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In this commentary, we report on lessons learned over 2 years (2020-2022) from conducting primary care research through a novel alliance of an ACO consisting of independent practices, a health plan, and several academic researchers, with the support of a private foundation. Am J Manag Care. 2023;29(6):In Press _____ Takeaway Points The process of collaborating on research was mutually beneficial for a network of independent practices and a group of academic researchers. * The process benefited the practices by facilitating more precise thinking about quality improvement, motivating the staff, and enabling readiness for health system change. * The process benefited the researchers by illuminating nuances of clinical and organizational workflow and revealing the practices' in-depth understanding of the communities they serve. * If practices have more federally funded opportunities to consistently participate in research, it could help speed greater adoption of payment reform models to promote health equity at the state and national levels. _____ A 2021 National Academies of Sciences, Engineering, and Medicine report, Implementing High-Quality Primary Care, has called out the persistent "neglect of basic primary care research" in the United States.1 A 2020 study by the RAND Corporation found that primary care research represents only 1% of all federally funded projects (including projects funded by the National Institutes of Health, the Agency for Healthcare Research and Quality [AHRQ], and the Veterans Health Administration).2 However, innovation in primary care is central to advancing health care delivery. Leaders in health care innovation recently called for CMS to test a proposal for primary care payment reform in accountable care organizations (ACOs) composed of independent practices (ie, practices not owned by hospitals).3 By innovating in independent practices, these leaders argued that CMS would provide incentives for those practices to stay independent, thereby potentially decreasing the vertical market consolidation that contributes to rising health care costs.3 Yet these same practices may have less experience with the kind of systematic innovation that leads to generalizable insights, because what little funding is available for primary care research is mostly awarded to large academic medical centers.1 AHRQ's practice-based research networks have not fully addressed this gap, as they have struggled to find infrastructure and maintain funding.1 In this commentary, we report on the lessons we learned over 2 years (2020-2022) from conducting primary care research through a novel alliance of an ACO consisting of independent practices, a health plan, and several academic researchers, with the support of a private foundation. [...]ACPNY found that experience with research facilitates innovation and readiness for health system change (lesson 1C).
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Psychosocial issues are cen-'tral to the care of adolescent patients. Pediatricians routinely discuss substance use, sexual health, and accident prevention with adolescents and are likely to see specific mental health concerns in about 20% of their patients. In light of rising suicide rates and the likely consequences of COVID-19, depression is an increasingly common concern. With limited access to mental health clinicians, individual pediatricians must manage patients' mental health needs by enhancing their own skills, collocating mental health personnel in their practices, and building trusted referral networks. Because psychosocial screening is now an expected part of pediatric primary care,1 this article focuses on screening adolescent patients, including choice of tools and follow-up of positive results.
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In the Philippines, a barangay is the smallest administrative unit serving as suburban neighborhoods' first line of defense. According to Bautista, barangays conduct a manual file-based process of storing the community's health information. Therefore, the need for a single platform enables a small government unit to manage its resources while being transparent to its community. The study aims to develop a web- based barangay health information system portal for Barangay 69 District 1 in Tondo Manila. The system would be a reference tool for barangays as their platform provides inventory management, the barangay's health programs, and a dashboard for data visualization inventory management, tracking of Covid cases, administration of health activities, and a dashboard for data visualization. As a result, the web portal is functional, and different test scenarios show above-average results. The study concludes that the system provided a platform for the barangay and its residents. It also concludes that it is user-friendly and efficiently disseminates the barangay's health programs and activities. © 2023 IEEE.
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Domestic violence against women increased during COVID-19 lockdowns. This inaugural study examined the content of Australian government online portals, for women seeking support and help for domestic violence, during the 2021 COVID-19 pandemic. This mixed methods study incorporated four phases: a search; measurement of portal quality standard using DISCERN; enumeration of portal items; and a qualitative exploration of portal text. Australian governments must continue to work alongside domestic violence services as we found some portals were better than others. Continued review, revision, and funding are needed to meet the demands associated with this evolving public health emergency.
