scholarly journals Factors to Effective Telemedicine Visits During the COVID-19 Pandemic: Cohort Study (Preprint)

2021 ◽  
Author(s):  
Kristin Nicole Gmunder ◽  
Jose W Ruiz ◽  
Dido Franceschi ◽  
Maritza M Suarez
Keyword(s):  
Health Care ◽  
Logistic Regression ◽  
Random Forest ◽  
Health System ◽  
Text Message ◽  
Mixed Effects ◽  
Descriptive Statistics ◽  
Phone Call ◽  
Patient Portal ◽  
Forest Modeling

BACKGROUND With COVID-19 there was a rapid and abrupt rise in telemedicine implementation often without sufficient time for providers or patients to adapt. As telemedicine visits are likely to continue to play an important role in health care, it is crucial to strive for a better understanding of how to ensure completed telemedicine visits in our health system. Awareness of these barriers to effective telemedicine visits is necessary for a proactive approach to addressing issues. OBJECTIVE The objective of this study was to identify variables that may affect telemedicine visit completion in order to determine actions that can be enacted across the entire health system to benefit all patients. METHODS Data were collected from scheduled telemedicine visits (n=362,764) at the University of Miami Health System (UHealth) between March 1, 2020 and October 31, 2020. Descriptive statistics, mixed effects logistic regression, and random forest modeling were used to identify the most important patient-agnostic predictors of telemedicine completion. RESULTS Using descriptive statistics, struggling telemedicine specialties, providers, and clinic locations were identified. Through mixed effects logistic regression (adjusting for clustering at the clinic site level), the most important predictors of completion included previsit phone call/SMS text message reminder status (confirmed vs not answered) (odds ratio [OR] 6.599, 95% CI 6.483-6.717), MyUHealthChart patient portal status (not activated vs activated) (OR 0.315, 95% CI 0.305-0.325), provider’s specialty (primary care vs medical specialty) (OR 1.514, 95% CI 1.472-1.558), new to the UHealth system (yes vs no) (OR 1.285, 95% CI 1.201-1.374), and new to provider (yes vs no) (OR 0.875, 95% CI 0.859-0.891). Random forest modeling results mirrored those from logistic regression. CONCLUSIONS The highest association with a completed telemedicine visit was the previsit appointment confirmation by the patient via phone call/SMS text message. An active patient portal account was the second strongest variable associated with completion, which underscored the importance of patients having set up their portal account before the telemedicine visit. Provider’s specialty was the third strongest patient-agnostic characteristic associated with telemedicine completion rate. Telemedicine will likely continue to have an integral role in health care, and these results should be used as an important guide to improvement efforts. As a first step toward increasing completion rates, health care systems should focus on improvement of patient portal usage and use of previsit reminders. Optimization and intervention are necessary for those that are struggling with implementing telemedicine. We advise setting up a standardized workflow for staff.

The – switch: an empirical account of the anglicisation of a Scots variant in Scotland during the sixteenth and seventeenth centuries

2019 ◽  
Vol 24 (1) ◽  
pp. 211-236
Author(s):  
SARAH VAN EYNDHOVEN ◽  
LYNN CLARK
Keyword(s):  
Logistic Regression ◽  
Language Change ◽  
Statistical Modelling ◽  
Mixed Effects ◽  
Descriptive Statistics ◽  
Statistical Techniques ◽  
Fine Grained ◽  
Regression Modelling ◽  
Modern Methods ◽  
Logistic Regression Modelling

This article explores the anglicisation of the Scots language between the sixteenth and eighteenth centuries, focusing on the variation between the orthographic clusters <quh-> and <wh-> found in relative and interrogative clause markers. Using modern statistical techniques, we provide the most comprehensive empirical analysis of this variation so far in the Helsinki Corpus of Older Scots (Meurman-Solin 1995). By combining the techniques of Variability-Based Neighbour Clustering (Gries & Hilpert 2008, 2010, 2012) with mixed-effects logistic regression modelling (Baayen et al.2008), we uncover a different trajectory of change than that which has previously been reported for this feature (Meurman-Solin 1993, 1997). We argue that by using modern methods of data reduction and statistical modelling, we can present a picture of language change in Scots that is more fine-grained than previous studies which use only descriptive statistics.

