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Pasat Z, Sinn CLJ, Rahman B, Gayowsky A, Lokker C, Tarride JE, Alarakhia M, Costa AP. The relationship between patient experience and real-world digital health access in primary care: A population-based cross-sectional study. PLoS One 2024; 19:e0299005. [PMID: 38713719 DOI: 10.1371/journal.pone.0299005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/04/2024] [Indexed: 05/09/2024] Open
Abstract
Implementing digital health technologies in primary care is anticipated to improve patient experience. We examined the relationships between patient experience and digital health access in primary care settings in Ontario, Canada. We conducted a retrospective cross-sectional study using patient responses to the Health Care Experience Survey linked to health and administrative data between April 2019-February 2020. We measured patient experience by summarizing HCES questions. We used multivariable logistic regression stratified by the number of primary care visits to investigate associations between patient experience with digital health access and moderating variables. Our cohort included 2,692 Ontario adults, of which 63.0% accessed telehealth, 2.6% viewed medical records online, and 3.6% booked appointments online. Although patients reported overwhelmingly positive experiences, we found no consistent relationship with digital health access. Online appointment booking access was associated with lower odds of poor experience for patients with three or more primary care visits in the past 12 months (adjusted odds ratio 0.16, 95% CI 0.02-0.56). Younger age, tight financial circumstances, English as a second language, and knowing their primary care provider for fewer years had greater odds of poor patient experience. In 2019/2020, we found limited uptake of digital health in primary care and no clear association between real-world digital health adoption and patient experience in Ontario. Our findings provide an essential context for ensuing rapid shifts in digital health adoption during the COVID-19 pandemic, serving as a baseline to reexamine subsequent improvements in patient experience.
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Affiliation(s)
- Zain Pasat
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Integrated Care, St. Joseph's Health System, Hamilton, Ontario, Canada
| | - Chi-Ling Joanna Sinn
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Integrated Care, St. Joseph's Health System, Hamilton, Ontario, Canada
| | - Bahram Rahman
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Anastasia Gayowsky
- ICES McMaster, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Cynthia Lokker
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Mohamed Alarakhia
- Michael G. DeGroote School of Medicine, McMaster University, Waterloo Regional Campus, Kitchener, Ontario, Canada
- eHealth Centre of Excellence, Kitchener, Ontario, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Integrated Care, St. Joseph's Health System, Hamilton, Ontario, Canada
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Sadeghi B, Tran J, Tsai IS, Sadigh G. Role of Online Patient Portal Self-Scheduling and Self-Referral Pathways to Decrease Health Disparity for Screening Mammography. J Am Coll Radiol 2024; 21:147-153. [PMID: 37516158 DOI: 10.1016/j.jacr.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/20/2023] [Accepted: 06/05/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE The aim of this study was to assess the rate of self-scheduling and self-referral for screening mammography and to assess sociodemographic factors associated with their use in an academic health care system in southern California. METHODS Patients scheduled for screening mammography between February 1, 2021, and September 20, 2022, were included in this retrospective study. Multivariable logistic regression models were used to assess associations among sociodemographic factors, self-referral, and online self-scheduling pathways. RESULTS In total, 22,306 patients were scheduled for screening mammography (mean age, 59 years; 66.8% White, 20.4% Asian, and 20.6% Hispanic). Overall, 3,566 (16.0%) used online self-scheduling, and 1,232 (5.5%) self-referred for screening mammography. Patients 70 years or older (versus 50 years or younger) (odds ratio [OR], 0.41; 95% confidence interval [CI], 0.34-0.51), Spanish (versus English) speakers (OR, 0.22; 95% CI, 0.16-0.31), and those on Medicaid (versus commercially insured) (OR, 0.71; 95% CI, 0.50-0.99) were less likely to self-schedule. Hispanic patients (versus non-Hispanic) (OR, 1.39; 95% CI, 1.20-1.61), Asian patients (versus White) (OR, 1.64; 95% CI, 1.46-1.85), and patients residing in the most (versus least) disadvantaged neighborhoods (OR, 1.16; 95% CI, 1.02-1.33) were more likely to self-schedule. Furthermore, patients 70 years or older (versus 50 or younger) (OR, 0.70; 95% CI, 0.52-0.93) and Spanish speakers (OR, 0.05; 95% CI, 0.03-0.09) were less likely to self-refer, whereas Black patients (versus White) (OR, 1.89; 95% CI, 1.30-2.75), patients on Medicaid (versus commercially insured) (OR, 3.70; 95% CI, 2.65-5.13), and patients living in the most (versus least) disadvantaged neighborhoods (OR, 1.52; 95% CI, 1.27-1.82) were more likely to self-refer. CONCLUSIONS Sociodemographic differences in online patient portal use and self-referral for screening mammography suggest that the two pathways have been successful in addressing some of the existing scheduling barriers and are a step toward closing the disparity gap.
