Developing a web-based toolkit for new mothers about postpartum pelvic floor health in collaboration with a professional medical association

Background: Few electronic resources are available for new mothers with concerns about changes in their pelvic floorfollowing childbirth. Patients may struggle when seeking authoritative information regarding pelvic floor conditions online given the sensitivity of the topic as well as the inadvertent connection to obscene or demeaning content found online. A health sciences librarian partnered with the Motherhood and Pelvic Health Study, an interdisciplinary research group, to provide expert searching skills for a particularly challenging health condition that patients struggle to find useful information on.Case Presentation:A custom rubric was developed to evaluate existing information products, which included criteria for cultural sensitivity, conflicts of interest, and other red flags. This evaluation process enabled the research team to identify top-tier evidence-based materials that were culturally congruent. This collaborative evaluation process led to the creation of a web-based toolkit resource for new mothers concerned about changes in their pelvic floor. The toolkit connects women to pertinent information on a national health organization’s patient portal, supplemented by videos created by the team to serve as models of communication for women and health care providers. Conclusion:When developing a web-based resource, health sciences libraries can partner with research teams to find, evaluate, and disseminate information. Culturally congruent toolkits such as this one can improve access to health information and lead to improved health outcomes. To ensure that the information highlighted in toolkits is both culturally congruent and authoritative, research teams should form advisory committees and partner with relevant professional medical associations.

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Patient Portal, Patient-Generated Images, and Medical Decision-Making in a Pediatric Ambulatory Setting

Applied Clinical Informatics ◽

10.1055/s-0040-1718754 ◽

2020 ◽

Vol 11 (05) ◽

pp. 764-768

Author(s):

Karolin Ginting ◽

Adrienne Stolfi ◽

Jordan Wright ◽

Abiodun Omoloja

Keyword(s):

Decision Making ◽

Health Care Providers ◽

Medical Decision Making ◽

Pediatric Population ◽

Private Insurance ◽

Medical Decision ◽

Ambulatory Setting ◽

Patient Portal ◽

Care Providers ◽

Patient Portals

Abstract Background Electronic health record (EHR) patient portals are a secure electronic method of communicating with health care providers. In addition to sending secure messages, images, and videos generated by families can be sent to providers securely. With the widespread use of smart phones, there has been an increase in patient-generated images (PGI) sent to providers via patient portals. There are few studies that have evaluated the role of PGI in medical decision-making. Objectives The study aimed to characterize PGI sent to providers via a patient portal, determine how often PGI-affected medical decision-making, and determine the rate of social PGI sent via patient portal. Methods A retrospective chart review of PGI uploaded to a children's hospital's ambulatory patient portal from January 2011 to December 2017 was conducted. Data collected included patient demographics, number and type of images sent, person sending images (patient or parent/guardian), and whether an image-affected medical decision-making. Images were classified as medical related (e.g., blood glucose readings and skin rashes), nonmedical or administrative related (e.g., medical clearance or insurance forms), and social (e.g., self-portraits and camp pictures). Results One hundred forty-three individuals used the portal a total of 358 times, sending 507 images over the study period. Mean (standard deviation) patient age was 9.5 (5.9) years, 50% were females, 89% were White, and 64% had private insurance. About 9% of images were sent directly by patients and the rest by parents/guardians. A total of 387 (76%) images were sent for medical related reasons, 20% for nonmedical, and 4% were deemed social images. Of the 387 medical related images, 314 (81%) affected medical decision-making. Conclusion PGI-affected medical decision-making in most cases. Additional studies are needed to characterize use of PGI in the pediatric population.

