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Hernandez J, Batio S, Lovett RM, Wolf MS, Bailey SC. Missed Healthcare Visits During the COVID-19 Pandemic: A Longitudinal Study. J Prim Care Community Health 2024; 15:21501319241233869. [PMID: 38400555 PMCID: PMC10893833 DOI: 10.1177/21501319241233869] [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: 12/12/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Missed visits have been estimated to cost the U.S. healthcare system $50 billion annually and have been linked to healthcare inefficiency, higher rates of emergency department visits, and worse outcomes. COVID-19 disrupted existing outpatient healthcare utilization patterns. In our study, we sought to examine the frequency of missed outpatient visits over the course of the COVID-19 pandemic and to examine patient-level characteristics associated with non-attendance. METHODS This study utilized data from a longitudinal cohort study (the Chicago COVID-19 Comorbidities (C3) study). C3 participants were enrollees in 1 of 4 active, "parent" studies; they were rapidly enrolled in C3 at the onset of the pandemic. Multiple waves of telephone-based interviews were conducted to collect experiences with the pandemic, as well as socio-demographic and health characteristics, health literacy, patient activation, and depressive and anxiety symptoms. For the current analysis, data from waves 3 to 8 (05/01/20-05/19/22) were analyzed. Participants included 845 English or Spanish-speaking adults with 1 or more chronic conditions. RESULTS The percentage of participants reporting missed visits due to COVID-19 across study waves ranged from 3.1 to 22.4%. Overall, there was a decline in missed visits over time. No participant sociodemographic or health characteristic was consistently associated with missed visits across the study waves. In bivariate and multivariate analysis, only patient-reported anxiety was significantly associated with missed visits across all study waves. CONCLUSION Findings reveal that anxiety was consistently associated with missed visits during the COVID-19 pandemic, but not sociodemographic or health characteristics. Results can inform future public health initiatives to reduce absenteeism by considering patients' emotional state during times of uncertainty.
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Parker CP, McMahan K, Rhodes B, Lokken K, Jain G. A Novel Nephropsychology Clinic: Partnering With Patients in the Era of Value-Based Care in Nephrology. ADVANCES IN KIDNEY DISEASE AND HEALTH 2024; 31:46-51. [PMID: 38403393 DOI: 10.1053/j.akdh.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 02/27/2024]
Abstract
CKD and end-stage kidney disease are highly prevalent and complex chronic conditions with a high disease burden that corresponds to a high cost of care. Mental health conditions have a high prevalence in this population and add to the burden of disease, increase the cost of care, and are co-related with worse clinical outcomes. Despite these clear co-relations, mental health disorders remain underdiagnosed and undertreated in this population, secondary to multiple reasons, including patient-specific factors as well as systematic issues, including difficulty in accessing mental health experts. Here we describe a novel collaborative care model for patients with advanced CKD within the nephrology clinic space, in the form of a nephropsychology clinic. We present the details of our clinic, our preliminary findings, and propose that an integrated behavioral health model offers convenience for the patient and improves workflow for the physician, allowing a pathway to timely mental health interventions.
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Affiliation(s)
- Christina Pierpaoli Parker
- Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Kristina McMahan
- Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Brody Rhodes
- Division of Nephrology, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Kristine Lokken
- Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Gaurav Jain
- Division of Nephrology, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL.