Design and Deployment of E-Health System in Perspective of Developing Countries: Machine Learning Based Approach (Preprint)

2020 ◽  
Author(s):  
Mohamad Afendee Mohamed ◽  
Md Saniat Rahman Zishan ◽  
Rabiul Ahasan ◽  
Chowdhury Akram Hossain ◽  
Siti Maryam Sharun
Keyword(s):  
Machine Learning ◽  
Developing Countries ◽  
Logistic Regression ◽  
Random Forest ◽  
Health System ◽  
Multilayer Perceptron ◽  
Medical Specialist ◽  
Disease Identification ◽  
System P ◽  
Identification Model

BACKGROUND We are living in a world where data science and machine learning is tightening its grasp on many sectors of modern life. The medical sector is not an exception. In developing countries, healthcare is one of the domains that need immediate attention. Due to the lack of manpower and technical resources, a large number of people in these regions do not receive proper medical care. Designing an E-health system with the help of machine learning and web technologies would be a great aid in such circumstances. OBJECTIVE This proposed E-health System will assist the medical professionals in determining diseases. Moreover, the system will be also helpful for the patients to check whether they have been diagnosed correctly. Based on their diagnosis results they can get medical specialist recommendation and medicine suggestions from the system. The automation of identifying the diseases and suggestion models with the help of machine learning will be cost-efficient and time-saving compared to the traditional methods. The main objective of this E-health system is to provide health care with the help of sustainable and realistic machine learning technologies. METHODS In this research, for the disease identification part, machine learning techniques have been applied to identify three diseases which are Dengue, Diabetes, and Thyroid. Decision Tree, Gaussian Naive-Bayes, Random Forest, Logistic Regression, k-Nearest Neighbors, Multilayer Perceptron, and Support Vector Machine Classifiers have been used for all three diseases. The E-health system comprised of disease identification model, medical specialist recommendation model, and the medicine suggestion model has been deployed on the web. The medical specialist recommendation model and the medicine suggestion model results are based on the finding of the disease identification model. Any user can insert their disease-specific data to use these three features of the E-health system. RESULTS For the disease identification model, Multilayer Perceptron for Dengue, Logistic Regression for Diabetes, and Random Forest for Thyroid performed the best with accuracies of 88.3%, 82.5%, and 98.5% respectively. These classifiers also showed good precision, recall, and F1 score. CONCLUSIONS The E-health system has performed well with real-time data. By making the dataset more enriched, the disease identification model will be more robust and thorough. Moreover, usability and acceptance tests can help us in finding different real-time scenarios of the E-health system.

Issues of co-financing of drug provision for the population: international and Russian practice

2020 ◽  
pp. 49-56
Author(s):  
Vasiliy Ryazhenov ◽  
Victoriya Andreyeva ◽  
Elena Zakharochkina
Keyword(s):  
Health Care ◽  
Life Expectancy ◽  
Health System ◽  
Health Care System ◽  
Russian Federation ◽  
High Quality ◽  
Russian President ◽  
The Russian Federation ◽  
Vladimir Putin ◽  
Drug Provision

Russian President Vladimir Putin defined increase in life expectancy from 72.7 to 78 years by 2024 as a national aim in the Decree № 204 of May 7, 2018. Achievement of this aim depends on drug provision system among other factors. Strategy of drug provision for the population of the Russian Federation for the period until 2025 sets the goal of increasing availability of high quality, effective and safe medicines to meet needs of the population and the health system based on the formation of a rational and balanced system of drug provision for the population of the country with available resources. The health care system should expand the possibilities of using modern and effective mechanisms to ensure the financing of drug provision for the population.

scholarly journals How Public Trust in Health Care Can Shape Patient Overconsumption in Health Systems? The Missing Links

2021 ◽  
Vol 18 (8) ◽  
pp. 3860
Author(s):  
Katarzyna Krot ◽  
Iga Rudawska
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Health System ◽  
Health Systems ◽  
Quantitative Research ◽  
Public Trust ◽  
Complex Problem ◽  
Health Care Consumption ◽  
Mediating Role ◽  
Countries In Transition

Overconsumption of health care is an ever-present and complex problem in health systems. It is especially significant in countries in transition that assign relatively small budgets to health care. In these circumstances, trust in the health system and its institutions is of utmost importance. Many researchers have studied interpersonal trust. Relatively less attention, however, has been paid to public trust in health systems and its impact on overconsumption. Therefore, this paper seeks to identify and examine the link between public trust and the moral hazard experienced by the patient with regard to health care consumption. Moreover, it explores the mediating role of patient satisfaction and patient non-adherence. For these purposes, quantitative research was conducted based on a representative sample of patients in Poland. Interesting findings were made on the issues examined. Patients were shown not to overconsume health care if they trusted the system and were satisfied with their doctor-patient relationship. On the other hand, nonadherence to medical recommendations was shown to increase overuse of medical services. The present study contributes to the existing knowledge by identifying phenomena on the macro (public trust in health care) and micro (patient satisfaction and non-adherence) scales that modify patient behavior with regard to health care consumption. Our results also provide valuable knowledge for health system policymakers. They can be of benefit in developing communication plans at different levels of local government.