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Use and Effects of Patient Access to Medical Records in General Practice Through a Personal Health Record in the Netherlands: Protocol for a Mixed-Methods Study

JMIR Research Protocols ◽

10.2196/10193 ◽

2018 ◽

Vol 7 (9) ◽

pp. e10193 ◽

Cited By ~ 1

Author(s):

Maria MT Vreugdenhil ◽

Rudolf B Kool ◽

Kees van Boven ◽

Willem JJ Assendelft ◽

Jan AM Kremer

Keyword(s):

Health Care ◽

General Practice ◽

Health Care Providers ◽

Personal Health Record ◽

Mixed Methods Study ◽

Personal Health ◽

Care Providers ◽

Group Discussions ◽

Web Based ◽

Staff Level

Background In the Dutch health care system, general practitioners hold a central position. They store information from all health care providers who are involved with their patients in their electronic health records. Web-based access to the summary record in general practice through a personal health record (PHR) may increase patients’ insight into their medical conditions and help them to be involved in their care. Objective We describe the protocol that we will use to investigate the utilization of patients’ digital access to the summary of their medical records in general practice through a PHR and its effects on the involvement of patients in their care. Methods We will conduct a multilevel mixed-methods study in which the PHR and Web-based access to the summary record will be offered for 6 months to a random sample of 500 polypharmacy patients, 500 parents of children aged <4 years, and 500 adults who do not belong to the former two groups. At the patient level, a controlled before-after study will be conducted using surveys, and concurrently, qualitative data will be collected from focus group discussions, think-aloud observations, and semistructured interviews. At the general practice staff (GP staff) level, focus group discussions will be conducted at baseline and Q-methodology inquiries at the end of the study period. The primary outcomes at the patient level are barriers and facilitators for using the PHR and summary records and changes in taking an active role in decision making and care management and medication adherence. Outcomes at the GP staff level are attitudes before and opinions after the implementation of the intervention. Patient characteristics and changes in outcomes related to patient involvement during the study period will be compared between the users and nonusers of the intervention using chi-square tests and t tests. A thematic content analysis of the qualitative data will be performed, and the results will be used to interpret quantitative findings. Results Enrollment was completed in May 2017 and the possibility to view GP records through the PHR was implemented in December 2017. Data analysis is currently underway and the first results are expected to be submitted for publication in autumn 2019. Conclusions We expect that the findings of this study will be useful to health care providers and health care organizations that consider introducing the use of PHR and Web-based access to records and to those who have recently started using these. Trial Registration Netherlands Trial Registry NTR6395; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6395 (Archived by WebCite at http://www.webcitation.org/71nc8jzwM) Registered Report Identifier RR1-10.2196/10193

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Development of a tool to assess health applications for healthcare providers: A Delphi Expert Panel Study (Preprint)

10.2196/preprints.17660 ◽

2020 ◽

Author(s):

Immaculada Grau-Corral ◽

Percy Efran Pantoja ◽

Francisco J. Grajales III ◽

Belchin Kostov ◽

Valentí Aragunde ◽

...

Keyword(s):

Literature Review ◽

Health Care Providers ◽

Expert Panel ◽

Panel Study ◽

Healthcare Providers ◽

Care Providers ◽

Web Based ◽

Health Apps ◽

Agreement Assessment ◽

Health Applications

BACKGROUND The presence of the mobile phone and devices is generating knowledge about the use of applications to support patient care, but there are few recommendations for apps dedicated to healthcare professionals OBJECTIVE To establish a validated scale to assess healthcare mobile applications is the most efficient step for health care providers and systems. The main goal is to create and validate a tool to evaluate health apps destined to be used by health professionals. METHODS A five steps simplified methodology to assess of the scale was followed. The first step consists of building a scale for professionals based on a literature review. Next step would be an expert panel validation by a Delphi method, rating web-based questionnaires to evaluate inclusion and weight of the indicators. It was agreed to carry out, as many iterations as necessary, to reach a consensus of 75%. Finally, a pilot of the score was developed to evaluate the reliability of the scale. For the inter-rater agreement assessment during the pilot, the Cohen Kappa was used. RESULTS After the literature review, a first scale draft was developed. Two rounds of interactions of the local investigation group and the external panel of experts were needed to select final indicators. Seventeen indicators were included in the score. For the pilot test, 280 apps were evaluated and 66 meet the criteria. The interrater agreement was strong (higher than 82% with significant kappa >0.72 per app and item). CONCLUSIONS We have developed, with a reproducible methodology, a tool that allows us to evaluate health applications for clinical, surgical and general medical providers. The ISYScore-PRO scale to be reliable and reproducible. The assessment permitted to consolidate every step of the methodology. We were able to reach consensus on the dimensions and items on the scale with only two rounds. The process of validation included two robust methodologies. The ISYScore-PRO scale is reliable and reproducible.

