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Jain NR, Zachary I, Boren SA. COVID-19 vaccine equity and health equity conversations on Twitter. AMIA Annu Symp Proc 2024; 2023:997-1006. [PMID: 38222403 PMCID: PMC10785937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
This study used social network analysis and trending hashtags on Twitter to identify trends related to health and vaccine equity during the Omicron wave. The analysis was conducted using consumer-friendly platforms/tools such as the Healthcare Hashtag Project and NodeXL. The study found that during the Omicron wave, there was a higher volume of tweets related to the more specific hashtag #VaccineEquity, as compared to the more general topic of #HealthEquity. The study also identified the top influencers for these hashtags and how they changed over time. The study proposes a combination of existing tools and approaches, including ontological surveillance and social network analysis, to develop proactive strategies that respond to public opinion in a timely manner. Social network analysis tools could also be useful for healthcare organizations and providers in training their staff involved in social media management to develop better social media communication strategies.
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Affiliation(s)
- Nishant R Jain
- MU Institute for Data Science and Informatics, University of Missouri, Columbia, Missouri
- Department of Health Management and Informatics, University of Missouri, Columbia, Missouri
- Missouri Cancer Registry and Research Center, Columbia, Missouri
| | - Iris Zachary
- MU Institute for Data Science and Informatics, University of Missouri, Columbia, Missouri
- Department of Health Management and Informatics, University of Missouri, Columbia, Missouri
- Missouri Cancer Registry and Research Center, Columbia, Missouri
| | - Suzanne A Boren
- MU Institute for Data Science and Informatics, University of Missouri, Columbia, Missouri
- Department of Health Management and Informatics, University of Missouri, Columbia, Missouri
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Narindrarangkura P, Ye Q, Boren SA, Khan U, Simoes EJ, Kim MS. Analysis of Healthy Coping Feedback Messages from Diabetes Mobile Apps: Validation Against an Evidence-Based Framework. J Diabetes Sci Technol 2023; 17:152-162. [PMID: 34530644 PMCID: PMC9846388 DOI: 10.1177/19322968211043534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In this study, we focused on Healthy Coping, a key principle of ADCES7 Self-Care Behaviors® (ADCES7®) that enables people with diabetes to achieve health goals for self-care. We aimed to validate Healthy Coping-related feedback messages from diabetes mobile apps against the framework based on behavioral change theories. METHODS We searched apps using the search terms: "diabetes," "blood sugar," "glucose," and "mood" from iTunes and Google Play stores. We entered a range of values on 3 Healthy Coping domains: (1) diabetes-related measures including blood glucose, blood pressure, HbA1c, weight, (2) physical exercise/activity, and (3) mood to generate feedback messages. We used a framework by adopting validated behavioral change theory-based models to evaluate the feedback messages against 3 dimensions of timing, intention, and content (feedback purpose and feedback response). The feedback purposes in this study were categorized into 7 purposes; warning, suggestion, self-monitoring, acknowledging, reinforcement, goal setting, and behavior contract. RESULTS We identified 1,749 apps from which 156 diabetes mobile apps were eligible and generated 473 feedback messages. The majority of generated feedback messages were related to blood sugar measurement. Only feedback messages on blood sugar under diabetes-related measures and mood domains encompassed all 7 feedback purposes under the content dimension. CONCLUSIONS Many feedback messages neither supported Healthy Coping domains nor followed the behavioral theory-based framework. It is important that feedback messages be structured around the dimensions of the behavioral theory-based framework to promote behavior change. Furthermore, our framework had the generalizability that can be used in other clinical areas.
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Affiliation(s)
- Ploypun Narindrarangkura
- University of Missouri Institute for
Data Science and Informatics, University of Missouri, Columbia, MO, USA
| | - Qing Ye
- University of Missouri Institute for
Data Science and Informatics, University of Missouri, Columbia, MO, USA
| | - Suzanne A. Boren
- University of Missouri Institute for
Data Science and Informatics, University of Missouri, Columbia, MO, USA
- Department of Health Management and
Informatics, University of Missouri, Columbia, MO, USA
| | - Uzma Khan
- Department of Medicine, Cosmopolitan
International Diabetes and Endocrinology Center, University of Missouri, Columbia,
MO, USA
| | - Eduardo J. Simoes
- University of Missouri Institute for
Data Science and Informatics, University of Missouri, Columbia, MO, USA
- Department of Health Management and
Informatics, University of Missouri, Columbia, MO, USA
| | - Min Soon Kim
- University of Missouri Institute for
Data Science and Informatics, University of Missouri, Columbia, MO, USA
- Department of Health Management and
Informatics, University of Missouri, Columbia, MO, USA
- Min Soon Kim, PhD, Department of Health
Management and Informatics, University of Missouri Institute for Data Science
and Informatics, University of Missouri, 5 Hospital Drive, Columbia, MO 65212,
USA.
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Narindrarangkura P, Boren SA, Khan U, Day M, Simoes EJ, Kim MS. SEE-diabetes, a patient-centered diabetes self-management education and support for older adults: Findings and information needs from providers' perspectives. Diabetes Metab Syndr 2022; 16:102582. [PMID: 35963033 DOI: 10.1016/j.dsx.2022.102582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/18/2022] [Accepted: 07/17/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Diabetes self-management education and support (DSMES) can improve clinical and health outcomes of people with diabetes. However, DSMES has been underutilized because of many barriers. We aimed to develop a patient-centered educational aid, SEE-Diabetes (Support-Engage-Empower-Diabetes), that facilitates shared decision-making about DSMES between patient and provider during the follow-up visit. We investigated the information needs to inform the design of the SEE-Diabetes from the providers' perspective. METHODS We conducted an online survey (N = 42) and three focus groups (N = 13) involving providers who have experience managing diabetes in older patients. Survey collected demographics and assessed knowledge of DSMES. During the subsequent focus groups, participants evaluated the Assessment and Plan section of three clinic notes of older people with diabetes. We also demonstrated the potential workflow of DSMES documentation using SEE-Diabetes during clinical practice. RESULTS The survey showed 60% of providers were familiar with DSMES. Focus group findings showed clinic notes should convey concise information at an appropriate reading level, numbered problems, and less medical jargon to improve the readability of clinic notes. Application of SMART (Specific, Measurable, Attainable, Relevant, Time-bound) goals was suggested to deliver effective diabetes self-care information. CONCLUSIONS Providers should consider adopting validated DSMES guidelines along with goal-setting strategies to provide patient-centered care. The research team will integrate the provider recommendations when we develop SEE-Diabetes.
