scholarly journals Growing Disparities in Patient-Provider Messaging: Trend Analysis Before and After Supportive Policy (Preprint)

2019 ◽  
Author(s):  
Nicole Senft ◽  
Evan Butler ◽  
Jordan Everson
Keyword(s):  
Health Information ◽  
Financial Incentives ◽  
Ethnic Disparities ◽  
Internet Adoption ◽  
Percentage Points ◽  
Health Factors ◽  
Before And After ◽  
Linear Probability ◽  
Over Time ◽  
The Web

BACKGROUND Public policy introduced since 2011 has supported provider adoption of electronic medical records (EMRs) and patient-provider messaging, primarily through financial incentives. It is unclear how disparities in patients’ use of incentivized electronic health (eHealth) tools, like patient-provider messaging, have changed over time relative to disparities in use of eHealth tools that were not directly incentivized. OBJECTIVE This study examines trends in eHealth disparities before and after the introduction of US federal financial incentives. We compare rates of patient-provider messaging, which was directly incentivized, with rates of looking for health information on the Web, which was not directly incentivized. METHODS We used nationally representative Health Information National Trends Survey data from 2003 to 2018 (N=37,300) to describe disparities in patient-provider messaging and looking for health information on the Web. We first reported the percentage of individuals across education and racial and ethnic groups who reported using these tools in each survey year and compared changes in unadjusted disparities during preincentive (2003-2011) and postincentive (2011-2018) periods. Using multivariable linear probability models, we then examined adjusted effects of education and race and ethnicity in 3 periods—preincentive (2003-2005), early incentive (2011-2013), and postincentive (2017-2018)—controlling for sociodemographic and health factors. In the postincentive period, an additional model tested whether internet adoption, provider access, or providers’ use of EMRs explained disparities. RESULTS From 2003 to 2018, overall rates of provider messaging increased from 4% to 36%. The gap in provider messaging between the highest and lowest education groups increased by 10 percentage points preincentive (<italic>P</italic>&lt;.001) and 22 additional points postincentive (<italic>P</italic>&lt;.001). The gap between Hispanics and non-Hispanic whites increased by 3.2 points preincentive (<italic>P</italic>=.42) and 11 additional points postincentive (<italic>P</italic>=.01). Trends for blacks resembled those for Hispanics, whereas trends for Asians resembled those for non-Hispanic whites. In contrast, education-based disparities in looking for health information on the Web (which was not directly incentivized) did not significantly change in preincentive or postincentive periods, whereas racial disparities narrowed by 15 percentage points preincentive (<italic>P</italic>=.008) and did not significantly change postincentive. After adjusting for other sociodemographic and health factors, observed associations were similar to unadjusted associations, though smaller in magnitude. Including internet adoption, provider access, and providers’ use of EMRs in the postincentive model attenuated, but did not eliminate, education-based disparities in provider messaging and looking for health information on the Web. Racial and ethnic disparities were no longer statistically significant in adjusted models. CONCLUSIONS Disparities in provider messaging widened over time, particularly following federal financial incentives. Meanwhile, disparities in looking for health information on the Web remained stable or narrowed. Incentives may have disproportionately benefited socioeconomically advantaged groups. Future policy could address disparities by incentivizing providers treating these populations to adopt messaging capabilities and encouraging patients’ use of messaging.

scholarly journals Growing Disparities in Patient-Provider Messaging: Trend Analysis Before and After Supportive Policy

10.2196/14976 ◽  
2019 ◽  
Vol 21 (10) ◽  
pp. e14976 ◽  
Author(s):  
Nicole Senft ◽  
Evan Butler ◽  
Jordan Everson
Keyword(s):  
Health Information ◽  
Financial Incentives ◽  
Ethnic Disparities ◽  
Internet Adoption ◽  
Percentage Points ◽  
Health Factors ◽  
Before And After ◽  
Linear Probability ◽  
Over Time ◽  
The Web