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BACKGROUND: Historically, people aged 65 years or older have been slower to adopt new technol-ogy. However, technology use in this demographic continues to increase. OBJECTIVES: This study aimed to understand how patients with cancer who are aged 65 years or older engage with technology and whether patient behavior related to technology use has changed because of the COVID-19 pandemic. In addition, this study evaluated whether respondents' understand-ing of technology was associated with increased likelihood of adoption and perceived utility of the ONS On-CallTM cancer treatment symptom assessment tool. METHODS: A U.S. population-based anonymous online survey was conducted between May 17 and May 31, 2021, with 103 patients with cancer aged at least 65 years. FINDINGS:The majority of respondents used tech-nology regularly as part of their daily lives. Activities included shopping online, reading the news, or engaging with a healthcare platform. As a result of the COVID-19 pandemic, most respondents reported an increased use of digital activities, particularly the use of healthcare technology. Respondents reported they would be likely to use ONS On-Call, particularly if it is recommended by a healthcare provider.
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OBJECTIVES/GOALS: Missed appointments (MAs) negatively impact the health outcomes of adults living with type 2 diabetes mellitus (T2DM), causing disruptions in clinic operation and added financial cost to healthcare providers and systems. This study aimed to identify risk factors for MAs in both in-person and telehealth settings among adults living with T2DM. METHODS/STUDY POPULATION: Using a sequential multi-method design guided by the modified Quality-Caring Model, the quantitative phase of this study used electronic health records (EHR) data in Calendar Years 2019 and 2020 with 7,276 encounters made by 2,235 patients with T2DM from four diabetes clinics within a tertiary academic medical center in Baltimore, MD. Multivariable random effect logistic regression were used to examine the association between MAs and included predictors (i.e., patient characteristics [e.g., age, race, health status], health provider factors [e.g., types of provider], and health system factors [e.g., scheduling lag]). Based on the results of the quantitative phase, a purposive sample of 23 adults with T2DM and 10 providers were then interviewed individually via phone or zoom. RESULTS/ANTICIPATED RESULTS: The EHR data found that the following variables decreased the odds of MAs: having an activated patient portal account, patients with age over 46 or with white race. Telehealth was associated with 50% decreased odds of MAs during COVID (after 3/23/2020). On the other hand, longer scheduling lag increased the odds of MAs. Qualitative interviews revealed that MAs were often related to social needs, such as lack of/limited health-related transportation and its associated financial burden. Telehealth helped break these barriers for some adults with T2DM, but technical challenges in telehealth persisted for those with low digital health literacy and people who did not have a digital device and/or with unstable internet connection. Providers worried that these challenges might undermine the quality of diabetes care. DISCUSSION/SIGNIFICANCE: Disparities in MAs by age and race were noted, which might reflect the impact of unmeasured social needs in EHR. Perceived convenient telehealth may reduce MAs in T2DM care. However, the persistent technical challenges of telehealth should be addressed to optimize the quality of diabetes care and to promote care continuity for underserved populations.
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During a public health crisis like the COVID-19 pandemic, a credible and easy-to-access information portal is highly desirable. It helps with disease prevention, public health planning, and misinformation mitigation. However, creating such an information portal is challenging because 1) domain expertise is required to identify and curate credible and intelligible content, 2) the information needs to be updated promptly in response to the fast-changing environment, and 3) the information should be easily accessible by the general public;which is particularly difficult when most people do not have the domain expertise about the crisis. In this paper, we presented an expert-sourcing framework and created Jennifer, an AI chatbot, which serves as a credible and easy-to-access information portal for individuals during the COVID-19 pandemic. Jennifer was created by a team of over 150 scientists and health professionals around the world, deployed in the real world and answered thousands of user questions about COVID-19. We evaluated Jennifer from two key stakeholders' perspectives, expert volunteers and information seekers. We first interviewed experts who contributed to the collaborative creation of Jennifer to learn about the challenges in the process and opportunities for future improvement. We then conducted an online experiment that examined Jennifer's effectiveness in supporting information seekers in locating COVID-19 information and gaining their trust. We share the key lessons learned and discuss design implications for building expert-sourced and AI-powered information portals, along with the risks and opportunities of misinformation mitigation and beyond. © 2023 Owner/Author.
