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Abrams MP, Merchant RM, Meisel ZF, Pelullo AP, Chandra Guntuku S, Agarwal AK. Association Between Online Reviews of Substance Use Disorder Treatment Facilities and Drug-Induced Mortality Rates: Cross-Sectional Analysis. JMIR AI 2023; 2:e46317. [PMID: 38875553 PMCID: PMC11041514 DOI: 10.2196/46317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 06/16/2024]
Abstract
BACKGROUND Drug-induced mortality across the United States has continued to rise. To date, there are limited measures to evaluate patient preferences and priorities regarding substance use disorder (SUD) treatment, and many patients do not have access to evidence-based treatment options. Patients and their families seeking SUD treatment may begin their search for an SUD treatment facility online, where they can find information about individual facilities, as well as a summary of patient-generated web-based reviews via popular platforms such as Google or Yelp. Web-based reviews of health care facilities may reflect information about factors associated with positive or negative patient satisfaction. The association between patient satisfaction with SUD treatment and drug-induced mortality is not well understood. OBJECTIVE The objective of this study was to examine the association between online review content of SUD treatment facilities and drug-induced state mortality. METHODS A cross-sectional analysis of online reviews and ratings of Substance Abuse and Mental Health Services Administration (SAMHSA)-designated SUD treatment facilities listed between September 2005 and October 2021 was conducted. The primary outcomes were (1) mean online rating of SUD treatment facilities from 1 star (worst) to 5 stars (best) and (2) average drug-induced mortality rates from the Centers for Disease Control and Prevention (CDC) WONDER Database (2006-2019). Clusters of words with differential frequencies within reviews were identified. A 3-level linear model was used to estimate the association between online review ratings and drug-induced mortality. RESULTS A total of 589 SAMHSA-designated facilities (n=9597 reviews) were included in this study. Drug-induced mortality was compared with the average. Approximately half (24/47, 51%) of states had below average ("low") mortality rates (mean 13.40, SD 2.45 deaths per 100,000 people), and half (23/47, 49%) had above average ("high") drug-induced mortality rates (mean 21.92, SD 3.69 deaths per 100,000 people). The top 5 themes associated with low drug-induced mortality included detoxification and addiction rehabilitation services (r=0.26), gratitude for recovery (r=-0.25), thankful for treatment (r=-0.32), caring staff and amazing experience (r=-0.23), and individualized recovery programs (r=-0.20). The top 5 themes associated with high mortality were care from doctors or providers (r=0.24), rude and insensitive care (r=0.23), medication and prescriptions (r=0.22), front desk and reception experience (r=0.22), and dissatisfaction with communication (r=0.21). In the multilevel linear model, a state with a 10 deaths per 100,000 people increase in mortality was associated with a 0.30 lower average Yelp rating (P=.005). CONCLUSIONS Lower online ratings of SUD treatment facilities were associated with higher drug-induced mortality at the state level. Elements of patient experience may be associated with state-level mortality. Identified themes from online, organically derived patient content can inform efforts to improve high-quality and patient-centered SUD care.
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Affiliation(s)
- Matthew P Abrams
- Center for Digital Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Center for Emergency Care Policy and Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Raina M Merchant
- Center for Digital Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Center for Emergency Care Policy and Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
| | - Zachary F Meisel
- Center for Emergency Care Policy and Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Arthur P Pelullo
- Center for Digital Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Sharath Chandra Guntuku
- Center for Digital Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
- Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA, United States
| | - Anish K Agarwal
- Center for Digital Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Center for Emergency Care Policy and Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
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2
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David Gomez JC, Cochran A, Smith M, Zayas-Cabán G. Prediction of rehospitalization and mortality risks for skilled nursing facilities using a dimension reduction approach. BMC Geriatr 2023; 23:394. [PMID: 37380969 PMCID: PMC10304328 DOI: 10.1186/s12877-023-03995-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 04/24/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Hospitals are incentivized to reduce rehospitalization rates, creating an emphasis on skilled nursing facilities (SNFs) for post-hospital discharge. How rehospitalization rates vary depending on patient and SNF characteristics is not well understood, in part because these characteristics are high-dimensional. We sought to estimate rehospitalization and mortality risks by patient and skilled nursing facility (SNF) leveraging high-dimensional characteristics. METHODS Using 1,060,337 discharges from 13,708 SNFs of Medicare patients residing or visiting a provider in Wisconsin, Iowa, and Illinois, factor analysis was performed to reduce the number of patient and SNF characteristics. K-means clustering was applied to SNF factors to categorize SNFs into groups. Rehospitalization and mortality risks within 60 days of discharge was estimated by SNF group for various values of patient factors. RESULTS Patient and SNF characteristics (616 in total) were reduced to 12 patient factors and 4 SNF groups. Patient factors reflected broad conditions. SNF groups differed in beds and staff capacity, off-site services, and physical and occupational therapy capacity; and in mortality and rehospitalization rates for some patients. Patients with cardiac, orthopedic, and neuropsychiatric conditions are associated with better outcomes when assigned to SNFs with greater on-site capacity (i.e. beds, staff, physical and occupational therapy), whereas patients with conditions related to cancer or chronic renal failure are associated with better outcomes when assigned to SNFs with less on-site capacity. CONCLUSIONS Risks of rehospitalization and mortality appear to vary significantly by patient and SNF, with certain SNFs being better suited for some patient conditions over others.