Background Public policy introduced since 2011 has supported provider adoption of electronic medical records (EMRs) and patient-provider messaging, primarily through financial incentives. It is unclear how disparities in patients’ use of incentivized electronic health (eHealth) tools, like patient-provider messaging, have changed over time relative to disparities in use of eHealth tools that were not directly incentivized. Objective This study examines trends in eHealth disparities before and after the introduction of US federal financial incentives. We compare rates of patient-provider messaging, which was directly incentivized, with rates of looking for health information on the Web, which was not directly incentivized. Methods We used nationally representative Health Information National Trends Survey data from 2003 to 2018 (N=37,300) to describe disparities in patient-provider messaging and looking for health information on the Web. We first reported the percentage of individuals across education and racial and ethnic groups who reported using these tools in each survey year and compared changes in unadjusted disparities during preincentive (2003-2011) and postincentive (2011-2018) periods. Using multivariable linear probability models, we then examined adjusted effects of education and race and ethnicity in 3 periods—preincentive (2003-2005), early incentive (2011-2013), and postincentive (2017-2018)—controlling for sociodemographic and health factors. In the postincentive period, an additional model tested whether internet adoption, provider access, or providers’ use of EMRs explained disparities. Results From 2003 to 2018, overall rates of provider messaging increased from 4% to 36%. The gap in provider messaging between the highest and lowest education groups increased by 10 percentage points preincentive (P<.001) and 22 additional points postincentive (P<.001). The gap between Hispanics and non-Hispanic whites increased by 3.2 points preincentive (P=.42) and 11 additional points postincentive (P=.01). Trends for blacks resembled those for Hispanics, whereas trends for Asians resembled those for non-Hispanic whites. In contrast, education-based disparities in looking for health information on the Web (which was not directly incentivized) did not significantly change in preincentive or postincentive periods, whereas racial disparities narrowed by 15 percentage points preincentive (P=.008) and did not significantly change postincentive. After adjusting for other sociodemographic and health factors, observed associations were similar to unadjusted associations, though smaller in magnitude. Including internet adoption, provider access, and providers’ use of EMRs in the postincentive model attenuated, but did not eliminate, education-based disparities in provider messaging and looking for health information on the Web. Racial and ethnic disparities were no longer statistically significant in adjusted models. Conclusions Disparities in provider messaging widened over time, particularly following federal financial incentives. Meanwhile, disparities in looking for health information on the Web remained stable or narrowed. Incentives may have disproportionately benefited socioeconomically advantaged groups. Future policy could address disparities by incentivizing providers treating these populations to adopt messaging capabilities and encouraging patients’ use of messaging.

Weekly Exercise Consistently Reinstates Positive Mood

1998 ◽  
Vol 3 (4) ◽  
pp. 271-280 ◽  
Author(s):  
Hannah Steinberg ◽  
Briony R. Nicholls ◽  
Elizabeth A. Sykes ◽  
N. LeBoutillier ◽  
Nerina Ramlakhan ◽  
...  
Keyword(s):  
Physical Exercise ◽  
Negative Mood ◽  
Real Life ◽  
Positive Mood ◽  
Field Investigation ◽  
Single Bout ◽  
Before And After ◽  
Exercise Class ◽  
Negative Feelings ◽  
Over Time

Mood improvement immediately after a single bout of exercise is well documented, but less is known about successive and longer term effects. In a “real-life” field investigation, four kinds of exercise class (Beginners, Advanced, Body Funk and Callanetics) met once a week for up to 7 weeks. Before and after each class the members assessed how they felt by completing a questionnaire listing equal numbers of “positive” and “negative” mood words. Subjects who had attended at least five times were included in the analysis, which led to groups consisting of 18, 20, 16, and 16 subjects, respectively. All four kinds of exercise significantly increased positive and decreased negative feelings, and this result was surprisingly consistent in successive weeks. However, exercise seemed to have a much greater effect on positive than on negative moods. The favorable moods induced by each class seemed to have worn off by the following week, to be reinstated by the class itself. In the Callanetics class, positive mood also improved significantly over time. The Callanetics class involved “slower,” more demanding exercises, not always done to music. The Callanetics and Advanced classes also showed significantly greater preexercise negative moods in the first three sessions. However, these differences disappeared following exercise. Possibly, these two groups had become more “tolerant” to the mood-enhancing effects of physical exercise; this may be in part have been due to “exercise addiction.”

Eliminating Invisible Barriers: Health Web Site Accessibility

2003 ◽  
Vol 1 (1) ◽  
pp. 70-86
Author(s):  
Christine Rzepka
Keyword(s):  
Health Information ◽  
Web Sites ◽  
Web Site ◽  
People With Disabilities ◽  
High Tech ◽  
Accessibility Issues ◽  
Accessibility Guidelines ◽  
Use Of The Internet ◽  
Simple Evaluation ◽  
The Web

One of the top reasons given for use of the internet is the ability to search for health information. However, much of the planning for web-based health information often fails to consider accessibility issues. If health care organizations and community agencies’ web sites have the latest, most wellresearched information on the health topics of the day, it is useless to those who cannot access it because of invisible technological barriers. Many flashy, high-tech sites were designed only to appeal to the needs of the mainstream population, with no consideration given to how people with disabilities must adapt their use of the web in order to access information. This article addresses issues of access specific to web site development, and will explore barriers to accessibility frequently experienced by web users with disabilities, requirements for ADA compliance, and how people with disabilities use the web. Web site accessibility guidelines, as well as simple evaluation tools, will be discussed. A thorough review of the article will enable even the least tech-savvy of health educators to enhance their skills in planning and evaluating web sites to promote access for people with disabilities.