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Affiliation(s)
- Ploypun Narindrarangkura
- University of Missouri Institute for Data Science and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
| | - Suzanne A Boren
- University of Missouri Institute for Data Science and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States; Department of Health Management and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO, 65212, United States.
| | - Uzma Khan
- Cosmopolitan International Diabetes and Endocrinology Center, Department of Medicine, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
| | - Margaret Day
- Department of Family and Community Medicine, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
| | - Eduardo J Simoes
- University of Missouri Institute for Data Science and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States; Department of Health Management and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO, 65212, United States.
| | - Min Soon Kim
- University of Missouri Institute for Data Science and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States; Department of Health Management and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO, 65212, United States.
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Narindrarangkura P, Boren SA, Khan U, Day M, Simoes EJ, Kim MS. SEE-Diabetes, a patient-centered diabetes self-management education and support for older adults: Findings and information needs from patients' perspectives. Prim Care Diabetes 2022; 16:395-403. [PMID: 35227635 PMCID: PMC9133060 DOI: 10.1016/j.pcd.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/26/2022] [Accepted: 02/21/2022] [Indexed: 11/17/2022]
Abstract
AIMS This study identified the information needs of people with diabetes aged 65 and older through surveys and focus groups to inform the development of a patient-centered educational decision aid for diabetes care, SEE-Diabetes (Support-Engage-Empower-Diabetes). METHODS We conducted survey (N = 37) and three focus groups (N = 9). The survey collected demographics, diabetes duration, insulin usage, and clinic notes accessibility through a patient portal. In focus groups, participants evaluated the Assessment and Plan section of three selected deidentified clinic notes to assess readability and helpfulness for diabetes care. RESULTS The mean age of participants was 66 (24-82, SD = 12), and 22 were female (60%). The mean diabetes duration was 20.9 years (1-63, SD=15). Most participants (80%) read their clinical notes via patient portal. In the focus groups, the readability of clinic notes was noted as a primary concern because of medical abbreviations and poor formatting. Participants found the helpfulness of clinic notes was negatively impacted by vague or insufficient self-care information. CONCLUSIONS We found the high use of patient portal for reading clinic notes, which offers a use case opportunity for the proposed SEE-Diabetes educational aid. Feedback about the readability and helpfulness of clinic notes will be considered during the design process.
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Affiliation(s)
- Ploypun Narindrarangkura
- University of Missouri Institute for Data Science and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
| | - Suzanne A Boren
- University of Missouri Institute for Data Science and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States; Department of Health Management and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
| | - Uzma Khan
- Cosmopolitan International Diabetes and Endocrinology Center, University of Missouri, Columbia, 3315 Berrywood Dr, Suite 201, Columbia, MO 65201, United States; Department of Medicine, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
| | - Margaret Day
- Department of Family and Community Medicine, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
| | - Eduardo J Simoes
- University of Missouri Institute for Data Science and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States; Department of Health Management and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
| | - Min Soon Kim
- University of Missouri Institute for Data Science and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States; Department of Health Management and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
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Kim MS, Khan U, Boren SA, Narindrarangkura P, Ye Q, Simoes EJ. Transforming AADE7 for Use in an Evaluation Framework for Health Information Technology in Diabetes Mellitus. J Diabetes Sci Technol 2022; 16:764-770. [PMID: 33435720 PMCID: PMC9294563 DOI: 10.1177/1932296820985842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is no validated framework to evaluate health information technology (HIT) for diabetes self-management education and support (DSMES). AADE7 Self-Care Behaviors is a patient-centered DSMES designed by the American Association of Diabetes Educators (AADE). We developed a codebook based on the AADE7 Self-Care Behaviors principles as an evaluation framework. In this commentary, we demonstrate the real-life applications of this codebook through three diabetes research studies. The first study analyzed features of mobile diabetes applications. The second study evaluated provider documentation patterns in electronic health records (EHRs) to deliver ongoing patient-centered DSMES. The third study analyzed feedback messages from diabetes apps. We found that this codebook, based on AADE7, can be instrumental as a framework for research, as well as real-life use in HIT for DSMES principles.
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Affiliation(s)
- Min Soon Kim
- Department of Health Management and
Informatics, University of Missouri Institute for Data Science and Informatics,
University of Missouri, Columbia, MO, USA
- Min Soon Kim, PhD, Department of Health
Management and Informatics, University of Missouri Institute for Data Science
and Informatics, University of Missouri, 5 Hospital Drive, Columbia, MO 65212,
USA.
| | - Uzma Khan
- Department of Medicine, Cosmopolitan
International Diabetes and Endocrinology Center, University of Missouri, Columbia,
USA
| | - Suzanne A. Boren
- Department of Health Management and
Informatics, University of Missouri Institute for Data Science and Informatics,
University of Missouri, Columbia, MO, USA
| | - Ploypun Narindrarangkura
- Department of Health Management and
Informatics, University of Missouri Institute for Data Science and Informatics,
University of Missouri, Columbia, MO, USA
| | - Qing Ye
- Department of Health Management and
Informatics, University of Missouri Institute for Data Science and Informatics,
University of Missouri, Columbia, MO, USA
| | - Eduardo J. Simoes
- Department of Health Management and
Informatics, University of Missouri Institute for Data Science and Informatics,
University of Missouri, Columbia, MO, USA
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Yoshida Y, Patil SJ, Brownson RC, Boren SA, Kim M, Dobson R, Waki K, Greenwood DA, Torbjørnsen A, Ramachandran A, Masi C, Fonseca VA, Simoes EJ. Using the RE-AIM framework to evaluate internal and external validity of mobile phone-based interventions in diabetes self-management education and support. J Am Med Inform Assoc 2021; 27:946-956. [PMID: 32377676 DOI: 10.1093/jamia/ocaa041] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/13/2020] [Accepted: 04/01/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE We evaluated the extent to which studies that tested short message service (SMS)- and application (app)-based interventions for diabetes self-management education and support (DSMES) report on factors that inform both internal and external validity as measured by the RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance) framework. MATERIALS AND METHODS We systematically searched PubMed, Embase, Web of Science, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and IEEE Xplore Digital Library for articles from January 1, 2009, to February 28, 2019. We carried out a multistage screening process followed by email communications with study authors for missing or discrepant information. Two independent coders coded eligible articles using a 23-item validated data extraction tool based on the RE-AIM framework. RESULTS Twenty studies (21 articles) were included in the analysis. The comprehensiveness of reporting on the RE-AIM criteria across the SMS- and app-based DSMES studies was low. With respect to internal validity, most interventions were well described and primary clinical or behavioral outcomes were measured and reported. However, gaps exist in areas of attrition, measures of potential negative outcomes, the extent to which the protocol was delivered as intended, and description on delivery agents. Likewise, we found limited information on external validity indicators across adoption, implementation, and maintenance domains. CONCLUSIONS Reporting gaps were found in internal validity but more so in external validity in the current SMS- and app-based DSMES literature. Because most studies in this review were efficacy studies, the generalizability of these interventions cannot be determined. Future research should adopt the RE-AIM dimensions to improve the quality of reporting and enhance the likelihood of translating research to practice.