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Affiliation(s)
- Juan Camilo David Gomez
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, USA
| | - Amy Cochran
- Department of Population Health Sciences, Department of Mathematics, University of Wisconsin-Madison, Madison, USA
| | - Maureen Smith
- Department of Population Health Sciences, Department of Mathematics, University of Wisconsin-Madison, Madison, USA
| | - Gabriel Zayas-Cabán
- Department of Industrial and Systems Engineering and BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, 3107 Mechanical Engineering Building, 1513 University Avenue, Madison, WI 53726 USA
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Temkin-Greener H, Mao Y, McGarry B. Online Customer Reviews of Assisted Living Communities: Association with Community, County, and State Factors. J Am Med Dir Assoc 2023; 24:841-845.e3. [PMID: 36934775 PMCID: PMC10238634 DOI: 10.1016/j.jamda.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVES Online reviews provided by users of assisted living communities may offer a unique source of heretofore unexamined data. We explored online reviews as a possible source of information about these communities and examined the association between the reviews and aspects of state regulations, while controlling for assisted living, county, and state market-level factors. DESIGN Cross-sectional, observational study. SETTING AND PARTICIPANTS Sample included 149,265 reviews for 8828 communities. METHODS Primary (eg, state regulations) and secondary (eg, Medicare Beneficiary Summary Files) data were used. County-level factors were derived from the Area Health Resource Files, and state-level factors from the integrated Public Use Microdata series. Information on state regulations was obtained from a previously compiled regulatory dataset. Average assisted living rating score, calculated as the mean of posted online reviews, was the outcome of interest, with a higher score indicating a more positive review. We used word cloud to visualize how often words appeared in 1-star and 5-star reviews. Logistic regression models were used to determine the association between online rating and a set of community, county, and state variables. Models were weighted by the number of reviews per assisted living bed. RESULTS Overall, 76% of communities had online reviews. We found lower odds of positive reviews in communities with greater proportions of Medicare/Medicaid residents [odds ratio (OR) = 0.986; P < .001], whereas communities located in micropolitan areas (compared with urban), and those in states with more direct care worker hours (per week per bed) had greater odds of high rating (OR = 1.722; P < .001 and OR = 1.018, P < .05, respectively). CONCLUSIONS AND IMPLICATIONS Online reviews are increasingly common, including in long-term care. These reviews are a promising source of information about important aspects of satisfaction, particularly in care settings that lack a public reporting infrastructure. We found several significant associations between online ratings and community-level factors, suggesting these reviews may be a valuable source of information to consumers and policy makers.
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Affiliation(s)
- Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Yunjiao Mao
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Brian McGarry
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Mao Y, Li Y, McGarry B, Wang J, Temkin-Greener H. Are online reviews of assisted living communities associated with patient-centered outcomes? J Am Geriatr Soc 2023; 71:1505-1514. [PMID: 36571798 PMCID: PMC10175089 DOI: 10.1111/jgs.18192] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Existing literature on online reviews of healthcare providers generally portrays online reviews as a useful way to disseminate information on quality. However, it remains unknown whether online reviews for assisted living (AL) communities reflect AL care quality. This study examined the association between AL online review ratings and residents' home time, a patient-centered outcome. METHODS Medicare beneficiaries who entered AL communities in 2018 were identified. The main outcome is resident home time in the year following AL admission, calculated as the percentage of time spent at home (i.e., not in institutional care setting) per day being alive. Additional outcomes are the percentage of time spent in emergency room, inpatient hospital, nursing home, and inpatient hospice. AL online Google reviews for 2013-2017 were linked to 2018-2019 Medicare data. AL average rating score (ranging 1-5) and rating status (no-rating, low-rating, and high-rating) were generated using Google reviews. Linear regression models and propensity score weighting were used to examine the association between online reviews and outcomes. The study sample included 59,831 residents in 12,143 ALs. RESULTS Residents were predominately older (average 81.2 years), non-Hispanic White (90.4%), and female (62.9%), with 17% being dually eligible for Medicare and Medicaid. From 2013 to 2017, ALs received an average rating of 4.1 on Google, with a standard deviation of 1.1. Each one-unit increase in the AL's average online rating was associated with an increase in residents' risk-adjusted home time by 0.33 percentage points (p < 0.001). Compared with residents in ALs without ratings, residents in high-rated ALs (average rating ≥4.4) had a 0.64 pp (p < 0.001) increase in home time. CONCLUSIONS Higher online rating scores were positively associated with residents' home time, while the absence of ratings was associated with reduced home time. Our results suggest that online reviews may be a quality signal with respect to home time.
