targeting frail multimorbid elderly. Papers including (1) Person-centered, integrated, and proactive (PIP) care; (2) at least 1 digital support element; and (3) an effect evaluation of patient health and/ or cost outcomes were eligible. We used a previously published ideal for the quality of care to structure descriptions of each intervention. In a secondary deductive-inductive analysis, we collated the descriptions to create an outline of the generic elements of a Digi-PIP care model. The authors then reviewed each intervention regarding the presence of critical elements, study design quality, and intervention effects. Results: Out of 927 potentially eligible papers, 10 papers fulfilled the inclusion criteria. All interventions idealized Person-centered care, but only one intervention made what mattered to the person visible in the care plan. Care coordinators responsible for a whole-person care plan, shared electronically in some instances, was the primary integrated care strategy. Digitally supported risk stratification and management were the main proactive strategies. No intervention included workflow optimization, monitoring of care delivery, or patient-reported outcomes. All interventions had gaps in the chain of care that threatened desired outcomes. After evaluation of study quality, 4 studies remained. They included outcome analyses on patient satisfaction, quality of life, function, disease process quality, health care utilization, mortality, and staff burnout. Only 2 of 24 analyses showed significant effects. Conclusions: Despite a strong common-sense belief that the Digi-PIP ingredients are key to sustainable care in the face of the silver tsunami, research has failed to produce evidence for this. We found that interventions reflect a reductionist paradigm, which forces care workers into standardized narrowly focused interventions for complex problems. There is a paucity of studies that meet complex needs with digitally supported flexible and adaptive teamwork. We predict that consistent results from care transformations for frail multimorbid elderly hinges on an individual care pathway, which reflects a synergetic PIP approach enabled by digital support. %M 31008706 %R 10.2196/12517 %U http://www.jmir.org/2019/4/e12517/ %U https://doi.org/10.2196/12517 %U http://www.ncbi.nlm.nih.gov/pubmed/31008706 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e13465 %T Associations Between the Use of eHealth and Out-of-Hours Services in People With Type 1 Diabetes: Cross-Sectional Study %A Hansen,Anne Helen %A Claudi,Tor %A Årsand,Eirik %+ Centre for Quality Improvement and Development, University Hospital of North Norway, PO Box 35, Tromsø, 9038, Norway, 47 91619655, anne.helen.hansen@unn.no %K eHealth %K internet %K health care utilization %K out-of-hours services %K cross-sectional study %K diabetes mellitus, type 1 %K Norway %D 2019 %7 21.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the increasing prevalence of diabetes and the increasing use of eHealth, little is known about the association between provider-based health services and eHealth among people with diabetes. This is the second study in a project exploring the associations between the use of eHealth and the use of provider-based health services. Objective: The objective of this study was to investigate which eHealth services are used among out-of-hours (OOH) visitors with type 1 diabetes (T1D), and whether the use of eHealth (eg, apps, search engines, video services, and social media) was associated with the use of OOH services. We also wanted to investigate associations between anxiety, reassurance, and change in doctor-seeking behavior because of health information acquired from the Internet, and the use of OOH services. Methods: We used data from a 2018 email survey of members of the Norwegian Diabetes Association (18-89 years old). Respondents with T1D were eligible for analyses. Using descriptive statistics, we estimated the use of OOH services and eHealth. Using logistic regressions, we studied the associations between the use of OOH services and the use of eHealth, as well as associations between the use of OOH services and reported consequences of using Internet-based health information. Results: In the sample of 523 people with T1D (mean age 47 years), 26.7% (129/484) visited OOH services once or more during the previous year. Among the OOH visitors, search engines were used for health purposes by 86.7% (111/128), apps (health apps in general) by 63.6% (82/129), social media by 45.3% (58/128), and video services by 28.4% (36/127). The use of OOH services was positively associated with self-reported anxiety/depression (odds ratio [OR] 4.53, 95% CI 1.43-14.32) and with the use of apps (OR 1.73, 95% CI 1.05-2.85), but not with other types of eHealth. Those who had felt anxious based on information from the Internet were more likely to visit OOH services compared with those who had not felt anxious (OR 2.38, 95% CI 1.50-3.78). People who had decided to consult a doctor based on information from the Internet were more likely to visit OOH services (OR 2.76, 95% CI 1.64-4.66), compared to those who had not made such an Internet-based decision. Conclusions: People with T1D were frequent users of OOH services, and the OOH visitors were frequent users of eHealth. The use of OOH services was positively associated with the use of health apps, with self-reported anxiety/depression, and with feeling anxious based on information from the Internet. Likewise, deciding to consult a doctor based on information from the Internet was positively associated with OOH visits. The use of eHealth seems to have a significant impact on people with T1D. %M 30896437 %R 10.2196/13465 %U http://www.jmir.org/2019/3/e13465/ %U https://doi.org/10.2196/13465 %U http://www.ncbi.nlm.nih.gov/pubmed/30896437 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 4 %P e51 %T Using an Internet-Based Hospital to Address Maldistribution of Health Care Resources in Rural Areas of Guangdong Province, China: Retrospective and Descriptive Study %A He,Cui %A Zhou,Qiru %A Chen,Wei %A Tian,Junzhang %A Zhou,Lihua %A Peng,Hong %A Luan,Shuo %A Wang,Shengfei %+ Department of Guangdong Online Hospital, Guangdong Second Provincial General Hospital, 466 Xingang Middle Road, Haizhu District, Guangzhou, 510317, China, 86 02089168777, 562783227@qq.com %K telemedicine %K health care delivery %K prescription %K cost %K patient satisfaction %K patient compliance %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: Health care maldistribution is a long-term problem in China. Telemedicine is an efficient way to deliver medical resources to remote areas; however, there are few studies on the effectiveness and challenges in providing health care from rural to urban areas in China. Objective: The objective was to describe the effectiveness and challenges of telemedicine for providing health care from Guangzhou to rural areas in Guangdong Province. Methods: We designed surveys and conducted them immediately after the consultation and 2-4 weeks later. Data were collected from June 2015 to May 2016 including patients’ demographic features, patient satisfaction, medicine effect, patient compliance, acceptability of prescription expenses, patients’ desire to revisit the department, the top 10 diseases, and self-reported difficulties in telemedicine experience. The monthly average prescription expense was described using a line chart. The monthly consultation and prescription, as well as monthly prescriptions of Western medicines and herbs, were described using a bar chart. Results: Women comprised majority (45,386/67,740, 67.00%) of participants and men comprised the minority (22,354/67,740, 33.00%). The top 3 diseases were upper respiratory diseases (12,371/36,311, 34.07%), laryngopharyngitis (4938/36,311, 13.60%), and menstrual disorders (4669/36,311, 12.86%). The monthly prescription for Western medicine was much more than that for Chinese herbs. The annual average medicine expense per prescription was 62.9 ¥. The participants’ perception of expense was acceptable (8775/12,450, 70.48%), mostly acceptable (2497/12,450, 20.01%), accepted but somewhat expensive (980/12,450, 7.9%), and unacceptable because of high cost (198/12,450, 1.6%). The surveys on patient satisfaction demonstrated very satisfied (55,687/67,740, 82.21%), satisfied (5891/67,740, 8.70%), basic satisfaction (3561/67,740, 5.26%), dissatisfaction (1454/67,740, 2.15%), and no comment (1147/67,740, 1.69%). Participants reported their treatment outcome as follows: full recovery (5008/12,450, 40.22%), recovering (4873/12,450, 39.14%), no effect (2153/12,450, 17.29%), or worsening (416/12,450, 3.3%). Approximately 89.01% (20,240/22,740) of participants will revisit the department, whereas 10.99% (2500/22,740) will not. Most patients complied with the doctors’ advice completely (5430/10,290, 52.77%), whereas the rest reported partial compliance (3684/10,290, 35.80%) or no compliance at all (1176/10,290, 11.43%). The participants reported poor computer skills (4980/22,740, 21.90%), transportation inconvenience (4670/22,740, 20.50%), unstable internet connection (3820/22,740, 16.80%), language barriers (3708/22,740, 16.30%), medication and medical hardware shortage (2459/22,740, 10.82%), tiring commute (2068/22,740, 9.08%), family care burdens (679/22,740, 3.0%), and other unclassified difficulties (356/22,740, 1.6%) as difficulties in using telemedicine. Conclusions: Telemedicine has a wide disease spectrum, similar to ordinary medicine in China. It saves costs, has high patient satisfaction and price acceptability, and can relieve disease and syndromes. However, certain problems need to be resolved. Telemedicine could be a feasible approach to address the health care maldistribution in rural China. This study may provide useful information for policy making and guidance for further telemedicine practice in China and other developing countries. %M 30578195 %R 10.2196/medinform.9495 %U http://medinform.jmir.org/2018/4/e51/ %U https://doi.org/10.2196/medinform.9495 %U http://www.ncbi.nlm.nih.gov/pubmed/30578195 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 4 %P e12241 %T Identifying Patients Who Are Likely to Receive Most of Their Care From a Specific Health Care System: Demonstration via Secondary Analysis %A Luo,Gang %A Tarczy-Hornoch,Peter %A Wilcox,Adam B %A Lee,E Sally %+ Department of Biomedical Informatics and Medical Education, University of Washington, University of Washington Medicine South Lake Union, 850 Republican Street, Building C, Box 358047, Seattle, WA, 98195, United States, 1 206 221 4596, gangluo@cs.wisc.edu %K data analysis %K inpatients %K emergency departments %K health care system %D 2018 %7 05.11.