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Affiliation(s)
- Yilin Yoshida
- Section of Endocrinology, Department of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Sonal J Patil
- Department of Family Medicine, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
- Division of Public Health Sciences, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Suzanne A Boren
- Department of Health Management and Informatics, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Min Kim
- Department of Health Management and Informatics, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Rosie Dobson
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Kayo Waki
- Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | - Astrid Torbjørnsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | | | | | - Vivian A Fonseca
- Section of Endocrinology, Department of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Eduardo J Simoes
- Department of Health Management and Informatics, School of Medicine, University of Missouri, Columbia, Missouri, USA
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Belden JL, Wegier P, Patel J, Hutson A, Plaisant C, Moore JL, Lowrance NJ, Boren SA, Koopman RJ. Designing a medication timeline for patients and physicians. J Am Med Inform Assoc 2020; 26:95-105. [PMID: 30590550 DOI: 10.1093/jamia/ocy143] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 10/17/2018] [Indexed: 11/14/2022] Open
Abstract
Objective Most electronic health records display historical medication information only in a data table or clinician notes. We designed a medication timeline visualization intended to improve ease of use, speed, and accuracy in the ambulatory care of chronic disease. Materials and Methods We identified information needs for understanding a patient medication history, then applied human factors and interaction design principles to support that process. After research and analysis of existing medication lists and timelines to guide initial requirements, we hosted design workshops with multidisciplinary stakeholders to expand on our initial concepts. Subsequent core team meetings used an iterative user-centered design approach to refine our prototype. Finally, a small pilot evaluation of the design was conducted with practicing physicians. Results We propose an open-source online prototype that incorporates user feedback from initial design workshops, and broad multidisciplinary audience feedback. We describe the applicable design principles associated with each of the prototype's key features. A pilot evaluation of the design showed improved physician performance in 5 common medication-related tasks, compared to tabular presentation of the same information. Discussion There is industry interest in developing medication timelines based on the example prototype concepts. An open, standards-based technology platform could enable developers to create a medication timeline that could be deployable across any compatible health IT application. Conclusion The design goal was to improve physician understanding of a patient's complex medication history, using a medication timeline visualization. Such a design could reduce temporal and cognitive load on physicians for improved and safer care.
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Affiliation(s)
- Jeffery L Belden
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, Missouri, USA.,MU Informatics Institute, University of Missouri, Columbia, Missouri, USA
| | - Pete Wegier
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, Missouri, USA.,Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada.,Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Andrew Hutson
- Department of Health Sciences, School of Health Professions, University of Missouri, Columbia, Missouri, USA
| | - Catherine Plaisant
- Human Computer Interaction Laboratory, Institute for Advanced Computer Studies, University of Maryland, College Park, Maryland, USA
| | - Joi L Moore
- MU Informatics Institute, University of Missouri, Columbia, Missouri, USA.,The School of Information Science and Learning Technologies, College of Education, University of Missouri, Columbia, Missouri, USA
| | - Nathan J Lowrance
- The School of Information Science and Learning Technologies, College of Education, University of Missouri, Columbia, Missouri, USA
| | - Suzanne A Boren
- MU Informatics Institute, University of Missouri, Columbia, Missouri, USA.,Department of Health Management and Informatics, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Richelle J Koopman
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, Missouri, USA
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Valenta AL, Berner ES, Boren SA, Deckard GJ, Eldredge C, Fridsma DB, Gadd C, Gong Y, Johnson T, Jones J, Manos EL, Phillips KT, Roderer NK, Rosendale D, Turner AM, Tusch G, Williamson JJ, Johnson SB. AMIA Board White Paper: AMIA 2017 core competencies for applied health informatics education at the master's degree level. J Am Med Inform Assoc 2019; 25:1657-1668. [PMID: 30371862 DOI: 10.1093/jamia/ocy132] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/02/2018] [Indexed: 11/15/2022] Open
Abstract
This White Paper presents the foundational domains with examples of key aspects of competencies (knowledge, skills, and attitudes) that are intended for curriculum development and accreditation quality assessment for graduate (master's level) education in applied health informatics. Through a deliberative process, the AMIA Accreditation Committee refined the work of a task force of the Health Informatics Accreditation Council, establishing 10 foundational domains with accompanying example statements of knowledge, skills, and attitudes that are components of competencies by which graduates from applied health informatics programs can be assessed for competence at the time of graduation. The AMIA Accreditation Committee developed the domains for application across all the subdisciplines represented by AMIA, ranging from translational bioinformatics to clinical and public health informatics, spanning the spectrum from molecular to population levels of health and biomedicine. This document will be periodically updated, as part of the responsibility of the AMIA Accreditation Committee, through continued study, education, and surveys of market trends.
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Affiliation(s)
- Annette L Valenta
- Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Medical Education, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Eta S Berner
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Suzanne A Boren
- Department of Health Management and Informatics, University of Missouri, Columbia, Missouri, USA
| | - Gloria J Deckard
- Department of Information Systems and Business Analytics, Florida International University, Miami, Florida, USA
| | | | | | - Cynthia Gadd
- Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, USA
| | - Yang Gong
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, Texas, USA
| | - Todd Johnson
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, Texas, USA
| | - Josette Jones
- Department of BioHealth Informatics, Indiana University-Purdue University, Indianapolis, Indiana, USA
| | - E LaVerne Manos
- University of Kansas Center for Health Informatics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kirk T Phillips
- Department of Health Management and Policy, University of Iowa, Iowa City, Iowa, USA
| | - Nancy K Roderer
- Division of Health Sciences Informatics, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA.,ISchool, University of Maryland, College Park, Maryland, USA
| | - Douglas Rosendale
- Deloitte Consulting for Federal Healthcare, Washington, District of Columbia, USA
| | - Anne M Turner
- Department of Health Services, University of Washington, Seattle, Washington, USA.,Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Guenter Tusch
- Department of Computer Science and Information Systems, Grand Valley State University, Allendale, Michigan, USA
| | | | - Stephen B Johnson
- Division of Health Informatics, Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, USA
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Yoshida Y, Boren SA, Soares J, Popescu M, Nielson SD, Koopman RJ, Kennedy DR, Simoes EJ. Effect of Health Information Technologies on Cardiovascular Risk Factors among Patients with Diabetes. Curr Diab Rep 2019; 19:28. [PMID: 31030289 PMCID: PMC6486904 DOI: 10.1007/s11892-019-1152-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW To identify a common effect of health information technologies (HIT) on the management of cardiovascular disease (CVD) risk factors among people with type 2 diabetes (T2D) across randomized control trials (RCT). RECENT FINDINGS CVD is the most frequent cause of morbidity and mortality among patients with diabetes. HIT are effective in reducing HbA1c; however, their effect on cardiovascular risk factor management for patients with T2D has not been evaluated. We identified 21 eligible studies (23 estimates) with measurement of SBP, 20 (22 estimates) of DBP, 14 (17 estimates) of HDL, 14 (17 estimates) of LDL, 15 (18 estimates) of triglycerides, and 10 (12 estimates) of weight across databases. We found significant reductions in SBP, DBP, LDL, and TG, and a significant improvement in HDL associated with HIT. As adjuvants to standard diabetic treatment, HIT can be effective tools for improving CVD risk factors among patients with T2D, especially in those whose CVD risk factors are not at goal.