Health Information on the Web for Canadian Teens: A Survey of Web Portals Designed for Teen Health Information Seekers

2013 ◽  
Author(s):  
Leanne Bowler
Keyword(s):  
Health Information ◽  
General Health ◽  
Web Portals ◽  
Environmental Scan ◽  
The Web

This paper reports on an environmental scan of the Web, the purpose of which was to identify and describe portals to general health information, in English and French, designed specifically for teens.Cet article présente une analyse de l'environnement du Web dont le but est d'identifier et de décrire les portails regroupant de l'information générale sur la santé, en anglais et en français, conçus précisément pour les adolescents. 

UK Fiscal Squeezes over a Century

2017 ◽  
Author(s):  
Christopher Hood ◽  
Rozana Himaz
Keyword(s):  
Data Sources ◽  
Fiscal Consolidation ◽  
Financial Outcomes ◽  
Financial Conditions ◽  
Deficit Reduction ◽  
Before And After ◽  
The Uk ◽  
Changes Over Time ◽  
Spending Cuts ◽  
Over Time

This chapter draws on historical statistics reporting financial outcomes for spending, taxation, debt, and deficit for the UK over a century to (a) identify quantitatively and compare the main fiscal squeeze episodes (i.e. major revenue increases, spending cuts, or both) in terms of type (soft squeezes and hard squeezes, spending squeezes, and revenue squeezes), depth, and length; (b) compare these periods of austerity against measures of fiscal consolidation in terms of deficit reduction; and (c) identify economic and financial conditions before and after the various squeezes. It explores the extent to which the identification of squeeze episodes and their classification is sensitive to which thresholds are set and what data sources are used. The chapter identifies major changes over time that emerge from this analysis over the changing depth and types of squeeze.

scholarly journals Land Policy and Food Prices: Evidence from a Land Consolidation Program in Rwanda

2021 ◽  
Vol 19 (1) ◽  
pp. 63-73
Author(s):  
Aimable Nsabimana ◽  
Fidele Niyitanga ◽  
Dave D. Weatherspoon ◽  
Anwar Naseem
Keyword(s):  
Food Prices ◽  
Land Policy ◽  
Land Consolidation ◽  
Easy Access ◽  
Food Crops ◽  
White Potato ◽  
Before And After ◽  
Price Differences ◽  
The Impact ◽  
Over Time

Abstract Rwanda’s “Crop Intensification Program (CIP)” is primarily a land consolidation program aimed at improving agricultural productivity and food security. The program, which began in 2007, focuses on monocropping and commercialization of six priority crops: maize, wheat, rice, white potato, beans, and cassava. CIP has facilitated easy access to improved seed stocks, fertilizer, extension services, and postharvest handling and storage services. Although studies have documented the impact of CIP on changes in farm yield, incomes, and productivity, less is known about its impact on food prices. In this study, we examine the crop-food price differences in intensive monocropped CIP and non-intensive monocropped CIP zones in Rwanda. Specifically, the study evaluates price variations of beans and maize along with complementary food crops in intensive and non-intensive monocropped zones before and after the introduction of the CIP policy. We find that the CIP policy is not associated with differences in CIP crop prices between the intensive and non-intensive monocropped zones. Over time, prices increased for CIP crops but generally, the crop prices in the two zones were cointegrated. Prices for non-CIP crops in the two different zones did show price differentials prior to the implementation of CIP, with the prices in intensive monocropped zones being greater than in the non-intensive monocropped zones. Moreover, the prices in intensive areas are cointegrated with prices in non-intensive areas for maize and beans and these prices are converging. This indicates that farmers who intensively produced one CIP crop were able to go to the market and purchase other food crops and that price differences between zones have decreased over time, potentially making the CIP intensive farmers better off.

scholarly journals A Bibliometric Network Analysis of Coronavirus during the First Eight Months of COVID-19 in 2020

2021 ◽  
Vol 18 (3) ◽  
pp. 952 ◽  
Author(s):  
Leonardo B. Furstenau ◽  
Bruna Rabaioli ◽  
Michele Kremer Sott ◽  
Danielli Cossul ◽  
Mariluza Sott Bender ◽  
...  
Keyword(s):  
Decision Making ◽  
Network Analysis ◽  
Web Of Science ◽  
Future Research ◽  
Future Trends ◽  
Damage Prevention ◽  
Over Time ◽  
The Web