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Affiliation(s)
- Yunjiao Mao
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY
| | - Yue Li
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY
| | - Brian McGarry
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY
- Department of Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY
| | - Jinjiao Wang
- Elaine Hubbard Center for Nursing Research on Aging, University of Rochester School of Nursing, Rochester, NY
| | - Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY
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5
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Andy A, Sherman G, Guntuku SC. Understanding the expression of loneliness on Twitter across age groups and genders. PLoS One 2022; 17:e0273636. [PMID: 36170276 PMCID: PMC9518878 DOI: 10.1371/journal.pone.0273636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/11/2022] [Indexed: 11/22/2022] Open
Abstract
Some individuals seek support around loneliness on social media forums. In this work, we aim to determine differences in the use of language by users—in different age groups and genders (female, male), who publish posts on Twitter expressing loneliness. We hypothesize that these differences in the use of language will reflect how these users express themselves and some of their support needs. Interventions may vary depending on the age and gender of an individual, hence, in order to identify high-risk individuals who express loneliness on Twitter and provide appropriate interventions for these users, it is important to understand the variations in language use by users who belong to different age groups and genders and post about loneliness on Twitter. We discuss the findings from this work and how they can help guide the design of online loneliness interventions.
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Affiliation(s)
- Anietie Andy
- Penn Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- * E-mail:
| | - Garrick Sherman
- Computer and Information Science, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Sharath Chandra Guntuku
- Computer and Information Science, University of Pennsylvania, Philadelphia, PA, United States of America
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Manges KA, Medvedeva E, Ersek M, Burke RE. VA nursing home compare metrics as an indicator of skilled nursing facility quality for veterans. J Am Geriatr Soc 2022; 70:2269-2279. [PMID: 35678768 DOI: 10.1111/jgs.17906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 03/18/2022] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Veterans Administration (VA) provides several post-acute care (PAC) options for Veterans, including VA-owned nursing homes (called Community Living Centers, CLCs). In 2016, the VA released CLC Compare star ratings to support decision-making. However, the relationship between CLC Compare star ratings and Veterans CLC post-acute outcomes is unknown. METHODS Retrospective observational study using national VA and Medicare data for Veterans discharged to a CLC for PAC. We used a multivariate regression model with hospital random effects to examine the association between CLC Compare overall star ratings and PAC outcomes while controlling for patient, facility, and hospital factors. Our sample included Veteran enrollees age 65+ who were community-dwelling, experienced a hospitalization, and were discharged to a CLC in 2016-2017. PAC outcomes included 30-day unplanned hospital readmission, 30-day mortality, 100-day successful community discharge, and a secondary composite outcome of unplanned readmission or death within 30-days of the hospital discharge. RESULTS Of the 25,107 CLC admissions, 4088 (16.3%) experienced an unplanned readmission, 4069 (16.2%) died within 30-days of hospital discharge, and 12,093 (48.2%) had a successful 100-day community discharge. Admission to a lower-quality (1-star) facility was associated with lower odds of successful community discharge (OR 0.78; 95% CI 0.66, 0.91) and higher odds of a combined endpoint of 30-day mortality and readmission (OR 1.27; 95% CI 1.09, 1.49), compared to 5-star facilities. However, outcomes were not consistently different between 5-star and 2, 3, or 4-star facilities. Star ratings were not associated with individual readmission or mortality outcomes when considered separately. CONCLUSION These findings suggest comparisons of 1-star and 5-star CLCs may provide meaningful information for Veterans making decisions about post-acute care. Identifying ways to alter the star ratings so they are differentially associated with outcomes meaningful to Veterans at each level is essential. We found that 1-star facilities had higher rates of 30-day unplanned hospital readmission/death, and lower rates of 100-day successful community discharges compared to 5-star facilities. Yet, like past work on CMS Nursing Home Compare ratings, these relationships were found to be inconsistent or not meaningful across all star levels. CLC Compare may provide useful information for discharge and organizational planning, with some limitations.