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Affiliation(s)
- Yilin Yoshida
- 0000 0001 2162 3504grid.134936.aDepartment of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, CE707 CS&E Bldg., One Hospital Drive, Columbia, MO 65212 USA
- 0000 0001 2162 3504grid.134936.aMissouri Cancer Registry and Research Center, University of Missouri-Columbia, Columbia, MO USA
| | - Suzanne A. Boren
- 0000 0001 2162 3504grid.134936.aDepartment of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, CE707 CS&E Bldg., One Hospital Drive, Columbia, MO 65212 USA
| | - Jesus Soares
- Centers for Disease Control and Prevention, Division of High-Consequence Pathogens and Pathology, Prion and Public Health Office, Atlanta, GA USA
| | - Mihail Popescu
- 0000 0001 2162 3504grid.134936.aDepartment of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, CE707 CS&E Bldg., One Hospital Drive, Columbia, MO 65212 USA
| | | | - Richelle J. Koopman
- 0000 0001 2162 3504grid.134936.aDepartment of Family and Community Medicine, School of Medicine, University of Missouri-Columbia, Columbia, MO USA
| | - Diana R. Kennedy
- 0000 0001 2162 3504grid.134936.aDepartment of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, CE707 CS&E Bldg., One Hospital Drive, Columbia, MO 65212 USA
| | - Eduardo J. Simoes
- 0000 0001 2162 3504grid.134936.aDepartment of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, CE707 CS&E Bldg., One Hospital Drive, Columbia, MO 65212 USA
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10
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Abstract
PURPOSE OF REVIEW This study was to present meta-analysis findings across selected clinical trials for the effect of health information technologies (HITs) on glycemic control among patients with type 2 diabetes. RECENT FINDINGS HITs may be promising in diabetes management. However, findings on effect size of glycated hemoglobin level (HbA1c) yielded from HITs varied across previous studies. This is likely due to heterogeneity in sample size, adherence to standard quantitative method, and/or searching criteria (e.g., type of HITs, type of diabetes, specification of patient population, randomized vs. nonrandomized trials). We systematically searched Medline, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and the Cochrane Library for peer-reviewed randomized control trials that studied the effect of HITs on HbA1c reduction. We also used Google Scholar and a hand search to identify additional studies. Thirty-four studies (40 estimates) met the criteria and were included in the analysis. Overall, introduction of HITs to standard diabetes treatment resulted in a statistically and clinically reduced HbA1c. The bias adjusted HbA1c reduction due to the combined HIT interventions was - 0.56 [Hedges' g = - 0.56 (- 0.70, - 0.43)]. The reduction was significant across each of the four types of HIT intervention under review, with mobile phone-based approaches generating the largest effects [Hedges' g was - 0.67 (- 0.90, - 0.45)]. HITs can be an effective tool for glycemic control among patients with type 2 diabetes. Future studies should examine long-term effects of HITs and explore factors that influence their effectiveness.
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Affiliation(s)
- Yilin Yoshida
- Department of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, CE707 CS&E Bldg., One Hospital Drive, Columbia, MO USA
- Missouri Cancer Registry and Research Center, University of Missouri-Columbia, Columbia, MO USA
| | - Suzanne A. Boren
- Department of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, CE707 CS&E Bldg., One Hospital Drive, Columbia, MO USA
| | - Jesus Soares
- Centers for Disease Control and Prevention, Division of High-Consequences Pathogens and Pathology, Prion and Public Health Office, Atlanta, GA USA
| | - Mihail Popescu
- Department of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, CE707 CS&E Bldg., One Hospital Drive, Columbia, MO USA
| | | | - Eduardo J. Simoes
- Department of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, CE707 CS&E Bldg., One Hospital Drive, Columbia, MO USA
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11
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Ye Q, Khan U, Boren SA, Simoes EJ, Kim MS. An Analysis of Diabetes Mobile Applications Features Compared to AADE7™: Addressing Self-Management Behaviors in People With Diabetes. J Diabetes Sci Technol 2018; 12:808-816. [PMID: 29390917 PMCID: PMC6134307 DOI: 10.1177/1932296818754907] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Diabetes self-management (DSM) applications (apps) have been designed to improve knowledge of diabetes and self-management behaviors. However, few studies have systematically examined if diabetes apps followed the American Association of Diabetes Educators (AADE) Self-Care Behaviors™ guidelines. The purpose of this study was to compare the features of current DSM apps to the AADE7™ guidelines. METHODS In two major app stores (iTunes and Google Play), we used three search terms "diabetes," "blood sugar," and "glucose" to capture a wide range of diabetes apps. Apps were excluded based on five exclusion criteria. A multidisciplinary team analyzed and classified the features of each app based on the AADE7™. We conducted interviews with six diabetes physicians and educators for their opinions on the distribution of the features of DSM apps. RESULTS Out of 1050 apps retrieved, 173 apps were identified as eligible during November 2015 and 137 apps during December 2017. We found an unbalanced DSM app development trend based on AADE7™ guidelines. Many apps were designed to support the behaviors of Healthy Eating (77%), Monitoring (76%), Taking Medication (58%), and Being Active (45%). On the other hand, few apps explored the behaviors of Problem Solving (31%), Healthy Coping (10%), and Reducing Risks (5%). From interviews, we identified the main reasons why only a few apps support the features related to Problem Solving, Healthy Coping, and Reducing Risks. CONCLUSIONS Future diabetes apps should attempt to incorporate features under evidence-based guidelines such as AADE7™ to better support the self-management behavior changes of people with diabetes.