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: In the United States, health care is fragmented in numerous distinct health care systems including private, public, and federal organizations like private physician groups and academic medical centers. Many patients have their complete medical data scattered across these several health care systems, with no particular system having complete data on any of them. Several major data analysis tasks such as predictive modeling using historical data are considered impractical on incomplete data. Objective: Our objective was to find a way to enable these analysis tasks for a health care system with incomplete data on many of its patients. Methods: This study presents, to the best of our knowledge, the first method to use a geographic constraint to identify a reasonably large subset of patients who tend to receive most of their care from a given health care system. A data analysis task needing relatively complete data can be conducted on this subset of patients. We demonstrated our method using data from the University of Washington Medicine (UWM) and PreManage data covering the use of all hospitals in Washington State. We compared 10 candidate constraints to optimize the solution. Results: For UWM, the best constraint is that the patient has a UWM primary care physician and lives within 5 miles of at least one UWM hospital. About 16.01% (55,707/348,054) of UWM patients satisfied this constraint. Around 69.38% (10,501/15,135) of their inpatient stays and emergency department visits occurred within UWM in the following 6 months, more than double the corresponding percentage for all UWM patients. Conclusions: Our method can identify a reasonably large subset of patients who tend to receive most of their care from UWM. This enables several major analysis tasks on incomplete medical data that were previously deemed infeasible. %M 30401670 %R 10.2196/12241 %U http://medinform.jmir.org/2018/4/e12241/ %U https://doi.org/10.2196/12241 %U http://www.ncbi.nlm.nih.gov/pubmed/30401670 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 4 %P e10221 %T Impact of Electronic Versus Paper Vital Sign Observations on Length of Stay in Trauma Patients: Stepped-Wedge, Cluster Randomized Controlled Trial %A Wong,David CW %A Knight,Julia %A Birks,Jacqueline %A Tarassenko,Lionel %A Watkinson,Peter J %+ Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Worsley Building, Level 10, Leeds, LS29JT, United Kingdom, 44 113 3439671, d.c.wong@leeds.ac.uk %K vital signs %K medical records system, computerized %K length of stay %K evaluation studies %K trauma %D 2018 %7 31.10.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: Electronic recording of vital sign observations (e-Obs) has become increasingly prevalent in hospital care. The evidence of clinical impact for these systems is mixed. Objective: The objective of our study was to assess the effect of e-Obs versus paper documentation (paper) on length of stay (time between trauma unit admission and “fit to discharge”) for trauma patients. Methods: A single-center, randomized stepped-wedge study of e-Obs against paper was conducted in two 26-bed trauma wards at a medium-sized UK teaching hospital. Randomization of the phased intervention order to 12 study areas was computer generated. The primary outcome was length of stay. Results: A total of 1232 patient episodes were randomized (paper: 628, e-Obs: 604). There were 37 deaths in hospital: 21 in the paper arm and 16 in the e-Obs arm. For discharged patients, the median length of stay was 5.4 (range: 0.2-79.0) days on the paper arm and 5.6 (range: 0.1-236.7) days on the e-Obs arm. Competing risks regression analysis for time to discharge showed no difference between the treatment arms (subhazard ratio: 1.05; 95% CI 0.82-1.35; P=.68). A greater proportion of patient episodes contained an Early Warning Score (EWS) ≥3 using the e-Obs system than using paper (subhazard ratio: 1.63; 95% CI 1.28-2.09; P<.001). However, there was no difference in the time to the subsequent observation, “escalation time” (hazard ratio 1.05; 95% CI 0.80-1.38; P=.70). Conclusions: The phased introduction of an e-Obs documentation system was not associated with a change in length of stay. A greater proportion of patient episodes contained an EWS≥3 using the e-Obs system, but this was not associated with a change in “escalation time.” Trial Registration: ISRCTN Registry ISRCTN91040762; http://www.isrctn.com/ISRCTN91040762 (Archived by WebCite at http://www.webcitation.org/72prakGTU) %M 30381284 %R 10.2196/10221 %U http://medinform.jmir.org/2018/4/e10221/ %U https://doi.org/10.2196/10221 %U http://www.ncbi.nlm.nih.gov/pubmed/30381284 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e10872 %T Television Advertising and Health Insurance Marketplace Consumer Engagement in Kentucky: A Natural Experiment %A Shafer,Paul R %A Fowler,Erika Franklin %A Baum,Laura %A Gollust,Sarah E %+ Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599, United States, 1 919 260 2711, pshafer@unc.edu %K advertising %K Affordable Care Act %K enrollment %D 2018 %7 25.10.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Reductions in health insurance enrollment outreach could have negative effects on the individual health insurance market. Specifically, consumers may not be informed about the availability of coverage, and if some healthier consumers fail to enroll, there could be a worse risk pool for insurers. Kentucky created its own Marketplace, known as kynect, and adopted Medicaid expansion under the Affordable Care Act, which yielded the largest decline in adult uninsured rate in the United States from 2013 to 2016. The state sponsored an award-winning media campaign, yet after the election of a new governor in 2015, it declined to renew the television advertising contract for kynect and canceled all pending television ads with over a month remaining in the 2016 open enrollment period. Objective: The objective of this study is to examine the stark variation in television advertising across multiple open enrollment periods in Kentucky and use this variation to estimate the dose-response effect of state-sponsored television advertising on consumer engagement with the Marketplace. In addition, we assess to what extent private insurers can potentially help fill the void when governments reduce or eliminate television advertising. Methods: We obtained television advertising (Kantar Media/Campaign Media Analysis Group) and Marketplace data (Kentucky Health Benefit Exchange) for the period of October 1, 2013, through January 31, 2016, for Kentucky. Advertising data at the spot level were collapsed to state-week counts by sponsor type. Similarly, a state-week series of Marketplace engagement and enrollment measures were derived from state reports to Centers for Medicare and Medicaid Services. We used linear regression models to estimate associations between health insurance television advertising volume and measures of information-seeking (calls to call center; page views, visits, and unique visitors to the website) and enrollment (Web-based and total applications, Marketplace enrollment). Results: We found significant dose-response effects of weekly state-sponsored television advertising volume during open enrollment on information-seeking behavior (marginal effects of an additional ad airing per week for website page views: 7973, visits: 390, and unique visitors: 388) and enrollment activity (applications, Web-based: 61 and total: 56). Conclusions: State-sponsored television advertising was associated with nearly 40% of unique visitors and Web-based applications. Insurance company television advertising was not a significant driver of engagement, an important consideration if cuts to government-sponsored advertising persist. %M 30361198 %R 10.2196/10872 %U http://www.jmir.org/2018/10/e10872/ %U https://doi.org/10.2196/10872 %U http://www.ncbi.nlm.nih.gov/pubmed/30361198 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e283 %T Associations of eHealth Literacy With Health Services Utilization Among College Students: Cross-Sectional Study %A Luo,Yi Fang %A Yang,Shu Ching %A Chen,An-Sing %A Chiang,Chia-Hsun %+ Institute of Education, National Sun Yat-sen University, 70 Lien-hai Road, Kaohsiung, 80424, Taiwan, 886 47612346, d996050002@student.nsysu.edu.tw %K eHealth %K health literacy %K health services %K student %K utilization %D 2018 %7 25.10.