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Affiliation(s)
- Kirstin A Manges
- Center for Health Equity Research and Promotion (CHERP), Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elina Medvedeva
- Center for Health Equity Research and Promotion (CHERP), Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Mary Ersek
- Center for Health Equity Research and Promotion (CHERP), Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Robert E Burke
- Center for Health Equity Research and Promotion (CHERP), Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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7
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Agarwal AK, Guntuku SC, Meisel ZF, Pelullo A, Kinkle B, Merchant RM. Analyzing Online Reviews of Substance Use Disorder Treatment Facilities in the USA Using Machine Learning. J Gen Intern Med 2022; 37:977-980. [PMID: 33728567 PMCID: PMC8904697 DOI: 10.1007/s11606-021-06618-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/07/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Anish K Agarwal
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA. .,Center for Digital Health, University of Pennsylvania Health System, Philadelphia, PA, USA. .,Center for Emergency Care Policy Research, University of Pennsylvania, Philadelphia, PA, USA. .,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Sharath C Guntuku
- Center for Digital Health, University of Pennsylvania Health System, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA, USA
| | - Zachary F Meisel
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Center for Digital Health, University of Pennsylvania Health System, Philadelphia, PA, USA.,Center for Emergency Care Policy Research, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Arthur Pelullo
- Center for Digital Health, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Bill Kinkle
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Raina M Merchant
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Center for Digital Health, University of Pennsylvania Health System, Philadelphia, PA, USA.,Center for Emergency Care Policy Research, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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8
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Tong JKC, Akpek E, Naik A, Sharma M, Boateng D, Andy A, Merchant RM, Kelz RR. Reporting of Discrimination by Health Care Consumers Through Online Consumer Reviews. JAMA Netw Open 2022; 5:e220715. [PMID: 35226076 PMCID: PMC8886543 DOI: 10.1001/jamanetworkopen.2022.0715] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
IMPORTANCE Little is known about how discrimination in health care relates to inequities in hospital-based care because of limitations in the ability to measure discrimination. Consumer reviews offer a novel source of data to capture experiences of discrimination in health care settings. OBJECTIVE To examine how health care consumers perceive and report discrimination through public consumer reviews. DESIGN, SETTING, AND PARTICIPANTS This qualitative study assessed Yelp online reviews from January 1, 2011, to December 31, 2020, of 100 randomly selected acute care hospitals in the US. Word filtering was used to identify reviews potentially related to discrimination by using keywords abstracted from the Everyday Discrimination Scale, a commonly used questionnaire to measure discrimination. A codebook was developed through a modified grounded theory and qualitative content analysis approach to categorize recurrent themes of discrimination, which was then applied to the hospital reviews. EXPOSURES Reported experiences of discrimination within a health care setting. MAIN OUTCOMES AND MEASURES Perceptions of how discrimination in health care is experienced and reported by consumers. RESULTS A total of 10 535 reviews were collected. Reviews were filtered by words commonly associated with discriminatory experiences, which identified 2986 reviews potentially related to discrimination. Using the codebook, the team manually identified 182 reviews that described at least 1 instance of discrimination. Acts of discrimination were categorized by actors of discrimination (individual vs institution), setting (clinical vs nonclinical), and directionality (whether consumers expressed discriminatory beliefs toward health care staff). A total of 53 reviews (29.1%) were coded as examples of institutional racism; 89 reviews (48.9%) mentioned acts of discrimination that occurred in clinical spaces as consumers were waiting for or actively receiving care; 25 reviews (13.7%) mentioned acts of discrimination that occurred in nonclinical spaces, such as lobbies; and 66 reviews (36.3%) documented discrimination by the consumer directed at the health care workforce. Acts of discrimination are described through 6 recurrent themes, including acts of commission, omission, unprofessionalism, disrespect, stereotyping, and dehumanizing. CONCLUSIONS AND RELEVANCE In this qualitative study, consumer reviews were found to highlight recurrent patterns of discrimination within health care settings. Applying quality improvement tools, such as the Plan-Do-Study-Act cycle, to this source of data and this study's findings may help inform assessments and initiatives directed at reducing discrimination within the health care setting.