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Affiliation(s)
- Qing Ye
- University of Missouri Informatics
Institute, University of Missouri, Columbia, MO, USA
| | - Uzma Khan
- Department of Medicine, University of
Missouri, Columbia, MO, USA
| | - Suzanne A. Boren
- University of Missouri Informatics
Institute, University of Missouri, Columbia, MO, USA
- Department of Health Management and
Informatics, University of Missouri, Columbia, MO, USA
| | - Eduardo J. Simoes
- University of Missouri Informatics
Institute, University of Missouri, Columbia, MO, USA
- Department of Health Management and
Informatics, University of Missouri, Columbia, MO, USA
| | - Min Soon Kim
- University of Missouri Informatics
Institute, University of Missouri, Columbia, MO, USA
- Department of Health Management and
Informatics, University of Missouri, Columbia, MO, USA
- Min Soon Kim, PhD, Department of Health
Management and Informatics, University of Missouri Informatics Institute,
University of Missouri, 5 Hospital Dr, Columbia, MO 65212, USA.
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12
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Becevic M, Clarke MA, Alnijoumi MM, Sohal HS, Boren SA, Kim MS, Mutrux R. Robotic Telepresence in a Medical Intensive Care Unit--Clinicians' Perceptions. Perspect Health Inf Manag 2015; 12:1c. [PMID: 26396554 PMCID: PMC4558480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Robotic telepresence has been used for outsourcing of healthcare services for more than a decade; however, its use within an academic medical department is not yet widespread. Intensive care unit (ICU) robots can be used to increase access to off-site supervising physicians and other specialists, reducing possible wait time for difficult admissions and procedures. OBJECTIVE To study the use of ICU robots through a pilot program in an academic hospital and examine provider attitudes toward the usability and effectiveness of an ICU robot. MATERIALS AND METHODS The study was done as a postinterventional cross-sectional seven-question survey in a medical ICU in an urban academic hospital. Participants were attending physicians, fellows, residents, nurses, and respiratory therapists. RESULTS Users of the ICU robot reported satisfaction with communication, and improved patient care. They also reported perceived improved quality of care with the use of the robot. CONCLUSIONS Findings show the importance of a whole-team approach to the installation and implementation of an ICU robot. The ICU robot is an effective tool when it is used to visualize and communicate with patients, bedside staff, and families. However, a number of providers are still not trained or have not been shown how to use the ICU robot, which affects the overall utilization rate.
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Affiliation(s)
- Mirna Becevic
- Mirna Becevic, PhD, MHA, is an assistant research professor of telemedicine at the University of Missouri Department of Dermatology in Columbia, MO
| | - Martina A Clarke
- Martina A. Clarke, MS, is a PhD candidate at the University of Missouri Informatics Institute in Columbia, MO
| | - Mohammed M Alnijoumi
- Mohammed M. Alnijoumi, MD, is a fellow in the Department of Medicine at the University of Missouri in Columbia, MO
| | - Harjyot S Sohal
- Harjyot S. Sohal, MD, is an associate professor in the Department of Medicine at the University of Missouri in Columbia, MO
| | - Suzanne A Boren
- Suzanne A. Boren, PhD, MHA, is an associate professor at the University of Missouri Department of Health Management and Informatics in Columbia, MO
| | - Min S Kim
- Min S. Kim, PhD, is an assistant professor at the University of Missouri Informatics Institute in Columbia, MO
| | - Rachel Mutrux
- Rachel Mutrux is a senior director at the University of Missouri's Missouri Telehealth Network in Columbia, MO
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Abstract
OBJECTIVE Content analysis of Internet-based diabetes forum text was used to examine the experiences encountered by students with diabetes transitioning into and through college. PARTICIPANTS Forum posts (N = 238) regarding attending college with diabetes were collected and analyzed. METHODS Thematic coding was used to identify prominent topics, followed by analysis of theme distribution across college transitional stages. Three students with diabetes were recruited to review results and corroborate findings. RESULTS Twenty thematic categories were identified. Preparation for college involved efforts to move toward autonomous diabetes management. Transitioning in was marked by adjusting to a college lifestyle, then working to manage issues such as busy schedules and alcohol use as continuing students, and turning attention toward future career options and finances while transitioning out. CONCLUSIONS As they move into and through college, students with diabetes negotiate developmental and diabetes-specific tasks within an environment that presents unique logistical, lifestyle, and psychological challenges.
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14
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Kent D, Haas L, Randal D, Lin E, Thorpe CT, Boren SA, Fisher J, Heins J, Lustman P, Nelson J, Ruggiero L, Wysocki T, Fitzner K, Sherr D, Martin AL. Healthy coping: issues and implications in diabetes education and care. Popul Health Manag 2011; 13:227-33. [PMID: 20879903 DOI: 10.1089/pop.2009.0065] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Psychological, emotional, and social factors not only impact quality of life, but also often play a role in chronic illness outcomes. Diabetes care, in particular, is greatly influenced by psychosocial factors when they hinder a person's ability to manage the disease and achieve metabolic control. Healthy coping, defined as responding to a psychological and physical challenge by recruiting available resources to increase the probability of favorable outcomes in the future, is essential to effective self-management by people with diabetes. In June 2009, the American Association of Diabetes Educators convened a multidisciplinary expert panel to discuss healthy coping in diabetes. The panel included diabetes educators and behavioral science and mental health professionals. Drawing on their knowledge and experiences, as well as information presented at the symposium, the panel probed several aspects of healthy coping including what it entails, common barriers, assessment, population diversity, and clinical applications. A team approach to addressing the patient's coping is critical. Team involvement relieves the diabetes educator of the entire burden of supporting the patient in this regard. The team should be broadly defined and include those who are formally and informally involved. Healthy coping is a complex, qualitative behavior that cannot be easily quantified. Future efforts to address the issue of healthy coping should add to the body of literature regarding diabetes self-management at the individual and population-based levels.
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Affiliation(s)
- Dan Kent
- University of Washington Medical School , Seattle, Washington, USA
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15
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Boren SA, Fitzner KA, Panhalkar PS, Specker JE. Costs and Benefits Associated With Diabetes Education A Review of the Literature. Diabetes Educ 2009; 35:72-96. [PMID: 19244564 DOI: 10.1177/0145721708326774] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose The purpose of this article was to review the published literature and evaluate the economic benefits and costs associated with diabetes education. Methods The Medline database (1991-2006) and Google were searched. Articles that addressed the economic and/or financial outcomes of a diabetes-related self-care or educational intervention were included. The study aim, population, design, intervention, financial and economic outcomes, results, and conclusions were extracted from eligible articles. Results Twenty-six papers were identified that addressed diabetes self-management training and education. Study designs included meta-analysis (1); randomized controlled trials (8); prospective, quasi-experimental, and pre-post studies (8); and retrospective database analyses (9). The studies conducted cost analyses (6), cost-effectiveness analyses (13), cost-utilization analyses (7), and number needed to treat analyses (2). More than half (18) of the 26 papers identified by the literature review reported findings that associated diabetes education (and disease management) with decreased cost, cost saving, cost-effectiveness, or positive return on investment. Four studies reported neutral results, 1 study found that costs increased, and 3 studies did not fit into these categories. Conclusions The findings indicate that the benefits associated with education on self-management and lifestyle modification for people with diabetes are positive and outweigh the costs associated with the intervention. More research is needed to validate that diabetes education provided by diabetes educators is cost-effective.