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Delavar A, Bu JJ, Radha Saseendrakumar B, Weinreb RN, Baxter SL. Gender Disparities in Depression, Stress, and Social Support Among Glaucoma Patients. Transl Vis Sci Technol 2023; 12:23. [PMID: 38149963 PMCID: PMC10755593 DOI: 10.1167/tvst.12.12.23] [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: 02/21/2023] [Accepted: 12/14/2023] [Indexed: 12/28/2023] Open
Abstract
Purpose To understand differences in measures of depression, stress, and social support by gender among those diagnosed with glaucoma. Methods We obtained a cohort of glaucoma patients (any type) ages 18 years and over who answered the COVID-19 Participant Experience (COPE) survey of the NIH All of Us Research Program. We analyzed several measures of depression, stress, and social support by gender. Logistic regression was used to evaluate the association among reported stress associated with social distancing, depression (using Patient Health Questionnaire-9 [PHQ-9] scores), and measures of social support by self-reported gender, with men as the reference group. Multivariable models were adjusted for age, race and ethnicity, health insurance status, education, and income. Results Of 3633 glaucoma patients, 56.8% were women. Many patients had a PHQ-9 score > 4 (33.3%), indicating mild, moderate, or severe depression. In multivariable models, women were significantly more likely to report a PHQ-9 score > 4 (odds ratio [OR] = 1.40; 95% confidence interval [CI], 1.20-1.62; P < 0.001) and some or a lot of stress (OR = 1.34; 95% CI, 1.14-1.57; P < 0.001) compared with men. Further, women were significantly less likely to report having help all or most of the time if they needed someone to prepare meals (OR = 0.78; 95% CI, 0.67-0.92; P = 0.002) or perform daily chores (OR = 0.79; 95% CI, 0.67-0.91; P = 0.003) than men. Conclusions Women with glaucoma were more likely to experience depression and stress and were less likely to have social support on some measures than men. Translational Relevance The disproportionate burden of psychosocial factors among women may complicate glaucoma management.
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Affiliation(s)
- Arash Delavar
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, CA, USA
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer J. Bu
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
| | - Bharanidharan Radha Saseendrakumar
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Robert N. Weinreb
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
| | - Sally L. Baxter
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, CA, USA
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
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Adkins D, Rojas-Ramirez MV, Shanker A, Burruss CP, Mirsky B, Westgate P, Shinn JB, Bush ML. Factors Associated with No-Show Rates in a Pediatric Audiology Clinic. Otol Neurotol 2023; 44:e648-e652. [PMID: 37590879 PMCID: PMC10529984 DOI: 10.1097/mao.0000000000003997] [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] [Indexed: 08/19/2023]
Abstract
OBJECTIVE To evaluate factors associated with no-show rates in a pediatric audiology clinic. STUDY DESIGN Retrospective review. SETTING Tertiary referral center. PARTICIPANTS All pediatric patients younger than 18 years whose parents/guardians scheduled an appointment at a tertiary Audiology Clinic between June 1, 2015, and July 1, 2017. MAIN OUTCOME MEASURES Data included whether the patient came to their appointment, patient age, sex, race, insurance type, appointment type, location, season of appointment, and day of the week of the appointment. RESULTS Of the 7,784 pediatric appointments scheduled with audiology, the overall no-show rate was 24.3% (n = 1893). Lower age was significantly associated with no-shows ( p = 0.0003). Black/African American children were more likely to no-show compared with White/Caucasians ( p = 0.0001). Compared with self-pay/military/other insurance, those with Medicaid were more likely to no-show ( p = 0.0001). The highest rate of no-shows occurred during summer (27%). On multivariate analysis, younger age, Black/African American race, and Medicaid insurance were associated with increased no-show rates. CONCLUSION A variety of factors influence no-show rates in a pediatric audiology setting. No-shows can affect treatment quality and affect overall hearing outcomes. Further investigation is necessary to assess barriers to appointment adherence and to develop interventions to improve adherence and care.