scholarly journals Impact of digitally acquired peer diagnostic input on diagnostic confidence in outpatient cases: A pragmatic randomized trial

2020 ◽  
Author(s):  
Elaine C Khoong ◽  
Valy Fontil ◽  
Natalie A Rivadeneira ◽  
Mekhala Hoskote ◽  
Shantanu Nundy ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Randomized Trial ◽  
Odds Ratio ◽  
Primary Outcome ◽  
Mixed Effects ◽  
Regression Analyses ◽  
Diagnostic Confidence ◽  
Diagnostic Uncertainty ◽  
Intervention Impact ◽  
High Uncertainty

Abstract Objective The study sought to evaluate if peer input on outpatient cases impacted diagnostic confidence. Materials and Methods This randomized trial of a peer input intervention occurred among 28 clinicians with case-level randomization. Encounters with diagnostic uncertainty were entered onto a digital platform to collect input from ≥5 clinicians. The primary outcome was diagnostic confidence. We used mixed-effects logistic regression analyses to assess for intervention impact on diagnostic confidence. Results Among the 509 cases (255 control; 254 intervention), the intervention did not impact confidence (odds ratio [OR], 1.46; 95% confidence interval [CI], 0.999-2.12), but after adjusting for clinician and case traits, the intervention was associated with higher confidence (OR, 1.53; 95% CI, 1.01-2.32). The intervention impact was greater in cases with high uncertainty (OR, 3.23; 95% CI, 1.09- 9.52). Conclusions Peer input increased diagnostic confidence primarily in high-uncertainty cases, consistent with findings that clinicians desire input primarily in cases with continued uncertainty.

Access to health care and Informal Patient Payments for health care in Serbia

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Buch Mejsner ◽  
S Lavasani Kjær ◽  
L Eklund Karlsson
Keyword(s):  
Health Care ◽  
Health System ◽  
Access To Health Care ◽  
Health Care Services ◽  
Local Population ◽  
Civil Servants ◽  
Care Providers ◽  
Care Services ◽  
Access To Health

Abstract Background Evidence often shows that migrants in the European region have poor access to quality health care. Having a large number of migrants seeking towards Europe, crossing through i.e. Serbia, it is crucial to improve migrants' access to health care and ensure equality in service provision Aim To investigate what are the barriers and facilitators of access to health care in Serbia, perceived by migrants, policy makers, health care providers, civil servants and experts working with migrants. Methods six migrants in an asylum center and eight civil servants in the field of migration were conducted. A complementary questionnaire to key civil servants working with migrants (N = 19) is being distributed to complement the data. The qualitative and quantitative data will be analysed through Grounded Theory and Logistic Regression respectively. Results According to preliminary findings, migrants reported that they were able to access the health care services quite easily. Migrants were mostly fully aware of their rights to access these health care services. However, the interviewed civil servants experienced that, despite the majority of migrants in camps were treated fairly, some migrants were treated inappropriately by health care professionals (being addressed inappropriately, poor or lacking treatment). The civil servants believed that local Serbs, from their own experiences, were treated poorer than migrants (I.e. paying Informal Patient Payments, poor quality of and access to health care services). The interviewed migrants were trusting towards the health system, because they felt protected by the official system that guaranteed them services. The final results will be presented at the conference. Conclusions There was a difference in quality of and access to health care services of local Serbs and migrants in the region. Migrants may be protected by the official health care system and thus have access to and do not pay additional fees for health care services. Key messages Despite comprehensive evidence on Informal Patient Payments (IPP) in Serbia, further research is needed to highlight how health system governance and prevailing policies affect IPP in migrants. There may be clear differences in quality of and access to health care services between the local population and migrants in Serbia.

scholarly journals Searching for Elysium: teaching universal health care as a human right

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
I Souza ◽  
T C Garcia ◽  
M N Sayão
Keyword(s):  
High School ◽  
Health Care ◽  
Health System ◽  
Health Care System ◽  
Human Right ◽  
School Class ◽  
Federal Constitution ◽  
High School Class ◽  
Free Health Care ◽  
Care System