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Affiliation(s)
- Jason K. C. Tong
- National Clinician Scholars Program, Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Center for Surgery and Health Economics, Hospital of the University of Pennsylvania, Philadelphia
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Eda Akpek
- Penn Mixed Methods Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Anusha Naik
- Center for Surgery and Health Economics, Hospital of the University of Pennsylvania, Philadelphia
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Medha Sharma
- Center for Surgery and Health Economics, Hospital of the University of Pennsylvania, Philadelphia
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Danielle Boateng
- Center for Surgery and Health Economics, Hospital of the University of Pennsylvania, Philadelphia
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Anietie Andy
- Center for Digital Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Raina M. Merchant
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
- Center for Digital Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department for Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rachel R. Kelz
- Center for Surgery and Health Economics, Hospital of the University of Pennsylvania, Philadelphia
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Stokes DC, Pelullo AP, Mitra N, Meisel ZF, South EC, Asch DA, Merchant RM. Association Between Crowdsourced Health Care Facility Ratings and Mortality in US Counties. JAMA Netw Open 2021; 4:e2127799. [PMID: 34665240 PMCID: PMC8527362 DOI: 10.1001/jamanetworkopen.2021.27799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
IMPORTANCE Mortality across US counties varies considerably, from 252 to 1847 deaths per 100 000 people in 2018. Although patient satisfaction with health care is associated with patient- and facility-level health outcomes, the association between health care satisfaction and community-level health outcomes is not known. OBJECTIVE To examine the association between online ratings of health care facilities and mortality across US counties and to identify language specific to 1-star (lowest rating) and 5-star (highest rating) reviews in counties with high vs low mortality. DESIGN, SETTING, AND PARTICIPANTS This retrospective population-based cross-sectional study examined reviews and ratings of 95 120 essential health care facilities across 1301 US counties. Counties that had at least 1 essential health care facility with reviews available on Yelp, an online review platform, were included. Essential health care was defined according to the 10 essential health benefits covered by Affordable Care Act insurance plans. MAIN OUTCOMES AND MEASURES The mean rating of essential health care facilities was calculated by county from January 1, 2015, to December 31, 2019. Ratings were on a scale of 1 to 5 stars, with 1 being the worst rating and 5 the best. County-level composite measures of health behaviors, clinical care, social and economic factors, and physical environment were obtained from the University of Wisconsin School of Medicine and Public Health County Health Rankings database. The 2018 age-adjusted mortality by county was obtained from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiological Research database. Multiple linear regression analysis was used to estimate the association between mean facility rating and mortality, adjusting for county health ranking variables. Words with frequencies of use that were significantly different across 1-star and 5-star reviews in counties with high vs low mortality were identified. RESULTS The 95 120 facilities meeting inclusion criteria were distributed across 1301 of 3142 US counties (41.4%). At the county level, a 1-point increase in mean rating was associated with a mean (SE) age-adjusted decrease of 18.05 (3.68) deaths per 100 000 people (P < .001). Words specific to 1-star reviews in high-mortality counties included told, rude, and wait, and words specific to 5-star reviews in low-mortality counties included Dr, pain, and professional. CONCLUSIONS AND RELEVANCE This study found that, at the county level, higher online ratings of essential health care facilities were associated with lower mortality. Equivalent online ratings did not necessarily reflect equivalent experiences of care across counties with different mortality levels, as evidenced by variations in the frequency of use of key words in reviews. These findings suggest that online ratings and reviews may provide insight into unequal experiences of essential health care.
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Affiliation(s)
- Daniel C. Stokes
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Center for Digital Health, Penn Medicine, University of Pennsylvania, Philadelphia
| | - Arthur P. Pelullo
- Center for Digital Health, Penn Medicine, University of Pennsylvania, Philadelphia
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Zachary F. Meisel
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Eugenia C. South
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Urban Health Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - David A. Asch
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Raina M. Merchant
- Center for Digital Health, Penn Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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10
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Andy A. Understanding user communication around loneliness on online forums. PLoS One 2021; 16:e0257791. [PMID: 34555106 PMCID: PMC8460046 DOI: 10.1371/journal.pone.0257791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/13/2021] [Indexed: 11/19/2022] Open
Abstract
Increasingly, individuals experiencing loneliness are seeking support on online forums-some of which focus specifically on discussions around loneliness (loneliness forums); loneliness may influence how these individuals communicate in other online forums not focused on loneliness (non-loneliness forums). In order to provide effective and appropriate online interventions around loneliness, it is important to understand how users who publish posts in a loneliness forum communicate in the loneliness forum and non-loneliness forums they belong to. In this paper, using language features, the following analyses are conducted: (1) Posts published on an online loneliness forum on Reddit, /r/Lonely are compared to posts (published by the same users and around the same time period) on two Reddit online forums i.e. an advice seeking forum, /r/AskReddit and a forum focused on discussions around depression (depression forum), /r/depression. (2) Interventions related to loneliness may vary depending on if an individual is lonely and depressed or lonely but not depressed; language use differences in posts published in /r/Lonely by the following set of users are identified: (a) users who post in both /r/Lonely and a depression forum and (b) users who post in /r/Lonely but not in the depression forum. The findings from this work gain new insights, for example: (i) /r/Lonely users tend to seek advice/ask questions related to relationships in the advice seeking forum, /r/AskReddit and (ii) users who are members of the loneliness forum but not the depression forum tend to publish posts (on the loneliness forum) on topic themes related to work/job, however, those who are members of the loneliness and depression forums tend to use more words associated with anger, negation, death, and post on topic themes related to affection relative to relationships in their loneliness forum posts. Some of the findings from this work also align with prior work e.g. users who express loneliness in online forums tend to make more reference to self. These findings aid in gaining insights into how users communicate on these forums and their support needs, thereby informing loneliness interventions.