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Affiliation(s)
- David Adkins
- University of Kentucky, Department of Otolaryngology – Head & Neck Surgery, Lexington, KY, USA
| | | | - Anita Shanker
- University of Kentucky, College of Medicine, Lexington KY, USA
| | | | - Becky Mirsky
- University of Kentucky, College of Medicine, Lexington KY, USA
| | - Philip Westgate
- University of Kentucky, University of Kentucky, College of Public Health, Department of Biostatistics, Lexington, KY, USA
| | - Jennifer B Shinn
- University of Kentucky, Department of Otolaryngology – Head & Neck Surgery, Lexington, KY, USA
| | - Matthew L. Bush
- University of Kentucky, Department of Otolaryngology – Head & Neck Surgery, Lexington, KY, USA
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Coppa K, Kim EJ, Oppenheim MI, Bock KR, Zanos TP, Hirsch JS. Application of a Machine Learning Algorithm to Develop and Validate a Prediction Model for Ambulatory Non-Arrivals. J Gen Intern Med 2023; 38:2298-2307. [PMID: 36757667 PMCID: PMC9910253 DOI: 10.1007/s11606-023-08065-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/27/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Non-arrivals to scheduled ambulatory visits are common and lead to a discontinuity of care, poor health outcomes, and increased subsequent healthcare utilization. Reducing non-arrivals is important given their association with poorer health outcomes and cost to health systems. OBJECTIVE To develop and validate a prediction model for ambulatory non-arrivals. DESIGN Retrospective cohort study. PATIENTS OR SUBJECTS Patients at an integrated health system who had an outpatient visit scheduled from January 1, 2020, to February 28, 2022. MAIN MEASURES Non-arrivals to scheduled appointments. KEY RESULTS There were over 4.3 million ambulatory appointments from 1.2 million adult patients. Patients with appointment non-arrivals were more likely to be single, racial/ethnic minorities, and not having an established primary care provider compared to those who arrived at their appointments. A prediction model using the XGBoost machine learning algorithm had the highest AUC value (0.768 [0.767-0.770]). Using SHAP values, the most impactful features in the model include rescheduled appointments, lead time (number of days from scheduled to appointment date), appointment provider, number of days since last appointment with the same department, and a patient's prior appointment status within the same department. Scheduling visits close to an appointment date is predicted to be less likely to result in a non-arrival. Overall, the prediction model calibrated well for each department, especially over the operationally relevant probability range of 0 to 40%. Departments with fewer observations and lower non-arrival rates generally had a worse calibration. CONCLUSIONS Using a machine learning algorithm, we developed a prediction model for non-arrivals to scheduled ambulatory appointments usable for all medical specialties. The proposed prediction model can be deployed within an electronic health system or integrated into other dashboards to reduce non-arrivals. Future work will focus on the implementation and application of the model to reduce non-arrivals.
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Affiliation(s)
- Kevin Coppa
- Clinical Digital Solutions, Northwell Health, New Hyde Park, NY, USA
| | - Eun Ji Kim
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Michael I Oppenheim
- Clinical Digital Solutions, Northwell Health, New Hyde Park, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Kevin R Bock
- Clinical Digital Solutions, Northwell Health, New Hyde Park, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Theodoros P Zanos
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Jamie S Hirsch
- Clinical Digital Solutions, Northwell Health, New Hyde Park, NY, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
- Division of Kidney Diseases and Hypertension, and Barbara Zucker School of Medicine at Hofstra/Northwell, 100 Community Drive, 2nd Floor, Great Neck, Donald, NY, 11021, USA.
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Matzkeit N, Kisch T, Waldmann A, Schweiger U, Mailänder P, Westermair AL. Deep wrist injuries from suicide attempts vs. accidents do not differ regarding sensorimotor outcome, but regarding patient-reported outcome measures. J Plast Surg Hand Surg 2023; 57:95-102. [PMID: 34730072 DOI: 10.1080/2000656x.2021.1993868] [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] [Indexed: 10/19/2022]
Abstract
Despite the clinical importance of deep wrist injuries (DWIs), data comparing the outcome of suicide attempt survivors vs. accident survivors are lacking. Patients admitted to our Clinic for acute treatment of a DWI from 2008 to 2016 were contacted for a follow-up assessment of sensory, motor and functional outcomes. Patients also completed the Disability of the Arm, Shoulder and Hand Questionnaire, the Modified Mayo Wrist Score, the Boston Carpal Tunnel Questionnaire, and the WHOQOL-BREF questionnaires. 51 patients could be followed up, on average 4.3 ± 2.9 years after their injury. Suicide attempt survivors did not differ from accidents survivors concerning two-point discrimination, grip and pinch strength, but showed poorer outcomes in self-reported disability, symptom severity, and quality of life. Patients with DWIs from suicide attempts vs. accidents do not differ in sensorimotor outcomes but patient-reported outcome measures. Level of Evidence: II.