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A Study Protocol for Increasing Access to Smoking Cessation Treatments for Low-Income Minority Smokers

Frontiers in Public Health ◽

10.3389/fpubh.2021.762784 ◽

2021 ◽

Vol 9 ◽

Author(s):

Alicia K. Matthews ◽

Karriem S. Watson ◽

Cherdsak Duang ◽

Alana Steffen ◽

Robert Winn

Keyword(s):

Health Care ◽

Smoking Cessation ◽

Health Care Providers ◽

Low Income ◽

Access To Health Care ◽

Social Determinant ◽

Evidence Based ◽

Patient Portal ◽

Care Providers ◽

Access To Health

Background: Smoking rates among low-income patients are double those of the general population. Access to health care is an essential social determinant of health. Federally qualified health care centers (FQHC) are government-supported and community-based centers to increase access to health care for non-insured and underinsured patients. However, barriers to implementation impact adherence and sustainability of evidence-based smoking cessation within FQHC settings. To address this implementation barrier, our multi-disciplinary team proposes Mi QUIT CARE (Mile Square QUITCommunity-Access-Referral-Expansion) to establish the acceptability, feasibility, and capacity of an FQHC system to deliver an evidence-based and multi-level intervention to increase patient engagement with a state tobacco quitline.Methods: A mixed-method approach, rooted in an implementation science framework of RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance), will be used in this hybrid effectiveness-implementation design. We aim to evaluate the efficacy of a novel delivery system (patient portal) for increasing access to smoking cessation treatment. In preparation for a future randomized clinical trial of Mi QUIT CARE, we will conduct the following developmental research: (1) Examine the burden of tobacco among patient populations served by our partner FQHC, (2) Evaluate among FQHC patients and health care providers, knowledge, attitudes, barriers, and facilitators related to smoking cessation and our intervention components, (3) Evaluate the use of tailored communication strategies and patient navigation to increase patient portal uptake among patients, and (4) To test the acceptability, feasibility, and capacity of the partner FQHC to deliver Mi QUIT CARE.Discussion: This study provides a model for developing and implementing smoking and other health promotion interventions for low-income patients delivered via patient health portals. If successful, the intervention has important implications for addressing a critical social determinant of cancer and other tobacco-related morbidities.Trial Registration: U.S. National Institutes of Health Clinical Trials, NCT04827420, https://clinicaltrials.gov/ct2/show/NCT04827420.

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A Pain eHealth Platform for Engaging Obese, Older Adults with Chronic Low Back Pain in Nonpharmacological Pain Treatments: Protocol for a Pilot Feasibility Study

JMIR Research Protocols ◽

10.2196/14525 ◽

2020 ◽

Vol 9 (1) ◽

pp. e14525

Author(s):

Amber K Brooks ◽

David P Miller Jr ◽

Jason T Fanning ◽

Erin L Suftin ◽

M Carrington Reid ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Primary Care Providers ◽