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Affiliation(s)
- Suzanne A. Boren
- Services Research and Development, Harry S. Truman Memorial
Veterans' Hospital, Columbia, Missouri, Department of Health Management and Informatics, University
of Missouri, Columbia, Missouri
| | | | - Pallavi S. Panhalkar
- Department of Health Management and Informatics, University
of Missouri, Columbia, Missouri
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16
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Goulis DG, Giaglis GD, Boren SA, Lekka I, Bontis E, Balas EA, Maglaveras N, Avramides A. Effectiveness of home-centered care through telemedicine applications for overweight and obese patients: a randomized controlled trial. Int J Obes (Lond) 2004; 28:1391-8. [PMID: 15356664 DOI: 10.1038/sj.ijo.0802773] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine if home-centered monitoring through telemedicine has an impact on clinical characteristics, metabolic profile and quality of life in overweight and obese patients. DESIGN Randomized controlled trial, 6-month duration. SETTING Tertiary care academic hospital. SUBJECTS A total of 122 patients were eligible to participate as they met the inclusion criteria of increased body mass index (BMI>25 kg/m(2)), age>18 and <70 y and ability to operate electronic microdevices. INTERVENTIONS All patients in the control group (n=77) received standard hospital care. Patients in the intervention group (n=45), additionally, measured three times a week, for 6 months, their blood pressure and body weight and transmitted them to an automated call center. These values were not shared with the patients' physician or dietician. MAIN OUTCOME MEASURES Clinical (body weight, BMI, blood pressure), laboratory (fasting plasma glucose, triglycerides, HDL-cholesterol, total cholesterol) and quality of life parameters (SF-36((R)), Visual Analog Scale of European Quality-5 Dimensions, Obesity Assessment Survey). Data were analyzed in an intention-to-treat-way (last observation carried forward). RESULTS Drop-out rate was similar in the control and intervention groups: 12 vs 11 percent, respectively, P=NS. There were no significant differences at baseline between intervention and control groups in all main outcome parameters. There were significant decreases for patients in the intervention group in body weight (from 101.6+/-22.4 to 89.2+/-14.7 kg, P=0.002, P=0.05 vs controls at 6 months), total cholesterol (from 247.6+/-42.0 to 220.7+/-42.6 mg/dl, P=0.002, P=0.05 vs controls at 6 months) and triglycerides (from 148.4+/-35.0 to 122.3+/-31.4 mg/dl, P=0.001, P=0.01 vs controls at 6 months). Intervention group patients made a total of 1997 phone contacts. The number of phone contacts was correlated positively with Social Functioning (SF), Vitality (VT) and Mental Health (MH) scores of SF-36((R)) at baseline (r=0.48, r=0.41, r=0.41, respectively, P=0.05) but not with weight loss. CONCLUSIONS Home-centered, intense treatment through the use of telemedicine can be effective in improving short-term obesity outcomes.
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Affiliation(s)
- D G Goulis
- Department of Endocrinology, Hippocration General Hospital, 49 Constantinoupoleos street, 54642, Thessaloniki, Greece.
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Krishna S, Balas EA, Boren SA, Maglaveras N. Patient acceptance of educational voice messages: a review of controlled clinical studies. Methods Inf Med 2003; 41:360-9. [PMID: 12501806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVES The objective of this study was to evaluate controlled evidence on the impact of automated computer-based telephone messaging technology upon health outcomes, cost savings and acceptance by patients, caregivers and care providers. METHODS Systematic searches of electronic databases were conducted to find controlled clinical studies of automated phone messaging used in patient care. Studies were selected based on the three criteria: 1) randomized controlled trials or controlled trials; 2) patients receiving health care related education, information, advice or reminder for a specific action to be taken in their home setting; and 3) use of automated computer-based phone technology to deliver the messages. Information abstracted from studies included information about the institution, persons targeted, intervention and its effect on health outcomes, costs and acceptance by patients and caregivers. RESULTS A total of nineteen studies were identified for review. Sixteen studies were randomized controlled trials and three were controlled studies with no randomization. Studies were placed in two categories, preventive care education and chronic care studies. Preventive care education studies covered childhood immunizations, medication compliance, influenza vaccinations, tuberculosis and health prevention activities and chronic care studies were related to cholesterol, diabetes, hypertension and congestive heart failure. More than 80% of studies showed significant impact upon measurable health outcomes. CONCLUSIONS Controlled evidence substantiates the efficacy of automated telephone communication in improving the quality of care. Educational voice messages are acceptable in patients and represent an important opportunity to enhance telemedicine and telehealth applications.
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Affiliation(s)
- S Krishna
- Center for Health Care Quality, University of Missouri, Columbia, MO, USA.
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18
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Pakpahan R, Balas EA, Boren SA. Computable decision modules for patient safety in child health care. Proc AMIA Symp 2002:592-6. [PMID: 12463892 PMCID: PMC2244201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
OBJECTIVE To identify controlled evidence from the child health literature on patient conditions and clinical procedures that resulted in unacceptable adverse outcomes. METHODS Systematic searches of MEDLINE (1966 to 2001), and Cochrane Database of Systematic Reviews (2001) were done. Studies that met the eligibility criteria, were verified for quality of methodology and lack of conflicting studies. A knowledge base of Child Health Safety Modules was then developed. The knowledge base could be used to transfer controlled evidence on potentially harmful interventions into clinical decision support systems conforming with Arden Syntax, a widely applied computer standard. RESULTS The searches identified knowledge to create 41 Child Health Safety Modules for medications and procedures in child health care, from 29 randomized controlled trials and 12 non-randomized controlled studies. The modules are focused on 28 medication interventions and 13 other clinical procedures. Eighty five percent of the studies were published between 1997-2001. CONCLUSION An increasing amount of controlled evidence on risks of adverse outcomes in child health is available to alert clinicians when potential planning errors are about to be overlooked.
