Exploring the Impact of Education Strategies on Individuals' Attitude Towards Telemental Health Service: Findings from a Survey Experiment Study.

While COVID-19 has caused significant mental health consequences, telemental health services have the potential to mitigate this problem. But due to the sensitive nature of mental health issues, such services are seriously underutilized. Based on an integrated variance-process theoretical framework, this study examines the impact of applying different education strategies on individuals' attitude toward telemental health and subsequently their intention to adopt telemental health. Two different education videos on telemental health (peer- or professional-narrated) were developed based on social identity theory. A survey experiment study was conducted at a major historically black university, with 282 student participants randomly assigned to the two education videos. Individual perceptions of the telemental health service (usefulness, ease of use, subjective norms, relative advantage, trust, and stigma) and their attitude and usage intention data were collected. The results show that ease of use, subjective norms, trust, relative advantage, and stigma significantly influence individuals' attitude toward telemental health in the peer-narrated video group. Only trust and relative advantage were found to be significant factors toward attitude in the professional-narrated video group. This study highlights the importance of designing education strategies and builds a theoretical foundation for understanding the nuanced differences in individuals' responsiveness to different educational materials.

Investigating the Impact of Covid-19 on Telepsychiatry Use Across Sex and Race: A Study of North Carolina Emergency Departments.

Introduction: The COVID-19 pandemic and the intervention measures have increased mental health problems among Americans. Telepsychiatry provides a safe and efficient way to serve mental health patients in emergency departments (EDs). The objective of this study is to evaluate the impact of COVID-19 on telepsychiatry consultations in North Carolina (NC) and analyze the differences across sex and race. Methods: This longitudinal observational study used data from the NC Statewide Telepsychiatry Program to examine temporal changes in ED telepsychiatry consultations from January 2019 to March 2021 (117 weeks), including 4,739 telepsychiatry consultations conducted by 27 hospitals in 24 counties in NC during the period. The outcome measures were telepsychiatry consultation counts. Weekly ED telepsychiatry consultation counts were calculated overall and stratified by sex and race. Results: The overall weekly ED telepsychiatry consultation counts were decreasing before the national lockdown but started increase after the lockdown. Moreover, the counts of telepsychiatry consultations for white patients had a stronger increasing trend than that for black patients. Comparing telepsychiatry counts during the lockdown period (March and April) in 2020 and the same period in 2019, male patients had higher counts while female patients had lower counts, and white patients had higher counts while black patients had lower counts. Discussion: It seems that the COVID-19 crisis has led to a heightening demand for telepsychiatry consultations in NC, and there is a possible race disparity in these demands between black and white mental health patients. These findings underscore the need to further develop telepsychiatry services and enhance access to black patients.

The impact of chest pain center on treatment delay of STEMI patients: a time series study.

OBJECTIVE: To study the effect of the establishment of a Chest Pain Center (CPC) on the treatment delay of ST-elevation myocardial infarction (STEMI) patients and the influencing factors of treatment delay in a large hospital in China. METHODS: The study subjects are 318 STEMI patients admitted between August 2016 and July 2019 to a large general hospital in Henan, China. Data were extracted from the electronic medical records after removing personal identifiable information. The interrupted time series regression was used to analyze the treatment delay of patients before and after the CPC establishment. RESULTS: After the CPC establishment, the patients' pre-hospital and in-hospital treatment delays were significantly reduced. SO-to-FMC (Symptom Onset to First Medical Contact time) decreased by 49.237 min and D-to-B (Door to Balloon time) decreased by 21.931 min immediately after the CPC establishment. In addition, SO-to-FMC delay is significantly correlated with age, occupation, nocturnal onset, and the way to hospital. D-to-B delay is significantly associated with time from initial diagnosis to informed consent of percutaneous coronary intervention (PCI), catheterization lab activation time, and time for PCI informed consent. CONCLUSION: The CPC significantly reduced the treatment delay of STEMI patients undergoing PCI.

Patient satisfaction in China: a national survey of inpatients and outpatients.