Patient Portal ◽

Low Back ◽

Care Providers ◽

Web Based

Background Low back pain is a costly healthcare problem and the leading cause of disability among adults in the United States. Primary care providers urgently need effective ways to deliver evidence-based, nonpharmacological therapies for chronic low back pain. Guidelines published by several government and national organizations have recommended nonpharmacological and nonopioid pharmacological therapies for low back pain. Objective The Pain eHealth Platform (PEP) pilot trial aims to test the feasibility of a highly innovative intervention that (1) uses an electronic health record (EHR) query to systematically identify a phenotype of obese, older adults with chronic low back pain who may benefit from Web-based behavioral treatments; (2) delivers highly tailored messages to eligible older adults with chronic low back pain via the patient portal; (3) links affected patients to a Web app that provides education on the efficacy of evidence-based, nonpharmacological, behavioral pain treatments; and (4) directs patients to existing Web-based health treatment tools. Methods Using a three-step modified Delphi method, an expert panel of primary care providers will define a low back pain phenotype for an EHR query. Using the defined low back pain phenotype, an EHR query will be created to identify patients who may benefit from the PEP. Up to 15 patients with low back pain will be interviewed to refine the tailored messaging, esthetics, and content of the patient-facing Web app within the PEP. Up to 10 primary care providers will be interviewed to better understand the facilitators and barriers to implementing the PEP, given their clinic workflow. We will assess the feasibility of the PEP in a single-arm pragmatic pilot study in which secure patient portal invitations containing a hyperlink to the PEP Web app are sent to 1000 patients. The primary outcome of the study is usability as measured by the System Usability Scale. Results Qualitative interviews with primary care providers were completed in April 2019. Qualitative interviews with patients will begin in December 2019. Conclusions The PEP will leverage informatics and the patient portal to deliver evidence-based nonpharmacological treatment information to adults with chronic low back pain. Results from this study may help inform the development of Web-based health platforms for other pain and chronic health conditions. International Registered Report Identifier (IRRID) DERR1-10.2196/14525

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A Pain eHealth Platform for Engaging Obese, Older Adults with Chronic Low Back Pain in Nonpharmacological Pain Treatments: Protocol for a Pilot Feasibility Study (Preprint)

10.2196/preprints.14525 ◽

2019 ◽

Author(s):

Amber K Brooks ◽

David P Miller Jr ◽

Jason T Fanning ◽

Erin L Suftin ◽

M Carrington Reid ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Primary Care Providers ◽

Patient Portal ◽

Low Back ◽

Care Providers ◽

Web Based

BACKGROUND Low back pain is a costly healthcare problem and the leading cause of disability among adults in the United States. Primary care providers urgently need effective ways to deliver evidence-based, nonpharmacological therapies for chronic low back pain. Guidelines published by several government and national organizations have recommended nonpharmacological and nonopioid pharmacological therapies for low back pain. OBJECTIVE The Pain eHealth Platform (PEP) pilot trial aims to test the feasibility of a highly innovative intervention that (1) uses an electronic health record (EHR) query to systematically identify a phenotype of obese, older adults with chronic low back pain who may benefit from Web-based behavioral treatments; (2) delivers highly tailored messages to eligible older adults with chronic low back pain via the patient portal; (3) links affected patients to a Web app that provides education on the efficacy of evidence-based, nonpharmacological, behavioral pain treatments; and (4) directs patients to existing Web-based health treatment tools. METHODS Using a three-step modified Delphi method, an expert panel of primary care providers will define a low back pain phenotype for an EHR query. Using the defined low back pain phenotype, an EHR query will be created to identify patients who may benefit from the PEP. Up to 15 patients with low back pain will be interviewed to refine the tailored messaging, esthetics, and content of the patient-facing Web app within the PEP. Up to 10 primary care providers will be interviewed to better understand the facilitators and barriers to implementing the PEP, given their clinic workflow. We will assess the feasibility of the PEP in a single-arm pragmatic pilot study in which secure patient portal invitations containing a hyperlink to the PEP Web app are sent to 1000 patients. The primary outcome of the study is usability as measured by the System Usability Scale. RESULTS Qualitative interviews with primary care providers were completed in April 2019. Qualitative interviews with patients will begin in December 2019. CONCLUSIONS The PEP will leverage informatics and the patient portal to deliver evidence-based nonpharmacological treatment information to adults with chronic low back pain. Results from this study may help inform the development of Web-based health platforms for other pain and chronic health conditions. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/14525

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Viewpoint: Health literacy and patient portals

Journal of Primary Health Care ◽

10.1071/hc15172 ◽

2015 ◽

Vol 7 (2) ◽

pp. 172 ◽

Cited By ~ 5

Author(s):

Yulong Gu ◽

Martin Orr ◽

Jim Warren

Keyword(s):

Health Care ◽

Health Literacy ◽

Health Information ◽

Health Care Providers ◽

Easy Access ◽

Patient Portal ◽

Care Providers ◽

Patient Portals ◽

Health Consumer ◽

Improve Patient

Health literacy has been described as the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Improving health literacy may serve to promote concordance with therapy, engage patients in their own health care, and improve health outcomes. Patient portal technology aims at enabling patients and families to have easy access to key information in their own medical records and to communicate with their health care providers electronically. However, there is a gap in our understanding of how portals will improve patient outcome. The authors believe patient portal technology presents an opportunity to improve patient concordance with prescribed therapy, if adequate support is provided to equip patients (and family/carers) with the knowledge needed to utilise the health information available via the portals. Research is needed to understand what a health consumer will use patient portals for and how to support a user to realise the technology?s potential.