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[...]of shelter-in-place ordinances, adults with diabetes and/or hypertension were vulnerable because their routine care involves close monitoring and medication management. Some AMGA members contributed data to a common data repository managed by Optum and through a partnership with AMGA provided access to their data. Because the data elements are derived from EHRs, practice management systems, disease registries, and population health software, data are mapped and normalized to allow valid and reliable comparisons across organizations. Encounters without a practice site identifier were excluded (n = 361,745;8.7%). Because we were interested in examining weekly practice-level trends, which required multiple patients per week for reliable estimates, we excluded encounters from practice sites with fewer than 50 patients (184,003 encounters;4.4%) during the study period. The analytic sample includes 3,016,761 encounters from 764,521 adults with diabetes and/or hypertension. Because we were interested in telemedicine use among established patients of health care systems, we limited the analytic sample to patients with at least 1 visit and at least 1 diagnosis of diabetes and/or hypertension between January 1, 2019, and March 12, 2020.
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Over fourteen million people suffer from neuromuscular diseases in the UK such as strokes, spinal cord injuries, and Parkinson's disease etc. That means at least one in six people in the UK are living with one or more neurological conditions. In order for patients to return to normal life sooner, a rigorous rehabilitation process is needed. In hospitals, physiotherapists and neurological experts prescribe specific neurorehabilitation exercises. In most cases, patients need to schedule an appointment to receive treatment in a hospital or to have physiotherapists visit them at home. The number of neuromuscular patients has increased, resulting in longer hospital waiting times. In particular, during COVID-19, patients were not allowed to visit hospitals or have physiotherapists visit them due to government restrictions. Online guides for personalised and custom rehabilitation therapy for joint spasticity and stiffness are also not available. This paper reports the development of an IoT-based prototype system that monitors and records joint movements using sensory footwear (consisting of FSR and IMU sensors) and Kinect sensors. In addition, a prototype web portal is also being developed to record performance data during exercises at home and interact with clinicians remotely. A pilot study has been conducted with six healthy individuals and test results show that there is a strong correlation between Kinect data and FSR data in terms of coordination between joint movements. © 2022 IEEE.
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Patient Education and Safety Pre-chemotherapy education sessions for breast cancer patients is a core element of care provided by clinic nurses to patients starting chemotherapy. This is a time intensive session, which outlines symptom management and home care needs. The goal of these sessions is to improve patient outcomes by empowering them to be an active participant in their care. Though a meaningful intervention, clinic nurses spend about 30 hours per month educating first time chemotherapy patients, which has hindered their ability to complete other pressing tasks. Given current staffing challenges and restrictions to visitation due to the COVID-19 pandemic, nurses and advanced practice providers (APPs) sought a novel approach to meet this need to ensure adequate patient education while improving nursing efficiency through the usage of a virtual platform. The purpose was to implement a virtual group chemotherapy teaching session for new breast cancer patients to improve the efficiency and workload for ambulatory nurses while providing a community network for patients. Clinic nurses conduct virtual chemotherapy education sessions weekly for all new patients. This allows patients the opportunity to learn and connect with other patients going through the same or similar treatment. The educational sessions are to be held Zoom and patients access through a link sent to the patient portal. Patients are provided an education packet prior to the virtual session. These sessions can also be utilized by other patients to refresh their knowledge or gain additional nursing support. In-person teaching will still be continued for those who prefer it. Following each session, patients will be given a survey to complete. Evaluation of effectiveness in teaching will be performed utilizing the teach-back method at their first session. Both staff and patient feedback is being evaluated to assess for satisfaction with the new process. With this process, we will save 22 hours per month of nursing time. This will also allow for increased family involvement while following COVID guidelines. Preliminary results suggest an improvement in both patient and nursing satisfaction. Utilizing a virtual format makes for improvement in both efficiency and workload for clinic nurses. In addition, this format of teaching is convenient for both patients and their families. Once this process is fully operational, we are looking at expanding this program within our care centers to hopefully produce the same results.