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Affiliation(s)
- Nico Matzkeit
- Clinic of Plastic Surgery, University of Lübeck, Lübeck, Germany
| | - Tobias Kisch
- Clinic of Plastic Surgery, University of Lübeck, Lübeck, Germany
| | - Annika Waldmann
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany.,Hamburg Cancer Registry, Ministry for Health and Consumer Protection, Hamburg, Germany
| | - Ulrich Schweiger
- Hamburg Cancer Registry, Ministry for Health and Consumer Protection, Hamburg, Germany
| | - Peter Mailänder
- Clinic of Plastic Surgery, University of Lübeck, Lübeck, Germany
| | - Anna Lisa Westermair
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
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Hart J, Summer A, Yadav KN, Peace S, Hong D, Konu M, Clapp JT. Content and Communication of Inpatient Family Visitation Policies During the COVID-19 Pandemic: Sequential Mixed Methods Study. J Med Internet Res 2021; 23:e28897. [PMID: 34406968 PMCID: PMC8477908 DOI: 10.2196/28897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Inpatient health care facilities restricted inpatient visitation due to the COVID-19 pandemic. There is no existing evidence of how they communicated these policies to the public nor the impact of their communication choices on public perception. OBJECTIVE This study aims to describe patterns of inpatient visitation policies during the initial peak of the COVID-19 pandemic in the United States and the communication of these policies to the general public, as well as to identify communication strategies that maximize positive impressions of the facility despite visitation restrictions. METHODS We conducted a sequential, exploratory, mixed methods study including a qualitative analysis of COVID-19 era visitation policies published on Pennsylvania-based facility websites, as captured between April 30 and May 20, 2020 (ie, during the first peak of the COVID-19 pandemic in the United States). We also conducted a factorial survey-based experiment to test how key elements of hospitals' visitation policy communication are associated with individuals' willingness to seek care in October 2020. For analysis of the policies, we included all inpatient facilities in Pennsylvania. For the factorial experiment, US adults were drawn from internet research panels. The factorial survey-based experiment presented composite policies that varied in their justification for restricted visitation, the degree to which the facility expressed ownership of the policy, and the inclusion of family-centered care support plans. Our primary outcome was participants' willingness to recommend the hypothetical facility using a 5-point Likert scale. RESULTS We identified 104 unique policies on inpatient visitation from 363 facilities' websites. The mean Flesch-Kincaid Grade Level for the policies was 14.2. Most policies prohibited family presence (99/104, 95.2%). Facilities justified the restricted visitation policies on the basis of community protection (59/104, 56.7%), authorities' guidance or regulations (34/104, 32.7%), or scientific rationale (23/104, 22.1%). A minority (38/104, 36.5%) addressed how restrictive visitation may impair family-centered care. Most of the policies analyzed used passive voice to communicate restrictions. A total of 1321 participants completed the web-based survey. Visitation policy elements significantly associated with willingness to recommend the facility included justifications based on community protection (OR 1.44, 95% CI 1.24-1.68) or scientific rationale (OR 1.30, 95% CI 1.12-1.51), rather than those based on a governing authority. The facility expressed a high degree of ownership over the decision (OR 1.16, 95% CI 1.04-1.29), rather than a low degree of ownership; and inclusion of family-centered care support plans (OR 2.80, 95% CI 2.51-3.12), rather than no such support. CONCLUSIONS Health systems can immediately improve public receptiveness of restrictive visitation policies by emphasizing community protection, ownership over the facility's policy, and promoting family-centered care.