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic health (eHealth) literacy has become an important topic in health fields. Studies have found that individuals with higher eHealth literacy are more likely to use preventive care services and to have effective interactions with their physicians. In addition, previous studies have revealed a gender difference in the utilization of physician access and outpatient services. Nevertheless, few studies have explored the effect of the three levels of eHealth literacy (functional, interactive, and critical levels) on the four aspects of health services utilization (type, site, purpose, and time interval). It is unclear whether the associations between these three levels of eHealth literacy and the four aspects of health services utilization among college students are positive or negative. Objective: The objective of this study was to investigate the associations among gender, eHealth literacy, and health services utilization. Methods: We used the eHealth Literacy Scale, a 12-item instrument designed to measure college students’ functional, interactive, and critical eHealth literacy, and the Health Services Utilization Scale, which is a 10-item instrument developed to measure the four aspects of health services utilization by college students. A nationally representative sample of 489 college students in Taiwan was surveyed. We conducted multiple regression analysis to examine the associations among gender, eHealth literacy, and health services utilization. Results: The study found that being female was negatively related to the purpose aspect of health services utilization (t487=−2.85, P<.01). However, the R2 value of gender on the purpose aspect was low enough to be ignored. Critical (t484=2.98-4.23, P<.01) and interactive eHealth literacy (t484=2.43-2.89, P<.05) were related to three aspects of the health services utilization, and functional eHealth literacy was related to the purpose aspect (t484=−4.99, P<.001). Conclusions: This study showed that Taiwanese college students with interactive eHealth literacy were more likely to have a higher rate of outpatient care use. Moreover, Taiwanese college students with critical eHealth literacy were more likely to make full use of health services than those with functional eHealth literacy. Finally, the educated and age-restricted sample may attenuate gender disparities in health services utilization among Taiwanese college students. %M 30361201 %R 10.2196/jmir.8897 %U http://www.jmir.org/2018/10/e283/ %U https://doi.org/10.2196/jmir.8897 %U http://www.ncbi.nlm.nih.gov/pubmed/30361201 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e10776 %T An mHealth Diabetes Intervention for Glucose Control: Health Care Utilization Analysis %A Quinn,Charlene C %A Swasey,Krystal K %A Torain,Jamila M %A Shardell,Michelle D %A Terrin,Michael L %A Barr,Erik A %A Gruber-Baldini,Ann L %+ Department of Epidemiology and Public Health, University of Maryland School of Medicine, 660 W Redwood Street, Howard Hall Suite 200, Baltimore, MD, 21201, United States, 1 410 706 2406, cquinn@som.umaryland.edu %K cluster randomized clinical trial %K health care %K health service utilization %K mHealth %K type 2 diabetes %D 2018 %7 15.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Type 2 diabetes (T2D) is a major chronic condition requiring management through lifestyle changes and recommended health service visits. Mobile health (mHealth) is a promising tool to encourage self-management, but few studies have investigated the impact of mHealth on health care utilization. Objective: The objective of this analysis was to determine the change in 2-year health service utilization and whether utilization explained a 1.9% absolute decrease in glycated hemoglobin (HbA1c) over 1-year in the Mobile Diabetes Intervention Study (MDIS). Methods: We used commercial claims data from 2006 to 2010 linked to enrolled patients’ medical chart data in 26 primary care practices in Maryland, USA. Secondary claims data analyses were available for 56% (92/163) of participants. In the primary MDIS study, physician practices were recruited and randomized to usual care and 1 of 3 increasingly complex interventions. Patients followed physician randomization assignment. The main variables in the analysis included health service utilization by type of service and change in HbA1c. The claims data was aggregated into 12 categories of utilization to assess change in 2-year health service usage, comparing rates of usage pre- and posttrial. We also examined whether utilization explained the 1.9% decrease in HbA1c over 1 year in the MDIS cluster randomized clinical trial. Results: A significant group by time effect was observed in physician office visits, general practitioner visits, other outpatient services, prescription medications, and podiatrist visits. Physician office visits (P=.01) and general practitioner visits (P=.02) both decreased for all intervention groups during the study period, whereas prescription claims (P<.001) increased. The frequency of other outpatient services (P=.001) and podiatrist visits (P=.04) decreased for the control group and least complex intervention group but increased for the 2 most complex intervention groups. No significant effects of utilization were observed to explain the clinically significant change in HbA1c. Conclusions: Claims data analyses identified patterns of utilization relevant to mHealth interventions. Findings may encourage patients and health providers to discuss the utilization of treatment-recommended services, lab tests, and prescribed medications. Trial Registration: ClinicalTrials.gov NCT01107015; https://clinicaltrials.gov/ct2/show/NCT01107015 (Archived by Webcite at http://www.webcitation.org/72XgTaxIj) %M 30322839 %R 10.2196/10776 %U http://mhealth.jmir.org/2018/10/e10776/ %U https://doi.org/10.2196/10776 %U http://www.ncbi.nlm.nih.gov/pubmed/30322839 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 1 %N 2 %P e10254 %T Health Care Cost Analyses for Exploring Cost Savings Opportunities in Older Patients: Longitudinal Retrospective Study %A Agboola,Stephen %A Simons,Mariana %A Golas,Sara %A op den Buijs,Jorn %A Felsted,Jennifer %A Fischer,Nils %A Schertzer,Linda %A Orenstein,Allison %A Jethwani,Kamal %A Kvedar,Joseph %+ Connected Health Innovation, Partners Healthcare, 25 New Chardon Street, Suite 300, Boston, MA, 02114, United States, 1 617 643 0291, sagboola@partners.org %K health care cost analysis %K cost acuity pyramid %K patient segmentation %K multicenter study %K Markov chains %D 2018 %7 01.08.2018 %9 Original Paper %J JMIR Aging %G English %X Background: Half of Medicare reimbursement goes toward caring for the top 5% of the most expensive patients. However, little is known about these patients prior to reaching the top or how their costs change annually. To address these gaps, we analyzed patient flow and associated health care cost trends over 5 years. Objective: To evaluate the cost of health care utilization in older patients by analyzing changes in their long-term expenditures. Methods: This was a retrospective, longitudinal, multicenter study to evaluate health care costs of 2643 older patients from 2011 to 2015. All patients had at least one episode of home health care during the study period and used a personal emergency response service (PERS) at home for any length of time during the observation period. We segmented all patients into top (5%), middle (6%-50%), and bottom (51%-100%) segments by their annual expenditures and built cost pyramids based thereon. The longitudinal health care expenditure trends of the complete study population and each segment were assessed by linear regression models. Patient flows throughout the segments of the cost acuity pyramids from year to year were modeled by Markov chains. Results: Total health care costs of the study population nearly doubled from US $17.7M in 2011 to US $33.0M in 2015 with an expected annual cost increase of US $3.6M (P=.003). This growth was primarily driven by a significantly higher cost increases in the middle segment (US $2.3M, P=.003). The expected annual cost increases in the top and bottom segments were US $1.2M (P=.008) and US $0.1M (P=.004), respectively. Patient and cost flow analyses showed that 18% of patients moved up the cost acuity pyramid yearly, and their costs increased by 672%. This was in contrast to 22% of patients that moved down with a cost decrease of 86%. The remaining 60% of patients stayed in the same segment from year to year, though their costs also increased by 18%. Conclusions: Although many health care organizations target intensive and costly interventions to their most expensive patients, this analysis unveiled potential cost savings opportunities by managing the patients in the lower cost segments that are at risk of moving up the cost acuity pyramid. To achieve this, data analytics integrating longitudinal data from electronic health records and home monitoring devices may help health care organizations optimize resources by enabling clinicians to proactively manage patients in their home or community environments beyond institutional settings and 30- and 60-day telehealth services. %M 31518241 %R 10.2196/10254 %U http://aging.jmir.org/2018/2/e10254/ %U https://doi.org/10.2196/10254 %U http://www.ncbi.nlm.nih.gov/pubmed/31518241 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e200 %T The Health and Retirement Study: Analysis of Associations Between Use of the Internet for Health Information and Use of Health Services at Multiple Time Points %A Shim,Hyunju %A Ailshire,Jennifer %A Zelinski,Elizabeth %A Crimmins,Eileen %+ USC Davis School of Gerontology, University of Southern California, 3715 McClintock Ave., Los Angeles, CA, 90089-0191, United States, 1 2137405156, hyunjush@usc.edu %K health information technology %K health services %K disease management %K chronic disease %K geriatrics %D 2018 %7 25.