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Affiliation(s)
- Ben Sadeghi
- Department of Radiological Sciences, University of California, Irvine, Orange, California
| | - Julia Tran
- Department of Radiological Sciences, University of California, Irvine, Orange, California
| | - Irene S Tsai
- Department of Radiological Sciences, University of California, Irvine, Orange, California; Director of Breast Imaging, University of California, Irvine
| | - Gelareh Sadigh
- Department of Radiological Sciences, University of California, Irvine, Orange, California; Associate Editor, JACR; Director of Health Services and Comparative Outcome Research, University of California, Irvine.
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Mai F, Ko DG, Shan Z, Zhang D. The Impact of Accelerated Digitization on Patient Portal Use by Underprivileged Racial Minority Groups During COVID-19: Longitudinal Study. J Med Internet Res 2023; 25:e44981. [PMID: 37384810 PMCID: PMC10414031 DOI: 10.2196/44981] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 05/02/2023] [Accepted: 06/17/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Prior research on the digital divide has documented substantial racial inequality in using web-based health resources. The recent COVID-19 pandemic led to accelerated mass digitization, raising alarms that underprivileged racial minority groups are left further behind. However, it is unclear to what extent the use of health information and communications technology by underprivileged racial minority groups is affected. OBJECTIVE We have considered the COVID-19 disruption as a rare exogenous shock and estimated the impact of the accelerated digitization on the quantity and variety of patient portal use. In this study, we aimed to answer the following 2 key research questions. Did patients alter their use of health information and communications technology owing to COVID-19-induced digital acceleration? Does the effect differ across racial lines? METHODS We used a longitudinal patient portal use data set gathered from a large urban academic medical center to explore the effect of accelerated digitization on the racial digital gap in health care. We limited the sample period of our study to 2 same periods (March 11 to August 30) in 2019 and 2020. Our final sample consisted of 25,612 patients belonging to 1 of the 3 racial groups: Black or African American (n=5157, 20.13%), Hispanic (n=253, 0.99%), and White (n=20,202, 78.88%) patients. We estimated the panel data regression using 3 different models: pooled ordinary least squares (OLS), random effect (RE), and fixed effect (FE). RESULTS Our study yielded 4 findings. First, we confirmed that the racial digital divide remains a significant issue for telehealth; underprivileged racial minority group patients had lower patient portal use than White patients before the pandemic (Minority: OLS, β=-.158; P<.001; RE, β=-.168; P<.001). Second, we found that the digital gap regarding patient portal use frequency between underprivileged racial minority groups and White patients is shrinking rather than widening after the COVID-19 pandemic started (COVID_Period×Minority: OLS, β=.028; P=.002; RE, β=.037; P<.001; FE, β=.043; P<.001). Third, the shrinking gap is foremost driven by access through mobile (vs desktop) devices (COVID_Period×Minority: web, β=-.020; P=.02; mobile, β=.037; P<.001). Finally, underprivileged racial minority groups expanded their use of a variety of portal functionalities faster than White patients during the pandemic (COVID_Period×Minority [for functionality]: OLS, β=-.004; P<.001; RE, β=-.004; P<.001; FE, β=-.003; P=.001). CONCLUSIONS Using the COVID-19 pandemic as a natural experiment, we offer empirical evidence that accelerated digitization has shrunk the racial digital divide in telehealth, and the trend is mostly driven by mobile devices. These findings provide new insights into the digital behaviors among underprivileged racial minority groups during accelerated digitization. They also offer policy makers an opportunity to identify new strategies to help close the racial digital gap in the postpandemic world.
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Affiliation(s)
- Feng Mai
- School of Business, Stevens Institute of Technology, Hoboken, NJ, United States
| | - Dong-Gil Ko
- Department of Operations, Business Analytics, and Information Systems, University of Cincinnati, Cincinnati, OH, United States
| | - Zhe Shan
- Department of Information Systems and Analytics, Miami University, Oxford, OH, United States
| | - Dawei Zhang
- Department of Decision and Technology Analytics, Lehigh University, Bethlehem, PA, United States
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Ganguli I, Crawford ML, Usadi B, Mulligan KL, O'Malley AJ, Yang CWW, Fisher ES, Morden NE. Who's Accountable? Low-Value Care Received By Medicare Beneficiaries Outside Of Their Attributed Health Systems. Health Aff (Millwood) 2023; 42:1128-1139. [PMID: 37549329 PMCID: PMC10860675 DOI: 10.1377/hlthaff.2022.01319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Policy makers and payers increasingly hold health systems accountable for spending and quality for their attributed beneficiaries. Low-value care-medical services that offer little or no benefit and have the potential for harm in specific clinical scenarios-received outside of these systems could threaten success on both fronts. Using national Medicare data for fee-for-service beneficiaries ages sixty-five and older and attributed to 595 US health systems, we describe where and from whom they received forty low-value services during 2017-18 and identify factors associated with out-of-system receipt. Forty-three percent of low-value services received by attributed beneficiaries originated from out-of-system clinicians: 38 percent from specialists, 4 percent from primary care physicians, and 1 percent from advanced practice clinicians. Recipients of low-value care were more likely to obtain that care out of system if age 75 or older (versus ages 65-74), male (versus female), non-Hispanic White (versus other races or ethnicities), rural dwelling (versus metropolitan dwelling), more medically complex, or experiencing lower continuity of care. However, out-of-system service receipt was not associated with recipients' health systems' accountable care organization status. Health systems might improve quality and reduce spending for their attributed beneficiaries by addressing out-of-system receipt of low-value care-for example, by improving continuity.