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Affiliation(s)
- Joanna Hart
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
- Palliative and Advanced Illness Research Center, Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, United States
| | - Amy Summer
- Palliative and Advanced Illness Research Center, Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Kuldeep N Yadav
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
- Palliative and Advanced Illness Research Center, Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Summer Peace
- Palliative and Advanced Illness Research Center, Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - David Hong
- Palliative and Advanced Illness Research Center, Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Michael Konu
- Palliative and Advanced Illness Research Center, Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Justin T Clapp
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, United States
- Department of Anesthesia and Critical Care, University of Pennsylvania, Philadelphia, PA, United States
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Morse AR, Seiple WH. <p>Decreasing Avoidable Vision Loss: Identifying Antecedents of Adherence</p>. Clin Ophthalmol 2020; 14:3735-3739. [PMID: 33173271 PMCID: PMC7648526 DOI: 10.2147/opth.s278627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/19/2020] [Indexed: 11/24/2022] Open
Abstract
Adherence to medication treatment protocols and active participation by individuals in their medical care are important for all patients, but especially for those with chronic conditions such as vision loss. Adherence is crucial for decreasing avoidable vision loss. Failure to take medications as prescribed and keep scheduled appointments reduces treatment effectiveness, increases complications and results in poorer outcomes. Reasons for nonadherence vary by diagnosis and include not understanding the importance of adherence, low health literacy, lack of adequate self-efficacy, low level of activation and behavioral issues including depression. Patients may lack information about their condition and its prognosis, available treatment alternatives, and other essential information such as how to monitor their eye condition, what to do if vision deteriorates and how to get needed community-based help. Each of these factors impedes patients’ ability to engage with their physician and participate in their own care. The ability of individuals with vision loss to actively and effectively manage their health care, ie, activation, has been understudied. When patients are involved with their own care, their care experience, and most importantly, their outcomes, are improved. Identifying antecedents of adherence may help provide disease- and patient-specific pathways to reduce avoidable vision loss.
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Affiliation(s)
- Alan R Morse
- Lighthouse Guild, New York, NY, USA
- Harkness Eye Institute, Columbia University, New York, NY, USA
- Correspondence: Alan R Morse; William H Seiple Lighthouse Guild, 250 West 64th Street, New York, NY10023, USATel +1 212 769 6215 Email ;
| | - William H Seiple
- Lighthouse Guild, New York, NY, USA
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
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Lagman RL, Samala RV, LeGrand S, Parala-Metz A, Patel C, Neale K, Carrino C, Rybicki L, Gamier P, Mauk ME, Nowak M. "If You Call Them, They Will Come": A Telephone Call Reminder to Decrease the No-Show Rate in an Outpatient Palliative Medicine Clinic. Am J Hosp Palliat Care 2020; 38:448-451. [PMID: 32845702 DOI: 10.1177/1049909120952322] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION A high outpatient clinic no-show rate affects clinical outcomes, increases healthcare costs, and reduces both access to care and provider productivity. In an effort to reduce the no-show rate at a busy palliative medicine outpatient clinic, a quality improvement project was launched consisting of a telephone call made by clinic staff prior to appointments. The study aimed to determine the effect of this intervention on the no-show rate, and assess the financial impact of a decreased no-show rate. METHODS AND MATERIALS The outpatient clinic no-show rate was measured from September 1 to December 31, 2015. Data from the first 8 months of the calendar year was removed since these could not be verified. Starting January 1, 2016, patients received a telephone call reminder 24 hours prior to their scheduled outpatient appointment for confirmation. No-show rate was again measured for the calendar year 2016. Opportunity costs were calculated for unfulfilled clinic visits. RESULTS Of the 1224 completed visits from September 1 to December 31, 2015, 271 were no-shows with an average rate of 11.8%. After the intervention, there were 4368 completed visits and 562 no-shows. The no-show rate for 2016 averaged 6.9% (p < 0.001), down 4.9% from the last 4 months of 2015. Estimated opportunity costs were about 396 no-show visits avoided, equivalent to an annual savings of about $79,200. CONCLUSION A telephone call reminder to patients 24 hours prior to their appointment decreased the no-show rate in an outpatient palliative medicine clinic. Avoiding unfulfilled visits resulted in substantial opportunity costs.