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Considering the public safety in current COVID-19 out-break, an IOT (Internet of Things) based non-contact temperature monitoring system integrated with RFID authentication system with an interactive Android application, and a web-portal to manage users and temperature records has been proposed. Temperature screening has become essential for all the industries, educational institutions, factories and corporate sector. This system is an online real-time non-contact monitoring system with an interactive android application and user-friendly web portal that help end-users to monitor and keep a record of temperature variations of registered users on daily/weekly/monthly basis. The temperature records are saved in a real-time database which is embedded with the user's RFID card information. In case of an alert (high temperature), a notification is sent to the authorized personnel on their cellphones or their desktop systems via web portal. An alarm is also generated immediately on the device (buzzer and blinking LEDs) to indicate high temperature, alerting the nearby security staff. As per the survey and testing of the device under different temperature environments it has been found that the proposed system has an overall accuracy of 99%. © 2022 IEEE.
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Although telehealth services grew exponentially in the U.S. during COVID-19, access has been inequitable, with underrepresented, including limited English proficient, patients less likely to use telehealth than non-Hispanic White, English-speaking patients. This could exacerbate existing outcomes disparities among underserved patients. We administered a cross-sectional survey on telehealth access beliefs and barriers among predominantly immigrant, racially and ethnically underrepresented community members and breast cancer patients(N=312) in the New York metropolitan area from August 2020 through February 2021. We then developed a program to facilitate telehealth access among underserved breast cancer patients. 56% thought video visits were inferior to in-person, 47% did not know if insurance covered telehealth, 42% lacked home internet for video telehealth, and 14% did not understand how telehealth works. In February 2021, we initiated, in partnership with over 20 health and community organizations, Access to Telehealth for Underserved Breast Cancer Patients (AcT), a multipronged, multilingual telehealth navigation program. Since January 2022, 154 patients have been screened for telehealth needs;111 needed and were provided with navigation;and 78 needed and were provided with mostly donated refurbished devices (25 smartphones, 28 laptops, 25 tablets) to enable telehealth visits. Over 250 healthcare professionals and 80 community organizations have received AcT information/education sessions. Because 68% of AcT patients need patient portal navigation, this has become a key AcT focus. AcT has demonstrated the importance of a culturally and linguistically tailored telehealth access program, built on strong partnerships, to facilitate telehealth access. At the health systems level, AcT has also helped to identify and disseminate potential evidence-based policy solutions, such as the provision of patient portal services in multiple languages and the ensuring of telehealth readiness among vulnerable patients. Information technology partnerships can make refurbished devices available to patients who do not have telehealth-ready devices of their own. [ABSTRACT FROM AUTHOR] Copyright of Patient Education & Counseling is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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Dermatology is facing a worsening scarcity of providers, especially since the onset of the COVID-19 pandemic. With lengthening waiting periods for skin cancer screening examinations, there is a distinct need for alternatives to in-person evaluation. Delayed diagnosis is associated with poorer outcomes, especially in melanoma. Teledermatology has the potential to prevent the increased morbidity and mortality associated with late-stage diagnosis, especially when utilized with dermoscopy. In the literature, this novel field of "teledermoscopy” has exhibited accuracy and reliability comparable to face-to-face visits and is a promising alternative intervention for those who require triaging or for patients who are unable to access in-person care (rural, underserved populations). Although the early data is promising, formal guidelines for acquisition and interpretation of dermatoscopic images need to be established before wider implementation is possible. With standardization, use at-home or in in primary care offices will with such standardization, may relieve some of the pressure on an overburdened dermatologic care system and help patients who require urgent care to be seen more expediently.