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Affiliation(s)
- Ishani Ganguli
- Ishani Ganguli , Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | | | | | | | - Nancy E Morden
- Nancy E. Morden, UnitedHealthcare, Minnetonka, Minnesota
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Motulsky A, Bosson-Rieutort D, Usher S, David G, Moreault MP, Gagnon MP, Schuster T, Sicotte C. Evaluation of a national e-booking system for medical consultation in primary care in a universal health system. Health Policy 2023; 131:104759. [PMID: 36907137 DOI: 10.1016/j.healthpol.2023.104759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 02/08/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
PURPOSE The Rendez-vous Santé Québec is a national online booking (e-booking) system of medical appointments in primary care rolled out in 2018 in Québec (Canada). The objectives of this study were to describe the adoption by targeted users, and analyze the facilitating and limiting factors at the technological, individual and organizational levels to inform policy makers. METHODS A mixed methods evaluation was conducted involving interviews with key stakeholders (n = 40), audit logs of the system in 2019, and a population-based survey (n = 2 003). All data were combined to analyze facilitating and limiting factors, based on the DeLone and McLean framework. RESULTS The RVSQ e-booking system had a low adoption across the province mainly because it was poorly aligned with the diversity of organizational and professional practices. The other commercial e-booking systems already used by clinics seemed better adapted to interdisciplinary care, patient prioritization and advanced access. e-Booking system was appreciated by patients, but has implications for the performance of primary care organization that goes beyond scheduling management issues, with potential detrimental consequences for care continuity and appropriateness. Further research is needed to define how e-booking systems could support a better alignment between primary care innovative practices and improve the fit between patients' needs and resources availability in primary care.
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Affiliation(s)
- Aude Motulsky
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada; Department of Management, Evaluation and Health Policy, School of public health, Université de Montréal, Montreal, Canada.
| | - Delphine Bosson-Rieutort
- Department of Management, Evaluation and Health Policy, School of public health, Université de Montréal, Montreal, Canada; Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Susan Usher
- Centre de recherche Charles-le-Moyne, Université de Sherbrooke, Longueuil, Canada
| | | | | | - Marie-Pierre Gagnon
- Faculty of Nursing Sciences, Université Laval, Québec, Canada; Centre de recherche VITAM en santé durable, CIUSSS de la Capitale-Nationale, Québec, Canada
| | - Tibor Schuster
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Claude Sicotte
- Department of Management, Evaluation and Health Policy, School of public health, Université de Montréal, Montreal, Canada
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Gangal A, Stoff B, Blalock TW. Ethical considerations for direct scheduling of patient appointments. JAAD Int 2023; 10:39-40. [DOI: 10.1016/j.jdin.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Demographic characteristics, outcomes and experience of patients using virtual urgent care services from 14 emergency department led sites in Ontario. CAN J EMERG MED 2023; 25:65-73. [PMID: 36380242 PMCID: PMC9666976 DOI: 10.1007/s43678-022-00407-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 11/02/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION As part of the COVID-19 pandemic response, the Ontario Ministry of Health funded a virtual care pilot program intended to support emergency department (ED) diversion of patients with low acuity complaints and reduce the need for face-to-face contact. The objective was to describe the demographic characteristics, outcomes and experience of patients using the provincial pilot program. METHODS This was a prospective cohort study of patients using virtual care services provided by 14 ED-led pilot sites from December 2020 to September 2021. Patients who completed a virtual visit were invited by email to complete a standardized, 25-item online survey, which included questions related to satisfaction and patient-reported outcome measures. RESULTS There were 22,278 virtual visits. When patients were asked why they contacted virtual urgent care, of the 82.7% patients who had a primary care provider, 31.0% said they could not make a timely appointment with their family physician. Rash, fever, abdominal pain, and COVID-19 vaccine queries represented 30% of the presenting complaints. Of 19,613 patients with a known disposition, 12,910 (65.8%) were discharged home and 3,179 (16.2%) were referred to the ED. Of the 2,177 survey responses, 94% rated their overall experience as 8/10 or greater. More than 80% said they had answers to all the questions they had related to their health concern, believed they were able to manage the issue, had a plan they could follow, and knew what to do if the issue got worse or came back. CONCLUSIONS Many presenting complaints were low acuity, and most patients had a primary care provider, but timely access was not available. Future work should focus on health equity to ensure virtual care is accessible to underserved populations. We question if virtual urgent care can be safely and more economically provided by non-emergency physicians.
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Physician Associates/Assistants in Primary Care: Policy and Value. J Ambul Care Manage 2022; 45:279-288. [PMID: 36006386 DOI: 10.1097/jac.0000000000000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Since the new century, primary care physician supply has worsened. Analysts predict that health service demand in the United States will grow faster than physician supply. One strategy is the utilization of physician assistants/associates (PAs). Most PAs work full-time, and approximately one quarter are employed in family medicine/general medicine. PAs deliver primary care services in a team-oriented fashion in a wide variety of settings, including private health systems and community health centers. One fifth work in rural and medically underserved areas. Together PAs and nurse practitioners provide approximately one third of the medical services in family medicine, urgent care, and emergency medicine.