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of the internet for health information among older people is receiving increasing attention, but how it is associated with chronic health conditions and health service use at concurrent and subsequent time points using nationally representative data is less known. Objective: This study aimed to determine whether the use of the internet for health information is associated with health service utilization and whether the association is affected by specific health conditions. Methods: The study used data collected in a technology module from a nationally representative sample of community-dwelling older Americans aged 52 years and above from the 2012 Health and Retirement Study (HRS; N=991). Negative binomial regressions were used to examine the association between use of Web-based health information and the reported health service uses in 2012 and 2014. Analyses included additional covariates adjusting for predisposing, enabling, and need factors. Interactions between the use of the internet for health information and chronic health conditions were also tested. Results: A total of 48.0% (476/991) of Americans aged 52 years and above reported using Web-based health information. The use of Web-based health information was positively associated with the concurrent reports of doctor visits, but not over 2 years. However, an interaction of using Web-based health information with diabetes showed that users had significantly fewer doctor visits compared with nonusers with diabetes at both times. Conclusions: The use of the internet for health information was associated with higher health service use at the concurrent time, but not at the subsequent time. The interaction between the use of the internet for health information and diabetes was significant at both time points, which suggests that health-related internet use may be associated with fewer doctor visits for certain chronic health conditions. Results provide some insight into how Web-based health information may provide an alternative health care resource for managing chronic conditions. %M 29802088 %R 10.2196/jmir.8203 %U http://www.jmir.org/2018/5/e200/ %U https://doi.org/10.2196/jmir.8203 %U http://www.ncbi.nlm.nih.gov/pubmed/29802088 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e186 %T Identifying National Availability of Abortion Care and Distance From Major US Cities: Systematic Online Search %A Cartwright,Alice F %A Karunaratne,Mihiri %A Barr-Walker,Jill %A Johns,Nicole E %A Upadhyay,Ushma D %+ Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, United States, 1 510 986 8946, ushma.upadhyay@ucsf.edu %K abortion seekers %K reproductive health %K internet %K access to information %K information seeking %K abortion patients %K reproductive health services %K information seeking behavior %D 2018 %7 14.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Abortion is a common medical procedure, yet its availability has become more limited across the United States over the past decade. Women who do not know where to go for abortion care may use the internet to find abortion facility information, and there appears to be more online searches for abortion in states with more restrictive abortion laws. While previous studies have examined the distances women must travel to reach an abortion provider, to our knowledge no studies have used a systematic online search to document the geographic locations and services of abortion facilities. Objective: The objective of our study was to describe abortion facilities and services available in the United States from the perspective of a potential patient searching online and to identify US cities where people must travel the farthest to obtain abortion care. Methods: In early 2017, we conducted a systematic online search for abortion facilities in every state and the largest cities in each state. We recorded facility locations, types of abortion services available, and facility gestational limits. We then summarized the frequencies by region and state. If the online information was incomplete or unclear, we called the facility using a mystery shopper method, which simulates the perspective of patients calling for services. We also calculated distance to the closest abortion facility from all US cities with populations of 50,000 or more. Results: We identified 780 facilities through our online search, with the fewest in the Midwest and South. Over 30% (236/780, 30.3%) of all facilities advertised the provision of medication abortion services only; this proportion was close to 40% in the Northeast (89/233, 38.2%) and West (104/262, 39.7%). The lowest gestational limit at which services were provided was 12 weeks in Wyoming; the highest was 28 weeks in New Mexico. People in 27 US cities must travel over 100 miles (160 km) to reach an abortion facility; the state with the largest number of such cities is Texas (n=10). Conclusions: Online searches can provide detailed information about the location of abortion facilities and the types of services they provide. However, these facilities are not evenly distributed geographically, and many large US cities do not have an abortion facility. Long distances can push women to seek abortion in later gestations when care is even more limited. %M 29759954 %R 10.2196/jmir.9717 %U http://www.jmir.org/2018/5/e186/ %U https://doi.org/10.2196/jmir.9717 %U http://www.ncbi.nlm.nih.gov/pubmed/29759954 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 1 %P e8 %T The Validity of Online Patient Ratings of Physicians: Analysis of Physician Peer Reviews and Patient Ratings %A McGrath,Robert J %A Priestley,Jennifer Lewis %A Zhou,Yiyun %A Culligan,Patrick J %+ Graduate College, Kennesaw State University, 1000 Chastain Road, Kennesaw, Kennesaw, GA,, United States, 1 4043331288, yzhou20@kennesaw.edu %K physician review websites %K online patient ratings %K physician peer review %D 2018 %7 09.04.2018 %9 Short Paper %J Interact J Med Res %G English %X Background: Information from ratings sites are increasingly informing patient decisions related to health care and the selection of physicians. Objective: The current study sought to determine the validity of online patient ratings of physicians through comparison with physician peer review. Methods: We extracted 223,715 reviews of 41,104 physicians from 10 of the largest cities in the United States, including 1142 physicians listed as “America’s Top Doctors” through physician peer review. Differences in mean online patient ratings were tested for physicians who were listed and those who were not. Results: Overall, no differences were found between the online patient ratings based upon physician peer review status. However, statistical differences were found for four specialties (family medicine, allergists, internal medicine, and pediatrics), with online patient ratings significantly higher for those physicians listed as a peer-reviewed “Top Doctor” versus those who were not. Conclusions: The results of this large-scale study indicate that while online patient ratings are consistent with physician peer review for four nonsurgical, primarily in-office specializations, patient ratings were not consistent with physician peer review for specializations like anesthesiology. This result indicates that the validity of patient ratings varies by medical specialization. %M 29631992 %R 10.2196/ijmr.9350 %U http://www.i-jmr.org/2018/1/e8/ %U https://doi.org/10.2196/ijmr.9350 %U http://www.ncbi.nlm.nih.gov/pubmed/29631992 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e27 %T Youth Mental Health Services Utilization Rates After a Large-Scale Social Media Campaign: Population-Based Interrupted Time-Series Analysis %A Booth,Richard G %A Allen,Britney N %A Bray Jenkyn,Krista M %A Li,Lihua %A Shariff,Salimah Z %+ Arthur Labatt Family School of Nursing, Western University, 1151 Richmond Street, FNB2333, London, ON, N6A 5B9, Canada, 1 5196612111 ext 86571, rbooth5@uwo.ca %K mental health %K youth %K adolescent %K social media %K population health %K mass media %D 2018 %7 06.04.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Despite the uptake of mass media campaigns, their overall impact remains unclear. Since 2011, a Canadian telecommunications company has operated an annual, large-scale mental health advocacy campaign (Bell Let’s Talk) focused on mental health awareness and stigma reduction. In February 2012, the campaign began to explicitly leverage the social media platform Twitter and incented participation from the public by promising donations of Can $0.05 for each interaction with a campaign-specific username (@Bell_LetsTalk). Objective: The intent of the study was to examine the impact of this 2012 campaign on youth outpatient mental health services in the province of Ontario, Canada. Methods: Monthly outpatient mental health visits (primary health care and psychiatric services) were obtained for the Ontario youth aged 10 to 24 years (approximately 5.66 million visits) from January 1, 2006 to December 31, 2015. Interrupted time series, autoregressive integrated moving average modeling was implemented to evaluate the impact of the campaign on rates of monthly outpatient mental health visits. A lagged intervention date of April 1, 2012 was selected to account for the delay required for a patient to schedule and attend a mental health–related physician visit. Results: The inclusion of Twitter into the 2012 Bell Let’s Talk campaign was temporally associated with an increase in outpatient mental health utilization for both males and females. Within primary health care environments, female adolescents aged 10 to 17 years experienced a monthly increase in the mental health visit rate from 10.2/1000 in April 2006 to 14.1/1000 in April 2015 (slope change of 0.094 following campaign, P<.001), whereas males of the same age cohort experienced a monthly increase from 9.7/1000 to 9.8/1000 (slope change of 0.052 following campaign, P<.001). Outpatient psychiatric services visit rates also increased for both male and female adolescents aged 10 to 17 years post campaign (slope change of 0.005, P=.02; slope change of 0.003, P=.005, respectively). For young adults aged 18 to 24 years, females who used primary health care experienced the most significant increases in mental health visit rates from 26.5/1000 in April 2006 to 29.2/1000 in April 2015 (slope change of 0.17 following campaign, P<.001). Conclusions: The 2012 Bell Let’s Talk campaign was temporally associated with an increase in the rate of mental health visits among Ontarian youth. Furthermore, there appears to be an upward trend of youth mental health utilization in the province of Ontario, especially noticeable in females who accessed primary health care services. %M 29625954 %R 10.2196/mental.8808 %U http://mental.jmir.org/2018/2/e27/ %U https://doi.org/10.2196/mental.8808 %U http://www.ncbi.nlm.nih.gov/pubmed/29625954 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 6 %N 2 %P e22 %T “A Phenomenal Person and Doctor”: Thank You Letters to Medical Care Providers %A Miron-Shatz,Talya %A Becker,Stefan %A Zaromb,Franklin %A Mertens,Alexander %A Tsafrir,Avi %+ Center for Medical Decision Making, Faculty of Business Administration, Ono Academic College, 104 Zahal St., Kiryat Ono, 55000, Israel, 972 0523304417, talyam@ono.ac.il %K quality of health care %K doctor-patient relationship %K content analysis %K decision making %K doctor-patient communication %K clinical encounter %K patient satisfaction %K online reviews %K patient-centered care %D 2017 %7 02.11.2017 %9 Original Paper %J Interact J Med Res %G English %X Background: Thank you letters to physicians and medical facilities are an untapped resource, providing an invaluable glimpse into what patients notice and appreciate in their care. Objective: The aim of this study was to analyze such thank you letters as posted on the Web by medical institutions to find what patients and families consider to be good care. In an age of patient-centered care, it is pivotal to see what metrics patients and families apply when assessing their care and whether they grasp specific versus general qualities in their care. Methods: Our exploratory inquiry covered 100 thank you letters posted on the Web by 26 medical facilities in the United States and the United Kingdom. We systematically coded and descriptively presented the aspects of care that patients and their families thanked doctors and medical facilities for. We relied on previous work outlining patient priorities and satisfaction (Anderson et al, 2007), to which we added a distinction between global and specific evaluations for each of the already existing categories with two additional categories: general praise and other, and several subcategories, such as treatment outcome, to the category of medical care. Results: In 73% of the letters (73/100), physicians were primarily thanked for their medical treatment. In 71% (71/100) of the letters, they were thanked for their personality and demeanor. In 52% cases (52/100), these two aspects were mentioned together, suggesting that from the perspective of patient as well as the family member, both are deemed necessary in positive evaluation of medical care. Only 8% (8/100) of the letters lacked reference to medical care, personality or demeanor, or communication. No statistically significant differences were observed in the number of letters that expressed gratitude for the personality or demeanor of medical care providers versus the quality of medical care (χ21, N=200=0.1, not statistically significant). Letters tended to express more specific praise for personality or demeanor, such as being supportive, understanding, humane and caring (48/71, 68%) but more general praise for medical care (χ21, N=424=63.9, P<.01). The most often mentioned specific quality of medical care were treatment outcomes (30/73, 41%), followed by technical competence (15/73, 21%) and treatment approach (14/73, 19%). A limitation of this inquiry is that we analyzed the letters that medical centers chose to post on the Web. These are not necessarily a representative sample of all thank you letters as are sent to health care institutions but are still indicative of what centers choose to showcase on the Web. Conclusions: Physician demeanor and quality of interaction with patients are pivotal in how laymen perceive good care, no less so than medical care per se. This inquiry can inform care providers and medical curricula, leading to an improvement in the perceived quality of care. %M 29097353 %R 10.2196/ijmr.7107 %U http://www.i-jmr.org/2017/2/e22/ %U https://doi.org/10.2196/ijmr.7107 %U http://www.ncbi.nlm.nih.gov/pubmed/29097353 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 5 %N 4 %P e39 %T Predicting Consumer Effort in Finding and Paying for Health Care: Expert Interviews and Claims Data Analysis %A Long,Sandra %A Monsen,Karen A %A Pieczkiewicz,David %A Wolfson,Julian %A Khairat,Saif %+ University of North Carolina-Chapel Hill, 428 Carrington Hall, CB #7460, Chapel Hill, NC, 27514, United States, 1 9198435413, saif@unc.edu %K consumer health information %K user effort %K patient acceptance of health care %K health expenditures %K health services accessibility %D 2017 %7 12.10.2017 %9 Original Paper %J JMIR Med Inform %G English %X Background: For consumers to accept and use a health care information system, it must be easy to use, and the consumer must perceive it as being free from effort. Finding health care providers and paying for care are tasks that must be done to access treatment. These tasks require effort on the part of the consumer and can be frustrating when the goal of the consumer is primarily to receive treatments for better health. Objective: The aim of this study was to determine the factors that result in consumer effort when finding accessible health care. Having an understanding of these factors will help define requirements when designing health information systems. Methods: A panel of 12 subject matter experts was consulted and the data from 60 million medical claims were used to determine the factors contributing to effort. Results: Approximately 60 million claims were processed by the health care insurance organization in a 12-month duration with the population defined. Over 292 million diagnoses from claims were used to validate the panel input. The results of the study showed that the number of people in the consumer’s household, number of visits to providers outside the consumer’s insurance network, number of adjusted and denied medical claims, and number of consumer inquiries are a proxy for the level of effort in finding and paying for care. The effort level, so measured and weighted per expert panel recommendations, differed by diagnosis. Conclusions: This study provides an understanding of how consumers must put forth effort when engaging with a health care system to access care. For higher satisfaction and acceptance results, health care payers ideally will design and develop systems that facilitate an understanding of how to avoid denied claims, educate on the payment of claims to avoid adjustments, and quickly find providers of affordable care. %M 29025697 %R 10.2196/medinform.7892 %U http://medinform.jmir.org/2017/4/e39/ %U https://doi.org/10.2196/medinform.7892 %U http://www.ncbi.nlm.nih.gov/pubmed/29025697 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 3 %P e43 %T Online Reviews as Health Data: Examining the Association Between Availability of Health Care Services and Patient Star Ratings Exemplified by the Yelp Academic Dataset %A Tran,Nam N %A Lee,Joon %+ Health Data Science Lab, School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON,, Canada, 1 519 888 4567 ext 31567, joon.lee@uwaterloo.ca %K Yelp %K health care access %K health care availability %K patient satisfaction %K patient rating %K patient experience %K open hour %K clinic hour %K online reviews %D 2017 %7 12.07.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: There have been public health interventions that aim to reduce barriers to health care access by extending opening hours of health care facilities. However, the impact of opening hours from the patient’s perspective is not well understood. Objective: This study aims to investigate the relationship between temporal accessibility of health care services and how patients rate the providers on Yelp, an online review website that is popular in the United States. Using crowdsourced open Internet data, such as Yelp, can help circumvent the traditional survey method. Methods: From Yelp’s limited academic dataset, this study examined the pattern of visits to health care providers and performed a secondary analysis to examine the association between patient rating (measured by Yelp’s rating) and temporal accessibility of health care services (measured by opening hours) using ordinal logistic regression models. Other covariates included were whether an appointment was required, the type of health care service, the region of the health care service provider, the number of reviews the health care service provider received in the past, the number of nearby competitors, the mean rating of competitors, and the standard deviation of competitors’ ratings. Results: From the 2085 health care service providers identified, opening hours during certain periods, the type of health care service, and the variability of competitors’ ratings showed an association with patient rating. Most of the visits to health care service providers took place between normal working hours (9 AM-5 PM) from Sunday to Thursday, and the least on Saturday. A model fitted to the entire sample showed that increasing hours during normal working hours on Monday (OR 0.926, 95% CI 0.880-0.973, P=0.03), Saturday (OR 0.897, 95% CI 0.860-0.935, P<0.001), Sunday (OR 0.904, 95% CI 0.841-0.970, P=0.005), and outside normal working hours on Friday (OR 0.872, 95% CI 0.760-0.998, P=0.048) was associated with receiving lower ratings. But increasing hours during outside normal working hours on Sunday was associated with receiving higher ratings (OR 1.400, 95% CI 1.036-1.924, P=0.03). There were also observed differences in patient ratings among the health care services types, but not geographically or by appointment requirement. Conclusions: This study shows that public health interventions, especially those involving opening hours, could use crowdsourced open Internet data to enhance the evidence base for decision making and evaluation in the future. This study illustrates one example of how Yelp data could be used to understand patient experiences with health care services, making a case for future research for exploring online reviews as a health dataset. %M 28701293 %R 10.2196/publichealth.7001 %U http://publichealth.jmir.org/2017/3/e43/ %U https://doi.org/10.2196/publichealth.7001 %U http://www.ncbi.nlm.nih.gov/pubmed/28701293 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 2 %P e17 %T Diversity in eMental Health Practice: An Exploratory Qualitative Study of Aboriginal and Torres Strait Islander Service Providers %A Bird,Jennifer %A Rotumah,Darlene %A Bennett-Levy,James %A Singer,Judy %+ University Centre for Rural Health—North Coast, School of Rural Health, University of Sydney, PO Box 3074, Lismore, 2480, Australia, 61 266207570, james.bennett-levy@ucrh.edu.au %K eMental Health %K Aboriginal and Torres Strait Islanders %K social and emotional wellbeing %K health education %K health promotion %K mental health %K indigenous health services %K culturally appropriate technology %K internet %K implementation %K training %D 2017 %7 29.05.