Abstract Background Brazil have a huge free health care system. Inspired on UK National Health System (NHS), the Sistema Único de Saúde (SUS, that means Unified Health System) was consolidate as a right for all citizens after 1988's Brazilian Federal Constitution. Despite your spread, part of Brazilian citizens have an opposite opinions about SUS. So, the main question is: How to teach the relevance of a universal free health care system as a human right. Objectives The main aim of this work is teaching the recognize of SUS as a human right and ratified by Brazilian Federal Constitution in a High School class. In this sense, we used the cinema and debate for stimulate an effective comprehension of Universal Declaration of Human Rights (UDHR) and health promotion as a human right in a high school class. We used the movie Elysium (Neill Blomkamp, 2013) that show a dystopian world with two social class: citizen and non-citizen of Elysium (an artificial satellite of the Earth with high technology of cure for your citizens). Results The class has three Lessons: in first lesson we teaching about different notions about rights and the UDHR. In the second lesson we teaching about free health care systems in the world and a historical perspective about SUS. The third lesson we show the movie Elysium and proceed a debate. In debate we discuss about citizenship and rights, how the movie show two societies with different rights about work, transport and health, and how this aspects impact the quality of life of human being. Conclusions What options we have? The notion of free health care as a human right isn't an easy concept. So, efforts are needed for this comprehension and cinema can be used, followed by discussion, as a significant teaching tool for achieving humanistic educational objectives about free health care system as a human right in the high school curriculum. Key messages Health care is a human right and free health care system is a concretization of this right. Cinema can be used for stimulate a critical evaluation and effective understanding of rights in a high school classroom.

scholarly journals Catastrophic Household Expenditure Associated with Out-of-Pocket Healthcare Payments in Spain

2021 ◽  
Vol 18 (3) ◽  
pp. 932
Author(s):  
Samuel López-López ◽  
Raúl del Pozo-Rubio ◽  
Marta Ortega-Ortega ◽  
Francisco Escribano-Sotos
Keyword(s):  
Health Care ◽  
Logistic Regression ◽  
Regression Models ◽  
Financial Risk ◽  
Household Expenditure ◽  
Financial Protection ◽  
Logistic Regression Models ◽  
Ordered Logistic Regression ◽  
Out Of Pocket Payments ◽  
The Subject

Background. The financial effect of households’ out-of-pocket payments (OOP) on access and use of health systems has been extensively studied in the literature, especially in emerging or developing countries. However, it has been the subject of little research in European countries, and is almost nonexistent after the financial crisis of 2008. The aim of the work is to analyze the incidence and intensity of financial catastrophism derived from Spanish households’ out-of-pocket payments associated with health care during the period 2008–2015. Methods. The Household Budget Survey was used and catastrophic measures were estimated, classifying the households into those above the threshold of catastrophe versus below. Three ordered logistic regression models and margins effects were estimated. Results. The results reveal that, in 2008, 4.42% of Spanish households dedicated more than 40% of their income to financing out-of-pocket payments in health, with an average annual gap of EUR 259.84 (DE: EUR 2431.55), which in overall terms amounts to EUR 3939.44 million (0.36% of GDP). Conclusion. The findings of this study reveal the existence of catastrophic households resulting from OOP payments associated with health care in Spain and the need to design financial protection policies against the financial risk derived from facing these types of costs.

scholarly journals Health care network for chronic conditions: an intervention and evaluation in the health system

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C S Cardoso ◽  
N R Baldoni ◽  
C F Melo ◽  
L O Rezende ◽  
K Noronha ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Care Professionals ◽  
Chronic Conditions ◽  
Panel Study ◽  
Health Indicators ◽  
Institutional Capacity ◽  
Local Health ◽  
Care Network ◽  
Health Care Network

Abstract Background Health assessments are necessary for the (re) formulation of effective public policies and to guarantee the quality of care offered. This study aim to evaluate the perception of health professionals concerning the institutional capacity of the health system to care for Chronic Conditions (CC) after intervention in a medium-sized municipality in Minas Gerais, Brazil. Methods It is a panel study with evaluation before, during and after an intervention in the health system with a focus on three CC, i.e., i) diabetes; ii) hypertension; and iii) pregnant women. Health care professionals from primary and specialized care units were interviewed using the Assessment of Chronic Illness Care (ACIC) scale, which was applied in nine focal groups organized by health care unit. Results A total of 240 professionals participated of this evaluation, being 94, 63 and 82 participants in 2013, 2015 and 2018 respectively. The ACIC scores showed an positive evolution in the capacity of the health system to care for CC over the years. In the first wave the global score was 5.40 (basic capacity), while in the third wave the score was 9.38 (optimal capacity), with a significant increase in the scores (p &lt; 0.01). Conclusions An important gain in the institutional capacity of the municipality was evidenced for the care of chronic conditions after intervention in the health system. Such an enhancement of the health system to operate in the CC might be sustainable over the time. Furthermore, its impact may directly reflect on the health indicators of the population. Key messages The results showed a strengthening of the local health system. These findings can subsidize other municipalities with a similar reality in the organization of the health care network and, consequently improve the care provided to chronic conditions.

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