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Bodenheimer T. Revitalizing Primary Care, Part 2: Hopes for the Future. Ann Fam Med 2022; 20:469-478. [PMID: 36228059 PMCID: PMC9512544 DOI: 10.1370/afm.2859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 05/16/2022] [Accepted: 05/27/2022] [Indexed: 11/09/2022] Open
Abstract
Part 1 of this essay argued that the root causes of primary care's problems lie in (1) the low percent of national health expenditures dedicated to primary care and (2) overly large patient panels that clinicians without a team are unable to manage, leading to widespread burnout and poor patient access. Part 2 explores policies and practice changes that could solve or mitigate these primary care problems.Initiatives attempting to improve primary care are discussed. Diffuse multi-component initiatives-patient-centered medical homes (PCMHs), accountable care organizations (ACOs), and Comprehensive Primary Care Plus (CPC+)-have had limited success in addressing primary care's core problems. More focused initiatives-care management, open access, and telehealth-offer more promise.To truly revitalize primary care, 2 fundamental changes are needed: (1) a substantially greater percent of health expenditures dedicated to primary care, and (2) the building of powerful teams that add capacity to care for large panels while reducing burnout.Part 2 of the essay reviews 3 approaches to increasing primary care spending: state-level legislation, eliminating Medicare's disparity between primary care and procedural specialty reimbursement, and efforts by health systems. The final section of Part 2 addresses the building of powerful core and interprofessional teams.
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Affiliation(s)
- Thomas Bodenheimer
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
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10
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Woodcock E, Sen A, Weiner J. Automated patient self-scheduling: case study. J Am Med Inform Assoc 2022; 29:1637-1641. [PMID: 35652165 DOI: 10.1093/jamia/ocac087] [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: 02/27/2022] [Revised: 05/15/2022] [Accepted: 05/19/2022] [Indexed: 11/14/2022] Open
Abstract
This case study assesses the uptake, user characteristics, and outcomes of automated self-scheduling in a community-based physician group affiliated with an academic health system. We analyzed 1 995 909 appointments booked between January 1, 2019, and June 30, 2021 at more than 30 practice sites. Over the study period, uptake of self-scheduling increased from 4% to 15% of kept appointments. Younger, commercially insured patients were more likely to be users. Missed appointments were lower and cancelations were higher for self-scheduled patients. An examination of characteristics, benefits, and usage of automated self-scheduling provides insight to those organizations contemplating the implementation or expansion of similar consumer-facing digital self-scheduling platforms.
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Affiliation(s)
- Elizabeth Woodcock
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Aditi Sen
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jonathan Weiner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Yang Z, Ganguli I, Davis C, Dai M, Shuemaker J, Peterson L, Bazemore A, Phillips R, Chung YK. Physician versus Practice-Level Primary Care Continuity and Association with Outcomes in Medicare Beneficiaries. Health Serv Res 2022; 57:914-929. [PMID: 35522231 PMCID: PMC9264477 DOI: 10.1111/1475-6773.13999] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To compare physician versus practice-level primary care continuity and their association with expenditure and acute care utilization among Medicare beneficiaries and evaluate if continuity of outpatient primary care at either/both physician or/and practice level could be useful quality measures. DATA SOURCE Medicare Fee-For-Service claims data for community dwelling beneficiaries without End-Stage Renal Disease who were attributed to a national random sample of primary care practices billing Medicare (2011-2017). STUDY DESIGN Retrospective secondary data analysis at per Medicare beneficiary per year level. We used multivariable linear regression with practice-level fixed effects to estimate continuity of care score at physician vs. practice level and their associations with outcomes. DATA COLLECTION/EXTRACTION METHOD We calculated clinician and practice level Bice-Boxerman continuity of care index scores, ranging from 0 to 1, using primary care outpatient claims. Medicare expenditures, hospital admissions, emergency department visits, and readmissions were obtained from the Medicare Beneficiary Summary File: Cost and Utilization Segment. Ambulatory care sensitive conditions (ACSC) were defined using diagnosis codes on inpatient claims. PRINCIPAL FINDINGS We studied 2,359,400 beneficiaries who sought care from 13,926 physicians. Every 0.1 increase in physician continuity score was associated with a $151 reduction in expenditures per beneficiary per year (P<0.01), and every 0.1 increase in practice continuity score was associated with $282 decrease (P<0.01) per beneficiary per year. Both physician- and practice-level continuity were associated with lower Medicare expenditures among small, medium, and large practices. Both physician- and practice-level continuity were associated with lower probabilities of hospitalization, emergency department visit, admissions for ACSC, and readmission. CONCLUSIONS Primary care continuity of care could serve as a potent value-based care quality metric. Physician-level continuity is a unique value center that cannot be supplanted by practice level continuity.