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A personalized, web-based prognostic tool for resectable gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e15575 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e15575-e15575

Author(s):

Brice Jabo ◽

John W. Morgan ◽

Mayada A. Aljehani ◽

Matthew J Selleck ◽

Albert Y. Lin

Keyword(s):

Gastric Cancer ◽

Health Care Providers ◽

Classification Model ◽

Adjuvant Chemoradiotherapy ◽

Care Providers ◽

Training Set ◽

Test Set ◽

Web Based ◽

Prognostic Tool ◽

Sensitivity Specificity

e15575 Background: Gastric cancer (GC) mortality remains high, with a 5-year survival of 30 percent. For patients with resectable GC, mortality varies depending on both patient and tumor characteristics. The current study sought to develop a web-based prognostic model to assist patients and health care providers in decision making regarding either surgery-only or adjuvant chemoradiotherapy (CRT). Methods: California SEER data was used and records, including demographic, pathologic, and treatment information, for 2,583 patients diagnosed with stage IB to III GC and treated with either surgery only or adjuvant CRT from 2006 to 2013 were retrieved. Purposeful selection using Cox regression model was used to identify important mortality predictors. Additionally, with simple random sampling, 70% of the data were assigned to the training set and the remaining 30% were assigned to the test set. Furthermore, generalized boosted classification model was trained using the training set and validated using the test set. Area under the curve (AUC) of the receiver operating characteristic (ROC), sensitivity, specificity and accuracy were determined for 5- and 10-year mortality. Results: The median survival was 33 months for patients in the training set, and 32 for the test set. Predictors included in the model were age, ethnicity (Asian/other, Hispanic, non-Hispanic black and non-Hispanic white), T-stage, histology (intestinal, diffuse and other), presence of signet ring (yes/no), proximal location (yes/no), lymph node ratio, and CRT following surgery (yes/no). Validation of the model on the test set showed as follows: AUC, sensitivity, specificity and accuracy of 0.78(95%CI = 0.75,0.82), 0.75, 0.65 and 0.70 for 5-year survival and 0.77(95%CI = 0.74,0.80), 0.79, 0.55 and 0.70 for 10-year survival. Conclusions: The proposed web-based prognostic tool using readily available patient and tumor characteristic provides validated and personalized prognostic information to aide clinicians and patients in GC adjuvant treatment decision process. [Table: see text]

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Brazilian guidelines for endovascular treatment of patients with acute ischemic stroke

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20160174 ◽

2017 ◽

Vol 75 (1) ◽

pp. 50-56 ◽

Cited By ~ 8

Author(s):

Octávio Marques Pontes-Neto ◽

Pedro Cougo ◽

Sheila Cristina Ouriques Martins ◽

Daniel G. Abud ◽

Raul G. Nogueira ◽

...

Keyword(s):

Health Care ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Health Care Providers ◽

Cerebrovascular Diseases ◽

Discussion Forums ◽

Care Providers ◽

Web Based ◽

Health Authorities ◽

Public Health Authorities

ABSTRACT These guidelines are the result of a joint effort from writing groups of the Brazilian Stroke Society, the Scientific Department of Cerebrovascular Diseases of the Brazilian Academy of Neurology, the Brazilian Stroke Network and the Brazilian Society of Diagnostic and Therapeutic Neuroradiology. Members from these groups participated in web-based discussion forums with predefined themes, followed by videoconference meetings in which controversies and position statements were discussed, leading to a consensus. This guidelines focuses on the implications of the recent clinical trials on endovascular therapy for acute ischemic stroke due to proximal arterial occlusions, and the final text aims to guide health care providers, health care managers and public health authorities in managing patients with this condition in Brazil.

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