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: In Australia, mental health services are undergoing major systemic reform with eMental Health (eMH) embedded in proposed service models for all but those with severe mental illness. Aboriginal and Torres Strait Islander service providers have been targeted as a national priority for training and implementation of eMH into service delivery. Implementation studies on technology uptake in health workforces identify complex and interconnected variables that influence how individual practitioners integrate new technologies into their practice. To date there are only two implementation studies that focus on eMH and Aboriginal and Torres Strait Islander service providers. They suggest that the implementation of eMH in the context of Aboriginal and Torres Strait Islander populations may be different from the implementation of eMH with allied health professionals and mainstream health services. Objective: The objective of this study is to investigate how Aboriginal and Torres Strait Islander service providers in one regional area of Australia used eMH resources in their practice following an eMH training program and to determine what types of eMH resources they used. Methods: Individual semistructured qualitative interviews were conducted with a purposive sample of 16 Aboriginal and Torres Strait Islander service providers. Interviews were co-conducted by one indigenous and one non-indigenous interviewer. A sample of transcripts were coded and thematically analyzed by each interviewer and then peer reviewed. Consensus codes were then applied to all transcripts and themes identified. Results: It was found that 9 of the 16 service providers were implementing eMH resources into their routine practice. The findings demonstrate that participants used eMH resources for supporting social inclusion, informing and educating, assessment, case planning and management, referral, responding to crises, and self and family care. They chose a variety of types of eMH resources to use with their clients, both culturally specific and mainstream. While they referred clients to online treatment programs, they used only eMH resources designed for mobile devices in their face-to-face contact with clients. Conclusions: This paper provides Aboriginal and Torres Strait islander service providers and the eMH field with findings that may inform and guide the implementation of eMH resources. It may help policy developers locate this workforce within broader service provision planning for eMH. The findings could, with adaptation, have wider application to other workforces who work with Aboriginal and Torres Strait Islander clients. The findings highlight the importance of identifying and addressing the particular needs of minority groups for eMH services and resources. %M 28554880 %R 10.2196/mental.7878 %U http://mental.jmir.org/2017/2/e17/ %U https://doi.org/10.2196/mental.7878 %U http://www.ncbi.nlm.nih.gov/pubmed/28554880 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 6 %N 1 %P e2 %T Assessing the Performance of a Modified LACE Index (LACE-rt) to Predict Unplanned Readmission After Discharge in a Community Teaching Hospital %A El Morr,Christo %A Ginsburg,Liane %A Nam,Seungree %A Woollard,Susan %+ Faculty of Health, School of Health Policy and Management, York University, 4700 Keele St, HNES #412, Toronto, ON, M3J 1P3, Canada, 1 416 736 2100, elmorr@yorku.ca %K patient readmission %K hospital readmissions %K health services %K quality improvement %K quality of health care %K cost savings %K eHealth %K medical informatics %D 2017 %7 08.03.2017 %9 Original Paper %J Interact J Med Res %G English %X Background: The LACE index was designed to predict early death or unplanned readmission after discharge from hospital to the community. However, implementing the LACE tool in real time in a teaching hospital required practical unavoidable modifications. Objective: The purpose of this study was to validate the implementation of a modified LACE index (LACE-rt) and test its ability to predict readmission risk using data in a hospital setting. Methods: Data from the Canadian Institute for Health Information’s Discharge Abstract Database (DAD), the National Ambulatory Care Reporting System (NACRS), and the hospital electronic medical record for one large community hospital in Toronto, Canada, were used in this study. A total of 3855 admissions from September 2013 to July 2014 were analyzed (N=3855) using descriptive statistics, regression analysis, and receiver operating characteristic analysis. Prospectively collected data from DAD and NACRS were linked to inpatient data. Results: The LACE-rt index was a fair test to predict readmission risk (C statistic=.632). A LACE-rt score of 10 is a good threshold to differentiate between patients with low and high readmission risk; the high-risk patients are 2.648 times more likely to be readmitted than those at low risk. The introduction of LACE-rt had no significant impact on readmission reduction. Conclusions: The LACE-rt is a fair tool for identifying those at risk of readmission. A collaborative cross-sectoral effort that includes those in charge of providing community-based care is needed to reduce readmission rates. An eHealth solution could play a major role in streamlining this collaboration. %M 28274908 %R 10.2196/ijmr.7183 %U http://www.i-jmr.org/2017/1/e2/ %U https://doi.org/10.2196/ijmr.7183 %U http://www.ncbi.nlm.nih.gov/pubmed/28274908 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 5 %N 2 %P e12 %T Assessing Quality of Life and Medical Care in Chronic Angina: An Internet Survey %A Alexander,Karen P %A Stadnyuk,Olena %A Arnold,Suzanne V %A Mark,Daniel B %A Ohman,E. Magnus %A Anstrom,Kevin J %+ Duke Clinical Research Institute, 2400 Pratt Street, Room 0311 Terrace Level, Durham, NC, 27705, United States, 1 919 668 8938, karen.alexander@duke.edu %K Angina %K Surveys and Questionnaires %K Internet %K Quality of Life %D 2016 %7 28.04.2016 %9 Original Paper %J Interact J Med Res %G English %X Background: Angina is a clinical syndrome whose recognition relies heavily on self-report, so its identification can be challenging. Most data come from cohorts identified by physicians and nurses at the point of care; however, current widespread access to the Internet makes identification of community cohorts feasible and offers a complementary picture of angina. Objective: To describe a population self-identified as experiencing chronic angina by use of an Internet survey. Methods: Using email and an Internet portal, we invited individuals with a diagnosis of angina and recent symptoms to complete an Internet survey on treatment and quality of life (QOL). In total, 1147 surveys were received. The main analysis was further limited to those reporting a definite coronary heart disease (CHD) history (N=646, 56% of overall). Results: Overall, about 15% reported daily angina and 40% weekly angina. Those with more frequent angina were younger, more often depressed, and reported a shorter time since diagnosis. They also had substantially worse treatment satisfaction, physical function, and overall QOL. Fewer than 40% were on ≥ 2 anti-anginals, even with daily angina. The subjects without a history of definite CHD had unexpectedly low use of antianginal and evidence-based medicines, suggesting either a lack of specificity in the use of self-reported angina to identify patients with CHD or lack of access to care. Conclusions: Use of inexpensive electronic tools can identify community-based angina cohorts for clinical research. Limitation to subjects with a definite history of CHD lends diagnostic face validity to the approach; however, other symptomatic individuals are also identified. %M 27125492 %R 10.2196/ijmr.4971 %U http://www.i-jmr.org/2016/2/e12/ %U https://doi.org/10.2196/ijmr.4971 %U http://www.ncbi.nlm.nih.gov/pubmed/27125492 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 1 %P e35 %T Health Systems Readiness to Manage the Hypertension Epidemic in Primary Health Care Facilities in the Western Cape, South Africa: A Study Protocol %A Deuboué Tchialeu,Rodrigue Innocent %A Yaya,Sanni %A Labonté,Ronald %+ Population Health Program, Faculty of Health Sciences, University of Ottawa, 25 University, Ottawa, ON, , Canada, 1 7807163879, rdeub006@uottawa.ca %K Hypertension %K Manage %K Health System %K Epidemics %K Scaling-up Interventions %K Requirements %K Supply Chain %K Antihypertensive agents %K Control %K Delivery of Health Care %D 2016 %7 29.02.