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Affiliation(s)
- Zhou Yang
- Omada Health, 500 Sansome St #200, San Francisco, CA
| | - Ishani Ganguli
- Brigham and Women's Hospital, Medicine, 1620 Tremont Street BC3-2M, Boston, MA
| | - Caitlin Davis
- Inova Fairfax Family Medicine, Residency Program, Fairfax, VA
| | - Mingliang Dai
- American Board of Family Medicine, 1648 McGrathiana Parkway Lexington, KY
| | - Jill Shuemaker
- The Center for Professionalism and Value in Health Care, 1016 16th Street NW Suite 700, Washington, DC
| | - Lars Peterson
- American Board of Family Medicine, 1648 McGrathiana Parkway Lexington, KY
| | - Andrew Bazemore
- The Center for Professionalism and Value in Health Care, 1016 16th Street NW Suite 700, Washington, DC
| | - Robert Phillips
- The Center for Professionalism and Value in Health Care, 1016 16th Street NW Suite 700, Washington, DC
| | - Yoon Kyung Chung
- The Robert Graham Center, 1133 Connecticut Avenue, NW Suite 1100, Washington, DC
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12
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Woodcock EW. Barriers to and Facilitators of Automated Patient Self-scheduling for Health Care Organizations: Scoping Review. J Med Internet Res 2022; 24:e28323. [PMID: 35014968 PMCID: PMC8790681 DOI: 10.2196/28323] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/25/2021] [Accepted: 11/26/2021] [Indexed: 01/26/2023] Open
Abstract
Background Appointment management in the outpatient setting is important for health care organizations, as waits and delays lead to poor outcomes. Automated patient self-scheduling of outpatient appointments has demonstrable advantages in the form of patients’ arrival rates, labor savings, patient satisfaction, and more. Despite evidence of the potential benefits of self-scheduling, the organizational uptake of self-scheduling in health care has been limited. Objective The objective of this scoping review is to identify and to catalog existing evidence of the barriers to and facilitators of self-scheduling for health care organizations. Methods A scoping review was conducted by searching 4 databases (PubMed, CINAHL, Business Source Ultimate, and Scopus) and systematically reviewing peer-reviewed studies. The Consolidated Framework for Implementation Research was used to catalog the studies. Results In total, 30 full-text articles were included in this review. The results demonstrated that self-scheduling initiatives have increased over time, indicating the broadening appeal of self-scheduling. The body of literature regarding intervention characteristics is appreciable. Outer setting factors, including national policy, competition, and the response to patients’ needs and technology access, have played an increasing role in influencing implementation over time. Self-scheduling, compared with using the telephone to schedule an appointment, was most often cited as a relative advantage. Scholarly pursuit lacked recommendations related to the framework’s inner setting, characteristics of individuals, and processes as determinants of implementation. Future discoveries regarding these Consolidated Framework for Implementation Research domains may help detect, categorize, and appreciate organizational-level barriers to and facilitators of self-scheduling to advance knowledge regarding this solution. Conclusions This scoping review cataloged evidence of the existence, advantages, and intervention characteristics of patient self-scheduling. Automated self-scheduling may offer a solution to health care organizations striving to positively affect access. Gaps in knowledge regarding the uptake of self-scheduling by health care organizations were identified to inform future research.
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Affiliation(s)
- Elizabeth W Woodcock
- Department of Health Policy & Management, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Lo B, Charow R, Laberge S, Bakas V, Williams L, Wiljer D. Why are Patient Portals Important in the Age of COVID-19? Reflecting on Patient and Team Experiences From a Toronto Hospital Network. J Patient Exp 2022; 9:23743735221112216. [PMID: 35899103 PMCID: PMC9310255 DOI: 10.1177/23743735221112216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The COVID-19 pandemic has changed how care is being delivered in Canada. With
conventional in-person care being transitioned to virtual care, the approach that patients
are able to engage and access their care has dramatically changed. At the University
Health Network (UHN), which is Canada's largest academic and teaching hospital network, we
expanded the myUHN Patient Portal in 2017 after its early adopter phase to enable patients
and family members to view parts of their clinical notes and test results. As the pandemic
progressed, we observed high adoption of myUHN to support virtual care and rapid delivery
of COVID-19 test results in real time. In this article, we share and reflect on our
experience of adapting myUHN to support the demands of the pandemic, including portal
adoption outcomes across multiple waves of the pandemic, the impetus for increased patient
experience staff dedicated for myUHN support, and patients’ perceptions of the value of
the portal and virtual care. Based on these reflections, we outline our perspectives on
the future role of patient portals to support patient care and experience in a
post-pandemic environment.