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Affiliation(s)
- Ratna Pakpahan
- Center for Health Care Quality, University of Missouri, Columbia, MO, USA
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19
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Abstract
OBJECTIVES To assess the impact of prompting physicians on health maintenance, answer questions regarding the mode of delivery, and identify opportunities and limitations of this information intervention. METHODS Systematic electronic and manual searches (January 1, 1966, to December 31, 1996) were conducted to identify clinical trial reports on prompting clinicians. Three eligibility criteria were applied: (1) randomized controlled clinical trial, (2) clinician prompt, alert, or reminder in the study group and no similar intervention in the control group, and (3) measurement of the intervention effect on the frequency of preventive care procedures. Data were abstracted by independent reviewers using a standardized abstraction form, and quality of methodology was scored. A series of meta-analyses on triggering clinical actions was performed using the random-effects method. The statistical analyses included 33 eligible studies, which involved 1547 clinicians and 54 693 patients. RESULTS Overall, prompting can significantly increase preventive care performance by 13.1% (95% confidence interval [CI], 10.5%-15.6%). However, the effect ranges from 5.8% (95% CI, 1.5%-10.1%) for Papanicolaou smear to 18.3% (95% CI, 11.6%-25.1%) for influenza vaccination. The effect is not cumulative, and the length of intervention period did not show correlation with effect size (R = -0.015, P = .47). Academic affiliation, ratio of residents, and technique of delivery did not have a significant impact on the clinical effect of prompting. CONCLUSIONS Dependable performance improvement in preventive care can be accomplished through prompting physicians. Vigorous application of this simple and effective information intervention could save thousands of lives annually. Health care organizations could effectively use prompts, alerts, or reminders to provide information to clinicians when patient care decisions are made.
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Affiliation(s)
- E A Balas
- School of Medicine, University of Missouri, Columbia 65211, USA.
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20
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Balas EA, Boren SA. Managing Clinical Knowledge for Health Care Improvement. Yearb Med Inform 2000:65-70. [PMID: 27699347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
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Abstract
There is a strong need to provide scientific evidence supporting the effectiveness of specific health care interventions. Guidelines alone are unlikely to persuade physicians to modify their practice styles, unless research evidence having a motivational impact is also provided. Process-outcome parameters provide a solution for linking the process and outcome of health care and incorporate potentially motivating research evidence.
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Affiliation(s)
- S A Boren
- University of Missouri, Columbia, USA
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22
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Abstract
OBJECTIVE In the present era of cost containment, physicians need reliable data about specific interventions. The objectives of this study were to assist practitioners in interpretation of economic analyses and estimation of their own costs of implementing recommended interventions. DATA SOURCES MEDLINE search from 1966 through 1995 using the text words cost or expense and medical subject heading (MeSH) terms costs and cost analysis, cost control, cost of illness, cost savings, or cost-benefit analysis. STUDY SELECTION The 4 eligibility criteria were clinical trial with random assignment; health care quality improvement intervention tested; effects measured on the process or outcome of care; and cost calculation mentioned in the report. DATA EXTRACTION After independent abstraction and after consensus development, financial data were entered into a costing protocol to determine which costs related to the intervention were provided. DATA SYNTHESIS Of 181 articles, 97 (53.6%) included actual numbers on the costs of the intervention. Of 97 articles analyzed, the most frequently reported cost figures were in the category of operating expenses (direct cost, 61.9%; labor, 42.3%; and supplies, 32.0%). General overhead was not presented in 91 (93.8%) of the 97 studies. Only 14 (14.4%) of the 97 studies mentioned start-up costs. The text word $ in the abstract and the most useful MeSH index term of cost-benefit analysis appeared with nearly equal frequency in the articles that included actual cost data (37.1 % vs 35.1%). Two thirds of articles indexed with the MeSH term cost control did not include cost figures. CONCLUSIONS Statements regarding cost without substantiating data are made habitually in reports of clinical trials. In clinical trial reports presenting data on expenditures, start-up costs and general overhead are frequently disregarded. Practitioners can detect missing information by placing cost data in a standardized protocol. The costing protocol of this study can help bridge care delivery and economic analyses.
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Affiliation(s)
- E A Balas
- School of Medicine, University of Missouri, Columbia 65211, USA
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Balas EA, Boren SA, Hicks LL, Chonko AM, Stephenson K. Effect of linking practice data to published evidence. A randomized controlled trial of clinical direct reports. Med Care 1998; 36:79-87. [PMID: 9431333 DOI: 10.1097/00005650-199801000-00009] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the effect of clinical direct reports (practice data with pertinent evidence from the literature) on dialysis modality selection for patients with end-stage renal disease. METHODS A randomized controlled clinical trial was conducted at five dialysis centers. Five of the 10 physician participants were assigned through centralized computerized randomization to the intervention group (who received 12 center-specific clinical direct reports encouraging the consideration of peritoneal dialysis), and five were assigned to the control group, who received usual information but no similar report. One hundred fifty-two patients were eligible for monitoring. RESULTS The number of patients allocated to peritoneal dialysis was significantly higher in the intervention group than in the control group (15.3% versus 2.4%; P = 0.044). Due to a need for transient initial hemodialysis by some patients, the percentage of patients receiving peritoneal dialysis further increased through the end of the 3-month follow-up (18.0% versus 4.9%, P = 0.041). CONCLUSIONS There were no significant differences between the intervention and control groups in meeting patient preferences, metabolic status, and complication rates. The results of this study show that linking pertinent published evidence to actual practice data can support the implementation of practice recommendations and influence the selection of dialysis treatment for new patients.
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Affiliation(s)
- E A Balas
- Department of Health Management and Informatics, School of Medicine, University of Missouri, Columbia 65211, USA
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Balas EA, Boren SA, Griffing G. Computerized management of diabetes: a synthesis of controlled trials. Proc AMIA Symp 1998:295-9. [PMID: 9929229 PMCID: PMC2232151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Computerized management of diabetes is the use of information technology to improve diabetic patient outcomes. The computer can be used to provide educational information to patients and facilitate the storage and transmittal of clinical data between patients and clinicians. The objective of this paper was to evaluate computerized management of diabetes in changing the health outcomes. Clinical trial reports were identified through systematic electronic database and manual searches. Four eligibility criteria were applied: diabetes clinical area; prospective, contemporaneously controlled clinical trial with random assignment of the intervention; computer generated information for patients in the intervention group and no similar intervention in the control group; and measurement of effect on the outcome of care (health status, social functioning, patient/family satisfaction). Data were abstracted using a standardized abstraction form and the quality of methodology was scored. Of 15 eligible clinical trials, 12 (80%) reported positive outcomes or significant benefits. A total of 48 outcome measures were reported, an average of 3.2/study. Significantly improved clinical outcomes included Hemoglobin A1c (HbA1c), blood glucose, and hypoglycemic events. Patient-computer interaction appears to be a valuable supplement to interaction with clinicians. Considering the need to enhance patient participation in the care of chronic illnesses, initial evidence indicates computers can play a more significant role in the future.