OBJECTIVES: Patient satisfaction is an important indicator of hospital healthcare quality. Little up-to-date information of patient satisfaction in China is available. This study attempts to gain a holistic understanding of patient satisfaction in China and identify the key antecedents of patient satisfaction. DESIGN: A cross-sectional national survey was conducted in 2018. SETTING: Hospitals in 27 provinces and 4 municipalities in 4 regions of China. PARTICIPANTS: A random sample of 15 699 patients who visited 1304 hospitals were surveyed, with around 500 from each of the 27 provinces and 4 municipalities. PRIMARY AND SECONDARY OUTCOME MEASURES: The Hospital Consumer Assessment of Healthcare Providers and Systems questionnaire was used to measure patients' overall satisfaction and willingness to recommend the hospital. RESULTS: We found significant variation in overall patient satisfaction but little variation in hospital recommendation across the four broad regions. Moreover, we examined determinants of patient satisfaction and their likelihood to recommend the hospital. The overall satisfaction for inpatients and outpatients is commonly influenced by communication with doctors (inpatient: ß=0.524, p<0.001; outpatient: ß=0.541, p<0.001), hospital cleanness (inpatient: ß=0.165, p<0.05; outpatient: ß=0.144, p<0.001) and acceptable charges (inpatient: ß=1.481, p<0.001; outpatient: ß=1.045, p<0.001). Both inpatients and outpatients are more likely to recommend the hospital if there are communication with doctors (inpatient: OR=1.743, p<0.001; outpatient: OR=1.647, p<0.001), acceptable charges (inpatient: OR=2.660, p<0.001; outpatient: OR=2.433, p<0.001). Outpatient satisfaction and hospital recommendation are also influenced by time spent with doctors (satisfaction: ß=0.301, p<0.001; recommend: OR=1.430, p<0.001) and waiting time (satisfaction: ß=-0.318, p<0.001; recommend: OR=0.844, p<0.001). CONCLUSIONS: There are regional differences of patient satisfaction in China. Patient satisfaction is influenced by a variety of hospital factors and province/municipality factors. The influencing factors of patient satisfaction may not motivate patients to recommend the hospital.

Motivating Physicians to Report Adverse Medical Events in China: Stick or Carrot?

BACKGROUND: Adverse medical events (AMEs) pose serious threats to patient safety. One of the major challenges of AME reporting is low physician engagement. This study attempted to examine how punishment and reward can improve physicians' AME reporting in China. METHODS: A survey was conducted in a large hospital with 1693 beds in China. Data were collected from 311 physicians. Ordinal and binary logistic regression was used for data analysis. RESULTS: This study reveals that both punishment and reward are positively associated with intention to report AMEs. There is a negative interaction effect between punishment and reward. Although collective punishment is positively associated with intention to report AMEs, collective reward is not. Moreover, the physicians who have fear of negative consequences of AMEs and lack knowledge of AME reporting have lower intention to report AMEs. These findings do not differ between male and female physicians. CONCLUSIONS: This survey suggests that punishment and reward have potential to motivate Chinese physicians to report AMEs. However, the implementation strategies of these control mechanisms may not be universally applicable and should be carefully designed on the basis of the specific characteristics of the practice site.

Predicting the risk of acute care readmissions among rehabilitation inpatients: A machine learning approach.

INTRODUCTION: Readmission from inpatient rehabilitation facilities to acute care hospitals is a serious problem. This study aims to develop a predictive model based on machine learning algorithms to identify patients at high risk of readmission. METHODS: A retrospective dataset (2001-2017) including 16,902 patients admitted into a large inpatient rehabilitation facility in North Carolina was collected in 2017. Three types of machine learning models with different predictors were compared in 2018. The model with the highest c-statistic was selected as the best model and further tested by using five sets of training and validation data with different split time. The optimum threshold for classification was identified. RESULTS: The logistic regression model with only functional independence measures has the highest validation c-statistic at 0.852. Using this model to predict the recent 5 years acute care readmissions yielded high discriminative ability (c-statistics: 0.841-0.869). Larger training data yielded better performance on the test data. The default cutoff (0.5) resulted in high specificity (>0.997) but low sensitivity (<0.07). The optimum threshold helped to achieve a balance between sensitivity (0.754-0.867) and specificity (0.747-0.780). CONCLUSIONS: This study demonstrates that functional independence measures can be analyzed by using machine learning algorithms to predict acute care readmissions, thus improving the effectiveness of preventive medicine.

What factors influence older people's intention to enrol in nursing homes? A cross-sectional observational study in Shanghai, China.