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Affiliation(s)
- Brian Lo
- UHN Digital, University Health Network, Toronto, ON, Canada
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Rebecca Charow
- UHN Digital, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sarah Laberge
- myUHN Patient Portal, Patient Experience, University Health Network, Toronto, ON, Canada
| | - Vasiliki Bakas
- myUHN Patient Portal, Patient Experience, University Health Network, Toronto, ON, Canada
| | - Laura Williams
- myUHN Patient Portal, Patient Experience, University Health Network, Toronto, ON, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - David Wiljer
- UHN Digital, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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14
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Woodcock E. Barriers and Facilitators to Automated Self-Scheduling: Consensus from a Delphi Panel of Key Stakeholders. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2022; 19:1m. [PMID: 35440921 PMCID: PMC9013230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Automated self-scheduling may benefit healthcare organizations, yet uptake has been slow. The aim of this study was to develop a consensus statement regarding the organizational-level determinants of implementation success based on the collective knowledge of experts. A three-stage modified Delphi method was used to reach consensus on the top determinants of implementation of self-scheduling solutions by healthcare organizations. A panel of 53 experts representing 41 academic health systems identified barriers and facilitators involving the organization's inner and outing settings, as well as the characteristics of the intervention and the individuals engaged in the solution. Offering convenience for patients is the leading enabler for organizations to implement the technology. The consensus may aid healthcare organizations and suppliers engaged in adopting and developing self-scheduling technology to improve implementation success. Further research is recommended to diagnose and examine each barrier and facilitator and how these factors interact. OBJECTIVE The aim of this study was to develop a consensus statement regarding the determinants of implementation success based on the collective knowledge of experts working in the field. METHODS A Delphi panel was constructed based on selected participants employed by academic health systems and experienced with self-scheduling implementation. Panelists were recruited based on participation in an educational event that featured the topic. Purposive and snowball sampling were used. Panelists participated in surveys collected over three rounds. An 80 percent agreement among panelists and interquartile range (IQR) <1 determined the barriers and facilitators. The top-10 determinants were presented in rank order. RESULTS Between January 6, 2021, and May 26, 2021, 53 panelists representing 41 academic health systems participated in three rounds of surveys to reach consensus on the barriers and facilitators to implementation of self-scheduling by healthcare organizations in the United States. In round one, panelists documented 530 determinants. In round two, the determinants were grouped into 72 barriers and 85 facilitators, each of which participants rated on a five-point Likert scale. Fifteen determinants met the 80 percent threshold and 1.0 IQR. The final round concluded with a top-10, rank-ordered listing of determinants (seven facilitators and three barriers) that also incorporated a median rating score using five-point Likert scale. CONCLUSION A three-stage modified Delphi method was used to reach consensus on the top determinants of implementation of self-scheduling solutions by academic health systems. The consensus may aid healthcare organizations and suppliers engaged in adopting and developing self-scheduling technology to improve implementation success. Further research is recommended to diagnose and examine each barrier and facilitator and how these factors interact.
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15
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Zhang X, Saltman R. Impact of Electronic Health Records Interoperability on Telehealth Service Outcomes. JMIR Med Inform 2021; 10:e31837. [PMID: 34890347 PMCID: PMC8790688 DOI: 10.2196/31837] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/20/2021] [Accepted: 11/14/2021] [Indexed: 12/21/2022] Open
Abstract
This paper aims to develop a telehealth success model and discusses three critical components: (1) health information quality, (2) electronic health record system quality, and (3) telehealth service quality to ensure effective telehealth service delivery, reduce professional burnout, and enhance access to care. The paper applied a policy analysis method and discussed telehealth applications in rural health, mental health, and veterans health services. The results pointed out the fact that, although telehealth paired with semantic/organizational interoperability facilitates value-based and team-based care, challenges remain to enhance user (both patients and clinicians) experience and satisfaction. The conclusion indicates that approaches at systemic and physician levels are needed to reduce disparities in health technology adoption and improve access to telehealth care.
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16
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Ganguli I, McGlave C, Rosenthal MB. National Trends and Outcomes Associated With Presence and Type of Usual Clinician Among Older Adults With Multimorbidity. JAMA Netw Open 2021; 4:e2134798. [PMID: 34846529 PMCID: PMC8634053 DOI: 10.1001/jamanetworkopen.2021.34798] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