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Developing countries are undergoing a process of epidemiological transition from infectious to noncommunicable diseases, described by the United Nations Secretary General Ban Ki-Moon as ‘‘a public health emergency in slow motion.” One of the most prevalent in sub-Saharan Africa is hypertension, which is a complex chronic condition often referred to as a “silent killer” and key contributor to the development of cardiovascular and cerebrovascular diseases. Hypertensive patients in this setting are estimated to increase from 74.7 million in 2008 to 125.5 million in 2025, a 68% increase. However, there is an important gap between emerging high-level policies and recommendations, and the near-absence of practical guidance and experience delivering long-term medical care for noncommunicable diseases within resource-limited health systems. Objective: To address this gap, our study will consist of field investigations to determine the minimum health systems requirements to ensure successful delivery of antihypertensive medications when scaling-up interventions to control the hypertension epidemic. Methods: A cross-sectional analytic study will be conducted in the Western Cape using a mixed-method approach with two semistructured interview guides. The first will be for health professionals involved in the care of hypertensive patients within at least 6 community health centers (3 urban and 3 rural) to understand the challenges associated with their care. The second will be to map and assess the current supply chain management system of antihypertensive medications by interviewing key informants at different levels of the processes. Finally, modeling and simulation tools will be used to understand how to estimate minimum numbers of health workers required at each supply chain interval to ensure successful delivery of medications when scaling-up interventions. Results: Funding for the study was secured through a Doctoral Research Award in October 2014 from the International Development Research Centre (IDRC). The study is currently in the data analysis phase and results are expected during the first half of 2016. Conclusions: This investigation will highlight the detailed processes in place for the care of hypertensive patients in primary health care facilities, and thus also identify the challenges. It will also describe the drug supply chain management systems in place and identify their strengths and weaknesses. The findings, along with the estimates from modeling and simulation, will inform the health system minimum requirements to scale-up interventions to manage and control the hypertension epidemic in the Western Cape province of South Africa. %M 26925539 %R 10.2196/resprot.5381 %U http://www.researchprotocols.org/2016/1/e35/ %U https://doi.org/10.2196/resprot.5381 %U http://www.ncbi.nlm.nih.gov/pubmed/26925539 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 4 %N 4 %P e21 %T Internet Services for Communicating With the General Practice: Barely Noticed and Used by Patients %A Huygens,Martine WJ %A Vermeulen,Joan %A Friele,Roland D %A van Schayck,Onno CP %A de Jong,Judith D %A de Witte,Luc P %+ School for Public Health and Primary Care (CAPHRI), Department of Health Services Research, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, Netherlands, 31 43 38 81 700, m.huygens@maastrichtuniversity.nl %K eHealth %K online communication %K primary care %K general practice %D 2015 %7 24.11.2015 %9 Original Paper %J Interact J Med Res %G English %X Background: The Netherlands is one of the frontrunners of eHealth in Europe. Many general practices offer Internet services, which can be used by patients to communicate with their general practice. In promoting and implementing such services, it is important to gain insight into patients’ actual use and intention toward using. Objective: The objective of the study is to investigate the actual use and intention toward using Internet services to communicate with the general practice by the general practice population. The secondary objective is to study the factors and characteristics that influence their intention to use such services. Methods: There were 1500 members of the Dutch Health Care Consumer Panel, age over 18 years, that were invited to participate in this cross-sectional study. People who had contacted their general practitioner at least once in the past year were included. Participants were asked to fill out a questionnaire about the following services: Internet appointment planning, asking questions on the Internet, email reminders about appointments, Internet prescription refill requests, Internet access to medical data, and Internet video consultation. Participants indicated whether they had used these services in the past year, they would like to use them, and whether they thought their general practice had these services. For the first two services, participants rated items based on the unified theory of acceptance and use of technology complemented with additional constructs. These items were divided into six subscales: effort expectancy, performance expectancy, trust, attitude, facilitating conditions, and social influence. Results: There were 546 participants that were included in the analyses out of 593 who met the inclusion criteria. The participants had a mean age of 53 years (SD 15.4), 43.6% (n=238) were male, and 66.8% (n=365) had at least one chronic illness. Actual use of the services varied between 0% (n=0, video consultation) and 10.4% (n=57, requesting prescription refill by Internet). The proportion of participants with a positive intention to use the service varied between 14.7% (n=80, video consultation) and 48.7% (n=266, Internet access to medical data). For each service, approximately half indicated that they did not know whether the service was available. Univariate logistic regression analyses revealed that all the constructs as well as age, level of education, and Internet usage had a significant association with intention toward using Internet appointment planning and asking questions by Internet. Conclusions: Internet communication services to contact the general practice are not yet frequently used by this population. Although a substantial number of persons have a positive intention toward using such services, not all people who receive primary care seem willing to use them. The lack of awareness of the availability and functionality of such services might play an important role. %M 26601596 %R 10.2196/ijmr.4245 %U http://www.i-jmr.org/2015/4/e21/ %U https://doi.org/10.2196/ijmr.4245 %U http://www.ncbi.nlm.nih.gov/pubmed/26601596 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 1 %N 2 %P e13 %T Patient-Reported Outcomes and Total Health Care Expenditure in Prediction of Patient Satisfaction: Results From a National Study %A Hung,Man %A Zhang,Weiping %A Chen,Wei %A Bounsanga,Jerry %A Cheng,Christine %A Franklin,Jeremy D %A Crum,Anthony B %A Voss,Maren W %A Hon,Shirley D %+ Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, United States, 1 801 587 5372, man.hung@hsc.utah.edu %K health care quality %K value %K expenditure %K cost %K medical outcomes %K patient satisfaction %K Medical Expenditure Panel Survey %K patient-reported outcomes %K Affordable Care Act %K big data analytics %D 2015 %7 23.09.2015 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Health care quality is often linked to patient satisfaction. Yet, there is a lack of national studies examining the relationship between patient satisfaction, patient-reported outcomes, and medical expenditure. Objective: The aim of this study is to examine the contribution of physical health, mental health, general health, and total health care expenditures to patient satisfaction using a longitudinal, nationally representative sample. Methods: Using data from the 2010-2011 Medical Expenditure Panel Survey, analyses were conducted to predict patient satisfaction from patient-reported outcomes and total health care expenditures. The study sample consisted of adult participants (N=10,157), with sampling weights representative of 233.26 million people in the United States. Results: The results indicated that patient-reported outcomes and total health care expenditure were associated with patient satisfaction such that higher physical and mental function, higher general health status, and higher total health care expenditure were associated with higher patient satisfaction. Conclusions: We found that patient-reported outcomes and total health care expenditure had a significant relationship with patient satisfaction. As more emphasis is placed on health care value and quality, this area of research will become increasingly needed and critical questions should be asked about what we value in health care and whether we can find a balance between patient satisfaction, outcomes, and expenditures. Future research should apply big data analytics to investigate whether there is a differential effect of patient-reported outcomes and medical expenditures on patient satisfaction across different medical specialties. %M 27227131 %R 10.2196/publichealth.4360 %U http://publichealth.jmir.org/2015/2/e13/ %U https://doi.org/10.2196/publichealth.4360 %U http://www.ncbi.nlm.nih.gov/pubmed/27227131 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 9 %P e219 %T Online Prediction of Health Care Utilization in the Next Six Months Based on Electronic Health Record Information: A Cohort and Validation Study %A Hu,Zhongkai %A Hao,Shiying %A Jin,Bo %A Shin,Andrew Young %A Zhu,Chunqing %A Huang,Min %A Wang,Yue %A Zheng,Le %A Dai,Dorothy %A Culver,Devore S %A Alfreds,Shaun T %A Rogow,Todd %A Stearns,Frank %A Sylvester,Karl G %A Widen,Eric %A Ling,Xuefeng %+ Stanford University, S370 Grant Building, 300 Pasteur Drive, Stanford, CA, , United States, 1 650 427 9198, bxling@stanford.edu %K health care costs %K electronic medical record %K prospective studies %K statistical data analysis %K risk assessment %D 2015 %7 22.09.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: The increasing rate of health care expenditures in the United States has placed a significant burden on the nation’s economy. Predicting future health care utilization of patients can provide useful information to better understand and manage overall health care deliveries and clinical resource allocation. Objective: This study developed an electronic medical record (EMR)-based online risk model predictive of resource utilization for patients in Maine in the next 6 months across all payers, all diseases, and all demographic groups. Methods: In the HealthInfoNet, Maine’s health information exchange (HIE), a retrospective cohort of 1,273,114 patients was constructed with the preceding 12-month EMR. Each patient’s next 6-month (between January 1, 2013 and June 30, 2013) health care resource utilization was retrospectively scored ranging from 0 to 100 and a decision tree–based predictive model was developed. Our model was later integrated in the Maine HIE population exploration system to allow a prospective validation analysis of 1,358,153 patients by forecasting their next 6-month risk of resource utilization between July 1, 2013 and December 31, 2013. Results: Prospectively predicted risks, on either an individual level or a population (per 1000 patients) level, were consistent with the next 6-month resource utilization distributions and the clinical patterns at the population level. Results demonstrated the strong correlation between its care resource utilization and our risk scores, supporting