OBJECTIVES: Given the increasing need of long-term care and the low occupancy rate of nursing homes in Shanghai, this study attempts to explore what factors influence older people's intention to enrol in nursing homes. DESIGN: A cross-sectional observational study based on the theory of reasoned action was conducted. Survey data were collected from subjects during face-to-face interviews. Structural equation modelling was employed for data analysis. SETTING: This study was conducted in six community health service centres in Shanghai, China. Two service centres were selected in urban, suburban and rural areas, respectively. PARTICIPANTS: A total of 641 Shanghai residents aged over 60 were surveyed. RESULTS: Structural equation modelling analysis showed that the research model fits the data well (χ2/df=2.948, Comparative Fit Index=0.972 and root mean squared error of approximation =0.055). Attitude (ß=0.41, p<0.01), subjective norm (ß=0.28, p<0.01) and value-added service (ß=0.16, p<0.01) were directly associated with enrolment intention, explaining 32% of variance in intention. Attitude was significantly influenced by loneliness (ß=-0.08, p<0.05), self-efficacy (ß=0.32, p<0.01) and stigma (ß=-0.24, p<0.01), while subjective norm was significantly influenced by life satisfaction (ß=-0.15, p<0.01) and stigma (ß=-0.43, p<0.01). CONCLUSIONS: This study advances knowledge regarding the influencing factors of older people's intention to enrol in nursing homes. It suggests that Chinese older persons' perceived stigma has the strongest indirect effect on their intention to enrol in nursing homes. This is unique to the Chinese context and has practical implications for eldercare in China and other Asian countries with similar sociocultural contexts.

Investigating the resistance to telemedicine in Ethiopia.

BACKGROUND: Telemedicine has great potential to improve health care in Africa as well as other developing areas, especially when medical expertise is urgently needed in emergency situations. Yet resistance from healthcare professionals could prevent telemedicine's social value from being materialized. OBJECTIVE: This article intends to understand why healthcare providers resist using telemedicine from a threat-control perspective. METHOD: A survey on 107 healthcare professionals in Ethiopia was conducted. CONCLUSIONS: The resistance to telemedicine is determined by perceived threat and perceived controllability, which in turn are influenced by reduced autonomy, anxiety, and costs. Government support weakens the effect of perceived threat but strengthens the effect of perceived controllability on telemedicine resistance.

Consumer choice of purchasing private-label drugs: an empirical study in China.

This research investigates factors influencing Chinese consumers' purchase choice of private-label drugs over rational brand equivalents. Survey data were collected from 251 Chinese consumers. Results show that their purchase choice of private-label drugs is significantly influenced by drug trust and perceptions of drug quality, but is not influenced by private-label drugs' price advantage. Store trust and perceived drug quality are significant predictors of drug trust. Store trust also positively affects perceived drug quality. Finally, store trust is significantly influenced by product quality and service quality.

Can price controls reduce pharmaceutical expenses? A case study of antibacterial expenditures in 12 Chinese hospitals from 1996 to 2005.

The objective of this article is to investigate whether the Chinese government's pricing policies have reduced pharmaceutical expenses. The purchasing records for systemic antibacterial drugs of 12 hospitals in Beijing from 1996 to 2005 were analyzed by separating the expenditure growth into three components: the price change, the volume change, and the structure change. Our results reveal that the structure change is the dominant determinant of drug expenditure growth. Despite lowered prices, the antibacterial drug expenditure was raised because more expensive drugs in the same therapeutic category were prescribed. It is insufficient to rely only on pricing policies to reduce drug expenses, given that physicians could circumvent the policy by prescribing more expensive drugs. In addition, physician behaviors need to be regulated to eliminate unnecessary overprescribing.

Effects of electronic medical record in a Chinese hospital: a time series study.

BACKGROUND: Electronic medical record (EMR) systems have potential to improve care quality and efficiency. Yet little is known about the effects of EMR in Chinese hospitals. OBJECTIVE: An inpatient EMR system was implemented in a large Chinese hospital. The objective of this research was to evaluate the impact of the EMR system on efficiency, quality, and cost of inpatient care in the hospital. METHODS: A five-year (2005-2009) longitudinal dataset with monthly data involving 251 physicians and 298,760 patient visits was created by querying the hospital's central database. Four key outcomes were examined: length of stay, infection rate, mortality rate, and cost per patient stay. Interrupted time series analysis was used to evaluate changes in level and slope for each outcome variable. RESULTS: Length of stay grew at 0.027 bed-days per month in the pre-EMR period and declined at 0.043 bed-days per month in the post-EMR period. Infection rate rose at 0.036 infections per 100 patients per month in the pre-EMR period and declined at 0.062 infections per 100 patients per month in the post-EMR period. Mortality rate grew at 0.048 deaths per 1000 patients per month in the pre-EMR period and decreased at 0.005 deaths per 1000 patients per month in the post-EMR period. Cost per patient stay declined at 33 RMB per month in the pre-EMR period and increased at 16 RMB per month in the post-EMR period. CONCLUSIONS: The EMR was associated with the declining patterns of length of stay, infection rate, and mortality rate. It had no positive effect on patient costs.