IMPORTANCE Declining primary care visit rates and increasing specialist visit rates among older adults with multimorbidity raise questions about the presence, specialty, and outcomes associated with usual clinicians of care for these adults. OBJECTIVE To examine trends in the presence and specialty of usual clinicians and the association with preventive care receipt and spending. DESIGN, SETTING, AND PARTICIPANTS This survey study used repeated cross-sectional analyses of Medicare Current Beneficiary Survey data from 2010, 2013, and 2016. Participants were community-dwelling Medicare Advantage and traditional Medicare members with at least 2 chronic conditions. Data were analyzed from March 1, 2020, to February 5, 2021. MAIN OUTCOMES AND MEASURES Trends and factors associated with self-reported usual clinician presence and specialty. Multivariable regression was used to examine associations between usual clinician presence and specialty with preventive care receipt and spending, controlling for respondent sociodemographic and clinical characteristics. RESULTS A total of 25 490 unweighted respondent-years were examined, representing 90 324 639 respondent-years across the United States. Overall, 58.4% of respondent-years belonged to women, and the mean (SD) age of respondents was 77.5 (7.5) years. From 2010 to 2016, those reporting usual clinicians dropped from 94.2% to 91.0% (P < .001). Across study years, respondents were more likely to report a usual clinician if they were women (adjusted marginal difference [AMD], 2.5 percentage points; 95% CI, 1.5-3.5 percentage points) or had higher income (≥$50 000 vs <$15 000: AMD, 2.2 percentage points; 95% CI, 1.1-3.4 percentage points) and less likely if they were Black beneficiaries (vs White: AMD, -2.8 percentage points; 95% CI, -4.3 to -1.3 percentage points) or had traditional Medicare (vs Medicare Advantage: AMD, -3.2 percentage points; 95% CI. -4.1 to -2.3 percentage points). Among 23 279 respondents with usual clinicians, those reporting specialists as their usual clinicians decreased from 5.3% to 4.1% (P < .001). Across the study period, respondents were more likely to report specialists as their usual clinicians if they had traditional Medicare (vs Medicare Advantage: AMD, 2.3 percentage points; 95% CI, 1.6 to 2.9 percentage points), were Black or non-White Hispanic (Black vs White: AMD, 1.5 percentage points; 95% CI, 0.2 to 2.8 percentage points; non-White Hispanic vs White: AMD, 3.8 percentage points; 95% CI, 1.9 to 5.7 percentage points), or lived in the Northeast (vs Midwest: AMD, 3.6 percentage points; 95% CI, 2.1 to 5.2 percentage points). Compared with those without usual clinicians, respondents with usual clinicians were more likely to receive all examined preventive services, such as cholesterol screening (AMD, 6.7 percentage points; 95% CI, 5.4 to 8.1 percentage points) and influenza vaccines (AMD, 11.6 percentage points; 95% CI, 9.2 to 14.0 percentage points). Among respondents with usual clinicians, those reporting specialist usual clinicians (vs primary care) were less likely to receive influenza vaccines (AMD, -5.6 percentage points; 95% CI, -9.2 to -2.1). CONCLUSIONS AND RELEVANCE In this study, older adults with multimorbidity were less likely to have a usual clinician over the study period, with potential implications for preventive care receipt. Our results suggest a key role for usual clinicians, especially primary care clinicians, in vaccination uptake for this population.
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Affiliation(s)
- Ishani Ganguli
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Claire McGlave
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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17
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Liang SY, Stults CD, Jones VG, Huang Q, Sutton J, Tennyson G, Chan AS. The Effects of Behavioral Economics-based Nudge on Online Scheduling and Appointment Completion: Observational Study (Preprint). JMIR Hum Factors 2021; 9:e34090. [PMID: 35353051 PMCID: PMC9008532 DOI: 10.2196/34090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/17/2021] [Accepted: 01/10/2022] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Su-Ying Liang
- Sutter Health Center for Health Systems Research, Palo Alto, CA, United States
| | - Cheryl D Stults
- Sutter Health Center for Health Systems Research, Palo Alto, CA, United States
| | - Veena G Jones
- Clinical Leadership Team, Sutter Health, Sacramento, CA, United States
| | - Qiwen Huang
- Sutter Health Center for Health Systems Research, Palo Alto, CA, United States
| | - Jeremy Sutton
- Clinical Leadership Team, Sutter Health, Sacramento, CA, United States
| | - Guy Tennyson
- Clinical Leadership Team, Sutter Health, Sacramento, CA, United States
| | - Albert S Chan
- Clinical Leadership Team, Sutter Health, Sacramento, CA, United States
- Center for Biomedical Informatics Research, Stanford University, Stanford, CA, United States
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18
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Association between Patient Portal use and Office Visits. J Med Syst 2021; 45:74. [PMID: 34097149 DOI: 10.1007/s10916-021-01749-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/30/2021] [Indexed: 10/21/2022]
Abstract
Extant research on the relationship between portal use and office visits is mixed. Some researchers have stated that there is no correlation between the two events, others have found a positive correlation, and still others have found a negative correlation between portal use and office visits. Through the use of system-generated data from two different portal systems, we demonstrate the correlation between portal visits and office visits. We also demonstrate how this correlation differs between two institutions and across three demographic attributes. We performed a retrospective bivariate correlation analysis between portal visits and office visits. The correlation analysis was followed by an application of Fisher's z transformation of the correlation coefficients to determine significant differences in correlation across ethnicity, gender, and age. We found a positive and statistically significant correlation between portal visits and office visits among both hospital patients (n = 2,594, r = .239, p < .000) and university health service patients (n = 1,233, r = .596, p < .000). This correlation varies significantly across the dimensions of ethnicity, gender, and age. Our findings support the importance of portal use in the care continuum. Future research should aim to better understand the nuance of personal characteristics on the relationship between portal visits and office visits. Knowing these nuances can assist practitioners with further promoting patient self-engagement through portal use.