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Affiliation(s)
- Anietie Andy
- Penn Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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11
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Manchaiah V, Bennett RJ, Ratinaud P, Swanepoel DW. Experiences With Hearing Health Care Services: What Can We Learn From Online Consumer Reviews? Am J Audiol 2021; 30:745-754. [PMID: 34491785 DOI: 10.1044/2021_aja-21-00041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective The aim of this study was to examine experiences of hearing health care services as described in online consumer reviews. Design This study used a cross-sectional design. Online consumer reviews about hearing health care services generated from Google.com to an open-ended question "Share details of your own experience at this place" and perceived overall experience (indicated on a 5-point rating scale: "very good" to "very poor") were extracted from 40 different cities across the United States. The open text contributed a text corpus of 9,622 unique consumer reviews. These responses were analyzed with the cluster analysis approach using an open-source automated text analysis software program, IRaMuTeQ, to identify key themes. Association between clusters and consumer experience ratings as well as consumer metadata (percentage of older adults in the city, region) were examined using the chi-square analysis. Results The majority of consumers appeared satisfied with their hearing health care services, with nearly 95% of consumers reporting "very good" and "good" on the global experience scale. The analysis of text responses resulted in seven clusters within two domains. Domain 1 (Clinical Processes) included the three clusters: administration processes, perceived benefits, and device acquisition. Domain 2 (Staff and Service Interactions) included the four clusters: clinician communications, staff professionalism, customer service, and provider satisfaction. Content relating to administration processes was associated with overall rating regarding the hearing health care service experience. Consumer's reviews relating to administration processes mostly described negative experiences, and these participants were more inclined to provide poorer overall experience ratings. In addition, city characteristics (i.e., percentage of older adults, region) had bearing toward what elements of hearing health care services are highlighted more in the consumer reviews. Conclusions Consumers comment on a variety of elements when describing their experiences with hearing health care services. Experiences reported in most clusters were generally positive, although some concerns in the "clinical process" are associated with lower satisfaction. Employing patient-centered strategies and ensuring patients have good experiences in the areas of concern may help improve both patient experience and their satisfaction. Supplemental Material https://doi.org/10.23641/asha.16455924.
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Affiliation(s)
- Vinaya Manchaiah
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal Academy of Higher Education, India
| | - Rebecca J. Bennett
- Ear Science Institute Australia, Subiaco, Western Australia
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Nedlands, Australia
| | | | - De Wet Swanepoel
- Ear Science Institute Australia, Subiaco, Western Australia
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
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Tong J, Andy AU, Merchant RM, Kelz RR. Evaluation of Online Consumer Reviews of Hospitals and Experiences of Racism Using Qualitative Methods. JAMA Netw Open 2021; 4:e2126118. [PMID: 34550386 PMCID: PMC8459189 DOI: 10.1001/jamanetworkopen.2021.26118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This qualitative study examines online consumer reviews for experiences of racism in US hospitals among patients.