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Ventilators have become the need of the hour in view of the pandemic COVID-19. Hospitals around the world have faced difficulty in managing the same. Non-Invasive Ventilation (NIV) involves offering breathing support in the form of a mask which can be a nasal or a face mask or a helmet. The proposed work analyses the design aspects of a helmet-based NIV and its effective management through the usage of a dedicated website capable of communicating with the ventilator directly. The entire analysis is carried out using the simulated ventilator model on Simulink. The communication aspects are tested by conveying necessary information to ThingSpeak, an IoT based analytics platform, which can be accessed by the user through a website. The website can be used to check availability of ventilators at places. © 2022 IEEE.
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Research on IT integration into teaching is an interdisciplinary field that has both educational (didactics) and informatics components. In particular, the situation with the Covid 19 pandemic has forced a push to address personal IT support for teachers in distance education. However, this runs into the problem of the lack of personal educational software, so that in practice the teacher has to adapt to existing technology and test how it can be used for teaching. In this context, the work of a university teacher requires the mass creation of educational content, its transfer between offline computers (laptop, classroom computers) and online environments (web, virtual learning environments, academic information systems, clouds, networks). Given the nature of university teaching, IT support solutions for self-study also face a challenge. However, no single technology covers such a broad scope, so there is a lack of universal solutions. The authors minimize this gap by programming universal software tailored to the needs of the teacher and by building a combined offline/online IT infrastructure on which to conduct the research. Collaborative research by an international team using the infrastructure is a solution to automate the creation of educational packages, including the multi-lingual support. The article clarifies the categories of barriers that the team had to overcome, either from a didactic or an informatics perspective. Here, a new paradigm using a specific data structure (called virtual knowledge) for the rapid reduction and concentration of educational content was proven to simulate virtually any teacher activity. Therefore, the goal of further research is to use the results and experiences to date to build a multilingual learning portal. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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PurposeThe purpose of this study is to examine the factors influencing the usage of cloud-based accounting information systems (AIS) in the crisis era (i.e. the COVID-19 pandemic) by expanding the unified theory of acceptance and use of technology (UTAUT) with new related critical factors.Design/methodology/approachA quantitative research approach based on a cross-sectional online questionnaire was used for collecting empirical data from 438 potential and current users of cloud-based AIS. Structural equation modeling based on analysis of a moment structures 25.0 was applied in the data analysis.FindingsThe outcome of the structural path revealed that performance expectancy, social motivation, COVID-19 risk (COV-19 PR) and trust (TR) were significantly influencing users' behavioral intention (BI) toward using cloud-based AIS and explained 71% of its variance. While, contrary to what is expected, the impact of effort expectancy and perceived security risk (SEC) on BI was insignificant. In addition, BI was revealed to influence the actual usage behaviors and explained 74% of its variance. The outcome factors: communication quality (CQ) and decision quality (DQ) were significantly influenced by the usage of cloud-based AIS.Practical implicationsThe current research would be valuable for small- and medium-sized enterprises officials and policymakers to illustrate the relatively low rates of cloud-based AIS and formulate strategies to boost the acceptance and use of cloud-based AIS by Jordanian users, where cloud-based services are still deemed as an innovation.Originality/valueTo the best of the authors' knowledge, the current study is the first academic paper that extends the UTAUT by integrating additional factors: TR, SEC and COV-19 PR. In addition to two outcome variables: CQ and DQ, to study the cloud-based AIS in the Jordanian setting beyond the COVID-19 pandemic. The current research contributes to the academic knowledge on information technology information system adoption by considering cloud accounting acceptance and use and integration into the work practices of users through the BIs and actual use of cloud-based AIS in Jordan.