The COVID-19 pandemic has affected all aspects of society. Researchers worldwide have been working to provide new solutions to and better understanding of this coronavirus. In this research, our goal was to perform a Bibliometric Network Analysis (BNA) to investigate the strategic themes, thematic evolution structure and trends of coronavirus during the first eight months of COVID-19 in the Web of Science (WoS) database in 2020. To do this, 14,802 articles were analyzed, with the support of the SciMAT software. This analysis highlights 24 themes, of which 11 of the more important ones were discussed in-depth. The thematic evolution structure shows how the themes are evolving over time, and the most developed and future trends of coronavirus with focus on COVID-19 were visually depicted. The results of the strategic diagram highlight ‘CHLOROQUINE’, ‘ANXIETY’, ‘PREGNANCY’ and ‘ACUTE-RESPIRATORY-SYNDROME’, among others, as the clusters with the highest number of associated citations. The thematic evolution. structure presented two thematic areas: “Damage prevention and containment of COVID-19” and “Comorbidities and diseases caused by COVID-19”, which provides new perspectives and futures trends of the field. These results will form the basis for future research and guide decision-making in coronavirus focused on COVID-19 research and treatments.

How Collective-Action Failure Shapes Group Heterogeneity and Engagement in Conventional and Radical Action Over Time

2021 ◽  
pp. 095679762097056
Author(s):  
Morgana Lizzio-Wilson ◽  
Emma F. Thomas ◽  
Winnifred R. Louis ◽  
Brittany Wilcockson ◽  
Catherine E. Amiot ◽  
...  
Keyword(s):  
Social Movements ◽  
Collective Action ◽  
Latent Profile Analysis ◽  
Profile Analysis ◽  
Social Identification ◽  
Future Research ◽  
Group Efficacy ◽  
Before And After ◽  
Using Data ◽  
Over Time

Extensive research has identified factors influencing collective-action participation. However, less is known about how collective-action outcomes (i.e., success and failure) shape engagement in social movements over time. Using data collected before and after the 2017 marriage-equality debate in Australia, we conducted a latent profile analysis that indicated that success unified supporters of change ( n = 420), whereas failure created subgroups among opponents ( n = 419), reflecting four divergent responses: disengagement (resigned acceptors), moderate disengagement and continued investment (moderates), and renewed commitment to the cause using similar strategies (stay-the-course opponents) or new strategies (innovators). Resigned acceptors were least inclined to act following failure, whereas innovators were generally more likely to engage in conventional action and justify using radical action relative to the other profiles. These divergent reactions were predicted by differing baseline levels of social identification, group efficacy, and anger. Collective-action outcomes dynamically shape participation in social movements; this is an important direction for future research.

scholarly journals Barriers to the Digitization of Health Information: A Qualitative and Quantitative Study in Kenya and Lao PDR Using a Cloud-Based Maternal and Child Registration System

2021 ◽  
Vol 18 (12) ◽  
pp. 6196
Author(s):  
Tarek Numair ◽  
Daniel Toshio Harrell ◽  
Nguyen Tien Huy ◽  
Futoshi Nishimoto ◽  
Yvonne Muthiani ◽  
...  
Keyword(s):  
Health Information ◽  
Financial Incentives ◽  
High Performance ◽  
Digital Health ◽  
Lao Pdr ◽  
Data Entry ◽  
Working Environment ◽  
Framework Analysis ◽  
Registration System ◽  
Low Middle Income Countries

Digitalization of health information can assist patient information management and improve health services even in low middle-income countries. We have implemented a mother and child health registration system in the study areas of Kenya and Lao PDR to evaluate barriers to digitalization. We conducted in-depth interviews with 20 healthcare workers (HCWs) who used the system and analyzed it qualitatively with thematic framework analysis. Quantitatively, we analyzed the quality of recorded data according to missing information by the logistic regression analysis. The qualitative analysis identified six themes related to digitalization: satisfaction with the system, mothers’ resistance, need for training, double work, working environment, and other resources. The quantitative analysis showed that data entry errors improved around 10% to 80% based on odds ratios in subsequent quarters compared to first quarter periods. The number of registration numbers was not significantly related to the data quality, but the motivation, including financial incentives among HCWs, was related to the registration behavior. Considering both analysis results, workload and motivation to maintain high performance were significant obstacles to implementing a digital health system. We recommend enhancing the scope and focus on human needs and satisfaction as a significant factor for digital system durability and sustainability.

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