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Affiliation(s)
- Jason Tong
- National Clinician Scholars, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Anietie U. Andy
- Center for Digital Health, University of Pennsylvania, Philadelphia
| | - Raina M. Merchant
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rachel R. Kelz
- Department of Surgery, Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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13
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Stokes DC, Kishton R, McCalpin HJ, Pelullo AP, Meisel ZF, Beidas RS, Merchant RM. Online Reviews of Mental Health Treatment Facilities: Narrative Themes Associated With Positive and Negative Ratings. Psychiatr Serv 2021; 72:776-783. [PMID: 34015944 PMCID: PMC9116241 DOI: 10.1176/appi.ps.202000267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Previous studies indicate that patients' satisfaction with mental health care is correlated with both treatment outcomes and quality of life. The aims of this study were to describe online reviews of mental health treatment facilities, including key themes in review content, and to evaluate the correlation between narrative review themes, facility characteristics, and review ratings. METHODS United States National Mental Health Services Survey (N-MHSS) facilities were linked to corresponding Yelp pages, created between March 2007 and September 2019. Correlations between review ratings and both machine learning-generated latent Dirichlet allocation topics and N-MHSS-reported facility characteristics were measured by using Spearman's rank-order correlation coefficient. Significance was defined by a Bonferroni-adjusted p<0.001. RESULTS Of 10,191 unique mental health treatment facilities, 1,383 (13.6%) had relevant Yelp pages with 8,133 corresponding reviews. The number of newly reviewed facilities and the number of new reviews increased throughout the study period. Narrative topics positively correlated with review ratings included caring staff (Spearman's ρ=0.39) and nonpharmacologic treatment (ρ=0.16). Topics negatively correlated with review ratings included rude staff (ρ=-0.14) and safety and abuse (ρ=-0.14). Of 126 N-MHSS survey items, 11 were positively correlated with review rating, including "outpatient mental health facility" (ρ=0.13), and 33 were negatively correlated with review rating, including accepting Medicare (ρ=-0.21). CONCLUSIONS Narrative topics provide information beyond what is currently collected through the N-MHSS. Topics associated with positive and negative reviews, such as staff attitude toward patients, can guide improvement in patients' satisfaction and engagement with mental health care.
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Affiliation(s)
- Daniel C Stokes
- Penn Medicine Center for Digital Health (Stokes, McCalpin, Pelullo, Merchant), Center for Emergency Care Policy and Research, Department of Emergency Medicine (Stokes, Meisel, Merchant), Department of Psychiatry (Beidas), and Penn Medical Ethics and Health Policy (Beidas), Perelman School of Medicine, University of Pennsylvania, Philadelphia; National Clinician Scholars Program (Kishton), Leonard Davis Institute of Health Economics (Meisel, Merchant), and Penn Implementation Science Center at the Leonard Davis Institute (Beidas), University of Pennsylvania, Philadelphia
| | - Rachel Kishton
- Penn Medicine Center for Digital Health (Stokes, McCalpin, Pelullo, Merchant), Center for Emergency Care Policy and Research, Department of Emergency Medicine (Stokes, Meisel, Merchant), Department of Psychiatry (Beidas), and Penn Medical Ethics and Health Policy (Beidas), Perelman School of Medicine, University of Pennsylvania, Philadelphia; National Clinician Scholars Program (Kishton), Leonard Davis Institute of Health Economics (Meisel, Merchant), and Penn Implementation Science Center at the Leonard Davis Institute (Beidas), University of Pennsylvania, Philadelphia
| | - Haley J McCalpin
- Penn Medicine Center for Digital Health (Stokes, McCalpin, Pelullo, Merchant), Center for Emergency Care Policy and Research, Department of Emergency Medicine (Stokes, Meisel, Merchant), Department of Psychiatry (Beidas), and Penn Medical Ethics and Health Policy (Beidas), Perelman School of Medicine, University of Pennsylvania, Philadelphia; National Clinician Scholars Program (Kishton), Leonard Davis Institute of Health Economics (Meisel, Merchant), and Penn Implementation Science Center at the Leonard Davis Institute (Beidas), University of Pennsylvania, Philadelphia
| | - Arthur P Pelullo
- Penn Medicine Center for Digital Health (Stokes, McCalpin, Pelullo, Merchant), Center for Emergency Care Policy and Research, Department of Emergency Medicine (Stokes, Meisel, Merchant), Department of Psychiatry (Beidas), and Penn Medical Ethics and Health Policy (Beidas), Perelman School of Medicine, University of Pennsylvania, Philadelphia; National Clinician Scholars Program (Kishton), Leonard Davis Institute of Health Economics (Meisel, Merchant), and Penn Implementation Science Center at the Leonard Davis Institute (Beidas), University of Pennsylvania, Philadelphia
| | - Zachary F Meisel