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Affiliation(s)
- Ruth L Lagman
- Department of Palliative and Supportive Care, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Renato V Samala
- Department of Palliative and Supportive Care, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Susan LeGrand
- Department of Palliative and Supportive Care, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Armida Parala-Metz
- Department of Supportive Oncology, 536516Levine Cancer Institute, Charlotte, NC, USA
| | - Chirag Patel
- Department of Palliative and Supportive Care, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Kyle Neale
- Department of Palliative and Supportive Care, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Cheryl Carrino
- Department of Palliative and Supportive Care, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Lisa Rybicki
- Department of Quantitative Health Sciences, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Pamela Gamier
- Department of Palliative and Supportive Care, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Mary Ellen Mauk
- Department of Palliative and Supportive Care, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Molly Nowak
- Department of Palliative and Supportive Care, 2569Cleveland Clinic, Cleveland, OH, USA
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Health Literacy, Health Numeracy, and Cognitive Functioning Among Bariatric Surgery Candidates. Obes Surg 2019; 29:4138-4141. [DOI: 10.1007/s11695-019-04149-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Meng J, Hussain SA, Mohr DC, Czerwinski M, Zhang M. Exploring User Needs for a Mobile Behavioral-Sensing Technology for Depression Management: Qualitative Study. J Med Internet Res 2018; 20:e10139. [PMID: 30021710 PMCID: PMC6068382 DOI: 10.2196/10139] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/01/2018] [Accepted: 06/10/2018] [Indexed: 01/16/2023] Open
Abstract
Background Today, college students are dealing with depression at some of the highest rates in decades. As the primary mental health service provider, university counseling centers are limited in their capacity and efficiency to provide mental health care due to time constraints and reliance on students’ self-reports. A mobile behavioral-sensing platform may serve as a solution to enhance the efficiency and accessibility of university counseling services. Objective The main objectives of this study are to (1) understand the usefulness of a mobile sensing platform (ie, iSee) in improving counseling services and assisting students’ self-management of their depression conditions, and (2) explore what types of behavioral targets (ie, meaningful information extracted from raw sensor data) and feedback to deliver from both clinician and students’ perspectives. Methods We conducted semistructured interviews with 9 clinicians and 12 students with depression recruited from a counseling center at a large Midwestern university. The interviews were 40-50 minutes long and were audio recorded and transcribed. The interview data were analyzed using thematic analysis with an inductive approach. Clinician and student interviews were analyzed separately for comparison. The process of extracting themes involved iterative coding, memo writing, theme revisits, and refinement. Results From the clinician perspective, the mobile sensing platform helps to improve counseling service by providing objective evidence for clinicians and filling gaps in clinician-patient communication. Clinicians suggested providing students with their sensed behavioral targets organized around personalized goals. Clinicians also recommended delivering therapeutic feedback to students based on their sensed behavioral targets, including positive reinforcement, reflection reminders, and challenging negative thoughts. From the student perspective, the mobile sensing platform helps to ease continued self-tracking practices. Students expressed their need for integrated behavioral targets to understand correlations between behaviors and depression. They also pointed out that they would prefer to avoid seeing negative feedback. Conclusions Although clinician and student participants shared views on the advantages of iSee in supporting university counseling, they had divergent opinions on the types of behavioral targets and feedback to be provided via iSee. This exploratory work gained initial insights into the design of a mobile sensing platform for depression management and informed a more conclusive research project for the future.
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Affiliation(s)
- Jingbo Meng
- Department of Communication, Michigan State University, East Lansing, MI, United States
| | - Syed Ali Hussain
- Department of Communication, Michigan State University, East Lansing, MI, United States
| | - David C Mohr
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Mi Zhang
- Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI, United States
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Abstract
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION The association between oral health literacy and missed dental appointments. Baskaradoss JK. JADA 2016;147(11):867-74. SOURCE OF FUNDING Information not available TYPE OF STUDY/DESIGN: Unmatched case-control study that used a convenience nonprobability sampling method.
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