Online health information seeking by people with physical disabilities due to neurological conditions.

OBJECTIVE: This study investigates how neurologically disabled people's intention to continue seeking and actual use of online health information are related to various factors. DESIGN: A cross-sectional survey was conducted to collect data from people who have neurological disabilities. MEASUREMENTS: An online questionnaire was used to measure demographic, physical, cognitive, and behavioral factors based on subjects' self-reported data. RESULTS: Regression analyses on 330 data show that a person's intention to continue online health information seeking (OHIS) increases as perceived usefulness (PU) and ease of use (PEOU) and disability level increase. The OHIS intention is also predicted by a negative interaction between PU and disability, a positive interaction between PEOU and disability, and a negative interaction between PU and PEOU. It is also find that a person's use of online health information is positively related to PU and negatively related to perceived risk and the interaction between PU and risk. LIMITATIONS: The sample was not randomly selected and the cross-sectional survey cannot suggest causal relationships between variables. CONCLUSION: Neurologically disabled people's online health information seeking and use can be predicted by their cognitive perceptions. A heightened disability level increases an individual's online health information seeking, but is not related to the use of such information. Moreover, seeking more online health information does not make an individual use more such information, suggesting that these two behaviors should be carefully differentiated.

An analysis of China's national essential medicines policy.

Although China embraced the concept of essential medicines in 1979 and issued its first National Essential Medicines List in 1982, until recently China has lacked a comprehensive national essential drug policy. In its most recent health-care reform (2009-2012), the Chinese government explicitly proposed the establishment of a national essential medicines system, and made it one of five top priorities in the coming years. We review the evolution of China's essential medicines policies, explain the importance of fully implementing the essential medicines policy, and analyze recent policy developments surrounding essential medicines.

Analysis of telemedicine diffusion: the case of China.

Telemedicine helps developing countries deliver medical services to underdeveloped rural areas where health resources are deficient. Yet telemedicine diffusion in the largest developing country, China, remains a secret to the world. This paper examines the evolution of telemedicine in China, analyzes factors influencing the diffusion of telemedicine, and provides recommendations to overcome obstacles to telemedicine.

Understanding PACS development in context: the case of China.

This paper describes the evolution of picture archiving and communication systems (PACS) in China and identifies several obstacles to its development, including vendors' opportunism, hospital administrators' IT ignorance, mindlessness in IT adoption, lack of system integration, and misfits between foreign PACS and local hospitals. Lessons learned from these obstacles are provided, which are of value to developing countries where PACS has just started diffusing.

Investigating public health emergency response information system initiatives in China.

Infectious diseases pose a great danger to public health internationally. The outbreak of SARS has exposed China's fragile public health system and its limited ability to detect and respond to emergencies in a timely and effective manner. In order to strengthen its capability of responding to future public health emergencies, China is developing a public health emergency response information system (PHERIS) to facilitate disease surveillance, detection, reporting, and response. The purpose of this study is to investigate the ongoing development of China's PHERIS. This paper analyzes the problems of China's existing public health system and describes the design and functionalities of PHERIS from both technical and managerial aspects.

Electronic data interchange usage in China's healthcare organizations: the case of Beijing's hospitals.

China has long since realized the potential benefits of adopting electronic data exchange. In particular, the Chinese government is promoting the usage of electronic data interchange (EDI) in healthcare organizations. However, little research has described the current status of EDI usage in these organizations. This study investigates the extent of EDI usage in Beijing's hospitals along four dimensions: volume, diversity, breadth, and depth. The results from 57 hospitals show that EDI usage is in its very early stages. The study provides possible reasons for the low EDI usage from cultural, economic, and technological perspectives, analyzes the differences of EDI usage in the different levels of China's hospitals, and suggests strategies to promote EDI usage in China's healthcare organizations.