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19
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Gilson SF, Umscheid CA, Laiteerapong N, Ossey G, Nunes KJ, Shah SD. Growth of Ambulatory Virtual Visits and Differential Use by Patient Sociodemographics at One Urban Academic Medical Center During the COVID-19 Pandemic: Retrospective Analysis. JMIR Med Inform 2020; 8:e24544. [PMID: 33191247 PMCID: PMC7721629 DOI: 10.2196/24544] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/11/2020] [Accepted: 11/15/2020] [Indexed: 01/17/2023] Open
Abstract
Background Despite widespread interest in the use of virtual (ie, telephone and video) visits for ambulatory patient care during the COVID-19 pandemic, studies examining their adoption during the pandemic by race, sex, age, or insurance are lacking. Moreover, there have been limited evaluations to date of the impact of these sociodemographic factors on the use of telephone versus video visits. Such assessments are crucial to identify, understand, and address differences in care delivery across patient populations, particularly those that could affect access to or quality of care. Objective The aim of this study was to examine changes in ambulatory visit volume and type (ie, in-person vs virtual and telephone vs video visits) by patient sociodemographics during the COVID-19 pandemic at one urban academic medical center. Methods We compared volumes and patient sociodemographics (age, sex, race, insurance) for visits during the first 11 weeks following the COVID-19 national emergency declaration (March 15 to May 31, 2020) to visits in the corresponding weeks in 2019. Additionally, for visits during the COVID-19 study period, we examined differences in visit type (ie, in-person versus virtual, and telephone versus video visits) by sociodemographics using multivariate logistic regression. Results Total visit volumes in the COVID-19 study period comprised 51.4% of the corresponding weeks in 2019 (n=80,081 vs n=155,884 visits). Although patient sociodemographics between the COVID-19 study period in 2020 and the corresponding weeks in 2019 were similar, 60.5% (n=48,475) of the visits were virtual, compared to 0% in 2019. Of the virtual visits, 61.2% (n=29,661) were video based, and 38.8% (n=18,814) were telephone based. In the COVID-19 study period, virtual (vs in-person) visits were more likely among patients with race categorized as other (vs White) and patients with Medicare (vs commercial) insurance and less likely for men, patients aged 0-17 years, 65-74 years, or ≥75 years (compared to patients aged 18-45 years), and patients with Medicaid insurance or insurance categorized as other. Among virtual visits, compared to telephone visits, video visits were more likely to be adopted by patients aged 0-17 years (vs 18-45 years), but less likely for all other age groups, men, Black (vs White) patients, and patients with Medicare or Medicaid (vs commercial) insurance. Conclusions Virtual visits comprised the majority of ambulatory visits during the COVID-19 study period, of which a majority were by video. Sociodemographic differences existed in the use of virtual versus in-person and video versus telephone visits. To ensure equitable care delivery, we present five policy recommendations to inform the further development of virtual visit programs and their reimbursement.
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Affiliation(s)
- Sarah F Gilson
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, IL, United States
| | - Craig A Umscheid
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, IL, United States
| | - Neda Laiteerapong
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, IL, United States
| | - Graeme Ossey
- Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, IL, United States.,Digital Health, University of Chicago Medicine, Chicago, IL, United States
| | - Kenneth J Nunes
- Department of Obstetrics & Gynecology, University of Chicago, Chicago, IL, United States
| | - Sachin D Shah
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, IL, United States.,Department of Pediatrics, University of Chicago, Chicago, IL, United States
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20
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Su W, Zhu C, Zhang X, Xie J, Gong Q. <p>Who Misses Appointments Made Online? Retrospective Analysis of the Outpatient Department of a General Hospital in Jinan, Shandong Province, China</p>. Healthc Policy 2020; 13:2773-2781. [PMID: 33273875 PMCID: PMC7708679 DOI: 10.2147/rmhp.s280656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/06/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Missed appointments in outpatient registration pose challenges for hospital administrators, especially in the context of China’s shortage of medical resources. Previous studies have identified factors that affect healthcare access via traditional appointment systems. Few studies, however, have specifically investigated Internet appointment systems. Therefore, this study explored the key factors related to missed appointments made on the Internet appointment system of a general hospital in Jinan, Shandong Province. Methods Online appointment data were collected from the outpatient department of a general hospital in Jinan from September 2017 to February 2018. Logistic regression was used to analyze the relative importance of eight variables: gender, age, interval between scheduling and appointment, day of the week, physician’s academic rank, appointment fee, previous missed appointments, and clinical department. Results A total of 48,777 online appointment records were collected, which included a 15% no-show rate. The key factors associated with no-shows included age, interval between scheduling and appointment, previous missed appointments, and clinical department. No significant relationships were found between no-shows and gender, day of the week, and appointment fee. Conclusion No-show rates were influenced by many factors. Based on this study’s findings, targeted measures can be taken to decrease no-show frequency and improve medical efficiency.
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Affiliation(s)
- Wei Su
- School of Management Science and Engineering, Shandong University of Finance and Economics, Jinan, Shandong, People’s Republic of China
- Correspondence: Wei Su; Xin Zhang Email ;
| | - Cuiling Zhu
- School of Management Science and Engineering, Shandong University of Finance and Economics, Jinan, Shandong, People’s Republic of China
| | - Xin Zhang
- School of Management Science and Engineering, Shandong University of Finance and Economics, Jinan, Shandong, People’s Republic of China
| | - Jun Xie
- Shunneng Network Technology Limited Company, Jinan, Shandong, People’s Republic of China
| | - Qingxian Gong
- Shunneng Network Technology Limited Company, Jinan, Shandong, People’s Republic of China
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