the effectiveness of our model. With the online population risk monitoring enterprise dashboards, the effectiveness of the predictive algorithm has been validated by clinicians and caregivers in the State of Maine. Conclusions: The model and associated online applications were designed for tracking the evolving nature of total population risk, in a longitudinal manner, for health care resource utilization. It will enable more effective care management strategies driving improved patient outcomes. %M 26395541 %R 10.2196/jmir.4976 %U http://www.jmir.org/2015/9/e219/ %U https://doi.org/10.2196/jmir.4976 %U http://www.ncbi.nlm.nih.gov/pubmed/26395541 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 2 %P e73 %T Rural Versus Urban Health Service Utilization and Outcomes for Renal Patients in New South Wales: Protocol for a Data Linkage Study %A Kotwal,Sradha %A Webster,Angela %A Cass,Alan %A Gallagher,Martin %+ The George Institute for Global Health, Sydney Medical School, University of Sydney, PO M201, Missenden Road, Sydney, 2050, Australia, 61 299934500, skotwal@georgeinstitute.org.au %K end stage kidney disease %K chronic kidney disease %K kidney transplant %K data linkage %K dialysis %K rural health care %K cohort study %D 2015 %7 16.06.2015 %9 Protocol %J JMIR Res Protoc %G English %X Background: Kidney disease is a significant burden on health systems globally, with the rising prevalence of end stage kidney disease in Australia mirrored in many other countries. Approximately 25% of the Australian population lives in regional and rural areas and accessing complex tertiary services is challenging. Objective: We aim to compare the burden and outcomes of chronic kidney disease and end stage kidney disease in rural and urban regions of New South Wales (Australia’s most populous state) using linked health data. Methods: This is a retrospective cohort study and we have defined two cohorts: one with end stage kidney disease and one with chronic kidney disease. The end stage kidney disease cohort was defined using the Australia and New Zealand Dialysis and Transplant Registry, identifying all patients living in NSW receiving renal replacement therapy at any time between 01/07/2000 and 31/07/2010. The chronic kidney disease cohort used the NSW Admitted Patient Data Collection (APDC) to identify patients with a diagnostic code relating to chronic renal failure during any admission between 01/07/2000 and 31/07/2010. Both cohorts were linked to the NSW APDC, the Registry of Births, Deaths and Marriages, and the Central Cancer Registry allowing derivation of outcomes by categories of geographical remoteness. Results: To date, we have identified 10,505 patients with 2,384,218 records in the end stage kidney disease cohort and 159,033 patients with 1,599,770 records in the chronic kidney disease cohort. Conclusions: This study will define the geographical distribution of end stage and chronic kidney disease and compare the health service utilization between rural and urban renal populations. %M 26082088 %R 10.2196/resprot.3299 %U http://www.researchprotocols.org/2015/2/e73/ %U https://doi.org/10.2196/resprot.3299 %U http://www.ncbi.nlm.nih.gov/pubmed/26082088 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 4 %N 2 %P e9 %T Web-Based and Telephone Surveys to Assess Public Perception Toward the National Health Insurance in Taiwan: A Comparison of Cost and Results %A Yang,Ming-Chin %A Tan,Elise Chia-Hui %+ Institute of Health Policy and Management, College of Public Health, National Taiwan University, Room 637, No. 17. Xu-Zhou Road, Taipei City, , Taiwan, 886 2 33668067, mcyang637@ntu.edu.tw %K Web-based survey %K telephone survey %K public perception %K National Health Insurance %K self-reported health status %D 2015 %7 17.04.2015 %9 Original Paper %J Interact J Med Res %G English %X Background: Numerous studies have examined the impact of global budget payment systems of health insurance on patient access to medical care. In order to monitor the population’s accessibility to health services, a series of survey are often used to understand public perceptions of the health care provider. Taiwan implemented the single-payer National Health Insurance in 1995 and has been conducting a series of surveys to monitor public perception of the NHI after adopting a global budget payment system in 2002. Although telephone surveys are commonly used in obtaining public opinions on various public health issues, limitations such as higher cost and influence of interviewers do raise some concerns. Web-based surveys, one of the alternative methods, may be free from these problems. Objective: Our aim was to examine the difference of sociodemographic characteristics, satisfaction of NHI and NHI-contracted health care providers, attitude toward NHI-related issues, behavior in seeking medical advice and self-reported health status between those who completed Web-based surveys and those reached by telephone. Methods: This study compared the demographic factors of participants who took either a Web-based survey (1313 participants) or random digit dialing telephone survey (2411 participants) that contained identical questions. Results: Compared to telephone survey respondents, Web-based respondents tended to be younger (P<.001), unmarried (P<.001), non-smokers (P<.001), with a higher education (P<.001), and a higher monthly household income (P<.001) and worse self-reported health status (P=.008); however, they were less likely to report suffering from a chronic disease (P<.001). Despite these differences in background characteristics, no significant differences were observed in their answers related to the seeking of medical care or NHI-related issues. Telephone survey respondents reported greater satisfaction with NHI services. Web-based surveys were also shown to provide a lower average cost per sample (US$0.71) compared to telephone surveys (US$3.98). Conclusions: Web-based surveys provide a low-cost alternative method for the polling of public attitudes toward NHI-related issues. Despite general similarities between the two polling methods with regard to responses, respondents to telephone surveys reported a stronger agreement with regard to satisfaction with NHI services and a more positive self-reported health status. %M 25886989 %R 10.2196/ijmr.4090 %U http://www.i-jmr.org/2015/2/e9/ %U https://doi.org/10.2196/ijmr.4090 %U http://www.ncbi.nlm.nih.gov/pubmed/25886989 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 1 %P e10 %T Health Information–Seeking Behavior of Seniors Who Use the Internet: A Survey %A Medlock,Stephanie %A Eslami,Saeid %A Askari,Marjan %A Arts,Derk L %A Sent,Danielle %A de Rooij,Sophia E %A Abu-Hanna,Ameen %+ Academic Medical Center, Depatment of Medical Informatics, University of Amsterdam, PO Box 22700, Amsterdam, 1100 DE, Netherlands, 31 020 5664543, s.k.medlock@amc.uva.nl %K aged %K aged, 80 and over %K information-seeking behavior %K Internet %K patient education %K empowerment %D 2015 %7 08.01.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: The Internet is viewed as an important source for health information and a medium for patient empowerment. However, little is known about how seniors use the Internet in relation to other sources for health information. Objective: The aim was to determine which information resources seniors who use the Internet use and trust for health information, which sources are preferred, and which sources are used by seniors for different information needs. Methods: Questions from published surveys were selected based on their relevance to the study objectives. The Autonomy Preference Index was used to assess information needs and preferences for involvement in health decisions. Invitation to participate in this online survey was sent to the email list of a local senior organization (298 addresses) in the Netherlands. Results: There were 118 respondents with a median age of 72 years (IQR 67-78 years). Health professionals, pharmacists, and the Internet were the most commonly used and trusted sources of health information. Leaflets, television, newspapers, and health magazines were also important sources. Respondents who reported higher use of the Internet also reported higher use of other sources (P<.001). Use of health professionals, pharmacists, leaflets, telephone, television, and radio were not significantly different; use of all other resources was significantly higher in frequent Internet users. When in need of health information, preferred sources were the Internet (46/105, 43.8%), other sources (eg, magazines 38/105, 36.2%), health professionals (18/105, 17.1%), and no information seeking (3/105, 2.8%). Of the 51/107 respondents who indicated that they had sought health information in the last 12 months, 43 sought it after an appointment, 23 were preparing for an appointment, and 20 were deciding if an appointment was needed. The source used varied by the type of information sought. The Internet was used most often for symptoms (27/42, 64%), prognosis (21/31, 68%), and treatment options (23/41, 62%), whereas health professionals were asked for additional information on medications (20/36, 56%), side effects (17/36, 47%), coping (17/31, 55%), practical care (12/14, 86%), and nutrition/exercise (18/30, 60%). Conclusions: For these seniors who use the Internet, the Internet was a preferred source of health information. Seniors who report higher use of the Internet also report higher use of other information resources and were also the primary consumers of paper-based resources. Respondents most frequently searched for health information after an appointment rather than to prepare for an appointment. Resources used varied by health topic. Future research should seek to confirm these findings in a general elderly population, investigate how seniors seek and understand information on the Internet, and investigate how to reach seniors who prefer not to use the Internet for health information. %M 25574815 %R 10.2196/jmir.3749 %U http://www.jmir.org/2015/1/e10/ %U https://doi.org/10.2196/jmir.3749 %U http://www.ncbi.nlm.nih.gov/pubmed/25574815