- Penn Medicine Center for Digital Health (Stokes, McCalpin, Pelullo, Merchant), Center for Emergency Care Policy and Research, Department of Emergency Medicine (Stokes, Meisel, Merchant), Department of Psychiatry (Beidas), and Penn Medical Ethics and Health Policy (Beidas), Perelman School of Medicine, University of Pennsylvania, Philadelphia; National Clinician Scholars Program (Kishton), Leonard Davis Institute of Health Economics (Meisel, Merchant), and Penn Implementation Science Center at the Leonard Davis Institute (Beidas), University of Pennsylvania, Philadelphia
| | - Rinad S Beidas
- Penn Medicine Center for Digital Health (Stokes, McCalpin, Pelullo, Merchant), Center for Emergency Care Policy and Research, Department of Emergency Medicine (Stokes, Meisel, Merchant), Department of Psychiatry (Beidas), and Penn Medical Ethics and Health Policy (Beidas), Perelman School of Medicine, University of Pennsylvania, Philadelphia; National Clinician Scholars Program (Kishton), Leonard Davis Institute of Health Economics (Meisel, Merchant), and Penn Implementation Science Center at the Leonard Davis Institute (Beidas), University of Pennsylvania, Philadelphia
| | - Raina M Merchant
- Penn Medicine Center for Digital Health (Stokes, McCalpin, Pelullo, Merchant), Center for Emergency Care Policy and Research, Department of Emergency Medicine (Stokes, Meisel, Merchant), Department of Psychiatry (Beidas), and Penn Medical Ethics and Health Policy (Beidas), Perelman School of Medicine, University of Pennsylvania, Philadelphia; National Clinician Scholars Program (Kishton), Leonard Davis Institute of Health Economics (Meisel, Merchant), and Penn Implementation Science Center at the Leonard Davis Institute (Beidas), University of Pennsylvania, Philadelphia
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14
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Andy AU, Guntuku SC, Adusumalli S, Asch DA, Groeneveld PW, Ungar LH, Merchant RM. Predicting Cardiovascular Risk Using Social Media Data: Performance Evaluation of Machine-Learning Models. JMIR Cardio 2021; 5:e24473. [PMID: 33605888 PMCID: PMC8411430 DOI: 10.2196/24473] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/14/2020] [Accepted: 01/15/2021] [Indexed: 01/23/2023] Open
Abstract
Background Current atherosclerotic cardiovascular disease (ASCVD) predictive models have limitations; thus, efforts are underway to improve the discriminatory power of ASCVD models. Objective We sought to evaluate the discriminatory power of social media posts to predict the 10-year risk for ASCVD as compared to that of pooled cohort risk equations (PCEs). Methods We consented patients receiving care in an urban academic emergency department to share access to their Facebook posts and electronic medical records (EMRs). We retrieved Facebook status updates up to 5 years prior to study enrollment for all consenting patients. We identified patients (N=181) without a prior history of coronary heart disease, an ASCVD score in their EMR, and more than 200 words in their Facebook posts. Using Facebook posts from these patients, we applied a machine-learning model to predict 10-year ASCVD risk scores. Using a machine-learning model and a psycholinguistic dictionary, Linguistic Inquiry and Word Count, we evaluated if language from posts alone could predict differences in risk scores and the association of certain words with risk categories, respectively. Results The machine-learning model predicted the 10-year ASCVD risk scores for the categories <5%, 5%-7.4%, 7.5%-9.9%, and ≥10% with area under the curve (AUC) values of 0.78, 0.57, 0.72, and 0.61, respectively. The machine-learning model distinguished between low risk (<10%) and high risk (>10%) with an AUC of 0.69. Additionally, the machine-learning model predicted the ASCVD risk score with Pearson r=0.26. Using Linguistic Inquiry and Word Count, patients with higher ASCVD scores were more likely to use words associated with sadness (r=0.32). Conclusions Language used on social media can provide insights about an individual’s ASCVD risk and inform approaches to risk modification.
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Affiliation(s)
- Anietie U Andy
- Penn Medicine Center for Digital Health, University of Pennsylvania, Philadelphia, PA, United States
| | - Sharath C Guntuku
- Penn Medicine Center for Digital Health, University of Pennsylvania, Philadelphia, PA, United States.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
| | - Srinath Adusumalli
- Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, United States.,Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - David A Asch
- Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, United States.,Center for Health Equity Research and Promotion, Corporal Michael J Crescenz VA Medical Center, Philadelphia, PA, United States.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Peter W Groeneveld
- Center for Health Equity Research and Promotion, Corporal Michael J Crescenz VA Medical Center, Philadelphia, PA, United States.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Lyle H Ungar
- Penn Medicine Center for Digital Health, University of Pennsylvania, Philadelphia, PA, United States
| | - Raina M Merchant
- Penn Medicine Center for Digital Health, University of Pennsylvania, Philadelphia, PA, United States.,Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, United States.,Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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