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Agriculture has been India's main profession for centuries. According to the Indian Agricultural Research Institute, the need for edible grains will increase to 345 million tones in the next decade, however its role in India's GDP has recently declined. The current situation of farmers is disappointing as most of them live in severe poverty. They have to take loans to make ends meet and at times it becomes difficult to repay the loan. Our portal aims at providing crop seeds and fertilizers at cheap prices. The option of renting farming equipment would also be available. The cutting-edge technology which has been used over the past few years, has been lagging when it comes to farming. The main reason for this is both the disregard of these technologies and also the inaccessibility. Though farmers strive hard, even in this 21st century, they are bamboozled by third party retailers, which increases their poverty. In this covid pandemic, there was a huge demand for the agricultural products but it was difficult to get all the materials as well as information online. The solution to all the problems is Agro marketing which would make everything easy and secure. E-Farming provides a way for farmers to buy produce with only a basic knowledge of how to use the internet. This website is a centralized approach to guide farmers in all aspects and display current market prices of various products without brokers' cost. It will also include various government agricultural programs and access to new cultivation techniques. [2] The farmer will also be helped in the harvesting process by giving them a 6-day weather forecast and a schedule via SMS provided by the system. Along with this, they will be able to connect with agro health advisors to raise their queries regarding crop health and efficient farming techniques. © 2022 IEEE.
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In this paper, through the use of laptop/desktop, web-portal, and internet, we have developed and created an environment for implementation of a virtual BEE laboratory and their effectiveness for our 1st year engineering students during Covid-19. The development of a virtual BEE laboratory is not intended to replace the existing physical laboratory rather it is a supplement to it during this pandemic and also proper exploration of the ICT tool. The student's outcome of this virtual lab is elaborated in terms of assessment and examination marks. It is observed from the outcome that the student's performance is enhanced in terms of efficiency and efficacy, when they are taught through the virtual laboratory during the pandemic. © 2022 IEEE.
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The COVID-19 pandemic has affected the way people work, forcing people to reduce physical contact with other people. So, legalizing documents by adding a signature and stamp in PT RST now requires a new method. Electronic documents with the legalization using digital products become legal for use. Digital products for legalization include electronic stamps, signatures and seal stamps. Adding a digital product to a document is done on a web application that provides document legalization services. Currently adding digital products to web applications is only for one or two products, for example electronic stamps, so to be able to add 3 products we have to use 3 different web applications. This method makes the process of adding digital products done in many stages. Therefore, it is necessary to create a web application portal that combines all services such as e-stamp, e-sign and e-seal stamp in one application. The web-based portal is developed using agile software development methods. The development process is done iteratively in 3 iterations. The result of this research is a web-based portal that can provide services for adding e-materai, e-stamp and e-sign for oneself, other people and collaborate with several people. Furthermore, user satisfaction was measured with the SUS questionnaire and the usability measurement result was 80.3. This score is in the 'Acceptable' acceptability range, acceptable with efficient use, easy to understand, and has a simple user interface. The signer portal development process for PT RST can be a reference for other industries to implement similar products in their organization, both in terms of technology and business processes. © 2022 IEEE.
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BACKGROUND: Historically, people aged 65 years or older have been slower to adopt new technology. However, technology use in this demographic continues to increase. OBJECTIVES: This study aimed to understand how patients with cancer who are aged 65 years or older engage with technology and whether patient behavior related to technology use has changed because of the COVID-19 pandemic. In addition, this study evaluated whether respondents' understanding of technology was associated with increased likelihood of adoption and perceived utility of the ONS On-Call™ cancer treatment symptom assessment tool. METHODS: A U.S. population-based anonymous online survey was conducted between May 17 and May 31, 2021, with 103 patients with cancer aged at least 65 years. FINDINGS: The majority of respondents used technology regularly as part of their daily lives. Activities included shopping online, reading the news, or engaging with a healthcare platform. As a result of the COVID-19 pandemic, most respondents reported an increased use of digital activities, particularly the use of healthcare technology. Respondents reported they would be likely to use ONS On-Call, particularly if it is recommended by a healthcare provider.