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Affiliation(s)
- E A Balas
- Department Health Management and Informatics, School of Medicine, University of Missouri, Columbia, USA
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25
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Balas EA, Jaffrey F, Kuperman GJ, Boren SA, Brown GD, Pinciroli F, Mitchell JA. Electronic communication with patients. Evaluation of distance medicine technology. JAMA 1997; 278:152-9. [PMID: 9214532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate controlled evidence on the efficacy of distance medicine technologies in clinical practice and health care outcome. DATA SOURCES Systematic electronic database and manual searches (1966-1996) were conducted to identify clinical trial reports on distance medicine applications. STUDY SELECTION Three eligibility criteria were applied: prospective, contemporaneously controlled clinical trial with random assignment of the intervention; electronic distance technology application in the intervention group and no similar intervention in the control group; and measurement of the intervention effect on process or outcome of care. DATA EXTRACTION Data were abstracted by independent reviewers using a standardized abstraction form and the quality of methodology was scored. Distance technology applications were described in 6 categories: computerized communication, telephone follow-up and counseling, telephone reminders, interactive telephone systems, after-hours telephone access, and telephone screening. DATA SYNTHESIS Of 80 eligible clinical trials, 61 (76%) analyzed provider-initiated communication with patients and 50 (63%) reported positive outcome, improved performance, or significant benefits, including studies of computerized communication (7 of 7), telephone follow-up and counseling (20 of 37), telephone reminders (14 of 23), interactive telephone systems (5 of 6), telephone access (3 of 4), and telephone screening (1 of 3). Significantly improved outcomes were demonstrated in studies of preventive care, management of osteoarthritis, cardiac rehabilitation, and diabetes care. CONCLUSIONS Distance medicine technology enables greater continuity of care by improving access and supporting the coordination of activities by a clinician. The benefits of distance technologies in facilitating communication between clinicians and patients indicate that application of telemedicine should not be limited to physician-to-physician communication.
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Affiliation(s)
- E A Balas
- Health Services Management Program and Integrated Technology Services, School of Medicine, University of Missouri, Columbia 65211, USA.
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26
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Krishna S, Balas EA, Spencer DC, Griffin JZ, Boren SA. Clinical trials of interactive computerized patient education: implications for family practice. J Fam Pract 1997; 45:25-33. [PMID: 9228910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A systematic review of randomized clinical trials was conducted to evaluate the acceptability and usefulness of computerized patient education interventions. The Columbia Registry, MEDLINE, Health, BIOSIS, and CINAHL bibliographic databases were searched. Selection was based on the following criteria: (1) randomized controlled clinical trials, (2) educational patient-computer interaction, and (3) effect measured on the process or outcome of care. Twenty-two studies met the selection criteria. Of these, 13 (59%) used instructional programs for educational intervention. Five studies (22.7%) tested information support networks, and four (18%) evaluated systems for health assessment and history-taking. The most frequently targeted clinical application area was diabetes mellitus (n = 7). All studies, except one on the treatment of alcoholism, reported positive results for interactive educational intervention. All diabetes education studies, in particular, reported decreased blood glucose levels among patients exposed to this intervention. Computerized educational interventions can lead to improved health status in several major areas of care, and appear not to be a substitute for, but a valuable supplement to, face-to-face time with physicians.
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Affiliation(s)
- S Krishna
- Medical Informatics Group, School of Medicine, University of Missouri-Columbia 65211, USA
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27
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Abstract
The purpose of this study was to measure the efficiency of simple searches in retrieving controlled evidence about specific primary health care quality improvement interventions and their effects. Searches were conducted to retrieve evidence on seven interventions and seven effect variables. Specific words and the closest Medical Subject Headings (MeSH) recommended by professional librarians were used to search the MEDLINE database. Searches were restricted to the MeSH publication type "randomized controlled trial." Two reviewers independently judged retrieved citations for relevancy to the selected interventions and effects. In selecting MeSH terms, the average agreement among librarians was 64.3% (+/-26.1) for interventions and 57.1% (+/-19.9) for effects. Analysis of the 755 retrieved reports showed that MeSH term searches had an overall recall rate of 58% while the same rate for textword searches was significantly lower (11%, p < .001). The difference in overall precision rates was nonsignificant (26% versus 33%, p = .15). In the group of MeSH searches, overall precision and recall was significantly lower for effects than for interventions (12% versus 52%, p < .001 and 41% versus 69%, p < .001). Two textwords appeared in more than 25% of the benchmark collection: reminder (25.7%) and cost (25.0%). The results of this study indicate that information needs for health care quality improvement cannot be met by simple literature searches. Certain MeSH terms and combinations of textwords yield moderately efficient recall and precision in literature searches for health care quality improvement. Clinicians and physician executives gaining direct access to bibliographic database could probably be better served by structured indexing of critical aspects of randomized controlled clinical trials: design, sample, interventions, and effects.
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Affiliation(s)
- E A Balas
- Program in Health Services Management, University of Missouri-Columbia 65211, USA
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Balas EA, Boren SA, Brown GD, Ewigman BG, Mitchell JA, Perkoff GT. Effect of physician profiling on utilization. Meta-analysis of randomized clinical trials. J Gen Intern Med 1996; 11:584-90. [PMID: 8945689 DOI: 10.1007/bf02599025] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES An American Medical Association survey reported that more than half of physicians are subjects of either clinical or economic profiling. This multilevel meta-analysis was designed to assess the clinical effect of peer-comparison feedback intervention (profiles) in changing practice patterns. METHODS Systematic computerized and manual searches were combined to retrieve articles on randomized controlled clinical trials testing profiling reports. Eligible studies were randomized, controlled clinical trials that tested peer-comparison feedback intervention and measured utilization of clinical procedures. To use all available information, data were abstracted and analyzed on three levels: (1) direction of effects, (2) p value fro the statistical comparison, and (3) odds ratio (OR). MAIN RESULTS In the 12 eligible trials, 553 physicians were profiled. The test result was p < .05 for the vote-counting sign test of 12 studies (level 1) and p < .05 for the z-transformation test of 8 studies (level 2). There were 5 trials included in the OR analysis (level 3). The primary effect variable in two of the 5 trials had a nonsignificant OR. However, the overall OR calculated by the Mantel-Haenszel method was significant (1.091, confidence interval: 1.045 to 1.136). CONCLUSIONS Profiling has a statistically significant, but minimal effect on the utilization of clinical procedures. The results of this study indicate a need for controlled clinical evaluations before subjecting large numbers of physicians to utilization management interventions.
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Affiliation(s)
- E A Balas
- Program in Health Services Management, University of Missouri, Columbia 65211, USA
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